Cost of Cancer

There is no one "fix" for healthcare; we have many problems to address and the sooner the better. It is criminal that some people continue to believe healthcare is a privilege in a country with our resources. I believe competent, affordable healthcare is a right. I apologize for the length of this but I have 3 stories to share.

My story: I am 53, take no medications and was remarkably healthy until this diagnosis in early April. My premiums hover at just under $400/mth. which is all I can afford. I have a $5000 deductible and $10000 annual out-of-pocket. I am being treated at a major university hospital which is a provider on my insurance plan. So far, their charges have been much lower than most stated here and, of course, they have accepted the insurer's writedowns. Last week, Duke even wrote my ins. co. to delete an erroneous $5.31 drug charge already approved. That said, my insurer has been sued in several states for discriminatory practices of terminating and denying tx. for catastrophic illnesses to individual policy holders. Welcome to the world of individual insurance providers....and in this economy everyone of you who is fortunate to have employment-related group insurance are at risk of having to live with this uncertainty if ANYTHING happens with your employment situation. COBRA is outrageous because group insurers do not want to continue to cover individuals. It is next to impossible for a woman with breast cancer, any stage, to get individual healthcare coverage and it's likely you wouldn't be able to afford it even if you found someone to cover you. For me, I'm covered so far but I  lie awake every night worrying what in the world we will do if my txs. are denied/delayed or if my coverage is terminated...or how we will afford next year's premiums after this diagnosis. Then, when I finish worrying about that, I worry about where in the world we'll get that $10000 annual out-of-pocket PLUS the mthly. premiums to afford followup and scans to try to keep this monster at bay if I get that far.

I, too, had begun postponing mammograms. Every year after age 45, my premiums and deductible ratcheted  up to the point that I just could not face the possibility of any condition that would make my insurance completely unaffordable. So I deferred preventative care and went to a dr. only when I had symptoms. I found my lump and was diagnosed with IDC with lymph node involvement..and who knows where else...this month? My DH and I each worked all our lives, both saved for retirement and paid for insurance coverage all our lives. We did all we could to stay healthy and now we worry constantly about how we will afford this illness.

Story 2: My DH is 15 yrs. older than me and has Medicare coverage. He had major surgery for prostatitis (was suspicious for prostate cancer) at Duke last year after it had been watched and biopsied and rebiopsied by a private medical practice for years. The university hospital/clinic system is very cost-conscious and efficient. They have access to the latest research and latest equipment and they accept Medicare reinbursement. DH received superior care and the benefit of surgical expertise he could never have gotten in our small community...all at lower cost.  Every tx. was approved with no delay....no Healthcare CZAR like I encounter with my private healthcare policy. If legislators would step up to the plate, Medicare could be given authority to negotiate  pharmaceutical charges comparable to other countries with public healthcare systems and save many more dollars. They could end  the ridiculously high Medicare Advantage supplements paid to private for-profit insurers for supplementary benefits at far beyond their cost. At Duke, all records are online and, yes, it does save tons of money and time by not duplicating tests, txs. and paperwork. Medicare could be solvent if enrollment was broadened to include younger, healthier people and if they work to regulate pharmaceutical costs as they do medical treatment charges. I wish I could pay into the Medicare program for quality care without the fear of cancellation.

Story 3: My sweet Dad died in 2004 of lung cancer (not a smoker) after two yrs. tx. by a private oncologist in Charlotte. He had Medicare coverage and a very good Aetna supplement, part of his retirement pkg. as a CPA at a large corp.  Early on, I asked for a referral to Duke for a 2nd opinion and to explore the possibility of clinical trials. The oncologist said it was premature and critical that my Dad stick to the protocol....at $30000+ per tx. and all the associated charges. My Dad and Mom, in their late 70s and in shock from his diagnosis of stage 4 lung cancer, were afraid to challenge his authority and we waited to go to Duke until the onc. said it was time. The onc decided it was time only after he finished the last chemo round his body could tolerate...when there was no more money to be made from my Dad's illness. By that time, Duke had nothing to offer (except some past-due compassion and respect for his heroic fight) and my Dad had less than 2 mths. to live. Now, after our recent experiences, I know  my Dad's tx. would have been more compassionate and less money-focused and his dr. would have been more skilled and medically ethical at the university hospital.

My heart bleeds for people who have no resources to pay for medical care of any kind. For many, it's not a matter of which kind of treatment to have or where...they have NO options. Others have few or diminishing options. Before my DH and I married, I fostered 13+ abused girls and worked for 12 years. I raised two of the girls to adulthood and often used my resources and time to provide the therapy and services they needed and deserved.  I could barely afford my own premiums and healthcare costs the whole time. Now that I have cancer and truly need help, I live in fear of that ole private insurance CZAR who gets to decide whether I get tx. and when (they're great at setting up the deny/appeal stall knowing the patient may die with enough delay). I'm not alone; the stories are too many and wrenching of good people who work  to support families and educate children only to face bankruptcy because of a  catastrophic illness. Guess what? Statistics show most of them worked all their lives and were insured... 

Can we afford healthcare for everyone?  So far, we have managed to afford $274,000,000 PER DAY for the war in Iraq. Add just some of  that to the obscene profits reported by for-profit insurance companies, add some prudent regulation and rate negotiation and, yes, electronic medical records and we could begin to catch up to other developed countries in healthcare. Instead of a country where a few get GREAT healthcare, some get some healthcare and many get NO healthcare, we can be a country where everyone gets competent healthcare. I could never in good conscience say "I'm afraid covering more people will cut into my healthcare coverage...I want my choices at the expense of people who have no choices."  We DON'T have to choose. You deserve healthcare. I deserve healthcare. Every struggling family in America deserves healthcare. So, we just need to get smart and efficient and innovative...like the university hospitals have already begun to do...and Get It Done!   

Octobergrac, your story gave me chills....It's heartbreaking what goes on....I can't even imagine what it must be like for those in developing countries....very sobering, and infuriating!

As a Canadian I am used to hearing  the 'horror' stories that people often refer to, most told by friends of friends who heard about so and so's cousin.  Do some exist?  Absolutely.  There will always be problems, mistakes, some with tragic consequences when the human element is involved.  This applies in the Canadian system and the American system.  Where I see the benefit to our system is that I do not have to make ANY medical decisions based on $$.  I decided to have a mast rather than a lumpectomy.  I decided to have a proph mast.  I chose to have the radiation and chemo that was decided upon by a board of oncs.  I also decided to have an oomph for prevention.  I was also given the opportunity for genetic testing.  I also chose the surgeon and onc that I wanted. I could have gone to any hospital anywhere in the country. I did not have to wait for any of my tx.   And it cost my $0.00.

I remember when my daughter was dx with cancer. She received about $1,000,000 worth of tx.  We did not lose our home or have to organize fund raisers for any of it.  I sincerely believe that she would not have received the same level of care in the US with us being able to devote all our time and energy directly to looking after her.  

As for 'health czars' that determine tx, I have no idea where that came from.  My understanding is that in America if your doc wants to do a test or tx, your insurance company decides whether or not they will cover it.  Up here, it is the doctor and the patient that decides what will be done.  And if you disagree with your doc, you are free to see another, and another....

I think it is a shame that we put a ceiling on a docs income.  They deserve more.  However, I had a doctor that moved to the states for this reason.  He was back a year later.  Apparently he spent more money on office administration for insurance and patient payments and ended up with too much overhead.  In Canada they know that they will be paid for their services and that is one reason we have so many top notch doctors here.  Research is also cutting edge and attracts top people.  You probably don't  hear a lot about that in your medical news though.

So please don't put down our health system that you know very little of.  I realize that you don't have exposure to much news from other countries and that there are probably people in your country that want to frighten you about our system.  There will always be those that will  complain in either country and some of them have reason to.  But overall, I do believe that the Canadian medical system is working well.  

There is no such thing as a free lunch. What works in a country with a small population like Canada as opposed to the US will be just mean more bureacracy in the US. We have too many people. There is massive fraud with medicare. Ask any doctor how long it takes for the gov. to pay them, if they get paid. Here is a great link that compares health care around the world with lots of articles. Reading it is fascinating.

http://www.liberty-page.com/issues/healthcare/socialized.html

States like Mass. that have tried a state run system have quickly gone bankrupt and had to ask for gov. bailouts. Don't you just love those bailouts? If every state needs a bailout, who will do the bailing? Obama's budget deficit is already triple the ridiculous deficit that Bush left. How big of a hole are we going to dig for our kids to try to get out of? The baby boomers reach medicare age this year. The system is already the biggest drain on our economy(the Iraq war only costs 2% and our military spending is still less than 12%). Who is going to pay for it as the baby boomers age and bring more people into the system? Obama said last week that he will be appointing a czar to oversee spending on medicare. As Fla Lady said, they will soon be deciding who can and cannot get treatments because there will be no money to pay for it. Insurance companies cannot turn down treatments prescribed by a doctor, as long as the treatments are sanctioned by the AMA or they can be sued. Who is going to sue the fed?

I agree that people should not lose their home because of catastrophic illness. But putting the government in charge is not the answer. It will just put us deeper in debt. What we need is a free market insurance system that everyone is entitled to, like car insurance. People should be able to shop around for the best deals, and the government should put a stop to all the price gouging. People should be able to take their insurance with them when they change jobs. Hospitals should all be non profit. Clinics should be set up in poor neighborhoods to take the burdens off of the ER's. And we need to have total torte reform. There are too many ambulance chasers. If someone sues unjustly, they should have to pay a penalty. This will cut the costs drastically. When my kids got a shot, 25 years ago, it cost about $5. Now the same innoculation costs hundreds. Why when the patents are long run out? Because the lawsuits have caused the costs to skyrocket.

How about we all ask our Doctors what they would like. That ought to be interesting.

 Interesting discussion indeed.  I think its wonderful that so many care and are willing to speak out, even if all don't agree.

Vivre: if you go to the AMA site you'll notice that they have finally come out in favor of reform, and better yet, are advocating for it.  They also have at that site a letter signed by 44 other health specialty societies (including the American College of Surgeons--a large, society with tradiationally well financed PAC) advocating for reforming our system.  Some of the reforms they advocate for sound similar to Obama's speeches. 

Sure seems to me like Americans are always talking about how unhappy the Canadians are with their system, and the Canadians come back and say, speak for yourself, we're happy.  Are there any women from Germany on these boards, anyother system American's don't seem to talk about much, or have opinions on, but is supposed to work very well? 

Roseinwinter:  I am so happy to hear that you are going to be in public health.  I have hope for a system that has well educated women who have lived within it working to better it.  (and I'm with you sister on medicare part D and what it could have been)

Octobergrace,

BRAVO!!!!!  I'm 54 and in the same boat, with the same sentiments, exactly!!  There is no reason we can't have universal healthcare in US, especially when we see how simple it is for our government to come up with12 trillion dollars to bail out Wall Street.  It's time to bail us out!  I'm 54 and have a wonderful job with wonderful health care benefits.  But, I'm more afraid of losing my job and having to afford healthcare on my own with history of breast cancer (until I reach the magic age of 65), than I am of actually dying from breast cancer.   There's something very wrong with this picture!

Yes, Leia, wouldn't it be great if alternatives, which are cheaper were covered. It burns me that my insurance company will pay $300 a month for a bottle of arimidex, but not $20 for a bottle of DIM, even though studies show they do the same thing.

2z-It was not "Simple" for the government to come up with trillions to bail out Wall Street. It was "simply" a matter of mortgaging our future. Our grandchildren will still be paying for this. The government did not "come up" with the money. They simply decided to print more. As soon as the economy starts to stabilize, we are headed for massive inflation, probably by the fall. Get ready for you dollar to be worth about 5 cents. The 70's are coming back. Get ready for gas lines and $5 gallons of milk. I am glad I gave up milk.

As far as defense spending, I actually got the stats wrong. The US spent only 4% of the GDP on defense. We spend about 6 billlion on defense. This is  a drop in the bucket next to the pork we are now going to spend. How do you feel about the 900 million going to Palistine? Maybe we should just money to al queda while we are at it. Here is a great article on the subject:

http://www.heritage.org/Research/HomelandDefense/wp040208.cfm

The US constitution states that the only thing our federal government is obligated to fund is defense. It has obviously gotten bloated since then, mostly with programs started by FDR called the New Deal. The only thing I want the feds to do is keep me safe. I think the rest should be up to the states.

As much as national health care sounds nice, as I said, there is no free lunch. It will cost us in the end and be run by by the most inept corporation in the world-the US federal government. We will lose any semblance of free choice, and like our school system, most of the money will be wasted by the overseers, and not those who need it.

I agree with you Jess, we do need health reform. But we do not need another federal government takeover. If everyone was given a yearly tax credit to use for the health insurance of their choice, we would have a better system. As Tricia said, it is not the poor who do not have health care. They can walk into any hospital, get care and walk out without paying. The hospital cannot go after them because they have no money to go after. This causes higher prices for the rest of us. It is the working class who have to pay. If we all were given a health insurance allowance, via a tax deduction, and we could put it where we wanted, the free market would work better. Of course, there would have to be stricter rules for insurers to provide insurance for everyone. I also happen to feel that those who are smokers or overweight should have to pay higher premiums for health insurance just as bad drivers do. People need to take responsibility for their habits. Maybe this would give Americans an incentive to get control of their health.

Health insurance needs to no longer be part of our employers and be back in our own pockets. Companies get tax credits for providing health benefits, and most of us are then taxed on our health benefits as income, so we pay for it in the end. If companies were allowed to get out of  health providing, they could streamline, and costs of what they provide would go down for all of us. If we were given a tax credit for what we spend on health insurance instead of being taxed on it as income, we would have an incentive to shop around for the best deal, and costs would come down. It is simple supply and demand.

It's a very tricky issue, but as a Canadian, I have ALWAYS been happy and proud of our system.  When I woke up with chest pains one morning, I was able to go to have it checked out immediately, and I went to the closest hospital emergency room that excelled in ER heart issues.  I also complained of headaches at the same time, and got an MRI on the spot.  I was discharged 4 hours later, knowing there was nothing wrong with me, but that I had done the right thing to get these weird symptoms checked out immediately.  It cost me zero.  I didn't even consider money, and the physician on call told me I was right to come in.

We may have a smaller population, but it is spread out across some big geography, so it's not that it's so much cheaper to provide health care here.  In the North, some have to be flown to health providers for critical issues, which costs big dollars.  There are economies of scale to be had when you have larger populations at hand as you do down there.  But there is something wonderful about knowing that at least in theory, people come before profits, and that each of us supports the other with our taxes. 

 The trouble with free-market medicine is that the people who should have your best outcomes foremost in their minds, as professionals in their field, are instead concerned FIRST with making a profit.  And that's how it has to be, otherwise, they'd be out of business and you'd be driving 60 miles further to get to the company that IS making pure profit.  Does it make sense to have someone make a profit on the life of a child or a loved-ones?  Yes yes I know that of course as people they care, but they are not operating as a charity...they need to make their profit margins PLUS to cover their overhead.

 Is ours a perfect system?  Far from it.  There are problems.  But I think that when the government can spend endless $$$ to bail out a bunch of schysters with dubious morals who then got your tax dollars to get bonuses...while some child or loved-one has to worry about whether they can get life-saving surgery....or lose their home instead...it's terrible.  It think the suits in power want us to THINK it can't be done.  How much wasted energy goes into this current system, of going to your doctor, contacting your insurance, them contacting the doctor, you, like a monkey in the middle wondering if you're going to get left out of the game or have to fight to get your treatment?  Seems to me:  if a doctor orders a test or a procedure, they must be trusted to know what they're doing.  They're licensed to do this work.  And why should any doctor make $$$$$$ to do the same work (prescribe a test) when it takes $$ worth of time and expertise to do it?  I know it's a can of worms, but there also should be some middle ground on this whole issue.  

Here's my Pollyanna wish for everyone:  that they get the health care they need so that they can live their lives and love their loved one...without worrying about money or ANYTHING else except getting better.... 

I've just finished reading through all the interesting posts on this thread.  As a Canadian, I've stated my thoughts/explanations about healthcare in Canada on other threads, so I won't do it again!

However, I will state that I find it utterly amazing that the U.S. is the only first world country NOT to have universal healthcare.  And so I say "If other countries-- France, Japan, Germany, the U.K., Canada, the Scandianavian countries etc. can manage it, why on earth can't/won't the U.S.?  Population size is not an excuse.  Octobergrace, you've put your case succinctly and persuasively.

Hoping that health care reform will happen soon for the benefit of all our U.S. cyber-sisters.

Linda

Octobergrace....

Brilliantly, elegantly, and intelligently put.  Bravo and thank you.

Karen

Well said, Octobergrace.

My parents have Medicare in the U.S..  They've both had lots of health problems over the past few years and the quality of care that they've received has been excellent.  On the other hand, when I lived in the U.S. I was frustrated by the duplicate tests that a breast specialist required before he would see me (extra billing $, I guess) so I came back to see my surgeon in Canada for treatment. I got in to see him faster than I would have been able to see the surgeon in the U.S..  And since it turned out that all I had was a cyst (which my surgeon aspirated on the spot), the additional tests would have done nothing for me - they would just have been an additional cost.  A friend of mine who lives in the U.S. has had the same complaint - she keeps being sent for tests that make no sense, given her medical concerns. The focus seems to be on increasing revenues for the doctors and medical institutions rather than reducing costs for the patients. 

My breast cancer diagnosis and treatment was all done in Canada.  Add me to the list of Canadians who are happy with the Canadian system.  It's not perfect of course but I honestly don't have a single complaint about my BC care.

vivre, about your comment "I was listening to a Canadian legislator last week. He said that one of the ministers who voted for the current Canadian health care system came to the US for treatments when she got breast cancer.", as Katalin mentioned, the person who's being referred to in this comment is Belinda Stronach.  Since Canada introduced national hospital insurance in 1957 and universal health care in 1966, I don't think she had anything to do with voting for the Canadian health care system - she was born in 1966.  As for her treatment, I was surprised when I heard that she went to California for treatment so I checked out the facts about it.  It turns out that she was diagnosed with DCIS and underwent a lumpectomy in Canada.  When it was determined that she would have a mastectomy, while she could have had reconstruction in Canada (likely with the same PS I had since I believe she was treated at the same hospital; I had immediate reconstruction, by the way), she wanted nipple sparing surgery and that was recommended against.  So she chose to go to California not because the treatment was better or because the treatment was not available in Canada but because she wanted a procedure which her doctor in Canada did not agree was appropriate for her.

As an aside, you might be interested to know that the actual "father" of Canadian health care is the late Tommy Douglas, who happened to have been Kiefer Sutherland's grandfather.  Yup, Jack Bauer is Canadian and no doubt, in favour of universal health care.

The US doesn't have universal healthcare. I hope changes can happen.

That being said, my BF is flying to Denver.She is flying out of Seattle and she asked me to drive her to the Seattle airport. I live in Vancouver,.....that's Vancouver B.C. Canada. Seattle is about a 2 hour drive south. Even though I am driving down, maybe doing a little shopping and have a late lunch I plan on getting medical coverage for the US on that day. My friend asked why? I explained and she had no idea.

I just can't take any chances of having something happen to me south of the boarder.I find it terrifying and can't imagine being a person in the US with no health insurance.

I am leraning a lot from this thread by the way!

Yay Tommy!  Our hero!  Such an upstanding, ethical, wonderful man!