Young couple (drive two Ferraris and own a $700,000 home) charged $21 for 3-day hospital stay. Average senior pays $1,364.

The corporate exec was sincere when he explained to me why he didn’t pay most of his workers a wage higher than $14.25 an hour:

That rate keeps them under $30,000, and that’s about the cutoff for Medicaid and many other public assistance programs for a family of three.  Without Medicaid they would have to pay for health insurance and that isn’t cheap.

A raise to $31,000 can leads to a disaster for a family:

This year, the average (health insurance) annual premiums are $7,188 for single coverage and $20,576 for family coverage. The average premium for single coverage increased by 4% since 2018 and the average premium for family coverage increased by 5%. The average family premium has increased 54% since 2009 and 22% since 2014. – Kaiser Family Foundation (KFF).

Ferrari plus nearly free healthcare!

Even if your company offers a health plan, getting a raise can still be very bad news. In those plans, some $11,000 in annual premiums on average are paid by a family, and the remaining $9,500 by employers.

The much-touted $15 minimum wage (equals equals $31,200 a year) means no Medicaid for your family. That leaves you only eligible for private or company insurance that reduces your pay $2.50 an hour minimum and up to $10 an hour maximum.

No wonder that 75 million Americans are on Medicaid today, compared to just 50 million in 2010.

It is especially attractive, because if you work “under the table”, or have a business that “reports” low income, you can get Medicaid regardless of huge real estate investments or even owning multiple mansions, thanks to changes enacted by the Affordable Care Act.

Someone could own a home worth $850,000, a Lamborghini, a second vehicle, hundreds of acres of farmland, and still technically be eligible for Medicaid. These Americans would be considered wealthy by any standards, but by sheltering their net worth under the current tax laws, they would be legally eligible for Medicaid. – KFF

The only folks who can’t take advantage of the goodies in Medicaid (and still own terrific assets) are all 47 million seniors on Medicare. The elderly face a unique “assets test.” That’s just for seniors, and there are no exceptions for the elderly.

The insane rule is that you can’t have more than $2,300 in the bank, other savings, etc. The government can even investigate you to learn whether you made large gifts from prior savings to your children during the past 60 months.

The usual reason that seniors want Medicaid is to pay for nursing home care. Medicare pays nothing, but Medicaid covers it all. About 40% of nursing home residents are on Medicaid.

America’s nursing homes charge more than $85,000 annually at list price and that’s what you’ll pay until you are dirt poor and qualify for Medicaid. Insurance companies and Medicaid cut special deals and pay nowhere near that amount.

Some friends have suggested that Medicaid and Medicare are about the same thing.

Let me count some of the ways they are starkly different:

  1. Annual premiums: Medicaid is $0. Medicare is minimum $3,468 a year for a couple. High earners pay as much as $5,700 each.
  2. Inpatient hospital care:  Medicaid co-pay is $3 for each day in the hospital, up to $21 for the entire stay. Medicare co-pay for even one day is $1,364, and if you re-enter the hospital after 60 days, each time another $1,364 is due. For Medicare hospital days 61-90: an added $341 co-pay each day, and days 91 and beyond: another $682 each day. After 60 days beyond the 90 lifetime limit, Medicare pays nothing and you are responsible for all hospital bills.
  3. Short Procedure Unit: Medicaid co-pay is $3 for Surgical Center (ASC) visits. Medicare co-pay is 20% of the charges, no matter how high the cost. Some common procedures may be billed in excess of $10,000 list price.
  4. Brand name drugs: Medicaid co-pay is $3 for each prescription or refill. Medicare requires monthly co-pays up to $100 or more per prescription, depending on the drug. For example, Xarelto co-pay is about $1,200 annually. Medicare pays for all additional drugs only if an individual spends more than $6,350 a year out-of-pocket.
  5. Outpatient x-rays:  Medicaid co-pay is $1 for the total  service (not for each x-ray). Medicare co-pay is 20%. X-rays generally cost $260 to $460 each. Some are more than $1,000 list price.
  6. Physician visits: Medicaid co-pay is $0. Medicare co-pay is 20%.
  7. Chiropractor visits: Medicaid co-pay is $1 for each visit. Medicare will only cover chiropractic care as a treatment for a condition called spinal subluxation. Co-pay is 20%.
  8. Emergency services: Medicaid pays everything. Medicare co-pay is 20% of all charges, plus set fees for procedures and supplies. Average ER visit is $775.
  9. Blood and blood products: Medicaid pays everything. Medicare minimum co-pay is 20% of all charges.
  10. Drugs: Medicaid pays all costs for high blood pressure, cancer, diabetes, asthma, epilepsy, heart disease, psychosis, HIV/AIDS, glaucoma, depression, and anxiety drugs, as well as anti-Parkinson agents, anti-manic agents, anti-convulsants, anti-neoplastic agents, oral contraceptives, test strips, lancets, meters, and needles. Medicare co-pay is 20%
  11. Dental visits: Medicaid pays everything. Medicare pays nothing.
  12. Skilled Nursing Facility: Medicaid pays everything. Medicare co-pay is $0 for days 1-20; $175 for days 21 to 100; and you pay everything for days 101 and beyond.
  13. Nursing Home Care: Medicaid co-pay is $0. Medicare pays nothing for long-term care.

If all that doesn’t disturb you, consider the stupidity of the current political promise to enshrine Medicare for All, a program with fatal flaws that date back to its inception in 1965.

Medicaid for Everyone has a more logical beneficial foundation, and maybe this time it could include the old, the sick, those soon to die, and not just the young and sometimes quite wealthy.

Jeff Bezos could go on Medicaid if he played it correctly, but the average working Jill can’t

Medicaid rules changed when President Barack Obama pushed through the Affordable Car Act (ACA) and he ensured that the very rich could join low-cost Medicaid, while the working class had to pay high medical expenses, either at work with private insurance or retired under Medicare.

While I’m sure Jeff Bezos would never stoop his mightiness to rub elbows with regular folks on Medicaid, it is amazing that he could so by following these steps: Continue reading “Jeff Bezos could go on Medicaid if he played it correctly, but the average working Jill can’t”

Is Donald Trump correct about drug companies taking advantage of the poor and defenseless?

Who would expect this from the leader of a pro-business political party:

Pfizer & others should be ashamed that they have raised drug prices for no reason. They are merely taking advantage of the poor & others unable to defend themselves, while at the same time giving bargain basement prices to other countries in Europe & elsewhere. We will respond! – Donald Trump,  10:08 AM – 9 Jul 2018

It’s easy to agree that there are much cheaper drug prices in other countries. Trump didn’t mention that we now see medicine manufactured in China, as well as India – just to save a few pennies on a bottle of drugs that costs hundreds, or even thousands of dollars here.

nursingYet, the charge that drug firms take advantage of the weak and powerless would seem unfair, until we examine what appears to be callous behavior by drug execs.

The following tale of so-called success in reducing drug use among the elderly shows how drug firms can evade, avoid and continue to make billions from seniors’ prescriptions. Continue reading “Is Donald Trump correct about drug companies taking advantage of the poor and defenseless?”

Should drug company execs get life in prison for their predatory pricing that endangers our lives?

Illegal drug dealers, who are designated as major suppliers, will face the electric chair or gas chamber if President Donald Trump has his way. Our sometimes alert members of Congress voice agreement, now suddenly aware that criminals who sell opioids, like heroin and oxycodone, deserve more than slap-on-wrist fines or jail time.

Don’t bet on the death penalty just yet for these creatures. With decades of litigation possible, it’s easier to prescribe life in prison.

Martin Shkreli, smug former CEO of Turing Pharmaceuticals LLC

And speaking of prescribing, when are we going to deal with the legal drug dealers, whose companies have priced life-saving medicine in the stratosphere, so that only the very rich, or those with golden health plans, are able to afford?

An illegal drug dealer who hooks 200 victims deserves their fate.

A legal drug dealer who ruins the lives of millions deserves no less a prison term.

Which brings me to the example of Hepatitis C and the story of Marsha Lecour, who contracted the condition when she was four, after open heart surgery that exposed her to contaminated blood. Lecour is a native of Canada, the only nation, other than the U.S., which doesn’t have government-provided prescription drugs, where there is national healthcare for everything else. Continue reading “Should drug company execs get life in prison for their predatory pricing that endangers our lives?”

Ryan thinks he is John Galt – defender of the rich, enemy of the poor, not a denizen of the swamp?

Ayn Rand’s novel, Atlas Shrugged, begins with a simple question: Who is John Galt?

The answer comes in the last third of that 1957 book, where Galt emerges as the champion of capitalism and defender of Rand’s Objectivism philosophy, which has opposed:

  • Child and Adult Care Food Program
  • Federal Housing Assistance
  • Food Stamps
  • Head Start
  • Low-Income Home Energy Assistance Program
  • Medicare & Medicaid
  • Nationalized Health Care
  • School Lunch and Breakfast Programs
  • Social Security
  • Special Supplemental Nutrition Program
  • State Children’s Health Insurance Program
  • Temporary Assistance for Needy Families
  • The Pension Benefit Guaranty Corporation
  • Title XX Social Services Block Grant Program
  • Trade Adjustment Assistance
  • Workers’ Compensation

Galt was not real, but he was a hero to the children of many wealthy families. These sheltered capitalists-in-training saw Ayn Rand as a hero, because she espoused that caring for nobody but yourself was not selfish, but a virtue. Continue reading “Ryan thinks he is John Galt – defender of the rich, enemy of the poor, not a denizen of the swamp?”

If all you want for Christmas is your two front teeth, it’s time to borrow $6,400 or pay 1/3 price in India

Visit Victoria Station while in Mumbai for implants

If our politicians ever make the effort to visit the “little people” – those neglected voters, who don’t live in gated communities and suck gin in the Capitol – our selected leaders will see smiles without front teeth. And that is just the beginning of their constituents’ dental problems.

Some 140 million Americans have no dental insurance, and for most who do pay premiums, the coverage won’t cover the cost of replacing those two front teeth with implants

Medicaid and Medicare will pay nothing.

If you search the web for how to afford dental implants, the usual answer is borrow the money. A few suggested contributing more to your Health Savings account (as if everyone has an account). One advised asking for charity on the Internet. I am surprised no one said: write a check or pay with cash. Continue reading “If all you want for Christmas is your two front teeth, it’s time to borrow $6,400 or pay 1/3 price in India”

GOP House passes plan to raise Medicare eligibility age to 67, then turn it over to insurance companies

Time after time, Mr. Donald Trump promised no cuts to Medicare and Social Security, but the current leader of the nation and Republican Party now seems to have a change of heart – to put it very kindly – or he has just wandered even deeper into the swamp.

It could be the President is distracted by his fake plan to lower taxes for the middle class  and so he hasn’t noticed the GOP-dominated House passed its 2018 budget resolution on Thursday by a vote of 219-206. The cunning House Speaker Paul Ryan led his swarm to approve  cutting $1.5 trillion from Medicare and Medicaid. Eighteen Republicans voted against the resolution, along with all the attending Democrats.

Robert Roach, who heads the Alliance for Retired Americans, was furious at the news: Continue reading “GOP House passes plan to raise Medicare eligibility age to 67, then turn it over to insurance companies”

Americans suffer while drug companies make a fortune because FDA isn’t timely approving generics

The Food and Drug Administration (FDA) last year had 4,036 generic drug applications waiting for approval. In October 2012, there was a backlog of 2,868 drugs. It now takes a median 47 months to approve a generic drug by the FDA – nearly four years.

What does this mean to the healthcare consumer?

drugsalesFirst, it allows a drug company to continue selling their “brand name” drug because there is no replacement on the market. Brand name drugs are sold at incredible prices, pushed up by obscene profits, as well as constant advertising, plus promotion of drugs by medical professionals. To many in the health business, brand name drugs are the real money makers.

By comparison to the United States, the European FDA – the European Medicines Agency (EMA) – has just 24 generics awaiting approval. It takes about a year to get approval in Europe, one quarter the time of the U.S.

Why would it be faster to approve generics in Europe than here? The answer is that patients in America pay for their drugs, either directly or through health plan premiums. In Europe the government negotiates drug prices, because they are working to lower costs to benefit their citizens and reduce spending. It’s the difference between healthcare for profit or Continue reading “Americans suffer while drug companies make a fortune because FDA isn’t timely approving generics”