Here's a nice story about how useless our current health insurance--we certainly can't call it health "care", can we?--system is, even at the highest level. My mom is 73, and has done all the things one is supposed to do to ward off osteoporosis and keep in good health. She takes daily, strenuous walks, eats Tums (for the calcium) like candy, drinks milk like she's a 2-year-old, has never smoked, doesn't drink, and if anything is underweight, eating simply and well. Despite all that, however, both her hips have broken and been replaced, but even that hasn't slowed her down.
Last Sunday, she fell once again, this time breaking her arm up near her shoulder. Ordinarily, that would merely be a serious inconvenience, but mom has only had the use of one arm since birth--guess which one broke?--so she is completely incapacitated. She is unable to feed, clothe, bathe, or wipe herself, and needs help just getting into or out of a sitting or lying position. Not good. But wait, there's a point to this that makes it meaningful for a political blog, trust me.
Apparently, according to the guidelines created not by doctors, but by hospital administrators in collusion with insurance companies, a broken humerus is not an injury or illness that warrants admission to a hospital "for treatment." Mom went to the ER--and btw, for any of the clueless out there, ER visits are not free, regardless of what right wing freaks try to tell you--and was admitted to the hospital "for observation" only. What's the difference, you ask? Well, "observation" can last up to 48 hours/2 nights total, and no more. Why is this important? I'll explain below the fold.
Many of us, during the fight over the ACA's creation and passage, thought "Medicare for all" was a decent slogan and a worthwhile goal for which to fight. I'm here to tell you, though, Medicare is still mere medical insurance, not a promise of universal health care, even for those who have it. You see, in my mom's case, Medicare refused to pay for full-time treatment or help for her, because her injury did not reach the level of whatever arcane measurement the insurance companies use to decide when they are bound to pay out, and which kicks in if you stay in a hospital for 3 nights or more. Even though mom now requires 24-hour care. In reality, the hospital will be charging my mom a ton of money for providing her with an ill-fitting sling, some advice, and a (literally) swift kick out the door.
What does this mean in dollars and cents? We had to scramble around, in the one day we had, to find a 24-hour homecare-giving service that could start virtually immediately (cost: $250/day), or attempt to find a room in a rehab facility (cost: $300/day), and none of those costs are borne by Medicare, or her second-tier insurance provided with my dad's pension from IBM. (Since Medicare is her "first insurance provider", if/when they pass on a claim, the second provider doesn't pick up the tab, either.) The prognosis for a break of this kind is that it will be at the very least 2 full weeks before she will even feel better, let alone regain the use of the only arm she has; it is well within the range of the possible that she will still need 24-hour care 2 or 3 times that time frame (doing the math: $1750/week for maybe 4 weeks, to take the middle = $7000 out of pocket, and that's before considering the potential for part time assistance for a number of weeks after that.)
My mom is lucky (if you can believe it), because my dad worked at a time when his employer provided a pension, and she gets disability checks due to her unbroken non-functioning arm, so she has an income and savings to draw on to pay for this disaster. It is crap like this, however, that causes those few remaining members of the middle class to fall out of it; how many times can she afford to simply lose $10K or so due to getting older? Absolutely sickening and disgraceful for a so-called world power.
11:17 AM PT: Spotlit? Thanks to all for that honor!
Thu Feb 23, 2012 at 12:51 PM PT: After investigating, it seems as though there is no way Medicare will cover mom's care. It is not considered a medical necessity. I asked if this really means that they are ok with patients' spending themselves into poverty before MediCal/Medicaid picks them up, and the answer was "yes." This is what living in the US will get you in the end, apparently.