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| 5/23 |
| 2008/2/13-14 [Politics/Domestic/California, Politics/Domestic/President/Bush] UID:49133 Activity:high 75%like:49141 |
2/13 Mythbusting Canadian Health Care
http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i
http://www.ourfuture.org/blog-entry/mythbusting-canadian-healthcare-part-ii-debunking-free-marketeers
\_ Oh sure, you'd expect this from free-market deniers.
\_ Care to respond to the arguments or just blather
and set up strawmen?
\_ "1. Canada's health care system is "socialized medicine."
False. In socialized medical systems, the doctors work directly
for the state."
This is a joke. It's a semantic nit-pick.
This is a joke. It's a semantic nit-pick. (And goes downhill
from there.)
\_ All I can say is that I have one of the best PPOs money
can buy in the USA, and it SUCKS DONKEY BALLS. If
what Canada has is socialism, then bring on the
socialism. ok thx.
\_ Move to Canada then psb.
\_ That wasn't psb. --also not psb
\_ Maybe your PPO isn't as good as you think. My
current one sucks, but my previous one was awesome.
If yours sucks then it doesn't indict the entire
medical system.
\_ Move to Canada then.
\_ yeah, because who would want to do anything to
improve America? -tom
\_ I don't think it would be good for America, and
the arguments at the links above are specious. I
think the government needs to get *less* involved
in health care, not more. If you want Canada's
system, go to Canada.
\_ If the system changes and you don't like it,
where are you going to go? -tom
\_ Excellent non sequitur, sir!
\_ Mexico, where health care is cheap and
of high quality.
\_ Cuba!
\_ What exactly sucks about it? That it's not free?
\_ This is my favorite:
"We'll have rationed care
Don't look now: but America does ration care. And it does it in the
most capricious, draconian, and often dishonest way possible.
"Mostly, the US system rations care by simply eliminating large
numbers of people from the system due to an inability to pay."
Um, yes. That's called capitalism. This is saying, "socialized
health care would be better because socialism is better!"
-emarkp
\_ no, it's saying that capitalism rations care. -tom
\_ No, capitalism puts care on a market.
\_ and that's good because...?
\_ Because markets are a proven mechanism for optimizing
results and give you a choice of where and how to
spend your money. What's good about socialism? You
are trying to change the system so the onus is on
you.
\_ Evolution is also a proven mechanism for
optimizing results. Just let all the poor, dumb
people die, it's the natural order of things.
\_ Don't forget about the UNLUCKY. Evolution
doesn't care if it operates fairly. Fairness
is a human peculiarity.
\_ It is a fallacy that markets optimize results.
An obvious failure case in the health realm is that
markets don't provide universal vaccine, which
ends up being a larger public health cost than
vaccine would be. -tom
\_ I'm not saying everything should only be driven
purely by markets. So provide free vaccine. Next?
\_ Socialist.
\_ Exceptions don't mean it's a fallacy. "Commons"
concerns are a known area where markets alone
can't optimize the problem, because the costs
and benefits aren't easily quantified or owned.
Another example is stuff like national parks
and open space. The actual value of open space
to the society at large or in the area is hard
to accurately capture. I'm open to discussion
of what constitutes such cases but I don't see
convincing arguments with respect to health
care.
\_ Proven, you mean like how the markets put CAs
power out a few years back? And gave us M$ as a
monopoly product? No one seriously believes in
unregulated markets as a mechanism for optimizing
anything.
\_ No one seriously promotes unregulated markets,
dumbass. Power markets are a laughable example
however: regulations prevented investment in
more power infrastructure.
\_ Then if you agree we need to regulate markets
you are just arguing over how much "socialism"
we really need.
\_ Regulation (laws) is not socialism, dumbass.
\_ I'm confused. op posts article debunking
myths about Canada's healthcare system.
emarkp makes comparison to socialism.
criticisms of capitalism follow, then
praises of capitalism (by way of the
free market, i.e., competition), then
bad examples of said competition, then
qualifications based on possible limited
regulation, followed by ironic
invocation of "socialism," followed by
literal reference to socialism. At what
point does any of this point to the US
system somehow being better?
\_ Well, it's true but oddly twisted. All limited resources
must be rationed some how. I only know of 3 ways, money,
politics, and violence. The Free Market uses money for a
variety of good reasons, but sometimes it doesn't work.
However, we are so used to the free market that we only call
political rationing, rationing. It's just a matter of
common language use.
\_ No, it's saying "fears of rationing care are based on a
fictional lack of rationed care in the US."
\_ I love this argument:
- Universal health care is Socialism! Capitalism rox! F U TAXES!
- Our health care system sucks! We need Canada's system! OBAMA!! |
| 5/23 |
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| www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i Sara Robinson February 4th, 2008 - 4:23pm ET 2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning -- and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee. I'm both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I'm in a unique position to address the pros and cons of both systems first-hand. If we're going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here. To that end, here's the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide. In talking to Americans about it, the better phrase is "Medicare for all." Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this: First, as noted, they don't have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself in the course of a standard workday. Second, they don't have to spend several hours every day on the phone cajoling insurance company bean counters into doing the right thing by their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid -- quietly, quickly, and without hassle. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off, and gets home in time for dinner. One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring. You don't realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who don't operate under that stress, because they never have to fight those battles at all. Third: The average American medical student graduates $140,000 in hock. The average Canadian doctor's debt is roughly half that. Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes a one of a family's major expenses, expectations tend to run very high. it may very well throw a middle-class family permanently into the ranks of the working poor, and render the victim uninsurable for life. With so much at stake, it's no wonder people are quick to rush to court for redress. Canadians are far less likely to sue in the first place, since they're not having to absorb devastating financial losses in addition to any physical losses when something goes awry. And, no matter what happens, the victim will remain insured for life. When lawsuits do occur, the awards don't have to include coverage for future medical costs, which reduces the insurance company's liability. True and False again -- it depends on which province you live in, and what's wrong with you. Canada's health care system runs on federal guidelines that ensure uniform standards of care, but each territory and province administers its own program. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But that's just as true in any rural county in the US You can hear the bitching about it no matter where you live, though. The percentage of Canadians who'd consider giving up their beloved system consistently languishes in the single digits. A few years ago, a TV show asked Canadians to name the Greatest Canadian in history; and in a broad national consensus, they gave the honor to Tommy Douglas, the Saskatchewan premier who is considered the father of the country's health care system. In spite of that, though, grousing about health care is still unofficially Canada's third national sport after curling and hockey. And for the country's newspapers, it's a prime watchdogging opportunity. Any little thing goes sideways at the local hospital, and it's on the front pages the next day. Those kinds of stories sell papers, because everyone is invested in that system and has a personal stake in how well it functions. The American system might benefit from this kind of constant scrutiny, because it's certainly one of the things that keeps the quality high. But it also makes people think it's far worse than it is. Critics should be reminded that the American system is not exactly instant-on, either. When I lived in California, I had excellent insurance, and got my care through one of the best university-based systems in the nation. Yet I routinely had to wait anywhere from six to twelve weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months. After two years in the BC system, I'm finding the experience to be pretty much comparable, and often better. The notable exception is MRIs, which were easy in California, but can take many months to get here. False for the vast majority of Canadians, but True for a few. I live in suburban Vancouver, and there are any number of first-rate GPs in my neighborhood who are taking new patients. If you don't have a working relationship with one, but need to see a doctor now, there are 24-hour urgent care clinics in most neighborhoods that will usually get you in and out on the minor stuff in under an hour. It is, absolutely, harder to get to a doctor if you live out in a small town, or up in the territories. But that's just as true in the US -- and in America, the government won't cover the airfare for rural folk to come down to the city for needed treatment, which all the provincial plans do. Somebody, somewhere, is getting paid a lot of money to make this kind of stuff up. The cons love to scare the kids with stories about the government picking your doctor for you, and you don't get a choice. For the record: Canadians pick their own doctors, just like Americans do. And not only that: since it all pays the same, poor Canadians have exactly the same access to the country's top specialists that rich ones do. You're still on your own for any extras, including prescription drugs. The province does charge a small monthly premium (ours is $108/month for a family of four) for the basic coverage. However, most people never even have to write that check: almost all employers pick up the tab for their employees' premiums as part of the standard benefits package; and the province covers it for people on public assistance or disability. "The basics" covered by this ... |
| www.ourfuture.org/blog-entry/mythbusting-canadian-healthcare-part-ii-debunking-free-marketeers Sara Robinson February 11th, 2008 - 5:55pm ET In the previous post, I looked at ten of the most common myths that get bandied about whenever Americans drag Canada into their ongoing discussions about healthcare. In this follow-up, I'd like to address a few of the larger assumptions that Americans make about health care that are contradicted by the Canadian example; and in the process offer some more general thinking (and perhaps talking) points that may be useful in the debates ahead. Government-run health care is inherently less efficient -- because governments themselves are inherently less efficient. If anything could finally put the lie to this old conservative canard, the disaster that is our health care system is Exhibit A America spends about 15% of its GDP on health care. Most other industrialized countries (all of whom have some form of universal care) spend about 11-12%. According to the WHO, Canada spends a bit over 9% -- and most of the problems within their system come out of the fact that it's chronically underfunded compared to the international average. Any system that has people spending more and getting less is, by definition, not efficient. And these efficiency leaks are, almost entirely, due to private greed. There is no logical way that a private system can pay eight-figure CEO compensation packages, turn a handsome a profit for shareholders, and still be "efficient." In fact, in order to deliver those profits and salaries, the American system has built up a vast, Kafkaesque administrative machinery of approval, denial, and fraud management, which inflates the US system's administrative costs to well over double that seen in other countries -- or even in our own public systems, including Medicare and the VA system. Not incidentally: one of the benefits of single-payer health care is that it largely eliminates the entire issue of "fraud." You can only "cheat" a system that already views its primary business as rationing and withholding care. In Canada, where the system is set up to deliver health care instead of profits, and medical access is considered a right, this whole oversight machinery is far cheaper and more compact. In general, the system trusts doctors and patients to make the right choices the first time. As a result, people generally don't have to lie, cheat, and grovel to get the system to deliver the care they need. They just go and get it -- and walk out without a moment's dread about the bills. Shareholder profit, inflated CEO salaries, and top-heavy administration -- all of which serve to work against the delivery of care, not facilitate it -- are anti-efficiencies that siphon off 20-25% of America's total health care spending. In the end, it doesn't provide a single bed, pay a single nurse or doctor, or treat a single patient. We'll have rationed care Don't look now: but America does ration care. And it does it in the most capricious, draconian, and often dishonest way possible. Mostly, the US system rations care by simply eliminating large numbers of people from the system due to an inability to pay. Last year, one-quarter of all Americans didn't go to a doctor when they needed one because they couldn't afford it. Nearly that many skipped getting a test, treatment, prescription, or follow-up appointment recommended by a doctor. Also: nearly 20% of all Americans had a hard time paying a medical bill last year; and these stresses now trigger over half of all personal bankruptcies in the country. Furthermore, nominally having health insurance is no guarantee against financial ruin, as Sicko amply illustrated. Being cut off or denied by your insurance company is rationing, too. And there are vast numbers of fairly well-off Americans -- many of them middle-aged, and too young for Medicare -- who have pre-existing conditions that render them uninsurable at any price. They're one heart attack, one diabetic event, or one bad turn away from financial disaster. Please don't insult these people by telling them that the American system doesn't ration care. Another persistent (and ridiculously mendacious) rationing myth about the Canadian system is that old people are cut off from treatment and left to die. but it happens routinely to Americans on Medicare and many private policies, which have strict limits on how long you can stay in the hospital with an acute illness. When the benefits run out, ready or not, they send you home. The Canadian plan has no such limits: you stay for as long as you need to. But in the US, these limits fit the very definition of "rationed care." Effectively shutting one-quarter of the population out of the medical system entirely, and putting many of the rest on short rations, certainly does make things so much nicer for those happy few who are still in it. In fact, Americans have these missing millions to thank for their system's impressively short wait times. Only 4% of American have to wait more than six months for non-elective surgeries, while 14-15% of Canadian and Britons do. If my friend's Aunt Millie gets her emergency hip surgery today because I'm willing to hobble along for an extra couple months before getting my knee surgery -- well, for any morally serious person, that choice should be a complete no-brainer. You can't have medical innovation without the incentives provided by the free market. The university that houses my local medical school, the University of British Columbia, ranked ninth in North America last year -- in league with UC, Stanford, and other powerhouses -- in total public and private research grants received by its labs. Among other things, it leads the way in genetics (David Suzuki is emeritus faculty), and stem-cell research (having attracted a handsome roster of American scientists whose research was thwarted by the political situation at home). Because the Canadian health care system is driven by delivering care instead of profits, the focus of research is sometimes different -- and often wider-ranging. While there's plenty of pursuit of patents and innovations, there's also considerable research put into questioning whether new treatments are really more effective than older ones; and in pursuing possible treatments that may not be patentable by anyone. Single-payer health care will make America less competitive. I can't believe people still have the gall to argue this point, but apparently, they do. There are several reasons this is flat-out wrong: Jobs, Jobs, Jobs -- It's no secret that public health care is making Canada a more attractive business environment for large manufacturers, who typically have very high insurance overhead. Toyota and GM have both moved plants to Canada in recent years, in large part to avoid the spiraling costs of insuring American workers. A Smarter, More Entreprenurial Workforce -- Being relieved of insurance worries also makes individual citizens more competitive. How would your life choices change if you didn't have to worry about health care? Would you go back to school and get your PhD in lepidoptery? Countries with universal coverage free up their citizens to take advantage of personal development opportunities that, in the long run, stimulate the economy and create a more skilled, traveled, educated, and fulfilled workforce. Americans, on the other hand, routinely stay chained to jobs they hate -- and are forced to pass up on chances to expand their horizons and their fortunes -- because they can't afford to jeopardize their health care coverage. Our health care mess has reached a point where it jeopardizes not only our lives, but also our liberty and our ability to pursue happiness -- as well as the long-term strength of the economy as a whole. Increased Financial and Social Capital -- When families are bankrupted by medical bills, or are thrown into poverty when a working member is disabled because they can't afford proper care, or simply break down and fall apart under the stress of debt and illness, it's not long before the country's entire social fabric begins to show the wear and tear -- along with the sense of optimism and the common good required for a democracy to function. Part of what makes a coun... |