I don’t understand, if such a large majority of people disagree with what congress is doing, WHO THE FUCK KEEPS VOTING FOR THEM??
Great article from physician and cancer patient. He should know…
Koffman: A Prescription For Life Or Death?
Washington Times (online)
Dr. Brian Koffman
March 17, 2010
Note: Public Affairs is reaching out to the publication to provide Access Solution information.
The ongoing health care debate is of more than academic interest to me.
It is not an exaggeration to say that if I still lived where I was born, in Ontario, I could be dead.
As a board-certified family-medicine doctor, educator, dual citizen of Canada and the United States, and a patient with a dangerous blood cancer, I have seen medical care from both sides of the examining table and both sides of the border.
I am fiercely proud of Canada, the country of my birth. I am forever grateful and in debt for my world-class education as a medical doctor at McGill University in Montreal, Quebec.
But I cannot return to Ontario, where I started my medical career, until I am convincingly cured of my own medical problem, an aggressive form of chronic lymphocytic leukemia (CLL). I must happily stay in California, my adopted and beloved home for the past 30 years.
I just can’t take the chance with my health.
The drug that saved my life, rituximab, is very expensive (thousands of dollars per cycle on either side of the border, but admittedly more in the United States) and is not covered by the provincial health insurance plans in much of Canada, despite large, well-designed studies that have proved clearly that it is the critical piece of the only treatment known to extend life with my type of leukemia. In my case, I developed a bleeding complication and without rituximab as part of my therapy regime, my status was, as we doctors are wont to say, “guarded.”
Because rituximab is paid for in only some Canadian provinces, it has created what Bill Hryniuk, past chairman of the Cancer Advocacy Coalition of Canada, has called a “postal-code lottery for cancer drugs.” Live in a province that covers the medication, and you get state-of-the-art treatment. Live elsewhere, and your care is clearly inferior. That is just the truth.
I would love to see universal health care coverage. It is the compassionate and moral thing, but it is only fair to point out the negative effects of the economic realities that universal care would impose.
It comes down to whom you cover versus what you cover.
You must make those hard decisions in a world of limited resources. To think otherwise is naive. Universal coverage courageously extends its umbrella to all the population, but shouldn’t it also cover all proven therapies? Canada’s situation proves you can’t do both, and lives are lost as a result. Give us universal care, and we will all be covered, but all that coverage had better be cost-effective. What care is good enough, and what is too expensive? What is your life worth? Don’t delude yourself. Someone will be deciding, for you, sooner or later.
Cutting expensive care seems very sensible until you or a loved one is the one in need.
Those who speak of savings from preventive care have not studied the history of the roll-out of universal care around the world. It doesn’t happen. Very soon, rationing care will be part the equation, with decisions made by distant committees that examine not the patient, but the bottom line. I left my practice in Canada because there was always a powerful, if unseen, third person in the consultation room, the government, telling me what I could and could not order.
True, insurance companies are already doing this, but they are regulated and must extend the best possible standard of care. To whom will you appeal when the government health care bureaucracy says no? I like the present checks and balances that insurance competition and government oversight offer.
There are two other concerns that are close to the heart of anyone like me with an “incurable” disorder looking for a better future yet to be invented.
The United States spends an estimated 5.6 percent of its total health expenditures on biomedical research, more than any other country, and $2 out of every $3 is put up by industry. With the government running the show, this, too, surely would decrease as the profit incentive is curtailed.
As big pharmaceutical companies, admittedly not always the best citizens, become the scapegoats for high cost and increasingly are squeezed, who will make good on their contributions to research and development? Without more research and development, most people with my cancer and many with other diseases remain incurable.
Then there is the brain drain - what some have called the “Gretzky effect” - in which the best and brightest from Canada and elsewhere head to the United States.
“Of eight Canadian babies who were born around the same time I was and who went on to win Nobel Prizes, seven of them did their prize-winning work in the U.S.” says Richard Taylor, an Alberta-born physicist and Nobel laureate at California’s Stanford University. Would this continue when our research budgets are cut?
My main point remains that you don’t get something for nothing. More coverage for some means less for others. Less profit means less research. That is an inalienable but often forgotten part of the health care debate that matters to me as a doctor and as a patient on a life-and-death basis.
As the United States moves toward the clear benefits of universal health care, I need to point out the enormous risks.
[quote]kneedragger79 wrote:
I think Chris Rock said it best, ‘the American drug companies are nothing but a fancy drug dealer. They can’t cure shit. The same diseases are around that have been here for 50 years. What was the last thing ‘they’ cured? P o l i o!?’ I just thought it was funny ; )
I work for pharma. I see the patients we impact - some with cancer and life threatening disease. Until you’re battling these diseases, it’s easy to rail against these companies like Chris Rock.
[quote]Tancredi wrote:
[quote]cord13 wrote:
exactly. health insurance is a business, which means their goal is to make money. If you can’t afford health insurance you can pay full price for your doctor visits. if you can’t afford the doctor, you can just tough it out next time you get the sniffles.[/quote]
My father worked for an american company for 30 years, paid into his insurance every single one of those years. He worked his way up from the line into management.
Then one day the company was brought, sold, and he was downsized since he was getting pretty close to retirement, and they didn’t want to pay.
My mother started working for wal-mart when my father went back to school at the age of 57. They paid their cobra until it ran out, and started on a partial insurance offered by walmart for the first 6 months of employment. During those first 6 months the coverage was limited to oh-so many dollars, I don’t remember how much.
My brother broke his leg in 5 places wrestling for 1st place in the district meet for the state championship. They covered it, but only after much haggling and nearly exhausting the limit. A lot of rehab care was left out due to cost. Can’t really tough out a leg broken in 5 places. Thank god this didn’t stop him and now he is a E-7 in the army, despite having a leg 1 inch shorter than the other.
A couple months later my father had a clot discovered in his heart, that threatened to come loose any minute and kill him. Emergency quintuple bypass surgry was necessary. Not much coverage was left, but we decided since we love him we’ll do what we can and thank god we had great credit and. . . .charged half of it on a visa, and had the hospital bill us the rest. It was difficult, but they still have the house, thank god. And he finished school, and found a new job at 59. Can’t tough out these sniffles.
As for me, I’m a medical clusterfuck in the eyes of the insurance companies and hence uninsurable. I’m perfectly physically and mentally healthy but my history won’t let me buy anything affordable. But I can’t let my coverage lest I literally loose one of my senses completely, my hearing. I speak and hear and loosing my hearing would be suicide for my social life and for my job.
I’ve come close to getting good group insurance via my jobs in industrial maintenance and drafting at a engineering firm, but both times buisness slowed down. I’m on pernament call at the engineering place. I now receive SSI and Medicare and deliver pizza the maximum I can without loosing benefits. I hate it. But I can’t simply tough out not hearing for a period of time-my ablitiy to get a job would be comprimised.
So you loose a little bit of freedom when the government takes over health care. I don’t give a rats ass about that and fail to see why I should. I and my family have been extremely lucky to get any care at all. A few $$ in the bank saved my dad, and despite doing everything “right” barely got the care he needed.
Fuck privately run insurance companies. I’ll take my chances with obamacare.[/quote]
Maybe you should ask yourself why there are so few options, why insurance is tied to employment, and why healthcare is so expensive. Or just say fuckit, too hard to think about the underlying problems, let’s let someone else pay for it.
[quote]saveski wrote:
Another thing .gov is gonna fuck up royally.
For all those (shitheads) that support this socialist feel-good nonsense, do you know what I, as an employer of 60 people will likely do when they force their utopian health plan on my business? Raise my prices and fire people. Then I’ll have to pay more for unemployment for all the clowns that can actually work but are too fucking lazy to find a job. (And yes, there are jobs out there - it’s just so much easier to just get unemployment!) These are the unintended consequences of the Democrap’s plans and their answer is always, as Ayn Rand perfectly stated, to drink more of the poison that’s killing them.
Do I sound bitter? Yeah - I’m a small business owner! I’m the animal that the human parasites attach themselves to.
And don’t give me any shit about a “right” to health care, you have a “right” to health care just like you have a right to a fuckin’ Ferrari. In this country, it used to be that if you wanted something, you had to pay for it. Now, Uncle Sam just fills the trough with barely edible shit that has a nice name and all the parasites dive in and then demand more.
DC can start worrying about health care after I can walk the streets of Detroit safely. I have very little hope for this country and our society.
[/quote]
Couldn’t agree more. Obama is pushing a Socialist economy and everyone is screaming NO. It’s STTTUUUUPPPIIIIDDDDD… China accepted an albeit heavily surveillanced “Capitalism” and people are flourishing, businessmen and common man alike! Even a COMMUNIST COUNTRY accepts a semi capitalist economy. Obama is a team killing fucktard. My 2 cents.
[quote]StrongSurvive wrote:
China accepted an albeit heavily surveillanced “Capitalism” and people are flourishing, businessmen and common man alike! Even a COMMUNIST COUNTRY accepts a semi capitalist economy. Obama is a team killing fucktard. My 2 cents.[/quote]
LOL do you know what you’re saying? You’ve been watching too much Hannity and Glen Beck man. America is by far the most capitalist country on the planet. China is flourishing because they are finally figuring out how to use 1.3+ billion people.
Surveillanced capitalism? Dude… c’mon.
/Throw this out if you were trying to be sarcastic
[quote]Gettnitdone wrote:
[quote]StrongSurvive wrote:
China accepted an albeit heavily surveillanced “Capitalism” and people are flourishing, businessmen and common man alike! Even a COMMUNIST COUNTRY accepts a semi capitalist economy. Obama is a team killing fucktard. My 2 cents.[/quote]
LOL do you know what you’re saying? You’ve been watching too much Hannity and Glen Beck man. America is by far the most capitalist country on the planet. [/quote]
Do I have to post the ranking of the Heritage Foundation?
Again?
Well, here we go:
http://www.heritage.org/index/ranking.aspx
The US is numbert 8 right now.
[quote]orion wrote:
Do I have to post the ranking of the Heritage Foundation?
Again?
Well, here we go:
http://www.heritage.org/index/ranking.aspx
The US is numbert 8 right now.[/quote]
Ok but that ranking is misleading. Singapore and Hong Kong are probably the most information oriented countries in the world. They dont have any natural resources, all their businesses are in the service sector. They are small markets and thus it is easy for them to have such unregulated economics.
I live in New Zealand. New Zealand is hardly a capitalist country. We have social welfare and interest free student loans and the whole government thing going on. They are thinking about raising GST (tax on consumable goods) and lowering income taxes and raising welfare. Most people like the balance though. Obviously because we are such a small economy that is growing at low rates our politicians have hummed down on regulations presumably to try and stimulate economic growth. In other words they want people to start investing in our financial markets. Also, Australia and New Zealand generate a large major part of revenue from trade.
Funny how canada is above the USA though and a lot of people give them shit for having govt healthcare.
Rituximab was banned due to dangerous side effects, some provinces allow people to take it as long as they are made aware of possible sides, but others don’t allow dangerous drugs to be used at all (ie Ontario).
http://www.healthyontario.com/DrugDetails.aspx?brand_id=1439&brand_name=Rituxan
Secondly their is an appeal process, where if he could prove both safety and efficacy of said drug, than he could get funding for it. That article is a bit off imo…
[quote]PAINTRAINDave wrote:
Rituximab was banned due to dangerous side effects, some provinces allow people to take it as long as they are made aware of possible sides, but others don’t allow dangerous drugs to be used at all (ie Ontario).
http://www.healthyontario.com/DrugDetails.aspx?brand_id=1439&brand_name=Rituxan
Secondly their is an appeal process, where if he could prove both safety and efficacy of said drug, than he could get funding for it. That article is a bit off imo…[/quote]
This guy was about to die.
Prove the safety?
WTF?
[quote]orion wrote:
[quote]PAINTRAINDave wrote:
Rituximab was banned due to dangerous side effects, some provinces allow people to take it as long as they are made aware of possible sides, but others don’t allow dangerous drugs to be used at all (ie Ontario).
http://www.healthyontario.com/DrugDetails.aspx?brand_id=1439&brand_name=Rituxan
Secondly their is an appeal process, where if he could prove both safety and efficacy of said drug, than he could get funding for it. That article is a bit off imo…[/quote]
This guy was about to die.
Prove the safety?
WTF?
[/quote]
Fortunately, both Ontario Dave and the doctor-author are wrong. Unfortunately as well, they are both wrong.
Rituximab has been approved as both safe and effective by both the US FDA and its Canadian equivalent.
In fact, this month it was specifically approved for CLL in combination with a more toxic therapy.
It has rather minor side effects when one considers the alternative treatments. Trust me on this one.
It is a standard treatment on both sides of the border
The afflicted doctor does not have an immediate life threatening disease, nor is rituximab curative for it.
So if Ontario has disallowed i for CLL, it has done so on the basis of some back-room cost-benefit analysis. Some nameless bureaucrats have decided that technology more appropriate to the 1990s is to preferred, without regard to the very real side-effects of chemotherapy for CLL.
Of course, an Ontarian can “appeal” the decision, but it may take 6 months, by which time most oncology questions have been “more naturally” decided
Now then, rituximab costs about US$4000 per dose, wholesale. As a single agent most patients would receive 4 doses and be done. The Canadian government has contracted with Biogen-Idec; wholesalers can purchase it at a 25% discount. And guess what? The US government forbids doctors to re-import the drug, which is manufactured in California.
As you say, “WTF?”
–
Erratum: Biogen-Idec, not Genentech, manufactures rituximab.
[quote]DrSkeptix wrote:
The afflicted doctor does not have an immediate life threatening disease, nor is rituximab curative for it.
[/quote]
Obviously a “back-room bureaucrat” death council has sentenced this man to death. wtf??
There are still serious doubt about BOTH the safety and the efficacy of this drug.
But hey? what the fuck would I know, being a brainwashed socialist.
[quote]PAINTRAINDave wrote:
[quote]DrSkeptix wrote:
The afflicted doctor does not have an immediate life threatening disease, nor is rituximab curative for it.
[/quote]
Obviously a “back-room bureaucrat” death council has sentenced this man to death. wtf??
There are still serious doubt about BOTH the safety and the efficacy of this drug.
But hey? what the fuck would I know, being a brainwashed socialist.
[/quote]
If you want to debate DrSceptic on the safety of cancer treatments, by all means, go for it!
[quote]pushharder wrote:
[quote]Tancredi wrote:
[quote]pushharder wrote:
[quote]Tancredi wrote:
…So you loose quote[/quote] a little bit of freedom when the government takes over health care. I don’t give a rats ass about that and fail to see why I should…[/quote]
“Those who desire to give up freedom in order to gain security will not have, nor do they deserve, either one.”
Benjamin Fucking Franklin
Tancredi my friend, you are a looser (sic). Stay on your knees, you look comfortable there.[/quote]
Push, I don’t ask for your sympathy. Have sympathy for yourself for there may come a day that you, too, find yourself in the gutter.[/quote]
Sympathy is not a factor here.[quote]
My family plays by the rules. I play by the rules to the hilt. The rules fucking failed for my family, for myself (to a degree) and for countless tens of millions of hard-working americans. Is it not reasonable to change them when they have so clearly failed?[/quote]
More government, more intrusiveness, less freedom with more security, is never the answer. It is a gold bricked pathway to serfdom.[quote]
Sticking your head in the sand will not save you. [/quote]
Which is precisely what you have resigned yourself to do. By your own admission.[quote]
You are not rich, unless you happen to be on the scale of Tim Patterson, and can still ‘loose’.[/quote]
What does he have to do with it? Do you resent him for being successful? Do you “deserve” a chunk of his wealth? If so and it appears to be the case, you should indeed lobby the royalty you have placed over yourself to coercively take Patterson’s money from him and “redistribute” it to you and others in your situation.
Or you COULD move to Cuba. EVERYONE is covered there and it is utopia from what I hear. (It’s only 90 miles from Key West, easy to get to, bud)[quote]
Do you really think you’re invincable? [/quote]
The perception of invincibility is not a factor here.[quote]
Push, I’d wonder why you seem to think you’re John Galt or something. You and I are still just another corpse at the end of the day. [/quote]
In that case one of us will have lived the life of a free man and the other that of a slave.
[/quote]
Push, does government even have a purpose in your eyes? Just curious.
And no, I do not resent Tim Patterson or wealthy folks in general. I don’t even know him, and wish him well. I only brought him up because it is quite likely he posseses more wealth than anyone else on these boards and to illuminate two things: People in his wealth percentile (if my assumption about his wealth is correct) rarely need to be concerned about coverage, and there are very few people in that percentile. Everyone else is “at risk” when it comes to healthcare. I regret using his name simply out of respect for him, and it was a mistake on my part.
And is it slavery when the government uses taxes for all sorts of things, like parks, major infrastructure, the US Army Corps of Engineers, etc? This attitude seems alarmist when applied to a mild reform of the health system.
I do think this reform plan is flawed, especially when it comes to smaller companies.
You seem to think the sole purpose of government is to steal. Is this correct?
[quote]Brother Chris wrote:
[quote]Tancredi wrote:
[quote]cord13 wrote:
exactly. health insurance is a business, which means their goal is to make money. If you can’t afford health insurance you can pay full price for your doctor visits. if you can’t afford the doctor, you can just tough it out next time you get the sniffles.[/quote]
quote]
So looking at now and fifty years ago. Fifty years ago hospital bills were cheaper, insurance was cheaper, there was less stress when getting procedures that needed to be done because they did not cost a lot. However, compared to now people cannot pay for most things out of pocket, insurance cost more, and the stress related with going to the hospital is much higher.
So the difference between now and insurance fifty years ago, is fifty years ago insurance was rarely regulated, it now has a ‘little regulation’ which in fact does not. It has a lot of regulation, and it has become more expensive over the years. So you say you want ObamaCare, I think you should rethink that.[/quote]
HMO’s started coming into existance just around 60 years ago with Kaiser. This was good at the time for several reasons-employment was damned near 100%, America had no economic competitors and collective bargining with the HMOs ensured good quality care. Unemployment is probably closer to 30% rather than 10% today, there is massive economic competition (a lot of it with countries that already have universal healthcare) and less and less americans get their healthcare as a group. Regulation is far from the only factor.
Deregulation does not always mean lower prices-electrical prices skyrocketed when california deregulated part of its system. The same happened in various parts of the country with gas and eletric deregulation. Yes, healthcare is a hell of a lot more complicated than that example, I admit.
*edited regulation deregulation whoops
[quote]Brother Chris wrote:
[quote]Tancredi wrote:
[quote]bigflamer wrote:
“A government big enough to give you everything you want, is strong enough to take everything you have”. ~Thomas Jefferson[/quote]
They’re already big enough for that. And they already give everything corporations and a certain class want. What solution do you have then?[/quote]
What are these classes and where is your empirical evidence to show these different classes? I think you mean they already give everything ‘certain’ corporations and certain ‘individuals’ want. Don’t be ignorant. [/quote]
Not so much certain corporations and individuals but classes of people and multinationals. Do I really need to prove that stuff like income inequity has radically increased compared to other nations of our economic weight class? Or find proof that Bush cut taxes?
[quote]orion wrote:
[quote]PAINTRAINDave wrote:
Rituximab was banned due to dangerous side effects, some provinces allow people to take it as long as they are made aware of possible sides, but others don’t allow dangerous drugs to be used at all (ie Ontario).
http://www.healthyontario.com/DrugDetails.aspx?brand_id=1439&brand_name=Rituxan
Secondly their is an appeal process, where if he could prove both safety and efficacy of said drug, than he could get funding for it. That article is a bit off imo…[/quote]
This guy was about to die.
Prove the safety?
WTF?
[/quote]
On the flip side insurance will often refuse to cover “experimental” treatments when they are clearly past that stage. . . .
and their officials will sometimes do anything to weasel out of their legally obliged coverage when the treatment is not experimental.
[quote]PAINTRAINDave wrote:
[quote]DrSkeptix wrote:
The afflicted doctor does not have an immediate life threatening disease, nor is rituximab curative for it.
[/quote]
Obviously a “back-room bureaucrat” death council has sentenced this man to death. wtf??
There are still serious doubt about BOTH the safety and the efficacy of this drug.
But hey? what the fuck would I know, being a brainwashed socialist.
[/quote]
There are no more doubts as to efficacy and safety of this agent–they are well published in over 14 years of publications–than for any cancer treatment. Truth be known, I was among many principal investigators for it, and I treated the first patients with monoclonal antibodies 14 years before that.
But that is not the point. I do not know how the author should be treated. But I would trust his physicians to decide with him, rather than trust some empowered functionary residing in a cubicle in Hamilton, Ontario.
Now Dave, if you have any questions, you can call my friend Joe Connors, in Vancouver, B.C., who wrote the rules and guidelines for the B.C. Cancer Control Agency. He may have more insights about working in and around Canadian health care than I would ever want.