Cost of Cancer

 Would you turn away someone in need of medical care if they had no money? 

I do believe health care is a right. 

I believe some things are more important than money.

There is a tremendous amount of MIS-information (well, okay, outright LIES) being broadcast and otherwise distributed by groups opposing health care reform, especially about healthcare in other countries.  And there will be far more, sad to say.......

Leia, we in Canada pay just a few percentages more in taxes than those in the U.S., and it's a graduated tax system.  It appears we get quite a bit for our tax dollars and, as Pip has said, wastefulness is NOT part of a government-run health care system -- at least not up here.  Oh, and just to emphasize this, Canadian life expectancy is higher than that of the U.S.  So, I guess the government is taking fairly good care of us.

Leia, this is not the first time you have stated we pay 50% taxes in Canada.  Ýou have been misinformed on that front.  You want to talk costs?  I make about 50K and pay 30% taxes.  Anyone who earns any money pays a graduated amount of income tax.  The very poorest of the poor get that money back at the end of the year when they file taxes.  That is a hardship on the poor, but they also get rebates on the taxes they pay for goods and services on a regular basis, ie a cheque in the mail, along with other subsidies depending on the number and age of children.  The poorest of the poor can come to the best hospital for the best treatment, provided they have the knowledge to chose which facility to be treated at.  Leila, when everyone contributes a little, then there are resources to pay for all.  This is the same CONCEPT as insurance.  The insurance companies collect a little (relatively speaking) from EVERYONE in the system, but not everyone uses the sytem. If there was no money in the system, even *your* system would collapse.  I hope you´ll absorb what you´re hearing from your Canadian sisters about our health care system.  It´s not perfect but it works.  I don´t understand why we think it´s okay to  have public services provided by our govt. for police, security, schools, roads, but not public health??? Thank god we got our health care figured out in Canada (THANK YOU TOMMY DOUGLAS!!!) before these difficult financial times hit.  I would really like you to address my comments, Leia, because I keep hearing the same argument from you on Cdn. health care and tax system, and your argument is  not based on fact.

Coming This Summer: Health Care Wars

by  Newt Gingrich

05/27/2009

The Washington battle that will most directly and profoundly affect you and your families' lives is the battle for the future of our health care system, which will play out this summer.

On one side are forces advocating a big government, big regulation approach that will transform the private health system into a government-dominated bureaucracy.

On the other side is a new plan that gives individual Americans control over their health care, and provides the affordability and choice that makes that control meaningful.

Both sides share the goals of providing health insurance to all Americans and reining in health care costs. The difference is how each plan would get there. One by government controlling -- and ultimately rationing -- your care.  The other by you controlling and making informed decisions about you and your families' most precious possession: Your health.
    
A Transformative Proposal for Health Care:  The Patients Choice Act

While the nation waits to see the plan President Obama will put forward, last week Senators Tom Coburn (R-Okla.) and Richard Burr (R-N.C.) and Representatives Paul Ryan (R-Wis.) and Devin Nunes (R-Calif.) introduced The Patients' Choice Act of 2009.

They should be applauded for their leadership.  The Patients' Choice Act is a serious, transformative proposal that, if enacted, would dramatically improve our health care system and the health of individual Americans.

Unlike government-centered plans that empower bureaucracies, The Patients' Choice Act empowers individuals.

Empowering Individuals Instead of Bureaucracies

The Patients' Choice Act takes on the toughest challenges we face: improving individual health and managing chronic disease; delivering the best quality care; expanding affordable coverage to every American; and putting Medicare and Medicaid on solid, sustainable ground.

And every idea starts in exactly the right place: with the individual. Individuals should be empowered and encouraged to decide for themselves what is best for them. From choosing what doctor to see to what insurance to buy to what course of treatment to take, only an individual-centered health care system will bring about the real change we need.

According to its sponsors, the main goals of The Patients' Choice Act are these:

• Emphasize Prevention:  Focusing on prevention not only leads to better health but lowers long term costs.
• Create a Market that Works for Patients:  The Patients' Choice Act gives insurance companies incentives to cover chronically sick patients, provides businesses transparent rules, and gives patients convenient and affordable options.
• Guarantee a Choice of Coverage Options:  Patients can choose from a variety of private insurance plans.
• Insist on Fairness for Every Patient.
• Fairly Compensate Patient Injuries:  The bill creates a legal system that serves the interests of the injured, not the interests of trial attorneys.
• No Tax Increases or New Government Spending:  For each American, our country already spends almost twice as much as other industrialized countries spend on health care.  It's time we got something better for our money.
• Restore Accountability to Government Programs:  Our children and grandchildren will face future tax increases to pay for the $36 trillion in unfunded liabilities in the Medicare program alone unless something changes.  And, according to some estimates, fraud and waste account for 10 percent of all health care spending.  That's approximately $100 billion each year.
• Include Ideas for Governors and States:  Washington has proven time and again that a one-size-fits-all mandate won't work.  True health reform must include governors, states, and every American citizen.

It's Time to Move From Ideas and Options to Real Solutions

The Patients' Choice Act complements the thoughtful work done so far by Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, and Sen. Chuck Grassley, the ranking Republican member.  They have published three detailed papers exploring what reform options are being considered in three major areas: improving the delivery of care, expanding coverage, and paying for reform.  They've invited public comment throughout the process and worked with industry representatives, in public hearings and in private meetings. 

The introduction of this transformative legislation is proof that it's time to move from options to real solutions.

The Center for Health Transformation (CHT), which I helped found, is working with both sides of this debate to encourage legislation that encompasses a number of policy proposals that are necessary to transform our health system.  Our proposals span the entire health care spectrum from improving individual health, converting to an electronic health system, combating fraud and waste in our Medicare and Medicaid programs, and expanding coverage to every American.

10 Essential Principles of Health Care Reform

CHT has developed the following 10 principles which we believe must be included in any major health reform bill:

• 1. Every American should be encouraged and incentivized to take personal responsibility for his or her health.
• 2. Every American should have genuine access to quality, cost-effective care that best meets his or her individual needs.
• 3. Every American should have health insurance coverage (private or public) that is affordable, accessible, and portable -- no matter where he or she chooses to work or live.
• 4. Health care providers should deliver the best possible care based upon best evidence or best practice.
• 5. Every provider of care, from doctors and nurses to pharmacists and hospitals, should be interconnected with an electronic health record for every American.
• 6. Payment to providers should be based on the quality of care delivered, not the number of transactions or services provided.
• 7. Cost, quality, and performance information should be available and accessible to all consumers.
• 8. Government should promote and encourage competitive, market-based solutions in the private sector.
• 9. Government should offer effective, efficient, and sustainable public programs for those who need them.
• 10. Government should aggressively invest in targeted clinical research, laying the foundations for future breakthroughs and cures.

You can read our entire plan here along with a checklist for you to grade any proposals your representatives put forth.  

The problems we face in health care know no political party, and neither do all the solutions.  As the debates begin in earnest over how to actually solve these problems, everyone should be encouraged to offer ideas [info@healthtransformation.net]. We are at our best when we work collaboratively to put forth bold, transformative solutions.

Your friend,

The problem I see  with the Patients' Choice Act is that people will still only be able to get the coverage that they can afford.  Which means that those with more $$ will get the better tx.  It also results in people 'betting' on their future needs.  No one wants to think that they will be the ones who will need the extensive health care at some point.  And what will that mean for those who know that they are high risk for certain illnesses, such as BC?  What kind of coverage can they expect and how much will they have to pay for it?

After reading a number of post here I decided to add up my medical bills . What was billed by the providers as apposed to what they were paid and the amount of what my copay was.

They billed over $60,300.00 (chem not finished, rads not done yet and no plastic surgeons bill they keep sending it to the wrong office)

They were paid (by contract)$ 33,600.00 only went to Drs in program.

My copay so far $600.00

There are still a number of outstanding bill PET, CT, Bone, hospital bills. I also have a second insurance company, and I am not sure they have been billed for anything yet.

A number of years ago, I fell and broke my leg in several places one being a spiral compound fracture. I had to have a rod inserted (I later had it removed). The Drs. were not a provider on my husbands insurance (the only one we had at the time) he was in a PPO 90% you would have thought that most of the bills would have been paid...NOT that little broken leg cost me over $12,000.00 more like $18,000.00. The insurance company found so many way not to pay it wasn't funny. I can only imagine if they were the only insurance company we still had.

One of the reason that I returned to work was for better insurance and I am happy I did

I am very grateful for the kind of medical care that I can have, and that I can be part of the decision making process. With many types of illness you only get one opportunity to correct the situation.  My big fear is that I might lose the ability to be part of the decision making process I don't want the government or insurance companys'  to tell me what kind of procedure I am entitled to. I want to be to able make those decision with my doctors in the privacy of his/her office.

The government does not tell us what procedure we are entitled to.  The doctor decides.  And if you don't agree with a doctors assessment, you are free to see as many doctors as you want.

 Yes there are 'standards of care' such as annual mammograms.  However, if your doc sees the need for another mammo, it will be given. Or, if he feels that an MRI is then necessary, he will order one. Basically, one test may lead to the next test as opposed to ordering a whole battery of tests because the clinic/hospital will profit by doing them. These standards of care insure that ALL women are able to have a routine mammo and reduces the amount of unnecessary tests.

Ikat:  Given your experience working with Medicaid I can certainly understand your concerns about government-funded healthcare.  As for lagtimes here in seeing a doctor:  unless one lives in a very remote area (and there are many such places in the northern parts of Canada!), we have fairly immediate access to a gp, and in cities there are several walk-in clinics and, of course, emergency rooms.  Waiting to see a specialist (and one must be referred by one's gp) depends largely on the seriousness of the problem.  It may take a month to get in to see a rheumatologist or an orthopaedic surgeon for a consult, but -- as many Cdns here will attest -- seeing a cancer surgeon or an oncologist will usually only take a week or so.  Again, if one needs immediate tx, then it happens!  One thing we don't have (and I feel we should, so that we are aware of the actual costs) is any printouts of the costs of services we receive.  I have no idea the cost of my mammo, US, lumpectomy, mast and subsequent chemo.  Rx drugs are not covered so, even though I have supplemental insurance (drugs, dental, etc.) I do know the cost of femara, and the neupogen shots I required during chemo.  If I were 65+, my drugs would be free -- with a very small deductible.

There are certainly many obstacles to overcome in creating a workable health care plan that covers all citizens.  It doesn't help, though, to have special interest groups spreading untruths about universal healthcare in other countries.  I guess that's why we Canadians on this board are trying to set the record straight!

Best regards, Linda

I have been watching this with great interest. Yesterday was Budget Day - the government announced its budget and tax cuts that had been indicated have been postponed so that there is enough mobey to fund health and education. I would much rather loose $12 a week over the next two years and not have to pay for health care.

The wait time here seems similar to Canada. For cancer and other emergency things it is about a week other things longer. I saw the onc at the hospital prior to chemo, he took one look at my good arm and said I needed a port. So chemo was post-poned a week so that I could get the port put in the next Monday - thats the day they do them. Small price to pay as my arm was already a mess. My daughter had to wait a few weeks for a gallbladder op but went in the next week when the doc rang the hospital. My DH has had several heart procedures, all in the public hospital that is a world leader in heart care.  He will need to have valve replaced sometime in the future, his doc said it could be done now but they prefer to wait as it will have to be replaced again later. It could be done privately but we would much rather it be done by one of the leading heart surgeon.

I am on Femara and if I wasn't on the trial would have to pay part if I wanted to take it - I think I could get Arimidex free. Problem of living in a small country however if a specialist really wanted you to have a certain drug then they can apply to the government. Sometimes I think that if we knew the actual cost of drugs we wouldn't be so wasteful.

Universal healthcare is very precious. Yes there is a huge bureaucracy which is/can be a problem and in hard times like now the gov wants to slim this down but at least I can get to a GP today if I want too, if after hours go to a clinic or to the Emergency at the hospital. It doesn't matter who you are or how much you earn if you need a certain procedure you will get it ( and like in Canada for some things you have to wait a while, which is why many of us have insurance). And as in Canada there is not the unnecessary testing or intervention. I asked the onc about neupogen injections and he said they are really expensive and most people's systems are able to cope naturally but if you need it we will give them to you.

I do not know how the US is going to impliment a more equitable health system. It will take time and people must not scaremonger about second rate services, that doesn't need to happen. I would hate to have gone through the last couple of years without our health system and their great support.

From a very chilly New Zealand, going in to a holiday weekend which look as if the weather will be terrible.

Alyson

I had to correct the typos

Alyson it sound like New Zealand really has it health care system well organized. I am pretty lucky with the prescriptions drugs I don't have to pay for them. But my dental is pretty steep because I go to a out of network provider (he has been my dentist for 24 years can't replace him).

kathy 

Insurance companies seem to be able to pay the ordered tests and still make "obscene profits".  If they don't want to pay for a test, they'll find a way to deny it. I don't feel too sorry for insurance companies. It's the business they're in, after all.

What about the 20% of biopsies that are positive? Should those not have been biopsied? 

One thing that Obama's health care team is already looking in to is lowering the cost of procedures. I would think that trying to make sure that unneccessary tests, duplicate tests, etc, are a large part of that. 

I do understand that part.  My hubby went to see a ortho doc about a torn rotator cuff. He already had an MRI from the GP that showed that. As soon as he got to the Ortho's office they wanted an x-ray. We protested, saying he had x-rays, they don't show anything. He has an MRI available to look at. They insisted on doing the x-ray anyway. It didn't show anything, they had to look at the MRI. So a waste of money for us and the insurance company. How do you get doctors to listen to you?

I guess we could have just left the office, but then we wouldn't have accomplished anything, and still been charged a office call. 

I haven't posted on this thread in a long time because I feel embarrassed, defensive, ignorant, etc. 

First of all, I found my lump in 2001, and it was already pea sized -- I had no trouble feeling it then.  I had no insurance, and I surely had no money.  Yes, maybe I could have afforded the mammogram, the sonogram, and maybe one step further.  But I could have NEVER afforded the bipopsy, the anesthesiologist, the pathologist, etc., to say nothing of all the treatments, dr. visits, surgery, etc.

I let it all go until 2008, feeling that if it was cancerous, I would just be one of the ones who died from it.  After a while, I convinced myself that it was "just a cyst" since so much time was passing and I was still here.

But it grew, and it puckered, and it grew and grew.  I was beginning to have arm problems --- felt like bees stinging me all the time.  Then the tumor broke through the skin, was black, and yukky!  I had to do something.  I went to the county health dept., because they said they did free mammograms and I thought they could direct me to some kind of care that would see me through dying.  It was there that they got me hooked up with the Woman's Breast and Cervical Cancer program.  After that, all my treatments were paid for, as was all the surgery, medicine, chemo and radiation, scans, etc.  I can't tell you how much of a thankful heart I have for that. 

I had to do the chemo first because the tumor was so large.  It shrunk from 10 cm down to 1 cm.  Surgery found 5 out of 15 nodes positive, one being a big problem because it had wrapped around a shoulder nerve which the surgeon had to cut. 

All that to say this:  Everywhere on this discussion board, no matter what type of cancer or what stage, so many women are making decisions for themselves about their care, what they will do and not do, and I just can't figure that out.  Money issues I can understand, believe me.  But when it comes to chemo or no chemo, or surgery or no surgery, or radiation or no radiation, I just don't understand it.  I consider myself quite intelligent, able to read and search out stuff, and believe me, I have read more than I ever should have about breast cancer and treatment!!!!  I have nightmares over it all.  But. . . . I still do NOT feel one bit qualified to make ANY of these decisions on my own.  If I had chosen NOT to do chemo because I didn't want to feel like road kill for a few months, I wouldn't be here today to type this post.  It was hell for me, believe me.  I got a triple dose of taxotere and cytoxen because "protocol" had it set up that way for my weight.  I think I was about as close to death as one can get with chemo.  But as soon as it was done, I sprang back quickly.  Had my surgery, burnt to a crisp through radiation, and here I am feeling great.  Was it worth it?  You bet!!!!!  The burns healed and the skin is all new and doing great.

I walk through the flowers.  I go shopping, see my friends, feed the birds, and hug my dog every day.  So I suffered for 9 months with treatments.  Had I NOT done it, I probably would be close to death, if not dead by now.

I just can't imagine what I would feel like if I had said no to chemo and/or radiation and it came back.  I would always feel that it was my fault, and all the "should have's" would follow me and haunt me to the grave.  When the oncologist said, "This is the plan. . . ." I never questioned it, never thought "Maybe no. . .", never looked back, and stuck my chest out there for treatment.  I still hate the port, hate chemo, hate radiation, hate being boobless. . . but I love being here!

I wish all of you the best of everything in your decision making.  I just feel badly that you feel you even have a choice to make!

Leia, you wrote:
Stage 1, no mets, no node involvement, surgery cured it.  

Perhaps your cancer was HER2- and Hormone positive. In that case, it is pretty likely that surgery cured it. However, for those of us who had HER2+ cancer, chemo is a pretty good idea - even if we are stage 1, not mets, no nodes. Last December, MD Anderson reported on the results of a respective study of women diagnosed between 1990 and 2002 with small (< 1 cm) node-negative breast cancer who got neither chemo nor get Herceptin. For HER2+, recurrence was 23% and distant recurrence (i.e. stage IV) was about 15%. For hormone positive HER2-, those numbers were 4.8% and 2.5%, respectively. Triple negative was in between at 15% and 4.4%. The vast majority of the recurrences happened between 2 and 4 years after diagnosis.The curves flatten outafter that.

The surgeon can get all the visible cancer and have clean margins, but with agressive cancer like HER2+, there is a significant risk that some cells have already traveled elsewhere and will cause a recurrence.

In the BCIRG 006 study 2nd interim results, women with node negative HER2+ cancers who received Taxotere, Carboplatin and Herceptin therapy (TCH) had a 7% recurrence after 4 years. And that group included women with cancers larger than 1 cm. TCH therapy also had very good safety results. The short term side effects were less than AC-TH and it doesn't have the long term heart effects. 

My 4 months on TCH weren't easy, but it wasn't terrible. It was definately worth it to knock down my recurrence risk down from about 1-in-4 chance.

Bluedasher wrote:

"Perhaps your cancer was HER2- and Hormone positive. In that case, it is pretty likely that surgery cured it. "

That is what my cancer was. I've stated this, on this board. 

Your cancer is worse, than what I had. And that's my point. YOU should be treated, I should not. These breast cancer "treatments" for my stage 1, ER+PR+/HER- are just... wasted Medical Treatments.

And Telid, your latest comment.  

"Neila, you mean you aren't going to take medical advice from our resident CPA?" 

Hahahaha. I'm not giving anyone, medical advice. I'm just telling you what I did. And saying that I feel great. And I still have both breasts, intact. And it's been three years.

I had a 2cm IDC. May, 2006. And did NOTHING, but surgery.  To cut it out. 

That IS my point.

WHY is everyone over-treating, themselves? The simple answer is, because they don't have to pay for it. 

And as the CPA, looking at Obama's Single Payer plan,this overtreatment is not included. I'm sorry, ladies, the numbers do not add up.

So, you will not be getting all of these "treatments,' anymore.  When Obama's plan, goes through. First thing, to go. 

Hello. There are only so many docs, and so many MRI machines. And so much $$$.  

And Obama has already shown, that he'll easily jettison, from his "campaign promises." Anything. To whatever is politically, expedient.  

The USofA isalready, bankrupt. We're owned, by the Chinese. Who buy all of our Treasury-Bonds. And Obama is just making it, worse.

Certainly, if so many other countries can pull off 'socialized medical care' for all citizens, America can do it too!