Medicare Prescription D Benefits

[Ody]

I assume some CPAP users are MEDICARE Prescription D participants. Those folks should read the following:

http://www.usatoday.com/money/industrie ... drug_N.htm

[mindy]

Since CPAP reimbursement from Medicare was around before Part D existed, I would assume it's not part of that .

Mindy

[Slinky]

What torques my jaws about the entire health care industry is that there is never any attempt made to curtail the excessive profits being seen in the insurance industry, the pharmaceutical industry especially. Why the FDA in its eminent wisdom (read that as stupidity) ever rolled back their restrictions on drug advertising is beyond my comprehension other than a kowtowing to the pharmaceutical industry's greed. When these companies spend more on advertising than on research and development something is drastically wrong!!! What especially torques my jaws is that these American pharmaceutical companies develop a drug at American expense, then trial it in foreign countries to circumvent the FDA regs and those that prove successful in foreign countries are then trialed here in the USA for FDA approval.

I see our local hospitals crying poverty and budget problems, fighting tooth and nail to avoid paying the actual patient caretakers a fair and reasonable wage and adding constantly to patient caretakers' duties, utilizing less skilled caretakers in more and more of the skilled area - but - building and adding on to their facilities, building outpatient facilities in outlying areas whilst having part of their main campuses vacant or under utlized. Reducing nurse/patient ratios is SOP. Contracting w/outside specialty groups for such things as anesthesiology and radiology rather than having specialists in those fields on staff ....

Despite advances in medicine I got BETTER medical care from my family practitioner back in the 60s and even 70s then I get now or at least it sure feels that way. I certainly had more confidence that I was getting good treatment back then.

My family doctor could pay off his college loans and do quite nicely financially w/one nurse/receptionist and no overbooking of patient appointments. I wish I could find the statistics on what the average general practitioner's patient-load for a comfortable income and good patient care was in the 1960s and 1970s compared to the needed patient load today to maintain a similar practice and lifestyle. I paid my own office calls and they were affordable. Each patient was given the time they needed. There was no billing office calls by time increments, there was one standard fee set by that doctor's office. I don't remember ever gasping at the cost of a prescription. Back then Mayo Clinic could provide even better medical care than our locals for 3/4s of the cost.

Who's soapbox did I borrow, so I can return it ???

[mindy]

What torques my jaws

[portions omitted - see previous post]

Who's soapbox did I borrow, so I can return it ???

Hi Slinky!

Love that expression "what torques my jaws ....". I must admit I agree with all of your points ... change is not always for the better. Before insurance companies came on the scene, medical costs were lower.....

Mindy

[oceanpearl]

The quality of medical care was also lower. 9 years ago I was given radioactive pellet implants for prostate cancer. The cancer was killed with no side effects. 30 years ago they would have given me a radical prosectomy with all kinds of terrible possible after effects including incomtinenec and impotency.
A few months ago I walked into the eye center, had a cataract removed and then took my wife out to brunch. Just 20 years ago this procedure would have required hospitilization of several days and then at least a weeks bed rest.
When I was born the life expectancy for a male was around 55 years. What is it now, around 80?
If you want to go back to the cheap old days of medicine and have the doctor making house calls in a horse and buggy, be my guest. I will chose the high price health care!
Much of the problem with modern health care is caused by competition among hospitals. In my area there are at least 5 hospitals competing for the patient dollar. In order to get the patients in they have to have all the latest gizmos or the doctors take their patients elsewhere. The area needs one good sleep center yet every hospital here has their own. This goes for MRI machines, surgical robots, etc.

[Slinky]

Nope. Don't wanna go back to the horse and buggy and don't really need house calls since there are cars and ambulances. BUT - if doctors are so busy they only hear the first 3 symptoms you mention, they miss out on a LOT of what is going on w/you, including some times, too often, the IMPORTANT symptoms.

Our area has two hospitals and altho there is some duplication and competition, one has taken over ob/gyn and critical care pediatric whilst the other has taken over severe burns as a for instance of reducing some duplication.

And I didn't say that the newer technologies weren't greatly appreciated. And needed. What I did say was that it was ridiculous that they build new facilities whilst there are large vacant unused facilities at their orginal, constantly being remodeled and added to, campuses. And they are doing this at the cost of direct patient care and nurse to patient ratios. What good is a heart monitor if the nursing staff is too busy elsewhere to be aware of the emergency so they can respond in time to save the patient?

[Bamalady]

Hey Slinky.......I would like to borrow that soapbox for a few minutes, then someone else can use it if they like.

Oceanpearl.....I do believe there have been many major advances in the medical field, however, I have do not believe that the level of care received is the same as it used to be. I think the findings of this study is right on the money:

<snip>

The survey examined whether people got the highest standard of treatment for 439 measures ranging across common chronic and acute conditions and disease prevention. It looked at whether they got the right tests, drugs and treatments.

Overall, patients received only 55 percent of recommended steps for top-quality care — and no group did much better or worse than that.

<snip>

And this statement from the study reflects, for the most part, what we see here on this Forum over and over:

Health experts blame the overall poor care on an overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions.

http://tinyurl.com/yt38zl

It seems that Sleep Disorders isn't the only field to be given the short end of the stick. The more advanced medicine has become, the more fragmented it is, and noone seems to be looking at the person as a whole.

Ok, I'm off the box.....if anyone else wants it.

[oceanpearl]

My beliuef is that every person should be proactive with their medical treatment. With the assistance of Google, in most instances when I get to the doctor's office I have diagnosed my own problem and know exactly what questions need to be asked.
If you allow a doctor to walk out of the examining room without your being satisfied with the interview, then you need to stop looking at doctors as gods and look at them as human beings that you are paying to do a service for YOU. I did not hesitate to tell my internist that very thing when I HIRED him!

[Slinky]

My beliuef is that every person should be proactive with their medical treatment. ... If you allow a doctor to walk out of the examining room without your being satisfied with the interview, then you need to stop looking at doctors as gods and look at them as human beings that you are paying to do a service for YOU. ...

I sure will NOT argue w/you on this, OceanPearl!! I agree with you on the above 101%!!!

[Bamalady]

No argument from me either. Last time I saw my Sleep Dr., I took a 3x5 Index Card on which I had listed my improvements and my concerns. He took the card from me, copied my improvements to my chart, and started to leave the room! I called him back. The only thing that has saved this Dr. / Patient relationship is the new nurse he has hired who is exceptional.

I tentatively diagnosed my own OSA, BTW because it was being overlooked. I didn't fit the profile.

[Slinky]

Well, shame on you, BamaLady, for not fitting the profile! Tsk, tsk. I didn't either! And still don't.

Back in 1996 or so I BS'd my way into a sleep evaluation, not for apnea, just for such lousy sleep all of a sudden after a whiplash 2 years previous. I was just reading that first sleep evaluation the other day. I have NO idea how they slipped a CPAP thru my insurance given the results - outside of absolutely LOUSY sleep efficiency. I would NEVER have qualified for insurance paid CPAP today w/those results! Not that it mattered much. I had so much trouble w/the mask and no support that I gave the whole shebangy back to the DME after an honest trial at being compliant.

Today, whilst I still don't fit the profile, I really do have sleep apnea and really do qualify for CPAP. *sigh* I'd rather not. Need CPAP, that is. But, oh well, if wishes were horses ....

[Perchancetodream]

One of the main problems with the health care industry today is the relentless pressure to provide maximum corporate earnings. Prior to "for profit" hospital corporations, they were run by communities and churches who had no need to make money for shareholders. There is no way that you can put a profit onto a service for the same cost of the service alone.

Medical advances have caused some price increases, but not all, or even most of the them.

We became active politically in the fight for federal funding for prostate cancer research ten years ago. We dropped out after a meeting that was held at UCLA for the activist community by a non-profit coalition, sponsored by a drug mfg. The point of the conference was to get us to help the drug company lobby the FDA for approval of a single drug that would replace the two drugs that were currently being used. In other words, let's not cure cancer, let's just make more money by playing with the formula of the drugs we use to treat it, thereby extending the patent.

As long as medicine is seen as a cash cow, we will be considered and treated like cattle. (And that includes the caring care givers.)

Okay, it's someone else's turn to use the soapbox!

Susan

[darthlucy]

I work for one of the dreaded insurance companies, and as part of my job I've gathered a lot of information on the Medicare Part D Plans. In a nutshell, what's happening is that the companies who offer these plans have found that the prescription-only plans (PDPs) are a lot less profitable than the combination Medicare Advantage + prescription drug programs (MA-PDs). Therefore, almost all companies have increased their premiums on the PDPs and many have left the premiums on MA-PDs untouched (or even lowered the premiums) to encourage people to switch. If you have a PDP and the premiums are going up, check out the MA-PDs instead. My guess is that over the next few years, the PDPs will disappear except for the low-income status plans.