Megan McArdle Thinks I Should Pay $72,000 More for Breast Cancer

Usually, Jane’s slap-down of concern trolls talking about breast cancer stands by itself. But in this case, I’m going to pile on Megan McArdle’s attack on a public option in the name of breast cancer survivors, because McArdle’s basically arguing that I should be thankful my insurance company had to pay $72,000 more for my breast cancer treatment.

Basically, for me, it all boils down to public choice theory.  Once we’ve got a comprehensive national health care plan, what are the government’s incentives?  I think they’re bad, for the same reason the TSA is bad.  I’m afraid that instead of Security Theater, we’ll get Health Care Theater, where the government goes to elaborate lengths to convince us that we’re getting the best possible health care, without actually providing it.

That’s not just verbal theatrics.  Agencies like Britain’s NICE are a case in point.  As long as people don’t know that there are cancer treatments they’re not getting, they’re happy.  Once they find out, satisfaction plunges.  But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.

You see, I’m no doctor. But based on my fairly sophisticated understanding of the breast cancer diagnosis I had, I understand that instead of the treatment I had here in the US–6 rounds of chemo plus Neulasta, surgery, radiation, then five years of Tamoxifen–the standard of care in Europe would have been just the Tamoxifen. Or, by my rough calculations, well over $72,000 more in costs.

And, at least according to the limited studies they’ve done on women with breast cancer at my age, the outcomes are exactly the same.

Now, when I went through breast cancer treatment I had absolutely superb insurance. For example, when I had $2,800 shots of Neulasta after each session of chemo, my insurance treated it as a prescription, so I paid just $10 of that. Each session of chemo was a doctor’s visit: $15 for me. I’m not even sure what I paid for 30 days of radiation.

I’m complaining not because of the money out of my own pocket–though I am offended that that much money was spent. The care was paid for by my husband’s company, which I’m sure could have productively spent the money on innovations in the auto industry rather than innovations in medicine that had no net positive on their bottom line. 

But there was a cost to me. One of the chemos I had leads to heart problems and has basically turned the veins in my arms into solid tubes. The radiation–particularly in someone with my apparent genetic background–can lead to new cancers. And those known risks are basically short term risks–because so few women are diagnosed as young as I was, they don’t know what happens 30 years after this stuff, because most women are dianosed with just 20 years left in a normal life span. Who knows? Maybe my husband’s company paid $72,000 extra for treatments that will eventually kill me.

You see, as with McArdle’s example of Britain, we here in the US also rarely learn about treatments we’re not getting. Only here, we’re not learning about the treatments that–according to admittedly limited science–have exactly the same outcomes for a tiny fraction of both the monetary and physical cost. We’re not learning that science says not all these experiments are worth it. We’re not learning that the health care industry is basically getting rich off of treating us all like human guinea pigs.

I think the big question is, which method of assessment is better for health care. Science? Or the "science" of the market place?

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  1. oldnslow says:

    Thanks for the post empty, but you said Megan McCardle and thinks in the same sentence. Not so sure that person is capable of that particular function.

    Just being a smart-ass. I really do appreciate the post.

  2. Citizen92 says:

    Clinton Era – 95% premiums to care, 5% to shareholders
    Today – 80% premiums to care, 20% to shareholders, exec salaries

  3. Rayne says:

    35% of my husband’s company expenses are for health care.

    Cuts into innovation.

    Cuts into winning work from other companies, especially when competing against overseas firms where nationalized health care is assured.

    And next year the percentage will be even higher without some real health care reform.

    There are at least three folks on the payroll who’ve had treatment for cancer or pre-cancer, too. Don’t know how many have diabetes or other chronic illnesses — all of which are likely being treated quite differently, and all without real emphasis on preventive care.

    It becomes an ugly tension of employer v. employees over health care, with no winners, especially if health care costs make the employer completely uncompetitive. A manager with responsibility for P/L should be able to look at Joe Employee and think, “great engineer, best for this project” instead of “health expense $100,000 this year,” simply for lack of any real overarching strategy to our health care system.

    • joanneleon says:

      Rayne,
      Don’t we have HIPPA laws to protect employees from having their employers know the details of their medical conditions and treatment? And how would a line manager know how much his employee cost the company in health care costs?

      Am I being naive?

      If this is the case, there’s a major, blockbuster story to be told by someone who could investigate the millions of layoffs that have occurred in the last decade.

      In any case, it’s just one more reason to detach health insurance from employment.

      • emptywheel says:

        Not sure if Rayne’s husband’s company self-insures, but at the point I went through cancer treatment, mr. ew’s did. So they had a bottom line number, at least.

        • Rayne says:

          Yes, self-insures, can’t participate in regular insurance as too expensive.

          If they had to buy insurance on the open market, health care expenses would have been much greater than 35% and they’d be out of business.

          joanneleon (11) — Sure, there’s HIPAA. But my spouse is the president, and he’s got diabetes, high cholesterol and been treated twice in three years for pre-cancerous growths. We know exactly how much that care costs. My spouse has also “grown up” with the business, working his way from grunt engineer to president over 25 years; most of the folks in the business have been not only co-workers, managers or now subordinates, but friends we know and love. We know about the complications of their pregnancies, the cancer which took a spouse’s life, the bypass surgeries, all of these intimate details not because we ever see their bills, but because we KNOW these people. They are often the last thing we think about at night as we pillow-talk about how to save his plant from closing up shop because they lost a bid on new work.

          And the reason the new work may have been lost comes down to the health care expenses – theirs and ours.

          • joanneleon says:

            Rayne, thanks for your response. When you said this:

            A manager with responsibility for P/L should be able to look at Joe Employee and think, “great engineer, best for this project” instead of “health expense $100,000 this year,” simply for lack of any real overarching strategy to our health care system.

            and mentioned specific conditions of some employees, it was not apparent to me that you knew this because of personal relationships.

            I fully realize that health care and insurance costs are killing companies and the economy as a whole. I am very much in favor of disconnecting health insurance from employment, and obviously, am involved in the fight to bring down the costs of a greed mongering for-profit medical establishment. I have (had? I’m not sure anymore) a small business which employed me and subcontractors as needed. I had hoped to grow the business and employ others full and part time. Health insurance costs and health related expenses and the outsourcing of jobs in this country are two of my major obstacles.

            I still maintain, and am not implicating your company, that if we were able to investigate the millions of layoffs in this country over the last decade, we are very likely to find that companies choosing to lay off people whose health related costs are high.

            • Rayne says:

              Don’t need much in the way of investigation; you could start with a single industry and survey them about their tenure.

              My sister worked for a rather large retailer for nine years and eleven months, had been promoted a few times from sales to management, had record-breaking sales volume in her dept. month after month.

              Canned four weeks before she was eligible for retirement benefits.

              Granted, it’s not health care, but I’ll bet there’s a similar story about terminations in concert with eligibility and illness.

              Businesses also have their own problems with the status quo, beyond the expenses. Surveys show that a majority of Americans are unhappy with their jobs but are staying where they are because they are terrified of losing health care benefits they have with their existing employer. What is this doing to overall morale and productivity in the workplace? How do employers build A-list teams when they have no good reason to move out
              B- and C-list team members, but C-list team members won’t move on their own?

              [edit: forgot to add something about businesses and individuals’ health care costs. While I don’t actually know of any firm which has terminated someone for their health, it’d be crazy to assume managers out there aren’t thinking this. Pick pregnancy, for example: there are many women who have been given a hard time for being pregnant or having kids because the demands these place on both time and health care resources. When I was first in the workplace, I actually had an employer tell me he’d have fired any female office worker who got pregnant. At the time I didn’t take it as a personal offense, just left his employment well before I got married…but his kind are still out there.]

    • ThingsComeUndone says:

      If that is the average for companies that provide healthcare then if Obama can cut those costs 5% then all those companies would get more cash to boost the economy.
      It would be a stealth stimulus plan:)

  4. clbrune says:

    I couldn’t agree more with this post. I’m a research scientist with collaborations with clinical doctors, and I’m constantly amazed by the practice of prescribing treatments without any real knowledge of effectiveness or potential side effects.

    When it’s a life threatening disease that is being dealt with, I figure it’s a blend of a psychological drive to DO something in the face of a crisis (for the doctor and the patient) and pharmaceutical corruption (medicine for profit: “Hey, you want a pill for something? We got a pill just for you!”).

    As an aside, before Tamoxifen was developed for clinical use, guess what doctors prescribed? Estrogen. In fact, high-dose estrogen is just as effective as Tamoxifen for cancer treatment. But where’s the profit (or patent rights) in producing a naturally occurring compound for clinical use?

    • emptywheel says:

      Estrogen? Really? Doesn’t that feed the tumors? I don’t get it!!

      (Another note on crappy health care: I had one resident who didn’t know shit tell me that Tamoxifen would make me sterile. Good thing I knew more than the doctor and knew that it in fact makes you more fertile, but causes birth defects).

      • clbrune says:

        Somehow estrogen has been turned into a real boogeyman, and the “dangers” of estrogen have been blown way out of proportion.

        Breast (and ovarian) cancer cells frequently respond to estrogen in a growth-promoting way, but they also respond to other growth factors that are present in the body–to a much much more potent degree.

        Tamoxifen probably helps, but probably not because it opposes estrogen (it’s prescribed even when a cancer surviver has had her ovaries removed…that is, when her source of estrogen is removed…so what would Tamoxifen be acting against?). The replacement of high-dose estrogen by Tamoxifen really only makes sense from a pharmaceutical profit-making perspective.

        Tamoxifen isn’t bad–keep taking it if your doctor says so–it just isn’t any better than, or a “cure for”, estrogen.

        • Rayne says:

          Isn’t part of the problem the body’s response to the different estrogens, including xeno, phyto, and mycoestrogens?

          As I understand it, each kind of estrogen is assimilated differently by the body, with xenoestrogens having a more negative impact and phytoestrogens having a more positive impact (at least during youth).

          Or am I misunderstanding this?

      • xargaw says:

        Actually, they use high dozes of estrogen to shrink cancerous tumors prior to surgery or radiation. They use high doses of estrogen quite often in brain, spinal and prostrate tumors prior to treatment.

      • MarkH says:

        Amazing stuff here.

        Do ya remember Dr. Jack Kevorkian, “Dr. Death”? I heard a speech of his one time where he talked about government interfering with medicine and how it had to stop. Well, the fact is medicine hasn’t been doing it’s job (researching what treatments work best) and we have to have government activism (just like the public option for health insurance) to do that job and get the medical profession onto the straight-and-narrow. There’s far too much corruption of medical practice due to money and only government can (try to) fix it.

      • Emily68 says:

        I took tamoxifen for five years, starting when I was 44. The doc predicted correctly that it would induce menopause. If I’d been younger, maybe my periods would have come back after I stopped taking it.

    • chimpyissatan says:

      Marcy,
      I’m truly happy you’re alive, your work enlightens and delights me, but you might want to think about the difference between aggregate mortality rates based on population statistics, and your own individual situation. “[E]xactly the same outcome” is a meaningless phrase in that context. For any individual, the choice of outcomes is limited to exactly two. I’d say you ended up with the better one.

      Don’t get me wrong, I’m no pharma or insurance company apologista, but goddamn, girl. If my wife needs treatment for cancer, I’m not going to bitch about getting too MUCH care, or someone trying too hard to use cutting edge methods to save her life. Maybe your oncologist was doing his/her best with the shitty understanding of your disease that curses us today? You may have shitty pipes and a bum pump b/c of your chemo, but they’re functioning a bit better than they would be in your grave.

      CLBRUNE,
      I’m a molecular pharmacologist who focuses on oncology research. I’m not sure what kind of “research scientist” you are, or what exactly you mean by “collaborations” with “clinical doctors” (clinical doctors?), but I am compelled to call bullshit.

      You are either ill-informed or a poor communicator, either way your comments on this topic are potentially dangerous. Please stop.

    • ThingsComeUndone says:

      Are the doctors collaborating with the drug companies to push new patent protected high cost drugs? I think this could be a great talking point.

  5. earlofhuntingdon says:

    You raise a vital point. The function of a credible public insurer would be to lead reform in the delivery of health care itself, as well as to perform the same role the TVA performed for 1930’s electrical power generation – to create a benchmark against which to measure other health insurers. (The peers of Edison’s GE fought hard to stop the TVA, failed, and had to lower their pricing when it’s power came on line.)

    A major business model of drugs companies is to repackage existing drugs into new treatments and to obtain patents on minor refinements of old drugs to extend their life. The fees they charge are exorbitant, while the drugs are often not more efficacious than cheaper substitutes. The same is true for very expensive new drugs. (The trick is for a reformed system to be flexible enough to allow and pay for the more expensive niche product when it actually improves patient outcomes.)

    Something the industry would hate with a passion is for there to grow a market for public consumption of such drug and treatment price and efficacy comparisons. It’s OK to inundate us with ads for purple or blue pills to treat obscure diseases, or to give us erections lasting more than four hours, but it’s not OK to distribute useful information on the economics of the industry. Its profits might bleed away like the lives of those waiting for improved access to health care. Thanks for sharing your story.

  6. joanneleon says:

    Thanks, Marcy, for shining a light, yet again, on something that really needs it.

    Gad, I hope that you can overcome the effects of that damned treatment. If there’s anyone who can, you can. But I know very well that hearing about how strong you are from other people doesn’t do much good when it never should have happened in the first place, and unless we can make some progress getting to the root of the problem.

    What you’ve outlined here is something I did not know about. Everytime I have a mammogram I have to go back for a follow up because of an abnormality that they tell me is not cancer. My mother had breast cancer late in life. So I could be going down that path at some point, I don’t know. At the rate I’m going, I’ll never make it that far because whatever is slowly killing me right now will get me first.

    I can’t even describe how furious and frustrated I am at the state of affairs in this country, and at the so-called allies we’ve elected who are now perpetuating it and undermining the first chance in decades to really do something about it. As I watch them using the majority power we gave them to exercise rules and shut down amendments to the Defense Appropriations bill and shove 636 billion dollars (for one year, sans supplementals and cost overruns) through the House, I wonder why they won’t use that power for us.

    I’m now seeing a doctor who refuses to accept any insurance except Medicare because he wants to be able to treat chronic Lyme disease, which seems to be slowly killing me right now. For three years my family doctor, otherwise a good doctor, refused to go past the useless ELISA test which comes up negative while the Western blot the new doc ordered came up with positive bands. For years, no doctor told me of other options. I had two surgeries (one a six hour surgery that was really 3 surgeries in one with a 70K+ bill) in the last three years. I have to keep my prescriptions in a bag, there are so many. And I’m still not well. With chronic, worsening conditions it’s sometimes hard to tell how much you’ve deteriorated. A few weeks ago, I finally admitted to myself that I can’t go to NN09 (even though it’s finally within driving distance) because my strength and stamina has so declined since last summer. I hope I can get it all figured out before the COBRA runs out and before I’m completely broke and before I’m unable to ever salvage my career. Time’s running out.

    We need all the help we can get in fighting against the insurance industry and medical establishment — the medical industrial complex — and I thank you again for shining a light in your inimitable way.

    Okay, enough ranting from me. I’ve been at it for a few days now. It’s time to make my phone calls and use the FDL Whip tool. What else can I do? I hope someone in better health than me organizes a massive protest. I’ll take the cane that I’m embarrassed to use in public with me for that.

    • tejanarusa says:

      My sympathies on your frustrating experience with doctors and Lyme disease. It’s terrible that you had to wait so long for diagnosis and treatment.

      I am wondering about this statement you made as if it were obvious:

      I’m now seeing a doctor who refuses to accept any insurance except Medicare because he wants to be able to treat chronic Lyme disease

      .

      Can you explain why taking other insurance would prevent him from treating chronic Lyme disease?

      • joanneleon says:

        For more than a decade, a battle royale has been waged over the diagnosis and treatment of Lyme disease. An excellent overview of the controversy is provided by Dr. Raphael Stricker, President of the International Lyme and Associated Diseases Society (ILADS), and his associate, Lorraine Johnson in an article published by the medical journal, Expert Review of Anti-infective Therapy:
        Myleftnutmeg.com (Netroots site for the state of CT)

        Bill passed preventing Lyme treating doctors from prosecution
        [Connecticut] House Bill 6200 states that after July 1 of this year, a physician can prescribe long-term antibiotics to a patient with chronic Lyme disease without the possibility of receiving disciplinary action by the Department of Public Health and the Connecticut Medical Examining Board only because of prescribing the antibiotics.
        Woman’s Day Magazine

        Chronic Lyme disease or late-stage Lyme is the third stage of this multi-system, multi-stage illness. Various factors may contribute to chronic Lyme disease. It can occur when patients have not been properly diagnosed or treated, or if they have received inadequate treatment. Some Lyme experts say that if all of the bacteria causing the Lyme infection are not killed, or if the patient does not continue to detoxify their body, and therefore creates conditions in which the Lyme bacteria can continue to infect them, the illness can move into a chronic stage, resulting in many other conditions, including rheumatoid arthritis, Chronic Fatigue Syndrome, neurological disorganization, cardiac problems and more.

        […]
        Medical insurance constraints on long-term treatment of chronic Lyme disease contribute to the problem. Many clinics, doctors and hospitals are heavily lobbied by wealthy insurance companies who refuse to acknowledge the evidence put forth by Lyme-literate experts that long-term care is necessary for treating chronic Lyme successfully. Many MDs simply adhere to the stringent protocol of this damaging disease posited by the Center for Disease Control (CDC).

        CDC protocol set by the IDSA, the Infectious Diseases Society of America, calls for the administration of a thirty day course of antibiotics and assumes that Lyme bacteria will be eradicated, and the patient recovered, by the end of the course. In some cases, this standard protocol may indeed be sufficient. Moreover, the ISDA refuses to recognize scientific evidence of the existence of chronic Lyme disease.

        lyme-disease-research-database.com

        Just as an aside, CDC claims that Lyme is hard to get and easy to treat. In my neighborhood, I know of cases of Lyme in five homes in my immediate vicinity. My next door neighbor is currently on an antibiotic pump and I’m being treated with two oral medicines. Her prognosis is better because it was caught earlier. Hard to get this disease, huh?

        • tejanarusa says:

          So, you’re saying if he accepted health insurance at all (or yours, because it is one that forbids long-term care), he wouldn’t be able to accept Lyme patients for long-term treatment?

          That still doesn’t make a lot of sense to me. I know something about insurers contracts w/ doctors, and they don’t forbid acceptance of other insurance by the doctor, or treatment of an illness they don’t cover, with the understanding that they won’t pay for such treatment.

          If this is what your doctor is telling you, it isn’t logical to me.
          That may not matter to you, as you are finally getting treated. Forgive me, I’m not questioning you, I just tend to pursue explanations that don’t make sense. And I don’t think your doctor’s explanation fits the facts I know.
          I get the idea you’re trying to get across. I just think there may be another reason this doc doesn’t accept insurance, and it isn’t exactly what he’s telling you.
          And I do understand this is not the most important point at this stage of struggle with this weird disease.

          • joanneleon says:

            tejanarusa,
            I will make this my last comment on the subject because I feel that I’m starting to derail the topic of Marcy’s post. There has been legislation brought up in at least eleven states which protects doctors from disciplinary action for treating chronic Lyme disease and/or mandates insurance coverage.

            Also, some doctors have small practices and simply cannot afford to deal with insurance companies anymore or they are completely fed up with them interfering with their treatment of patients. If you are informed about doctors and insurer contracts, surely you know about this. My doctor chooses not to accept insurance. No one is forbidding him from accepting insurance other than Medicare. Medicare is the only one he chooses to deal with.

            I am not an expert in either medicine or insurance. I know about this only through my own experience and through people who made me aware of it in recent months. But if you want to find out more about this situation, there is a lot of information out there on the net.

            I have encountered people on line who have some motive that I can’t fathom and who ardently question this whole situation, and frankly I have no time for them.

  7. SaltinWound says:

    Wheel, I’ve been trying for a day, over at fdl, to find out if “day one” was always meant to mean a few years from now, or if that was a concession in order to add Barney Frank to the health care heroes list. As far as I can tell, the “pledge” has been rendered meaningless. Do you happen to know if day one for a public plan never meant day one, or if that’s new parsing?

  8. ecthompson says:

    Marcy, you of course, are right and Megan is of course, wrong. She’s arguing that somehow the private sector has a patent on ingenuity. She is proud of the propaganda machine that is trying to tell Americans that a private option is inherently better than a public option. Megan’s example of the Wal-Mart revolution in supply chain management is one of the reasons why our country is in such dire straits right now. She looks as this as a positive when in fact it is a negative. Wal-Mart revolution has allowed companies to ship millions of jobs overseas which is why the middle class has been shrinking the last 20 years.

    She argues that government researchers and pharmaceutical company researchers are different animals. Yeah, so? No one is getting rid of pharmaceutical company researchers. They will still be able to do exactly what they were doing before. A single-payer option does not eliminate them from the healthcare equation.

    Thanks for your thoughtful comments on this issue. As a surgeon, I have written a lot on health care and health care issues — here.

  9. clbrune says:

    Rayne wrote: ”Isn’t part of the problem the body’s response to the different estrogens…?”

    I don’t really understand the question (specifically what ”the problem” is). If you feel like clarifying by email or here I can try to follow up (clbrune at gmail dot com)

  10. bobschacht says:

    Please excuse if this has already been covered, but isn’t this situation meant to be addressed by Obama’s national panel of health care experts?
    From an NPR report:

    Council Of Independent Experts

    In response to these concerns, the Obama administration stepped forward late last week with an 11th-hour tourniquet. The president called for an independent council of medical experts to oversee Medicare payments and recommend cost-saving changes.

    “Our proposal would change incentives so that providers will give patients the best care — not just the most expensive car — which will mean big savings over time,” Obama said.

    The government already has a Medicare Advisory Commission, but its advice on cost-cutting is often ignored by lawmakers. The president’s plan would give teeth to the recommendations by requiring Congress to approve or disapprove them as a package, much as it did with the military-base-closing commission.

    “What we want to do is force Congress to make sure they’re acting on these recommendations to bend the cost curve each and every year,” the president said.

    Of course, Republicans and Insurance Industry lobbyists are painting this as a draconian panel of “government bureaucrats” who will deny health care to those who need it.

    One place where the leading edge of this debate becomes problematic: With seniors, some treatment is merely palliative: it seeks only to make the patient comfortable, recognizing that no “cure” is possible. If Obama’s standard of care is only about curing, then support for palliative care will be left aside.

    Bob in HI

  11. bgrothus says:

    Thank you for this post, Marcy.

    The people who are happy with their “health care” coverage are people who have never had to use their insurance for any kind of major diagnostic or disease treatment/care.

    Yes, with insurance, you can see your doctors, pay the co-pay for the doc and the scrip, follow directions at home. No big deal. And that may be the primary thing that people do with their insurance.

    But if there is anything outside the main stream in terms of diagnosis or treatment, the insurance company will do exactly what we all know it does: deny, delay, or drop you.

    This has got to change.

  12. marksb says:

    With my throat cancer, it was a fight every day to get all aspects of my tests and treatment “authorized”. The treatment was cutting-edge in terms of the radiation machine and the computer modeling the docs used to design treatment unique to my cancer, but the radiation treatment, as a whole, and my chemo, cisplatin (the granddaddy of chemo drugs and quite cheap), were simple, inexpensive, and proven with this kind of cancer, in this location of the body.

    Yet I bet the local cancer center and I made a hundred calls over the course of a year to get the insurance company to pay. I could go on about the shit they pulled and we fought, but suffice to say it was like pulling teeth to get them to fulfill their legal obligations. The lovely pitbull insurance lady at the cancer center said this is normal: the companies refuse to pay and hope you, the patient, will “just go away”, as she put it. Die and leave us with a nice end-of-year profit, is the business model.

    What pissed me off in MacArdle’s comments was these people, once again, using cancer and a set of lies about treatments in other countries to scare Americans into giving them the profit-centered outcome they feel they are due. It’s callous and it’s close to criminal.

    • MadDog says:

      Having worked briefly (2 1/2 years) once at a Blue Cross/Blue Shield company (I was just an IT type so don’t blame me *g*), one of the very first things that I came to understand was the underlying motivation for all that they did/do:

      Our jobs are to find as many ways possible to deny coverage because that is how we make our profits. The more we deny, the better we do!

      And you believed Blue Cross/Blue Shield was a non-profit organization? Silly you! /snark

  13. MrWhy says:

    I think the big question is, which method of assessment is better for health care. Science? Or the “science” of the market place?

    Bingo!

    Programs like House annoy me for many reasons, their multiple guesses, multiple tests on the human guinea pigs is one reason.

  14. lilybelle says:

    Wow. Amazing post. It isn’t just the $72,000 extra price but the bodily toll of chemo, radiation and surgery.

    Wouldn’t it be just terrible–like nasty evil socialism–for best practices to prevail.

  15. bgrothus says:

    I’ve always had to self-insure. Once I had an insurance company that made me pay for everything up front and would reimburse me when they authorized it. Fortunately, I only had office visits for annual exams, but I always had to wait for their check. Imagine how long I lasted on that plan.

    I was only in the hospital once, diagnosed with encephalitis. I was out of there in 3.5 days, quick diagnosis, good drug. Later, doing my taxes I realized I had been billed by the insurance for a doctor they should have paid. When I questioned it, they told me, “you had encephalitis, the doctor diagnosed “psychosis.” They did reimburse me for that, but only after I raised a ruckus. I don’t recall any doctor who could have diagnosed that, I don’t know if there was one or if the hospital just billed for it. I am sure it happens all the time.

    • PJEvans says:

      Probably one of those control numbers got typo’d. That’s one reason why the insurance companies shouldn’t have the power they have now: there’s no way to check on their stuff easily, and they’ll cheerfully deny any errors.

  16. ThingsComeUndone says:

    How much does health insurance cost GM per car how much would they save per car under Obama does anyone have the details?

  17. chimpyissatan says:

    Xargraw,

    I’m not a clinician, but I’m currently working on drugs for prostate and breast cancer, and have read some recent scientific literature on this topic. High dose estrogen treatment is indeed applicable in some settings, most notably in women previously exposed to antiestrogen treatments. That would be the treatments so derided here (tamoxifen and DES, for example).

    My understanding is that high dose estrogen is not a first line of attack because of the unacceptable side-effect profile when compared to selective ER modifiers. The long-term effects of high levels of estrogen are unknown, and the acute effects are unequivocally associated with severe side effects not typically seen with pharmaceutical company-developed ER antagonists like tamoxifen or DES (death by thromboembolism and hepato-renal disease, for example). I refer you to

    http://jcem.endojournals.org/c…../90/6/3688

    as a starting point in the literature. Please consider that, as with all data in oncology, clinical trials examininng high dose estrogen AND selective estrogen receptor targeted drugs point the way to newer, better synthetic compounds that will reduce side effects and improve efficacy.

    Blind acceptance that Mother Nature knows best, and insistence on the least common denominator in cancer treatment (i.e., based on population statisics for survival) is, of course, anyone’s option. I chose to err on the side of enlightenment and science. I can recommend a few good Hospices and funeral directors for those who chose otherwise.

  18. gtomkins says:

    Expensive equals invasive

    The point that emptywheel is making is just one aspect of a wider underlying truth, that medical interventions are expensive in proportion to how invasive they are. If an intervention costs a lot of money, you can bet that its costs in human terms to the patient are also high in proportion, and, in absolute terms, much steeper.

    This simple truth should dispel concerns about the need to “ration health care” to control costs after we make it freely available. You can make health care free of dollar cost to the patient, but you can never make it free of costs in terms of blood, sweat and tears. The more expensive interventions are the ones that exact the highest prices in these human terms, and are therefore in no danger of being used except where the alternative of not using them is even worse.

    Well, unnecessarily invasive treatments are in no danger of being used as long as the patient can exercise rational, informed, control over the decisions of what interventions to use. Making health care universally available is only the first step in reform. The next step is to put the patient in charge of his or her primary care provider, and primary care in charge of the welter of subspecialists. That second step won’t happen just by making care universal, or even with the additional reform of getting the private insurance industry out of the way. But it can’t happen until and unless care is made universal by way of destroying the insurance industry. The industry needs to stay in control if they are to continue to profit, and if the patient is to be put in control, this rival for control must be first destroyed.

  19. milly says:

    Marcy…I am so sorry about your unfortunate experience with health care.

    Germany is so far ahead of US on cancer treatment. It is amazing how good health care can be when there is no profit to be made. They use inducing high fevers to allow the body to fight the cancer. No longer use chemo and radiation…which to me is as barbaric as leeches.

    Have you noticed how our elites… movie stars and politicians seem to live a lot longer with so called deadly cancer? Sen Kennedy is a good example. His son was cured with the Ojibway herbal formula Esiac.It cures , unlike AMA approved formulas which put you through hell on earth with no good statistics for serious cancer.

    Unfortunately with state media and a carefully controlled health care system …these cures are kept secret.

  20. marksb says:

    Milly, I had a number of dear friends come to me with grave concern when I was diagnosed, telling me of the barbaric nature of chemo and radiation, and the various herbal and lifestyle “cures” they had heard of, how this person they knew or knew of had cured their cancer by using the tea, or solution, or tincture, or… They figured that since I was in my mid-fifties, a thirty-year health-food nut vegetarian, cool and groovy spiritual soul, and a 24 mile-a-week runner, I’d go with the groovy new-age formula.

    And I did research their suggestions, as well as the documented results of “traditional” (modern medical) treatments.

    I found a collection of quacks selling snake oil and people ranting against organized western medicine. I found a complete and total lack of actual research and a lot of he-said, she-said “reports”. And I found nothing, nothing at all, to back up the claims and boasts for the alternative “cures”.

    Meanwhile, I found detailed, peer-reviewed research using thousands of patients that backed up what my western medical professionals claimed. Before we started I went to UCLA for the worst medical experience of my life and completely rejected the so-called expert’s recommendation. I returned to my local cancer center and discussed the proposed treatment with my excellent and caring docs, as well as several experts across the country.

    In the end, I had to abandon a couple of dear friends because they would not shut up about their belief system-based healing regime and the evils of modern medicine.

    No mistake, the modern treatment regimes are deadly, horrible, and make us sicker than dogs. I hated it, but I threw myself into it with complete dedication.

    Two and a half years later I am healthy, cancer-free, running over 20 miles a week, and still cool and groovy. I have a nice scar on the side of my neck from stripping out my lymph nodes, a “second belly button” from my feeding tube, and my throat doesn’t work quite as nicely as it did before the radiation. But I’m alive.

    We make choices using our intelligence and the tools available. I really tried to find alternative therapies that would spare me medicine’s difficult treatments, but in the end, I had to go with what works. I think I’d be dead today, not heading for a nice five mile morning run and attending my ten-year old’s swim championships this weekend, if I’d listened to my friends and ignored medical research.

  21. sharonsj says:

    Yeah, well I’m one of those people who believes in alternative treatments since none of the standard cancer treatments saved most of my relatives. I saw four out of five die after suffering through radiation and chemo. Only my mother made it through after dealing with a benign thyroid tumor, skin cancer, and a mastectomy.

    However, I went without health insurance for seven years because I couldn’t afford it. Two years ago a government program paid for a mammogram, which showed a possible problem. That same program paid to send me for more tests, during which I wondered what I would do if it turned out I had cancer. I realized I would have to sell everything I owned, sell my house, put my pets to sleep, live in a Salvation Army hostel, and then see how long the money would last before I died anyway. After all, if the sum total of my estate was $150,000, I figured that was good for maybe six months or less of treatment. Given those choices, I would have stayed and home and learned how to cook macrobiotically.