[Sandy in Silicon Valley]

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