Landmark milestone for those who with chronic illnesses in the U.S.…including many cancer patients

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Casey59
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Date Joined Sep 2009
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   Posted 9/14/2010 8:26 AM (GMT -6)   

As a benefit of the new U.S. healthcare legislation, starting next week the “cap”, or upper-limit, on lifetime benefit coverage by insurance companies will be eliminated.  The most common insurance lifetime cap is one million dollars coverage.

 

Many in the U.S. don’t even know that the “cap” existed until they “capped-out” by passing the limit.  “Capping-out” has led to financial ruin for some while dealing simultaneously with serious health issues.  Those with chronic illnesses who became aware of the “cap” were faced with the prospect of changing jobs every so often simply to maintain coverage.

 

In prostate cancer, the vast majority of patients are (thankfully) not confronted with this dilemma.  To a large extent PC patients require only a single-line of therapy.  However, for others (and for many of our brothers & sisters, fathers & mothers, husbands & wives fighting cancer) the disease becomes chronic and requires years of expensive treatments, and an unfortunate minority have been impacted by the “cap.”  None of these unfortunate souls foresaw themselves in the financial/insurance predicament that befell them, but this new legislation now removes this constraint.

 

Karen Pollitz, head of an office at the Department of Health and Human Services to help consumers navigate overhaul, says it's a big change:

“This is sort of the ultimate example of what insurance is for. We're buying protection against the financial ruin that comes with a very expensive medical condition or injury as well as assurances that we'll be able to connect to the care we need to get better. So when you hit the lifetime limit, you often lose access to the treatment, not to mention your house.”

 

Casey’s comment:  Good job!


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 9/14/2010 8:45 AM (GMT -6)   
At least something positive from change - I live in a major metro area, and there had just recently been several cases of city employees who discovered that their medical coverage had a $100,000 lifetime cap. You can imagine how they found out about it.
 
I could be cynical and say they should have known, but few people understand what their insurance covers. Just in my PCa DaVinci and radiation journeys, I've learned more than I ever feared I would need to know. Many bills have been questioned and appealed.
 
And, yes, my treatments in the last 365 days far exceeded $100K, so you can do it with PCa as well.
 
Anytime anyone asks about insurance, the cap has been my first question. Few could answer it.

60Michael
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Date Joined Jan 2009
Total Posts : 2222
   Posted 9/14/2010 9:35 AM (GMT -6)   
My cap was 2 million, but I was amazed at how little I have used thru Robotic Surgery and SRT due to negotiated prices with the insurance company and health provider.
Michael

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 9/14/2010 6:49 PM (GMT -6)   
142 said...
At least something positive from change - I live in a major metro area, and there had just recently been several cases of city employees who discovered that their medical coverage had a $100,000 lifetime cap. You can imagine how they found out about it.
 
 
Ouch!   That's awful...devistating for them, I'm sure.

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 9/14/2010 7:11 PM (GMT -6)   
This is just one of the many benefits of health care reform that people are slowly starting to realize. Another is that you can keep your child on your health insurance up to age 26. That's one we were ready to use, except our youngest just found a job this past summer, so we don't have to. Time to shut out the nonsense on TV and in the media and pay attention to the actual benefits of this new law as it slowly rolls out.

goodlife
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Date Joined May 2009
Total Posts : 2691
   Posted 9/14/2010 7:24 PM (GMT -6)   
And of course no one expects health care costs to rise as a consequence.

As an employer, as well as paying individual, the costs of all of this change has to concern me. While certainly $100,000 is pitiful, maybe unlimited is excessive.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 9/14/2010 8:41 PM (GMT -6)   
Of course cost is an issue...but do you think that the solution to the problem of health care costs is to pull the plug on people when their cap runs out? All of us have sympathy for those who have the same problems that we have, but can't get what they need because they don't have insurance. Our health care is much more expensive than the rest of the world, so clearly cutting out health care insurance for part of the population doesn't solve the problem. The health care reform bill deals partially with the issue of lack of insurance and poor insurance, but it's unclear what it's going to do to cut costs. Either it has to implement some unpopular rules to control costs (there are some mechanisms in it that can be used for this), or another bill is needed.

The New York Times had an editorial about this (bottom). I don't totally agree with what they say, because they bash PSA screening in it. But they do touch on a key point. Most people follow economic incentives in their activities, and doctors are influenced by money like anyone else. For decades, US health care has been driven to find new expensive treatments, and use them as much as possible. If they do, they stay in business and prosper. It's hard to believe that health care costs could become less with changing doctor's incentives and reining in some of the use of expensive treatments and tests. For PCa, this might mean, say, no more proton beam machines unless there was good medical evidence--a level 1 study--that it was better in some way than other treatments.

The problem is, that everyone wants what they want, whether it be color dopplers or HFO treatment, and doesn't want anyone--insurance company or government--to deny it. At the same time, no one wants to pay more for insurance. I think the reason that health care reform is unpopular, is that people think that they are going to have to pay more money just to help those people that are uninsured. It's the old "I've worked hard for what I've got, why do I have to pay for that deadbeat that doesn't work as hard as me?" The problem is, that when you get sick and can't work because you are sick, in the past, you lost your insurance, and voilà, suddenly, YOU become one of those deadbeats. Or you exceed a cap that you didn't know about, and your insurance stops paying. There but for the grace of god...

One problem with health care is that it is full of waste. Unnecessary tests repeated over and over again; treatments that don't work, etc., etc. No question that people are going to disagree about what is necessary and what is waste. But the only solution is to try to use science to decide. You may think HFO is the cat's meow, but there should be an adequate clinical trial to prove it before it gets paid for. If you want it anyway, then you should have to pay for it yourself. Our choice--1) have any treatment you want but have your insurance rate double in the next 5 to 10 years, or 2) face some restrictions and rules, but have costs go up at the rate of inflation, currently about 2%. You pick.


http://www.nytimes.com/2010/09/12/opinion/12sun1.html?scp=1&sq=health%20care%20costs%20editorial&st=cse

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/14/2010 9:49 PM (GMT -6)   
postop,

another good post. i like your thinking.

waste - that alone could pay for health care for all, the waste at all levels is attrocious and shameful

as far as the other part of your post, the everyone wants what they want part, my take on that - and these are my words not yours, of course - when push comes to shove, many people are too d* selfish to care about anyone but themselves, let alone have empathy for the poor, the needy, the long term unemeployed, etc. it's a sad truth to sink in.

thanks

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 9/15/2010 9:26 AM (GMT -6)   

 

First of all, I'm glad that this thread did not take on an inappropriate political tone...politics was not my original intent, but I realized after I posted it that it could go down that rat hole.  As cancer victims, I think many of us have had concerns about the costs, and our insurance coverage (for those of us--the majority--who have insurance), but few have probably considered the devistating prospect of "capping-out."

goodlife said...
And of course no one expects health care costs to rise as a consequence.

As an employer, as well as paying individual, the costs of all of this change has to concern me. While certainly $100,000 is pitiful, maybe unlimited is excessive.
 
Goodlife, with all due respect, I think the discussion needs to move into why do some health care services cost so much and what can we do to address those issues.  I see it largely as righting a wrong that had been built into the system, and for that I say "good job!"   I thought that the Karen Pollitz quote nailed it:  "This is sort of the ultimate example of what insurance is for."
 
To the issue of reducing health care service costs...that's for another thread on another day.
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