Value Added Health Service

How does Canada ration its health care services?

Also, how does the U.S. ration its health care services?

Public Comments

1. Let's start with the US. First fact, the VA offers nothing but RATIONED care. Let's have a Dem tell you about it in just one state: http://obama.senate.gov/press/060125-veterans_admini/ IHS care is RATIONED care. They get about half PER CAPITA what other government programs get and it shows: “The average cost of mainstream health insurance plans is approximately 40 percent greater than the IHS funding level for American Indian and Alaska Native people. This funding gap limits health care services and contributes to the lingering disparities of death and disease among Indians” (info.ihs.gov/Files/FundingDisparity-Jan2007.doc). IHS care is rationed care (nihb.org). Medicare, the "darling" of the uninformed keeps raising prices and digging the budget deficit deeper and deeper: In the US, Medicare is going bankrupt. In 1998, Medicare premiums were $43.80 and in 2008 will be $96.40--up 120%. "Medigap" insurance is common because of the 20% co-pay required for service. Medicare HMOs are common because they reduce that burden without an extra charge in many cases. HOWEVER, many procedures which used to have no or a low co-pay NOW cost the full 20% for the HMO Medicare patient. ALSO the prescription coverage they tended to offer has been REDUCED in many cases to conform to the insane "donut hole" coverage of the feds. Doctors are leaving Medicare because of the low and slow pay AND because the crazy government wants to "balance" their Ponzi scheme on the backs of doctors. "That dark cloud lurking over the shoulder of every Massachusetts physician is Medicare. If Congress does not act, doctors' payments from Medicare will be cut by about 5 percent annually, beginning next year through 2012, creating a financial hailstorm that would wreak havoc with already strained practices. Cumulatively, the proposed cuts represent a 31 percent reduction in Medicare reimbursement. If the cuts are adjusted for practice-cost inflation, the American Medical Association says Medicare payment rates to physicians in 2013 would be less than half of what they were in 1991." http://www.massmed.org/AM/Template.cfm?Section=vs_mar05_top&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=11037 The current Bush budget seeks to REDUCE the budget for Medicare AND Medicaid because they are GOING BANKRUPT. "President Bush's new budget proposal would cut $196 billion over five years from both Medicare and Medicaid -- programs that provide health care to millions of poor and elderly, federal officials announced Monday. The proposed cuts are part of a plan to stop Medicare from running out of money in little more than a decade, Secretary of Health and Human Services (HHS) Mike Leavitt told reporters during a press conference. He said the savings would help keep premiums affordable, maintain the Medicare/Medicaid system, and balance the current Medicare budget. "The Medicare portion of the budget should be viewed as a stark warning," Leavitt said. "Medicare on its current course is 11 years from going broke. Americans have become numbed to entitlement warnings as a repeated cycle of alarms and inaction," he said." http://www.healthcentral.com/diet-exercise/news-201946-31.html Focusing on Medicaid, here's more on how it RATIONS care in the US: Oregon's at least honest about the FACT that ALL government health care IS RATIONED care: "But the real-life story of 18-year-old Brandy Stroeder may come to embody a harsher truth: namely, that even as we perfect more and more advanced medical procedures, not everyone is going to have access to them. And, as Americans struggle to come up with an equitable health care system, that even the best-intentioned system can seem heartless when forced to balance the good of thousands against an individual's suffering. The story began last fall when doctors told Brandy, who lives with her single mother in a weather-beaten farmhouse about an hour south of Portland, Ore., that she was likely to die within a year unless she got a simultaneous lung-liver transplant, an operation that has been performed fewer than a dozen times in the United States. Under Oregon's unique Medicaid system, which openly rations healthcare in order to provide basic care to as broad a population as possible, Brandy was eligible for a liver transplant or a lung transplant, but not both. In January, and again after a review in May, the state-run health plan said no. There wasn't enough data to show the $250,000 procedure was worthwhile, the health plan's administrators said, and the plan didn't cover experiments. But Brandy wouldn't take no for an answer. A tough, determined young woman who had managed to work part-time at a photo studio, baby-sit her boss's children, coach the high school football team and maintain a 3.2 grade point average between numerous and prolonged bouts in the hospital, Brandy wasn't about to give up her life without a fight. She sued the state of Oregon, charging that it was making a flawed moral choice in refusing to save her life. Since then her caustic, articulate criticisms of the Oregon system have given a vivid sense of the obstacles any universal healthcare plan for the nation would face. "They'll pay for an alcoholic to get a liver transplant because they've been drinking all their life," she says, sitting with her mother at a rickety picnic table under a cherry tree by her front door. "They'll pay for a heroin addict to get cured, to help someone kick the cigarette habit. Those are things people do to themselves. If you put it to a vote the people would say pay for some girl's operation instead of some alcoholic's liver transplant or some crack head's needles. I just think it isn't very fair.'" http://archive.salon.com/health/feature/2000/07/07/brandy/ Texas has also been the boldest in supporting the growing-in-popularity "futile care theory": "Texas, however, has become ground zero for futile-care theory thanks to a draconian state law passed in 1999 — of dubious constitutionality, some believe — that explicitly permits a hospital ethics committee to refuse wanted life-sustaining care. Under the Texas Health and Safety Code, if the physician disagrees with a patient's decision to receive treatment, he or she can take it to the hospital ethics committee. A committee hearing is then scheduled, all interested parties explain their positions, and the members deliberate in private. If the committee decides to refuse treatment, the patient and family receive a written notice. At that point, the patient/family has a mere ten days to find another hospital willing to provide the care, after which, according to the statute, "the physician and health care facility are not obligated to provide life-sustaining treatment." Since the patients threatened with death by ethics committee are often the most expensive to care for, it will often be difficult for families to find other institutions willing to accept a transfer. But the futility deck may be especially stacked against Houston patients. Many city hospitals participate in the "Houston City-Wide Guidelines on Medical Futility," raising the suspicion that participating hospitals will not contradict each other's futility decrees. If so, this would mean that patients seeking refuge from forced treatment termination will have to be transported to distant cities, as has already occurred in a few futile-care cases, perhaps even out of state. Illustrating the level of hardball some hospitals play against patients and families, the Clarke family's lawyer Jerri Ward told me that St. Luke's agreed to pay the $14,806 transportation costs to transfer Clarke to a hospital in Illinois — more than 1,000 miles away — if the decision to transfer is made on Thursday (4/27). If the family doesn't decide until Friday, the hospital will pay only one-half of the cost of transportation. Thereafter, it would pay nothing." http://www.nationalreview.com/smithw/smith200604271406.asp So that's how the GOVERNMENT RUN health programs in the US RATION care routinely--and that's the surface look at it. How does Canada do it? Well Canada has territories and provinces and they all work a bit differently so I can't go over each of their issues, but here's a very quick overview of genuine Canadian problems: "Comparing Canada with other industrialized countries in the Organization for Economic Cooperation and Development (OECD) that provide universal access to health care, a study released by The Fraser Institute in May revealed that Canada spends more on its system than other nations while ranking among the lowest in several key indicators, such as access to physicians, quality of medical equipment, and key health outcomes. ... In 1999, Richard F. Davies, MD, described how delays affected Ontario heart patients scheduled for coronary artery bypass graft (CABG) surgery. In a single year, for this one operation, 71 patients died before surgery and another "121 were removed from the list permanently because they had become medically unfit for surgery;" 44 left Ontario and had their CABG elsewhere, such as in the USA. In other words, 192 people either died or were too sick to have surgery before they worked their way to the front of the waiting line. One of the reasons Canadians are slow to acknowledge the problems with their system is that general practitioners have been relatively easy to access and reasonably efficient at providing everyday services for common complaints, such as colds, sprains, aches and pains. As time passes, however, more and more Canadians are confronted by the halting quality of their system when they face complex and expensive medical problems. They often cannot get timely or appropriate care for bone fractures, prompt treatment for cancer, or non-emergency surgery such as hip replacements. Their doctors complain that they are unable to help them and the government pleads shortage of funds. ... Canadian physician frustration with their inability to provide quality and timely care is resulting in a brain drain. According to one poll, one in three Canadian doctors is considering leaving the country. A doctor shortage looms, as the nation falls 500 doctors a year short of the 2,500 new physicians it needs to add each year to meet national health needs, according to Sally Pipes, a policy expert formerly with the Canadian Fraser Institute. Another casualty of the lengthy waiting periods is Canada's much-vaunted equal access to medical treatment. Even though medical emergencies allow some people to jump ahead in the waiting line — making others wait longer — a survey published in the Annals of Internal Medicine medical journal found that more than 90 percent of heart specialists had "been involved in the care of a patient who received preferential access" to cardiac care based on non-medical reasons including the patient's social standing or personal connections with the treating physician." Jewish World Review June 11, 2004 written by Dr. Cihak AND "The biggest Canadian fiscal drain comes from the single-payer medical system. "Current model of health-care delivery leading us down the path to financial ruin," states the lead editorial in the Calgary Sun. Health-care costs would consume 50% of Alberta's budget by 2016 (according to the Fraser Institute) or 2017 (according to Aon Consulting, a firm hired by the Alberta government). Health care would devour 100% of the provincial budget by 2030, if present trends continue. ... An estimated 90,000 Canadians sought medical care outside their country in 2005. The cry "no two-tiered system" could be replaced by "set our patients free," stated a lead editorial (National Post 9/18/06)." Jewish World Review Dec. 1, 2006 by Dr. Glueck So why no total collapse yet? Because “illegal, for-profit health-service centers” have “proliferated” in Canada and are so accepted that the head of one became the president of the Canadian Medical Association (“Individual Freedom vs. Government Control,” 1 August 2007, nationalreview.com). Here's what one Canadian who wanted to live and couldn't get the care she needed IN Canada did: "When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin’s favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab." Same source on how HIS med student mind changed based on experience: "Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks. ... My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. ... Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. And so on. ... As if a taboo had lifted, government statistics on the health-care system’s problems are suddenly available. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.5 million Ontarians (or 12 percent of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment. Dr. Jacques Chaoulli is at the center of this changing health-care scene. Standing at about five and a half feet and soft-spoken, he doesn’t seem imposing. But this accidental revolutionary has turned Canadian health care on its head. In the 1990s, recognizing the growing crisis of socialized care, Chaoulli organized a private Quebec practice—patients called him, he made house calls, and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance. ...Baker isn’t a neurosurgeon or even a doctor. He’s a medical broker, one member of a private sector that is rushing in to address the inadequacies of Canada’s government care. Canadians pay him to set up surgical procedures, diagnostic tests, and specialist consultations, privately and quickly. “I don’t have a medical background. I just have some common sense,” he explains. “I don’t need to be a doctor for what I do. I’m just expediting care.” ...Baker isn’t alone: other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week. Companies like MedCan now offer “corporate medicals” that include an array of diagnostic tests and a referral to Johns Hopkins, if necessary. Insurance firms sell critical-illness insurance, giving policyholders a lump-sum payment in the event of a major diagnosis; since such policyholders could, in theory, spend the money on anything they wanted, medical or not, the system doesn’t count as health insurance and is therefore legal. Testifying to the changing nature of Canadian health care, Baker observes that securing prompt care used to mean a trip south. These days, he says, he’s able to get 80 percent of his clients care in Canada, via the private sector. ...Another sign of transformation: Canadian doctors, long silent on the health-care system’s problems, are starting to speak up. Last August, they voted Brian Day president of their national association. A former socialist who counts Fidel Castro as a personal acquaintance, Day has nevertheless become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center as a remedy for long waiting lists and then challenged the government to shut him down. “This is a country in which dogs can get a hip replacement in under a week,” he fumed to the New York Times, “and in which humans can wait two to three years.” And now even Canadian governments are looking to the private sector to shrink the waiting lists. Day’s clinic, for instance, handles workers’-compensation cases for employees of both public and private corporations. In British Columbia, private clinics perform roughly 80 percent of government-funded diagnostic testing. In Ontario, where fealty to socialized medicine has always been strong, the government recently hired a private firm to staff a rural hospital’s emergency room. http://www.city-journal.org/html/17_3_canadian_healthcare.html Canada can't keep letting its people come to the States for health care and then paying for it either.
2. this might be overly simplistic, but my first thought was the phrases defining socialism and capitalism: "...from each according to their ability; to each according to their need." that's canada. "...from each according to their ability; to each according to their ability." that's the u.s.
3. Here is some documentaries on this topic. Socialized medicine is not Utopian, and has serious flaws. Our health care system needs to be fixed, but so does Canada's.