Most US doctors now support a national health plan

[turbo]

There is too much reliance on insurance-company propaganda and not enough fact here. The reason that Medicare is hugely expensive is that is has to pay for care under a system in which the insurance companies are siphoning off billions a year in denied and delayed payments and dropped coverage for sick people. We have by far the most expensive health-care system in the developed world, and we are getting less benefit than Canada, European nations, etc. A real, public, single-payer system would be far cheaper and would cut overhead for providers, who would be able to maintain their current incomes while charging less for services. This is basic economics, not rocket-science.

 

[mheslep]

I believe it has been reestablished in the past few weeks that the public in the US is highly skeptical of government directed or run health care. I certainly am. However we see more than ample criticism of public plans, to the point that doesn't add much to the debate. The US health system never the less has some serious cost problems, and I'd like to see more discussion on what can be done, rather than spending large amounts of time on what shouldn't be done, because the status quo is not acceptable either.

I still favor the ideas proposed by McCain's adviser Holtz-Eagin during the campaign which unfortunately the Senator Biden put out a lot of bad information about during the campaign. The biggest part of the McCain plan is killing the employer tax deduction, and moving the tax breaks to the individual. Sen. Baucus recently revisited the employer tax break (without individual breaks in lieu of). Either way, the employer deduction has got to go to re-enable a free market for health care, and make Americans health shoppers, not health suckers.
http://money.cnn.com/2008/03/10/news/economy/tully_healthcare.fortune/
http://www.heritage.org/Research/Healthcare/bg2198.cfm

 

[mheslep]

There is too much reliance on insurance-company propaganda and not enough fact here. The reason that Medicare is hugely expensive is that is has to pay for care under a system in which the insurance companies are siphoning off billions a year in denied and delayed payments and dropped coverage for sick people.

What does that have to do with Medicare, since it operates without insurances companies in the loop?

We have by far the most expensive health-care system in the developed world,

yes

and we are getting less benefit than Canada, European nations, etc.

no

 

[turbo]

What does that have to do with Medicare, since it operates without insurances companies in the loop?

The insurance companies drive up the cost of health care by imposing administrative overhead on health-care providers, and Medicare has to pay for services under these inflated prices.

 

[mheslep]

Today's NYT Brooks column:

Something for Nothing
By DAVID BROOKS
June 22, 2009

On May 12, the Senate Finance Committee held a hearing on health care reform. There was a long table of 13 experts, and a vast majority agreed that ending the tax exemption on employer-provided health benefits should be part of a reform package.

They gave the reasons that experts — on right or left — always give for supporting this idea. The exemption is a giant subsidy to the affluent. It drives up health care costs by encouraging luxurious plans and by separating people from the consequences of their decisions. Furthermore, repealing the exemption could raise hundreds of billions of dollars, which could be used to expand coverage to the uninsured.

Democratic Senator Ron Wyden piped up and noted that he and Republican Senator Robert Bennett have a plan that repeals the exemption and provides universal coverage. The Wyden-Bennett bill has 14 bipartisan co-sponsors and the Congressional Budget Office has found that it would be revenue-neutral.

The Finance Committee’s chairman, Senator Max Baucus, looked exasperated. With that haughty and peremptory manner that they teach in Committee Chairman School, he told Wyden and the world that this idea was not going to happen.
...

The problem with the committee plans is that they don’t do much to change the underlying incentives, and consequently don’t do much to control costs. “The single most expensive option is to build on the existing system,” says the health care costs guru John Sheils of the Lewin Group.
...
The committee staffs don’t like the approach because it’s not what they’ve been thinking about all these years. The left is uncomfortable with the language of choice and competition. Unions want to protect the benefits packages in their contracts. Campaign consultants are horrified at the thought of fiddling with a popular special privilege.

KILL IT already.

So here comes one of those tough moments for a President. No substantive health care reform is going to happen unless Obama gets off the I-support-whatever-works fence and takes the heat for getting behind McCain's original proposal: repeal the employer based tax cut. But that is not going to happen. Instead we'll see a lot of blame thrown on Republicans as the 'party of no', despite overwhelming Democratic majorities.

 

[turbo]

The problem with the committee plans is that they don’t do much to change the underlying incentives, and consequently don’t do much to control costs. “The single most expensive option is to build on the existing system,” says the health care costs guru John Sheils of the Lewin Group.

This is the reason that Medicare and Medicaid are so horrendously expensive. They are publicly funded, but they are forced to obtain services from a private system that is terribly expensive, inefficient, and laden with administrative overhead. The insurance companies have bought Congress (both sides of the aisle) to prevent the establishment of a single-payer or public-option program.

 

[mheslep]

This is the reason that Medicare and Medicaid are so horrendously expensive. They are publicly funded, but they are forced to obtain services from a private system that is terribly expensive, inefficient, and laden with administrative overhead. The insurance companies have bought Congress (both sides of the aisle) to prevent the establishment of a single-payer or public-option program.

We have examples of single payer elsewhere in the world; as has been documented in these forums they have huge problems the US doesn't want. Health outcomes are inferior to the US. Care is rationed. Innovation suffers. The Health Minister becomes the most important ministerial job in the government; foreign minister and defense become minor positions in comparison. And several countries that used to go single payer, like the Netherlands, have dumped it.

The way to drive to down costs, as it has always been, is to have competition for services that people actually have to buy themselves (in most cases), not to have big brother take care of it all for us.

 

[turbo]

Well, I know a lot of Canadians due to my geographic location, and naturalized US citizens with extended families in PQ and NB. I don't know a single one of them that would prefer the US system to the Canadian system. By the way, when insurance company proponents cite the fact that some Canadians seek treatment in the US, they never mention that most of the procedures done in the US are paid for by the Canadian health insurance system. Much of Canada is very rural, and like in the US, it may be necessary to travel quite a distance to get to be diagnosed and/or treated by a specialist instead of a general practicioner. Their public health-care insurance system is set up to be able to respond to such situations.

The fact that it can be easier to go cross-border and be treated in the US is not a condemnation of the Canadian system, as it is usually portrayed by the insurance company lackeys, but is a practical response to uneven distribution of medical resources. For the same reason, people in Maine often have to travel all the way to Boston to get special treatments that are not available in Maine.

 

[drankin]

Well, I know a lot of Canadians due to my geographic location, and naturalized US citizens with extended families in PQ and NB. I don't know a single one of them that would prefer the US system to the Canadian system. By the way, when insurance company proponents cite the fact that some Canadians seek treatment in the US, they never mention that most of the procedures done in the US are paid for by the Canadian health insurance system. Much of Canada is very rural, and like in the US, it may be necessary to travel quite a distance to get to be diagnosed and/or treated by a specialist instead of a general practicioner. Their public health-care insurance system is set up to be able to respond to such situations.

The fact that it can be easier to go cross-border and be treated in the US is not a condemnation of the Canadian system, as it is usually portrayed by the insurance company lackeys, but is a practical response to uneven distribution of medical resources. For the same reason, people in Maine often have to travel all the way to Boston to get special treatments that are not available in Maine.

I live in WA state and have many Canadian friends and colleagues. This article reflects the opinions I've heard from Canada.

http://seattletimes.nwsource.com/html/opinion/2001977834_cihak13.html"

Basically, their government run system is not ideal by any means.

 

[turbo]

From a peer-reviewed scientific paper:

ABSTRACT
Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

http://www.openmedicine.ca/article/view/8/1

 

[mheslep]

From a peer-reviewed scientific paper:



http://www.openmedicine.ca/article/view/8/1

I note that the OpenMedicine editorial board is 100% Canadian.

Edit: I am at a loss to explain the logic of this statement:

...For instance, we excluded studies of national rates of death from cancers because lower mortality may be due either to a lower incidence of cancer or to better care for those with the disease...

First, we don't need to look at national death rates, we have figures for survival rates for those who have contracted the disease which is what's important to me. Second, excluded results because of 'better care for those with the disease'? Isn't that an outcome we want?

 

[turbo]

I note that the OpenMedicine editorial board is 100% Canadian.

is the nationality of the authors of a peer-reviewed scientific paper an issue? Their analysis seems quite rigorous and controlled, and their conclusions bear consideration. I certainly wouldn't invalidate a peer-reviewed paper on the basis of the nationality of the people conducting the study.

 

[mheslep]

is the nationality of the authors of a peer-reviewed scientific paper an issue? Their analysis seems quite rigorous and controlled, and their conclusions bear consideration. I certainly wouldn't invalidate a peer-reviewed paper on the basis of the nationality of the people conducting the study.

Individually no it is not an issue, but when nationality is pervasive yet it is. For comparison, the NEJM editorial board is composed of physicians from http://content.nejm.org/misc/edboard.shtml" .

Their conclusions bear consideration, I just don't know how much. I see for instance that in some of the outcomes reported as favourable to Canada, it used other factors such income, as in Table 3:

..Breast and prostate cancer ...Canada: significantly higher 5 yr survival in low income groups..."

where 'low income groups' would seem to trigger Medicaid, an already US/state government run program, or race:

renal transplant recipients ... US: 1y and 3y graft survival rates significantly lower among black recipients...

Given the large black population in the US, I doubt this means black Americas would statistically obtain a better outcome in this category by heading North.

Also, there is peer review and then there is peer review. Several of the OM board members were fired just a couple years ago from CMAJ and have just started up OM. It is a new publication and it doesn't have much standing yet that I can see, based on the few cites of that two year old article.

Edit: I also see this:

Canadians had longer wait times for surgery, longer post-operative lengths of stay, and higher inpatient mortality. Differences in mortality were not, however, attributable to differences in wait times for surgery. Furthermore, the increase in mortality did not persist over time, and Canadian outcomes proved superior for several other surgical procedures

I can not fathom how this can be the case, that wait times for surgery for life threatening illnesses do not impact outcomes.

 

[turbo]

Is there any chance that graft survival rates among black recipients might be affected by the quality of care available to them? If you have evidence that medical outcomes are affected by race when income levels and access to health-care are equal, please drag it out. Otherwise that red-herring argument holds no water. A prime reason to go to a public-health care system is to provide the same access to regular check-ups and preventive care, so that patients do not enter the health-care system with their survivability already seriously compromised by lack of access to prior care. When poorer patients cannot get easy access to preventative coverage, it is a slam-dunk that too-late surgical interventions and treatments will not be as successful as earlier procedures performed when the patients are healthier.

 

[mheslep]

http://www.nber.org/papers/w13429"
June E. O'Neill, Dave M. O'Neill
NBER Working Paper No. 13429

Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys. We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs. We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

http://www.ncpa.org/pub/ba596#footnotes"

* For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
* For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

 

[mheslep]

Paper focused mainly on cancer survivability in Europe, but compares to US data:
http://www.thelancet.com/journals/lanonc/article/PIIS1470204507702462/abstract"
The Lancet Oncology, Volume 8, Issue 9, Pages 784 - 796, September 2007

Background
Traditional cancer-survival analyses provide data on cancer management at the beginning of a study period, and are often not relevant to current practice because they refer to survival of patients treated with older regimens that might no longer be used. Therefore, shortening the delay in providing survival estimates is desirable. Period analysis can estimate cancer survival by the use of recent data. We aimed to apply the period-analysis method to data that were collected by European cancer registries to estimate recent survival by country and cancer site, and to assess survival changes in Europe. We also compared our findings with data on cancer survival in the USA from the US SEER (Surveillance, Epidemiology, and End Results) programme.
Methods
We analysed survival data for patients diagnosed with cancer in 2000—02, collected from 47 of the European cancer registries participating in the EUROCARE-4 study. 5-year period relative survival for patients diagnosed in 2000—02 was estimated as the product of interval-specific relative survival values of cohorts with different lengths of follow-up. 5-year survival profiles for patients diagnosed in 2000—02 were estimated for the European mean and for five European regions, and findings were compared with US SEER registry data for patients diagnosed in 2000—02. A 5-year survival profile for patients diagnosed in 1991—2002 and a 10-year survival profile for patients diagnosed in 1997—2002 were also estimated by the period method for all malignancies, by geographical area, and by cancer site.
Findings
For all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 2000—02, especially for patients with colorectal, breast, prostate, and thyroid cancer, Hodgkin's disease, and non-Hodgkin lymphoma. The European mean age-adjusted 5-year survival calculated by the period method for 2000—02 was high for testicular cancer (97·3% [95% CI 96·4—98·2]), melanoma (86·1% [84·3—88·0]), thyroid cancer (83·2% [80·9—85·6]), Hodgkin's disease (81·4% [78·9—84·1]), female breast cancer (79·0% [78·1—80·0]), corpus uteri (78·0% [76·2—79·9]), and prostate cancer (77·5% [76·5—78·6]); and low for stomach cancer (24·9% [23·7—26·2]), chronic myeloid leukaemia (32·2% [29·0—35·7]), acute myeloid leukaemia (14·8% [13·4—16·4]), and lung cancer (10·9% [10·5—11·4]). Survival for patients diagnosed in 2000—02 was generally highest for those in northern European countries and lowest for those in eastern European countries, although, patients in eastern European had the highest improvement in survival for major cancer sites during 1991—2002 (colorectal cancer from 30·3% [28·3—32·5] to 44·7% [42·8—46·7]; breast cancer from 60% [57·2—63·0] to 73·9% [71·7—76·2]; for prostate cancer from 39·5% [35·0—44·6] to 68·0% [64·2—72·1]). For all solid tumours, with the exception of stomach, testicular, and soft-tissue cancers, survival for patients diagnosed in 2000—02 was higher in the US SEER registries than for the European mean. For haematological malignancies, data from US SEER registries and the European mean were comparable in 2000—02, except for non-Hodgkin lymphoma.

 

[Alfi]

Debunking Canadian health care myths

By Rhonda Hackett
Posted: 06/07/2009 01:00:00 AM MDTRelated
canadian health care perspective
Jun 7:
What do we pay for, anyway?As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it.While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in anyone geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

 

[Evo]

If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise),

That's a problem, IMO, if Canadians have to go to the US to get proper care in some cases.

Also, I don't know why the personal opinion of some psychologist would have any partiular merit in weighing these issues.

 

[Alfi]

Also, I don't know why the personal opinion of some psychologist would have any partiular merit in weighing these issues.

As a Canadian living in the United States for the past 17 years.

That, plus her professional standing, should merit more than someone that has not experienced both systems.

 

[mheslep]

Debunking Canadian health care myths

By Rhonda Hackett
Posted: 06/07/2009 01:00:00 AM MDT

...

Alfi do you have a link for this source? Was this published in a major news source or is it a personal blog page or the like?

 

[mheslep]

Some of these are strawmen and self contradictory.

Debunking Canadian health care myths


Myth: The Canadian system is significantly more expensive than that of the U.S.
...

Strawman. Everybody, and I mean everybody acknowledges US health is expensive.

Myth: Canada's government decides who gets health care and when they get it.While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

"If your ... doctor says you get an MRI, you get one". Stuff and nonsense. You may, or you might wait a year. Why? Because the doctor thinks that is the best schedule? No. Because the Canadian government has decreed how much MRI equipment will be purchased, or how many 'radiation therapists' will be trained, or which medications it deems worthy, and there's an under supply of these so you wait, all of which has to do with money.
These two are, at the least, self-contradictory.

 

[mheslep]

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

The superior system? In the US:

What is the cost of a knee replacement?
The cost of a total knee implant depends on your individual needs, but typically costs from a few thousand to several thousand dollars, plus orthopaedic surgeon fees and the cost of your hospital stay. However, most insurance companies as well as Medicare and Medicaid cover knee replacement surgery. You should contact your insurance provider to see whether knee replacement is covered under your plan.

Also:

...Remember, there is no cure for osteoarthritis. It is a degenerative disease, which means that your condition will get worse over time if left untreated.3

http://www.kneereplacement.com/DePuy/docs/Knee/Replacement/BeforeSurgery/knee_FAQs.html

The fact that Medicare/Medicaid covers the procedure in the US is easy to find, yet in the face of pain and suffering by a family member Hackett clings to the state system like a character from Orwell's Animal Farm. She'd likely report the Aunt to the commissar if she crossed the border for help.

 

[Alfi]

Alfi do you have a link for this source? Was this published in a major news source or is it a personal blog page or the like?

I've asked the person that posted it. He may not be able to get back to me till later today.

 

[turbo]

I've asked the person that posted it. He may not be able to get back to me till later today.

I believe that the article was originally published in the Denver Post. Maybe there's still a link up somewhere.

Edit: Yep! Denver Post. My guardian software warns me that the paper's web-site appears to host some mal-ware, so I'm not going to post a link.

 

[Alfi]

http://www.denverpost.com/recommended/ci_12523427

I get no warnings :)
but...
As per the post above - open with caution.

 

[mheslep]

... Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. ...

No, for purposes of comparing health care systems incident rates are not noteworthy. Incident rates are related to all kinds of factors having nothing to do with the health care system, especially diet which notoriously bad in the US. That, and genes of course. http://apps.nccd.cdc.gov/uscs/Table.aspx?Group=3f&Year=2005&Display=n#Asian/PacificIslander" . What matters are outcomes, that is, what are your chances of surviving once you are in the system. And for outcomes of all cancer types on average across the population at large, the US has better outcomes than Canada as posted above.

* For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
* For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

http://www.ncpa.org/pub/ba596#footnotes

 

[mheslep]

http://www.denverpost.com/recommended/ci_12523427

I get no warnings :)
but...
As per the post above - open with caution.

Thanks for the link

 

[mheslep]

As a Canadian living in the United States for the past 17 years.

That, plus her professional standing, should merit more than someone that has not experienced both systems.

Note Hackett claims to be a psychologist, not an MD. She need not have ever stepped into a hospital.

 

[turbo]

Note Hackett claims to be a psychologist, not an MD. She need not have ever stepped into a hospital.

That does not invalidate her claims that the "faults" of the Canadian health-care system are overblown by the insurance companies and their shills. The idea that only doctors can properly evaluate a health-care system is pretty lame. I was the IT guy for a large ophthalmic practice for years, and we constantly had to fight the insurance companies for timely payment, and sometimes for any payment at all. The administrative costs foisted on the health provider by the insurance companies' false denials and delays are incredible, and people who have never worked in private health practice have no idea how pervasive the problem is.

 

[mheslep]

That does not invalidate her claims that the "faults" of the Canadian health-care system are overblown by the insurance companies and their shills. The idea that only doctors can properly evaluate a health-care system is pretty lame. ...

Note that I was responding to Alfi's statement about 'professional standing', implying that should give additional weight. And I agree doctors are not the only ones that are entitled to opinions on health care economics, though their experience on the inside certainly carries weight, since in the US system they are the ones in diatly contact with the middlemen, the patients rarely are in comparison.

 

[turbo]

Actually, the doctors in large practices are heavily insulated from day-to-day contact with insurance companies. Those roles are filled by coding specialists, accounting managers, practice managers, and IT specialists such as myself. Doctors know from their staff about the generalities surrounding delays and denials of payment, but they are not "in the trenches".

 

[mheslep]

Actually, the doctors in large practices are heavily insulated from day-to-day contact with insurance companies. Those roles are filled by coding specialists, accounting managers, practice managers, and IT specialists such as myself. Doctors know from their staff about the generalities surrounding delays and denials of payment, but they are not "in the trenches".

Yes, yes, I mean their offices, their agents if you will, and thus the docs are very cognizant of the costs and time involved.

 

[WheelsRCool]

This is the reason that Medicare and Medicaid are so horrendously expensive. They are publicly funded, but they are forced to obtain services from a private system that is terribly expensive, inefficient, and laden with administrative overhead. The insurance companies have bought Congress (both sides of the aisle) to prevent the establishment of a single-payer or public-option program.

Not saying you are wrong, but are you sure you don't have this backwards? From my understanding, it is Medicare and Medicaid that drive up the costs of healthcare in the private sector, because there is a price ceiling on how much the private sector can charge them.

They are publicly-funded, government-run health insurance companies, that themselves are very inefficient and expensive, but since the private sector cannot charge people on Medicare and Medicaid beyond a certain price, the private sector is thus forced to yank up prices elsewhere or flat-out ration to make up for the lost money.

 

[turbo]

Not saying you are wrong, but are you sure you don't have this backwards? From my understanding, it is Medicare and Medicaid that drive up the costs of healthcare in the private sector, because there is a price ceiling on how much the private sector can charge them.

They are publicly-funded, government-run health insurance companies, that themselves are very inefficient and expensive, but since the private sector cannot charge people on Medicare and Medicaid beyond a certain price, the private sector is thus forced to yank up prices elsewhere or flat-out ration to make up for the lost money.

The coding standards and rules enforced by Medicare and Medicaid are simple and relatively easy to understand and comply with. Thus, even if their reimbursal rates are somewhat lower than the ideal private insurer, the doctors can live with that because the administrative overhead that private payers impose on them to fight arbitrary denials and delays aren't present. If there was a single-payer insurer in this country with ONE set of rules and coding standards, doctors and hospitals could eliminate a vast amount of waste imposed by administrative overhead. Private insurers love to create mazes of rules and coding standards allowing them to (seemingly legally) delay or deny payments to providers. This behavior should be criminal. The insurance companies make fortunes on pools of unpaid claims, much like the banks used to do by dragging their feet while clearing checks. The unpaid balance is called the "float". The government forced the banks to clean up their acts, but allows the insurance companies to perpetrate much more egregious frauds on the public - for profit.

 

[Hurkyl]

The coding standards and rules enforced by Medicare and Medicaid are simple and relatively easy to understand and comply with...

Was there supposed to be a reply to WheelsRCool's objection in there? It looks to me as if you completely ignored him and went off on a canned spiel.