Canadian Heathcare system sucks!!

[Ziggurat]

This is called self-selection and it’s one of the most serious problems in the US health care system.

I understand that very well.

This drives the unavailability of insurance except in large pools

This is wrong. Insurance is available outside large pools.

the sensitivity of insurance companies to preexisting conditions

Correct. And that's something critics often don't understand: exclusions of pre-existing conditions has a positive purpose alongside its negative impact.

the high cost of insurance

Not so much. It does not explain the high total health care spending, which is the primary driver of insurance costs.

and the extremely high administrative overhead in the US health care system.

There's no reason to think that everyone buying insurance would change this.

 

[Rolfe]

Everytime I flip on CNN or Fox News there's that ad playing with the woman who had a brain tumour in Canada and claims she would have died if she didn't go to America for treatment. She ends warning Americans not to "give up their rights".

I'm assuming it's the same woman as was featured in the polemic Dan linked to in the "Stossel solves the healthcare crisis" thread? If she's spouting actual anti-universal-healthcare rhetoric, then I'm afraid, given the circumstances, I merely wonder how much she's being paid.

If you've not read it ask Rolfe for her comments of that particular case - it would appear that the facts are not quite as portrayed.

I've just dredged up the two posts where I tried to explain that.

http://www.internationalskeptics.com/forums/showthread.php?postid=4510661#post4510661
http://www.internationalskeptics.com/forums/showthread.php?postid=4512454#post4512454

I'm pretty sure she said in so many words that she had Cushing's syndrome. Which would have been the pituitary-dependent form, caused by an ACTH-producing adenoma of the hypothalamus. Only a "brain tumour" if you really stretch the definition. The clinical problems are a result of the over-production of hormone this triggers. And the "brain surgery" is micro-surgery done through the nose, it doesn't involve cracking the skull. And the disease is a very very slowly progressive condition that can safely be managed conservatively for a very long time.

This is one of the most blatantly dishonest things I've seen in many years.

Short answer: the story is a lie. She didn't have a brain tumour at all. She had something called a Rathke Cleft Cyst.
http://brainsurgery.upmc.com/condit...utm_medium=cpc&utm_term=8382619&iq_id=8382619

Are you sure? I could swear she said in so many words she had Cushing's. Mind you, I'm not familiar with this Rathke Cleft thing, and the description of the surgery for that sounds very similar to the approach for Cushing's surgery. It's possible that the Rathke Cleft Cyst is a (rare) cause of pituitary Cushing's, I'm only a bloody vet! I'd be interested to know where you got that information, because it seemed clear enough to me from her own testimony that she had bog-standard pituitary Cushing's.

ETA: A quick check reveals that the wait time was a lie too. The Ontario govt keeps track of these things, and the wait time (defined as the point at which 9 out of 10 patients have completed surgery) for neurological surgery in Ontario as a whole is 49 days. Also, a search of wait times right now shows 5 out of the 8 facilities that perform neurological surgery in her area report no volume - i.e. no wait time!

5-6 months my aching ass.

Well, that doesn't surprise me. Because the whole thing about Cushing's is that you don't do anything hasty. You don't rush in. Because it's very very slowly progressive, and treatment is not without risk. You have to be absolutely sure of your diagnosis, and absolutely sure that intervention will benefit the patient, before you intervene. So it's perfectly possible to have someone with Cushing's, and empty slots in your neurosurgery facility, and yet you still aren't ready to go for it.

I always teach that it's vitally important to keep your early/possible Cushing's cases on-side, by explaining what you're doing to the client, otherwise they may feel they're not getting anywhere, and decide to jump ship to another practice. It appears this is what happened with this woman. Though where she came by the rest of her misapprehensions, I really have no clue.

Rolfe.

 

[Rolfe]

See Darat's post for evidence that do you have companies. And I am sure that they would appreciate tips too for transporting your back and forth to the doctor.

This is all a bit niche though. Only people with close relatives or friends needing transfer between nursing homes are really going to be in a position to say how this is usually accomplished.

As far as just being taken to the doctor is concerned (if you're housebound, for example), where I live that's done by charity volunteers attached to the Red Cross. They definitely appreciate a donation to Red Cross funds.

Rolfe.

 

[volatile]

There's no reason to think that everyone buying insurance would change this.

Errrm.... yes there is.

There are theoretical reasons: Economies of scale, for starters, as well as the reduction in paperwork / staff needed to do means testing, claims reviews, claims refusals etc. All f these would reduce overheads, and other costs would drop too.

There are also empirical reasons: Countries with universal healthcare systems (even those where universal coverage provided by private enterprise) often spend less per capita in total than the US currently spends. The figures also suggest, if I remember correctly, that the % spend on overheads is much, much higher in the private compared to the pubic sector.

ETA: I was right. http://www.governmentisgood.com/articles.php?aid=20&p=3

the New England Journal of Medicine estimates that administrative costs take 31 cents out of every health care dollar in the U.S., compared to only 17 cents in Canada.13 Why is this the case? Private insurance companies spend much more on paperwork and administrative overhead. The sheer number of people that are working in these private insurance bureaucracies far outstrips those required in government-funded programs. In Massachusetts alone, Blue Cross/Blue Shield employs 6,682 workers to cover 2.7 million subscribers. This is more people than work in all of Canada’s provincial health care plans, which cover over 25 million people.

You're simply wrong. I honestly don't understand how a smart guy like yourself - and you're in a different intellectual league to many other people who post against UHC systems - can parrot such nonsense.

 

[pgwenthold]

The beauty of this commercial is that, despite all the rhetoric about "having medical decisions made by doctors, not government beaurocrats," from what Rolfe says, her treatment course was actually perfectly ok with the doctors (and probably what the doctors preferred) and that the medical decision was made by HER.

I think this case actually says a lot about the real underlying agenda. It's not about wanting medical decisions made by the doctor. It's about getting what she wants, now. Regardless of the medical indications.

It's kind of like the stories that have been related about trying to get an appointment with the dermotologist, which can take weeks or months. It's annoying, and the natural response is, "I have an itch! I need to see the dermotologist now!" The medical response is, "No you don't. Your rash isn't going to kill you. Wait your turn."

Sure, we are happier if we can get in right away, but that is an issue of convenience and not a medical decision to make.

 

[D'rok]

Are you sure? I could swear she said in so many words she had Cushing's. Mind you, I'm not familiar with this Rathke Cleft thing, and the description of the surgery for that sounds very similar to the approach for Cushing's surgery. It's possible that the Rathke Cleft Cyst is a (rare) cause of pituitary Cushing's, I'm only a bloody vet! I'd be interested to know where you got that information, because it seemed clear enough to me from her own testimony that she had bog-standard pituitary Cushing's.

Right from the horse's mouth:

Dr. Naresh Patel, neurosurgeon, diagnosed Holmes as having a Rathke's cleft cyst (RCC). The rare, fluid-filled sac grows near the pituitary gland at the base of the brain and eventually can cause hormone and vision problems.

http://www.mayoclinic.org/patientstories/story-339.html

 

[ponderingturtle]

This is all a bit niche though. Only people with close relatives or friends needing transfer between nursing homes are really going to be in a position to say how this is usually accomplished.

As far as just being taken to the doctor is concerned (if you're housebound, for example), where I live that's done by charity volunteers attached to the Red Cross. They definitely appreciate a donation to Red Cross funds.

Rolfe.

They handel things like transport between hospitals and rehab centers?

This is not that strange a service, as most trasportation between hospitals and such is done this way, at least in the US.

Arround here there are probably about the same number of these kinds of jobs as there are emergency 911 jobs.

 

[Rolfe]

They handel things like transport between hospitals and rehab centers?

This is not that strange a service, as most trasportation between hospitals and such is done this way, at least in the US.

Arround here there are probably about the same number of these kinds of jobs as there are emergency 911 jobs.

Look, I'm saying I don't know, because I don't have any close acquaintances who've needed that sort of transport. It's perfectly possible that sort of thing is carried out by private contractors. These "ambulances" would not attend emergency calls though.

If you really think it's relevant to the discussion I could try to find out, but I don't really know what difference it makes.

Rolfe.

 

[Rolfe]

Right from the horse's mouth:

That would all fit with this rare condition being the cause of a subset of pituitary-dependent Cushing's presentations. I suspect it comes down to the same thing so far as treatment is concerned.

Rolfe.

 

[Architect]

I cannot help but notice that our local hospital seems populated by two kinds of ambulance; the usual red and blue flashing light emergency type, and another kind rather like glorified minibuses with "Patient Transfer" on the side. Both bear the Scottish Ambulance Service logo on the side and hence, I assume, are publically owned.

 

[Rolfe]

Sure, we are happier if we can get in right away, but that is an issue of convenience and not a medical decision to make.

So far as Cushing's is concerned, the patient should not be able to demand immediate intervention when "masterly inactivity" may be the better course of action at the particular stage of the condition.

I'm still very puzzled as to why she was apparently given the misconceptions she was by the doctors who treated her in the USA. All that stuff about being dead in two weeks if she hadn't had the surgery and so on. It's complete hogwash. Of course she may have made it all up herself.

Rolfe.

 

[ponderingturtle]

Look, I'm saying I don't know, because I don't have any close acquaintances who've needed that sort of transport. It's perfectly possible that sort of thing is carried out by private contractors. These "ambulances" would not attend emergency calls though.

If you really think it's relevant to the discussion I could try to find out, but I don't really know what difference it makes.

Rolfe.

Why shouldn't they be able to answer emergency calls? It gives you a larger reserve if you need lots and lots of ambulances at short notice, say a bus crash.

 

[Ziggurat]

Errrm.... yes there is.

There are theoretical reasons: Economies of scale, for starters

No. As most Americans are already insured (and many who aren't are young, and hence don't represent as much per-capita load on the system), an increase to the entire population would not change the scale much at all.

as well as the reduction in paperwork / staff needed to do means testing

Where's the evidence that means testing represents a significant portion of our administrative costs?

claims reviews, claims refusals etc.

None of that would stop or even reduce with 100% coverage. You seem to be thinking about the administrative advantages of a single-payer system, but that's different from the administrative advantages of everyone having insurance.

There are also empirical reasons: Countries with universal healthcare systems (even those where universal coverage provided by private enterprise) often spend less per capita in total than the US currently spends.

I keep hearing this, and the cost differential is quite real, but the numbers never add up to a case for America adopting UHC based on cost advantages. The idea that our costs would drop to the level of those other countries by expanding coverage just doesn't add up. Nobody can point me to any quantitative evidence of the savings we can realistically expect. There are inefficiencies in our system, but there is no indication that the inefficiencies are that large, or that they can be eliminated so easily.

The figures also suggest, if I remember correctly, that the % spend on overheads is much, much higher in the private compared to the pubic sector.

Enough to close the gap between us and other countries? No, I don't think so.

ETA: I was right. http://www.governmentisgood.com/articles.php?aid=20&p=3

"the New England Journal of Medicine estimates that administrative costs take 31 cents out of every health care dollar in the U.S., compared to only 17 cents in Canada."

But cutting down our administrative costs to Canadian levels wouldn't bring about cost parity, not by a long shot. Hell, eliminating our administrative costs completely (which isn't possible) wouldn't accomplish that. Like I said, the numbers don't add up.

Americans do not demand the same things from our healthcare system that others demand. We demand access to the newest drugs (something many single-payer systems refuse outright to keep costs down), lots of high-tech diagnostics like MRI's, and expensive end-of-life care. You can argue that we are wrong to do so, that we don't get worthwhile care for the dollar, but the demand is there. And that demand won't go away under any universal health care system.

 

[Rolfe]

I cannot help but notice that our local hospital seems populated by two kinds of ambulance; the usual red and blue flashing light emergency type, and another kind rather like glorified minibuses with "Patient Transfer" on the side. Both bear the Scottish Ambulance Service logo on the side and hence, I assume, are publically owned.

Yeah, I was thinking about those. But these are just minibuses - what's being discussed is the transfer of a bedridden and dependent patient.

I simply have no idea how it's done. Suppose a patient in private nursing home A needs to go to higher-dependency private nursing home B? Maybe the Scottish Ambulance Service will take them, maybe there is a private firm who specialises in that sort of work. I have no idea. And I don't see the relevance to the discussion.

Unless it's to avoid what I was saying about the effects of the current US system on the economy, and the lunacy of a system that compels businesses to provide goods and services to people who have no means of paying for these, and other pertinent posts.

Rolfe.

 

[ponderingturtle]

I cannot help but notice that our local hospital seems populated by two kinds of ambulance; the usual red and blue flashing light emergency type, and another kind rather like glorified minibuses with "Patient Transfer" on the side. Both bear the Scottish Ambulance Service logo on the side and hence, I assume, are publically owned.

Are the minibuses transporting patients in streatchers or wheelchairs? In the US there are also Ambulettes that transport people in wheelchairs, but have no medical equipment what so ever and only one staff member.

 

[Rolfe]

Why shouldn't they be able to answer emergency calls? It gives you a larger reserve if you need lots and lots of ambulances at short notice, say a bus crash.

Look, I don't even know if they exist at all! And if they do, I suspect they aren't equipped to the standard required to answer emergency calls. There are contingency plans for disaster management that call on all available resources.

Rolfe.

 

[ponderingturtle]

Unless it's to avoid what I was saying about the effects of the current US system on the economy, and the lunacy of a system that compels businesses to provide goods and services to people who have no means of paying for these, and other pertinent posts.

Rolfe.

This is pertenent as if a private ambulance is flagged down and the person wants to go to the emergency room, they have to take them unless they already have a patient.

 

[Rolfe]

Are the minibuses transporting patients in streatchers or wheelchairs? In the US there are also Ambulettes that transport people in wheelchairs, but have no medical equipment what so ever and only one staff member.

Why do we care? Is there some actual point here, that might make it worth our while finding out?

I have a very good friend who is a GP and is the chairman of her local Stroke Association. I imagine she knows how this sort of thing is handled. If there really is a point to this, I can telephone and ask her. But why?

Rolfe.

 

[ponderingturtle]

Look, I don't even know if they exist at all! And if they do, I suspect they aren't equipped to the standard required to answer emergency calls. There are contingency plans for disaster management that call on all available resources.

Rolfe.

The point is that the role for them must exist, and their must be people filling it. It is wrong to take a primary emergency ambulance out of service to take a patient back to a nursing home from the hospital.

 

[ponderingturtle]

Why do we care? Is there some actual point here, that might make it worth our while finding out?

I have a very good friend who is a GP and is the chairman of her local Stroke Association. I imagine she knows how this sort of thing is handled. If there really is a point to this, I can telephone and ask her. But why?

Rolfe.

I would find it interesting. I wonder how these things are handeled in nations with different health care policies.