Bay

Patsy Bates should also sue the doctor who prescribed her the fen-phen. I remember when that diet drug combo was popular in the mid '90s. It was only available by prescription and doctors claimed it was perfectly safe. Ha. Patsy Bates (and the insurance cos.) are the ones being punished for that bad medicine now. She is uninsurable now and may die of untreated cancer because she trusted her doctor when he gave her the fen-phen years ago.

And she was also probably just earnestly trying to rid herself of those extra 35 pounds!

lealdragon

Eh, if everyone sued their docs for stuff like that, there would be no docs.

http://www.mercola.com/2003/jan/15/doctors_drugs.htm

rds248

A few more comments about health insurers:

First of all, the idea of picking patients for health care coverage based on their risk of getting sick, and refusing to cover those who have higher risk is an idea that the "managed care" companies thought up about 15 years ago to make the industry more profitable. It is unethical and wrong. The idea of providing health insurance to large groups is to spread the risk over a big enough group that the company can make a reasonable prediction what it is going to cost them, and charge a fair fee to the group. This ended when the non profit restrictions on these companies were lifted, they became large public companies, and had nothing but CEO and shareholder profit as their goal. Picking only healthy patients for health insurance and rejecting anyone who is overweight or has higher risk of disease is called "cherry picking". It is illegal in many states. In New Jersey as long as you have continuous coverage, an insurer cannot refuse you for a "preexisting condition".
If Healthnet was allowed to do whatever they wanted, they would exclude every person with any disease from coverage, and only collect money from healthy people. These companies have perverted the concept of health insurance to the ultimate degree.

Now let me focus on health care fraud. This is a big fraud indeed.. the fraud is the concept that it is prevalent, and that it is carried out by health care providers. The true fraud is insurers trying to make patients believe that they have any interest in their health. They do not. The Healthnet story is just a small example... workers told to specifically find records of patients that are costing them money and find some excuse to refuse them care. I know for a fact that before we went to electronic claims, that some insurance companies told their workers to throw claims in the garbage, and deliberately make physicians refile them before they pay anything. Aetna was just fined $9 million dollars in New Jersey for unilaterally reducing payments to out of network physicians by 40%...they just figured they would try to get away with this, and the Dept. of Banking and Insurance told them they couldn't do it and fined them. So they will just go back to their workroom and figure out some new fraudulent way to steal money.
For those of you who don't work in the system, believe me, it is much worse than you could possibly imagine. These are totally unethical money grubbing people running these companies, and they wouldn't think twice about denying payment for your care as you lay on your death bed dying of cancer because you wrote on your application that you weighed 130 pounds instead of 140. Then they give the person who discovered the error and decided to throw you out a bonus.

We have allowed these large corporations to totally take over the health care system with virtually no regulation. This occurred during the Clinton administration where Hillary's plan failed and they were emboldened to step in and use their clout to gain control of the system. They provide no value. They are not like drug companies that are actually producing a product that is valuable. They have used their market power which is completely stacked in their favor to reduce payments to hospitals and doctors, increase charges to clients, and extract most of the money for profit. This is money that should be going to healthcare and is not. William Mcguire was paid $120 million dollars when he left as CEO of United Healthcare. Horizon of New Jersey (formerly Blue Cross) is sitting on $1 billion dollars in cash. To me this is an obscenity that these companies are making profits like this and denying sick people care, so they can make more.

I am not going to go into my idea for a solution, but suffice it to say, these companies need much more oversight and regulation. Their profits, their fees, the way they deny care all need to be regulated carefully by state or federal agencies. That's the first step. I'm not sure whether a single payer system would work better. Certainly more of the money contributed would actually go to health care. I'll leave that for another discussion.

menloparkmom

^^ Couldn't have said it better!

lealdragon

Everyone should seriously go see Sicko. Quite an eye-opener. Alot of the cases such as that described in post #33.

If you think that the health insurance companies are corrupt (many are) but the drug companies are somehow benevolent, then wow, respectfully, either you have put on blinders or you work in the drug industry.

Health insurance companies offer a product, too, but just not as tangible.

You think drug companies care about people? About cures? No way. They are all about profit. All the big businesses are about profit, don't kid yourself. Drug companies have denied people access to info, they try to shut down harmless alternative treatments, their drugs are responsible for hundreds of thousands of deaths & serious side effects, which they downplay...oh don't get me started!

What about the obscenity of drugs costing $100 here and those same drugs costing $1 in other countries? (see Sicko)

from http://www.mercola.com/2007/mar/13/a...n-the-rise.htm

Even though I sell health insurance, I recognize that there is a lot of corruption in the industry. But to think that the drug companies are any better...is just naive.

teriwtt

This is the time I can say I'm glad CC allows us to post anonymously, because otherwise I couldn't tell this story.

Eight to ten years ago, I was working for a friend, very, very part-time, who sells financial products, including life and health insurance. I knew this friend from church, so it occurred from time to time that his clients would be other people we knew from church. I remember one middle-aged woman in particular, who I'd heard had a history of pretty serious depression. She applied for life insurance, and since I was the one to complete some parts of the application, I noticed under the section that related to depression, she denied ever having it. She got her life insurance, no problem, no higher rates, etc.

Fast forward a couple of years later (this woman was no longer a member at our church and I was no longer working for my friend), while I'm completing a clinical position in a hospital, this woman was admitted for adverse reactions to chemo from breast cancer. When I was reviewing her chart, I saw that she did admit to her depression history, and it included time prior to the date she applied for the life insurance. I was so incredibly p*ssed!... because -
a couple of years before I worked for my friend, I had applied for life insurance through State Farm, and was denied based on my honesty of some mental health issues I'd had earlier in my life. When I answered these questions a certain way, they made me sign a release of information form for a doctor I'd seen, who had charted just enough to affirm my past. It didn't help when our agent said, "I've never known our company to deny someone based on your history." Soon after that (before I was working for him), I approached my friend, who was able to insure me (term only, not whole life), at an increased rate. At least I got the insurance, but when I think back to the woman who lied, and had no problem getting the whole life policy at standard rate, it infuriates me. I was honest, and got screwed for it.

Opie ofMaybery2

"Your argument about the football coach is a red herring. Lying about your diploma is generally grounds for termination of employment because the punishment fits the "crime." Would understating your weight by 35 pounds be grounds for firing you from a desk job? I don't think so."

Nope no herring, not even trout. Why is one acceptable and the other not? because today it's something you support? Me? I've got dog in this fight, but I know both parties did something wrong. I could understand if it came down to choosing food and shelter before medical care, but do "we" know that is her case? Maybe she wanted to travel and didn't see the value of owning health care. Maybe her rates went up because of her condition (treatments) with her old plan and there wasn't a provision for portability in arnold land? So she pulled a fast one by not disclosing information. Evidently they found her out so somebody treated her previously.

Would it be OK to lie on auto insurance about DWI's? I mean I only got one and I don't drink that often......

Should I disclose 3 tickets?

Call it a red herring if you wish but simply calling it a red herring doesn't dismiss which actions are acceptable and which aren't.

I feel sorry for the lady if an agent sat there with her and walked her through an app and caused this, but then again I wasn't there and don't know, but usually I finish my applications at signature reading the fine print (yes, that's why I'm poor) and the statement "and to the best of your knowledge, everything here in this application is truthful and honest." But she wasn't one of my clients.

lealdragon

Agents can lose their licenses for helping people lie or misrepresent their health histories. I doubt many agents would be willing to risk their licenses for a sale.

Opie ofMaybery2

"doubt many agents would be willing to risk their licenses for a sale."

There always will be some. But ya gotta figure if it's worth it or not personally.

I'd be alot wealthier and in a different voting block if I would have said yes rather than no a few years back. Kicking back a few thousand dollars on a deal would have netted an additional 50-60k a year for years, but I said NO. My ethics are good, but my wallet is thin... lost a major account cause a week later he found somebody who would.

Maybe that why the kids got all that scholarship money, god pays you back in funny ways.

Nova10

According to Medicare, the top 20% healthcare users use up 80% of total costs, and the top half use 97% of costs.
Most private policies once accepted will not cancel you as long as you make the payments.
Government, once you combine all the programs, is the largest payer of healthcare. Healthcare providers are being squeezed by the government. It costs $10 to fill a prescription, the government only gives them $3.50. So, pharmacies are reviewing plans to remove counseling services from being included in prescription price and add an extra fee for them. A number of doctors refuse or limit medicare/medicade patients. The average reimbursement time for medicare/medicare is 3-4 months compared to 1 month for private insurance. The government is a major cause in the disappearance of independent pharmacies.
The drug companies and PBMs make the biggest profit. The major issue according to Pharma is that the cost of creating a new drug is in the hundreds of millions. I am willing to believe that. I am also willing to believe that most of their drugs fail and don't make it to market. I also know the cost of ingredients for most drugs is less than $1 per tablet, and also, some companies spend more on marketing than R&D. They have a right to make back their investment and make a profit, the issue is the amount.
FDA states if any alternative drug claims cure, they have to go through trials to prove it. If you read any claim by a supplement, they do not claim to cure a disease. Most alternatives do not survive the trial process. As a class, some of the Chinese herbals have the highest percentage of drug causing liver disease. If you claim a handful of dirt cures heart disease, then it comes under FDA jurisdiction.

lealdragon

Many raise their rates once you have a major claim or diagnosis. I often hear horror stories from people whose rates doubled after getting cancer, diabetes, etc.

lealdragon

That's because supplements are not drugs and therefore do not singlehandedly 'cure' anything; rather, they tend to work with the body's own immune system to effect healing. A completely different concept.

kluge

Everyone has done "something" wrong. It's a question of whether what you've "done wrong" justifies the penalty someone else wants to impose (for their benefit, of course.) It would be like an insurance company refusing to reimburse you for your car being stolen because you didn't tell them you'd been cited for making an illegal U-turn. Their excuse for not paying you money they owe you isn't justified by what you "did wrong."

You gotta learn to smell a fishy story, Opie.

rds248

I didn't say they were benevolent. I said they provided a valuable product.
Managed care companies do not.

Let's put it in perspective. Go back to 1940. There are no antibiotics except sulfa, which is not very effective (Penicillin was not widely available until the 50's). There are no antihypertensive meds (FDR died of a stroke from uncontrolled hypertension), no antidepressants or antipsychotics, and few effective vaccines. There are no anti cholesterol agents, and many men drop dead in their 40's from heart attacks. A diagnosis of cancer of any kind is a death sentence, since there are no oncology drugs, and most cancers are ineffectively treated by surgery only. There is no treatment for leukemia, and patients die in a few weeks. Anesthesia for surgery is with ether, which is actually very hard to use and very dangerous, so there are many anesthesia related deaths. There is no effective medicine for peptic ulcers, and many patients need major surgery to remove the acid producing portion of their stomach to survive or prevent bleeding.

Every one of the medical conditions above is now effectively treated by a huge number of effective and safe medications which were developed and made available by the pharmaceutical industry. To fail to acknowledge that is simply ridiculous. I am not saying that everything they do is ethical or done to benefit patients, but over the last 100 years they have provided immeasurable benefit and revolutionized medical treatment.
All health Insurance companies have done is make their CEO's rich.

And don't tell me about how drug companies are hiding the fact that alternative therapies are better. People that argue that kind of thing for the most part have no understanding of how science is done, and how effective medical therapies are developed and tested. Unfortunately our society has for the most part become completely ignorant of the scientific method and how it works, so they think that if someone claims that a particular treatment helped them, that's enough. If we depended on that kind of information, we'd still be in the Middle Ages where the average person lived to be about 35.

And by the way, I don't work for the drug companies, but I am a physician.
If I had to practice with the drugs available in 1940, I would be telling most patients that there is nothing I can do to help them. Before we had all these effective treatments, most of Medicine was just diagnosis and prognosis... telling patients when they are going to die from the disease they have, and trying to make them more comfortable.

lealdragon

That's not what I said. Alternative therapies are not necessarily 'better' - they are a different healing modality and each has its place. No, it's not 'enough' for the FDA to embrace these methods. But, it IS 'enough' for people to be able to pursue these modalities if they so choose, with no interference from the medical establishment.

Alternative therapies often work very well for prevention and even for facilitating healing, according to the claims by many people. Has this been proven by scientific method? In most cases, no. Most of these claims are anecdotal, for 2 simple reasons: 1.) In cases of alternative healing, the patient often utilized a variety of alternative therapies, so it's next to impossible to isolate which therapies were effective and which weren't. However, to even attempt to isolate individual therapies is to miss the point of 'wholistic' medicine which, guess what, sees the person as a wholistic entity and cannot be reduced to individual components. It's an entirely different paradigm and does not fit into the allopathic paradigm. 2.) Most studies are funded by pharmaceutical companies. They have no interest in studying herbs and other natural substances which cannot be patented. Sure, most drugs were derived from natural substances, but a component of the substance has to be isolated to be considered a drug, and only then can it be patented. Natural therapies, on the other hand, work on a principle of 'wholeness' and favor 'whole' foods and herbs in their natural state. Again, it's a completely different paradigm and one cannot be forced into the other. It is useless to compare the 2 approaches. Natural herbs would never act as quickly in an acute situation as a drug. However, neither do they have the degree of side effects that drugs have. For those who see the value of both, it's a matter of determining the appropriateness according to the situation and the inclination of the patient.

My entire point is not that drug companies have to embrace alternative medicine - that would be ridiculous since there's no way they could regulate it, and it doesn't fit the paradigm. My point is simply that they should not PROHIBIT people form pursuing alternative therapies if they so choose.

Alternative therapies are certainly not for everyone. But its very nature, alternative medicine requires a more active role on the part of the patient. The patient works together with various practitioners and has a greater degree of responsibility and control over his/her healing process. Many people do not pursue alternative methods until they've been given a death sentence and given up on by the medical establishment. There are countless stories of people practically on their deathbeds with cancer, who, in desperation, pursued some seemingly 'radical' alternative protocol, and are alive and vibrant many years later. I've met some of them in person.

The medical establishment continues to call those cases 'anecdotal.' OK, no problem with that. But when they post these stories on quackwatch and completely ridicule them, as if those stories are all bogus, that is crossing the line! It is none of their business if some people chose to pursue alternative therapies! I can only surmise that they do it because it's bad for their business. Why else would they care? And don't say it's because they are trying to 'protect' people - most of these people ALREADY tried the conventional route and, guess what, it didn't work. I do not expect allopathic doctors to embrace alternative methods. But they should at least be neutral. They should offer their own protocol, but if someone chooses to try alternative methods, advise them against it if they feel so inclined, but NOT try to make it illegal for them to do so!

I have received acupuncture many times over the years. The last time I went to an acupuncturist, he refused to treat me unless I went to an MD and got a diagnosis FIRST. I was outraged! Why should I be REQUIRED to go to a particular type of practitioner that I don't want to go to? I had already chosen acupuncture. I should have had that freedom. But no, the medical establishment is now trying to regulate something they don't even believe in!

About 20 years ago, the FDA took L-Tryptophan off the market because about 10 people died. It was traced to a single bad batch. How many bad batches of drugs have there been? Of meat? Did they take meat off the market? No. Look at how many people die from side effects of drugs, and even from drugs used properly.

It's completely biased and yes, they are indeed ATTACKING the natural health industry. Because the industry is a threat to them.

No one would deny that in an acute situation such as a heart attack, car accident, gunshot wound, etc., modern medicine is a miracle worker. Yet the medical establishment continues to deny the reality of the countless people who have been healed by utilizing natural therapies. Again, they don't have to approve these therapies - but they should not be scoffing at them either. That is completely uncalled for and just shows a lack of understanding and respect for those who have worked very hard, and SUCCEEDED in their healing process, often when modern medicine had given up on therm. Both approaches have their place!

And no one, even those who believe in natural methods, would ever want the drugs-and-surgery options to be taken off the table. ALL those options should be available. Different people may choose different healing protocols.

I'm just saying the allopathic establishment should allow alternative medicine to have its own place, and not interfere with it, and let people choose for themselves. The AMA/FDA should not have a monopoly on healthcare. There are many who would choose allpathic in acute situations but never for degenerative conditions. They should have that choice.