Take it easy, it's not raw and racy.
I'm going to tell you about breasts, but it's not exactly the discussion some of you may be expecting.
Stay with me though, this a deadly serious subject and the ramifications are enormous.
This another piece of the huge American healthcare catastrophe, it involves breasts, cancer, mammography and The Big Lie.
THE BIG LIE:
The Big Lie involves waiting lists. They want you to think no one waits--this is abject bullshit. Lengthy waiting lists are a prominent reality of our collapsed American healthcare system.
And what's most frightening is that the waiting lists are longest and most dangerous at the critical points when people need the quickest care and expert advice. I'm no doctor, but plain old common sense tells me, when you're talking about cancer, you want a quick diagnosis, not to be put at the end of a lengthy waiting list.
So at the risk of repeating myself, please hear me well. WE HAVE WAITING LISTS. I REPEAT, WE HAVE LONG WAITING LISTS TO SEE DOCTORS IN THE UNITED STATES. They want you and me to think there are no waiting lists. This is a lie on the same order of magnitude as the lies that got us into Iraq.
nyceve isn't the only one warning of this horrendous situation. Here's a letter to the editor from former director of the New York Public Health Association in the New York Times.
To the Editor:
Re ''Mammograms in Decline'' (editorial, May 15):
Women are not skipping their mammograms. Rather, in New York, it takes four to six months just to get an appointment for a screening. Once we get an appointment, we build our schedules around that date to be sure that we can keep it.
Further, hospitals and mammography centers are having great difficulty finding radiologists who are trained and want to read mammograms. Low reimbursement rates and high malpractice risk make the field undesirable compared with other radiology subspecialties.
There is much discussion about our health care system's being broken because of the number of uninsured who can't get timely care. The mammography crisis should serve as a canary that even for those with insurance, our system is cracking.
Linda Landesman
White Plains, May 15, 2007
The writer is immediate past president, Public Health Association of New York City.
http://query.nytimes.com/...
THE TRUTH:
This is what is happening in the middle of Manhattan, to women just like me. Women with very expensive for-profit health insurance. You think just because you have health insurance you can march in and see a doctor? You think you live in the middle of the nation's biggest city you can just march in and see a doctor? Think again.
This is a story of what happens in 2007, in the largest city in the United States. This is what happens if a woman or her doctor happens to detect a pesky little lump in them pesky breasts.
Women who have had the pleasure of a mammogram know that there are two types, one is the screening mammogram, the other is what is known as a diagnostic mammogram.
The screening mammogram is that once-a-year dreaded nuisance, most women over a certain age must endure (especially if they are privileged to be insured). The diagnostic mammogram is the one you we get when either we or our doctor finds something a little funky amiss.
WE HAVE NO WAITING LISTS, SAY WHAT?:
In New York City Manhattan at the major university medical center where I go (I'd prefer to not reveal which hospital, but there are only about three or four major medical centers in Manhattan), the wait for a screening mammogram is over one year.
LITTLE BREAST LUMPS--A MANHATTAN STORY:
I had a tiny lump--no big deal my ever vigilant, brilliant and very sensible doctor assured me--repeatedly, I should add. But he thought I needed a diagnostic mammogram and an ultrasound.
Coincidentally I was already scheduled for a screening mammogram so I thought a quick call to the breast imaging clinic and I could easily change the appointment. No way. I was wrong.
I was told that the earliest appointment available for a diagnostic mammogram and ultrasound was over a month away. At the precise moment you need the healthcare system to function at maximum efficiency--it collapses in a shambles.
I had the diagnostic mammogram and the sonogram and everything is totally normal, thank you God. Nyceve will live to fight another battle. But while I waited for my name to be called in that pretty little room designed in soothing neutral tones, to help you forget about how long it took to get there, I heard the same story from all the women--about waits.
Women in a mammography waiting room bond very quickly. We exchange worried glances, horror stories and tales of courage. But there's one overriding reality we all share. The truth of the waits in the country with no waiting lists.
THE ENDLESS WAITS:
A lovely middle-aged woman described her situation. She had come for a routine screening mammogram on August 1st. On September 5th, she received a call from the clinic. They told her her mammogram was decidely irregular(asymmetries and calcifications--not good), they told her the earliest follow-up available for a further mammogram and a sonogram was today, September 21. Almost two months from the time of the original screening mammogram.
She was appalled, frightened, ashen and aghast--she took what they had--she had no choice.
I'm sorry to say that if you do find yourself with a lump, trust me, you'll run a gauntlet just like this woman. You may even say to yourself this must be what life in the Third World is all about. You may be correct.
Mammography clinics are closing, so if you're a female, do yourself a favor and try and stay healthy. You should also know that these doctors who specialize in mammography are doing heroic work. They are doing the best they can, they are swimming upstream, they are not getting the money they need and deserve despite White house photo ops and bullshit.
Like I said, these doctors are doing the best they can heroes.
Dr. Eva Sciandra, a member of the panel and director of cancer prevention strategies for the society, said the group of experts combed through reams of data to find key problems.
"The strike force looked at a lot of information that very strongly suggested there is a downtrend in the number of physicians choosing mammography as a specialty," Sciandra said.
She noted that analyzing mammograms is difficult and requires extraordinary skill. "It involves reading X-ray films, and in many instances these are X-ray images that are digitized. Physicians have reported in many published surveys that it is very tedious to be closeted for a period of time to analyze the films. The level of responsibility is very high. They can't miss anything suspicious because if they do a woman may have to undergo an unnecessary biopsy."
Physicians, she said, also report extreme stress, and many have fled the specialty. There is also a fear of litigation. "The missed diagnosis of breast cancer is the single most common cause of malpractice suits," Sciandra said. "So in looking at this trend of fewer and fewer physicians going into breast imaging, you can see how that is having an impact on women getting an appointment when they want a mammogram."
Difficulties with obtaining appointments, she added, vary within New York. "In upstate New York there is not a significantly long wait time. There are longer wait times in the city, but usually shorter in Manhattan than in the other boroughs. There are certainly longer wait times on Long Island."
http://www.newsday.com/...
A FEW ADDITIONAL POINTS ABOUT THE BEST MOST EXPENSIVE HEALTHCARE IN THE WORLD:
Whether you're supporting her or not, you should know that Senator Hillary Clinton has been a loyal advocate in the effort to restore funding to mammography clinics. She is a co-sponsor of the Access to Medicare Imaging Act of 2007 (S.1338). Funding for myriad health care programs, as you undoubtedly know, was cut by the Republican Deficit Reduction Act of 2005.
A couple more things worth noting.
I'm not even touching the awful subject of the financial ruin facing women Americans who receive an awful diagnosis of cancer. If you're curious, take a look at Jane Hamsher's bills. Jane has insurance. Nuff said.
G E Healthcare is a division of General Electric. G E Healthcare manufactures a huge variety of very sophisticated imaging and medical devices. G E Healthcare has on its website a Medicare reimbursement calculator. This is a fun little tool. Plug in your state and you'll get a real good sense of what Medicare is paying for this life-saving test. Very, very little.
If you're your doctor is lucky, the for-profit insurance industry, follows the lead of Medicare and pays about what Medicare does for a mammogram. Sometimes your doctor isn't so lucky. The last time I had a mammogram, my insurance company thought the Medicare payment was excessive and paid a magnanimous $16.00. But as they say, that's water under the bridge.
There's a bit of good news on the horizon. A new techology called tomosynthesis could be in our future. It can supposedly detect even smaller cancers and yes, ladies, it involves less compression and is less painful.
Tell us please about your waits for medical care in the nation with no waiting lists.