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Old 03-23-2020, 11:15 AM
Dr_Paprika is offline
Join Date: Oct 2000
Location: South of Toronto, Canada
Posts: 4,532
Single payer and other medical systems have been discussed elsewhere at length.

I’m going to discuss issues specific to coronavirus: centralized decision making, ability to carry out testing, supplying hospitals with needed equipment and public health messaging.

More government involvement in the medical system means potentially greater influence in how things are done. Centralized decision making may help get things done more quickly - hospitals are compelled to follow directives, a strategy can be made and articulated, regional hospitals have some guidance.

Carrying out testing means having access to testing kits and necessary reageants and labs, guidelines for whom to test, testing centres away from hospitals to divert the “worried well” or mildly symptomatic and a strategy for improving things and collecting and analyzing the data.

Supplying hospitals means manufacturing or procuring needed equipment including masks, PPE, ventilators and having available staff and enough hospital isolation and critical care beds.

Public health messaging means having experts involved in creating a strategy, having a consistent message, educating the public, cultivating an atmosphere of trust, avoiding an excess of fear, reassurance with regard to economic issues (and although health is “more important”, health and economic issues hugely overlap) and changing the message and strategy as new information is available.

Different countries have done these jobs at different levels of efficacy. Health system is a major influence on all of these things, though obviously government, media, business and society play key roles.

To discuss Canada, since I lack detailed knowledge of other places...

We have a degree of central decision making with a lot of local independence. Canada is not autocratic and there were some delays in deciding what to do but once done things happened reasonably quickly. Regions in this case have followed government directives and local differences in messaging have been small.

Canada has opened up nearly 60 testing centres after some delay and only tests symptomatic people or those exposed. Retesting is minimal and tests are limited due to system capacity. Since only public labs were being used initially, testing capacity is less and prioritized to more serious cases. A public system and some distrust of private involvement can mean delays.

Procuring supplies is done regionally, and medical licenses are provincial. Both smaller and bigger centres are running low on some supplies. The system is designed to use beds efficiently during normal operation and has very limited surge capacity. This needs to change.

Because people like the system, they tend to trust health messaging and are not generally concerned about being bankrupted by enormous bills (unless by the cost of obscure drugs for rare conditions or auxiliary costs). 35 million Americans have a friend or family member who died since 2014 due to high costs of treatment. But if treatment in Canada is unlikely to help, it may not be offered at any price. More than 50% of Americans fear the high costs of treatment. (Stats from January 2020 Harper’s Index). The question of how Canada responds to complex and changing circumstances remains to be seen. I think they have done a good job reacting to the crisis and an excellent job of messaging. Business have been supportive and the media informative with some fearmongering incidental to constant attention to the issue. Backing off from measures is going to be tough, though, and the costs are both large and not fully known.
"A noble spirit embiggens the smallest man"

Last edited by Dr_Paprika; 03-23-2020 at 11:18 AM.