With the medical system over-burdened, the system is now fundamentally reactionary in many specialties; delaying anything that can possibly be delayed.
It's saving a penny today to pay a dollar (or a loonie, I should say) tomorrow. It's economically burdensome and, obviously, creates a great deal of unnecessary hardship for those in line.
Nearly every Canadian has anecdotal stories of elderly relatively who had a minor ailment that needed surgery - were delayed for months because they were low priority - and then needed a larger intervention as the problem compounded over said months.
Where does this show up in the data? How do you measure and value up to a year - which can be more than 10% of an elderly persons remaining life - being mired in uncertainty, discomfort, and pain waiting for a procedure? How do you measure medical efficiency and patient outcomes in this context?
The best way to describe the current system is that doctors (surgeons, in particular) are forced not to look out for the individual patient's best interest, but the best interest of their entire surgical waiting list in aggregate (and this can be dozens of names long).
So, yes, it is in the best interest of Patient X to have the minor operation done this week as there is a strong likelihood of further complications and a worse patient outcome if delayed. However, Patient Y needs a major surgery this week so Patient Y, rationally, gets the higher priority.
> There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (39.0 weeks), while those waiting for medical oncology begin treatment in 3.8 weeks.
Still, the Canadian system is demonstrably better when it comes to outcomes. Canadians live longer than Americans, and have lower infant mortality rates for instance. Canadians also pay half of what Americans do for health care, when everything is accounted for. My partner is diabetic; like most medicines its a fraction of the cost of in the US. A universal system brings with it purchasing power. No system is perfect, but this one seems much better than the American one for the average person.
It's a choice. In my case, I'd much rather the Canadian system over the American. Even when it comes to surgery, I had a vaginoplasty (took 8 months between GP consultation and surgery; $25k surgery paid for by govt). My friend got her tubes tied (took a month; paid for by govt). My other friend was in the hospital for a month (admitted immediately; paid for by govt). My uncle had heart surgery. He did not have to lose his house. My step-dad had hip surgery (took 4 months; paid for by govt). Not to mention all the doctor's visits and tests accrued over a lifetime.
[1]: https://www.fraserinstitute.org/studies/waiting-your-turn-wa...
I lived for a few years in southern Québec, and I was amazed at the quality of care there. My wife had some pancreatic stones, and it all got dealt with (including 2 surgeries, multiple scans and a 2-week hospital stay) within a couple weeks. No bill. My daughter fell and had a concussion, we were scared about possible brain damage so I took her to the hospital at around 8PM. We were out of there at 6AM after an X-ray, an MRI scan and a few hours of observation. Again, no bill. I had four kids, and I think in total I paid less than $100 for their births, and that was for the food I ate or for parking.
Right now I'm more in central Québec, and the quality of care is a bit lower. It's a pretty rural area, so the budget is probably lower and the points of service are more spread out. Still, I like to know that a medical issue will never bankrupt me.
I'm in one the largest and wealthiest metro areas of the US, and there is a 6+ month waiting list to see mental health professionals.
> "So wealthy people get access to better care and everyone else has to take whatever is available" The alternative is that everyone gets access to sub-par care.
When I lived in Manhattan, despite living right down the street from some of the best paid surgeons in the country, my wealthy clients would fly overseas to France and Israel for their surgeries.
The fact is that countries with universal health care have better health outcomes, better quality of care, shorter wait times for care, pay half of what the US does and manage to cover all of their citizens. Each of those statements of fact can be cited here[1].
[1] https://www.healthsystemtracker.org/chart-collection/quality...
Publicly funded healthcare may not solve all issues, but it removes the perverse incentive to refuse or reduce care quality because you don't have access to insurance or cash. Free market means shit to me if I'm mid-heart attack, I don't have the time to review pamphlets about why ABC hospital has the best care for the low-low price of $4999!
Maybe rich Canadians think differently, but universal healthcare will always be better for the general population.
Need some physio, but delaying it isn't going to cause ongoing problems? You're going to wait.
If you want to skip the queues then there's affordable private healthcare as well for non-urgent issues ... my plan with BUPA costs my employer £1,600 per year.
Sub-par care is excellent when the current reality is that most people don't get access to any care at all.
You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists. When a poor person is in pain they will continue to be in pain until the pain goes away or they die.
When given that versus a shitty but free healthcare system, who wouldn't want to see a doctor? To get $5 prescriptions to medicine that can help them?
And remember, this is assuming the healthcare system will be shitty - universal healthcare has never been repealed in a country that has implemented it. Don't you think if the citizens of these countries were so fed up with free care, they would be protesting and electing candidates that promise to dismantle it? Even Boris Johnson has to tiptoe around privatizing the NHS because he knows how wildly unpopular that would be, even among his conservative constituents.
>You must understand that the vast, vast majority of people don't go to doctors. They don't have dentists.
Uhh… what? This sounds either out of scope for the US or just wildly inaccurate. Over 90% of Americans have insurance.
Edit: I do not live in a bubble. I stand by this comment, "only" 1/3 delay medical treatment [0]. The claim that the vast, vast majority of people never get it at all is simply false. Fact checks do not bear counterargument in a healthy discussion unless the fact check itself is lie.
[0]https://news.gallup.com/poll/269138/americans-delaying-medic... (2019)
Insurance != Healthcare or the financial capacity to see a doctor.
I have excellent insurance through my employer and still pay several hundred a month to cover my and my partners medical needs, on top of the insurance premiums in my paycheck. We are extremely lucky to be able to afford that but it's still nearly $500 a month that could be going to savings, retirement, a safer car, or more. Instead we spend about $6k a year to an inefficient system that doesn't produce better outcomes than universal systems like in Canada.
If your out of pocket excess is $1000 and you need $900 of treatment, but you also need to make rent, buy gas, feed your family ... well, you don't get the treatment (or you do, can't pay, and are made bankrupt). I think you might live in a slight bubble.
Yes, I pay a lot more tax, but then again, public transport, healthcare free at the point of need etc. etc. are worth it to me.
https://www.theguardian.com/society/2013/sep/12/hospital-dea...
Private insurance, even those run as non-profit, still turn a profit. Does the head of the DHS make 15 Million dollars in year? No? That's the average compensation for private insurance CEOs. Bernard Tyson CEO of non-profit Kaiser Permanente made 16 Million in 2017.[0]
Is that really "all the same"?
[0]https://medium.com/@kaiserkeepthrivealive/this-analysis-look...
There is no reason to have it exclusively. Having single-payer healthcare with mandatory participation for residents does not preclude existence of healtcare providers that are outside of that system.
Although it is likely that such providers would be just a small part, as for patients it would have zero monetary marginal cost to use providers that are part of system, so they would likely use providers outside of the system as a last resort or if there are significant non-monetary cost.
I have many more stories, (family member being sent home with an Abdominal aortic aneurysm on the verge of happening (Friday) because the Surgeon didn't have time to perform the surgery until Monday. Guess what happened on Sunday? Guess what else happened a couple of days later?
Wife almost died because she had to wait a month for a specialist. She just couldn't get anyone to take her seriously. Finally got the treatment in an Emergency room (she went septic).
I live in the USA now and have the best medical care in the world for my family.
https://vtdigger.org/2019/06/19/patients-face-frustrating-lo...
> At the beginning of the year, the wait to see a cardiologist at three of Vermont’s rural hospitals was more than 100 days, according to data from state regulators.
> At Southwestern Vermont Medical Center in Bennington, hospital officials reported patients would need to wait nearly 200 days to see a dermatologist.
> As of March, some of the hospital’s specialists, including cardiologists, ear nose and throat doctors, gastroenterologists and psychiatrists could only see between 20% and 30% of patients requesting appointments within 10 days.
I had a relatively minor injury (wrist) from a car accident. Nevertheless, it needed some interventions and I was advised to start PT right away. Was given a referral and a list of in-network providers (for a large insurer). In my (metropolitan) area, I could not find a provider with a less than 3-4 month waiting period within 30 miles.
My step daughter wants counseling - 2 month wait. All three of my closest options for a PCP are "not accepting new patients".
This isn't a problem of socialized medicine. I grew up in Australia, and I know that much.
In my part of the US, that is about the normal wait for that sort of surgery as well. Unless, of course, you're a millionaire.
There are plenty of multi-month waitlists in the US for common medical procedure. My wife sees a sleep doctor. Our insurance is fantastic. He has a nice, expensive office in an upscale regional medical center. I don't know which car in the parking lot is his, but there's a lot of nice cars in that parking lot.
It is a ----ing nightmare. Multi-month waiting lists to first see him. Month-long waits for scheduling anything. Three-month wait to schedule a minor surgery. [1] He screws up her prescription changes, the pharmacy won't dispense because he didn't tick some box on a form, and he goes on holiday for a few weeks. His on-calls aren't able to fix the problem, because, well, they aren't on-call for his sleep practice. Guess who can't get her prescription?
And for this privilege, we and my employer pay ~$20,000/year. I suppose we could fire his ass, and switch doctors, with no guarantee that the next one won't be any worse. [3]
[1] Cherry on top - despite being fully covered for the procedure, and paying what they asked for at the time of the operation, the surgery center started calling us, demanding money. Guess who gets to untangle billing? [2] We do. Guess who, once the dust settled, turned out to have overcharged us, and eventually cut us a cheque? The surgery center.
[2] Double-whammy - my wife dropped her old insurance two years ago, to switch to mine. Guess who started sending us bills last month? Her primary care provider, because at some point his office realized that she is no longer on her old insurance. Somehow, it's taken them two years to realize this. I'm assuming that the new provider has been paying them all this time, but who even knows at this point?
[3] I must say, my best interaction with the US healthcare system so far has been at a walk-in clinic located in a crummy office with peeling wallpaper, patient examination rooms that doubled as storerooms, a broken water cooler, and a bathroom with a door that mostly closed, located above a laundromat in an, ah, common part of town. The staff consisted of the doctor, who was cycling through patients, and his assistant, who was translating to and from Spanish, juggling papers and photocopies, and doing vaccinations and blood draws. I was in, I had what I needed done, and I was out, with zero billing bullshit. I didn't see any Teslas in the parking lot, though.
The US is certainly not immune from this reality.
https://www.keranews.org/post/shortest-wait-time-see-doctor-...
In other words, you didn't actually need surgery. The system worked as intended.
If you look at it in terms of economic productivity, the inability of the doctors to schedule this properly was taking some useful out of the workforce and jeopardizing their continued employment and financial stability.
So, instead the of the rushed surgery, my relative waited. After a day of waiting, she decided to go straight to Vancouver, B.C., where the issue was taken care of immediately, with no wait times.
However, because of the delay, her outcome was significantly worse than it would have been.
Basically, she lost much of her eyesight because of the "billing department."
That's the States for you.
Highly disagreed. I had several unnecessary surgeries as a child in canada. I had some swollen drainage things in my sinuses removed, and the only danger is that I was really sniffly all the time!
"We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market."
Does this mean that the free market means hospitals can choose not to treat patients that are too sick, too black, too gay, etc?
wishful thinking.
we already see this with ambulance service. there is an overabundance of supply, but it has not reduced price. in fact, the opposite as all the companies run much less efficiently (less billable time).
people aren't going to shop and buy on price for hospital care. they are going to shop and buy on local presence. for regular doctor visits, the costs are already low.
Contrast that to the US which could leave a person bankrupt for the same emergency.
Indeed. Even if you have good insurance, getting something like a heart attack, cancer, etc. in the US makes it likely that you'll be bankrupt in the end. I know three people that this has happened to.
The main one is, the (expected) medical costs are different for different populations. In particular, the expensive sub-populations are (1) the elderly (because aging & death), (2) women (because pregnancy) and (3) some children (born with genetic diseases, birth deficiencies etc. but having no income/wealth to pay for them).
If we argue that medicine should be driven by the free markets, we should also allow the free market to take over other things, but we as a society (currently) refuse to do that (IMO for good reasons).
What's the value of old age? Retirees are almost completely non-productive, a drain on the society... you could argue about saving for retirement (it's "free market") but that's a bit of a lie, you can't "save" labour or energy, so there's always a transfer of value from the working population to the non-working population, and as the non-working retired population increases and the working population shrinks, that's going to become a problem one way or another (both in socialized and in individualistic retirement systems). Old age awaits everyone, a populace would probably be feeling very uncomfortable about their own future if they saw poor old people dying on the streets, refused medical care.
What's the value of bearing children? It's kind of parallel to the above, children are an investment into the future (future workers), currently it's on the individual to pay for this investment (pregnancy, career income loss, more housing, education costs) but the society benefits (extracting taxes / parts of the value produced by this future worker). Should women also bear the cost of medical care? You could say there's always a father in the picture, but some people also claim that fathers should have the option of financial abortion (given that they have no say in physical abortion). Generally I argue that there should be incentives for people to have kids (correlated with their income, so that high-income, usually highly educated people, have more of an incentive to have kids - e.g. some kind of negative tax rate).
And finally, what's the value of a human life? Should we condemn a kid to a short life full of suffering just because s/he was born with some mistake in their body? I mean, resources are limited so we always have to make trade-offs, but refusing medical care to kids born to poor parents seems particularly evil.
I'm not sure what the solution is... personally, I'm leaning towards a "highest highs, highest lows" kind of a society - having some kind of social net (regarding medicine, jobs, ...) while also allowing private markets for those who can afford them (i.e. if you want to buy private surgery, you can, if you're wealthy enough). But this needs to be carefully managed so the whole system kind-of works.
All of my relatives in Canada come over to the US for any major surgery. The reason? The wait time is in years, instead of weeks and some can't get the surgery at all.
"Once you start running a hospital like a business, you create an environment of perverse incentives. Care is no longer solely based on what's best for the patient, but how that patient's care relates to the hospital's finances."
Government-run care is no different. It doesn't magically solve the issue of treating patients as a number.
"So wealthy people get access to better care and everyone else has to take whatever is available"
The alternative is that everyone gets access to sub-par care.
The answer is an actual free market, rather than another, large middleman monopoly over our health care. We need to get rid of all insurance companies, allow hospitals and doctors to compete over price (which will reduce prices for everything to true values (instead of $80 Aspirin), and only have insurance for surgeries that are rare and can't benefit from the free market.
Monopolies are bad for everyone, whether it's big business or the government.