The Bush healthcare proposals will leave employees worse off.
Paul Fronstin, director of health research at the Employee Benefit Research Institute, a nonpartisan organization, said: “The president’s proposal would mean the end of employer-based benefits as we know them. It gives employers a way out of providing the benefits because their employees could get the same tax break on their own.”
Surprise! Actually, not. Like most of the modern conservative movement the White House believes that Americans consume too much health care. Being over insured, people go to the doctor without properly weighing the costs. The solution usually involves some combination of higher copays, increased power for the insurance providers and breaking up group coverage in favor of individual plans. It’s a blighted, Hobbesian view of society that would get an honest candidate slaughtered at the polls, so instead we see plans like this which never seem to work like advertised. Dissembling spokesmen will go on spinning features as bugs, and it will be up to citizens to find out the many legal ways that an individual plan can drop you like a hot potato, never to be insured again, the moment you actually need it.
Anyway that’s the plan. Good for us, and thanks to our newly-socialist Congress, the plan died in utero.
Davebo
Thanks Tim. The insurance industry is drooling at the concept of eliminating group policies and going towards individual ones.
Who can blame them?
As an employer I can understand the desire to push off the incredible insurance costs. But I still want my people to be healthy enough to work!
Andrew
I’m so over-insured that I’m thinking about a recreational heart transplant to complement my Pelosi-mandated abortion next week.
jake
Last year Medicare started scolding doctors for over-providing healthcare services (in part to blame them for the fact payments for services were going to plummet like Dick Cheney bungee jumping). But here’s the thing, there are two ways for a provider to give services to a Medicare patient: 1. By following Medicare’s byzantine rules and giving the patient exactly what Medicare allows or 2. By breaking the law.
But Medicare wasn’t saying the doctors were breaking the law they were saying…well, in a way they were saying break the law, but by cutting back on the services you give your patients. If a doctor gives privately insured patient a treatement but denies it to a Medicare patient, guess what? He could get smacked for discrimination. If a doctor misses a diagnosis because he ordered a cheaper diagnostic, guess what? Law suit! (Note: Every year Medicare begs doctors to participate and scratches its head when they don’t.) No one ever mentions the folks who ultimately set the prices for these services. Hmmm.
I suspect the same sort of bassackwards thinking is in play here: Blame the mythical end user who is “over insured.” I’m not even sure what “over insured” is supposed to mean, but I doubt the term would ever be applied to the CEO of a company.
Jessica
I doubt it would be applied to the pharmaceutical companies who charge us out the ying-yang for egregious profits, a benefit negotiated by Congress specifically for that purpose.
ThymeZone
I’m over insured, and I am entitled to the several organ transplants, cosmetic touchups, and experimental libido enhancements that I’ve signed up for this year. I want to thank all the little people and single parents who will pay for these well deserved modifications.
And of course, if anything goes even the slightest bit wrong in any of these procedures, you can bet your ass that my legal team will sue the doctors and hospitals for every single misbegotten penny they’ve got …. which again, will take money out of the pockets of the stupid little people who don’t have enough sense to be well off like me. Fucking losers.
Mike
What? No abortion? Are you sure you are a librul?
Dave
I didn’t think Bush could come up with anything worse than the current system. As usual he never ceases to amaze me.
Jay
Reading the article, this stood out at me:
Having a family of four myself and doing my own taxes every year, this seemed fishy to me. So I looked at the 1040 tables and crunched the numbers myself. Assuming the standard deductions (which would be the least advantageous situation for this hypothetical family, their tax obligation would be about $4700 before the Bush plan and about $2500 after, not counting the child tax credits of $2000 which would remain the same under both plans.
I expect that so few people actually understand the internals of their taxes that most readers will miss this and I take it as a given that the Bush administration will misrepresent their plan, but doesn’t the Times have any sort of basic fact checking? It would be trivial for a intern/drudge/slave to verify such simple claims made by their sources. “Objectivity” doesn’t mean that you have to assign equal credibility to both sides, regardless of what they said.
ThymeZone
Darrell says I am, so I guess I am. He’s the final authority on such things here.
Mike
Well, we must defer to his “authoritah”. Tell you what, you sign up for a uterus transplant now, then the abortion, and all will be forgiven.
Zerthimon
Conservatives? Try most economists.
Of course it’s a bit more complicated than that. Yes some who have over generous health care plans go to the doctor far more than they should. But the other side is that those that don’t have health insurance don’t go enough, until they have an emergency, which further raises health care costs. The trick is to find a balance, where we discourage people from consuming too much, but ensuring that everyone has the ability to access health care. So a Universal System is still ideal, but any system which doesn’t tackle the problem of some going to the doctor far more than they should is doomed to failure.
Once again, both sides have a piece of the puzzle necessary to fix the system, but you need both sides. Making snarky comments like this just prevents the puzzle from being complete.
Zifnab
And the big joke, of course, is the fact that tax breaks against your AGI (that’s the amount of money you subtract your standard and personal deductions from for the uninformed) don’t do a damn thing when you’ve already passed the point of not paying taxes.
I can tell you straight off that over half my tax clients don’t pay a single penny to the IRS. Most never even get to use their Child Tax Credit because their income is too low. Giving them another tax deduction, regardless of the size, won’t improve their financial situation one lick.
And the absolutely hands-down biggest joke is that you have no reason or incentive to use your new tax dollars towards medical insurance anyway. Much like after the Katrina disaster, when FEMA just started flinging out $2k debt cards without any rhyme or reason, the Republican Party appears to believe that thoughtlessly throwing money at a problem can solve it. Why is “tax break” the panacea for everything with the Republican Party? Do they even know what the word “plan” or “system” or “results” means? I’m still waiting for them to propose “tax breaks for victory in Iraq”.
cleek
Why is “tax break” the panacea for everything with the Republican Party?
it’s simple pandering. “hey rubes! here’s some money, vote for me!”
Pooh
*grumblegrumble*ignoringriskaversion*grumble*
Seriously though, post facto its slightly easier to say “oh, well that diagnostic wasn’t necessary, because you know, you already know the results were negative.
How many times do you have to repeat that health-care is not a normal good and that one should not expect it to respond the same way to “market conditions?”
Tim F.
Health care responds poorly to market conditions because the more you spend on prevention the more you save. People who can’t afford to see a doctor when the injury, or cancer, or other long term illness is minor end up costing the state far more, often millions, when the problem becomes emergent. In that sense we already have federalized healthcare, it just kicks in when the problem has become intractable and ridiculously expensive.
In a single-payer system (sound familiar?) the government saves money if it compels the insured to undergo regular checkups. Treating regular doctor visits as a luxury ignores the way both health and the markets work in real life.
TenguPhule
No CEO left behind!
Pooh
Right, Tim. Add in the common optimism bias (“if I ignore it, it will go away…”) and its not at all clear (and I’ve never, ever, ever seen it empirically demonstrated) the health care is in any way “over-consumed” in this country. To stay in the field, the GOP is trying to treat the wrong illness, with predictably disastrous results, as the original sickness remains, plus we OD on drugs we never needed in the first place.
demimondian
Worse, there’s a standard line in the health care debate “Yes, there are people who consume too much health care if their benefits are too generous.” That’s the classic moral hazard argument for other markets.
The only problem with the health insurance market is that the study most frequently cited in support of the existence of moral hazard actually shows that the effect is at worst, small, and, once preventive care is incorporated, in fact, negative, even with the most generous health plans.
jcricket
Great summary Tim – to bad libertarians and Republicans are idiots about healthcare. They keep offering up such gems as “it’s time we started making people more aware of the cost of their healthcare so they can make informed choices” or they propose healthcare that works like car insurance (only for massive emergencies). If you’re born with a genetic predisposition to cancer, how exactly is giving you a high deductible plan going to do anything good for your cost of healthcare? If you are poor and your kid falls and breaks his arm, or your multiple kids get sick enough that you regularly have to pay for treatment on your high-deductible plan (but never a true emergency) – how does knowing that enable you to change your behavior?
The fact that people at “libertarian think tanks” regularly offer such solutions is why the healthcare debate is so “queered” in this country. They show such a poor understanding of how medicine and health itself “work” that they should be laughed off the stage. Instead we treat their policies as if they offer something.
Every country with nationalized health insurance has achieved universal coverage with higher satisfaction rates and better outcomes, while spending less as a % of GDP and less per capita. Not to mention the lower overhead, less paperwork, employee mobility and decreased employer obligations/costs. Single-payer like systems are the only solutions worth discussing, period.
Sure, there are problems with each system, unique to each country, but those problems pale in depth and breadth when you think about the ones our system faces (esp. considering that as private insurance continually insures less people, all we do is have the most expensive care on the federal dole).
jake
Fixed.
Bubblegum Tate
Or, as Stephen Colbert so beautifully summarized it:
That pretty much says it all.
Punchy
Fixed for Timothy. Pro bono, and quid pro quo. Gracias.
demimondian
Um, Punch? Your correction makes no sense — _in situ_ means “in its natural place”. That would mean it died in Bush’s brain, without ever being inflicted on the rest of us.
Punchy
It’s all far more entwined than that. Private healthcare ensures docs can get paid the big bucks. Which they need, cuz medical education puts many of ’em back about $180-200K.
In Canada, their OBGYNS make about 40K. Just try and tell an American OBGYN that his/her salary is about to be cut by about two-thirds (one-fourth?), but she still owes $100K in loans, all b/c of “universal” health care.
Sorry, but there’s exactly NO chance this ever changes. Too many rich people affected, and God knows, Congress doesn’t listen to the homeless and downtrodden.
TenguPhule
What I never understood is why the Federal Government couldn’t subsidize medical education on a larger scale in exchange for the doctors working for a set period of time as a general practitioner in a public hospital or health care center.
stickler
Hey, Punchy:
Um, not to be a nitpicker or anything, but by chance do you have any idea what medical school COSTS in Canada?
In other words, do Canadian docs run up schooling debt of $200 grand? Because if they don’t, your “argument” kind of fall apart.
Punchy
Say what? My point was this–US universal health care, much like they offer in Canada, would absolutely crush the salaries of most docs. The gov’t wont pay those salaries. But unless medical schools want to likewise chop their tuition costs, US docs will still graduate $100+K in the hole but making half the salary they expected. This just wont be tolerated by the medical establishment. Period.
I have no idea what docs pay for school in Canada, but 40K is peanuts for the level of education they undergo.
J Bean
Canadian docs make a lot more then $40K. Last year the average primary care doc made $140K vs. $160K for a U.S. primary care doc from the numbers that I found. It’s hard to compare between countries though. You have to look at salaries in context. For instance, French docs make about 80% of an American salary which sounds low until you remember a bit about the French work week and the French salary distribution.
Canadian docs can easily immigrate to the U.S. compared to the Europeans as a Canadian education and residency are considered equivalent to U.S. training. Non-North American docs have to do a North American residency to become licensed in the U.S. There was a big migration from Canada to the U.S. in the 80s driven by the income discrepancy, but that has reversed with a lot of Canadians going home.
The cost of medical school tuition is not the only cost of going to medical school. Remember that most physicians don’t complete their training until they are near 30 years old. That’s a lot of lost income in that decade.
As a primary care physician (albeit a raging liberal) I have to say that some individuals do tend to overconsume medical care, however, it tends to be the cheap stuff that they are overconsuming. Conversely, there are a lot of well insured people who underconsume appropriate care and cost the system money in the long run. It’s probably pretty hard to measure, but I’m an engineer by early training and I don’t trust words like “a lot” and “a little” — I like numbers and I haven’t found any great studies that quantify this kind of stuff. The HMO payment system was designed to wring overconsumption out of the system as well as encourage increased consumption where appropriate. I believe that a lot of non-politicized health economists feel that that was a one time savings and that there is much fat left to cut.
J Bean
Punchy: The government employs a lot of docs and pays them a reasonable salary. They also employ lawyers, accountants, and other professionals. I tend to feel that I’m more likely to get decent treatment from the government than I am from the insurance companies.
The CEO of United Health Care made $1.4 billion last year. That’s almost 9000 times the salary of an primary care doc.
The Other Steve
I for one am glad that President Bush has put partisanship by the way side and has come up with a plan to deal with the dreadful gap between the haves and the have nots with regards to health insurance.
Where is the Democratic plan to eliminate healthcare for those who already have it?
That’s what I thought. All you moonbats can do is bitch and complain.
ImJohnGalt
To paraphrase J Bean, this is complete horseshit.
Super-duper amazing, I-can’t-believe-you’ve-ever-read-this-anywhere bull-pucky. A 1st year schoolteacher makes more than this in Canada. Are you seriously suggesting a *specialist* makes less? It is to weep that Americans are *way* too fucking credulous when it comes to bullshit like this.
Here is a column from the Globe and Mail that addresses a prior article that showed average doctors salaries, and then discusses how the probably underestimated average salaries.
Now, do I think some doctors are undercompensated in Canada? Maybe a little. However, many of them are choosing to work less hours as well.
At any rate, until we can lose the myth that Canada’s health care system is like a third-world country’s, we can’t even have a conversation about it. If I have to hear one more right-wing American ask about our 10-year waiting list for heart surgery, I’m gonna have a cardiac event myself.
It’s called triage. If you’re dying, you get treatment ahead of people who need hip replacements.
Of course our system could be more effective and responsive. Efforts are being made to reduce these waiting times, and improve health care delivery. But at least everyone has basic coverage, from the hooker on the corner to the guy who just lost his job and hasn’t yet found one. Plus, nobody is second-guessing the doctors here like an HMO panel.
As another raving liberal who thinks that kids and the less fortunate should have quality healthcare, I’d take it over the US system any day.
poppinfresh
The big problem with the Canadian system is that, unlike every other socialized medical system in the world, it’s illegal to seek private treatment (except for all the loopholes that the government gleefully exploits to offload costs while pretending to be Good Red Comrades, but whatever). If the Canadian system continues as it is now, it will bankrupt the country- you simply can’t give 40 million people CAT scans and MRIs and stem cell therapy yadda yadda, without having a way to give the wealthy their Super Special treatment. Since I’m not wealthy, and never will be, I don’t LIKE saying this… but it’s a fact. Rich people can either have a seperate for-profit system in Canada that can be developed and intergrated in a way that helps the current medical system, or the super rich (and the desperate) can keep on flying down to the States to jump the queue. The system needs to be reformed, so that everyone has access to the sort of basic medical care and emergency access Canadians currently enjoy, before the whole thing implodes.
That said, I’m sure being able to see a GP for free (or a tiny copay designed to prevent overuse, like they have in British Columbia now) saves a lot of money in the long run, as per prevention vs. treatment. The Canadian system, while flawed and needing some realistic thinking and open debate without the “OMG CAPITALIST SWINE” rhethoric that flies out of Toronto salons, is a lot better than what Americans enjoy.
ImJohnGalt
I agree. And so do most of the people I know. And guess where I live?
Much of the resistance to a two-tier system (and face it, as you’ve said, it already exists here in Canada) that I’ve seen comes either from Manitoba and Saskatchewan or Quebec. Most of the people in those salons you speak of already have supplemental health care. My wife, who is one of six senior VPs in a publicly-traded company has a “corporate doctor” paid for by her company. She goes and has all of her organs ultrasounded every two years, as well as V02 tests and a bunch of other things I’ve never even heard of.
As I said in my post above, of *course* our system could be improved, but hyperbole (like all 40 million people need CAT scans and MRIs) isn’t going to help solve it. I’m halfway through my life and haven’t ever had (or had anyone suggest I needed) an MRI, even though I slipped a disc at 22. And while I recognize that “anecdote” is not the singular form of “data”, anyone I know who has been diagnosed with cancer has been immediately put into a treatment program – no waiting list, no mucking about. Including people of little means.
Angry Bear did a series of articles on US health care vs. the rest of the world – it’s really worth a read.
poppinfresh
1) as long as we’re swapping anecdotes, my mother (a high-level Canadian federal bureaucrat, and as such the recipient of some level of fast-tracking in non-critical surgical waiting lists) STILL had to wait ten months for hip and knee surgery. In the meantime, she could barely walk, and was in intense pain. I asked her doctors how normal this was, and they looked at me like I was stupid and told me she was actually pretty lucky given the state of some of the waiting lists. So no, the Canadian system will not let you die of cancer of bleed out in a hospital waiting room like the rhethoric so often claims, but neither is it doing it’s job in some major, fundamental, quality-of-life ways.
As for what I said about stem cells and CAT scans, my point is that the level of what we consider ‘basic’ medical services continues to advance (and get more expensive). There was a time when getting heart surgery was rare and special, ditto for organ transplants- now anyone, even I for that matter, would call it a fiasco if we started restricting those things to the wealthy. It’s not going to stop. Nobody wants to die before they’re good and ready (which, of course, nobody ever is), and the idea of restricting certain treatments to those who can afford them strikes most as being somehow unfair.
So what do we do? If the cost of care keeps going up, and the number of specialists and treatments designed to keep us all living to be 200 keep increasing, what’s the end-game solution? I’d rather just let your wife’s company pay for ALL her services, let her get into surgery two months ahead of my mom instead of ten, and call it ‘fair enough’.
But, seriously, you’re from Toronto, so I automatically must hate you and everyone you know. Die, effete eastern scum!
ImJohnGalt
Just so we’re clear, I’m not disagreeing with you about two-tier care. My mom started as a nurse in the ER 45 years ago, and when she retired a couple of years ago had risen to second-in-command in a hospital. Through her, I feel like I came to a pretty fair appreciation of the flaws and the benefits of the current system. I also think if the current system can’t be improved enough, that an alternative system should be available to those with means — especially if it means taking them out of the queue.
The stumbling block, however, comes with trying to keep all the federally-funded physicians from immediately bolting to the for-profit system. How do you ensure that the public system doesn’t become starved for physicians? Do you reduce tuition for doctors who commit to 5 or 10 years in the public system? Do you make every private physician work at least one day a week in a public facility?
Hard questions, but I agree with you that they need asking.
You potsmoking lotus-eater.
poppinfresh
I really like the idea of free med school for people who put a stint in the public system, but that wouldn’t be QUITE enough… you’d still need experienced specialists, and that doesn’t have as much lure for qualified nurses, who are increasingly more important AND don’t have as much schooling to suffer through to use as bait. Tax breaks for experienced specialists? Or hell, howabout give some of those jobs to all those incredibly qualified foreign doctors who have trouble emigrating. I doubt anyone cares if their cardiologist has a funny accent as long as he’s qualified.
Still, already you and I are smarter than the federal Liberal party in ten years of rule. Just in case Americans thought they had a monopoly on dumb governance.
ImJohnGalt
Yeah, one thing that has always pissed me off is how (at least here in Ontario), there are only something like 50 spots each year for foreign-trained doctors to get accredited. I mean, WTF? Government wants to solve the doctor shortage, drop 20-30 million a year across 4 or 5 medical schools for the *express* purpose of accrediting foreign-trained medical professionals. Of course, I’m sure the Canadian Medical Association has some reason why that isn’t a great idea.
I swear, given how hard it was to allow nurse practitioners to do the simplest shit that they could do blindfolded in order to free up doctors’ time, I often wonder if the doctors and their lobby aren’t themselves the biggest impediment to change. If they could just accept that some of this care doesn’t have to be delivered by *them*, it might take some of the burden off the system. Of course, J Bean might be able to shed some light on that. I could be (okay, likely am) completely full of shit on this one.
And another thing – enough of these fucking “Royal Commissions” looking into changing the health care system. Don’t talk to every Joe Schmoe in the country who can’t add dice to tell you how to fix the system. Get the health care professionals in a room with a patient advocacy group, some developers, some technologists, some facilitators and a few government officials and lock ’em in until they come up with a plan. And don’t let anyone named Romanow anywhere near the proceedings.
jake
OT question re: Canadian doctors (if anyone knows).
What are medical malpractice insurance payments like in Canada? I ask because it seems that in the US those payments take a huge chunk out of a doctor’s income. Is MMI less/more/about the same in Canada?
RSA
I don’t have anything to add in the way of anecdotes, but thinking about this:
. . .my understanding is that one of the biggest single chunks of health care money goes to services for sick patients in the last six months of their lives. (We’re talking anywhere from 15% to 30% or perhaps higher.) Some may consider that the “excessive” part, but unfortunately there’s not much you can do about it except [a] try to shift the costs to care earlier in people’s lives, hoping for a reduction in overall cost, and [b] try to convince people that that they shouldn’t have everything medically possible when they’re dying. I think the first option has a better chance of being successful, on a personal level.
Krista
Hear, hear!
(From another Canadian with a mom who’s a nurse…)
Nikki
…or [c] recognize that people have the right to choose if they want to live or die and get out of the way of compassionate euthanasia as medicine.
RSA
There is that, yeah. I think what some conservatives are getting at (and it’s something I have some sympathy for, even as a die-hard liberal) is that health care is a bounded resource. We need to make decisions, eventually, about how to distribute it. Where we differ is that conservatives, in my opinion, are perfectly happy to say that it’s a market where if you can afford health care you get as much as you want, and if you can’t, too bad. I’d rather allocate care such that there’s a minimum level everyone gets, and if you want to pay for more and you can afford it, good for you. While the latter is sometimes decried as rationing, because some sick people won’t be able to afford what they need because it’s not included in basic care, my view is that rationing is inevitable and it’s already happening; we need to focus on how to ration it fairly.
poppinfresh
Hear, hear.
Zifnab
This can be re-written as…
Or…
And so forth.
But a Republican Administration doesn’t believe that funding the problem at the ground level is very efficent (read: lucrative for big business). The only way to solve the insurance crisis is to give insurance companies more money and/or tell patients to spend less. Honestly, this rhetoric is remenicent of the whines during the Carter Administration when ‘Pubs were claiming the Government was going to turn off your plumbing and cut off your heating oil to save a flock of spotted owls. The “you’ll just have to suck it up and do without” meme that Republicans absolutely loathed in the 70s suddenly becomes the motto of the modern movement.
Bubblegum Tate
Geez, don’t you Canadians know how to have political debate? What’s with all this comity? Somebody question somebody else’s sexuality/intelligence/patriotism, for fuck’s sake!
ImJohnGalt
From the article here, the Canadian Medical community benefits from a few things which keep down their MM costs:
there is a non-economic damages cap of about $350K.
doctors up here are defended not by their own legal council but by the Canadian Medical Protection Associations (CMPA). I’ve read elsewhere that because they are not a risk pool, they are much more aggressive than an insurer would be, rarely settling cases, which means that much like in the US, about 2/3rds of cases are dropped or dismissed.
From the article re:payments:
Note: this means that taxpayers are funding the defense of the (wealthy) people they may be suing. See? We appoint public defenders for *everyone*!Finally, my understanding is that at least here in Ontario the window for filing the malpractice suit is *very* short (like, 10 days or something), which also disadvantages a claimant.
poppinfresh:
While I will blame the Liberal government for steadfastly refusing to reopen the Canada Health Act (and the conservatives before it), much of what is wrong with the current delivery system [at least here in Ontario] is a result of the crap-a-licious policies of the prior Conservative government of the province. They closed down hospitals with impunity, which the current government are now having to re-open. They slashed funding as well.
As far as I understand it, the only thing the Feds can do is withhold funding to provinces that go around the system, and how likely are they to do that *really*, if it means losing an entire provinces votes in perpuity?
demimondian
In fact, we do exactly that — that’s the whole point of hospice. Patients turn out to be quite accepting of that option, since in that case the notion of “everything medically possible” means “permitting you to be as independent and comfortable as possible”.
The Other Steve
My mom had knee replacement surgery here in Minnesota at the Mayo Clinic. She scheduled it about 6-9 months in advance. But she was walking on a cane for 5 years prior, while the doctors tried other things.
My grandfather had hip replacement years ago, and it was a similar story.
CLUEBAT: America has wait lists for surgery as well.
Andrew
Don’t listen to this librul propaganda to make us hate the world’s best health care system!
Every serious American knows that you get whatever health care you want, instantly. Except for the uninsured, but they’re that way because they are immoral nihilists who want to die because they hate President Bush so much.
Zifnab
Surgeries are long, expensive, and difficult endevours. I don’t understand why people think they should be able to get “on-demand” treatment. Do you really want a McHospital?
I waited 9 months for a back operation in order to ensure I got the best doctor in the nicest hospital during the most under-trafficed time of year. Today, my back is great and I feel fantastic. Totally worth the wait.
You know what else I schedule weeks or more in advance? Dental visits, physicals, eye-exams, haircuts, airline flights, car rentals, and theater tickets. I just bought a pair of passes to Cirque du Soliel in April and that’s just a three-hour performance with several hundred other spectators, not a three-hour surgical procedure face-to-face with the best doctor I could get my hands on.
Plan ahead. Welcome to the world of personal responsibility. Yesh.
ImJohnGalt
Weird, in that post above I typed HTML tags and it worked in preview, but failed miserably in the posting, sorry. Apparently, UL tags are not allowed (but OL ones are – strange, that).
Krista
Good to know. I know that I get pretty fed up when certain people (ahem…you know to whom I’m referring) defend the American private system by basically saying, “Oh yeah! Well, you guys have to wait for surgery!”
Um…what about the uninsured in the US? Ask them if they’d rather wait 10 months for surgery, or not have the surgery at all ’cause they can’t afford it.
Not our style. The worst it would get would be for me to call ImJohnGalt a “Fucking Upper Canadian”, and he would respond by repeating some sort of stereotype about Maritimers, or some such thing. That’s pretty much as bad as it’ll get.
ImJohnGalt
Screech-drinking fiddler-monkey.
ImJohnGalt
Are you kidding? We let teh g4yz get married up here. We’re one broadway show and manicure away from all being homosexuals. We all laugh at the breeders.
RSA
Yes, I agree that hospice care is a good idea. I don’t think everyone realizes or agrees with that, though, and it’s not a complete solution. For example, there are estimates that $100 billion a year goes to saving (or not saving) gunshot victims in the U.S. Difficult moral issues are raised. . .
poppinfresh
How many Newfies does it take to screw in a lightbulb?
Only one, but you’d better have the welfare ready when he’s done.
Did you seriously just compare my mother’s arthritis to an acrobatic performance? Is this some kind of bizzare attempt to remind me that Democrats are as capable of being beholden to retarded ideology in the face of cold, hard, Canadian facts as Republicans are? Because I assure you, her waiting nine months for serious orthopedic surgery wasn’t spent choosing the fucking draperies in her O.R., or picking the best surgeon o’er the land; it was mostly spent hobbling around crying and wishing she could just get it over with. Last I checked, crippling pain had little in common with fruity French Canadians in leotards playing with fire, but I guess I’m just a raging neocon or something.
Guess what? Illegalizing for-profit medicine doesn’t work. I know this because I was born in Canada and spent my entire life in this system, not to mention following a number of policy papers on the subject as I grew up and became a voter. Unless you have a better comeback to that particular fact than to trivialize the particular anecdote I have cited (which every other Canadian of BOTH political spectrums here in this thread would agree is absofuckingloutely representative of some of the major problems of our system), I suggest you save your limited kung-fu for soft targets like the incompetence manifest in your federal administration, and leave the wonky details of effective semi-socialized medicine to those of us who read books and stuff.
And, because I’m still Canadian enough to be polite: thanks for stopping by.
Bubblegum Tate
And that is why you will never rise to the level of Carelessly Marauding Superpower.
(I have heard several times, though, that the best way to get a rise out of a Canadian is to say, “You guys are just like Americans!”)
I know…seriously, when I trade emails with various Canadian acquaintences, I often find myself typing variations of the theme, “Would you stop it with your rationality and levelheadedness and sense-making? You’re making us look bad!”
ImJohnGalt
Yikes. Ready, fire, aim?
I re-read Zifnab’s comment, and I don’t think his point was to trivialize the painful wait that your Mom had. My reading of his point was that:
a) it’s impossible to have “next-day surgery” for everyone, so waiting times of some length are inevitable
b) people understand having to wait for other goods and services, so why should health care be any different?
c) if you want access to a particularly limited resource (Cirque du Soleil tickets or that fantastic specialist everyone raves about), you should expect to wait, and
d) as much as yer Fox-News-watcher talks about waiting times in Canada as proof of the inferiority of communist medicine, there are waiting times in the US for-profit system as well.
I can’t imagine many people on this particular board (only a couple come to mind) that would use your anecdote about your Mom as an instrument with which to bludgeon you.
Krista
Why is it that everybody assumes that if someone indicates that they’re from the Atlantic Provinces, they automatically assume that that person is from Newfoundland?
poppinfresh – Breathe, man. He was just making a point that due to the complexity and difficulty of surgery, it’s not going to be something that people can get the second it’s needed, unless it’s a lifesaving procedure. As far as the problem with wait times…well, it’s a tricky situation. I can’t fault people with money for going to the U.S. to get stuff done, because it then takes them out of the queue, which allows everybody else to move forward in line, which means a shorter wait time for everybody else. I know that the idea of two-tier health is verboten to a lot of people, and there are some serious obstacles to it working well (the aforementioned problem of doctors going to where the money is, i.e. the private care), but I don’t think it benefits us at all when policymakers refuse to even put the idea of privatization for certain treatments on the table.
poppinfresh
I’m not angry or bent out of shape, but its 2am here in Taipei and I will readily concede I could have misread it as my eyes slowly start to cross. If I did, I apologize and withdraw the remarks. If not, neener neener, etc.
ImJohnGalt
Taipei? You’re not even *in* Canada, you brain-draining Chinese wanna-be! Take your foreign-earned tax-free (in Canada) dollars and buy your health insurance like every other snowbird and ex-pat. Now go, you empty-headed trough-water licker of other people’s bottoms, or I shall be forced to taunt you a second time.
This rant has been brought to you by the Home for Disadvantaged Canadian Right-wing Radio Announcers.
ImJohnGalt
That’s true. Everyone knows that all the Newfoundlanders are actually in Alberta now. So what culturally sensitive touch-point can we taunt you with, Krista? I mean, other than the obvious one that you hate it when people assume you’re a Newfie.
Krista
I don’t hate it — heck, Newfoundlanders are some of the finest people on the planet, IMHO. I just find the automatic assumption to be perplexing.
Hm. That’s a toughie. When I lived in Halifax, it irked me that people would assume that my province consisted solely of fishing villages. However, I now live in a fishing village. So all I can do is laugh at my earlier sensitivity.
dreggas
Fixed.
Tim as everyone in software knows bugs are really features :)
Jake
Interesting. Thanks. I know for doctors who bill Medicare, assistance with MMI (usually from hosptials) is frowned on by the government, although it does allow some MMI subsidies for obstetricians, nurse midwives and other health care personnel who specialize in baby extraction.
Of course, when a hospital absorbs the cost it has to come out somewhere else.
Bombadil
Clarified.
Zifnab
Krista and JohnGalt got it. I’m sorry if I insulted your mom, but I’m not sure what the more preferable system would be. Certainly, you’d want to give your doctor a chance to brush up on the specifics of your procedure. I imagine “drive through” surgery would be infinitely worse in the long run than waiting nine months on pain meds to get it done right.
My point is the Circus tickets is much more to do with volume of service than severity of condition. A Circus can serve a thousand people, but you can only have one doctor per patient. Good doctors are hard to find. You want a specialist in your procedure and specialists are always in short supply. With such a limited pool, and so many mothers with your ailment, its no surprise she needs to wait. That doesn’t go away when you get to the private system, it just creates a bunch of “have it quick”s and “don’t have it at all”. Imagine if you were living in the states and needed to shell out ten times the amount to get your mother healthy again. Imagine if she had to mortgage her house, sell her car, or go on one meal a day to pay for her procedure. She had to wait 9 months, but at least she got it done. So many people in America never get to dream of the luxury of surgery. A long line is better than service.
Andrew
Fuck that shit, dude (PBR!). He was funnin’ with your moms. Time to bring the noise.
sandy p
Various thoughts:
More doctors is maybe not just a good thing. They’ve fond in areas were there are more specialists, special procedures go up.
Increasingly health care falls on cheaper, highly trained specialists, some such as nurse practoners and doctors assistants can do a lot. And they can give far more time, their overhead is lower.
Just standardizing medical records is estimated to save up to 5%, that is a 100 billion.
Dr. Berwick estimates that up to 50% of our expences are unnecessary. This is the guy who is just estimated to have saved over 100,000 lives.
Here is a link to his organization:
http://www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCenteredCareGeneral/Literature/
I chose this page because you can look at some of the articles, note the word “apology.” It’s being discovered that if doctors and institutions admit their mistakes and try to make compensation, they pay less while paying more people. And (tied into Berwicks theme of “transparency’) the problems can be corrected.
Doctors and lawyers have been running their damn love affair too long. The doctors got to pretend they were perfect, thet got to do lots and lots of preventive medicine that made them huge sums of money, and they got to bitch about lawyers.
But this coddling of doctor’s egos cost too much.
They are responsible for this system, whatever they say, we know they are stupid in most things which is why conmen flock around them, a lot of them are assholes, they leave 25 cent tips, and they need to be managed correctly.
Right now you can’t even get your own blood tests, even though all a doctor does is look at certain ranges of number, something that can be done by computer. They’ve set things up to get a cut of everything.
r€nato
The Bush healthcare proposals will leave employees worse off.
It’s not a bug…it’s a feature.
Focus On Your Own Damn Family!
Unbelieveable. “All” that doctor is doing when he/she looks at the results of your bloodwork is evaluating trends and synergies among the results, and interpreting those values in light of your ongoing diagnoses and care.