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The decline of Brachytherapy

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Posted 2/21/2015 8:09 PM (GMT 0)
JohnT,

Quite well said.

A good argument for a single payer system (as used in Holland, France, Sweden and the rest of the industrialized world). Who else then Americans would pay 18 percent of their GDP for Medical care when the rest of the industrialized world pays 8 percent? (That's a rhetorical question).

But I fear we are on thin ice with this discussion .......
Posted 2/21/2015 8:19 PM (GMT 0)
JohnT, I like the way you think. I saw an example of your question about preserving the life of a 90 yr old just a few years ago. It's tough, and it gets highly emotional..witness the kerfuffle a few years ago about "death panels"?

My modest proposal for end-life care: When someone gets an end of life diagnosis, they get a check for (say) $500K. You're free to do whatever you want with it. Go home and bring in a hospice nurse, and pass on the balance to your heirs? Great. Take your family on a round the world cruise? Go for it. Spend it at a big research hospital with you as the test subject? That's fine too.

For the rest, I really don't know. I do know that if you want to find a hospital in a major (or even minor) city, look for the construction cranes. Millions (Billions?) are being spent on construction..and we're paying for it.

Plenty of food for thought.
Posted 2/21/2015 8:30 PM (GMT 0)
Another angle on the choice of therapy. Years ago I bought an AFLAC cancer policy because my older brother had cancer. They have paid me thousands so far for the diagnosis and the biopsies and the TURP. Now on the matter of radiation treatments they pay $300 per treatment. That is directly to the policy holder. If the policy holder is covered by med insurance that money is pure found income. So the math on radiation therapy is they pay the bearer $300 for BT, $1500 for 5 treatment SBRT, or $12,000 for 40 treatments of photon or IMRT. Personally I am not desperate for money and will choose the best treatment for longevity and lack of SE's. But the difference in money can make a difference for some people.
Posted 2/21/2015 9:29 PM (GMT 0)
What about HDR brachy? Is that rising among men or is it splitting between surgery and IMRT?
Posted 2/21/2015 9:38 PM (GMT 0)
RCS,
I'm not for a single payer system, but there is no doubt that it works and would be much better than our current system.
The best allocation of resources is the pricing system of supply and demand set by millions of individuals acting in their own interest. This will always lead to some unfairness as a certain percentage of individuals will always be priced out of the market, but the majority will be served well by it as shown by our everyday lives. As soon as you try to set or influence pricing you set off many consequences that cannot be controlled, as indicated by the long lines for toilet paper in Venezuela or the old Soviet Union. The everyday things we take for granted like food, pencils, and millions of other items just magically appear on store shelves without any 3rd party ordering that they be made, sold or priced. To give up such a system that works magically without any outside interference for the sense of fairness would be folly as proven time and time again by centrally planned economies.
The world and life are not fair, never have been and never will be. We just make things worse by trying to affect it. The medical system would work the same way if we just let it alone. Services that are needed would appear on their own and be priced much lower than currently. This is how it worked until a few decades ago. Of course the truly needed would be taken care of by charities like St Judes or the government, but the system of supply and demand would set pricing and allocate resources just as it does for the billions of other things we consume on a daily basis.
Posted 2/21/2015 10:05 PM (GMT 0)
When I was a kid I remember my parents had Ohio Blue Cross which was non profit. Healthcare was fine back then. I know this is the U$ but we don't need to make a buck off everything. If not single payer I'd rather have it a public utility.
Posted 2/21/2015 10:15 PM (GMT 0)
Another stimulus to maximize profits above all else is malpractice insurance of $100,000++ per year. How's that for some overhead? I had a surgeon retire on me because, even covering two small hospitals as their only surgeon(but lots of, actually mostly, Medicare and Medicaid who will only pay a small fraction of normal fees), he could not generate enough profit to make it worth it for him to keep on working, especially with all that night and weekend on call stuff. So he just retired.
Posted 2/22/2015 2:49 PM (GMT 0)

Buddy Blank said...
What about HDR brachy? Is that rising among men or is it splitting between surgery and IMRT?

Seems to be relatively few providers specializing in HDR, with LDR more prevalent (at least in the USA). Would guess HDR's share of the total treatment mix is also decreasing, SBRT probably taking some who might formerly have gone to HDR.

From what I've found on this site, the centers where HDR is heavily done are in LA, Detroit, Atlanta and FL, all of which require traveling for me, complicated by treatments needing to be spaced a week apart (by the usual protocol). Maybe I've missed some places?

Have seen references to some other places where HDR been done, but if I go HDR I'd prefer an experienced black belt, rather than a generalist who has done some.
Posted 2/22/2015 5:20 PM (GMT 0)
John T,

I apologize for putting words in your mouth.

Your first post compares the U.S. Health system to the rest of the industrialized world and makes an argument that US health care costs (as a percentage of GDP) should be in line with theirs. Since all of these countries have a single payer system, I assumed you favored a single payer system.

With the amount of the US health care system essentially already on a single payer system (Medicare, Medicaid) I feel it is highly unlikely we will ever get back to the free market roots that you envision; therefore, I conclude that when compared to other industrialized countries, the US is destined to continue paying excessive salaries to doctors and hospitals. That US patients will continue to pay a cost for health care management (insurance companies costs and profits) not paid by patients in the other industrialized countries. And, as a percentage of GDP, we will continue to pay double what the rest of the industrialized countries pay for health care. We will do this, gladly, because we feel we are getting better health care then folks in the other industrialized countries. I do not know how long this will be going on, as I already see a growing trend for Americans to go off shore for treatments and drugs. Heck, many guys on this forum already go outside the U.S. system and buy drugs overseas ... it saves them money.

Post Edited (RCS) : 2/22/2015 10:28:55 AM (GMT-7)

Posted 2/22/2015 5:27 PM (GMT 0)

Works Out said...

Buddy Blank said...
What about HDR brachy? Is that rising among men or is it splitting between surgery and IMRT?

Seems to be relatively few providers specializing in HDR, with LDR more prevalent (at least in the USA). Would guess HDR's share of the total treatment mix is also decreasing, SBRT probably taking some who might formerly have gone to HDR.

From what I've found on this site, the centers where HDR is heavily done are in LA, Detroit, Atlanta and FL, all of which require traveling for me, complicated by treatments needing to be spaced a week apart (by the usual protocol). Maybe I've missed some places?

Have seen references to some other places where HDR been done, but if I go HDR I'd prefer an experienced black belt, rather than a generalist who has done some.

Works Out,

I had HDR in Atlanta and have recovered well with very minor SE's. I would guess most of the teaching hospitals in the cities you mentioned have low cost lodging for those traveling a certain distance. I know Atlanta does, supported by a mission.

After both of my procedures, two weeks apart, I went out to dinner that very night. So I think a plane ride wouldn't be that big a deal a couple days later.

I hear you though. It's odd some regions don't do HDR very much.
Posted 2/22/2015 5:51 PM (GMT 0)

Works Out said...

From what I've found on this site, the centers where HDR is heavily done are in LA, Detroit, Atlanta and FL, all of which require traveling for me, complicated by treatments needing to be spaced a week apart (by the usual protocol).

UCLA has housing available within walking distance. HDR can be done in two sessions with an overnight hospital stay, so nothing has to be removed between sessions. Dr Demanes is the HDR guy at UCLA and you could ask him if he would do two sessions.
Posted 2/22/2015 6:01 PM (GMT 0)
RCS,
The results of single payer are mixed, France is very good, Holland requires insurance, but I believe it is private insurance, The UK is completely government run and is a mess by all rational measurements. The costs are kept low through rationing service, which is not a bad idea. The US costs are high due to primarily overuse of medical services.
We can reduce costs through rationing, limiting the use of some drugs and procedures and narrower networks, basically rationing, where a central authority, be it government or an insurance company, refuse to pay for certain drugs or services or by making patients only see certain doctors. (medicaid or bronze plans in Obama care). Or by letting the free market determine price and availability and let individuals choose the service and providers they want through competition.
Philosophically, I prefer the latter as I feel individuals collectively can make make better economic decisions than a 3rd party or a government body. Government run systems become too bureaucratic and political as shown by the VA system and insurance companies will act in their own self interest rather than the patient's. Many will point to the success of Medicare, but it is a system that currently averages $33,000 in lifetime payments and doles out $350,000 in life time services, what's not to like about that, but how can a system that pays out more than 10 times what it receives last more than a few decades without collapsing.
Posted 2/22/2015 6:21 PM (GMT 0)
I think we're going to wind up with some form of "medicare for all" if you like, with supplemental insurance available on the public market for the extras. I actually think the two biggest causes of high costs are overtreatment and an attitude by pretty much everyone that "latest is automatically best".

Overtreatment happens, in part, because our medical tort system is so screwed up (so a patient who presents at the ER with a respiratory virus spends all day there and gets cat scans rather than a quick swab to eliminate influenza and a throat culture to eliminate strep), and in part because the hospital has to pay for all their neat toys that they've spent $millions buying and housing.

And, don't minimize the attitude of both patients and physicians who truly believe that if they are really sick, go the ER, and don't get ever test known to man run, that they aren't getting optimal care. I go back: for many years doctors diagnosed appendicitis by palpating the patient's abdomen and doing a white cell count. Is a cat scan really needed?

Then the second: is the newest technology (generally also the most expensive) really better than what came before? Maybe, or maybe not. But, there is an assumption that it MUST be, because, well, it's newer and better. Circular argument.

And then, spending less on hopeless end of life treatments, and doing better on true end of life care would make a huge difference.
Posted 2/22/2015 7:17 PM (GMT 0)

John T said...
......... Many will point to the success of Medicare, but it is a system that currently averages $33,000 in lifetime payments and doles out $350,000 in life time services, what's not to like about that, but how can a system that pays out more than 10 times what it receives last more than a few decades without collapsing.

My lifetime payment into MCare, counting the total I was forced to pay when self employed and the part my employers added to my payments was $72,000. Most of those 45 years the interests rates were from 6 to 14%. I once actually received 18% from a bank for a short time. If the money taken from me had actually been set aside in my name and invested in CDs or government T-bills, even at a mere 6% return I would have $153,000 towards my medical expenses. At 6%, $371,283. At higher rates, or some part in the stock market, it could easily be a million+.

Or another way I often look at it, if that money that was taken from me for my future medical care had instead been used to buy a health insurance policy at an average of $134 per month times 12 months a year X 45 years($72360) starting in my teens which I could not touch until I was 65, can you imagine what kind of gold plated policy that would buy, with the insurance companies free to invest that money over 45 years?

But of course it was not invested, and it did not buy me a future health ins policy except for MCare, and in fact the original sum may not even be there but already spent somewhere else, and there is not enough money in reserve to cover the coming expenditures.

Post Edited (BillyBob@388) : 2/22/2015 12:20:14 PM (GMT-7)

Posted 2/22/2015 9:42 PM (GMT 0)
John T,

For reasons I posted earlier, and which I am sure you are familiar with, I feel your preferred system will never happen .... unless the existing system collapses and we start over. Single payer has a better chance of getting by congress ... and I would put that probability as very small. At best we look at continued patches (compromises) and continued high costs.
Posted 2/22/2015 11:00 PM (GMT 0)
RCS,
I agree, but still can hope.
Posted 2/23/2015 11:25 AM (GMT 0)
Very interesting thread. Makes me do some research!
Posted 2/23/2015 12:07 PM (GMT 0)
For me, as a patient, and I'm sure for many of you as well, the biggest insanity of our existing system is the profusion of billing notices, many from people and companies I've never heard of. Just trying to keep track of them, and the individual IOB statements from Blue Cross, is maddening. When a clinic that employs 6 MD's has to have a billing clerk for every MD, just to handle the plethora of insurers, with their schedules of payments, and hundreds of different insurance plans, the wasted time and money is mind boggling. This is the argument for single payer.

My PCP, the last time I was in getting my annual scrip renewals and I griped about how Express scripts was calling me every 90 days, like clockwork to put me on a cheaper version of a med (it saves them money, not me), told me that he has someone at the office who's job is to field the calls and faxes from the drug plans, research the charts, call the patients, and respond to those requests. Full time. Insane.

If you don't believe that your insurer decides what care, and what drugs you're entitled to, think again. They drive the whole mess, and all they care about is the bottom line. We already have rationing, and the rules are set up in secret and administered by nameless drones in insurance company offices.

I remember, years ago, I was trying to find out if a particular treatment one of my kids needed would be covered. The person I talked to kept saying, "It appears so, but the actual contract will determine it." After the third reiteration, I stopped her, and asked her why she couldn't give me a straight answer. In a moment of honesty, she told me, "Because I truly don't know. And, if I give you a straight answer and I'm wrong, and you sue us for payment, I will be held PERSONALLY liable for the payment if I tell you yes and the company later turns you down."

Crazy.

End Rant.
Posted 2/23/2015 1:05 PM (GMT 0)
Wow, so this thread sure has taken off on a completely different path! From making the point about one of the main drivers of BT decline, to a healthcare / health insurance topic. That's all good though, but I'm wondering if we're not missing more input to that issue because of the topic of this thread. Maybe I should re-name my thread?
Posted 2/23/2015 1:27 PM (GMT 0)
John T,
Yeah ... for me, my views are utopian.

Yop,
I apologize for the hijack. But I feel that one of the reasons BT is declining in the USA is the medical system it is operating in. Guys are allowed to choose (rightly or wrongly) their treatment .... even if it costs more and the end results are not any better. I feel the articles you posted point this out rather well.

This reminds me of the competition betWeen MS Dos and Apples Operating System. In my mind Apple"s system was far superior; however, DOS somehow grabbed the PC market and ran with it for many years.

Post Edited (RCS) : 2/23/2015 6:35:54 AM (GMT-7)

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