Oh, Canada!

Monday, August 10, 2009

NPR had a nice spot this morning that shed some light on the reality of the much-maligned Canadian health care system. All in all, they have many of the same problems we do with a couple of key differences.Give it a listen. It's only about 7 and a half minutes long.

I did my best to paraphrase some of the key points.

A lot of U.S. ads being run against the ObamaCare plan make claims about the Canadian system and how "horrible" it is. Part of the dishonesty in those ads is that neither chamber of Congress is debating a plan that looks anything like the Canadian plan. I am not surprised that the opposition would run a dishonest ad. I just wish that NBC, CNN or another national news org would run this NPR story too. Among the claims listed about Canada's horrifying system are that care is rationed (like the Brit system), there are miles/years-long waiting lists/lines, and that some "bureaucrat" makes ultimate decisions about your health care and what you can receive.

"Nonsense," say Canadian health care professionals. "We are not a 3rd world country." If you need access to services, you get them. Are there cases where people have had to wait for care? Sure. JUST LIKE ANYWHERE. [I had to wait 5 months to see a specialist I needed once, but it wasn't for anything life-threatening].

In response to some well-publicized "waits" for services [we all know that good news isn't news, and that even Canadian news agencies report the worst of the worst] the Canadian government added billions to their health plan to reduce wait times for cancer, cardiac and joint replacement services. It's not a like a cancer patient is waiting the duration of their illness for services, but if you have cancer, you'd like to see someone pretty frigging quickly.

Some provinces pay for Canadians to go to the U.S. for care in some specialty fields like high-risk neonatal care. But that's because there are a shortage of neonatal docs and because, well, we have some really damn good clinics for that.

Half of canadians would like to option to buy some private insurance.

Canadian health ministers, just like the US, have anxiety over paying for aging boomers; Canada, like the U.S., has shortage of primary care physicians; and Canada (again like the U.S.) has a chronic problem with the overuse of ERs.

That said, the article ends with the statement that Canadians do not have to worry about losing their health insurance or going bankrupt because of an injury or an illness. Ad that means a lot.

12 comments:

Bob 9:32 AM  

Nice article. I suspect though that the average NPR listener already knew a lot of this, or was at least open to the possibility that Canada has a damn good system. NPR’s core listeners aren’t the people who need convincing.

I have a colleague whose husband is Canadian. Him and his sister have been incredibly healthy, neither one them ever had a cavity. They have lived under both systems and prefer Canada’s.

The thing is, the changes being proposed here aren’t radical and would not bring us even close to a Canadian system, which I why the people screaming about reform seem like such madmen. (See previous post.)

Kelly 9:39 AM  
This comment has been removed by the author.
steves 9:45 AM  

Great post. I think the most important point is this:

Part of the dishonesty in those ads is that neither chamber of Congress is debating a plan that looks anything like the Canadian plan.

The discussion/concern regarding a Canadian system should stop right there. If we are looking at something totally different, then why the comparison. OTOH, if there are comparable facets, then we should look at those, specifically.

This report from the Hoover Institute (a conservative think tank that, IMO, has a good reputation) talks about some of the waits and mortality rates in regards to cancer. From what NPR is saying, Canada is trying to improve some of these problems, but I would like to see some proof.

Anecdotally, the Canadians I know from Alberta seem to think their health care is decent, but the ones I know from Newfoundland think it is pretty shitty. I remember listening to a radio call in show where people spent the entire 4 hours just calling in and bitching about some aspect of the health care system.

That said, the article ends with the statement that Canadians do not have to worry about losing their health insurance or going bankrupt because of an injury or an illness. Ad that means a lot.

It does. I would prefer that try and develop something different from Canada's system, as I may not see it as horrible, but in need of some major improvements.

or was at least open to the possibility that Canada has a damn good system.

I am open to the possibility, but I have seen little that would make me think it is anything better than mediocre.

steves 9:48 AM  

Oops, the link to the Hoover Institute Report didn't work in the previous post. I'll try again.

B Mac 10:35 AM  

A rational, level headed analysis of the rhetoric surrounding the "OMGCanadaNOOOOOO...." debate.

I counter with this analysis released by the RNC...

(Caution: mildly NSFW)

Bob 11:12 AM  

I think the lack of portability is a huge issue for those who want to start a small buisness. If I had insurance for my buisness, i would have likely started a small buisness years ago.

steves 3:10 PM  

I should note that one area where the Canadian system is obviously 100% better is in being able to cover everyone. If you don't have insurance in the US, then the medical system is mostly out of reach.

Critics of gov't involvement should focusing on the public health care system we already have in place instead of looking at Canada. There is room for serious reform in Medicaid and Medicare.

Bob 4:13 PM  

"Critics of gov't involvement should focusing on the public health care system we already have in place instead of looking at Canada. There is room for serious reform in Medicaid and Medicare."

It is true that reform is needed, here, but people like their medicare, so critics will get nowhere with that tactic. Plus, those programs have effeciencies that the public sector doesn't match.

steves 4:59 PM  

Plus, those programs have effeciencies that the public sector doesn't match.

Did you mean private sector? Medicare, maybe, but not Medicaid. I worked for an agency that was mostly funded by Medicaid and had hundreds of clients that received Medicaid and I can say that in Michigan, Medicaid is not more efficient than the Private sector (I had worked in the private sector, too).

I had clients that were put on waiting lists. I had clients that had to travel 2 counties away for dental care because no one would treat them in the county they lived in. I spent 45% of my time filling out bullshit paper work instead of doing direct care because some fucktard committee in DHS dreamed up some other stupid report they thought would help.

I am generally supportive of some level of public health care, but my experience with Medicaid is what is making me nervous. There was an incredible amount of waste from the top down.

People love medicare? Bullshit. What choice do they have? I suppose they love it more than the other option of having no health care at all. My parents have Medicare and they don't love it. My grandfather fought continuously with them as his Parkinson's worsened and had a very low opinion of the people he dealt with. My grandmother also fought with them when they refused to pay for things they were supposed to pay for.

I am certainly not suggesting that we scrap either of those programs. They are very important. I don't think they are a model of efficient care delivery, from what I have observed.

steves 5:08 PM  

I should note that my evidence is anecdotal. I did some poking around for actual studies on efficiency and found huge disagreement. Some said Medicare was more efficient, but other pointed out that key expenditures were left out. Frankly, I don't have the time to go through dozens of studies, so I will leave that up to someone else.

Bob 9:40 PM  

"Did you mean private sector?"

Yup.

Polls have shown satisfaction with Medicare. There are also efficiencies when compared the private sector in administrative costs.

Some of the problems you mention with Medicaid is do to cuts and underfunding, not necessarily inefficiencies.

steves 7:11 AM  

There are also efficiencies when compared the private sector in administrative costs.

I have seen some studies that show administrative costs in Medicare/Medicaid are anywhere from 2 to 3 times the cost of the private sector. Doesn't seem efficient to me.

Some of the problems you mention with Medicaid is do to cuts and underfunding, not necessarily inefficiencies.

Underfunding is a problem, but most of the problems are systemic. Additional paperwork, BS rules that do nothing to improve care or help clients, and dreadful auditors that don't always know much about the agency they are auditing. In addition to this, budget cuts seem to only affect the people working in the trenches. The CMH system is very heavy with mid-level administrators and they seldom get canned during budget cuts.

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