Your sanctimonious drumbeat of hyperbole taken directly from the talking points of the Democratic party are silly. But what's even sillier, is your phony repeated ROTFLMOA's. If you truly are that good at cracking yourself up with those simple barbs, then you have my sympathy.
Here is the dream system of health care Gore and Democrats want to inflict on Americans. Article....
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Canadian Health Care - A System in Collapse
fraserinstitute.ca
President Clinton may soon tell Americans that the cost of pharmaceuticals in the US requires consideration of Canadian-style drug price controls. Americans, he may argue, can have cheaper drugs without risk. Is this too good, to be true?
The evidence from Canada suggests Americans should be highly skeptical of such claims. Why? Canada's drug price controls cannot be separated from the overall state control of health care north of the border. The street runs both ways. You can't impose price controls without, at the same time, encouraging further government intervention in health care. What started in Canada as a public subsidy for hospital visits ended up as a near-monopoly which has effectively prohibited the private sale and purchase of health care services. This, in turn, has virtually eliminated Canadians' access to comprehensive health care insurance. The result in Canada of a political decision that government would both fund and administer health care is a system now in crisis; over-burdened, forced to ration care and unable to shake off a straight-jacket of centralized, bureaucratic planning.
Overview
In 1984, the Canadian government promised its citizens that health care would be "universal, portable, comprehensive and accessible." In reality, the system enjoys none of those traits.
NOT Universal - Despite the claims, not everyone is covered under the government-run health care system. Two provinces, British Columbia and Alberta require premiums to be paid or else an individual is not covered. Other provinces require residents to register in order to receive coverage. As a result, a fair number of people have no coverage. For example, studies show that in 1997-1998 about 170,000 people in British Columbia - 4.2 percent of the population - were not covered.
The British Columbia Medical Association expects that as many as 4,000 patients every day will be refused funding for legitimate medical care. At a large teaching hospital in Vancouver, 10 percent of emergency room patients have no coverage.
NOT Portable - A Quebec resident who becomes ill in another province must first pay out of his or her own pocket for health care services. Then the Quebec government will only reimburse them for what that service would have cost in Quebec. Canadians who fall ill abroad are not covered for all of their medical treatment. They frequently face large personal bills.
NOT Comprehensive - Each province defines what services are medically necessary and then only pays for those services. Pharmaceuticals and many surgical procedures are generally not covered for those under 65 and often only partially for those over 65.
NOT Accessible - The government's inability to fund the health care system sufficiently to overcome the inefficiencies of centralized control has resulted in the widespread rationing of services.
An Ontario study has shown that waiting times for cancer treatment in Canada are substantially longer than in the U.S. The times are also longer than what radiation oncologists consider to be the medically acceptable maximum.
Most recently, media reports in December 1999 and January 2000 told of emergency rooms being closed because of patient overload. On January 2, 23 of 25 Toronto emergency rooms were closed to all patients regardless of the severity of their illness.
In May 1999, the Canadian Medical Journal explained how in Ontario during one 12-month period, 121 patients were permanently removed from the waiting list for coronary by-pass surgery. They had become so sick that they could no longer undergo surgery with a reasonable risk of survival.
Rationing takes many forms. The Organization for Economic Cooperation and Development (OECD) ranks Canada in the bottom third of its 29 member countries for availability of medical technology such as MRI and CT scanners, yet it ranked fifth in 1997 national health expenditures. In the United States, due to private investment in health care services, there is no comparable shortage of capital and human resources. Increasingly, Canadians unable to obtain timely treatment for certain medical procedures at home come to U.S. facilities.
Attitudes are changing towards the merits of government-run health care as Canada's population ages and the demand for health care services grows. A May 1999 poll found that 76 percent of Canadians believe that the health care system is in crisis and 71 percent said that changes are necessary because today's health care needs are not being met.
Prescription Drugs in Canada
Government Bureaucracy + Price Controls = Less Choice and Access to New Drugs
As government control over health care grows, whether it starts with hospitals or prescription drugs, the resulting bureaucracies are forced to keep costs from rising. Remember funding is no longer provided by satisfied patients, but by disgruntled taxpayers. The simplest way to keep costs under control is to restrict patient demand. For example, health planners will retain older, more intrusive surgical treatments because the pain involved will lower demand: they will delay purchasing technology for new, less intrusive treatments because the lack of discomfort would only stimulate demand.
Just as the health bureaucrats restrict patient access to new medical technology, so, too, do they impose impediments to access of new prescription drugs. Starting with the drug approval process, the government's incentives do not favour the patient, but rather meeting its own budget targets. The longer the drug approval basis, the better -- the longer patients do not have access to more expensive new drugs, no matter their benefits. In order to further control costs, Canada's federal government imposes a set of price controls on patented drugs, thus further discouraging the availability of new drugs to Canadians. What's lost in government medicine is the primacy of the patient and the doctor to decide together on the best treatment choices. Health bureaucrats have taken upon themselves to "second guess" what treatments or what drugs should be administered.
Government Control Produces Delay
Government bureaucracy at the federal and provincial levels leads to significant delay in approving new prescription drugs in Canada. In fact, Canadians wait up to a year or longer than U.S. citizens do. The initial delay occurs at the federal level where, in comparison to the U.S., Canada takes 13 percent longer to approve new drugs. But that's not where the delay ends.
In addition to the longer approval process at the central government level, additional delays occur in the provinces. Each province has a "formulary" or list of drugs that the provincial health plan will pay for or subsidize for certain populations - primarily the poor, elderly and those in long-term residential care. Nova Scotia approves drugs for its formulary in 250 days. Ontario's wait is nearly 500 days. Of the 99 products approved in 1998 and 1999 by the Canadian federal government, only 25 were listed on the Ontario formulary. Ontario patients dependent on drug therapies for the other 74 approved drugs were simply out of luck.
Provincial decisions are further complicated by decisions made by various committees that review the therapeutic value of prescription drugs. Little is known how people are appointed to serve on such committees or what the necessary qualifications must be. These committees, funded by the government, are beholden to government, whose paramount objective is cost containment. Worse, these "gatekeepers" stand between patients and their medicines. From 1994-1998, only 24 drugs - 6 percent-- were deemed "breakthroughs" -- defined by Canadian officials as drugs that produce a substantial improvement over predecessors.
Price Controls -- Limited Choice, Less Access to New Drugs
While Canadian drug prices are often cited as less expensive than those in the U.S., the reason is a damaging system of price controls that limits Canadians' choice and access to new drugs.
The Patented Medicines Price Review Board (PMPRB) is a government "watchdog" agency over the pharmaceutical industry. It negotiates a final price for prescription drugs with pharmaceutical companies rather than rely on market forces such as anticipated demand and anticipated sales volume. Generally, a newly introduced drug cannot be priced higher than the highest cost existing drug use to treat the same condition. In other words, you cannot charge more than your competitors, even if for some patients, you have a better product. Under normal market conditions, a superior product will support premium pricing.
The Canadian system, therefore, penalizes patients who have difficulty with a more popular medicine but would thrive on the second, third or fourth developed medicine, which is similar but not exactly the same. Suboptimal patient response is a significant pharmacological problem that the Canadian government treats by simply ignoring it. In a modern world with 30 types of ice cream and 15 types of mustard at the local supermarket, it seems perverse that patients would not be given a choice of treatment drugs to find one that best suits patients' needs. In essence, the government has decided that the best choice is to give patients no choice at all.
This bureaucratic interference between patients and doctors plus the imposition of price controls has done nothing to improve the health care of Canadian citizens. In fact, according to a University of Toronto study, price controls did not contribute to overall health system price control or improve patient outcomes. Rather, price controls simply limited patients' choices so they must use hospitals more and rely on surgery in lieu of modern medicine.
New Drug Investment Discouraged
A perverse result of price controls lies in the creation of an incentive for Canadian research and development pharmaceutical companies to bypass Canada as a market for introducing their products. Canadian biotech companies dependent upon single discoveries may have to launch those drugs in the U.S. first to avoid an artificially low Canadian price. For Canadian patients in need of new drugs, this means longer waits for potentially life-saving treatment.
Patients Are Harmed
The most damaging aspect of price controls placed on prescription drugs is the harm they cause to Canadian patients - the very people government bureaucrats purport to help through their price controls. In truth, government-imposed price controls are an attractive choice because they carry limited political risk. Unfortunately, the short-term political expediency has helped create a system that is adverse to patients.
In British Columbia, 27 percent of physicians reported that they had to admit patients to the emergency room or hospital as a result of the switching of medicines mandated by the operation of the government reference price system. Confusion or uncertainty by cardiovascular or hypertension patients due to mandated medicine switching was reported by 68 percent of doctors while 60 percent observed a worsening or accelerating symptoms. British Columbia doctors for other types of patients reported similar problems with the result being an increase of patients who stop taking their medications and increased emergency room admissions. This patient confusion and uncertainly generated by government's price control system is a clear implication that the system operates for the convenience of government, not the well being of patients.
Conclusion:
Canada's health care is an experiment in government funding and control. After nearly thirty years, the results are clear. No matter how well-intentioned, no matter how well "planned," and even no matter how well funded, complete state control over health care cannot provide the same level of service as private providers. The government may have a role in subsidizing the less-fortunate, but to the degree that it directly, or evenly indirectly, either provides the services itself or seeks to direct prices, inefficiencies and perverse incentives abound. The result is lower standard of health care than patients and taxpayers have a right to expect. The Canadian experiment is failing to deliver on its promises.
American decision-makers should heed the lesson of the whole Canadian experience even if they are only examining one part of it, pharmaceutical price controls. They should not assume that they can adopt Canadian-style drug price controls without unleashing the dynamic of growing inefficiencies and public expectations leading to ever greater state control of the health care system.
Bad policy drives out good policy. The growth of state control of health care in Canada was evolutionary. So, too, might be the Canadianization of American health care. |
