[dominotw]

insurance issues are provider and insurer going back and forth detrmining if doctors assessment of necessity is agreed upon.

i am not familiar with universal system. In that system if your doctor thinks something is medically necessary then thats the end of it and its gets done?

[nradov]

All healthcare systems have some form of rationing. Even if your doctor thinks something is medically necessary it can only get done if the system actually has capacity.

In most countries where there is universal coverage with a single payer, certain expensive treatments have long waiting lists or are simply unavailable at any price. Thus we see wealthy Canadians coming to the USA as medical tourists and paying cash for procedures like MRI scans or joint replacements in order to avoid the queue back home. There are always trade-offs, it's just a matter of what we want to prioritize.

[dominotw]

yea queue is fine . i was wondering about gp's claim that universal would be more efficient because there is no more back and forth about approving.

i wasnt sure if it simply takes a different form or gets eliminated completly.

[throwway120385]

In my experience, insurance issues are usually insurer and patient going back and forth and then patient getting 6 different answers from 6 different representatives, then reviewing the 3000 page plan document, finding the single line that properly describes what should have happened, calling the insurance company, explaining to the rep how your plan works, and demanding that it be reprocessed. Like my wife has to do this frequently and spends several hours per month dealing with this but she has saved us probably tens of thousands of dollars in mis-processed claims that the insurance companies can't even properly handle. I usually am the person carefully reading plan docs, finding the proper billing codes, and explaining things like that to the insurance company. Sometimes we have to get the doctor's billing people to code things, like once they coded something that was an outpatient appointment as a minor surgery which could have cost us a lot of money.

So in my book since we get to speculate about what the system should look like, it should absolutely result in people getting care without all of this run-around. It's about eliminating as much misery as possible from the system and letting people just get treated and providers just get paid. We can talk about efficiency once the misery is gone.

[nradov]

Yes, part of the overall solution needs to be health plan transparency on clinical guidelines and coverage rules. Currently much of that is concealed, or applied unevenly.

But we're not going to eliminate misery from the healthcare system. Demand is effectively infinite, mainly from patients with complex conditions, and supply is finite. Developed countries with more socialized healthcare systems typically do a pretty good job of delivering basic primary care but things often fall apart when more complex or specialized care is needed. Those systems also ration and deny care but it tends to be through forcing patients to wait in long queues, or simply not offering expensive treatments at all. Like under the UK NHS, some prescription cancer drugs just aren't available. So that's a different form of misery.

[dominotw]

you think there is scope for a non profit here that can advocate on behalf of patients and read the contracts. perhaps with ais help.