The Medicare System and Senior Citizens

Medicare benefits are, inevitably, something we must all become familiar with as we get closer to retirement age. However, what exactly is medicare? When did it begin? And what is its purpose? Here is a brief outline of the federal government’s medicare program, including its history and the rationale for its existence. Medicare came into existence in 1965. It was created as one of the component parts of then-President Lyndon B. Johnson’s “Great Society” initiative. The principal purpose of medicare was to provide a system of healthcare for elderly U.S. citizens, i.e. individuals who were sixty-five years of age or older. However, medicare benefits are not simply for the elderly. Medicare is also availabe to individuals who are younger than sixty-five and who are disabled.

Qualifying for medicaid benefits on the basis of disability status, of course, requires that a person file an application, or initial claim, for title II benefits with the social security administration. Title II benefits are mandated under title 2 of the social security act and title II benefits are commonly referred to as social security disability benefits, or SSD.

Individuals who are approved for social security disability benefits are eligible to receive medicare benefits two years after their date of entitlement has been established and, no doubt, this provides for a healthcare safety net for disabled citizens who must subsist on a relatively small monthly disability benefit.

Who is eligible for medicare? Fortunately, unlike supplemental security income and medicaid benefits, medicare is not considered a needs-based program. In other words, younger individuals who are disabled and individuals who are of retirement-age may be eligible without regard to their income.

Until recently, medicare benefit coverage was thought of primarily in terms of hospital insurance and medical insurance. Medicare part A covers hospital visits and nursing home stays, while medicare part B pays for outpatient care and services, including doctor’s visits, xrays, and lab reports. However, the medicare program was recently restructured to include a prescription drug benefit. This is known as medicare part D.

Medicare part D went into effect on January 1st, 2006, as part of the Medicare, Prescription Drug Improvement and Modernization Act. Medicare Part D is available to any individual who is eligible to receive medicare part A and medicare part B benefits. The intent of medicare part D is to guarantee prescription drug coverage for medicare beneficiaries. However, the federal government does not actually provide this coverage. Prescription drug coverage under medicare part D is provided by independent drug plans that are actually operated by private health insurers, though, legally, such plans are regulated by the federal government, i.e. the medicare program.

Are medicare benefits free? No, medicare part B requires the payment of a monthly premium which, for 2006, was $88.50. However, for those individuals who might have difficulty paying this premium, an assistance program is available to qualified individuals to pay part B premiums. This program is known as MQB, or medicaid for qualified (medicare) beneficiaries. Like other types of medicaid, this particular medicaid program is needs-based and serves no other purpose than to pay a medicare recipient’s monthly medicare insurance premium.

The Medicare program may well be the most transformational program to arise as a result of Lyndon Johnson’s Great Society initiative, and its effect, in many ways, may be as profound as the creation of the social security program under President Franklin D. Roosevelt. Recent estimates hold that medicare accounts for more than a tenth of all federal spending and approximately one-third of healthcare spending.

The author of this article is Tim Moore, who, in addition to being a former food stamp caseworker, medicaid caseworker and AFDC caseworker, is a former disability claims examiner. He publishes a blog on the disability process which is titled the Social Security Disability and SSI blog

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Trasylol Heart Surgery Side Effects

In 1993, Trasylol (generically known as “aprotinin”) received FDA approval for use in certain cardiac surgeries. Trasylol is still used today to reduce the amount of blood a patient loses both during and after a surgery. However, a mounting controversy surrounds the continued use of Trasylol, and in February of 2006, the FDA issued a public health advisory warning physicians to limit use of Trasylol. On September 21, 2006, the FDA met to investigate the dangers of Trasylol. Although Bayer appeared to cooperate with this FDA investigation, Bayer was withholding data from a study which indicated Trasylol causes life-threatening side-effects. The FDA learned that Bayer did not disclose this damaging data shortly after the FDA completed its investigation. However, the FDA learned about this data only because a scientist from Bayer’s study tipped off the FDA. Bayer did not willingly disclose the data to the FDA even when Bayer representatives were face to face with FDA officials to discuss the dangers of Trasylol, and even though numerous FDA officials commented to Bayer that they needed more data.

The damaging data from Bayer’s study indicated that Trasylol increases a patient’s risks of death, stroke, congestive heart failure, and kidney failure. This data was comparable to an earlier study that indicated the administration of Trasylol during surgery dramatically increases a patient’s risks of life-threatening complications and death. This earlier study showed Trasylol use during surgery results in a 181% increased risk of stroke or encephalopathy, a 55% increased risk of heart attack or heart failure, and an over 200% increased risk of kidney failure.

On top of this dramatic inflation of life-threatening risks, Trasylol may actually be less effective than other drugs that were available before Trasylol. These alternative drugs are generics that are cheaper, and more importantly do not pose the same life-threatening dangers to patients. Since these generics are readily available, the continued use of Trasylol imposes substantial and unnecessary risks on patients. Because of these risks, some scientists have concluded that Trasylol should not be used in cardiac surgery patients anymore. If you have had heart surgery, but are unsure whether you were given Trasylol, please contact a Trasylol attorney for more information on obtaining your medical records.

If doctors listen to these scientists and replace Trasylol with available generics, they will help prevent kidney failure in patients following heart surgery. Currently, it is estimated that around 10,000 patients may be unnecessarily on kidney dialysis due to Trasylol use. The resulting reduction in the need for kidney dialysis will save over $1 billion in health care costs every year. Furthermore, replacement of Trasylol with the available generics will save $250 million in health care costs every year because Trasylol costs $1,300 per dose, while the two available generic replacements cost $11 per dose and $44 per dose.

The following references were relied on to write the above article:

Dennis T. Mangano, Ph.D., M.D., et al, The Risk Associated with Aprotinin in Cardiac Surgery, New England Journal of Medicine 2006; 354:353-65.

William R. Hiatt, M.D., Observational Studies of Drug Safety — Aprotinin and the Absence of Transparency, New England Journal of Medicine 2006; 355:2171-73.

Jerry Avorn, M.D., Dangerous Deception — Hiding the Evidence of Adverse Drug Effects, New England Journal of Medicine 2006; 355:2169-71.

Gardiner Harris, FDA says Bayer failed to reveal drug risk study, The New York Times, Sept. 30, 2006.

Food and Drug Administration, Public Health Advisory: aprotinin injection (marketed as Trasylol), updated September 29, 2006 (accessed Dec. 10, 2006, at http://www.fda.gov/cder/drug/advisory/aprotinin.htm).

Charles W. Hogue, M.D. & Martin J. London, M.D., Aprotinin Use During Cardiac Surgery: A New or Continuing Controversy?, Anesthesia and Analgesia 2006; 103:1067-70.

Food and Drug Administration release; Dec. 30, 1993 (accessed Dec. 10, 2006, at http://www.fda.gov/bbs/topics/NEWS/NEW00453.html).

Steve Fields Fields Law Firm Injurygroup.com

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How the Insurance Companies Look at Mesothelioma

Mesothelioma is a malignant cancer that is found in the mesothelium (or protective covering) of the lung, heart, and abdomen. It is caused by the exposure of asbestos and is the focus of thousands of lawsuits across America.

Many people who are diagnosed with mesothelioma are those who worked in factories, automotive factories, construction, and with jobs that manufactured or produced products that was made of the asbestos fibers.

Thousands of people are winning billions of dollars in mesothelioma lawsuits; however, the insurance companies frown on these lawsuits because of the lack of evidence that the asbestos exposure is the cause of the mesothelioma. The insurance companies are feeling the pain of these lawsuits because they are losing billions of dollars.

Although it is proven that mesothelioma is caused by exposure to asbestos, it is not known for sure where and when the asbestos exposure really occurred since it probably occurred over the course of thirty to forty years.

Mesothelioma is not a disease that occurs overnight. It occurs as a result of prolonged exposure to asbestos. Many people who are diagnosed with mesothelioma worked for company’s decades earlier where asbestos exposure was very high. It is evident that that the mesothelioma was probably caused by this exposure, but the insurance companies say that there is not real evidence to prove this exposure. Therefore, the insurance companies really frown on the mesothelioma cases.

If you have been diagnosed with mesothelioma and you are having a hard time getting your insurance company to pay for your medical expenses, then you should contact a mesothelioma lawyer. You have a right to have your medical expenses paid regardless of what evidence your insurance company says it has or is missing.

There are mesothelioma lawyers who are trained and who have a lot of experience in dealing with insurance companies and mesothelioma and they can answer any questions or concerns that you have about your mesothelioma and how your insurance company is or is not handling your medical expenses that are related to your condition.

So, if you feel you are not receiving fair benefits or treatment from your insurance company in regards to your mesothelioma, you may be able to file a lawsuit and you may be entitled to many benefits as a result of your mesothelioma lawsuit. There is no need to suffer more than you already have. A mesothelioma lawyer will be able to help you.

Nick Johnson serves as lead counsel with Johnson Law Group, with principal offices located in Houston, Texas. Johnson represents cases involving Fen-Phen and PPH, Paxil, Mesothelioma and Nursing Home Abuse. Contact Nick Johnson at 1-888-311-5522 or visit http://www.johnsonlawgroup.com

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Living Will And Durable Power Of Attorney For Health Care

A Living Will is a legal document addressing only deathbed considerations; a client unilaterally declares his/her desire that life-prolonging measures be discontinued when there is no hope of ultimate recovery.

On the other hand, people use a Durable Power of Attorney for Health Care to appoint someone to make all healthcare decisions, limited by certain elections regarding deathbed issues.

The client must be at least 18 years old and mentally competent at the time he/she executes either document but incompetent to participate in the decision-making process when either is implemented. It is important to remember that both documents are only applicable if the client is incompetent.

Under the a Living Will, a client declares that if he/she is certified to have an incurable, terminal injury/illness and/or to be permanently unconscious by two examining physicians (including the client’s attending physician), that artificial life-support systems be withheld or disconnected. The client may also elect to discontinue artificial nutrition and hydration (intravenous feeding) by so designating on the form. (Find more information at: legalhelper.net/living-will.aspx)

Under the Health Care Power of Attorney, the client makes three separate and independent elections authorizing the agent:

1. To direct disconnection of artificial life-support systems in the event of terminal illness;

2. To direct disconnection of artificial life-support systems in the event of irreversible coma; and

3. To direct discontinuation of artificial nutrition and hydration.

In addition, the Health Care Power of Attorney form provides a space for the client to set forth any specific medical, religious or other desires concerning his/her health care. The client may also use this section as a backup source for organ donation. (Find more information at: legalhelper.net/power-of-attorney.aspx)

Both documents are signed in front of two witnesses and a notary public or a justice of the peace who acknowledges the client’s signature. The witnesses to a Living Will are sworn by the notary public/justice of the peace and indicate that the client is at least 18 years of age and signed the instrument as a free and voluntary act.

The Living Will witnesses may not be the client’s spouse, attending physician, heirs-at-law or person with claims against the client’s estate.

The Health Care Power of Attorney witnesses may not be the designated agent, the client, spouse or heir or person entitled to any portion of the client’s estate upon death under Will, Trust or operation of law.

People are frequently confused as to why both a Living Will and Health Care Power of Attorney are necessary or appropriate. The Living Will is helpful as a backup document: In the event that the client enters an irreversible coma and the health care agents designated in the Health Care Power of Attorney are deceased or unloadable, the Living Will sets forth the desires of the client concerning his/her death-bed treatment which may be followed by attending physicians. The law provides that to the extent that a Durable Power of Attorney conflicts with a Living Will, the Health Care Power of Attorney controls. Copies of both the Durable Power of Attorney for Health Care and the Living Will are forwarded to the client’s primary care physician for inclusion in medical records.

Both documents are revocable through normal revocation procedures.

Note that LegalHelper.net provides an easy-to-use, quick, and economical online method for creating completed legal documents for any occasions.

James Wood is a free-lance writer on family issues; his main goal is to help people during their complicated period of life, to find a right legal solution in regards to family relationship.
Website: LegalHelper.net (http://www.legalhelper.net/power-of-attorney.aspx).
wjames@legalhelper.net

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Health, Health Care Insurance and Bankruptcy

Imagine for a moment that your health has taken a turn for the worse. You need extensive medical attention and expensive treatments. Would you be prepared to account for these medical costs? Or would you or a family member ultimately have to deal with this financial burden?

Surely, you would not want to suffer the consequences of paying big medical bills on your own. This is why health insurance is so important. A Harvard study conducted in 2001 found that medical bills caused half of all bankruptcies. Therefore, you should make sure that you have some form of medical insurance. You should also make sure that your money is well-spent on insurance that meets your needs.

Insurance Provided by Employer

You should feel lucky if you are in the minority of people who receive health insurance through your employer. According to bankrate.com, company health insurance is actually part of a group insurance plan. Your employer pays for most of your insurance and also pays for your insurance with portions of your paychecks. Everyone in your group plan pays the same rate. The premiums paid by healthy members go towards paying the bills of sick members. Bankrate.com recommends that you study up on your employee benefits package to make sure that the insurance plan you choose provides you with the services and options you will need. If you are young and/or relatively healthy, you may want to consider choosing to pay for your company’s cheapest health plan.

Bankrate.com also recommends that you review your insurance plan periodically. You may be paying more money for services you no longer need. For example, if you have children that have graduated from college or are no longer on your insurance plan, you should change your insurance plan accordingly. Additionally, if you have lost weight or quit smoking, you could qualify for a cheaper insurance plan.

Have You Been Laid Off?

If you have recently lost your job, you may want to consider the Consolidated Omnibus Budget Reconciliation Act (or COBRA) plan. With a COBRA plan, you pay for the medical benefits your former employer paid for on your own. The plan lasts up to 18 months. Keep in mind that the COBRA plan is a bit expensive. In addition to paying the premiums your company used to pay, you would also have to pay a 2% service fee.

Are You Uninsured?

Unfortunately, according to bankrate.com you may face discrimination from insurance companies if you try to insure yourself on your own. You may have difficulty buying insurance if you have any medical problems whatsoever. Remember, with a company group insurance plan, your insurance provider only has to pay the medical bills of the sick members in the group.

Look for health plans that have higher premiums. You may pay more upfront for medical coverage, but you will ultimately spend less on deductibles. At the very least, financial analyst Suz Orman recommends paying for worst-case-scenario insurance for medical bills that top $5,000. This way you can at least be sure that you will not have to foot the entire bill for high costs.

Conclusion

No one wants to live their life fearing the worst. By insuring yourself, you can at least rest assured knowing that you are prepared if your health takes a turn for the worse. As a result you or your family would not have to suffer the additional hardship of having to pay for your medical costs yourself. The good news is that if you can not afford insurance coverage, filing bankruptcy could eliminate your medical bills if necessary.

Shobhana R. Kasturi is a partner with LegalHelpers and specializes in consumer bankruptcy law.

www.legalhelpers.com, the law firm of Macey & Aleman, is one of the nation’s largest consumer bankruptcy firms. Legal Helpers can be contacted by phone, 888-743-5787 or by email, info@LegalHelpers.com.

Georgia Health Care Law

Health Care Law encompasses an array of the legal topics dealing with the organization, financing, and delivery of health services. Health law ultimately covers a range of areas connected to health care providers to patients.  Medical malpractice claims, Medicare and Medicaid all relate to Health care Law. Other types of issues that relate to health care are corporate organization and reorganization, joint ventures, and employment issues, as well as matters unique to health care, such as reimbursement, consent to treatment, certificate of need, licensure, professional service contracts, HIPAA, fraud, and abuse, compliance programs, and managed care contracts. Provided is a list of legal health care issues:

  • HIPAA Regulatory Compliance

  • Fraud and Abuse Investigations

  • Fraud and Abuse

  • Stark Compliance Advice

  • Corporate Compliance Programs

  • Health System Operations

  • Medical Staff Relations

  • Health System Employment Law

  • Employee Benefits

  • Joint Ventures

  • Long-Term Care Project Development and Operations

  • Managed Care Organization Development and Representation

  • HMO Formation

  • PSO Formation

  • Licensing and Representation

  • Health Plan Representation

  • Physician Group Formation and Representation

  • Integrated Healthcare Delivery Systems

  • Healthcare Merger and Acquisition Transactions

  • Corporate Finance and Securities

  • Antitrust Counseling and Litigation

  • Tax Advice 

  • Tax Exempt Bond Financing

  • Reimbursement Advice/Litigation

  • Certificate of Need Litigation

  • Litigation and Regulatory Proceedings

  • Government Relations and Policy Advocacy

  • Medical Device and Pharmaceutical Industry Representation

  • Intellectual Property and Information Technology

  • Real Estate and Construction Matters

For more information on Health Care Law Contact our Georgia Health Care Lawyers.

Health Care Law

Health Care Law encompasses an array of the legal topics dealing with the organization, financing, and delivery of health services. Health law ultimately covers a range of areas connected to health care providers to patients.  Medical malpractice claims, Medicare and Medicaid all relate to Health care Law. Other types of issues that relate to health care are corporate organization and reorganization, joint ventures, and employment issues, as well as matters unique to health care, such as reimbursement, consent to treatment, certificate of need, licensure, professional service contracts, HIPAA, fraud, and abuse, compliance programs, and managed care contracts. Provided is a list of legal health care issues:

  • HIPAA Regulatory Compliance

  • Fraud and Abuse Investigations

  • Fraud and Abuse

  • Stark Compliance Advice

  • Corporate Compliance Programs

  • Health System Operations

  • Medical Staff Relations

  • Health System Employment Law

  • Employee Benefits

  • Joint Ventures

  • Long-Term Care Project Development and Operations

  • Managed Care Organization Development and Representation

  • HMO Formation

  • PSO Formation

  • Licensing and Representation

  • Health Plan Representation

  • Physician Group Formation and Representation

  • Integrated Healthcare Delivery Systems

  • Healthcare Merger and Acquisition Transactions

  • Corporate Finance and Securities

  • Antitrust Counseling and Litigation

  • Tax Advice 

  • Tax Exempt Bond Financing

  • Reimbursement Advice/Litigation

  • Certificate of Need Litigation

  • Litigation and Regulatory Proceedings

  • Government Relations and Policy Advocacy

  • Medical Device and Pharmaceutical Industry Representation

  • Intellectual Property and Information Technology

  • Real Estate and Construction Matters

For more information on Health Care Law Contact our Georgia Health Care Lawyers.

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