[O/E] Five freedoms you would lose under Obamacare

[Serafina]

What a load of shit. Triage dictates who see's whom in an emergency situation.

Did I even mention emergency situations? Thank you for putting words in my mouth.

Triage is not limited to emergency situations. It is about giving care to those who need it first, then to the second most-important and so on.
Doctors have only limited time. So, they treat critical patients first, and then those with non-critical conditions. It's very simple, but you apparently do not get it.

To be fair, Canada and Britain are overly used as examples of why a single payer system leads to long waits, but, other countries, like Germany, of course don't necessarily have that problem.

You know, i live in Germany. We have socialised health care. I never had any waiting time that caused me considerable grief in any way. Nor had anyone in my family. Nor do i know anyone who had to wait too long for treatment.
Sure, there are waiting times - e.g. , i had a pharyngeal tonsil removal, and had to wait about three months.
My sister had nearly the same condition, but in a more critical state - she had to wait three days, which were used to make addtional checkups.[/quote]

Do you see how that doesn't answer the question? In order for any Single Payer system to work, there has to be some point at which treatment is denied because it is too expensive. For every cure, their is a cost.

Some insurance policies in the US cover treatments that are denied to people in other countries where they are thought too expensive. What is the premium Americans pay due to this? Or does it not exist?

'Treatment' isn't some all encompassing words. There are degrees of treatment and in some countries more is available than in others and the quality varies

Why? Of course it can not possibly cover EVERYTHING, but whats wrong with denying non-necessary treatments?
I do not know of a single life-threathening treatment that the german health care system denies to treat because it is too expensive. Sure, there are some things that are denied, but those are mostly minor things (say, randomly happening minor pain attacks). And those are denied because it is not clear that there IS a treatment.
To name an expample: Acupuncture was not covered for a long time, because it was not considererd an effective treatment. They were wrong, but that happens - no one is perfect. It is covered now, because it is a proven treatment.

That's nonsense. Regardless of your personal family history, insurance works on the grand scale. If we separated the population into two groups, the people who ate healthy foods and the people who ate unhealthy foods and then compared the groups you would find that while both groups had heart disease one group had a significantly reduced risk.

Reasonably, there should be some relationship between the risk you produce and the costs to you. While discriminating against someone for being a man in the case of car insurance is wrong (since they can't change being a man) in the same way it's wrong to discriminate against someone with a pre-existing condition, it's just to discriminate someone who's been in an accident (in the case of car insurance) in the same way it's just to charge higher health insurance premiums to a smoker.

So, you say its fair that someone has to pay very huge sums of money just because he has the wrong genetics?
There are a lot of diseases that are triggered by genetics - you want to discriminate against those people?

[PeZook]

Why do these people keep assuming that minimum coverage standards mean that they won't be able to pay more to get their insurance policy upgraded?

Because right now in the US virtually no one can afford to "upgrade" from whatever slop their employer gives them right now - therefore, the concept of buying additional insurance over and above "basic" is quite simply inconveicable to the average American. Telling them they can "upgrade" their health insurance on their own is like telling them they can buy a Lear jet on their own to go with their car.

Right, but these people don't complain about wait times, because they'll most likely gladly wait a few weeks for surgery in exchange for not going bankrupt.

People who complain seem to be mostly wealthy fuckers who already have good insurance, already pay large sums for it (themselves or through their employer), enjoy better service thanks to that, and complain...about what? That the poor souls will be able to buy insurance with a minimum standard of care? The bill that doesn't actually ban premium insurance in any way?

[Broomstick]

What a load of shit. Triage dictates who see's whom in an emergency situation.

Did I even mention emergency situations? Thank you for putting words in my mouth.

Triage has been extended to apply to ANY medical situation where resources are limited. Even non-emergencies are seen in the emergency room, typically in the order of severity of complaint.

'Wait time' is a very general term. In the United States, access to MRI's(and other kinds of expensive medical equipment) and certain kinds of emergency treatment are much much faster than in other countries (excluding Germany, which has the shortest wait times in general).

Arguably, there are too many very expensive machines like MRI's in the US, which has lead to over utilization. It is wasteful to use an MRI on every sprained ankle because the vast majority of sprained ankles don't require such an expensive test to diagnose and treat. CAT scans are over utilized to the point where there are documented cases of actual, real harm stemming from too many of them in too short a time period. "More tests" is not necessarily better medicine. "More expensive" tests are not inherently better.

Of course people always have to wait, but difference between surgery next week and next month can be very significant. Certainly it also cuts down on wait times since the US has more specialists than most countries per capita but also less people per capita seeking treatment because they don't have insurance.

WTF? The US has 46 million without health insurance, more than the entire population of many countries! And you say this is a good thing? How?

Do you see how that doesn't answer the question? In order for any Single Payer system to work, there has to be some point at which treatment is denied because it is too expensive.

As opposed to our current system, where if you don't have insurance, or enough insurance, you just don't get treated period. Try getting an organ transplant without insurance. Good luck! Of course, you'll die without that new heart or liver, but whatever...

Some insurance policies in the US cover treatments that are denied to people in other countries where they are thought too expensive. What is the premium Americans pay due to this? Or does it not exist?

And yet... if I recall correctly, Serafina is getting full coverage for treatment from her government health insurance, whereas NO American insurance company will cover treatment for that condition at any price. This has bummed out Marina (Duchess of Zeon) considerably. I have to wonder if she's contemplating moving to Germany instead of France.... This notion that somehow you can get coverage for everything in the US whereas all but the most minimal is denied elsewhere is manifest bullshit.

'Treatment' isn't some all encompassing words. There are degrees of treatment and in some countries more is available than in others and the quality varies.

Yes. Like how in the US my Other Half went nearly a year without a particular medical test regarded as standard treatment for diabetes in every civilized country as well as the US because he had no insurance and lack the money to pay up front. Uh, yeah, that's a variation in quality!

Personally I wouldn't trust someone with my life unless they had some references and at the very least looked up what medical school they went to.

What makes you qualified to judge the quality of a medical school? Is there an appreciable difference between the top of the class at, say, the University of Buffalo vs. the bottom of the class from Harvard Medical School, or vice versa, or any way for you to know the doctor's class standing?

If you're airlifted into an ER after a bad traffic accident are you going to insist on researching the trauma doctor prior to letting him touch you?

And you're analysis is a poor one since you didn't even deduct the payment contribution from the employer among my other mild criticisms.

Not all of us have an "employer contribution" in our health insurance costs. I sure as hell don't.

I just find it very frustrating when people just gloss over little details while ignoring huge differences in culture and outcomes.

Translation: America is different! Nevermind that it works everywhere else in the world, America is different so it won't work here!

(Because Americans are really fucked in the head on the issue, mostly.)

It also plays into the assumptions that by 'living right" one can truly avoid chronic health problems. You know, my mom exercised daily (until she was physically no longer able to) and ate right - but she still had debilitating heart disease. Why? It was genetic - she was going to have heart disease no matter what she did. So, while pursuing a "healthy lifestyle" might have benefits for her, it did jack to keep her medical costs cheap. I have a sister who inherited the same condition. She is fanatical about exercise, healthy eating, taking her medications.... she still has heart disease. Granted, it's not as bad as mom's was at her age, not nearly so, but she's already cost money and there wasn't a damn thing she could do to prevent it. So this is just another way of saying "the sick/chronically ill must have done something wrong and deserve to be sick" just as so many conservatards think the poor deserve to be poor and should be punished for lack of money.

That's nonsense. Regardless of your personal family history, insurance works on the grand scale. If we separated the population into two groups, the people who ate healthy foods and the people who ate unhealthy foods and then compared the groups you would find that while both groups had heart disease one group had a significantly reduced risk.

It's bullshit - my mother would have had cardiac problems no matter what she did. In fact, most people with her condition die in their mid-40's. Some die in their teens from it. That's why insurance companies look a hell of a lot farther than just what you eat. That's why they want to exclude anyone who carries that particular gene regardless of what they eat.

Reasonably, there should be some relationship between the risk you produce and the costs to you. While discriminating against someone for being a man in the case of car insurance is wrong (since they can't change being a man)

Um... actually there is surgery available today that can do that, at least from a physical standpoint...

Men can not change being men, but they CAN change their behavior. That is why older, more experienced male drivers have a lower accident rate than younger, inexperienced male drivers. I remember a number of FAA seminars where, upon pointing out that female pilots have a lower accident rate than male pilots, the men in the room were urged to "fly more like women". Yes, it generated some chuckles, but it's also generating some behavior changes, too.

Saying "men can't help it" in regards to auto accidents is like saying "smokers can't help it" in regards to nicotine addiction. Yes, change is difficult, but it most certainly can be done and has been done by many.

[bdh]

Triage is not limited to emergency situations. It is about giving care to those who need it first, then to the second most-important and so on.
Doctors have only limited time. So, they treat critical patients first, and then those with non-critical conditions. It's very simple, but you apparently do not get it.

I'm not arguing against it by any means.

You know, i live in Germany. We have socialised health care. I never had any waiting time that caused me considerable grief in any way. Nor had anyone in my family. Nor do i know anyone who had to wait too long for treatment.
Sure, there are waiting times - e.g. , i had a pharyngeal tonsil removal, and had to wait about three months.
My sister had nearly the same condition, but in a more critical state - she had to wait three days, which were used to make addtional checkups.

I know, germany's a good example, though I'm surprised it took you so long for treatment.

Why? Of course it can not possibly cover EVERYTHING, but whats wrong with denying non-necessary treatments?
I do not know of a single life-threathening treatment that the german health care system denies to treat because it is too expensive. Sure, there are some things that are denied, but those are mostly minor things (say, randomly happening minor pain attacks). And those are denied because it is not clear that there IS a treatment.
To name an expample: Acupuncture was not covered for a long time, because it was not considererd an effective treatment. They were wrong, but that happens - no one is perfect. It is covered now, because it is a proven treatment.

There's nothing wrong with not covering non-essential treatment. I don't disagree.

I can't speak for germany, but I do know that in Britain a governmental organization essentially puts a cap on the value of a treatment versus it's life saving benefits, in, which case, the treatment is not used and people die. It's an unfortunate reality but necessary. Ironically though, it does lead to some highly expensive drugs being sold at reduced prices in there because they would not be covered otherwise. It just goes to show how much economic rent can be extracted in the US.

Nevertheless, I wouldn't be surprised if there was a similiar system set up in germany where some highly expensive treatments are not available, but I could be wrong.

So, you say its fair that someone has to pay very huge sums of money just because he has the wrong genetics?
There are a lot of diseases that are triggered by genetics - you want to discriminate against those people?

Genetics would qualify as a pre-existing condition, much like being a man in the case of auto-insurance.

Behaviors, however, ought to have a price or benefit associated with them.

A few facts of life:
1) Everybody dies in the end. Sooner or later, you'll either need health care, or you'll be dead.

2) Nobody has perfect genes.

In other words, we're all "sick" or we all have some form of "pre-existing condition" in that eventually we'll have some disease or syndrome develop, or we'll get in an accident, or both. All of us. So all of us are 100% "at risk".

Ridiculous. If I immediately die in a car accident than there is ZERO risk because there is no medical cost associated with my death.

OK, let's immediately ban cars, french fries, step-stools, alcohol, firearms, knives, chain saws, bathroom floor tile, and everything else in life. Particuarly home hazards like step-stools and bathroom floor tile since, after all, most accidents happen in the home, right? Or did you mean some other form of risk, such as one you don't personally engage in or approve of?

First, I didn't say ban, I said charge a premium.

Secondly, rooting out some things would cost more money than could be gained for by any premium charged, so it's not practical.

Reasonably then, we should only charge premiums on the low hanging fruit so we can get the most money out of it and provided a disincentive to the most obviously and cheaply prevent destructive behaviors.

I'm not talking about right and wrong, just profitability.

I can quantify is as "delusional". ALL doctors make errors. Most of them are caught before damage is done (as an example, pharmacists double-check prescriptions to make sure they make sense and don't conflict with other medications) but ALL doctors make errors. Anyone who believes otherwise is foolish at best.

What part of the words, 'less likely to make a mistake,' means 'never ever ever ever ever makes a mistake?'

All doctors make mistakes, but some doctors make less mistakes than others. Anyone who believes otherwise is a fool at best.

[bdh]

It's bullshit - my mother would have had cardiac problems no matter what she did. In fact, most people with her condition die in their mid-40's. Some die in their teens from it. That's why insurance companies look a hell of a lot farther than just what you eat. That's why they want to exclude anyone who carries that particular gene regardless of what they eat.

And I think that's wrong. I'm sorry they're trying to exclude her.

What makes you qualified to judge the quality of a medical school? Is there an appreciable difference between the top of the class at, say, the University of Buffalo vs. the bottom of the class from Harvard Medical School, or vice versa, or any way for you to know the doctor's class standing?

I can't judge the quality of the school, but, if there is a selection bias in the school, I can believe that a average student at Harvard is better than the average at the University of Buffalo.

Can I make distinctions about whether they are at the top of the class or the bottom of the class? No, I cannot.

BUT, if I know that harvard is better than Buffalo, and I take my 'expected' doctor from both schools (I.E., the average) I could reasonably presume that Harvard doctor is better than the Buffalo doctor. It's a simple game of imperfect information.

[Serafina]

I know, germany's a good example, though I'm surprised it took you so long for treatment.

As i already said: It was completly non-critical. They only removed it because it was likely to cause damage in the future, no because there was any imminent danger. Heck, they could have waited till today (about 16 years later) without any problems.

There's nothing wrong with not covering non-essential treatment. I don't disagree.

I can't speak for germany, but I do know that in Britain a governmental organization essentially puts a cap on the value of a treatment versus it's life saving benefits, in, which case, the treatment is not used and people die. It's an unfortunate reality but necessary. Ironically though, it does lead to some highly expensive drugs being sold at reduced prices in there because they would not be covered otherwise. It just goes to show how much economic rent can be extracted in the US.

Nevertheless, I wouldn't be surprised if there was a similiar system set up in germany where some highly expensive treatments are not available, but I could be wrong.

As i already said: Some treatments are not avaiable because they are largely untested.
It works like this: Someone has *superspecialraredisease* - and there is no treatment. Wait, there is a single doctor somewhere in the US (or whereever) who has *superspecialawesometreatment* - but has only operated a dozen patients so far, and wants a shitload of money.
In these cases, yes, treatment is often denied.
But i NEVER heard of a case where there is a established treatment where treatment was denied - no matter how expensive.

So, you say its fair that someone has to pay very huge sums of money just because he has the wrong genetics?
There are a lot of diseases that are triggered by genetics - you want to discriminate against those people?

Genetics would qualify as a pre-existing condition, much like being a man in the case of auto-insurance.

Behaviors, however, ought to have a price or benefit associated with them.

And yet... if I recall correctly, Serafina is getting full coverage for treatment from her government health insurance, whereas NO American insurance company will cover treatment for that condition at any price. This has bummed out Marina (Duchess of Zeon) considerably. I have to wonder if she's contemplating moving to Germany instead of France.... This notion that somehow you can get coverage for everything in the US whereas all but the most minimal is denied elsewhere is manifest bullshit.

You recall correctly. Oh, and IIRC, it's covered in France, too. And Austria. And Italy. But NOT in Switzerland.

[Broomstick]

You know, i live in Germany. We have socialised health care. I never had any waiting time that caused me considerable grief in any way. Nor had anyone in my family. Nor do i know anyone who had to wait too long for treatment.
Sure, there are waiting times - e.g. , i had a pharyngeal tonsil removal, and had to wait about three months.
My sister had nearly the same condition, but in a more critical state - she had to wait three days, which were used to make addtional checkups.

I know, germany's a good example, though I'm surprised it took you so long for treatment.

That's probably because you (I presume) live in the US where every illness is treated as urgent (unless you have no insurance, in which case you're told to STFU and go home until you're actually dying). Bad tonsil is not an emergency. It doesn't require urgent care. Most cases are safe waiting for months with appropriate monitoring. Much like Mike's hernia, which also wasn't urgent but was monitored while he waited his turn.

Really, a lot of this comes down to "wait your turn" which, judging from what I've seen over the past 40+ years, Americans are shitty at from pre-school through old age.

So, you say its fair that someone has to pay very huge sums of money just because he has the wrong genetics?
There are a lot of diseases that are triggered by genetics - you want to discriminate against those people?

Genetics would qualify as a pre-existing condition, much like being a man in the case of auto-insurance.

But behavior modifies genetics. Men can learn to drive in a safer manner. Someone prone to diabetes can change their diet and exercise to avoid or reduce the odds. Those with pale skin can use sunscreen and avoid tanning beds in order to reduce their chances of skin cancer.

Arguably, someone who knows they have a genetic susceptibility should change their behavior if that would be beneficial. Of course, that's not always possible.

Ridiculous. If I immediately die in a car accident than there is ZERO risk because there is no medical cost associated with my death.

You think the coroner who does your autopsy doesn't get paid? Don't you think autopsy is a medical procedure?

I'm not talking about right and wrong, just profitability.

Then we'll continue to disagree at times, because for me this whole issue is a matter of ethics and morality, that is "right and wrong".

It's bullshit - my mother would have had cardiac problems no matter what she did. In fact, most people with her condition die in their mid-40's. Some die in their teens from it. That's why insurance companies look a hell of a lot farther than just what you eat. That's why they want to exclude anyone who carries that particular gene regardless of what they eat.

And I think that's wrong. I'm sorry they're trying to exclude her.

Well, not anymore - she's dead now so it's a moot point.

What makes you qualified to judge the quality of a medical school? Is there an appreciable difference between the top of the class at, say, the University of Buffalo vs. the bottom of the class from Harvard Medical School, or vice versa, or any way for you to know the doctor's class standing?

I can't judge the quality of the school, but, if there is a selection bias in the school, I can believe that a average student at Harvard is better than the average at the University of Buffalo.

On what do you base that assessment? Do you have any actual proof of that belief, or is it based just on the fact overall Harvard has a stellar reputation so you assume ANY student at Harvard in ANY subject is naturally superior?

Are you even aware that different medical schools have different reputations by specialty? Harvard might be wonderful for, say, training oncologists but if you want a top notch pediatric cardiologist you might want to go to Pennsylvania and the best trauma training might be in Detroit or Chicago or LA.

My former college roommate is a doctor. My sister is an MD. I certainly don't feel qualified to make judgments like that, and I'm pretty sure my sister would think choosing a doctor based on their medical school is a pretty fucking hilarious concept - where they did their residency is MUCH more significant.

BUT, if I know that harvard is better than Buffalo, and I take my 'expected' doctor from both schools (I.E., the average) I could reasonably presume that Harvard doctor is better than the Buffalo doctor. It's a simple game of imperfect information.

It's also based on false premises. Namely, that Harvard is better than Buffalo without proof to back it up, and the medical school is the most important part of a doctor's training.

So - are you a troll or just a garden variety moron who has swallow the conservatard Kool-Aid?

[Broomstick]

Oh, about "waiting for treatment" - not everything requires treatment. Really, the US has an obsession with perfection, which leads to stuff like braces even for minimally misaligned teeth that cause no functional and often no cosmetic problems.

As an example - I have had a small lump on one of my hips for about 30 years. I was kicked across a corral by a horse and the result was something like "cauliflower ear" where the resulting bruise/damage formed into a lump, just on my hip instead of my ear. Now, I have had in the past medical insurance that would have covered its removal. Yet I never had it done. Why? Because there is no need to do anything. Like Serafina's tonsil, there might be a problem in the future (though in the case of my hip lump it is unlikely)... but there might not. Not everyone goes skipping to the doctor or surgeon even when treatment is justified because in many cases there really is no harm in letting the patient choose to undergo some sort of treatment or to let the condition alone. It's not all about Dire Emergencies, you know?

So... am I waiting for treatment for a lump on my hip, am I ignoring a medical condition, or am I deciding that the benefit of eliminating a lump is not great enough to balance the pain and discomfort of a minor operation?

Likewise, although breast reconstruction is mandated for women in most (if not all) US states, not all women choose to have their breasts reconstructed. Some just don't want any more surgery. Some don't see it as an issue. Some are concerned with the risks of reconstructive surgery. Even when a procedure is available that doesn't mean everyone will be going out to spend the maximum money, even if it's not their money. I don't know anyone who gets medical shit done for kicks. Probably there are a few, humans are so inventive when it comes to mental dysfunctions, but they are very much a minority.

[bdh]

But behavior modifies genetics. Men can learn to drive in a safer manner. Someone prone to diabetes can change their diet and exercise to avoid or reduce the odds. Those with pale skin can use sunscreen and avoid tanning beds in order to reduce their chances of skin cancer.

Arguably, someone who knows they have a genetic susceptibility should change their behavior if that would be beneficial. Of course, that's not always possible.

We should always strive to reduce risks wherever possible, but we can't always regulate behavior completely so we should look for the low hanging fruit like smoking.

Should we use genetics to help people know the risks, yes. Should we use genetics to exclude treatment, no.

You think the coroner who does your autopsy doesn't get paid? Don't you think autopsy is a medical procedure?

Witty. I'll concede that minor point.

Then we'll continue to disagree at times, because for me this whole issue is a matter of ethics and morality, that is "right and wrong".

In order to maximize the benefit to society, we have to balance the benefits with the costs.

Health care isn't an absolute right. There will always be limits on treatment.

On what do you base that assessment? Do you have any actual proof of that belief, or is it based just on the fact overall Harvard has a stellar reputation so you assume ANY student at Harvard in ANY subject is naturally superior?

Are you even aware that different medical schools have different reputations by specialty? Harvard might be wonderful for, say, training oncologists but if you want a top notch pediatric cardiologist you might want to go to Pennsylvania and the best trauma training might be in Detroit or Chicago or LA.

My former college roommate is a doctor. My sister is an MD. I certainly don't feel qualified to make judgments like that, and I'm pretty sure my sister would think choosing a doctor based on their medical school is a pretty fucking hilarious concept - where they did their residency is MUCH more significant.

You're funny.

Here, take these limited facts and try and pick the better doctor. BUT WAIT, thats not how you should pick your doctor.
I'm not an idiot. There's more to this than the fucking MCAT.

I'm sorry, I probably shouldn't have given such a simple answer. In all truth, if your life is on the line, individuals ought to pursue the best care they can and factors like the doctor's reputation and education come into play. Albeit, there do exists means of vetting one's doctor, even if one isn't a medical professional oneself.

Alot of times it comes down to reputation and trusting other medical professionals, and that is an unfortunate reality for the laymen.

It's also based on false premises. Namely, that Harvard is better than Buffalo without proof to back it up, and the medical school is the most important part of a doctor's training.

If I say 'if something is true,' whether or not the premise is false doesn't mean anything in the absence of any other fucking information.

So - are you a troll or just a garden variety moron who has swallow the conservatard Kool-Aid?

At what point did I fucking argue for the current system or even argue against universal health care?

Or have I just been critical of some people's statements?

Is believing that payment proportional to risk caused by people's behavior somehow immoral?

Is it retarded to question some arguments against the current system? After all, legislation passed based on the wrong premises is going to be utterly fucked.

[SCRawl]

As i already said: Some treatments are not avaiable because they are largely untested.
It works like this: Someone has *superspecialraredisease* - and there is no treatment. Wait, there is a single doctor somewhere in the US (or whereever) who has *superspecialawesometreatment* - but has only operated a dozen patients so far, and wants a shitload of money.
In these cases, yes, treatment is often denied.
But i NEVER heard of a case where there is a established treatment where treatment was denied - no matter how expensive.

This is an apples-to-oranges comparison, since your experience is from Germany and mine is from Canada, but I can think of at least one example of such a treatment which is routinely denied in my province, Ontario. Avastin is one chemotherapy drug that's used to treat colon cancer and has a pretty good track record. Of course, it's fairly new and quite expensive: $1750 (Cdn) per two-week course of treatment. Regardless of whether or not the treatment is working, there is an absolute 16-course limit per person. It isn't simply a cost issue, though: from this article here, we get this blurb:

Clinical trials have shown Avastin or bevacizumab is most effective as a first-line treatment for 16 weeks, and that's why funding was capped at that level, said ministry spokesman Andrew Morrison.

If it becomes known that this drug can be a viable option for longer periods, I'm sure it will be approved for longer. It might be anyways, if it's deemed to be in the public's interest to do so.

[Serafina]

´
This is an apples-to-oranges comparison, since your experience is from Germany and mine is from Canada, but I can think of at least one example of such a treatment which is routinely denied in my province, Ontario. Avastin is one chemotherapy drug that's used to treat colon cancer and has a pretty good track record. Of course, it's fairly new and quite expensive: $1750 (Cdn) per two-week course of treatment. Regardless of whether or not the treatment is working, there is an absolute 16-course limit per person. It isn't simply a cost issue, though: from this article here, we get this blurb:

If it becomes known that this drug can be a viable option for longer periods, I'm sure it will be approved for longer. It might be anyways, if it's deemed to be in the public's interest to do so.

Well, yes, of course cost is a factor. The thing is, they are only denying experimental (of course, you can stretch that definiton) due to costs.
I have never heard of a single case where a reliable, proven treatment was denied due to costs.
(unless there is a cheaper treatment avaiable.)

[Knife]

As i already said: Some treatments are not avaiable because they are largely untested.
It works like this: Someone has *superspecialraredisease* - and there is no treatment. Wait, there is a single doctor somewhere in the US (or whereever) who has *superspecialawesometreatment* - but has only operated a dozen patients so far, and wants a shitload of money.
In these cases, yes, treatment is often denied.
But i NEVER heard of a case where there is a established treatment where treatment was denied - no matter how expensive.

This is an apples-to-oranges comparison, since your experience is from Germany and mine is from Canada, but I can think of at least one example of such a treatment which is routinely denied in my province, Ontario. Avastin is one chemotherapy drug that's used to treat colon cancer and has a pretty good track record. Of course, it's fairly new and quite expensive: $1750 (Cdn) per two-week course of treatment. Regardless of whether or not the treatment is working, there is an absolute 16-course limit per person. It isn't simply a cost issue, though: from this article here, we get this blurb:

Clinical trials have shown Avastin or bevacizumab is most effective as a first-line treatment for 16 weeks, and that's why funding was capped at that level, said ministry spokesman Andrew Morrison.

If it becomes known that this drug can be a viable option for longer periods, I'm sure it will be approved for longer. It might be anyways, if it's deemed to be in the public's interest to do so.

So we are counting things as being denied when someone can't self prescribe for longer than a recommended treatment period? Would you consider it being denied if they won't let you have more than 1200mg or Tylenol in a day?

[SCRawl]

As i already said: Some treatments are not avaiable because they are largely untested.
It works like this: Someone has *superspecialraredisease* - and there is no treatment. Wait, there is a single doctor somewhere in the US (or whereever) who has *superspecialawesometreatment* - but has only operated a dozen patients so far, and wants a shitload of money.
In these cases, yes, treatment is often denied.
But i NEVER heard of a case where there is a established treatment where treatment was denied - no matter how expensive.

This is an apples-to-oranges comparison, since your experience is from Germany and mine is from Canada, but I can think of at least one example of such a treatment which is routinely denied in my province, Ontario. Avastin is one chemotherapy drug that's used to treat colon cancer and has a pretty good track record. Of course, it's fairly new and quite expensive: $1750 (Cdn) per two-week course of treatment. Regardless of whether or not the treatment is working, there is an absolute 16-course limit per person. It isn't simply a cost issue, though: from this article here, we get this blurb:

Clinical trials have shown Avastin or bevacizumab is most effective as a first-line treatment for 16 weeks, and that's why funding was capped at that level, said ministry spokesman Andrew Morrison.

If it becomes known that this drug can be a viable option for longer periods, I'm sure it will be approved for longer. It might be anyways, if it's deemed to be in the public's interest to do so.

So we are counting things as being denied when someone can't self prescribe for longer than a recommended treatment period? Would you consider it being denied if they won't let you have more than 1200mg or Tylenol in a day?

Um, no. People do not self-prescribe this drug anywhere, unless they're an oncologist or something. The point is that our health system will not pay for more than 16 weeks of treatment with this drug. Your doctor can prescribe more, but the patient will have to pay out of pocket for it. As I said, it isn't strictly a cost issue, but I'm sure cost is a non-negligible factor.

[Darth Wong]

I don't know why cost savings measures are even an issue when attacking socialized medicine. Do these imbeciles actually think private insurance companies don't care about costs? What are these people, fucking retarded? Seriously, how incredibly naive do you have to be, in order to think that insurance companies don't care about costs? At least UHC systems don't actually boot you off the system entirely if they think you cost too much. The most they might do is try to maximize the health benefits for the amount of money being spent.

[Teebs]

I don't know why cost savings measures are even an issue when attacking socialized medicine. Do these imbeciles actually think private insurance companies don't care about costs? What are these people, fucking retarded? Seriously, how incredibly naive do you have to be, in order to think that insurance companies don't care about costs? At least UHC systems don't actually boot you off the system entirely if they think you cost too much. The most they might do is try to maximize the health benefits for the amount of money being spent.

Assuming that doctors and insurance companies are separate (which I believe is the case for non-HMOs, but I'm happy to be corrected) then the economic theory behind it all says that costs will be kept high because there is no incentive for doctors not to spend as much as they can and if insurance pays for the treatment then patients will demand as much as possible.

Obviously that doesn't take into account things like copayments and treatments not covered by insurance, not to mention the simple removal of people from the system that you mentioned. Anyway, even if it's the case that insurance companies can't force cost cutting, that's not a good thing necessarily since lack of costs means that more resources will be spent on healthcare than is efficient.

[Serafina]

I don't know why cost savings measures are even an issue when attacking socialized medicine. Do these imbeciles actually think private insurance companies don't care about costs? What are these people, fucking retarded? Seriously, how incredibly naive do you have to be, in order to think that insurance companies don't care about costs? At least UHC systems don't actually boot you off the system entirely if they think you cost too much. The most they might do is try to maximize the health benefits for the amount of money being spent.

Assuming that doctors and insurance companies are separate (which I believe is the case for non-HMOs, but I'm happy to be corrected) then the economic theory behind it all says that costs will be kept high because there is no incentive for doctors not to spend as much as they can and if insurance pays for the treatment then patients will demand as much as possible.

Obviously that doesn't take into account things like copayments and treatments not covered by insurance, not to mention the simple removal of people from the system that you mentioned. Anyway, even if it's the case that insurance companies can't force cost cutting, that's not a good thing necessarily since lack of costs means that more resources will be spent on healthcare than is efficient.

It's not like there is no competition with socialised medicine.
If a doctor wants too much money, insurance will not pay for his treatments.

Besides, even if there was no competition, you can always pass laws regulating the prices.

[Broomstick]

I don't know why cost savings measures are even an issue when attacking socialized medicine. Do these imbeciles actually think private insurance companies don't care about costs? What are these people, fucking retarded? Seriously, how incredibly naive do you have to be, in order to think that insurance companies don't care about costs? At least UHC systems don't actually boot you off the system entirely if they think you cost too much. The most they might do is try to maximize the health benefits for the amount of money being spent.

Assuming that doctors and insurance companies are separate (which I believe is the case for non-HMOs, but I'm happy to be corrected) then the economic theory behind it all says that costs will be kept high because there is no incentive for doctors not to spend as much as they can and if insurance pays for the treatment then patients will demand as much as possible.

You are correct, for the most part. Doctor-owned HMO's may have an economic incentive to withhold treatments. Doctors on salary (not exclusively HMO's - the Mayo Clinic, for example, has salaried doctors) may have no incentive to either withhold or increase treatments from an economic viewpoint.

But that is operating out of a model that assumes money is the ONLY incentive or motivation at work here. That is not the case. Money is one factor, but there is no doubt that at least some doctors (and probably most) are motivated by relief of suffering or other impulses.

Obviously that doesn't take into account things like copayments and treatments not covered by insurance, not to mention the simple removal of people from the system that you mentioned.

It doesn't take into account the fact that many medical treatments are uncomfortable, undignified, embarrassing, or even actually painful, which provides a disincentive for people to get medical treatment even when it costs them nothing. Again, far too many models operate from the idea that money drives everything. It doesn't. Personally, I don't like to go to the doctor whether it costs me money or not, and I sure as hell don't go looking for reasons to have medical treatments.

[Darth Wong]

I don't know why cost savings measures are even an issue when attacking socialized medicine. Do these imbeciles actually think private insurance companies don't care about costs? What are these people, fucking retarded? Seriously, how incredibly naive do you have to be, in order to think that insurance companies don't care about costs? At least UHC systems don't actually boot you off the system entirely if they think you cost too much. The most they might do is try to maximize the health benefits for the amount of money being spent.

Assuming that doctors and insurance companies are separate (which I believe is the case for non-HMOs, but I'm happy to be corrected) then the economic theory behind it all says that costs will be kept high because there is no incentive for doctors not to spend as much as they can and if insurance pays for the treatment then patients will demand as much as possible.

Who says that doctors and public insurers are not separate under a socialized medicine system? A socialized system is, at a bare minimum, a public insurer. There is no requirement that the doctor be a government employee. My own family doctor is part of a privately run clinic which bills the government insurer for its services.

Incidentally, I've seen some American articles mentioning the rise of private clinics in Ontario as evidence that socialized medicine is failing: these imbeciles obviously don't understand that the private clinics bill the government and are therefore part of the socialized medicine system. Or maybe they do understand and they're deliberately distorting the facts.

Obviously that doesn't take into account things like copayments and treatments not covered by insurance, not to mention the simple removal of people from the system that you mentioned. Anyway, even if it's the case that insurance companies can't force cost cutting, that's not a good thing necessarily since lack of costs means that more resources will be spent on healthcare than is efficient.

Insurance companies care about profit margin, not cost cutting. They don't care if the system wastes huge amounts of money as long as their profits are high. If a system increases waste but also increases profit, they would go for it.