What should "national health care" be in the USA?

[pervert]

I found this surprising especially in that it came from PBS. It seems to be a sort of doctor regulated HMO, but I’m not sure I’ve characterized it correctly.

Under capitation, a hospital’s and physician’s entire income is based on their success in keeping patients healthy, rather than on maximizing the number of medical services delivered to those patients.

The use of capitation removes all the clumsiness, inefficiency, and antagonism inherent in the three ring circus typical of providers, patients, and “utilization managers” in traditional managed care settings. Pushing all the financial risk and associated medical responsibility for an insured population past the MCOs and squarely onto hospitals and physicians greatly simplifies the process of “managing care,” rendering the phrase a long overdue redundancy. Most importantly, capitation aligns the incentives of providers with those of patients.

And especially this:

As the specter of professional liability and, failing that, professional conscience police against the withholding of needed patient care under capitation, even better safeguards exist with the long- term financial interest inherent in the capitation system itself. Herein lies the purest elegance of capitation as an economic tool. A capitated hospital that prematurely discharges a patient to improve its own profit on that patient will lose this profit many times over when the patient returns with complications associated with the premature discharge. If the patient does not re-admit, then the discharge, however inconvenient or unpleasant, was obviously not medically premature. Similarly, capitated physicians who line their pockets by denying needed treatment to sick people under their capitated care will be contractually obligated to treat those people when they become very sick. Under capitation, the foxes may be guarding the henhouse but they are also responsible for egg production.

I’m shocked to discover this sort of thing. It seems like the solution to a lot of the problems related about health care in general.

Do any of you have more information on this concept? More recent studies for instance?

[GIGObuster]

Not that simple, it looks like that “solution” is just shifting the problem: here are some comments and a reply from the producers:
http://www.pbs.org/wgbh/pages/frontline/shows/doctor/talk/

Your portrayal of Dr. Solomon’s Dilemma creates the impression that he and his colleagues are battling a nameless monster that is somehow bent on destroying the sacred doctor/patient relationship. In truth however, Dr. Solomon and his colleagues have created their own dilemma. They are not the whole problem, but they are a major part of it and that should be made known to the public and to their patients.

Here is one example. The introduction of capitated payment schemes stimulated the formation of “networks” of medical care organizations (as CareGroup or Partners) which could negotiate and manage large capitated contracts more efficiently and profitably than small medical practices. In order to maintain the necessary stream of referrals, the networks purchased primary care practices like Dr. Solomon’s. The doctors then accepted 3 or 5 year contracts to practice in the network. The doctors jumped at this arrangement because under it 1) many of them became instant millionaires, 2) they allied themselves with what seemed to be the winner in the health care consolidation war, and 3) they stood a good chance of making a substantial entrepreneurial profit. So it seems to me that Dr. Solomon’s Dilemma bears an eerie resemblance to that of a famous former colleague, Dr. Frankenstein. And it deserves just about as much sympathy from his patients.

If the situation were better thanks to this “solution” it would be apparent by now. even doctors and nurses did not have kind words for that investigative report.

[snip]

Dear FRONTLINE,
Were you able to ascertain how much the doctors in POD 11 were paid for their practices when they joined CareGroup? CareGroup is probably in a precarious position because they over-paid physicians for their practices. And after making substantial gains from selling their practices, physicians are now complaining about having to pay the bill now.

Norbert Guimond
phoenix, arizona

FRONTLINE’s editors respond:
Several viewers have raised this point. It is a fine example of how quickly the accepted wisdom of day can be turned upside down in the medical marketplace – driving administrators, doctors, and patients to distraction.
Five years ago the hospital systems like CareGroup and the much larger competitor known as Partners were in a huge rush to buy up primary care practices in order to funnel patients into their hospital beds. This kind of frenzied buying was taking place in many areas of the country. No system wanted to be left behind in the rush to grab doctors. Today, this medical arms race is looked on as one of the most unfortunate miscalculations in the health care business. These purchases did play a part in putting these systems in the hole they find themselves in today. Mr. Guimond and other viewers are correct to suspect that this is one of the reasons the systems now are expecting the doctors to help control costs and make the institution more financially stable.

As I mentioned before, the financing of think tanks like the Cato institute does make suspicious of their conclusions. However, those real numbers in my last links (even from a private health company), showed that many are mistaken into assuming there is no problem, or that is not getting worse.

And now my turn to sound condescending:

---

From the article
In this way, rising health-care costs are the core driver of the uninsured problem in America.

And from the table listed: General Inflation: 18%
Drugs, Medical Devices and Medical Advances: 18%
Rising Provider Payments: 18% Increased Consumer Demand: 15% Governemnt mandates and Regulations: 15%
Impact of Litigation and Risk Management: 7% and Other: 5%

---

Especially interesting is the fact that nont of the top 3 issues would be addressed by nationalizing health care. And the 4th and 5th would increase. Can you tell me again how this is going to reduce costs?

Sorry, but I do detect a great bit of avoidance by assuming that none of the top 3 are a concern or that they are being ignored by all the proponents of national health care. In fact, inflation, cost of drugs, and rising payments are the main reasons why there is talk of national health care.

I am not 100% sure about all the proposals, but the implied OP solution of not doing nothing is dead wrong, lets see the Hawaii case:

http://www.thirdage.com/news/ap/hlth/20031021.3f955b79.6a41.12.html

The state’s 1974 Prepaid Health Care Act made Hawaii the only state where most employees are guaranteed health insurance by law. Employees who work 20 hours or more a week for four consecutive weeks must be given coverage with a premium that costs no more than 1.5 percent their salary.

[snip]

Yet, the state still posts the 10th-best coverage rate in the country, according to census statistics for the three-year period from 2000 to 2002. The state with the highest number of uninsured people, Texas, has a rate 21/2 times Hawaii’s.

“Hawaii looks like nirvana” compared to the rest of the country, said Emily Friedman, a Chicago-based health policy analyst who authored a history on the island health care system. “What’s frustrating is that Hawaii almost made it.”

Before the 1974 legislation, an estimated 17 percent of Hawaii residents had no health insurance, according to Joan White, executive director of the Hawaii Uninsured Project, founded in 1999 to address the growing no-insurance problem.

Mmm Texas is the worst! Do I see a correlation there with voting republican?

In any case, even with reform in mind, the changes will only be in the percentage workers will pay for the insurance; IMO, when the economy gets better, all this talk of changing the rates will go away. Fact is, the majority of the people in Hawaii do think their system is better that what we have in the continental USA. So much for claiming that there is no better way than the currrent mess we have.

[DSeid]

Well pervert, this was the original conceptualization of HMOs. Problem is that no single HMO (private or MD owned) is likely to have the risk for the long term. The purchasers of healthcare (the businesses that buy insurance) are always looking for that year’s best deal and switch around with regularity. As docs we have formed a large group to help mitigate this (if we are able to negotiate good at risk contracts with enough of the local players and we do right by our patients, then they’ll stay our patients even as they change insurances and the benefits of investing in prevention will be ours to reap. Sounds good but reality is that our local world is turning mostly PPO. Plus some healthcare investments do not make economic sense when only direct healthcare expenditures are taken into account … they do make societal economic sense when lost wages etc are factored in, and make decision analysis economic sense if some dollar value is place on years of life saved or for the nonfinancial cost of hospitalizing someone. But they are losing investments from the business model POV.

Most of these models were indeed the ill fated “PHO” - Physician Hospital Organization - which was always manged by hospital interests and hospitals don’t know diddley about running offices or providing outpatient care. But who listened to consultants and bought up practices left and right. Their sole motive, to keep the hospital solvent by funnelling in-patients and ancillaries (XRay, lab, etc) their way.

Tell me more about medical savings accounts. Take this example: middle class couple making 60K a year has manged to put 30K into thier account over a few years. She gets pregnant. Pregnancy, delivery without problem runs 10K plus. Kid is premie with a heart defect though and expenses run into 100K plus. What happens to that excess 50K of expense? I never quite got how this was supposed to work.

[pervert]

*Originally posted by GIGObuster *
**As I mentioned before, the financing of think tanks like the Cato institute does make suspicious of their conclusions. However, those real numbers in my last links (even from a private health company), showed that many are mistaken into assuming there is no problem, or that is not getting worse. **

OK, but don’t fall into the trap of believing “industry funded” numbers when you like them and not believing them when you do. Not accusing you or anything, just that your paragraph seems to suffer from a bias. I’ve never said that CATO is honest while others are lying. I like some of their reports because they seem to include references. I certainly don’t check every one. But I tend to trust sources that are willing to let me if I wish.

**
Sorry, but I do detect a great bit of avoidance by assuming that none of the top 3 are a concern or that they are being ignored by all the proponents of national health care. In fact, inflation, cost of drugs, and rising payments are the main reasons why there is talk of national health care.**

If you detect any avoidance it is coming from you. You missed my question. I understand that rising costs are the main reason for this debate. But I question the ability of socialized medicine to address them. I posted information in the begining challenging the assertion that Canada has been able to control costs better than the US. If you cannot provide me evidence that I’m wrong on this, I’d be willing to listen to the possibility that there is some mechanism which has not been considered. But I have not found any argument which suggests such a mechanism.

ttp://www.thirdage.com/news/ap/hlth/20031021.3f955b79.6a41.12.html

Did you read this article? It suggests that the atempt to provide near universal insurance coverage has not succeeded in Hawaii.

*HONOLULU (AP) - Hawaii - once held up as a model for its near-universal health coverage, boasting uninsured rates as low as 2 percent - is edging closer to the national average.

Today, nearly 10 percent of Hawaii’s residents are uninsured, hospitals and clinics say they’re struggling to care for those patients, and small businesses are pressing for reform of the stringent 1974 laws. *

In other words they did not succeed in controlling costs. They did not succeed in forcing employers to pay for universal health coverage. They did not succeed in preventing the demand for medical care from exceeding the supply.

What proposal exactly are you advocating which would correct this problem?

**
In any case, even with reform in mind, the changes will only be in the percentage workers will pay for the insurance;
**

Yes. so soon the system will go from mandating the employer to pay for insurance to mandating that the employee pay for insurance. Is this the solution you are advocating?

**IMO, when the economy gets better, all this talk of changing the rates will go away. Fact is, the majority of the people in Hawaii do think their system is better that what we have in the continental USA. So much for claiming that there is no better way than the currrent mess we have. **

Great. So they think its better. Canadians think their system is better, and Britons think their system is better.

Seriously. I’ll stop teasing you if you just explain what you are in favor of. Are you in favor of socialized medicine (ala Canda, Great Britain, or perhaps the old soviet union ;))? Or are you simply advocating “universal coverage” with no proposals as to how to achieve it.

[GIGObuster]

My last line should have given you a clue that I indeed read the article, even with the alarming tone, there is no movement afoot to change the system, only to tweak it. If you are growing frustrated that I am not giving much clues about what I would propose is because I am concentrating first on your misconceptions. As I see it, your cites always need more work.

Anyhow, in latest polls it is Americans who think we are not doing better:
http://abcnews.go.com/sections/living/US/healthcare031020_poll.html

In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments.

Support for change is based largely on unease with the current system’s costs. Seventy-eight percent are dissatisfied with the cost of the nation’s health care system, including 54 percent “very” dissatisfied.

The “problems” of a limited choice of doctors and waiting lists have already been dealt before by dopers from other countries here, and still in those countries, they approve on keeping universal health care.

*Originally posted by pervert *
**Great. So they think its better. Canadians think their system is better, and Britons think their system is better.
**

And with the majority of Americans thinking it could -and should- be better, does not tell you anything?

[pkbites]

*Originally posted by Maximum C *
It seems to me that pkbites is playing the typical greedy so-and-so who is clinging to the idea of personal responsibility because it benefits him

Greedy? Greedy? I’ve been called a lot of things, but greedy has never been one of them. It’s not greedy to not want ones taxes to go through the roof. It’s not greedy to oppose a huge government bureaucaracy. Are you saying that everyone who opposes nationalized health care is greedy? Are those who supported wellfare reform all “greedy”? Are we a nation of greedy sonsabitches?

[pervert]

*Originally posted by DSeid *
**Tell me more about medical savings accounts. Take this example: middle class couple making 60K a year has manged to put 30K into thier account over a few years. She gets pregnant. Pregnancy, delivery without problem runs 10K plus. Kid is premie with a heart defect though and expenses run into 100K plus. What happens to that excess 50K of expense? I never quite got how this was supposed to work. **

I’m not entirely sure this is the same thing, but I didfind this link to a lengthy article about newer plans.

It had this to say in the historical section:

As the nation moved from the Artesian era to the Managed Care era, many commentators realized that the financial incentives guiding various participants were sometimes in sharp opposition. The early days of Medicare DRGs, for instance, encouraged hospitals to discharge patients as quickly and efficiently as possible, since they would receive the same payment no matter how long patients lingered or how many services they received. At the same time, physicians were still paid fee-for-service for those same patients’ care, hence they were still rewarded for keeping patients hospitalized as long as possible and performing as many interventions as possible. The better hospitals did, the worse physicians fared, and vice versa.

And this regarding the capitation ideas:

Fundamental change ahead involves a shift from “defined benefits” to “defined contribution.” Under the traditional defined benefits approach, an institutional purchaser such as an employer determines what range of services it will cover, then seeks or creates a plan that will provide those services for an acceptable price. It has become increasingly difficult to sustain a defined benefit system. A steady stream of emerging technologies requires an equally steady stream of decisions about which ones will be covered by the plan. Moreover, it has become nearly impossible to provide such benefits economically, in the face of rising health care inflation and increasingly impotent cost-cutting tools.

And this regarding acounts and one of the several arguments in their favor.

Newer versions of defined contribution, commonly implemented as “consumer-directed healthcare benefits,” feature financial accounts on which the beneficiary can draw. The account might be a Flexible Spending Account (FSA) in which employees set aside their own pre-tax money to cover expenses of designated sorts, including health care. Or it can be a Personal Health Account (PHA) that an employer funds, or some combination of the two (Wye River Group on Healthcare et al. 2001, Robinson 2001, Parrish 2001).

This seems more like a history of hmos. But it has a lot of good information.

This may be a better overall discussion of the value of Savings Accounts.

While this is a more recent link. It is a speech and does not contain many references. But does contain more up to date assertions.

Including information on:

Medical Savings Accounts & Cost-Sharing Clones

**Remove Barriers to Growth of Defined Contribution Health Plans

Lower Costs Trump Insurance Subsidies

Market-Driven Deregulation via Competitive Federalism

A Real Safety Net for the Medically Uninsurable

Citizens’ Appropriations for Charity Care
**
Market mechanisms can’t eliminate every unfortunate human experience in health care access, affordability, and quality. Private charity and a backup safety net of transparent, direct subsidies have necessary roles to play. Unlike centralized government “solutions,” markets don’t promise perfect outcomes, just better ones.

The current climate of annual double-digit percentage increases in health care costs, dissatisfaction with the mature version of managed care, and remaining political resistance to centralized command-and-control mechanisms points to greater acceptance of the last remaining, relatively unexplored health care reform option-putting choices back in the hands of individual consumers and competitive free markets.

In a more market-based health care system, you would, to a large degree, get what you pay for, unless someone else wanted to pay for it voluntarily on your behalf. Income redistribution issues should be debated separately and resolved in the larger political arena, while we finally allow health insurance markets to operate more efficiently for the purposes for which they are best suited.

[GIGObuster]

No perfect outcomes just better ones? Sorry, the guys at Cato are now dipping into the propaganda well. At this stage it is obvious the answer is no.

And to show how complex is this: there is also private insurers in Europe, many governments do not have total control of health care, AFAIK Switzerland has a system like this: Everyone must have health care coverage. There are private insurance companies that offer package deals. The government has guidelines for those plans every insurer has to follow. The twist is that if you cannot afford any of them, then the government foots the bill for the plan, if you can afford a better one you are free to do so. The point is: there are many solutions out there, but our current “solution” sucks.

[DSeid]

Okay. So Medical Savings Accounts (MSA) are an still an employer based system that couple having a high deductable catestrophic only insurance policy with job based savings obligated to be set aside for first dollar health expenses. I presume that preventative medicine, if people decide to spend on it, comes out of the MSA: screening mamography, cholesterol screens and medication, hypertension screens, diabetic care, asthma preventative care, immunizations, etc. In other words, the very interventions that we have the best evidence for being of long term societal economic benefit, are the ones which this system provides a personal disincentive for, while catestrophic care is covered by a traditional high deductable insurance system.

And this voluntary employer based system provides for the minimal health care that all citizens are entitled to how?

The flaws in the analysis linked are many. Even catastrophic plans are expensive if not bought by a group; they are unaffordable by most individuals - this would not decrease the numbers of uninsured. It would discourage use of preventative care which would likely increase costs for society as a whole over a longer term analysis.

I am unimpressed.

[pervert]

*Originally posted by GIGObuster *
even with the alarming tone, there is no movement afoot to change the system, only to tweak it.

Yes. And as I said, tweak it by shifting the burden to the individual. That is, to move away from free health care for everyone. Over time, unless costs begin to fall, this burden may continue to shift. It seems to me another case against universally mandated health coverage.

**
If you are growing frustrated that I am not giving much clues about what I would propose is because I am concentrating first on your misconceptions. As I see it, your cites always need more work.**

But you are not doing this either.

I have never claimed that Canadians, Britons, or Hawaians are disatisfied. On the contrary. I think the satisfactions is almost irrelevant. So, while you may have addressed it, I hardly think it was a “misconception” on my part.
I have presented evidence that nationalized health care is not more efficient nor higher quality than the American system. You have not addressed this except to say you don’t trust the Cato Institute.
You did address the issue of poorer health for uninsured (although not with a study that corrects for other factors such as poverty). But you never addressed your “misconception” that a lack of insurance is equivalant to “effectively no healthcare”.

Somehow you never addressed the claims that waiting lists in socialized medicine countries amounts to a body of “underinsured patients”. Or did you think waiting lists were only about convenience?

I am at a loss to discover what “misconceptions” you have addressed.

[London_Calling]

*Originally posted by jsgoddess *
My questions:

What happens with malpractice in a government paid system? (Someone asked this, above.) Are awards limited in any way? If not, who pays the award? Can doctors afford to do business in the US at government rates if they still have to pay for malpractice insurance?

Sorry to hear of the difficulties you and your husband have been having.

I can’t quite work out which of your questions are genuine and which are, ermm, rhetorical, so I’ll have a stab at this as it seems to have been asked more than once:

Ultimately the public pay, any award against an individual is an award against their employer, say a ‘Heath Trust’ (a group of hospitals). So, because all the funding for that hospital comes out of taxation, the tax payer pays for the (few and not particularly costly) malpractice cases. But, but, but . .

Who do you think pays for the malpractice suits in the US ? – you, the public do, every bit as much as a Brit would through taxation. Except you pay for it in insurance premiums, higher consumer prices (passed on by employers/companies, etc), lower wages, amybe – the money doesn’t come from nowhere, it all traces back to the public’s pocket, whatever the system.

[GIGObuster]

*Originally posted by pervert *
**Somehow you never addressed the claims that waiting lists in socialized medicine countries amounts to a body of “underinsured patients”. Or did you think waiting lists were only about convenience?

I am at a loss to discover what “misconceptions” you have addressed. **

:rolleyes:

Please tell me that you do realize they do eventually receive treatment.

The subject here to me is the growing number of uninsured, and in this glorious “heaven” of HMO’s and private insurance companies, this should not be the case.

The uninsured don’t have to wait for care, I grant you that.

[pervert]

*Originally posted by GIGObuster *
**AFAIK Switzerland has a system like this: Everyone must have health care coverage. There are private insurance companies that offer package deals. The government has guidelines for those plans every insurer has to follow. The twist is that if you cannot afford any of them, then the government foots the bill for the plan, if you can afford a better one you are free to do so. The point is: there are many solutions out there, but our current “solution” sucks. **

No, the point is that this system does not work either.

Rising health care costs is a global phenomena. National health services address it either by cutting services or increasing the burden on private parties. The truth is that a completely different solution must be found. I suggest that it starts with education.

P.S. I found a link not related to the cato institute so you will not have to reject it out of hand.

[London_Calling]

Yep, they are waiting lists and not ‘no-treatment’ lists.

I wouldn’t get too caught up in the waiting list game; UK waiting lists were long because of under investment on a remarkable scale. Until quite recently the UK spent only 7.7% of GDP on Heath – that’s for the entire population, when, at the same time the US was spending 14%.

That’s big potatoes.

[pervert]

*Originally posted by GIGObuster *
**Please tell me that you do realize they do eventually receive treatment.

The subject here to me is the growing number of uninsured, and in this glorious “heaven” of HMO’s and private insurance companies, this should not be the case.

:rolleyes: right back at you.
Yep they usually do receive treatment. Unless they die waiting. Sometime they get more treatment than they would have because they get sicker waiting.

Fine. I accept that you are only interested in the uninsured. how would you solve it? I have posted many suggestions form various sources. They range from tax incentives to medical savings accounts, to changes medicaid system and other safety net reforms. The only thing you have done is make unsubstantiated claims about how much better it is in other countries.

[pervert]

*Originally posted by DSeid *
**And this voluntary employer based system provides for the minimal health care that all citizens are entitled to how?
**

The point, unless I missed something, is that the medical savings plan may address the rising costs of health care for most people. Ideally, this would lessen the burden on others. And in conjuction with medicaid and other safety net programs might just solve this problem.

It certainly has more merit IMHO than socialized medicine.

[pervert]

*Originally posted by London_Calling *
**Yep, they are waiting lists and not ‘no-treatment’ lists.
**

Just like the uninsured list.

[Gorsnak]

*Originally posted by pervert *
:rolleyes: right back at you.
Yep they usually do receive treatment. Unless they die waiting. Sometime they get more treatment than they would have because they get sicker waiting.

Oh for chrissakes, the waiting lists are for elective procedures, not for critical ones. You wait for hip replacement, not for chemotherapy.

Now, granted, there are likely some cases where the procedure in question isn’t truly elective in this sense, and it does lead to negative consequences. However, this can’t be very common. I can’t think of anyone in my acquaintance experiencing it, and while that might seem unremarkable, note that my mother keeps me informed (involuntarily) on the health status of a rather large group of people.

Certainly I cannot present any body of anecdotal evidence of this phenomena existing from my Canadian acquaintances the way I could present a body of anecdotal evidence from my American acquaintances of compromising medical care due to lack of health insurance, or difficulties in switching (pre-existing conditions, etc).

[GIGObuster]

pervert, Once again, that was misleading.

Nowhere in that article there is a cry to change the system, the problems are identified and mentioned: underfunding and understaffing, and the chicken little title of the piece does not quite reflect what is inside, (They must be learning from the US media) this it is just like what you attempted to do with the Hawai piece: mislead readers into thinking the worst, when in reality it is not as bad as you imply.

Health costs in Switzerland accounted for 10.7 per cent - or SFr43.4 billion ($31.8 billion) - of the country’s Gross Domestic Product (GDP).

AFAIK England reduced the health care GDP from 12% resulting in the “sky is falling” longer wait complaints in England. Many times the number I see for the USA is 13% (and we still have much more than 40 million uninsured!) What I think this shows, is a good rule to follow on what should be adequate funding under national health care, and to show what the current system in the US is good at: propaganda.

[pervert]

I promised myself I’d stop posting for a bit. But I can’t seem to stop. Can someone recomend a free addiction clinic?

*Originally posted by Gorsnak *
**Oh for chrissakes, the waiting lists are for elective procedures, not for critical ones. You wait for hip replacement, not for chemotherapy.
**

Well, I found this story on my first try. Its not chemotherapy, but it is cancer surgery.

More than a third of cancer patients treated by Ontario regional cancer centres had to wait an inappropriate length of time for surgery, reported one study, the first attempt to track cancer surgery waiting times in the province.
The second found that Montreal patients who had to wait longer than three months for coronary bypass surgery had a lower quality of life and higher rates of complications and death post-surgery than patients who received treatment more quickly.

Of course its not all bad news. But the fact that waiting lists are part of the problem is NOT in contention.

“In these difficult times, we are very pleased to have found a Canadian solution to our waiting list challenges,” said Dr. Brent Schacter, President & CEO of CancerCare Manitoba. “We appreciate the cooperation of Cancer Care Ontario in helping us bring this about.”

This is not Canada, but it is chemotherapy

For the first time cancer patients in Auckland and Northland are having to wait weeks for chemotherapy treatment because of staff shortages and an increasing number of people diagnosed with cancer

I know I should not post this one, but since you don’t like the CATO Institute I know you’ll like this one. Did I mention I was a pervert?

Furthermore, in 1999, over 120 people were removed from the coronary by-pass surgery waiting list in Ontario because they had been on it so long, they were so unhealthy that they would not survive the surgery anyway.

**
Certainly I cannot present any body of anecdotal evidence of this phenomena existing from my Canadian acquaintances the way I could present a body of anecdotal evidence from my American acquaintances of compromising medical care due to lack of health insurance, or difficulties in switching (pre-existing conditions, etc). **

Well, if you can not find anecdotal evidence for one case and can find it for the other, then that settles it.:dubious:

Seriously, though. The waiting list numbers are published by the NHS in England. Specifically here.. And many stories for Canadian studies exist as well. Do a google search for “waiting list for health care Canada” or any other country, and you’ll find some good information. A lot of crap, granted, but some good information as well.