[15155]

Do you think countries with even the most coveted universal healthcare just approve everything blindly?

Should everyone (anyone?) receive monoclonal antibodies, gene therapies, biologic medications? What criteria should be used to make these determinations?

[trinix912]

> Do you think countries with even the most coveted universal healthcare just approve everything blindly?

Yes. Everything that they are trained and able to do here, is covered by the national insurance, at least where I live.

We never even have to explicitly ask them to approve anything, it's all automatic. You don't see the bill.

You might have to pay the difference for "nonessential upgrades", like a plastic cast instead of a normal one when you break your arm. Had to pay 5.00 EUR for that and it was the only time I had to pay out of pocket in my entire life.

[terminalshort]

> You might have to pay the difference for "nonessential upgrades"

This is exactly what happens in the US. It's just that in your case the nonessential upgrade is a $5 cast. Sometimes the nonessential upgrade is an expensive surgery. My grandfather had heart surgery at 86 shortly before he died. My relatives went to 3 surgeons who all refused to perform surgery on the grounds that he was too old and frail for the procedure. Then they went to a fourth who agreed to perform it. The first three doctors were right, and he died a few months later. The insurance company quite correctly denied the claim and my family ended up fighting them over a bill for open heart surgery north of $50,000.

Your government wouldn't (and shouldn't) have paid for that surgery either. I think the real difference is that since you have a government system, that in your country that unnecessary surgery just never would have happened in the first place. I will admit this is a more efficient system, but it is no different in that there is a cost benefit analysis being done over what gets paid for and what doesn't whether you see it happening or not.

[15155]

Which country do you live in that pays for gene therapies or other biologics?

[diob]

I love that you're thinking this is what USA insurance companies are denying, not simple diagnostics / medications that save lives.

[15155]

The point is that there's a value judgment being made somewhere - who should be the arbiter and why?

Diagnostics aren't free, either: many (most?) countries do not have anything remotely resembling the private offerings that Quest Diagnostics and Labcorp provide (breadth of tests, 3+ different methodologies for some tests, etc.)

[Turskarama]

Everything? No. But routine stuff will NEVER be denied. If your doctor thinks you need a scan, you're getting the scan. I have quite literally NEVER heard of someone in my country (Australia) going bankrupt from medical bills. It can happen but the rate is so low it's not something anyone ever worries about happening to them.

[terminalshort]

Routine stuff is never denied in the US either. I've never had one thing denied ever and I even have a weird condition that requires expensive testing to diagnose and even more expensive treatment (narcolepsy). The insurance companies will throw up annoying bureaucracy like prior authorizations, and made me switch medication to generic when it came out (reasonable) and then back from the generic to another brand name when it came out (WTF??), but never actually a denial.

[im_down_w_otp]

Never denied eh? Interesting.

I had an MRI denied for a partial pectoral rupture. Which was a routine diagnostic as a precursor to open shoulder surgery to determine the extent and location of the rupture to figure out if surgery was absolutely necessary and to prep a viable surgical plan.

I had to fight the insurance company with the assistance of both my surgical and non-surgical sports medicine doctors.

The good news though appears to be that I imagined the entire thing, because denials for routine things never happen.

[terminalshort]

Gemini states that an ultrasound is just as good for diagnosis as an MRI and is much cheaper. Could it be that the denial was correct and the mistake was from your doctor ordering a less cost effective diagnostic test, not from the insurance company?

And from my personal experience with narcolepsy, AI is a much better doctor than most human doctors.

[mcherm]

Odd that your experience would be so different from mine. I routinely experience denials.

To give an example, about 60 to 80% of the time, when I visit the dentist for a regular cleaning the charge is denied and I have to submit additional paperwork to convince them to pay it. I can't think of any more simple and basic procedure than that.

I have no idea why your experience with healthcare in the US is so much better, but I can assure you that there are many people whose experience is more like mine.

[15155]

Dental is an entirely different system: dental insurance isn't actually insurance.

[terminalshort]

I am in 100% agreement with you about dental insurance, but that's a completely separate system.

[ErroneousBosh]

> Should everyone (anyone?) receive monoclonal antibodies, gene therapies, biologic medications? What criteria should be used to make these determinations?

Yes, if that's an indicated and effective treatment.

Do you think people should just be left to die if they can't pony up the dough in the hospital? Oh, your card's declined, no oncology ward for you?

[15155]

Where is the limit to how much money is expended on one person?

What if they have a 99% likelihood of death, are unlimited funds expended in this case?

What if there's a shortage on drugs - who should get the limited supply available?

Which country with public health options pays for biologic medications or similar patient-tailored solutions?

[ErroneousBosh]

> Where is the limit to how much money is expended on one person?

It depends on what would be an effective and indicated treatment.

> What if they have a 99% likelihood of death, are unlimited funds expended in this case?

Then treatment would neither be effective nor indicated. But if it was your parent, your child, your granny, wouldn't you rather they at least try?

> What if there's a shortage on drugs - who should get the limited supply available?

The people for whom treatment is most likely to be effective

> Which country with public health options pays for biologic medications or similar patient-tailored solutions?

The UK, for a start.