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Jay Lake
Date: 2011-09-21 05:29
Subject: [cancer] Following up on recent events, and more on costs
Security: Public
Tags:cancer, health, personal, politics

After a good night’s sleep for the first time in a week, I am happy to report that I saw my oncologist yesterday about the recent GI issues. As the day had gone by, my lower GI violence was abated in favor of a sullen ache, so we weren’t doing intervention so much as discussion. They did pull a full set of labs on me, and everything was, in her word’s, excellent. She commented on how healthy I was, beyond the obvious.

Among other things, this indicates that I was not suffering from a GI infection these past days.

I explained how things had gone since last Thursday night, and how desperate I was to have better control if they recurred. We discussed FOLFIRI, my recent diet, and medications. The oncologist was of the opinion that the basic problem is just life on FOLFIRI, but that I may have made it worse by consuming a lot of meat last week. (I was craving meat protein horrendously, so an unusually high percentage of my food intake had been meat.) I made a passing comment about loving cured meats and the link between nitrites and colon cancer. She pointed out that horse had left the barn a long time ago and I might as well enjoy bacon in moderation.

In the end, she prescribed a gas reducer, endorsed the use of kaopectate or other OTCs if I wished, and recommended papaya enzymes as a dietary supplement. She also asked me to eat more yogurt, bananas and pineapple, and to keep the meat content of my diet relatively low.

All to the better.

I was also forcibly reminded of the financial costs of this disease. Due to an unusual confluence of appointments, even with my fairly good insurance, my out of pocket costs for visit copays and pharmaceutical copays this week alone is over $200. That of course doesn’t count against my long-since-met annual out of pocket limitations on my insurance plan.

Think about that. I have done everything right. I have the privilege of being white, male and having a short English name. I have an excellent education, quite a good job, good insurance. And yet cancer is costing me as much as $200 per week in direct, hard costs. How would that hit your household budget?

This actually jibes with my overall estimate of cancer costing me about $10,000 per year. Most of that is healthcare direct, hard costs, a lot of which is front-loaded in the out-of-pocket limitations, but it’s also things like higher energy bills for keeping my house warmer than I would if I were not ill, extra transit costs for trips back and forth to medical appointments, and so on.

So who the hell can afford to be this sick? This eats up a significant percentage of my takehome pay. Even as someone relatively affluent who has done everything right by the American rules, cancer is slowly bankrupting me.

My friends in Europe and Australia and New Zealand aren’t forced to take unpaid leave or burn their vacation to be ill, and they aren’t forced to spend every spare dollar and more to meet the costs not covered by insurance. And their healthcare outcomes are as good or better than ours.

Tell me again why we don’t need a better system of healthcare finance?

Tell me again why ours is the best in the world?

This sucks in so many ways.

Originally published at jlake.com. You can comment here or there.

Post A Comment | 11 Comments | | Flag | Link

User: cathshaffer
Date: 2011-09-21 12:52 (UTC)
Subject: (no subject)
Ugh! I've been similarly outraged this week after having a conversation with a NURSE who can't afford her own medication (as I blogged yesterday). We are getting to the point where health care providers can't afford health care. So who exactly is this health care system FOR?
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russ: quo vadis
User: goulo
Date: 2011-09-21 13:05 (UTC)
Subject: (no subject)
Keyword:quo vadis
It's the best system in the world because otherwise you're a socialist traitor who hates America!
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User: cissa
Date: 2011-09-23 18:51 (UTC)
Subject: (no subject)
The health insurance system is primarily for the executives in the for-profit health insurance companies, and to a somewhat lesser degree for the shareholders in said companies. You will note that the purchasers of insurance do not appear in this list. In fact, the more a company does to actually pay for the health CARE which it promises to pay for, the more the stock prices go DOWN; they are rewarded for denying as much care as possible to as many customers as possible. (I'm reading "Deadly Spin", which is about exactly this.)
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Larry Sanderson
User: lsanderson
Date: 2011-09-21 13:29 (UTC)
Subject: We're #1!* We're #1!* We're #1!*
Best healthcare in the whirled!*

You forgot the asterisk!

*Only for those that can afford it.
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User: voidampersand
Date: 2011-09-21 15:12 (UTC)
Subject: (no subject)
Best in the world at creating wealth.
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When life gives you lemmings...
User: danjite
Date: 2011-09-21 17:53 (UTC)
Subject: (no subject)
(Reposting this from my response over at theferrett's page.)

This is one of the reasons I left the US- it is no place to grow old.

It was after I left I found out just how terrible the system there is, or perhaps better phrased, how respectful of people a non-profit driven system can be. Even the smaller details, like when my partner was hit by a car, how I could stay by her side and take care of her, rather than running around gathering data about all the vehicles and drivers and witnesses related to the accident- that is what cops are for.

The reduction in daily stress of being able to assume full, free coverage is amazing. A whole sector of over-40 worry just disappears, so that, for instance, when I was working as a lumberjack I didn't have to fret about injury in a high risk, under-the-counter job and when (ouch!) I did get a hernia - that all I had to do was go to the hospital and my surgery would be 100% covered.

It was also knowing - when we were broke - that we could still go to the doctor is we got sick rather than hoping it went away 'cos medical visits were beyond our reach.

I can go on and on and on. As long as the USA is married to for profit medicine, it will have the worst system in the world for most of its citisenry.

Also, in New Zealand, there is a non-profit that sees to the well being of 90% of the nations babies.

Great health care, increased availability, reduced cost, infinitely lower daily stress, better outcomes and all for the low price of leaving behind all my family, friends and loved ones.

Worth it, I fear.
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User: nicosian
Date: 2011-09-21 19:23 (UTC)
Subject: (no subject)
I'm grateful for the last couple years here in canada. Not counting that I probably would have bankrupted my parents several times over for severe asthma, but that i got treated and mom never had to really scrounge for work or money to afford me, ( in kind, the same system saved her life a year ago when she contracted a fairly severe illness, and has recovered.)...

but that in the last two years, two surgeries, 4 specialists, 2 hospital stays and I had only cab fare and a magazine to pay for. I got seen very fast, insanely so. I have a sinus surgery that will almost certainly be required again, this was my 4th go, and every time the wait is shorter.

My friend with the liver issues and is on transplant list ( albeit very low) gets care. A friend with a catastrophic brain infection: expedient care. Neither was run into the poorhouse for it. They got as good as care as you could possibly wish for.

Even in the netherlands, out of pocket was cheap for me.

So I just don't GET the US system, but the stats and reports obviously back this, where its not serving people and if I had to choose a gatekeeper to access, I would not pick someone who's primary interest is the bottom line, over my life.

I know an american who is battling cancer and he can't get chemo covered without a battle. A friend here in canada is breezing through treatment and merrily recovering. Such a marked difference.
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User: farklebarkle
Date: 2011-09-21 20:16 (UTC)
Subject: (no subject)
I was talking to a friend who lives in Vancouver, and she had to go to a hospital a few weeks ago for some blood work. She said there was a list on the wall of procedures and costs ... presumably for Americans coming across the border for treatment. (She pays $50 a month, which covers everything. EVERYTHING.) I can't remember the entire list, but I think a liver transplant was around $10,000.

I can't even imagine what that would cost in an American hospital, even covered by insurance. It's insane.
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User: mymatedave
Date: 2011-09-21 22:21 (UTC)
Subject: (no subject)
I work for my local council in the post room earning less than 20k a year, and I've been ill and stuck in bed this past week and haven't had to worry the slightest bit about keeping my job. I'm going back to work tomorrow and that'll be the end of it, even if I'd been off over a week I'd only need a doctor's note and that wouldn't cost a penny.
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User: tyellas
Date: 2011-09-21 22:49 (UTC)
Subject: (no subject)
It's not perfect here in NZ. Helping out a friend who had cancer here in NZ...she did have a lot of out of pocket expenses, and if she'd been in a traditional job, would have run through her sick leave (I get 10 days a year) and probably used some vacation time (I get 20 days a year, it's the law). Unable to work, she did get on the sickness benefit and was eligible for some grants.
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Danny Adams
User: madwriter
Date: 2011-09-25 23:48 (UTC)
Subject: (no subject)
>>And yet cancer is costing me as much as $200 per week in direct, hard costs. How would that hit your household budget?<<

It wouldn't...because I simply couldn't afford it. The money wouldn't be there, and that's also assuming I was healthy enough to continue working full time (and keep my insurance).

(Or maybe I'm just too lazy to get a third job to make up the difference. At least I suppose that would be some folks' answer.)
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