52293-Health Care Reform

[vorpal blade]

Regarding vorpal blade's comment:
I'm not saying that doctors deserve to paid well just because they spend a long time in school. I'm saying that to make up for the opportunity cost of spending so much time falling into debt instead of making a salary while they're in school, you have to offer future doctors enough of an incentive that the really smart people will want to go into medicine.
It is really important for the quality of life of all Americans that their doctors be the best and the brightest. It's only marginally important to the quality of life if historians are smart. (please, nobody read that the wrong way, I'm not trying to open up a debate about the relative merit of the humanities)

In an unrestricted market it does come down to earning whatever the market place finds you are worth. But I'm not so sure I agree that we need to put our best and brightest into the medical field. Most of our visits to the doctor don't require a rocket scientist.

One of my daughters is a nurse, and another one majored in a subject heavy with pre-med students. They tell me that the competition is ruthless to get good grades in school so you can gain acceptance to medical school. I suspect, but I can't prove it right now, that we could double the number of students admitted each year to our medical schools and the average intelligence of our doctors would not diminish. The quality of our doctors would be just as good or better.

What I would really like to see is more choice. What if I choose to go to a doctor who didn't get his degree in the U.S.? Would he necessarily be inferior to one of our doctors? And what if he were? Why can't I choose to pay one fourth as much to see this doctor than I would be paying to see an AMA approved doctor? I'm willing to take the risk, especially if the doctor was highly recommended by my friends.

A few years ago I had a cyst removed from my abdomen. Some people urged me to go to some specialist in another town. I choose to go under the knife of our local surgeon because I figured he was good enough. Why go to the expense of going elsewhere to do the job? I don't need the best and the brightest.

If we made it easy for foreign doctors to set up shop here, and let people choose for themselves to pay hundreds of dollars instead of thousands of dollars to visit the doctor, what would be the harm in that?

[Darth Fedora]

This is a very good example of a topic where cursory internet research is absolutely no substitute for actually knowing what you're talking about.
For example, there is only one state in which I can get in-state tuition. In that state, the cheapest tuition for an allopathic school is around $30,000 a year. With living expenses, especially for anyone with a spouse and/or kids, that could so, so easily get up to $50,000 a year. $200,000 is a reasonable average debt for people who don't have their parents helping them, especially considering the fact that most private medical schools cost $45-50 grand a year even without living expenses. But you couldn't have known that because whatever websites you were looking at were either inaccurate or didn't tell what it was like for a student who wasn't getting aid from other sources.
And a salary in the forty-thousands is quite meager for the amount of hours you're required to put in, clinically and studying (yes, you still have to study when you're a resident), in residency.
The free food is only if your doctor's lounge happens to be stocked up with bagels during the ten minutes when you might get to have a break if it's a slow day during your shift.
In most residencies you CANNOT moonlight. If you have a decent residency director at all, you will not be allowed to moonlight. If you have free time, you're expected to study for the boards.
In many grad programs, students take fewer credits than they did in undergrad, and fill up their remaining time with research and writing a thesis. A typical medical school schedule is equivalent to 24-26 credits per semester, plus clinical duties, plus studying for the boards.

I'm really not trying to make you feel bad for not knowing these things. But I think that, evidently, reading a few websites on the subject is not enough to educate someone regarding what being a doctor is like. Perhaps if one's opinions are formed by reading a few inaccurate websites, we all might be better served if those opinions were not presented as "The Truth."

[vorpal blade]

Thank you for your opinion, Darth. Here are a few more good websites showing what the average loan debt is for medical student graduates. That's the average, not for special cases.

About $100,000 says this site: http://www.studentdoc.com/medical-school-loans.html

According to this site the average debt is $139,517 http://www.ama-assn.org/ama/pub/about-a ... debt.shtml

This site says over $100,000 for public medical school, and $135,000 for private medical school. http://www.medrounds.org/medical-answer ... t-for.html

[NerdGirl]

This discussion is interesting to me, because at the moment I am finishing (meaning finishing about a year from now) my Ph.D. in astronomy, and I am fairly seriously considering going to medical school afterwards (in Canada, so things are a bit different and, apparently, tuition is a lot lower). I don't know that I have anything to add to the discussion at the moment, but I just wanted to throw that in there.

[vorpal blade]

As for the supply restrictions, I don't know exactly how those operate (is there a set number, percentage of applicants, etc? Any actually real, cited, informative statistics would be good), but I for one don't mind medical schools being really selective. I'd like to visit a doctor who deserves his degree, and hopefully didn't just squeak by his licensing examination.

The condensed version is this: The law requires that you have a license to practice medicine in this country. The requirements for licensing have been put in the hands of the medical profession, namely the American Medical Association. They are a monopoly of medical services protected by law. Using this power the AMA has engineered the system to maximize for themselves benefits, such as income, at the expense of the public.

Dr. Shirley Svorny, chair of the Economics Department at California State University, Northridge discusses the various viewpoints of this topic in an article published in Econ Journal Watch, August 2004. I urge everyone to read it. http://www.econjournalwatch.org/pdf/Svo ... st2004.pdf

[vorpal blade]

As for the supply restrictions, I don't know exactly how those operate (is there a set number, percentage of applicants, etc? Any actually real, cited, informative statistics would be good), but I for one don't mind medical schools being really selective. I'd like to visit a doctor who deserves his degree, and hopefully didn't just squeak by his licensing examination.

The Liaison Committee on Medical Education (LCME), sponsored by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA) accredits medical schools (in the U.S. and Canada) that award the MD degree in allopathic medicine. A state license to practice medicine requires, among other things, an MD degree, or a DO degree (Osteopathic medicine), or graduation from an approved foreign medical school. The AAMC keeps data on all applicants to medical schools, and those that are accepted (matriculants). Looking at the AAMC

[Waldorf and Sauron]

This is a very good example of a topic where cursory internet research is absolutely no substitute for actually knowing what you're talking about.

At least Vorpal Blade provided citations. Even Levar Burton doesn't ask us to just take his word for it.

For example, there is only one state in which I can get in-state tuition. In that state, the cheapest tuition for an allopathic school is around $30,000 a year. With living expenses, especially for anyone with a spouse and/or kids, that could so, so easily get up to $50,000 a year. $200,000 is a reasonable average debt for people who don't have their parents helping them, especially considering the fact that most private medical schools cost $45-50 grand a year even without living expenses. But you couldn't have known that because whatever websites you were looking at were either inaccurate or didn't tell what it was like for a student who wasn't getting aid from other sources.

Like Vorpal said, averages are different from outliers.

And a salary in the forty-thousands is quite meager for the amount of hours you're required to put in, clinically and studying (yes, you still have to study when you're a resident), in residency.

Certainly no one disputes that residency is a grueling process.

The free food is only if your doctor's lounge happens to be stocked up with bagels during the ten minutes when you might get to have a break if it's a slow day during your shift.

I wonder how you know this... I suppose you've been to every hospital break room?

In many grad programs, students take fewer credits than they did in undergrad, and fill up their remaining time with research and writing a thesis. A typical medical school schedule is equivalent to 24-26 credits per semester, plus clinical duties, plus studying for the boards.

At BYU a grad student's full time credit load is 8.5 credits compared to 12 for an undergraduate. But, at least in my experience, graduate credits are much more intense. I took a class that was offered for both undergraduates and graduates, and the syllabus listed different requirements depending on what credit you wanted. For graduate credit, you had to do roughly twice as much out-of-class work as an undergraduate. I don't know how you arrived at your figure of 24-26 credit hour equivalency, but I'd sure like to see a citation.

[Waldorf and Sauron]

Two more interesting articles:
"Debunking Canada's Health Care Myths" - Denver Post - http://www.denverpost.com/recommended/ci_12523427

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

"The Truth about the Insurance Industry" - Washington Post - http://voices.washingtonpost.com/ezra-k ... rance.html

The best way to drive down "medical-loss," explains Potter, is to stop insuring unhealthy people. You won't, after all, have to spend very much of a healthy person's dollar on medical care because he or she won't need much medical care. And the insurance industry accomplishes this through two main policies. "One is policy rescission," says Potter. "They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment."

[...]

The issue isn't that insurance companies are evil. It's that they need to be profitable. They have a fiduciary responsibility to maximize profit for shareholders. And as Potter explains, he's watched an insurer's stock price fall by more than 20 percent in a single day because the first-quarter medical-loss ratio had increased from 77.9 percent to 79.4 percent.

The reason we generally like markets is that the profit incentive spurs useful innovations. But in some markets, that's not the case. We don't allow a bustling market in heroin, for instance, because we don't want a lot of innovation in heroin creation, packaging and advertising. Are we really sure we want a bustling market in how to cleverly revoke the insurance of people who prove to be sickly?

[vorpal blade]

I emailed one of my nephews who completed a residency a couple of years ago, and is now a full fledged Osteopathic physician. Here is what he had to say about some of the questions we have been discussing:

He said that his medical school debt was around $200,000. Tuition for him was $25k-$27k per year, and went up every year he was in medical school. His wife did not work (they have several children) so they had to borrow money to live on. They were very frugal and survived on $20-$25k per year. He would guess that most students, even those who are single (like most med students) have more than $135k of debt before it is over between living expenses and tuition.

He didn't say so, but I don't think his parents were able to help him financially, or chose not to do so. A lot will depend on such factors.

In regard to moonlighting my nephew said that some programs do allow moonlighting. The pay is extremely variable. He worked at a surgery center a few nights a month, sleeping there overnight and being in "house" in case there was a problem with the one or two patients who had to stay overnight after their surgery. He slept most nights, and got paid $40/hour. He says it "was a good gig because I almost never got called." He knew people who worked in ERs, or for doctors in their offices. Technically the moonlighting he did was against the rule of not working more than 80 hours a week. This is a rule for patient safety, not to protect the residents. His residency program did not allow moonlighting, but they turned a blind eye to it. Not all residents work 80 hours. Obstetrics and General Surgery are notorious for working many hours. Once he worked over 120 hours in a week. But many programs are not quite so demanding. He says, "Moonlighting is even encouraged and even expected in some programs. It is almost part of the training." It really comes down to the individual residency program, how much the residents work, and what is allowed.

Thanks Waldorf and Sauron for your support.

[vorpal blade]

I don't hear complaints that Canada's health care system is a cumbersome bureaucracy, or that it is more expensive than that of the U.S. What I hear is that the quality of the care in Canada is inferior to that of the U.S., and you have to wait months for something like an MRI. The government decides who is worthy to receive medical attention, and who is too old or too sick to be worth it. That's the kind of thing I hear. I think our system needs reforming, but I don't think Canda is a good model of what we want to have.

I think it may be a little misleading to say that Canada's system provides health care for 100 percent of the population, but 15 percent of the population in the U.S. has no coverage whatsoever. The system is the U.S. provides health care coverage for 100 percent of its population as well, it is just that about 15 percent of its population chooses not to have health insurance, cannot afford health insurance, or is between jobs and is only temporarily without insurance. Those without insurance still get health care, either with their own money, or as charity cases, or at government expense. I think the article confuses health care with health care insurance.

I really don't understand why emergency rooms need to be so much more expensive than other medical service. I believe some people are paying for services others get free, but the total health care cost is not changed by this process of who pays for it, unless people who get it free get more of it than they need.

Those are my thoughts, anyway.

[Waldorf and Sauron]

What I hear is that the quality of the care in Canada is inferior to that of the U.S., and you have to wait months for something like an MRI. The government decides who is worthy to receive medical attention, and who is too old or too sick to be worth it. That's the kind of thing I hear. I think our system needs reforming, but I don't think Canda is a good model of what we want to have.

Read the rest of the article! The excerpts were just to whet your interest.

I think it may be a little misleading to say that Canada's system provides health care for 100 percent of the population, but 15 percent of the population in the U.S. has no coverage whatsoever. The system is the U.S. provides health care coverage for 100 percent of its population as well, it is just that about 15 percent of its population chooses not to have health insurance, cannot afford health insurance, or is between jobs and is only temporarily without insurance. Those without insurance still get health care, either with their own money, or as charity cases, or at government expense. I think the article confuses health care with health care insurance.

That's very true that insurance is different than, and secondary to, health care. I think this is a major flaw in Obama's health plan— he talks a lot about insuring everyone, but not about providing care for everyone.

Don't forget that many are uninsured because they are denied coverage, not because they aren't willing to pay for it.
It's not true that those without insurance still get health care in a degree in anyway comparable with the insured. Sure, emergency-room crises will be taken care of (subsidized by the hospital bills of the insured), but that doesn't make up for the lack of preventative care. And what if you need a specialized procedure? Your chances of getting an organ transplant are extremely slim.

I really don't understand why emergency rooms need to be so much more expensive than other medical service. I believe some people are paying for services others get free, but the total health care cost is not changed by this process of who pays for it, unless people who get it free get more of it than they need.

I think this is a case of "a stitch in time saves nine." It is also expensive to staff emergency rooms with enough specialists to face whatever might happen. It's more economical to visit a specialist during an open window of his schedule than to wake him up and bring him to the emergency room for one patient.

[NerdGirl]

Waldorf and Sauron, that article you linked to was probably the most accurate and fair description of what healthcare is really like in Canada, and I really hope that Vorpal and everyone else reads it. I really get a bit sick of hearing about how Canada has inferior medical care or that the government decides who gets medical treatments - those things are simply not true. Yes, there are issues with healthcare in Canada. Many of those issues stem from shortages in rural areas - keep in mind that Canada is larger than the US and has 1/10 the population. I'll give you an example of how things you hear about healthcare in Canada can be misleading. About two years ago, the hospital in my hometown decided that it would no longer deliver babies, unless there wasn't enough time to get the mother to a different hospital in a town 40 minutes away. That sounds kind of bad on the surface. But here are the missing facts. My hometown has a population of approximately 1,200. Our hospital has 11 acute care beds and two separate long-term care facilities. There are two doctors in my town (both of whom still make house calls). It's mainly a farming community. There aren't any stores open after 6 pm or on Sundays. There are no malls or fast food restaurants. The hospital is just not equipped or staffed to deal with complicated pregnancies, so they decided it would be safer to send women to the big hospital. Doesn't really sound so bad anymore. Actually, it's starting to sound kind of good that there's even a hospital in a town like that.

My father has worked in the Canadian healthcare system for over 30 years, and my mother taught at a Canadian medical school for 15 years before she had me. I've worked in that small town hospital I described, and I've been a patient in both the American and Canadian systems. Now that I'm back in the Canadian system, I can choose my own doctors and specialists, and I can get any tests I need without having to worry whether my insurance will cover it. I've had more specialist appointments in the last year than I care to count, but I've never had to wait more than a couple of weeks for a procedure or appointment. I am in fairly large city now, though, and it would probably be different if I were out in Nowhere, Saskatchewan. The big problem in Canadian healthcare is recruiting rural physicians. It's just not appealing to many young doctors to move to a town like my hometown. On top of the lack of things that most people would consider part of a fun lifestyle, when you're a rural doctor, you're on call ALL THE TIME. Both of the doctors in my hometown are LDS, and it's rare for them to both be able to attend church on any given Sunday.

Vorpal, when you say that the government decides who is too old or too sick to be worth medical attention, you may be referring to things like organ transplants. That's an issue in any healthcare system, and even in the US you don't get to automatically be on the transplant list just because you have money. For medical care that doesn't rely on things that are in short supply like donated organs or tissue, you will get treatment regardless of how old or sick you are. If you are in certain areas you may have a long wait if it's not an emergency (but then you are always free to travel if you choose to). I don't think it's fair to say that the quality of care is inferior. It's been my experience that the quality of care is about the same in both countries. But I would much rather be in this system where I don't have to worry about my insurance covering things. Sure, there are problems with both systems. But most of the problems with the Canadian system are unlikely to ever become problems in the US, even if the US did switch to a single-payer insurance system.

[Tao]

Aye, there are costs to any benefit. In the US, specialists can make copious amounts of money, attracting many of the best and brightest, but at the cost of, well, cost. In Canada, specialists can be scarce (perhaps due to the ease of coming to the US where there isn't a wage cap), and thus while monetary costs can be slim-to-none, time can be where you get hit. My sister has some heart complications that created no small stir during the birth of her youngest child. An appointment was scheduled with a heart specialist. As it was, the soonest availability turned out to be six months later, whereupon the doctor checked her out and placed her on urgent priority to surgery; another six months out. It would have been free, had she opted to remain in Canada and go through with the procedure there.

My biggest struggles with the current debate come from the (apparent) lack of specifics. I have heard much of 'this needs to be better' or 'this is what our goals are', but precious few 'these are the steps I'd propose, and this is how I feel they'll improve the status quo'. But, I myself have little to offer by way of suggestions, so I cannot castigate those who are in authority who are ostensibly trying to help out a faulty system.

[Waldorf and Sauron]

Tao, In relation NerdGirl's point, would you care to specify where in Canada your sister was, big city or not? Also, I'm not sure why you see a lack of specifics, given Obama's proposal of a specific health care plan. I might be misunderstanding you.

I think we should understand that the horror stories about foreign health care systems aren't without their American counterparts. Saying that MRI's in Canada have a year-and-a-half-long wait-list (whether true or not) doesn't prove that America's system is better, or even adequate.

I'm not accusing Tao of this line of arguing, but I've seen divisive politicians do it all the time with similar anecdotes. And the public buys into it. I fear that the debate in this country is more along the lines of a smear campaign than actual reasoned debate.

[vorpal blade]

Well, I’ve now read the entire Denver Post “Perspective” by Rhonda Hackett. I’ve also read many other articles. I hate to say it but Hackett’s perspective was the most inaccurate and unfair article I’ve read on the subject. Consider this statement by Hackett:

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Now, Hackett does not give any references to her “perspective,” but she may have gotten her “facts” from this article in the New England Journal of Medicine (NEJM) http://content.nejm.org/cgi/content/ful ... bbd373345d :

Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

At least the 31 percent figure is there for the U.S., and the 1 percent figure is there for Canada, but Hackett misses the 16.7 percent figure. As it turns out, the 1 percent number for Canada is just a small part of Canada’s administrative costs. If you take all the same categories for spending for Canada as you do for the U.S. you get 31 percent for the U.S. and 16.7 percent for Canada. And that is according to this article in the NEJM, which is trying to show how we should emulate Canada.

As it further turns out, as seen in a NEJM editorial, the difference of 31 percent and 16.7 percent is greatly exaggerated. http://content.nejm.org/cgi/content/ful ... f_ipsecsha Plus, many of the Canadian administrative costs are hidden, unreported costs involving government expenditures for tax collecting and government buildings and so forth.

So Hackett greatly underreports the administrative costs in Canada. I don’t deny that there may be large differences in administrative costs between the two nations. Considering how much the U.S. government imposes huge administrative burdens on the health care industry, it isn’t too surprising. But it is not nearly as much difference as Hackett would lead you to believe.

I find similar inaccurate and unfair statements throughout the Hackett perspective. So, here are a few articles I would recommend. The Wikipedia article comparing the U.S. and Canada health care systems. http://en.wikipedia.org/wiki/Canadian_a ... s_compared
A good, well-referenced article showing some of the problems in the Canadian system is “The Top Ten Things People Believe About Canadian Health Care, But Shouldn't” http://www.heritage.org/research/healthcare/hl856.cfm

And for another perspective on the myths of single payer health care see http://www.freemarketcure.com/singlepayermyths.php

[NerdGirl]

I really don't want to get into a big debate about the Canadian healthcare system, but I just have several things to say. First of all, Vorpal, your two articles other than the wikipedia article are from sources with what I would consider a very conservative bias, and I feel that they are designed to mislead people. While I said that the Denver Post article was the most accurate and fair, it of course does not paint a perfect picture of the situation - that's why I wrote a long bunch of stuff hoping to further clarify the situation instead of saying "Yay, great article!". But these are the points that I would like to get across:

1. Canada and the United States are two very different countries. I grew up in Canada. I spent the first seven years of my adult life in the US and I've spent the last two back in Canada. There are significant cultural, political, economic, and other differences, despite the fact that they appear very similar on the surface. As an aside, that's a big problem that I had with the movie "Bowling for Columbine". The fact that Canada has less gun violence has much more to do with the fact that Canada has fewer people is and much less densely populated than it does with gun control laws. Criminals get guns regardless of the laws. And now back to healthcare.

2. There are significant problems with healthcare in both countries. The main problem I see in the US system is that poor people don't have access to enough healthcare. The main problem I see in the Canadian system is doctor and nurse shortages and lack of services in rural areas.

3. Switching to a single-payer system in the US is a solution, but not the only solution, to the problem.

4. Switching to private insurance in Canada is unlikely to solve the problems in the Canadian system, but it's also unlikely to make it worse (assuming that public healthcare would still be a choice for people). No matter how much you pay specialists, you're still not going to get the services that people need in remote, Northern, and rural areas.

5. When people say things like "the quality of care is inferior in Canada", I tend to get really defensive because I feel that is insulting to many people I know (including myself) who work or have worked as Canadian healthcare providers. There may be shortages and problems, but Canadian doctors, nurses, and other providers are just as capable as their American counterparts.

Maybe my main point is that the Canadian system is just not the best case study for what switching to a single-payer would do to the American system. What country would be a good case study? Unfortunately, probably none. And I don't even necessarily think that it would be the best solution. A reform of the current Medicare program would probably be the most efficient thing to do.

I realize that I'm coming off as very pro-Canada at the moment. I actually find that there are many things I love and hate about both countries, and if I had to pick which one I like living in the best, the US would win, but by a rather smaller margin. My family and my citizenship are in Canada, however, so that is where I feel I need to be at least for now. But I just would like people to realize that the Canadian healthcare issues are more complicated and nuanced than any article on the internet can convey.

Also, a bit of disclaimer - I'm not sure if I sound really angry here, but if I do, I'm really not - at least not at any of you. I've just been in a really bad mood all week because there's a lot of ridiculous crap happening in my department at school that I've somehow gotten dragged into the middle of, and all because I did something about three months ago to help someone who needed help and wasn't getting it from anyone else. Something perfectly ethical legal and actually rather minor. But that's not a story for a public forum.

[vorpal blade]

Nerd Girl,

I’m sorry you have been having a bad week. You haven’t sounded angry to me, just a tad defensive. I apologize for saying that the quality of care in Canada is inferior to that of the U.S. I can see how that might be offensive, and how a Canadian might get defensive over that. After doing some more research I believe that the health care providers in Canada are competent and well trained.

I do have some questions about the attitudes of health care workers in Canada. The government negotiates fixed fees, with the result that doctors in Canada earn only half of what they earn in the U.S. Do the doctors resent that? In a system where everyone feels entitled to “free” medical care, do people take advantage of it and see doctors unnecessarily? Do the health care administrative staff, who are paid the same whether there are patients or not, feel that patients are a burden and an unwanted increase in workload? Or are they glad to have patients to make their health care center profitable?

How do the health care professionals feel about the rationing of health care due to a chronic shortage of tax money? How do they feel about the lack of hospital beds, causing patients to sleep on cots in hallways? How do they feel about the inadequate expenditures for capital equipment to save money, causing shortages of modern technology such as MRI machines? How do they feel about making patients wait on average more than 15 weeks to see a gynecologist, or more than 30 weeks for neurosurgery? How do they feel about relying on the Americans to bail them out when they can’t offer care or facilities in a timely manner? How do they feel when prominent and wealthy people in Canada go to America for treatment for such things as breast cancer, because they say that they can get better care in America? And the survival rate is better?

Your experience with the health care system in Canada may be different from most, Nerd Girl, because you are articulate and have connections to the medical profession. I found this comment interesting

Roy Romanow has made it clear that he wants to ensure that "two-tier" health care continues to be forbidden in Canada and this was a major theme of the 2004 federal election. Too late. If you are on worker's compensation; are in the Royal Canadian Mounted Police or the military; if your company has its own salaried physicians; if you use a private hospital like Shouldice (which specializes in hernia surgery) in Toronto or one of the country's private abortion clinics; if you are a member of the medical professions or know someone who is; or are just articulate and determined or famous and connected; if you travel to the U.S. or any one of a number of other places, you can get better, faster, or more satisfactory care than someone who just lets the wheels of Medicare grind on.

My last two references in my previous post were from conservative sources, but I don’t believe they are biased or misleading. Frequently in this forum people use sources that I believe are biased in the liberal direction, and are misleading to say the least. I just try to dig up the facts to show exactly why they are misleading.

1. I agree with you that Canada and America are two very different countries. It worries me when people say that our system would be better if we tried to be more like Canada. I think the system you have is not sustainable, but may work for a few more years to provide basic care, or special care if you can live long enough, and live in the right place, and…. I believe adopting your system would be disastrous for the U.S. And where would many Canadians go if the U.S. was no different from Canada? Sweden is an option, but not as convenient as the neighbor just to the south.

2. I applaud your desire to care for the poor people in the U.S. I think they are better off than you think, but I don’t believe it is the proper role of government to provide healthcare. The negative consequences of government involvement far outweigh the positive consequences, in my opinion.

3. I believe switching to a one-payer system is not a solution, but would only make things worse here. I think Obama’s plan is a disaster.

[vorpal blade]

My biggest struggles with the current debate come from the (apparent) lack of specifics. I have heard much of 'this needs to be better' or 'this is what our goals are', but precious few 'these are the steps I'd propose, and this is how I feel they'll improve the status quo'. But, I myself have little to offer by way of suggestions, so I cannot castigate those who are in authority who are ostensibly trying to help out a faulty system.

According to Washington journalist E.J. Dionne, Jr. http://www.ibdeditorials.com/IBDArticle ... h,strategy

Every general studies the mistakes of the last war, and President Obama's style has been much influenced by the difficulties of Bill Clinton's presidency.

In particular, Obama has shied away from handing Congress his own plans on "stone tablets," a phrase much loved by senior adviser David Axelrod, and instead allowed it room to legislate....

Obama's initial approach of laying out principles and giving Congress latitude was the right response to Clinton's mistake of offering an immensely detailed proposal, only to see it mocked and rejected.

Dionne believes Obama is being vague as a strategy.

[Imogen]

vorpal, i'd just like to say that i often have to make my gynecology appointments anywhere from a month to 3-4 months in advance because my doctor is alsways booked. it's not like americans don't wait to get appointments.

[medievalman]

If I may be permitted to scoff... vague as a strategy? That sounds more like a cop-out than an actual valid strategy. That sounds like the kind of "strategy" I had for essays/papers just before they were due. Heck, it sounds a lot like what most politicians running for an office will resort to, making vague promises/goals that never come into an semblance of detailed fruition.