Having just seen Michael Moore’s “Sicko,” I’m wondering what kind of care diabetics in countries with socialized healthcare get? Is the scene in Canada, the UK or Cuba as rosy as Moore paints it? As an american, I’d love to hear what your experiences – good and/or bad – have been.
I’m in the UK. I saw Sicko here on holiday in the US this week.
In the time devoted to the UK system in the film it just isn’t possible to accurately portray every facet of the NHS as it really is. The biggest benefit of our system is that you don’t need to worry about being taken care of. There is a baseline level of care that will keep you alive (if possible!) regardless of how old or young you are, how thin or fat or how rich or poor. If you collapse in the street and an ambulance picks you up, you don’t need to fret about the cost.
The prescription scenario in Sicko is a little inaccurate. For starters, non-eu citizens on holiday in the UK are not entitled to NHS prescriptions. Remember that we pay for healthcare in taxes, so it stands to reason that not everyone can come and take a piece! You will usually get free A&E (ER) treatment though. The prescription charge is also per item. So Moore is accurate when he says that it costs the same regardless of the number of tablets required, but if you need six different types, it is six charges - albeit cheap charges! Doctors are unwilling to prescribe in bulk though, for the very reason that the patient contribution is the same s the NHS loses out. Some doctors will only write two week scrips.
The real upside? Many people pay NOTHING for prescriptions. This includes people with diabetes and many other chronic diseases requiring medication as well as under 16s, over 65s and those on various welfare benefits and low incomes. This saves me a fortune every year. You can also pay a flat charge upfront each year if you are not entitled to free medication and then pay no more regardless of how many scrips you get.
There are huge buts to the system though. We experience many identical problems of fighting to prove what is necessary. Instead of arguing with insurers, we argue with government bodies and or doctors. Test strips are frequently rationed and obtaining a pump can require a long and gruesome battle with the local NHS - known as a primary care trust or PCT and responsible for paying for he healthcare of all those who are registered with a doctor within its boundaries from a budget given from central government. The suitability of any treatment for use within the NHS is assessed by a central body called NICE. If they do not recommend it, or have not assessed it (as with CGM) your chance of getting it paid for is small. There are very specific criteria set by NICE on who ca use a pump, but even if you meet them it is still a long road to get a pump in hand.
The fact that doctors are paid for meting performance targets means that they want to put every patient on ACE inhibitors and cholesterol lowering drugs. And all referrals to specialists must come from a primary care physician (GP, General Practitioner). If they won’t take your symptoms seriously, you can struggle to see a specialist.
Of course there are often long waiting lists but that is partly because urgent stuff gets dealt with first. And the time doctors get to spend with patients can be very limited.
I could go on at length about the NHS, but I’m sure I’m getting boring already. The bottom line is that no system is perfect. I am very grateful for the NHS and that fact that I know people with diabetes can always get insulin even if pumps are more of a struggle and people who are sick get looked after. Treat first, questions later. I’m happy to pay he level of tax that I do for that piece of mind.
Interesting and, although it may surprise you, not boring at all! It’s really helpful to hear all of that. As much as I admire Moore’s work, he tends to present an extreme vision of one side. I had to jump through some hoops to get my pump. The insurance company tried to tell me that I wasn’t a T1 in spite of having been diagnosed at age 10. Several months and blood tests later, I was finally approved. And I’m going to have to buy glucostrips for my trip to europe outright because the insurance won’t pay for any more at the moment (who, after all, needs to check her BG 10 times a day?). You’re right that there is NO perfect system. Our ERs are clogged with those needing basic medical care.
Keep an eye on Massachusetts:
http://www.civilrights.org/press_room/buzz_clips/massachusetts-begins.html
Oh, I might add this was done without Michael Moore’s input.
I joined this forum without Michael Moore’s guidance too.
Personally I hope folks will continue to write their reps when they discover flaws in the system rather than wait for movies, the news media, etc to shape the issue(s).
After reading some of the remarks made here over the past few weeks I might go see the movie afterall, but in saying that I also believe I have learned more about diabetes and our health care system HERE @ TU than his movie, I’ll let ya know when I finally see the movie.
Maybe I’m rambling but many say they think his movie will get a dialogue going but isn’t that what we already have here?
It’s frustrating to me to think even within your own countries coverage can differ. You can’t help what province or territory or state you live in if that’s where your family is, etc…I read C’s link regarding Mass. Hell, we could move there, be legally married and have healthcare (eventually) but what about our friends? My entire family is in Houston…As for insurance being tied to employment; how many people are stuck in jobs they hate just to have health insurance? As for small business owners, it is financially unfeasible to provide health insurance. My beloved offers her employees (she has 3) a bonus (or bolus, if you will) to help them purchase insurance on their own. Her own insurance, a group policy through AVMA (American Veterinary Medical Ass), is terribly expensive with a $5K deductible.
I was going to say pretty much this same thing. I saw Sicko a few days ago and it does make me very glad to live in Canada, at least I will not be left to die by the government. But there are many things the government does not cover at all (like insulin pumps, Lantus, part of Humalog/NovoRapid, certain pump supplies, etc.), or that it requires hoops to be jumped through in order to cover (such as the blood pressure medication I’m on because I can’t tolerate ACE inhibitors, which is all that is covered). It also depends on province. So we have many of our own problems, but I think the system is definitely better than that in the U.S. because all hospital expenses (with the exception of a $40 charge if you get a non-essential ambulance ride) and the costs of most standard doctor’s appointments are covered.
In England we don’t technically get to choose our doctor, but in practice there is a degree of flexibility. You are restricted on which GP (PCP) yo can register with based on where you live, but most practices are group practices and you are entitled to choose which doctor within the group you see and can chop and change at will. Most people, other than those in very remote areas, have at least a couple of practices to choose from.
If you need a secondary referral, fairly recent changes also mean you get to choose the hospital you go to. This is usually a choice of three or four who will all be in your local area (“contracted” by your PCT) unless there is a very specialist service that is only available in certain centres - normally teaching hospitals in large cities. The system is called “Choose and Book” and appointment booking is handled over the internet. You don’t get a choice of which doctor you see at that hospital, but again in practice if you have a particular reason you can usually get a direct referral. For example if you want to see one particular doctor because they specialise in pump therapy your doctor can write a direct referral letter addressed only that doctor. This way you will often have to wait longer, rather than seeing the first available doctor. To be honest though waiting longer is often a good thing, as popular doctors, or doctors who spend longer with their patients and so have a longer wait list, are usually better!
Something called “The Patient’s Charter” means you are also always entitled to a second opinion if you are not happy. This applies equally to primary and secondary care. The frustrating thing is always how slowly the system moves. If you decide to pay privately you can see who you want very quickly! That seems to be the same in almost any healthcare system.
Ok, here’s the honest truth regarding my experience. I’m an American living in Germany for a year now and have the standard gov’t insurance (called AOK). You can see ANY doctor you want, but you’ll generally want to coordinate care through one family doctor (GP) because it’s cheaper that way. If you don’t like the family doc you saw before, though, then see a different one. There are no restrictions on this. You can literally see anyone you want. If, like me, you have several doctors, you pay your 10 Euros to the GP’s office at the beginning of each quarter and get a referral for each of the other docs. You can then have 1 to a thousand appointments that quarter with whomever you’ve been referred to and pay nothing more, no matter how many expensive tests they do on you. (And all docs here have at least ultrasound machines for immediate tests, and often more equip in the other room. If they need an MRI, you’ll get it very soon.) The longest I ever waited to see a specialist was 2 weeks. The insurance company actually calls us periodically just to remind us that if we ever can’t get in to a specialist within 2 weeks, THEY will call around and guarantee an appointment somewhere for us.
Prescriptions for folks that aren’t on welfare are 10 bucks for a 3-month supply. With pump supplies, test strips, thyroid meds, ARB, asthma meds, bc pills and insulin, that can feel high, but when I remember than my insurance copay in America was $75 a MONTH just for insulin… hey, this is way cheap!!! My only complaint with prescriptions is that they aren’t as electronic as in America. They don’t have “refills”. You must visit docs every single time you’re about to run out of something to get a whole new paper prescription that you must take to the pharmacy. For chronic illnesses, this is a serious pain in the butt, with constant doc visits.
As far as hospitals go… ambulance rides are a flat 15 bucks, no matter if it’s head trauma or a tummy ache. We’ve been to the ER a couple times (not for me, the diabetic, ironically) and we’ve never had to wait as long as I’ve waited in the US. Hospital stays are something like 20 bucks a day (but they won’t charge you at all after the initial few days), no matter if it’s intensive care, surgery or just needlessly staying there to “relax”, which they’ll always try to make you do for an extra week or so. (Seriously, lol.) Of course, again, if you are broke and on public assistance, you will pay NOTHING. It’s true that you don’t generally get a private room, though. Rooms are shared and you have to pay cash (if you don’t have any, you’re out of luck) if you want to use the telephone or access the tv (this, imo, is ridiculous). My husband needed a minor non-life threatening surgery and got it in less than a week, no problem. Last year he had chest pains and felt dizzy and they kept him in the emergency cardiac ward for 10 days (!) and ran every imaginable test on him. I’m talking CAT scans, echocardiograms, ECGs, blood tests, chest x-rays, things I’m forgetting the names of and more. In the end it was nothing. Overall it cost us about 60 Euros. I had an MRI in the ER once in America and my copay was $500, and I didn’t even stay 6 hours.
I think Michael Moore’s rosy picture of the UK, Canada and France was probably a little overdone, but not entirely. However, I have yet to meet a German who doesn’t think the US system is just flat-out immoral. No one here goes bankrupt from a heart attack or a fall from a ladder. Everyone can see a doc when sick. It’s just the way it is in the rest of the civilized world. So what’s wrong with America?! Americans really have been lied to about “socialized medicine”. And even if, say, someone thinks the UK’s program sucks. So?! Can’t America create a program that doesn’t have the same shortcomings? We haven’t even TRIED…
Here in Finland, compared to NM at least, the care for diabetes is outstanding. For my daughter we pay a €20 copay to see the endo. Even with my insurance in NM, I had to pay $250 a visit. All our supplies are free. I just call up the local health care clinic and tell them what I need and then go pick it up. I get about 3 months worth at a time. Insulin is €5 for 3 months supply. We also are part of the diabetic union and get a small monthly stipend from the gov. as caretakers(parents) of a diabetic. We were not given the choice of an endo as they divide it by districts. We go to the local hospital to see her Endo. But he is her Dr and we’d only see another one if he were out of town and it wasn’t a regular appt. We see him every 3 months. We also have a Diabetic Educator/nurse who is the same we see each appt too. I can call her anytime during the day. If I have questions ,concerns after hours, I can call the childrens unit at the hospital where they have an Endo on call. It’s great as they all know my daughter and me, so I don’t have to explain who I am or wait hours for someone to call back.
My friends and some people sometimes ask if I would ever move back to the States, and I’d have to say compared to the U.S medical system, Finland is much more better for her health and care then I would ever get back home…
I am very happy to read this, C. I agree we do have a dialogue going on here, C, but hopefully there can be a MUCH bigger dialogue going on as a result of the movie.
I want to take the opportunity to ask this question once more, because the Democratic debate is around the corner, and we have the opportunity of being heard there (and later on, in the Republica debate too):
“What would you ask the candidates for US president (in regards to healthcare for diabetes)?”
I broke my ankle in Austria about 5 years ago (singing “The Sound of Music” no less). Our trip to the Umfallkrankenhaus – or accident hospital – took under 2 hours. That included 2 sets of x-rays (and copies that they sent with me), 2 casts (the first one wasn;t set right), pain meds, heparin and syringes for the flight home. 6 years ago that cost us under $200 US dollars and the dollar was faring much better against the euro then.
It’s been interesting reading all of these replies. I’m in the USA and I’m lucky to have health insurance through my job. I pay half the monthly premium and my job pays half. This means I pay about $47/week just for the premium, and that’s going to go up some when our plan’s renewal comes up in August. I pay $25 co-pay for a doctor visit (PCP or specialist) and an ER co-pay is $75, I believe. We’ve been raising our co-pays bit by bit each year to keep the overall premium cost down. There is no charge if you’re admitted to the hospital. If you enter through an emergency room and are admitted, you’re not responsible for the $75 ER co-pay.
I pay $25 for a one month’s supply of a brand name prescription, or I can get 3 months at a time for $50 through the mail order pharmacy. Generic drugs are $10/month, or $20 for 3 months. All diabetes supplies (insulin, strips, syringes, pen needles) are $10 no matter what the brand is. My insulin pump was covered 100% and all of the supplies are also covered 100%, no co-pays. I have never been denied an amount of any medication or strips. I get 400 strips a month and the only time I ever had a problem was when an $#%*# pharmacist (at a local chain) decided that was too many, cut it down to 200 and insisted that’s all my insurance paid for. That’s when I switched to mail order.
I don’t need a referral to see any specialists. I can change my primary care doctor at any time. I can get a second opinion from another specialist if I want. I’m in a big city, so there are a lot of doctors to choose from. The only catch is they must be on my insurance company’s roster, but it’s a massive list.
I know not everyone has insurance, and that even those who do have less-than-decent coverage and have to fight for every little thing. I think universal health care is a good idea, because there are times I actually have nightmares about losing my health insurance. For now, though, what I have beats out any government funded program because I have no headaches, no fights, and basically no restrictions on my care.
What is made apparent through the posts is that each system has its pluses and minuses. I’d be hard pressed to decide if (relatively) free healthcare outweighed my ability to be on the pump. Also, I have a difficult time with not being able to necessarily pick my own doctor. On the other had…I feel like Tevye in “Fiddler on the Roof.”
US Healthcare for me:
I’m one of eleven, that’s right I said eleven.
Dad did most of the tooth pulling and any minor surgery needed until my sister became a nurse.
He also acted as barber to his seven sons. We always had buzz cuts.
I think for the most part we were covered by those group medical insurance policies from school.
Mom didn’t work outside the home, she was too busy!
I don’t think whatever policy they had back then covered birth control, personally as #9, I’m thankful.
Dad never made over $30,000 until after I moved out at age 18.
When I joined the USAF
They have Universal Health!
No choice of doctors though.
Oh yeah and lining up with 50 strangers to get shots – from the same air gun like needle.
Had two children delivered in AF hospitals.
Can’t say the care was bad but it wasn’t too personal, spent a lot of time in lines. Hurry up & wait.
Never saw the same doctor or dentist twice, ever. Even my wife never met the doctor who delivered our 1st child until that day.
But we did have Universal Health!
Got out after 8 years.
Boss paid full Blue Cross / Blue Shield benefits after a year, we were covered by COBRA until then.
3rd child born, we had to pay a portion, about $1000.00 if I recall correctly.
Self employed – too cheap to give myself benefits!
After eight years decided to get serious about the future and went back into the “workforce”.
Every employer I have had since then has paid for full family medical plans and individual dental plans without co-payments.
My present employer likewise which is fairly rare nowadays – about 30 employees – Tufts which is a pretty decent plan.
$15 for an office visit co-pay, $50 for an emergency room visit co-pay.*
My wife on the other hand has a group Blue Cross / Blue Shield family plan, she pays $20 per week for her share. Her employer employs thousands nationwide.
For her an office visit co-pay is $20, specialist is $30, emergency is $50.*
*actually we don’t pay anything for visit co-pays, since we both have plans the other insurance policy picks those up – sometimes we need to educate office managers but they always come around.
So what do we pay?
$80 a month for her policy, nothing for mine.
About $40 a month for my test strips and lancets.
Nothing on going for her.
I’m 47, she’s not saying.
Then there’s the matter of my son’s epilepsy.
He has had four brain surgeries, and one VNS pacemaker like implant that stops or slows seizures.
Bill: Over $450,000 to date, we’ve paid about $1,000 total for our complete share (my wife says $250 total).
His monthly meds cost us about $100.00 / $1200 per year.
Office visits are free and he visits Children’s Hospital Boston on a regular basis.
In all of this his largest bill we had to pay out of our pockets was for an ambulance called by the school nurse because he looked unsteady, he wasn’t admitted so we had to pay about $300.00 for 1000 foot ride – more than all the surgeries combined!
So we still only pay $80 per month for her plan or $960 annually.
About $480 for my supplies.
And about $1200.00 for our son’s meds.
Total = $2640 anually for the best doctors in the world imho.
My guess is “universal health” will cost more and deliver for less in my case.
I’ll be watching how Massachusetts’ new “Universal Health” will effect this - in theory my costs should go down since everyone without plans are now required to get them, so instead of getting free services they have to start paying up, either as individuals or from their employer.
What’s the coverage like for pump supplies? Is there any way to get them covered if you have some other way to get a pump?
Good question. My supplies are covered at 80% once I meet my (high) deductible – which, fortunately ( or unfortunately depending upon through which lens I’m looking), I 've already done this year. The insurance guys at Animas were really helpful at figuring out how I could get the most supplies for the least money. I’m intrigued by the Canadians having benefits through the workplace as well. If you have supplemental insurance, could you choose to use that instead of the government plan in which case would you also be able to choose your doc? Or do you use the insurance as a supplement to the government plan?
I am in Canada and the government will not cover pumps. Our insurance Blue Cross, will cover about 1000 of a pump and then will cover the supplies. 5000-6000 is a lot for us to come up with. My husband and son are diabetic so times that by 2! It is wonderful that we do not have to pay to go to the doctor, but my husband says that since insurance knows that the government will pay for my dialysis someday, they aren’t too concerned in covering things that are not “necessary” but will improve my quality of life and longevity!
That’s a pretty good summing up. 
I consider myself extremely lucky to be in the UK, because I don’t know how I’d pay for prescriptions at £6.85 per item and rising year on year. That said, I wish I was treated like some kind of maniac for needing lots of test strips. I understand that the cost to the NHS is approximately £15 for a box of 50 (I used to work at NHS Direct and spent an hour with the pricing catelogue working it all out) but I don’t waste them. My diabetes nurse and my consultant want me to test 5 - 6 times a day at the moment. All I ever get is the doctor saying “Are you sure? The guideline is 2 - 4 times a week”, at which point I have to remind the doctor that the guideline applies to those with Type II, not Type I. But that’s another issue.
My other bugbear (other than trying to get a pump) is the problem with education. About 45 hospitals in the UK run the DAFNE course, and it’s free. However the waiting list is at least a year. So I’ve now been struggling with rubbish blood sugars, waiting to get on the course, and waiting to be taught some basic carb counting. I’ve been taught that now, at least.
One thing worth noting in this discussion is the state of dental insurance in the U.S. I know some (most?) countries with universal healthcare include dental maintenance and work within the healthcare spectrum. In the U.S., however, dental insurance is an outright scam, far moreso than health insurance; dental insurance companies typically take in more in premiums than they are even contractually obligated (in a worst case scenario) to pay out on an annual basis.
And, as we know, diabetes can potentially be related to tooth problems. I myself had my ketoacidosis worsened last year by a (potentially lethal!) dental abscess that went untreated because my insurance wouldn’t cover it.