Healthcare in Canada

[Charles Anthony]

Is this wait the result of a lack of specialists? I've heard there are smiliar waits for sleep studies in the States just because there are so many people suffering from a sleep disorder and not so many specialists in the field.

I could be in at Belleview in Detroit, MI in a week if I was willing to pay. If I could I would.

With all due respect, you are not answering the question.

Why must you wait for the service you need?

If you need a sleep disorder specialist, but there are very few of those in your province and no new specialists want to come to your province no matter how much they get paid, how can you blame the government???

There are illnesses that exist which have no cure.

There are illnesses that are treated by very few specialists in the entire world.

There are people waiting for organ and marrow transplants.

There are people waiting for compatible blood transfusions.

There are accident or violence victims whose lives depend on the arrival of paramedics.

All of those patients have to wait too. Is that all be the government's fault??

It is physically impossible to serve everybody instantly -- to varying degrees, there will always be a wait for service.

Canadians need to grow up and lose their stigma against reform. Until then, we'll all suffer. Two tier is already here, those that can afford to fly south for fast treatment, and those that can't and suffer in our system.

Correct. It has always been here. Expanding two tier to allow more privatization will take people (willing to pay extra) out of waiting lists and let the very poor move along waiting lists faster.

Start demand privatization in Canada or wait in line!

[jbg]

If I or my husband had to use the US system we would have no health care. We never made enough money to pay for it. We worked hard all our lives but we never made over $14 an hour. Can you save money on that wage. There are a lot of Canadians like us.

As a practical matter, most get it through their employment, because of the tax incentives.

[Hicksey]

Is this wait the result of a lack of specialists? I've heard there are smiliar waits for sleep studies in the States just because there are so many people suffering from a sleep disorder and not so many specialists in the field.

I could be in at Belleview in Detroit, MI in a week if I was willing to pay. If I could I would.

With all due respect, you are not answering the question.

Why must you wait for the service you need?

If you need a sleep disorder specialist, but there are very few of those in your province and no new specialists want to come to your province no matter how much they get paid, how can you blame the government???

There are illnesses that exist which have no cure.

There are illnesses that are treated by very few specialists in the entire world.

There are people waiting for organ and marrow transplants.

There are people waiting for compatible blood transfusions.

There are accident or violence victims whose lives depend on the arrival of paramedics.

All of those patients have to wait too. Is that all be the government's fault??

It is physically impossible to serve everybody instantly -- to varying degrees, there will always be a wait for service.

Canadians need to grow up and lose their stigma against reform. Until then, we'll all suffer. Two tier is already here, those that can afford to fly south for fast treatment, and those that can't and suffer in our system.

Correct. It has always been here. Expanding two tier to allow more privatization will take people (willing to pay extra) out of waiting lists and let the very poor move along waiting lists faster.

Start demand privatization in Canada or wait in line!

Primarily, I wait because of waiting lists which would lend to a shortage of specialists--here. Its obvious there isn't a shortage of specialists in Detroit if I can get in in a week.

The secondary reason I have to wait is because I cannot afford to go outside the country to get the care I need.

I believe that with each paycheque I receive that I have paid my taxes on, I have already paid for my health care and should not have to leave my country to be properly cared for in a reasonable time frame.

I would expect a month or two, maybe three, but six with no initial consult after which I have to wait further for an actual date for the tests? That's unreasonable for a relatively uncomplicated and inexpensive diagnostic procedure IMO.

If I am to be denied the care I need, then I should be refunded the money I paid for it.

I CAN blame the government. They pledged to provide my health care if I agree to let them tax me to pay for it. They are taxing me and I am not getting the care I need. Its legal fraud. It is their responsibility to overcome the challenges, not mine to pity them for not meeting their obligations. I did my part in paying my taxes. Now, its their turn.

I don't mind paying for it if I get what I pay for. I am getting nothing and paying dearly.

[scribblet]

If I or my husband had to use the US system we would have no health care. We never made enough money to pay for it. We worked hard all our lives but we never made over $14 an hour. Can you save money on that wage. There are a lot of Canadians like us.

As a practical matter, most get it through their employment, because of the tax incentives.

Or they qualify for medicaid - right? Am I correct in believing that the low income people are not turned away, and are entitled to hospital care. That anyone can get free medical care at any emergency room in the country and will not be turned away?

As to Canadian health care, I have a real problem at not being able to purchase some services if I wish to. I can get an MRI for my pet right away, but cannot pay for one for myself. It is ridiculous that Canadians cannot pay for diagnostic services if they wish to, but on the other hand the gov't funds abortions in private clinics - go figure.

[geoffrey]

Tons of charity and teaching hospitals that provide care free or dirt cheap as well in the States.

The Health Care horrors of the US are limited, it's a populatio of 300mil, of course they'll have some trouble. The ratio in Canada I'm sure is much higher. In the States at least you have a choice if you want to live or die, in Canada, you just die waiting because the government tells you to.

That's why the Supreme Court ruled against the current system, saying it violates your rights. You should not be forced to die due to the government's incompetance at running the system.

[Hicksey]

If I or my husband had to use the US system we would have no health care. We never made enough money to pay for it. We worked hard all our lives but we never made over $14 an hour. Can you save money on that wage. There are a lot of Canadians like us.

As a practical matter, most get it through their employment, because of the tax incentives.

Or they qualify for medicaid - right? Am I correct in believing that the low income people are not turned away, and are entitled to hospital care. That anyone can get free medical care at any emergency room in the country and will not be turned away?

As to Canadian health care, I have a real problem at not being able to purchase some services if I wish to. I can get an MRI for my pet right away, but cannot pay for one for myself. It is ridiculous that Canadians cannot pay for diagnostic services if they wish to, but on the other hand the gov't funds abortions in private clinics - go figure.

If you end up in an emergency room in the US you cannot be denied life saving care. They can patch you up to send you to a government run hospital if you cannot pay or do not have insurance, but they cannot deny you care. While Clinton was in office that was passed through the house and senate, in 1993 I think.

[scribblet]

Tons of charity and teaching hospitals that provide care free or dirt cheap as well in the States.

The Health Care horrors of the US are limited, it's a populatio of 300mil, of course they'll have some trouble. The ratio in Canada I'm sure is much higher. In the States at least you have a choice if you want to live or die, in Canada, you just die waiting because the government tells you to.

That's why the Supreme Court ruled against the current system, saying it violates your rights. You should not be forced to die due to the government's incompetance at running the system.

I agree, but I change doesn't seem to be coming, even the CPC is reluctant to allow more private options.

[jbg]

Or they qualify for medicaid - right? Am I correct in believing that the low income people are not turned away, and are entitled to hospital care. That anyone can get free medical care at any emergency room in the country and will not be turned away?

You're pretty much right. Our gap is with self-employed people, and people employed by small businesses. That's unfortunately where the perfection of our system ends.

[geoffrey]

Or they qualify for medicaid - right? Am I correct in believing that the low income people are not turned away, and are entitled to hospital care. That anyone can get free medical care at any emergency room in the country and will not be turned away?

You're pretty much right. Our gap is with self-employed people, and people employed by small businesses. That's unfortunately where the perfection of our system ends.

Even with that gap, I'll take the American system of choice over our system of denied care. Even better, I'd take France or Norway's system, accessible and people don't die waiting!

[jbg]

Even with that gap, I'll take the American system of choice over our system of denied care. Even better, I'd take France or Norway's system, accessible and people don't die waiting!

Mypoint is, despite my love for and pride in my country, not to oversell its virtues.

[jdobbin]

Tons of charity and teaching hospitals that provide care free or dirt cheap as well in the States.

The Health Care horrors of the US are limited, it's a populatio of 300mil, of course they'll have some trouble. The ratio in Canada I'm sure is much higher. In the States at least you have a choice if you want to live or die, in Canada, you just die waiting because the government tells you to.

That's why the Supreme Court ruled against the current system, saying it violates your rights. You should not be forced to die due to the government's incompetance at running the system.

This is a huge promotion of the U.S. system. If it is true, why are there 40 million people in the States uninsured and why aren't they going to the doctor if it is free?

And you say that there are more mistakes in Canada but offer no evidence.

[jdobbin]

If you end up in an emergency room in the US you cannot be denied life saving care. They can patch you up to send you to a government run hospital if you cannot pay or do not have insurance, but they cannot deny you care. While Clinton was in office that was passed through the house and senate, in 1993 I think.

In practice, it is what they called "treat and street."

It doesn't mean that you getting identical treatment to a paying customer.

[Hicksey]

If you end up in an emergency room in the US you cannot be denied life saving care. They can patch you up to send you to a government run hospital if you cannot pay or do not have insurance, but they cannot deny you care. While Clinton was in office that was passed through the house and senate, in 1993 I think.

In practice, it is what they called "treat and street."

It doesn't mean that you getting identical treatment to a paying customer.

You are right in that.

An aside.

You know why I think the last CPC promise has gone unmentioned and essentially forgotten? I think it was an ignorant promise, one that they thought they could do because they had no grasp of exactly how bad waiting times were, the number of people on them and the associated costs of moving them outside their area to get care. Once they found out it would likely bankrupt the system they just decided the best course of action would be to let it die and hope the political consequences wouldn't be too much to bear.

[Renegade]

The United States rations healthcare through cost. Rich people or insured people can get the tests fast because they will pay whatever it costs. The uninsured or the under insured don't even bother to show up or get denied tests because they can't afford it or it isn't approved by their companies.

Virtually every essential (food, shelter, clothing, etc) is rationed on the basis of cost. For better or worse, money is the way society measures the worth of each individual's contribution to that society. It is a fact of life that the more the worth of an individual's contribution, the more he gets to partake in the rewards of society. Personally I don't see why medical care should be any different.

There is much to be said for the system we have in Canada, but there is also much to fault in it. One fault is that we refuse to allow people who can improve their personal medical care, to do so by buying better care, on the grounds that it would be unfair to others. We seem to be blind to our own hypocracy in that we allow people with money to buy better food, shelter, and education than those who don't have it. We see nothing wrong with that, but yet have an emotional and irrational response when it comes to healthcare.

[Hicksey]

The United States rations healthcare through cost. Rich people or insured people can get the tests fast because they will pay whatever it costs. The uninsured or the under insured don't even bother to show up or get denied tests because they can't afford it or it isn't approved by their companies.

Virtually every essential (food, shelter, clothing, etc) is rationed on the basis of cost. For better or worse, money is the way society measures the worth of each individual's contribution to that society. It is a fact of life that the more the worth of an individual's contribution, the more he gets to partake in the rewards of society. Personally I don't see why medical care should be any different.

There is much to be said for the system we have in Canada, but there is also much to fault in it. One fault is that we refuse to allow people who can improve their personal medical care, to do so by buying better care, on the grounds that it would be unfair to others. We seem to be blind to our own hyprocracy in that we allow people with money to buy better food, shelter, and education than those who don't have it. We see nothing wrong with that, but yet have an emotional and irrational response when it comes to healthcare.

I had not thought of this in these terms before. This is a great point. And the irrational response dictates that the one we need the most is the one that the restrictions are placed upon. We don't need more expensive food, shelter or eduation as much as we need better health care.

So why is this?

[jdobbin]

Virtually every essential (food, shelter, clothing, etc) is rationed on the basis of cost. For better or worse, money is the way society measures the worth of each individual's contribution to that society. It is a fact of life that the more the worth of an individual's contribution, the more he gets to partake in the rewards of society. Personally I don't see why medical care should be any different.

I have no problem with supplemental insurance or people paying for swifter diagnostics. I do have a problem if this leads to people who don't pay extra not getting the service at all.

[Hicksey]

Virtually every essential (food, shelter, clothing, etc) is rationed on the basis of cost. For better or worse, money is the way society measures the worth of each individual's contribution to that society. It is a fact of life that the more the worth of an individual's contribution, the more he gets to partake in the rewards of society. Personally I don't see why medical care should be any different.

I have no problem with supplemental insurance or people paying for swifter diagnostics. I do have a problem if this leads to people who don't pay extra not getting the service at all.

That's all I want. Let them buy their insurance and build their clinics. Just get out of the line in front of me.

One thing that must be is that these clinics cannot be subsudized any more for a procedure than a government owned procedure. Anything beyond that they'll have to get from their patients and their insurance companies.

[Renegade]

I had not thought of this in these terms before. This is a great point. And the irrational response dictates that the one we need the most is the one that the restrictions are placed upon. We don't need more expensive food, shelter or eduation as much as we need better health care.

So why is this?

We have created an artifical situaion in Canada in order to provide "universal" healthcare. We are far from the most efficient healthcare system, but we are far more efficient than the US. Cost are contained in Canada in a number of ways:

1) Having a single-payer system. This pretty much eliminates the overhead of the HMO approach which adds a lot of adminstative cost.

2) Regulating the costs that healthcare providers can charge.

3) Limiting access to certain high-cost procedures and drugs.

Points 2 and 3 above have a number of consequences. Regulating the cost of procedures, has in impact on the wages of professionals in the healthcare industry, resulting in many of them leaving ot more lucrative environments. Limiting access means that certain procedures or drugs are either not available at all or have prohibitive wait times.

Here are some of the things which can be done to improve our healthcare system:

1) Improve the supply of healthcare workers. It seems obvious in market economics the greater the supply the lower the price given stable demand. We can increase supply in a number of ways including fast-tracking foreign doctors and nurses for immigration and practice, greatly increasing the number of spaces in medical schools. The caveat is if the government invest in educating doctors, they would be obliged to commit to serve in Canada.

2) Restrict the "free" healthcare to basic healthcare. Individuals should have to buy an insurance plan to cover all procedures and drugs over what is considered "basic"

3) Remove the restrictions on private health care, allowing those who want to purchase better care to do so.

[Hicksey]

I had not thought of this in these terms before. This is a great point. And the irrational response dictates that the one we need the most is the one that the restrictions are placed upon. We don't need more expensive food, shelter or eduation as much as we need better health care.

So why is this?

We have created an artifical situaion in Canada in order to provide "universal" healthcare. We are far from the most efficient healthcare system, but we are far more efficient than the US. Cost are contained in Canada in a number of ways:

1) Having a single-payer system. This pretty much eliminates the overhead of the HMO approach which adds a lot of adminstative cost.

2) Regulating the costs that healthcare providers can charge.

3) Limiting access to certain high-cost procedures and drugs.

Points 2 and 3 above have a number of consequences. Regulating the cost of procedures, has in impact on the wages of professionals in the healthcare industry, resulting in many of them leaving ot more lucrative environments. Limiting access means that certain procedures or drugs are either not available at all or have prohibitive wait times.

Here are some of the things which can be done to improve our healthcare system:

1) Improve the supply of healthcare workers. It seems obvious in market economics the greater the supply the lower the price given stable demand. We can increase supply in a number of ways including fast-tracking foreign doctors and nurses for immigration and practice, greatly increasing the number of spaces in medical schools. The caveat is if the government invest in educating doctors, they would be obliged to commit to serve in Canada.

2) Restrict the "free" healthcare to basic healthcare. Individuals should have to buy an insurance plan to cover all procedures and drugs over what is considered "basic"

3) Remove the restrictions on private health care, allowing those who want to purchase better care to do so.

I think that your plan is good except I would like to add one thing. All hospitals should be government run. We do not want to get into what jdobbin has characterized as "treat and street" siutations. Private health care should be restricted to specialized clinics designed to let people who wish to pay to get the more restrictive and expensive treatment faster.

[Renegade]

I think that your plan is good except I would like to add one thing. All hospitals should be government run. We do not want to get into what jdobbin has characterized as "treat and street" siutations. Private health care should be restricted to specialized clinics designed to let people who wish to pay to get the more restrictive and expensive treatment faster.

What exactly is the philosophical difference between a private clinic and a private hospital? If I walked into a private clinic specalized in hip-replacement, with a gunshot wound and couldn't pay, do you not think they too would "treat and street".

Personally I don't have any issue with "treat and street". The phrase is created by opponents to the concept, but the idea is that emergency care is provided for and the patient is dispatched to the medical institution which can best accomodate their financial ability.

[Hicksey]

I think that your plan is good except I would like to add one thing. All hospitals should be government run. We do not want to get into what jdobbin has characterized as "treat and street" siutations. Private health care should be restricted to specialized clinics designed to let people who wish to pay to get the more restrictive and expensive treatment faster.

What exactly is the philosophical difference between a private clinic and a private hospital? If I walked into a private clinic specalized in hip-replacement, with a gunshot wound and couldn't pay, do you not think they too would "treat and street".

Personally I don't have any issue with "treat and street". The phrase is created by opponents to the concept, but the idea is that emergency care is provided for and the patient is dispatched to the medical institution which can best accomodate their financial ability.

First of all, unless you want to die, walking into a clinic with no emergency trauma care would be positively stupid. But if you did, you should be dispatched to the nearest hospital for care. From there, if you wish to be after-cared for in a fashion in a better environment and get rehabilitated better, then you pay to get that care.

[Renegade]

you should be dispatched to the nearest hospital for care.

If what you are suggesting is that as a policy, a private clinic don't provide any medical care (despite having qualified individuals) but instead dispatch someone in need of emergency treatment to a hospital, then you are suggesting a standard even lower than "treat and street".

With a "treat and street" policy, they are obliged to stabilze an individual before sending him off to a hospital. If you agree that a private clinic can stabize an individual prior to sending him for emergency care at a hospital, why can a private hospital not do the same?

[geoffrey]

This is a huge promotion of the U.S. system. If it is true, why are there 40 million people in the States uninsured and why aren't they going to the doctor if it is free?

Why should you expect to get something for free? They need to pay for insurance or pay to see the doctor. You do in Canada, through our taxes and premiums... and you don't even get care for that price. In the States, you choose what care you want, how much your willing to pay and the quality you recieve. It's even better in Europe where costs are covered by medical services are provided through private operations... no waits and no cost (no cost is a bit of stretch, there is a nominal fee in Sweden I know to discourage frivilous vists, great idea).

And you say that there are more mistakes in Canada but offer no evidence.

Waiting lists are all I need. You should not be forced to wait... or forced to die... if I want my leg/arm/heart/brain/whatever fixed, I should be able to pick where it's fixed, and when it's fixed. Waiting lists are all I need to prove our system is a failure. People die waiting because Canadians don't want to change... when really, the only other countries that share our health care values are North Korea and Cuba.

[Hicksey]

you should be dispatched to the nearest hospital for care.

If what you are suggesting is that as a policy, a private clinic don't provide any medical care (despite having qualified individuals) but instead dispatch someone in need of emergency treatment to a hospital, then you are suggesting a standard even lower than "treat and street".

With a "treat and street" policy, they are obliged to stabilze an individual before sending him off to a hospital. If you agree that a private clinic can stabize an individual prior to sending him for emergency care at a hospital, why can a private hospital not do the same?

Obviously a clinic would care for a patient and do what could be until an ambulance came to deliver them to proper trauma facilities. They wouldn't be able to stand there wide-eyed and watch someone die. In this instance the person gets the proper care they need, and is delivered to facilities equipped to handle the aftercare. Proper, not minimum, care on emergency cases should be the focus. Beyond that if people want more they can go pay for it.

[daddyhominum]

Waiting lists are all I need. You should not be forced to wait... or forced to die... if I want my leg/arm/heart/brain/whatever fixed, I should be able to pick where it's fixed, and when it's fixed. Waiting lists are all I need to prove our system is a failure. People die waiting because Canadians don't want to change... when really, the only other countries that share our health care values are North Korea and Cuba.

http://www.cmaj.ca/cgi/content/full/175/5/464

"The reports, collectively entitled The Future of Emergency Care, are the first extensive studies of US emergency care in the past 40 years. They present a bleak picture: a half million times a year — about once a minute — ambulances carrying critically ill patients are diverted from full EDs to more distant sites. Once stabilized, patients can wait several hours, even days, on gurneys in ED hallways for inpatient beds. On-call specialists are in short supply because of the cost of malpractice insurance and the difficulty of collecting payment from uninsured patients."

Apparently there are waiting lists for emergency services in the USA system. If forced to choose, I prefer the canadian system of waiting lists for surgery, especially elective surgery.