Posted by
Blondie on Monday, August 03, 2009 12:00:00 AM
Many of you already know that I am a 1 1/2 year breast cancer survivor, but you probably don't know all the details regarding my experiences with the healthcare system at Overlake Hospital in Bellevue, WA. It is important for all of us to identify the specific problems in order to find the correct solutions. So, in order to demonstrate that the problem with our healthcare system is NOT the quality of care, I want to tell you my story, and contrast it with what women experience in the government-run healthcare systems in Canada and the United Kingdom.
My 2006 mammogram did not show any anomolies, yet in summer of 2007, my nipple inverted. I had my annual mammogram in August, 2007. It also did not show anything, so the doctor conducted a sonogram within 1/2 hour. Sure enough, there was a shadow, so we scheduled a biopsy for the following week. Days after the biopsy, on Sept. 5, the doctor called me to tell me the biopsy showed signs of cancer. She suggested I call my general practitioner to get a referral to a surgeon.
I was able to talk with my GP the same afternoon, and scheduled a meeting with the surgeon he referred me to within a couple of days. I wasn't comfortable with the surgeon, so I did some internet research and found one regarded as the best breast surgeon in the Northwest - fortunately at the local hospital. I was able to see him within two days.
Bear in mind that prior to surgery, it is difficult, if not impossible, to know the full scope of stage and treatment required. So my surgeon had his assistant schedule a blood test (same day), CT scan, bone scan, and breast MRI, and meetings with an oncologist for chemotherapy and a radiology oncologist, which all took place within a week. He said these tests would prove to me that the cancer wasn't anywhere else. Yet we still had a scare when the CT scan showed an abnormality on my liver, which required a liver MRI, which took place within a couple of days. Fortunately, it came back negative, so we proceeded with a mastectomy on September 20 - a mere 15 days after my diagnosis, yet it seemed like an eternity since I didn't know my prognosis.
A couple of days later, my surgeon called to tell me that there was no nodal involvement, meaning that my cancer was at stage 2A and did not require radiation therapy. Yet the tumor was the size of a golf-ball, so he recommended that I undergo chemotherapy just to make sure. Additionally, he scheduled several follow-up appointments and referred me to a physical therapist to regain full function of my arm (which locked up after the mastectomy, which is a very common side effect.) He also recommended that I wait for three weeks before starting chemotherapy in order to regain my strength after surgery.
I started chemotherapy in mid-October and met with my oncologist regularly throughout treatment. Since treatment was completed, I meet with her twice a year and have a mammogram in September and a breast MRI in March, all of which I can easily schedule within 2 weeks or less. I have also had a heart test and a dexa scan to use as baselines to test against for potential long-term side effects. And I am on Arimidex for at least five years, which may be extended to ten years.
Yes, I had excellent insurance and was very well cared for. But let me tell you that this great care is not restricted to only those with great insurance. A young woman came into my surgeon's office while I was in the waiting room and told the receptionist that she was diagnosed with breast cancer and didn't have insurance. I asked about her about a month later, and was delighted to hear that my surgeon had treated her pro bono, and the hospital costs had been covered by a charity! I learned that she was doing well, but of course no one would tell me all of the details due to privacy rights.
If we "reform" our entire healthcare system, the quality of service that I received would not be available to anyone - not even with the help of charitible organizations, as can be seen by the wait times experienced in Canada and the UK under their national healthcare systems.
According to a blog by Professor Mark J. Perry summarizing a 2007 Canada Fraser Institute report, median wait time for a CT scan is 4.8 weeks and for a MRI is 10.1 weeks. Typical wait time for surgery was 18.3 weeks. (See
http://mjperry.blogspot.com/2007/10/surgery-wait-times-in-canada-hit-record.html.) In the UK, the government dictate in 2006 was a maximum 18 week wait time from general practitioner visit to treatment, including all diagnostic tests, according to http://www.privatehealth.co.uk/news/july-2006/mri-and-ct-scans/. 75% of the 15 most common diagnostic tests were carried out within 13 weeks. Can you imagine waiting for months to determine if your cancer may have spread to other parts of your body? Talk about mental stress - I would even call it emotional abuse.
There is better information on the Canadian system's treatment of breast cancer at
http://www.cbcn.ca/documents/pdf/ENG_CBCN_fin_book.pdf. According to this study, the benchmark for breast screenings is once every 2 years. (Bear in mind that my tumor grew from undetectable to the size of a golf ball in one year.) The target for abnormal screen to diagnosis is 7 weeks, while the targets for surgery = 12 weeks, within 3 months for chemotherapy, and 4 weeks for radiation. Most jurisdictions were able to meet these targets at least 90% of the time. Yet there is no information on what types of diagnostics are conducted. So let's see - rather than my experience of less than one month from abnormal screen to surgery, patients in Canada routinely wait 19 weeks (nearly 4 1/2 months). Based on the fast growth of my tumor, it would not be a stretch to believe that, had I needed to wait an additional 3 1/2 months, the cancer could have spread to my lymph nodes, which would have required me to undergo radiation, as well as the chemotherapy.
Note that a class-action lawsuit by up to 4,000 patients in Quebec that had to wait more than 3 months for breast-cancer chemotherapy was settled out-of-court in July, 2009 for $5.4 million. (See
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090713/mtl_breast_cancer_settlement090713/20090713.) 3 months is outside of the "safe zone," meaning that there are significantly higher chances of reoccurence. Even if the lawyers don't take a cut (which you know they will), that's only $1350 per patient. How would you like to be one of these patients, worrying every day that you could get breast cancer again, and knowing that the wait times for treatment may be so long the next time that the cancer may spread to other organs?
As you can see from my experience, our healthcare system is far superior to government-run systems. So let's leave it intact and focus on the real problems. What are the real problems?
- Too many government mandates on what insurance must cover cause insurance rates to increase and no ability to shop across state lines reduces competition. This reduces the number of people who can afford insurance for catastrophic occurences.
- No portability causes people to be uninsured between jobs.
- Patients who are insured often don't know anything about the costs since they receive their insurance through their employers. This often causes patients to use the healthcare system when they wouldn't had they needed to pay out-of-pocket. Additionally, uninsured patients often misuse hospital emergency rooms, where they receive free care no matter how minor their illness.
- A lack of personal responsibility causes many Americans to believe that someone else will take care of them if they make bad decisions.
- Malpractice insurance costs have gone through the roof over the last couple of decades.
Here are my proposed solutions:
- Reduce state mandates and allow people to shop for insurance across state lines. We should be able to purchase insurance for catastrophic care only if we want (which would be much less expensive than current health insurance, which covers everything from accupuncture to alcohol rehab - kind of like expecting good rates on auto insurance that covers gasoline and oil changes). We should also be able to save tax-free money in a health savings account to use for general care. These HSA accounts should be able to accumulate over time, and should be able to be inherited upon death just like any other asset. Also, if each person had to spend their own money on their general care, doctors would be forced to offer competitive rates, just as lasik eye surgeons and plastic surgeons (not to mention veterinarians) do now. Bottom line - we want more choices!
- Insurance should be owned by the individual/family, and not by the employer. We don't receive auto or home insurance from our employers, and you may notice that auto insurance costs keep going down. Also, health insurance companies should be able to provide discounts based on factors such as weight, smoking, and alcohol consumption, just as auto insurance companies provide discounts for students with high GPAs and on cars that have alarms.
- Tort reform to place caps on what attorneys can receive for lawsuits against doctors in order to reduce the malpractice insurance that excellent doctors have to pay - and pass on to us via higher fees.
- Allow people to suffer the consequences of their decisions - and not be saved by the taxpayers. We, as good Americans, should give to charities to help these people. But it is not the government's responsibility to save everyone from their bad decisions all the time.
If you have read all the way to here, thank you very much for your attention and consideration. I hope that you will speak out with me against government-run healthcare in America. I hope I don't have a reoccurence of cancer, but if I ever do, I pray that I can receive the same quality care that saved my life 1 1/2 years ago. God bless us all.