THANK GOD for PRIVATE HEALTH INSURANCE

[King]

Last week, I went to my doctor because of problems I've been having with my current asthma medication Proventil.  After examining me, he gave me a prescription for a different asthma medication: Symbicort.

After the appointment with the doctor, I stopped by my local CVS/pharmacy to fill the prescription and handed them my nice little Blue Cross/Blue Shield (which happily paid for my Proventil refills over and over and over and over again) card.  And within 15 seconds of entering my info into the computer, the BC/BS notifies CVS that I do not need Symbicort because, suddenly, it has been determined that I no longer have asthma.

The pharmacist contacts my doctor, who is a Blue Cross/Blue Shield licensed care physician, who then contacts Blue Cross/Blue Shield, who then contacts the pharmacist, and once again rejects the prescription.  My doctor then faxed a complete medical report and chest x-ray to BC/BS to prove that I in fact needed Symbicort.

Today, I received a call from my BC/BS representative saying something a long the lines of "after reviewing your case, we find you are eligible to receive Symbicort."  Woo-hoo! So, I finally got it filled.

Before leaving, I asked the pharmacist what the price for both my new prescription Symbicort and my old prescription Proventil would be if I didn't have insurance.

Symbicort is $289 a refill.
Proventil is $45 a refill.

I can see why BC/BS no longer wanted me to have asthma.

So, thank you, PRIVATE INSURANCE.  Thank you for being around so the DECISIONS are between ME and MY DOCTOR and not BUREAUCRATS in WASHINGTON.

[Ban my account ffs!]

Bingo.

I'd rather have a bureaucrat I can vote out of office than have some profit-seeking selfish pig blowhard in an office somewhere trying to kill people for a living in order to increase his margin.

[Keystone Phil]

I'd rather have a bureaucrat I can vote out of office

Those aren't the type of bureaucrats that would be running the system.

[I spent the winter writing songs about getting better]

I'd rather have a bureaucrat I can vote out of office

Those aren't the type of bureaucrats that would be running the system.

So are corporate bureaucrats like described here so much better?

[King]

I'd rather have a bureaucrat I can vote out of office

Those aren't the type of bureaucrats that would be running the system.

I highly doubt a NHS would be full of rejections.

The federal government is notorious for paying whatever invoice comes their way without reading them.  (See the famous $400 toilet seats).

[Ban my account ffs!]

I'd rather have a bureaucrat I can vote out of office

Those aren't the type of bureaucrats that would be running the system.

Ultimately, they would be more accountable to the people.  

But let's look at the issue here.. it is often argued that government provided healthcare increases bureaucracy and wait times, and yet here is a great example of private health insurance companies deciding that someone no longer has asthma despite never having been in contact with the doctor about it.

If anything, we need to remove all incentives and benefits to doctors provided by drug companies to prescribe new, expensive meds.  Then we need to remove the ability for insurance companies to question a prescription written by a doctor if those types of prescriptions are covered under the policy.

The doctor should have the final say on what treatments are used.  If the insurance company thinks a doctor is being unreasonable in general, they can drop them from their network.

[Keystone Phil]

I'd rather have a bureaucrat I can vote out of office

Those aren't the type of bureaucrats that would be running the system.

So are corporate bureaucrats like described here so much better?

I don't believe that government bureaucrats would be much better so I'm not willing to take the risk.

Sits back and waits to hear that I am "satisfied" with the corporate bureaucrat described above.

I'd rather have a bureaucrat I can vote out of office

Those aren't the type of bureaucrats that would be running the system.

I highly doubt a NHS would be full of rejections.

The federal government is notorious for paying whatever invoice comes their way without reading them.  (See the famous $400 toilet seats).

I'm not saying they'd be full of rejections; I'm saying it would be plagued with a bunch of other problems.

As for your second sentence...uh...is that supposed to convince me that this is a good idea? If anything, you totally made my point.

All I was saying was the bureaucrat Snowguy described would not be the type we can vote out of office.

Ultimately, they would be more accountable to the people.

Uh, no, they wouldn't be. 

You must be logged in to read this quote.

Ok? That doesn't negate the point.

You must be logged in to read this quote.

Ok and none of that has to do with the bureaucrats you initially mentioned.

[Lief 🗽]

Yeah but I think you're forgetting LONG WAITS, RATIONING, SOCIALISM.

[Rowan]

Yeah but I think you're forgetting LONG WAITS, RATIONING, SOCIALISM.

[King]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

What BC/BS obviously tried to do was keep me on the cheaper Proventil, despite it being ineffective, just because it was cheaper.

[King]

Yeah but I think you're forgetting LONG WAITS, RATIONING, SOCIALISM.

I know this was sarcastic, but I had to wait a week for prescription that took 5 minutes to fill.  I didn't have to stand in line for a week.  But I still had a damn long wait.

[Keystone Phil]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Ok but at the same time, you were proving why some of us have very serious issues with a government system.

[Ban my account ffs!]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Ok but at the same time, you were proving why some of us have very serious issues with a government system.

But while he has personal evidence to go by, you have only "could" and "might" and "maybe" tossed in with a bunch of "LONG WAITS AND SOCIALISM"

[Keystone Phil]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Ok but at the same time, you were proving why some of us have very serious issues with a government system.

But while he has personal evidence to go by, you have only "could" and "might" and "maybe" tossed in with a bunch of "LONG WAITS AND SOCIALISM"

Oh, ok, so until I prove that the system would be a complete failure, we ought to jump at every proposal. Brilliant.

And some of us don't just have "could" or "might." Nice try though.

[phk]

Yeah but I think you're forgetting LONG WAITS, RATIONING, SOCIALISM.

[Lief 🗽]

Yeah but I think you're forgetting LONG WAITS, RATIONING, SOCIALISM.

lol

[© tweed]

Yeah but I think you're forgetting LONG WAITS, RATIONING, SOCIALISM.

lol

scare game works.  you and I will go to our grave(s) without a US 'public option' in place

[Sbane]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Ok but at the same time, you were proving why some of us have very serious issues with a government system.

But while he has personal evidence to go by, you have only "could" and "might" and "maybe" tossed in with a bunch of "LONG WAITS AND SOCIALISM"

Oh, ok, so until I prove that the system would be a complete failure, we ought to jump at every proposal. Brilliant.

Well the current system isn't working so shouldn't we try something else, something we have a model for from every other developed nation. I don't see what's the harm in giving the insurance companies more competition with the option of a public plan. The level of service provided by them is horsesh**t as proven by the OP's example and countless others. Perhaps private insurance itself will improve as a result of competition.

[John Dibble]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Except they would care. They may not have a profit motive like private insurers do, but they do have the same problem that private insurers face, that being limited resources and virtually endless demand. Their solution pretty much ends up being the same as private insurers as well - they ration. This happens in both public and private systems, though what type of care is rationed and how may vary.

[Sbane]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Except they would care. They may not have a profit motive like private insurers do, but they do have the same problem that private insurers face, that being limited resources and virtually endless demand. Their solution pretty much ends up being the same as private insurers as well - they ration. This happens in both public and private systems, though what type of care is rationed and how may vary.

Yes common sense measures should be taken like using the cheaper drug when possible. If the doctor had prescribed him the more expensive drug to begin with, I can see why the insurance company would have a problem with it and why they would recommend a cheaper option. In this case the cheaper option was explored and when it was proven to be ineffective, the doctor decided to go with the other option. At this point I do not feel the insurance company has a right to deny him the drugs. They can try and present other options to the doctor, but they shouldn't be pulling dick moves like saying his asthma doesn't even exist. This is extremely shoddy service and would not be acceptable in almost any other field except for health insurance.

[John Dibble]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Except they would care. They may not have a profit motive like private insurers do, but they do have the same problem that private insurers face, that being limited resources and virtually endless demand. Their solution pretty much ends up being the same as private insurers as well - they ration. This happens in both public and private systems, though what type of care is rationed and how may vary.

Yes common sense measures should be taken like using the cheaper drug when possible. If the doctor had prescribed him the more expensive drug to begin with, I can see why the insurance company would have a problem with it and why they would recommend a cheaper option. In this case the cheaper option was explored and when it was proven to be ineffective, the doctor decided to go with the other option. At this point I do not feel the insurance company has a right to deny him the drugs. They can try and present other options to the doctor, but they shouldn't be pulling dick moves like saying his asthma doesn't even exist. This is extremely shoddy service and would not be acceptable in almost any other field except for health insurance.

Well, I don't know why they said he didn't have asthma anymore - the problem could have been caused a simple bureaucratic snafu, which again can happen in both kinds of systems. You should hear about the hoops that my Canadian co-worker has had to go through just to get his green card renewed after a small snafu in the paperwork. His driver's license also expired, which means he hasn't been able to drive for the last seven to eight weeks since he needs a valid green card to get that renewed. Just this week they finally said his case is good, but they won't be able to send him his card for up to another sixty days since they have a problem with the machine that prints them. Point is that in either system's bureaucracy, if one person puts one bad piece of information on a piece of paper or into a computer it can completely screw things up. Of course companies shouldn't be allowed to outright lie, but we can't show with any degree of certainty that they did in this case.

None of this is relevant to my previous point though, which is that both systems will care about how much they are spending on you and they will ration care accordingly.

[Sbane]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

Except they would care. They may not have a profit motive like private insurers do, but they do have the same problem that private insurers face, that being limited resources and virtually endless demand. Their solution pretty much ends up being the same as private insurers as well - they ration. This happens in both public and private systems, though what type of care is rationed and how may vary.

Yes common sense measures should be taken like using the cheaper drug when possible. If the doctor had prescribed him the more expensive drug to begin with, I can see why the insurance company would have a problem with it and why they would recommend a cheaper option. In this case the cheaper option was explored and when it was proven to be ineffective, the doctor decided to go with the other option. At this point I do not feel the insurance company has a right to deny him the drugs. They can try and present other options to the doctor, but they shouldn't be pulling dick moves like saying his asthma doesn't even exist. This is extremely shoddy service and would not be acceptable in almost any other field except for health insurance.

Well, I don't know why they said he didn't have asthma anymore - the problem could have been caused a simple bureaucratic snafu, which again can happen in both kinds of systems. You should hear about the hoops that my Canadian co-worker has had to go through just to get his green card renewed after a small snafu in the paperwork. His driver's license also expired, which means he hasn't been able to drive for the last seven to eight weeks since he needs a valid green card to get that renewed. Just this week they finally said his case is good, but they won't be able to send him his card for up to another sixty days since they have a problem with the machine that prints them. Point is that in either system's bureaucracy, if one person puts one bad piece of information on a piece of paper or into a computer it can completely screw things up. Of course companies shouldn't be allowed to outright lie, but we can't show with any degree of certainty that they did in this case.

None of this is relevant to my previous point though, which is that both systems will care about how much they are spending on you and they will ration care accordingly.

I agree that both options have bureaucracies which are at times inefficient and make mistakes. That said a lot of these "mistakes" by insurance companies seem to be intentional.

[Platypus]

Australia's Pharmaceutical Benefit Scheme, easily the best part of our healthcare system, lists symbicort at the following rates:

Max Price to consumer..............................A$32.90
PBS Safety Net/Conc. Price.......................A$5.30
Price paid by Government.........................A$86.89

so not only does the Australian Government only have to pay about 1/6 of the unit price that a US consumer does (i guess that's scale economics for you), but it then subsidises this life-saving medication to make it affordable, covering about 60% of the price.

One an individual spends over $1200* on medications, or a family $2400*, they qualify for the 'safety net' price, which is about 1/15th of the price paid by the government...or 1/90 that paid by a US consumer, if my maths are right.

Recently, i've been very unwell, and had to have three prescriptions filled. Maxolon cost the government $17.81, and me $5.30; Hybylbron cost them $27.45 and me $5.30, and the Comfarol cost the government $9.58 and me...$5.30.

So, it cost me $15.90 - not nothing, but doable - and saved me $48.94. Considering my weekly budget is about $70, not spending all but a few dollars of it is appreciated, and as part of the social contract, when i'm a taxpayer i'll be very very happy to see any cent of my taxes that goes to the PBS be spent well.


*of the top of my head

[Keystone Phil]

Yeah but I think you're forgetting LONG WAITS, RATIONING, SOCIALISM.

lol

scare game works.  you and I will go to our grave(s) without a US 'public option' in place

And I'm sure you can't get to sleep just thinking about it, Cornell student.

Well the current system isn't working so shouldn't we try something else, something we have a model for from every other developed nation. I don't see what's the harm in giving the insurance companies more competition with the option of a public plan. The level of service provided by them is horsesh**t as proven by the OP's example and countless others. Perhaps private insurance itself will improve as a result of competition.

I don't care that the insurance companies have competition. I love competition and I'm certainly not some insurance company hack but we're talking about a program that would cost so much money that it's just not feasible. Pointing to "every other developed nation" only goes so far, by the way. There are reasons why we can't implement such a system even though "every other developed nation" has done so.

[justfollowingtheelections]

Isn't it hilarious how EVERY single republicanconservativelibwrtarian or whatever the duck they call themselves this week opposes every democratic position that makes sense... Or all of them brainwashed or sth?