Aetna: Instead Of Approving That $113,000 Life-Saving Brain Operation, We're Going To Cancel Your Coverage. Sorry!

Meet 19-year-old Caitlin Jackson. Caitlin was recently diagnosed with Chiari Malformation, a potentially fatal brain disorder that interferes with motor control and memory. Immediate brain surgery is Caitlin’s only treatment option, but her insurance company, Aetna, took its sweet time approving her operation, and then reversed itself claiming her benefits had expired.

Thankfully, Caitlin’s story ends well. After Florida Governor Charlie Christ’s office read about Caitlin and had a nice quiet chat with Aetna, the insurer quickly to agree to pay the full cost of Caitlin’s $113,000 operation.

The moral of the story: if your heartless insurance company changes its mind about a life-saving operation, call the media and the governor.

Why was a brain surgery patient turned away? [News 10]
Governor Crist hears Tampa Bay’s 10 story, and takes action! [News 10]

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  1. mythago says:

    Oh, I remember when my spouse worked at a company with Aetna as an insurer. One of his co-workers, who had breast cancer, could not get chemotherapy approved until her doctor filled out forms certifying that the chemo was not an “elective procedure”.

    Nothing makes me happier about having gone to law school than realizing that I’ll be dealing with insurance companies.

  2. Krystm says:

    My girlfriend actually just had this surgery @ 28 she was diagnosed at 24. Best of Luck with everything. There is a few support groups out there. Really are 1 in a Million. (Which are the odds of having this) Apply for disability also.

  3. junkmail says:

    @mythago: Insurance companies almost make me want to go to law school. Please feel free to give them an extra punitive kick in the nuts for me, next time you get a chance.

  4. MsClear says:

    Consumers need to take note. If you get a serious disease, media strategy may be a necessary component, depending on your insurance company.

    Boy am I glad we don’t have any of that socialized medicine! [/sarcasm]

  5. se7a7n7 says:

    Let’s hear it for free market heath care!!!

  6. @se7a7n7: I might be wrong and probably depends on the country, but I was under the impression there are a variety of treatments that aren’t covered by socialized health care/NHS type system. That are covered here in the US. I’ll have to look it up.

  7. DamThatRiver says:

    Damn. Glad to hear this had a happy ending and best of luck to the woman.

  8. snoop-blog says:

    I wonder if this govener is up for re-election or if he would do this for anybody, anytime? You never can tell a politcians real motive. You just have to assume they are all motivated by the wrong things.

  9. ConsumptionJunkie says:

    It’s time we have universal health coverage. Vote Nader!

  10. Trai_Dep says:

    Clearly it’s the patient’s fault due to a pre-existing condition. She had a brain, after all.
    Good thing this didn’t happen in Europe. They don’t even have governors!

  11. snoop-blog says:

    I wonder how many calls he will recieve now from people who’s health insurance is denying their claim. I wonder if he will help all of them, or just the ones that make him look like a hero with the media.

    I’m a pessimist I know, but for me to assume a politician did anything out of the goodness of his heart is pretty much not possible for me.

  12. You know insurance companies are out of control when Christ has to intervene just to get them to cover stuff.

    The power of god compels you….to pay for this surgery!

  13. TeraGram says:

    I wonder if this govener is up for re-election

    Crist is supposedly on McCain’s short-list as a veep. He was inaugurated January 2007, so he’s not up for a little while, yet. He just recently announced his engagement to Carole Rome, a “Halloween business” heiress. One of the things her company makes is beards.

  14. johnva says:

    @ConsumptionJunkie: Voting Nader is one of the best ways to ensure that we don’t get universal health coverage anytime soon.

  15. snoop-blog says:

    @ConsumptionJunkie: Please lets not try to recruit votes on the consumerist. It WILL lead to a nasty discussion, especially when your telling people to vote for Nader…

  16. snoop-blog says:

    @johnva: A vote for Nader, is a vote for McSame.

  17. bohemian says:

    They need to establish some sort of punitive damages or fines against insurance companies who pull this crap. They also need to make insurance policies pass a government review before they can be sold. Insurance companies purposely make things vague and don’t spell many things out so they can cover and deny at will. No other industry could get away with selling such a vague service.

    Two options. Crack down on the insurance industry and put some black and white laws on what they do, or finally institute national health insurance. I just want them to pick one.

  18. Kevino says:

    That is just downright wrong. They call themselves an insurance company?

  19. PølάrβǽЯ says:

    To all those arguing about which “type” of health care system we have, that point is kind of irrelevant. The point here is, if you pay for an insurance policy, that policy is supposed to cover the costs when something happens.

    You pay for your car insurance, so when you wreck your car, the insurance company buys you a new one. Likewise, you pay for your medical insurance, so when you need an operation, the insurance company should pay for it.

  20. chucklebuck says:

    I still can’t figure out how an insurance company isn’t going to win the Golden Shit.

  21. leastcmplicated says:

    @snoop-blog: Different situation obviously but I was having a real problem involving USCIS and the National Visa Center regarding some adoption stuff. After contacting both places a couple times and each time them blaming the other for the issue I contacted my governer’s (Johnny Isaakson) office, it was resolved in 3 days. So hopefully the only reason the governor did this was because his job is to look out for his citizens.

  22. BuddyGuyMontag says:

    Charlie Christ rules. TeraGram, I see what you did there, but honestly, I’d vote for McCain/Christ ticket in a second.

  23. dezeinstein says:

    @Trai_Dep:
    HAHAHAHAHAHAAAAA!

    (You’re joking, right?)

  24. dezeinstein says:

    @dezeinstein:
    Hmmm that was meant for Consumption Junkie’s Nader comment.

  25. ibored says:

    @bohemian:

    Screw punitive damages, and screw going after them at a corporate level. Make it a felony for a claims adjuster to deny medically neccesary benefits. Obviously these people aren’t the cause of the problem, but I doubt many would be willing to go to jail for their jobs. That would scare the insurance companies straight I’m sure.

  26. Puck says:

    Where’s all these hooray privatization and free market assholes now?

  27. snoop-blog says:

    Hmmm, If we do go to a similar system as Canada, I wonder if all the foreign doctors would move back overseas or just stop coming over here?

  28. JeffDrummer says:

    Actually Fox News contacted Charlie Crist’s office and that’s how he found out. Fox carried this story first…

    And if we adopt universal healthcare, where will the canadians who want good healthcare go?

    It doesn’t surprise me to see support for government intervention in the comments here, but an all-out assault on capitalism, and support for socialism… that is a new low here.

    I understand that you want to be anti-corporation, but check your Communist views at the door please.

  29. aphexbr says:

    @hypochondriac: Yes and no. In the UK, there are certain types of procedure (largely cosmetic, elective and/or experimental) and drugs that are either not covered at all by the NHS or which have a long, low priority waiting list. However, it’s possible to buy private health insurance that covers these.

    Whenever people bring up socialised medicine in these kinds of threads it’s to point out the simple fact that with a socialised system, nobody will get refused a life-saving operation regardless of cost, insurance status or patient income. There are problems, but the risk associated with a socialised system pales in comparison to this story. Yeah, this particular person managed to get a win in the end but that’s not going to happen for everyone. I’d be extremely concerned to think that when I need a vital operation, some paper-pusher is going to be paid to look for a way out of providing it.

  30. JeffDrummer says:

    Oh and vote for Nader, please, if it weren’t for him we would have a that fat alcoholic al-Gore in the White House.

  31. aphexbr says:

    @JeffDrummer: What about the other 99.9% of Canadians who are happy with the health service there and don’t go across the border? It doesn’t surprise me that Fox would come up with such an idiotic “talking point” though.

    Why are Americans so scared of a system where it’s only incompetence that screws up their healthcare? Are you really happier when it’s corporate greed that’s killing people?

  32. BluesFan says:

    My son was approved for an overnight stay in the hospital by our insurance company.

    He was only going in to have a minor procedure done.

    Getting a new pulmonary artery and valve is minor, right?

    That said, I’ve seen enough to know that the last thing I want for him is socialized or single payer medicine.

    At least when he needs something here, he gets it. And insurance can get straightened out later.

  33. timsgm1418 says:

    geez everytime something about insurance is brought up everybody pulls the “we need national healthcare” I mean I’m glad this girls operation got approved, but this is one case we heard about. Has anybody looked into Aetnas record to see how many surgeries are requested versus how many are denied?
    As far as private health care, my health care rocks. I’ve had 12 surgeries over the last 2 years and my insurance company has been awesome, I’ll stick with private insurance thanks.

  34. mwdavis says:

    Oh, what a terribly meaningful moral you glean from this story. Twerps.

  35. Trai_Dep says:

    @aphexbr: And the thing about comparing competing systems is you avoid the anecdotal, instead focusing on reliable statistics.
    Compare Europe vs US health stats on any measure, and we’re at the bottom of the list among Industrialized nations. Period. Except, perhaps, optional cosmetic surgery.

    If “socialized” medicine were so bad, we’d pay less and get more. Since the opposite is true, any rational person would recognize we don’t have a workable system.

    Of course, all you irrational commentators, I don’t expect you to see this…

  36. Average_Joe says:

    That’s cool and all, but if you don’t fine them 10 times what the claim is worth they have no incentive to do the right thing the next time.

  37. Pro-Pain says:

    Wow, insurance companies are the spawn of satan. Everytime I hear one is getting sued for the big bucks it makes my day. And don’t give me that bs that our rates will go up either.

  38. dweebster says:

    Moral of the story: Private insurance companies will gladly and openly kill you unless you contract some muscle- political or otherwise.

    What a way to run a civil society.

  39. Ubermunch says:

    Ok… Let me offer this and you can all yell…

    My family is insured by Aetna QPOS and have found it to be really good. And we should know… Three years ago my wife needed cancer treatment/surgery that required a few days of inpatient care and a LOT of outpatient visits. We paid all the co-pays ($15 per visit and I think $50 at the hospital – maybe $300-$400 out of pocket) and received great service from doctors we chose and who were part of the Aetna system. So a few weeks go by and no bill…. I figured that the other shoe had been delayed in its dropping so I called Aetna.

    Story was…

    It was all taken care of. Period. All the surgery, hospital bills, specialists, consults, etc. ALL paid for when we paid the co-pay. There was no hassle, no fights, no ethical lapses, no lengthy mumbo jumbo bills/explanations…. just good service.

    Sorry to tell a positive story, but we find Aetna QPOS to be great, especially after years of Care First/BCBS (Ugh!) home of the “THIS IS NOT A BILL”. Now QPOS is not ALL of Aetna, but it is worth noting, isn’t it?

  40. dweebster says:

    @timsgm1418: Thanks for your comment, Senator!

  41. mac-phisto says:

    a few years back aetna axed its benefits package for retirees. retired employees used to have benefits for life, but now they’re left out in the cold. not really anything new in this market, except they not only axed benefits for those that retired after the change, they made the changes retroactive! [hr.blr.com]

    kind of funny when even the insurance company can’t afford their own insurance anymore, isn’t it?

  42. AgentTuttle says:

    big surprise. Watch sicko.

  43. dweebster says:

    @Ubermunch: Yes, and I’ve had some fairly routine reimbursements from Blue Shield without having to call the governor to shake them down. That’s the way it’s allegedly supposed to work, and really not a defense of what these companies are really up to.

    You don’t get a gold star just for showing up – you get it for going above and beyond what is expected of you.

    The rest of the industrialized countries manage to keep their citizenry healthy and happy with shared insurance risk – the USA is the *only* one that allows private corporate oligopolies to kill (or maim, or lessen the health of) its citizenry who were unfortunate enough to be born broke, or not be contract attorneys, or politically powerless, or have purchased “health” insurance from a company having too many “losses” the same quarter they develop brain cancer, or….

    It’s these stories that point out that single payer healthcare is the only direction to strive. The fact that many bills actually get paid in the current corrupt “managed care” system is hardly a reason to celebrate or defend it.

  44. themrdee says:

    bohemian,

    I don’t think your statement of (they) “make things vague and don’t spell many things out so they can cover and deny” is not the plan of the insurance companies. I think it’s more of a lack of education on the customers part and the fact that insurance companies have lawyers who write these documents and don’t take into account the education level of the readers.

    Even so, I hate insurance companies!

  45. dweebster says:

    @snoop-blog: A few months ago, my doctor confided in me that his business is being squeezed left and right by the managed care reimbursement rates and lag time, and wasn’t sure if he could stay in business. Said that nearly the only viable option for doctors now is closing up shop and work for Kaiser or another group where he’ll just be another employee of a bigger company, with corporate bureaucrats micromanaging his every move. He’s spent many “vacations” volunteering his services down in latin america and other areas that are underserved for the most basic of needs, and he is just shocked by how bad medical care has been taken by HMOs.

    Just got a letter last week that said he’s leaving the practice.

  46. dweebster says:

    @JeffDrummer: Instead of the skinnier alcoholic Bush?

  47. AlphaWolf says:

    Definitely we need some kind of government intervention, the system we have now is not working. Our politicians knew back in the early 90’s it was not working and decided to ignore it as usual.

    More likely rather than denying a surgery claim, you would go to the hospital and get hit by the old 80/20 and go broke trying to pay the 20% they would not cover.

  48. MonstrousCosmos says:

    @timsgm1418: Oh, well if you have had positive experiences with your private insurance company then there couldn’t possibly be anything wrong with private medicine! This woman should just be more like you and then she won’t have anything to worry about!

    On a not-sarcastic, long story note: Aetna did a similar thing to me when I was in high school. They cashed my parents’ checks every month for years, but when it became necessary for me to have surgery, they denied the claim because, while the procedure itself was covered in my plan, they decided that it was elective in my case. We appealed the decision, providing additional documentation from my doctors (current and former) that they considered the surgery medically necessary. About two weeks after sending off the appeal, we got two letters from Aetna: a letter of receipt of the appeal and a notification informing us that the entire family was being dropped because of delinquent payments. It took about two weeks of phone calls and paper shuffling convince them that not only had every payment been on-time and for the correct amount, but that they had cashed every check and even noted these payments in subsequent bills.

    It could have been coincidental incompetence, but that doesn’t sound much better to me. They spent another several months claiming that the appeal was “pending,” but we wound up just giving in and dropping them, switching to a Blue Cross/Blue Shield provider available from my mother’s job. The new insurer approved the surgery in about a week and I had the procedure about two weeks later: almost five months later than I should have.

    It was actually a good thing that we ditched Aetna when we did, though: when I checked into the hospital for surgery I saw a sign that said that Aetna plans would no longer be accepted. According to a staff member, it was just too difficult to get them to pay for procedures that they had approved!

  49. emilayohead says:

    Thanks, Ubermunch, for the reality check that this discussion sorely needs. Not all insurance companies are evil, even though they are attempting to (gasp! heaven forbid!) make a profit. Clearly they were wrong on this one, but if this were the standard of care that insurance companies offer, then the market would have already dealt with this company. This is just one bad, bad decision.

    I was in England last month visiting my parents, when my son cracked his chin on a seesaw and split it open. It looked bad enough for stitches, so we went to the ER. I was told that it didn’t need stitches, just a butterfly bandage, which they would be happy to put on him for free in three hours. I left and put a band-aid on him myself.

    Therein lies the flaw in the national health care fanboy’s thinking. There is not a magical, endless supply of medical care. Currently, the medical care that is available is rationed out according to money. When money isn’t a concern, it will be rationed out according to time. When everyone in the country is eligible for their life-saving procedures, the only people to get them will be the ones who can wait (read: last) the longest. Or the ones with private insurance who can cut to the front of the line. There will always be inequality in resource allocation, and just because we want everyone to have equal access doesn’t mean that we can make it so.

  50. danseuse322 says:

    @timsgm1418: Please tell us who insures you! I have the evil Administrative Concepts that basically is for students (working on a PhD) and Aetna sounds compassionate compared to them. I want to buy good private insurance, so DO TELL!

  51. waitaminute says:

    @TeraGram: I’m laughing so hard I can barely type… good lord that was funny.

  52. MonstrousCosmos says:

    @emilayohead: You defend the accumulation of profits in all realms of life as if it is something so unproblematic that it shouldn’t even be questioned. As if there isn’t even the possibility that providing the highest possible level life-sustaining care to human beings (the normative principle of medicine) and the achieving the highest possible profit margins (the normative principle of capitalism) are, in certain respects, incongruent.

    “The market” is not a magical thing — most economists even agree to that. Markets are only magical to the extent that we do not fully understand how they work. But to suggest, categorically, that the market only allows “good” businesses to thrive is pretty far-fetched.

  53. clickable says:

    I’m curious about the details – why did the insurer say she ran out of benefits? They must have thought they had some legal leg to stand on to initially deny coverage, at least before the gov’s intervention. Whatever clause it was, it was probably intentionally worded in a vague or ambivalent way, and it would help to know their rationale so we’re better armed to fight when they deny claims for obscure reasons.

  54. Britt says:

    A girl I know fell down a full flight of stairs and smashed her face on a wall. Because of the severity, she was in for a CT scan the next day. Socialised medicine = hooray!

  55. aphexbr says:

    @emilayohead: I have an anecdote too. I was mugged a few months ago (in Spain), which left me needing stitches on my forehead. I didn’t have to wait to see a doctor and was treated and ready to leave in about 10 minutes. I was given a prescription for painkillers and antibiotics. When I had the stitches taken out a week later, I could do it near my workplace in Gibraltar – different country but still no waiting and no charge. Total cost for my experience: 3 euros (for the prescription). How much would it have been in the US? How much if I wasn’t insured?

    I don’t know exactly how you can equate your 2nd and 3rd paragraphs. You have a single anecdote of a person with a minor injury requiring no treatment. Would such an injury really be seen to any quicker in the US? I’d hate to be the guy requiring stitches being forced to wait behind your son.

    Anyway, you actually answered your own question. Yes, healthcare is a limited resource, even in a socialised system. Therefore, people with life-threatening complaints are treated ahead of people with minor or cosmetic requirements (e.g. your son). Don’t like this? There’s private health insurance available, who don’t “cut to the front of the line” – they’re in a different line altogether. the difference is that if your insurance is cancelled, refused, not accepted at the hospital or just plain non-existent, you’re not left with an unpayable bill.

  56. varro says:

    @ConsumptionJunkie: I agree with the first sentence, but not the second. Nader’s as big of an insider as anyone.

    American health insurance companies are a perverted bunch – actually using their coverage often makes you ineligible to comparison-shop in the future because you’ll have a pre-existing condition.

    We can complain as much as we want about Bank of America and Comcast, but credit cards and cable television are not necessities. Unless you sleep on a bed of money, health insurance is a necessity, and the state risk pools are horribly expensive.

  57. varro says:

    @bohemian: Perhaps indicting the bean-counter who rejects claims and the policy-makers in charge with either practicing medicine without a license, or if there are doctors on the boards, making a diagnosis without seeing a patient.

  58. varro says:

    @JeffDrummer: There will still be plenty of BoTox doctors and cash-only doctors here, as there are now.

    What we won’t have is Americans going into Canada to get health care and buying “illegal” prescriptions that the provinces bought using their market power.

  59. GizmoBub says:

    Yeah, but Nader would legalize “IT”…

  60. varro says:

    @emilayohead: Wouldn’t your son still have to wait three hours in an emergency room in the U.S.? You’d also have to pay the $100 ER co-pay as well, as opposed to getting it covered in the U.K….

  61. bobpence says:

    @clickable: Good question, why Aetna at one point denied coverage. Inexact wording doesn’t help, since one article said her coverage had run out — does that mean expired due to time or unpaid premiums, or exhausted due to a lifetime maximum?

    I conjecture that the latter MIGHT be the case because her brain condition — which affects something like 0.1% of the population — often accompanies spina bifida. It could be that the Disney job was a good choice if it offered health insurance apart from her parents’ insurance. I do recall that years ago some of my coverage had a lifetime maximum.

    Typically, none of the news stories seem to address Aetna’s reasoning, possibly because so many journalists believe that any attack on American health insurance benefits the move for socialized medicine. (My concern there is that the governor will be less willing to go to bat for you, because it will be the government that said “no.”) However finances, it is important that this young woman be helped.

  62. mythago says:

    Not all insurance companies are evil, even though they are attempting to (gasp! heaven forbid!) make a profit.

    So, are you trying to say that insurance companies must be evil or they won’t make a profit, and therefore anyone criticizing insurance practices is an evil Communist? What a load of crap. You must work for an insurance company.

    The reality is that insurance companies are supposed to profit by careful underwriting. That is, they are supposed to price their product and determine whom they will insure. But when it comes to paying claims, profit is no longer supposed to be part of the picture. Yes, they need to confirm that the claim is not fraudulent. But by the time it comes to paying a claim for an insured, it is not supposed to be an adversarial system, or one intended to maximize profit. Claims is the insurance company keeping its end of the bargain.

    Problem is that insurance companies have come to believe that the best way to make money is to be sloppy on the underwriting and stingy with claims. That way they have more people paying premiums (instead of just the ‘good risks’) and throw up barriers to paying out claims; they take in more money, but pay out less.

    The issue isn’t “making a profit”. It’s choosing to maximize profits by cheating their customers.

  63. pollyannacowgirl says:

    They won’t cover a lifesaving brain operation, but…

    I had a friend who had all kinds of facials and minor cosmetic things covered by her insurance. Used to ENRAGE me. My SIL had teeth-whitening covered by her dental insurance.

    WTF?

  64. andrewe says:

    With private insurance you make payments to a company that is legally obligated to try to weasel out of as many claims as possible. I find it galling that part of your insurance premium goes to pay people who’s sole job is to deny claims.

    I often wonder just how many Americans die, become maimed or have their lives financially ruined because, by the luck of the draw, they became ill.

    It is a great comfort to know that I can receive medical treatment as often as I require it with no hassles and zero cost.

    Socialized medicine? How about socialized garbage pickup, socialized road repairs, socialized employment insurance, among a slew of others? Why are these socialized services OK but the care of your fellow Americans is not?

  65. SBR249 says:

    @andrewe: I don’t know about where you live, but where I live, garbage collection is anything but socialized…

  66. JoeVet says:

    Health insurance is all about maximizing shareholder value. We need a system that is all about the patient and rendering care.

  67. Bulldog9908 says:

    I am continually amazed at all the people who think socialized medicine is somehow free. You will pay for it through taxes–massive, punitive tax rates. Europe has an average unemployment rate of 8.65% while the US has about 4.6%. Massive, punitive tax rates. Sure, you get to go to the ER and get stitched up without paying at the time, but you’ll pay for it through taxes, and you may not have a job to boot!

    [And, if you’re thinking “But it’s the rich who will pay their fair share”–that’s the most defeatists statement you can make. You’re as much as admitting you’ll never be rich.]

    And to those who think somehow everyone will magically get the care they need–I guarantee we will see rationing in short order. If money isn’t the issue, time and other resources will be (such as doctors, MRI machines, etc.). Your 95 year-old grandmother needs brain surgery? Sorry, no-can-do, she doesn’t have enough life left to make it worthwhile for the state to do her brain surgery before the 36 year old father of three.

    The system in the US is broken, no doubt about it. But, the answer is not socialized (or worse, communized) health care. The real problem is that we don’t have a free market in health care. We have 50 state jurisdictions with their own rules and health care tied to employment. Break insurance away from the employer and give the power to individual families. Also make health insurance portable across state lines. Introduce legislation to expand the risk pool to everyone (similar to how car insurance and homeowners insurance is done). This way, individuals can buy insurance at the same rate as the largest corporations. And, you can choose your coverage. Want low premiums? Go for an HMO or a high deductible plan. Want everything covered 100%? Pay a higher premium. Your choice. Not your employer’s, and not a government bureaucrat’s.

    In short, the answer is a freer marketplace for insurance. Force companies to market insurance directly to consumers, and when consumers have a real choice in they will have real power over their health care decisions.

    (BTW, these ideas are not mine originally, they are the ideas of the American Medical Association. Read about it [www.voicefortheuninsured.org])

  68. xrmb says:

    Well at least they have enough money to send me a letter for each use of my FSA, and a copy if the bill. Which I open & shred, since I can get a copy online anytime. I guess they have a braintumor as well…

  69. JeffDrummer says:

    @aphexbr: I am canadian… And most Canadians do NOT NOT NOT love the health care system. I am guessing that you have spoken with few Canadians about this, because all my family and at least 3/4 my current friends are 100% canadian, and we have some major problems with having to wait 1 and 1/4 years to get any sort of CT scan, or surgery.

    @dweebster: Exactly, except Bush’s alcoholism ended in his thirties, al-Gore’s is still on, at least he acts like an unwieldy drunk.

  70. andrewe says:

    @Bulldog9908:

    The trouble with your ideas is that poor people get the worst or no medical service, In Canada poor people do indeed receive free health care. Any doctor, any hospital, any procedure. If you are lucky enough to make a good living you’ll pay taxes. I think the average Canadian pays far less for medical care than anyone making insurance payments. And, as stated above, many pay nothing.

    It’s about ensuring that every citizen of your country will not have their lives destroyed by an illness or injury.

  71. catastrophegirl chooses not to fly says:

    @MsClear: socialized medicine sounds good superficially, except for the story i read in the UK Daily Mail a few weeks ago about a cancer patient who killed himself after the NHS told him that his cancer treatment wouldn’t be cost effective for them

    AETNA handles disability claim benefits for my employer and I had a recent paperwork nightmare when they denied my intermittent FMLA leave for managing my MS/diabetes/gastroparesis because none of my doctors could predict the number of days/duration of absences due to illness i will need in the next year.
    got it straightened out after several appeals but they still insist that i get the documentation renewed every 90 days to prove that i still have type I diabetes

    when i was hospitalized last year they called me every day in ICU to see if i was getting discharged that day…..

    i’m glad they don’t handle my insurance too. BCBS hasn’t given me too much hassle so far *knock on wood*

  72. Bulldog9908 says:

    @andrewe: Please read the AMA’s plan. They specifically mention how to handle people who cannot afford coverage. I didn’t mention it because my post was already too long.

  73. SuffolkHouse says:

    There comes a time when you need to promote an uprising. Sure, you can go up the food-chain to complain higher, and the rest. Still, this is a case of something so egregious that it’s not just bad business, but it is immoral.

    People who voted for BofA for Golden Shit Award suck. Losing a few bucks to fees is nothing compared to even ONE person having their benefits denied.

    This should be criminal, but the christo-fascist capitalists-at-all-costs just don’t care. They need to lose this fight.

  74. aphexbr says:

    @Bulldog9908: Are you reading the same thread? I don’t see anyone claiming that the healthcare in other countries is free.

    First of all, how recent are your unemployment figures? If that’s recently, remember that a large number of countries have recently joined the EU, largely from former Eastern Bloc (and therefore poor and less developed) states, and that will skew the figures. If you want to make comparisons, at least to to make them somewhat like-for-like (e.g. compare states with a similar population to each other – such as New Jersey vs. Sweden). I’m also not exactly sure what unemployment rates have to do with healthcare. With the current economic crisis, I’d be surprised if the US unemployment rates don’t skyrocket soon, anyway.

    I agree with a few of the later points you’re making, but the tax is will always be a red herring. You *already* pay taxes to pay for Medicare/Medicaid and other low-income support schemes. The amount that the average American currently pays for health insurance isn’t really that much different from the additional European tax burden. The difference is that there is a guaranteed minimum level of healthcare regardless of income, which leads to higher levels of preventative medicine.

    The rationing argument is interesting to an extent, but you also miss a few details about how the healthcare system actually works elsewhere. there have been cases of rationing for elective and/or minor surgery, but I can’t think of a single case where vital surgery has been rationed in this way. You can’t opt out of the NHS in the UK, but you can purchase additional healthcare is desired – just as you can upgrade to a better plan in the US, so you have an option if you don’t like the basic level of service.

    The difference is that nobody gets bankrupted by co-pays, you don’t get a company refusing vital treatment on the basis of cost (as per the article). You’re entitled to treatment that *you’ve already paid for* with no additional cost. Also, it’s funny how anti-socialised medicine folks always seem to bring out the “OMG communist!” argument. Why didn’t that argument die with McCarthy? You argue expanding the risk pool to everyone. Well, since people need to pay health insurance, if everybody pays doesn’t that make it a form of tax anyway, albeit one that places control over peoples very lives in the hands of amoral corporations?

    I agree that a nationalised, blanket healthcare system won’t work in the US. But, like all political arguments in the US, it’s not a simple black and white issue as is quite often argued. It’s very possible to have a system that implements some elements of social healthcare without putting the entire thing in the hands of either corporations or the government. Try making arguments based on reality rather than worst-case scenarios of what could happen, especially if those scenarios have not occurred in countries with a socialised system already.

  75. drjayphd says:

    @JeffDrummer: that fat alcoholic al-Gore

    @JeffDrummer: in his thirties, al-Gore’s is

    I see what you did there. -_-

  76. barty says:

    @se7a7n7: Problem is, we DON’T have free market health care. I, as an individual, at am a financial disadvantage trying to purchase insurance on my own or trying to negotiate with a doctor. Tax law is currently slanted towards employer provided health insurance, which is done that way to give health insurance companies the freedom to do whatever in the hell they want to, since it costs alot of $$$ for most larger companies to switch insurance providers.

    If we had REAL choice in this country, this kind of BS would not be tolerated. Think about it, if you, as an individual, heard about a particular insurance company screwing around with folks in such a manner, would you even begin to consider them as an option? I don’t think so!

    As it stands now, there is no real competition in the health insurance market and most of the providers know it. Unless someone takes something to the extreme and exposes them in the media like this, the average joe can’t just take their dollars and walk, nor will *most* large employers pull up shop because of one instance such as this.

    Here’s one interesting thing I found out by paying cash for some medical procedures. If the doctor finds out they don’t have to jump through the insurance BS, they are VERY likely to give you a very nice discount, as much as 40-50% just for offering to pay cash. That tells me that it ain’t really the healthcare system per se that is screwed up, but the insurance industry.

  77. aphexbr says:

    @JeffDrummer: I have friends in Canada, but the healthcare system has never been a topic of discussion with them. Let’s just say I’ve never heard any complaints, and my experience of other socialised healthcare systems (UK, Spain, Gibraltar, Portugal and Germany) have led me to believe that most of the Canadian stories are either made up or greatly exaggerated. Anecdotal, of course, but most people arguing here have never lived in another country long enough to experience healthcare from the POV of a native.

    Of course, everyone’ opinions differ based on experience – I’ve never had problems, but I’ve not personally needed a serious operation since I was 12. The people I know who have generally seem happy with the way it’s gone.

  78. aphexbr says:

    @catastrophegirl: Hint for understanding how the UK works: ignore everything you read in the Daily Mail. That newspaper is notorious for printing overblown scare stories that have little basis in reality. It’s no better than The Sun, but at least that paper has the good graces to announce its unreliability with its tabloid style.

  79. Jon Mason says:

    The problem is the “I’m alright Jack” mentality of the right wing – if their insurance is OK and they have never had a serious illness, they are happy with the system. They really don’t care about the people who can’t afford insurance or, and this is my real problem, the people who have it but get screwed over. As much as Michael Moore’s Sicko was clearly biased in places (I come from the UK and I can tell you right now the NHS is not the land of roses he makes it out to be), the stories of the middle-class, well insured people whose lives were ruined by massive medical bills really shine a light on the problem.

    Government health care (It is not ‘socialized medicine’ any more than we have ‘socialized law enforcement’ or a ‘socialized military’, it is a taxpayer funded service to keep ourselves and our fellow citizens healthy and alive) is, like everything in life, not perfect – but, and I have experienced both systems, the advantage of a government system is: A guaranteed minimum level of care and no worrying about finances when illness happens. What you give up from a private system is: some choice of medical provider, you may not get the “luxury”/immediate treatment you are used to. I for one, would rather everybody have healthcare that is decent, but not luxurious, than some of us have amazing care and some have none.

  80. andrewe says:

    @Bulldog9908:

    There is not one person employed by the Canadian medical system whose job it is to deny claims to sick people.

    Beyond the issue of income vs. medical care are the people, as in the article, that do have insurance and are refused treatment. This simply just does not happen here.

    Our health care system is not perfect. Wait times can be long for some procedures. Frankly I find this an easy compromise to make over the possibility of being denied medical care due to a financial decision.

    I can’t imagine being a parent and watching your child suffer or die because your insurance company is doing everything possible to prevent you from receiving benefits as it is required to by law.

  81. FrankReality says:

    I would have liked to hear what the Governor actually said to Aetna.

    Might have threatened a state lawsuit and banning Aetna from doing business in the state of Florida.

  82. DanaM says:

    @drjayphd: Wow, and I was just reading that as sloppy typing…good catch!

  83. @Bulldog9908: In every western country in the world where healthcare is paid by taxes it’s cheaper than the US system.

    Look it up.

    Also in every western country in the world where healthcare is paid by taxes, you STILL have the alternative of going to private provider, if you want to pay for it.

    Look it up.

  84. LostAngeles says:

    @Bulldog9908: Hmmm… more taxes… being stuck with a $6000 MRI bill for my brain cyst.

    More taxes… $700 for a month’s prescription of triptans…

    More taxes… worrying about whether the cyst and the migraines will be considered, “pre-existing,” conditions after I graduate and (likely) change insurance companies.

    I’ll go with the, “massive punative taxes,” please, thank you very much.

  85. RodAox says:

    if you think we got a free market then you are dreaming…… like a commenter once posted….. when there are profits they are privatized however once sh*t hits the fan the costs are socialized……. look at the bailing out of companies and banks……

    they bought the politicians then pushed for deregulation then all this mess happened and here comes the government bail out provided by US.

    it is not a free market so quit playing that tune and calling others a socialist….

  86. Blackneto says:

    when i get terminally ill, i’m going to die.

    I can live with that.

  87. catastrophegirl chooses not to fly says:

    @aphexbr: ok, here’s another take on the same story from the telegraph.

    [www.telegraph.co.uk]

  88. linbey says:

    @ConsumptionJunkie:

    Yeah we need universal health care. Then she couldve waited 16 months for that FREE surgery waiting behind people who just want free boob jobs and rhinoplasty. On top of that the surgeons would probably do a half assed job because they all get paid the same by the government and as such there is no incentive to do a good job whereas in a free market doctors dont get patients if they suck.In actuality what she did was effective and her insurance paid.

  89. alice_bunnie says:

    @leastcmplicated:

    Well, hmmm, who did you contact? Not your Governor, because Johnny Isaakson is not your Governor. He’s a Senator from Georgia. :/

  90. shavethatsoulpatch says:

    @BuddyGuyMontag: If you’re such a fan, you should learn how to spell his name. It’s Crist.

  91. OsiUmenyiora says:

    For whatever it’s worth, I’ve had AETNA for several years and they’ve done right be my and my family. When my wife had childbirth complications and my newborn son had to be in intensive care for a week we had zero problems with AETNA. They dished out over $60,000 and we paid $100 and they never questioned anything. When my kid 18 months later wound up in the hospital for a week with Celiac Disease they again dished up $35,000 and we paid $100 and we never had a problem with anything, including seeing out of network docs in the hospital or wherever.

    Just my experience.

  92. timsgm1418 says:

    @danseuse322: humana, I have them trhough my work.

    @pollyannacowgirl: that is exactly why insurance is so high, so many wanted stupid things covered and many states require insurance companies to cover what most of us would think of as cosmetic. Way back when I first started working in the late 70’s my employer paid for my health insurance, I just had a deductible. Well visits weren’t covered, neither were vaccines. Even with the deductbiles and paying for my sons well care and vaccines, and 20% of his medications, I paid far less of my income for medical than I do now.
    when you wonder why people can’t afford insurance, check out your states requirements for insurance companies. If we dropped all the elective and cosmetic coverage, everyone COULD afford healthcare. The government didn’t force this health care crisis on the people, the people demanded it by lobbying to get everything under the sun covered under insurance.
    life or death brain surgery, absolutely should be covered, teeth whitening no.

  93. timsgm1418 says:

    @linbey: AMEN

  94. timsgm1418 says:

    @aphexbr: while I completely disagree with a national health care system, I have to say your comment is one of the best I’ve read, very intelligently (hmm is that a word) written and brought up good points…nice

  95. bwcbwc says:

    @snoop-blog: He’s supposedly on McCain’s list for VP candidate.

  96. Tom Servo says:

    @linbey: “Then she couldve waited 16 months for that FREE surgery waiting behind people who just want free boob jobs and rhinoplasty.”

    Thanks for showing off that you know very little about health care in countries like Canada or the UK. If you did, then you’d know that an essential, emergency brain operation takes far greater precedence over elective cosmetic surgery.

    I guess Rush Limbaugh didn’t mention that on his program. :(

  97. nequam says:

    @bohemian: Wasn’t sure of your first paragraph was sarcastic, because those things (state-approved policies, punitive damages for intentional unfair claims denials) already exist.

    No really, they do!

  98. jackkerouac says:

    I live in Canada and our healthcare systems sucks. Eight to 10 hour emergency room waits, 14-month waits for knee surgery and people are taking “vacations” to India for hip replacements the waits are so long.

    Oh, we also pay 60% of our salaries in taxes.

  99. No, the moral of the story is…..

    Governor’s Hot Line.

    Wanna really get the attention of a business that must receive a state license to operate in the state? Call the Governor. Most Governor’s have a Hot Line staffed with motivated employees that have a big ole roledex of secret telephone numbers to call.

  100. varro says:

    @andrewe: The poor get no medical care, and people who do have insurance get ripped off out the wazoo.

    Not to mention businesses who are faced with constantly increasing premiums and their employees, who are faced with constantly increasing restrictions and fees.

    The Canadians who complain about their health care are welcome to come down here and pay hundreds of dollars a month for health care that doesn’t kick in until you meet a deductible, and even then only covers 80/20.

    American businesses have a novel solution – moving operations to Canada, especially auto manufacturers. They’d rather pay a consistent tax than constantly rising premiums.

  101. failurate says:

    @jackkerouac: You seem to be lying… or at least exaggerating… and hoping that no Canadians actually read this blog.

  102. varro says:

    @jackkerouac: Again to the Canadians who complain about their system: please move here and get similar problems with waiting for appointments.

    How many Americans have had to wait months for a routine appointment, or hours in an emergency room? Lots. Plus, we get to pay hundreds of dollars a month in premiums (or our employers pay insurers money they could pay us), co-pays and deuctibles, and risk being blacklisted for actually using our insurance.

  103. Britt says:

    As a Canadian from the same province as Tommy Douglas, I am always ready to stand up and say that I am happy with the health care system. Whenever there’s a wait time, I remind myself that it’s because someone with far worse a problem than me is ahead. I’d much rather wait a few hours than be the one rushed to the front of the line because I’m in critical condition. It’s very humbling.

  104. parad0x360 says:

    @linbey: Thats not how it works. The Doctors in Europe for instance dont get paid the same rate. They get paid based on performance which means…

    The more healthy people there are, the better they get paid. The better job they do helping someone who is sick so they dont come back for the same issue, the better they get paid.

    Doesnt work like that here in America. In America the more you get treated for the same issue the more they get paid. The sicker you are and more you see them the more they get paid. Unless of course its a really SERIOUS issue. Then your insurance figures out a way to pay as little as possible or nothing at all which in turn forces you to take out a loan or ruin your credit or worse you lose your house.

    Its obvious we cant all agree here on what system is better but its clearly obvious the system we now use is so broken it needs to be replaced.

  105. gomakemeasandwich says:

    @jackkerouac:

    People from the US are already going to places like India and Thailand for the same thing. What’s your point?

  106. gomakemeasandwich says:

    @johnva:

    I don’t think it matters who we vote for.

  107. gomakemeasandwich says:

    @dezeinstein:

    Nothing gets by you.

  108. gomakemeasandwich says:

    @JeffDrummer:

    It still amazes me that people equate universal health care with communism and actually try to put that in to an argument. Sad.

  109. gomakemeasandwich says:

    @emilayohead:

    Trading ER horror stories probably isn’t a good idea if you want to make your point about how “great” the current system in the US is.

    Anyway, even given the “unequal access” to treatment (which of course is speculative as it would apply to any proposed plan for this country, since we have no such plan), at least people would HAVE access, even if it was a tiered system.

    I honestly can’t believe still argue for the system we have now. Unbelievable.

  110. gomakemeasandwich says:

    @aphexbr:

    Well said.

  111. JeffDrummer says:

    @Britt:

    In America you don’t have to wait years, months, or even weeks for healthcare, a CT scan takes maybe a day tops, usually a few minutes. ER waits for me in Buffalo have been 1 hour the one time I went, and for my Dad it has never exceeded 15 minutes.

    I lived in Quebec for 13 years, Ontario for 8, and healthcare here is far better; however I have heard that out west lines are shorter than in ON, and PQ.

    And Britt, in the US the people with serious conditions are rushed to the front, and no one who is going to die can be turned away for emergency care (by law). Even though we still treat people with dire conditions first, the wait still manages to average about an hour in the ER.

    I am probably one of few here with extensive experience in the both canadian and american health care – yes in Canada the taxpayers (ie you) foot the bill, but lines are longer, and in America you pay (if you are in the 20% of people without healthcare (excluding illegals)), but you get the care you NEED in far less time.

    Pretty much everyone I know talks about how great the canadian system is, yet they have no idea about the incredibly long lines. However, wait times aside, the care you receive in Canada is as good as America as long as you aren’t terminally ill.

  112. JeffDrummer says:

    @gomakemeasandwich: Then what is it? The government controls the people by taking the hospitals away. It is certainly socialism – it can very easily lead to socialism (ie. agree with Barry O or don’t get healthcare)

  113. timsgm1418 says:

    @MonstrousCosmos: aren’t you doing the exact same thing? based on this one story you are assuming all private insurance is bad? How many articles are written on people that don’t have any problems with their insurance?
    This is like assuming that HP is a terrible, wasteful company based on the one article about them shipping s/w licenses in too many boxes.

  114. timsgm1418 says:

    @varro: people can get medicaid based on income. Generally it’s the people in between that don’t have health care, and in some instances people that choose not to have health care.
    While I agree there are those that need health care that don’t have it, there are also quite a few that choose not to have it.
    Most of the 20 something year olds I know, don’t have health care by choice. My daughter is one of them, she’d rather spend the money on having cable, internet access and a cell phone, than pay for something she may or may not use. I won’t be so bold to say she is in the majority of people without health care but, I’m sure the statistics include people like her when they add up who doesn’t have health care. A lot of people in their 20’s figure they are relatively healthy so they’d rather spend their money on something they know they will use than something they may not use.

  115. guevera says:

    @snoop-blog: Charlie Crist is in the running for McCain’s VP slot, though the conventional wisdom is that he’s not short listed. But this is the sort of stuff any competent governor does. Problem is that you shouldn’t have to appeal to the governor like it’s 11:45 and you’re on death row

  116. failurate says:

    @varro: It kills me when people site wait times in Canada for why they don’t want universal health care. My wife is a scheduler for a specialist. Her doctor is consistently booked for 2 to 3 months in advance. You want to see him, you wait 4 months.

    Emergencies get dealt with in Canada just as they do in the U.S. You don’t wait weeks or months or even hours for emergencies.
    Well, hopefully they are dealt with better than here in the U.S.
    [cbs4.com]

    And, operating room time here in the U.S. is currently booked the same way it is in Canada, by priority. If you have more money or good insurance, you don’t get to go to the front of the line. There happens to be long waits in the U.S. in quite a few hospitals for surgery time.

    Whether you like it or not, two growing population in the U.S. already have Universal Health Care, the elderly and the poor.

  117. kable2 says:

    As a Canadian, I would punch anyone in the mouth anyone who tried to take away my government health care.

    Yea there are some that want a private run health care system in Canada. The following list covers some of them

    - insurance companies
    - doctors
    - nurses
    - drug companies and their salesmen
    - ahhh i cant think of too many others , but you get the idea
    -

  118. failurate says:

    I think Ontario is screwing the U.S. out of advancing with the rest of the World.

    So Ontarionians, quit acting all Michigan ghetto and get your shit together!

  119. Angryrider says:

    Huzzah Aetna! You did the right call denying the poor girl’s life saving surgery! It’s more important to earn a profit or save money than to save a human life.
    Fox News was right, the Canadian health care system is screwed up!

  120. Trai_Dep says:

    I wonder if Fox would have covered the story if it was about a Democratic governor saving a constituent’s life. I heartily doubt it.

  121. SkyeBlue says:

    What do people in this country do when they need say a serious operation to save their lives and they have no medical insurance, just die, seriously?

    My 22 year old stepson has had no health insurance with his jobs. He had a bad infection on his leg for some time that hadn’t cleared up, even with treatment. The doctor said the small infected area would need to be surgically removed. His Dad and I could help him pay for his doctor visits and the medicine he needed to try to keep it from getting any worse, but neither of us could pay for surgery for him. 2 weeks ago the area that was infected became so bad it ruptured and his local emergency room finally had to treat him. Thank God it hadn’t spread through his system.

    Our country is in such a sad, sad state.

  122. Tom Servo says:

    @jackkerouac: You’d think that, if Canadians hate their health care so much, they’d try to change it.

    The Canadians I personally know are very happy with their health care system. Since Canadian health care is largely managed by the provinces and territories, perhaps your province isn’t really managing its part of the system very well. My friends are in Ontario, Quebec, and Nove Scotia and they are pretty happy with it.

  123. GearheadGeek says:

    @emilayohead: Here’s another anecdote for you. My partner received an injury to his hand that required stitches. We’re insured, and went to a good ER. It took about 3 hours, perhaps a bit more, and cost a $75 co-pay. The ER wasn’t busy. We went mid-morning, it just took forever. It wasn’t the county hospital or a charity hospital, ERs are just slow sometimes.

    Re: butterfly bandage vs. stitches… especially for a cut on the face, if a butterfly bandage is sufficient, it’s nicer to use because it tends to lead to less scarring.

  124. P_Smith says:

    Her having a pretty white face probably had something to do with it.

    When the mother of Sun Hudson called the media, she was ignored back in March 2005, and her son was cut off from medical care. If that date doesn’t ring a bell, that was the height of the Terry Schiavo circus, where a dead white person was kept on life support against her husband’s wishes while a black child in Texas (Hudson) was left to die against his mother’s wish to keep him alive.

  125. P_Smith says:

    @failurate: Emergencies get dealt with in Canada just as they do in the U.S. You don’t wait weeks or months or even hours for emergencies. Well, hopefully they are dealt with better than here in the U.S.

    You missed the whole point about Canada’s medical system versus the US: In Canada, it’s about prevention and detection. In the US, it’s about waiting until it’s critical before doing anything about it.

    US insurers will say, “It’s not life threatening” and deny treatment instead of fixing it while it’s cheap, and discourages people from using medical care as a preventative measure. That’s where the greatest waste comes from in the US system: people are paying premiums to a bureaucracy that denies care instead of paying doctors to treat them.

  126. BIG WHEEL says:

    @jackkerouac: You are WAY off-base. As a Canadian, I am not saying our system is perfect, but it’s not anywhere near as bad as you say. I thought I had a cracked-rib last week (don’t ask) and went to emergency just to make sure I didn’t have a collapsed lung or anything. The triage nurse saw me almost instantaneously, and I waited about an hour to see a doctor. Others were allowed to go before me, because their condition was more serious. That’s fine. For a serious illness, you are treated first, and that’s how it should be. There are lots of people who come in for trivial things and they wait. Long story short- I’d rather pay taxes to live without worry about getting sick. The only people advocating the current U.S. system are either wealthy or benefiting from it (ie insurers). It kind of reminds me of the private prison system (which unfortunately we are starting to use). Once profits start to be balanced with caring for a person, well you know which one wins…

  127. bobacus says:

    Our health care system is easy to fix. All hospitals, clinics and insurance companies should be non-profits. Boom. Fixed issue.

  128. pollyannacowgirl says:

    I don’t know what the ER is like anywhere else, but the waits have always been LOOOOONG any time I’ve ever gone. The only time I’ve ever had a short wait was when my 2 year old broke her leg and our pediatrician called ahead.

    ER waits have NOTHING to do with insurance.

  129. Trai_Dep says:

    @SkyeBlue: Simple. Get fixed. Then kiss off all your material possessions when you declare bankruptcy. You do know that over half the US bankruptcies are because of medical expenses, right?
    Number of bankruptcies in the EU because of medical expenses? None. Zero. Zed. Zilch.

    Yup, we’ve got the bestest, most superiorist, wonderfulist system in the world!

  130. TechnoDestructo says:

    @bobacus:

    They’ll still have to worry about remaining solvent. I don’t think that would solve all problems.

  131. TechnoDestructo says:

    Also, why does EVERY discussion of health care end up turning to Canada’s system, with the free(hah)-marketroids dismissing the idea of …ANYTHING other than what we have now based on the ALLEGED deficiencies of that system, as though that’s the only one there is.

    THE WORLD IS BIGGER THAN JUST THE US, CANADA, AND MEXICO.

  132. veronykah says:

    @aphexbr: Great point. A few years ago, when I still had insurance, I sliced my hand open while cooking. It was on my palm and really seemed like I should have stiches. I went to the ER, it was Sunday night, and waited NO LESS than 3 hours to get in to see the doctor. Then it was another half hour to actually get the stitches. So for the other poster with the son to claim that socialized healthcare made them wait 3 hours, no ER visits whether you pay or not are usually about 3 hours.

    I also never get the argument against socialized healthcare when it is made by saying you will have to wait ridiculous amounts of time to get care. For people like myself with NO INSURANCE, I will gladly wait weeks or even, god forbid, HOURS for treatment. If my other option is I can’t afford it. Yes, waiting is not a problem. I gladly wait hours everytime I visit Planned Parenthood for birth control and exams and when I lived in NYC I gladly waited weeks for dentist appointments that were from a provider that had a sliding scale fee.[I had insurance then, it didn’t cover dental]
    I’m sure in a socialized environment you could still pay extra if you wanted to get your own special insurance. But to deny those of us who are not covered under any insurance access to healthcare is pretty ridiculous.

  133. TechnoDestructo says:

    @varro:

    Japanese businesses, too. (Although with the rise of the Canadian dollar, I’ll bet Toyota isn’t feeling as good about that decision as they once were)

    Not having some form of national (or even state) health insurance is a competitive disadvantage for the US. How do you like THAT aspect of the free market?

  134. dwcusc says:

    Insurance companies should be fined so extensively for such blatant acts of assigning someone a death sentence that they never do so again. Idiotic.

  135. HogwartsAlum says:

    @TeraGram:
    Why do I find this uproariously funny? :D

  136. clarkbarr says:

    I have plenty of friends in Canada. Not one of them complains about their health care. Not one. BUT, they are just amazed at the costs I pay for my prescriptions and coverage AND my waits with Kaiser for needed care!

  137. pal003 says:

    @aphexbr: “the difference is that if your insurance is cancelled, refused, not accepted at the hospital or just plain non-existent, you’re not left with an unpayable bill.”

    There you go – no huge expense, no hassle, no denial of treatment, no mountains of paperwork and stress.

    Insurance companies in US, HMOs, and some of the AMA are a Big Racketeering Operation that needs to be reined in. Some doctors refuse to treat you unless you get the expensive MRI instead of an xray. No wonders costs in the US are huge.

    It’s shameful how many people in the US are dying or disabled – because they cannot afford to get treatment or medications.

  138. Sanveann says:

    We just got back last month from a trip to the UK to visit my DH’s family. We chatted about about their NHS, and the consensus seemed to be that it’s not perfect, but no one could imagine not having it.

  139. Green Goth Brit Chick - AlternatEve says:

    Don’t know if I’ve pointed this out before, but I live in the UK. The following is an anecdote, take from it what you will.

    I am currently under the care of a psychiatrist, two therapy groups, a neurologist and a gynecologist. Due to compounded health matters, I have had to leave work. All my care is free, and rapid. The only time I have to wait a significant period to see anyone is when I’m under review, which means I’ve been set on a treatment plan, and there needs to be a gap of time before I can be seen again to judge the effects of said treatment.

    I waited no longer than six weeks at the most to have my initial appointment with my specialists. They are not afraid to order tests “to be sure”, to rule things out, rather than rule them in. Yes, I’m still pending diagnosis on one of my problems, but that is because basically, they have NEVER seen anything like it. With the other two issues, I know what is wrong, and how to “fix” it.

    This is all under the NHS.

    Yes, I know it can and does screw up – my mother works for them in a fairly senior position. Hello human error, it happens everywhere. I’m not saying its not terrible, that some of those errors shouldn’t have happened, but I’ll take them over not being able to afford the care I NEED any day.

  140. redkamel says:

    the doco@pal003: yeah, but sometimes you need an MRI and sometimes you need an X-ray, and the doc can always get sued if he doesnt cover himself. You can also go to a different doctor

    in a socialised system the money saved on xray vs MRI might be more than the money lost on wrong vs right diagnosis..so they might be gambling and just do X-rays for everyone.

    Our healthcare system is messed up, and needs to be regulated. What I cant believe is people who lived through the last 8 years of Bush are willing to put their healthcare in the govts hands…rather than in the insurance companies, who will anything for a profit…even the right thing. So pass laws to make healthcare profitable , and denial unprofitable..for example, tax them on actual outcome vs expected outcome for pts, etc etc.

  141. timsgm1418 says:

    @dwcusc: I was talking to my sister today (who works for a health care insurance company) and she said each state has a government agency where people can report ridiculous denials of claims and treatment and the companies are charged fines, all the time, and they are large fines. I would imagine it would be in the blue pages of a paper phone book, I believe she said it was state run

  142. failurate says:

    @bobacus: The problem with the U.S. non-profit systems is they simply turn the profits over to admins and doctors. Or, in order to dump profits, they build, build, and build some more.
    Heaven forbid they lower their damn prices.

  143. failurate says:

    @redkamel: You seem to have missed the part where the insurance companies have failed us miserably and are now just abusive share-holder-pleasin’ profit centers.

  144. SisterHavana says:

    Oh, Aetna. I had insurance and a FSA through them at a previous job. One year I needed to get reimbursements for a few things from the previous year, and it was close to the deadline. Because I didn’t want to risk my claim form getting lost in the mail, I faxed it over. I kept the sheet showing that the fax had gone through. A few weeks later I got a letter from Aetna saying that I’d sent my claim in past the deadline so I wasn’t getting reimbursed. In the same envelope, they sent over a copy of my faxed claim form showing when it had come over on the fax (a few days before the deadline)…and a RECEIVED stamp dated a week AFTER the deadline had passed! Apparently it was my fault that my fax had just sat on someone’s desk for almost two weeks until someone got around to looking at it! Luckily we had a really good HR person at my job – I showed her the letter the next day, she got right on the phone with Aetna…and I got my reimbursement a couple days later.

  145. failurate says:

    @failurate: oops… read twice, then reply. sorry @redkamel

  146. Frank_Castle says:

    Again… pathetic. Just plain pathetic.

    If you can’t afford health insurance, die. If your health insurance won’t cover your medical condition… die. If someone tells you that your procedure is elective, even if you think it’s necessary… die.

    If you really want good health insurance, work for a hospital or an insurance company. If you’re unwilling to do either of these, remove your sorry *ss from consuming my oxygen. If neither of these options work for you… p*ss off. And die.

    And before I get crapped on by all of you… I haven’t had health insurance for 15 years. Any problem that I have had, including a car accident involving jaws-of-life extraction and surgery, was taken care of in the ER, and paid for out of pocket. The rest were “Take an Advil or three, and call a doctor in three months if you’re dying.”

    If you are not able to take care of yourself and your children, quit hogging valuable resources like oxygen and arable land, and die of your own stupidity already. Health care is not a right– pay up, shut up, take what you get and like it, or shuffle off this mortal coil and quit p*ssing and moaning about it.

  147. jamar0303 says:

    @Frank_Castle: Spitting into the wind, I see.

  148. all4jcvette says:

    @MsClear I’m glad we don’t have socialized medical. It’s not the doctor or the hosiptal denying her treatment, but the insurance company. If we had socializied medical, she’d be put on a waiting list, like in Canada, England, and every other bloody country that has their medical industry socialized. Why do you think people with life threating conditions come to America from these other countries? It isn’t because of cost or even quality of care, it’s because by the time their number is called for the operation, they’ll already be dead from their condition.

  149. all4jcvette says:

    @FoneMonkeh: How much did your taxes go up to pay for this new system?

  150. For those complaining about a three-hour wait for a butterfly bandage or ten hour wait in a Canadian ER, try one here in the States. I goddamguarantee that the wait times will be similar. A three-hour wait for a butterfly bandage? How dare they treat more urgent illnesses first!!

  151. zibby says:

    All right, I didn’t cheat and look at the other comments yet – but I’m saying “Thank God we don’t have socialized medicine like in da Europe” was one of the first three. It’s right up there with “This is why I don’t fly”, “Slow news day?” and “I make my own pizza!” as a sure thing on this site.

    Let’s see if I’m right here…

  152. zibby says:

    Dammit! Fourth post. MsClear, please try to be 6 minutes faster next time :(

  153. johnfrombrooklyn says:

    I’d be fine with some type of government health care as long as we could deny benefits to smokers, alcoholics, obese people, motorycycle riders, skateboarders, and people that drive without seat belts.

  154. Bobg says:

    I’m with Aetna HMO. My doctor prescribed a cholesterol drug at 80mg. I went to Wal-Mart to fill the scrip. The pharmacist told that the 40 mg dose was generic at $24 for three months but the 80mg dose was $326 a month (What??????)
    The pharmacist had my doctor write two scrips. Aetna refused to pay saying I didn’t need two pills. It was explained to them why we were doing this but they refused to budge. I paid for the scrip myself; $24 for 3 months supply as opposed to the $978 that Aetna would have had to pay. I know that I should have let Aetna eat the4 higher bill but I just shook my head and called it a day.

  155. chenry says:

    What kind of person do you have to be to evaluate someone like that and decide “nah, we’d rather just let you die”?

    God that makes me sick.

  156. aphexbr says:

    @Bobg: That’s another advantage of the health systems in other countries – lower incentives for people to screw you on price. Each prescription in the UK would cost you £7.10 (around $14). Most pharmacies will sell you a lower priced over-the-counter alternative if one is available rather than fill the prescription. There’s also exemptions from even this charge for children, the elderly, the poor and the unemployed. Drugs can be even cheaper in other countries – I pay roughly half for the gout medicine I take in Spain than I did in the UK and I can get it without a prescription if needed.

    @A few others in this thread who thanked me. Erm, wow thanks, glad to know my comments are appreciated. Just to clarify for anyone else, I’ll repeat – I don’t think that completely socialised medicine is the way to go in the US, nor is it perfectly implemented elsewhere. However, it’s sad to see people on an international forum claiming “communism” and pointing to myths and/or exaggerations as to why a system that favours profits over human life (as per the article) is favourable.

  157. redgreen21 says:

    I live in Canada, and I love our system. Although it does has some problems that need to be addressed (as if anything out there doesn’t) it is much better than the alternative. Every time a serious injury/illness has occurred in either friends or family the health care system was there.
    We don’t pay 60% taxes (a blatant lie, actually ~35%), we don’t wait long times for life saving treatment, we don’t have to deal with HMOs, insurance companies, it is not communism, and it raises the quality of life of everyone in Canada, and as a result we live in one of the top countries in the world, even with the room for improvement. I think the reason it works in Canada is we don’t have a duopoly of governing parties in our political system. There are currently four parties vying for votes (with a fifth moving up) and it makes for a more balanced approach where the average American doesn’t get. I can see with the current administration why they would not have trust in government to run health care.

  158. RvLeshrac says:

    @BluesFan:

    Unless you can’t afford a large legal team, or can’t get the media interested in your story. Then your insurance gets “straightened out” shortly after you’ve lost your home… or your son. The hospital will NOT perform the procedure until you’ve provided proof that you can pay.

    That’s just a fact of a for-profit health care system. The hospital can’t provide free non-emergency care because they’d be out of business in no time flat. Of course, the waters are a little muddier when you realise that an insurance company likely owns your hospital.

    @failurate:

    He is. People spout that crap constantly, but no canucks I know have ever validated it. I spent 6-7 hours in an emergency room with chest pains here. Told one of them about it, and his response was “But don’t you guys have to pay for your health care?”

  159. Marko_Vulvic says:

    Hey,

    I live in Canuckistan and I have *no* problem at all paying higher taxes knowing they go to healthcare and education and infrastructure….. and not murdering foreigners so old white men can continue to bank away blood money for their children.

  160. varro says:

    @FoneMonkeh: Compare your experience with the UK NHS to that in the U.S. – if you seek out treatment for ailments like you did, you become ineligible to get individual health insurance except for a very expensive high-risk policy.

  161. RvLeshrac says:

    @Frank_Castle:

    I blame the consumer a lot… because the consumer is frequently wrong.

    I often write posts stating that the consumer should probably DIAF because, well, they’ve done something stupid.

    But your post there, I don’t think I’ve ever before encountered such a hate-filled pile of BS on this site. You’re saying that she should die because her insurance company refused to cover a procedure that they were supposed to cover? You’re saying that people should die because they’re not super-rich and can’t afford life-saving medical treatments that cost six figures or more?

    —–

    Isn’t there supposed to be a Report button somewhere?

  162. RvLeshrac says:

    @varro:

    Speaking of high-risk, my parents recently had to cancel my mother’s health insurance entirely in favor of a HSA. Insurance for her was topping $500/mo.

    All because she was infected with Hep-C from a bad blood transfusion after I was born. So the medical system ROYALLY screwed up and nearly killed her – but she’s somehow considered responsible for it, and now has to pay for it the rest of her life.

    I will say ONE good thing about the medical industry – the antivirals she was on were provided at a discount through the pharmaceutical company. I still think that they’re (when they’re for-profit corporations) largely hucksters and cheats, but they don’t do EVERYTHING wrong.

  163. heyo says:

    ok, I understand the disdain for insurance companies, but I do believe they are often attacked in the media without fair cause. there was a case in my state that was reported all over the news: employee of a company needed a transplant, company new this and STILL switched insurance providers *knowing* that this provider required a 6 month wait period for all transplants after joining their coverage (something about not wanting people just to switch when they needed something). so the employer made this decision knowingly but the insurance agency gets turned into “the big bad insurer won’t pay to help him!” shouldn’t the media also be looking at the type of options companies offer their employees? sometimes it seems they are equally to blame in offering limited policies to their employees….

  164. RvLeshrac says:

    @heyo:

    If the transplant was covered and had been vetted PRIOR to the switchover, the original insurance provider should be held responsible for the procedure.

    They wouldn’t be, of course, because they don’t actually care about what you’ve paid them for over time, they only care about what you’re paying them for at this minute. The irony, of course, being that they can decline coverage for past (covered) events, even after you’ve cancelled your (future) coverage, though you can’t request payment for past (covered) events when you’re no longer covered by them.

    The crux of the story’s fairness to the insurer would be when the switchover was made, did they cover that?

  165. heyo says:

    @ RvLeshrac: Hmm…this was about a year ago so I am not sure… or at least I don’t remember reading about the past insurer in the news. The reports on it were just totally sensationalized. Yes, our health care system is seriously messed up and needs revamping. Way too many people don’t receive the treatments they need on a regular basis (due to insurance or lack of etc etc) but I am also tired of reading about all these situations where we don’t have all the details (like, as you said, when was the switchover made? did she need a transplant before?)

    I am sure that a lot of times the customer is in the right, but I also think that there are other times when the insurers just cave to keep the press positive, regardless of their policy. after all, you can’t simply say to a reporter “well, our policy that the sick person or their employer signed says xyz, so we aren’t responsible” when someone is about to lose a family member/friend. you know?

  166. RvLeshrac says:

    @heyo:

    The problem is precisely the number of stories you DON’T hear about on the news. The number of “unfair” cases hasn’t even placed a dent in the insurers’ bottom lines, so I’m perfectly fine with the “unfair” cases being processed if it means they’ll take more care with what they do and don’t cover.

    A dozen “unfair” stories about the insurance company doesn’t justify even a single death due to the inability to obtain a necessary medical prodcedure. I understand what you’re saying, but the penalties for the insurers are infinitely lower than those for the insured.

  167. HeartBurnKid, creepy morbid freak says:

    @emilayohead: You’ve never been to an ER in the US, have you? Having been in a California ER several times, I’d KILL for a three-hour wait for a non-life-threatening problem (which, let’s face it, your son’s cut chin is). Average wait in my area is closer to 4-6 hours.