Sickness and Health

[magedragonfire]

Socialized public health care has been available in Canada for as long as I can remember; it's been around, nationally, since 1966. I'd definitely never want to have to pay to be seen at a hospital in an emergency, or even for a routine doctor's checkup. Last night, however, I watched Michael Moore's documentary Sicko, a diatribe against the privatized health care system in the USA. During the course of the film, he presents a number of rather dire charges against medical insurance companies, physicians, and hospitals in the country, and extolls the virtues of public health systems, much like the one we have here in Canada.

Although I realize the film is certainly biased in favour of public health, I can't quite figure out how much of it is hyperbole and how much is truth. It seems so alien to think of doctors, of all people, refusing sick patients treatment on the basis of their ability to pay – would that not violate the Hippocratic Oath, somehow?

And yet, so many people in the documentary have disturbing stories to tell about their treatment, and I've heard numerous other terrible things from friends who live in the States. One of them, a diabetic like myself, is unemployed and can barely afford to pay for the doctor visits and insulin that he needs to survive. Between having no insurance (and he wouldn't even qualify for most plans, nor would I if I moved there) and the inflated costs of drugs, it is a sorry situation, and one I can't even imagine living in.

But even though Moore praises our Medicare, as do the Canadians he interviews, many people here still complain about the system. Surgery wait lists are long, there aren't enough doctors or treatment beds in hospitals, and the quality of care is declining. Still, what would we face if we switched to a privatized system? It's possible that the complaints we have now could seem trivial in such a future. It's an issue that needs much consideration before any changes are put in place.

Comments

[palmer-kun.livejournal.com]

The main difference between single-payer systems (here) and multiple-payer systems (the US) comes down to administrative overhead.

Roughly 2% of the health care budget in Canada is actually spent on running the health care benefit system. The other 98% actually goes towards doctor and surgeon fees, medication costs and hospital operating expenses.

In the US, up to THIRTY percent of the money goes towards administration.

Factors behind this include that health care in the US is a for-profit enterprise, and so some of the money has to go to profits, as well as things like advertising budgets.

But a major factor is simple inefficiency. When you have multiple HMOs, each with their own rules, guidelines and, most of all, paperwork to fill out, things start grinding down. Many doctors have gone to the point where they'll only take patients from one HMO - just to keep down the variety of paperwork.

Interestingly enough, Medicaid and Medicare, the govt-run medical benefits in the US, come out as a single-payer system (like Canada) and only have about a 2% overhead... like Canada.

Yet even when presented with this evidence, the US still insists that private, competitive health care is "more efficient and less wasteful"

Just google "single payer health care" and you'll find a lot of reading. Like the fact that if the US as a whole went to single-payer, everyone who is currently uninsured could be completely covered, everyone with partial coverage could be completely covered, and everyone who is currently paying could pay 20% less (this means the poor still not paying anything), and despite this, the health care industry would make BIGGER PROFITS.

As for surgery waiting lists, it's a supply and demand thing, really.
The main reason we have lists and the US doesn't? Because the US has a LOT less people actually GETTING surgery, per capita. There are a lot of Canadians who are on the list for surgery who, in the US, could never afford it and thus wouldn't be on the list in the first place.

[theguindo]

The whole major problem with US healthcare is that it's so expensive, but the reason it's so expensive is because of doctors needing ridiculous amounts of coverage in malpractice insurance because suing is the national pasttime.

So many doctors have been sued for malpractice for absurd reasons, and this means that 1) legitimate malpractice cases get passed over because malpractice cases are seen so very often, and 2) healthcare costs go up because doctors gotta cover themselves in case you arbitrarily decide to sue them. Also 3), doctors will sometimes turn away patients they're not absolutely sure they can actually help. Which means that if you have some very risky surgery procedure to undergo, they might refuse on the basis that if it fails for reasons unrelated to them, you'll sue them for it.

So, in other words, greedy Americans shot themselves in the foot by suing their doctors for no reason.

[magedragonfire.livejournal.com]

Hmm. So if there is evidence that they're going about things completely wrongo, and they could be making even more profit and be helping people more than they are... Why aren't they doing something about it? Are they really content to keep their heads in the sand for no reason?

Of course, reducing the number of HMOs would put some CEOs and their profits out of the game, so that could never happen, hmm? Sure, they could be replanted somewhere within the new system, but they'd be afraid that they wouldn't be making the same amount of money as they were previously. Greedy pigs.

And yeah, the surgery wait lists, that's easy to see. Doesn't mean people complain about it any less.

[magedragonfire.livejournal.com]

Yeah, I was goggling over the price of visits when my friend told me. It's rather ridiculous - I've /seen/ the prices doctors here get paid for certain treatments, when I worked with a medical billing system. They're nowhere near as high as the prices my friend claimed.

If the malpractice thing (and I won't get into the whole litigatious society thing except to say that it's nuts) is true, though, that doesn't account for the high cost of drugs - surely they can't sue the drug company for what their doctor prescribes?

[chriseh.livejournal.com]

I've always been happy with our medicare. The first time it let me down was this christmas when I had my asthma attack.

I had it at my in-laws home, which is in Ontario. I'm a Quebec resident. The Ontario health system was super fast, nice and they even gave me my first Ventolin inhaler for free. Once I got back home, the pharmacist didn't wanted to give me the medication on my prescription because it was from Ontario. And I had to wait 5 hours in the emergency room just to get my prescription re-done by a Quebec doctor.

Which didn't happened because there was only 1 doctor on staff on that day and after 5 hours, someone from a car accident came to the hospital and delayed the waiting time for another 5 hours. So I left.

I still didn't got my medications but I'm fine until my next check-up :P

[theguindo]

I think the cost of drugs is just pharmacies getting greedy, and/or claiming that the doctors' costs gets passed down to them.

[palmer-kun.livejournal.com]

It's a belief-dogma thing. "Free market is best" and "Private enterprise is most efficient." They keep saying that, and will actively ignore any evidence to the contrary. You see this behaviour from big business all the time, it's hardly news.

And you're dead on with point #2. There would be more profit overall, but it would involve some of those companies going out of business, and most of all, having to SHARE that profit.

HMOs have an INCREDIBLE racket going on right now, and they want to keep the status quo for as long as possible. You know, just like the recording industry. Not because it's the best it could be, but because it's a sure thing, and going single-payer doesn't guarantee they'll win.

If things start turning towards single-payer, the lobbyists will be whispering in ears and greasing palms like there's no tomorrow, and next thing you know, a "Protection of Traditional Health Care" bill will hit the table, filled with all kinds of "evils of socialism" propaganda.

People should stop bitching about waiting lists. Would they rather not be eligible for the surgery at all?

And you KNOW waiting lists will be at the forefront of the propaganda and various ads against the change.

But that's the real problem. The people with money control politics, and the people with money have the most to lose from the change. They already HAVE coverage, and no waiting lists because only they can afford procedures.

[palmer-kun.livejournal.com]

In most markets, including Canada, drugs are price-controlled. The government legislates a maximum selling price on medications, and big pharma can either sell at that price, or not sell at all.

The US has no such price controls. Ergo, big pharma charges whatever they can get away with.

And they're entrenched. It's a known fact that major drug purchasers like Wal-Mart and Veterans Affairs directly negotiate with the providers for bulk discounts.

So when it was suggested that a bill be added to the US-run Medicare allowing the government to also negotiate with the providers (rather than just buy at face value), there were a lot of negative reactions, and people saying "This is SPARTA! madness."

Here's a snippet example of the attitude prevalent there:
The theory behind Part D is that market forces and competition among drug plans, overseen by government, can achieve better results than a government-run program. The multitude of plans allows seniors to pick one that best meets their needs. Both the non-partisan Congressional Budget Office and Medicare actuaries have said they doubt the government could negotiate lower costs than the private sector.

Now is it just me, or is there logic missing there.
Maybe the govt can't get lower prices than the private sector, but they could still get lower prices than they pay now. The other rationale for opposing this? "If we don't buy them all at face value, then they'll just withdraw the drugs completely and not sell at all, and so we'll have no coverage."

Seriously.

[palmer-kun.livejournal.com]

That may very well be a Quebec issue rather than a general medicare issue. Quebec is notorious for treating anything (and anyone) from another province as if it came from another continent - they insist on separate rules for everything.

[magedragonfire.livejournal.com]

Man, that bites.

I do agree with palmer_kun on this one, though. Since the healthcare things are provincially run, there can be some delays in paperwork, but...

Well, I used to work in a physio clinic, and sometimes we'd get in folks from Alberta who out here on a job and had an accident, thus Worker's Comp. Since they didn't have a BC Care Card, there'd be all kinds of wrangling to get them covered.

But I don't know that pharmacists here would deny someone a prescription because it came from out-of-province... Medicine's medicine, it's all the same everywhere. Quebec seems to be the sore thumb on a lot of provincial crossovers, so they might have different rules or regulations from the rest of the country on it.

[magedragonfire.livejournal.com]

..."Traditional Health Care"? Ho boy.

There's plenty of palm greasing as is, though - according to the movie, politicians high up in the chain of command were getting 'donations' of 200K to 600K to push through some bill that the drug companies wanted. Bush got top dollar, of course, at 800K.

I don't bitch about waitlists! But of course, I'm not scheduled for anything. XD My dad was just in for a surgery, though, and he only had to wait a month and a bit for it - wasn't anything rushful, neither, just something to do with his knee.

Maybe people with money control the politicians, but they can't control politics at it's core - that's what we're supposed to have the vote for, isn't it? But of course, no one will rise up against the healthcare issue if it comes to it, because they'll be distracted by all the other shiny flak that'll get in the way as voting day approaches. Agree on one issue, disagree on a dozen others, and no one wins who'll do any good.

[magedragonfire.livejournal.com]

Hooray for the almighty dollar, eh?

[magedragonfire.livejournal.com]

'Whatever they can get away with' - as if people'll start boycotting and stop buying their medicine in protest. Some of those things y'just can't do that with, so they'll buy them at whatever the cost, until they start dying of poverty.

*looks at the logic*
*counts on fingers*

... 2 + 2 = 47 ??

[palmer-kun.livejournal.com]

The people vote for their representatives.

The reps then vote on the bills. They are under no obligation to vote according to the wishes of the people.

Plus people are stupid. A little smoke blowing rhetoric can sway half the nation and make them ignore important shit.

Remember the debacle that was "morals based voting"?

The last election was pretty much decided on the question of abortion... even though nothing has been done about it since then.

Unfortunately, the core of politics IS the politicians. For the ultimate proof that the vote of the people is meaningless... just look at the David Emerson debacle. Elected as a Liberal, and then promptly became a Conservative.

Yep. Those votes had all the power.

[chriseh.livejournal.com]

Maybe, but the same situation happened to a friend of mine, but reverse the provinces.

But Quebec's health system is really sloppy, even when no other provinces are involved. All our doctors get offers for better jobs in Ontario and B-C. And the hospitals took a big hit from the C.-Dificil bacteria epidemic a little while ago.

Heh, I guess we still can't complain much anyways.

[chriseh.livejournal.com]

ahah, I do agree though. Quebec laws/systems are either amazing, or terrible when it comes to other provinces.

Our education system, mainly the student loans, will give higher amounts of bursaries to out-of-province students. It's the "far-from-your-hometown" bonus, which has an actual name but I forgot XD And it has a lot of other bonus and the people are all super nice and friendly. Even when you call them and bitch for an hour about something that's actually your fault (I did it ;P..)

But our medicare is shit compared to other provinces~