Attention Senior Citizens – have your grandchild read this to you

Bright logoWe senior citizens are noted for two things, diminishing physical and mental abilities. We cannot do much about the former except exercise, what I call “running from Father Time.” It is loss of mental capacity that keeps the advertising industry interested in us. Senior citizens have to be the reason for the waves of robocalls that are torturing all of us. They only need a <1% response to make money, given their low overhead. Shame on us! We are the reason your phone is always ringing.

Every year, during a 45-day period known as “open enrollment” (OE), we seniors are deluged with mailings from members of AHIP, “American’s Health Insurance Providers,” trying to lure us into a program called “Medicare Advantage.” I bit, one time, but was able to escape the grips of Humana by complaining directly to Medicare about its deceitful practices. I re-entered Medicare last June. I now ask myself this: “I spent the first 65 years of my life trying to get away from health insurance companies. Why would I voluntarily go back to them?”

The answer, of course, is diminished mental capacity.

One thing was obvious to me: The degree of advertising that goes on each year during OE can only mean one thing: Insurers are making boatloads of money on the program. I don’t feel up to a research project, but some things are easy to see. Insurance companies are reimbursed by Medicare for all of their costs, so there is a real incentive for them to exaggerate these costs. And they do, and the record shows billions in fines levied against them for such practices. (One example only.)But there are other things going on:

Cherry Picking: Wendell Potter was an insurance executive who left a cushy job with CIGNA to write the book Deadly Spin, about the health insurance industry. I’m kidding, of course! Potter was controlled opposition and never lost his AHIP backing. The book was a limited hangout, and as with all LH’s, we should take the good and discard the rest. He spoke of Medicare Advantage, and noted practices that AHIP engaged in to lure healthy people out of Medicare. They would offer public meetings late in night, in remote locations, and even on upper floors of buildings without elevators so that the people who responded would be the healthier ones. Companies who sell Medicare Advantage plans do not want sick people aboard. That’s a given.

(Further evidence of Potter’s status as controlled opposition: When ACA, or “Obamacare” was introduced, he quickly jumped onboard. This legislation was the most massive and cherished subsidy ever given private businesses by government since the invention of the windmill, written by the insurance industry for the insurance industry.  Say what you will about the Trump Administration, and I’ll probably agree, but the elimination of penalties for failure to carry private health insurance was a landmark reform.)

False advertising: Last year during OE we were swamped with advertising from insurance companies trying to lure us into Advantage. One in particular caught my eye, that of Bright Insurance. In addition to the usual advertising techniques like exaggeration and borderline lying, Bright said in its brochure that enrollment in its plan would save seniors “thousands of dollars in health care costs.” That tipped it for me, and I wrote to the Colorado Attorney General about the false claim, which I said “crosses the line.”

Bright’s claim was based on two things that all Advantage plans offer, dental and vision coverage. Bright claimed to offset up to $2,500 in dental costs, and a few hundred for vision. That’s how they justify the claim. It’s a lie.

Humana had a similar plan, offering $2,000 in dental coverage. (I read the fine print on their $150 in vision coverage, which was really only worth only $5.00 towards purchase of a pair of glasses.) The dental plan really only paid $50 or so towards an annual checkup, and nothing else. If indeed that other $1,950 in coverage is available, it must be for events so rare as to be negligible, perhaps something like being hit by a flying fish while water skiing.

Early in 2019 I lost a crown while biting into scrambled eggs, of all things. It was a front tooth, leaving me with what I call an “Arkansas smile.” The repairs included extraction of the remaining base tooth, a long period of convalescence while wearing a temporary bridge, and finally a real bridge.

The total costs were in excess of $8,000. Humana paid … $0.00.

At one point they said a charge was actually covered, but was being applied towards my “Maximum Out of Pocket.” This was the point where I contacted Medicare to get out of the plan, which was advertised as “zero deductible.” It actually carried a $7,900 MOOP. (“MOOP” is an Obamacare concept designed to protect insurance companies.) Humana had merely changed the definition of a deductible to a “co-pay.”

Humana later backtracked, by the way, claiming that the dentist’s clerk had screwed up in filing the claim. They really didn’t cover anything in any manner. That was what they meant to say.

Bright’s dental and vision coverage are most likely worthless too, or perhaps like Humana’s, worth at most $55 per year. They are only in place to lure seniors of diminished mental capacity, like me, away from regular Medicare.

Behind the scenes: The means by which insurance companies are reimbursed by Medicare for Advantage plans are not simple. They involve the general health of the people who enroll, and vary even by locality. So what I offer here is a general and oversimplified example:

Most Advantage plans introduce members to “co-pays,” along with premiums and the usual AHIP mumbo-jumbo of deductibles and denied coverage. So, for instance, when I visited a doctor, I would have to pay $30 up front, and $200 up front for an MRI. (Regular Medicare only covers 80% of costs, so we are forced to buy “Medigap” coverage for the other 20%.) Essentially, the Advantage up-front co-pays are another form of Medigap, a way of insuring that we always have to pay something for care, be it in the form of an insurance premium or a co-pay. (That’s not a complaint about having to pay something. I am merely saying that there isn’t much difference in coverage between Advantage and regular Medicare.)

Advantage plans do not use insurance company coffers to pay benefits. When we sign up, we assign our benefits to the insurance company. So behind the Advantage wall, we are still in regular Medicare with an AHIP mask. Seniors are often surprised to learn that doctors who do not accept Medicare also do not accept Advantage. To the doctors, they are one and the same.

While under Humana Advantage, I saw a doctor regarding my stenosis, part of the physical deterioration that goes on with aging. I paid $30 up front. Humana was billed for the rest. Humana submitted the claim to Medicare, which reminbursed it in full. Humana then reimbursed the doctor what Medicare allowed less the $30 copay.  Humana made $30 on the deal. Multiply that by the millions of people who are enrolled in Advantage, and who see doctors far more than I do. Most seniors I know see doctors monthly, if not more often.)

I am not sure how this works, but I currently pay $144.60 per month for Medicare B coverage, which covers doctor visits. I originally assumed, when joining Humana, that that premium would be assigned to them along with any benefit claims. The reimbursement scheme is, as I gather from brief reading, more generous and more complicated. This is why insurance companies are lining up at our mailbox each year to get us to join. It is just another profit center for them.

Medicare Advantage is just another AHIP scam on senior citizens. Most of us have days in our lives that we remember forever, such that first real love, first kiss, first time getting laid. Another is the day we turn 65 and kiss insurance companies good bye. That so many of us have been lured back into the AHIP trap only speaks of our general mental deterioration, part of the aging process.


PS: I started out my morning wondering how on earth “Medicare for All” will cost $36 trillion to put in place.It doesn’t make any sense! The US already has by far the largest per capita health care costs in the world. Much of that is courtesy of AHIP, which incentivizes high overhead and over-billing. The table below is from 2014, but only dollar amounts will have changed since that time. We are still, I assure you, number one.

Health Care Costs

Most of the other countries shown have some form of M4A, or publicly financed health care systems. Notice I did not say “free,” as these countries merely substitute tax dollars for private ones. The result is lower costs AND 100% coverage. Reasons for lower costs include centralized billing and lower administrative costs.

Notice Canada (red arrow). What changes as we cross our northern border into the land of aboot? In 1966 they kicked private health insurance companies out. Despite bad press here in the US, they will not be invited back. Canadian health care is not free, and like all large bureaucratic systems, including our own, is fraught with problems. We cannot escape problems, only minimize them. Indeed there are wait times in Ontario, the largest province. (Big Swede, who generally does not read to the end of blog posts before he comments, will cite below that Canadians come to the US for treatment in droves. Evidence does not support that claim. Don’t tell him.)

Back to the claim that M4A will cost $36 trillion (over ten years) to put in place – it might well be true. It is but one side of the coin, the other being that those costs are being transferred from the private side to the public side, and are not new costs. If the experience of every other goddamned country on goddamned face of the goddamned planet is goddamned repeated here, M4A will be a goddamned blessing.

Given that M4A is supported by Democrats, don’t get your hopes up. That party, after all, merely exists to kill hope.

23 thoughts on “Attention Senior Citizens – have your grandchild read this to you

    1. The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.

      RELATED CONTENT

      Global Millennials Rank Canada as No. 1 Country
      In citing those numbers in its 2015 report, “Leaving Canada for Medical Care,” the organization said difficulties in obtaining timely medical care at home is, increasingly, leading Canadians to seek it abroad. “It is possible [they] may have left the country to avoid some of the adverse medical consequences of waiting for care, such as worsening of their condition, poorer outcomes following treatment, disability, or death,” the report says. “Some may leave simply to avoid delay and to make a quicker return to normal life.”

      Canadians could expect to wait 9.8 weeks for medically necessary treatment after seeing a specialist in 2014, the researchers found, three weeks more than the time physicians considered to be clinically “reasonable.”-US News

      Like

      1. Funny as hell! Read the third to last paragraph. You feature prominently.

        Canadians don’t come to the US for health care unless they are 1) very wealthy, and 2) very stupid. The reason is simple … they are covered in Canada, where coming down here they would pay through the nose. We are the most expensive system in the world. They are advised to purchase health insurance policies if they travel here, and that probably accounts for the 52,513 people who had medical care here. Anther reason is cross-border agreements to share expensive equipment, efficiency of use. Remember that Sarah Palin as a child got her health care in Canada.

        Liked by 1 person

        1. Sharon Shamblaw was neither wealthy or stupid.

          TORONTO — WHEN SHARON Shamblaw was diagnosed last summer with a form of blood cancer that could only be treated with a particular stem cell transplant, the search for a donor began. A Toronto hospital, 100 miles east of her home in St. Mary’s, Ontario, and one of three facilities in the province that could provide the life-saving treatment, had an eight-month waiting list for transplants.

          Four months after her diagnosis, Shamblaw headed to Buffalo, New York, for treatment. But it was too late. She died at the age of 46, leaving behind a husband and three children, as detailed by the Toronto Star.

          Like

  1. All public citizens are, in fact, agents or employees on their captains’ pirate ships.
    The status of “senior citizen” is no exception. In the competitive monopoly game played by commoners the fiat paper money has no value but the belief in it by those being robbed of everything, principally of our estates, our identity and our souls. We have even been conditioned to steal from each other — an “American value.”
    Health insurance, or a national health care system, is based on mass delusion. The
    common goyim of nations — All nations — are no more than livestock (property) in voluntary enslavement. The masters of nations don’t care a rat’s behind about health care for the masses. It’s all lies based on usury and foolish belief that government cares about more than mind control and thievery. Don’t eat fruit from poisonous trees.

    Liked by 1 person

    1. Not so, as I make no claim that Americans flock to Canada for health care, as you do about Canadians coming here. I happen to like Palin, but she’s like an icon of the right wing, and trampled on your presumptions by her actions.

      Like

  2. There is a special place in hell for those who scam seniors.

    Once out of the blue on a random workday, I got a bunch of worried phone calls from various family members. Turns out someone had been impersonating me over the phone to my grandmother and had convinced her that I was in trouble and needed money (of course). Good thing someone got in touch with me before any money changed hands.

    There are some evil, sick people out there. If I would have caught them in the act, I would have introduced their face to a baseball bat.

    Like

    1. Health insurers are racketeers, in my humble opinion. The definition of racketeering is creation of a problem in order be paid to solve it. Health insurers refused to offer insurance to millions of Americans, and then “solved” the problem with Obamacare.

      Like

      1. The US Government is a mega racketeer. Just look at what happened to the SS trust fund. Those monies have been redirected to other pet projects.

        But what about the costs? It’s had to find any economist who’s says the $30T 10 year price tag isn’t an accurate estimation. Taxes on the 50% ( actual taxpayers) would triple. And go ahead confiscate every estate above one million, its pays HC for less than a year.

        But timing is everything. Dems know pushing Medicare for all is a now or never proposition. When the bill comes due for SS and SS Disability the mask will come off these socialistic programs.

        Like

        1. Yeah, what Cruz says. God I wish you’d read now and then. I specifically said in the post that the estimated costs under M4A would be transferred from private to public sector. Since we already have the most expensive and inefficient health care system in the industrialized world, trust me, if we were to make the change, costs would go down, not up. Since it is proposed by Democrats, don’t worry. It will never be enacted. They just propose stuff like that to keep their base from disintegrating.

          There is no SS Trust Fund. It is just a device used to justify over-taxation of working people. I’ve written about that too, not that you would read anything not from a source that you are not predisposed to agree with, for reinforcement of existing beliefs purposes.

          https://pieceofmindful.com/2018/06/26/what-of-this-trust-fund/

          Liked by 1 person

          1. You don’t listen to me either. Call it what you will the money coming in from SS taxes can’t make the payout. When that happens taxes are raised to make up the difference.

            When taxes rise exponentially layoffs commence so instead of 50% of Americans paying in to the system you have less contributors.

            Now add HC for All and the house of cards collapse.

            Like

          2. The problem is, Swede, what you cannot and will not see, that every other industrialized country on the face of the planet that has universal health care spends not just a little less than us on health care, but a whole boatload less than we do, negating your whole argument.

            You’re like an icycle stuck in permafrost, never advancing, never changing, never learning anything, frozen in time.

            It’s probably been 16 years since I first suggested to you that you need to look at the health care systems of other countries. But that would require independent judgment, and your only demonstrated capability to to run to your authority sources, never using your own brain. It is no coincidence that your idea of a comment is to bring forward what someone else thinks in quotes or video, as for you, that is “thinking,” or being a sponge.

            Now hush.

            Liked by 1 person

            1. I’m a complete novice on this issue but I found your points in the post valid, Mark. I will never understand those who equate taxation with theft. In the USA, we are perhaps getting our tax dollars stolen on a larger scale than elsewhere, but the problem is not inherently taxation. Amazing things can be done with public funding when efficiently utilized. When a problem clearly calls for increased taxation, the political right ends up looking very absurd. And as you said, the political left is always just floating a pipe dream. Sadly, the USA may need to be run by technocrats to ever get these things right, but it will never happen. We will always end up with one disastrous boondoggle after the other.

              Like

          3. The critical time in our history was post WWII, when a decision was made that health care was an employer responsibility. As a result, most of us got health insurance from our employers. It made no sense, as it chained us to our desks, and why should people who are making airplanes or mining have to worry about childbirth and illness and all of that? But that was probably the intent, to enslave us.

            Other countries took on health care as a public responsibility, relieving employers of the burden. There are many forms in various countries, but essentially the idea is this: If you are an Italian or Canadian citizen, regardless of your employment status or income level, you are guaranteed basic health care. Your employment status and your health care are not connected.

            In the US, we created a monster, the health insurance industry. As various companies accumulated power, they became openly greedy, refusing to insure people with “preexisting conditions” which meant that millions of Americans were without insurance, and incidentally, health care. In essence, this was a feature of “capitalism”, the other side of the “competition makes us all better” coin, a race to the bottom. If one insurance company refuses to cover people with, say, diabetes, all the others must follow. Otherwise, people with diabetes flock to those companies that will insure them, and they go broke. It is called “adverse selection,” and while insurance companies will tell you it is a real threat to their existence, there is something more basic at work. It is a signal that markets don’t work in health care. Private health insurance companies should not exist. Canada figured this out in 1966 and booted the insurance companies. The “insurance” model, which does work for automobile and homes, does not work in health care. If auto insurance worked like health insurance, every time we gassed up, we would have to file a claim somewhere.

            It is not a perfect world, and everyone everywhere complains … but numbers tell the tale. Those countries that adopted single payer, or even Britain with government owned health care, achieve far better results than us, providing basic care to ALL their citizens for less per capita than we pay. In the US, we have millions who have no insurance, and even those are “insured” are scared shitless of any major medical event. The single most common cause of bankruptcy in our country is medical costs. The reason is that decision made after World War II that the private sector could do a better job. I don’t give two shits for philosophies. I go with what works.

            I was hard on Swede. I’ve known him for years. As you see him now is as he was then, no change. I think he read Atlas Shrugged at a young age, and his intellectual development stopped there, not uncommon. There are many ways to try to communicate with him. None work.

            Like

  3. Hold up. If my non senior citizen memory holds up, I believe that our tax dollars go to the incorporated in Puerto Rico IRS which in turns sends that cash we paid over to the UK where Queen Elizabeth says Hey Now and stacks that cash in her personal coffers. The US pays the Queen due to the terms of the agreement of the Revolutionary War where the United States agreed to pay a tax or honorarium or something to the King on the profits of the land that he ceded to us. I know people are going to say that’s nuts so I am now going to go on the hunt for my sources.
    I was under the assumption that the Fed just creates more worthless money and that is what was making the government and the world go round. I have been wrong a million times and I am probably wrong again…

    Like

  4. Just read this, thought it belonged here. Jeffery Brown author who cites an example of a Canadian couple who got in a car wreck in the US was initially treated for injuries here and sent back to home to “socialized” medicine and was “rationed” out of any follow up.

    I know your standard response of their story would be “anecdotal” but what I find most interesting is his concluding paragraph and effects of rationing on doctors and nurses.

    “The myth of free healthcare is that the care you get now will continue, but it will be “free.” Advocates of socialized medicine aren’t interested in telling the truth about what will really happen when care is rationed, treatments are discouraged, and doctors and nurses become disillusioned and quit, leaving fewer health care providers to meet skyrocketing demand. We think that Canada, which is just as modern and civilized as the United States, must have figured this all out, because a modern citizenry expects modern care. Yet, they don’t have it, because socialism cares nothing for modernity. Despite having imposed government control over medical care, it is still an environment that is subject to supply and demand. This reality is further exacerbated when one contemplates not only socialized medicine for a country the size of the United States, but the open borders that every Democrat candidate for president proudly demands. Canada strictly controls its borders, is a fraction the population of the Unites States, and is failing its citizens completely. The end of modern health care in the United States, should we have socialized medicine forced upon us, will be catastrophic. Think “Cuber,” as Sanders touts. As we have come to ask about so many other myths, exactly how many deaths will be enough to pay for this ridiculous lie?

    Read more: https://www.americanthinker.com/articles/2020/03/the_canadian_health_care_myth.html#ixzz6FjbjxjLU
    Follow us: @AmericanThinker on Twitter | AmericanThinker on Facebook

    Like

    1. We can count on few things in life … the sun will rise in the east, we will all someday die, and Swede will never change an opinion that he formed in his twenties. He’s calcified.

      The United States has a highly inefficient health care system, wildly expensive and failing in one big essential – too many people are unable to get the care they need.

      Every other civilized country on the face of the earth has figured out that the private insurance model does not work unless it is backed by government force to make people buy that insurance. That’s all Obamacare was. Government forcing us to buy private insurance.

      No health care system is perfect, anywhere. Problem arise, unlike here, they try to fix them.

      Canada’s health care system is not perfect. It is, however, much better than ours.

      The last country to abandon the private health insurance model was Taiwan. They used as a model for their new system Medicare. Not our Medicare, but the Canadian system that goes by that name. They had early problems, such as hundreds of thousands of people flooding the system, people who could not before get care. But it has settled down and trust me, they ain’t going back to private insurance again.

      And again, Swede, how do you spell A-N-E-C-D-O-T-A-L>

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s