The CMA's Plan for Medicare Plus: What does the Evidence Say?

  1. A constitutional challenge to Ontario health care legislation prohibiting the purchase of private health insurance for medically-necessary healthcare services (dubbed the "Ontario Chaoulli) was announced on September 5th, 2007. It's another call for increased privatization, based on the misinformed notion that an expanded role for private health insurance will remedy wait times in Canada.
    Just last month, the outgoing President of the Canadian Medical Association (CMA), Dr. Colin McMillan, put forward Medicare Plus, the CMA's solution for sustaining our health care system. It proposed expanding the role for private insurance and private payment, and allowing physicians to work for the public system and treat private patients too. After facing a stream of backlash in response to their Medicare Plus report from the Canadian Healthcare Association, the Registered Nurses Association of Ontario, Canadian Doctors for Medicare and others, the CMA responded by saying that Medicare Plus should not be read as an endorsement for a two-tier health system, but that it is time to examine the nature of the public versus private health care debate. Indeed it is. Will their recommendations make Medicare better? The evidence says no.
    http://www.cihr-irsc.gc.ca/e/35154.html accessed today.
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  2. 13 Comments

  3. by   CRNA2007
    Those poor Canadians. Just think if we socialize our system, then where will all the Canadians go for decent healthcare and short wait times.





    Quote from HM2Viking
    A constitutional challenge to Ontario health care legislation prohibiting the purchase of private health insurance for medically-necessary healthcare services (dubbed the "Ontario Chaoulli) was announced on September 5th, 2007. It's another call for increased privatization, based on the misinformed notion that an expanded role for private health insurance will remedy wait times in Canada.
    Just last month, the outgoing President of the Canadian Medical Association (CMA), Dr. Colin McMillan, put forward Medicare Plus, the CMA's solution for sustaining our health care system. It proposed expanding the role for private insurance and private payment, and allowing physicians to work for the public system and treat private patients too. After facing a stream of backlash in response to their Medicare Plus report from the Canadian Healthcare Association, the Registered Nurses Association of Ontario, Canadian Doctors for Medicare and others, the CMA responded by saying that Medicare Plus should not be read as an endorsement for a two-tier health system, but that it is time to examine the nature of the public versus private health care debate. Indeed it is. Will their recommendations make Medicare better? The evidence says no.
    http://www.cihr-irsc.gc.ca/e/35154.html accessed today.
  4. by   HM2VikingRN
    the comment does nothing to advance the discussion. please see:

    though admittedly the canadian system is underfunded, and extended waits
    for some elective services may be a problem in some parts of the country,
    these problems are often exaggerated by its detractors based on unreliable
    self-reported data. in 1998, fewer than 1 percent of canadians were on waiting
    lists, with fewer than 10 percent of these waiting longer than four months
    (19). waiting times in the united states, even for the privately insured, are
    now increasing for checkups as well as for sick visits (20).
    ...
    comprehensive and reliable provincial databases on waiting times show that
    in recent years, waiting times have decreased while services have increased.
    for example, coronary bypass surgery increased by 66 percent between
    1991 and 1997 in manitoba, while waiting times were reduced for that
    procedure and also shortened for five other elective procedures--carotid
    endarterectomy, cholecystectomy, hernia repair, tonsillectomy, and transurethral
    resection of the prostate (21).
    * although there is a widespread myth that many canadians seek medical
    care in the united states, a three-state study reported in 2002 found that
    this number is very low for either outpatient or hospital care, and largely
    due to these canadians needing medical care while traveling in the united

    states (22).
    source: http://pnhp.org/facts/myths_memes.pdf accessed today.

    see also:

    blendon, r. j., et al. inequities in health care: a five-country survey.
    [font=timesnewroman-normalitalic]health aff.
    [font=timesnewroman-normalitalic](millwood) 21(3): 182-191, 2002.
    16. dirnfeld, v. the benefits of privatization. [font=timesnewroman-normalitalic]cmaj 155(4): 407-410, 1996.
    17. weber, t., and ornstein, c. county usc doctors say delays fatal. [font=timesnewroman-normalitalic]los angeles times,
    april 23, 2003.
    18. derlet, r. w. trends in the use and capacity of california's emergency departments,
    1990-1999. [font=timesnewroman-normalitalic]ann. emerg. med. 39: 430, 2002.
    19. tuohy, c., et al. [font=timesnewroman-normalitalic]how does private finance affect public health care systems?
    [font=timesnewroman-normalitalic]marshalling the evidence from oecd systems. canadian health economics
    research association, toronto, may 2001.
    20. center for studying health system change. press release. washington, d.c.,
    september 5, 2002.
    21. rachlis, m., et al. [font=timesnewroman-normalitalic]revitalizing medicare: shared problems, public solutions, p. 25.
    tommy douglas research institute, vancouver, january 2001.
    22. katz, s. j., et al. phantoms in the snow: canadians' use of health care services in
    the united states. [font=timesnewroman-normalitalic]health aff. (millwood) 21(3): 35-41, 2002.
    23. canadian health services research foundation. [font=timesnewroman-normalitalic]a parallel private system would
    [font=timesnewroman-normalitalic]reduce waiting times in the public system. mythbusters series no. 2. toronto, 2001.

  5. by   CRNA2007
    does the discussion really need to be adavanced? everyone knows the canadian system is horrible. taxes are through the roof in canada what more needs to be discussed?



    Quote from hm2viking
    the comment does nothing to advance the discussion. please see:

    though admittedly the canadian system is underfunded, and extended waits
    for some elective services may be a problem in some parts of the country,
    these problems are often exaggerated by its detractors based on unreliable
    self-reported data. in 1998, fewer than 1 percent of canadians were on waiting
    lists, with fewer than 10 percent of these waiting longer than four months
    (19). waiting times in the united states, even for the privately insured, are
    now increasing for checkups as well as for sick visits (20).
    ...
    comprehensive and reliable provincial databases on waiting times show that
    in recent years, waiting times have decreased while services have increased.
    for example, coronary bypass surgery increased by 66 percent between
    1991 and 1997 in manitoba, while waiting times were reduced for that
    procedure and also shortened for five other elective procedures--carotid
    endarterectomy, cholecystectomy, hernia repair, tonsillectomy, and transurethral
    resection of the prostate (21).
    * although there is a widespread myth that many canadians seek medical
    care in the united states, a three-state study reported in 2002 found that
    this number is very low for either outpatient or hospital care, and largely
    due to these canadians needing medical care while traveling in the united

    states (22).
    source: http://pnhp.org/facts/myths_memes.pdf accessed today.

    see also:

    blendon, r. j., et al. inequities in health care: a five-country survey.
    [font=timesnewroman-normalitalic]health aff.

    [font=timesnewroman-normalitalic](millwood) 21(3): 182-191, 2002.
    16. dirnfeld, v. the benefits of privatization. [font=timesnewroman-normalitalic]cmaj 155(4): 407-410, 1996.
    17. weber, t., and ornstein, c. county usc doctors say delays fatal. [font=timesnewroman-normalitalic]los angeles times,
    april 23, 2003.
    18. derlet, r. w. trends in the use and capacity of california's emergency departments,
    1990-1999. [font=timesnewroman-normalitalic]ann. emerg. med. 39: 430, 2002.
    19. tuohy, c., et al. [font=timesnewroman-normalitalic]how does private finance affect public health care systems?
    [font=timesnewroman-normalitalic]marshalling the evidence from oecd systems. canadian health economics
    research association, toronto, may 2001.
    20. center for studying health system change. press release. washington, d.c.,
    september 5, 2002.
    21. rachlis, m., et al. [font=timesnewroman-normalitalic]revitalizing medicare: shared problems, public solutions, p. 25.
    tommy douglas research institute, vancouver, january 2001.
    22. katz, s. j., et al. phantoms in the snow: canadians' use of health care services in
    the united states. [font=timesnewroman-normalitalic]health aff. (millwood) 21(3): 35-41, 2002.
    23. canadian health services research foundation. [font=timesnewroman-normalitalic]a parallel private system would


    [font=timesnewroman-normalitalic]reduce waiting times in the public system. mythbusters series no. 2. toronto, 2001.
  6. by   HM2VikingRN
    The data says otherwise about the canadian system......
  7. by   HM2VikingRN
    canada indicator value
    (year)life expectancy at birth (years) males ? 78.0 (
    2005) life expectancy at birth (years) females ? 83.0
    (2005) healthy life expectancy (hale) at birth (years) males ? 70.0 (2002) healthy life expectancy (hale) at birth (years) females ? 74.0 (2002) infant mortality rate (per 1 000 live births) ? 5.0 (2005) maternal mortality ratio (per 100 000 live births) ? 5 (2000)
    source: http://www.who.int/whosis/database/c...ct_process.cfm#
  8. by   HM2VikingRN
    united states of america indicator value (year)
    life expectancy at birth (years) males ? 75.0
    (2005) life expectancy at birth (years) females ? 80.0
    (2005) infant mortality rate (per 1 000 live births) ? 7.0 (2005)

    source: http://www.who.int/whosis/database/c...ct_process.cfm
  9. by   HM2VikingRN
    The discrepancies are:
    LE Male Birth Canada 78 US 75 Advantage Canada
    LE Female Birth Canada 83 US 80 Advantage Canada
    Infant Mortality Canada 5.0 US 7 Advantage Canada

    Somehow I think the US needs to learn some lessons about addresssing health disparities from our neighbors to the north. Making undocumented/unsourced derogatory claims about another countries health system absent referenced data and sources indicates an unwillingness to learn and inquire with an open mind.
    Last edit by HM2VikingRN on Oct 26, '07
  10. by   CRNA2007
    Let me dump 20 million illegal aliens into the Canadian healthcare system and let's see how well it manages itself. Data doesn't really matter when we are hearing from Canadians directly about how miserable their health system is.


    Quote from HM2Viking
    The discrepancies are:
    LE Male Birth Canada 78 US 75 Advantage Canada
    LE Female Birth Canada 83 US 80 Advantage Canada
    Infant Mortality Canada 5.0 US 7 Advantage Canada

    Somehow I think the US needs to learn some lessons about addresssing health disparities from our neighbors to the north. Making undocumented/unsourced derogatory claims about another countries health system absent referenced data and sources indicates an unwillingness to learn and inquire with an open mind.
  11. by   HM2VikingRN
    A mind can be like a steel trap "rusted shut."..

    Ignoring the population data doesn't make it go away. There are problems in every health care system. Issuing vague indictments that are unsupported by population data is neither productive or useful. The Canadians to their credit are working on reduction of wait times by implementing evidence based practice guidelines.

    Frankly, I think that the criticisms of single payer are based on the thinking error of "I want what I want when I want it...."

    Objective data should be used be used to improve practices and procedures. That is a lesson from graduate school that should never be forgotten.

  12. by   HM2VikingRN
    Quote from crna2007
    let me dump 20 million illegal aliens into the canadian healthcare system and let's see how well it manages itself. data doesn't really matter when we are hearing from canadians directly about how miserable their health system is.
    a trip to the library is in order:

    [font=univers-oblique]
    objectives.
    [font=univers]we compared health status, access to care, and utilization of medical
    services in the united states and canada, and compared disparities according
    to race, income, and immigrant status.

    [font=univers-oblique]
    methods.
    [font=univers]we analyzed population-based data on 3505 canadian and 5183 us
    adults from the joint canada/us survey of health. controlling for gender, age,
    income, race, and immigrant status, we used logistic regression to analyze country
    as a predictor of access to care, quality of care, and satisfaction with care,
    and as a predictor of disparities in these measures.

    [font=univers-oblique]
    results.
    [font=univers]in multivariate analyses, us respondents (compared with canadians)
    were less likely to have a regular doctor, more likely to have unmet health needs,
    and more likely to forgo needed medicines. disparities on the basis of race, income,
    and immigrant status were present in both countries, but were more extreme
    in the united states.

    [font=univers-oblique]
    conclusions.
    [font=univers]united states residents are less able to access care than are canadians.
    universal coverage appears to reduce most disparities in access to care.

    (
    [font=univers-oblique]am j public health. [font=univers]2006;96:xxx-xxx. doi:10.2105/ajph.2004.059402)
    [font=univers]
    [font=univers]source: http://www.pnhp.org/canadastudy/canadausstudy.pdf accessed 10/26/2007.
  13. by   HM2VikingRN
    another trip to the library:
    immigrants1 and emergency department visits2 by the uninsured are not the cause of high and rising health care costs.
    1. mohanty et al. "health care expenditures of immigrants in the united states: a nationally representative analysis," american journal of public health; vol 95, no. 8, august 2005
    2. tyrance et al. "us emergency department costs: no emergency," american journal of public health; vol 86, no. 11, november 1996
    source: http://www.pnhp.org/single_payer_res...th_program.php accessed 10/26/2007.
  14. by   HM2VikingRN
    another library trip:
    for-profit, investor-owned hospitals (link 11, 22, 33, & 44), hmos5 and nursing homes6 have higher costs and score lower on most measures of quality than their non-profit counterparts.
    1. editorial by david himmelstein, md and steffie woolhandler, md in the canadian medical association journal
    2. devereaux, pj "payments at for-profit and non-profit hospitals," can. med. assoc. j., jun 2004; 170
    3. devereaux, pj "mortality rates of for-profit and non-profit hospitals," can. med. assoc. j, may 2002; 166
    4. himmelstein, et al "costs of care and admin. at for-profit and other hospitals in the u.s." nejm 336, 1997
    5. himmelstein, et al "quality of care at investor-owned vs. not-for-profit hmos" jama 282(2); july 14, 1999
    6. harrington et al, "himmelstein, et al "quality of care at investor-owned vs. not-for-profit hmos" jama 282(2); july 14, 1999," american journal of public health; vol 91, no. 9, september 2001
    source: http://www.pnhp.org/single_payer_res...th_program.php accesed 10/26/2007.

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