-
Website
http://thehappyhospitalist.blogspot.com/ -
Original page
http://thehappyhospitalist.blogspot.com/2009/07/how-much-could.html -
Subscribe
All Comments -
Community
-
-
Top Commenters
-
Popular Threads
All Comments
I see you are continuing your assault on the concept of socialized medicine. But you failed to answer my last query after your last post; are Canadians health suffering as a result of delays in testing and treatment? How many Canadians would choose to give up their current health care system? I actually like the idea that if you are in such a rush to have your test or procedure, then you can skip the que and pay out of pocket. The pure capatilistic system you seem to so desire!
Keep in mind that the guy who brought Canadian health care to fruition is considered a national hero!
You seem to prefer your rationing by ability to pay. The weak should simply suffer and die (or is your take that the stupid and lazy should suffer their just fate). Either way, it seems a cruel postion to take for someone in the healing profession.
Maybe doctors and health care execs should all just make less money so we can have a more affordable health care system. After all, I will bet most of us said we were not going into medicine for the money when we applied to medical school.
http://gatewaypundit.blogspot.com/2009/07/more-on-canadas-single-prayer-health.html
http://archives.chicagotribune.com/2009/mar/25/health/chi-oped0325natashamar25
Canadians come to the US all the time for a diagnosis and tests that their "health credit score" etc would not allow them in Canada.
"Maybe doctors and health care execs should all just make less money so we can have a more affordable health care system."
Yes, this is definitely the answer. Just have these people make less money, that will fix everything.
By the way, you must not have read my suggestion for a universal access with a market based approach where I suggested the government's contribution to heatlh care financing should be fixed and sustainable and that private market financing on an ability to pay sliding scale should subsidize the government's low payment rate.
And in less than a minute anyone can google results printed by Canadian authorities such as:
"Wait times for colonoscopies vary across LHINs median waits range from 12 weeks in the North West LHIN to 4 weeks in North Simcoe Muskoka, a difference of 8 weeks. Ninetieth percentile waits show a wide range as well, with Erie St. Clair reporting the longest waits (40 weeks), and North Simcoe Muskoka again showing the shortest waits (13 weeks).
Why are Canadians interested in reducing wait times if there is no increased mortality or morbidity associated with increased wait times?
Karen
Kate
At least in terms of a cancer diagnosis Canadians do fare worse than those patients in the US. The average 5 year survival is 5% better in the US than in Canada or the UK. The question isn't whether in cancer care specifically who has better outcomes (by far the US), the question is are those outcomes worth the increased price. I think that question is better answered by the individual than by the State.
Interestingly at one of Obama's health care "Town Halls" he profiled a women with metastatic renal cell cancer who was having trouble getting cancer drugs (she got them through the company). What Obama didn't mention was that in the UK if you have renal cell cancer you CANNOT get ANY of the 4 drugs for metastatic renal cell cancer because the NHS has deemed that these drugs are not cost effective. If you as want to pay for these with your own money in the UK you can't because then they will kick you out of the entire NHS system (doctors, hospitals, etc). This is what happens when the State decides your healthcare instead of the individual.
The reasons you state for the increased cost of an MRI here make no sense. If, as you suggest, it is because of lack of competition on the insurance side, then the usual market response is that the insurer could drive the price of an MRI down in a saturated market of MRI providers (which is what we have).
Now I could accept that insurers are happy to keep the prics higher, because the number they track in being profitable is the percent they pay out in medical claims. The higher the percentage, the less they have to pay stockholders and executives. If the market bears higher prices for insurance, which it has till now, then they stand to make more paying 1000 dollars for an MRI vs 500 dollars. If their medical loss ratio is 80%, then simple math tells us that they get to keep 200 dollars for the 1000 MRI vs 100 dollars for the 500 dollar MRI. Of course they have to keep charging more for medical insurance which seems to have been a successful strategy the past few years. This may explaiun why they seem so willing to pay hospitals more for these type tests when they could be performed for much less cost in an outpatient facility.
Karen,
Of course Canadians don't WANT to wait for their test. But I can tell you if I refer a patient to a rheumatologist at my hospital, they will be offered an appointmnt in three months. And I can think of several other examples where wait times exist just in my world, which is, by the way, at a very well funded hospital and health care system. Secondly, what about the patients who have limited or no access to cancer screening and the examples of women who do not get proper pap sceening or mammograpy? And your example of colonoscopy waits; I dare you to try and get a screening colonoscopy AT ALL if you have no insurance in this country. You currently have to wait more than 6 months for a mammogram at the county hospital here in Chicago.
As to my oncology friend, length of survival is but one parameter which you have conveniently picked. More important is months of MEANINGFUL survival. Who wants to sign up to live an extra 6 months while being bombarded with highly toxic chemotherapeutic agents while you suffer a slow but painful death? And the NHS in Britain allows you to obtain private healthcare if you wish (but few do) and does not restrict you from receiving any form of therapy unless it is not approved by their equivalent of the FDA, which is no diffrent from what we have here. Nothing highlights the problem that we have her in this country than the recntly approved Avastin, which I undrstand gives a patient maybe 6 months mor of existence for an astronomical price tag. If Happys free market model of health care existed, how many patients would find that an enticing proposition!
And the defense rests.
This is here in this country. What about mammography waits in other countries? And furthermore most mammograms are non urgent anyways. And by the way, I just heard a patient say she couldn't get a mammogram at Northwestern without a 4 month wait.
We can trade examples of the imperfections of both systems all day. I beleive a goverment run (or at least the option of a goverment health plan) woul be better than our current extremely expensive and dysfuntional attempt at the free market system.
Here is a little tutorial on statistics. Overall 5 year survival from diagnosis means that 5% more people live 5 years in the US than in Canada after a cancer diagnosis. In most oncologsy studies a 5% increase in 5 year survival means a 5% difference in CURE. In other words 5% more people in the US are CURED of their cancer. It DOES NOT mean that an individual lives an extra 6 months with "toxic chemotherapy." You obviously haven't heard of Gleevec or Herceptin or Rituxan if you are still thinking that chemotherapy is "toxic." As for Avastin, 10 years ago median survival in metstatic colon cancer was 12 months, it is now 24 months.
Please tell my patients who got to live to see weddings and grandchildren and graduations that that 12 months has no value. Also, why should some government stooge decide for me how much 6 months of my life is worth? The main difference in this arguement is that I think that I should decide for myself how much my six months is worth and you think that you (or your government proxies) should decide for me.
In addition you are incorrect about the NHS in the UK. If you are in the NHS system and want to pay for a drug that NICE has not elected to pay for(NICE is NOT the equivilant of the FDA!! NICE has a QALY value placed on what it will pay for - currently about 60,000 pounds. The FDA, thus far ONLY looks at safety and effectiveness - NOT cost) if you buy that drug you are no longer able to use the NHS system.
BTY - nice stands for "National Institute for Comparitive Effectiveness." Hmm... does that sound familiar.
The idea that a bunch of people in Washington somehow "know" more than practitioners out in the field is offensive.
I became a nurse at 40 after completing three other degrees and working in Washington, D.C. for several years. I will tell you how this is going to work.
Obama and Congress are going to fill hundreds of posts in D.C. with 20 and 30 year olds with fancy degrees who have almost no professional experience and absolutely no experience in the real world. Assured that they truly are the "best and brightest," they will begin to shape programs and policies that have NO BEARING on the reality that we face in health care.
It is NOT up to the government to make the decision whether an additional 6 months of life is
"worth it." But that is what is going to happen.
Ohio Oncologist: YOU are the one who worked so hard to become a physician. YOU are the one who is responsible for helping someone through one of the most difficult times of their life. The decisions is between you and your patients and no one else.
The government has no business meddling in areas where it does not belong.
Nobody suggested that you cannot have your cancer chemotherapy if you want. It is a matter of whether these therapies that are exorbitantly expensive will be covered by insurance, which drives up the cost for everyone and forces more compaines and individuals to drop their coverage. If one wants to pay the 100 grand cost, feel free to buy your drug. Just don't expect someone else to pay for it for you.
Goverments in other countries are making the hard decisions that we seem incapable of here. They are making decisions to provide for the basic health care needs of their citizens before they began buying all the fancy new toys and drugs that provide little improvement over the old therapies. You can go to this link to verify the issues that I mentioned regarding Avastin.
http://www.nytimes.com/2008/07/06/health/06avas...
Defining "basic health care" is impossible. If you have RA, you need DMARDS. If you have lung cancer, you need chemo. If you have a stroke, you need rehab.
Every disease is basic. There is no such thing as basic health care, but I'd love to hear you define it.
What I think you are saying is that you want the government to decide what is the appropriate medical care for your disease.
You should be verrrrrry afraid......
I want somebody to give us more choices. If insurance companies offered policies that did not include treatment coverage for items and treatments that were not proven to be clinically more effective than the old therapies, then that would be choice. Right now, you get expensive policies that cover everyhting, proven or unproven, that are outrageously expensive.
You deride the goverment for bringing the country to the brink of bankruptcy, but I will bet you cash those checks from Medicare every month. You shold stop being so two faced about this and do fee for service/ no medicare or insurance in the hospital and stop robbing the Medicare National Bank!
And I will say it for the umpteenth time; EVERYONE CAN BUY WHATEVER THEY WANT IN TERMS OF THEIR TREATMENT;GOVERMENT DOES NOT DECIDE FOR YOU WHAT TREATMETNS YOU CAN OR CANNOT HAVE. JUST DON'T EXPECT YOUR INSURANCE COMPANY OR MEDICARE TO PICK UP THE TAB FOR UNPROVEN OR MINIMALLY EFFECTIVE TREATMENTS. Otherwise, we might as well have snake oil salesman sending their bills to Medicare for their unproven remedies.
I will define basic health care for you. Those things that are clinically proven to be beneficial to improving health. Not things that MIGHT improve your health, but only those things we have firm proof of clinical benefit. If we had this rule, we might not have had 20 million kids have there tonsils extracted with no clear medical benefit and we wouldn't have had all these men having TURPs in the 70s and 80s till it was shown not to be MEDICALLY BENEFICIAL!
Your definition of basic health care INCLUDES Avastin, Erbitux, Gleevec, Sutent, Tarceva, Velcade, Revlimid, and virtually every new advance in oncology care in the last 15 years. They all meet FDA levels of safety AND effectiveness or else they would NOT have been approved by the FDA. The question really is not your definintion of basic health care, but rather what value you would like to place on QALY. Again, you would rather have the goverment set this (and they do - do look into the covert rationing of epo growth factors such as Aranesp). I personally would rather have a high deductible insurance that is relatively low cost and then if I need these drugs pay for them myself.
By the way, if you as a Medicare patient choose to pay for a drug that isn't covered (ie epo - Medicare does not pay for the approved FDA indication - only drug that Medicare doesn't pay when used on label) and your provider takes the payment then you have committed Medicare fraud and you go to jail. So no, you really can't choose to "pay for your drugs yourself." The government puts you in jail for fraud if you do that.