American Health Care at its best?

I was talking with a buddy the other day.  He lives and works in Denver, Colorado. He has developed at strange lump on his nether region and sought the advice of his local doctor. He is one of the lucky Americans because he has health care coverage through an HMO paid for in part by his company. For those who do not know, an HMO is the American equivalent to a combined group practice and membership-only clinic.

HMOs general work pretty well as long as you don't have a really difficult case because many HMO also subscribe to a regime called managed practice. One example of managed practice is as follows; if you have condition A, you can be treated for condition A. But is you have condition A and then develop condition B, you may have to wait for condition A to be cured before condition B is treated because, and here is the real rub, the insurance companies that fund the health care coverage will not pay for the second condition. Why not? There is a caveat in many US health care policies that talk about pre-existing conditions. Condition B may or may not be related to condition A but the pre-existing condition clause make the insurance company the arbiter of the condition... not the doctor.

In my buddy's case he had a hernia about 10 years ago - before he went to work for his current company. His insurance company decided that his current suspected condition was the consequence of that hernia. It is a totally stupid assertion but try to fight the insurance company over it.  The company will not pay for his treatment.  Maybe he should come to Canada for treatment.  Or maybe go to Mexico or even... Cuba.

With all its warts and blemishes the Canadian health insurance system does better than my buddy's private one. Just remember that when the Cons come knocking on your door trying to sell you a private plan.