Universal Health Care-British Style

1of42 · February 21, 2008, 11:54pm

I’m sorry, but what universe are you living in that it is up entirely to the person suffering to determine when and how pain will be addressed? In my universe, in Canada it is left up to those who I mentioned, and in America it is left up to insurance companies. Sorry, but I trust the government more - at least they have no financial incentive to refuse care.

The only people I’ve ever met who can get any medical care they want anytime are those who can pay for it themselves, out of pocket.

ucsd_ucla_dad · February 22, 2008, 12:04am

mini:

Do you have a link to an article where the CEO of Aetna makes that statement? I’d like to read it. I tried googling it but only came up with some quotes in liberal blogs about similar statements made by Troy Brennan who’s Aetna’s Chief Medical Officer (not CEO) but what I read didn’t state that US cancer patients waited longer than Canadian elective surgery patients although he did bash US wait times.

StitchInTime · February 22, 2008, 12:06am

<a href=“%5Burl=http://talk.collegeconfidential.com/1059827406-post37.html]#37[/url]”>quote</a> Why is it that CEO of Aetna, one of the largest health insurers in the U.S., says that waiting lists for CANCER surgery in the U.S. (for those WITH insurance) are now longer than waiting lists for elective surgery in Canada?

Is he some kind of commie pinko?

[/quote]

Assuming you’re correct (a link confirming your assertion would be appropriate), it appears that the longer U.S. list is in the total number of people not longer wait time…a classic apples and oranges obfuscation.

Certainly, you’re not implying that people are waiting more than two to three years ([as</a> noted by Canadian Dr. Gratzer in his reference to elective surgery in Canada](<a href=“http://opinionjournal.com/editorial/?id=110010266]as”>http://opinionjournal.com/editorial/?id=110010266)) for cancer surgery in the U.S.

So…considering that the U.S. population is over 8 times Canada’s ([301</a> million](<a href=“https://www.cia.gov/library/publications/the-world-factbook/geos/us.html]301”>https://www.cia.gov/library/publications/the-world-factbook/geos/us.html) U.S. vs Canada’s [34</a> million](<a href=“https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html]34”>https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html)), we should expect that the total number of people on a waitlist for cancer surgery in the U.S. is larger than the total number of individuals waiting for elective surgery in Canada.

As noted, a link to the CEO’s statment would help in determining what exactly he was referring to.

Opie_ofMaybery2 · February 22, 2008, 12:08am

"While Canada’s system does many things well, "

1 of 42, I agree with this part and here’s why. What Canada does better than the US is encourage activity. They build parks, they build ballfields, they encourage atheletic participation. Last year a Toronto mom stated the government gave them a tax rebate for atheletic fees…

This is what I mean about culture… The best control of costs is to encourage healthy activities and participation from youth up. Encouragement of healthy lifestyles will over time reduce health related costs. Because the best prevention for many aliments is simply a healthy lifestyle.

We talk about that here, but do little. A ball field can take a decade or more to build. We cut recess and PE out of our schools as they aren’t part of NCLB. We make fat kids, who if you check are becoming diabetics at an alarming rate. We have young teenagers with the fitness of 60 year olds. We want free healthcare for their treatment, but we aren’t willing to address the causes, we only want free treatment…

That is why I say it won’t matter if it’s a single or multiple player system, if we don’t change our culture, neither is going to work. We are making sicker people faster than we can afford to care for them. But the rub is the same person who demands UCare, can’t often walk around the block.

The math won’t work until we change the culture. The culture won’t change because we have no leaders willing to address it. I remember in grade school the presidents physical fitness challenge and what a big deal it was… where’d it go. Was JFK the last guy to push the culture towards fitness? We’ve had 45 years of eat as much as you want, sit watch tv/internet and be contented. We’re a culture of veal or kobe beef.

marite · February 22, 2008, 1:30am

Oh please. I refuse to feel guilty for having a genetic predisposition to cancer, which I have unfortunately passed on to my kids. It’s enough to know that I have gone through two surgeries and am waiting with a certain degree of fortitude for cancer no. 3 to strike. No amount of broccoli or exercise will change my genetic make-up, nor my kids’. Nor would any of this have prevented my H from nearly dying when he was hit by a car early in our marriage.
And let’s not blame the poor folks who have to live in highly contamined environments–they also probably are the uninsured poor. Miners’ lungs, children affected by lead paint, whole communities affected by toxic waste. Yes, let’s make them feel guilty for not eating their broccoli and exercising.

StitchInTime · February 22, 2008, 1:35am

<a href=“%5Burl=http://talk.collegeconfidential.com/1059827687-post41.html][/url]”>quote</a>…I’m sorry, but what universe are you living in that it is up entirely to the person suffering to determine when and how pain will be addressed? In my universe, in Canada it is left up to those who I mentioned, and in America it is left up to insurance companies. Sorry, but I trust the government more - at least they have no financial incentive to refuse care.

The only people I’ve ever met who can get any medical care they want anytime are those who can pay for it themselves, out of pocket.

[/quote]

[You’ve</a> already established that](<a href=“http://talk.collegeconfidential.com/1059826890-post31.html]You’ve”>http://talk.collegeconfidential.com/1059826890-post31.html):

The “universe” I live in is called the United States with the best health care in the world which we purchased for [$2</a> trillion annually](<a href=“http://www.cms.hhs.gov/nationalhealthexpenddata/01_overview.asp?]$2”>http://www.cms.hhs.gov/nationalhealthexpenddata/01_overview.asp?).

When one considers what one gets for the money (treatments today that weren’t even available 5 years ago, drug efficacy, access to health care, etc.), the value of health care is improving year-over-year. People whine about the cost of health care, but we as a nation take care of more people’s health needs than at any time in history. Yes, it might cost me a few hundred bucks to get an MRI; but a few years ago, costly (both in $ and risk) exploratory surgery would have been the only option. This theme is repeated time and again in the medical industry.

Our health care is expensive…but anything that has value is going to be expensive. Are there opportunities to cut costs? There are always costs and efficiencies to be gained in any process, the challenge is to allow the free market to work its way through it. The [declining</a> costs in eye surgery might serve as a good model](<a href=“http://www.marginalrevolution.com/marginalrevolution/2004/11/seeing_is_belie.html]declining”>Seeing is believing (in the free market) - Marginal REVOLUTION).

Private care is legal here. And millions upon millions of individuals have the resources (combination of health insurance (government (Medicare, Medicaid, SCHIP, Veterans) and private), assets (homes, stocks, access to loans/equity, etc…as noted, at least $2 trillion nationally) to make their own decisions about their health care purchases.

There are at least [7.5</a> million millionaires](<a href=“http://money.cnn.com/2005/05/25/pf/record_millionaires/]7.5”>Record number of millionaires - May. 25, 2005) in the U.S. alone that have every right to legally purchase whatever health care they deem necessary. People make choices everyday with the resources they have. Heck, [58%</a> of American households have gone out and bought an HDTV while a regular TV would have sufficed.](<a href=“http://talk.collegeconfidential.com/1059686645-post502.html]58%”>http://talk.collegeconfidential.com/1059686645-post502.html) Wouldn’t it be reasonable to have a bureaucrat dictate the television one can have in their home way before they dictate what medical procedure one can have?

In Canada, as you noted, private care is not an option; thus the travel to the U.S. and other countries by Canadians for elective care.

1of42 · February 22, 2008, 1:40am

marite… somehow I suspect that wasn’t what Opie was getting at. The phenomenon of increasing obesity in America is very real, and while it isn’t fair to blame people who become very sick due to factors outside their control, I don’t think it’s unfair to point out that many are becoming sick due to factors within their control, either.

Opie: That’s probably true (though Canada has its own obesity problems). I wouldn’t mind seeing statistics that attempt to compensate for that potential statistical difference.

StitchInTime: I’m sorry, but your source for that hip replacement fact is an article that quotes another doctor? So we’re going on a second-hand, ad hoc statistic here? Sorry, but you’ll need to do a bit better than that.

And I’m not sure what you’re getting at with your last post. Yes, we know the independently wealthy can choose whatever care they want. That, too, is true of the independently wealthy in Canada, who just go to America. But I’m focusing on the 90%+ of the population here who aren’t millionaires. For them, their care is no more free in America than it is in Canada - in America, it is chosen for them by insurers, in Canada, by policymakers in the government health agencies.

So what exactly are you saying?

marite · February 22, 2008, 2:12am

10f42:

I’ll let Opie explain what he means himself. What he supposedly means and what he said are two quite different things.

I don’t know about the Canadian system, so will not comment. But from my long ago stay in Britain, I know about the mutli-year long queues for such things a hip replacement or knee surgery and all other types of “elective” surgical procedures. British GPs are overburdened. Friends explained that with free health care, lots of people go to the GP to unburden themselves of minor complaints, sometimes not even remotely of a medical nature. 
As the article I started the thread with makes clear, helath bureaucrats micromanage medical decisions just as badly as many insurance companies do in the US. Instead of insurance companies, it is the government that tells doctors to rein in costs. But whoever does it, the effect on patients is the same.

I do have a great HMO. For a family plan costing $300+ a month, my family and I get terrific free preventive care and I have received excellent and prompt medical care for major surgeries and minor problems. This is what I would like to see extended to the rest of the population.

alwaysamom · February 22, 2008, 8:37am

Neither the U.S. nor the Canadian system is perfect, but as I’ve said before (in the multiple times this subject has been discussed here on CC), having lived in both countries and experienced both healthcare systems for everything from minor to chronic to life-threatening illnesses, I’ll take the Canadian system every.single.time. And I should say that in the U.S., we had the best possible healthcare package available.

The comment earlier in the thread about the Canadian system possibly not scaling well into the U.S. system may be very true. The other part of that equation is that Americans would not be willing to pay the taxes that we are willing to pay in Canada in order to make sure that everyone is covered.

The links to supposed studies that crop up every time this comparison is made provide information which, frankly, I have never seen ANYone I know have to experience with Canadian healthcare. Are there problems? Certainly, but the repeated reports of waitlists and rationing have not been experienced by people we know, and I would be interested to know if they are for areas in remote parts of the country. One of my Ds had a soccer injury which required an MRI every three months. She waited two days for the appointment, and of course, the cost was covered, and would have been covered for anyone. Our experience with cancer diagnosis, testing, and treatment were in similar waittimes, within days. Opthalmological surgery for a detached retina, next day after diagnosis. I agree with 1of42 that people who are electively having surgery for hip or knee replacement may have a longer wait but those who are in the position of being totally incapacitated with such an ailment are not waiting months. I’ve mentioned here before that my father-in-law and a friend’s elderly mom both had the needed surgery within weeks of discussions with their physicians. I do agree that more private insurance organizations should be permitted, and they are starting to increase in number. It’s not totally illegal because there are certainly some types of services and care now available privately. Most large corporations have a private coverage system for their senior executives, as do the professional sports teams, and that’s been around for many years.

Opie’s right about the tax incentive to get kids active in sports. I was the one who mentioned that when we previously discussed this. Schools also encourage this with a program that was started in the school system when my kids were young, called Quality Daily Fitness. It is now province-wide, and kids participate for 20-30 minutes a day in organized physical activity, in addition to regular phys. ed. instruction. Sports for kids to participate in are more available year round here than they were in any area we lived in in the U.S., with as Opie pointed out, more baseball diamonds, more soccer fields, more outdoor tracks, running and bike trails, hockey and skating arenas, cross-country skiing trails, etc.

I think the bottom line for me is that, while the U.S. system MAY do SOME things better, the reality is that even those who do have a good healthcare package in the U.S. are often not happy with their coverage. All you have to do is look at the many discussions here on CC about the issues people have with their HMOs or their insurers, fighting to get some type of care or treatment or medication covered. Is there anyone who hasn’t been through that? Who hasn’t had to call their insurer with a problem like that? In Canada that doesn’t happen. Ever. Doctors may have an issue with billing through the provincial healthcare organization but patients don’t ever have to be concerned with that.

Anyone who thinks that the U.S. system is perfect should read the thread here in the Cafe called Support for latetoschool and see the profound issues she has discovered and been faced with in her struggle with cancer since being diagnosed in September. The brother of a friend had similar revelations last year when he had a near catastrophic sudden illness. Fortunately, he has wonderful healthcare and most of his near $100,000 costs were covered but, only most, and it took months of wrangling with his insurer, for his family while he recovered. Imagine how much worse it would have been had he had no health insurance.

mammall · February 22, 2008, 8:48am

For those of you who think the Canadian system is so wonderful, I suggest that you obtain Alice Munro’s memoir that came out about a year ago - The View from Castle Rock. She is such a fine writer and certainly no polemic. She is Candadian with a deep and abiding love for the country that shows throughout her wonderful writing. The final sections of her memoirs concern the death of her father and her own experience with cancer. Although she certainly doesn’t put forth a tirade against the Canadian nationalized system, it is truly horrifying to read of the impersonality, bureaucracy, lack of choice, and sense of no control over your health care decisions. She’s certainly liberal in the perspective of most of her writing. That’s why her first-hand account of her experiences is so chilling.

And 1of42 - you are simply completely off base in your analysis of the economic impact of a single payer model on innovation. You point to medicare and medicaid as evidence that single payer does not harm innovation. Preposterous! How about the growing numbers of physicians refusing to taken on Medicare or Medicaid patients? Why do you think this is? It’s because of price-fixing by the government for their services. The only reason we have not seen really dire impacts on the drug and device industries R & D budgets yet from the Medicare Part D supplement is that it stops short of designating the government as the single payer. And as for the argument that innovation is primarily fueled by the government. Simply not so. Like all entities, the government must take on risk and make calculated guesses on where to put funding dollars. Just like corporations. The difference is that the government is ultimately not accountable if they invest millions in research dead ends. Corporations are. And furthermore, corporations actually pour substantial funds into universities for research. The drug and device industries also fund virtually 100% of the FDA’s operating budget. That is a very little known fact. And if we really want to look at this in cohesive way, it must be acknowledged that the drug, device and medical professions generate enormous amounts of tax revenue to fuel those marvelous government investments.

VeryHappy · February 22, 2008, 9:22am

dntw8up and ucsducladad: You both asked me questions about details of my “plan” – one of you about whether the government should provide health care coverage to adults, not just children, and the other about how I would define “minimal health care.”

I don’t know. I think a major problem with the health care argument is that we’ve not even agreed on the overriding principles, but when we get into the details, everyone starts yelling at each other over all sorts of red herrings. There is lots of time for different points of view – but we need to first agree on the overriding principles!

On some other thread months ago, I made the point: We agree that education is good, and should be provided by the government. The states have set up different laws, so that some states require attendance until age 14, some until age 16. Some states require three years of English, some require four. Some states require health education about AIDS and safe sex, others don’t.

Let’s first agree on the big themes. There’s plenty of time to argue once that’s taken care of. That’s why the discussion about health care never seems to move forward.

alwaysamom · February 22, 2008, 9:59am

mammall, I don’t see anyone here saying that the Canadian system is “so wonderful”. What those of us who have HAD experience with both systems are saying is that we prefer the Canadian system which covers everyone. I haven’t read Alice Munro’s account of her father’s care but I can tell you that my personal experience is not what you have described. In the past five years, I’ve had three dear friends who have died horrible deaths from cancer. All had excellent, and timely care, and all died in hospice after lengthy palliative care, given by committed and caring doctors, nurses, volunteers, and other healthcare workers.

The issue that those of you, who continue to feel that the Canadian system is horrrible, seem to ignore is what about the awful problems in the U.S. system? Even for those who are fortunate enough to have excellent health insurance? What I’ve pointed out every time this discussion comes up is that neither system is perfect but that somewhere in the middle, perhaps, there’s a solution. I’m not hopeful that Americans will agree to increased taxes, though, in order to provide coverage to everyone.

mammall · February 22, 2008, 10:11am

alwaysamom, did your friends who died of cancer have access to the latest and patented and expensive cancer drugs? In England breast cancer patients are denied Avastin which generally doubles survival time with metastasized cancer. Not on the formulary. Not allowed. Morevover, if the patient opts to take the drug on their own dime, they lose all other health care from the nationalized system because those providers are not willing to modify their treatment plan to accommodate a drug not on forumulary.

I agree - no model is perfect. Neither is our education system. But what we do most certainly have in our education system is choice. And what most parents want more in educating their children is increased choice. Universal or nationalized or whatever we’re going to call it had better retain choice and especially retain the incentives that drive innovation. Otherwise our grandkids will still be getting chemo for their cancer instead of something far better that we most certainly are going to achieve here in the US and not in England or Canada. Unless we blow it.

originaloog · February 22, 2008, 10:28am

No one heath care system is superior in all respects. The USA system is incredibly expensive but if you are insured the level of care is the best available. If we look at health statistics, there is little evidence that overall health outcomes are better in the USA, so we are not getting good “bang for the buck”. On the other hand, the treatment and care for some cancers and neurological problems is far superior to that generally available in other areas of the world. And statistics show that the level of care for the terminally ill in the USA is very intense, though I am not sure if this is a good or bad thing. The cost of prescription drugs is much higher in the USA which means that we are subsidizing pharma research for the rest of the world. I am all for that w/re to underveloped countries but object to subsidizing Canada, Europe and parts of Asia. The fact that as many as 40 million people in the USA are uninsured certainly exacts a heavy toll on both those uninsured and the rest of us. Preventative care is minimized, the GP is replaced by the expensive ER and little health problems are defered until they may become big ones far more expensive to treat.

Many large companies are recognizing that their accellerating health care costs are putting them at an economic disadvantage in the global economy as well.

I like my current health care situation but I am not sure that it is best for our nation in general or in the long term. If I knew that overall cost could be significantly reduced and universiality achieved, I would be willing to accept some compromises.

ellemenope · February 22, 2008, 10:50am

Sick people fight their insurance companies all the time over coverage issues. Having insurance doesn’t mean you are home free. Only mounds of cash gives you complete freedom.

Opie_ofMaybery2 · February 22, 2008, 11:24am

marite,

Let me explain and make myself a bit clearer, I’ll write slower for you. Ok?

My point is roughly half the medical care in America is delivered to self induced health conditions, not genetically occurring or accidental or just dumb luck. So if we work on reducing the self induced claims, we lower the cost overall and make healthcare work for the genetic occurring, accidential or people struck by dumb luck.

Go ahead and take offense, if that’s what you want to do. If you know you have a family history of cancer and continue to smoke or live a lifestyle that allows that gene combination lottery to strike cancer, I do consider you a lifestyle medical problem. You’re comments are exactly why we will continue to drive costs through the roof no matter who collects the premium.

How dare I consider someone who smokes or has a bmi of 35+ as not a “victim” of a genetic disorder?

I hope you understand my point because in your arguement you support it.

Opie_ofMaybery2 · February 22, 2008, 11:27am

“Sick people fight their insurance companies all the time over coverage issues. Having insurance doesn’t mean you are home free. Only mounds of cash gives you complete freedom.”

And the government never says “no”?

This is another false arguement for UHC, that you will be treated for anything and everything and you’ll never hear “no” again. Look into SSI disability insurance and how long it takes to get approved, if approved at all… Uncle Bucks says NO and if he doesn’t raise collection, he’ll say no alot.

barrons · February 22, 2008, 11:58am

We all hear the sob stories about denials of some treatments. Often they are last resort types of “Hail Mary” attempts to forestall a near certain outcome. They are usually also very expensive. The two combine for a huge waste of money in any system. I think most national systems would deny such treatments also.

mammall · February 22, 2008, 12:04pm

^ They certainly do. Moreover, they will deny expensive treatments that simply offer better quality of life than cheaper treatments. As do insurance companies. This presidential election is just sickening in all the rhetoric it’s producing on health care. So much pandering, and inflated promises and so very little willingness by any of the candidates to talk realistically about what is possible. Just raises my blood pressure. Wake me up when it’s over. I just hope all the “change rhetoric” doesn’t put us in a place that’s certainly different but not one many are happy with.

VeryHappy · February 22, 2008, 12:06pm

Opie, I have seen statistics that something like 50% of health care conditions are due to “behaviorial” considerations – smoking, obesity, driving without a seat belt.

I agree with you.

But I don’t understand why that means that 47 million of our citizens continue to be uninsured and to not have access even to preventive care. No one has said that with universal health care we’ll be treated for everything and anything.

Universal Health Care-British Style

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