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Comment by ruste | Hacker News Reader

Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government.

Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.

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Yes you can. In the UK people sue the government, or specially the NHS, over treatment decisions all the time. Including over things like denied coverage of specific drugs etc. (usually when there's no proven benefit from a given drug).

And as I pointed out: If you think they are too strict, then you can pay for a private insurer to cover things the NHS doesn't cover or won't do fast enough for you.

In Hillary Clinton's proposed health care plan in 1993, no, you weren't allowed to sue. You could get an appeal from a Board, but that's it. The proposed legislation explicitly said there could be no other review.

Note that this is a very good cost containment strategy. Note also that this can probably not reduce patient outcomes at all. Note also that it is extremely unpopular.

(successful) Suit against Medicare:

https://www.cms.gov/medicare/medicare-fee-for-service-paymen...

That case was against Medicare contractors. Not Medicare.

Jimmo v. Sebelius

The named defendant was the Secretary of Health and Human Services. The suit was over practices followed by Medicare contractors, but it's not like they were operating outside the knowledge of Medicare, they were acting as Medicare had directed them to act. The settlement agreement has Medicare changing the procedures the contractors will follow.

Except the very first paragraph states that the reason for the suit was that the contractors were not appropriately following Medicare guidelines.

"...in which the plaintiffs alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled care..."

I read that as mealy-mouthed cover for future questions about Medicare expanding coverage unilaterally, but I would agree that is pretty subjective.

... because Medicare contracts out services

You've got that almost completely backwards, though few people are aware of this (in the United States).

I'm hazy on the details myself, but briefly:

1. Healthcare insurers are covered under ERISA, the Employee Retirement Income Security Act, of 1974. Among the provisions of that act are limitations on the right to sue, under the theory that a retirement fiduciary is an agent of the employees. It's been a long time since I've looked at this, and I don't recall all the specifics, but yes, there are some limitations on suit for lack of coverage.

https://en.m.wikipedia.org/wiki/Employee_Retirement_Income_S...

2. Lawsuits against the government are possible and happen all the time. I'd have to see what specific limitations apply, if any, to Medicare, Medicaid, Disability, and VA care, but you'll find numerous instances of suits:

https://duckduckgo.com/?q=lawsuit+medicare+denial+of+(care%7...

Update, additional info on ERISA and its impact on lawsuits: appeals through the insurer must first be exhausted, but statute of limitations applies whilst lawsuits are blocked: https://www.lawyersandsettlements.com/articles/stock_option/...

"Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. "

With what money? And furthermore, what good will that do if you die before the trial is over?

You can have the procedure done then sue them when they won't pay for what they're contractually obligated to. You don't generally get a hospital bill until the procedure is done.

Will a hospital even perform the procedure if the insurance company has said no and they know the patient will never be able to pay for it?

> Except you can sue your insurance provider if they deny > you coverage for something that they're obligated to > cover.

There's an enormous information and power imbalance in the health insurance contractual relationship. The large number of medical bankruptcies by people that had health insurance is surely a testament to this fact.

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