Canadian Heathcare system sucks!!

[kellyb]

It won't be politically sustainable with the American public.

Hmm...

I think if everyone was aware that the current situation according to the US supreme court is this:

(someone tried to sue their HMO because the P4P measures led to poor care, and nearly cost her her life)

http://www.law.cornell.edu/supct/html/98-1949.ZS.html

SUPREME COURT OF THE UNITED STATES

PEGRAM et al. v. HERDRICH

Herdrich argues that Carle’s incentive scheme of annually paying physician owners the profit resulting from their own decisions rationing care distinguishes its plan from HMOs generally, so that reviewing Carle’s decision under a fiduciary standard would not open the door to claims against other HMOs. However, inducement to ration care is the very point of any HMO scheme, and rationing necessarily raises some risks while reducing others. Thus, any legal principle purporting to draw a line between good and bad HMOs would embody a judgment about socially acceptable medical risk that would turn on facts not readily accessible to courts and on social judgments not wisely required of courts unless resort cannot be had to the legislature. Because courts are not in a position to derive a sound legal principle to differentiate an HMO like Carle from other HMOs, this Court assumes that the decisions listed in Herdrich’s count cannot be subject to a claim under fiduciary standards unless all such decisions by all HMOs acting through their physicians are judged by the same standards and subject to the same claims. Pp. 5—9.

I think a platform of "the BEST, most transparent, most logical, most compassionate and evidence based rationing humanly possible" might fly.

IF people first accepted the fact that rationing is just an unfortunate necessity now that we have effective medicine and lots of technology which makes it amazingly expensive.

 

[Morrigan]

Currently, it would be politically impossible (except perhaps in Quebec - where every exercise of the federal spending power is obstructed on basic principle)

 

[Rolfe]

But I thought that there was already too much demand and not enough supply? On one side, people are complaining about the shortage of doctors. On the other side, you want to allow people to get excessive medical care? More care than is medically necessary?

I did say, if there is capacity in the system. In veterinary medicine, it's pretty self-evident that the capacity is there if the resources are there to pay for it. The practice partners just smile happily and take on more staff and invest in more equipment. It's called business expansion.

In human medicine, it's not usually quite so simple. How it works in Britain is that the doctors (well, the consultants, that's who we're really talking about) do a set amount of contracted work for the NHS, and they're free to do more work over and above that, either privately or for charity. If they increase the amount of private work they do, it doesn't really impact directly on the NHS, because they still have to fulfil their NHS contractural obligations.

I can understand the arguments against this - hey, shouldn't these guys be spending every working moment ploughing through NHS work? However, in my view it's oppressive to shackle professionals like this, and oppressive to bar citizens from spending their own money the way they want to spend it. So, so long as the private work dosn't impact on their NHS commitment (which it doesn't), I don't mind if they spend the rest of their time doing facelifts or reconstructing disfigured children in India or whatever floats their boat.

Rolfe.

 

[Rolfe]

You admit admin costs, bulk purchasing, etc will bring the cost down some, right?
For the rest, what about overt rationing?
Just being completely upfront about the fact that we're all working on a limited budget, and that people will get what they need, but not necessarily everything they want?

I don't know if anyone can find the link now, but buried somewhere back in one of the earlier threads was a fascinating, detailed article looking at where the extra money is going in the US system. Can anyone find this now?

Unsurprisingly, it wasn't just one thing, it was a combination. Insurance company overheads. Overpaying for goods and services. Superfluous, unnecessary goods and services being provided. Services being provided in highly cost-ineffective ways. And more. You could look at each item and say, well, fixing this isn't going to bring costs down all that much. But if you look at them all together, it's a different story.

There isn't an entirely painless way to do something like this, and anyone looking for such a way is doomed to disappointment and inaction. Expenditure on healthcare is way in excess of what it needs to be to provide the outcomes being achieved. However, that money is going somewhere. A certain group of people is trousering a substantial wodge of cash and not giving good value for that money. And this covers everything from the drug company executive in his private jet and his gold-plated cutlery to the single mother working for a pittance to process insurance claims. If the system needs more nurses and lab technicians and fewer accounts clerks, how do you convert the latter into the former?

And pretending that everyone will be able to get exactly what they want from a universal healthcare system is dishonest, and ought to be stamped on from the outset. Emphasising that people will get what they need, which will put a large number of citizens in a substantially better position than they're in at present, and that anyone who wants to pony up extra money for extras is still at liberty to do that, should make the ground rules plain.

I appreciate the view that the wealthy should not be allowed to purchase extras while the capacity in the system is stretched coping with the actual necessities. However, even in Britain it has been deemed unacceptable to prevent physicians from running private practices if they want to, and to prevent citizens spending their money that way if they choose. From what I can see of US society, such a prohibition would be even more unacceptable there than here. Good-quality, universal provision of necessities to a high standard, plus allowing physicians to sell supplementary services to the better-off is surely the way the American people would be happiest with a system?

Rolfe.

 

[Rolfe]

No, it's billable to the taxpayers.

No. The service is provided from taxpayer funds. It is not "billable". Nobody sends anyone an invoice.

I thought the discussion was that your wife as a foreigner was not covered under the NHS?

Without going back I can't say the exact misunderstanding here, but his wife would most certainly be covered by the NHS if she was legally resident in Britain. I saw no suggestion in his post that she wasn't eligible for NHS care.

I think some people have misconstrued the story a bit. His wife was found collapsed in a public place. Concerned people called the emergency services. She might have been having a stroke, or a heart attack, after all. When the ambulance arrived, it was established that she was drunk and incapable. So what is the ambulance crew supposed to do?

If she'd been completely out of it, they'd have had no option but to take her to hospital, one more A&E admission to clutter up the system and consume staff time and resources there. However, she wasn't. She was compos mentis enough to take care of herself if she was in a safe place, that is home. The ambulance crew couldn't just leave her where they found her. They'd much rather not take her to hospital where the staff have better things to do than sober up a woman who's simply had too much to drink. So they took her home.

And no, that's not "billable". It's part of what the ambulance service is funded to do. It's not all blue-light dashes to hospital with barely-breathing RTA victims. Sometimes it's dealing with low-level concerns that turn out not to be anything too worrying. But they deal with it anyway.

And as an aside, for something as trivial as this, nobody would care if the "patient" was eligible for NHS care or not. If the victim turned out to be a foreign holidaymaker, so what? It's not worth stressing about. Job done.

Rolfe.

 

[brodski]

And benefits is a broad term, it includes things like sick time and vacation.

Given the laws on statutory sick pay and the legal minimum of 4 weeks annual leave in the UK, these benefits are largely not a matter for employers either.

 

[ponderingturtle]

This is the country that put a man on the moon. I can't believe they can't manage what every other developed country (and quite a few we'd not necessarily agree are developed) have managed pretty well.

Rolfe.

Given who much we can't manage health care, I wonder if we need to give more credit for putting a man on the moon to the germans.

 

[ponderingturtle]

But you can't negotiate savings unless you're willing to walk away, which is what's at issue here. Without the ability and willingness to forgo a purchase, you have zero negotiating power. Can the government have such power in regards to new drugs? Yes, it can: if it's willing to walk away, and demonstrate that willingness to drug companies.

Proof that this happens to an extent that hurts patients?

Of course if you are a drug company it is a great way to get involved in legal extortion. Where else do you get to change someone what ever you want and they will die with out it and have it all legal?

 

[ponderingturtle]

I'm not assuming that. But any such discounts should already apply to Medicare. What's being discussed are negotiated discounts on top of any generic bulk discounts.

No remember medicare legaly can't get such discounts. It is great when your lobbiests write the laws for you.

 

[ponderingturtle]

I'd prefer to start by decoupling health insurance from employment. And tort reform.

Good this way all the really sick people will be on medicaid at least once they loose enough money.

 

[Rolfe]

Proof that this happens to an extent that hurts patients?

Of course if you are a drug company it is a great way to get involved in legal extortion. Where else do you get to change someone what ever you want and they will die with out it and have it all legal?

Sounds like the current squealing going on over the Mexican flu vaccine.

While announcing that contracts for 195 million doses worldwide were in place, the firm was also accused of profiteering, with a mark-up of up to 600% on its vaccine. It has agreed contracts with 16 countries worldwide.

However, note the "up to" 600%. I'll bet the countries negotiating for the biggest bulk buy are the ones paying significantly lower than that.

All systems suffer from being held over a barrel when they need something being sold by a monopoly supplier. However, as I explained above, it's not all one-way. The monopoly supplier wants to do other business with the purchaser. Being in the market also for non-monopoly items can be a significant bargaining tool. Give us a better discount on the Tamiflu, or we'll place our regular order for amoxycillin with your competitor.

Also, monopoly items are actually a very small part of a health system's expenditure. The vast bulk of it is boring routine stuff like bandages or lab reagents or common antibiotics. Bulk buying can make a huge difference overall.

It also helps if you don't pass a law forbidding your main centrally-funded bulk-buying outfit from negotiating prices, and require them to pay the up-front list price without question. What was the US government thinking of when it did that? (It's OK, I know, protecting their big-business buddies, i.e. corruption. Dearie me.)

Rolfe.

 

[ponderingturtle]

Sorry Rolfe and Volatile, but that wasn't the point of my post at all. The issue I raised isn't whether Obamacare will make the private market smaller or whether that's good or bad, but that Obama, other democrat leaders, and the man (Jacob Hacker) who is widely recognized as developing the health care approach that Obama has adopted have admitted in various speeches to their liberal base that their plan will spell the end of private insurance eventually and turn us into a single payer system ... something that Obama and the other advocates of his health care reform have denied.

This simply will not happen. Even if there is a universal single payer system, there will be room for suplemental insurance sales.

And why is it always single payer or the current system? Why do people ignore all the other models?

 

[ponderingturtle]

This is a bit over simplified. There are government jobs that pay better than private, security guards vs cops, for example.

And health care workers here in both the private sector and the public such as VA hospitals all make about the same.

But in ambulance services there is a big difference.

 

[ponderingturtle]

Another example, our fire fighters provide ambulance service or if they are tied up they can now call a private service. The fire fighters make a lot more than the private ambulance company pays.

Exactly, as they are public servants. Even if they were just EMTs they would make more. That is partialy why those jobs are very hard to get.

 

[ponderingturtle]

And then add in the obvious, those who stand to lose millions (insurance companies in particular) have millions to pour into these dishonest campaigns while those of us who want change have much less to pay for counter-ads.

Nonsense, they stand to loose billions not millions.

 

[ponderingturtle]

Yes.



It won't be politically sustainable with the American public.

So you think that the american public will demand infinite spending on their health?

 

[Rolfe]

But any such discounts should already apply to Medicare. What's being discussed are negotiated discounts on top of any generic bulk discounts.

My God, I didn't notice that one. You mean, you don't know that Medicare is legally compelled to pay the full-whack list price for everything it purchases? I'm not even American, and I can scarcely believe that's true, but I've been involved in the debate long enough that I know this fact.

As I said, I just bought a nice car. I negotiated the dealer down by a factor of about 7.5% over the list price. This is normal - nobody expects to pay list for that sort of purchase. Nobody expects to pay list for big, bulk-buy drug purchases either. The list price is merely intended as a benchmark to begin haggling. Except, the Bush government (I believe it was) passed a law that compels Medicare to pay the list price without question.

Who do you think persuaded it to do that?

So there's a nice opportunity for saving a shed-load of cash right there. I'm simply gobsmacked that someone who declares that he's studied the subject in such detail he can declare with confidence what will work and what won't, doesn't even seem to know about that.

You just aren't that bright, are you?

I don't know about bright, but I'm beginning to suspect you're not very well informed.

Rolfe.

 

[volatile]

Just as I was going to bed last night, I caught a snippet of the live-feed from Obama's healthcare-reform speech on the radio. Anyone else catch it?

 

[Oliver]

Just as I was going to bed last night, I caught a snippet of the live-feed from Obama's healthcare-reform speech on the radio. Anyone else catch it?

I watched it on CNN international, but those Barbarians didn't air the whole thing. Anyway:

Presidential Prime Time News Conference pt.1
Presidential Prime Time News Conference pt.2
Presidential Prime Time News Conference pt.3
Presidential Prime Time News Conference pt.4
Presidential Prime Time News Conference pt.5
Presidential Prime Time News Conference pt.6

 

[Mikister]

Let me speak from experience as someone who has dislocated their arm under the Canadian health care system.

After I dislocated my arm, I was quickly brought to the hospital. Immediately, I saw a doctor who swiftly stopped the pain and my arm healed.