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Health / Science / Technology > Transsexualism, gastric bypass, healthcare in general, health policy

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message 1: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
I was looking at health insurance sites today and Assurant had a list of Ineligible Medical Conditions. The ones you might expect to be on there were there, but also transsexualism and gastric bypass/stapling. Seems kind of harsh!

They also had an Ineligible Occupations list. It included:

*adult entertainers/dancers
*professional athletes including but not limited to ballet...
*professional crop dusters

:(


message 2: by RandomAnthony (last edited Aug 03, 2010 04:31PM) (new)

RandomAnthony | 14536 comments Huh. A friend of mine's wife just had gastric bypass and it was covered. Or at least he said it was. He's a Chicago public school teacher, though, and they have kick ass insurance.

So these conditions are for if you try to get the insurance as an individual? A neighbor's daughter has that...thing where you can't eat wheat...celiac, don't know if I spelled that right. He's a contractor now, for a small business, so he has to get his own insurance, and some of the companies are turning down his family because of his daughter.


message 3: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
This was individual insurance. Group coverage is nearly always better.

I thought the transsexualism was especially interesting because you might be a post-op transsexual, all your surgery is done with, and they still don't want to insure you. Is it because transsexuals have to take hormones forever? I don't know. Why couldn't they just accept you and decline to pay for your hormone treatments?

People with suicide attempts were also ineligible...


message 4: by RandomAnthony (new)

RandomAnthony | 14536 comments Wow. How would they know about suicide attempts? Isn't that confidential?


message 5: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
All of this was part of a self-reported questionnaire. If you lie about treatment or doctors' visits and it then shows up on your MIB report, you're going to get turned down. Presumably some suicide attempts will show up on a MIB report? The ones where people ended up at an emergency room, or in psychiatric care.


message 6: by Kevin (new)

Kevin  (ksprink) | 11469 comments both of my older children wear hearing aids (and both are musician/singers btw) and as they were growing up their hearing aids were not covered by my insurance and i had otherwise GREAT free health insurance provided by my company. some of the doctors visits for them were partially covered but not the actual hearing aids themselves. as they both started wearing them when they were around 6 there were a few times when they lost or damaged the devices and the only help i got was putting the hearing aids as a rider on my home insurance. that worked briefly. at a cost of $1200-$1800 a set we went through a lot of money up until they went off my insurance (after college). they had to rough it on their own with them after that. recently my son's wife had an insurance change which allowed him to get new hearing aids paid for by her insurance. he jumped on that. anyway, my point is that there were some cosmetic surgeries and cosmetic type dental work procedures that were covered on my plan but not hearing aids. one guy even went into a insurance covered alcohol rehab center. that always made me furious


message 7: by Phil (new)

Phil | 11667 comments The insurance racket fucking sucks.


message 8: by [deleted user] (new)

That might be why they can keep on building nicer buildings.


message 9: by Sarah (new)

Sarah | 13815 comments Misha - do you have a link for that? That would be useful for some of the people with epilepsy that I work with.


message 10: by Phil (new)

Phil | 11667 comments My wife's work is dropping their HMO plan. Next year they'll have a PPO and one of those plans that only covers big stuff (and you contribute to an HSA).

Her prescription medication will go from a co-pay of $35/month (HMO) to a whopping $500/month, until her individual prescription limit of $3,000 is reached. After that, she'll pay 20% the rest of the year. One medication, and our annual out-of-pocket cost will go from $420 to $3,500.

The insurance racket fucking sucks.


message 11: by Phil (new)

Phil | 11667 comments Thanks for that, Misha, I'll look into it. I don't predict much success, as hers is less common than most that would be discounted. It's a depression medication, delivered via a transdermal patch, and is the only one we've found to be effective.

I didn't know that about the preventive stuff. She can ask the benefits coordinator at work about that.


message 12: by RandomAnthony (new)

RandomAnthony | 14536 comments Her prescription medication will go from a co-pay of $35/month (HMO) to a whopping $500/month, until her individual prescription limit of $3,000 is reached. After that, she'll pay 20% the rest of the year. One medication, and our annual out-of-pocket cost will go from $420 to $3,500.

Holy FUCK. I'm sorry, Phil. Drug companies suck.


message 13: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
Anti-big government forces in Congress purposely planned the post-WWII piecemeal development of healthcare, in particular employer plans, so that a chunk of America would be really happy with their healthcare and never want to change it, and would be vociferous about NOT changing it. Thus the many-decade delay in serious attempts to do anything to change the system and its spiralling costs. (Thanks to Nixon and Clinton, who tried.) Thus the circumstances of 2008-09, when Rudy Giuliani could talk about how "we have the best healthcare in the world" (sure, he does) while more and more people lost their great healthcare when they lost their jobs.

Obamacare is certainly better than no change at all, but some people's healthcare expenditures are going to continue to be ridiculous. The premiums on a lot of these plans (the private plans and the state-sponsored high-risk plans) are going to be stratospheric. A lot of families and individuals simply won't be able to afford them, unless they stop eating, driving cars, and having mortgages.

America is going to be divided into people who have great insurance, and people who don't.


message 14: by smetchie (new)

smetchie | 4034 comments Was anyone able to find out why gender reassignment surgery isn't covered? Is it because it's not considered "medically necessary?" I'm curious.


message 15: by Scout (new)

Scout (goodreadscomscout) | 3434 comments Lobstergirl, you said, "America is going to be divided into people who have great insurance, and people who don't." I think America, more and more, is going to be divided into people who have money and people who don't. People with money are going to hire the best doctors to be their private physicians. I think they may even build their own private hospitals and staff them with the best doctors.


message 16: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
I certainly agree with you on the money divide. The thing about the best doctors is (specialists at least), they tend to be at places like Sloan-Kettering, for cancer, and they're not there because of the money, they're there because it's got the best reputation and the best doctors. It's true that boutique doctors' practices (sometimes called "concierge care") are growing in number, but I don't necessarily think the best doctors are gravitating toward them.


message 17: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
smetchie wrote: "Was anyone able to find out why gender reassignment surgery isn't covered? Is it because it's not considered "medically necessary?" I'm curious."

I don't know....but I would like to.


message 18: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
Would you be happy with a healthcare plan that required you to pay $730/yr in premiums for an annual benefit capped at $2,000?

http://www.nytimes.com/2010/10/06/bus...


message 19: by Phil (new)

Phil | 11667 comments Lobstergirl wrote: "Would you be happy with a healthcare plan that required you to pay $730/yr in premiums for an annual benefit capped at $2,000?

http://www.nytimes.com/2010/10/06/bus......"


No.


message 20: by Ken (new)

Ken (playjerist) | 721 comments Phil wrote: "The insurance racket fucking sucks."

Yep.


message 21: by Pat (new)

Pat (patb37) Lobstergirl wrote: "Would you be happy with a healthcare plan that required you to pay $730/yr in premiums for an annual benefit capped at $2,000?

http://www.nytimes.com/2010/10/06/bus......"

I was offered a similar plan when I was temping. The 'HR" person talked about it like it was a great benefit. I laughed in her face, and declined.

Insurance is like anything. You gotta figure out what you getting before you buy.


message 22: by Scout (last edited Oct 28, 2010 09:38PM) (new)

Scout (goodreadscomscout) | 3434 comments Lobstergirl wrote: "I certainly agree with you on the money divide. The thing about the best doctors is (specialists at least), they tend to be at places like Sloan-Kettering, for cancer, and they're not there becaus..."

I think that will change. Like most others, doctors will be tempted to follow the money. In these uncertain times, I can envision private hospitals built by the moneyed and luring the best doctors with huge salaries. I think the days of equal health care for all are coming to an end.


message 23: by Jim (new)

Jim | 6485 comments Scout wrote: "I think the days of equal health care for all are coming to an end."

When did it start?


message 24: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
I think the only time we had equal health care was when the population was only Native Americans. There was probably rough equality throughout the 19th century, although people in isolated areas would get little or no care compared to people in cities.


message 25: by Jan (new)

Jan | 241 comments >>I think the only time we had equal health care was when the population was only Native Americans.<<

Isn't it true that in Indian tribes, when a single woman (unmarried or widowed) got old, she was left out in the netherlands to die? At least it was equal.


message 26: by janine (new)

janine | 7715 comments BunWat wrote: "Yeah but then we decided that shipping unmarried Indian women to Amsterdam was just too costly."

my thoughts exactly.


message 27: by Jan (new)

Jan | 241 comments >>No Jan, it is not true.<<

Maybe it's Eskimos I'm thinking about. :-)


message 28: by Jan (new)

Jan | 241 comments Yup, it was the Eskimos I had heard about:

Feature – Eskimo Old Age

One of the most well-known stories about the Eskimos is the strange practice that they have adopted when facing death, and old age.

According to the popular conception, Eskimos must work so hard to survive that they simply cannot manage to support adults who are no longer contributing to the well-being of the group.

Thus, when old-age strikes, rather than waiting around as they dwindle toward death, eating food their companions fight to catch and clothing their companions struggle to construct, the elderly Eskimos are taken to sea, and set adrift on a floating iceberg.

Alone on their iceberg, the elderly must inevitably freeze or starve to death, facing their end, uncomfortable, and horrifyingly alone.

However, it is important not to instill modern Western values on the practices of another culture.
To see this as a disgraceful abandonment of those they should love the most is to fail to understand the dire circumstances which might lead to such a practice, as well as the spiritual understanding that might justify it.

As the Eskimos believed that another world awaited their dead, they would not be sending the elderly off to die and disappear, but to move on to the afterlife.


message 29: by Scout (last edited Oct 30, 2010 07:51PM) (new)

Scout (goodreadscomscout) | 3434 comments Jim "Badgerilla" wrote: "Scout wrote: "I think the days of equal health care for all are coming to an end."

When did it start?"


Point taken, Jim. Currently, the insured have more access to health care than the uninsured, yet anyone in an emergency has access to good doctors.

In the past, the wealthy have built wings in public hospitals and donated large sums of money in order to leave a legacy with their names attached. The future I see is one in which the wealthy, who can afford to pay a premium for the best doctors, put their money into establishing their own private health care system. There's a big divide between the very wealthy and the rest of us, and I think health care is going to reflect this. We all know that good health is number one when it comes to enjoying life, and those with money (along with the best doctors, who don't want to deal with a bureaucracy) will desert the sinking ship of public health care. Just my opinion, and maybe too gloom-and-doomish.


message 30: by Jim (new)

Jim | 6485 comments I doubt your scenario, I hope that you are wrong, but I really have no proof either way, just faith in mankind.


message 31: by Scout (new)

Scout (goodreadscomscout) | 3434 comments So, too much gloom and doom. I hope I'm wrong, too. I'm worried because no one knows what's coming with this new health care agenda. The bill wasn't made public before it was approved, so we had no input. That doesn't seem to be a democratic way of doing things. If it had been made public, I would have read it, and I'd know more about what's coming. The secrecy bothers me.


message 32: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
Scout, it's not true that "no one knows what's coming." Read this book. I read it and it's a pretty quick read. It describes how the reform was passed, what compromises were made, and what's in each section of the bill, as well as what it means (or might mean) for patients, doctors, hospitals, etc.

Landmark: The Inside Story of America's New Health Care Law and What It Means for Us All

I think there was a lot less secrecy than you imagine. Reporters were covering the reform process for over a year. (Granted, not nearly as well or as thoroughly as they should have, but they were covering the basic outlines and a lot of specifics.) If you were a consumer of news, you would have gotten a pretty good idea of what would be in the bill.


message 33: by Scout (new)

Scout (goodreadscomscout) | 3434 comments Thanks, Lobstergirl, for the info.

I'm tired now and cranky, so will ask outright: Should or should not have the bill in its entirety been available to the public before the vote? I think many people felt, as I did, that they were being hoodwinked. I don't think I should have had to glean information from news channels. Hell, the bill affected me directly; shouldn't I have been privy to what was in it?


message 34: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
Scout, I don't mean to sound preachy, but often being a good citizen means digging for information when the newsmedia doesn't present it, or doesn't present it well enough. I direct this at everyone, including myself.

Where the media fell down on the job regarding healthcare reform wasn't so much in reporting the day to day legislative battles or the content of the legislation (which was constantly shifting), but much more basic questions about why healthcare in America costs so much more than in any other industrialized nation, what the public option was and why we should or shouldn't want it, the role of insurance companies, whether healthcare should be provided by capitalistic markets or not. These are critically important questions, not least because they directly affect how much healthcare costs. Yet you seldom saw, heard, or read the mainstream media addressing them properly.


message 35: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
I often turn to books, and blogs, to get my "news." Or maybe I should say "information." They are usually more helpful than the MSM if you want to figure out the different sides of policy issues.


message 36: by Scout (new)

Scout (goodreadscomscout) | 3434 comments Bun, Lg, your point is taken regarding the effort it takes to find out what's really going on. I don't make that in-depth effort. I get my information from newspapers and NPR and public television for the most part. I'm open to the info anyone here has to share.

News reporting is always biased, in my opinion, by what the media choose to report or emphasize - and what they choose to downplay or ignore. I'm not a blog reader. Is this true of blogs, too? Does a non-biased, fact-based news source exist?

Bun, is there a copy of the health care bill online? I wasn't aware that the information was available to us citizens before the vote. I'd like to see what's in there. I think it's ironic that the people we trusted to vote on our behalf knew they wouldn't be affected by the bill, so weren't personally motivated to even read it.

I'm already seeing increases in premiums and decreases in coverage with my insurance. The extended coverage for children up to 26 years of age sounded great, but I have a one-time opportunity to cover my son (deadline today), and I can't afford the premium at this time. I don't recall anyone's mentioning the one-time opportunity aspect.

Ah, me. Riddles, mysteries, enigmas.


message 37: by Lobstergirl, el principe (last edited Nov 09, 2010 09:22PM) (new)

Lobstergirl | 24279 comments Mod
Scout, you would be seeing increases in premiums regardless of whether reform had passed or not. The cost increases in healthcare way outpace inflation and have been for years. One Obama administration goal with reform was trying to "bend the cost curve", i.e., slow the rate of increases.

Re your son, is that a one-time opportunity for this calendar year? I bet there is a window each year in which you could add him, although I don't know for sure. It's also worth looking at the individual health insurance market, if he lacks insurance. If he's healthy and has no preexisting conditions, it can be reasonably priced for healthy young people.

News reporting is always biased, in my opinion, by what the media choose to report or emphasize - and what they choose to downplay or ignore. I'm not a blog reader. Is this true of blogs, too? Does a non-biased, fact-based news source exist?

Totally agree that news reporting is biased in the sense you state - what they cover and emphasize. Blogs are probably more so in the sense that even if they are strictly fact-based (and they aren't always, often they are opinion-based, though of course they can be fact and opinion based), they have more depth than breadth.

Here's an award-winning news source that is nonprofit and does investigative journalism "in the public interest." I think it would be safe to call them fact-based.
http://www.propublica.org/

I like this blog on medical issues which debunks kooky, quackery-based medicine:
http://www.sciencebasedmedicine.org/

This blog is from a progressive vantage point but is also extremely critical of the so-called "liberal" MSM. Basically he's trying to expose liars and dissemblers - and he finds them everywhere. I also find him very enlightening on educational issues. He taught in the Baltimore public schools for 17 years a while back and does a good job exposing the mistakes of the education beat in major newspapers.
http://www.dailyhowler.com/

There's another good media criticism blog which I can't remember now. I'll try to think of it.


message 38: by Scout (last edited Nov 10, 2010 02:55AM) (new)

Scout (goodreadscomscout) | 3434 comments Thanks, both. I'm putting the sites on my favorites list.


message 39: by Scout (new)

Scout (goodreadscomscout) | 3434 comments I've been thinking about this new insurance program and its purported benefits. They sound great until you look at the costs for an individual. To cover my 23-year-old son, it would cost me $150 more a month on a fixed income. Not doable. And this was a one-time offer.

I'm wondering what the premiums are for covering someone with a pre-existing condition. Again, sounds great, but is it doable for an ordinary person? Would they opt out like I did because they couldn't afford it? Is this also a one-time opportunity? If so, why weren't we informed? How good is insurance reform if people like me can't take advantage of it?


message 40: by Scout (new)

Scout (goodreadscomscout) | 3434 comments Well, no one fought to the death (or even sickness) for single payer, and that's a done deal.

I'm saying that there's something rotten in Washington when we're led to believe that covering dependents and people with pre-existing conditions is within the means of a middle-income person. And I do think that's what we were led to believe. No one said, "Your insurance premiums will be so out-of-sight that you won't be able to afford them."


message 41: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
Scout, that has nothing to do with the reform. Nothing. I don't understand your complaint.

First, be aware that people with pre-existing conditions could not obtain coverage in the individual market before the law was passed. They still can't right now - that part of the law doesn't go into effect until 2014 when the law mandates that insurance companies must offer coverage for these people. So the reform had a positive, not a negative, effect on those with preexisting conditions. Same goes for your adult dependents - before the reform, they would have to get their own policy. The price of that particular policy is not related to the passage of reform. Now your dependent can be on your policy. That is an improvement, isn't it? I agree that many of these premiums are unaffordable for middle class people. But there will be subsidies for people who are faced with expensive premiums. Have you looked into that? Again, I suggest you check out this book. It goes into great detail about the reforms.
http://www.landmarkbook.com/

You are so big on personal responsibility, but you need to take some responsibility for finding out facts and information on your own. The media is not going to hand deliver every single fact that you need to you. You have to go out and dig around and find it. You could have followed all these debates and discussions on various policy websites and blogs and Cspan. You can still do that. It takes some effort.


message 42: by Scout (new)

Scout (goodreadscomscout) | 3434 comments Uncle. There's so much I want to say, but we could go on and on and never agree, so how about we agree to disagree. Better to make friends than enemies, I think.


message 43: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
Money Won’t Buy You Health Insurance

http://www.nytimes.com/2011/02/20/opi...

Important. Read it.


message 44: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
The people who don't understand that the system is broken are the people who work for large employers who have good group health insurance. The vast majority of Americans get their health insurance through their employer, and it's a pretty good deal for them. For the most part, they are ignorant of what it's like for people unlike themselves. Thus when Obama tells them the system is broken, they don't know whether or not to believe him. Maybe they assume the 40 million uninsured Americans are homeless, or Medicaid-eligible, or don't need or want insurance.

Sadly, I do find it easy to comprehend how lots of people don't know the system is broken. These people are ignorant of the facts. They hear Republican political candidates like Rudy Giuliani telling them over and over that America has the best healthcare in the world. But some of the people who are pretending it's not broken, like members of Congress, do know better.


message 45: by Helena (new)

Helena | 1058 comments I have some close American friends that live in NY state. The differences between our healthcare systems (NY state vs Canada) has been an ongoing debate between us and we eventually stopped discussing it as it became heated. My friend believes that his healthcare is better. Perhaps. He and his wife both work for the state, so I imagine they have it pretty good and he’s always refused to see it from another pov- someone with ’normal’ or less coverage. Recently, sadly- his mother passed away. It came time to sell her house and they realized that she owed more than she paid for it because she re-financed to supplement her health care costs. It was an eye-opener for him, to say the least. His mother had decent health coverage provided through her employer- so he never really worried about it and was shocked at how much her insurance didn’t cover. Even if she had lived, she probably would have lost her house.


message 46: by Helena (new)

Helena | 1058 comments It was hard for me to understand how being a US citizen he couldn’t be aware of the flaws in the health care system. Not to say that our system in Canada is without flaws- it’s not. I know of people that will go to the US for things like CT scans and MRI’s because the wait list here is too long, they pay upwards of $500.00 to get immediate service in the US. Many of our hospitals and clinics are dismal too because there’s no commercial competition, also- more and more of our services that were once covered are becoming privatized, it’s a bit scary.


message 47: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
I'd rather have your system, Barb. Any day.


message 48: by Lobstergirl, el principe (new)

Lobstergirl | 24279 comments Mod
Yes, but Barb, if you're a millionaire you can get fabulous care. The best in the world.


message 49: by Félix (new)

Félix (habitseven) Indeed it is Barb. The insurance companies seem to have a strangle hold on so much that happens with healthcare here. I am really sick of the whole mess.


message 50: by Helena (new)

Helena | 1058 comments Barb wrote: "Our system sure isn't perfect, but I'd rather wait and not re-mortgage my house, than get it right away and be in debt and/or have my insurance company try to screw me.
Just this morning I had to ..."


I agree completely with you, Barb- our system isn’t perfect but it’s way better than the average US citizen’s. The only people I know that argue with that are my American family/friends that have fantastic health care. My friend’s mom that passed away, had she lived would have lost her house and her health care was decent (she was ill for quite some time) then you have my American sister in law that has had cosmetic surgery covered completely by her insurance, and not just one- but three surgeries in one year.


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