What do you pay for?

[cariad]

The silly thing about what noahvale is saying is that dialysis patients are on Medicare, which is socialized medicine. And he readily admits that "some of us do fall through the cracks" which is all that that article was saying, some UK patients also fall through the cracks.

Our current system has worked out fine for me, but I am a renal patient. It did not work out so well for the wife of Gwyn's colleague, who was two credits short of qualifying for Medicare (she made the decision that many conservatives want women to make - to be a stay at home mother) and she literally paid for that with her life when her husband lost his work insurance (the company pulled it) after she was diagnosed with aggressive cancer. She died in February, a year after diagnosis, still on the wait list for charity hospice, and her husband has been forced to declare bankruptcy. I don't know how anyone reaping the benefits of Medicare can say that the NHS is so awful and that insurance reform is going to kill us all. You are getting socialized medicine, but many others in need are not.  Political ax to grind indeed.

I came very close to losing my insurance right before I was due to have a transplant, and my centre, like every other one I visited, would not have done the procedure without that insurance. Where is the freedom of choice in that? You can go the private pay route in the UK, too, or buy private insurance, assuming you have the means.

[Riki]

That is why I like universal health care like we have here.  It doesn't matter if you are penniless or if you can swim in your money like Scrooge McDuck, you get treated if you need it.  I think different provinces have different policies, since healthcare is run by each province.  As an example, I think Alberta has a yearly copay, so much per family, but I'm not sure.  My province doesn't do this.  I can travel anywhere I want in Canada and get treated, as long as it's approved first.  I went to Ottawa last weekend and got treatment there, but it was approved about a month before by the PEI government.  When I go to the US, I have to pay upfront, and I'm reimbursed when I get home.  One thing about travelling.  I wish there were flat fees for dialysis treatments.  I'd like to go to other places in the US, but I'm afraid of what dialysis costs would be.  A friend told me he was planning to go to Chicago for a vacation, but decided against it when he found out that dialysis was going to cost him $1000US per treatment. but, I'm digressing.

As I said before, my friend, who lives in NJ, should have had surgery on her knee years ago.  She's also asthmatic, and has a mild TBI and should be seeing a doctor on a regular basis, but is not because she can't afford to do so.

[okarol]

Whenever I glance at this topic I see it as saying "What do you pray for?" LOL

[Zach]

 

[RichardMEL]

Yes, we pay higher taxes to support stuff like this, and cancer treatments and whatever else. Our govt was prepared to pay nearly $1 million to give my mother surgery in the US that was not available in Australia for her DVT caused condition. Alas when she got there they found even they could not help her, so it was a trip for nothing, but I love that our system was prepared to make that effort for a citizen who had worked and paid taxes for 40+ years. Meantime, the systems pays upwards of $80,000 a year to keep me living, and will pay for a transplant when it happens, and subsidize the medication for as long as I need it.

That's why when I get my tax bill I will NEVER complain and pay it happily.

Yes, our system is FAR from perfect (nobody's is) but it's a hell of a lot better than what some others have to deal with.. and I'd rather pay taxes thinking of dialysis folks and the like getting the treatment they need with my tax $$$ rather than slack-arse dole bludgers sitting on their arses using social security payments to buy more cigarettes and booze (but I digress....)

[noahvale]

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[noahvale]

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[noahvale]

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[greg10]

Let me apologize for my countryman noahvale, he is from Atlanta, Georgia, USA, and not representative of everyone there or of the nation.  The question of this topic is what do you pay, not what is socialize medicine.

These are some of my father's big out of pocket expenses after Medicare takes care of about 70%, he does not have "medigap" supplemental insurance:

Big "chain" dialysis center, Claim balance for 6/2/10-6/30/10  $872.54
Costco Pharmacy Fosrenol, 1000mg tablet, 90 (1g permeal)  $590.73
Costco Pharmacy Sensipar, 30mg tablet, 30 (1 per day)        $415.15

Average payment for dialysis related balance due per month $1878.42

That is not including other drugs, transportation, visits to vascular center, nephrologist, infectious disease and other specialists.  My father is fortunate enough to be able to afford $30,000 or more of out of pocket expenses  per year, but I wonder how long this can go on for an individual or for the nation.

From a cost containment point of view, the big "chain" dialysis center is billing for as much epogen shots as they could and that is why the high cost.  There are longer lasting alternatives to epogen and  the recombinant DNA produced hormone should not cost more than $50 a shot for a longer lasting version (1-2 months) of the treatment.  As I have written in another thread, Fosrenol (lanthanum carbonate) can be produced at about one cent per gram and a monthly treatment should be no more than $50.  Similarly, Sensipar or cinacalcet is a fairly simple compound that should cost no more than a few cents per dose.

The US and other governments around the world don't seem to have a good handle on the cost containment of their health care system.  The answer is government sponsored research, development and implementation of treatments.  Instead of being hostages to CEOs and bean counters of big pharma and big clinics, you will have cost containment when you own the patents and implement the solutions.  I have no doubt that if governments could spend $25 billion a year on stem cell research and trials, which is the same amount Medicare spend on treatments for kidney failure per year, a cure for kidney failure based on stem cells could be had in less than 10 years.

The common argument I hear about government involvement in healthcare is the sarcastic remarks of 'how do you like your health care run like your local department of motor vehicle?'  Well, my retort is how do you like to depend your life on your government run military and police force?  Your government is only as good as you are willing to contribute to it and to make it work.  Most of the fundamental discoveries in the sciences, including health science, could not have been done in the last 70 years without the involvement of governments sponsored research around the world.

[Marina]

Costco Pharmacy Sensipar, 30mg tablet, 30 (1 per day)        $415.15

 

have you  tried  getting  a  prescription card  from  sensipar?? only   $5.00  co-pay with  card


The Sensipar® Pharmacy Card Program

As part of its ongoing commitment to improve access to healthcare, Amgen actively supports a Pharmacy Card program for eligible Sensipar® patients.

Most patients who have commercial prescription insurance are eligible to participate in the program.  The patient is responsible for the first $5.00 of out-of-pocket costs. 

The Sensipar® Pharmacy Card will pay up to $3,000 each 6-month period to cover out-of-pocket costs for Sensipar® ($6,000 per year), including co-payments, co-insurance, and prescription deductible

http://wwwext.amgen.com/amgenassist/copay_sensipar.html
To enroll, please call the Sensipar® Pharmacy Card Program hotline at 1-866-711-4162. Agents are available to assist you Monday-Friday from 8:00 am to 8:00 pm ET.

[Marina]

my best friend hates going to the doctor, because she really can't afford to do it.  a few years ago, she slipped on some ice on steps going into the subway in NYC. She tore something in her knee, and it really should be operated on, but instead, she lives on Motrin because she can't afford the surgery.

Rikki,
please do me  a favor,  warn your  friend  that  frequent  and long  term  use of  Motrin  will  damage her  kidneys.

[glitter]

Let me apologize for my countryman noahvale, he is from Atlanta, Georgia, USA, and not representative of everyone there or of the nation.

I dont understand why you think you have to apologize for your 'fellow American'?

Every single person on this site is entitled to their own opinion- and its okay to have a different opinion then everyone else.

[Stoday]

The US and other governments around the world don't seem to have a good handle on the cost containment of their health care system. 

There are strong political restraints from governmental bodies trying to contain costs.

In the UK the National Institute for Clinical Excellance decides what drugs and procedures are cost effective and produces guidance on implementation throughout the NHS. The overall cost of dialysis, for example, is around £25,000 a year per patient and is permitted. A cancer drug that extends life by up to a year costs much the same but is excluded. It's too expensive for the short extra life (whereas the kidney case is not). That policy should bring down the manufacturer's prices, which would make it acceptable. However, the political outburst that that causes limits the policy.

Click for NICE drug policy

Click for political outburst

Interesting note: The dialysis cost of £25k a year is half the US cost, indicative, I think, of the excessive administration costs of the US commercial health system and associated insurance companies.

[Riki]

I have a question... I know this is kind of off topic, but it has to do with what noahvale said about the govt dictating what doctor they can see once the HCR bill goes into effect.  Isn't this how much insurance companies work now?   You have to pick from their list of doctors?

I currently can't stand my family doctor.  He's an idiot, and I sometimes wonder if his licence to practice is real.  I can't switch doctors, but it has nothing to do with govt dictating who I see, it's because there is a huge doctor shortage, and no other doctor has room to take me on.  Anyone here with a doctor is lucky, because there's a waitlist of people who don't have one a mile long.  We lost a lot of doctors to the US in the last 15 years, including my doctor's brother, who I think actually inherited the brains in the family

[Sax-O-Trix]

Why would Canadian doctors come to the U.S. to practice?   

[greg10]

Costco Pharmacy Sensipar, 30mg tablet, 30 (1 per day)        $415.15

 

have you  tried  getting  a  prescription card  from  sensipar?? only   $5.00  co-pay with  card
..
Most patients who have commercial prescription insurance are eligible to participate in the program.  The patient is responsible for the first $5.00 of out-of-pocket costs. ..

Thank you for the information.  He does not have commercial insurance, only Medicare and he neglected to enroll in Medicare part D.  At this point if he enrolls in Medicare part D insurance, the quote he got is about $1200 per month, which case he might as well just pay for the drugs himself.

Why would Canadian doctors come to the U.S. to practice?

Generally doctors are paid higher in wages in the US and lower taxes as well.

The US and other governments around the world don't seem to have a good handle on the cost containment of their health care system. 

..
Interesting note: The dialysis cost of £25k a year is half the US cost, indicative, I think, of the excessive administration costs of the US commercial health system and associated insurance companies.

Thank you for your UK perspective.  My personal and admittedly novice perspective is that the outrageous costs are driven by the policy loopholes that is taken advantage of by the drug companies and dialysis clinics.  For example, a chain dialysis clinic in the US could over treat the patient with repeated doses of short acting Epogen and bill Medicare $50,000.00 a month. These excessive Epogen actually may be harmful to the patient by causing more clotting, which in turn they would need to treat with more anticoagulants as well as more affiliated vascular access centers referrals to clear the clots.  Similarly, the drug companies are always pushing for new and unproven drugs, such as Fosrenol which they often have to post a warning letter on their website stating that the claims they have made is inaccurate and that they may not have long term studies to show the efficacy and safety of the drug, and they get away with charging a ransom for a unproven drug.

http://ihatedialysis.com/forum/index.php?topic=19909.msg335353#msg335353

[cariad]

No, Medicare is not socialized medicine - at least not yet.  It is a single payer system utilizing public funding to pay both public and private providers of care.  As originally written as law, Medicare was intended as supplemental insurance for those over the age of 65 - for their retirement years.  ERSD funding for those under age 65 wasn't added until 1972.  It was the first step towrds UNIVERAL HEALTHCARE - not socialized medicine - in the U.S.

[EDIT] - The Veteran's Administration is an example of socialized medicine in the US.  The VA provides medical services to retired, disabled, or recently discharged military personnel who are eligible to receive benefits. VA medical benefits can only be used at VA hospitals and medical centers, which are owned and operated by the government; health care providers working within the VA are government employees.


Socialized medicine - as practiced in the UK and Scandanavian countries - means the state is in control of all aspects of healthcare from financing through taxation and compulsory national insurance contributions, operating all aspects of the delivery of health care (including having physicians working for the state and deciding who receives scarce limited resources) to having none or limited private access to care.

I'm sorry for the wife of Gwyn's collegue.  However, please don't try to lay it on "conservatives."   This was a personal decision made between a husband and wife.

However, I too have made some bad decisions that affected my health and quality of life and can easily blame the system.  I won't because at this point in time I can still choose where I wish to go for dialysis, which hospital serivces I wish to utilize, who I wish to see to take care of my medical needs and which transplant faciliities I wish to be listed on.  I want medical decisions to stay between me and the providers.  Even when I had employer based insurance I could always go out of network if I was willing to pay the difference.  MY CHOICE on how to spend MY INCOME.

I will reitterate - some fall through the cracks.  No healthcare systme is perfect.  But I fight any initiative that takes away my right to healthcare choices.

Wow, I have to admit this left me and my husband speechless. So, deciding to be a stay-at-home-mother is a bad decision now? Interesting. I am going to take a wild guess and say you either do not have children or have zero respect for just how difficult and complicated children are to raise. We all get to live with the results of the children raised in this world - those who were abused and neglected or just felt ignored most of their lives. You know what was an even worse decision on that woman's part? Coming down with cancer in America before her husband reached 65. See, if she had married a much older man, she could have had Medicare through him. Your sorrys are useless to her and anyone else in her situation - if you really are sorry that this happened, say so with your vote. 

Socialized medicine has many different definitions based on the personal or political leanings of the speaker. I like the term because it is quick and to the point, and scares conservatives. Wikipedia says that Medicare fits the looser definition of the term. And look, I went to the trouble of consulting the dictionary for you:

Definition of SOCIALIZED MEDICINE
: medical and hospital services for the members of a class or population administered by an organized group (as a state agency) and paid for from funds obtained usually by assessments, philanthropy, or taxation [Source: Merriam-Webster.com]

The larger point I was making, which you totally ignored, was that this colleague of Gwyn paid taxes, as did his wife when she was working. Their tax dollars went to your medical care. Not one dime of your tax dollars went to hers. I will never see the fairness in that. Anyone who thinks there is any rhyme or reason in that is either none-too-bright, or has a ferocious sense of entitlement because they have Kidney Disease and the world owes them.

If we get Medicare, I want the rest of the country to have that option, especially if you so clearly fit the medical definition of disabled. My cousin (a 27-year-old licensed attorney) suddenly found he had stage 3 or 4 brain cancer. Average life expectancy: 6-18 months. You have to wait a year after applying for disability to get Medicare. That's one way to cut costs.....

You can only CHOOSE to go someplace else if you have the MONEY. Therefore, the CHOICE is non-existent for most people. Do you really fail to understand this? No one takes this CHOICE away from you in the UK. My husband lived there for the first 30 years of his life. His family still does. His father was born and died under the British system. Even conservatives (like David Cameron) believe in the NHS. A UK conservative is generally more like a conservative Dem over here. David Cameron had a severely disabled child who died at age 6 (just last year, I believe). He thoroughly praised the NHS.

I have not read all the replies, but I do agree with Stoday that cost containment here is a must. Obama has talked about this endlessly. I don't think anyone here doubts that Obama is an extremely intelligent man - he took his education seriously and it was not just handed to him like some presidents. I think the White House is entirely aware that measures must be taken to contain costs and streamline administration. I trust this country has enough creative intellects to come up with solutions, so long as the politicians do not stand in the way.

[peleroja]

I'm in the US doing PD,  and Medicare pays for everything. 

[Zach]

Actually, Medicare pays for 80% of approved charges.
Then, hopefully, you have a private Medigap policy to pay the remaining 20%.

[pdpatty]

In US Medicare pays our bills BUT,there is always a but, we pay a premium of $96.40 (some are higher) a month and we have to have a secondary insurance  which  mine is $161 a month and we pay a premium for PartD prescription drug plan  and if you are in gap,you still pay and get NO insurance coverage.(Little gift from the Republicans and GW Bush)

So I have to rely on donated meds from Shire(Fosrenol) and a card from a bone charity for my sensipar.

Bless that Republican party to you know where.

[davecapper]

In the United States the taxes we pay are 66% when you add federal tax, state tax, FICA tax and then match it by an employer. Not exactly cheap and not have health care covered.

Not to get political, but those who believe we pay lower taxes, are wrong. Medicare pays 80%, true but not 80% of the bill, but 80% of an approved amount Medicare has contracted to pay for each service or product.

Just sayin
Dave

[jeannea]

The post about help paying for Sensipar got me excited. For a minute. Since I have Medicare Part D I'm not eligible. But in the donut hole I have to pay over $200/month for it.

[Whamo]

Americans on dialysis could wind up paying more after the next election.  Republicans want to replace Medicare with a voucher system that won't cover the rising costs. 

[HILINE]

I have MEDICARE and TRICARE4LIFE, zero for dialysis and $9.00 for meds for a 90  supppy

[mcclane]

I don't pay a thing; whenever I show up at my home hemo unit, I needle myself, the nurses take care of the rest.  When done, I put pressure on the buttonole, and when it has stopped bleeding, I get up, say good bye to the nurses and leave.

The hospital also paid an electrician to rewire the plug in for the dialysis machine, plus pay to have someone do plumbing for the machine as well.  They also pay for water tank service.  And they also pay for all the supplies I require.  Everything I need for home hemo the hospital has paid for.