If America adopts Canada's health care system

[Brad Sallows]

How do you figure you'd be liable for all that money?  Would you not buy health insurance for your family if taxpayers didn't do it?

 

[retiredgrunt45]

Fine for the people who can afford insurance or are covered through their work. What about the millions who aren't or can't afford insurance? Low wage earners, jobless people, etc. How do they pay for their care? The good will of others, charity, handouts?

Just because you have insurance in the U.S, doesn't mean your of the hook for fees. Theres the Co-payment and depending on the % of the co-Payment and the amount of the bill, it could still be in the thousands.

Up here in Canada, everyone is covered, rich, poor, jobless etc. I really wish people would get their heads out of the sand, have good look around and see how good we have it up here. I do think that unless someone is confronted with a serious illness in their family, that they will contiinue to take our system for granted and will never really know the real benefits of a system like ours has.


Heres some interesting stats completed in 2004, done by the (STATE COVERAGE INITIATIVES PROGRAM), showing how many americans aren't covered. The numbers speak for themselves.

(PDF)http://www.statecoverage.net/pdf/coverage.pdf

(HTML) http://72.14.205.104/search?q=cache:O0Brajp4bbcJ:www.statecoverage.net/pdf/coverage.pdf+Health+care+in+the+united+states&hl=en&ct=clnk&cd=9&gl=ca

 

[Edward Campbell]

Fine for the people who can afford insurance or are covered through their work. What about the millions who aren't or can't afford insurance? Low wage earners, jobless people, etc. How do they pay for their care? The good will of others, charity, handouts?

Just because you have insurance in the U.S, doesn't mean your of the hook for fees. Theres the Co-payment and depending on the % of the co-Payment and the amount of the bill, it could still be in the thousands.

Up here in Canada, everyone is covered, rich, poor, jobless etc. I really wish people would get their heads out of the sand, have good look around and see how good we have it up here. I do think that unless someone is confronted with a serious illness in their family, that they will contiinue to take our system for granted and will never really know the real benefits of a system like ours has.


Heres some interesting stats completed in 2004, done by the (STATE COVERAGE INITIATIVES PROGRAM), showing how many americans aren't covered. The numbers speak for themselves.

(PDF)http://www.statecoverage.net/pdf/coverage.pdf

(HTML) http://72.14.205.104/search?q=cache:O0Brajp4bbcJ:www.statecoverage.net/pdf/coverage.pdf+Health+care+in+the+united+states&hl=en&ct=clnk&cd=9&gl=ca

Everyone is "covered" in the USA, too. No one is turned away from hospital emergency rooms.

The problem is that treating everday, minor medical problems in hospital emergency rooms is hideously expensive - that's one of the reasons (not the only one, to be sure) why the US has the most expensive health care system in the Western world.

But, the fact (and it is a fact) is that the USA also has the most "effective" health care in the world - in terms of "outcomes" when the healthcare system is utilized. The US system is not very "efficient," however, because a whole bunch of people, for a whole host of reasons, don't use it when and as they should. That's why there are such shocking statistics around some medical situations.

 

[Flip]

RG45 Glad to hear of the happy outcome - For me, it's all I can take when one
of my cats get sick.

Brad,

How do you figure you'd be liable for all that money?  Would you not buy health insurance for your family if taxpayers didn't do it?

It's pretty fair bet that the tab would have been higher than 75k in the US.

There is also some possibility of denial of coverage.
Insurance companies don't always pay out when they should.  They have been
known to lie cheat and steal to try to wiggle out from under a liability.

I would also be loathe to allow some insurance adjuster to participate
in the decision making process as they do in HMOs.

E.R.

Everyone is "covered" in the USA, too. No one is turned away from hospital emergency rooms.

I have a very hard time disagreeing with you - But respectfully, I have to say
this is a flawed statement.

Just because you have access to a band-aid or stitches does you are not ""covered"".

In some regions, emergency facilities are forced to provide non-emergency care
as when someone is in the emerge. and there is no currently available alternative.
This happens in Edmonton too, but at least insurance coverage is not a factor.

When a patient presents himself in an emergency room and is not an emergency
case the patient is forced to wait until services are available and, these services
can be anything from what should be taken care of in routine care to palliative care.

It's a lousy way to use the most expensive resource in the healthcare system.

In Edmonton - closing beds "upstairs" to save money, saves nothing because
patients pile up in the emergency.  This happens south of the border too,
but for different reasons.  I wouldn't want insurance company issues thrown
into the mix.  They are in it for the money after all.

 

[retiredgrunt45]

RG45 Glad to hear of the happy outcome - For me, it's all I can take when one
of my cats get sick.

Thanks Flip for the kind words and believe me I have a new appreciation for my daughter and our health care system. In fact it changed me to the point, were now I don't take anything for granted. There's nothing as life changing, as looking into your childs eyes and thinking that they may be taken away from you, nothing.

Yes I do know how you feel about the cats, I have three and now that my girls are on their own, i've found myself treating then like my children. Must be the empty nest syndrome. But afterall they are family.

Here in London Ontario, we have one of the best cancer centres in Canada, doctors, nurses, staff, they are all as my daughter would put it "Awesome".

Mr. Campbell, not everyone is covered in the U.S. There are people everyday who are turned away from hospitals, because they have no insurance only to be sent to a charity centre for treatment, even then treatment is not guaranteed.

 

[Edward Campbell]

...

It's a lousy way to use the most expensive resource in the healthcare system.
...

That's exactly what I said. The US system is highly effective (outcomes) when it's used but it is, at the same time, woefully inefficient because it "covers" people with the most expensive method and the rationing (which is characteristic of all emergency rooms, I think) discourages use of any of the healthcare system alternatives - meaning it isn't used when it should be.

 

[Brad Sallows]

1) "What about the millions who aren't or can't afford insurance?"  What about them?  How many times must I repeat the concession that there needs to be some sort of provided care for people on low incomes, so that we can meaningfully discuss the responsibilities of people on medium and high incomes?  If the only response people can come up with is, "But what about poor people?" and the poor have already been seen to, I conclude there are no persuasive arguments against a greater role for private insurers and private acquisition of services and products.

2) "It's pretty fair bet that the tab would have been higher than 75k in the US."  So what?  Some people seem to believe that "efficiency" is an effective argument for public control.  It is not.  Even were we to assume away the problem that government gets shafted in matters of health care as routinely as it does in others, it is not a sufficient argument.  Just because "government" might be able to do something more efficiently, is not sufficient cause that it should legislate restrictions on a freer market in able to do so.  The fact that government must legislate the playing field to its advantage tends to negate the "efficiency" argument - if it were "efficient", it would be competitive in a freer market and wouldn't need to make rules to suit itself.

3) We might collectively - public and private - spend more on health care.  So what?  There are no controls on the amounts of money people are permitted to spend on their housing or automobile choices, and there is no suggestion that people be protected against their money management problems as a result.  If we allow people to spend more on health care and they do so, thereby expanding the capacity of the system overall, it is a feature, not a bug.

4) Some private insurers may deny coverage.  But if payment is due, then the service was received.  That is a better prospect than not being allowed to buy the service at all because of legislative restrictions.  Our system doesn't have to lie or cheat or wiggle when the bill is due; it just says "No" to the service which would drive the billing in the first instance.

5) "Everyone is covered" leaves out the most important part: "Everyone is covered for what the system will cover".  We all have equal access to a lower level of coverage than one might aspire to elsewhere.

 

[Reccesoldier]

There are no controls on the amounts of money people are permitted to spend on their housing or automobile choices, and there is no suggestion that people be protected against their money management problems as a result.

But a lot of the same people who praise our healthcare system would dearly love to be able to tell everyone what kind of car or house you should be allowed to buy.

"There is no greater tyranny that to force a man to pay for what he does not want merely because you think it would be good for him."  Robert Heinlein

 

[Blackadder1916]

But, the fact (and it is a fact) is that the USA also has the most "effective" health care in the world - in terms of "outcomes" when the healthcare system is utilized. The US system is not very "efficient," however, because a whole bunch of people, for a whole host of reasons, don't use it when and as they should. That's why there are such shocking statistics around some medical situations.

What is your measurement of "effective" and "outcome"?

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care

Overview
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
...
Summary and Implications
Findings in this report confirm many of the findings from the earlier two editions of Mirror, Mirror. The U.S. ranks last of six nations overall. As in the earlier editions, the U.S. ranks last on indicators of patient safety, efficiency, and equity. New Zealand, Australia, and the U.K. continue to demonstrate superior performance, with Germany joining their ranks of top performers. The U.S. is first on preventive care, and second only to Germany on waiting times for specialist care and non-emergency surgical care, but weak on access to needed services and ability to obtain prompt attention from physicians.

Any attempt to assess the relative performance of countries has inherent limitations. These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients' and physicians' assessments might be affected by their experiences and expectations, which could differ by country and culture.

The findings indicate room for improvement across all of the countries, especially in the U.S. If the health care system is to perform according to patients' expectations, the nation will need to remove financial barriers to care and improve the delivery of care. Disparities in terms of access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. The U.S. must also accelerate its efforts to adopt health information technology and ensure an integrated medical record and information system that is accessible to providers and patients.

While many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, the U.S. could improve the delivery, coordination, and equity of the health care system by drawing from best practices both within the U.S. and around the world.

A systematic review of studies comparing health outcomes in Canada and the United States

Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92–0.98, p = 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

Practitioners in the United States may have made impressive (individual) technical advances in medicine (but they are not the only ones) and it may be a "go to" place for those few who can afford the latest, fastest, shinyest (and most publicized/advertised) care, but it has not translated into better (best in the world?) clinical outcomes on the whole.

 

[Edward Campbell]

What is your measurement of "effective" and "outcome"?

That those who (can) make proper use of the system get first rate and timely treatments. Those who fail to make good and proper use of the system don't - and I suspect that large, poor, ill-educated, frightened (of authorities) underclasses (there's more than one) pull all those statistics way down.

Broadly, US "healthcare" is below par while their "medical care" is first rate.

But I think that applies here, too. We offer good if often slow "medical care" but we provide little in the way of real, meaningful "healthcare." We, like the Americans, are in the business of treating the ill and injured, not in preventing illness or injury. On that basis the Americans do it faster and better for most people.

 

[Roy Harding]

My youngest son is an RN.  He has worked Emergency, and is currently employed in the ICU at the U of A Hospital.

For such a fresh faced young whipper snapper, he has an impressive amount of knowledge and experience regarding access to, and consumption of health care.  The opinions I will express below are nothing more than distillations of his remarks to me.

There's something "broken" in our system.  Folks shouldn't be presenting at Emerg because they have a head cold.  If they do, they shouldn't be surprised at having to wait ten or more hours while the emergency staff take care of EMERGENCIES (what's up with THAT?)

We (Canada) have a decent system for treating traumatic conditions - we have a lousy system for "normal, run of the mill" health concerns.  Of course, "normal, run of the mill" health concerns are often (but not always) indicators of serious health issues.

The system we've built is fairly good at addressing serious health issues - it's not so great at addressing "normal, run of the mill" health problems.  Perhaps if it was better at that, there would be less pressure on the Emergency services available.

My son, Gawd love him, has the same answer to health issues that I have to defense issues - namely; more money, more emphasis, and more CONSIDERED THOUGHT regarding the issue.  We can't BOTH be right - or perhaps we can be.

 

[Blackadder1916]

That those who (can) make proper use of the system get first rate and timely treatments. Those who fail to make good and proper use of the system don't - and I suspect that large, poor, ill-educated, frightened (of authorities) underclasses (there's more than one) pull all those statistics way down.

Broadly, US "healthcare" is below par while their "medical care" is first rate.

But I think that applies here, too. We offer good if often slow "medical care" but we provide little in the way of real, meaningful "healthcare." We, like the Americans, are in the business of treating the ill and injured, not in preventing illness or injury. On that basis the Americans do it faster and better for most people.

If only the world worked that way, exclude all the underclasses because they drag down our statistics.  I don't deny that you can usually find adequate (I use that word deliberately) medical care in the United States, but the studies I've seen do not indicate that "clinical" outcomes are significantly improved simply because the patient is in the United States as compared to other industrialized countries.

In one of the studies I referenced above, one point noticeably struck me.

Quality: The indicators of quality were grouped into four categories: right (or effective) care, safe care, coordinated care, and patient-centered care. Compared with the other five countries, the U.S. fares best on provision and receipt of preventive care, a dimension of "right care." However, its low scores on chronic care management and safe, coordinated, and patient-centered care pull its overall quality score down. Other countries are further along than the U.S. in using information technology and a team approach to manage chronic conditions and coordinate care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to identify and monitor patients with chronic conditions. Such systems also make it easy for physicians to print out medication lists, including those prescribed by other physicians. Nurses help patients manage their chronic diseases, with those services financed by governmental programs.

If their provision of preventive care scores the best, how much worse are the others factors of quality (in comparison to the other countries)? 

 

[Edward Campbell]

...
If their provision of preventive care scores the best, how much worse are the others factors of quality (in comparison to the other countries)? 

My, personal, short answer to your question, Blackadder1916, is: Dunno.

I’ve strayed waaaaay out of my lane.

----------

To scramble back into it: My experiences with our health/medical care systems have been, thankfully infrequently, as a patient. But, three times over the past decade, and each with the full knowledge and support of my Canadian physician (Gp and specialist) I have taken my “business” (and my gold card) to the USA because either:

1. The care (tests, actually) I needed were unavailable in Canada (some, less than adequate tests were available); or

2. The care (test, again) I needed were available in Canada only after a long, long wait; or

3. The best possible care (treatment) was only available in the USA.

In situations 1 and 3 we see the essential nature of rationing. In a single payer system there is no alternative to rationing; we have a single payer system.

In situation 2 we have another form of rationing. Although the test was approved there were so few test facilities and so little money that everyone had to wait. Such waits can be worrisome. I decided not to wait for situation 2 and I also decided, for 1 and 3, that I should have the “right” care, so off I went to the USA, gold card in hand.

Had my tests (1 and 2) turned out badly I would have jumped the queue in Canada because the American physician sent everything up to the specialist in Canada and he (Canadian specialist) assured me that a “bad” test result would see me in a hospital bed, receiving urgent and excellent treatment, within hours of my return.

Equally, had my US treatment (3) resulted in problems I know I would have been treated quickly and competently in Canada.

The nature of our system is that it must be rationed.  The nature of the US system is that anyone with “good” insurance or a healthy bank balance can have whatever care good physicians and informed patients agree is necessary or even desirable.

 

[Flip]

Today on Cross Country Checkup Rex Murphy had
a Dr Day on as a guest ( I think the CMA pres.)

The point made by Dr Day was that funding was provided in
a budgetary process that is unique in it's disfunction.

A hospital is given X number of dollars at the start of the year.
Every patient represents X-1 and removes some of those resources.

A more appropriate method is to make the patient into a Y+1
commodity. The more patients you treat the greater the billing.

Unfortunately some specialties have had severe limits placed on
billing so that doctors are golfing more than they want to and
patients are stacking up in the ER.

In a nutshell................

It's the way the suits do it. (management )

It was a good listen........ Cheers all.

 

[Bane]

The Commonwealth Fund 2003 International Health Policy Survey -  its a bit old, but interesting to look through.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=239252

There were some surprises for me in it, both good and bad.

 

[Blackadder1916]

My, personal, short answer to your question, Blackadder1916, is: Dunno.

It was a rhetorical question.

While rationing occurs in Canada, so it does in the USA, even for people with insurance, however it is often hidden under the name of managed care.  The basis for extolling the virtues of the American system is often due to anecdotal evidence.  And your experience, luckily, was mainly limited to diagnostic procedures, with the full expectation that any further treatment and costs would be borne by your public funded health plan in Canada.   My experience (as a patient) with the American health system has been limited to one exposure (two, if you count a visit to the TMC at Fort Sam Houston).

If all the anecdotal evidence of Canadians going to the USA for health care were accurate, my expectation would be that busloads of Canadians would be crossing the border each week heading to the nearest American medical provider in the same manner that they now head to the outlet malls.  But I don't think that south of the border medical use is as great as most people imagine. 

Now this is also anecdotal evidence, but a few years back I managed a fairly large group of physicians (primarily GPs but some specialists).  In one of our clinics, patient encounters in the first year that I was there totaled over 74,000 (this equates to approx 14-15,000 patients).  Though I was not directly involved in all referrals outside the clinic, I was usually aware of any that were "outside the box".  During that year, there was one (1) patient that was referred to a medical facility in the US for his condition (and that was mainly because the US doctor was doing some experimental work in that specific field).  The following years that I worked there had similar numbers. 

Incidentally, during that first year, I recall receiving at least 5 letters from Americans who had been seen at our facility and wanted to commend the staff and our health care system for its excellent service.  As a business oriented manager, I even looked at the potential for “medical tourism” both ways across the border.  My research led me to the conclusion that there were greater numbers of Americans coming up here for limited use of our health services (but my location did not fit a good business opportunity) than there were Canadians going there for usually more specialized elective procedures.

Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States

PROLOGUE: Over the past three decades, particularly during periods when the U.S. Congress has flirted with the enactment of national health insurance legislation, the provincial health insurance plans of Canada have been a subject of fascination to many Americans. What caught their attention was the system’s universal coverage; its lower costs; and its public, nonprofit administration. The pluralistic U.S. system, considerably more costly and innovative, stands in many ways in sharp contrast to its Canadian counterpart. What has remained a constant in the dialogue between the countries is that their respective systems have remained subjects of condemnation or praise, depending on one’s perspective.
Throughout the 1990s, opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that "refugees" of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.
This paper by Steven Katz and colleagues depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system. ….
   
Abstract

….Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home.

 

[TCBF]

We can't make a 'business case' if we don't operate like a business.  We have people waiting for MRIs and the MRI machine sits unused 120 hours a week.  So, Thunder Bay Ont sends people to Duluth Minn. for MRIs and they get appointment times like 2230 hrs and 0430 hrs because the Americans amortize the cost of their MRI by crewing it 24/7 and selling the day shift to Americans and the 4-12 and graveyard shifts to us.

Why can't we do that?

 

[Brad Sallows]

>But a lot of the same people who praise our healthcare system would dearly love to be able to tell everyone what kind of car or house you should be allowed to buy.

I know; but the campaign to have them declared morally unfit to vote (ie. exercise power over others) is making very little headway.

 

[retiredgrunt45]

But a lot of the same people who praise our healthcare system would dearly love to be able to tell everyone what kind of car or house you should be allowed to buy.

I know; but the campaign to have them declared morally unfit to vote (ie. exercise power over others) is making very little headway.

Since when does praising our health care system turn us into the former soviet union? I smell conspiracy theory here coming on. The government and the rest of us socialist pigs are out to get you and control your every move, is that it?.  :

I have a doctors appointment his afternoon, I must go and have my monthly mind control and brain washing session, free of charge of course...

I will then go down to our "state run" care dealership and buy that nice little pre-approved Lada that only comes in black and be really happy about it, because I don't want to anger the big bad Harper for fear of being sent to a gulag somewhere on Greenland for 20 years, by the big evil Canadian political bureau.

 

[TCBF]

... I have a doctors appointment his afternoon, I must go and have my monthly mind control and brain washing session, free of charge of course...

- How did you get those mind control sessions so fast?  I have been waiting years for mine.  I'm beginning to smell a big fat commie rat!

;D