Insurance company denies treatment for a 5 year old

[Darwin333]

Sure, but perhaps the rationing that would occur under socialized medicine would be more rational (not going to keep dying people alive for an extra month at a cost of $1 million) and less harmful than the rationing that occurs today (tens of millions uninsured or under-insured). I don't hear the British or the Canadians crying out about how they desperately want to adopt the American system, at least not middle class Canadians and British.

Therein lies the problem. Our politicians have zero desire to control spending. Do you really think any of them are going to cut end of life care? Grandma and Grandpa vote to often for that to happen in any meaningful way. Do you really think they actually care about what a plan might cost in 15 years when they are out of office?

What you suggest requires common sense out of our politicians and I am not optimistic that we will see that for quite some time.

 

[GoPackGo]

Here is a whole list of drugs not approved by the FDA...you may recognize some of them:

http://compoundingtoday.com/FDA/FDAPre1938Drugs.cfm

 

[WhipperSnapper]

Possibly but that again would require us to make the tough decisions. And politicians will be in charge of making that decision. We cant even cut spending on needless functions of govt. I doubt we will see it happen in healthcare.

Therein lies the problem. Our politicians have zero desire to control spending. Do you really think any of them are going to cut end of life care? Grandma and Grandpa vote to often for that to happen in any meaningful way. Do you really think they actually care about what a plan might cost in 15 years when they are out of office?

What you suggest requires common sense out of our politicians and I am not optimistic that we will see that for quite some time.

We as a society and our politicians definitely need to mature and grow up. If we don't do that then there won't be any hope for us regardless of what we do with health care. (Of course, you know what my prediction is; we're going to become a third world country as a result of our collective irrationality.)

And I dont hear a whole hell of a lot of Americans wanting the candien and british systems. So we are back to this circular argument again.

I think that Americans definitely want change in health care and in the direction of socialized medicine. I don't know if there are any reliable polls, but since the majority of Americans are no better than middle class and can't afford to waste their money on the inefficiencies of our current system, it would make sense for them to support significant reform and I suspect that most of them do--at least the ones who haven't succumbed to conservative dogmatism that they probably do not fully understand. ("We gotsta s'port captolism or we'll become just like those heathen non-Christian Soviet pinko commies who support gay marriage and 'bortion and we'll be forced to use wooden toilet paper and get splinters in our butts!")

 

[BoberFett]

I'm far from convinced of that, at least not if the American people were informed about the matter. How do you think most Americans would vote if they had a choice of the following?

(1) Spend 17% of the GDP on health care while leaving tens of millions of Americans uninsured or under-insured with the rest living in sheer terror of losing their jobs and/or health insurance with hundreds of thousands of medical cost-induced bankruptcies every year and businesses and an economy burdened by insurance concerns. One benefit of this system is that it allows wealthy insurance company CEOs and executives to purchase five new yachts every year.

(2) Spend (say) 13% of the GDP (if that) while having 100% coverage, a more relaxed populace, zero medical bankruptcies, and businesses and an economy not burdened by insurance concerns. However, wealthy insurance company CEOs and executives will no longer be able to afford five new yachts each year (oh the horror!).

Which one do you think Americans would vote for?

You actually think the government run system would end up being cheaper? I have a bridge for sale if you're interested...

 

[alchemize]

What a piece of trash, from a journalistic perspective...practically an opinion piece.

 

[Rainsford]

Every time I hear how a government system is bad because health care should be "between you and your doctor" I think of cases like this, where the insurance company overrules the doctor. It happens all the time, because doctors are primarily concerned with curing the patient, and health insurance companies are concerned with making money (which often involves NOT properly treating the patient).

 

[Rainsford]

Therein lies the problem. Our politicians have zero desire to control spending. Do you really think any of them are going to cut end of life care? Grandma and Grandpa vote to often for that to happen in any meaningful way. Do you really think they actually care about what a plan might cost in 15 years when they are out of office?

What you suggest requires common sense out of our politicians and I am not optimistic that we will see that for quite some time.

I think the entire premise of your question is wrong, and the reason health care needs reform. The health care system should not be primarily concerned with making money (or spending the least amount of money)...it should be about helping sick people. Health care should be like the police, fire department and military. We know what needs to be done, and we spend the money necessary to do it. Nobody complains that it's too expensive to have the fire department respond to EVERY fire. Yet it's apparently a good thing if we have a health care system that's tightfisted about treating people. I'd say that's a MUCH bigger failure than being expensive.

 

[BoberFett]

I think the entire premise of your question is wrong, and the reason health care needs reform. The health care system should not be primarily concerned with making money (or spending the least amount of money)...it should be about helping sick people. Health care should be like the police, fire department and military. We know what needs to be done, and we spend the money necessary to do it. Nobody complains that it's too expensive to have the fire department respond to EVERY fire. Yet it's apparently a good thing if we have a health care system that's tightfisted about treating people. I'd say that's a MUCH bigger failure than being expensive.

So you think there is no amount of money too great to spend on treating a single person?

 

[Red Dawn]

If it's an experimental treatment why don't those who are puching for it to become approved by the FDA donate their time,services and medicine to this poor child.

Oh right, there's no money in doing that.

 

[WhipperSnapper]

You actually think the government run system would end up being cheaper? I have a bridge for sale if you're interested...

It's been proven to be less expensive in other first world nations. When you eliminate all of the paper pushers who have nothing to do with actually delivering health care to people--the insurance companies, medical billings people, insurance brokers, company benefits plan managers, etc., you can save a whole lot of money and enjoy increased efficiency.

It's been shown that the U.S. is currently spending 17% of its GDP on health care while leaving tens of millions of Americans uninsured or under-insured with the rest living in sheer terror of losing their jobs and health insurance while having hundreds of thousands of medical bankruptcies and businesses and an economy burdened by insurance issues.

In contrast, other nations spend a smaller percentage of their GDP on health care while having 100% coverage, zero medical bankruptcies, and businesses and economies that aren't burdened by insurance concerns.

How do you explain that? Basically, by removing all of the inefficiency inherent in our type of system, they're able to do all of that for a smaller percentage of GDP. Why can't the U.S. do the same?

Anyone concerned about this issue should watch this excellent PBS program that looks at other nation's health systems and how they do it:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

 

[Red Dawn]

It's been proven to be less expensive in other first world nations. When you eliminate all of the paper pushers who have nothing to do with actually delivering health care to people--the insurance companies, medical billings people, insurance brokers, company benefits plan managers, etc., you can save a whole lot of money and enjoy increased efficiency.

It's been shown that the U.S. is currently spending 17% of its GDP on health care while leaving tens of millions of Americans uninsured or under-insured with the rest living in sheer terror of losing their jobs and health insurance while having hundreds of thousands of medical bankruptcies and businesses and an economy burdened by insurance issues.

In contrast, other nations spend a smaller percentage of their GDP on health care while having 100% coverage, zero medical bankruptcies, and businesses and economies that aren't burdened by insurance concerns.

How do you explain that? Basically, by removing all of the inefficiency inherent in our type of system, they're able to do all of that for a smaller percentage of GDP. Why can't the U.S. do the same?

Anyone concerned about this issue should watch this excellent PBS program that looks at other nation's health systems and how they do it:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

What about all the Lobbyist for the HMO's that will be left unemployed?

 

[alphatarget1]

If it's an experimental treatment why don't those who are puching for it to become approved by the FDA donate their time,services and medicine to this poor child.

Oh right, there's no money in doing that.

Bitch about money all you want. The fact of the matter is, without investors investing in the big pharma and medicine there would be much less treatment options today. If you're so interested in helping people, why don't you go through a phD program and develop drugs afterwards while getting paid minimum wage?

Liberals want other people to do the hard work and reap the benefits without paying.

 

[alphatarget1]

So you think there is no amount of money too great to spend on treating a single person?

I think a lot of modern medicine is preventing evolution from properly taking place. We're keeping people alive that otherwise wouldn't be alive due to genetic weaknesses.

It might sound cold-hearted but I swear I have a point.

I had asthma when I was little. I probably could've died if it weren't for advances in medicine. However, inventions back in the day like penicillin and vaccine for polio treated simple diseases that greatly improved health. Modern medicine today is aimed to treat the trickiest to treat diseases with evermore complicated medications. A lot of health problems within the population is simply due to poor choices in lifestyle, and we're trying to rectify that by prescribing pills.

You *have* to put a dollar sign for human life. We don't have infinite resources to treat everybody. It sucks to hear that a 5 year old has been sick all of his life, but the question becomes whether he will really have a chance to recover and have a possibility to live a meaningful/fulfilling life. WE are playing God by keeping somebody alive that would otherwise have died. Think Terry Schiavo but not in the same magnitude.

 

[Darwin333]

I think the entire premise of your question is wrong, and the reason health care needs reform. The health care system should not be primarily concerned with making money (or spending the least amount of money)...it should be about helping sick people. Health care should be like the police, fire department and military. We know what needs to be done, and we spend the money necessary to do it. Nobody complains that it's too expensive to have the fire department respond to EVERY fire. Yet it's apparently a good thing if we have a health care system that's tightfisted about treating people. I'd say that's a MUCH bigger failure than being expensive.

Thats complete and total bullshit.

Everything and I mean EVERY DAMN THING has a risk/reward, including your life (along with mine). Want proof?

We still have crime. A lot of cities with the highest crime rates are LOWERING their police budgets.

What you may think you NEED has absolutely no relevance to the conversation. Its what we can AFFORD. If we can't afford it, or find some sucker to pay the tab for us, we don't get it. Period. Why do you think we are talking about end of life care costs and such? Is it "right" to tell a person who has worked his ass off and paid into the system that he is shit out of luck because he is an old bastard? No, but is it better than telling 10 young people with potentially long lives in front of them "Sorry, but Gramps needs an extra month so your fucked"? I don't have the answer to that question but I do know the math says we can't afford both.

Edit: I came off a little harsher than I intended to. I agree with your ideology but at the end of the day the math doesn't lie. You simply can not provide infinite services with finite resources. If you can figure a way to do the impossible please let me know. I will make us both a fortune.

 

[werepossum]

Thats complete and total bullshit.

Everything and I mean EVERY DAMN THING has a risk/reward, including your life (along with mine). Want proof?

We still have crime. A lot of cities with the highest crime rates are LOWERING their police budgets.

What you may think you NEED has absolutely no relevance to the conversation. Its what we can AFFORD. If we can't afford it, or find some sucker to pay the tab for us, we don't get it. Period. Why do you think we are talking about end of life care costs and such? Is it "right" to tell a person who has worked his ass off and paid into the system that he is shit out of luck because he is an old bastard? No, but is it better than telling 10 young people with potentially long lives in front of them "Sorry, but Gramps needs an extra month so your fucked"? I don't have the answer to that question but I do know the math says we can't afford both.

Edit: I came off a little harsher than I intended to. I agree with your ideology but at the end of the day the math doesn't lie. You simply can not provide infinite services with finite resources. If you can figure a way to do the impossible please let me know. I will make us both a fortune.

Whether it's better depends on your point of view, I suppose. If you have ten young hoods who contribute nothing to society but ills, is it still better to devote resources to them even if they are the resources that Gramps worked to obtain? At what point does simply being human override the sweat of one's brow, the right to one's own work product? Because inevitably the more one devalues the rewards for work (by seizing them and redistributing them to others), the less incentive there is to work, and the less work gets done.

Seems to me this is exactly the situation that socialized medicine seeks to impose. Look at the medications and treatments that are available in the USA but not in the UK or even in Canada. One common way socialized medical systems ration care is in waiting, time spent in queue for services. Seems to me under a system of socialized medicine this five year old would probably never have been a five year old, but rather much of that million plus would have been spent on other, healthier people with cheaper health problems.

 

[Hayabusa Rider]

It's interesting that some people feel that the government would pay for this, but the cost of health care would decrease. A Mercedes at a Fiesta price tag. Nope.

Semantics 101:
Insurances generally cover medication which is generally accepted as safe and effective, but not officially approved for a particular indication. Happens all the time, and there's nothing wrong with the practice.

An unapproved use is NOT the same as experimental therapy. The latter comes up for review for private insurance AND government health care.

I see the rate of rejection being no lower for government programs that private insurance. "UHC will cover this!" is bogus.

It's tragic, but realize that the government isn't going to pick up the tab. The hospital is more than likely going to eat the cost because Medicaid requires the same process, and in almost all cases they do not provide retroactive payment. Their "expectation" is more of a hope than anything.

I did notice that LL mentioned suing the insurance company. I don't think that will work, however imagine trying to sue the government? Good luck with that.

This is a "sucks to be him" kind of thing. There is nothing anyone can really do.

 

[werepossum]

It's interesting that some people feel that the government would pay for this, but the cost of health care would decrease. A Mercedes at a Fiesta price tag. Nope.

Semantics 101:
Insurances generally cover medication which is generally accepted as safe and effective, but not officially approved for a particular indication. Happens all the time, and there's nothing wrong with the practice.

An unapproved use is NOT the same as experimental therapy. The latter comes up for review for private insurance AND government health care.

I see the rate of rejection being no lower for government programs that private insurance. "UHC will cover this!" is bogus.

It's tragic, but realize that the government isn't going to pick up the tab. The hospital is more than likely going to eat the cost because Medicaid requires the same process, and in almost all cases they do not provide retroactive payment. Their "expectation" is more of a hope than anything.

I did notice that LL mentioned suing the insurance company. I don't think that will work, however imagine trying to sue the government? Good luck with that.

This is a "sucks to be him" kind of thing. There is nothing anyone can really do.

Quoted for truth and wisdom. Medicare/Medicaid has a higher refusal rating than any insurance company.

 

[WhipperSnapper]

Quoted for truth and wisdom. Medicare/Medicaid has a higher refusal rating than any insurance company.

Could that be because people covered under medicare and medicaid are more likely to seek treatment for ailments that don't warrant treatment or in the case of the elderly, that won't increase quality of life or significantly increase longevity?

 

[WhipperSnapper]

It's interesting that some people feel that the government would pay for this, but the cost of health care would decrease. A Mercedes at a Fiesta price tag. Nope.

The savings would come by completely eliminating the inefficiencies inherent in the current system--the insurance companies, the medical billing specialists, the insurance brokers, company benefits plan managers, etc., all those people who just push paper and have nothing to do with providing health care.

That's how the U.S., in spite of spending 17% of its GDP on health care, leaves tens of millions uninsured or under-insured while other nations can spend a smaller percentage of GDP on health care and have 100% coverage.

 

[Red Dawn]

Bitch about money all you want. The fact of the matter is, without investors investing in the big pharma and medicine there would be much less treatment options today.
Liberals want other people to do the hard work and reap the benefits without paying.

So it wouldn't make sense from a business standpoint to donate this experimental drug and absorb the cost to treat this little boy even if it helps get this drug and treatment approved by the FDA?

If you're so interested in helping people, why don't you go through a phD program and develop drugs afterwards while getting paid minimum wage?

Well if I were to do that it would be a Christian thing to do.

 

[dmcowen674]

I think the entire premise of your question is wrong, and the reason health care needs reform.

The health care system should not be primarily concerned with making money (or spending the least amount of money)...it should be about helping sick people.

Health care should be like the police, fire department and military.

We know what needs to be done, and we spend the money necessary to do it.

Nobody complains that it's too expensive to have the fire department respond to EVERY fire.

Yet it's apparently a good thing if we have a health care system that's tightfisted about treating people.

I'd say that's a MUCH bigger failure than being expensive.

That's been the problem. Up until recently not enough people were burned by the health care system. Now that the numbers are much more significant people are not happy about being burned.

It's the same premise as said a Century ago:

It's a cycle if the neighbor down the street loses his job.

It's a Recession if a family member loses a job.

It's a Depression if you lost your job.

 

[Genx87]

Every time I hear how a government system is bad because health care should be "between you and your doctor" I think of cases like this, where the insurance company overrules the doctor. It happens all the time, because doctors are primarily concerned with curing the patient, and health insurance companies are concerned with making money (which often involves NOT properly treating the patient).

Except the insurance company didnt overrule the doctor. The doctor is going ahead with treatment with the hope Medicaid picks up the tab. If Medicaid doesnt pick up the tab will you be back here complaining about socialized medicine?

 

[Genx87]

The savings would come by completely eliminating the inefficiencies inherent in the current system--the insurance companies, the medical billing specialists, the insurance brokers, company benefits plan managers, etc., all those people who just push paper and have nothing to do with providing health care.

That's how the U.S., in spite of spending 17% of its GDP on health care, leaves tens of millions uninsured or under-insured while other nations can spend a smaller percentage of GDP on health care and have 100% coverage.

A lot of the percieved savings in administrative in Medicare vs Private insurance has to do with Medicare shoveling the costs onto the providers. Also the admin costs is a %. Avg private insurance per capita is about 2800 vs 6500 for Medicare. If it cost 150 bucks to process a claim the system with a lower avg cost will see a higher avg admin cost. I can gurantee you a lot of the paper pushers in those private insurance companies will be hired by a govt run program to perform the exact same job function.

And what % of the system is profit? Insurance companies last year cleared about 15-20 billion out of 2 trillion. We are talking pennies on a dollar.

If we were serious about saving money we would tackle fraud. There was a thread about 2 months ago that had a study that estimated about 250 billion dollars a year is wasted within the system due to fraud. That would be a bigger boon to the system than trying to eliminate 1% profit and 3% of admin costs.

 

[halik]

There's always going to be some form of a "death panel".

DING

What about a treatment that cost $1M and has 15% survivability in 5 years? $10M ? $50?

No such thing as "free" healthcare.

 

[halik]

before people start bashing the insurance agency read the article and not just the OP's topic.

Unbelievably, Kyler's insurance carrier, Harrisburg-based HealthAmerica, has denied coverage for the treatment, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness."

The therapy is not approved by the Food and Drug Administration, another criterion that HealthAmerica require

It is not covered by the FDA. NO insuarance is going to cover it and if you think that once the goverment gets to insure people they will cover it you are sadly mistaken.

but still a sad story.

Yupp, that kid will is die, regardless of whether that therapy is paid for or not.