vic,

i have to admit that i didn't read the responses right now.
however, my answer would be to do what is best for YOU. if you run the #'s and find one outweighs the other then i'd pick that option.

also take into consideration pro's and con's of each choice, not just the $$$.

i'm inclined to stick with the insurance, especially since you can afford it.
you will be better medical care IMHO. it still may not be cheap but i believe it's better to have insurance than to navigate as a destitute needing medical care.

hope this helps.
J

Hi, I'm new to this thread but would you clarify something for me? You are saying 12 people in this survey are w/o insurance and have NO out of pocket expenses?

If so, what meds, what docs, what hospitalizations have they had?

My friend, 31 yo with MS and very handicapped makes $400 SSI and is on Medicaid. She has to buy her own diapers, medical equipment except the electric wheelchair they bought her that she is unable to navigate now and is unable to get a manual chair so someone can push her around.

She is currently been trying to get on Ty for over a year with no luck.

So, at this point I would say pay the insurance if you can.

Cherie --

I have all kinds of opinions, about both the Canadian and American health care system. IMO, neither system is perfect. Both are broken, and need fixing.

I was appalled, 10 years ago in Canada, when my mom, who was terminally ill with cancer, had to wait many weeks before she was able to even see an oncologist. My goodness -- she only lived 7 weeks after her dx! What were they waiting for?

I have also been financially devasted, in the U.S., with $25,000 of uncovered medical costs, even with insurance. We were due to have our house paid off in 2008. Instead, due to medical expenses (MS and 2 surgeries) and lost income, we refinanced in 2003 and started over with a 30-year mortgage.

My brother and SIL have tried to talk me into moving back to Canada, because of their health care system, but I worry about the quality and waiting lists there. Here, I worry about the cost.

~ Faith
Canadian citizen; U.S. resident.
Grew up in Canada; married U.S. citizen

I am of the school of thought that you MUST do what you have to do to take care of YOUR family. These services are put in place for a reason, and we expect them to be used by folks that need them. yes, there are now, and will always be many who abuse, and bend the rules to get more. (my sister is one of them)

If your insurance/medical costs are overwhelming your family and finances, its time to get help. if that is social services then so be it. Once you get on the wagon, many doors can and will open. I dont view it as giving up, nor as a cheat. its a valid way to keep your head above water, to keep your family fed, clothed, and keep the roof over their heads. If you were just sitting home whining about your pimples, or depressed because a g/f left you college or you were passed over for a promotion, this would be different. you have been diagnosed with a quailfying disease, and have the war wounds to show for it.

If it were me (prepared for the egging) I would take the social services, and start saving my money for rainy days, and ways to care for and comfort my family.

you are loved and respected in many circles. I hope you are able to make a decision and know that no matter what you chose, you are still loved and respected in many circles. :hug:

Because from what I have read here Vic is considering not only what will be the best protection for his family but also the ethical issues regarding taking advantage of social services when you still have other options. I appluad him for being so thoughtful with regard to both concerns.

When I read stories about people who can't afford fricken diapers on their disability income it breaks my heart and I could not live with myself if I thought I was taking money from them unless I absolutely needed to. These funds are not unlimited.

Again I am in no way saying anyone that truly needs it should feel bad about applying, just that as long as I still have the option of taking care of myself and freeing up those funds for someone who truly can't get other insurance I will continue to provide for myself even though I have also paid into it for 30 years. I hope I can pay into it for another 30 without ever needing it for that matter.

Hi Faith,

My mom had what was immediately deemed as terminal cancer, and what they did was made the rest of her life as comfortable as possible in a hospice. I was thankful for how well the system cared for her in her final weeks . . but we also understood right from the get-go that there was absolutely nothing they could do to impact the outcome.

My BIL and best friend ultimately died of later stage cancer too, both discovered completely by accident on Fridays (one by an eye doctor and the other an xray technician). The day following the discovery, my BIL had already been operated on and was recovering in hospital. My best friend had her confirming MRI (the next day) and by Monday had met with the Onocologist. I couldn't believe she was already undergoing treatment by mid-week. :eek:

Perhaps they prioritize, based on the severity AND their perception of the opportunity to impact the outcome (triage).

I think we could find horror stories about what's happened to people on both sides of the border, in both types of systems. Unfortunately, your example hits very close to home, and perhaps has tainted your perception of the system overall. No, it's not perfect, but it has served me and everyone I know extremely well . . . at least so far, thankfully. No doubt, some have slipped through the cracks though.

Cherie

My employer sponsored insurance REQUIRES employees to takes Medicare when they are eligible. If Vic is looking for a backup for a catastrophe, then I would think Medicare is it. I don't know a lot about Medicare, because I'm not of the age to have it yet, but everyone I know who is does have it even if they use it as a backup to their private plan, which most that I know choose that route. Because Medicare doesn't cover a lot of the things they get with the private plan. Sorry, but just a few people not signing up for Medicare is not going to fix our system.... or make that much of a difference. But for those that are wealthy enough to do so, then more power to them. :)

Vic,

Those 25 people, who are paying an average of $35,000 . . . is that amount influenced by unusually high med costs, ie. is that JUST premiums, or does it include co-pays, some of the cost of the meds, etc.?

Cherie

Without knowing how the Canadian system works this was my first thought also especially since she passed away so soon after. :(

Cherie,
What I was wondering, for example, if I were a Canadian citizen and the wait to get into a MS specialist is longer than I want to wait, could I just pay out of pocket for whatever medical care I wanted?

We will have to agree to disagree. ;)

I'm not talking about fixing it for sure but as the most basic example it is a fact that if there is $5 dollars in the fund and 5 people who need to collect they will get more money than if a 6th person signs up. And I would bet for that person who can't afford their diapers every penny sure does make a difference.


Edited to add: Medicare and medicaid are two different beasts.

The 12 I referenced do pay $25 for each medical visit, including Tysabri, which is being provided by Biogen at no cost (or a minimal cost). The State of California picks up the rest of the bill for each of them.

Good points!

It is the combined cost if the medication, infusion, insurance premiums and co-pays.

Theoretically, no, Jules.

The people (and government) do not want to see a two-tier system evolve (where the more affluent can get better care) . . . but it is happening.

In my case, I can cross the border and pay out of pocket in Washington too . . . just like Americans can cross to ie. Latin America and get much cheaper surgeries if they pay cash.

Basically, it is illegal to set up a "private clinic" in Canada, and all hospitals are run by our government. However, there are ways around it, and there are private clinics out there that will do services for cash. The services they provide must be considered "non-essential" though, like plastic surgery, laser eye surgery, full body work-ups, etc. If a person wants a NON-emergency MRI, and they don't want to wait for a free one, they can pay a private clinic $500 - $800 to have one done the next day.

Of course, a lot depends on what our medical providers deem an emergency too . . . Even though the average wait is somewhere around 4 - 6 months, my doctor had both my daughter and I in (for non-emergency) MRIs within 6 weeks of the requisition.

If it is an emergency, then we jump the queue, of course. If there is a shortage (of nurses, doctors, testing equipment, specialty services, etc.), our government has been known to transport people to the US too.

Cherie

Ok, so I guess that means that if those people chose a much less expensive option, it might be fully or substantially covered by their insurance?

What is sounds like, perhaps, is that these insurance companies are saying "enough is enough" as far as how much they are willing to pay out . . .? I presume the reason is that if they didn't, that could ultimately jack up everyone in the pool's premiums (if the insurer still wishes to make the same profit ;)).

I guess that makes sense, since most any "insurance" coverage includes caps of some sort . . . well at least here they do. For instance, I am allowed $300 every year for eyeglasses, and I can pick whichever kind I want, but if I chose PRADA with sunglass snap-on's, I would have to pay the "extra" $300 that pair might cost. Or, if I get in 5 car accidents a year, which are my "fault", my annual car insurance premiums are going to go up.

It's a "user pays" system, and like it or lump it, insurance is really only helpful for the "average" person. :rolleyes:

If all those people on these expensive drugs/treatments say, "hey, I can get this cheaper if I go on the public system", obviously this is going to negatively impact the costs that the government is paying out. That is going to influence taxes (cuz clearly it has to), and then what you have is a "social medical system" well underway. ;)

The only problem is that the public system there probably doesn't offer adequate health care in many other ways, at least not at the moment.

Hey, BTW, if a person can hide their assets (on paper) enough to qualify for public health, how can they take those assets away if a person dies? Can't those assets be hidden forever?

Cherie

No clue but your question brought up another issue. :)

I just don't get being so concerned about your estate after you are gone. It will be nice if I have money left to leave animal charities but if I need to use my money for my own care then so be it. The humans in my life have been raised to be self-sufficient so they aren't getting anything from me unless someone happens to have a disabled child etc.

I always tell my parents that I hope they spend every last penny they have on fun stuff before they die. I don't or need an inheritance .

With Tysabri, if you have insurance, there is a set price, and not a less expensive option (unless you are uninsured and have no assets).

I agree that if everyone opted to use a public system the government would be in deep financial trouble.

Hiding your assets: If your assets are assigned legally to another owner, then they are no longer yours. Hence, they cannot be taken from you because the do not exist officially. If a person dies, then that person had better made sure that his/her Trust awards the assets to a charity or other place before they are taken by the government.

Good questions indeed!:)

I figure people have the ability to take care of themselves but the critters don't, hence my decision. Science does get my lesion riddled brain and any other parts they deem scavengable though.

I will consider your kind offer of taking them. You sure seem responsible and like a heck of a nice guy. :p

Edited to add: your offer take my assets that is not my defective brain, lol.

I am one of those that rides the fence. I dont qualify for low cost/no cost services because of our COMBINED income in this house. I refuse to divorce my husband as has been suggested by many in the social services field, just to qualify for more/better services. Medicare is my primary insurance, and because I am married, I am carried under the hubby's policy for a secondary. Without that, my co pays/deductables would surely drive me to the poor house. I dont qualify, nor will I lie about my income when applying for things like cooling vests, and such. I have sat and held the application in my hand and seriously considered it, but in the end, my morals and ethics win out everytime. I have a sister who bends the social services system into pretzels and dances around the camp fire of many benefits she is not qualified for, nor should have ever applied for. She is of the mind, that if they are dumb enough to give it to her, then she is gonna be dumb enough to take it. Her ex b/f was a SS supervisor, and taught her well. I just cant do it.

IF my copays/deductables reached a cresendo of placing my food budget, and or household budget in jeopardy, forcing others to have to do without and or with sub standard care because of me, I would divorce the hubby of 20 years in a hurry to make sure they were taken care of. Its a really sad state of affairs that so many feel forced to take drastic actions because of the way the system forces them to work it. You cant have a car worth X amount of dollars, so you sell it to your spouse that you just divorced, or your son and rent it back from him to show an expense. You give up your property to your divorced spouse as a "divorce decree" and then show a rent payment every month to show expenses on a house that just yesterday you owned free and clear. Its an awful spot to be in, and when you are sick and suffering, its not the time to feel abandoned by the system. I hope we find better ways to truly start taking care of those who not just want it, but those who need it. The problem is for every VictorH in the crowd, there are 10 of my sister in the crowd crying about her adult onset acne. She frustrates, and overwhelms the system and the workers to the point that when a VictorH sits in front of them, they are skeptical and suspicious.

Right between a rock and a hard place. That is where I sit. I dont make enough to get what I need, but I dont make so little that others will help me. It really ticks me off that the only way to get real help is to give up my marriage. For now, I stay married.

Good luck Vic:hug:

Wow, interesting topic:

I have never been on any public assistance my whole life - even when my husband left, was on unemployment and did receive a dime in child support.

But (of course you knew that was coming)

When Chris started have his sx's - I first took him to a neurologist which cost me $150 (Chris was unemployed at the time) he said to take him to our county hospital's ER because the tests that were going to be necessary would break me.

Well, a year 1/2 later Chris is on disability and medicaid. I feel almost guilty that he has no out of pocket expenses for medications/doctors/hospitals, but I don't know what other alternatives there were - I sure couldn't afford these expenses and I feel so sorry for you that have insurance and have to come up with so much of the costs, it just doesn't see fair.

Vic, this is one really deep discussion.

As always in discussions such as this it makes me so sad and angry that the USA can not completely take care of their own 100%. It is always about money.

As far as a national question. IF you (the patient) are in the category to financially need government assistance for you and for your family to live, then I feel that people should take advantage of the system.

If the family is able to afford the private insurance, then that should be the focus. Even if that means some adjustments must be made in the family budget as long as the needed items are not sacrificed.

I just had my bathroom toilet area reconstructed due to the fact that I "may" need a wheelchair again one day and that I want to be able to deal with the toilet in my own home without much to do. I am aware that there are insurance deals that might have paid for all or part of this if I were already in the wheelchair, BUT I don't want to wait months and months at that time and fight for something that I can afford to take care of now. I know this is not the question you are debating, but it is a statement about our responsibility as people, patients, and patrons of our country. You do what you can when you can.

Responsibility. I think that is the key word to your discussion. How responsible are you to take care of yourself.

My brain keeps spinning here. I'm going to sign off, before I totally change the discussion!!!

Peace!

I understand that guilty feeling. I am (was) like Chris. I wasn't working, just finished full time school and ready to get married before sx's hit me. I was in the process of trying to get an affordable insurance when I started having trouble, it was optic neuritis.

Every insurance company I tried refused coverage because of what they considered pre-exsiting conditions. (I hadn't got a dx yet) I paid close to $6,000 in less than 3 months for Drs. appointments, MRI, spinal tap...anything that it took for a dx. It wasn't until I got a dx that the it was suggested to me to try to get assistance with the county hospital. (btw, same hospital and dr. that Chris went to)

It wasn't something that I wanted to do. I hated having to ask, the entire process made me feel ashamed and helpless. But I didn't have a choice. Dh is considered self employed and although he makes decent money, there was no way we could continue to pay for everything ourselves and still have a place to live. I wish I had insurance, I wish I could afford to pay for it all, I wish I wasn't sick...but I don't, can't and am so I push my pride to the side and do what I have to. I would rather work 60 hours a week and be dead tired because of the work than to be exhausted from just making the bed.

I don't quite understand, I've never heard medicare classified as government assistance.. It's not a need based program, it's for people who've paid into it and are disabled or 65 & older.

Do you refuse Social security benefits too when you are eligible for those??

Just wondering, this is all a very new concept for me. I've worked since I was 15, never received a penny of any 'assistance', and doing fairly well for myself, but this classifying Medicare as 'public assistance' is a very new concept that I haven't heard of. I looked at Medicare's website and it mentions that individuals are automatically signed up for it at 65. Maybe I'm confusing Medicare with the other 'assistance' like medicaid, prescription assistance, free care programs, etc that are available and are need based.... FYI - also Medicare reimburses providers a certain amount based on DX, procedures, etc, which is a lot less than what others pay also. Just confused here.

I'll quickly answer your question, Vic. I hope never to be financially poor enough to NEED public assistance and MediCAID. I've worked with people who did have to use these programs and they really are a nightmare!

Right now I'm not rich or poor. We're solidly middle class. I have decent medical insurance, but I couldn't afford my co-pay for Tysabri (over 800/month) so I stopped it. I have a mortgage and bills, so the medication had to take a backseat. I'm not extravagant and never have been, although I did have a "shoe problem" at one time. ;).

I'm all for investigating a more social insurance program like the ones in Canada and Europe, and I pray hard that I never have to know what it's like to be truly poor.

Soooo on that note, no, I would not make myself financially unstable so that I could take advantage of the public programs.

My focus is on the following:
Is it ethical/legitimate for a person with a positive net income at the end of the year but who can hide the assets legally, to take governmental assistance?

-Vic

Amen To That!!!:)

Vic's question was with regard to living off the "public dollar"?

I don't understand the American system, but this is what I found on the internet:

"Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are either age 65 and over, or who meet other special criteria."

"In general, individuals are eligible for Medicare if they are a U.S. citizen or have been a permanent legal resident for 5 continuous years, and they are 65 years or older, or they are under 65, disabled and have been receiving either Social Security (Old-Age, Survivors, and Disability Insurance (OASDI)) or the Railroad Retirement Board disability benefits for at least 24 months, or they get continuing dialysis for permanent kidney failure or need a kidney transplant, or they are eligible for Social Security (disability) and have Amyotrophic Lateral Sclerosis (ALS-Lou Gehrig's disease)."

http://en.wikipedia.org/wiki/Medicar...ited_States%29
http://en.wikipedia.org/wiki/Social_...ited_States%29

Social Insurance is defined as:

Social insurance is any government-sponsored program with the following four characteristics:

- the benefits, eligibility requirements and other aspects of the program are defined by statute;
- explicit provision is made to account for the income and expenses (often through a trust fund);
- it is funded by taxes or premiums paid by (or on behalf of) participants (although additional sources of funding may be provided as well); and
- the program serves a defined population, and participation is either compulsory or the program is heavily enough subsidized that most eligible individuals choose to participate.

http://en.wikipedia.org/wiki/Social_insurance

This seems to imply that a person needs to be deemed disabled, and receiving SS benefits of some sort.

Vic, I'm not sure if this is what you are talking about, or if it is Medicaid . . .?

"Medicaid is the United States health program for individuals and families with low incomes and resources. Among the groups of people served by Medicaid are eligible low-income parents, children, seniors, and people with disabilities. Being poor, or even very poor, does not necessarily qualify an individual for Medicaid.[2] Medicaid is the largest source of funding for medical and health-related services for people with limited income."

http://en.wikipedia.org/wiki/Medicaid

If it is Medicare you are thinking about, which means you have been deemed "disabled", it doesn't seem to matter how much money you have in assets. Unless of course they get you from that angle when you apply for SS . . .?

Cherie

A whole lot of rich people take SS at 65 and Medicare..:rolleyes:

JFK did not take his salary as President. :cool:

JFK was great!:)

I agree with you Vic and I have a sense of pride in being able to take care of myself and my family for now. Like you said the day may come but for now I will gladly fork out the $12,000 a year for my health insurance premium. Being able to look at myself in the mirror and sleep at night are priceless.

What I am really confused about is why people keep bringing up Medicare? Isn't Medicaid the one for disabled people?

No Medicare is for the disabled and people 65 and over. Medicaid is for people who meet a certain requirement with assets/income etc. Medicare is a payroll tax that most of us pay.

Unless one is very wealthy when you are 65 and over or disabled, it's going to be so hard to predict how much money you need, that it's a hard thing to say we can care for ourselves because there are so many unknowns on what the future brings especially once one is not working and on a fixed income. So I would think this doesn't apply to much of the population. When I become disabled or 65,I won't have enough money to know for sure I can always pay for my health insurance and everything else I need.

As far as hiding assets to illegally obtain help, I agree it is wrong.