October 27, 2004

• CBC's take on health care, from their ever informative Indepth pages.
• There is a curious disconnect of recognition between the health-care systems of the US and Canada. Whenever I've spent time in Canada I've noticed that the worst critics of Canadian Medicare invariably ignore the fact that US health care is very arguably worse, and certainly much more expensive. While there is constant debate about the future of the Canadian health system, the author makes a good point in saying that debate is simply the price of a democratic system. Those same critics never seem to have a concrete answer on what they would replace the Canadian system with, only that it would somehow be magically 'better' if it were more like the American system.
• The American system rations by money; the Canadian system rations by queues. Depending on your angle, the American system is either inefficient in providing service (high costs) or efficient in creating wealth (high profits). In short, America is more capitalist than Canada. News at 11. /glib Media myths aside, whether Canada - and everyone else whose population is aging - can afford health care in the years to come is a difficult question. Just what are we going to do with the boomers? Landfills? /jest
• *Walks out, takes a look around, sees lots of healthy folks* /whistling in the graveyard.
• /pops in tape of Logan's Run and whistles to oneself whilst waiting for a healthy serving of Soylent Green to finish baking in the oven
• Smartass comments aside, America's healthcare system is inefficient because of all the paperwork involved. I think by the last count, over 55% of the cost of healthcare is just handling the accounting for every last procedural detail. Because there is no centralized, agreed-upon method for handling billing, most of the time the insurance companies are haggling with hospitals and care providers with the itemized bill. If anything, the Canadian single-payer method can point to lessons learned about efficiency of bureaucracy, if not efficiency of care. These lessons would do the US system a world of good.
• I think it's because the American system is evil-based while the Canadian system is good-based. Can't find any links to back me up, sorry.
• We have a friend who's a doctor in a downtown ER who, like me, used to live in the U.S. for a long time. Her opinion of the differing systems is interesting, and I recall her saying early in the summer that the primary difference she encountered was the quality of care toward people with lower or no incomes. While both countries treat the poor, in the U.S. she felt the care given was minimal, rushed and delivered with disdain, while her experience here in Canada has exposed her to doctors and nurses who treat people of all classes relatively the same. Her experiences in upper class care are minimal, as she prefers to work inner-city public clinics, but my experience as a police officer backs her up. Paramedics I knew back in Missouri confirmed the disdain that the poor were shown, and I know I saw more than a few examples of bad behaviour on the part of hospital staff. The fact that the U.S. media rips the Canadian health care system is unsurprising. Having lived in both countries, I'm familiar with the ignorant dismissal of Canadian issues by many people from the U.S., and with the obviously foolish misconceptions which percolate in those same minds. My idiot brother-in-law, as rabid a flag-waver as exists, asked me if I knew that Canada only had two MRI scanners for the entire country when I told him I was emigrating. Obviously wrong, he didn't even know what an MRI was: he'd read it on some right-wing journal. Yet, he's middle-income and has a few years of college under his belt.
• just what are we going to do with the boomers? Carousel? A young girl here died recently because she needed a transplant, and her family could not raise $250,000 for a deposit. It was apparently a $1 million operation - but the hospital would not touch her unless they came up with at least the $250 K. They actually had health insurance (unlike many), but the claim was denied because the girl was in a high-risk category or something. In Canada, she would have probably lived - but some wealthy person may have had to wait a month for his/her turn. The fact is, we don't usually let people die on the street - so there is a de facto national healthcare system. It's just tied up in a Kafkaesque bureaucracy of taxes, insurance, forms, and employment ties. All those people that end up in the ER and have no insurance? We're paying for them, anyway. But in the U.S., they become a convenient excuse for the medical industry to keep raising costs and make windfall profits.The uninsured may add 5% to a medical cost a year - but the drug company or hospital or insurance company will raise rates by 10%. I think that's mainly what it's about - and why they are against a standard national healthcare system. I spent the Summer in the UK, and took some other American friends to hospital after a minor car accident. They received x-rays, lab work, casts. It was completely weird to have all this care and not have to fill out 50 different forms and call 8 insurance companies and not have the doctors on the phone fighting with the insurers because the company thought a certain recommended treatment option was not as "cost effective" as a lesser one. We just left after a few hours - no need for a chequebook and no waiting for prescriptions and coming up with $1000 for co-pays.It was amazing. And for what it's worth, two of my friends have parents who are surgeons, and they felt the care they received was on par with the quality they would have in most U.S. ERs.
• I'm Canadian and don't know much about the US situation. The fact that 55% of American health costs are paperwork blows my mind. Can that really be regulatory necessity? My knee-jerk reaction is that it has to be bureaucrats exploiting the system. This can happen in private industries as much as public. Canada has its share of crazy governmental expenses, but strangely, not so much in healthcare.
• over 55% of the cost of healthcare is just handling the accounting for every last procedural detail If that's true, I'm profoundly shocked. That's terrible.
• Looking around, the numbers I can find are 25%, which is still pretty damn bad. A number like 55% is, if true, true only for some limited class of services -- maybe 55% of the cost of a routine office visit with no tests. Health care in the US is good and bad at different things. One of the things it's routinely very bad at is routine care for the poor(ish) -- many poor(ish) people don't have family physicians and end up using the ER for everything, which wastes a lot of money and gets them worse care for routine matters. On the other hand, I live in a boringly normal suburban setting and can walk to at least 2 MRI / imaging shops in local strip malls, and presumably another few in the medical complex a little farther away. Likewise, the nice Canadian lass I'm hitched to, who spent some time as a nurse in Toronto, says that trauma care in the US is years ahead of that in Canada. On the other other hand, not long after we were married I received a boo-boo* in the kitchen. It was late enough that I went to the ER for a stitch or two, and she was unpleasantly surprised after we were done that I had to stop and pay the cashier. *Please. Children. For God's sake, use the hand guard when using a mandoline. Don't be a fucktard like YT.
• Canada's health-care system has an overhead of approximately one percent, far below the 15 to 30 percent levels of the private-sector insurance companies that rule the roost in the United States. Holy crap. The difference that would make in premiums...
• For God's sake, use the hand guard when using a mandoline. Are mandoline strings really that sharp?
• Literally? Hospitals have a cashier in the U.S.? That blows my mind.
• The problem with the British national health system is that it's often viewed with such distain, it is seen as a service with no hope. Alternatively, the Canadian system has always been
• the British national health system is ... often viewed with such distain I recently fell off I lion in trafalgar square, and I found the NHS was extremely competent, well staffed by hot nurses and zero-cost*. From getting scraped off the ground through waking up in Hospital to some minor surgery to put my face together, it was a wonderful experience and one I can't wait to repeat. Also they give you these little cakes with toffee in them. *although not the hot nurses
• We had an emergency visit in California to our local hospital and we were sitting in the waiting room for 90 minutes, then an hour in a cubicle with only vitals being taken by an EMT, then finally, after I harangued the nurses' desk, we got a doctor. Once the doctor had come in, it was only minutes before he had a specialist sent in, and an hour later, after an endoscopy, we were home again. Without insurance, the bill was $18,000. We hadn't brought our card and I really wonder how much differently we'd have been treated if we'd brought it at the time. We were lucky we did have insurance, because then we only paid something like $256. In NZ, you have an emergency and your healthcare both at the time and in follow-up are paid for by the government's ACC scheme. Treatment times are slow, but still not as slow as our experience in the US.
• *makes note to push quidnunc off a lion next London meetup*
• Literally? Hospitals have a cashier in the U.S.? Sort of. Not a gum-snapping cashier at a row of cash registers, no. It's the person you drop off insurance forms with; one of the record-keepers. It's normal in the US to have to pay a copay -- you might be expect to pay $30 or $50 for an ER visit, unless you're admitted or otherwise diagnosed with an Actual No-Shit Emergency.
• Literally? Hospitals have a cashier in the U.S.? That blows my mind. Canadian hospitals have a cashier too. I made a payment to one for my wife's private room after the birth of our daughter. More telling is that the private room fee was only C$40 a night. I had a friend pass out going to the 7-11 while we were storm chasing in OK and the private room fee was several hundred dollars a night. Plus they asked him which hospital he wanted to go to; that's the part that blew me away.
• The reason there's so much inefficiency/overhead is that this is where people get rich out of it. That "overhead" is the profit of a privately run system, to all intents and purposes. It's also telling that objective indicators that tie into healthcare - infant mortality, average lifespan, and so on - show Canada well ahead of the US. Even the much maligned NHS, which American ideologues don't even bother attacking any more, has better outcomes by such measures. US healthcare: costs more, does less.
• That "overhead" is the profit of a privately run system Exactly. It also creates a mind-boggling number of jobs in that sector. Much of the money flows back to the government in income tax, corporate tax, goods & services tax, etc. I live in a boringly normal suburban setting and can walk to at least 2 MRI / imaging shops in local strip malls, and presumably another few in the medical complex a little farther away [...] trauma care in the US is years ahead of that in Canada. The American system is far richer and thus provides better services to clients who can afford them. No "universal" system could possibly compete in that regard. I like our Canadian system very much. I can live with the waiting lists and without the best-of-best medical equipments. But I also understand why most Amercians have never wanted a system like ours.
• What I was really interested in is the media aspect of it all. In Canada, the media seem to love to be health care doomsayers - health care crises sell papers, or so the papers seem to think. But what does the American media have to gain by concentrating on the problems in Canada? Wouldn't they get more attention by being doomsayers about their own system? They seem to be sometimes, but then pull back and decide that, despite problems, it's the best. rogerd: I agree whole-heartedly that some of the best indicators of problems, in not just health care but overall society, are infant mortality and life-expectancy. However, I believe that puts the US behind many Western countries, not just Canada. This isn't US bashing - I worry about it for Americans' sake.