Tag Archives: health-insurance

[Note: Although the two ladies are real people I know, their names are fictitious for obvious reasons.]

Lady One

Doris, a multi-millionaire, lives in a luxurious $460,000 condominium. Her front window overlooks a picturesque inlet through which ships constantly navigate. The recently built complex is located at the waterfront of Sheepshead Bay. The street below her window runs through a famous strip known throughout New York City for its recreational activities and restaurants.

Domestic help maintains her beautiful furnishings, floors, and spotless kitchen. She has an extensive wardrobe of exquisite clothes, a masseur, a beautician, and a manicurist that keep her impeccably groomed at all times.

Doris is on Medicaid.

Lady Two

Elaine, a poor lady, lives in a middleclass neighborhood. Her front window overlooks another front window across the street. She’s on every government subsistence program available to her, including the Food Stamp Program. Assiduously collecting heaps of food from charities, she sells all her food stamps at 100% profit.

Elaine is on Medicaid.

I

I live in the same neighborhood as Elaine does. Like hers, my front window overlooks another front window across the street. I’m still working part-time because I love my job and need the small income to maintain my home.

In the past, portions of the salaries I earned were ‘withheld’ for future Social Security benefits. I happened to work for employers that did not provide their employees with health insurance. So, I paid and continue to pay for private health insurance. The premiums were and still are high because of a pre-existing heart condition I had when I first applied for health insurance from Blue Cross and Blue Shield. I’ve been eligible for Medicaid for decades.

I am not on Medicaid.

I want it that way. And here it gets tricky. I’ve had a heart specialist’s care for over four decades. Office visits are no less than two and no more than three per year. Each visit includes a cardiogram. Although very conservative about the use of medicines, he prescribed Valium for me ten years ago because of depression and anxiety caused by grief following the death of my sister and best friend. I’ve occasionally asked him if I might do without the Valium. He advises me to stick with it.

A few years ago, I routinely asked him to renew a prescription for Valium. He told me he was no longer able to prescribe Valium for me because of a new law (just passed) that required I go to a ‘primary’ physician for that particular medicine. So, I found a general physician. He pushed me for routine visits and cardiograms even though my visits to the cardiologist always included cardiograms. So, despite my resolve not to burden others, I was compelled to do so with duplicate cardiograms and unnecessary visits to a ‘primary’ physician. When he retired, I was forced to find another ‘primary’ physician so that I might continue with Valium.

Like his predecessor, this physician also pushes me for cardiograms and office visits I don’t need. Politely but firmly, I’ve succeeded in refusing cardiograms, but I need to continue the office visits because I do need the Valium. In effect, his greed and my need for that medication drain Medicare funds to pay his office fees.

I don’t usually make societal judgments based on personal experience. But it occurs to me that Doris and Elaine are not alone. Neither am I. My personal experience is an example of the consequences of bureaucracy. The medical care maze forces me to waste money. Although legal, government aid for the two ladies is questionable at best. Compounding the waste, doctors and private insurance companies engage in fee and claim wars.

And what of Medicare and Medicaid entitlements? Well, why not two cardiograms taken by two different doctors on the same day. They’re free.