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Simple summary of health care
Tweet Topic Started: Jun 18 2009, 01:26 PM (818 Views)
HoosierLars Jun 18 2009, 01:26 PM Post #1
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1) Law suits must be controlled. The system can handle $2-5M to cover the expenses of people who are harmed by honest mistakes made by doctors, but the >$10M payouts must be stopped.

2) If you don't know how much something costs, you will probably overpay. It is insane for companies to provide health insurance where the insured person gets service and doesn't care about the cost. You can see why co-pays have become standard so the insured bear some of the cost. At least the company bears the costs and has an incentive to find the lower cost insurer. Now imagine a single insurance provider (the federal government), and you will lose control of costs until the system runs out of money and we see rationing.
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eelbor Jun 18 2009, 02:20 PM Post #2
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3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
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"Liberal, shmiberal. That should be a new word. Shmiberal: one who is assumed liberal, just because he's a professional whiner in the newspaper. If you'll read the subtext for many of those old strips, you'll find the heart of an old-fashioned Libertarian. And I'd be a Libertarian, if they weren't all a bunch of tax-dodging professional whiners." - Berkeley Breathed


Meat is Murder. Sweet, delicious murder.
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brumdog44 Jun 18 2009, 03:15 PM Post #3
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4) The parasitic condition of other countries living off of our FDA results needs to be stopped. Canada continues to use our FDA results as a basis of their own regulations.
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Mr Gray Jun 18 2009, 04:25 PM Post #4
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Jun 18 2009, 02:20 PM
3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
the insurance companies should be allowed to deny any treatments they want to, so long as it is clear and mutually understood between insurer and insured in advance. The public should start to understand their insurance, their health care, and the associated costs in between.
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The body knows what fighters don't: how to protect itself. A neck can only twist so far. Twist it just a hair more and the body says, "Hey, I'll take it from here because you obviously don't know what you're doing... Lie down now, rest, and we'll talk about this when you regain your senses." It's called the knockout mechanism.
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brumdog44 Jun 18 2009, 04:45 PM Post #5
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aaronk2727
Jun 18 2009, 04:25 PM
eelbor
Jun 18 2009, 02:20 PM
3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
the insurance companies should be allowed to deny any treatments they want to, so long as it is clear and mutually understood between insurer and insured in advance. The public should start to understand their insurance, their health care, and the associated costs in between.
Yeah, screw medical necessity. :(

The insurance companies change the rules all the time mid plan, so exactly how are they keeping up with their end? I've had medicines that I have taken for years all of a sudden become denied as 'not medical necessary.' The only change was what they deemed as acceptable (i.e. -- to their financial benefit). I had an acid reflux medicine that I took that was covered by my plan and with no change in the plan itself, the insurance company declared it as one not covered by the plan...the options they gave me were one that would be covered that I already had taken previously and knew didn't work, or one that was over the counter which I would have to fully pay for with no cost to them (and my out of pocket expense would be much greater than what the plan called for).
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Mr Gray Jun 18 2009, 04:54 PM Post #6
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brumdog44
Jun 18 2009, 04:45 PM
aaronk2727
Jun 18 2009, 04:25 PM
eelbor
Jun 18 2009, 02:20 PM
3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
the insurance companies should be allowed to deny any treatments they want to, so long as it is clear and mutually understood between insurer and insured in advance. The public should start to understand their insurance, their health care, and the associated costs in between.
Yeah, screw medical necessity. :(

The insurance companies change the rules all the time mid plan, so exactly how are they keeping up with their end? I've had medicines that I have taken for years all of a sudden become denied as 'not medical necessary.' The only change was what they deemed as acceptable (i.e. -- to their financial benefit). I had an acid reflux medicine that I took that was covered by my plan and with no change in the plan itself, the insurance company declared it as one not covered by the plan...the options they gave me were one that would be covered that I already had taken previously and knew didn't work, or one that was over the counter which I would have to fully pay for with no cost to them (and my out of pocket expense would be much greater than what the plan called for).
I don't think that should be Ok either brum. It is a two way street...if they don't want to dover a drug anymore, they should give advanced notice (90 days or so) so that you have time to find another policy.
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The body knows what fighters don't: how to protect itself. A neck can only twist so far. Twist it just a hair more and the body says, "Hey, I'll take it from here because you obviously don't know what you're doing... Lie down now, rest, and we'll talk about this when you regain your senses." It's called the knockout mechanism.
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sirbrianwilson Jun 18 2009, 09:14 PM Post #7
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aaronk2727
Jun 18 2009, 04:25 PM
eelbor
Jun 18 2009, 02:20 PM
3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
the insurance companies should be allowed to deny any treatments they want to, so long as it is clear and mutually understood between insurer and insured in advance. The public should start to understand their insurance, their health care, and the associated costs in between.
lmao. that would be impossible. one, their policy and exclusions would be about 8 inches thick of paper, at LEAST.

plus, it would change so frequently (if not daily) that amendments would have to be signed over and over and over and over.

br
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Mr Gray Jun 18 2009, 09:58 PM Post #8
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sirbrianwilson
Jun 18 2009, 09:14 PM
aaronk2727
Jun 18 2009, 04:25 PM
eelbor
Jun 18 2009, 02:20 PM
3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
the insurance companies should be allowed to deny any treatments they want to, so long as it is clear and mutually understood between insurer and insured in advance. The public should start to understand their insurance, their health care, and the associated costs in between.
lmao. that would be impossible. one, their policy and exclusions would be about 8 inches thick of paper, at LEAST.

plus, it would change so frequently (if not daily) that amendments would have to be signed over and over and over and over.

br
you're sure not much of a critical thinker are you sirbri? I would spend some time explaining a solution to the problems you stated, but you would undoubtedly just say "owned" or LMAO, or "yawn"...so I don't feel like it is worth the time.
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The body knows what fighters don't: how to protect itself. A neck can only twist so far. Twist it just a hair more and the body says, "Hey, I'll take it from here because you obviously don't know what you're doing... Lie down now, rest, and we'll talk about this when you regain your senses." It's called the knockout mechanism.
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eelbor Jun 18 2009, 10:06 PM Post #9
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aaronk2727
Jun 18 2009, 04:54 PM
brumdog44
Jun 18 2009, 04:45 PM
aaronk2727
Jun 18 2009, 04:25 PM
eelbor
Jun 18 2009, 02:20 PM
3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
the insurance companies should be allowed to deny any treatments they want to, so long as it is clear and mutually understood between insurer and insured in advance. The public should start to understand their insurance, their health care, and the associated costs in between.
Yeah, screw medical necessity. :(

The insurance companies change the rules all the time mid plan, so exactly how are they keeping up with their end? I've had medicines that I have taken for years all of a sudden become denied as 'not medical necessary.' The only change was what they deemed as acceptable (i.e. -- to their financial benefit). I had an acid reflux medicine that I took that was covered by my plan and with no change in the plan itself, the insurance company declared it as one not covered by the plan...the options they gave me were one that would be covered that I already had taken previously and knew didn't work, or one that was over the counter which I would have to fully pay for with no cost to them (and my out of pocket expense would be much greater than what the plan called for).
I don't think that should be Ok either brum. It is a two way street...if they don't want to dover a drug anymore, they should give advanced notice (90 days or so) so that you have time to find another policy.
Sure, yeah that'll work.

Dr Jim - "Mr. Knight, you have pancreatic cancer. I am prescribing a medicine for you that has been shown to be successful during clinical trials and the three years it has been on the market in cases like yours."

Mr Knight - "Well let me check with my insurance company to see if they will cover it. If not, what is my prognosis?"

Dr. Jim - "I wouldn't dwell on that. Suffice it to say less than 5% off all cases are still alive 5 years after diagnosis. On this new medicine your survival rate climbs to nearly 40%"

Mr. Knight - "Well, I am a loyal customer, and have been on this policy at work for the last 12 years. They will not turn me down! I will fight this disease!! (calls the insurance company)"

Insurance company - "I am sorry Mr. Knight, but we have determined that the medicine you need for your pancreatic cancer is still 'investigational', and you won't be able to use your policy to obtain it. I know the FDA has approved the medicine and found it to be 30+ percent effective at dealing with your particular strain of cancer, but it is too 'inverstigational', I mean c'mon the FDA just approved it two or three years ago..they may find it causes cancer."

Mr. Knight - "Thats OK, I will just take my business elsewhere. I am looking for a new insurance company, Who wants to insure me. I know I have pancreatic cancer, and all that, but hey. Getting those premiums will be good for your bottom line!!"

Other Insurance companies - <crickets> <wind whistling through the empty field> <perhaps the howl of a coyote far far away, maybe somewhere near Des Moines, Iowa>

It is bullshit, and you know it is. Insurance companies should not be allowed to deny coverage for an FDA approved medically neccessary treatments. (Elective procedures are another matter entirely) There are medicines out there you can not afford to buy. That is why you have insurance. Insurance exists to spread the risk.
Posted Image

"Liberal, shmiberal. That should be a new word. Shmiberal: one who is assumed liberal, just because he's a professional whiner in the newspaper. If you'll read the subtext for many of those old strips, you'll find the heart of an old-fashioned Libertarian. And I'd be a Libertarian, if they weren't all a bunch of tax-dodging professional whiners." - Berkeley Breathed


Meat is Murder. Sweet, delicious murder.
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Mr Gray Jun 18 2009, 10:26 PM Post #10
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eelbor
Jun 18 2009, 10:06 PM
aaronk2727
Jun 18 2009, 04:54 PM
brumdog44
Jun 18 2009, 04:45 PM
aaronk2727
Jun 18 2009, 04:25 PM
eelbor
Jun 18 2009, 02:20 PM
3) Insurance companies should not be allowed deny FDA approved treatments. I would like to know how an FDA-approved treatment, being used for the original FDA-approved indications by an adult, can be declared by Insurance companies to still be “investigational”, or disallowed by merely sneering that a MEDICALLY NECESSARY treatment is “deluxe”, without providing any valid reasons to deny its coverage. Medical treatments should be decided by Doctors, not accountants.
the insurance companies should be allowed to deny any treatments they want to, so long as it is clear and mutually understood between insurer and insured in advance. The public should start to understand their insurance, their health care, and the associated costs in between.
Yeah, screw medical necessity. :(

The insurance companies change the rules all the time mid plan, so exactly how are they keeping up with their end? I've had medicines that I have taken for years all of a sudden become denied as 'not medical necessary.' The only change was what they deemed as acceptable (i.e. -- to their financial benefit). I had an acid reflux medicine that I took that was covered by my plan and with no change in the plan itself, the insurance company declared it as one not covered by the plan...the options they gave me were one that would be covered that I already had taken previously and knew didn't work, or one that was over the counter which I would have to fully pay for with no cost to them (and my out of pocket expense would be much greater than what the plan called for).
I don't think that should be Ok either brum. It is a two way street...if they don't want to dover a drug anymore, they should give advanced notice (90 days or so) so that you have time to find another policy.
Sure, yeah that'll work.

Dr Jim - "Mr. Knight, you have pancreatic cancer. I am prescribing a medicine for you that has been shown to be successful during clinical trials and the three years it has been on the market in cases like yours."

Mr Knight - "Well let me check with my insurance company to see if they will cover it. If not, what is my prognosis?"

Dr. Jim - "I wouldn't dwell on that. Suffice it to say less than 5% off all cases are still alive 5 years after diagnosis. On this new medicine your survival rate climbs to nearly 40%"

Mr. Knight - "Well, I am a loyal customer, and have been on this policy at work for the last 12 years. They will not turn me down! I will fight this disease!! (calls the insurance company)"

Insurance company - "I am sorry Mr. Knight, but we have determined that the medicine you need for your pancreatic cancer is still 'investigational', and you won't be able to use your policy to obtain it. I know the FDA has approved the medicine and found it to be 30+ percent effective at dealing with your particular strain of cancer, but it is too 'inverstigational', I mean c'mon the FDA just approved it two or three years ago..they may find it causes cancer."

Mr. Knight - "Thats OK, I will just take my business elsewhere. I am looking for a new insurance company, Who wants to insure me. I know I have pancreatic cancer, and all that, but hey. Getting those premiums will be good for your bottom line!!"

Other Insurance companies - <crickets> <wind whistling through the empty field> <perhaps the howl of a coyote far far away, maybe somewhere near Des Moines, Iowa>

It is bullshit, and you know it is. Insurance companies should not be allowed to deny coverage for an FDA approved medically neccessary treatments. (Elective procedures are another matter entirely) There are medicines out there you can not afford to buy. That is why you have insurance. Insurance exists to spread the risk.
it's not bullshit eel. Your just not really applying yourself to really think this through...you're too quick to sell me down the river and sell yourself short. Where there's a will, there's a way.....if you want to preserve capitalistic freedom while also improving healthcare in the USA, you have to really work for it, but it can be done with some strong critical thinking. Like I said to sirbri, I would love to discuss this and some ideas I have with you guys, but you seem very closed minded on this subject.
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The body knows what fighters don't: how to protect itself. A neck can only twist so far. Twist it just a hair more and the body says, "Hey, I'll take it from here because you obviously don't know what you're doing... Lie down now, rest, and we'll talk about this when you regain your senses." It's called the knockout mechanism.
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eelbor Jun 18 2009, 10:36 PM Post #11
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aaronk2727
Jun 18 2009, 10:26 PM
aaronk2727
Jun 18 2009, 04:25 PM
eelbor
Jun 18 2009, 02:20 PM

It is bullshit, and you know it is. Insurance companies should not be allowed to deny coverage for an FDA approved medically neccessary treatments. (Elective procedures are another matter entirely) There are medicines out there you can not afford to buy. That is why you have insurance. Insurance exists to spread the risk.
it's not bullshit eel. Your just not really applying yourself to really think this through...you're too quick to sell me down the river and sell yourself short. Where there's a will, there's a way.....if you want to preserve capitalistic freedom while also improving healthcare in the USA, you have to really work for it, but it can be done with some strong critical thinking. Like I said to sirbri, I would love to discuss this and some ideas I have with you guys, but you seem very closed minded on this subject.
By all means, post away. But you are right I am quite closed minded in regards to insurance companies. You will have a hard time changing my notions of insurance companies. They rate slightly above genital warts, and just below pond scum in my book.

I have taken on several insurance companies because they refuse to cover FDA approved devices for my child. I have won every appeal. I do not fear goverment involvement ruining healthcare in America nearly as much as I fear the accountants that already work for the insurance companies ruining it and making in inaccessible. I have stated before that my family can not obtain insurance outside of a group policy at work, and I am not poor. I make a very good living.

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"Liberal, shmiberal. That should be a new word. Shmiberal: one who is assumed liberal, just because he's a professional whiner in the newspaper. If you'll read the subtext for many of those old strips, you'll find the heart of an old-fashioned Libertarian. And I'd be a Libertarian, if they weren't all a bunch of tax-dodging professional whiners." - Berkeley Breathed


Meat is Murder. Sweet, delicious murder.
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brumdog44 Jun 19 2009, 12:34 AM Post #12
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aaron, seriously, 90 days to find another policy? One that won't cover pre-existing conditions and that I'll have to pay 100% of instead of what the one that comes with work?

The school that I work at (as well as pretty much every school in the United States) has one year agreements with insurance companies, usually September to September. Yet the insurance companies regularly change what prescriptions that they cover during this time and there isn't a damn thing we can do about it. They simply bump a prescription from formulary to non-formulary and no longer cover it. The contract says they will cover formulary drugs..which is all well and good, but what is formulary in September isn't what necessarily what will be formulary in October, so how in the hell would knowing your policy help?
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Cattman96 Jun 19 2009, 08:36 AM Post #13
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In agreement with EEl and Brum. Especially about pre existing conditiions. You cant find another insurance provider that covers pre existing...
The nine scariest words in the english language. " I'm with the government and I'm here to help" - Ronald Reagan
"When the people find they can vote themselves money, that will herald the end of the republic." -Benjamin Franklin
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eelbor Jun 19 2009, 09:01 AM Post #14
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Hey Cattman, glad to see you. Where you been hiding?
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"Liberal, shmiberal. That should be a new word. Shmiberal: one who is assumed liberal, just because he's a professional whiner in the newspaper. If you'll read the subtext for many of those old strips, you'll find the heart of an old-fashioned Libertarian. And I'd be a Libertarian, if they weren't all a bunch of tax-dodging professional whiners." - Berkeley Breathed


Meat is Murder. Sweet, delicious murder.
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Cattman96 Jun 19 2009, 09:13 AM Post #15
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Hey Cattman, glad to see you. Where you been hiding?
Hey Eel. Kind of a long story but I will make it short. It involved me, my nephew with a shotgun and me being about a half second to late to stop him. I lost my best friend in a mili second. So alot of hydrocordone on my part later to get rid of the images, and still having a hard time , I ma somwewhat coherent. Sorry if that is TMI man.
The nine scariest words in the english language. " I'm with the government and I'm here to help" - Ronald Reagan
"When the people find they can vote themselves money, that will herald the end of the republic." -Benjamin Franklin
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