What is the current Republican position on this?

[Malcolm Kirkpatrick]

The discussion is about health care delivery systems and political party positions thereon. And your stance is determined by a single treatment you got 20 years ago? Really? I don't know which is dumber: that approach itself, or that you would admit it on a skeptics board. You may need to go to the ER for the damage to your credibility.

I don't think that hospital was dedicated to my treatment alone. You suppose otherwise? I don't know which is dumber: that approach itself, or that you would admit it on a skeptics board. You may need to go to the ER for the damage to your credibility.

 

[joobie]

I don't think that hospital was dedicated to my treatment alone. You suppose otherwise? I don't know which is dumber: that approach itself, or that you would admit it on a skeptics board. You may need to go to the ER for the damage to your credibility.

is that really how you interpreted his post? you may want to try reading it again, especially if you are going to call someone else dumb.

 

[Travis]

No. The taxes it requires would be better spent by taxpayers. Dunno. I'm neither "pro-business" nor "conservative" but I'll take a stab at it.
Two questions:...
I. From State control (or subsidization) of what industries does society as a whole benefit? You may imagine either a dichotomous classification: A={x:x is an unlikely candidate for State control}, B={x:x is a likely candidate for State operation} or a continuum:...
(highly unlikely) -1______.______+1 (highly likely).
II. What considerations determine an industry's classification or position on the continuum?

Devout Marxists will put every industry in B. Devout Libertarians will put every industry in A. To most of us, most industries fall somewhere in between, with "control" being itself a continuum, defined by the degree of regulation. I suggest that an industry's classification or position on the continuum depends upon the degree to which the industry exhibits economies of scale and the relative contributions which detailed local knowledge and general expertise make to performance.

Seems to me both the education industry and the medical treatment industry are highly unlikely candidates for State (government, generally) control.

Regardless. You really don't think that American businesses would benefit from not having to provide health insurance to their employees?

That's not the real cost - that's the billed amount. I expect a charity hospital might have a $25k-$30k expense to correspond with that level of billable cost. First you have to realize that that number is (I assume) the amount billed by hospitals. If you had even the crummiest insurance they would get a "negotiated rate" that would be around 30-40% of that amount (which is still well above the actual cost+profit). They reason for this is complicated but hospitals are mandated by law to treat ER patients to the point of stabilizing them, and most choose to accept medicare/medicare assignment - on which they lose money. Hospitals and other providers then shift these unpaid/underpaid costs onto insurers and paying patients. When a hospital bills a patient w/o insurance they expect to take a huge loss most of the time and the bill is the amount they would like to take as a loss (minus the value of selling the unpaid bill to a collector).

I don't know what your Dad's excuse for not having insurance is - but my approach, were I him, would be to (if he has the assets) to offer the hospital $40k cash IF they will accept that as payment in full for all the services billed. If he doesn't have $40k and can't come up with enough income to pay the $120k over - he may as well look into bankruptcy. Worth getting a lawyer involved either way.

My dad did have insurance. And the insurance company paid out $120K for his treatment. If he had no insurance he would be dead now. Same as I would be if I found out tomorrow that I had some form of cancer.

 

[Malcolm Kirkpatrick]

Regardless. You really don't think that American businesses would benefit from not having to provide health insurance to their employees?

If Martians paid the bill, sure, but in the real world, some share of humans' aggregate production goes to medical treatment. Either people allot resources which they control to their own care or someone else decides what resources to apply to some other person's condition. If that "someone else" is a State actor, s/he gains control over those resources through taxation. People pay, ultimately, one way or another.

My dad did have insurance. And the insurance company paid out $120K for his treatment. If he had no insurance he would be dead now. Same as I would be if I found out tomorrow that I had some form of cancer.

We are all born terminally ill.

 

[Drachasor]

If Martians paid the bill, sure, but in the real world, some share of humans' aggregate production goes to medical treatment. Either people allot resources which they control to their own care or someone else decides what resources to apply to some other person's condition. If that "someone else" is a State actor, s/he gains control over those resources through taxation. People pay, ultimately, one way or another.

Yes, and if the it is a system covering all residents and run by the State, then it saves loads of money. Saving money is a good thing.

We are all born terminally ill.

This statement has nothing to do with anything. You act like unlimited money means unlimited health. Again, THIS IS NOT TRUE.

 

[Undesired Walrus]

Travis, surely it isn't too long until insurers are no longer allowed to refuse coverage?

 

[Chaos]

Travis, surely it isn't too long until insurers are no longer allowed to refuse coverage?

Yeah, like that´ll happened before insurers run out of money to funnel into Washington.

 

[eeyore1954]

Regardless. You really don't think that American businesses would benefit from not having to provide health insurance to their employees?



My dad did have insurance. And the insurance company paid out $120K for his treatment. If he had no insurance he would be dead now. Same as I would be if I found out tomorrow that I had some form of cancer.

I firmly believe you would be able to get treatment regardless of your financial or pre existing situation, especially in California.

 

[eeyore1954]

Well, you're lucky then.

I seriously cannot stand how people like you base their entire indea of how health care works on "well I've never personally had this particular problem - so it probably does not exist!" If you're going to claim something isn't happening, using a survey sample of one to confirm that is just bad research.


And keep in mind, I'm only talking about denial of claims, after the services are already rendered. We have far, far more services that are denied before the services are rendered - i.e. we apply for authorization for a service, and it is denied as not medically necessary, so the procedure is not done. As an example, we had a 24 year old patient denied by a major insurance company for a bone marrow transplant as "not medically necessary." At the time, the young man expressed to us his deep fear that now he would die because his insurance had denied his authorization. He was correct. He just died a couple weeks ago.

You start about people using anecdotal situations in their life but you end with an anecdotal situation of your own.

Under a universal system won't there be similar situations as this one. Won't there be any type of review system to determine if a major treatment is medically necessary (if not fraud will certainly increase). And sometimes won't it be wrong and people will die because they did not get the treatment.

 

[Schrodinger's Cat]

You start about people using anecdotal situations in their life but you end with an anecdotal situation of your own.

I see your point, Eeyore, but my point in highlighting this case was two fold.

1. People on this thread (and in my past experience) often hold up their own experiences to argue that "well, I didn't have a problem, so this problem does not exist or is unlikely to exist." My point was to offer an anecdotal case that is the opposite to their anecdote. I.E. okay, well you're situation went one way, but yours is not the only way things can go. Here is an example in which it did not work out for this patient. My point is to show that the original claimant's case was just an anecdote, not the way things always work.

2. Steve's anecdote is based on one singular case: his own. I have worked with thousands of patients at one of the largest hospitals in the country. While Steve is able to provide an example of one, I have countless examples of things working the other way. The patient I listed in the example is only one individual case, I could have given you hundreds of others. Now of course, I could also give you examples of hundreds of cases in which things worked out completely fine for the patient and they had no problems with their insurance. That certainly happens too. But Steve said that he doubts that insurances deny patients. My point is that no, insurances deny patients all the time. As his only point is "I don't think this actually happens, here's my anecdote that makes me believe this," why shouldn't I be able to give the counter example of, "No, this actually happens all the time. Every single day, and here's just one example?"

For instance, if someone said "I doubt that black people have the capability to earn advanced educational degrees" wouldn't an appropriate response be, "No, that's not true. Cornell West is a black man who holds advanced degrees, as an example."

Now, if I were making a claim that patients are denied more often than they are approved for services, I would completely agree with you that me offering anecdotes of denials would not be sufficient. However, I think when I am only claiming that denials exist, then me offering up examples of cases in which denials occurred is appropriate for my arguement.

Of course, I understand that I am only offering up my own personal claims here. Due to privacy laws, I simply cannot give detailed information that would validate the claims. I can't say "Mr X was denied on this day by this insurance for this service." So even though I hope the detailed information I have provided in this thread is convincing enough that I'm not making all this up, I would understand if someone said in response "well you're just some person on the internet offering no actual proof that these things happened, for all I know you're making all this up and these denials never happened." I understand and accept if people just do not want to take my claims at face value. It is a skeptic's board, after all, I couldn't fault someone for that!

Under a universal system won't there be similar situations as this one. Won't there be any type of review system to determine if a major treatment is medically necessary (if not fraud will certainly increase). And sometimes won't it be wrong and people will die because they did not get the treatment

Honestly, I don't know, but it is a valid concern. I would assume this would probably happen at some point. I can tell you that right now I see denials with government sponsored insurances, far, far, far less (unless there were cases in which a service was performed which was explicitly excluded from the patient's policy. But in such a case, the error was on the hospital's part for not checking the patient's policy guidelines as we are supposed to to make sure the service was allowed).

Also, from what I have read and heard about European health care systems (I myself lived in Europe for a time), they do not have this problem (of being denied medically necessary treatment) at anywhere near the rate we do.

As an example, when I was in Ireland in 2007, there was a huge scandal because there was a case in which a woman was not able to receive a particular cancer treatment, and she died. This was a big news story, it created a huge scandal, and there was a protest in Dublin because of it. The fact that this was such a big deal and such a scandal indicates to me that it is a rare event. After all, we see this all the time just at our one hospital. It's simply routine here. The fact that here, it's just something that happens all time, and over in Ireland, it was a huge news story and scandal when it happened once, tells me that it isn't as big a problem in universal healthcare as it is with private insurance.

But of course, that doesn't mean it couldn't be the case if the United States adopted universal healthcare, and it is a valid concern that would need to be addressed if we were ever to impliment such a system. For instance, there is one particular medicaid plan I deal with in which this happens a lot, at the same rate I see with private insurances. Obviously, if we were to model a universal healthcare system after this particular medicaid plan, it would be very problematic. However, even in the worst case scenario, if universal healthcare denied patients as often as private insurances does now, at least cummulatively more people would be getting health care services because everyone would at least have health care coverage.

There are other problems with Medicaid and Medicare as they exist now that also would have to be addressed if we turned to a universal system. For instance, Medicare and many Medicaid programs have very low contractual reimbursement rates, significantly lower than the contractual rates with most private insurances. They'll only reimburse us at a fraction of what we actually charged for the visit. For ecample, the reimbursement rate for New York Medicaid is simply deplorable. I'll see us getting paid $55 for a service that cost us thousands upon thousands. This is another way hospitals lose money, low reimbursement by Medicare and Medicaid. This fact is often touted by Republicans, and for good reason. I can't see our healthcare system being viable if we were to have reimbursement rates similar to what we see now with many state sponsored plans.

For hospitals to remain solvent under universal healthcare, we would need to make sure that the reimbursement rates for government sponsored healthcare would be high enough to cover the cost of care.

 

[eeyore1954]

the original is post #233. read it and tell me if you think he understood the post at all.

I wasn't commenting on whether he understood the post only that

Really? I don't know which is dumber: that approach itself, or that you would admit it on a skeptics board. You may need to go to the ER for the damage to your credibility.

Was just as childish (IMHO) as his response.

 

[eeyore1954]

I see your point, Eeyore, but my point in highlighting this case was two fold.

1. People on this thread (and in my past experience) often hold up their own experiences to argue that "well, I didn't have a problem, so this problem does not exist or is unlikely to exist." My point was to offer an anecdotal case that is the opposite to their anecdote. I.E. okay, well you're situation went one way, but yours is not the only way things can go. Here is an example in which it did not work out for this patient. My point is to show that the original claimant's case was just an anecdote, not the way things always work.

2. Steve's anecdote is based on one singular case: his own. I have worked with thousands of patients at one of the largest hospitals in the country. While Steve is able to provide an example of one, I have countless examples of things working the other way. The patient I listed in the example is only one individual case, I could have given you hundreds of others. Now of course, I could also give you examples of hundreds of cases in which things worked out completely fine for the patient and they had no problems with their insurance. That certainly happens too. But Steve said that he doubts that insurances deny patients. My point is that no, insurances deny patients all the time. As his only point is "I don't think this actually happens, here's my anecdote that makes me believe this," why shouldn't I be able to give the counter example of, "No, this actually happens all the time. Every single day, and here's just one example?"

For instance, if someone said "I doubt that black people have the capability to earn advanced educational degrees" wouldn't an appropriate response be, "No, that's not true. Cornell West is a black man who holds advanced degrees, as an example."

Now, if I were making a claim that patients are denied more often than they are approved for services, I would completely agree with you that me offering anecdotes of denials would not be sufficient. However, I think when I am only claiming that denials exist, then me offering up examples of cases in which denials occurred is appropriate for my arguement.

Of course, I understand that I am only offering up my own personal claims here. Due to privacy laws, I simply cannot give detailed information that would validate the claims. I can't say "Mr X was denied on this day by this insurance for this service." So even though I hope the detailed information I have provided in this thread is convincing enough that I'm not making all this up, I would understand if someone said in response "well you're just some person on the internet offering no actual proof that these things happened, for all I know you're making all this up and these denials never happened." I understand and accept if people just do not want to take my claims at face value. It is a skeptic's board, after all, I couldn't fault someone for that!



Honestly, I don't know, but it is a valid concern. I would assume this would probably happen at some point. I can tell you that right now I see denials with government sponsored insurances, far, far, far less (unless there were cases in which a service was performed which was explicitly excluded from the patient's policy. But in such a case, the error was on the hospital's part for not checking the patient's policy guidelines as we are supposed to to make sure the service was allowed).

Also, from what I have read and heard about European health care systems (I myself lived in Europe for a time), they do not have this problem (of being denied medically necessary treatment) at anywhere near the rate we do.

As an example, when I was in Ireland in 2007, there was a huge scandal because there was a case in which a woman was not able to receive a particular cancer treatment, and she died. This was a big news story, it created a huge scandal, and there was a protest in Dublin because of it. The fact that this was such a big deal and such a scandal indicates to me that it is a rare event. After all, we see this all the time just at our one hospital. It's simply routine here. The fact that here, it's just something that happens all time, and over in Ireland, it was a huge news story and scandal when it happened once, tells me that it isn't as big a problem in universal healthcare as it is with private insurance.

But of course, that doesn't mean it couldn't be the case if the United States adopted universal healthcare, and it is a valid concern that would need to be addressed if we were ever to impliment such a system. For instance, there is one particular medicaid plan I deal with in which this happens a lot, at the same rate I see with private insurances. Obviously, if we were to model a universal healthcare system after this particular medicaid plan, it would be very problematic. However, even in the worst case scenario, if universal healthcare denied patients as often as private insurances does now, at least cummulatively more people would be getting health care services because everyone would at least have health care coverage.

There are other problems with Medicaid and Medicare as they exist now that also would have to be addressed if we turned to a universal system. For instance, Medicare and many Medicaid programs have very low contractual reimbursement rates, significantly lower than the contractual rates with most private insurances. They'll only reimburse us at a fraction of what we actually charged for the visit. For ecample, the reimbursement rate for New York Medicaid is simply deplorable. I'll see us getting paid $55 for a service that cost us thousands upon thousands. This is another way hospitals lose money, low reimbursement by Medicare and Medicaid. This fact is often touted by Republicans, and for good reason. I can't see our healthcare system being viable if we were to have reimbursement rates similar to what we see now with many state sponsored plans.

For hospitals to remain solvent under universal healthcare, we would need to make sure that the reimbursement rates for government sponsored healthcare would be high enough to cover the cost of care.

I agree that denials do exist. But in my life experience of all the people I have known who were sick never have I know of one being denied treatment. Many of these people are poor. Of course this is also anecdotal and not provable. But it is not just one case I am sure it is over a hundred.

I believe the people who work at insurance companies handling claims and pre approvals are for the most part caring individuals who are interested in making sure the claims are handled correctly.

I wonder if your view is also slightly skewed by the fact that you work where you deal with the problem cases. My father was a judge and because of all the criminal cases he saw I believe he thought "my walking down a dark street was much more dangerous than it really was."

 

[BenBurch]

...

We are all born terminally ill.

That is a really dumb statement.

We all die, that much is true. But terminal illness has a specific and dire meaning that you are cheapening here in a most unconscionable fashion.

We have several people on this board now who are battling what are likely to be terminal illnesses, and I think it is an insult to them to attempt to make their pain, fear, and suffering out to be no big deal.

 

[BenBurch]

I firmly believe you would be able to get treatment regardless of your financial or pre existing situation, especially in California.

You'd be amazed at how poor that care can be.

 

[eeyore1954]

That is a really dumb statement.

We all die, that much is true. But terminal illness has a specific and dire meaning that you are cheapening here in a most unconscionable fashion.

We have several people on this board now who are battling what are likely to be terminal illnesses, and I think it is an insult to them to attempt to make their pain, fear, and suffering out to be no big deal.

Agreed terminal ilness is no laughing matter.

 

[eeyore1954]

You'd be amazed at how poor that care can be.

You'd also be amazed at how good that care can be. I know many people who are on government sponsered insurance plans and they can go to the same hospitals as me and they have choices of the same doctors (rightfully so).

 

[BenBurch]

You'd also be amazed at how good that care can be. I know many people who are on government sponsered insurance plans and they can go to the same hospitals as me and they have choices of the same doctors (rightfully so).

If you have that sort of insurance in your state. If you depend on charity care for cancer, have your affairs put in order.

 

[eeyore1954]

If you have that sort of insurance in your state. If you depend on charity care for cancer, have your affairs put in order.

I am sure there are charity programs that are not up to par.

 

[BenBurch]

I am sure there are charity programs that are not up to par.

If you can dignify what exists as a "program." It's not.

 

[Schrodinger's Cat]

I agree that denials do exist. But in my life experience of all the people I have known who were sick never have I know of one being denied treatment. Many of these people are poor. Of course this is also anecdotal and not provable. But it is not just one case I am sure it is over a hundred.

A few points on this:

1. As I said to Steve, you don't actually know if people you know have been denied, because it is entirely possible they did receive denials, they were just never charged, because patients are only allowed to be billed in certain cases, in other cases the hospital must cover the cost if a service is denied. I think this is even more likely if they were poor, because many hospitals will waive fees or have some kind of freecare program to cover patients below a certain income level, so if they are denied, it doesn't matter, because the hospital's freecare program.

2. It's entirely possible that you have known people who were denied services who didn't tell you about it. When I was young and fresh out of college, I myself was denied services several years ago by my insurance (and I have top notch insurance that, in my working experience, has a very low denial rate) and had to pay about 10K out of pocket. But my parents are well off financially, so they were able to pay this amount without a problem. I don't think I've ever told anyone I know that there was even an issue.

3. It is entirely possible you really don't know anyone who was ever denied for a service, whether they know it or not. But at the same time, how many really sick people receiving a great deal of very costly health care do you know? On the other hand, I work at a cancer hospital, so almost everyone I work with falls into this category.

I believe the people who work at insurance companies handling claims and pre approvals are for the most part caring individuals who are interested in making sure the claims are handled correctly.

I can't really speak to that definitively, as neither you nor I have the ability to know the minds of all insurance representatives and what their mentality is. I can tell you that I work very closely with many case workers at insurances, and some of them I have gotten to know very well, and I do know that they are caring individuals who genuinely want the best for their clients. But that doesn't mean they are all that way. And what's more, the individual case workers only have a given amount of power over the cases they handle. Sometimes the decisions come from the higher ups and the case worker can't do a thing about it no matter how much they want to help the patient. They are constrained by what they are ordered to do.
Really, I would say that in my experience, most insurance workers are paper pushers who at least appear indifferent to the patient one way or the other. It's just a job to them. I would apply this to many hospital workers as well, by the way, it's not exclusive to insurance reps.
One thing that really surprised me about working in healthcare is my dealings with pharmaceutical companies. These guys tend to get a lot of flak, particularly from leftists, and I'm not saying they are without their problems. But in my experience, they are much, much better to work with than insurance companies. An insurance will deny a drug, or the patient will be uninsured and unable to afford the drug, or maybe they just can't afford the copay, so we reach out to the drug company to see if they can help out. I have had overwhelmingly (though not 100%) positive experiences working with drug companies, much more so than working with insurances, and their case workers, on average (again, in my experience only) seem to me to be more genuinely concerned about the patient's welfare, and willing to work with us to try and help the patient. Also, even if they cannot help the patient for whatever reason (like the patient just doesn't qualify for their assistance program), they have been very helpful in pointing me to other resources that can help the patient.

Also, a lot of insurance work is outsourced to India these days. A huge number of the insurance workers I deal with are working in India and have pretty minimal training, they're just paper pushing worker bees who do what they're told and have little to no autonomy over decisions they make. Their personalities and whether they "care" about the patient doesn't really have any effect on anything.

I wonder if your view is also slightly skewed by the fact that you work where you deal with the problem cases. My father was a judge and because of all the criminal cases he saw I believe he thought "my walking down a dark street was much more dangerous than it really was."

I think you may think I'm promoting a view that I am not. I really have no idea how many people face insurance denials, and I make no claims as to how big a problem this is because I honestly have no idea. I certainly do believe that far, far more claims are approved than denied, that denials definitely make up a minority of authorization requests and claims.

But the fact that they are a minority does not make them not a problem. It still costs us a lot of money each year, and I still have a lot of patients who get denied.

Remember, I did not initiate the conversation about denials in order to somehow claim that this was some staggeringly enormous problem that most patients will face in their lifetimes. I only brought up my experience with denials in response to Steve's claim that he doubts they exist.

I also have brought up denials in discussions like this when people have made the argument that universal healthcare takes the decision of what care you receive away from your doctor and puts it into the hands of the payer for your care. I point out that this already is the way it works with private insurance. They have the ultimate decision making power (with the notable exception that some services actually have state mandates which require an insurance company to provide a particular service for a particular diagnosis for a particular plan type). Which doesn't mean they are more likely than not to deny your care, only that they have that ability.

I firmly believe you would be able to get treatment regardless of your financial or pre existing situation, especially in California.

I wish I had more advice for Travis on this, but unfortunately, as I'm on the east coast, I deal with very few California patients and insurances and am not well informed on either how their Medicaid works or what resources would be available to him. I do think he'd be more likely to get treatment one way or another in California than in many other states.

The only advice I could give is to call major hosptials in California, ask for their financial counseling department, and see if they can do anything for you, and if not, see if they know of a hospital that can.

What help you can get also depends on what services you need. If you need a certain drug, there are a lot of resources available to you and more liklihood of assistance than if you need a stem cell transplant.