Jump to content
IndiaDivine.org

A Canadian doctor diagnoses U.S. healthcare

Rate this topic


Guest guest

Recommended Posts

Guest guest

notice the reference to doing away with alternative care. It's under 'lesson 4'.

 

http://www.latimes.com/news/opinion/la-oe-rachlis3-2009aug03,0,538126.story

 

From the Los Angeles Times

Opinion

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.

 

looking for a few good women and New Yorkers

ourrealnewsplace/

 

 

Link to comment
Share on other sites

Join the conversation

You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...
×
×
  • Create New...