randomly assigned......

One of the scariest situations we face in America today is the plight of our waning medical system. If you belong to a company that offers benefits, you have a better chance than most people of receiving the care. If not, you are almost left to your own designs to find some measure of coverage on your own; but with costs that they are, most people will sacrifice coverage if they have to pay for it independently. There are a few systems in place, such as medicaid and medicare, that will pick up these costs if you are elderly or can prove that you are poor or handicapped. All others can only hope that they stay reasonably healthy.

Well.... starting on the 1st of this year, our government has redesigned the medicare system. Since it is already a perplexing predicament, they decided they needed to go one step further to make it more confusing by going to their own private plans. All patients have been reassigned by the government to this new drug plan... that may not cover some of the medicines these people are currently taking. Our government is not worried though as they said they will fill those prescriptions no matter what drug plan anyone is in, or whether people have already been contacted of their reassignment.

Ok, maybe this is a good step in the right direction. Maybe this will weed out the non-deservers, but in the meantime, it puts a great strain on the people who truly depend on their medications to keep them alive. Apparently the nursing home officials and pharmacy groups say they do not foresee a doomsday situation, but consumer advocates fear that the drug plan will cause some trouble, given the nature of the forty percent out there who are mentally or cognitively impaired. This is within good reason as the new benefit has been plagued by widespread confusion about the details. You see, certain people have dual eligibilities with medicare and medicaid. Not all of these people were assigned a plan prior the change, although (in their favor) millions were. For the few who have slipped through the cracks, this could be their worst nightmare.

How this all works is a minor miracle in itself. You see, many people do qualify as dual eligibles. While they may receive help from the providers to help them choose the correct plan (and there are many), they essentially have to pick a plan that will cover the specific medications they are on. People without cognitive ability to enroll themselves have to depend on a family member or guardian to make these arrangements for them. If they do not have a person in line to make those decisions for them, the state takes control. And we all know how fast the state works, don't we? What worries healthcare providers is patients being delayed their necessary medications while the system works out the bugs. It puts tremedous pressure on nursing homes as well as pharmacies. Because of these random assignments, it is a possibility that some patients may find themselves enrolled in a plan that isn't covered by the particular pharmacy they purchase from.

Ok, are you quite confused now? Well, let's add some numbers in there to get a real perspective on the situation. As it stands now, there are some 42 million people nationally who depend on the Medicare system. They have a total of 82 plans to choose from. (My plan from Kaiser had maybe 20, and I was tired of reading after the first 3). What worries the Medical Right Center is that even with a 99% success rate, some 60,000 people will suddenly be without the medications that they need to survive.

I'm not knocking the redesign, I only agree with what the administrators of facilities are worried about, which was not allowing the system to have a little more time to make everyone ready for this. Well, yes, every new system looks good in theory, it's when it is put into it's practical use that the "bugs" surface. One good piece of news is that nursing homes, by law, must provide medicines that patients need, even if they are not covered. One bad piece of news is for the people who are not in a nursing home. While these bugs are being worked out, some people will not receive their necessary prescriptions and there could be a run on hospital emergency rooms where nurses and personnel will have to become social workers for each individual coming through the doors.

So my point.... If you have a family member in this type of situation, look after the matter to help them through it. You can call 1-800-Medicare or consult www.medicare.gov for more information. As confusing as it is, it is a system put in place that one day we will all face. It's not much, and perhaps not even a great system. We all know that Europe and Canada have a free healthcare system, but at least we have something until the next redesign comes along.

As a post-script, and not too far off the subject. If you know a child, sick or not, with parents that cannot afford healthcare, check into your local county health departments. They can provide services that would cost a fortune in a doctors office. My son received all of his innoculations from the county health department, thereby saving me tons of money, and him from mumps, measles, and all the other childhood diseases. You cannot even enroll them in school or college until their immunization sheets are filled out these days.
If you know a child who does suffer cancer, St. Judes Hospital should be contacted. They will not turn away any child for any reason, including financial hardships. It is a noble and worthy foundation, and one I have supported for years. Their address is: www.stjude.org/ .

We may not have a lot in place, but we do have a few things. It is to our advantage, and the future of our off-spring to know all we can, if ever faced with the possibility of what to do.