The myth of the non profit hospital

[southernhybrid]

I am not surprised in the least. Although public health doesn't automatically mean it's done right, it just means different incentives to doing things wrong.

Of course that's true. I briefly worked as a prn nurse filling in at public health departments. Some of them had terrible management. I quit that job after a few weeks. The person running the company was totally unqualified. Health departments are good or bad depending on management. The same goes for nursing homes, as I also had a job inspecting nursing homes for quality of care. It all depended on the administrator and the director of nursing, when it came to quality of care. We could usually tell when we walked through the door whether of not the home provided good care. Yes. I changed jobs way too often. Nurses can do that.

I was fortunate to work in the public health department in Greenville, SC and in Raleigh, NC. Greenville was the best but the state was run by Democrats at the time. Just sayin' Greenville even had an environmental control department, so anytime one of my poor home health patients had rats in their homes, all I had to do was call that department and they would come out and exterminate the rat or rats. Raleigh wasn't nearly as good as Greenville, but it was still pretty good for the most part.

I don't know much about our local health department.

 

[Toni]

I think DoD Tricare for retirees probably helps remediate the overuse issue by basically flipping the cost of copays and monthly premiums. $15 monthly premium. $150 copay for a visit. They've stuck with this model for as long as I've been in it, that's at least the last fourteen years.

The overuse issue may subside some as those who are unfamiliar with the internet die off. Being 59, ailments are starting to creep in, I always go to the Mayo Clinic website or the like first to see if it's something I should make an appointment for or just hold off until my next checkup and make mention of it then.

Are you saying it's $150.00 copay for any visits? That seems like a lot but it would persuade a reasonable person to not run to a doctor needlessly.

I"m hoping that was a typing error and he meant 15 dollar copay. I can't imagine a copay of 150 for a doctor's visit. Medicare rarely pays that much for the entire visit unless it's a complicated or extended visit.

My late father received a lot of his care from the VA, despite having Medicare and a Medigap supplement. I missed the chance to get a supplement since I didn't realize that unless you live in one of 4 states, you can be denied a supplement unless you ask for one during the first 6 months you are eligible for Medicare.

The problem with the supplements is that they can start out being very reasonable, but the older you get, the higher the premiums usually are. I worked with a woman in her mid 80s who was only working so she could afford her supplement. It was 350 per month when I worked with her. If she is still alive, she'd be about 93. I wonder how much her supplement would be at 93. Sadly, the woman didn't know that she should have a Part D drug plan. Luckily, she took no drugs, until she was diagnosed with hypertension when in her mid 80s and that drug was cheap.

If you don't sign up for Part D when you are 65, you will have to pay a higher premium if you choose a Part D plan years later. Most Advantage Plans have the drug plans as part of the plan. The first few years I was on Medicare, I took the traditional Medicare with a Part D drug plan. Since I've always been healthy and will likely refuse aggressive care when I start to deteriorate, I thought that would meet my needs. However, traditional Medicare has no limit as to what you might have to pay out of pocket in any given year, while Advantage Plans do have a limit. My current AP has an out of pocket limit of about 6500 per year. A lot of people don't even have that much money available, so unless they are poor enough to have M'caid as their supplement, they are screwed.

At least half of my previous patients in the long term care facility did have M'care and M'caid as their supplement. They usually were able to receive good care as most doctors in the area took patients with that combination. M'caid pays less than M'care. If M'caid is all you have, it's a lot harder to always find a doctor who takes M'caid. Most of you probably know that you have to pay into M'care through your work for at least 10 years to qualify. Those I knew who were only on M'caid, had cognitive disabilities that made it hard for them to work.

I know we've gone away from the topic I started in the OP, but it's all related to how profit has influenced our healthcare. Plus, Medicare is complicated and a lot of people make the wrong choice. Let me add that I knew a couple about 10 years ago, who gave up their Medigap and took an Advantage Plan because they could no longer afford the supplement. It becomes too expensive as they aged. Most of my older friends are on Advantage Plans. They either can't afford or didn't want to pay the high cost of having a supplement, aka Medi-gap.

A lot of people don't realize that other than a few weeks of rehab, Medicare doesn't pay for nursing home care.

I don't know if this is true everywhere but in the state where my mother lived, it is possible to get a Medicaid bed in a nursing home if one needs one. Most (maybe all???) nursing homes reserve a few beds (I believe determined by law) for Medicaid patients. Those beds fill quickly and quickest of all in good quality nursing homes. However, at least at the time my mother required a nursing home, if one began as a Medicare patient or private pay, and funds ran out, they would not kick you out but convert to Medicaid. Same level of care although if you had been in a private room, you probably would be moved. Great for continuity of care to not have to switch nursing homes but again, eats into the availability of beds available in nursing homes for poor patients.