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A little common sense about health care - will the morons get a clue?

August 7 2009 at 7:49 PM


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, health-care costs and vital statistics.

The U.S. and Canadas different health insurance decisions make up the worlds 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 of 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 health-care 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 percent of its economy on health care; the U.S. spends 16 percent. The extra 6 percentage points 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 dont need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80 percent to 90 percent lower administrative costs than private Medicare Advantage policies. And providers and suppliers cant 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 nonpatient 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 percent 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 didnt 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 worlds 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 health-care 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 policy-makers could learn these lessons. But they seem less interested in Canadas, or any other nations, 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 doesnt let us choose our own doctors. In fact, Canadians have free choice of physicians. Its Americans these days who are restricted to in-plan doctors.

Unfortunately, many Americans wont get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

By Dr. Michael Rachlis

Dr. Michael Rachlis is a physician, health policy analyst and author

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We have a few new prospects

August 7 2009, 10:14 PM 

to send your way, so you can experiment on them and write back about how your plan is working out. We like to play this 'show & tell' game and look forward to your results. Perhaps a cooler climate and more frozen precipitation will work wonders for many of those from the hotter regions of the world that seem to prey on the USA. We have a few quacks (so-called doctors) to send north of the border, too. Foreign exchange at the moose lodge? Tell us more about how it goes with the incoming onslaught of desparate, hungry, drunk, stoned, sad, and infectious lost souls we TRY to care for from all over the world. After they thaw out and realize they are no longer sweating out their ills, you can promise plenty of free land and good hunting seasons. Canada needs more medical research to practice on, so we should divert a few samples north of the border. We are not worthy! No wonder the 'great one' and MJ Fox left home. Maple syrup does not count as good medicine. Let us know how it feels to take in illegal or non-documentable residentia. Hosers are only funny on tv. Their real life suffers badly. Why do you think they come running to America when it gets bad up there?

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So you posted an article from one doctor, and anyone who disagrees is a moron??

August 8 2009, 9:20 AM 

You take yourself waaaaay to seriously.

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Ice Age economics

August 8 2009, 12:25 PM 

and 'mark of the beast' medicine at work. If you really think there is a singular or universal health plan for all citizens, you are treading on slippery slush above a shrinking glacier. What works for some of those in the 'great outdoors' may not go over well for those living in closer confines. We can respect your appearances of clean politics in 1 or 2 really nice cities, but most of your homers leave much to be desired. This is why Canadians leave in droves to shop in America, seek medical expertise here, and eventually choose to reside in the USA. Many a modern US citizen ventured into the frozen wonderland (Canada) to escape problems in Europe, Africa, Asia, the Caribbean and South American world, not to mention the middle east. They eventually circulated into the lower 48 states or traveled to and through Alaska and Hawaii to stake a claim in this great nation. Nobody goes to stay or live in Canada very long. Those who do are frozen in time or drink anti-freeze.

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Outright Lie

August 8 2009, 10:37 PM 

"On the U.S. side, 46 million people have no insurance, millions are underinsured and health-care bills bankrupt more than 1 million Americans every year."

there are approximately 1 million bankruptcies per year, personal AND corporate. No way they are all related to medical bills. The biggest reason for personal bankruptcies are consumer debt - car loans, mortgages and credit card debts. But since it sounds devastating, no one in the MSM will Fact Check it.

Just think, there are roughly 75 million households (300,0000,000 / 4), and that would represent 1.3 percent of all households filing for bankruptcy EACH year.

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Why let the facts get in the way of a good story?

August 9 2009, 8:37 AM 

Of the 46 million "without insurance", many millions are illegal aliens, many more could afford coverage but choose not to (e.g., singles in their 20s), and many more are between employment and coverage (i.e, temporarily have no coverage). When all is said and done, the actual number "without insurance" is closer to 25 million. Nothing like overstating the number by better than 80% to make the point.

BTW, no one is denied medical treatment at an emergency room -- not the uninsured, not illegal aliens, no one. In essence, then, everyone has health care insurance.

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Re: A little common sense about health care - will the morons get a clue?

August 9 2009, 11:28 AM 

Great article from Dr. Rachlis. "Will the morons get a clue?" Obvious from the following rebuttals, posters don't care to hear or learn about anything else that would offer better healthcare. Americans are so easily brainwashed by political agendas, its scary! Greed is the driving force in this country and Drug and Insurance companies will do everything in their power not to lose one of their precious pennies. They hear the odd stories about some canadians waiting for hip surgery and that's what sticks in their minds. What they don't hear or don't want to hear is all the excellent healthcare most canadians get and don't have to file bankrupcy due to illness. Lots of horror stories americans suffers due to lack of medical attention because they can't afford it or do have insurance but their insurance refuse to pay.

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Re: A little common sense about health care - will the morons get a clue?

August 9 2009, 12:45 PM 

"Americans are so easily brainwashed by political agendas, its scary!"

And you are the most perfect example of that. Be honest with yourself, is there anything Obama would propose that you would not support?

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Not sure we should iew him as an expert, rather a part of the Canadian system

August 9 2009, 9:27 PM 

Really think he will tell you they screwed up? How many foreign nationals seek treatment in Canada? How about the US?

Dr. Michael Rachlis was born in Winnipeg, Manitoba in 1951 and graduated from the University of Manitoba medical school in 1975. He interned at McMaster University in Hamilton and then practiced family medicine from 1976 to 1984 at the South Riverdale Community Health Centre in Toronto. He completed specialty training in Community Medicine at McMaster University from 1984 to 1988.

Dr. Rachlis practices as a private consultant in health policy analysis. He has consulted to the federal government, all ten provincial governments, and two royal commissions. He also holds associate professor appointments (part-time) with the University of Toronto Department of Health Policy, Management, and Evaluation and the Dalla Lana School of Public Health.

Dr. Rachlis has lectured widely on health care issues. He has been invited to make presentations to committees of the Canadian House of Commons and the Canadian Senate as well as the United States House of Representatives and Senate. He is a frequent media commentator on health policy issues and the author of three national bestsellers about Canada's health care system. HarperCollins published his third book, Prescription for Excellence: How Innovation is Saving Canada's Health Care System, in paperback in March 2005. In his free time, Dr. Rachlis enjoys running and duplicate bridge. He lives in Toronto with his wife and two children.

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Is this an application (w/ resume) or

August 10 2009, 9:24 PM 

his prepared obituary? Dreaming in ice-land does not make for more green or good land deals. He seems to be selling stuff that most of us are not buying down here. We have seen the results of heavy taxation and 'spreading the wealth' from afar. The only people living in Canada are too old, drunk, or stuck between the ice and large mosquito swarms. Canada is a place to go for hunting, getting lost (AWOL), or after you have tried everywhere else.

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and look at the nonsense that Pelosi and Hoyer spew:

August 10 2009, 10:32 AM 

" insurance reform will mean more patient choice. It will allow every American who likes his or her current plan to keep it. And it will free doctors and patients to make the health decisions that make the most sense, not the most profits for insurance companies."

Really? With government-mandated coverages and a federal medical board that makes decisions about what procedures and services are allowed?

"Never again will medical bills drive Americans into bankruptcy"

Really? Where is that guaranteed in any of the bills proffered? (It's not)

"Never again will Americans lose coverage if they become sick"

That doesn't happen now

"Never again will insurance companies be allowed to deny patients coverage because of pre-existing conditions."

It's impossible to guarantee this without increasing costs.

"Reform will mean affordable coverage for all Americans."

Affordable? Not only will we pay at elast as much for coverage as now, but taxes will increase to extend coverage to others (high-risk people who couldn't get insurance; illegal aliens, people who can't afford anything but catastrophic coverage).

"Our plan's cost-lowering measures include a public health insurance option to bring competitive pressure to bear on rapidly consolidating private insurers"

Competitive pressure (subsidized, operated at a loss) that will put insurance carriers out of business. So much for choice.

"Reform will also mean higher-quality care by promoting preventive care so health problems can be addressed before they become crises. This, too, will save money. We'll be a much healthier country if all patients can receive regular checkups and tests, such as mammograms and diabetes exams, without paying a dime out-of-pocket."

"Preventive care" does not necessarily result in higher-quality care, and almost certainly does NOT result in lower overall costs. And there's no way what is named can be offered to everyone without any out-of-pocket unless taxes are raised significantly. It can't be paid for by "bending the cost curve"

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How should this work?

August 10 2009, 10:46 AM 

I am a drunk. I have 2 DUIs. I can't get reasonably priced insurance.

Take that to health care. I have a high risk lifestyle. Should I pay the SAME amount as everyone else? And your reasoning?

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here's the Obama answer

August 10 2009, 11:11 AM 

yes, you will get coverage and you will pay the same as everyone else. it isn't fair for you to be discriminated against...

but when it comes to actual treatment the benefit board will deny you anything costly (like a liver transplant). Because of your high-risk lifestyle it just isn't cost-effective to try to salvage you, so when you are too sick and in too much pain to work (and pay taxes) you'll be given some cost-effective pain-relievers and some lovely reading material with which to wait out your death.

But hey, you got "coverage".

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equal premiums =/= equal treatment

August 10 2009, 11:45 AM 

figures. And the public will not be privy to how those decisions are made......

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CBO: Preventive Care Raises Health-Care Costs

August 10 2009, 1:12 PM 

ABC's Jake Tapper reports:

In yet more disappointing news for Democrats pushing for health care reform, Douglas W. Elmendorf, director of the Congressional Budget Office, offered a skeptical view Friday of the cost savings that could result from preventive care -- an area that Obama and congressional Democrats repeatedly had emphasized as a way health care reform would be less expensive in the long term.

Obviously successful preventive care can make Americans healthier and save lives. But, Elmendorf wrote, it may not save money as Democrats had been arguing.

"Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," Elmendorf wrote.

Tapper goes on to round up quotes from Democrats who have complained previously that the CBO's estimates have left out all of the supposed cost-savings from preventive care:

Pelosi said that "it's always been a source, yes I will say frustration, for many of us in Congress that the CBO will always give you the worst-case scenario on one initiative and never ... any credit for anything that happens if you have early intervention, health care. If you have prevention, if you have wellness ... you name any positive investment that we make, that we know reduces cost, brings money to the Treasury in the case of education but never scored positively by the CBO. Yes, it is frustrating."

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I think they plan to save money

August 10 2009, 1:57 PM 

by preventing you from getting care - right, thats preventative care?

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Earth to Pelosi:

August 10 2009, 2:01 PM 

"If you have prevention, if you have wellness ... you name any positive investment that we make, that we know reduces cost, brings money to the Treasury in the case of education but never scored positively by the CBO. Yes, it is frustrating."

Earth to Pelosi:

1)it costs a lot of money to provide ongoing comprehensive preventive care to thousands in the hopes of uncovering or avoiding that 1 or 2 that might have turned catastrophic. You probably end up spending more than you would have on the catastrophic cases. And people that live longer continue to consume health care services. Not saying that's a bad thing, but to claim it will save money is idiotic.

2)"positive investment" means spending tax revenues, right? Is there any credible study that demonstrates that federal spending on education results in increased tax revenues? Maybe that's why the CBO declines to "score" it positively?

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Defensive Medicine

August 10 2009, 1:03 PM 

Doctors ordering tests or procedures not based on need but concern over liability or increasing their income is the biggest waste of health care dollars, costing the system at least $210 billion a year, according to the report. The problem is called "defensive medicine."

"Sometimes the motivation is to avoid malpractice suits, or to make more money because they are compensated more for doing more," said Dr. Arthur Garson, provost of the University of Virginia and former dean of its medical school. "Many are also convinced that doing more tests is the right thing to do."

"But any money that is spent on a patient that doesn't improve the outcome is a waste," said Garson.

Some conservatives have suggested that capping malpractice awards would help solve the problem. [why is this not included?]

President [Doctor] Obama doesn't agree; instead, his reform proposal encourages doctors to practice "evidence-based" guidelines as a way to scale back on unnecessary tests. [Yeah, the trial lawyers have him in their pocket, along with many in the house - given that this is the largest waste in the system]

The proposed Health Care / Health Insurance / Call it what you will Bill has nothing to do with making the system better.

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ha ha ha - Obama just said the Canadian approach wouldn't work in US

August 10 2009, 2:44 PM 

who's the moron?

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