Brits, Canadians, and others: tell me about socialized medicine

Great Debates
21

I find that explaining the “socialized” medical systems to Americans can best be done by analogy to the police department.

The police provide services to everyone, paid for by everyone (through taxes.) They set up a priority system – which cases are more urgent. For instance, when my 70-year old neighbor recently called the police because a bird flew down her chimney, she was told that they would get there eventually, but it was obviously a fairly low priority. She accepted that. If she had wanted faster action (or if I didn’t want to use the police but wanted a private cop), she could have paid for one.

Social medicine is much the same. The services are available to everyone, paid for by everyone (through taxes.) They have a priority system, which means that some cases will have long waits. If you want to bypass the queue, and you can afford it, you can always buy private.

No medical system is perfect, not until we can find a way to provide immediate, high-quality care to everyone at no cost. Every system will have its share of problems – Lord knows, the American free-enterprise medical system is not without flaws. Medical care is a limited resource. Under a social system, the allocation of that resource is based on need, as defined by the community (or by medical boards representing the community.) Under the U.S. system, the allocation of that resource is based on financial ability to pay.

Yes, there may be long waits under a social system. In contrast, there are people in the U.S. who never even seek treatment, because they can’t afford it. Our former cleaning woman always waited until her son was sick enough to warrant a visit to the emergency room (which was paid by Medicaid), rather than seek earlier treatment from a doctor (which she would have had to pay for.) So, there are still “long waits” under the U.S. system – you just never see them, and they’re not recorded statistically.

22

I should hasten to add that my comments above were directed at well-functioning medical systems of developed countries – Canada, UK, Australia, Sweden, Germany, France, and the like. If we get into the topic of developing nations, liek Brazil or Nigeria that claim to have socialized health systems, that’s a different story entirely.

23

Just so we know what kind of delays are being talked about here is a quote from an article in The Times about the UK’s health service.

"The average patient had to wait 203.8 days, more than 29 weeks, from seeing a GP to getting hospital inpatient treatment. "

24

For what kind of treatments, puddle?

I can only comment, my wife fell when we were in London and broke her ankle. We went to National Heatlh hospital in downtown London, we were x-rayed, a cast put on, and we were released in about two hours (it would have taken twice as long in a U.S. hospital, I suspect) … and we were charged nothing. Oh, wait, I lie, we had to put down a ten pound deposit on the crutches because we told them we were leaving the country.

Statistics on waiting periods, like all other statistics, can be distorted to prove whatever point you’d like to make.

25

Thats kind of generic, I would bet that the wait varies depending on the procedure. It’s also doesn’t mean much to me without knowing what the average wait in the US is, using the same criteria. Ideally, I’d like to see a list that compared wait times procedure by procedure, along with the number of procedures performed. (If the wait time on breast enlargements in the UK is 500 days, for instance, I really wouldn’t care. :p)

26

If the stats I found are correct there are in excess of 43,000,000 Americans without health insurance. If you are Hispanic one out of every three lives without insurance. All in all sixteen percent of Americans have no health insurance. This is from the U.S. census bureau (1996).

Our health care has a cost… since my employer pays half of my premium I pay a whopping $30.00 a month to cover a family of six. I also have extended benefits through my employer which get me 100% prescription coverage, 80% dental, and 100% ambulance coverage. Total cost is something like $46.00 / month. If we were destitute our health care would be paid for by the government. No-one has to be without health care here.

So far, I have no complaints with what I pay or the service we have received. When Lola was pregnant with our last child we had a health care nurse come to our home on a regular basis to check on her. When she was seven months pregnant she broke her ankle in a car accident and stayed in the hospital for three days. She needed to have a pin put into her ankle. The extra cost to us was zero dollars.

A client I work with just had open heart surgery to replace a defective valve. I lost track of how many tests were done and he is currently being seen by two cardiologists and his family physician. A health nurse comes to his home twice a week and the lab people come twice a week to take blood samples. He spent more than a month in the hospital and had a private room for three weeks. This is service that would be available to anyone here and there would be no extra cost to them.

Perhaps someone from the U.S. could tell me what this would cost an uninsured person and whether their insurance would cover this kind of care.

All this being said, our health care system is in a state of crisis. There is a gross shortage of nurses and there is a great debate on whether privatized health care should be allowed here to run alongside our existing system. With a federal election looming this is a big issue. Any party that would not support UHC hasn’t got a hope in hell of getting any votes.

Hospital closures and cutbacks do not sit well with us and I am one who would pay more to see our health care system improve. With an aging population there is going to be more and more demands on the system and the cost of delivering first rate service will cost more.

Canadians expect that there will be universal health care from birth to death and that health care should be available to everyone regardless of their financial situation. I see this as a sign of a progressive modern society. I do not want to see an American style of health care here ever. To have nearly one in five people living without coverage is unthinkable for us.

I get annoyed when people bash our system, we can do that ourselves. Canadians are experts at complaining about things that are really pretty good.

27

I did not cite that statistic to condemn the UK system, merely to inform the US dopers what kind of waits were being discussed. It seems to me that most Americans would not want to be told by their doctor “You have something wrong with you, come back in seven months and we will fix it.” I was miffed when I had to wait three weeks a while back.
When I was first out of college I went for a couple of years without health insurance. I had a low paying job and was very healthy so I chose not to get health insurance.
It is not true that those who do not have insurance can not get medical care. Everyone in America gets health care if there is an emergency.

28

This is incorrect. It is illegal to do so in Canada.

29

I think that puddleglum’s figure refers to elective, non-urgent treatments. Examples might include varicose vein removal and hip replacements; treatment for conditions which might be painful and even debilitating but are not life-threatening. It probably also includes waiting times for organ transplants, which are largely determined by the availability of donated organs, not hospital resources. For urgent treatments–heart surgery, cancer surgery and the like–waiting times are generally less than a fortnight and often only a day or two.

Reporting of waiting times is distorted in the British press because most papers fail to draw the distinction between a patient who is waiting for a procedure purely because of resource constraints (i.e. the doctors want to proceed immediately but there is no bed / theatre slot / etc.) and those who are waiting for clinical reasons (i.e. the patient is not in a condition to tolerate the procedure).

Every so often they run a story about somebody who has been waiting months for a coronary artery bypass graft (CABG) and it transpires that the patient has not given up smoking. CABG is not clinically indicated in smokers since the benefits are not great enough to outweigh the risks, so the patient is told to go away and come back in six months when he has given up. This is invariably reported as “Patient waits two years for life-saving op”.

30

**

My political ideology says that it is the governments job to protect the rights of individuals. Therefore it is acceptable for them to set up a police force to acomplish this goal.

I don’t view healthcare as a right so I don’t see why the government should be giving it away at my expense.

**

Almost every other resource in the US is based on financial ability to pay. Housing, food, clothing, and locomotion are all based on the ability to pay for it. Since medical care is not a right why should it be treated any different?

Marc

31

Many posters to this thread have asked for real life examples of waiting times. Some can be found at this Government of British Columbia sponsored web site on waiting times. Note that this site is hardly unbiased given its sponsor and note also that it is dealing with a generally very well serviced population unlike the case in some othe provinces.

There is mean wait for an “urgent” knee replacement of 21 weeks. Please note that does not include a similar period of waiting to get in to see the surgeon for the initial assessment. So, maybe a total wait of 40 weeks or so. There are many reports of total times of around two years in various areas.

The wait times vary according to the procedure. At my hospital a simple colonoscopy has a wait time of 4 to 6 months. MRI? A similar wait.

Again, if you’re an emergency case and admitted to hospital (assuming there’s space), you’ll get things done much faster. People don’t fall through the cracks for “life and limb threatening” illnesses (or at least they shouldn’t). The problem is that for less urgent stuff, you’ll wait. So, even if reading is your life, you’ll wait over a year for a cataract extraction to restore your vision. You’ll wait 9 months for a knee replacement etc.

Overall, despite the tone and content of this post, I think it is a good system. It does, however, test the patience of those whose illnesses have been deemed “less serious”.

A final word for the American reader: If you think health care is expensive now, just wait until it becomes free. One third of the provincial budget goes to health care, ie. one third of my provincial tax dollar. This is approximately equal to one sixth my total tax dollar (50:50 provincial to federal amounts). For that type of money I could get a hell of a private plan anywhere.

32

First why not look at the political background as to why NHS systems were set up.

For the UK WWI and WWII were a total disaster, coupled with the Great Depression they reduced the UK from being the most powerful nation on earth in 1900 down to 3rd by a long way and even in 1948 it was clear that this would continue.
The collective struggle by the whole of the British Commonwealth left most in those nations wondering how they would use the experience to improve society, one election slogan in 1948 was ‘A land fit for heroes’

Socialism was a response to this and the most obvious and pressing needs were ,

Feed the population - Americans as a nation have no real idea what shortages of every commodity including clothes, food and housing mean.

Provide work and guarunteed income for all - with memories of extreme deprivation from the 1925 general strike and government troops shooting starving miners on the streets of Featherstone (one of Churchills little quirks) there was a will to never be held in thrall of factory owners again. As a result many major industries were nationalised, no longer would they be under-invested for maximum returns and bugger the safety of the workers.(yes we all know that nationalisation didn’t work well)

Provide education - WWII caused massive social change and ordinary workers saw for the first time how the wealthy maintained their position, it was also seen as a strategic requirement as a badly educated workforce would not be capable of maintaining a major world power.This was done by providing university places on a scale not previously seen.

Provide universal healthcare - People who had fought and were injured both on war fronts and in their own houses during Nazi air raids demanded that their pain be justified by a society that cared for its own rather than leave them to the gentle mercies of the workhouse.
The British had decided that after decades of pain there should be some benefit in it for them.

These were the major issues in the 1948 general election and were promised by the Labour Party - The Conservatives led by Churchill wanted to go back to the old system of keeping people in their place and ‘respect us because Churchill was a great leader’

No wonder the Conservatives lost, yet Americans seem to think Churchill was betrayed, you are quite wrong, if anything it was the other way round.

Once the NHS was set up (and that is a story all of its own) the scale of unmet demand was simply staggering, it didn’t take long for other Commonwealth nations to realise that some sort of NHS was needed elsewhere.

The result of this was that the UK was rightly proud of its achievement and the NHS has a very special place in the British psyche - Think US gun laws, freedom and democracy and all the flag waving things that bring tears to the eyes of the US patriot and you are just about there.

I’ll leave it there for a moment and yes I agree that this post somewhat simplifies things but it does give you a good idea of why things in healthcare happened.
It might also give you an idea of the UK attitude to healthcare.

I’d get on to other issues but many of those have been explained, still I will add my two pen’orth later.

33

One might consider Life and Health to be rights that the government is obliged to protect.

34

KarlGauss: I’ve lived in both BC and Ontario, and I must say that something is very wrong with BC’s system, at least it was when I lived there 3 years ago. I lived right in Vancouver and couldn’t find a GP who was taking new patients. Luckily I was also a student at UBC, so could avail myself of their health services.

I haven’t had that problem in Ontario. The last time I tried, the doctors in my small town weren’t taking new patients, but I had no trouble when I went to the next city. As I said earlier, I’ve never had to wait more than 2 or 3 weeks for elective surgery (jaw surgery, hernia repair, wisdom teeth removal with general anesthetic). My sister got an MRI a couple of days after she told her GP about her headaches, and my dad just got a detached retina repaired the same day of diagnosis. This is all under Mike Harris’ regime as well.

So don’t judge all Canadian universal health care by one bad apple.

35

Firstly, there are lies, damn lies and health care. While GDP (Gross National Product) is the simplest way to measure comparative national expenditure it is now believed by many to be little more than a headline indicator. However, GDP is a measure that has been the standard for some time and so more data is available using this measurement than any other. A fuller analysis should perhaps use other indicators such as Genuine Progress Indicator (GPI) or the Index of Social Health – you pays your money and takes your choice

But, lets just take a peek (please excuse the hopeless layout):

…………………1990-97……1997
United States:……13.8%……14%
Germany:…………9.9%………10.4%
France:……………9.6%………9.9%
Canada:………….9.8%………9.3%
Netherlands:………8.7%…….8.5%
Ireland:……………7.1%………7.0
UK:………….……6.7%………6.7%

(Sorry Oz and NZ weren’t on this particular table)

Every country in the above list with the sole exception of the United States practices universal health care. The US system, by contrast, excludes 35% (or 47 ish million – who really knows ?) of its people while at the same time spending between 100% more (Ireland and the UK) and approximately 50% more (damn near every other mentioned country) than countries where the entire population is covered.

The only possible conclusion from the above general indicator is that the system as practiced in the US is deeply flawed and immensely wasteful.

The above was the first table I came across and the info is courtesy of the Israeli Government. You may have to d/l Hebrew to view the full text: http://www.cbs.gov.il/health/tb11e.shtml

36

And, of course, I cocked something up - for Gross National Product in the first sentence please read: Gross Domestic Product.

Just to clarify, the above data is purely a comparison of GDP expenditure on health care.

37

As a “registrar” in Canada, I think the health care in Canada is probably superior to that offered to the average American in many ways. I think the Americans who describe it as a failure have pretty powerful agendas of their own. What does “socialized medicine” mean, anyway? That everyone is covered?

Seattle probably has more MRI machines than Canada. But the reality is that MRI machines, while extremely helpful in a few diagnoses, don’t provide that much more info than CT or ultrasound most of the time. In the US, MRI is flagrantly abused as a way to make hospitals money. If the doctor shares in the profits for unnecessary blood work or more expensive imaging, there is no incentive to reduce these costs, as has been pointed out. People who need urgent MRIs get them pretty damn quickly. But if you were diagnosed with cancer, you would probably want an MRI quickly too without knowing anything about whether it would be more helpful than an ultrasound or CT, or how fast your cancer is likely to metastasize, etc. And you may complain if you can’t get it fast enough.

The waiting lists for CABG and orthopedic operations are long. They will get worse. Part of the problem here is the governments remarkable short-sightedness in reducing medical school enrollment and residency positions here ten years ago. Unlike the States, there is a relative shortage of doctors. Now, many people are having difficulty finding a family doctor, which does threaten or system. In Sudbury, Ontario, 50,000 people lack a family doctor. The problem does affect every province since internists and pediatricians in Canada do not provide primary care.

A doctor in Canada probably makes about 70% of the American value, maybe 50% more than in Britain. I think they work fewer hours, in general though. Tuition costs here have skyrocketed 300% in the last five years as universities get greedy. This is a lot more than amounts available in Student loans, and has both forced more students to take out huge lines of credit as well as make it likelier the average medical student will be from a wealthy family to begin with. The government does not subsidize the high costs of school these days. Hence, many Canadian residents are thinking about the States to pay off their loans. Also, this year only 29% (traditionally 50%) of residents chose Family Medicine as their specialty. These facts will have a big effect on our system and the ability of Canadians to find a family doctor, many of whom are nearing retirement age.

So the bad things are bad. But the good things are good. Everyone has access to very good medical care including reimbursement for most drug costs. Doctors don’t need to advertise and get to make decisions, rather than HMOs or patients deciding what needs to be done. As an example, few pediatric ear infections (maybe 1 in 7) benefit from antibiotics, but in the US everybody gets an antibiotic because the patient expects one. The doctor gets more money, the patient is happy. But it is not necessarily good medicine since antibiotics have side effects. The pediatricians know this but the patient drives the system since they are paying out of pocket. The patient also wants lots of blood tests and imaging which is not needed. Americans don’t understand good medicine is not having access to expensive machines and tests all the time, but using them when they are needed. It still is true that 97% of diagnoses and treatments can be determined by a good history and physical exam. Tests confirm diagnoses, but are not often needed to make them.

Too damn late to continue my harangue. But I’ve had lots of friends who’ve gone to the States for a few years to pay off their debts. When they come back, and they often do, they have lots of valid complaints about the way medicine is practised in the US. The poor may have coverage, but the lower middle class don’t and this just opens the door to so many other problems.

38

Well, one of the nice things about learning about how things are viewed and done in other countries, is that it gives us all a chance to broaden our perspectives a bit. [Whether we take advantage of that opportunity is clearly up to us! ;)]
Americans views of rights tend to be rather broad in the individual, particularly individual economic, rights realm and narrow in more collective realms. E.g., many Americans think they have the right to drive their gas-guzzling SUVs around, polluting the air that the rest of us breathe, and not pay the price for this (to simplify a complicated issue to a one-sentence sound-bite).

Back to health care…I am American but spent 4 years in Canada. Admittedly, I didn’t use the health care system that much, but when I did, I found it quite easy and efficient. One thing that did bug me a bit is that I remember someone blowing out his knee playing ultimate in Vancouver and having to wait several months for ACL surgery. However, now that I am back here in the U.S., I see people in pretty much the same situations…so I seem to have been naive in imagining that such non-urgent surgery here would get done that much more quickly.

And, by the way, it is also important to remember that when the insurance industry here starts talking about the horrors of “socialized medicine” in other countries, they ain’t doing it because they have your and my best interests in mind for God’s sake!!! That ought to be obvious, but seems not to be for many people!

39

A couple of years ago I had elective, non-urgent surgery (removal of a hydrocoele from my scrotum) from the time I decided that it was better off out to the time I had the op. was approx. a year. However when I was in a car crash and had possible neck and back damage everything was done quickly. All tests etc. and treatment within a week.

My uncle who was diagnosed with cancer in his leg was pushed through the system immediately. It comes down to this if you need it you get it. Some people may fall through the gaps but that is true of all systems.
BTW great post casdave

40

I’ve heard you post this twice. But I happen to know it’s not true. Canadians come to America for treatment all the time to avoid 1 year queues. And I know some Canadian doctors who’ve opted out of the system altogether. They take cash.