As candidates campaign for the nation's highest office, they make promises about reforming health care. Actually delivering on those promises can be another matter entirely.
A visit to the Cape Girardeau Senior Center revealed that most retired people there that day had Medicare and a supplement and were, for the most part, satisfied with them. Some have found they unexpectedly had to dip into their savings to pay for health care costs.
Brenda Hargrave, part-time administrative assistant at the center, has looked at the health care proposals from candidates John McCain, Barack Obama and Hillary Clinton. She said that while she has not yet decided whom she will vote for, she believes Obama has the best proposal.
But any real kind of health care reform will not come from anyone running for office, Hargrave said.
"While [Obama] addresses concerns, there are things going on that if they would enforce what they already have in place, the government would be out a lot less money now," she said.
Hargrave said she has 30 years' experience in medical billing, collecting and management. She has seen first hand where reform needs to take place, she said.
Health care reform, she said, should start with the "usual and customary rates," or UCR, established by Medicare and Medicaid. Medicare/Medicaid providers say they will pay 80 percent of an insured person's medical costs, but in fact pay an amount based on what they consider "usual and customary," often less than what a doctor or hospital charges. Physicians and hospitals write off the difference and recoup it from patients with private insurance or uninsured patients who are expected to pay full price for procedures, often in advance of being treated, Hargrave said.
"If doctors participate in Medicare they're not allowed to charge more than a certain amount. Some doctors refuse to take any new Medicare patients because they know they can't get any more money," she said. "They leave room on their schedule for other patients with private health insurance because they know they will get more money."
"Everybody needs the same UCR, whether private, Medicare, Medicaid or whatever. No insurance should be charged more than the UCR; UCR should be established across the board."
Better oversight on Medicare/Medicaid billing could save hundreds of thousands of dollars, Hargrave contends.
"I have personal knowledge of one Medicare patient who had a problem with Medicare," she said. "I kept billing, trying to get them to pay. When they did pay, they paid 20 times for the same office procedure. The money went in that patient's account as a credit. I was told not to return credits until somebody found them."
When she made one company aware of double billing for a one-time procedure, she said "nothing was done about it. That's why insurance costs are out of line."
Hargrave said more people should monitor their doctors' office billing procedures and codes and compare what is being charged with the work actually delivered.
"If we could get that done, then health insurance will be within reason and the government will have a lot more money," she said.
Hargrave said she would like to see part-time employees have access to the same insurance as full-time employees. For a semiretired person not yet on Medicare, the cost of health insurance leaves little money for other living expenses. Yet some companies, she said, will hire several part-time people to avoid the cost of providing insurance for a full-time employee.
Monitoring costs and codes would be frustrating and time-consuming for most people. Karen Riley of Cape Girardeau said she and her husband, Dean, are both on Medicare and have a supplemental policy. Both Medicare and the supplement pay for mammograms.
"I called Southeast Missouri Hospital to see if it is in the network," she said. "They said yes. But the doctor who read it was out of network. Since Jan. 15, both insurance companies are arguing over who is going to pay the bill. It has still not been paid."
Riley said she and her husband pay high premiums for their supplemental insurance, partly because she has a pre-existing condition. They dipped into their savings to pay for medical costs and insurance premiums after her husband, who worked at Southeast Missouri State University in the facilities management department, required knee surgery and retired early as a result. While he was working, the university covered the cost of his health care premiums. Until both qualified for Medicare, their monthly costs after he retired meant "we were paying money we could have spent on something else," she said. "It's got to stop somewhere. We can't keep on paying and paying and paying. You can save for retirement, but when you're saving you don't anticipate your medical costs going up and up and up."
Nor did she anticipate that just changing doctors would result in the second doctor asking for lab tests that had already been done not long before that, "so they can get more money."
Riley said she believes Clinton has the best health care proposal.
"She is saying lower premiums and give better quality insurance," Riley said.
Harry Floyd, a retired business owner, said he was considering dropping his supplemental policy because he could pay out of pocket for health expenses for less than his $145-a-month premium. His table companions urged him to keep it, saying they envied him that low premium and warning him that his medical expenses could go up drastically with one illness. Floyd is one of the few not adversely affected by health care costs. He said he supports Clinton because "she has the background. Her husband was president, so she knows a little bit about the ins and outs.
"I figure most wives know what their husbands do and she has a little insight."
Hargrave said that at whatever level health care reform comes, it has less to do with whomever is elected than with the person at the bureaucratic level chosen to implement and manage it. She said she told that to U.S. Rep. Kenny Hulshof when he campaigned at the senior center in his bid for governor.
"I told [him] if anybody is going to reform the health system, it needs to be somebody who knows what he is doing and knows what the program is all about, not somebody who donated money to a campaign," she said.
This article was printed in the June edition of TBY (The Best Years), a special publication of the Southeast Missourian.
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