Government Health Care – Personal Concerns

My wife wrote a comment on Facebook that I want to follow up on. Mrs Ozz said:

“The idea of universal health care for our family is SCARY! At least we would still have Medicaid for Caden but who knows how that would change!”

While the Medicaid program that Caden is on works well for us college educated middle class folk…I seriously don’t know how uneducated (illiterate) people get it for their children.  The red tape and paperwork processes to get approved are horrendous.  You not only have to be able to read and comprehend the applications, but you have to have good records.  I was told to expect it to take 4-6 months to get Caden approved.  I had good records and followed the instructions and got the approval back in a few weeks.  The paperwork was heavy on the front end but has been almost non-existent on the back end.  These government run programs like Medicaid don’t provide specific benefit information like private health care.  You never get an explanation of benefits (EOB) from medicaid and from what I have seen there are no processes for reimbursement if you do pay for something out of pocket.

Caden has been covered by Medicaid (Katie Beckett – TEFRA program) since birth which was almost five years ago.  Children who qualify for TEFRA Medicaid are defined as follows:

These are children age 18 or younger that live at home and meet the SSI definition of disability for a child and meet the level of care required for Medicaid sponsorship in either a nursing home, ICF/MR or an acute care hospital. The parent’s income and resources are not considered in determining eligibility… Source

That definition gives me a reality check on how serious Caden’s conditions have been since birth.  What they are basically saying is that if the family is not willing or able to care for the child then they would likely be institutionalized if a suitable home could not be found.

This medicaid plan has worked for us but it has had some bumps in the road.  Beginning in 2008 the state of South Carolina began outsourcing Medicaid to private industry (HMOs) so this particular “GOVERNMENT” health care is no longer run by the Government in most cases.  We opted out of the HMO choices which were offered through SC Healthy Connections Kids and went back to fee-for-service Medicaid after being forced into an HMO that did not even provide coverage for most of Caden’s care.  The HMO we were auto enrolled into has only one participating hospital within 100 miles and it is not the Medical University of South Carolina (MUSC) Children’s Hospital where ALL of Caden’s inpatient, outpatient, and surgical work has been provided since birth.  As a matter of fact MUSC is the only hospital in the state that performs pediatric cardio-thoracic surgery. So why they choose an HMO for Caden, a child with congenital heart defects, where the only hospital in the state that can provide care is a non-participant in the HMO is completely illogical?

The scariest part of government run health care for me is the lack of equal value on life.  Many health care professionals believe that kids like Caden are a burden on families and society.  For instance, the women’s clinic where Mrs Ozz got most of her prenatal care went out of their way to make sure that we knew that we “had choices” during the pregnancy.  They made sure that we understood how difficult it would be to care for a special needs child and that we did not have to put our family through that.  Never mind that a life is a stake here.  They were basically saying that our family could have lived an easier life if we had chose to end our baby’s life at approximately 26 weeks in the pregnancy.

The mentality behind government health care is similar in that there seems to be no regard for the life of the patient if cost high and end of life are possible anyway.  You may remember that President Obama has made it pretty clear that some life saving procedures may not be worth performing on some patients.  I see this attitude held by some politicians along with their lack of value for all life to be the precursor to a slippery slope into situations like the one Dr. Bernhard Moeller faced in Australia.  The doctor was denied a visa because his son had DOWN syndrome and that would have caused a drain on taxpayers through the Australian government health care system.  And where does it all go from there?  When does the government decide to stop prenatal care or even force abortions on women who are carrying babies with known life threatening conditions that will almost surely put a drain on the taxpayers if the child is allowed to become a citizen?

The assessment of Dr. Moeller’s family medical needs were likely accurate if his son’s care cost anywhere near as much as my son Caden’s care.  Our family takes out at least twice as much benefit from the health insurance system as we put in during an average month even when there are no major procedures or extended hospitalizations.  Major surgeries along with associated hospital stays are particularly draining on the insurance system when they do occur.  Let me provide some personal details to clarify by using the first two months of Caden’s life.  I stopped adding the bills when the total passed $330,000 so we will use that number as a reference since we know that the first two months was at least $330K for Caden’s care.  My current insurance plan premiums are about $13,445 per year for our family coverage for Blue Cross Blue Shied Standard (non-postal rates).  While I was not a government employee at the time of Caden’s birth my plan was similar in benefit and premium costs so the example here is fairly representative.  Like most plans I pay a portion and my employer pays the remainder of the premiums to the insurance company.  At $330K in bills for those two months of care that means that it took more than 24 employees worth of yearly insurance premium contributions to cover the first two months of Caden’s hospital care after birth.  Caden has also had several other major surgeries since birth so these first two months is only a small example of what health care costs for a child with complex medical conditions.  For example Caden’s regular ongoing care today totals in excess of $2,000 per month due to tube feeding supplies, therapies, medications, specialist visits, and associated tests.  That is nearly double the monthly premiums ($1120) being paid in total for my family between me and my employer.

So the scariest part of the government run health care model is brought to light in Australia’s denial of Dr. Moeller’s visa.  If that example runs it’s course in the United States then Caden’s care might be categorized as too costly and the system might have to drop him from coverage if the politicians and burracrates get too involved in the process.

One Response to “Government Health Care – Personal Concerns”

  1. Milly Says:

    My sister has a very rare kind of cancer. From what I’m hearing she would be sent home to die rather than going to MD Anderson for help. It’s going to be a very sad thing if the pln passes.

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