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	<title>Comments on: Court Says Bureaucrats, Not Doctors, Decide What Is &#8216;Medically Necessary&#8217;</title>
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	<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/</link>
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		<title>By: Class Clown</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-270431</link>
		<dc:creator>Class Clown</dc:creator>
		<pubDate>Sat, 30 May 2009 21:47:09 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-270431</guid>
		<description>I think too many of you are framing this as a choice between government bureaucrats and insurance bureaucrats. Those two are virtually indistiguishable anyway. The real fear is that any options for private medical care are going to trickle away.

And I have spent time in a French hospital. It was not the standard of care that Americans are accustomed too, I can tell you that....</description>
		<content:encoded><![CDATA[<p>I think too many of you are framing this as a choice between government bureaucrats and insurance bureaucrats. Those two are virtually indistiguishable anyway. The real fear is that any options for private medical care are going to trickle away.</p>
<p>And I have spent time in a French hospital. It was not the standard of care that Americans are accustomed too, I can tell you that&#8230;.</p>
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		<title>By: G Alston</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-266597</link>
		<dc:creator>G Alston</dc:creator>
		<pubDate>Tue, 26 May 2009 04:49:55 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-266597</guid>
		<description>This is a funny site. The state can&#039;t make medical decisions, only doctors and patients can!

And yet...

The same people saying this claim that patients shouldn&#039;t be allowed to have abortions. Only the state should be able to make that decision.

So the *real* argument isn&#039;t one of statism, but who&#039;s pulling the strings.</description>
		<content:encoded><![CDATA[<p>This is a funny site. The state can&#8217;t make medical decisions, only doctors and patients can!</p>
<p>And yet&#8230;</p>
<p>The same people saying this claim that patients shouldn&#8217;t be allowed to have abortions. Only the state should be able to make that decision.</p>
<p>So the *real* argument isn&#8217;t one of statism, but who&#8217;s pulling the strings.</p>
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		<title>By: Well Educated Cad</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-266582</link>
		<dc:creator>Well Educated Cad</dc:creator>
		<pubDate>Tue, 26 May 2009 04:22:23 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-266582</guid>
		<description>And we already have a totally government run Health care system- it&#039;s called the VA. Go check out their hospitals- it&#039;s the future for all America.</description>
		<content:encoded><![CDATA[<p>And we already have a totally government run Health care system- it&#8217;s called the VA. Go check out their hospitals- it&#8217;s the future for all America.</p>
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		<title>By: Jane Orient</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-266524</link>
		<dc:creator>Jane Orient</dc:creator>
		<pubDate>Tue, 26 May 2009 02:03:03 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-266524</guid>
		<description>If you are dependent on the government, whether for your livelihood or your medical care, you belong to them. And remember, the government is bankrupt.

Universal coverage means that you are forced to pay for everybody&#039;s medical care, and you get whatever the bureaucrats think you should have. If there&#039;s a &quot;single payer,&quot; such as Medicare, you are forbidden to pay extra to get extra, even if you have any money left after taxes, if your doctor or hospital takes any money from the single payer.</description>
		<content:encoded><![CDATA[<p>If you are dependent on the government, whether for your livelihood or your medical care, you belong to them. And remember, the government is bankrupt.</p>
<p>Universal coverage means that you are forced to pay for everybody&#8217;s medical care, and you get whatever the bureaucrats think you should have. If there&#8217;s a &#8220;single payer,&#8221; such as Medicare, you are forbidden to pay extra to get extra, even if you have any money left after taxes, if your doctor or hospital takes any money from the single payer.</p>
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		<title>By: Mark Kellen</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-266449</link>
		<dc:creator>Mark Kellen</dc:creator>
		<pubDate>Mon, 25 May 2009 23:19:29 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-266449</guid>
		<description>Many good comments, but you all make a wrong assumption.  You assume that either the government or an insurance company must pay your bills for you.  Both are wrong.  What people think of as health insurance is actually a third party payment plan which the government adds mandates to that keep it much more expensive than it needs to be.

The proper fix to the system is to keep as much money away from the government and insurance companies as possible. We need vastly expanded health savings accounts, so that we control the resources for day to day spending.  This and only this approach will lead to quality, innovation, and lower costs.

As a physician, I see this dynamic play out every day. I see people, especially medicaid dependent people, who do not care what anything costs, because to them it is all free.  In reality, the court decision is correct. The state, if they pay for you should have the right to decide what you do or do not get.  Those who control their own resources, get to make their own decisions.  If we do not set it up this way then their is no incentive not to be on the public dole.  If we put everyone on the public dole, then nobody gets a choice.

Check out www.aapsonline.org for additional information.</description>
		<content:encoded><![CDATA[<p>Many good comments, but you all make a wrong assumption.  You assume that either the government or an insurance company must pay your bills for you.  Both are wrong.  What people think of as health insurance is actually a third party payment plan which the government adds mandates to that keep it much more expensive than it needs to be.</p>
<p>The proper fix to the system is to keep as much money away from the government and insurance companies as possible. We need vastly expanded health savings accounts, so that we control the resources for day to day spending.  This and only this approach will lead to quality, innovation, and lower costs.</p>
<p>As a physician, I see this dynamic play out every day. I see people, especially medicaid dependent people, who do not care what anything costs, because to them it is all free.  In reality, the court decision is correct. The state, if they pay for you should have the right to decide what you do or do not get.  Those who control their own resources, get to make their own decisions.  If we do not set it up this way then their is no incentive not to be on the public dole.  If we put everyone on the public dole, then nobody gets a choice.</p>
<p>Check out <a href="http://www.aapsonline.org" rel="nofollow">http://www.aapsonline.org</a> for additional information.</p>
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		<title>By: dmk3</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-266283</link>
		<dc:creator>dmk3</dc:creator>
		<pubDate>Mon, 25 May 2009 18:21:11 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-266283</guid>
		<description>It seems to me that the 11th Circuit ruling is in direct opposition to the rational in &#039;Roe vs Wade&#039;; i.e., the state may not come between a patient and her doctor in making a medical decession.  If the &#039;right to privacy&#039; protects abortion as a medical procedure, why not any other?  If the state does not approve, the state doesn&#039;t have to pay but the patient should be free to pay for it themself. If the patient thinks the doctor is guilty of medical malpractice, the patient (or the patient&#039;s heirs) sues the doctor. If the patient (or the patient&#039;s heirs) think the doctor has committed fraud, they file a complaint with the state and the state may prosecute.  The Medicare/Medicade practice of preventing the patient from persuing care not approved of by government bureaucrats seems not only unamerican, it seems it should be unconsitutional under the left&#039;s favorite constitutiona opinon.</description>
		<content:encoded><![CDATA[<p>It seems to me that the 11th Circuit ruling is in direct opposition to the rational in &#8216;Roe vs Wade&#8217;; i.e., the state may not come between a patient and her doctor in making a medical decession.  If the &#8216;right to privacy&#8217; protects abortion as a medical procedure, why not any other?  If the state does not approve, the state doesn&#8217;t have to pay but the patient should be free to pay for it themself. If the patient thinks the doctor is guilty of medical malpractice, the patient (or the patient&#8217;s heirs) sues the doctor. If the patient (or the patient&#8217;s heirs) think the doctor has committed fraud, they file a complaint with the state and the state may prosecute.  The Medicare/Medicade practice of preventing the patient from persuing care not approved of by government bureaucrats seems not only unamerican, it seems it should be unconsitutional under the left&#8217;s favorite constitutiona opinon.</p>
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		<title>By: Beldar</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-265882</link>
		<dc:creator>Beldar</dc:creator>
		<pubDate>Mon, 25 May 2009 03:38:25 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-265882</guid>
		<description>Mr. Emmanuel, you&#039;ve confused decisions over what course of treatment to pursue with decisions over what a government-sponsored plan will PAY FOR.  They&#039;re not the same.  No one&#039;s being prevented from getting whatever sort of treatment he or she -- and his treating physicians, or voodoo doctors, or whomever -- think appropriate, except in the very same sense that the government is &quot;preventing&quot; me from driving a BMW (because, dammit, it won&#039;t make the required monthly payments for me).

Thus, you&#039;ve conflated a question of fiscal responsibility with a question of liberty.  It&#039;s sloppy thinking, and I hope you&#039;ll do better in the future.</description>
		<content:encoded><![CDATA[<p>Mr. Emmanuel, you&#8217;ve confused decisions over what course of treatment to pursue with decisions over what a government-sponsored plan will PAY FOR.  They&#8217;re not the same.  No one&#8217;s being prevented from getting whatever sort of treatment he or she &#8212; and his treating physicians, or voodoo doctors, or whomever &#8212; think appropriate, except in the very same sense that the government is &#8220;preventing&#8221; me from driving a BMW (because, dammit, it won&#8217;t make the required monthly payments for me).</p>
<p>Thus, you&#8217;ve conflated a question of fiscal responsibility with a question of liberty.  It&#8217;s sloppy thinking, and I hope you&#8217;ll do better in the future.</p>
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		<title>By: Slider</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-265863</link>
		<dc:creator>Slider</dc:creator>
		<pubDate>Mon, 25 May 2009 02:58:36 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-265863</guid>
		<description>Praetorian, this discussion could be endless so I will leave it at this post. Medicare has trillions in debt and has left the insured to pay through higher cost what it won&#039;t. That&#039;s not fantastically successful. That debt will have to be paid back. Private insurance does not carry that debt. It can&#039;t. Your generation and the following have to pay these debts. 

The point is not that some people won&#039;t get life saving care when they need it, the point is that even MORE people will not get life saving care. 
Government run health care will end up being more expensive, subject to more delay, and what YOU will get will be of lower quality. It&#039;ll be the law and politicians will have removed alternatives.
 
By all means, remove profit from everything. History tells you what will happen. Competition is the key to improvement and money is how the market rewards success. Once the government steps in, competition disappears, the bureaucrats take over and impetus for improvement disappears. Tax increases will supplement inefficiencies as they always have. Remember these people couldn’t see the housing bubble disaster coming and are telling us that we will save trillions just with electronic records. They also don&#039;t see the perfect economic storm they&#039;re busily creating. Should be profoundly disturbing to all Americans.

To state that you are young was kind of superfluous; the lack of life experience comes through clearly. It&#039;s more about quality of life and having access to highly skilled, tireless, and motivated professionals when your life is threatened by treatable disease. God forbid anything happens to you but if it does, I would like you to have the quality of care I have had (along with thousands of other Americans) from my oncologist, Blue Cross, Genentech, and Stanford. I don’t think that will possible if the government is calling all the shots.</description>
		<content:encoded><![CDATA[<p>Praetorian, this discussion could be endless so I will leave it at this post. Medicare has trillions in debt and has left the insured to pay through higher cost what it won&#8217;t. That&#8217;s not fantastically successful. That debt will have to be paid back. Private insurance does not carry that debt. It can&#8217;t. Your generation and the following have to pay these debts. </p>
<p>The point is not that some people won&#8217;t get life saving care when they need it, the point is that even MORE people will not get life saving care.<br />
Government run health care will end up being more expensive, subject to more delay, and what YOU will get will be of lower quality. It&#8217;ll be the law and politicians will have removed alternatives.</p>
<p>By all means, remove profit from everything. History tells you what will happen. Competition is the key to improvement and money is how the market rewards success. Once the government steps in, competition disappears, the bureaucrats take over and impetus for improvement disappears. Tax increases will supplement inefficiencies as they always have. Remember these people couldn’t see the housing bubble disaster coming and are telling us that we will save trillions just with electronic records. They also don&#8217;t see the perfect economic storm they&#8217;re busily creating. Should be profoundly disturbing to all Americans.</p>
<p>To state that you are young was kind of superfluous; the lack of life experience comes through clearly. It&#8217;s more about quality of life and having access to highly skilled, tireless, and motivated professionals when your life is threatened by treatable disease. God forbid anything happens to you but if it does, I would like you to have the quality of care I have had (along with thousands of other Americans) from my oncologist, Blue Cross, Genentech, and Stanford. I don’t think that will possible if the government is calling all the shots.</p>
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		<title>By: E. Andrews</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-265756</link>
		<dc:creator>E. Andrews</dc:creator>
		<pubDate>Sun, 24 May 2009 23:10:40 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-265756</guid>
		<description>For a glimpse of what our lives may be like under two of O&#039;s plans for us common folks (socialized medicine and redistribution of wealth), I highly recommend two short stories in &quot;Atlas Shrugged.&quot; They also appear in Rand&#039;s book &quot;For The New Intellectual&quot;:

1. &quot;The Forgotten Man of Socialized Medicine&quot;.  (It&#039;s one page long in our paperback edition of &quot;For The New Intellectual&quot;.) 

The story basically explains why my husband and many of our physician friends have already given up medicine and taken up other occupations. Many others say they will do the same when ObamaCare becomes reality. Living with Medicare and Medicaid&#039;s frequently changing codes and rules are already a nightmare, as are the constant fear of frivolous lawsuits, the expense of outrageous liability premiums, and the time consumed keeping up with annual changes in Medicare Part D formularies. 

2. &quot;From Each According to His Ability, To each According To His Need&quot;. &quot;This is the story of what happened at the Twentieth Century Motor Company, which put the above slogan into practice -- as told by one of the survivors.&quot; (It&#039;s about 12 pages long in our paperback edition of the same book.) Even reasonably literate teenagers can understand this one.</description>
		<content:encoded><![CDATA[<p>For a glimpse of what our lives may be like under two of O&#8217;s plans for us common folks (socialized medicine and redistribution of wealth), I highly recommend two short stories in &#8220;Atlas Shrugged.&#8221; They also appear in Rand&#8217;s book &#8220;For The New Intellectual&#8221;:</p>
<p>1. &#8220;The Forgotten Man of Socialized Medicine&#8221;.  (It&#8217;s one page long in our paperback edition of &#8220;For The New Intellectual&#8221;.) </p>
<p>The story basically explains why my husband and many of our physician friends have already given up medicine and taken up other occupations. Many others say they will do the same when ObamaCare becomes reality. Living with Medicare and Medicaid&#8217;s frequently changing codes and rules are already a nightmare, as are the constant fear of frivolous lawsuits, the expense of outrageous liability premiums, and the time consumed keeping up with annual changes in Medicare Part D formularies. </p>
<p>2. &#8220;From Each According to His Ability, To each According To His Need&#8221;. &#8220;This is the story of what happened at the Twentieth Century Motor Company, which put the above slogan into practice &#8212; as told by one of the survivors.&#8221; (It&#8217;s about 12 pages long in our paperback edition of the same book.) Even reasonably literate teenagers can understand this one.</p>
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		<title>By: Praetorian</title>
		<link>http://pjmedia.com/blog/court-says-bureaucrats-not-doctors-decide-what-is-medically-necessary/#comment-265659</link>
		<dc:creator>Praetorian</dc:creator>
		<pubDate>Sun, 24 May 2009 18:24:24 +0000</pubDate>
		<guid isPermaLink="false">http://pajamasmedia.com/?p=56814#comment-265659</guid>
		<description>Slider, your dead wrong on this.  The only function of the private health care insurance industry is profit.  They do not care about your health.  Their only function is to take in more money in premiums than they pay out in claims.  They answer to the shareholders, not the patients.  The bean counters make the decisions, not doctors.  

I don&#039;t know about your personal situation, and I am glad that you got the treatment that helped you, but I&#039;m guessing that you either have a Cadillac health plan or you had to haggle a whole bunch to get it.  People are denied life saving treatment ALL THE TIME and you know it.  Bottom line: no matter what system we have there will be controls.

In terms of Medicare, it is running into a demographic problem (we, as a society, are aging) but it, if you judge by the results is a fantastically successful program.  Seniors are living much longer and healthier lives (my grandmother was 102 when she died, thanks to Medicare).

Ultimately, I believe there are philosophical differences that anchor your position and mine.  Personally, while life is a wonderful thing, I do not believe that it is so precious that it should be extended as long as possible and at any cost.  Some people end up getting your, so called, life saving treatments only to add six months to their life.   My grandmother died at 102 from a sudden stroke.  While she was getting a little slow she was pretty healthy up until then, so she didn&#039;t cost the system massive amounts of money (most health care costs are incurred in the later years of an individuals life).  I&#039;m pretty young, but I understand that we&#039;re all going to die someday, some sooner than others.  I suspect, if my relatives are any indicator, that I&#039;ll be around a long time but I could also get hit by a bus tomorrow.  It sucks but that&#039;s just the way it goes.  ACCEPT IT!</description>
		<content:encoded><![CDATA[<p>Slider, your dead wrong on this.  The only function of the private health care insurance industry is profit.  They do not care about your health.  Their only function is to take in more money in premiums than they pay out in claims.  They answer to the shareholders, not the patients.  The bean counters make the decisions, not doctors.  </p>
<p>I don&#8217;t know about your personal situation, and I am glad that you got the treatment that helped you, but I&#8217;m guessing that you either have a Cadillac health plan or you had to haggle a whole bunch to get it.  People are denied life saving treatment ALL THE TIME and you know it.  Bottom line: no matter what system we have there will be controls.</p>
<p>In terms of Medicare, it is running into a demographic problem (we, as a society, are aging) but it, if you judge by the results is a fantastically successful program.  Seniors are living much longer and healthier lives (my grandmother was 102 when she died, thanks to Medicare).</p>
<p>Ultimately, I believe there are philosophical differences that anchor your position and mine.  Personally, while life is a wonderful thing, I do not believe that it is so precious that it should be extended as long as possible and at any cost.  Some people end up getting your, so called, life saving treatments only to add six months to their life.   My grandmother died at 102 from a sudden stroke.  While she was getting a little slow she was pretty healthy up until then, so she didn&#8217;t cost the system massive amounts of money (most health care costs are incurred in the later years of an individuals life).  I&#8217;m pretty young, but I understand that we&#8217;re all going to die someday, some sooner than others.  I suspect, if my relatives are any indicator, that I&#8217;ll be around a long time but I could also get hit by a bus tomorrow.  It sucks but that&#8217;s just the way it goes.  ACCEPT IT!</p>
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