Never should have created a privately owned healthcare system in the first place. Medical needs are not something to make money off of. All you end up with is what we have now: insurance companies that will do everything in their power to avoid paying out, while increasing costs continuously to make the most profit possible. Not the types you want in control of your life, or your family's well being.

So, who should decide what treatments are "medically necessary?" Somewhere, somehow, there needs to be someone in the system who says "no, we won't pay for that." It doesn't matter if it's a publicly funded, privately funded, single payer, whatever. In any health care system, some people aren't going to get all the services they may want/need.

Also, I hate to nit-pick, but this article does come from a website owned and operated by personal-injury attorneys. Doesn't mean the facts are wrong, but it might be a good idea to highlight that - the author is anything but an unbiased observer.

@Saboth: It's sad when I hear idiots claim that health care is a privilege. Every other first world country has a UHC system in place and most of them are better run, more efficent and cheaper than the current options. The Republicans poisoned the well so much that even the Democrats are proposing the same do-nothing plans the Republicans have.

@Saboth: But, but, do you want a Washington bureaucrat making medical decisions for you?

Oh wait, we already have those and they have 10x more incentive to deny you than a government worker.

My daughter has Angelman Syndrome, and I'll be damned if our insurance company deny a god d*mn thing for her. She is on a special formula called elecare, we have to get "prior approvals" for all the time to get insurance to cover. ($1,000 for a months supply)

In the upcoming years, she'll need special communication devices, probably adaptive equipment and such. I'll drive my ass to headquarters if they start denying things- if you've never seen a bat shit crazy mom, its not pretty.

@Saboth: So if you don't want the private insurance companies making these decisions, it leaves you with one of two options: pay for it out of pocket (like we did twenty/thirty years ago) or opt for government control.

But they'll still say the same things to limit costs. Do you really think that a government system is just going to open the floodgates and approve everything? Go look at Canada, England, Scandinavia and see how many of them have just unlimited health care.

Funny how Consumerist didn't mention the fact that Canada couldn't find a neonatal intensive care unit (NICU) is the entire province of Quebec, so they sent, and paid, for a room in the US. [news.bbc.co.uk]

So I guess the question is: either pay out of pocket or accept that some company, whether it is private or government-sponsored, is going to limit the care you can consume.

This is typical of insurance companies in general. Parents should be able to get the equipment needed for special need children with no exceptions. And the insurance companies that are negligent should be put out of business. I for one would like to see the health providers prosecuted for negligence.

My son has Autism, I haven't been able to find one private insurer that will cover him for the therapies his condition requires. Luckily, I've been broke enough to qualify for CHIP (participation based on income), however, that always leaves me with the difficult choice of making enough money to provide us with a good life style and my son's recovery. Out of pocket expenses for speech and occupational therapy would run me almost $1200 a month so paying out of pocket is not an option for my skill level (I'm not qualified enough for a position that would pay another $1200 a month over my current earnings. Enough to disqualify him from recieving CHIP, but not enough to close the gap between what I make and what medical care costs.) I've decided that a vow of poverty is the better option. I'm going back to school so I can hopefully break out of this, but it does illustrate how the lack of covereage for special needs children in the private insurance market drives up goverment health care costs. Many children default to programs like CHIP because there is no other option for parents. I'm sure that shortly someone will post a comment about how the rest of insurance customers shouldn't be burdened with the cost of care special needs children because they are such a resource consuming small population, BUT regardless everybody bares the cost either in the form of higher premiums or higher taxes. Even if a child is not treated the system will absorb the cost as those children that would have otherwise gown to be self sufficient adults fail to thrive for lack of intervention and end up in state run facilities once the parents pass on.

Don't most states give special needs parents money to help with medical expenses. My ex's brother had ceribal palsy and I am almost certain they got a check from the state each month.

@JamieSueAustin: Huh. That could have used a little tender love and care from the return key, eh?

Like the government would be any better.

Well, somebody has to be the jerk here, but I actually have to side with the insurance companies. They are "health" insurance, not "take care of every physical and emotional want you may ever have in your life" insurance. You pay them to cover your medical bills. They need to cover you for things to keep you alive and healthy. If you have some kind of disability that affects your quality of life, but doesn't affect your physical well-being directly, then I agree the health insurance companies shouldn't have to pay for it.

That said, of course there should be some system in place to provide assistance to those that can't afford it. *This* is where the government programs can come in. Keep basic health insurance private, keep the public assistance programs, um, public.

@Saboth: If you remove the incentive to profit off of medicine, you remove much of the incentive to develop new cures and breakthroughs. So which is better; giving all American's access to the treatments we have now at the expense of limiting new cures available for our children, or letting the pursuit of profits drive new medical breakthroughs thus allowing our children to benefit from cutting edge treatments yet to be developed? I think the former is much more selfish then the profits you denounce.

@I Love New Jersey: They might well be.

@NeverLetMeDown: While this is true, the incentives are different for different systems. Insurance companies make more profit the more healthcare they can deny. I'm not convinced that is a reasonable way to keep costs down, and it's certainly not working.

Let me fill you in a bit on services for children with special needs. 99 percent of insurance companies will not pay for anything that they consider to be "developmental" or "habilitative". They will more often pay for rehabilitative. So, for example if you have a child with a significant language delay (3 years old and not talking) if the child is diagnosed with a receptive/expressive language delay (which is the most common diagnosis in kids this age) the private insurance company will not pay for it as it is "developmental". If by chance the child is diagnosed as having apraxia the odds of payment increase substantially as this is a neurological diagnosis and not a developmental diagnosis. The result to the child's language is the same but the diagnosis is different.

Now if that child is eligible for Medicaid (income based) they will be able to get speech therapy services for either diagnosis with little to no out of pocket cost to the family. If they are not eligible for Medicaid the state that they live in should be able to provide some services but keep in mind that those services are provided on a sliding fee basis.

Years of research has shown that early intervention is the key, unfortunately no one wants to pay for it.

@David Eckert: Why would you WANT to keep health insurance private, when it's proven that that increases costs for us all?

In a way, I agree. I just think that for-profit insurance is the wrong model to pay for healthcare. But I mainly blame society for making that the only way to get affordable healthcare more than I blame the insurance companies for trying to make a profit. Although there are a lot of unethical and illegal practices that are common at health insurers, and they DO routinely deny even care that is perfectly medically reasonable. So it's important for us to heavily regulate them if we're going to allow them to exist.

@HIV 2 Elway: IF they qualify for disability. Not all special-needs kids (or adults) will necessarily qualify for disability, and there's a rather long application and confirmation process for most applicants.

@NeverLetMeDown: It's true that not everyone will get everything they ask for, but you're speaking like everyone who wants these special services are asking for something excessive. I don't think asking for a wheelchair for a child with no use of his arms or legs is excessive, but I've personally seen a case where the insurance company denied the claim because it wasn't medically necessary. They were more than willing, however, to pay for the treatment required when this child got bedsores and other related injuries from being bedridden.

@Tux the Penguin: I don't think people are suggesting that it would be unlimited. I think we're suggesting that a payment system that has resulted in better health, lower infant mortality, and greater longevity in dozens of countries is more beneficial overall than the one we've got now.

Even in countries with Government run health care. Their is a limit to what is covered and what's not. I'll have to do some more research, but from what I've read about many cases where something denied by an insurance company wouldn't be covered in Canada or England either.

If done correctly Government run care is better then private, but has limits as well.

I think we should consider insurance co-ops more than the usual private vs public. They drive down costs and are competitive options.

@HIV 2 Elway: That's a straw man, though, since no system gives everybody access to everything. What we've got is a system that's more expensive and less effective than most industriaized countries', with the added benefit, courtesy ERISA, that huge numbers of people have no legal recourse for malfeasance, let alone bad policy.

@floraposte: On the topic of greater longevity. How much of the longer European life expectancy is due to having cities that are walking friendly? All the health care in the world doesn't change the fact that I need to drive to get where I need to go around my city.
Do Europeans live longer because they have better health care or because they live healthy lives on their own?

@David Eckert:

That's the major problem. We don't need health insurance. We need health care. Get the insurance companies out of the mix and we'd all be a lot better off.

@johnva: Why WOULDN'T you want to keep healthcare insurance private? Look at how many complaints and stories there are here at Consumerist. Most of them are about monopoly companies: Comcast, Verizon, local utilities, etc. No competition = lousy business practice, and the government is no exception. Sure, at the beginning, it might be great. But in a decade or two, it's going to fall apart. Britain has UHS: how many Brits rave about how awesome it is? I don't see many.

Sure, they might need some regulation, but having one central provider is the sure road to disaster.

@bibliophibian: If they are under 18 you aren't allowed to make much to get the assistance. I think it's about 35K in PA.

@hypochondriac: "If done correctly Government run care is better then private, but has limits as well."

That's a fairly objective statement. You have evidence to back that up, I assume?

@I Love New Jersey: Unfortunately you live in NJ. I've heard it's difficult there. Speaking from experience, PA has been wonderful. I have private insurance, but what they don't pick up is picked up by the state. That's not to say that every experimental procedure is approved, but we don't have any problems with whatever we can get a script for. The biggest problem we encountered was finding a provider for the services. There just aren't enough out there for all of the kids that need help.

@Blackadar: And l'd like 100 ponies with gold saddles. How are we going to pay for that?

You're right, a lot of people don't want to pay for developmental care...including the parents of the kids who have the problems, that's why they want insurance to pay for it. Unfortunately kids don't come with extended warranties.

@David Eckert: So what if the "quality of life" disability is due to some underlying physical disability? How do you know without testing? For many of these issues there aren't even good tests to prove anything one way or the other, it's just process of elimination.

@verucalise-T minus 22 days!: Most likely at the time where it gets really expenive, they'll retroactively cancel your policy because you put an X in a form that said you needed to put a checkmark.

@Saboth: I'm not entirely opposed to (more) public health care.

However, when I ask "how much will it cost?" and "how will it be paid for?", few will answer the first question (the CBO did but the current administration didn't like the answer) and no one will answer the second.

@HIV 2 Elway: It's not just Europe or small countries, though, as witness Canada kicking our longevity ass.

@I Love New Jersey: Yes, if you underfund, understaff, staff it with incompetent people and generally treat it like cr*p. A certain political party actively does that, declares them a failure and then tries to privatize it. Tell me, how bad is the police department or fire department? They do a pretty good job because that's one of the few areas that politicians know they can't mess with. Also, people complain about the post office. How much does it cost to send a letter across the country using UPS and FedEx? How much better is their service?

@David Eckert: People will always bitch about the flaws in the system they have to deal with, and heaven knows the NHS isn't perfect. But those complaining aren't suggesting the system should be privatized, and the objective measures indicate that it's better at keeping citizens healthy than our system.

@Tux the Penguin: There was a report on CNN last night. US was 1st in spending $8000+/person, more then double number 2. World Health Orginization has US ranked 37th in quality of care. You're trying to say that something isn't broken?

One case don't make a rule, read the article: 'One in 13 million' If something doesn't change we'll be in the same situation here. People can't afford to pay for health care and malpractice insurance is so expensive that nobody wants to provide it.

@floraposte: Its just something that needs to be considered before we declare universal health care to be some panacea. Access to health care won't magically make American's healthier. We still need to collectively get off our asses and start taking care of our health on our own.

@lvhotrain: EDIT: The parents pay is capped for benefits.

@David Eckert: As the mother of a child that was developmentally delayed and had a heart defect, our only option was paying $1200/month with BCBS (who, in Michigan, cannot deny coverage) I really had no options.
Considering that most states have 1-2 major health insurance conglomerates, where is the competition? Perhaps your should read the results of this AMA-sponsored study ([www.ama-assn.org])on health insurance monopolies and then get back to me on the "competition" that exists today.
Here's a bit of what they concluded:
"Health insurers claim that eliminating rivals through mergers creates greater efficiency and lower health care costs, but this just isn't the case. Patient premiums, deductibles and co-payments have soared in this increasingly consolidated market, without an increase in benefits," said Dr. Rohack. "The AMA urges federal and state agencies to enforce antitrust laws that prohibit harmful mergers and restore a competitive balance to health insurance markets."

@AllanG54: Allan that's a remarkably callous and short sighted opinion. Do you have any idea the cost involved in these therapies? I can't quote the hourly rate throughout the country but in N.C. the rate for physical therapy, occupational therapy, speech therapy and special instruction are between 75 and 100 dollars per visit. These therapies are often recommended twice a week. Lots of families with young children don't have an extra 200-800 dollar a week lying around. Not to mention the fact that often these children have underlying issues that make having both parents work very difficult.

Before you make snide comments you might want to think it through.

@sonneillon: Can you cite something to back up that statement? I'd be interested in reading about it.

@ARP: They are private providers and services though, not government run. There aren't enough no matter where you go.

This happened to me when I was a child.. My doctor wanted me to get foot/ankle braces and our insurance company said that they would not pay for it because... I was not diabetic! My mom couldn't believe that they said that and she fought with them for months, and they finnally agreed to pay for them.

I still wear braces today and I couldn't walk in public (IE. while wearing shoes) without them.

I don't see what diabetic has to do with any of it.. but it just goes to show how stupid this companies can be.

@David Eckert: Health insurance practically is a monopoly. If you get it through your job, you ussually only have 1 choice. If you have to get it yourself, you still don't have many choices. There are established industry standards saying what they will pay and will deny.

@HIV 2 Elway:

As for Europeans...not only do they have different diets and walk a LOT more...but they also aren't worked to death. Despite our advances in leisure time, Americans work harder and longer now than ever before, with little to no vacation time (even when you do have vacation, you are so overworked you don't want to take it, because it means more work when you get back). Compare this to Europe where people get 4-6 weeks of vacation a year, and work shorter hours, for comparable pay. They have better mental and physical health due to not being overworked like mules.

@AllanG54: Can you back up that ridiculous statement?! You obviously know nothing about raising a special needs child and the outrageous costs that go with the job.
Mean people suck.

@Saboth: I agree. Knowing that, where is the reform really needed? I'm not sold that health care for all is best solution.