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Open Discussion Discuss Evidence of impending healthcare rationing at the General Forum; Originally Posted by off the porch Since I recently worked for a doctor, I can tell you that you are ...

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Old 11-19-2010, 09:33 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by off the porch View Post
Since I recently worked for a doctor, I can tell you that you are exactly right. The insurance companies only have their bottom line in mind when they turn down (ration) treatments, meds, etc. I've had to talk to them many times to get approval for treatments, meds, etc. and they are brutal - even with the doctors in the "peer review" phone calls. I've heard my doctors slam down the phone after a peer review too many times!

They inundate the doctors with paperwork inquiring whether or not this is a pre-existing condition, even when the patient has been with the doctor for years and it's clear that it is not...as well as other stall tactics to keep from paying or to prevent the treatment/med that the doctor recommends.
As I have indicated in other threads (dating back about a year), I am opposed to exclusions for pre-existing conditions.

And I am very much in favor of the government's offering tax incentives to employers to offer a menu of 20 or more different choices--HMOs, PPOs, and traditional, fee-for-service plans--so that those who choose the most penurious healthcare providers will have only themselves to blame for their unwise choices.
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Old 11-19-2010, 09:41 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by off the porch View Post
Since I recently worked for a doctor, I can tell you that you are exactly right. The insurance companies only have their bottom line in mind when they turn down (ration) treatments, meds, etc. I've had to talk to them many times to get approval for treatments, meds, etc. and they are brutal - even with the doctors in the "peer review" phone calls. I've heard my doctors slam down the phone after a peer review too many times!

They inundate the doctors with paperwork inquiring whether or not this is a pre-existing condition, even when the patient has been with the doctor for years and it's clear that it is not...as well as other stall tactics to keep from paying or to prevent the treatment/med that the doctor recommends.
So true. I read a book awhile back by John Grisham that chronicles up how really dirty Insurance companies have gotten.
I suggest you read it if you're up for some entertainment and good guys vs bad kind of story.


Click on the picture to go to Amazon.com or get it from your library. It's been out awhile.
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"...When Rudy agrees to represent the parents of a dying 22-year-old denied insurance coverage for a bone-marrow transplant, he finds that he is up against the firm that broke contract with him... "
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Old 11-19-2010, 10:11 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by saltwn View Post
So true. I read a book awhile back by John Grisham that chronicles up how really dirty Insurance companies have gotten.
I suggest you read it if you're up for some entertainment and good guys vs bad kind of story.


Click on the picture to go to Amazon.com or get it from your library. It's been out awhile.
The made a movie of that one...it really touched my heart!
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Old 11-19-2010, 10:22 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by pjohns View Post
As I have indicated in other threads (dating back about a year), I am opposed to exclusions for pre-existing conditions.

And I am very much in favor of the government's offering tax incentives to employers to offer a menu of 20 or more different choices--HMOs, PPOs, and traditional, fee-for-service plans--so that those who choose the most penurious healthcare providers will have only themselves to blame for their unwise choices.
I remember our discussions - they were enjoyable and rational - and I thank you for those. I remember that you didn't like the exclusions for pre-existing conditions. But as long as one is dealing with for-profit insurers, there will be rationing. If I remember correctly, you had personal experience (without getting too personal, it was a family member, I believe) with extensive medical treatments/meds and you didn't have that (rationing) experience. I'm so glad you didn't.

Please believe me, it happened very, very often...daily, in the doctors' ofc I worked in. I would talk to the insurers and hear it with my own ears.
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Old 11-19-2010, 10:24 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by Binky View Post
The last time I was in the hospital I was flown by helicoptor (this was the second time), to a hospital better equipped to handle my case. Since our insurance paid for the flight the first time around, they refused to pay for the second trip and said the company was way overcharging their customers. So.......on that happy note, we ended up having to pay out of pocket $10,000 for a 45 minute flight to a larger hospital. That was a huge bite in our wallet.... The odd thing is that company had charged that same amount on the first trip and blue cross paid every penny of it. You'd think they would've complained to the helicoptor company when they got whacked the first time....
I'm very glad that you're ok. Medical costs can be so damn astronomical!
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Old 11-19-2010, 10:39 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by off the porch View Post
I remember our discussions - they were enjoyable and rational - and I thank you for those. I remember that you didn't like the exclusions for pre-existing conditions. But as long as one is dealing with for-profit insurers, there will be rationing. If I remember correctly, you had personal experience (without getting too personal, it was a family member, I believe) with extensive medical treatments/meds and you didn't have that (rationing) experience. I'm so glad you didn't.
You are correct in your memory of those discussions.

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Originally Posted by off the porch View Post
Please believe me, it happened very, very often...daily, in the doctors' ofc I worked in. I would talk to the insurers and hear it with my own ears.
I cannot dispute your personal experience.

But that is why we should encourage employers to offer a menu of options, in my opinion. As long as there is a single, one-size-fits-all policy offered--take it or leave it--one cannot really blame the consumer (i.e. the employee) for the fact that he or she has chosen a bad insurance policy.

But if one can choose from a variety of options; and one chooses a healthcare policy with very low premiums, but not-so-terrific coverage; then one cannot reasonably complain about its paying little or nothing when one really needs it.
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Old 11-19-2010, 11:31 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by rivrrat View Post
Huge difference. If the FDA doesn't approve a drug, there's not a damn thing I can do about that. I can't go get it anyway.

If my insurance company refuses to pay for something or otherwise displeases me, I can drop them and either find a better one or pay out of pocket from then on out. (which we should all do anyway, insurance companies should all be put out of business)
The meds that were requested were legal in the United States, approved by the FDA.

You can drop your insurance, but if you've been sick and you have a pre-existing condition (which you would if you drop your other insurance carrier because they won't pay for the treatment that you and your doctor believe to be appropriate), good luck in getting another carrier to accept you without loads of $$, and even with $$, they may not accept you. Sure - if your really sick, you could pay out of pocket, if you have big $$. If you aren't rich, then you are sh!t out of luck.
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Old 11-19-2010, 11:42 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by off the porch View Post
The meds that were requested were legal in the United States, approved by the FDA.

You can drop your insurance, but if you've been sick and you have a pre-existing condition (which you would if you drop your other insurance carrier because they won't pay for the treatment that you and your doctor believe to be appropriate), good luck in getting another carrier to accept you without loads of $$, and even with $$, they may not accept you. Sure - if your really sick, you could pay out of pocket, if you have big $$. If you aren't rich, then you are sh!t out of luck.
Not so much. Insurance accepted me with a pre-existing condition. They just wouldn't pay for a year on anything having to do with that condition. But, that's their choice. They certainly shouldn't accept me if they don't want to.

I lived most of my life without insurance. Never has been an issue, I've always made payments on whatever treatment I received. So, hardly **** out of luck.

But, if the govt forces me to their coverage, I have no choice in anything. I have to pay for their coverage whether I want it or not. I have to pay for their coverage even if it won't pay for my treatments. Then, not only do I have to pay for their coverage, I also have to pay out of pocket for what they won't pay for. Not so with private insurance. I can drop them.

Also, if the govt doesn't approve certain drugs because they don't want to pay for them via govt sponsored healthcare, then that hurts all the rest of us that just ****ing might want to use those drugs. There's no recourse for us. They ban them, we can't get them. Simple as. (like they did with one of my medications) It's utter horse****. We need to do away with the FDA as well as any govt involvement in healthcare. Ideally, we would do away with insurance too, but that can't really be done without a major effort by the people to stop paying them en masse and put them out of business.
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Old 11-19-2010, 11:57 PM
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Default Re: Evidence of impending healthcare rationing

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Originally Posted by rivrrat View Post
Not so much. Insurance accepted me with a pre-existing condition. They just wouldn't pay for a year on anything having to do with that condition. But, that's their choice. They certainly shouldn't accept me if they don't want to.

I lived most of my life without insurance. Never has been an issue, I've always made payments on whatever treatment I received. So, hardly **** out of luck.

But, if the govt forces me to their coverage, I have no choice in anything. I have to pay for their coverage whether I want it or not. I have to pay for their coverage even if it won't pay for my treatments. Then, not only do I have to pay for their coverage, I also have to pay out of pocket for what they won't pay for. Not so with private insurance. I can drop them.

Also, if the govt doesn't approve certain drugs because they don't want to pay for them via govt sponsored healthcare, then that hurts all the rest of us that just ****ing might want to use those drugs. There's no recourse for us. They ban them, we can't get them. Simple as. (like they did with one of my medications) It's utter horse****. We need to do away with the FDA as well as any govt involvement in healthcare. Ideally, we would do away with insurance too, but that can't really be done without a major effort by the people to stop paying them en masse and put them out of business.
You're lucky that you were accepted. The insurers I talked to on a daily basis wanted to know if the treatment/med was for a pre-existing condition and if it was, they wouldn't be paying for it or approving the treatment/med.

And you're lucky you have money to pay for treatment. Many just don't - what are they supposed to do? Die? There is certainly no recourse for those people who have had such high medical costs that they have to declare bankruptcy and they use all their life savings for meds that will be needed for the rest of the life in question.

No, life isn't as simple and sweet as yours for many chronically sick people.

And someone needs to be checking the medicines we take and regulating the food companies and farms that produce the foods we eat. Or do you suggest that those industries self-regulate? That (mostly) self-regulation worked so well with the banksters. (sarcasm intended)
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Old 11-20-2010, 12:06 AM
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Default Re: Evidence of impending healthcare rationing

Our medical and insurance sytem is perfect as is. Everyone is happy and it is wrong to try and mess it up with these insane progressive pipe dream ideas. Why try to fix what isn't broken.
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