By Ethel M. Austin
Although "I told you so" is the classic expression
to use when things go sour, there is no joy in me to read day
after day in the papers or hear on the TV or radio about the
plight of HMOs. Whether it is the sad tale of those who bought
out healthcare portions of reliable insurance companies for astronomical
sums, are paying their executives astronomical sums to run the
HMOs, or how dissatisfied the medical profession is with the
interference of non-medical personnel telling them how to advise
or treat their patients, I'm not happy.
From the very first I doubted how any company could pay for healthcare
claims without any premiums. Since the day that Lloyd's of London
insured ships cargos, it has always cost something to be able
to do this. It wasn't termed a premium then, but the principle
was the same. The payee gambled that the ship would arrive safely
and the money paid in to supply any loss would be returned with
a bonus because the money was invested in other British markets.
While today's insurance companies work on a similar premise,
the HMO's have taken a part of the Federal Medicare premium and
assured everyone that they would replace Medicare for seniors,
give them more benefits and everything would be rosy.This low
amount HMO's are getting from the government is much lower than
the claims they are paying.
From the start I advised clients to hold on to their Medicare,
take out a Medigap policy, join ConnPACE for medications if eligible
and to readjust their budgets to make this possible. For all
the coverage one can get, there is still a need to "put
a little each month aside" because an illness always costs
more than one imagines.
Having spent part of my working life in an insurance company,
it seemed to me that those on HMO's could not benefit for long,
as the negatives were against them. I was amused when I saw a
cartoon which said HMO means Healthy Members Only, and while
these policies do fill the gaps for seldom ill (but occasionally
injured skiing, or driving or swimming) younger members, we third
age members, with multiple ailments, many controlled by high
medication costs, were just not really covered. In addition,
many had to give up long time physicians, sometimes family members
who charged them little or nothing, and had to run all over the
place for pharmacies, blood labs, X-Rays or other tests they
formerly had right in the office, or in the building where their
long term doctor had his practice.
For those with transportation on Dial-A-Ride limited to one ride
a day, these and other tests required for the doctor to make
a sensible diagnosis, became a major problem.
For those who found that retirement income was even further limited
by rising medical costs and who changed to HMOs now find themselves
unable to get back on their old policies because they have developed
serious health problems which are uninsurable.
For all these reasons, I take no joy in saying "I told you
so" but certainly will help in any way I can to solve individual
problems. I am available at the Salvation Army Senior Center
after my vacation is over on October l9, for you to come in to
see me, because each problem is different. I do not make appointments
but am frequently away from my desk, so you can call after the
l9th to make sure I am there when you can get to me. I hate to
disappoint you, or to have you make a trip to no avail. Call
Also standing by to help anyone who is dropped from a company
or whose doctor drops out of the HMO and leaves them stranded,
is the North Central Area on Aging Agency at 724-6443. Ask for
the Choices Dept.
We both can also help those who have no health insurance at all
but feel they need to look into it. Those about to retire need
to explore this area carefully to make the right choice as third
age members, those over 65, have a possible 30 year life span
The AARP Hartford Chapter meets next Wednesday, October 2l,
at 1pm at the American Legion Post, 2121 Main Street, Hartford.
Each paid up member is requested to bring the name and address
of elderly shut-ins for the Holiday Season mail list by the Cheer
Fund. Hartford and Bloomfield residents are the sponsors of this
New members from these communities are invited to join. For more
information please call 249-0056 or 728-339l. Also call one of
these numbers if you cannot make this meeting to give them your
list of shut-ins.
Talk with you next issue.
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