Jack Challem
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 The New York Times articles pointed out that in the treatment of diabetes, insurers balked at paying $75 for a nutritional consultation, but they were willing to pay more than $300 for each dialysis treatment (due to diabetes-related kidney disease). Likewise, insurers hesitated to pay $150 for a visit to a podiatrist, whc can address diabetes-related foot problems, but the insurers would pay more than $30,000 for an amputation.
Even though most hospitals are technically nonprofit corporations, they are very much interested in earning a profit instead of taking a loss. |
Craig Pepin-Donat
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 The FDA bends to the will of the political winds in Washington based on hard lobbying from special interest groups representing pharmaceutical companies, doctor's groups, and health insurers. The least represented of all constituents are "we the people."
The one thing that doctors, HMOs, hospitals, lobbyists and drug manufacturers have in common is their pursuit of money under the guise of health care. It is a broken, unworkable system that puts you in a vulnerable position. |
Shannon Brownlee
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 Bettercare was entirely voluntary, and it would give private insurers a piece of the action.
Members of the Ways and Means Committee were still bickering over which bill to support when Mills launched a preemptive strike on March 2, 1965, calling Wilbur Cohen, an assistant secretary for the Department of Health, Education, and Welfare, to a meeting of the committee. At the meeting, Mills told the Republicans he liked their Bettercare idea so much that he intended to fold it into the Medicare legislation, creating a three-tiered program. |
| Physicians all over the country were banding together into group practices in the hope that they could exert more leverage on insurers when it came time to sign managed care contracts. Peabody agreed to stay on with the new practice for five years, with a salary guarantee for the first three. The group paid its doctors according to a complex formula based on their specialty and productivity. Pediatricians and family practice doctors were at the bottom of the salary heap, and cardiologists and radiologists were at the top, with other specialists ranged in between. |
| Every time individual physicians raised their fees, Medicare and private insurers were forced to raise reimbursements, and soon physician payments were in an inflationary spiral.
The government's payment system helped physicians' incomes grow at a far faster rate than that of general inflation. In the first year after Medicare's enactment, average physician income rose by i i percent, although some were bigger winners than others. Primary care doctors did not play the usual, customary, and reasonable game as effectively as specialists did, so their incomes rose more slowly. |
Charles Barber
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 What has happened is that in the last twenty years, as insurers have paid for psychotropic medications, they have compensated for the extra costs by "carving out" the rest of mental health care—inpatient stays, intensive outpatient, residential services, and psychotherapy— from their general benefits package. Those "specialty services" are managed by subcontractors, "managed behavioral health care" groups, which in my experience have a reputation for watching expenses and denying services with even more vigilance and ruthlessness than general managed care. |
Jacky Law
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 Everyone had felt the hikes over the 1990s as insurers tried to cover the mounting costs of healthcare. Premiums were raised and were soon passed on from employers - who have traditionally paid for their staff's health expenses - to employees who found restrictions had been creeping into the deal since they were last sick.
Insurers did what it took to reduce costs. They signed up doctors into health maintenance organizations (HMOs), for example, which operate a bit like a mini-NHS with strict rules about what can and cannot be prescribed. |
Andreas Moritz
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 According to Johns Hopkins University Health Alert, "When these therapies improve survival by only a few months, this presents troubling issues for cancer patients, their doctors, insurers, and society as a whole." Considering that the production costs for these drugs are a tiny fraction of their selling price and that nearly one in every two people in the U.S. will develop cancer at some stage in his or her life, you can readily understand why the cancer industry makes no real attempt to find a true cure for cancer. |
Bill Sardi
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 They feel they are facing a disease that poses a mortal risk, they paid for their health insurance or Medicare, and the insurers need to do battle over costs, not the patient. But patients are now paying considerable amounts of money out of their pockets because the newer types of drugs are not covered, or only partially covered by insurance.
A report written by Jeff Donn of the Associated Press says modern anti-cancer drugs produce an unanticipated side effect: acute sticker shock. |
| In 2000, insurers finally stopped paying for ineffective bone marrow transplants for women with breast cancer. The treatment was costing $100,000 per patient. [New York Times, Feb. 16, 2000]
Survival and chemotherapy
It is difficult to comprehend the disarray breast cancer care is in today. A report in the New York Times states: "After years of adding more and more to the regimen - more drugs, shorter intervals between chemotherapy sessions, higher doses, longer periods of harsh therapy - doctors are now wondering whether many women could skip 'chemotherapy altogether." Dr. Eric P. |
Paul D. Blanc, M.D.
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 Industrial insurers in particular remain reluctant to embrace a new syndrome that recognizes the possibility of persistent aftereffects from a brief, even if overwhelming, exposure.
An ongoing natural experiment of another sort has been taking place in Turkey. In eastern Anatolia, housewives intentionally mix concentrated hypochlorite bleach and hydrochloric acid in a misguided belief that the irritant gas given off provides better cleaning power. |
Michael J. Panzner
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 By the time the systemic crisis is full-blown, there will almost certainly have been a domino-like collapse of more than a few large intermediaries and allegedly sophisticated global financial firms, including hedge funds, insurers, and brokers. As the number of failures grows, concerns over counterparty risk will take center stage. Lenders, investors, and risk managers will fret and gossip about which institution is next. Worries about fraud and chicanery will boost anxiety to a fever pitch. Even firms not in dire straits may suddenly find themselves at risk. |
| In the spring of 2006, the Wall Street Journal noted that many states had implemented rules requiring health insurers to cover the adult children of members still living at home. Massachusetts, meanwhile, planned to introduce statewide health insurance funded by a mandatory fee on employers and individuals.
But in the end, such measures won't bridge the gap. They will merely shift a portion of the burden to a different spot, like the air in a squeezed balloon. |
Shannon Brownlee
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| Patients disappeared when their parents' employers switched insurers and he was no longer one of the in-network doctors on their plans. In their place came patients whose parents had picked his name out of the book. The number of no-shows started to rise. What did they care if they missed an appointment? They didn't know him from Adam. Peabody desperately wanted to tell the chronic no-shows to find another doctor, he says, "but of course, they would report you to the plan if you did. |
Michael J. Panzner
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| These developments lend further credence to the dangerous assumption that the federal government will pick up the tab for virtually any disaster, including the failure of a large financial institution or one of the many guaranty funds and insurers of last resort, or ILRs, around the country.
Some ILRs are state backed, while others are not. Set up in most cases to cover risks that the private sector would not—or could not—underwrite, many have been faced with growing financial problems exacerbated by political meddling, poor management, and artificially low premiums. |
Jacky Law
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| A whole string of class-action lawsuits alleging that HMOs withheld medical services to boost profits expressed some of the mounting anget over healthcare costs in general and drug prices in particular
Insurers, via HMOs, also started contesting FDA decisions about safe, widely used drugs which they thought patients should pay for themselves in pharmacies rather than have prescribed at the insurers' expense. |
Mark Lynas
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 Rebuilding a city may be an option after the water is pumped out, as long as insurers are willing and able to cough up the necessary sums. But who will pay to rebuild a city twice? Or three times? In the very long term, the only solution will be for hundreds of millions of coastal dwellers to retreat inland, as civilisation's map is continually redrawn with constantly changing geographical boundaries.
The pressure on societies will be immense. |
Benjamin H. Natelson, M.D.
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 Not allowing a person to take this drug is clearly backward thinking, but insurers also don't cooperate because modafinil is more expensive than stimulants that have been on the market for many decades. Although reducing health costs is important, making people take potentially dangerous drugs simply because they're less expensive than the alternatives is a mistake.
In the past, and occasionally still today, I prescribed another drug that is usually used in the treatment of Parkinson's disease, an illness in which fatigue is often prominent. |
Too Profitable to CureBrent Hoadley, Ph.D.
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| He has even gone so far as to say vaccine makers should not need to give discounts or deductibles to insurers of public health. Additionally, he wants vaccine makers to be exempt from culpability and prosecution. Mr. Miller's recommendations for reforming the FDA are reminiscent of the power and autonomy enjoyed by Hitler's Nazi medical mechanics.
The FDA and government should not approve any drug that does not provide full disclosure. |
Bottom Line Health
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| Outrageous! insurers Put Asthmatics at Risk
Nancy Sander, president and founder, Allergy and Asthma Network/Mothers of Asthmatics.
Jennifer Kim, MD, attending physician, division of allergy, Children's Memorial Hospital, and clinical instructor of pediatrics, Feinberg School of Medicine, Northwestern University, both in Chicago.
Michael Blaiss, MD, immediate past president, American College of Allergy, Asthma and Immunology, and clinical professor of pediatrics, University of Tennessee Health Sciences, Memphis.
American College of Allergy, Asthma and Immunology annual meeting, Anaheim, CA. |
| Other possible explanations for the study results may include disparities in prescription guidelines or financial constraints from insurers on ordering secondary medications, she says.
"This is an important study to publish and will provoke a lot of discussion, as it really highlights some of the gaps between official society recommendations and clinical practice," says Dr. Gregory Haber, director of the division of gastroenterology and the Center for Advanced Therapeutic Endoscopy at New York City's Lenox Hill Hospital. |
| Dozens of screening options can diagnose deadly diseases in the earliest stages, when treatment has the greatest chance of success—but doctors, pressured by increasing patient loads and hamstrung by what insurers will cover, don't always order them when they should.
KEY TESTS
The following conditions can be detected by simple tests. These tests may not be covered by insurance—check with your insurer—but consider paying for them even if they're not.. .*
•Diabetes. |
| Some bill the insurers directly.. .others do not.
You can find this information on the pharmacy Web sites or you can call your insurance company to find out which, if any, Internet pharmacies are part of its network.
•Figure in extra costs. Some Internet pharmacies offer free shipping for standard ground delivery. This usually takes two weeks, so order well in advance. Fees for overnight delivery can be high.
A few Internet pharmacies, such as AARP's, charge patients annual membership fees. If you need many prescriptions over a year, the savings can more than offset the extra fee. |
Dawson Church
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 Many informed people will tell you so: doctors, hospitals, insurers, politicians, alternative medicine practitioners, and the makers of public policy. But they are almost all wrong. They are wrong about the nature of the crisis, wrong about the causes of the crisis, and wrong about the solutions to the crisis. The debate about "health care" is everywhere: in magazines, in boardrooms, in debates between political candidates, on web forums and the electronic media. It fills thousands of minutes, lines, and bytes—yet all this chatter manages to miss the most important problems—and their solutions. |
Jack Challem
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 All too often insurers ration health care or deny coverage instead of fulfilling their social obligation.
The consequence may be a collision between your right to know about genetic risks for disease and an insurer's temptation to discriminate against you. There is a legitimate reason for this concern. insurers have often appeared arbitrary and unfair in denying approvals or payments for medical care, and it is common for an insurer to deny coverage for a preexisting condition. |
| For all practical purposes, the tradition of patient-physician confidentiality does not exist when it comes to insurers. They want to learn as much as possible to predict the cost of your potential future medical claims. In one potential scenario, if insurers learn that you have a genetic predisposition for a serious disease, they may define it as a "predisease," similar to the current definition of a preexisting condition. With a predisease you may be denied insurance coverage, or your insurance may exclude coverage for the predisease.
However, there are possible alternative scenarios. |
Shannon Brownlee
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| Wennberg, Fisher, and their colleague Jonathan Skinner estimate that as much as 30 percent of the medical care that is paid for by Medicare as well as private insurers is useless, unneeded, a waste—a figure that has been arrived at independently by other researchers. As of 2006, when the total health care budget reached two trillion dollars, Americans were spending as much as seven hundred billion dollars a year on health care that not only did them no good but caused unnecessary harm. |
Michael J. Panzner
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| The domino-like failures of numerous hedge funds, insurers, brokers, and other financial intermediaries because of incompetence, greed, or fraud will inspire outrage. Where money is concerned, people will be in no mood to forgive or forget, instead feeling a growing desire for revenge.
Even where no explicit crime or impropriety seems to have taken place, individuals and companies that can afford it will attempt to use the legal system to extricate themselves from deals and potentially costly commitments agreed to during times of unbridled optimism. |
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