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  1. #1
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    Good read, IMO.

    Jury delivers $25.5 million 'statement' to Aetna to change its ways

    (CNN)An Oklahoma jury has awarded $25.5 million to the family of a cancer patient denied coverage by Aetna, with jurors saying that the insurer acted "recklessly" and that the verdict was meant as a message for Aetna to change its ways.
    The award is believed to be the largest verdict in an individual "bad faith" insurance case in Oklahoma history, one court observer said, and could have major ramifications across the country for a form of cancer treatment called proton beam therapy.
    The case revolved around the 2014 denial of coverage for Orrana Cunningham, who had stage 4 nasopharyngeal cancer near her brain stem. Her doctors wanted her to receive proton beam therapy, a targeted form of radiation that could pinpoint her tumor without the potential for blindness or other side effects of standard radiation.
    Aetna denied her coverage, calling the therapy investigational and experimental.

    https://www.cnn.com/2018/11/10/healt...ham/index.html

    For those averse to CNN, here's a Fox link:
    https://fox61.com/2018/11/10/jury-de...ange-its-ways/
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  2. #2
    Believe.
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    Unfortunately,

    Companies like Aetna knowingly play the odds and 25 million is just a gamble that they gladly pay because they allow many people to die instead of treating them properly.
    They figure most will die before suing and possibly winning a case. They will not spend millions in treatment of people with serious illness and just deny them and watch them die.

    Once in a while they will pay out these judgements and still come out ahead.

    The medical game is now;

    Get patients hooked on meds
    watch as the meds become addictions
    begin to treat the "side effects" which the meds caused in the first place
    once the patients are too expensive to treat - deny them coverage
    hope patients die before their lawsuits get to court

    Sickening new reality.

  3. #3
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    "Those aged 65 to 69 take an average of 15 prescriptions per year,

    while those from 80 to 84 take an average of 18,

    according to the American Association of Consultant Pharmacists
    . It’s a practice that begins early. AARP found that,

    on average, 45-year-olds take four different prescription drugs — every day
    ."

    https://www.huffingtonpost.com/ann-brenoff/elderly-taking-too-many-pills_b_7079060.html

    DTC's $100Bs have LIED to people that their health DEPENDS on BigPharma.



  4. #4
    Mr. John Wayne CosmicCowboy's Avatar
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    We will never solve the health care cost issue. Health care has gotten too good. There is a drug or surgery for everything and people live longer and longer using more and more expensive health care.

  5. #5
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    As long as profits (amassing Capital) are more important than health care, health care will continue screw Americans badly throughout their lives.

    USA spends more than any other industrial county and gets worse health care outcomes.

    Health care isn't the desired outcome, profits are.

  6. #6
    Veteran DMC's Avatar
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    They'll probably never pay the actual penalty and if they ever do it will go mostly to the lawyers.

  7. #7
    Veteran vy65's Avatar
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    The family would still clear 15mm with a 40% contingency, so no.

    You’ll have a point if the OK appellate courts are anywhere near as conservative as those in Texas (which is a safe bet). Awards like this come out of the Texas trial courts and get widdled away on appeal. But, it might stick if OK voted in a bunch of democratic appellate judges like what happened here last week. Still doubtful though.

  8. #8
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    We will never solve the health care cost issue. Health care has gotten too good. There is a drug or surgery for everything and people live longer and longer using more and more expensive health care.
    All we have to do is put it under govt control so people like this have no recourse when denied expensive coverage.

  9. #9
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    IMO, it's ridiculous that the insurance company approves it for children, but if you're an adult the excuse is that it's experimental. You can't have it both ways, it's either experimental or it isn't.

  10. #10
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    We will never solve the health care cost issue. Health care has gotten too good. There is a drug or surgery for everything and people live longer and longer using more and more expensive health care.
    We never are going to solve it if we never tackle it, that much is clear. We also need to acknowledge, if the case is as you put it, that the insurance model is outdated, and won't serve the best interest of patients.

  11. #11
    Believe. Pavlov's Avatar
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    We never are going to solve it if we never tackle it, that much is clear. We also need to acknowledge, if the case is as you put it, that the insurance model is outdated, and won't serve the best interest of patients.
    CC just can't believe that basically every other country in the world has this better figured out.
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  12. #12
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    "people live longer"

    American white people longevity has been going down (unique among industrial nations), due to suicide from drugs, alcohol, and of course super reliable guns.

    My guess is they see little future for them and their kids as the so-called booming economy has meant nothing for them.

    While the oligarchy has been enriching itself beyond insane, govt, starved of funds and of care For The People, has been cutting mental health care, while the oligarchy has been killing good jobs and fleecing the non-oligarchy.

    Last edited by boutons_deux; 11-11-2018 at 05:55 PM.

  13. #13
    Veteran DMC's Avatar
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    The family would still clear 15mm with a 40% contingency, so no.

    You’ll have a point if the OK appellate courts are anywhere near as conservative as those in Texas (which is a safe bet). Awards like this come out of the Texas trial courts and get widdled away on appeal. But, it might stick if OK voted in a bunch of democratic appellate judges like what happened here last week. Still doubtful though.
    Thanks.

  14. #14
    Veteran DMC's Avatar
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    We never are going to solve it if we never tackle it, that much is clear. We also need to acknowledge, if the case is as you put it, that the insurance model is outdated, and won't serve the best interest of patients.
    You're not going to be able to build a system from ground up which is what you would need to ever bring to fruition some of the ideas I've read here. The system we have now cannot be modified nearly as easily certainly not as extremely as some people here are suggesting.

  15. #15
    Veteran DMC's Avatar
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    CC just can't believe that basically every other country in the world has this better figured out.
    So what is it about the United States that makes you want to live here instead of living in one of the other countries? If you want only the good things and none of the bad, that's just wishful thinking.

  16. #16
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    So what is it about the United States that makes you want to live here instead of living in one of the other countries? If you want only the good things and none of the bad, that's just wishful thinking.

    Let's not forget that there are more homeless and destitute in our nation that need healthcare than the entire populations of nations that have it "better figured out".

    The "they have it figured out better" audience is too ignorant to the rest of any of those nations' people's financial cultures to make any more of a legitimate argument.

    We'll NEVER overcome this mess because the cost of actual healthcare, not just the ticket to the healthcare (insurance) has some kind of regulation to prevent the price exploitation we see here more than anywhere else because we're THE consumerists in the world.

  17. #17
    Veteran DMC's Avatar
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    Let's not forget that there are more homeless and destitute in our nation that need healthcare than the entire populations of nations that have it "better figured out".

    The "they have it figured out better" audience is too ignorant to the rest of any of those nations' people's financial cultures to make any more of a legitimate argument.

    We'll NEVER overcome this mess because the cost of actual healthcare, not just the ticket to the healthcare (insurance) has some kind of regulation to prevent the price exploitation we see here more than anywhere else because we're THE consumerists in the world.
    I have yet to see a legitimate plan laid out for how any of these utopian societies would function in the United States. You have to get there from where we are now not from some imaginary point in an alternate reality.

  18. #18
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    I have yet to see a legitimate plan laid out for how any of these utopian societies would function in the United States. You have to get there from where we are now not from some imaginary point in an alternate reality.
    Those "Utopian" societies are utopian in the sense they aren't spoiled Americans.

    It's a very complex solution but the answer includes Americans being honest with their addiction to consumerism.

    The absurd tax rate to provide the type of healthcare the other nations that are 1/50h our size employ would kill the average American. Period.

    The average American spends more on goods than any other average citizen from these small nations. Since we are a huge country that has hundreds of millions of spenders, it'd take generations to get off the dependence and also figure what the hit to the global economy would be IF we did figure this out and the general public accept they will have to stop liking new stuff as much because health care is, ya know, healthcare.

    It's a societal issue American's aren't ready to even explore.

  19. #19
    Veteran DMC's Avatar
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    I believe there's lower hanging fruit than a total overhaul of the Medical Healthcare System. For example, it's not uncommon when you get blood work done that you will be asked to go back in a few weeks to have it done again. And then a few weeks later you might be asked to go back and have a different set of test run that could have been done on the exact same blood work test that you had done prior. You might go in to see a doctor for shoulder pain and they might ask for x-rays, MRI and other tests that are completely unnecessary because you have a history of something like gout or other arthritis. I feel like too many tests are being run now just for the sake of running the test. This is especially true in an emergency room. Go into an emergency room and complain of chest pains, you'll be $10,000 in in the hole before you get out of there. You could only have a chest cold.

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