Ranting to /dev/null

Wow, a hospital with a smoking habit. Those brits take their fags seriously.

I appreciate where you're coming from, but working in the healthcare industry myself, I can honestly say that you're wrong about private insurance companies "ponying up for any treatment no matter how ineffectual, unproven, or expensive." It is the employers themselves that determine what is covered under their health insurance plans. The insurance company merely bids on a contract to obtain the business. Health insurance is very expensive, and providers and insurance companies like to keep costs low however they can without jeopardizing their business because it will allow them the best chance to make money.

There are indeed certain pre-defined, pre-disclosed things, like pre-existent conditions, that insurance will not pay for, but the rule of thumb is that you're pretty much covered. The kinds of things that American policies exclude tend to be conditions, while the Brits are starting to rule out kinds of treatments.

Usually you do good research before making claims, so your comments come as a bit of a surprise to me. Can you tell me what your basis is for saying "the rule of thumb is that you're pretty much covered." What it seems you're forgetting is that employers negotiate with insurance companies what will and won't be covered before it takes effect. Then the insurance company determines the appropriate premiums or fees for covering all the things that an employer wants covered. Particularly when it comes to group insurance, employers pay fees per employee to insurance companies for administering the plan only and determining which claims meet the conditions agreed upon ahead of time by the employer.

On a side note, I think what you'll find as time goes on is that employers will decide that medical insurance is not necessarily something that they will consider "standard." That will turn the healthcare insurance industry on its head because that means people will be looking for individual rather than group coverage.

One other thing I should have mentioned is that what is covered and how much of it is covered is also determined by the plan you elect (i.e. PPO, HMO, Indemnity, etc.). The less you pay in premiums, the more risk you assume for your healthcare cost. Conversely, the more you pay in premiums, the less risk you assume for your healthcare cost.

I also work at the same place as Rob and concur with his comments. Healthcare plans are essentially a salary benefit for employees. Your boss decides how much he can afford to partner with you on the cost of your healthcare and looks for a suitable plan. Sometimes they even pay for all of the premiums. It's our job to help them select the type of plan that is appropriate for their budget and ability to handle risk.

In terms of how that relates to what we cover and don't cover, there are some items that are off the list (e.g., bariatric surgery), but it is the employer who largely determines the richness or lean-ness of the plan. I wish that more people understood this concept, as there is no such thing as a free lunch in healthcare. Somebody has to pay for the services, even when private insurance is involved. And as long as the government isn't paying for it, then they have no business denying the treatment.

That doesn't mean that insurance companies just pay every claim or that we don't try to encourage healthy lifestyles; as we have plenty of programs design to get people quit smoking, stay active, etc. We also have doctors and nurses that work for us as case managers who get involved with large claims such as the ones you cited in your post. Those people are there to assist people in making wise healthcare decisions.

Private health insurance, employer-sponsered health insurance, both work exactly the same in the sense that both provide coverage for previously disclosed and declared losses. The only difference is who gets to chose what's declared and what isn't. But If a given condition is covered, the insurance company is legally obligated to pay as agreed up to any pre-defined cap. They do get some says as to where you get your treatment - again, this is all previously disclosed - but they don't get to tell you that a given treatment is too expensive unless they've already excluded it from your policy on your declarations page. And having just read a health insurance declarations page, the items on there have far more to do with conditions than treatments. They will cover admittance to the hospital for trauma, cardiac conditions, etc., but they don't cover anything related to mental health. That's just the way my policy is written.

In essence, the NHS is saying that there is a condition which is generally covered by them - Alzheimer's in this case - but that they aren't going to treat it anymore, because it is a huge expense for little benefit.

I am fully aware that a health insurance policy is not a carte blanche for expenses, and it covers carefully defined and explicitly disclosed conditions. But the NHS is taking a more restrictive approach than most American insurers are, and it's certainly far more restrictive than the Mediplans.

OK, so:
1. Britain's National Health Care System is more restrictive in the conditions that they will treat than the average health care plan bought in the U.S.,
2. Private insurance in the U.S. allows an employer to purchase coverage for whatever they want, whether that is based on treatment or condition, and offer this to their employees,
3. The U.S. employers generally choose to offer coverage for treatments that the NHS wouldn't.

I cannot see how this would bother you on an economic level, as you generally seem to be a fan of people being able to access whatever they want, so long as they pay the price. And in this case the employers choose to buy this product for their employees.
Would you rather that they did not have that choice?