Our fucked up medical system stikes again ..... I'm asking for your thoughts on this .....

[Stinky The Clown]

I spoke earlier today with a dear, dear friend. He is 61 and just found out he has prostate cancer. It was caught early and is the classic slow growing variety ...... the kind they tell older guys to simply monitor. My friend is youthful and vigorous.

He also found out, upon calling his insurance company, that he is essentially fucked. They won't cover the surgery and the cost will be $55,000. Don't bother with suggestions about how to deal with the insurance company. Suffice to say that path has been followed and he has no more recourse.

So ...... here are the choices he seems to have:

Pay the bux out of pocket and then face the next years with a substantial part of his modest savings gone. The old Cat Food/Hemlock debate.

Go to India where he can have the surgery done for about $10,000. More financially palatable, but he fears the quality of medical care.

Just put it off a few years until he can get on Medicare. And hope for the best.

I have no clue what the best option of the three might be.

I am ashamed of my generation for allowing it to get this bad. When we were young, we were a powerhouse that effected real change. Then we got middle aged and lazy and complacent and just fucking stupid. Maybe, in our golden years, we can do some good again. Like take over AARP and make them REALLY represent old people.

And I miss Claude Pepper. (<----- Trivia Question for the people who got this far in my post)

[dflprincess]

1. I'm curious as to why the insurance company won't cover the surgery

isn't that pretty much the standard treatment?

[Lance_Boyle]

7. Not standard in most cases

actually, unnecessary in most cases. A slow-growing tumor in the prostate that is not metastasizing will continue to grow slowly and not cause harm until the growth reaches a certain stage. At that stage, if he is in otherwise good health, his physician might recommend surgery. But in the meantime they will monitor it closely, for signs that it's no longer slow-growing, or that it is spreading beyond the prostate.

[Clear Blue Sky]

13. I would agree.

Many prostate tumors are very slow growing and treatment may be worse than the actual natural history.

I would suggest a second or third opinion from trustworthy doctors. See if there is a consensus of watching versus doing something. Ask if there is harm in waiting until Medicare age.

Insurance companies are not just paying for something just because the doctor says so. For better or worse, many are looking at "evidence based medicine" to see if expensive treatments are really worth it. Same in countries with universal health care. They are only paying for treatments where the benefits are clear.

Scary situation though. Good luck with it.

[dflprincess]

21. Thanks

I am fortunate in that (so far) family and friends have had limited experience with this cancer. Mostly it's been friends' dads and most of them have had surgery, so I assumed that was the norm.

[TooBigaTent]

10. There is disagreement over "standard" treatment for this disease. The watchful waiting

approach is, in many cases, the better option. The problem is, it is impossible to tell any specific man whether it is the right decision for him.

Eventually, genetic research will be able to determine whether the cancer is slow-growing or aggressive. Until that point, insurance companies will always take the cheaper way out. Thus, they will not pay for what they consider "experimental" or "unsubstantiated" care. It all comes down to the numbers - dollars and age.

[proud2BlibKansan]

2. Why won't they pay for the surgery?

[Lance_Boyle]

3. "watchful waiting" is standard in many cases of prostate cancer.

I would not dismiss that out of hand, assuming it is his physician's advice. At 61, if he has a slow-progressing prostate cancer that is not metastasizing, he's likely to die of something else long before the cancer gets him. So... if doc's advice is "keep tabs on it," that's likely the thing to do.

[antigop]

4. Does the insurance company have a local office?

Get a group of people outside and picket -- contact the news media. Make a stink. Contact Michael Moore.

I'M BITTER ABOUT OUR HEALTHCARE SYSTEM AND HOW IT TREATS PEOPLE IN THIS COUNTRY.

[annabanana]

5. (I miss Claude Pepper too)

He was true - blue.

[laylah]

6. I am sorry to hear about

your friend.

I recently read about a facility in India where many Westerners are going for various types of treatments. I do not remember the name of it but here are a few links providing information on medical tourism in India. Hope this helps and good luck to your friend.

http://www.xploresouth.com/medical-care-in-india.html

http://www.bio-medicine.org/medicine-news/Indian-Hospitals--u2013-A-Destination-For-Quality-Medical-Care-4182-1/

http://www.garamchai.com/MedicalTourism.htm

[TomInTib]

8. If we had a few more Claude Peppers, we would be living in a much better world.

Man, that guy was a pit bull when it came to retirees and Social Security.

He would have kicked Shrubbie's little shriveled balls up into his throat, just to get his attention.

Then he would straighten out *'s punk ass, talking real slow-like in that unmistakable voice.


Damn, I am old...

Tom

[Lars39]

9. Is surgery the best option?

My dad had prostate cancer, but no surgery...just radiation treatments. His was caught early, too.

[eleny]

11. If he qualifies for medicare in a year that's seems a decent option

But if it was my husband and he had to wait 4 years to age 65, I'd encourage him to go to India. Anything I've read, which isn't extensive, is that the care is good. It asks for research at least before rejecting the option.

One situation that comes to mind is an article I read here at DU. A guy, who is an accountant, takes care of his elderly parent. They have very little income. He found a solution for things to work out. They all moved to India. He works from there via the net. He has people come in to cook and care for his parents who can afford the whole shebang of their personal care on their social security. The cook does a lot of vegetarian dishes. His father is now off cholesterol meds (if I recall the meds right). Everything is affordable. It reminds me of how people on SSA go down to Mexico to live except it's overseas.

Like I said, if it were my husband, I'd go to India after finding a doc I felt good about. Maybe found some connections here and I'd make arrangements in a heartbeat. There have to be some good hospitals there. After all, they have a large population of well employed people who are demanding services.

Can you please keep us up on what's going on with your friend and how it all works out if he decides to go abroad? It would be great if we could slip across our northern border for surgeries even if we had to pay some towards it.

[shireen]

20. my brother told me a similar story.

I'm originally from Malaysia, and my family still lives there. My brother is a psychiatrist and has several expatriate patients from western countries. They like the lifestyle because it's modern, comfortable and affordable. Hiring domestic help -- maids, cooks, nannies, and gardeners -- is not only affordable, but is quite common, even for middle-class families. A modern city like Kuala Lumpur (capital of Malaysia) has almost all the amenities found in US and European cities, even Ikea. Medical services are excellent and affordable. In Kuala Lumpur, most people speak English so communication is not a problem. Malaysia is an absolutely beautiful country, so if you're a nature-lover, there are some wonderful places to explore, not just in the country but also surrounding ASEAN countries like Thailand, Philippines, Indonesia. Beaches are amazing. If you're a foodie, you'll be in heaven!

Not a bad place to retire ....

[eleny]

22. Wow, it sounds like a beautiful vacation plce for those who want to spend time aborad

[stellanoir]

12. It's criminal.

I've an older friend who's almost 70.

She and her SO went to the Canary Islands. He has dough. She doesn't. She had serious consternation about taking the trip.

She went anyway.

A toddler darted around in front of her as they often do, and she lost her balance. She is fairly thin.

She fell and broke her hip. She got a full hip replacement for next to nothing and they did a phenomenal job.

There are many other countries than India to consider.

It could cost him far less than 55 grand for excellent care.

Our health car system is so screwed up it's not even worth dealing with at this point.

A broken leg costs 40 grand. A broken arm costs 30.

These reparations used to cost hundreds not thousands of dollars.

It's a mess.

[madinmaryland]

14. What is the advice of his doctor? In many cases, the doctor

will monitor the situation at three to six month intervals. This is typical.

And if he can avoid surgery, all the better. It is a painful (for the obvious reasons) surgery.

[Juche]

15. I appreciate that

I am ashamed of my generation for allowing it to get this bad. When we were young, we were a powerhouse that effected real change. Then we got middle aged and lazy and complacent and just fucking stupid. Maybe, in our golden years, we can do some good again. Like take over AARP and make them REALLY represent old people.

I really do honestly, maybe it sounds pretentious or rude (isn't meant that way) but its nice to hear responsibility for what has happened in the US. My parents are late 50s and diehard republicans (I am 28) and I look at the world they helped create politically. We are $10 trillion in debt (much of the debt is due to Bush, Bush II and Reagan), we don't have universal healthcare, half the country struggles to make ends meet, the world has lost respect for us, the rich are richer than ever, the tax system is barely progressive anymore, the middle class hasn't gotten a raise in 30 years, we are in debt to China. I've asked them about the world they are leaving for their grandchildren, aka my brother's kids (the national debt or the lack of policies that make life easier on the middle class for example) and they either don't know or don't care about any of it. Of course there were alot of liberal or moderate people in the last 30 years, but alot of the damage that has happened to america can be traced back to the 1970s onward, which was the time the religious right went into grassroots overdrive in an effort to overturn Roe v. Wade and the rich realized they could use the religious right as unpaid foot soldiers to overturn the new deal, business regulation and progresive taxation. And everyone fell asleep at the wheel while the rich and the religious right were working together to hollow out America. As a result in the last 30 years the rich have had their incomes go up 300-700% and their tax rates cut in half while the rest of us struggle for basics and we all fell asleep at the wheel.

I'm not trying to be rude or anything, its just good to hear someone admit that things have gone wrong and hopefully the young (who are very progressive) can work alongside those in their 50s and 60s to reverse alot of this damage. I look forward to spending the next 10-20 years working in grassroots abilities, donating money and registering voters to overturn the damage.

As for your friend, I would seriously look into medical tourism. It can be India, Singapore, Thailand, Mexico, Malaysia, etc. In fact the quality of Indian healthcare can be superior to US healthcare because the insurance company isn't trying to push you out the door so fast and nursing care is supposedly better. The Indian hospitals that cater to westerners are designed to be top notch. If they were shoddy or dangerous, then word of mouth would have them shut down. My understanding is alot of the doctors there were trained in the West, but wanted to move back for nostalgia or to provide healthcare in their home country and work to treat westerners to help raise money to help the poor in their home countries.

[grasswire]

16. what about seeing a holistic doctor for a consultation?

There seem to be some supplements that help retard prostate trouble. A consultation with a naturopath sure wouldn't hurt.

My BIL was diagnosed with prostate cancer two decades ago. He had radiation therapy and is still doing well. That's an alternative to surgery.

[Stinky The Clown]

17. In reply to all the respondants ths far ........

Thank you all for your thoughts. I've distilled them down and passed them on to my friend.

To anyone reading this thread this far ....... please add your comments. Ths post was not intended at all to end the discussion.

[damntexdem]

18. Find a good foreign medical facility.

The quality of medical care can be bad in the U.S. -- and it can be excellent elsewhere. He might check out Mexico; but India could be fine. He could pick up some health-tourism tips from Europe.

Hell, get Michael Moore to take him to Cuba. ;-)

Meanwhile, he should get active politically in supporting true health reform in the US.

[pitohui]

19. if it's the slow growing kind he's supposed to monitor, not have surgery, for then Y not monitor?

i am not a doctor so i generally follow my doctor's advice

a friend of mine was told to monitor his slow-growing prostate cancer in 1992, and he's still with us, my friend is a bit of an anti-surgery nut to begin with so he didn't have a problem with following the doctor's advice

you do realize that some forms of prostate cancer can grow for 20 years or more?

why have the surgery before you have to, some men will lose sexual function as a side effect of surgery, maybe a small risk but still something to think about

i believe your friend's best option is to follow the doctor's advice and do nothing except monitor for now

at such time as surgery is indicated, his insurer will have to cover it, they're not covering it now because the surgery is not indicated!

if he was really panicked and wanted the surgery now, i would opt for the second choice of having the surgery in a foreign country, i've had care in mexico but don't know where you go for this surgery, if india is the place, then so be it, that's a SIGNIFICANT savings at a time of life when you probably can't ever replace that money once it's spent

[HughMoran]

23. I called to make an appointment today and all the horrid secretary did was ask about insurance

I wanna smash her face in - I call a hospital for help because I am sick, not to be given the 3rd degree about what kind of insurance I have. I hate our system.

[girl gone mad]

24. Negotiate.

I don't have time to read through the posts to see if anyone else has suggested this.

Since he is not going in for emergency surgery (it can be considered "elective"), he has leeway to negotiate with the the hospital and doctors. There is no way insurance companies are paying 55K for the surgery. Find out what they would pay and try to get close to the same rate. The more he can pay upfront, the better of a position he will be in.

I think medical tourism would not be a bad idea if he can't work something out here. Korea and Thailand both have excellent reputations for care. If I ever needed life-saving or prolonging "elective" surgery, this is probably what I would do.