Links to threads about health care

[Surlethe]

Okay, here's a thread to link to board threads about health care. Ideally, this will run the gamut from news threads to anecdotes to the old debates with the likes of tharkun.

[Op/Ed] Canada's ObamaCare Precedent
Shriner hospitals in trouble.
Healthcare Vents

Add your own!

[The Spartan]

I mentioned this in the "Shriner hospitals in trouble" thread but I'll direct link to it here.

Link

Summary: A family with a $100k earner and a stay at home mom are about to lose insurance on their then three year old son because he's used up the lifetime cap of $1 million due to his severe anemia. They have a few options available to them: bankrupting themselves in order to keep their son alive; trying to get on Colorado's public healthcare plan (unlikely because of his income) which itself has a $2 million cap; divorce so that the mother can go on welfare and qualify for insurance through Medicaid; let their child die.

[Surlethe]

Debating Health Care (Long OP): Debating Help thread about health care argument.

[Darth Wong]

A nice article about Shona Holmes: the Canadian woman who is the American right-wingers' latest Joe The Plumber:

http://www.theglobeandmail.com/news/nat ... le1235958/

U.S. debate reminds us our medicare is worth it
André Picard

Montreal — From Thursday's Globe and Mail
Last updated on Thursday, Jul. 30, 2009 01:15PM EDT

Shona Holmes has become a central figure in the bitter debate about U.S. health-care reform.

The Waterdown, Ont., woman is featured in a TV ad telling her tale of horror – how she had a life-threatening brain tumour but would have had to wait months for treatment. So Ms. Holmes remortgaged her home and flew to the Mayo Clinic in Arizona for treatment, paying $97,000 cash for her care.

“Now, Washington wants to bring Canadian-style health care to the U.S.,” the narrator says gravely in the ad, paid for by Patients United Now, an offshoot of the Americans for Prosperity Foundation, a conservative group that promotes less government and lower taxes.

Ms. Holmes has also recounted her nightmare story in countless media interviews, warning that “free” Canadian health care comes at a heavy price – lack of access – and lamenting her inability to buy private insurance to get quicker care.

“My agenda, if I have one, is to tell them [Americans], be careful what you wish for,” Ms. Holmes told The Washington Times.

Discussions surrounding the provision of health care always elicit strong emotions and outbursts of rhetoric, and Ms. Holmes's case is no exception.

She is, of course, entitled to bash medicare and promote the idea of private health-care insurance both at home and abroad. That is the beauty of free speech. (And, to be fair, Ms. Holmes has always praised the quality of care in Canada; her issue is access and timeliness.)

But a few important details are missing from the “commercial” version of this socialized-medicine-kills tale.

Ms. Holmes did not have a deadly brain tumour, she had a benign Rathkes cleft cyst. Yes, she had vision loss, but it was temporary and reversible. This is not to suggest what she went through was not awful and frightening, but it was not life-threatening.

Initially, Ms. Holmes said she had a six-month wait to see a specialist. Later, she amended that to three months. Canadian hospitals and physicians won't say how long the wait was nor comment on the gravity of her condition because of privacy rules.

For the sake of argument, let's acknowledge that the wait to see specialists like neurologists can be long. It's a problem that needs to be fixed, and the situation is already better now than it was in 2005, when Ms. Holmes had her health problems.

The reality is that, in Canada, we “ration” care. Under our state-financed insurance program, we try to provide universal care efficiently and cost-effectively. We make choices. Getting the balance perfectly right is difficult.

The United States, by contrast, has over-capacity. That is one of the principal reasons that, per capita, care costs about 50 per cent more there than in Canada.

Money buys you access, and lack of money denies you care. In Canada, we have a not-always-happy medium: Universal access with sometimes frustrating waits.

So what happens when a patient feels they are waiting too long for care? Ms. Holmes had a “gut feeling” that her life was in danger and made a radical choice to pay out-of-pocket for immediate care in the United States rather than wait for “free” (read: tax-financed) care in Canada.

Now, she wants to be reimbursed by the Ontario Health Insurance Program. She is also a party to a lawsuit against the Ontario government arguing that a “government-run monopolistic” health system that prohibits the sale of private insurance for medically necessary care is unconstitutional. (The case, very similar to the Chaoulli case in Quebec, is backed by the Canadian Constitution Foundation. It is still before the courts.)

There are complex legal issues here and competing rights that the court will need to balance. But what insurance program, private or public, would ever allow clients to determine their own treatment and reimburse them without question?

In the discussion flowing from Ms. Holmes's ad, it has been noted often that some 45 million Americans do not have health insurance. For them, the right to buy private insurance is moot because they cannot afford it and the Canadian-style system looks pretty appealing. But that is largely beside the point here.

Ms. Holmes is insured – albeit by a state-financed plan. The question is: Can insurers (and providers) delay and deny care, and can they limit and deny coverage?

Of course they can, and they do so all the time. In the United States, health insurance is expensive and it is often tied to employment. Even those with good insurance see their claims denied because of “pre-existing medical conditions,” insurers' attempts to hold down “medical losses” (the industry term for paying for care), and caps on total payouts.

Ironically, for all her lauding of private insurance, someone like Ms. Holmes would find it virtually impossible to buy insurance, given her medical history.

The infamous ad claims that Canadians have long waits and are denied all manner of care because the “government says patients aren't worth it.”

On the contrary, medicare – universal state-financed health insurance – means everyone is worthy of care and entitled to care.

If nothing else, Ms. Holmes' foray into the U.S. health-care debate should remind us of how medicare, despite some shortcomings, is worth it.

Americans can only dream of having such a system to bemoan.

Captain Picard makes some very interesting points, and in many ways, this woman's whirlwind publicity tour is an excellent example of the sort of dishonest tactics employed by the right wing on this issue in general.

[Surlethe]

http://www.denverpost.com/recommended/ci_12523427

A Canadian living in the US takes certain health care myths to task:

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

[Darth Wong]

Follow-up on Shona Holmes:

http://www.cbc.ca/health/story/2009/07/ ... on523.html

Anti-medicare ad an exaggeration: experts
Last Updated: Friday, July 31, 2009 | 8:20 AM ET
CBC News

A U.S. ad featuring an Ontario woman who spoke out against the Canadian health-care system may be exaggerating the severity of her condition, say medical experts.

Shona Holmes has appeared in U.S. ads saying she had to go to the Mayo Clinic in Arizona to be treated for a rare type of cyst at the base of her brain — a Rathke's cleft cyst. She mortgaged her home and paid $100,000 to be treated there because getting care in Canada involved a six-month wait, she said. She is currently suing OHIP to recoup those costs.

Holmes, from Waterdown, Ont., said she would have died had she relied on the Canadian health-care system and waited to see a specialist.

But the director of the brain tumour research centre at the Montreal Neurological Institute says he thinks that claim is "an exaggeration."

Dr. Rolando Del Maestro says the lesion Holmes was diagnosed with is benign, and usually slow-growing. It typically does not require urgent attention, he said.

"If it's a real emergency in the sense that the patient's visual function is getting substantially worse, the patients would be brought in immediately and would be operated on the next day," he said.

In 2005, Holmes, complaining of headaches and vision loss, went to see a Canadian doctor and was put on a six-month waiting list to see specialist.

After trying unsuccessfully to expedite the process, she was diagnosed and treated at the Mayo Clinic. Holmes said U.S. doctors considered the cyst a tumour, and that it would cause death if not removed immediately.

But neurosurgeon Michael Schwartz of Toronto's Sunnybrook Hospital says he's never seen or heard of a death from a Rathke's cyst. He told CBC News symptoms can be alleviated if the cyst is drained or part of it removed to take pressure off the optic nerve. "Then the person's vision almost always improves.

"If somebody called me about a patient that was losing her vision or had a structural abnormality of the brain I would see them within days."

Opposition to Obama

The contentious advertisement is being run by a conservative lobby group, the Americans for Prosperity Foundation, opposed to U.S. President Barack Obama's plan to involve the government playing a role in reforming U.S. health care.

It warns that Washington wants to bring in Canadian-style health care that would cause "deadly" delays for people waiting for important medical procedures.

Holmes denies taking any money from Americans for Prosperity for her message. Her publicist, paid for by the lobby group, says she's now declining interviews.

But Holmes told CBC News in an earlier interview she believes Canadians are not speaking up about the problems in the health-care system. She said that every time she thinks about stopping her criticism of the system, she gets "another really sad phone call or desperate phone call of somebody who is tragically trying to get treatment in Canada and can't."

Americans for Prosperity says it has spent nearly $1.8 million US running the ad in Washington, D.C., and 11 states with key senators who are either writing health-care bills or wavering on the issue.

It is one of a handful of commercials that are expected to grow in number and criticism this summer as detailed health bills emerge from the U.S. Congress and dozens of interest groups, companies and labour unions tussle to influence legislators.

Through June 27, $31 million has been spent for roughly 47,000 TV ads on health care this year, says Evan Tracey, president of the Campaign Media Analysis Group, a firm that tracks issue advertising.

So far, Tracey said about $15 million has been spent on ads favouring the Democrats' push to revamp the health-care system and $4 million to oppose it. Another $12 million has gone to ads generally favouring better health care, nearly all of it from the Pharmaceutical Research and Manufacturers of America, representing drug makers, which hopes its market will expand if more people have insurance.

Tracey estimated that $250 million will ultimately be spent on the campaign this year.

[Surlethe]

Health care financial issues.