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Hi Teri,
Thanks for the break out. During his Health care review last night, I was very interesting in hearing his thoughts on "evidence-based care." This really is common sense, letting doctors treat patients as they should rather than have "others" dictate treatment.
Another very important point is those who are happy with their insurance can keep it, making no changes. Or people who are employed but not offered health care with their employer would be able to get health care. And a vital piece of the picture would be those who are currently uninsured would finally be able to get affordable health care.
It sounds like we may be on to something.
Dear Teri,
First off having worked in healthcare and being affected severely by migraines to the point of financial breaking to cover costs while being unable to work I am hopeful that our president is able to fix our problem in America.
I feel everyone has a right to healthcare -- a universal right like food, shelter, clothing, peace of mind, etc.
It would also be nice to know what the doctors on this site have to say. What are there thoughts as physicians? Could you have our doctor specialists weigh in on how they feel migraine disease will be treated or affected. This could be helpful for those of us who are very worried.
Living in a modern country outside the USA for my husband's job has been a nightmare. When our president says we need a uniquely American plan, I hope and pray this is exactly what they are working on.
The country I have been living in has 3 distinct ways to get healthcare based on your wealth:
Everyone is taxed 12% of pay under a certain amount and then higher for each dollar over this amount.
If you have money + insurance you go completely private. I don't know a citizen of this country who has not begged me to go private due to the difference in quality of care and access these doctors have to better treatment even though we can not find a neuro that can help and per the neuro foundation there is no doctor in a country with the population of the state of Indiana that is a migraine specialist. Not one.
I have tried both and found it unfortunate that private care quality was far superior.
A private consult with a neuro is $350.00. Each follow-up is $150. This has been the case of the last four neuros consulted.
You also purchase insurance if you have the money.
I know one American in the country holding THREE private health insurance policies because she can afford to, the average person could not. She has chosen to due to the poor running of public care and the lower quality.
Private hospital - astronomical.
If you can't afford it you go public. Still a doc's visit for primary care is $45.00-100.00 based on your income and the geographical location of the physician (rural or suburban vs central business district).
Getting a script refill is generally $15.00 per GP offices.
There is no dental coverage under their scheme. You pay out of pocket. My husband's root canal was $2,000.00 last year.
If you still can not afford public care that is available to everyone...
There are charitable clinics where the fee for a GP is $10-45 and if you are direly poor you may qualify for a community service card to subsidize this cost.
Most prescriptions are $3.00, but not all and not if written by a specialist that is not a public provider you then pay the higher cost which can be easily $30.00 as high as $145.00 a month for my topirimate.
To have the reduced cost a local district health board must approve the drug necessity especially if it is not frequently used.
The government puts out contracts with different pharmaceuticals and the lowest bidder wins, however they have only two triptans on contract in the country. A Canadian physician I have met and discussed the system with stated, "I feel I am treating disease with 1/4 the meds available in the USA and Canada and not able to give the most therapeutic drug, it isn't here."
However, you also have to realize that you can buy sumatriptan by simply presenting at the pharmacy and stating you have or have had migraine -- how dangerous?
You can present and purchase opioids without question in boxes of 12, 24, 100.
In light of the recent swine flu scare you could present and state you had flu-like symptoms and purchase Tamiflu without an rx for $75.00. Now that they think they will run low with the pandemic you finally must have an rx.
You can purchase diflucan, orlistat, and I could go on and on, all meds that your doctor should be aware you are taking, but will never know if you purchased full RX strength orlistat (not like Alli) and used it or any other drug like a combination of a sedative, codeine and acetamenophine pharmacists tell you to use if you have migraine. You basically self medicate for your illness until it is so bad you need to go to the doctor.
Where has the concept of preventive care gone in a country with a system fully in place? This is not safe for patients to self diagnose and treat with rx strength medicines.
This is what I have seen. These are things that scare me and make me pray we do have a uniquely American system that truly covers all people with the same quality of care regardless of if you are insured privately or go publicly, but I struggle to see how we will not end up with a tiered system as well.
Our doctors are overworked by rules and regulations. I am pleased to see this acknowledged, but this happens in the public health system too.
You go through lots of paperwork to prove necessity to your local district health board which in essence acts like the big arm of our insurance industry trying to control costs by refusing the patient the drug a doctor feels is most appropriate.
My hospital stay for migraine in this country put me in a ward with five women. I was there for four days and never saw the same doctor more than once. I was rx'd ultram, codeine and morphine together.
They could not start an IV easily so I was left vomiting. I could not have gotten these pills down if I even had felt comfortable with the combination.
It was loud and noisy with all these women and as they were severely ill unable to control their bodily functions, the odor of soiling was unbearable to deal with for hours at a time with migraine.
I fear that we could find ourselves in a similar situation? I hope that our president really takes this carefully, but we can not seem to keep medicaid or medicare well funded.
Naturally, I find my personal experience living in a country with public healthcare where people still can't afford it and the wealthy go private because the public care is not that good concerning.
Is the president looking at higher taxes or a single payor model? Do we have information on this yet? If so, please share ASAP.
I appreciate very much your post to highlight these things and to help ease anxiety and will say without question I sincerely hope you continue to give us updates.
I will say that if it seems the US has too few migraine specialists, this country has none. Migraine is not perceived as life threatening, they do not believe in rebound headache and as such it is pushed to the very bottom of the list.
I asked one doctor why the system in this country was as it is regarding migraine and he said, "It isn't a health threat, it can't kill you like cancer. Chronic pain comes last in funding."
I have been working with a pharmaceutical company trying to bring injectable sumatriptan to the country and they have told me how difficult this is and how undertreated migraine is, it is barely recognized.
So Terri, please keep it coming! We need to hear this information and help dissecting it is needful for those of us who have experiences like mine that make this all very frightening, or simply those who may not understand what information we are getting, or just feel uncomfortable and anxious about this kind of change.
The average salaried surgeon in the country of reference was reported in the paper a few months ago (a surgeon) of making $100,000/year.
I would assume this is less than what a good many surgeons in this country make and these surgeons are paid by the government, they are not private in which they would make much, much more. Will our doctors seperate into financial brackets due to less pay and will we have a three tier system too? Or will our doctors still be paid well? I am wondering how fee for service vs salaried or non fee for service may affect us and who will go private, who will go public?
Some doctors there even participate in bartering for services advertised at the front desk -- it is a national network. It is a scheme where the doctor may help you and you may compensate the physician with a skill you can offer back.
I hope you can see why I have grave concerns and hope that you will continue to advocate and keep us informed. I fear migraine disease may fall to the bottom of funding leaving us all in a mess. I believe there is hope...I am just very concerned.
Lastly, if the presidential committee would listen to the migraine/pain organizations it would be awesome if in this global package of healthcare they are presenting would include and decrease the costs of alternate medicines which are frequently prohibitive, but are very helpful for so many (acupuncture, massage therapy, chiropractic care, biofeedback, and others). I hope you can have the ear of someone to make sure that migraine does not get left out of whatever will come of our healthcare system. You have worked tirelessly for the help we have along with the NHF, MAGNUM and others.
Thank you for your work.
This is what I posted on Teri's facebook thread on this topic:
There are a zillion sides to this debate, but we have the resources, brain power and compassion to provide quality health care to everyone in the U.S.
We just don't have the political will to fight the lobbyists and the propaganda. We can spend billions of dollars, possibly bankrupt the country, to bail out failing corporations, but we can't ensure that we all have access to health care? Plus the trillions of dollars we have spent on military weapons and equipment that is not used, becomes obsolete, or at inflated costs to begin with?
It is a matter of priorities, and while education, health care and the well-being of our country are somehow evil or socialistic, subsidizing corporate America, bailing out failing businesses and spending trillions on wars of choice (let alone all the lives lost and ruined by physical and emotional injuries!!) and wasted military expenditures are not?...
We need health care for all - now. And it shouldn't be dictated by profits. The present system is failing miserably and cannot be sustained. Unless you are extremely rich or have fabulous befefits with your job (and are not going to lose them, as many people are), you know this.
P.S. The majority of Americans have indicated they support health care reform and at a minimum a public option. If your Congress men and women do not follow the will of the people, they are failing at their jobs.
Betsy speaks my mind. We have a healthcare tragedy in this country. People are dying from dental absesses in areas where there are no dentists. Many of us who have health insurance can't afford what we have. While there have been problems with single-payer systems in other countries, studies show that in those countries people aren't left without basic healthcare, as they are in our country, every day. We can be creative, we can come up with a solution that works, as long as we don't allow vested interests to turn this "reform" into an inadequate bandaid on a gaping wound. We can learn from what's been done in other countries and build on top of it.
Any public option will put the private sector out of business when it comes to insurance. Government options don't compete with private ones. The Government option won't have to operate as a business; it has an unlimited supply of public tax dollars to subsidize itself. Government laws can always regulate and control all prices and costs the public option will pay. No private business can do either of those things ... ever. Every company out there that sees itself as crippled by having to provide employee health insurance options will immediately drop their employee plans from benefits leaving their employees two choices: cover their private plans solely out of pocket or go public. Their are reports that as many as 23 million more Americans will lose their health care as soon as a public option is passed, and that the public option being debated currently will only cover a fraction of the current pool of uninsured. Add to that the knowledge that those of us who are currently covering ourselves will now be taxed for being able to cover ourselves as though we ever see a dime of that money in our pockets, and our lives will only get harder as we struggle to maintain a standard of care. Also, you have to understand that migraine treatment is highly individualized and what is considered effective and efficient and cost effective will vary widely from individual to individual. Under any public option, you will be given the one-size-fits all treatment for migraine, and if it doesn't fit for you, too bad. We will lose our voice in our treatment options; our doctors will lose their voices. We'll be no better off than some of the people who visit this site from countries who currently have the public option for health care, and I think their experiences and frustrations speak for themselves.
No one says this system is perfect, but we need to start working with things like loser-pays-all tort reform to tame malpratice insurance costs. We need to open up insurance pools so that companies can compete across state lines so that we can draw insurance from bigger pool of people to lessen costs to ourselves. We need to start examining the mechanisms of Medicaid and MediCare - two currently existing public options that are rapidly going bankrupt and taking us all down with them - and finding ways to reform them before we add new entitlements into the mix.
""And in terms of how doctors are going to be reimbursed, it's going to be the same system we have now except we can start making changes so, for example, we're rewarding quality of outcomes rather than the number of procedures that are done.""
I find this concept particularly interesting. My recent experiences with pathetically lacking outcome in my search for migraine care makes me wonder if such a change is really feasible and if so exactly by what criteria would a "good outcome" be defined. --We tried 3 drugs and they didn't work. You are untreatable -- (my personal experience) doesn't not qualify as an positive outcome to me. Apparently that neurology office has a different opinion. Who will oversee such a plan?
We need to remember that most doctors are small businessmen. Yes, many are allied with local hospitals, and most are in group practices. Still, the vast majority of American doctors are the same as American plumbers, hardware store owners, barbers, etc.
These people have payrolls to meet, office and equipment rentals to pay, insurance payments to make. And, they have to stay current in their fields, just like electricians, plumbers, teachers, and engineers. Doctors' classes and testing to stay current are expensive.
American doctors, clinics, and hospitals lose money on certain patients - Medicaid, uninsured, etc. These costs are passed on to insured patients.
Please, don't tell me about the 43 million uninsured people in America. I'll ask you how many of those people live in subsidized housing while dressing in designer-label clothes, driving high-end SUV's, and watching 42" flat-panel cable premium channels while eating steaks paid for with food stamps.
Yes, I know there are people in the US who really can't get health insurance because of pre-existing conditions. For these people, there needs to be major reform in our health care system. But, letting the federal government do the reforming is like letting a bunch of fish design a spaceship. I'd rather see the doctors' office managers, these patients, a few of the doctors, and a few good insurance agents sit down and talk it over.
The problem with this type of concern about public health insurance fraud is that it doesn't really matter whether the uninsured are "deserving" or not (though I would argue that the number of uninsured who are enjoying lavish lifestyles is actually pretty small). The bottom line is that, we, as a society, are not going to turn away a sick or injured child (or adult for that matter) because their parent could have afforded insurance. So, regardless of what value judgments we may want to pass on those without insurance, as long as there is a large pool of uninsured, everyone will pay more and the system will not work.
alicep, what I was trying to say was: Let's have the people who are uninsurable because of preexisting conditions, like Migraine Disease, sit down with small businessmen, like doctors and insurance agents and office managers, and design a health care plan for their area.
Do this in areas of each of the 50 states, then hold discussion sessions/meetings for representatives from the smaller groups to forge a plan that will encompass the needs of most of us in the US.
BUT, keep the US and state governments and Big Insurance out of it all. Let the people who actually USE health care design health care coverage.
I understand what you're saying, Rebecca, but the group you'd want to get together to accomplish this would be even slower than the government to get anything done. If ONE insurance company can't settle ONE claim in a timely fashion, and many of them can't, they'd never get through a project such as this.
It really doesn't look like we're heading for a one-payer system with the government making decisions, so I'm interested to see what progress gets made.
Patients, doctors, insurance agents, etc., have had years and years to address this and did nothing. I'm not convinced they'd ever agree enough to get anything to together.
Anonymous, have you ever talked over a bill with your doctor? Or with your doctor and her/his office manager? Within ten min. my doctors and I have set up manageable payment plans.
I'm NOT talking about involving the big insurance companies, who have MBA's deciding on triptan limits. I'm talking about having local insurance agents, who write car and homeowners' policies.
I'm talking about groups of around 5-7 people, meeting together for 30-45 min, with a definite agenda. Then, these groups send a representative to a regional meeting of, say, 10-12 people for another 30-45 min meeting a week later, etc., so that, within 3-4 months, the issue has been discussed and decided, without involving Big Government or Big Insurance. Groups would never be large, so that discussions wouldn't get out of hand.
Teri,
So sorry not to have posted to this before. I'm embarrassed that I'm very vocal about the need for healthcare reform, yet I didn't respond when I first saw this. Shame on me! 
Obviousily, the economy is a major issue for our country. Beyond that, I think that the two issues that most impact the future of our contry are health care and education. This country is going to slide downhill big time if our citizens aren't healthy and well educated.
I don't think there's much question that our healthcare system is horrifically flawed, but I don't think a one-payer system is the answer either. You and I both know of a woman in Canada who died of an aneruysm while waiting for an MRI. I wish everyone who thinks the Canadian system is so perfect could personally know of such cases so they'd better understand.
This is another of those cases where everyone wants better healthcare, but nobody wants to pay for it. No, I don't want to pay for healthcare for people who won't work so they can afford insurance, but I also relaize that some of those people are trying, and some of them aren't. Some of the states instituted plans where welfare recipients had to work at assigned jobs to get their benefits. Surely, something like that could be implemented to fit this situation too.
Well, I could go on and on, but I won't. You're right though. This needs to be a major discussion. I'll be contacting my Senators and House member to see where they stand and what they're doing to help.
Namaste,
Abi
The following countries are some that have one form of universal health care or another( this list is in no means complete) : Argentina, Australia, Belgium, Brazil, Canada, Chile, China, Cuba, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Japan, the Netherlands, New Zealand, Russia, Saudi Arabia, Spain, Sweden, South Korea, Sri Lanka, Ukraine and the United Kingdom.
Many of these countries have had this type of health care for many years. The United Kingdom's system was developed after WWII thinking health care should be available to all. The United States, I believe, is the only industrial nation left without a health care policy for all. Ummm. As the biggest and brighest, why are we last on this.
Enough already with "I'm not paying for someone else's health care" when it is available for everyone now. But you're ok with paying for all those bank bailouts? What part of this am I missing.....
People who need health insurance but cannot afford it or are underinsured don't get the help they need. BUT, the banks and bankers at the top with big salaries, you all are ok to pay for??
Help me out here..
Nancy,
I guess I didn't make myself clear enough. First of all, I don't think single-payer healthcare, paid for by the taxpayers is the way to go at all. The care in many of the countries you listed is hardly all it's cracked up to be. Teri and I were talking just the other day about a patient in Canada who died while waiting for an MRI because there's such a long waiting list. I have friends in both the UK and France. They pay for extra health insurance.
On the cost, I was (unsuccessfully) trying to refer to the objection I've heard about the taxpayer paying for insurrance for people who don't have jobs because they don't want jobs. Personally, I think those people are few and far between, but the "plan" is to make insurance available for everyone to purchase and for the taxpayers to subsidise the cost for those who can't afford it. To my way of thinking, if someone is able to work, but not working, that's where the work programs such as those some states use for their welfare programs come in. No, I don't mind at all if my tax dollars go to cover people who legitimately are working and can't afford it or CAN'T work and can't afford it. BUT, yes, if someone CAN work, then they should have to work for their health insurance coverage.
Namaste,
Abi
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What an eloquent post. Good job, Terry. It will be a pleasure to honor our new Presidient by becoming pro-active in our healthcare system, instead of "letting someone else take care of it". Thank you for the post!
Thank you; and you're welcome. You probably already know how much I believe in being proactive!
Teri