Friday, July 24, 2009

Breast Cancer Care Under a Private or Government-run Health Care Plan?


I am an American living under a private health care system, an American who lived and worked in London and was covered under Britain's government-run health care system. I have dedicated my life to helping women and men realize the breast cancer risks they may face. Through my Team Heather fundraising, blogging, speaking, facebooking, writing, and twittering, I have read a great deal on the differences between service under different health care systems, and it has become clear there are problems under any system a country might employ: private or government-run.

So, private health care plan or government-run health care plan?

It has been stated, under President Obama's proposed health care reform plan, one would be able to keep one's current private health care coverage as long as it remains available from one's employer. The employer responsibilities and obligations under any proposed legislation is still up in the air, however, the Congressional Budget Office estimated that over 100 million employees will leave private health care, in lieu of being dumped by their employers into the government-run system.

Private employers and insurers will find it difficult to compete against the federal government - unlike the federal government, private employers and insurers must answer to stockholders and boards, balance their budgets, produce earnings, make sensible decisions, and so much more. It isn't as simple as those currently pleased with their private health care coverage being able to continue on uninterrupted; much of the decision, or the facts that go into making that decision, will be out of their hands and out of their control. I know for a fact, as an employee of the Fairfax County Public School System who is pleased with his current private health care plan, I will be asked to accept government-based health care.

When it comes to attempting to pinpoint how many Americans are currently uninsured, the number "47 million" has been batted about quite consistently. However, to say 47 million Americans do not have insurance isn't exactly accurate. Of the 47 million uninsured in the United States, 9.7 million are not citizens of this country. Another 14 million of those uninsured are eligible for Medicaid and SCHIP but have never signed up for either program. They could have either form of government insurance if they made a visit to the emergency room. Another 17.6 million of those uninsured have annual incomes of more than $50,000. This leaves approximately 5.5 million Americans currently without insurance - clearly a group of individuals who need a departure from and an improvement upon the present health care system.

The 1018 page health care reform bill currently being discussed has sparked an examination into health care and treatment in countries with similar government-run plans around the world. We clearly have problems under the current United States private health care system. Covering the 5.5 million uninsured Americans should be a priority and addressing other problems within our current health care system should be paramount, but a blanket statement that the United States has "a very serious health care problem" isn't taking into consideration some recent studies and reports:

Breast cancer mortality is 52% higher in Germany than in the United States, and 88% higher in the United Kingdom. When it comes to breast cancer, early detection is key to survival. The BBC reported that United States women were more likely to survive breast cancer than their European counterparts because they are diagnosed earlier. Similarly, prostate cancer mortality is 604% higher in the U.K. and 457% higher in Norway and the mortality rate for colorectal cancer among British men and women is about 40% higher than their counterparts in the United States, who participate in a private health care system. ("Cancer Survival in Five Continents: A Worldwide Population-based Study" & "Europe: Failing on Breast Cancer")

Some 56% of Americans who could benefit are taking statins, HMG-CoA reductase inhibitors designed to reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs in countries with government-run health care systems, only 36% of the Dutch, 29% of the Swiss, 26% of Germans, 23% of Britons and 17% of Italians receive them. ("Diffusion of Medicines in Europe" & "The Grass is Not Always Greener: A Look at National Health Care Systems around the World")

Americans of the appropriate age have better access to preventive cancer screening under their private health care system than Canadians of the same appropriate age under their government-run health care. Nine of 10 middle-aged American women (89%) have had a mammogram, compared to less than three-fourths of Canadians (72%). Nearly all American women (96%) have had a pap smear, compared to less than 90% of Canadians. More than half of American men (54%) have had a PSA test, compared to less than 1 in 6 Canadians (16%). Nearly one-third of Americans (30%) have had a colonoscopy, compared with less than 1 in 20 Canadians (5%). Accessibility and availability to life-saving screening methods are greater under private health care systems. ("Health Status, Health Care and Inequality: Canada vs. the U.S.")

More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either "fundamental change" or "complete rebuilding." ("Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007")

Criticized as a waste of resources by economists and policymakers, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade. The United States has 34 CT scanners per million Americans, compared to 12 per million in Canada and eight per million in Britain. The United States has nearly 27 MRI machines per million compared to about 6 per million in Canada and Britain. Access to these life-saving innovations is more limited under government-run health care systems. ("Physicians' Views of the Relative Importance of 30 Medical Innovations" and "OECD Health Data 2008, Organization for Economic Cooperation and Development")

Health care innovations thrive under free market health care systems: 1) The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country. 2) Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined - In only five of the past 34 years did a scientist living in America not win or share in the prize. 4) Most important recent medical innovations were developed in the United States. (The Nobel Prize Internet Archive and "The U.S. Health Care System as an Engine of Innovation")

Hospital by hospital data, unpublished by the Scottish Government, shows that, for certain types of cancer, patients in some units are waiting an average of 100 days before getting treated. Between January and April in 2008, head and neck cancer patients at Hairmyres Hospital in East Kilbride waited an average of 112 days after GP referral before treatment. Average waits at Falkirk and District Royal Hospitals for gastrointestinal cancer between April and June was 118 days. In the same quarter, patients at Stobhill Hospital in Glasgow suffering from urological cancer waited an average of 105 days. The figures also show that lengthy waits are still common for cancers such as breast cancer, where speedy treatment is needed and life-saving. Of 28 hospitals treating women with breast cancer in 2008's last quarter, 14 had an average wait of over 40 days. ("Secret Wait for Cancer Patients")

No system is perfect. Our health care system needs help. It is clear that other countries also find challenges and difficulties with their own systems of health care. It will be interesting to see how things play out in the future for the United States and its friends, when it comes to health care reform, however, in my work within the breast cancer movement, I am finding more and more evidence that being screened, tested, diagnosed, treated, and monitored for breast cancer under a private health care system leads to more positive outcomes.


Thursday, July 23, 2009

"So You Think You Can (Fight Breast Cancer)?"

This is a piece highlighting a dance on Wednesday night's "So You Think You Can Dance." The dance, choreographed by Emmy Award winning Tyce Diorio, was meant to represent a woman's struggle with breast cancer, showing the way she'd react, fight, survive, as well as how her friends would support her in her battle. Breathtakingly poignant!