STEAM ROOM FOR ANGER
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Beesie, in the upcoming article I hope I at least get a credit and flattering photo. As JKL said, no system is perfect.
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In both countries from what little I know, it seems geography is a big part of the problem as well. We have docs and nurses being recruited to places like Alaska and other less populated places across the US. It's usually around a year. They get paid pretty well to do this, but as you can imagine there's not many that will just pick up and re locate for a time, so folks living in those areas do not have access to care as easily as someone near a major or even smaller city.
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Even in the lower 48, healthcare can be a nightmare away from urban areas because of lack of doctors, particularly specialists. I'm pleased with my Medicare Advantage plan (no extra premiums, co-pays have gone down or disappeared, benefits have increased), but I live in a good-sized city and there are several hospitals and a huge amount of doctors of every type from which to choose. In that same plan, less than an hour from here, people would be lucky to have one primary care doctor in the same plan, and would have to go to another town or into this city to find covered care. Farther out, the situation would be even worse. My parents were lucky that they still had coverage their entire lives through my Dad's work, even though he retired from his low-level blue-collar job at age 59 and they both lived into their 90s (3 million cheers for his union!). If I'd had to get a Medicare supplement plan, I don't think we could have afforded it, but in many places, it's the only option. I don't particularly like living in this city, and would prefer a small town, but I'm stuck here forever because of the insurance issue. Now, even if I could afford it, I can't switch from an Advantage to a Supplemental plan because of my cancer history, at least for a few years - I think it has to be at least 5 years clear to qualify. Even when I was working, and where my husband works, the premiums and co-pays kept going up and the employers cover less of it each year.
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What happened to me shines a very bright light on both healthcare systems. They are each defective in their own way. The US system is totally dependent on money. Many defects arise from that. The skill level has dropped. I never even thought of advising my son to become a doctor. I don't know that much about the Canadian system but there are not enough doctors if what happened to runor can happen. That is my quota for thinking right now.
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In the rural areas in the US they have the same issue. In other areas, access to healthcare. I personally would never live in an area where access or timing sucks as I get older and dxs are added to my list.
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Sorry, Artista, but it has already happened.
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we cannot provide state of the art health care across this entire huge country. it was a huge deal when interior health got a PET scanner a couple years ago; it needed to wait until a certain population around it grew.
Areas outside of huge metro regions will always be lacking international live ballet. big Broadway productions will not stop there, they won't get an NHL team, Taylor Swift will not book a concert date there. Top notch super speedy health care is also just not possible in regions which do not have a certain population level to support those things.
I had chemo yesterday. I'm trying to decide how I feel today. I would like to be in the NYT article as passionate defender of Cdn health care who comes to these discussions with mouthguard on & also glares at CAR! "like could you just drive on the next block, we're playing here"
I'm cranky I never got acreage cause I thought maybe I'd get some around now, with lots of space for all my dogs & a pony. But close to hospital. This stupid terminal cancer thing gets me down some days. I had PLANS. 35 years of plans. Stupid dna.
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spookie: I, too, missed your post about your DH's passing. I am sorry for your loss of a partner in life. I cannot imagine the grief added to your stress.
runor and others: Geography plays a HUGE part here. Most of BC's population (provincial pop. is about 5M) is clustered along the border. For most everyone else it is a long drive somewhere to get specialists etc. Up until recently anyone living in the interior or the north had to come to Vancouver for a PET, as only Vancouver and Victoria had the equipment. Kelowna now has one but it is a still a major drive for most. How many people needing a PET get one quickly with only one machine to scan a lot of people. To add to that, we have no train system and Greyhound left the province. No one seems to want to be a GP anymore, they all want to be specialist. We should be fast-tracking foreign trained physicians. You know the joke "If you want a doctor call a taxi"
I chose to live in a major centre because I like the broad spectrum living that is available. I am essentially an urban person but as I got older I was happy to be closer to facilities and now that I have joined this club I am even happier. My MO contacted me within four days of my PET and apologized profusely for the delay but he had been swamped with covid-vaccine related stuff.
13M of us Canucks have had our first dose. That is pretty okay, not brilliant but a good sign, since there are only 38(?)M of us. I am not sure of the count. I lost count after our Centennial in 1967 when we crowed "Now we are 20M"
We are supposedly getting more vaccines supply on the horizon so I have hope if we can all just behave for a bit longer. Please. Behave.
Let's just pull the jersey over an opponent's head (those who don't behave) and punch him in the head a couple of times. Gloves off, of course
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What has already happened Jaycee? I stated my preference to be in largely populated urban areas.
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serious decline in quality in all areas. You are not safe in cities from bad doctors.
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I remember a few years ago a Canadian snowbird would come to the dog park. Older guy. Could hardly walk. Had rollator still had a lot of difficulty walking. Said he was on a wait list for hip replacement. Said if he’d had stroke, heart attack, etc he could get tx right away. Don’t know what part of Canada he was from. He was in so much pain. I thought his wait was terrible.
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To All: I so agree that a knee or hip replacement is considered elective and you can wait a stupid amount of time, especially when you are in major pain. Not right.
moth: I will cheerfully co-write your defense of Canadian medicine, all universal medicine. For all their flaws the alternative of the USA's "health care for profit" is worse.
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As an American I, too, am super curious about Canada’s healthcare. I’m a bookkeeper for a small business and the rising cost of health insurance is frightening. I am grateful for my health insurance but I worry for the many that can’t afford it. I have been the most frustrated with the insurance companies. When I was in treatment, I would receive these “explanations of benefits” letters denying my chemo treatments and stating my financial responsibility as $10,000+ per treatment. My doctor’s office told me to ignore the letters because they got everything pre-approved before my first treatment. It all worked out but it was very stressful at the time. But, even this year my insurance company tried to deny coverage for a recent MRI. It’s all so complicated and there’s no easy answer.
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1 in 4 Americans have delayed medical visits, diagnostics and treatments for *serious* illness due to costs.
56% of Americans report medical financial hardship. This story profiles someone who stopped cancer treatment due to costs. https://www.theguardian.com/us-news/2020/jan/07/am...
anytime I see an american announce they have cancer on twitter it's pretty much always followed by a gofundme link. It's crazy imo
Mr Snowbird waiting on the hip replacement has $ in the bank to go snowbirding & is not going to go bankrupt due to medical bills. But yes, absolutely wait lists could be shorter. BC has been aggressively working on slashing the surgical waitlist, even during covid they actually got ahead of their targets but now we're falling behind again as covid is cancelling surgeries.
BTW, in BC surgical wait times are public so we know exactly how long people wait. I just looked. 50% of hip replacements in BC are done within 16 weeks, 90% within 44 weeks. My MIL has had 2 hips and a knee done & my dad has a hip done - all in the past few years so I know first hand what the waitlists are like.
Maybe other provinces have longer lists but that's how it looks here. Sure even faster is better but this isn't *that* bad imo. I know these crazy long wait times get tossed around but maybe that was from a few years ago - there was a larger backlog a while back. & other provinces are not as aggressive so again it's not really the 'Canadian healthcare system' because provinces have a lot of leeway on what they invest in. Alberta is bleeding doctors and nurses right now as they're slashing contracts under a right wing gov't. BC gained a bunch of new medical staff who moved out west from Alberta.
Anyway, yeah check up for both systems & maybe a quick round of CPR for some areas is probably in order. I think we still don't spend enough on prevention but then again, there's a lot of resistance from people being told what to do to live healthier so I'm coming around to the view that spending on prevention is a waste of $. <<- that part is my official rant so it qualifies for this thread LOL
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Beesie, well said.
Yes, I already was discussing all this with my husband as an example of how bad it is.
He though said that quality of healthcare system is determining by overall health data in society. And if look at those numbers, they are good in Canada. Life expectancy, etc. etc. This is how we evaluate how successful the system is not individual stories which we all have to share about our frustration. And with those numbers in the USA not better than in Canada, we still have it very expensive for the country budget.
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Spookie: I am so sorry to hear about your husband! My thoughts are with you and I am sending you gentle hugs!
To my neighbors to the North: Yeah, rural areas are hard. Distances are long, health care professionals want good schools for their families and to not have to work EVERY weekend and holiday and evening because they have no one else to do it, in my area the pay for health care is terrible but housing costs (and heating costs) are really high, not to mention gas, since those distances are long... Sigh.
Now my own rant for today: My 46 year old cousin's colon cancer just came back in her liver and lungs. Oh, and by the way, she was an x-ray tech who lost her job when she got diagnosed with locally advanced Colon Ca because she couldn't work during chemo, which meant she and her kids also lost insurance as well as income, which led to them getting evicted DURING HER CHEMO. Meanwhile I had offered to help then I got diagnosed with cancer and was laid low by my own chemo.
Are we allowed to swear in here? Because fuckity fuck fuck fuck.
Now, I know exactly where my hockey gear and jerseys are (I am not so far from the border!) Who can I take it out on?????
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oh man, dragon, absofuckinglutely we can swear.
let's go beat up someone. Gloves off. That's a horribly sad and tragic story. The landlord, the boss, the insurance adjustor, a local Congress person? Suddenly those random violence stories make sense to me
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Haha and yes i still have that peace sign on my avatar (& my car ) lol & here I am swinging my stick. Oh damn cancer changes everything
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Spookie, I am so sorry. Even when expecting someone's passing, it is heartbreaking.
Yeslama, that's awful about your cousin. I would say unbelievable, except that we know it happens. How is it possible that someone can lose their job and home because they are seriously ill? Where is our humanity?
I appreciate that we are having a broader discussion now about healthcare in both Canada and the U.S... I've posted so many times over the years that concerns about healthcare have much more to do with urban vs. rural, and good doctors vs. crappy doctors, than whether one lives in the U.S. or in Canada. This seems to be inherently understood when someone complains about a healthcare issue in the U.S., but when someone from Canada complains, too often the single complaint is taken to represent the entire 'Canadian healthcare system' and every Canadian's experience.
It is true that elective surgeries as a rule have longer wait times in Canada than in the U.S.. Hip replacements are often used as the example. Just as moth posted for British Columbia, Ontario has a wait times website. Currently 'priority 4' hip replacements (lowest priority) take on average 4 1/2 months. To the urban vs. rural disparity, the wait time appears to be about 2 months in larger urban centers. More urgent, 'priority 2' hip replacements are done more quickly. While the website doesn't mention 'priority 1' hip replacements, it happens that I know someone who broke her hip a couple of weeks ago. She had hip replacement surgery in less than 48 hours.
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Thanks everyone for good thoughts. If we can't swear, here, how can we discuss cancer? The only time I want a hockey stick is for a gator, or the Toronto Blue Jays. If you follow them, you know they are playing in Dunedin. That's my town, and they took the best dog park for training. Grumble grumble .
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jaycee49
There have always been crappy doctors. I worked in a hospital almost 50 years ago, and there was one orthopedic surgeon the nurses wanted to warn patients about. He always had to do second or third surgeries to get it right - but he was a charming old fart who convinced his patients that doing it over and over until the results were right meant he was looking out for them.
My parents were American snowbirds. They lived in a small trailer part of the year. But my mom had some health conditions that made a warm climate better for her in the winter. When they first moved to Florida, they took care of mowing all the grounds in their trailer park for reduced rent. Not all snowbirds are wealthy.
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I do wonder if, at the end of the day, the technological and pharmalogical advancements are happening at a pace too quick to keep up with existing structures. Sure, the knowledge we have about genetics and cancer and drugs like Trodelvy or Ibrance are amazing but come at huge cost, regardless of who is paying (govt or insurance). Layer that on top of aging populations and populations with more chronic disease and of course systems are going to start to break down. But then you look at the huge wastage across so much of the delivery chain that could be cut through automation (particularly in the more socialised countries) but the political will and necessary investment required and its daunting, so the can gets kicked down the road some more. It does feel like there is quite the global reckoning coming post Covid and the start of conversations that should have happened decades ago.
And that is before you get to the question of physician quantity and quality. Covid is going to have a massive impact - why would a medical professional stay in this field (especially nurses) after a year or two like this? At what point does recruiting from the developing world have a detrimental effect to delivery of health services? Here in the UK you can absolutely see the difference - top tier of surgeons, anesthetists, oncologists,senior nursing staff etc are invariably English (potentially South Asian, depending), fancy accents. As you descend through the tiers of nurses you get into nurses recruited from the Philippines, Caribbean nations, Africa, Middle East etc. Not in any way less dedicated or capable, but enough cultural and communication barriers that its tough as a patient to always get the right information, or timely information. That results in delays, challenges with patient home treatment, pressure on other parts of the system to answer questions that should have been answered at that point of contact, potential drug issues, etc.
News here says there are now 14 million on all NHS waiting lists, with some people waiting 2+ years before for hip replacements. This backlog is going to impact everyone, regardless of if you have public or private coverage because everything runs through the same national system. I've watched Other Half's father toddle around for YEARS because the Swedish social system decided he wasn't bad enough for a full knee replacement (yet) and instead just scraped out the deposits. Why he just doesn't pay to get the damn surgery done privately is beyond me, but there is a strange mentality that goes with socialized medicine that you are lucky to have it, be grateful for what you get, and I mean, you don't want to be like the Americans do you?! So you suck up the impact to your life and think well, its ok to lose a few years of mobility and be in constant pain because at least I'm not paying eleventy billion dollars for treatment, which isn't necessarily true either.
Like moth I never expected to be in this position - we were going to move to the UK for a few years in our mid-30s to check this box off in our wishlist and move back to the US (or on to Europe) to do other things. Now I'm stuck - do I stay in the country with a social health system (NHS) which the government is increasingly dismantling but with private insurance (which is like US insurance 30 years ago, I actually love my insurance company which is weird) to get me access to more timely services that bring it almost up to US style care, or do we go home to the US and risks of lack of insurance coverage and potential employment challenges?
The world is at a lot of inflection points but at a personal level, when it impacts you through delays or a crappy doctor who doesn't pay attention or experiencing mental/physical angst that shouldn't be while an outdated or expensive system grinds slowly, yeah, its hard NOT to have angst and its definitely healthy to let off some steam about whatever medical bs is thrown in our paths any given day. I wish I had appreciated more in my 20s the freedom of good health!
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Sondra, very thoughtful post. It looks like inflation has started here in the states. Although there are a lot of help wanted signs who knows what will happen in a few months. Do you have family here? The demographics are changing as people are leaving high taxed states. Hospitals who have a large campus are one of the major employers in most states and offer very good health insurance. Family practice doctors are scarce as far as the demand because of the cost of medical school. A lot of the practices hire a NP or a PA. I agree Covid has started a conversation the world needed. I hope it continues. I would love just to turn the clock back to 40!! Sending you best wishes.
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Spookie: don't you need a baseball bat for the BlueJays? Hee hee.
Pre-Pandemic folks were crossing literally by the busload to come to Canada to buy insulin. It was something like $36 for Canadian insulin and $360 in the USA. WTF?! Justify a 100% difference!
runor: how goes your struggle/battle?
No censorship for "deleted expletives" here. Truth be told I have been told by friends and relations that I have a mouth like a drunken sailor or a biker, I cannot help myself. Nor can I help that my middle finger automatically stands to attention when I am confronted by crap.
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SondraF: i started Prolia in Feb. EOB 4000 odd $. I had to pay 325. The cost from a pharmacy 1200. I called to see if i could give myself the injection BUT....NO! Plan to talk to onco about this in June. It's a simple injection and as a former nurse i think i can manage it. DUH. Fucking makes me mad. American healthcare is certainly driven by $. Biden brought up in is his state of the union (ha ha) address that there are 400 or 600 odd people in the US that are worth 4 trillion $. WTF. Really??? Not paying taxes on that money i'm sure. If everyone and i mean corporations, folks with more money than they can spend in 10 lifetimes paid what was fair things might be better. And don't get me started on their god damn advertisements. I live outside Buffalo and would cross the border if i could for meds
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In the first days of his 2021 term, U.S. President Joe Biden temporarily froze a federal rule initiated by former President Donald Trump aimed at lowering insulin and EpiPen prices. Who knows what is going on with drug prices and who the politicians are in bed with. My doctor wanted me to take Boniva and it was $70.00 for 4 pills. My Medicare part D did not cover this med. I decided not to take it. I think everyone needs to study what is in the HR3 bill. I read a report where other countries who have a price setting policy only 59% of people can have access to all new available cancer medications. In the US it is 96%. I don't know what the answer is and who to believe. There isn't any media transparency you can trust anymore.
KIDI919, they should be able to teach a family member on how to give you an injection. I think it is hard to inject yourself. I give my daughter her weekly RA injection.
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KID1919: I don't see why you cannot self-administer Prolia and I would pursue this with your onco. People self-administer Epipens, insulin and anticoagulants such as heparin and enoxarin as needed or on a daily basis. My 90+year old mother had to self-administer enoxaparin daily after having a DVT and given that this is meant to be administered in the "love handle" and not the abdomen, it was a challenge for her but she did it.
My DD was using DepoProvera and told her gyn that her office personnel were lousy at giving shots and she wanted me to do it (yes, I am an RN). Her gyn agreed and after that I gave all her shots. She usually would ask when I was going to give it and I was already done. So yes, shots do not always need to hurt. I cringe when I watch the administration of the Covid vaccine because in most cases the technique is wrong. Please do not squeeze the deltoid, the skin should be spread since it is a low volume vaccine going into a muscle, stabilize the syringe before administration to ensure it stays in the muscle/skin and for god's sake do not count to 3! Most injections should be a 2 handed administration for safety reasons.
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Prolia had to be pre-authorized every single time by my MO office. They had to "justify" giving it to me. When the cancer meds zapped my bones. They would not blink at paying for a broken hip though apparently.
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My MO told me that if I took an AI, Medicare would cover Prolia only if it's given as part of cancer treatment. Otherwise, it's out of pocket. It's outrageous, but getting authorization twice a year for it strikes me as not a bad deal if it gets it paid for. I decided against the AIs for other reasons, and luckily my Dexa scans aren't bad.
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prolia is easy to self admin because it comes preloaded in a safety syringe.
I'm in xgeva now which comes in a vial & needs drawing up but I'm still self administering.
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