When Barbara’s lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon’s state run health plan denied the potentially life altering drug because they did not feel it was "cost-effective." Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.
When queried about withholding Barbara’s treatment, Dr. Walter Shaffer, a spokesman for Oregon’s Division of Medical Assistance Programs, explained the policy this way, "We can't cover everything for everyone. Taxpayer dollars are limited for publicly funded programs. We try to come up with policies that provide the most good for the most people."
Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, echoed Shaffer, "If we invest thousands and thousands of dollars in one person's days to weeks, we are taking away those dollars from someone [else]."
When Barbara’s lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon’s state run health plan denied the potentially life altering drug because they did not feel it was "cost-effective." Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.
When Barbara’s lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon’s state run health plan denied the potentially life altering drug because they did not feel it was "cost-effective." Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.
this is a sick world we are living in.
Yes that is wrong. The arguments for legalizing assisted suicide don't take into account that at some point a bean counter is going to figure out it's cheaper for somebody to die than be treated. Since she was a smoker I wonder how she would have fared with private insurance. Granted she wouldn't have gotten the "we'll help you end it all" letter but I doubt they would have helped her with an alternative treatment either.
Actually, according to the company's website, many private insurers to cover this drug.
Obviously, some don't. However, that's the beauty of private enterprise. There are choices and options. Once you go to single payer that choice and those options disappear.
When Barbara’s lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon’s state run health plan denied the potentially life altering drug because they did not feel it was "cost-effective." Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.
this is a sick world we are living in.
Yes that is wrong. The arguments for legalizing assisted suicide don't take into account that at some point a bean counter is going to figure out it's cheaper for somebody to die than be treated.
See we can agree on something! It disgust me every time I hear that an insurance company(public or private) denies someone a legitimate treatment based on cost/benefit. they base these on future contributions, well the past contributions should count a hell of a lot more.
Elderly people are treated less and less each passing year as people with rights. I had a neighbor who had a wheel chair assisted mother and they were going on vacation so they sent her to a rest home for two weeks. As they were wheeling her to the car she kept saying she wanted to stay home, she takes care of herself on weekends while they are away. They of course made her get in the car and go. This is legal in the US. If you forced a twenty year old to get in the car and stay somewhere they didnt want to it would be kidnapping, yet and elderly person it is perfectly legal.
Actually, according to the company's website, many private insurers to cover this drug.
Obviously, some don't. However, that's the beauty of private enterprise. There are choices and options. Once you go to single payer that choice and those options disappear.
This is what scares me the most about Obama's plan. With competition innovation always wins out. People will seek out plans that cover their needs.
Actually, according to the company's website, many private insurers to cover this drug.
Obviously, some don't. However, that's the beauty of private enterprise. There are choices and options. Once you go to single payer that choice and those options disappear.
The ones I've seen do take into account if your a smoker. Can you list one company that doesn't penalize you for that?
In other words, the Speaker of the House thinks that questioning socialized medicine is unAmerican, but attacking the troops is the highest form of patriotism.
The "death panels" are already here Sorry, Sarah Palin -- rationing of care? Private companies are already doing it, with sometimes fatal results
By Mike Madden
Aug. 11, 2009 | The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they're ready to operate, but the bureaucracy -- or as Palin would put it, the "death panel" -- steps in and says it won't pay for the surgery. Despite protests from the girl's family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent -- but the patient dies before the operation can proceed.
It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama's healthcare reform plans are. Except that's not the future of healthcare -- it's the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company's analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn't have saved her life.
That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."
Coverage of Palin's remarks, and former House Speaker Newt Gingrich's defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.
Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty.
"You're asking us to decide that the government is to be trusted," Gingrich -- who may, like Palin, be running for the GOP's presidential nomination in 2012 -- told ABC's "This Week With George Stephanopoulos" on Sunday. But as even a quick glance through news coverage of the last few years shows, private insurers are already doing what reform opponents say they want to save us from. (The insurance industry, pushing back against charges that they're part of the problem, said last month that "healthcare reform is far too important to be dragged down by divisive political rhetoric." The industry has long maintained that its decisions on what to cover are the result of careful investigations of each claim.) Here is a look at a handful of healthcare horror stories, brought to you by the current system. It took Salon staff less than an hour to round these up -- which might indicate how many other such stories are out there.
-- In June 2008, Robin Beaton, a retired nurse from Waxahachie, Texas, found out she had breast cancer and needed a double mastectomy. Two days before her surgery, her insurance company, Blue Cross, flagged her chart and told the hospital they wouldn't allow the procedure to go forward until they finished an examination of five years of her medical history -- which could take three months. It turned out that a month before the cancer diagnosis, Beaton had gone to a dermatologist for acne treatment, and Blue Cross incorrectly interpreted a word on her chart to mean that the acne was precancerous.
Not long into the investigation, the insurer canceled her policy. Beaton, they said, had listed her weight incorrectly when she bought it, and had also failed to disclose that she'd once taken medicine for a heart condition -- which she hadn't been taking at the time she filled out the application. By October, thanks to an intervention from her member of Congress, Blue Cross reinstated Beaton's insurance coverage. But the tumor she had removed had grown 2 centimeters in the meantime, and she had to have her lymph nodes removed as well as her breasts amputated because of the delay.
-- In October 2008, Michael Napientak, a doorman from Clarendon Hills, Ill., went to the hospital for surgery to relieve agonizing back pain. His wife's employer's insurance provider, a subsidiary of UnitedHealthCare, had issued a pre-authorization for the operation. The operation went well. But in April, the insurer started sending notices that it wouldn't pay for the surgery, after all; the family, not the insurance provider, would be on the hook for the $148,000 the hospital charged for the procedure. Pre-authorization, the insurance company explained, didn't necessarily guarantee payment on a claim would be forthcoming. The company offered shifting explanations for why it wouldn't pay -- first, demanding proof that Napientak had tried less expensive measures to relieve his pain, and then, when he provided it, insisting that it lacked documentation for why the surgery was medically necessary. Napientak's wife, Sandie, asked her boss to help out, but with no luck. Fortunately for the Napientaks, they were able to attract the attention of a Chicago Tribune columnist before they had to figure out how to pay the six-figure bill -- once the newspaper started asking questions, the insurer suddenly decided, "based on additional information submitted," to cover the tab, after all.
-- David Denney was less than a year old when he was diagnosed in 1995 with glutaric acidemia Type 1, a rare blood disorder that left him severely brain damaged and unable to eat, walk or speak without assistance. For more than a decade, Blue Cross of California -- his parents' insurance company -- paid the $1,200 weekly cost to have a nurse care for him, giving him exercise and administering anti-seizure medication.
But in March 2006, Blue Cross told the Denney family their claims had exceeded the annual cost limit for his care. When they wrote back, objecting and pointing out that their annual limit was higher, the company changed its mind -- about the reason for the denial. The nurse's services weren't medically necessary, the insurers said. His family sued, and the case went to arbitration, as their policy allowed. California taxpayers, meanwhile, got stuck with the bill -- after years of paying their own premiums, the Denney family went on Medi-Cal, the state's Medicaid system.
-- Patricia Reilling opened an art gallery in Louisville, Ky., in 1987, and three years later took out an insurance policy for herself and her employees. Her insurance provider, Anthem Health Plans of Kentucky, wrote to her this June, telling her it was canceling her coverage -- a few days after it sent her a different letter detailing the rates to renew for another year and billing her for July.
Reilling thinks she knows the reason for the cutoff, though -- she was diagnosed with breast cancer in March 2008. That kicked off a year-long battle with Anthem. First the company refused to pay for an MRI to locate the tumors, saying her family medical history didn't indicate she was likely to have cancer. Eventually, it approved the MRI, but only after she'd undergone an additional, painful biopsy. Her doctor removed both of her breasts in April 2008. In December, she went in for reconstructive plastic surgery -- and contracted a case of MRSA, an invasive infection. In January of this year, Reilling underwent two more surgeries to deal with the MRSA infection, and she's likely to require another operation to help fix all the damage. The monthly bill for her prescription medicines -- which she says are mostly generics -- is $2,000; the doctors treating her for the MRSA infection want $280 for each appointment, now that she's lost her insurance coverage. When she appealed the decision to cancel her policy, asking if she could keep paying the premium and continue coverage until her current course of treatment ends, the insurers wrote back with yet another denial. But they did say they hoped her health improved.
First, there is the old "two wrongs don't make a right" axiom. Even if we accept everything in the editorial as factually true, that only points to flaws in the current system needing correction. It doesn't point to throwing out that system and replacing it with socialized medicine. And it doesn't show how a government system would be any better. It only argues that the flaws would move from private industry to the government.
In addition, it's likely that any flaws, once institutionalized in the government, would be exacerbated, not abated.
Because we still have private insurance there are companies that compete with each other. Therefore, people have the right to shop around for competitive programs that may provide supplemental insurance to avoid this. Conversely, once the government takes over health care, there is no choice left (or soon won't be).
Case in point, there are people under the Canandian system who have cancer who can't get the drugs to treat it. The government system won't pay for them. Furthermore, the government prohibits the patients from paying for it out of their own pockets, effectively banning people from making decisions about their own treatment. This is most likely why, for example, the mortality rate in Canada from some forms of cancer is much higher than in the U.S.
If people want to find ways to improve the system that's fine. But as anyone who's seen how a government bureaucracy works knows, handing it wholesale over to a bunch of politicians and their cronies is rarely the way to fix anything. Instead, it's usually a recipe for institutionalized waste, abuse and limits on personal freedom.
Two wrongs don't make a right but your prematurely guessing that there will be a second wrong. And private insurance will still exist if this gets passed, there's nothing barring the private sector to continue.
do you want to watch it? i'll post it, i just didnt want to post it and you say i dont watch videos. i know you love your game but its a bit predictable.
You certainly like your game too basams. Your unique way of interpetting posts here for example. If you don't have a quote with a link for something that should be easy to provide then I remain skeptical.
I refuse to see and hear people actually saying things as it can easily prove me wrong.
whomod said: I generally don't like it when people decide to play by the rules against people who don't play by the rules. It tends to put you immediately at a disadvantage and IMO is a sign of true weakness. This is true both in politics and on the internet."
Charities warned that patients with less common forms of cancer were being discriminated against, while others condemned the system as a “scandal”.
Patients and their doctors can appeal for the NHS to pay for drugs not currently licensed for that type of the disease.
But one in three applications were turned down in the last three years, leaving patients having to pay up £20,000 for the medication themselves.
The Rarer Cancers Forum, who obtained the figures, said that patients in France were up to 55 per cent more likely to get so-called “near-label” treatment, drugs licensed for a similar disease, than those in Britain.
Rare cancers include pancreatic cancer, which Patrick Swayze is currently battling and which affects around 7,000 people in Britain every year.
Stella Pendleton, executive director of the charity, said: “If a doctor thinks that a patient with a rarer cancer should be given a drug, then the NHS should fund it.
“The NHS is forcing desperate patients into the cruel situation where the chances of their being given the treatment they need depend on where they live.
“No patient should be denied a treatment recommended by a doctor simply because the cancer it treats is too rare for the medicine to be licensed.
“We need these obstacles removed.”
Dr Beatrice Seddon, a consultant clinical oncologist at University College Hospital, London said: “When conventional treatment options are exhausted, some patients are still strong enough to be able to continue their fight against cancer.
“For these patients (these) drugs may offer a further therapeutic option, and the hope of prolonged good quality life.
“It can be desperately difficult to be told that a patient’s last-chance treatment won’t be funded.
“There needs to be a better way to deal with this hugely complicated issue.”
The figures were obtained by the charity through the Freedom of Information Act.
Around a third of healthcare trusts provided data, indicting that there were 902 requests were made over three years, with 583 approved and 298 rejected.
The charity said this suggested a total of 3,188 requests made during the same period, with 2,061 approvals and 1,053 patients denied treatment.
A total of three Primary Care Trusts, North Staffordshire PCT, Oldham PCT and Western Cheshire PCT, turned down all applications.
In contrast, another 11 funded them all.
Andrew Lansley, the shadow health secretary, said: “It is a scandal that effective cancer drugs that are widely available in other countries are not available here.
“No patient should be forced to pay privately for clinically effective drugs that they need for their treatment.”
A spokesman for the Department of Health said: “Doctors can use their clinical judgement to prescribe any treatment that will benefit their patient, even if it is outside its licensed indication.
“Such decisions need to be made in discussion with the patient concerned and funding may need to be agreed with the local PCT.”
He added: “The Government is committed to increasing patients’ access to innovative new drugs and treatments.”
You may have heard President Obama trumpet in many recent speeches his plan to have government run health insurance cover everyone's pre-existing medical conditions. As an example, he said to the American Medical Association on June 15, 2009:
"That is why we need to end the practice of denying coverage on the basis of pre-existing conditions. The days of cherry-picking who to cover and who to deny--those days are over."
That certainly sounds like signing up for one of the government insurance plans, no matter what ails you, will get you covered, doesn't it?
I was curious to see if the President is right about his plan putting an end to "cherry-picking" which illnesses to cover, so I decided to wade through the 1,018 page proposed health care law to find out if that's true.
Come with me on this fantastic voyage through a mess of cross-referenced and confusing legalese. As your tour guide, I have nearly 20 years experience in practicing insurance law, but reading this was not easy for me. We can get through it together though.
If the President wanted his health insurances to cover all pre-existing conditions, you'd expect some pretty simple language that says,"All pre-existing conditions will be covered." Take a look at what is written into the law instead:
Section 111 has this paragraph about pre-existing conditions:
A qualified health benefits plan may not impose any pre-existing condition exclusion...
Great! Looks like the President is telling the truth. Oh but wait, the paragraph doesn't end there. It continues...
...(as defined in section 2701(b)(1)(A) of the Public Health Service Act)...
Ok, that means we have to look up a whole other law - the Public Health Service Act (PHSA) - to find out what the definition "pre-exiting condition exclusion" is. But before we do that, the paragraph we are reading continues:
...or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.
Ok, the paragraph we are reading has ended, but we now have two tasks: Go to the PHSA and look up the definition of "pre-existing condition" in section 2701(b)(1)(A) and the definition of "health status related factors" in section 2791(d)(9).
When we Google those sections of the PHSA to read it, we run into a problem: The section numbers referenced in Obama's bill for the PHSA are the old numbers. The PHSA has been amended with new numbers, so our Googling has failed us.
Undeterred, we print out the full text of the PHSA so we can read the whole thing and find the correct section numbers. Much to our chagrin, it is 1,476 pages long. There goes our Saturday. But we are committed to this project, so we bear down and find the right sections.
Here is how the PHSA defines "pre-existing condition exclusion" in section 2701(b)(1)(A):
IN GENERAL.-The term "preexisting condition exclusion" means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
That's great! I have to tell you, President Obama seems a man of his word...oh wait. We had two things to look up here in the PHSA, didn't we? Section 2701(d)(9) defines "Health Status-Related Factor" like this:
The term "health status-related factor" means any of the factors described in section 2702(a)(1).
Ok, what kind of dirty trick to waste our time was that? President Obama sends us to section 2701 for a definition, and the definition is"see section 2702." Why not send us right to section 2702? Sigh. Fine. Let's keep reading.
Section 2702 (a)(1) of the PHSA says:
(a) INELIGIBILITY TO ENROLL.-
(1) IN GENERAL.-Subject to paragraph (2),...
Ok, stop right there. Just know that as we continue reading paragraph 1, we have to withhold any conclusion, because everything we are about to read is subject to paragraph 2. Ok? So let's continue with paragraph 1:
...a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(A) Health status.
(B) Medical condition (including both physical and
mental illnesses).
(C) Claims experience.
(D) Receipt of health care.
(E) Medical history.
(F) Genetic information.
(G) Evidence of insurability (including conditions arising
out of acts of domestic violence).
(H) Disability.
Well I have to tell you up to this point President Obama is still looking good. Paragraph 1 seems to say the Government can't deny you coverage based upon any of the above pre-existing conditions. Oh but I forgot - the whole thing is "subject to paragraph 2." Let's see what that says:
(2) NO APPLICATION TO BENEFITS OR EXCLUSIONS.-To the extent consistent with section 701,...
OK, stop right there. They are making us work again. We are going to continue reading paragraph 2, but we have to withhold conclusions because we have to make sure it is "consistent with section 701." All right, here is paragraph 2:
paragraph (1) shall not be construed-
(A) to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or
(B) to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or overage for similarly situated individuals enrolled in the plan or coverage.
The bottom just fell out, and Obama is looking pale. The above language in paragraph 2 just put a whole bunch of power in the hands of the folks writing the policies when it comes to pre-existing conditions.
But before we analyze that, remember paragraph 2 has to be "consistent with section 701." So let's look at that. It says:
The purpose of this subpart is to enable the Secretary to provide a Federal program of student loan insurance for students in (and certain former students of) eligible institutions (as defined in section 719).
Wait...what? What's that got to do with the price of tea in China? We are talking about pre-existing medical conditions and suddenly we get sent to a section about - I don't know - giving loans to foreign exchange students from Kenya?
I think I know what happened there. The Public Health Service Act was originally written in the 1940's and has been amended many times. Somewhere along the way Congress just got sloppy, and now there is a cross-reference that either makes no sense or the connection is so obscure even comedian Dennis Miller thinks it's a little far-fetched.
I think it's just a huge typographical error, so the only thing we can do is ignore section 701 and get back to paragraph 2 of Section 2702, which we were discussing above.
I know all of this is confusing, but let your trusty tour guide tell you where you stand:
What paragraph two says in part A is that policy writers for the government will be allowed to make the insurance you buy cover certain ailments, and not cover others (one of which may be a condition you happen to have, which is pre-existing).
What paragraph two says in part B is that policy writers for the government will be allowed to limit the amount, level, extent, or nature of the treatment you get for certain ailments (one of which may be your pre-existing condition).
So who will be writing your insurance policy? According to the President's plan, a new bureaucracy known as the "Health Benefits Advisory Committee." It will be made up of 27 people, and guess how many have to be a treating doctor: One.
So if you believe President Obama's quote to the AMA means that if you sign up for government insurance your pre-existing condition will automatically be covered, - you're wrong, and so is the President. You'd better read the fine print on whether the gang of 26 bureaucrats plus one doctor is going to cover your pre-existing condition or not. President Obama is giving them the power to not cover you.
When Congressman Rick Larsen (D-WA) took his health care forum to the pitcher's mound on Wednesday at Memorial Stadium in Everett, Washington, of course he expected detractors to be lobbing hard balls.
But when a woman began literally reading a list of scary-yet-false claims about the president's health care proposals -- concluding with, "I'm unwilling to throw my health insurance away for them" (meaning the poor) -- Larsen took a deep breath.
First, he clarified that nobody will be forced to buy health care or change their current policies. Then he broke through to his real point: "Some folks will say that's not true. But, I've got facts on my side, you've got Glenn Beck on your side."
The audience erupted in cheers.
Also worth noting, one speaker toward the very end makes a very good counter-point to those who suggest that the Constitution does not authorize Congress to initiate an optional public health insurance plan.
He says: "Article 1, section 8 says that it's the duty of Congress to provide for the general welfare. That's what I see this health care bill as. Providing for the general welfare. So, for the Constitution people, there it is. Maybe you haven't read it."
Meanwhile, after being targeted by American conservatives for its allegedly "Orwellian" health care system, the British are finally being dragged into America's health debate as well. In a lengthy expose' on American health care, The Independent sent a reporter into the belly of the beast: A free health care fair in Los Angeles, California, where over $2 million in health services were given away over eight days.
The poor lined up around the block. Hundreds of teeth were pulled. Blood pressure was taken. Mammograms given. Blood was tested. Children received vital immunizations. It improved the quality of life for thousands of Americans, to whom health care is oh-so scarce.
In other words, it was evil, "Orwellian"-style Socialism. (Not to say there's nothing "Orwellian" about the UK; there is.)
Most striking about the piece is a list of numbers printed at the bottom. Let these figures soak in, as sourced from the World Health Organization:
Health spending as a share of GDP
US 16%
UK 8.4%
Public spending on healthcare (% of total spending on healthcare)
US 45%
UK 82%
Health spending per head
US $7,290
UK $2,992
Practising physicians (per 1,000 people)
US 2.4
UK 2.5
Nurses (per 1,000 people)
US 10.6
UK 10.0
Acute care hospital beds (per 1,000 people)
US 2.7
UK 2.6
Life expectancy:
US 78
UK 80
Infant mortality (per 1,000 live births)
US 6.7
UK 4.8 How do you like that? The UK spends half as much of their gross domestic product as we do, yet their life expectancy is longer, they have more doctors per 1,000 people and a lower infant mortality rate.
And their poor are not forced into wage slavery because they could not afford or were denied health insurance.
Yet, they spend less per person than we do.
Seriously, has anyone ever seen so many allegedly "free market" Republicans act like such children when their friends at the insurance companies were confronted with a little potential competition?
You'd further think that figures like these would encourage more pro-lifers to support health care for the poor. Think about it. Making medical treatment available to a woman newly pregnant and throughout her expectancy would ultimately Save More Babies while lowering the costs of bringing a child into the world.
Until Democrats begin framing their arguments in terms the frightened opposition can understand -- in their logic, on a level that even (and especially) makes sense to dumb folk -- I'm unconvinced the public option will succeed.
