Sunday, April 04, 2010

Take two aspirin and call Obama in the morning

My recent post celebrating the passage of health insurance reform led to an interesting debate in the comments section. There are sincere people on both sides who put forth arguments of merit. At the risk of causing more headaches for myself and others, I want to address some of the points made.

First, this new law is about as conservative as a liberal reform can be. There is no public option. The bill was supported by Big Pharma, with which the White House cut a deal early on. While these factors may be mightily annoying to some people on the left, they also mean that the worst fears of those on the right are unlikely to be realized. Decisions about what care you can have will still be made by corporate bureaucrats –- as opposed to government bureaucrats –- although the reforms do provide some better consumer protections, such as changes to the appeals process. Drug companies will still be able to charge American customers an arm and a leg and a spleen, which means they will still have money and incentive to develop new therapies for CLL and other diseases. There will be no government-mandated NICE program, like they have in the U.K.

The concerned physician wrote in his comment that "Healthcare providers will either grow wealthier, or they will leave the system, further diminishing availability of care." I am guessing that with a new group of 32 million captive customers, health insurance companies won't suffer. They have enough money to hire attorneys to exploit loopholes or gray areas in the law, which has already begun, as the recent flap over whether they can weasel out of covering children with preexisting conditions demonstrates. There are lots of ways for health insurers to game the new system, just as they have gamed the old.

On another point I made, the doctor wrote: "I hope that you really don't believe that many people died for lack of coverage. As a physician I categorically assure you that that has not been the case."

Alas, there is plenty of evidence that more than a few people have suffered fatal consequences from lack of insurance. Last fall, researchers reported in the American Journal of Public Health that an estimated 45,000 deaths per year in the United States are associated with the lack of health insurance. A 2007 study from The American Cancer Society found that uninsured cancer patients are 1.6 times more likely to die within five years of their diagnosis than those with private insurance.

The bottom line, as I see it, is that the current system is unfair (take refusal to cover preexisting conditions as an example) and unworkable for too many people (the estimated 45 million Americans who have no insurance, those even with insurance who face bankruptcy if they become seriously ill, those with chronic diseases -- hint, hint -- who face dollar caps on coverage, those whose insurance can be lost at any minute due to the capricious whims of an insurance company).

This reform package is flawed and will no doubt need some corrections as time goes on. There may well have been better ways to go about it. But in correcting some of the worst abuses, it is a step in the right direction. We may have gone from bad to middling, but as we CLLers know from our treatment experience, a partial response is better than none at all.


Tom said...

Yes, much more down the middle this time. My concern in the comments was that something might get denied in the future. I understand the statement "corporate bureaucrats –- as opposed to government bureaucrats" that is what we have now. I can see health care moving in two directions.
1) It can become a true free market endeavor with real competition and smart companies making a real difference.
2) The government can get into the game creating a government "option" that becomes a disincentive and financially impossible for companies to continue supplying health care other than the new government option. If this happens, then I am back to my fear of getting "government bureaucrats".

Again, I am happy that there are now no limits to benefits, I am happy that I can not be denied for insurance. I'm not sure how all of this is going to lower costs, but these are real benefits for sick Americans.

I want to see my first scenario happen and not the second.



As I mentioned in my previous comment in the earlier post on this subject, I am glad I have Japan's health care system to return to if needed. There were neither corporate nor government bureaucrats standing in my way there, only clueless doctors, much like the ones found here. But neither were there idiots arguing about "guns and butter" like you find here in the States.

Kiyla said...

Hi Dave,
I have been following your posts for awhile now. My dad fought CLL for 9 years and passed a week ago. He died peacefully surrounded by his family. I have to admit I was fearful of the healthcare bill passing, until I saw how my dad was cared for by the VA (which typically gets a really bad rap)during his last 3 weeks...If it wasn't for the government taking care of him (he didn't have health insurance) I don't know what he would have done.
Keep on writing..many nights your blog has provided me comfort, laughter and encouragement.
Love and Success,
Kiyla Fenell

Anonymous said...

When cancer drugs stop being approved here in the US, then your victory for socialism will be complete.

Wait- oops!- You have cancer! So maybe IVIg will be deemed 'too expensive' which I believe will be one of the first CLL therapies to be eliminated.

Maybe you'll get a secondary malignancy. But wait! Kidney cancer drugs are too expensive, so, too bad!

Perhaps you'll get what you asked for: worse care, rationing, fewer drug approvals, less research, and dying cancer patients.

But since you are a Ebay millionaire, you'll be able to fly to one of the few countries left where you can get cutting-edge treatments.

You'll have no one else to blame, but yourself. But you'll still try. Why not blame Bush for your predicament? That'll make you feel better.

elizabeth said...

Just found your blog and it's been fascinating reading about your journey through CLL. Let me know if you're interested in writing a blog post for CURE ( for our upcoming CLL feature. Thanks! Elizabeth(at)

Bruce Atherton said...

As a Canadian CLLer who has had a Bone Marrow Transplant in the US and two here in Canada (just going through the last one now at Day 55), I thought I'd offer a perspective on this, having experienced both systems.

The care I got under the Canadian system and the American one was identical. Fortunately for me, my insurance for the US BMT (at Dana Farber) was provided by my government so I didn't pay a dime and got exactly the treatment that was medically best, regardless of cost. There was no insurer pushback. That has not been the story for many CLLers in the US whose stories I've followed over the years. Depending on their HMO and medical plan, some have been refused modern chemotherapies and only offered archaic ones, just as an exxample. So I consider myself among the privileged elite in terms of the care I got in the US.

There is no privileged elite in Canada. Everyone gets exactly the same standard Universal Health Care, which as I have said is as good as the privileged treatment in the US. Most Canadians are worried about any change to our system that smacks of introducing "two-tiered" health care which would result in an elite.

We do pay for our health care system, of course. We pay in two ways: taxes, and waiting time.

In terms of taxes, the Canadian system is actually cheaper in overall dollars spent than the US. In 2006, for example, health care cost $3,678 per person in Canada but $6,714 in the US (both figures in US dollars). As a percentage of GDP, Canada spent 10% while the US spent 15%.

In terms of waiting time, I understand that HMOs will often introduce their own delays into getting care, so I'm not sure how dissimilar the two systems are (I didn't have any waiting at Dana Farber). In any case, in Canada private clinics are opening up to provide services to people who are willing to pay to avoid the wait times. While this starts us on the slippery slope to two-tier medicine (and much hand-wringing is being done as a result) it nicely solves the problem of long wait times.

If you are interested in reading more of a comparison between the two systems, Wikipedia has a good article.