Canada's royal commission on health care
November 28, 2002 10:30 AM Subscribe
Canadian Royal Commission: medicare a 'moral enterprise, not business venture'. After 18 months of talking to Canadians, former premier of Sastatchewan, Roy Romanow, has releases the final report from the royal commission on health care. The word is: public is good, and it's gonna cost us. Also see CBC coverage including video of the release.
"I believe it is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care."
[this is good]
posted by zygoticmynci at 11:16 AM on November 28, 2002
[this is good]
posted by zygoticmynci at 11:16 AM on November 28, 2002
But boy is it nice to have that private American system right next door, just in case!
Absolutely, even if every Kleenex you use costs you $10,000....
posted by scotty at 11:38 AM on November 28, 2002
Absolutely, even if every Kleenex you use costs you $10,000....
posted by scotty at 11:38 AM on November 28, 2002
"I believe it is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care."
So my money's no good at the hospital any more? Well hot dang, I think I might just need to have a mole removed. I think I need to have this scrape on my knee looked at. No need to buy that ergonomic chair for work anymore, the doctors will fix my back! Hey you, doctor, I demand you treat this cold of mine. After all, I'm the one in need here, because I said so.
posted by MarkO at 11:47 AM on November 28, 2002
So my money's no good at the hospital any more? Well hot dang, I think I might just need to have a mole removed. I think I need to have this scrape on my knee looked at. No need to buy that ergonomic chair for work anymore, the doctors will fix my back! Hey you, doctor, I demand you treat this cold of mine. After all, I'm the one in need here, because I said so.
posted by MarkO at 11:47 AM on November 28, 2002
In other words, MarkO: "I will go to the doctor not because I need, but because I can."
And dagny, But boy is it nice to have that private American system right next door, just in case!. Not "just in case", but to take Canadian med.grads. (and nurses too) away from Canada, in search for a (way) better salary. (and I don't blame them)
Actually I'd like to know if the report mentions anything about the fact that if you are not Canadian and move to Canada you cannot practice medicine, regardless of how good a doctor you are in your country. All because of the stupid doctors-mafia, sorry, association.
posted by crisdias at 12:07 PM on November 28, 2002
And dagny, But boy is it nice to have that private American system right next door, just in case!. Not "just in case", but to take Canadian med.grads. (and nurses too) away from Canada, in search for a (way) better salary. (and I don't blame them)
Actually I'd like to know if the report mentions anything about the fact that if you are not Canadian and move to Canada you cannot practice medicine, regardless of how good a doctor you are in your country. All because of the stupid doctors-mafia, sorry, association.
posted by crisdias at 12:07 PM on November 28, 2002
crisdias, care to support that bit of conjecture? Are you suggesting American-trained (for example) doctors can't perform medicine in Canada? If so, why is the Canadian government spending so much money recruiting med students from other countries to take up residence in Canada?
posted by GhostintheMachine at 12:11 PM on November 28, 2002
posted by GhostintheMachine at 12:11 PM on November 28, 2002
(here's the Health Canada information on how foreign medical students can become doctors in Canada. Seems odd that they would outline exactly how to do it, in a nice easy to follow manner, if as you say, we don't allow foreigners to practise medicine here. Sounds like you have an agenda or personal gripe.
posted by GhostintheMachine at 12:19 PM on November 28, 2002
posted by GhostintheMachine at 12:19 PM on November 28, 2002
Hey you, doctor, I demand you treat this cold of mine. After all, I'm the one in need here, because I said so.
True, any civilised society should decide such things in consultation with bank managers, not patients. It's only logical - these 'poor' types are, by definition, scroungers seeking only to exploit the system. Send 'em all to the workhouse, I say.
posted by zygoticmynci at 12:36 PM on November 28, 2002
True, any civilised society should decide such things in consultation with bank managers, not patients. It's only logical - these 'poor' types are, by definition, scroungers seeking only to exploit the system. Send 'em all to the workhouse, I say.
posted by zygoticmynci at 12:36 PM on November 28, 2002
GhostintheMachine, I support crisdias' assertion. There is a strong bias in favour of homegrown docs, and as a result, numerous well-qualified ones from Eastern/Southern countries are forced to take non-medical jobs when they immigrate. The National, I believe, had a report on this one evening last week.
posted by stonerose at 12:42 PM on November 28, 2002
posted by stonerose at 12:42 PM on November 28, 2002
All because of the stupid doctors-mafia, sorry, association.
crisdias, I an giving you the benefit of doubt on this. But you should notice that, except in very special cases (usually covered by international treaties), almost no country allows someone without a degree from an accredited institution (meaning and institution allowed to dispense such degrees by that countries' Ministry of Education or the equivalent). It is true not only for medical doctors, but also for lawyers, engineers, dentists etc. In Brazil, for instance, it is extremely difficult for a foreign doctor to have his/her degree accepted.
posted by nkyad at 12:52 PM on November 28, 2002
crisdias, I an giving you the benefit of doubt on this. But you should notice that, except in very special cases (usually covered by international treaties), almost no country allows someone without a degree from an accredited institution (meaning and institution allowed to dispense such degrees by that countries' Ministry of Education or the equivalent). It is true not only for medical doctors, but also for lawyers, engineers, dentists etc. In Brazil, for instance, it is extremely difficult for a foreign doctor to have his/her degree accepted.
posted by nkyad at 12:52 PM on November 28, 2002
I support GitM's assertion. Them's that want to work as doctors in Canada, can work as doctors in Canada. They may have to jump through some hoops to do it -- namely, they need to prove their qualifications are equal to our standards, said proof not being at all easy to prove -- but it can and is done.
I really hope the Feds use their leverage to bring health care back up to spec. I would like to see a nominal user fee on emergency/clinic usage, waivable upon demonstration of need.
This would (a) encourage parents to take their kids to a single family doctor, who'll have a proper history and familiarity with the little blights; (b) discourage improper use of emergency services; (c) and maybe even encourage people to quit fretting about every little sniffle, headache, or tummyache.
Most colds resolve themselves in a week, and all the medical intervention in the world won't speed it up.
posted by five fresh fish at 1:06 PM on November 28, 2002
I really hope the Feds use their leverage to bring health care back up to spec. I would like to see a nominal user fee on emergency/clinic usage, waivable upon demonstration of need.
This would (a) encourage parents to take their kids to a single family doctor, who'll have a proper history and familiarity with the little blights; (b) discourage improper use of emergency services; (c) and maybe even encourage people to quit fretting about every little sniffle, headache, or tummyache.
Most colds resolve themselves in a week, and all the medical intervention in the world won't speed it up.
posted by five fresh fish at 1:06 PM on November 28, 2002
Canada did actually make immigrant doctors jump through some very unfair hoops to practice here (as well as cut back enrolment at med schools) back in the 90s when various governments were cutting back healthcare left and right. They had to revise the rules when they found out there weren't enough doctors. Oops!
posted by transient at 1:09 PM on November 28, 2002
posted by transient at 1:09 PM on November 28, 2002
I am still wondering about what at the time I thought was a brilliant and workable solution (was it in Oregon or Washington State?)
The idea was for the public system to have its medical procedures rated: the top of the list was effective procedures that were also inexpensive; the bottom of the list was ineffective and terribly expensive procedures.
By eliminating the bottom 4 or 5 procedures, that cost millions of dollars and *never* worked, they saved enough money to both enroll far more people into the system *and* to establish an effective preventative medical system to keep them healthy in the first place.
But even though it worked very well, last I heard, the system was limited to just that one State, without even consideration by other States or the Federal (US) government. And I've no idea why.
Would you Canadians be willing to trade socialized medicine, for better or worse, with both privatized and government sponsored medicine that really, really worked?
Or is it a matter of faith, like a religion?
posted by kablam at 1:14 PM on November 28, 2002
The idea was for the public system to have its medical procedures rated: the top of the list was effective procedures that were also inexpensive; the bottom of the list was ineffective and terribly expensive procedures.
By eliminating the bottom 4 or 5 procedures, that cost millions of dollars and *never* worked, they saved enough money to both enroll far more people into the system *and* to establish an effective preventative medical system to keep them healthy in the first place.
But even though it worked very well, last I heard, the system was limited to just that one State, without even consideration by other States or the Federal (US) government. And I've no idea why.
Would you Canadians be willing to trade socialized medicine, for better or worse, with both privatized and government sponsored medicine that really, really worked?
Or is it a matter of faith, like a religion?
posted by kablam at 1:14 PM on November 28, 2002
Hey you, doctor, I demand you treat this cold of mine. After all, I'm the one in need here, because I said so.
I think you misunderstand. The patient's perception of need is not a guarantee of treatment. The guarantee of treatment applies to those who are assessed as having a true need. Perhaps you can explain how one who does not have to pay for treatment has more power to command than a patron of for-profit treatment.
posted by holycola at 1:19 PM on November 28, 2002
I think you misunderstand. The patient's perception of need is not a guarantee of treatment. The guarantee of treatment applies to those who are assessed as having a true need. Perhaps you can explain how one who does not have to pay for treatment has more power to command than a patron of for-profit treatment.
posted by holycola at 1:19 PM on November 28, 2002
kablam, the major concern is that a mix of private and public heathcare would lead to two separate systems: one well-funded by its users and therefore able to offer higher salaries, attracting more and better doctors away from the public system. The quality care woul be available to those who can afford it, while the poor are once again screwed.
In other words, sure, we'd all love to have something that really, really works, but that won't.
posted by transient at 1:32 PM on November 28, 2002
In other words, sure, we'd all love to have something that really, really works, but that won't.
posted by transient at 1:32 PM on November 28, 2002
" Would you Canadians be willing to trade socialized medicine, for better or worse, with both privatized and government sponsored medicine that really, really worked?"
Sure, kablam. If it could be made to work. There are definite problems with the current system (hence the need for a 350 page tome on the subject), but it's still providing a reasonable level of care for the vast majority of Canadians.
I mean, it's not as if there isn't a two-tiered system already in Canada. Most people buy supplementary health insurance to cover private hospital rooms and other non-essential levels of treatment, and there are a few private clinics in various places. There's a bit of controversy right now here in Nova Scotia about a private MRI clinic. Some people oppose it as "the end of medicare", but I think it could be a good thing if it could be made to work.
Making it work is the tough job, though.
posted by GhostintheMachine at 1:44 PM on November 28, 2002
Sure, kablam. If it could be made to work. There are definite problems with the current system (hence the need for a 350 page tome on the subject), but it's still providing a reasonable level of care for the vast majority of Canadians.
I mean, it's not as if there isn't a two-tiered system already in Canada. Most people buy supplementary health insurance to cover private hospital rooms and other non-essential levels of treatment, and there are a few private clinics in various places. There's a bit of controversy right now here in Nova Scotia about a private MRI clinic. Some people oppose it as "the end of medicare", but I think it could be a good thing if it could be made to work.
Making it work is the tough job, though.
posted by GhostintheMachine at 1:44 PM on November 28, 2002
'socialized' medicare... why the scare-vocabulary? It's called public healthcare, like public roads and public schools. Easy, right?
posted by Space Coyote at 2:09 PM on November 28, 2002
posted by Space Coyote at 2:09 PM on November 28, 2002
Immigrant doctors have to, basically, go back to med school if they want to practice in Canada. I understand other countries might have similar rules, but hey... We are lacking doctors here.
Last Friday I heard the story of a (rich) Canadian man who decided (the "just in case" story?) to cross the border to have surgery that would take 8 months to happen in Canada.
When he came back he met a Russian doctor, internationally recognized (in the rich guy's words, I wasn't there) who, after moving to Canada, had to work cleaning beds in hospitals.
Again, other countries might have similar rules, but Canada, in theory, has an agenda of incentive to skilled immigrants, we all know that. Engineers and lawyers (and laws surely change from country to country) can practice in Canada after jumping the so-called hoops. Doctors simply can't . Period.
posted by crisdias at 2:16 PM on November 28, 2002
Last Friday I heard the story of a (rich) Canadian man who decided (the "just in case" story?) to cross the border to have surgery that would take 8 months to happen in Canada.
When he came back he met a Russian doctor, internationally recognized (in the rich guy's words, I wasn't there) who, after moving to Canada, had to work cleaning beds in hospitals.
Again, other countries might have similar rules, but Canada, in theory, has an agenda of incentive to skilled immigrants, we all know that. Engineers and lawyers (and laws surely change from country to country) can practice in Canada after jumping the so-called hoops. Doctors simply can't . Period.
posted by crisdias at 2:16 PM on November 28, 2002
I've been treated by many immigrant doctors in Canada. I understand some people have a hard time, but what's the alternative? Accept hard-to-verify out of country paperwork and hope for the best?
I'd hope that any doctor could go back to med school and pass their final finals at any time. If that's a major challange for them, I'd probably rather wait for the next guy.
posted by Leonard at 2:25 PM on November 28, 2002
I'd hope that any doctor could go back to med school and pass their final finals at any time. If that's a major challange for them, I'd probably rather wait for the next guy.
posted by Leonard at 2:25 PM on November 28, 2002
As an American, I've never understood why people aren't considered as part of the economy's infrastructure. For example, the government pays for many transportation needs, from highways to airlines and nobody runs around yelling "socialism! Kill it!" As is discussed elsewhere, the US government spends hundreds of billions of dollars to support private industries in the name of infrastructure. People, on the other hand, have nothing to do with the running of the economy and aren't valued as a resource. Instead people in America receive sub-standard education and medical care - unless they can pay. I call it class war, really, but it isn't the kind of class war people usually think of. In America the class war is being fought by the rich against the poor in a series of preemptive strikes. I worry that in a few generations America's economy will be over-shadowed by some country more willing to create a well educated and healthy population.
posted by elwoodwiles at 3:01 PM on November 28, 2002
posted by elwoodwiles at 3:01 PM on November 28, 2002
Ghost> Actually, it's illegal to provide essential health-care services in Canada for profit as it stands. The 'private clinics' are for things like plastic surgery.
Folks> It's not difficult to become accredited in Canada if you're a doctor from another country with reasonable medical education - it's expensive and time consuming. I have an aunt who's an anaesthesiologist from Scotland, and it took her about five years, IIRC, to go through the entire accreditation process. Typically, the most difficult part is the 'Canadian Experience' which means you need to work as an intern once again at some hospital for next to nothing. Pulling an intern's schedule doesn't leave much time to work a second job to pay the bills.
Elwood>Actually, the libertarian viewpoint, which is more or less the one being advanced here by advocates of private health care, _does_ hold that the government building roads, funding corporations and propping up airlines is not desirable either.
posted by Pseudoephedrine at 3:10 PM on November 28, 2002
Folks> It's not difficult to become accredited in Canada if you're a doctor from another country with reasonable medical education - it's expensive and time consuming. I have an aunt who's an anaesthesiologist from Scotland, and it took her about five years, IIRC, to go through the entire accreditation process. Typically, the most difficult part is the 'Canadian Experience' which means you need to work as an intern once again at some hospital for next to nothing. Pulling an intern's schedule doesn't leave much time to work a second job to pay the bills.
Elwood>Actually, the libertarian viewpoint, which is more or less the one being advanced here by advocates of private health care, _does_ hold that the government building roads, funding corporations and propping up airlines is not desirable either.
posted by Pseudoephedrine at 3:10 PM on November 28, 2002
Well, though I am the first to advocate the efficiency of multiple health care systems over a single, monolithic creature, I'd like to throw another curve ball into the discussion: Cuba.
One of Fidel's eccentricities is doctors. He wanted, and created more doctors per capita then just about anywhere else in the world. Cuba is still flush with medical schools, and exports, as it were, care to the rest of central and South America--now one of Cuba's big money makers.
My point is this: if both the US and Canada forced the medical schools to admit anyone qualified, resulting in a huge surplus of doctors, how could patient care *not* improve, NO MATTER what the national health care policy?
Strictly a supply and demand thing. Easy enough, just force the medical students to admit all reasonable applicants, and graduate all who are objectively qualified.
Break up the bottleneck in the market.
posted by kablam at 4:30 PM on November 28, 2002
One of Fidel's eccentricities is doctors. He wanted, and created more doctors per capita then just about anywhere else in the world. Cuba is still flush with medical schools, and exports, as it were, care to the rest of central and South America--now one of Cuba's big money makers.
My point is this: if both the US and Canada forced the medical schools to admit anyone qualified, resulting in a huge surplus of doctors, how could patient care *not* improve, NO MATTER what the national health care policy?
Strictly a supply and demand thing. Easy enough, just force the medical students to admit all reasonable applicants, and graduate all who are objectively qualified.
Break up the bottleneck in the market.
posted by kablam at 4:30 PM on November 28, 2002
The guarantee of treatment applies to those who are assessed as having a true need.
The problem with that statement is the word "assessed." Who gets to decide whether a patient needs care? In socialized healthcare this responsibility rests with the government.
Perhaps you can explain how one who does not have to pay for treatment has more power to command than a patron of for-profit treatment.
Because in such a system, the government is forced to restrict the onslaught of spurious patients. Fill out a certificate of need and we'll get back to you in 6 weeks. Perhaps you're friends with a bureaucrat in high places, well now you can get treatment in one week.
But that's not even the worst part. In socialized healthcare the freedom is siezed from the hands of the doctors. They have to obey the whims of whatever government regulations are put in place, as if they know what treatments are necessary in every case. Let us not forget that healthcare today is a highly technological and creative endeavor, brought about by years of advancement and competition for superior services. To force such a practice to be rationed out on the basis of "need" condemns the doctors and other practitioners to slavery.
posted by MarkO at 6:44 PM on November 28, 2002
The problem with that statement is the word "assessed." Who gets to decide whether a patient needs care? In socialized healthcare this responsibility rests with the government.
Perhaps you can explain how one who does not have to pay for treatment has more power to command than a patron of for-profit treatment.
Because in such a system, the government is forced to restrict the onslaught of spurious patients. Fill out a certificate of need and we'll get back to you in 6 weeks. Perhaps you're friends with a bureaucrat in high places, well now you can get treatment in one week.
But that's not even the worst part. In socialized healthcare the freedom is siezed from the hands of the doctors. They have to obey the whims of whatever government regulations are put in place, as if they know what treatments are necessary in every case. Let us not forget that healthcare today is a highly technological and creative endeavor, brought about by years of advancement and competition for superior services. To force such a practice to be rationed out on the basis of "need" condemns the doctors and other practitioners to slavery.
posted by MarkO at 6:44 PM on November 28, 2002
Waiting until you are sick and trying to play catch up and treat the symptoms is barbaric. In the not-too-distant future, preventive medicine will be an integral and virtually universal part of society and our current system will be deemed almost as primitive as we now regard dancing around the sick to drive the evil spirits away.
posted by rushmc at 8:57 PM on November 28, 2002
posted by rushmc at 8:57 PM on November 28, 2002
Harper's Index, August 2002:
Chance that an American filing for bankruptcy last year did so because of medical expenses : 1 in 2
Source: Debs-Jones-Douglass Institute (Washington)
There are problems with the system in Canada, but that's why this report was done. And as Hugh Windsor points out in the Globe and Mail, the report suggests that things are actually pretty good.
posted by mzanatta at 11:03 PM on November 28, 2002
Chance that an American filing for bankruptcy last year did so because of medical expenses : 1 in 2
Source: Debs-Jones-Douglass Institute (Washington)
There are problems with the system in Canada, but that's why this report was done. And as Hugh Windsor points out in the Globe and Mail, the report suggests that things are actually pretty good.
posted by mzanatta at 11:03 PM on November 28, 2002
MarkO, I live in a country (New Zealand) with a public healthcare system not unlike Canada's. "Socialised medicine" does not preclude a parallel, private system, funded directly by patients or indirectly by health insurance. Choice does exist, though only for the middle and upper classes.
To force such a practice to be rationed out on the basis of "need" condemns the doctors and other practitioners to slavery.
Your scare quotes around "need" are very interesting. Why are governments necessarily poor at policy (or worse than a profit-driven private sector)? That's a huge assumption.
My observation of privately funded healthcare in practise is that it relies on insurance companies or other collective schemes to organise it. These corporate entities are at least as unresponsive as goverment, and considerably less accountable. In theory you might have a free market for health care, but in practise, you have to commit to paying one company's premiums and accepting its judgement. It is not at all clear to me that a profit-driven corporation will have my interests at heart to any greater extent than the Ministry of Health.
rushmc: a continual controversy here in health policy is the balance between funding primary and preventative care vs hospital treatment. Is it better to educate people to stop smoking, exercise, and eat better, or to pay for heart transplants? We know it's not an either-or thing, so where do we put the balance? Shall we let you die because you can't afford it? Shall we try and prevent the next generation from suffering as you have? Hard, hard policy questions,with very unclear outcomes.
posted by i_am_joe's_spleen at 11:10 PM on November 28, 2002
To force such a practice to be rationed out on the basis of "need" condemns the doctors and other practitioners to slavery.
Your scare quotes around "need" are very interesting. Why are governments necessarily poor at policy (or worse than a profit-driven private sector)? That's a huge assumption.
My observation of privately funded healthcare in practise is that it relies on insurance companies or other collective schemes to organise it. These corporate entities are at least as unresponsive as goverment, and considerably less accountable. In theory you might have a free market for health care, but in practise, you have to commit to paying one company's premiums and accepting its judgement. It is not at all clear to me that a profit-driven corporation will have my interests at heart to any greater extent than the Ministry of Health.
rushmc: a continual controversy here in health policy is the balance between funding primary and preventative care vs hospital treatment. Is it better to educate people to stop smoking, exercise, and eat better, or to pay for heart transplants? We know it's not an either-or thing, so where do we put the balance? Shall we let you die because you can't afford it? Shall we try and prevent the next generation from suffering as you have? Hard, hard policy questions,with very unclear outcomes.
posted by i_am_joe's_spleen at 11:10 PM on November 28, 2002
MarkO, replace "government" with "HMO" and "socialized medicine" with "private insurance" in your last post, and you have America's health care system summed up rather nicely.
The rationing idea that was attempted in Oregon was interesting, but it got torpedoed by Bush I before it was ever enacted because it seemed to violate the Americans With Disabilities Act (treatments for disabilities were ranked at a lower priority than other treatments because they did not return the patient to an assymtomatic state). I'm totally in favor of single payer health care, but the reality is that there must be a system for rationing care or health care costs will eat up more and more of our economy. Health care is already at 13 percent of GDP and growing fast. It is very tough to come up with a workable system, but anything is better than the current rationing system, which, of course, is by ability to pay.
posted by boltman at 11:27 PM on November 28, 2002
The rationing idea that was attempted in Oregon was interesting, but it got torpedoed by Bush I before it was ever enacted because it seemed to violate the Americans With Disabilities Act (treatments for disabilities were ranked at a lower priority than other treatments because they did not return the patient to an assymtomatic state). I'm totally in favor of single payer health care, but the reality is that there must be a system for rationing care or health care costs will eat up more and more of our economy. Health care is already at 13 percent of GDP and growing fast. It is very tough to come up with a workable system, but anything is better than the current rationing system, which, of course, is by ability to pay.
posted by boltman at 11:27 PM on November 28, 2002
It is not at all clear to me that a profit-driven corporation will have my interests at heart to any greater extent than the Ministry of Health.
I can agree with you to an extent on that, but what I am advocating is more doctor freedom, which really can't come at the hands of a company with more than 20 or so doctors or a public entity. Medicine should be about doctor-patient connections, where the doctor and the patient discuss treatment rationally and free from opressive regulation.
But can you really be serious that any government has the efficiency or even the ability to take responsibility for such a large and important part of our lives as healthcare? Just look at the state of our public education system, or our first class mail service, and compare that with the distribution network of even the worst retail company and you will see how profit = quality. And most importantly freedom.
posted by MarkO at 11:48 PM on November 28, 2002
I can agree with you to an extent on that, but what I am advocating is more doctor freedom, which really can't come at the hands of a company with more than 20 or so doctors or a public entity. Medicine should be about doctor-patient connections, where the doctor and the patient discuss treatment rationally and free from opressive regulation.
But can you really be serious that any government has the efficiency or even the ability to take responsibility for such a large and important part of our lives as healthcare? Just look at the state of our public education system, or our first class mail service, and compare that with the distribution network of even the worst retail company and you will see how profit = quality. And most importantly freedom.
posted by MarkO at 11:48 PM on November 28, 2002
"I believe it is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care."
[this is good] indeed. Maybe things aren't getting as bad back in Canada as I'd thought. The only good thing I can see coming out of the bushy madness that seems to be gripping our neighbours to the south is that perhaps it will push Canada back away from the Americanizing of the nation that started rolling in earnest under Mulroney many moons ago...
posted by stavrosthewonderchicken at 12:16 AM on November 29, 2002
[this is good] indeed. Maybe things aren't getting as bad back in Canada as I'd thought. The only good thing I can see coming out of the bushy madness that seems to be gripping our neighbours to the south is that perhaps it will push Canada back away from the Americanizing of the nation that started rolling in earnest under Mulroney many moons ago...
posted by stavrosthewonderchicken at 12:16 AM on November 29, 2002
"Socialised medicine" does not preclude a parallel, private system, funded directly by patients or indirectly by health insurance.
Actually, as I said, it does in Canada. It is illegal to provide essential health services for profit in this country. There is no private system for the upper and middle classes, other than going to America for treatment.
posted by Pseudoephedrine at 12:22 AM on November 29, 2002
Actually, as I said, it does in Canada. It is illegal to provide essential health services for profit in this country. There is no private system for the upper and middle classes, other than going to America for treatment.
posted by Pseudoephedrine at 12:22 AM on November 29, 2002
A company with more than 20 or so doctors? I'm afraid legislation would be required to enforce such a state of affairs - economies of scale in the consolidation of service provision are as inevitable in health as any other field.
And yes, I have reasonable faith in government efficiency, most particularly in important areas. I can only offer my experience in a different society with different values. (Other Kiwis may well not share them. holloway? catch? shaft?).
In my society public education is not devolved to local authorities, and where it is inferior to private education this is wholly explicable in terms of the background of those who can afford to pay. The publicly owned mail service recently had to reduce service levels for standard mail, because they were approaching the next-day service promised by first-class mail. My mileage varies.
posted by i_am_joe's_spleen at 12:26 AM on November 29, 2002
And yes, I have reasonable faith in government efficiency, most particularly in important areas. I can only offer my experience in a different society with different values. (Other Kiwis may well not share them. holloway? catch? shaft?).
In my society public education is not devolved to local authorities, and where it is inferior to private education this is wholly explicable in terms of the background of those who can afford to pay. The publicly owned mail service recently had to reduce service levels for standard mail, because they were approaching the next-day service promised by first-class mail. My mileage varies.
posted by i_am_joe's_spleen at 12:26 AM on November 29, 2002
Pseudoephedrine, how is "essential" defined?
posted by i_am_joe's_spleen at 12:29 AM on November 29, 2002
posted by i_am_joe's_spleen at 12:29 AM on November 29, 2002
Two things have always puzzled me about Americans.
1) Public healthcare = bad
2) Gun ownership = good
Understand those two, and I'll be well on my way to understanding America.
posted by salmacis at 2:42 AM on November 29, 2002
1) Public healthcare = bad
2) Gun ownership = good
Understand those two, and I'll be well on my way to understanding America.
posted by salmacis at 2:42 AM on November 29, 2002
Pseudoephedrine: I didn't mean to imply private clinics were for essential services. The MRI clinic I mentioned is a case in point. Is it an essential service? The clinic says no, its opponents say yes - hence the controversy. Where exactly to draw the line between essential and non-essential is a major contributing factor to Canada's problems.
salmacis: You and me both. You would think guns & free medical care would go together...
But seriously, could an American please explain the revulsion towards universal health care? And why the need to call it "socialized medicine"? Is it just the taxes thing?
posted by GhostintheMachine at 5:06 AM on November 29, 2002
salmacis: You and me both. You would think guns & free medical care would go together...
But seriously, could an American please explain the revulsion towards universal health care? And why the need to call it "socialized medicine"? Is it just the taxes thing?
posted by GhostintheMachine at 5:06 AM on November 29, 2002
boltman asserted, without citation:
The rationing idea that was attempted in Oregon was interesting, but it got torpedoed by Bush I before it was ever enacted because it seemed to violate the Americans With Disabilities Act
As far as I can tell, the Oregon Medicaid Priority List, aka the "Oregon Plan", is still in effect. It had drawbacks as well as advantages, though, and there has been some modification; but the state still seeks to expand the program to more of the working poor.
Ghost, you have to understand that while for some Americans socialism is a dirty word, for others it's simply an evocative phrase for high taxes, lousy services, and no choice -- the Soviet bread line thing. The Democrats are traditionally quite good at seizing on ideas that certain core constituencies wholeheartedly believe in as articles of faith, while utterly failing at explaining why they're good ideas with specific advantages for everyone else. (Then they get miffed when they're rejected.) In a nutshell, that's the failure of universal health-care proposals in the US. The fact that health insurance was tied directly to employers (under Nixon) means you have to have a good job to get it, which makes those without seem like burdens on the taxpayer.
In any event, there's a rough consensus that instead of an over-reaching umbrella reform, targeted improvements are the rule of the day. (But the Dems still misunderstand that things like a prescription drug benefit are "nice ideas" to most Americans, but not things that will motivate them to the polls.) Partly this helps at building political backing, but it's also a way of fixing the parts of the system that are broken -- while leaving untouched the parts that most Americans feel are not broken. Meanwhile the market is finding ways to, for example, offer better individual insurance plans that bypass the need for a job with a larger company.
posted by dhartung at 7:24 AM on November 29, 2002
The rationing idea that was attempted in Oregon was interesting, but it got torpedoed by Bush I before it was ever enacted because it seemed to violate the Americans With Disabilities Act
As far as I can tell, the Oregon Medicaid Priority List, aka the "Oregon Plan", is still in effect. It had drawbacks as well as advantages, though, and there has been some modification; but the state still seeks to expand the program to more of the working poor.
Ghost, you have to understand that while for some Americans socialism is a dirty word, for others it's simply an evocative phrase for high taxes, lousy services, and no choice -- the Soviet bread line thing. The Democrats are traditionally quite good at seizing on ideas that certain core constituencies wholeheartedly believe in as articles of faith, while utterly failing at explaining why they're good ideas with specific advantages for everyone else. (Then they get miffed when they're rejected.) In a nutshell, that's the failure of universal health-care proposals in the US. The fact that health insurance was tied directly to employers (under Nixon) means you have to have a good job to get it, which makes those without seem like burdens on the taxpayer.
In any event, there's a rough consensus that instead of an over-reaching umbrella reform, targeted improvements are the rule of the day. (But the Dems still misunderstand that things like a prescription drug benefit are "nice ideas" to most Americans, but not things that will motivate them to the polls.) Partly this helps at building political backing, but it's also a way of fixing the parts of the system that are broken -- while leaving untouched the parts that most Americans feel are not broken. Meanwhile the market is finding ways to, for example, offer better individual insurance plans that bypass the need for a job with a larger company.
posted by dhartung at 7:24 AM on November 29, 2002
But can you really be serious that any government has the efficiency or even the ability to take responsibility for such a large and important part of our lives as healthcare?
Well, somebody's got to do it. I'd rather have it be a publicly accountable body than a backroom group primarily concerned with profits. As for your argument that the government kills doctor-patient connection, it just ain't so. I've never gone to a doctor in Canada without feeling that s/he has my best interests at heart. It isn't your alleged opressive regulation that's a problem, it's lack of funding and resources. The Romanow report seems prepared to address that.
posted by transient at 7:47 AM on November 29, 2002
Well, somebody's got to do it. I'd rather have it be a publicly accountable body than a backroom group primarily concerned with profits. As for your argument that the government kills doctor-patient connection, it just ain't so. I've never gone to a doctor in Canada without feeling that s/he has my best interests at heart. It isn't your alleged opressive regulation that's a problem, it's lack of funding and resources. The Romanow report seems prepared to address that.
posted by transient at 7:47 AM on November 29, 2002
MarkO wrote: The problem with that statement is the word "assessed." Who gets to decide whether a patient needs care? In socialized healthcare this responsibility rests with the government.
This is far from accurate, demonstrating I think that you've got extremely limited experience with "socialized" healthcare.
To clarify: there are not bureaucrats in the examination rooms of Canadian hospitals flipping through policy binders to determine whether that gash on your leg needs stitches. Governments in Canada decide at the provincial level which treatments and procedures are covered by the government plan and which aren't. At the clinical or hospital level, medical professionals - doctors, nurses, etc. - are the only ones who decide what's ailing you and what to do about it.
Admittedly, this leads to some odd anomalies. Here in Ontario, for example, the government makes me pay for "travel medicine" (i.e. vaccinations, anti-malarials, etc.). But if I contract malaria overseas, the government will pay for the treatment when I get back to Canada.
Regardless, I - like most Canadians - believe that basic health care is a civil right. Anomalies like this one are frustrating, but that doesn't mean the whole system's busted. I would no more support my government in privatizing our healthcare system than I would in privatizing elementary schools or the Trans-Canada Highway. This is a point of view Canadians share with virtually every other industrialized nation in the world - except the U.S. This doesn't make us"socialized." It makes us "enlightened."
posted by gompa at 8:31 AM on November 29, 2002
This is far from accurate, demonstrating I think that you've got extremely limited experience with "socialized" healthcare.
To clarify: there are not bureaucrats in the examination rooms of Canadian hospitals flipping through policy binders to determine whether that gash on your leg needs stitches. Governments in Canada decide at the provincial level which treatments and procedures are covered by the government plan and which aren't. At the clinical or hospital level, medical professionals - doctors, nurses, etc. - are the only ones who decide what's ailing you and what to do about it.
Admittedly, this leads to some odd anomalies. Here in Ontario, for example, the government makes me pay for "travel medicine" (i.e. vaccinations, anti-malarials, etc.). But if I contract malaria overseas, the government will pay for the treatment when I get back to Canada.
Regardless, I - like most Canadians - believe that basic health care is a civil right. Anomalies like this one are frustrating, but that doesn't mean the whole system's busted. I would no more support my government in privatizing our healthcare system than I would in privatizing elementary schools or the Trans-Canada Highway. This is a point of view Canadians share with virtually every other industrialized nation in the world - except the U.S. This doesn't make us"socialized." It makes us "enlightened."
posted by gompa at 8:31 AM on November 29, 2002
"In socialized healthcare the freedom is siezed from the hands of the doctors. They have to obey the whims of whatever government regulations are put in place..."
In corporate healthcare the freedom is siezed from the hands of the doctors. They have to obey the whims of the CEO, where profitability, not health, is the driving force.
The health of citizens should not be bought and sold as if it were a can of Coca-Cola.
Furthermore, most Americans have been bamboozled by their media: flat-out lied to, in fact. The Canadian healthcare system is cheaper to run than the American-style system, and Canadians on the whole receive better healthcare than Americans.
Please go read Canada's Burning: Media Myths about Universal Healthcare Coverage and this USA Today blurb about how the American system is failing a lot of citizens. (Might as well throw in this link, too, from the National Academy.)
posted by five fresh fish at 9:16 AM on November 29, 2002
In corporate healthcare the freedom is siezed from the hands of the doctors. They have to obey the whims of the CEO, where profitability, not health, is the driving force.
The health of citizens should not be bought and sold as if it were a can of Coca-Cola.
Furthermore, most Americans have been bamboozled by their media: flat-out lied to, in fact. The Canadian healthcare system is cheaper to run than the American-style system, and Canadians on the whole receive better healthcare than Americans.
Please go read Canada's Burning: Media Myths about Universal Healthcare Coverage and this USA Today blurb about how the American system is failing a lot of citizens. (Might as well throw in this link, too, from the National Academy.)
posted by five fresh fish at 9:16 AM on November 29, 2002
I would no more support my government in privatizing our healthcare system than I would in privatizing elementary schools or the Trans-Canada Highway.
I'm still irritated about the privitization of Highway 407. I didn't mind so much paying tolls to the government, but knowing that my money's going to a private company who ripped off the government to purchase it in the first place just irks me.
posted by DrJohnEvans at 9:16 AM on November 29, 2002
I'm still irritated about the privitization of Highway 407. I didn't mind so much paying tolls to the government, but knowing that my money's going to a private company who ripped off the government to purchase it in the first place just irks me.
posted by DrJohnEvans at 9:16 AM on November 29, 2002
"But can you really be serious that any government has the efficiency or even the ability to take responsibility for such a large and important part of our lives as healthcare?"
Are you at all serious about wanting someone who's primary concern is profitability to be deciding whether or not you should get treatment?! Fuck, that's scary!
posted by five fresh fish at 9:21 AM on November 29, 2002
Are you at all serious about wanting someone who's primary concern is profitability to be deciding whether or not you should get treatment?! Fuck, that's scary!
posted by five fresh fish at 9:21 AM on November 29, 2002
Happy coinkydink: the local paper has an article about a foreign doctor today.
It says there are three steps to getting licensed in Canada:
1) pay $100 to get their current certificate validated.
2) pay $1000 for the preliminary evaluating exam, administered by the Medical Council of Canada. The exam is a compilation of four years of med school training. Nasty bugger, and perhaps it would be better if it were broken into several parts a few months apart, to give the doctor time to bone up on content.
3) Do a two-year residency.
4) Profit! (actually, you then jump through the hoops all other doctors do to become licensed to practice.)
Impossible? Not at all.
Difficult? Surely. But so is doctoring.
Could be improved? Undoubtedly. I'd hate like hell for someone who was poorly educated to get a license, but I do think a single exam covering four years of training is a bit much.
posted by five fresh fish at 10:03 AM on November 29, 2002
It says there are three steps to getting licensed in Canada:
1) pay $100 to get their current certificate validated.
2) pay $1000 for the preliminary evaluating exam, administered by the Medical Council of Canada. The exam is a compilation of four years of med school training. Nasty bugger, and perhaps it would be better if it were broken into several parts a few months apart, to give the doctor time to bone up on content.
3) Do a two-year residency.
4) Profit! (actually, you then jump through the hoops all other doctors do to become licensed to practice.)
Impossible? Not at all.
Difficult? Surely. But so is doctoring.
Could be improved? Undoubtedly. I'd hate like hell for someone who was poorly educated to get a license, but I do think a single exam covering four years of training is a bit much.
posted by five fresh fish at 10:03 AM on November 29, 2002
Are you at all serious about wanting someone who's primary concern is profitability to be deciding whether or not you should get treatment?!
Are you at all serious about wanting some bureaucrat whose primary concern is covering his own ass to be deciding whether or not you should get treatment? No matter what happens to you, he'll make sure it's anybody's fault but his.
That said, I no longer believe that a single-payer system would be the disaster I used to think it would be, and that it is likely to come about in my lifetime due to changes in health insurance caused by increasingly sophisticated genetic testing. Coming from a former member of the Libertarian Party, that is a pretty huge shift in thinking.
posted by kindall at 10:33 AM on November 29, 2002
Are you at all serious about wanting some bureaucrat whose primary concern is covering his own ass to be deciding whether or not you should get treatment? No matter what happens to you, he'll make sure it's anybody's fault but his.
That said, I no longer believe that a single-payer system would be the disaster I used to think it would be, and that it is likely to come about in my lifetime due to changes in health insurance caused by increasingly sophisticated genetic testing. Coming from a former member of the Libertarian Party, that is a pretty huge shift in thinking.
posted by kindall at 10:33 AM on November 29, 2002
Are you at all serious about wanting someone who's primary concern is profitability to be deciding whether or not you should get treatment?!
Heck yes, as I am very comfortable with doing business with profit-oriented people in every other aspect of my life. I have also seen bureaucrats at the DMV, or giving out foodstamps, or working for a thousand other government organizations that I wouldn't trust with my health any more than the Taliban health services.
I trust government to do two things ONLY(*): police inside the country and be military badasses outside the country. Any other form of government is an abomination.
(*) and even in these two, only when carefully regulated and controlled.
posted by kablam at 10:57 AM on November 29, 2002
Heck yes, as I am very comfortable with doing business with profit-oriented people in every other aspect of my life. I have also seen bureaucrats at the DMV, or giving out foodstamps, or working for a thousand other government organizations that I wouldn't trust with my health any more than the Taliban health services.
I trust government to do two things ONLY(*): police inside the country and be military badasses outside the country. Any other form of government is an abomination.
(*) and even in these two, only when carefully regulated and controlled.
posted by kablam at 10:57 AM on November 29, 2002
could an American please explain the revulsion towards universal health care? And why the need to call it "socialized medicine"? Is it just the taxes thing?
At a guess: most (or at least enough) Americans see themselves either paying more or losing quality-of-service under state-run/financed health care schemes.
This is probably false -- if nothing else, moving to a single-payer (or at least few-payer) system would save a lot of administrative overhead (and also get a bunch of possibly-unionized admin employees fired, if that's something you care about).
Add to that that most poor people are covered under medicaid (or medicare if they're old), and enough people don't see much to gain. Folks aren't going to have a rally for ARGUABLY LOWER ADMINISTRATIVE COSTS FOR HEALTHCARE, NOW!
Yes, there are lots of uninsured people (though how many of those are actually covered under medicaid I dunno), and if push came to shove I wouldn't cry if the MRI shop down the street (no, I'm not joking) had to close down. But coverage is good enough and widespread enough that enough people see themselves as having something to lose rather than something to gain, especially when their experiences of government-run stuff is the DMV.
posted by ROU_Xenophobe at 11:22 AM on November 29, 2002
At a guess: most (or at least enough) Americans see themselves either paying more or losing quality-of-service under state-run/financed health care schemes.
This is probably false -- if nothing else, moving to a single-payer (or at least few-payer) system would save a lot of administrative overhead (and also get a bunch of possibly-unionized admin employees fired, if that's something you care about).
Add to that that most poor people are covered under medicaid (or medicare if they're old), and enough people don't see much to gain. Folks aren't going to have a rally for ARGUABLY LOWER ADMINISTRATIVE COSTS FOR HEALTHCARE, NOW!
Yes, there are lots of uninsured people (though how many of those are actually covered under medicaid I dunno), and if push came to shove I wouldn't cry if the MRI shop down the street (no, I'm not joking) had to close down. But coverage is good enough and widespread enough that enough people see themselves as having something to lose rather than something to gain, especially when their experiences of government-run stuff is the DMV.
posted by ROU_Xenophobe at 11:22 AM on November 29, 2002
kindall and kablam, lissen for a sec: no bureaucrat makes a decision about my treatment. A doctor does. This doctor is not hogtied by regulations or rules for treatment, he just does his job. And I get better. And my neighbour will be treated the same way. Welcome to Canada.
posted by transient at 11:55 AM on November 29, 2002
posted by transient at 11:55 AM on November 29, 2002
What I don't like about "right to health care" is that once you have that phrase in your head, the doctor becomes your servant. If I invent a new and challenging procedure that saves lives, all of the sudden people will be knocking on my door demanding that they have the right to my services. Simply depressing.
MarkO, replace "government" with "HMO" and "socialized medicine" with "private insurance" in your last post, and you have America's health care system summed up rather nicely.
The HMO system was created by the government. The poor state of healthcare in America today is the result of a deviation from capitalism, not because of capitalism itself. Read here.
posted by MarkO at 1:33 PM on November 29, 2002
MarkO, replace "government" with "HMO" and "socialized medicine" with "private insurance" in your last post, and you have America's health care system summed up rather nicely.
The HMO system was created by the government. The poor state of healthcare in America today is the result of a deviation from capitalism, not because of capitalism itself. Read here.
posted by MarkO at 1:33 PM on November 29, 2002
If I invent a new and challenging procedure that saves lives, all of the sudden people will be knocking on my door demanding that they have the right to my services. Simply depressing.
Yup. Nothing depresses me more than saving lives. What a bummer.
posted by gompa at 1:55 PM on November 29, 2002
Yup. Nothing depresses me more than saving lives. What a bummer.
posted by gompa at 1:55 PM on November 29, 2002
Yup. Nothing depresses me more than saving lives. What a bummer.
How about being depressed because if you lived on the other side of the street you would both save lives and make a buncha-million dollars doing it?
Medicine is and should be a commodity. And like the commodity of food, the poor should get what they need to survive, the middle class to thrive, and the rich to pay for whatever they want. Government doesn't help this process, and should butt out.
Insurers should only write policies based on actuarial tables, not government health dictates. The government's pool of money to pay for the health of the poor should only increase by the rate of inflation. If the health care system wants to provide care more expensive than that to the poor--tough.
No reason for health care to be treated any different than food.
posted by kablam at 2:10 PM on November 29, 2002
How about being depressed because if you lived on the other side of the street you would both save lives and make a buncha-million dollars doing it?
Medicine is and should be a commodity. And like the commodity of food, the poor should get what they need to survive, the middle class to thrive, and the rich to pay for whatever they want. Government doesn't help this process, and should butt out.
Insurers should only write policies based on actuarial tables, not government health dictates. The government's pool of money to pay for the health of the poor should only increase by the rate of inflation. If the health care system wants to provide care more expensive than that to the poor--tough.
No reason for health care to be treated any different than food.
posted by kablam at 2:10 PM on November 29, 2002
In corporate healthcare the freedom is siezed from the hands of the doctors. They have to obey the whims of the CEO, where profitability, not health, is the driving force.
And let's not forget the surge in "incentives" to doctors provided by pharmaceutical companies (and others) to "influence" their treatment decisions. Talk about frightening.
posted by rushmc at 8:06 PM on November 29, 2002
And let's not forget the surge in "incentives" to doctors provided by pharmaceutical companies (and others) to "influence" their treatment decisions. Talk about frightening.
posted by rushmc at 8:06 PM on November 29, 2002
I've always been curious about medicare in the US. It was my understanding that for the poor there was some level of free medical coverage. Is that not the case? I thought that if you got hit by a car you'd get medical attention. Or do you get medical attention and a $100k bill? If half of all bankruptcies are medical, then why don't the healthcare companies figure out a way to have smaller bills with a bigger chance of getting repaid? Other industries would seriously look at their bills if half their customers went broke.
posted by Salmonberry at 8:45 PM on November 29, 2002
posted by Salmonberry at 8:45 PM on November 29, 2002
I've always been curious about medicare in the US. It was my understanding that for the poor there was some level of free medical coverage. Is that not the case?
Yeah, there is. It's called Medicaid.
The catch is that you have to be pretty poor to get it -- a rule of thumb is that if you're poor enough to be getting (partly-)federally funded welfare, you can get on Medicaid. BUT Medicaid is partly funded by the feds and partly by the states, so there's a LOT of variation in exactly who is eligible and what the supports are. In practice it's the working-poor, who make a little too much to be on Medicard and don't always get health insurance through work, who end up well and truly fucked. Them and their kids, that is.
There's also a related program called Medicare that takes care of seniors irrespective of income. It's also a whopping great complicated mess, with (for most people) a free part and a monthly-charge part, and covers some stuff and not others.
They end up being related, since a lot of old people are also poor. This is especially true in cases where people need stuff that Medicare doesn't (didn't?) normally cover, like longterm care for Alzheimer's patients. What people in this boat end up doing is spending down most of their assets (or finding ways to give them to their relatives) and then going on Medicaid too.
We may well be getting the worst of both worlds, with the substantial exception of the bulk of people who are on employer-sponsored health insurance.
I thought that if you got hit by a car you'd get medical attention. Or do you get medical attention and a $100k bill?
The latter, if you're utterly uninsured (unless the hospital takes you on as a charity case, I guess). Whether they really expect to ever get paid is another question entirely.
posted by ROU_Xenophobe at 9:20 PM on November 29, 2002
Yeah, there is. It's called Medicaid.
The catch is that you have to be pretty poor to get it -- a rule of thumb is that if you're poor enough to be getting (partly-)federally funded welfare, you can get on Medicaid. BUT Medicaid is partly funded by the feds and partly by the states, so there's a LOT of variation in exactly who is eligible and what the supports are. In practice it's the working-poor, who make a little too much to be on Medicard and don't always get health insurance through work, who end up well and truly fucked. Them and their kids, that is.
There's also a related program called Medicare that takes care of seniors irrespective of income. It's also a whopping great complicated mess, with (for most people) a free part and a monthly-charge part, and covers some stuff and not others.
They end up being related, since a lot of old people are also poor. This is especially true in cases where people need stuff that Medicare doesn't (didn't?) normally cover, like longterm care for Alzheimer's patients. What people in this boat end up doing is spending down most of their assets (or finding ways to give them to their relatives) and then going on Medicaid too.
We may well be getting the worst of both worlds, with the substantial exception of the bulk of people who are on employer-sponsored health insurance.
I thought that if you got hit by a car you'd get medical attention. Or do you get medical attention and a $100k bill?
The latter, if you're utterly uninsured (unless the hospital takes you on as a charity case, I guess). Whether they really expect to ever get paid is another question entirely.
posted by ROU_Xenophobe at 9:20 PM on November 29, 2002
"Are you at all serious about wanting some bureaucrat whose primary concern is covering his own ass to be deciding whether or not you should get treatment?"
I've yet to see a bureaucrat involved with my health care. I go to my family doctor, and he does the family doctor thing. There is no pressure from the government on him. If he thinks I'll be okay, he'll send me on my way. If he thinks I need meds, he'll write a prescription -- no kickback to him. If he thinks I need to see a specialist, he gives me a referral, no penalty to him nor to me.
That's a damn lot more freedom for him, than to have to account for his decisions to the Comptroller of the Corporation. You've heard the stories about HMO-run hospitals pressuring doctors to reduce/increase surgeries to save/make money. There's no incentive for that sort of bullshit in the Canadian system.
posted by five fresh fish at 10:40 PM on November 29, 2002
I've yet to see a bureaucrat involved with my health care. I go to my family doctor, and he does the family doctor thing. There is no pressure from the government on him. If he thinks I'll be okay, he'll send me on my way. If he thinks I need meds, he'll write a prescription -- no kickback to him. If he thinks I need to see a specialist, he gives me a referral, no penalty to him nor to me.
That's a damn lot more freedom for him, than to have to account for his decisions to the Comptroller of the Corporation. You've heard the stories about HMO-run hospitals pressuring doctors to reduce/increase surgeries to save/make money. There's no incentive for that sort of bullshit in the Canadian system.
posted by five fresh fish at 10:40 PM on November 29, 2002
Oh, and as regards the American uninsured:
"Americans without health insurance are more likely to have poorer health and die prematurely than those with insurance, says a new report from the National Academies' Institute of Medicine. Uninsured patients with colon or breast cancer face up to a 50 percent greater chance of dying than patients with private coverage. Uninsured victims of trauma also are more likely to die from their injuries. Being uninsured for even a year appears to diminish a person's general health."
That'd be from one of the links I posted earlier. The uninsured and underinsured one in seven in the USA are dying because of the private health care system.
posted by five fresh fish at 10:44 PM on November 29, 2002
"Americans without health insurance are more likely to have poorer health and die prematurely than those with insurance, says a new report from the National Academies' Institute of Medicine. Uninsured patients with colon or breast cancer face up to a 50 percent greater chance of dying than patients with private coverage. Uninsured victims of trauma also are more likely to die from their injuries. Being uninsured for even a year appears to diminish a person's general health."
That'd be from one of the links I posted earlier. The uninsured and underinsured one in seven in the USA are dying because of the private health care system.
posted by five fresh fish at 10:44 PM on November 29, 2002
I think those statistics are startling because the US actually notes its failures. But can you find a statistic for how many Canadians die because they can't get a surgery for six months?
In fact, you'll find that countries with socialized medicine have a disincentive to collect efficiency data, because nobody can force a government to improve a system, slash prices or costs--so often they don't, because politicians have to be elected, and you don't get elected for being "courageous" in budgetary matters.
posted by kablam at 6:16 AM on November 30, 2002
In fact, you'll find that countries with socialized medicine have a disincentive to collect efficiency data, because nobody can force a government to improve a system, slash prices or costs--so often they don't, because politicians have to be elected, and you don't get elected for being "courageous" in budgetary matters.
posted by kablam at 6:16 AM on November 30, 2002
kablam, you're not at all likely to die because of being put on a wait list for some manner of surgery; if your condition deteriorates, you'd move up the list pronto.
About the only place where you'd be actually more likely to die ``because of'' the Canadian health care system would be following a major injury, since Canadian trauma centers, last I heard, lag a good ways behind their southern neighbors. Even here, though, I'd place more ``blame'' on Canada being merely poorer than the US.
Others will know a lot more than me about both of these, though.
posted by ROU_Xenophobe at 9:28 AM on November 30, 2002
About the only place where you'd be actually more likely to die ``because of'' the Canadian health care system would be following a major injury, since Canadian trauma centers, last I heard, lag a good ways behind their southern neighbors. Even here, though, I'd place more ``blame'' on Canada being merely poorer than the US.
Others will know a lot more than me about both of these, though.
posted by ROU_Xenophobe at 9:28 AM on November 30, 2002
The provincial paper had information about healthcare in general (it's getting attention because of the Romanow report).
9% of the Canadian GNP goes toward healthcare. 14% in America. In other words, it costs the USA 50% more to provide healthcare.
So much for the efficiency of the private system.
Markups in the US healthcare systems run from a few hundred percent to over 1300% above cost. Medication costs in the USA are horrendous compared to Canada, and in-hospital costs are enough to hemmorhage you!
The only thing efficient in the private system is the movement of money from your pocket to the HMOs. You guys are being raped over a barrel, and are happy about it!
It seems to me that Americans typically believe the line of bullshit that's been sold to them regarding the private healthcare system, while we Canadians are well-informed of the problems our socialized system has, the problems your private system has, and know that we want to work toward a better system.
Or, to put it bluntly, we know there's a problem and are working to fix it, while you guys are oblivious to the problems and so continue to get screwed.
posted by five fresh fish at 1:12 PM on November 30, 2002
9% of the Canadian GNP goes toward healthcare. 14% in America. In other words, it costs the USA 50% more to provide healthcare.
So much for the efficiency of the private system.
Markups in the US healthcare systems run from a few hundred percent to over 1300% above cost. Medication costs in the USA are horrendous compared to Canada, and in-hospital costs are enough to hemmorhage you!
The only thing efficient in the private system is the movement of money from your pocket to the HMOs. You guys are being raped over a barrel, and are happy about it!
It seems to me that Americans typically believe the line of bullshit that's been sold to them regarding the private healthcare system, while we Canadians are well-informed of the problems our socialized system has, the problems your private system has, and know that we want to work toward a better system.
Or, to put it bluntly, we know there's a problem and are working to fix it, while you guys are oblivious to the problems and so continue to get screwed.
posted by five fresh fish at 1:12 PM on November 30, 2002
9% of the Canadian GNP goes toward healthcare. 14% in America. In other words, it costs the USA 50% more to provide healthcare.
That statistic, on its own, doesn't support that conclusion.
If you were to look at statistics on food, you'd find that Italians spend roughly twice the percentage-of-income on food as do Americans. Some of this is inefficiency, reflected particularly in the very high levels of EU farm subsidies. Some of it, though, is also just that Italians, as a measure of central tendency, have a stronger taste for food than do Americans and so are more willing to spend on (good) food instead of other stuff.
Ditto health care. Americans spend more in part because of inefficiency -- administrative overhead from dealing with a bajillion insurance companies can be horrifying.
But Americans also seem to have a taste for consuming health care. We don't buy healthcare as a big block, where once you've paid for it you don't need any more healthcare, and neither do you. We buy different kinds of health care services, the capital equipment they require, and places to do them, and so do you.
We just buy a shitload more than you, which is why there's an MRI clinic about a mile away next to the Wal-Mart, and probably another one in the sports-medicine place a mile the other way, and why there are prenatal sonogram places in strip malls, and why turnarounds for cardiac bypasses (even prophylactic ones) are very short. That this doesn't show up in life-expectancy stats is galling, but doesn't really have anything to do with the fact that we seem to like consuming services even past the point of usefulness.
posted by ROU_Xenophobe at 1:53 PM on November 30, 2002
That statistic, on its own, doesn't support that conclusion.
If you were to look at statistics on food, you'd find that Italians spend roughly twice the percentage-of-income on food as do Americans. Some of this is inefficiency, reflected particularly in the very high levels of EU farm subsidies. Some of it, though, is also just that Italians, as a measure of central tendency, have a stronger taste for food than do Americans and so are more willing to spend on (good) food instead of other stuff.
Ditto health care. Americans spend more in part because of inefficiency -- administrative overhead from dealing with a bajillion insurance companies can be horrifying.
But Americans also seem to have a taste for consuming health care. We don't buy healthcare as a big block, where once you've paid for it you don't need any more healthcare, and neither do you. We buy different kinds of health care services, the capital equipment they require, and places to do them, and so do you.
We just buy a shitload more than you, which is why there's an MRI clinic about a mile away next to the Wal-Mart, and probably another one in the sports-medicine place a mile the other way, and why there are prenatal sonogram places in strip malls, and why turnarounds for cardiac bypasses (even prophylactic ones) are very short. That this doesn't show up in life-expectancy stats is galling, but doesn't really have anything to do with the fact that we seem to like consuming services even past the point of usefulness.
posted by ROU_Xenophobe at 1:53 PM on November 30, 2002
Pseudoephedrine, how is "essential" defined?
i_am_joe's_spleen>
It varies from province to province in actual practice. Where I live, Ontario, it seems to include anything more serious than dentistry or cosmetic surgery. I believe in Quebec they allow private optometrists, but I know that they don't here. On the other hand, one generally pays for one's own drugs from the pharmacy for reasons that are unclear to me.
On a more personal note, my family has had some fairly hideous experiences with the Ontarian health system - my sister repeatedly waits in the emergency rooms with a broken wrist or concussion for up to half a day. I personally have memories of waiting two hours to see a triage nurse, let alone what it took to see a doctor once she'd placed me in the hospital's list. While anecdotal evidence proves little, I can't quite bring myself to believe all these statements about Canadian health care being substantively better than American care.
posted by Pseudoephedrine at 5:19 PM on November 30, 2002
i_am_joe's_spleen>
It varies from province to province in actual practice. Where I live, Ontario, it seems to include anything more serious than dentistry or cosmetic surgery. I believe in Quebec they allow private optometrists, but I know that they don't here. On the other hand, one generally pays for one's own drugs from the pharmacy for reasons that are unclear to me.
On a more personal note, my family has had some fairly hideous experiences with the Ontarian health system - my sister repeatedly waits in the emergency rooms with a broken wrist or concussion for up to half a day. I personally have memories of waiting two hours to see a triage nurse, let alone what it took to see a doctor once she'd placed me in the hospital's list. While anecdotal evidence proves little, I can't quite bring myself to believe all these statements about Canadian health care being substantively better than American care.
posted by Pseudoephedrine at 5:19 PM on November 30, 2002
Here's a bedtime story: The history of HMOs.
Also, find out about a competing proposal, Medical Savings Accounts.
posted by MarkO at 7:22 PM on November 30, 2002
Also, find out about a competing proposal, Medical Savings Accounts.
posted by MarkO at 7:22 PM on November 30, 2002
« Older Thanksgiving Prayer | The Massey Lectures Newer »
This thread has been archived and is closed to new comments
posted by dagny at 11:01 AM on November 28, 2002