Daily Kos

Cancer MD: "Insurance co's. are evil, they want my patients to die"

Sat Apr 08, 2006 at 11:09:45 AM PDT

I have a friend, he is an oncologist. Oncologists treat people with cancer.

With each passing day, he is having more trouble getting insurance companies to pay for the medications he wants his patients to take. When he is not treating his patients, he is fighting with insurance companies.

Remember how it used to be? Remember when doctors made medical decisions? Not any more, dear friends.

I will be writing more about this doctor in the coming months, he has plenty he wants to tell me.

I was not surprised then, to see the latest horror story, Drug Plan's Side Effect Is Severe  about Medicare D in the New York Times this morning.

http://www.nytimes.com/...

You should not be surprised either.

You should be outraged though. You see, America is the richest country on the planet.

But,  be very clear about one thing: it was never the intention of Medicare D to help America's elderly. In a scathing essay in TruthOut, Robert Hayes explains why Medicare D is a failure--a program which will never work.

Picture this movie: It's 2003 in the wealthiest nation in the world and millions of Americans are suffering needlessly and dying prematurely because they cannot afford medicine.

    Employers have hiked up the cost of their retiree drug coverage and pharmaceutical companies have continued to drive up the prices of life-saving prescription drugs.

    Congress and the president know they must act or risk being run out of office. There is near-universal support to add prescription drug coverage to the nation's treasured Medicare program.

    So, two of the nation's most powerful economic interests, the drug and insurance industries, are invited up to Capitol Hill to collude with leaders of Congress to develop a prescription drug benefit - one that serves their interests.

Remember the shameful and thoroughly corrupt Medicare D legislation was passed under cover of darkness in the dead of night.

With no public oversight and with the press milling outside locked doors, the congressional junta drafts legislation locked arm in arm with the puppeteers that control the federal government.

    In a back room, they design a drug "benefit" that allows the pharmaceutical companies to further inflate the price of medications and reap billions of dollars in windfall profits. They promise tens of billions more in profits to health insurers to deliver this coverage.

    But there is a human cost - this $700 billion package is leaving millions of older and disabled Americans worse off and millions more of them still without drug coverage.

Now let's take a look at what the New York Times is reporting. How is all this corruption harming American citizens.

As a result of the new Medicare drug program, thousands of people who take pills to fight cancer have suddenly found themselves with new bills to pay for their essential medicines. Frances Blue is one of them.

Frances Blue, who has lung cancer, says she is without medicine because she cannot afford the new Medicare deductible.

Ms. Blue, a retired teacher, learned five years ago that she had lung cancer. In December, her doctor decided that her old medicine was not working and that her best bet would be the cancer drug Tarceva, a medication from Genentech that costs about $3,000 a month.

A few weeks later, on Jan. 1, the new Medicare Part D program, which is supposed to help provide prescription drug coverage for people like Ms. Blue, went into effect.

So, what happened to Ms. Blue? You say this legislation is benefiting who--American citizens or the pharmaceutical and insurance industries?

Ms. Blue says she cannot afford the $3,600 in annual co-payments that are required before her Part D insurance fully kicks in. And her income from her teacher's pension and Social Security disability payments, about $4,000 a month, is too high to qualify for charitable programs that help patients with drug co-payments.

Remember the famous "donut hole"?

But now that the oral cancer drugs are covered by Part D, they are bound by rules requiring Medicare enrollees to pay $3,600 in out-of-pocket costs each year.

Here's how Robert Hayes describes the reality for people like Ms. Blue and millions of Americans.

16 million Americans with Medicare-men and women age 65 and older and people with severe, long-term disabilities-still have no drug coverage. Just 7 million Americans who were uninsured before the drug program was launched are newly insured. Six million of the poorest and frailest Americans who lost Medicaid coverage on January 1 now have inferior, less-reliable drug coverage. And the anger and dissatisfaction of people who are enrolled in drug plans increases each day as they discover how inadequate and unreliable the benefit is.

    Coverage gaps, excessive out-of-pocket costs and routine denials of coverage for needed drugs are commonplace. Even enrollment in a private drug plan frequently leaves older Americans going without the medicines they need.

http://www.truthout.org/...

The same crooks who gave us Iraq, gave us Medicare D.

Nothing but lies. Nothing but deceit. Nothing but corruption.  

Tags: Medicare part d, health care, Recommended (all tags) :: Previous Tag Versions

Permalink | 152 comments

  •  Back in the day.... (15+ / 0-)

    in the 1960s, we found poverty as an issue.  People were hungry in America.  Elders couldn't afford medicine.  Now fewer people are hungry and more people can't afford healthcare.  We need to have a moving documentary with sick children and dying parents.  Americans can only respond to personal messages, not tables and charts.

    You shall know the truth, and the truth shall make you mad. Aldous Huxley

    by murrayewv on Sat Apr 08, 2006 at 11:17:17 AM PDT

      •  Web site for that (17+ / 0-)

        http://www.americansforhealthcare.or...

        Share Your Story

        Countless Americans are facing the growing problem of rising costs and failing quality in health care. Are you troubled by rising monthly costs? Do you confront health care choices that you never imagined? Have you heard of someone else's horrible experience? By sharing your story, you can help us reach the politicians and force them to face up to this important problem.

        Health Care Story: Dave Flowers, Illinois
        I own a pizzeria in Peoria called Mickie's Pizzeria where I have 25 employees. However, I am unable provide health insurance to my employees because I can't afford to pay the premiums.

        I haven't just seen the health care crisis, I've lived it. In 2002, I acquired a viral infection that almost collapsed my heart. I lost my job because I was unable to work full-time.

        I couldn't afford the COBRA rates because they were $1,000 a month for my family. It was frustrating and scary. I found a way to get them insurance but I couldn't afford it for myself. No insurance company will insure me as an individual because of my pre-existing condition.

        The health of my wife and two daughters is what I value most.  Nothing in life is more important. But I don't want this to happen to my employees or their families. Quality, affordable health care is a right and I am going to do everything I can to get coverage for all my employees.  No one should have to make the choice that I did.

      •  My mother is lucky (7+ / 0-)

        She just finished 6 mos of chemo and is currently in remission from stage 4 NOn Hodgkins Lymphoma. She is even luckier that her teaching retirement provided her with a backup insurance plan that has covered anything that Medicare did not. She does not have to select one of the new plans, in fact, her pharmacist advised her to just sit tight with the plan she has and she will be fine. In the past 10 years she has had rotator cuff surgery, two knee replacements, a mild stroke and now this cancer shit....all paid for, with a couple of minimal co-payments to see some specialists, and her prescriptions are covered at about 50% with her backup medical insurance. She is fortunate to be able to afford the other 50%.
        She knows how very lucky she is!

        It should be like this for all seniors.

        Politics is like driving...if you want to go backwards, choose R. If you want to move forward, choose D.

        by fireflynw on Sat Apr 08, 2006 at 01:59:49 PM PDT

        [ Parent ]

        •  I never thought I'd say this (5+ / 0-)

          Recommended by:
          sj, nyceve, 3goldens, Quotefiend, station wagon

          My mom died of cancer in the fall of 2004.  I am so glad we never had to deal with Part D.  Can you imagine dealing with terminal cancer and insurance problems too?  

          I was disabled myself for a while.  How can they expect you to figure out the ins and outs of insurance when you're sick?  But they do.  

          "Republicans are poor losers and worse winners." - My grandmother, sometime in the early 1960s

          by escapee on Sat Apr 08, 2006 at 04:02:13 PM PDT

          [ Parent ]

        •  My mother-in-law has that ... (0+ / 0-)

          and she's in India.  (She's still only stage 2, happily, so no imminent danger.)  No insurance.  Everyone in the family will chip in for her treatment, but it's going to be rough financially nevertheless.  I'm not sure they could do it at all without contributions from my husband and me, since our salaries are so much higher.

          People in this country who lack insurance are in the position of those in India who aren't lucky enough to have sent children to richer countries.  It's a tragedy.  

          I'm glad your Mom made it to remission.

        •  Part of the problem (1+ / 0-)

          Recommended by:
          Buckeye BattleCry

          I lurk on another board that is concerned with financial stuff. Many posters are obviously in high-paying positions based on their comments about number of properties they own, etc. I'd say they are more in the 28-38 age group.

          I think when they hear about these impossibly high health costs, they just figure, "Well, too bad. It's their fault, and they are old, anyway." In your twenties and thirties, your eighties look to be pretty far away. And besides, you are healthy and belong to a health club and eat the best food.

          I think most adult children have been around an elder or two who rattles off all their ailments, and all their medications and surgeries. When it is just stated as fact, and not as the only topic of conversation, I think most of us past forty are probably willing to listen to our folks, and look to find ways to ease their difficulties if we can.

          My guess is, when younger professionals hear this stuff, it's like hearing people from some third world country. Who in the world wants to go on after  two cancers and a heart attack? Why do they still want to live? Can't they see how much money (inheritance) this is chewing up? Too bad, and all that, but get real. If it happened to ME, I would just end it all...

          Of course we have the exercise-addicted president who likes to imply that following a healthy regimen will prevent any health problems, and that we ought to take responsibility for our own health. Trouble is, many of the people who fought WWII, who participated in the tremendous growth of this country in the boom years can't just go back now and  keep from injuring a back or catching high blood pressure before it becomes a serious health problem.
          All they can do is what they can manage, now.

          Most everybody can feel some sympathy for a cute child with a serious illness. Once they start to get older, though, they're just another sick person that  we don't really want to think about. Being sick is like being poor. Many people are uncomfortable with thoughts of illness and weakness and mortality.

          We need some way to make the health of our citizens everybody's business. The program that tells real stories is a good idea, but is it enough to tweak the conscience of young go-getters climbing the ladder to success? As long as they see universal health as a drag on their personal wealth-building capability, they are not going to want to support it.

          Finally, my apologies to the many many under forties on kos who don't fit the same profile I described here. I know there are plenty of younger Americans who care what happens to older Americans. I just don't see it too often on message boards that focus on building capital.

        •  My mom, too (0+ / 0-)

          Last year, my mother was diagnosed with breast cancer.  She's in her 70's.  She was very lucky.  It was caught as a tumor in it's earliest stages.  She was treated with radiation therapy for 6 weeks.  It's been a year and I can report she is still cancer-free.  She also had insurance to back up Medicare.  Fortunately.  But my parents weren't so fortunate as far as my dad was concerned.

          My dad died in 2001 after battling lung cancer for seven years.  I truly believe it was his own will that kept him battling for all those years after all he'd been through.  The insurance company they'd paid so much into, of course, let them down.  They covered just so many of his chemo treatments.  And only just so many of his prescriptions.  Five years after his death, my mom is still paying off credit card bills because my dad used his cards to get medication or pay bills he had no other way to pay for.  He was on a fixed income because his illness forced him into retirement early.  Mind you, my mom is on a fixed income now.  But this wasn't the end of the story.  I recently found out something about my dad's care that I didn't know, thanks to a medical crisis that struck my pet cat.

          About three weeks ago, a pet cat of mine became ill and I had to rush her to a vet hospital.  After a couple of days in hospital, she took a bad turn.  I was faced with a decision.  To have her put to sleep now, or give her more time to recover.  Plus, I was faced with a rising bill.  While faced with this dilemma I talked to my mom about what to do. During the conversation, my mom told me something about my dad.  In the earliest months after he was diagnosed with cancer, his oncologist told him that there was a medication that would help him.  It was just what he needed to help his cancer.  But my parents couldn't afford it.  In the last few weeks, this thought has popped up again and again in my mind.  They couldn't afford it.  So I'm left to wonder--would my father be alive today if their insurance covered it?  It's a thought that does not bear up under close examination without bringing up a lot of hurt.  To help my dad, my parents did everything they could and then some.  If they couldn't get this medicine, it must have been way beyond them.  My parents became casualties in the war on the middle class by the insurance companies.  

          Btw, if you have a pet or pets, I'd recommend getting health insurance for them, too.  I now wish I hadn't waited to long to do it.  My cat was hospitalized for eight days.  After initial improvements, her health took a bad turn and she died.  Now I have a big vet bill to pay off and it will not be easy for me.  At least pet health insurance would've offset some portion of the cost.  If you think a young, indoor cat can't become gravely ill, believe me, it can happen.  The burden can be as much as a human illness.  It helps to be prepared.  If, you can afford it.  It hurts me to finally, fully realize that who lives and who dies, human or animal, depends on how much money is in your bank account.              
                 

          i'm tired of these mutha f*ckin' snakes in this mutha f*ckin' White House!

          by trinityX127 on Sat Apr 08, 2006 at 09:11:20 PM PDT

          [ Parent ]

    •  We don't need 'moving documentaries' to reach (6+ / 0-)

      people with this problem, it's staring them in the face every time they get a call from a parent saying "I can't afford my medicine, can you help?" This problem is so pervasive throughout the country that everyone knows or has in their family someone without coverage, or with such high co-pays they can't afford to get the  needed medication. What we need to do is mobilize those people to the voting booths come November, and get in a Congress that will restructure Medicaid so that it is affordable for the elderly and doesn't dump millions, if not billions, of dollars in the pockets of the drug and insurance companies.

      And as for fewer people being hungry, what country are you living in?? At minimum wage jobs, even with overtime, many people can't afford to feed their families properly. I know several families where second helpings are a thing of the past. And the only time they get a really good meal is when their vegetable gardens are in top production. They also can out of the garden. They are lucky to live in FL where the growing season is much longer, and for some things, year round. If they lived up north, their kids would be going hungry a lot of the time.

      This administration has not only bankrupted the country, but has reduced many American families to rationing food so they have enough to get through the week. This is outrageous, and things must change. And soon.

      What happens when Bush takes Viagra? he gets taller. Robin Williams

      by Demfem on Sat Apr 08, 2006 at 01:34:11 PM PDT

      [ Parent ]

  •  nyceve (31+ / 0-)

    This is a very important and timely diary and thanks for putting this out there.  I have a friend who is battling ovarian cancer and she has just discovered that the PET scan, which is a much better tool for determining if the cancer has re-seeded itself after a remission, will now no longer be paid for by Medicare.  A CT scan will be paid for which is much less accurate than the PET scan.  I don't know who is making these decisions, but it is outrageous.  I've alerted my friend to this diary--maybe she'll get a chance to read and comment as well.

    •  Meant to add (16+ / 0-)

      that my friend also faces the fear that a med used for chemotherapy that she and her oncologist feel is the best one for her, will not be covered by Medicare OR her private insurance plan.  That cancer patients must battle not just the disease but nameless, faceless bureaucrats in order to get the treatment they need is despicable.

      •  I plan a diary on the conflicts between . . . (7+ / 0-)

        the medications that oncologists administer intravenously in their offices and the medication administered orally which I gather are much more expensive.

        Here's the catch which I am currently researching. The intravenous medications are reimbursed at a higher rate than the oral medications, hence there is a built in conflict. More $$ for the doctor, the insurance co. or better therapy for the patient.

        Obviously I am not a doctor, but I can read and what I'm reading is troubling.

        To make the situation even worse, oncologists at academic medical centers seem to use the oral medication more frequently then what are known as community based doctors. Remember, oral medication usually more expensive.

        So just add this to the shit heap of American medicine.

        •  I'm an oncologist to be... (41+ / 0-)

          ...at a very early stage in his training (I'm still in med school, working on a combined MD/PhD degree).

          I've been following a breast cancer oncologist for a while who's at a major medical center (not community, as nyceve points out the difference above).  This is a major problem.

          Many elderly patients who have metastatic (i.e. spread to the bones, liver or lungs) breast cancer cannot tolerate the higher doses of IV chemo that are recommended in the metastatic setting to alleviate tumor burden.  In the past 2-3 years (I think) an oral medication of an IV drug that's way off patent and is extensively used in colon cancer, 5-FU, has been developed for breast cancer patients in the metastatic setting (the drug in the oral form is known as Xeloda).

          THis drug has done WONDERS for my patients.

          Now, to be sure, it's not a cure.  But it has reduced metastatic tumor burden to a highly significant degree, improved quality of life, lessened pain, and although there's no definitive data from clinical trials yet, it may even help to increase overall survival of patients with mets.  So far, no therapy has been able to do that in breast cancer.

          The funny (sad) thing is that it's just a reformulation of a drug that's been around for decades in IV form.  The mechanism of action of this drug has been well known for a long time.  There's nothing earth-shattering about it.

          But since it's ORAL, and thus must be dispensed by a PHARMACIST, that means drug-plan insurance must pick up that tab.  And Xeloda, even though there's nothing particularly new about the underlying drug, costs a fortune.

          Luckily, my patients have been receiving it as part of a study protocol, so they haven't had to pay for it.  But as nyceve has pointed out, it's starting to be used more widely, especially in academic centers, because it is tolerated much better than IV chemo, and may be more effective in certain cases.

          What will those patients with metastatic BrCA, who have no hope for cure and who are by and large in their late 60s-70s (and thus less likely to tolerate high dose chemo) do now?  Here we have a fairly effective option for these people, where no such option existed before.  And we would deny them that?  Especially when this is, in essence, a drug we've used for decades in colon cancer, and very little R&D was needed to bring it to market?

          Oh, and just as a point of clarification, it's not that IV chemo necessarily is cheaper than oral chemo, it's just that it's treated differently by the system (esp. medicare).  Medicare (and I think also private insurance) will reimburse oncologists directly for the cost of IV chemo administered in their offices, because it's seen as an "office expense" and not necessarily as a drug expense.

          Oral chemo can be dispensed by pharmacists, and thus patients must have their prescriptions filled.  This is covered by medicare part D (and drug insurance plans), not directly by your basic comprehensive private health insurance plan or medicare.  That's why it is "more expensive" because it is the pharmacy, not the doctor who is reimbursed for the drug.

          This is also true for all the adjuvant meds that go along with IV chemo to help ameliorate the symptoms of nausea, diarrhea, weakness, low blood counts, etc.  Patients, in my experience, have a tougher time getting access to these drugs (which are often very expensive) than in getting the chemo.  But the fact is without some of these drugs, there would be a certain subset of the population that would never tolerate the chemo, and could never really be able to finish a complete protocol.  So, they are just as important in my book as the chemo itself.

          Even more important, and again  at least in breast cancer, are the oral hormonal therapies that are being employed in estrogen-receptor positive tumors (the large majority of BrCA).  The newest generation, which have some significant benefits over our old mainstay, tamoxifen, are again very expensive and must be filled by a pharmacist.  While there's not a lot of data to suggest that they actually are superior to tamoxifen in overall survival, there is some good data to suggest that they prevent relapse better than tamoxifen.  And, again, there is a subset of the population that cannot tolerate tamoxifen, so these drugs are absolute lifesavers in these women.

          And it's a little known fact, but if you divide up the overall benefits pie of the various modalitites of treatment of BrCA, next to surgery, hormonal treatments like tamoxifen and the aromatase inhibitors (the new kids) actually have the highest benefit.  It's something like helping 11% of the patient population that would otherwise relapse vs. like 2% for chemo.  So, in reality, we're treating WAY more people than we need to with chemo, but until we can reliably ID those whom we think chemo will benefit, we'll continue to do that.

          People should not be afraid of their governments. Governments should be afraid of their people.

          by viget on Sat Apr 08, 2006 at 12:53:16 PM PDT

          [ Parent ]

          •  Thank you so much, viget (9+ / 0-)

            Really, really helpful to have your input.

            Regarding intravenous chemotherapy, I thought there was a very desirable reimbursement rate, this was one reason community based oncologists use it.

            But, to make matters more complicated, I believe my oncologist friend once mentioned that even the reimbursement for the chemo infusion is being cut.

            •  Yes, some chemotherapeutic agents (4+ / 0-)

              Recommended by:
              nyceve, viral, imabluemerkin, Andy30tx

              are not reimbursed. And as oncs often prescribe "cocktails" of them--you can find yourself in the position where only part of your chemo is being reimbursed, but you don't find out about this until you get the notice declining payment. This frequently happened with people on the PanCan forum that I frequent for help and support.

              Seul l'incrédule a droit au miracle. - Elias Canetti Road2DC

              by srkp23 on Sat Apr 08, 2006 at 01:14:37 PM PDT

              [ Parent ]

            •  IV versus oral chemo (4+ / 0-)

              Recommended by:
              Margot, nyceve, Janet Strange, madaprn

              I am an oncologist, in practice for 12 years.

              There IS an advantage in many cases in using IV chemo in our office, because of the reimbursement rates. I don't pay attention to this however; can't imagine putting someone on infusional (IV) 5FU instead of oral xeloda unless their insurance just won't cover the oral form and we can't get them on the drug company "freebie" program because of their income. The infusion requires a permanent IV, and being hooked up to an infusion pump 24 hours a day for 1-4 weeks: This is a huge imposition problem in terms of quality of life, versus just being able to take a few pills twice a day.

              I do not know the variables in our office in terms of reimbursement for drugs, etc; I make a point NOT to know. In my opinion, it has NO bearing on how to treat patients. What does have a bearing, is their insurance and what will be paid for, or not, as the case may be. We spend an enormous amount of time and money dealing with this issue with various insurance companies. All unreimbursed...

        •  IV chemotherapies cannot be administered at home (9+ / 0-)

          so that also adds to the cost of taking IV treatments, because you have to check into the hospital or also pay for a doctor's appointment. The thing is, the oral monotherapies like Tarceva (yes, they can be more expensive than IV chemos) are targeted to specific proteins, and are thus much more effective (if your tumor produces that particular protein) and less devastating to the system than traditional chemotherapies, which are essentially just a scorched earth policy killing every cell in your body  beginning with the most quickly dividing. I believe that ultimately research should take us away from IV chemos altogether--they are devastating on the body, and for the psyche of the patient--it makes you feel "sicker" to have to go in and get sticked and pumped with poison 4 hours a week. Taking a pill at home can make you feel more like a "normal" person.

          Thank you so much, nyceve, for doing this important work on a crucial and complex issue.

          P.S. My mother has stunned every doctor with the fact that she is still alive and that her Stage IV metastatic pancreatic cancer has almost completely regressed! I believe that this miracle is due to the combination of my mother's unbelievable tenacity, Tarceva, and lots of love!

          Seul l'incrédule a droit au miracle. - Elias Canetti Road2DC

          by srkp23 on Sat Apr 08, 2006 at 01:07:13 PM PDT

          [ Parent ]

    •  3goldens, it happens that . . . (10+ / 0-)

      the oncologist who is my friend is a Gyn oncologist.

      I will ask him about this PET scan issue.  This is simply unbelievable.

      •  gyn/onc. vs. gyn for surgery (5+ / 0-)

        My friend has also been battling the issue of the gyn. who performed her initial surgery not referring her to a gynecologic oncologist for that surgery.  There are gyn/oncs available within the same healthcare system, but for some reason she's been meeting a stone wall in trying to influence the gyn. group to establish a protocol that in cases of suspected ovarian cancer the patient WILL be referred to a gyn/onc for surgery.  I admire her to much for the fight she's put up both against the cancer (she was given a 20% chance of survival to 3 years at the time of diagnosis and just passed her 5th anniversary on March 28!!!) but also for fighting for better treatment for her "sisters" who battle and frequently lose to this dreadful form of cancer.  She has become a real force for ovarian cancer awareness and she did it all on her own.

      •  It's true (3+ / 0-)

        Recommended by:
        Margot, 3goldens, ladybug53

        My mom's doctor told me (privately, thank God) that her insurance would only pay for a CAT scan (this was in 2003), but that since she was diagnosed at stage IIIC, it didn't really matter - he didn't need the precision of a PET scan.  

        "Republicans are poor losers and worse winners." - My grandmother, sometime in the early 1960s

        by escapee on Sat Apr 08, 2006 at 04:07:11 PM PDT

        [ Parent ]

    •  We had to go through this (4+ / 0-)

      Recommended by:
      Margot, joynow, nyceve, ladybug53

      My mother's doctors order a CT PET scan, which Medicare doesn't cover (and my mother's secondary insurance won't pay if Medicare doesn't). She actually called New York Presbyterian and bargained the price down to $500, which she felt she could afford to pay. So please tell your friend to try this.

      I kind of understand why Medicare won't pay, because althought the CT PET scans are incredibly more sensitive to picking up fast dividing cells, they are not reliable. In fact, my mother's was negative, when in fact she did have an incredibly aggressive adenocarcinoma on the head of the pancreas. Apparently the false negative is frequently a problem with these scans.

      I send healing energies and wishes to your friend.

      Seul l'incrédule a droit au miracle. - Elias Canetti Road2DC

      by srkp23 on Sat Apr 08, 2006 at 01:11:50 PM PDT

      [ Parent ]

      •  srkp23 (0+ / 0-)

        Thanks much for this info and for the good wishes to my friend.  I'll pass it along.

        •  srkp23 (1+ / 0-)

          Recommended by:
          Margot

          Shoot--I posted too quickly!  Meant to add that my friend tells me that her private insurer will pay for the PET scan, so she's safe at this point.  You always wonder, however, when an insurer might make a decision that they're just not going to cover a particular diagnostic tool any longer. It's just one more added concern.

      •  That's a good recommendation (1+ / 0-)

        Recommended by:
        nyceve

        Some hospitals actually have different rates for people who aren't paying through insurance.  Going to support sites is a good way to get recommendations, too.  It's amazing the power of ordinary people getting together to share information.

        McCain: Less jobs, more war.

        by Unstable Isotope on Sat Apr 08, 2006 at 05:29:02 PM PDT

        [ Parent ]

    •  Americans for Healthcare (2+ / 0-)

      Recommended by:
      nyceve, 3goldens

      SHARE YOUR STORY (or your friend can share her story)

      Share Your Story

      Countless Americans are facing the growing problem of rising costs and failing quality in health care. Are you troubled by rising monthly costs? Do you confront health care choices that you never imagined? Have you heard of someone else's horrible experience? By sharing your story, you can help us reach the politicians and force them to face up to this important problem.

  •  I'll just relate my story for my mom... (8+ / 0-)

    she's the wife of retired military guy who has the Tricare for Life option.  Basically, this plan is a medicare wrap ... for those who know insurance terms.

    She went to pick up a prescription and the pharmacy (the name escapes me, but the initials are C. V. S.) had mistakenly used an outdated entry in their computer system where it wasn't showing her Tricare coverage.

    Mom nearly fell over when she was told that she was assigned to a plan that didn't cover her drug.  She was really, REALLY upset about it because she knew that they were wrong.

    To make a long story short, that particular chain made an entry into her computer file that noted the wrap coverage.... but more to the point... my mother was highly embarassed by this.  She's moved to another chain for her medicines because in her words "I don't want people in town to think I can't afford my medicine".

    Shrub/Frist's medicare plan has screwed not only the folks who could benefit from it, but also people who don't really need it (like my mom).  It's been a hassle and a disaster from the get-go.

    •  You know, you have to ask . . . (8+ / 0-)

      yourself what sort of people--politicians, lobbyists, pharma thieves, whomever--would chose to prey on our most vulnerable.

      Now, whenever I ask this admittedly dumb question, many of you respond, Eve, of course these people have been targeted, this group is so easy to go after.

      Maybe so. But my bet is they are going to return the incoming artillary with a vengeance come November 7th.

    •  Tri-care is a scam (0+ / 0-)

      The whole point of Tri-care is to not cover anyone but to send them to any other service. They will re-direct and misdirect, until forced to cover the insured. Rummy laid this all out at a hearing about the Budget. He admitted that part of the Budget was in part made up from the saving they plan on making by taking in insurance payments, and not paying out as much as they should. He freaking admitted it, and still nothing has really been made of that point.

      -8.63 -7.28 We all have to be concerned about terrorism, but you will never end terrorism by terrorizing others.~Martin Luther King III

      by OneCrankyDom on Sat Apr 08, 2006 at 05:54:09 PM PDT

      [ Parent ]

  •  This makes it all the more important. (5+ / 0-)

    We need to get a Universal single-payer system after we get out of Iraq. Not only do doctors have to do the things you mention, people can't start their own businesses because they cannot attract enough quality employees because the cost of health insurance is so high.

  •  Several organizationsinvolved in the cancer fight (2+ / 0-)

    Recommended by:
    joynow, 3goldens

    There are several organizations trying to bring together advocates on these types of issues - and tell elected officials that cancer should be a national priority.  I'm sure that won't bring about wholescale change, but at least it is a start and at least people are trying to do something about issues like the one you describe.

    • Lance Armstrong Foundation (organizing a LIVESTRONG Day in May) - yeah, they're a young foundation, but it is becoming more and more apparent that Armstrong is serious about working as a cancer activist.  I say give 'em a chance - http://www.livestrong.org/...

      While LAF is new and still putting together the issues they will work on, being involved with them likely means a greater chance of helping to shape their agenda.

    • American Cancer Society Cancer Action Network (ACS CAN) - trying to inject cancer into electoral politics and hold politicans accountable on their promises - http://www.acscan.org

      ACS is also bringing around 5,000 or more people to the National Mall in September to lobby Congress and raise awareness about cancer issues.  It's called Celebration on the Hill and it happens the third week of September I believe.

      Of course, ACS has been around for quite awhile and still has a huge focus on tobacco use reduction (tobacco causes 1/3 of all cancers).  So, they do a lot of great things and have many resources (they're a $800 million a year organization) but you've got much less of a chance of actually helping to shape the agenda.

    In addition, I think the National Breast Cancer Coalition (NBCC) is supposed to have one of the best grassroots networks out there.  Don't have the link, but if breast cancer is your thing and you want to be involved politically - they're probably your best bet.

  •  This is prolife (5+ / 0-)

    and pigs fly.

    "Rupert Murdoch Loves Hillary Clinton"--CBS News headline.

    by Thistime on Sat Apr 08, 2006 at 12:10:20 PM PDT

  •  We need to eliminate profit from insurance (12+ / 0-)

    All insurance companies are pretty evil, be it homeowners, health, auto, whatever.  And the reason for it goes right back to that old adage-'the lust for money is the root of all evil'.

    Risk mitigation of all sorts would be far better handled by the federal government.  It would remove all the uncertainty from our current process, lower costs substantially and provide the widest possible pool to offset catastrophic occurances.

    Ask anybody along the Gulf Coast how they feel about homeowners insurance.  We have all heard horror stories about insurance companies.  For example, you are NOT in good hands with Allstate.  They should not be allowed to use that name anymore, since they are more like 49State after pulling all of their homeowner's insurance out of Florida after failing to pay claims.  I will not tolerate any sob stories about the 'poor' insurance companies.  It is their stated job, the ONE THING they sell, to mitigate loss and if they cannot or will not live up to that due to poor management then they do not deserve to be in business.

    Need surgery?  Lots of doctors now require you to agree to arbitration before they will treat you.  This is not for their benefit, it is their malpractice insurance requiring them to do it.  This means that to get needed medical treatment you have to sign away your Constitutional right to a jury trial.  Patriots DIED to obtain and protect our rights, but now they are just an inconvenience to be signed away like used clothes going to Goodwill.

    We are under attack from so many places right now that it is hard to pick which battles to fight first.  Unfortunately, this battle probably has to be a second line battle, since it will take a turn toward the progressive to win it, but it is not to early to start raising the issue and discussing options.

    Live Free or Die-words to live by

    by ForFreedom on Sat Apr 08, 2006 at 12:17:22 PM PDT

    •  I think (1+ / 0-)

      Recommended by:
      vivacia

      that we might be better served by a two-tiered system. The profit motive spurs innovation and effiency, and should not necessarily be discarded out of hand. But we definitely do need a non-profit safety net for those of us who are unable or unwilling to compete in the darwinistic jungle of the "free market".

      Al Qeada is a faith-based initiative.

      by drewfromct on Sat Apr 08, 2006 at 12:25:05 PM PDT

      [ Parent ]

      •  I agree there is a place (1+ / 0-)

        Recommended by:
        vivacia

        for profit based insurance companies, particularly those that specialize in high risk and niche areas.

        But for general risk mitigation-home and auto in particular-we need a base line security.  If people want excess insurance for their own reasons the market can provide that as well.

        Sorry, forgot to include that point in my initial rant.

        Live Free or Die-words to live by

        by ForFreedom on Sat Apr 08, 2006 at 12:56:45 PM PDT

        [ Parent ]

    •  Right you are . . . (2+ / 0-)

      Recommended by:
      tiggers thotful spot, ladybug53

      I went to an ear doctor in Los Angeles a year or so ago. They handed me a big stack of papers to fill out including one telling me I could only be treated if I agree to binding arbitration.

      What a joke.  Actually it's not joke for people harmed by incomptence in medicine.

      •  Regards arbitration (2+ / 0-)

        Recommended by:
        nyceve, ladybug53

        My insurance company won't cover my malpractice unless I get my patients to sign an arbitration agreement, which basically states the patient, if sueing, waives their right to take the case to court, and must use arbitration.

        Share. Share resources, share delight, share burdens, share the healing. If we only could realize that sharing will bring us back from mass suicide.

        by MarkosNYC on Sat Apr 08, 2006 at 02:03:46 PM PDT

        [ Parent ]

        •  Yup, I don't think the doctors (1+ / 0-)

          Recommended by:
          nyceve

          are the ones causing the problem.  With the exception of the occasional wingnut.

          This is just one reason for a national risk mitigation plan.  All medicine involves risk, and doctors are still human.  The consequences to the patient of a simple mistake can sometimes be enormous.  And what really gets me is that often the tactics the insurance companies use to avoid paying make both medical and legal conditions worse, and more expensive in the long run.  That's why the cost of litigated cases can get to be so much.  The only way the client or the lawyer can pursue reasonable compensation is to assume substatial financial risk, which leads to high legal fees.  If the insurance would just pay what they were supposed to when they are supposed to it would be half the cost it is now.

          What we need is a system that pays for needed care at time of need.  Over the long run this will be much cheaper, due to lessened medical and legal costs.  It gets expensive when treatment is not provided shortly after detection, and the problem grows worse before it is treated.

          I think most doctors would be quite happy with a system where if they or their staff made a mistake they could honestly admit it and immediately begin to treat the problems that mistake may have caused.  But I would love a doctor's opinion on that.

          Live Free or Die-words to live by

          by ForFreedom on Sat Apr 08, 2006 at 04:21:18 PM PDT

          [ Parent ]

  •  Everything you say about Part D is true (4+ / 0-)

    It was not designed to help patients - but rather protect drug companies from the government negotiating discounts on drug costs.  Medicare sets prices for what doctors who want to participate in Medicare can charge.  Medicare sets prices for what hospitals who want to participate in Medicare can charge.  But the pharmaceuticals managed to conspire with Republicans and insurance companies to 1) needlessly insert the insurance companies in the middle of this process and 2) protect the pharmaceutical industry from the same kinds of price constraints physicians and hospitals deal with.

    That being said ... I would caution people about throwing claims around that Medicare is routinely denying life-saving diagnostics or therapeutics (e.g., PET scans for metastatic ovarian cancer).  Medicare has a reasonably good process for determining whether something is "standard of care" or "state of the art" versus still experimental or investigational.   You can go here for a review of the CMS decision re PET scans and cancers.  Keep in mind, that if we go to a federal government single payer system (which I am not entirely opposed to - as 50 different state plans will be a mess), there will be this kind of process to determine what is and is not a covered benefit.

    In addition, whether it be single payer or a Clinton-esque plan, there will never be enough money for everything that everybody wants - especially if we don't require some scientific rigor to our coverage decision making.  For those that remember - there was a big push in the mid 1990s for High Dose Chemotherapy with Autologous Bone Marrow Transplant for stage four breast cancer.  Each of those treatments cost hundreds of thousands of dollars.  And yet today the literature is still equivocal at best (note the limitations on who MIGHT benefit) as to whether there is any real benefit to the treatment.

    This whole issue of what you cover and how you go about making that decision is a very important discussion.  I welcome any other health policy wonks - or just folks with opinions - to chime in.  Well reasoned debate usually helps clarify reality.

    "That's hard to explain without using the phrase 'you gullible toad.'" Dilbert

    by gbussey on Sat Apr 08, 2006 at 12:22:31 PM PDT

  •  Sherry teaches in my district (9+ / 0-)

    http://www.connpost.com/...

    Sherry Lonergan says she's lucky.
    By VIN MORAN vmoran@ctpost.com

    Having survived two bouts of breast cancer and two mastectomies, a hysterectomy, other cancer-related treatments and procedures, after a five-year battle with ovarian cancer, she may be right.
    But the staggering costs for Lonergan's fight against cancer have opened a new battlefront for the Trumbull woman husband, Dana and their two kids Justin and Carly.

    The couple says their health insurance company, HealthNet, is refusing to help cover the $8,000 monthly cost for Avastin, the one prescription medicine helping Lonergan.
    _____

    HealthNet rejected Lonergan's claim for Avastin, she says, because the drug is not FDA approved to fight ovarian cancer. Lonergan has been forced to switch drugs several times, not because of price, but because of her weakening response to treatment. "Cancer is smart," Lonergan says. "It changes, adapts" and finds a new way to consume the resources a body needs. It has also forced her to leave a biology teaching position at Bridgeport Regional Vocational Aquaculture School where she taught for 10 years. Amy Dennean, a Black Rock Medical Group nurse practitioner who has helped treat Lonergan for the last year, said she responded well to Avastin. "When she stops responding to something, we switch to new agents. She ran out of new agents a while ago," Dennean said, referring to medicines.

    ........
    Cutler said an external medical review board looked at evidence in Lonergan's case and determined that she was not eligible for reimbursement.

    "It comes down to the review board," she said.

    Lonergan claims the HealthNet doctors reviewing the claim did not read her history before issuing their denial for coverage. In their report, they recommended Avastin, which is still being examined as an ovarian cancer treatment, only as a last resort after all other treatments had been tried. "I've exhausted all the other drugs," she said. Julie Coulombe, a nurse administrator at Black Rock who has helped treat Lonergan through 17 years of fighting cancers, agreed that Avastin is one of the last options Lonergan has left. "She went through just about every surgery and every drug," Coulombe said. "This is her last option."

    ___

    State Attorney General Richard Blumenthal said his office is trying to help victims of what he calls "bureaucratic blindness." Blumenthal said his office, each year, handles more than 1,000 cases or claims for treatments that are medically necessary but denied by insurers. "To be very blunt, it's a matter of life and death for this woman and for thousands of others, who are being denied medical treatment," Blumenthal said. "She clearly deserves coverage for this medicine. There is no doubt in my mind." Lonergan insists she just wants the protection and compensation that health insurance is supposed to provide.

    "I don't want special treatment," she says. "I just want what's coming to me.

    •  Sprinkles, this is just so . . . (8+ / 0-)

      on target.

      It's hard to imagine having cancer and at the same time, being denied the medication you require and having to battle the insurance company.

      Wait until some whistle blower releases some emails which will conclusively prove that the business plan requires that a certain percentage of cancer patients will just go away and die.

    •  HealthNet is infamous (0+ / 0-)

      Bad for both providers and patients. We stopped accepting it on account of their nasty habit of delaying payment for up to 1 year from the date of service. Ironically, my family had HealthNet commercial insurance at the same time. $45 co-pay for 4 triptan pills (migraine blockers). Initial denial of benefits clearly guaranteed in our agreement. Many, many stories in the local papers about HealthNet giving sick people and providers a horrible time, with many miserly and nonsensical decisions.

      "And tell me how does god choose whose prayers does he refuse?" Tom Waits

      by madaprn on Sat Apr 08, 2006 at 08:00:09 PM PDT

      [ Parent ]

  •  so true (5+ / 0-)

    Recommended by:
    tryptamine, joynow, nyceve, 3goldens, ladybug53

    I know a doctor who found a drug that worked for his patient. Then her insurance changed its formulary and she had to switch drugs. When we spoke, she had tried practically every drug out there. She was about to give up. She said she'd just pay for the non-formulary drug to get healthy, which is an extra $100/mo. $1200/yr. What does she have that insurance for?

    And by the way - what is more expensive to that insurance co? The cost of the drug that works? Or the costs of the drugs that don't work, plus repeated doctors visits and lab tests? They are idiots.

    •  i believe this is because (2+ / 0-)

      Recommended by:
      nyceve, OrangeClouds115

      big pharma had a bigger ass and took up more of the money couch.

      seriously. they both have different interests. insurance companies have an interest in people getting well and staying well to continue to pay premiums without having to shoulder any of the burden of care cost.

      pharma companies have an interest in making people buy their product. they have to be ill, or convinced they're ill, in order to do so, and that the medication offered is the only one available with which to find a cure.

      so right now, the field is tilted slightly more in favor of pharma. but i think insurance companies are playing around with formularies and costs, so this may change.

      /there are no rules except discovery /the only tradition is invention. -rachel pollack

      by joseph rainmound on Sat Apr 08, 2006 at 01:24:51 PM PDT

      [ Parent ]

  •  i remember your first thread (3+ / 0-)

    Recommended by:
    nyceve, vassmer, ladybug53

    i remember your first thread on healthcare when you couldn't find coverage. Did you get coverage eventually?

    Recently, my 59 yr old mom and 62 yr old dad had to shop for private insurance. They thankfully, found kaiser which they pay $666/mon for just the premium and then there is all the deductibles for doctor visits and medication. Their household income is about 2500/month so you can see the stress of paying this kind of money. But they are glad that they aren't a burden on me and happy they have coverage. Especially since BlueCross saw their BP and cholesterol medications on the application and took all of 1 day to turn them down.

    For my part, i am going to apply for permanent residence in Canada. i don't want to be held slave to medical insurance.

    •  Thanks for asking . . . (2+ / 0-)

      Recommended by:
      ladybug53, Overseas

      Yes, I got coverage. It wasn't easy and I was lucky to have a very resourceful and skilled insurance agent.

      I now have small group coverage which I am told, has some protections that individual coverage doesn't have.

      Needless to say, after reading and doing a diary about Blue Cross of California terminating enrolleees who file claims, I get sick at the thought of filing a claim or making a doctor appointment.

      •  Group coverage,huh? (2+ / 0-)

        Recommended by:
        nyceve, ladybug53

        My uncle who is retired isn't dissolving his corporation till him (he is 63) and his wife (60) both reach 65 just in case he has to buy private insurance when his wife cannot work anymore. He knows that no private insurance will sign them on.

        Did you just see the news report that even the rich are worried about health insurance costs eating into their retirement? Just came out hte other day.

  •  Ask your friend about clinical trials (4+ / 0-)

    Recommended by:
    tryptamine, nyceve, Ari Mistral, ladybug53

    This is the cutting edge of oncology research, where the questions are not just "does the patient live or die" but what's the quality of life from the treatment.

    Big Pharma justifies our high drug prices because of the need for r&d.

    And most insurance won't pay for patients participating in clinical trials.

    "In a time of universal deceit, telling the truth is a revolutionary act." George Orwell

    by zic on Sat Apr 08, 2006 at 12:29:21 PM PDT

  •  Well done, (1+ / 0-)

    Recommended by:
    ladybug53

     It does seem that they are actively waging war on the people.  People need to know about rummy's tie to the industy.  This will be are biggest battle in the long run we will be waging war with insurance, big Phrama, the AMA and the bio-tech sector, and thier powerfull lobbysists.  I've read they profit off a lot of taxfunded research at the NIH.  The commercials should be made illegal.  At a townhall meeting recently someone asked our congressman, why will need a passport to enter Canada to get cheaper drugs.  Well he spun that answer,  we have to make sure they're safe.  yada yada yay.  The war is on us folks.

    Democracy is not a spectator sport

    by Sophie Blue on Sat Apr 08, 2006 at 12:35:45 PM PDT

  •  Spoke to a survivor today (4+ / 0-)

    Recommended by:
    nyceve, Ari Mistral, ladybug53, lazybum

     A woman who beat breast cancer and was diagnosed with  luekiema this year.  She is taking a liquod chemo,doing well but will probably take it for life.  2000 grand a month, she has ins.
     Note how their is no profit on prevention for diabetes.  More money in the end of dis-ease.  
    Note they are forcing the Philapenes into high cost drugs.  They are shameless.  I see red on this topic in more ways than one.

    Democracy is not a spectator sport

    by Sophie Blue on Sat Apr 08, 2006 at 12:43:58 PM PDT

  •  Geez, why are so many in Congress (5+ / 0-)

    so SILENT on the issue? I would expect every single Democrat rep and sen screaming that something should be done now--people are dying.
    Sure the "Tough Luck" wing of the GOP has the majority, but their constituents are hurting too, aren't they?
    I just don't get it. So depressing. And as Boomers get older, it is just going to get worse.

    Thank you for this diary. This issue has to be on the front burner.

    A conservative is a man with two perfectly good legs who....never learned how to walk forward.-FDR

    by vassmer on Sat Apr 08, 2006 at 12:51:01 PM PDT

    •  IMO (4+ / 0-)

      Recommended by:
      nyceve, 3goldens, ladybug53, lazybum

      Congresspeople are lobbied to death by Big Pharma and the Insurance co's, and so they are players in making money. That's why they remain silent, they are seduced by lobbyists.

      Share. Share resources, share delight, share burdens, share the healing. If we only could realize that sharing will bring us back from mass suicide.

      by MarkosNYC on Sat Apr 08, 2006 at 02:08:26 PM PDT

      [ Parent ]

      •  Big Pharma = Big Money (4+ / 0-)

        Recommended by:
        Erin, 3goldens, ladybug53, lazybum

        I posted some figures down-thread about this.  In 2002, the pharmaceutical industry spent $91.4 million dollars on lobbying.  That works out to about $170,000 per congressman.  Who says money can't buy happiness?

        Newspapers are unable, seemingly, to discriminate between a bicycle accident and the collapse of civilization. -- George Bernard Shaw

        by dsteffen on Sat Apr 08, 2006 at 02:27:41 PM PDT

        [ Parent ]

      •  Big drug companies tell congresspeople (0+ / 0-)

        that if they continue to get about $200 billion a year from Americans, cures that might save their lives will be produced.

        If you are worth millions like the average congressperson and the government pays for your healthcare, it is a no lose investment.

  •  Something wrong with this story (1+ / 0-)

    Recommended by:
    Minerva

    $4,000 X 12 = $48,000 - $3,600 = 44,400. $48,000 is the equivalent of $65,000 gross give or take. This strikes me as a bad example for a good story. That works out to $300 a month. I pay that on much less income just for insurance which doesn't include any drug costs as I'm sure plenty of Americans do.

    Lets assume there was no plan and she had to come up with $3600 a year for a drug to save her life. Would it then become affordable?  

    Using "Mrs Blue" as an example of the fallacies of Medicare D doesn't help unless there's a lot of relevant detail on why she can't afford that copayment at that income level.

    This is coming from a guy who pays $300 a month for insurance with a $5,000 deductible on substantially less income.

    Support Col Hackworth's watchdog group for the troops with money or a sign

    by Dburn on Sat Apr 08, 2006 at 12:54:18 PM PDT

    •  the person i (1+ / 0-)

      Recommended by:
      nyceve

      am speaking of her medicine costs 2grand not her insurance.  Don't know what the actual cost to the ins.co is.
       But i know this they charge the uninsured up to three times as much as an insured person.  And i believe due to my experience with invitro they tell the doctors what to do.  I went through this on cobra which i carried for a year, when i found out the new plan included invitro,  had to have an operation on the ovary and i was cancelled after the next cycle.  The next year the ins. jumped over 150 bucks. And i gave up.  And contrary to public perception some of us actually try too pay those bills.

      Democracy is not a spectator sport

      by Sophie Blue on Sat Apr 08, 2006 at 01:06:18 PM PDT

      [ Parent ]

    •  $4,000 a month is a higher incoome example (3+ / 0-)

      Recommended by:
      nyceve, 3goldens, ladybug53

      but someone with an income of $1,250 would be in that position too. The income cut off for assistance on medicare D is under 15K per year.

      People in that range of 15 to 20+ thousand a year are in the worst shape even if the program is going well. They did qualify for low or no cost drugs through the drug companies.
      Newer drugs are outrageously expensive. Since once in the donut hole drugs you get from a cheaper pharmacy or Canada or through a program don't count toward your spend down...there is no way out once you fall in. If your drugs are 800/month and you have only 200 month after living expenses how do you do that?

      I am on disability now. I haven't gone on a plan. The deadline is coming, rates will go up every month I am late in signing up. I'm sure I am in a position many are in. The lower cost plans won't help much in the drugs I am told to take because the 25% will be too much and the donut hole too deep to get out of. There are higher price plans that avoid the donut hole but they cost too much for uncertain coverage.  The drug that I do take is off label for my condition and the doctor would have to do a lot to get it approved. I don't think he will. I often can't drive so doctor shopping doesn't work. I get it from Canada.

      The drugs that I don't take will be bad on any plan. Since I don't want them they don't matter but I'm one of the few that refuses them. I want to bring them up as an example that it seems clear the cost of the drug and price of the drug are not related. With MS there are 4 self injected drugs that are used. One of them is 30 shots per month, one is 12 shots per month, one is 8 shots per month, one is 4 shots. Coincidentally they all cost about $1,200 per month.

      As I read about the cancer treatment costs I feel like it's best I just not get screened if you can't afford to fight it.

      I have a friend who was prescribed Tamoxifen for her cancer. She had insurance with a 25% copay. It was cheaper for her to buy it from Canada and pay 100% then to pay the 25% copay here.

      It's just a true crime that they both did not negotiate for lower cost (as they do for Medicaid and Veterans) and people are not allowed to get insurance to pay the gap.

      And I hate them. But I guess if we die sooner it helps the social security problem.

      •  Yeah- I agree with this (1+ / 0-)

        Recommended by:
        joynow

        I don't even use the insurance I have for drugs. It's cheaper to pay cash for them at Costco- especially generics then even Canada. But the important thing is if it goes on the claims records the insurance goes up, so you still end up paying for them one way or the other.

        I had another problem hit me out of the blue. My Dog got diagnosed with Terminal Cancer. Well, his health insurance is better than mine. My out of pocket treatments for a 18 months of chemo ( life expectancy) is maybe $400. I asked the vet if I could go there for cancer screening and treatment. Call me Rover.

        Trust me I'm crying about my dog- he's my only family, but I'm crying worse that as we get older it's much cheaper just to grab your favorite happy pills and let the cancer do it's thing.

        The kicker here was, as I was doing research on my dogs cancer, I was sobbing over the fact that it is 99% terminal. Then I see a couple had their dog cured with stem cell treatment for $45,000. You know they probably did it under the table. But that's what it's going to get down to. Got the cash they got the cure.

        This religion excuse over stem cell treatment is obnoxious. There's no money for dung (drug) companies in cures. Otherwise they'd be all over stem cell therapy and congress would pass it through while flipping off the religious right.

        Support Col Hackworth's watchdog group for the troops with money or a sign

        by Dburn on Sat Apr 08, 2006 at 07:19:10 PM PDT

        [ Parent ]

    •  It's not the total, it's the schedule (0+ / 0-)

      Dburn:

      It's confusing unless you read the article closely.

      The problem isn't that she has to pay the $3,600 per year--it's how she has to pay it.

      The co-pay for filling one prescription is supposed to be $2,800. She may have enough money to get by on a monthly basis, but she might not have $2,800 lying around to pay for the medication in a single lump sum.

      The solution to this problem would be a system that capped co-pays per prescription. [A fair limit would be, say, $X plus up to Y percent of income over Z dollars per month.]

  •  My mother takes Tarceva (5+ / 0-)

    and my parents probably have the same kind of income as that Ms. Blue in the Times article has. We applied directly to Genentech, which has a program to supply Tarceva free of cost and we were approved. Still, for the first couple of months my parents had to pay for it out of pocket and at my mother's dosage it was $6,000 a month. I hope Ms. Blue will try and apply directly to Genentech!

    I do not believe that healthcare--and that includes drug manufacturers--should be "free market" enterprises. Since their R&D is also largely funded by government grants, they should not be allowed patents. Also, drug companies should not be allowed to advertise--they should only be allowed (excuse the unfortunate phrase here) tombstone advertising.

    Can't wait for Michael Moore's current project on HMOs and big pharma to be completed.

    Seul l'incrédule a droit au miracle. - Elias Canetti