Bhutch, I don't have a clinic social worker or advocate.
My onc's nurse does most of that kind of stuff, and I may have to put my "large case manager" that the insurance co. assigned to me, to work (since all they do is call every 3 weeks and ask how I am doing and what my next treatment is).
I intend to take it up with my Onc tomorrow (it's Herceptin day) and see what he says. Then I'll go from there.

Hi Brenda,

There is no guarantee of anything in life, I think we are all prime examples of that. I personally never think of my health care as "free" because I pay high taxes, just as you pay insurance premiums. But I gladly pay the taxes so everyone in the country gets equal access to health care, at all times.
Yes, at times there are reports that the system here needs more money, but so does the system in the US, because many Americans have no kind of health insurance. And I have repeatedly stated, when someone is ill, they should not have to be wondering if they will receive treatment, or have to fill out many forms, fight with insurance companies for certain tests etc. I have seen on these boards and others how women cannot get certain scans, medicines etc approved by their insurance company without a fight, or like Brenda D, could possibly have her treatment curtailed. I shudder at this thought.
And look at all the paperwork involved - Brenda D needs Herceptin for one year, the world wide standard of care. It is enough she has to deal with the BC diagnosis, yet alone worry about getting the correct lifesaving treatment and having to get a social worker or advocate to contact Genetech. She, and all others like her in the same situtation, should be concentrating on getting well.
If the day comes when we have to pay "extra", I am sure most Canadians would accept this, if it keeps the status quo of the system's fairness. I would be more scared of the US system, in the state is in right now, because I am sure you would agree, Brenda, it is not working. Ask the 25 or 30 million + who have no medical insurance. Ask Brenda D.
And I will state once again, I know the system up here is not perfect, but I have to tell you, it's pretty close, with all things considered. The government here is working to make the universal health care system better, and the thing is it will be better for ALL Canadians, not just the ones with insurance.

all the best
caya

Brenda_H may be more concerned about how OUR government will handle
socialized health care than how the French or Canadians gov's handle it.
I can understand that, since our government is notorious in mis-handling programs and public funds. That's just my guess. Sorry BH if that's not the case.

All I know is that something has to change. What good is all the research and development if the end user can't access the treatment due to cost?

I'm not too worried. I think that somehow I will be able to work it out.
(thinking positively here) :)

Yes Brenda D, I am praying you will work something out. The point is here in Canada you would not have to be doing that.
I think we all have little faith in our government's handling of public funds, they all seem to screw up in some area, somehow. I just hope that the Canadian government keeps improving on our very good universal health care system.

all the best
caya

Another vote in favor of nationalized health care
 

Hi, Brenda -

Yay - it is lovely, for me, to read a brisk dialogue about U.S. health care on this forum. Thanks, Brenda, for bringing it up.

I'll weigh in on the side of socialized medicine. I lived in Israel at the time that I found a lump in my right armpit, and received my CAF chemo, and start of Tamoxifen, there. It is a country with socialized medicine - but, as I believe the U.S. would institute, it's a two-tier system, and anyone who wants to and can afford to pay for private medical care, or extras like therapeutic massage, acupuncture, herbal supplements, homeopathy, etc., has ample opportunities to access such care. I went to Hadassah Hospital in Ein Kerem (suburb of Jerusalem) - a private hospital where many wealthy Israelis, and foreigners covered by their private health insurance or willing to pay out-of-pocket, receive care.

In the U.S. at the time (1992), and I think still, there was no government-researched protocol for treating breast cancer - neither depending on the pathology, nor in general. In Israel, there is a governmental board that investigates global research on "best care" medicine (most effective, with least harmful side effects). My U.S. oncologist (I'd returned to the U.S. & had my mastectomy done there, largely to avoid insurance hassles, as well as to be among family) had ordered 8 cycles of CAF. In Israel, they'd settled on 6 cycles as optimally effective without LVEF damage, based on research conducted worldwide. Trusting national standards derived from research, more than that individual onc's "gut feel", I had Hadassah write their rationale for reducing the number of cycles, fax it to my onc, and he agreed to reduce my ordered tx.

Here are my main "issues" with private U.S. healthcare:

1) Medical expenses cause more personal bankrupsy in the U.S. than any other cause.

2) The U.S. infant mortality rate is in the toilet - this is horrible for one of the wealthiest industrialized nations in the world. Some private medical decisions - like Caesarian sections on demand date - are simply bad practice, but done to "compete in the market economy".

3) Pharmaceutical companies get away with unfettered greed in this country. They seem to see their stockholders as their target "consumers". They plead the need for huge profits so that they can do research - then often design biased studies slanted to give their product the best possible chance of passing FDA approval, and sometimes don't even report unfavorable results. Then they advertise - on tv and in magazines at high expense - to PATIENTS!!! WHY??? These are PRESCRIPTION drugs!!! IMO, the pharmaceuticals need much closer monitoring, objective arbiters, and for Phase III research to be taken out of their hands, and put in the hands of other scientists, who do not stand to make a profit from good results.

4) Instead of a governmental agency running our health care insurance in the U.S. (like Social Security and Disability insurance are run - pretty well, IMO) - the health insurance companies actually run health care here. Not the medical facilities/personnel!!! DRG - designated related groups (?) - that health insurance companies set - often determine how long patients with certain conditions get to stay in hospitals. I've belonged to 3 different health insurance companies since moving to CA, and each one has different "formulary" drugs, so I've had to switch medications - not just brand names, but the basic way that the drugs perform! - not for "best practices" medicine, but b/c the insurance company du jour won't cover the med(s) I was on with another company. Ridiculous and a big hassle!!!

5) My experience with CA health insurance companies here has been quite horrific - double billing, out-sourced customer service, refusal to approve basic diagnostic tests on occasion, causing my onc to have to spend his valuable time, and me mine, jumping through hoops and making dozens of phone calls, to "justify" needed tests, drugs, procedures.

6) Subscriber costs - both monthly "buy-in" subscriptions not covered by employers, and private/ government (COBRA) member fees have become exhorbitant, and out of reach for many. "Pre-existing conditions" disallow many, many would-be subscribers from getting affordable health insurance. Co-pays and deductibles and out-of-pocket caps keep going higher and higher, while covered medical expenses keep getting cut. Vision and hearing medical care is usually not included - yet is an absolute medical necessity for many, and can be hugely expensive.

For all of these reasons, I support a nationalized alternative. I'm sure that it will take some time, effort, and negotiations with greedy medical service providers, to "tweak" any system into something that is actually serving the public good with best practice care. I'm also sure, in this "free enterprise"-based economy, that a second, for-a-fee, level of care would arise here, and be available for people like you, who want something more/different than governmentally-set standards of care. I can't stand seeing families without health coverage sitting for hours in hospital emergency room lobbies, with sick, feverish children or other medical attention-needing conditions - both b/c these families & children ought to be getting better, more personal & rapid, care, and b/c contagious diseases can be quickly spread in congested ER environments.

Thanks again for the opportunity to read interesting, thought-provoking posts about a very important issue!

(((hugs)))
Sandy in Silicon Valley

Caya, I appreciate the prayers, and yes, I shouldn't have to be jumping through these hoops to get my Herceptin.
I had this straightened out once already and the insurance co. threw in another hoop.

I can tell you a horror story about Blue Cross/Blue Shield and how it went about searching to find the smallest detail to deny paying for my son's medical tests, or how his wife had to wait weeks to get her Humira, for Crohn's disease.

Like I said, I live in fear of losing my health insurance.

I'm confused. I thought there were two types of gov. funded medical care in the US, one for poor people and one for old people, or are they the same?

How does medicare differ from the Canadian system, or the French one?

All valid points Sandy - but they do not make the case for me that the ONLY answer is socialized, rationed healthcare. It is time to set the private insurance companies on their ear, and turn the system upside down and shake it out, but I DO NOT want another gov't. run social program in our country. As Brenda D. correctly said - our gov't is tremendously horrible at EFFICIENTLY creating and running any type of social program. Their purpose should only be to help the poor, provide transparency, and protect against fraud and abuse—rather than telling your doctor how to practice medicine. I am not defending insurance companies, either. I know that many insurance companies have become evil beaurocracies... that is what we are left with in the wake of HMOs and an attempt to ration/determine care from a level of socially, beaurocratically standardized managed care. Universal/National/Socialized health care would be nothing more than HMO style managed care, which is what ins companies have been trying to emulate now for the last decade. It was never like this before the HMO debacle of the 90s. Caya - I am certain that Canadian healthcare is very popular in Canada and great for Canadians. I am not putting it down. I know it works for you. It is what you have had your whole life and are accustomed to... I do not believe it is the prudent system for the US. Currently, 15% of Americans are not insured privately. That does not mean that they don't have access to healthcare. Many of those qualify for medicare or medicaid, but do not apply. 10 million of them are aged 25-35 and make more than $50,000 a year. That tells me that they can afford it but don't. I am mortified that Brenda D is in the quagmire she is in. I have had the option of HMO style employer provided insurance in the past and have declined it in favor of always keeping my private PPO insurance. Keeping my own private insurance helped protect me from losing my coverage if I ever lost my job... and it gave me the choice of who my plan was with. And I can honestly say, my ins. company has given me virtually no problems since my b/c Dx four years ago.

The utopian dream of national healthcare coverage lauds supposed substantially lower costs of single-payer, government-run systems, like the U.K.’s and Canada’s. Yes; but costs are controlled by rationing health care to the sick. Apparently, onerous waiting lists have caused illegal, for-profit health-service centers to proliferate in some countries, thriving outside of the gov't. monopoly. (Good for them I say!) The rogue establishments are so well-accepted that the head of one became the president of the Canadian Medical Association. (To me, that speaks volumes about the efficiency and equity of the system...) And single-payer systems do not always achieve equality of access or health status — often the powerful, assertive, litigious, and connected go to the head of the line.

And at the same time, private insurance cannot be lauded as a model industry. The massive bureaucracies patients encounter when they attempt to obtain the medical services they paid for are not merely frustrating, they sometimes kill. One enormous problem with U.S. insurance firms arises from their lack of accountability. Agents, such as governments and employers, use our money to buy our health plans for us. The agents’ incentive — simplicity and cost control — is not at all aligned with the needs of the us, the ultimate user.

Senators Richard Burr (R., N.C.), Bob Corker (R., Tenn.), and others on both sides of the politcal spectrum, want to refigure the tax code so that we could buy health insurance with tax-sheltered money, a right currently reserved solely for our employers. If we purchased our own health insurance with tax-protected funds, we could keep these arrogant behemoth insurance companies in check, just as we do in the other sectors of the American economy. The Swiss universal-coverage, consumer-driven system requires the person, and does not allow the employer or government, to buy health insurance. (The poor primarily receive funds from a gov't. program to purchase insurance just like everybody else.) This consumer control enables the Swiss to enjoy an excellent quality of care (at costs that are a third lower than ours), due to consumer choice, market forces, and open, competitve free enterprise, without the social inequality of single-payer countries.

I am a proponent of the Swiss system of healthcare.

Mke - for disabled and older - it is Medicare and is federally run. For the poor it is Medicaid and is a combination of federal and state run.

It differs because it is designed only as a safety net for the disabled, poor and elderly.