Hi Paul,

It was not my desire or intention to indicate whether or not I thought health care reform was needed in the U.S.A.; just to offer the knowledge to anyone who can use it. It certainly seems that some sort of reform will take place but I can't foresee whether it will produce a better or worse situation compared to what we have now. In mentioning rationing I'm simply referring to the reality that scarce/expensive resources cannot be made available to everyone. Since there have been only five Proton Centers in this country, for millions of patients, Massachusetts General Hospital has chosen to treat very few if any Prostate cancer patients, instead prioritizing more deadly cancers. I gather that Loma Linda and UFPTI use plentiful prostate cancer business to help fund pro bono work. Perhaps it's good that a single uniform policy is not centrally mandated to all five centers by a national czar, perhaps not.

Anyone managing the time sharing of a precious resource obviously should strive mightily to be as efficient as possible; in this case that translates to keeping the patients moving and minimizing wasted time between treatments. In this context, I think I observe UFPTI management become frustrated when city or county transport vehicles fail to deliver apparently poor patients on time for their appointments, which sometimes results in as much as thirty to ninety lost minutes per gantry per day. From this observation I surmise that some patients are not paying for their therapy. I don't know if Health Care Reform can improve this situation.

Based on my research and conversations with the Europeans I've met here, I know that it was not possible for them to receive PBT in Europe. They talk about how their National Health Systems limit the cost of treatments, which was recently publicized when the Brits denied leading/expensive breast cancer drugs to women. And, costs of treatment are amortized over a citizens remaining life expectancy determined from mortality tables. So, a $175K therapy might be acceptable for a guy expected to live seventeen years, but likely not for someone actuarially expected to die in seven years.

At least twice when I started businesses, I couldn't afford anything other than major medical as a precaution for catastrophic illness. I haven't been able to buy life insurance since I went on blood pressure meds years ago. If I lose coverage under my wife's insurance from her employer, I'll have two different kinds of pre-existing cancer histories. Yeah, there's lots to not like about U.S. health insurance, but I find it hard to believe that eliminating AETNA, BC/BS, CIGNA, et al, and placing everyone, plus anyone who can sneak into the country, on Medicare will be a superior system. I hope our corrupt Congress somehow stumbles into a more sensible plan.

A brilliant author once said, "paranoia is one thing, but to trust Government is truly insane". INMHO, that's the beginning and ending consideration in any reform.

Best regards, Don Parker