[niko851]

Hi all -

I'm glad this was brought up; I was just put on this stuff 3 days ago (100MG), was given a 30 day free supply, courtesy of Astra-Zeneca... And trust me - they can afford to give ALOT away.....

Problem is - more and more ins. co's (I have Aetna for now - soon to be insureless since I've already 'capped out' for the year) have mandated formularies - which more/less means that they don't care what you doctor tells you you need, the ins. co. has teh ultimate 'say' as to what you get...

For Generics, I used to pay $10, $20 for Brand. Now they changed that to 80%, I pay 20%. Now for some, that was in my favour; for others, they went up. For Brand names, like most of what we take, they 'meet you half way' (50%)... Isn't that special? So instead of having to pay $20 per brand name, I now have to pay 50% - and all that on $150/week with what I get on DB. They also capped the amount they would cover - whether generic or not - at $2,000 PER YEAR... I can literally eat that up in 2 months; in fact, just got a letter from them saying I've hit the maximum on Outpatient psych, counseling, or other 'mental health services; another one stating I have EXCEEDED my maximum on diagnostic testing and I should 'expect a bill for the difference from the provider'; and the third one said that "I need to plan ahead and/or talk to my doctor about current medications as I have utilized $1,872.00 YTD for RX coverage...... So in 3 months time, I used up damn near everything - and I still have to cough up another $142.00/month.... Well, obviously THAT will not be paid since I literally have no coverage for anything......

My only saving grace? I have to fill out EACH company's 'poor folk' form in order to get my medications free-of-charge. Another kicker to this? It is only good for ONE medication per manufacturer. Since I have 3 that are made by A-Z, then I guess I have to pick the most expensive one (the Seroquel if they keep me on it) and go sell my behind on the streets to pay for the rest. It will be several months before State Medicaid kicks in, so I may end up having to go without again... It won't be the first time, nor the last, nor am I the only one that is up against several high-profit corporations.....

I know DaveyJ (hope your move went well by the way - I apologize for not writing to check on ya ] has INCREDIBLE resources that helped me out. He pointed me towards NIMH and other agencies that offer 'some' assistance. There's a waiting line, so be prepared. By the grace of God, I found a local behavioural clinic that offers low-to-no cost services, depending on income, nd they have on-site case workers to sign you up for State Medical (in Indiana, they call it "Hoosier Healthwise"). i guess it is not truly 'medicaid' bcuz you have a monthly premium to pay, of course dependent upon your income and family size, but I tell ya'll this - it is 100 times BETTER than any private insurance I ever had. Everyone is doing cut-backs left & right, the people who need care aren't getting it, and we're paying more and more out of our money trees that are takign over our property... I mean they are just SOOO pleantiful that I don't have a right to say a word..... Yes, sarcasm is what gets me 'over' this beauracracy for the most part....

What I REALLY do not understand is how good ol GWB and Congress passed a RX coverage for Medicare, for older people, who have to go to a damn classroom 'class' just to get information. It's further ridiculous that pharmacists have to be scheduled to handle 900 senior citizens who don't understand the Encyclopedia's they were sent about their coverage options. The kicker of them all? If they don't decide by May (I think it got extended bcuz no one knows what the hell is going on with the programs), they get PENALIZED - yes PENALIZED BY HAVING $$ TAKEN FROM THEM EVEN IF THEY DO NOT ELECT COVERAGE IN TIME!!!! Then, you are STUCK with that company that you 'chose' for a minimum of one year!!!!

I had to work w/an elderly friend of mine who is quite intelligent, but bcuz of having 300 different choices, she and I LITERALLY had to go medication by medication, price by price, and plan by plan to determine the 'most economical' choice. For example, she is on the following:
1. Lipitor
2. Singulair
3 Advair
4. Arthri??? something or another
5. Zocor
(and some generics).....

Now, Plan "A" will cover 1,2, & 4 for chump change, but no coverage for 3 & 5. Plan "B" will cover 2-5, not too great, and no coverage for 1; Plan "C" will NOT cover any, but will offer a 10% discount on them until she spends $1,000 per year and then she'll get all 5 for 80% covered. The plans go on and on and on......

Now, should her doctor change to antoher medication, she runs the risk of it either being non-covered by that provider or on the '^%&# discount" formulary. To top it all off, we went to TWO different seminars and about 5 different pharmacies - all of which gave conflicting information and really didn't know what they were talkig about.

Finally, we took 2 FREAKIN' WEEKS and did the math, etc. ALL ALONE and found out that plan "AHE-2" (being a smarty here) was the 'best choice' as long as her physician(s) keep her on the same meds. No offense AT ALL to any seniors out there, but I, as a 28 year old, had a hell of a time helping her - and I can only imagine what you [seniors] have gone, going, or are going to go through.. This was NOT thought out at all - this was put together with the DRUG CO's in mind, and again, if you DO NOT elect coverage, YOU STILL HAVE TO PAY PREMIUMS!!!!

I don't know about anyone else, but I'd rather pay some flat-fee a month, have EVERYTHING covered whether I use it or not, and NEVER EVER EVER have to choose between eating, paying my house pyament, car payment, or MY HEALTH... It TOTALLY disgusts me that the USA 'PROCLAIMS" to be the richest, best, and fairest country in the world when we CANNOT EVEN TAKE CARE OF OUR OWN!!!

We spend MORE money for taking care of our 'obligations' to others BEFORE we take care of our own people.... If we spent just a FRACTION of what we did on this 'war on terror' on heathcare, I'd be willing to bet a hell of a lot of our OWN NEEDY PEOPLE would be taken care of. We ouldn't be living in poverty or relyig on food stamps, others, charities, etc. JUST TO LIVE.... I'm in this sinking ship - and I guarantee I'm on it with many many people - even people on here!! It's no wonder that they had to change bankruptcy laws and raise credit card minimums - WE CAN'T AFFORD HELTHCARE AND WE'RE FILING BANKRUPTCY'S LEFT & RIGHT TO GET OUT OF THE TENS OF THOUSANDS WE OWE TO HEALTH PROVIDERS... It's a HUGE shame that the ones who do NOT have to worry about these things are the ones who made it SO MUCH HARDER for those who DO worry every minute of the day if they are going to be able to eat tomorrow...

My final thought: If all our legislators were FORCED to use the plans they came up with for 6 months, they would ALL be crying a new lake, not a river.. As per usual, the rich get richer and the poor get poorer and screwed... Some will defend this with "well, it is better than nothing at all" and yes, this has merit - but VERY little... Just as I said in the beginning, I had 3 months of 'grace' where I didn't have to worryabout paying for all this... For the remaining 9 months, I have to concoct plans to break-in to pharmacies so I can get my meds. This is beyond sad; this is a disgrace.....

Sorry all for going off the deep-end on this one; I'm not in a manic phase nor a depressive phase right now so I had to get it out while I still could..... Hope ya'll are doing well and are doing the best you can with what you have......

I also have added two questions to this posting as a "poll":

1. Do you feel Americans have access to AFFORDABLE and QUALITY healthcare (Yes/No)?

and

2. Do you feel that the Medicare RX program is beneficial to MOST senior citizens OR the Drug Companies? (Seniors/Drug Co's)?

[DaveyJones]

Couldn't have said it better, except that the insurance companies are making out like bandits, too...(move went OK, by the way, thanks...)

DJ

[SleepsWithButterFlies]

Ya know...I am gonna lose my house soon as I use 100% of my income for my medical care now....sigh and that story will be posted in general but ..this is just crazy and I do NOT qualify for ANY aid.....because I make too much 1700 a mo and they dont care if I pay 1547.00 of it on my medical insurance ..the rest on co-pays on rx some are 50 dollars and nobody cares all in all

[allthegirls6]

This is all quite scary to read. Here in the Uk we can see our doc as often as we want with no charges. If you dont work all medication is free of charge. It then goes on a sliding scale for income but basically the most you will pay for medication is £7, thats about $11. My GP gives me prescriptions for the largest amount of drugs I need. That is, for example paroxetine - she can write a prescription for say 120 pills and all it will cost me is £7. Its something we take for granted here, free health care. If i need an op i just wait my turn and get it free. Sure there are problems, long waiting lists etc but if its urgent you get seen there and then, no money exchanges hands. I still cant get my head round having to pay for health care. ATG

[SleepsWithButterFlies]

(((( ATG )))) I know its very scary here now..we get good care but at WHAT cost..I would move to Canada in a second..I lived there once I like the US better but now with the health care issues Id move...they are taxed a lot....

[sujunew]

I have just been in chat saying how lucky we are here in NZ with our health system which is more or less the same as in the UK. Ppl take it for granted, or they grumble about the cost of healthcare (if only they knew, after reading all of the above)! The mental health system here, esp in the (small) city I live in, is fantastic. If you are put under the community mental health team you are assigned your own case worker (nurse), you have access to the psychiatrists, the social worker (who does needs assessments which allows healthcare workers to come into your and help with housework, domestic chores, personal aide, whatever you need), and all sorts of support groups etc, AND ALL FOR FREE. Where I live too, there a 2 day centres for mental health consumers- for a gold coin donation ($1 or $2) I get to go to the gym 5 days a week, and I could be taking part in organised activities etc also. As the song in my head is going... "We don't know how lucky we are". (Oh, and medical insurance isn't needed at all either...)

[Larry_Hoover]

About the taxes....

I saw an economic comparison last year that looked at the percentage of an individual's productivity that went towards funding government, and it adjusted for the difference between the U.S. and Canada on how health care is funded; Canadians pay taxes for health care, whereas Americans pay private companies for their care.....and it was pretty much a wash. The dollar cost difference was less than 2% of individual productivity, between the two systems. That's everything all rolled in together, federal and provincial/state taxes, and services funded privately. We do things very differently, but the individual pays about the same, on average.

Yes, I pay more taxes, as a Canadian. But, I don't pay for health care directly. Right now, in my individual situation, I not only pay (virtually) no taxes, but I still retain my health care privileges, which are granted to me as a Canadian citizen. I need help right now, not bills I can't pay. And soon, this year, I expect to be paying my full taxes once again.

I think health care ought to be a right, just like free speech. It's in the Canadian Constitution. It's a right, in Canada. I don't really know what it takes to establish legal residency in Canada, but once you do, you get the same care I do. The same right to care, I mean.

Lar

[funnygirl]

Hi

Just an additional note to Allthegirls6. Waiting lists for operations in the UK are very short now - under New Labour it's the law that no-one waits longer than 6 months, and the lists are actually very much shorter, about 2 or 3 months at the most. My sister has just had an op and she got her admission less than two months after the initial consultation. All good news.

Yes, it's terrific to receive free healthcare and I'm surprised that the richest country in the world (USA) hasn't yet got it together in that respect, probably because it smacks of socialist tendencies. What a shame for the poor and sick. It's a travesty of so-called freedom.

FG

[dottie]

Exactamundo!

[drunksunflower]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
irishsj said:
I have just been in chat saying how lucky we are here in NZ with our health system which is more or less the same as in the UK. Ppl take it for granted, or they grumble about the cost of healthcare (if only they knew, after reading all of the above)! The mental health system here, esp in the (small) city I live in, is fantastic. If you are put under the community mental health team you are assigned your own case worker (nurse), you have access to the psychiatrists, the social worker (who does needs assessments which allows healthcare workers to come into your and help with housework, domestic chores, personal aide, whatever you need), and all sorts of support groups etc, AND ALL FOR FREE. Where I live too, there a 2 day centres for mental health consumers- for a gold coin donation ($1 or $2) I get to go to the gym 5 days a week, and I could be taking part in organised activities etc also. As the song in my head is going... "We don't know how lucky we are". (Oh, and medical insurance isn't needed at all either...)

</div></font></blockquote><font class="post">

yea we're not too bad ... but i dislike how i have to pay $60 for a ten minute dr visit ... when I was a student it was fabulous, free dr and $3 prescriptions.

sure i earn quite well but i also know that the income threshold for free healthcare and subsidised prescriptions is NOT that high - e.g., we have a Community Services card for lower-income families/students etc - it's good if you can get it, but i've interviewed (through work) people who *just* do not qualify - so their medical expenses (whether they be physiological or psychological) are still very steep. They may be able to do OK day to day, but an unexpected illness can blow the budget.

I have fairly comprehensive health insurance through work, but I would *never* claim anything to do with depression or anything through that policy - too risky (and some policies don't fully cover any medical conditions like depression or PTSD).

I do prefer the British system - even when I'd only just moved there to work it was entirely FREE and all you do is subsidise the prescription charge (a few pounds). I don't know about the more comprehensive psychiatric component though (like mental health nurses etc) in either country.

We are lucky in comparison to the USA, certainly, but it's not all roses here either.

[DaveyJones]

You guys aren't lucky...you're SMART!

Things are the way they are here in the US because it might cost the insurance companies and drug companies a penny or two to move to a single-payer (goverment) system. Never forget, in the good ol' USA, the only thing that counts is the bottom line...period. If you're ever confused as to why the United States adopts a particular policy, just follow the money!

DJ (Just call me a socialist, I guess!)

[funnygirl]

Yes, that's where the capitalist society falls down - right on its bottom line!

Give me Socialism every time. They care about everyone, young, old, poor, not just the moneyed and high-born, which is why the UK government are reforming all the hereditary stuff like the House of Lords etc. High time they got rid of royalty too, IMO. Such a load of privileged twerps. They disgust me.

FG

[(JD)]

Hmm IMO that's a bit too far along the political side on which to comment...

[Azalysa]

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drunksunflower said:

I have fairly comprehensive health insurance through work, but I would *never* claim anything to do with depression or anything through that policy - too risky (and some policies don't fully cover any medical conditions like depression or PTSD).

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This is one area that has improved in the U.S. I remember in the past when filling out paperwork for a new job it included past medical history. I always debated if I should include depression and the meds I was taking or not. Even though the group health insurance was never denied, one still had to list any illness (including psychiatric) they had, so everyone whose hands the paperwork passed (bosses, secretaries, etc.) could see that information. Not real secure.

Now with the new HIPPA law on medical privacy, medical history cannot be asked and medical information has to be handled ~very~ carefully. I know from my job in Workers Comp that anything I saw re: other health conditions an injured worker had that were unrelated to the reported injury could not be relayed to ANYONE, including the employer.

If I'm not mistaken, keeping HIV/Aids info private was the forerunner of this. I for one am VERY grateful for the HIPPA enactment.

On the flip side, the only way in this country to have good health insurance is to have a job that includes this as a benefit. There is still a cost, but mostly paid by the employer. There have been times I stayed with a particular job JUST for the insurance due to my medications and pdoc visits.

HOWEVER, this absolutely precludes those of us who can't work; not because we don't want to or are "lazy" (as I've heard uneducated people who don't live with disabilities sometimes say) but because we are ill!!!

Which goes right back to Niko's original post. Well done, Niko. And yep, Davey, follow the money. On capitalism vs socialism, I'll plead the fifth.

[DaveyJones]

Please don't get me wrong; I am not advocating "Socialism" per se. What I DO say, however, is if advocating for universal health care makes me a socialist, so be it!

DJ

[LMo]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
drunksunflower said:
I have fairly comprehensive health insurance through work, but I would *never* claim anything to do with depression or anything through that policy - too risky (and some policies don't fully cover any medical conditions like depression or PTSD).

</div></font></blockquote><font class="post">

You're right that treatment for depression and other MI's really ding you when you apply for private insurance. I've taken the hit on that a number of times. However, it is a huge risk to take to lie about medical history to your insurance company. If you ever had a big claim, the insurance company is going to comb through your personal life and if they find any evidence that you lied, then your coverage evaporates because you breached the contract. I wouldn't take that risk, but I also feel an ethical obligation to be truthful.

The other thing is that we will never combat the stigma of mental illnesses if we deny our own experience. I WANT insurance companies to know that they are better off having us be truthful and get treatment, than to NOT get treatment or lie about it because we get penalized. At the risk of sounding like an activist, I believe that worldwide outreach and reform is badly needed regarding mental health treatment. We just had another "postal" situation here in the US a few months ago. If people were encouraged and supported in getting the treatment they need, then the world would be a much better place.

I'll get off my soapbox in a second, but I would also like to say that I am very well-respected in my field and am considered to be successful by most standards. However, I freely admit that I go to therapy and advocate therapy for ALL adults, whether or not they have a problem. Now that I'm starting meds, I will freely admit that as well. I want to set an example of how it can be "okay" for people to seek therapy and make themselves the best person they can be. The stigma is ridiculous in this day and age, and I'm doing my part to dispel it.

[(JD)]

With regards to HIPPA...it only protects the original doctor, not the patient, imo. Once you sign that waiver, which you must,btw... you have no more control over your records. Secondary -Other - doctors, insurance claim agents, and even lawyers who receive (after asking for) your records HAVE NO LEGAL REQUIREMENT now to keep your information confidential. I've been hit by this fact personally.

[wheretogo]

i used to take a generic of Atarax - hydroxyzine Hcl for anxiety which was a round purple tablet (50 mg), when i went to pharm to pick up refill it was hydroxyzine PAM generic for Vistaril a capsule that is green and white (50mg). What is the difference?

[Azalysa]

LMo,

I'm with you 100%!!

I've probably said on this board until people are sick of hearing it that the #1 reason I sought grad. work in mental health counseling is to become better educated on the full range of mental illnesses, not just my particular "flavor" and to get some credentials as, at the time I intended to become licensed...and I still might.

So, I said all that to say that I too see myself as an activist in my little sphere of influence but hope to see that widen as time goes by.

One thing I was really pleased with was the way my disability from work was handled. Meaning no disrespect to anyone with my next statement - but I have seen women take months on end off for maternity leave (and most needed) as well as any kind of surgery, etc. So I felt it a step in the right direction to have my psych illness covered, with no questions asked!

I'm sort of rambling here, but I haven't done my taxes yet and that's on my mind...lol.

[TortieKitty]

I am fortunate in some respects that I work for a state agency, so we have decent security when it comes to insurance and retirement. I'm on a PPO, and generally, it works out. However, it wouldn't pay for custom orthopedic inserts for my shoes even though it'd probably pay for surgery, which is silly. And what gets me the most is dental "insurance," which is a terrible misnomer. Health insurance covers everything--you may have to pay a percentage of the cost, but if you were in a car wreck and needed lots of work, it'd pay. Dental "insurance" is just a capped fund. There's X amount of money, and when it's gone, it's gone. I've paid $8000 out of pocket for dental work. $8000. Half of that was from my grandfather's bequest. They sent me a check for $4000, and I turned right around and gave it all up to my dentist. And outside of some bleach trays (which he charged me cost for), everything I've had done was needed. It pisses me off.

[Azalysa]

Same here, TortieKitty (love that nick, btw)...

I've spent vast amounts of time in the dental chair, beginning at age 3. Unfortunately I have/or inherited very cavity-prone teeth. By the time I was a young adult, pretty much every tooth had a filling. Now, almost every tooth I have is capped, in addition to most having had root canals.

I don't even want to add up the amount, but I totally agree on dental insurance.