Of course it’s relevant, because 5,000 people going to the states for medical procedures is 5,000 less that are going to be on waiting lists in Canada. So any measure of how Canada’s health care is doing has to factor in the number of people who had to go elsewhere because they couldn’t get what they needed in Canada.
Here’s a Comprehensive Report on wait times in Canada from the Canadian Institute on Health Information. Let me quote from the executive summary:
Emergency room wait times:
The report has an interesting case study of “Hani”, a typical health care consumer. It’s worth reading as it strikes me as being a very accurate portrayal of the Canadian health care experience.
From the article, 60,000 to 85,000 people travel to the U.S. for treatment. 7% of them come from Canada. So, that’s between 4200 and 5950 Canadians per year. That’s an average of 5075 people per year, which I rounded down to 5,000 and used the qualifier ‘about’ to indicate it wasn’t a precise number.
As for the other statement… I guess I left out that they might have gone to the U.S. simply because they think the treatment is better. Unless you can think of another reason someone might travel a long distance and pay out of pocket for medical treatments that are available for ‘free’ at home, I think that about covers it.
Don’t get me wrong with all this. I don’t think Canada’s system is horrible. I think it’s actually fairly good. But it’s not great, and we have a lot of natural advantages the U.S. doesn’t have. Our population tends to be healthier, for one thing. We also free ride on the U.S.'s robust R&D, and we offload some of the most difficult and expensive procedures to the U.S.
Also, an equivalent system in the U.S. would not be federally-managed single payer - it would be state managed single payer. The Canada Health Act is 6 pages long. Obamacare is over 2,000. That’s because in Canada all the details are left up to the individual Provinces, and they have wide latitude in how they administer their own programs. That’s one of the reasons the system works as well as it does - the wealthy provinces can afford more health care than the poor ones, and adjust their service delivery accordingly. In addition, we have a competitive market of sorts in that the individual provinces learn from each other what works and what doesn’t, and people can vote with their feet if they don’t like the care they get at home.
Within the provinces, authority is often delegated to regional health authorities. So our management of health care is very distributed. I don’t think liberals in the U.S. pictures a ‘states rights’ health care system. They want the feds to manage it. That will be a disaster whether or not it’s Obamacare or a new single-payer system with the feds paying for it all.
And like I said, we have a very robust private health care system that exists alongside the single payer system and Canadians are on the hook for a significant percentage of our overall health care. I have job-related health insurance just like Americans do. It’s cheaper, because it only covers non-government costs like prescription drugs, dental, optical, orthotics, that sort of thing. But if I didn’t have that insurance, I’d be responsible for paying all that on my own.
Sure. I never said they didn’t. They to it to save money, or because some treatments just aren’t available in the U.S. because of regulations. But note that you’re talking about Americans who go to all other countries, while the figure for Canada is just those Canadians who go to the U.S.
It’s hard to find numbers on the total amount of Canadians who travel outside of the country for health care procedures, but This CTV article says,
If the two percent number is correct, that would be 600,000 Canadians per year traveling outside of the country for health services. That would be close to 10X the rate of Americans traveling outside their country. That’s pretty astounding when Canada’s home health care is ‘free’.
The article opens by saying that surveys show that if health insurance covered out-of-country health services, up to 60% of Canadians would be willing to travel to get health care.
The number of people going to HealthCare.gov is honestly not that big, especially considering the Obama Administration knew that this site would attract immense amounts of attention and I think they were forecasting something like 7m enrollments in year one. Lots of websites have vastly more traffic than that.
Further, I’m not seeing a lot of evidence the problems are really “traffic” related.
When the website first went live I tried to create an account in order to just get an idea how much health insurance would be. I have my own insurance and I have no intentions to enroll, I was just curious to finally see what the “real” premiums were going to be in this system for someone like myself (older male, income too high for any subsidies.)
So the first problem I ran into was something very simple in web design relating to “forms validation.” Validation is basically when a web application validates user entry into a free text field to validate that what the user entered is acceptable to the system based on its technical rules for what that field can contain.
An example is a website that wants you to use your email address as your username, a simple validation would check to make sure that whatever the user entered as their username contained the “@” character in it. If it didn’t contain the “@” character, then we can be quite certain the user was not entering their username address.
Another common example is if you want a user to enter a password for their account, and you want them to use both a capital and lowercase letter, and at least one number or special character. You would use a regex to make sure an appropriate string was entered.
Two important things can then be done with validation, you can block the form from sending that data anywhere else and halt the process, and you then convey to the user in some form of message why their form can’t be processed any further and what they need to do in order to correct it. Well, the first problem you might run into when HealthCare.gov launched was that some of these forms had requirements (which is fine), but no messages to inform the user when the field had been filled with an invalid string. So what happens is you’d try to advance the form and nothing happened, with no indication as to why. Only by word of mouth did people find out what they needed to put in some of these fields to advance their enrollment.
Okay, so once I got my account created, I had to select three security questions and type answers. Instead, I was presented with three drop down lists (basically a rectangular box on a web page that you click and it contains a list of options), that had no list items. Three empty drop down lists. You couldn’t advance to the next step because you couldn’t advance without choosing three questions. But since the three drop down boxes weren’t populated, you physically could not choose questions. That’s when my attempt at getting a price estimate from Healthcare.gov ended. Now, I’m hoping stuff like that was cleared up on day one, but those problems have nothing at all to do with traffic to the site.
Those are extremely simple, should have been seen the first time they did a user test sort of problems with the web application. An undergraduate student building a webapp as a capstone project would be expected to get that stuff down rock solid, and would be severely penalized for failing at such simple elements in their application.
I’ve read that integration testing for Healthcare.gov didn’t happen until like a week before go-live (I’ll search the internet for a more exact timing, but it was very, very late in the process.) That’s insane, and is simply incompatible with even the most shitty form of good software project practices. To be honest a good project manager if they saw that such a huge project was about to go live and had yet to even have integration testing done would communicate up the chain of command that they had missed the deadline. There would then be consequences, but if you’re doing integration testing that late in the game then you’ve missed your deadline. If you go forward with your deadline you are going to release a horrible, bug ridden piece of shit software, and that very often is far more damaging than missing some deadline. Some software companies do it quite frequently, release shit because they ran out of time and just had to ship and deliver NOW. They get bad reputations for producing bad software, and while they might patch it later, it is very difficult to fix the perception that the steaming pile of shit you released to the public created for your product.
It’s also astounding that the US, at 5,000 people a year, is capturing less than 1% of Canadians travelling for health care.
I’m suspicious that either the 5,000 number is too low, or the 600,000 is too high. I would expect the US to get a much higher percent of Canadian’s business just from sheer proximity.
GTA Online had a painful launch, but Rockstar got their act together and is giving every user $500,000 for the inconvenience. And who knows, the same thing may happen here!
It’s been alleged that some of the problems were the result of a decision to shield people from seeing the underlying cost of the plans, by not showing any prices until the subsidized prices could be shown. To accomplish this they had to disallow upfront browsing and force people to submit and have verified a lot of personal information in advance, which involved a lot of systems and slowed things down.
The Canadian taxpayer, like the taxpayers of nearly every developed nation, pays less for government healthcare than the US taxpayer does. From a certain US viewpoint, healthcare in Canada is actually free, as the US taxpayer pays even more for government healthcare but sees nothing in return.
There have been serious studies on that. They show that the number of Canadians getting healthcare in the US is minute, and mostly made up of snowbirds who take ill while in the US.
It is certainly far smaller than the number going the other way for healthcare.
Ref. “Americans filching free healthcare in Canada”, Ontario Ministry report. I don’t think it is online but there are reports on it.
That is based on a report that should be disregarded. McKinsey is normally quite good, I don’t know what happened with that report, but it should not be taken seriously. It puts the number of medical tourists in the world at between 65 000 - 85 000. Now, few countries keep records of how many people leave the country for medical treatment, most developed ones and many developing ones keep stats on arrivals. That year, a lot of countries had more medical tourists each than the McKinsey report claimed was the world total.
(I have a vague memory thats some hospitals in India and the Philliphines had more medical tourists than that, but I wont swear to it)
The report also claimed most medical tourists go to the US. Given that between 10 and 20 times than number leave the US for meidcal treatment, I think the report should be considered a work of wishful thinking.
Every healthcare system has its strong and weak points. Canada does particularily badly on waiting times. Note that beating Canada on waiting times is a very low bar. And it does not add any cred to the US system to beat the worst performer in class. Given US spending, the US ought to compare performace with the top countries.
“It has been alleged”? By whom has it been “alleged”? By someone who’s intelligence and insight you trust, or the smelly guy on the bus talking to himself?
Traveling for expensive elective medical care is something of a special case, though. It doesn’t take much of a percentage difference to pay for a plane ticket somewhere else.
American medical care is quite expensive. I’d guess there are few procedures where the net savings isn’t way better to buy a plane ticket and go somewhere where the doctors make 1/5th as much.
Another possibility is that the two cites are comparing two different things. The first cite that speaks of 5000 Canadians is speaking specifically of in-patient procedures where the second cite seems to speak more generally by using the phrase ‘health services’. I suggest that this term is more inclusive and may include things such as travel for dental or day surgeries.
He cites the WSJ as saying “An HHS spokeswoman said the agency wanted to ensure that users were aware of their eligibility for subsidies that could help pay for coverage, before they started seeing the prices of policies.””. So that part is reliable.
The question then is to what extent that structure impacted the website’s performance. I’m sure it didn’t help, but I don’t know.
No you didn’t. You started the thread to snark and point fingers at Obamacare.
But to answer your question: There were doubtless major software mistakes, caused by over-ambitious schedule and by requirements that government must observe (or thinks it must observe) that private firms need not. However there are three other problems:
[ul][li] Delay waiting for constitutionality question to make its way through Federal courts.[/li][li] Delay waiting for the 2012 (Romney would cancel Obamacare) general election.[/li][li] Extra load caused by refusal of Republican-controlled states to implement their parts even though this causes financial loss to those states.[/li][/ul]
Well, being the one who has personal access to my own motivations, I can testify that I did. I wanted to know whether the reports coming in were accurate or not; there appears to be agreement that they were.
Wherever there is democracy, there will be elections, courts, and politicians. It can’t be avoided. Wherever the government decides to construct a major piece of technology, it will take a long time to build, and during that time there will be a possibility of an election, a court ruling, or an uncooperative politician that doesn’t support the government’s use of that piece of technology. It can’t be avoided.