American Cancer Society advocates for government-run national health-care
 

Not good, IMO...

http://www.nypost.com/seven/09102007...ly_medicin.htm

well, I had "great" health insurance and when I got cancer in the USA it still cost me $10,000 in hard cash. Of course if you make enough to deduct it from your income (and then basically the government is subsidizing your health insurance) you don't care how much health insurance costs. But since the USA (in other words all American taxpayers and I'm one) pay twice as much per person as the "universal" health care governments, I'd have to say, universal healthcare is fairer for everyone and cheaper for governments because poor people don't have to turn to emergency wards for assistance. Also you can always pay extra to see a different or "better" specialist. I can see any doctor I want to, anywhere I want to, but I may have to pay a little extra - so that's my choice. As a doctor's daughter, and my father would agree, (he gave 3 mornings a week to care for patients free who couldn't pay) I am not comfortable to think that I can get better care than others who are just as deserving can't because of cost - and who ultimately pays???
In France healthcare is a right not a privilege and those of us with more money, pay more, it is our privilege for having more to pay and I am not a rich person monetarily but my heart and the opportunities I have been blessed to have, have made me feel very rich and I could not live with myself if others couldn't have the same opportunities as I have had. I am pleased to see that California, one of my home states, is considering it. Doctors would be relieved from paying out so much in malpractice insurance and no one would have to chose their health or food or whatever. Isn't one of our purposes in life to help those less fortunate than us? Giving to others is a gift. Not everyone who is poor is a lazy, thieving brat. Let's save ourselves and our government money and help those that are less fortunate - let's have some sort of universal care. We will always be in charge of our lives and our health - no one can take that away - that's just a paranoid public relations campaign devised by the "thieves" in the healthcare industry. I'm a capitalist with a capital C but that doesn't mean, I can't care about my fellow human beings. If I sound angry - I am. Health care is too important to everyone not just to those who can pay for it.

I have to agree Sarah, we have to be concerned with those less fortunate. We are paying much more for health-care, because big business if profiting a huge amount. There are some things that should not be profitted from and one of them is a person's health. I also believe that big business plants rumours about how bad universal health care is. I have a friend from Canada who told me that the Canadians would revolt before they gave up their healthcare system.

Personally, I don't believe that just because our system is perceived complex and seems comparatively expensive to perceived "free" care in other countries national systems, that a national govt system is the only solution for the US or a good option. I think there is some solution in the middle of the two systems that makes it affordable and accessible, and is consumer driven, not govt run or mandated. I don't want the govt deciding ANYTHING about my healthcare options.

I recommend googling Regina Herzlinger, see who she is and what she knows...

And a good informative opinion from Dr. Val...at Revolution Health...
http://www.revolutionhealth.com/blog...ommentary-5390

Also - this looks like an interesting read: The Fight of My Life by Barbara Clark (UK nurse, mother and foster mother)

The Fight of My Life
Barbara Clark
RRP: £7.99
Price: £3.99
You Save: £4.00 (50%)
Release Date: 4 October 2007

Synopsis
Barbara Clark is a former nurse, foster carer and mother of two children, one with special needs, and was diagnosed with an aggressive form of breast cancer in February 2005. During her treatment, she found that there was a drug existing, Herceptin, that would double survival chances for her particular form of cancer from 14 per cent. However, it wasn't available on the NHS and therefore, for Barbara, unaffordable. In the midst of aggressive chemotherapy, Barbara, incredibly, found the strength to fight not just the NHS but the government, and to win the right to be prescribed the drug on the NHS, not just for herself but for thousands of other women. The "Fight of My Life" will tell the story behind those headlines.

Look for more info on Amazon UK...

A Canadian perspective
 

I am so thankful that, as a Canadian, we have universal health care. When you are seriously ill, the last thing I think you would want to do would be filling out forms, fighting for scans, tests that have not been approved etc. When my daughter was born in 1986, after a total normal pregnancy, I had a fever while in labour and she was put into the NICU for 10 days as a precaution for possible meningitis. Of course we were worried sick about her, but I could focus on her health, and did not have to think about anything else. Can you imagine if we had no health coverage? I shudder to think of that thought.
It was the same with my BC diagnosis last fall. My GP referred me to an oncologist - and I got to choose anyone I wanted to go to in the city of Toronto - and I saw both him and the breast surgeon within a week. The breast surgeon was assigned to me from a group of about 6 doctors. All my tests and scans pre-surgery were ordered by my onc. in a timely manner, at world class hospitals. I also had an appointment with a plastic surgeon to discuss reconstruction - again, the PS I chose, not who was part of a certain HMO or "group", as ordered by an insurance company. Everything was covered with my provincial health card, just a swipe at each visit and that was it.
I am not saying our system is perfect - it isn't, nothing is. But everyone is equal here with regards to their health, and I believe this is morally the right way. Yes, I pay high taxes, but I feel it is worth it. As in France, health care in Canada is a right, not a privilege.
Yes, you will hear occasional stories in the US about long wait times for certain surgeries etc. here and that is sometimes true. But these are the exceptions, not the rule. I truly believe that some US insurance companies exaggerate these issues to scare the US population into believing it would be chaos if a universal health care system was created in the States, and that care would evaporate. Ask the millions of Americans who have no health care - and I am not talking about the ones that can afford it but balk at paying. Or the ones who just lost their jobs and are worried sick about losing their health coverage - it's bad enough to lose your job. Or the ones who stay in horrible jobs because they cannot afford to lose their insurance- I would hate to feel trapped that way.
Again, it is not perfect up here, but in general, I'd much rather have it this way. In fact, Herceptin was cleared for use in early stagers up here earlier than in Nov. 2006 as in the States.

Just MHO - Canadian HO, that is.

all the best,
caya

Actually I have had breast surgery in both the US and in Canada, have spent roughly half my adult life in each county. Treatment was fine in every case, no complaints.

We were poor when I was growing up in the US and going to to doctor was something to be avoided if at all possible. There were public clinics at school for polio shots and the like. Our family doctor was a kindly man and apparently was always willing to wait for payment. I don't know that I really felt deprived, but I think my parents worried about bills. I grew up, married well and was covered by my husband's insurance.

I never worried about taking my kids to the doctor or the ER in Canada, of course by now both my husband and I were white collar employees so we wouldn't have worried anyway, but the same right was enjoyed by the welfare moms in the co-op housing around the corner and I liked that. My kids were rather healthy so didn't need much care, contrary to popular opinion running off to the doctor because "it's free" is not common in countries with universal health care.

There are some things that I just don't understand about the attitude, and I would almost call it fear, of US citizens to universal health care. There are benchmarks of population health, things like infant mortality and life expectancy. The US which spends way more per capita than any other country is like 35th or 40th for these. How does this compute?

Sure there are lots of factors, but the most obvious one is the layers of beaurocracy that need to deal with the costs. Government is worth complaining about but insurance companies are not better. Unless you have a bottonless purse there is a gate-keeper in both cases.

I worked in management in a 450 bed community hospital in Ontario. We had a 3-4 person perchasing department, billing was done by one of the secretaries that I shared with another manager. We did not count things by patient. The province funded the hospital based on its patient base. We did have to worry about overspending our budget on expensive items or expensive elective procedures.
I watched a program about a similar sized community hospital in with Oregon or Washington which had a separate building with 250 people doing billing. That is where your money is going - billing clerks and insurance companies.

I am not afraid of universal health care. I just don't agree that it is the best and only solution in the US. I am tremendously interested and concerned about how it will be sustained... which Canada, Italy, England, etc etc are facing currently. Much like our failing social security system, (simplistically) more are using than are paying in. Over time, it will require curtailed services or even higher taxes, and many countries will also have to tackle reforming and more aggressively enforcing their taxing system to accomodate their healthcare system. I believe that just because there are aspects to our system that are bad, that the current model used in mentioned countries are NOT necessarily good or the only option or answer. Inside Canada for example, one is not allowed to seek and pay directly for health care outside of the public monopoly. This means that if you would prefer a procedure other than that offered by your Nat'l health doctor (and approved/mandated by the Nat'l healthsystem), you cannot go to a different Canadian doctor and pay privately. Any Canadian doctor who would agree to it would be breaking the law and would/could be prosecuted. These are the types of controls that make my blood boil.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Written by a Canadian:

The top ten things many people believe about Canadian Medicare, but shouldn't:

• Number One: Canada has the best health care system in the world.
• Number Two: The Canadian public love Medicare.
• Number Three: Canadian Medicare is sustainable.
• Number Four: Single-payer, Canadian-style coverage, keeps costs under control.
• Number Five: More cash is the solution to Medicare's problems.
• Number Six: Under Medicare, people get the health care services that they need.
• Number Seven: "Free" health care empowers the poor.
• Number Eight: Canadian Medicare is fairer because no one gets better care than anyone else
• Number Nine: Medicare-type spending is the best way to improve health.
• Number Ten: Medicare is an economic competitive advantage for business.

Now, like most Canadians, I believe that our system is superior in many respects to the U.S. system, but it is a system that staggers under the burden of serious design flaws. I am deeply worried about the long-term sustainability of our health care system, and I think that we have much to learn from countries that ranked much higher than either Canada or the U.S. in the World Health Organization rankings.

These countries demonstrate that many of the fears that Canadians have about significant reform to Medicare (to introduce payment for health care, to allow people to pay directly for health care outside the government monopoly, and even breaking up the provision monopoly to allow competition and a greater role for the private sector) are all reforms that can be carried out within a public policy framework that continues to be preoccupied by equity considerations. That gives Canadians better value for the tens of billions of dollars they so patiently and lovingly devote to public health care spending in a repeated triumph of hope over experience.
Brian Lee Crowley is the President of the Atlantic Institute of Market Studies located in Halifax, Nova Scotia, Canada.
http://www.heritage.org/Research/HealthCare/hl856.cfm

AS Caya said about Canadians, here in France there would be a violent revolution if they changed the health care system. Having been treated in both the USA and France for cancer, I personally am happier to be here where I don't have to worry will the insurance company fight me about my care. Health insurance in the US costs a lot of money. I had "great" insurance and still paid $10,000 or more out of pocket for the loop holes.
The French government has absolutely NOTHING to say about my treatment and wouldn't dare to say anything. My oncologist is who decides and he decides with me - since I'm a pro-active patient.
I too have trouble understanding this fear that the government will take it over - it's certainly not being used properly or economical now and since the USgovernment is paying twice as much as the universal health care countries per person, something is wrong.
As for social security, it's a right and it's fully funded and if the government would not borrow from its lucrative fund, it would be even better funded.
Many doctors I've had in the US have fallen out of various health insurance plans because of the paperwork; and malpractice is hugely expensive for them.
Also there is always the danger of an epidemic breaking out and poor people, who can't afford to go to their doctors, getting sicker and making others sicker. I really think it is cheaper for a person to see their local doctor and be treated early than to wait until it becomes a catastrophic illness.
Sadly I think the American public will be scared again into thinking they can't choose their doctors or can't get the best care - as if many can now. Don't you have to refer to a list of doctors signed to your insurance!!?? I know I did when I had my private insurance in the US.
As I've said before just because you're in a universal care system doesn't mean you can't see any doctor you want - some you just may have to pay for out of pocket.

I LOVE the universal heath care here in France - it's great - the New York Times voted France #1 for health care and very human. However I'd still rather be healthy!
sarah

Brenda,

With all due respect, you are not Canadian, you do not live here, you do not deal with my medical system. Like Sarah in France said, my oncologist and I decide what my treatment will be - the government DOES NOT decide. They approve drugs, but that is done in the States as well.
It is true that if you want to have a procedure done, and have to wait for it (i.e. a hip replacement), you cannot seek out another doctor who will do it immediately for payment. But all procedures are fully covered, and believe me all emergencies are done IMMEDIATELY.
My DH had a brain aneurysm in Jan. 2006 - it was discovered after a few weeks of misdiagnosis, ultimately by a brilliant neuroradiologist who did a few different brain scans. The aneurysm was discovered at 1:00 p.m. at the CT/MRI clinic, DH was rushed to a first rate hospital that specialized in brain surgery, he was seen within 1 hour by 2 neurosurgeons, and the decision was made by all of us to operate on him the next day. And we were asked which hospital we wanted to go to - none of this "they're not in your network" stuff.
Again I will state again that it is not perfect here, and I agree that if I want a procedure done more quickly, and I want to pay, I should be able to do it. But not at the risk of collapsing universal health care - when people are very ill, they should not have to be worrying about medical bills. Period. Or wondering if they can afford to take their sick child to the pediatrician.
I can also tell you that since DH had his aneurysm in Jan. 2006, and my diagnosis with BC in Oct. 2006, I have been under extreme emotional, physical and mental stress just dealing with all this. It has been a tremendous pressure to bear for my family, but at least I never have had to worry about money. My finances have not for one second been diminished in any way because of medical bills. There are no medical bills. I pay my taxes, kind of like paying insurance - when you need the coverage you will have it. But I will always have it, along with every Canadian citizen.

all the best
caya

I highly recommend Michael Moore's new documentary "Sicko". He documents stories of people here in the U.S.A., with and without health insurance, and also goes to other countries and interviews citizens on various national health plans. A real eye-opener. Warning, you will cry.

<3 Lolly

With all due respect as well, we will have to agree to disagree about universal/national healthcare being the answer for the US. I have had Canadian friends, British friends and I have family who live in France. I do understand both systems. I understand that your system works for you, I don't believe it is the proper solution for the US. Sorry Lolly, Michael Moore could never make me cry, because I won't spend my $$ on his half-truths and posed re-enactments.

Brenda,

I'm with you on this one! Universal Health Care is nothing more than socialized medicine. I have had experience with it while living overseas and would definitely not want to deal with it here in the United States. I see what has happened to my medical care since I had to go on Medicare and not due to cancer. I also have my original health care plan. All you have to do is look at how Medicare, Medicaid, and Social Security are run and you realize that socialized medicine is not the answer for the U.S.

Hey!
I just love a good clean fight! I guess being in the middle makes it easy! My insurance doesn't pay for some of my care, but does cover most. But as a "wish I could retire, but have 3 more years til medicare kicks in, it's hard to cover the cost of insurance sometimes. We see life through our own life experiences and understandings.
The one delightful thing about chemo has been that my understandings and thinking are "roller-coaster" like now! I'm a terrible "True Blue Texan" so can't imagine living anywhere else, but would sure love to let go of just one stresser!
Thanks to all of you for being so willing to share an make us aware. I guess the important thing is to keep our eyes on the real enemy...cancer!
Luv U bunches,
Mary Anne

I don't what the answer is. Something in between.
My greatest fear right now, is not the cancer itself, but losing my insurance coverage.
I'm on my husband's health insurance through his work, and whether we have it or not from quarter to quarter, is based on the hours he works. In his field (construction) he may work alot, or very little in a given time frame.
We can self pay for 2 quarters, but only 2, and after that we lose coverage. I'm not even sure we could go to Cobra since it would be due to a lack of work, and not that he no longer works there. Besides the full cost of Cobra coverage would more than likely be much more than we could afford, and I can't get on Medicare for at least another year. We make too much for Medicaid, and are the ones that fall between the cracks.
I've already run into problems affording the co-pay for my herceptin, and the onc writes it off. Now the insurance co. decided to take away the "provider discount" because my onc doesn't buy from "their pharmacy", and guess who that is now billed to? I can't afford that either, so if the onc doesn't waive it too, I guess I will be done with Herceptin.

Are 4, 3 week treatments enough??

Brenda D - This would NEVER happen in Canada. You are a prime example of what I mean - NO ONE SHOULD BE DENIED HEALTH COVERAGE, ESPECIALLY TREATMENT FOR A LIFE-THREATENING ILLNESS, BECAUSE THEY CANNOT PAY.

Brenda H and Kate - Sorry, but I agree to disagree. Again, the Canadian system is not perfect, but how would you feel if you were in Brenda D's position?

And Mary Anne - you are so right - the enemy here is Cancer. Tomorrow my girls and I with some neighbours and friends are doing the CIBC Run for the Cure - the big coast to coast Breast Cancer Run/Walk in Canada. Let's hope this is the last year we will have to do it!!

all the best
caya

It will be interesting to see where the USA goes next in dealing with health care, now that so many have either lost insurance coverage entirely as part of their jobs in the USA, or when they are still able to get it as part of their jobs, are getting far less coverage than most employees were able to get just a decade ago (now at far higher cost). What is most concerning is how easy it is with a chronic expensive disease to end up without employer-sponsored insurance even when a person has spent years and years sharing the cost, and then left to cope with whatever is available through government programs.

The people I've known by chance who have dealt with Canadian health care as U.S. citizens have had only praise for it, even though the coverage does vary between provinces -- although I don't know whether any of them were not covered by insurance of any kind at the time, or whether that would make any difference.

One of the controversies about the 2 systems is that it is very expensive to fund educational training and research, which is much more extensive and available in the USA than in Canada, and therefore Canada benefits from that major investment by the USA without having to spend as much for it.

A.A.

Brenda, what made me cry in M.M.'s documentary are the REAL stories told by REAL people. Some of the tears were happy, and yes, some were sad, but the operative word is that it is a documentary and not filled with "half-truths and posed re-enactments"(IMO).
Our health care system functions well for MOST people fortunate enough to have health insurance, but even for some who have coverage (and I'm not speaking of Medicare; I'm on Medicare and have pretty good coverage and guess what, it's a government-run program)
our system is broken, and for way too many who have no insurance, it's just a very sad situation.

<3 Lolly

Hi Lolly - I don't see it as I am "fortunate enough" to have health insurance. Health insurance has been a priority my whole life and I have always had it. Individual insurance. Not employer provided. It is a matter of priorities, I believe. I have never made more than $30,000 a year. That does not make me one of the "fortunate" few. It puts me right there in the lower mid-income range of the US population. I had no problem affording it. I made a choice that health ins was a necessity, whereas, for example, luxuries such as an expensive car or the most expensive cable TV package or expensive clothes, etc etc that were beyond my means, were not a necessity. It was how I was raised... in a personal responsibility, priorities in order, financially conservative family.

As I have said before, I know many people who make a lot more money than me and can certainly afford health insurance, however they don't have it because they are waiting for it to be free and/or are complaining because their job doesn't currently offer it. Instead, they spend a bulk of their money on having a cooler car than their friends, or on risky and unhealthy lifestyle choices. In the meantime they don't go to the doctor or take care of their health. It burns me up.

I don't necessarily agree that our system is broken as much as it is just upside down. I am newly on medicare as well. I didn't want it, but was basically forced into it as a by-product of being on disability. I don't have a bias or negative opinion about a "safety net" (medicare, medicaid) being provided for the truly needy in our society. I don't feel as though I am truly needy. I can still work part-time and did not want to be a burden on the system yet... however, if I did not take the option of medicare now, I would not get another chance in the future, when perhaps I was truly unable to work. I just know that there is a solution out there that makes sense, and is not a huge beaurocratic, inefficient government monopoly program.

I know there are sad stories out there. I am not heartless by any means. But, I won't pay a proven liar to tell me about it. IMO, MM is not a documentarian. Ken Burns is a documentarian. MM is a screen-writer and he makes movies. His fabrications/exaggerations/posed situations in his movies over the years are pretty well-documented. I don't know about this movie, because I haven't seen it and don't need to. IMO, if he was a real, genuine documentarian, he would go to countries with national health care and also tell the stories of their people in their 'rationed' type of systems who have been left out of care that they needed or denied new and/or expensive treatments that their systems won't approve... there are sad stories all around the world, regardless if you have perceived "free" health care or "private consumer insurance" health care.
_________________________

I am very interested in one particular expert who has researched for many years how to transform our healthcare system... Regina Herzlinger, who is known as the 'Godmother' of consumer-driven healthcare. Google it. Consumer-driven health care empowers individuals and brings their force to bear on the offerings of doctors, hospitals, and insurance and pharmaceutical companies. It converts the entire system to one that is responsive to the ultimate consumers of its goods and services.

Imagine the concept of consumer-driven health insurers that give you the health care you need at a price you are willing to pay; lower-cost hospitals that do not treat you like a slab of meat; and a government that does only what it is supposed to do—help the poor, provide transparency, and protect against fraud and abuse—rather than telling your doctor how to practice medicine. There is a way to create dynamic markets for health services that are more effective, more efficient, and more responsive to the patient-consumer—and the doctor—than anything we have today.
_______________________

Healthcare solutions are not globally applicable. Looking to other countries for magical fixes to U.S. healthcare woes is like expecting that all cancers will respond to the same chemotherapy regimen.

Brenda D - have you had your clinic social worker or advocate contact Genetech to see if you can qualify for Herceptin under their access program?

Hi Caya - I am not certain that there is a guarantee that you will always have the level of coverage you currently have, for free. From the reading I have done, if I am not mistaken, it seems that Canada and other countries are currently struggling with the sustainability of their national healthcare systems. It sounds similar to our failing social security system. Not enough people paying into it/current taxation rates can't sustain it... either taxes/contributions will have to go up quite a bit more than they already are before too many years pass, the levels of care and coverage might have to be curtailed or more rationed, and/or the population may be required to begin paying a monthly stipend (as in 'insurance premium' type of payment), or a high 'copay at time of service' (as they already have in France on top of their exorbitant tax structure)to keep the system going. That will end up being quite a shock to those in countries who are not used to paying anything out of pocket for their own healthcare...

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.