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Daniel P. Malito

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To Walk Or Not To Walk? Humanizing Medicare Cuts

Posted: 07/27/11 01:11 PM ET

With the debt ceiling deadline date approaching, both sides of the aisle in Congress are scrambling to come up with a spending cut plan that will pass muster when it comes time to vote. No one is quite sure what should stay and what should go -- except for one thing, that is. Medicare/Medicaid and Social Security seem to be universally accepted as ripe for the cutting.

Out national debt is somewhere in the neighborhood of fourteen trillion dollars, and it is only going to get larger as time goes on. It is important to come up with a sensible plan to start chipping away at this debt, but we cannot and must not cut the government provided medical services any more than they already have been. This issue is of personal importance to yours truly, and here's why: I am disabled, and I rely on Medicare and Social Security to keep my feet on the ground -- literally.

Most of the congressmen, pundits, and organizations out there who are championing cuts in Medicare have no visceral ties to the program and thus will not be greatly affected by any of the changes that have been made, much less any of the new cuts that are being proposed on a daily basis. To combat this, I'd like to take this opportunity to humanize the problem for those who have no stake in this fight.

I have Rheumatoid Arthritis. Many of you are probably saying to yourself "Arthritis? That's nothing." Wrong. Rheumatoid Arthritis is an auto-immune disease which affects millions. My body is quite literally eating my own joints, destroying them bit by bit as it would any perceived threat. Since I have been suffering from the disease since the age of nine, I have serious joint destruction and have had both hips replaced. I am 34 years old now, and again I am facing joint replacement. Both shoulders have to go within the year. In order to pay for this and more, my main source of medical insurance is Medicare. I rely on the service to provide me with a lifeline to the medicine and procedures I need in order to live any semblance of a normal life.

Now, service fee cuts have already been put into place with Obamacare, and further cuts that might be applied with one of the debt ceiling reduction plans. It is no secret that more and more doctors every day are refusing Medicare patients because the reimbursement does not even cover their basic costs. What would happen if my current doctors no longer accepted Medicare?

Well, the first and immediate result would be that I would no longer be able to see the doctors whom I have been with for many years. Even a simple office checkup costs in the neighborhood of $200 dollars. If I had to pay that out of pocket, that would add up to almost $2500 a year. Without a doubt, I would have to see one of the remaining doctors in the area who accepted Medicare. Since this doctor would likely be absorbing a slew of new patients at the time, the quality of care would be mediocre, at best.

The next proposed Medicare cut would raise the costs of premiums for the patient. Currently, I receive less than $800 dollars a month as a disability payment, of which close to $100 dollars is removed to pay for medical coverage. Even if we assume the premiums are doubled, that leaves me with less than $600 dollars a month to live on. In addition, the proposed part D changes would force the pharmaceutical companies to pay a rebate on drugs purchased by low-income individuals.

Forgetting for now that it is near-impossible to live on $600 dollars (I'm forced to live at home), let's examine exactly what I would be getting for the near-$200 premium paid every month. As you probably can imagine, I take a significant amount of medication. On top of Rheumatoid Arthritis, I suffer from Hypertension, Carpal Tunnel Syndrome, and I have lost partial sight in my right eye. All of this equates to around eight different medications per day. As you can imagine, the company that handles my Medicare Part D insurance has no love for me. I'm sure my face dons many a dartboard at their corporate offices. Granted, I am the type of patient that medical insurance companies hate -- a patient that they have to actually spend their money on. Because of their reluctance to pay, I have been through the medication appeal process more times than I can count. Currently, I am in the process of fighting a decision made by the company to cut a medication that I had been stable on for four years previous. They simply decided it was too expensive, and refused to cover it.

As you can see, the part D insurance company already views me as someone whom they will never be able to profit from. Now, if Washington gets to control the rebates paid on drugs, it virtually guarantees that the price of drugs will increase. The companies will have to build those rebates into their costs, and that will result in a higher overall end price. Now, I don't have to spell out to you what increasing drug costs will do for someone who already has to fight for every "high-priced" drug that I take. If you think fail-first policy is prevalent now, wait until drug costs increase across the board. I've already detailed how policies such as step therapy can hurt patients, and these new cuts will only lead to more draconian measures being put in place.

I live my life on a day-to-day basis. The drugs I take and the quality of care I receive are directly responsible for the quality of life that I enjoy. If I was forced to see a doctor who ran a Medicare patient mill and was made to take drugs that were not specifically prescribed, there is no question at all as to the end result. Within a year, I would be bed-ridden with occasional trips in my wheelchair. No exaggeration here, readers. I have been given the gift of a semi-normal life based solely on my medical care, and Medicare (in its current form) is almost wholly responsible for that quality of life. Many of you tend to forget that it's not just the elderly who use Medicare/Medicaid. Besides, there are many other areas of the budget can and should be cut first before we put a thirty-five year old like me into a wheelchair for life. Leave Medicare alone, and let people like me enjoy a piece of the life most of you take for granted every day.

 

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