Will Obama's Plans for Health Care Have an Impact

On Canada's Health Care System especially since it is an American the Feds are using to get feedback and recommendations. And of course many Doctors living in the USA are taking a wait and see attitude as to Canada's antiscipated change over to private. Obama talks of universal health care and I know it will take some talking and doing before that is ever realized but would it not impact Canada greatly as doctors will not be so quick to leave the country for profits. Although they certainly all don't but they often do live in the USA also.

Social Democratic Europe....

Many (most?) European countries have a "parallel" health system as an adjunct to the "government" system.

Germany, Austria, Switzerland, France, the Benelux/Scandinavian countries, etc.

The moderate social democratic movements within Europe approve and engage in this dual system, which provides patients with much better results than the Canadian system, esp. in terms of wait times.

OTOH, here in Canada we have a system comparable to Cuba and North Korea. Too much idealogy and dogmatism prohibits Canada from moving toward the social democratic "parallel" system of Europe.

Santé !!

If only we had the European coverage :

http://www.oecd.org/dataoecd/52/33/38976604.pdf

but the demand for private clinics is almost exclusively a function of Europe's class structure.

The strategic trap being set by privateers for Medicare advocates to avoid is defending a stressed system. Demonstrating better public solutions rather than arguing principles (such as 'choice' or 'freedom')

A closer comparison is between Canada and Australia ; small population, highly urbanised, large geography, federal structure, mixed public-private systems. We can learn from their mistakes :

http://www.canadiandoctorsformedicare.ca/English/AustraliaHurleyParallelPrivateHealthInsuranceinAustralia.pdf

van isle...

You sure about Taiwan? Looks like it's mixed, just like the rest of the world; excepting, of course, Cuba, North Korea and Canada.

At least here in Canada we don't make our pets suffer with socialized medicine.

"ACCESS TO MEDICAL CARE January 2008

For both short-term visitors to Taiwan, and long-term residents, urgent or elective medical care is readily available in four different settings: priority care clinics that cater to foreign visitors, emergency rooms, hospital outpatient clinics, and private doctor's clinics. Without question the most convenient place for privately insured Americans who don't speak Mandarin is in one of several western style clinics. Hospital based outpatient clinics, while frequently boasting very good doctors, will differ dramatically from Western notions of privacy and the doctor-patient relationship. Health care is generally much less expensive than in the United States. However, priority care centers for Westerners are more expensive - though generally cheaper than similar care in the U.S. Wherever you seek care, it is always pay as you go. If you are privately insured you must submit your own receipts for reimbursement."

system comparable to Cuba

It's a long time since I was in Cuba, but I see no reason for drastic changes to have taken place in Cuba's system.

First, there was triage. If you presented a mild problem, or an unexplored problem, or just an uneasiness, you went to someone trained,in your own neighbourhood. This person decided if you needed a cup of tea and lots of listening, or more highly trained listening. And so on, several steps up the scale.

We don't have this in Canada. If you sneezed funny, had trouble sleeping last night, if you are talking about your health details but really need listening to about something else, hey, whoosh, you go straight to doctor, top of the scale.

It does not take a doctor to perform a PAP smear, for example. Good listeners with a few months' intensive training could be doing a lot of routine tasks. When are Canadian doctors going to admit they are stressed and overworked because they insist upon being the only people who can perform procedures that are the medical equivalent of singing Happy Birthday.

We are also overtreating people because we revere routine screening, the wrong kind of stats on early diagnosis, and "awareness" weeks that drive people to seek treatment they seem to have qualified for.

And because doctors don't have time to persuade Mrs. or Mr. Smith that a good walk, even in the rain, might fix everything, the overprescription of pharma in Canada is phenominal.

ok phenomenal

I am forgetting how to spell. No I don't need Alzheimer meds, it's just normal.

margot

"And because doctors don't have time to persuade Mrs. or Mr. Smith that a good walk, even in the rain, might fix everything, the overprescribing of pharma in Canada is phenomenal."

Very true but how do you get people to stop running to their doctor so frequently when it's completely free? Shouldn't there be a nominal charge to encourage more recreational walks outside, instead of drives to the doc?

Realistic Taiwan

Universal single payer system in Taiwan:

http://www.nhi.gov.tw/webdata/AttachFiles/Attach_8819_1_77-88.pdf

Public/Private mix in medical service systems:
see OECD link in prior post.

User fee experiments always fail

... or we can take our 'realists' to the vet.

"He was distinguished for ignorance; for he had only one idea, and that was wrong. "
Benjamin Disraeli

France is always cited as No.1

No wats but not completely free.

"In France all medical treatments from a routine visit to a GP to major surgical procedures have a tarif (cost). Medical practitioners and hospitals/clinics that adhere to this official tarif de convention are defined as conventioné. Those that do not are defined as non-conventioné and can charge what they like, although they do have to display their prices. If you go to a non-conventioné you will have to cover the extra cost yourself. "

http://www.frenchentree.com/fe-health/DisplayArticle.asp?ID=197

"Constant development is the law of life, and a man who always tries to maintain his dogmas in order to appear consistent drives himself into a false position."
Mohandas Gandhi

Luke and R'man

Admit it, you guys didn't bother reading the article again did you?

I'll quote the relevant passage

"He will find that with few exceptions, European nations spend more on publicly funded care than Canada. In Canada, governments pay for 70.2 per cent of all health services compared to 83.6 per cent in Denmark, 79.9 per cent in France and 87.1 per cent in the United Kingdom. This is because many European systems cover more services, including medications, dental services, eye care and home care."

Sounds like Denmark, the UK and France are the new "Cuba and North Korea".

Reality ; evidence-based

The recent development of user fees for medical access in France will fail. (like Saskatchewan's seven year user fee experiment 1968)

Interestingly, France has moved since 1990 away from employee contributions through social security toward the Canadian tax-based model in order to reduce its deficits.

Even so, the private medical sector in France is smaller than in Canada's (... identical to Cuba? North Korea ?)

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2244666

... and here (esp pgs 76/77) :

http://www.euro.who.int/document/e83126.pdf

Waiting lists are a function of human resources and management - not delivery model :

http://www.policyalternatives.ca/documents/BC_Office_Pubs/bc_2007/why_wait_surgical_waitlists.pdf

Nothing is so unbelievable that oratory cannot make it acceptable.
Cicero

Doctor's salaries

One hesitates to criticize a value that has been elevated to the sacred by the Right Wing press over the past few decades: making lots and lots of money!

Once there was a time when people worked because not only did it provide a living, it was also satisfying for the worker, who perceived that he or she had done something useful and beneficial to society.

This purportedly naive view has gradually been eroded and replaced by a "smartest guys in the room" philosophy. Under this ideological regime, you're smart if you work very little and manage to screw the rest of society out of vast sums, allowing you to enjoy a proportionally opulent lifestyle at others' expense.

Doctors have not been immune to this altered creed; after all, most of them grew up with the same ideological forces at play that the rest of us face.

Of course, doctors should be well-paid, better than an average worker with less training and perhaps less important work to do. But the notion that doctors somehow need to improve their financial living standards beggars belief. When the yearly return on their stock portfolios is greater than their salaries, which in turn are vastly higher than average, isn't that enough?

Further privatization is simply pandering to greed. Because it's in medicare, we're rather more coerced into agreeing to such demands, but it's hard to find much sympathy for them.

Well put Birch

Maybe a factor of 10:1 - on the salary ratio...be much better for everyone.

And you're right, privatization won't solve anything.

User Fees...

...are not so bad. Who hasn't been in pain in an emergency room and seen people go through there with an ailment that should have been treated in a simple clinic?

Why shouldn't those with the means go to a faster-service clinic and thereby relieve and speed up the free system for those who need it?

The added costs of waiting for simple surgery by even those that can afford otherwise, in the free system costs everyone in pain and loss of productivity.

the UserFee Zombies will die ...

... with repeated blunt trauma to the cranium.

For those who have moved beyond the geo-centric universe and the regular use of leeches to re-balance the humours, quality improvements in Medicare have been demonstrated all across Canada resulting in lower costs within the public system :

http://www.michaelrachlis.com/pubs/Prescription%20for%20Excellence%20pb%200412.pdf

Private market 'solutions' repeatedly fail because medical services are not a free market - they are a compulsory market.

The Real Rx

Nice one, OilbertaRedTory. Send 'em back to their Strauss textbooks.

But your header is actually a prescription frequently administered to families who interfere inappropriately with care to their loved ones in a variety of ways. The Rx actually reads "Cerebro-cranial application of dimensional lumber p.r.n. until attitude changes."

It's a Rx that needs to be more often administered to Asian families with loved elders dying painfully of every disease under the sun, who think it's respectful to demand that every last lifesaving measure be given to their elders without regard to how much pain it might cause or how little quality of life they will have left in a morphine fog, never mind how much money it costs.

The wife's cared for a patient with terminal lung cancer who was given one additional painful day of life with a "heroic measures" order by the family that resulted in broken bones, a single dose of very expensive medication, and another day in an ICU bed with the ministrations of the team at a cost of perhaps $12,000. This resulted in a "blocked bed" (prevented admission) for a needy patient that had to be transported to another ICU in another region for treatment. Nobody could talk the family out of it, and they threatened lawsuits if it didn't happen.

This was before on-call ethicists, of course, but I venture to say that this one case would cost more than 30 days of Class 4 admissions (hangnails, etc.) in the ER, which aren't as common as you might think...

What a hoot!

The Rx actually reads "Cerebro-cranial application of dimensional lumber p.r.n. until attitude changes."

Zalm, I laughed out loud over this one.

A Rx for Excellence ...

... that can be administered regardless of ethno-linguistic ancestry, socio-economic status or gender.

"The art of medicine consists of amusing the patient while nature cures the disease."
Voltaire