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What with the measles news out of North Carolina (and Israel), vaccines and the folks on the anti-vaxx bandwagon are at one another (again). We tend to side with the folks who think protecting our children (and hence our communities) seems like a no-brainer, but the anti-vaxx folks contend that the medicine leads directly (and inexorably) to autism.

Okay, so what's your point, Henry?

Well, it seems that the folks who run nationalized health care schemes have their own vendetta out for the autistic among us:

"The euthanasia of Nancy Fitzmaurice, a severely disabled child who was not dying, has made international waves ... Nancy’s mother had requested that her daughter be killed and was granted approval by the British legal system."

But that was then, and this is, well:

Is autism a valid reason for euthanasia? Belgium opens criminal investigation into doctors who euthanized a 38-year-old woman. https://t.co/tBmKn9i4sN

— AP Europe (@AP_Europe) November 27, 2018

As we've long noted, the challenge with state-run health "care" schemes is that it is, ultimately,the state that gets to make real life-and-death decisions. And, of course, the culture itself plays an important role: why else would this doc think helping a young woman kill herself was acceptable?

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Shot (courtesy Surgery Center of OK, about which we've posted):

"Family frustrated with lack of bed at Halifax hospital for mother with cancer"

One of the major problems with nationalized health care schemes is that the law of supply and demand is immutable. That is, there will always be a (growing) demand for health care, but there is also a limited (or at least finite) supply. We've seen what happens when you make health care a "right," and it's not pretty:

"Vowing to maintain public dental services in the province, Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system." The case at hand, though, is far more serious, since it involves a potentially life-threatening condition, and the patient suffering even more damage as a direct result of the system.

But then, these systems are also capable of turning out world class meds, which brings us to...

Chaser (via Ace of Spades):

"It is one of this country's great scientific achievements. The first drug ever approved that can fix a faulty gene ... But most Canadians have never heard of it."

Yup, that's right: Canadian researchers at the prestigious University of British Columbia "spent decades developing the treatment for people born with a genetic mutation that causes lipoprotein lipase disorder."

Decades, and tonnes of dollars loonies.

The condition, more commonly known as LPLD, is the result of a genetic mutation, and causes ones blood to thicken with potentially deadly results. It also renders females who suffer from it barren (due to the high risk of miscarriage).

The med, called Glybera, promises to fix all that. The problem is that it was just too expensive, and thus was allowed to whither away on the vine.

To be fair, this isn't the fault of Canada's health care system, but one of simple economics:

"Van Deventer says the company never considered lowering the price ... Why would we? Pricing shouldn't be a political decision. It should be a rational decision based on merits and values.'

Which is contra what a lot of folks here say about "Big Pharma."

Interesting dilemma, no?

Bonus:

Canadian Hospital Urgent Care Waiting Room To Patients: Kill Yourself https://t.co/Q9lwPzlPVS from The Political Hat Blog

— Political Hat Blog (@PoliticHatBlog) November 27, 2018

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No, not that kind of vet, this kind.

Our youngest is the proud mother of two cute cats and, as a graduate student, has a limited budget for feline-related medical expenses. She uses the services of a national chain called Banfield Pet Hospitals, which offers a unique (AFAIK) and interesting option that looks a lot like the Direct Primary Care (for people) about which we've written so often:

"We focus on preventive veterinary care to promote and improve overall pet health. Routine check-ups allow us to diagnose, treat and protect your pet from contracting serious, costly and sometimes fatal diseases."

These services include vaccinations and dental care, complete exams, even nutritional counseling. That last, by the way, may be something that our own DPC providers may not routinely offer (but which might be a great idea).

The basic Banfield plan looks to be about $30 a month or so (depending on services, breed and age), which seems pretty reasonable. There's a modest one-time sign-up fee, as well; I've seen these with DPC practices, as well.

Of course, the "Hospital" in the name also means that they offer more robust services, as well, but I like the preventive care idea, and wonder if we'll start seeing similar collaborations with the DPC community/model.

Meow!

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Regular readers may recall our piece on Direct Primary Care "wrap" policies from a few years back:

"Pan-American VP Carlo Mulvenna was kind enough to walk me through the basic idea behind the plan's design, as well as share product details."

Recently, a reader emailed asking about the status of this plan:

"Have you seen any new major medical/catastrophic wraps for DPC since the article was written in 2015?"

So, I reached back out to Carlo Mulvenna (subject of the interview) who, as it turns out, is still with Pan American Life, and graciously responded with an update:

"Henry,

Good to hear from you.

The MedLion relationship remains though they are focused on a new segment of Virtual Primary Care. For our traditional relationships of employers with large populations of hourly workers we have added a new relationship with HealthCare2U. I've attached a copy of our promotional/info piece."

Regards,

Carlo"

Very nice.

The brochure explains that the program is designed to offer "Affordable, Convenient Access To Healthcare" by packaging online tools and "unlimited same-day/next-day doctor appointments for acute issues at $10 a visit and around-the-clock telemedicine for no out-of-pocket cost."

There are also tools and services available to help manage chronic diseases, which could be very handy.

The "bad" news, of course, is that we still don't have a workable DPC "wrap" plan for catastrophic situations. Oh, well.

Thanks Carlo and Jeremy!

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Back in October, a realtor from Dallas took a trip south of the border for some body work (rhinoplasty and a breast enhancement tune-up). What seems like fairly routine procedures led to some pretty serious complications, and ultimately took her life.

But there's a larger lesson in this, one having to do with getting what one pays for, at least according to her attorney:

"So that her death is not in vain, people should think of Laura before they look for cross border discount surgery ... Always LOOK before you leap!"

Always sage advice, and it appears that Ms Avila had done her homework:

"Laura's fiance Enrique Cruz said he had researched the clinic and found positive reviews online."

Which may or may not be worth the pixels they're printed with.

I don't really think that one can generalize from this that medical tourism is inherently more dangerous than care we receive here, but it's worth noting that it's not necessarily worth the savings, either.

Caveat emptor, indeed.

[Hat Tpi: FoIB Holly R]

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There's a theory that the original Thanksgiving celebration, and the holiday itself, is modeled on the Jewish Festival of Sukkoth (Tabernacles). The idea is that they're both harvest festivals that take place in the Fall, and that the Pilgrims, as religious folks, would have looked to the Bible for inspiration.

The reality is that it's highly unlikely to be true, but it's always fun to speculate on these kinds of connections.

A joyous and blessed Thanksgiving to all of our readers!

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It's currently Open Enrollment season for both ObamaPlans and Medicare Supplements. The former has been a bit frustrating (the only non-Medicaid carrier available in this market has a *very* narrow network) and I've been referring the latter out for many years.

But it got me to thinking that perhaps it's time to reprise another of my former Answers.com gig's posts:

For millions of younger Americans with health problems, Medicare may be available to cover medical expenses. This would include those with long-term disabilities or who have been diagnosed with specific diseases or health conditions, such as amyotrophic lateral sclerosis (ALS) or end-stage renal disease. As with those who qualify due to their age, though, Medicare itself doesn't cover everything, and some form of supplemental coverage may be desirable.

What's the problem?

During surgery, a client's adult daughter was deprived of oxygen for many minutes, resulting in brain damage that left he unable to support herself. She was eligible for Social Security Disability, and thus for pre-65 Medicare health coverage. The challenge is that there are deductibles and co-payments that add to her out-of-pocket costs. A Medicare Supplement policy might be able to pay for most of them. Unfortunately, many people don't know that these plans exist.

What's available?

In some states, one can purchase a standardized Medicare Supplement policy from a licensed carrier. These plans, which are usually available only to those 65 and older, are made available to those who qualify for pre-65 Medicare. They can be expensive, but in many cases the coverage they provide far exceeds the monthly premium.

Medicare Advantage Plans may also be an option, depending on one's residence.

How does Medicare Advantage work for pre-65 beneficiaries?

There are several benefits to an Advantage Plan. First, it caps one's maximum out-of-pocket in case there are a lot of claims (or one very big one). Second, many plans are available at little or no cost to the consumer. This can save thousands of dollars a year in premiums over a standardized Medicare Supplement policy.

The downside to Advantage plans is that one is limited to certain providers for health care, and not all of one's medications may be covered.

What about Open Enrollment?

One challenge with switching to a Medicare Advantage plan is that this can generally only be done during Open Enrollment. Fortunately, my client's daughter was also participating in Social Security's "Extra Help" program. Extra Help enables qualifying Medicare beneficiaries to purchase their meds at greatly reduced prices, with the government picking up the cost. According to the Social Security Administration (which oversees the program), Extra Help "[is estimated to be worth about $4,000 per year]( ttp://https://ift.tt/2DQ6b61" 

What about an Exchange Plan?

One of the alternatives we explored was whether or not an ACA-compliant Exchange plan would be appropriate. This was quickly discarded because, according to the Centers for Medicare and Medicaid, "it’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan".

And people who do choose to reject Medicare and end up buying a plan from the Exchange are ineligible to receive any subsidy.

And so?

Americans who are on Medicare due to serious health conditions have limited health insurance choices. For many, a Medicare Advantage plan may be the most efficient means to supplement their Medicare coverage.

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