Lisa Benson for January 05, 2010

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I wrote my senators and congressman about health care, stated my oppoistion of what is going on, all three democrats said they will do what they want and support it. What a country!

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Why stand when you can lie down?

I have friends with severe disabilities who have ALWAYS held jobs and worked. I have some “healthy” relatives who’ve drawn benefits and been highly allergic to work. What the system needs is helping those who DO try, but can’t get insurance, or are UNDER insured for their family needs due to costs or pre-exisiting conditions. A single payer system, where EVERYONE pays into the tax base to support BASIC health care, increases the broadest possible client pool, and reduces costs- period.

Those who scream bloody murder about supporting such a system– please do NOT DRIVE on ANY of our PUBLIC roads- build your own!

Maintaining a strong and healthy society does not equal either “socialism” or “marxism”- it’s called the “general welfare” which the Constitution supports.

Imajs: You are not the only person in your representatives’ district. If the majority supports their decisions then they are supporting the majority. That’s democracy. In a dictatorship they would simply arrest you.

Here’s a quotation from David Brooks’ column in the Times today:

“The tea party movement is a large, fractious confederation of Americans who are defined by what they are against. They are against the concentrated power of the educated class. They believe big government, big business, big media and the affluent professionals are merging to form self-serving oligarchy — with bloated government, unsustainable deficits, high taxes and intrusive regulation.”

He goes on to say that the tea party movement could become very influential.

I think we see certain indications on this list that he could be right. And quite a few of the cartoonists seem to foster these positions. Benson is often a good example (this is my attempt to tie this post to the cartoon).

I have a certain sympathy for some of these fears. I don’t like the concentrated power of big business and big media, and I don’t think there should be an oligarchy of the educated – what used to be called a meritocracy. I am all for the rights and interests of the little guy.

What worries me is that the tea party people seem to have a very shallow analysis of what the problem is and how to solve it.

For instance, this cartoon seems to suggest that a national health insurance system is the equivalent of being frisked at gunpoint by the police. But the image is confused. It’s not clear why these people have been stopped by the police, and health insurance is stated as a right, equivalent to Miranda rights for some reason. It’s all very confused. But I have to think the cartoon is opposed to a national health insurance system.

The whole discussion has gotten off the rails, somehow. Let’s keep it simple. Citizens should have a right to decent health care, and the current system clearly doesn’t provide that. What system would best guarantee that right? Probably not the bill we are likely to get. I still support that bill, because I think if it’s defeated the drive for a national system will be dead for a generation. Pass the bill and then make it better.

Please cite an example of someone being denied life saving health care, that the current system doesn’t provide, regardless of ability to pay. Continuation of the same level of care is the recipients financial burden to carry. The “only rights” anyone “should” have are enumerated in the Constitution.

Just an addendum to my previous post – while I oppose an oligarchy of the educated, I would even more strenuously oppose an oligarchy of the ignorant.

Dear Beast,

I suspect we may have some fundamental disagreements. But here’s an attempt at some discussion.

First, Congress has the power to pass legislation beyond the civil rights specifically enumerated in the Constitution. So even if there is no Constitutional right to health care, Congress can still legislate in the area. I understand there is a Constitutional challenge i the works on other grounds. Since I’m not a lawyer I would have no useful opinion on the subject. It will be interesting to see how it plays out.

Second, what rights are guaranteed by the Constitution is a matter of interpretation. For instance, the Constitution does not in so many words say that segregated schools are a violation of anyone’s rights, and there was a period (after Plessy v. Ferguson) when separate but equal accommodations were considered to be Constitutional. But then Brown v. Board of Education ruled that school segregation was inherently unequal. Both decisions were matters of interpretation.

Third, because these are matters of interpretation, there is room for change and room for people to argue for change in interpretation. So even if the Constitution does not specifically enumerate a right to health care, one might argue that such a right is implied.

Fourth, though I have a lot of respect for the Constitution, I don’t consider it a closed document. So even if the Constitution does not now include any implication about a right to health care, I could say that it should, and I can agitate for an amendment to the Constitution. I don’t think that it’s necessary to do that, but I could. Rights have been added before, and they can be added again. I don’t believe that there is a set group of rights established from the beginning of time. I believe that our concept of rights grows historically.

And fifth, I believe we would have a better society if we had a national health insurance system. There is more to health care than emergency treatment to prevent death. For instance, I get a prostate exam every year and a colonoscopy every five years, and I think every man my age should have the opportunity for the same. A poor person might not choose to spend the money on such tests, but this kind of test could make a big difference to his health, and could also save money for the health care system. There would be individual benefit and social benefit as well. My preference is for a single payer system funded through progressive taxation, but I am happy to hear about other proposals.

trout, It IS possible to disagree as to what services SHOULD be provided by the government WITHOUT agreeing to everything. Agreeing to one service does not mean that you have to agree with anything someone wants to fund. The degree of proper government in health care is a debate in progress. I have mostly stopped participating in the debate here, on this issue, since most of the participants on this board have firmly made up their minds. I consider most of these positions to have been made with a degree of rational thought whether I agree with them or not. There are some exceptions but not too many.

Single payer=longlines, rationed care,denied drugs, your old you dont get that hip,you ate too many cheese burgers no heart sugery for you,sorry alcohol is bad for you and since we supply your health care you cant have it . If you think Im wrong your just fooling yourself. Govt. unchecked IS tyrany and I will fight till my last dieing breath any one or any thing that tries to enslave me under the guise of,(” For my own good”).

I’ve spent a lot of time in Canada, which has a single payer system. I would not say that the Canadian system is perfect, far from it, but none of the fears you express are a reality there. They are more typical of many plans in the US. I’ve seen both the Canadian system and the US system, and I vastly prefer the Canadian system. Perhaps others on the list with experience in Canada can help out here.

You have the right to pay our paychecks with the taxes we collect from your paychecks, then let us tell you what to do.

“Single payer=longlines, rationed care,denied drugs, your old you dont get that hip,you ate too many cheese burgers no heart sugery for you,sorry alcohol is bad for you and since we supply your health care you cant have it .”

Pardon me, but as far as I know a lot of these exist in the current US system (predetermined conditions, denied coverage, drugs/procedures not covered in your plans, etc). Rationing exists one way or the other - all that differs are the criteria. As for long lines… well, as far as I know Germany and France don’t have much higher longer waiting times (some sources actually say the Germans wait less for emergency procedures), so I don’t think single-payer healhcare is the problem here.

“If you think Im wrong your just fooling yourself. Govt. unchecked IS tyrany and I will fight till my last dieing breath any one or any thing that tries to enslave me under the guise of,(” For my own good”). ”

Sure, I agree with that and support it. However, I simply do not believe a public healthcare plan is tyranny.

Bruce – I’m not happy with the way this system is going to turn out, and I think it’s vulnerable to your comments. But here’s how I would like it. Think about roads. Whether you drive or not, the government takes your money and builds roads. Think about schools. Even if you are past school age and without children, the government takes your money and builds schools and pays teachers. That’s because these are public benefits. But once the roads and schools exist, everyone can use them.

In Canada the government takes part of your tax money for the health care system, and then everyone has the right to use the system. It’s true that some people will pay for more than they use, and some will pay for less than they use, but it’s always there if you need it, and it’s a public benefit as well as a private right.

DrC – I know it’s all been said, but so long as people continue to repeat inaccurate statements about other national health insurance programs, it’s important to correct them. Otherwise they win on air time, if not on truth.

(Since you ask – all others can ignore this part:) I started my BA in the US, then I moved to Canada and did my BA and MA at UofT. I went back to the States for my PhD and lived there for a while, then I got a job at York in Toronto. Mostly I know Ontario, but I’ve spent some time in Nova Scotia, and of course I’ve travelled around and about for conferences. In the US I’m an east coast person – Washington, New York, Ithaca, Boston. And you?

DC you’re just not right…even in canada..private healthcare was better than single payer

Dear Magnaut – In what way?

bruce and lonecat…before single payer you could get to the front of the line without being a politician or a hockey player…I’ve lost relatives to the delays in the system…the peolpe are good, the doctors are good and yet a parallel system is emerging…there are no bad guys but government incompetenc is universal….we’re Americans and therefore better at incompetence too

Bruce – That’s right. You pay your taxes and you’re automatically insured. I have never heard of anyone having extra insurance (except for travel outside the country), and I’m not sure what good it would be, since everyone is already covered. You get a card from the government, and you show that to your doctor (or the nurse) every time you have an appointment, or to hospital staff. They do everything from then on. The patient never sees a piece of paper.

And by the way, you choose your own doctor, subject of course to availability. In rural areas there isn’t a lot of choice, and in the outlying areas there aren’t enough doctors, but that’s a problem in any system, I bet.

I’m not an MD, so I don’t know all the details, but I figure there’s a set fee for every standard procedure. The doctor submits records to the government and gets paid by the government. That’s why it’s called single payer. In the US, a doctor sometimes has to deal with several different insurance companies, and I gather that can be a pain.

Increasingly, the government is trying to get doctors to join together into group practices, and then the doctors are paid per patient rather than per procedure. I think that’s how it works.

You just don’t worry about not being able to afford a heart operation or a cancer operation, or chemo-therapy, or whatever. If your doctor says you need it, you get it. I believe that the numbers show that Canadian outcomes are as good as US outcomes overall, and less expensive.

I remember explaining all of this to a friend of mine who is an MD in the US. At some point in the conversation he said, “You mean I’d get paid for every procedure for every patient?” It turns out that he had about $30,000 a year in bills that he couldn’t collect. Because he was a good person he would treat people even if he knew they couldn’t pay. In the Canadian system there would be no uncollectible bills.

What are the problems? Wait times. You can wait a while for non-emergency operations. Hip replacements are a big problem – there’s quite a wait. But my friends who are MDs tell me that if there’s anything life-threatening they can get attention immediately. Hospitals can be overcrowded. Now and again a patient needs a procedure that isn’t covered – these are usually new or experimental or controversial procedures. I’m sure there are other problems, but those are the ones that occur to me right now.

Income taxes in Canada are higher than in the US, partly to pay for his system, but on the other hand you simply don’t pay for private insurance.

There are other systems, in Europe for instance, and I don’t know how these work. I don’t claim that the Canadian system is the best, or the only one worth considering. But in my opinion it’s a lot better than the US system.

lonecat, Your mention of hip replacements reminded me of a case in 2005. I do not keep up with Canadian law. Were there any legal changes or reactions to the case? (I figured our Canadian members would have a better take and yes I know a lot can change in 5 years. and yes I know that the WSJ’s conclusions are offensive to a # of people here. I cited it as the first article I found about the case)

Link to article follows.

http://tinyurl.com/8wb6b

I guess thats why no other country can touch the survival rate from cancer as in the U.S. Canada cant, niether can France or Great Britan. Oh but its just as good -NOT!

Well said, lonecat.

Thanks, DrC and Charlie.

Gladius – I’m going to have to read that again before I say much. I remember reading about it at the time. It’s consistent with my earlier comments, which specifically mentioned wait times for hip replacements.

My quick impression is that it was a good decision – if people pay taxes for health care, then they should get health care – but it hasn’t destroyed the Canadian public health insurance system.

Could one say that the Canadian Supreme Court in effect recognized that Canadian citizens have a right to timely health care? Would a US court say that US citizens have a right to timely health care? Could you go to court in the US on similar grounds?

dave– I’m not a big stats person, but my quick reading of the numbers says that life expectancy at birth is a couple of years better in Canada than in the US, that infant mortality rates are a touch lower, but that expenditure per head is quite a bit less. I thought that these numbers were well known, because they came out in Congressional testimony over the summer. But I’m no expert in these areas, so if I’m wrong please correct me. With references.

My post was not intended to be an idictment of the Canadian system but a serious question as to what changes resulted due to the case I posted above. Even though the ‘toom has changed here, I’m still interested in an answer.

Dear Gladius,

I didn’t take your comment as an indictment, but one comment in an ongoing conversation. I wish I could give a definitive answer. Here’s my impression. Overall the Canadian system is pretty much what it was before this particular court case. It was not destroyed. There has been a big flurry of political talk about improving wait times, but so far I think it’s more talk than action. But I could be wrong, and I don’t have numbers. Certainly the public wants shorter wait times, and at least politicians know that.

There has always been resistance to the single-payer system – more out West than in Ontario. Probably there are several reasons for this resistance, and I don’t want to paint with a broad brush.

But what would be the effect of dismantling the current system of insurance? One effect might be that people with more money could move to the front of the line, or get better service. That’s okay in some areas of life. I don’t think the government should subsidize the purchase of yachts, or expensive houses, or diamond rings. Health care, however, is in another category, for me, anyway. I don’t believe that rich people should get quicker health care, or better health care, than anybody else.

I had a personal experience a few year ago that’s perhaps relevant. I needed a minor out-patient operation, and for some reason my doctor sent me to one of the few, perhaps the only, clinic in Toronto that operated outside the system. The operation itself was covered by public insurance, but the clinic charged me an extra $300.00 for extra services. I might mention that the clinic was very posh, whereas most hospitals in Toronto are decidedly not posh. Anyway, the extra services consisted of a very lovely waiting room, a plate of cookies, and a phone call the next day to see if I was okay. Was that worth $300.00? Not to me. The physician, by the way, also worked three days a week in the public system, so I could have had exactly the same procedure performed by exactly the same physician without the $300.00 plate of cookies.

A few years later the owners of the clinic decamped with a bundle of money. They were found in Florida, I think, and extradited back to Canada to face fraud charges.

Dear Church,

Here is an excerpt from an interview with Dr. Doig. She certainly sees problems in the Canadian system – as do I, if you read my posts – but she does not advocate dismantling it and replacing it with the American system. She would like to look at the European systems and the Israeli system. I apologize for the length of the excerpt, but context does matter. The full interview can be found at:

http://www.canadianmedicinenews.com/2009/08/new-cma-president-anne-doig-urges.html

Do you believe, like Dr Day and Dr Ouellet, that the Canada Health Act’s restrictions on private insurance are detrimental to the healthcare system?

I think the whole point is the principles that are articulated in the Canada Health Act – you know, principles around access, principles around affordability, principles around transportability, that kind of thing – those are basic, fundamental principles. The principles may not need not change. But where the Act has strayed into being prescriptive about process, perhaps government does need to look at that and say, “We revised legislation for every other type of legislation that covers benefits or services, or even the rules of road.” I mean, all those things get changed over time – they’re not static. Why is the Canada Health Act seen as a static piece of legislation? Its principles may be static, they may be inviolable, they may be principles to die on. But how we interpret that in the context of the current reality is, I think, open to debate.

There is almost daily stream of fear-mongering in the United States about the evil Canadian healthcare system with its horrific wait times and Communist rationing. It seems like that can’t help but to have some effect on how Canadians feel about our system in some way. Do you think the CMA has a role to play in countering the criticism from the US?

I don’t think the CMA has a role to play in engaging in the US debate.


I guess I mean as it pertains to the Canadian system. There have been all sorts of accusations from US groups recently about what is wrong with Canada’s model or how we’re rationing care for the elderly, etc.


Well, I have to tell you parenthetically that one of the things that the CMA wants to see improved is the availability and provision of care for those who require longterm care. We are acutely aware that the provision of longterm care is inadequate in Canada. So part of my point is it really irritates me when inflammatory rhetoric is used instead of people being able to engage in debate. There is a problem in longterm care in this country. People need to wake up and smell that coffee, and the CMA is certainly not going to be shy in giving that message to the public. However, what this whole US thing says to me is, you know, it’s the two-headed hydra. The physicians in each country are looking at the systems and saying, “You guys, the system is about to implode. It’s going to fail.” And the US guys are saying, “Oh, my god, we don’t want Canada.” And Canadians are saying, “We don’t want the US.” Okay. Both of us need to sit down, each in our own jurisdictions, and come up with something that works for our citizens and for our doctors, and go forward. I mean, I think one thing that the US finger-pointing has done is it’s made some Canadians who were complacent – you know, they were content to sit back and think, “Oh yeah, I’ve got the best healthcare system in the world” – maybe they’re realizing that, oh, maybe it isn’t. And people who individually have experienced things that are not quite right, people who have experienced long waits, people who have been sent home with services – they may have thought they were individuals and something bad happened to them but, overall, the system is good. Maybe some of those people are now beginning to realize the problems are far more systemic than they thought.

lonecat, Nice to see a restrained, thoughtful look. At the time as well as now, I never thought the Can. system was in any danger of being destroyed by that case. I did expect some sort of impact but didn’t really get curious until recently. I had expected a little more effect than just debate.

Gladius,

I didn’t mean to say that there have been no changes, but the changes have not been fundamental. If I understand the court ruling, the court said that patients have a right to timely care. If a province can’t provide timely care through the public system, then patients have a right to look elsewhere. But if the provinces can provide timely care, then the system can stay as it is. I believe that many provinces have pledged to improve the delivery of care and have made certain promises to that effect. How much they have delivered on their promises I don’t know.

It’s interesting that the area Doig singles out is long-term care (not, say, cancer treatments, heart surgery, and so on). I have some personal experience here. If you have money, you can find a bed in a private long-term care facility tomorrow. If you don’t, you go on a waiting list, and you can wait literally years. If, however, a patient has been admitted to hospital and if the hospital then determines that the patient is not in a condition upon release to be returned home, then that person can jump to the head of the waiting list and get into a public facility.

This situation shows both sides of the problem. The public system is underfunded and people have to wait too long. The private system is unfair because it favors people with money. The solution, I would argue, is better public funding. And I would generalize that solution to many problems in the delivery system. Since Canada spends per patient about half what the US spends, it should be possible to improve funding without breaking the bank.

Just a quick addendum – in Canada citizens have a right to timely medical care, because they are all insured by the system. In the US citizens do not have any right to timely care.

I was aware of U.S. law. You have to prove discrimination to get anywhere here. I just wasn’t aware of the actual current legal issues in Canadian law. There’s been so much garbage thrown around on this board recently. I already spend a good bit of my time on research and just hadn’t gotten around to this issue.

Church,

I do not claim to be expert in US Constitutional law. Please explain to me where I have gone wrong. Random insults are not enlightening.

You may be right that there are better systems than the Canadian. I repeat a comment of mine from an earlier post in this stream: “There are other systems, in Europe for instance, and I don’t know how these work. I don’t claim that the Canadian system is the best, or the only one worth considering. But in my opinion it’s a lot better than the US system.”

Gladius,

I don’t know if you’ll come to this steam again, but in case, it has been a pleasure conversing with you, and I look forward to continuing the conversation on another occasion.