Teen Being Murdered By UnitedHealth Spreadsheet

UPDATE: UnitedHealth Will Cover Teen’s Bone Cancer Procedure

Pacificare, owned by UnitedHeatlh, has decided to deny coverage for Nick Columbo, a 17-year-old dying from bone cancer. Nick has been unresponsive to chemo and his doctors recommend the “CyberKnife” treatment (read their letters here). Nick’s family is holding a protest outside the Pacificare today to try to get the insurance company to change its mind. UnitedHealth is ranked as the worst insurance company in the nation, is being investigated by the state of California, and has been fined over $3.5 million for negligent claims practices. Inside, a plea for help from Nick’s brother.

Pacificare denies 17-year-old cancer patient lifesaving treatment [DailyKos] (Thanks to Evan!)

This is Nick’s older brother, Ricky, and I want to ask all of you for a huge favor. Our insurance company, PacifiCare, denied Nick to go to Kansas City for a special treatment of radiation for his cancer (this could save his life). Nick has suffered with cancer for 4 years of his life and he has exhausted every avenue to get better, but nothing worked. This is our last effort and this procedure has worked before with people in Nick’s situation. I think it is our duty to stand up for Nick and tell PacifiCare that what they are doing is wrong.

I am putting together a demonstration in front of the PacifiCare building at 5701 Katella Ave Cypress, CA 90630. Tuesday, March 25th, at 10:00 a.m. We are getting the media to step in and put pressure on (kcal9 and newspapers).

If we can at least get 300 people there I know they will have to say something about it. I know that my brother isn’t the only one suffering because of America’s poor healthcare system.

If you guys know anyone else that is suffering because of this, have him or her come out too. We need to let not only PacifiCare but America know that what they are doing is wrong and we need change.

Thank all of you so much.

Ricky Colombo

Comments

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  1. hypnotik_jello says:

    Way to sensationalize the topic.

  2. rewinditback says:

    Sorry to hear about your brother… good luck.

  3. razremytuxbuddy says:

    OMG! When will these companies learn? Someone needs to reach out and touch PacifiCare where it really hurts. My heart is breaking for Nick and his family. Whether he ends up getting the insurance coverage or not, this company is criminal for what they are putting Nick and his loved ones through.

  4. deedrit says:

    OMg is that right they have 12 BILLION DOLLARS? and they cant pay for this?

  5. am84 says:

    This makes me ill. My younger brother is a cancer survivor after radiation and a bone marrow transplant (not chemo)saved his life. Give them hell – everyone deserves a fair shot.

  6. failurate says:

    Hmm… shouldn’t the doctors perform the procedure and then worry about billing later?

  7. JackHandey says:

    Thanks for posting this story! This is much more important than receipt checking, a typo at Wal-Mart, or a snotty cashier!

  8. henwy says:

    Yeah. Why don’t the doctors just perform the procedure no matter what? They should donate their time and the materials for it.

  9. cmcd14 says:

    I like how the executives of this company are making some ridiculous 8 figure number.

  10. zrikz says:

    I agree that our healthcare system sucks big time, but I think the hospitals and doctors are also part of the problem. Hospitals bring in millions and doctors also make millions, yet they can’t donate their time / equipment to save someones life every now and then?

    Hopefully the protest and media will make a difference in this case.

  11. burgundyyears says:

    I can’t wait until we socialize medicine, then as a society we can come together and decide just how much a human life is worth and settle that debate once and for all.

    The whole billing thing is odd though – usually, the billing concerns comes after the procedure, not before.

  12. I couldn’t find this in the story: what is PacificCare’s stated reason for denying care? Did I miss it somewhere?

  13. Morgan says:

    It’s too bad this didn’t get posted earlier; less than an hour’s notice isn’t much time to get to a protest. I’m actually close enough that I might have been able to make it (I just moved here recently and google mapped the address out of curiosity and realized it was about 8 miles away) if I’d known far enough in advance to schedule my day around it. My heart’s with the Nick and his family, even if I can’t physically be there.

  14. PHX602 says:

    What was the Denzel Washington movie where he held an operating room hostage because health insurance wouldn’t cover his son’s heart surgery? John Q?

    I’m surprised the same crap hasn’t happened in real life.

  15. JustAGuy2 says:

    OK, here we go again.

    1. I certainly feel sorry for this guy.
    2. Every health care system has to have someone who decides “given the chance of success, the benefits of success, and the cost, we’re not going to do this procedure.”
    3. We need to decide who the entity in #2 is. In single-payer national systems, it’s a gov’t official who makes the call. In our system, that responsibility is held by private health care companies. In any case, it has to be SOMEBODY who says “no, we’re not going to do this.”

    #2 and #3 suck, but until we find a system where health care fairies deliver medical services to everyone for no cost at all, the call has to be made.

  16. EBounding says:

    The insurance company is actually holding this guy hostage in California just to kill him? It’s too bad they’re being held against their will. Because then they could just go to Kansas City and try to pay for it themselves.

    Instead of a demonstration, how about a fundraiser to pay for his procedure? It’s clear that this company has no interest in paying it.

    But I sincerely hope he can be cured one way or another. My prayers are with him and the family.

  17. mc101 says:

    Did a bit of research on this procedure and it sounds like managed care companies don’t know enough about it to feel comfortable approving it. Plus the cost of the tx tends to be anywhere from 20 to 60 thousand dollars–this for a device that costs several million to buy. If there is a chance that it could be effective, and it has been for others, why no approve it? As an aside it does beg the question as to why the tx is so expensive when a hospital could make their initial investment back in no time.

  18. Coelacanth says:

    @failurate: From a moral standpoint, perhaps… but the way a lot of PPOs and HMOs work is that unless expensive medical procedures are pre-authorised, the insurance companies reserve the right to deny coverage.

  19. Sasquatch says:

    It makes me angry that this isn’t even a little bit surprising.
    Health Care Providers are the most unconscienably evil companies in the
    US.

  20. Zyzzyva100 says:

    @zrikz:
    The doctors may not be blameless, but the they are getting screwed by the insurance companies too. Most doctors don’t make millions, in fact an average salary for a pediatrician is maybe 125k. I am currently in med school and even with a partial scholarship am going to be 160k in the hole when I am done. And thanks to congress I won’t be able to defer my loans anymore when I am a resident for 3-7 years (making maybe 40-50k that whole time). I am going into medicine because I want to help people, but I am not going to ruin myself financially because of the insurance companies/our healthcare system sucks. 8 years of college plus at least 3-7 more years of training all while being poor sucks.

    To everyone else, next time you have to take your sick kid to the doctor, especially if its a young physician, remember they are getting the short end of the stick too. Until a nationalized healthcare plan (including goverment paid for schooling) is in place this type of situation is only going to happen more frequently. There is already a shortage of doctors (and only getting worse). Blame the executives making money off other people’s misery, but don’t blame the doctors.

  21. Tux the Penguin says:

    @Sasquatch: There will be little to no difference between what we have now (companies making the call) and what a single-payer/universal system will be (the government accountant making the call). Ultimately, as it has been stated before, someone is going to put a value on a human life (relative to the cost of the procedure, the chance of survival and other factors) and we’ll have to live with it.

    What method would be appropriate? Should we handle this using an actuarial table? How much is this person going to earn (discounted of course for time-value of money) set against chance of death, etc. If its the government, wouldn’t they then factor in the amount of taxes that he’ll be paying against the cost of the procedure? Again, you can’t get away from the financial aspects of this decision… unless the hospital and doctors want to do this pro bono.

    But I doubt they want to do that. Doesn’t that make them just as evil?

  22. Amelie says:

    “PacifiCare was recently fined $3.5 million by the state of California for systematic mishandling of at least 133,000 claims like Nick’s. The company is facing up to $1.3 billion in addition penalties, for illegally denying care, and a Department of Managed Health Care investigation found that the corporation wrongly denied claims in 30 percent of its HMO cases in 2006-7. In 2005, PacifiCare was taken over by the nation’s largest health insurer, UnitedHealth, which is expected to grow its profits 13 percent in 2007-8, according to recent reports.”

    [www.calnurses.org]

  23. vdragonmpc says:

    Hmmmm Yet another person denied a needed medical procedure from UHC. Im so surprised give those scumbags a year or two and aspirin will be ‘experimental’ and seeing a doctor for any reason will require pre-approval from an outsourced medical ‘authorization facility’ in a third world country.

    I wouldnt shed a tear if I saw these executives getting picked off one by one. Heck I may even have a drink in celebration. There is no excuse for these companies to have such lopsided compensation for ceos and stockholders while the PAYERS get nothing in benefits.

    Its time for them to be broken up, prosecuted for fraud, jailed and shut down. That company does NOT provide Health Care Benefits to members as they are supposed to.

  24. Murph1908 says:

    Tux and JustaGuy have it right.

    #2 and #3 suck, but until we find a system where health care fairies deliver medical services to everyone for no cost at all, the call has to be made.

    …unless the hospital and doctors want to do this pro bono. But I doubt they want to do that. Doesn’t that make them just as evil?

    If every procedure was paid for every patient, regardless of the cost and the chance for success, we’d all be paying a large multiple of what we are paying for our own health care.

    If it is nationalized, someone still has to pay for it, and it’ll still be you.

    Someone suggested instead of protesting, start a collection. That’s a great idea, if only for the fact that YOU get to start deciding if it’s worth sending YOUR money for an expensive procedure that has little chance of having any prolonged benefit.

    I do feel for anyone going through this.

    But the saddest part of all of these stories is that we have the nerve to complain that incredible life-saving procedures are available to us, but we can’t pay.

    What a miserable country we live in where people have performed fantastic medical advances, but were too dense to make it affordable by everybody.

  25. Tux the Penguin says:

    @vdragonmpc: Maybe you missed something in the stupidly short notes by the blog’s author: “Nick has been unresponsive to chemo.” If you read the doctor’s letter, they also state that he had been given several other forms of treatment, all of which did nothing to prevent the tumor’s growth.

    Like it or not, there comes a point at which risk/cost v reward must become a factor. Sure, United could approve any and all treatments for Nick, spending a fortune to do it, but then everyone else would ask the same thing, and then they would be in bankruptcy.

    I find it so ironic that people bemoan the insurance companies making a profit, C-level officers making money, shareholders making money, but they have no problem with the doctors, hospitals, etc making money. Would the family be willing to sell their house and other possessions and saddle themselves with debt to pay for the treatment? If they did that, I’m sure there are people/organizations that would donate to reduce the cost and help them survive.

    But, oh my, a universal, government-run system would make EVERYTHING better. Oh dear God help us all.

  26. The Porkchop Express says:

    @Tux the Penguin: That’s the kind of good thing about the way it is now, competition means that at some point some company will make a lot more friendly choices on this stuff. It may cost us more, but when it is one entity for everyone…what do you do about their decisions? go somewhere else, threaten them with this kind of publicity? that won’t work with the gov.

    I’m not saying that any protesting/show of support is going to help this guy’s brother for sure, but it could help others in the long run.

  27. SkokieGuy says:

    Who has read the Doctor’s letter? It does not say this treatment will cure anything, but allow them to provide palliative support, start to kill the tumor and allow opportunities for OTHER treatments.

    In other words, it seems that this treatment – if succesful – will keep the young man alive for a while longer, make him more comfortable, all in the hope that they will be able to provide some sort of other future treatments.

    United Healthcare may be a vile company, but paying an insurance premium cannot be construed as carte blanche to any treatment, at any cost, regardless of expected outcome. Regardless of whether it’s an insurance company or our government making the decisions healthcare can never be unlimited. Others have already made this case well.

    Of course many people happily buy $500,000 houses and accept 30 years of debt. Is the family not willing to do the same to help extend Nick’s life?

    Since the procedure has NOT been done, no claim can be denied, no claim has been made, as there is no bill for services. Likely, the treatment plan was submitted (HMO preapproval) and was denied. The family can proceed with treatment, and when the bill comes, then try to fight. Of course they can just declare bankruptcy like many stuck with huge medical bills do. This simply shifts the costs back to the hospitals and doctors with eventually trickle’s back to everyone.

    I would strongly encourage this family (if they haven’t already) to sit down with the hospital’s patient ombudsman, learn about the expected costs of the treatment plan, available discounts, charity & forgiveness programs and payment plans. Start a fund to accept donations, start holding fund raisers, cross your fingers and forge ahead.

    Having national ‘guaranteed’ healthcare is not the same as unlimited. This problem is not going to go away and the sooner a national, reasoned dialogue can be started, the better.

    Now – all that being said, yes my heart breaks for this family. I like most people, have had cancer and other illnesses impact those closest to me and I will join others in prayer for a succeful outcome.

  28. dsears says:

    Not to defend PacifiCare here, but “murder” is a bit hyperbolic.

    If the procedure costs $100,000 and has a 2% chance of success, should they pay for it? What if it costs $1,000,000 and has a 0.2% chance of success? Where is the line?

    Absent these details, I think it’s premature for readers to pass judgment.

  29. Techguy1138 says:

    First of all I believe that the person is not being murdered by UHC but is instead dying of cancer.

    It sounds like he was treated in the standard way and didn’t respond, in fact in the linked letter he got worse.

    How much is the surgery in the US? How about other countries? Have a fund raiser and sue for the money after he survives.

    I understand how hard it is to watch loved ones suffer. It’s important to make his life as comfortable as possible. Consider medical care in other countries. If you really think that this will work try to haggle with the hospital. They have a lot of room to negotiate when it comes to billing and payment.

    Can you pay for most of the surgery and have the insurance cover hospital care and bedrest? Can the surgeon justify splitting the operation into several procedures with some that are covered?

    Good luck. Don’t spend so much time fighting insurance that you forget to enjoy life. Don’t wait until he is bedridden to spend serious time with your loved one

  30. poodlepoodle says:

    doctors also make millions, yet they can’t donate their time / equipment to save someones life every now and then?

    Um, what doctor do you know makes a cool mill a year? All the pediatricians I know make 90k or so. Also, hospitals are out donating their time, ever go to an ER on a Saturday night? How many of those cases do you think they get paid for? 50%, 30%, at my local tier 1 trauma center it’s closer to 9%.

    Finally while I suppose insurance cos aren’t ideal what makes anyone think that the outcome in the UK would have been better where survivability for cancer over 5 years is lower than it is here (Britain’s survival rates are on par with east European countries such as Poland and Slovenia). [tinyurl.com]

    You can spend as much as you want on health care, the entire GDP and people will still die, the money won’t be enough because there will always be a new test, a new treatment, SOMETHING experimental. I don’t know the particulars of this case but I’m reminded of the recent Michael Moore movie which showed a grieving woman and pictures of her dead husband who died (I believe of liver cancer) she complained that the evil insurance company wouldn’t pay for a bone-marrow transplant. Which is all very well and good — except that isn’t a treatment for liver cancer. Truth is, there isn’t one, pretty much a death sentence at this point, maybe that will change in the future.

    This is why I think nationalized health care will be a disaster in the US. Americans aren’t going to be OK with being told it just isn’t worth it to save their 98 year old granny with failing kidneys. You have to draw the line somewhere, people are going to want that line to be drawn “somewhere else.”

    1. good
    2. efficient
    3. cheap

    Pick two.

  31. CRNewsom says:

    @Michael Belisle: The insurance companies are not capable of denying care they are, however capable of denying coverage. They are not saying that he cannot have the procedure, they are saying that they won’t pay for it. I am not saying that they are right, but if he needs the procedure that badly, why isn’t the family just going through with it and suing the insurance company once he gets better?

  32. bohemian says:

    Are people really this clueless? These people are being denied because it CUTS INTO PROFITS. Asking someone to DIE to “take one for the team” is frankly sub-human. I really do think that UHC can make a little less for their shareholders and CEO’s this year and give this guy the medical chance he needs. That is what you call holding up your end of the bargain under the contract where UHC agreed to provide medical care in return for premium payments.

    The problem with the current health care system is that we have a middle man whose entire business plan revolves around denying as much care as possible so they can pocket as much money as possible.

    I am so tired of the scare tactics that national health insurance is going to be more oppressive than the scam private carriers are currently running. My friend on Medicare has better coverage than I do and I am on one of the better Blue Cross plans in the country.

  33. ThinkerToys says:

    Terminal illness is a reality. It is sad, and it is not nearly as uncommon as we would like. Wanting to go to every possible extreme to save a loved one is natural, but there is a point past which there is no reason to continue. That may be where the medical professionals are on this case, and it is definitely where the insurance company is. Perhaps the family needs to deal with the reality of losing him rather than fighting for something that, ultimately, won’t matter.

    Please note, however: The insurance company isn’t killing him, they aren’t even saying he can’t have the treatment. All they are saying is that they will not cover it. The family is free to make whatever financial arrangements are necessary in order to have the procedure done. That is a great deal of expense, I am sure, and if it is due to the insurance company dodging a responsibility, sue them to recover the expenses. We don’t need the melodrama of claiming the company’s spreadsheet is killing him. Insurance companies do plenty of evil without making more up.

  34. oakie says:

    @burgundyyears: “I can’t wait until we socialize medicine, then as a society we can come together and decide just how much a human life is worth and settle that debate once and for all.”

    yes, because it works so well in Canada. [www.americanthinker.com]

    where will we go if under a socialized healthcare system that we arent able to get the care we need?

    you DO realize that this situation only means that their insurance wont PAY for the procedure, but they are still free to get it done on their own dime? but in a socialized healthcare system, this situation wouldnt be about payment, it would be about just doing the procedure AT ALL.

  35. ben1711 says:

    The patient above is certainly in my prayers….

    However…to create a balanced discussion what are the odds of survival for the mentioned treatment and what is the cost?

  36. Tux the Penguin says:

    @bohemian: Would you be willing to pony up some of your hard-earned cash to pay for his procedure? Start a charity/foundation/whatever and begin working to cover those who are denied coverage. Then see how much money it would take to do just that.

    But lets simplify all of this: As the insurance company, how much of that are you willing to pay to give him a 100% chance at life? What about 50%? 10%? 1%? Those are the decisions that you are bashing the insurance companies for. And, like it or not, the government will do the same thing.

    But lets make this even more simple: remove the insurance companies. How much are you willing to pay out for those same chances above? Are you willing to sell everything, house, cars, boats, empty all savings and retirement funds, borrow as much as you can while maxing out credit cards for those chances?

    Those are the hard questions that people don’t want to think about. Most people don’t have a problem calling for someone else to pay for something. But are YOU willing to pay for it. If so, then as I said before, start the “Foundation to Cover the Uncovered.”

  37. pagancollective says:

    What the fuck is wrong with you all?

    Way to use someone else’s terrible life crisis to serve as a prime example for your political thoughts/agendas.

  38. JackAshley says:

    Oh Canada!

    This is a hint that if the kid marries a canadian (depending on province, with parental consent, methinks this can be age 16 or higher for legal marriage – NOT SURE ON THIS!) then he can swoop into a Canadian hospital and have it fixed semi-pronto! I think there is a website somewhere where canadians auction themselves for marriage to US citizens (with a fun pre-nup) so they can get healthcare, then divorce and head back down. If not, i’ve got to create one…

  39. Beerad says:

    Something that a lot of people seem to overlook in the analysis is that while it’s true that a government official would be making the call in a state-managed system, one significant difference would be that the government should be looking to maximize public health, and not shareholder profit. Insurance companies have no interest in providing the best health care possible, rather to simply generate the greatest revenue possible (while not being burned at the stake by irate mobs for denying coverage). The government (in theory) should be willing to give up “profit” for “greater coverage.”

  40. mikelotus says:

    @JustAGuy2: It does not have to be the government that decides, it can be doctors that decide in a single payer system. Its easy to assume all the negatives when it works in other countries by delivery better health care at a much lower cost?

  41. renilyn says:

    First and foremost, I want to say that my heart goes out to this family.

    Its just another reason that I fear this summer. We will be switching to Pacificare (employer insurance change) and I suffer from chronic pain. Cigna, which should be up there with the crappiest insurance companies, is even smart enough to know that a $2k ER bill is more expensive than fully (or partially) paying the $125 a month for my meds. Pacificare has already stated that they would NOT in any way, shape, or form-be paying ANYTHING toward my monthly meds.

    Nothing in comparison to cancer, I realize this… but it just goes to show how unreasonable they are about $125 – let alone whatever this poor child needs.

    Pathetic

  42. FLConsumer says:

    @Tux the Penguin: Find me a hospital in the US which is turning an honest profit. The truth is that most hospitals are barely staying afloat at this point. We’ve seen a few hospitals shut down various departments and some entire hospitals even close in Florida. I’m not going to say hospitals and doctors are innocent bystanders, as the problem is multi-faceted.

    The balance of trial attorneys, insurance companies, doctors, and hospitals has become terribly unbalanced. Doctors are ordering excessive tests as part of “defensive medicine”, just in case they happen to get sued. Doctors and hospitals also get reimbursed by insurance to cover procedures related to their own screw-ups (nonsocomial infections anyone?) I’ve also seen very few doctors who actually know what the hell they’re doing. I shouldn’t have to go to 5 different doctors to get a correct dx.

    Insurance. 30-50% of the costs of healthcare are due to paperwork and insurance. It costs money to employ people to look at paperwork and deny your claim.

    Then add in the trial attorneys who will sue an OB/GYN because the baby from an alcoholic crack whore dies 3 days after birth. Entirely the doctor’s fault, right? Bad outcomes DO NOT = malpractice, despite what the current vultures think. Sure, it’s profitable, but at the expense of everyone else. When ER docs are having to carry malpractice insurance that costs $250k/year, don’t be surprised when your local hospital’s ER suddenly shuts down.

    Then there’s the cold, hard truth about resources. There are only so many dollars to go around. In a socialized single-payer system, there are only so many dollars available to share for the WHOLE system. That’s it. Ultimately, there IS a price on human life. It’s unavoidable. We could spend money on USDA & local health inspectors to make sure our food never gets us sick….but that costs money. We could make our cars and roads much safer….but that costs money. We could give our children a first-rate education….but that costs money. We could spend $5M to save one patient’s life, at the exepnse of basic health care for 50-250 others. If people are willing to place a high enough value on life and do so by spending money, then maybe… but I doubt it.

    From what I see, the only true way to fix this system is to scrap it and start over, but insurance industry and the attorneys have too much political influence to allow that to happen. Personally, I like the idea of socialized medicine. I do believe it only makes sense. Health care should be a right for all rather than a privilege for those who can afford it. **BUT** I fear what that would look like here in the USA. I don’t trust the lobbyists, I don’t trust our government. I won’t claim to have the answer, other than to know that it depends on addressing ALL of the issues I’ve raised here. Until that happens and someone is willing to take on ALL of those issues, things are only going to get worse.

  43. hegemonyhog says:

    @oakie:

    A couple of critical problems with virtually every critique of the Canadian healthcare system:

    1.) Canada has some particularly nativist laws on the books making it virtually impossible for foreign doctors to practice in Canada, which is what usually leads to the “shortages” in Canada. It has nothing to do with the healthcare or health insurance system.

    2.) Canada spends half as much per capita on healthcare as we do, and has generally similar (if not better) results. Do you think we’d hear a single complaint in terms of care received if we poured our extravagant sums of money into a single-payer system?

  44. mikelotus says:

    @Tux the Penguin: well universal health care delivers better results at a lower cost in the UK, France, Germany (put in by Bismark that liberal), Sweden, Norway, Japan, Switzerland, Italy, Greece, Isreal, need I go on? I want to know what system you propose that will lower our health care costs in half (what France is at compared to us and they are the next highest in the world) and provide better results like these countries (live longer, lower infant mortality). Let us know your plan or let us know where a system anywhere in the universe does this that is not universal health coverage.

  45. poodlepoodle says:

    a government official would be making the call in a state-managed system, one significant difference would be that the government should be looking to maximize public health,

    You mean like the shining success at Walter Reed? And the fine care we give our vets with head trauma? I can’t wait for that. Gives me a warm feeling.

    Seriously, name one thing that the government does well. Taxes DMV? Infrastructure upkeep? Drug War? Foreign policy? IRS? Simplicity in our tax code?

    You want these people telling you what they’re going to cover.

  46. mikelotus says:

    @poodlepoodle: Well why do these other countries have cheaper coverage with better results then? Not efficient? Are you saying you can be less efficient but somehow deliver better results at a cheaper price?

  47. mikelotus says:

    @renilyn: correct

  48. mikelotus says:

    @hegemonyhog: actually Canada spends less than half of what we do per capita. And their results are superior. We do get the privilege of funding their cheap prices on prescription medications though.

  49. hegemonyhog says:

    @poodlepoodle:

    The funny part is almost all of those programs are either naturally botched or botched through the actions of the same people who oppose universal health care.

    I also find it hilarious that anyone who’s a regular reader of this site is holding up private industry as the paragon of efficiency and responsiveness.

  50. hegemonyhog says:

    @mikelotus:

    For 2007, it was just over half (probably also depends on the exchange rate):

    [www.infoplease.com]

  51. mikelotus says:

    @poodlepoodle: just because this incompetent administration assumed the war in Iraq would be over in 6 months and did no planning for large number of injured soldiers has nothing to do with this discussion. Funding of universal health care delivered by doctors does not mean the DOD is running health care. And Veterans and DOD health care was great until the lack of planning for Iraq happened. They were overwhelmed and not funded. What do you expect?

  52. katylostherart says:

    @pagancollective: “Way to use someone else’s terrible life crisis to serve as a prime example for your political thoughts/agendas.”

    that person’s brother is doing just that though. hypothetical situations are nice but if you have a real, solid factual case base for an argument the chances are it has a better chance of winning. it’s not wrong to use a real example to further an idea. it’s actually the correct way to argue.

    that said, i feel bad for this kid. i’m trying to move to a socialized nation for reasons just like this. sorry, i’m not in california.

  53. He should have planned a protest earlier and then orchestrated a dance number like the truth.com commercials. That would have gotten mad attention from the media and maybe some donors would kick in some cash for the procedure.

  54. mikelotus says:

    By the way, I dropped United Health Care because they suck. I am now on Empire Blue Cross and its much superior. And I pay less. How about that? United Health Care are rip off artists. Forget them making a profit. Specialist leave them and then when there are none in the area you are forced to go out of network. Oh, but they cover that right? Yea, they told me that they would pay nothing because my $35 co-pay for the hour was all they would pay. So evidently doctors work at $35 an hour in the DC area now. I make much more than that and I am no doctor for sure.

  55. Tux the Penguin says:

    @mikelotus: I’ve said this to almost anyone who ask: make health insurance more like car insurance. Instead of having them pay for every little thing that we do (a routine checkup, my toe hurts, my kid has a fever) you pay for that out of pocket. The insurance company pays only for major things (surgeries, emergency car, etc).

    What we have set up in the medical industry would be like our auto insurance covering oil changes, gas purchases, new tires, etc.

    We should have insurance that covers… oh my, emergencies and distasters, much like auto insurance.

    Considering that you can set up health savings accounts (that are not use-it-or-lose-it) that dollar-for-dollar reduce your taxable income, I don’t see what the big deal is. Oh, wait, I do. You’d be responsible for yourself. That seems to be the big hang up when talking about anything now-a-days.

  56. poodlepoodle says:

    Every NHS system rations to keep costs down. You can say “well we treated XYZ for ABC and this is how well they did” but if you put a 6 mo waiting list on them and then drop them from the roll if they’re not treated in that time so that they have to go back on the waiting list and then they die in the meantime so you never have to treat them — uh, I don’t really call that a good outcome, do you? [tinyurl.com]

    There is a great deal of manipulation in the figures. Take forexample infant mortality rates which are often bandied about as an example of how bad it is in the US. In the US ever child born (and not born up to a particular age) is counted in our infant mortality statistics. In most of Europe and Canada it’s only those born to healthy mothers, in normal pregnancies, who live for more than two weeks. Kinda a big difference to be making comparisons and drawing conclusions. [tinyurl.com] In fact in the US heroic efforts will be made to keep even the sickest baby alive.

    I’m not saying the US system isn’t flawed, I rather like the German model because it allows for some flexibility and the current system we have of letting the ERs act as community doctors is NOT working. But, know that there is rationing everywhere. Don’t like it? I suggest you become independently wealthy.

  57. mikelotus says:

    Is there a reason that there is now a shortage of family practitioners and internal medicine practitioners but med students are flocking to dermatology so they can get rich doing plastic surgery? More med students are applying for residencies in dermatology now than ever in history. The field is competitive and booming. Why? No insurance companies to deal with.

  58. pal003 says:

    No one should ever have to go bankrupt because of illness. We should be a better country than that. For-Profit Health Care does not work, except for the company CEOs.

    Like UHG’s former CEO McGuire who had over 1.6 Billion of stock options – and was so obscenely greedy, he decided to backdate them for more money to himself.

    So why does this healthcare system only work for people like him?

  59. mikelotus says:

    @Tux the Penguin: and this system is working where now?

  60. poodlepoodle says:

    Funding of universal health care delivered by doctors does not mean the DOD is running health care.

    Seriously, who here has been in a VA? Anyone? I have. I wouldn’t send my poodle there. Both before 2001 and after. It might actually be the most depressing place on earth.

    For those of you arguing that it is only Bush’s fault that the VA is in bad shape and if not for him everything would be fine there — so we should turn over our health care of the US — do you think a similar president won’t be elected in the future?

  61. jgarra says:

    Director, Investment Management – stephen p henry – steven_p_henry@uhc.com
    COO Stephen J. Hemsley – stephen_j_hemsley@uhc.com
    CEO William W. McGuire – william_w_mcguire@uhc.com
    CFO Patrick J. Erlandson – patrick_j_erlandson@uhc.com
    office receptionist Lee deStefano – Lee_A_deStefano@uhc.com
    Senior Vice President and Treasurer – Robert Oberrender – Robert_W_Oberrender@UHC.com

  62. jgarra says:

    Please email the people I listed above. I’m pretty sure those are correct. Remember that you attract more bees with honey so hopefully Nick will get the treatment he needs. Does anyone know if there’s a donation fund for him?

  63. jgarra says:

    How about instead of arguing semantics you all find ways to help this boy?

  64. katylostherart says:

    @poodlepoodle: i would rather be on a waiting list to receive treatment then never have even a hope of a chance of receiving that treatment. having to wait is one thing, being outright denied a procedure and told “tough shit, no” is a very different standard of care.

    most people i know without insurance would also prefer to wait rather than just get told to go screw themselves.

  65. poodlepoodle says:

    Bah, my posts keep on getting eaten.

    And Isn’t the DoD yet an other example of a government entity that isn’t particularly well run? If I remember correctly the Pentagon was at one point paying $800 for a toilet seat?

    I know I’ll be accused of cutting and running but seriously I can’t sit here and post all day.

    To the OP I can’t stress this enough you should go see a grief counselor. I wish you the best, please take care of yourself and weigh what you and your family want to do. Also consider what is best for your brother.

  66. modenastradale says:

    I hope Pacificare/United comes around for this family. From everything I have heard, Pacificare and Kaiser are so lousy that they’re barely better than having no health insurance at all. I know I won’t be doing business with either of them, or taking a job with any employer that uses them exclusively.

  67. mikelotus says:

    @katylostherart: they argue but they offer nothing provably better. They tell us how bad it will be I guess because they figure Americans are incompetent compared to the rest of the world. Scare tactics but no provable solution.

  68. Tux the Penguin says:

    @pal003: So if I’m sick, I shouldn’t have to go bankrupt to save my own life? But I should expect you to pick up my tab instead? Wow, the logic on that is astounding.

    So, in your mind, death is a better outcome than going bankrupt to save your life? Last time I checked, bankruptcy is a temporary thing. Death isn’t.

  69. jgarra says:

    Please search for my post in this thread and email the executives @ the addresses I have posted. Get their attention. Help this boy.

  70. mikelotus says:

    @poodlepoodle: are you telling me as a nation we are not competent to do what much of the world is already doing better than us? Are we now just a wreck of a third world country accelerating towards the trash heap of history? Is this nation just now plain useless when it comes to solving what are clearly solvable problems? I tend to be an optimist and don’t believe we are about to die as a viable great nation, but I guess that is not everyone’s opinion here.

  71. giggitygoo says:

    @mikelotus

    You’re missing a couple of key points. First, a large part of the reason that nations with socialized medicine have lower costs is price controls on drugs. Pharmaceutical companies make little or no profits on drugs sold to those nations, and make up for it by overcharging here in the US. Of course, without the profits made in the US those companies would not be able to discover and produce the modern medicines used worldwide. Essentially, we in the US are subsidizing the research, development, and production of pharmaceuticals for the whole world. That is not reflected in the numbers you cite. (What was that about “lies, damn lies, and statistics”??)

    Also, socialized medicine works just fine for treating minor or common illnesses. However, when it comes to rare or serious diseases, socialized systems fail miserably. It is no coincidence that Canadians and Europeans with the means come to the US for treatment for such ailments. We have the best doctors and surgeons in the world, and they’re here because of the profits the private system offers them. The stats may show lower overall costs or greater average life expectancies than in the US, but there’s no better place to be if you’re seriously ill.

  72. JustAGuy2 says:

    @mikelotus:

    This isn’t a single-payer vs. private health care system question. This kid’s problem would exist regardless of who’s paying. In any system, there have got to be cases where we, as a society (either through private or government actors), say “no, we’re not paying for that, because the $ it would cost outweigh the benefit.” I know it’s harsh to tell someone “your life isn’t worth enough to do this,” but it has to be done. Think of it this way, in an extreme example:

    A procedure would cost $100 billion, and extend the life of a 95 year old by 1 hour. Should the procedure be done? If not, then how about 2 hours and $50 billion? How about 1 year and $1 billion? A line has to be drawn somewhere.

    We can’t escape the fact that someone’s got to make these calls, regardless of who’s actually writing the check. It can’t be the doctors, since they have a legal and moral obligation to act solely in the interests of their patients, regardless of the financial impact on society.

  73. JustAGuy2 says:

    By the way, that headline is absurd. He’s not being murdered by anyone, he’s dying of cancer.

  74. Tux the Penguin says:

    @mikelotus: Lets simplify this argument down to a simple fact, all other things being equal (give and take a little, but I’m trying to reach a middle ground).

    -Health care will, to some extent, always be rationed. The only difference is who would be doing the rationing (private v public).

    Everything seems to feed into that. The argument seems to be which would be better at rationing, private versus public. However, in theory, they would arrive at the same situation in the end. Why?

    With private care (our current system), you yourself participate in the rationing, given that you pay for your own coverage out of your own pocket. Do you want really high coverage (for a higher price) or lower coverage (such as the one I have currently)? So between the insurance company making decisions, you make some your own.

    In a public system (socialized/universal/etc), the individual-level rationing is removed since your paying for your care via tax dollars (and taxes, unfortunately, aren’t optional).

    In the end, then, it is a trade off between choice and responsibility. The more choices you have, the more reponsibility for your own decisions you have. And vice versa.

    Am I missing anything?

  75. katylostherart says:

    @mikelotus: actually i kind of wonder how incompetent we’ve become. we have no real working social welfare system, our healthcare system is shot, our educational system is shot, our jobs go overseas or south of the border, the housing market is screwed, the wrong income brackets are over taxed and life in general is too expensive for the majority of the population to maintain for a 75 year lifespan with out heavy amounts of debt.

    we’re not doing so well. i’m not even going to blame bush for all of this, but that iraq war bill isn’t helping. no child left behind didn’t help. allowing corporate lobbyists to even exist doesn’t help. nafta is a bad idea.

    i’d actually say canada/europe have got the provable solution. yeah sure, they have their problems. every nation does. a lot of those countries are big into taking care of the people and the people aren’t afraid to tell their government to fuck off. we can’t do that so much. there are things like living on the dole in the uk pays better than a lot of the jobs, but then again when you’re employed you have a livable minimum wage because your healthcare and education are free or next to nothing.

    we have a failing social infrastructure and very large corporations run by a very very small percentage of the top of the wealthy population run them and consequently our government. and yet things like SPEND YOUR ECONOMIC STIMULUS PAYMENT is the offered solution. i’m sorry $3-600 is nothing. that’s not even one month’s rent in the majority of the country. it’s not enough to purchase most cds in order to pump money back into the banking market. it’s the groceries for a family of four for a month. and they want us to what? head to walmart and buy some tvs! buy furniture! buy 10 tanks of gas!

    europe is at least attempting to make renewable energy. they have a wave farm off portugal. i’m sorry we have one of the longest coastlines of any single nation, why aren’t we doing this? in englan eon has set up loads of wind farms. we have near 1500 miles of flat nothing between one mountain range and the other that we could do this with. why aren’t we doing this?

    education in europe – if you don’t get into uni, you can get an apprenticeship. education in america – if you can’t AFFORD college, you can work at mcdonalds and take a decade trying to put yourself through school.

    taxes in england – nuts right? except under £6k a year you don’t pay taxes. that’s the rough equivalent of 12k here. their minimum wage is £5.35/hr for age 21 and up that’s the rough equivalent of $10.50 here. our income tax credit this year i think was $3k for the lowest tax bracket being under $25k a year. that’s not a feasible living in the areas of the country where most of the high paying jobs are yet that’s what a lot of people attempt to live off.

    in france either parent gets 3 YEARS maternity/paternity leave. we get a few weeks or a few months, i can’t even remember but it’s pathetic. a breast feeding baby basically is a year and a half on the tit and mothers aren’t even allowed to give that to their children.

    there are proven systems at play in the rest of the western world.

  76. jgarra says:

    Wow, a lot of rants that do nothing for this boy except see that people think his plight is an academic exercise or an advertisement for socialism.

    Please search for my post in this thread and email the executives @ the addresses I have posted. Get their attention. Help this boy.

  77. North of 49 says:

    anyone else believe the insurance company is stalling until he turns 18 in order to deny all coverage?

  78. JustAGuy2 says:

    @jgarra:

    I’m not emailing them, because I don’t think that I (or you, for that matter) know that they’re wrong to deny coverage.

    If you really want to “help this boy,” email the insurance company and offer to pay for part of his treatment. Being generous with other people’s money isn’t that impressive.

  79. modenastradale says:

    @giggitygoo:
    “[T]here’s no better place to be if you’re seriously ill.”

    I think what you meant to say is, “there’s no better place to be if you’re seriously ill AND WELL-FUNDED.” Because, as this article demonstrates, the United States’ innovative, high-tech wizardry and world-renowned physicians are not available to those of us who rely on insurance to provide health care coverage.

  80. jaewon223 says:

    Move to Canada. Why must there be a pricetag for good health? SOrry to hear your situation hope things work out for you and your brother.

  81. pmls says:

    @giggitygoo: “there’s no better place to be if you’re seriously il.”

    …and rich!

  82. PermanentStar says:

    Hmmm…maybe he could try to become a citizen of England or Canada, or some other country with socialized medicine?

  83. johnva says:

    @Tux the Penguin: Yes, you’re missing something. What you’re missing is that “individual responsibility” is not what drives healthcare costs. I can’t “be more responsible” and avoid getting cancer or a genetic disease. By allowing insurance to cost a variable amount for different people, you are shifting more of the cost burden onto the UNLUCKY, not just the irresponsible. This defeats a lot of the whole purpose of insurance in the first place, which is to spread risk (so that everyone pays a small amount more in order to lower their own risk). If you’re going to make people pay more for things outside of their control, you may as well just abolish health insurance and start making everyone pay out of pocket for all health costs. Then everyone would pay way less, except for the people that have something really bad happen to them. It would be more “fair” under the same logic that the free market approach uses.

  84. katylostherart says:

    @North of 49: if he goes to college (ya know, assuming he was healthy enough to enroll and attend) he can extend coverage until he’s 22.

  85. mikelotus says:

    @giggitygoo: yes, the Dutch, Swedes, Austrians keep trying to sneak into this country for our health care, right? So they can not live as long? By the way, Europeans are now taller than Americans for the first time. Most probable reason? Superior health care. They live longer, they live better. That be the fact jack. Go there and see for yourself. I am almost 6 feet tall and felt like a shrimp. Just think how much longer they are going to live than us now that they are starting to cut back on smoking.

  86. mikelotus says:

    @johnva: We don’t have a free market when it comes to health industry. My choices in insurance are limited. The plans are so complicated that I can only judge them by trying them for a year. I have no way of judging the quality of doctors comparatively. Doctors are rushing to specialties where there is no insurance. My parents doctor is dropping insurance and going “boutique.” United Health Care determines what is reasonable compensation for out of network based on bogus numbers. We and our doctors hate insurance companies. There is nothing free market about this system. I am not sure it can ever be a market based system because the information required to be available in a timely manner does not exist or is not measured. All I know is other places pay less and get better results. Hell the whole world pays less than we do.

  87. @Tux the Penguin: /fail … because in the private system, 24% of your medical dollar goes to advertising and paper-pushing. Only 3% in socialized systems. You’ll receive 20% more health care for your dollar under any single-payer system, regardless of who is making the decisions.

    Moreover, our current system so effectively masks prices that consumer don’t make rational cost-based decisions, and that’s part of the problem. Health insurance doesn’t function particularly well as a free-market good, partly because the vast majority of people don’t make “economically rational” decisions about health, even when those costs ARE transparent.

    (Furthermore, in all socialized systems I’m aware of, you’re allowed to purchase supplemental coverage or seek treatment from private providers … so you still can make your own, independent decisions.)

    And on two other points (not to Tux specifically) — the profits drug companies make in the US fund their ADVERTISING. Yes, drug research costs a lot. But compare the advertising and R&D budgets. Moreover, many of these drugs are research and developed using grants from the U.S. government, AND PATENTED BY THE COMPANY, who then provides them low-cost to other countries and gouges us out the ass. Also, the incentive structure in a capitalist economy is for these companies to discover “lifestyle” drugs, not live-saving drugs.

    And second, rational health-care buyers take their rational money to INDIA for treatment these days, not the U.S. (Although with the dollar-vs-euro where it is, we may get some of that business back.)

  88. mikelotus says:

    Just think, the direct costs/funding of the war in Iraq would pay for his treatment in 21 seconds of funding for the war, assuming that his treatment costs $100K.

  89. ManPurse says:

    @hegemonyhog: I know. Let’s defend one of the most messed up industries in the country.

    Now if the hospital staff wanted this kid to show his receipt before leaving, then people might have some sympathy for him…

  90. johnva says:

    @mikelotus: I’m totally with you. Our system is not functioning well as a “free market”. I’m just arguing with the people who seem to think that a free market system is going to fix our problems with healthcare cost and availability. It won’t, beause costs vary so much from person to person based on factors outside of our control. If insurers are free to practice price discrimination and reject certain people as customers, care will only be available to people who aren’t expensive. Even if the reason some people incur more expense is totally outside their control.

  91. mikelotus says:

    @JustAGuy2: And untrue, no doctor worth a damn is going to try and extend someone’s life by an hour. If you can’t trust the doctors, who do you trust then? There can be rules put in place that people by and large will see as fair. Right now you don’t know if something will be covered until you apply for the coverage. The insurance company made me waste my time with a x-ray of my back when an MRI was clearly needed according to two doctors, so United Health Care paid for both. They would not pay for a Catscan of my sinuses, just an x-ray which showed no problems. Of course if a sinus x-ray does show a problem, you are probably near death. Blue Cross paid for the Catscan and guess what? There was a significant problem. Now did I have a way of knowing who would and would not pay before I got that insurance? Nope.

  92. Juggernaut says:

    @SkokieGuy: Amazing how one person can put the whole issue into three paragraphs and state it succinctly(?). Thanks Skokie.

  93. vdragonmpc says:

    @Tux the Penguin
    Thats great that you saw that the doctors are saying it may not help.
    Im saying UHC is a pack of scumbags that will do anything to NOT pay the coverage. They will find any reason NOT to pay for a health problem. Its a nice try to say they are doing the right thing in some warped ‘lets make money off the dead kid’ mentality. I would wonder why they have ANY input in the prognosis or dispensing of medicine. They should only be negotiating final payment.
    I have been through them taking money from me at over 6500 a year and then denying every claim. There is nothing like some bullshit artist in a call center telling you that they would rather have your wife in the ER getting a temporary fix that requires weekly visits for pain injections instead of 6 month injections that let her live a productive life where she can continue college, work and be a good mother. I had to deal with them all the way up to an executive carpet bomb where they said “oh we reviewed the situation and its an experimental procedure” whoops Aetna and Anthem covered it before for 4 years and now Anthem takes care of it. I asked for a refund of my payroll deductions they took out since they could not provide coverage and were actually banned from the clinics in the area for non payment of services.

    Also: Have you ever seen what they actually pay? HMOs dont pay anything to Doctors and Hospitals… We pay insane amounts of money compared to the crumbs the HMOs drop.

    They should be tarred, feathered and dropped into a nest of angry fire ants.

  94. DoctorMD says:

    The insurance company is a public traded entity that BY LAW must do everything possible to maximize profit for shareholders. Paying for a 4th line salvage care that may cause severe bowel complications does not fit into that equation.

    The treatment will not save his life, but will likely palliate his pain and prevent quality of life issues with the bowel and bladder. With the way health care dollars are wasted on geriatric terminal patients they should pay for the procedure.

    But for you people that want Socialized healthcare. Based on our VA system and other “industrialized” countries they would not even consider this treatment and probably would not have offered some of the chemo he already received because there is no proven benefit to any of it.

  95. SAO says:

    By the way, Europeans are now taller than Americans for the first time. Most probable reason? Superior health care.

    Well, that or a whole lot of Mexicans.

    Seriously, who here has been in a VA? Anyone? I have. I wouldn’t send my poodle there.

    I’ve volunteered there, and yes I’d love to have access to their free, quality care (after 2001). Especially if I weren’t healthy.

    make health insurance more like car insurance. Instead of having them pay for every little thing that we do (a routine checkup, my toe hurts, my kid has a fever) you pay for that out of pocket.

    Of course this already exists, it’s called high-deducatable plans and they are sold by UH, Blue-Cross, and everyone else. It works great if your are a healthy, non-pregnant young person. Kind of sucks otherwise.

  96. mikelotus says:

    @DoctorMD: Using the term “socialized” for single payer is the last refuge of the scoundrel who has nothing better to offer.

  97. Teh1337Pirate says:

    way to post this the day of instead of giving people more of a notice.

  98. DoctorMD says:

    He could marry a Canadian but them both of them would have to cross the border back to the US. It is a very common occurrence for Canadians to come across the border for radiation treatments. The more advanced treatments are usually not available and wait times are months. There actually are border radiation oncology offices that have sprung up to meet the need.

  99. Orngbliss says:

    @burgundyyears: Socialize Health care? Are you serious? Go take a look at Canada’s failing “socialized Health care” system or even England’s Health care system. You might recant your statement about socializing health care.
    However, I do agree that our health care system isn’t the greatest and it does need to change, unfortunately socializing it is not the answer.

  100. Stush0104 says:

    @justaguy2
    That is the wrong way to look at this. Insurance companies are taking a risk, a gamble, on who they agree to have as a customer. Just because they gambled on the risk and lost (so to speak) by having someone who needs an expensive procedure, it doesn’t mean you don’t have to pay because of the “bottom-line.” Of course they go into every situation hoping that their customers will never get sick and pay up their monthly dues, but sometimes someone costs more. If they are going to take this stance, then I should be able to demand and receive all of the money I have ever given to my insurance and have not seen any benefit from.

  101. DoctorMD says:

    @mikelotus. Government run health care is “Socialized”. They can socialize medicine after they socialize food and shelter. Oh that sounds unreasonable now doesn’t it but those are more basic needs.

    I do have something better to offer: Not-for-profit regulated but PRIVATE health care plans(not insurance). But remember if you want everything done regardless of cost or benefit your health care should cost more than your mortgage.

  102. axiomatic says:

    Subby, I’m very sorry about your brother. I hope you get this resolved somehow.

    Just thought you should know that my employer (200,000+ employee company) just dumped UnitedHealth for these very reasons. On one case my employer actually went ahead and paid for the cancer treatment that was denied by UnitedHealth, but that was for an employee though. (Sorry I can’t reveal my employer.)

    Fight this tooth and nail though. UnitedHealth is SCUM. They need some chopping at the knees.

  103. mikelotus says:

    @DoctorMD: Interesting that their system seems to be causing a shortage of radiologists while ours causes a shortage of primary care physicians. Or maybe that is not the reason for the shortage and we are about to experience the same thing: [findarticles.com]
    Now what is also interesting is we provide more radition treatments when it appears that there is no reason to do this, [www.pubmedcentral.nih.gov]

  104. mikelotus says:

    @Orngbliss: and the answer is? they pay less and they live longer. what is failing about that compared to ours? so what is the answer? I tend to go with what works, which is what, well Europe has. You got something better or is it just knee jerk reaction against single payer?

  105. slapBOXmaster says:

    @Tux the Penguin:” In a public system (socialized/universal/etc), the individual-level rationing is removed since your paying for your care via tax dollars (and taxes, unfortunately, aren’t optional).”

    But just like your taxes aren’t optional your healthcare ( at least basic ) in that system would be guaranteed. You could walk in to a hospital and be given treatment without worry. Unlike now where even if you have Healthcare insurance you aren’t guaranteed anything. Your HMO can deny even the most basic of care for seemingly any reason they want. These people have been paying for care they hardly ( if they are average people ) used. Now when they need to full power of the insurance they pay for they are told to take a hike..

    How kind of the company to take years worth of his cash and then leave him to die when he needs his HEALTH INSURANCE. I have no problem with the company making money but this is too much. For every case like his ( high cost potentially life-saving treatment ) there are tens of thousands of people paying into the system that don’t need to ( and probably never have to ) collect on the full benefits. The point of insurance is to have a buffer if anything major happens and to be able to get basic care for when you don’t have anything major…

    or am I wrong on that?

  106. mikelotus says:

    @DoctorMD: Then many things are socialized, such as Defense. So what? We intervened and got JP Morgan Chase to buy Bear Stearns and guaranteed the loans. Socialized market intervention. So what? You label but offer no proven alternatives. It works much better in Europe. They pay less, they live longer. Show many another system that works better than this mess we have besides that and I’m all for it.

  107. Buckus says:

    They need to hire Matt Damon…

  108. SkokieGuy says:

    We are fooling ourselves to think that even in a fantasy world of free and unlimited healthier that our healthiness as a nation would mirror or exceed other countries. If we want the longer longevity and lower healthcare costs of Europe, we must emulate more than their healthcare system.

    We also must lower stress (shorter work weeks, longer vacation, more generous leave policies), shorter commute times, less fragmented families, more exercise, bigger emphasis on holistic medicine and natural cures, no fluoridation in water, reduced use of antibiotics, reduced use of immunizations and vaccines, less processed foods, (most foods in the US contain genetically modified organisms, canola oil was originally called rapeseed oil and developed as an industrial lubricant), etc. etc. etc.

    Sadly, it is virtually impossible for the average American to live this way.

  109. slapBOXmaster says:

    @SkokieGuy: ” canola oil was originally called rapeseed oil and developed as an industrial lubricant)”

    Really? ( not being sarcastic ) Where did you read that.

  110. LucyInTheSky says:

    oh god i think im gonna puke.
    this is horrible.

  111. descend says:

    @Tux the Penguin:

    Yeah, it’s weird how people get outraged with insurance companies but not the employers who provide these crappy plans. Just because your job gives you “health insurance” doesn’t mean you have Cadillac Care. Read the terms of your plan, understand what’s covered and what’s not, and if you aren’t comfortable with the risk, either buy more coverage or pressure your employer to pick a better plan. In these situations, I think insurance companies trying to enforce a contract and make sure there’s money left to pay for the procedures they actually agreed to cover are the least culpable in sad stories like these.

  112. Ben Popken says:
  113. Orngbliss says:

    @mikelotus: Have you spent time in England? The National Health Service, as it is called in England,is not superior to that of the health care system in America. NHS is an uncaring, and unresponsive form of health care. Yes, treatment is free, but have you ever heard, you get what you pay for? Patients wait months for treatment and sometimes are poorly treated. Many people in England have opted for private Health Care, which is an alternative to the National Health Service.

    Before you opt for a national health system, maybe you should do some research on it. There is a waiting list for patients that need hospital treatment, not treatment like a kidney transplant, but minor procedures as well as major. Read this article before you stand up for a national health care:
    [www.burtonreport.com]

    What I suggest, and I know several people already do this, are health savings accounts, HSA, also known as medical savings accounts, MSA. I believe these types of accounts are tax free. The MSAs allow the individual to be in control of their own health care decisions, rather than a third party. Here is some info on HSAs:
    [en.wikipedia.org]

    So, as you can see, I have given a lot of thought into the health care system, it is not just a “knee jerk reaction.”
    America’s Health care system is not the greatest and does need to be revised. However, national health care is not the answer, IMHO.

  114. amccoll says:

    @pagancollective: Agreed.

    My grandmother had cancer, chances are it may have been treatable, but she decided to pass gracefully rather than spend her last years sicker from the treatments. This, however, is a kid, and if anyone should have a fighting chance it should be him. If there’s a treatment that worked from someone else, like the letter says, the insurance company should pay for it. That’s why you pay for insurance in the first place!

  115. yokodol says:

    This is my first look at this website, and I’m constantly amazed at stories I’ve read here, and heard about on the news, on health and insurance practices in the U.S. Unfortunately, Americans are misinformed (big time) about health care in Canada. If I had had the misfortune of having to rely on U.S. health care, I would have died numerous times since 1988. Why is it that the most powerful nation on earth doesn’t understand that a nation is judged on how it cares for those who cannot care for themselves? And Americans wonder why they are so disliked in most of the world?

  116. JustAGuy2 says:

    @slapBOXmaster:

    In fairness, in a single-payer system, you’re not “guaranteed anything” either. I don’t know the details of the case, none of us do, but it’s entirely possible that, if Nick were English, the NHS would say “sorry, not going to do that, it’s just too expensive given the potential benefit.”

    I happen to think that single payer is likely a better solution, but we shouldn’t pretend that it means that everyone gets everything they want. Health care, like all products, will still be rationed.

  117. pastabatman says:

    there are so many contradictory arguments here it’s amazing. I mean i think it’s interesting.

    we have the people who are anti-UHC saying:

    “We have the best medicine IF you have something serious and or difficult”

    but then I get the vibe from the same side that:

    “We have to make the hard fiscal choice to let people die, because our experimental awesome technology is too iffy – aka they will probably die, so why lay out the dough.”

    Well, for one, we can’t be cutting edge without taking some treatment risks now can we? Regardless, most people, i feel, are playing devils advocate to a set of circumstances that they know very little about. Like the way in which actual doctors make actual life or death treatment decisions.

    also – can we ease up on the absolutely stupid scenario of the old:

    “We can’t pay for a 98 year old to live for a few months…” bullshit.

    You show me where that happens. ever. while you’re at it, find me a 98 year old person who says: “Yeah shove that thing through my chest or dose me with some experimental drug so I can live 3 more months.”

    Good luck with that.

  118. graydoll says:

    Ill logic…

    It makes no sense to say that money matters more than human life — i.e. a decision will always have to be made regarding the validity of doing yet another test or procedure when we can’t be sure of its success rate in advance — and then in the next breath to recommend a fund raiser. Clearly, there are those of you out there who think 1. that there is a point at which money becomes more important than trying to save a person’s life, and 2. you don’t want to be the one funding it. What good is a fundraiser when such a large portion of commentators here honestly believe in keeping their money in their wallets — even when it’s not their own wallet — over the possible benefit of trying to save this boy’s life?

    This is why we create systems in our society like insurance. The idea is you pay, you get coverage. It’s insurance because not everyone needs it. It’s a social safety net, and it makes a damn good bit of sense. And no, it wasn’t based on the primary notion of making grand amounts of money. The idea was based on a need for health care that can be an unexpected and high cost.

    As to the argument that if UHC approves the procedure, then everyone else will want it, and UHC will go bankrupt — well, that’s just uneducated silliness. There are plenty of insurance companies out there who approve these procedures under these exact circumstances. And trust me, they make a LOT of money to boot.

  119. Ben Popken says:
  120. Fait Accompli says:

    @johnva:
    What you’re missing is that “individual responsibility” is not what drives healthcare costs. I can’t “be more responsible” and avoid getting cancer or a genetic disease. By allowing insurance to cost a variable amount for different people, you are shifting more of the cost burden onto the UNLUCKY, not just the irresponsible . . . If you’re going to make people pay more for things outside of their control, you may as well just abolish health insurance and start making everyone pay out of pocket for all health costs.

    This is different topic, but a large portion of healthcare costs result from self-inflicted harm such as (s) smoking, (b) poor eating habits, (c) poor weight management/failure to keep physically fit, and(d) alchohol and drug related illness and injury (drunk drivers anyone?). There is also a chunk that can be attributed to people using emergency rooms in place of primary care physicians (i.e., broken bones are not emergencies . . . they go to primary car phsycians or urgent care centers. Teh cost there is lower, and it allows ER docs to tak care of true emergencies . . . like people who may die absent immediate care).

    I’m not arging that these healthcare costs should be re-allocated, just that the premise of your post is flawed. “Individual responsbility,” or a lack thereof, is a factor driving healthcare costs.

  121. Angryrider says:

    @deedrit: So?! They want it and no one’s gonna take it from them!
    This poor boy isn’t alone, plenty of people have died so big health insurance can allow their higher ups live in mansions and go to the tropics for vacation.

  122. whydidnt says:

    @mikelotus: You are over simplifying things when you state Europe and Canada provide better care at lower cost. Better care is quite subjective– I personally don’t find being put on a waiting list for 6 months to be better care. I don’t find the government telling me I’m too fat to get a hip transplant better care. These are realities of life in many of the socialized medicine states.

    I believe it was you who talked about Dr’s moving into cosmetic surgery and the like because they didn’t have to also deal with Insurance companies. They also don’t have to deal with Medicare, who is actually most responsible for setting medical costs in the country.

    Isn’t it also interesting that over the last 15 years the price for cosmetic surgery has dropped significantly, in some cases as much as 300-400% (Lasic eye surgery for example), while the cost for standard medical services has increased by the same amount. How could that be? Why would one type of medicine get cheaper, while the other got more expensive. It’s simple, when the steak is free people keep eating until they are stuffed. When they have to pay, they settle for the 6 oz. sirloin. The current system (and a socialized one) gives no incentive for people to manage the cost of the health care. When you suspect you have strep throat do you check with 3 clinics to see who offers the best combination of rates/service for your strep test? Of course not, consumers have no idea about the cost. But when they want laser surgery they check for the best combination, and cost IS a factor. Dr’s have learned that they have to compete on cost, not simply charge a fixed price based upon what the government says they can charge.

    Socialized medicine would only make the problem worse. To flat out say socialized medicine is better without looking at underlying factors — how many immigrants does Sweden accept every year that abuse or use the system? — is incorrect.

    I wish we could wave a magic wand and say one system is the best, but there are too many examples of rationing of care in countries that have socialized this to think that in itself is the only solution. Just as we have too many examples of people being abused by the current system. I for one don’t trust the government to be more efficient at this than private enterprise is. There is nothing in our government’s past to suggest that any service the national government provides is a model of efficiency.

  123. kable2 says:

    I have to put my two Canadian cents in on this.

    Sorry Americans, but your health care system sucks. Its a pity that you guys have been brain washed by your HMO things. Listen guys just face it your system sucks. It really does.

    In Canada we use our money to save peoples lives. Not to make some CEO and shareholders rich. Our system kicks the shit out of your system, it provides better care and is more efficient then yours.

    When someone goes to the hospital with a emergency here, they start treatment and help you. In the states they wont look at you unless you have insurance and even if you do they have to call for permission. Thats F’ed up. Canadians get whatever treatment or test that the doctor thinks you need.

    My father was seriously ill when I was a teen and almost died. Spent like four months in the hospital. Amd was back and forth for years untill he passed away.

    Mom had a tumor removed 6 months ago. Cat scans, X-Rays, exploratory surgery, emergency surgery, drugs, biopsy’s, specialists etc etc etc. She is cured, no trace of cancer anymore thank god, but is having chemo and radiation as a precaution now and been in hospital an average of 1 week per month since due to a weakened immune system from the treatments.

    She has $12,000 worth of drugs in the fridge up stairs that is boosting her immune system during the chemo. She is currently in hospital again from a burn from the radiation that got infected. The doctors were getting ready to do surgery if she needed it, but she doesnt need it now.

    You know how many treatments had to be approved ??? none…. the doctor signed his name and it was a done deal.

    Would she be alive in the states even if she had insurance….. I doubt it.

    /did not have to sell the house to pay the co-pay as it does not exist up here.

    //Did have to pay $20 for a cast once.

    ///I feel sorry for you guys in the states. I really do.

  124. Orngbliss says:

    @kable2: “When someone goes to the hospital with a emergency here, they start treatment and help you. In the states they wont look at you unless you have insurance and even if you do they have to call for permission. Thats F’ed up.”

    I do not know where you get your information, but it is against the law for the emergency room to require you to show your insurance card in order to receive care. In fact, one of the reasons for rising health care costs is due to that fact that many hospitals treat patients that do not have health insurance and can’t afford to pay the services that they received. Therefore, the hospitals have to recoup their losses by raising the prices of treating patients. Maybe you should do a little more research and back up your claims before spouting out complete fallacies.

  125. whydidnt says:

    @kable2: Hmm,then why did the Canadian Supreme court write the following: “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.” This was just 3 years ago, BTW.

    This was in a case where the Government was being sued to allow privatized medicine. The person suing was a LONG waiting list and did not want to wait longer for a hip replacement.

    Sorry, but there are too many stories like this to allow you carte blanche on false statements as you posted.

    Thankfully, the case in the original story has a happy ending as the Insurance company has relented and agreed to provide the service. For all you socialists in the crowd — what are the odds a government agency would have changed their mind due to public pressure, without some sort of legal action. I seriously doubt it since they answer to no one.

  126. kable2 says:

    @DoctorMD:

    are you an idiot or just ignorant on how crappy the american health care really is. Go stick your head back in the sand.

    If its so bad why is it that canadians love it so much?

  127. mikelotus says:

    @SkokieGuy: reduced vaccinations? No fluoride? Like the nut cases in New England that are worried about the purity of their vital fluids and essence?

  128. mikelotus says:

    @Orngbliss: you have complaints about systems that a cheaper and deliver superior results but you only offer that mysterious “something else.” Great.

  129. mikelotus says:

    @whydidnt: make the problem worse? we are the worse without it. how can you possibly say that something that works in Italy and Greece, two countries that know how to have bad governments, is worse that what we have now? The bottom line — we pay more, we get less. And unless you have something besides single payer that can provably change that, you and everyone else are not contributing to a solution. You just feed and fan fears like those insurance commercials did during Clinton’s attempt at universal health care. If Bismark, no socialist, can put a system in Germany that has worked since the 1880’s, even under Hitler, then I think perhaps we should try something like that unless you can point me to something else that works better. I have laid the challenge out to find something better out here for months. So far its been goose eggs from the “we can’t have socialized medicine” crowd. That is why the Republicans offer nothing but “tax breaks.” And by the way, using the tax system for social planning is the worse possible thing that can occur unless you like our current convoluted tax system now that requires an expert to figure out and tax breaks that never die.

  130. mikelotus says:

    @whydidnt: Canadians pay less and still end up with better results. That is the fact.

  131. redkamel says:

    mikeloutus:

    universal health care is fine, but having the government run it is the worst idea ever. I dont care what happens in Europe. We are not in Europe. We have a different system of government, different politics, and different society. try telling someone their taxes wont cover a procedure for grandma, that they shouldnt be obese, or no more MRIs for lower back pain.

    Also, you cite this current administration as not being relevant. Well, if they were in charge, the healthcare system would have been gutted…and taken years to fix. You are proposing a radical change in our country without even understanding what it would do here. Rather you look at projections that only take facts and ideals into account…and never explain why the best healthcare is available in the US, even though the other countries have the “best system”

    Our healthcare system works great, IF you have money. So why ruin the whole basis of its funding, and basically start over, when all you have to do is “trim the fat” and regulate the insurance companies? Regulate their profits, and their policies. Get a unversal billing form. Tax them for uninsured people. Cap profits. Cap rates. Review their policies. Take their hand out of the cookie jar. Instead there are a bunch of people too lazy to do REAL policy work and just go with the solution that sounds great and is easiest to justify. hm a problem…just give everyone healthcare and make everyone pay for it! should work no problem! and the person setting the policies should be a politician or social service worker! Try changing the laws so that providing healthcare is profitable and required.

    I am not joining further in this discussion since you have already had several people, including at least one physician, and two medical students (counting myself), as well as people on consumerist, a Pro-Consumer website I might add, tell you that you are wrong. I wouldnt be surprised if you are a med student too, we have plenty of your viewpoint at my school…and none of them know anything about govt or econ, just dreams and plans about how the government would really have the public interest, and not kickbacks, profit, and power, as their priority.
    So:
    1. please look at things objectively and not as in “no healthcare for everyone=murder”
    2. take an economics course, or at least read a book about it.
    3. talk to some doctors with different points of view
    4. go to some city council meetings and see how decisions are made.
    5. take sicko out of your DVD player for a few days while you are at it.
    6. sit down with a blank piece of paper, all you have learned and draw a way for everyone to have healthcare and have in interest in keeping costs down too rather than getting wasteful treatments.

  132. redkamel says:

    mike I left my healthcare plan on your profile, its my solution. I didnt write it just for you, ive been working on it for a while, hopefully it helps.

  133. Orngbliss says:

    @mikelotus: I don’t really know what was mysterious about my post. I offered a link to HSA and how it works. But, in case that wasn’t clear enough for you, here is another link that gives a little more info on MSAs: [www.forhealthfreedom.org]

  134. mikelotus says:

    @Orngbliss: Tax exemptions are a terrible way of social policy. First you need a job that you can afford to contribute. Second, what the hell does this do to lower costs and improve outcomes? Nothing.

    @redkamel: We die sooner and have higher infant mortality. The only outcome this is useful is do we live longer and better lives. We do not by any measure. And we pay much more for this benefit. Is your system something that has been proven to work some place? Yes, the German system might not map perfectly to us, but you start with something like that since it works and you measure and adjust. TQM process. But as long as people pick at this is bad or this is bad, nothing happens. It just gets worse. I pay more for less every year.

  135. mikelotus says:

    This should add fuel to the fire: [www.cnn.com]

  136. mikelotus says:

    @redkamel: Your ideas are great except the usefulness of tax policy to encourage social policy. That is just another middle class entitlement. Your ideas are good, when mapped onto a system that works. Alone they are just one off fixes that don’t guarantee any improvement in quality or costs. Health care costs are lower in every single payer system. We are twice the cost of Canada and France (well maybe not so with France due to declining dollar but still much higher) and everyone else’s is even lower. The power of one system, economies of scale, is hard to beat. Administrative costs alone would cause a 25% drop in costs.

  137. johnva says:

    @Fait Accompli: I never said that there are not some elements of healthcare costs that ARE due to personal responsibility. But those things are not the dominant part of the cost (and anyway, our system is obviously not doing well at convincing people to change unhealthy behavior). And anyway, our current for-profit insurance system doesn’t differentiate between conditions that are due to “irresponsibility” and conditions that are due to bad luck, like genetics. Either way, you’re going to end up paying more for insurance under our current system. Period. They don’t care why you cost them more; they only care that you do. So if your goal is to punish people for being “irresponsible” with their health our system is a pretty poor and unfair way to do that, since it doesn’t care if your bad health is due to something within your control or not. If you really want healthcare insurers to engage in social engineering to encourage people to lead healthier lives, then at least prevent them from doing the same thing to people who have no control over their conditions.

  138. @Orngbliss: Perhaps you are unaware that in side-by-side comparisons of wait times for minor surgeries (typically the major “waiting list” complaint in socialized systems), US and Canadian consumers have quite similar wait times. US consumers just pay a helluva lot more for the same surgery after waiting the same six months to get it.

    I have a health care savings account AND a flexible spending account. Neither has improved my access to health care or the quality of the care I receive, and our insurance costs have actually increased. All they do is pay for my out-of-pocket health care costs pre-tax instead of post-tax, and the trade off is that my deductible is MUCH MUCH higher. And I still pay the premiums, which are still rising. It doesn’t solve any problems in the health care system; it’s just a shell game of at what point the money comes out of my paycheck. (And since you can deduct certain medical expenses, it’s really just a convenient form of bookkeeping to have it automatically done pre-tax.)

    How exactly are these magical savings accounts supposed to improve my health care access or the quality of care I receive?

    @graydoll: “Clearly, there are those of you out there who think 1. that there is a point at which money becomes more important than trying to save a person’s life,”

    I think many people are merely acknowledging the reality that we have as a society now invented far more medicine than we can pay for, and our medical model is still based on “do everything possible for the patient.” “Everything possible” can mean $1.5 million in bills in the last 10 days of a patient’s life, and frequently there’s no increase in quality or comfort for that $1.5 million.

    Any serious discussion of health care in the U.S. or ANY first-world nation, whether health care is private or public, no matter who is paying, does have to address the issue of rationing health care dollars. There is simply no current scenario under which we as a society can afford all possible treatments for all patients, even after we take the profit motive out of health care and insurance. Until we achieve the Star Trek future (or some similarly radical advance in technology), there will simply never be enough medicine to do everything for every person.

  139. wellfleet says:

    It’s interesting to me, as a Canadian living in the U.S., how vilified socialized medicine is. It seems that many people in the U.S. believe that their neighbor’s health doesn’t affect them, therefore they should not have to contribute their hard-earned money toward the neighbor’s health. Imagine if policemen and firemen worked the way insurance companies do. If you pay them, they will come save you from your burning home, if you don’t, you’re SOL. So, you pay a “fireman fee” every month and your neighbor doesn’t. His house catches fire, but since he did not pay this fee, the fire dep’t won’t come, and your house catches fire as well.
    We are not islands, we are not a collection of individuals, your well-being in tied to my well-being.
    How is it good for the economical well-being of the U.S. if the leading cause for bankruptcy is an overwhelming health-care debt? If you look at it in pure economic terms, if these people mortgage their entire existence to pay for this child’s care, they will not be stimulating the economy by buying a plasma. every american should own a flat screen

  140. Orngbliss says:

    @mikelotus: I would just like to say thanks for poking at my theories… You have really made me think and do some research, which I enjoy. I am in accounting and I am finishing up school so I can sit for my CPA. That might explain why I like the tax exemption policies. However, I recognize that this may not work for all.

    My argument was not to lower health care costs, rather find an alternative to help make insurance affordable for everyone. While MSA does have its disadvantages and will probably only work for people like myself, i.e. young, relatively healthy. I thought it could be an alternative to our current failing insurance policies, that are ridiculously outrageous in price. I guess I will have to do more research for another alternative.

    Anyways, my point to my ramblings is that no matter how much we debate and try to come up with a reasonable answer for Health Care in America, There is no way to satisfy everyone. I guess we can all agree that a change needs to be made. Exactly what that change may be?? I do not have answer for.

    On another note…. Wikipedia has a post comparing the American Health care system to that of the Canadian, It was quite interesting.
    [en.wikipedia.org]

  141. vdragonmpc says:

    I cant beleive someone posted ‘you dont have to show your insurance card at the ER’… No way is anyone that stupid or mis-informed….
    I went through that at John Randolf, Southside Regional and Johnston Willis in VA. My wife was in agony and crying and screaming for me (cue ER music) and we waited in the waiting room… After a nice wait I was called up front. Was it to see a Doctor? No it was to fill out insurance forms and ‘contracts to pay’… Funny the non-english guys that seemed to have had a constuction accident just filled out something and went in. I had to provide ID, INsurance card and sign a pile of papers and then WAIT for her to enter the information into a computer. THEN we waited some more. Finally she was allowed into the back to sit in a bed and wait more for a Doctor. The Doctor turned out to be a nurse practicioner who took more information and vitals. Then the doctor showed up and administered treatment.
    My deductable: 200$ time spent 9 hours for a treatment that should have been 40$ and outpatient with a 2 hour office visit incuding wait time.
    Thanks UHC!

  142. Orngbliss says:

    @vdragonmpc: Sorry that you had an unfortunate experience at the ER, but legally they cannot ask for your insurance card before treatment. I was admitted to the ER twice last year, actually 3 times- – sports related accidents. Anyways, when I was admitted to the ER, in Las Vegas, they didn’t ask for any of my information until I was treated and ready to leave. The other two ER visits I had were in California. When I was in the ER in Mission Viejo, CA I asked the nurse @ check in if she wanted my insurance card, she responded by saying that legally they cannot ask for insurance or payment until treatment has been administered. Same scenario with the ER I visited in San Diego. I did even look at payment paperwork until I had been treated and cleared to leave.

    Obviously, you are the stupid and misinformed person here, either that or the hospitals in your area are in serious violations, if this is truly what happened.

  143. johnva says:

    @Orngbliss: Maybe it’s a state law difference. I also live in VA, and they also asked me for insurance info before administering treatment when I went to the ER for a broken arm. I don’t know if they could actually legally turn you away if you refused, but they did ask me about it first thing.

  144. vdragonmpc says:

    @Orngbliss you = epic fail. Im neither stupid nor misinformed. There is nothing quite like your wife screaming in a booth while you fill out forms and watch the illegals roll right in with no insurance. We had at least 5 people go ahead of us while I filled out forms and the paper-person told my wife to calm down its not so bad.

    Yes we get to fill out forms that state we will be hammered by collections while the insurance company decides when to pay the bill. EVERY time we went to that ER they had to copy my ID and medical card along with me filling out several pages of information.

    The only time they let me fill out the forms in the actual exam area was when my son was in there and I was climbing the walls. I told them I was not leaving his side (he was 2) and they brought the forms to me. We didnt see anyone until those forms were filled out though.

    Now if I was uninsured I guess I get to come through a different door?