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Tilting at Windmills

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April 18, 2007
By: Kevin Drum

HEALTHCARE IN CANUCKISTAN....Despite the seemingly endless stream of scare stories peddled by the insurance industry and its conservative enablers about the nearly third-world condition of Canadian healthcare (hip replacements!) it turns out that a review of all the known studies comparing Canadian and American health outcomes gives Canucks the nod. Ezra Klein has the details:

Of the 38 studies examined, 14 showed clear advantaged for Canadian patients, five suggested US care was superior, and the remainder were mixed....How can we possibly countenance a system that costs twice as much as the Canadian system but delivers slightly worse care? Even assuming diminishing returns, our expenditures should result in care outcomes at least 20% or 30% better than Canada's. Instead, they're about 5% worse, but cost around 187%. Does it sound like we're getting a good deal?

Maybe not, but did you know that Canada has waiting lines for some hip replacements?!? Seriously. They do. Clearly this means that national healthcare would be a disaster. As for the rest of the elephant behind the curtain, please ignore it.

Kevin Drum 3:17 PM Permalink | Trackbacks | Comments (88)

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Comments

I'm too lazy to find the article but within the last week the Post or Times reported that waiting for hip replacement is good. The problem is you can't (easily) replace a hip replacement, so you want to delay it as long as you can stand the pain. (I exaggerate, but barely.) This was buried in an article discussing the advantages of resurfacing hip joints. The idea is you can get a joint resurfaced when you're 50, go awhile, then have a replacement when you're 70.

Posted by: Bill Harshaw on April 18, 2007 at 3:37 PM | PERMALINK

Okay, I'll bite. How many Americans are forced to wait for hip replacements? And who makes them wait? Would it be insurance companies by any chance? I'm just guessing.

aa

Posted by: aaron aardvark on April 18, 2007 at 3:42 PM | PERMALINK

As a Canadian, I can take some issue with this sentence from Ezra Klein's quotation:

"How can we possibly countenance a system that costs twice as much as the Canadian system but delivers slightly worse care?"

One possible way to countenance your system is that it isn't run by the government, which is an argument about the principle and not about the evidence. However, here in Canada, there are people who make this same argument, except that there is no way outside of the current box, there's no middle ground in that argument between the government providing healthcare (as in the current model) and completely privatized healthcare, simply because any effort in Canada to provide limited privatization in order to offer the service of decreased wait-times and improved service gets demonized as an attempt to undermine the government-run system in an effort to get more of an American-style system. I don't think it's an entirely insane or unreasonable position to want to only take small steps in a direction with that end.

The argument that not even small steps should be made in that, yes, that seems difficult to countenance.

Posted by: msmackle on April 18, 2007 at 3:44 PM | PERMALINK

I doubt that single payer will reduce the cost of health care in America. Look at the example of Medicare, which is a form of single payer coverage. After Medicare was implemented, health care costs for seniors exploded. I think single payer universal health care is more apt to drive costs up than down.

Posted by: ex-liberal on April 18, 2007 at 3:47 PM | PERMALINK

Yeah, about waiting lines. I have a major tooth ache; so bad that I can't sleep at night. I spent half of yesterday trying to find a dentist that could give me a root canal ASAP. The *best* anyone could do is see me next Monday!!! This after calling 10 F-ing dentists!!! Some of them were booked so solid that they couldn't see me till June!!! And on top of writhing in pain and not sleeping for a week, I'm going to paying at least a couple of grand out-of-pocket this exceptional service (and I even have insurance). I'm sure the wealthy wouldn't have to wait under these circumstances, but believe it or not, not all of us are CEOs.

Good thing there are no waiting lines in America, though. Best healthcare in the world!!!!!!!

Posted by: CKT on April 18, 2007 at 3:47 PM | PERMALINK

I think single payer universal health care is more apt to drive costs up than down.

Once again, all available evidence is ignored in favor of gut instinct! That's ALWAYS a great decisionmaking process!

Posted by: chdb on April 18, 2007 at 3:50 PM | PERMALINK

... any effort in Canada to provide limited privatization in order to offer the service of decreased wait-times and improved service gets demonized as an attempt to undermine the government-run system in an effort to get more of an American-style system.

Well, that's not really an unreasonable basis on which to demonize, is it? After all, the only basis for comparison is the U.S., and our privatized system doesn't really offer decreased wait-times or improved service - especially when you factor in those forty-odd million who are uninsured.

Posted by: Alek Hidell on April 18, 2007 at 3:51 PM | PERMALINK

I doubt that single payer will reduce the cost of health care in America.

Yeah, but you're a terminally dishonest neocon toad, "ex-liberal," so your doubt doesn't amount to a bucket of piss.

Posted by: Gregory on April 18, 2007 at 3:51 PM | PERMALINK

Actually, maybe Canadian hip replacements are done so much better or something that people don't want to wait....

And, thanks, CKT... any AL who talks about waiting lines without discussing American dentistry ought to have to undergo anasthetic-free hip replacement.

And, Aaron, in the U.S., maybe it's not so much waiting for the hip replacement as it is to get an HMO to pay for the damn thing!

Yeah, AL, let's talk about HMO paper trail lines again.

Posted by: SocraticGadfly on April 18, 2007 at 3:53 PM | PERMALINK

"ex-liberal" wrote: After Medicare was implemented, health care costs for seniors exploded.

Yeah, and new procedures and drugs, not to mention increased lifespans and the greater demands of elder care, had nothing to do with it.

You get a sick thrill when you post that kind of bullshit, don't you, "ex-liberal"? One wonders what else motiviates you -- it certainly isn't good faith debate.

Posted by: Gregory on April 18, 2007 at 3:53 PM | PERMALINK

"After Medicare was implemented, health care costs for seniors exploded."

That's like saying that after the sun rose on Sept. 11, 2001, planes crashed into the Twin Towers, therefore we can only assume that it was the sun's fault.

Posted by: Chocolate Thunder on April 18, 2007 at 3:53 PM | PERMALINK

msmackle: I agree that a system in which only national healthcare is allowed is a bad one. It's one reason why the Canadian healthcare system isn't a model to follow. But even at that, it seems to be no worse than ours.

Needless to say, if America ever adopts national healthcare, private healthcare will continue to be available to anyone who wants it.

Posted by: Kevin Drum on April 18, 2007 at 3:54 PM | PERMALINK

I'm too lazy to find the article but within the last week the Post or Times reported that waiting for hip replacement is good.

I read the same article. Hip replacements have a lifespan of about 20 yrs, and it's very difficult to replace a hip replacement, so the recommendation is to deal with the pain and put off getting a hip replacement as long as absolutely possible.

Posted by: Disputo on April 18, 2007 at 3:55 PM | PERMALINK

Needless to say, if America ever adopts national healthcare, private healthcare will continue to be available to anyone who wants it.

You only take away my private healthcare when you pry it from my cold dead hands.

Posted by: Disputo on April 18, 2007 at 3:57 PM | PERMALINK

I doubt that single payer will reduce the cost of health care in America.

Why? It works for everyone else. What is so specially screwed about our government that we could not do as well, except for all the conservatives in it?

I think it's pretty well sad that keep running one after another single-country study, trying to figure out if there's some way that our system maybe doesn't suck against some country out there. On the big, obvious metrics (infant mortality, expected lifespan, percentage of life healthy), we lose, against dozens of other countries, all at a fantastically higher cost. Seriously, what metric could possibly trump those three? What on earth is better than a long healthy life?

Posted by: dr2chase on April 18, 2007 at 4:03 PM | PERMALINK

Ah, Kevin.

You've got you're studies, we've got ours.

"As for the rest of the elephant behind the curtain, please ignore it."

There's something behind the curtian, but it ain't an elephant.

Posted by: egbert on April 18, 2007 at 4:04 PM | PERMALINK

Theirs is explicit rationing of care, ours in implicit rationing depending on cost to control utilization.

FYI in our private health care system, my wife recently waited three months for an appointment with her orthopedist (not hip replacement). That appears to me to be a wait, though admittedly not on a list.

Posted by: Cycledoc on April 18, 2007 at 4:07 PM | PERMALINK

Kevin Drum: Needless to say, if America ever adopts national healthcare, private healthcare will continue to be available to anyone who wants it.

Kevin, I wish I could agree with you. Sadly, this isn't automatic.

Look at Medicare for example. Doctors who take Medicare patients are restricted in how they charge non-Medicare patients. As a result, some Doctors refuse to take any Medicare patients.

Or look at the health care approach promoted in 1993 by our likely next President. It had all kinds of restrictions on voluntary, non-governmnetal health care providers. If President H. Clinton implements a single payer system we will be lucky if healthcare continues to be available outside of the governmental system.

Posted by: ex-liberal on April 18, 2007 at 4:08 PM | PERMALINK

Is that like Rove saying "You have your math, we have The Math" before the election, when he was predicting Republicans would hold the majorities, not lose House, Senate and Governorships?

By the way, please link those studies that we may look at them critically.

Posted by: Blue Girl, Red State (aka G.C.) on April 18, 2007 at 4:08 PM | PERMALINK

Anybody who thinks Canuckistan medecine is better should move there. Granted, they are world leaders in treating frost bite and hypothermia, but for anything else say in the USA.

Posted by: Al on April 18, 2007 at 4:09 PM | PERMALINK

If President H. Clinton implements a single payer system we will be lucky if healthcare continues to be available outside of the governmental system.

Please expound on this assertion...In a way that I will not pummel you with your answer, please.

Posted by: Blue Girl, Red State (aka G.C.) on April 18, 2007 at 4:11 PM | PERMALINK

I have navigated both the American health care system (with my in-laws) and the Canadian system (with my parents) in the last decade. My experience is that the American hospital system and doctor access wins hands down over the Canadian system. My mother died in a hospital emergency cubicle in British Columbia last year, 30 minutes after I pled with the nurse in charge to respect her dignity and not to send her back to die en route to her extended care facility. When my father was in a minimally staffed cardiac care unit in the same hospital a decade earlier after suffering a heart attack, we were accosted by striking workers who wanted to explain their reasons for work stoppage in the parking lot. The hospital was crowded and ill maintained as were all provincial government facilities I had experience with. Incidentally, my mother waited almost 5 years for a hip replacement, until age 79, consistently being told, "it isn't bad enough yet." When I told my American orthopedic surgeon I could no longer live with my deteriorating knee and increasing pain, I had knee replacement surgery within a month. Americans may pay more, but the service is better.

Posted by: ringrid on April 18, 2007 at 4:11 PM | PERMALINK

"Doctors who take Medicare patients are restricted in how they charge non-Medicare patients."

They are? News to me. My experience has been that docs have fees they can charge Medicare, and fees they can bill to private insurance, and they bill to private insurance what the market will bear.

Posted by: Chocolate Thunder on April 18, 2007 at 4:11 PM | PERMALINK

msmackle: However, here in Canada, there are people who make this same argument, except that there is no way outside of the current box, there's no middle ground in that argument between the government providing healthcare (as in the current model) and completely privatized healthcare, simply because any effort in Canada to provide limited privatization in order to offer the service of decreased wait-times and improved service gets demonized as an attempt to undermine the government-run system in an effort to get more of an American-style system.

Bottom line though, given only 2 choices (American or Canadian), which would you prefer? Seriously.

This is not to say that there isn't room for improvement, including private provisions, in the Canadian system. Indeed, many Americans supporting UHC (including myself) don't think that the Canadian system is the best. We often cite French, German or Japanese mixed systems as superior. IIRC the doctor who pursued the private insurance court case in Quebec cited the French model (IIRC he was from France).

It does seem as though the health care debate in Canada is dominated by an obsession with your Southern neighbors. Remember, Americans are just like Canadians except they're less likely to get frostbite and more likely to be serial killers.

Posted by: alex on April 18, 2007 at 4:13 PM | PERMALINK

Of course there's a line -- if the people in the line could move along faster, they wouldn't need hip replacements, would they?!? geez...

Posted by: DB on April 18, 2007 at 4:14 PM | PERMALINK

The American system will be reformed by extending medicare for all, it will run parallel to the private insurance medical system.
The Canadian system will be reformed by allowing private health service providers to enter the system and compete for medicare dollars on fee for service basis.

Essentially we are both heading for a French/German/Japanese type system.

Posted by: Northern Observer on April 18, 2007 at 4:15 PM | PERMALINK

Al: "Anybody who thinks Canuckistan medecine is better should move there."

I call. I live "there" and I like it just fine. I can go into a hospital, show my Health Card and get top treatment. That's it. The simplicity in my life is worth a lot.

There are problems of lineups, but if the US started working on the same types of problems in the same system, we both would benefit from the cross-pollenization of thinking together. The problems are not insurmountable.

Posted by: Bob M on April 18, 2007 at 4:18 PM | PERMALINK

Kevin I don't know why you got sucked into a bogus debate with msmackle. Most of the canadians I know think were pretty batshit crazy when it comes to healthcare. Considering they're all covered and were not. 40 or 50 million people without healthcare. And probably another 40 or 50 milion with inadequate health coverage. Let's add in how it makes us less compettive economically because we pay so much for it.

Posted by: Gandalf on April 18, 2007 at 4:19 PM | PERMALINK

My experience has been that docs have fees they can charge Medicare, and fees they can bill to private insurance, and they bill to private insurance what the market will bear.

And another set of fees that they charge to cash paying patients.

Posted by: Disputo on April 18, 2007 at 4:21 PM | PERMALINK

Truly weird is that one of big Bushnik and reactionary points is US style comprehensive coverage is 'gold plated' -that is, too many benefits. Their solution is ungoldplate it -that is have FEWER benefits, unless you were wealthy enough and also lucky enough to have a health history consistent with getting an individual policy with generous benefits.

So, what they are really saying is that the "best health care system in the world" will do better by making coverage for some procedures unavailable to most people, rather than making them wait for them.

But, I grant you, it does solve the problem. If most people cannot afford a procedure at all because it is not in the lean mean and efficient nongoldplated benefit package, presto! no waiting lines. And we have a healthcare paradise!

Posted by: anon on April 18, 2007 at 4:25 PM | PERMALINK

"Doctors who take Medicare patients are restricted in how they charge non-Medicare patients."

BULLSHIT.

Next assertion?

Posted by: Blue Girl, Red State (aka G.C.) on April 18, 2007 at 4:27 PM | PERMALINK
Or look at the health care approach promoted in 1993 by our likely next President.

I would, but I can't find a copy of Obama's 1993 health care plan anywhere.

Posted by: cmdicely on April 18, 2007 at 4:31 PM | PERMALINK

> When my father was in a minimally staffed cardiac
> care unit in the same hospital a decade earlier
> after suffering a heart attack, we were accosted
> by striking workers who wanted to explain their
> reasons for work stoppage in the parking lot. The
> hospital was crowded and ill maintained as were
> all provincial government facilities I had
> experience with. Incidentally, my mother waited
> almost 5 years for a hip replacement, until age
> 79, consistently being told, "it isn't bad enough
> yet."

The majority of these anecdotes that I read compare provincial/small town Canadian heath care to big-city US care _with_ good insurance. Try _rural/small city_ US health care with insurance. Then try rural/small city US health care _without_ insurance. It is nowhere near the paradise that the US Radical Right likes to paint, and generally matches your description of Canadian provincial care. Proving I guess that Canadian doctors no more want to live in the sticks than US doctors.

Cranky

Posted by: Cranky Observer on April 18, 2007 at 4:33 PM | PERMALINK

I have navigated both the American health care system (with my in-laws) and the Canadian system (with my parents) in the last decade. My experience is that the American hospital system and doctor access wins hands down over the Canadian system ... I had knee replacement surgery within a month. Americans may pay more, but the service is better.
Posted by: ringrid on April 18, 2007 at 4:11 PM | PERMALINK

In any head to head comparison someone who can afford the American system is going to have a much better experience than the average Canadian experience.
Still, the people who have a smooth ride are more likely to be silent. My step father just had quadrouple bi pass surgery in Ontario. From diagnosis to operating table was a 1 week wait. He is recovering fine. And my wife has had serious endometreosis that has required two surgeries. One was elective and one was emergency (interference with the kidney by the endometrial tissue) For the elective the wait was 2 months, the emergency was 4 days. I can only imagine how much in the hole we would be if the care was only via insurance. After the first surgery she would have been labeled as a high risk patient and shunted to a higher premium.

Interestingly enough, stuff like hip replacement and knee surgury are percisely the kind of procedures that would benefit from more private service participation in Canada. I think Ontario has private participation with a specialist hernia clinic. It does almost all the hernia operations in Ontario and is very efficient. We should get similar centers going for hip and joint surgeries.

I googled it Shouldice Hernia Centre, Thornhill Ontario.

Posted by: Northern Observer on April 18, 2007 at 4:35 PM | PERMALINK

Blue Girl - please read this NY Times article

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9C0CE1D7143EF93BA3575AC0A966958260

Posted by: ex-liberal on April 18, 2007 at 4:37 PM | PERMALINK

"I'm too lazy to find the article but within the last week the Post or Times reported that waiting for hip replacement is good."

This is true. Replacing an artificial hip joint is difficult. Most people can can have two surgeries on the same hip and some can have three. The problem is that after you remove a hip stem, you have to drill the hole in the femur to a larger size in order to secure a new stem. If you keep drilling out the femur, eventually there is insufficent bone material to accept another hip stem. I believe there are similar issues with knee joints.

You also want to delay spinal fusion if you can. A recent study showed that most people eventually heal themselves without fusion. It usually takes 2-3 years. If you can get over that hump, you will probably be as good as you would have been with surgery. Although 2-3 years of severe back pain may not be something you want to endure.

Posted by: fostert on April 18, 2007 at 4:38 PM | PERMALINK

Next assertion?

Why bother? It'll just be more bullshit.

(The great Lawrence Tierney in Reservoir Dogs, but it applies to "ex-liberal" as well. I think he/she/it is cranky from the shellacking doled out in the Bush's Mouth thread, in which his/her/its dishonesty was exposed time and again.

It's funny -- I'd think a normal person would be too embarrassed to post, but "ex-liberal" is back for more -- almost like it's a job...)

Posted by: Gregory on April 18, 2007 at 4:42 PM | PERMALINK

That article is 17 years old, and therefore useless, right? You realize that Medicare morphs constantly?

Posted by: Blue Girl, Red State (aka G.C.) on April 18, 2007 at 4:43 PM | PERMALINK

Blue Girl - please read this NY Times article

I see "ex-liberal" is now using Marler's tactic of providing a context-free link as a pretense of offering evidence of their bullshit assertions.

You know it's sad when one dishonest Bush fluffer falls down so baldy they adopt the tactics of another.

Posted by: Gregory on April 18, 2007 at 4:43 PM | PERMALINK

Well that first question reads like I was raised by wolves...But you get the idea...

Posted by: Blue Girl, Red State (aka G.C.) on April 18, 2007 at 4:44 PM | PERMALINK

That article is 17 years old, and therefore useless, right? You realize that Medicare morphs constantly?

Have a heart, Blue Girl..."ex-liberal" is just used to offering bullshit neocon assertions. Since facts aren't on his/her/its side, it's only natural he/she/it would have trouble with that pesky thing called "evidence."

I also note, by the way, "ex-liberal"'s criticism of single-payer as if the aspects found as fault were a done deal, and not entirely likely to be written out of any sensible legislation.

"ex-liberal" argues in bad faith; it's almost like he/she/it gets jollies (or paid, or both) by posting the lames, easily-debunked assertions.

Posted by: Gregory on April 18, 2007 at 4:46 PM | PERMALINK

ringrid,
My condolences about your parents treatment. To generalize from BC about the Canadian health care system is a mistake. This province (the one I live in) is currently governed by a party that has slashed health care and education budgets.

Readers should know that while health care in Canada is federally mandated, and partially funded, it is provincially administered. There is a wide difference in the quality of care across provinces, and dependent on who is in power provincially. Though BC is governed by provincial Liberals, they are far to the right of the Federal party of the same name, not to mention the NDP.

Posted by: lisainvan on April 18, 2007 at 4:51 PM | PERMALINK

people get paid to post here? Where do I sign up?

Posted by: Chocolate Thunder on April 18, 2007 at 4:53 PM | PERMALINK

Politically speaking, wealthy and middle class retirees control the health care delivery debate in the U.S.. If you want to reform the U.S. system, it is required that Medicare recipients be convinced that their standard of care will not decline in any way. This isn't easy. As much as kevin derides it, waiting times for joint replacements is something that is cared about by the most powerful political faction. As a regular poster in this forum rightly noted, in many ways the U.S. has become a gerontocracy.

Posted by: Will Allen on April 18, 2007 at 4:55 PM | PERMALINK

This is all very simple.

If you are one of the relatively small minority in the US without health insurance, of course you would be better off in Canada, where you would have access to at least some health care besides ER care.

On the other hand, if you are one of the majority of people with pretty good health insurance, you are a lot better off in the US, where medical care for severe illnesses (like cancer) and/or "optional" treatments (like hip or knee replacements) is far better.

Posted by: DBL on April 18, 2007 at 4:56 PM | PERMALINK

DBL, what are you basing your assertions on? The study says the opposite-- for insured groups in both countries, outcomes are better for insured canadians than they are for insured Americans.

Posted by: Tyro on April 18, 2007 at 5:04 PM | PERMALINK

If you are one of the relatively small minority in the US without health insurance, of course you would be better off in Canada, where you would have access to at least some health care besides ER care.

40 million plus Americans are a "relatively small minority"?

And that's not counting, of course, the under-insured, i.e. those people who have nominal coverage but whose coverage is either inadequate or denied by their carriers.

Posted by: Stefan on April 18, 2007 at 5:10 PM | PERMALINK

Chocolate Thunder >"...Where do I sign up?"

Contact Karl Rove via his Blackberry & the RNC email address. And let us know what the going rate is would ya ?

"...It is those who describe me as an extremist who happen to be the extremists against whom I am warning the electorate." - George Soros

Posted by: daCascadian on April 18, 2007 at 5:10 PM | PERMALINK

My condolences about your parents treatment. To generalize from BC about the Canadian health care system is a mistake. This province (the one I live in) is currently governed by a party that has slashed health care and education budgets. Readers should know that while health care in Canada is federally mandated, and partially funded, it is provincially administered. There is a wide difference in the quality of care across provinces, and dependent on who is in power provincially. Though BC is governed by provincial Liberals, they are far to the right of the Federal party of the same name, not to mention the NDP.

In general, the further West in Canada you get, the more "American" the system becomes.

Posted by: Stefan on April 18, 2007 at 5:12 PM | PERMALINK

Hey CKT, I've had the inflamed-nerve-tooth thing before too, while I waited for a root canal. My sympathies. You might try to get a regular dentist (if you have one) to just write you a script for antibiotics - that can knock out the inflammation and get you to the endodontist appointment. (Took about 12 hours for the pain to go away, after taking the amoxicillin). That or Anbesol/Orajel - both are topical anesthetics similar to the lidocaine the dentists use.

Posted by: luci on April 18, 2007 at 5:14 PM | PERMALINK

Perhpas they have waiting lines because more people qualify for government-funded hip replacements than qualify for personally or insurance-funded hip replacements in the US?

So, if I need a hip replacement in the US, but I'm poor and don't have insurance, it does me no good to wait in line forever for one, but according to conservative dimwits I'm better off never being able to get a hip replacement than in a system in which I can get that hip replacement if I just wait in line a while.

Yeah, conservatives have convinced me.

The Canadian system is better; conservatives are liars.

Posted by: anonymous on April 18, 2007 at 5:17 PM | PERMALINK

On the other hand, if you are one of the majority of people with pretty good health insurance, you are a lot better off in the US, where medical care for severe illnesses (like cancer) and/or "optional" treatments (like hip or knee replacements) is far better.

Well, unless you have a medical catastrophe that bankrupts you, then you're pretty much fucked.

Turns out that about half of the bankrupties in the U.S. are due to unforeseen medical catastrophes, and three quarters of that figure are people who were covered by health insurance. And that's not counting the people whose medical bills above and beyond their coverage destroyed them financially but didn't technically bankrupt them.

Add the number of that group to the 44 million uninsured that Stefan pointed out is already a significant number. How "relatively small" is that pool now?

Posted by: trex on April 18, 2007 at 5:17 PM | PERMALINK

I think that going to a single payor system would save a ton of money, but the question that I think I know the answer to but would like confirmation from our Canadian commentators is: If Canada spent twice as much per capita on its health care system (or I guess 87% more)would that eliminate the waiting times and improve the quality of care in some of the provincial hospitals?

Posted by: Terry on April 18, 2007 at 5:21 PM | PERMALINK

Will Allen: in many ways the U.S. has become a gerontocracy

Gee, Will, sounds like you're claiming to be YAOM (Yet Another Oppressed Minority).

Look on the bright side though. Unlike race, age can be changed. All you have to do is live long enough, and you too can be a gerontocrat!

Posted by: alex on April 18, 2007 at 5:24 PM | PERMALINK
private healthcare will continue to be available to anyone who wants it. Kevin Drum at 3:54 PM
Rather "... to anyone who can afford it."
but for anything else say in the USA. Al at 4:09 PM
Americans travel abroad for health care

The conference opens April 30 in Las Vegas. Featured speakers such as Michael McCallister, president and CEO of Humana Inc., one of the nation's largest health plans, will explore the fact that an estimated 2 million Americans have recently traveled to foreign countries to receive medical care.

Thank you, Canada, for being a neighbor.

Americans may pay more, but the service is better. ringrid at 4:11 PM

Stats don't bear that out.
Politically speaking, wealthy and middle class retirees control the health care delivery debate in the U.S....Will Allen at 4:55 PM

Politically speaking, drug companies, insurance companies and lobbyists control the debate in this country. Not only was "Hilliarycare" defeated by them, but now there are commercials on TV telling people not to change Medicare D, that is, don't let Democrats change it to allow negotiating for price which benefits drug companies.
... if you are one of the majority of people with pretty good health insurance, you are a lot better off in the US... DBL at 4:56 PM

Again, stats don't bear that out. Life expectancies and infant mortality are both better in countries with national health care.

Posted by: Mike on April 18, 2007 at 5:27 PM | PERMALINK

DBL

tell that to people who have had to go to court in order to make thier insurance company pay for treatment after they have reached some artificial cap.

Posted by: klyde on April 18, 2007 at 5:32 PM | PERMALINK

Did I say drug companies and lobbyists? Republicans just filibustered the amended drug bill .
...The Senate blocked legislation on Wednesday that would let the government negotiate Medicare drug prices. Democrats couldn't muster the 60 votes needed to bring the bill up for a vote.....
Keep the big bucks flowing to good campaign contributors as long the bill goes to future taxpayers..

Posted by: Mike on April 18, 2007 at 5:34 PM | PERMALINK

Two things:

1) One problem with the waiting time argument is that "never" isn't part of the calculation of comparitive waiting times. Never, as in when the millions of uninsured Americans will get their hip replacement, or whatever it is they need. What's worse, waiting a while or waiting forever?

2) Health care is an example of how conservative beliefs won't be swayed by evidence. A private health care system is better simply because it's better; even if it's more expensive and less effective, it's better because it's "free" enterprise at work. Markets uber alles!

Posted by: jrw on April 18, 2007 at 5:39 PM | PERMALINK

Anybody who thinks Canuckistan medecine is better should move there. Granted, they are world leaders in treating frost bite and hypothermia, but for anything else say in the USA.

Posted by: Al on April 18, 2007 at 4:09 PM |

Like gunshot wounds, f'rinstance? Been to Vancouver and Victoria numerous times, loved them. Don't know whether they'd want me moving there, though.

What's the Canadian lifespan versus US, anyway?

Posted by: Trollhattan on April 18, 2007 at 5:40 PM | PERMALINK

I don’t like anecdotal evidence but since people are going that direction.. my Canadian parents who are both 85 years have had excellent care for all their various aliments ranging from broken bones to heart disease and cancer.

They pay far less for their coverage than I pay for mine.

I have not been seriously ill yet but I will say that the quality of care that I get from my doctors is deteriorating as my older doctors retire. The younger set that I have encountered are interested in one thing…MONEY

Posted by: MsComment on April 18, 2007 at 5:54 PM | PERMALINK

my sister is an American living in Canada (permanently) havingworked at a Canadian University. She swears by their health system. What we have in America is an extremely effective, super efficient, right wing propaganda/media control. If our health system worked half as well as right-wing disinformation our health system would beat the Canadian system hands down. It is true that the right wing have intelligent creative people...they are just involved 24/7 in mind games/propaganda/slime machine; and when you spend all your time on such basic work you cannot think about other things such as solving real problems for ordinary people.

Posted by: della Rovere on April 18, 2007 at 5:54 PM | PERMALINK

well, what's not reported here is that in the last 20 years, the Canadian government has cut its transfer payments to the provinces in order to balance the budget and this has severely hurt health care in almost all the provinces. The federal government is now running a very healthy surplus, but the money for health care still hasn't been returned - we're talking a $12 billion surplus, which would be the equivalent of $120 billion in the US (maybe less in US $) and the provinces are haggling for this money, but not necessarily putting it back in health care. So, these waiting lists for hip replacements, knee surgery, cancer treatment, would probably not exist if the federal government hadn't tried to balance the budget on the backs of the sick people of Canada. And, since the federal government has been running surpluses for almost 10 years now, they have been delinquent in not propping up the health care system as soon as they could have. Strangely, nobody in Canada seems to complain about this.

Posted by: Michele on April 18, 2007 at 6:05 PM | PERMALINK

total life-expectancy at birth
Canada
man: 77.2
women: 82.3
US
men: 74.6
women: 79.8

Healthy life-expectancy at birth
Canada
man: 70.1
women: 74.0
US
men: 67.2
women: 71.3

Healthy life-expectancy at 60 years
Canada
man: 16.1
women: 19.3
US
men: 15.3
women: 17.9

from World Health Organization
http://www.who.int/whr/2004/annex/en/index.html
data for years 2001-2002

Posted by: anon on April 18, 2007 at 6:07 PM | PERMALINK

Americans may share a common mother tongue with their Canadian and British friends, but when it comes to health care, they're speaking different languages. Their national health systems, emphasizing preventive care, appear to provide much better outcomes at dramatically lower cost than the ad hoc market-driven approach in the U.S. That's the clear message from two recent studies showing that the people of Canada and the UK are far healthier than Americans.

For the data, see:
"The Health of Nations: British, Canadians Healthier Than Americans."

Posted by: AngryOne on April 18, 2007 at 6:07 PM | PERMALINK

I live in Canada. My family is in the US. My elderly mother has Rolls Royce coverage. Nice treatment.

But last fall, she got a knee replacement right after her cancer treatment and before anyone decided to see if she was strong enough for it.
--Weak immune system
--endemic MRSA in US hospitals a profit-driven
--a surgeon who knew that a surgery deferred didn't pay the bills
meant that she spent 3 months in the hospital for MRSA infection.

People who must make economic decisions about care miss some quality assurance measures, like cleaning and infection control and immune system checks.

It makes your system that much more expensive.

Posted by: Alison on April 18, 2007 at 6:09 PM | PERMALINK

Lets see - blood cultures alone for a MRSA case like that are in the hundreds of thousands of dollars.

At 2-3 sets collected each time they are ordered, daily at first, then routinely every couple of days, and stats whenever a fever spikes, and a single set from collection to reading the stains by a Microbiologist costs about $3300. Wow. Staggering. And that is just one lab test that is run repeatedly.

MRSA and C-Diff are huge problems, and exacerbated by for-profit healthcare systems that cut corners on staffing.

I personally read the plates when three newborns in NICU at a HCA facility contracted MRSA. That happened one of two ways: Either understaffed housekeepers weren't cleaning isolettes properly, or understaffed nurses weren't washing hands properly.

Posted by: Blue Girl, Red State (aka G.C.) on April 18, 2007 at 6:19 PM | PERMALINK

So, Al sez:

Look at Medicare for example. Doctors who take Medicare patients are restricted in how they charge non-Medicare patients. As a result, some Doctors refuse to take any Medicare patients.

Then he posts a link to an ancient NYT article about how doctors who take Medicare patients are upset about caps on their fees charged to Medicare patients of only 25% over what Medicare allows, so they are refusing to treat Medicare patients. Nowhere in the article does it say anything about non-Medicare patients. But Al was extremely specific about limitations on what they could charge non-Medicare patients.

My diagnosis? Al needs to learn to read with comprehension.

comprehension

Act of or capacity for grasping with the intellect. The term is most often used in connection with tests of reading skills and language abilities, though other abilities (e.g., mathematical reasoning) may also be examined.

Posted by: majun on April 18, 2007 at 6:31 PM | PERMALINK

Excuse me, late to the party.

I'm Canadian, and yes, I've had frostbite.

I explained and defended the Canadian system yesterday in the AARP thread, so I won't say much here. I just wanted to take issue with msmackle's contention way upthread that there's no middle ground between our system and the US private approach. In fact, if you look here you'll see a description, province by province, of various ways that private options exist for patients, doctors and insurance providers.

Also, to answer a question from above about life expectancy: In Canada 80.5 yrs., USA 77.7 yrs. according to the WHO (via Wikipedia).

Posted by: skeg on April 18, 2007 at 6:32 PM | PERMALINK

Interesting anecdote on the MRSA infection above. The frenetic and barely controlled chaos of both private academic and community hospitals and clinics is interesting. I've had relatives in acute care in both recently. Lots of mess and confusion and problems. One very anemic oldster with obscure post-op bleed problems was moved around from regular room to ICU to 'holding area' almost every night because of 'capacity' and 'scheduling' problems.

Had another oldster relative with major surgery in the VA -a different world, the VA. I vastly preferred the VA. Of course I wasn't the patient, just the related observer.

Posted by: anon on April 18, 2007 at 6:32 PM | PERMALINK

Many people in America have to wait until they die before they are relieved of hip pain because they do not have any insurance or an ability to pay for a hip replacement.

Posted by: Brojo on April 18, 2007 at 7:01 PM | PERMALINK

Gee. I wonder why the President isn't working on providing health care to the uninsured? Didn't Al Gore have a plan in this area? I THOUGHT he did. Oh, shit! That's right! Bush beat Gore. THAT's why nothing has been done to help these people. How the heck did Bush get elected? Hmmmmmmm. Christ. That's a stumper. Brojo?

Posted by: Pat on April 18, 2007 at 8:07 PM | PERMALINK

There are 300 million Americans. If only 40 million of them do not have health insurance, that seems to me to be relatively small problem, hardly worth throwing the baby out with the bathwater.

How many people here would choose to be treated in Canada for cancer or open heart surgery versus the US? Me, I'd take the Mass General or Mayo Clinic or Columbian Presbyterian over any Canadian hospital for a serious medical problem. For a broken arm, it probably wouldn't matter much.

Posted by: DBL on April 18, 2007 at 8:30 PM | PERMALINK

How many people here would choose to be treated in Canada for cancer or open heart surgery versus the US?

Me. For one thing, it wouldn't bankrupt me in Canada.

Me, I'd take the Mass General or Mayo Clinic or Columbian Presbyterian over any Canadian hospital for a serious medical problem. For a broken arm, it probably wouldn't matter much.

Talk about cherrypicking -- those are three of the best hospitals in the country. The correct comparison would be any average American hospital against any average Canadian hospital.

Posted by: Stefan on April 18, 2007 at 9:09 PM | PERMALINK

"There are 300 million Americans. If only 40 million of them do not have health insurance, that seems to me to be relatively small problem, hardly worth throwing the baby out with the bathwater."

40 million people are bathwater? Jesus.

Posted by: jrw on April 18, 2007 at 9:29 PM | PERMALINK

"Me, I'd take the Mass General or Mayo Clinic or Columbian Presbyterian over any Canadian hospital for a serious medical problem. For a broken arm, it probably wouldn't matter much."

Yeah... all our research-intensive hospitals affiliated with large universities are only good for apply band-aids.

Posted by: Soviet Canuckastani on April 18, 2007 at 10:32 PM | PERMALINK

Look! There's a number of people out there who are minimizing the problem and deliberately keeping figures low, high as they are.

http://www.kff.org/uninsured/index.cfm

The uninsured numbered 46 million at the end of '05, rising from 39 million in 2000. There's no reason to believe it slowed down last year. The way the Feds count unemployed, you have to be unisured the whole calendar year. So you could live uninsured from Feb one year 'til November the next and never count in the numbers.

I have been unable to find if illegal workers are in these figures.

Then you have those with pre-existing conditions that are not covered for their main ailmant, or those with inadequate coverage who do not fill prescriptions or decline treatment they need. How do you quantify that?

Or the ill it does to our economy? 20% (9 million) are 0-18 years old, 40% 19-34. Native-Americans and Hispanics are about 2 1/2 times as likey to be uninsured and Black-Americans over 1 1/2 times as white folk, at 13%.

People oppose universal health care on the basis of ideology and prejudice and greed. I can't think of any facts on their side that make the present US system the optimum for this country. Just another way to trap and marginalize people.

Lastly, how the hell are we going to afford it, that is except for the very rich and our priviliged federal employees including Congress? The last years have seen double digit inflation.

Average annual premiums:
---------------SINGLE------------------FAMILY----
---------------2000-----2005---------2000-----2005-
Overall:--- $2471----4242--------6438----11480-
Employer:-- 2137----3615---------4819---- 8508-
Employee:--- 334----- 627--------- 1619---- 2973-

And that's the average!

Posted by: notthere on April 18, 2007 at 11:16 PM | PERMALINK

Related information>
Drugs,etc. are only covered in Canada while a person is in hospital. Generally speaking, dental care is not covered ( I understand some emergency procedures might be ).
There is still 'health insurance' in Canada. It just relates to different expenses, such as private/semi-private rooms for a policy offered by an employer.

Posted by: opit on April 18, 2007 at 11:25 PM | PERMALINK

I recently had an intestinal biopsy, a 1 day procedure, here in Sydney, Australia. Because it's the closest, I was able to have the procedure at one of Australia's finest hospitals, performed by a world class team. The whole procedure was FREE (universal healthcare here, with a private component) there was no waiting list & I'm glad to say everything worked out fine.

Exactly the same 1 day operation at a comparable New York hospital - Mount Sinai - costs US$224,000.00 (!) & that's just the hospital charges. The substantial doctors & anaesthetists bill would be added to that. Little wonder then that the #1 cause of personal bankruptcy in the US is unpaid medical costs.

The US spends 16% of its' GDP on health, about 50% more than Australia & other industrialized countries yet its' health outcomes are no better & on some measures slightly worse. Furthermore its' huge costs increasingly make American companies non-competitive. One of the major problems besetting General Motors & Ford is the cost of the healthcare they provide present & retired employees.

The US ALREADY has the clinicians, expertise, hospitals & infrastructure to potentially provide ALL its' citizens with the finest healthcare on earth by a considerable margin. The US also ALREADY pays vastly more for healthcare than any other country on earth. Despite these facts the majority of Americans are so uninsured, under-insured or poorly served by their insurers that any major or chronic illness can & frequently does bankrupt entire families. It's hard to imagine a more literal example of "adding insult to injury".

As long as Big Insurance & Big Pharma are the primary beneficiaries of their massive healthcare costs, Americans will pay vastly more for a system that underserves, overcharges & bankrupts them, for health outcomes that are no better, & in some cases worse, than the rest of the industrialised world.

Posted by: DanJoaquinOz on April 19, 2007 at 12:54 AM | PERMALINK

DanJoaquinOz, I've only been around here a year, but it doesn't matter what facts you put up, it's like the gun lobby, it's not reason that counts. But point taken here.

G'donya, mate! Glad it came out OK.


Posted by: notthere on April 19, 2007 at 1:01 AM | PERMALINK

I live in Switzerland now, and the doctors here really suck. Every time I go in to see a doctor about a flu or cold for some relief, they try to get me to ok a series of blood tests to see if it is viral (which it most probably is) or bacterial. The reason? So they can make money on the tests themselves. Doctors in Canada never gave me this song and dance but here I really get the feeling that I am a commodity even when I am ill. There doesn't seem to much humanity involved.

Posted by: Michele on April 19, 2007 at 4:16 AM | PERMALINK

I live in Switzerland now, and the doctors here really suck. Every time I go in to see a doctor about a flu or cold for some relief, they try to get me to ok a series of blood tests to see if it is viral (which it most probably is) or bacterial. The reason? So they can make money on the tests themselves. Doctors in Canada never gave me this song and dance but here I really get the feeling that I am a commodity even when I am ill. There doesn't seem to much humanity involved.

Posted by: Michele on April 19, 2007 at 4:17 AM | PERMALINK

I always wonder if those who decry "waiting lines" in other countries live in the same world I live in-- where you have to wait even for important procedures. (In the US, I mean.) A colleague of mine had to wait 3 weeks for a biopsy of her cervix to prove cancer. Another waited 3 weeks for a hysterectomy to remove her ovaries when she'd already been diagnosed with ovarian cancer, and it was definitely needed to sustain her life. Both of them were insured even.

I have a serious neurological condition and wanted to switch to a new medication, so was sent to a specialist. No joke-- I couldn't get an appointment with him for TEN MONTHS. Not even 15 minutes worth. So please don't tell me people in Canada have to wait for a hip replacement and we don't. I don't believe it.

Posted by: lister on April 19, 2007 at 8:59 AM | PERMALINK

I'm going to paraphrase a comment I made in the last healthcare thread:

Single-payer healthcare will mean longer waits for many routine procedures. Eye surgery, hernias, hip replacements, etc. The reason? You can live with it. Other people need urgent care NOW. There is a finite amount of resources, and priorities must be set.

This isn't a bad thing, it's just reality for a system like this. America's instant-gratification culture won't like it; Americans are used to the idea that they can spend endless amounts of money for a modicum of immediate personal comfort. This does not fly in a single-payer scheme, where the health of all must must be weighed against the comfort of individuals.

Progressives need to face this reality head-on rather than pretend it doesn't exist. It's not just SOME hip replacements that will take longer - it's a lot of things.

Posted by: Elisha Sessions on April 19, 2007 at 9:57 AM | PERMALINK

Maybe American doctors, health care professionals, hospital administrators, drug companies and insurance companies make more money than their Canadian counterparts. You pay the difference.

Posted by: slanted tom on April 19, 2007 at 11:18 AM | PERMALINK
...If only 40 million of them do not have health insurance, that seems to me to be relatively small problem... DBL at 8:30 PM
If it's a small problem, why can't you fix it? After all, it's important to 13% of your population and very costly to your society as a whole.

American vs Canadian health care
We are Canada's Mexicans
Tue Jan 16, 8:04 PM ET
The Healthcare Crisis for the Rest of Us
...But most of America's 47 million uninsured live and die without coverage because they can't afford it. Worse than a national scandal, our failing healthcare system is an international disgrace. Hundreds of thousands of Americans are so desperate that they travel overseas in order to leech off socialized medical care systems, which are prevalent in other industrialized nations.
"We are overwhelmed by you (expletive deleted) Americans," an exasperated emergency-room physician at a Canadian hospital across the border from upstate New York told one of my friends, whose girlfriend had driven him the eight hours from Manhattan to Quebec after he'd fallen down some stairs and broken his arm...

Posted by: Mike on April 19, 2007 at 1:09 PM | PERMALINK

I think most wealthy people against a large government-run healthcare system know that the system would work out much better for a majority of Americans. It's just that said opponents don't want to pay higher taxes to fund such a system when they'll get little to no return on those taxes. But who said the wealthy aren't selfish?

Posted by: The Political Gamer on April 19, 2007 at 5:27 PM | PERMALINK

How would people stand in line for hip replacements? Better to provide ergonomic seating while they wait. :)

Posted by: Mortie on April 19, 2007 at 6:37 PM | PERMALINK

Logically no countries economy can afford to have all the medical capacity necessary in place waiting to do any and all procedures when the need arises. Waiting lists and rationing are about efficiency and mximising the usage of scare and expensive resources.

There would be a lot of operating theatres vacant if the capacity was in place to do a hip replacement immediately it presented.

Hospital waiting lists in Australia are a cheap and easy political point, just as they would appear to be in Canada.

Medicare in Australia combines private & public.

Posted by: Oz on April 20, 2007 at 2:59 AM | PERMALINK




 

 

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