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At random: "Submarines Forever, Forever a Submariner" - Mike Hemming
Just a kick in the.....
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Corabelle
Posted 2009-09-18 9:31 PM (#30957 - in reply to #30954)


COMSUBBBS

Posts: 2561

Location: Rapid City, SD
Subject: RE: Why can't you buy what you need?

I thought it was the other way...the insurance companies dictate to the doctors and the pharmacists what they will pay for. When I was still working, one of the best OB-GYN men in Rapid City retired early because he felt responsible for his patients, and he didn't want insurance companies to tell him how long he could keep his patients hospitalized.

And now...someone, I don't know for sure who...but I'm going to try to find out, is telling the medication supplements which drugs they will include in their formulary. I was prescribed a long-acting Nitroglycerin capsule (not the sublingual pill), and I have to pay full price for it because, "The medication you requested is one of several drugs not covered by Medicare Prescription Drug plans by law, Section 1927(d) of the Social Security Act." This was the response my cardiologist received when he asked for a reversal of the first denial. My doctor thinks I should be on this med; someone who helped write the Social Security Act rules doesn't think I need it. This, of course, is one of the most expensive drugs that have been prescribed for me.

Cora



Edited by Corabelle 2009-09-18 9:34 PM
Donald L. Johnson
Posted 2009-09-19 12:01 AM (#30960 - in reply to #30954)


Great Sage of the Sea

Posts: 602

Location: Visalia, Ca.
Subject: RE: Why can't you buy what you need?

Both the States and the Federal Government regulate insurance companies.

Every State has an Insurance Commissioner of some sort who regulates the Insurance Companies that do business in that state. They adopt and enforce regulations as specified by the State Legislature as to what coverages they MUST provide in to their policyholders, and regulate premiums and corporate practices.

Healthcare and Insurance companies set their policies and coverages to comply with the regulations. They also set policies to control costs, including "guidelines" for appropriate treatment of certain illnesses and conditions. You want them to pay for your medical care, you play by their rules. Plus, being private companies, they have to make enough profit to maintain their required cash reserves, pay their personnel costs, and maybe have some left over to pay the shareholders a dividend.

The Federal Government runs Medicare, Tricare, Military Healthcare and the VA Medical System. They operate in a similar fashion - the Congress establishes basic rules as to who is eligible for what program, what can be covered, how Pharmacy programs work, and then delegates the details to the appropriate bureaucracy - DOD, DVA, or the US Health Benefits Agency(?) that runs Medicare/Medicaid. They establish what the government will pay for a given medical procedure, what drugs get the best discount or subsidy, and which the patient will pay full price for, etc. Insurance companies and healthcare providers that serve Medicare/Medicaid or Tricare patients must comply with these regulations.

So no matter what healthcare system you are in, to a certain extent the government is in control. With private healthcare, you have some flexibility, since you can (sometimes) change plans if you don't like the one you are in. With a Government-run system, you take what they give you.

crystal
Posted 2009-09-19 6:39 AM (#30963 - in reply to #30842)


Master and Commander

Posts: 2191

Location: Port Ludlow, WA (the Olympic Penninsula)
Subject: RE: Just a kick in the.....

Hey Ric, good planning means "you make it happen", no one is acting superior here... If you made bad decisions, lost money "whatever", you didn't plan well, s**t happens and if it happens to you, you tighten your belt and get busy, whining doesn't cut it - and NO I wasn't handed what I have, I worked for it and planned!  Stop trying to turn it around to where you're the victim, if you had a good ride, get off and pay again!
dex armstrong
Posted 2009-09-19 11:56 AM (#30970 - in reply to #30842)


COMSUBBBS

Posts: 3202

Location: Alexandria, Virginia
Subject: RE: Just a kick in the.....

No argument here. First I don't know what the answer is or profess to know. That simple. I would like to state a few facts as they directly apply to my family. My Dad was a company grade officer during the Depression and he and my Mother dreamed of building their own home. They began saving in 1932 and continued saving until 1946 when they bought a piece of property on the side of Lookout Mountain overlooking Chattanooga at the halfway stop in the Incline (Shingle Road) by that time my Dad was a Colonel commanding a Parachute Infantry Regt at Fort Benning. On the weekends, he and my Mother built a house to the plans and specifications of the House of the Month in a pre-war edition of POPULAR MECHANICS...He mailed off for the prepackaged Plans and Specs and sent a Postal Money Order for $8.95" for them. Mom and Dad mixed the cement in a mudbox and poured the foundations in form boxes in the basement they hand dug. Wes, my Dad, would take leave and do framing and roofing (only hiring a licenced and certified electrician to do the wiring.). He and Mom laid the oak flooring and installed an Iron Fireman and duct system by themselves. We moved in in early 48. A month later after we moved in....My Mother had been bothered by a "knot in her breast" while they were ticking off the pre-occupancy check list. Turned out to be advanced breast cancer...over the next couple of years she underwent six major surgeries...lost both breasts, the stripping of five or six feet of lympth system and other organs as the cancer slowly advanced taking her by inches. God mercifully look what little was left of her April 6, 1950...My Father, resigned his commision to be with her. A childhood friend of his Leland B. Godfrey got him a position as the Asst. Sales Director of Signal Mountain Portland Cement Company to provide him what was considered good medical insurance. Another dear childhood friend Dr. Cecil B. Newell, a neurosurgeon operated on my Mother each time AND GOD BLESS HIM NEVER CHARGED MY FATHER A DIME...The largest hospital in Chattanooga is named for this wonderful doctor. But the uncovered expenses bankrupted my Father and he lost his home, his car...he lost everything, but the court judgement attending the bankruptsy cleared him from any futher payments on the debt. He was part of Brokaw's Greatest Generation...He paid back every cent and celebrated meeting his obligations by taking me and my Sister to dinner in 1958 and we burned a letter from the Pioneer Bank in Chattanooga, thanking him for satifying all his obligation without requesting discounts or a reduced balance. In his world, a man paid his debts in full. But, he never recovered...he never had the will or ambition to begin again...medical bills destroyed him...that monster ate all of his dreams when it took their dream home away and destroyed him financially and left him, a man who paid everything on time with a bankuptsy on his record....He felt like some kind of societal leper. Fast forward, I had Blue Cross/ Blue Shield (FEP) Federal Employees Plan when my Solveig got sick....In my 30 year federal career I had taken less than two-weeks sick leave and had several thousand hours of sick leave on the books. I was granted what is known as "Family Friendly Sick Leave" where I could apply my sick leave to nursing her through her illness as she progressed to her death, which mercifully came in less than four months. During her illness, I opted for some promising experimental treatments and chemo not covered by my medical insurance. I was fully aware of what I was doing to myself, but when you love someone with all of your earthly being, you grab every damn straw you are offered. When she died with my medical bill debts and funeral expenses....I watched her life insurance, retirement assets, inheritance from her mother and father and savings account balance evaporate as I shovelled money into the mouth of the Medical Industry monster. John, I satisfied it all. Here's my view, in a country as bountiful as the United States no child should go hungry, or sleep in a home with no heat....No citizen should suffer unnecessary pain or lose everything they have to allieviate the pain and suffering of their loved ones of get them the best lifesaving treatment available. There is absolutely no excuse for this Blessed By God nation to be 37th in the world hit parade of quality of health care provided to its' citizens. I've seen the devistation that medical bills can bring to responsible families who satisfy their debts. Up close and personal. No whining here, just a statement of facts as I have lived them....No solutions offered...no advocacy of any proposed plan...DEX
dex armstrong
Posted 2009-09-19 11:57 AM (#30971 - in reply to #30842)


COMSUBBBS

Posts: 3202

Location: Alexandria, Virginia
Subject: RE: Just a kick in the.....

No argument here. First I don't know what the answer is or profess to know. That simple. I would like to state a few facts as they directly apply to my family. My Dad was a company grade officer during the Depression and he and my Mother dreamed of building their own home. They began saving in 1932 and continued saving until 1946 when they bought a piece of property on the side of Lookout Mountain overlooking Chattanooga at the halfway stop in the Incline (Shingle Road) by that time my Dad was a Colonel commanding a Parachute Infantry Regt at Fort Benning. On the weekends, he and my Mother built a house to the plans and specifications of the House of the Month in a pre-war edition of POPULAR MECHANICS...He mailed off for the prepackaged Plans and Specs and sent a Postal Money Order for $8.95" for them. Mom and Dad mixed the cement in a mudbox and poured the foundations in form boxes in the basement they hand dug. Wes, my Dad, would take leave and do framing and roofing (only hiring a licenced and certified electrician to do the wiring.). He and Mom laid the oak flooring and installed an Iron Fireman and duct system by themselves. We moved in in early 48. A month later after we moved in....My Mother had been bothered by a "knot in her breast" while they were ticking off the pre-occupancy check list. Turned out to be advanced breast cancer...over the next couple of years she underwent six major surgeries...lost both breasts, the stripping of five or six feet of lympth system and other organs as the cancer slowly advanced taking her by inches. God mercifully look what little was left of her April 6, 1950...My Father, resigned his commision to be with her. A childhood friend of his Leland B. Godfrey got him a position as the Asst. Sales Director of Signal Mountain Portland Cement Company to provide him what was considered good medical insurance. Another dear childhood friend Dr. Cecil B. Newell, a neurosurgeon operated on my Mother each time AND GOD BLESS HIM NEVER CHARGED MY FATHER A DIME...The largest hospital in Chattanooga is named for this wonderful doctor. But the uncovered expenses bankrupted my Father and he lost his home, his car...he lost everything, but the court judgement attending the bankruptsy cleared him from any futher payments on the debt. He was part of Brokaw's Greatest Generation...He paid back every cent and celebrated meeting his obligations by taking me and my Sister to dinner in 1958 and we burned a letter from the Pioneer Bank in Chattanooga, thanking him for satifying all his obligation without requesting discounts or a reduced balance. In his world, a man paid his debts in full. But, he never recovered...he never had the will or ambition to begin again...medical bills destroyed him...that monster ate all of his dreams when it took their dream home away and destroyed him financially and left him, a man who paid everything on time with a bankuptsy on his record....He felt like some kind of societal leper. Fast forward, I had Blue Cross/ Blue Shield (FEP) Federal Employees Plan when my Solveig got sick....In my 30 year federal career I had taken less than two-weeks sick leave and had several thousand hours of sick leave on the books. I was granted what is known as "Family Friendly Sick Leave" where I could apply my sick leave to nursing her through her illness as she progressed to her death, which mercifully came in less than four months. During her illness, I opted for some promising experimental treatments and chemo not covered by my medical insurance. I was fully aware of what I was doing to myself, but when you love someone with all of your earthly being, you grab every damn straw you are offered. When she died with my medical bill debts and funeral expenses....I watched her life insurance, retirement assets, inheritance from her mother and father and savings account balance evaporate as I shovelled money into the mouth of the Medical Industry monster. John, I satisfied it all. Here's my view, in a country as bountiful as the United States no child should go hungry, or sleep in a home with no heat....No citizen should suffer unnecessary pain or lose everything they have to allieviate the pain and suffering of their loved ones of get them the best lifesaving treatment available. There is absolutely no excuse for this Blessed By God nation to be 37th in the world hit parade of quality of health care provided to its' citizens. I've seen the devistation that medical bills can bring to responsible families who satisfy their debts. Up close and personal. No whining here, just a statement of facts as I have lived them....No solutions offered...no advocacy of any proposed plan...DEX
SOB490
Posted 2009-09-19 1:02 PM (#30972 - in reply to #30877)


Old Salt

Posts: 489

Location: San Freakcisco CA area
Subject: RE: W.H.O Standards, 2000......

>>>Just Googled 'best healthcare system in the world'? and by the the World Health Organisation's Standards....not Stoops Standards, here is the list:

WHO, a UN organization, has its own "standards" by which "best" is determined - which is no different than the rest of us having our own standards.

What constitutes "best" anyway? Universal coverage? Treatment? Quality of care? Research and innovation? Prevention?

Without getting into a political rant here, it appears that some folks believe that everyone having access to the same medical care constitutes "best."

While equal access may indeed be an issue, that access may be to a medical system that still uses leeches to cure disease -- i.e. the matter of quality of care is essentially ignored by subscribing solely to the "access" criteria.

Quality of care, in turn, is driven principally by two factors - co$t and effectiveness.

Effectiveness is achieved because medications and techniques are developed and perfected. I wouldn't be alive today absent the ability for a doctor to look into an artery, locate and then effectively reduce a blockage. 

Those tecniques and the sophisticated equipment that enables a skilled cardiologist to work this miracle had to be invented and perfected --- and that takes $$. They sure as hell didn't come with the proverbial apple tree in the Garden of Eden.

I remember my father and grandfather discussing the flu epidemic in this country at the end of WWI - and that the local ice house and the freezers at Bishop's Cafeteria were converted into morgues because there were hundreds and hundreds of bodies and no place to store them.

Today - back to the start of this entire thread - flu is a discomfort but is rarely fatal anymore. Even swine flu has a relatively low mortality rate - especially contrasted with the common flu epidemic of 1918. I even remember an outbreak of Asiatic Flu in the early 60s that put thousands in the hospital and then in dormitory beds at universities because the hospitals overflowed - and a relatively low death rate.

My point? Effectiveness of treatment not only reduces the death rate, continued research also eradicates diseases. Anyone remember the huge polio epidemic in the summer of 1945? I sure do - and the loss of 2 cousins and a brother. When is the last time anyone heard of a death caused by polio?

Effective treatment needs infrastructure and tools by which it is delivered - old Doc Sutton doesn't come to your house, black bag and all, in a horse and buggy anymore. Hospitals have replaced leeches with the latest drugs.

Where do these modern hospitals, drugs, and diagnostic devices come from? Surely not the gummit -- they come from research programs that you and I pay pennies on the dollar for every time we use them.

So, I respectfully submit that WHO can't determine "best" any more than I can. WHO's basis is not prevention, rather it is cure. I think they have the cart and horse a bit confused.

Again - back to the start of this thread - innoculation against swine flu is prevention!

Every government health agency knew in April that we were susceptible to a massive outbreak again starting as early as September - so while an incubation period necesary to produce vaccines exists, we started with full knowledge of what the effective vaccine is, we had the cultures, and we knew the process by which it would be manufactured.

So why is it necessary for the gummit to now prioritize youngsters? Simply because, as gummits do, they sat on their hands instead of going balls-out to produce more vaccine.  This has nothing to do with Blue's "chosen ones" and everything with governmental inertia - and proclivity to do our thinking for us.

steamboat
Posted 2009-09-19 1:27 PM (#30976 - in reply to #30970)
Master and Commander

Posts: 1814

Location: Boydton, Virginia
Subject: RE: Just a kick in the.....

Well spoken Dex. If someone can't take a lesson from that, I pity them.
Steamboat sends
dex armstrong
Posted 2009-09-19 1:29 PM (#30977 - in reply to #30842)


COMSUBBBS

Posts: 3202

Location: Alexandria, Virginia
Subject: RE: Just a kick in the.....

I have no idea who SOB490 is....and to be honest, I have no idea of what he said. It is my understanding that the World Health Organization is the outfit that compiled the statistcal data ranking us 37th....I didn't Google that, got it from this Board. DEX
Scrivener
Posted 2009-09-19 2:36 PM (#30979 - in reply to #30842)
Senior Crew

Posts: 217

Subject: RE: Just a kick in the.....

"WHO, a UN organization, has its own "standards" by which "best" is determined - which is no different than the rest of us having our own standards.

What constitutes "best" anyway? Universal coverage? Treatment? Quality of care? Research and innovation? Prevention?"




SOB, you are correct to inquire into the criteria by which WHO ranked each country. Sometimes the devil is in the details.

"WHO’s assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs).

http://www.photius.com/rankings/who_world_health_ranks.html

It appears to me that the WHO's scales are heavily weighted in favor of universal health care. Maybe that is what we will end up doing, but hopefully not because the UN says it is a good thing.
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