Stossel Solves the Health Crisis with Capitalism

[DaN K. StAnLeY]

Well, I'm not really laughing. It wasn't that funny.

I was laughing more at the "i got what I asked for" thought that passed through my head while reading your posts.

What puzzles me is how come you even imagined that Stossel had "solved the health crisis". He himself didn't claim to have done any such thing. He didn't even look at how to deal with any big-ticket items of essential healthcare expenditure. He seemed to think that being able to wrongfoot Michael Moore when he had control of the questions and the editing was enough to make some sort of point.

Sorry for the misleading title. It was either that or "Stossel Pink-Bellies Moore on 20/20".

Didn't you notice that his "solutions" (actually just a couple of mildly successful niche ideas) didn't address the problems he set out at the start of the programme? I mean not at all. No suggestion about how to decouple health insurance from employment. No suggestion about how to reduce the amount skimmed off by the insurance companies. No suggestion about how to make healthcare accessible for the disadvantaged.

Now that you mention it, he doesn't address those specific issues. I thought some of the points being made might spark ideas from posters on other things that could possibly bring down cost or drive up efficiency.

like I keep saying, that's one of the great advantages of universal healthcare. You're free to make your employment choices without thinking about healthcare, and the burden of providing employees with health coverage is removed from businesses. I'm not quite sure why he didn't mention that....

NO, you're right. It's awesome to not worry about things like that. I'm sure you do know why he didn't mention that.

There was a lot of irrelevant padding in there. Food insurance? You cannot be serious! Ford motor cars and mobile phones and lasik eye surgery and cosmetic surgery. Zero relevance to the questions at issue, and zero illumination of the problem. But it's amazing how much obfuscation you can stir up with bad analogies.

Question: Does the UHC system suffer in the R&D arena? How many new drugs or procedures are developed using a UHC system? Are there doctors who are specifically paid to experiment with new drugs, or are drug companies still a part of the equation? I guess what I'm trying to ask is if there is just as much room for innovation in a UHC system?

Then there was what can only be called a hatchet job done on universal healthcare systems. Cherrypicking headlines for examples of stuff that went wrong, apparently designed to scare the hell out of American viewers who don't know that this was not a fair portrayal of such systems. Yes, a two-second acknowledgement that Canadians are happy with their system - before spending about ten minutes finding about three people who had issues and giving them a platform to complain.

Well, part of the reason I posted it was because I knew someone would fill in the gaps Johnny Stoss left out.

What he completely ignored was the difference in entitlement between the victims of the two systems. The victims of the US system had no redress. They'd fallen through the cracks. They weren't covered. Tough. In contrast the victims of universal healthcare failings are empowered by entitlement. Stossel obviously didn't consider that. Have you, Dan?

Sure I have. You mean the people I "want to die", how could I forget? Thanks again for the breakdown, and I'm looking forward to anyone who might have something to add from another POV.

 

[bobrayner]

Question: Does the UHC system suffer in the R&D arena? How many new drugs or procedures are developed using a UHC system? Are there doctors who are specifically paid to experiment with new drugs, or are drug companies still a part of the equation? I guess what I'm trying to ask is if there is just as much room for innovation in a UHC system?

Successful UHC systems generally buy in drugs and other expertise from the private sector. There usually isn't a centralised "Ministry of developing new drugs" or a "Ministry of hospital construction" &c; that's left to whichever business makes the best offer, and the UHC system concentrates on providing healthcare.

There can be some problems with this, but they're not overwhelming. I've seen it urgued that UHC systems are successful at pushing down the prices of many medical supplies in a way which may reduce funding for the development of future supplies.

For comparison, look at education. In most developed countries, government funds schools and teachers, but the government doesn't run special farms to make food for school meals, nor does it have a special committee of textbook writers; these things are usually bought in from outside suppliers, and rightly so.

 

[Rolfe]

I was laughing more at the "i got what I asked for" thought that passed through my head while reading your posts.

Thanks for reading, and for responding to my post. It was good to start the thread and get the critique. The trouble was, I note that you imposed condtions in your OP. You wanted ideas that didn't involve any sort of universal healthcare. (Because the idea of that bothers you. Because you don't like the idea of being forced to contribute to the care of people who expect handouts. Even though you're just as forced to contribute to the care of people who expect handouts in your present system, and as far as I can see you've come up with no idea how to avoid that.... O.... K....)

You know, this is a bit like someone standing in the middle of their burning house, asking for suggestions about how to put the fire out, but please, don't ask me to make any use of that big red fire engine that's sitting at the end of my drive, because the idea of a universal firefighting service bothers me.

I'll be interested to see if anyone does come up with anything genuinely constructive that fulfils your criteria. I doubt it though. If a bunch of people on an internet forum could solve that one, it would already have been done.

Sorry for the misleading title. It was either that or "Stossel Pink-Bellies Moore on 20/20".

Moore is good at cherrypicking data and misrepresenting arguments too. (He's just a damn sight more entertaining about it than Stossel....) He's a big boy, in more ways than one, and he can take it. But he of all people should know that he who decides on the questions to ask and who controls the editing process wins. Every time.

Now that you mention it, he doesn't address those specific issues. I thought some of the points being made might spark ideas from posters on other things that could possibly bring down cost or drive up efficiency.

While I'm sure that there are many places where costs could be reduced and efficiency improved, in your system as well as ours, I really think you're chasing rainbows here.

My own big idea to cut costs is to shoot the insurance companies. FOUR insurance clerks employed by ONE doctor??? 14% of every doctor's income going on administering insurance reimbursements???? Plus the time it takes????? And all the insurance companies' overheads and staff costs and executive bonuses and advertising budgets and profits and shareholder dividends... Shoot the lot. Let them find productive work elsewhere in the economy.

I know Francesca doesn't necessarily agree with me here. I don't follow her explanation well enough to be swayed, but I do observe that some countires with universal healthcare systems have not shot the insurance companies and still seem to be doing OK, so I'm open to persuasion, but right now I don't see what they're for and I do see them eating a huge slice of resources.

The trouble is, I think you can probably see where we're going with this again.

The real trouble is, big-ticket medical and surgical needs have an irreducible cost. There is a limit below which no efficiency savings are going to reduce the price. And nobody sells their wares for below the cost of production - or not for long, anyway. I simply cannot see, not in our lifetimes anyway, how it will be possible to reduce the cost of the quadruple bypass and the brain tumour removal and the childhood leukaemia treatment and even the appendectomy for goodness sake, to the sort of level that can be afforded by someone on the minimum wage. It's never happened in veterinary medicine, and I don't see how it could possibly happen in human medicine either. And for just one thing, long before you got close, medical professionals would be earning so little that nobody with any brain or talent would want to do the job. They'll go off and be investment bankers instead.

NO, you're right. It's awesome to not worry about things like that. I'm sure you do know why he didn't mention that.

Yeah, maybe I do have an inkling. But you know what? It's not awesome not to worry about all that stuff. It's normal. It's only when participating in threads like this that it even crosses my mind. I then thank God fasting that I'm not in your shoes. Srsly.

Question: Does the UHC system suffer in the R&D arena? How many new drugs or procedures are developed using a UHC system? Are there doctors who are specifically paid to experiment with new drugs, or are drug companies still a part of the equation? I guess I'm trying to ask is if there is just as much room for innovation in a UHC system.

Nope. For one thing, the drug companies are not part of the universal system. They go on doing their thing for profit, like they always do. The only difference is that they sell their products to the universal system. The universal system gets a good deal on bulk-buying, and the drug companies get to sell their product to everyone who has a need for it, not just those who can find the money themselves. Everybody's happy. Ish.

Also, there's a lot of charity-funded resesearch. Seriously, read that link. That's a British outfit. These are the guys who decided that the American researchers who announced they were going to sequence the human genome first and patent it, bloody well weren't going to do that. They poured money into the public sequencing effort, and succeeded. They are the reason the human genome is free-access.

They and other similar outfits will fund appropriate clinical and non-clinical research projects, taking advantage of the large NHS patient base where appropriate. If a British doctor has an interest in research, and the talent, and can write grant proposals, he has all the opportunity he needs.

Did you even read the newspaper article about the Berlin heart? That wasn't developed in the US, you know.

Abigail is blissfully unaware that she is a world first when it comes to the treatment of the complex heart defect with which she was born. She is the only child suffering from her condition who has been fitted with a mechanical heart - and survived.

The Berlin heart, which is controlled by a laptop computer, crucially bought little Abigail, and her parents Gillian and Stephen, the extra time they needed as the "rollercoaster" wait for a suitable transplant heart went on.

Normally, those who have Hypoplastic Left Heart Syndrome, can't take the artificial organ. But somehow, the last hope for survival connected with the little girl, who thanks to the device just made it through to the day her replacement heart arrived.


Her mother Gillian, 35, a primary school teacher, said: "When I was told Abigail was a world first, I just burst into tears. To say thanks to the doctors just seems so inadequate. It just doesn't seem enough."

Berlin heart
Named after the German city in which it was invented, it is designed to pump blood around the heart in the proper manner.

Devised in 1997, the first Berlin Heart was implanted in 2002.

The device works by helping the right ventricle of the heart pump blood to the lungs and the left ventricle to pump blood to the body.

The pump comes in a range of sizes, which means that even newborn babies can benefit from a Berlin Heart.

The bulk of the artificial heart device sits outside the body with only the tubes "plumbed into" the damaged chambers.

Can I ask you again, was that just "some" care that child got, just the cheapo version? Is there anything more she could have got if she'd been a US citizen? And please, can you tell me, if Abigail had indeed been a US citizen, would she have been guaranteed that standard of care, no matter what her parents' background was?

Well, part of the reason I posted it was because I knew someone would fill in the gaps Stossel left out.

Fair enough, this forum is a resource. However, I think you'll find it works best when you don't put unreasonable restrictions on the scope of the answers you want to get.

Sure I have. You mean the people I "want to die", how could I forget? Thanks again for the breakdown, and I'm looking forward to anyone who might have something to add from another POV.

Well, not exactly. I'm not really talking about the entitlement of people on the breadline here. I'm talking about how entitlement empowers anyone who has the misfortune to get a raw deal from the system.

If you fall between the cracks of the US insurance system, like that women with the breast cancer did, you're nobody's responsibility. Doesn't matter it's not your fault, doesn't matter it was just rotten luck. The system doesn't owe you anything. There's not a lot you can do. Because you have no entitlement.

If on the other hand you fall between the cracks in the NHS, there's a great deal you can do. Because you are entitled. You therefore have the power to make one hell of a stink about how the system has let you down.

Been bounced four times from your scheduled surgery to have your hip replacement because every time some motorcyclist with a busted pelvis showed up in A&E? Go to the papers. Write to your MP. Start a "patients' association" and enlist other aggrieved patients. Use your vote. Funny, you know, people are seldom bounced from their hip replacement operation slots these days, and yet the Hell's Angels are still falling off their bikes. I wonder how that was achieved?

Americans keep going on about how they'd lose their "liberty" if they had universal healthcare. Dammit, the more I investigate the matter, the more I see the chains and the shackles. And it's not me who's wearing them.

Rolfe.

 

[Rolfe]

Just a last mention of some examples. I already posted about Abigail's heart transplant. And this isn't some great exception - it made the news because of the pioneering technology, not the standard of care. For every headline you see about someone having a long wait or dirty sheets, there are dozens and scores and hundreds of people who just got the care they needed, no fuss and no expense, and got on with their lives.

There have been many changes for Abigail since her transplant, but one thing that stands out for her parents is the colour of her little fingernails and lips. Now they are a rosy pink, but in the past they were blue. Her poor heart function made it difficult for the blood to be fully pumped to her face, hands and feet.

"We have looked back at photographs and sometimes her lips are the colour of blackberries. That was when she really went downhill, when we were first waiting for a transplant," said Mr Hall.

The couple were waiting for a phone call for six weeks which would give the go ahead for the transplant.

"And boy did we cram a lot into those six weeks. We went to the beach at St Andrews, went to as many playparks as we could and took as many trips as we could.

"We didn't know when we were going to get the call and didn't know what that call would bring, or what it would lead to. We just wanted to enjoy each other as much as we could," added Mr Hall.

When they heard that a possible heart had been found, the toddler was quickly on an NHS plane - the "yellow plane" as Abigail calls it - to Newcastle. Cruelly, the organ was a poor match and couldn't be used.

It was shortly after that Abigail's condition severely deteriorated and that a Berlin heart was first considered. After an initial improvement in her condition, it emerged that the artificial organ might not sustain Abigail for as long as expected.

Then a phone call came informing them that another suitable heart had been delivered from the continent - just in time for Abigail's third birthday.

"We can't express enough our gratitude to the family who allowed their own child's heart to be used. It was a tragic time for them and a dark time for us. But thanks to their selflessness, we got hope - and they gave Abigail life."

And nobody asked for a penny from the Hall family - artificial heart, heart transplant, trips in the air ambulance and all. I can say I'm genuinely proud that my taxes go towards providing that standard of care - for all my compatriots, not just those who are in some nebulous way "deserving".

Note particularly that if you do find horror stories about the NHS in the press, these will not be about lack of entitlement. These will be about people who did not receive what they were entitled to. A subtly different matter.

In the USA though, the worst horror stories all seem to be about lack of entitlement. For example, Cole's appendicitis.

When her youngest son, Cole, awoke one night last month writhing in pain, Theresa Devers pleaded with him to hang on until morning so they wouldn't have to go to an emergency room.

Then, when they got to a Tacoma hospital and found out that the 11-year-old's appendix had ruptured and he urgently needed to be transferred to Seattle, Devers asked without success if she could drive her son there instead of having him taken in an ambulance. And when they arrived at Seattle's Swedish Medical Center, Devers urged the staff to skip tests or procedures unless they were vital.

Anxious actions of a mother without health insurance? Actually, the family has what many critics say is just as dangerous: a bare-bones insurance policy that Devers says has left her family financially devastated.

The family were assured by the salesman that the healthcare policy would meet their needs. But it had a very low ceiling coverage, which the father had already more than maxed out with knee surgery, leaving them in debt. Then the little boy got appendicitis. Helluva pubishment for being a bit naive when purchasing your insurance policy.

Actually, Dontae Adams' dog bite isn't so bad. Believe it or not.

When a stray pit bull attacked 12-year-old Dontae Adams last August, tearing a chunk of the boy's upper lip from his face, his mother took him to the University of Chicago Medical Center. Instead of rushing Dontae into surgery, however, Angela Adams said, the hospital's staff began pressing her about insurance.

"I asked them why that should matter. My child's lip was literally gone," said Adams, a medical assistant whose only insurance is her son's Medicaid coverage.

Adams said she demanded that the medical staff admit Dontae but that they refused. The emergency room staff gave Dontae a tetanus shot, a dose of morphine, prescriptions for antibiotics and Tylenol 3, and told Adams to "follow up with Cook County" in one week, according to medical center documents.

Panicked, Adams took her son on a bus that night for the hourlong journey to John Stroger Hospital. With bloody gauze pressed to the boy's face, they arrived at 5 a.m. Dontae was quickly admitted for surgery so his lip could be fixed and his speech preserved.

Well,at least he was treated in the end, and apparently without charge to the parents. But I suspect a 5-hour bus trip wasn't good for anyone. And what if the mother had just accepted the original advice to go away? No, there is no possibility this would happen in Britain. None.

Here's another one, Starla's new baby.

Starla Darling, pregnant and due for delivery, had just taken maternity leave from her factory job at Archway & Mother’s Cookie Company, in Ashland, Ohio, when she received a letter informing her that the company was going out of business. In three days, the letter said, she and almost three hundred co-workers would be laid off, and would lose their health-insurance coverage. The company was self-insured, so the employees didn’t have the option of paying for the insurance themselves—their insurance plan was being terminated.

“When I heard that I was losing my insurance, I was scared,” Darling told the Times. Her husband had been laid off from his job, too. “I remember that the bill for my son’s delivery in 2005 was about $9,000, and I knew I would never be able to pay that by myself.” So she prevailed on her midwife to induce labor while she still had insurance coverage. During labor, Darling began bleeding profusely, and needed a Cesarean section. Mother and baby pulled through. But the insurer denied Darling’s claim for coverage. The couple ended up owing more than seventeen thousand dollars.

I fully agree that "anecdotes" do not an argument make. But how many examples of people in the US who needed medical treatment but who weren't entitled to it, through no fault of their own, does it take to get Americans seriously looking outside the box they're currently imprisoned in?

Rolfe.

 

[Rolfe]

Oops, sorry, not a 5-hour bus journey, a one-hour bus journey arriving at 5am. Still not good. But still not the worst story, because that one was more about one hospital which failed to provide entitlement it probably should have, rather than about a failure of the system as a whole.

Rolfe.

 

[Professor Yaffle]

Totally agree Rolfe.

Everytime I think about my 1 year old niece, it makes me glad to live in a country with universal health care. She had large numbers of tests, several operations, a 4 month stay in hospital (mostly in intensive care, with a bed for her mum so she could stay overnight at her bedside whenever she wanted) and eventually a heart transplant, not to mention all of the different drugs, including the anti rejection drugs which she will have to take for life, and the outpatient visits to check how she is getting on and make sure everything is working as it should be. And if the worst happens and she begins to reject the heart, she will get the same excellent treatment, regardless of how much has already been spent on her.

I shudder to think what would have happened if they lived in the US. At the very best, they would have been saddled with enormous debt when they reached the limit of their policy.

 

[Professor Yaffle]

How's this for innovation...

A baby dying from kidney failure was saved when her doctor designed and built her a dialysis machine from scratch in his garage.
Millie Kelly was too small for conventional NHS machines, so Dr Malcolm Coulthard and a colleague constructed a scaled-down version. Two years later, her mother Rebecca says she is "fit as a fiddle".

http://news.bbc.co.uk/1/hi/health/7542404.stm

 

[Rolfe]

Everytime I think about my 1 year old niece, it makes me glad to live in a country with universal health care. She had large numbers of tests, several operations, a 4 month stay in hospital (mostly in intensive care, with a bed for her mum so she could stay overnight at her bedside whenever she wanted) and eventually a heart transplant, .... <snip>.

Wow. Scary stuff. But so much better than the alternative!

I keep thinking about the freedom issue. We keep getting US posters here declaring that they don't want universal healthcare because they'd be less free, or they'd lose their liberty. Frankly, I'm completely baffled. I was baffled in any case, because I find it hard to believe that some notional and hypothetical "liberty" loss is sufficient reason to reject a system that may otherwise confer great benefits. But now, I don't even see where the liberty loss occurs.

The argument seems to be that we can't opt out of the NHS, so we're less free. But actually, of course we can opt out of the NHS. We are entirely free to do that. I had a sinus operation in 1999 paid for by BUPA, and the same year my mother chose to pay for her cataract surgery to be done privately. Nobody would have dreamed of trying to stop us.

Ah, but you can't opt out of paying for the NHS. Uh, no, dude. I can't opt out of paying my taxes. How terrible! I'm a slave!

But how does that make us less free than US citizens? They can't opt out of paying their taxes either! And the proportion of their tax take that goes to support their socialised healthcare system is actually slightly greater than the proportion of my tax take that goes to support the NHS. So how does that make the US citizen any freer than I am?

The main difference is that while most US taxpayers cannot access the socialised healthcare system that they are paying for (Medicare and Medicaid), we all have full rights of access to the NHS. They are forced to contribute to a system that gives them no benefit. I'm "forced" to contribute (a little bit less than they do) to a system that for me appears to be the bargain of the century. As I see it, that makes me more free, for goodness sake! What am I missing here?

Well, they're free to choose their healthcare provider. So they say. But are they? So much insurance seems to be tied to employment, and in most of these cases I understand that the employee pretty much has to take the policy provided by the employer. Then, it appears, the insurance company can dictate which hospital or facility the insured person can go to. This has to be some new definition of "freedom" I was previously unfamiliar with.

In contrast, we can choose whichever NHS facility we want to be treated by. I told in another thread of when my parents changed their GP, because the guy they were with had been rude to my father. The doctor they left was very annoyed, and even said "I'm trying to build up a business here." (Note for the US - NHS practitioners are self-employed but are paid according to how many patients they have on their list. Losing a couple of patients means losing income. Well, he shouldn't have been so bloody rude.) Another local practice was very happy to take them on.

We can also choose which hospital we want to be treated at, and would make the choice based on a combination of the expertise available and the convenience of travel to any particular hospital. We're not bound by the geographical boundaries of the individual health boards either - I live in Borders region, but because of the way the boundaries run I'm more likely to end up in Lanarkshire or Lothian for any hospital treatment I require. There's no insurance company saying "sorry, we don't cover the Edinburgh Royal Infirmary, you'll have to go to Melrose."

We're also completely free to take out healthcare insurance and choose to go to any one of the private hospitals. We're even free to go to any of the private hospitals even if we're not insured, simply by paying for the treatment out-of-pocket.

This is an awful lot of freedom. How is it reasonable to declare that we're "not free" just because we're not free not to pay our taxes - in just the same way as US citizens are not free not to pay their taxes?

I'm also seeing a lot more restrictions the US people have, mainly in employment. I'd have thought that mobility of labour was an important feature of a free economy. But how free is the labour to move if it's reliant on its present employer to provide its healthcare cover? I expect moving directly from one healthcare-providing job to another is easy enough, but what if you want to start up your own business? Or go back into education for a bit? Or spend a year doing voluntary charity work? Or leave the job market to care for an elderly relative? Or even take an exciting-looking job that doesn't have a healthcare plan you're happy with? You can't, really. Or you can, but only if you're prepared to take a big risk with your healthcare entitlement. This is some weird definition of freedom we're seeing here.

And what about the burden on business, providing all that healthcare coverage? Having been a partner in my own business, I'm fairly suspicious of what I hear of the US system. One of the things that was stated in the 20/20 film was that General Motors spends more on healthcare insurance for its staff than it spends on steel. This is a sensible way to run an economy? You're telling me that this imposition doesn't have any impact on a citizen's freedom to start up their own business? (Never mind the requirement for anyone starting their own business to take care of their own personal healthcare coverage.) Or on business viability during times of recession? I find that a bit hard to accept.

Then there's the freedom to complain. I've pointed out that while nobody will have any trouble at all finding reports of failures occurring in the NHS, these will all be situations involving negligence or incompetence, which resulted in someone not getting the service they were entitled to. In this case, a social contract has been broken, and the victim has redress. You may have to complain pretty hard, but the complaining is not pointless. You were entitled, and you didn't get what you were entitled to. It's the basis of a case.

In contrast, the unfortunate US citizens who have fallen through the gaps in the insurance system (like the breast cancer woman, or the woman whose company folded just before she was due to give birth), have nobody to complain to. Nobody is responsible. It just so happens that they had no entitlement. Shrug.

So really, I totally don't get it. In the context of healthcare it's perfectly obvious that there is no freedom that US citizens have that we lack. And indeed, there are many freedoms that we have that they lack.

But no, we don't want no steenkin commie universal healthcare system, because we'd lose our precious FREEEEEEEDOOOOOOMMMMMMSSSSSSSS!!!!

What are these guys smoking?

Rolfe.

 

[Rolfe]

How's this for innovation...

http://news.bbc.co.uk/1/hi/health/7542404.stm

That's fairly awsome! I wonder if there are miniature dialysis machines available in the States? You'd think, with all that competition, and all that free market incentive, that somebody would have developed one. In which case, why wasn't the manufacturer exploiting the foreign market?

Second thought. I wonder if it would work on a cat? Additional market available there guys, and not a small one. What are these US free marketeers waiting for?

Rolfe.

 

[Solitaire]

If you were uninsured and had no hardship, you might negotiate the cost down a bit, with evidence of hardship you might get it down by half and get an interest-free loan, but you could never get it anywhere near $4000. So even if you're wealthy enough to be self-insured, you still need insurance just to avoid getting ripped off. I once had a policy that was catastrophic coverage only, plus they negotiated the fees on the rest. So to avoid getting overcharged, a whole lot of unnecessary billing overhead was added.

Around here when you get a bill from the hospital or a doctor you can negotiate the price down and in some cases all the way down to 80% of the total bill if they like you.

Generally, though, you’re given a month or three to pay the full amount. If you don’t pay the full amount the debt gets sold to a loan company, which isn’t so bad. They’ll charge you the annual interest rate for a personal loan if you credit score is above 720. Those that can’t pay for the loan wind up pay the fees for counseling to go into bankruptcy. Or they wind up with penalties and the loan being sold to various collection agencies. Trust me you never want to go down that rout.

 

[Rolfe]

It was also pretty scary for the woman on the show who's doctors told here she had to wait months for "elective" surgery that ended up almost killing her. Luckily she made it to the doctors in the US who were able to treat her and BTW said if she would have waited any longer she'd be dead. She wasn't upset at the cost though. She was just fine with being alive.

You know, we didn't really look at this one. The Canadian lady said that she'd been given a wait time for elective surgery, but she wanted it sooner. She didn't say why. Descriptions of agony and fear for her life at that stage were conspicuous by their absence.

Fair enough. You can do this in a universal healthcare system - if you don't like the wait, you can go private. But bear in mind that in these systems patients are prioritised by urgency, so if she's been given a relatively long wait time the probability is that it isn't so urgent.

She chose to "go private" to the USA. Fair enough, again. If you're paying, then you can go where you like. British self-payers often go to continental Europe, and indeed some eastern European countries have quite a little sterling earner going in that department. So has India, as it happens.

However, what did she have? "A blocked artery that stopped her digesting her food." Calling human-type doctors here, 'cos I have no clue what condition that is supposed to be. So I have no idea how urgent her case really was, or how much suffering the wait might have been causing her.

But then, the woman herself reports that her US doctor told her that she would have had only a few weeks to live without the surgery. This seems to have been the first intimation of that angle. And this is in direct contradiction to the Canadian assessment of her condition as "elective".

So who's right? No way to tell. Neither the Canadian nor the US doctor was interviewed. We have no idea at all what was wrong with her. She could have misunderstood what the US doctor said, or he could simply have been giving her validation that she hadn't wasted her money in coming to him (people do that, you know). We just don't know and we have no way to find out.

People who have entitlement to free healthcare do choose to go to a paying system from time to time, for many reasons. It's part of that great freedom thing we have. If this was Stossel's best example of someone treated badly by the Canadian system, I have to say I'm not impressed. Note that Stossel interviewed a man in Canada who was running a business organising private care for Canadians who didn't want to wait. One would imagine that he might have had quite a number of alarming and salutory cases to present. If there is indeed a systemic problem, rather than just the usual penny-numbers of impatient people with the money to do as they please, that is. So where were they?

We did hear from a Canadian doctor who was disgruntled with the system. But he spoke only in generalities. When we were introduced to this actual patient, we only had her account of what the US doctor allegedly told her. We didn't get to hear from either the US or the Canadian doctors who could have explained to us first, what was actually wrong with her, and second, who was right about the urgency or otherwise of her case.

So mainly, not enough information to make a judgement. Except to say, surely, if the alleged problem with Canadian waiting times was as bad as Stossel would like us to believe, couldn't he have found a more clear-cut and convincing example, possibly backed up by direct evidence from a doctor?

Then there was the bit about the lottery to get on a GP list in Canada. Knowing how dishonest Stossel was over the NHS dentist thing, I wonder how true that actually was. Still, consider this. Would Stossel's presentation leave you thinking that this was how it is in all countries with universal healthcare? Well, he certainly didn't show us anything else.

FYI, in Britain every resident has a right to go on a GP's list. Even if you show up off the bus from Poland looking for a job, with the intention of residing here even temporarily, you have that right. When I moved house recently, with my elderly mother in tow, I simply went to the local practice, and asked for the paperwork. I filled it in, returned it, and within days we were on the list. It occasionally (rarely) happens that a patient is such a complete pain in the arse that a doctor will take them off his or her list. Usually a neighbouring doctor will take the nuisance patient on. But sometimes the patient is so impossible that none of the doctors will have him. In that case the government is obliged to step in and put the patient on somebody's list. (I'm not sure how they manage that, but there is some provision.)

However, telling the viewers about that wouldn't have suited Stossel's agenda. So all we got to hear about was the Canadian lottery.

If it's all like that, you have to wonder why Canadians are in general so happy with their system. Which makes me suspect that it's not all like that, and given Stossel's obvious agenda, maybe none of it's like that.

Rolfe.

 

[Solitaire]

A fascinating programme could have been made, contrasting the freedom people have under universal healthcare systems - freedom to change jobs, to drop out of work (and back into education, or a caring role, or even just take a sabbatical), to become self-employed - all with no effect on their healthcare entitlement - with the restrictions placed on employees where healthcare comes with the job. And contrasting the powerlessness of those in an insurance-based system who fall through the cracks in the system, with the empowerment of people who have healthcare as an entitlement by virtue of their citizenship, and who can (and do) then cause an almighty row if the system doesn't deliver what they're entitled to.

You might try this program.

Sick Around The World

It more of a medical travel program, but it does contrast different medical systems around the world.

Click on the plus sign for the video.

 

[blutoski]

KellyB, what was really scary for me was seeing a Canadian man who was having a heart attack waiting for an available bed. It was also pretty scary for the woman on the show who's doctors told here she had to wait months for "elective" surgery that ended up almost killing her. Luckily she made it to the doctors in the US who were able to treat her and BTW said if she would have waited any longer she'd be dead. She wasn't upset at the cost though. She was just fine with being alive.

These anecdotes are hard to validate, though. My wife is an MD and her patients go to the media all the time with their version of the story. The doctors involved are not authorized to discuss whether the patient is telling the truth or not, unfortunately. It sounds like these patients have a good case for a lawsuit: how's that turning out for them? (delays leading to morbidity and mortality are considered very serious in Canada, and there have been cases - they result in pretty serious tort damage awards).

Having worked and lived in both the US and Canada, I can verify that delays happen in both countries due to a variety of reasons that are shared by both: peak demand, shortage of resources, &c. My coworker sawed off his thumb in Washington State and waited 22 hours to see an emerg doctor in Tacoma. And even then, he was seen by a 2nd year student. $800/mo health premiums.

Stossel is misleading if he is attempting to say that it is a problem of one system that is absent in another. This is a pretty good example of what the other posters describe as an emotional appeal, tapping into fear, rather than reason.

So, the misleading part is the implication that the examples are:

1. more common in a single-payer system

2. caused by a single-payer system

Both of these claims are probably untrue.

 

[blutoski]

The most obvious point that proves Stossel's point ridiculous is comparing consumer goods to healthcare. You just don't "shop around" for healthcare for numerous reasons, but primary among them the massive asymmetry in information.

There's one other important distinction: you can put off buying a car if you can't afford it, but you can't put off getting a brain tumour removed.

Consequently, medicine is the only business where it is legal to use the following salespitch:

"Your money or your life."

It is because of this that medicine has very high profit margins and very few countries apply a laissez-faire attitude toward its regulation. Even the US has very entangled regulations. I believe relaxation of these rules is what Stossel has traditionally advocated.

The recent programming is more a response to public interest in single payer.

 

[ponderingturtle]

There's one other important distinction: you can put off buying a car if you can't afford it, but you can't put off getting a brain tumour removed.

BUt it is all about responcibility, you shouldn't get the brain tumor if you can't afford it. That is the libertarian way. It is just like those people who bought houses they couldn't afford. People need to live with in their means, if it is in the houses they get or the diseases.

 

[blutoski]

[regarding the lineup for dentist in UK clip]
This blatant misrepresentation by the programme makes me very wary indeed of the entire thing.

I saw the same thing with the Canadian examples.

He now goes on to show protests by doctors in mainland Europe complaining that they aren't being paid enough. I'm struggling to see how this is relevant to the eventual aim, which seems to be to suggest ways to bring down US healthcare costs. So he's going to do that while still allowing the doctors to set their own remuneration?

The example in the US is that MDs working for HMOs have openly discussed unionization because they feel their remuneration is now so low that they are not able to cover their student loans. Yet US healthcare costs about twice as much per patient. If the MDs are paid less, where is the value going?

And now he's back on the wait times. One case is presented of a woman expecting quadruplets in Canada who went to the US to give birth because of a shortage of neonatal cots. But there's simply not enough detail given to know how compelled she really was to do that.

This example was local. We have a reciprocal agreement with some hospitals in Washington State for setups that are so rare that when there are more than a handful coinciding we may not have the staff or facilities. When we exceed capacity, we send the patient to Group Health. They send their overflow to us. It's not a unique artefact of private or public care. In fact: at St. Paul's right now, we have about twenty US patients who could not get care in WA, OR, or CA in what their HMOs deemed was a timely manner.

He's got hold of one Canadian doctor who thinks Canadian wait times are excessive. One guy.

One *famous* guy! He owns a chain of private hospitals, and is challenging his province to get more private contracts. Privatization would make him lots of money. This isn't an argument for or against his claims, but it should make us think about whether his testimony is sufficient to inform us of a real situation. Given the source, we should probably consider comparing his opinion with more objective data.

Wait times *are* excessive, because care delayed is almost as bad as care denied.

Relevant question when comparing systems: are the excessive wait times in Canada longer or shorter than wait times in the US (not discussed). Related question: would an absence of waits in the US be just as bad if the people are not waiting because their care is actually denied, or because they have no access at all (not discussed).

No exploration of how the wait times are managed, of whether the really urgent cases get put to the front while the less urgent ones wait a bit longer, no exploration of whether it might be better to wait a few weeks and get the treatment "free as the air" or to be in the position of the woman at the beginning with the breast cancer....

It's stated that Canadians like their system, but then there seems to be a big search for stressed doctors and people waiting. The heart attack guy who is getting treatment, but who hasn't yet been transferred to intensive care. People unable to get on to GPs' lists. What I'm not seeing is an acknowledgement that these people are actually being treated.

The rest of the segment concentrates on finding problems in Canada. I recognise that Canada's system does have particular problems. So how about asking how long patients in France have to wait? Oops, no, don't ask that. Because France is well-known for not having waiting lists. Or even in Britain. Yes, there are waiting lists, but they're less than they used to be because pressure was put n the government to do something. And examination of overall times is misleading anyway, because it's routine to bump those with the urgent need to the top of the queue. But I see no balanced assessment of how severe the wait problem generally is in a range of universal healthcare sytems, or any discussion of whether people might prefer to wait a few weeks for a non-urgent procedure when they know they will get it done and they won't have to pay for it, rather than go down the US route.

This programme has an agenda, maybe it will become clearer later what that actually is.

Rolfe.

My impression is that it's a response to renewed interest in the US regarding a single-payer system. Cato Institute is ideological, and they already feel that there is too much regulation of the medical industry in the US, so they want to counter arguments for single-payer or enhanced regulation.

 

[blutoski]

KellyB, what was really scary for me was seeing a Canadian man who was having a heart attack waiting for an available bed.

My previous post hadn't covered this example properly, sorry. I phoned a colleague who was familiar with this example, and he did confirm that the patient was waiting for an ICU bed, but this was not causing a delay to his treatment. Post-surgery, he would be cared for by ICU nurses, but in a different ward which was a 'flex' ICU for overflow.

This is not to say that there are no delays in Canada - just that this program didn't find proper examples, and I need to repeat that there's no exploration about whether these examples would or would not be different in the US.

 

[Rolfe]

Yes, as you said, that heart attack patient was being treated. He was in a comfortable temporary situation, waiting to go to the main unit. It's possible he was only in that situation for 10 or 15 minutes, the length of his wait is never even hinted at. What we saw was clearly a staged question-and-answer session - the guy in the white coat asking the leading question didn't seem to be part of the man's care team, and the man didn't seem at all distressed. One wonders if he even knew what his image was being used to suggest.

You don't really shock me that the Canadian critic was an interested party. As I said, the whole thing reminded me of the NRA film of the Countryside Alliance protest, which claimed the protest (which was certainly, in crude terms, pro-hunting) was against gun control, when actually it was against being forced to use guns to kill the foxes because that was held to be more humane than running them down with a pack of dogs.

The 20/20 film was presented to push a certain agenda. But one thing that struck me was that it was the American patients featured who were not getting treatment for their serious illnesses. The Canadian patients shown had all been treated. Some of them had certainly exercised their choice to be treated outside their country's health system, for whatever reason, but that was all.

If universal health care is such a disaster, why couldn't he find a patient who had actually been left untreated by such a system? You'd think he might have found someone. But in fact the only patients we saw who were left high and dry, facing cancer with no entitlement to treatment, were the Americans.

Rolfe.

 

[Rolfe]

Actually, talking of the NHS, and dentistry in particular, me and my still-slightly-sore mouth have had some pretty close acquaintance with that recently.

The NHS requires that every patient go for a checkup every 6 months. After my last checkup in May, my dentist was going on maternity leave, so I arranged an appointment for early December when she returned (which was actually a 7-month gap). During that gap I became aware of something not quite right around one molar. But it wasn't really painful, so I didn't request an immediate appointment, which I could easily have done, and seen one of the other dentists in the practice.

Then I mistook the date of my appointment, and missed it. I phoned and apologised, and was given a very quick re-appointment. But the date wasn't convenient, so I was offered another, and by now we were into January.

Two days before the new appointment, something even weirder happened in the same corner of my mouth - a wisdom tooth felt slack. So I showed up for the checkup and told my dentist the whole story, including a broken incisor as well. Turned out the wisdom tooth was broken. She removed the broken pieces and filled the remains, on the spot, remarking that if that didn't do it, she'd have to crown the tooth. We both thought the earlier symptoms had been early signs of the same problem.

I got another appointment to have the broken incisor seen to, but while I was waiting for that (wait was to get a date that suited me), I realised that the original minor, niggling symptoms were still there, and it was the tooth in front of the repaired wisdom tooth. So while the dentist was filling the incisor, I asked her to look at that one again. She tut-tutted at what she saw, then x-rayed it. Discovered bad decay underneath an old crown. Said it would have to be extracted or it would turn into big-time trouble.

So, appointment no. 4. That was Friday last week (again I repeat that the reason this has dragged on was to fit in with my work rota - the dentist was trying to persuade me to come sooner). I had the extraction. As this was the end of the course of treatment, I paid. £50 the lot - checkup, one large molar filling, one smallish incisor filling, x-ray, one molar extraction. I get no reductions, because I have a good income, that was the standard NHS charge. Oh, and before I left, I was given an appointment for my next 6-month checkup, again at a time to suit me.

All was well until Sunday, when my jaw got very sore. I suspected an infection. It so happened that today I was already scheduled to take time off work and drive past the dentist's door this afternoon. I telephoned yesterday, and although my own dentist was away at a conference today, I was given an appointment to see the senior partner at 1.45. He washed the socket out with antiseptic, packed it with antiseptic dressing and gave me a prescription for 5 days amoxycillin.

Oh dear, the extra treatment cost me - £6.20. And a £5 prescription tax when I had the prescription filled at a nearby chemist, ten minutes later (that tax is due to be abolished next year). My mouth feels a lot better and I've kicked the paracetamol habit.

So that's how hard it is to get an appointment with an NHS dentist. Five in less than two months. All arranged to suit me, and nobody getting too stressed when I was a no-show on one, although it was my fault.

Oh, and did I mention that when I moved to that town, quite recently, I was taken on as an NHS patient in that practice without a murmur? No wait, no quibble. I've never had any trouble getting an appointment whenever I wanted one.

And the great thing is, if I want to have something done that isn't covered by the NHS, something with a better cosmetic result perhaps, I just have to ask my dentist and she'll do it with me as a private patient. So no loss of choice.

Oh, and why was I taking the afternoon off and driving past the dentist anyway? Because I was taking my mother to her regular eye clinic appointment. This again was down to her choice - her previous consultant had left his job, and she wasn't that impressed by the new woman. Also, she wanted to go to a hospital closer to home. She only had to ask, and she was moved to the list of a more senior consultant who happened to take a clinic at a more convenient hospital. She saw the new guru this afternoon, after my dental problems were sorted.

He wasn't 100% happy with her intraocular pressure, and wants to see her again soon. So again, appointment made on a day and time of my choosing. And of course all that (like the glaucoma surgery she had years ago, which she only had to wait about three weeks for, and the eye drops she goes through daily) is free.

Guys, what's not to like? And why did Stossel go so far out of his way to suggest a very different picture?

Rolfe.

 

[Earthborn]

How's this for innovation...

A baby dying from kidney failure was saved when her doctor designed and built her a dialysis machine from scratch in his garage.
Millie Kelly was too small for conventional NHS machines, so Dr Malcolm Coulthard and a colleague constructed a scaled-down version. Two years later, her mother Rebecca says she is "fit as a fiddle".

http://news.bbc.co.uk/1/hi/health/7542404.stm

A story reminiscent of the way dialysis machines were invented in the first place...

None the less Kolff set to work, begging and borrowing from a local factory, salvaging a cooling system from an old Ford car and metal pieces from a downed German fighter plane. Eventually he fashioned a machine out of cellophane sausage skins wrapped around a cylinder, resting in an enamel bath of cleansing fluid.

You have to wonder where all the medical garage tinkerers are in the USA.