Latest tweet from @johnidavies
Never thought I would say this but would be better off under US system -
covid19treatmentguidelines....
"The COVID-19 Treatment Guidelines Panel...recommends using ... (Evusheld) as SARS-CoV-2 pre-exposure prophylaxis (PrEP) for...moderately to severely immunocompromised"
Be careful what you wish for
Interesting graph 🤔
The harsh reality is it depends whether you have quality health care coverage or not in the US. If you do you are far better off with what you receive in the US than the comparable package in the UK. If you don’t you are far worse off than what you receive in the UK. Unfortunately, many don’t have quality healthcare in the US and this is the reason for the shape of the US trend-line you have cited.
The spending on healthcare in the US is not sustainable at current levels but neither is it in the UK. In fact, both countries spending overall can not continue over the medium to long term at current levels.
Is it true that the pharma companies effectively 'own' the hospitals and medical system in the USA?
I do not agree with that point of view. Is there some influence? Certainly. Is it out of control. No. In fact, I think the US pharmaceutical industry is the envy of the world and makes healthcare in the US better. Just look at how the industry met the challenge of the pandemic and compare that to how the second most powerful economy in the world, China , continues to struggle with Covid. Despite successes like this, people love to hate the US pharmaceutical industry. For the life of me I don’t know why
Unfortunately, political divisiveness on both political extremes continues to stymie a solution to healthcare reform in the US. I’m not sure what the answer is.
Best,
Mark
Mark, the only point I wanted to make with the graph was that the US system in its present form may not be the best alternative to the NHS as proposed by the OP. The fact is, healthcare spend per capita in the US is way more than that of other developed nations and more than double the UK's oecd-ilibrary.org/sites/154.... Fig 7.4.
Many countries face difficult choices ahead, with an aging population making greater demands on health services, and a diminishing workforce to finance them. Sections of the UK economy are already critically dependant on foreign workers, and that's only partly due to a skills shortage. The same is true elsewhere in Europe.
Soylent Green here we come.
Hello JIDD
Very astute observation. Both nationalize health care and private pay has problems. If you are the one making a decision to feed 10,000 starving people or save one person with transplant, what would you do? At the same time private pay leaves many, (but not all) without health care. The US has basic health care for all, regardless of ability to pay and it functions like nationalized health care, slow and underfunded. Many of the drugs we as CLLers take today would not be around if it not for the profit motive. we all suffer from the illusion that we will live forever.
I have spent this morning in an oncology unit having ivig. Last week I had an appointment with neurology. The nurse consultant spent 45 minutes discussing my issues and made me another appointment for November. Tomorrow I visit my GP for my 4th B12 jab. Also in November I will see a rhumatologist, have ivig in Oct and Nov. Also a cll consultant appt.
I wont pay for Ibrutinib or co trimoxazole or other drugs. I wont pay for a flu jab or a covid booster. I have had more than my share of NHS.
I know very little about the USA system. If the poorest people who cant afford it get very little help and the wealthy get treated with luxury, then it will be like Britain was before the NHS.
Is the Us system better? Those people who need replacement joints and other treatment that there is a wait for are paying for private treatment. I heard today that there is a wait for that treatment. A&E are horrendous. Ambulances cant take patients in. That is where there is a problem. Waiting times and no beds to move people in to.
This is just an example. Nurses and doctors are wonderful. Anne uk
Anne,
I agree. After a nasty fall that resulted in a possible fractured elbow a friend took me my nearest critical care unit ( major London hospital ) I was booked in, saw a nurse, went for an X-ray and was then given the results and an appointment was made for the fracture clinic. This was all done within an hour. Mask wearing was strictly adhered to and the seating was a brilliant design to allow good space between patients. I emailed the CEO to complement him on his hospital and staff. Much to my surprise I received a reply this morning thanking me and saying he would pass on my complements to the relevant staff. I replied saying his response further illustrates that care starts at the top and works down.
Anne sadly your diary sounds like mine. My only gripe with the NHS is too many managers. One of my lovely surgeons agreed and said by the time people realise how useless they are they have moved to another department.
Regards
Colette
My mother was admitted to A and E on Friday and they had no bed for her, she's being discharged later today. It took until this morning for her to get the tests she needed following a suspected stroke. The system is completely broken.
Its a few years since my Mother fell but she waited hours until a doctor rushed her into xray. Then the doctor said there wasnt a break and sent her home. 3 weeks later the xray was reviewed and there was a break in her leg.
Its a while ago, poss 3 years that my friend had pneumonia. The doctor allowed her husband to lay her in his car and take her to A&E because it would take a long time for an ambulance to come. She was laid across 3 chairs and insisted her husband go home to feed the cat. Other patients panicked because her breathing was so shallow they thought she had died! Her husband wasnt long. There was no bed and eventually she was given antibiotics and he took her home to nurse her. She was ill and fatigued for weeks.
It was found she had sepsis. A small lump was found between her lungs and spine. It wasnt cancer but it was growing. This was something that would not have been found in time if she hadnt had pneumonia.
Our A&E is definately not functioning but the surgery my friend had to remove the lump was complicated and shows the NHS still works. I would not go to A&E unless I was desperate. Anne uk
I have to admit to being anxious about the future. The national insurance wasnt necessarily the best way of raising money but the intention was to invest in the NHS and then social care. We cant do anything except hope.
Where Evusheld deployment is concerned, it's not only the US, every other G7 economy is "ahead" of the UK.
Not everyone agrees that Evusheld is the way to go. British Columbia has withdrawn it while Omicron BA.4 and .5 are dominant, and has published its scientific analysis. In contrast, the UK government's counter-evidence is shrouded in mist and in retrospect it's clear they kicked the drug into the long grass early in 2021, before it became Evusheld. See healthunlocked.com/cllsuppo...uk-department-of-health-evushelds-in-the-long-grass?responses=148393739
My main take from this discussion, irrespective of our country's health system(s) - many have public and private, is that being an informed consumer of health services and our specific health needs is invaluable. This community helps us educate ourselves on both, at least with respect to our CLL.
As you, cllady01 and Jm954 have noted, it's not just the pharmaceutical industry (and why should it be, when you have a for profit sector?), but the entire industry, where health insurance companies in the USA are key players. These frightening prices bandied about are pretty well only paid by the uninsured. Those insured pay a bargained price, which is considerably lower and closer to what is paid elsewhere in the world. A personal example is that my month's supply of IgG is priced at about US$2,000, which includes a profit margin. While I do my infusions weekly at home with perhaps US$200 tops worth of medical supplies. I gather that the nominal price (not cost) is about US$10,000 for a monthly IgG infusion in the USA. I tried to find out the cost of a monthly infusion in through a Medical Cost Finder for Australia, only to find it was bulk billed to Medicare - I'm paying it through my taxes.
health.gov.au/resources/app...
(It's worth checking out for those interested)
While I don't recommend using fiction books as a source of information, how I though US medical insurance coverage of hospital patient costs works was "confirmed" for me on page 58 of Robin Cook's 2021 book "Viral". (The book is about mosquito transmission of viruses and how health insurance "works" in the USA) . The bill in dispute is $27,000 for an ED admission to supposedly Manhattan Memorial Hospital in Inwood, NYC. The full bill for a couple of days in ICU then a general ward bed supposedly comes out at just under $200,000.
The bill was entirely unintelligible, composed of long lists of alphanumeric entries, with every page mostly entries followed by dollar amounts. Disgusted, Brian tossed the stack onto the desk. "It's not in English. It's all in goddamn code!" "I warned you that it would be incomprehensible." "Why is it in code? Why isn't each procedure or product just listed with a price? This format doesn't make any sense." "Prices are proprietary information," Roger explained. "We have to keep that information confidential for our negotiations with insurance companies. "I don't follow," Brian said. "Isn't there one specific price for every product and procedure?" Roger scoffed at Brian's naivete. "There are different prices for different insurance companies. It's all a matter of bargaining. Surely you must know this." "That's crazy," Brian said. "I've never heard of such a thing. Do I get a chance to bargain?" Roger genuinely laughed, although he was obviously losing patience. "No, you don't get a chance to bargain. As an individual, you have to pay full freight." "Why is that? Why do I have to pay more than health insurance companies for the same service?" "This is how American hospital-based medicine works," Roger snapped. "I don't have time to explain it to you, nor is it my job. It's complicated. But, look, I'll have a slightly more comprehensible bill drawn up, which I can email to you if you give me your email address." "I never had any idea of any of this," Brian said as he dashed off his email address and handed it over.
So keep in mind that to a degree, the high costs you hear bandied about for US medical costs are also somewhat fictional - unless you are uninsured, or your insurance company refuses to pay your bill. I would expect that the percent of the US GDP spent on health costs is real, however.
Hawkeagle, having worked in middle management myself at times and faced several thinning down drives, I do acknowledge that a significant part of middle management's effort can go into justifying their existence. Manager's salaries are paid out of loading the cost of services.
Neil
OK. I tried to clarify my position on health systems but this was removed as "too political" by the moderation team. I will try again.
For all the reasons in other replies to my initial post, I am not advocating that the UK adopt a US style health system. I simply observe that even the USA , with the least attractive and efficient health system in the developed world, has allowed access to Evusheld. Of health systems in the developed world I believe we are in a minority (perhaps of just one) in blocking this. I wonder why private access is also being prevented? If there was private access to Evusheld in the UK the pressure to make it available to NHS patients would become irresistable.
Hoping this is un-political enough to be permitted.
Excellent comment.
Updates on Evusheld Dosage per FDA (USA)
Shielding advice by UK GOVERNMENT 
