Please Read This Article Regarding Medicare and Let us Know How you Feel.

Congressman Ryan, I Don’t Want To Be A Lab Rat

Congressman Ryan, I Don't Want to Be a Lab Rat

posted by MARK SUNSHINE

Just a few questions...

An open and a sent letter to Rep. Paul Ryan (R-Wisc.)

Congressman Paul Ryan
1233 Longworth HOB
Washington, D.C. 20515

Dear Congressman Ryan,

Please explain your Medicare plan to me and my wife.  We are in our early fifties and are concerned about how your changes to Medicare will affect us.  We know that Washington can seem disconnected from the real world but, for people of our age, your plan to do away with Medicare is very real.

Getting rid of Medicare feels like a free markets experiment to us and neither of us wants to be a “lab rat” for a social and economic experiment gone awry. Lab rats are usually expendable and we don’t want to be part of a discarded generation.

By way of background, both of us believe in free markets, personal responsibility and individual choice.  We agree that the nation’s future demands fiscal responsibility.  We are educated (we have graduate degrees), are employed, are savers and have put aside money for retirement.

We were surprised by the fast track House acceptance of your plan to eliminate Medicare benefits and change Medicaid.  Because of the lack of meaningful debate or hearings we don’t know anything about the details of your plan and want to understand how it will change our lives.

Please do not take offense by any of the questions.  They are intended to be non-partisan but these are questions that need to be addressed.  We believe that elder care benefits will determine when we die and whether or not we end with dignity.  We just want to know what the future holds under your voucher program.

As we understand your plan, when we reach our golden years, we, like every other senior in our age group, will be given a voucher to purchase private health insurance.  We will need to personally chose which health care plan to purchase from what is hoped to be an array of choices.  To the extent that insurance or non-covered health care costs exceed the amount of our voucher, we will pay the extra amount out of our savings.

Since we will be elderly, after we get sick we won’t have a “second chance” to go back to work, earn new money or financially recover.  If our savings run out before we die that’s it — there won’t be any more money coming our way  — so we think that it’s really important for your plan to get it right, and the first time. There won’t be any second chances for us.

Since you are known as a “serious and responsible” thinker, before proposing the dismantling of Medicare as we have known it, we assume you figured out what will replace it and verified that the private insurance market can fairly and adequately service the needs of seniors.  We just want to know what you were thinking before introducing legislation on the floor of the House that was passed in a matter of hours from introduction.

We assume that you looked at the current Medicare Advantage program as a starting point for your plan.  Medicare Advantage is also known as Medicare Part C and gives seniors the option to enter an HMO or PPO rather than receive traditional Medicare benefits.

We hope insurance experts told you that Medicare Part C is a bad reference point for what you want to do because it is a reversible option.  Seniors that don’t like or aren’t adequately covered by Medicare Part C can opt back out into a traditional Medicare program.  So the insured pool of seniors in the Medicare Advantage program isn’t random or representative of what will happen if your program is adopted.  The Medicare Advantage program provides false comfort that private insurance can be expanded to all seniors without serious bad effect.

Below are some of our questions about your program.  We will probably have other questions after we understand some of the basics of your plan.

1.  How is your plan going to deal with pre-existing conditions and pricing?

If we need to change insurance companies will we be rejected by replacement companies because of pre-existing conditions?

Since your plan calls for a repeal of the President’s health care bill it seems that protections for pre-existing conditions will be repealed .  Is that correct or do you expect to keep some parts of the President’s healthcare reform law?

Also, what insurance company in their right mind is going to voluntarily insure me and a group of old people?  We will be a bad risk because every one of us will either be sick and dying or about to be sick and dying.  For the insurance company to make a profit on a group of old people they will have to charge a really high premium.  Will there be a cap on premiums and if so how is this a “free market solution”?

2.       How does your program protect us if we have diminished mental capacity?

It is a fact that as some people age they have diminished mental capacity and I am expecting that neither my wife nor I will be an exception.  I am worried that we won’t be able to make an informed decision as to which insurance plan to purchase.  The contracts are complicated and full of small print.  They are drafted by Wall Street lawyers and designed to protect the insurance company.  If we can’t understand our insurance options and make an intelligent choice how will we purchase the right plan?

3.       What happens when we have less than diminished capacity and can’t effectively make any decisions on our own?

I know from firsthand experience that in some states elderly are still deemed to have “legal capacity” even though they are dramatically diminished and can’t make their own decisions or take care of themselves.  Are you proposing some new form of Federal definition of “capacity” that supersedes state law so that very impaired elderly people have someone that helps them purchase insurance?

As an example, my wife’s grandfather is 90+ years old and has had several strokes.  He can’t read, talk, write, drive, feed or otherwise take care of himself without full time assistance.  He lives in Maryland and despite his mental and physical disabilities, in the state of Maryland he is legally competent and was only recently denied his driver’s license renewal (we took away his car keys more than 8 years before Maryland took away his legal right to drive).

Even before my wife’s grandfather had his major stroke, when he was in his early 80s, he didn’t have the mental capacity to understand and purchase MediGap insurance.  When he got sick we discovered that he had messed up the application and thought that he was covered even though he hadn’t paid premiums for years.

If that happens to me or my wife, who will help us when we are still deemed competent by the state, but clearly unable to live independently or make adult decisions?

And, what happens if we are deemed incompetent?

Who will take care of us and purchase insurance if we are truly incapacitated?

Also, what happens to us if our guardian makes a bad insurance purchasing decision and we neither have money, insurance nor capacity to help ourselves?

4.       If an insurance company decides to incorrectly deny benefits who will protect and defend us?

When we are old and sick who will protect us from an insurance company refusing payment on legitimate claims?

Even worse, how will anyone even know if an insurance company refuses payment on necessary care and I (or my wife) am harmed as a result?

Will the insurance company have any liability for refusing to pay for care or for dictating what care we receive?  Can we sue?  If we are old and permanently harmed, will it even matter if we can sue?

Who at the insurance company will be making coverage and payment decisions?  What standard of care will they need to use?  Do they have a fiduciary responsibility to me as the insured or will their shareholders obligations be more important?

Will the insurance company be allowed to earn more money if they deny care to seniors?

It’s my impression that seniors and their doctors know the Medicare rules and as long as they stay within the rules, reimbursement is predictable and timely.  No one from the government has a financial incentive to deny payment or mess around with patient care.

Private insurance is different.  There is a big incentive to go cheap on care and not pay out benefits.  I am worried that panels of insurance executives will end up effectively deciding who lives and who dies in an effort to maximize profits while fulfilling fiduciary responsibilities to their shareholders.  These will be real Death Panels and the prospect terrifies me.  It’s bad enough when insurance companies take advantage of young people.  How will old people who killed off by insurance companies defend themselves?

5.       What will protect us from bait and switch advertising and tactics?

For seniors, it’s too late to figure out that an insurance company has pulled a bait and switch after care is denied.

I think that the recent national experience of having banks bait and switch virtually every individual and institutional customer should be enough to be concerned about conflicts of interest between customer needs and shareholder profits.  Regulators couldn’t control the banks, why do you think they will be able to control insurance companies any better?

Seniors need more protection than bank customers.  The elderly can’t risk regulators being late to the game.  There aren’t any do overs when it comes to seniors.  Small mistakes are fatal.

How do you propose to protect me and my wife from bait and switch tactics?

6.       Medicare is a national program but insurance is regulated on a state by state basis.  Are you proposing an expansion of Federal authority over insurance companies or will the options, protections and risks be different depending upon what state I live in?

When I am a senior, will I have to decide where to live based upon insurance regulation of my state?  My parents didn’t have to make those choices or decisions, nor did their parents, nor did anyone before me since Medicare was enacted.

Will my wife and I have to move from our home if our state has crummy insurance and consumer protection laws?

Or, are you proposing new Federal regulation over insurers that provides consistent national coverage for seniors that isn’t dependent upon state residence status?

And, if you are proposing new Federal insurance regulations how do governors, state insurance officials and state’s rights advocates feel about the Federal government expanding onto their turf?  Also, where in your budget is the funding for this new agency?

7.       What happens if I outlive my financial resources?  Will Medicaid cover me so that I can die with dignity? Or will I just die?

With the cost of nursing home care in some places exceeding $75,000 per year per person, it isn’t hard to imagine that my wife and I may outlive our financial resources.  You are proposing large scale cuts to Medicaid.  What happens if we run out of money before we die because we are placed in a nursing home?

Will someone take care of us and help us when we literally can’t go to the bathroom by ourselves but also have no money to pay for help?

Or will we have to choose between food, clothing or housing and medical care (and that assumes we have the mental or physical capacity to make choices)?  Will your plan make us homeless and indigent like many of the elderly of the 1920’s and 1930’s?

8.       What other large industrialized countries have adopted a plan for senior care similar to what you propose and how has it worked?

I am hoping that sometime since the beginning of the industrial revolution another country has tried your plan and it worked.

Can you point to any country, anywhere in the world, where your plan has been tested and it worked?  I would feel a lot better if that were the case.

Congressman Ryan, please feel free to provide as much detail as possible on how, as a practical matter, your plan will be implemented.  I understand that your objective is to save money — I just wonder if there isn’t a less radical approach that would work.

For example what’s wrong with modifying the current Medicare system to include means testing on co-payments and deductibles, increasing the eligibility age by a few years, restricting payment of certain elective procedures and working to reduce hospital and provider administrative costs.  Tort reform relating to end of life care couldn’t hurt either.  These changes would be easy to implement, fair to all and still provide protection for the elderly.

When I was a child I read stories about how animals that that get old walk into the forest to die.  They are never heard from again and as a result aren’t a burden on their herd.  The remaining animals have better survival odds because they are not forced to waste precious resources on old animals that are going to die anyway.

For better or worse, a long time ago we decided that we were different than animals and that old people shouldn’t be asked to “take one” for the team.

Congressman Ryan, I am worried that your plan basically is telling me and my wife to get ready for that long walk into the forest.  Please tell me it isn’t true and that I am over reacting.

Sincerely,

Mark Sunshine

PS.  Even though I don’t live in your district it would be nice if you answer this letter.

Plan to Cut $389 Billion From Medicare

Republican leaders released their new budget for 2012 they plan to pay for a  29% cut in the tax rate on the top 10% by cutting $389 Billion from Medicare.
This plan cuts the top income tax rate by nearly a third, from 35 percent to 25 percent.

A big part of the House Budget Chairman's plan rests on the assumption that President Barack Obama’s health care law will be repealed. Over the next decade, that would cut $1.4 trillion in spending alone, according to Ryan's budget. Those savings, however, wouldn't go directly to deficit reduction, because Ryan would also repeal the elements of health care reform that are aimed at raising revenue or reducing costs.



The Wisconsin Republican's budget spends less on nearly every major category of the budget. Over the next decade, Ryan (R-Wis.) wants to cut $389 billion from Medicare, the public health insurance program for seniors. Over the same period, Ryan's budget puts $735 billion less toward Medicaid, which benefits Americans too poor to afford private insurance. Discretionary spending on domestic programs is also reduced by $923 billion.

What Health Care Bill?

CNN Interna... Behind FL Judge's Ruling Against Health Reform

Examiner.com - ‎
In a Pensacola, Florida District Court ruling carefully engineered to deliver exactly such an outcome, the federal Patient Protection & Affordable Care Act (PPACA) that's already forcing health insurance companies to insure men, women and children with

pre-existing medical conditions for the very first time in American history, has now been declared unconstitutional by Judge Roger Vinson.


Continue reading on Examiner.com:

Blizzard comes to Chicago

Blizzard coming to Chicago


Chicago is in the direct path of what The National Weather Service is predicting to be the most severe winter storm of the past decade. All charts are pointing to a ruff two days for the whole Chicagoland region. The National Weather Service has taken the step of replacing it’s the Blizzard Watch with an all-out Blizzard Warning for the entire Chicago area....



» Read "Blizzard coming to Chicago"...

Cancer patient loses coverage over a single penny

Jonathan Berr

Jul 13th 2010 at 11:00AM  under: Insurance - Health Insurance

It seems like the Mother of all health care horror stories: an unemployed single mom suffering from leukemia almost lost her health insurance because she underpaid her COBRA premium by a penny. It's made the national media, including MSNBC's "Countdown with Keith Olbermann" and the Huffington Post. But there's more to the story than meets the eye.



Larosa Carrington of Colorado Springs, Colo. was treated shabbily by Discovery Benefits, the administrator of her COBRA benefits. Since she never received a bill, the laid-off college admissions counselor was forced to calculate how much she owed on her own. By Carrington's reckoning, she figured that $165.15 was the correct amount and sent the payment to North Dakota-based Discovery Benefits. In response, the company sent her a badly written, legalistic letter saying that "the amount of your payment was not enough to satisfy your initial premium payment ... so your coverage has not been reinstated with your insurance carrier."



The 52-year-old telephoned Discovery Benefits to find out and was stunned when the Discovery representative told her she owed $165.16 and wanted her to send a payment for 1 cent. Carrington says that the representative insisted she pay the shortfall with either a check or money order and there was no way that it could be overlooked. Carrington was incredulous.



"I actually called them from my hospital room, [lying] in my hospital bed," she says. "At that particular moment, I wanted to know how much I was short ... Of course, I was in disbelief when I found out" that the amount due was a single penny.



Carrington says she tried "everything" she could think of, including "ridiculing them and shaming them," to no avail. Her argument was that she could not send a payment because she was undergoing chemotherapy. Another problem Carrington pointed out was that her bank might not cash her check, thinking it was a "mistake." A supervisor was more sympathetic, but still could not help.

"The best she could do for me was keep a 'special eye' out for my payment," she says. "I kept hearing 'that's not our policy.'"

Frustrated with Discovery's stubbornness, Carrington mentioned to the supervisor who called herself "Gina" that she was considering telling her story to the media. Later that day, Gina phoned back to say she had come up with the figure of $161.1545. Carrington had rounded down while the company had rounded up. Discovery then corrected its error and reinstated her coverage. Carrington was so mad that she told her story to the media anyway.


The whole Kafkaesque exercise lasted three hours and was pointless, since the cost of processing a 1-cent check probably would be far more than the value of the payment. If Discovery really wanted that penny, it would have made more sense just to ask for it in the next payment. Technically, Carrington was without insurance and would have received sufficient coverage if she made her payment before the grace period. That's no excuse, though, for how she was treated.

Discovery President John Biewer admits the company made a mistake, which it rectified as soon as it could and has taken steps to prevent it from happening again.

"The letter should not have gone out for only a penny," he says, adding that it was spit out by a software program run by a third-party vendor that has been fixed. Its cold, bureaucratic language was mandated by state insurance laws.

Carrington was inconvenienced for a few hours by the snafu, which gave her -- understandably -- a headache. Media reports also have failed to note that Discovery only collects payments and has no say over who gets insurance and who does not. Carrington says she was not aware of the exact role the company plays and only confronted them because she knew of no other place to go.


"Our motivation is to keep her insured," Biewer says, adding that the company does not make money otherwise. "We're not the evil people everyone thinks we are. We do not pay medical claims. We are just in shock in how this is being portrayed."


Indeed, Olbermann declared Biewer "The Worst Person in the World" on July 7, saying of Discovery, "They'll let you die for one hundredth of a dollar." That refers to the discrepancy between Carrington's and the company's initial calculations. Carrington's story has gone viral, resulting in the morphing of a regrettable error into an evil plot to deny a sick woman life-saving health care.

Help the Earthquake Victims in Haiti

An overnight 7.0 earthquake in Port-au-Prince, Haiti- has the pontential to leave more than one hundred thousand people dead- and an untold number of families homeless.
We can all remember back to the death, destruction and general horror that was Katrina. A death-toll so large that it stretched our ability to truly comprehend. Years have passed, yet New Orleans is still wearing the visible scars, and any sense of normalcy, can still be years away. It is with that in mind, that we read about the devastation that occurred today of the island nation of Haiti. it is truly impossible to grasp what it means to hear of Hundreds of thousands are feared dead in the wake of the 7.0 -magnitude earthquake. Haiti, already the poorest nation in the hemisphere, has few resources to even begin the long task ahead.

Click below for a list of licks to help.http://www.urbaninsuranceagency.com/insurance-articles/544/help-the-earthquake-victims-in-haiti.html

Together, we can make a difference

Health Insurance Debate

November 30, 2009

Car insurance is mandated!

As Health care bills bounce from the House to the Senate, understandingly people and groups are concerned how these changes might impact their lives. Such concern is well founded. But it is necessary that there be more light and less heat. It was for that reason that I responded to the below comment. November 9, 2009 by Jason
Another fantastic straw man from the shameless promoters of universal health care.
Here is the premise: It is not unreasonable to have a health care mandate, since it is good for everyone and is no different from auto insurance [which is mandated with penalties for non-compliance].
1. Auto insurance that is mandated by the [state] government(s) is to protect other people, not you. You are required to carry liability insurance to cover damages to other personnel or property, not yourself. Lenders however, require insurance levels, which protect their investment – the car. If you do not want to carry collision insurance for repairs, you buy your car outright and are the only owner. You can also choose the level of coverage, for example towing, rental reimbursement, and roadside assistance.

2. If you do not drive a car, you are not required to carry insurance. Urban dwellers, children, and the elderly who do not drive automobiles are not required to carry automobile insurance of any kind.

3. Most importantly, a health insurance mandate instituted by the federal government is unconstitutional. Auto insurance requirements are at the state level and such decisions are reserved by the state according to the Constitution of the United States. The 10th Amendment of the US Constitution states, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

You bring up three very interesting points.
First you are correct, the state does not demand that you buy Physical Damage insurance to cover a loss to your own car, the state just demands that you have coverage for the damage you might do to someone’s person or property.Secondly you are again correct when you state If you do not drive a car, you are not required to carry insurance. I could point out that if you are an Owner/non-driver, you will need car insurance- but for the most part you are correct.Your third point that a health insurance mandate instituted by the federal government is unconstitutional, falls under the heading “Unsettled-Law”.The federal Government does pass laws that are national is scope. The simple truth is if a health insurance mandate instituted by the federal government was clearly unconstitutional, we would not see so many people fighting so hard to stop the bill.