Cut price defences – so government department doesn’t fear appeals

Many people believe it would cost the government less to pay disability benefits from the beginning, rather than face appeals.

The benefits, Employment and Support Allowance, and Personal Independence Payment, are claimed by people with disabilities. These include those of us with disabilities resulting from diseases such as MS, or other causes.

I was one of the many who thought the appeals were expensive. Now, though, figures found in the back of a new department for work and pensions (DWP) document show a different story. 

Indeed, it seems the UK’s DWP can make a ‘mandatory reconsideration’ decision for less than £40. Further, appeals can be handled for under £100 each.

For that sort of money, you have to ask how much commitment the department is devoting to reconsiderations and appeals. In short, not enough time for the decision-maker to give any real attention to each case.

appealsCampaigner and claimant-helping website workandbenefits.co.uk agrees. It says: “More likely, it’s enough for a very quick flick through the papers, maybe a phone call and then cutting and pasting some standard phrases refusing to change the decision.

“And for an appeal, which might run to over 100 pages of documents, £100 isn’t going to pay for more than the time needed to collate the paperwork and send it to the Tribunals Service.”

That’s ridiculous, but it is cheap! And that’s why the DWP does it.

appeals

Sir Ernest Ryder (pic: judiciary.gov.uk).

It doesn’t care that it’s defence of decisions, at appeals, have been rubbished by a top tribunal judge. Sir Ernest Ryder, senior president of tribunals, says most of the benefits cases that it hears are based on bad decisions where the department has no case at all.

Tribunal appeals: DWP defences poor

He told barristers, at a meeting of the Bar Council, that the quality of evidence provided by the DWP is so poor it would be “wholly inadmissible” in any other court.

Ryder also said tribunal judges found that 60% of cases were “no-brainers” where there was nothing in the law or facts that would make the DWP win.

He added that he and his fellow judges were so incensed by the volume of such cases that they were considering sending them back. Either that, or charging the DWP for the cases it loses.

However, the new figures do point out the DWP’s logic.

Step one: the DWP refuses benefits to many thousands of people who should receive them.

Step two: the DWP makes all those who challenge the decision go through the dispiriting reconsideration process.

The DWP knows that most claimants will give up as soon as they realise that their mandatory reconsiderations have failed. Others will drop out during the appeal process itself and never reach a tribunal.

Of course, some do stay the course and do have a tribunal hearing, leading to:

Step three: the DWP resists the appeal but, in most cases, is unable to defend a clearly unjust decision.

The sad truth is that the DWP saves so much money through incorrect and unfair decisions that it can well afford the tribunal losses. Perhaps, Sir Ernest is right – the DWP should be made to pay, financially.

* * * * *

Affiliate disclaimer: This affiliate disclosure details the affiliate relationships of MS, Health & Disability at 50shadesofsun.com with other companies and products. Read more.

* * * * *

50shadesofsun.com is the personal website of Ian Franks, a freelance medical writer and editor for various health information sites. He enjoyed a successful career as a journalist, from reporter to editor in the print media. He gained a Journalist of the Year award in his native UK. Ian received a diagnosis of MS in 2002 and now lives in the south of Spain. He uses a wheelchair and advocates on mobility and accessibility issues.

Health: Debate over best system will continue

There is no doubt that I prefer social healthcare. That means I support healthcare funded by countries, such as the UK and Spain, rather than needing to buy private health insurance, as in the US.

Now, that is not to say either healthcare system provides superior medical care. It is purely about the costs.

health

An American protester calls for the country to have one health plan.

Neither system is entirely free as workers pay something from their salary or wages as contributions toward the cost. But there are other big differences. Social medicine is free at the point of use, with no charges for doctors’ treatment or hospital care. The same cannot be said of private health care, where even GPs charge fees and you need health insurance. In fact, in the US, not having health cover has legal penalties.

Despite that, many people find the cost of insurance to be prohibitive.

I find it strange, and more than a little ironic, that insurance costs got worse after the US passed the Affordable Care Act, otherwise known as Obamacare. How can ‘affordable’ equal more expensive? Some monthly premiums escalated from less than $60 a month to more than $300. And others cost a lot more.

Let me be clear, I am not saying the American system is flawed. It is just not for me.

Prescription costs a question of health

One item of contention in the UK is the cost of prescriptions. First, you must recognise that the UK IS made up of four healthcountries. A trip to the pharmacist in England will cost you £8.60 per prescription drug or item.  But prescriptions in Scotland, Wales, and Northern Ireland are all free.

Since Lisa and I moved to Spain almost two years ago, we have been surprised by the low prescription charges here. Yes, we do pay – but just cents, certainly not excessive.

The standard of care here is excellent but, as anywhere, it can vary from doctor to doctor. We recently chose to change our doctor to another within the same health centre. It was so simple.

Last week, I had my first appointment with our new doctor. He listened to what I had to say, prescribed a couple of medications, and, as I have MS, he referred me to see a neurologist. Stopping at reception on the way out, I left with a confirmed appointment with a neurologist. It will be my first in 12 years.

* * * * *

Affiliate disclaimer: This affiliate disclosure details the affiliate relationships of MS, Health & Disability at 50shadesofsun.com with other companies and products. Read more.

* * * * *

50shadesofsun.com is the personal website of Ian Franks, a freelance medical writer and editor for various health information sites. He enjoyed a successful career as a journalist, from reporter to editor in the print media. He gained a Journalist of the Year award in his native UK. Ian received a diagnosis of MS in 2002 and now lives in the south of Spain. He uses a wheelchair and advocates on mobility and accessibility issues.

Why are DMTs – Drugs to treat MS – Resisted by so Many?

Many people with multiple sclerosis await the launch of each new disease modifying therapy (DMT), hoping it will bring some improvement.

Meanwhile, a significant number of those in the same situation seem to ignore a new drug and carry on regardless. But why?

dmts

Different DMTs for MS can be infusions, injectables, or tablets.

Well, there are a number of reasons; let’s take a look at a few of them:

  • The newly diagnosed often delay starting treatment because they are in denial or just decide to ‘wait and see’ how the disease develops.
  • Very many of us dislike taking medications of any sort, for any ailment.
  • Others say ‘no’ after researching possible side effects before they decide that they may be riskier than the disease itself.
  • Some have a type of MS for which DMTs have little or no benefit.

Of course, there are other reasons too, such as costs, and I am not decrying those.

I fully understand the ‘wait and see’ approach, especially at diagnosis, when symptoms may not be too bad. But research tells us that it is one of the worst choices that can be made. And that is equally true of clinically isolated syndrome (CIS) that can lead to MS.

DMTs: Better to start treatments early

Healthline.com explains: “Experts recommend starting one of the DMTs approved by the Food and Drug Administration as soon as a diagnosis is made. A study published in the Journal of Neuroscience Nursing, found that patients with MS or CIS benefit from starting treatment the first time they experience an event suggestive of MS.”

It continues: “Other research has found that delays in treatment, even in those with CIS, may result in more severe disability and a poorer response to treatment with DMTs later on.”

I think most of us resist taking ‘unnecessary’ medications and there is nothing wrong with that. It’s just a case of recognising, in consultation with your doctor, which treatments are needed and which aren’t.

Now, let us turn to the vexed issue of side effects. All drugs, not just ones to treat MS, have their own list of both common and rare side effects. I recommend you discuss this with your doctor, to ensure the benefits are worth any risk. The ultimate decision, however, is yours; it is your body.

Not every type of MS responds to every DMT. Most are suitable for the relapsing form of the disease where they work to prevent relapses. Relapsing patients who go on to develop Secondary Progressive MS often continue with the same drugs. Currently, nothing exists that is more suitable without having too high a risk.

For primary progressive MS patients, there is a new DMD that is now approved as a treatment in the USA. The drug is ocrelizumab, brand name Ocrevus.

DMTs for me?

I am frequently asked what drugs I take for MS. The answer, perhaps strange but nevertheless true, is ‘none’. In fact, in the 15 years since diagnosis, I have never been offered any drug treatment. Yes, I have pills to treat various symptoms but nothing for MS itself.

To be fair, though, I do check out each new drug and its side effects and there isn’t one that I’d be happy to take. A serious side effect, death, may be rare but it is final.

Enough said!

* * * * *

Affiliate disclaimer: This affiliate disclosure details the affiliate relationships of MS, Health & Disability at 50shadesofsun.com with other companies and products. Read more.

* * * * *

50shadesofsun.com is the personal website of Ian Franks, who has enjoyed a successful career as a journalist, from reporter to editor, in the print media. During that career he gained a Journalist of the Year award in his native UK. Diagnosed with MS in 2002, he continued to work until mobility problems made him retire early in late 2006. He now lives in the south of Spain. Besides MS, Ian is also able to write about both epilepsy and cardiovascular matters from a patient’s perspective. Besides that, he is a keen advocate on mobility and accessibility issues.

MS Patients in US and UK Face Very Different Treatment

healthcare costs

We may have international cooperation and worldwide this and that, but the fact remains that countries vary drastically from one another in all sorts of ways. Take healthcare as an example, and the costs of treatment.

Yes, we have the World Health Organization and there are various health-related initiatives from the United Nations, but that is about it on the international front.

Let’s have a brief look at healthcare provisions, including how they affect people with multiple sclerosis, in two Western countries said to be close allies and who enjoy what they term a “special relationship.” That’s the United States of America and the United Kingdom.

I was born, and lived my entire life until last year, in the U.K., which is supposedly a welfare state. I say “supposedly” because, at the rate at which David Cameron’s government was cutting the welfare budget, there can be no certainty this will continue.

Anyway, a key element of the founding of the welfare state, just after the Second World War, was the setting up of the National Health Service, which includes all GPs, hospitals, and ambulance services. It is a healthcare service that took good care of me when I lived there.

And everyone living in the U.K. is entitled to the treatment they need absolutely free of charge. Yes, you did read that right. The British do not need private medical insurance, have no co-pay to worry about. If they fall ill they just visit their family doctor, or go to a hospital if their condition’s more serious, where they know all tests, treatments and stay, if admitted, will not cost one penny.

World’s apart

The only expense they may incur is the small cost of prescriptions, and only in England. Charges for these, all of which go to the government, vary by country. Residents of England face a prescription charge of £8.40 (about $11.15) for each medicine or appliance dispensed. In each of the other constituent countries in the U.K., namely, Wales, Scotland and Northern Ireland, all prescriptions are free. There are, however, charges for NHS dental and optician services.

It’s a far different story in the U.S., however. If you live outside that country, as I do, then let me assure you that what became known as Obamacare is far from NHS-style service. It still requires that hefty medical costs be paid.

Americans go to see their GP – they get a bill; they go to a hospital as an outpatient — they get a bill; they see a specialist – they get a bill; they are admitted to a hospital – they get a bill; they have an operation – they get a bill; they are taken to a hospital by ambulance – they get a bill.

The costs go on and on, and can really add up. Then there are prescription costs, which can be tremendous. A study published in May 2013 in the Journal of Medical Economics found that the total cost of healthcare for MS patients in the U.S. ranged from about $8,500 to more than $54,000 per year during the period studied (1999 to 2008), with prescription drugs accounting for a large percentage of those costs.

OK, medical insurance policies may cover most of these costs, but not all. Most policies in the U.S. come with co-pays, sometimes substantial ones. The precise level of a co-pay, or the portion of total health costs carried by patients, depends on the specific insurance policy. And then, again, patients still have to pay for their insurance, except for those whose employer pays or who qualify for help.

Clearly, even among special friends, we’re often worlds apart. And I, at least, find that sad.

 

This article, written by me, firs t appeared on Multiple Sclerosis News Today website.

 

MSNT-strapline-copy-2

 

 

Ian Franks

Ian Franks is Chief Patient Columnist with MultipleSclerosisNewsToday.com. He has enjoyed a successful career as a journalist, from reporter to editor, in the print media; during which he gained a Journalist of the Year award in his native UK. He was diagnosed with MS in 2002 but continued working until mobility problems forced him to retire early in late 2006. He now lives in the south of Spain and uses his skills to write his own flourishing specialist Health & Disability blog at http://www.50shadesofsun.com. Besides MS, Ian is also able to write about both epilepsy and cardiovascular matters from a patient’s perspective and is a keen advocate on mobility and accessibility issues.