Monday, February 9, 2009

Be Afraid. Be VERY Afraid.

This article was published in the WSJ. The important thing to remember is that all of the countries that have Universal Health Care (or "socialized medicine" or whatever you want to call it) all started out like we are starting out right now. With good intentions. Good intentions that failed.

The government cannot even manage itself (look at the out-of-control spending going on as we speak!) and we are naiive to believe that the government could run healthcare more efficiently than it is being run right now. Yes, yes, I KNOW that we have things that need to be fixed in our current healthcare system and I do not know what IS the answer. I do, however, know what is NOT the answer. Please see below. I hope you are as scared as I am.

'Too Old' for Hip Surgery
As we inch towards nationalized health care, important lessons from north of the border.
By NADEEM ESMAIL


President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of Schip -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience.

Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.

Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.

In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.

Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.

Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.

On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.

These constitutional challenges, along with one launched in British Columbia last month, share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health-insurance system.

The cases find their footing in a landmark ruling on Quebec health insurance in 2005. The Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health-care system, and that the government monopoly on essential health services imposes a risk of death and irreparable harm. The Supreme Court ruled that Quebec's prohibition on private health insurance violates citizen rights as guaranteed by that province's Charter of Human Rights and Freedoms.

The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance.

In the wake of the 2005 ruling, Canada's federal and provincial governments have tried unsuccessfully to fix the long wait times by introducing selective benchmarks and guarantees along with large increases in funding. The benchmarks and the guarantees aren't ambitious: four to eight weeks for radiation therapy; 16 to 26 weeks for cataract surgery; 26 weeks for hip and knee replacements and lower-urgency cardiac bypass surgery.

Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.

Mr. Esmail, based in Calgary, is the director of Health System Performance Studies at The Fraser Institute.

9 comments:

Krista said...

think this a long way off? think again.

President Obama and Senator Harry Reid still claim that the so-called Stimulus Bill will create four million jobs, provide a tax cut for the middle class, and invest in America's future.


The devil is in the details, and there are a lot of devils in this bill. Many of the detail devils we do not even know about yet, because it is moving so fast.

Because of all the media attention on the hundreds of billions of dollars in the "Stimulus Bill", the public paid little attention to the $35 billion SCHIP (State Children's Health Insurance Program) signed by President Obama. The amount is not the issue by Washington standards, but expanding the eligibility requirements to include adults and higher income families is the issue. It is supposed to be about covering children in low-income families, not about a back door approach to socialized medicine.

We have a whirlwind SCHIP bill passed into law, and a soon to be whirlwind "Stimulus Bill" that is a long way from the rhetoric of President Obama.

Martyn Oliver said...

Krista,

Leaving aside the "stimulus" plan for the moment, I do wonder about the opinion article in the WSJ. Do you think that medical horror stories are uncommon in the US?

That is, while rationed care makes for some messed up stuff, the denial of care due to the inability to pay is also messy.

I'm always cautious when it comes to anecdotal tales about health care--they can always be manipulated depending upon the perspective (that is, nasty or amazing stories are rife on all sides). The fact is, Canada has both a higher life expectancy and healthy life expectancy rate than the US--Fareed Zakaria mentions this in a recent article in Newsweek. All while paying far less for health care per GDP than the US.

For me, this makes for a conundrum--how do we increase the health of our populace, the access to medical care, and insure that we lead the way in medical advancement?

On a side note, and especially given your own experience, any thoughts on the new mother of octuplets?

best,
Martyn

Krista said...

Hey Martyn! I have to head out the door to work but I am glad to hear from you. I hope that everything is well on your end.

Just a quick thought on the octuplets. I am so happy that we have the ability to do procedures like IVF to help people start a family. It's an amazing process and the advancements that have been made, and are continuing to be made, are unbelievable.

I have been going back and forth about what I think about the situation and struggling to come up with a solid opinion on it. I do think that what she did was wrong b/c of the unnecessary risks to the children (who will most-likely all have severe developmental problems) and the money situation is also important to look at. If she can't afford those kids (which she obviously can't if she is living with her 14 kids in a house that her mom owns and has only 3 bedrooms), then in my opinion, she shouldn't have them. It's not fair. But, that is my emotion talking and ultimately the choice to have children should be up to her.
IF a woman wanted a massive boob job, would I object? No, because that decision affects her and her only.

Where I draw the line, I guess, is when is effects other people. Then it becomes a problem. In her situation, she is affecting the lives of her children - - they will most-likely have severe problems all of their life because of her reckless decision. I am not excusing the MD, either, because I think that most IVF physicians (including mine) do not recommend implanting more than 1 or 2 (MAX) to prevent such a thing.

So, all in all, I think that this lady desperately needs medical attention as she has some big problems to work through and I do not approve of what she did.
It's bad b/c of the terrible effects it has on other people - the kids, the taxpayers in California, and ultimately, the tax payers across the US.

What are you thoughts on the octuplets?

Meimi said...

I watched the Dateline special on the octuplet mom last night and it really touched a nerve in me for a number of different reasons that I am still trying to define. There just seemed to be something very "off" about everything about her - her reasons to wanting all those children, the methods she pursued to get them, the way she explained her financial situation, the way she presented herself on camera (even the smallest things - like, who has time to get her nails done when she just had eight children and six more at home?). I think she was very, very detached from reality. For example, she thought that once she went back to school and got her degree, she'd magically have the means to provide for the children. But WHEN is she going to have time to get that degree? And student loans are just that - LOANS. She also stayed very "on message" with talking points obviously given to her by the PR firm that is representing her and refused to honestly answer the tougher questions - even ones referring to possible plastic surgery, the father of the children, food stamps, etc. That same PR firm also set up the donation website that they referred to at the end of Dateline and something about that donation site also rubbed me the wrong way.

Anyway, I guess I am saying I am still debating with myself how I feel about it all. I used to love to watch Jon and Kate Plus 8 because, well, those kids were really cute, but the longer I watched the more saddening it became - I was disgusted at the way the children were being pimped out for free things and free trips and it seems like those children might have emotional or developmental issues down the road for being on TV and in the public eye during their developmental years. However, if I was suddenly faced with the prospect of feeding and clothing six children, who could say that I would not do the same? It's certainly a complex subject and it's difficult for me to make broad, sweeping generalizations or opinions.

Krista said...

Martyn, just like you, I am skeptical about things that I read. Especially when they are "facts" brought into focus by the media. On the surface, the life expenctancy and infant mortality SEEM to suggest that the US healthcare system is inferior to that of other countries, oftentimes those who spend less $$ on healthcare.

At first glance it seems like we can draw a direct conclusion here. But, as in most cases, we can't. Upon digging for further information, I have found that these measures are not good measures and cannot be used to compaare healthcare "results" between countries. This data, to no one's surprise, is provided by the The Center for Economic and Policy Research, a Washington D.C. think tank that supports government-run health care. I anticipate that bias lies within the charts and graphs and data that is presented.

Please check out this link: http://www.nationalcenter.org/NPA547ComparativeHealth.html
for several reasons WHY these measures are not considered to be ideal for comparing healthcare systems. Different research measures, different people with different lifestyles (look at the obesity in the US, look at the rate of car accidents, look at the murder rate, look at the rate of HIV, look at the races involved - for example, African-Americans have shorter life expectancies (which brings down our life expectancy average since there is a larger pop of Af-Am's in the US than in Canada), etc.)

Plus, when singling out data of the US versus, say, Canada, you could SAY that there is a correlation b/w spending. But, when you add in all of the other countries that have been assessed in the same comparative fashion, and plot them on a graph, you can clearly see that there is NO correlation b/w spending and healthcare "results".


In the US, no one is denied healthcare. The ER's are open to everyone and by law cannot turn people away. Also, Medicaid is available to people below to means of being able to pay for their medical care. Low cost (or free) meds and healthcare are available to these people.

what are your thoughts?

Krista said...

Also, I can't help but imagine how much our healthcare expenditures would DECREASE if we calculated only costs with legal citizens.

That may be a topic for another time, though. :)

Martyn Oliver said...

Heya Krista,

Food for thought, indeed. I think my primary point was that we shouldn't use anecdotal "oh, this horrible thing happened" evidence to judge health care systems. As you note, its difficult enough just using "data"! I'd say, if there's something to be learned from the Canadian system--good or bad--we should make it our business to LEARN that!

As for demographic differences and whatnot, for me, the bottom line is: regardless of the differences (race, economics, obesity, immigrant status), we are paying the cost regardless. That is, even if we could factor out the cost of undocumented workers from our health care system, the cost is still being incurred. I think the question is: Is there a better way to deliver healthcare, both in terms of price and health outcome? There has to be.

Next, it is true that no one is denied emergency care at ER's. That, however, is not to say that folk aren't routinely denied hip replacement, MRI scans, etc (like in the Canada article) for conditions that aren't deemed emergencies. ER's are for trauma. If you take your kids there for the flu as a last resort b/c you couldn't afford a more routine doctor's visit--well, that's an inefficiency that should be corrected, don't you think? Its cheaper to prevent or catch a problem earlier than to react to ER trauma like situations. (Obesity could fall in that same category--cheaper to prevent than treat with stomach staples. As an aside, why are we so fat?)

Finally, and I know this will raise a ruckus, but I was intrigued by your suggestion for a rationale about IVF treatment: "the choice to have children should be up to her" as long as it doesn't affect other people. Could one not defend abortion on these same grounds? All I'm saying is, this case brings us to a sticky point in terms of women, their bodies, and reproductive choices. Thoughts?

best,
Martyn

Krista said...

Hey there! I'm going to need to write more later as I'm heading out the door right now but wanted to thank you for your points.

And, to answer the most controversial question that you posed, I believe (so this is my opinion, and my opinion only) that the choice of abortion should be left to the female. It's her body, in my opinion, and not up to someone else to decide what is best for her. That being said, I obviously depart from the traditional republican stance here and definitely fall more into the libertarian (or democrat) category.

Krista said...

I think it would fair to say that we both agree that you cannot really compare healthcare "results" across countries due to many uncontrollable differences, right? That being said, then, I wonder if the american public has been misled to believe that the US health care system is in more peril than it actually is?

The only measure that I think would be relevant would be to compare the US's past statistics to the US's present statistics. Then we'd be comparing apples to apples more so than comparing the US's stat's to another countries stat's. I mention this b/c while I agree that there are things that could be fixed - there are many, many inefficiencies - we may not be in as much of a "healthcare crisis" as we think that we are. I do not believe that the gov't role is to manage healthcare for the US. The constitution mentions nothing of the gov't managing healthcare - - and for good reason.

That is what I think we learn when looking at the MULTIPLE failures of gov't run healthcare systems. With all of the failures out there, couldn't there at least be one "success" if it was such a good idea?

Healthcare is too important to be politicized. We all know that politicians say one thing, do another, and cite information that supports their rationale for garnering more power. Left to the free market place, people are smart, competitive, and intuitive and will no-doubt find a solution for the gaps that may currently exist.

What are you thoughts on the article below? This is what happens when politics and healthcare are too intertwined.

http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs