Wasn't there someone on here who could not get their enbrel or another biologic because their country's plan stated that they didn't need it???
I have NO idea..
Seriously
Wasn't there someone on here who could not get their enbrel or another biologic because their country's plan stated that they didn't need it???
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I believe it was in the UK, and their policy was if you had tried one or two biologics, and there was no success, you could not go on to try another biologic. I think it was being challenged. Maybe someone from the UK can address this more accurately.
But, in other countries, like Germany or France, there is access to expensive prescription meds, in some of these countries they negotiate with drug companies to control price. And, since people have access to medical care, physical conditions are treated sooner, costing less, than if people sought treatment later, when they become real sick, and then incur costlier treatment.
Edited to add: I forgot to mention that in the United States, there are people WITH insurance that are denied RA biologics and other meds; some of these drugs are classified as Tier 4 drugs, which means in certain insurance plans, instead of a copay, the insuree is charged a percentage of the drug's cost, so for a drug like enbrel which costs around ,800 a month, the Tier 4 charge could be something like 30%, which would be 0 a month; and, for the individual with no insurance (and it could be someone whose employed by someone who does't provide insurance or someone who has a preexisting condition who can't buy individual health insurance) they have limited or no access to such meds.
Joie2008-10-07 10:46:05Yeah, there was a couple people and one recently - like during this thread.
We have to think of something - you know I'm not big on the biologics - but I sure as heck want them available if I need them.
I do think GoGo is right tho when she posts about countries with Universal Coverage as being more into finding the cure if only as a way to lower their costs. Some of the most innovative research I've seen is coming out of UC countries. When first diagnosed, I concentrated on US research assuming we were the most cutting edge. Now, I'm watching a couple of other countries because they're more 'radical' in looking for the cure. More 'outside of the box' if you know what I mean. That Karolina Institute that Nikkilynn posts from all the time. Some stuff out of Great Brittan. Some Austrailian (tho they still use Gold - OMG), New Zealand, and Israel. The Israeli's rock!
Nor am I short sighted. While I think either the Danger Model or the Infectious Model are the most likely to bear our cure - I'm watching all of it. And the most interesting for Autoimmune is still coming out of those areas.
Hugs,
Pip
Joy -
You've hit on a really important point. When that Medicare Act was railroaded thru congress, the one thing the Pharma Lobby wanted was to prohibit the governments ability to negotiate price like with the Veterans administration. And they got it - illegally - but they got it.
Think of all that money that the government could have saved which could have been used to fund innovative research.
Pip
PS - My bad Babs - there was a thread while this thread was going about an INSURANCE company that refused to OK a med. There have been quite a few of these lately. I thought you were referring to those - not the UK one.
Pip
From NATIONAL PUBLIC RADIO "Health Care for All: A Reality in Western Europe"
An excerpt:
Everyone in France gets health insurance. When someone has a difficult disease, such as cancer, the national health system steps in and pays for 100 percent of the care.
Unlike in the United States, insurance in France is not linked to employment, nor is there a lifetime limit on how much treatment a long-term survivor like Hubert can get.
The guarantee of health insurance is the first reason why cancer experts around the world look to France as a model for cancer treatment and care. Another is that cancer care is well organized at the national and hospital levels. To treat patients, a hospital or clinic has to prove it meets national standards for high-level care. It must treat a minimum number of patients a year, and it must use a team of doctors, nurses and others to provide coordinated care.
These standards are found at the best cancer centers in the United States, but they are set in national standards and required of all hospitals and clinics in France.
France guarantees that every cancer patient can get any drug, including the most expensive and even experimental ones, says Dr. Fabian Calvo, deputy director at the relatively new National Cancer Institute.
For complete article see:
New York Times
Business Cool toward McCain's Health Coverage Plan
Kevin Sack
October 6, 2008
American business, typically a reliable Republican cheerleader, is decidedly lukewarm about Senator John McCain’s proposal to overhaul the health care system by revamping the tax treatment of health benefits, officials with leading trade groups say.
The officials, with organizations like the U.S. Chamber of Commerce, the Business Roundtable and the National Federation of Independent Business, predicted in recent interviews that the McCain plan, which eliminates the exclusion of health benefits from income taxes, would accelerate the erosion of employer-sponsored health insurance and do little to reduce the number of uninsured from 45 million.
For complete article see:
WALL STREET JOURNAL
MCCAIN PLANS FEDERAL HEALTH CUTS --- (Medicare/Medicaid)
Laura Meckler
October 6, 2008
John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of .3 trillion over 10 years to the government programs.
The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan "budget neutral," as he has promised. The McCain campaign hasn't given a specific figure for the cuts, but didn't dispute the analysts' estimate.
For complete article see:
What???
In the last presidential debate, Senator McCain spoke about how his health proposal would allow for the selling of health insurance policies across state lines. We all look for ways to save money, especially during these times, but is buying an insurance plan from a company in another state a good thing?
True, your premium may be less, but what does this cheaper plan cover? What are the deductibles and copays? If you have a problem with this insurance company (has anyone had a problem with their insurance company?) who do you go to for recourse -- the insurance commissioner in your state, they have no regulatory power over an insurance company in another state -- the insurance commissioner in the state the plan is sold -- you're not a state resident; or some federal entity?
Senator McCain's plan would move people from employer based insurance to the individual health insurance market -- so you'd be on your own, rather than choosing from plans vetted by your employer, you'd have to decipher insurance plans on your own, no easy task. Also , consider in the individual health market, plans may be cheap for the young and healthy, but costlier for those who have a history of medical problems and illness. Insurance companies make a profit off insuring the healthy, and make less, covering those who use their plans, so they would "cherry pick", excluding those with preexisting conditions.
We have seen how the lack of government oversight and lack of regulation has contributed to this financial crisis, a similar policy, reliance on the free market, unregulated health insurance practices, could hasten a health care crisis.
Excerpt from article by Jeffrey Liebman, Professor of Public Policy at Harvard's Kennedy School of Government:
"In the McCain model of deregulated health care, employer-provided health insurance will gradually wither as price-sensitive consumers instead purchase high-deductible policies from the individual market. In this brave new world, consumers will come closer to facing the true marginal cost of their care and over consumption of health care will decline.
But embarking on such a radical change in our health care system presents many risks. First, premiums are likely to rise rather than fall under the McCain plan. Today premiums in the individual market average 17 percent higher than those for employer-based insurance due to higher screening, marketing, and underwriting costs. Second, consumers shopping for insurance in this market would face a bewildering array of insurance options. In many ways, health insurance is an even more complicated product than a mortgage. Third, McCain's plan to let insurance companies sell across state lines will lead to a race to the bottom as insurance companies shift their headquarters to states with the fewest protections for policy holders."
Sell insurance across statelines, consider what happened with credit card companies:
"In 1978, the U.S. Supreme Court ruled that banks could charge the maximum interest rate determined by state legislatures in the banks’ home states, not the interest rate of the states in which they do business. Credit card businesses quickly set up shop in Delaware and South Dakota -- two states with virtually no interest caps. The result? State usury laws were rendered worthless and consumers were left to fend off
an array of confusing and punitive measures aimed at raking money from customers. Another good example is our current
banking system. And we all know what happened there. "
For more info on this subject see:
Selling insurance across state lines—cheaper premiums or skimpy benefits?
Gimpyagogo-
Question about Canadian system.
I've read that often people are diagnosed with early stage cancer that is treatable but there is long wait for treatment in Canada so by the time they get treatment it is no longer treatable. It is ILLEGAL to get private treatment in Canada so people WHO CAN AFFORD IT come to the U.S. for treatment. A friend of Hillary Clinton did this.
Is there concern about this? Are their ideas for solutions? How is this problem being handled?
Still curious about the previous question.I don't think she saw it so...
Bump...
Pip
Coming into work today they were saying that the Wall Street Journal called Obamas plan An Illusion that could never work. I have no link but thought that was some statementHere it is - GoGo - I think you've answered this elsewhere, but not here.
Pip
Jan, in some areas the waits are long, but the lists are organised by priority. My Mother was diagnosed with cancer and was in treatment 2 weeks later, but recently a friend of mine had slow growing, non-life threatening cancer on her skin that it took 3 months to have removed and this was
incredibly stressful for her.
Wait times varies from region to region, and from case to case. I have known many people with cancer and some have received amazing service and some have not.
One good thing is once you're in the loop, cancer services are integrated. That means your doctors, nutiritionist, radiologist, and all other services are all in the same building and these health professionals meet and discuss patients. There are also support services such as counselling for patients and loved ones, and transpostation via Cancer Car (volunteer driven). This is great if you live near a Cancer Centre, but not so great if you live far away from one. Centres are always in a Hospital complex or near one.
(BTW, there are other "centres". I get treated at the Arthritis Centre which integrates my RD, physiotherapist, occupational therapist, arthritis library, arthritis school (self-management), and research centre. There's even a gym and a warm water exercise pool. I get my blood drawn monthly at the lab next door----my choice, there are many many labs throughout the city to choose from---and I can and do get my lab results delivered to me as well as my doctors).
It is not illegal to offer private treatment in Canada unless it is a guaranteed under the Canada Health Act. For instance, it is legal to offer private elective surgeries and MRI's, but illegal to offer a kidney transplant.
There are many political factors at work in healthcare. Neo-con governments erode services (resulting in less services and longer wait times) in a bid to bring in privatisation, but this has been strenuously opposed by the people of Canada. Most Canadians prioritise maintaining and improving universal healthcare in their political decisions.
People are divided. Everyone wants immediate access to care, be they having cancer or a hangnail. Naturally the rich would like the option for private services, but since most people aren't rich most want to maintain socialised service, where care is available to ALL and not just SOME (how long does an uninsured, poor American wait for cancer treatment?).
There are many, many other factors at play. Medical degrees are subsidised by the government (AKA the People). Some provinces, such as BC, have drug subsidy plans. Some areas do not have enough family doctors.
Many people also have private extended insurance through their employers. I have it, and it covers acupuncture, naturopaths, oncologists, dental splints, etc.
Any kind of WooWoo fringe medical care can also be legally purchased privately.
Statistics show that survival rates of disease are pretty much the same as in the US or slightly better.
I waited 3 months to get in to see my RD. I have read many times on this forum of people waiting a similar amount of time to see American counterparts.
You will always find stories of outrage and disatisfaction on both sides of the border, but in the end I think most Canadians agree we'd rather have our system.
SOME MYTHS ABOUT CANADIAN HEALTHCARE I HAVE ENCOUNTERED ON THIS FORUM FREQUENTLY
---"Canadaians do not get to choose their own doctiors". This is total and utter BS. You can choose and rechoose 'til the cows come home.
---"The Canadaian Government approves healthcare decisions on a case by case basis" Also completely and utterly false. The governement doesn't act like a big US Health insurance corporation. Some services are covered and some are not. If your doctor says you need and it's covered under the Canada Health Act you get it. However, like many insurance companies you might have to go through a progression (ie: MTX, then Combination therapy, then Biologics. (The problem comes when it's not in the ACT---then you might have to pay out of pocket. Sometimes there's a delay in getting drugs covered under the act.)
Oh yeah, and in answer to your question there are always many discussed ways to improve it. It's an ongoing project. Doctors try to improve it, governments try to improve it (or dismantle it, depending on who's in office at any given moment), and many health avocacy groups, especially Friends of Healthcare. Some of the stuff works, some of it doesn't. At the end of the day, though, all Canadians have access to healthcare, not just the wealthy and the employed.
Gimpy-a-gogo2008-10-15 09:55:53My cousin had a double mastectomy 3 years ago, was treated with chemo immediately and is doing well, thank goodness.
Healthcare is a complex issue.
You're telling me! No system is perfect, but I'm grateful for what I have.
(PS---The Cancer Agency is quite aggressive, in a very kind way, of getting the ladies in for mammograms. I got lassoed in a Mall! Because I'm in my '40's I have to go every year but the lady who does my mammograms is really gentle and nice. An ounce of prevention....)An interesting page for those wanting to compare US and Canadian health systems:
http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_comparedFROM FACTCHECK.ORG
Health Care Spin
October 14, 2008
McCain and Obama each make false claims about the other's health care plan. We sort through the misinformation.
Summary
McCain and Obama have sharply different health care plans, and each has made sharply worded attacks that are either false or misleading. McCain proposes a market-based system that relies on tax incentives, which one Obama ad falsely characterizes as the "largest middle-class tax increase in history." Obama proposes new subsidies to expand private insurance coverage and some expansion of government insurance, which McCain falsely claims "will rob 50 million employees of their health coverage."
Neither candidate has offered enough specifics about his plan to allow experts to assess the cost or impact without making various assumptions. Studies agree generally, however, that Obama’s plan would cover more of the uninsured than McCain’s would.
Here we lay out a brief explanation of both plans, what the experts are saying about them, and some of the ways each campaign is trying to fool the voters about the other.
Hey Joy -
Missed you!
Pip
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