Health Care Reform And "unnecessary" Tests

[mushroom]

Many people base their employment decisions on the availability of health insurance. I.e., if you can get a job with a good company that has good health insurance options, grab it. I have worked many jobs in the U.S. where there were no health benefits (smaller companies, law firms, etc.--the law firms insured the lawyers but none of the support staff); when I was younger I thought it didn't matter, but the older you get the more it matters. and unfortunately, even if you have good health insurance the company can unilaterally change it to some crappy HMO where you have to go hat in hand begging doctors to accept your insurance, and begging your PCP for referrals. Employer-based insurance ain't what it's cracked up to be. At one firm all the men could have coverage for their spouses, but none of the women could This was when my husband was in college.

And then there were the companies who discriminated because of medical issues. I was once offered what I thought would be a fabulous job for what I thought would be a fabulous company (a big one), only to have the offer withdrawn after my pre-employment physical because I had had cancer and they said they could not provide health insurance coverage because of my pre-existing condition (under a group policy, even)! Well, at that time I had great insurance through my husband, so I offered to waive the health insurance, but they said that was not an option under their company policies. I was flabbergasted. I think it was just pure discrimination but I didn't feel like fighting them. If that's the way they were I didn't want to work for them anyway.

Yes, I know things have improved greatly since those days, but even now employer-based health insurance has multiple problems and sometimes leaves you with no choice, or Hobson's choice, and with some employers, no insurance at all.

[Shalia]

  On 11/2/2009 at 8:28 PM, Nancym said:

Health care reform isn't going to eliminate insurance companies, they're going to still be there, but they are going to set rules about who they can refuse and stop all the nonsense like Open Original Shared Link. There's also the potential for a government run option. I don't hear too many seniors or vets complaining about their government run health care. Besides, if we don't like the health care we end up with we can always kick people out of office until they fix it. Hard to do that with private companies...

I'm a veteran, and I honestly have to thank God every day for that fact. I'm absolutely thrilled and consider myself lucky to be in the one of the only socialized medicine programs in the nation.

The government doesn't decide what tests I need... my doctors do. And when I show up with sound, logical reasons for something, they do it. When the results aren't particularly logical for me, they'll repeat them without nagging.

My medications are paid for, I can see a specialist quickly, and my medical records are all tied up in one system so my Gyn can see what my GI doctor did, who can see what my psych prescribed. I consider myself majorly blessed.

[scarlett77]

Regardless of reform or not "unnecessary" tests are an issue even now. At 9 months our pediatrician and I decided that we would run a RAST test in addition to checking iron levels of my youngest son. Normally the iron check isn't done until 12 months and the RAST isn't done unless there is a reason. Well our reason was because my older son (his full biological brother) has Celiac and his cousin (my sister's child) has a severe peanut and milk allergy. You know what happened? Even though he is fully insured by a PPO and the doctor ordered it with just cause we had to pay over $400 out of pocket because the insurance company deemed the RAST testing "unnecessary".

[conniebky]

I work for the largest insurance company in the country. So, I will have to be careful here....

The whole thing is a MESS and I think it's going to get messier with the reform, at least for the first 5 years of it.

I think the President and others have good intentions. Before I worked at the insurance company, I worked for a doctor for years, so I'm well versed in both sides of it.

It's just a MESS. I've seen hospitals run test after test when they didn't need to and I've seen sick people denied tests.

...

the whole thing is just a mess. Interesting, Medicare was the fastest, best paying insurance that we dealt with at the doctor's office. and that's government insurance, so, I don't know, we'll just have to wait and see. Politically speaking, I think both "sides" are freakin out. We'll just have to see how it goes.

[Tina B]

I've been hearing a lot lately about how "cutting waste" from the health care system in the US is the way they are planning on paying for health care reform.

[Tina B]

  On 11/10/2009 at 2:35 AM, psawyer said:

I live in Canada, where we have had publicly funded health care for decades. It isn't perfect, but I would much rather have what we have here than what the US has.

We have no for-profit HMOs that decide who gets cared for, and who doesn't, based on a profit motive.

We don't worry about "pre-existing conditions." Everybody is covered to exactly the same extent. The 80-year-old with a heart attack will get the same treatment as a 35-year-old.

Not everything is covered. Drugs are not, whether prescribed or over-the-counter. Dental care is not covered. Routine eye care is not covered, nor are the glasses you may need. For all of these, private insurance is available. But again, the insurers may not disallow a claim due to a "pre-existing condition" (trip cancellation insurance is an exception).

If a test is covered by the public plan (and most are), then it will be done if your doctor deems it necessary. There is no prior review by an insurance administrator--it just gets done.

Drugs are still sold by pharmaceutical companies at a profit, so there is still money to be made by researching and developing new drugs. Private, for-profit, companies make and sell medical supplies and equipment. They are still thriving.

There are waits for many procedures. But I will take that in a moment over not being able to get them at all because I don't have insurance, or because my diabetes or celiac disease is a "pre-existing condition."

DITTO! My own husband who is a physician ordered his own prescription from Canada and tell his patients who can't afford their to do the same. He tells them to make sure they do it from a pharmacy that requires a prescription. His arrived in 2 days and was exactly the same brand and company as here. BTW skied in Canada many times, love it.