Commentary: Some health care claims must be denied

Money Watch) COMMENT In response to my comments yesterday about the need for a universal mandate for health care coverage, here's another reality on the subject that all of us - especially our politicians - would be: It is inevitable that some medical claims are denied each time someone else, such as a commercial or government insurance entity will pay the costs. Indeed, companies probably will not reimburse the cost of "snake oil" remedies, and they will continue to demand for many procedures that have not been proven effective to refuse.

It is also reasonable to assume that the government insurance applications for procedures by health care providers who cost much more than the standard or average rates for such procedures to refuse. These restrictions often come with their own medical insurance now.

No health care, commercial or governmental, has an unlimited amount of money to spend to pay for claims. Limits should be set to control costs.

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As with all commercial health insurance, which will supervise a public need for medical, scientific and economic sense to use certain procedures to assess whether the fee will be rejected, either due to ineffectiveness or excessive costs. It is not only reasonable to suppose that this process would go from the government and insurance - it is expected to control costs.

So it is hypocritical for presidential candidate Mitt Romney to give the campaign that he would carve out $ 500 billion from Medicare, and then accuse President Obama to propose Medicare costs by this amount. Romney endorsed Rep. Paul Ryan program for containing Medicare costs, which happens to Medicare costs by $ 500 billion. It does not matter who's in charge, they are going to need to trim Medicare costs by reducing payments to or not too expensive treatments.

The point is that Medicare, like any medical insurance, it must continually treatments and procedures which are regarded as effective and efficient. That is the purpose of the Independent Payment Advisory Board (IPAB), the panel that will advise you how to contain the costs of Medicare.

The Republican opposition to the IPAB has no sense if you want Medicare's costs under control. The party says it opposes the government tell you what medical procedures and treatments are covered, but private insurers do the same now. They say they're opposed to an unelected board of directors to decide what care we receive. But insurance research, are not elected either.

The Republicans say that the use of the IPAB will lead to rationing of medical care. In a sense, that is what insurance review boards do when they deny claims. I have several friends and relatives denied claims from health care boards. Was that the rationing?

It's just a reality that an insurance program, commercial or governmental, will deny some claims. And this process will involve delivery of a number of actual human beings. We must live with this reality, and our politicians certainly do not help matters when she was at a process that commercial insurance programs already use to contain costs.

In case you want to accuse me of being a bleeding heart liberal or a heartless conservative, I will that now that I have never registered with a political party. When I was younger, it was because I could not figure out which party I wanted to join. But now it is a purposeful, conscious choice. I am shocked that so many politicians in both major parties are more loyal to their parties than to solving the problems of our country. We need leaders who will solve our country's challenges of their highest priorities, including reforming our current health care.


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