Socialism and Cancer

[CRguy]

While I respect most of the discussion offered here, there are some inaccuracies which need correcting. (( don't agree with it all !!! but I do respect the posters. ))

In no particular order and without pique or rancor, because I don't know whose post this reply may follow :

1. Canada is NOT a socialist state, which is a perspective I have inferred from some of the discussion regarding our health care system. Canada is a parliamentary democracy which, since the time of the late Tommy Douglas (1950-1960's), has attempted to enact and promote "universal health care." Possibly a distinction without a difference to some ?

2. I was the poster who sought info on the travel insurance to the USA, for the purpose of seeking a more timely PET scan. In a reply post to Gaelen, I clarified that while my government insurance AND private insurance would cover me for costs of medical care in the USA, they would not completely cover costs above the prescribed rate for similar services in Canada, specifically : the USA system is considerably MORE expensive than the Canadian system and I would have to cover the balance. NOT acceptable to me, to essentially be put in the category of being a "non-insured" patient in the USA system. Further, as a cancer patient seeking "diagnostics" I would be barred from even emergency medical coverage by the so called "travel" insurance programs (all private companies...NOT government), which in fact was my primary concern. I did not seek to have coverage for the PET scan...just travel in the USA. SO on the free market system I COULD NOT EVEN BUY INSURANCE IF I WANTED IT. So much for free market competition ?

The "delay" in receiving the PET scan here in BC was occasioned by the fact that the private PET facility was, in fact, in the process of physically moving locations and would not be operational, nor recertified, until March 2010....the same time my FREE PET scan would be provided by the BCCA. At any other time, I WOULD have had access to a more timely PET scan at my own cost OR could still have chosen to wait for the FREE PET scan. My issue was not the waiting time due to "universal health care", but simply that my normally available alternative was not open to me at this particular time due to unforseen circumstance, NOT a fault of the government health care system.

3. I too, have had issues with receiving coverage for "standard" chemo (with frickin' Xeloda for ****sakes !!) The denial came from my own private extended health benefit insurance...Screwed Blue Cross...again NOT the government funded health care which FULLY FUNDED ALL MY CHEMORADIATION INCLUDING XELODA !!!

4. My out of pocket expenses for everything, since my first office visit, to follow up on what would eventually be diagnosed and treated as CRC...$ 2,700.00 which was for the Xeloda that Screwed Blue Cross would not cover.

5. For the record, I am impressed and satisfied with the level of care I have received in Canada for my condition.

6. I echo hannahw's sentiments here : "The GREATness of a society will be judged by how it treats its WEAKEST citizen." Forgot the reference, though.... ( Is there such a thing as NON chemo brain ?? )

In harmony fellow travelers on the journey, but like someone said...I also usually try to stay away from the "political" issues... Damn, I get into enough trouble just dealing with the medical health and personal wellness issues.

Your Mileage May Well VARY !

Cheers and in Harmony
CRguy

[karin]

With all due respect to everyone on here, and as I said on another thread yesterday, one should be aware that, unfortunately, health care is a business...doctors and clinics can choose which insurance to accept and not accept, and, it is not illegal or unethical. I worked for a major hospital here in central Texas that only recently started accepting many private insurances because those companies wanted to pay them less than Medicare, the insurers thought they could consider them rural and the hospital would just accept it. The hospital never started accepting those insurances until the margin went up.

They have a business to run. The Fam Practice doc I collaborate with almost had to close his practice of 35 years last year, it ended up that a local hospital was able to take it over and save it, fortunately. because it iss basically a Medicare/Medicaid practice, and the community needs that. For the record, small practice doctors don't get to decide how much they make, they have to accept the reimbursement that is considered allowed (insurers consider it "the average" per region). They can charge whatever they want, but they only get the allowable. It is negotiable a little bit, but, basically, you get paid what the insurance company says you get paid. Your pets' veterinarian probably makes more than a regular GP.

Insurers are for-profit companies (and many claim they don't make much $$-only 2-3% profit margin). There are a lot of players here, hannahw listed them. But, one thing to realize is that John Q. Public, unless they or an immediate family member has had a serious medical illness, has no concept of how expensive it is or how little one's insurance will cover, people can and do go bankrupt just trying to pay copays, deductibles, parking fees, etc. etc. etc. It's sad, but it's true. Certainly, something needs to change.

[hannahw]

It's a business, true, but at what point does this become sort of akin to "an eye for an eye and everyone ends up blind"? It seems to me that while it is understandable that every business and every individual is trying to get what's best for their company and/or themselves, eventually everyone pays a price because we're all, to some degree, dependent on each other.

Insurers raise premiums and cut back what they reimburse which causes doctors to have to change which patients they will treat. Pharma gauges on drug prices which screws insurance companies, doctors and patients. Lawyers will sue anything with a pulse which jacks up the malpractice premiums which creates costs that negatively impact insurance, docs and patients. It goes on and on.

And everyday people suffer. If we rely entirely on a free-market system we're essentially placing the health of the health care system in the hands of people who have a personal interest in being as greedy as they can possibly be. If we put the system in the hands of government, it's just a different set of people whose greed dictates how the game is played.

No matter what industry we're talking about, there is a human toll when greed rules. In health care, the suffering is right out front, very noticeable and still it is ignored. There is something wrong, imo, with a business that puts profit ahead of humanity. If every player were to give a little ground, not be so focused on screwing some other area of the chain, would everyone benefit? For example, some sort of tort reform would help get out of control malpractice lawsuits reigned in and cut some of the outrageous overhead docs can face. Less unreasonable overhead should trickle down and allow them to be more flexible about the patients they are able to see. More emphasis on producing quality primary care doctors and really utilizing (and insurance paying for) preventative care would cut down the expenses insurance companies (and hospitals) face when medical issue goes from preventable to catastrophic. It's a lot cheaper to do a colonoscopy than it is to treat someone for stage IV treatment. Medicare needs to be smarter about how and what it pays out for. One of my favorite examples continues to be bedsores - medicare won't pay for a preventative mattress (and oversight) for people in at risk populations (like the elderly and disabled) until there actually is a bedsore, at which point treatment is often much, much more expensive. A problem that didn't need to occur in the first place can easily become one that requires hospitalization, surgery, all sorts of antibiotics and can actually become deadly quite quickly (see: Reeve, Christopher).

We can excuse the systemic failures on capitalism or we can all give a little to befit the greater good.

[PGLGreg]

There is something wrong, imo, with a business that puts profit ahead of humanity.

Insurance companies weren't always healthcare gatekeepers. As I recall, here is the way it went. Healthcare costs were going up fast, no end in sight, and businesses and taxpayers were howling. Insured patients had no incentives to economize, doctors had none, hospitals had none. Politicians couldn't stop the spending spiral, because medical patients are voters. You can't say no to medical spending without hurting people. So, who can we find to say no? There has to be a fall guy. Well, we've found one. But really, the insurance companies are just doing what we asked them to do.

[hannahw]

There has to be a fall guy. Well, we've found one. But really, the insurance companies are just doing what we asked them to do.
I don't look at insurance companies as the fall guy. As I mentioned in the full post, there are plenty of players in the game, plenty of blame to go around. But insurance companies are also not innocent victims. What may have started with good intentions now serves the best interests of only some.

Politicians couldn't stop the spending spiral, because medical patients are voters.

If voters really had power, I don't think we'd be where were at. Politicians are serving special interests more than their constituents. I we, as voters, deserve some of the blame, because we let them.

You can't say no to medical spending without hurting people.

I believe this to be false and just the type of rationale that keeps us from creating meaningful change within our system. Healthcare is full of wasteful spending. Whether it's refusing to pay for preventative medicine that is cheaper up front, instead choosing to roll the dice and pay more on the back end when a disease has taken hold or whether it's the misuse of testing brought on by the "cover your butt" mentality of a litigious society, there are plenty of ways to cut costs that would not compromise care.

Karin mentioned up thread that one of the most expensive forms of care is the care provided in the last six months of life. I'm not talking about treatments that have a reasonable chance of extending life, but rather the kinds of treatment that come from a lack of information and planning. An ICU stay can cost more than $15,000/day. If you are dying and don't have a DNR you could spend your last days in the ICU, hooked up to a ventilator and no one benefits. In fact, studies show that real, measureable harm is caused to both the patient and their family/friends. This is another example of heath care costs gone wild.

Another expensive form of health care is that provided in the ER. Due to the lack of primary care doctors and (un)der-insured people, more and more people are using their local ER for primary care. More wasteful spending that no one benefits from.

And a third example can be found when you check the medicare roles. How is it that two towns in Texas with similar demographics differ by more than $10,000 in cost per patient and yet have negligible difference in results? Are all the extra procedures in the town that spends more really creating any benefit? No - it's more wasteful spending.

The result of all this wasteful spending is a system that forces a lot of poor and middle class people into the margins where they can't receive care or can't receive the right care, or can't receive care in a time fashion, or can't receive care without losing something like their home. These are the real harms. You don't have to spend through the roof to provide quality care, you have to spend wisely. You have to invest in a system that prevents disease when possible and educates patients to make smart decisions.

[karin]

hannahw is right, and especially about we, the voters, being most at fault. Here is where the big political discussion comes in, we need to set term limits on politicians (8 years...period!!!), so they cannot be bought by big business at our expense....government by the people (not the politicians) and for the people...we are just doing it bass ackwards!