There have been many studies proving the benefits of statins...in fact recent ACA studies have suggested more people than ever are candidates to be on the cholesterol-lowering drug class. Yet the govt is now saying only those with a 10% risk of heart attack in the next 10 yesrs ought to be on them.......with the all-import disclaimer that as an individual, your situation may warrant that you be on a statin anyways. In other words,"you may well benefit from these drugs, but we aren't going to pay for them like they have been paid for up until now".
This is rationing, pure and simple.
If the government had wanted to address the cost of the statin drug use, they should have addressed the drug companies fee schedule. But that would be crossing Big Pharma, Obama's biggest ally these days, and that is not going to happen. Once again, the middle class will be dumped upon - pay more for what had been covered in the past, or go without.
Link: http://news.yahoo.com/advice-qualifies-cholesterol-lowering-statins-225722161.html
Private insurance companies were basically forcing "rationing" on its customers by not covering anything they could possibly say was "optional, experimental, etc.). I learned this when my wife had cancer and even basic tests (pet scans) to determine if the cancer was gone were denied. This all happened before Obamacare.
That said, I don't disagree that Obamacare is a trainwreck. The only way it was going to work was with a low-cost government option. Without that, it has just increased demand for healthcare coverage and done very little to increase supply.
Why on Earth do you thinnk that a federally run program with taxpayer money wouldn't be even a bigger windfall for Big Pharma? You should look at a line item bill from Lockheed to the defense department before you start imagining that a govt run system would be advantageous. They net results would be much higher taxes to pay for things, and markedly more rationing.
You mentioned your wife not being covered for experimental treatments by insurance companies in the pre Obamacare 2009 days. Well, what I am showing you here is an example of proven medical regimens not being covered. NOT JUST EXPERIMENTAL TREATMENTS, BUT PROVEN TREATMENTS AND SCREENING PROCEDURES. You have to see the difference. Since the govt officials -especially this administration and Hillary Clinton's Clinton Foundation - are so deeply in debt to big business interests, there is no chance that they will not continue to rape the middle class under a government socialized medicine system (or "Single Payer System" if it makes you feel better calling it that).
I think that we should focus on a problem that everyone should be able to recognize....Big Pharma.
I hear a lot of bitching and complaining but no plan details to replace the ACA. Could it be that all you do is complain, complain and complain but have no new ideas?
.....therefore, there is no point answering your question yet again.
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It wasn't experimental stuff. A Pet scan is the industry standard, scientifically proven way to screen for cancer (at least according to her oncologist)...and our insurance wouldn't cover it. They said it was experimental, not me. Our doctor wrote letters to no avail b/c their on-staff doctors wrote counter letters.
Do you remember this pre-Obamacare congressional testimony?
It is the fundamental problem of any healthcare system that is based on insurance. If you need to use it, your insurance company will fight you. I've experienced it over and over...at least 20 times in my adult life has a claim for myself or family member been initially unpaid....Sometimes they eventually pay, but never before I get a bill directly from the provider.
.....I know quite a bit about PET scans, and I am shocked that yours was not covered...at any point in the past 10 years. i suspect you had a very crappy insurance company. But the exception does not prove the rule. There is not better coverage of PET scans today because of Obamacare. To the contrary, the general screening for early detection is being all but eliminated. It makes one worry since i know they are smart enough to know that this would cost them more in the long run......unless the don't plan on covering it for many people down the road that are presently having it covered.
Also, the game of resubmission of claims is the same as it always was (and i agree thatit is stupid), but the bills almost always get covered. usually it is a matter of how the bill was submitted - proper codes, etc. ....another ridiculously complex government spawned bureacracy.
...and that was just one example, not an isolated experience. When my wife was 39 and half...she had an unusual mammogram, and given her cancer history, the doctor wanted to remove some tissue that looked suspicious. However, our insurance (Humana this time), said it was not necessary b/c it was unlikely to be breast cancer since she was under 40. The doctor strongly urged us to have the procedure anyway instead of waiting 6 months when insurance would cover it. 10K out of pocket.
I could go on and on.
...and the claim resubmission game is due to insurance company bureaucracy not gov't bureaucracy.
I agree that Obamacare hasn't made any of it better. My point is these issues existed before it went into effect..
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Due to the nature of my work, I know many people in many countries. In discussions about single-payer healthcare, my friends from Canada and England all said the same thing - it works great if you're in danger of dying, but otherwise, not so much. Months to see a doctor, months to get tests done if the doctor ordered them, and more months to get a procedure if the tests dictated it.
Canada and England are both democracies. At any time they could vote to abolish government healthcare...but they don't. Not only that its not even an issue. Canada's conservative party was in control of the government until the recent elections and not once did they even broach the subject of doing away with gov't healthcare.
Its the same in England. The idea of doing away with government healthcare is never even debated.
HC in England is horrendous as compared to the USA.
cancer, she chose to pay for her HC out of pocket in the USA due to the poor quality of care available under the single payer system in her home country. She was working her for the French Govt. when I met her. She was assigned a new duty station in South Koreas when she diagnosed shortly after.
with big Pharma and insurance to create this monstrosity, lying all the way to get it through.
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....you claim that "things suck, we need to go farther". We never should have implemented this crap to begin with. I have heard your personal anecdotal experience, but I don't see how it justifies Obamacare in the slightest. More claims than ever are being denied.
ICD-10 has made things worse yet wrt billing complexity which has lead to even more of the type of claims denials that you experienced....and this is a government spawned idea.
Look ATL, the government has a system ythat they have had complete control of for the past 50+ years - The VA system. Why the hell do you think they are going to do better on a larger scale, when they have failed so miserably on a smaller, more controlled one. You are speaking idiocy.
Afterall that is a single-payer gov't provided healthcare system.
First I never wanted or supported Obamacare (at least not without a low-cost gov't option). You seem to have me confused with someone else. I have always been steadfast in wanting a single payer system. Obamacare is like a bandaid on a gaping head wound.
As far as single payer...You are cherry-picking examples with the VA. The reality is we already have a single payer system in this country for everyone over 65. Medicare is not great, but I don't know anyone 65+ that would trade it in for private insurance,. And eliminating Medicare would never succeed politically b/c the vast majority of Americans support it.
I'd like to see Medicare for every American citizen, and just like Medicare we could then choose to buy supplemental insurance if we wanted/needed additional coverage.
See any problems here?
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Here is a tidbit for you.
The government recently issues a self pat on the back for how many less cases of early prostate cancer there have been since they instituted their new policy of not screening. See anything wrong here?