An illustration of the problem with UHC

[Loren Pechtel]

Yes, this is in America but since we are talking Medicare it's effectively a UHC situation:

They have noted the fact that hormone replacement does not confer the health benefits that were supposed for it--and thus have decided it's not to be covered under any Medicare plan. Never mind that some women take it for other reasons which remain as valid now as before the studies came out.

Since they're the government they can get away with simply defining it as not medically necessary even when it clearly is. (The doc I learned this from had an example: A M->F transsexual was denied coverage.)

 

[bilby]

Yes, this is in America but since we are talking Medicare it's effectively a UHC situation:

They have noted the fact that hormone replacement does not confer the health benefits that were supposed for it--and thus have decided it's not to be covered under any Medicare plan. Never mind that some women take it for other reasons which remain as valid now as before the studies came out.

Since they're the government they can get away with simply defining it as not medically necessary even when it clearly is. (The doc I learned this from had an example: A M->F transsexual was denied coverage.)

How is this a problem with UHC?

What makes you think that a stupid government decision not to cover something, is somehow a more likely event than a stupid insurance company decision not to cover the same thing?

The profit motive suggests that private insurers would do this more often than government ones; and the ballot box suggests that government is far more likely to listen to the ordinary people who are affected by this than any private insurer is.

 

[Bronzeage]

Yes, this is in America but since we are talking Medicare it's effectively a UHC situation:

They have noted the fact that hormone replacement does not confer the health benefits that were supposed for it--and thus have decided it's not to be covered under any Medicare plan. Never mind that some women take it for other reasons which remain as valid now as before the studies came out.

Since they're the government they can get away with simply defining it as not medically necessary even when it clearly is. (The doc I learned this from had an example: A M->F transsexual was denied coverage.)

It doesn't seem any different from healthcare policies which will not cover birth control drugs, even when prescribed for non contraceptive reasons.

 

[untermensche]

No insurance company has an unlimited formulary.

There is limited funding to Medicare, mostly due to Republican hatred of the program, which really means corporate hatred of the program.

Choices have to be made.

Hormone replacement only goes so something else can be covered.

Your squabble is with the Republican party. Not UHC.

We could easily afford a better system. But lowering taxes on the most wealthy so we can create a nice oligarchy and endless war is more important to politicians of a certain stripe.

 

[barbos]

I expected to see some horror story about bad service in UHC.

I had a minor crap which needed to be taken care few times.
One time they simply cut it off and fut few stitches, insurance paid for it.
Another time it was small and they simply used some electro-something.
It was clearly less work and less expensive but stupid insurance would not pay for it because they (I guess) have a list of procedures and it was not on the list. So next time I told doctor put in a report something which is covered by insurance and he said OK.

 

[ZiprHead]

I had a minor crap which needed to be taken care few times.

 

[Jimmy Higgins]

Yes, this is in America but since we are talking Medicare it's effectively a UHC situation:

They have noted the fact that hormone replacement does not confer the health benefits that were supposed for it--and thus have decided it's not to be covered under any Medicare plan. Never mind that some women take it for other reasons which remain as valid now as before the studies came out.

Since they're the government they can get away with simply defining it as not medically necessary even when it clearly is. (The doc I learned this from had an example: A M->F transsexual was denied coverage.)

There, you see, instead of everyone having no out of pocket cost health insurance coverage via taxation instead of premiums to private companies, we'll protect the rare anecdotal situations Loren can come up with. Instead we have the current system which is very difficult to afford without a job that offers it, to receive services that you have no idea how much they will cost until a few months after you get them.

 

[laughing dog]

Any system - health care or otherwise - will have some problem associated with it, because people are diverse enough in their desires and situations that make the perfect system unattainable. So pointing out a potential flaw is not terribly useful if it is not viewed in the larger context of the goals and strengths of the competing proposals and status quo.

 

[braces_for_impact]

Yep, sorry, I don't see that as a problem with UHC. Insurance companies can and do all the things that opponents of UHC complain about. They get between you and your doctor. They limit your choice in health care professionals. They deny treatment, and sometimes, this results in death.

 

[Toni]

Well, Loren has a point but perhaps accidentally. The trend now is that health insurance companies follow the lead of Medicare and what Medicare won't cover, pretty soon no insurance company will cover. I'm just hoping mine holds out and am not looking forward to Medicare when that time comes.

It's a real problem that insurance companies, including Medicare, make determinations about what is or is not medically appropriate. I've had my own battles with Medicare on behalf of my mother . Not fun .

 

[Loren Pechtel]

Yes, this is in America but since we are talking Medicare it's effectively a UHC situation:

They have noted the fact that hormone replacement does not confer the health benefits that were supposed for it--and thus have decided it's not to be covered under any Medicare plan. Never mind that some women take it for other reasons which remain as valid now as before the studies came out.

Since they're the government they can get away with simply defining it as not medically necessary even when it clearly is. (The doc I learned this from had an example: A M->F transsexual was denied coverage.)

How is this a problem with UHC?

What makes you think that a stupid government decision not to cover something, is somehow a more likely event than a stupid insurance company decision not to cover the same thing?

The profit motive suggests that private insurers would do this more often than government ones; and the ballot box suggests that government is far more likely to listen to the ordinary people who are affected by this than any private insurer is.

A private company could be called to account for denied coverage. The government can't.

 

[laughing dog]

How is this a problem with UHC?

What makes you think that a stupid government decision not to cover something, is somehow a more likely event than a stupid insurance company decision not to cover the same thing?

The profit motive suggests that private insurers would do this more often than government ones; and the ballot box suggests that government is far more likely to listen to the ordinary people who are affected by this than any private insurer is.

A private company could be called to account for denied coverage. The government can't.

Of course it can. There is lobbying with elected officials, and there are elections.

 

[Loren Pechtel]

No insurance company has an unlimited formulary.

There is limited funding to Medicare, mostly due to Republican hatred of the program, which really means corporate hatred of the program.

Choices have to be made.

Hormone replacement only goes so something else can be covered.

Your squabble is with the Republican party. Not UHC.

We could easily afford a better system. But lowering taxes on the most wealthy so we can create a nice oligarchy and endless war is more important to politicians of a certain stripe.

You just ass-u-me that I'm talking about something expensive. I'm not--it's $80/yr at Walmart.

 

[Loren Pechtel]

Yep, sorry, I don't see that as a problem with UHC. Insurance companies can and do all the things that opponents of UHC complain about. They get between you and your doctor. They limit your choice in health care professionals. They deny treatment, and sometimes, this results in death.

The point is because it's government they can absolve themselves of all responsibility for making medically insane calls. It's bad enough with employer-paid plans where your recovery is capped at the value of the denied coverage but with the government there's no recourse at all.

 

[Jimmy Higgins]

Yep, sorry, I don't see that as a problem with UHC. Insurance companies can and do all the things that opponents of UHC complain about. They get between you and your doctor. They limit your choice in health care professionals. They deny treatment, and sometimes, this results in death.

The point is because it's government they can absolve themselves of all responsibility for making medically insane calls.

This can be said about everything the Government is involved in. Also sounds like how an amendment in Ohio to perform redistricting via a non-partisan board was bad because they couldn't be held accountable!

It's bad enough with employer-paid plans where your recovery is capped at the value of the denied coverage but with the government there's no recourse at all.

And somehow Tom Sawyer has survived all these years living in Canada. Granted, I think he is only 2 to 2.5 hours from the US border.

 

[ZiprHead]

Well, Loren has a point but perhaps accidentally. The trend now is that health insurance companies follow the lead of Medicare and what Medicare won't cover, pretty soon no insurance company will cover. I'm just hoping mine holds out and am not looking forward to Medicare when that time comes.

It's a real problem that insurance companies, including Medicare, make determinations about what is or is not medically appropriate. I've had my own battles with Medicare on behalf of my mother . Not fun .

Conversely, Medicare is also usually the leader in accepting new procedures before private insurance providers.

 

[ZiprHead]

And somehow Tom Sawyer has survived all these years living in Canada. Granted, I think he is only 2 to 2.5 hours from the US border.

I first read that as Tom Sawyer was 2 to 2.5 hours from death due to Canadian UHC.

 

[Bronzeage]

How is this a problem with UHC?

What makes you think that a stupid government decision not to cover something, is somehow a more likely event than a stupid insurance company decision not to cover the same thing?

The profit motive suggests that private insurers would do this more often than government ones; and the ballot box suggests that government is far more likely to listen to the ordinary people who are affected by this than any private insurer is.

A private company could be called to account for denied coverage. The government can't.

I don't know where you got that idea. I typed in "How to appeal medicare coverage denial?" and found this website:

File an appeal

When someone calls a private company to account for denied coverage, it's called a civil suit. The government is infinitely more callable than a private insurance company.

 

[SimpleDon]

A private company could be called to account for denied coverage. The government can't.

I don't know where you got that idea. I typed in "How to appeal medicare coverage denial?" and found this website:

File an appeal

When someone calls a private company to account for denied coverage, it's called a civil suit. The government is infinitely more callable than a private insurance company.

If you have your health insurance from your employer and they are a large company, say more than 50 to 100 employees then most likely your company is self-insured. Who ever you think that your health care insurance company is, Wellpoint, Blue Cross-Blue Shield, Atena, etc. they aren't. Your company hires them administer the health plan but they don't have any financial interest in your care. For a fee of say 5% they collect all of the bills for the medical care of all of the employees for your company, add them up and add 5% to the total and send it to your company. When they get the payment from your company then then they pay the doctors, druggist and hospitals.

If the insurance company denies coverage just go to your boss and complain. If your company is willing to cover it then the insurance will, after all your company is paying for it. The insurance company doesn't care. In fact they will earn slightly more money, the 5% of the cost of the previously denied item.

 

[Jolly_Penguin]

Don't let a government beaurocrat get between you and your doctor! Get an insurance company with a profit motive to screw you over get between you and your doctor!

Makes perfect sense eh?