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Thursday, September 6, 2012

The Real Story - Canadian Healthcare

This is a re-posting of two related posts from The Real Story.  An awesome blog. It quite accurately describes the reality of the Canadian healthcare system. My experiences with both the Canadian and US systems, for different reasons, are much similar to these. The healthcare system has always been there when me or my loved ones needed it. I come from a family that has known real poverty and we never had to worry about not affording medical help when we needed it. They call the US system "patient-centred" when actually it is insurance company centred and far more expensive than ours for far less benefit to far fewer people. We get the patient what is needed as soon as realistically possible. No one is intentionally refused emergency or vital care.

The Koch brothers lie about Canadian healthcare

Loma Linda Hospital

The Koch brothers are spending $6million on a new anti-Obama ad; an ad featuring a Canadian woman from Ontario.

Shona Holmes claims our medicare system blocked her from getting the immediate treatment she needed to prevent her from dying from a brain tumour.  She mortgaged her home to buy life saving treatment at a Mayo Clinic in the US.

Except she never had a brain tumour.  She had a benign cyst on her pituitary gland.  Very serious, but not life threatening and treatable in the time period planned in Ontario.

I completely get the fear one goes through when you get told you have a tumour on or near the brain.  I do have a brain tumour and have come close to dying more than once.

My tumour is actually a brain stem tumour that has spread throughout the area around my brain stem, around my throat, below my nose, on my spinal chord and flopping around next to my carotid artery.

It will probably kill me, not now, but someday. But more importantly, I’m alive because of our medicare system.

Friends I made during treatment in the States didn’t have Canada’s options.  They died.  Let me tell you about that.

In 2002 I had a tennis ball sized tumour excised from my nasopharyngeal cavity.  The surgery saved my life but wasn’t enough to keep me alive.  Scalpels couldn’t get every microscopic chunk of tumour so the next step was radiation.

The problem with radiation around the brain is that it kills the good with the bad – you can decide for yourself which is which.  So I needed something precise with a record of effectiveness.  In my case that meant proton radiation.

Proton radiation isn’t available in Canada.  At the time there were four sites in the US that offered it and I was referred within two weeks to Loma Linda hospital, just off the number 10, half way between LA and Palm Springs.

All it took was a letter from my radiologist to MSP reviewing my condition and very limited treatment options.  The full expenditure was immediately approved and I was on my way to Loma Linda.

I spent three months there at the out patient clinic buried deep underground with it’s concrete walls a metre thick.  Proton radiation requires an atom splitter and Loma Linda had a big track underground that created the velocity to smash atoms and send a single proton ray down a tube and out a gun into my head.

It was right out of DC comics.  Lex Luthor was probably sitting alone in some white office behind the thick walls, laughing at us.

Five days a week I’d go in for my treatment, strapped down on a metal bed with a mask molded to my face, keeping my head still as the proton gun pumped the rays into it.

Like some crazy asylum, the waiting room was full of patients.  Most were there for one of two reasons – brain tumours or prostate cancer.  The prostate guys were generally older, richer white men who could afford to pay for the best, optional treatment for prostate cancer.  They gathered around the TV and watched Fox news.

The others were regular folks with brain tumours and HMO funding.

There was a free phone in the waiting room and there was always a line for it.  At the end of the line was a patient on the line, often to their HMO talking about funding.

I made friends there with a woman from Texas with a lousy husband, kids and her own promising career.  Except, like me, she had a chordoma.

The treatment for chordoma was 8-10 weeks of proton radiation, give or take a few days.  It cost somewhere between $100 and $200 thousand and most HMO’s didn’t want to cover it.  My friend was no exception.  So several times a week she’d get on the phone to plead with her insurer to pay for another week of treatment.

She didn’t complete the treatment.  And she stopped answering my emails a year later.  She was dead.
I met a very funny guy from the South with some kind of cancer of the scalp.  He didn’t complete.  He’s dead.

I was asked to talk with a young guy who didn’t have the money to get a proper diagnosis until too late.  So as the chordoma destroyed the vertebrae in his neck he saw a chiropractor who told him he was out of alignment.  For two years he was out of alignment.  Then in terrible pain he saw a real doctor.  He didn’t complete.  He’s also dead – late diagnosis, limited treatment.

There are problems with our system.  Waiting lists for painful but less catastrophic illnesses are often too long.

But in Canada there are no people at the end of a phone pleading for funding to continue life saving treatments.  People die in the States because they can’t afford treatment and their private plans won’t pay for it.

I’m at the BC Cancer Clinic a lot.  I see frustrated people.  I’m often frustrated.  But I don’t see people pleading for treatment they need but can’t afford.  None.  You can’t say that about the US.

People like me, living in Canada, have it so much better.

The medicare battle

Earlier this week, steaming mad, I wrote about the new Kock Bros. ad attacking Obama and his meek and mild Obamacare plan.  I think the ad is disingenuous, uses a proven unreliable narrator and is generally all round garbage.

More to the point it completely goes against my experience of the US private medical system.

My piece generated a lot of response and a huge number of reads.  And this comment.  It’s important and also first hand and, I also believe, mistaken.  So I want to look at it in more detail.  First the comment:

Proton Beam Therapy is the 21st Century cutting edge treatment for prostate cancer as well as many others Ian. I had a Radical Prostatectomy surgery for prostate cancer in Kamloops in 2001 which failed. In 2009 after eight years of being told not to seek further treatment but to focus on quality of life I contacted Loma Linda University Medical Center and was accepted as a patient. There were approx. 150 – 160 patients undergoing Proton Therapy at the James M. Slater Proton Center during the period I was there of which the vast majority was being treated for Prostate Cancer and on a few like yourself for brain cancer. Of this group I would say that there were about ten patients who were not US citizens and all but one of the US citizens was was covered by private health insurance. If you did not have insurance Loma Linda did the treatment for cost which was $37,000 US if you had a Social Insurance Number. For foreign nationals such as the Canadians and Australians I met there the cost was $70,000. The Canadian medicare system does not pay for this treatment because there are alternative cheaper radiation treatments available in Canada. The difference is with Proton Radiation the cure rate is higher without side effects such as impotence, incontinence, and bowel problems which are common in Canada. So in Canada we save on the front end by going cheap and then spend money on the side effects for the remainder of the patients life who has to undergo needless misery.

There are problems with the US healthcare system but there are greater problems with the Canadian medicare system. The Koch brothers commercial contain a lot more truth than this blog does about the state of the Canadian medicare system.

If you have a serious healthcare problem you have to be aware that treatment in Canada is inferior if you need cutting edge treatment. It does not usually exist in Canada and never will under Medicare. There is no use arguing about which system is better as we all have our own opinions but the fact that the author went to Loma Linda should give you a big hint. My advice is to get an insured line of credit on your house if possible and use in the case of a catastrophic medical condition or accident. The waiting lists are appalling in Canada and will never be remedied as long as the government prevents private insurers from selling insurance.

My neighbour waited five months after being diagnosed with brain cancer before receiving any treatment. He has since passed on.

First off, proton radiation is not “the cutting edge treatment for prostate cancer.”  Several studies have found no greater efficacy and more side effects for proton radiation therapy than Intensity Modulated Radiation therapy, another fairly new contender.

They do find that proton therapy is far more heavily marketed, probably because the cost of building a proton facility is so steep.

The most recent study was a comparative one from the University of North Carolina that found 34% less gastrointestinal side effects with IMRT than proton therapy.

IMRT is half the cost.  The cure rate was found to be the same as proton therapy

Should proton radiation be a paid treatment for prostate cancer in Canada?  Canada does offer the much cheaper and apparently as effective IMRT treatment.  There’s a facility at VGH, here in Vancouver dedicated to prostate patients.

But it’s not really the debate over which therapy is better and which should enjoy full medicare funding.  It’s who doesn’t have access.

That’s where this commenter leaves me.  He talks about the folks he met when he was at Loma Linda.  Almost all were insured.  But if you’re not insured you don’t get through the door.  That’s my point.
The poster notes that Loma Linda cuts the cost of treatment in half for uninsured patients.  Something tells me they’re still not breaking down the doors to pony up the $37 plus grand.

There are over 40 million uninsured people in the States, most poor without home equity to arrange a loan against.  Why don’t they count in the poster’s story?

I have one more point.  Often when you do get through the door, insurance in hand, you’re cut off.  The US system doesn’t even work for many insured patients and that hasn’t changed in the ten years since I was at Loma Linda.

Can we do better?  Of course.  Anyone can see that.  And I don’t take issue with the number of commenters on this article who point that out.  But remember our system delivers better health outcomes at half the cost, and to all citizens, regardless of income.

We could also do much worse than that.  And the poster’s preference for the US system of private care and private insurers would be a fast road to hell in a handbasket.