Archive for the ‘Insurance’ Category

Service of Don’t Hold Your Breath

Tuesday, May 28th, 2024

I attended a Master Plan for the Aging town hall meeting, a New York State initiative. The most enlightening information came from the audience. Otherwise after a far too long list of acknowledgements and thanks—almost 20 minutes’ worth–we heard about the priorities and committees and subcommittees addressing the issues before attendees were invited to speak.

By 2030, 1 in 4 New York residents will be 60 or over. Right now, there are 4.6 million in this demographic.

We heard about a 2022 executive order to:

  • Create a blueprint of strategies
  • Address challenges related to communication
  • Coordinate all State policy and programs

It has taken two years to listen to those in the trenches–or their prospective clients–so I don’t have great hope for much implementation anytime soon. I kept thinking of a committee gathered for an hour to plan the menu for a gala dinner leaving the meeting, inflated with pride, with a fancy PowerPoint presentation and this menu, bereft of detail: a starter, main course, salad and dessert.

The citizen gatherings across the state were to shed light on the public’s concerns. The audience seemed to be made up of seniors, volunteers and directors or employees of the not for profits that address the concerns of the aging. Many of the New Yorkers who spoke asked that their needs be met immediately, not tucked into some subcommittee’s agenda never to be heard from again.

The State is looking into transportation and housing; healthcare services as people age; family caregivers and remaining in community to name some of the master plan’s “bold agenda.”

In no special order, here were just some of the public’s concerns expressed last week.

Safety came up due to the unregulated, life-threatening motorized bikes that fly through the city in every which way, even on sidewalks, knocking over people of all ages. Interpreting the safety issue in another way, one woman said she’s afraid to go outside because unsavory neighbors make her community so dangerous.

Loneliness. One man who lives in Stuyvesant Town, the private development on 80 acres with 11,250 apartments, described what a coalition of older residents asked the owner to do. Two benches now have plaques that declare that anyone sitting on them would welcome a chat. Another speaker suggested the plan explore initiatives that put together young and old New Yorkers.

Nursing homes. We learned that residents in such homes are treated worse than prisoners, and, for example, are not allowed to leave for an outing, for insurance reasons. Another person said this wasn’t true where she worked.

Erratic bus schedules. A 73-year-old described that after waiting 25 minutes on Lexington Avenue to get to the 1:00 pm town hall, she walked to the meeting leaving behind a woman with a cane who did not have this option.

Lack of or shrinking funding to support crucial volunteer services that nevertheless need some paid administrators and/or directors. One provides weekly speech therapy, free, to stroke victims whose health insurance runs out far too soon said a speech therapy volunteer.

We were given an email address to send other ideas— mpatownhall@health.ny.gov. I did, asking that the state provide professional grant writers for diminutive organizations like the speech therapists to tap into the money provided by foundations and government initiatives that support the elderly. [I didn’t think of it in time to speak up.]

However, I did ask that the master plan put the squeeze on federally funded Medicare insurance decision makers asking for full or partial coverage of eyeglasses and hearing aids for those 60+. An attendee sidled up to me thanking me and admitting that she’d just paid a fortune for hearing aids.

If you would like to chime in to the Master Plan powers that be in New York, again here is the email address to send concerns for yourself or loved ones: mpatownhall@health.ny.gov. Regardless of where you live, about what else should a state concern itself to make it possible for aging citizens to live a safe and comfortable life hopefully at home.

Service of “You Choose”

Thursday, March 9th, 2023

Image by martynaszulist from Pixabay 

A friend was a talented interior designer. She would come to our home with a stack of fabric samples all of which were great choices. “Big deal,” you think. When it came to home décor, my husband and I had very different likes: He leaned to the formal and elaborate. I prefer the opposite. Yet she’d surmount that hurdle with ease and arrive with perfect color and pattern pitches for the pieces that needed upholstering. And we’d happily choose the finalists and the winner.

But you don’t expect that approach at a doctor’s office. Seems it’s a popular tactic these days. A few years ago my doctor, knowing I was going to visit a surgeon next, said, “I hope to goodness he doesn’t give you choices.” Sounded strange to me: I either needed a procedure or I didn’t.

Here are two examples in which the patient was asked to decide. In one, it involved which operation of several needed should take place first. The surgeon told the patient to choose. In the other, the same words were uttered about two powerful drugs. Neither patient is a physician. Without the background, how in the Sam Hill can a patient make the most judicious choice?

Had we made a bad selection of fabric the only damage would have been to our wallet. But a patient choosing door number one when it should have been door number three could be seriously up the creek.

There are exceptions. My dentist has warned me that a conservative approach and tricky fix for a dental crisis might not work and I’ve chosen to give it a whirl. Dr. Alan Jaslove is a spectacularly talented dentist and if anyone can carry out a challenging procedure, he can. I’m braced to tolerate the more costly alternative if he can’t pull off the difficult, less expensive one—he makes clear the risks.

And obviously there are countless examples of patients who refuse to take medicine the side effects of which are worse than the disease or who stop physical therapy or decline to follow suggested diets. But sometimes we need guidance from an expert.

I’m guessing that passing the buck to the patient approach is influenced by insurance companies in a litigious society. Can’t you hear it: Doctor to the judge: “Well Jeanne opted to do thus and such. I gave her the choice. I had nothing to do with her decision.”

Has a doctor—or anyone else, such as a builder–given you a choice you weren’t prepared or educated to make? Are the medicine and operation examples I described one-offs? Why do you think some doctors leave crucial decisions up to the patient without recommendation?

Image by Max from Pixabay

Service of Say it Isn’t So: Promises, Promises

Thursday, October 20th, 2022


Image by Jacquelynne Kosmicki from Pixabay 

This is a true story.

Five women were close friends. They’d been through a lot together, took breaks from their busy lives to meet for dinner and even went on weekend trips. They all had families and jobs yet were in touch frequently week-to-week.

Tragedy struck when the husband of one of them was in the wrong place at the wrong time. A tree fell on his car cutting into it and landing on his stomach. He had many surgeries and still has residual issues.

His wife told her friends that if they received the insurance money they expected–$3million to him and $600,000 for her stress and having to care for him—to celebrate her husband’s recovery she would take them all on a fabulous trip.         

The money came through and that’s the last the four friends heard from her. She no longer responded to texts or phone calls. They learned that her family moved to another state and opened a restaurant. They weren’t invited to the opening.

We read stories—who knows if they are true—about celebrities who drop old friends as they rise up the ladder of success.

I have made statements such as “if I win the lottery………….” and I’ve delighted in what I would do with the riches. One of my favorite daydreams is to send cards to friends and then envisioning their reactions at an enclosed check for $15,000, or whatever tax-free gifts are these days. [Don’t plan your cruise just yet. Every few months when I remember to buy a ticket I win $1.00.] Would I be like the woman in this story? I like to think not. What about you? Is the infidelity of a friend far worse than the forfeiture of a promised trip?


Image by StockSnap from Pixabay

Service of Disappointment

Thursday, April 21st, 2022

The saying “less is more,” may apply to interior design but I’m finding that more and more we get less for our money.

What Happened to “Neither Rain nor Snow….”

There is a postbox about four blocks from my apartment in a commercial neighborhood with pickups three times a day, the last at 5 p.m. When I went there this week the times had changed: Now its once a day at 11:00 a.m. not only there but in all the boxes I checked nearby. That early in the day might be a good time for postal workers perhaps but not so hot for customers.

Yes then No

A friend was scheduled for surgery which entailed three days in the hospital and a week at a rehab facility. She knew the drill from a previous operation and all was approved. The day before hospital discharge she learned that her insurance wouldn’t cover the cost of rehab. She lives alone. Don’t you love how insurance companies–not doctors–determine how we are treated?

Poor Training

I tried to buy a gift online and the system wouldn’t work so I called the 800 number and placed the order. I opted to pick up the item at the store, a short walk from home because its feather weight and tiny size didn’t warrant the $6.99 shipping fee. The customer service rep said they’d send it home, as it was easier, [not sure for whom], and he’d remove the shipping fee. Long story short, when I was charged the fee I called and customer service told me I had to work it out with my credit card company. This didn’t set well so I contacted headquarters and eventually it was sorted. No more online purchases for me from these folks. Customer care operators should be trained not to turn off customers.

Have you been disappointed by a service lately?

Image by mohamed Hassan from Pixabay

Service of Uneven Performances During a Pandemic

Thursday, June 18th, 2020

When a company or organization works well these days it does so splendidly and when it doesn’t……I’ve encountered both.

Kudos to the New York State Department of Motor Vehicles. In spite of the pandemic, its staff sent me a receipt in record time acknowledging they’d destroyed the license plates we’d shipped to them. Shortly thereafter I received a refund check for what they owed me because there was still time on my registration.

It took a shockingly few minutes to cancel my auto insurance. When I called USAA the customer service person trusted the date on my motor vehicles receipt and voila! Done.

On the other hand, the New York State Board of Elections so far gets an F. I requested a write-in ballot well over a month ago and since have read and heard countless suggestions from the NYC Mayor and others urging folks to do the same. The deadline to vote in the June 23 primary is approaching and no ballot as of yesterday. I reported this to my councilman’s office. The staffer who took the message said that someone in the office was looking into this as plenty of others are in the same boat.

Have you tried to call Verizon? Ha! What a rigamarole to report a change of address! I was refused access to my online account; live chat doesn’t handle this task and sent me back to the site I couldn’t enter. There is no place on the bill to  make the address adjustment. I pleaded with Mr. or Ms. Live Chat for a phone number which I got. I called,  clicking on “technical difficulties” to get a person who heard my distress and transferred me to a woman in the finance department. Jackpot. Let’s hope I get the next bill at the right address. Time wasted: 3/4 of a frustrating anxiety-provoking  hour.

I filled out the online United States Postal Service change of address form and when done was asked for my credit card number. I thought “I must be in a scam lookalike website,” and clicked off. I then asked for the old fashioned paper form at the post office and mentioned the credit card request that had alarmed me. The postal clerk told me that I was on the right site and that online address changes cost $1. I’d be happy to donate $1 but the reason for the charge and credit card request should have been made clear. I’ve been burned before: I thought I was on a site that I had accessed. It was an almost-the-same address. The mistake scrambled my computer requiring an expert to salvage it.

One friend still waits for her stimulus check when everyone else seems to have received theirs; another in an adjacent state hasn’t seen a cent of unemployment money in six weeks. She called the office 70 times one day and couldn’t get through.

Please share experiences that you have faced trying to get things done during the pandemic– more remarkable than exasperating I trust.

Service of Insurance: What it Pays For, Making Coverage Easier and When a Company Should Consider Ducking Coverage

Monday, October 28th, 2019

If I had back all the premiums I’ve paid for everything from renter’s and owner’s to car, life and health–even Social Security–insurance I’d be a wealthy woman as many would be. I admit that when I’ve needed it, I was grateful for the coverage.

For humanitarian reasons I question how insurance companies can get away with not covering a sick person for lifesaving medication and related legitimate health expenses. Drugs that aren’t on approved lists aren’t covered nor is unlimited home health care which is cheaper and in most cases far better than carting off a person to a nursing home. In this post I write about a pharmaceutical company that’s addressing how to help insurance companies pay for a pricey drug.

I also question whether an insurance company should have to pay an organization’s settlement and legal expenses in cases of abuse. The exception would be legal expenses. They should pay them if the accusations prove false.

Medical

Here’s a creative way that pharmaceutical company Novartis is helping insurance companies pay for Zolgensma, the most expensive drug in the world. I first read about it this summer in a Wall Street Journal [WSJ] article by Denise Roland, “Insurers Limit Access to $2 Million Drug.” One dose of the innovative gene therapy helps prevent a rare condition in young children from getting worse.

They are born without a gene that controls the muscles that allow them to sit up and later, stand on their own. When this article was written, insurance companies were reluctant to spring for the money to pay for the one injection because they weren’t sure it would work. It is meant to halt the progression of the disease, it doesn’t reverse or cure it. It is most effective when given in infancy, before symptoms appear.

Things have changed since summer. Recently Novartis made concessions to help patients acquire the drug. Denise Roland and  Carlo Martuscelli explained the company’s compromises in the WSJ article “Novartis Lauds Launch of World’s Most Expensive Drug.”

Novartis agreed to refund some of the cost to the insurance company if the drug didn’t work. It also offered to divide the cost evenly over five years [though few insurers have opted for this choice]. Sales of $160,000 in the first three months have exceeded analyst expectations. CEO Vas Narasimhan “said on a call with reporters that 99 percent of patients who were eligible for Zolgensma were receiving it, although some must go through an appeal process to do so.” Regardless, Narasimhan said patients “on average” received the drug within 30 days of requesting it.

Insuring Abuse

On the other hand I wonder how some insurance customers think that they should collect and why a company should pay them.

The title of a recent WSJ article by Nicole Friedman and Ian Lovett was: “Insurers Face Wave of Costly Child Sex-Abuse Claims–As 22 states move to ease victims’ pursuit of damages against alleged abusers, disputes over decades-old policies loom.” In New York, the Child Victims Act gives victims a year to report abuse with no time limits.

The reporters wrote: “Most of these institutions, such as churches or schools, are expected to try to use liability insurance to cover some of the cost of defending against these lawsuits and paying potential damages.” They continued ” The legal disputes underscore the complexity of litigating decades-old claims and the uncertainty about how much money will ultimately be available to compensate victims.” It could be $billions they estimated.

According to them insurance companies have already paid 20 to 80 percent of settlements for victims against churches. [The New York Archdiocese has been compensated in one or another way since 1954.]

As the statute of limitations kicked in, insurers calculated what their exposure would be. Now that it has been lifted for a year, those calculations are out the window and exposure to compensation has increased, but not without complications. “Many institutions and insurers don’t hold on to decades-old policy documents, and it can be difficult to track down details. Sometimes ‘insurance archaeologists’ are hired to hunt down evidence of old policies,” Friedman and Lovett reported.

They identified additional reasons to derail compensation: Did the policyholder know about the alleged abuse? “Liability insurance policies typically cover negligent acts but not intentional ones.” And should a claim cover one alleged abuser or each of his victims?

Do you agree that health insurers/Rx plans should cover costs for medicine, generic if necessary–even expensive experimental drugs?

What about an institution with a sexual predator among its employees?  Should court or settlement costs be eligible for insurance coverage if the person is proved guilty? Wouldn’t this be like my buying insurance to cover my legal and bond costs were I to be accused of robbing a bank?

Service of Celebrating the Worst of the Past: What’s with Lloyd’s of London?

Monday, March 25th, 2019

I was surprised that this behavior survives in a civilized country.

I first heard this story on Bloomberg Radio over the weekend during a review of Bloomberg Businessweek stories. For more I linked to Gavin Finch’s story, “The Old Daytime-Drinking, Sexual-Harassing Ways Are Thriving at Lloyd’s.”

During the radio interview he emphasized the rampant drinking during business hours even more than in the article. It seems that after each insurance deal those involved retire to the local pub to celebrate, often many times a day. Sounded like “Mad Men” and the advertising industry in the 1960s though drinking in the latter took place at lunch while in London the practice seems to happen 9 to 5.

Appalling behavior outweighs the old world traditions that Finch described. He covered the unchecked “deep-seated culture of sexual harassment” for the majority of the article. The drinking makes it a dangerous place for women to work, he wrote.

For almost five years Inga Beale, as CEO, did her best to address “modernization of technology, attitudes, and behaviors—and met resistance at every step.” Currently, women in the industry “fear that Lloyd’s, already a deeply backward-looking institution, might actually be on the verge of regressing.” Finch added: “When she took over, everything was being done on paper, much as it had been for the past three centuries. By the time she stepped down, about 16.5 percent of the market’s business was being placed online.”

The drinking isn’t the only thing that harkens to the past and some is charming if anachronistic. Finch wrote: “Beyond the quaint nature of the trading, other rites date to the first exchange Edward Lloyd opened in a 1680s London coffee shop. When a ship is lost at sea, the event is recorded with a quill pen in a leather-bound ledger kept near the center of the main trading floor, which Lloyd’s calls the underwriting room. To mark major disasters that yield billions of dollars in claims, such as the terrorist attacks of Sept. 11 and the Indian Ocean tsunami of 2004, a man in a red tunic and white gloves rings a golden bell.”

And According to Finch “the underwriters and brokers of Lloyd’s mostly do business the old-fashioned way: face-to-face, using rubber stamps, pens, and sheaves of paper. Well-tailored dark blue and gray suits are the norm, often with bold chalk stripes. One does not wear brown shoes. A code mandating suits was lifted last year, but it was clear on several recent tours of the trading floors that almost everyone still adheres to it. Some of the older underwriters wear brightly colored suspenders, or braces. Even by the standards of London’s financial district, the vibe is sartorially conservative.”

Was this news to you as it was for me? How come such behavior is accepted in the global marketplace? Isn’t the contemporary look of the Lloyd’s building in striking contrast to the culture of this company and what goes on inside? Do you think working under the influence impacts the insurance industry?

Service of Family: No Marriage, No Children=No Family & Unfit to Serve?

Thursday, May 3rd, 2018

I was at an auto dealership in upstate New York last weekend speaking with an insurance company customer service rep. Our salesman was arranging for the transfer of our insurance to a new car and when done, he passed me the phone.

After “Hello”—I’d expected a quick “confirming that you’re Jeanne Byington leasing a car,”–but instead the rep bombarded me with questions starting with “What’s your PIN number?” I panicked, looked at my husband and we spat out a few options. The rep interrupted me and then asked, “What is the name of your child?” I answered: “I don’t have one.” He said, “You have to call back. I’ve been logged out.” Click.

So we called back, this time logging in with a PIN number, which worked thank goodness, and we reached a pleasant woman who took the information she needed from the salesman and she then asked me: “What’s your child’s birthday and year of birth?” I told her I don’t have children, but decided to share the birth info of my stepdaughter to move things along. That was the right answer. The company, its staff or computer had assumed that everyone has a kid and that my husband’s daughter–he uses the same company for a range of services—was also mine.

I immediately thought of a comment I read on Twitter by author Father James Martin, @JamesMartinSJ,  regarding the replacement of the fired House of Representatives Chaplain Father Patrick J. Conroy: “The idea that a priest can’t be House chaplain because he’s not a ‘family man’ is absurd and borderline anti-Catholic. Priests have families: mothers and fathers, sisters and brothers, nieces and nephews. Also, by that yardstick, Jesus Christ wouldn’t qualify.”

He was responding to a remark by Mark Walker, a Republican representative from North Carolina who is on a committee to find a new chaplain. According to The Hill, Walker said: “I’m looking for somebody who has a little age, that has adult children, that kind of can connect with the bulk of the body here, Republicans and Democrats who are going through, back home the wife, the family—that has some counseling experience…”

I take Walker’s comment a step beyond religion: Is Supreme Court Judge Sonia Sotomayor unable to do her job appropriately because she never married nor had children yet her judgments impact citizens?

Nobody knows for sure why the Chaplain was fired. According to America Magazine’s Michael J. O’Loughlin who wrote “House Republicans rebuff investigation into firing of Jesuit chaplain,” New York Representative Joe Crowley noted that “Mr. Ryan and other Republican members of Congress were unhappy with the chaplain for delivering a prayer in November they viewed as partisan.” Father Conroy reported to The New York Times that after he offered the prayer on taxes, Mr. Ryan told him, “Padre, you just got to stay out of politics.”  While the Republican tax bill was on the table Father Conroy had urged the planners not to create “winners and losers.”

O’Loughlin wrote that “Mr. Ryan told Republican colleagues on Friday that some lawmakers felt Father Conroy was not providing appropriate pastoral care to House members.” I heard Representative Peter King from Long Island, NY disagree on TV news with this allegation.

So why did it take the House seven years to react if this was so? In his work as pastor at numerous churches as well as chaplain at Georgetown and Seattle Universities, for how many people had he provided pastoral care without complaint?

In a subsequent interview with Walker, Scott Wong reported in The Hill in “Conservative leader: Next House chaplain should have a family” that the congressman said “When you walk the journey of having a kid back home that’s struggling or made some bad decisions, or when you have a separation situation or your wife’s not understanding the [congressional] schedule, having somebody who’s walked in those shoes allows you to immediately related a little bit more than others.”

To be effective, must a grade school teacher have children; a female psychiatrist counsel women exclusively, or an obstetrician be female? Is an unmarried man or woman or a couple with no children, regardless of religion, without family? Is a doctor who doesn’t suffer from his/her specialty unqualified to treat that disease? Are there certain jobs unmarried or childless people are ill-equipped to have?

Service of Irritating and Charming Commercials: Phony and Legitimate Laughs

Thursday, March 15th, 2018

It was less than a year ago that I wrote about the commercials that drove me nuts. Clearly I’ve been listening to the radio and watching TV too much as there are two more to add to the “I immediately change stations or channels as soon as I hear them” list.

This time I’ll also share some adverts I like.

Fake giggles over unfunny circumstances are the worst. The prize goes to 1-800-I-Got-Junk for radio commercials in which business or homeowners laugh hysterically when the junk crew tosses out a piece of rubbish. My hands can be wet or sticky but off goes the station at the first sign of this shrill irritation and sometimes I don’t return. In looking for a link to it, which I didn’t find you’ll be relieved to know, I noticed a similar reaction to it on a website “Commercials I Hate!

Speaking of laughter, I can envision the room of 30-something creative types cracking up as they developed and produced the E*Trade commercial to scare people into saving money so they have funds for their retirement. Sung to the tune of “Banana Boat Song” that Harry Belafonte made famous, it consists of 85 year olds still working and looking foolish as they drop packages they’re trying to deliver, are dragged around by a heavy fire hose, are compared to model-perfect lifeguards and “DJ Nana” spinning records while hideously dolled up. Subconsciously, it could be this ad that inspired my post earlier in the week, “Service of Aging Gracefully.” The commercial isn’t aimed at me but at 30-somethings whose Nana’s and grandpas are, I hope, spending their time making money under more appropriate, dignified circumstances.

And I love “Banana Boat Song.”

I also enjoy the catchy tune that NYU Langone, a well-regarded NYC hospital, uses in some of its TV commercials which make me smile. There’s a series of which “Winter” and “Athletes on their Feet” are only two. Kudos NYU Langone! [And please take good care of my friend who has not been well.]

I wish there were more State Farm “Hall of Claims” commercials as this series is clever. My first favorite is the Mer-Mutts scene where the family pooch turns on the water in the kitchen and floods the living room transformed into a swimming pool. The woof and his pals perform a water ballet while their human mom and pop look on horrified. Actor J.K. Simmons is terrific. Some other good ones are The Truck-Cicle; Frightning-bolt and Vengeful Vermin.

My bet is that the ads that aggravate sell their products like crazy and the ones I like don’t—but I’m not in advertising so what do I know? Are there ads that motivate you to change channel or station in an instant and others you don’t mind hearing and even enjoy?

Service of Cost vs. Benefit in Healthcare: Who Decides?

Monday, July 6th, 2015

This New York Times article, “Cancer Doctors Offer Way to Compare Medicines, Including by Cost,” made significant—if terrifying–points in addition to how cost impacts what drugs a patient may get. Given their ineffectiveness, I wondered why those given as examples are prescribed in the first place.

If you or a loved one has a heart condition, don’t click away just yet: Reporter Andrew Pollack noted that cardiology societies are following in oncologists’ footsteps. And I wouldn’t be surprised if this trend soon affects patients with any and all conditions if it effectively cuts costs for insurers.

Pollack wrote “Roche’s Avastin, when added to chemotherapy, had a net health benefit of 16 out of 130 possible points when used as an initial treatment for advanced lung cancer. Its monthly cost was $11,907.87, compared to $182.09 for the chemotherapy alone.

“Eli Lilly’s Alimta for that same use had a net health benefit of zero with a cost exceeding $9,000 a month compared to about $800 a month for the drugs it was compared to in the clinical trial.”

Later in the article Pollack spelled out the rating system: “Drugs for advanced cancer are given a score from 0 to 130. Up to 80 of the points are based on a drug’s effectiveness in prolonging lives, delaying the worsening of cancer or shrinking tumors. Then up to 20 points can be added or subtracted based on side effects. And up to 30 bonus points can be granted if the drug relieves cancer symptoms or allows a patient to go without treatment for a period of time.”

Regardless of cost why would anyone prescribe a drug that benefits a patient from zero to 16 “points” out of 130?

Other news that was unsettling: “The release by the American Society of Clinical Oncology of what it calls its ‘value framework,’ is part of a change in thinking among doctors, who once largely chose drugs based on their medical attributes alone.” [The underline is mine.] Silly me: and I thought doctors still prescribe what they do according to how a drug helps a patient.

According to Pollack the average cost of cancer drugs runs $10,000/month and some as much as $30,000/month. This is information, Dr. Richard Schilsky said at a news conference, that some doctors don’t know nor do patients. Schilsky is chief medical officer of the American Society of Clinical Oncology. [Why is this significant? Even if you’ve been paying for health insurance for eons and have hardly used a cent until you need to, you can reach the ceiling when off goes the insurance spigot.]

Pollack wrote that this value framework considers the cost to the patient and the health system.  I assume “health system” translates to government supported Medicare and Medicaid plans.

As a result, Pollack observed, doctors are now put in the role of “being stewards of societal resources.” He continued, “That is somewhat of a controversial role for doctors, since it might conflict with their duty to the patient in front of them. But the oncology society said it did not see those roles as being in conflict.”

Other points Pollack made include:

  • A rep for the Pharmaceutical Research and Manufacturers of America said the cost of drugs represents only 20 percent of treatment.
  • The cost of drugs is unrelated to how “novel it is or whether it prolonged life versus just shrinking tumors.”
  • In Britain, a drug is rated according to its “cost per extra year of life they provide adjusted by side effects and symptoms.”
  • Starting in June United Healthcare requires “oncologists to get prior approval from the insurance company for every cancer drug they administer. The company will then track what happens to patients and eventually provide information to doctors about how well each drug works.”

Summarizing the questions:

  • Why prescribe a drug that does little if anything to better a patient’s health or length of life?
  • Is a doctor who chooses a drug for a patient based solely on its medical attributes old fashioned and out of step and will he/she soon be forced out of work by insurance companies?
  • If a patient can scrape together the co-pay of a super expensive drug, can an insurance company refuse to pay its part? Then what?
  • Will United Healthcare only use its approval to track drug effectiveness, as Pollack suggests, or eventually will it control costs by refusing to pay?
  • Is the American Society of Clinical Oncology correct when it asserts that there is no conflict for doctors who are now made responsible for the country’s medical resources and their responsibility to their patients?
  • Unless people have unlimited incomes, most adults are aware of what they pay for food, beverages, clothing, shelter and only recently have they become aware of the cost of healthcare. Isn’t this a good thing?

 

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