<p>Several friends in the past few years were diagnosed with very aggressive (I believe stage 4) cancers. In one case, the young man in his early 40s was told to start planning his funeral as there was nothing more the local docs could do. In the other case, the woman was told she had a 50% chance of living another year & given aggressive treatment.</p>
<p>The young man & his mom decided to fly to NY to Sloan Kettering for aggressive NOT COVERED treatment. It was successful & after some recovery time, he flew back to HI for more covered treatment. There was a recurrence & again he was told to get his affairs in order & again he & his mom flew to NY for more NOT COVERED treatment & then returned to HI for more COVERED treatment.</p>
<p>Both people have defied the odds and are alive and contributing to society today. I guess Kettering is somewhat of a concierge situation, but I believe they do take some insurance, just not the young man’s. I would definitely not want to not be able to have treatments that have kept these people alive & functioning available.</p>
<p>People who go to the specialty respiratory hospital I go to in Denver are getting concierge treatment & I guess I am too, even tho it’s covered under my BCBS plan (tho the travel expenses are NOT). I am very grateful that the hospital & research center does exist, as it handles a lot of the most difficult, challenging respiratory and allergy patients all over the world. I’m not all that sure I would have survived these past 11 years if they hadn’t had a huge role in keeping me as healthy and active as I am. They do NOT charge a premium or “cherry pick” & they do consult with providers all over the world.</p>
<p>In our area, we have a nice set-up to some degree that helps me big-time. My patients don’t get hurt during “business hours” very often and in many areas that can mean spending several hours in the ER. Remember, I am not a fan of the ER for anything less than an ambulance trip!</p>
<p>I can have my patients seen by an orthopedic surgeon at 8PM on a weeknight with no appointment. X-rays and full orthopedic evaluation within 2-3 hours–NO WAITING. If needed, that patient has an MRI next day; results 2 days later. </p>
<p>Tell me where else in the world you can get specialized treatment in that short of a period of time?</p>
<p>cpt, I hope that your son is doing well. Our D had a very difficult time for several years but she is healthy today and heading off to medical school in the fall so we have been incredibly fortunate. She inspires me every single day. </p>
<p>Yes, we do have concierge medicine here, although I’ve never heard it referred to by that name. It started, actually several years ago, with clinics and groups of doctors who sold their services to large corporations, law firms, etc. as a perq for senior executives, partners, etc. Most large corporations require their senior execs to have extensive annual physicals and this type of perq assured the ease of doing so. I’m not sure how much is paid on an annual basis but the actual care and services - lab, physio, tests, etc. - are billed to the provincial health plan. So, in effect, it’s the access that the employers are paying for but the care is still funded through our universal healthcare system. </p>
<p>More recently, these groups have made themselves available to the general public as well. I’m not certain of the number of people who have utilized the services but I do know several. There’s a lot of grumbling in the press here whenever the topic comes up because some people think that these groups shouldn’t be allowed to exist. People here are fortunate in many respects, though, because no one here goes without care and no one has to pay thousands and thousands of dollars a year on premiums. There’s also no issue of fighting with an insurance company in order to get approval for a particular test or treatment. When we were at the stage in our lives where we had to decide, for the final time, where we were going to live, we made the decision to return to Toronto. There were many reasons but the overall quality of life, for everyone, was our primary reason. People are treated better here in just about every possible way. The social safety net and the wonderful public education system, in addition to universal healthcare, made our decision for us. I don’t know what the solution is for the U.S. It’s impossible to have the type of system we have in Canada but I hope that those who are smarter than I, can come up with a level of improvement that will eliminate at least some of the glaring issues with how things are done currently. It often amazes me that more Americans don’t demand it. With all the chest-beating, flag-waving, best-country-in-the-world claims, how anyone can be happy with the state of the delivery of healthcare as it is, boggles my mind.</p>
<p>What boggles my mind, as I wrote in a post, is that many of those who would most benefit from such a health system are so adamantly against it. But that is what the situation is here. They do not want to be forced into paying for it. In my personal situation, it would not matter if we went to the Canadian system unless we lost our research hospitals and access to leading edge treatment when needed. </p>
<p>I think the reason is that for all of the complaining about our health care system, most people do get treated here and if they don’t have the money, they simply do not pay. My one son fell into an uninsured situation through his own fault and choice. When he needed care, he got it. Just filled out the Medicaid forms and as a starving actor, did not owe a cent for the top of the world care he got. Where it can be a problem is if you are not deemed needy, get care and can’t pay for it. Your credit is then ruined for 6 years, but people go through that if that is the case. Though there are many complaints about the way our healthcare works, many people do not want to lose the possibility of getting what the world comes here to get for a government mandated system. </p>
<p>The CEO of DH’s company is Canadian, and has nothing good to say about the Canadian healthcare system. The waits and triaging is something he simply could not tolerate, and apparently there was not the freedom to buy ones way out of the system when he was there. Here he gets what he wants when he wants it. </p>
<p>I’ve long preferred the Canadian model for the consistency and ease of use that it gives most of the time for most people. I have no idea how to bring this into being here, and still keep the leading edge research options. As for overall quality of life, I’ve often told DH, I would prefer to move to Canada, because in our case, too, i think it would be an overall better quality of life. Too much heritage and family here for DH to want to make the move, plus his field of work is here. For whatever reason, more people move here from Canada in his type of work than the other way around. </p>
<p>In terms of health care, I think Obama did what he could in bringing things a bit closer to a national system. But private enterprise in the health industries have so much at stake here, that I don’t see things changing more in that direction. That and the many Americans that don’t want any more government intervention in their lives even if they are the ones most benefiting from it.</p>
<p>Yes, it has always struck me as ironic that those who have the most to gain from reforming healthcare (all of us as patients) are those who stick up most for the insurers who make it so tough and keep denying claims & benefits.</p>
<p>If we had everyone pay and insured (as well as they are able), it would help spread the risk so we as a national can do more in preventative and maintenance care instead of so much crisis intervention (which is never as good and much more costly in health and $$$$).</p>
<p>I too like that the US does have a lot of excellent resources and facilities, but other countries have some of them as well, but still provide better preventative & maintenance care than our country does. Managed care systems are trying to use those models (tho of course they prefer the healthiest patients). I do hear some horror stories about managed care systems but also know that they do provide good basic care for most of their members and are willing to let members get 2nd opinions even out of their system as appropriate.</p>
<p>Rich non-Americans come to the US for the best medical care money can buy for what ails them (though for some ailments, the best medical care may be in some place other than the US).</p>
<p>Not-so-rich Americans go to Thailand, Mexico, and other places for medical care at lower cost than the US.</p>
<p>We also don’t do so well in the US with maintenance either, especially for folks with chronic conditions. For example, it is well established that cardiopulmonary rehabilitation is a very important tool in treating folks with cardiac and/or breathing problems. There are VERY FEW facilities providing them in the US, including only the VA in HI–no other for the entire 1 million plus who live here, including the approximately 30,000 who have been diagnosed with emphysema or chronic bronchitis plus all those with cardiac conditions. Medicare & Medicaid finally reimburse for such programs but many have folded in the interim and not been revived.</p>
<p>Some insurers are encouraging Americans to go to other countries for care that is less expensive than they would get in the US. Issues can & do arise when there are complications afterwards–most US docs would not want to handle it.</p>
<p>Money does buy access to more options for care an the ability to travel to get there.</p>
<p>Perhaps one of the biggest obstacles to overall population health here in America is the power and influence wielded by our food conglomerates. Their business models seldom mesh with the need to promote overall good health. And most of us are very much out of touch with the particulars of our chain of supply. Most of us have no idea what companies like Kraft (a subsidiary of one of the big tobacco companies—which have never been concerned over Americans’ health) put in packaged foods to increase our appetites, causing us to consume more and more, thereby boosting their profit margins (and most of any given grocery store is dedicated to packaged foods, much of it junk foods), or what companies like ADM put in animal feed to speed along the cycle of animal products to market. It should be illegal, for instance (in my opinion), for cattle farmers to grain feed animals that, over millennia, evolved to be grass feeders. Grain fed cattle produce meat extremely high in saturated fat, and we have been conditioned as a culture in this country to eat a lot of beef. The steroids and anti-biotics used by factory farms in our beef and poultry industries are also showing deleterious effects on our health, as well as that of our children. Junk food, full of empty calories, saturated fat, and high-fructose corn syrup is much cheaper, and more readily available than fresh fruits and vegetables—and those are often genetically altered and full of pesticides. </p>
<p>This is all catching up with us here, with childhood obesity and the adult disease syndromes common to adult obesity decreasing average life expectancy for the first time since the beginning of the industrial revolution. If we fail to aggressively address these issues, we will still continue to see poor health outcomes, and realize runaway costs for health care delivery, even if we do convert to “socialized medicine.” The problems of health care in America are complex, and we can’t focus on just one aspect and ignore all the rest.</p>
<p>There are quite a few powerful interests converging–the tobacco and alcohol companies are also making huge profits in things as they are and a HUGE source of morbidity and mortality in the US and worldwide.</p>
<p>Yes, the problems are complex, but we all need to start where we can instead of throwing up our hands and saying things are just TOO complex for any of us to have any effect in helping with a solution.</p>
<p>Michelle Obama & others urging WalMart & others to lower the cost of fresh fruit & vegetables, so that it can be more affordable and available to everyone over the attractive & inexpensive high caloric & sugary “junk foods.” She’s also urging the nation to “move.” American Heart & American Cancer Assns are also lending their voice to these initiatives.</p>
<p>As a country, we will benefit most if we move forward on as many areas as reasonable to get the most benefit in the shortest time. There are signs of movement, which is encouraging but we have a long ways to go.</p>
<p>Those people are the wealthy, who can afford not only the care, but the travel. For state-of-the-art care for acute or chronic illness, as far as I know, no one does it better than the US – for those who can get it. The problem is, that level of care is not accessible to all Americans. If you’re rich enough or lucky enough to have great insurance, fine. If not, you’re out of luck. </p>
<p>Every country rations health care. Some ration it based on medical considerations. We ration it on based on ability to pay. Is that really better?</p>
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<p>I bolded “willing to let” because that’s exactly the problem (as you recognize, HImom). The insurers and HMOs have all the power. What if they’re not willing to let? The patient has little recourse. Our health and lives are in the hands of corporate giants who have a first duty to make money for their shareholders.</p>
<p>Himom, it’s questionable if tobacco is bad from a purely economic standpoint. Tobacco typically doesn’t make people unproductive while they’re working, and keeps the years of retirement low. If people don’t smoke there’s nothing to say that they won’t rack up a lot of bills in the last few years of life - it’s just that it will be later (more SS and years of medical care) and less likely to be lung CA . What I’m saying is these arguments aren’t all good or bad - everything with a plus comes with baggage.</p>
<p>Thank you to everyone on this thread for the thoughtful, intelligent, civil discussion. All the posts have contributed to my learning.</p>
<p>I don’t think it is surprising that people would flock to Sloan-Kettering, M.D. Anderson, Mayo Clinic or places of that caliber from anywhere in the world.</p>
<p>People do not flock to Podunk, Arkansas, or thousands of other places in the United States where most of us get our medical treatment. If we can afford it.</p>
<p>I don’t think there is anything wrong with concierge treatment. But it doesn’t qualify as noble, which is how I would describe doctors who dedicate their lives to treating everyone who needs it. I think physicians should make a lot of money. They deserve every penny. Let’s take the profit out of the paper-shuffling and gatekeeping (insurance) and put that into paying the health care providers (which also includes nurses, therapists and lots of other cool people).</p>
<p>The people I know who are at Sloan coming from all over the world are not necessarily wealthy. Many have gotten there through determination and fund raisers. I believe Canadians can get their national insurance to pay for treatments here in the US that are not offered in Canada. I know a number of such famililes. </p>
<p>We don’t really ration our health care by ability to pay. Those at the bottom end of the spectrum get health care through Medicaid. There appears to be a hole in our system where one can make too much for Medicaid, but not enough to pay for a private policy when they do not work for a company that provides care. Also many are underinsured or have restrictions that their insurance puts on the type of care they can have. We have a crazy patchwork system that I’ve yet to understand. </p>
<p>If you have a truly unusual condition, you are in the best place in the world. The same if you are willing to do the work and research to get the care. But the government systems provide over all more consistent and easy care for more people. I’d like to see that overlay on our current system. </p>
<p>Actually the US has become Canada’s concierge system is what the head of the company where H works says.</p>
<p>That’s an excellent refinement of what I said. Unfortunately, there are an awful lot of people in that hole, most of them middle-class working people who really have no good options for decent, affordable insurance.</p>
<p>Excuse me, but COPD (chronic obstructive pulmonary disease) which includes emphysema and chronic bronchitis is the SECOND leading cause of DISABILITY in the US and 3rd leading cause of death. How does that not have an econonmic impact? COPD is only ONE of the many preventable conditions caused by tobacco. Heart disease, stroke, diabetes, kidney disease, and many cancers are also directly attributed to tobacco use. Tobacco has a HUGE economic cost to our society in terms of medical costs and lost productivity & wages–the patient and those who may have to provide care.</p>
<p>There are not great treatments for most of these conditions that are lifelong and progressive, if not quickly fatal. The treatments generally require lifetime medications and sometimes surgical interventions.</p>
<p>“If the American system is so poor, why do people come from around the world to receive treatment?”</p>
<p>This is not as true as it used to be. In fact, heart patients from Arab countries (and the wealthy of Africa) are now more likely to go to India.</p>
<p>The principals of my publishing house, in Canada, have been ill. One with Parkinsons, one with incipient MS. They have NO waits, first class treatment coordinated between allopathic and natural approaches, all paid for by Canadian health, and wouldn’t dream of coming to the U.S. for treatment. </p>
<p>And the reality is that, when given the choice (we had employees in both the U.S. and Canada), many of the employees would have moved to Canada because of the health care, and NONE of the Canadians, presented with the same opportunity, would move here.</p>
<p>Of course, there are problems with the Canadian system. Since they pay only about half what we do, a little bit more in the way of funding would go a very long way.</p>
<p>I think that the best high-end healthcare is in the US for those that can access it. But I’m willing to be convinced in the other direction if there’s some research that shows it.</p>
<p>“And what percentage of Indians have access to the medical care comparable to that in the US?”</p>
<p>Multiple tier, as in U.S. My sister works in the neonatology unit in the 2nd largest public hospital in Tamil Nadu, and is brought into lecture at Oxford, Johns Hopkins, etc. on cutting edge infant care. (Since there are more births in her hospital than in the entire state of Washington annually, she sees many, many more cases, and hence the possibilities for leading edge work are greater.) All of her services are free. </p>
<p>The leading heart specialists in India make a very, very good living.</p>