No, we don't have the best healthcare system

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mpbser
Posts: 509
Joined: Wed Apr 19, 2017 11:52 am

Re: No, we don't have the best healthcare system

Postby mpbser » Wed Jun 06, 2018 4:47 am

Thanks for sharing that link. I was glad to see Cleveland Clinic at the top of the list. I have the utmost respect for the Cleveland Clinic as I have paid a great deal of attention to its work in the cardiovascular health arena over the years (for my atherosclerosis).
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

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LeonW
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Location: Amsterdam, Netherlands

Re: No, we don't have the best healthcare system

Postby LeonW » Wed Jun 06, 2018 6:41 am

NHMike wrote:If we look at world rankings, we find that 17 out of the top 20 hospitals are in the United States with the United States also holding the top 7 spots.
http://hospitals.webometrics.info/en/World

And then you have the NCI which can develop treatments that even the top cancer hospitals in the US don't have. Yet. The NCI treatments will eventually go out to the US major cancer centers and then to the rest of the world.

You're correct, research is of utmost importance. But the subject of this thread is not top hospitals, it is healthcare as a system . . .

If you have the dough, it's not that difficult to go to any hospital in the world that you think can of to serve you best. There are hardly limits for the Steve Jobs of this world, or the desperate Chinese people that you referred to your link that spent $70,000 out of pocket by finding a treatment in San Francisco and avoided parallelization.

But something in the system must be flawed when (quote that started this thread):
radnyc wrote:"average per-patient costs across all chemotherapy treatments were $12,345 per month in Western Washington state and $6,195 per month in neighboring British Columbia" with “overall survival was no different between the two locations.”

That's why I posted the links to the NYTimes articles that concluded similarly:
NYTimes, May 14, 2018 wrote:America was in the realm of other countries in per-capita health spending through about 1980. Same for life expectancy. In 1980, the U.S. was right in the middle of the pack of peer nations in life expectancy at birth but then it diverged. By the mid-2000s, we were at the bottom of the pack.

The first graph in the article shows it most clearly - I'd wish I knew how to insert a picture here, but have a look via this link
https://www.nytimes.com/2018/05/14/upshot/medical-mystery-health-spending-1980.html



Public policy (government spending) in health financing makes the diference:
NT Times (further down in the article) wrote:Other countries have been able to put limits on health care prices and spending with government policies. The US has relied more on market forces, which have been less effective. One result: Prices for health care goods and services are much higher in the United States . . . the differential between what the U.S. and other industrialized countries pay for prescriptions and for hospital and physician services continues to widen.


Best wishes
Leon
(Who had / has 100% of medical expenses covered by (mandatory) national insurance :D )
Dec 2012 CC (7 cm mass), 2 unresect liver mets, CEA 41.8 (MM @65yrs)
Jan 2013 colectomy @ spleen, 2/26 nodes IVa T3N1bM1a MSI-low
Feb-Aug - 1x Xelox-7x Xelox/Avastin, shrinkage from #3
Sept - 2x failed PV embolization
Oct 2013 - R liver resect 28 hosp days (delirium, liver failure, emboli, encephalopathy) pCR - no cancer cells
2014/15 - recovery; scopy finds polyp
2016 - new town, new life
June 2018 - 5 yr mark, 2 polyps
clean CTs and (1.3-1.4) CEAs: 4x2014, 6x2015-17, 1x2018; next June 2019

NHMike
Posts: 1838
Joined: Fri Jul 21, 2017 3:43 am

Re: No, we don't have the best healthcare system

Postby NHMike » Wed Jun 06, 2018 7:23 am

LeonW wrote:
NHMike wrote:If we look at world rankings, we find that 17 out of the top 20 hospitals are in the United States with the United States also holding the top 7 spots.
http://hospitals.webometrics.info/en/World

And then you have the NCI which can develop treatments that even the top cancer hospitals in the US don't have. Yet. The NCI treatments will eventually go out to the US major cancer centers and then to the rest of the world.

You're correct, research is of utmost importance. But the subject of this thread is not top hospitals, it is healthcare as a system . . .

If you have the dough, it's not that difficult to go to any hospital in the world that you think can of to serve you best. There are hardly limits for the Steve Jobs of this world, or the desperate Chinese people that you referred to your link that spent $70,000 out of pocket by finding a treatment in San Francisco and avoided parallelization.

But something in the system must be flawed when (quote that started this thread):
radnyc wrote:"average per-patient costs across all chemotherapy treatments were $12,345 per month in Western Washington state and $6,195 per month in neighboring British Columbia" with “overall survival was no different between the two locations.”

That's why I posted the links to the NYTimes articles that concluded similarly:
NYTimes, May 14, 2018 wrote:America was in the realm of other countries in per-capita health spending through about 1980. Same for life expectancy. In 1980, the U.S. was right in the middle of the pack of peer nations in life expectancy at birth but then it diverged. By the mid-2000s, we were at the bottom of the pack.

The first graph in the article shows it most clearly - I'd wish I knew how to insert a picture here, but have a look via this link
https://www.nytimes.com/2018/05/14/upshot/medical-mystery-health-spending-1980.html



Public policy (government spending) in health financing makes the diference:
NT Times (further down in the article) wrote:Other countries have been able to put limits on health care prices and spending with government policies. The US has relied more on market forces, which have been less effective. One result: Prices for health care goods and services are much higher in the United States . . . the differential between what the U.S. and other industrialized countries pay for prescriptions and for hospital and physician services continues to widen.


Best wishes
Leon
(Who had / has 100% of medical expenses covered by (mandatory) national insurance :D )


I'd have to understand what they mean about costs. I've written about my experiences in where sticker prices is often far higher than the price that insurance actually pays or that people actually pay (a lot of medical bills simply don't get paid).
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
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MissMolly
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Location: Portland, Ore

Re: No, we don't have the best healthcare system

Postby MissMolly » Wed Jun 06, 2018 9:33 am

One of the problems with our American health care system is the reliance on employer provided health care as an employee benefit. If you ever are in a situation where you are unable to work a full time position with benefits (ex. frail health), the Healthcare landscape changes dramatically.

I had employer provided medical/dental benefits through a large consulting/accounting firm. My health deteriorated and I was unable to sustain gainful employment, approximately 6 years ago.

I now rely on purchasing medical insurance through the Obamacare Affordable Care Act on the open exchange. I am 57 years of age. As I am a frequent consumer of healthcare services, it is advantageous for me to purchase the most comprehensive policy available - a top tier gold plan. I pay $1,200 a month for medical insurance coverage and $100 a month for dental coverage. I do not receive any off-setting federal or state voucher to reduce the premium cost. The top tier policy has a $6,800 annual deductible.

To visualize my annual health insurance premium out of pocket expenses: $14,400 for medical insurance premiums and $1,200 for dental insurance premiums. Annual total: $15,600.

I have already met my annual out of pocket deductible for the year. I have paid $6,800 in co-pays and hospital charges, meeting the deductible for the year.

My out of pocket health care expenses at a minimum for this year will be $22,400 (annual insurance premiums $15,600 + annual $6,800 deductible).

This does not include medical expenses that I will incure that are not covered by medical insurance (ex. ostomy supplies above the Medicare monthly allotment; a dental mouthguard for TMJ; holistic/integrative care that enhances my quality of life).

I face this sticker shock every year. This has been my reality for the past 6 years. I am grateful for the Affordable Care Act, for without it the prospect of my being eligible for medical insurance given my chronic health conditions would be nil/zero. But the actual expenses that I pay out of pocket each year for medical insurance premiums and the annual deductible ($22,000 plus) is a sobering reality of the American healthcare system that I experience on a personal level.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

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LeonW
Posts: 348
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Location: Amsterdam, Netherlands

Re: No, we don't have the best healthcare system

Postby LeonW » Wed Jun 06, 2018 5:22 pm

MissMolly wrote:My out of pocket health care expenses at a minimum for this year will be $22,400 (annual insurance premiums $15,600 + annual $6,800 deductible).
This does not include medical expenses that I will incur that are not covered by medical insurance

Wow, that's big money . . . . .
In our system (Netherlands) health insurance is mandatory. This is to spread costs between the sick and the healthy, young and old, smokers and non-smokers.
Costs are paid as tax (income tax surcharge), insurance premium and deductibles.

Income tax
- pensioners, freelancers, small business owners, or persons receiving alimony --> 5.65% charge
- employees or anyone on unemployment benefit -------------------------------------> 6.90% charge
- charged on personal income up to $64,000 annual; no withholding on the portion that exceeds $64,000

Insurance Policies
Between US$ 1400 and $1700 premium per person (all policies have identical coverage - the cheaper ones limit care to contracted providers)
A deductible of $470 per person (standard amount, irrespective of insurer) no deductible for GP fees and maternity costs
Policies with higher deductibles are offered at discounts.
Kids under 21 in the family of the insured person, are free

Max total costs is between $ 5,500 and $ 6,700 per person
1) Income dependent tax charge
-- for pensioners, freelancers, etc ------> $3,600 max (@ $64,000 income)
-- extra for (un)employed persons etc --> $1,200 max (@ $64,000 income)

2) insurance premium $1,200-$1,400 --> $1,400 (max)
3) max deductible ----------------------------> $470 (max)
4) includes minors in the family


All my cancer costs (see treatment summary in signature) were covered, except travel. Had we opted for taxi-for-patients service, travel would have been covered too.

(Interesting discussion - thank you all)
Leon
edit June 7: I've included the max costs (per person) for both the high and low tax charge; not actual costs for two pensioners
Last edited by LeonW on Thu Jun 07, 2018 6:41 am, edited 1 time in total.
Dec 2012 CC (7 cm mass), 2 unresect liver mets, CEA 41.8 (MM @65yrs)
Jan 2013 colectomy @ spleen, 2/26 nodes IVa T3N1bM1a MSI-low
Feb-Aug - 1x Xelox-7x Xelox/Avastin, shrinkage from #3
Sept - 2x failed PV embolization
Oct 2013 - R liver resect 28 hosp days (delirium, liver failure, emboli, encephalopathy) pCR - no cancer cells
2014/15 - recovery; scopy finds polyp
2016 - new town, new life
June 2018 - 5 yr mark, 2 polyps
clean CTs and (1.3-1.4) CEAs: 4x2014, 6x2015-17, 1x2018; next June 2019

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betsydoglover
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Re: No, we don't have the best healthcare system

Postby betsydoglover » Wed Jun 06, 2018 5:58 pm

Not saying that our health care system doesn't have issues. But the issue is what ins co pay, not the billed amt. My onc (no surprise) told me she has no clue where those billed amts come from. Maybe they are the most any ins co would pay under exceptional circumstances - maybe the "prices" are set so that there is no question of getting the maximum negotiated (with ins company) payment. Who knows - but when comparing our medical system compared to other countries, there are adjustments that may need to be made to actually compare "apples to apples".

Just a thought,
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 06/18

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LeonW
Posts: 348
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Location: Amsterdam, Netherlands

Re: No, we don't have the best healthcare system

Postby LeonW » Wed Jun 06, 2018 6:20 pm

NHMike wrote:I'd have to understand what they mean about costs. I've written about my experiences in where sticker prices is often far higher than the price that insurance actually pays or that people actually pay (a lot of medical bills simply don't get paid).


The study that the article is based on, measured the total amount a country actually spent on health care. The same amounts (as in turnover) that end up in the GDP of a country.
Besides average cost per person, the countries were compared in the percentage of total GDP spent on health care.

Leon
Dec 2012 CC (7 cm mass), 2 unresect liver mets, CEA 41.8 (MM @65yrs)
Jan 2013 colectomy @ spleen, 2/26 nodes IVa T3N1bM1a MSI-low
Feb-Aug - 1x Xelox-7x Xelox/Avastin, shrinkage from #3
Sept - 2x failed PV embolization
Oct 2013 - R liver resect 28 hosp days (delirium, liver failure, emboli, encephalopathy) pCR - no cancer cells
2014/15 - recovery; scopy finds polyp
2016 - new town, new life
June 2018 - 5 yr mark, 2 polyps
clean CTs and (1.3-1.4) CEAs: 4x2014, 6x2015-17, 1x2018; next June 2019

rp1954
Posts: 1391
Joined: Mon Jun 13, 2011 1:13 am

Re: No, we don't have the best healthcare system

Postby rp1954 » Wed Jun 06, 2018 8:25 pm

Our entire chemo costs for 8 years of daily chemo, without using our insurance for chemo in any way, are approximately $18,000 for generic versions of UFT (a 5FU prodrug), low dose leucovorin, cimetidine, celecoxib and...aspirin.

We avoided Celebrex and its related costs in the earlier years, and by the time it was needed, had generic celecoxib after patent expiration. Someone could probably go to India and cut these costs in half.

This does not include the cost of supplements, IV vitamin C, or transport.
watchful, active researcher and caregiver for stage IVb/c CC since early 2010. 8 yrs immuno-Chemo for mCRC, now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher

crikklekay
Posts: 71
Joined: Thu Feb 15, 2018 9:47 am
Location: Richmond, VA

Re: No, we don't have the best healthcare system

Postby crikklekay » Thu Jun 07, 2018 12:36 pm

betsydoglover wrote:Not saying that our health care system doesn't have issues. But the issue is what ins co pay, not the billed amt. My onc (no surprise) told me she has no clue where those billed amts come from. Maybe they are the most any ins co would pay under exceptional circumstances - maybe the "prices" are set so that there is no question of getting the maximum negotiated (with ins company) payment. Who knows - but when comparing our medical system compared to other countries, there are adjustments that may need to be made to actually compare "apples to apples".

Just a thought,


My husband's 2 week hospital stay and surgery was billed at $408,000 but the negotiated rate the insurance paid was closer to $40,000. This way the insurance company can show you how much money they save you and keep you as a customer. These costs aren't real, they're inflated so the insurance company can show the discount, but the problem is if you are uninsured you get charged the bogus rate. Then you're at the mercy of the hospital and your negotiation abilities. But it doesn't really matter, even if I managed to negotiate down to what the insurance company paid we couldn't afford a $40,000 bill. We'd either be on a payment plan for the rest of our life or go bankrupt, and that's the reality of a lot of Americans. Even with insurance we had to pay $10,000 out of pocket, thanks to his first hospital stay starting on 12/30/2017 so they got to stick us with two yearly out of pocket max in the span of three months.

We are insured through my husband's company, and I will never forget sitting in the hospital after he was diagnosed terrified we'd lose coverage and wouldn't be able to afford his care. I was already dealing with an incredibly sick husband with a cancerous mass blocking his colon and I had to worry about our health insurance too? It all felt like too much. Thankfully we pulled through with FMLA and a lot of stress, but I still worry about running out of FMLA if the treatments make it so he can't work full-time.
Caring for DH John, 41
DX: Colon Cancer, Sigmoid colon
Tumor type: Adenocarcinoma
Tumor grade: G2, Moderately differentiated w/invasion of visceral peritoneum
Stage IIIC
Positive lymph nodes: 6/22
Chemotherapy: FOLFOX (6)
12/17 ER and emergency surgery
02/18 Hospital w/ MSSA infected port, PICC line inserted, abdominal CT scan clear chest CT scan showed septic emboli & blood clots
03/18 Hospital w/ CDIFF
04/18 Chest CT scan clear
06/18 Colonoscopy Clear
08/18 CT Scan Clear, NEMD

Stewsbetty
Posts: 136
Joined: Thu Jul 14, 2016 7:08 am

Re: No, we don't have the best healthcare system

Postby Stewsbetty » Sat Jun 09, 2018 8:23 am

You get used to the system you know. :). I am a Canadian living in BC - though my data wouldn’t have been included in this study since my journey didn’t start til 2016. Pretty sure after reading the reticle they were comparing apples to apples. Actual cost of treatments, not billed amounts.

Anyway, like I said you get used to the system you know. I am delighted that I never had financial concerns around my chemotherapy, hospital stays or scans. All completely covered with B.C. medical. BC medical rates at this time are on a sliding scale with income. Under 24,000 you pay $0 over 42,000 you pay $75 per month/per adult. Income in between varying rates. Children have no premiums. Many employers cover these in rates along with extended health benefit plans. I feel blessed that I have never had the pressure to work through my illness and that I have not been a huge financial burden on my family (though my prescription costs have adjusted the budget somewhat).

On the flip side, drugs are slower to be approved in Canada and added to the province’s list of covered drugs. After failing folfox and folfiri, I wanted to try Keytruda (am MSI h). It is not approved here in Canada (for CRC or MSI h) so it isn’t on the list of paid for drugs. We asked for approval from BC cancer for them to provide but were denied. Then we had to look at the option for self paying. Here Keytruda is $8,800 per dose. Thankfully Merck ended up covering me under compassionate care so we aren’t having to sell all we own to keep me alive.

Just sharing my thoughts on the pros and cons of our system. I don’t think it is possible to have a perfect system. Every one will let someone down in a particular area. Canada’s may have lower costs but less cutting edge research or less accessibility to certain treatments. The US system may be cost prohibitive for people in certain financial brackets.

Health care can be another arena where we can be advocates for meeting more people’s needs.

Beth
42yo At diagnosis. Female in BC, Canada
Dx: CC ascending
Right Hemi colectomy 06/16 clear margins
Adenocarcinoma 6cm High Grade
pT3 pN2a Stage 3
10 out of 16 lymph involved
MSI-h, Kras mut, Braf wild
Finished chemo Feb. 2017
PET scan showing active area April 2017
July 2017 CT showing LN mass and spread to other LN
Stage 4
Aug 2017 failed Fofiri
Sept 2017 keytruda
Nov 2017 CT scans show significant shrinkage in tumours
Feb 2018 CT continued shrinkage
May 2018 CT shrinkage and stable spots


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