Canada Health care killed Richardson

[el jefe]

billcoe's source article from the ny post is the usual highly slanted bullshit expected from that rag. joseph is one the money. the issue with an epidural is getting the patient into the hands of a neurosurgeon asap. this can happen fairly quickly in an urban, heavily populated area like portland or seattle but neurosurgeon availability in rural areas throughout the u.s. is very poor. even getting a patient with a bad head injury from mt hood to portland takes much longer than most people realize despite the fact that helicopter transport exists in this area. first of all, the helicopter isn't stationed at the ski area so there is the time it would take to get to the mountain, the time to pick up the patient, then the flight to pdx -- all assuming that the weather is clear and the chopper can actually fly all the way to the mountain. many times this isn't possible and a patient has to be shipped at least part way by ambulance, etc. add a 3 hour delay caused by patient refusal of care and the outcome is the same as for poor natasha. hers was a tragic case to be sure but hardly the result of the canadian healthcare system as the same outcome would likely have occurred in the u.s.

 

 

[akhalteke]

ditto jefe. Bitch killed herself. No sense blaming anyone but her.

[Choada_Boy]

Cures for a closed head injury:

 

 

 

 

 

 

You gotta open that shit UP! And all three are available for less than $18K!

[el jefe]

she made the wrong choice, but then there was no way for her to know that at the time. epidural hemorrhage is caused by an arterial injury so at first there is nothing wrong (hard blow to the head but patient quickly recovers as no brain damage caused by initial event), then a rapidly accumulating lesion (artery is a high pressure system) results in rapid neurological deterioration. bad luck was the culprit. any delay with this sort of injury is bad but it is also insidious injury because once it becomes apparent from clinical presentation that something is wrong, then the neurosurgeon needs to be standing right there at that moment if disaster is to be averted. single-payer health care system had nothing to do with the outcome.

[Mal_Con]

I fell going down my driveway in runners in early January after years of hiking and climbing and fell backwards. My wife called the EMT's and I felt like an idiot. Got 6 stitches for about 5k my insurance paid about 4k. Seemed like a lot at the time but I feel better about it now. The system pretty much sucks though.

[el jefe]

http://www.nypost.com/seven/03262009/postopinion/opedcolumnists/canadacare_may_have_killed_natasha_161372.htm

 

Perhaps. Got to love the government control of healthcare they "enjoy" eh?

 

My only experience with the Canadian Healthcare system was sitting with my climbing partner in the emergency room for 8 solid hours so he could get a cast for his broken arm after he banana peeled while walking on the wet rocks of the trail at Squamish. That sucked. and x-ray and a cast is generally about a 20 min affair, if that, in the US.

 

do you have a source for this "20 min affair, if that" claim? can't say i've ever seen a broken arm managed that quickly in any emergency dept i've worked in. perhaps your "8 solid hours" in canada was caused by people with real emergencies (e.g., myocardial infarction, potential stroke, seizures) being treated before your friend got treated. emergency department operates according to the principle that the sickest people-- those with potentially life-threatening complaints -- get treated first, those without life-threatening problems (e.g., broken arm with pulses intact distal to the site of injury) get treated when time is available, and that's true regardless of whether health care is organized according to a single-payer or multipayer system. restaurants operate according to the "first come, first served" principle but emergency rooms don't because there is a profound difference between delivering health care and serving big macs.

 

having to wait in the emergency room for care is usually a good thing. it means you aren't about to die or lose a limb. it means you aren't very sick or too badly hurt.

[akhalteke]

I, too worked in ER's around the country and you are looking at at least and hour even if the ER is empty (and this is never the case).

[el jefe]

also note the bogus argument that uses reported 8 hours to get a broken arm fixed as evidence that the canadian health care system would also be slow to properly manage a patient with a severe traumatic brain injury: this assumes that broken heads and broken arms are managed the same way. comparing apples with oranges, as they say.

[giza]

In summary, Americans should not visit Canada because it is like a third-world socialist country whose citizens say 'eh' a lot, like beer, and grow the dank chronic. You're likely to get better health care service in Haiti or Rwanda. If you come to Canada you could DIE!!! Stay home - leave Canada to the savages.

[j_b]

More fear-mongering by the corporate media about "commie healthcare" while industry lobbyists and their toady politicians develop policy "reform" behind close doors. Canadians have among the longest life expectancy on the planet (3 years longer than americans on average) which certainly couldn't happen without a healthcare system benefitting the population.

 

 

[RuMR]

ditto jefe. Bitch killed herself. No sense blaming anyone but her.

wow dude...you're an asshole...

[el jefe]

my point was that there is no one to blame here and certainly not the canadian health care system. an epidural bleed can kill very quickly but is also a completely inobvious injury until it is too late. using this tragic, unfortunate event as an argument against a single-payer health care system is crass, opportunistic, and in extremely poor taste.

[Bug]

ditto jefe. Bitch killed herself. No sense blaming anyone but her.

wow dude...you're an asshole...

Anyone who skiis, deserves to die(?).

 

[DirtyHarry]

Good info Jefe. Are you a doc, medic, P.A. ?

[el jefe]

nurse.

[Hugh Conway]

ditto jefe. Bitch killed herself. No sense blaming anyone but her.

wow dude...you're an asshole...

Anyone who skiis, deserves to die(?).

 

threatening me again. I'm keeping a log of this harassment.

[ivan]

ditto jefe. Bitch killed herself. No sense blaming anyone but her.

wow dude...you're an asshole...

Anyone who skiis, deserves to die(?).

x2

 

at least i feel this way whenever down-slogging on hood

 

i'm surprised more folks don't die skiing each year - i damn near do everytime i go out!

[Choada_Boy]

http://www.nypost.com/seven/03262009/postopinion/opedcolumnists/canadacare_may_have_killed_natasha_161372.htm

 

Perhaps. Got to love the government control of healthcare they "enjoy" eh?

 

My only experience with the Canadian Healthcare system was sitting with my climbing partner in the emergency room for 8 solid hours so he could get a cast for his broken arm after he banana peeled while walking on the wet rocks of the trail at Squamish. That sucked. and x-ray and a cast is generally about a 20 min affair, if that, in the US.

 

do you have a source for this "20 min affair, if that" claim? can't say i've ever seen a broken arm managed that quickly in any emergency dept i've worked in. perhaps your "8 solid hours" in canada was caused by people with real emergencies (e.g., myocardial infarction, potential stroke, seizures) being treated before your friend got treated. emergency department operates according to the principle that the sickest people-- those with potentially life-threatening complaints -- get treated first, those without life-threatening problems (e.g., broken arm with pulses intact distal to the site of injury) get treated when time is available, and that's true regardless of whether health care is organized according to a single-payer or multipayer system. restaurants operate according to the "first come, first served" principle but emergency rooms don't because there is a profound difference between delivering health care and serving big macs.

 

having to wait in the emergency room for care is usually a good thing. it means you aren't about to die or lose a limb. it means you aren't very sick or too badly hurt.

 

And white guy with a paper cut get served first, obviously, even if the black guy with Ebola is bleeding out.

[JayB]

At the end of October I had what seemed to be a heart attack while at a conference in LA. I went to Good Sams ER on the insistence of my sister who is an ER doc down there. I was treated promptly, but still spent eight hours in the ER before being admitted for an echocardio stress test in the morning. The upshot of it all was I apparently had a gastro-reflux episode, not a heart attack (could have fooled me). So in the end it cost about $18k for the following of which very good (and expensive non-group) insurance picked up about $13k. God forbid anything had actually been wrong.

 

- 1 hour of ER work (the rest was waiting for things)

- ER doc

- 2 nurses

- 1 stress tester

- Review by cardiologist

- Review by pulmonologist

- 3 ecg

- 1 xray

- 1 blood workup

- 1 baby's aspirin

- 1 nitro spray under tongue

- 1 nitro patch

- 1 intravenous nexium

- 1 bed

- 1 echocardio stress test

 

Is that reasonable? Could be, but when it costs $18k to handle someone who is basically fine it gives you some idea of how fast you'd be racking up costs if something were actually wrong. All in all I have good insurance, but even with that we're still basically one bad incidence away from being wiped out. Add to that I'm self-employed and the risk goes higher (totally on me and by my choice).

 

Our healthcare system? Go to SE Oregon where the last nurse practicioner is closing their doors leaving the SE part of the state with no medical coverage of any kind like much of rural America. Add to that the fact that employee and retiree health benefits are just killing U.S. competitiveness in world markets, and then add the wholly unecessary administrative overhead of a myriad of insurance companies, and I come solidly down on the side of our system being a complete trainwreck. We don't run any other part of our infrastructure for profit, and it's completely stupid to run our healthcare system that way from an international competitiveness perspective.

 

And the rightwing mantra of "leave medicine to the doctors, not the gov't" - what utter bullshit - these are the same clowns who took over, raped, and all but destroyed our medical system in the '80s and '90s with 'managed care'. The republicans explicitly didn't want doctors making medical decisions - they manufactured a system which explicitly took decision-making out of doctor's hands and gave it to insurance companies.

 

And poor Natasha? She doomed herself on the slopes when she weighed appropriate medical care against the potential media circus which would ensue and chose wrong. She'd have likely been just as dead skiing anywhere in the US. And with regard to helivac services in CA - get real. All of CA has a massive remote northern territories to provide coverage to - much of it inaccessible in the winter - their helivac coverage is prioritized to service those remote northern areas that have no medical coverage of any kind (SE Oregon should be so lucky).

 

Makes you wonder if there's any cost-shifting going onto private insurers to recoup costs that exceed reimbursement schedules elsewhere...cough...cough.

 

The prices that hospitals charge for care and supplies would make for an interesting conversation* (I'd be surprised to see a pair of latex gloves show up on an itemized bill for less than $50), but let's talk for a moment about mechanisms to control costs.

 

And the rightwing mantra of "leave medicine to the doctors, not the gov't" - what utter bullshit - these are the same clowns who took over, raped, and all but destroyed our medical system in the '80s and '90s with 'managed care'.

 

What makes you think that the the government won't also have to develop and impose additional mechanisms to restrict treatment options in an effort to control costs if we institute a single payer model, and what evidence from other single-payer only systems do you have to support that claim?

 

 

*Do you disagree that hospital billing practices represent an effort to shift costs from parties who don't pay the full cost of their care onto those who can? If not, why? If so, what's driving this cost shifting?

 

 

[el jefe]

"And the rightwing mantra of "leave medicine to the doctors, not the gov't" - what utter bullshit - these are the same clowns who took over, raped, and all but destroyed our medical system in the '80s and '90s with 'managed care'. The republicans explicitly didn't want doctors making medical decisions - they manufactured a system which explicitly took decision-making out of doctor's hands and gave it to insurance companies."

 

let's use the complete statement if you are going to quote from it, jayb. seems to me that joseph is saying that rightwing shills used fear of guvmint bureaucrats restricting treatment options as a smokescreen to shift this power to corporate bureaucrats instead. try going to a specialist who is "outside" your hmo, ppo, or whatever and you'll find it isn't covered -- in other words, your treatment options are being limited. myself, i'd rather this decision be made by the government bureaucrats because i can, at least on some level, influence that decision by how i vote. corporate bureaucrats, on the other hand, have the best interests of the corporation in mind, not the public interest.

[JayB]

More fear-mongering by the corporate media about "commie healthcare" while industry lobbyists and their toady politicians develop policy "reform" behind close doors. Canadians have among the longest life expectancy on the planet (3 years longer than americans on average) which certainly couldn't happen without a healthcare system benefitting the population.

 

 

If you are going to make a relevant comparison of the precise contribution that a healthcare system makes to longevity, you first have to make sure that you are measuring outcomes that are actually affected by what happens in clinics and hospitals, no?

 

If your intention is to make an accurate comparison between countries on this basis, you have to start ruling out things like...murders. Trauma centers can make a marginal difference here (actually, I have to wonder how much of the decline in our vaunted decline in the murder rate is due to substantial improvements in trauma care after things like requiring ER docs to get ATLS training, diffusion of best practices for gunshot trauma, etc), but in most cases killers finish the job before anyone can intervene. Then you have to consider the impact of lifestyle choices (please present any evidence that doctor/nurse + patient interactions have any effect on people's habits), nutrition, immigration, etc.

 

After you've made at least an effort to control for mortality from factors that no one in the health-care system can actually do anything about, *then* you can start making an honest effort to compare the *actual effectiveness* of country A's health-care delivery system relative to country B's. Then you have to make sure that country A and B measure the same thing in the same way. Infant mortality statistics are a wonderful example of a cases where virtually every country determines what constitutes infant mortality in vastly different ways. Then you have to make an effort to adjust for the actual incidence of a disease in country A and country B. If both countries have the same population, and have the same number of deaths from lung cancer, but the incidence of lung cancer is three times as high in country B, what does this say about how good the treatment for lung cancer is in country B versus country A?

 

None of this necessarily amounts to a defense of the American health system. It is quite possible that once you've made an effort to institute the appropriate controls, that the US will look even *worse* relative to the rest of the world - but all too often the data required for an accurate comparison just isn't available - and this is something that intellectually honest scholars on the left and the right often find themselves disagreeing about.

 

I am aware of one study that seems to make a good apples to apples comparison of cancer care between countries, and I'll post a summary of that data below.

[ivan]

we could solve all these problems if we just started using one of these sweet puppies on everybody at age 30!

carousel! renew! renew!

[el jefe]

"Do you disagree that hospital billing practices represent an effort to shift costs from parties who don't pay the full cost of their care onto those who can?"

 

of course hospitals shift the cost of providing care for those who don't pay onto those who do -- what choice do they have? the law requires hospitals to provide a medical screening exam to anyone who shows up seeking care and to treat accordingly or, if they lack the specialized resources/technology/staff necessary to provide care, then they have to arrange transfer to a center that has the resources necessary to treat. it is illegal to turn away someone seeking care or to refuse care regardless of whether the person seeking care can pay or will pay. yet at the same time, the hospital doesn't get its resources (staff, equipment, electricity, etc) for free, so how do you make the books balance? the only recourse is to jack up the prices and thus shift cost for unreimbursed care onto those who do pay.

[JayB]

http://www.ncpa.org/pub/ba596/#footnotes

 

Overall Cancer Survival Rates.

 

According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology : 1

 

* American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women. [see Figure I.] U.S. Cancer Care Is Number One. fig1

* American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.

* Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.

* For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.

These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent.

 

Survival Rates for Specific Cancers.

 

U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology , confirming the results of previous studies. As Figure II shows:

 

* Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher. 2

* Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher.

* The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular).

 

Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years — about 16 percent — whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent.

 

 

Results for Canada. Canada's system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O'Neill, former director of the Congressional Budget Office, and economist David O'Neill, found that overall cancer survival rates are higher in the United States than in Canada: 3

 

* For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.

* For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

 

Early Diagnosis. It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government. 4

 

* In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.

* The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.

 

Access to Treatments and Drugs. Early diagnosis is important, but survival also depends on getting effective treatment quickly. However, long waits for treatment are “common devices used to restrict access to care in countries with universal health insurance,” according to a report in Health Affairs . 5 The British National Health Service has set a target for reducing waits to no more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment. A study by the Royal College of Radiologists showed that such long waits are typical, and 13 percent of patients who need radiation never get it due to shortages of equipment and staff. 6

 

Another reason for the higher cancer survival rates in the United States is that Americans can get new, effective drugs long before they are available in most other countries. A report in the Annals of Oncology by two Swedish scientists found: 7

 

* Cancer patients have the most access to 67 new drugs in France, the United States, Switzerland and Austria.

* Erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the United States than in Europe.

 

 

One of the report's authors, Nils Wilking, from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the United States in the 1990s was due to “the introduction of new oncology drugs,” and he urged other countries to make new drugs available faster.

 

 

 

Conclusion. International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs. Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles. No country on the globe does as good a job overall as the United States. Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically overhauling the current system.

 

1. Arduino Verdecchia et al., "Recent cancer survival in Europe : a 2000–02 period analysis of EUROCARE-4 data," Lancet Oncology, 2007, No. 8, pages 784–796.

2. The U.S. bladder cancer data is from "Cancer Facts & Figures 2007," American Cancer Society. Available at http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf.

3. June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, NBER Working Paper 13429, September 2007. Available at http://www.nber.org/papers/w13429.

4. K. Davis et al., "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care," Commonwealth Fund, May 2007. Available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678.

5. Sharon Willcox et al., "Measuring And Reducing Waiting Times: A Cross-National Comparison Of Strategies,"

Health Affairs , Vol. 26, No. 4, July/August 2007, pages 1,078-1,087.

6. M.V. Williams et al., "Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the UK in 2005," Royal College of Radiologists, Clinical Oncology , Volume 19, Issue 5, June 2007, pages 273-286.

7. Bengt Jönsson and Nils Wilking, "A Global Comparison Regarding Patient Access to Cancer Drugs," Annals of Oncology , Vol. 18, Supplement 3, June 2007.

 

Betsy McCaughey, a former lieutenant governor of New York, is chairman of the Committee to Reduce Infection Deaths ( http://www.hospitalinfection.org/) .

[JayB]

"Do you disagree that hospital billing practices represent an effort to shift costs from parties who don't pay the full cost of their care onto those who can?"

 

of course hospitals shift the cost of providing care for those who don't pay onto those who do -- what choice do they have? the law requires hospitals to provide a medical screening exam to anyone who shows up seeking care and to treat accordingly or, if they lack the specialized resources/technology/staff necessary to provide care, then they have to arrange transfer to a center that has the resources necessary to treat. it is illegal to turn away someone seeking care or to refuse care regardless of whether the person seeking care can pay or will pay. yet at the same time, the hospital doesn't get its resources (staff, equipment, electricity, etc) for free, so how do you make the books balance? the only recourse is to jack up the prices and thus shift cost for unreimbursed care onto those who do pay.

 

So your contention here is that it's uninsured patients, rather than patients covered by Medicare and Medicaid, that drive the vast majority of cost-shifting onto patients with private insurance.

 

If you have data that proves this claim, I hope that you'll share it.