Saturday, June 27, 2009

Chart of the Day: Med. Equipment, Canada vs. U.S.

Source: Fraser Institute

“Advocates of single-payer health care systems tend to promote the allegedly lower monetary costs, but they ignore the lack of access to medical resources,” said Brett Skinner, Fraser Institute Director of Health, Pharmaceutical and Insurance Policy Research and lead author of the peer-reviewed study: "The Hidden Costs of Single Payer Health Insurance: A Comparison of the United States and Canada."

The study shows that health care in Canada appears to cost less relative to the United States because Canadian public health insurance does not cover many advanced medical treatments and technologies, common medical resources are in short supply, and access to health care is often severely delayed.


At 6/27/2009 9:48 AM, Anonymous Anonymous said...

Every week, emergency rooms do tens of thousands of MRI scans, determine the pain is Not Immediately Life Threatening, and send the patient home.

Only to be repeated the next week.

I'm tired of paying the ERs to "rediagnose" week, after week. No one's getting cured, and I'm getting broke. If I've gotta go broke I'd just as soon go broke "Curing" someone.

You people really Don't understand how "health care" works in the United States. You're paying for a bunch of shiny toys, but you're NOT getting the "Care."

At 6/27/2009 10:37 AM, Blogger Milena said...

That is a remarkable difference in access to supplies. I'm surprised more people don't know/understand this, and when they are informed, continue to ignore it.

At 6/27/2009 10:40 AM, Blogger fboness said...

Where would Canada get MRI and CT equipment?

Oh, right. They come from the United States where these things are invented, developed, and built. I've been to the GE plant in Waukesha, Wisconsin where their MRIs are made. Pretty cool.

It's Americans doing the jobs Canadians won't.

At 6/27/2009 2:36 PM, Blogger DaveinHackensack said...

Dr. Perry,

This post makes a good point about the lack of access to health care in the Canadian system, but you are preaching to the choir somewhat here. I agree that a Canadian-style system isn't the answer. My question is how you would slow the rate of growth in health care inflation in the U.S., particularly of Medicare. I'm sure eliminating third-party payers, as Milton Friedman suggested years ago, would do this, but it wouldn't be politically feasible as it would leave a lot of (most?) people unable to afford advanced health care.

Forgive me if you've already posted your proposed solution to this problem and I've missed it, but I am interested in hearing your thoughts on it.


At 6/27/2009 2:46 PM, Blogger Orlin said...

Looks like a sure recipe for rationing to me!

At 6/27/2009 2:52 PM, Blogger bix1951 said...

I agree with rufus
too many procedures
too many people who die from prescribed medications and errors
usually the worst thing you can do is go to the hospital

that is the greatest risk of getting worse
stay away from doctors and you will be healthier and live longer

At 6/27/2009 3:38 PM, Anonymous Anonymous said...

I never said anything like That. My point is, simply, that there's a world of differnce between having equipment, and doing useful work.

We do a lot of testing, but not enough "treating."

Af for "inflation" in healthcare. Easy. The next time your Dr. prescribes an MRI tell him you want an X-Ray, instead.

Or, instead of a hip-replacement, tell him to just give you a crutch. Voila, no inflation.

On a more reasonable level when your doctor goes to prescribe Nexium, tell him to make it Omeprazole (generic prilosec.) You really won't know the difference. Or, instead of the Most expensive, newest statin tell him you want Simvastatin (generic Zocor.) You might want to go the 80 mg, though.

Anyhoo, a date with tha new, advanced MRI is going to cost you more than MRI, which is going to cost you more than an X-Ray, which is going to cost you more than having the Family Doc feel of it, which is more expensive than having Unca Jake say, "Yep, it looks like it's broken."

Or Not.

At 6/27/2009 3:53 PM, Blogger Benjamin Cole said...

I would like to see more comparisons to German or Brit, or Aussie systems, along with outcomes, and total health expenditures as a fraction of GDP, and per capita.
Generally, I eschew government solutions. But maybe other countries are doing a better job. Is there a reason we will look like Canada, and not, say Italy or France?

At 6/27/2009 3:56 PM, Blogger rbblum said...

Most appreciative of any direct presentation of the economic considerations for the intervention of the bureacracy's invisible hand; HOWEVER, it still is most bewildering why anyone would trust a governing unit that votes for any legislative bill without reading the contents and understanding the implications before actually voting for the legislative bill.

At 6/27/2009 4:12 PM, Anonymous Anonymous said...


At 6/27/2009 6:17 PM, Blogger Craig Howard said...

We have to remember that Canada's system forbids profit and -- as it's socialized -- has no real prices upon which to make economic decisions. In the US, the purchase of an MRI can be justified through the additional business it may bring in or by the increased productivity it can provide.

In a socialized system, there is no incentive for either. A hospital may appreciate the diagnostic value an MRI might bring, but any additional patients will only further overtax the facilities without any bottom-line benefit (since there is no bottom-line.) And the expenditure must be approved by a body of politicians who have pledged to hold the line on medical costs.

This is the same phenomenon which bedevils any government-run agency: think rusty city buses, busted post-office stamp machines and 1980's computer technology at the DMV. Government does pretend to have a capital budget, but without the economic incentives that profit provides, any capital expenditures will only be made in emergencies or when a particular capital good "looks" worn-out.

At 6/27/2009 7:06 PM, Anonymous Dr. T said...

To Rufus:

Yes, the ERs use diagnostic equipment, including scanners, to exclude serious problems. This prevents unnecessary and very expensive admissions.

ERs are designed to treat medical emergencies. They aren't supposed to be one-stop medical care facilities. Patients with recurrent problems should get worked up by an appropriate specialist, instead of going to the ER every time the pain gets worse or the bleeding recurs.

At 6/27/2009 7:42 PM, Anonymous Anonymous said...

Dr. T,

You're whistling past the graveyard.

If they're in the ER with a "recurrent" problem it's Because they can't Get treated by a Specialist.

Specialists want "Proof of Insurance" before they will see you. It's understandable. When your Libility Insurance, alone, can run as high as $300,000.00/Yr you Have to "get paid" for your services.

A poor person that's caught without insurance is NOT going to get treated by a "specialist."

Which means "He/She Will NOT Get Well. Which means He/She will STAY POOR. Rinse, repeat.

At 6/27/2009 7:48 PM, Anonymous Anonymous said...

Most of you are Good Folks, but you've managed to convince yourselves of something that is not true.

There is NOT some magical way that poor people receive medical care w/o money, or insurance.

You would not let your dog suffer without treatment, but you are turning a "blind eye" to the plight of millions of American human beings.

It will not be positive for your "political" future.

At 6/27/2009 8:11 PM, Blogger Rick Caird said...

I wonder if Rufus realizes he just contradicted himself in two successive posts. On the one hand,he complains that specialists will not treat someone without insurance and then he complains that people are coming into emergency rooms for treatment. Then he says "There is NOT some magical way that poor people receive medical care w/o money, or insurance." So, which is it? No treatment or treatment in an emergency room.

Rufus also tries to tell us that an x-ray and an mri are the same thing. Uh, no. X-rays do nothing with soft tissue.

Case in point: about 10 days ago, someone I know went into the emergency room with acute abdominal pain. Within 20 minutes the patient was in a treatment room. Within 30 minutes the doctor made the initial diagnosis. After drinking some stuff, there was a 90 minutes wait for the stuff to get through the body. After 90 minutes and MRI to confirm the diagnosis (a X-Ray would have been useless). Two hours after that, into the operating room for the removal of a ruptured appendix. Outstanding service, I would say.


At 6/27/2009 11:49 PM, Blogger PeakTrader said...

Rufus states are turning a "blind eye" to the plight of millions of American human beings."

Those millions of American human beings are free riders, who receive free medical care that other Americans pay for. A large proportion of them are Third World immigrants and their children, who would have earned $3 a day in their home countries, if they could get a job.

The U.S. needs to lower its standards and quality, e.g. to the Canadian or European levels, to make health care more affordable.

At 6/28/2009 12:17 AM, Blogger PeakTrader said...

Craig, yes, the reason capitalism works so well is the goal of profit creates by-products, e.g. capital and efficiencies in production, which benefit the masses (e.g. through lower interest rates and greater output).

Dr. T implies foreign countries should import more U.S. medical equipment.

At 6/28/2009 5:26 AM, Blogger juandos said...

rufus whines: "You would not let your dog suffer without treatment, but you are turning a "blind eye" to the plight of millions of American human beings."...

Hmmm, maybe you and these supposedly 'millions' can visit this medical paradise...

At 6/28/2009 3:09 PM, Anonymous Γερώνυμος Αμάτι Nώνυμος said...

Do you have a blank cartridge for Milena's obviously perfect health 2tonCommon?
ʖQuién Sabe, KiloSwami? One thing for sure we are running short on silver bullets today. But you can use one silver bullet for less than one percent of Americans who are willing to stay within Armed Forces for 20 years thus never worry one whit about medical care for themselves during lifetime of exceptional health made possible by free gymnasium and health food from commissary at nearly 40% discount if you they don't mind standing in line at checkout for 22 minutes.
Double check to make sure that President Johnson did not take all the silver out of your silver bullet before I put it into my inexpensive revolver.
I can do that with nuclear magnetic resonance analysis for only $2, 490.49. KiloSwami.
Will we need to stand in line at the insurance desk for 22 minutes 2tonCommon?
ʖQuién Sabe, KiloSwami? But if we do, you can be proud that it is the American Way.
America the Beautiful.

At 6/28/2009 4:35 PM, Blogger PeakTrader said...

The U.S. is heading towards substantially lower living standards, and it's completely unnecessary. The U.S. government is massively increasing the costs of production, crowding-out the private sector, and will squander trillions of dollars.

The nonpartisan Congressional Budget Office estimates the U.S. budget deficit will be $1.85 trillion dollars in 2009, gradually shrink to about $700 billion in 2012, and then gradually expand again to $1.2 trillion in 2019.

The U.S. budget deficit makes California's $24 billion budget deficit look like nothing.

Also, Obama wants MDs to lower their salaries for the public good, and wants Americans to increase volunteerism. Raising the cost of living, while expecting Americans to work for free doesn't add up.

At 6/28/2009 5:14 PM, Blogger PeakTrader said...

More Obama math:

Doctors react to Obama's AMA speech in Chicago
June 15, 2009

CHICAGO - There were standing ovations at his speech, which President Obama is accustomed to, but the crowd of doctors who attended the president's speech to the AMA Monday morning booed the president when he talked about malpractice awards.

In an emotional reaction, physicians responded as the president said he did not believe in caps on malpractice awards. He wants doctors to work harder, stop ordering costly and unnecessary tests but stand firm when patients want to sue.

That was a hard pill to swallow.

AMA members are critical of the overhaul plan but were on their feet repeatedly in standing ovation, saying they are hopeful a compromise will make the healthcare system better.

The AMA is typically against much government involvement with healthcare. It's estimated about a quarter of the nation's physicians are AMA members, and leaders of the organization responded with caution to President Obama's speech, as did other doctors.

At 6/29/2009 11:07 AM, Anonymous Ralph Short said...

It seems to me we all talk about "reducing the cost of health care". Stats are frequently offered showing how medical cost increase rates are so much higher than other services and products. The reality to me is there are serious dynamics at work to make this unavoidable:
1) millions of illegals required by law to have free health care via the hospital emergency rooms.
2) millions of people who decided not to purchase health coverage because they a) will take the risk and b) know they can get it free at the emergency room through medicaid.
3) an aging population that not only has more issues with health because of age but like everyone else wants to live forever (or at least as long as possible). This creates a demand on services and markets for the invention and manufacture of devices, equipment and drugs, etc. to facilitate a longer life.

We won't know how good this system is until the rationing program begins under "obamacare".

At 6/29/2009 2:29 PM, Blogger QT said...

2 important tests:

There are 2 very inexpensive diagnostic tests (less than $100) to identify risk of stroke: BRI (brachial-radial index) and an ultra-sound of the corroted artery. The first measures the difference in blood pressure between the forearm and the leg to identify patients with extensive arterial schlorosis. The second test detects arterial schlorosis in the corroted artery.

2/3rds of all strokes are caused by a piece of placque breaking off and going to the brain. 1/3 are hemmoragic (ie. an aneurism bursting). Stroke remains the #1 cause of institutionalization and disability.

What better gift for an aging parent?

At 6/29/2009 2:45 PM, Blogger Thai said...

@Rufus, give ER physicians the power to say "no" and you will see a lot of this stuff stop.

You will never get inappropriate utilization under control unless you give ER physicians med mal immunity. And while mal mal is not the only issue driving inappropriate utilization, it is clearly significant (and we are all waiting on the data to show up from the states that passed med mal reform)

Also, please understand there is this crazy notion that health care providers always want patients leaving satisfied. Being allowed to say "no" means some people will not leave satisfied.

Not everyone is reasonable.

In fact, it is quite clear that the most expensive person in the world is a person with a serious medical illness AND mental illness, particularly anxiety.

And it is nearly impossible to guarantee these people they are OK as they do have serious illness and the probability of a bad outcomes is therefore greater.

yet the reality s the majority of their utiilzation is for anxiety.

When are well allowed to simply say "no" understanding we may be wrong.

If physicians are not given med mal immunity regarding this issue you will never get this problem under control.

And you can't blame most ED physicians over utilization on fee for service models as most are not paid this way.

@Milena, many people do understand this.

Remember, at its most basic level, systems like Canada or Britian are basically saying it really sad your mom does not get 4 months of additional life from her breast cancer but they think the money would be better used treating the guy who smacked his car while drunk into a family of four killing two of the passengers as the same amount of money spent on the drunk will allow him to live for 5 months of life and 5 is more than 4 and all life is the same so he wins and your mom loses.

Remember that the second largest component of health care costs in America is trauma. The demographics of trauma are very well known and many of its participants do not have a dime to their name.

@Dr perry- rufus is correct, inappropriate utilization is a major source of health costs. But we are in a catch 22 as the biggest predictor of whether you spend a lot on inappropriate utilization is whether you have good insurance.

It is fare to blame physicians bu the patients are pushing this just as strongly as the physicians.

Ralph is also correct. If 100 people took apples from a store but only 10 paid for the apples, the 10 who did pay would have to pay 10 times more than they would if everyone paid.

Only a very small % of (say) ED patients actually pay for the care of everyone else so they get these wildly inflated bills for (say) $3000+ and wonder why care is so expensive in the ED.

At 6/29/2009 5:26 PM, Blogger misterjosh said...

This comment has been removed by the author.

At 6/29/2009 5:33 PM, Blogger misterjosh said...

Something tells me that the nations with nationalized health care don't want the US to move to single-payer. One of the reasons the US pays more for health care is that we are bearing the burden (cost) for most of the medical advancements in the world.

If we went to single payer and monopsony (new word for me yay!) then our drug prices for one would go down, resulting in either diminished drug development or higher prices for drugs worldwide, or both.

Same for medical equipment. Maybe Rufus is right and we aren't using our new-fangled drugs and equipment efficiently, but under the one-payer system, we won't have the choice to use the next generation of advancements at all. They won't exist.

At 6/29/2009 11:07 PM, Blogger QT said...


Doesn't the world's dependence on the U.S. reflect the geo-political realities of living in a unipolar world?

At 6/30/2009 11:34 AM, Blogger misterjosh said...

QT, That sounds sad but plausible. Though with the rise of China and the EU, I think we are moving more towards a multipolar world.

What you are describing reminds me of Welfare addicts. They could probably get off their arses and get a job to support themselves, but why would you do that when you can do nothing and still collect a check?

If/When the US stops funding (the lion's share of) development, I wonder if other nations will step up to the plate.


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