Dear lathomasmd:
It is not easy to be in a situation where you have a lot of out of pocket expenses, so I definitely feel for you. Difficult to know where to begin. Good oncology costs a lot of money so it has to come from somewhere. Research and new drug development needs to be funded and skilled personnel retained. Our ‘system’ has seen a steady deterioration in quality and timeliness of service. Diagnostic testing is difficult to access whether you are already diagnosed or are having symptoms that suggests you may be ill. Where I live my GP will send you to the ER, where you can literally wait anywhere from 10 to (recently one person waited 33 hours) just to be seen by a doc in the hope of getting a scan. Otherwise, possibly as long as a 3-month wait for an MRI if you get your GP to just put in a request. In the ER docs tell you go to your GP to get scanned. People are often diagnosed late stage, at which time, the system is more likely to spring into action. Once in the system you are limited in getting a second opinion. First, by then, you have lost time, and second, where I live the docs in a particular oncology specialty are few in number, and work in a ‘team’ approach, so don’t count on an unbiased 2nd opinion.
The drugs and treatment available to you are dictated by a formulary established by government regulation. Therefore, anything new and innovative might be available about 5 to 8 years after they are in the USA or in Europe or not at all. In the latter all you can hope for is to be enrolled in a trial, which again are limited in a socialist system. There are just not enough doctors to train new ones, to do proper research or even understand existing research done elsewhere to keep up with the latest information. For my family member’s condition everyone enrolled with her received the same drug, whether or not they could tolerate it or not. The only woman who was ever taken off the drug, to which many are allergic, had flat-lined during her treatment. All others were drugged up for three days pre and post treatment so they could get through it. Furthermore, they would typically be administered 3 weeks worth of chemo in one sitting rather than come in once a week. This makes it extremely difficult to tolerate and has secondary cardiac impacts, which the oncologists dismiss as relevant. Why is this done? To save on chemo nursing resources. It is a public system after all and you should be grateful for what society is prepared to do for you.
Follow up care post-treatment is also sketchy. No bloodwork! During the pandemic, all that was done was a quick phone call and three or four questions, leaving it to you to know when something is worthy of attention.
Multiply all of this across all medical modalities.
For the healthy folk, be prepared to wait 2 years (yes, years!) for a routine colonoscopy. A friend of mine had to wait 3 years for a new hip and in one community south of where I live, a paramedic who incurred a back injury at work was told he would have to wait 5 years for surgery and then most likely be wheelchair bound. His community collected the $50,000. needed to send him to a clinic in Germany, where he was treated and came to back to work within the following several months.
Please check out our income tax rates. It is not that we don’t pay enough to get the services we desperately need. Many of us have had to go to another country to pay full freight and pay a much higher tax amount than you would in any state of the USA.
This state of affairs did not come upon us all at once, for if it had, we would have been like the proverbial frog dropped in boiling water. There is no one specifically who can be blamed for this and yet we are all complicit in the outcome.
Good care costs money. If you value your life you have to be prepared to invest in it. To do that effectively you need to have choice. That is the key element missing from a wholly public system. Some well meaning person determines what that is for you. If you are fine with that then by all means go the Canadian way. I don’t have an issue with a baseline of care that is available to everyone and having it be cost free. But, we should always be able to access alternatives if we feel that this is in our personal best interest.