Posted on 03/22/2010 8:52:30 AM PDT by Wontsubmit
For nearly a decade, Paula Oertel's brain tumor was kept at bay by a drug that was not approved to treat her condition.
Then Oertel did something she never imagined would jeopardize her good health.
She moved -- less than 30 miles -- from one county in Wisconsin to another.
That move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including the drug.
And the tumor returned within four months.
What happened to Oertel stunned her doctor, Dr. Mark Malkin. Nothing he learned in medical school prepared him for what now is too often a sad and frustrating part of his job as an oncologist: fighting Medicare and private insurance companies over life-or-death decisions.
Doctors aren't supposed to get emotionally involved in the cases of their patients, but tears well up in Malkin's eyes when he talks about Oertel, the 40-year-old Oshkosh woman he has been treating for several years.
"I wish Paula would have a second chance," he said, choking up.
(Excerpt) Read more at abcnews.go.com ...
And most likely the research that resulted in the drug was done at the expense of the taxpayers via the NIH.
Socialize the costs, privatize the profits. What a plan!
you can't. It's against the law if you charge Medicare patients a fee then you have to charge all your patients. Gee, what do you think doctors are??? compassionate or something. The government made a point out of "giving away" services that they are charge for.
You know why of course????
It's not "fair".
Beautiful, it's a Catch-22. So unless he wants to charge all his medicare patients zero, he has to bill her.
The whole system is designed to make the doctor patient relationship antagonistic in order for the government to come in and control the proles.
As far as the comment about "rich" doctors... they have good cash flow but if you look at the debt the ones now are graduating with and what you have to borrow to set up a practice, you'll see a person with delayed payout over about 20 year period of time.
The big house that doctors have... the reason is that in most states your primary residence can't be taken by a malpractice verdict that goes over your insurance limit. So you load up with as big a house and/or property you can borrow and sell it off when you retire. It's like re-insurance for bankruptcy. Same with primary vehicle for work.
It's all a big game for the politicians/lawyers to get everybody to fight against each other when we should be treating them like Mussolini after the war.
Disability-SSI. She is disabled from her cancer and eligible for Medicare.
Wonder if Zeke Emanuel helped with the rationing decision.
Sorry that you can relate! and thanks!
The point of the story is to print the headline “Cancer patient loses her Insurance”. The truth be damned.
Ole Zeke is Obama’s Mengele and Rahmbo is his Henrich. I wish I had the money to put that on a billboard!
Medicare paid 22,500 a month for drugs that limited\didn’t work but wont pay 8,000 a month for drugs that do work.
there has to be a better way to handle all this.
sad part is, under OBama care, she probably would have faced an end of life doctor by now.
My mother is on a targeted therapy for stage IV lung cancer. The drug is given orally and therefore covered under Medicare part D rather than Medicare part B as her chemo was.
The prescription is $4,000 per month. I thought that was shocking too until I did some research. It cost the company that developed the drug $1 billion to develop it and bring it to market. Unlike a drug that has a wide potential market (think Nexxium for heartburn—anyone is a potential user), this drug is only approved for treatment in advanced Lung Cancer and Pancreatic Cancer. A very small market and not every patient with those diseases will survive long enough to get this drug.
Still $4,000 per month is steep. But when I checked my mom’s Medicare statement I discovered that the chemo she had been off and on for three years was $10,000 a treatment—and she was getting that every three weeks. So by comparison, the $4,000 per month is a bargain, but Medicare won’t classify it as a chemo, because she takes the drug by mouth.
Mom and Dad are retired and cannot afford $4,000 per month. Good thing they have a Medicare part D plan. This drug is considered tier IV so initially Medicare pays 2/3 and Mom pays 1/3 until she hits the doughnut hole (which is in the second month for this drug). Her co-pay ended up being about $1,500 for January and about $2,700 for Feburary. After that she was through the doughnut hole and will pay about $200.00 per month for the rest of the year. Better, but those initial co-payments place the drug out fo reach.
But that is still not the end of the story. The manufactuer provides grants to Seniors (actually anyone)who cannot afford their co-pays. Total actual monthly cost for the drug? $25.00
For mom, it is really the evil drug company that is making it possible for her to afford to take this drug. And the drug is working wonders. She is full of energy, feels great and is living her life. Three months ago she was coughing all the time and rapidly growing weaker. I’m not sure she would still be with us but for this expensive drug.
My fears: first that Obama care is going to deny treatment for anyone with a Stage IV cancer. The comparative effectiveness research panels will look at drugs like the one my mother is on and decide they are not worth the expense. Second that they are going to place such a burden on drug manufacturers that they will slow down or cease drug development for cancer treatments. Third, that it will be almost impossible for Medicare patients to see doctors on a timely basis because so many physicians will stop accepting Medicare patients.
All the best to your mom!!!
Actually, if he was found not billing her for her copays under medicare, he would be cut off from medicare. Oh, he could treat her for free if he was willing to let go of all of his medicare patients.
There is a way around that. He could treat her anyways, bill medicare and let the claims be denied, the copays go unpaid, and write it all off as a loss. If she lives, she declares bankruptcy. If she dies, no one cares anyway.
He could have got it done.... if he wanted to.
Not for all. The existing treatments would be rationed. Only the right kind of people would get what they needed. Only those who had friends in high places, those who bribed their politicians, doctors, and bureaucrats would have the clout to get to live to see another day.
Just like in every other socialized or communist country.
you can’t write off “no pays” as a loss.
Are you saying that doctors are forced to count uncollected payments as earned income?
So Stupak was right in saying the democrats are the party of "life". They know how much you're worth right down to the penny.
Now I just know that fat Teddy Kennedy would have been cut off the medication cause all of us are equal. /sarc
RE: “When government pays the bills, government makes the rules.
All animals are equal, but some are more equal than others.”
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More equal than others — hmmm — this has been a long time coming. Worked for a large health insurer for years and we all noted that welfare monkeys got the BEST of care thanks to CA’s version of Medicaid, “MEDI CAL” — not sure what happens next but the wrong people are definitely now having our assets redistributed to them more and more.
RE: “Read the Health Bill. You can keep your insurance IF and it’s a big IF.....you don’t make any changes to your policy. Once you make changes, you will loose the insurance. Just changing your address will make a difference. Soon, you will have to ask permission to change your residence. This is exactly what happened in the USSR. The government had to approve where you lived. Our government will start this with health care and then take it to the general public. It will take years but it will happen if the people let it.”
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Yes, not only did you need permission to change residences, they were TOLD WHERE THEY WOULD LIVE AND WITH WHOM. Apartments (tenements) in Moscow, for example, were shared with relatives and adjoining units shared bathrooms with other families.
There was NO competition, no choice in anything. Markets carried one ‘brand’ — the govt. brand, i.e., USSR green beans! No quality control, nothing — everything was in disarray, grey and dull and the people beaten down. I was there in ‘77 and again in ‘85 and believe me, ‘85 was a little better because Gorby had taken power and things were opening up a LITTLE bit. We actually saw Pepsi trucks in ‘85 unlike in ‘77 when the whole country was under siege by the commies.
Look out Amerika, it’s coming — incrementally but it’s coming!!!!
RE: “Medicare is usually the senior citizen health care.
She is only 40?
Something doesn’t smell right here”
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She probably fell into some category that allowed her to get Medicare early. I knew a guy with a bad kidney condition needing dialysis 4 days a week. He could not hold down a job because he was always at dialysis and then felt horrible for 6 hours afterward. But.... finally got a transplant and is STILL on Medicare! So there are tons of loopholes to getting on Medicare.
RE: “I’d guess she’s on disability...which I believe makes you eligible for medicare at any age...”
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Yes, and some of them STAY on disability and thus Medicare coverage until they either die or recover, if then. I know one who’s been on Medicare for YEARS due to medical problems and he is not even 60 yet.
You can get limited Medicare if you are catagorized as disabled.
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