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InvisibleJRayV
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A look into socialized medicine.
    #8563358 - 06/25/08 04:40 PM (15 years, 8 months ago)

A Canadian Doctor Describes How Socialized Medicine Doesn't Work

By David Gratzer

I was once a believer in socialized medicine. As a Canadian, I had soaked up the belief that government–run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people.

My health care prejudices crumbled on the way to a medical school class. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute.

Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care.

I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three–year wait list; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

Government researchers now note that more than 1.5 million Ontarians (or 12% of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment.

These problems are not unique to Canada—they characterize all government–run health care systems.

Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state–of–the–art drugs aren't available. And so on.

Single–payer systems—confronting dirty hospitals, long waiting lists and substandard treatment—are starting to crack, however. Canadian newspapers are filled with stories of people frustrated by long delays for care. Many Canadians, determined to get the care they need, have begun looking not to lotteries—but to markets.

Dr. Jacques Chaoulli is at the center of this changing health care scene. In the 1990s, he organized a private Quebec practice—patients called him, he made house calls and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.

Eventually, Chaoulli took on the government in a case that went all the way to the Supreme Court. Representing an elderly Montrealer who had waited almost a year for a hip replacement, Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. A majority of the court agreed that Quebec's charter did implicitly recognize such a right.

The monumental ruling, which shocked the government, opened the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of Canada for now, at least two people outside Quebec, armed with Chaoulli's case as precedent, are taking their demand for private insurance to court.

Consider, too, Rick Baker. He isn't a neurosurgeon or even a doctor. He's a medical broker—one member of a private sector that is rushing in to address the inadequacies of Canada's government care. Canadians pay him to set up surgical procedures, diagnostic tests and specialist consultations, privately and quickly.

Baker describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion—he had no family history of epilepsy, but he did have constant headaches and nausea, which aren't usually seen in the disorder—he requested an MRI.

The government told him that the wait would be 4 1/2 months. So he went to Baker, who arranged to have the MRI done within 24 hours—and who, after the test revealed a brain tumor, arranged surgery within a few weeks. Some services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him.

Other private–sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week.

Canadian doctors, long silent on the health care system's problems, are starting to speak up. Last August, they voted Brian Day president of their national association. Day has become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center and challenging the government to shut him down.

And now even Canadian governments are looking to the private sector to shrink the waiting lists. In British Columbia, private clinics perform roughly 80% of government–funded diagnostic testing.

This privatizing trend is reaching Europe, too. Britain's Labour Party—which originally created the National Health Service—now openly favors privatization. Sweden's government, after the completion of the latest round of privatizations, will be contracting out some 80% of Stockholm's primary care and 40% of its total health services.

Since the fall of communism, Slovakia has looked to liberalize its state–run system, introducing co–payments and privatizations. And modest market reforms have begun in Germany.

Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money.

Politicians like Hillary Clinton are on board; Michael Moore's new documentary, "Sicko," celebrates the virtues of Canada's socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer–sponsored health insurance.

One often–heard argument, voiced by the New York Times' Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.

Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall or a car accident. Such factors aren't academic—homicide rates in the U.S. are much higher than in other countries.

In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life–expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.

And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five–year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England—a striking variation.

Like many critics of American health care, though, Krugman argues that the costs are just too high: health care spending in Canada and Britain, he notes, is a small fraction of what Americans pay. Again, the picture isn't quite as clear as he suggests. Because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M.D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.

That said, American health care is expensive. And Americans aren't always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like–minded politicians could take off the shelf, dust off and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.

But such initiatives would push the U.S. further down the path to a government–run system and make things much, much worse. True, government bureaucrats would be able to cut costs—but only by shrinking access to health care, as in Canada, and engendering a Canadian–style nightmare of overflowing emergency rooms and yearlong waits for treatment.

America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home—in the other four–fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.


http://www.manhattan-institute.org/html/_ibd-canadian_doctor_describes_how.htm

Edited by JRayV (06/25/08 05:49 PM)

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OfflinePhred
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Re: A look into socialized medicine. [Re: JRayV]
    #8563452 - 06/25/08 04:57 PM (15 years, 8 months ago)

jRayV, the forum rules require that URLs be provided for cut and paste jobs. Please give us a link to the source for that article.



Phred


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

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InvisibleJRayV
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Re: A look into socialized medicine. [Re: Phred]
    #8563637 - 06/25/08 05:46 PM (15 years, 8 months ago)

my bad, hang on.

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Offlineanarchist1776
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Re: A look into socialized medicine. [Re: JRayV]
    #8563931 - 06/25/08 07:12 PM (15 years, 8 months ago)

Socialised healthcare would definitely kill far too many innocent victims.  The problem with our healthcare system isn't a lack of government regulation, but an excess of it.  Two items I would recommend to those who wish to research this more are "We Can Have Affordable Health Care" by Jarret B. Wollstein and "Whose Body is it Anyway?  Sick in America" by John Stossel.


--------------------
Alex

"The difference between free-market capitalism and state capitalism is precisely the difference between, on the one hand, peaceful, voluntary exchange, and on the other, violent expropriation" (Murray N. Rothbard, 1973).

"The market is not a jumble of distorted and unrelated events.  Instead, it is a highly complex but orderly and efficient mechanism which provides a means for each person to realize the maximum possible value and satisfaction commensurate with his abilities and resources" (Linda & Morris Tannehill, 1970).

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InvisiblePrisoner#1
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Re: A look into socialized medicine. [Re: JRayV]
    #8564802 - 06/25/08 11:05 PM (15 years, 8 months ago)

Quote:

JRayV said:
America is right to seek a model for delivering good health care at good prices




where you can sit for 8-10 hours in an empty waiting room hoping to get medical attention

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Offlinezouden
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Re: A look into socialized medicine. [Re: Prisoner#1]
    #8575629 - 06/28/08 09:14 PM (15 years, 8 months ago)

Why not have a mixture of the two? Private health care for those who want to pay to avoid waiting lists, yet still have public health care for those who can't afford it.

That's what we have, and it works brilliantly.


--------------------
I know... that just the smallest
                                                part of the world belongs to me
You know... I'm not a blind man
                                                    but truth is the hardest thing to see

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OfflineRebirtha
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Re: A look into socialized medicine. [Re: zouden]
    #8575666 - 06/28/08 09:26 PM (15 years, 8 months ago)

Quote:

zouden said:
Why not have a mixture of the two? Private health care for those who want to pay to avoid waiting lists, yet still have public health care for those who can't afford it.

That's what we have, and it works brilliantly.




I've always wondered this, seems like a solution that would make both sides happy.

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InvisiblePrisoner#1
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Re: A look into socialized medicine. [Re: zouden]
    #8575814 - 06/28/08 10:23 PM (15 years, 8 months ago)

Quote:

zouden said:
Why not have a mixture of the two? Private health care for those who want to pay to avoid waiting lists, yet still have public health care for those who can't afford it.

That's what we have, and it works brilliantly.




with or without insurance/out of pocket payment it's the same,
sit for hours and get misdiagnosed or a simple "we dont know
whats wrong with you, try this pill, it could help or maybe
it'll kill you, we dont know that either"

and then they kill you just for stopping in.

brilliant!

http://www.medicalnewstoday.com/articles/11856.php

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Offlineanarchist1776
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Re: A look into socialized medicine. [Re: zouden]
    #8578704 - 06/29/08 08:46 PM (15 years, 8 months ago)

Quote:

zouden said:
Why not have a mixture of the two? Private health care for those who want to pay to avoid waiting lists, yet still have public health care for those who can't afford it.

That's what we have, and it works brilliantly.




No offense, but it does not work.  In fact, I cannot think of a better way of fucking over the poor than to introduce this sort of system.

The fact is, any government involvement in healthcare is going to increase prices and thereby hurt the least well off.  E.g.:

- The more testing that becomes required, (A) the more people waiting for drugs to reach the market, (B) the more pharmaceutical companies have to charge to get the drug developed, and (C) the fewer types of new drugs that will even begin R&D.

- The more bureaucratic the healthcare system, (A) the longer doctors have to spend filling out paperwork, (B) the more they have to charge patients to make up for lost time, and (C) the less time they have to devote to patient care.

- The more the state makes the healthcare appear to be free, the more people who will go to the doctor for various things.  Less supply of medical care relative to the demand therefor causes lines to become longer, and many find themselves needing to wait months and months for needed medical procedures.  I recall hearing about various Canadians coming to the U.S. to get life-saving procedures performed, knowing that they would have died if they had simply waited in line for Canadian healthcare.

The idea that the rich will still be able to afford free-market healthcare doesn't appease me one bit.  Why should the poor have to suffer with a government-based healthcare system in the first place?  That's the crux of the issue, and why I personally call for a complete separation of healthcare and state.

Respectfully,
Alex


--------------------
Alex

"The difference between free-market capitalism and state capitalism is precisely the difference between, on the one hand, peaceful, voluntary exchange, and on the other, violent expropriation" (Murray N. Rothbard, 1973).

"The market is not a jumble of distorted and unrelated events.  Instead, it is a highly complex but orderly and efficient mechanism which provides a means for each person to realize the maximum possible value and satisfaction commensurate with his abilities and resources" (Linda & Morris Tannehill, 1970).

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Offlinejoekenorer
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Re: A look into socialized medicine. [Re: anarchist1776]
    #8579236 - 06/29/08 11:37 PM (15 years, 8 months ago)

That'd be the same as socialized HC crowding: Everyone with health care be it insurance or government, will be trying to see a doctor.  So, theoretically, if everyone had health care, the hospitals would still end up just as crowded.  Crowding is a useless argument.

As far as doctor integrity, in a capitalist system the primary goal of the insurance company AND the hospital is to make a greater profit than the previous year.  In a well ran social system (That is, keeping politicians away from it) doctors can be put on a program of bonus' for actually improving a patients health, rather than keeping the patient on a series of prescriptions or treatments to soak up insurance. 

And as long as this government can pull trillions of dollars out of its ass for war, then we can certainly pull  billions out for something just as important. 

Its not like social systems are new to this nation anyway.  We have mail, fire dpt, police, military, school.  Socialism, no matter how bad someone demonizes the term, has, and will continue to have, a very important role to play in the evolution of this country.  It's not going to end in socialism though, and its not going to end in capitalism either, because either of those alone have proven a bane to humanity.  There will be a hybridization of some sort. 

I have to stop here, I could write pages about this subject.


--------------------
My favorites are weeping willows, which aren't really weeping at all. They're very wispy, witty and will dance in the breeze with you. Nothing like a tree that wants to dance with you. Although it doesn't like its thin limbs being pulled at all, it absolutely LOVES it when you walk through them, letting them gently slide over your face and shoulders. If you're naked, the willow considers it to be sex. It will orgasm on your mind and you will blow dream chunks into outer space. All very fun until your neighbor sees you.                                    -The Joekenorer

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Offlinezouden
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Re: A look into socialized medicine. [Re: anarchist1776]
    #8579538 - 06/30/08 02:02 AM (15 years, 8 months ago)

Quote:

- The more bureaucratic the healthcare system, (A) the longer doctors have to spend filling out paperwork, (B) the more they have to charge patients to make up for lost time, and (C) the less time they have to devote to patient care.



Socialised healthcare doesn't mysteriously get rid of doctor's secretaries. The doctors themselves don't do any paperwork.
That point aside, there's actually less paperwork because we know that everyone is insured. If I break my leg, I can go to the hospital where'll they'll treat me and put it me in a cast, etc, and I can limp out of there without having to fill out any forms or pay a cent or deal with an HMO.

It's not perfect - no system is. But it works very well. I suspect the Australian health system is better than the Canadian one because we have the option of going to a private hospital if we want, and I never hear people talking about that in Canada.


--------------------
I know... that just the smallest
                                                part of the world belongs to me
You know... I'm not a blind man
                                                    but truth is the hardest thing to see

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OfflineSeussA
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Re: A look into socialized medicine. [Re: zouden]
    #8579646 - 06/30/08 03:56 AM (15 years, 8 months ago)

> Socialised healthcare doesn't mysteriously get rid of doctor's secretaries.

Having spent a lot of time around doctors (both as clients of mine and as friends), I have seen first hand how much time doctors spend on the phone with Cigna and other health providers talking to some drop out veterinarian on the other end that doesn't want to approve a needed treatment because of the expense involved.  The secretaries and nurses cannot make these calls, as it is the doctor that has to justify his diagnosis and treatment path to some bureaucratic bean counter that gets a bonus if he denies enough treatments for the week.

> That point aside, there's actually less paperwork because we know that everyone is insured

It never works that way in reality.  I see why it should, but it doesn't.


--------------------
Just another spore in the wind.

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Offlinezouden
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Re: A look into socialized medicine. [Re: Seuss]
    #8579693 - 06/30/08 05:21 AM (15 years, 8 months ago)

I say get rid of the "bean counter that gets a bonus if he denies enough treatments for the week." since he's causing the problem. In fact, as you said, it's essentially his job to cause problems.


--------------------
I know... that just the smallest
                                                part of the world belongs to me
You know... I'm not a blind man
                                                    but truth is the hardest thing to see

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Offlinejoekenorer
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Re: A look into socialized medicine. [Re: zouden]
    #8579903 - 06/30/08 08:14 AM (15 years, 8 months ago)

Bureaucrats wouldn't be deciding who gets what treatments, everyone will get all treatments on a first come, first serve basis.  Privitized health care picks and chooses who does and doesen't, depending on how it will affect profits.  The only real problem with social health would be supply and demand.  The exact same problem we'd have if everyone in this country could afford private healthcare, but in that reality, we'd ALL get bumped down behind the highest bidders.  I'd rather wait in line for my doctor than try to win him at auction.


--------------------
My favorites are weeping willows, which aren't really weeping at all. They're very wispy, witty and will dance in the breeze with you. Nothing like a tree that wants to dance with you. Although it doesn't like its thin limbs being pulled at all, it absolutely LOVES it when you walk through them, letting them gently slide over your face and shoulders. If you're naked, the willow considers it to be sex. It will orgasm on your mind and you will blow dream chunks into outer space. All very fun until your neighbor sees you.                                    -The Joekenorer

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