Location: Somewhere in dreamland
Posted on: 03-08-09 12:48:19
A Canadian doctor diagnoses U.S. healthcare
The caricature of 'socialized medicine' is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients' health.
By Michael M. Rachlis
August 3, 2009
Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.
Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.
The U.S.' and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results?
On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.
On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.
Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer.
Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.
Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.
Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.
The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.
However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms.
On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.
These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse.
Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world's best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.
Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.
U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's, experience than ever. Why?
American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors.
Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.
Michael M. Rachlis is a physician, health policy analyst and author in Toronto.
If one wants to know more about health care system of US,Canada, France, UK, Cuba etc, please watch the movie/documentaory SICKO by Michael Moore, it says everything
Good health to all of you and your loved ones.
PEACE ALWAYS
newincanada
Having experienced both Canadian and American Healthcare systems, I can vouch that American healthcare is far superior than Canadian Healthcare any day!
Please don't start a rant about healthcare costs in US vs. "Free Healthcare" in Canada. If in Canada, you can afford to pay 13% tax on everything you buy, 28% of your salary in income taxes, $900 a year in Ontario health premiums (what happened to free healthcare????) and generally exorbitant prices for everything, you can certainly afford to pay healthcare premiums in the US, and more 
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Microsoft - Which end of the stick do you want today?
Location: Western Hemisphere
Posted on: 11-08-09 08:15:26
I would agree with desitiger that US healthcare is far better. However, US healthcare can start biting you when you don't have employer coverage and private coverage is quite expensive. In Canada (ON at least), the unemployed still get basic coverage without having to pay the premium.
Michael Moore has extreme views. He takes a little bit of facts, twists the context to his convenience. He is as "fair and balanced" as Fox news is. I would rather see someone really present the facts and not far left or far right views.
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Dimple2001
Quote:
Originally posted by DesiTiger
Having experienced both Canadian and American Healthcare systems, I can vouch that American healthcare is far superior than Canadian Healthcare any day!
Please don't start a rant about healthcare costs in US vs. "Free Healthcare" in Canada. If in Canada, you can afford to pay 13% tax on everything you buy, 28% of your salary in income taxes, $900 a year in Ontario health premiums (what happened to free healthcare????) and generally exorbitant prices for everything, you can certainly afford to pay healthcare premiums in the US, and more
Can anybody update on the Ontario health care premiums ? It used to be free but the website says it depends on the taxable income.
There is one big difference..
If u dont have a job and are not making money , u dont pay towards health premiums in canada..
In the US, u bankrupt ur self getting treatment if u are uninsured...
Health care is far better than US..
I have experience both sides , in the usa i had PPO and it was great, it was just like here in canada. Then my company changed and they had very high premiums for PPO and had a cheaper Kaiser plan.. well the kaiser was a nightmare to deal with..
I could not change doctors , my doctor was the worst in the world.. i was glad when i left usa , because i did not have to deal with Kaiser..
I have had a shoulder surgery here , and have only good things to say about the medical system,.
Yes there are wait times.. but when it is a non emergency.. waiting is not all that bad..
My neighbor had a Angioplasty with 8 hrs of having a heart attack in canada..
Most people like the american system when they can afford the premiums.. when they cant, they all wish they were in our Canadian system..
Quote:
Originally posted by DesiTiger
Having experienced both Canadian and American Healthcare systems, I can vouch that American healthcare is far superior than Canadian Healthcare any day!
Please don't start a rant about healthcare costs in US vs. "Free Healthcare" in Canada. If in Canada, you can afford to pay 13% tax on everything you buy, 28% of your salary in income taxes, $900 a year in Ontario health premiums (what happened to free healthcare????) and generally exorbitant prices for everything, you can certainly afford to pay healthcare premiums in the US, and more
Location: Western Hemisphere
Posted on: 04-08-11 18:42:27
Quote:
Originally posted by dan
Can anybody update on the Ontario health care premiums ? It used to be free but the website says it depends on the taxable income.
http://www.rev.gov.on.ca/en/tax/healthpremium/rates.html
The above table provides the premium.
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Dimple2001
