Asymmetrical Information

I can't resist replying to this and then it's off to work.

PEI is a charming place for a family summer vacation but I wouldn't go there for complicated medical treatment (or university) any more than I'd head down to the Ozarks for a quick and accurate diagnosis or a PhD.

this whole story has so many large gaping holes, the biggest of which is what type of father lets his unrecognizable daughter return to the land of the medically incompetent to get a diagnosis for an illness that no one can be bothered to make in her home country?

Puh-lease!

I thought this was a story about how someone was denied coverage becuase it (socialized medicine)costs too much.

Yes Joan, but many people do live in PEI or Newfoundland or Saskatchewan or many other places you may consider too quaint or rustic to be concerned about. To dismiss an entire province as a backwater where you shouldn't expect decent medical care is slightly offensive. You can't expect some of the smaller provinces to have the same levels of expertise as a place like Toronto, but getting an allergy prescription isn't exactly cutting edge.

If those are the arguments that defenders of the Canadian medcial establishment have to resort to then maybe change can't be too far off. Can you imagine the reaction if someone in the US dismissed similar treatment there as "it's just the Ozarks"?

I would hope that a situation like the one described isn't commonplace, but it is entirely believable and it's a disgrace.

Joan Benz,

I am from the DC area. She developed the allergies while at UPEI and couldn't get them treated there. The US Military health care system took care of her.

Greg,

I get your point, but I tend to believe that if there was that much of a wait for an allergist, open competition would have drawn in another allergist or two, thereby reducing the wait.

Sorry to post anonymous, but I don't want to embarass my daughter by giving out names. She occasional read this blog too.

I just posted on yesterday's thread, but it seems just as relevant to today's. Why does ours always get contrasted to 'theirs' ?

If the question is whether the US health care system needs to be reformed, why would anyone say, "[Insert pitiful socialized system of choice] sucks. Why the hell would we want to go that route ?" Certainly we should just look at our system and decide if it needs reformed. Then discuss the devilish details of how.

If the issue is, yes, the US health care system does in fact need to be reformed; how do we best accomplish that ? Why would anyone say, "[Insert pitiful socialized system of choice] sucks. Why the hell would we want to go that route ?" Why the hell, indeed. Certainly we wouldn't want to emulate bad systems when fixing our own.

Are there any systems out there that provide 'better' coverage (i.e. broader, at less cost, better quality of care, etc.) ? Note that these issues do not have to all be found in one superior system. (Yes, we all know ad infinitum about the drawbacks to [insert pitiful socialized system of choice].)

Why not think about cherry picking good bits from here, better bits from there. And if it turns out that the US provides universal coverage at the lowest cost with the highest quality of care, that still doesn't mean that the system can't be improved.

Or do all the folks who so vehemently oppose reform really believe that reforming health care is some kind of socialist wedge issue to bring about the USSA ?

Color me puzzled by the resistance to an honest debate of the topic.

Cheers,

All of us Americans, who live in cities near the Canadian borders, know that Canadians fill up our doctor’s waiting rooms and hospitals. All are seeking treatment not available to them because of the long queues for treatment in Canada.

And we thank Canada for all the business.

If the Canadian government did not pay for health treatment received in other countries, the Canadian health care system would implode. The citizens would rise up in revolt and a private health care insurance system would be adopted.

The Canadian system can not exist without the American health care system filling in the huge gaps left by socialist medicine.

Isnt' the US military medical system also a form of socialized medicine?

I'm not a defender of the Canadian medical establishment Sean E. I'm a defender of what's good about Canadian medicine and an advocate of changing what's bad about it.

The fact of the matter is there are never going to be top-of-the-line cardiac units in Goose Bay. That doesn't mean the people who live there don't deserve the best heart care, it just means they're going to have to go elsewhere to get it. This is what happens in the US where people from all over go to New York and Bethesda to get the best cancer treatments.

As for PEI, of course people there should have access to competent family doctors and, yes, people who are "unrecognizable" should see an allergist immediately. If I were this girl's parent, I would have told her to see another doctor right away, and if that didn't work I would have had her on the next flight home.

But doesn't it strike you there are a lot of unanswered questions about this story?

As it happens, I've had a lot of experience with the Canadian healthcare system over the past few years. I have elderly family members and young children and we've always gotten the care we've needed promptly.

When I myself had an operation two years ago i was pleased that it was performed by a world renowned expert in the field. But this did not blind me to the fact that there was paint peeling off the hospital walls and that recently I had to wait months for a follow-up ultrasound.

I fail to understand why you seem to think the US system is some sort of panacea when it is clearly plagued by problems of its own.

It is illegal (and definitely malpractice) for an ER to deny critical care to indigent patients as a condition of their tax exemption. The State (and by extension, the taxpayer) picks up the bill for this "universal coverage" through networks of "safety net" hospitals and emergency rooms.

So, your point is correct but misguided. We do have "socialized" medicine here in the United States. And it is highly inefficient, expensive, and has poor outcomes. The fact is that preventative care is almost always preferable to ER treatment, from all perspectives. The fact is that the Canadian model provides for the best system of universal coverage because it removes the disincentives for people to seek preventative care thereby lowering costs.

Well my wife started to get really bad hay fever last spring after we moved into a valley close to our town centre. She was seen straight away by a Doctor who pescribed anti-histamines and also referred her to a specialist asthma centre in case of problems. She saw them within the week, had a series of tests which confirm she was turning asthmatic and provided her with the rest of the necessary medication.

One year on the specialists contacted her for pre-spring reassesment and yesterday she got a same day appointment with our doctor for stronger anti-histamines.

Not bad for the NHS. Interestingly as a South African she hates every minute of such a system even though its working for her.

I could recount the story of the breat cancer screaning system too, but that would be too much detail.

"The Canadian system can not exist without the American health care system filling in the huge gaps left by socialist medicine."

Absolutely correct.

Here is an old Calgary Herald article that suggests our PM missed the funeral of Jordan's King Hussein because he was in Minnesota taking advantage of the private medicine he fights against back home:

http://www.ezralevant.com/EzrasArticles/PMHealthCare_Jan1502.htm

Rofe, I agree with you in principal - the assumption that the US system is the only alternative to the Canadian one is one of the main reasons any change to the Canadian medical system is opposed by so many people. It's not a question of either/or, and both countires should be open to ways their systems can be improved.

But in this case, I get the impression that Howard Dean is proposing a fully nationalized health care plan similar to Canada's or the UK's. In that case, it is legitimate to look at how things function in those countries and ask if that would be an improvement.

That's a red herring, Amitava. The U.S. military health care system is an independent system designed to meet the needs of military personnel and their dependents because military personnel cannot always count on receiving civilian medical treatment.

I've also seen no evidence that it's cheap, which is the main subject of contention: enthusiasm for single payer is vanishingly small unless advocates claim substantial cost savings without substantial service impairments.

I don't understand why bringing up the military's socialism is a red herring. Obviously, if the system works (I don't know that it does), then it is false to say that socialized medicine can never work.

I'd never recommend a country to look to the UK as a model for a healthcare service. It is, afterall, one of the only true "free" at point of service healthcare services in the world. The UK's health service is poor by the standards of the rest of the industrial world.

Nor would I have imagined that anybody would argue that universal national healthcare is "cheap".

It is normally contended that it is fair that there should be a minimum level of healthcare available to all.

Not here; anything which promises to either increase costs, or decrease service levels, is wildly unpopular here. The only way single payer advocates make any headway is by claiming they'll save money.

This is an example of "Tyranny of the Process", which occurs whenever laywers and politicians get together to decide how to do something so that it is "fair" to everyone. They establish a "process", and then they force everyone to "follow the process", but these sort of processes can't predict every little twist along the way, and so can't deal very well with the inevitable setbacks that are part of life. As a result, the process gets dragged out, and people suffer while the process wends its way to completion. Most of the time, the process eventually works, and people get the service that is promised. However,ocasionally, someone dies while the process proceeds. In these cases, some ambitious laywer/advocate seizes on the example as a failure of the process, and the particular bad example gets incorporated into the process as a special case, making it more complex and opaque, and causing more delay to the people who don't fit into the special cases.

Businesses that don't have to worry so much about fairness, or the scrutiny of the media, and are much more concerned about the bottom line, do a cost-benefit study, and figure out how to save time (and money) by simplifying the processes. Governments worry about the need to be "fair", so they add more and more layers of process and complexity, till the system essentially stops.

Believe me - I work in the government.

Amitava, why is military health care a socialist system? From what I can tell, it's more like a private HMO.

The only way single payer advocates make any headway is by claiming they'll save money.

Quite a silly argument to make.

Also, military doctors have different training and different methods that a civilian doctor. Military medicine puts a premium on quick and easy, even if it is not necesarily the best solution. It makes sense, they are trained to deal with battlefield emergencies. Military dentists are famous for pulling teeth a civilian dentist would try to save. I'm missing a couple of teeth for that very reason. When I broke my arm as a kid, the USAF ER doc told my parents to give me Aspirin, and I saw a private ortho the next day. I had a broken arm, but military protocal said do nothing because there was minimal chance I would futher damage it before I saw the doc the next day.

Military medicine is a different world and really can't be compared to traditional medicine in the US.

I recall when I discovered I had an allergy to Sulfa drugs. I awoke with a rash on my Hands and Feet. I was part of an PPO. No one could see me. The rash slowly began to spread throughout my body. No one could see me. I began to have trouble breathing. No one could see me. Not even doctors outside of my plan. I finally had to go to the hospital where I was perscribed Steroids. The Canadian story just sounds like a bad HMO here in the US. The difference? $150 per pay period was removed from my paycheck and very poor people did not have access to even the lackluster health care I did.

joan benz,

Your arguments don't hold water. You're nitpicking a four paragraph summary of three months worth of events. The gist is, my US citizen daughter got sick in Canada and didn't get proper treatment until three months later when she came home to the US and got treatment within 12 hours.

I feel confident that if she dislocated a limb that it would be taken care of as an emergency in Canada...by a very competent physician at that, but I'm not confident that if she needed surgical repair of injuries related to that limb she could get it in any reasonable amount of time.

Amitav,

The US military is actually very akin to the Canadian system with a few exceptions. 1) It only covers military and thier families, not everyone. 2) If they can't see you for a non-emergency problem within 28 days in a military facility, they send you to a civilian provider. 3) If you or a family member that is seen has insurance through an employer, they bill that insurance company to recoup costs. So, they aren't really a socialized system, but there are parallels.

Sorry nothing, I don't get it.

I would have told my daughter to get a second opinion right away if she were in distress and discomfort.

And I would have arranged for her to see an allergist when she was home on break.

To me this isn't nitpicking. It's getting the treatment you or a family member deserve. Whether you're on my side of the border or yours.

Joan Benz,

My daughter isn't much of a complainer. The only thing I noticed was her sniffling when I talked to her on the phone, but felt confident that it wasn't a big deal, since she had seen a doctor and had a consult to an allergist. I didn't realize the extent of the problem until I saw her at the airport. I am appalled that the nurse and doctor didn't do anything for her other than get her room cleaned. They, obviously, saw the extent of the problem, but where either unable or unwilling to do anything about it.

As for seeing an allergist, our primary care physician wrote her the prescription she needed and followed up five days later to make sure it was working. If the meds weren't working, he would have sent her to an allergist - that is the way it is done here. The primary physician tries to relieve your distress and sends you to a specialist if he/she is unsuccesful.

And, that is my point. In Canada, she did not recieve appropriate medical treatment after three months of suffering, but was treated succesfully in the US by the first person she saw after only a twelve hour wait.

See this collection of links which includes a table comparing fatality rates from cancer cases in all the Canadian provinces and US states. I'd much rather be treated for cancer in the US than in Canada because I'm really keen on not dying.

I have a Canadian friend who is trying to get US job that will get him a green card in part because he does not want to be at the mercies of Canadian health care. If anyone knows a company that wants a really bright and able computer programmer let me know and I can get his resume to you.

Canada's health care system is benefitting the United States...

Hey nothing,

There's an old joke: "What do you call the doctor who finished last in his med school class?"

and the answer -- admittedly not that funny -- is "Doctor."

You know what there are bad doctors in Canada and the US. And your daughter obviously met with one of them in PEI.

the fact of the matter is she could have gone to another doctor and she didn't. I mentioned in the other med thread that I worked with someone who had a botched emergency appendectomy in the US. To me, that's not an indictment of the entire US medical system but of one particular doctor. Ditto
the doctor who saw your daughter in PEI.

Hi Joan.

I apologize if I mischaracterized your comments. Your initial post seemed to dismiss the incident solely because it happened in PEI, which I don't believe is a reasonable position. I have no problem with people being required to travel for specialized care, but this seems to fall under what I would consider to be fairly routine.

I don't think the American system is a panacea - I really don't know that much about it. I just find it hard to believe that anyone would consider the Canadian system a panacea either, given all its problems. Unfortunately there are large segments of the Canadian population that consider our health care system sacrosanct and resist any serious exploration of other options. Glad to hear you're not one of them. ;)

Call me Percy Pedantic ...

>I know that my readership is biased rightwards -- but surely someone can come up with stories about how they were denied access to critical care because of cost.

If you're denied access to critical medical care, you're dead. That's what "critical" means.

I was using it in the generic sense, not the medical sense -- although I believe that critical care does, in fact, cover a wider swathe of illnesses than those with 100% fatality.

holy jeeze...

that's horrible... i had similar experiences recently...

PEI can be written off, however.. it's 100,000 people... get off the g-d damned island!!!! bu tthat's hard for students

to get effective care in canada you need to be a complainer, demanding, and have large numbers of friends who are doctors

even then its hit or miss...

one of themajor issues with a nationalised health system is that they restrict (massively) the number of doctors... 10 years ago, budget crisis, wanted to reduce health care spending.. reduce number of doctors.. cut admissions to med school...

now all the baby boomers are retiring/cutting back on hours... no doctors... but you need a mid 90s minimum to get into med school (in at least your best year in university.. if not overall average... and that's in competitive programs... canadian universities curve like crazy, unlike harvard)

military is not socialised medicine.. it's a private employer hmo... amitava is (as always) not a useful person to discuss with)

when something is free, rationing must take place by other means.. in canada this is by time (horrible waits for mris) or by connections (the "right neighbourhood" health care plan... very good)

as i've said before, this is unethical and inefficient, as people with good connections and minor problems get seen before people with really big problems... rich and well connected individuals will always have better health outcomes (they know doctors socially from school, camp, golf, houses.........) but when you use cash as a rationing mechanism, people of modest means can get the help they need if they really need it (by fundraising, spending assets, or relying on heroic ER service to indigents)

now people will say that you get better primary care in canada, but this is untrue.. most places it is difficult to impossible to get a doctor (almost no doctor in Ontario is taking new patients, communities of 300,000 people near toronto have been going through a 5 year search for new docs with no luck.. never mind actual rural centres).. if you have a doctor (and they don't kick you out to reduce their hours) then you're getting decent service... but the doc is overowrked, underpaid, and has really crappy offices (billing cap of 400k annually, which most docs don't hit due to ridiculously low set fees for services, out of which must come offices, staff, malpractice, and then salary)...

most doctors are lucky to make 100k... canadian.. or say 75k us... also known as annualized intern salary at microsoft in 2000-2001

so while its ok with connections, the candian system sucks really really badly.. and its only liberals and socialists who are committed to following failed and false ideologies at the expense of real people (see opposition to gmos, war on terror, ddt, capitalism........... for more of these egregious and inhumane tactics)

if you like the system so much amitava etal... move to freaking pei, cut off your ties to all the doctors you know... and tell me how wonderful canadian health care is!

United States spent 13 percent of GDP on health care in 2000 and Canada spent 9.1 percent. In other words a 42.9% difference.

GDP per capita at purchasing power parity of exchange was US $36200, Canada $24800. In other words a 46% difference.

1.429 x 1.46 = 2.1 In other words, the US spending is more than double the Canadian spending.

In other words, you can't compare the level of care received in the US with the level of care in Canada!

It would be more instructive to examine if the Canadian system would provided same, better, or worse care than the US if spending were doubled in Canada.

As for the girl in PEI, she should have just called another doctor. I know that's a bit of a problem if you're in a small population centre but in Vancouver I never see general practitioner if I have to make an appointment, I just move on to another drop-in clinic. When I was younger I wasn't as insistent (pushy?) in most matters as I am now, but surely PEI has telephones and more than 1 doctor. You live (hopefully) and you learn. The problems in the Canadian system probably start at the specialist level where the big pay lures them to go south of the border and then there's the fact that at half the spending level as the US and the boomers ageing perhaps 9.1% spending should justifiably be increased.

Regarding military health care, another thing to keep in mind is that military doctors are all in the military being paid a pittance compared to what they would make in private practice. And many military installations don't provide care to dependents because they don't have the wherewithall to do so.

There is also an effective triage system for the military patients, which differs from dependent care. First you see a corpsman, and most complaints are handled at that level. If the corpsman refers you to a doctor, then you see either a doctor or a PA (physician's assistant). (Dependents go directly to the doctor/PA step when they have a health problem.) Referrals to specialists such as allergists usually take 30 to 60 days, while a referral to an orthopedic surgeon would take only a few weeks. Emergencies are always treated right away.

I never had a problem with the care I received during 11 years of active duty, nor did I have any complaints about how my wife and children were cared for. If we got the children to the base hospital/dispensary before 0900, we would be seen sometime that day--and we had to wait around. If we wanted an appointment, there would be a 1-3 week delay. (This doesn't apply to the follow-up appointment which was scheduled at the time of the initial visit.)

I have no idea what the military health system costs, nor whether or not it would be "cost-effective" compared to civilian care. But I felt entirely comfortable with the idea that I didn't have "a doctor" but would have to see whovever was available.

Libertarian:

I'm not in favor of the Canadian system, so why would you tell me to move there?

I am opposed to ideologically rigidity.

Hence my questions about whether the military system disproves the notion that universal health care -- single payer or otherwise -- will never, ever work. It seems inadequate to just call it an HMO. It is a mini-society of a million and a half current members and many millions of veterans, all of whom are guaranteed medical care and would never be dropped from their health plan.

I let the ad hominem attack pass for now.

The US spent 13 percent of GDP on health care in 2000 and Canada spent 9.1 percent.

GDP per capita at purchasing power parity of exchange was 36200 in the US, 24800 in Canada.

(13*362)/(9.1*248) = 2.1 The level of spending in the US is double that in Canada. (Or twice as expensive).

In other words, you're not supposed to compare the level of health care in Canada with the US.

As for the girl in PEI, surely PEI has telephones, she should have called around for another doc. I realize in small population centres and if you don't have a car it can be difficult but when I was young I probably would have taken "no" or "later" as an answer too. In Vancouver, I use drop-in clinics and I rarely wait more than half an hour. Problems probably arise at the specialist level where big pay lures them south of the border. Also, at half the spending level, the care cannot be as good and with ageing boomers, perhaps the 9.1% spending should justifiably be increased.

I found it odd that in the earlier thread, an unpaid $230,000 medical bill is somehow proof of a system that works.

Isn't an unpaid medical bill effectively "socializing" the cost?

Adding up my three earlier posts, you could say the US has "socialized" health care at double the cost of Canada. Of course the level of care is better in the US! It has to be at that level of spending.

Brian said:

I found it odd that in the earlier thread, an unpaid $230,000 medical bill is somehow proof of a system that works.

I thought that the earlier thread was (initially) about refuting the common accusation that people in the US are regularly refused expensive medical care if they don't have insurance. Granted, the thread wandered far and wide from there, but that was the original point, as I understood it.

There may be better ways of providing services for the uninsured, but we'll never get around to discussing them as long as canards such as "uninsured people are regularly denied medical care" keep being spread around by the HillaryCare fans.

Isn't it ironic that the solution to the evul commie Candaian healthcare system being so socialist and terrible is the good and free-for-all V.A. system?

It's not just Canadians - don't overlook the fact that in California, Arizona, New Mexico, Texas, New York and other states, U.S. medical care benefits illegal aliens.

Firstly the unpaid bill and the idea that these costs would be automatically passed on to taxpayers. No.

Believe it or not doctors often do 'pro bono' work for the uninsured. Huge bills like that are often written off--without affecting the costs--even indirectly. This is NOT a widely pubicised practice, but it occurs regularly.

Joan, in the anecdote in question, you keep going back to the idea that the student should have seen another doctor--but the doctor wasn't the problem. Procedure was.

The doctor claimed that the first protocol was thourough cleaning of the room for an allergy diagnosis--no script, no tests to see what type of allergy--room cleaning. Which he had to do even though it'd been done. The doctor knew the problem and--according to the post--wanted to do something. But he couldn't because procedure demanded that an allergist set up the tests(and, apparently that an allergist prescribe allergy meds). Procedure did this--not bad doctoring.

Procedural problems are endemic to bureaucracies.

And bureaucracy, government and otherwise, is the cause of healthcares' problems.

This may be a little bit off target, but the young woman's experience with Canada's socialized medicine at least turned out better than that system's response to SARS, where a significant number of cases occurred from transmission in hospitals. Conversely, US hospitals were able to recognize something unknown and potentially dangerous and react appropriately.

*cough* life expectancy figures *cough*

... gosh, I hope that cough wasn't the first inkling of SARS, since I would end up in a socialised hospital and therefore die.

If anyone's using SARS as a datapoint, btw, I'd note that the only Asian country to have stamped the disease out is Vietnam, where I believe they still have a few socialist institutions left.

My belief has always been that the problem with healthcare in the US is that because of insurance people aren't worried about getting the most cost effective care, just the most effective care. If a medicine is 5% more effective but costs 3x as much, those costs are never passed on to us so we would take the most effective medicine.

Then it occured to me that since my employer has always paid my healthcare, I really have no idea how much my healthcare really costs. John Kerry's plan allocated around $2000 per person in his recently announced plan. Anyone have an idea of what kind of healthcare $2000 dollars would get you in a non-HMO employer provided health plan?

"United States spent 13 percent of GDP on health care in 2000 and Canada spent 9.1 percent. In other words a 42.9% difference"

Although this ubiquitous statistic is alarming, I believe it is also wrong. I believe these figures include medical research, which is vastly greater in the US. When restricted to health care, the numbers as GDP % are very close.

It's important to remember that both the Canadian and British Health Care systems have nothing to do with medicine as primary motivations. They are a raison d'etre (Canada) and a crushing of class system (British). Most developed nation health systems are some mix of compulsory/voluntary insurance with more or less cost controls and regulations (France, Germany, USA). Canada and Britain have severe medical care crises on a continuing basis but fixes are impossible due to the mythological nature of the beast.

I agree with joan benz. Nothing's daughter should have seen another doctor. She made a choice, and suffered the consequences. If that's unfair, well that's what libertarians have been telling us all along, right?
Here's another medical story. Afriend of mine went to several hospitals in Baltimore , USA complaining of headaches. Several doctors told her it was pyschosomatic. One recommended that she get a root canal! Turns out it was a brain tumor. How's that for misdiagnosis? Unfortunately, lousy doctors are all around.
AS someone who was unemployed without health insurance for a long time, I can assure you that I did not go to the doctor even when I was sick.I rode it out the best way I could. I broke down and went to the Er once or twice when I was in excruciating pain. Is this the way to run a health care system? I am willing to bet that not one single poster who wrote in praise of the US System was or is without health insurance. If you have health insurance, its a great system. If you don't, its really, really tough.I had bad allergies that went completely untreated through my unemployed period, for what it's worth .

I agree with joan benz. Nothing's daughter should have seen another doctor. She made a choice, and suffered the consequences. If that's unfair, well that's what libertarians have been telling us all along, right?
Here's another medical story. Afriend of mine went to several hospitals in Baltimore , USA complaining of headaches. Several doctors told her it was pyschosomatic. One recommended that she get a root canal! Turns out it was a brain tumor. How's that for misdiagnosis? Unfortunately, lousy doctors are all around.
AS someone who was unemployed without health insurance for a long time, I can assure you that I did not go to the doctor even when I was sick.I rode it out the best way I could. I broke down and went to the Er once or twice when I was in excruciating pain. Is this the way to run a health care system? I am willing to bet that not one single poster who wrote in praise of the US System was or is without health insurance. If you have health insurance, its a great system. If you don't, its really, really tough.I had bad allergies that went completely untreated through my unemployed period, for what it's worth .

Shuan Rose -- how much you want to bet? I'm uninsured and unemployed.

So what do you expect to happen should you fall ill?

To answer Kate above, while you did have a nasty experience with your PPO, it's certainly unfair to claim that you simply paid $150/month for your insurance without noting that you would also pay, through taxes, for the Canadian health system. In addition, you incorrectly claim that the very poor would not even have had access to what little care you did. Unless there's something you're not saying, you're ignoring both the existence of Medicare and that the very poor do get treatment in the US anyway.

dsquared-- yes, Communist countries have often been successful at preventing communicable diseases. A profound lack of civil liberties often helps. China officially eliminated venereal diseases in the 1960s by killing those who had them. Cuba has been largely immune to AIDS, unlike Haiti, by putting their AIDS sufferers in concentration camps, where they live out their lives unable to infect others. There's a world of difference between a national health care system in a social democracy, and a system run in a totalitarian state. A lot of Canada's problems had to do with health care workers violating basic quarantine regulations. In a totalitarian state, this could be prevented through quite nasty methods.

To follow up mj's comment, I am not sure why Brian is applying a general PPP number to health spending.

And why is Joan saying that allergists practice some sort of esoteric specialty like neurosurgery? Most US cities and counties have more than a few allergists.

There appears to be a misconception here that the figure of 14.1% includes research and development of pharmaceuticals and medical equipment companies. It doesn't. The figure comes from the National Health Accounts produced by the Centers for Medicare and Medicaid Services in the USA.

http://cms.hhs.gov/statistics/nhe/definitions-sources-methods/

has a very clear breakdown and makes it clear that:

"Research and development expenditures of drug companies and other manufacturers and providers of medical equipment and supplies are excluded from research expenditures. These research expenditures are implicitly included in the expenditure class in which the product falls, in that they are covered in the final cost of that product"

There used to be a category called "Research" among the expenditures, to take account of noncommercial biomedical research, but it got lumped in with hospital construction in a new category called "Investment" in an attempt to make the Health Accounts look more like the income accounts.

Could we now be clear on this?

The way I read it, the main causes of the problems were lack of access to an allergist and regulations that prevented the GP from prescribing allergy medication himself. I don't see how going to another doctor in PEI would have made any difference. It sounds like a systemic problem, not a bad doctor.

There appears to be a misconception here that the figure of 14.1% includes research and development of pharmaceuticals and medical equipment companies. It doesn't. The figure comes from the National Health Accounts produced by the Centers for Medicare and Medicaid Services in the USA.

http://cms.hhs.gov/statistics/nhe/definitions-sources-methods/

has a very clear breakdown and makes it clear that:

"Research and development expenditures of drug companies and other manufacturers and providers of medical equipment and supplies are excluded from research expenditures. These research expenditures are implicitly included in the expenditure class in which the product falls, in that they are covered in the final cost of that product"

There used to be a category called "Research" among the expenditures, to take account of noncommercial biomedical research, but it got lumped in with hospital construction in a new category called "Investment" in an attempt to make the Health Accounts look more like the income accounts.

Could we now be clear on this?

Sorry for the double post.

John: you're quite right. I wasn't seriously attempting to advocate that the world follow the Vietnamese model; just trying to point out that a silly debating point about Canada and SARS could always be matched with an equally silly debating point on the other side.

I have done, and paid out of pocket a great deal less than I would pay for health insurance, even though I have several fairly expensive conditions.

If I got something catastrophic, I'd probably have to declare bankruptcy. I balance that against the fact that I am currently enjoying several brand new drugs that have dramatically improved my quality of life, which were paid for by our free market system. TANSTAAFL.

TANSTAAFL?

btw, Jane, why not just get a catastrophic plan? Sure it won't cover a lot of things but if you're worried about bankruptcy, maybe it's a good hedge.

I went without for about 2 years -- and I can say this: you pay a lot more attention to your diet and activities when you know that it'll cost you big time if you wind up in the hospital with something stupidly expensive. Which is of course, the whole point behind reforms that propose to eliminate indiscriminate benefits.

I'm an enormous fan of Cat Care, and I'd buy one in a shot, but they're illegal in New York State, and I can't afford the crappy HMO alternative, which is several hundred dollars more expensive.

Then Jane,
I sincerely hope you don't get sick :-)
This is why I don't gamble.

Damon.. In regard to the Kerry plan if he is using a figure of $2000 he is way off target. The average employer cost for what an employee would consider a "good" health plan based the most recent numbers is around $5000 an employee.I work as a benefit consultant and sell private health insurance to large employers. I would say the cost is closer is to $4000 in my area.New England has some of the highest cost in the country so I have no idea where he got the number. He must be pulling out the usual arguments of... if we stop waste , abuse, cut admin cost etc we will save untold billions.

JT, I applied the GDP measured with *general* purchasing power to health care purchasing because I don't know of any GDP numbers that are calculated under the assumption that the economy produces nothing but health care. So what goes into healthcare: wages, medicine, rent, disposable plastic things, fancy machines. Sounds like a good cross-section of the economy. I think the calculation is still going to be roughly valid.

My grandmother complained of pain in her side. She went to see her doctor who ordered an X-ray. The HMO called her to tell her that they had reviewed the data and that it turned out that an X-Ray wasn't necessary because it was just old age aches and they had given her a prescription for asprin (extra strength). A year later she winced standing up, and my aunt, a radiologist, snuck her in to discover she had cancer near her kidneys that had by then spread to her adrenal gland and lungs. She was pronounced terminally ill the next week. She died in agony a year later. Without a Patient's bill of rights, we had no legal recourse. I may not be a liberal when it comes to most things, but a patient's bill of rights or some free preventative health care would be alright by me.

JT, I applied the GDP measured with *general* purchasing power to health care purchasing because I don't know of any GDP numbers that are calculated under the assumption that the economy produces nothing but health care. So what goes into healthcare: wages, medicine, rent, disposable plastic things, fancy machines. Sounds like a good cross-section of the economy. I think the calculation is still going to be roughly valid.

I was unemployed a couple of years ago and didn't have health insurance or hardly any money. When I had an ear infection, I went to the local community clinic. It costs $20 for the doctor and $5 for the medicine. Sure you have to sit in a room with the masses but it is available to all. I could afford health insurance now but won't get it. If I get hit with something, so be it. It seems to be a poor choice over the long run. I'd rather save it.

Which leads me to a country's medical system that does interests me, Singapore. They have mandatory Medical Savings Accounts under their Central Provident Fund program. Employees are required to contribute a certain percentage of wages, which for the medical portion increases over time. They have one of highest WHO rankings(I think they were 2nd) for medical care and yet have the lowest public expediture, less tha 2%, of any industrialised countries. There are criticism of such a forced savings plan, but I think that's out weighed by shutting up the democrats.

Jack, I didn't say the unpaid bill is "socialized" by being passed on to the taxpayer. It's "socialized" in the sense that it is passed on to a group or segment of society such as shareholders. If Jane Galt declares bankruptcy she also passes costs onto shareholders. Managers will just raise prices to make up for it.

How much does the high immigrant population in the US affect the life expectancy and infant mortality rates? Does anyone know how similar population in the two countries fare?

Bolie IV

Sean, I agree there may be systemic problems but what system doesn't have problems. I just wanted to point out by my calculations that the US and Canadian health systems have a 100% difference in spending so you can't easily discern what is a failure of the sort-of-one-payer universal model.

Where this leads me is: We might want to consider that because the boomer population is ageing, the system is inevitably going to make people wait for specialists if funding isn't raised. If there are abuses of the one-payer-model why not fix it with user fees? If we want to improve Canadian health care we might want to focus on growing our GDP in the economy as a whole. The solution may lie completely outside fo the area of health care.

Kate: the last time I experienced an allergy (very similar to yours) to a drug, I called my doc, he told me to stop taking the pills that were causing the allergy, and I did. But that was just from an antibiotic... I don't know what you were taking the medication for. Was it such a dire situation that you were forced to deal with the rash lest something worse happen if you stopped taking it? Could your doc tell you nothing over the phone?

Brian: the $230,000 is the whole point of the story. Jane's request specified that there be a large unpayable cost of treatment... without that large chunk of change, the story is nothing more than "Our system is more advanced than yours"... the money point shows that "our system has fail-safe measures designed to put lives ahead of costs". And yes, I do regard that as a sign that something good is going on.

Shuan: While I have my qualms with the US healthcare system, I still prefer it to any other. And I'm uninsured as well... and poor. ;) I might have allergies right now (can't afford to get tested), but it's not enough to make me want to move to Canada (well, at least not because of the healthcare). Also, I fail to see how your friend's experience with several bad doctors reinforces the idea that Nothing's daughter was wrong not to talk to several of them as well. If anything, it argues for stricter standards for medical practitioners rather than more action on behalf of the patients (note: I don't necessarily agree, just pointing out for the sake of clarity).

As a Canadian living in Saskatchewan, it is with great trepidation that I post that not only do I get to see my doctor in a timely fashion, but I receive quite good health care, as does everyone I know.

Surely this anecdote is sufficient to prove that the Canadian system is vastly superior to the American one...or it is if you believe that the anecdote that prompted these comments is sufficient to prove that the American system is vastly superior to the Canadian one.

They're quite different systems, and I have yet to see any....any....study, or indeed even opinion piece that is based on more than anecdotal evidence.

Sean and Jack, I love the way you attribute this to a systemic problem or procedure and imagine that there were regulations preventing the doc from prescribing something temporarily.

No one stops doctors from prescribing common drugs. If this is what the Doc said, he was full of it.

Also, the procedure in Canada is that a family doctor refers you to a specialist. which, according to nothing, is the same procedure as in the US. When the first doctor judges you are in need of immediate care, you are in that day. I've seen this happen many times.

If a doctor dismisses you, go to see another one. This is called getting a second opinion. I remember Ann Landers telling her readers that back in the seventies -- and she lived in the USA. This is one of the best pieces of medical advice you can give -- along with get off the couch and eat well.

As for SARS, well yes the Toronto Docs didn't pick up on it right away but the Vancouver ones did. Same country, same system.

Citing SARs as an example of why the Canadian medical system is a failure is about the same as me claiming that the pharmacist in Kansas who didn't give his clients enough chemotherapy drugs and caused several of them to die is an example of the evils of private medicine.

If all it takes is one example, well, hey, you can prove any health care system on earth sucks.

I knew an uninsured guy in the US who was mistakenly diagnosed with a kidney tumour after an ultrasound. Several CAt scans and an MRi later, whoops it was all a mistake, here's the $30,000 bill.

Frankly, the problem we all have is that costs of medicine have risen astronomically as we've discovered expensive new treatments. We're all trying to figure out how to give the best possible treatment to the most people. And the answer is, it aen't easy.

HMO horror stories don't make me anxious to endorse national health care. I'm afraid we'd just turn the whole country into one big HMO, complete with a big beauracracy to tell us we don't need that X-ray.

As an independent contractor, I buy my own health insurance. For a family of 5, it is 650 / month for Kaiser. I expect next year to be close to 900/month. I shall be looking for a pay as you got doctor next year with a catrostrophic plan.

--Stephen

Nothing..I'm sorry to hear about what happened to your daughter. I am originally from Canada, went to university in Canada and now live in the U.S. Generally, your story doesn't jive with my own experiences with health care in Canada. Usually you see a doctor the next day and he can send you to a specialist.

However, from my university days (I went to the University of Western Ontario) I remember that the Student Health Services there was, in general, overly bureaucratic and the doctors were generally not that good. Quite frankly I have my own medical horror story dealing with the university clinic that was fixed by a trip to my family doctor in Toronto. My advice to you is to tell your daughter to get care outside of the university. I can almost guarantee you that it will be much better than what's she's getting at the UPEI's clinic.

Gosh, but it's always fun to hear Americans sit around discussing health care. The debate always seems to wind up concluding that the U.S. of A. has got the best health care system in the world, bar none.

Give it up folks. What you really have is the system that's best designed to deliver heroic interventions at the last possible moment. Taking a broader view, your health care system is an expensive mediocrity. You spend 13% of your GDP on health care, far and away the highest level in the world and way above the 8% average for OECD countries. In purchasing power parity terms, the gap is even wider---you spend about two and a half times the OECD average. And what do you get for that? A life expectancy that ranks about 20th in the world, just nosing out that of Guadeloupe's.

I'm the first to admit that Canada's health care system could use a tune-up, but, for all its flaws, it delivers more for less than its U.S. counterpart. That's right---we Canucks live an average of two years longer than Americans, although we spend only about 9% of our GDP on healthcare, or about 25% less than the U.S. does. Canada's superiority is even larger if you go on the basis of what the World Health Organization calls healthy life expectancy---in other words, the number of years a person can expect to live in good health before the onset of debilitating conditions. Canada's healthy life expectancy is 70 years; that of the U.S. only 67.2.

Why is the U.S. system such an underperforming disappointment? The most thorough analysis I've read is a study by Elizabeth Docteur et al for the OECD. I believe it's available on the OECD website if you're interested. If you're not, suffice it to say that two of the reasons for the high cost and mediocre results of U.S. health care are Americans' love affair with 1) advanced medical technology and 2) sugar. At the risk of oversimplifying, it appears that the U.S. is a nation of lard-asses that want---nay, demand---the latest in medical technology, even if the benefits of that technology are dubious.

National health insurance was a high school debate topic way back when, and it appears they've brought it back.

Here's an interesting analysis of single-payer health care systems by the National Center for Policy Analysis--a conservative think-tank in Dallas that advocates an Singapore-style medical savings account.
http://www.debate-central.org/topics/2002/book2.pdf

Though its conclusions remain controversial, it cites interesting statistics which are relevant to the current discussion.

The reason Canucks (supposedly)live longer is because it is so COLD up there their blood slows so it takes you longer to die! LOL

Why is it then that the Mayo Clinic in Minnesota is so full of Canucks that can't get the proper care quickly enough! They tell us the stories of why they came to an American clinic. Why is it in England the Rich have their private hospitals?

I see no one has posted a tale of horror about being denied care in the US. The fact is, it is illegal for any US hospital, nonprofit or not, to refuse emergency care. The penalty is loss of Medicare funding, which is a death penalty for hospitals. Clearly, then, no one is being denied emergency care in the US.

One of things that irritates me about health care debates (and there hasn't been much of it in this thread) is conflation of "no third-party payment" with " no care." Keep an eye on Dean and the rest, and you will see this sleight of hand.

Finally, in looking at statistics about the apparently large number of people who have no insurance, keep in mind that young people routinely turn down insurance that is offered to them because they don't want to pay the premiums. For a young healthy person, this is actually not a bad bet to make.

The US health care system is the best in the world. It provides better care and is the world's research engine. No one is denied emergency care, and most people get all the care they need regardless of whether they can afford. It better be all these things, because it is the most expensive.

>>Why is it in England the Rich have their private hospitals?

Same reason they do everywhere else; they can afford 'em

Few people in the US are entirely without health insurance.
Anybody hurt on the job is covered by workers compensation, unless a sole prop or partner in an unincorporated business, although this varies from state to state.
Also varying from state to state, but more true than not, is the health coverage for auto accidents.
In Michigan, a pure no-fault state, your own auto insurance covers you for any accident involving cars, including if you're a pedestrian clipped by some clown who gets away undetected.
Although not properly health insurance, some injuries suffered at another's home or place of business may be covered by liability insurance or some other kind. If you slip on a grape at the grocery store and they pay for the medical treatment, that's not your health insurance, or theirs.
That leaves illness, which, as another poster implied, is not likely to worry young folks much.

Why is it in England the Rich have their private hospitals?

Why shouldn't they? It doesn't devalue the need for comprehensive national care.

I see no one has posted a tale of horror about being denied care in the US. The fact is, it is illegal for any US hospital, nonprofit or not, to refuse emergency care.

What about non-emergency care? Would cancer treatment count as emergency - if a person is to present at ER with an advanced or early but treatable cancer - would they recieve full treatment?

How about something like a diabetic illness or something chronic which could be cured but won't kill immediately.

Those are the areas which I've heard can be of concern.

Dave - the US is full of non-profit hospitals and health systems, and in fact they are some of the best. They have a legal duty to provide charity care and to write off bad debts owed to them by indigent people. I have been working in the health care area for over 10 years, and I have never heard of a doctor or hospital showing someone the door because they were uninsured. Not once. I am not saying it doesn't happen, only that if it does happen, it is exremely rare.

I am distinguishing here between the behavior of the health care providers and of the patients. I have no doubt that lots of people don't go to the doctor when they should because they don't want to pay the bill, but that is their choice, isn't it?

Ishannon,

Why does the Mayo Clinic treat a lot of Canadians? The reason is obvious---the U.S. system is perfectly designed to provide heroic, state-of-the-art (and very expensive) care to seriously sick people who can afford it. If I were diagnosed with a late-stage cancer and found that I could get immediate treatment by going to Rochester rather than waiting here in Toronto, I would be on a plane right now.

Unfortunately, the ability to do immediate, highly sophisticated procedures on very sick people is just one part of the whole health care picture. The best measure of a health system is the broadest measure---its ability to provide long, healthy lives for all citizens. And by that standard, the U.S. system is so-so at best, perhaps because it spends so much money on expensive late-stage treatment rather than cheap early-stage prevention. That, frankly, is rather dim. You wind up burning through bundles of cash to produce thoroughly mediocre results in terms of longevity.

Strangely enough, Americans seem to pride themselves on this. It's a bit like refusing to fix the brakes on your car, but installing a huge crash cushion, then claiming you have the best auto safety system on the planet.

For Ian, in the post immediately above, I would like to know your sources for your claim. As far as I am aware, there is an adequate (certainly not perfect!) system within the US to provide long healthy lives. Immunization for children is readily available, on a no-cost or sliding-fee schedule based on ability to pay. There are nutrition programs (WIC, etc.); and I am personally aware of low-income persons who had access to medical treatment, including routine physicals and dental treatments. I also am personally aware of elderly persons who are afforded long-term nursing and acute care. And, as previously stated, ER visits are covered.

I think one might be able to argue that baseline and non-acute care for non-children, non-elders may be more scarce in the US, and also that the expertise of the doctor certainly is driven by our market economy -- but I'm not sure that is a negative.

What I haven't seen addressed here is the fact that US taxpayers fund billions of dollars in basic research, an investment that is reaped by Pharmaceutical companies. I also haven't seen a discussion of the impact of malpractice suits on healthcare costs. Furthermore, I think the US should look into the practices of healthcare systems attempting to garner market share, including the resultant duplication of costly services, and the effect bankruptcy of such entities has on the drain of dollars from the healthcare field (i.e., locally we've experienced near-Enron mismanagement of health services, which has resulted in degradation of nursing practices and executive buy-offs).

I have had really nasty experiences with HMO's (granted, when HMO's were new, perhaps the system is better), but PPO options seem readily available to those employed. There are sometimes a few headaches in getting a claim processed, but probably no more so than with any customer service unit.

I agree, the problem is that health insurance is linked to employment. I don't know what my employer pays (other than a generic 25 percent assessed to my employer's budget by the system), if you lose employment or retire -- especially if you have a pre-existing condition -- insurance can be nigh unprocurable/affordable. If I can join a credit union based on my residence, or any other number of arbitrary "groupings," why cannot I purchase health insurance that way?

CJ,

At the risk of sounding like a pedant, let me point you to some interesting studies on the question of preventive health care in the U.S. compared to Canada:

---The Robert Wood Johnson Foundation (www.rwjf.org) sponsored a study of the use of medical care in the U.S. vs. Canada. It found that poor Canadians had one-quarter to one-third more hospital admissions than their U.S. counterparts, although the rate of admissions among wealthy patients was actually lower in Canada than in the U.S. This strongly suggests that poor U.S. residents dramatically underconsume health care compared to what they would use in a system where they didn't have to pay for those services. If this is the case, it's not a great leap of logic to assume that many preventive measures must go undone in the U.S. among this group.

---Canadians, of course, live longer than Americans by about two years (you can check the World Health Organization site for all the relevant stats). In comparison to the U.S., Canada has a lower infant mortality rate and a higher rate of immunization for measles among children under a year of age. Again, all of these stats suggest a stronger emphasis on preventive care in Canada, although I'm happy to acknowledge that lower crime rates and much lower obesity rates probably play a part in the life expectancy stats.

---the study by Elizabeth Docteur et al for the OECD cited other alarming numbers about health care for infants in the U.S. If I remember correctly, something like 17% of mothers in the U.S. receive no early pre-natal care; about a third of infants under two do not receive the full course of recommended immunizations. (I don't have the report in front of me so these numbers may be slightly off.)

Let me emphasize that I'm not saying that the Canadian system is perfect. Far from it. But I do think that most Americans hear only one very prejudiced slant on it. All the macro stats indicate that Canadians achieve a better level of health than Americans for much less money.

The most likely cause for this efficiency is better preventive care in Canada. I've heard many anecdotes from doctors who've practiced on both sides of the border and they all agree that if patients are seriously ill and insured, the U.S. system tends to treat their illnesses more aggressively and with a higher level of technology than the Canadian system. That is to be applauded. But these doctors also say that they've been shocked by the frequency with which uninsured people wander into U.S. emergency wards with advanced medical problems. These doctors concur that such cases don't occur nearly as often in Canada because up here there's no financial impediment to seeking medical help before a problem reaches an unbearable level.

Also on an anecdotal level, nurses who've worked in both systems suggest another reason for the greater efficiency of the Canadian system. They say that in the U.S. a big part of their job isn't patient care, but accounting. They have to track every item consumed by every patient: "One bag of glucose solution...$25; one box of Kleenex...$6" and so on. One nurse I know who returned to Toronto after two years working in Galveston said in Texas she must have devoted at least an hour every shift to accounting. paperwork. Multiply that across an entire health care system and the loss of patient care time is staggering.

cj, a couple of posts up, says, "If I can join a credit union based on my residence, or any other number of arbitrary 'groupings,' why cannot I purchase health insurance that way?"

I always find these questions a bit surreal, because as far as I've been able to tell since moving here (I'm from Canada originally), that pretty much IS how it works. Lots of groups seem to offer insurance to their members -- Guru.com was doing it, for example, and I think it's not unusual in professional organizations, freelancers' unions, etc.

On the downside, I think many of the above organizations are selling "individual" insurance. Here's the part that Americans seem not to believe when I tell them: last month I obtained real-live GROUP health insurance on my own, simply by walking into an insurance agents' office and picking a plan out of a bunch of plans in brochures and paying them money for it. It wasn't any more complicated than buying car insurance, and (here in San Francisco) a good midrange health insurance plan was CHEAPER than insurance for my old Honda Civic.

The "group" for this group insurance is a business that legally consists of me and my girlfriend. The business isn't a corporation, just an ordinary sole proprietorship. I didn't lie to anyone or pretend anything, I just said "I have a business with two employees including myself and I want to buy group insurance". It was no problem at all; the insurer simply assigned a risk multiplier based on my declared industry (software = low risk :) and added a 10% factor for being a company of fewer than 5 people.

The significance of "group" insurance is that the rules are better than for individuals: the insurance DOES cover all pre-existing conditions after a 6-month grace period, even if they're known in advance. "Individual" insurance policies, I was told, can impose a 2-year noncoverage period for preexisting conditions and then drop you; "group" insurance can't. (Note: I don't know why "group" insurance has better terms at lower rates than "individual" insurance, but I assume the cause is regulatory; this may be another way in which the US system is quietly socialized.)

To be clear, this is the same insurance policy at the same rate that I'd get as an "employee" of a company that chose it for me, so as far as I can tell there's nothing magic anymore about working for a "real company" vs. being self-employed -- any group of two or more people who work together can be a "group" for health insurance purposes.

I agree that we should get health insurance out of the hands of employers altogether, but at least the insurers seem to be reaching out to the self-employed in a way that (I assume) they haven't always done in the past.

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