2013년 12월 4일 수요일

About 'united health care supplemental insurance'|VIVA FRENCH HEALTH CARE







About 'united health care supplemental insurance'|VIVA FRENCH HEALTH CARE








               Ray               is               in               his               middle               fifties.

I               met               Ray               nearly               fifteen-years-ago.

I               was               managing               a               restaurant               and               he               worked               at               a               hardware               store               up               the               street.

I               had               an               account               there               and               purchased               tools               and               hardware               from               him.

Eventually,               we               became               good               friends.

We               both               belonged               to               the               local               Elk's               lodge.

We               played               golf               together.

We               still               see               each               other               from               time-to-time.

A               couple               of               week's               ago,               I               called               him               up.

It               had               been               at               least               three               years               since               I               had               talked               to               him.

We               met               for               coffee.



               Ray               was               raised               along               with               his               two               brothers               by               his               mom               who               worked               in               the               same               factory               for               forty-five               years.

His               father               left               when               he               was               three.

His               mom               never               remarried.

Most               of               the               time               he               stayed               with               his               grandparents               while               his               mom               worked.

Ray               was               the               youngest               in               the               family               and               rather               sickly               as               a               child.

Later               on               in               life               this               would               manifest               itself               when               he               came               down               with               severe               hypertension               and               diabetes.
               Despite               his               health               problems,               he               did               well               in               school               and               actually               got               a               partial               scholarship               to               college.

He               was               interested               in               medicine               and               wanted               to               be               a               doctor.

Maybe               that               was               because               he               had               been               so               exposed               to               it               when               he               was               a               child.

But               unfortunately,               he               had               to               put               his               plans               on               hold               and               get               a               job               when               he               was               eighteen.

He               moved               out               of               the               house               a               few               months               later.

His               job               was               working               in               a               retail               store               for               a               large               national               chain.
               Eventually,               he               worked               his               way               up               to               assistant               manager.

The               pay               was               alright,               but               really               not               enough               to               get               ahead.

Despite               the               long               hours               and               his               health,               he               sometimes               worked               a               second               job               on               his               days               off               to               make               ends               meet.

At               first               he               intended               to               go               back               to               school,               but               he               never               made               it.

He               just               didn't               have               the               time               or               money.
               After               about               thirty               years               in               the               retail               job,               he               found               that               he               could               no               longer               do               the               long               hours               standing               on               his               feet.

Besides               the               diabetes               had               started               to               take               its               toll.

He               had               neuropathy               in               his               feet               and               legs               and               vision               problems               that               required               extensive               laser               surgery.

He               went               blind               in               each               eye,               but               fortunately               he               eventually               regained               most               of               his               sight.

He               also               came               down               with               severe               end-stage               kidney               disease.

Despite               all               of               this,               he               still               managed               to               keep               his               job,               even               though               he               was               on               the               firing               block               a               lot               of               the               time.
               Finally,               he               had               to               give               up               when               he               was               in               his               early               fifties.

He               just               couldn't               do               it               anymore.

He               went               on               Social               Security               Disability,               but               he               wasn't               eligible               for               Medicare               for               two               more               years.

During               that               time               he               paid               $500/month               to               COBRA               to               keep               his               insurance               active.

During               those               years,               he               used               up               what               meager               savings               he               had               and               nearly               starved.
               When               he               finally               got               Medicare,               he               bought               a               top               tier               supplement               policy.

That               cost               him               two               hundred               a               month,               but               he               figured               it               was               worth               it               as               many               times               as               he               went               to               the               doctor.

Then               his               kidneys               failed               altogether               and               he               went               on               dialysis.
               He               was               on               dialysis               two               years               before               a               kidney               became               available               for               transplant.

During               that               time               he               switched               to               Medicaid               as               his               supplemental               insurance               because               it               was               free               and               he               was               struggling               to               make               the               United               Health               Care               payment               every               month.

The               only               way               that               he               could               get               Medicaid               was               to               have               a               spend               down.

The               spend               down               was               over               seven               hundred               dollars               a               month.

It's               complicated,               but               if               you               incur               medical               bills               over               the               spend               down               amount               at               the               first               part               of               the               month,               then               you               have               coverage               for               the               rest               of               the               month.

For               the               two               years               that               Ray               was               on               dialysis,               it               wasn't               a               problem               as               a               single               treatment               cost               that               munch.
               He               had               the               transplant               and               it               didn't               go               well.

There               were               a               lot               of               complications               and               he               was               in               and               out               of               the               hospital               a               lot.

That,               plus               the               expensive               cost               of               the               anti-rejection               drugs               met               the               spend               down               for               several               months               after               the               operation.

Then               he               messed               up.

He               started               to               get               better.

He               still               couldn't               go               back               to               work               because               of               the               other               complications               from               the               diabetes.

He               had               to               face               the               fact               that               he               would               be               disabled               for               the               rest               of               his               life.

But               he               still               managed               to               work               a               part-time               job               that               paid               about               two               hundred               dollars               a               month.
               Then               his               Medicaid               became               inactive.

He               wasn't               accumulating               enough               bills               to               cover               the               spend               down.

Suddenly               he               was               responsible               for               twenty               percent               of               his               medical               bills.

Even               though               he               was               healthier,               he               still               had               weekly               labs               and               other               expenses               that               came               to               a               lot               more               than               he               could               afford               to               pay               each               month.
               None               of               the               private               insurance               companies               would               take               him               back               even               during               open               enrollment.

He               lived               in               a               state               where               the               new               laws               against               being               turned               down               due               to               prior               conditions               didn't               apply.

His               state               opted               out.

He               tried               to               get               help               through               numerous               other               programs               like               "Ticket               to               Work"               but               he               made               too               much               money.

Between               his               job               and               Social               Security               he               made               about               $1600               a               month               and               the               cut               off               point               for               aid               was               $1279               for               a               single               person.

To               get               Medicaid               without               the               spend               down               you               have               to               make               around               $650               a               month.

Ray               has               no               family               left               to               help               him.

How               can               anyone               possibly               live               on               $600               a               month?

Even               on               $1600               a               month               Ray               has               trouble               making               ends               meet               sometimes.
               He               doesn't               qualify               for               food               stamps,               assistance               with               his               utilities               or               rent               because               again,               he               makes               too               much               money.

His               social               worker               suggested               for               him               to               ask               the               doctors               if               they               would               just               accept               the               Medicare               payment,               but               two               have               already               said               no               and               now               require               the               twenty               percent               upfront.
               He               needs               an               operation               to               help               the               vision               in               his               left               eye,               but               he               can't               afford               it.

He               worries               a               lot               about               becoming               an               "emergency               room               patient"               even               though               he               has               Medicare.

The               only               solution               is               to               reject               the               kidney               and               go               back               on               dialysis.

In               other               words,               get               sicker.

Then               everything               would               be               paid               for.

Ray               is               being               penalized               for               getting               better               and               there               is               no               way               out               in               sight.

He               makes               just               enough               money               to               not               get               the               help               he               needs,               but               he's               still               poor               and               struggling.

That's               a               tragedy               for               someone               who               has               worked               hard               his               entire               life               just               trying               to               get               by.






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    2013년 12월 3일 화요일

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    The               health               care               reform               signed               into               legislation               by               the               Obama               Administration               took               effect               on               September               23rd,               2010.

    Children               in               Texas               will               be               significantly               impacted               by               this               change               as               many               of               the               top               insurance               carriers               in               Texas               will               be               doing               away               with               child-only               policies               in               the               wake               of               this               reform.

    What               does               Health               Reform               State?
                   The               Health               Reform               legislation               will               now               require               all               insurance               providers               to               carry               children               with               pre-existing               conditions.

    In               the               past,               many               children               were               denied               coverage               if               they               were               found               to               have               a               pre-existing               condition,               but               thanks               to               the               new               law,               insurance               providers               cannot               deny               them.

    However,               these               companies               have               decided               that               in               order               to               prevent               themselves               from               having               to               carry               children               with               pre-existing               conditions,               it               would               be               better               to               do               away               with               all               child-only               policies.

    "Child               Only"               policies               are               policies               that               just               cover               children               under               the               age               of               19.
                   Who               is               Doing               Away               with               Insurance               for               Children?
                   In               Texas,               the               biggest               insurers               are               Blue               Cross               Blue               Shield,               United               Healthcare,               Aetna,               and               Cigna.

    Blue               Cross               dominates               44               percent               of               the               Texas               market               and               United               Healthcare               dominates               a               quarter.

    United               Healthcare,               Aetna,               and               Cigna               have               all               stated               that               they               will               be               doing               away               with               child-only               policies,               which               means               that               they               will               keep               the               current               policies               until               they               are               up               for               renewal,               but               will               not               renew.

    Their               argument               for               this               change               is               that               they               are               trying               to               "keep               family               coverage               affordable               for               as               many               people               as               possible               and               avoid               significant               price               hikes"               and               that               "under               the               new               law,               people               suddenly               seeking               coverage               would               predominately               be               those               who               need               to               consume               health               care               services               immediately               for               known,               high               cost               conditions."               There               are               currently               263,800               Texas               children               under               the               age               of               19               covered               by               these               policies.
                   What               is               the               Impact?
                   There               is               no               evidence               to               support               that               these               large               insurance               companies               will               suffer               as               a               result               of               this               element               of               health               care               reform.

    In               fact,               according               to               the               September               13th               edition               of               the               Houston               Chronicle,               Texas               Representative               Garnet               Colemen               of               Houston               was               quoted               as               saying               that               the               actual               number               of               children               who               have               pre-existing               conditions               and               are               seeking               coverage               is               small.

    According               to               the               Kaiser               Foundation,               43.4%               of               Texas               children               are               covered               on               their               parents'               employer               insurance,               30.7               percent               of               children               are               covered               through               Medicaid,               5.8               percent               are               covered               through               individual               or               other               public               plans,               and               20.1percent               are               uninsured.

    It               seems               that               these               companies               are               worried               about               the               number               of               children               with               pre-existing               conditions               who               fall               into               that               20.1percent               of               uninsured               Texans.
                   The               slogan               for               United               Healthcare               is               "Helping               people               live               healthier               lives"               and               Aetna's               website               states               that               they               are               "committed               to               compliance               with               the               new               legislation,               and               we               are               fulfilling               our               obligation               to               implement               new               benefit               and               health               plan               requirements."               How               exactly               is               United               Healthcare               helping               people               live               healthier               lives               when               they               are               dropping               children               from               policies?

    How               is               Aetna               fulfilling               their               obligation               by               coming               up               with               a               new               way               of               denying               children               in               need               of               health               coverage?

    These               insurance               giants               have               decided               that               their               bottom               line               is               more               important               than               the               health               of               their               subscribers               and               their               subscribers'               children.

    They               claim               that               they               are               trying               to               prevent               a               spike               in               premiums               by               not               allowing               certain               children               coverage,               but               is               that               really               the               case?

    According               to               Pauline               Rosenau,               who               is               a               professor               of               Management,               Policy,               and               Community               Health               at               the               University               of               Texas               School               of               Public               Health,               the               "middle               class               will               feel               the               greatest               impact               from               the               change               and               likely               have               to               forgo               coverage               of               their               children               if               their               employer-based               family               plans               cut               coverage               of               dependents."
                   If               children               cannot               receive               health               insurance,               parents               will               be               more               reliant               on               emergency               care               and               public               funding               to               take               care               of               their               children,               which               will               pass               along               the               burden               to               the               rest               of               Texas               citizens.

    We               need               to               allow               all               people               access               to               health               insurance,               so               we               don't               see               price               increases               in               emergency               room               visits               and               our               own               premiums.

    These               insurance               giants               have               always               care               more               about               their               bottom               line               than               their               customers,               and               I               we               need               to               continue               to               support               legislation               to               prevent               them               from               making               our               healthcare               decisions               for               us.
                   Ackerman,               T.

    (2010,               September               13).

    As               new               law               kicks               in,               thousands               of               Texas               children               may               be               left               out.

    Houston               Chronicle               ,               pp.

    A1,               A4.
                   www.uhc.com               
                   www.aetna.com






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    If               Republicans               were               confronted               with               the               facts               and               they               answered               honestly,               I               feel               certain               it               would               become               clear               to               objective               thinkers               that               the               interest               of               the               general               public               are               not               what               occupies               their               time.

    This               isn't               intended               to               demonize               them;               it's               just               to               point               out               an               obvious               reality               in               contemporary               U.S.

    politics.

    Both               Party's               names               give               a               bit               of               a               clue               on               how               their               leaders               might               be               inclined               to               pursue               goals               related               to               critical               social               issues.

    Democrats,               a               derivative               name               of               government               set               up               by               the               Greeks               ages               ago               whereby               each               individual               within               the               society               had               an               actual               say               in               the               issues,               tend               to               focus               on               a               collective               need               of               the               people.

    Republicans,               also               originating               within               Greek               culture               as               a               representative               form               of               government               where               people               would               elect               someone               to               stand               in               for               them               on               the               issues               (much               like               we               have               today               in               America)               tend               to               focus               on               a               more               powerful,               yet               smaller               constituency.

    Clearly               I               take               license               with               this               bit               of               word               play,               but               you               get               my               drift.
                   Democrats               are               not               innocent               of               pursuing               their               own               self-interest               over               real               constituent               needs               or               aligning               themselves               with               corporate               interests.

    And               though               it               may               not               seem               clear               to               some               that               voting               with               the               interests               of               a               select               few               from               time               to               time               can               ultimately               benefit               the               larger               population,               it               IS               clear               that               a               recurrent               and               often               unabashed               pattern               of               doing               this               has               developed               within               the               ranks               of               the               Republican               party.

    Many               during               the               Bush/Cheney               years               followed               the               lead               of               Grover               Norquist               that               sought               to               shrink               the               roll               of               government               to               a               point               where               the               private               sector               could               take               over,               replacing               government               agencies               answerable               to               the               people               with               corporate               boards               rooms               answerable               only               to               their               stock               holders.
                   The               Democratic               Party               of               today               evolved               from               the               principles               found               within               Jeffersonian               and               Jacksonian               politics.

    Both               of               these               political               views               sympathized               with               and               expanded               the               role               in               politics               of               working               class               people               as               our               country               developed               in               its               early               years.

    Within               the               contemporary               Republican               Party               we               see               vintages               of               the               Hamiltonian               Federalists               who               often               aligned               themselves               with               financial               institutions               and               the               aristocracy.

    In               fact,               it               is               not               uncommon               for               many               within               the               ultra-conservative               factions               of               the               Republican               Party               today               to               refer               back               to               the               Federalist               Papers,               of               which               more               than               half               are               attributed               to               Alexander               Hamilton,               to               define               the               role               of               government               and               interpretations               of               the               Constitution.
                   The               concepts               of               personal               liberty               within               each               framework,               Democrat               and               Republican,               are               postulated               in               accordance               with               these               earlier               perspectives.

    It               comes               as               no               surprise               then               that               corporations               were               first               defined               as               "natural               persons"               by               a               Republican               appointee               to               the               Supreme               Court,               Chief               Justice               Morrison               Waite               in               the               case               of               Santa               Clara               County               v.

    Southern               Pacific               Railroad               Company               (1).Corporate               "personhood"               has               since               been               enhanced               by               Republican-appointed               justices               in               the               recent               Citizens               United               v.

    FECcase.
                   Holding               the               views               that               they               do,               Republicans               are               more               willing               to               trust               what               fellow               Federalist               James               Madison               referred               to               as               a               "select               ..

    portion               of               enlightened               citizens",               but               often               are               guilty               of               attributing               a               wisdom               and               virtue               to               this               select               group               that               omits               the               human               weaknesses               of               "lesser               men".

    Over               the               decades               and               nearly               two               centuries               since               these               ideas               were               first               communicated,               a               conservatism               has               evolved               that               throws               its               weight               behind               the               well               healed               establishment               of               commerce               and               their               financial               supporters.

    This               association               has               become               so               natural               in               its               course               that               Republicans               often               seem               oblivious               to               it.
                   A               clear               example               of               this               is               the               Republican               and               Senate               minority               leaders               who               have               continuously               and               openly               stated               the               misconception               that               "the               American               people               have               spoken.

    They               oppose               government-run               health               care."(2)               In               light               of               the               fact               that               polls               show               quite               the               contrary               (3)               and               that               Republicans               have               less               support               than               do               President               Obama               and               the               Democrats               on               nearly               all               critical               domestic               and               foreign               issues,               including               how               to               deal               with               terrorism,               one               can               only               assume               that               Rep.

    John               Boehner               and               Senator               Mitch               McConnell               are               referencing               the               sentiments               of               another               constituency               of               theirs;               in               this               specific               regard,               the               health               insurance               industry.
                   If               we               take               a               close               look               at               their               arguments               that               oppose               universal               health               care               for               Americans               we               see               the               underlying               values               of               corporate               interests,               disguised               as               virtuous               capitalism.

    Of               their               4               "common               sense               solutions"               stated               on               their               web-site               (2)               all               are               mere               iterations               of               simplistic               options               that               offer               no               real               guidelines               or               concrete               actions               to               reduce               the               growing               number               of               people               who               are               without               health               care               coverage.

    For               example,               solution               #3               suggests,               though               extremely               vague,               that               states               be               given               "the               tools               to               create               their               own               innovative               reforms               that               lower               health               care               costs."
                   Where               this               would               allow               the               governors               and               legislatures               genuinely               concerned               with               needed               health               care               reform               in               their               states,               it               would               do               nothing               in               states               like               Texas               where               the               governor               has               assured               voters               that               he               will               oppose               any               federal               funding               that               would               pull               his               state               out               of               the               bottom               ranking               where               people               are               not               covered               with               health               insurance.

    According               to               the               grassroots               coalition               Health               Care               For               All               Texas,               one               in               four               Texans               are               uninsured.

    "Only               35%               of               small               businesses               in               Texas               offer               health               insurance,               and               only               43%               of               their               full               time               employees               are               enrolled.

    Fewer               than               half               of               all               Texans               get               their               health               insurance               through               an               employer."(4)
                   Whereas               Democrats               favor               legislation               that               ends               discriminatory               practices               within               the               insurance               industry               that               refuses               coverage               based               on               pre-existing               conditions               and               terminating               policies               bought               in               good               faith               because               physician-ordered               treatments               or               procedures               are               deemed               "unnecessary"               by               insurance               industry               bureaucrats,               Republicans               are               strangely               silent.

    Nor               do               we               see               any               efforts               on               the               part               of               conservative               Republicans               to               admonish               health               insurance               companies               when               they               raise               premiums               beyond               inflation               rates               or               seek               higher               medical               loss               (ML)               ratios               on               their               profit               reports.

    ML               ratios               reflect               the               percentage               of               insurance               premium               revenues               that               pay               for               medical               services.
                   What               we               have               seen               are               large               campaign               contributions               from               health               insurers               and               drug               makers               to               Republicans               who               oppose               health               care               reform.

    Recent               data               showed               that               "the               biggest               beneficiaries               in               the               Senate               included               John               McCain               (R-Ariz.),               with               $546,000;               Minority               Leader               Mitch               McConnelly               (R-Ky.),               with               $425,000               and               [i]n               the               House,               the               two               groups               gave               $257,000               to               Minority               leader               John               Boehner               (R-Ohio)               and               $249,000               to               Minority               Whip               Eric               Cantor               (R-Va.)."               (5)Though               these               lobbying               groups               have               a               practice               of               contributing               to               any               in               political               power,               be               it               Democrat               or               Republican,               only               the               Republicans               have               failed               to               advance               health               care               reform               when               they               were               in               control               of               influential               House               and               Senate               seats.
                   The               writing               is               on               the               wall,               as               they               say,               for               any               who               want               to               read               it.

    The               feigned               interest               Republicans               are               now               displaying               about               wanting               to               address               the               rising               costs               of               health               care               are               the               result               of               Democratic               efforts,               headed               by               the               President,               to               effect               necessary               change               here.

    Republican               efforts               are               not               intended               to               correct               a               wrong               they               have               over-looked               throughout               their               history,               but               to               do               what               ever               they               need               to               in               their               continued               support               of               the               corporate               constituency               they               have               come               to               represent               in               all               things.
                   SOURCES:
                   (1)               -               http://ratical.com/corporations/SCvSPR1886.html
                   (2)               -               http://www.gop.gov/solutions/healthcare
                   (3)               -               http://www.pollingreport.com/health.htm
                   (4)               -               http://www.healthcareforalltexas.org/
                   (5)               -               http://www.washingtonpost.com/wp-dyn/content/article/2009/03/07/AR2009030701748.html






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