Good morning BT!

So the next time you see Bill O’Reilly or Eric Cantor prattling on and on about What Americans Really Want From Health Care Reform

How the heck would they know?

Unfortunately, none of those numbers are really great. That’s telling in and of itself.

Obama may have a staggering lead, but he still has the albatross twins Reid and Pelosi around his neck keeping the Republics in the game.

So the next time you see Bill O’Reilly or Eric Cantor prattling on and on about What Americans Really Want From Health Care Reform, just remember: no one’s listening.

I never listened to those fools. They don’t know their ass from their elbow, maybe because their head is planted up there so far..

Hi EG thanks for showing up yesterday you helped make the meetup such a great success!! It was much a lot of fun all the Pups!

Hi All,

I’m a Canadian who once walked among you (and had an HMO plan, and started a family while I was there).

So, I’ve written a couple of diaries about another Canadian whose been acting as a shill for the Repubs’ ‘Canadian Health Care Haters’ Club’ (here and here).

Anyway….

One of the things that came up in the comments was a very important, and I think legitimate, comment from ‘Wigwam’ who asked:

The Canadian medical system has a reputation (in the U.S.) for comparatively long delays:
– Is that reputation deserved?
– If so, why are the delays so long?

Now, I’ve seen this question asked by a lot of folks, even progressive folks, who have this nagging, lingering concern about how well the system really works north of the 49th parallel.

As such, a wrote quite a long, detailed response that I hope will set their minds at ease:

________

Wigwam asks a very, very important question about wait times that gets right to the heart of the (more realistic) matter.

First off, let me say the following (skip the next passage if you want to get straight to the answer)…..

When we lived in the States I worked for a University and had what, I now understand (but didn’t then) is a Cadillac plan….We had our first kid down there and the care was very, very good….but, overall the co-pays and the nickle-and-diming with just about every visit and every prescription just about drove me crazy (I was a post-doctoral fellow so, even though I got the benefits, my actual pay was crap)…. And then I had an old chonic problem of my own flare up it took some time, but not an unreasonable time, to get referred to the required specialist….I knew precisely what I needed (given my past experience with a similar specialist up here in Canada) but this guy, a staffer with the HMO, hemmed and hawed and ultimately would not give it to me (it involved a course ofexpensive antibiotics). Instead, he handled the problem very conservatively and it took much longer to resolve than I was used to… So, what’s the point?….Well, in Canada, where the system is Universal, when something like that happens you can go back to your GP and ask for another referral…Nobody at the HMO would help me do that.

Now, getting right down to wait times….Anything urgent is dealt with urgently….Anything truly elective is dealt with much less urgently…In between, say a knee ligament replacement after you’ve hurt yourself running around on the softball field, is where it becomes greyer.

However, overall, in my experience the following passage, from another border straddler named Ronda Hackette who wrote a very good piece in the Denver Post that every American, even progressive Americans, who have nagging concerns about really going for Universality and/or a true Public Option should read called ‘Debunking Canadian Healthcare Myths’:

Myth: There are long waits for care, which compromise access to care.
There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists’ care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Hope this helps you all.

_____
Sorry to be so verbose about all of this, but I’ve just got to reiterate the central tenet of the Canadian system that I mentioned in my original post…..We never worry….We may gripe sometimes…..But we never worry….For example, want to change jobs?…..We don’t worry…..Lose your job?….We don’t worry….Get sick?…..We don’t worry….Why?…Because the thing is completely portable and it’s always there.

OK?

.

TRUSTING INSURANCE COMPANIES TO BE THE GATEKEEPERS TO OUR NATION’S HEALTH CARE IS SUICIDAL

Should we want ours and our children’s health and lives to be in the hands of Insurance Company Executives who receive millions/billions of dollars to make as humongous a profit as possible……or should we want our federal government to manage our health care in the same manner it has managed Medicare, Medicaid and the Veteran’s Administration? And before anyone starts trashing the VA, let me remind them that quality of care has always been rated high at the VA. The problem has always been insufficient funds to provide timely care in quantity, not bad doctors/nurses.

Should we want insurance companies to CONTINUE denying coverage to people with pre-existing conditions? What are they supposed to do…just suffer and die because they’ve had the misfortune of getting sick and don’t have the money to pay $100+ per aspirin or $10,000+ for a diagnostic test or $100,000+ for surgery or treatment?

Should we want insurance companies to CONTINUE denying claims based on the fine print in contracts designed to trick people into believing they’re paying for health care they won’t receive?

Should we want insurance companies to CONTINUE increasing premiums at rates that force millions of families to drop coverage, to declare bankruptcy, to close business, to move their jobs overseas and to inevitably cause a recession much worse than the one we experienced in the 1930s?

IS THAT WHAT WE SHOULD WANT? THAT’S WHAT REPUBLICANS WANT!

i don’t trust any of them at this point. given all the sausage making so far and the benefits to big pharma and the insurance companies, i say, “scrap it all and go back to square one – single payer”. the table needs to be cleared and single payer put on it.

Yeah but Pelosi isn’t prattling about bi-partisanship. She’s saying ‘no triggers’, because the insurance companies have had long enough.

The last poll shows people trust their doctors and hospitals to “do the right thing”

The New Yorker has a great article about why this is “foxes guarding the henhouse” and why. McAllen Texas was used as the poster child of bad medical practice.

Payment for procedures, doctors’ greed and for profit hospitals are all a part of the problem.

DeMint can dish it out but not take it.

http://www.thestate.com/local/story/877856.html

You’d be surprised at the level of bullshit propaganda that the repubs lay down about the Canadian system. My local (Methodist) church administrator a true ‘Limbaugh believer’, who used to live in Seattle, claims that the Wash. State hospitals fill-up every Oct as the Can. system runs out of funds and turfs all their patients out! I moved from the U.K. to Canada in the late ’70’s (my wife was born in Ottawa) transitioning from the UK’s NHS to Ontario’s OHIP. Other than the (relatively small) monthly premium, I didn’t notice much difference. The rest of the (developed) world just looks at the U.S. and scratches its head!

iceman15–

This, from the Denver Post, is one heck an antidote to all that codswallop.

.

I chat with an editor in Hallifax who laughs a lot at the wingnut myths. He is very glad not to have insurance execs standing between him and his health care.

27 July 2009
My Fellow Americans,
Today is a watershed event as the U.S. government has begun replacing U.S. Army troops with private contractors or mercenaries. This is means the U.S. Army is stretched to the breaking point in one job – 11 Bravo or Infantry. Today I went down to the Louisiana Superdome because the Lutheran Evangelicals decided to bring together 37,000 teenagers in New Orleans for a Christian revival type of assembly.
Figuring the U.S. Army needs Infantry troops and the evangelicals like to vote for people who start wars, I decided to go to a local printer and print up the following message on little 2 by 3 pieces of paper:

Christians – You are needed in Afghanistan!
Please call 1-800-USA-ARMY
Volunteer for “11 Bravo” Infantry
Come Fight Your Christian War
Relieve the Troops at the Front!

You activists can print up hundreds of these with little or no cost and we can step up into DIRECT PASSIVE ENGAGEMENT with the neo-conservative voting block by asking they serve as Infantry Soldiers in Afghanistan. It is best if you go with a veteran. I was wearing an Obama t-shirt and as a veteran went alone. I was surprised by the 2 things:

1)One group of people would not take anything from my hand thinking I
was filthy or diseased and this is part of the secular evangelical racism and classism that exists when someone different does not think and act like they do. They see dissenters as scum.

2)The other group reacted with disdain but once he or she read the small piece of paper requesting Infantry service, there was stunned silence and no reply as they were being asked to volunteer for Infantry duties in Afghanistan.

DO NOT ARGUE with these people if they wish to argue. Just say “Thank You
for getting into the U.S. Army INFANTRY,” as they take a slip of paper. We must get veteran’s groups to bring these pieces of paper with this writing to Evangelical Revivals and begin to penetrate the republican voting block of evangelicals. This must be performed now as the republican strength is waning and the party is falling into dissolution. Pro-democrat Veterans must lead the way. Here are the reference pages of Evangelical Revivals. http://www.elca.org -Lutheran Evangelicals. http://ag.org/top/ for the Assembly of God revivals. Distribute “Infantry Service” request as they exit the revivals. – Michael Angelo 99

Interesting comment to my post on Bobby Jindals (grossly unsat) health care proposal:

The scariest part of the House health care bill and Jindal’s version is the Big Brother enforcement of “evidence-based” practice by physicians (”the best disease-management practice” Jindal). It does not permit doctors to consider the unique characteristics of each individual patient, but instead forces them to apply a “one-size-fits-all” standard in their practice, dictated by a federal panel of “experts” (like the car-czar whiz kid?).

As an osteopathic physician, I would have to opt out of such a system, or betray my principles.

Wow! A doctor who doesn’t like either the Republican plan or the Democratic plan?!?!? Yowza! I dunno, seems to me that the vast majority of cases are all pretty much alike. Obviously, there are unique cases that require unique solutions, but in general, you’ve got a hernia or you don’t, you’ve got too much cholesterol in your diet or you don’t, how much variation between diagnoses is there really likely to be?

Uh… wow.

i don’t trust any of them at this point. given all the sausage making so far and the benefits to big pharma and the insurance companies, i say, “scrap it all and go back to square one – single payer”. the table needs to be cleared and single payer put on it.

Friday (07/24/09) evenings Bill Moyers Journal featured two spokespersons (both presumably quite progressive and one from the Harvard Medical School) who called us to face the reality that the current proposed legislation does very little to really reform the medical care system, continues to reward the health insurance and medical industry at exorbitantly high levels and does virtually nothing to insure serious reduced costs, etc. The Harvard lady said we should give up the current work and start over, that the process at hand has essentially sold out to basically maintain the same old, same old structures and processes.

So that’s what the Democrats have produced, never mind what the Republicans might have produced, aside from nothing.

The Harvard lady’s conclusion has been a frequent hesitant assessment by some of the commenters at FDL over the last few months whom I’ve come to respect and admire for their passion and comprehension.

I have very little REAL knowledge of what is actually in the House’s 1000+ bill, as one commentator noted at the time that it was released, the summaries/highlights are of very little help in understanding what’s really included. There are almost daily reports on some particular aspect of the larger basic reform issues that give me some hope, but I really don’t know what it means in the sausage grinding business of Congressional action. I had hoped that FDL would undertake a serious comprehensive analysis of the proposed House bill, bringing the same high level of documentation and assessment that I’ve come to depend upon at FDL.

I’m certainly not sure what the bill means in relation to some specific concerns I have relative to treatment options for those with neuropathy, much less the many other crises I’ve observed in trying to get competent and caring health care for the homeless and poor I’ve come to know and tried to help in recent years. And God knows the health crisis in the state of California is all the more compromised with our pitiful, but not pitiable governor and legislature.

I certainly have no real knowledge of what a public option now or would finally look like and how it would be administered. That has not stopped me from speaking out at public health education/advocacy meetings and made calls and signed petitions seeking Congressional support and passage of a “robust public option,” though God only knows what that might actually mean in a bottom line for final legislation. (I always tack on JUST to go with the “robust” language because we could have a robust and totally unjust package.

I have deeply appreciated the work of Scarecrow and the many really knowlegeable and thoughtful people involved in FDL post dialogues. They have given me a basis for knowing and understanding a TINY bit of the humonguous reality and fantasy/misinformation/despicable outright lies of the ongoing “debate.”

I don’t know whether we should abort and start over. I know that I don’t want what is passed so far unless and until I know that means. I welcome your counsel on this question, FDL community.

Blessings,

I guess the question is, -if- the whole Congressional exercise so far has been partly a Kabuki run at finding a non-single-payer solution that was never expected to succeed — and I wouldn’t necessarily count that out — then, is there enough popular support for single-payer to back up those Congresscritters willing to get out front for single-payer. Maybe, maybe not, that remains to be seen. So far it looks like by backing the half-measures version PBO may have — emphasize -may- — have already spent most of his available political capital for this issue. Does he have it in him to re-inspire the public for a re-targeting toward single payer? Given his corporatist advisors, would his heart even be in that? I hope so, because I would very much like to see an efficient and universally effective system result. But the main point is, in the idea of abandoning this current push and switching to a single-payer goal there is significant risk of getting neither.

Grim thought: An H5N1 disaster might help the public see the advantages of a modern-state approach to the country’s health care financing.

Hi! Best synopsis I have found is here for the House bill:

http://energycommerce.house.go…..ummary.pdf

Wow! A doctor who doesn’t like either the Republican plan or the Democratic plan?!?!? Yowza! I dunno, seems to me that the vast majority of cases are all pretty much alike. Obviously, there are unique cases that require unique solutions, but in general, you’ve got a hernia or you don’t, you’ve got too much cholesterol in your diet or you don’t, how much variation between diagnoses is there really likely to be?

Rich2506, I’m sure that the quoted DO, along with many MDs and a heck of a lot of patients could tell you that there are an infinite variety of diseases and disease states for which “one size fits all” is totally inappropriate, if not disastrous. Your list of typical chronic conditions reminds me of typical Republican simplistic prattle – eat right (who is to determine that?), exercise (which kind, how often, for how long, what kinds of medical constrictions should be considered?) and all will be well. The usual simplistic model of medical care is totally bunk, for these and many more reasons. There are many ways to treat high cholesterol – once can choose, as most doctors do, to prescribe high priced medications, which can produce very serious side effects, and which Big Pharma wants to maintain at all costs, without ever spending the time and money to help patients adopt life style changes that might help much more, more effectively, and with greater patient safety.

For example, one can do a wide range of wellness strategies for this and other chronic conditions, including supplements, exercise and dietary changes, but genetic variations, duration and intensity of the disease state all need individualized treatment strategies.

When it comes to neuropathy, there are more than 100 different types and more than 200 different causes of neuropathy (i.e. any disease state in which there are several if not many types of central and/or peripheral nerve damage symptoms, affecting one or many more nerves throughout the body from head to toe, and that are often commonly found with several other neurological disorders like MS, lupus, etc. Under no circumstances will one medication or any number of dosage levels of that one med suffice for all these neuropathies, although most doctors typically know only one or two and are helpless to go outside their comfortable boxex because their ignorance of the disease is so pathetically huge.

Many of Obama’s proposed system changes are medically and financially essential for cost containment, real health improvement and maximizing coverage. However, the devil, as always, is in the details and we need to be educating ourselves about many, many of the details with an open mind, a sincere hope for real justice and an end to the various medical indus-tries’ gross exploitation and economic rape of the American public.

Blessings,

Many thanks for your input. I had previously shown in another forum that the usual capitalist bidding/competition model has grave weaknesses when dealing with health care. Looks like the bureaucratic approach has serious problems as well. How do we go about management to see to it that doctors don’t exploit all sorts of loopholes to make money with?

Thanks, TomThumb. Got to the site and began to scan through the summary but could never get past page 17, the beginning of the portion covering Medicare D. Wonder if that’s intentional. At least the supposed whole document is now saved to Word.

First impression is that there will be an absolutely humonguous expanded existing and new bureaucracy, and that there is no imminent substantive change of much of anything and most real change is a decade away. I don’t understand why that is so, beyond Congressional selling out to maintain industries’ stranglehold to maintain their high profits.

The whole thing seen thus far is disgustingly revolting for anyone wanting significant real change for the better for consumers.

Blessings,

Follow the money… Link Call Congress and demand, “Single-Payer Health Care for All Now!

Sign the Single-Payer Petition: Link

SEMPER FI!

Even though the GOP may be wrong as to why the Dem’s and Obama are failing at health care reform, that doesn’t mean they arent failing.

Single payer was and is the only way to solve our current problem. At this point, I hope the Dem’s fail to pass a bill since it will be throwing more money at failed institutions just like our banking comglomerates, auto conglomerates, etc.

I cant say I’m surprised, Obama only came out with a health care plan AFTER Hillary and Edwards and Kucinich. You get what you vote for. Thanks Dems.

How do we prevent doctor exploitation?

I haven’t a clue as to 99.9999999% of all the medical conditions.

But, as compared to the present operational reality, at least when it comes to neuropathy, I would much prefer Obama’s concept of paying for diagnostic and treatment packages rather than the current piece meal reimbursement plan that usually gets us no where. Then maybe we can get some functional diagnostic procedures to identify real and therefore better treatable causes.

I can’t talk about other chronic conditions, but as I’ve been dealing with neuropathy as a patient for ten years and an educator/activist for six years, I can speak to that reality.

Right now the common practice has a primary physician or podiatrist (as the most common neuropathic symptoms begin in the feet) will do a simple office procedure to test for sensory and/or motor nerve loss somewhere in the lower extremities (maybe upper as well, if carpal tunnel syndrome is suspected, etc.) with a determination that either one does or doesn’t probably have neuropathy. They may or may not then refer their patient presenting with common and clearly definable neuropathic symptoms (if they know them, which is asking a lot of most physicians) to a neurologist. But probably 90-95% of all neurologists know very little about neuropathy. It doesn’t matter that there are nearly 20 million of us. “Everyone” knows about Alzheimer’s, ALS, epilepsy, migraines, and MS and they are much more commonly taught in med school to both primary care givers and neurological specialists. Either may or may not order some basic labs (e.g. that could identify some causes, such as diabetes, nutritional deficiencies, hereditary/genetic, immunological or toxin exposures causes, etc.) and minimal neurological exams (i.e. EMG, NCV, MRI, CT etc. studies)to identify potential other causes such as trauma, surgeries, etc. and whose results may or may not clearly define where and what kinds of nerve damage exist – is it axonal and/or myelin damage? And if you don’t have primarily axonal damage, the latter tests won’t disclose the small fiber nerve damage that can only be discerned with a skin biopsy, and so those patients will be dismissed with – it’s all in your head, you have no neuropathy. Or maybe there will be a hesitant response of maybe you have some kind of neuropathy, but we don’t know what kind or why or how to treat it. But, what the heck, here’s some some neurontin (or Lyrica), both of which are Pfizer products, which may or may not be included in an insurer’s or medical group’s given formulary. There will generally be no discussion of side effects, and if they are found to be either onerous or the med not helpful, most doctors won’t know what to do next. They have have no idea of alternative treatments (either from Big Pharma, or other treatment modalitiesIas they have dozens if not hundreds of other conditions to keep up on, so learning about neuropathy (commonly referred to as “the most common disease you’ve never heard of”) is at the bottom of their ongoing clinical medical education requirement agenda for pain or other syndromes. And even if they knew and might want to actually prescribe a particular med, the insurer may or may not cover it, or may require a tiered approach of several least effective options before one can finally get to a more appropriate one. Actually, even if one has access to a full range of options, the patient and doctor usually has to experiment with several drug families and dosages and other treatment options to finally find an appropriate single or package of meds that actually really works. But that package can become ineffective as the symptomatology changes over time with remitting and relapsing patterns, triggered by God knows what medical, emotional, or environmental variables.

Billions of dollars are spent every year on more commonly known diseases, but very, very little on neuropathy. Unless of course it’s for diabetic peripheral neuropathy (DPN) because Big Pharma knows that it is and will continue to be a humonguous market potential into the forseeable future as it is estimated that some 50% of all diabetics will develop some form of neuropathy at some point in their lives. Big Pharma knows that means untold $billions in profits. There are dozens and dozens of new meds at various stages of development for this condition, partly because Big Pharma knows that while they may (or may not) finally get FDA approval for DPN, they know their products may eventually have extremely widespread off-label use by doctor choice, and they will continue to do everything they can via “canned” research studies to show safety and effectiveness – anything to maximize an unending line of profitability from their products. And of course, their products will be aggressively promoted via popular media and doctor groups with donated samples and all kinds of industry perks for the doctors. There have been a lot of articles about these problems in both major medical journals and the popular press in the last few years.

So how would I fix the above outlined problems? I don’t know beyond educating patients, doctors, legislators, the media and public about the realities of PN, raising tons of money for research on the causes and potential cures for neuropathy and the need for far reaching systemic reforms in its diagnosis and treatment.

And for PN and all the other critical medical conditions that need comparable system changes……… Lord have mercy…..

Blessings,

Again, many thanks! You’ve clarified the issues for me.