But neglect their own American neighbors: Universal health care in Thailand

James Cameron Mielke's story:
I was disappointed, but not surprised, when I read the story about the couple that were obviously confident enough to be holidaying in Indonesia, but when the guy broke his ankle, they freaked out and high-tailed it all the way back to the USA - taking that long, expensive and arduous journey just to fix his broken ankle. Apparently they were not aware of the world-class health care available in nearby countries like Singapore, and in Bangkok and Hong Kong, to name a few. They would have been amazed at the stellar care available had they simply hopped over to Singapore - and while cheaper than in the USA, their insurance should have covered it anyway.

I can't tell you how depressed I get when I hear the news each day - and I'm sure most people around the world have been rolling their eyes in dismay over the pitiful health care debate in the USA. It is simply appalling that Americans don't have a universal health care system of some sort. As you know, we are the only developed nation in the world that doesn't have this - but people have been fed so much misinformation, and have been so frightened - and of course, too many of the politicians have been bought out by big business that likes the status quo. If we could only extricate ourselves from fighting so much global warfare, and trying to do nation-building everywhere except in our own country!!! Man, then perhaps we could do better with our education system, for one thing. Then America might not be looked at as such a naive, inward-looking nation that we are, like that couple in Indonesia, perhaps still thinking the only safe place to get health care is in the USA. Wake up, folks!! America is no longer the only player in the world. Asia, in particular, has taken off dramatically, as the USA decays...

My sister Jean in the USA pays 25% of her earnings on health insurance premiums that don't always cover her care. Her policy has a $5,000 deductible, so she pays for most of her care out of pocket.

She is healthy. But when she arrived in Thailand over Christmas, she had a nasty, sharp cough. She said she had just decided it wasn't too bad to live with. She had had it for over a year!! And the cost of seeing an MD was enough of a deterrent, so she just lived with it. But I insisted she see the doctor here. Without an appointment, and for a $25 doctor fee and some meds, she was diagnosed with chronic bronchitis. Within days the cough cleared up. She returned for two more days (she was only in Thailand for a week). She spent three days at the hospital because it was so convenient, pleasant, caring, and affordable, with one-stop shopping. She didn't have to be sent all over to different facilities or to see different doctors for the various procedures, e.g., X-ray, etc.

In short, the system here works, even at the most expensive private hospital in the country (Bumrungrad), 60% of the patients are Thais. It is not just a place for rich foreigners to go. And Thailand has universal health care: for 30 baht ($1), all people in the country have access to basic health care. This is one of the few good things former Prime Minister Thaksin did to help the poor here. So why can Americans pour out their hearts and give so much to places in need like Haiti and Afghanistan, but neglect their own American neighbors in the USA!!!

Read a story about medical tourism. Thanks to James Cameron Mielke for the source email message.

The alternative was to have no insurance: Betting on good health

Carl Arrington, 58, is a free-lance writer and chef in New York. When his company closed shop nine years ago, at first he chose to pay for extended coverage under COBRA. But the high premiums forced him into a difficult decision: he dropped the insurance.

"The alternative was to have no insurance, which was so scary in the beginning," he said. "And then I decided, look, when you have insurance you're betting that you're going to get sick."

He decided to change his lifestyle. He stopped eating meat, and cut excess sugar from his diet. He began to exercise, eventually losing 40 pounds.

He still sees his physician annually for checkups, but he avoids screening tests like colonoscopies. If doctors discovered something that needed further treatment, he said, he probably could not afford it anyway.

"I am in control of my health, and I'm not afraid of dying. What more do you need?" he asks.

Advice: Stay healthy – and work for universal health insurance.

Read another story about a limitation of the COBRA safety net.

Thanks to Karen Barrow for the source article in the New York Times of Nov. 4, and to Alex di Suvero.

Before he had health insurance: The public option in health insurance reform

On this scary Halloween, it's comforting to see that the U.S. House of Representatives is including a public option in its healthcare reform bill.

The House bill, if it passes, could save the lives of many very ill people – like Fred Holliday. With insurance coverage for a physical exam, Fred might have received prompt detection and treatment.

Dr. Rahul Parikh describes what had happened instead, as told to him by Fred's widow, Regina Holliday:

Fred Holliday developed the early symptoms of his disease-fatigue, weight loss and occasional blood in his urine - before he had health insurance. In late 2008, his insurance kicked in after he got a job at American University teaching film studies. Last January, he developed low back pain. He went to see his doctor multiple times. Each time, she prescribed pain medication, but his pain worsened. Regina wondered: if Fred just had muscle pain, then why the night sweats? Why the blood tinged urine? Why didn't his clothes fit him anymore? Still, Fred's doctor didn't reconsider her diagnosis and treatment.

His pain worsened. In March, Regina demanded more. Fred's doctor ordered an MRI of his back. Three days later, they got a call telling them that he had "shadowing over his kidneys." What that meant wasn't entirely clear, but the next thing Fred and Regina knew, they were in the office of a Maryland oncologist, who admitted them to a hospital in Silver Spring for further tests.

On Friday, March 27 around 11 am, Regina was at work when Fred called. He was crying. "I think the doctor just told me I have cancer," he managed to tell her.

What exactly did the doctor say? Fred remembered being told that he had a growth on his kidneys. Regina rushed into see the doctor, but he had left town for the weekend. They had to wait until the next day before another doctor (not an oncologist) tried to clarify his diagnosis: it looked like he had stage IV metastatic renal cell carcinoma. That jumble of words didn't make any sense. Regina went onto the Internet. Wikipedia turned out to be more helpful than Fred's doctors.

When their oncologist returned, he was curt and often distracted by his cell phone. He didn't like Regina's detailed questions, telling Fred that, "If Miss type-A personality wants me to answer her questions, she can come to my office hours."

In retrospect, Regina believes that if Fred's doctor had been clear about his prognosis from the beginning, he may have made the decision to stop fighting sooner. Instead, he informed him of how he could fight: surgeries, radiation, and chemotherapy. So he decided he needed more advanced care than what Holy Cross could provide.

Patient transfers between hospitals are normally the responsibility of doctors who work there. The hospital's doctors, however, told her they had not been able to find another center willing to accept him. So Regina contacted her own internist, who sat on the board of directors at a hospital in Bethesda. After hearing Fred's story, he pulled strings and arranged a transfer.

The Hollidays arrived at there four weeks after Fred's diagnosis. The first thing they learned was that he needed surgery to repair a broken hip - which happened after an orderly at the first hospital bumped him into a wall while he was moving Fred on a gurney. Fred had been complaining of severe hip pain for two weeks, but nobody there had followed up on it. All it would have taken was an x-ray.

After surgery, his new oncologist ordered a chemotherapy drug called Sutent. While his health insurer approved the drug, Fred's doctor told Regina that the pharmacy refused to order it. At $40,000 for a 28-day supply, it was too expensive. "Sometimes this happens," Fred's doctor told her. So Regina had the drug mailed home, picked it up, tucked it safely into a fanny pack, and dispensed a dose to her husband each day.

Fred's cancer advanced. He still couldn't walk. He had become incontinent. The doctors decided to transfer him to a rehabilitation center with the goal of getting him to walk again. Once he was there, Regina’s duties as his caregiver intensified. She learned where the center's storage closets were so she could collect fresh sheets and change them herself. She emptied his trash, and changed and disposed of his bedpans.

While he was in the hospital, Fred required blood transfusions every 10-14 days. Regina knew when he needed them because he would begin to get very tired, eat, move, and talk less. One afternoon, this is just what happened. At the hospital, it was easy to ask the nurse to get a blood test to know just how low his counts were. In the rehab center, they only did blood tests once every morning, no exceptions. So Fred suffered until morning came and his test confirmed what he and Regina knew the day before.

Fred would had to be re-hospitalized. Fred continued to deteriorate. It quickly became a question of how much longer to fight. On May 19th, he was moved to hospice care to get his pain under control and on June 11th, he went home. On June 17th, less than three months after he was diagnosed with cancer, Fred Holliday died at home. Ironically, this was the same day that the United States Senate began debating health care reform.

Advice: Call your congressman and ask them to support health insurance reform with a strong public option. Commercial insurers might prefer not to insure someone like Fred - or like you.

Read another story about the lack of health insurance. Thanks to Dr. Rahul Parikh for the source blogpost, and e-patient Dave Bronkart.

A healthcare Catch-22: Kidney transplant for a homeless man

Pedro Cendeno Lora, age 47, had come to the U.S. in 1995 from the Dominican Republic, and had lived here quite happily for most of that time.

But he knew something was wrong when he became too tired to keep going to work. In late 2006, his lethargy was attributed to kidney failure; by then, he was out of work, and struggling to hang onto his rooming house in Dorchester, Massachusetts. Doctors told him he needed a kidney transplant. But in an all-too-common American healthcare Catch-22, he couldn't work because of his health, and he couldn't qualify for a transplant while in danger of losing his home.

He was running out of time when Health Care for the Homeless and Boston Medical Center came together last year to save him, in two ways. First, they searched for a donor, and realized his younger brother could donate a kidney. Second, Health Care for the Homeless helped him catch up on his rent so he could have a home to recuperate in.

The transplant was performed at Boston Medical Center. Pedro and his brother were able to stay at Barbara McInnis House for the homeless for the week before to prepare for the surgery, and for a month afterward.

"America saved me," he says.

Advice: Work to expand the safety net so it's there if and when you're out of work.

Read another story about a brother’s kidney donation.

Thanks to Adrian Walker for the source article in the Boston Globe of Dec. 9.

They plan to address the problem with a new staff position: Access to care by a wounded Iraq veteran

Captain Brendan Fogerty, 32, of North Kingston, Rhode Island, has been the commanding officer of Weapons Company, a Marine reserve unit of New England's Own battalion. He is slow to anger, but now he is irate.

He had been visiting Marines from his company who suffered wounds. A particular concern was the treatment of Corporal Cody Hill, who suffered burns over 60% of his body as the sole survivor of a blast from an improvised explosive device (IED) that destroyed his Humvee on September 4 in Fallujah.

Cody was sent to the Broke Army Medical Center in Texas, one of the best in the armed forces. Though he saw a burn surgeon on October 5, 2006, no one had prescribed a long-term rehabilitation plan for him until May 4, a delay that jeopardized his recovery.

His father quit his job on an Oklahoma ranch to help his son heal. He dressed his son's burns and slept by his bedside. The family was struggling financially, but no one showed them that they were entitled to benefits - $29,000 in compensation and $100,000 in insurance. Paperwork went missing, and the claim was delayed for months.

A nurse on the East Burn Ward told Capt. Fogerty and Cody's family that Cody had slipped through the cracks.

Infuriated, Capt. Fogerty investigated, and then wrote a memo, addressing it up the chain of command, ultimately to a congressional committee. The memo described the lost paperwork, the failure to inform the military family what benefits they were entitled to, and the inability of the Department of Defense and Veterans Affairs Administration to work together.

A spokesman for Brooke Army Medical Center concedes failures to coordinate care, and said the center plans to address the problem with a new staff position.

Hello? They plan to? When? With one staff position, they'll solve these widespread problems? Is anyone in charge? No? Whose responsibility is that?

Advice: Ask the next veteran you see if he's getting all the medical care and support he needs. And get them a patient advocate like Capt. Fogerty.

Read another Iraq veteran story, or read Charles Sennott’s source story in yesterday's Boston Globe.