Category Archives: financing healthcare

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The Introverted Thinker decides about the Mad as Hell Doctors

I got home from the  Mad as Hell Doctors road trip, where we were doing town halls for HR 676 and a single payer system, on Monday night. I had left my daughter, the introverted thinker, on the first day of school and was gone for a week. Her uncle stayed with her for two days at home and then she spent 4 nights at a friend’s house.

She was very glad to see me.

I was inspired and joyous and confused about the trip. Applause when I spoke about why I was Mad as Hell and praise. Praise made me want to weep. I have been looking at that.

On Tuesday I spoke to my mother out law on the phone. Ex-mother in law? I like outlaw better. I want to rejoin the Mad as Hell Doctors for the last week, but it would mean taking the introverted thinker out of school for a week. She gets horribly car sick, so I can’t take her on the trip, but her grandmother is in Rockville, MD. I could leave her with her grandmother and rejoin the team. It’s insane, but worth it, I hope.

Tuesday night the introverted thinker wept at bedtime, said she didn’t want to go and then asked why I thought it was important.

I explained a little. We are the only industrialized country where people go bankrupt from medical bills. Lots of people are not getting care for treatable illnesses and even lethal illnesses like cancer, because they can’t afford it. People don’t have health insurance or they use it all up. We have the most expensive health care in the world yet are ranked 37th overall for health care. And the insurance companies first job is to make a profit. The money that they and their investors pocket could go to health. No, the government won’t do it perfectly, but exactly what in your life is perfect? And driving from Seattle to Denver, the roads of the United States and the rest areas remind me: this is MY country. The people of the United States agreed to have the government help maintain roads. The people can decide that everyone has a right to health care. Our government does not belong to corporate America. I will make a noise until Congress remembers that we the people are the ones who vote: not the corporations, no matter how much money they have. The insurance companies are paying 1-2 MILLION dollars daily to lobby to keep their profit, at the expense of someone’s health. Thirty percent of the health care dollars go to administration and profits and that is not where I want it to go. Health care for health, not for profit!

Then I dropped the topic for two days, to let her think.

Thursday night I brought it back up.

Here is the thinker’s logic: she wants to be in 4 A, the school club that stands for Attitude, Academics, Attendance and Activities. She got a 63% on her first language arts paper, all because of spelling. She inherited my math/music brain, not her father’s visual spelling brain. She is busily attacking spelling, like a tiger, but she says that she doubts she can get an A in that class. Therefore she is willing to defer 4 A until next quarter and she is willing to let me go with the Mad as Hell Doctors. With a pre-excused absence, it does not count against the attendance for the 4 A and she is considering asking for extra credit work to make up for that initial spelling score.

I love watching her make her way through emotion and logic. I am sure that she is also thinking about the health care issues, though she is reserving comment.

And I think she is 4A.

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on the road, September 12

I wrote this on September 12, at the Salt Lake City Library.

I am on the road with the madashelldoctors, day 5.

I am a Mad As Hell Doctor because my patients are not coming in. They are calling to get refills because they have lost their jobs, lost their health insurance, are losing their houses, are stressed and frightened. We Americans agree that anyone who shows up at the  emergency room has to have care, but that is last minute care. We give care when someone is dying, their cancer is advanced, their heart attack is happening, they are near death. It is expensive, inefficient and stupid. This road trip brings home that we take better care of our highways and rest stops than we do of our citizens. How can we have life, liberty and the pursuit of happiness without health? Our health is our wealth! Single payer, one system, just like police, highways, our mail — single payer is the way to go! It is time to get mad and make Congress put it back on the agenda! It is an embarrassment to have a Canadian citizen ask, “Why don’t you Americans take care of your own people?” and I want my health care dollar to go 100% for health care, not for insurance company profits and CEO salaries over 14 million dollars yearly. Fire them! Single payer!

HR676! A single payer proposal. Remember that the insurance companies are pouring 1.4 million dollars a day into lobbying to protect their profits!

Follow us on the website and fight the corporate medical behemoth!

Yours,

On the road, incoherant and down to 6% computer power….

Katherine Ottaway MD

1:42pm

Salt Lake City Library

Whew, finally computer access. We haven’t had time.

This morning we awoke to a knock on the door at 5:59 in a Motel 6 in Idaho Falls, Idaho. We were supposed to be on the road at 6:00. I am rooming with Barbara, a researcher from the Department of Family Practice at the University of Washington. We rushed around and left before most of the guys.

On the road, to Pocatello, Idaho, to the Holt Arena Park, S. 18th Avenue and E. Bonneville Street. We were early and went to find coffee for everyone. We wondered for a bit if Starbuck’s had missed Pocatello, but no, hidden in a grocery store.

In spite of the fact that it was 8:30 am on Saturday, nice crowd. Adam introduced the single payer theme, each doctor said why they personally were mad as hell, and then the audience was invited to step up. Each person has one minute to say why they are Mad As Hell. A woman who has been at two previous venues spoke and said that her beloved had committed suicide because he couldn’t pay his medical bills. I hugged her afterwards. She said that she had to leave us now and it was her last chance to tell us. She was very brave.

An elderly woman with a red-tipped blind person’s cane said, “I’m covered but the woman who helps me and cleans house for me has no insurance. She has breast cancer, two lumps removed, but it’s been infected and she has no money for chemotherapy or radiation It is a shame on us as Americans.” People are speaking up and the more people that speak, the more we all realize that it isn’t just a few people but everyone has been touched by this. Two thirds of bankruptcies are for medical bills and we are the ONLY industrialized country where you CAN go backrupt from medical bills.

Our next Town Hall is here in the Salt Lake City Library at 3:00 pm. We’ve been trying to cut the program down to 90 minutes, from two hours. We are getting used to the pattern. Yesterday I woke up feeling like death warmed over from a combination of exhaustion, 4500 foot altitude and one beer (I know, I’m a wimp with alcohol). Got on the road anyhow and Barbara drove the 250 miles from Helena to Idaho Falls while I displayed my talent at sleeping anywhere. By the time we met the caravan, I was shaky but improved and by the time we did the Town Hall at 7:00 pm, I was fine. Adam has nearly lost his voice but still is the MC and everyone is a bit glassy eyed and tired. We have to look at the notebooks to remember which city we are in. “What day is it?” we ask each other.

I will blog when I get a chance.

Town halls coming up:

9/12/09 Orem, Utah: Utah Valley University Student Center Room 206C 7:00 tonight

9/13/09 Rally at Fort Collins, 4:30 pm @ Civic Center Park, corner of LaPorte Ave & Howes street, Fort Collins, Colorado

9/13/09 Town Hall 7:00 pm Greyrock Commons, 2265 Shooting Star, Fort Collins, Colorado

9/14/09 Town Hall 8:30 am Plymouth Congregational Church, 916 W. Prospect Road, Fort Collins, Colorado

9/14/09 Rally Denver 12:00 (noon) West Steps, State Capitol Building 200 E. Colfax Ave, Denver, Colorado

(I leave on a 5 pm plane for my daughter and home.)

9/14/09 Town Hall — Picnic 5:00 pm Washington Park Boathouse, E. Virginia Ave and S. Downing Street, Denver, Colorado

….and I don’t have the rest of the schedule, but caravan from Gettysburg to the White House on 9/30/09 and meet us in Lafayette Park in Washington DC on October 1, 2009!

Originally published on Everything2.

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Rationing Health Care

A little article in JAMA (Journal of the American Medical Association) caught my attention yesterday:

Cancer Drug Costs

Citing the extremely high cost of many cancer drugs that produce only a marginal survival benefit, scientists from the National Institutes of Health (NIH)Clinical Center and the National Cancer Institute are urging the oncology community, regulators, drug makers, and the public to begin to set limits on the use or pricing of such drugs.

The scientists noted that 90% of the anticancer drugs of biologics approved by the US Food and Drug Administration (FDA) in the past 4 years cost more than $20,000 for a 12-week regimen, but many offer an additional survival benefit of only 2 months or less (Fojo T and Grady C. J Natl Cancer Inst. doi: 10.1093/jnci/djp 177 published online ahead of print June 29, 2009). For example, a study presented in 2008 found that adding cetuximab to other chemotherapies extended life by only 1.2 months at considerable cost: in the United States, 18 weeks of the drug cost $80,000, which translates to $800,000 for a single additional year of life for 1 patient. The researchers also point out that many studies that do demonstrate a small survival benefit do not take into account a patient’s quality of life.

The authors recommend several measures to reign (sic) in such unsustainable spending on drugs with minimal benefits, including limiting price based on survival benefit, more stringent requirements for toxicity, discouraging the use of such drugs in patients with advanced cancer, and approving or prescribing drugs only for the subset of patients for whom they have been demonstrated to be effective.

–Health Agencies Update, JAMA, August 26,2009 vol 302, No. 8 p.838

My mother died of ovarian cancer in 2000. It had recurred. Her CA-125 marker was rising again. She walked bent over, because her abdomon hurt. She was only taking ibuprofen. She said, “I can have more chemotherapy or go be in a clinical trial.”

I went with her to her cancer doctor. Dr. X is kind and sweet. She said, “We can start another round of chemo.” Dr. X was perfectly willing to answer questions, but only answered if they asked.

My mother said, “Ok.”

I said, “My mother keeps losing weight. Do you think that taking a stronger medicine than ibuprofen would help her gain some weight?”

This was pure hooey. Narcotics do not help people gain weight. My mother was losing weight because the cancer was so big that it was stealing all the nutrition.

But Dr. X understood. “Oh! We should give it a try. Here.” She wrote a prescription for percoset, thank goodness. “Now you try this instead.”

I followed Dr. X out of the room. “My mother thinks that she could be in a clinical trial.”

“No,” said Dr. X “The cancer is too advanced and she’s been through too many treatments. But, we will give her chemo for as long as she wants.”

We went home.

Think of the questions that neither my mother nor my father asked.

Will this prolong my survival?

How much will this prolong my survival?

How sick will it make me?

What does it cost?

If your mother was in my shoes, would you recommend taking this?

My parents didn’t ask and Dr. X did not answer anything that they didn’t ask. My mother did not want to know.

A week later, my mother said, “You know, that percoset is helping. I didn’t realize how much I was really hurting.”

She was walking more easily, though still bent over.

Within a few months she was admitted to the hospital with her intestines entirely blocked by cancer. We took her home, hospice for 5 1/2 weeks, before she died.

We are afraid to talk about death, about cost, about whether a treatment is worth it.

I ran into the son of a woman who died last year.

“You know that you helped me more than anyone, with what you said.”

“What did I say?” I say a lot of things.

“I told you that my mother was back in the hospital and that she’d pulled through another pneumonia. You said, I’m glad and then, someday she won’t. I was shocked and then I thought, it’s true, some day she won’t. I went home and I changed what I was doing. We took time with the relatives and they came to visit and it was a very special time. She died about a year later.”

“Thank you for telling me. I’m glad that it helped.”

“Thank you.”

Originally posted on Everything2.