I haven’t “ignored” it. I’ve patiently explained several times (at least) about triage based on urgency. I’ve even offered my personal experiences to show how it actually works, not in theory but in real life. It is you who has persistently ignored the evidence and persistently repeated your talking point like a broken record.
No health care system is perfect, but rational people make decisions about the kind of health care system they want their nation to have based on rational principles and tradeoffs. And every country in the world except the US has opted for UHC. And there’s a reason for that. Sure, there may be varying degrees of wait times for appropriately triaged non-critical elective procedures, but these are largely just a matter of funding level in exchange for level of convenience and not a matter of medical access or outcome.
What the US is doing instead, not by explicit choice but as the default of a century of government inaction, is trading away all the advantages of UHC and instead getting:
[ul]
[li]a system of pervasive claim denials[/li][li]a system where insurance bureaucracy regularly opposes the best interests of the patient by interfering with clinical decisions[/li][li]very high uncontrolled costs[/li][li]an administrative nightmare[/li][li]an immoral and inhumane lack of universality[/li][li]a critical dependence on employment or personal wealth for basic health care[/li][li]a generally sicker nation[/li][li]health care as the #1 cause of personal bankruptcies[/li][li]and a lot of other horrors.[/li][/ul]
What the rest of the world has instead is universal coverage with assurance of always getting the health care they need, with no bureaucratic obstacles and regardless of financial circumstances.
The rational choice seems obvious, except to ideologues and shills for the insurance industry.
Unlike some of the other arguments that sound like talking points from Fox News and the insurance lobby, those are good questions that can form the basis of a reasonable discussion. I’ll try to give my best summation of how it generally works.
You’re right, of course, that a doctor can’t just declare anything to be “medically necessary”. Medical necessity is determined, essentially, by a hierarchy of principles that begins with the Canada Health Act, which lays out as a foundational principle the general requirement that all medical procedures commonly performed by doctors and hospitals must be covered by the provincial health plans. Next, each provincial plan codifies all such procedures in the health plan’s fee schedule. Anything in the fee schedule is deemed medically necessary if your doctor says it is.
The important point here that I genuinely think is hard for many people conditioned to the American insurance system to grasp, is that this is where the bureaucracy ends. Full stop. From this point, as I said in a previous post, the responsibility for clinical decisions about your health care moves completely away from some self-serving anonymous insurance bureaucrat, and is given to your doctor or medical team. It empowers your doctor – whoever is looking after you – to decide what’s best for you, regardless of cost.
In a few specific instances the fee schedule (formally, in Ontario, the “Schedule of Benefits: Physician Services under the Ontario Health Act”) might have limits on utilization, but even in those rare cases, the doctor generally has wide discretion. For example, there’s a limit on the number of pregnancy-related ultrasounds per pregnancy, unless the doctor deems the pregnancy high-risk. The empowerment of the health care provider to make these kinds of decisions is an intrinsic philosophy that runs through the whole system. As opposed to private insurance, where the pervasive philosophy – often incentivized by bonuses for the insurance bureaucrat – is to minimize medical payouts by meddling in each and every claim, piling up paperwork and exorbitant costs while denying claims quite literally at every opportunity. Even Medicare has “Medicare Administrative Contractors” that do this, though not so egregiously as private insurers, but true single payers like the UHC systems in Canada have no such agency at all.
Perhaps the most important difference from both US Medicare and private insurance that can’t be overestimated is just the fundamental meaning of that phrase “medically necessary” and the implications for unconditional coverage. Medicare is just absolutely loaded with conditions and limitations that simply don’t exist in the necessity-driven and doctor-mediated UHC systems in Canada. For example, Medicare has arbitrary limits on even something so basic and medically critical as the length of a hospital stay, and private insurance can be even worse. In Canada, you leave the hospital when you’re healthy enough to leave. Some elderly people unfit to return home have literally stayed in hospital until a suitable long term care facility became available. In the US, you’re on the street when your insurance runs out.
The delays in Canada have not been debunked. They exist and by default they endanger people waiting for diagnostic tests or treatment. And the medical care advantage that wealthy people in Canada have is the ability to sidestep those delays and get the healthcare they need outside system such as cancer treatments.
No: Not ideologues and shills for the insurance industry…It’s Republicans that are the problem.
We would already be extremely near UHC if one of our political parties wasn’t obstinate about healthcare, or obstinate about anything to do with Obama. The ACA, as originally designed, where the states would operate their own exchange and where all states get the medicaid expansion, would have gotten us very near UHC. All it needed was a little more generous subsidy for lower-middle to middle class people, and a little bit stronger of an individual mandate penalty, as well as more states that actually wanted to implement it. Even with it’s flaws, in the states that have made an effort, they have had a marked decrease in the uninsured. Massachusetts, which did the forerunner of the ACA, got their total uninsured down to just a few % for the under 65 ages prior to the actual ACA kicking in.
And the ACA had aspects of it that were designed to help slow the growth of costs, and that I think would work if given time. The accountable care organizations, the IPAC, some tweaks to Medicare. It was a well-thought-out, if imperfect, bill. The insurance industry certainly wrote large parts of the bill. But the system they came up with would’ve worked.
In the old days, a bill like this would’ve been implemented, and any flaws would later get fixed with a technical mark-up. This used to occur when both parties were interested in governing.
But we have a political party, the Republicans, that is not interested in governing in good faith, and will not implement what used to be their own idea. The ACA was actually inspired by an idea that originated in the Heritage Foundation, more or less, and implemented by a Republican governor in a blue state.
Until we fix the Republican party, or they cease to exist in their current form, there will not be UHC in this country.
Yes, rational people have decided they don’t want to wait for diagnostic and medical treatment. That you can’t understand this is mind boggling. You can’t triage what you haven’t diagnosed and that’s just the delay to treatment. You think it’s fine to delay one surgery because somebody bumped to the head of the line of a list of limited availability of care. something you call Triage. We call that benefit throttling. “Delays” for short. I cited the problems you have with cancer care delays as an example. The rich in Canada get on a plane and get treatment in a timely manner. The rest of you get triage.
Gosh, I never knew I was so badly off. And here’s me thinking undergoing major surgery and staying two weeks in the hospital costing $15 for the painkiller prescription I left with was a pretty good way to go.
The scales have been lifted from my eyes. And I didn’t even have to fork over a co-pay, whatever that is. Thanks, Magiver!
So you’re going to cite a cherry-picked anecdote about acute myeloid leukemia, a rare disease that, frankly, has a poor prognosis and has major treatment challenges regardless of where you live, as evidence of your stupid argument?
Among your many inadequacies in this discussion is your failure to understand that “triage” is a clinical term for a critical assessment procedure that is used everywhere, because whether you acknowledge it or not, medical resources are always finite.
medical resources are finite in a UHC system. Much less so in a market driven system. I’ve already walked you through my leg example. I didn’t think the specialist’s opinion was accurate so I went around him. No triage. My family doctor set up yet another test (the day I called) and my leg was saved. that was the 3rd test in as many weeks.
When I had a kidney stone I was in the emergency room for less than an hour and got an X-ray. It was inconclusive so I got an MRI within the next hour. Back on the street with pills in hand in under 2 hrs. Saw my family doctor once and the specialist 2 times in the space of a week to change medications. After 2 weeks I saw the surgeon who gave me the option to have it removed. I was home by 5 on the same day after out-patient surgery.
Looking at your own resource guide for Toronto the average wait was 5to19 days for the specialist and 13to36 days for surgery.
You totally fucked up the quote where you’re quoting me. I’m sure it was unintentional but it completely obscures the meaning of what I was saying. It does seem strange that the part that you omitted was the part that directly refuted your stupid argument once again.
You can add the word “average” to the word “triage” to the list of words that you don’t understand in this context. These are important words that you should try to understand better before further discussing these issues. You have yet to make a single factual argument based on an understanding of … well, anything.
Medical resources are finite everywhere. Whether they’re allocated in accordance with medical priority or in accordance with the highest monetary bid is a measure of the quality of the society that we live in, and one way or another it ultimately determines the quality of life of everyone in it.
Just for comparative purposes: I’ve had three kidney stones. All three resulted in ER visits; in all three cases, I was in the ER for four to eight hours (including multi-hour waits for X-rays / imaging). When I was referred to a urologist, it was over a week to simply get in to see him. And, all of that was with a high-quality U.S. insurance plan (Blue Cross and Blue Shield of Illinois).
Your posts make it clear that you believe that immediate attention is (a) always preferable, and (b) not going to happen under a single-payer system, even when the patient is in need of immediate care. I don’t get the sense at all that you feel the points are worth debating; you’re convinced of your opinion.
Here’s another article on “medicaid buy-in”. States are still looking at this, and it appears that New Mexico might try and push it through.
I would have to see the details of what is proposed and passed, before being able to opine, although I’m skeptical about Medicaid buy-in being viable in much of the country. However, I tend to think that various states - particularly blue states - are looking to get to UHC within their state. So, I think in the absence of any fixes to the ACA from the Feds, and in the absence of any political ability to implement nationwide single-payer or near-single-payer, the push to get more people insured and fewer uninsured will come from individual states. If a few blue states are able to pull something off to serve as a model, you might see more changes to come.
+1 for the Spanish public system. With the exception of treatments considered “in an experimental phase” (approved only on experimental cases) or “semi-experimental” (fully approved for some situations, in trials for others), if a treatment is approved it’s approved. And for the experimental ones, what happens is that a doctor who is using a treatment not fully approved may get a call from his manager or from the equivalent of his place of employment’s Internal Affairs, and even be sanctioned if found to use it on non-approved situations. Experimental cases get reviewed and approved by either the department head or the group meeting, depending on local organizational policies.
Most Americans have health insurance the cost of which is not directly visible. And that cost is … costly! America spends more than twice, per capita(*), what other rich countries like Canada, France or Japan spend.
With these facts in view, it would be shamefully bizarre if most Americans did NOT like their own healthcare.
But …
Ask Americans who cannot get insurance at an affordable price how well they like their healthcare plan.
Ask Americans presented with a five-figure bill for “out of network” costs how well they like their insurance.
Ask an American who loved his insurance until he had a major problem and an auditor noted an undisclosed “pre-existing condition” how well he likes his insurance now.
I should ask my wife, who has an expensive medical condition that she was born with, and our affordable, private insurance has done a great job of paying the bills with little hassle, and our co-pays have been affordable. And I know many others with similar situations who are doing fine financially, because their private health insurance is good.
Look, I’m in favor of expanding the government’s role in health insurance. We should beef up the ACA subisides, and get the rest of the states on the Medicaid expansion. There are too many uninsured in this country. But before we go down the path of “Medicare for all” (i.e., single payer), we should take seriously polls that 3 out of 4 are fine with their healthcare. That stuff matters.
That’s great that you and your wife and your friends have private insurance that’s so generous and affordable. I, too, have expensive medical conditions–lupus, serious vision issues, and, last spring, breast cancer. My co-pays and deductible have not been reasonable nor affordable, and I’m in debt now, debt I’ve tried hard to avoid. It took my Boston friend two years to pay off her medical expenses for breast cancer–lots of co-pays and a high deductible.
And according to a 2018 Gallup poll, the level of satisfaction with our healthcare system is a far cry from 3 out of 4:
I have no doubt some of the wealthiest Canadians come to the US for medical care; only the wealthiest could afford care here. A hip replacement in the US would cost them $100,000 out of pocket, not counting transportation and lodging. But while the Canadian system needs fixing, they overwhelminglydo not want to privatize healthcare, and that says a lot.
If single payer is so terrible, why are those who have it so reluctant to give it up?