I am sorry about that. Hey guys, this is about** Has any country with universal healthcare ever repealed it?**, and we always seem to run off the rails into a discussion of Canadian Healthcare, which is off topic methinks.
Waiting time really isn’t an issue in France. I know it sometimes happens, for instance I know that there seems to be a shortage of ophtalmologists, and many people have to wait a long time to see one (never had to, but I live in Paris which is hardly representative). But I’ve yet to hear about someone having to wait any significant amount of time for, say, a knee surgery or whatever Canadians seem to wait forever for. I typically take an appointment with my generalist for the next day, and for a specialist for within the next week (sometimes, I’m told the next possible appointment is in, say, three weeks, at which point I just call another specialist). I don’t expect a surgery, a scan or whatever to be significantly delayed, either (same thing : if I can’t have a scan within the week, I call some other place but typically I would expect to have it within, say, three days).
I’m not saying that there’s absolutely no waiting times in France ever, but that’s not an issue that I or that people I know encounter. Neither it’s an issue that is mentioned when people complain about the healthcare system, or articles criticize its failings, so if they exist it has to be a marginal problem. In fact, it seems to me that long waiting times might be specifically a Canadian issue. I’m not hearing about the long waiting times in Germany or Italy, either, for instance. I strongly suspect too that it’s an underfunded healthcare issue.
I also understand that many doctors in Canada don’t take any patient anymore, while nobody I know ever had an issue finding a doctor. A close friend had her family doctor retiring recently, and she just shopped around until she found one she had a good feeling about, for instance. Nobody told her “I don’t take any new patient”. Again, I suspect this is a specifically Canadian issue.
There’s a clear issue of shortage of doctors in rural areas, though, and maybe there it’s more difficult to have an appointment or even possibly a surgery at the local small hospital. But still, I’ve been raised up in a rural area, I have relatives still there, and I don’t hear about it from them, either.
There’s a numerous clausus on the number of doctors licensed each year in France, though, and Doctors’ Unions are very involved in deciding how many, which I believe isn’t a good thing. There are a lot of medical students who fail (I think it’s in the 90% range, or even more), and I suspect that much more than 1 student in 10 or 20 could become a good doctor. However, it’s also a general flaw of the French university system : selection by failure is quite typical. You can join pretty easily an University, and not much selection is involved, but then, half or two third of kids enlisting in sciences, for instance, drop out during the first year, and they don’t do much to try and retain them. That’s a “swim or sink” system. It’s just massively worst for medecine, and at least, in other fields, they don’t have this numerous clausus that makes sure that the overwhelming majority will fail, regardless how hard working they are.
Waiting times are complicated to measure.
There is waiting time to see a GP, waiting time to see a specialist, waiting times in emergency rooms, waiting times for urgent surgeries, waiting times for non-urgent surgeries… and countries can be all over the place on them. (Although if these cost serious money you haven’t got, then waiting time is the rest of your life.)
There are also confounding factors, such as Norway letting patients pick the hospital they want to be treated at, private or public. Patients often chose the hospital near their home and families for non-urgent procedures prioritizing that over speed.
So a country can do real well on seeing a specialist and still have waits for a GP. Or do urgent surgeries fast but have waits for non-urgent ones.
Yes, sorry about that. (How Canadian…)
The problem is, almost no government is going to come in and repeal health care unless they have a large number of soldiers who continue to have health care.
Instead, and what we have sort of been discussing peripherally, is that the government that wants to get rid of health care, would have to let it fall apart by degrees until it was so unusable that nobody would mourn its passing. That takes a long time.
This is the dilemma the Republicans are in. They would like to say “repeal it, go back to how things were”. But the market has changed so significantly - pre-existing conditions, covered to age 26, more items mandatory covered, subsidized exchanges - that they can’t (we hope) just pull the rug out from under tens of millions of people.
From what I’ve seen in the news, nobody has a clue what they should do instead now. They’re like the dog that chases cars and finally caught one…
For comparison - Canada 2.1 doctors per 1,000 people, UK 2.2, US 2.3; many other European countries are a bit above 3 per 1,000. (Eurozone average 3.1)
So if people don’t have to wait as much in the USA, it must be because Americans are so healthy.
If you don’t have insurance in the US, the wait time is infinite.
Seriously, when I hear criticisms from US sources about the Canadian wait times, my reaction is to ask: how is it possible to compare wait times in a system where everyone is covered and will get medical care, to a system where a certain percentage does not have insurance and will not get medical care?
If you just look at wait times in the US for people with insurance, you’re not using a valid comparator to the Canadian population and medicare system.
The wait-time for the first is “until your economic situation improves, if ever”. The wait-time for the second may be from days to months.
LOL. How many kinds of fucked up is this sentence: USA! USA!
Certainly in the UK, waiting time is a function of economic conditions; waiting time is crap in times of austerity, waiting time is much better in normal circs.
The population generally accepts this as a fact of life.
The Uk NHS is much cheaper even than the other western european systems though. People often don’t appreciate just how much less it costs than, say the German or French systems.
In Canada wait times are often a function of Drs triaging access to care. There is undeniably an oversized cohort of baby boomers who will overload the system as they require knee and hip replacements etc. So Drs triage patients who can still walk, and who’s pain can be managed with OTC meds, ahead of others in more dire straights. But that leaves a lot of cranky old people not getting what they want, when they want it. Which can be hard for them to understand when all their lives, what they wanted, was always easily accessed.
So if your doctor, for whatever reason, doesn’t prioritize your access in line with what you feel is timely, you get to loudly complain. And they do. But some of that, wait times complaining, needs to be taken with a grain of salt, as a result.
I personally know two people who raised hella stink about wait times, because they wanted to get back to their golf games. They were still mobile, if slower, and on mild pain meds. But they wanted their replacement knees done now! So they could be healed by golf season! And they honestly felt they were entitled to that consideration.
There are entitled people everywhere, after all. And always person’s who feel if they can afford it they ought to be to be able to purchase faster access. The thing is, if that’s what you want, nothing is stopping you, America is right there, cross the border and buy whatever services you’d like. There is no need to transform our universal system into two teir or pay to purchase, to do so.
If you can have faster access across the border for a price, then do so, if that’s your thing. But your need to jump the queu shouldn’t require our system shift to a two tier system, with different access to resources for rich and for poor. Canadians understandably always push back hard against any such suggestions.
Yes, but it’s not like the numerus clausus springs forth out of thin air. On the contrary : it’s the mechanism that ensures both that you and I can see a doctor quickly, and that doctors themselves get to live comfortably without having to worry about having either too few or too many patients. It’s calculated annually based on the specific number of doctors of this or that specialty missing here and there or due to retire, plus predicted growth. This to best adequate supply with demand and have an overall stable system.
I agree that it results in tossing out a great many students who would have made adequate physicians out on their ears (but then again, that does also mean the ones who get in are consistently the best of the best… at cramming useless crap anyway :p), but at the very worst they lost two years of their life, not* too much *money, and learned stuff that will give them an edge should they try for pharma, biochem engineering and so on afterwards.
Yes, it’s classist and rigged in favour of the middle and upper class, like the rest of the French higher education system, but that’s by historical deliberate design so…
The Germans repealed the British health care system in 1940 …
But these people are paying for a health care system, through tax dollars. Why is it “entitled” to demand treatment in a speedy fashion? This is the grand solution to healthcare? Miss a golf season (of which there are not many more) because the system cannot accommodate the people who need it? Should you wait longer in a restaurant because others are hungrier, or longer in a barber shop because others have longer hair?
This stuff doesn’t happen in a private market, which is why it is generally superior to centrally managed government controlled systems. If I need my car fixed, I find a mechanic, we negotiate on price, and it is fixed. I don’t wait while some bureaucrat determines how badly my car needs repair compared to others and go on a list.
I find it astounding that people would be not only satisfied with this system, but hold it out as a better alternative.
Do you act this way in an emergency room? Where resources are triaged based on need?
You pay taxes, dammit! You should get what you want when you want it! You’re willing to pay! Why should you have to wait?
There have always been, and always will be, people who share your view. But, I believe they will always be in the minority, and unlikely to prevail.
(I say, Fly to America and pay if you want to get service now! You’re fortunate you live very close, it’s right at hand. You kind of have the best of both worlds!:D)
Eh?
Well it IS objectively better. It gets better results for much less money.
Part of the reason for this is that allocating limited resources according only to medical need and in accordance with the priorities of the people with the medical knowledge is simply better use of resources. When you start mixing in priorities such as “ability to pay”, “status of insurance” and whether the insurance will actually pay out, you’re not using resources in a very effective manner.
Subjectively, it is better because the flip side of long waits for stuff triaged to be unimportant is short waits for stuff triaged to be important.
The car analogy breaks down because you have a fixed top value on your car, you can buy a new one if your old one is uneconomic to repair, and you can refuse service if you consider it too expensive. There safeties, the ability to refuse too-expensive services, and an upper limit on value, are safety features in a functional market that may simply not exist if the service is healthcare.
The descriptinon here of the Canadian system sounds like something the Australian courts decided was unconstituional. They were unable to introduce “conscription” for Doctors (although they wanted too), so they were forced to allow a parallel private system.
Pre-NHS, the “consultants” provided free medical care in the public hospital system, funded by their lucractive private practices. The decision to conscript them into a marxist/syndicalist state service and pay them for the public hospital care was deeply political, and their opposition to it was not just based on what they got paid.
Part of the opposition to Medicare in Aus came from emigrant English doctors, who had come to Aus to excape the NHS. Part of the opposition came from doctors who were watching the NHS, and had seen how badly it was managed in the 1960’s. It was the English poster child for all that was bad about state management, combining wasteful excess with hopeless service, justified only partly by comparison with the previous system.
Even in the 70’s, if you had heart problems, you died. There was no funding for, and no services for, treatement of heart failure. You just died. The NHS was able to get away with running a technically backward system. It appears to me that is no longer the case (but I am much less informed than I used to be), Also, I’m not seeing the jokes about the NHS that I was seeing up through the 90’s (jokes always trail reality).
We may not be 100% satisfied as Canadians, but we accept the compromise. I find it astounding that people are willing to accept that some people die because they can’t afford treatment. Remember that UHC has been part of the national fabric since the 50s.
A while back the Canadian Broadcast Commission (CBC) had a contest to finish the phrase “As Canadian as…”
The winning phrase was “As Canadian as possible, under the circumstances.”