rolanni | Mail Call

Anthem doesn't care whether your knee hurts. Anthem only cares whether they're going to have to pay for it . . .

Three years to Medicare and counting.

please soon.

I am hopeful that the congress will give us that mythical 'public option' before the first of the year. Because as a self-employed person, I want #$%#% insurance.

Once upon a time, we had been able to afford our own health insurance as freelancers, but it kept edging up toward "impossible," then the publisher went bust and it was impossible, and thus the day-job.

If there was any way I could afford to pay for health insurance out of our freelance pocket, I'd be outta there like a shot, poorly as it reflects upon me to say so.

*whispers: soon, soon, soon, soon. . .*

As a mid-twenties female, my insurance oop is high, Even without a maternity rider, they seem to assume I'll get pregnant and want to cover that.

soon. please, for the love of all that is good and holy, soon.

Even without a maternity rider, they seem to assume I'll get pregnant and want to cover that.

Right, because all women of childbearing age *obviously* want children...

Preach it, sister.

Yeah, isn't it great that we don't have bureaucrats between us and our doctors? At least with government bureaucrats, they're not trying to make money by delaying or denying. Bletch.

I remember the MRI I had on my left knee. The most difficult part of the test is holding still for the whole time, especially if your knee hurts in the position in which the MRI operator places it.

Thank God, Anthem paid for my test, too.

Kay Webb Harrison
Norfolk, VA

Thank God they decided to let you have it! I have had such... lovely conversations with insurance companies.

Me: X needs to be covered.
Insurance Idjet: Y doesn't need it.
Me: Yes, they do; reference Z.
Insurance Idjet: Oh they couldn't possibly have Z.
Me (resisting urge to use Supr Sekret Machine™ to go through phone and strangle Idjet): Yes, they do; reference two doctor's reports which you already have in your possession concerning Z.
Insurance Idjet: They aren't FITB to have Z.
Me: Let me speak to your supervisor. NOW.

I've lost track of how many times I've had this conversation. I've had it at least twenty times just about my taking NSAIDs other than ibuprofen because I'm not over 65 yet. ::head:desk:: Nevermind their records showing that I have had osteoarthritis since 1987.

What makes any of you think that a national system is going to be any better regarding unresticted access to health services (such as MRI) or certain medications than the current system? Look at Medicaid, and all the things that they will not cover. Be careful what you wish for!

Be careful what you wish for!

Wishing for a health care system that works is a Bad Thing?

For a look at what the health care system would do you only have to look at the VA system where effective treatment is denied because of the expense. MRI's can fall into that category.

I am a veteran and have never had anything denied because of expense. This has indeed included an MRI to find out why my arm continued to hurt despite nothing found on xrays.
Granted, the VA hospital in Fresno, CA is probably one of the best, but that is in large part because staff worked for over twenty years to change and improve it. They also had help from various veteran's groups.
If care in your area is not the best what are you doing to improve it?

Am not "anonymous" above, but we have a single VA hospital for the entire State of Maine. I am a veteran. I don't know of any veteran who uses that VA hospital if they have a choice.

I've never been in it, so I don't know if that reflects distance or quality of care. Togus is about a two hour drive from here. The major regional hospital is about half a mile . . .

Togus is by all accounts a disgrace: it's out-moded, badly staffed and a last resort of the hopeless.

I hear that not all Veteran's Hospitals are like this. We have to remember that Maine is a third-world state.

Do we make as high as third?

Twenty-five years ago that was the situation at Fresno. It serves an area about the same size as Maine (in square miles) including the poorest county in the state.

The improvemt didn't come from above. A few stubborn, dedicated staff members, and a lot of volunteers worked hard and eventually it did percolate up so that now it has support from above as well as on location.

For models of what can be done best to look at the good, not just the failures.

Another VA hospital I have (one) experience with is in Portland, Oregon. From what I saw it is also one of the best.

The biggest difference between the VA experiences I've had and the others is that at VA I'm treated with respect.

Tap-tap

IS THIS THING ON?

*clears throat*

Wishing for a health care system THAT WORKS is a Bad Thing?

Nothing is perfect. I live in Australia which has had Medicare for yonks. One of the main issues is that most governments see Medicare as a loss and so when they need to cut costs they close beds. This leads to longer waiting times. There have been some reports of people waiting 3 or more years for elective procedures (such as knee reconstructions). For emergency procedures they are fantastic. I also have private health insurance cause as a patient I am not.

That having been said - I am soooo glad we don't have your system.

Here are a couple of links to info on the Australian system for your interest.

http://www.drs.org.au/new_doctor/75/fact_sheet_7.html

And if you disregard the political chest beating:

https://www.nsw.liberal.org.au/public_news_and_events/media_releases/nsw_hospital_waiting_list_rises_to_59000.html

Good Luck.

The whole business model of "health insurance" depends on their collecting as much premium as possible and paying as little in claims as they can get away with.

Many perfectly legitimate claims get automatically denied the first time they're submitted -- they'll be paid on appeal, of course, but in the meantime the insurance co. keeps the money, and if you don't go to the effort of appealing, they don't have to pay at all.

And medical review/pre-approval has almost nothing to do with actual medical need, everything to do with cost-benefit calculations (their benefit, not yours).

Darn right it's a broken system with perverse incentives.

Also, while we're at it, can we have comparative effectiveness research? I am sick and tired of having my glasses and orthotics be luxuries. As someone with 20/700 vision, I don't need prescription safety glasses for lab work, prescription goggles for swimming, and even a backup pair of glasses is something I pay for out of pocket. And risky surgery to fix my feet is fine, but two pairs of orthotics so I can have ones that actually fit in my shoes is right out.

That isn't coveren in Canada either, and neither is dental. But with dental you just have to tell them you don't have an insurence plan, and they work with you on a 'pay monthly' basis.

Uh... Orthotics here were custom only, and would run about $200-300 until very recently. You guys pay around $100 CDN for the same stuff in Ontario. (dunno about the other provinces...) The surgical treatment doctors here have tried to foist on me is treated as elective in Canada, and costs about the same in both countries.

And I will be very surprised if Canada doesn't cover some kind of treatment for those who are legally blind. In the US, vision coverage is optional. When you have vision coverage here, it's much easier to get the insurer to pay for contacts than it is to get even one pair of glasses.

They're very good examples of exactly how the US goes wrong, because the patient *doesn't* get to choose which treatment they prefer. Take the more expensive treatment, or do without.

I don't understand how a country that claims to be free and democratic, can allow it's residence the humiliation of having to suffer at the hands of greedy insurance companies.

The idea of having to wait to see if I need a medical proceedure (MRI, for example) is ludicrous! If I need a proceedure, my doctor gives me a referal (and yes they are required otherwise every hypocondreact(sp) and his brother would be wanting proceedures done, clogging up the whole system), I go to the office or building where it's done, either have it done that day or book an appointment AND. IT'S. DONE. PERIOD. No waiting to see if it's approved or not.

From what I can understand, the government option that President Obama is suggesting is for the 50 or so million Americans who don't have proper health insurance. And if the big companies don't like it, then they better make themselves more appealing to the public.

Try Britain, where the government take the money anyway and still make you wait months and/or deny treatment on the grounds that it is too expensive. And where a lot of our best people have left (either the National Health Service or in some cases the country) because they weren't paid decently (and had to work long hours -- do you want a person operating on you who has only had 6 hours sleep in the last 48 hours?). And where they have pledged to make waiting times shorter, but all they've done is shorten the maximum (and therefore the mean) but the median (most likely) time has stayed the same or gone up.

I'm not sure if I could get an MRI for a non-life-threatening condition here within 6 months. I do know that when I was in Germany (another national heath system) my knee (cartilage abrasion, it turned out) only got seen quickly because my private insurance paid for it and it would have taken months to get an appointment otherwise...

Nationalised health scemes aren't utopia either...

No, they are not, true. But they are far better than the system in the US. I'm from a Third World country, with a public system (free for all: public hospitals, for example), then the semi-public (a health insurance paid from your income, but the cost is ten times lower than any private company) and private health care. There are great problems in public hospitals. However, they can't deny any kind of procedure to patients (be MRI, surgeries, etc), OR medication (contraceptives are freely given in public hospitals, as well as antibiotics, or other treatments for people who otherwise would not have the chance to buy them). However, you depend on the fact that the machines are working, the surgery rooms are ready and fully provided, and the hospital pharmacies have the drugs required. Sometimes, you do have to wait months for a surgery or a procedure like your MRI. However, these services are entirely free.

Within this category also falls treatments like those for cancer or HIV, or insulin for diabetics. You can apply for them at the Health Ministry, and they'll give these for free.

Then those who have a job in any branch of public administration (in town, province or federal administrations) has a sort of health care on their own. They don't ask if you want to belong to it, you just do. They take a small amount from your paycheck, and you are included on it. It's compulsory for all public employees.

(However, anyone can join it for a slightly more than the public employees, and the cost is really not much, compared to the private companies).

This one is much, much, much better than the free, public system. You might still have to wait for procedures but never as long as in the public system, and sometimes, not at all.

I had hernia surgery and hysterectomy a couple of years ago. I paid nothing, except a plus the surgeon and then to the anesthetist, a plus that was absolutely within my budget (husband is a public employee, and the second job is veterinarian). The health care system covered the costs of the surgery, and the stay at the private clinic where I had it, plus medication.

I am diabetic and have thyroids problems, and my daughter has asthma. The health care system pays 70% of the cost of our medications. The voluntary second health insurance we have with the Union of public employees covers more than 20% of what's left. So, we end paying almost nothing.

I have had all kind of procedures and tests (including mammographies and ultrasounds). All they require is an authorization, which is never denied if the doctor attaches a report explaining why you need it. And you don't have to wait weeks to get the authorization. You go to the Health Care office closer to your home and present your papers there, and they approve it (they have a doctor there).

Now, there are procedures that require a deeper review. They can take months, and sometimes, but MRI's or CAT scans aren't among them. We are talking about meds that need to be imported, or experimental treatments here. Everything outside this category, that's considered normal, you get almost without incident, always.

I wear glasses (severe myopia), and I do have to get authorization from them, but they basically cover half the cost of my glasses and 60 to 70 % of contacts, so it's worth the wait, and all the paperwork.

Health is a Constitutional right. You can sue the State here and get compensation if they don't cover your medical needs if you can't pay for them, so they cover themselves.

It might be not perfect, but sure as hell it beats the alternative. I wouldn't have been able to my surgeries, my glasses or my meds if some sort of public system had not been in place. So, considering the alternatives, I would still take this system over nothing at all.

I'm willing to believe that a "third world" country does better than Britain. Here we often do have to fight to get the correct drugs (if the NHS decides that the drug or treatment "isn't worth the cost" you're out of luck, and they often substitute cheaper versions which contain different ingredients). Adults here don't get glasses or eye surgery discounts at all (children may, I'm not sure whether that's means-tested) unless they are on 'benefits' (i.e. below minimum wage) except when the (private) shops do offers; we do get free eye tests (again done privately, NHS subsidised to the testers) at intervals (and employers are required to provide them as as well).

Prescribed medicines are subsidised, being fixed price per item (I take enough that I buy a fixed-price prepayment certificate, it works out cheaper if you have more than 2 items per month), or again free to those on benefits. But anything else you buy from a pharmacist (but they compete and for common drugs like Ibuprofen the "own brand" ones are cheap).

Better than the US system? For emergencies, certainly, there's no checking of insurance on admission. For 'elective' and non-urgent surgery I'm not so sure...

I know, and don't get me wrong, I'm not trying to tote that socialized medicine is perfect, but living so close to the States, I hear so much complaint about people not getting the treatment they need because some unknown person says it isn't needed.

It may not be the fastest, but at least you know you're going to get the treatment you need and not have to argue and fight to have your voice heard. Especially when you've paid your premiums.

Sorry, I know I sound argumentive, and I don't mean to be. It just makes me so angry, and I'm not even American. But the thing that burns me the most, is that all those polititicans who are against any kind of government plan, would get the treatment they need without a second thought. Why can't it be lik that for every American?

From what I've heard Canada is better than the UK for health service (and social services in general), it doesn't surprise me that yours works. Emergency care is one area where I agree that there should be an automatic system, I've been appalled by reports of Americans being not treated because they don't have insurance (or don't have it with them when they are injured), but non-urgent and 'elective' treatment is another matter, at least the UK system is slow and a "postcode lottery" (i.e. it depends where you live and what your GP is like).

Why isn't it like that for every American? Because a lot of them don't want it. A lot of non-politicians strongly oppose a 'tax' or forcing people to pay for it (some of them on my f-list), many on principle, some because they (think they) can't afford it, and others because it's "someone else's problem". The same for education.

I really do not understand why people think having the government step in is a good thing – in anything.
The company I work for routinely shops the different health care insurance companies to get the lowest rates. Yeah, I bet there is stuff my health care might not cover – but they are trying to balance cost (mine and the companies – health care insurance is split 50/50).

So we make government health care. My taxes go up – now I am paying for mine and yours.

Sure some people can not afford health care and the human thing to do would be to pay for it for them. But I am trying to make a living myself and taking even more of my money away is not helping me. It is bad enough that the current government is de-valuing the dollars. That makes thing more expensive for me and kills the little bit I have set aside for retirement. Thanks a lot. I would love to blame Obama, but the real problem is the people in the US want a quick fix / magic pill solution for everything.

You are probably totally against it because you have never experienced it. I have. I grew up in Germany and I never had to wait for any surgery, procedure, doctor's visit or medication in 27 years.

I lived in the UK and I never had to wait for anything during the time I was there. Even in Croatia (a country that is barely out of a war), where part of my family lives, health care is better than here in the U.S.

It's really depressing me that so many people believe the right-wing and health insurance company propaganda claims about nationalized health care being bad for the citizens. It's only bad for the health insurance and pharma companies that are making billions off the backs of the insured.

It's really depressing me that so many people believe the right-wing and health insurance company propaganda claims about nationalized health care being bad for the citizens. It's only bad for the health insurance and pharma companies that are making billions off the backs of the insured.

THIS. Oh god, is it ever THIS.

The bigger the organization the more prone it is to in-efficiencies and corruption. Can you think of a bigger organization the US government?
What other countries are able to do, does not necessarily hold true to the US. Your argument holds no weight with me.

I hope you never lose your job.

i have, several times. it sucks.

No one likes high taxes, but you're telling me (and this is a hypothetical senerio) that if you could have a healthcare system where all you did was show a card to the doctor and not get a huge whomping bill when you left, and the cost was say a one percent increase in your taxes, you wouldn't go for it?

You already pay for education (teachers, librarians, aids), and safety (police, fire and rescue) why not doctors and nurses?

Referring back to the VA hospitals - there's a reason I (a vet) take the basic plan, then pay extra to choose my own doctors and facilities:

Lack of basic sanitary precautions during colonoscopies passes AIDS and Hepatitis around like a party favor:

http://tinyurl.com/lkvqkj

http://tinyurl.com/l5chsm

Some issues with treatment of prostate cancer (which my husband will be having in three weeks):

http://www.nytimes.com/2009/06/21/health/21radiation.html

...and a trivial little piece about Gyn exam rooms opening out onto the waiting room:

http://tinyurl.com/ktqduj

Finally, a problem common to both civilian and military medical care - no room at the inn:

http://tinyurl.com/nlancg

A government "thou shalt" isn't going to fix this. A government "thou shalt treat all emergency room patients, regardless of their ability to pay" led to the Orange County hospital closest to my brother-in-law shutting down its emergency room entirely. Unfunded mandates. Gotta love 'em.

But in answer to Sharon's question, "Wishing for a health care system THAT WORKS is a Bad Thing?", my response is "HELL, no!" I just have serious doubts as to the competency of the federal government (and most state governments) to come up with one. Although they've done such a GOOD job of project (and money) management so far!

First response to the articles: AAAAAAHH.

Second response: I note that the first article about the endoscopy equipment includes this tidbit:

The internal report noted that the VA is not alone in reporting problems with endoscopy procedures: Private hospitals in California and Pennsylvania have notified thousands of patients in recent years after similar concerns.

It's not just the VA, sadly.

This is true - and the last article expresses a universal problem as well. Earlier folks in this thread commented that their own VA hospitals were exceptional. That's terrific. I hope they continue to be so.

In fairness, I have to add that while I pay extra to choose my own caregivers, my medical care is still heavily subsidized. What I pay is not what the average 45-year-old woman trying to buy health insurance would pay.

We're back to Sharon's request - a health care plan that WORKS.

Sigh...

If it was an opt in -- I only get billed/taxed if I join. Yes.

Trust, I do not trust my government to do the job right.

I would actually feel better about it if it was done at the state level.

I really do not understand why people think having the government step in is a good thing – in anything.

The greatest paean to just how effective the US government is, is that reasonably intelligent people can grow up there to be libertarians without dying instantly of cognitive dissonance.

The company I work for routinely shops the different health care insurance companies[...]

So, you're saying that everyone should work for your company, or some comparable company, or be denied affordable health insurance?

LOL, try an actual argument next time.

Well, how much would you pay for an albuterol inhaler? How long a hospital stay is covered after a caesarean section? What do they do to prevent caesarean sections? How are diabetes testing strips rationed? What's the amount you'd pay for glasses, and how often are eye exams covered?

You should already know the answer to at least one of these... And it should be easy enough to find out. It's not like I'm asking about exotic conditions, just 4 exceedingly common chronic ones.

The tax rate for Medicare is 1.5% in Australia. Nobody even notices that the money has gone!

Every year my insurance carefully reviews my need for Celebrex, suggests a number of cheaper alternatives, my doctor fills out a form, and they call to tell me that they have given me SPECIAL approval, but just for one year. They expect that any moment now I will recover from chronic arthritis and skip off into the sunset.

Medical cover in Australia works as a three tier system - emergencies are treated immediately, for free, no matter what needs doing. Non-emergency stuff means you can be treated either as a public patient (and I've experienced the 2 year wait for a knee reconstruction myself) or as a private patient if you pay extra for it - and for the 2nd knee op & preceeding MRI, I was privately covered - referred to the specialist, saw him the same day, had the MRI on the wednesday & the operation on the Friday (I got really lucky) Out of pocket costs were about $300.

The other thing is that if you earn over a certain amount and you don't have private cover, the government taxes you at a higher rate, so it's worth more to have it than not.

I personally love that Medicare covers everybody, whether you can afford private cover or not. It doesn't matter if you have a job or not, just that you're a citizen of the country, and it's one size fits all. It's not logical to me that your health cover is tied to your job - you don't stop being sick just because you lose your job, now do you?

(Plus, any out of pocket expenses over $1500 are tax deductible!) Go for it, USA!!!

And don't trust medicare to help you out. Last year I paid $18,000 of non covered expenses even though I had a doctor's prescription for it. Medicare decided I didn't really need it. I got a little bit of it back at tax time $4,000.

It's wonderfully strange when one section of government says NO (Medicare) and another section (Tax bureau) says we'll pay part of it.

Thank God I have secondary insurance as a Vet.

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MRI

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Check out the VA

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this completely disgusts me.

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Totally against government health care.

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Wow, talk about a hornet's nest!

sorry, that last one was me!

Medicare