Pragmatic look at OHS

[dick0236]

Much is being written here concerning heart surgery and "re-ops" down the road. I'd like to pose a few questions regarding future costs.

When I had the surgery, in 1967, the total cost was under $8000 including 14 days in hospital, valve cost and doctors/surgeons fees. That cost today is 10 to 15+ times that amount and is increasing at an increasing rate. Many patients now have to pay an "out-of-pocket" share that is greater than my total bill. Back then I think I paid under $100 as my share.

I entered the health care funding business in 1978 as a Group Health Care Consultant. At that time a very comprehensive "family" plan was under $50/month. When I retired in 1997, that cost was +/- $600/mo and the plans no longer had all the "bells and whistles". I get the idea, today, that premiums have continued to increase at rates uaffordable to many people. I am currently on Medicare that takes the "sting" out of my health care costs......but that will change because the current USA system has to change to survive.

We see current action by insurers or government to limit, deny or cost shift services. Most recently, the situation in Arizona denying transplant surgeries. We expect health care innovations too continue, but at what cost, and who will pay that cost. Few of us could write that check. When doctors or hospitals say "oh, we'll just do it again in a few years"........uh, who pays and how much? My experience in dealing with most doctors is that they have "no clue" what health care costs......so long as they can make their next Mercedes lease payment.

This is not a political statement and little of these changes will affect me at my age, but it will be true for those of you at mid-life or younger. It might be wise to try to limit "known exposures" to a health system where the costs are totally out of control.

PS: I just remembered an old cartoon from years ago...."Old age can be defined as the time in life when ones financial assets are transferred from his bank account to his doctors bank account":tongue2:.

 

[neil]

luckily enough i live in england where we dont have to worry about this, but for you guys elsewhere it must be a worry

 

[normofthenorth]

Good Qs, Dick. I wish I had answers for them. You'd think that these Qs would factor into the discussion about options, including valve choice, but they seem not to. The med-insurance companies seem to make some choices (by disallowing some options), but they don't usually get involved in advance -- e.g., by refusing to pay for a tissue valve because they don't want the liability of replacing it later. And ditto with the Ontario provincial-government insurer up here. With the government pensions, you've got actuaries and such doing the math and figuring out how bad it's going to be; with the upcoming wave of "re-dos" from today's tissue-valve HVRs, I doubt that anybody's doing any math.

If it's any comfort, I think the situation with my previous infirmity -- a ruptured Achilles Tendon -- was even screwier: The latest randomized-trial studies (all since 2007) have produced pretty solid evidence that the best NON-surgical treatment for an AT rupture (shove it in a boot, non-weight-bearing for 2 weeks then gradually return to walking, Physiotherapy and exercise starting at 2 weeks, ditch the boot at 8 weeks) produces results that are statistically identical to the standard surgical repair in every way EXCEPT that you skip the scars, the infections, the sutures that "bubble up" instead of dissolving, and most of the Deep Vein Thromboses! Identical in strength, range-of-motion, and re-rupture rates! Oh, yes, they're also NOT identical in COST!! The boot and the Physio sessions cost about the same either way, but the surgery itself is around $12k-$15k in most US hospitals. Most patients are still being rushed under the knife by their local surgeons, and the insurance companies just pay the bills.

And now the political part: I'm a US Expat, living in Canada, and the US medical system looks pretty dysfunctional to me from here -- sorry friends! I mean, what's the use of becoming the biggest, richest, most powerful nation in the world, if you've got to live in fear of getting sick, or needing a life-saving operation that you can't afford, maybe because you or your spouse lost a job at a bad time. Hello?!?

 

[Lily]

Interesting, since many of us hope to live long enough to need a valve replacement, those with either mechanical or tissue.

Of course, the continuing development and implantation of percutaneous valves may happily continue on the horizon!

Oh, but what about the expense of regular anticoagulation therapy and all of those clinic visits, for the average working and insured person with a high yearly deductible? Not to mention any possible complications.

Being born with a bum heart can be expensive. Of course, so can most of the issues that people will eventually succumb to.

 

[dick0236]

luckily enough i live in england where we dont have to worry about this.....

My granddaughter recently married a young(32) Englishman. He concerns us because he refuses to purchase health insurance on himself. I guess he is counting on going home to England for any future care.....otherwise, he and his parents will be in for a $$$ shock:frown2:. I would also like to know how ya'll fund your "womb too tomb" coverage:confused2:.

 

[Michelle D]

I don't know how much my surgery totaled because my husband wouldn't let me look, but I did just receive 32 seperate bills from the Cleveland Clinic, yes I said 32, for things my insurance wouldn't cover. I have BCBS PPO, and the best policy you can get. But I still owe them an arm and a leg. I know from going in after surgery for a 1-1/2 day stay at my local not-for-profit hospital and the bill was around $30,000 and they didn't do anything but an x-ray and ultrasound. At 28 years old and don't plan on there being any government assistance left, and I can't imagine what will happen. I think eventually it will become so expensive that people will just start dying from things that are treatable and then finally the system will have to change.

I just have to tell my uncle's story real quick. He is 42 years old and has diabetes, he had a stroke and can no longer work because of physical and mental impairments. Because he was working previous to this (approx. 5 months ago) he cannot get on social security and Medicare (or Medicaid) not sure which one. Because no neurologists will see him he has permanent damage that could have been reversed eventually. Because he can't see a family practitioner and get his medications he is in and out of the ER a few times a week because his sugar will sky rocket and he goes into diabetic comas. All of the doctors he sees at the emergency room have told my dad (his brother) that if he could see a regular doctor to have certain tests and procedures done he'd be able to manage this, but now he is under the care of hospice and nobody expects him to make it more than a few more months. Each time he goes to the ER to be stabilized it makes things even worse the next time he crashes. I don't know all the details but I know my father who is trying to do everything he can to save his little brother is beyond frustrated because he can't find one doctor that will see him.

I may not understand what it is like to have out of control diabetes or a stroke, but I know each time I went to the ER after my surgery they'd put my one horrible meds that my cardiologist would immediately take me off of, they'd give me narcotics that would put my palpitations into a frenzy, and I'd take a step back each time from laying around in a hospital bed on hardcore drugs. If that is all I had to rely on, first off I'd have a mechanical valve and not a repair valve because that is my only option in the local hospitals here. I probably would have died before I could have even gotten one from asphyxiation because I would have kept assuming it was asthma not heart failure. Yeah I'm being slightly dramatic, but I only go to the hospital if my doctor tells me to so I wouldn't have gone and found out what was wrong until someone called 911 from me collapsing dead. Really I hate hospitals. So I'm glad I have insurance and I feel bad that my husband is stuck at a job to keep the insurance. But long before any of this heart stuff without insurance I would be dead from cervical cancer at 20 years old anyways. Sorry for my rant, I don't have answers for how things should change but something's gotta give.

 

[OldManEmu]

Dick health care costs are rising all over the world however, health inflation is much worse in the US than other developed countries.
I have attached a link below that clearly shows just how much more health care is costing the US economy compared to other western economies.

http://www.reuters.com/article/idUSTRE5504Z320090601

I never cease to be amazed at some of the figures people post regarding surgery cost in the US and even the exorbitant charges made for the valve itself.
Given that most valves are made in the US I have attached the Australian cost of these valves from about two years ago.
Here are some valve prices in AUD.
STJude 'Regent Prosthetic Heart Valves 25-29mm 6K
STJude 'Regent Prosthetic Heart Valves 17-23mm 6.5K
ON-X 'Aortic On-X Prosthetic Heart Valve 19-33mm 5.5K

My own Medtronic Mosaic
'Mosaic Aortic, Mitral Model 305 & 310 19-35mm $4445

Do not forget that these valves are being sold for a profit in Australia.
If people are being charged more than this in the US people need to ask why?
The cost of health care in the US would be far less of an issue if it was more closely aligned with other western countries.
This cost differential needs to be addressed at some point.

 

[Missy]

This if forNeil Brewer or anyone else that knows.. Maybe you could explain the health care system in England. I also would like to know if you like it and think it is adequate.
Thanks

 

[Missy]

luckily enough i live in england where we dont have to worry about this, but for you guys elsewhere it must be a worry

Will you tell me about Englands insurance and if it is adequate. Thanks
Maybe the USA should take lessons .. we tend in this country to have so much red tape and confusion. By the time our politicians get through with something.. they take a good idea and ruin it.
Maybe it wouldn't be for us but maybe it would..

 

[dick0236]

Dick health care costs are rising all over the world however, health inflation is much worse in the US than other developed countries......
.....The cost of health care in the US would be far less of an issue if it was more closely aligned with other western countries.
This cost differential needs to be addressed at some point.

Thanks for your post and the "Healthcare costs in US vs rest of world" insert tells it all. Now I understand why so many US Corporations have moved their customer service "call centers" to India....health care cost per capita $36(India) and $6657(US). It also explains why we have so many Indian docs practicing in the US.

When I was active in the health insurance business, computers and the Internet were not around. The standar argument used by insurance companies, hospitals and our Government was that other countries had very inferior health care to the US....that care was rationed....and if we didn't like it, tuff ****.

With the internet, we find that you folks have every bit as good....or even better than, what we pay "an arm and a leg for".

Since we can't beat 'em, we will just have to......what?:confused2::mad2::mad2: Unfortunately, we have many, many financially powerful political lobbies and change will come very slowly.....until the system breaks down completely and that will not be too long.:frown2::frown2:. Maybe you will loan us some money cause I think we have just about tapped the Chinese dry.

 

[OldManEmu]

Dick in India hundreds of millions of people have no realistic access to health care so that makes their expenditure look low.
The important figure is the percentage of GDP being spent, most western countries listed are between 8% and 11%, the US is almost 16% this is 50% greater and these were 2006 figures so it is most likely more now and this difference will not be sustainable long term.
This 16% is currently being met by employers providing insurance to employees making US companies less competitive, tax payers via government programs such as Medicare and Medicaid, hospitals with bad debts from the uninsured and inflated insurance premiums to pay inflated hospital costs trying to cover bad debts.
Unfortunately I think you may be correct

change will come very slowly.....until the system breaks down completely and that will not be too long

I am pleased there were a few left over Indian doctors for the US I thought they were all in Australia
:tongue2:

 

[Bryan B]

And now the political part: I'm a US Expat, living in Canada, and the US medical system looks pretty dysfunctional to me from here -- sorry friends! I mean, what's the use of becoming the biggest, richest, most powerful nation in the world, if you've got to live in fear of getting sick, or needing a life-saving operation that you can't afford, maybe because you or your spouse lost a job at a bad time. Hello?!?

It might be like that in some places in the US but that has not been my experience for people in financial distress. Yes I have been though hell the last 6 months trying to get financial help because my doctors put me on a "work restriction" which did not allow me to keep continuous health coverage. But as long as it took for Medicaid and SS Disability to come to a decision they did, and I was accepted on the first attempt. Also Duke Medical Center (my hospital) has a charitable hardship program for people who can not qualify for financial assistance but meet their basic requirements (basically being too poor to pay the bill). My church offered to start a charity benefit to raise money if needed. I am friends with members of a popular regional band in my area that offered to have a concert with several other popular bands in the area to raise money if needed. People complain about the cost of health care in this country but I don't hear them complain about the quality of health care they receive and the lives that are being saved by new technology that our country is at the forefront of. I hear people complain about the cost of medication in this country but I don't hear them complain about the new medications that are saving lives that were not able to be saved before.

I agree that some changes need to be made...but put health care in the hands of government? You have to be kidding. Name one other industry they have been successful at running? I'll give you a hint...NONE! Also ask patients in nations with nationalized health care about the waits they have to endure for non emergency situations. Better yet, ask them how much more they pay in taxes a year for this "free service". When you balance out the added taxes and the bureaucracy of government run health care I don't see where there is an advantage.

If anyone has some type of compromise between private health care and government health care I am all ears, but both systems have their flaws and you are going to have to pick your poison.

Finally...after my surgeon examined me he came to the determination that he was going to do the surgery with or without me being accepted for financial assistance. Now that my friends is a good American doctor. He realizes that saving my life is more important than (as someone put it) the next payment on his Mercedes Benz.

 

[Philip B]

Pragmatic?

Pragmatic?

Costs associated with cardiac procedures and operations have spiraled upwards. Personally, I've had the misfortune of receiving pretty lousy insurance coverage from employers on more than one occasion.

When I was in my twenties, I had to default on a $2,000.00 bill I owed a cardiologist because my insurance refused to pay. The heart cath procedure that I had done was at an out of state hospital.

In 2007, we had to figure-out how to pay our $80,000.00 share of the $250,000.00 my AVR surgery cost. Even more recently, 2009, the same insurer we had during 2007 required that we pay back around $10,000.00 because the company felt it shouldn't have paid expenses when I was a hit & run victim. The company insisted that my expenses should've been covered by the individual who ran over me. Now, if we could just figure out who that person is and hold him accountable.

The sad thing is that it's not really the fault of the insurance companies. What's that statement about people getting what they pay for? I got exactly the level of coverage my employer paid for. Lousy insurance is... well, it's lousy.

I do wonder how many people have the conversation like my wife and I did where we considered skipping my surgery because we weren't sure we could afford it. How many people look at the costs and pass on the surgery. That was one of the toughest conversations we've ever had. We're lots worse off financially, but it's nice to still be alive.

My current employer has great insurance, but my boss didn't really want me enrolled in the school district's plan. The district pays me a stipend to take my health insurance business some place else.

-Philip

 

[OldManEmu]

Bryan I find it interesting that you consider can rattling by your church or a charity concert a good way to fund your health care.
Medicare US cost as a percentage of claims 2010 3.3%, private funds 8.9% excluding commission after commission 16.7%
from www.cahi.org/cahi_contents/.../CAHIMedicareTechnicalPaper.pdf
Here is the Warren Buffet opinion on US health care costs and he has been more successful than any of us.
http://www.reuters.com/article/idUSTRE62022120100301

 

[neil]

yes i consider myself very lucky living in england,all health is paid for by our taxes,myself my wife and all my children have needed the health service at some point, i have only praise for them,when i needed my ohs i was treated absol brilliant,i had a top cardio and surgeon and the after care was top notch,so no grumbles at all from me,i often read sum of the stories on here about private insurance etc and feel so lucky not to have to consider that,

 

[Duffey]

My first replacement was covered under two BC insurance plans--mine from work and my husband's.

I ended up paying less than $200.

I doubt that I will be that fortunate next time around.

 

[ShezaGirlie]

A little clarification ..

A little clarification ..

I agree that some changes need to be made...but put health care in the hands of government? You have to be kidding. Name one other industry they have been successful at running? I'll give you a hint...NONE!

Uh Bryan ~~ FYI, that socialist healthcare (Medicaid) you've been approved for is run by the government and that socialist Social Security disability payment you're getting is also run by the government..:thumbup:

A couple more of those socialist healthcare government programs are called Medicare and Veteran's health benefits..! Boy, don't try and touch one of those 'cause you'd get your hand whacked by gramps and granny and all the war veterans...:mad2: Yeah, trusting that 'government' stuff is not for everybody, is it..??:biggrin2:

 

[Greg a]

History of health care in Canadahttp://www.civilization.ca/cmc/exhibitions/hist/medicare/medic00e.shtml

http://www.hc-sc.gc.ca/hcs-sss/medi-assur/index-eng.php

Canada's national health insurance program, often referred to as "Medicare", is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis. Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage. Framed by the Canada Health Act, the principles governing our health care system are symbols of the underlying Canadian values of equity and solidarity.

Roles and responsibilities for Canada's health care system are shared between the federal and provincial-territorial governments. Under the Canada Health Act (CHA), our federal health insurance legislation, criteria and conditions are specified that must be satisfied by the provincial and territorial health care insurance plans in order for them to qualify for their full share of the federal cash contribution, available under the Canada Health Transfer (CHT). Provincial and territorial governments are responsible for the management, organization and delivery of health services for their residents.

AS YOU READ ABOUT ME KEEP IN MIND THAT TODAY I STILL SEE A HEALTH CARE PROFESSIONAL ABOUT EVERY TWO WEEKS AND THROUGH ALL THIS I HAVE NEVER PAID A CO-PAY OF ANY FORM ​

May 8, 2007 enter hospital short of breath and have an angiogram that shows numerous blockages

May 11 open heart surgery lasting 7 hours and comprising of five bypasses and one valve ring support

May 11 -25 Life support as the Dr's cant awake me and they tell my family that they don't know if i'll ever come out of it

May 26 fourteen days after surgery I wake up

Still unaware of my situation i am weaned from all of my IV's

I am moved to a recovery floor where a groin infection plagues me

I am then moved to a rehab floor where upon complaining about a sore lower back a surgeon removes a cyst

June 13 my original surgeon looks at my incision and he sticks a finger in it up to his knuckle and then informs me that he is going to have to tiighten a wire holding part of my breast bone in place and so..............

June 16 i am back in surgery to tighten the wires holding my sternum and ribs in tact

I was home in July but dropped in our drive in August

Gee since then i was back in hospital with a massive infection and that resulted in them removing my sternum/breastbone in August again i was out of it (coma) for 14 days and the family was all gathered but i pulled through and was finally out of hospital mid october

I am still off work (don't know if I even have a job) but it is GREAT to be alive

I have a Medtronics ICD implanted in July 2008 and a patient in the RAFT study by the Ottawa Heart Institute but implanted at London Health Sciences and Monotored by St Marys here in Kitchener

I was "paced" on August 17,2008 but was not aware until Sept when I attended at the Implant Clinic for my second monitor reading then on Nov 23 it once again tried to pace me but failed so the defibultor kicked in and brought me back... It was 10:30 am and I was sitting injecting insulin and wondered why it was taking me longer than usual and only found out in Jan when I was on for the RAFT study monitoring

Then Feb 18,2010@2:30pm I was once again revived unbeknown to me until I was at the Heart Function clinic @ St Marys and as my Cardiologist was telling me I could not drive he said that on the bright side we knew it worked and I should stop testing it ..... sure he has never been a passenger with my wife driving ........ just kidding honey you are a much better driver now that I keep my eyes shut

My ICD has saved my in more ways as stated I have no sternum and CPR would do me in .... by the way my implant was done as an out patient booking in at 8am and leaving at 2 pm.

I have been in touch with only a couple of others whom have had a radical sternectomy and have given me hope in knowing that I am not alone. If you feel the need I can provide you with more personal contact information for us ( I say us as my wife may be better able to see it from your side) I will provide you with email info and from there we can send phone numbers...I think Sharon would be great to talk to as she was there all along doing the hard work while i slept LOL


I had not been able to work for some time when entering hospital in 2007 and have only paid $100 co-pay for scripts each year and one $40 ambulance surcharge I am still unemployed and now the Government is willing to retrain me for a less physical job with up to three years education

While Neil feels good about being from England...I am proud to be Canadian

 

[Bryan B]

Bryan I find it interesting that you consider can rattling by your church or a charity concert a good way to fund your health care.
Medicare US cost as a percentage of claims 2010 3.3%, private funds 8.9% excluding commission after commission 16.7%
from www.cahi.org/cahi_contents/.../CAHIMedicareTechnicalPaper.pdf
Here is the Warren Buffet opinion on US health care costs and he has been more successful than any of us.
http://www.reuters.com/article/idUSTRE62022120100301

OldManEmu,

First of all I just stated my opinion so don't even think about making it personal or I am totally willing to do the same. I was just stating that there are good people in our country and both the church and the band offered to do this without my solicitation. I really don't care about Medicare costs or what Warren Buffet has to say. We have had many different leaders/government on both sides of the aisle over the years that have neglected to have the foresight to make needed changes to the system. Medicare IS government run health care...not working too well either. With better health care comes people living longer. As the population continues to grow and people live longer the costs (both private and government) continue to grow. So what are the solutions. Go to nationalized health care which will not only reduce the quality of the care we receive now but cause insurers and pharmaceutical companies to be forced to make drastic cuts if not go out of business completely. That is exactly what we need now...more huge job losses. Nationalized health care will also create a shortage of qualified doctors, which in turn will lower the quality of care. How many doctors, many who like my surgeon spend 12+ years in training before they start to make the money most people don't think they deserve, will stop practicing because it is no longer profitable. It takes many of them who used student loans to get through their training several years just to pay them off and get back to the break even point.

ShezaGirle,

Yes I know and I payed my azz off in taxes for 25 years to get these "benefits". My SS disability payment would barely pay the rent. There is no way I could live on my own with the payments I will receive. I have a 20% deductible I have to pay with Medicaid based on what my disability payment is. I can only see doctors or receive treatment by doctors or facilities that except Medicaid which is becoming more difficult to find because of what they are willing to pay. So yes I am getting help from the government but it is not all that it is cracked up to be. As far as VA benefits...if it wasn't for our veterans we probably wouldn't be here having this debate.

I have probably heard about an equal amount of complaints and praise from those who live in countries with nationalized health care. What I would like to know from those people is what percentage of your salary is going towards taxes to fund it. From what I have heard it's anywhere from 10-20% which is no more than the average person would pay in insurance coverage for health care in the US. I realize that much of this debate is fueled by people's political party affiliation. You would think that I would be the poster boy for nationalized health care...but IMO I am the exception and not the norm. The only thing I agree with is that pre-existing condition clauses need to be reduced or eliminated all together. If it was not for this I wouldn't be in the situation I was.

Having said all of this...remember that everyone here has a right to their opinion. While we might not agree about a subject we all need to keep it civil. No one was "rattling cans" for me or at my request. These were offers by very caring people IN CASE the government denied me assistance. I guess the myth that everyone gets denied on their first attempt is either false or has changed recently. But like I said I have been donating to this "fund" (without choice) for 25 years, and so have perfectly healthy people who have never had to rely on it so I have no problem receiving the assistance. If my surgery is successful I will most likely be off of the "government dime" within a year.

 

[Bryan B]

History of health care in Canada

http://www.civilization.ca/cmc/exhibitions/hist/medicare/medic00e.shtml



AS YOU READ ABOUT ME KEEP IN MIND THAT TODAY I STILL SEE A HEALTH CARE PROFESSIONAL ABOUT EVERY TWO WEEKS AND THROUGH ALL THIS I HAVE NEVER PAID A CO-PAY OF ANY FORM ​

May 8, 2007 enter hospital short of breath and have an angiogram that shows numerous blockages

May 11 open heart surgery lasting 7 hours and comprising of five bypasses and one valve ring support

May 11 -25 Life support as the Dr's cant awake me and they tell my family that they don't know if i'll ever come out of it

May 26 fourteen days after surgery I wake up

Still unaware of my situation i am weaned from all of my IV's

I am moved to a recovery floor where a groin infection plagues me

I am then moved to a rehab floor where upon complaining about a sore lower back a surgeon removes a cyst

June 13 my original surgeon looks at my incision and he sticks a finger in it up to his knuckle and then informs me that he is going to have to tiighten a wire holding part of my breast bone in place and so..............

June 16 i am back in surgery to tighten the wires holding my sternum and ribs in tact

I was home in July but dropped in our drive in August

Gee since then i was back in hospital with a massive infection and that resulted in them removing my sternum/breastbone in August again i was out of it (coma) for 14 days and the family was all gathered but i pulled through and was finally out of hospital mid october

I am still off work (don't know if I even have a job) but it is GREAT to be alive

I have a Medtronics ICD implanted in July 2008 and a patient in the RAFT study by the Ottawa Heart Institute but implanted at London Health Sciences and Monotored by St Marys here in Kitchener

I was "paced" on August 17,2008 but was not aware until Sept when I attended at the Implant Clinic for my second monitor reading then on Nov 23 it once again tried to pace me but failed so the defibultor kicked in and brought me back... It was 10:30 am and I was sitting injecting insulin and wondered why it was taking me longer than usual and only found out in Jan when I was on for the RAFT study monitoring

Then Feb 18,2010@2:30pm I was once again revived unbeknown to me until I was at the Heart Function clinic @ St Marys and as my Cardiologist was telling me I could not drive he said that on the bright side we knew it worked and I should stop testing it ..... sure he has never been a passenger with my wife driving ........ just kidding honey you are a much better driver now that I keep my eyes shut

My ICD has saved my in more ways as stated I have no sternum and CPR would do me in .... by the way my implant was done as an out patient booking in at 8am and leaving at 2 pm.

I have been in touch with only a couple of others whom have had a radical sternectomy and have given me hope in knowing that I am not alone. If you feel the need I can provide you with more personal contact information for us ( I say us as my wife may be better able to see it from your side) I will provide you with email info and from there we can send phone numbers...I think Sharon would be great to talk to as she was there all along doing the hard work while i slept LOL


I had not been able to work for some time when entering hospital in 2007 and have only paid $100 co-pay for scripts each year and one $40 ambulance surcharge I am still unemployed and now the Government is willing to retrain me for a less physical job with up to three years education

While Niel feels good about being from England...I am proud to be Canadian

Niel I am glad that you survived your ordeal...you sound like a real fighter. I agree that with all of your complications you were lucky to have free coverage, but I have to ask you a frank question and I mean nothing personal by it...I just want your honest opinion. Do you think all of these complications would have happened if you were at the Cleveland Clinic or do you think they were all unavoidable?