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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Lazarus_Long who wrote (73)	1/12/2005 11:38:45 AM
From: Solon	Respond to of 42652

"What isn't clear is that a socialize medical system overall would cost less or deliver better results" I don't have time right now to make an argument either way. But I think there is little doubt that it is more humane and more practical for society to treat health as a social resource. I will speak to that at another time...

To: Lazarus_Long who wrote (73)	1/12/2005 2:20:38 PM
From: fresc	Read Replies (1) \| Respond to of 42652

This Article sums it up! Canada's Single Payer Health Care System - It's Worth a Look Bruce Robinson -------------------------------------------------------------------------------- According to a Harris Poll of all industrial nations, Americans are the least satisfied with their health care. An economic overview of America's system is: 42 million people are not covered, the various health care plans place rigid limitations on which doctors and hospitals people can use, cost-saving measures are forcing patients out of hospital beds prematurely, administrative costs are approaching 25% of the health care dollar, managed care is generally structured such that physicians have incentives to cut costs and gain revenue by withholding care, and many Americans live in fear of losing whatever care they have. Our current system is based on the power of the insurance industry to stifle any challenges from alternatives. They advocate a competitive environment where they set the rules. These rules give us health care at a very high cost with unusually high profits going to the health care industry and massive salaries going to the associated executives. In contrast, the single payer system that Canada has used for the last 25 years has drastically simplified their administration costs. For instance, it takes more people to administer Blue Cross Blue Shield of Massachusetts that it does to administer the entire health care system of Canada. Before Canada implemented their national health program, their health costs were the same portion of their economy as in the U.S. After they implemented their program, their costs stabilized at 9% while U.S. costs have increased to 14%. They spend one tenth of what U.S. health care providers spend on overhead. The Canadian system is a publicly funded insurance program where costs are controlled and both hospitals and doctors are private. Any Canadian can go to any doctor or hospital in the country. Each province has its own system and its own unique way of funding it. In spite of this decentralized approach, there are agreements among all provinces that provide for treatment of any Canadian citizen regardless of where the need occurs. The great success of their system causes almost all Canadian politicians, even conservatives, to defend it vociferously. It is called single payer because there is only one "payer"; there is no alternative program, such as private health insurance, to which Canadians can turn for basic health care. Since the wealthy as well as the middle income people have no alternative, they make sure it is funded adequately. This together with cost controls insures that everyone including the poor, who use the same system, receives the same high quality care. Canada has a much higher percentage of general practitioners and fewer specialists. Canadian doctors make about one third less that American doctors and yet their satisfaction level is high because they have more time to practice medicine because paper work is minimized. Since there is a "single payer", it is easier to set up and adhere to budgetary limits. Effective planning eliminates duplication of facilities and expensive technology. In the U.S., competition has led to great redundancies in expensive equipment such as for CAT scans; doctor groups buy high technology equipment and then compete for selling these services. The economic advantages of the Canadian system are multi-faceted. Canadians are healthier and live longer than Americans. Preventive care to an entire population minimizes expensive care associated with undetected, untreated health problems. There is very little litigation because there is no need for awards to cover future health care costs; they are already covered. Further savings occur because there is no longer a need for a health insurance component of automobile or home insurance. There is less loss of productive labor due to absence and sickness and health care is much more practical and less expensive for companies to provide to employees. Estimates show that Canadians produce American cars for $700 less than Americans do because of the difference in the costs of providing health care to employees. The benefits to competitiveness are obvious. Both the Congressional Budget Office and the General Accounting Office estimated that if we were to implement a health care system similar to the Canadian one, we could extend coverage to all Americans while saving billions of dollars annually. During the health care debate in 1993, there were 89 cosponsors of the single payer system. And yet, it was not given serious consideration. One reason for this is the well-funded health insurance power structure with its effective lobbying forces in Congress. This single payer ballot issue will appear in various states in the upcoming years. It is anticipated that, just as with the 1994 California single payer ballot issue, the health industry will spend enormous amounts to defeat them. It is also anticipated that the issue will receive very little press coverage just as happened in California. FAIR (Fairness and Accuracy in Reporting) reported after studying the 1994 California ballot issue that there were no articles in the media during the entire pre-election period that pointed out that other countries have single payer systems or what their experience has been. Americans might be interested to know that Canadians live longer, have lower maternal mortality rates, and lower infant mortality. Before single payer was implemented in Canada, infant mortality was similar to that in the U.S.; today there are 9.1 deaths in the first year of life per 1000 births in the U.S. and 6.8 in Canada. In addition, they have more hospital admissions, more hospital days, more physician visits, more immunizations, and more surgical procedures per person than we have in the U.S. Ongoing misinformation perpetuates myths about long wait times for care, availability of high-tech care, and the amount and quality of medical research done. There are very small differences between the U.S. and Canada in these three areas. The large differences between the U.S. and Canada are in the tens of millions of people with no coverage or inadequate coverage in the U.S. The differences are also in peoples' losing everything they have and becoming destitute to cover medical expenses in the U.S. They're in the lack of preventive care in the U.S. which results in expensive treatment of illnesses in their later stages. Economic considerations are very important as are issues such as the general state of a country's health, the anxiety over health care and the level of satisfaction experienced by those in the health care industry. The economics certainly indicate that the Canadian approach should be observed and considered as a model for the U.S. The U.S. spends about $1000 per year per person more than does Canada. We have nothing to lose by giving it an objective analysis, seeking out both sides of the argument. It's worth a look. Quoting a letter to the editor from Ove Madsen in the Montana Senior Voice: "I have read all about the health care plans in the paper. I have done a little work to find out what the general public Canadians think about their health plan. Everytime I see a car with Canadian license plates, I go up and talk to them. They are all nice to talk with, and I ask them how they like their health care plan. So far, 99% of the Canadians I've talked to like their system. They say it is such a peace of mind and the service at the doctor's office and hospitals is really quite good. If the ordinary run of the people like it, that's all we need to know." According the Harris Poll of all industrial nations, Canadians are the most satisfied with their health care.

To: Lazarus_Long who wrote (73)	1/12/2005 2:34:20 PM
From: fresc	Read Replies (1) \| Respond to of 42652

How is this.. Costs matter: But in the US costs really matter. Over a quarter of Americans had out-of-pocket costs of over $1,000, compared to less than 5% of Canadians. Americans were two to five times more likely than Canadians to have an access problem due to cost, such as not getting a needed drug or not seeing a doctor. And when you look at those with below average incomes, in Canada only 9% failed to get recommended follow up care due to cost. In the US, over one third did not. More than a quarter of Americans (26%)--including 39% of those with below average incomes--didn't fill a prescription because of costs, more than twice the number than in Canada. 21% of Americans have problems paying medical bills compared to only 5% in Canada, and that goes for 35% of Americans with below average incomes. So on a macro level it's true that nationally Canadians sacrifice getting access to expensive resources (such as MRIs and surgeons). But in turn they don't have to put up with the individual cost issues that are a problem for many Americans, especially the poorer ones.

To: Lazarus_Long who wrote (73)	1/12/2005 2:38:31 PM
From: fresc	Respond to of 42652

Laz this sounds like you :)) The impatient inpatient: This is where the arguments get anecdotal, and little ridiculous. I never understand, for instance, why American small business owners who have to buy insurance in the world's most dysfunctional market complain so much about the prospect of Canadian-style health care. In 1993 I talked to a Rotary Club where, before I even got my international comparisons slide out, the small business owners in the room came after me with the classic anti-Canadian argument that goes something like "When he needed care the Prime Minister of Alberta/Nova Scotia/Yukon Territory/Canada came down to the US". There has always been an extremely limited number of Canadians getting new high-tech care in the US that isn't available in Canada, almost always paid for by their province. However this has been transposed into the argument that thousands of Canadians are flooding across the border to get care that is unavailable at home. There is even the very occasional and underfilled patient bus trip coming down to get prescriptions and treatments unavailable in Canada, of course massively outnumbered by the buses taking Americans to buy cheaper drugs up north. While the argument about Canadians flooding south to get medical care withheld from them up north is widely heard, it's bullshit. Yup, lots of Canadians get care in the US, but that's because, due to the better weather, the higher incomes, going to college or that NAFTA thing, they eitherlive here, or are on vacation in Florida to escape that terrible winter. Work done by a team led by Steve Katz at University of Michigan with the Evans/Barer/Cardiff team at UBC which looked into this in obsessive detail found essentially no evidence of Canadians crossing the border to get care. (Incidentally plenty of Americans are still going up there for non-covered surgery like laser corrective eye surgery, which is cheaper and just as good up north). In fact according to Canadian insurers there appears to be no interest amongst Canadian consumers in commercial insurance products to cover care abroad, other than standard holiday cover. Note that this is not the case in the UK, where private insurance allows about 10% of Brits to jump the queue to get surgery in a private hospital. So it looks like the Canadians accept the fact that they have to wait for surgery, and not surprisingly don't want to come down here to pay for it out of pocket.

To: Lazarus_Long who wrote (73)	1/12/2005 2:47:04 PM
From: fresc	Read Replies (1) \| Respond to of 42652

How about those Canadian Doctors :) It is logical for Canadian doctors who need no additional qualifications to work in the US to go south for another reason. It pays better; much better! Canadian physician incomes averaged about C$135,000, and even surgical specialists get only about C$180,000. In the US specialists in groups averaged somewhere between $150,000 and $350,000, primary care around $150,000--and don't forget that Canadian dollars are worth 1/3 less than their American namesakes! In fact this chart of international physician incomes shows that virtually any doctor would be better off moving to the US. (Actually FYI Japanese doctors make more than Americans). So when Medpundit says that Canadian doctors are coming here in droves, you can't exactly blame them. Only one little thing is a bit strange; they are not! The brave folks from UBC led again by my old colleagues Morris Barer and Bob Evans, as reported in this issue brief called The myth of Canadian physician emigration, show that although roughly 500 doctors a year are leaving to the US, somewhere between 250 and 300 were coming back the other way, and that the deficit was more than made up of other doctors immigrating to Canada--mostly Brits who thought that Canadian pay scales were pretty good compared to what they got at home! Even at its greatest extent Canada was losing 1.4% gross of its physicians and more than making it up through returning Canadians and importing foreigners. And even though Canada has fewer docs per head than the US (2.1 per 1,000 v 2.6) it has more than the UK or Japan (1.7 & 1.6) so these numbers are not significant either as a share of all doctors or proportionally to the population. It is worth pointing out that the other 99% of Canadian doctors didn't believe that doubling their salary was enough to compensate for the associated unpleasantness of having to move to the US!