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Happy birthday Medicare! post 2

a little night musing's picture

Call the previous post "a dream" and this one "reality". I have one of those supposedly wonderful insurance plans provided by Unions, and I've encountered Mom's initial problem (to the point that I in fact have no health care paid for by the plan that is bankrupting my union.)

Here is my Mom's more, shall we say, anodyne experience. It's only gotten worse since then.

Mom's experience with Medicare part C

Just one anecdote, and a mild one at that. I know: the plural of "anecdote" is not "data". So take it as you will.

My Mom is enrolled via Medicare part C in an HMO whose name will be changed to protect the people working for it who bent the rules a bit. I'll refer to it as MPCHMO. Mom is mostly pretty much happy with MPCHMO. Bear that in mind as you read.

Mom recently found herself suffering from a bewildering array of vague symptoms which were reducing her quality of life dramatically. Age-related? She decided to check it out.

"One thing I like about MPCHMO is that about half of their doctors are women. But my doctors keep leaving MPCHMO: I don't know why," she told me, recounting the story later on. [I could speculate...] "So I keep having to pick a new doctor. So when I found out that my last one was leaving, I asked her if she could recommend anyone. And she told me that they are not allowed to talk about other doctors.

"Can you imagine?" she asked. "I don't know how to choose a doctor."

I sympathized. "We've got to get the insurance companies out of this," I murmured. She agreed. Then she went on:

"Well, anyway, my doctor told me, 'Maybe you should talk to the nurses.' The nurses said, 'well, we're really not allowed to talk, but Dr. X's patients seem to be very happy.'" So my Mom decided to use Dr. X. And a good thing, too.

In a very Dr.-House-like manner, Dr. X managed to diagnose all of my Mom's varied and vague complaints as due to a hormonal imbalance caused by an overgrown gland. [I'm not using the medical terminology, but that's the gist of it.] The problems, which were seriously eroding my Mom's quality of life, could be easily treated by surgery to reduce the overgrown gland.

Now the problem was... to schedule the surgery.

This was not emergency surgery, but it was certainly urgent surgery. My Mom was having trouble concentrating, remembering, thinking clearly, just living her normal life. She was told that the surgery date would be scheduled within 3-4 weeks. Note: not that the surgery would take place within 3-4 weeks: but that she would received a phone call setting the date within that time.

When she told me this story, it had been three weeks. She was still hoping to hear from the scheduling department in the next week or so.

She was not scheduled during that next week, and in fact, she did not receive a date until she decided on her own to stop dealing with the scheduling department and called her doctor's office directly. She then received a surgery date - the surgery was to take place nearly seven weeks after she first received confirmation of the diagnosis.

Remember that awful Canadian system with its long waits?

Mom's now (thankfully) out of hospital and on the mend. But it was almost in spite of her insurer:

• She likes her PCPs (so far), but they keep leaving just when she's developed a relationship with them. [Would a new doc necessarily have known that Mom's symptoms were out of the norm for her, even at her age, and gone looking for another explanation? Would electronic medical records have contained that information?]

• The doctors are forbidden from making recommendations or referrals or even giving any information about other PCPs to help her choose a new one. [Thank goodness for the nurses!]

• And she still had to wait almost 7 weeks for needed surgery - a wait that might have been even longer if she had meekly followed directions and dealt only with the scheduling office.

Mom's still happy with her doctor. I hope this one sticks around awhile.

The bottom line, we all want choice: we want to choose our doctors and other health-care providers. We don't want to choose among a morass of confusing and expensive insurance plans.

(That last paragraph is almost a quote from someone here at Corrente, possibly a commenter, who said it a lot better. If you know who it was, please leave a comment here!)

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a little night musing's picture
Submitted by a little night ... on

as a good outcome of Robamney care = remember what Mom went through, Because I have a "choice" - if I can find anyone still participating in my plan and accepting new patients.

ralphbon's picture
Submitted by ralphbon on

I'm not sure whose comment you're paraphrasing -- I think maybe just good ol' reliable lambert -- but your question made me dig out a 2009 interview Trudy Lieberman of Columbia Journalism Review conducted with Yale professor and Medicare historian Theodore Marmor. At one point, he said, "It’s literally idiotic to suggest that the choice of insurance plan rather than the choice of provider is paramount in peoples’ minds." The whole interview is worth a read and a weep.

And good god, is it really 3 years since I wrote this puppy?

Submitted by lambert on

Perhaps Hipparchia?

Submitted by ubetchaiam on

is really the key: "and in fact, she did not receive a date until she decided on her own to stop dealing with the scheduling department and called her doctor's office directly."

I'm a vet and can't afford medicare so it's just the VA for me and what I can tell you from talking to the 'worker bees' is that they consistently indicate that 'one has to take charge of one's healthcare' ,meaning appt.'s. prescriptions(DR.'s seem to be prescription 'happy' nowadays;"I'm sure some drug will fix the problem') and even research into what ails oneself.

And same rules apply in the VA system about doc's referencing other doc's; BUT the nurses/physicians assistants can and are the best source; and if all else fails, demand to see the administrator of the hospital/institution where care is given. It truly has become a situation where 'the squeaky wheel gets the grease'.

Unfortunately, your mum is probably like so many others, just really uncomfortable being demanding of their healthcare provider. We really need more people screaming.

Submitted by lambert on

.... that the insurance companies are in the business of denying care, and not providing it.

Think of the scheduling department as having the same business model as one of those sociopathic call center operations that put you on hold to make you go away. Rather like ComCast.