When policies send people to die seemingly out of options, those policies need to burnt to the ground. I'm leaving Canada and the 3rd-world healthcare system is one of the primary reasons.
Countries that are supposedly "developing" have better, faster and cheaper healthcare than we do (you might be surprised to know that "backwards" Iran figures on that list).
Meanwhile, we argue over which pronouns to use and whether a man can become a woman. We've lost the plot.
I bet Iran's government doesn't pay for people to travel to America for HIPEC. It's not clear that it works. Testimonials from people who've survived a treatment isn't evidence that it works.
Look at it this way. Playing craps in a casino is a losing game. There is no strategy that allows you to beat the house consistently. The longer you play, the more you lose. The occasional player who wins for a few hours and comes away with a lot of money doesn't change the mathematical fact that the odds are against you. You wouldn't suddenly take up casino craps as a way to pay off your mortgage just because you read about one guy who cleaned up, would you?
I wasn't commenting about HIPEC, but healthcare in general. They have excellent doctors and fast care for a fraction of the cost. Their only disadvantage is their equipment that's slightly less advanced than in the west.
I know a woman who went from BC to Mexico for a knee replacement after two years of waiting. She’s a farmer and needs her knees to work so she can work. $25,000 later she is fine but had to bear the costs. If she lived in Quebec that would not have happened.
I don’t doubt that’s true. But they also are able to say No. if someone wants to get unproven or very expensive treatment in a foreign country that’s not available at home, it’s on her dime. No whining to the government after the fact to pay her a quarter million bucks.
Too much politics in healthcare and too many Canadians that believe the politicos. The biggest single lie foisted on Canadians is the our system is the best in the world. BS on that. Compared not to the USA but OECD single payer systems Canada fails badly. Funny this doesn't even rate as a voting issue.
Yes, the depth of ignorance about health care in our population is one of the biggest impediments to reforming it. I don't want American health care! But I'd certainly take German, French, Swedish, Finnish, Austrian, or Spanish health care. Basically every European country has some sort of mixed system with universal coverage, and they get way better results than ours, despite having far worse demographics and spending about the same. It's madness.
And I say that as someone who at 16 years old with a left nut the size of a navel orange was told he had to wait 6 months to see a surgeon about his incredibly painful hernia. Instead I wound up in the emergency room on New Year's Day 1998 with a left nut now the size of a grapefruit, and said surgeon was quite pissed he got pulled away from his game of Myst. This isn't a new issue. It's been festering for decades and none of our politicians have had the balls to actually try to fix it. Thankfully I still have one mostly normal one.
French and Canadian spending on healthcare as a percentage of GDP is basically identical. Yet their system is far superior to ours. I was surprised that our median ages are also nearly the same, I'd have guessed they were a bit older than us.
In what way is the French system "far superior" to ours. I can say it's "far worse". How will readers know who is correct if neither of us produces evidence for the claim?
The French don't have to provide care to an underclass with terrible health status scattered over vast remote territory where airplanes and helicopters are necessary for even routine care by nurse-practitioners.
Have you ever been to France. If anything, their underclass is much larger than Canada's.
How is France's health care superior? It's proven via quantitative metrics as gathered by organizations such as the WHO and OECD. Metric's including wait times, access to a doctor, doctors and nurses per capita, etc.
Canada's health care is on par with upper middle income countries but Canadians have way too much "America sucks"politics tied up into it. The Canadian left is projecting their insecurities like with any other faith. In Canada the closest thing to a national religion among the left is government health care. What a pathetic lot they are.
European health care systems don't pay for HIPEC. It's kind of an American enthusiasm done by a few cowboy surgeons there. So if we had German, French, Swedish, Finnish, Austrian, or Spanish health care, Ms. Ducluzeau would still have had to go the the U.S. to get HIPEC.
One of the ways European systems provide better results for less money is they don't waste it on very expensive care that is not proven to be better than more meat-and-potatoes stuff (or tofu and kale if you prefer.) One reason our system is so expensive is that we have to copy some American enthusiasms and try to give everybody what they want so they don't complain too much about not getting it when the glittering emporia just over the border offer it for cash.
Yes, but in Europe you are given the option to pay for those "enthusiasms" yourself. In Canada both you and your doctor are prevented by law from pursuing and arrangement to engage in those "enthusiasms." That just isn't a thing that free countries do.
I'm glad her treatment worked out, but I guess I've got to be that guy and point out that there's a couple of important details skipped over in this story:
1) What was the probability that the patient's condition could be treated effectively? There's a difference between being eligible for a treatment and for that treatment to be effective. Long shot treatments sometimes work, but all I'm told here is that a Canadian oncologist thought this one was a long shot.
2) Would private US insurers have typically covered this treatment for the same diagnosis? If not, or if only the so-called "Cadillac Plans" would've, I'm not sure it's fair to indict the Canadian system.
Like I said, I'm happy that this worked out. I've known quite a few people with cancer who've spent huge amounts of money on specialized treatments and alternative therapies and it almost always doesn't, except for their family being left with huge debts or having spent large amounts of money that could've helped a lot with adapting to life without their family member.
I admit I'm also struggling to see how availability of private care in Canada would necessarily have changed things in this case. OK - you can pay for private care in Canada. You're stuck with the same problem of the medical bills. You can buy insurance, which would be great *if you'd bought insurance* instead of relying on the public system, and assuming your insurer would cover this treatment. A private system *could* add capacity and take pressure off the public system.
The thing is, I'm in favor of allowing a parallel private health care system in Canada. I just don't see the logic tying it to this particular horror story.,
The treatment in question might or might not have been a long shot. But it seems to me that our health system should allow a patient to make the choice of whether to try or not -- financed personally or through a private insurance company if one can be found. Forcing a patient to travel out-of-country, thus adding to cost and stress, seems bewildering to me.
It seems to me that the B.C. government should have been liable for the additional costs of receiving this treatment in the U.S., compared to what it would have cost her if she could have made private arrangements here in Canada. The B.C. government might also throw in any savings from not having had to offer her palliative care in Canada.
Like I said, I support a private system for Canada. Not sure that makes a significant dent in the cost incurred in the US, though. And no insurance company is going to cover a pre-existing condition. You'd either need to have insurance before diagnosis, or you're out of luck,
Expecting the BC government to pay for a long-shot treatment if it proves successful is a pretty bad idea. It incentivizes people to try all sorts of long shot treatments on the hope that they'll be reimbursed if it works. Also, it removes the ability of the province to determine what is reasonable and customary treatment that they'll cover. There might be more of an argument for covering the equivalent of costs that would've been incurred with the treatment covered in Canada, but that's not really how the medical system budgets. There's a certain amount they spend each year, and every dollar not spent on one patient is a dollar they can spend on somebody else.
"Family and friends contacted four U.S. clinics, which all said she was a candidate for CRS and HIPEC"
Doesn't sound like a long shot. Rather, a standard treatment, albeit expensive, which Canadian health care budgets don't allow for. Now I recognize that government budgets are funded on taxes, and that there are limits on how high governments will go. That's why we need to inject private money into the system. On this, I think we agree.
But our provincial governments should not get a free ride when an individual turns to private health care. Rather, the relevant government should pay him or her the savings that the government makes by not spending on the inferior Canadian treatment. There should be money for out-of-system treatments. After all, governments pay now for emergencies in other jurisdictions, presumably from some allocation. All I'm saying is make this allocation a bit bigger to cover in-country treatments as well.
More generally, are we really so broke that we are resorting to triage, to decide who should be given a chance at living and who should be quietly left to die? That's a sign of a deeply broken system.
You’re getting confused by medical lingo: being a candidate for a treatment doesn’t mean the treatment is going to be effective, it means that you don’t have other factors (e.g. other medical issues, drug problems, mental health problems) that rule you out for getting the treatment.
I know what "being a candidate for a treatment" means. The part of the quote that I found interesting is that ALL of the medical establishments contacted were willing to offer the treatment. That's four "yes" and zero "no". That suggests to me that its use is fairly widespread, hence not a "long shot". But I am not a medical professional. I defer to their opinions on whether she was offered a standard treatment in the U.S., one that could advantageously be offered in Canada, or not.
Of course they were willing, so long as they were guaranteed payment on their end. A relative of mine recently went to Europe for a disc surgery that would allegedly solve a chronic nerve pain. It did not. Turns out another doctor here was willing to do another entirely different (and covered) surgery, which will now also allegedly be the cure. I agree with the original commenter, we can’t use one individual’s circumstances to make a statement on our healthcare system. There are enough issues that surely we can be more data-driven.
"A candidate for" simply means the hospital and surgeon will do the surgery and associated chemo treatment for the condition the patient has. Honest to God these American centres will do anything on anybody who's willing to pay.
The fact that a treatment is widespread does not mean that it works. That becomes part of the problem: once a treatment becomes widespread because of enthusiasm instead of evidence, it becomes very hard to do the randomized trials to find out if it really works. Patients refuse to be randomized to a 50% chance of getting standard treatment and demand to be treated with HIPEC outside the trial, especially if they came all the way from Canada. A lot of trials of HIPEC have failed for this very reason. So it becomes, "Well if you want this treatment and can pay for it, we'll go ahead. No idea if it works."
HIPEC should be regarded as still experimental after all these years (since the 1990s), meaning that no insurance company, private or public, should be expected to pay for it.
Public insurance covering long shot treatments also encourages profit motivated folks, including snake oil salesmen, to pursue customers covered by that system.
It's like all those sketchy BS colleges that opened up when a path to citizenship via student visas opened up. People are incentive motivated.
But the Canadian system *did* allow the patient to make the choice of trying it or not, financed personally. She got what she wanted. But what she wants now is for the taxpayers to pay for something that she was originally told No to. If a treatment isn't offered in Canada -- HIPEC is big, complicated surgery that requires special expertise and training -- you can't just wave a magic wand and say, OK, you want this treatment in Canada, voilà! here is an operating room and a surgical team all ready to operate. And would you want to have an operation by someone who had never done one before but was willing to give it a whirl just so a patient didn't have to travel to an American centre of excellence?
The difficulty with having private insurance for this sort of thing is that insurance companies aren't stupid. They aren't going to let people buy insurance to get preferential care because that tells the insurance company that the patient must be *planning* to use the insurance to pay for preferential care. (What would the premiums have had to be to cover $200,000 for this treatment for just one patient?)
Insurance only works if everyone has to buy the insurance, the way the banks require that all the houses they take mortgages on have fire insurance, not just houses owned by people who smoke in bed and who have kids who play with matches.. So private health insurance would be economically viable only if everyone in Canada was made to buy it, on top of the taxes we pay for free care. Otherwise only the sick and entitled will buy it. This is how Obamacare was supposed to work in the States: you were going to be forced to buy private insurance or pay a penalty. But the Supreme Court ruled the government had no authority to force you to buy broccoli, so it couldn't make you buy insurance. And so health insurance in the U.S. is still a mess.
Health insurerers in Canada put limits on what they will pay, both in terms of the selection of procedures they will cover and the maximum dollar amount for each covered procedure. Everyone doesn't need to buy the insurance for them to make money. Dental coverage is a prime example.
Not everyone has to buy the insurance... BUT ... the insurance company has to protect itself from adverse selection. If your employer offers a dental plan, you have to take (and pay for) the insurance. Otherwise only the employees with rotten teeth would want the insurance, and they would end up just insuring one another. There would be no risk pooling. The insurance company has to draw all the people into the pool, especially the ones with good teeth who will pay premiums but won't make many claims. Employee groups are a natural for this because only registered employees join, not independent contractors who, again, might sign up voluntarily (if they were allowed) if they had bad teeth and expected to do better out of the insurance.
All insurance is a wager between the insurance company and the potential policyholders. The potential policyholders are betting that they will consume more care than premiums they pay. Very few do, of course. The insurance company is betting that the total cost of claims will be less than the premiums paid + plus the investment return on the premium dollars between the time the premiums are received and claims paid out. This bet favours the insurance company, obviously, or they wouldn't offer the bet. Insurance companies may suffer an underwriting loss but still make money if investment returns are good. If there is an underwriting loss plus poor investment returns then premiums have to go up. If every employee has to stay in the pool, the employees with good teeth can't drop out and self-insure. They are stuck in the plan unless it gets so expensive that the employer drops it entirely. But employee benefits are paid out of the compensation budget, so the employer is indifferent as to whether the dollars go to the insurance company or to the employees as cash wages. Premium increases in employee benefit plans don't come out of company profits. (That's one reason why employee wages have been stagnating in the U.S. Health insurance premium increases have eaten up the productivity gains that would have gone to increased cash wages were it not for health insurance.)
And as you say, private health insurance is picky about what it will cover. Dental insurance at work is really not much more than pre-paid teeth cleaning. Anything else you pretty much have to pay out of pocket.
Then people have to accept to pay significantly higher taxes (yes, that means everyone) or accept co-pays. None of this is free and Canadians have absolutely no idea how much health care costs.
I had the same questions. I understand that I could pay a private clinic a couple hundred bucks to get my colonoscopy done earlier, say, but a complex procedure? How much would that cost me? I also agree with David above, that the lack of medical personnel is a huge part of the problem, over and above the system. Aren’t there OR’s closed because of not enough anesthetists or nurses? It’s all so complex, and as each province manages things differently, how can there be a national solution?
My wife and I have an active private insurance in India, where we immigrated from. If the need ever arose, we would be headed on the first plane out with the full knowledge that I would be seeing a specialist the day I land. And if surgery was needed, that would take place either the same day or the next. All in an excellent private, for-profit, clinic with great doctors and facilities that parallel or exceed what are found in Canada. All of it at my own cost - and BECAUSE I EVEN HAVE THE OPTION!
I just can't believe how an entire population has been brainwashed into thinking NOT HAVING the option to pay for your own healthcare is a point of pride! What insanity is this? Is the only metric of success that Canada does not have US style healthcare? That's it?
Spot on about the about the brainwashing. By the Laurentian Concensus "elites". (you will find out who that bunch is, if you do not know already. You have similar lots in India. They are ALWAYS able to skip the line).
On this website perhaps not so many people feel that way. But everyone who listens to the CBC is totally that way.
Edit: But wait: you said you have "active private insurance" in India, but further down you say you would get excellent private etc. care "All of it at my own cost." So which is it? If you go to India for treatment, do you pay, or does the Indian insurance pay?
Meaning I pay for the cost of premium, any out of pocket costs, flights, medicines, and other expenses. The actual healthcare costs are mostly covered by the insurance.
It's the private health insurance angle that I find most annoying. I don't think as a society we can afford to literally pay for any and every health procedure that exists - it is already bankrupting us. I don't believe that was the original intent of the Canadian system. However, by taking away the option of access to private health insurance that would allow the existence of a parallel private healthcare option, it would solve some of this challenge, and bring Canadian healthcare into line with other social democracies.
Private insurance for anything (fire, life, health, car, disability etc.) is only economically viable if everyone has to buy it or is strongly motivated to buy it *but the motivation can't be because you are planning to make a claim.* (A twenty-year old breadwinner whose wife gets pregnant suddenly has a reason to buy life insurance on himself.) Insurance that covers only rare events not of your own making is cheaper than insurance that is supposed to cover cradle-to-grave health care that everyone wants to consume large quantities of, encouraged by medical miracles that were invented only because insurance would pay for them! For employee benefit insurance, every employee at the company has to be enrolled. But that causes bad feeling when premiums have to go up because somebody submitted a bill for $200,000. No insurance company will make private health insurance available to anyone who wants to sign up, because the insurance company suspects that the new applicant knows something about his health that the company doesn't. For instance, if you saw blood in your stool, you might sign up for insurance, (lying about your health), and only go see your doctor to get a colonoscopy *after* the insurance was approved. Then your cancer treatment (if that's what the blood was due to) would be on the insurance company's dime. The insurance companies know that people do this, so they work out ways to keep you from doing it. They might not pay for any condition that emerges in the first six months after you sign up, for instance.
No insurance company is going to offer "jumping the public queue" as a benefit. Because then everyone with insurance will jump the queue and the insurance company becomes the public system. just more expensive because the doctors bill higher fees to private insurance. Systems elsewhere that have parallel public and private systems struggle with who covers what, to protect the insurance companies -- the insurance companies lobby for their interests -- and prevent a run on the private systems. Sometimes they compel every healthy person who can afford it to buy private insurance, leaving the public system only for the elderly and the indigent, and they prescribe long waits in shabby hospitals with bedbugs and restrict the specialists you can see to push you into buying your way out of the public system by going private. If too many sick people want to use the private system especially for luxury care, premiums have to skyrocket to cover it. No easy solution.
The system you describe as not sustainable is in fact available in most every country in the world, including access to VIP clinics and such.
The way it works in the rest of the developed world not the US is that everyone has basic insurance. Either mandatory private (with subsidy) such as in Switzerland, or no fee public like in the UK. Most are somewhere in the middle, such as in Germany and Australia where they actually encourage high income people to take out private insurance for basic care.
Then, if you want something more special or specialized, you can take out extra insurance for that.
They treat health insurance like car insurance. You have your mandatory 3rd party liability portion to drive on the public roads, but then you have your optionals such as theft insurance, collision insurance, etc.
My friend is a doctor in BC but is originally from Croatia. She told me she will leave Canada when she retires specifically because our healthcare system is so broken and she doesn’t trust it. She told me she can access much better care in her home country of Croatia. Canadians need to take their heads out of the sand and stop gloating about our world class healthcare. If we all want to live long, healthy lives, our public system alone cannot do the job. We must resign ourselves to some form of two tier system so health needs can be addressed and paid for IM CANADA!🇨🇦
The other thing is that many immigrants to Canada come from societies where they had access to private insurance and private care which wasn't very expensive, even at the salaries they were making back home. (Not all immigrants were poverty-stricken before they came to Canada. Many were quite well off. Those are the ones we want anyway, right? We don't need ditch-diggers and railway navvies.) So they are disappointed that they are stuck in the public system in Canada and can't get faster care or better amenities by going private, because it's illegal. Kind of a WTF moment for them. We think Tommy Douglas was the Greatest! They don't.
If she thinks care is better in Croatia, she really isn't paying attention. There are numerous treatments available here but not there. You may have quicker visits with physicians but that doesn't mean that there is the same access to therapies.
I can attest that I am already on the email newsletter mailing list for a few hospitals in the Balkans, including one in Zagreb that offers online coupons for knee surgery if you are willing to book a month ahead.
I don't think old stock Canadians realize how poorly they are served by their state religion equivalent health care monopoly. It's pathetic and an indictment on the Laurentian Elite. They had one job, at least make this place more pleasant to live in than the US if we can't complete economically, and they have failed. The health care monopoly is the god that has died but people are propping it up Weekend at Biden's style.
Why prop up the corpse of a failed health care monopoly? Because we are instinctually both cheap and personal accountability adverse. Many generations of cultural reasons for that, but in this case it is literally killing not just people, but the country.
Agree. Despite everything I've said about having to make hard decisions about how much we are willing to pay for everything for everybody, paying for gender-affirming surgery is just plain NUTS!!
Additionally, I will say that this country has a fundamental and serious character flaw that I have seldom observed elsewhere; Canada is so f.......g sanctimonious about itself.
Anyone wanting to boast about Canada being the best country because we have “free health care” needs to read this. Then pull their head out if the sand.
You’re right David it’s the provincial (and territorial and Quebec National) systems that are destroying the their heath systems. Canada has no health system only a central payment system. And the laws banning private coverage options are only there to shield incompetent provincial bureaucracies from competition. A good example in the case of a friend of mine with prostate cancer was prepared to pay a $1800 to private clinics in either the Quebec or the American nations to get a timely and save 3 to 6 months waiting for treatment. But both the Quebec and US MRI clinics document results on flash drives which the Ontario medical establishment won’t accept. I smell a powerful odor of essence of CYA…
Well, don't go to a foreign MRI clinic if you know your oncologist won't accept foreign results to plan your treatment. 3 to 6 months doesn't make much difference in treating prostate cancer. Faster is nicer, sure, but remember: Fast, Good, Cheap. Pick any two.
Personally, I wouldn't pay $1800 out of the money my wife will need to look after herself after I'm dead just to get an MRI 6 months faster. All it is is a picture of an incurable disease. And I'm of the age where I may well get prostate cancer sooner than later.
I see your point but it’s still an individual decision how you spend your money at least in most free countries. My point was that not accepting test results because of format differences and using legislation to ban competition is just an excuse for monopolistic government incompetence.
Or it could be that the local medical establishment wants its own local radiologists to get paid for doing the MRI and not some foreign guy in Quebec or Idaho. I can tell you that when I was working in a big university hospital in Canada, patients brought in flash drives all the time from all over the world. Even little old me could upload the files to any computer in the hospital’s system and our radiologists could read the scans just fine. Now if the machine the patient was scanned on was out of date and the image quality wasn’t good enough to see specific things, then it might have to be repeated locally. But anyone scanned in the U.S. is going to have a good, high-quality study.
I know of no Canadian legislation that prohibits patients from having scans abroad and bringing the results home for Canadian doctors to use at their discretion. It would be inappropriate for a Canadian doctor to refuse to look at a perfectly good scan done outside the province, and make him have the scan repeated here. That would be waste of healthcare dollars and, if the scan involved radiation or contrast dye, possibly dangerous to the patient. Something in your friend’s story doesn’t ring true. I wonder if something got lost as the story was passed along.
Agree with your first point. My friend who I’ve known for years and see weekly was only repeating what he was told to me directly. But you raise a good point I’ll ask him who his source was. Thanks for the question.
Girls can have prostates, you know. ... ;-) Kidding!
Actually this is Leslie. Substack gets our accounts mixed up and calls us both Susan. Usually when it needs to be clear that I'm a man, I say so, and I should have when talking about prostate cancer. But I slipped up.
There are often two lineups when checking in for flights. One a regular lineup and the other one a faster lineup, for travellers who have a Nexus pass, or a high end credit card such as American Express. The same situation applies to airline seating. Business Class gets seated first. Rather odd that people who run our medical system, have failed to see this system at work when they utilize our airports.
In BC and Ontario the plot was lost on our health care systems decades ago about the same time as people started talking about Canada's health care system as a sacred trust or some such nonsense.
People educated in health care administration are paid a fortune, have multiple degrees and the consultants come and go, then they die and more are born to take their place. Massive and expensive bureaucracies have been writing reports about demographics and the need for community care and home based care for for more than 50 years. And yet, health care has been politicized and now is re-invented with every change in government. Not enough medical school places, not enough residencies, not enough operating rooms, nurses. Long term care home of your choice is likely to have a 5 year waiting list.
Those who can afford to pay should have the option of payng extra for the treatment they want and need. The Swedish system requires doctors to proide a minimum number of days per week to public care and can offer the rest to private care. This boosts their incomes, takes pressure off the public purse and would prevent the tragedy of assigning a young woman an incorrect palliative diagnosis. There is today, I know for a fact, so much waiting and suffering going on in our best
hospitals. Nurses do their best to keep their patients comfortable but even our greatest teaching
hospitals are under resourced. Particularly in oncology - getting access to the system, as you point out is the biggest bottleneck. And so the palliative diagnosis. What an indictment of a failed system.
And long life and health to Allison. In the end, it's only money.
This is insane - that someone being alive 1.5 years later and in remission wouldn't be seen as a successful treatment. Maybe it's the BC cancer society's recommendations that are out of date. Wonder if there's any case to be had for medical neglect? Yeesh.
But the initial prognosis she was given by her BC doctors with standard Canadian treatment was 2 months to 2 years. 18 months is less than 2 years. So she is still within the window of the original prognosis suggested with what the author disparaged as "palliative chemotherapy" (which is what HIPEC is, too, just fancier and more expensive.) So this testimonial does not prove that HIPEC extended her life. Besides, you don't hear about the patients who might have died 2 weeks after getting HIPEC, who would have lived longer if they'd settled for standard treatment. WE DON'T KNOW IF HIPEC WORKS! Some people think it must, for $200,000 you'd think it bloody better work. But for most cancers it is promoted for, we just don't know. Sorry, but that's the facts, and it's why Canadian health care systems won't pay for it.
What a dreadful experience for the Ducluzeau family. But pleased to read the author will be acting for all those so ill-served by our broken healthcare system. The decision in the Cambie case was deeply disappointing and it's hopeful to know others will take up the cause.
Should a publicly funded health care system (i.e., we taxpayers) be compelled to pay for every treatment that some medical zealot in a foreign country believes passionately might be helpful at a truly eye-watering price? Mr. DeHaas and his client seem to think we should be. Is that what you all think, too?
Ms. Ducluzeu was not "given two months to live." By Mr. DeHaas's, own words, the prognosis offered with standard Canadian treatment was between two months and two years. Here she is alive 18 months after having HIPEC. 18 months is less than two years. What evidence is there that HIPEC was better for her than standard palliative chemotherapy? That her truth is that she is convinced it was? Not good enough.
Canada's provincial cancer agencies will pay for almost anything, believe me, that offers even the slightest benefit in prolonging survival. If they won't pay for HIPEC (and therefore Canadian surgeons won't do it), you can probably conclude fairly that the evidence is thin to non-existent that it is more beneficial than standard "palliative chemotherapy" ....OR.... the cost for one patient is just too high for us to afford. (I can't know which because I don't know what cancer Ms. Ducluzeau actually has. But B.C. Cancer Agency does, and they would have reviewed the evidence that HIPEC would benefit her at acceptable cost before they turned her down.) Palliative chemo can prolong life meaningfully in most patients. If it didn't, it wouldn't be offered. To disparage it because it is the only recognized, validated treatment that BC Cancer Agency will pay for this particular cancer that Ms Ducluzeau has, whatever it is, seems unfair.
Mr. DeHaas has not proved his case that the B.C. taxpayers owe her $200,000.
When policies send people to die seemingly out of options, those policies need to burnt to the ground. I'm leaving Canada and the 3rd-world healthcare system is one of the primary reasons.
Countries that are supposedly "developing" have better, faster and cheaper healthcare than we do (you might be surprised to know that "backwards" Iran figures on that list).
Meanwhile, we argue over which pronouns to use and whether a man can become a woman. We've lost the plot.
I bet Iran's government doesn't pay for people to travel to America for HIPEC. It's not clear that it works. Testimonials from people who've survived a treatment isn't evidence that it works.
Look at it this way. Playing craps in a casino is a losing game. There is no strategy that allows you to beat the house consistently. The longer you play, the more you lose. The occasional player who wins for a few hours and comes away with a lot of money doesn't change the mathematical fact that the odds are against you. You wouldn't suddenly take up casino craps as a way to pay off your mortgage just because you read about one guy who cleaned up, would you?
I wasn't commenting about HIPEC, but healthcare in general. They have excellent doctors and fast care for a fraction of the cost. Their only disadvantage is their equipment that's slightly less advanced than in the west.
I know a woman who went from BC to Mexico for a knee replacement after two years of waiting. She’s a farmer and needs her knees to work so she can work. $25,000 later she is fine but had to bear the costs. If she lived in Quebec that would not have happened.
I don’t doubt that’s true. But they also are able to say No. if someone wants to get unproven or very expensive treatment in a foreign country that’s not available at home, it’s on her dime. No whining to the government after the fact to pay her a quarter million bucks.
Too much politics in healthcare and too many Canadians that believe the politicos. The biggest single lie foisted on Canadians is the our system is the best in the world. BS on that. Compared not to the USA but OECD single payer systems Canada fails badly. Funny this doesn't even rate as a voting issue.
Yes, the depth of ignorance about health care in our population is one of the biggest impediments to reforming it. I don't want American health care! But I'd certainly take German, French, Swedish, Finnish, Austrian, or Spanish health care. Basically every European country has some sort of mixed system with universal coverage, and they get way better results than ours, despite having far worse demographics and spending about the same. It's madness.
And I say that as someone who at 16 years old with a left nut the size of a navel orange was told he had to wait 6 months to see a surgeon about his incredibly painful hernia. Instead I wound up in the emergency room on New Year's Day 1998 with a left nut now the size of a grapefruit, and said surgeon was quite pissed he got pulled away from his game of Myst. This isn't a new issue. It's been festering for decades and none of our politicians have had the balls to actually try to fix it. Thankfully I still have one mostly normal one.
Careful what you wish for. The French system runs up a notoriously high deficit and they're not far behind Canada in how fast it's all crumbling down.
Shortages and long waits are becoming the norm over there too.
French and Canadian spending on healthcare as a percentage of GDP is basically identical. Yet their system is far superior to ours. I was surprised that our median ages are also nearly the same, I'd have guessed they were a bit older than us.
In what way is the French system "far superior" to ours. I can say it's "far worse". How will readers know who is correct if neither of us produces evidence for the claim?
The French don't have to provide care to an underclass with terrible health status scattered over vast remote territory where airplanes and helicopters are necessary for even routine care by nurse-practitioners.
Have you ever been to France. If anything, their underclass is much larger than Canada's.
How is France's health care superior? It's proven via quantitative metrics as gathered by organizations such as the WHO and OECD. Metric's including wait times, access to a doctor, doctors and nurses per capita, etc.
Canada's health care is on par with upper middle income countries but Canadians have way too much "America sucks"politics tied up into it. The Canadian left is projecting their insecurities like with any other faith. In Canada the closest thing to a national religion among the left is government health care. What a pathetic lot they are.
European health care systems don't pay for HIPEC. It's kind of an American enthusiasm done by a few cowboy surgeons there. So if we had German, French, Swedish, Finnish, Austrian, or Spanish health care, Ms. Ducluzeau would still have had to go the the U.S. to get HIPEC.
One of the ways European systems provide better results for less money is they don't waste it on very expensive care that is not proven to be better than more meat-and-potatoes stuff (or tofu and kale if you prefer.) One reason our system is so expensive is that we have to copy some American enthusiasms and try to give everybody what they want so they don't complain too much about not getting it when the glittering emporia just over the border offer it for cash.
Yes, but in Europe you are given the option to pay for those "enthusiasms" yourself. In Canada both you and your doctor are prevented by law from pursuing and arrangement to engage in those "enthusiasms." That just isn't a thing that free countries do.
Canada is in a stellar group in the banning of people paying for their own care, Cuba, North Korea and Venezuela. Wow
I'm glad her treatment worked out, but I guess I've got to be that guy and point out that there's a couple of important details skipped over in this story:
1) What was the probability that the patient's condition could be treated effectively? There's a difference between being eligible for a treatment and for that treatment to be effective. Long shot treatments sometimes work, but all I'm told here is that a Canadian oncologist thought this one was a long shot.
2) Would private US insurers have typically covered this treatment for the same diagnosis? If not, or if only the so-called "Cadillac Plans" would've, I'm not sure it's fair to indict the Canadian system.
Like I said, I'm happy that this worked out. I've known quite a few people with cancer who've spent huge amounts of money on specialized treatments and alternative therapies and it almost always doesn't, except for their family being left with huge debts or having spent large amounts of money that could've helped a lot with adapting to life without their family member.
I admit I'm also struggling to see how availability of private care in Canada would necessarily have changed things in this case. OK - you can pay for private care in Canada. You're stuck with the same problem of the medical bills. You can buy insurance, which would be great *if you'd bought insurance* instead of relying on the public system, and assuming your insurer would cover this treatment. A private system *could* add capacity and take pressure off the public system.
The thing is, I'm in favor of allowing a parallel private health care system in Canada. I just don't see the logic tying it to this particular horror story.,
The treatment in question might or might not have been a long shot. But it seems to me that our health system should allow a patient to make the choice of whether to try or not -- financed personally or through a private insurance company if one can be found. Forcing a patient to travel out-of-country, thus adding to cost and stress, seems bewildering to me.
It seems to me that the B.C. government should have been liable for the additional costs of receiving this treatment in the U.S., compared to what it would have cost her if she could have made private arrangements here in Canada. The B.C. government might also throw in any savings from not having had to offer her palliative care in Canada.
Like I said, I support a private system for Canada. Not sure that makes a significant dent in the cost incurred in the US, though. And no insurance company is going to cover a pre-existing condition. You'd either need to have insurance before diagnosis, or you're out of luck,
Expecting the BC government to pay for a long-shot treatment if it proves successful is a pretty bad idea. It incentivizes people to try all sorts of long shot treatments on the hope that they'll be reimbursed if it works. Also, it removes the ability of the province to determine what is reasonable and customary treatment that they'll cover. There might be more of an argument for covering the equivalent of costs that would've been incurred with the treatment covered in Canada, but that's not really how the medical system budgets. There's a certain amount they spend each year, and every dollar not spent on one patient is a dollar they can spend on somebody else.
From the article:
"Family and friends contacted four U.S. clinics, which all said she was a candidate for CRS and HIPEC"
Doesn't sound like a long shot. Rather, a standard treatment, albeit expensive, which Canadian health care budgets don't allow for. Now I recognize that government budgets are funded on taxes, and that there are limits on how high governments will go. That's why we need to inject private money into the system. On this, I think we agree.
But our provincial governments should not get a free ride when an individual turns to private health care. Rather, the relevant government should pay him or her the savings that the government makes by not spending on the inferior Canadian treatment. There should be money for out-of-system treatments. After all, governments pay now for emergencies in other jurisdictions, presumably from some allocation. All I'm saying is make this allocation a bit bigger to cover in-country treatments as well.
More generally, are we really so broke that we are resorting to triage, to decide who should be given a chance at living and who should be quietly left to die? That's a sign of a deeply broken system.
You’re getting confused by medical lingo: being a candidate for a treatment doesn’t mean the treatment is going to be effective, it means that you don’t have other factors (e.g. other medical issues, drug problems, mental health problems) that rule you out for getting the treatment.
I know what "being a candidate for a treatment" means. The part of the quote that I found interesting is that ALL of the medical establishments contacted were willing to offer the treatment. That's four "yes" and zero "no". That suggests to me that its use is fairly widespread, hence not a "long shot". But I am not a medical professional. I defer to their opinions on whether she was offered a standard treatment in the U.S., one that could advantageously be offered in Canada, or not.
Of course they were willing, so long as they were guaranteed payment on their end. A relative of mine recently went to Europe for a disc surgery that would allegedly solve a chronic nerve pain. It did not. Turns out another doctor here was willing to do another entirely different (and covered) surgery, which will now also allegedly be the cure. I agree with the original commenter, we can’t use one individual’s circumstances to make a statement on our healthcare system. There are enough issues that surely we can be more data-driven.
"A candidate for" simply means the hospital and surgeon will do the surgery and associated chemo treatment for the condition the patient has. Honest to God these American centres will do anything on anybody who's willing to pay.
The fact that a treatment is widespread does not mean that it works. That becomes part of the problem: once a treatment becomes widespread because of enthusiasm instead of evidence, it becomes very hard to do the randomized trials to find out if it really works. Patients refuse to be randomized to a 50% chance of getting standard treatment and demand to be treated with HIPEC outside the trial, especially if they came all the way from Canada. A lot of trials of HIPEC have failed for this very reason. So it becomes, "Well if you want this treatment and can pay for it, we'll go ahead. No idea if it works."
HIPEC should be regarded as still experimental after all these years (since the 1990s), meaning that no insurance company, private or public, should be expected to pay for it.
Public insurance covering long shot treatments also encourages profit motivated folks, including snake oil salesmen, to pursue customers covered by that system.
It's like all those sketchy BS colleges that opened up when a path to citizenship via student visas opened up. People are incentive motivated.
But the Canadian system *did* allow the patient to make the choice of trying it or not, financed personally. She got what she wanted. But what she wants now is for the taxpayers to pay for something that she was originally told No to. If a treatment isn't offered in Canada -- HIPEC is big, complicated surgery that requires special expertise and training -- you can't just wave a magic wand and say, OK, you want this treatment in Canada, voilà! here is an operating room and a surgical team all ready to operate. And would you want to have an operation by someone who had never done one before but was willing to give it a whirl just so a patient didn't have to travel to an American centre of excellence?
The difficulty with having private insurance for this sort of thing is that insurance companies aren't stupid. They aren't going to let people buy insurance to get preferential care because that tells the insurance company that the patient must be *planning* to use the insurance to pay for preferential care. (What would the premiums have had to be to cover $200,000 for this treatment for just one patient?)
Insurance only works if everyone has to buy the insurance, the way the banks require that all the houses they take mortgages on have fire insurance, not just houses owned by people who smoke in bed and who have kids who play with matches.. So private health insurance would be economically viable only if everyone in Canada was made to buy it, on top of the taxes we pay for free care. Otherwise only the sick and entitled will buy it. This is how Obamacare was supposed to work in the States: you were going to be forced to buy private insurance or pay a penalty. But the Supreme Court ruled the government had no authority to force you to buy broccoli, so it couldn't make you buy insurance. And so health insurance in the U.S. is still a mess.
I have used private clinics in Alberta for health procedures other than dental.
Procedures were either not covered at all by my insurance or only partially covered. In one case it was fully covered by Alberta provincial insurance.
Health insurerers in Canada put limits on what they will pay, both in terms of the selection of procedures they will cover and the maximum dollar amount for each covered procedure. Everyone doesn't need to buy the insurance for them to make money. Dental coverage is a prime example.
Not everyone has to buy the insurance... BUT ... the insurance company has to protect itself from adverse selection. If your employer offers a dental plan, you have to take (and pay for) the insurance. Otherwise only the employees with rotten teeth would want the insurance, and they would end up just insuring one another. There would be no risk pooling. The insurance company has to draw all the people into the pool, especially the ones with good teeth who will pay premiums but won't make many claims. Employee groups are a natural for this because only registered employees join, not independent contractors who, again, might sign up voluntarily (if they were allowed) if they had bad teeth and expected to do better out of the insurance.
All insurance is a wager between the insurance company and the potential policyholders. The potential policyholders are betting that they will consume more care than premiums they pay. Very few do, of course. The insurance company is betting that the total cost of claims will be less than the premiums paid + plus the investment return on the premium dollars between the time the premiums are received and claims paid out. This bet favours the insurance company, obviously, or they wouldn't offer the bet. Insurance companies may suffer an underwriting loss but still make money if investment returns are good. If there is an underwriting loss plus poor investment returns then premiums have to go up. If every employee has to stay in the pool, the employees with good teeth can't drop out and self-insure. They are stuck in the plan unless it gets so expensive that the employer drops it entirely. But employee benefits are paid out of the compensation budget, so the employer is indifferent as to whether the dollars go to the insurance company or to the employees as cash wages. Premium increases in employee benefit plans don't come out of company profits. (That's one reason why employee wages have been stagnating in the U.S. Health insurance premium increases have eaten up the productivity gains that would have gone to increased cash wages were it not for health insurance.)
And as you say, private health insurance is picky about what it will cover. Dental insurance at work is really not much more than pre-paid teeth cleaning. Anything else you pretty much have to pay out of pocket.
Then people have to accept to pay significantly higher taxes (yes, that means everyone) or accept co-pays. None of this is free and Canadians have absolutely no idea how much health care costs.
I had the same questions. I understand that I could pay a private clinic a couple hundred bucks to get my colonoscopy done earlier, say, but a complex procedure? How much would that cost me? I also agree with David above, that the lack of medical personnel is a huge part of the problem, over and above the system. Aren’t there OR’s closed because of not enough anesthetists or nurses? It’s all so complex, and as each province manages things differently, how can there be a national solution?
My wife and I have an active private insurance in India, where we immigrated from. If the need ever arose, we would be headed on the first plane out with the full knowledge that I would be seeing a specialist the day I land. And if surgery was needed, that would take place either the same day or the next. All in an excellent private, for-profit, clinic with great doctors and facilities that parallel or exceed what are found in Canada. All of it at my own cost - and BECAUSE I EVEN HAVE THE OPTION!
I just can't believe how an entire population has been brainwashed into thinking NOT HAVING the option to pay for your own healthcare is a point of pride! What insanity is this? Is the only metric of success that Canada does not have US style healthcare? That's it?
Spot on about the about the brainwashing. By the Laurentian Concensus "elites". (you will find out who that bunch is, if you do not know already. You have similar lots in India. They are ALWAYS able to skip the line).
Canadian kind of insanity.
And for too many, yes that's it.
Good on you to keep that private insurance.
Pretty much, yes. That's Canada.
On this website perhaps not so many people feel that way. But everyone who listens to the CBC is totally that way.
Edit: But wait: you said you have "active private insurance" in India, but further down you say you would get excellent private etc. care "All of it at my own cost." So which is it? If you go to India for treatment, do you pay, or does the Indian insurance pay?
Meaning I pay for the cost of premium, any out of pocket costs, flights, medicines, and other expenses. The actual healthcare costs are mostly covered by the insurance.
It's the private health insurance angle that I find most annoying. I don't think as a society we can afford to literally pay for any and every health procedure that exists - it is already bankrupting us. I don't believe that was the original intent of the Canadian system. However, by taking away the option of access to private health insurance that would allow the existence of a parallel private healthcare option, it would solve some of this challenge, and bring Canadian healthcare into line with other social democracies.
Private insurance for anything (fire, life, health, car, disability etc.) is only economically viable if everyone has to buy it or is strongly motivated to buy it *but the motivation can't be because you are planning to make a claim.* (A twenty-year old breadwinner whose wife gets pregnant suddenly has a reason to buy life insurance on himself.) Insurance that covers only rare events not of your own making is cheaper than insurance that is supposed to cover cradle-to-grave health care that everyone wants to consume large quantities of, encouraged by medical miracles that were invented only because insurance would pay for them! For employee benefit insurance, every employee at the company has to be enrolled. But that causes bad feeling when premiums have to go up because somebody submitted a bill for $200,000. No insurance company will make private health insurance available to anyone who wants to sign up, because the insurance company suspects that the new applicant knows something about his health that the company doesn't. For instance, if you saw blood in your stool, you might sign up for insurance, (lying about your health), and only go see your doctor to get a colonoscopy *after* the insurance was approved. Then your cancer treatment (if that's what the blood was due to) would be on the insurance company's dime. The insurance companies know that people do this, so they work out ways to keep you from doing it. They might not pay for any condition that emerges in the first six months after you sign up, for instance.
No insurance company is going to offer "jumping the public queue" as a benefit. Because then everyone with insurance will jump the queue and the insurance company becomes the public system. just more expensive because the doctors bill higher fees to private insurance. Systems elsewhere that have parallel public and private systems struggle with who covers what, to protect the insurance companies -- the insurance companies lobby for their interests -- and prevent a run on the private systems. Sometimes they compel every healthy person who can afford it to buy private insurance, leaving the public system only for the elderly and the indigent, and they prescribe long waits in shabby hospitals with bedbugs and restrict the specialists you can see to push you into buying your way out of the public system by going private. If too many sick people want to use the private system especially for luxury care, premiums have to skyrocket to cover it. No easy solution.
The system you describe as not sustainable is in fact available in most every country in the world, including access to VIP clinics and such.
The way it works in the rest of the developed world not the US is that everyone has basic insurance. Either mandatory private (with subsidy) such as in Switzerland, or no fee public like in the UK. Most are somewhere in the middle, such as in Germany and Australia where they actually encourage high income people to take out private insurance for basic care.
Then, if you want something more special or specialized, you can take out extra insurance for that.
They treat health insurance like car insurance. You have your mandatory 3rd party liability portion to drive on the public roads, but then you have your optionals such as theft insurance, collision insurance, etc.
My friend is a doctor in BC but is originally from Croatia. She told me she will leave Canada when she retires specifically because our healthcare system is so broken and she doesn’t trust it. She told me she can access much better care in her home country of Croatia. Canadians need to take their heads out of the sand and stop gloating about our world class healthcare. If we all want to live long, healthy lives, our public system alone cannot do the job. We must resign ourselves to some form of two tier system so health needs can be addressed and paid for IM CANADA!🇨🇦
The other thing is that many immigrants to Canada come from societies where they had access to private insurance and private care which wasn't very expensive, even at the salaries they were making back home. (Not all immigrants were poverty-stricken before they came to Canada. Many were quite well off. Those are the ones we want anyway, right? We don't need ditch-diggers and railway navvies.) So they are disappointed that they are stuck in the public system in Canada and can't get faster care or better amenities by going private, because it's illegal. Kind of a WTF moment for them. We think Tommy Douglas was the Greatest! They don't.
If she thinks care is better in Croatia, she really isn't paying attention. There are numerous treatments available here but not there. You may have quicker visits with physicians but that doesn't mean that there is the same access to therapies.
I can attest that I am already on the email newsletter mailing list for a few hospitals in the Balkans, including one in Zagreb that offers online coupons for knee surgery if you are willing to book a month ahead.
I don't think old stock Canadians realize how poorly they are served by their state religion equivalent health care monopoly. It's pathetic and an indictment on the Laurentian Elite. They had one job, at least make this place more pleasant to live in than the US if we can't complete economically, and they have failed. The health care monopoly is the god that has died but people are propping it up Weekend at Biden's style.
Why prop up the corpse of a failed health care monopoly? Because we are instinctually both cheap and personal accountability adverse. Many generations of cultural reasons for that, but in this case it is literally killing not just people, but the country.
This does seem wrong, especially when we have Ontario courts finding much less well supported surgeries as protected: https://toronto.ctvnews.ca/ontarian-wins-legal-battle-for-public-funding-of-gender-affirming-surgery-argued-as-experimental-1.6843504
Agree. Despite everything I've said about having to make hard decisions about how much we are willing to pay for everything for everybody, paying for gender-affirming surgery is just plain NUTS!!
F...
Additionally, I will say that this country has a fundamental and serious character flaw that I have seldom observed elsewhere; Canada is so f.......g sanctimonious about itself.
Anyone wanting to boast about Canada being the best country because we have “free health care” needs to read this. Then pull their head out if the sand.
Dear Mr. Dehaas, How can I get this article posted to my Linkedin. I want to help to get the word out... Thank you for your work.
Steve@isaix.com
You’re right David it’s the provincial (and territorial and Quebec National) systems that are destroying the their heath systems. Canada has no health system only a central payment system. And the laws banning private coverage options are only there to shield incompetent provincial bureaucracies from competition. A good example in the case of a friend of mine with prostate cancer was prepared to pay a $1800 to private clinics in either the Quebec or the American nations to get a timely and save 3 to 6 months waiting for treatment. But both the Quebec and US MRI clinics document results on flash drives which the Ontario medical establishment won’t accept. I smell a powerful odor of essence of CYA…
Well, don't go to a foreign MRI clinic if you know your oncologist won't accept foreign results to plan your treatment. 3 to 6 months doesn't make much difference in treating prostate cancer. Faster is nicer, sure, but remember: Fast, Good, Cheap. Pick any two.
Personally, I wouldn't pay $1800 out of the money my wife will need to look after herself after I'm dead just to get an MRI 6 months faster. All it is is a picture of an incurable disease. And I'm of the age where I may well get prostate cancer sooner than later.
I see your point but it’s still an individual decision how you spend your money at least in most free countries. My point was that not accepting test results because of format differences and using legislation to ban competition is just an excuse for monopolistic government incompetence.
Or it could be that the local medical establishment wants its own local radiologists to get paid for doing the MRI and not some foreign guy in Quebec or Idaho. I can tell you that when I was working in a big university hospital in Canada, patients brought in flash drives all the time from all over the world. Even little old me could upload the files to any computer in the hospital’s system and our radiologists could read the scans just fine. Now if the machine the patient was scanned on was out of date and the image quality wasn’t good enough to see specific things, then it might have to be repeated locally. But anyone scanned in the U.S. is going to have a good, high-quality study.
I know of no Canadian legislation that prohibits patients from having scans abroad and bringing the results home for Canadian doctors to use at their discretion. It would be inappropriate for a Canadian doctor to refuse to look at a perfectly good scan done outside the province, and make him have the scan repeated here. That would be waste of healthcare dollars and, if the scan involved radiation or contrast dye, possibly dangerous to the patient. Something in your friend’s story doesn’t ring true. I wonder if something got lost as the story was passed along.
Agree with your first point. My friend who I’ve known for years and see weekly was only repeating what he was told to me directly. But you raise a good point I’ll ask him who his source was. Thanks for the question.
How is Susan going to get prostate cancer?
Girls can have prostates, you know. ... ;-) Kidding!
Actually this is Leslie. Substack gets our accounts mixed up and calls us both Susan. Usually when it needs to be clear that I'm a man, I say so, and I should have when talking about prostate cancer. But I slipped up.
Glad to hear it. Much of what you say is well worth consideration but that was a step too far.
There are often two lineups when checking in for flights. One a regular lineup and the other one a faster lineup, for travellers who have a Nexus pass, or a high end credit card such as American Express. The same situation applies to airline seating. Business Class gets seated first. Rather odd that people who run our medical system, have failed to see this system at work when they utilize our airports.
In BC and Ontario the plot was lost on our health care systems decades ago about the same time as people started talking about Canada's health care system as a sacred trust or some such nonsense.
People educated in health care administration are paid a fortune, have multiple degrees and the consultants come and go, then they die and more are born to take their place. Massive and expensive bureaucracies have been writing reports about demographics and the need for community care and home based care for for more than 50 years. And yet, health care has been politicized and now is re-invented with every change in government. Not enough medical school places, not enough residencies, not enough operating rooms, nurses. Long term care home of your choice is likely to have a 5 year waiting list.
Those who can afford to pay should have the option of payng extra for the treatment they want and need. The Swedish system requires doctors to proide a minimum number of days per week to public care and can offer the rest to private care. This boosts their incomes, takes pressure off the public purse and would prevent the tragedy of assigning a young woman an incorrect palliative diagnosis. There is today, I know for a fact, so much waiting and suffering going on in our best
hospitals. Nurses do their best to keep their patients comfortable but even our greatest teaching
hospitals are under resourced. Particularly in oncology - getting access to the system, as you point out is the biggest bottleneck. And so the palliative diagnosis. What an indictment of a failed system.
And long life and health to Allison. In the end, it's only money.
This is insane - that someone being alive 1.5 years later and in remission wouldn't be seen as a successful treatment. Maybe it's the BC cancer society's recommendations that are out of date. Wonder if there's any case to be had for medical neglect? Yeesh.
But the initial prognosis she was given by her BC doctors with standard Canadian treatment was 2 months to 2 years. 18 months is less than 2 years. So she is still within the window of the original prognosis suggested with what the author disparaged as "palliative chemotherapy" (which is what HIPEC is, too, just fancier and more expensive.) So this testimonial does not prove that HIPEC extended her life. Besides, you don't hear about the patients who might have died 2 weeks after getting HIPEC, who would have lived longer if they'd settled for standard treatment. WE DON'T KNOW IF HIPEC WORKS! Some people think it must, for $200,000 you'd think it bloody better work. But for most cancers it is promoted for, we just don't know. Sorry, but that's the facts, and it's why Canadian health care systems won't pay for it.
Agree. Testimonials are not evidence.
What a dreadful experience for the Ducluzeau family. But pleased to read the author will be acting for all those so ill-served by our broken healthcare system. The decision in the Cambie case was deeply disappointing and it's hopeful to know others will take up the cause.
Should a publicly funded health care system (i.e., we taxpayers) be compelled to pay for every treatment that some medical zealot in a foreign country believes passionately might be helpful at a truly eye-watering price? Mr. DeHaas and his client seem to think we should be. Is that what you all think, too?
Ms. Ducluzeu was not "given two months to live." By Mr. DeHaas's, own words, the prognosis offered with standard Canadian treatment was between two months and two years. Here she is alive 18 months after having HIPEC. 18 months is less than two years. What evidence is there that HIPEC was better for her than standard palliative chemotherapy? That her truth is that she is convinced it was? Not good enough.
Canada's provincial cancer agencies will pay for almost anything, believe me, that offers even the slightest benefit in prolonging survival. If they won't pay for HIPEC (and therefore Canadian surgeons won't do it), you can probably conclude fairly that the evidence is thin to non-existent that it is more beneficial than standard "palliative chemotherapy" ....OR.... the cost for one patient is just too high for us to afford. (I can't know which because I don't know what cancer Ms. Ducluzeau actually has. But B.C. Cancer Agency does, and they would have reviewed the evidence that HIPEC would benefit her at acceptable cost before they turned her down.) Palliative chemo can prolong life meaningfully in most patients. If it didn't, it wouldn't be offered. To disparage it because it is the only recognized, validated treatment that BC Cancer Agency will pay for this particular cancer that Ms Ducluzeau has, whatever it is, seems unfair.
Mr. DeHaas has not proved his case that the B.C. taxpayers owe her $200,000.