Is Health Care a Right?

KP RN · Feb 11, 2003

OK! Here's a newsflash!!!!

The United States government has a massive deficit. Social Security is unfunded. Why would I have faith in the federal government?

P.S. We really do have a national health care system. Medicare and Medicaid!!

P.P.S.S. If hospitals, doctors, and nurses relied on Medicare and Medicaid payments exclusively, guess what???? We would all be living in poverty.

diquweed · Feb 11, 2003

OK I live in America, and I don't see dead bodies laying around the streets from a lack of health care.

KC CHICK · Feb 11, 2003

JMP, I agree that having everyone's healthcare covered in my country would be a dream. However, NO SYSTEM IS PERFECT. You said that long waiting times for procedures in your country is a myth. I have found an article that gives another side to that story. Please read and give your thoughts.

IMO, this would be the dark side of your universal system for the hard workers within your country that contribute to society. What a way to be repaid for your contributions.

Anne

POSTED AT 12:00 PM EST Monday, December 2, 2002

"Long lists for surgery are Canada's Achilles' heel"

By LISA PRIEST

From Monday's Globe and Mail

Paul Chartrand sits in his wheelchair. His legs are crossed, his muscles atrophied and he cannot remember the last time he had a restful sleep.

He thinks it could have been when he was put on a waiting list for hip replacement surgery more than three years ago.

In the time he has waited for the operation, he has gone from walking with a cane, to a walker, then finally a wheelchair. He has had to install bars in his bathroom. If something drops on the floor, it stays there -- at least until the cleaner comes by.

"I'm totally crippled now," the Saskatoon-based law professor said. "I can't do anything; I can't go out. I just manage the pain so I can do my work."

Like thousands of others, the 59-year-old is on a waiting list. Though the date for his surgery has been set, he has spent more than three years in health-care limbo. During that time, his one bad hip in need of repair has become two, which will mean another operation. "I'm appalled," he said.

Canada's universal health-care system has the one big downside of finite resources. Consequently, many patients often have to wait for care as services are rationed.

While most agree the waits for some procedures -- such as hip replacements -- are far too long, some argue lengthy queues are proof that Canadians need a private, parallel system where those with cash can purchase quicker care.

Part of the problem is that no one tracks precisely how many Canadians are waiting for diagnostic tests, surgeries and other treatments. Most waiting lists are kept by individual hospitals and doctors.

However, waits for certain procedures are measured in some pockets of the country. Ontario tracks waiting times for open-heart surgery. British Columbia tracks surgery waits. New Brunswick, Nova Scotia and Ontario have all catalogued how long patients have had to wait in emergency once it has been determined that they needed to be admitted to hospital.

Roy Romanow, who chaired a royal commission that reported last week on how to fix the ailing health-care system, has recommended the provinces take immediate action to manage waiting lists more effectively. He also recommended a $1.5-billion diagnostic service fund to improve waiting times for tests such as MRIs and CT scans.

Mr. Romanow called for waiting lists to be centrally managed, urged that there be standardized and objective criteria to assess patients, and recommended that patients be told the approximate time they should expect to wait.

"The important thing is for Canadians to know that waiting times are being reduced, that people with the most urgent needs do not have to wait, and that wait lists are being managed in a co-ordinated and objective way based on the urgency of people's needs," Mr. Romanow's report said.

While waiting lists are expected, some cases like Mr. Chartrand's, are ridiculously long.

When Senator Michael Kirby was told of his three-year wait, he said: "That's insane."

Mr. Kirby, chairman of the Senate standing committee on social affairs, science and technology, has recommended that any changes to medicare must tackle waiting lists.

"It's absolutely the major issue," Mr. Kirby said in an interview. "If you don't deal with the care guarantee, you won't get public support for any of the other changes because you will not be dealing with what they perceive to be the major issue."

Under Mr. Kirby's care guarantee, a patient -- who has reached a pre-determined maximum waiting time for a procedure, test or operation -- would be provided the option of care in another part of Canada or even the United States. It would be paid for by the province.

"If the government rations the supply and lengthens the waiting, the government doesn't suffer directly any consequences," Mr. Kirby said. "But the minute they are in a position to pay for it elsewhere, there's a huge incentive to make the system more efficient."

Indeed, Mr. Chartrand was upset that there was no backup system he could draw on. At one point, he contemplated quitting his job and moving back to Australia -- where he used to live -- to get the surgery.

"I wouldn't have had to go through all this agony if we had a backup system," he said.

But Mr. Romanow said he is not keen on care guarantees. Reliable methods, he wrote, are not available to determine what the appropriate guarantee should be. And flexibility in managing elective surgeries, such as knee replacements, could be lost if provinces were forced to meet rigid care guarantees.

"They cannot simply be pulled out of thin air and trumpeted to Canadians as a magic-bullet solution," his report said.

Robert Hill, an orthopedic surgeon at St. Joseph's Hospital in Comox, B.C., said his patients have to wait longer because the hospital, keen to keep its budget in line, limits his operating room time. "They're allowing me to do one joint a week when I could do three or four easily," Dr. Hill said.

His waiting list is 50 weeks long. But he said that's based on some people "waiting two years and some only waiting a few months."

Tirone David, chief of cardiac surgery at Toronto General Hospital, said he usually performs 350 valve replacements and complex cardiac bypass operations each year. This year, he will do about 190.

Unlike the B.C. case, Dr. David's hospital gets paid for each heart surgery it performs. The doctor cannot operate as much because of shortages of perfusionists -- those who work the heart and lung machine -- anesthesiologists and intensive-care nurses.

"The frustration has never been so high," Dr. David said. "I don't remember it ever being this bad."

Dr. David attributes the problem to the cuts of the early 1990s that saw a reduction in medical-school students and the layoffs of thousands of nurses.

But some are working to fix waiting-list problems, or at least determine a way to establish priorities so the sickest patients are seen the soonest.

Tom Noseworthy, a physician and chairman of the Western Canada Waiting List Project, is trying to develop a waiting-list scoring system so those with the highest scores are treated the quickest.

Under the system, the severity of the illness would be measured, as would the impact on a person's life and how beneficial the intervention would be.

The group looked at five procedures: cataract surgery, children's mental-health services, general surgery, hip and knee replacement and MRI scanning.

"There's no simple, singular explanation for why waits are long," Dr. Noseworthy said. "But there's no point having a really great system if you can't get into it."

In Mr. Chartrand's case, the surgery he waited one year for was supposed to take place May 1, 2001, but it was cancelled the night before due to a doctors' job action in Victoria, the place he last lived.

When he asked when the surgery would be rescheduled, he was told no one knew. Eventually, he changed surgeons, which prompted yet another wait.

On Dec. 16, he will undergo a replacement on his left hip. Some time next May, he is expected to get his right hip replaced. And if all goes well, Mr. Chartrand will be able to walk without canes in May, 2004.

"This is very deteriorating and degenerative," he said. "I'm quite sure I wouldn't be able to work for very much longer. You never get a full night's sleep."

...and yet another article r/t waiting times for procedures (if anyone's interested). http://www.heritage.org/Press/Commentary/ed092900.cfm

fiestynurse · Feb 11, 2003

Again, study after study has shown that universal coverage with a simplified administrative structure, like national health insurance with everyone in "one risk pool," would actually cost us less while including everyone. Ensuring that all Americans stay healthy and work, aids in the growth of the economy.

In May 2002, the Institute of Medicine released the second of a series of six reports on the consequences of uninsurance - entitled "Care Without Coverage: Too Little, Too Late." The study estimates that over 18,000 adults die each year in the U.S. because of lack of health insurance. Of course there are no dead bodies in the streets - come on, get real!

Medicare needs to be improved and expanded. National Health Insurance, with "one risk pool" for all Americans, would be an improved Medicare. Currently Medicare is a "single risk pool," which takes care of the sickest portion of our society. The proposed single payer plan would have a more comprehensive range of benefits than the current Medicare.

edianarn · Feb 11, 2003

Originally posted by K O'Malley
I think that health care is a right but with rights come responsibilities, like not trashing your health and expecting others to pick up the tab. But, knowing human nature there will always be those who abuse the system. I never could understand giving liver transplants to alcoholics.

fiestynurse · Feb 11, 2003

The Canadian health system has it problems, mostly originating from years of underfunding when a conservative government was in power. There are some wait lines for non-emergency services. But personal communications and studies being done indicate that these wait times are nowhere near as long as onerous critics of the Canadian system claim.

But the Canadians do have universal coverage with a single-payer system for each province. No one worries about going without needed care or about going bankrupt should he/she have a serious illness.

Lastly, we have "waiting lines" in America, too. Maybe, we don't have to wait as long to get an MRI or a cardiac cath because we have an excess capacity for those kinds of expensive procedures. But how long do we Americans have to wait to get an appointment with an ophthalmologist, an orthopedist, or a lung doctor? I currently had to wait 2 months to see my physician for a yearly exam and then another 2 months for a mammogram that she ordered.

How about the uninsured, I know a patient who has been waiting several years to get her gallbladder taken out. If she shows up in the emergency room with a "hot" gallbladder and a temperature of 102, she will have it taken out immediately. Of course, as a result, she might need to make payments to a collection agency for the next 10 years. She is waiting until she turns 65 to get her surgery - when she is eligible for Medicare!

The definition of U.S. style rationing is: If you can afford it, you get it. If you can't afford it, you either can't or won't get it unless it's a dire emergency and you're lucky enough to catch the problem in time to survive.

fiestynurse · Feb 11, 2003

Article 25 of the United Nations' 1948 Universal Declaration of Human Rights states:

"Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstancesbeyond his control."

Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Martin Luther King, Jr.

Allowing 40+ million people to go without decent access

to health care in the richest country in the world is :

a) moral

b) immoral

KC CHICK · Feb 11, 2003

Maybe people within Canada's (and other universal programs) healthcare system are being overlooked as well. It's hard to tell since they aren't tracking numbers on waiting lists...according to the article I posted. Would be interesting to see how many are going without.

But...gotta have accurate data first.

If you want to start debating morality...fine.

I have added another quote from a different article relating to universal coverage.

How moral is this??

"Such waiting lists are an inevitable by-product of any system of socialized medicine. Demand outpaces supply, so the government must ration care. Because prices are fixed, the only way politicians and bureaucrats can "control" demand is to limit supply, which entails long waiting lists for many types of medical conditions.

Dr. Richard Davies, a cardiologist at the University of Ottawa, recently wrote in the Canadian Medical Association Journal that "Canadian patients are being forced to wait much longer than is really necessary" for heart bypass surgery. Using figures from the Cardiac Care Network of Ontario, he showed that more than 1,500 patients were on the provincial waiting list at any given time in a typical year. Sadly, some die while waiting for surgery, while others are taken off the list because they've become "medically unfit for surgery" due to their extended waiting time.

Similar revelations are coming out of Britain. According to The Guardian, in 1998 more than 1.3 million British patients were on waiting lists for medical care. The new Labor government, elected in 1997, promised to tackle the problem, but 100,000 more patients were added to the waiting lists in a year. It is now a scandal."

quote is from this article: http://www.heritage.org/Press/Commentary/ed092900.cfm

OzNurse69 · Feb 11, 2003

Originally posted by Gromit
Ever notice how some people just resort to insults?

Why do you do that?

Did I start out by insulting you? (in case you forgot that too, the answer is no)

Ok, maybe calling you witless was a little severe, and for that I apologise....:kiss

I did not call you a hick, FYI I grew up on a farm also, and I have no problem with rural people being educated....some of the most intelligent people I know are from rural areas.

Having said that, however, it seems to me that some on this board have very set opinions of certain topics, and refuse to logically consider the arguments that others present to try and educate them.

I am quite happy to accept any EVIDENCE that any member can give me that will support the argument that the US health system is more effective & equitable than that of other countries. However, the more I learn about it, the less I like it. If that makes me a socialist, so be it.....

My opinion is just that.....an opinion based on evidence which I have been presented. If that evidence can be refuted, or contradictory evidence is presented which can be PROVEN to be more reliable than the old, I am quite happy to change my opinion.....

Gromit · Feb 11, 2003

Originally posted by fiestynurse
Again, study after study has shown that universal coverage with a simplified administrative structure, like national health insurance with everyone in "one risk pool," would actually cost us less while including everyone. Ensuring that all Americans stay healthy and work, aids in the growth of the economy.

In May 2002, the Institute of Medicine released the second of a series of six reports on the consequences of uninsurance - entitled "Care Without Coverage: Too Little, Too Late." The study estimates that over 18,000 adults die each year in the U.S. because of lack of health insurance. Of course there are no dead bodies in the streets - come on, get real!

Nobody here disputes the consequences of uninsurance. However, my particular dispute here is that I have YET to see anything the government took over, become simplified (thats a laugh!) or more cost effective.

OzNurse69 · Feb 11, 2003

You do have a point there, in that even if your govt did manage to introduce a health care system that was less complicated & expensive than the one you already have, the average Joe on the street would be likely to see his tax cuts on about, oh, say, the same day that hell freezes over!!!....if they are anything like the average public administration, that is.....

Gromit · Feb 11, 2003

Originally posted by OzNurse69
Ok, maybe calling you witless was a little severe, and for that I apologise....:kiss

I did not call you a hick, FYI I grew up on a farm also, and I have no problem with rural people being educated....some of the most intelligent people I know are from rural areas.

Having said that, however, it seems to me that some on this board have very set opinions of certain topics, and refuse to logically consider the arguments that others present to try and educate them.

Nah, the Hick part was mine for myself (grin). But otherwise, where the set opinions are concerned, I agree that mine are set, as are the rest of the members, this is evidenced by the postings. I am open to information and have (though not easily) changed my opinions on things. As for the arguments posted and the attempt to educate the posters, I haven't seen anything that would change my belief in a universal healthcare system. I am not without compassion, but I'm just plain tired of spending more. Several here say that it can be done less expensively. Well, on paper, I agree completely! HOWEVER, having worked for years in a loca (county-level) government, and watched our own federal inefficient beaurocracy, I say :show me where or when our government made ANYTHING less expensive, and more efficient?

Its all fine and dandy to wish everyone could have everything health-wise, sadly, human nature has shown time and again that ANYTHING that is percieved as "free" will soon be overwhelmed with demand far exceeding supply.

An example? Welfare was started as an attempt to ASSIST people in times of need, with the idea that they would pull themselves up by their own bootstraps. It was NEVER intended to turn into the behemoth 'venus fly-trap' that it has become.

Actually, I think I can say that for EVERY social program the government has come up with. They never get smaller, only larger. The larger, the more inefficient.

I do not trust my government to restrict itself, it has NEVER shown any tendancy to do so.