Actual Article: "Socialized Health-Care Nightmare"

kitkat24 · Jan 26, 2004

A lifestyle choice does not make you a minority. I have heard many African-Americans take offense at the way homosexuals portray themselves as a minority and equal to being black, or in a wheelchair as a disabled person, or any other true minority.

For my nursing courses we had a 1.5 hour lecture from a lesbian woman who is "married" to another woman. They have adopted two children and "co-parent" these two children with a male homosexual couple. I had to listen to her rant for 1.5 hours of my public and personal college paid tution. She went off on politics and other topics and nobody disagreed or said a word except one black female student who said, please do not compare your struggle with mine. I walk into a room and everybody knows immediately that I am black. You walk into a room and nobody knows unless you advertise your sexuality. Point taken.

I disagree with the homosexual lifestyle. I do not hate homosexuals. In fact, I know several that I think are very quality people whom I respect immensely. However, I should still have the legal right to state that I disagree with that lifestyle without having it be termed hate speech, when that couldn't be further from the truth. Just another little American faux paux.

If you speak your mind, you can almost be arrested and charged with a federal hate crime. Should a thin, healthy, non-obese person be charged with a federal hate crime for stating they disagree with the morbidly-obese lifestyle?

In the US Fergus, judges are making decisions that are contrary to the general public. For instance, the State of Minnesota elected over-whelmingly Governor Tim Pawlenty. The citizens of this state new that by electing Mr. Pawlenty that he had promised not to raise taxes on MN citizens. (notabley one of the top ten HIGHEST taxed states in the US) So, there are "entitlement" programs run by the state. The governor cut many programs to be able to not raise taxes. Subsequently, law suits were filed because people again, thought they were entitled and had a legal right to taxpayers aka other peoples' money. So, the judges filed in favor of the plaintiffs. This is an example of legislating from the bench. This is what our US founding fathers attempted to prevent with the three branches of government, so that one could not have all the power over the others. Yet judges ARE making these decisions AGAINST the majority of the public. When CLEARLY our preamble to the consitituion states, ....provide for the common defense and promote the general welfare of the people....

kitkat

kitkat24 · Jan 26, 2004

October 30, 2003 --Dr. Ron Gleason, Ph.D: Do You Really Want Universal Healthcare?

Three mornings ago, my alarm clock went off at "o-dark-thirty" and the commentator was shrieking in a high-pitched voice that there was a growing tendency in the US for universal healthcare. Even in my groggy state I thought, What? Are you nuts? You've got to be kidding me! Who in their right mind would want universal healthcare? The short answer is: obviously more than a few people. I was awake.

The notion of ostensibly affordable, universal healthcare might seem attractive at first glance, but upon closer scrutiny it is fraught with a number of serious difficulties. I have good reason to write about this because I lived under the social healthcare system in Holland for nine plus years as well as another nine plus years in the Canadian system. Some people are just gluttons for punishment I suppose.

We're rapidly becoming a bunch of "rights" oriented people here in the US. For some strange reason, we believe it's our "right" to earn a minimum wage and to have our employer pay all of our healthcare benefits--even if we're in a low or non-skilled job. Therefore, as the reasoning goes, somebody, anybody ought to pay for my healthcare. It really doesn't matter who pays it, just so someone picks up my end of the stick. Given the lunacy of many modern Democrats and their incessant carping about the Bush tax cut, the most obvious people to pay for universal healthcare are the rich.

Since a lot of you don't speak Dutch--I know that some of my readers do--I'll give you some of the headlines that appeared in Canadian newspapers when I lived up there. "Metro wait for surgery forces 100 heart victims to hit U.S.," "Second heart patient dies as surgery delayed nine times," and "Patients wait in line for hospital bed." Get the idea?

Dr. Bill Gairdner, a Canadian whom I greatly admire, wrote a book that was published in 1991 with the title The Trouble with Canada.1 As he chronicled the ills of our neighbor to the north, he put pen to paper and described what he called the "medical mediocrity" of Canada--interesting phrase. Some of the most egregious problems with the national healthcare system in that country included "regular cost overruns, long line-ups for surgery, experts leaving the country, patients dying as they wait for service, lack of equipment, wage clashes between professional staff and hospitals, fee-schedule battles between physicians and the government."2 Other than that, it was a fine program.

No, that's not entirely true either. As someone who experienced it, the care was simply sub-standard. That's not to say that the doctors were not qualified. They were--by and large. The problem arose from the ubiquitous presence of the government with its hand involved in regulating everything! And you're going to get that every time you head down the path for universal healthcare.

A bureaucracy will be called into being and, God help us all, life will become exponentially miserable. Oddly, there are still people who refuse to accept this truth. And you can count on the fact that those who will be most in favor of universal healthcare for the masses will not have it for themselves. They'll be insured privately--and probably on the taxpayer's dime. These are the same fine folks who rail against school vouchers, but refuse to send their children to public schools, once again proving that we're all equal, but some are more equal than others.

Bill Gairdner came up with two very predictable reasons for the veritable demise of Canada's healthcare system. He writes, "First, because as human nature and economic theory tell us, the demand for an unlimited free commodity is infinite; and second, because others who have tried to make socialized medicine work, whether in Eastern Bloc or Western nations, have failed miserably."3

Let's reflect on those words of wisdom from Gairdner for a moment.

In the first place, the system gets log-jammed by people who have little or nothing to do in life than to visit the family physician--and this actually happens. People with perceived illnesses inundate the doctor and those who really are sick get dumped on in the process because the waiting list is so long. You see, it's free. There's no co-pay so you just go and go and go. The demand for a "freebie" is infinite whether it's healthcare or a three-martini lunch. The problem is that the demand is infinite while the commodity is decidedly finite. Many, however, never give this truth a second thought.

The second reason Gairdner gives for the failure of Canada's healthcare system is the lesson of history. I remember when Hillary Clinton was hot to trot about her healthcare plan. I could not believe that anyone with any historical consciousness would be in favor of it. Fortunately for us all, it crumbled, crashed, and burned. Nevertheless, it had its supporters and if something similar is presented in the future no doubt some will step forward in support of what has repeatedly--repeatedly--failed miserably elsewhere.

Some genius will probably think that the US is different and what was a failure elsewhere will not be a failure here. Don't count on it. What is required for such a system is a collectivist, utopian Socialism run by an elite group of ideologues and bureaucrats. Why we could have the majority of our tenure-track, liberal college and university professors and those permanent bureaucrats that have never had a real job implement the program for us. Wouldn't that be fun, not to mention very costly?

How would the US healthcare program be funded? The answer is simple: the same way any (quasi)-socialistic program is funded: out of tax revenue. Any socialistic, cradle-to-grave (womb-to-tomb) "giveaway" is designed to curry favor with the non-thinking, buy vote support from those who have bought the lie that they're "disenfranchised," and to increase government's power over the people.

###

Dr. Ron Gleason is the father of six, the grandfather of nine, a volunteer wrestling coach, and the pastor of Grace Presbyterian Church (PCA) in Yorba Linda, CA.

[email protected]

1 William D. Gairdner, The Trouble with Canada, (Toronto: General Paperbacks, 1991) 2 Ibid., 299. 3 Ibid., 300. Emphasis his.

kitkat24 · Jan 26, 2004

THE HEARTLAND INSTITUTE

19 South LaSalle Street #903

Chicago, IL 60603

phone 312/377-4000 - fax 312/377-5000

http://www.heartland.org

--------------------------------------------------------------------------------

Single-Payer Proposal Called 'Politically Impractical'

Author: Conrad F. Meier

Published: The Heartland Institute 10/01/2003

A controversial socialized medicine proposal published in the August 12 issue of the Journal of the American Medical Association (JAMA) suggests the federal government should pay all health care bills for everyone living in the United States, effectively putting private insurers out of business and health care providers on the government payroll. The proposal makes no distinction between U.S. citizens and millions of undocumented immigrants.

The proposal's sponsors, Physicians for a National Health Program (PNHP), claim the plan has attracted the signatures of 7,782 supporters, including hundreds of academics, medical school deans, thousands of practicing doctors, and medical students. The plan also is endorsed by former surgeons general Dr. David Satcher, who served under President Bill Clinton, and Dr. Julius Richmond, who served under President Jimmy Carter.

The American Medical Association (AMA), which publishes the journal, was quick to say it does not support the proposal. The insurance industry, which is often at odds with the AMA, also opposes the plan.

Dr. Donald J. Palmisano, president of the AMA, said the association "advocates a solution to the uninsured crisis that builds on the strengths of our current system. By implementing a single-payer system, the United States would be trading one problem for another."

Organizations representing insurers also gave the plan a cold shoulder. Dr. Donald A. Young, president of the Health Insurance Association of America, said, "private insurance offers patients better quality care and greater control over health care decisions than the 'one-size-fits-all proposal' the doctors group put forward."

The proposal comes as many of the 2004 Democratic Presidential candidates have made universal health care coverage a major focus of their campaigns. None of the leading Democratic candidates, however, has stepped forward to fully support the PNHP plan. Only Dennis Kucinich (D-Ohio), former Senator Carol Mosley Braun (D-Illinois), and civil rights activist Al Sharpton have endorsed anything like the PNHP proposal.

In a recent political debate in Philadelphia, Rep. Richard Gephardt (D-Missouri) responded to the plan saying, "The single-payer plan is politically impractical. Oregon voters last fall rejected a single-payer plan by a 4-1 ratio."

Medicare for All

Dr. Quentin Young, a Chicago internist and cofounder of PNHP, and Dr. Steffie Woolhandler, an associate professor at the Harvard Medical School and primary care physician, co-authored the plan. Both were prominent during the failed attempt to pass former President Bill Clinton's universal health care plan. Many of the supporters of the PNHP plan served on Hillary Clinton's Health Care Task Force.

Woolhandler, an outspoken advocate of socialized medicine, wrote last year in the September issue of the Socialist View Point, "We pay the world's highest health care taxes. But much of the money is squandered [on administration.] The wealthy get tax breaks. Every other developed nation has national health insurance." Woolhandler also says, "Simply cutting administrative costs could yield $200 billion a year in savings, enough to cover the uninsured and upgrade coverage for Medicare beneficiaries." (See "PNHP 'Factless' on Canadian Health Care," page 6.)

Susan Pisano, a spokeswoman for the American Association of Health Plans, said it is unreasonable to think administrative costs could be reduced as much as the doctors' group says, because many of those costs are imposed by the government.

Linda Gorman, senior fellow with the Independence Institute and director of the Rocky Mountain Center for Health Care Policy, questions Woolhandler's statement as well.

"Market systems reward those who reduce costs by increasing their profits. Government systems offer no such incentive, with the result that single-payer health care is extraordinarily costly to run," wrote Gorman in a January 13 essay.

"Wharton professor Patricia Danzon calculated that with all costs included, the overhead of the Canadian system is about 45 percent of claims," Gorman noted. "Danzon's estimate of overhead for U.S. private insurers, net of government cost shifting, was about 7.6 percent of claims."

According to health actuary Mark Litow, Gorman continued, "Medicare and Medicaid spend about 27 cents on overhead for every dollar of benefits. Private insurers spend about 16 cents. In Oregon, a decade-long attempt to rationalize Medicaid spending by running it like a single-payer system succeeded only in reducing access and doubling spending."

A Threat to Quality Care

The PNHP plan differs from Clinton's 1993 initiative in that Clinton tried to avoid massive tax hikes by shifting the financial burden to employers in a mandate requiring all employers to provide health insurance.

The government's role under the PNHP proposal, as in Canada's health care system, would be to collect whatever additional taxes are needed to pay for universal health care. The arrangement is popularly known as "single-payer" because the government essentially becomes the insurance company, paying all health care bills. That responsibility is currently shared under the U.S. health care system by citizens, the government, and private businesses.

The PNHP proposal would attempt to control costs by setting a national or global budget, rationing money to hospitals for day-to-day operations and major expansions, rationing payments for nursing homes, rationing in-home services for the elderly, and implementing a national prescription drug formulary identifying the only "approved" drugs for which the government would pay.

Gorman warns the single-payer approach seriously threatens the quality of health care and positive medical outcomes that currently set U.S. health care apart from the rest of the world.

"The poor performance of single-payer systems can be seen in cancer mortality ratios, the death rate divided by the incidence of disease," she writes. "For breast cancer, the U.S. mortality ratio is 25 percent. In Canada and Australia it is 28 percent, in Germany it is 31 percent, in France it is 35 percent, and in New Zealand and the United Kingdom it is 46 percent. For prostate cancer, the U.S. mortality ratio is 19 percent. In Canada it is 25 percent, in New Zealand it is 30 percent, in Australia it is 35 percent, in Germany it is 44 percent, in France it is 49 percent, and in the United Kingdom it is 57 percent."

While most hospitals and clinics would remain privately owned and operated under the PNHP plan, the federal health care bureaucracy would control the purse-strings, setting a monthly budget for the facilities' operating costs and paying them no more than that budget. Investor-owned facilities would be converted to non-profit status. Private insurance companies would essentially be eliminated.

One Size Fits No One

Merrill Matthews, director of the Council for Affordable Health Insurance (CAHI), expressed dismay at the PNHP's inability to distinguish between dreams and reality.

"I can understand their desire to provide health care for everyone--that's why they keep proposing this idea," Matthews said. "What I can't understand is why these doctors think a single-payer system achieves that goal. Every country that has enacted a single-payer health care system is in far worse shape than the United States. No government can provide all the care that everyone can effectively use."

Matthews also noted, "When you politicize health care dollars, health care has to compete with other valid claims for government funds, such as education, welfare and defense. There is never enough money to go around."

Greg Scandlen, director of the Center for Consumer Driven Health Care at the Galen Institute, agreed with Matthews' assessment, noting "countries that adopted the approach are racing to change it." And while Americans are registering discontent with the health care status quo, Scandlen points to surveys by Dr. Robert Blendon of Harvard University that show a similar level of discontent among the people of Canada, the UK, Australia, and New Zealand.

"Popular support [for single-payer health care] in Canada has plunged in the past 10 years. These countries now see that a single-payer approach leads to rationed care, high rates of taxation, and the virtual banishment of new technology and innovation. It is time for single-payer advocates to join the twenty-first century and support empowering consumers instead of relying on command-and-control bureaucrats to make decisions for Americans."

Dr. Donald Palmisano, AMA's president, sums up the PNHP plan as one that "... would lead to long lines, an even thicker health-care bureaucracy, and a slowness to adopt new technologies and maintain facilities."

Pisano warned against turning health care over to the government, emphasizing the essential role the private sector plays in health care. "Private industry, not the government, has led the way in adopting disease management programs and prescription drug coverage. Innovation almost always begins in the private sector. It is very difficult for the government to innovate and change with changing times."

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Conrad F. Meier is managing editor of Health Care News. His email address is [email protected].

fergus51 · Jan 26, 2004

Originally posted by kitkat24
A lifestyle choice does not make you a minority. I have heard many African-Americans take offense at the way homosexuals portray themselves as a minority and equal to being black, or in a wheelchair as a disabled person, or any other true minority.

kitkat

In the US that may be so. In Canada, sexual orientation has already been determined to make someone a minority as a matter of law, therefore they are protected from discrimination by the charter. In order to be "discriminated" against as a matter of law, one must belong to a protected group (such as visible minorities, the disabled, etc) and homosexuals have been determined to be a protected group. Whether or not they are a "real" minority in my mind or yours doesn't matter as far as the Charter is concerned.

Again, I stress that this is Canadian law, not American. Canadian laws relating to human rights do not get to be put up to a vote, not since the creation of the Charter anyways. The elected parliament writes new laws, but it is the court's role to interpret laws already on the books. Same as how the supreme court in the US ruled on desegregation or abortion. A lot of people may disagree with court rulings (in Canada and the US), but under our laws it is the courts that make this type of decision, not the population as a whole. That's simply our system of law and government, which is why I have to object when a collumnist who doesn't understand that tries to paint it as a power grab by liberal judges.

As for your second article.... First of all, I have never seen anyone make a habit of going to the doctor for fun despite it being free. Scondly, anyone who could describe the care I provide to my patients as mediocre or substandard is on crack. Our unit stacks up against any of the best units on the continent as far as equipment, research, staff and patient outcomes (they do keep track of these things through a computer system). As someone who has actually worked in both systems, don't tell me the Canadian system sucks and the American one is the best in the world. There are great and crappy facilities in both. There are horror stories and stories of praise in both. That's why you need to look at the big picture, and not some guy that says "I had bad care there, so the system is a failure". I received horrible care in the US. That doesn't mean the whole system is horrible, it means I had a bad experience, know what I mean? It's silly to judge a system that serves over 30 million people by one guy's experience.

The real way to improve both systems is to ask ourselves: "what are they doing really well over there and could we do that?", not focus on trying to defend an ideology (pro or anti-universal care). I swear, I would mail you that book!

caroladybelle, BSN, RN · Jan 26, 2004

I am indeed a nonpartison voter.

I personally believe that the party system is to blame for many of this country's problems.

And what your diatribe about liberals has to do with me, I will never know.

Stepping out as the OP continues to label people and just doesn't get it.

fergus51 · Jan 26, 2004

For-Profit Health Care:

Expensive, Inefficient and Inequitable

Dr. Arnold S. Relman, Professor Emeritus of Medicine and Social Medicine at Harvard Medical School and Emeritus Editor-in-Chief of the New England Journal of Medicine, Presentation to the Standing Senate Committee on Social Affairs, Science and Technology

February 21, 2002

Mr. Chairman, Honorable Members of the Standing Senate Committee on Social Affairs, Science and Technology :

My name is Dr. Arnold S. Relman. I am Professor Emeritus of Medicine and of Social Medicine at the Harvard Medical School and former Editor-in-Chief of the New England Journal of Medicine. I have been asked by the Canadian Health Coalition to appear before you today to testify about the U. S. experience with private, for-profit health care.

I have been studying and writing about this subject for over two decades. In 1985 and 1986 I served on a committee established by the Institute of Medicine of the U. S. National Academy of Sciences to report on "For-Profit Enterprise in Health Care." During my editorship and afterwards, the New England Journal of Medicine published many articles in this field and, since I retired from that post, my own writings have continued to focus on this topic. I am now at work on a book that surveys the present unhappy condition of the U. S. health care system, with particular attention to the role of private enterprise.

My conclusion from all of this study is that most of the current problems of the U. S. system - and they are numerous - result from the growing encroachment of private for-profit ownership and competitive markets on a sector of our economy that properly belongs in the public domain. No health care system in the industrialized world is as heavily commercialized as ours, and none is as expensive, inefficient, and inequitable -- or as unpopular. Indeed, just about the only parts of U. S. society happy with our current market-driven health care system are the owners and investors in the for-profit industries now living off the system.

The U. S. may be a world leader in medical science and technology, and its major medical centers may provide some of the best and most sophisticated care available anywhere, but taken as a whole, our health care system is failing and will need major reform very soon. We have tried private for-profit markets, first in hospitals, in ambulatory care facilities and services, and in nursing homes, and then more recently, in the ownership of insurance plans - and the experiment has failed. Private health care businesses have certainly not achieved the benefits touted by their advocates. In fact, there is now much evidence that private businesses delivering health care for profit have greatly increased the total cost of health care and damaged - not helped - their public and private nonprofit competitors.

The U. S. experience enables students of health care policy to compare the performance of nonprofit and for-profit facilities as well as the performance of insurance systems, and the results are clear for all who want to examine the evidence. For-profit hospitals were much more expensive than their nonprofit counterparts when Medicare and private insurers simply reimbursed charges. That difference disappeared when the payers began to negotiate fixed prices, but there has never been any evidence that for-profit hospitals could provide similar services at lower prices than their nonprofit competitors. However, a recent study of Medicare per capita expenditures for all health services, including hospital care, found that they were much higher in regions served exclusively by for-profit hospitals than in regions where there were fewer or no for-profit hospitals.

There is no good evidence about the relative quality of hospital services in for-profit and nonprofit facilities, because such studies are difficult to do. Quality is easier to ensure in nursing homes and kidney dialysis centers. They are largely paid through fixed, negotiated prices by public insurance, and their products are more or less standardized. Studies that have looked at objective measures of quality of service show that public and private non-profit nursing and dialysis facilities provide significantly better and safer services to patients than their for-profit counterparts. This shows that when you fix the price and the services so that there is no wiggle room, non-profits clearly provide better care.

A little over a decade ago, for-profit investor-owned businesses took over the private insurance field, and now they cover more than half of our people - mainly through employers. More than a quarter of our population is covered by Medicare and Medicaid, which are largely financed by government. Comparisons of these private and public systems are instructive. The Medicare system has administrative costs of less than 3 percent, with all the remainder of expenditures going to physicians, hospitals and other providers. The private insurers, on the other hand, have corporate and administrative costs of 15 to 30 percent, and in addition outsource many other services they use to control costs by restricting the use of expensive resources. As a result, it can be estimated that only 50 to 60 percent of the premium dollar ends up with the providers, who themselves must pay additional administrative costs to deal with the regulations of the multiple insurers they must bill. And, while the private insurers at first held down premium prices by drastically cutting utilization, they have now run out of cost-cutting options and are meeting increasing resistance from providers and the public. Recently, premium prices of private for-profit insurers have again begun to increase at double-digit rates, more rapidly than the costs of Medicare and Medicaid.

A remarkable demonstration of the failure of the commercial, HMO insurance system was seen a few years ago when senior citizens covered by Medicare were encouraged to obtain their care from private, for-profit HMOs that would be paid by the government. It soon became obvious that the costs of care under the private system were much greater and that senior citizens were dissatisfied with the care they received. A wholesale exit of senior citizens from the private system ensued. They voted with their feet for the public system.

In short, the U. S. experience has shown that private markets and commercial competition have made things worse, not better, for our health care system. That could have been predicted, because health care is clearly a public concern and a personal right of all citizens. By its very nature, it is fundamentally different from most other good and services distributed in commercial markets. Markets simply are not designed to deal effectively with the delivery of medical care - which is a social function that needs to be addressed in the public sector.

We in the U. S. are belatedly learning this lesson and soon may be ready to try other options that will depend more on public action. Many of us south of the border have always believed that you Canadians had the right idea in deciding that the financing of health care is primarily a public responsibility. We still think you are right and that we ought to emulate you, rather than vice versa. I am surprised and disappointed in your Committee's Interim Report, which seems to favor policy options dependent on private market involvement in Canadian health care. Before making your final recommendations, I hope you will look more closely at the U. S. experience - which ought to convince most evidence-driven observers that markets can't solve public problems like health care - and in fact make them worse.

However, to make a publicly financed system work effectively, I believe both our countries need to begin reforming their medical care delivery systems. That is where we both ought to be looking for ways to optimize our use of resources and improve the quality of our health care.

I believe that splintering the delivery system into many different, highly specialized facilities, as has been proposed in both our countries, is not in general a sound option for improving quality and effectiveness. A much better approach would be to re-organize how physicians work together. Both our countries now depend largely on independent solo medical practitioners to provide ambulatory and hospital services on a fee-for-service basis. We should both begin to encourage physicians and other health care professionals to organize themselves into self-governing, multi-specialty and multi-disciplinary teams to deliver comprehensive care at prepaid, capitated rates. Physicians provide the best care when they work in teams, not as competitors. Furthermore, to discourage over service, they should be paid primarily for their time, and not on a piecework basis. That would reduce both fraud and the resources wasted on the processing of claims.

Finally, I want to say just a word about "consumer choice," which is now being touted in the U. S., and I gather in Canada, too, by believers in the magic of the market as a mechanism for controlling costs and improving the quality of services. While there is much to be said for making more information available to people about their health care, it is a fundamental misconception to imagine that sick patients can or should behave like ordinary consumers in commercial transactions, selecting the services and prices they want. Health care is totally different from most goods and services, and that's why we have medical insurance and why sick people need the professional and altruistic services of physicians and other providers.

I suspect most Canadians understand why health care is special and why it needs to be insured by a public system like the one you now have. I would be surprised if they want the fundamental fairness of their Medicare system to be changed by the introduction of market forces.

Thank you for your attention.

A counterpoint for you to consider. The one thing I know is that Canadians will not abandon universal care in my lifetime, and Americans are so terrified about government intervention that they will never adopt it.

LilgirlRN, ADN, RN · Jan 26, 2004

I coulda sworn this thread was about socialized medicine.

kitkat24 · Jan 26, 2004

Gorman warns the single-payer approach seriously threatens the quality of health care and positive medical outcomes that currently set U.S. health care apart from the rest of the world.

"The poor performance of single-payer systems can be seen in cancer mortality ratios, the death rate divided by the incidence of disease," she writes. "For breast cancer, the U.S. mortality ratio is 25 percent. In Canada and Australia it is 28 percent, in Germany it is 31 percent, in France it is 35 percent, and in New Zealand and the United Kingdom it is 46 percent. For prostate cancer, the U.S. mortality ratio is 19 percent. In Canada it is 25 percent, in New Zealand it is 30 percent, in Australia it is 35 percent, in Germany it is 44 percent, in France it is 49 percent, and in the United Kingdom it is 57 percent."

And administrative costs:?

"Wharton professor Patricia Danzon calculated that with all costs included, the overhead of the Canadian system is about 45 percent of claims," Gorman noted. "Danzon's estimate of overhead for U.S. private insurers, net of government cost shifting, was about 7.6 percent of claims."

kitkat24 · Jan 26, 2004

http://www.fraserinstitute.ca/admin/books/chapterfiles/Executive%20Summary-pages1-6.pdf#1

Please see above PDF files: I love you guys. This discussion has led me to searches where I find the stats that I have been looking for. Fergus, this report says that Canada does NOT have access to MRI and CT scanning machines...... ETC. Very informative

Canada spends more on

health care than any

other universal access

industrialized country.

Canada also uniquely

bans private medicine.

Do we get our money's

worth and are we well

served by our

government-centered

health care system?

While it is easy to calculate the comparative

costs of health care amongst the

OECD nations, it is somewhat more difficult

to know whether we receive value

for money expended. In this study,

seven indicators of access to health care

and outcomes from the health care process

are examined. Four relate to access

to high technology equipment, and

three relate to health outcomes.

With regard to access to high-tech

machinery, Canada performs dismally

by comparison with other OECD countries.

While ranking number one as a

health care spender, Canada ranks eighteenth

in access to MRIs, seventeenth in

access to CT scanners, eighth in access

to radiation machines, and thirteenth in

access to lithotripters. Lack of access to

machines has also meant longer waiting

times for diagnostic assessment, and

mirrors the longer waiting times for

access to specialists and to treatment

found in the series of comparative

Executive Summary Table 2:

Performance of Health Systems in OECD Countries

Disability-Free Life

Expectancy/Life

Expectancy

Rank 1999

Potential Years

of Life Lost

Rank 1998

Breast Cancer

Mortality Rank

2000

Australia 2 6 3

Austria 8 14 16

Belgium 7 19 11

Canada 10 7 6

Czech Republic 18 23 24

Denmark 20 18 15

Finland 15 9 2

France 1 8 5

Germany 20 13 12

Greece-17 17

Hungary 19 26 22

Iceland 23 4 27

Ireland 16 21 20

Italy-10 10

Japan 4 2 4

Luxembourg 13 12 14

Netherlands 6 11 8

New Zealand 24 15 9

Norway 12 5 7

Poland 22 25 21

Portugal 10 22 13

Slovakia 13 24 25

Spain 4 16 23

Sweden 8 1 1

Switzerland 16 3 19

Turkey--- 26

United Kingdom 3 20 18

fergus51 · Jan 26, 2004

kitkat, we do have CTs and MRIs. We have less per person, and wait times are an issue, but they are actually used very well and we do have private clinics that offer MRIs and the like as it is in the US, but it hasn't helped which is one of many reasons I don't think private healthcare is the solution. Canada actually has several areas of healthcare that have private clinics which are not government run or subsidized (such as orthopedic surgeries, eye surgeries, MRIs) and none of them have been proven to be more effective, or cheaper (the opposite is true). Last I heard, an MRI in Vancouver costs a few hundred dollars and can be done in a week. The healthcare system here has much more private industry than you seem to realize. Uneducated people approve and think it will improve costs or wait times, then are shocked when that doesn't happen.

One reason it can be difficult to compare the use of MRIs is that our population is spread out on such a large geographical area that a lot of towns can't support having million dollar equipment. The US has way more, but they aren't as accessible. One of the principles of primary healthcare is appropriate use of technology. That means that we have to evaluate whether or not they are needed, and how they affect outcomes.

I would love to know how someone calculated that we spend 45% on administrative costs. Not likely.

Now, I've played devil's advocate for a while. How about you start answering the complaints about the US system? If the Canadian system sucks, what should the US do to improve?

kitkat24 · Jan 27, 2004

http://www.mja.com.au/public/issues/173_01_030700/leeder/leeder.html

The real debate that we have to have

If we dwell too long on the issues of private versus public insurance, we overlook more basic issues in health financing. We need now to address wider issues; the longer we defer this debate the harder it will be, as even uninformed views tend to become entrenched in a state of serious muddlement. This is especially so in a country with a large first- and second-generation migrant population, who have come from countries with a variety of contracts between citizen and government, from cradle-to-grave welfare through to a culture of laissez faire.

We offer three issues for this debate.

First, let us clarify the government's role in healthcare; is it charity or is it something we share? On that point we tend to the latter view. Even if we are generally inegalitarian, accepting the slings and arrows of life as a matter of private fortune, we may have a different attitude to healthcare. We may know our inheritances of material wealth and of physical and intellectual talent, but we do not know what lies around the corner when it comes to health. In the terminology of the Harvard philosopher John Rawls, when it comes to our healthcare needs we are in an "original position", and are more likely to choose to share our lot with others to the extent that we can.17

The second issue relates to the boundary between third-party funding and the market. The debate should not be between private and public insurance, but between insurance and the market.

The final issue, after the first two have been settled, is how to rationalise the complex set of programs in healthcare. To those in the healthcare professions or who study healthcare from an academic perspective, it is complex. To the consumer it is bewilderingly unintelligible. Some programs have copayments, some do not. Simple procedures like ambulatory care usually require visits to several establishments, with different payment systems. Why, for example, is pharmacy separated from general practice? Why does a public hospital stay attract no copayment, while much less expensive procedures attract large patient contributions? Why is medical care separated from nursing care in private hospitals and nursing homes? Why does one have to wait days for test results which are generated instantly with new technology?

The Canadian Experience

Programs such as Canada's national health care plan can do nothing to check the demand for medical services. In order to keep such a system from hemorrhaging, administrators must limit the type and quantity of health care available to individuals, which inevitably leads to long waits for treatment and restricted access to medical care. In 1991, the Fraser Institute in Vancouver conducted a study of patient waiting covering five Canadian provinces, 10 medical specialties, and 333 physicians (representing 20% of all practitioners in each of the 10 fields). The study showed that waiting time ranges from 2-5 weeks (for Internal Medicine) to 10-42 weeks (for Cardiology). In an article for Reason magazine, Michael Walker, executive director of the Fraser Institute, described Canada's system this way:

The total cost of health care is controlled by arbitrarily limiting the number of procedures of certain types, by limiting access to technology and diagnostic machinery, and by compensating physicians so that they are discouraged from responding to the demands of their patients. There are measurable consequences of this supply limitation in the form of queues or waiting lists for surgery.[6]

In a series of articles for the Boston Globe, Colin Nickerson has chronicled the steady disintegration of the Canadian system:

April 1996: Canadian doctors are moving to the US to practice in record numbers, complaining that their country's national health system denies them the freedom, technological resources and funding to provide top-notch medical care. The system is desperately strapped for cash and is a constant target for politicians seeking to reduce state spending. Things taken for granted in the US, such as ordering CT scans, MRIs (magnetic resonance images), or securing operating room time, are a constant struggle. People needing surgery for conditions which are not immediately life threatening, such as hip replacements, cataract surgery and removal of certain tumors, often wait for months or years. More than 70 communities in Canada's richest province, Ontario, do not have access to basic medical services.[7]

October 1996: Obstetricians in southern Ontario, angered by health spending cuts, are refusing to take on new patients, including women about to give birth. As a result health officials are making deals with US medical centers to allow Canadian women to deliver their babies in the US.[8]

February 1999: Cuts in Canada's medical system combined with the seasonal arrival of broken bones and pneumonia cases are transforming hospitals into disaster areas. Emergency rooms in major urban centers are headed for meltdown, with insufficient doctors, nurses and technicians to handle caseloads. Ambulances in Toronto were told to take patients to less crowded hospitals in the suburbs. In Quebec, emergency room patients were parked on gurneys in hallways and supply closets because of a bed shortage. A Montreal hospital is a scene out of a Dickens novel, "with bleeding patients screaming for attention in jam-packed facilities reeking of urine and vomit." Patients have died waiting for surgery and other services. The shortage of general practitioners forces more Canadians to head for emergency rooms to receive basic care.[9]

January 2000: A flu epidemic, along with a shortage of doctors and nurses, has tranformed emergency rooms across Canada into disaster areas. In Montreal, people with non-critical problems, such as broken bones and serious flu, are waiting up to 48 hours to see a doctor. The city's 17 emergency rooms are staggering under a patient load that is 209 percent in excess of capacity. There are dangerous shortfalls of beds, equipment and, in some cases, medicines. In Toronto, radio appeals from ER staff to ambulance drivers to stop delivering patients are ignored. In Winnipeg, fire inspectors say jammed hospitals have become a fire hazard, with stretchers blocking corridors and exit doors. Canadian health professionals describe their system as "reeling from budget cuts, bureaucratic interference, and political indifference." Government officials have closed scores of hospitals in recent years and reduced health care programs by millions of dollars. Health care bureaucrats blame vacationing doctors for the overflowing emergency rooms.[10]

January 2001 (Reuters): New Brunswick's 1300 doctors closed their offices on January 8th to protest slow negotiation with the provincial government over wage increases and better working conditions.[11]

The Last Word

In describing government-run health care systems, Goodman and Musgrave note:

In Britain, with a population of about 57 million, the number of people waiting for surgery is more than 1 million. In New Zealand, with a population of 3 million, the waiting list is more than 50,000. And in Canada, with a population of about 25 million, the waiting list is more than 250,000.[12]

Runaway costs associated with the Medicare program in the US belie the notion that government-funded plans are the answer to the health care crisis. The single most important factor in controlling medical costs is the presence of financial incentives for health care consumers to seek cost-effective care. Yet, Medicare officials fail to take action against hospitals which routinely waive co-insurance and deductibles for their patients.[13]

Moreover, government programs are not particularly efficient. The low administrative costs claimed for the Medicare program do not take into account the billions of dollars spent each year for unnecessary medical treatment (See A System Out of Control and Studies on Avoidable Medical Care). And Medicaid is notorious for being a procedural nightmare: "The complexity of this particular (New York State) Medicaid system is reflected in the huge procedure manuals sent to physicians: the instructions for filing a one-page billing form run for 135 pages, followed by 260 pages of procedural codes."[14]

A national health system is not the answer to the health care crisis. Any government health care program is inconsistent with limited government and respect for individual liberty and would simply be a massive wealth re-distribution scheme.

As a practical matter, whom would you rather have building your house, supplying the grocery store, teaching your child and treating your illnesses?: A government worker whose pay is only loosely tied to performance or a market player whose next paycheck depends on providing you with high quality, reasonably-priced goods and services.

Footnotes

1. Dan E. Beauchamp and Ronald L. Rouse, "Universal New York Health Care," New England Journal of Medicine, Vol. 323, No. 10 (Sept. 6, 1990), pp. 640-644.

2. Steffie Woolhandler and David U. Himmelstein, "The Deteriorating Administrative Efficiency of the US Health Care System," New England Journal of Medicine, Vol. 324, No. 18 (May 2, 1991), pp. 1254-1255.

3. Gerald W. Grumet, "Health Care Rationing Through Inconvenience," New England Journal of Medicine, Vol. 321, No. 9 (Aug. 31, 1989), p. 608.

4. Stanley B. Jones, "Multiple Choice Health Insurance: The Lessons and Challenge to Private Insurers," Inquiry, Vol. 27, (Summer 1990), p. 164.

5. Alan Sager, Deborah Socolar, David Ford, and Robert Brand, "More care, at less cost," Boston Globe, April 25, 1999, p. C1.

6. Michael Walker, "Cold Reality: How They Don't Do It in Canada," Reason, Vol. 23, No. 10 (March 1992), pp. 37-38.

7. Colin Nickerson, "Disgruntled Canadian physicians flock to US," Boston Globe, April 8, 1996, p. 1.

8. Colin Nickerson, "Crisis spurs mothers-to-be to quit Canada," Boston Globe, October 19, 1996, p. A1.

9. Colin Nickerson, "Canada's hospitals are feeling a chill," Boston Globe, February 11, 1999, p. A2.

10. Colin Nickerson, "Canada patients wait for beds as flu takes over" Boston Globe, January 7, 2000, p. A1.

11. (Reuters), "1,300 doctors mount strike on work issues" Boston Globe, January 9, 2001, p. A8.

12. John C. Goodman and Gerald L. Musgrave, Patient Power, (Washington D.C.: Cato Institute, 1992), p. 499.

13. "IG seeks clearer regulations on fraud and abuse," Hospitals, Vol. 62 (May 20, 1988), p. 79.

14. Gerald W. Grumet, "Health Care Rationing Through Inconvenience," New England Journal of Medicine, Vol. 321, No. 9 (Aug. 31, 1989), p. 608.

pickledpepperRN · Jan 27, 2004

Here in the USA we pay for all full time government employees whatever insurance plan they choose, elected officials have health insurance for life, the Veterans Administration is another system with red tape and inconsistant care for our veterans some of whom do not qualify, there are county hospitals and clinics, and various tax paid indigent care, most notable is Medicaid.

There are school and prison based programs. We pay for our elderly and disabled.

I mentioned my friend who went to Canada so she could work and have healthcare becaiuse she is disabled. We taxpayors pay for SSI for people who could work but do not qualify for healthcare unless permanently disabled.

Then there is the overhead of the insurance companies.

They own many large buildings, often with marble floors, where NO healthcare is provided ever.

Just 10 business day waits for care while taxpayors pay for those unable to work until treated.

Oh, almost forgot workers compensation. What else do we taxpayors pay for already?