A First Person Account Of California’s Budget Cuts
Jul 22nd, 2009 | 38 responses
I am shocked to discover this morning I am a victim of the on-going budget cuts in California’s MediCal system. It seems so simple on the surface but in reality is a life-threatening disaster.
I am a diabetic low-income senior. My health is dependent on testing my blood glucose levels to determine the dosages of insulin I require to maintain a normal life. This is achieved by pricking blood from a finger tip and applying it to a test strip attached to an electronic monitoring device.
As I discovered today, MediCal no longer offers a co-pay of $3.10 for the test strips. Instead, I must pay $40 retail for a box of 25 strips directly to the pharmacy. It is mandatory to test four to five times a day. I did the math. It amounts to an average of $240 a month.
But, here’s the big picture. Between Medicare Part D, Health Net’s HMO Seniority Plus insurance and MediCal, all other medical drugs are covered with a minimal or no co-pay and almost all medical costs are covered with no co-pay. In fact, after paying my share of an initial cost of $787 for an insulin pump, all supplies and replacement parts are covered in full by Health Net — except test strips and lancets.
In my case, the test strips are the fuel which drives the engine to a healthy life which I indeed cherish. Since acquiring the insulin pump, the diabetes-related symptoms of heart, lung and kidney problems have diminished. My blood pressure is normal as is the lipid panel detecting cholesterol and triglycerides. In fact, the only concern my primary physician has is my tendency to become dehydrated.
In short, this approach to preventive medicine is saving the state, feds and private insurers thousands of dollars. Now that is questionable because some faceless bureaucrat in Sacramento drew the line in the sand over a measly box of test strips.
In the interest of clarity, MediCal stopped paying for test strips some weeks ago but I was never notified until I learned the hard way from the pharmacist when I ordered a refill today.
Paying full price for the test strips represents about 21% of my monthly income, pushing all medical costs to almost a quarter of my income. Perhaps on a national average that’s not so bad for an old man with diabetes, but it robs other areas that contribute to a quality of life.
They say health care reform involves a series of tough decisions. I fear in my case it was a stupid decision. It defies logic. It reminds me of my grandmother’s admonition of “being penny wise and pound foolish.”
I confess we low-income seniors in California may have been coddled by our state and federal governments in terms of casting safety nets in our direction. Oh, I will find a way to pay for the test strips in my meager budget. I’m old enough to go with the flow.
But it would be easier to reconcile this dilemma if it made any sense.
Cross posted on The Remmers Report
38 Responses to “A First Person Account Of California’s Budget Cuts”
Well, at least your taxes won't go up.
Exactly, Ryan. It's always this way, every time you hear the shrill cry of “no new taxes!”, that means that whatever they're talking about will be paid by those least capable of doing so.
I wish you luck, Mr. Remmers, and I wish that our state could manage their budget without putting the burden on diabetes patients.
Hear, hear!!
Mr. Remmers, you outlined the entire issue that is health care: COST! $240 a month for test strips? $1.60 per strip? I just can't believe that manufacturing costs for test strips justify the markup. This has always bothered me about the health care industry: the for profit part. I'm no capitalism hater and have owned a business myself. But when it comes to health care, making fat profits off of people's health seems so seedy.
Best of luck to you Mr. Remmers.
What brand/type of test strips do you use? Over $1 a strip seems high compared to strips that I'm familiar with. Have you tried price shopping other pharmacies, or online sources?
Jer, as we are both diabetics (you and I have talked this over when we first met on the phone for 'lessons' in uploading pix to wordpress for TMV as you were trying to undo that Gordian knot of weirdo instructions for uploads… it was a little I am afraid like the blind leading the blind… but I see you mastered it)…
and your article today about your and others' situations is INFURIATING.
Just to add to your clear facts for our readers (I wish I didnt know this sh–, but I do, have to face it every day): Diabetic complications; loss of sight, loss of circulation in legs, loss of kidney function, cardiac arrest, diabetic coma.
These are not possibilities with diabetes: they are CERTAINTIES…. IF a person does not daily take the right amounts of insulin, moderate food intake, move, and be alert to blood glucose spikes.
We who are diabetic are grateful to the ends of this universe that there are medical ways of helping us, and ways we can, with life-conduct, help ourselves to some extwnt too, otherwise Jer and I would have been dead and buried long ago. Long ago. Unchecked diabetics do not live. They die.
And those who have poor controls on their glucose via lack of medications like glucophage, and CRITICAL syringes of insulin– you see them all the time in the nursing homes at way too young an age… blind, in wheel chair, with both legs amputated.
Diabetes has two forms, both are deadly.
I cannot, CANNOT in anyway imagine how California will manage with what it will cost to take care of severely disabled Diabetics who will not be able to afford this essential part of monitoring insulin… and thus need constant dialysis, prostheesis wheels chairs, cardiac care unity services, et al.
Governor Schwartz has finally done it by putting saving of money before PREVENTATIVE saving of lives that is so straightforward, easy to follow, and WORKS!
Also, Jer, if it came to Cali, it's going to come to Colo too. And elsewhere.
Tyrone, you are ace right. Greed over humanitarian need. Wrong. Dead dead wrong.
hang in there Jer, I am seeing how much my pricks and sticks cost; i dont have ins to cover them and last I paid it was well over $100 for sticks (blood holders that are about half an inch long and made of plastic that you put into the 'reader') and the sharps cost about $50 some dollars. Frankly cheap for staying alive, but devastatingly expensive if you have no resource to turn to.
I'd suggest Jer too, that you contact maker and ask if they have program for free or far less $ for fixed income people. If the maker doesnt, for SURE, report back to us. That would be my pleasure to write about.
dr.e
Here's an index of all of the major patient assistance programs by drug manufacturers, and links to some other Rx assistance sites:
http://www.diabetesnet.com/diabetes_treatments/…
“Exactly, Ryan. It's always this way, every time you hear the shrill cry of “no new taxes!”, that means that whatever they're talking about will be paid by those least capable of doing so. “
Please explain why California is responsible for Mr Remmers' medical needs. It sounds like a tough situation, but it isn't California's fault. If anything, we should be asking why the federal government isn't helping him. I pay a lot more federal taxes than I do state taxes.
For that matter, shannonlee, I'd also ask why the private insurer through which he has coverage for the gaps in Medicare isn't picking up the tab for this. Those are all avenues that should be investigated- perhaps if Healthnet isn't going to pick up the cost that has now been dropped by MediCal, then it may be time to switch to a different Medicare Advantage provider that might do so.
Two words:
Pre-existing.
Condition.
George- I'm pretty certain that one can't be denied coverage by a Medicare Advantage provider for preexisting conditions. I assume there are restricted time periods when people can change providers though (open enrollment periods), so he may not be able to shift right away even if this is an option down the road.
CStanley–
I'm pretty certain you're not a mean-spirited person.
But did you read your own last comment?
dr.e–
Any chance of a fundraiser for Jerry at TMV?
I'm pretty certain you're not a mean-spirited person.
But did you read your own last comment?
I generally do read what I write. Why?
Around here diabetic testing supplies are paid though Medicare, not the state program (Medicaid). That's why you see old Wilford Brimley on TV for Lincoln Medical trying to get you to get your test strips through them. In fact I just checked the Lincoln Medical website and they say Medicare pays for testing supplies including strips. You might want to call your pharmacist about this. I don't know why Medicare wouldn't pay for these supplies in California.
So, are all the conservatives here satisfied with pushing California's health care expenses off onto the federal government?
Medicare has been paying for diabetic testing supplies for years. I'm surprised Medi-Cal was paying for them at all, but I don't know the medical system in California.
Personally I'd prefer that most of these things be administered at the state level, to answer your question, George, but I think what DaGoat is saying is just acknowledging that we already have a federally administered program that covers certain expenditures for retirees, and if that program covers the cost of test strips for people in Ohio and Maine then there's no reason it shouldn't do so for Californians. Like DaGoat, I'm not familiar with how each state handles the various cost burdens though.
George Sorwell, thanks for giving the reality: pre-existing conditions. And also, switching policies, most people have NO idea the huge GAPS in time, therefor in health. No idea. None. It sounds easy. But it is like waiting in line for penicillin In another nation. During the cold war.
Regarding a fund-raiser for Jerry, if he wishes, it will be so, I have no doubt. You have a good heart GS.
dr.e
CStanley, Thanks for giving readers /writers the link to 'assistance' programs from drug manufacturers; that's going to help many who know others in need Good job.
dr.e
I just came back on-line and believe me, I am overwhelmed with the heart-felt support all of you have offered and mostly to my pen pal Dr.E. After filing the post, I went to the phones with the insurance company exploring ways to buy the test strips at a cheaper price but mostly to argue with Health Net to pay for the strips since they pay for all the rest of my insulin pump supplies. I'm still looking for answers and as some of you expressed in your messages, remain confused and befuddled at the system which at this time is passing the buck big time. My pharmacist just delivered a box of strips ($40) and said they have not been paid or endure months of waiting for reimbursement from all the insurers — Medicare, Medicaid and the private carriers. I hope to achieve some resolve before this latest batch of strips run out in five days. But again, thanks to all of you with love and the kindest of regards, Jer
Jer, email me privately and I will send you half of my strips, ok? I have just opened the last box on the scrip and need to go PAY for the doc to write a new scrip. For readers, it's ridiculous to have to have an Rx for these, but you cant get them without one. THey're just little plastic strips on which blood can be read by the unit– 1/2″ each. You cant like overdose on them, or eat them, or use them even to build a computer.. Geez.
dr.e
So, just to be sure, CStanley and DaGoat are in favor of having the federal government pick up California's health care expenses?
I stated what my views are, George. Why do you characterize this as “California's health care expense” when Medicare is a federal program? We're simply questioning why Medicare beneficiaries in one state might not be getting the same reimbursements as those in other states, which seems neither fair nor logical.
GeorgeS, I am in favor of Medicare buying Jerry Remmers glucostrips like they do for thousands of other Americans. Are you arguing to turn this currently federal expense back to the states?
One of the reasons I moved from California to Arizona was for it's proximity to Mexico and reasonable prices of drugs on the ‘other side’.
Since I have only 4 more months of Cobra left and won't be eligible for Medicare for another three years I had very few options to consider BUT in the mean time my prescriptions:
… For Advair would go from $10 to $275 / mo… BUT in Mexico it's $25
… For Albuterol would go from $10 to $57 / mo… BUT in Mexico it's 3 for $6.75
I won't bore you with my blood pressure & cholesterol medicine but the savings are the same.
By simply walking across the border I will be able to save about FIVE HUNDRED dollars a month!.. And still some here seem to think the US Health System is just fine. Hells fire folks… what does it take to realize that something's not just wrong, it’s broken?
PS – A few months ago my dog contracted a skin infection… I took him to the vet and, after the $65 'normal visit’, she sold me 28 cephalexin pills for $35. They cleared up the infection but it's returned. Last week I bought him 100 of the EXACT same pills in Mexico for $5.45. I also bought a 1 liter bottle of Don Pedro Brandy for $7.45… but that was for me!
Jerry's situation is outrageous. He needs a simple product, a commodity that millions of people need, in quantity, constantly. Why on earth should he have to deal with layer upon layer of bureaucracy over it? Every other commodity can be bought on extremely competitive terms online, why not this one?
The answer is obvious of course, our health care laws are protecting him from the those affordable Mexican products whose quality…well, who knows, are probably terrific. But there might be a risk, and our industry regulators and lobbyists have–probably inadvertently–decided it's better he go without.
Ugh, it's all so infuriating.
Ever since I first started reading I always judged a group or a country by how they took care of the young, the old and the specials who can't live without help.
With 100,000+ veterans living on the streets of the united states, 7,000 women veterans living on the streets,
One of the worst birth death rates in the industrial countries,
a school system that has become a joke except for the rich elite who go to private schools,
a country where a birth defect and lack of health insurance equals death,
a country that cannot adequately care for the specials and leaves them to the predators that want victims on the street,
a country where the aged cannot be treated with respect (I remember screaming at a nurse at mom's death bed when she called her Jean and I asked if she knew Mom, “no” then I screamed she is Mrs. xxxx to you. She's my mother, you will treat her with respect.)
America pretty much rates a solid D- on most and F on the rest. That anyone could say with pride “I am an american” is a sad sick joke.
Sadly, I can solve this problem for this man by moving him to a civilized country but if I list an email I will be swamped with scamsters. I tried to help a family get out of Iraq with family treasures that had been in the family for years, but that were being abandoned or left with friends, taking only what they thought would be saleable in Egypt. I was willing to pay the shipping costs and the bus costs but my email overloaded with scamsters and I never heard from the family again. I hope they made it.
California's Governor is cutting off MediCal benefits for many low income disabled and elderly with a “waiver from the Federal government to do so”. If you have been receiving MediCal as a disabled or elderly person and you have income over $830 a month, you won't be able to get MediCal. But the Federal government has a plan that will fund MediCal for laid off workers for two years regardless of their benefits, assets, and other income. YOU CAN HAVE $,$$$ A MONTH AND GET MEDICAL if you are laid off. What do you think of that? I think it time for all public employees and representatives — Governors, Senators, Assembler Member, State and Federal employees to only have MediCal. It is a health program for the very low income families with children, disabled and elderly (and now the laid off). Few doctors will accept patients with MediCal. If everyone had MediCal, it would have to improve. Have a Happy Year 2009
CStanley–
Knowing you to be a conservative, it seemed to me that your attitude–if the state government won't pay, then just get the federal government to pay–might come across as kind of sarcastic.
Instead, nobody even sees it as ironic.
That's all.
As for why I “characterize this” as “California's health care expense”–I wonder if you've read the same post as I have. I characterize this as California's health care expense because it's a health care expense that California is–or, rather, was–paying.
I hope this brings some clarity.
DaGoat–
I'm not sure why you're calling this a “currently federal expense” in the case of Jerry Remmers.
Currently, it's a Jerry Remmers expense.
I wonder if you've read the same post as I have. I characterize this as California's health care expense because it's a health care expense that California is–or, rather, was–paying.
But we're questioning why that was happening, when it apparently is not structured that way in many or most other states. We're wondering if there was some sort of glitch- perhaps the reason that Medi-Cal dropped this is that someone realized that it was a duplication of an expense that the beneficiaries could be getting from Medicare. That's simply a suggestion, as I've said I'm not familiar enough with the details, but it could be something to check into, to see if Jerry could be submitting this as a Medicare claim.
Knowing you to be a conservative, it seemed to me that your attitude–if the state government won't pay, then just get the federal government to pay–might come across as kind of sarcastic.
It would only be ironic if that was actually a general attitude that I held. You're overgeneralizing and attempting to restate my position inaccurately, as I don't generally think that we should push off state responsibilities on the Federal govt. I think I made that clear in my first response when you questioned my position, that my preference still is for these issues to be handled at the state level. Obviously back in the 1960's a lot of people felt otherwise though and enacted a large federally administered program called Medicare, and whatever is promised to people through that program should not be reneged on. (Just because I don't agree that this is the most efficient or best way to administer a program doesn't mean that I wouldn't hold the federal govt accountable for what it has promised to do.) I'm sure that Jerry has paid into the Medicare system through his years of employment, just as the citizens of other states have, so I see no reason that he should be given fewer benefits from the program that he paid into than other people do in other states.
So, instead of trying to catch us in a 'gotcha', perhaps just recognize that we were attempting to help Jerry check into all of the potential issues to see if he is eligible for having this necessary expense covered?
Dr J–
I agree with most of your comment on how infuriating this is that this relatively common commodity should be so expensive. Actually, I'd go even further than you did. It's expensive because the government subsidizes it–or subsidized it until recently.
And as you may have noticed, Dr E complained that these strips require a doctor's prescription for no sensible reason. Unless that reason is to make sure doctors are also getting their taste.
Everyone's taking a bite out of Uncle Sugar.
CStanley–
As I said, I don't think you're a mean-spirited person. Same for DaGoat.
I'm not trying to play gotcha, but I do think there is some plainly obvious confusion in your thinking.
Maybe you've squared the circle. This is a public thread. Readers can judge that for themselves.
I don't have to have a script to get my strips but then I have to pay for them. I pay $60 for a 3 months supply (well it never quite lasts 3 months) But I've started buying my extras on Amazon and I get One touch Ultra 100 Count for $59.09.
Diabetes is expensive, even with insurance.
Just to fill in some holes in the conversation regarding the price of test strips, let’s figure out why they are so expensive.
It only costs pennies to make these things. Liberals naturally have it in their heads that the difference between the 2 cents production cost and the $1.60 sale price is profit.
Well, think again. If that were the case, hundreds of entrepreneurs would enter the business and over a very short period of time the price would drop to a level slightly above the break even level. So why the wide difference between what it costs to make them and the sales price?
Probably a couple of things – both, incidentally, probably caused by liberals. The first would be liability. Any company making or selling something in the U.S. needs to cover itself from crushing defense costs caused by frivolous product liability suits. With a product that actually draws blood, this is even more essential. If a user decided to check his blood sugar and then pick at his butt, he naturally will have a lawyer standing by claiming the strip was contaminated from the factory. No matter what, the expenses to defend the suit need to be paid. Liberals will fight to the death to defend the interest of trial lawyers to sue at the drop of a hat without any repercussions if they are wrong. Check the prices on step ladders next time you’re at the store. Half the price is liability coverage.
The second is the left wing’s old favorite – Regulation. Why would something as simple and benign as a test strip be sold as prescription only? Are there some interests that make money by doing this? Of course. Mexico (and to a less extent Canada) recognize that if someone wants test strips, let them buy it. No need to track and account for each unit as prescription products need to be.
When you think about efficient healthcare, try to imagine it with more government and see why conservatives are fighting it tooth and nail.
Butt-pickers with trial lawyers!
“Butt-pickers with trial lawyers!”
Pretty much sums up the left side of the aisle, doesn’t it?