Apr 24 2007

Sticker shock


The FDA just approved this drug for patients with mondo HER2-positive breast cancer. Lucky for Glaxo-Smith-Kline! And lucky for the 4 or 5 women on the planet who can fucking afford it! My insurance company doesn’t feel like coughing up. I’ll be on it for a year, assuming it doesn’t kill me, to the tune of 40 large, not including the creepy radioactive MUGA scans every 90 days to make sure my heart is still beating.

But that’s nothing. My father, who has pancreatic cancer, has on his bathroom vanity a bottle of pills that cost $5000 for a month’s supply. He calculates that so far it has cost him about three quarters of a million dollars to stay alive for the past 3 years.

I have yet to find a single thing about cancer that isn’t fucking inconvenient as hell, but this kill-the-poor bullshit takes the fucking cake.

Fucking megameditheocorporatocracy.


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  1. Spinning Liz

    Oh yeah. I’m looking at two years of Rituxan maintenance therapy, and a quickie with my calculator tells me that the entire course would run about $75,000. That’s just for the drug itself and doesn’t include peripheral expenses like the costs of infusions, tests, scans, bloodwork, hospitalization, other drugs to counter the side effects and complications, etc. It’s still up in the air whether I’ll be eligble for free samples of Rituxan from Genentech or whether I’m just going to have to forgo treatment. If the cancer recurs I’ll need a stem call transplant, in which case my name will legally change to Old MacDonald because I’ll have no choice except to purchase the farm.

  2. Anji

    Holy crap! I have never been more grateful to my country’s National Health Service. Just the thought of paying that much for medication made me wince.

  3. Bird

    Universal health care is a precious, precious thing. Concerned Canadians should send a copy of this particular receipt to any Conservatives who think privatizing medicare is a good idea.

    Not-so-funny story: my mother, who has brain cancer, was on a trip with a group in Nicaragua providing medical and dental services to people in poverty in a rural area of the country. Her wealthy fellow travellers were all discussing how privatizing medicare would be such a good idea. My mother looked at them in shock. “Look around,” she said. “If I lived here, I’d be dead by now.”

  4. Urocyon

    I thought I was beyond shock at pharmaceutical prices by now, but apparently not. That is truly frightening.

    Anji, I think you are in the U.K., yes? Unfortunately, I don’t think the NHS covers Tykerb, unless they have changed their tune drastically since this report. I didn’t see any signs of it from a quick glance at Google, at least. If the NHS do put it on the approved formulary, I’d still anticipate the usual rationing by obstacle course.

  5. EE

    The best part of that photo is the “We Appreciate Your Business” at the bottom. Ha!

  6. kate

    EE — exactly my thought.

    Privatized healthcare; its the new eugenics.

  7. cycles

    Jesus, Twisty. I’m so sorry.

    Frontline’s “The Other Drug War” has a good set of links and interviews about prescription drug pricing. Unfortunately, i’s not one of the episodes you can watch online.

    It’s the episode where I learned that pharmaceutical companies get a 20-30 percent margin. Margin. That’s ridiculous. Even for a company that claims to need a high R&D budget.

    Again, I’m so sorry. Is there any way we could gather up a small militia and raid a GSK factory? “To arms! For Twisty!”

  8. Twisty

    Aw, that’s sweet, but it’s not me I’m worried about, cycles. I will manage. It’s all the girls who can’t scrape the cash together who need your militia.

    So much is made of our supposedly high standard of living, but the bloodthirstiness of the American “healthcare system” just astonishes me. Ours is a country where you don’t get a liver transplant unless you can cough up half a million bucks. Fuck’em all.

  9. MzNicky

    Fuckin’ fuckall fuckety fuck. That’s all I got to say.

  10. jessant

    I would die if I got any kind of cancer. I don’t have health insurance. I haven’t been to the doctor in…damn, I think it’s been four years or more now. I’m sure there are a lot of people in my boat too. Kinda sad, but I don’t even check for things anymore. I would be in debt for the rest of my life. A simple doctors visit costs more than I can afford now.

    I hope you are okay and that they work. I don’t think anyone in the administration realizes this but a human life is worth any monetary cost…that’s basic human kindness and consideration…our health is a right…How are we suppose to pursue our happiness if we’re sick and dying in droves…

  11. Dot

    It is the new eugenics. Kill all the old or sick poor people. Especially the wimmin, so they can’t kick out any more!

    I want to know who’s gonna scrub their toilets then?

    Ah, the ownership society. Gotta luv it.

  12. Ron Sullivan

    Ours is a country where you don’t get a liver transplant unless you can cough up half a million bucks.

    Witness, sister!

    Good luck with the damned stuff; for all that, it should make you able to walk on water, at least.

  13. magickitty

    Yeah really, for that much money I’d want some superpowers to go along with my cancer-killing. Fucking disgusting.

  14. Sylvanite

    It’s amazing to me how inhumane America is, and how many people seem to think that’s just peachy. Or maybe they’re just really unimaginative.

  15. the first born fish

    Yikes, and I thought I shelled out for birth control.

  16. Ana Casian Lakos

    That’s true, but we’re still going to exist that it’s a level playing field for poor people and rich people.


  17. Hattie

    That’s godawful. My Canadian cousin is a six year survivor of stage three colon cancer. He got the best of care: in Canada. If he had been in the U.S. who knows what would have happened to him? As it is, he takes luxury cruises and winters in Palm Springs.
    I can’t believe the stories I’m hearing from the many many breast cancer patients I know who have more or less been dropped from the health care services because they can’t pay for treatment. Who cares what happens to a lot of middle aged women anyway? Who took birth control and “hormone replacement” that probably gave them cancer! Where are the class action suits on that one, by the way???
    My husband and I are typical elderly Americans. We’ve been careful about our finances and have medicare, but the kind of treatment we would be given if we should get seriously ill would be minimal unless we paid for it out of pocket. We have a medical emergency fund.
    Grr! I hate all this, Twisty. It’s just sickening that this has happened to you.

  18. utsusemi

    I remember having much the same set of thoughts as a teen a few years ago, when my father went on a new drug for his very obscure form of liver cancer. He’d been in the stage 3 clinical trial–free, obviously–but once the magic pill got approved he had to start paying for it.

    His insurance covered it, but I remember looking at the price on some piece of paper (receipt? insurance statement?) left lying on the kitchen table and thinking what a travesty of medical ethics it is–anyone can get treatment when it’s experimental, but once we /know/ it works and won’t hurt you, well, anyone who isn’t rich is out of luck. The hell?

    I mean, for drugs like this–literally lifesaving targeted therapies–it’s more affordable to be a guinea pig than, y’know, a regular patient. I am sure there were people in that trial who didn’t have Big Law Firm health insurance and couldn’t afford this drug (I think it was called Gleevec? Memory fails). What would you do in that situation? Take out a second mortgage. or start shopping around for a trial of another drug that might or might not work for you?

    At the time, I was so relieved my dad was still alive and (mostly) okay, I was a little afraid to ask. Now I wish I’d brought it up while I had the chance. Yet another thing I regret not being able to talk to him about.

  19. smmo

    Wow. I knew how bad it was, but seeing it in black and white is stunning. Culture of life my fat white ass.

    I always laugh when my Republican father tells me that “socialized medicine” would lead to delays in treatment and not being able to see the doctor of one’s choice. Even for people with insurance, this is the reality right now. We have the absolute worst of both worlds.

  20. Pinko Punko

    Their receipt machine probably sets off an alarm in back going “wooop wooop wooop” and maybe there is a balloon drop at Big Pharm HQ. Jesus H.

  21. MedeaOnCrack

    smmo tell your father; socialized medicine recently flew me 1,800 miles across the country to see the doctor of my choice, at no cost to me. No, wait. I did have to buy my own chocolate fudge at the airport. I’ll be having the recommended surgery at no cost too, and the recommended stint in rehab.

    Tykerb won’t be covered here for everyone even if it gets Health Canada approval. After HC approves a drug each province makes its own decision about putting it on their formulary.

  22. Ana Casian Lakos

    Did i just say “exist that it’s a level playing field?”
    Ana really needs her some coffee.

    I meant to say:

    “That’s true, but we’re still going to INSIST that it’s a level playing field for poor people and rich people.”

  23. virgotex

    Holy shit.

  24. Jenny Dreadful

    Well fuckety fuck. If I ever get the big C, I’m gonna die. That’s all there is to it. At a whopping twelve bucks an hour, I’m ineligible for state-subsidized medicare, and unfortunately, nobody I know has that kind of money to throw down on my behalf.

    Even when I had “really good” medical/dental insurance, it cost me over $200 bucks for a root canal.

  25. CafeSiren

    I always laugh when my Republican father tells me that “socialized medicine” would lead to delays in treatment and not being able to see the doctor of one’s choice.

    What your Republican father really means (though he may not know it) is “socialized medicine would lead to me experiencing delays in treatment and me not being able to see the doctor of my choice.” Because in this country, if you’re not wealthy, that’s the way it’s done already — you end up in some cheap HMO (if you’re lucky enough to have insurance at all) where the doctors give you 10 minutes of their time, refuse tests that are too expensive, won’t provide drugs that aren’t available in generic form, and generally treat you like you’re an idiot. What people who rail against “socialized medicine” are really protesting against is the thought that the few might lose a few privileges so the many could be given adequate care.

  26. bitchphd

    But Twisty, the pharmacy “appreciates your business.”

  27. MedeaOnCrack

    Pinko Punko the cry that goes up is *Stockholders Rejoice*

  28. NKBurlington

    Did you have to pay a dispensing fee on top of that?

    Seriously, that’s some serious coinage. Yikes! Makes me wonder if they ever do find a cure for cancer, who will be able to afford it?

  29. Antoinette Niebieszczanski

    “The rich stay healthy, and the sick stay poor” — John Lennon

    Sign me up for the Can’t Afford the Really Pricey Drugs Brigade. And we ain’t in the minority.

    I just made an appointment for a follow-up ultrasound. The doc found something hinky in my left boob the last time I had my mammos grammed. And to be honest, I’m more afraid for my finances than my health.

  30. Mar Iguana


  31. compcat

    utsusemi, the drugs given in clinical trials aren’t exactly “free”. They are paid for by whopping big NIH grants + a tiny sparkling of big pharm money (but it costs them! so much!, wait, that’s the advertising, nevermind.) The drugs are “hand made” in some studies for each researcher, so that ups the cost per pill. I’m just glad that they are now required to continue to supply medications to study participants after the study, if it isn’t made commericially available. That saved my aunt.

    The NIH budget has remained stagnant for 5 years, while the number of scientists applying for them has increased by many folds. The recent congress discussed cutting it further, cause who needs research? It’s not like our scientific community was driving the US’s ability to compete with the rest of the world. All of the CEO’s here have already invested in China. Obviously, research shouldn’t expect to be funded by the government anymore. *snark*

    This is why there has been recent discussion of how US based scientists might be able to apply for EU grants. Its always been the other way around before.

    Research funded by big pharma has recently been found to have results skewed in pharma’s direction. Just ask the FDA, when they aren’t so busy explaining why they haven’t been doing their job. (Remember “Don’t Tell Mom, the Babysitters Dead? Well the current administration tends to get rid of folks who point out problems, instead of just chanting “I’m right on top of that.”, even when they’re not.

  32. Sara

    And why do I keep thinking these prices are just artificial numbers someone pulled out of their ass? Kind of like the price of health care generally? Does it really cost this much money to make and distribute this many pills? Really? How does that break down, exactly?

    Terribly sorry to hear your father has pancreatic cancer. Best wishes to the Faster family generally. It’s been a rough year.

  33. lawbitch

    Gawd, I weep for my country.

  34. hedonistic

    I’ll never complain about my $100 prescriptions again.

    Watch us get National Healthcare once the babyboomers begin to drop dead from preventable and curable diseases. This huge cohort has an awful lot of political pull. Of course, by the time it’s finally implemented it will be too late for the babyboomers. Sigh.

  35. Catherine Martell

    Eeesh. Twisty, that’s awful. Next time someone wonders why Americans, who live in arguably the most developed country in the world, have significantly worse health than Cubans, who live in a country that is halfway to the bottom of the league – you can just show them that picture.

    As well as the “We appreciate your business”, I hate the “Your price”. As if it’s all special for you, and they are doing you a favour. Sickos.

  36. Bird

    Actually, I should point out that Canadians still have to pay for many of our drugs, but those costs are subsidized. In the case of cancer drugs and similar, provincial cancer boards generally decide which drugs are listed to be fully covered. This list can vary from province to province, so in some regions you may not get the newest drugs paid for. But most of them are covered.

    As for seeing the doctor of one’s choice, it’s really easy. You just phone, find out if they’re taking new patients, and book an appointment. My doctor is great, and I usually get in to see her pretty quickly.

    As for delays in treatment, they had my mother in for surgery within three weeks of her diagnosis, and she got one of the best oncology neurosurgeons in the world. Her surgeon also made sure that Mum got chemo to give her time to see my youngest brother finish high school and watch me get my degree—we had to tape my convocation and play it for her in the hospital last year, but she was here for those things.

    We do have some waiting list problems when it comes to stuff like joint replacements, but generally, if you need treatment, you get it.

    Antoinette, I understand the worrying. They found “abnormal cells” on my last pelvic exam. Now we wait six months and check again. Whee.

  37. femhist

    Seems appropriate that I read this post while Tracy Chapman’s song “Revolution” was playing on my local alt-radio station. “Poor people gonna rise up, take what’s theirs.” Yeah right. I just hope that we can succeed in making health care more of a priority in the next few legislative/electoral cycles.

  38. blondie

    Ahh, feudalism. By any other name (like maybe, capitalism?) would smell as sweet.

  39. rootlesscosmo

    I join in the expressions of horror and outrage and sympathy.

    On a related point, the March/April issue of Women’s Review of Books (not available online) has a review by Ellen Leopold of a “Pink Ribbons, Inc.: Breast Cancer and the Politics of Philanthropy,” by Samantha King. Sample quote:

    “The great virtue of [King’s] book is that it interprets the success of breast cancer fundraising not as an isolated phenomenon–a unique response to a unique disease–but rather as an expression of broader trends in contemporary philanthropy and politics. The pink-ribbon phenomenon, King says, reflects a recent marriage between new corporate giving strategies and what she calls ‘consumption-based citizenship.’ … The new mantras of civic participation are self-help and personal accountability. Forget about the social safety net and public accountability. Citizenship, like charity, now begins at home.”

  40. medrecgal

    I always said our American healthcare system was broken…and this is just one manifestation of it. However, I’ve heard the argument that they’re passing on the cost of innovation & technology to the consumer, & that if they tried to reduce the price to more reasonable levels, science would come to a screeching halt and we’d all be screwed. I don’t think that’s necessarily true; I think that there are several factors contributing to this situation…and that insurance companies have a lot of us by the balls because they know we can’t afford healthcare without them and will thus cough up their at times exorbitant premiums, deductibles, and copays. (This depends on what kind of insurance, and through what kind of company you’re getting it, however; there are still some reasonable ones out there.)

    Nationalized medicine (a national healthcare system) may not be the answer, however…in some places in Canada, for instance, the waiting list for something like a coronary bypass (which is routine in the US) is several months to even years. Most people sick enough to require such surgery don’t have that kind of time to wait. So it’s a matter of the lesser of two evils: do you go for the national health plan, where you might very well die before you get the chance to have the procedure, or do you go for the individual insurance coverage where you might wind up paying considerable amounts out of pocket? It can often be a no-win situation. It will only get worse as our population ages, too. Scary thought, indeed!

    I think you put this very well when you wrote above in the comments that “ours is a country where you don’t get a liver transplant unless you can cough up half a million bucks. Fuck ’em all.” Problem is, in places with socialized medicine, you’d be much less likely to get even the chance for a liver transplant. I’m in total agreement that no one has found the right solution to the mess that is healthcare. And to think I’ll be right in the midst of it (again) everyday when I do finally get back to medical records.

    Hopefully in spite of all of this, you’ll still be able to beat that cancer into remission (or cure)…that’s the point, after all, as much as it sucks.

  41. Bird

    medrecgal, I call bullshit. You do not wait years for a coronary bypass in Canada. The median wait time in the province of Alberta (where I live) for all cardiac surgeries is 3.6 weeks. In urgent care cases, that time is shorter.

    Please see http://www.ahw.gov.ab.ca/waitlist/WaitListPublicHome.jsp to get an idea of other wait times. And note the message at the top of the page: “Persons who need emergency surgery or treatment receive it without delay. They are not entered on a waitlist.”

    Our federal government is also working on a system that will see more patients moved around the country for timely procedures if necessary, and there is a serious effort underway to find further strategies to reduce wait lists.

    If you’re going to make that sort of claim about Canada’s healthcare system, please cite some real facts next time, thanks.

  42. Foilwoman

    I stay in a job that is good but not great and that doesn’t pay well at all because it has great health insurance at a reasonable pricetag. I used to pay $900 a month for coverage with a small employer (family coverage — two kids and me). Switching to an employer with good (better than the $900/month people) health and dental coverage at $250/month (with $10 copayments) has saved my life. It’s scary how much of a luxury health care is for most people. Of course, I took a $30,000 pay cut to take this job, but looking at the cost of that medicine, I think if anyone in my family ever needs real medical treatment for an actual illness we’ll come out ahead. I blame the patriarchy, naturally.

  43. antonia

    medrecgal: “I think you put this very well when you wrote above in the comments that “ours is a country where you don’t get a liver transplant unless you can cough up half a million bucks. Fuck ‘em all.” Problem is, in places with socialized medicine, you’d be much less likely to get even the chance for a liver transplant.”

    well i disagree with that. especially with regard to organtransplantations, if there are no organs, no transplanations and this goes as well for socialized medicine as for the US-healthcare system.
    Sure there are waiting lists. But is the solution in order to get rid of waiting lists to get rid of socialized medicine? That these waitinglists exists has to do with political decisions, not with some ‘natural’ scarcity or the mythical overaged society. Capitalism has an interest in maintaining scarcity in order to show us who rules. More scarcity and waitinglists will make the people having doubts in the nationalized system and demand one like you have in the US, because then at least those who have the cash can get treatment in time. The growing waitinglists are a plain result in the unwillingness of politicians/pharmaindustry/etc. in maintaining socialized medicine. They want to deteriorate the socialized system so that they can say: ‘see doesn’t it work badly’ so that they have a free way to implement your US system. Because it has such an empowering effect, you see, when we feel ourselves us customers who go shopping (if we can afford it) at the different insurance companies in order to make good & responsible choices about our health (so that in the end you can blame yourself when you somehow forget to buy insurance for the rare disease x). I am from a european country, my monthly healthinsurance-rate does not exceed double digits and everything is covered except some dental stuff and now the politicians tell us this system is crap we need to take over the one from the US, because it is so cool, because it educates the patients – no the customers – to more reasonable healthy behaviour i.e. going less often to the GP and such things. Throw out the whole prophylactic medicine, who needs that anyway. Prohylaxe is for the sissies anyway, no? Why not throwing out all the pelvic exams, mammograms and all that fuss, why not in the first place having cut your boobs off like poor Ashley so there is never any worry anymore about cancer rape etc. that’s the solution: Mandatory amputative surgery for everything that can get ill before you are eligible for healthinsurance, now isn’t that something?

  44. MedeaOnCrack

    “In some places in Canada, for instance, the waiting list for something like a coronary bypass (which is routine in the US) is several months to even years.”

    I doubt this. Since people are triaged those who are waiting several months are not in immediate need, but rather are fear-mongered into thinking they are by our increasing drift to for-profit health providers, and people’s natural inclination to think their physicians and surgeons are motivated primarily by medical necessity. Bypass pays several times what other procedures do. Cardiovascular surgery is no different than any other: We always need the most expensive procedure, of course.

    In fact there is some evidence that no one told they must have bypass surgery actually *must*.

    Since the spam filter dislikes links, google here:

    Patient information: Angina treatments: medical versus interventional
    Julian M Aroesty, MD

    Dramatic Rise in Cardiac Procedures, But Heart Attack Rate Stays Constant
    Center for Medical Consumers

  45. teffie-phd

    medrecgal–the waiting list stuff you’re talking about has been blown out of proportion by the media. People in Canada are not dying waiting for lifesaving surgeries in this country. They are inconvenienced and live in pain for longer than is probably good waiting for orthopaedic surgery and for some medical tests, but that’s about it. People may die waiting for organs, but that is about supply, not surgical wait times.

    People are pretty satisfied with healthcare, considering the free-market alternative. I’ve lived in both urban full-service places and remote, not so great places and while it isn’t perfect, having access to medical care regardless of ability to pay has been great and I’m happy to live in a country that thinks it’s important.

    Regarding cancer meds: I’m actually not one to take these new breakthrough drugs at face value. My father who has end-stage colon cancer is also a statistician and he looked up the studies on some of the drugs he was taking or was offered. Many are hailed as breakthroughs, but the average addition to life expectancy compared to the current standard treatment was often measured in weeks or months. Of course it is presented as living 100% longer, but that means doubling the current 2 month life expectancy. Sure, a few more weeks is good when you’re going to die, but may not be worth the extra money, suffering etc. He opted to stop treatment because chemo was killing him anyway and these were clinical trials for which he saw little benefit. Now he’s just ramping up the pain meds. We’re just all happy that he didn’t have to sell everything he owns to get the treatment he had that kept him alive the last 2 years.

    Cancer really does fucking suck.

    That is also why drugs are sometimes not covered by socialized medicine. Just because big pharma says something is better, doesn’t mean that it is. Or that the benefit is worth the enormous cost.

    When medicine is socialized it leads to some big and ugly questions about the limits of medical care and the minute but expensive steps that are seen as important breakthroughs. Patriarchy hasn’t been doing a crack job of dealing with women’s health issues (think DES, thalidomide, HRT, contraception, stupid killer diet pills) I’m not ready to demand anything that pharmceutical companies say is good for what ails me.

  46. Jodie

    I work on some of those clinical trials. Not all of ’em are funded by NIH; in fact, most of the ones I’ve done are funded only by the pharma company. Other trials are funded solely by the MD, especially those that use an older drug or a generic drug, or use a company’s drug in a way the company doesn’t see any profit for that use. A lot of MDs won’t even bother with doing those because the required paperwork is huge and they must bear the cost.

    Clinical trials, which are required by the FDA, are enormously expensive.

    In one of the cancer trials I’m doing right now, there are 25 sites who have signed up to do the study; the trial has enrolled 11 patients out of the 18 required over the past 18 months (two of those patients are mine). Each site gets start up $$; two to three people from each site are flown to a meeting to learn how to do the study so everyone is on the same page (and since half those people are MDs, it’s usually held in a ritzy place, because most MDs won’t go to a meeting at Holiday Inn and eat burgers). You can see that most of the sites which are “participating” never get a patient.

    Every time a site considers (not sees, just evaluates the chart) a patient who is then deemed unsuitable, the site is paid $250 for that patient (this study has had around 60 of those). For cancer studies, the study must cover scans (CTs, MRIs and PETs aren’t cheap), labs, the medication, sometimes a patient’s travel expenses (for those that come a long way), the doctor’s time, the study nurse’s time, the forms to capture data, $$ for the person who comes out to check the data once a month, $$ for the data entry people, more $$ for the data analysts…I’m sure you get the idea.

    I’m sure there must be a better way of doing these studies, but so far, no one’s come up with one.

  47. Clio Bluestocking

    At “$3,300” you’re goddamn right they “appreciate your business.” Assholes.

  48. MedeaOnCrack

    Just a wee bit more on the genesis of sticker shock:

    “It’s my job to figure out what a physician’s price is. For some it’s dinner at the finest restaurants, for others it’s enough convincing data to let them prescribe confidently and for others it’s my attention and friendship…but at the most basic level, everything is for sale and everything is an exchange.”

    —Shahram Ahari

    Quote from:

    Following the Script: How Drug Reps Make Friends and Influence Doctors
    Fugh-Berman A, Ahari S

    PLoS Medicine Vol. 4, No. 4, e150 doi:10.1371/journal.pmed.0040150
    Read the open-access, full-text article here:


  49. S-kat

    “medrecgal–the waiting list stuff you’re talking about has been blown out of proportion by the media. People in Canada are not dying waiting for lifesaving surgeries in this country. They are inconvenienced and live in pain for longer than is probably good waiting for orthopaedic surgery and for some medical tests, but that’s about it. People may die waiting for organs, but that is about supply, not surgical wait times.”

    I’m hopping on the band wagon here. I couldn’t help but notice that those with positive things to say about socialized healthcare all had real life examples whereas everybody saying “Oh, but you could die before your number comes up,” never cites an example where they saw that happen.

    Once again the rich are trying to convince us that what applies to them applies to the common folk. I think we all know who benifts from the current system in the US.

    On another note, I was explaining the system to a friend of mine from Bangladesh and he was appalled to hear about it. Despite having lived in the US for several years he did not realize that our situation is little different from his. Sure, people die on the street all the time in his country, but he couldn’t fathom that a country as wealthy as the US would allow them to die just as readily (though often not on the street-yipee!)

    Thankfully, I know who to blame.

  50. Hawise

    I get sick, I go to the doctor. My son gets sick, we go to the doctor. My American ex-lawyer aunt is glad that she came north with her partner as 1) they could get married and 2) her wife’s medical treatments aren’t costing them their house, savings and sanity. Socialized medicine is not perfect but I had a friend who was four month in intensive care and I can’t imagine what that would have cost down South.

  51. utsusemi

    Compcat and Jodie, that’s really interesting. I had a sense clinical trials were expensive (maybe I didn’t realize they had quite so many random costs involved), and that makes sense. But it still seems terribly f’ed up that we (collective we? the state? the you-know-what that starts with P?) realize it’s necessary to spend money to develop and test new therapies, but don’t always make the connection that as long as we are investing in the possibility of saving lives and/or improving quality of life, we may need to–shock!–keep on spending money on that goal once we actually know a particular treatment works. If you develop an amazing drug that hardly anyone can afford, you almost may as well never have invented it.

    Except I guess it doesn’t work that way, really, because our society is all too happy to let its more disposable members spend their way into massive debt just trying to keep their heads above water. So long as somebody somewhere is making money, the whole thing will just keep lurching along. Sigh.

  52. Mandos

    I’ve developed a late Futurama addiction, and this (“We appreciate your business”) reminds of the suicide booth scene in the first episode.

    “You are now dead. Thank you for using Stop’n’drop, America’s favorite suicide booth since 2008.”

  53. yankee transplant

    OK, that’s just wrong. Wrong.

  54. Frumious B

    Actually, I should point out that Canadians still have to pay for many of our drugs, but those costs are subsidized.

    Yes, even with socialized medicine, someone pays the drug company. Neither drug manufacture nor drug research is socialized.

    There’s not much excuse for the profit margins, though. Compared to other industries which employ highly qualified and paid professionals, and which use expensive, specialized equipment, pharmaceutical profits are very high.

    I wonder what the profit margin is for the same drugs sold in Canada vs sold in the US.

  55. Frumious B

    I’m sure there must be a better way of doing these studies, but so far, no one’s come up with one.

    Just skip all the data entry, analysis, review, etc. It works for the alt-medders.

  56. Hawise

    Canada struck a deal with the drug companies exchanging longer patent protection for lower cost- basically amortizing the costs over a longer term. Also with the provincial governments being the primary purchasers they have deals on the costs that bring it down. Add to that the savings that drug companies have testing medications in a country with socialized medicine. We have the advantages of many of the front line drug testing as well. Of course, as my aunt found out, once the testing is done, the drugs become unavailable in Canada as the companies limit distribution to the States to recoup the costs and make their profit.

  57. medrecgal

    OK, let’s stop trying so hard to show how the other guy or gal is wrong and be at least somewhat civil. Yes, perhaps the MSM has distorted the situation regarding ANY country’s healthcare system. The only point I was trying to make is that NEITHER system (ours or Canada’s) is a perfect one, and in some cases you make trade-offs to get the kind of care you need and can actually afford. Really what is needed is something in between these two systems that takes the best from both, if that’s even possible.

    If you really want statistics and other detailed information about the pros and cons of nationalized healthcare (and there is much of it out there to filter through, a decent piece of which does in fact support my original contention of availability issues and waiting lists for procedures), try these links: http://www.cbc.ca/news/background/healthcare , or particularly try: http://www.fraserinstitute.ca/admin/books/files/HowGoodHealthCare2006.pdf. The latter is a rather large file, but there are an abundance of statistics about the workings of healthcare in Canada, good and bad. I am not Canadian, but neither am I completely off my rocker, as a couple of posters here seem to imply.

  58. Urocyon

    That these waitinglists exists has to do with political decisions, not with some ‘natural’ scarcity or the mythical overaged society. Capitalism has an interest in maintaining scarcity in order to show us who rules.

    Good point, antonia. I am not sure that the intention is to scuttle the healthcare system, so much as it’s just icky dominance behavior for its own sake. Not to say that undermining is not also a likely factor.

    Healthcare is another area in which we don’t have any really good options, FWICT. The people in charge are not interested in making it work for actual people, no matter how the system is set up (within the very limited range of options shown us thus far). For the most part, our choices are between profiteering gone mad–with extra callousness–or the power-mad petty obstructionist approach (á la British NHS). There is a bit of middle ground, but not much, and those who manage it are usually still laboring under a lot of the same assumptions.

    Sometimes I get really discouraged at not being able to get away from dominance plays and false scarcity. More often I get irked. Bah.

  59. Bird

    Oh, dear god, don’t trust the Fraser Institute. It’s a right-wing fiscal conservative think tank devoted to destroying social programming in Canada.

    See http://en.wikipedia.org/wiki/Fraser_Institute for an overview

    Or try http://www.sourcewatch.org/index.php?title=Fraser_Institute

    Or check the CBC backgrounder at http://www.cbc.ca/news/background/fraserinstitute/

    Not a trustworthy source—they’re in bed with the Bush/Cheney regime, too.

  60. Hawise

    medrecgal- no system is perfect but the Fraser Institute is an organization that is dedicated to privatizing health and education in Canada and skews its reports to that goal. The Supreme Court ruling has influenced the way waiting lists and medical services are offered in Quebec and the system is in constant mutation as it tries to balance emergent medical treatments, changing demographics and staffing issues. It is highly unlikely that the US will adopt anything like the Canadian system, the tax shock would kill most conservatives before they realized that their overall costs were down. What is increasingly apparent is that investment in general health, especially preventive medecine and early intervention, creates enormous health savings over the long term. Crisis and trauma medecine will always be the same and if you need it now, you get it now in most systems and the only question is- is the bill coming to your mailbox or did you pay for it at tax time?

  61. thebewilderness

    Your post sounded like the same talking points that we have been listening to since the discussion began in earnest during the ’88 election campaign. Most of which have proven to be half truths, lies, and damn lies. I think that is the reason it was refuted so agressively.
    I haven’t kept up much since the drubbing health care got by the Congress in ’93. But, I wouldn’t be surprised if the main difference isn’t the same as it was in ’88. In Canada the person most in need gets treated first. In the US the person with the most money gets treated first.

  62. Bird

    Hawise, I have a post caught in moderation with links to some info on the Fraser Institute—they’re tied into the Bush-Cheney regime and are a nasty lot of politically-motivated fiscal conservatives. Ick.

  63. Bird

    And contrary to the opinion of some vocal conservatives, most Canadians want to keep universal healthcare. We want to fix the system we have, not to adopt an obviously broken method from the US.

  64. Catherine Martell

    medrecgal, I don’t actually think it’s possible to have something between the two systems. What needs to happen is an excellent, well-funded, efficiently-run social health system. That really will be the best of both worlds: the best care, fast, and free at point of use. Otherwise you’ll end up with something like we’re heading towards in the UK: a half-arsed compromise of free care for everyone, but the rich opting out and going to swanky hospitals. Ultimately, we’re going to have a two-tier system, and that means we all suffer.

    Mind you, what’s interesting to watch is how quickly the rich flock back to the NHS when they actually get ill. It’s not just the statistics, though those are scary: thanks to the lack of regulation in the private sector, you’re 8 times more likely to die in a private hospital in the UK than in an NHS hospital. It’s actually the simple economics of insurance. If you have, say, cancer, or even a checkup that implies you may be vulnerable to cancer, your health insurance premiums immediately skyrocket. Often to the level where it’s actually not worth paying them even if you can afford it. This is the nub of the problem for private healthcare: it’s cheap if you’re healthy, and unbelievably expensive forever more if you aren’t. Ergo, most of those that need it are unable to get insurance.

    The only sensible way to deal with this is to spread the burden across healthy and unhealthy people. Interestingly, in societies which do this (Europe, Canada, and even, as I mentioned above, Cuba), the average health of everyone – richest percentile as well as poorest percentile – improves significantly. It is in the interests of everyone to have an equal distribution of healthcare payment and provision. Richard Wilkinson’s book Unhealthy Societies backs this up with plenty of scholarly research and a ton of empirical evidence if you’re interested.

    Private healthcare systems don’t benefit “consumers” (which is what you are, rather than “patients”) at all. They’re designed to maximise profits for companies and shareholders. Ultimately, it’s their game and they’re going to play it by their rules, using their special dice with the spots rubbed off.

  65. Jenny

    I’m patiently waiting for “I blame the Patriarchy” t-shirts. Will you get a move on and make some already? How about “Twisty for President in ’08” or “Advanced Patriarchy Blamer” or “Keep your culture offa me, freak!” Let us foot the bill.

  66. Artemis

    Holy healthcare, I had no idea there were so many Canadian posters and lurkers here. If one of them would just marry me so I can move up north.

    Anyway, back to the sticker in this post and big (U.S.) pharma: there is no more evil industry in the world – and I know there are many in the race to the bottom. What makes them more evil than, say, the dispensers of weapons of mass destruction? In that case, there is no artifice about what the industry is doing – they sell their products to the highest bidder and the health of the planet and all living things be damned. But in the case of big pharma, the lies never end and the result is at least as devastating.

    For a few years I collected, managed, and reported data for AIDS and tuberculosis clinical trials involving the largest 5 pharma companies in the world. There was nothing about our data that was off limits to being manipulated for pharma’s benefit. Nothing. They make their own rules and the FDA is nowhere in sight.

    This is an industry that has stopped producing some of the most effective antibiotics ever developed because the profit margin was too small. This isn’t a secret; this was something that the CEO of a famous pharma company stated at a shareholders’ meeting as a sign that his company was committed to shareholders’ interests.

    What that same company’s reps said at a medical conference differed only through spin. They explained that, by discontinuing the production of certain antibiotics, they could be “focusing their efforts” on the “new generation” of drugs. New drugs = more money to big pharma. Look at Twisty’s sticker. It’s the same wherever – and for whatever purpose – drugs are produced. Big pharma spends far more money on marketing than on R & D and the cost shows up in the drugs that could save someone’s life (if they can afford them).

    The costs of clinical trials? Set arbitrarily, then Inflated to make doctors and researchers comfortable. Who would challenge them? Other than the lowly patient, the only other folks with stakes in that game are the corporations that own the vast majority of health plans and hospitals in the U.S. These chummy corporations reach agreements – together (collusion anyone?) – and everyone is happy.

    Hey, I’m eternally grateful that there are real live pharmaceutical researchers that give a good goddamn about human beings and who are employed by pharma. We have Twisty’s continued health to be thankful for; I have my parents’ as well. But we can’t let them convince us that it has to be for obscene profit and there’s no reason to believe their lies about their research process or expenditures on developing and testing drugs.

    Universal healthcare may have drawbacks, but getting a muzzle and leash on big pharma so outweighs any of those problems, it’s enough of a reason to do it in the U.S. (or at least a reason to find a way to marry a Canadian).

  67. qiqa

    I wanted to say a coupla things about socialized health care. Some good, some bad. First of all, I agree that the Canadian system is awesome (or at least it was until I lived there). Just think, a foreigner who could benefit from free treatment instead of being tossed out of the host country if she has no money for surgeries. In the US of which I am a citizen, I once risked incurring in thousands of dollars of debt for a sprained ankle. Also, the cost of other medical procedures (including prenatal ultrasounds) is plum ridiculous.

    Now I live in Italy, where there is socialized healthcare too. However, the system is a lot less perfect. Italy recently had to pass a law whereby hospitals must give appointments for things like mammograms or colonoscopies of cardiac surgery within 60 days or accept fines. Last summer I needed a mammogram, but all the public hospitals were booked up for waaaay more than 60 days. My only choice was to go to a private hospital (we have those too), which luckily was one of those that can accept national health prescriptions, so after only one month, I got my scan and did not have to pay. I have relatives who have preferred shelling out the big bucks to go to a private doctor so they don’t have to wait months for urgent care.

    However in a kind of ironic twist, over here there is a transplant hospital that was born as a collaboration between the bigger hospital in the city and the University of Pittsurgh medical center. There you can get a liver transplant for free if you are on the national health service, one of those that would cost in the US a quarter mil. So it’s not all bad.

  68. Mandos

    Italy has a mixed public-private system. I suspect that such things are a symptom of that mixture. France has a mixed system too (or something like that) but I gather it works better. Canada doesn’t techically have a mixed system, since doctors who want to bill privately cannot bill the system at the same time; there are people working to force a private system on Canadians. The usual suspects.

  69. medrecgal

    For thebewilderness–I’m sorry, in 1988 I was too young and ignorant to follow politics very closely. I was more concerned with getting through school with decent grades so I could eventually get into a good college, so I wasn’t aware that my current arguments were “half truths, lies, and damn lies”. I don’t doubt that there is some degree of truth in your comment about most in need vs. with the most money, so what do you suggest we do about these faults in the American healthcare system? Do we limit access to technology so everything is more affordable across the board? Do we cut the earnings of physicians and surgeons? Does this have anything to do with our cultural problems of the need for instant gratification and wide access or our general tendency to sue everyone who doesn’t give us exactly what we wanted? I’d be curious to see what degree of malpractice insurance Canadian physicians hold on average.

    For Catherine Martell–thanks for putting this whole issue in a sensible light for ALL of us. I’ll have to check out that book you mentioned, just out of pure curiosity. As for spreading out the costs evenly across society, would some politicos frame that as a sort of socialism or communism? Personally I think that would be sensible, but just listen to the richest people howl with indignation if something like that happens.

  70. Bird

    Artemis, at least in Canada you could marry us!

  71. Artemis

    “at least in Canada you could marry us!”

    Exactly! Queer marriage, good health care, Banff Mountain Film Festival, Sarah McLachlan and k.d. lang, Nova Scotia, far fewer guns, what’s not to like? For a fine Canadian woman, I’ll be a mail order bride any day.

  72. Panic

    Holy hell, Twisty.
    I just found you, so you better stay around a good long time.

  73. Bird

    Wow, and I live in the province that produced both the Banff film festival and k.d. lang! I think I’d have a hard time explaining to my partner that I was getting a mail order bride from the US, though. He’d be a little confused. Not that I don’t confuse him regularly anyways.

    However, I have a good friend who’s looking for someone to live on her acreage out in the country and help do the dishes and plant the garden. She’s a research scientist (plant genetics) who works really long hours and would like to have someone else around the place to keep her company and help look after the house and the cats. She’s not a lesbian, but she’s mentioned that she’d be happy to have a wife (she’s given up on the whole man thing).

  74. Kim

    I was JUST thinking aboout you yesterday and wondered how things with the boob were going. Now I know – expensive. It’s truly shocking.

  75. Panic

    Hi Bird,
    Fellow Albertan here, transplanted to Toronto.
    Let’s not give everyone else a false impression of the place!
    Klein was the only premier to deny same-sex marriage rights in Canada, and the only one who said he’d ignore any federal ruling for it.
    Which puts all this lovely lesbian homestead talk a bit into the theoretical.
    Have things changed any since he’s been gone? It’s still a Conservative government after all.

  76. Artemis

    “However, I have a good friend who’s looking for someone to live on her acreage out in the country and help do the dishes and plant the garden. She’s a research scientist (plant genetics) who works really long hours and would like to have someone else around the place to keep her company and help look after the house and the cats.”


    I just found a job that I want at the Banff Center, too. Home, thy name is Alberta. Kinda catchy. But I have to wait for year. I think. Maybe. Or not.

  77. Bird

    Oh, I don’t try to make Alberta out to be some sort of socialist utopia. In other threads and other places, I’ve referred to my beloved home province as Redneckia, Redneck-land, and the people who brought you Stephen Harper (really, fellow Canadians, I am so sorry about that!).

    But same-sex marriage is legal in Alberta despite Ralphie’s stormy protests to the contrary. Federal law wins on that one, and our government knows that a challenge on its part would never stand up in the Supreme Court. Lesbian friends of mine held their wedding in Alberta just last year. Even the so-cons’ rumblings about marriage commissioners being able to refuse to solemnize same-sex marriages didn’t bear much fruit.

    And in our last provincial Conservative leadership race, people rejected the social conservative candidate who was screaming about “family values” and also dumped the hardline fiscal conservative guy who wanted to ditch medicare for a relatively middle-of-the-road farmer. Now the government is putting money into affordable housing and healthcare programming!

    Here in Edmonton, things are actually pretty liberal (and we tend to vote that way, at least provincially). We just got listed as a top-five gay-friendly tourist destination for Canada by OutTraveler, too. Runs a little contrary to the stereotypes held by those out east.

    Alberta is a hotbed of Canadian conservatism, especially in the south, but we’re not all redneck assholes here! Plus I’d like to point out that most Canadian Conservative voters are to the left of many American Democrats.

  78. Bird

    I love the Banff Centre. The Book Publishers Association of Alberta has its annual general meeting and conference there every fall. The facility and the surroundings are gorgeous, the accommodations are fantastic and the food defies description. I’d love to do one of their writing programs too.

  79. Spinning Liz

    Good heavens, people, if there were suddenly free universal health care here, just imagine the gleeful mass exodus from crappy jobs and miserable marriages. All hell would break loose! We can’t have that now can we.

  80. TinaH

    Blondie said

    Ahh, feudalism. By any other name (like maybe, capitalism?) would smell as sweet.

    I just snorted tea all over the keyboard and monitor. Ugh. Anyone got a towel?

  81. Lill Hawkins

    Twisty, I found your blog about ten minutes after my brother emailed to tell me that he has cancer and has to have his voicebox removed, after they decide if he can pay for it. Without the op, he’ll be dead within a year. He’s already survived throat cancer and was given a clean bill of health and assurances that they got it all and there was little chance that it would come back. He’s still paying for that and will probably have to sell his house to finish paying. His wife, who survived lung and brain cancer also had huge medical bills that they’re paying. (Starting to sound like one of those TCM movies, isn’t it?) Well, anyhow, I hope you beat this because you’re one hell of a writer and funny to boot. I’ll be sending positive thoughts your way.
    Shine on,

  82. Jezebella

    Canada sounds SO much better than Mississippi, but for the frackin’ cold. Is there ANYWHERE in Canada I will not freeze my tits off six months a year? Because if there is, I’m going. Tomorrow.

  83. LouisaMayAlcott


    Your only hope would be the west coast, Vancouver area.

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