Ask500

That's not actually the way it works. Kidney transplants are paid 80% by Medicare. We had medigap insurance that would pay most of the other 20%. Medicare did not cover non-kidney related costs. Private insurance paid 80% of dialysis costs. We paid out between $120,000 and $130,000 out of pocket before it was all over. Money was not an immediate problem for us, but I can no longer retire without going to a much lower standard of living.

Technically, the government doesn't limit transplants. As you mentioned, there is a shortage of transplant organs. The government sets the standards about what transplants Medicare will pay for. It is all very reasonable that transplant organs should go in the patients without other major problems that are likely to kill them. It's reasonable for the transplant organs to go to those patients with the greatest likelihood of success. It is even arguable that they should go to parents who have children at home. Although I have some ideas about increasing transplant options, I agree that there has to be some kind of basis to decide who gets a transplant organ.

Medicare sets the requirements because they pay most of the bills. In 1992, it took a transplant team 6-8 weeks to meet Medicare requirements for a kidney transplant. In 2003-07, it took the same transplant team 189 weeks to meet the Medicare requirements for a kidney transplant. Now remember that this is just to get on the waiting list, not the time required to actually get a kidney once you are approved. We had no choice in how these requirements are met... none at all.

Some have suggested that it's one of the ways the government can save money. Transplants are very expensive and my wife died before she got one. Though I grant the possibility, I don't believe it in this case. I dealt with the transplant teams for years and from top to bottom, they were unfailingly professional, caring and excellent patient advocates. It's more likely to be a problem with the nature of medical bureaucracy. Efficiency is measured by whether a patient recovers and how fast a patient recovers. By requiring every test known to man and appointing people to audit every decision made, you CAN make the numbers go up. If you can make the numbers go up, you get to keep your job and maybe even move up in the organization. The head of Medicare gets to stand before congress and swear that they are getting more efficient and cost effective. After all, they have the numbers to prove it. The only little problem from my point of view is that people die waiting.

This fits into the national health care debate because it illistrates a perfectly reasonable expectation of what we can expect of national health insurance in the US. If there are unintended casualties, there is no way to fix it. If private contracts are gotten around, there is legal recourse. If you prove your case with private medical care, private companies can be forced to change or dissolve. With Medicare, it doesn't much matter what I can prove.

This is a link to an alternate organ transplant view.

http://www.investors.com/NewsAndAnalysis/Article.aspx?id=511440

The best ones pay claims as stipulated in their contract. (policy) American Family and Allstate are poor payers. State Farm and Farm Bureau are much better payers. The poor payers have to be sued more often to get them to pay legitimate claims.

If its not possible for an insurance company to survive by paying out legitimate claims then please tell me how you expect a government to survive by paying out ALL claims?