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  •  There will always be bean counters... (0+ / 0-)

    ...who will approve and deny care both as a matter of policy and as a matter of individual application of policy.

    When Medicare denies a treatment option, it's still a bean counter decision (hopefully, to the greatest extent possible, based on an objective process of evaluating cost vs. statistical benefit to the patient). Medicare is currently quite generous with allowable procedures (although not necessarily with reimbursement) but as costs become politically difficult to deal with, I would expect that this generosity will wane and the standard of medical review in individual cases will become higher.

    Sadly, due at least in part to insufficient case-by-case Medicare review, the blatant fraud in the system is shocking. Although, of course, private insurance companies don't advertise such fraud if they experience it, I seriously doubt (based on personal anecdotal experiences with the level of review done by private insurance companies) that they experience nearly this level of fraud. These long term problems make me very skeptical of a universal government funded system run by private enterprise.

    Of course, a centrally controlled system (either since most of the payments, approvals, and denials are done by the government or because the health care system itself is actually run by the government) has knobs to control costs not by "denying" a procedure but simply "delaying" it by limiting the number of resources available to perform it (either by keeping the compensation low or by simply not buying more equipment or hiring more practitioners).

    Some bean counter will always be deciding if Nataline Sarkisyan gets a liver transplant or not - and it will always be based at least in part on the cold reality of available resources (government or private), political pressure (on administrators or by regulators), and odds of "success" (quality and quantity of life).

    •  that OK, willR (0+ / 0-)

      somebody has to keep track of things.  Just so the decisions being made aren't being fed into a corporate, for-profit enterprise.

      don't always believe what you think...

      by claude on Sat Nov 15, 2008 at 05:53:29 PM PST

      [ Parent ]

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