Candidates’ Health Care Plans: Private Vs. Public

Posted by Kendall Harmon

Health care has fallen from its status as the top domestic issue in this year's presidential campaign, but that doesn't mean voters no longer care.

A poll released last week found more than 80 percent of those surveyed think the nation's health care system needs fundamental change. Both Arizona Sen. John McCain and Illinois Sen. Barack Obama are promising that, but change is really the only feature their plans have in common.

McCain and Obama have very different prescriptions for solving the problem of ballooning health care costs, says Jonathan Oberlander, a professor of health politics and policy at the University of North Carolina at Chapel Hill.

Read it all and consider listening to the longer, linked report.

Filed under: * Culture-WatchHealth & Medicine* Economics, PoliticsUS Presidential Election 2008

121 Comments
Posted August 27, 2008 at 7:41 am [Printer Friendly] [Print w/ comments]



1. Henry Greville wrote:

We got through the Second World War with an economy that relied on federally enforced price controls, and did fine. The only hope of containing the explosion of health care costs, which are dragging working Americans down just as the population of longer-living retired Americans is increasing, is for the federal government to regulate the health care industry far more than it already does. Therefore the McCain health care reform plan would be disastrous, because it would weaken the federal government’s leverage as a controlling agent. (The unregulated marketplace does not take care of all things, and there is such a thing as “enough profit.”)

August 27, 9:09 am | [comment link]
2. Jeffersonian wrote:

More government intrusion is a cure that is worse than the disease.  Government intrusion is what has gotten us into this mess in the first place, with over half of all healthcare expenditures now coming from some level of the State (and often below costs, thus shifting those costs onto private payers).  That is, of course, not even factoring in the huge cost of regulation in healthcare.

No, the government needs to back out of medicine to a very large degee if we’re ever going to see the light at the end of the tunnel again.

August 27, 11:04 am | [comment link]
3. Henry Greville wrote:

#2 Jeffersonian:
Just because recent health care regulation has not been ideal does not mean that it cannot be greatly improved. In the history of the USA, the federal government has organized and done a great many things, if not everything, very well. The key has been when elected leaders have had the integrity to stay ahead of the corrupting influence of private sector lobbyists. The last people we should ever trust to tell us what, for example, medications and medical equipment and corrective surgeries should cost are the commission-chasing and/or stock option-chasing marketing executives for pharmaceutical and medical technology companies and hospital-owning health management organizations.

August 27, 11:35 am | [comment link]
4. Sick & Tired of Nuance wrote:

The AMA is a monopoly.  They determine how many medical students are allowed to be trained each year, ensuring a shortage in the “supply” of qualified doctors.  Take that power away from them, and the market should work.  There may need to be tort reform to put reasonable ceilings on lawsuit payouts, too.  Then again, I shudder every time I think about the surgeon that removed the wrong foot on a diabetic patient a few years back down in Florida.  The surgeon dropped the lens into my father’s eye while removing the cataract that they caused by earlier procedures.  Still, there should be some reasonable cap besides the malleable hearts of a jury.

August 27, 12:07 pm | [comment link]
5. Jeffersonian wrote:

Just because recent health care regulation has not been ideal does not mean that it cannot be greatly improved. In the history of the USA, the federal government has organized and done a great many things, if not everything, very well.

This is simply bizarre.  Each and every year, Medicare loses some $15 billion and has no idea where it goes, an amount more than ten times that plundered by Enron’s pirates.  It’s hard to find a single field into which government has injected itself that isn’t rife with corruption and manipulation (the “green” energy field being just the latest). 

If you don’t trust the corporate entites, fine.  Please eschew their MRI machines, CAT scanners, tongue depressers, pharmaceuticals, catheters, etc. in favor of those produced by the government’s lawyers, poli-sci majors and activists.

August 27, 12:14 pm | [comment link]
6. mugsie wrote:

I’m only speaking from experience. I grew up in Canada. I left there at the age of 42 to follow my husband back to America. I worked in the health care field as an RN for 17 years. I can honestly state that in my own personal and in my professional experience, I have NEVER had cause to consider a “private” health care system. I never had to worry about having to pay out of pocket for any doctor’s appointments, procedures, surgeries, etc. There was no such thing as a co-pay. I never got denied any diagnostic procedure, or any surgery my doctor felt I needed. I never got told I couldn’t get a prescription filled which my doctor ordered because a “compendium” did not include it. NEVER did any any bureaucratic official or office clerk make decisions regarding my health care or those of the patients I cared for. The doctor and the patients are the ones who decide what needs to be done.

Yes, taxes were higher. However, I would rather pay a bit more in taxes on a paycheck or my purchases than to be hit with a HUGE bill blown WAY out of proportion for actual services rendered. The bottom line is that I NEVER lived in FEAR of not being able to get the health care I needed as I do now here in the US.

Yes, there are those who abuse the system. That’s an area that needs to be dealt with. One method we used in ER triage areas where I worked was to screen patients presenting for care. If their problems were not considered “emergency” care problems, then they were asked if they called their doctor’s offices before coming to the ER. In most cases, they would tell you they did not. We then would call the doctors’ offices from the ER, and guess what, in most cases the patient’s own doctor would tell us to send the patients to the office for care. THAT’s where they should have gone in the first place. ER care costs the system far more than an doctor’s office visit, and it also causes serious delays and increases risks for those who REALLY need ER care when the emergency rooms are clogged up with non-emergency cases.

I am speaking from my own experience. I have never been denied any care I needed. Neither has any of my family. Some will complain about waiting periods for elective surgery. In most cases, there’s more to the story than they are telling you. It’s the “me” element that they are not telling you. Those people want their selfish needs being met NOW, regardless of all those out there who have a more serious need to use the surgery services. NO ONE has been denied care in any life threatening situation in my own experience, both personal and professional.

As to costs, here’s an example of how bloated the costs in the US are compared to Canada. I was visiting here a few years back when I became ill and needed to be hospitalized. I had a few tests run and was only in the hospital for a couple of days. The US system tried to charge my OHIP system in Ontario, Canada over $20,000. OHIP refused to pay such exorbitant costs. The costs for the exact same services in Canada added up to just over $6,000. THAT’s what they got paid from OHIP. Health care should not be about profit. It’s should be about caring for those around you in need, and NOTHING else. There should be no personal gain for anyone’s pocket book. THAT’s where the problem is here in the US. It’s about lining the pockets of the health care industry’s executives, NOT about taking care of those who really need caring for.

August 27, 12:27 pm | [comment link]
7. Ross wrote:

I wish I knew the answer to the health care situation, but I don’t.  These two things seem axiomatic to me:

1) Health care is not an industry like making and selling DVD players, because the demand for health care is fundamentally different than the demand for DVD players.

2) Providing health care costs money—studying medicine costs money, running a hospital or clinic costs money, designing and building medical equipment costs money, researching new drugs costs money—and all of this money has to come from somewhere.

(1) means that I’m wary about throwing health care over entirely to the free market.  (2) means I don’t know where else all this money is going to come from.  In combination, I don’t know what the answer is.

I do know that #7 mugsie’s comment, “There should be no personal gain for anyone’s pocket book” can’t be held to throughout the entire field, because—just to take an example—the engineer who spends her days designing life-saving medical gadgets needs to be able to feed her family, and where does her paycheck come from?  From the profits of her employer, who makes money selling those gadgets.

On the other hand, my stepmother, who spent her career as an RN before she retired, has an extended rant about how the MBAs ruined American health care when they moved in and tried to treat hospitals as profit centers no different than, say, a Kwik-E-Mart.

So in the end, I don’t know what we need to do.  I wish I did, but I just can’t see the answer.

August 27, 12:47 pm | [comment link]
8. magnolia wrote:

npr did a series exploring other societies’ healthcare systems. i think the german model had the most efficient system. there was a corporate entity that handled it but was strictly overseen by the government.  i have always told my hubby that we can never get sick or old in this country unless we are filthy rich, cause our fellow citizens sure don’t care how we end up, right jeffersonian?

August 27, 12:59 pm | [comment link]
9. Jeffersonian wrote:

Mugsie, I understand the impulse, but the reality of the situation in Canada is that the state-run system is in such poor condition that your supreme court declared it unconstitutional.  And Canada does have a private health care system…it’s called America.

August 27, 1:00 pm | [comment link]
10. mugsie wrote:

#8 Ross wrote:

I do know that #7 mugsie’s comment, “There should be no personal gain for anyone’s pocket book” can’t be held to throughout the entire field, because—just to take an example—the engineer who spends her days designing life-saving medical gadgets needs to be able to feed her family, and where does her paycheck come from?  From the profits of her employer, who makes money selling those gadgets.

I agree with this statement. Non profit organizations also pay their employees. However, the focus of the funds made always goes back into the organization’s services. Top executives don’t take home huge bonuses and exorbitant salaries. There are no “perks” per se, which profit the executives over and above the people the organizations serve. I was referring to the profits lining the pockets of the executives, NOT the wages paid to the workers providing the services required. Sorry if that was not clear.

On the other hand, my stepmother, who spent her career as an RN before she retired, has an extended rant about how the MBAs ruined American health care when they moved in and tried to treat hospitals as profit centers no different than, say, a Kwik-E-Mart.

Your stepmother and I both seem to be on the same page. It’s the whole idea of hospitals, clinics, diagnostic centers, etc. being private (for profit) corporations that is causing the problems. This goes back to my first comment. The top executives of these organizations (corporations) are lining their own pockets. THAT’s what needs to stop. Government controls may play a part in that. All I know from my own experience is that it has worked well in Canada. I have no first hand experience from other countries who have government controlled health care, so I can’t speak for them.

August 27, 1:11 pm | [comment link]
11. mugsie wrote:

#10 wrote:

Mugsie, I understand the impulse, but the reality of the situation in Canada is that the state-run system is in such poor condition that your supreme court declared it unconstitutional.  And Canada does have a private health care system…it’s called America.

I’m sorry but I have to disagree with your statement here. My whole family still lives in Canada. I’m the only one in the US. What you say is just not true. I know this first hand. I don’t know the source of your information,  but I seriously question it’s validity. Like I said earlier, its the “me” element that most people will not tell you about. Those seeking health care outside of the Canadian system are selfishly seeking a NOW fix, instead of understanding that their care is not life threatening. Yes, they will get care, and in a timely manner. BUT, it may not be NOW, as opposed to a couple of weeks from now. The system is run on a need for care basis. You will get the care you need. You will not be denied. However, if your need is not as serious as another person’s the other person will get use of the surgery services (for example) before you will. You will be given an “elective” service, whereas the other personal will be given an “emergency” service. I’ve had surgery in Canada a couple of times. When I broke my arm I was treated immediately. I didn’t have to wait in ER for hours either. I was taken in immediately and treated very quickly. Unlike my 90 year old father in law here who was forced to sit in an ER waiting room for 2 hours on a broken hip. It took me and my husband raising quite a stink to get him in even that quickly. That’s unacceptable.

Another surgery I had in Canada was a cholecystectomy (gall bladder removal). I had some not so nice symptoms from my gall bladder ailment, but it was not life threatening. I was given instructions to care for myself to avoid any further attacks of serious symptoms. I was scheduled for surgery 3 weeks from the day I first presented with the problem. I had all my tests and diagnostics done in just a few hours. There was no “authorization” process to hold up my care. My doctor ordered the tests the day I presented in her office with my symptoms. I had the test done that same day. I was notified with the results later that same say. I was scheduled for surgery and informed with the details by the next day. I did as I was instructed and my symptoms were very minimal during my 3 week waiting period for the surgery. It was very successful. That was 14 years ago. I haven’t had any problems since then and don’t need to take any medication due to the removal of my gallbladder.

When my mother was having some serious fainting spells, she presented in ER and was diagnosed with “atrial fibrillation”. She was immediately hospitalized and treated aggressively. That was about 5 years ago. She’s not had to return to ER with those symptoms since then. She takes the medication her doctor prescribed to help her keep in “normal sinus rhythm”. My family helps monitor her medications at home. ALL the family was educated about her condition and care. Since I have siblings living very close by they were all included in her care. Believe me, it works quite well.

I gave birth to all 3 of my children in Canada. I received the best of care during all 3 pregnancies. I even experienced a postpartum hemorrhage after the birth of my son. I was aggressively treated before I even left the delivery room. I never suffered any ill effects due to that aggressive care being given when I needed it. I have friends here who have been denied prenatal care by their health insurance providers. A lot of insurance companies just don’t provide it as a standard. You have to pay higher premiums for this care. If your spouse or you, yourself, don’t have a really good job which provides the top level of health care insurance, you are faced with exorbitant costs just to have your family. I am SOOOO grateful I had my children in Canada. Too may women have to take such risks with their pregnancies here due not being able to afford insurance for good care. They lose out on the most necessary prenatal teaching provided with good prenatal care. They may also be missing out on early diagnosis of problems with the pregnancy which can become life threatening if not treated promptly.

I’m sorry, jeffersonian, but I could go on forever with examples of how this country does not meet the needs of health care for everyone. I have to honestly say that I detect a note of bitterness in your comments. I’m sad to see that. I have to ask, do you have any “personal” experience with the health care system in Canada? My whole life has been my experience. My family is still using that system quite successfully. Believe me, it truly does work!!!

August 27, 1:40 pm | [comment link]
12. Denbeau wrote:

I work for a private company supporting an IT aspect of health care in Canada, and I would like to support mugsie in everything that she has said.
As an outsider, it almost seems that Americans - at times - seem unwilling to look elsewhere for ideas. You can win the most gold medals almost all the time, but you’ll never will all the gold medals; somewhere, there is somebody else who might be doing something better. Magnolia’s suggestion of looking at European models, possibly Germany’s, is a good one. Almost all western democratic countries spend less on health care (per capita) than the U.S., and provide better overall service.

August 27, 2:04 pm | [comment link]
13. Jeffersonian wrote:

I’m sorry but I have to disagree with your statement here. My whole family still lives in Canada. I’m the only one in the US. What you say is just not true. I know this first hand. I don’t know the source of your information, but I seriously question it’s validity. Like I said earlier, its the “me” element that most people will not tell you about. Those seeking health care outside of the Canadian system are selfishly seeking a NOW fix, instead of understanding that their care is not life threatening.

How selfish of them not to suffer in silence, eh?

I had a colleague from Kitchener that fit your exact description, Mugsie.  He had numbness in his fingers that progressed up his hand, then his arm.  His Ontario doc told him it was all in his head.  Then his side went numb.  His doc finally scheduled a CAT scan…three months out.  When his face slouched, numb, he said enough and got a CAT scan in Detroit within a day.  Turns out he had a severely pinched nerve that would have been severed within a month, leaving him paralyzed.  He had surgery, again in the US, and was back on the job within a couple of weeks.

But, you know, paralyzed isn’t “life-threatening.”

Canada rations care, just like we do, but with different criteria.  Of course, those with money can always come to America to get problems fixed the Canadian system cannot, or will not, address in a timely fashion.

One error correction in my post in #10:  It was the Supreme Court of Quebec that declared unconstitutional the ban on provision of private healthcare, so shoddy was the government system (ever see “The Barbarian Invasions?”), not the Canadian SC.  Three of the justices, one short of a majority, voted to declare the system itself so bad the system itself unconstitutional.

August 27, 2:10 pm | [comment link]
14. Clueless wrote:

The AMA is not a monopoly.  It has no say over whether a medical school is created.  In point of fact, there is a shortage of reasonably qualified people who wish to go an average of 150,000 in debt to become a physician.  At this point, with schools taking 1 out of 2 applicants, just about anybody with a warm body who graduated college, and was able to pass the prerequisite courses, can make it into medical school.  In addition to medical schools, there are (equally expensive) osteopathic school which the AMA has no input into whatever.

The requirements for being a physician are set by the Federal government (begining after the Flexner report, when the government closed down more than half the medical schools in the US, over the objections of the AMA and other physicians.  It was the Federal government who insisted on a BA prior to an MD (unlike the system in Europe, where one enters medical school after high school).  It was the Federal government that insists that medical schools do research as well as simply engage in teaching.

Personally I am no fan of the AMA and do not belong to it.  That is due to the fact that I believe that her policies have been harmful to most physicians younger than 40 (I"m 50 myself) and have been enginnered to keep the status quo for the folks who “already have theirs”.

However the reason there is a shortage of health care is not due to the shortage of MDs.  Most care in this area is provided by nurses and PAs anyway, who see the majority of primary care patients, do most anesthesia, and just about all non specialty follow ups.

The reason there is a shortage of health care is because of price fixing.  If you have price fixing, you will have shortages.  And yes, America, despite the high price of heath care, if you didn’t have price fixing the price would be higher yet.  The reason the price is so high is because:
1.  The uninsured, Medicaid and Medicare none of whom pays full freight and whose bill is subsidized by the self insured and those with private insurance.
2.  Regulation, that requires that a physician put up over 150,000 a year to keep up with all documentation, hospital call (done free), other coverage, malpractice etc before earning a dime.
3.  Medical school bills (some kids leave medical school 400,000 in debt nowadays, while schools in Europe and Canada are subsidized or free.

I think we do need a national health system, and that we will get it.  However I can promise you that you will not like it after 10 years.

Howver, by then I will no longer be a physician, and will be a teacher (God willing) instead.  Paid by the hour, they earn more than primary care physicians.

August 27, 2:11 pm | [comment link]
15. Jeffersonian wrote:

I work for a private company supporting an IT aspect of health care in Canada, and I would like to support mugsie in everything that she has said.  As an outsider, it almost seems that Americans - at times - seem unwilling to look elsewhere for ideas.

Well, the Canadian system is clearly coming apart at the seams (see my post above), and the only other two places that have 100% single-payer systems are Cuba and North Korea.  Michael Moore aside, does anyone want to emulate Fidel Castro’s system?

August 27, 2:13 pm | [comment link]
16. Clueless wrote:

Oh I forgot to mention 2 more reasons that health care is so expensive:

4.  Unreasonable expectations.  Everybody however old, and frail expects to live forever, and sues if they don’t.  In our 50 bed ICU 20% are over the age of 90, 40% over the age of 80, and 20% over the age of 70.  Those in the last 2 years of life use half the health care dollars in the US.  None of the folks in the ICU would be alive in a place like Greece or Italy.

5.  Litigation which forces unnecessary tests.
For example I just finished seeing a 82 year old woman who had a mild stroke 2 weeks ago.  She was initially seen in her local community ER with hand weakness (that she awoke with) and had a CT of her neck which confirmed severe cervical spine disease.  The ER doc thought she had weakness from her neck and sent her (within 4 days) to be evaluated by one of the neurosurgeons in my practice.  The neurosurgeon felt a stroke was more likely, so I saw the patient the same day, we did an MRI, confirmed the stroke, initiated therapy, and did the workup. 

The patient is almost back to normal, but plans to sue the ER for “missing the diagnosis” even though there is nothing that can be done for a stroke that one wakes up with.  (Clot busting drugs only work in a 3 hour window).  This is depite the fact that the patient does indeed have severe neck disease, that will likely need treatment (Yes, Europe and Canada, in the US, we do spinal surgery on 82 year olds all the time, and we would be sued if we “discriminated by age”, as y’all do).  This is despite the fact that the correct diagnosis was made within 4 days.

However y’all will be glad to know that in the future, that ER doc will certainly make sure that everybody, however old, however unlikely to have a stroke will have an MRI before he leaves the local ER.

And you wonder why prices are high.

August 27, 2:38 pm | [comment link]
17. Denbeau wrote:

Jeffersonian,
It is not coming apart at the seams. Polls in Canada consistently show that Canadians want their health care system preserved. Is it perfect? Far from it; there’s lots of room for improvement.

80% of my company’s clients are in the U.S., and I spend a lot of time traveling around to various hospitals and clinics there. Most of them provide exceptional care, no question about it. But it ends up costing almost twice as much per capita as the Canadian system, and there are still some 45 million uninsured.
Both systems would probably be improved if they took the best aspects of the other, but until that happens, I’ll stick with the Canadian system seven days a week.

August 27, 2:44 pm | [comment link]
18. Jeffersonian wrote:

Well, then we’re in agreement:  You keep yours, we’ll keep ours.

You are also comparing apples and oranges, Denbeau.  Even the uninsured get good treatment in America, and with a lot more alacrity than in Canada.

August 27, 2:49 pm | [comment link]
19. Denbeau wrote:

Jeffersonian,
Only partly in agreement. I’m not sure that you will find your compatriots will agree that the uninsured in the U.S. get good treatment.
And by the way, about 2 million per year go bankrupt in the U.S. due to the costs of medical care, whereas in Canada, the last time I checked, it was about - let me see ... - zero.

August 27, 3:00 pm | [comment link]
20. mugsie wrote:

#14 jeffersonian, are you basing your entire opinion on one instance alone. I’m sure there is more to the story than you state with this fellow in Kitchener. One thing that first comes to mind may be the quality of the physician. He may not have been the best. There are “questionable” physicians everywhere. I would also ask, why did this fellow not get a second opinion, or even a third? It’s quite easy to do that in Canada. You can even pick who you would like to see. For example, this fellow could have chosen to be assessed by someone at McMaster University Hospital (a medical teaching facility just up the road from Kitchener) or Toronto General Hospital in downtown Toronto. Both are reputable medical research facilities in southern Ontario well within reach of this fellow. Did he even request this service? I can assure you that if this fellow had presented at either of those facilities with the symptoms you described he would not have been refused. He would have received aggressive thorough investigation if his complaints indeed matched his physical neuro examination results. Where did this fellow go for care? Was it just his doctor’s office? You leave so much out. So, on that alone I can’t buy your argument. I know too much first hand. I moved to the US from Guelph, which is just adjacent to Kitchener. I know Kitchener well. There are many wonderful physicians in the city. And for this man to be in such a wonderful area full of specialists and some of the best medical research facilities in the world, I truly have to question what happened in his case.

Here’s another personal case for you of how poor the quality of care in the US is. I presented in an ER department feeling quite ill. I had just started to recover from a very serious stomach virus. I was supposedly recovering and that’s the only reason my doctor back in Canada felt I was able to travel. We had already delayed our flight by 3 days so we could recover. My husband and son also were afflicted by the same virus I was. However, they were recovering quire rapidly. I continued to feel quite nauseated and generally unwell. I couldn’t eat properly. Once I was in the US for a couple of days I was certain that something was really wrong. That’s why I went to ER. Do you know what I was told——even with the history of the sudden illness from the virus——-I was told I had Irritable Bowel Syndrome!!!! Can you imagine how that made me feel??? Here I am a critical care nurse, so I’m not totally ignorant of a lot of medical problems. I would not have even gone to the ER if I didn’t believe something was truly wrong. I was amazed at the audacity and ignorance of this fellow who called himself a doctor. Irritable Bowel Syndrome just does not occur suddenly and make someone as ill as I was before I left Canada. Needless to say, after discussing the whole situation over with my husband we chose to just get me back home to Canada as quickly as possible where I knew I would get a REAL diagnosis. We rearranged flights again and left in a couple of days. I maintained on sips of clear fluids during that time. As soon as I got home I met with my family physician in her office. She could clearly see that something was very wrong. She knew me well and that in itself was a factor. She arranged for me to see a local gastroenterologist right way. He did several tests. His diagnosis based on the test results was “gastroparesis” (partial paralysis of the stomach). He suggested that I get one or two other opinions if I felt the need. Naturally I thought that was a very good idea. I knew of an excellent gastroenterologist at McMaster who specialized in problems like mine. I also got the name of a fellow in Toronto. I saw them both. They both confirmed the diagnosis of gastroparesis. I chose to be treated at McMaster. They had the most advanced techniques and were the closest to my home in Guelph. It took me a year to recover using medication and a very strict diet to allow my stomach to heal, but I did fully recover. That was 12 years ago. I’ve been fine ever since.

That is another example of why I don’t trust the American health care system. It has way too many flaws, even if you have insurance. Like I said earlier, I’m speaking from personal experience. I don’t personally know anyone who was denied care that they TRULY needed, WHEN they needed it. Like I said above, I’m sure there’s a lot more to your story with this fellow than neither he or you are telling.

August 27, 3:18 pm | [comment link]
21. Jeffersonian wrote:

As my account in #14 attests, not all the insured in Canada get good treatment, either, and in Canada it’s a matter of policy that they don’t.

BTW, I just checked the Ontario Wait Times Strategy website, and it looks like my pal would still have to wait for two more months than it would take him to be irreversibly paralyzed…Ontario is striving for 9 out of 10 people to get their CAT scans within 98 days.

August 27, 3:19 pm | [comment link]
22. Jeffersonian wrote:

Mugsie, #21, you completely missed the salient point in my recounting of my friend’s ailment.  It wasn’t the two weeks he spent getting worse because of an indifferent doctor, it was the three months he was going to have to wait for a CT scan appointment once a doctor agreed something was actually going on.  Even if the appointment had been made on the first visit, my friend would have long been paralyzed by time he was pushed down the CT tunnel.

If it’s so wonderful, why do brokers exist in Canada to find medical treatment in America?  They don’t exist here for treatment there.

August 27, 3:26 pm | [comment link]
23. mugsie wrote:

#17, what you describe is a classical example of the “attitude” I mentioned above. The “me” attitude. The “now” attitude. No, I’ve never seen anyone discriminate on age wherever I worked in Canada. My folks are both in the late 70’s and early 80’s and they are treated just like anyone else who sees a doctor for medical care. However, they are also realistic. They would have been overjoyed if they were the lady you mentioned. To have caught a stroke and recovered so well from it? Awesome! I think that’s wonderful; a gift from God, and I would never mess with that by bringing litigation against the ER doctor. It’s this litigation attitude that’s a BIG problem here in the US. You just don’t hear of too many people taking their doctor’s to court in Canada.

Strokes are an example of something that can present in very vague ways. It’s not always imminently obvious that someone has suffered a stroke. Many tests need to be run, and wherever I worked they were run. The patient was always hospitalized and the tests were run as an inpatient. We never took chances with anyone’s life.

Here’s something I see frequently here. People present either in ER or at their doctor’s office with chest pain, shortness of breath, etc. WAY too many doctors in the local clinic here just tell them to go home and rest. They may prescribe medication to calm their “anxiety”. I’ve heard of several of these cases ending in death due to severe heart disease. How would those patients have been treated in my experience in Canada? If presenting at the doctor’s office, the patient would have been immediately transported to the nearest ER department for a total battery of tests to “rule out” cardiac problems. That’s the norm. If presenting in the ER the patient would have IMMEDIATELY been taken in for examination. An EKG would have been run immediately and other tests (cardiac enzymes especially) would have been done. If those come back normal, the patient is held over for 24 hours. Usually due to the fact that cardiac enzymes often rise in that period after a heart attack. Also more tests may be run, depending on the presenting symptoms. Under no circumstances would that patient be allowed to go home. Sorry, but that has been a really scary observation for me here.

August 27, 3:35 pm | [comment link]
24. mugsie wrote:

#19, jeffersonian,
Even the uninsured get good treatment in America, and with a lot more alacrity than in Canada.

And just what evidence are you basing that statement on? The last time I looked, that was indeed NOT the case. Most uninsured in the US get NO health care. They will not seek it because they cannot PAY for it. As a result, they usually end up in far worse a state than they would have if they had received “preventative” care through regular physical checkups, etc., which costs far less than treating a far severe “emergency” situation in an advanced case of illness.

August 27, 3:40 pm | [comment link]
25. Clueless wrote:

#21 Please notice that you are comparing a diagnosis made in the course of an examination in an emergency room by an ER physician with a diagnosis made by a GI specialist after careful testing.

NB:  The emergency physician is not a:
    1. GI specialist
    2.  A Neurologist
    3. An ENT physician
    4. A Cardiologist
    5.  Fill in the blank.

An ER physician’s job is to make sure you don’t have a life threatening emergency and get you slotted to the right specialist if you do.  If you do not have a life threatening problem, and by your own history you did NOT (Gastroparesis is not life threatening) then AFTER you go to the ER, you can be seen as an outpatient by whomever you think may help you.  As apparently you did.  In point of fact it is not uncommon to have irritable bowel syndrome (or for that matter gastroparesis after acute viral illnesses.  This does not make them emergencies, however “hurt” the feeling of the people who have tummy pain might be.

That is not a failure of the ER.  The ERs job was to make sure you weren’t about to die of acute appendicitis, not to correctly diagnose gastroparesis (or irritable bowel, or Crohns disease or Wilson’s disease or any number of bizarre “zebras” that cause abdominal pain in otherwise healthy people.

If you want careful diagnosis and testing of a non-medical emergency, then you go to the appropriate specialist.  If you have a medical emergency then go to the ER.  If you have a common problem you go to your primary physician.

As a nurse, you should know this.

August 27, 3:40 pm | [comment link]
26. Denbeau wrote:

Jeffersonian, I don’t deny your information. Perhaps we do agree on more than we realize. I will acknowledge that the best health care in the U.S. is better than the best in Canada, and faster as well. However, the other side of that coin is that the worst health care in the U.S. (e.g. often none at all) is worse than the worst in Canada. Canada’s struggling with wait times and delays for scans is partly a result of attempts to control costs, partly as a result of bad planning, and partly due to the fact that some rationing must take place. In a universal health care system, there have to be some constraints; it is simply not possible to deliver the platinum level of service to 100% of the people. In order to deliver the greatest good to the greatest number, some limits must apply. Brokers exist in Canada because some who are wealthy want the platinum level service they can’t get here.
Having admitted all that, and acknowledging that there is much to be improved in our health care system, I would still choose a Canadian or European model over the current U.S. system every time.

August 27, 3:45 pm | [comment link]
27. mugsie wrote:

Jeffersonian, clearly no matter what evidence is given to you, you will still disagree. That’s your opinion, and that’s fine. However, many don’t agree with you who have “personal” experience on BOTH SIDES of the border.

As Denbeau mentions in comment #18, most Canadians want to PRESERVE their healthcare system. I wouldn’t defend it so strongly either if it wasn’t worth it. I’ve been here in the US for 11 years now. I have to honestly say I’ve never had so many headaches and so much frustration trying to get BASIC healthcare in all my years in Canada. The system here is not working. More and more people admit this every year. Yes, the Canadian system has flaws too. I’ve already said that. BUT, it’s far better in my own experience than anything I’ve ever encountered in the 11 years I’ve been here in the US. Like Denbeau also stated, nobody goes bankrupt in Canada due to healthcare costs. That’s one fear they are not faced with, thank God!

August 27, 3:48 pm | [comment link]
28. mugsie wrote:

And Jeffersonian, regarding your friend’s CAT scan, I still believe there’s more to the story than is being told here. I know for a FACT that if that man had presented in the ER of either McMaster or Toronto General with symptoms as serious as you suggest, he would have had his CAT scan as an inpatient on an EMERGENCY basis. Those kinds of presenting symptoms fall into the critical category that could also be related to cardiac disease and are never put off like you stated. So, I have to state again, there’s got to be more to the story than you state here. I would love to read his medical record. I’m sure it’s full of surprises you are not mentioning here.

August 27, 3:52 pm | [comment link]
29. libraryjim wrote:

My sister-in-law and her family live in Ontario.  Since she is an American citizen (and by extension, her children have dual-citizenship), she often travels across the border to New York State where they have a family doctor and dentist. 

Most of their health care comes from out of pocket, since, as she says, she can get faster treatment and better care even if it means she pays more. 

She has little good to say of the Canadian system.

Jim Elliott <><

August 27, 3:57 pm | [comment link]
30. Clueless wrote:

” Under no circumstances would that patient be allowed to go home. Sorry, but that has been a really scary observation for me here.”

We used to admit folks who had “funny” symptoms that we figured probably were not serious.  However beginning a few years ago, Medicare, after the hospital admitted the patient and ran the tests, if the test came back negative would refuse payment on the grounds that the patient was admitted “unnecessarily”.

Over the past couple of years, Medicare has actually been going back a few years and if they find that the patient was admitted for concerns about an MI but actually had anxiety or a panic attack, they ask for refunds back from the hospital, of care given several years earlier. 

This “unnecessary care” is considered “Fraud and Abuse”.

Some hospitals have gone out of business due to engaging in such “Fraud and Abuse”.

Thus, the ER physician tries very hard to get it right.  If it is not an emergency and he insists on admission, the hospital may not be paid, and if there are too many of these, he will be fired.  If it is an emergency and he sends the patient home, he may easily be sued.  Such lawsuits do not need to stop at the limits of malpractice coverage.  I know one physician who, when a case went over the limits of his insurance, had not only his house, and savings taken away, but his salary garneeshed.  He commited suicide in order to provide for his children (he did have life insurance).

I too have made sure that my life insurance is in the name of someone else (my sister).  If I am sued beyond the limits of my malpractice coverage (and thus far I have not been sued ever) I too will plan on doing “the honorable thing” and providing for my children.

August 27, 3:59 pm | [comment link]
31. mugsie wrote:

Clueless, I understand everything you state. However, I DO disagree with most of it. I DID see my physician before leaving Canada. She believed I was recovering, slowly, but recovering. It was not until I was already in the US and discovered that I was NOT recovering that I became concerned. It was quite necessary to present to ER. I had family physician in the US, and was not able to hold down much food at all. That is quite serious, NOT just a “tummy ache” as you state.

No, gastroparesis is NOT common after a virus, NOR is IBS. I suffered about 12 hours of constant severe spasms while I was going through the acute phase of the virus. I have Chronic Fatigue Syndrome, and the specialist at McMaster believes that may have contributed to the fact I developed the gastroparesis, but my husband son did not. I’ve had many strange things happen to various body systems as a results of CFS. Not fun, but I’ve learned to live with it.

Your are quite right that it’s not the job of an ER physician to diagnose every presenting illness. However, he ordered NO tests. He offered no alternatives at all. He was quite haughtily certain that I had IBS and that was it. I had no history of IBS. I still don’t have IBS now, many years later. It was negligence on his part and you can deny that however you chose, but that’s a fact.

August 27, 4:02 pm | [comment link]
32. mugsie wrote:

#30, well I guess we’re all looking at the American attitude. How fast is “fast” to your sister-in-law? How life threatening are the health care concerns involved. Canada’s health care system is bases on PREVENTION. There’s a LOT of health teaching that just does not occur in my experience here. I still have to say, reality to one person is not reality to another depending on what you’ve been raised to believe. I was raised to be patient and realistic when it comes to healthcare. I don’t expect the healthcare professionals to put me before everyone else out there who may be far worse off than me. If I can safely wait a few weeks for a surgical procedure, then I’m fine with that. If it’s life threatening, then I’ve never experienced having to wait like that. Neither has any member of my family. So, something just doesn’t jive here. My family members are all still quite happy with the health care system in Canada. Some of them are even health care professionals themselves. So, I guess it all goes back to that “me” attitude again.

You mentioned your sister in law even goes to the US for dentistry. Wow! I’ve always received excellent dental care. I was always able to choose the dentist of my choice. If I didn’t like one, then I would go to another. There are health care professionals of questionable quality everywhere, Canada is no exception.

August 27, 4:12 pm | [comment link]
33. Clueless wrote:

#32
Do a google search on irritable bowel syndrome, chronic fatigue and viral illnesses.  Count the hits.

The bottom line is you did not have an acute GI emergency.

But you are angry, because you didn’t get enough testing even though an ER physician cannot perform endoscopy (that is done as an outpatient by a GI physician).

Again, this is why health care costs are high.  Patients wish every test, and they wish it NOW and do not care about the cost.  If they don’t get worked up the wazoo, it must be “negligence”.

It is not.  You didn’t have a medical emergency.  He was right.  You were wrong.  If they reengineer health care, so that folks who did not have an emergency are billed for “unnecessary ER visits” the way that hospitals who admit folks who don’t need to be there are charged for “fraud and abuse unnecessary admissions” ER visits wil drop.

I would not be surprised if folks do start being billed for going to the ER when it is not an emergency.  After all, it will cut costs.  Possibly it may even change attitudes about “NOW”

August 27, 4:21 pm | [comment link]
34. mugsie wrote:

#31, Wow is all I can say. Wow! Wow! Wow! You’ve just given a very strong and revealing testimony of what’s GLARINGLY wrong with the health care system here!!!! Asking for refunds because a patient was not as sick as was originally feared???? I can’t even wrap my mind around that one. Committing suicide to use life insurance to provide for your family???? Wow! Where is God in this equation????? Where is the sacred value of human life? It’s not “fraud and abuse” to admit a patient for a 24 hour period for observation or to run tests to try to determine the cause of symptoms. It’s caution. It’s SENSIBLE!!!! It’s thinking the whole thing through and trying very hard to get to the root of the problem. It’s WRONG to presume to know everything that goes on within the human body. It’s a gross SIN to take the life of another. THOU SHALT NOT KILL! It’s wrong WRONG to take one’s own life. The same commandment applies.

Wow! I’m really trying to wrap my mind around your statements here. You’ve totally blown me away. The reason I became a nurse was to care for humans, to hold sacred human life. If it takes a few more hours or dollars to do that, then so be it. I will know that I did everything in my power to try to help that person. If I missed something, it wasn’t because I didn’t try. Thank God for that!

August 27, 4:24 pm | [comment link]
35. mugsie wrote:

#34. I just don’t know what to say. Clearly you and I are on very different sides of the coin. I have to say it again, you are WRONG! Not being able to keep food down for a prolonged period of time is quite serious. Having your stomach not emptying and having the contents sit there is QUITE serious. Infections occur very quickly. Dehydration occurs. And then I don’t want to even mention what might happen next. The point I was trying to make is that this ER physician was was not making any effort to help me at all. He didn’t want to order any tests. He didn’t refer me to anyone. I had NO family physician here. I was VISITING! I would have worked with him if he had tried to help me find out why I was not recovering. BUT HE DIDN’T! End of story.

I knew I could safely get home in a day or two. So, I did that. Like I told you earlier I was sipping clear fluids to try to hydrate myself to the best of my ability. I was rapidly losing weight. I lost over 30 pounds. I was emaciated and looking quite gaunt. I was not able nourish my body. You call that not serious!!!! I’m sure glad you’re not my doctor!!!!

And I have to ask, why are you defending this guy? You weren’t there. You don’t even know him.

August 27, 4:34 pm | [comment link]
36. Clueless wrote:

I may not know this guy.  But I know the guy who blew himself away in order to provide for his children, after he got his a## sued doing his best to take care of folks in a busy emergency room.  He was a good physician.  He worked like a dog.  He went into medicine to help people and the folks he tried to help sucked out his life, blew up his debt and if anybody involved in a suicide goes to hell.  it is the lawyers and the greedy, litigiounous, unreasonable, ungrateful patients who will be there.

August 27, 4:43 pm | [comment link]
37. Clueless wrote:

If the government (egged on by patients) can ask for refunds from physicians and hospitals because a patient wasn’t as sick as thought, why is it wrong to expect the same for a patient?

In point of fact it is both wrong.

But nobody gives a sh%t about physicians.  They are just slaves to be sucked dry, and sued because they (SURPRISE) weren’t God

August 27, 4:46 pm | [comment link]
38. mugsie wrote:

#37, I can only pray for you and the family of the doctor who did this. He was clearly a victim of the problems of the health care system that have already been mentioned on this thread. The family lost a wonderful husband and dad; which he seemed to be by your words. And the health care system lost a wonderful doctor who truly cared about the patients he cared for. Clearly they were people to him; not just numbers and dollars in his pocket. Unfortunately he was of the minority.

I don’t think for one minute that this man will end up in hell for his actions. God is not cruel! He doesn’t just throw everyone in hell just because they didn’t get it the first time around. He may not make the “first resurrection” according to Jesus’ revelation to John in the book of Revelation.

Revelation 20:5     But the rest of the dead did not live again until the thousand years were finished. This [is] the first resurrection.
Revelation 20:6   Blessed and holy [is] he who has part in the first resurrection.   Over such the second death has no power, but they shall be priests of God and of Christ, and shall reign with Him a thousand years.

You can be assured that God will not forget his efforts. He will give him a chance to learn the truth without satan’s influence and will reward him accordingly. Your friend just doesn’t sound like someone God would treat harshly, like a false teacher (Pharisee, for example). We are all given a fair chance to overcome satan. God will give your friend this same fair chance. Count on it.

August 27, 4:55 pm | [comment link]
39. libraryjim wrote:

Mugsie,
I’m sorry, but you are not affirming my sis-in-laws experiences, choosing to nit-pic and invalidate her views because you have a different view and experience.  Shame on you.

In her opinion and experience, Canadian Health care is not as good as American health care. It must be the view of her Canadian-born husband, too, because he’s cut it down to me when we have had conversations on this.

So, while you have had good experiences, this is not universally the case.

Jim

August 27, 5:01 pm | [comment link]
40. mugsie wrote:

Clueless, clearly you are very upset by what happened to your friend. I am so sorry about that. He did what was right, and he was persecuted for it. Doesn’t that sound like the work of satan to you? It sure does to me.

I don’t understand your last comment. Aside from the government asking for refunds from physicians, hospitals, etc. for care that the “government” didn’t deem to be necessary, who else is asking for refunds? What else are you referring to here?

If anyone is playing God in this situation, it’s the government, NOT the doctor, hospital, etc. It just makes me physically ill to read what you have written here. I have no experience with the government asking for refunds for care already rendered. I have no experience with ANYONE (government, insurance agency, etc.) asking for refunds for care already rendered. That is so wrong, it just is beyond my comprehension.

August 27, 5:03 pm | [comment link]
41. mugsie wrote:

#40, libraryjim, I guess I would have to hear him say that to me with specifics. Without clear factual evidence, I just have a very hard time believing it. Is there any chance that he may be just going along with his wife because that is HER experience? I really have no clue. All I can say is that from over 40 years of experience with the Canadian health care system, and 11 years experience here in the US, I don’t agree.

I’m looking at many things when I say that. Money is a factor to getting good healthcare in the US. Yes, you can get superb health care in the US if you are affluently wealthy and and have lots of extra cash to dole out. However, the every day person who has to rely on insurance doesn’t get the same. They get the headaches of having to go through delays in health care delivery waiting on bureaucratic decisions about whether they should get such care or not. Those delays only add to already existing stress. In more cases than not, after waiting out the delays, they are only told NO, they cannot have the procedure, tests, medications, etc. which the doctors deem to be necessary for their care at that given time. They are politely told in a letter that they can “appeal” which will take about 30 days in most instances, at the least about 72 hours. These bureaucrats are not in the position to know whether such prescribed care is medically necessary or not. The doctor is the one who decides that with the help of the information the patient and patient’s family gives him. The doctor knows the patient, NOT the bureaucrat sitting in some government office somewhere.

All this unnecessary paperwork is what costs the extra money. All these extra “tiers” in the system, all the “redundancy” in the system, are what cost the extra money. It’s a very bad joke, and you can bet satan is having a field day with it all.

In Canada, EVERYONE who is legally there is given the SAME level of care. What is needed medically is what’s given. There is no need for an education in learning how to “work the system” in Canada as there is here. You need to have so much medical knowledge to advocate for yourself here. I can’t imagine how hard it must be for those who are elderly, mentally challenged, etc. I’ve had to dig deep into the system to get care for my husband’s elderly parents simply because they didn’t know what to do. It’s really scary. I’ve never had to do that in Canada. Yes, I’ve had to advocate for patients with some doctors I’ve worked with. There are some who are cocky and just just don’t care about the patients. Those are what I’ve had to deal with. It’s a totally different matter, and needs to be addressed too, but in my experience it’s far less frustrating and stressful that what I’ve had to deal with since moving to the US.

August 27, 5:21 pm | [comment link]
42. Denbeau wrote:

LibraryJim, I would agree that personal experiences are not a good measure; they provide far too tiny a window on very complex systems. I would go even further and suggest that it’s nearly impossible to say either “The Cdn system is better than the U.S. system” or “The U.S. system is better than the Cnd system” without defining “better” (or, in view of the current Democratic convention, without defining “is”).

The U.S. system has a very broad range of levels of service, from the best in the world to inadequate. The Canadian system has a narrower range of services, from excellent to poor.  As a Christian, I believe that the Canadian system does an overall better job of comforting those in need, and specifically a better job of comforting those who are poor, and in need.

I think the challenge to us, as citizens, and specifically as Christians, is to look at the options without prejudice, and model - as closely as we can - our service on His.

August 27, 5:24 pm | [comment link]
43. Clueless wrote:

Well who do you think is the “government”?  I’m not talking about Mao Tse Tung.  We live in the US which is a DEMOcracy which means that the government is the people, and the people are the patients.  So yes, it is the patients who demand to that money be “refunded” for “unnecessary” care, and call it “fraud and abuse” to admit people who do not have a clear medical emergency (as defined in hindsight by bureacrats)  for evaluation.

The DEMOS could fix this problem any time they liked, but they would rather blame physicians, and keep their malpractice lottery ticket.

So yes.  It is the patients who are responsible for his death because guess what?  In the USA we choose the government we want.

However rest assured, in a few years time, our choices will be rewarded by the health care system that we deserve.  However, I will be gone by then.

August 27, 5:25 pm | [comment link]
44. mugsie wrote:

Thank you Denbeau, you said it so very well. It’s very hard to measure. Experience is only part of the equation. But I guess what I’ve been trying to say all along is what you said so well. Canadian health care providers do a wonderful job of comforting those in need. I think Canadian government in general is a bit better at that than the US. Coming from a Christian perspective, as you are, I believe that is the right thing to do. No one is centered out. No one is rejected. Everyone is treated equally. The poor and needy are cared for just as well as the most wealthy. There is no segregation between the levels of income, etc.

I truly believe that is the right and Christian approach.

August 27, 5:30 pm | [comment link]
45. mugsie wrote:

#44 clueless, I’m sad for you. You seem so sad. Please know that my prayers are with you.

Yes, the government may call itself a democracy, but I don’t believe it to be a TRUE democracy. I won’t get into it here, but the whole voting system in the US is not an accurate reflection of the ACTUAL votes of the people. There is just too much lobbying going on behind the scenes, to mention one problem. Do you really think the people are calling the shots in the US? I sure don’t.  And I sure don’t think the people have much say in how the health care system works. We had a “California Speaks” symposium a little over a year ago regarding the health care system. Several sites were on live in various parts of the state. We voted “live” on what we believed. Our voting results were tallied electronically and returned to us on screen immediately. It was overwhelmingly voted by the PEOPLE that the health care system is seriously broken and needs to be changed. The largest percentage of the votes were for a government system funded by taxpayers like the Canadian system. It was almost overwhelmingly unanimous that the “private” and “corporate” entities needed to be removed from the system. It was strongly stated by the people that there should be no “profit” in health care. It’s also the level of illegal immigrants using the health care system. I’ve just touched the tip of the iceberg here. There is so much more. But, I can assure you, it’s not the PEOPLE who are calling the shots. It’s the corrupt leaders in the government.

August 27, 5:42 pm | [comment link]
46. Don R wrote:

Mugsie, if the government is so corrupt, how can the solution be to turn the whole health insurance system over to it?

August 27, 6:09 pm | [comment link]
47. Clueless wrote:

Most physicians would be happy to be in a National Health System where we were paid as civil servants, (or VA physicians) had the hours of civil servants, and had the governmental immunity of civil servants. (BTW, Veterans physicians are not immune like other civil servants, however they cannot be bankrupted by false claims like private physicians)

Unfortunately, such a system (even if it were to make a VA of every hospital, would be vastly more expensive than our current one, while greatly increasing wait times.

Physicians would certainly prefer it.  I would.  I used to work in a VA hospital.  Care was not as good as private as one could not get certain diagnostic tests, and there were long waits (several months) for most things, but it was much much easier on the physicians who actually had not unreasonable hours most of the time (usually 8 to 7) as distinct from 7 to 10 in the private sector.

Thus, having “no profit” will not reduce costs.  “No profit” will increase costs as well as wait times, in the absence of rationing. 

The health care system is seriously broken, but you will not like the fix, which will involve rationing care, as is done in Europe.  In England there is no dialysis over the age of 50.  Eighty year olds do not get elective spine surgery (nor do 70 year olds).  All of the folks in our ICU would be dead in England. Their ICUs are filled with folks who had MIs, not folks who have multi system failure.  But basic, preventive care is cheaper and more easily accessible, and folks don’t know what they don’t have.  Thus, since their gall bladders, appendectomies, child births and tonsils will be readily removed, they will not care that their elderly grandfather dies 3 or 4 years earlier, or that the infant with spina bifida is quietly left in the back of the ward to die, instead of being taken to surgery.  (And yes, that happens.  We had a talk with one of the English neurologists while I was in training.  (He thought it was a reasonable allocation of scarce health care dollars).

August 27, 6:15 pm | [comment link]
48. Clueless wrote:

I am sick and tired of hearing about how the “poor and needy” are not taken care of.

In the US, if you are an illegal alien, or an uninsured drunken idiot, and you go to the ER with a broken leg or appendicitis, or any other true medical emergency, they HAVE to admit and treat you.  They will bill you afterward, however since the uninsured and illegals usually give fake social security numbers and addresses, they will not be able to collect.

If you need surgery, the Orthopedist (or any other specialist) MUST come in and treat you regardless of insurance status.  If they fail to come in, it is called EMTALA violation and results in an automatic 50,000 dollar fine that is paid by both the specialist AND the hospital (100,000 total).

Thus, I am on call every third night.  I do not get paid for being on call.  When I am on call, I am usually paged to come in at least 1 or twice a night.  I bill for the patient’s I see, however since these are 30% medicaid and uninsured, and 60 % Medicare, I would not cover my costs if I came in late the next day (regardless of whether I slept the night before).

Surgeons in small groups face the same calculus.  They would not be able to keep their practices open if they did not work during the day, despite being called in at night, thanks to the fact that night call in the ER is essentially performed free as a compulsory public service by physicians.

August 27, 6:23 pm | [comment link]
49. Clueless wrote:

The EMTALA rule applies even with illegal aliens (who never pay) and legal ones like Mugsie (whose countries like Canada refuse to pay).

Had Mugsie been admitted, Canada would have refused the costs as being “excessive” (what’s the hospital going to do?  Bomb Canada?) and the Gi specialist who was called to diagnose Gastroparesis would have been stiffed, as with any other alien, illegal or not.

But the bottom line is that Mugsie was evaluated in the ER, and was found to not have a medical emergency.  She didn’t like the fact that she didn’t get a free workup immediately, instead of just having the usual free ER evaluation (paid for by everybody in the US who has private insurance).

The cry of the consumer “I need more free stuff and I need it now, and and need it right!  Or else I’m gonna sue).

The only reason I don’t leave medicine now is because when I do, there will be no neurologist in a three hundred mile radius who sees children, and some kids will die.  I dream of leaving medicine every day.  I can’t wait to leave.  Every physician I know dreams of leaving medicine, and none of our children will go into the field.

August 27, 6:39 pm | [comment link]
50. libraryjim wrote:

if the government is so corrupt, how can the solution be to turn the whole health insurance system over to it?

And that’s the truth! The problem in a nutshell

We live in the US which is a DEMOcracy which means that the government is the people,

Actually, the Government of the US is a represenational REPUBLIC, not a true democracy.

Anon. person: What kind of government have you given us, Mr. Franklin?
Franklin: A Republic, sir, if you can keep it!

Pledge: and to the Republic for which it stands ....

August 27, 7:39 pm | [comment link]
51. libraryjim wrote:

And of course I misspelled “representational”  rolleyes

August 27, 7:40 pm | [comment link]
52. libraryjim wrote:

Sicne the call went out for fact over experience:

Some interesting statistics:

Overall Cancer Survival Rates.
  According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology:1

American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women. 

American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.

Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.

For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.

These figures reflect the care available to all Americans, not just those with private health coverage.  Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average:  British men have a five-year survival rate of only 45 percent; women, only 53 percent.

Results for Canada.
  Canada’s system of national health insurance is often cited as a model for the United States.  But an analysis of 2001 to 2003 data by June O’Neill, former director of the Congressional Budget Office, and economist David O’Neill, found that overall cancer survival rates are higher in the United States than in Canada:3

For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.

For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

Early Diagnosis.

It is often claimed that people have better access to preventive screenings in universal health care systems.  But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment.  For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government.4

Access to Treatments and Drugs.
  Early diagnosis is important, but survival also depends on getting effective treatment quickly.  However, long waits for treatment are “common devices used to restrict access to care in countries with universal health insurance,” according to a report in Health Affairs.5 The British National Health Service has set a target for reducing waits to no more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment.  A study by the Royal College of Radiologists showed that such long waits are typical, and 13 percent of patients who need radiation never get it due to shortages of equipment and staff.6

Conclusion. 

International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs.  Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles.  No country on the globe does as good a job overall as the United States.  Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically overhauling the current system.

August 27, 7:50 pm | [comment link]
53. mugsie wrote:

Clueless, it’s hard to explain what you are faced with, except that what you describe is the “effect”  which has been “caused” by the greed of corporations who want to line their pockets in the health care field.

I had very good insurance when I came to visit from Canada. The thing that the American health care system doesn’t want to admit is that their charges are “excessive” due to being a “private industry” with no caps on pricing. Canada was fully within its right to refuse to pay exorbitant prices equal almost 4 times what it would cost in Canada for the exact same services. I can assure you it’s not their fault the prices are so high here and they should not have to pay the penalties. For the record, the time I was referring to when I was hospitalized was more involved than you think. I not only had my insurance through the province of Ontario, but I also had private travel insurance from the university where my husband worked. The hospital tried to milk it for what they could get. They tried to do oodles of unnecessary tests that time because they knew I had good insurance and thought they could make a mighty nice profit off my care. I was so flabbergasted that I actually had to call my insurance company in Canada and tell them to get on the horn with the hospital to put a stop to the racket. They were trying to do several tests that had nothing to do with my reason for admission. All I wanted to do was get the heck out of there and go home. I felt like a guinea pig. They didn’t hear a word I said, and certainly didn’t care about me, the person in this body. I requested to be discharged. I was confident that I was able to get home. My flight was the next day. I knew what I had was the gallbladder problem I had mentioned earlier. I also knew what precipitated it; my late pregnancy with my youngest son. My symptoms were classic gallbladder symptoms. So, like I said earlier, I went home, got tested properly and diagnosed in one day. By the next day I was scheduled for surgery to take place 3 weeks later, in Canada.

No, it wasn’t me trying to get “free” stuff from your system. It was the system trying to get “free” cash from my insurance providers back in Canada. I’m quite clear on that.

What you state here is not caused by the people who need care, as you seem to believe. I think I very clearly stated that in the case I mentioned regarding my gastroparesis, I was definitely in need of urgent medical attention. I lost over 30 pounds in just a few days. I could not eat. I could not adequately hydrate my body. I have very deep concerns about your comments about this. You seem to want to slough it off as me taking advantage of the system. You couldn’t be more wrong. Being raised in, and having worked in, the Canadian health care system, I don’t believe in wasting resources. I’m not one to rush to the ER with every little thing. If you knew me personally you would know that and would never make a statement like you did. I’m more likely to wait a while to see how things pan out before I go for medical attention. Often things do work themselves out if it’s just a virus and no unusual complications occur. For instance, I don’t run to the doctor every time I get a cold. Almost everyone I know does. It’s a virus and needs to run its course. I treat the symptoms until I pass through them. The case I spoke of was very unusual for me. It was enough to “scare” me to seek help in ER, which I would not normally do. I prefer to call my doctor’s office first. But, being here in a foreign country with no family doctor nearby, and being scared since I could not understand what was going on, and was seriously losing weight and hydration daily, I knew I needed to seek help. I’m totally amazed that you would say what you did. I consider myself fortunate to have been able to get my flights changed so I could get home quickly. My doctor there treated it like the emergency it was. I was diagnosed and treated as I should have been. I’m actually glad I was able to get home for the bulk of it, considering what I now know about the health care system here.

“I need more free stuff and I need it now, and and need it right!  Or else I’m gonna sue).

This statement sounds more like something an American might say. Most people in Canada are not litigious. Most people in Canada are also quite happy with their health care system. It’s only a minority who aren’t. I have a feeling that if one digs deep enough into the cases of these folks, you will find it’s all about the “self”, not about the quality of the health care system.

You sound like you NEED to leave the health care system. You sound burned out. That’s not doing anyone any good. No one is irreplacable. If you choose to leave, and give a certain amount of notice, surely someone else can be brought in to take over the practice. If there is no joy in it for you any more, then you may want to consider making a change sooner than you think for the good of not only yourself, but also your family, and the patients you care for. If we don’t feel joy in what we do, it comes across in many ways we may not be aware of. Just think about that.

August 27, 8:11 pm | [comment link]
54. mugsie wrote:

#53, libraryjim, when you factor in the population to geographic area ratio, I think the Canadian health care system is going quite a good job. The figures you show are not much lower than the US. When you factor in the reduced cost per patient for resources in Canada, that’s quite phenomenal. Remember also that you only have figures for those “recorded” to have received care in the US. How about all those who NEVER seek medical care due to not having any insurance. Of course, the US can provide wonderful care, as I mentioned before. However, money does factor very highly into the level of care one receives regardless of what your statistics say. Everyone in Canada receives the same level of care regardless of socio-economic status. The statistics from Canada are more likely to be accurate since most people in Canada do seek medical care on a regular basis.

As to cancer, I don’t have a lot of experience with it here, except for my mother-in-law. I have to say that it was a horrific experience. Her family physician was probably one of the most negligent doctors I’ve ever encountered. My mother-in-law had visited her several times in a row with complaints of shortness of breath, pain in her upper back, and spitting up mucus. She kept telling her she just had “arthritis” in her back. That didn’t explain the shortness of breath, or the mucus. My sister in law had been taking her in for these visits so I was not aware of what was going on. I spoke to her on the phone one day and she sounded horrible to me. She told me had been to see the doctor several times. She was not able to give me any satisfactory answers for her condition. So, I suggested we go pick her up and take her in to see someone at urgent care. I was concerned she may have pneumonia. What we actually found out was quite a shock. Not once, even with such obvious presenting symptoms did her family physician order a simple chest xray. Such a simple and inexpensive test can tell you so much. I requested that one be done in urgent care. They did it, and what we found was a growth in her left upper lung lobe that almost completely filled the lobe. The urgent care physician ordered a CT scan which was done that very same afternoon. The radiologist report told us it was probably cancer, but we needed to do a needle biopsy to confirm the diagnosis. Here’s where things went sour. The clinic (her medical group) only does these one day each week. They wanted to wait another couple of weeks for her to have the test. No matter how hard we fought, that didn’t change. However, the biopsy was a total waste of time.  They didn’t even get an adequate specimen to give us reliable result. First it took them about 10 days to get the results back to us. Next, the results were useless. I was so filled with anxiety for my mother in law. She was not sure what to do. I got on the phone with Loma Linda Medical Center just up the road and asked them about their procedure and how reliable would the results be. How long would it take for us to get the results? They don’t even take the patient off the table until the lab confirms they have a reliable sample to work with. The results are back within 24 hours. More reasonable, in my opinion. Even a couple of days would have been acceptable, but TEN DAYS??? Not satisfactory in this type of situation. I looked into the costs to have a private consultation with a surgeon at Loma Linda. A nice tidy sum of about $1600 dollars. However, we needed an answer. My mother in law decided to go with it. We couldn’t even look at treatment options until we had a diagnosis. We got the consult and the surgeon believed it was probably cancer based on the CT films and blood results. However, she needed to do a biopsy to know for sure. My mother in law’s insurance wouldn’t pay for her to have the biopsy at Loma Linda even though her medical group’s source already FAILED big time. Again we looked at costs. We were talking about at least $6000 just for the biopsy. My mother in law decided to go with it due to needing a diagnosis. She’s an elderly lady in her 70’s. She lives off her meager savings and what little social security she gets. She should not have to spend such exorbitant amounts just to get a diagnosis.

The biopsy was done, and the results came back with stage 4 lung cancer. Then the trouble just got worse. Her medical group only has one oncologist on staff. He didn’t want to do the recommended treatment for her. We had to fight again. He also had the worst bedside manner I have ever seen. He only seemed to want to fight with us. Strange as it sounds, I actually had the insurance staff on the phone fighting with the medical group to provide care to the patient. That was a first for me. I was very quickly educated about the dishonest practices in medical groups through this experience. That’s only the beginning of the story. There was so much more.

August 27, 8:49 pm | [comment link]
55. Clueless wrote:

The costs in the US is what it costs in the US.  Private patients pay for both the uninsured, the illegal alien, the Medicaid patient, and the Medicare patient as well as for themselves.  That is why it costs 4 x the price in the US than in Canada.  This is the system that the US government has set up.  We are not permitted to charge the unininsured less than what we charge private patients because this would be considered Medicare/Medicaid fraud (as the government would no longer be getting the lowest price).  I can see a patient free in church and not charge him.  If I see a patient in the ER I MUST charge him my full fee or else I can be turned in by a government “whistleblower” as committing “FRAUD and ABUSE”.

The fact that in Mozambique, the cost of an ER visit would be a bottle of goats milk does not mean that a patient from Mozambique can go to a hospital in Canada and pay for his stay with a bottle of milk.  Explaining how it is so much better in Mozambique will not change the fact that Africa is not Canada.

Nor can a patient from Canada go to a hospital in the US and dictate price.  That patient can only stiff the hospital, (as you successfully did) while complaining about care. The US is not Canada.  We do not have a government run hospital system paid for by taxes.  We have a hospital system that excessively charges private patients in order to subsidize the favored by the government who are Medicaid, Medicare, and aliens (illegal and legal, those empty handed, as well as those bearing goat milk or bearing vouchers for “really good insurance” whether from Germany, Canada or Botswana)

As to my leaving medicine, unfortunately, not all who are irreplacable will be replaced.  You can replace a physician, but you can’t make him work for less than cost.  Most kids have Medicaid.  The only way to make money on Medicaid is to run a mill, seeing patients in 5 minutes or to have a very diverse population and to (like the hospitals) make money on the well insured, and accept that you will lose money if you see kids.  I choose for now to do the latter.  I know who will die when I stop.

It is a lot easier to just say “I don’t see kids, they are too complicated for poor little old me”.

There are no pediatric neurologists in the pipeline.  The nearest ones are in university centers where they are subsidized by the other physicians in the group.

When I leave folks will simply say (sadly) unfortunately you are going to have to go to Kansas City or Little Rock.  We don’t have a specialist here.  They already say that for pediatric Rheumatology, pediatric Endocrinology, Pediatric Surgery, Pediatric Orthopedics and Pediatric Neurosurgery and Pediatric Cardiology.  Then mom and dad can figure out whom to parcel the other kids to, while they live in their kid’s hospital room 300 miles away.  Or else they can let their kid go away alone.  Or they can simply say, “what’s the use” and take him/her home.

It is beginning to happen with Medicare.  The internists are all becoming hospitalists, and their patients keep coming to me asking “where can I find somebody who takes Medicare”.  Right now, it is only nurse practitioners who are taking new patients.  This is where Kid care was 10 years ago.  Some specialists are also already closing their practice to new Medicare patients (and virtually all close their practices to Medicaid patients). 

I am an outlier.  I could improve my burn out by doing likewise.  I don’t need to leave medicine.  I could simply do private pay only.  Many specialists are doing just that.

August 27, 8:57 pm | [comment link]
56. mugsie wrote:

Wow! You reveal many sources to the problems in the healthcare system. This paragraph in particular is quite revealing:

We do not have a government run hospital system paid for by taxes.  We have a hospital system that excessively charges private patients in order to subsidize the favored by the government who are Medicaid, Medicare, and aliens (illegal and legal, those empty handed, as well as those bearing goat milk or bearing vouchers for “really good insurance” whether from Germany, Canada or Botswana)

If there was ONE healthcare system paying for ALL patients as in Canada, these problems wouldn’t exist. The paperwork alone is phenomenal here. That must cost a fortune to pay for in time and resources. I’m sure Medicaid and Medicare are not perfect, but perhaps they don’t want to pay for the same reason my insurance provider in Canada didn’t. The costs are extremely inflated. You can’t blame all that on patients. I can assure you a LOT goes into the pockets of the executives of these “corporations”. Yes, there are illegal immigrants who use the services. That’s a problem that came up during our “California Speaks” symposium. The federal government needs to clamp down more on illegal immigrants. In my opinion, if someone presents for care, and is not legally here, they need to be just stabilized and then sent home. The government has a perfect opportunity to intercept these illegal immigrants in hospitals where the ER departments are abused. Just think about how many could be deported to their home countries if intercepted in ER departments. I know Canada won’t provide full care to these individuals. They do stabilize them, but that’s all. They are told that they need to go home and get legal status.

As for the milk from a cow scenario, that was a good one. However, what are the chances that someone from a country that poor would present for care in a Canadian ER department as a visitor? Not very likely. The poor in Canada are cared for by their own country. That’s the right thing to do. The poor in the US are just thrown to the dogs. That’s NOT the right thing to do.

Please don’t misunderstand me. I do understand what you say. However, I just don’t happen to agree with a lot of it. The US dug itself into its own hole here. It let illegal immigration get out of control. It let private industry take over health care and then grossly inflate the prices for their own gain. It boasted around the world about how wonderful this country is; not true when a person actually comes and learns for himself. However, that boasting made millions, even trillions of people want to come here for the American Dream! A rather over-inflated idea in my opinion. We always have an effect to every cause. The US did it’s own things to CAUSE this EFFECT to occur.

As for me, I would go back to Canada any day if I could. My husband is an American. He wanted to be close to his family and that’s why we came here. We was in Canada for several years and agrees the healthcare system is much better there in fairness to everyone who populates that country. He agrees that healthcare is quite segregated here and not evenly distributed across the socio-economic scale. He just wants to be near his family. I made that sacrifice for him, but many days I wish I could go back.
So, please think again about what you say. There’s more to the picture than you might choose to believe.

You can accuse me of “stiffing” the hospital. However, I think I clearly explained how they tried to “stiff” my insurance providers back in Canada. I did not allow it. I left their facility and went home and had my own country help me with my medical problems. That was the right thing to do. So please think again about who’s actually “stiffing” who!

August 27, 9:32 pm | [comment link]
57. mugsie wrote:

Oh, and another thing. I was not carrying a “voucher” for my medical insurance. The hospital called and confirmed my insurance before they would even treat me. They knew they would get paid. They just did not know they could not ROB my insurance providers.

August 27, 9:34 pm | [comment link]
58. Clueless wrote:

Oh.  It’s our fault that we are overrun by illegal immigrants.  We told the world we loved our country.  If we had truthfully told everybody how dreadful we truly are, then everybody would stay at home quietly milking their goats.

Odd how loud China was beating its drum last week.  I guess hordes of illegal immigrants will just be piling into Beijing because just as they are stupid enough to believe US propaganda they will now believe Chinese propaganda. 

Here’s a suggestion.  If you come to live in a country and take advantage of its benefits (meager though you may think them) maybe you should consider supporting it.  Alternately in the same spirt that you urged me to leave medicine, I suggest that if you don’t like the US, you go home.  After all you have so much better health care there.  Please continue to tell the world all about how wonderful Canada is.  We have lots of illegal aliens being swept up in INS raids who need a new home.  Canada would work fine.  After all, you have free health care.

August 27, 9:42 pm | [comment link]
59. libraryjim wrote:

Basically I think it comes down to this;
If you like the Canadian system better, then maybe that’s where you need to live.

I see it the same way as those who come into an established church or other organization and say “You don’t do things the way I think they need to be done, so I’m going to insist that you do it this way” (the Episcopal Church is a good example).

I still never understand why someone comes somewhere willingly, and then insists they do it the way they did where they came from. (for example, many priests I’ve met who used to be Baptist want to turn the liturgy into a mirror of a Baptist service.)

Our system, flaws and all, is OUR system.  I’m content to live with that.  Just as our church is OUR church. Don’t come into it just to change it.  In comparison studies, such as I cited above, the US system comes out better.  Period.  Did you know that over 11% of Canadian trained dentists leave Canada for the US each year?  Why would they want to leave such a nice system? Probably because it isn’t that nice. 

Yes, we need to fix the flaws in our system (Medicare fraud, for example), but not scrap it for something that has been proven to not work as well.

That’s like trading a Caddy for a Kia!

Peace
Jim E. <><

August 27, 9:47 pm | [comment link]
60. libraryjim wrote:

heh, Clueless, our messages crossed in the posting. 

JE <><

August 27, 9:49 pm | [comment link]
61. mugsie wrote:

Well, clueless, I believe we’ve come to an impasse. I’ve stated my position quite clearly. I just don’t happen to agree with your opinions, based on my own personal experience with the health care systems with BOTH countries. Neither is perfect, no doubt about that. BUT, I honestly do believe its wrong to expect your population to live in fear of bankruptcy if they should find they need surgery, etc. I never had that fear before. It’s not a good thing. It’s wrong.

I do support this country. I pay my taxes just like you do. I work here to support myself, and so does my husband. I paid over $6000 so I could get through a very flawed immigration system. It took me 7 years to get through it. I think this country has definitely made profits off me too, don’t you kid yourself.

Health care in Canada is not free, as so many believe. You do pay for it. It’s just not one BIG payment at a time. It’s small payments through your taxes. It doesn’t hurt as much that way, and it doesn’t cause bankruptcy. It’s an example of where tax dollars are truly working for the people. I look on that as a good thing.

Well, I’m going to sign off. I keep telling myself to not get into these blogs. They are such a drain on time and energy. But, every so often I see something that I’m truly passionate about and I end up participating. I’ve got to work harder on disciplining myself in that sense.

August 27, 9:55 pm | [comment link]
62. Country Doc wrote:

Socialism never works in any area.  Look at schools, welfare, government medicin, etc.  Basically, by the force of the state assets are taken from the productive to give to the less productive, with a bureaucratic surcharge taken out.  Cluless in 100% correct.  The government, legal plunder system, and faceless corporations have taken the joy out of medicin and ever doctor I know is angry and can’t wait to get out.  One nice thing though is that when we are all government employees, we will work like government workers!  Too bad the voters are suduced by the Marxist who have the simplistic answers.  By the time they find out the infrastructure in medicin will be destroyed and not recoverable.  Maybe an underground black market system of health care will arise, but not for many years.

August 27, 11:50 pm | [comment link]
63. Denbeau wrote:

Clueless, you said:

Private patients pay for both the uninsured, the illegal alien, the Medicaid patient, and the Medicare patient as well as for themselves.  That is why it costs 4 x the price in the US than in Canada.

The U.S. spends about 15% of GDP on health care. That’s averaged across everybody; those who pay, those who can’t, illegal immigrants, long-time taxpayers, etc.

America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and wait times   (1)

I’m not saying that the U.S. system is bad and Canada’s is good. I’m saying that both systems could be better. And one of the ways to try to figure out how the U.S. system could be made better is to look at other countries that are succeeding, and try to figure out what they are doing that might help in the U.S.

The U.S. spends almost twice as much per capita as most other countries (2), and yet comes 47th in male mortality, trailing countries such as Japan, Sweden, Australia, France, Italy, Canada, Spain, the U.K., Germany, Ireland, Finland and many others. It only just surpasses Albania and Cuba, who follow in spots 48 and 49.  (3)
I don’t know what the best strategy for the U.S. is, but surely we can admit that there’s a problem.

1 Karen Davis, Ph.D., Cathy Schoen, M.S., Stephen C. Schoenbaum, M.D., M.P.H., Michelle M. Doty, Ph.D., M.P.H., Alyssa L. Holmgren, M.P.A., Jennifer L. Kriss, and Katherine K. Shea, “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care”  Commonwealth Fund, May 15, 2007.

2 Pear, R.. “U.S. Health Care Spending Reaches All-Time High: 15% of GDP.” The New York Times, 9 January 2004

3 CIA World Factbook (2007)

August 28, 12:25 am | [comment link]
64. Clueless wrote:

“The U.S. spends about 15% of GDP on health care. That’s averaged across everybody; those who pay, those who can’t, illegal immigrants, long-time taxpayers, etc.

  America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and wait times (1)”

This is true.  Some 50% of costs are spent in the last two years of life.  This is because in the US, we are aggressive about treating critically ill patients.  In the Netherlands or Belgium, there is active euthanasia of the fragile elderly and of infants.  In England or France, if a 75 year old patient with severe renal failure presented to the ER in congestive failure with an acute MI, they would be placed on the hospital ward, given morphine to “keep them comfortable” and would be allowed to “die with dignity” with an attentive nursing staff and the presence of their family.  In the US, the same patient would be admitted, dialysed, intubated and ventilated briefly until their fluid was off if need be, would, after a stay of about 5 days be transferred to the cardiac ward, with a slew of medications to keep his heart going, would then go to cardiac rehab until they were strong enough to go home, and would then go home.  They would continue to need specialist follow up while at home, and it would not be surprising if a year later, the same thing happened once more.  Eventually they would die 3 to 5 years later.  Nobody lives for ever.

All this extra care costs money.  HOwever in the US the elderly and the disabled are treated in the same fashion that they would be treated if they were 40 years old and still contributing to the economy. 

The extra couple of years that folks with severe illness live in the US (and if you look at how long people with cancer, or people with an MI or a stroke live after they get ill in the US compared to Canada, England let alone the Netherlands) does not help us with our mortality statistics.

The reason that the extra years we give the elderly do not show up in our statistics is because we also treat the young.

In England, France, Canada, most places, an infant who is premature who then dies before the 40 weeks that they would normally have had is considered a “still birth” and is not counted in life expectancy tables.

In the US we try to save the lives of just about every infant who has a prayer of making it.  If they die before they are 40 weeks gestation then it is called a death, and their lack of 78 years of expected life, subtracts from the 78 years of average mortality taking away from the extra few years we give our elderly.

In point of fact, premie infants tend to be fragile children, and may have other problems including seizures, hydrocephalus, learning disorders, retardation, cerebral palsy, asthma and are at much higher risk of dying, thus wrecking our scores.

Other nations solve that problem by simply having them die (with “dignity”, with “grief rooms” and flowers and kindly attendants who assist the families through the “grieving process”.

We choose not to.  That is about to change.  Enjoy.

August 28, 9:32 am | [comment link]
65. Don R wrote:

The effects of socialized medical care combined with the cultural acceptance of euthanasia can be lethal.  And they are beginning to appear here, too.

August 28, 11:00 am | [comment link]
66. mugsie wrote:

Clueless, your comment at #65 is very misinformed and largely a bald faced lie. I’m speaking from first hand personal experience working IN HOSPITALS——IN CANADA for almost 20 years!

Let’s address this point regarding elderly patients. I can’t speak to what occurs in other countries, but I CAN speak to what occurs in Canadian hospitals. As a nurse who spent the bulk of my career in Canada working in critical areas I can assure that VERY AGGRESSIVE measures are taken to save the lives of ALL elderly patients who are brought in for care. The only time the care is not aggressive is when the patient, or the patient’s legal representative has already documented on record a DNR (do not resuscitate) order. That order MUST be on the patient’s record before any efforts to resuscitate are waived. There is no MERCY killing going on I can assure you. I can also assure you that a very LARGE percentage of the patients in Canadian hospitals are elderly, just like in the US. There are entire wards in hospitals dedicated to their care. They are labeled as either “geriatric” or “extended care” wards. There are also many patients who actually “live” in hospitals who need permanent care due to severely handicapped conditions. I know this first hand.

So, you are wrong. The system there has the same burdens in caring for its population as the system does here.

Now, let’s address the issue of premies. Let me define for you what a “stillbirth” is in Canada. It’s a child who had ALREADY died prior to leaving the womb. It’s not a child who has been born and then left to die because it “probably won’t survive”. I can assure you that VERY AGGRESSIVE efforts are taken to save each and every child while still in the womb. Advanced monitoring techniques are used the instant there is any reason for concern. The life of every child is HIGHLY VALUED and is not left to circumstance as you seem to think. I’ve seen premies that just barely make the size of my index finger. Yet, the premature nursery staff are aggressively working to save those lives. It tears our hearts out when we lose one.

You are so wrong. I don’t know where you got this information from, but it could not be more false. It’s this very misrepresentation of another country that causes people to get false impressions. It’s dangerous, and does far more harm than good.

Before I actually came and lived in the US I was not in a position to form an opinion about the health care system here either. I had experience through a couple of uses during visits, but I did not have regular need to use the system. Now, after living here for 11 years and having had to face some very serious health care situations in my family I’ve had to dig deep into the system to advocate for my family. That’s how I came to my conclusion that I personally believe the Canadian system does a much better job.

But, I do take offense when I am told bald faced lies about a system that has been very effective for its members in my experience both as a consumer and working professional.

August 28, 11:40 am | [comment link]
67. Clueless wrote:

We have physicians who come from Canada who work here.  They are stunned at how aggressively we treat our patients.  When Canada and England give up, we are just getting started.  The British, and Italian physicians say the same thing.

As to what is called a still birth, your right, doctors call dead babies still births.  But that is not how Canadian statisticians record them.  That is why third trimester deaths are so high not only in Canada, but in England, France, Belgium and essentially every other nation. (They are much higher than ours).  I posted the World Health tables the last time this argument came up.

Go look it up.

August 28, 11:51 am | [comment link]
68. mugsie wrote:

Clueless, I don’t know these doctors you are talking about. I would love to have them tell me to my face what you just said they told you. It’s a total lie. As a critical care nurse who worked in Canada for almost 20 years, I know first hand how “aggressive” the efforts are to save patients in Canada. I’ve been in many emergency rooms here too and I have to say that in some cases (not all) the efforts haven’t even been as strong. I’ve attended my husband’s elderly parents in critical care areas. Yes, the staff did a fairly good job, but not any more aggressive than what we would have done in Canada. I also observed some glaringly obvious malpractice events which we would have had cause to take to court, but did not. Things such as doctors orders being written, but not implemented. Wrong medications being ordered even with very obvious labeling of allergies on the patient record. Inaccurate recording of information by doctors (information I personally gave to those same doctors). Don’t kid yourself. There are problems on BOTH sides of the border. We actually had to fire a doctor who was caring for my father in law while in hospital because of his negligence. He scared the hell out of us.

I don’t know about the 3rd trimester statistics in Canada, but I do question what you say simply because I know first hand what is done to save these babies. I will have to check to see how Canadian statisticians record still births. In my experience, it’s recorded on the patient record as a “still birth”, meaning the patient was dead before leaving the womb. Efforts are always taken to make every attempt to save babies at risk while still in the womb. Like I said above, the instant a problem is noted advanced monitoring is initiated and the baby is kept alive at all costs. Cesarean sections are done on an emergency basis if the child needs to be taken from the womb. Yes, all efforts are taken to allow the mother to have a natural birth. That’s in the best interest of both the mother and child. But if the situation calls for an emergency c-section, then it’s done. No questions asked. The mother just has to agree to the procedure.

Another thing. If as you say the statistics are recorded as you state, then that’s a false representation of the facts. I will have to look into that one. It definitely does not accurately reflect the TRUE statistics of what goes on in hospitals in Canada.

August 28, 12:11 pm | [comment link]
69. Clueless wrote:

I do not have the citation from World Health handy today (though I remember posting it about 6 months ago.  (NOne of my comments are available in the archives for some reason, I can’t pull them up from the member section).

However here is some confirmation, though obviously not from World Health.

From:
http://pajamasmedia.com/blog/the-doctor-is-in-infant-mortality-comparisons-a-statistical-miscarriage/

“Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies — considered “unsalvageable” outside of the U.S. and therefore never alive — is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

When Canada briefly registered an increased number of low weight babies previously omitted from statistical reporting, the infant mortality rose from 6.1 per 1,000 to 6.4 per thousand in just one year.

August 28, 12:27 pm | [comment link]
70. Clueless wrote:

Maybe you could go be a “critical care nurse” in the US.  I think you would be surprised.

Folks who would be in the ICU in Canada are sent to the floor in the US.

Folks who would be admitted in Canada are sent home (like you) with instructions to drink fluids.

Folks in US ICUs would die in Canada.  Or England.  Or France. 

But cheer up.  Soon that will change.

August 28, 12:31 pm | [comment link]
71. mugsie wrote:

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

WHAT!!!!!! THAT’S PURE BULL!!!!! Where does it say that? EVERY child no matter how small who leaves the womb and breathes and has a heartbeat is considered a LIVING child.

I just read the article you linked. Like commentor “Nan G” states at the bottom of the article you linked, it would have helped if the doctor would have included some footnotes to back up her figures. This is only a newspaper article based on the information given by one doctor. Hardly what I would call reliable information. It’s also an American doctor. Has this women even had any experience working in the Canadian health care system? I’m sorry clueless, but this article bears no weight for me. I just have way too much actual hands on experience in the Canadian health care system that leads me to a very different conclusion.

August 28, 12:40 pm | [comment link]
72. Clueless wrote:

Elves, I posted a link to a table with third trimester deaths from the World Health Organization on a similar article about six months ago.

Could you please find it for me?
Thanks

August 28, 12:43 pm | [comment link]
73. mugsie wrote:

Maybe you could go be a “critical care nurse” in the US.  I think you would be surprised.

Folks who would be in the ICU in Canada are sent to the floor in the US.

Folks who would be admitted in Canada are sent home (like you) with instructions to drink fluids.

Folks in US ICUs would die in Canada.  Or England.  Or France.

But cheer up.  Soon that will change.

Now I KNOW you’re making this stuff up. These statements are all false. Canadian nurses are hired by American hospitals all the time. They are frequently hired in critical care areas. I was actually offered one of those positions myself, but turned it down. I have many friends who work in critical care areas in the US, who went into those positions straight out of school from Canada. We are actually told that American Hospitals LOVE Canadian nurses (not a lie, but a FACT). We receive very aggressive training. Actually, to note an observation, a daughter of a friend of mine was considering nursing training. She asked me to look over the curriculum for nursing training at local colleges. I was shocked at how much was left out that was considered standard for our basic nursing training in Canada. I’m not saying that all institutions may have the same level of training, but all of those did. I encouraged her to look elsewhere.

Your third statement is actually very revealing. That’s not considered safe patient care. To send a patient home and instruct them to “drink fluids” without doing any investigation to find the source of the problem is nothing but GROSS NEGLIGENCE! I could never do such a thing in good conscience.

Your next statement is about as arrogant as one can get. “Folks in US ICUs would die in Canada.  Or England.  Or France.” I can’t speak for England or France, but I know that’s a lie regarding Canada.

Well, clueless, I’ve had enough this “discussion”. It seems to me you’ve begun grasping at straws now. Not what I would consider a meaty discussion based on facts alone. I don’t care to be part of a discussion based on lies, hearsay, and deceit. I’ve given you nothing but the facts as I personally saw them physically in hospitals in Canada. None of what I’ve said has been based on hearsay by other people who may have gripes of whatever sort. None is based on newspaper propaganda without supporting evidence to back up their claims. Virtually everything I’ve said is based on my own experience as a nurse in the Canadian health care system for almost 20 years, and as a consumer here in the American health care system for the past 11 years who advocated for family members in very serious health conditions. Contrary to what you may believe, I’ve spent LOTS of time in ICU’s, CCU’s, and ER departments here in the US helping my family members get good care. I’ve also had an ER instance myself as a patient, but I won’t get into that one. It’s quite an interesting story in itself.

No, clueless, in this area, I guess your screen name applies. You can’t debate on something when you don’t have the facts first hand. You can only make empty statements and that’s what you seem to have been throwing out there for the last while. I’m done. I’ve got far more important things to do with my time now.

I will keep you in my prayers. It became very evident to me that you are suffering from burnout in your professional position. I pray you will find a way out of that and find peace. May God be with you!

August 28, 1:01 pm | [comment link]
74. Clueless wrote:

http://en.wikipedia.org/wiki/Infant_mortality

This article in Wikipedia includes some references.


While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that “First, it’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don’t reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates.

August 28, 1:05 pm | [comment link]
75. Clueless wrote:

Well Mugsie.  How about some references from yourself, instead of ad hominems?  Oh Sorry.  Not the Liberal way.

“God be with you too”.  Nice touch.  Must be a California episcopalian.

August 28, 1:07 pm | [comment link]
76. Jeffersonian wrote:

I got swamped with work and family stuff yesterday, but it doesn’t appear that the discussion went in a positive direction in my absence.  Mugsie, believe it or not, we’re not all lying.  Grow up.

August 28, 1:23 pm | [comment link]
77. mugsie wrote:

Clueless, I will speak for myself here. First of all, I’m not liberal, nor do I believe in the liberal/conservative terminology. I am not a California Episcopalian. I did check the church out for a while, due to having been raised in the Anglican Church of Canada. However, the Anglican Church in both the US and Canada don’t even remotely resemble the church I grew up in. I’m totally removed from all Anglicanism now.

You may call my comments ad hominems, but they are statements based on facts from actual personal experience. If I were you, I would talk with some more professionals who actually worked in the Canadian health care system for a long time and get their facts too. You will find that they match. You will find that most Canadian consumers and medical professionals are actually quite happy with the health care system there unless they are greedy. There are wonderful people who work in that system who aren’t there for the money. They are there because they love working with people and just want to help them. I was one of them. I personally worked in Ontario, Manitoba, and British Columbia. I can speak from experience for the health care system in all 3 of those provinces. The other provinces I have no first hand working experience in, so I won’t speak for them.

The point is that if you are serious about checking out the TRUE facts from reliable sources, you will find that everything I’ve said is true. I would have to pull records from every institution I’ve worked in and been in as a consumer to back up these statements. However, I’m certain there are reliable sources of data out there that will back up these statements.

August 28, 1:30 pm | [comment link]
78. Clueless wrote:

http://www.theglobeandmail.com/servlet/Page/document/v5/content/subscribe?user_URL=http://www.theglobeandmail.com/servlet/story/RTGAM.20080505.wpregnant05/BNStory/specialScienceandHealth/home&ord=29193473&brand=theglobeandmail&force_login=true


Well, I can’t vouch for the reliability of the Canadian Globe and Mail, however if you believe that this CANADIAN newspaper is a reliable source, here is what it says.  (The link requires purchase, unfortunately).

According to the May 5, 2008 Globe and Mail, Canadian women and newborn babies are suffering due to rationing of neonatal care:  High risk births are sent to the US.  This lowers Canadian costs, while also improving their birth statistics.


“More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors’ group attributes to the lack of a national birthing plan. The problem has peaked, with British Columbia and Ontario each sending a record number of women to U.S. neonatal intensive care units (NICUs).

  ...“Neonatologists are very stretched right now,” Dr. Lalonde [Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada] said in a telephone interview from Ottawa. “We’re so stretched, it’s kind of dangerous.”

  ...“We’re transferring babies across the province, in all directions, to try to find an extra bed for the next potential birth or for any baby already born,” Dr. Chessex [Philippe Chessex, division head of neonatology for B.C. Women’s Hospital & Health Centre] said in a telephone interview from Vancouver. “We now have babies who have been transferred up to six times after leaving here before reaching home.”

August 28, 1:42 pm | [comment link]
79. libraryjim wrote:

GAAAA! Clueless! You forgot to use a tiny url or an imbedded url
link! Now the messages go off the screen and I have to scroll
over!!!

August 28, 1:45 pm | [comment link]
80. Clueless wrote:

Not only can Canada not handle their high risk pregnancies, they can’t even handle their critically ill.  (No surprise if their ICUs are filled with folks who folks with gastroparesis).

From March 1, 2008 Globe and Mail (this link is free):

http://www.theglobeandmail.com/servlet/story/RTGAM.20080301.wheart01/BNStory/National/home

“More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here.

  Most of the heart patients who have been sent south since 2003 typically show up in Ontario hospitals, where they are given clot-busting drugs. If those drugs fail to open their clogged arteries, the scramble to locate angioplasty in the United States begins.

  “They rushed me over to Detroit, did the whole closing of the tunnel,” said Eric Bialkowski, 47, of the heart attack he had on March 14, 2007, in Windsor, Ont. “It was like Disneyworld customer service.”

  ...“We keep coming back to the same root cause,” Dr. Day [Canadian Medical Association president Brian Day] said in a telephone interview from Ottawa. “The health system is not consumer-focused.”

August 28, 1:47 pm | [comment link]
81. Clueless wrote:

Mugsie, I would like you to find me an article where a the US was forced to dump critically ill patients or high risk patients on Canada.

August 28, 1:49 pm | [comment link]
82. Denbeau wrote:

Clueless, to support your comments in #75, I would refer you to http://www4.hrsdc.gc.ca/indicator.jsp?indicatorid=2&lang=en

However, I would also ask you to notice that, while reporting that the U.S. has the highest infant mortality rate in the G7 (and a rate 25% higher than Canada), it also notes that:

Results should be interpreted with caution because live births are registered differently in different countries. Canada and the United States include very premature babies with lower chances of survival, which results in higher mortality rates compared to other countries.

.

But as I suggested in an earlier message, I don’t want this to become a shouting match between Americans and Canadians. I think the question that should be addressed is “Is the U.S. getting the best health care possible, given that it’s spending 16% of GDP and ending up in 47th position for male mortality?”

August 28, 3:49 pm | [comment link]
83. Denbeau wrote:

Clueless, I admit and acknowledge the weaknesses in the Canadian system, including the ‘dumping’ of patients that you refer to. This is one of our major problems at the moment. I will even go so far as to admit that if the U.S. were not right across the border, this problem would be more acute. But these patients are getting treatment, and the treatment is being paid for, and the costs do appear as part of the costs of the health care system in Canada.
But I would ask you to stop focusing on Canada for a moment, and return to the final question of my previous post.

August 28, 4:00 pm | [comment link]
84. libraryjim wrote:

Den,
I’ll admit that the health care system in the US could be broken.

But that’s no reason to scrap it totally in favor of a system known to be fraught with even more problems.

As I said previously, that’s like trading in a Caddy for a Yugo because the radio didn’t work properly.

What we need is a mechanic who is trained to work on radios to fix the one we have.

Peace
Jim E.

August 28, 5:10 pm | [comment link]
85. mugsie wrote:

Denbeau, #83, I just went to your link. Thanks for providing that source. I was looking through Statistics Canada for information like that, since I know for certain how premature infants are treated in at least the 3 provinces I worked in. I wasn’t able to find too much yet on neonatal statistics. I found lots of birth statistics in general (registered births), but not specifically neonatal. I did find lots about immigrant impressions of the Canadian health care system. In general, the immigrants did feel wait times are long, but for some, compared to what they came from, they were quite happy with what they got in Canada. For me, being a life-long citizen born in Canada (I left for the US 11 years ago) the wait times have always been reasonable. I do hear stories, but I have no facts to support them.

As you also state, ALL the cases that are sent to the US by the Canadian health care system are PAID for by the Health Care system in Canada, and those expenses are registered as paid care provided for Canadians. In comparison, I don’t know of any American who receives care in another country where such care is paid for by the US government. Some have private insurance and SOME, but not all, expenses are paid for by the insurance companies. There are deductibles that apply; which often are quite large.

You do ask a very good question: “Is the U.S. getting the best health care possible, given that it’s spending 16% of GDP and ending up in 47th position for male mortality?” My answer would be no. A very large percentage of Americans just can’t afford what care they need. They either can’t afford the deductibles, or can’t afford insurance in general. Many don’t have employer based insurance coverage. Many even decline that due the very high cost of the premiums.

Also, there are many barriers to care here that aren’t in place in Canada. For example, if a doctor orders a specific procedure, that request has to go through an “authorization” process. That process alone can take days to complete. What happens for the patient while this process is going on? Stress levels rise. That doesn’t help the patient in any way, shape or form. Very often the procedure is denied. This decision is made by a person in some clerical position in some office somewhere who has never laid eyes on the patient. In order words, why bother going to see a doctor at all, since their PROFESSIONAL opinion is not worth a grain of salt to the “decision makers” in the head office.

In Canada, yes, it may take a bit longer to get a procedure. But at least you will know right away that you are going to get it. The scheduling is done right there in the doctor’s office right after the doctor writes the order. You leave the office with all the information you need. There is no need to wait for authorization. There is no need to “appeal” for your medically necessary care, according to the doctor who ordered such care.

It’s this irony that the doctors, who know the patients, who are professionally trained, cannot make the decisions they need to make in order to properly care for their patients.

On the other side of the coin, one other thing that is common here is kickbacks from private industry “selling” their products to doctors. If the doctors use the “equipment, medications, etc.” that are being sold to them, the doctors get a kickback for every instance of use. So, the doctor is highly motivated to use these measures, even though they may not be the best choice for the patient.

That is to name a few problems I am quite familiar with. I’m sure there are many more I’m not familiar with. By no means do I think the Canadian system is perfect. They have their problems too. Both countries do. The one big difference is that Canada does provide the same level of care for ALL it’s population, whereas the US does not. That’s a starter.

August 28, 7:00 pm | [comment link]
86. Clueless wrote:

#84:  The reason for including Canada and the US in treating premie is that while Canada (and Austria etc.) count premies less than 500 gms of age as being “dead on arrival”, Canada, unlike Sweden, and a number of other European nations includes children who die on day one, while many other European nations and all Communist nations (witness Cuba) boost their scores by not counting day one death (some go out to day 7, others to day 30).  Canada is relatively honest compared to many, but is not as honest as is the US in this regard.

In terms of is the US getting its money’s worth.  Probably not.  I think if the other nations used out means of measuring mortality and morbidity we would be in number one place, however we are still spending a sizable portion of our GDP on health care, and we have a very sizable GDP.

I do not believe that a Canadian model would be useful.

What would be useful (in my opinion) is the following:

It is critical to reduce health care costs.  Drivers of health care costs include:
1.  Saving the fragile elderly and infants (which is where Europe and Canada save their costs)
2.  Technology and Pharmaceuticals (the US pays full freight for research and development, and our drugs which we make are sold all over the world including in Canada for 25% of the price.  We also invent more health care stuff (MRIs and the like) and we end up using them more).
3.  Regulation and Paperwork (Keeping up with the ever changing and Byzantine rules of Medicare (my practice has 8 people working on insurance, and documentation).
4.  Liability (which results in vastly unnecessary testing in order to catch the 1 in a thousand chance of a bad outcome that would result in a lawsuit that would bancrupt a physician.  This defensive medicine is by far more expensive then the price tag of the actual lawsuit payments.
5.  Cost shifting from uninsured.

————————————
My solutions:
1.  Regarding care of the elderly and disabled infants:  I do not believe it is honest to restrict care secretly which is what Canada and Europe does.  I think it is reasonable to have a referendum on what restrictions should be legal.  Should patients who have a life expectancy of less than 5 years be automatically “DNR” regardless of their desires?  How about 1 year?  How about 1 month?  Hospice and nursing home care should be available for such patients, with the understanding that if anything happens, they do NOT go to the hospital, but remain in place.  Should patients who have a terminal illness that is not immediately threatening receive transplants?  (Somebody with HIV for example who is health other than liver failure).  Should patients who have a terminal illness that is not immediately threatening receive dialysis?  I think that America needs to have an open discussion of these questions.  I prefer open discussion to the behind the scenes “evidence based guidelines” that are currently being bruted about, and to the mandates that Europe has already accepted.

2.  Technology and Pharmaceuticals.  We need to stop subsidizing research.  I’m sorry, but we can’t afford it.  The NIH needs to go private (and I say that with sorrow, being a graduate).  Federal funding for research needs to stop, and research needs to be done with private funds (the MDA association, MS association, Cancer association etc.).  Our drug companies need to give the US the same price they give everybody else.  Fair’s fair.

3.  We need not a single payer health system (which would turn into a substandard mess like Canada or the UK or the VA) but a limited number of health systems that compete among themselves.  I would decouple insurance from employment, income or age and simply have a consumption tax to fund a national health insurance system (giving up Medicare/medicaid/private insurance) and let people choose among a selection of insurance companies insisting that politicians choose from the same slate.  This would mean that folks whose income is currently under the table (illegal aliens) would also pay into the system (though I imagine the consumption tax would need to be supplemented by revenues from what we now collect for Medicare in order to not overwhelm folks at the bottom of the income scale).  This would mean that hospitals and physicians would have a relatively small slate of insurance companies, and that everybody would be covered.  It would also mean that if you got sick and was unable to work, you wouldn’t automatically lose your health insurance coverage.  It would also mean that your insurance would be portable.

I would make insurance companies publish how they make their denials, and explain what precisely they will and will not cover in simple English.  I would also permit insurance companies to offer lower premiums to patients who agree to have all liability claims submitted for arbitration, rather than go through litigation. 

4.  Liability:  See above.  If premiums were lower for patients who agreed to go through arbitration as opposed to the court system, then more patients would choose this option. Similarly more physicians would be attracted to that particular option, and would be more likely to accept such patients.  High risk patients would find their care cheaper and more available if they chose this option.

5.  Cross coverage of uninsured.  See above.

August 28, 7:10 pm | [comment link]
87. Clueless wrote:

#84:  The reason for including Canada and the US in treating premie is that while Canada (and Austria etc.) count premies less than 500 gms of age as being “dead on arrival”, Canada, unlike Sweden, and a number of other European nations includes children who die on day one, while many other European nations and all Communist nations (witness Cuba) boost their scores by not counting day one death (some go out to day 7, others to day 30).  Canada is relatively honest compared to many, but is not as honest as is the US in this regard.

In terms of is the US getting its money’s worth.  Probably not.  I think if the other nations used out means of measuring mortality and morbidity we would be in number one place, however we are still spending a sizable portion of our GDP on health care, and we have a very sizable GDP.

I do not believe that a Canadian model would be useful.

What would be useful (in my opinion) is the following:

It is critical to reduce health care costs.  Drivers of health care costs include:
1.  Saving the fragile elderly and infants (which is where Europe and Canada save their costs)
2.  Technology and Pharmaceuticals (the US pays full freight for research and development, and our drugs which we make are sold all over the world including in Canada for 25% of the price.  We also invent more health care stuff (MRIs and the like) and we end up using them more).
3.  Regulation and Paperwork (Keeping up with the ever changing and Byzantine rules of Medicare (my practice has 8 people working on insurance, and documentation).
4.  Liability (which results in vastly unnecessary testing in order to catch the 1 in a thousand chance of a bad outcome that would result in a lawsuit that would bancrupt a physician.  This defensive medicine is by far more expensive then the price tag of the actual lawsuit payments.
5.  Cost shifting from uninsured.

————————————
My solutions:
1.  Regarding care of the elderly and disabled infants:  I do not believe it is honest to restrict care secretly which is what Canada and Europe does.  I think it is reasonable to have a referendum on what restrictions should be legal.  Should patients who have a life expectancy of less than 5 years be automatically “DNR” regardless of their desires?  How about 1 year?  How about 1 month?  Hospice and nursing home care should be available for such patients, with the understanding that if anything happens, they do NOT go to the hospital, but remain in place.  Should patients who have a terminal illness that is not immediately threatening receive transplants?  (Somebody with HIV for example who is health other than liver failure).  Should patients who have a terminal illness that is not immediately threatening receive dialysis?  I think that America needs to have an open discussion of these questions.  I prefer open discussion to the behind the scenes “evidence based guidelines” that are currently being bruted about, and to the mandates that Europe has already accepted.

2.  Technology and Pharmaceuticals.  We need to stop subsidizing research.  I’m sorry, but we can’t afford it.  The NIH needs to go private (and I say that with sorrow, being a graduate).  Federal funding for research needs to stop, and research needs to be done with private funds (the MDA association, MS association, Cancer association etc.).  Our drug companies need to give the US the same price they give everybody else.  Fair’s fair.

3.  We need not a single payer health system (which would turn into a substandard mess like Canada or the UK or the VA) but a limited number of health systems that compete among themselves.  I would decouple insurance from employment, income or age and simply have a consumption tax to fund a national health insurance system (giving up Medicare/medicaid/private insurance) and let people choose among a selection of insurance companies insisting that politicians choose from the same slate.  This would mean that folks whose income is currently under the table (illegal aliens) would also pay into the system (though I imagine the consumption tax would need to be supplemented by revenues from what we now collect for Medicare in order to not overwhelm folks at the bottom of the income scale).  This would mean that hospitals and physicians would have a relatively small slate of insurance companies, and that everybody would be covered.  It would also mean that if you got sick and was unable to work, you wouldn’t automatically lose your health insurance coverage.  It would also mean that your insurance would be portable.

I would make insurance companies publish how they make their denials, and explain what precisely they will and will not cover in simple English.  I would also permit insurance companies to offer lower premiums to patients who agree to have all liability claims submitted for arbitration, rather than go through litigation. 

4.  Liability:  See above.  If premiums were lower for patients who agreed to go through arbitration as opposed to the court system, then more patients would choose this option. Similarly more physicians would be attracted to that particular option, and would be more likely to accept such patients.  High risk patients would find their care cheaper and more available if they chose this option.

5.  Cross coverage of uninsured.  See above.

August 28, 7:11 pm | [comment link]
88. Clueless wrote:

I seem to be trying to upload too large a response.

#84:  The reason for including Canada and the US in treating premie is that while Canada (and Austria etc.) count premies less than 500 gms of age as being “dead on arrival”, Canada, unlike Sweden, and a number of other European nations includes children who die on day one, while many other European nations and all Communist nations (witness Cuba) boost their scores by not counting day one death (some go out to day 7, others to day 30).  Canada is relatively honest compared to many, but is not as honest as is the US in this regard.

In terms of is the US getting its money’s worth.  Probably not.  I think if the other nations used out means of measuring mortality and morbidity we would be in number one place, however we are still spending a sizable portion of our GDP on health care, and we have a very sizable GDP.


See next post for what I think would be useful.

August 28, 7:14 pm | [comment link]
89. Clueless wrote:

What would be useful (in my opinion) is the following:

It is critical to reduce health care costs.  Drivers of health care costs include:
1.  Saving the fragile elderly and infants (which is where Europe and Canada save their costs)
2.  Technology and Pharmaceuticals (the US pays full freight for research and development, and our drugs which we make are sold all over the world including in Canada for 25% of the price.  We also invent more health care stuff (MRIs and the like) and we end up using them more).
3.  Regulation and Paperwork (Keeping up with the ever changing and Byzantine rules of Medicare (my practice has 8 people working on insurance, and documentation).
4.  Liability (which results in vastly unnecessary testing in order to catch the 1 in a thousand chance of a bad outcome that would result in a lawsuit that would bancrupt a physician.  This defensive medicine is by far more expensive then the price tag of the actual lawsuit payments.
5.  Cost shifting from uninsured.

————————————
My solutions:
1.  Regarding care of the elderly and disabled infants:  I do not believe it is honest to restrict care secretly which is what Canada and Europe does.  I think it is reasonable to have a referendum on what restrictions should be legal.  Should patients who have a life expectancy of less than 5 years be automatically “DNR” regardless of their desires?  How about 1 year?  How about 1 month?  Hospice and nursing home care should be available for such patients, with the understanding that if anything happens, they do NOT go to the hospital, but remain in place.  Should patients who have a terminal illness that is not immediately threatening receive transplants?  (Somebody with HIV for example who is health other than liver failure).  Should patients who have a terminal illness that is not immediately threatening receive dialysis?  I think that America needs to have an open discussion of these questions.  I prefer open discussion to the behind the scenes “evidence based guidelines” that are currently being bruted about, and to the mandates that Europe has already accepted.

2.  Technology and Pharmaceuticals.  We need to stop subsidizing research.  I’m sorry, but we can’t afford it.  The NIH needs to go private (and I say that with sorrow, being a graduate).  Federal funding for research needs to stop, and research needs to be done with private funds (the MDA association, MS association, Cancer association etc.).  Our drug companies need to give the US the same price they give everybody else.  Fair’s fair.

3.  We need not a single payer health system (which would turn into a substandard mess like Canada or the UK or the VA) but a limited number of health systems that compete among themselves.  I would decouple insurance from employment, income or age and simply have a consumption tax to fund a national health insurance system (giving up Medicare/medicaid/private insurance) and let people choose among a selection of insurance companies insisting that politicians choose from the same slate.  This would mean that folks whose income is currently under the table (illegal aliens) would also pay into the system (though I imagine the consumption tax would need to be supplemented by revenues from what we now collect for Medicare in order to not overwhelm folks at the bottom of the income scale).  This would mean that hospitals and physicians would have a relatively small slate of insurance companies, and that everybody would be covered.  It would also mean that if you got sick and was unable to work, you wouldn’t automatically lose your health insurance coverage.  It would also mean that your insurance would be portable.

I would make insurance companies publish how they make their denials, and explain what precisely they will and will not cover in simple English.  I would also permit insurance companies to offer lower premiums to patients who agree to have all liability claims submitted for arbitration, rather than go through litigation. 

4.  Liability:  See above.  If premiums were lower for patients who agreed to go through arbitration as opposed to the court system, then more patients would choose this option. Similarly more physicians would be attracted to that particular option, and would be more likely to accept such patients.  High risk patients would find their care cheaper and more available if they chose this option.

5.  Cross coverage of uninsured.  See above.

August 28, 7:15 pm | [comment link]
90. mugsie wrote:

#87, I read your sources for what you claim Canada does regarding premies less than 500 g, but I did not find Canada (specifically) listed there. Yes, there were other countries listed, but NOT Canada. The source Denbeau gave states that BOTH Canada and the US treat premies the same. Where is your source to state Canada does this? I’ve never witnessed any instance where a Canadian hospital does this:

Canada (and Austria etc.) count premies less than 500 gms of age as being “dead on arrival”, Canada, unlike Sweden, and a number of other European nations includes children who die on day one

August 28, 7:20 pm | [comment link]
91. mugsie wrote:

I do not believe it is honest to restrict care secretly which is what Canada and Europe does.

Where is your documentation that Canada does this? I’ve never seen this done anywhere in the three provinces I worked in.

August 28, 7:24 pm | [comment link]
92. mugsie wrote:

clueless, your first long post came out fine. At least it came out fine on my system. I just had a couple of questions which I just posted.

August 28, 7:29 pm | [comment link]
93. Clueless wrote:

The fact that Canada and Europe does not aggressively treat premie infant below 500 is ipso facto restriction of care.  Just standing around saying “Oh we are doing everything possible” doesn’t equal actually doing everything that WE (the US) can.  Your ignorance about what is possible does not make those limits real.  The fact that Canada has a need to define premies less than 500 g as “dead on arrival” speaks for itself.

August 28, 7:29 pm | [comment link]
94. Clueless wrote:

What would be useful (in my opinion) is the following:

It is critical to reduce health care costs.  Drivers of health care costs include:

1.  Saving the fragile elderly and infants (which is where Europe and Canada save their costs)
2.  Technology and Pharmaceuticals (the US pays full freight for research and development, and our drugs which we make are sold all over the world including in Canada for 25% of the price.  We also invent more health care stuff (MRIs and the like) and we end up using them more).
3.  Regulation and Paperwork (Keeping up with the ever changing and Byzantine rules of Medicare (my practice has 8 people working on insurance, and documentation).
4.  Liability (which results in vastly unnecessary testing in order to catch the 1 in a thousand chance of a bad outcome that would result in a lawsuit that would bancrupt a physician.  This defensive medicine is by far more expensive then the price tag of the actual lawsuit payments.
5.  Cost shifting from uninsured.

See below for my suggested solutions

August 28, 7:33 pm | [comment link]
95. Clueless wrote:

My solutions:
1.  Regarding care of the elderly and disabled infants:  I do not believe it is honest to restrict care secretly which is what Canada and Europe does.  I think it is reasonable to have a referendum on what restrictions should be legal.  Should patients who have a life expectancy of less than 5 years be automatically “DNR” regardless of their desires?  How about 1 year?  How about 1 month?  Hospice and nursing home care should be available for such patients, with the understanding that if anything happens, they do NOT go to the hospital, but remain in place.  Should patients who have a terminal illness that is not immediately threatening receive transplants?  (Somebody with HIV for example who is health other than liver failure).  Should patients who have a terminal illness that is not immediately threatening receive dialysis?  I think that America needs to have an open discussion of these questions.  I prefer open discussion to the behind the scenes “evidence based guidelines” that are currently being bruted about, and to the mandates that Europe has already accepted.

2.  Technology and Pharmaceuticals.  We need to stop subsidizing research.  I’m sorry, but we can’t afford it.  The NIH needs to go private (and I say that with sorrow, being a graduate).  Federal funding for research needs to stop, and research needs to be done with private funds (the MDA association, MS association, Cancer association etc.).  Our drug companies need to give the US the same price they give everybody else.  Fair’s fair.

More for 3 and 4

August 28, 7:36 pm | [comment link]
96. Clueless wrote:

Solutions, continued

3.  We need not a single payer health system (which would turn into a substandard mess like Canada or the UK or the VA) but a limited number of health systems that compete among themselves.  I would decouple insurance from employment, income or age and simply have a consumption tax to fund a national health insurance system (giving up Medicare/medicaid/private insurance) and let people choose among a selection of insurance companies insisting that politicians choose from the same slate.  This would mean that folks whose income is currently under the table (illegal aliens) would also pay into the system (though I imagine the consumption tax would need to be supplemented by revenues from what we now collect for Medicare in order to not overwhelm folks at the bottom of the income scale).  This would mean that hospitals and physicians would have a relatively small slate of insurance companies, and that everybody would be covered.  It would also mean that if you got sick and was unable to work, you wouldn’t automatically lose your health insurance coverage.  It would also mean that your insurance would be portable.

I would make insurance companies publish how they make their denials, and explain what precisely they will and will not cover in simple English.  I would also permit insurance companies to offer lower premiums to patients who agree to have all liability claims submitted for arbitration, rather than go through litigation. 

4.  Liability:  See above.  If premiums were lower for patients who agreed to go through arbitration as opposed to the court system, then more patients would choose this option. Similarly more physicians would be attracted to that particular option, and would be more likely to accept such patients.  High risk patients would find their care cheaper and more available if they chose this option.  Folks who wish to buy a ticket to the liability lottery should pay for the priviledge.  Physicians who wish to accept less money for peace of mind can refuse insurance that does not include arbitration.  Those who have lower risk specialties or don’t care can go for it.

5.  Cross coverage of uninsured.  See above.

August 28, 7:37 pm | [comment link]
97. mugsie wrote:

Clueless, you didn’t answer my question. Where does it state from a reliable Canadian source that Canada “defines premies less than 500 g as “dead on arrival”? My experience in those actual NICU’s in Canada has been different. We have never considered premies less than 500 grams to be “dead on arrival”. I’ve never witnessed such a thing. That’s why I’m asking that question. I’ve never been told such a thing by any hospital authority, and I’ve never done such a thing myself. That’s why I’m asking.

The rest of your statement I’ll just disregard. That’s quite subjective information to make such a comment on, and the way you posed it just comes out in an arrogant manner. At least that’s how I’m interpreting it here.

Tell me something. Have you ever worked in a Canadian NICU? Have you even set foot in one? Do you have any idea what equipment is used there and what measures are taken there to save the lives of those premies? I just really need to know.

August 28, 7:38 pm | [comment link]
98. Clueless wrote:

For some reason, half of my posts are appearing on this computer as long blanks.  Is anybody else having this problem?  If you can see the entire post, including my solutions, I will shut up.

August 28, 7:40 pm | [comment link]
99. mugsie wrote:

I’ve been able to see all our posts just fine. Both the entire ones as well as the partial ones you posted afterwards.

August 28, 7:42 pm | [comment link]
100. mugsie wrote:

Have you tried refreshing the page?

August 28, 7:43 pm | [comment link]
101. Clueless wrote:

I don’t have access to “reliable Canadian sources”.  What I have access to is the data published in US News and World Report, as well as elsewhere which explains that when the deaths are calculated (by statisticians for the government using hospital mortality figures, not by physicians or nurses) an infant weighing less than 500 gm in Canada (also most other places) is considered “dead at birth” if she/he dies during the hospitalization, but alive if she lives long enough to leave the hospital.

The US does not play clever games like that in health care.  We save our clever games for the way we calculate such things as “inflation” or “unemployment”.

Government figures

August 28, 7:46 pm | [comment link]
102. Clueless wrote:

yes, I’ve also tried logging out and coming back in.  I’m not sure what’s wrong.  Can you see everything, including the five cost drivers I identified for health care and my five proposed solutions to those cost drivers?  It’s not showing up for me.

August 28, 7:48 pm | [comment link]
103. mugsie wrote:

clueless, the link Denbeau gave takes you to statistics which came from Statistics Canada, the main source, and the most reliable for Canadian statistical information. I’m afraid I’m more likely to believe what they say over “US News” or “World Report” or “elsewhere” which are the sources you gave. Statistics Canada DOES record all the statistics for the government using hospital figures. You still haven’t shown me a reliable source that states that Canada defines premies less than 500 g as “dead at birth”. I really do need to see that since I’ve never been told that as a nurse. I’ve never witnessed anyone making such a judgment as a nurse. I don’t care if that’s enough for you or not, but that’s what I actually witnessed in hospitals in 3 provinces in Canada. You still haven’t answered my question about whether you’ve worked in, or even set foot in, a NICU in a Canadian hospital.

You state that the US doesn’t play “clever games like that in health care.” WHAT clever games!!!

By the way, who do you think RECORDS this information for the “statisticians”? It’s the nurses, doctors, etc. in the hospitals. Those whose efforts you want to disregard here.

August 28, 7:58 pm | [comment link]
104. mugsie wrote:

In answer to post 103, everything is showing up just fine on my screen.

August 28, 7:58 pm | [comment link]
105. Clueless wrote:

Why would you be told that as a nurse?  I’m a neurologist, and neither my hospital nor my government tells me how mortality and morbidity rates for stroke patients or trauma patients are calculated.  Our job on the front lines are to do what’s best for the patient.  How the data is massaged later by statisticians, why would you expect to know that?

I honestly don’t understand you.  I am not pretending that Canadian nurses kill patients.  I am saying that Canada does not report preemie deaths the way the US does.  Nor do most countries (see my various links).

August 28, 8:02 pm | [comment link]
106. Clueless wrote:

I still seeing blanks for most of my posts, but I will take your word for it.

Anyway, I gotta go.  Bye.

August 28, 8:03 pm | [comment link]
107. Clueless wrote:

Yes.  The doctors and nurses record the birth weight, and the time and date of death, the gestational age, and the age at death.

In the US, those numbers then go directly into the countries statistics. 

In other countries the numbers are “cleaned up” by governmental statisticians. 

This is not unique to Canada and Europe.  Our inflation numbers would be 2 to 3 times as high if we didn’t keep changing the basket of commodities.  For example we used to calculate housing directly in the inflation numbers.  Then we switched to the “rent” we would pay if folks rented out their homes instead of paying a mortgage on their homes.  This kept the CPI down.  Similarly our unemployment numbers do not include folks who are “self employed” or who hold 3 lousy part time jobs without benefits.  Any income is enough to take a person off of the official unemployment figures. 

No I have not been in a Canadian NICU.  Have you studied statistics?  I have, quite intensively, back when I was in academic medicine.  You do not appear to understand how statistics work.

August 28, 8:12 pm | [comment link]
108. Clueless wrote:

As to Canada “paying” for those patients, I doubt that Canada was paying the full undiscounted price, which is what an uninsured patient coming to the hospital would be billed.  After all you didn’t pay the full undiscounted price when you were hospitalized.  Canada “paid” the US hospital what it would cost if the care had been given in Canada.  So yeah, Canada “paid” subsidized by US citizens with private insurance..  Sort of like Medicaid “pays” subsidized by US citizens with private insurance (or who self pay). 

But the hospital I am sure, appreciated the goat’s milk. 
Anyway, gotta go.  Really. (Assuming you are reading any of this, which is more than I can read).

August 28, 8:21 pm | [comment link]
109. mugsie wrote:

This from wikipedia. I’m looking for more:
Canada

Beginning in 1959, “the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization.” [5] The definition of “fetal death” promulgated by the World Health Organization in 1950 is as follows:

  “Fetal death” means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.[6]

August 28, 8:30 pm | [comment link]
110. Jeffersonian wrote:

As a short aside, it would seem that the claim in #20 that 2 million people go bankrupt every year because of medical bill is bogus, the figment of AARP’s addled imagination.

August 28, 8:34 pm | [comment link]
111. Clueless wrote:

#110 Still doesn’t say anything about the number of grams.  Please see my previous posts.  In an earlier posting I had access to the World Health tables, and I posted the third trimester “fetal loss” rate, (which was unusually, and unexplicably high for England, France, Switzerland, and Australia) but exceptionally low for the US. Canada, as I recall was between the two.  “Third trimester fetal loss is a euphamism for a premie who is born at 28 weeks, and dies before 41 weeks.  Calling it “fetal loss” means that you don’t have to call it infant mortality.

HOwever I don’t have access to the tables now.  And all my postings appear to have vanished from the archives.  (Elves?)

But whatever.

August 29, 9:46 am | [comment link]
112. Sarah1 wrote:

Clueless, thank you for your yeoman’s work on this thread.

Thanks especially for your recommendations on the healthcare issues in the US—I agree with some, disagree with others.

One of the things that leads to the immensely high costs of drugs in America is the high cost of getting promising drugs through the onerous horrors of the FDA—the bulk of the costs associated with new drugs.  One of my recommendations would be to drastically reduce those FDA requirements and reduce its power.

Another of my recommendations would be for states to enact tort reform such that non-deliberate harm would be subject to a cap on PUNITIVE damages [not cost of care, rehab, or lost wages, which are different things].  If a doctor screws up but was not drunk or grossly incompetent—he made a human error such that we are all subject too—he should not be inflicted with PUNITIVE damages beyond a certain number [again, cost of care, rehab, and life-long lost earnings should be required, of course].

Another of my ideas is that we need to de-couple the *patients* from the bureacracies [hospitals, insurers, medical practices, government] as much as possible so that it is the *patient* that is making the choices, along with his very own selected/chosen doctor.

My best bet for that is HSAs.  One of my clients—a medium-sized law firm with about 80 employees—switched to an HSA and they *love* it.  Employees could remain under the old plan or switch to the new—and I believe that most have switched to the new.  The *power* is with the consumer—not the insurer or the government or the hospital.

The more this happens, the better. 

The more other pools are developed for the catastrophic health insurance—the kind of insurance that is actually legitimate in my opinion—the better, as well.  I look for individuals to begin grouping into pools as restrictions are lessened.  My bank—a small regional bank—is launching their own HSA as well for their customers.

This is incredible freedom and I look for it to be a race against the liberal solution which is one gigantic VA hospital in which everybody gets the same level of care—The Pits.

August 29, 10:08 am | [comment link]
113. Sarah1 wrote:

Clueless,

Are these threads what you are looking for?

http://www.kendallharmon.net/t19/index.php/t19/article/5026/
http://www.kendallharmon.net/t19/index.php/t19/article/9814/
http://www.kendallharmon.net/t19/index.php/t19/article/9201/

Whether they are or not . . . thank you for all you do as a physician.  I know your job really is awful sometimes . . . but you are doing some good, some patients leave with a glow of appreciation towards you [and talk about you to their friends], and you have changed lives for the better.

I’m confident of that.

As long as you are where God decided to place you to use your particular skills and unique mind, then that’s really all that matters anyway, not the slings and arrows of the government and ungrateful patients and ugly insurance providers.

God bless you!

August 29, 10:17 am | [comment link]
114. Clueless wrote:

Hi Sarah!
  Yes, those were the threads, thanks a lot.  And Mugsie, you were right, and I am wrong.  Canada’s most recent third trimester fetal death statistics are the same as the US.  So it is likely that they have changed their accounting techniques.

August 29, 12:04 pm | [comment link]
115. mugsie wrote:

Clueless, Thanks for sticking it out. I still wasn’t able to find any legal documentation for the “less than 500 g” definition you stated, but the definition I gave above for death at birth came from the World Health Organization. It’s exactly the same definition as the US. That’s all I know on that.

Are you saying in your comment #115 that Canada’s figures are now accurate? As for changing their accounting techniques, I’m not sure what that’s about. What specifically are you referring to here? I know that in general the costs are lower in Canada due to the caps placed on all medical costs. What were you referring to in that statement?

August 29, 12:37 pm | [comment link]
116. Clueless wrote:

#116

I’m saying that there seems to be no discrepancy between Canada’s infant death rates and there “third trimester fetal losses” as of the most recent World Health scores (2007).  By contrast France is clearly manipulating her data to make preemies who die in infancy (which shows up in their life expectancy scores) look like third trimester fetal losses (which does not).

Of course if Canada ships her high risk pregnancies to the good ol USA (as seems clear by the above article) it wouldn’t be necessary to manipulate. 

And yes, costs are cheaper in Canada.  Making sure that expensive patients (including high risk pregnancies) are taken care of in the US, would tend to keep those costs cheaper also, wouldn’t it?  The caps placed on medical costs result in shortages (obvious since Canada has to dump on the US).  The shortages are not apparent because the US is Canada’s safety valve. 

Then Canada, pays the hospitals the “Canadian price” even though the hospitals are faced with US costs. 

If this were a US hospital turfing, it would be an EMTALA violation for dumping: 50,000 fine each for both physician and hospital. 

In the US, a hospital is not allowed to send expensive patients (read critically ill or high risk) elsewhere in the US unless they require a service that cannot be provided by the hospital. Angioplasties are common procedures that are handled by any hospital above the lowest level (rural access hospital).  Apparently Canadian hospitals cannot routinely handle this.  Most hospitals (certainly mine) has a “door to needle” time of under an hour (meaning the time the patient with an MI comes in the door via ambulance and the time the angioplasty is begun.  Time is (heart) muscle. 

If the hospital is unable to handle a heart attack, or high risk pregnancy then the hospital will be downgraded and will not be allowed to accept patients with decent insurance for routine care (which is the folk hospitals make money on, as high risk pregnancies and critically ill patients are huge money losers for hospitals.  (Hospitals make money on nice little hernias and gall bladders and lab and Xray stuff).

Canada’s health system basically pays for what in the US would be considered rural access hospitals (unable to handle angioplasties or high risk births) and then dumps her sick patients on the US, and then “reimburses” the hospital using Canadian scales.

It would be illegal in the US.  However nobody wants our friends in Canada to die even if they are abusing US health care so the US puts up with it.  I don’t mind putting up with it.  Canada and the US are good neighbors.  However, I resent being told by freeloaders friends that they are so much better at managing their money when they keep their costs down, using our wallets.

August 29, 5:59 pm | [comment link]
117. mugsie wrote:

Clueless, clearly you are making a lot of assumptions. You seem to have the impression that Canadian hospitals can’t handle “anglioplasty” and “high risk pregnancy”. That is just plain false. There are many excellent trauma centers in Canada who do wonderful jobs of handling “high risk” cardiac cases. There are also store front “angioplasty” clinics where outpatients are served. I can assure you they are QUITE qualified to handle these cases.

They also have excellent “high risk pregnancy” services. Sick Children’s Hospital (Sick Kids) is well known internationally for its work. People are flown in from around the world to have special procedures done at Sick Kids that these specialists specialize in.

I can assure you that again you are quite wrong. These are very HUGE assumptions and very dangerous ones. The only reason a Canadian hospital would sent someone into the US is because they don’t have the bed capacity for the patients at the time of the need. Rather than take a risk with the patient’s life they will look at other options, which usually means to send the patient to another large center with the same advanced medicine capabilities. I can assure you every effort is made to care for patients in Canada. There is no “dumping” as you seem to believe.

As to costs, the costs in Canada are lower due to there being no profits added on. Health care in Canada is all nonprofit, government based. Virtually ALL costs in US hospitals are negotiable. As a matter of fact I’ve been encouraged by those very US hospitals to negotiate costs when paying privately for care. There’s a lot you are just not saying here. Is that a convenient, intended omission, or do you truly not understand some of these things.

As for the services available in Canada, I’m sorry but you are hardly an authority on that. You have admitted yourself that you’ve never set foot in an NICU there, yet you presume to know everything that goes on there. Have you even set foot in ANY medical institution in Canada? I, personally, have worked for almost 20 years in those very institutions you claim to know so much about, and I can assure you, your comments are drastically misinformed.

This is supposed to be a Christian site. I would prefer if commentators used at least a MODICUM of integrity. To pass on information without verifying that it’s fact, is not what I call a demonstration of integrity.

I’m definitely done with this now. I know your position makes it hard for you due to the stresses involved. I can fully understand your stresses. A high level of stress was a very big part of the reason why I left nursing a while back. Stress in one’s job just does not give that person license lash out at things he or she knows nothing about.

I have stated clearly that there are problems with the health care system on BOTH sides of the border. I don’t know what it will take to fix those problems. Quite honestly, I personally believe they will just get worse. Prophecy in the Bible tells us how things will become so bad that God will have to intervene before mankind totally annihilates itself. So much of history has already documented the truth of that prophecy. As a Christian, I believe what the Bible tells me. Jesus has instructed all his followers to use his inspired Word for our guidance and instruction. It’s not very easy to do that in the corrupt world we live in, but I’m personally doing the best I can. All of us are sinful. But God wants us to be honest about that. Are you willing to do that? Are you willing to just come out and honestly say that you truly don’t know the deep inner workings of the Canadian health care system? Are you willing to admit that you may be wrong on many points and just don’t know all the answers?

August 29, 7:41 pm | [comment link]
118. Clueless wrote:

Look Mugsie.  Canada has some trauma centers and Cardiac centers yes.  But 400 patients needing US angioplasties in a year?  One angioplasty is an unfortunate emergency.  Ten angioplasties in a year is inefficiency.  400 is more than one a day.  It is a deliberate choice.  They need to hire or train more interventional cardiologists, more nurses, and build more cath labs.  But this will drive up costs and Ooops.  Look at the caps.  Canada can’t drive up costs.  So they dump on the US, and let them deal with the costs.

Similarly everybody knows about high risk pregnancies.  One hundred high risk transfers to NICUs a year?  You guys need to build more NICUs.  But, oops.  There are those caps.  Canada can’t build more, so she dumps her sick kids on the US.

It isn’t necessary for me to know the deep inner workings of the Canadian health care system to know that its wrong to dump your problems on other people and then lecture them about how much more efficient you are.  Its like getting your friend to write your essay for you and boasting that you got a higher grade. 

Integrity requires more than words.  I think we think of integrity differently.  First, integrity means honest accounting.  Not the word play with human lives that goes on in the World Health Organization.
Second, as a fellow immigrant, I believe that when one eats a nation’s salt, one sticks up for her.  I’m an American. There are many things about Sri Lanka that I could say positive things about (and sometimes I do) but I don’t go on and on about it, because, I’m an American.  I work at fixing what I can fix, here in the US.

August 29, 10:55 pm | [comment link]
119. Country Doc wrote:

Let me now jump in here and maybe cast some light.  I think much of the sparing between Mugsie and Clueless is because there is a confusion about the practitioners and the government system.  We would all agree that Canadian physicians and nurses are ethical, well trained, and concerned with their patients.  However, if we just look at a particular NCICU, or cath lab we miss the fact that the problem is outside the facility.  The reason a patient seeks care in the US is not because the doctors and nurses won’t treat them, it is because of the inbuilt shortages built into the system.  There are actually brokers that arrange for US care for distraught patients.  I read that 40% of care on Canadians was obtained in the US, not because the Canadians were mean or indifferent, but because the rationing made it necessaary.  A few years ago I was in St. Johns Newfouland at the Grenfield Hospital, founded by the first medical missionary over one hundred years ago.  He was a local hero still.  This was a hugh hospital with hundreds of beds, nearly all of which were empty.  There were five nurse practiners and no physician.  The next closest hopital was 150 miles away. 
  I met a doctor who was working in an ER in North Carolina.  A Canadian business man who flew in in his company jet came in with small bowel obstruction.  They offered to operate that night, but he felt since he had national health and the surgery would be “free”  he would fly back to Canada.  They put down an NG tube and gave instructions.  Later he said that on reporting to the hospital, they told him a surgeon could not see him until Monday and the first available slot in the OR would be seven days later.  So they sent him home with the NG tube and a syringe to suck on it every two hours and told to come back next week!  There is no free medical care.  Someone has to pay.  Socialism is not the answer.
  We have a young neurosurgeon who came to our hospital from Montreal.  His opinion was that Canada had better quality and availability for ordinary things, but not for complex things, usually due to budget cuts.  He felt we had unlimited acces (and this is about the poorest area in the nation) but we had poorer outcomes due to poor patient compliance and an unhealthy culture.
    I believe we are going to have complete socialized medicine here and it will only make the problems worse.  I have fourty-four years experience in multiple areas of medicine including teaching.  Once the infrastructure is gone it probably can’t come back. 
    Dr. Dalrymple who is British has some great materials on the horrows of National “Health”  This is still the greatest nation.  That’s why people are dying to get in here.

August 29, 11:15 pm | [comment link]
120. Clueless wrote:

I have no doubt that we will have socialized medical care in the next few years with a system similar to Canada’s.

One need only look at Medicaid to see how well that will work.

On one level, this has been a blessing.  Any kid can get his fracture casted, receive immunizations etc.  Any adult can get insulin or BP medications.  Such care can be given cheaply, and is quite cost effective, enabling the individual to get back to work or school.  In this part of the US, usually folks have a nurse practioner or physicians assistant to deal with the above.  Since NPs and PAs,  are now commanding salaries greater than primary care physicians, and are becoming hard to find, I imagine that “med techs” will do it in the future.  (It isn’t difficult).

Slightly higher level care (gall bladder operations, knee surgeries, tonsillectomies, child birth) is also easily available for Medicaid folks, and usually does involve a physician though there may be a long wait (usually 3 to 6 months around here for this.)

The problem is not with getting care for healthy people, but getting care for sick people.  If you are a kid and need to have a brain tumor operated on, then you have to go several hundred miles away.  This is not because we do not have competant brain surgeons in the area.  Indeed we have about 6 excellent neurosurgeons, however none of these have seen children for several years (kids usually have medicaid, thus pay less, and also have higher liabilty).  Thus, they no longer have the ability to find their way around a kids brain.  (One needs to stay in practice.  Thus, in point of fact, they are no longer competant to practice on children, though all of them did so easily 5-10 years ago.

Four of the above six neurosurgeons will be going to a “spine only” model within the next year.  This will mostly eliminate the uninsured as folks who have subdurals are usually uninsured drunk people who are usually as litiginous as they are irresponsible, and operating on the brain is high risk.  After a few years, such neurosurgeons will no longer be competant to remove subdurals on ANYBODY, adult or child.  This is what Country Doc means when he talks about “loss of infrastructure”.  It takes 7 years to train a neurosurgeon (after medical school) and only a couple of years to lose one.  They cannot be replaced as easily as “med techs”.

I know physicians who have left the practice of medicine to become a “physicians assistant”. There is one such in my group.  She just does intake evaluations for one of our neurosurgeons, and make more money, has vastly less liability, and has better hours than when she was in practice.  I look at her with envy, and calculate whether it would be preferable for me to do likewise, or to simply leave medicine altogether, when socialized health care comes in.

You see, the more folks who leave, the more the liability, uncompensated care, and workload falls on those who remain.  Thus, I see patients with Medcare from about 60 miles away, and patients with Medicaid from about 100 miles away.  This is not because there are no neurologist there.  It is because those physicians have limited their practices to exclude “geriatrics” (thus getting rid of Medicare) and “pediatrics” thus getting rid of most Medicaid.  What is left are pretty health adults with usually reasonable insurance.

That works fine until somebody gets sick.  If a kid needs a neurosurgeon, he/she needs to go hundreds of miles away.  This makes it very difficult for his parent to remain employed.  In 5-10 years, I anticipate that if a person over 65 needs a neurosurgeon, he/she also may need to go hundreds of miles away.  During that period, some folks will die.  The individual in question will be far from family, and supports and is much more likely to end up in an out of state nursing home. 

And no, the above is not due to “dumping”.  If you don’t take care of patients for a while, you will lose your skills, and you will indeed be incompetant to do the procedure in question..

But finally, there is an upper limit to how long the “turfing” strategy can last.  Canada turfs their head trauma emergencies to the US.  When detroit’s remaining neurosurgeons (who are on continous call and are rapidly exhausting) go to “spine only” (which they surely will) where will Canadians go then?  Presumably, they will go to the same place that Medicaid kids go.  They will go home, with instructions to “call this number” and get an appointment if you can.

A health care system based on treating the patient like a hot potato to be turfed to whomever is most responsible, who will then be blamed, sued, and robbed is not practical.  This is the system that Canada has, and this is what Medicaid is.

This puts tremendous, and unfair liability on the most responsible of physicians.  We saw that in highlight during Katrina.  Most physicians left, the governer, national guard, and mayor abandoned the hospitals.  The remaining hospitals had a skeleton crew dealing with critically ill patients with gunfire going off downstairs, criminals looking for drugs, and no electricity with 100+ degree temperatures.

The governer said up front that evacuating the hospital was not a priorty, taking folks off rooftops was a priority.  There were patients who were DNR.  They could not be evacuated.  They could not be helped.  Some poor smuck of a physician gave them morphine for the pain, and when some of these patients died (remember they were DNR), the physician who was essentially practicing in a battlefield environment was charged with murder.  (She got off but still has a slew of malpractice suits).  Where were the families of those patients when their family member was trapped in the hospital?  Where were the lawyers then?  Too busy, apparently to come get the folks they pretended to love out, apparently.

One think Katrina taught health care workers (nurses as well as doctors) is “don’t be the last physician holding the bag in an emergency”.  Whomever is last responsible for the patient will be blamed, imprisoned and sued.  They will not blame the mayor or the governor.  They will blame who is left.  Thus it would seem to be preferable to make sure one is never responsible for the patient in the first place.  This can be done by limiting your practice up front (“I’m too stupid to take care of pediatric or geriatrics patients, they need somebody smarter than me” or “I’m too stupid to operate on brains, I can only do necks”) or by simply moving down the food chain(to be a physicians assistant, for example, where nobody will expect you to take care of complex patients, and where you can expect to be paid a salary, rather than be expected to simply do your job without pay because after all “you are a professional”.

The infrastruture will be gone quite soon.

September 2, 5:02 pm | [comment link]
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