There are 5 extra days of this exhausting occasion we name the American Presidential marketing campaign. To my Aussie readers I would like to put in perspective the most up-to-date “revelations” about Hillary’s emails. It’s not going to make a lot of a distinction. To the dedicated on both aspect, they’ve already made up their minds (and like me, many have already voted with absentee ballots). Perhaps in sure swing states like Ohio and Florida some disgruntled voters, liking neither candidate however Trump even much less than Hillary, may determine simply to move on voting for both due to this unwell-timed announcement by the head of the FBI (a Republican, although nominated for the submit by Obama). But the polls present solely a 3 level lead for Hillary presently which is scary. But I think her electoral school vote benefit will probably be far more substantial. Still in the Blue state of California all of us stay a bit nervous.
Meanwhile whereas I’ve your consideration I assumed I might share one other instance of the variations between the health care methods of the U.S. and Australia. I’ve written extensively on Aussie attitudes in the direction of utilizing psychiatric drugs with youngsters in contrast to the U.S. But as lots of you already know I’ve additionally commented on their health care as an American affected person who occurred to bear a radical prostatectomy in Melbourne in September 2015.
The surgical procedure eradicated all however roughly three prostate cells (I am guessing on this actual quantity however will shortly let you already know foundation of my estimate) from my pelvis. But earlier than I had the surgical procedure I had a state of the artwork scan, referred to as a Prostate Specific Membrane Antigen Positron Emission Tomography essentially abbreviated as a PSMA PET scan to rule out any metastasis which might have obviated the surgical procedure. This scan is thought-about extra delicate than the traditional presurgical full physique MRI and bone scans to rule out metastasis. The PSMA PET scan is provided at solely 5 websites in the world, together with because it occurred in Melbourne and now in San Francisco. Can you inform the place this story is heading but?
The scan is thought-about quasi-experimental in each nations. My urologist in Melbourne was very keen about this scan’s benefits over the conventional scans and urged me to get it regardless that it was not coated by Australian Medicare. He forgot that since I solely had a yr-lengthy visa I used to be not coated by Australian Medicare. I paid for all the remedies (together with the three night time in-patient surgical admission and earlier than the surgical procedure, an unplanned go to to the emergency room and in a single day keep after the biopsy) with a bank card to be reimbursed by my personal American health insurance coverage firm, United Health Care (UHC), the largest personal insurer in America.
So I obtained the scan comparatively shortly. It was carried out at the Alfred Hospital solely blocks from my house in South Yarra. Aussies, who know the Alfred, know sure elements of the hospital are fairly previous (it is the oldest constantly working health facility in Melbourne however has many trendy buildings).
So I walked over to the Alfred from my house. I might guess the part that homes the PET scanner hadn’t been redecorated since the 1970s. I met one receptionist. She gave me a one-web page type requiring one signature that advised me the check was experimental and what my value can be. A nurse then positioned a easy i.v. on my left arm. The neuroradiologist got here in and injected me with the radionucleotide. I then spent about 50 minutes in the machine getting scanned. The check value $800AUD which translated, given the change fee, to about $600US. UHC reimbursed me at 80% so my remaining value for the examination, which mercifully confirmed no mets, was $150US.
A yr later, now again in San Francisco, these three cells have been placing out a PSA (Prostate Specific Antigen) of zero.33. Given I had already had the surgical procedure, my Australian urologist thought I ought to get one other PSMA PET scan to probably localize these three remaining cells extra particularly in case radiation was added to my remedy (the effectiveness could be elevated, whereas unwanted effects diminished with a extra exact location). My American urologist agreed and I used to be scheduled for a repeat PSMA PET scan at UCSF (the University of California, San Francisco Medical Center) which has a number of campuses in San Francisco. That’s when the enjoyable began.
Two days earlier than the check was scheduled (I had cancelled sufferers for that morning) I acquired name from “Gloria,” a UCSF insurance coverage authorizations coordinator. She stated UHC hadn’t permitted my repeat scan but. The insurance coverage firm was ready for a peer-to-peer docs’ evaluate of the indications for the scan earlier than approving it. Urology hadn’t responded and Radiology was ready.
Gloria stated if I most popular to go forward with out the authorization I might self-pay for the process. I naturally requested her “How much?” In essence, she stated “For you a special deal…” – she particularly informed me that the value for the scan was $11,000US but when I used to be self-paying UCSF would supply me the scan at a discount price of $5000US. I informed Gloria I paid $800AUD for precisely the similar scan in Melbourne and the $5000US was approach an excessive amount of for me out of my pocket. I most popular to await the insurance coverage approval to come via.
It did the subsequent day. Gloria advised me that the “negotiated rate” between UCSF and UHC was $3000US for the scan. I shortly did my 80/20 calculation and concluded my portion of the value of the scan can be $600US – 4 occasions extra than I had paid in Melbourne – however given the distinction between the two health methods, comprehensible and price it to me.
I’d point out that the UCSF PET scanner was at the India Basin campus of UCSF, a state of the artwork trendy constructing proper subsequent to AT&T Baseball Park, the house of the San Francisco Giants. At least six individuals have been concerned in getting me prepared for the scan, not together with the neuroradiologist whom I by no means met. I used to be given three varieties totaling 13 pages and three signatures earlier than my i.v. was began. The check took solely 45 minutes at UCSF (they usually did moreover inject me with a dye to spotlight my blood vessels which the Australian docs did not assume was mandatory).
I checked in with my Australian urologist and requested him if the authorities was funding any a part of the PSMA PET scan. He informed me to the better of his information, “no.” Later I requested Gloria why she thought the fees for the similar actual check have been a lot extra at UCSF. She candidly stated, “Doctor Diller, we are the only center west of the Mississippi offering this more sensitive test for prostate cancer metastasis. Clearly we think we can get this price (and likely have wealthy men pay for it out of pocket – she didn’t say that – I’m adding it) which is why we are charging this price. We pay a negotiated rate with the insurance companies who refuse to pay the $11,000.”
Oh, I almost forgot. The scan was utterly adverse – which means it did not even present the remaining prostate tissue I had left in my pelvis answerable for the zero.33 PSA. Gratefully there was additionally no proof of any new additional-pelvic indicators of prostate most cancers. I used to be once more relieved however a bit dissatisfied that the greatest check was nonetheless not delicate sufficient to decide up what I’ve determined are three nasty prostate cells left in my physique.
So there you might have it: a tremendous distinction of the two methods. One is for sufferers’ health, the different is for suppliers’ revenue. In delicate protection of the charging what you will get, UCSF, offers, at a big loss, providers to the indigent or these missing insurance coverage. MediCal (authorities insurance coverage for these under a sure poverty line) solely pays a fraction of the actual prices to docs and establishments accepting these sufferers. By charging larger charges for providers and procedures that will probably be paid by Medicare (the US model for these over 65, pays comparatively decently), personal insurers or self-paying rich sufferers, UCSF can higher keep financially afloat.
Still even with Obama Care, U.S. health care prices proceed to escalate. Some giant personal health insurers (like UHC and Aetna) are opting out of sure insurance coverage markets (principally in Red States the place native help for the restricted nationwide health insurance coverage has been weak). Still a reckoning is due with burgeoning medical prices. In the first spherical, attacking the energy construction of medical care in the U.S., the authorities (learn Democrats) remoted the insurance coverage business from their ordinary allies, docs/hospitals and large Pharma (the drug corporations). Indeed, the latter two made off like bandits in the Affordable Care Act.
I predict the subsequent spherical of reform will go after massive Pharma requiring them to do what they already do with the Veteran’s Administration in negotiating and decreasing the costs of their commonest drugs. Once these costs are introduced into line the authorities will lastly problem the docs/hospitals’ expenses hopefully decreasing funds to specialists whereas growing reimbursements to gate-keeper main care docs (does this remind the Aussie readers of their GPs’ roles?). Overall although, Americans could have to be reeducated on their expectations about what trendy drugs can do for them. Less cash have to be spent devoted to finish of life care and extra in the direction of stopping the self-damage of sure life types — in order for prices to go down.
Or they will simply spend a yr in Oz and find out how an imperfect however far more practical healthcare techniques operates.
Wish us luck on November eighth.