BoatBanter.com - Canada's health care crisis

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Rick surmises:
=============
Looks like you're reading that into the story, not reading it.
Why would he have looked into going to the states for treatment
if he was unwilling to leave at all. I doubt that he can go to
other facilities in the health system he is tied to.
================

Well, why else would the reporter go into great length about how much a
day away from work would cost him and how he was unwilling to to accept
that loss and that he'd insist on staying in Penticton. If he were
willing to leave town, that would be an entirely irrelevant bit of
info. [Citation: "If he were to hire a roving notary to cover for him,
it would cost $220 a day, plus living expenses "I don't make that, so
the end result is I have to close my business." He has operated the
business in Penticton for 15 years...."] Clearly he's unwilling to
leave town to have the operation done.

frtzw906

rick recommends a reading that says very little about actual deaths
while waiting:
===========
should the people of Ontario be concerned by those numbers?
There are doctors there that think so...
http://www.cmaj.ca/cgi/content/full/170/3/354
==========================

Again, I commend you on your sources. I read this source and it is very
much a theoretical or hypothetical-case paper. Dr Hill presents a
simple compartment model. He hypothesizes that perhaps waiting times
could be reduced if, rather than giving hgh-risk patients priority for
sugery, those with lower risks were given that priority.

The concluding comments are what really counts:

"Thus, the natural clinical tendency to give priority to the group with
a higher mortality rate does not yield fewer deaths among patients on
the waiting list and leads to a larger overall waiting list. To reduce
the size of the waiting list by giving priority to the group with lower
mortality rate (see Table 1) would probably be considered cynical and
unethical, but it should be noted that such a policy would not increase
the overall number of deaths per year.

It can also be shown that these results hold where there are more than
2 risk groups.

This analysis is not intended to be normative or to constitute a
recommendation that priorities for surgery be changed. "

So, there you have it. An interesting theoretical exercise "not
intended to be normative or to constitute a recommendation that
priorities for surgery be changed. "

frtzw906

rick insists:
==========
Because what you really want is for 'special' treatment to end,
===============

YES I DO! Special treatment undermines the system.

rick maintains:
=============
You've continued to argue that no one has any special treatment.
That there are no ways to get ahead o the waiting lists.
===============

You've got me confused with someone else.

I've known for years about special treatment for cases like WCB cases.
It's ****ed me off for years.

frtzw906

rick gleefully asserts:
=============
LOL Thanks for admitting I'm right. There is a dual system
already in place in Canada. The prefered get to have their
treatment first, regardless of how many more serious cases may be
in front of them. Maybe the ministers pretend it doesn't happen
because they also take advantage of the system.
================

We've established that there is a degree of "duality". In the case of
the armed services, I'm willing to accept that. In the case of the
RCMP, I'm not convinced. In the case of WCB, I'm opposed. So, as a
citizen, I have an opportunity to voice my opposition and vote
accordingly.

As to other types of duality, you'll also know, since you're very
familiar with the Canadian system, that this is highly controversial.
Further, you'd know that provinces which support such duality risk
their federal funding for healthcare.

This duality is far from a "given" in the long term. Nonetheless,
Canada, no less than the USA and most western nations, must grapple
with healthcare issues. It is probably useful to explore options.
Perhaps the Bismark model might be more appropriate than the current
Beveridge model. Perhaps the American model (highly unlikely)?

Ultimately, the decision will be political. As such, it will be based
on values. Right now, if I were betting, I'd bet on a system that is
universal with priorities determined by medical need. "Special"
treatment appears to be anathema to most Canadians (according to all
polls).

frtzw906

KMAN points out:
===============
That's why many Canadians are passionate about the issue and concerned
about the rise of private health care. They are desperate to avoid
becoming like the United States...

Maybe the ministers pretend it doesn't happen
because they also take advantage of the system.

Could be. What's your point? That the US doesn't have a monopoly on
selfish scumbags? We know that.
=================

KMAN is absolutely correct. Canadians are passionate about this issue,
and most (the VAST majority - check the polls) want no part of an
American-style system. Don't forget, we've tried that and discarded the
TShirt.

So when there are flaws (name a system that has no flaws), we're also
keen about fixing them. When there are selfish scumbags, the loopholes
they used need to be plugged.

Like ALL systems, it's a "work in progress".

frtzw906

KMAN shares:
================
On a lighter note, I share with the group a low-res version of a photo
that
I call "Melt...Please?"
===================

Melt? What are you talking about?

Surely you guys don't still have ice and snow?!

Condolences from the WEsT COAST.

frtzw906

A Usenet persona calling itself BCITORGB wrote:

Scott insists:
===============
Everyone should be able to seek out a hospital and/or a surgeon
that can provide service immediately. In Canada, while people sit on
waiting
lists, beds in hospitals are empty or occupied by chronically-ill
patients.
Even if your local hospital is idle, if you're not at the top of the
list,
they won't help you.
===============

If beds are empty and the hospital is idle, why wouldn't they help you?

Because they don't have any money or staff, and evidently because government
bureaucrats don't give a damn about sick people and don't want to fill
hospital beds because it makes them look bad to be at capacity all the time.

It seems to me, you get waiting lists (waits of any kind) when
enterprises (including hospitals) are operating at or near capacity.

That would be true. But in the free market model, when such shortages occur,
the market responds with more beds and services.

You'll wait when there are no more beds, no more doctors, or no more
nurses. What other reason would there be to wait?

The question is *why* are there no beds, nurses or hospital rooms available.

One of the most discussed waits in Canada appears to be MRI's. It seems
we've not bought enough. On the other hand, it appears they're as
commonplace as slurpy machines at a 7-11 in the USA. Quite likely,
we've been a bit miserly when it comes to MRI's. On the other hand, all
the private clinics in the USA which sport these spiffy macines are
going to have to recoup their investments. This they do by taking it
out of the pockets of those who require the MRI.

Well, not quite. They can't simply charge whatever they want because their
customers will go to a competitor, so they have to keep the prices down.
Other than that, what's wrong with their providing a service for a fee?

The Canadian government sees no need to spend more money on MRI machines
because there's no economic reason to do so. They, like most government run
enterprises, don't respond to marketplace pressures, they respond only to
political pressures.

So, wait for a couple
of days in Canada, or wait a few minutes in the USA (and pay dearly for
the convenience).

Try "wait a year or more" in Canada.

"Although computer scanning (in place of conventional x-ray) is routine
diagnostic procedure in the United States, a patient in Ontario can wait as
long as a year and four months for an MRI scan."

If hospitals are "idle", there's absolutely no waiting. They quickly
spring into action.

You would think, but evidently not:

"Despite many recent claims, there is little evidence of efficiency in
countries with national health insurance. While people wait for months and
even years for hospital admission, hospital managers appear uninterested in
admitting more patients.

€ While more than 50,000 people wait for surgery in New Zealand, at
any point in time one in five hospital beds is empty and one in four is
occupied by a chronically ill patient using the hospital as an expensive
nursing home.

€ While more than one million people wait for surgery in Britain,
at any point in time about one-fourth of all beds are empty and another
one-fourth are being used by nursing home patients.

€ While more than 250,000 people wait for surgery in Canada, at any
point in time almost one in five hospital beds is empty and a fourth of all
beds is being used by nursing home patients."

Where do you get your data?!

National Center for Policy Analysis, Report 166

frtzw906

--
Regards,
Scott Weiser

"I love the Internet, I no longer have to depend on
friends, family and co-workers, I can annoy people WORLDWIDE!" TM

© 2005 Scott Weiser

Scott simplistically states:
==================
But in the free market model, when such shortages occur,
the market responds with more beds and services.
====================

But... http://www.usaweekend.com/03_issues/...831nurses.html ...

"More than 126,000 nursing positions in hospitals around the country
are unfilled, according to the Joint Commission on Accreditation of
Healthcare Organizations. In addition, the workforce is shrinking,
because it's aging (and retiring) at twice the rate of other
occupations."

Hmmmm.... as far as I can tell, there are shortages of medical
personnel EVERYWHERE; whether in the Canadian system or the American.

There are likely a myriad of reasons, but allow me to ride one of my
hobby horses: as far as docs are concerned, it's the doctors' unions (I
know they don't call them unions, but they're the toughest one of them
all). They very successfully play the supply management game. The
enrollment in universities is influenced by the "union". And, let's
face it, the entrance requirements to get into med school in both
Canada and the USA are nuts. If med schools pumped out more docs and
nurses, neither Canada nor the USA would have shortages.

This is not a free market vs any other kind of system issue, because
there is no free market in the supply of labor in this industry.

frtzw906

A Usenet persona calling itself BCITORGB wrote:

Scott, commenting on many (most) in Canada getting immediate ca
==================
Yup. While at the same time, teenagers who need knee surgery have to
wait
three years.
==================

Notwithstanding the protestations of rick, several of us from Canada
have commented on, and admitted, that one of the consequences of our
style of healthcare is that, for some procedures, there are waiting
lists. That's a fact. But it's a price we're willing to pay,

I doubt you speak for everyone, or even a substantial number of Canadians,
given how much dissatisfaction there is in Canada now and how many calls for
privatization and reform.

So let's take the cae you bring up: teenagers who need knee surgery. I
don't know if teenagers in Canada who need knee surgery nmust wait 3
years as you claim. [Aside: you might be able to pull such an isolated
case out of the archives somewhere, but it is unlikely to be the rule.]

Now let's switch our focus to the USA for one moment. Let's also assume
a teenager who needs knee surgery. Let's further assume that this kid's
family is uninsured.

Can we expect that she'll get immediate attention at her local
hospital? Or will she need to wait?

She need only wait till the money's available or her parents can find a
charitable program or hospital to do the surgery pro bono. In Canada, it's
not possible to take out a loan or get a grant and get the surgery done in a
timely manner, so what was an acute injury will turn into a chronic
disability due to lack of timely medical care that may cripple the child for
life.

Is it likely that as people with
insurance arrive, some "bureaucrat" in the hospital will priorize and
thereby establish a "waiting list"?

Nope. The priority is set by the patient.

Can you assure me that, under the American system, the teenager will
get immediate attention,

Yup.

ahead of those with (a) more emergent need

Yes, because she can go to a specialist surgical clinic that only operates
on knees, and in so doing, avoid the critical care queue for emergent
patients.

(after all, she did arrive ahead of them) and (b) those with equivalent
need but covered by insurance?

There's lots and lots of surgical specialty clinics in the US.

Tell me about your waiting lists for non-emergent cases without
insurance, OK?

That would be, perhaps, a list used by a charitable organization. However,
the point is that in the US, the teenager is not *prohibited* from seeking
out and obtaining any medical care that she needs from a provider willing to
provide the service. In Canada, no matter how willing the surgeon, no matter
how ready the charity is to pay for it...or the parents for that matter,
government bureaucrats decide who gets to be treated.
--
Regards,
Scott Weiser

"I love the Internet, I no longer have to depend on
friends, family and co-workers, I can annoy people WORLDWIDE!" TM

© 2005 Scott Weiser