Pragmatic look at OHS

[Greg a]

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?

Its GREG here, and yes I feel the complications were unavoidable .....There are two CAnadians on the Sternectomy site we have started recently and we have a gent in Florida and one in Georgia a lady in Texas and Two men in California I know of three others from Ohio, Kentucky and Minesota

I have been in touch with the Clevland Clinic (in Toronto, Cleveland and Florida) and they will make patients past and future aware of the support site as the worst part is feeling that you are alone in this world with this condition

So I would say that the opposite is true that my survival is soley due to the dedicated skills of my health care team.....by the way Justin (LynnW's son) has a partial sternectomy

 

[dick0236]

Bryan, I understand you have been approved for Social Security Disability. My experience was that folks approved for SSD could go on Medicare before age 65. Have you applied for Medicare? The benefits are superior to Medicaid. I am on a Medicare Advantage Plan. I pay no premium, other than the +/- $95 Part B premium. I have little or no copays for Drs or Drugs and have access to most Health Care Providers, normally without referral.

From what I understand, and have read, the current Health Reform proposal would not be considered "nationalized" health care, but an attempt to BEGIN to make sense out of an untenable financial and social problem......and I agree with you, the pre-existing exclusions should have been eliminated decades ago. That exclusion "haunted" me throughout my career.....and I was IN the business. The exclusion only caused those patients to seek, and get "free" care....which was then payed by those with insurance. No insurance company every "sucked it up" and paid these claims out of their "house money".

 

[Bryan B]

Greg,

I apologize for even posing the question. I had sternum complications as well although not as serious as yours or others. I just feel very strongly through past experiences with our government trying to take over private enterprise that it never seems to work out well. It's quite possible that with other country's government structure a national health care system can and does work, but our government has yet to prove (IMO) that they can run anything efficiently. My apologies again.

Bryan

Dick,

The only problem with going with Medicare versus Medicaid under the age of 65 is that there is a two year waiting period after being accepted before you can receive Medicare benefits. According to my surgeon I don't have two years. Actually he planned on doing surgery with or without approval from SS Disability or Medicaid because he doesn't know how long I can wait but he doesn't want to take the risk of finding out at my expense. Medicaid is immediate and that was is what I need (as in cath on 2/21 and surgery on 2/22 and that was his first opening).

 

[OldManEmu]

Bryan
I think you make a good point and I find it is usually the case at VR.

While we might not agree about a subject we all need to keep it civil.

I wasn't saying that you requested anyone raise funds on your behalf.
My statement was referring to adhoc charitable activity not being the basis for proper healthcare funding, however well intentioned that charity may be.
I think the slang "rattling the can" may have been lost in translation it is used to describe any soliciting of donations, unless a church has business activities this will be how ALL of their funds are raised irrespective of what those funds are used for.

I am curious about your two statements that "pharmaceutical companies to be forced to make drastic cuts if not go out of business completely."
The major pharmaceutical companies operate in all western health systems, if they were loosing money they would close their operation in the unprofitable markets the same as other businesses do, I haven’t seen any evidence of this.
I can't make the doctor shortage connection, the only place I am aware of doctor shortages is in rural areas and this is not because there are not enough doctors, rather it is that local doctors do no want to live in the middle of nowhere. In addition many doctors these days do not want to be GPs (PCP). This is why there are lots of foreign doctors in rural areas because it is a condition of their visa that they practice in these areas for a certain period of time.

 

[Philip B]

Reality Check?

Reality Check?

People are certainly entitled to their opinions, but I often wonder where some of these opinions come from. Is it first hand experience that makes us wise or what we hear and believe from others.

I've heard criticism of the "nationalized" or "socialized" health care systems which exist in other countries... poor standards of care, long waits for non-emergency care, high taxes to fund services, etc... Believe it or not, that's not been my family's experience with the Canadian health care system. My son and his family live in Canada and use the Canadian system. Yes, the system is funded with taxes, but they did the math. The taxes they pay are far less than the health insurance premiums they paid while living in the U.S. The coverage they have received in Canada is better than what they could afford to pay for in the U.S.

Unfortunately, the health care debate in the U.S. often tends to be fueled by politics. That's great for individuals and companies whose business involves making money; it's not so great for those who have to figure out how to pay medical bills.

The real difference in health care in the United States and that available in countries with nationalized or socialized systems is that health care in the U.S. is profit-oriented. Systems in other places are people oriented; health care is a right rather than a privilege.

Who really benefits from the lies, and misinformation which are used to fuel the political debate. It doesn't take a rocket scientist to figure-out that it's the people who are making money off the health care industry in the U.S.

Socialized medicine in the U.S.? As others have noted Medicare and the VA system are accurate examples.

I work on an Indian reservation where tribal members receive free health care. The system is people oriented and that's a good thing because the reservation has the highest incident of Type II Diabetes in the U.S. Most of the people who receive health care services on the reservation couldn't afford health insurance coverage or treatment anywhere else.

The downside to discussions like this one is that the discussions seldom result in shifting anyone's opinions.

-Philip

 

[ALCapshaw2]

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.

My Coumadin Clinic Bills INR tests at $83 but accepts less than half that amount in payment from insurance companies. (FWIW, I have NEVER been charged a co-pay.)

In range patients are tested every 4 weeks. If there is a dosing change they are tested again in 2 weeks.

Even with 20 visits to the clinic, annual expenditures would be in the neighborhood of $800.

Compare that to the cost of replacing a (tissue) valve which often wears out in 10 years or less.

Very FEW people need to have their Mechanical Valves replaced.
Dick0236 has had his for 43 years and counting.
Robthatsme had to have his SJM Master's Series valve replaced
due to Pannus Tissue Growth after 10 years. It is my understanding
that this problem is seen by only a small percentage of patients (<<10%).
Endocarditis can necessitate replacement of Both Tissue and Mechanical Valves.

 

[dick0236]

The real difference in health care in the United States and that available in countries with nationalized or socialized systems is that health care in the U.S. is profit-oriented. Systems in other places are people oriented; health care is a right rather than a privilege.
-Philip

Congratulations to ALL:thumbup:. We have gotten thru 25+ posts without having this thread degenerate into political tirade's...keep up the good work.


When I received my valve, the total cost was $8000. Six weeks after my surgery, I went to work for a Fortune 50 company as an accountant at a salary of $9000/yr.....a good starting salary back in 1967:cool2:. Starting salaries today for that job are $40000/yr?... an increase of 4+X...and valve replacements are $100000+, an increase of 10++X. I can't find the logic? From what I read here, the operation sounds much the same except ya'll usually spend a lot less time in the hospital post-op.

My valve was implanted at the Chandler Hospital, the teaching hospital at the University of Kentucky(GO BIG BLUE). This was, and I hope, still is a NON-profit health facility. I also believe that good health care is a right and not a privilege and we, in the USA, are loosing sight of that. I was taught, in college, that there are two different types of goods....Private Goods(Cars, refrigerators, shoes, and other commodities) and Public Goods(sewers, utilities, highways, school systems). Where do you think health care belong??.....right or privilege??....Public or Private Good??

Please consider this an ECONOMIC....NOT POLITICAL issue. I have been, at one time or another, a Democrat, Independent, Republican(in alphabetical order:tongue2....and ALL parties continue to "kick the problem down the road".

 

[buncle]

all parties have kicked it down the road.(maybe because they have their own health care plan that we citizens dont get?) At the rate that costs are spiraling out of control , both ins priemiums and medical costs it is becoming a privilege that less and less can afford every year.Emergency rooms at county hospitals are becoming office visits for colds and minor illnesses because fewer and fewer can afford basic health care.We are heading towards government paid health care by default.

 

[OldManEmu]

Dick well said on both counts

Please consider this an ECONOMIC....NOT POLITICAL issue.

Congratulations to ALL. We have gotten thru 25+ posts without having this thread degenerate into political tirade's...keep up the good work.

Your comment on length of hospital stay has prompted my curiosity how long you were in hospital for in 1967 when you had your AVR.

 

[dick0236]

Your comment on length of hospital stay has prompted my curiosity how long you were in hospital for in 1967 when you had your AVR.

I'm pretty sure it was fourteen. They held me over for 2 or 3 days because I had a low-grade fever, +/- 100F that they could not get down. Finally discharged me with that little fever because I was becoming a "pain in the A--". Told me to come back to the hospital if it went up one degree...it didn't. Today, they probably would not do that due to medical liability issue.

 

[normofthenorth]

A couple of quick points on the "political" issues about various national health-insurance schemes and such:

1) In Canada, it's true that most of the hospitals are publicly (provincially =~ "State") owned, but virtually all the Doctors, medical clinics, and labs are private, as are the drug companies. Virtually all the funding comes from the one (provincial-government) insurer, by way of fees for services, but the practitioners are private. So if you think the profit motive is the root of all evil, then you'll find lots of that evil in Canada, almost as much as in the States.

2) Last I checked, Canada's average medical spending was way lower than the US, and most objective health indicators were at least as good, and many were better. Of course, the US numbers are a numerical average of a huge range of different kinds of patients -- healthy and sick, rich and poor, insured and uninsured, etc. -- while the Canadian numbers tend to be a better reflection of actual "normal people" who live close to the average. Sometimes it seems as if there AREN'T any Americans who actually LIVE near the AVERAGE when it comes to health or health care: either you have excellent access to a very fancy and gold-plated health system, or you have limited access.

3) As I've mentioned before, here in Ontario we have relatively few problems with excessive wait times for elective surgery, and I certainly had incredibly quick access to OHS in a very "fancy" and world-class cardiac center. As a funny spin-off (of past (and present) concerns that wait times MIGHT be excessive), I was FORBIDDEN to schedule my OHS for November 2010, when I tried to do that in around April 2010! My surgeon said I could just schedule it a few weeks before I wanted it, but that if they put it "in the books" for 6 or 7 months in the future, the government would "come down on them like a tonne of bricks" because it would look like I was being forced to wait that long for heart surgery!! (When I showed up in the Fall, ready to schedule it for "soon", I had to turn down the soonest appointments, because they were too soon for my convenience!)

4) Whatever any of us believes, or prefers, about tissue valves or mechanical valves, I suspect that an honest accounting of the MONEY cost of the options for somebody in their 50s or even (like me) in their 60s would probably show that the mech-valve option is quite a bit cheaper, even including the cost of all the INR stuff and even the extra clots and bleeds. There's also some additional Endocarditis risk (maybe triple?) in the first few months after a mech-valve implant, according to one study I just read. But the financial cost of a tissue-valve re-do is so humongous, that I think it would swamp all of those mech-valve costs, and more. Whether we do "cost-minimization" through government insurers or private insurers or individual "self-insurers", it seems logical that this big discrepancy in average costs, or expected costs, would influence surgical practice -- but my impression is that it doesn't. The fact that most tissue valves implanted today will last 15 years or more (according to the newest studies, like the "Gold Standard" study on the Hancock II) just means that the bill won't have to be paid for quite a while. But unless we all get hit by a bus first, the bill is on its way, because of today's overwhelming popularity of tissue valves, in increasingly younger patients.

Don't get me wrong: I think there are many good reasons for many patients to choose a tissue valve, even people quite a bit younger than I am. But saving money for the medical system does NOT seem to be one of those good reasons. . .

 

[OldManEmu]

Norm
I think the other thing we need to keep in mind is that redo surgery, especially for older patients will increasingly be done with purcutaneous valves.
This will bring the cost down considerably compared to a traditional OHS redo.

 

[Lily]

My Coumadin Clinic Bills INR tests at $83 but accepts less than half that amount in payment from insurance companies. (FWIW, I have NEVER been charged a co-pay.)

In range patients are tested every 4 weeks. If there is a dosing change they are tested again in 2 weeks.

Even with 20 visits to the clinic, annual expenditures would be in the neighborhood of $800.

Compare that to the cost of replacing a (tissue) valve which often wears out in 10 years or less.

Very FEW people need to have their Mechanical Valves replaced.
Dick0236 has had his for 43 years and counting.
Robthatsme had to have his SJM Master's Series valve replaced
due to Pannus Tissue Growth after 10 years. It is my understanding
that this problem is seen by only a small percentage of patients (<<10%).
Endocarditis can necessitate replacement of Both Tissue and Mechanical Valves.

I didn't realize you still read my posts, AL
--------------------------
The cost consideration of heart surgery isn't a new discussion on this site. All of us consider it; and probably most of us worry about it. I can't get life insurance. And I don't feel good about it. But I'm glad to be alive.

Anyway, there are all kinds of costs, even for our families, because of the necessity of our heart surgeries, consultations, followups, treatments, complications, etc. Also, I'm not the breadwinner, and I think that makes things a little easier for me.

I live in a semi-rural area. My hospital was, and my cardio is, three hours away. It's quite a distance to travel. A nuisance to me, though my husband always drives. I mention that because it is also a factor to consider, when analyzing costs. One of my neighbors, a widow who is in her 70's, has a mechanical aortic valve. After she suffered a series of strokes a few years ago and was released from the hospitals, her son needed to drive her back and forth to the city for all of her INR tests and doctors appointments, for quite some long time. Eventually I saw her driving again but lately her son is apparently again doing all of the driving. Another example of that cost factor to consider.

Here's a link to an older discussion here about some ACT costs:
http://www.valvereplacement.org/forums/showthread.php?32074-INR-Test-Charges-and-Payments

And on an older poll here, over half who responded said they test weekly. That seems very smart.

And, while some of the statistics may be older, here are some other interesting links:

Cost considerations surrounding current and future anticoagulant therapies: http://www.ccjm.org/content/72/Suppl_1/S43.full.pdf

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy: http://www.cmaj.ca/cgi/content/abstract/174/13/1847

Complications of prosthetic heart valves: http://cmbi.bjmu.edu.cn/uptodate/Va.../Complications of prosthetic heart valves.htm

 

[ALCapshaw2]

I didn't realize you still read my posts, AL
--------------------------

Yep, as long as they aren't too long.

 

[dick0236]

Lets not turn this into another of the "mech vs tis" threads:rolleyes2:. As chronic patients who will always be "joined at the hip" with the medical profession, we should ALL be keenly interested in future health costs. Lets keep talking about the possible solutions. I am very interested in how other countries can do what we do for significantly less money than us folks in the good ole USofA:confused2:.

I have never been able to figure how I could buy Coumanin in Canada and save 40-50% off local prices......or how I could go to New Zealand(internet shopping) and buy a Coaguchek XS INR meter for $800 when Alere, QAS and Phillips wanted 2 to 3 times that:tongue2::cool2::eek2:.

 

[ALCapshaw2]

As chronic patients who will always be "joined at the hip" with the medical profession, we should ALL be keenly interested in future health costs. Lets keep talking about the possible solutions. I am very interested in how other countries can do what we do for significantly less money than us folks in the good ole USofA:confused2:.

I have never been able to figure how I could buy Coumanin in Canada and save 40-50% off local prices......or how I could go to New Zealand(internet shopping) and buy a Coaguchek XS INR meter for $800 when Alere, QAS and Phillips wanted 2 to 3 times that:tongue2::cool2::eek2:.

Dick,

I was going to ask why you would want to buy Coumadin from Canada when you can get it (well, it's GENERIC Warfarin) at Walmart and other pharmacies for $4/30 pills or $10/90 pills.

To reduce your Drug Costs, Bug your Congressman to allow Medicare to negotiate a Volume Discount with the Drug Manufacturers. Guess Who made it ILLEGAL for them to do that? (And who was behind that bill). I'll bet Other Countries don't have their (Bargaining) Hands Tied by such Laws!

 

[ShezaGirlie]

Regarding costs..

Regarding costs..

I have a little experience with comparing UK costs to USA costs..
1. I paid about $1,200 for a CoaguChek in the USA in 1999
2. I paid about $600 for a CoaguChek S in the UK in 2002
Where's the financial logic in this?

1. I paid about $1,200 for a minor procedure in the USA in about 2002
2. The exact same procedure cost $85 in the UK in about 2003. I asked how long the 'wait' would be. Answer - about 40 minutes!
The above numbers are NOT typos - they are accurate. Again, where's the financial logic?

My OHS cost about $110,000 in 1999 and there were no complications - just an AVR. I had insurance and my out-of-pocket was about $10,000. I was in no shape to argue with the insurance company, so I just paid to get rid of them when they claimed that the lab sent the wrong code to them and the lab said the insurance company had the correct code. I think the insurance company lied so they wouldn't have to pay that $1,200 part of the $10K. I canceled them and was self-insured for a year. Talk about scary..:eek2:

For the one year that I was self-insured, I figured that should I require another OHS I would hot-foot it to Toronto to Dr. Tirone David - world renouned cardiothorasic surgeon. I figured the cost at around $17,000 for the same procedure I had done in the USA which cost $110,000 plus all those insurance premiums over the years.

Then I found out about the Texas High Risk Pool and qualified and remained on that from age 56 to age 65 and MEDICARE......hallelujah..!!! The insurance pool started out reasonably priced, but like all insurance, the premiums increased exponentially every year even as I raised my annual deductible to the highest available. When I canceled to go on MEDICARE, my deductible was up to $7,500 and the premiums were about $500monthly.

Yes, something is really rotten in Denmark with healthcare/insurance costs in the good ol' USofA. As my nephew doctor says - he's got more paper pushers than nurses in his office and most doctors order so many tests because that's where the money is. Sad, isn't it..

I just went off my Medicare Advantage insurance plan which ended up stinkin' to high heaven. The insurance company dropped the best hospitals in my area and one week before the 'open enrollment' ended - my cardiologist dropped them..!! What good is insurance when the doctors/hospitals/labs have to continually fight to get paid?? The USA desperately needs insurance reform. Either get rid of insurance companies or make them honest..! That's my story and I'm stickin' to it..:thumbup:

 

[OldManEmu]

Dick
I have included a link below to the Australian PBS; it has information on how drug subsidies work.
If a drug is not listed on the PBS it doesn't attract a subsidy and therefore is unlikely to be prescribed, needless to say drug companies want their products listed.
To be listed the drug has to demonstrate that it provides a superior outcome to current medications in the same class or the government will not subsidise a higher price.
If this improved outcome can be demonstrated then a price is negotiated, this is cost control, companies complain however they do not stop lining up to get their products listed.
As drugs have been on the market longer and come out of patent so the subsidy is reduced this causes more complaints from drug companies but they still keep selling the product.
Drug companies complain about the system however it is obviously still profitable enough for them, just not as profitable as they would like or they wouldn't stay in the market.
If the drug is priced less than the copay you just pay the going price.
Generic drugs are also a big cost control for out of patent medications, generic drugs must be exactly the same as the original patented medication or they can’t be sold as a substitute.
Once a generic is available that becomes the new reference point for price subsidies.
http://www.pbs.gov.au/info/about-the-pbs

Government subsidised drug programs are a open opportunity for rorting and cost blowouts unless they also have a cost control mechanism.

I take Perindopril (generic) and get 3 months supply (90) as a bulk buy for $28 as this is less than the copay amount for that quantity, so this effectively is the unsubsidised price.
I would be interested what the price for 90 Perindopril tablets is in the US that the insurance company pays, the patented name in the US is Aceon.

 

[dick0236]

I was going to ask why you would want to buy Coumadin from Canada when you can get it (well, it's GENERIC Warfarin) at Walmart and other pharmacies for $4/30 pills or $10/90 pills.
!

Al, that was what what I paid 4 or 5 years ago. I have been paying $10 for 90 days of Warfarin since Walmart busted the generic pricing market a few years ago. I was on Coumadin for almost 40 years before I found a young cardiologist who would prescribe Warfarin. The old docs are(were) pretty much brainwashed by DuPont(patent holder of Coumadin until a few years ago when they sold the Brand name). I remember paying $100+ for 30 Coumadin tabs in the early 1980s. Back then, $100 was a bunch.....so improvements do come slowly......very slowwwwlllyyy and it took an aggressive, large marketer, like Walmart, to fight the "good ole boys" in the pharmaceutical industry. Maybe we need more real competition among hospitals(not likely) or a strong single payor that has the clout to bargain with powerful hospitals. And thank y'all for bringing the thread back on target. The problem is cost.....the solution is almost entirely in lowering those costs....or the best technology in the world ain't worth a **** if you can't afford to access it.

 

[Kathy McCain]

My PERSONAL experience this time around with my health insurance, I have to say, was EXCELLENT. I won't get into the exact cost, but let's just say, it was very affordable. I had one of he very best surgeon's and the best care. I don't like the idea of a total government controlled health care system. I do believe we certainly could afford some changes......BUT just fix what is broken, please.