Since when have the republicans been talking about the reality of any situation?  They even made up their own lies and laundered them through a “respected research organization” owned by a health insurer.  They constantly make shit up, because reality doesn’t conform to their fantasyland, but lies do.

Might I add that the same Royal Canadian Wingnuts that populate my brother’s world love them some socialism because it allows them to keep farming as independent farmers, and have enough money due to socialized health care and child care to put their kids in the private Christian schools they favor.

We already have rationing…  Based essentially on class.  The rich get it, the poor do not.

We already have wait times.  My mother has had both hips replaced…  Each time, she had to wait months for the surgery once she was told it was needed.  (Of course, she could have spent a lot of money to jump the queue.)  And, in an email from a friend on July 15:

I’ve been referred to a liver specialist, whom I cannot see until September.

This friend has “good” insurance and a potentially serious condition…

Michelle Bachman was actually making this point the other day: that if more people were covered, the lines and waits in the doctors’ offices would be longer.  As a “mother bear” she’ll fight for her cubs so they only have to wait for an hour of so with properly insured sick people instead of just sick people.

I scanned something in the paper this weekend about how there are not going to be enough geriatric doctors to handle the Baby Boomer’s giant aging pool.  What else can we do but tell those damn Boomers that their pre-existing conditions mean they should just die?  How else can those 23 insurance company CEOs be paid ~$3 billion/year in salary?

My mom’s insurance company refuses to cover the drugs her doctor prescribes.  Her doctor gets pissed b/c her insurance company is “practicing medicine without a license”.

I wish Congress would lose its medical plan and all those assholes would have to buy a private plan.  It’s true that they’d make their wives or assistants fight the system for them, but maybe their wives/assisstants would complain enough that they’d realize The Future Is Now.

When my husband was laid off for the second time, we were in a bad way.  We’d eaten through our savings during the first layoff and were now uninsured with 3 kids.  Gov. Blagojevich created AllKids which insured any child in Illinois—on a sliding scale so even self-employed parents and pregnant women could have health care.

No, going to the public clinic was not as nice as going downtown, but the care we received was exemplary.  Once we understood the process, it didn’t take much time, either.  Not to mention, we could have hooked up with a Kaiser HMO, had I taken the time to figure out all the paper work, which would have made us indistinguishable from “properly” insured people.

What’s awesome about that program, is that even though we’ve been properly employed and insured for years now, they still send me information once a year or so (to a new address even) informing me that health care is available.

You know, I think a big part of the delusions surrounding healthcare are rooted in the Grand Hornswaggle: the belief that most people are middle class.

These people simply don’t see that when they are fed the “you got yours, screw everybody else” mentality, they are, in reality, “every body else”, not “you”.

There I go with that reality again ...

Ms. Kate, the financial reporter for teh Sun-Times, Terry Savage wrote a half page article last week about how lowering taxes really does make the world better and ponies and rainbows.  She completely ignored W’s deficits and showed how the evil repeal of his tax cuts was really going to hurt people.

She had a table next to the article showing how much more in taxes people were going to pay, and since they’d be paying taxes, they wouldn’t be spending money elsewhere stimulating the economy.

Her table started with a family of four that made….

...wait for it…

...$450,000

...and it went up from there.

She wrote about the top .05%ers, but tried to claim it was an article about the middle class.  Well, it might have been about her North Shore friends, but it sure as hell had no basis in the reality that the average American makes <$50,000/year.

Same shit with insurance.  You have millionaire politicians with platinum federal coverage petrified of getting the same coverage the rest of us have (or fail to have).  Whether they truly understand that the Future Is Now or they are so safe in their bubbles that they just have never met anyone without millions and good coverage is debatable.

As a disclaimer I’d like to say that I’d much rather live under the Canadian health care system, for all it’s faults, than the American one.  I feel much better knowing that even if I lose my job, I won’t be denied care at a hospital.  But this is simply not true:

“I’ve said it before, but I’ll say it again—-if you’re actually irritated by having to wait in E.R. for a couple of hours for care, then you should support universal health care.  “

I can’t predict what a universal health system in the U.S. will look like, but waiting hours and hours for care in a Canadian E.R. is common.  This is because of how a public system works.  The government needs to keep a lid on costs, just like any company.  So, they restrict the number of doctors licensed to practice in a given province, as a way to keep down costs.  Further, they restrict the number of family doctors, specifically.  1/4 of the population doesn’t have a family doctor, who is the health care “gateway” under our system.  So they go to the E.R. 

Our doctors are also capped at a certain number of hours they can bill to the public system.  This gives them a disincentive to work more hours to catch up on patient load, because who wants to work for free?  The result: patients have to wait a week to get an appointment.  Or they go to the E.R.  But wait!  The system also fines family doctors every time their patients go to the E.R.  I’ve been threatened by my doctor with removal from her practice because I went to the E.R., and with years long waiting lists for another family doctor, it’s not an idle threat. 

As for the system not being separated by class, it still is.  My family doctor had everyone who wanted into her practice come in for interviews, she picked only the “best” people, with the fewest chronic health problems, no addictions, alcoholism, etc.  You think she’d pick a homeless alcoholic or a person with a mental illness for her practice?  Those are the people who end up in the E.R.s. in Canada.

So yeah, everyone gets treaded equally, except some get treated more equally than others.  And the E.R.s are still hours-long waits, and full of the underclass.

The world of rich, healthy white people has an ethnic purity that the mere world of rich white people can’t every attain. Because as soon as you get sick, you’re not in it any more (if you ever were). So the people making these ads may never see anyone who’s not just like them.

What’s weird, though, is the perverse need that ordinary wingnuts seem to have to believe that health care reform would make things worse for them. I had an argument with a guy a while back who kept insisting that he and his family were just barely hanging on, so the extra tax burden of paying for medical care would send them into bankruptcy. And as soon as I pointed out the numbers on that he switched to the extra tax burden of cap-and-trade…

Her table started with a family of four that made….

...wait for it…

...$450,000

...and it went up from there.

Wait, what? I have what I consider a *really* good paying job. Now if my gf worked the same salary, and I somehow got the same jobs for BOTH my hypothetical children, our family of four would be raking in half of that amount.

What planet are these people from anyway?

I know I’ve beaten this one to death already, but perhaps part of the reason why stories about “long waiting times if medicine is socialized” have such traction is because people are all too familiar with the experience of having to take a day at the DMV just to get a drivers’ license when they move to a new state (although, thankfully, most DMVs are now much streamlined), with waiting for two hours in line with a young kid in order to merely apply for a passport for said tyke, etc.

Progressive liberalism argues (which argument we here all would endorse, it would seem) that there are certain things that government can do much better than private concerns.  However, in order to make this argument successfully, government needs to be (at least seen as) being half-way competent at getting things done.  Outside of military actions (or to some degree firefighting and to an even more limited degree, policing), what are examples of government actually getting things done in an efficient manner?

If we want to transform political thinking in this country to be more friendly to progressive programs (and now is a good time to do it—the massive failures of private enterprise should create an environment friendly to progressive ideology), what needs to be done is to make government work well at the things it already does.

The stimulus package should have been a carrot to get this done: politicians who clean up their acts and push for better service from government services should have been rewarded with the opportunity to say “I brought stimulus money to my community”.  The moneys could also have been used to essentially buy off the political machines that strangle politics in certain places and free up funds for states that still have only semi-professional legislators (who are looking to make ends meet and do so via corruption), e.g. NJ, to have professional (in all senses of the word) law-makers.

Ms. Kate, look at the people in line when free health care is offered in Appalachia and other rural areas of America. They are all white and (because of BIG GOVERNMENT PROGRAMS) they are all under 65 and not eligible for Medicaid. I have seen as many as 16,000 poor and working class white people lined up for the mere chance to see a doctor. Only 4,000 could be seen and treated. That’s rationing. So your guess is as good as mine for why folks are still swallowing that “hornswaggle” about socialism when lack of health care is killing the people they are already being social with.

Peter Zero One ... what province are you in?

How much does the practice of care for all vary by province?

I wonder how many of Bachmann’s constituents are having “sudden emergency needs” while on Canadian “vacations”?

I wish a large percentage of the people opposed to government involvement in health care would just admit that they are racists - people who would rather cut off their own nose than to allow ‘undeserved’ heath care for others they need to consider as their race or class inferiors.

A large intellectual effort on the right wing is to come up with abstract ‘principles’ that can be used to justify a position based on racism/classism.

It is much better to say ‘free markets’ rather than ‘social darwinism’ to explain that poor people will stay poor because they are stupid and can’t compete. I can’t believe how ‘free markets’ and ‘freedom’ are conflated because completely unregulated ‘free markets’ leads to slavery.

I’ve actually heard a few times that the low score of the US in world health rankings are because of the poor and non-white population segments. If they could be eliminated then USA would rank #1.

In re DC Fem’s comments:

Is the “hornswaggle” a, shall we say, “post-racial” version of the hornswaggle described in The Strange Career of Jim Crow, e.g. as summarized by Dr. MLK in one of his most famous speeches?

Yesterday my husband came back from mountain biking with three wasp stings on his legs, a red face and body, a terrible overall itch, a tight throat, a “weird” chest, and a voice several registers deeper than normal. (He had never had any such reaction before in his life.) I got on the phone to our free 24-hour nurses hotline (available through my GPs co-op), who told me she was calling an ambulance for him.  We were in the country at the time but fortunately have a little community hospital only 10 mins away (which we’d never beed to before).  I assured the nurse I would take him to ER immediately by car, instead.

Walked into ER, told the registering nurse what was up.  The gates immediately opened, husband was put into a bed and hooked up to heart-rate machine and panic button within 3 minutes of our having parked outside.  Two nurses took his stats and info, gave him an antihistamine and watched, watched, watched. A doctor came in 20 mins later and prescribed an epi-pen for future attacks.  We were shown to another bed and told to wait another hour before leaving.  Before we left, I asked for another couple of antihistamine pills for later that night, since there are no 24 hour drugstores in the sticks.  A nurse happily gave me those pills.

As for paperwork, I gave a nurse, at some point, my husband’s info and things were done in under 5 minutes—and this is “out-of-province”, to boot.  Hospital will be billing everything to the province.  So a moderate allergy attack treated immediately, kindly, vigilantly, and free.  Remember: small, miniscule country hospital in a province we don’t live in, with maybe two doctors on staff on a Sunday evening (though I only saw one).  Granted, my husband was “triaged” given his condition but still.  He absolutely got the care he needed, when he needed it.  At no cost.

Interestingly, at no point was his occupation asked for (just DOB, address, and parents’ names), which suggests to me the truly “egalitarian” flavour of universal healthcare in Canada.

I’ve said it before and the facts just never get through to some people.  Any problem someone can think of with “socialized” health care already exists in our current system.  It’s not just the rationing scare either.  Basically, we have the choice of politicians coming between patients and their doctors, or we can have both politicians and insurance company bureaucrats coming between patients and doctors (for the people who can even see doctors).  The choice should be obvious, but just the idea of poor people getting something they need is enough to enrage conservatives so much that they ignore reality.  They’d rather suffer themselves as long as it means poor people suffer too.

“Peter Zero One ... what province are you in?

How much does the practice of care for all vary by province? “

I’m in Ontario.  The practice of care for all is universal for each province in theory, but some provinces allow some degree of a private system to exist along with the public system, which allows for queue-jumping by richer people for some procedures and treatments.  As far as I know, the percentage of people without a family doctor is more or less constant throughout the country.

I say in care for all is a theory, because the political/economic calculations of government, the poor in each province get underserved the most.  Rural areas in Ontario are seeing closures of emergency rooms as an effort to curtail costs, as well as closure of hospitals.  This is because rural areas have fewer votes per square kilometer, thus, closing the countryside E.R.s is more politically viable than limiting service in cities.  Even though closing the only E.R. within an hour’s drive of thousands will hurt more people than limiting the number of beds in an urban hospital.

Peter’s comment about an “interviewing” GP undermines what I said above, but thankfully that certainly hasn’t been the experience of anyone I know in Ontario, myself included (I got a new GP about 5 years ago when my old one retired, and I didn’t automatically slide into the practice I was referred to by the outgoing doc—I chose my GP based on a friend’s recommendation, and I wasn’t interviewed).

Peter, it’s common here. So at worst, we get an even swap. But the proposed plan doesn’t involve government ownership of hospitals, so concerns about hospital rationing are misplaced.

One thing that would have to be different in the US: any nationalization would have to be exactly that.

I do not trust many states to impliment things properly or fairly without a federal mandate.  The incompetence and cost-saving on the backs of the poor that has been seen in the poor Atlantic provinces of Canada would be magnified multiple times over in places like Mississippi, Lousiana, etc.

Wow, I just loved that “the US would have great health stats if not for poor people and blacks”. Pretty much explains it all. (Albeit not accurately—the lowest economic segments of the UK population have about the same morbidity and mortality stats as upper-middle US.)

“This friend has “good” insurance and a potentially serious condition… “

James this is what infuriates me!  I have excellent insurance!  thanks to Obama btw , and his cobra subsidy.  But the fact is I was able to keep my insurance from a non profit I previously worked at, and it’s great insurance.  I have a potentially serious problem right now too. I waited almost two months for the first specialist and when that didn’t turn out so great, they tried to make me wait over one month to see a gyncological oncologist!  I said fuck no, I’ll have a nervous breakdown by then.  And I got in earlier, the appt is this afternoon actually.  But what I don’t get is what is wrong with people??  I have always, always been 100% for universal single payer.  Previos to this year I have never lost my health insurance and I’ve never really needed it, barring one time that I broke a bone.  I always knew that I was lucky and that it could change on a dime, and even if it didn’t what about other people?

Either no republicans have ever gotten sick and had to navigate insurance companies and specialists, or they just don’t care about anyone but themselves, or they live on another planet, or a mixture of all of these things.  I just don’t get it.  I can’t even talk to people about it.  Oh, while I am babbling, my aunt used to not have health insurance. She had to have fibroids removed in her doctor’s office fully conscious, he did it for free.  It was unpleasant.  I remember her saying the why can’t we have socialized medicine like they do in England?  Her daughter’s friend was from England and raved about their system.

Now she is married to a right wing fuck, and she is old and on medicare! and she is 100% against health care reform.  I swear to God she is an actual teabagger!

You tell me, how does that happen?  How do you go from a terrible and painful medical experience and learning that something is very wrong and has to change, to what she is now?

I can’t predict what a universal health system in the U.S. will look like, but waiting hours and hours for care in a Canadian E.R. is common.  This is because of how a public system works.

It’s interesting because I’ve seen quite a few people online quote statistics about ER wait times that are not actually equivalent.  The wait times for actual emergencies are pretty similar.  The way people cook the books is by comparing the time it takes on average for an American to see a doctor in the ER (about 4 hours) and how long it takes a Canadian emergency patient to be discharged from the ER.  I think you’ll agree that comparing those two is comparing apples to oranges.

What bugs me is people who try to pretend that we don’t have rationed health care in the US.  We absolutely do ration it.  The only difference is that we let private companies do the rationing based on their profit margins rather than rationing it based on medical need.  And yet somehow having a private insurance company cancel your insurance rather than pay for your surgery is FREEDOM! while having to wait a couple extra months for the same surgery is EVIL!!! under a government system.

Rural areas in Ontario are seeing closures of emergency rooms as an effort to curtail costs, as well as closure of hospitals.

So are we, which would lead one to conclude it has something to do with circumstances other than private vs. public insurance since it’s happening across both systems.

As a Canadian, I can speak from personal experience with what single-payer health care works like. And it’s actually pretty well. My wife had cancer many years ago (before I met her). Her parents had good jobs, but thankfully weren’t financially ruined by expensive treatments. With private insurance? I couldn’t begin to guess.

For myself, I need some minor surgery. Really minor (hernia). When I went to the doctor, he wasn’t sure, so sent me for an ultrasound the next week. I know, I had to wait a whole week! Crazy wait time. They couldn’t find anything, so they sent me to a specialist later in the week that they got the ultrasound results. He figured it out immediately, and could have scheduled the surgery for the very next week.

Since I was in the middle of renovations, I couldn’t do that. So we figured out a date in the summer, and when I learned that they couldn’t do the surgery because I had cracked ribs (even though I had the IV already in and everything), it was no big deal to reschedule.

So. Flexibility, low costs, no serious wait times most of the time… I’m really not seeing a downside here.

Oh, and when it came to childbirth, the provincial government sensibly recognizes that home births are not significantly riskier and are about half the cost of hospital births, and so our midwife-assisted home births were covered just fine.

Every time I or anyone in my family has needed a doctor, we’ve gotten to see one, and promptly. This narrative people are constantly spouting about wait times and all that are based on the rare exceptions. The standard experience is actually quite reasonable; the long wait times are the exception, at least in my experience.

DAS, I think that it’s way too optimistic about human nature to assume that ideological opposition to the government providing services is the result of lived experience, instead of a steady diet of right wing media.  I’d say about 95% of my bureaucratic headaches in life were due to privately owned companies.  Waiting for an hour at the DMV has NOTHING on waiting for hours and sometimes days to get a routine maintenance on your cable when it goes out. 

Plus, even if there was a legitimate beef with government services vis a vis private services, that doesn’t mean much in terms of health care reform, which is overly solicitous to the insurance companies already.

As a Canadian, I can speak from personal experience with what single-payer health care works like.

I’m sure of it, but one of the problems with bringing up the Canadian system is that it’s nothing like the bills being brought up by Congress.  Single payer could work great for America, but there’s no way in hell we’re getting it any time soon.

One thing about “rationing” that could help people out that’s not talked about much is having some higher standards on doctors ordering treatments and tests that aren’t relevant.  You don’t think about that much, but Pal MD’s recent podcast touched on it some, particularly the problem of ordering tests for things in elderly patients that, even if they had these problems, wouldn’t kill the patient before old age does.

I’ve never lived in Canada or the UK, so I don’t have that sort of experience with their healthcare systems.  But, while visiting family in the UK a couple of years ago, I had to take my 2 year old to see a doc because he had slammed his finger in a door and it got infected.  I took him to the local walk in clinic, signed us in, and waited about half an hour to see a doctor.  The doc was quite young (younger than me anyway, and I was 30 at the time), but he was absolutely great—friendly, great with the kid, etc.  He checked him out, ordered an x-ray just to be sure nothing was broken, cleaned it up, prescribed an antibiotic, and we were out of there in under 3 hours.  And didn’t have to pay anything at all.  They didn’t even want my travel insurance info (which I offered and which pissed off my sister in law because at the time she worked for the NIH and apparently if you have private insurance they’re supposed to ask for it and bill them first) and assured me that everything would be taken care of and not to worry about it.  It was nice.

Whereas here, even with pretty good insurance (husband is a state employee), I have to wait a month to get my other son in to see a dermatologist about his eczema (even when his flare up is so bad that he’s walking around with open sores on his legs) and we had to wait almost 3 months to get him into an ENT last year (even though he apparently had so much fluid built up in there that he had hearing loss and was, according to the doc when we finally did get in, in imminent danger of busting an ear drum) because the insurance has to approve it first, and last time we were at the emergency room (one of the kids needed stitches) we had to wait several hours with a bleeding and crying child because the ER was full up.

Since when have the republicans been talking about the reality of any situation?  They even made up their own lies and laundered them through a “respected research organization” owned by a health insurer.  They constantly make shit up, because reality doesn’t conform to their fantasyland, but lies do.

It’s important to bear in mind that these campaigns of lies and FUD from “respectable research sources” have been S.O.P. for conservative corporate scumbags since 1953, when the PR firm Hill and Knowlton began laying the groundwork for the Tobacco Institute. They’ve had over half a century to refine the process, to the point where they’ve created a parallel world to peer-reviewed academia composed of “independent” issue-oriented think-tanks (owned and operated by corporations who “just happen” to have an interest in their agendas), fake colleges (like Liberty U. and Patrick Henry), lobbying organisations, and astroturf operations (e.g. the Teabaggers, brought to you by various Koch family Libertarian outfits).

It’s a very American propaganda operation, stunning in scale and subtlety when compared to the ham-handed variety we’ve seen in most places for most of history. And while it’s undertandable that the ignorant and stupid and uncritical might fall for their BS, it’s almost as common to see lazy MSM journalists grasp at their various studies and surveys in an effort to seem “fairnbalanced.”

A year or so ago, there was an excellent article in some magazine (I think it was the New Yorker) about the rising number of people- fully insured people- who go to the ER with some serious health emergency and, due to the large number of uninsured people seeking healthcare at the ER, do not get treated soon enough and DIE. (I wish I had a link for you.)

This is similar to the ‘Obama has plans to destroy the super-successful capitalist economy of America’.  Were those people alive in 2008?  Who nationalized, Fannie, Freddie, & AIG?  Sure wasn’t Obama.  Who brought the banking system to its knees?  Not Obama, and not anything he has done or is proposing.  We had a real collapse in banking, but it’s more important to rant about the stimulus and ‘hyperinflation’ (we had real inflation through investment banks ramping up their leverage, but that was free market inflation and is not a concern).

This is similar to the ‘Obama has plans to destroy the super-successful capitalist economy of America’.  Were those people alive in 2008?  Who nationalized, Fannie, Freddie, & AIG?  Sure wasn’t Obama.

Yes, but Obama had won the election by then, so even though he wasn’t in power, his skin was dark enough to magically make it all his fault for simply existing.

“Rural areas in Ontario are seeing closures of emergency rooms as an effort to curtail costs, as well as closure of hospitals.

Mnemosyne:
So are we, which would lead one to conclude it has something to do with circumstances other than private vs. public insurance since it’s happening across both systems. “

Wel, at least the public system allows for “some” level of service to rural communities.  Though, in comparison to the service people get in cities, it is of much poorer quality. 

“I’m sure of it, but one of the problems with bringing up the Canadian system is that it’s nothing like the bills being brought up by Congress.  Single payer could work great for America, but there’s no way in hell we’re getting it any time soon. “

I think a parallel (two-tier) system might work better in the U.S.  I agree with extending government insurance coverage to the uninsured on compassionate grounds.  When people are willing to pay extra for their health care for shorter wait times, or coverage, or whatever, then that can drive innovation and new treatments or whatever.  A purely public system, like Canada’s, is by necessity stagnant, because the same government that pays for the care also approves treatments, so there’s little incentive to add new things to the list.

Some say, for example, that a parallel private system takes away resources from the public system, say from surgical hours by specialists.  But in Canada, surgeons are capped in the number procedures they can perform while getting reimbursed from the gov’t, so there’s slack there that can be used to treat richer people.  At least then you’d have defeated a crucial Republican talking point about being forced to wait for a hip replacement while some poor dude gets his first.

Either way, because of the demographic challenges of both the U.S. and Canada, we will see a marked deline in the quality of care.  A person uses 90% of their health care dollars after the age of 65, and 10% before.  So with every year that another part of the baby boom cohort hits 65, your costs go up exponentially.  Health care itself is unaffordable, it doesn’t matter if private corporations or the public pays for it.

It’s also worth mentioning that some people seem to fundamentally misunderstood what “rationing” means in a national health service.  I read a hiarious comment from some joker who seemed, in all seriousness, to think that “rationing” on the NHS meant that once a hospital had done its quota of operations (or whatever) then it couldn’t do any more, and anyone who came along after they had reached their “rationed” amount.

After drying the tears of laughter from my cheeks, I explained that this was entirely not what happened.  One version of “rationing” means, for example, that NICE (the National Institute of Clinical Excellence) pronounces on what drugs it thinks are cost effective and recommends for or against their use.  Their pronouncements aren’t actually legally binding on NHS Trusts, but their advice is closely heeded. This has led to some controversial decisions regarding some new, particularly expensive, drugs - but here’s the thing - those controversies were publically debated as a matter of public concern.  Sometimes they changed their recommendation, sometimes they didn’t - but it’s not done in boardrooms at the behest of shareholders.

The other form of “rationing” could be in the form of waiting lists for certain procedures.  This is basically down to funding and resource allocation.  Some waiting lists got shamefully long in the NHS after, wait for it, 18 years of Conservative government.  Since then, funding has increased, and a lot of waiting lists have got a lot longer.  But I can’t imagine that resource allocation is much different under a purely private system - no system has unlimited funds, unlimited hospital resources and unlimited staff.

It’s worth noting regarding all of this that at no point has the ability to go private been taken away.  So for richer people who want to skip the whole NHS thing, then there are private alternatives.

PeterZeroOne, there is one huge difference: overhead.

Right now, a good 20-35% of our health care dollars are spent pushing paper - be it physicians who are handling enormous paper loads for numerous insurers, or claim forms flying back and forth in all directions.

At least you guys are not paying for that degree of administrative overhead!

A purely public system, like Canada’s, is by necessity stagnant, because the same government that pays for the care also approves treatments, so there’s little incentive to add new things to the list.

I’m sorry Peter but that’s just rubbish.  Is there any real evidence that medical care is backwards in public systems?  By that argument no innovative treatment would originate in publically run systems, but that’s clearly not the case.

In fact, you could pretty much make the argument that a system run by insurance companies will be either stagnant or blacksliding, because the same corporate officers who approve treatment get their bonuses by paying a minimum of claims…

“Peter Zero One ... what province are you in?

How much does the practice of care for all vary by province? “

I’m in Ontario.

The problem is that this is all highly variable even within the same province.  I live in Toronto and have attended three different “ERs” within the GTA over the past three years, making many more than one visit to two of those locations. (Yeah a lot of visits, I have several chronic health conditions and my mil was in and out of the hospital constantly before she passed away.)  I and/or the person I am with, have never waited more than one hour for care even for something like cat bite and sometimes it has been as simple as walking straight back to a bed after handing over the health card. It did take me awhile to find a family doctor, however once I was able to locate someone who was accepting new patients, I in no way had to go through an interview process.

Her table started with a family of four that made….

...wait for it…

...$450,000

...and it went up from there.

OMG…  I wouldn’t even know what to do with that much money.  Ok maybe not completely true, I would go buy that 1 million dollar home that’s for sale several blocks over, but ack!  Talk about being completely disconnected from reality.

I’m sure of it, but one of the problems with bringing up the Canadian system is that it’s nothing like the bills being brought up by Congress.

Exactly, but it gets our hackles up because, trust me, we hear the American news (noise?) machine, and all the assertions that Canadians must be dropping like flies because of our “horrible” health care.  We get defensive because most of us realize the benefits to our system.  The commercial’s running on CNN alone are enough to make me want to throw things across the room!

A purely public system, like Canada’s, is by necessity stagnant, because the same government that pays for the care also approves treatments, so there’s little incentive to add new things to the list.

Please… I really tire of this myth being perpetrated.  Canada is in no way a “purely” public system.  Most areas of Canada actually have a three tier system.  First: public funded, government run; Second: public funded, privately run; and Third: privately funded and privately run.

I think a parallel (two-tier) system might work better in the U.S.

It’s not so much a parallel system as a system like the one they have in France or Germany, which have combined public-private systems.  I know people love to compare the US and Canadian systems because Americans like to think that Canadians are Just Like Us, but we would probably be better off modeling ourselves after France or Germany than Canada.

“I’m sorry Peter but that’s just rubbish.  Is there any real evidence that medical care is backwards in public systems?  By that argument no innovative treatment would originate in publically run systems, but that’s clearly not the case.”

I believe that fewer innovative treatments, etc. originate in publically run systems, yes. 

Many modern treatments are not available in Canada, due to the clear interest of government regulatory bodies to keep costs down for government health care.  Tests - same thing.  The difference is that new and innovative treatments, tests, and procedures are funded and tested privately.  Someone (rich) comes along and has a sick little boy with leukemia and funds a doctor with some crazy ideas to try something new, and the kid lives or dies but something new get tried and learned.

By contrast, in Canada, it’s against the law to pay for health care privately.  All the money for health care (with the exception of un-listed services like cosmetic surgery, some elective surgeries, and with the exceptions of some private for profit clinics) comes from the government. 

Let’s take another example:  MRI machines.  These are notoriously expensive, but think of the economics.  From an American hospital’s point of view, it invests capital money in the MRI machine, then gets money back from the insurance companies/private fees/medicaid, pays off the capital costs, then it’s just pure bucks from there.  From a Canadian hospital’s point of view, it receives almost all of its funding from the government, and hence it is de facto a not-for-profit government corporation.  The government has no incentive to spend capital on an expensive MRI machine when any scans performed will be paid for by the government.

My uncle owns several clinics that help people with addictions and he once tried to explain to me all the stuff he has to go through with insurance companies. It made my head want to explode, because there is an extra company in there whose sole purpose is to act as a go-between for his clinics and the insurance companies. I can’t imagine a more hellish nightmare world of bureaucracy.

Katherine:
“It’s also worth mentioning that some people seem to fundamentally misunderstood what “rationing” means in a national health service.  I read a hiarious comment from some joker who seemed, in all seriousness, to think that “rationing” on the NHS meant that once a hospital had done its quota of operations (or whatever) then it couldn’t do any more, and anyone who came along after they had reached their “rationed” amount. “

Actually, this is precisely what happens in Canadian health care.  A cardiac surgeon can only claim a certain number of surgeries per week/month or whatever from the public health system.  If he does anymore, he’s working for free, so he’s not working, so you really are waiting for it, since 99% of the money that comes into the system is from the government. 

“I and/or the person I am with, have never waited more than one hour for care even for something like cat bite and sometimes it has been as simple as walking straight back to a bed after handing over the health card.”

The federal government recently had some extra dirty oil money that they handed off to the provinces.  But it won’t last, for the demographic reasons I outlined above.  Exponentially more people will need care while being removed from the workforce/tax base.

Right now, a good 20-35% of our health care dollars are spent pushing paper - be it physicians who are handling enormous paper loads for numerous insurers, or claim forms flying back and forth in all directions.

Yes, exactly!  Insurance companies spend so much money on trying to not spend money.  Claims don’t deny themselves though; they have to pay someone to do that.

A purely public system, like Canada’s, is by necessity stagnant, because the same government that pays for the care also approves treatments, so there’s little incentive to add new things to the list.

That is full of shit.

New stuff gets added all the time.  What does happen is that it’s efficacy has to be proven before the government agrees to cover the cost (note, NOT to decide whether or not it happens).

From a Canadian hospital’s point of view, it receives almost all of its funding from the government, and hence it is de facto a not-for-profit government corporation.  The government has no incentive to spend capital on an expensive MRI machine when any scans performed will be paid for by the government.

And yet, there those MRI scanners are sitting there.  Don’t you hate it when reality intrudes?

And here’s more reality: much of the hardware like CT and MRI scanners is not paid for by the government but by community fundraising which, remarkably enough, the government does not in fact oppose, which they would if your theory was correct.  For instance, just in the last week the Richmond BC Hospital Foundation (the ones who, not the government, actually run the hospital) announced they’d met their fundraising goal for the purchase of a new MRI at the Richmond Hospital, at the same time as the local Rotary club announced a large donation toward the project of upgrading the CT scanner.

In other words, the hospitals are doing exactly what you claim they aren’t doing, while governments aren’t doing what you claim they are.

At least you guys are not paying for that degree of administrative overhead!

In fact, there’s a whole job function eliminated by single-payer: “medical billing specialist.” Which moves benefits management out of the Human Resources Dept (thereby eliminating one of the semi-legitimate rationales for the existence of said Dept) and into the CFO office, where it belongs.

There are additional efficiencies that come from standardisation of forms and (especially important) data formats. For a variety of reasons, private corporations prefer that their systems (paper or digital) don’t talk to each-other.

In fact, you could pretty much make the argument that a system run by insurance companies will be either stagnant or blacksliding, because the same corporate officers who approve treatment get their bonuses by paying a minimum of claims…

Bingo—one way or another, you’re going to be dealing with huge, impersonal bureaucracies. The question is, to whom should the bureaucracy be accountable: a relatively small group of shareholders who are mainly concerned with profits, or a massive group of end-users (via their elected officials) who are mainly concerned with outcomes.

Almost everything else falls under ceteris paribus.

I believe that fewer innovative treatments, etc. originate in publically run systems, yes.

Innovative treatments don’t originate from health insurance programmes—they originate in research universities (public and private) and laboratories (public and private). That’s true for the US, Canada, and any other country.

Insurers (public or private) pick and choose which treatments they’ll pay for, and for-profit corporations have as much (if not more) interest as governments in keeping their costs down by denying experimental or novel treatments. Again, ceteris paribus.

The government has no incentive to spend capital on an expensive MRI machine when any scans performed will be paid for by the government.

There’s an incentive when an MRI scan becomes less expensive to the system than an existing scan (say an x-ray) or no scan at at all (“if only we’d caught it earlier—now we’ll spend twice as much getting it out”). Physicians and nurses and patients don’t look at MRI and CT scanners as money-printing machines.

This is a complex systematic issue. Don’t make the typical Libertarian error of reducing everything to a linear or sequential cash transaction. It messes up their thinking to the point that they’re happy to discard social libertarian principles.

The difference is that new and innovative treatments, tests, and procedures are funded and tested privately.

Bull, the Canadian and various provincial government provide funding to various private research and pharmaceutical companies to encourage development.

By contrast, in Canada, it’s against the law to pay for health care privately.

I would LOVE to see this law, but however seeing as how there are private companies, doctors, nurses and technicians charging for health care privately everyday here in Ontario,  I severely doubt they are out there to break the law.

The government has no incentive to spend capital on an expensive MRI machine when any scans performed will be paid for by the government.

So the only reason a government tries to keep it’s people healthy is to make profit?  Uh no, government keep their citizens healthy because it creates happy and more productive.  I mean how do you think this even makes sense, governments are not a profit making entity in any circumstance.

Also you are once again working on the premise that there is no private health care in Canada, which is FALSE.

When they talk about people “abusing” the system and taking more health care than they deserve, they mean that working class and poor people might actually think they deserve more than a nominal resuscitation attempt when they die.

When I imagine people “overusing” health care, I’m more likely to imagine a Terry Schiavo situation where a brain-dead person is kept alive beyond all reason by fundie relatives, even when that person would not have wanted to be kept alive like that.  But I’m not willing to leave everyone to a shitty, expensive health care system just to keep the government from paying for a few vegetables on life support.

The question is, to whom should the bureaucracy be accountable: a relatively small group of shareholders who are mainly concerned with profits, or a massive group of end-users (via their elected officials) who are mainly concerned with outcomes.

Thank you.  I have tried to make this point many times, but I’ve never been able to summarize it so nicely.

One thing that would have to be different in the US: any nationalization would have to be exactly that.

I do not trust many states to impliment things properly or fairly without a federal mandate.  The incompetence and cost-saving on the backs of the poor that has been seen in the poor Atlantic provinces of Canada would be magnified multiple times over in places like Mississippi, Lousiana, etc.

The main concern I have with nationalized health care (though I think it *could be* great) is the ability and willingness the right wing has shown to take rights away from people they don’t like.  So, I have a fear of women and gay men in particular being refused medical care because that care “conflicts with the morals of” the people in the state, nation, etc.  I mean, we know that the democratic party just lives for opportunities to throw ‘special interest groups’ like non-white, non-straight, non-male citizens under the bus so that they can seem reasonable.

The main concern I have with nationalized health care (though I think it *could be* great) is the ability and willingness the right wing has shown to take rights away from people they don’t like.

Corporations can do that just as easily as the state can—with fewer built-in preventatives.

Capital-L Libertarians like to indulge in the fantasy that only the state can excercise tyranny . Those Libertarians either don’t understand the meaning and history of the term “company town,” or believe (usually erroneously) that as “natural aristocrats” they’ll be the ones in charge of said town.

Is there any factual claim P01 has made that hasn’t been refuted?

“By contrast, in Canada, it’s against the law to pay for health care privately.

I would LOVE to see this law, but however seeing as how there are private companies, doctors, nurses and technicians charging for health care privately everyday here in Ontario, I severely doubt they are out there to break the law. “

Canada Health Act, 12a
[the system must provide] “uniform terms and conditions, unprecluded, unimpeded, either directly or indirectly, by charges (user charges or extra-billing) or other means (age, health status or financial circumstances);”

Translation: you can’t pay for stuff privately, as it is judged that you paying to jump the queue for a procedure, then someone else is worse off because they couldn’t. 

“And yet, there those MRI scanners are sitting there.  Don’t you hate it when reality intrudes? “

How many of them per patient?  Per hospital?  Way, way fewer than in the U.S.  What about PET scans?  Never heard of those?  They’re practically unavailable in Canada.  It’s widely acknowledged that the Canadian system is undercapitalized. 

“For instance, just in the last week the Richmond BC Hospital Foundation (the ones who, not the government, actually run the hospital) announced they’d met their fundraising goal for the purchase of a new MRI at the Richmond Hospital, at the same time as the local Rotary club announced a large donation toward the project of upgrading the CT scanner.

In other words, the hospitals are doing exactly what you claim they aren’t doing, while governments aren’t doing what you claim they are. “

No, Keith, I never said governments would oppose community efforts to raise money for an MRI machine.  You said I did.  I only said government would not pay for an MRI machine themselves.  Can a government oppose community funding for hospitals?  That’s not politically tenable, and I never claimed this was the case. 

“Innovative treatments don’t originate from health insurance programmes—they originate in research universities (public and private) and laboratories (public and private). That’s true for the US, Canada, and any other country.

Insurers (public or private) pick and choose which treatments they’ll pay for, and for-profit corporations have as much (if not more) interest as governments in keeping their costs down by denying experimental or novel treatments. Again, ceteris paribus. “

It’s not about the insurance, it’s about accepting any private money.  In Canada, a physician can’t give you any treatment/procedure unless it’s approved by the government, which means it’s funded by the government, which means that you aren’t allowed to pay for it privately.

“Is there any factual claim P01 has made that hasn’t been refuted?”

Yeah!  I know there are plenty of Kanucks that read Pandagon, if he’s full of shit, say so!

Is there some Canadian Healthcare FAQ (by an actual respected Canadian) or some other readable source (readable by non-lawyers) that will let us shut down the wingnuts with something other than anecdotes?...

“What does happen is that it’s efficacy has to be proven before the government agrees to cover the cost (note, NOT to decide whether or not it happens).”

Keith, when you have a federal agency like the FDA approve a treatment, it doesn’t automatically mean insurance companies will cover it. But some very expensive plans might.  Some rich people will pay for it privately.  The FDA, at least in theory, approves or disapproves treatment based on medical facts.  The decisions by insurance companies (or individuals) to fund this treatment are a separate decision, made by many, so the chances of a treatment making its money back after FDA approval are increased.  This is known as an economic incentive.  Maybe further studies show the treatment doesn’t work, and it won’t get listed on more insurance plans.  Or the opposite happens.  New things are tried.

By contrast, in Canada a government decision to approve a treatment is de facto the SAME decision as an approval to cover the costs.  So, like you said, the government only approves “proven” treatments.  “Proven” where?  The United States.

In short, lies about “rationing” of health care have traction because people don’t understand how getting all your care at the emergency room affects the system?

PeterZeroOne, you are welcome to move south of the border and see how much ... better ... things are here firsthand.

Either that, or propose some changes to the Canadian system to improve it.

“Is there any factual claim P01 has made that hasn’t been refuted?”

Actually, the only claim that’s been refuted has been the “interview” process that my GP subjected prospective patients to.  I’d made the assumption that was a common thing with Canadian GP’s these days, but I guess my doc is just a control freak.

Other claims I’ve made?
-Long wait times in ER?  Noone has disproved that. 
-1/4 of Canadians don’t have a GP?  Nope, noone’s disproved that either.
-Quality of care still uneven between rich and poor based on geography?  Noone’s disproved that.
-Innovation in health care?  Capitalization?  Noone’s disproved that either.

The ONLY reason wait times have gone down in Canada (and we’re talking like, down from 12 hours in the E.R. to 4) in the last few years is because of the fat oil revenues the federal government has been raking in, which they have mostly spent on health care.  No Canadian on this board would claim to have gotten high-quality care back in the 1990’s and very early 2000’s.  Now that government revenue is shrinking, they’ll cut back on health care again.

One thing that would have to be different in the US: any nationalization would have to be exactly that.

I do not trust many states to impliment things properly or fairly without a federal mandate.  The incompetence and cost-saving on the backs of the poor that has been seen in the poor Atlantic provinces of Canada would be magnified multiple times over in places like Mississippi, Lousiana, etc.

One thing screwy in the US is that health insurance is regulated by the States not the Feds. This means that you wind up with ‘separate’ companies like Blue Cross Blue Shield of Oklahoma and BCBS of Illinois that have to operate under seperate regulations even though they are both owned by the same parent company. (Right-Wing talking point - there are thousands of insurance companies that offer you choices. Reality - only a few of them are legal for you to use in your state).

The right-wing has been using state insurance regulations for social engineering. For example in some states insurance regulations make it illegal for insurance to pay for some or all types of abortions for public employees or all citizens.

Some on the Right say our health care problems can be cured by better insurance regulations. I most certanly would not trust this at the current State level but I am sure the Right is opposed to nationalizing insurance regulation.

Capital-L Libertarians like to indulge in the fantasy that only the state can excercise tyranny

What you obviously do not understand is that a sick person in need of money is perfectly free to dump their insurance company and seek another to cover them if they’re unhappy with the service. That’s the beauty of the free market…

Other claims I’ve made?
-Long wait times in ER?  Noone has disproved that.
-1/4 of Canadians don’t have a GP?  Nope, noone’s disproved that either.
-Quality of care still uneven between rich and poor based on geography?  Noone’s disproved that.
-Innovation in health care?  Capitalization?  Noone’s disproved that either.

And how are any of these things worse than the current system in the United States?  If we can have coverage for everyone with all these problems or coverage for only some with the same exact problems, the choice seems pretty obvious to me.

“PeterZeroOne, you are welcome to move south of the border and see how much ... better ... things are here firsthand.

Either that, or propose some changes to the Canadian system to improve it. “

I said at the beginning of my comments that I’d much rather have Canadian than American health care.  I don’t want to get denied treatments or be forced to pay six-figures retroactively for a hospital visit.  I don’t claim that the American system is fair or just to the millions of uninsured who deserve some coverage, but it is far better at creating innovative treatments, new procedures, whatever. 

I’m only listing the problems with single payer as I see them, and there are many.  It’s not that the U.S. health care system is unjust, unfairly rationed, tilted towards the rich OR that the Canadian system is equitable but it sucks.  Both are true. 

Changes to improve the Canadian system boil down to two recommendations:
1. Spend more government money. 
2. Spend more private money (by allowing private payment/insurance).

Option #1’s been going strong for the last few years, but now the coffers are empty again, so that leaves Option #2.  But would I really want some fat-cat businessman getting in line ahead of me for an MRI because of his supplementary private insurance coverage? Probably not.  But at least then that money gets spent in Canada instead of Mr. Fat-Cat driving over to Buffalo to get the scan, which he does right now.

<blockquotes> No Canadian on this board would claim to have gotten high-quality care back in the 1990s and very early 2000s. </blockquotes>

Ahem.  And ahem most people I know in Ontario and Quebec and BC, where I have friends and relatives.  I posted about my one-time 8-hour wait in ER for a gastro infection in another thread last week, but it certainly has never been the standard narrative IME—just fodder for lunch-time gripes.  The One That Stood Out, so to speak. Long wait times existed in that period—o my yes—but so did many more short or “normal” ones, and “quality of care” seemed to be the norm, with some sad variation from time to time that made news headlines or…lunch-time gripes…or selective memory orts, perhaps.

A year or so ago, there was an excellent article in some magazine (I think it was the New Yorker) about the rising number of people- fully insured people- who go to the ER with some serious health emergency and, due to the large number of uninsured people seeking healthcare at the ER, do not get treated soon enough and DIE. (I wish I had a link for you.)

This could have been me.

When I was pregnant, and had great health insurance (in fact I was employed by an insurance company), my face and arm went numb, and my doctor told me that yes, pregnant women are at higher risk for stroke than women in my age group would otherwise be. So I went to the ER because I might be having a stroke. They triaged me “urgent”, obviously considering it a likely possibility that yes, I was having a stroke. And then I wasn’t examined by a doctor for ten hours, and it was going to be another six before they could run a CAT scan to confirm whether or not I was having a stroke.

Clot-busting drugs, if given within the first three hours of a stroke, can often save all brain function. 12 hours after a stroke, there is *nothing* they can do, no medication they can give you to help recover your brain… at that point you’re in for rehabilitative therapy and good luck with that. I was at Johns Hopkins, one of the top-rated hospitals in the US. I am white, college-educated, and middle-class. I had good insurance, was pregnant and already had two kids I was supporting. And because of all the people at the ER who were actually *dying*, and all the people at the ER who couldn’t pay, which caused the ER to be understaffed (how can they not have an imaging technician available at night? 2-4 am is the most common *time* for strokes!), I could not be seen in time to have done a goddamn thing if I’d really been having a stroke. Thank god, it was probably a pinched nerve or something, but when I went in there I was having three of the four classic stroke symptoms and there was *no* way to know I would really be okay.

The difference is that new and innovative treatments, tests, and procedures are funded and tested privately.

Not in the US, they’re not.  Didn’t you know?  They’re tested at public universities using federal money.  Sometimes a drug company will kick in some money once something shows some promise, but 90 percent of the research done in the US is done with government money, not private money. 

Long wait times in ER?  Noone has disproved that.

Yes, I did.  Note above where I linked to the article that pointed out that Canadian wait times and US wait times aren’t even measuring the same thing.  US wait times measure how long it takes for someone to first see a doctor in the ER; Canadian wait times measure how long it takes someone to be released from the ER. 

1/4 of Canadians don’t have a GP?  Nope, noone’s disproved that either.

That’s still better than the US.  Which is, you know, kind of the point.

What you obviously do not understand is that a sick person in need of money is perfectly free to dump their insurance company and seek another to cover them if they’re unhappy with the service. That’s the beauty of the free market…

Heh. Thanks for pointing out (with bone-dry wit) the other fantasy capital-L Libertarians like to indulge in.

I most certanly would not trust this at the current State level but I am sure the Right is opposed to nationalizing insurance regulation.

IIRC, they’re actually in favor of it, because they’re dreaming of nationwide consolidation that will result in massive campaign donations.  Think about how media conglomeration worked and then think about what happens when all of those regional insurance companies get bought up by the medical equivalent of Clear Channel.

In short, lies about “rationing” of health care have traction because people don’t understand how getting all your care at the emergency room affects the system?

I think they have traction because people feel like if they are lucky enough to have insurance, and they feel like they’re hanging by a thread, they worry that including more people might make what they have even worse or even more costly, or even blow up the whole system, costing them the advantages they now have and want to keep.  So, privilege, mostly.

Despite the bullying tone Bob Somerby’s increasingly adopted towards, well, everyone that isn’t him, I feel like his point about how much we pay into the system per household for NOTHING that helps our health—which Somerby thinks we should call being looted—is quite convincing.  Basically we’re all helping to fund a money machine that’s based on thievery, only they whitewash it by giving us a modicum of health care, as little as required to maintain the scam.  It’s about like Madoff:  it’s bad enough to take someone’s money and blow it on risky investments; it’s so much worse to just take someone’s money and make it into a big pile.  That’s what the insurance companies are doing to us.

So I took a look at some of the FAQs out there. Private health care is perfectly legal in Canada. You can pay for anything you want that the public healthcare system doesn’t cover. What you can’t do, apparently, is set up a practice where you treat patients being paid for by one of the provincial plans with one set of fees and those paying privately with a different set of fees.

“Think about how media conglomeration worked and then think about what happens when all of those regional insurance companies get bought up by the medical equivalent of Clear Channel.”

I’m thinking along the lines of Microsoft crossed with Enron.  Ugghhh!...

It’s not about the insurance, it’s about accepting any private money.  In Canada, a physician can’t give you any treatment/procedure unless it’s approved by the government, which means it’s funded by the government, which means that you aren’t allowed to pay for it privately.

And in the U.S., a physician can’t give you any treatment/procedure (FDA approved or unapproved) unless it’s also approved by your private insurer—at least not if he’s expecting to get re-imursed for it.

In both the US and Canada, you can go out of system and pay out of pocket. The Canada Health Act, 1a clause you quoted refers to approved and established in-system procedures.

Here’s the situation, laid out by scenario in Canada:

1. Treatment medically approved, covered by insurance (most common medical procedures): you can get the treatment, and absent clear fraud the government must (repeat must) pay out under the terms of its insurance plan.

2. Treatment medically approved, not covered by insurance (e.g. elective plastic surgery, psychological therapy, dentistry, optical exams, meds): you can get the treatment, but you pay for it out of pocket (or take additional private insurance).

3. Treatment medically approved, not covered by insurance (e.g. experimental treatments under standard approved under research trial protocols): you can get the treatment if you qualify for participant status, but you and/or the researcher cover the costs.

4. Treatment not medically approved, not covered by insurance: You’re on your own, and your doctor is probably breaking his professional code as well as the law—taking money only makes things worse.

Scenario 1 is by far the most common one, and really the only one where the two systems differ, as follows:

1. Treatment medically approved, covered by insurance (most common medical procedures): you can get the treatment, but the insurer can try every trick in the book to get out of paying under the terms of its insurance plan.

Sorry, scenario 3 should read “Treatment medically approved, covered by insurance.”

Also, what Paul said @4:50PM. Private money can be and is accepted under a variety of circumstances, as long as it doesn’t undermine the system as a whole.

Third try (arghhh): scenario 3 should read:

3. Treatment NOT medically approved, covered by insurance (e.g. experimental treatments under standard approved under research trial protocols): you can get the treatment if you qualify for participant status, but you and/or the researcher may have to cover all or part of the costs.

BTW Peter01, the shortage of GPs has less to do with the payments, and more to do with the medical schools selecting people who are on the specialization track, and then trying to convince them to become GPs. 

In some places, the answer is a souped up nurse known as a Nurse Practitioner - they often have a lot more experience than GPs anyway and can do an excellent job of routine care.

No Canadian on this board would claim to have gotten high-quality care back in the 1990s and very early 2000s.

In Ontario, that period seems to coincide with provincial government by the sort of doctrinaire neoconservatives who gut as many government services as they can the moment they take power, to “prove” that the government can’t deliver. In Quebec, it seems a party more obsessed with nationalism and language than delivering health care and other services was in charge during that period.

“Is there any factual claim P01 has made that hasn’t been refuted?”

Yeah!  I know there are plenty of Kanucks that read Pandagon, if he’s full of shit, say so!

I’m registering and delurking to say: He’s full of shit.

There’s a pretty good rundown here on Snopes.  Relevant points include:

Other claims I’ve made?
-Long wait times in ER?  Noone has disproved that.

“The good news for the extremely ill is that 50 per cent of patients who require the most urgent care were seen by a doctor within six minutes and <NOBR>86 per</NOBR> cent were seen within 30 minutes of arrival in emergency departments.”

-1/4 of Canadians don’t have a GP?  Nope, noone’s disproved that either.

“A 2005 survey conducted by the College of Family Physicians of Canada, the Canadian Medical Association, and the Royal College of Physicians and Surgeons of Canada reported that “more than 4 million Canadians do not have access to a family doctor.” This figure represented about 12% of the 2005 population of Canada. “

Further stats on this can be found in this article on CBC.ca:

“The 2007 Canadian Community Health Survey found that among those who have no primary-care physician, about 78 per cent seek medical care elsewhere.  The federal agency says 64 per cent reported going to walk-in or appointment clinics, 12 per cent went to a hospital emergency room, while about 10 per cent went to a community health centre.  The remaining 14 per cent chose to use other types of health-care facilities or services such as hospital out-patient clinics, telephone health lines or doctor’s offices.”

The ONLY reason wait times have gone down in Canada (and we’re talking like, down from 12 hours in the E.R. to 4) in the last few years is because of the fat oil revenues the federal government has been raking in, which they have mostly spent on health care.  No Canadian on this board would claim to have gotten high-quality care back in the 1990’s and very early 2000’s.  Now that government revenue is shrinking, they’ll cut back on health care again.

I’m sure this initiative has nothing to do with it at all:

“The 10 Year Plan outlines strategic investments directed toward reducing waiting times for access to care, especially for cancer, heart, diagnostic imaging, joint replacement and sight restoration services. To support the reduction of wait times, the Federal Government committed to investing $4.5 billion over six years, beginning in 2004-05, in the Wait Times Reduction Fund.”

By contrast, in Canada, it’s against the law to pay for health care privately.  All the money for health care (with the exception of un-listed services like cosmetic surgery, some elective surgeries, and with the exceptions of some private for profit clinics) comes from the government.

“Canada is distinct from other industrialized countries to the extent that it does not have a parallel private system for the services covered by the public system. For example, care provided in hospitals and by family doctors is almost exclusively publicly funded.

Private medical care is not illegal in Canada. But the provinces do employ a number of disincentives to discourage a parallel private system. The disincentives used vary from province to province. One of the main disincentives used is to deny physicians the opportunity to work under the public insurance plan and to also have eligible patients paying privately. In other words, physicians are forced to choose between whether they will have only patients who pay for services themselves or patients who are covered under public provincial plans.

Some provinces deny any public subsidy to patients of physicians who opt out of their Medicare program. Some provinces do not allow physicians who opt out of the public system to bill patients more than what they would under the public system. Others ban the sale of private insurance for services covered by the public plan. It is this last legal disincentive which is the subject of a recent Supreme Court case [in which the court ruled that a Quebec law banning the sale of private medical insurance for medical services already covered by the public health care system violates Quebec’s Charter of Human Rights and Freedom]. “

Personal anecdote time: I have never, in any province I’ve lived in, been interviewed by a potential new family doctor.  And back in my roving student/co-op days (ie, between family doctors), I never once had a problem finding a walk-in clinic rather than going to the emergency room.

Amanda:

Waiting for an hour at the DMV has NOTHING on waiting for hours and sometimes days to get a routine maintenance on your cable when it goes out.

This is a great comparison which I will be borrowing extensively.

Heo Cwaeth:

I have a fear of women and gay men in particular being refused medical care because that care “conflicts with the morals of” the people in the state, nation, etc.  I mean, we know that the democratic party just lives for opportunities to throw ‘special interest groups’ like non-white, non-straight, non-male citizens under the bus so that they can seem reasonable.

I assume it’s going to happen.  If abortion is paid for under the final plan, I’ll eat my hat.  As MonkeyBoy noted, abortions are not allowed to be covered by private insurance *by law* in some states, and we have the Hatch Amendment as a federal precedent for not spending good Amercians’ dollars on eevul abortion.

I think our argument is simple:  Rationing already happens.  It costs us each $6,000 more than the next country, we die on average five years earlier, and twenty thousand adults die preventable deaths, and four thousand more infants die each year than other industrialized nations because of it.

We are paying six thousand dollars times three hundred million so that four thousand infants can die, never having taken a breath.

Whatever the President wants to do cannot be worse than this, can it?

Suck on that, pro-lifers.

Progressive liberalism argues (which argument we here all would endorse, it would seem) that there are certain things that government can do much better than private concerns.  However, in order to make this argument successfully, government needs to be (at least seen as) being half-way competent at getting things done.

People love the “government is inefficient” meme, but really, when was the last time you waited in long lines?  My last passport came to me in under two weeks, and I was able to do it all by mail, and that was without the expedite option.  The only time I’ve ever waited at the DMV was when I went on the Saturday half-day.  My foreign friends prefer applying for American visas over all other nations because the American embassy is fast, friendly, and reasonable about what documentation is required.  My friend is currently fighting to get a visa to visit Spain, and the Spanish embassy is asking him for things that don’t technically exist.  He’s gone back personally about four times.  My other friend said he likes the American embassy because they don’t play games: they put exactly what you need on a list, you just do it, and if they reject you they do so quickly and tell you exactly why.

When the government wants to, it can run a giant bureaucracy quite nicely.

Waiting for an hour at the DMV has NOTHING on waiting for hours and sometimes days to get a routine maintenance on your cable when it goes out.

One thing about the DMV is that it doesn’t have to move quickly.  Compare that to emergency services.  With some exceptions, like conveniently ignoring emergency calls to poor neighborhoods, police departments, fire stations, and EMTs do their best to respond to emergency calls quickly, and there’s usually political hell to pay if their response times are lagging.  No one cares enough about wait times at the DMV to do anything about it.  People do care about responses to crimes, fires, and medical emergencies, and they’ll certainly care as much about access to preventive medical care.

I gotta say, one reason the DMV moves so slow is that lots of people don’t bring all the proper documents with them, know all their information, etc.  Last time I had to go to the DMV—change license and car registration to new state—it didn’t take very long.  That’s because I went to the website before hand to see what I needed to bring with me, and then when I wasn’t sure, I called customer service.  When I actually went to the DMV, the clerk was quite surprised that I had everything in order.  Apparently that’s pretty rare.

Ditto the passport.  Read the instructions, people!

A state’s DMV can be easy or hard.

I’ve had no problems with DVMs in the past. However 2 years ago I needed to renew my driver’s license and I needed it fairly quickly so that I could show it to airport security for an upcoming flight.

My problem was that I was supposed to get a license renewal form in the mail but it never arrived.

So I went to my local DMV and found that it had been outsourced to the AAA. The employees there were mostly nice elderly women who quickly told me I could re-request my renewal by mail which might take two weeks or that I could go to a real DMV office downtown.

So I went downtown and sat in a waiting room for an hour while the guy next to me loudly talked to his friend about how he was a true libertarian and hoped to get his first job ever as a roadie for a rock band.

Then the DMV computer system crashed. The head of the office came out and apologized, and then personally told me that I was in the system and to come back the next day, ask for him, and pick up my new license without any wait.

Other than having to make two 4 mile trips downtown and listening to a libertarian blowhard most everything in my interaction was pleasant.

My main concern was with the Post Office who did not deliver my renewal form. I was worried that somebody had stolen it so that they could steal my identity. The nice DMV head gave me a good technical explanation about why that couldn’t work.

I don’t know why people are disrespecting DMVs. But then again I have never experienced one in a neighborhood where the DMV hates the clients because they are minorities. In my case there were lots of minorities at both offices I visited (and lots of white folks) but I noticed no disparity of treatment.

I’m thinking along the lines of Microsoft crossed with Enron.  Ugghhh!…

Adds a whole new meaning to the term “Blus Screen of Death”, don’t it?

“Welcome to the stroke help line.  Please hold, and one of our diagnosis specialists will be with you shortly…”

No Canadian on this board would claim to have gotten high-quality care back in the 1990’s and very early 2000’s.  Now that government revenue is shrinking, they’ll cut back on health care again.

Well, technically it was my wife who received excellent care for her cancer back then. She was 18, which means… 1993. She was able to go on disability, which meant better-than-welfare income. In fact, she had a real loser of a boyfriend at the time and as far as finances went, it was the best they ever did.

She had the latest in cancer treatments, and some of her fellow patients were receiving even more expensive treatments (like drugs containing platinum and crazy stuff like that) than she was.

Katherine:
“It’s also worth mentioning that some people seem to fundamentally misunderstood what “rationing” means in a national health service.  I read a hiarious comment from some joker who seemed, in all seriousness, to think that “rationing” on the NHS meant that once a hospital had done its quota of operations (or whatever) then it couldn’t do any more, and anyone who came along after they had reached their “rationed” amount. “

Actually, this is precisely what happens in Canadian health care.  A cardiac surgeon can only claim a certain number of surgeries per week/month or whatever from the public health system.  If he does anymore, he’s working for free, so he’s not working, so you really are waiting for it, since 99% of the money that comes into the system is from the government.

Yes, but I was talking about the NHS.  Y’know, the National Health Service in the UK, where I live.  These endless comparisons between the US and Canada are instructive, no doubt, but they in no way cover the whole gamut of healthcare options.

Which is that health care is already rationed severely, and reform is about finding a way to loosen the grip.  Of course, when insurance companies do it . . .

At least when an insurance company does that, you have the opportunity to change providers.  That possibility is absent when there is a “single payer” government monopoly.  If you are dissatisfied, you will have to write your congressman or wait for the next election.

The DMV got seriously better when the internet happened, because then everyone can see what forms and whatnot are required.

Bismarck, what psychotic fantasy universe do you live in in which the average person can change health care providers?  There are two choices at most, and both are bad.

PD, there are a fair number of health insurance providers in the U.S.  If your employer provides your insurance, you can at least make your case to them.  If you pay for your own, you are only limited by the licensing policy of your home state.  The limitations that we now have to deal with come from the federal and state laws that are already on the books.  The plan under discussion will further limit the choices.  We do need reform, but I think that this plan is moving in the wrong direction.

Canada Health Act, 12a
[the system must provide] “uniform terms and conditions, unprecluded, unimpeded, either directly or indirectly, by charges (user charges or extra-billing) or other means (age, health status or financial circumstances);”

Translation: you can’t pay for stuff privately, as it is judged that you paying to jump the queue for a procedure, then someone else is worse off because they couldn’t.

Sadly I actually knew that you would quote this one because there are far too many people who misunderstand it.  This doesn’t mean you can’t “pay for stuff privately” it means that:

A) Doctors and hospitals can’t “double dip”, it prevents the unscrupulous from charging patients for services AND then being reimbursed by provincial health service.

B) A facility can’t bump down patients covered by provincial health care in preference of those that pay directly. So no line jumping but that doesn’t mean they can’t pay, they just line up like everyone else.

Seriously it’s like you have no actual experience with the Ontario Health Care system.  You might want to actually bother googling it.  Or read Nancy_H’s post, which was excellent I might add.

Even within the system there are charges, tray fees, ambulances, “extra” medication charges, sick notes, disability assessments, physio therapy, “unnecessary” vaccinations etc.

By the way I love how you are using the MRI as an example because it is literally the easiest procedure to get done as an out of pocket private expense in Ontario (maybe all of Canada).

Courtesy of the Toronto Star. (October 6th, 2008)
“Across Canada, there are 42 for-profit magnetic resonance imaging (MRI) and computed tomography (CT) clinics, 72 private surgical hospitals (excluding cosmetic surgery facilities) and 16 “boutique” physician clinics, the Ontario Health Coalition says in a report…”

At least when an insurance company does that, you have the opportunity to change providers.

You truly are an idiot.

What exactly do you think happens to a sick person who needs money for their condition who goes looking for a new private provider to sign them up?