Universal Access = Restricted Access + Long Waits
From today's IBD: Long waits are a hallmark of government health care anywhere it's employed. When the perception exists that treatment is free, system overuse is inevitable. People can think of no reason to self-ration care. They show up in emergency rooms and doctor's offices with conditions for which they wouldn't seek treatment if they paid directly at the time of service.
Thanks to the profit motive, private health care providers have an incentive to cut waiting times, lest they lose customers to the competition. Government providers have no such motivation.
They do have incentive, however, to ration care when demand gets too high and costs soar. But to do so exposes "universal access" and "equal access" to be inaccurate descriptions. "Restricted access" would be more fitting.
Case Study: Canadian Health Care
Waiting times are the weak spot in Canadian healthcare. Canadian health consumers with a complicated condition can be subject to up to four lengthy waits: the first, to see their family doctor, or to find a general practitioner if they do not have a regular doctor; the second, to see the appropriate specialist for their ailment; the third, for diagnostic procedures to determine appropriate treatment; and the fourth, for treatment. It is not unusual for these cumulative delays to exceed a year.
40 Comments:
You better get ready, when Hillary the communist gets elected. Watch out!
U.S. Worst At Beating Death From Treatable Illness
In a comparison of 18 countries, the United States ranked at the bottom for number of deaths that could have been prevented by timely and effective health care.
“Had we achieved the gains of the top performers, we would have saved 101,000 lives. Repeat that to yourself: 101,000 lives. That’s more than the total population of Boulder, Colorado.”
The U.S. was worse than Denmark, Portugal, Ireland, U.K., Finland, Germany, New Zealand, Austria, France, Netherlands, Canada, Norway, Spain, Greece, Italy, Sweden, Australia or Japan.
Anon 11:45...
You forgot to mention that Canada has 100% of its citizens insured but the U.S. only has 47 million citizens without healthcare coverage.
Another interesting point is that over 50% of bankruptcies in the U.S. are due to medical bills but 0% of bankruptcies in Canada are due to medical bills.
If you need any medical care in Canada like a new hip your deductible is zero. How much is it in the U.S.?
If you are a senior citizen over the age of 70 in the U.S. how much would your insurance premiums be for 100%, no deductible, coverage be?
What's with the picture of people lining up Mark? That is a photo taken in the U.S. and they are not lining up for health care.
Another name for universal or single-payer healthcare is government rationed healthcare!
Looks like the folks at Kaiser are having a few problems with customer/patient satisfaction/care.
"That is a photo taken in the U.S. and they are not lining up for health care."
I think they are lining up for their "free" money from the IRS.
A better measure of a country's health care system is mortality rates for those diseases that modern medicine can treat effectively. The U.S. has one of the lowest mortality rates for prostate cancer in the world at 19%. The U.K. at 57%. France at 49%. Germany at 44%. Australia at 35%. Canada at 25%. Additionally, in the U.S. only 1 in 4 women diagnosed with breast cancer dies of the disease. This is one of the lowest rates in the industrial world. When it comes to cancer and heart disease, the U.S. provides the best care in the world. The problem with the U.S. system is affordable "access" to world class care.
Single-payer or Universal health care will not guarantee world class health care.
British Healthcare Crisis:
http://www.csmonitor.com/2007/1019/p04s01-woeu.html
vulcanhammer you are wrong when you state that "The U.S. has one of the lowest mortality rates for prostate cancer in the world at 19%."
Mortality Rate = (Cancer Deaths / Population) × 100,000
You see Mortality Rates are not expressed as a percentage.
The figures you quote came from a study that looked at what percent of men were alive 5 years later after being diagnosed with prostate cancer. The differences are not due to a statistically significant difference in mortality rates but are because of differences in diagnostic criterion results in different percentages of men being diagnosed with prostate cancer.
More men are diagnosed with prostate cancer in the U.S. than anywhere else but the number of men dying from prostate cancer per 100,000 men is nearly identical across modern industrialized nations.
The difference in prostate cancer mortality rates between the U.S. and the U.K. is about 1/10th of one percent.
Let's see.
If I have a choice between no health care and waiting for health care, I choose ...
If I have a choice between fast health care and slow health care, I choose ...
Why can't we strive for a system that provides fast health care for all. And provide those with money the opportunity to get their own health care faster, but at a premium.
despite the wait and the other inconveniences the Canadians have better life expectancy and their medical system is more effective at addressing preventable conditions. and they spend a lot less.
while the American system delivers excellent care to many patients most of the healtcare expenditures are done late in the disease process ( out of total medical services an average American buys during his lifetime over 70% are services done for mostly futile care at the end of life). that's because the system is geared to selling tests and procedures ( the more a hospital or a doctors sell the more money they make) and not taking care of the actual medical needs of the person.
a wise system will spend a little more money early on for education, prevention and management of chronic diseases early on not on keeping very sick people in the ICU's at costs of over 2000$ a day, when there is not much you can do to reverse their advanced disease process.
Alter ego,
I live in Canuckistan. The problem in Canada is wait times. See www.fraserinstitute.org for more details.
There are some things that can wait. You aren't going to die if you have to wait 2 years for hip or knee replacement surgery.
If you are waiting for an MRI for a condition that has a limited window for surgical correction (think radical tear of the rotator cuff in the shoulder), your condition can become inoperable resulting in permanent disability if you end up waiting 8 months as my husband did. Been there, trusted the system, and got screwed.
Cancer treatment is also time sensitive. The Quebec Supreme Court ruled in favor of cancer patients who were forced to wait for chemotherapy beyond medically safe limits. I recall the words "access to a line up is not the same as access to care".
Our health care problems stem from cuts to staffing, medical school enrollment, nursing school enrollment, and diagnostic imaging. Canada has fewer MRIs per capita than South Korea and thousands of patients do not have a primary care physician. Nursing and many specialties facing critical staff shortages with retirement of senior staff over the next 10 years.
The politicians who decided to cut the health system to the bones placed cost ahead of all other concerns. It will take years to improve this picture.
Our health system has no rating for doctors or hospitals so patients cannot even find out where the services are. As a patient, you have to become a detective to find out where you can get treatment. While it's ok if you have something simple, sometimes illnesses don't come in that flavor.
Our system favors the upper middle-class and rich who can find the best specialists through their network of social contacts or just pay for service with a smile in the States while the rest of us enjoy the line and take whatever level of care we get.
The grass, my friend, is always greener.
Government funded health care is not a panacea and it takes decisions that affect the care of millions out of the hands of those capable of making the best decisions, ie. health care professionals.
Most of the politicians do not even understand the issues. It's just not what they do. It is as unrealistic to expect a politician with no medical training to organize a health care system as it is to expect a politician to run the local nuclear power plant and expect that they will fair any better than Homer Simpson.
Anon 1:14pm
No, I’m not wrong. The percentages are sound as expressed in the study regarding prostate cancer criteria and not the general “cancer deaths” criteria: You can read it if you wish:
Peter S. Hussey and G. F. Anderson, Multinational Comparisons of Health Systems Data, The Commonwealth Fund, October 2000 (The most recent study I could find.)
Yes, more men are diagnosed with prostate cancer in the U.S. than anywhere which may be a result of lifestyle, diet, and genetics. Yet, these men have a higher chance of survival in the U.S. This is due to American patients having better access to high tech equipment, less waiting periods to see a specialist, and in some cases better medication.
Ask yourself this: If you had prostate cancer, where would you rather be? (Even if you didn’t have health insurance!) The U.S. or Britain?
I can tell you that I would rather be in the states.
no system is perfect. you might very well be in US work for 10-15$ an hour and not be able to afford health insurance at all. and when you get to the doctor's office be asked to show the cash before you get to be seen. then the doc may run the test he has available in his office even if you don't really need them but may have the slightest complaint that justify them. then you'll be sent to the MRI that as long as you fork 1000 1500$ you can have it on the spot. then you'll see the ortopedist in few more days and have your surgery done if indicated in couple of days to weeks.
the prostate cancer thing is a fake, too bad Rudy Juliani fell for it. prostate cancer is a disease you die with not a disease you die from. over 75 years 80% of mens who have their prostate checked at autoopsy will have acncer, American system is more agressive in performing the testing on everybody. the differences in outcomes are limited though for this cancer.
truth is that is far as cancer care goes US is the best in outcomes ( and given the fact that the budget for cancer care is the most generous it should be that way). however France or Sweden ahve similar results in cancer care again with only 2/3-3/4 of spending.
anyway you look at the American system the conclusion is that the results lag well behind the expenditures. one can argue that there is not enough free market in the system as it is, but surely there is a lot more free market that there is in all the other developed countries. but so far in this field the universal system has delivered better results with less cost. one can go with the reform towards more free market ( the riskier appoach) or can go towards a Universal system as a blanket for everybody with the private insurances picking up the faster and more personalised care for the ones who want to buy it and can afford it.
Anon 2:11
I went to grad school in Canada and I know all to well and agree with you on the discrepancies you noted about Canadian health care.
Let's not forget the landmark case in Quebec several years ago where a 72yo man sued his gov't regarding health care access and he won. The Supreme Court of Canada struck down Quebec laws that banned private health insurance:
http://www.cbc.ca/canada/story/
2005/06/09/newscoc-health050609.html
I say the problem w/ the U.S. system is the cost of access to the best health care in the world. The way of achieving cost-effective access, for more people while maintaining high quality, is not more government intervention.
Anyway, that's my 2 cents.
you don't have to have the government get much more involved than it is already. 45-50% of healthcare bills in the US are already payed by medicaid and medicare. you can keep the same proportion or just increase it slightly and cover basic services for everybody.
and frankly if I would have the choice I would rather buy insurance from medicare or Medicaid than from Aetna or Cigna. Medicare runs a 4-5% administrative cost while the private insurances run 9-12%. so when people are paying Aetna premiums they're getting 88 to 92$ worth of services bills payed while the Medicare will pay 95 to 96$.
the situation gets even worse down the stream as the physicians and hospitals use 30-45% of the money they get payed for administrative costs ( billing services, filling FMLA papers and trying to get approvals for medicines and treatments the insurance companies don't want to pay, malpractice insurance). In the end out of the 100$ one pays in insurance premiums only 50-60$ worth of services are actually received...
Medicare's claimed advantage in administrative costs is fraudulent. As for "only a bit more to cover everybody", that too is a lie. If you think health care is expensive, wait til the government pays for it. Oh wait, it does! The massive increase in price is highly correlated with Medicare and Medicaid spending.
you claim the financial statements of medicare are falsified?
getting the pie to everybody will mean that some of the services covered will have to be dropped or provided only with a copay. the ideea is to agree to a minimum of services that would have universal coverage remaining that the rest be covered by private insurance and/or copays. the way we manage social security. everybody gets a little of retirement revenue from there and most of us supplement that with our own retirement savings.
some people will cry "rationing" but there is already rationing. some people already are not able to get the care they need when they need. and the care for the uninsured is already payed for by somebody as the hospitals charge more the people who can pay, to provide for in-extremis services provided in the ER for those who don't or can't pay.
the massive cost increase for Medicare has an obvious explanation. the people over 65 have the most complex medicall needs. similarly the poor are also difficult patients as their lifestyle and social turmoil affects their health behaviour. the private insurances even get to cherry pick whom they cover.
if you are a diabetic and you lose your job 9 and with it your insurance) see if you can afford the premiums asked by the private insurance. you are basically relegated to poverty as 95% of Americans could not afford the healthcare on their own in this circumstances.
Hmmm, for all those folks who think the MICHAEL MOORE view of socialized medicine is a good thing, think again...
Ahhh, I see that comment #2 relied on the never reliable, barely believable Health Affairs people...
Maybe you should consider perusing the: Five Myths of Socialized Medicine
"If you need any medical care in Canada like a new hip your deductible is zero. How much is it in the U.S.?"...
Hmmm, does socialist medicine of Canada deserve a round of applause?
I think not: Released in October 2005, Waiting Your Turn: Hospital Waiting Lists In Canada found the median wait from the time a patient was referred by a general practitioner until the time he or she actually received treatment was 17.7 weeks
Let me add insult to injury regarding those clamoring for (but not offering to pay for) socialized medicine...
Mind you the following is from the AP and ran in a rag in barking moonbat paradise, Seattle: Medical costs higher for thin, healthy folks
LONDON — Preventing obesity and smoking can save lives, but it doesn't save money, researchers reported Monday.
It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.
"It was a small surprise," said Pieter van Baal, an economist at the Netherlands' National Institute for Public Health and the Environment, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."
In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are higher than those of either fat people or smokers.(there is more)...
BTW for those wanting to leech off of the taxpayers for S-CHIP do consider the following: In order to get the tobacco revenue necessary to fund the congressional expansion of SCHIP, Congress would need to recruit 22.4 million new smokers...
juandos, try as you might there is no other option except to have government funded health care available for every U.S. citizen that wants it.
The U.S. spends nearly twice as much per person on health care as Canada for what?
Show me what we get here for all the money we spend on medical care. Show me something from some respected journal that you approve of. I'm talking about real scientific research here not the dressed-up, quasi-legitimate opinion pieces that Rush would be proud to give as evidence.
Show me how our system is even 10% better than the Canadian system that spends half as much as we do.
Hmmm, basic book keeping and basic economics isn't your strong point I see: "try as you might there is no other option except to have government funded health care available for every U.S. citizen that wants it"...
What absolute nonsense! According to whom?
Are YOU offering to foot the total bill?
"The U.S. spends nearly twice as much per person on health care as Canada for what?"...
Hmmm, so why do Canadians keep coming to the US for real medical care?
"Show me what we get here for all the money we spend on medical care. Show me something from some respected journal that you approve of. I'm talking about real scientific research here not the dressed-up, quasi-legitimate opinion pieces that Rush would be proud to give as evidence"...
LOL! Coming from a New York Times kool-aid drinker this is funny...
The Ugly Truth About Canadian Health Care
"Show me how our system is even 10% better than the Canadian system that spends half as much as we do"...
Canadians get exactly what they pay for, lousy medical service...
The Health of Nations
America’s health outcomes compare favorably to Canada’s, a new study shows.
29 October 2007
If you listen to left-leaning critics attack U.S. health care, some version of the following complaint invariably surfaces: “Americans spend more on health care per person than anyone else. . . . Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation.” These outcomes result from profit-driven insurance companies’ mismanaging resources, continues New York Times columnist Paul Krugman, and a single-payer system modeled on Canada’s would offer us a cheaper alternative with superior results.
But as Canadian physician David Gratzer has pointed out, health outcomes like infant mortality and life expectancy aren’t always a reflection of health care; instead, they represent a “mosaic of factors such as diet, lifestyle, drug use, and cultural values.” For instance, in The Business of Health, economists Robert Ohsfeldt and John Schneider show that once you factor out U.S. accident and homicide rates (which are far higher than in other wealthy countries), Americans actually live longer than their counterparts in other wealthy Western nations.
Gratzer’s argument got another big boost last month when economist and former Congressional Budget Office director June O’Neill and her husband, economist Dave M. O’Neill, released a study comparing U.S. and Canadian residents’ health status, health care, and access to care. The study makes for compelling reading. First, the authors point out that infant mortality and life expectancy are poor proxies for health-system performance. Take infant mortality, which averages about 6.8 deaths per 1,000 live births in the U.S., compared with 5.3 in Canada. Advantage Canada?
(there is more
)
juandos, you gave me exactly what I told you not to give me. Statements like Once you factor in America’s high rate of low-weight births, an interesting statistic emerges: “If in Canada the distribution of births by birth weight was the same as in the U.S., their infant mortality rate would rise to 7.06.”
Which translates to if you cook the numbers you can get any answer you want.
juandos, give me some real numbers that are not cooked.
Oh but wait, you can't because there aren't any.
Hey anon, its not my fault that you have less than the minimal it takes to understand simple English...
Cooking the numbers indeed!
The fact is that Canadians keep coming to the US for real medical care whether you want to believe it or not...
Educate yourself anon: Paying More, Getting Less 2007
Measuring the Sustainability of Government
Health Spending in Canada
nobody can repel the laws of economics... a society with income per capita of 35K annually can not afford health care of 10k per capita annually. you can spend easily couple of hundred of thousand a year on a very sick person, and you can easily find or make a lot of them ( simply by not letting somebody terminally ill to die). one needs to make a choice how much one can afford to spend on this one item. a blanket universal insurance will give a minimum. from there on everybody can make their own spending decision.
so on the question of who will pay the bill the answer will be the same as now. we already pay medicare contributions and we pay for private insurance. and we pay taxes that fund the medicaid. will continue to pay a bit more for medicare and medicaid and a bit less for the private insurance. the ones who don't want they can opt out and go all private but without the posibility of returning to the public system unless they back pay the contributions they have not payed.
the ones who agree they'll get a basic package of preventative care, accidental medical coverage and chronic disease management with generic drugs and limit on testing spending. on top of that they can buy supplemental insurance ( the same way seniors buy Medicare supplemental insurance) or they can decide not to and save in health care accounts. this should make everybody at least partially happy. first step would be to allow people to buy into the state's medicaid programs. the poor will get this subsidised partially or totally. second step would be to gradually unify medicare and medicaid.
the private insurances can then compete better for the private slice as their risk pooling will become easier - the main items on a diabetic or chronic lung patient will be covered by the public scheme so they can afford to offer supplemental insurance for special items - new drugs, new testing, extra home care and physical therapy, etc.
the other advantage will be for the companies that will have a smaller and more predicatble contributions. GM, Ford and Chrysler they were practically dragged down by the healthcare cost for their employees and retirees. will also help labor market flexibility as people will be more willing to leave a job if they know they have a basic health insurance available. small entrepreneurs can also take the risks of venturing on their own if they don't have to worry about shelling 10k a year for their family medical insurance. medicaid costs at this time are about 1200$ per capita. you'll get what you pay for but it's better and fairer than going without insurance and have your kid get sick and being slapped with a 10k hospital and physician bill for an appendicitis.
I live in Canada and our health care system is certainly no better than the American system...
Only the private will save our health care system.
My husband is permanently disabled thanks to an orthopaedic surgeon who gave him weight lifting exercises for a rotator cuff tear resulting in a complete severing of the rotator cuff. The rotator cuff consists of 4 tendons that connect the muscles to the front & back of the shoulder. When a tendon is torn, exercising the muscle causes the muscle to contract pulling on the torn tendon further tearing it.
My husband's symptoms were textbook symptoms of a rotator cuff tear ie. intense pain in the shoulder and difficulty raising the arm above 90 degrees. When the rotator cuff ruptured, my husband's arm turned black and he suffered intense pain.
My husband had an MRI scheduled in 2 weeks for the left shoulder. He requested that the MRI be changed from the left to the right shoulder and was told that this would not be possible and that he would have to wait for another MRI for the right shoulder. My husband waited 8 months for an MRI only to be told that the condition was no longer operable by the incompentent specialist who had prescribed the exercises.
By contrast, I was able to locate the foremost orthopaedic surgeon in North America, Dr. James Andrews in Birmingham, AL and able to arrange for a consultation for my husband in 2 weeks. At the Alabama Sports Medicine Clinic, the staff took 8-10 x-rays and my husband had an extensive consultation with Dr. Andrews. He learned how the joint worked and how to use the arm to minimize pain. Unfortunately, the muscle atrophies if it is not reconnected within 6 months and even Dr. Andrews could not repair the injury. The total cost for this service including all x-rays was $200.00. No that is not a misprint - two hundred dollars.
Rotator cuff tears are very common sports injuries. Often the patient has a history of shoulder dislocation. According to Dr. Andrews, a patient who has torn his bicep will often tear the rotator cuff several years later since the rest of the arm must compensate.
The health care in Canada currently favors the pro-active patient. Low income patients or patients who do not have a relative who can work to ensure good care, often end up receiving inadequate care.
Obviously, we cannot change the past. We make the best decisions we can with the knowledge that we have available at the time. It is my hope that this knowledge may assist someone else to avoid disability and pain. Hopefully, the situation will improve in Canada.
juandos you messed up again. Sorry buddy but the Fraser Institute is a well known mouthpiece for private industry and therefore anything they say is suspect especially when you take a closer look at their funding, their methods and their authors.
The main author of the piece has worked for private insurance companies and his job at the Fraser Institute is to provide arguments against universal health care. If he wants to keep his job then he must maintain his public opposition to universal health care. If that isn't biased I don't know what is.
The Fraser Institute is the author of six of the 16 references cited. Nothing like supporting your own theories is there?
The disclosure on page 25 of the opinion you cite states:
Because the authors’ employer receives charitable donations from research-based pharmaceutical
manufacturers, the authors have chosen to disclose financial relationships
in accordance with the policies of the International Committee of Medical Journal
Editors
Kind of like having tobacco companies pay for research that says nicotine isn't addictive isn't it.
Now can you come up with something academic that has credibility?
Let's put that 47 million figure in perspective, Okay?
Analysis of data from earlier Census Bureau and other government reports shows that roughly 7 million are illegal immigrants; roughly 9 million are persons on Medicaid; 3.5 million are persons already eligible for government health programs; and approximately 20 million have, or live, in families with incomes greater than twice the federal poverty level, or $41,300 for a family of four.
http://righttruth.typepad.com/right_truth/2007/08/who-are-the-uni.html
Most of the uninsured are in and out of health coverage. The professional literature also shows that, overwhelmingly, the vast majority of the uninsured are persons who are in and out of coverage, largely as a result of job changes. Only a small number of the uninsured are chronically uninsured. For most of the uninsured, the problem is fixable if policymakers simply take steps to make health insurance portable, so the insurance policy sticks to the person, not the job.
http://www.heritage.org/Press/NewsReleases/nr082807a.cfm
One other thing that needs to be put in perspective is “cancer survival rates.” Most articles are referring to five-year survival rates. This is the usual common denominator in medical journals. If you Google the numerous articles by the Lancet Oncology journal and comments & critiques on these articles there is one common thread running through most articles that compare the “cure rates” among various countries. Cancer survival rates, outcomes, are better in the US. The older you are the better the US looks, especially if you have prostate cancer.
Just two comments here.
First - Alter Ego says,
"the ideea is to agree to a minimum of services that would have universal coverage remaining that the rest be covered by private insurance and/or copays. the way we manage social security."
Alter, I gotta tell ya - if you are arguing in support of anything and you can compare it to the way Social Security is managed, you offer the best antithesis to your own argument. It's like a General comparing his proposed brilliant battle plan to Napoleon's campaign at Waterloo.
Secondly,
From what I can gather, the only arguments in support of the Canadian model of health care seem to be coming from non-Canadians. By contrast, several of the comments opposing the Canadian model have come from our friends north of the border who are subject to the care this model provides. Hmmmm...I wonder who has more credibility here?
darryl, I've lived for decades in both the U.S. and Canadian system (not at the same time.)
I can tell you as someone that "has actually been there" that the Canadian system is better. The only criticism that keeps coming up that can be substantiated with reliable data is that wait times are longer in Canada. That may be true but it has not been my experience, nor has it been the experience of anyone I know or have asked.
Lets say that wait times are longer in Canada. What does that mean? According to researchers that do not have a bias or agenda and are not paid directly or indirectly by interested parties it means that:
The U.S. has better acute care than Canada BUT Canada has better longer term and chronic care than the U.S.
In the end the difference in recovery and end results for the populations in both countries over the course of various illnesses turned out to be nearly identical.
So how to fix the Canadian system? Spend more money. Now before people (not you darryl) go crazy and start foaming at the mouth understand that Canada spends about half what the U.S. does on healthcare. So any increases in Canadian healthcare spending are likely to have a big impact on wait times and still wind up costing less than the U.S. system.
Remember that the Canadian system doesn't have deductibles, there are no co-pays and ALL citizens are covered.
My Canadian healthcare system anecdote is that my mother was diagnosed with cancer. She went in for tests on a Monday, was asked to come back 3 days later on Wednesday at 4:00 pm. In the meeting with the oncologist she was told to go home and pack her suitcase to return the next day at 7:00 am for a month long course of inpatient cancer treatment followed by an operation. She survived the cancer and that was that.
Anon 8:13 short comment for you.
Lets say that 5 year prostate cancer mortality rates in the U.S. and the U.K. are 25 and 25 per 100,000 respectively.
Lets also say that prostate cancer diagnosis rates in the U.S. and U.K. are 200 and 50 respectively.
That means that in the U.S. only 25/200 = 12.5% of people diagnosed with prostate cancer die within 5 years but in the U.K. 25/50 = 50% of men diagnosed with prostate cancer die within 5 years.
The mortality rate is actually nearly identical in both countries but the standards for diagnosing cancer are different.
Now which system is better?
"I've lived for decades in both the U.S. and Canadian system (not at the same time.)I can tell you as someone that "has actually been there" that the Canadian system is better."
I stand corrected - score one for the Pro-Canada side. I guess when it comes to anecdotal support for/against, your mileage may vary.
DB
Darryl,
I'm another Canadian. You're on the right track but there is another variable: where one lives.
Most of the people that I talk with from large Canadian cities are extremely satisfied with the health care they receive. Large cities attract the best specialists and offer specialized treatment centres for the treatment of diseases like Parkinson's.
If you live in a small town or rural community, you may or may not have a family doctor. Your regional hospital will provide basic services but you may have to travel to a hospital in a major city for specialty care. In my community, the local hospital did not offer obstetrics services for several years and patients had to travel 30 minutes to Oakville to have their babies.
Mark Perry’s commentary, plus the high quality of the exchanges in this forum, are all illuminating --- one of the best to-and-fro discussions of the US health care system, in its own right and comparatively viewed, I’ve seen. What follows are some brief add-on comments that might help clarify the nature of what’s at stake.
First off, is there a crisis of medical care in the US? To read the media and listen to lots of politicians, a crisis is exactly what has occurred, and for that matter 69% of Americans surveyed in late 2006 agreed with that view. And yet the same survey found that 89% of those covered by private insurance --- roughly 83-84% of all American households --- were satisfied with their insurance and the medical treatment they get. Somewhere, somehow, the widespread view that there is a crisis conflicts with the high level of satisfaction that Americans evinced in that survey.
To note this is not to deny that there are problems with our health care system, some of which we share with other rich industrial countries like Canada or those in West Europe, and some of which are specific to our system. Four of them stand out. Noting them separately would help, I believe, to stimulate a more focused exchange on the pros and cons of our system, whether in this forum or elsewhere.
Problem One: The Uninsured
This is a problem largely confined to the US. Until we can reach agreement on roughly the nature of those 45 million residents here --- residents, please note: not necessarily citizens --- the problem is likely to be exaggerated. No need for me to delve into the nature of those 45 million. Someone else in this forum has already done a good job of dissecting it, according to the best available information. What’s missing in the discussion so far of this problem are two things:
1) How long does the average uninsured person remain without coverage? Apparently, it’s 6 months.
2) Are those uninsured persons, including illegal immigrants, deprived of medical treatment? The answer is no. Though the laws vary from state to state, in California --- I live in Santa Barbara --- all emergency rooms and public clinics are required to treat anyone without coverage, though those with adequate incomes --- about a quarter to a third of those who are uninsured in this country --- will probably have to pay at least some of the treatment, all depending on what the hospitals and clinics will try to charge and how they’ll collect payment.
It doesn’t follow that there aren’t a large number of those in this group of uninsured who would benefit health-wise from more predictable and dependable medical treatment, but my own knowledge on this point is fragmented and uncertain.
Problem Two: Lack of Insurance Portability
This problem is also largely American-made, and it may limit to an extent the mobility of our labor force. In particular, if a job-holder has medical coverage through his or her employer but is dissatisfied with the job for various reasons and would like to move on and take another job that is more challenging and with better prospects, that person might fear such a change if the other, more promising job lacks any medical benefits. The hesitation here will be all the greater if the job-holder has a family to look after that is currently covered by the existing medical coverage. Those who think that our economy would benefit from greater choice of jobs --- matching talents, aspirations, and work-commitments more closely to the job market --- would, it seems, support some sort of portability that goes way beyond the existing COLA system, no?
Problem Three: An Aging Population
This is a problem we share with all other industrial countries, except that all of Europe and Japan are starting to find it’s more acute. That’s partly because their populations are aging faster than ours, and their demographic working population --- say, 18-65 --- is shrinking every year. It’s also because their economic growth has generally been slowed than ours since 1975, as has their rate of productivity growth for the last 15 years or so. No matter. As is the case abroad, so it is here in the US: more and more retirees who live longer and longer will necessitate more and more medical treatment, a costly prospect that is not going to be reversed no matter what system of medical care a country has.
About all one can say is that the problem is likely to be more easily handled --- if that’s the right term --- thanks to the reproduction levels of the US population, immigration, and steady progress in labor- and multifactor productivity. . . the latter meaning the growth of knowledge, whether embedded in machines or in specific firms’ ability to manage and work effectively with an ever more qualified and motivated labor-force.
Problem Four: Rising Medical Costs.
Though several of the posters in this forum have rightly noted that we spend much more on medical care than Canada (or Japan or West Europe) as a percentage of GDP, they are experiencing the same sorts of cost-spirals these days that we are. In France, as a result, the state-run health system has recently ended the ability of its users to choose any doctor they want, including a specialist. They must now register with a particular general practitioner, and access to specialists and tests will operate more or less like our HMOs. The French public will also have to pay a larger share of any prescribed medicines. (France, like almost all of West Europe --- but not Canada outside of British Columbia --- allows individual citizens to supplement tax-supported medical care with private insurance, including the use of specific doctors and privately run hospitals and clinics.)
Once again, I have no knowledge about any solutions here but can add one thing --- a personal note, based on having studied and taught in several European universities over the last 46 years in Britain, France, Germany, and Switzerland. Namely? Average per capita income in this country --- and for that matter disposable household income (after taxes, deductions, and transfer benefits are reckoned in) --- is more higher than in West Europe or Japan. In rounded off figures, per capita income adjusted for purchasing power parity is about $44,000 in the US. The average for the EU-15 (West Europe) is about $33,000, or about a third higher. Disposable income is about that much higher too in the US, actually a little more so.
The moral?
It may not be the right one, it’s only a speculation --- but a richer country’s citizenry might prefer to pay more if they think they are getting higher-quality medical treatment and medicines. So do we get better treatment and medicines than Europeans get?
One Final Point
Leaving aside the statistical bandying back and forth that some posters have engaged in --- treatment outcomes and longevity in Canada as opposed to the US --- I can say without hesitation that, in my own experience, American doctors are much better trained than their counterparts in the countries I’ve mentioned; have access to far better diagnostic equipment, and with rapidity; and can call on more expert specialists to help their patients efficiently and with promptness than is the case in West Europe. The same is true when it comes to getting prompt access to specialists and, if need be, getting operated on in generally cleaner and better run hospitals. But note. Whether the American advantages here exist vis-à-vis Holland or Scandinavia is a matter beyond my own experience or knowledge.
Oh, almost forgot: the costs of medicines here and in Europe. We do pay more here than Canadians or Europeans, much more . . . and overwhelmingly because of the decentralized nature of our health system compared to the monopsonistic buying power of European and the Canadian governments. The core reason besides the buying power of single-payer systems? In effect, these governments are free-riding on the pocketbooks of American health consumers who, alone, support the high costs of pharmaceutical R&D. Ultimately, it’s true, the initial cost burdens of such R&D will be offset by the availability of generics --- more widely used, until very recently, in this country than in the four European countries I mentioned --- but whether those low generic prices fully compensate us for the free-riding of others is another matter. I don’t know. I do know that if we were --- as is unlikely --- to move to a state-run health system, the US government would also adopt a monopsonistic buying stance and hence the costs of medicines in Canada and Europe would have to rise in the upshot.
In the meantime, part of the higher expenditures on medical care in this country compared to Canada and West Europe goes back to our being both richer and able to afford pharmaceutical R&D at the technological frontier. Whether that’s “fair” or not is another matter.
Michael Gordon, AKA the buggy professor: http://www.thebuggyprofessor.org
PS Just remembered, in line with what Mark Perry has mentioned the last few days in his blogging posts. In Santa Barbara, down the steep hills where I live not far from downtown, there’s a shopping street that largely serves the city’s fairly large Spanish-speaking minority: most citizens, but with lots of illegals. There are, in a stretch of about 13 blocks, two community-supported clinics manned by good doctors and nurse practitioners that are open to all, with minimal fees. There are also two privately owned walk-in clinics. One of those just opened, run by a doctor who was at the other private clinic. He’s an excellent practitioner, whom we use for our own doctor; he speaks excellent Spanish; his new offices are immaculate and attractive; and he has a sign out in front in Spanish: $40 a consultation.
The moral here? We can certainly expect far more of these private initiatives to materialize all over Southern California and no doubt elsewhere.
Interesting comment here: "juandos you messed up again. Sorry buddy but the Fraser Institute is a well known mouthpiece for private industry and therefore anything they say is suspect especially when you take a closer look at their funding, their methods and their authors"...
So are you implying that just because its private industry subject to market forces its somehow inherently dishonest whereas governement reports are not?
Need I remind you of the myth of global warming propagated by governement paid scientists so same said scientists can continue to feed at the taxpayer financed trough?
it might be worth noting that it is usually a good thing to have to wait for "health care" since most is unneeded (studies estimating 80% of people in waiting room shouldn't be there). Medicine & Culture by Lynn Payer shows cross-cultural arbitrary medical procedure biases.
People sometimes do need medical care, so they go to the emergency room. But going to doctors annually for tests, or whenever one has a cold, flu or pain is wasteful. There is limited scientific data supporting the efficacy of many or most medical procedures (back surgery, for example).
Just as people are likely to drive more carefully without seat-belts or insurance, so they are likely to stay away from unneeded care when they have to pay for it themselves. Catastrophic health insurance is a good thing, but is, of course, regulated away in most of the U.S.
I would prefer to have just catastrophic care ($2,00 deductible or higher), but the State of Washington says I have to also pay for psychiatric "care" insurance and other unwanted "care"--driving prices up.
Just check the medical procedures performed on the children of doctors (who of course get the highest level of quick "service). Many (most?) have had many unneeded operations and procedures.
juandos said...
So are you implying that just because its private industry subject to market forces its somehow inherently dishonest whereas governement reports are not?
No.
Your point about Washington and minimum care is a good one. One of the things that drives the large differences in health insurance price between states is the mandatory types of care each state requires. Some states, like Massaschusetts, have very expansive minimums, which makes for very expensive insurance because the insurance companies have to charge you even if you don't use most of the covered services (like psychiatric or prenatal). Some states, like Maine and New York, have rules permitting you to wait to buy insurance until the day you're actually sick. Insurance in those states is some 4-5x as expensive as elsewhere. Some states don't even permit high-deductible health insurance. Thus we see the problem with government-knows-best health care: it tends to tell you what you need rather than let you decide what you need, making it too expensive to afford what you need. I'd bet that most people who complain they can't afford insurance could afford it if their state's insurance rules allowed the consumer to choose what is covered by their insurance policy.
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