I mean “effects” on the care-provision side, not on the tax-burden side. E.g., which system is more efficient, the UK’s National Health Service or Canada’s single-payer system, and how do both compare to the U.S.’? How do the systems affect the remuneration of physicians, and has that produced a shortage of people willing to go into medicine? IOW, everything relevant to the anti-UHC talking points. I’m really asking for hard facts and stats, but if I posted this in GQ it would stay there for about 5 posts.
bump
I don’t have any “hard facts and stats”, but since you’re at the point of having to bump the thread with no responses, I feel like I can relate some anecdotal evidence. Which is that people I’ve known from Canada have universally complained of the fact that treatments & tests that we in the US take for granted as being available virtually on demand, are carefully rationed in Canada, and are frequently not available for months.
These people hated the Canadian system, and alleged that people die all the time due to these delays. I can’t vouch for whether this is true.
In addition, studies have shown that the US suffers from too much medical intervention, which is damaging in it’s own right.
Apparently ‘watchful waiting’ is used extensively in Canada. Anecdotal based upon my wife’s experience in the system with cancer and MS and various friends who have had cancer (those that survived!)
Here’s a list of doctors per captia. Basic gist: tax havens have a lot of doctors. Ex-communist countries have a lot of doctors. Amongst industrialized countries, the US has a somewhat low number of doctors, though the UK and Canada are a few spots under us (but not really a meaningful amount).
Moral of the story, on a first glance anyways, universal health care doesn’t seem to create a dearth of doctors.
Well, since we’re into the anecdotes already, here’s one from the opposite side of the Canadian issue. My mother has worked as a secretary for a small company for over 50 years. They have less than 10 employees, so I suppose in the US this would mean she’d have no employer insurance. My father spent his entire life either working for various small businesses or being self-employed. Again, he wouldn’t qualify for employer insurance. There’s no family money whatsoever, all they have is what they’ve earned. They aren’t below the poverty line, though, so I suppose they wouldn’t qualify for medicaid. I doubt they could have afforded private insurance, and even if they could have I doubt they would still qualify (reasons below).
My mother sees cardiologists and a neurologist (for an irregular heart rhythm and a benign brain tumor, respectively) once a year. My father had prostate cancer, requiring prostate removal, and a near heart attack, which turned out to need a quintuple bypass. (He got the bypass within a day of arriving at the hospital, by the way.) Cost billed to them: Nothing.
To sum up, my parents are still alive, healthy, and living in their own house. I am extremely grateful for the Canadian system.
From my understanding, the issue is more one of tests and specialists rather than doctors.
xnylder
In the US your parents would qualify for Medicare coverage, which is heavily subsidized by the government but not free.
Well, if we’re being anecdotal: I attended the 2003 World Science Fiction Convention in Toronto. At one of the panel discussions, I forget on what topic, the floor was thrown open to questions and I found some reason to justify asking, as somehow related to the topic, “Is there any downside to Canada’s single-payer health care system?” Given what I had been exposed to from the U.S. media, I was expecting that question to open a lively, even furious, debate. Instead, each and every one of the panelists – all writers or editors – said, one after the other, “No.” “No.” “No.” “No.” “No.” All responded with a sort of shrug, as if slightly surprised the question would even be raised. And nobody in the audience – which was well over 200 persons – ventured a contrary opinion.
Now, granted, SF writers, editors and fans might not form a scientifically representative sample of the Canadian population, but none of them are desperately poor or ignorant. Most are middle-class or higher. If there is any widespread resentment in Canada over its health-care system, I would expect it to be well represented among exactly those people.
The majority of anecdotal experience I can relate (self and others) would suggest that the problem with Canada’s health care system is in the optional stuff - sports injuries, long-term annoyances, etc that get pushed to the bottom. But even there, I don’t see much of a problem, other than that of convenience. Apparantly here in Ottawa there is a dearth of avaiable MRI time - so much so, that private clinics advertise from Quebec and even New York for MRIs. I twisted a knee playing rec hockey a year ago, and was only hurt enough to not play hockey - hardly a high priority. I got an MRI done within 2 weeks. It was at 12:30 in the am, but I had no problems with that. Anyone I’ve heard directly needing to wait for months has turned down alternate times repeatedly, due to their own incovenience. If you are dying, or badly injured, the service is quick, efficient, and as effective as any western medicine.
My wife is on a waiting list for an MRI for a sinus condition that she’s been fighting for over 3 years now. She should get in about a year from now. We could pay at a private clinic and get it done, according to the clinic’s website, in about 3 days.
If you wanted to “fix” the American healthcare industry, more doctors would be the right place to start. Over the years, people have managed to make it less and less attractive to become one, which is really unwise. If you can even get slots at medical school (there are both too few applicants and too few slots, oddly enough).
For starters, the AMA should be kneecapped, shift med schools to offering a single 6-year degree with no bachelor’s prereq (but allowing people to skip some classes if they already took them in a college), and capping certain malpractice claims. Offering better grants for such schoolwork to those who lack the funds would help significantly, since doctors graduate, then do a poorly-compensated internship, and then have to pay back pricy student loans.
Mythbusting Canadian Health Care -- Part I | OurFuture.org by People's Action Here is an article mythbusting the Canadian system.
I have a Canadian friend who got a heart transplant. In America he would have been dead for over 2 years now.
I don’t usually come into GD but I can contrast the UK with France. Or rather talk about France. We pay high “social charges” and in return get very well looked after on the healthcare front.
You go to the doctor (specialist or GP*) of your choice, and pay at the end of the consult (I still feel very odd handing over a cheque or my debit card directly to a doctor). A week or so later the government refunds 80% of the standard price of a consult. Most people have health insurance through their company which will make up the deficit.
So when I go to my GP I pay €25. The Govt. thinks a GP consult should cost €23 so they refund me €18:40. My health insurance pays me the remaining €6:60. Now I live in a cheaper part of the city but some GPs would charge €45 euros, the govt. would sill refund €18:40.
Unlike the UK there is no charge for prescriptions so any prescription drug is essentially free. GPs traditionally end any consult with “Now is there anything else you need ?” It was only after 4 years here that I understood that at this point some people will take the opportunity to ask for prescriptions for painkillers, cold remedies etc. so they don’t have to buy them :eek:
If you are diagnosed with a long term condition (cancer, infertility) you pay nothing - no up-front payment to be reimbursed it’s just free.
When my aunt was being treated here (unsuccessfully as it happened) for pancreatic cancer she need a particularly expensive injection - so she got it. My mother, a retired GP, commented that “in this country they’d still be having meetings to decide if they could afford it”.
Hospitals meals are three courses and nursing staff come round with a menu in the morning so you can order your lunch, dinner and breakfast for the next day.
At the same time my uncle suffered a massive heart attack & developed mild diabetes - the treatment he received was again the very best.
(When husband went to A&E /ER with a suspected broken shoulder he got pretty much the same standard of treatment as I’ve experienced in the UK.)
OTOH you have to be pretty autonomous as a patient. Especially in a big city like Paris. You may leave a consult clutching prescriptions for blood tests, scans, X-rays and the like … it’s up to you to find a lab to get them done. Then you get the results directly - no support, you may no even really understand what the results mean until your next appointment with your doctor who generally sees the results for the first time when you hand them over so any decision they in light of the results is pretty much on the spot. Any X-rays, scans etc. go home with you. After having a smear you actually leave with your sample and an envelope (prepaid) which you have to post, after putting in the cheque that is ! Ah the tales I could tell …
So in terms of “care provision” France is way ahead but, certainly in Paris, there is a certain lack of “humanity”. The concept of a “hospice” seemed alien to them and my aunt spent her last 3 months in hospital. It’s very “just a job” and there is assumption of a certain amount of knowledge on the part of the patient. Without going into detail I myself have found I lacked support, explanations perhaps even counseling. The result is a population who know (or think they know) a lot about health & take good healthcare for granted, so much so that the govt. have run campaigns to fight against the addiction to taking antibiotics for everything.
*The system has changed slightly in recent years, there was a big campaign to get people to choose one doctor as “their GP” rather than going to the doctor with the earliest appointment prior to which you could go anywhere (which is how one person I know managed to get sick leave for a year with each certificate being signed by a different doctor). Similarly until recently I could have called and made an appointment with any specialist on a whim and been refunded as explained above. Now I believe if you haven’t been referred you don’t get the full govt. refund.
I am a Canadian who has lived in the US for the past 8 years. I love living here, with the main exception that I hate the US health care system. IMHO if this country indroduced a Canadian style health care system America would really benefit.
First things, American health care is already socialized in the worst kind of way. The problem is, our taxes just pay for all of the poor and all of the old. These people are the biggest drain of any health care system, as the poor wait until they show up in an emergency room and the old, well, just get old until some disease or injury comes along that needs ongoing medical treatment.
The working class must pay for the old and the poor, while themselves receiving nothing. The working class is generally younger or wealthier and by these measures usually healthier and in need of the least medical attention. However they, or their employer, must pay a separate private company to get health insurance. Why? Why not pay a little more into the systems they are already paying into for the poor and the old, and get that same health care back.
Second thing, employers should never provide health insurance. Who is the customer? Your HR department. That is all the insurance company has to please. Certainly not you. As a result you’re stuck with whatever your company provides, whether their quality is good or not. So, to get to the doctor you need to go through your HR dept. who goes through a insurance company who tells the doctor they will cover your visit.
How stupid is it that when I want to change jobs my biggest hurdle is figuring out how soon I will be eligible for the new health plan, and how much I’m going to have to pay in the meantime? What if my spouse loses their job but I have to wait until some arbitrary annual date to add him/her and the kids onto my health plan?
Thirdly, many seem to argue government is inefficient. However, I would argue that the insurance industry is at least as inefficient. I’ve been to medical offices staffed by two doctors who need a support staff of 12 people. I’ve known people working in clinics whose only job was to call insurance companies and harass them to pay the money owed to the clinic. How inefficient is it to employ all these people working for and against the insurance industry? How often have you or someone you’ve known had to call up an insurance company to argue for correct billing?
My doctor back in Canada has a staff of 1 person. That person works as a receptionist and bills the government for the visits. The government reimburses the doctor without dispute.
Canada Health Care.
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Wait times. This is based on your need, which is determined by the doctor. My brother-in-law had a spot on his lung and was taken in for a MRI the next day. Turned out to be benign, but he did not have to wait. If your doctor decides your condition is not serious or time critical then you get in the queue, which provinces are always trying to work out ways to shorten.
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Patient Satisfaction. In my experience every Canadian I know is satisfied with the system and very few successful politicians campaign on privatizing it. I’ve never met a Canadian who would want to go to American health care. Interestingly though, I’ve met many Americans who believe this fallacy (except for the ones who personally know other Canadians).
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Fairness. Unless you die some sudden way, I would argue that most people will use health care at some point in their lives, and it will be expensive. And even if you personally manage to get along fine then surely you must have someone you care about who gets sick, badly injured etc. and needs to partake on the system. Almost everyone uses it, or will use it. So if you pay taxes for someone else’s health now, then you can be comfortable knowing someone else will pay for you down the road.
But you want to keep it private. Fine. But first let’s cut off the poor, old and otherwise socialized users (too bad grandma). And lets make the real customer the people and not your companies. Finally, lets appeal to insurance companies to never again try to misbill doctors and patients. I’m sure if we just asked nicely…
Like the author of this article I have seen health care both side of the border and would like to second this article as a good FAQ on the differences.
‘It is true that Canada’s system is not the same as the U.S. system. It’s designed to deliver a somewhat different product, to a population that has somewhat different expectations. But the end result is that the vast majority of Canadians get the vast majority of what they need the vast majority of the time.’
It sort of depends how they interpreted the question. Most Canadians would say the system is not perfect - it’s the subject of endless bellyaching, editorials, TV commercials from interest groups, political grandstanding, so on and so forth. Every hospital in the country is subject to endless criticism by the people who write letters to the editor in local papers. In fact, the system isn’t even all that universal. It doesn’t cover dentistry, prescription drugs, and a wide variety of other things you need private insurance for.
But as to whether we should HAVE it, you’ll get opposition from nobody but the most hard core Objectivists. The Canada Health Act is inarguably the most universally popularly supported government program in the history of Canada; I would say, absent any quick cites but with great confidence, that it is more popular than the Charter of Rights and Freedoms. When they held a poll on who the greatest Canadian to ever live was, the respondents chose not the father of our country, or the father of the Charter of Rights, or the longest serving Prime Minister or greatest scientist or even Wayne Gretzky; they chose Tommy Douglas, who is widely (albeit simplistically) credited as being the father of medicare. Any major political party that suggested dumping it would cease to exist withion one election; even suggesting small and reasonable changes will evoke tremendous, emotional opposition.
Whatever the details, Canadians WANT this system. So, people are getting the health care they want.
All of this could pretty much have been written about the British NHS, too. Attacking that would be as politically beneficial as arguing against the second amendment in America. It’s also worth noting that it’s not gained such a status through being tied up in centuries of history, rather it simply emerged as a necessity of post-WW2 reconstruction.
The problems with the NHS aren’t really a result of the overall intent of the system - it’s to do with incessant small-scale short-term meddling by politicians, and the serious questions about funding, such as for treatments which have limited success, or for patients with dementia, for which the question arises as to when social care crosses over into medical provision.
Uzi, are you in Canada? If so are you located within an hour’s drive of the MRI facility? If so, I strongly suggest that you get in touch with the Medical Imaging booking people, and let them know that you are available at a moment’s notice and can be there within X number of minutes if they have a cancellation. This can actually work.
Alternatively, she should let her specialist know about any worsening of the condition. If they don’t know, they can’t help. Make (polite) noises about how you can get her seen faster. Be persistent, but polite.
The government may or may not be inneficient, but one thing we do know is they’re not in the profit-making business. Every government employee has a fixed salary and they have no incentive to cut corners or refuse payments.
I am a physician, neither pro nor anti UHC, although in general I am opposed to any government program which supplies unlimited money to the clueless (instead of the helpless)–think Octomom, e.g. My own prinicpal reservation about UHC–not that you asked–is that we won’t ration healthcare but we will make it a universal “right.” There will then be no upper limit to what we spend. No upper limit. In a crazy half-assed way our current ridiculous insurance system helps to ration healthcare, even for the insured.
I take it you are after efficiency, effectiveness and supply of providers.
The current US system is so inefficient it’s hard to argue anything could be worse. On the other hand, bureaucracy is inefficient, and much of the current inefficiency is directly related to regulatory oversight.
For effectiveness, it’s very difficult to calculate how good care is across populations. Culture, genetic make-up and environmental influences all vary among countries and within populations in those countries. If you have a country with a large population of unwed witless teenage mothers and you compare it to a different country without that equivalent pool, your infant morbidity/mortality is going to reflect that regardless of the healthcare system’s structure. And of course most medical care is superfluous anyway. You need good public healthcare–vaccinations and the like–at one end, and good specialty care–advanced treatments for the occasional really sick person–at the other. The vast middle is feel-good care for a lot of stuff that would get better on its own. I suspect many of those waiting for MRIs in Canada can wait a little longer without a significant increase in morbidity. Annoying, but not ineffective care.
In terms of provider supply, the bugaboo here is the quality of the supply and not whether or not there are enough of them. I don’t want my neurosurgery done by a guy with a marginal IQ and mediocre standardized scores. YMMV, of course, but I’ve been around doctors long enough to know which ones are bright and which ones got through on the lucky plan. Any country can turn out enough physicians–the question becomes how intrinsically bright they are and how well-trained they are. One of the bright spots in American medicine is the amount of innovation which occurs here. While we have our share of pluggers lucky enough to get into medical school with marginal scores under some set-aside program or another, for the most part the high remuneration drives a pool of fairly academically competitive individuals. You need that to advance medicine. We’ll see physicians trained overseas who are utterly unqualified to touch a patient in a physician role here in the US. If, along with UHC, we lower salary incentives, we will see a drop off in the quality of the selection pool over time. Another discussion, I suppose.