5 freedoms you'd lose in health care reform

nomix

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What I really don't get is how the insurance companies are able to drop someone when they get sick.

I would be able to grasp the idea of the insurance company dropping you after paying for your treatment, but denying a paying customer his or her product?

Y'know what? I thought Americans were demanding with regards to service. Like that really annoying guy wanting a waldorf salad in Fawlty Towers..
 

tigger

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Never underestimate the persuasive powers of the propaganda machine that is Fox Noise... ;)
There's a lot more to it than that, but Fox certainly doesn't help anything.

FUCKING BULLSHIT
Sounds like it. I can't afford insurance at the moment, but even if I could I don't think they'd cover anything with my knees, since both have damaged meniscus and I've had my right ACL replaced.

Y'know what? I thought Americans were demanding with regards to service. Like that really annoying guy wanting a waldorf salad in Fawlty Towers..
That's the line anyway. The idea is, of course, that if you don't like your coverage you can get someone else. Problem is that every insurance company out there will screw you over. I thought it was particularly hilarious when we were debating public option and conservatives kept saying that the plan offered no competition, no options :?.
 

nomix

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The hidden hand of the market - screwing people since the beginning of time.
 

freeferrarisdonotexist

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It's not just Fox, it's the deeply implanted ideological buffer called the American dream. It was the ideological buffer that made sure Hoover wouldn't make sure people had stuff to eat, it was what made enough people realize that the dream didn't work, which put FDR in office, however, it also got in his way all of the time.

People say Social Security is the third rail of American politics. That's bullshit. The third rail of American politics is the American dream. It's the single thing that has been the biggest restriction on common sense pragmatism.. ever.

Not everybody can pull themselves up by their boot straps.

America has one big problem. The idea of the American dream. It's as addictive as heroin.

The problem is that the so-called American dream is unrealistic and ultimately meaningless, considering that 90% of the "dream" is concerned with possessions and one-upping your neighbours.

Carlin becomes relevant again:

"There's just enough bullshit to hold things together in this country. Bullshit is the glue that binds us as a nation. Where would we be without our safe, familiar, American bullshit?

Land of the free,

home of the brave,

the American dream,

All men are equal,

Justice is blind,

The press is free,

Your vote counts,

Business is honest,

The good guys win,

The police are on your side,

God is watching you,

Your standard of living will never decline,

And everything is gonna be just fine.

The official national bullshit story. I call it the American okie-doke. Every one of those items is provably untrue at one level or another, but we believe them because they're pounded into our heads from the time we're children."

:mrgreen:
 

Plissken

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http://www.philly.com/philly/busine...o_cover_their_ailing_son_s_therapy_needs.html

Parents suing to force insurance firm to cover their ailing son's therapy needs


By Ronnie Polaneczky
Philadelphia Daily News
Daily News Columnist

PAUL AND MARIA VanNocker are filing a federal lawsuit today on behalf of their 5-year-old son, Kyler, whose insurance company, HealthAmerica, refuses to pay for the latest treatment needed to prolong his life.

The complaint raises lots of questions that I assume will be answered at trial, should it come to that. The question it won't answer is one that's been gnawing at me since I first wrote of Kyler's plight in December:

How do HealthAmerica's overlords sleep at night?

I know my own dreams would be haunted if I acted as arbitrarily, capriciously and abusively - to borrow some pointed adjectives from the complaint - as the VanNockers allege HealthAmerica has regarding their little boy.

The Harrisburg-based company's denial of benefits to Kyler, the lawsuit claims, is the result of "a biased, self-serving misreading and misinterpretation" of everything from Kyler's medical records to the company's own internal documents.

HealthAmerica's Kendall Marcocci told me yesterday that the company won't comment on pending litigation. Center City attorney David Senoff, though, was happy to explain why he is representing the Van Nockers for free in the lawsuit.

"These companies have to be brought to the courthouse to get them to do the right thing," said Senoff, a specialist in insurance disputes. "This child needs this treatment, or else."

He didn't need to explain what "or else" meant.




Readers may recall that Kyler has neuroblastoma, a rare, deadly childhood cancer that attacks the nervous system, creating tumors throughout his body.

He was diagnosed in 2007 and endured a year of medical treatment, with complications he barely survived. Thankfully, it knocked his cancer into remission for 12 lovely months, and he got to revel once again in the glories of childhood.

Last September, the disease came roaring back. This time, only one form of treatment, something called MIBG therapy, could help save his life.

But HealthAmerica refused to pay for the MIBG, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness." Nor is MIBG approved by the Food and Drug Administration, another criterion that HealthAmerica requires.

How come, then, asks the lawsuit, HealthAmerica covered not one but two prior therapies for Kyler that did not possess these supposed requirements?

In April 2008, the company approved Kyler's use of a drug to treat a life-threatening blood-flow complication, even though the drug wasn't FDA-approved, wasn't manufactured in the United States and wasn't "peer-reviewed."

However, it was the only known drug to treat Kyler's condition, and he responded well to it. Four months later, HealthAmerica paid for another medication that wasn't FDA-approved for neuroblastoma treatment.

Again, Kyler responded well.

So why, pray tell, is HealthAmerica playing the "experimental therapy" card in the case of the MIBG treatment Kyler now needs? Gee, money couldn't have anything to do with the decision, could it?

In my December column, HealthAmerica's Marcocci was emphatic that her company declined Kyler's MIBG therapy not because of its cost but because of its experimental nature.

But that doesn't mean MIBG is ineffective.

"It's considered the standard of care in Europe and the United States for recurrent neuroblastoma," Kyler's oncologist, Stephan Grupp, told me then. "It's not an unproven treatment with no basis in medical science. Actually, the results are often very good."




Regardless of how you describe MIBG, one thing became clear last week when Paul and Maria got the results of Kyler's latest tests to track his neuroblastoma.

The MIBG is working.

Children's Hospital, where Kyler receives much of his care, proceeded with two rounds of MIBG therapy for Kyler - at a cost of $110,000 - despite the VanNockers' inability to pay for it. (CHOP hopes that HealthAmerica will reconsider or that Medicaid will cover the MIBG cost; the VanNockers are Medicaid-eligible because they are bankrupt by medical costs).

"He's doing phenomenal," said Paul, noting that some of Kyler's many tumors have disappeared; others have shrunk in size and density. Kyler's improved condition now makes him eligible for treatment less toxic to his overall system than the "big guns" of MIBG.

That doesn't mean Kyler is out of the woods. His serious diagnosis ensures that his prognosis will always be uncertain.

But for now, because his internationally renowned neuroblastoma doctors, not his insurance company, is making the medical decisions, Kyler might make it to his sixth birthday in November.

E-mail polaner@phillynews.com or call 215-854-2217. For recent columns:

http://go.philly.com/polaneczky. Read Ronnie's blog at http://go.philly. com/ronnieblog.

The parents had jobs, had not one but two insurance policies to cover their son and they are still technically bankrupt.
 

Plissken

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http://www.philly.com/philly/busine...o_cover_their_ailing_son_s_therapy_needs.html

Parents suing to force insurance firm to cover their ailing son's therapy needs


By Ronnie Polaneczky
Philadelphia Daily News
Daily News Columnist

PAUL AND MARIA VanNocker are filing a federal lawsuit today on behalf of their 5-year-old son, Kyler, whose insurance company, HealthAmerica, refuses to pay for the latest treatment needed to prolong his life.

The complaint raises lots of questions that I assume will be answered at trial, should it come to that. The question it won't answer is one that's been gnawing at me since I first wrote of Kyler's plight in December:

How do HealthAmerica's overlords sleep at night?

I know my own dreams would be haunted if I acted as arbitrarily, capriciously and abusively - to borrow some pointed adjectives from the complaint - as the VanNockers allege HealthAmerica has regarding their little boy.

The Harrisburg-based company's denial of benefits to Kyler, the lawsuit claims, is the result of "a biased, self-serving misreading and misinterpretation" of everything from Kyler's medical records to the company's own internal documents.

HealthAmerica's Kendall Marcocci told me yesterday that the company won't comment on pending litigation. Center City attorney David Senoff, though, was happy to explain why he is representing the Van Nockers for free in the lawsuit.

"These companies have to be brought to the courthouse to get them to do the right thing," said Senoff, a specialist in insurance disputes. "This child needs this treatment, or else."

He didn't need to explain what "or else" meant.




Readers may recall that Kyler has neuroblastoma, a rare, deadly childhood cancer that attacks the nervous system, creating tumors throughout his body.

He was diagnosed in 2007 and endured a year of medical treatment, with complications he barely survived. Thankfully, it knocked his cancer into remission for 12 lovely months, and he got to revel once again in the glories of childhood.

Last September, the disease came roaring back. This time, only one form of treatment, something called MIBG therapy, could help save his life.

But HealthAmerica refused to pay for the MIBG, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness." Nor is MIBG approved by the Food and Drug Administration, another criterion that HealthAmerica requires.

How come, then, asks the lawsuit, HealthAmerica covered not one but two prior therapies for Kyler that did not possess these supposed requirements?

In April 2008, the company approved Kyler's use of a drug to treat a life-threatening blood-flow complication, even though the drug wasn't FDA-approved, wasn't manufactured in the United States and wasn't "peer-reviewed."

However, it was the only known drug to treat Kyler's condition, and he responded well to it. Four months later, HealthAmerica paid for another medication that wasn't FDA-approved for neuroblastoma treatment.

Again, Kyler responded well.

So why, pray tell, is HealthAmerica playing the "experimental therapy" card in the case of the MIBG treatment Kyler now needs? Gee, money couldn't have anything to do with the decision, could it?

In my December column, HealthAmerica's Marcocci was emphatic that her company declined Kyler's MIBG therapy not because of its cost but because of its experimental nature.

But that doesn't mean MIBG is ineffective.

"It's considered the standard of care in Europe and the United States for recurrent neuroblastoma," Kyler's oncologist, Stephan Grupp, told me then. "It's not an unproven treatment with no basis in medical science. Actually, the results are often very good."




Regardless of how you describe MIBG, one thing became clear last week when Paul and Maria got the results of Kyler's latest tests to track his neuroblastoma.

The MIBG is working.

Children's Hospital, where Kyler receives much of his care, proceeded with two rounds of MIBG therapy for Kyler - at a cost of $110,000 - despite the VanNockers' inability to pay for it. (CHOP hopes that HealthAmerica will reconsider or that Medicaid will cover the MIBG cost; the VanNockers are Medicaid-eligible because they are bankrupt by medical costs).

"He's doing phenomenal," said Paul, noting that some of Kyler's many tumors have disappeared; others have shrunk in size and density. Kyler's improved condition now makes him eligible for treatment less toxic to his overall system than the "big guns" of MIBG.

That doesn't mean Kyler is out of the woods. His serious diagnosis ensures that his prognosis will always be uncertain.

But for now, because his internationally renowned neuroblastoma doctors, not his insurance company, is making the medical decisions, Kyler might make it to his sixth birthday in November.

E-mail polaner@phillynews.com or call 215-854-2217. For recent columns:

http://go.philly.com/polaneczky. Read Ronnie's blog at http://go.philly. com/ronnieblog.

The parents had jobs, had not one but two insurance policies to cover their son and they are still technically bankrupt.
 

Steve Levin

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Only on the internet can a situation where a company allowed twice for treatments that didn't meet his guidelines but then refused the third time be treated this way.

The NHS would have denied any of the treatments and the child would have died years ago. But that's supposed to be better?

The story here is... a sick young boy got two types of experimental treatments that insurance doesn't fundamentally cover, and then a third covered by the hospital when they knew that the parents couldn't pay. In other words, medical care far above and beyond the norm. Certainly a far better level of service that nationalized health services would provide.

Yep, that's a real failure of health care.

As I said, only on the internet.

Steve
 
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tigger

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Steve, that is bullshit.

This is just another example, on a very long list, of the failure of private insurers.
 
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marcos_eirik

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Only on the internet can a situation where a company allowed twice for treatments that didn't meet his guidelines but then refused the third time be treated this way.

The NHS would have denied any of the treatments and the child would have died years ago. But that's supposed to be better?

The story here is... a sick young boy got two types of experimental treatments that insurance doesn't fundamentally cover, and then a third covered by the hospital when they knew that the parents couldn't pay. In other words, medical care far above and beyond the norm. Certainly a far better level of service that nationalized health services would provide.
Eh? In a country with a working health care system, like here, the nationalized health care system would have covered such a treatment. It would only require the patients (parents in this case, as it's a kid) permission to use "experimental" treatments, and it wouldn't cost them a dime...

That's the problem with the American healthcare system; firstly it's ridiculously expensive, and secondly it's not certain you might actually get the coverage you're paying for. Just ask British Rover about that... The insurance companies can deny coverage by defining treatments as "experimental" to sneak away from their obligations.
 

Plissken

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Only on the internet can a situation where a company allowed twice for treatments that didn't meet his guidelines but then refused the third time be treated this way.

Unfortunately, this isn't the internet. This is real life.

The NHS would have denied any of the treatments and the child would have died years ago. But that's supposed to be better?

Wrong. He would have got treatment.

The story here is... a sick young boy got two types of experimental treatments that insurance doesn't fundamentally cover, and then a third covered by the hospital when they knew that the parents couldn't pay. In other words, medical care far above and beyond the norm. Certainly a far better level of service that nationalized health services would provide.

Repeat after me, until you get it into your thick skull Wrong. He would have got treatment.

Two lots of health insurance, two parents doing everything they can and they are still bankrupted by medical bills.

Only in America.
 

Top Geek

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The NHS would have denied any of the treatments and the child would have died years ago. But that's supposed to be better?
Um... no.

In all of the public healthcare systems I'm aware of (including Canada's), you get whatever medical treatment is required. Period.
 
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Steve Levin

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Wrong. He would have got treatment.

You're claiming that the NHS routinely approves treatments not on its approved list? And that if the NHS turns it down, the hospital will perform the treatment anyway?

You DO realize I'm not talking about your fantasy Neverland Health Service, right?

Steve
 

h-p

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You're claiming that the NHS routinely approves treatments not on its approved list? And that if the NHS turns it down, the hospital will perform the treatment anyway?

You DO realize I'm not talking about your fantasy Neverland Health Service, right?

Steve

Atleast in here there's no "approved list". If the doctor decides to give the treatment, it's given.
 

2Billion

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You're claiming that the NHS routinely approves treatments not on its approved list? And that if the NHS turns it down, the hospital will perform the treatment anyway?

You DO realize I'm not talking about your fantasy Neverland Health Service, right?

Steve
You've never lived in a country with a real healthcare system, have you?

I have, if the doctor says it's necessary, that is the treatment you get. There's no list of approved treatments, it's not like going through an insurance company to get approval. The ONLY hard part is if you have to go out of province for a treatment, because healthcare is under provincial jurisdiction.

I know plenty of people who have had to go to the hospital with serious or life-threatening conditions, and they've never had to worry about any of the crap you're spouting. They go in, get a diagnosis, and get scheduled for the treatment depending on the severity of the illness. If only an experimental treatment will work, that is explained to them, along with the risks inherent, and then they get the treatment if they choose. My mother has had several experimental MS treatments proposed to her by her doctors, and she wouldn't have to pay for any of them.
 

Steve Levin

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Actually, it's pretty clear you folks don't actually understand your own health care systems -- not surprising, since many of the issues we are discussing only really impact the seriously ill.

For the NHS, just a simple google news search of "NHS denies procedure" will yield pages and pages of articles talking about exactly this issue (not every single one is 100% on target to this discussion, but the first page of my search of that just yielded at least two articles directly on point).

For example, to quote from a result on the first page of many results....

http://www.walesonline.co.uk/news/h...s-decides-to-pay-for-new-drug-91466-25649252/

Patients in Wales are being denied a cancer drug that could keep them in remission because the NHS has yet to decide whether it will fund the ?20,000 cost.

Steve
 
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nomix

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It must be hard living a lie.

Nothing personal Steve, but you are reminding me of the Lords who kept on voting against the People's Budget back in 1911. They ought to know that what they were doing DID NOT work, but they kept on running into the bloody wall..
 
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2Billion

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Actually, it's pretty clear you folks don't actually understand your own health care systems -- not surprising, since many of the issues we are discussing only really impact the seriously ill.

For the NHS, just a simple google news search of "NHS denies procedure" will yield pages and pages of articles talking about exactly this issue (not every single one is 100% on target to this discussion, but my search of that just yielded at least two articles directly on point).

For example, to quote from a result on the first page of many results....

http://www.walesonline.co.uk/news/h...s-decides-to-pay-for-new-drug-91466-25649252/



Steve

So the NHS not yet giving funding - but potentially doing so in the future - is worse than Americans never getting funding, and getting their insurance cut for no reason.

You, sir, are an idiot.
 
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