I received this email today:
Questions: How would it be handled under UHC in the U.S.? How is this kind of situation handled in other countries?
ETA: How do Medicare and the VA handle it?
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She’d have been given a prosthetic leg on the NHS in the UK.
In Canada her insurance would not ‘run out’, so she would not have a debt, hence no repossession of her leg.
In UHC the risks (of the costs of those with special needs) are spread over an enormous base, (basically the whole province/territory), so there is no real need to cap coverage or deny coverage for those with the greatest needs. It’s not going to bankrupt a small pool, because it’s a huge pool.
Which is not to say every, every, thing is fully covered. The latest technique; maybe, maybe not yet. Questionable drugs/techniques, maybe they are still waiting to see. With every system there are lines drawn somewhere, etc.
Who gets a leg amputated from the flu?
How that would be handled is pretty much orthogonal to the issue of UHC. In the United States’ current system some insurance programs would have covered it, others would have covered even less than that unfortunate girl’s did. Likewise, each country’s UHC is different. Probably in some of those programs an expensive prosthesis would be covered and in others it wouldn’t. Many people covered by UHC have some sort of private, supplementary insurance as well.
UHC does not ensure an infinite amount of resources will be applied to every malady, it’s just a way of making sure everyone has access to healthcare. It also seems to do it at a lower cost than the United States’ current system.
Didn’t we have similar questions like this already several dozen times?
Why do you people bother asking non-Yanks if you only keep dismissing it?
The answer is always the same: in socialist Europe and Canada, healthcare means that people’s health is taken care of. Nobody gets in terrible debt to receive care. There are no death panels for people like Stephen Hawking. There may be waiting times depending on how many doctors are there in the place you live - which happens in the US, too, from what Dopers say. People go to the emergency room for emergencies only and to the Doctor for normal visits.
Healthcare outside the US is cheaper both for individual persons paying their part (indirectly through taxes or directly to Health insurance) and on the national level. And the quality of medicine is not worse than the US because more people get care. There are also specialists to handle difficult cases. It’s also untrue that all wealthy foreigners go to the US because it has the bestest care in the world or because of the terrible waiting lines - foreigners come to Europe, too, for special treatment. Clinics in different cities are known as top specialists for subject X, and depending on the subject, you go to Berlin or London or Paris, just as in the US you go to Hopkins or other specialists. And just as some Yanks go to Mexico for cheaper treatment, Europeans go to Eastern Europe and Turkey for elective (cosmetic) surgeries.
There was a TV documentary series about a children’s hospital specializing in leg and prostetic treatment. They showed a young woman with a missing leg who rejected a prothesis for over 15 years until finally those specialists showed her one she was happy with. (They showed her riding inliners with two sticks like a devil on wheels before she got it).
In the second season, a girl with a missing leg had seen the first season on TV and therefore came to the clinic to also get a protesis; she and the young woman even bonded.
So the protesis wouldn’t be repossessed, she wouldn’t have to rely on dead people’s parts, but would get a custom-fitted protesis plus physotherapy to cope with it. If she refuses protesis (many contergan kids do for example, they don’t want to be forced to “look normal” anymore like adults tried to do to them in the 60s and 70s), then she goes without.
Any other questions?
[ul][li]Please point to where I’m dismissing anything.[/li][li]I’m asking non-Americans because we don’t have UHC and I want to know how this specific situation would be handled in other countries.[/li][*]This is not a debate. This is a question about how this situation is handled in other countries, how the VA and Medicare handle it here, and (speculative) how it would be handled in the US if the US had UHC.[/ul]
I think it’s important to point out that, assuming that “the insurance ran out” means that they reached their total lifetime limit, that is no longer legal in the US. The Affordable Care Act makes it illegal to put lifetime or annual limits on essential medical care.
I don’t know what sort of help you would get for a prosthesis in Alberta. I’m guessing that the basic Alberta Health Care coverage wouldn’t cover it since I see that my supplementary Blue Cross coverage does cover some types (I can’t see why Blue Cross would mention anything that Alberta Health Care already covers). However, we have something called Alberta Aids to Daily Living that is free and universal (to Alberta residents) that helps with things like wheelchairs, so it might help with prostheses; never needed one, so I don’t know. Other provinces may have similar plans. Just remember, in this context “universal” means everyone, not everything.
That said, the story looks like crap to me. How does a viral respiratory infection (the flu) result in the need to amputate? I understand prostheses are custom-fitted; if that is the case, what would be the point in repossession (and why would it be an insurance company doing the repossession)?
[quote=“Johnny_L.A, post:7, topic:609702”]
[ul][li]I’m asking non-Americans because we don’t have UHC and I want to know how this specific situation would be handled in other countries.[/li][/quote]
The same as the dozen other situations that have been asked about last year when UHC was being discussed in the US legislature and on these boards. One thread after the other was “How would this situation be handled in UHC/ other countries?” Every time, the answer was “people get treatment without going bankrupt. (In special situations, like extremly experimental techniques or Meds that haven’t been approved yet, conventional treatment will be done instead. If a specialist lives 500 or 1500 km away and it’s a sick child, the parents have to pay the travel cost themselves etc.)”
What’s so difficult to understand about the principle of “people are insured so they get treatment - no pre-existing conditions; no kicking out of insurance once somebody gets a disease; not based on employer; no special varying conditions on how much is covered - just people get treatment. They might have to pay a fee for the doctors of 10 Euros or 12 Euros for the meds. They have to pay 10 Euros per day for staying in a hospital bed (if they are poor, those fees are waived).”
[quote]
[li]This is not a debate. This is a question about how this situation is handled in other countries, how the VA and Medicare handle it here, and (speculative) how it would be handled in the US if the US had UHC.[/ul][/li][/QUOTE]
I didn’t say it was a debate. But those other threads always followed the same scheme: the pro-UHC side and the socialist foreigners talk about how it works; then the anti-UHC side comes in and simply denies it. Why should this go a different route?
Not that it’s limited to this forum - a major economist newspaper did report after all that if Stephen Hawking had been born in the UK, he wouldn’t have been allowed to live because he couldn’t contribute to society or similar (death panels, in other words). So apparently your people aren’t interested in facts.
Yes, of course there’s a difference between “standard wheelchair that gets you from A to B” (and costs the insurer x Euros) and “super racing model that’s suited for additional activities” (and costs the insurer x+ 5 000 Euros). A patient in socialist EUrope/ Canada will always get the standard model, but might need to explain the reason for wanting super model, and might get denied that.
But in this case, it’s apparently the choice between “custom-fitted protesis” (which is the only way they work) and “no protesis” (Because one borrowed from somebody else won’t work.)
And that wouldn’t happen in a normal insured country.
The OPs story mentioned “gangrene or similar”. The flu is nasty; if you have to get hospitalized, you can get those Multiresistant bugs - and those might necessitate amputation. (An elderly relative of mine who should have known better at his age was climbing around on a ladder half a year ago, fell down and broke his leg; in hospital, he got a MMR bug of some kind and ended up with amputation).
As long as it isn’t flesh-eating necrosis …
Well the point is: If you (the customer) don’t pay for the item, you don’t get to use it.
That the insurance company can’t use it, either, is a secondary issue.
I was challenging the OP! I agree totally with most of your reply (notice I’m Canadian; we have UHC). However, you do know that the flu is a particular, viral, respiratory illness?
Perhaps the real answer is that with UHC an enormous savings is realized because people access care based on need without regard to co pay or rate hikes or being denied coverage.
Which, it’s starting to sound like, may have meant she would have received care early enough that she would likely have not lost her leg.
Preventative care, timely care, are all enormous budget savers in the big picture.
Um, yes. It’s also an illness that can turn bad enough to kill. A flu can easily turn into pneumonia, high fever, dehydration and other serious issues that requires hospital; and once in the hospital, a patient - esp. if weakened because the disease has been allowed to progress too far* or because it is a particularly “nasty” = dangerous strain - can catch a different, MMR “bug” (bacteria or virus); and the secondary infection might necessitate an amputation to stop it.
*because of problems with health insurance / high copay/ non-coverage of flu / similar delayed a visit to the doctor and proper treatment.
The OP doesn’t give much details - name of girl? City this happened in? Hospital she was treated at? Date? Insurance company? Nothing that can be checked up on (a FOAF story emailed around?), which also makes it difficult to assess the real cause, even for one of our doctor dopers - and IAMNADoctor.
Pssst, don’t go confusing the Yanks with facts that have been repeated a hundred times already - they know that if visits to the doctor were free, people would just abuse it, because Nixon said so back when he wanted to destroy anything socialist like affordable medical care. Obviously if they claim that free doctor visits would be used by elderly and lonely people wanting human contact clogging up all the waiting rooms, then this is exactly what would happen, but the benefits of preventive care that countless studies in Euro-Can countries have shown would not happen.
Please don’t generalize about “the Yanks.” Some of us, myself included, would much rather see universal health care than what we have now.l
I’ll second this. I’d even go so far as to say the majority of Americans I know would prefer UHC.
We’re not all nutso like the media portrays.
[Moderator Warning]
constanze, I have recently warned you about political jabs in General Questions. This is another official warning. If you can’t restrict yourself to answering questions factually in this forum, then don’t post here at all. If you keep this up you will find your posting privileges under review.
Colibri
General Questions Moderator
In Spain she would have had to pay nothing at all for most items; 60% on prescription medication obtained outside the hospital (see 1 below); she would have been fitted with a prosthetic leg (see 2) as needed and provided training in how to use it and care for it. Some Autonomous Regions are now introducing a “cost information bill” they give to patients showing how much the expenses associated with their care have been, but you don’t pay it. There would have been limits on how much physical rehab and psychological assistance she got from SS; if she wanted more or a different kind (see 3), she would have chosen a therapist with a private practice and paid for it herself.
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At 18 she would usually be considered “active and able”; if she was declared disabled with a disability over 33% (which for a missing leg would usually be the case), then she’d move to the group of people who don’t pay for medication if it has been prescribed by an SS doctor (they pay in full if it’s been prescribed by a doctor from a private practice). This is the case for medically-disabled folk even if they hold full-time jobs, as they’re assumed to have more expenses than healthy people due to their disability. Her family would also be able to access assistance for items such as improvements to their home required to make it more livable for her; for example, if there wasn’t any shower-only bathrooms, to remove one bathtub and turn that spot into a flat-to-the-floor shower.
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Normally this would be your basic “articulated at the knee, made of plastic, looks a lot like a doll’s leg” prosthesis. SS would pay for a better model only if it was part of a study or if there was some special reason for it. If she wanted a better model, she’d have to purchase it herself (well, her parents probably, at 18 and in Spain).
If she was a kid, SS would pay for replacement prosthesis as growth made them necessary. -
Example: my mother gets a month of physical rehab every year from SS; she also goes to a massage therapist once a month, paying for it.
From the UK Limb Loss Information Centre:
ETA: realised the bit about insurance could be misleading as it is insuring of the leg, not insurance for the leg.