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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Lane3 who wrote (25516)	3/27/2013 5:57:05 PM
From: i-node	4 Recommendations Read Replies (1) \| Respond to of 42652

>> It's interesting that when patients make the decision it's considered sensible but when health coverage won't pay for it it's considered rationing. I see a pretty big difference there, personally -- although the net result is the same, the process matters. There is a big difference between one individual making a choice on his/her own behalf, versus having the choice made by a bureaucracy (whether state run or privately run) -- and where directives followed by state run bureaucracies so often become the standard of treatment experience by everyone, regardless of insurance. I'm not saying it should or should not be paid for by Medicare because I don't know; but I do think there is a big difference between limiting access because someone just chooses not to have the procedure versus limiting access because some arbitrary age limit has been reached. The idea of using Quality-Adjusted Life Years or some arbitrary age to determine eligibility for preventive procedures seems a little unusual to me. Consider, for example, that when a person has polyps removed they'll typically have a follow up colonoscopy or perhaps a flex-sig scheduled a year or two down the road on the basis that they are more apt to have future problems. The judgment of the GI doc has to be given reasonable deference in this decision process, it seems to me.

To: Lane3 who wrote (25516)	3/27/2013 6:10:11 PM
From: skinowski	2 Recommendations Read Replies (2) \| Respond to of 42652

It's interesting that when patients make the decision it's considered sensible but when health coverage won't pay for it it's considered rationing But this is precisely what it is. Especially with Medicare. Years ago, HMOs used to play a little game. If they would deny a test, when questioned about possible responsibility if their decision would prove to be wrong, they would answer -- "We are not stopping you from doing the test, we're just declining to pay for it". And, technically, they were right. I know cases when patients, after denied appeals, agreed to pay out of pocket. With Medicare, it's different. Usually, providers cannot charge them for things which are normally covered - but in their case denied - by Medicare. This represents enforced rationing, all the way. For as long as patients cannot go outside the system, all those concerns about the way insurers may decide what is covered and what is not - are far from groundless. They could be, quite literally, issues of life and death - decided by bureaucrats holding schematics in their hands.