Did anyone catch 60 Minutes last night?

CherylHutch said:

Your mileage may vary
Hey Monica... thanks for joining the conversation as a fellow Canadian. Hahaha... sometimes I feel that I'm the token Canadian entering the fray and yet my opinion/experience is only one of the millions that live in Canada. Of course, we are all going to have different experiences (horror stories and miracles).

Let it be known that this is not the first time that I have talked about the Canadian system AND also said that as much as we have a National "Subsidized" system, I'm not advocating that the States looks to ours and in anyway copies it because our system certainly has more than it's fair share of problems that needs fixing up too. What I do use our system for in comparison is the bottom line... every Canadian citizen, no matter which province you are in, has the right and access to fair health care without the fear of "How are we going to afford this???" And, of course, we have choices of going elsewhere if one wants/needs to do that.

Now, having said that, I think I'll point out one (of many) weakness in our system that would be something to seriously consider when thinking of going to a National system. And that is having the individual Provinces/States in charge of their own Health Care Insurance system. In Canada, we have 10 provinces and 3 Territories... and the population in those areas varies big time. But it means we have 13 mini-systems under the umbrella of one National system.

In plain layman's terms, the Canadian National Health Act basically says, the federal monies will be allocated to each province/territory depending on population (IE: how much tax can be collected from a Province with 10 million people vs a province with 200,000 people? Hence, how much money would be allocated to said provinces is dependant on how much (percentage-wise) each province puts into the system). The Feds allocate X amount of dollars to each province/territory and then the province/territory has to either match or come up with how much more they need. If for any reason a province would decide to use that money elsewhere and not provide adequate healthcare, then the Feds would pull their money (and the province would be in huge doo-doo since it is the law that each Canadian citizen has access to affordable health care).

Since both the Feds and the individual Provinces/Territories are responsible for Health Care monies, this explains why our Canadian taxes (Federal as well as Provincial) are higher than the average American's taxes, no matter which State you live in. We have some of the oddest taxes and it can make one grind their teeth when it seems taxes are constantly going up but income remains the same or goes down. Ha! Every Canadian may have medical coverage, but is having a hard time buying a loaf of bread and milk ... and we won't even discuss Gas prices

But I digress. So here we have Monica with her situation (Monica, I'm going to assume you live in Ontario because of your one comment about how hard it is to get a PET scan?). I'm on the west coast, in BC, so we are in two different provinces... two provinces that handle their Health Care systems very differently it appears.

In all fairness, I really and truly don't know how easy it is to get a PET scan when needed in BC, if say you live up north, or in central BC. I know that if I need a PET scan, then the appt. is made and if it is not an emergency (IE: just part of the follow up checking), then I would get it in a couple of weeks. The first one I needed because it was obvious my CEA was rising, I got within a week. BUT, I must add here that I live in the heart of the city (Vancouver) and the BC Cancer Agency where I go for treatments has a PET scan in the building (as well as CAT, XRAY, etc). So we are not dependant on going to a hospital for these scans. Would someone living up North have a machine close by? I don't know but if they don't then they would have to fly down to where the closest one is. So one could say that this is not good or fair... on the other hand, they are given access, it's just they may have to do a lot of traveling to get to it

Now, I'm particularly interested in your comments/situation...

Because in Canada, once you are considered 'not curable', the only treatment available to me is chemo (and we all know how well that works in the long term).

I think that comment should be changed to "Because in some places in Canada" and not all of Canada. I am also Stage IV "not curable" (don't you HATE those two words???" and have found it to be the exact opposite. My oncologist was very upfront when my DX was changed from Stage III to Stage IV. She told me that Stage IV was the last stage of colon cancer, there is no stage V. It does mean I'm "incurable" and when they found that my cancer had spread to the adrenal gland and the lungs, I was told the prognosis was not good. Certainly not as good as if I had remained a Stage III. I, of course, freaked out and I'm sure everyone who has been diagnosed as Stage IV knows exactly the feeling and panic you go through when told you are Stage IV, the cancer has spread, and you are now incurable.

She did take my case to the "Tumour Board" (although I think they call it something different here... I think she called it "case conference")... and the bunch of oncologists/surgeons/specialists sit around and discuss these "incurable" cases. It was at this case conference that it was determined we would start with surgery to remove the adrenal gland, and then we should look at surgery or RFA for the lungs. Obviously, chemo is also an option, but the recommendation was for removal before thinking of chemo. This had to be decided fairly quickly because typically, when cancer spreads, it can be quite aggressive and grow very quickly. Turns out, my adrenal gland cancer was not spreading and we got that out successfully and my lung nodules are growing so slowing, it's almost that they aren't growing at all. So the recommendation now is not to do invasive surgery until we know what we are dealing with. The one nodule that did light up (two PET scans) we dealt with RFA instead of surgery. Now, I still have nodules, but none of them are lighting up the PET scan.

The reason I re-wrote all of the above in my own situation is to show that our two provinces obviously handle things differently. My oncologist is very positive and has said for me not to even think about chemo and what combos I should be thinking of because we are going to stay off chemo for as long as possible... and if any of the nodules decide to start growing, then we have various options of how we will treat them. Whereas it sounds like your oncologist and doctors pretty much said, "You are Stage IV, incurable, chemo is the only option. Period."

Of course, your condition and mine are probably vary different so we can't compare situations. Interesting that your doctors told you this, opinions from American doctors agreed with the Canadian... and yet Argentinian doctors were willing to try some other options, including surgery. I think if I were not happy with the care I am being given, my first choice of out of country options would be for me to go to India. Although we all hear about the poverty, third-world conditions... their technology and medical field surpasses both Canada and the States. I have no idea what their health care system is for their own citizens but their facilities, research and specialist are phenomenal. Now I might have to add Argentina to my list

As for not being able to get meds (Avastin/Erbitux, etc)... I guess I'm in one of the provinces that they are readily available. In another topic, I posted the link to an article and it mentioned the couple of provinces that those drugs are not available and I can't remember which provinces but I'm thinking it was the smaller ones like PEI, Nova Scotia and ? I didn't think Ontario was on that list.

Again it comes down to "insurance" decisions and how that works. The province sets up an insurance company and someone (committee or dept. made up of doctors, government and insurance folk?) determines just what the insurance will cover and won't cover. The "won't covers" are probably then negotiated on an individual case by case basis... the doctor would have to convince the "payer" that a treatment not covered by insurance would, in fact, be of benefit to the patient and then that treatment would be covered... but this is not the case in all requests.

Hehe... I don't know and don't have the answers. I am not a doctor, lawyer or government person who makes these kinds of decisions or is involved with the Health Care Insurance plan. I am willing to bet the countries that have the best system, still have problems and individuals have hassles.

But one more thing that I have to add before I forget and that's the long waiting lists that we hear about. I am not doubt or saying they don't happen... they certainly do!! I, personally (knock on wood) have never been affected by them... when I've needed treatment or surgery (not just cancer-related but prior to my diagnosis), I have gotten it within a week of being told I need it. I don't know of anyone, personally, who has had to wait, but like everyone else I certainly have heard about it, read about it and have had friends say that "friends of friends" have been told of outrageous waits and had to go to the States to get their surgery (again, not cancer-related but just surgery in general). I don't doubt that this does happen, although I am not sure it happens as often as we think it does. I also happen to know, that the same thing happens in the States, where people can't get in for their treatments/surgeries because of a wait list (we've heard of that right here on this board). So, in all fairness... both systems have that problem and I think it is part of all medical systems... when there are more people that need surgery/treatment than there are working hours in the day, a backlog starts, some worse than others.

Again, I can only say that I have no answers or solutions to the problem, but I am a firm believer that EVERYONE should have access to affordable health care, however that can be arranged. One shouldn't necessarily copy one country's system, but if one is going to start from the bottom up, then look at all the systems that are working, take the best parts and form one super system that will benefit everyone... and let the rest of us then envy the new Super System

Hugggggs,

Cheryl

CherylHutch said:

Interesting debate
Bob, Judy and Mike... you all bring up some wonderful (and opposing) viewpoints. But all of them, like Bob said, are healthy discussion and this is what your government officials (or is it the Administration?)... whoever is going to be involved with trying to fix the problem has got to have. I know one can never assume anything, but I am going to assume that the "Officials Who Be" understand that the "system" is broke, not the actual "care, treatments or research". There is no doubt that the USA has phenomenal surgeons, oncologists, specialists, researchers, etc. That is not what is needing fixed and those same phenomenal professionals will still be around no matter what/how the system were to change.

Bob, you used the example of Cleveland State vs Harvard. Ok, being the foreigner here, I don't know Cleveland State but I think the message you were trying to get out is that Cleveland State is a State-run college/university, whereas Harvard is the cream of the crop in educational institutions. Am I right in also assuming that Harvard is funded by private funds and does not receive any State or Government funding? Yes, everyone, even us out of country folk know that having a degree from Harvard or Yale is "Prestige". Both Harvard and Yale have a history of being fine institutions and if you say you have a degree from either, then I think the term is that you are "ivy league".

OK, so continuing to use that example... if someone gets their law degree from Harvard and someone else gets their law degree from Cleveland State... does that mean the Harvard lawyer is any smarter or better than the CS lawyer? They both have had to pass the Bar exam and both will have to have studied hard to be able to pass it (students from both Harvard and CS have not passed the exam and others have passed after 2 or 3 attempts).

The difference as I see it from an outsider, the Harvard lawyer has prestige on his side and one immediately thinks that he/she is so fortunate to have had parents who have money and can afford to send their kid(s) to Harvard and then it's up to the kid to succeed because opportunity only goes so far. The CS lawyer, one doesn't really think what their financial background is other than the first impression would be that he/she does not come from a family that has a lot of money, since he/she is not at Harvard/Yale. So maybe mom/dad could afford to send him to college/university but not the ivy league... or maybe he/she managed to get scholarships to see them through. The end result, they worked hard and graduated with their law degree... as did the kid who happens to come from money.

But healthcare... I think I see where those for a National Health Care system are banging heads against those are totally against one. It seems we are talking three totally different systems.

System 1: National Health Care, run by the government where the government supplies the funds to every hospital/medical institution and has a lot of say into how that money is used, hence making regulations, limits, rules, who has to see who, etc. In other words, all existing medical facilities would be run by the government, sort of like how they run their various departments.

System 2: Health Care itself continues being run exactly as it is now. VA has their rules/regulations (IE: Only vets are eligible, no civilians). Civilians choose their own doctor(s)/specialists or their doctors refer them to specialists. The Vets are covered financially by the VA and civilians are covered by whichever Insurance coverage they have... whether paid for by an employer or paid for by themselves. Others don't have any insurance because they can't afford it, so they tend to have to go without treatment (which plays havoc with survival statistics because maybe they would have survived if they had had care).

System 3: A National Health Care Insurance system. Everything continues running as in System 2. The government has no say as to which doctors you go to, not even to the extent that HMOs currently have. You, as an American citizen would be entitled to go to any doctor/specialist you need to (assuming they can take on more patients... but that's true as of today, so that's not really a change). The government's role is to adjust the collection of taxes so that they receive revenue for this National Health Care Insurance program and monitor other sources of revenue, and then distribute it to every State level of government who will have a Health Insurance dept. that looks after their State's plan. Doctors/Specialists/Hospitals/Nursing Homes, etc. would all BILL the State Health Insurance, and this State Dept. will pay the invoices. Basically the State Dept. is just an Insurance accounting department. Money coming in (Fed money from taxes, Citizen's portion from their State, money that the State budgets for their State's Health Insurance), money going out (IE: Doctors' invoices, hospital invoices, etc). That is all they are looking after. Doctors/Specialists/Hospitals/Nursing Homes/etc. would continue with business as usual, but now they have less paperwork because they are billing ONE insurance company and not a multiple of HMOs and a kajillion different insurance companies, all with different rules and regulations. The State Dept. is all about accounting for the money and making sure the invoices get paid.

Oh, and the one HUGE difference System 3 will make, other than the medical professionals only have to bill one insurance company for everything they do, is that EVERY citizen is entitled to have this insurance... so every citizen is entitled to get the same treatment everyone else gets.

System 1 is the system that most people seem to be afraid of... and if that is what is decided then I would be scared too. There is no way the government should EVER be in charge of making decisions about what is good for anyone's care/treatment. The government has the ability to collect and distribute money and set budgets and then monitor those budgets... but care/treatment decisions are to always be left up to the doctors and specialists with the agreement of the patient.

Now, how to take System 2 and convert it into a System 3, that will take someone, or a group of someones with a much better brain than I. And it will take a heck of a lot of healthy debate to figure it out so that everyone benefits.

Ok... gotta go! Speaking of Health Care... my poor little dog, Bridget, was at the Vet today because of what I thought were 2 loose teeth and a gum infection. Turns out she had 8 loose teeth that had to be extracted and a fairly severe gum infection. She had to be put under anesthesia to have the teeth extracted and the poor little thing is not comfortable tonight. The anesthesia has now worn off and I have given her her pain med, but the little darling is lying on her pillow and crying. So time for me to go have some doggy cuddle time.

Hugggggs,

Cheryl