"I'm so sick from this COVID," Jacqueline Smith cried over the telephone. "I don't have $952!"
On Sunday, Smith, a Sun-Times subscriber who lives on the North Side, had written to the metro desk:
"Dear Sir or Madam," she began. "I'm 85 years old and somehow caught COVID-19. I've tested Saturday and when I went to get a prescription filled for Paxlovid I was told it would cost me $1,450. The cheapest I could get it from two pharmacies was $950. I am on living on my [Social Security] check every month. I have no savings. I'm supporting my mentally disabled daughter also. ... I called Medicare to find out why it's not covered but they aren't available on weekends so someone is calling me back on Monday, hopefully. Can you help me find out what is going on with this? I'm desperate."
Among the many uses of a newspaper — news, puzzles, filler for packing boxes — is court of last resort for the desperate. The city desk forwarded the email to our consumer reporter, who was on vacation. She passed it back to an editor, who nodded at me. Among my several functions is to be the paper's free safety, lurking in the backfield, ready to tackle any story that slips past my sturdier colleagues.
First, call her.
"I don't know if Trump canceled ..." Smith said, quite upset. "Maybe he did something where people can't get Paxlovid for COVID."
I said I'd see what I could find out. Nothing online about Medicaid refusing to pay for Paxlovid, the drug used to squash COVID in its early stage. If this were a thing, as the kids say, something probably would be there. Though perhaps this is the vanguard in the fast-moving destruction of the government over the past month.
Next call, her physician, Dr. Ariel Katz — I identified myself to the nurse and said why I was calling. She hung up without a word. I phoned back and went straight to voicemail. Far be it for me to lecture a doctor. But remember the Bible story about being kind to strangers, lest one be an angel in disguise. Or a newspaper columnist ready to question the professionalism of your office in print.
I had better luck with her pharmacy, at the Mariano's on Halsted.
"Her insurance on Medicare wanted something ridiculous," Mariano's friendly pharmacist said. But it isn't that Medicare won't cover it. "Other patients have gotten Paxlovid; Medicare completely covers it. The problem might have been her deductible."
So not a societal issue, but something particular to this reader. That happens. Many, as Thoreau neatly put it, "mistake their private ail for an infected atmosphere.”
Or is it? This is where time helps. A situation sometimes has to mellow for the news to rise to the surface. The next morning, the part of the above that represents a significant development we will see across the country in the days, weeks and months to come occurred to me. Let's play, "Be the Reporter" — can you spot it?
It's the uncertainty, the "I don't know" part. Not knowing whether your medicine is still covered or if there is anyone still employed in the right department to help you — an issue already, on our health care system's most efficient day, now made far worse by Donald Trump and Elon Musk ripping out the guts of federal agencies and flinging them over their shoulders like toddlers going at a low china cabinet, slashing programs that help regular Americans so tax breaks can be given to billionaires.
"The whole nation is anxious and that includes older people, especially these Medicaid cuts," said Dr. Naoko Muramatsu, a professor in the University of Illinois Chicago School of Public Health and co-director of the Center for Health Equity in Cognitive Aging. "Whether you can get this coverage, whether this procedure is covered, that kind of thing has been always there. The new thing is uncertainty about anything that involves federal funding."
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Corporate-forced malpractice is already so rampant in our area that even people with decent coverage and means are looking wild-eyed. Even Trump supporters, though they place ultimate blame on immigrants, sloths and Democrats.
ReplyDeleteUsed to have 2 local hospitals. One is now a MASH unit without the medical expertise and compasdion of Hawkeye and Trapper John. The other is a little better, but ships patients to their main corporate hospitals a few hours across the adjacent state border which most insurers will not cover. One hour north were our nationally-recognized hospitals. Despite all the positivity marketing, they can't raise their local ratings above a 2.9. Meanwhile staff encourage patients to avoid both ERs and the chances of seeing a qualified doctor instead of a PA in under a year is slim, unless you are of a certain clique safe in the knowledge you will be moved to Grand Rapids, Ann Arbor or Cleveland where the "real doctors" are. The elderly, working class and the poor...well, need to cull the herd ...
Gotta love this Judeo/Christian nation.
The healthcare system was an absolute travesty already even before Trump and of course he's making everything a million times worse.
ReplyDeleteI'm a little confused with her situation though since she said she was calling Medicare to figure it out, but then you're talking about cuts to Medicaid and how many people depend on it. If she has no savings she should qualify for Medicaid and that should cover the prescription without a deductible. She might have both, Medicare and Medicaid, and the confusion is on the pharmacy's end getting it covered? Just an example how byzantine the bureaucracy is, which is an unconscionable evil, causing so much unnecessary suffering.
This situation confused me, too, because the US Government Patient Assistance Program (USG PAP) should still be functional (but maybe it has suddenly been shut down??) . In any case, Paxlovid has always been expensive, but patients should still qualify for patient assistance for it through the end of 2025. Even patients on Medicare can usually get some assistance if unable to meet co-pay requirements. At least that's what their website says.
DeleteHowever, you have to apply for the assistance, and as you all probably already know, Paxlovid only helps if started within 5 days of developing symptoms. So the red tape involved might have rendered the cure ineffective, in this case.
Which is more reason to be angry about our health care system's dysfunction.
I am worried about what lies ahead for us.... it may be true that RFK, Jr will not stop folks from getting vaccines. But if the vaccines aren't mandatory or recommended, access to them will be more difficult, and insurance will likely stop covering them. $$$ = even fewer vaccinated .
Medicare may cover Paxlovid now, but it wouldn't surprise me if that changes soon. This administration has shown that cruelty is its primary reason to exist.
ReplyDelete👍
DeleteI believe you're right. Ever greater piles of wealth, sure, consolidating power, sure, but cruelty above all.
DeleteVery true words
DeleteAs someone has repeated posted on Blue Sky, 32 of 33 industrialized countries on the planet, have managed to make national health insurance work.
ReplyDeleteWhy can't the 33rd, the USA do the same?
Because of republicans, and Joe lieberman.
DeleteBecause of fox news, youtube, newsmax, meta...
also because democrats are spineless.
Shareholders.
DeleteIt's probably the deductible. I went to renew a prescription I'd been paying $40 a month for in January. Now it was $297. Walgreens could not explain what was going on. Humana wasn't very good explaining it either. What I finally figured out was that my yearly deductible for prescriptions had gone from $0 to $250. So this was a one-time charge. Once you get the deductible out of the way, you price goes back to where it was before. I asked Humana why they couldn't take the deductible out in installments but got nowhere. The lesson I hope I've learned here is to read those notifications your Advantage plan sends you telling you about the changes for the following year.
ReplyDelete"Because we don't really care"
DeleteHumana is a nota good one either. Many people think of saving money but then pay with poor coverage in the long run. Stick with trad. medicare and the supplent. And if it's just a supplement steer clear of some brands. UHC is the one with the CEO who was denying most claims. Not sure if that was medicare related.
DeleteAnother possible answer is if you can afford Medicare Part B, stay away from Medicare Advantage plans. They work pretty well until you get sick, but then it’s a crap shoot.
DeleteWe do worry about Medicare coverage. Certainly. But of equel concern to we seniors SHOULD be the annual increases to our private supplemental coverage. Like many of you folks I have Blue Cross/Blue Shield of Illinois for my supplemental. My monthly rate is going from $142.50 to $197.00 in April. That's a crazy jump in one year.
ReplyDeleteRomberg, have you not been paying attention to what republican's have been saying for close to 50 years?
DeleteAt some point people really need to understand Pastor Martin Niemöller's "First they came."
If you don't protect the other, you protect no one.
Try Mutual of Omaha for the supplement. And steer clear of Medicare advantange. That could be why this lady's deduct. are so high.
Deleteas part of president widens inflation reduction act:
ReplyDeleteSeniors Won’t Pay More Than $2,000 for Drugs at the Pharmacy Starting in January.
“Before the law, there was no cap on what Medicare enrollees might have to spend on medications covered by their Part D drug plans. They were on the hook for 5% of their drugs’ cost in the so-called catastrophic coverage phase, which, in 2023, began when they hit $7,400 in out-of-pocket spending.”
“More than 3 million enrollees who do not receive Medicare’s low-income subsidy should benefit from the $2,000 cap, according to AARP. That figure will rise to more than 4 million in 2029. About 40% of beneficiaries who reach the limit between 2025 and 2029 will see an estimated annual savings of $1,000 or more.”
this is a challenge seniors on limited incomes struggle to deal with. Biden made it better as far as I know trump has not reminded this very popular benefit.
its tough not having enough money
hope to see everybody at the federal plaza today at noon
I will be there.
DeleteI never really understood the idea that everyone needs to suffer for the mistakes of a single person. If one person talked during silent study time in grade school, the entire class had to have five more minutes of quite study. A single player decides he's mad at the ref and says something he shouldn't the whole team essentially looses a few points and the ball.
ReplyDeleteMost of society operates this way, the idea of all for one and one for all. It's annoying, but when everyone believes in the same thing, its not too painful.
Then there are the "outliers."
One bad apple spoils the bunch? Not for cops. Not for CEOs. Not for corporations. Not for millionaires. Not for elected officials, well i guess democrats are maybe held that standard.
We as a country will suffer dearly for the actions of very few.
And if we make it, i doubt those who are responsible will be held accountable.
Let's make a complicated system even more complex. Thank you republicans and you know who. Hang on it's going to get worse. BTW, I voted for Camilla.
ReplyDeleteGreat story about the seven marriages! And a very real point about how not knowing is an additional stressor all on its own. A lot of that going around these days.
ReplyDeleteBut the usual confusion on Medicare vs Medicaid. Not the same thing at all. Traditional Medicare doesn't cover prescription drugs at all, and Medicare supplement plans don't either. Those of us on traditional Medicare (Part A) have to have both a Medicare supplement plan (Part B) and a Medicare prescription drug plan (Part D). Nationwide there are 464 Medicare drug plans--in any one state there are at least a dozen. There are fifteen in Illinois from six different companies. so even if you know you have a Blue Cross plan, you have to know which Blue Cross Plan. They all have different formularies, co-pays, premiums, and deductibles.
Or people can be (God help them) in a Medical Advantage plan (Part C). There are more than 100 of those in Illinois, including 26 from Aetna alone. All with different etc etc etc.
If a person is on Medicaid (generally very very low income) Paxlovid is covered with no co-pay.
No wonder no knows anything. The good news is that actually there is a program, apparently continuing through 2025, for people to get Paxlovid from a government patient assistance program operated by Pfizer. Her pharmacist should have told her that. https://www.medicareinteractive.org/resources/dear-marci/will-medicare-cover-my-paxlovid-prescription.
The bad news is that the latest research suggests that Paxlovid does not actually reduce hospitalizations in older adults. https://www.uclahealth.org/news/release/paxlovids-impact-hospitalization-and-death-covid-vaccinated
It's a mess. And a shame.
You mean Kamala? spell it right if you voted for her
ReplyDeleteMaybe she wrote in the name of the wife of King Charles III...
Delete“So whoever I was dating, we ended up getting married.” she said.
ReplyDelete“Marry me and see the world.”
So she is used to turbulence.
We’d all better strap in. It’s going to be a bumpy flight.
Killer wrap-up, Mr. S, after all that negativity.
Always leave 'em laughing. I sure as hell did.
Brightened my busy day. Thanks.