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cancer, Editorials, health insurance

Cancer v. the Constitution

The patient in the emergency department smelled of advanced cancer. It is the smell of rotting flesh, but even more pungent. You only ever have to smell it once.

She had been bleeding irregularly, but chalked it up to “the change.” Peri-menopausal hormonal mayhem is the most common cause of irregular vaginal bleeding, but unfortunately not the only cause.

She hadn’t gone to the doctor because she had no health insurance. The only kind of work she could get in a struggling rural community was without benefits. Her coat and shoes beside the gurney were worn and her purse from another decade. She could never afford to buy it on her own. She didn’t qualify for Medicaid, the local doctor only took insurance, and there was no Planned Parenthood or County Clinic nearby.

So nothing was done about the bleeding until she passed out at work and someone called an ambulance. She required a couple of units of blood at the local hospital before they sent her by ambulance to our emergency department.

I looked at the fungating mass on her cervix. Later the Intern wondered why she hadn’t picked up on the smell. Probably a combination of it being so gradual and denial. It’s amazing what people learn to tolerate when their options are limited.

“I’m very sorry to tell you this looks like a cancer of the cervix,” I said

She looked surprised. “Oh.” She paused in silence as she adjusted to the news. And then quietly she added, “But the doctor back home said you could fix me up. He said you can offer free care because you have the university.”

But we didn’t have free care at the university hospital. While resident salaries come from Medicare dollars, there is very little, if any, money from the State for the medically indigent. We were in the same situation as her local OB/GYN. The cost of caring for those without insurance was born by the profits from those with insurance. But medical care was becoming more expensive and what insurance companies were willing to reimburse was decreasing. In addition, with more unemployment there were fewer insured patients and more uninsured. Not a sustainable model.

She needed a biopsy to confirm the type of cancer and a CT scan to see if the tumor had spread beyond the cervix. If she were lucky, she would have a some combination of a hysterectomy, chemotherapy, and radiation with a 50-65% chance of survival. If the cancer had spread, she would have radiation and chemotherapy with about a 25% chance of surviving.

But the cancer surgeons were not allowed to offer an uninsured woman a hysterectomy. Every now and then they snuck someone in, claiming to the administrators that the patient was more emergent than they really were. But one surgery doesn’t cure stage 2 or 3 cervical cancer, or even stave it off for long. It takes multiple admissions and week after week of expensive chemotherapy and/or radiation.

The radiation doctors were also not allowed to see uninsured patients. They could not even give a dying women a few weeks of radiation to ease her tumor’s stench while it caused her to bleed to death or killed her another way. They could give her one dose today. A very temporary measure for the bleeding, but only if her blood count was low enough. It wasn’t because she’s had the blood transfusion to get her here.

There was a charity program that paid providers and hospitals pennies on the dollar for cancer care. One hospital had signed up, resigned to the fact that they were seeing those patients anyway so better to get something for the cost of the care than nothing. Our hospital administrators had declined to participate. Better to get no money and keep seeing these uninsured patients over and over in the emergency room, each time providing the same stop-gap care that has no hope of cure or even palliation like a purgatory version of Groundhog Day, than to be inadequately reimbursed for the right care.

I had never encountered this clinical scenario during my training in Canada. I had never seen a woman suffer because she couldn’t afford something as simple as a Pap smear, never mind deal with the indignities of shopping around her sorrow and hard luck to try to patch together what would inevitably be inadequate medical therapy. It is this reality of medical care in America for which I was wholly unprepared. Many times I found the residents comforting me.

I gathered my thoughts before explaining the situation. To get her care through the charity program there was a catch. A set of hoops to jump through and we could jeopardize her eligibility with specific tests. I explained the ins and outs of accessing care through the program, where she needed to go, and what specifically she must say. The Intern printed out the sheet of community resources and advocacy groups that might also be able to help her patch together some kind of treatment.

It’s not health care, not by any stretch. But as long as the Supreme Court finds it constitutional I guess they’ll sleep better than I do.

Thank you for all the feedback, opinions, discussion and debate. Comments are now closed.

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Discussion

178 thoughts on “Cancer v. the Constitution

  1. I suspect all physicians have seen this happen. One of my colleagues’ patients was a young man diagnosed with a treatable form of cancer. I came to know him during the weekends I took call. At first he had insurance through his employer. As the cancer and treatments took a toll on his health, he could no longer work. He applied for and received disability. This, however, left him without insurance. Medicare takes two years to kick in after qualifying for disability (why?). The disability payments made his income “too high” to qualify for Medicaid. So, he was unable to receive treatment for his cancer. This young man died from a treatable form of cancer, leaving behind a wife and two small children. We can and should do better for our fellow citizens.

    Posted by Melissa Benavides | March 28, 2012, 7:57 am
    • Omg!, what a horror story!, as a Dr, don’t you take an oath to “save” human lives?
      IF you had a heart and treated him anyway, he would still be alive! :(

      Posted by Paula Jackson | March 30, 2012, 5:24 am
      • Read the story above. Doctors can only do just so much with their hands and for free. Treatable forms of cancer still require more than just the doctor’s input & effort. Don’t blame the doctor for the system WE’VE created. Why do you think Obama wants to implement the Affordable Care Act?

        Posted by Jewell | March 30, 2012, 8:25 am
      • How dare you? You don’t know the full story, or the circumstances around it. Until you walk a mile in his/her shoes, keep your damn mouth shut. “Judge not, lest ye be judged! “

        Posted by kjaques | March 30, 2012, 9:14 am
      • Read the next comment. You are being terribly unfair and naive.
        This doctor did a service by pointing this out. As do other doctors.
        They are not the problem – the system we have in place now is the problem.
        That’s why it needs to be changed!

        Posted by Susan Simon | March 30, 2012, 10:15 am
      • The Dr WORKS there. Do salespeople give goods away FREE. He did all he could do and MORE than the hospital by telling woman just how to get care.

        I thank GOD for NYS. No matter what else in wrong in NY. A body can ALWAYS GET CARE even without insurance.

        They will not allow you to die suffering.

        Posted by Bernice Edwards | March 30, 2012, 10:22 am
      • You can’t “just treat him anyway.” Read the article. Cancer treatment requires drugs (chemo), radiation, and/or surgery — an entire system of care that the hospital will not allow unless the patient has insurance.

        Posted by KB | March 30, 2012, 11:08 am
      • Paula you’re such a goddamn stupid moron. Stop commenting on the internet!

        Posted by Deckard | March 30, 2012, 10:14 pm
      • Doctors cannot magically treat patients by themselves. 21st century medical care can ONLY be provided within a system: a system of doctors, technicians, specialists, nurses, pharmacists, clerks, patient transporters, hospital administrators, etc. Doctors cannot mandate other workers and professionals to donate their time for free. Doctors do not own and operate radation therapy suites and pharmacies that can provide free chemotherapy and radiation. The real world is not like a TV show. This comment is as moronic as US healthcare; a perfect fit.

        Posted by desertviews | March 30, 2012, 11:29 pm
      • Paula, It’s very expensive to have an independent medical practice any more, between rent and other supply costs, plus the lousy reimbursements you get from the for-profit ” insurance” companies…so most of us work for someone; THEY control who you can see…..it’s not about what the provider wants to do, it’s that the bean counters (” insurance” companies and organizational administrators) decide what we are allowed to do!

        Posted by Perrine, NP | March 31, 2012, 5:31 am
      • Paula, that completely irrational opinion is the lie on which much of the anti-O-care resistance is based. Objectors outside the Supreme Court have literally said, “Why should I pay for insurance when I can get free care?” with absolutely no comprehension of the truth.

        The anti-O-care faction that is spreading this lie and manipulating the protesters is NOT your friend; it consists of very, very rich people and corporations that do not want the responsibility of subsidizing insurance for their employees. They do not want you to understand that, for example, your insurance company may be paying over $10,000 for EACH chemotherapy treatment; no doctor or hospital can just absorb that kind of loss and continue treating patients.

        Wake up.

        Posted by Fiona Mackenzie | March 31, 2012, 6:13 am
      • The physicians and other caregivers are not the problem and in fact only want to give their patients the best care possible. They are at the mercy of a broken system of healthcare in this country. Treatment for diseases like cancer are prohibitively expensive. Health insurance is costly and many simply cannot afford the premiums and have no choice but to take the risk of being uninsured, especially as the maximum income allowed for Medicaid is absurdly low. Low cost health insurance plans offer inadequate coverage — enter the “underinsured” – and even if you think you are covered, you can end up owing thousands upon thousands in out-of-pocket expenses that aren’t covered. This is especially true in cancer care. According to Livestrong, 8 weeks of chemo can cost up to $30,000. This doesn’t include the costs of necessary diagnostic tests, and specialists such as surgeons and oncologists.

        The other sad fact is that the poor and underinsured lucky enough to get treatment for their cancer will likely not get the latest and best. They will get treated in overcrowded, underfunded clinics, cared for by an overworked staff of medical residents with brief and infrequent interactions with an actual oncologist. They will not have access to the latest in clinical trials and emerging therapies. Many of these people will have poorer outcomes than the private patient seen at a good cancer center. This is the reality of healthcare in the U.S. and until we fix it, the good people on the front lines — the doctors, nurses and other caregivers — will have to continue delivering the best care they can with the tools at hand.

        Posted by brooklynwellness | March 31, 2012, 11:34 am
      • Paula, How do you vote? If you truly mean what you say, you will NEVER VOTE REPUBLICAN, because they are the cause of this situation.

        Posted by Bluebluesdancer | March 31, 2012, 12:53 pm
    • similar to my son’s condition, however, he was able to finally qualify, but his spend down each month was $1200. (that is his out of pocket before medicaid and later medicare kicked in – better than nothing – he now starting to pay off the debt.). We were fortunate, he has been in remission for almost 2 years after 2 bone marrow transplants and is now back working full time. My heart goes out to the family you mention as that could easily have been my son had we not had support from folks to help navigate the system and the dedication of the medical staff. (he was cut off twice during the process due to paperwork not being processed once submitted and because he could not personally show up to the ss office because he was in ICU.)

      Posted by cancer survivor's mom | March 30, 2012, 7:22 am
    • Tens of thousands of Americans fall into this loophole every year. It’s unconscionable. This is another thing that will change with the Affordable Care Act — if the Supreme Court allows it to stand.

      Posted by Leslie Boyd | March 30, 2012, 12:56 pm
      • “Loophole” makes it sound like an accident. It’s by design.

        Posted by Pezdrake | March 31, 2012, 7:44 am
      • Somewhat true…….but there will still be 20+ million Americans still falling through the “cracks”.

        I consider that inadequate.

        Posted by Kurt | March 31, 2012, 9:23 am
    • Exactly, I am familiar with this situation. It happened to me. I didn’t have cancer, thank goodness, but had to go without medical insurance after being unjustly fired. I thought it took a year for me to qualify for Medicare, though.

      I know about the earning too much to qualify for Medicare but not being able to afford Health Insurance. I know of it personally. I also don’t believe in free healthcare, so it is a very confusing situation.

      Posted by Stacy Patterson | March 30, 2012, 2:39 pm
      • If you were dying of cancer with no treatment, or your children, would you believe in free healthcare then? By the way, Medicare is free healthcare darling, it’s the single payer model that other countries have, only they include everyone, not just those under a certain income.
        .

        Posted by Arlene | March 30, 2012, 4:29 pm
      • Medicare is “free healthcare”. We have a perfectly functioning, government-run free healthcare system and millions of Americans love it. But it is only open to people over 65 years old. Why can’t it be open to every American?

        Those who say “get the government out of my healthcare” have no idea what they’re talking about. Some of those same people are on Medicare. But they don’t know, or are willfully ignoring, that it’s a government-run program. And a successful one at that!!

        Posted by petimetra | March 31, 2012, 5:34 am
      • You want to qualify for Medicare, right? That means that you want to qualify for free healthcare. Medicare is a government-run “free healthcare” program for Americans over the age of 65. Medicaid is a government-funded program designed to help the poor get access to healthcare. Both are successful government-run programs.

        Posted by petimetra | March 31, 2012, 5:46 am
    • This breaks my heart, because unless his state is very different from mine (and southern states especially are utterly horrible to the poor/disabled), he died from lack of accurate information – he COULD get Medicaid. He ‘simply’ had to get a doctor to start treatments and bill him, and when the bills reached half his disability income in a quarter (different rules for different states) – probably one treatment! – he would’ve qualified, AND he wouldn’t have had to actually pay half his income for an entire quarter (it’s based on the bills, not the payments in our state). But like I said, I suspect that’s not an option in most of the south of this insane nation. Moral of this horrendous story: Go NORTH, on either coastal side!

      Posted by vchanges | March 31, 2012, 12:00 am
    • I know it won’t make any difference, but I pasted this entire post in a message on the Supreme Court website – along with a personal admonishment. One can only hope.

      Posted by Reggie | March 31, 2012, 10:06 am
  2. Living in the UK, with the NHS, the situation above seems inconceivable. And yet our government seems ever more eager to emulate the American model. It’s terrifying.

    Posted by Rhian | March 28, 2012, 8:07 am
    • I cannot understand the headlong rush to Americanize. I moved to the UK from the US over two years ago, partly because it is a more sensibly run nation. I could no longer abide the cruelty of virtually every American “system” and fortunately, had dual citizenship so I could do it. I can think of no reason for the UK government to proceed in this manner except one: there are now more unethical greedy financiers in government who think they are self-made capitalists than there are hereditary rich folk who at least pay lip service to noblesse oblige. The nobility constrained by duty and expectation worked well combined with Labour. Now, with Labour out and a collection of navel-contemplating overaged prepsters running things….well, I think we are all going to have to yap loud and long to keep them from ruining the great social safety net the UK has long enjoyed.

      Posted by LH McBride | March 30, 2012, 6:34 am
      • Then yap you must. The squeaky wheel gets heard. If we remain silent, whether in USA or UK, we get nothing but more abuse heaped on us. Govt should work for the People, not the monied classes. It has taken 25 years for us to reach this point in America where healthcare insurance for the average citizen now costs as much as our rent or mortgages. Meaning it will overtake our housing as the single largest expense in any individual’s budget. Even then, you’re not guaranteed that you will be treated, your costs covered, etc. For-profit healthcare insurers are sucking the life out of many.

        Posted by Jewell | March 30, 2012, 8:45 am
    • I know. I have been diagnosed with advanced anaplastic large cell lymphoma. A treatable form of cancer. I am receiving chemotherapy and have had a three month stay as an inpatient. Cost restrictions on my treatment- none. Cost to me-zero. God hless the NHS.

      Posted by Mike | March 30, 2012, 7:01 am
      • We wish you better health, Mike.

        Posted by Jewell | March 30, 2012, 8:46 am
      • Thank God you are getting treatment, Mike. My son, also named Mike, died of cancer because he had a birth defect (a pre-existing condition) and couldn’t get insurance or the access to care that comes with it here in the US. He died April 1, 2008; he was one of 45,000 Americans who died from a lack of insurance that year.

        Posted by Leslie Boyd | March 30, 2012, 12:59 pm
      • Whatever you do, do NOT allow your system to change to the Americanized system! My husband had employer insurance until about 2002 when he changed to a better paying job. The new employer promised to pay $500 each month toward our health insurance, but we were responsible for finding a private insurance plan ourselves. Because of COBRA, we were allowed to continue our former insurance for 18 months while we looked for a private, non-group plan ourselves.

        This is when the nightmare started.

        Even though I had never been hospitalized in my life, all insurance companies denied our applications due to my one “pre-existing” condition: Headaches. Every policy we applied for said we could not buy their product. The state offered to sell us a “high risk” policy that was only for catastrophic claims (over $5000) but the premium just for me alone were $900 per month! No doctor visits or preventative screening tests were included in this very expensive policy.

        The insurance companies said that they would allow me to reapply for insurance IF I could prove that my headaches were gone. I had to avoid going to a doctor for two years — with the fear that if they found anything wrong with me, I’d be cut off from ever getting insurance again.

        So that is what I did — I avoided all doctors for two years. Thankfully nothing happened to me during those two years! When I reapplied, Blue Cross finally accepted my application — BUT they said I had to buy an “Up-Rated” plan — one that was more expensive than the others. After that ordeal, my family was okay with paying $650 per month for the premium (with doctor visit copays of $25 each, a $2500 family yearly deductible and our cost of 20% of all our bills – with the insurance share capped at $1 million lifetime).

        But the very next year, the premium went up to $750 per month. And the next year, it went to $850 per month. Then $950…..then $1150!

        Then, in 2011 — the year I turned 50 — our premium shot all the way up to $1500 per month! That was 50% MORE than our house payment!! And that was the year of record profits for Blue Cross.

        PLEASE don’t allow your country to let greedy corporations control the lives of your citizens like this. What they are doing to those of us in the USA is horrendous!

        Posted by JOANN | March 31, 2012, 10:24 am
    • Only in England, Cameron and Lansley have no powers to destroy the NHS in the rest of the UK, where more civilised governments have control of health.

      Posted by Sue Bowyer | March 30, 2012, 9:31 am
    • Similarly, living in Australia the situation in the article is totally alien. Anybody can get health care at any stage for free. We do have private health insurance as well but EVERY citizen is covered for basic health care needs – why would we have it any other way? When you’ve lived in a country that cares for all its citizens, the situation in the USA seems ludicrous. “Give me your tired, your poor, Your huddled masses yearning to breathe free;
      The wretched refuse of your teeming shore, Send these, the homeless, Tempest-tossed to me…” Where did you guys go wrong? Is it money, greed and indifference to your fellow man?

      Posted by Jack Kerr | March 30, 2012, 9:58 am
      • Where did we go wrong? Greed, stupidity, the lie that one day we could all be rich, and that the poor deserve it for the crime of being poor.

        Posted by mrscandal | March 31, 2012, 3:08 am
      • Good question. I think the right in the US long ago made “socialism” into a scare word akin to Stalinist Russia or Hitler. So even people who are dirt poor fear it. Health care for all is still described as socialized medicine even by the leaders of the Republican Party, and very successfully. Indeed if you read the transcript of the oral arguments of the Supreme Court on Obamacare, Justice Scalia said we could solve the problem caused by the law requiring emergency treatment at hospitals by just repealing the law! Completely heartless, the man calls himself a Catholic, and he is a sure vote to strike down Obamacare, which isn’t even single payer, which is the only solution.

        In the US people hear stories about your nationaal health systems (supposedly long waits for treatment, etc.). But when you point out that Canada, Australia, the UK are all democracies where the public could abolish the system if it was so bad, yet have left it in place for decades, no one seems to have an answer for that.

        I think the left in the US will have to suck it up, declare in favor of a national health, admit it may be called socialized medicine, and make the argument that it works. But taking on the American Medical Association will take a long time and I will never see it happen in my lifetime.

        Some day the US will look back on this period and think of it as the Dark Ages.
        Nd

        Posted by Jim | March 31, 2012, 10:51 am
    • The National Health Service in the UK entitles anyone and everyone to free health care. What exists in the US is a digusting disregard for the people who can’t afford .health insurance. I remember when I was living in CA, it cost me $1000 just for the ambulance to take me to the nearest hospital; let alone the other expences. People in Canada and Europe simply don’t have this problem. To us, it is just absurd. We fund all our medical from the taxes paid by working people to the government. The more you earn, the more tax you pay. Much fairer?

      Posted by c burns | March 31, 2012, 6:23 am
  3. I have a friend who had cervical cancer which spread to her liver, intestines, lungs, and around her body. By the time she was able to get medical care, she was in the ER with a tumor the size of a basketball. Full hysterectomy, and on her 4th round of chemo now. Additionally she spent 9 months with a colostomy bag, and repeated other surgeries to clean up. She has very poor medical insurance, but at least some. Its the copays she can’t do, she has to keep working during all of this so she can keep the insurance, but her bills are already over 150K. The only thing she can do is keep getting treated as long as she can, then declare bankruptcy. What a system.

    Posted by ruggerducky | March 28, 2012, 8:27 am
  4. It’s a very touching story, too bad that you and your colleagues aren’t touched enough by it to lobby your own professional organizations, LCME and the AMA, to increase the number of doctors, especially primary care physicians, in the United States. Instead we have a medical school lottery, heavily weighted towards the children of privilege, that produces self-entitled satraps that rule their hospitals with both eyes firmly glued to the bottom line.

    No, the people in this country have no right to healthcare. That is because a better sort of person, the doctor, has an inalienable right to _at_least_ a BMW. Sure, there is drug company greed and insurance company greed, but both of those are made possible only by physician greed that makes sure that basic prophylactic care is out of reach for many of even the lucky “insured.”

    Not that being “insured” is guarantee of better health care: sometimes it is just the opposite. For example, a woman in her seventies with a diagnosis of DCIS becomes a golden goose for the oncologists as she is regaled with ever more invasive surgeries and ever more useless drugs as her quality of life is destroyed by interminable appointments while her chest is festooned with pink ribbons—ribbons that probably do more to help her than all the tamoxifen forced down her throat—until the oncologists pluck every last dollar they can, pressuring the patient with poorly explained statistics that fail to explain why in France, with the same diagnosis a patient will receive only increased monitoring and have a _better_ outcome.

    So next time, doctor, take a deeper whiff: physician greed forms as indispensable an odor in the smell as the putrescine of insurers and the cadaverine of big pharma. But on the bright side, that’s the stench that’s going to get your beach-house built.

    Posted by Dmitri | March 28, 2012, 10:24 am
    • Your opening line is an ad hominem that made anything else you said after that worthless. Wasted words on your part. Funny that Canada doesn’t seem to have any of these problems.

      Posted by Emily Willingham (@ejwillingham) | March 28, 2012, 7:11 pm
      • Unfortunately the AMA speaks for only 19% of doctors. Most are not members because we find the lobbying of the AMA counter productive.

        Posted by Dr. Jen Gunter | March 28, 2012, 8:42 pm
      • You may replace the word “Canada” with “the reast of the developed world”.

        Posted by Anders | March 30, 2012, 5:28 am
      • ‘Ad hominem’ seems to be the dog whistle reply to most points folks make lately. You really should learn what ad hominem means. The doctor attacked no one in his story. There was no intent to defame or to deceive. Think about how mean you sound to so many people. Besides, in America this could happen to you.

        Posted by John-David Hughes | March 30, 2012, 5:39 am
      • Emily, in all fairness to Dmitri’s comment, if even an uneducated person (in America) is watching, listening & reading, they know that (overpaid) American doctors are part of the problem & not the solution. Perhaps for Britain, allowing doctors from other countries to practice in their healthcare system who may have been exposed to the American system which lavishes obscene salaries on them is causing them to become more greedy. Dmitri makes some valid points which we should not overlook or dismiss when discussing WHY our system is so broken for 1 out of 6 Americans.

        Speaking of Canada, it is unfair to compare the USA to them.

        Posted by Jewell | March 30, 2012, 8:54 am
      • Emily, I think you need to learn a little bit more about what is and is NOT ad hominem. Try reading this… http://plover.net/~bonds/adhominem.html and you’ll see your claim of ad hominem is incorrect.

        Posted by Graham Murphy | March 30, 2012, 10:49 am
      • Jewell, where do you get that doctors are overpaid? Their pay has been consistently hacked down by insurance companies. The LATTER are the real problem… as well as the politicians too chicken to change the corrupt status quo.

        Posted by Randall "Texrat" Arnold | March 30, 2012, 1:02 pm
    • Why are you attacking her? I read from her post how she is viewing this system as wrong. I don’t know where you are getting your information about medicine but it is actually incorrect. The amount of spots in a medical school while it might be approved by AMA, it also has to be approved by the individual state and its board of regents. However, it does not do any good to increase the slots in medical school if you do not have the residency slots for training which is approved through CMS (Center for Medicare and Medicaid Services) not the AMA nor the AOA. Additionally, reimbursement rates for most physicians are based on what Medicare and Medicaid set at least for those that take insurance and medicare and medicaid. And laws and contracts make it at times impossible to write off care for the indigent if wanted by the physician. I don’t know a doctor with a beach house. Pharmaceutical companies are neither evil nor good, and insurers tend to be the biggest winners in the game, not the physician.

      You are attacking someone attempting to give voice to what she sees as wrong. Under the University setting, she is not her boss, and has to answer to administration. Are you saying that she would better serve her patients by ignoring what her employer says- perform a surgery that her cancer stage would have limited benefit- and potentially lose her job? You seem to believe that physicians have more power than they do.

      Posted by Melissa Gastorf | March 28, 2012, 7:51 pm
      • I don’t see that post as an attack on the blogger, but on the medical profession which in fact does not lobby against the GME medical school caps instituted during the glut in the 1980s. I believe Dimitri is correct that the AMA would have been able to change that if they took a stand against it, but the skyrocketing salaries available in the GP shortage are too hard for physicians to resist. Not Dr. Gunter personally, but certainly her colleagues.

        Posted by James Salsman | March 28, 2012, 8:17 pm
      • Most of my colleagues are not members of the AMA. I am most certainly not. The AMA has never spoken for me.

        Posted by Dr. Jen Gunter | March 28, 2012, 8:51 pm
      • You do realize that the “skyrocketing” salaries in the GP shortage are a myth. Primary care physicians (pediatrics, internal med, and family practice) make far less than any other specialty. And when you consider the average medical school debt of well over $150K compared to threatened decreased reimbursement every year for the primary care specialties it is not difficult to see why physicians are not going into these areas. There is only so much time some one can lobby for causes, and since they have to fight yearly to try and get Congress to fix the SGR formula, it is hard to have to fight for everything. And while I see numbers throwing out that the average salary of a physician can range to $400,000, these numbers don’t actually reflect primary care. In some areas pediatricians have salaries of $90K, and internal medicine and family practice are sitting around $125K. While no one is yelling poverty, it is not exactly a salary one would buy a beach house or BMW, especially when couple with $150K-$200K in student loans.
        However, few of the physicians actually support the AMA. Less than 10% are members, partly due to the belief that the AMA sold out physicians interest for the multi-billion dollar coding empire. And when I say their interests, I mean the physician as a whole, and many aspects in patient care. Few physicians I know have time to lobby because they spend so many hours fighting insurance companies on the patient’s behalf.
        And while you said it was not personal, maybe it wasn’t, but it sure felt personal. He did tell her to enjoy the stench that would personally allow her to buy a beach house.

        Posted by Melissa Gastorf | March 29, 2012, 3:11 am
      • I was a Utilization and Review Nurse in a NYS hospital. I was working at the time this glut began. The PHARMACEUTICAL COMPANIES started this glut of greed by ALL the medical companies. When REAGAN
        allowed them to start charging WHATEVER they pleased everyone got into the act.

        DOCTORS STARTED OVERCHARGING MEDICARE UNTIL FEDS CAME DOWN AND STARTED PROSECUTING THEM. NYS CAME DOWN ON MEDICAID DOCTORS AND DISALLOWED EXTREME CHARGES. THEY WILL ONLY PAY CERTAIN AMOUNTS. They also outlawed some brand drugs because of pricing and Medicaid patients were REQUIRED to use generics unless the specific drug did not have a generic counterpart.

        BLUE CROSS WAS THE FIRST OFFENDER I REMEMBER. They started putting ALL of their costs onto Medicare
        THIS WAS WHAT HILLARY CLINTON FOUND OUT WHEN SHE TRIED TO PASS A HEALTH CARE BILL.
        Companies were forcing people to RENT MEDICAL EQUIPMENT AND CHARGING ENORMOUS PRICES TO
        MEDICARE instead of just buying the item and the patient paying the 20% co pay,I believe.

        My mother was renting a chair after her illness at I think 20 dollar charge per month. I asked why could not she just
        buy the chair and pay the 35 dollar co pay. The chair cost under 200 dollars as I remember. THEY TOLD ME
        THAT THE LAW DIDNT ALLOW IT.

        The people who set that up was BLUE CROSS. WHO WAS THE PROVIDER FOR MEDICARE IN NY.

        ALL OF THAT EXTRA PROFIT WAS GOING IN THE MEDICAL EQUIPMENT COMPANY’S AND BLUE CROSSES’
        POCKETS.

        The whole insurance systems is nothing but a system of FRAUD AND EXTORTION.

        They claim they are paying so much money for drs law suits. ITS A LIE. IF I AM NOT MISTAKEN I READ THAT
        DOCTORS LAWSUIT COSTS DOES NOT AMOUNT TO 1/4 THE COSTS OF THE TOTAL PREMIUMS THE
        INS COMPANIES RECEIVES. All the rest is sheer profit.

        THE GLUTTONY BY ALL THESE CORPORATIONS IN AMERICA IS DESTROYING OUR PEOPLE.
        WE ALL NEED TO FIGHT FOR OUR WELL BEING AND THE SURVIVAL OF OUR DEMOCRACY BEFORE ITS
        TOO LATE!

        Posted by Bernice Edwards | March 30, 2012, 10:41 am
      • Bernice is correct that malpractice insurers pay only about 2% of their premiums in claims; the nationwide campaign to convince states and people that they needed exorbitant premiums because “lawsuits are increasing” was a lie from the start.

        Health care insurers have a great scheme, too. Their biggest department is “review,” where, for seriously ill policy holders, they pick over your original application, your life story, and any information they can find, looking for an excuse not to pay for your care. The head of Cigna’s review department in California was giving a BILLION dollar bonus a couple of years ago for developing a more successful system for refusing to pay your claim.

        Posted by Fiona Mackenzie | March 31, 2012, 6:45 am
    • The supply of physicians in the US has increased. The per capita supply is 61% higher than it was 40 years ago. Sure, a bigger supply of primary care docs would make things better. But American med schools don’t produce many primary care docs so I’m not sure what your point is. It could be better made, however, by not launching a personal attack on this doctor who obviously is concerned with lack of access to medicine.

      Posted by SteveH | March 30, 2012, 12:32 pm
      • Doctors in this country enjoy the benefits of a limited supply. But it is an artificial limit. The AMA limits the number of graduates. How nice it would be if an agency limited the number of graduates in my profession. I, too, could command a great salary. This is not free enterprise, and I’m sorry, but doctors ARE part of the problem. Health Care costs are high due to good old fashioned greed.

        Posted by Willy Hersman | March 31, 2012, 6:35 am
      • The United States government has a direct need for new primary care physicians. The feds could fund med school for PCPs with loan/debt forgiveness plans. One of the biggest reasons that many otherwise charitable doctors can’t be spending time with patients in the old fashioned family doctor manner is that they owe far too much in student loans to do anything that pays a modest wage. This is an easily solvable problem.

        Posted by Pezdrake | March 31, 2012, 7:49 am
      • As I said above, the supply of physicians has greatly increased in the USA.

        But Willy, you’re operating under a misconception. Increasing the supply of physicians doesn’t reduce their income or lower health care costs. I work on health care policy and I can tell you that every study I’m aware of shows that increasing the supply of physicians increases health care costs and spending, not the opposite.

        You’re also wrong about the AMA limiting the number of graduates but that’s a long story.

        Posted by Steve Hirsch | March 31, 2012, 11:41 am
    • Graham, the first line IS iff vis-a-vis ad hominem, but the last line most assuredly is not. Neither is the one about BMWs. The post is an attack.

      Posted by Randall "Texrat" Arnold | March 30, 2012, 12:58 pm
    • You’re also wrong about invasive treatment – patients always have the right to refuse any treatment they don’t want.

      Posted by Rebecca White | March 30, 2012, 7:53 pm
    • Interesting and ignorant comment. Look at the amount of debt that physicians come out of medical school with- well into the 200 thousands. Then residency, where physicians make a base salary that doesn’t begin to cover their debt. Then years of paying off debt (even while living comfortably, if they can chase down the insurance companies to pay them the money they are owed based on the care provided.) Do some research into where the real cost of healthcare lies.

      Posted by doctor to the sick, regardless of ability to pay | March 31, 2012, 6:28 am
  5. I’m one of the lucky well-insured people. I retired from the military when I was 38 and am entitled to continued coverage through that system, and I immediately went to work for a private corporation with an excellent insurance plan. Over the last 16 years, the cost of my employee plan has at least tripled while the number of dependents covered under the plan has gone from 4 to 1 as my children have grown up and moved on to their own lives and career.

    Part of the healthcare system in the US is broken. What is the point of having the best care in the world if it’s only available to a portion of the population? The insured are paying higher and higher premiums, in part, to subsidize emergency care for the working poor and the indigent who have few, if any, other recourses for medical care. At the same time, most Americans are only one healthcare crisis away from bankruptcy.

    The Affordable Healthcare Act does at least try to address some of the issues in our healthcare system by expanding the base insurance base and by expanding the availability of preventive care which would reduced the burden on the emergency portion of the system. I believe a single payer system would be better, but this is at least a step toward a solution.

    It’s really too bad that some people can’t see past their own selfish political desires to see a person or a party fail so that the greater good of American society can be accomodated. This country has become captive to political ideology and can no longer compromise so that all of our population can benefit.

    Posted by Mark | March 28, 2012, 10:31 am
    • Well said.

      Posted by Amy Coyle | March 30, 2012, 6:36 am
    • Kudos, Mark. You are spot-on in a general sense. As for Melissa Gastorf, she also shines a light on -among other things- a burdgeoning & very real issue: The cost of tuition for those qualified to enter medical school. Can anyone explain to me WHY college/university costs have skyrocketed? Does anyone think a component of that equation is the student loan program, whereby student loans are bundled & resold in the investment arena as bonds, specifically speaking about SALLIE MAE?

      In any case, Melissa speaks from an experienced POV, about specifics of the day-to-day operations of a doctor’s practice. It ain’t pretty, folks.

      Posted by Jewell | March 30, 2012, 9:08 am
    • Ugh! The AHA is a massive gift to the health-insurance industry. What we need is a universal healthcare plan, not a requirement for those of us who cannot currently afford insurance and are not offered it through work to buy it anyway. Obama, Baucus, and the rest of the criminals in Washington sold us out (no surprise there) when they refused to even consider single-payer. Instead we get, “well if the problem is poor people don’t have health insurance, let’s just force them to get it.” F-ing brilliant. Our healthcare system is broken, for sure. Nepal has free universal healthcare for cripe’s sake, even for foreigners. But the AHA is not the solution. We need universal Medicare, period. The sooner the SC overturns AHA, the sooner we can try again at something that will help the majority of people (as compared to enriching the few).

      Many people seem to have horror stories about the insurance industry and their dispicable practices, but then turn-around and support a law that will massively enrich the insurance companies! Wake up! Obama does not care about your interests any more than Scalia does, and apart from banning some of insurance’s most egregious practices, the AHA has done and can do little to solve the problem we face.

      Posted by Josh | March 31, 2012, 2:19 pm
  6. This is a horrible situation and it is very common. If so many other countries have medical care available to all
    why don’t we?

    Posted by Joyce West | March 28, 2012, 3:47 pm
    • Because Americans decided that the free market should take care of everything in your system, yet with everything corporatized free markets don’t work. There is no competition among the corporate giants, they are monopolies and have fixed the costs. The rest of the world knows this which is why they decided certain things like education and healthcare should never be fully privatized or these systems would be at risk to robber barons and the elite controlling them for their own good and not everyone else’s.

      Posted by Arlene | March 30, 2012, 4:45 pm
  7. This would be a good example of the prime reason I left the US to practice in Canada

    Posted by Gil Grimes | March 28, 2012, 5:14 pm
  8. It is interesting to note that you practice in SF, and yet you made no mention of the many programs that are available locally, providing free *no questions asked* healthcare. As a healthcare professional practicing in the Bay Area, I’ve chosen to donate my time to some of those organizations. I can only hope that you do the same, rather than just criticize the system you work in. I am sure you do, and if so, that is awesome. I am also from Canada, and worked for many years at LHSC-UH. I’ll never go back after living here- after living in the Bay Area, it’d be suicide- so I’ll just try to make this the best place possible. I am not sure if you keep up with Canadian politics, but the provision of healthcare to everyone is proving to be a large problem there. My Father-in-Law spent six days on an emergency surgery list (three of those on a stretcher in ED) at LHSC. With escalating costs, it appears that the universal healthcare that Canada offers will become increasingly stratified and the poorest will suffer outcomes not unlike they do here.

    Posted by ben | March 28, 2012, 8:03 pm
    • You assume this case happened in California. It did not.

      My parents find their Canadian care excellent. My mother waited 3 months for her 1rst hip and 9 months for her second. She had no issues waiting because her hip was elective. When it fractured 7 days later she was operated on within 24 hours. No Canadian is denied cancer surgery because of costs. No Canadian is denied a Pap smear because of costs.

      You assume there are no wait times for urgent and emergency surgeries in the United States, even for those with insurance. You are wrong.

      “No questions asked healthcare” is very difficult to access and does not typically extend to free cancer surgery, free chemo, and free radiation. If you know of those places, please post them here. The free clinics that I know of patch together the care they can.

      I spent years working in a free county clinic in the evening in addition to many “lost billing slips” for in office consults, never mind the procedures that I did without submitting a charge knowing the patient was self-pay. Most of the time I got the anesthesiologist to look the other way as well. However, now my free time is largely occupied doing intensive hand therapy for my son because it isn’t covered by our health insurance as it’s a congenital condition and hand therapy is only covered for injuries. He would, however, get that therapy in Canada. Funny that.

      No system is perfect, but if you are uninsured in America it’s about as bad as it can get and to imply there is some kind of effective safety net is wrong.

      Posted by Dr. Jen Gunter | March 28, 2012, 8:35 pm
      • Thank you for writing the truth about the Canadian system. I own property in Montreal for 12 years and my neighbors are appalled at what is done in American in the name of healthcare access and treatment.

        Posted by Linda Grassia | March 30, 2012, 6:55 am
      • Here in Canada I had breast cancer surgery, treatment, and reconstructive surgery after mastectomy. Cost to me? A total of 6 CAD to rent the TV while I was an inpatient. No co-pays, no waiting, no questions except what was my carecard number. The world really can be like this.

        Posted by Kaye | March 30, 2012, 1:55 pm
  9. Revisionist? Let my comments stand. Your “Lasso of Truth” would defy you to delete and revise.

    Posted by ben | March 28, 2012, 9:39 pm
    • Dude, personal attacks get deleted.

      Posted by Dr. Jen Gunter | March 28, 2012, 9:41 pm
      • I am sorry, there was no personal attack. If you believe in something, you should be willing to discuss these things. If you can’t handle the discussion, no problem..weak….I’m out.

        Posted by ben | March 28, 2012, 9:45 pm
      • I disagree. It was a personal attack and your tone in the deleted comment was spiteful. It’s my blog and so I get to decide that. Sorry.

        Leave all the stats you want, links, personal experience. All cool.

        And I’m glad you had a chance to volunteer at a free clinic with no questions asked primary care. There are very few of those and I’m sure the directors scramble each month digging up grants and pleading with fundraisers. Although, if the clinic you mentioned sees HIV positive patients then they get Ryan White Act dollars for patient care, so it’s partially funded by the government.

        Escalating cost of care is an issue in both the United States and Canada, although care is still much more expensive in the United States. Remember, we have a 30% administrative overhead on everything here.

        There are problems with both models. I never said the Canadian system was perfect. I just said that my experience in Canada left me wholly unprepared for the all to common experience of seeing patients who could not afford care and who had suffered for it.

        Posted by Dr. Jen Gunter | March 28, 2012, 10:05 pm
      • Yes, of course you disagree, and since this is your blog, you can and will revise. You also take any disagreement personally, and therefore any posts which paint you as less than intelectual and more of a knee-jerk revisionist are deleted. For those who disagree with you, your “lasso of truth” seems a bit more likened to a lynch rope.
        In the real world we let other people have opinions that differ from our own, and encourage discourse. We also don’t take disagreements personally. I am done arguing with you in your own format. I’ll be taking leave of your little fiefdom.

        Posted by ben | March 28, 2012, 10:19 pm
      • Ben, you just proved her point.

        Posted by Randall "Texrat" Arnold | March 30, 2012, 12:42 pm
  10. I’m not sure where the supreme court is going to land. Back when I was in medical school, I thought the ‘answer’ was pretty obvious: scrap the private insurance companies and switch everybody to a single-payer system, a la Canada or the UK. With all of the money the US government already spends (and wastes) on healthcare, it only seemed to make sense–why not just eliminate the administrative BS, streamline the system, etc., and let everybody (except the evil insurance cos) profit?

    If only it were that simple. The first assault on my liberal values came during my ED rotations. Nothing like alcoholics and narc seekers looking for 3 hots and a cot complaining of 10/10 substernal chest pain day after day after day to make you understand how broken EMTALA really is in the absence of any personal responsibility or a more realistic social safety net. (Free meals needn’t come at the price of stories that demand pointless nuclear stress tests.) When it comes down to it, Dmitri, yeah, I’ve come to fervently believe (as nearly all doctors do, regardless of how uncomfortable they might be admitting it in public) that some people really are better sorts of people, as I’ve certainly met my share of the lesser sorts (both without and with stethoscopes).

    So, what’s the real solution? I’d propose that we staunch the collective hemorrhaging of money on healthcare and start rationing it for real, first and foremost. Doing that in anything resembling an ethical manner will involve society re-discovering the notion of personal responsibility. I’m not holding my breath.

    Posted by Ken | March 28, 2012, 11:23 pm
    • I think one approach to ameliorate the drain on ED funds (and providers’ compassion) would be decriminalization of recreational substances. The milieux in which “the lesser sorts” currently function, rarely include sufficient inspiration/incentive to better versions of themselves.

      Posted by MALove | March 30, 2012, 9:53 am
  11. wow !! is this blog only for dr, and other health care profesionals? a friend just sent link so
    I am not sure….I’ve not seen anyone Canadian or American talk personally about their health care experience. May I say something about my health care and insurance?

    10 yrs ago I was dx’d with parkinsons disease, and yes I lost job and ins am now on medicare and medicaid.. Has it been easy NO but I have participated in several clinical trial funded by pharmaceutical companies and currently am having dbs (deep brain stimulation) which my dr says helps everyone who has it . This treatment requiers me to have 4 surgeries. It is FDA approved and medicare and medicaid will together pay 100% of the $80000 price tag.
    Is the health care system perfect here ? Hell NO but some parts of it seem to work pretty well…Lets fix the broken part first and then go from there

    Posted by Roy Brown | March 29, 2012, 12:09 am
    • Excellent point… ObamaCare is not the solution and will be struck down in the Courts as of June.

      Posted by T. Cole | March 30, 2012, 5:27 am
      • ObamaCare is the only hope for the US. How can a country in this day and age think it’s viable to exist without universal health care, free at the point of need? I find it incomprehensible and sad. I am so glad I do not live in the US. Please vote for ObamaCare if you want any real future for your country.

        Posted by Mary | March 30, 2012, 10:20 am
      • God, we had all better hope not.

        Posted by Randall "Texrat" Arnold | March 30, 2012, 12:50 pm
    • I am glad you are getting good care but I do NOT want myself or my family to have to participat in programs and take surgeries. I dont want them to refine any surgery on me or my family.

      I remember several people “minorities” who were paralyzed and mentally disable because they agreed to something called an “enarterectomy”. This procedure was new and the doctor was trying to get his
      proficiency doing it. HE DID but he ruined about 4 peoples lives.

      THE PRICE IS TOO GREAT. THEY NEW IT WAS A NEW PROCEDURE BUT NOT THAT THE DOCTOR DIDNT REALLY KNOW HOW TO DO IT.

      I truly think that Health Care is a RIGHT and it is the DUTY of a nation to see that its citizens get care if they
      wish it. I hate to think of all the children who cannot visit the doctor. Fortunately, in NYS EVERY child is entitled to health care and all the parents have to do is go apply for it.

      Posted by Bernice Edwards | March 30, 2012, 10:49 am
    • Obamacare DOES fix at least some of the broken parts. It is designed to do exactly what you say needs to be done. Is IT perfect? No, but it is a far greater improvement than we have had in many many years and far better than any alternative solution to the current unsustainable PROBLEMS with the American health care system.

      Posted by Pezdrake | March 31, 2012, 7:52 am
    • It appears that you are able to use Medicare and/or Medicaid. If Obama had pushed for a public option that was based on a similar model, then what you experienced would be available to more Americans at a lower age than 55. It’s the insistence on a greed-based for-profit motive at the heart of all American Health Care (via its implementation by for-profit insurance corporations) that is strangling the humanity out of the American health care system.

      Posted by Michael Moricz | March 31, 2012, 12:27 pm
  12. oops i see now it is cancer v. constitution never mind.

    Posted by Roy Brown | March 29, 2012, 5:02 am
  13. Thanks for your article. I am without health insurance and scared.

    It is a shame for all of us. And we wonder why our country is failing….

    Posted by Theresa Candelaria | March 30, 2012, 5:50 am
  14. Thank you for publishing this article, D. Gunter. It is a tragic reflection on our country. As a former social worker specialised in disability services, witnessing the failures of America’s health and social service system broke my heart and was just too much for me. I left the US in 2004, never to return unless something changes… Given the resistance to President Obama’s attempt to bring health care reform to the US, it doesn’t look hopeful. :(

    Posted by Madeline R. | March 30, 2012, 6:14 am
  15. Is it just me or does the idea of so-called “strict constructionalist” Supreme Court jurists relying on a Constitution that was written at a time when cutting-edge medicine meant the use of blood letting and leaches strike anyone else as problematic?

    Posted by Mike R | March 30, 2012, 6:32 am
    • Of course it’s problematic, but we gotta work with it/them. What other choice do we have?

      Posted by Jewell | March 30, 2012, 9:31 am
      • In their wisdom the founding fathers (they were all men) did provide for amending the document because they knew that is the only way it would stay relevant. In the context of our time with all of our advances in medicine, we need to amend the Constitution to provide for universal health care for all Americans. If the Supremes over turn the Affordable Care Act based on a 200 plus year old document, we are missing the point the founders intended when they wrote it in the first place.

        Posted by Mike R | March 30, 2012, 9:46 am
  16. Such horror… how can something like this be allowed? And in one of the richest countries in the world and one which claims to be a nation of Christians? Truly monstrous…

    Posted by Shahin Kordasti | March 30, 2012, 8:03 am
    • What I cannot understand is how can that happen in the richest country in the world, while spending so much in wars and arms

      Posted by Maria J. Viteri | March 30, 2012, 11:41 am
  17. What we need is Canadian-style single payer. From a policy standpoint, the Supreme Court is a sideshow and election year kabuki.

    The ACA is a bailout of the insurance companies, pure and simple; it guarantees them a market through the mandate. Anybody who thinks the junk insurance they’ll provide through the health exchanges will save any more than a few of these parents is dreaming. The real problem is that health care for profit is a contradiction in terms: It provides profit, but not care. That’s because the health insurance companies profit by denying care. Because the ACA doesn’t remove the source of the problem, it’s a placebo, a dangerous palliative.

    Posted by Lambert Strether | March 30, 2012, 8:04 am
    • Perhaps we should also look at stellar models like France. Granted, their population isn’t at our level, system of taxation, how their govt treats the issue of healthcare, doctors, caregivers. It seems to me that Medicare/Medicaid are consistently on the budget chopping block in Washington which then dictates the rationing we see. Doctors are forced to zig & zag just to cover what those programs won’t, and something gets lost in the mix, namely the patients & the caregivers.

      Is it fair to say then that we, as a nation, need a paradigm-shift? We need to rework how we view healthcare & the importance we place on it vs say, our bloated military budget? As a middle-aged female US citizen whose medical premiums are covered by my employer, I am fortunate. I am also aware that should I suffer a catastrophic illness, my fortunes could change, based on what an insurer says they will cover, won’t cover, co-pays, deductibles, etc.

      I doubt our elected officials have much to worry about when it comes to their healthcare coverage. If one of the basic tenets of our Constitution is equality for all, why are they provided that which may now be denied 1 in 6 Americans? What happened to taking care of our own? Perhaps I’m being too simplistic in my thinking, so feel free to educate me.

      Posted by Jewell | March 30, 2012, 9:59 am
    • Greetings, Lambert,

      I live in California. In California we have a private, not-for-profit version of the British NHS called “Kaiser Permanente.” Kaiser uses the premiums it collects from its members to run and staff its own hospitals, labs, clinics and equipment.

      Kaiser is not ideal for uninsured patients who cannot afford to pay them (see the opening of Michael Moore’s SiCKO). However, I’ll happily purchase not-for-profit Kaiser Permanente insurance on the exchanges if the Supreme Court allows Obamacare to stand.

      Posted by J | March 31, 2012, 1:08 pm
  18. I am a lawyer and I run a nonprofit that provides free legal and insurance services to patients with chronic illnesses. As I am sure you know, Dr. Gunter, there is a TON of federal funding for uncompensated care. There is no reason why your hospital should not be required to provide charity care, reimbursed by the federal government, to people in such dire straits. Reports here in Connecticut are that the hospitals are sitting on funds that are available to them that they are not using, turning people away rather than accepting these funds. Can’t you and your colleagues talk to the hospital administration about this? I charge my clients nothing and I never turn anybody away. I earn about 1/3 of what I could make in private practice, but I choose to do good with my skills. I’m sure you could find a clinic or community-based hospital that would be happy to have you donate your time at least some of the time.

    If we are going to get a handle on health care costs in America, everybody in the health care sector is going to have to take a financial hit. Doctors, hospitals, pharma, insurers — everybody is making too much money off of a system that is bloated with pure profit. Before one more person dies of neglect, every health care provider (other than primary care providers, who already are underpaid) should take a pay cut. Every hospital administrator should forgo their annual bonus, Same for pharma and insurance executives.

    Health care is about life and death, not about supporting lifestyles that are completely out of control.

    I respect you for writing this and for thinking about it and worrying about it. Now, how about you DO something about it on top of the hand-wringing? I know I am asking alot, but if every doctor in America volunteered some portion of their time, it would go a long way towards providing care to those in need. And before you say it, I’ll say I’d say the exact same thing of lawyers.

    Posted by Jennifer Jaff | March 30, 2012, 8:15 am
    • Ms. Jaff, I applaud your efforts. I recently volunteered here in California with an organization that provides free legal services and connects people with benefits. Many benefits go unused by peoople who need them. Making those connections is a great way to work within this broken system while advocating change.

      Posted by Stephanie L. | March 30, 2012, 10:27 am
    • Jennifer, you can practice law on behalf of your clients with a pen, paper and law books, if necessary. Toss in a computer and a Lexis subscription, and you can accomplish miracles for them. Medicine doesn’t work that way, when someone is truly sick. As Dr. Gunter explained in her post, just to find out whether this woman’s cancer had metastasized would take a CT scan. That costs $$$. If we stopped paying a penny to all the physicians in this country, we wouldn’t change the problem one bit: physician salaries are well under 15% of total healthcare cost of $2.6 Trillion per year (this link says it’s 8% – http://www.prweb.com/releases/2011/5/prweb8496514.htm). In fact, as one previous commenter implied, there’s good reason to think that we need to pay primary care physicians better, in order to attract more doctors into the field.

      Our healthcare system is a very complicated and very broken system, and there is no “quick fix”. We’re all going to have to work together to come up with solutions. Some of us have seen these problems building for decades, and they won’t be fixed overnight.

      Posted by Geoff Mamlet | March 30, 2012, 11:01 am
      • First, I’d challenge you to try to raise the money it costs for us to do what we do. It ain’s easy. Second, I wasn’t saying only doctors should do something — all health care providers, including hospitals, need to step up. The fact is that there are BILLIONS of dollars of federal funding for uncompensated care at hospitals. There is NO excuse for ANY hospital — and especially nonprofit hospitals, which include all teaching hospitals — to turn away a patient as sick as this one. Indeed, legally, they HAVE to provide the care, which is why the federal government pays for it.

        And you appear to have missed the fact that I said “other than primary care providers, who already are underpaid.”

        And yes, I agree, this is really complicated and there is no quick fix. Which is why every President since at least Nixon has been trying to figure out what to do about this mess. And why, when Congress finally passes something that is imperfect, but at least a good place to start, the states should have tried it rather than suing to stop it from happening. And why I wrote a friend of the court brief. And why I spend 15 hours a day helping one patient at a time.

        What we can’t do is keep wringing our hands over it, saying it’s complicated, saying it will take a long time to fix it, and leave it at that. EVERYBODY in the system has to commit themselves to change, and that means sacrifice from ALL stakeholders, not just patients. J

        Posted by Jennifer Jaff | March 30, 2012, 1:07 pm
  19. Did you guys read the number of people advocating rationing for the decent producing population. I guess that is OK unless “they”, being the determining body, doesn’t think you or your loved one qualifies. No part of this law is Constitutional.Reform is needed, not restructure. Tort reform, open state lines for insurance shopping, health accounts,health exchanges are all good ideas. I’m not letting the HHS secretary decide my health!!!

    Posted by Dody Warner | March 30, 2012, 9:14 am
    • Tort reform is a terrible idea. Advocacy for it is based on flawed assumptions about the cost of lawsuits, etc. Not many people follow up to find that most huge jury awards are overturned or whittled down on appeal. In addition, too many doctors guilty of malpractice are allowed to continue, which increases costs for ALL doctors.

      Research tort reform objectively. You might have your mind changed, like I did.

      Posted by Randall "Texrat" Arnold | March 30, 2012, 1:44 pm
    • Dodgy, there is rationing now, by insurance company accountants. ACA does not ration health care, it does the opposite, forcing insurance companies to provide more care. Tort reform can’t help – lawsuits are only 0.1% of health care spending. Better to go after the 20-30% wasted on insurance companies.

      Posted by Laird | March 30, 2012, 4:53 pm
    • Dodgy, there is rationing now by insurance companies. The accountants and formularies at insurance companies decide whether or not procedures you need are on the “approved” list. If they don’t approve it, you don’t get care. Why is that not “rationing” to you?

      You should step back a little from the anti-Obama rhetoric and try to look at the ultimate beneficiaries of the proposals you say you like. Tort reform benefits insurers and corporations, by requiring them to pay less if they hurt someone or make mistakes. Open state lines for insurance shopping means that companies would not be subject to state laws regarding the kind of regulations that a particular state might wish to place on insurers. Health accounts benefit the investment companies and Wall Street, who can’t wait to get their hands on that money.

      What is your feeling about Medicare? Do you think Medicare is a bad program? Do you know someone who is on Medicare? If so, you are in favor of, or know someone who is currently benefiting from, being on a government-run national healthcare program, with no “rationing” or “death panels”. Why would it be a bad thing for everyone in the United States to have access to the same kind of program? That’s exactly what Obamacare is a first step toward trying to provide.

      Posted by petimetra | March 31, 2012, 5:41 am
    • Yes because the real problem is that I can sue a doctor for malpractice when he kills my wife on the operating table due to neglect. If we didn’t have that personal accountability for doctors and hospitals I’m sure everything would get better.

      Posted by Pezdrake | March 31, 2012, 7:54 am
  20. It’s odd that you are complaining about the flaws in the American healthcare system considering you chose to leave Canada knowing how things worked in the states. The Canadian system is constantly struggling to retain the doctors necessary to service our universal system because people like yourself flee south after receiving a world class education that is highly subsidized by government.

    The U.S. spends more on healthcare than any other country yet performs horribly compared with other industrialized nations. The reason for this is simple; U.S. doctors are the world’s highest paid, by far. Doctors benefit from a “free market” employer system that no other country’s system can compare to. I’m not saying there aren’t great doctors in the U.S., on the contrary, the best doctors in the states are among the best if they aren’t THE best in the world. The problem is that only people who can afford the most expensive coverage receive their care, for the most part.

    Instead of blaming judges and politicians for all the ills of the system, ask yourself: would you be willing to take a significant pay cut? And if so, why didn’t you return to Canada upon completion of your specialization?

    Posted by Louis Stefanik | March 30, 2012, 9:42 am
  21. I live in the U.S. and have decent health insurance provided by my husband’s employer and our twice a month payment. I am disabled and have numerous chronic health problems and Medicare from the government. I use my private insurance as my primary and Medicare as my secondary so that the government pays very little. I am scared to death of what will happen once my husband has to stop working because of health problems and we are left with little in the way of income and insurance. I take about 15 medications and some have no generic and cost hundreds per month. I didn’t ask to be this way and after working for almost 20 years, I waited 7 years to file for disability and left it all to my husband to provide for us. I pray daily for our country to come up with a program for those who are ill and have little or no insurance. I may some day be that person in the E.R. who has little and no way to be helped. Thank you Dr. Gunter for your post.

    Posted by Nancy Honeycutt (@Kalasa27) | March 30, 2012, 9:48 am
  22. People can bash Canada’s system all they want, but I can only talk from experience. My mom has had Chrons disease since she was a teenager. So as her son, I’m not a stranger to emergency rooms, operating waiting rooms, and hospital rooms in general.
    She gets CT scans when needed, most of the time the same day she goes in. ER’s can get backed up at times, but never to the point you’re missing care you need. The care is top notch, and never a penny out of pocket.

    Her perscription drugs, are another story, as those are an out of pocket expense unless youre insuranced. (Though drugs given while in the hospital are covered by OHIP)

    As a Canadian without insurance (all I have is long term disability coverage from work), my biggest fear is getting hit in the mouth and losing some teeth.. Not sure how I would pay for emergency dental work… But I could not IMAGINE that same type of worry for breaking a leg or chest/stomach pains,etc.
    I go and get it fixed. No 12 hour wait times or trouble finding a family doctor, or any other false horror stories I always read when it comes to trying to impose fear for a gov’t system.

    I’m 27 and have been to the doctor’s maybe once in the past 15 years. Never to the hospital (except to take/visit family) yet I don’t have this feeling of bitterness ‘why should I pay for your problems’ mentality. Ill continue paying the high taxes for healthcare I haven’t used, and am glad to do it.. because I’m a human being, and an ‘everyone for themselves’ healthcare system that sees those less fortunate denied care is absolutely shameful.

    Posted by Andrew Black | March 30, 2012, 9:55 am
  23. The ugly reality of healthcare in America…

    Posted by Ian H | March 30, 2012, 10:03 am
  24. I was in the US on a short visit and had an acute pancreatitis attack. I went into the ER for help. After explaining my medical history to the doctor he told me he needed to do an x-ray, which would cost me $9000.00. I told the doctor I couldn’t afford that. He said he wouldn’t treat me without the x-ray, inspite of the fact that an x-ray does little to help diagnos or provide insite on pancreatitis. I told the doctor I was flying back to Canada later that day and asked if I could just get some pain medication to get me through the flight. He said not without the x-ray. So I got the x-ray, which ended up being inconclusive, and the doctor gave me the meds. If this doesn’t sound like extorsion I’m not sure what would qualify.

    Posted by jlindsay24 | March 30, 2012, 10:12 am
  25. As a Canadian, I’m truly puzzled by the US healthcare system. My wife had breast cancer before the age of 40. We had 3 young children at home at the time. She received surgery, chemotherapy, and radiation, from one of the top cancer centres in the world. Total out of pocket cost to us? 0

    We can walk into any hospital or clinic in our province and receive treatment without worrying about whether it’s in our network. No one checks to see if a test or procedure is covered by our insurance before ordering it.

    Our system is not perfect. Costs are increasing, wait times can be a problem, and doctor shortages exist in some areas. But our system is compassionate. People receive care according to their needs, not according to how much money they or their insurance companies are willing or able to spend.

    Patients are people – mothers, fathers, sons, daughters. They are not profit centers. You shouldn’t structure healthcare as a business where maximizing profit is more important than maximizing health. Americans happily fund their fire departments through tax dollars. They want professionals to be available to save them should fire strike. And even if they are fortunate enough to never need the services of the fire department, they are willing to pay anyway. Why can’t they see healthcare in the same light?

    Universal, single payer systems are more efficient, less expensive, and more compassionate. Yet they are somehow politically toxic in the US. I really, really don’t get it.

    Posted by David | March 30, 2012, 10:23 am
  26. This scenario looks just about like my experience two years ago in Canada. But I was more fortunate. The Canadian health care system has a lot of warts and often is short on cash resulting in waiting lists. But one thing they do right in those circumstances is an efficient triage system where those with life threatening illnesses are always at the front of the line. I had a hysterectomy and radiation, and have just passed two years of quarterly examinations at the local cancer centre with a clean bill of health.

    Yes, I have paid into the health care system through my taxes for my entire adult life, but I got every dollar back in the last two years. My only out of pocket expenses amounted to about $200 which included the parking fees in the hospital parking lot.

    I wouldn’t trade our system, warts and all, for the American health care system. I’m retired and living on a pension. Thanks to our health care system, I didn’t lose my house. I really can’t understand why Americans are so afraid of single payer health care. It saves money. And I can’t understand why Americans so distrust their governments to run it. You seem to think that somehow the government would decide whether you would get treatment or not, yet every single day in America, health insurance companies are turning down claims.

    Posted by E. Dawson | March 30, 2012, 10:24 am
    • You seem to think that somehow the government would decide whether you would get treatment or not, yet every single day in America, health insurance companies are turning down claims.

      There is no logical, rational thought process and so we get mindless repetition of provided talking points. Most of which are false but which favor the current powers. People have been told that the government can not do anything right, and they believe it. People have been told that the problem is lawyers, not the health care system itself. And they believe it. This has been going on for years and has permiated our discourse, such as it is. The you have human nature which generally dislikes change. You have people who have insurance who mostly get it from their employers and probably don’t know the actual cost of insuracne. But they are learning as they are asked for copays and deductables that get raised often. And then if they know the cost of insurance they don’t want to have to pay for those who have nothing. The entire system is broken but it is too big to replace all at once. There is fear of the unknown, there is fear of the loss of what crappy system we have, there is fear that their Dr. will quit practice because they don’t earn enough…
      Need I go on?

      Posted by Ruckus | March 30, 2012, 3:04 pm
  27. Dr. Jen,

    Your story should be on the front page of every newspaper. And you speak the truth:
    as a pastor whose served both rural urban congregations, I see similar things often.

    The brutality of the American ‘health care’ system is devastating to individuals,
    their families and their communities. Sadly, many don’t see the connection between
    their political responsibility (to be an informated electorate) and their personal situation.
    Too many gladly jump on whatever partisan bandwagon
    is being touted thru the media or thru the political views of another person.
    They’d rather stand up for their constitutional right to bear arms (even if they can’t afford a weapon,
    or they’d rather buy a weapon than health insurance)… than see the need for
    compassionate care for themselves and their community.

    I try not to get into politics with the people I serve; it puts walls up between us, and
    if we disagree politically, they won’t trust me with their spiritual concerns.

    I’ve wondered what the medical community thinks about our nation’s current disgrace.

    Please continue to be vocal and honest about your experience. We need to hear from
    more doctors like you.

    Posted by Noel | March 30, 2012, 11:02 am
  28. Doctors in the USA are controlled by money. From pharmacy medications that do not even heal but cost a fortune to Doctors who do not even know how to treat a person. Lack of interest over all in our medical is appalling. WORSE is the fact that many studies where done in USA showing how the people over all have lost 70% Empathy towards each other. A country full of wealth,tech and opportunity and they became selfish,elf centered and egotistical. Caring more for Hollywood celebrities and fancy toys then “people” The US society is in decline. Inverted values,horrid media control and lack of proper education. including parenting education. I Live in Brazil now and i have seen more charity,love,kindness and advancements in my 4 months here then my 33 years in USA.

    Posted by jadezebra | March 30, 2012, 11:39 am
  29. I am tired of the old anecdotal stories trotted out by extremists to ostensibly illustrate how horrifying socialized medicine is. I listened a while back as certain family members circulated such tripe one evening after supper, and when I was asked to comment, I asked them a simple question:

    “Who at this table has actually been treated by socilaized medicine?”

    Not a one had. However, I had been to two hospitals during a business trip to Finland for what turned out to be (thank God) gout instead of thrombosis. Total outlay for a foreigner: $190. Here in the US, I would have been looking at thousands for those exams. When I related that experience, they were all dumbfounded.

    Ironically, many of the people I hear complain of healthcare systems they’ve never experienced are equally angry over the one they have. They demand change, but when the rubber hits the road, they scream about it happening. Unreal.

    Posted by Randall "Texrat" Arnold | March 30, 2012, 12:49 pm
  30. These stories in a country as wealthy as ours is sickening. My aunt, a resident of Canada, had breat cancer. Watching her go through surgery and radiation and chemo was bad. But I also knew she did not have to worry about not being able to get treatment or the bills from those treatments. It is a shameful situation here in the US.

    Posted by Donna Wilson | March 30, 2012, 12:54 pm
  31. Just goes to show how once again corporate Americia takes care of their own . Pretty sad if you ask me

    Posted by Mary | March 30, 2012, 12:56 pm
  32. As a Canadian let me tell you we do not live in a total utopia, our wait times at hospitals are horrendous and we face the same problems with lack of beds and cramming many patients into one room.
    As an outsider looking in to America I recognize the problems while people look to Canada as the model. Remember though, we only have 30 million people and are encountering issues, America has over 300 million people. How can they possible not run into issues. If Canada had 300 million people God knows what the state of our health care would be.

    Posted by jamie | March 30, 2012, 1:41 pm
    • You’re the first Canadian I’ve EVER heard with any complaints. Waiting times “horrendous?” No one I know who lives in Canada has said anything like that. They all love their system and think we’re albsolutely nuts. I doubt you are who you say you are.

      Posted by Rebecca White | March 30, 2012, 7:57 pm
    • If you think the wait times are bad in Canada then clearly you have not been to a US hospital. 8 hour waits in an *emergency* room are not uncommon. No one is saying Canada or anywhere else has the perfect health care system. But so many countries are so far beyond the US in quality of care and economy of care that it is truly staggering.

      Posted by Jesse | March 30, 2012, 10:31 pm
    • I’m a Canadian living in the U.S. I’ve seen both sides. *Believe* me, it’s better up there than down here. Unless you’re seriously rich.

      In Canada, you may have to wait around for 2, 4, 6 hours, possibly in pain…but in the US, you put off even going to the hospital for 2, 4, 6 days. Or weeks. Or months. In the same pain, but you’re still going to work. You can’t afford to see a doctor.

      You can’t afford the deductible. Or the coinsurance. God forbid you’re uninsured, there’s no way you can afford the whole pricetag. If you go to the doctor, it’s going to bankrupt you. Keep going to work, holding on to that job that (maybe) buys you the insurance you can’t afford to use…or at least keeps a roof over your head so that you have some privacy when you’re lying awake at night moaning in pain.

      Eventually, you have to go to the hospital. Either you collapse at work and go in an ambulance, or you wait until Saturday so you don’t have to take off work (you’ll lose your job and any insurance you may have). Show up at the ER. Give them your insurance info, if you have it. You probably don’t have to wait more than an hour or two…more than you’ve already waited.

      From this point on, if you have insurance, everything the doctors do is subject to your insurance company’s approval – if they don’t want to pay, you don’t get the treatment. If you don’t have insurance, you get nothing but the absolute minimum care required to ‘stabilize’ you. Sometimes they can’t really stabilize you. Sometimes you’re like the woman in this story…you’re just going to die.

      Any sane person who’s experienced both for any length of time (and isn’t so rich they can buy a double bypass out-of-pocket) would pick the Canadian system any day and twice on Sunday. It’s not perfect – there’s no Utopia – but it’s damn near the best humanity has done so far.

      Posted by Evan | March 30, 2012, 11:17 pm
    • Thank you for your comment, Jamie. A friend was discovered to have a mass on her ovary during fertility testing in Canada. It was believed to be cancerous and she was referred to an oncologist with a FOUR MONTH waiting list. Ovarian cancer is rapid and if untreated, easily fatal. She was 24 years old. My FIL had a massive heart attack just a few days after returning to the US from visiting family in Canada. Our Canadian family was so thankful that heart attack hadn’t happened on the vacation stating that he would have surely died in Canada, waiting for care. The system in the US is decidedly flawed, broken, and horrifically negligent. However, when I hear of some of the problems faced by my relatives in Canada, I’m not eager, and actually somewhat fearful to embrace a similar healthcare system. Even without insurance, I’ve been able to get care when I needed it in the US. No, I haven’t had cancer or a heart attack, but my mother did spend two weeks in the ICU for a ruptured appendix without insurance. She was near death, but was saved by some radically expensive treatments, thousands upon thousands of dollars worth of drugs, and expert care. The hospital completely waived the bill. From my limited experience and anecdotal stories, the US doesn’t seem as comprehensively worse than Canada. I’m trying to be open-minded, but struggling to embrace a healthcare system based on a model of socialism.

      Posted by jenster7 | March 31, 2012, 11:03 am
      • “The hospital completely waived the bill.”

        I’m glad your mom’s OK, but think about where the money must have come from to pay for “radically expensive treatments, thousands upon thousands of dollars worth of drugs, and expert care.”

        That hospital overbills its insured patients to absorb the costs of treating uninsured patients like your mother. They also charge taxpayers for those bills. The hospital’s already socializing its costs. It’s just not doing so openly.

        Posted by J | March 31, 2012, 1:23 pm
      • If it’s so bad in Canada, why haven’t they repealed it and put in our horrible system? Canada is a democracy, you know?

        Posted by Jim | March 31, 2012, 2:29 pm
      • By the way, was your mother on Medicare? That is socialized medicine.

        Posted by Jim | March 31, 2012, 2:39 pm
  33. All problems stem from making the US Health Care Industry and US Health Insurance Industry “profit-making companies”. Until this changes, we will see millions die needlessly.

    Posted by Richard | March 30, 2012, 2:03 pm
  34. wow, really hits home and cuts through the amazing bullshit that surrounds this topic, JG. couple of questions: (1) why are you practicing in usa vs. canada? (2) are there more enlightened medical organizations than the AMA that lobby in the right direction? i forget the rest. :)

    Posted by Sonoma Madman (@SonomaMadman) | March 30, 2012, 4:51 pm
  35. In Australia the system is this. If you earn over a certain wage, from memory it’s $50k but don’t quote me, you have to take out private health insurance or get a tax of 1.5% of your wage. So on $50k that’s $750 a year. That’s the stick. The carrot is if you instead take insurance then the govt will subsidise part of it, so it works out cheaper or the same - so most people have private insurance.

    As a single person, my basic private health insurance package last year cost me $750 and the govt paid roughly $200 of that. Net result - I paid only $550 for health cover and avoided a much bigger tax.

    But that’s not all - if for whatever reason, I or any Australian, chooses it, I can instead just use the universal public healthcare system provided free to all. The downside to that is waiting times, and room sharing, less choice of doctor etc. Either way, it’s there, use it or not, or fastrack with private insurer instead. The system works and given it’s cheaper to have insurance than not have it, private health insurers are in no sign of going bankrupt any time soon, and can take a big load off the public system.

    My understanding is that Obamacare is bringing in a similar stick approach as Australia? The only way I can see it not working is if the insurance premiums are too high to be sustained by individuals. Otherwise, what is everyone so afraid of? It works! And I don’t care one whit I am paying this now even though I have never used it, it’s awesome peace of mind for the day I might need it, for a relatively low fee, all things considered.

    Posted by Perthchick | March 30, 2012, 5:55 pm
    • In some ways it’s the same. Seems to me the main difference is that here there will be no basic care that you can subsidize with insurance. For the indigent, there might be medicaid (there is now, but you really do have to be practically income-less to get it) – they might expand it. But for everybody else, they will be required to buy insurance and that’s all they’ll have. There will be SOME income adjustment, but it won’t be anything near as inexpensive as yours.

      We share hospital rooms, too, depending on how many patients are in at the time, and we have wait times as well. I have been waiting to get some fairly serious tests scheduled for about a month.

      Posted by Rebecca White | March 30, 2012, 8:03 pm
  36. Heath Insurance Companies are the REAL “Death Panels”.

    Posted by Richard | March 30, 2012, 5:56 pm
  37. I’m a nurse and saw the same diagnosis on a patient. She died in 3 weeks after the doctors diagnosed her. She was treated in the hospital, even without the insurance BUT she did not get a pap because she had no insurance. And thought nothing of it. It’s so sad to see a woman die such a painful death for something that is usually treatable if caught in time.

    Posted by Nurse B | March 30, 2012, 6:32 pm
  38. I am a rural primary care doctor. One day a week I go to “big city” near by and make as much money in a locum as I do the other four days here in my little community (town of 1200, valley of 6000). I can not leave because no one else will come here and I don’t want the people here to die. In the last three years: I have seen an uninsured woman with breast cancer that ulcerated, smelling like a dead carcass; she solved her problem by turning her face to the wall and starving herself to death after sending her son to visit a family member. I have seen a local mill worker who had a fight with his girl friend and slept under the bridge get beaten up by local teens, develop seizures and organic brain damage with eyesight loss as a result, and be unable to get onto disability because he could not get to the specialists to document his condition; one doctor (myself) was not enough. He died in a seizure in the park within the year. I have known one old lady who could not get into a doctor because she had no Medicare secondary who died in the summer at home and was not found for three weeks; by then her seven cats had tracked her remains into several rooms. I had a new patient , a man with no insurance, come into the office for some heartburn medication; I told him we needed to do some tests and he left. Three days later he was dead of the cancer of the esophagus he had developed from his undiagnosed Barrett’s esophagus. This is what you get if you turn your health care system over to people whose business it is to maximize their income and the income of their stockholders. We should expect no more.

    Posted by Joanne Holand | March 30, 2012, 7:29 pm
  39. (follow-up to the multiple comments about health insurance companies)
    We will move from our current complex way to pay for health care to a simple way to pay for health care: single-payer health care, improved Medicare for All.
    Our complex way of paying for health care includes 3 types of bureaucracy:
    http://www.medicareforall.org/pages/Bureaucracy
    … one of which is health insurance companies,
    which also contributes to the other two beauracracies
    We care very much about the deaths and the hardships and the associated friend, family and all those directly impacted. We will make progress by contacting those who have been impacted (with polite timing!) and those being impacted to help ensure that they are informed about the benefits of single-payer health care, improved Medicare for All:
    http://www.medicareforall.org/pages/Explanation

    - Bob the Health and Health Care Advocate

    Posted by Bob Haiducek | March 30, 2012, 7:55 pm
  40. I find it very, very strange that a civilized nation should even discuss universal health care. Even in a country a lot less rich than the US, such as Brazil, where I live, everyone is covered by whatever the nation can afford to provide for the neediest. There is consensus that this is fair and fundamental. What society debates is how to improve service provided, and reduce waste, which is very much a part of such a huge system, run by the state, with its traditional managerial problems and corruption. But these problems are by no means reasons to even dream of discontinuing or reducing coverage, quite the contrary.
    A modern society produces so much wealth that it is very strange to question its duty to distribute some, in the form of essential protection for all of its citizens.
    The US puzzles us.

    Posted by Marcelo Carneiro da Cunha | March 30, 2012, 8:12 pm
  41. My fiance died of breast cancer due to her oncologist slavishly following insurance rules. He had ordered and received, for her, the cancer pharmaceutical “Herceptin” (forgive me if the spelling is wrong). But when she went in to begin treatment she mentioned having changed insurance plans. The doctor did a quick check, found out that the new plan did not cover that drug, and refused to give it to her. It was in his office, yet he denied her treatment. Six months later she was dead. That happened in Oakland, California, twelve years ago. Whether the Herceptin would have saved her life I don’t actually know. But the fact remains that it was denied because of an insurance company.
    What, exactly, is keeping people from being aware that insurance companies are the true death panels?
    And I wonder; a great many extremely loud religious people are insisting that this is a nation “under God”. Those same people are against “socialized medicine”. Although the Jewish, Christian and Muslim religions ALL implore their followers to care for the needy, why is it that none of these people care about the poor?

    Posted by Rod Lamkey | March 30, 2012, 9:10 pm
  42. Ignoring private insurance completely, the US federal and state governments alone spend MORE per citizen on health care than any other country. Other countries manage to cover 100% of their citizens while spending LESS per citizen than our government spends to cover only ~35% of the country. Why?

    A routine appendectomy costs $3k in Canada, while Medicare pays over $12k for the same routine surgical procedure. We’re simply paying too much for the care being provided. It’s not a matter of insurance, since Medicare is already single payer. So ObamaCare is barking up the wrong tree.

    The US government is extremely inept at cost containment. They passed a very modest cut to the reimbursement rates paid to Medicare doctors way back in 1998. This is essentially the poster child for how government COULD possibly rein in costs. Simply tell doctors they are going to get paid less and make them adapt. But instead, the politicians broke down under pressure from doctors. Now Congress has to scramble around finding hundreds of billions of dollars to pass a “Doc Fix” in the budget so that these modest cuts never actually happen.

    We need to use examples like a routine appendectomy to gauge how and why we’re being fleeced. Is it the hospital, the doctor, the prescriptions, malpractice insurance? Are there too many nurses involved? Too many hours allotted, too much recovery time provided? Just go through the costs one item at a time and find out how and why we pay 4x more than Canada.

    Then REFORM THE GOVERNMENT systems. They already have more than enough money to pay for health care for every US citizen, but we’re only getting 35% coverage. If we reform the government’s problems there is already more than enough money there to care for everyone. If we ignore it, there will never be enough, no matter what else we try to do.

    Posted by KC | March 31, 2012, 1:18 am
  43. Thank you Dr. G or this horrifying yet accurate article. I am a “non traditional” first year medical student. I am not from a “privileged” family. My husband has also been unable to receive care for his medical condition despite going through all the appropriate appeals to the insurance company with physician support for medical necessity. I have a family and will come out of medical school with over 200k in debt. The federal subsidized loans are being taken away from all medical students as of July, increasing our debt load. This year’s match was very tough. There were hundreds of fourth years competing for 8 remaining pediatric residency spots in the scramble, meaning hundreds of potential primary care physicians are unable to receive training in the field this year. In the face of decreasing medicare funding, many residency programs are letting residency spots go unfilled. I know many people in the public view docs as rich country clubers, but the vast majority of docs I have encountered are generous caring chevy-driving members of the community. I am disheartened looking at the future of medicine in the US without the ACA. Currently we are cutting care and seriously threatening medical training. How can we possibly hope to take care of an ever expanding and aging population? I just wonder wonder why the individual mandate is being met with such opposition. The fine for not carrying insurance would only be $95 if a person wanted to opt out. Yet, if that same person was in a vehicle crash, s/he would still be treated when brought to the ED due to EMTALA. The physicians are not the enemy. I don’t need to nor do I expect to be wealthy. I hope to be able to pay back my loans, provide for my family, and enjoy my work. I cannot imagine doctors looking at dying patients and withholding treatment if they had the power and resources available. As students, we are constantly being taught to practice “evidence-based medicine”, but I wonder where the evidence is supporting patients with a treatable cancer dying without treatment. How has the policy of medicine strayed so far from the principles. I know I am a fresh med student idealist, but just have hope for the future and I shudder to think what may come when we continue to turn our backs on our neighbors. Thank you for sharing your experience and having this conversation.

    Posted by CMac | March 31, 2012, 1:43 am
  44. I work for the ambulance service here in Britain and take patients to our local large teaching hospital, Addenbrookes in Cambridge, continually. People are seen and treated and don’t usually give a thought to the cost of their treatment. People don’t have to worry about bankruptcy due to medical costs and can have their health issues attended to without that fear hanging over them. I lived and worked – in a hospital – in Southern California for a number of years and often compare the two systems of healthcare.

    Whenever we transport somebody who does nothing but moan and complain about the NHS I firmly relate to them my experiences of living in the US. To begin, I tell them (nicely of course) that the 50 mile round trip journey we are making in California would probably cost them in the region of £50-60 PER MILE. Also, the treatment they are about to receive is probably in the region of several thousands of UK pounds. Cost to them – nothing.

    We pay 12%, after income tax allowance, from our income for National Insurance, which covers health care, amongst other things. Ok, in Britain we do seem to pay a lot of tax but, having seen both sides of the water, I know where I would rather be, healthcare wise, as I get older! By-the-way, my wife is American and she also knows where she would rather be, healthcare wise.

    Posted by David St. Laurent | March 31, 2012, 4:30 am
  45. The U.S. is one of the world leaders in deaths from preventable causes (http://www.commonwealthfund.org/Newsletters/The-Commonwealth-Fund-Connection/2011/Sep/Sep-26-2011/Whats-New/US-Last-in-Preventable-Deaths.aspx, We also lead the world in bankruptcy related to medical costs– in other industrialized countries such bankruptcy is unknown. We are number 1.

    http://www.medicynic.com

    Posted by medicynic | March 31, 2012, 5:45 am
  46. I call BS on this story…part of the oath Drs. take is “to do no harm”, plus Federal law requires persons presenting themselves at an Emergency room are to be treated whether or not they have insurance…no one can be turned away. That is one reason some many hospitals are closing their ERs or the whole hospital.

    Posted by David | March 31, 2012, 7:37 am
    • “I call BS on this story…”

      On what grounds? EMTALA doesn’t require treatment. It only requires that the hospital to stabilize the person in the ER. They don’t have to perform surgery and cure them, just stabilize and send them on their way. Anything more is charity care.

      Posted by Steve Hirsch | March 31, 2012, 11:55 am
  47. I posted here last night. My post was respectful and relevant. Yet it never appeared.

    Posted by Rod Lamkey | March 31, 2012, 8:03 am
  48. Just want to share my recent experience: I’ve lived with clinical depression that has not responded to any treatment. When i found out about a new treatment called Transcranial Magnetic Stimulation, i felt hopeful since the research showed a high success rate. I called one of the centers that advertised for it to make an appointment for an evaluation, only to find that they only take 2 insurances (for partial coverage), mine not included. It’s a 5-day-a-week treatment course that lasts 6 weeks. When i inquired about the cost for it cash, i was shocked that it i would be charged $500 for evaluation and $300 for every time i would get treated, totalling $9,500. I guess this treatment was only advertised and available for the fortunate was ones under the 2 insurances and rich people. I don’t know what the average person would have to do to whip out $9,500 in 6 weeks. I certainly can’t.

    Posted by HopingforChange | March 31, 2012, 8:22 am
  49. If a system of health care is publicly financed and privately delivered, it is called a single payer system. Now, there are many, particularly the Republicans when referring to the single payer system say that it’s “socialism”. In the United States the Republican Party has historically had negative associations with socialism and is one of the main factors the United States is the only wealthy industrialized nations that does not provide universal health care. The Republican imply that the private run health care system if a single payer system was instituted it would become controlled by the government thereby associating it with socialism. It seems the word socialism is the main factor that many Republicans bring up about a single payer system. In the United States there already is a single payer system that is called Medicare, Medicaid and the U.S. military’s “Tri-Care. It seems if one says something to kind about single-payer and there is a Republican around ready to brand you a “socialist”.

    If the mandate in the a Affordable Care Act is repealed it should radicalize Democrats on the health care issue because of the way the U.S. Supreme Court is stacked against Democrats that will in turn will move the Democrats toward the single payer system that will in time lead to the U.S. Congress to pass single payer legislation. The Republicans seem to be hoping that if they fight hard enough the Democrats will eventually give up and move on to something else. But, this is where they are wrong. Many Republicans say they favor universal coverage, but seem unable to every come up with a workable plan. The Democrats see universal care as a right and will not give up on this issue till universal care for all Americans is achieved. If the Affordable Care Act is struck-down only the Democrats will have a viable plan for universal coverage, and will be even less likeable to Republicans than the Affordable Care Act enacted in 2010. And absent of another viable proposal the Democrats will eventually get their way and Medicare for all will become a reality and the Law of the land

    Posted by William A. Perry | March 31, 2012, 9:03 am
    • Sorry, Mr. Perry, but you have inappropriate expectations about the Democrats.
      — Obama literally shouted his support in 2003 at a public meeting during a talk he was giving. He never took the lead in 2008-2010.
      — The Democratic Party platform, established every 4 years (next one August 2012, as far as I know), makes it very clear that they are AGAINST universal health care … by being FOR the continued use of health insurance companies. You can read the words about private health insurance options and health insurance companies in both the 2004 and 2008 party platforms here …
      http://www.medicareforall.org/pages/Democratic_Party

      Note: this is where a reader of this realizes that NEITHER one of the major political parties is supporting the will of the people, as very well documented in the Popular Support section of the Single-Payer Support Monitor
      http://www.medicareforall.org/pages/Monitor_Popular_Support
      Tip: at least select the first link at that web page to see the chart. From there you could select the link to the Massachusetts web page, where 67% of a QUARTER OF A MILLION AMERICANS (255,213) voted at the ballot box for single-payer health care.

      Regarding socialized medicine see an Answer here: http://www.mforall.org/p/830#socmed

      And .. if you go to that answer I suggest that you check out each of the 3 links provided to more information.

      SHOUT THESE TWO POINTS TO THE ROOFTOPS
      PEOPLE POWER TOPIC —- Based on the extremely low lack of support in the U.S. Senate (maximum of around 5%) and the very low lack of support in the U.S. House (maximum around 18 to 20% … less than 90 out of 435) THIS TOPIC IS NOT A POLITICAL ISSUE IN THE UNITED STATES. And, although there are continual attempts to tear down what other countries have, it is not a political issue in other free-market counties either, because the PEOPLE in those countries LIKE their health care. Therefore, it is sometimes political suicide to be in opposition to health care for all.

      - Bob the Health and Health Care Advocate

      Posted by Bob Haiducek | March 31, 2012, 12:25 pm
    • (a continuation of my comments)

      SECOND POINT TO SHOUT TO THE ROOFTOPS
      PEOPLE EDUCATION TOPIC — Since this is very much a people power topic, the need is for education of the American public. We are getting ready for that education, which needs to be done by as many Americans as possible, one-on-one contacts preferred.

      ———————————————–

      Your words “the only wealthy industrialized nation that does not …” certainly caught my eye. That was the accurate statement in the past. I said and wrote something similar to that for a long time. But now it is ALL free-market countries. The two poor ones within the OECD free-market countries (Mexico and Turkey) have been implementing universal health care. So … now … all those people who had been writing that ALL other industrialized / free-market countries have universal health care are CORRECT. But it has now gone way beyond that. One can now call that Phase 1. More countries have been implementing it as a kind of Phase 2 toward a world full of health care for all systems.
      http://www.medicareforall.org/pages/World_View#worldactivity

      But I want you to know that we can and will get single-payer health care, improved Medicare for All, and that it will be the best in the world.
      http://www.medicareforall.org/pages/Best

      We need to start by people knowing what the subject is. Trust me, they do not. We are part of a tiny choir among today’s estimate of 313,279,000 people in the United States.
      Talk to someone — but please use your time wisely. Contact people who themselves or their families are directly impacted — or someone who VERY clearly cares. Don’t bother with the rest, but I don’t have room here to fully explain why.
      http://www.medicareforall.org/pages/Explanation
      http://www.medicareforall.org/pages/Answers

      - Bob the Health and Health Care Advocate

      Posted by Bob Haiducek | March 31, 2012, 12:48 pm
  50. Is there a name & address you can share so people who really care about this woman can contribute money to help her?

    Posted by Harry | March 31, 2012, 9:09 am
  51. This is terrible. Sadly many of my fellow Americans are brainwashed to believe single payer is the worst thing ever.
    Did anyone see the Youtube video of the Republican debate where the crowd CHEERED at the idea of a hypothetical man dying because he lacked health insurance? Sick and mean.

    Posted by Sharon M. | March 31, 2012, 10:47 am
    • The saddest part is that it was not a hypothetical situation for one of the candidates. The candidate’s friend had died uninsured and left his family in $400,000 of medical debt: http://tinyurl.com/7szqq7q

      Posted by J | March 31, 2012, 1:33 pm
  52. I wish for all folks opposed to universal health care to lose their job (and therefore their insurance), and then get cancer. If I lived around Washington, DC, I’d go up to and tell those selfish, idiotic protesters myself.

    Posted by swampwiz | March 31, 2012, 12:03 pm
  53. While I agree the point that the US Healthcare delivery system is the most effed-up of the first world nations, I disagree that this mis-mash bill is a step in the right direction. Nor do I agree that it’s this…or nothing. All this bill does is to enfranchise the biggest problem with the delivery system, namely abusive “health insurance” companies.

    While this bill was the right wing’s wet dream a few years ago and in some ways mimics the German system, it essentially compels the individual to purchase the world’s most defective product in exchange for a promise that those who have been most cruel in US Healthcare delivery system will do better in the future. We have seen those promises before…and we have seen them broken before.

    The US “healthcare insurance” companies play the role of a wife beater in front of cops who promises to never to do it again…and like the pummeled wife, the supporters of this bill accept this promise at face value…and I stand like a cop, who knows these promises will be broken and the wife will be beaten again and again…until she ends up as a murder victim. This bill will be modified in time, at some point you will be forced to purchase “health insurance” that has all the shortcomings of today’s model…with no hope of real reform.

    Fortunately, the right wing on the Supreme Court is too stupid to realize this is a divinely sent golden parachute for all the present evil doers in the US Healthcare delivery system. That combined with Kennedy questioning the wholly unique proposition of citizens being compelled to purchase a privately held defective product/promise on constitutional grounds this bill may be pushed back for a new bill that expands Medicare into a base insurance program.

    Posted by S Brennan | March 31, 2012, 1:49 pm
  54. Here are clarifications about my posts at this web page.

    #1 — About the importance of education.

    Some activists like to “shout” out the fact that American people want this:
    health care for all, single-payer health care, improved Medicare for All, universal health care.

    That obviously would indicate or imply that no particular emphasis on education is required. Nothing could be farther from the truth, as “they” say.

    Why do I communicate a graph that over half of Americans want it, and also share that Americans do not know what the subject is?

    Because both items are factual.

    A) Responding to a well-timed survey that is appropriately worded will get positive answers.

    B) People being surveyed do not necessarily fully understood nor have a highest degree of support when faced with the subject in a one-on-one conversation. I’ve been on multiple national conference calls (for multiple organizations) over the last few years where single-payer activists communicate this: they go to people “on the street” or anyplace and find that most people are not aware. My latest check on this was making contacts in a drive across 7 states during which literally nobody I contacted had heard of this topic.

    Last but not least, the “over half of Americans” in support can, in a flash of multi-million-dollar advertising, turn that into about 80% against.
    http://www.medicareforall.org/pages/Media

    What is at that Media web page must be kept in mind. Education is critical, not just important.

    #2 — We (Medicare for All Teams) are not ready yet.

    I find this particular blog page as especially good or else I would not have spent time posting comments. The benefits to the Medicare for All Teams is that some web pages were refined as part of my providing the comments. We make refinements over time as we work to finish the final projects. Posting comments forces us to make certain that the linked web pages are in good shape.

    Thus, I am promoting what you can do on your own to be on the ground floor of what needs to occur. However, an active promotion among the masses is NOT ready to occur, at least not from our perspective.

    - Bob the Health and Health Care Advocate

    Posted by Bob Haiducek | March 31, 2012, 1:53 pm

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