Canadian Heathcare system sucks!!

[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.

Sorry, does not compute. You don't "flag down an ambulance" here.

If you need an ambulance to take you to A&E, you dial 999. One will be sent, with tight targets on how soon it has to get there. If you live in a remote area, a local "first responder" with first-aid training will also be sent to you immediately.

If you are "walking wounded", you ask a friend, neighbour or relative to drive you there. Or you call a taxi.

If an ambulance happened to pass a horrendous car crash that had just happened, I imagine the driver would stop to help unless he had a real emergency in there already. But beyond that, ambulances are doing their job, and members of the public don't get to flag them down like taxis.

Rolfe.

 

[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.

I suspect you're right, and I suspect there may be private provision, or possibly charity provision. However, as it's not within my experience, I don't actually know.

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

I will ask my friend next time I'm speaking to her. Not everything is provided on the NHS - nursing home care, for example. So there may well be private provision exactly as you envisage.

Rolfe.

 

[Rolfe]

Look, the economics of devoting such a high percentage of citizens' income to healthcare provision. The rationality (or otherwise) of compelling businesses to provide goods and services to people who cannot possibly pay for them.

The lies the Cushing's woman is telling, and why huge amounts of money which people have paid in health insurance premiums are being spent on propagating these lies, and why such flagrant misrepresentation is being permitted.

Far more interesting than who provides nursing home transport.

Rolfe.

 

[volatile]

---

 

[volatile]

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

"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.

Why not?

How can you claim that "the numbers don't add up" when the staffing levels are something in the order of, if the Maryland Blue Square numbers extrapolate, EIGHT TIMES greater in the private sector? How can you read those figures and claim with a straight face that "there's no reason to think that everyone buying insurance would change [the extremely high administrative overhead in the US health care system]"?

You're staring the facts in the face and still claiming blue is red and up is down.

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.

By "Americans", I really don't think you mean "Americans", do you?

 

[billydkid]

OK. I was just in Montreal for 7 days. One of the staffers of the Hostil I stayed at just dislocated his shoulder.

#1. He told me he had to wait for 2 HOURS for an ambulence to come. They eventually decided to give up on the ambulence and his dad drove him to the hospital.

#2. The hospital treatment and x-ray was free. But..he told me that national insurance does NOT cover physical therapy!! He said he would have have to fork over at least $40 a session..and he would need like 6 weeks at least.

#3. I asked him if he has a G.P. He said that it is very difficult to get a G.P. in Montreal, all the doctors refuse to take any more patients, and many doctors actually move to New York or other border states where they can get more pay.

Is this all true? Is the Canadian system this bad or does this guy simply not know his $$$$?

If even half of this stuff is true...it would be very bad for Obama's plans for health care in the USA.

Canadians...please respond.

Honestly I don't know what to believe. I don't know who is lying or being deceptive - the likes of Michael Moore who has shown himself not to be above a fair amount of deceit (him being on the side of the angels and all) or the horror stories I hear about people coming to the states because that can't get decent treatment under their socialized system. For my money, if you want to know what federally controlled healthcare would look like in the US, all you have to do is look at the VA which has something less than a stellar track record. It was government involvement which gave us HMOs and all the nightmares associated with them. There is no reason on earth to suppose that federal burearcrats will do anything but a half assed job of doling out healthcare at best.

 

[Ziggurat]

Why not?

I just told you. The cost gap is significantly larger than the total administrative costs of our system. You can't close it even if you eliminated all administrative costs. Which you can't.

How can you claim that "the numbers don't add up" when the staffing levels are something in the order of, if the Maryland Blue Square numbers extrapolate, EIGHT TIMES greater in the private sector?

Because that's what the numbers you provided about the total administrative overheads in Canada and the US indicate. No extrapolation is necessary.

And there's no "Blue Square".

By "Americans", I really don't think you mean "Americans", do you?

I mean what is commonly meant: citizens of the United States.

 

[volatile]

I just told you. The cost gap is significantly larger than the total administrative costs of our system. You can't close it even if you eliminated all administrative costs. Which you can't.

Because that's what the numbers you provided about the total administrative overheads in Canada and the US indicate. No extrapolation is necessary.

Even though I think closing IS plausible (everyone else manages to do what the US can't, cheaper), that's by the by. Don't think we won't notice that neat little goalpost move you just did there: your claim was not that cost parity would be achieved, but that everyone buying insurance wouldn't CHANGE the extremely high costs. I, and the whole of Canada, beg to differ.

I mean what is commonly meant: citizens of the United States.

I think you're [quite wrongly] assuming that all Americans think exactly like you. Further, you're over-stating the extent to which UHC systems fail to provide "cutting edge technology", and under-estimating the severe needs of a huge proportion of the population who currently don't have access to care at all.

If your position is that the private healthcare system should be maintained (at extreme cost to both the taxpayer and those who currently slip through the healthcare net) simply to ensure that those on the best (and most expensive) plans get more MRIs than they clinically require, then shame on you.

 

[volatile]

There is no reason on earth to suppose that federal burearcrats will do anything but a half assed job of doling out healthcare at best.

What is a "federal bureaucrat" and how will they "dole out" healthcare? In the UK, the government simply PAYS for the care the patients doctor thinks she requires.

On the flipside, the private system you currently have DOES involve a considerable number of bureaucrats assessing claims, matching them with small-print, maxing out claims and refusing to pay even in cases of need. So what are you talking about?

We all hear a lot about these dreaded "federal bureaucrats", but who are they? What function do you imagine they fill in UHC systems? What role do you think they have in the healthcare systems of, say, the UK or Canada?

 

[ponderingturtle]

Sorry, does not compute. You don't "flag down an ambulance" here.

If you need an ambulance to take you to A&E, you dial 999. One will be sent, with tight targets on how soon it has to get there. If you live in a remote area, a local "first responder" with first-aid training will also be sent to you immediately.

So ambulances in Britian will drive past accidents if there was not a call made?

If you are "walking wounded", you ask a friend, neighbour or relative to drive you there. Or you call a taxi.

Why? I mean if you are out shopping and see an ambulance at a resturant why wouldn't you walk up to them and get help if you started having crushing chest pain? You might be able to walk but you certainly should call an ambulance.

If an ambulance happened to pass a horrendous car crash that had just happened, I imagine the driver would stop to help unless he had a real emergency in there already. But beyond that, ambulances are doing their job, and members of the public don't get to flag them down like taxis.

Rolfe.

With the ammount of time you spend on the road as an ambulance that is more common that you would think.

 

[ponderingturtle]

I will ask my friend next time I'm speaking to her. Not everything is provided on the NHS - nursing home care, for example. So there may well be private provision exactly as you envisage.

Rolfe.

So you have no public way of dealing with people who need 24 hour care?

We do here, it is called wait until they run out of money and then they qualify for medicaid.

 

[ponderingturtle]

Honestly I don't know what to believe. I don't know who is lying or being deceptive - the likes of Michael Moore who has shown himself not to be above a fair amount of deceit (him being on the side of the angels and all) or the horror stories I hear about people coming to the states because that can't get decent treatment under their socialized system. For my money, if you want to know what federally controlled healthcare would look like in the US, all you have to do is look at the VA which has something less than a stellar track record. It was government involvement which gave us HMOs and all the nightmares associated with them. There is no reason on earth to suppose that federal burearcrats will do anything but a half assed job of doling out healthcare at best.

Ah the americans are dumb argument.

 

[Ziggurat]

Even though I think closing IS plausible (everyone else manages to do what the US can't, cheaper), that's by the by. Don't think we won't notice that neat little goalpost move you just did there: your claim was not that cost parity would be achieved, but that everyone buying insurance wouldn't CHANGE the extremely high costs. I, and the whole of Canada, beg to differ.

Don't think I didn't notice your change from everyone buying insurance (which is what I said) to the adoption of a single-payer system. You've got no grounds to accuse me of moving the goalpost, volatile.

I think you're [quite wrongly] assuming that all Americans think exactly like you.

Not at all.

Further, you're over-stating the extent to which UHC systems fail to provide "cutting edge technology", and under-estimating the severe needs of a huge proportion of the population who currently don't have access to care at all.

OK, so we've got this problem of people who don't have access to care at all. And providing them access to care will... lower costs? Does not compute.

If your position is that the private healthcare system should be maintained (at extreme cost to both the taxpayer and those who currently slip through the healthcare net) simply to ensure that those on the best (and most expensive) plans get more MRIs than they clinically require, then shame on you.

I said nothing of the sort, but thanks for trying to poison that well. Rather, I'm being realistic about what I think would happen in the event that the US tried to adopt a UHC system. Hell, the results might even be better than what we've got now. But a cost reduction that would bring our total costs in line with the Canadian system? No, there's no evidence that would be accomplished. Hell, I haven't seen much in the way of evidence for ANY significant cost reductions under any plan that has a chance of adoption here.

 

[Rolfe]

So you have no public way of dealing with people who need 24 hour care?

We do here, it is called wait until they run out of money and then they qualify for medicaid.

Well, it depends. In Scotland, we have "free" personal care for the elderly, which isn't entirely free, and some local authorities have been criticised for operating waiting lists (declared to be unlawful), but covers quite a lot. In effect, people judged to be in need of such help are given a grant for what the government thinks nursing home care should cost. Which doesn't always cover the entire amount that's being charged. This isn't the NHS though, it's social services.

In England, it's kind of like you stated above. Wait till they run out of money and then pay for their care.

That's talking about people who aren't medically ill, though, just old. People whose need is due to a medical condition are theoretically covered by the NHS. I say theoretically, because the system isn't great. There are instances of relatives having to fight tooth and nail to have a sick person designated as eligible for such care. If they're not so designated, then yes, the system will keep taking their money until they run out of it and then just go on caring for them anyway.

Personally, I'd be in favour of paying higher taxes to improve coverage in this area, but the democratic will isn't there to make it happen.

Rolfe.

ETA: I should maybe make this clearer. Medical care is provided by the NHS, and everybody is eligible. It is not means-tested. Care of the elderly or long-term disabled is provided by Social Services, and this is means-tested. That means you pay for it yourself until you run out of money, then Social Services will step in. There is obviously some grey area here, which is subject to dispute.

 

[volatile]

Don't think I didn't notice your change from everyone buying insurance (which is what I said) to the adoption of a single-payer system. You've got no grounds to accuse me of moving the goalpost, volatile.

We're talking about the differences between universal systems - where, in some cases (such as Germany, or Switzerland) buying insurance is mandated - and non-universal ones. When you talk about "everyone buying insurance" in a thread about universal healthcare, one might reasonably assume you're talking about universal healthcare.

You're still wrong, though, even if you were just talking about mass uptake of the US system.

Not at all.

You think the guy who needs to go bankrupt to pay for his heart-transplant cares how many superfluous MRIs he gets?

"Hey Joe, sorry your coverage maxed out and you're now going to be bankrupt - but don't worry, the guy in the next ward is getting an MRI he doesn't need". "Hey Bill, sorry we had to deny you coverage because you've developed diabetes - don't worry, though, Jim down the hall is getting this awesome new drug that works slightly better than the generic equivalent."

The "benefits" of the system you cite - more MRIs, flashier drugs - are only benefits for a tiny fraction of the fraction of people who have coverage, and even then they are benefits of little or no clinical importance. Why on earth would you defend them, let alone cite them as reasons in favour of the system?

OK, so we've got this problem of people who don't have access to care at all. And providing them access to care will... lower costs? Does not compute.

Works in pretty much every country that's implemented UHC systems so far. What makes the USA system different?

It DOES compute. More people covered equals a bigger risk spread, greater purchasing power and less bureaucracy. The numbers are in, Ziggurat.

I said nothing of the sort, but thanks for trying to poison that well. Rather, I'm being realistic about what I think would happen in the event that the US tried to adopt a UHC system. Hell, the results might even be better than what we've got now. But a cost reduction that would bring our total costs in line with the Canadian system? No, there's no evidence that would be accomplished. Hell, I haven't seen much in the way of evidence for ANY significant cost reductions under any plan that has a chance of adoption here.

So, the USA are, in the Western world, uniquely incapable of implementing a healthcare system for the same costs as other comparative systems? Why? What makes the USA so different from every other country in the developed world?

 

[Rolfe]

So ambulances in Britian will drive past accidents if there was not a call made?

I imagine it would depend on the balance of competing priorities. If they're rushing someone to hospital with a serious heart attack and they see someone with a broken leg, probably not so much. If they're on their way back to base after responding with blue light flashing to some brain-dead prank call and they see someone being pulled unconscious from a lake, quite probably.

Why? I mean if you are out shopping and see an ambulance at a resturant why wouldn't you walk up to them and get help if you started having crushing chest pain? You might be able to walk but you certainly should call an ambulance.

What would an ambulance be doing at a restaurant? I'd imagine they might have been called to deal with someone else with crushing chest pain, or something similar. If you're taken suddenly ill like that, and there happens to be an ambulance there dealing with another emergency, you might well ask them for help if it's that urgent. It would be up to the ambulance crew how they dealt with competing priorities. I imagine they'd probably radio back to base and ask for a second ambulance to be sent out ASAP if they felt that was necessary. You seem to imagine that they should drop the emergency they're already dealing with to care for the person who flags them down, and I don't think that's reasonable.

With the ammount of time you spend on the road as an ambulance that is more common that you would think.

You sound as if you have personal experience as ambulance crew. In that case, you can probably work out the answers as well as I can. An NHS ambulance is there to deal with the casualty it has been called to attend to, but if another casualty shows up, they'd be expected to do what was reasonable. So far as I know.

A hypothetical privately-operated ambulance contracted to do a nursing home home transfer would be in much the same position as any other bystander if it came across some sort of incident. If they are in a position to stop and help, then they should do that.

By the way, I noticed a picture of a "private ambulance" in today's newspaper.

Little could be seen at the first-floor flat where the bodies were found except for police forensic experts' camera flashes glinting through closed curtains.

The covered bodies were taken away in a private ambulance and a police officer stood at the entrance to the four-storey block

The picture in the online paper is much smaller and cropped from the paper version, but you can just see the words "PRIVATE AMBULANCE" on the side. I don't know for sure who pays for this, but I'd put money on it being the taxpayer!

Rolfe.

 

[Ziggurat]

We're talking about the differences between universal systems - where, in some cases (such as Germany, or Switzerland) buying insurance is mandated - and non-universal ones.

And yet, you predicated a number of your arguments on a comparison to a single-payer system.

You're still wrong, though, even if you were just talking about mass uptake of the US system.

Pray tell, how exactly will that reduce administrative costs significantly?

You think the guy who needs to go bankrupt to pay for his heart-transplant cares how many superfluous MRIs he gets?

What, you think I'm claiming that such a patient is who currently drives the use of expensive diagnostics? Don't be silly.

"Hey Joe, sorry your coverage maxed out and you're now going to be bankrupt - but don't worry, the guy in the next ward is getting an MRI he doesn't need". "Hey Bill, sorry we had to deny you coverage because you've developed diabetes - don't worry, though, Jim down the hall is getting this awesome new drug that works slightly better than the generic equivalent."

Appeals to emotion with no logical connection to the point being made.

The "benefits" of the system you cite - more MRIs, flashier drugs - are only benefits for a tiny fraction of the fraction of people who have coverage. Why on earth would you defend them, let alone cite them as reasons in favour of the system?

I did not call them benefits. I am not claiming they are benefits. Nor am I even defending them. But they are features of the system that Americans are demanding. And will continue to demand. You seem unable to distinguish between statements about the way things are from statements about preferences.

Works in pretty much every country that's implemented UHC systems so far. What makes the USA system different?

We're different. Hell, the fact that we're the only ones without such a system kind of proves that point.

It DOES compute. More people covered equals a bigger risk spread

So individual insurance costs may lower. Overall costs? That doesn't help at all.

greater purchasing power and less bureaucracy.

Less bureaucracy? Extending coverage creates less bureaucracy? No, I don't think so. A single payer system might create less bureaucracy, but again, single payer is not the same thing.

So, the USA are, in the Western world, uniquely incapable of implementing a healthcare system for the same costs as other comparative systems? Why?

Perhaps because we do not want, and will not accept, the same healthcare system as other countries. As I said, we make different demands. Whether or not we are right to make such demands, whether or not it's worthwhile to make such demands, doesn't change the fact that we make such demands and will continue to do so.

But whatever the reason, there is not a single plan that has been put forth in congress which would reduce our healthcare spending to Canadian levels. Nor have there been serious proposals from outside Congress which can realistically hope to accomplish that either. References to the cost structures in other countries don't cut it: nobody can point to any achievable savings in this country which could bring our costs in line with Canada, unless you're willing to cut services dramatically. Which nobody is willing to do.

 

[volatile]

"We're different"? That's IT?

Sheesh, Ziggurat. There's not much point entering into a discussion with you if you're just going to stick you fingers in your ears and go "Laaaa! Laaaa!".

 

[Ziggurat]

"We're different"?

That's IT?

"Other countries do it"?

That's IT?

Where are the savings, volatile? What spending can we eliminate? Do tell. Because apparently Congress can't figure it out.

 

[volatile]

there is not a single plan that has been put forth in congress which would reduce our healthcare spending to Canadian levels

Do you think that might have something to do with the mendacious, ideologically-driven, propagandistic rhetoric mentioned in this thread? You can't complain that "no-one's proposed a system" when any such proposals are shot down by exactly the same kind of nonsense you're peddling.