Thanksgiving
In a sea of the bottom line, black and white profit driven corporate healthcare we have become used to- thanks to the insurance and pharmaceutical companies- I want to say thank you to the doctors, nurses, and scores of other professionals who go to work daily and continue to strive to do the right thing.Dr. K.
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Thank You
The definition of the problem with health care might differ depending on circumstances. The employed person with employee-paid coverage, the retired person on Medicare, the person on Medicaid, or the unemployed or working poor may give widely differing answers.
I am not exactly in any of the above groups (not on medicare, not employed but a previous employer pays part of my insurance premium for a policy that covers most anything I need at 100% with a few copays). Sounds great doesn't it? It's called an HMO and the premiums are considerably less than the other options I was offered. But, I can't go outside the group (and have my care covered) unless it is pre-authorized by the carrier. So, I am somewhat limited unless I 1) jump through the HMO hoops or 2) pay for such out-of-plan treatment myself. I have never been very sick (except for a couple of hip replacements which turned out to be wildly successful) so it has not mattered so much yet. But even with my THR, my HMO includes ONE orthopod who does hips. ONE. I cringe to imagine what I might have endured had my hip jobs not been routine.
One thing I like about this HMO is that member may consult many specialists on their own - no gatekeeper referral needed for many specialties. But, in the back of my mind, I do wonder if I would get the best treatment if I got really really sick and my options might not include treatment that I could benefit from. This I won't know until it happens - and it will be too late. Maybe I need additional education in how to choose a doctor (or an HMO). When one has choices, how do we health consumers make an intelligent choice rather than one that is based solely on economics or expedience?
So for me it may be a trade-off: lower cost premiums and virtually no paperwork in exchange for coverage from a large if limited group of doctors and hospitals. Although my particular HMO frequently ends up on "Best" lists, it is still an HMO after all and they are trying to keep their costs down. An example of this is the cholesterol lowering drugs that they will cover. I have taken such a med for about 4 years. In that time I have had to change drugs twice because they have removed it from their maintenance drug list. They are saving $$ by not covering it. I am spending $$ if I want to continue an uncovered drug. So far I have chosen to do it their way.
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