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Can it really be called a downside?

According to Joseph M. Connors, MD, Clinical Professor and Director of the BC Cancer Agency’s Centre for Lymphoid Cancer, Vancouver, British Columbia, in an article in the ASCO Post, the downside to Canadian health care is

We [the Canadian health care system] don’t get to give patients treatments unless they have proven benefit, so we have an entire system devoted to examining what evidence justifies which treatments.......

..........I [Dr. Conners] cannot give a drug without evidence-based proof that the drug has efficacy and works better than the less-costly alternatives in the particular disease I’m treating. So the drawback to a centralized system is that it constrains innovative behavior, is resistant to change, and is slow to introduce new approaches. The system waits for adequate evidence before moving ahead.......

Well, I'm not so sure I'd categorize that as a downside, and neither do I believe it constrains innovation.

Just because something is new, and may have shown efficacy in a petri dish, or even in a stage 1 trial, doesn't necessarily mean it will be effective when given to humans. And let's not forget about potential side effects of rushing treatments to market. You only have to look at drugs such as Thalidomide, and more recently Avastin, to recognize the flaw in that thinking.

And besides, isn't that what clinical trials are for? Something else Canadians and Europeans have far greater access to than those in the US, that is unless you

have adequate coverage or can pay out of pocket
I don't know about everyone else, but if that's the only downside to Canadian health care, I'm willing to take my chances!

Originally posted to MetalMD on Fri Dec 30, 2011 at 05:55 AM PST.

Also republished by Single Payer California.

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Comment Preferences

  •  Tip Jar (190+ / 0-)
    Recommended by:
    TexMex, kyril, ChemBob, Bob B, pathman, pioneer111, historys mysteries, Ian S, FloridaSNMOM, farmerchuck, scorpiorising, blue jersey mom, grannysally, marleycat, timewarp, Brooke In Seattle, DRo, MKSinSA, CTPatriot, Wee Mama, GeorgeXVIII, Dr Colossus, Miggles, MartyM, commonmass, Scientician, dotsright, alrdouglas, Sychotic1, lineatus, zerelda, MuskokaGord, irate, Sark Svemes, leu2500, DBunn, Jake Williams, dmhlt 66, ruleoflaw, tobendaro, maybeeso in michigan, angstall, Mentatmark, OleHippieChick, gfv6800, kerflooey, ask, Involuntary Exile, Audio Guy, leonard145b, dance you monster, Flint, SadieSue, Rogneid, Losty, Orinoco, ItsSimpleSimon, ER Doc, semiot, Preston S, liberaldregs, northsylvania, concernedamerican, Shockwave, Barcelona, regis, jessical, tgypsy, bythesea, wishingwell, Joe Bacon, VTCC73, tegrat, ZedMont, BachFan, Wreck Smurfy, nio, eyesoars, No one gets out alive, trumpeter, Chi, 88kathy, Mac in Maine, Anthony Page aka SecondComing, cpresley, Bluesee, Hirodog, aerie star, divineorder, SoCaliana, tiponeill, absolute beginner, wayoutinthestix, Ozzie, Bionic, MadRuth, Byron from Denver, radical simplicity, paul2port, caul, ColoTim, createpeace, itsbenj, zerone, HugoDog, blue armadillo, sleipner, CoolOnion, ItsaMathJoke, jaf49, sea note, bnasley, ontario, profh, ccasas, davelf2, gustynpip, doingbusinessas, anyname, middleagedhousewife, Its a New Day, DiegoUK, ClutchCargo, pixxer, CarbonFiberBoy, bloomer 101, RMliberal, howd, bluicebank, NYWheeler, bibble, opinionated, MarkInSanFran, Tonedevil, Milly Watt, oldliberal, happymisanthropy, Sun Tzu, salmo, DixieDishrag, Agathena, leftover, Calamity Jean, mygreekamphora, PeterHug, ladywithafan, glorificus, imchange, Bob Duck, BlackSheep1, Getreal1246, unclejohn, UncleCharlie, msazdem, skrekk, Laughing Vergil, Curt Matlock, sb, Dragon5616, Lost Left Coaster, kck, anonevent, lexington50, jazzizbest, where4art, Sylv, ajr111240, bluesheep, Grandma Susie, cynndara, monkeybrainpolitics, legendmn, wvmom, Ice Blue, bozepravde15, joliberal, dRefractor, eru, exNYinTX, mofembot, blueoasis, chimene, mamamedusa, fumie, Marie, JDWolverton, terabytes, billlaurelMD, Funkygal, Yogurt721

    The future is just a concept we use to avoid living today

    by MetalMD on Fri Dec 30, 2011 at 05:55:31 AM PST

  •  They think evidence-based medicine is a detriment? (97+ / 0-)

    Sounds like an asset to me, fewer resources sucked up paying for woo woo treatments that have no proven efficacy.

    I'm sitting here with a torn rotator cuff trying to decide whether I can afford to make my January health insurance Cobra payment ($517, up from $450 for the new year) or save it for the February house payment if I can't find a job. I'd certainly rather have access to an evidence-based medical care system than the situation I am in.

    I've paid taxes to the US for over 36 years and at 61 I have to make this sort of decision? Because our leaders would rather bomb other countries than have the superb quality of life here that we are capable of having?

    •  One of the "consequences" of this (62+ / 0-)

      is that if a person goes to the Dr and anitbiotics are not needed, they aren't prescribed.  A benefit is that there is much less antibiotic resistance which means that when a person really needs them, they are much more likely to be effective.

      •  And a litany of tests are pared back... (25+ / 0-)

        to those that are relevant and required.

        "now this is not the end, it is not even the beginning of the end. But it is, perhaps, the end of the beginning." W. Churchill

        by Thor Heyerdahl on Fri Dec 30, 2011 at 07:47:00 AM PST

        [ Parent ]

        •  The Stats... (54+ / 0-)

          Canadian health care costs less than half of what it costs here in the US and has equal or better outcomes per disorder.

          Reasons?

          1. Single Payer System.

          2. Docs don't have profit sharing with hospitals so no financial incentive to admit to hospital unnecessarily.

          3. Docs don't own testing labs so no incentive to do unnecessary tests.

          Evidence based health care also cuts down on unnecessary procedures.

          •  number 1 is most important (6+ / 0-)

            numbers 2 and 3 actualy add very little to the total cost.  Additional tests to protect against malpractice claims do add a great deal of additional cost.  Earlier decisions for c-sections to avaoid malpractice claims- also very prevelant. (the c-section rate at my hospital soared after the hospital and several docs were hit with a multimillion dollar verdict in a case where the baby had a congenital defect which was incompatable with long term survival.)

            Medicare spends 7% on overhead.  Private insurers pay 30-40% for overhead and profits.   Then the docs and hosptials spend 20-30% of the remainder on overhead trying to get paid.  We could insure everyone in the country for what we are paying now, if the majority of the money didn't go to administration, billing and malpractice.

            Evidence based medicine won't reduce the cost of care, unless by following it the docs don't get sued anyway for bad outcomes.  You can do everything right with respect to evidence based medicine, but that doesn't protect you in a jury based advocacy system.  

            As my father used to say,"We have the best government money can buy."

            by BPARTR on Fri Dec 30, 2011 at 09:27:51 AM PST

            [ Parent ]

            •  Yet when laws are passed making it more (10+ / 0-)

              difficult for patients to actually get compensated for their doctor's negligence and mistakes, malpractice premiums don't go down.

              Pursuing this meme that people having the right to be made whole - or at least as whole as money can make them - when a medical provider is negligent or makes a serious mistake is what causes medical costs to be so high is so shortsighted.  While medical malpractice premiums might be high, that's primarily so the insurance companies can make a huge profit, not because so much is paid out in claims.  Laws already exist in every state that make it nearly impossible for a person to sue a medical care provider unless the injury is so serious and devastating the the negligence so clear and obvious that it will be a slam dunk case.  And even then, the recovery is generally extremely limited.

              So while the rest of what you say has some merit, please drop the right ring meme that people being compensated when they're seriously injured is a major part of the problem.

              "If you trust you are not critical; if you are critical you do not trust" by our own Dauphin

              by gustynpip on Fri Dec 30, 2011 at 10:19:14 AM PST

              [ Parent ]

              •  Here! Here! (13+ / 0-)

                Health care providers over treat and over test for one simple reason,

                THEY GET PAID TO DO SO!

                It's called fee-for-service medicine! They don't get paid for doing nothing.

                The future is just a concept we use to avoid living today

                by MetalMD on Fri Dec 30, 2011 at 10:23:50 AM PST

                [ Parent ]

              •  gustynpip - it's a completely different issue (1+ / 0-)
                Recommended by:
                nextstep

                It is the practice of defensive medicine that adds so much to our costs, not the actual malpractice insurance premiums or liability insurance awards.

                "let's talk about that"

                by VClib on Fri Dec 30, 2011 at 11:43:43 PM PST

                [ Parent ]

                •  I agree. 2 points: (1+ / 0-)
                  Recommended by:
                  VClib

                  When MICRA passed in California, malpractice premiums dropped significantly, and stayed much lower than, say, Florida.

                  Defensive medicine, rather than evidence based medicine will continue to be practiced as long as just following evidence based medicine doesn't protect you.

                  C-section rates will remain high as long as doing a c-section pretty much protects you from later second guessing and lawsuits while waiting for a vaginal delivery which may or may not occur carries significant risk.  Getting sued is devastating- even if you win.

                  Do docs who own surgi centers or lithotriptors do more surgeries- of course.  Is that a big part of the total? I don't think so.

                  As my father used to say,"We have the best government money can buy."

                  by BPARTR on Sat Dec 31, 2011 at 06:25:21 AM PST

                  [ Parent ]

                  •  I still believe the defensive medicine excuse (1+ / 0-)
                    Recommended by:
                    gustynpip

                    is overplayed.

                    The problem in this country isn't with malpractice insurance rates, it's with the cost of health care. Even as you say, in CA, while malpractice insurance rates were lowered, it did nothing to stem the tide of health care costs.

                    The true culprit in all this is fee-for-service health care, as practiced in this country.

                    Doctors don't get paid for doing nothing, and until we recognize that fact, no amount of rhetoric, or tweaking of the system will change anything. We will continue to have the highest cost medical care, with the fewest people having access to health care, and the worst outcomes of the OECD countries.

                    The future is just a concept we use to avoid living today

                    by MetalMD on Sat Dec 31, 2011 at 07:35:05 AM PST

                    [ Parent ]

                  •  The defensive medicine argument is a crock, too. (0+ / 0-)

                    If a doctor is using a standard of care that is usual for his or her area of practice, there's no negligence.  Period.  So this idea that hindsight proving that a different action would have been a better one is absolute nonsense.  The defensive medicine argument is used to make doctors have an excuse for over treating and over charging.  And it's used so they can take the easy route.  It is so unbelievably difficult to bring a medical malpractice action, it makes me angry to hear people buying into this crap.  People are seriously injured and have virtually no recourse to compensation for it, because medical care providers have special protections that No One Else enjoys, yet all they can do is try and blame those that manage to somehow get a bit of compensation for gross negligence as the cause of their greed.  And I call bullshit on it.

                    "If you trust you are not critical; if you are critical you do not trust" by our own Dauphin

                    by gustynpip on Sat Dec 31, 2011 at 08:28:10 AM PST

                    [ Parent ]

            •  The largest lab (2+ / 0-)
              Recommended by:
              Flint, mamamedusa

              in the province I live in (B.C.) is owned by a physician

              •  How is it regulated? (3+ / 0-)
                Recommended by:
                Leap Year, kareylou, Ice Blue

                I stand corrected on ownership, but the question is how is it regulated in terms of requirements for testing and profit margins?

                The reason I raised testing labs and hospital profit sharing was because of the study below which compared Medicare costs per patient per year.

                Tale of two hospitals:

                Highest in US:
                McAllen Texas = 2006, Medicare spent $15,000 per enrollee.

                Lowest in US
                Mayo Clinic = 2006, Medicare spent $6,688 per enrollee.

                The Mayo clinic is highly advanced in terms of technology and it had the best health care outcomes.

                The reasons they sited in the article for the cost differential were:

                1. Doctors at the Mayo Clinic are paid an salary and not paid by procedure.

                2. Mayo Clinic does not have profit sharing so no financial incentive to admit to hospital.

                3. Texas hospital, Docs own the testing lab so they have a financial incentive to test

                Annals of Medicine
                The Cost Conundrum
                What a Texas town can teach us about health care.
                by Atul Gawande June 1, 2009

                Read more http://www.newyorker.com/...

                Thanks for the info!

            •  You had me, then you lost it (5+ / 0-)
              unless by following it the docs don't get sued anyway for bad outcomes.  You can do everything right with respect to evidence based medicine, but that doesn't protect you in a jury based advocacy system.  

              A false meme. What drives up the costs of malpractice insurance is - wait for it - PRIVATIZED medical malpractice insurance companies!

              I have been in the medical reimbursement industry, on both sides of the business model ( physician/hospital and insurance ) for over twenty years. I've sat in on and served as a witness on more than one malpractice trial during that time. It's much more difficult for the plaintiffs to obtain a favorable judgement than you think, especially before a jury.

              No matter what the rightwing screech machine is propagandizing out there, what's driving up the costs on the provider side are private medical malpractice insurance companies and their GREED.

              "..rich people (and the) political class..cannot be rich and do politics without us..They have no skills that we depend on; they have no control of anything except through paper. "To keep you is no benefit; to destroy you is no loss." Visceral

              by ozsea1 on Fri Dec 30, 2011 at 12:40:36 PM PST

              [ Parent ]

              •  we actually do not disagree (1+ / 0-)
                Recommended by:
                VClib

                In a jury system, awards are a lottery- fr both sides.  Cases are lost that should have been won and vise versa.  I undestand that defendants usually win- and bad medicine is proteted- while good doctors doing what is reasonable can be ruined by bad outcomes.

                The jury system pits lawyers against each other, and non specialists are expected to make complex, sophistocated decisions for which they are wholly unprepared.  Then the lawyers, the expert witnesses and the judge all lie to the jurors.  ( I stopped doing expert testimony when I witnessed the two lawyers and the judge agree to lie to the jury about whether or not the physician being sued had malpracice insurance.  Not to prevaricate, to lie.- One of the attornies said- , "Well, the jury won't believe the judge.!")

                A fair system would be a no-fault compensation system, or a panel of judges, preferably with both JDs adn MDs who would determine what the community stanrd ataully was- and compensate those who actually suffered malpractice.  Instead, unless the awards are potentialy enormous, lawyers are unwilling to even take the case, and poor plaintiffs cannot afford to sue.  With a panel of judges, and reasonable awards, rather than a lottery system where victims of actual malpractice are uncompensated, and others who simply had bad outcomes, beyond the preent abilities of good physicians can get millions, fairness would triumph.  And physicians would not have to practice defensive medicine.

                By the way, I have testified for plaintiffs and for defendants in malpractice cases. I have seen victims of malpractice get no compensation, and I have seen good doctors ruined by awards which bore no relation to the care they gave. The whole system is so distasteful that I no longer do it.

                Malpractice is not the major cause of skyrocketing costs, but it is one of them.  As I stated above, single payer would solve most of the problems.

                most Kos members seem to think that the system only protects "bad" doctors-  when the system really only protects all lawyers.  The actual patients are completely irrelevant to the lawyers, who vie in court and then go out to dinner together.

                As my father used to say,"We have the best government money can buy."

                by BPARTR on Fri Dec 30, 2011 at 06:01:10 PM PST

                [ Parent ]

                •  interesting (1+ / 0-)
                  Recommended by:
                  billlaurelMD

                  However, this paragraph gives me pause

                  The jury system pits lawyers against each other, and non specialists are expected to make complex, sophistocated decisions for which they are wholly unprepared.  Then the lawyers, the expert witnesses and the judge all lie to the jurors.

                  I get an off-taste of extreme generalizing as regards sworn court officials and the jury system, to put it mildly. They ALL lie to the jurors? Really? Really?

                  "..rich people (and the) political class..cannot be rich and do politics without us..They have no skills that we depend on; they have no control of anything except through paper. "To keep you is no benefit; to destroy you is no loss." Visceral

                  by ozsea1 on Fri Dec 30, 2011 at 08:19:14 PM PST

                  [ Parent ]

                  •  sounds like an agenda may be (1+ / 0-)
                    Recommended by:
                    BPARTR

                    getting advanced here, perhaps, ozsea1?

                    "Mitt Romney has more positions than the Kama Sutra." -- me

                    by billlaurelMD on Fri Dec 30, 2011 at 09:05:56 PM PST

                    [ Parent ]

                    •  perhaps (0+ / 0-)

                      may also be just an emotional reaction due to personal experience,
                      flavored with lots of hyperbole!

                      "..rich people (and the) political class..cannot be rich and do politics without us..They have no skills that we depend on; they have no control of anything except through paper. "To keep you is no benefit; to destroy you is no loss." Visceral

                      by ozsea1 on Fri Dec 30, 2011 at 10:35:59 PM PST

                      [ Parent ]

                    •  long day, sorry! (0+ / 0-)

                      The short and serious answer is yes, the agenda sounds like disparagement of the court system and those greedy lying trial lawyers.

                      "..rich people (and the) political class..cannot be rich and do politics without us..They have no skills that we depend on; they have no control of anything except through paper. "To keep you is no benefit; to destroy you is no loss." Visceral

                      by ozsea1 on Fri Dec 30, 2011 at 10:40:22 PM PST

                      [ Parent ]

                      •  no, it is the basis (0+ / 0-)

                        of advocacy trial systems.

                        How many jury trials have you sat in on where you knew the intimate details of the entire case- often running to thousands of pages of depositions, charts and expert testimony?

                        The issue is not "greedy trial lawyers" it is a broken system where the jury must make its decision based upon fragments of information presented by the lawyers, must decide between competing advocate expert witnesses- rather than a system where expert witnesses are paid by the court to render unbiased information to the court.  It is easy to say that phyicians are just afraid of greedy trial lawyers- but if you read my post carefully, you will see that I say that the current system penalizes patients at least as much as physicians.  this is an extremely hard point to get across to the average Kos resident.  Right now, only plaintifs with a lot of money of their own or potentially extremely high damages ever get heard at all.  Laywers simply wont take a case which may cost $300,000 to bring to court for a potential 20-30K in dmages.
                        But, yes, I do believe that the current system only really benefits the trial lawyers.  I would like to see a system which benefits the patietns harmed by actual malpraactice. ( Remember that I have testified against other doctors and for other doctors depending upon the facts of teh case.)

                        As my father used to say,"We have the best government money can buy."

                        by BPARTR on Fri Dec 30, 2011 at 11:11:33 PM PST

                        [ Parent ]

                        •  Then why do you make such a sweeping (0+ / 0-)

                          overstatement, ie hyperbole?

                          the lawyers, the expert witnesses and the judge all lie to the jurors.

                          As this stands, it reveals much about your commentary.

                          The current legal system as represented in medical malpractice suits is indeed imperfect. But this

                          But, yes, I do believe that the current system only really benefits the trial lawyers.  I would like to see a system which benefits the patietns harmed by actual malpraactice.

                          sounds and reads like the rightwing/libertarian talking points propagated daily on Fox Entertainment News and parroted by  rightwing radio bloviators. I do commend you for your honesty. Thanks.

                          "..rich people (and the) political class..cannot be rich and do politics without us..They have no skills that we depend on; they have no control of anything except through paper. "To keep you is no benefit; to destroy you is no loss." Visceral

                          by ozsea1 on Sat Dec 31, 2011 at 12:39:43 AM PST

                          [ Parent ]

                          •  I am sorry if it sounds right wing (0+ / 0-)

                            I am very left wing- but my experience with the legal system leaves me jaundiced.  And as an expert witness, I have quite a lot of experience.One more than one occassion, and in more than one trial, I have had attorneys say to me, "Yes, I know that the other lawyer is lying, but the judge knows too, so we cannot call him on it.  Anyway, it is his job."  really.  
                            Since I believe that the current advocate system does not benefit the majority of patients who had actual malpractice, or the majority of doctors who did not commit malpractice, the only people left to benefit are the lawyers.  

                            At any rate, the primary causes of rising medical costs are
                            1) multi-payer, for profit insurance
                            2) for profit hospital chains
                            3) aging baby boomers who demand more care and in greater numbers
                            4) more expensive tertiary care and equipment and treatments- and everyone wants the "latest"
                            5) increasing numbers of uninsured- whose care is paid for by those with insurance, whether or not they realize that. ( People with insurance who think that single payer would cost them more are nuts- they would no longer be the victims of cost shifting)

                            6) a lack of decision making ( death panels, if you will) recognizing when treatment is futile.  we spend 90% of our health care dollars in the last year of life- the difficulty is knowing when the last year starts.  As things currently stand, it is insurance companies who decide who lives or dies, not bioethics panels or health care providers.

                            7)lack of preventative care or support for it.

                            we spend more for poorer outcomes.  some of it is due to different definitions ( our perinatal death rate incudes any baby , mny countries only include live births, or even births  who survive several months.)  Some of it is due to lifestyle- we expect medicine to cure us no matter how we live or what we ingest.  Some of it is due to inequitable allocation of resources.  Some of it is due to lack of early intervention and preventative care.

                            As my father used to say,"We have the best government money can buy."

                            by BPARTR on Sat Dec 31, 2011 at 06:11:37 AM PST

                            [ Parent ]

                          •  ps (0+ / 0-)

                            I appreciate your willingness to discuss and try to understand my point of view.

                            My background:  Doctorate and biology professor with over 60 peer reviewed publications, then Medical doctorate and  25 years provider in university, government ( VA), and private practice.  20 years negotiating contracts for a 200 member specialty group with hospitals, outptient surgi centers, big insurers ( the Blues, Met Life, etc.), capitation, fee for service, fighting with MediCal and to a much lesser extent Medicare, expert witness for med mal and for the Calif Medical Board, reviewer for peer journals,

                            cheers,

                            Have a good New Year.

                            As my father used to say,"We have the best government money can buy."

                            by BPARTR on Sat Dec 31, 2011 at 06:18:09 AM PST

                            [ Parent ]

                          •  by the way, I am up all night on call (0+ / 0-)

                            and am replying between cases. what are you doing up so late?

                            As my father used to say,"We have the best government money can buy."

                            by BPARTR on Sat Dec 31, 2011 at 06:29:43 AM PST

                            [ Parent ]

          •  Number 3 is why I don't see my lung Dr. He (5+ / 0-)

            bought a machine to test lung function so he wants to this test yearly so he can tell me I have improved by 1.5% or NOT. It costs me $800+ out of pocket. I bought an O2 Sat meter for $35. That amount does not take into account the premiums paid so I can have Docs do other unneccessary  tests as well as put me on continuous drug regimens to pour money into pharmas pocket on thier word that the drug is helpful.  Not one of them likes to hear that I react to many drugs after short trials.... my reactions are inflammatory  and many of the diseases beign treated are the result of inflammation.

            Fear is the Mind Killer

            by boophus on Fri Dec 30, 2011 at 09:51:32 AM PST

            [ Parent ]

          •  A visit to ER in Canada costs an average of $75. (8+ / 0-)

            in the USA it costs an average of $1,000. That's not 50%. Those figures are from a BC government advisory.

            Your reasons for the higher costs in the USA do apply but there must be even more factors involved. There must be the incentive not only to make a profit but to make a killing.

            ❧To thine ownself be true

            by Agathena on Fri Dec 30, 2011 at 11:20:47 AM PST

            [ Parent ]

            •  Per Capita Spending is the measure (1+ / 0-)
              Recommended by:
              blueoasis

              The most recent study I could find is 2008 with spending per person per year as:

              US   =        $7,538
              UK   =        $3,129
              Canada =  $4,079

              These are 2008 numbers from Kaiser and it noted that the US is increasing faster than any other country.

              Physicians for a National Health Care plan puts the number for US higher:

              US = $8,160 per person per year

              Physician Administrative Costs in the US vs. Canada

              The US spends far more per capita on healthcare than any other developed country -- $7,538 per person, compared to $3,129 in the UK, $4,079 in Canada, and $5,003 in Norway (the second-biggest spender), according to 2008 totals compiled by the Kaiser Family Foundation.


              http://scienceblogs.com/...

              Kaiser Study
              http://www.kff.org/...

              Physicians for a National Health Care plan
              http://www.pnhp.org/

            •  It's a complicated ethos. (4+ / 0-)

              American medical recommendations for care assume a best-case scenario where resources are infinite and every patient can be given every possible treatment.  Then the assumption is passed into real practice as a Rule: that every patient MUST be given EVERY test and treatment that has the SLIGHTEST chance of producing a benefit, no matter how meager, because to do otherwise is to admit that there are limits to the powers of American Medicine and that some of those limits are pecuniary.  Therefore a patient who resists the incessant demand to have ever more testing and more treatment for a meaningless bump on the bottom of their foot is labelled "non-compliant" and "uncooperative" and BLAMED for having the fantastical notion that costs (both in money and in time, convenience, and discomfort) must bear some relationship to the benefits received.  Such a patient is then lectured to, treated with ever-increasing degrees of patronization, and assumed to be uneducated and stupid, no matter if they have four more degrees than the medical personnel making this judgment.

              In the meantime, those patients who have bought into the prevailing memes and are perfectly compliant complain mightily at insurance companies refusing to pay for treatments with no proven benefit, grab at experimental straws, and DEMAND every treatment that can possibly be construed to have a hairs-breadth of potential benefit when they are seriously ill, in complete contradiction to a rational attitude towards the limits of science and physical life.  These are the people (along with those whose diseases have rendered them unconscious or demented, and therefore completely at the mercy of Rules devised to leave no stone unturned, no matter how useless) who run up end-of-life costs of DYING in America that consume more than 50% of the nation's medical bill.

              The only thing that will bring THAT part of our excess expense level down, is for Americans as a society to learn to treat illness, death, and dying from a rational, adult perspective.  Good luck with that one.

          •  Flint - little malpractice risks (0+ / 0-)

            While malpractice insurance is not a big cost factor for most physicians, in most states, defensive medicine has a huge impact on healthcare costs in the US.

            "let's talk about that"

            by VClib on Fri Dec 30, 2011 at 11:41:37 PM PST

            [ Parent ]

      •  Do Canadians dump the same amount of anti- (1+ / 0-)
        Recommended by:
        Calamity Jean

        biotics in animal feeds like they do in the US.  It would appear to me that the use of antibiotics, not for sick animals, but just to get them to grow bigger, is a large source of antibiotics in the environment.  

        And it feels like I'm livin'in the wasteland of the free ~ Iris DeMent, 1996

        by MrJersey on Fri Dec 30, 2011 at 09:23:16 AM PST

        [ Parent ]

        •  Good question. Any Canadians on here (0+ / 0-)

          familiar with farming practices in Canada?  

          Renewable energy brings national global security.     

          by Calamity Jean on Fri Dec 30, 2011 at 11:01:37 AM PST

          [ Parent ]

          •  Almost any CAFO system will be using obscene (0+ / 0-)

            amounts of drugs on the animals due to the very nature of a CAFO. Antibiotics are not used to grow larger animals, those are what steroids are for. All of which gets put into animal "feed." If you can call what is being fed to these animals (which are treated as industrial inputs, not living creatures) "feed." Even some organic products are produced in CAFOs, which is despicable and speaks to the corruption of our system. We cannot expect to force thousands of stressed, drug filled animals to be healthy when they are treated such.

            Canada's agriculture system is just as industrialized as ours is.

            As long as consumers demand ever cheaper food (something for nothing), we will have massive environmental damage coming from the sector.

            The fact of the matter is that Westerners spend less money on food than ever before in history. This has spurred growth in other areas, but the race to the bottom (across the board) has been and continues to be a catastrophe for the biosphere.

      •  And newly approved treatments aren't used first (7+ / 0-)

        You know, the ones that still have patent protection and a 10,000% markup and are supposed to be second or third line treatments if and only if the old generic cheap proven treatment doesn't work for some reason or the patient is allergic to it.

        That's one of the reasons our medical system costs so much compared to theirs.

        New favorite put-down: S/he's as dumb as a flock of Sarah Palins

        by sleipner on Fri Dec 30, 2011 at 09:52:02 AM PST

        [ Parent ]

      •  There's even.... (4+ / 0-)
        Recommended by:
        glorificus, jazzizbest, taonow, chimene

        ....a fairly extensive ad campaign against the unnecessary use of antibiotics, pointing out that over-use promotes the development of super-bugs. The ads are all over the public transit system in Vancouver.

        When we are no longer children, we are already dead. (Constantin Brancusi) And whoever gave it, thanks for the gift!

        by sagesource on Fri Dec 30, 2011 at 10:15:31 AM PST

        [ Parent ]

    •  That downside (10+ / 0-)

      is exactly how my current health care plan works.  

      In fact my current plan is worse because I am automatically denied many drugs that could help me by my insurance because they simply take them off the list of drugs they will pay for.

      I'll bet the vast majority of people with health care insurance have the exact same issue.

      "If you tell the truth, you'll eventually be found out." Mark Twain

      by Steven D on Fri Dec 30, 2011 at 08:39:22 AM PST

      [ Parent ]

    •  Evidence-based medicine (4+ / 0-)
      Recommended by:
      ColoTim, i like bbq, dhcallahan, VClib

      is also used widely here in the states, because--surprise!--hospitals and insurers are interested in paying for what works, as well.

      Sometimes a .sig is just a .sig

      by rhubarb on Fri Dec 30, 2011 at 09:21:38 AM PST

      [ Parent ]

    •  I've got an itchy throat and low-grade fever... (4+ / 0-)

      ...but I'm putting off going to the doctor because I know what their answer will be--antibiotics.

      I'm self-medicating with neti, steam inhalation, and gargling with salt water.  I absolutely do not want some random pill!

    •  IAWTC (1+ / 0-)
      Recommended by:
      ChemBob
      Sounds like an asset to me, fewer resources sucked up paying for woo woo treatments that have no proven efficacy.
      I'm rather surprised that you weren't flamed by gullible alties for this.
      •  Most of us are also (0+ / 0-)

        do-it-yourselfers who rarely need someone else to pay for our alternative care, which is much less expensive in general than the high-ticket conventional "care" that counts on the bills being picked up by third parties.  No insurance admin costs passed on to patients, and no escalation of prices due to third-party pre-paid contracts (call it the "All-you-can-eat-buffet" Syndrome).  A model for what medicine COULD cost, if the distortions were removed from the market.  And mind you, alternative providers still have the incentive to recommend and provide all the treatment you can stand.

    •  Have you tried exercises for your (0+ / 0-)

      rotator cuff?  My doctor told me that was one option for mine, or I could do some exercises that should gradually help.  After a few months I got that arm's full motion back.

      It goes without saying, ask your doctor first.

      Never meddle in the affairs of cats, for they are subtle and will piss on your computer.--Bruce Graham

      by Ice Blue on Fri Dec 30, 2011 at 01:38:55 PM PST

      [ Parent ]

  •  Evidence based treatment. What a concept! (56+ / 0-)

    What we have in the US is a profit driven treatment system. They don't care if what they are giving patients actually works as long as it makes them boatloads of money. Also too, ignore all those pesky side effects which include DEATH.
    Thanks for the post.

    We have "Nobel Peace Drones" creating terrorists one hellfire missile at a time

    by pathman on Fri Dec 30, 2011 at 06:18:17 AM PST

    •  And something a friend just pointed out (38+ / 0-)
      not allowing routine off-label use of drugs seems to improve enrollment rates in clinical trials based on the higher rates of enrollment in countries that have this policy, Germany and France come to mind.  It also motivates the companies to do the trials … Why run them to test for efficacy in new indications if they are making money with off-label sales?

      That's something I hadn't thought about

      The future is just a concept we use to avoid living today

      by MetalMD on Fri Dec 30, 2011 at 06:27:13 AM PST

      [ Parent ]

      •  What do you think about off label use? (2+ / 0-)
        Recommended by:
        Rogneid, DRo

        It seems like it might be very risky.  

        I am an atheist for moral purposes. Seriously.

        by otto on Fri Dec 30, 2011 at 06:52:55 AM PST

        [ Parent ]

        •  There's no doubt it's risky (9+ / 0-)

          Taking any medication, even if it's proven efficacious (especially with cancer treatments), is risky.

          But in that same vein, if all other [evidence based] treatments have failed, sometimes off label use might be warranted, or even recommended.

          But then again, that's what clinical trials are for!

          The future is just a concept we use to avoid living today

          by MetalMD on Fri Dec 30, 2011 at 06:59:59 AM PST

          [ Parent ]

        •  off label use is extremely common (3+ / 0-)
          Recommended by:
          HugoDog, ladywithafan, Ice Blue

          and generally safe.  The label only includes indications for which the manufacturer got FDA approval- evidence based medicine can show off label benefits.   Eg. Did you get an epidural or labor- all the medicines used are "off label".

          Drug companies get a drug approved with the clearest and simplest indication..  Physicians can then study the drug in other indications, and the drug companies will never spend the oney necessary to add it to the label.

          As my father used to say,"We have the best government money can buy."

          by BPARTR on Fri Dec 30, 2011 at 09:30:43 AM PST

          [ Parent ]

          •  It gives useful flexibility, (0+ / 0-)

            true.  It's also hideously abused, as drug companies heavily promote off-label usage to both physicians and patients and the hard research isn't there to back it up.

            •  that is true- although (0+ / 0-)

              they aren't allowed to do so.

              As my father used to say,"We have the best government money can buy."

              by BPARTR on Fri Dec 30, 2011 at 05:48:22 PM PST

              [ Parent ]

            •  Drug companies do NOT heavily promote off-label (0+ / 0-)

              use. It is against the law and huge fines $100+ million have been levied, which has dramatically curtailed off label marketing. It is still done, certainly, but very much under the radar and they cannot be heavily promoted. Companies cannot even print any marketing pieces promoting off- label use.

              "let's talk about that"

              by VClib on Sat Dec 31, 2011 at 12:01:39 AM PST

              [ Parent ]

      •  Interesting. nt (1+ / 0-)
        Recommended by:
        SadieSue

        We have "Nobel Peace Drones" creating terrorists one hellfire missile at a time

        by pathman on Fri Dec 30, 2011 at 07:03:05 AM PST

        [ Parent ]

      •  Republished in Single Payer California (4+ / 0-)

        No wonder people go to Canada to buy drugs cheaper.

        Prescriptions drugs are a bit of a scam in the US.

        Daily Kos an oasis of truth. Truth that leads to action.

        by Shockwave on Fri Dec 30, 2011 at 08:30:21 AM PST

        [ Parent ]

        •  Note though.... (4+ / 0-)

          ....while prescription drugs are less of a scam in Canada, they're still a scam due to the way drugs are manufactured.

          Case in point: I was prescribed Dexedrine to counteract the side effects of some other medications I was taking. Dexedrine was first put on the market in the 1930s, with the research that led to the development of the drug going back into the 1890s, I understand. Because I am low income, I paid very little, but the company was still dinging the government about fifty cents a capsule. I asked my pharmacist how they got away with charging so much for so old and easy to manufacture a drug, and he simply shrugged and said, "There's only one company that makes it now." One supplier = set your prices as high as you dare.

          When we are no longer children, we are already dead. (Constantin Brancusi) And whoever gave it, thanks for the gift!

          by sagesource on Fri Dec 30, 2011 at 10:31:30 AM PST

          [ Parent ]

      •  viagra (2+ / 0-)
        Recommended by:
        cailloux, glorificus

        Here's an example of an off-label use.  Viagra was originally tested and marketed to improve blood supply to the heart, but one of the side effects was countering erectile dysfunction in men who suffered from ed due to their heart problems.

        It had already been approved for people with heart conditions, arguably a physically weaker group than men who suffer from ed for other reasons.  So if it was safe for people with bad hearts, it would generally be safe for healthier people.  [As an aside, it may be that the side effects could be bad, but not as bad as heart failure.  You have to balance bad side effects of a drug and what it cures.]

        Personally, the only depression drug(effexor which is also treating my eating disorder as an off-label use) that has worked for me has given me ed.  Viagra let's me have a normal sex life.  So I have a stake in this example. :)

        The higher enrollment rates in other countries may be due to other factors.  Our health care system is so broken compared to first world countries that any comparison might just be impossible.

        I can think of two reasons that companies would still do tests for off-label uses*.  

        Increased sales due to insurance coverage.  Generally, insurance doesn't cover off-label uses.  If it is a choice between drug A, covered by insurance, and drug B which is better but not covered, most people wouldn't pay the added expense.  

        Extending the patent on the drug.  If I'm an evil pharmaceutical company(redundant) and I have a drug that has an off-label use, then I'm going to tweak it just enough that I can get a new patent but not so much that I have to start the trials from scratch.  That way I don't lose sales to generics and I don't have to change my entire production process, just a tweak here and there.

        *I'm not saying this isn't evil.

      •  MetalMD - as we both know (0+ / 0-)

        drug companies cannot market for off label uses so they make a calculation of what a US trial would cost versus the additional sales that could be achieved if they had a specific label. The problem is that the costs of trials in the US are too high. The cost to approve a new drug or device in the EU is about one third the cost of approval in the US. That is why the most advanced drug and device therapy in the world are available in the EU, not the US. New products reach patients 2-4 years sooner in the EU.

        "let's talk about that"

        by VClib on Fri Dec 30, 2011 at 11:57:30 PM PST

        [ Parent ]

  •  Speaking as a Canadian... (93+ / 0-)

    there are issues with the health care system.  But, one has to remember, health care is managed PROVINCIALLY, so those problems are different across Canada.  In some places it's a shortage of specialists (especially in places with high elderly population--and YES, people do live much longer in Canada than in the US), in others is a shortage of generalists.

    The creeping power of the insurance industry is slowly eroding and chipping away at universal health care in Canada.  

    But, it is FAR better than anything you have in the US.

    At the moment, I don't get health care benefits at my work, so I'm on the public system in Quebec.  It costs me 600 dollars for an entire year of coverage.

    This covers medication, doctors visits, hospital stays, tests...everything except prescription glasses and dental care.

    Most of the crap they say about Canadian health care is Republican propaganda.

  •  Um, if you move to or "visit" Canada from the U.S. (8+ / 0-)

    are you afforded health care right away, or is there a waiting period?

  •  canadian innovation in medicine (23+ / 0-)

    I believe it's the very same hospital in Vancouver, if I am not mistaken, that recently announced a new treatment for all forms of cancer, essentially killing it and the same hospital which just announced a new innoculation against the AID's virus.

    Oh those damned "socialists"!

  •  Sounds sound to me! (12+ / 0-)

    Personally I've shifted to looking up and telling my DRs I want the oldest most tested medicines and to avoid the newest at all costs.. There's comfort in knowing something has long standing benefit and I don't have to worry about the 'rush to market'.

    There's a joke about the latest medicine...

       "You better hurry up and take it, before the side effects are known and it is removed from the market."

    Be the change you want to see in the world. -Gandhi

    by DRo on Fri Dec 30, 2011 at 06:45:14 AM PST

  •  Isn't the real question the value of drug trials? (8+ / 0-)

    Avastin and so many other drugs may show promise in clinical trials, but it's only when they're more widely available that we find out how well they work in the general population.

    I'm not a doctor, but it seems to me that we keep hearing about findings of studies that do not bear out when repeated by other scientists. That seems to also hold true for a number of drugs that do seem to hold their promise through clinical testing -- not just in Phase I -- but only after years of widespread use do we get a fuller picture.

    Coming Soon -- to an Internet connection near you: Armisticeproject.org

    by FischFry on Fri Dec 30, 2011 at 06:45:47 AM PST

    •  Agreed! Completely (6+ / 0-)

      But as I pointed out in a previous comment,

      where's the incentive to do a clinical trial if you're making money with off label use?

      The future is just a concept we use to avoid living today

      by MetalMD on Fri Dec 30, 2011 at 06:52:22 AM PST

      [ Parent ]

    •  clinical studies have limits to what evidence they (6+ / 0-)

      give you.  Further, you seldom find studies which are equivalent to real life.  People are on multiple medications that seldom get studied with other medications.  e.g., hypertensive and diabetic medications.  Further, more rare side effects will be more likely to not appear until thousands of people are treated.  What is being discussed is cost effectiveness and comparative studies.  These are different than safety and efficacy studies done for FDA.  

    •  Trials have limits, but replication not the issue (8+ / 0-)

      With very few exceptions, a New Drug Application must be supported by at least two separate Phase 3 clinical trials.

      The problems that occur post-approval relate to efficacy versus effectiveness. That's where the limitations of the traditional clinical trial become apparent.

      Even Phase 3 clinical trials have pretty restrictive inclusion and exclusion criteria. Participants are cherry picked. Results of these trials are said to demonstrate (or not) efficacy.

      But when drugs are approved for general use, patients have comorbidities. Some have limited literacy or just don't understand the importance of following instructions precisely. Some have trouble paying for their meds so can't take them consistently  ... .

      What really matters is how a drug holds up in the less-than-perfect real world. This is called effectiveness. And prior to approval, we do nothing to test it.

      There is a Phase 4 category, which is post-marketing surveillance.  As the name implies, these studies are conducted only after the drug is approved for general use (and only if the FDA mandates them). Vioxx was pulled as a result for Phase 4 findings.

      There is no "Phase 5" in actual practice, but some researchers use this term to refer to studies of effectiveness vs. efficacy (aka translational research). They investigate the integration of health care innovations (including, but not limited to, new drugs) into general practice.

      I think there should be some kind of effectiveness trial with a wider variety of participants prior to FDA approval. Of course the downside to that is slower approval. But drugs are marketed in the real world, not in a pristine research environment. As you noted in your comment, the real world results can be dramatically different.

      Just because you're not a drummer doesn't mean that you don't have to keep time. -- T. Monk

      by susanala on Fri Dec 30, 2011 at 07:40:25 AM PST

      [ Parent ]

      •  susanala - US trials are already too long (0+ / 0-)

        and too expensive effectively pricing out all competition except for big pharma and big biotech. Small and medium sized drug and biotech companies are being driven out of business by the FDA. In the EU they bring new drugs to market 2-4 years sooner that in the US, with comparable safety.

        "let's talk about that"

        by VClib on Sat Dec 31, 2011 at 12:13:33 AM PST

        [ Parent ]

    •  I wonder how much of the "promise" in trials (4+ / 0-)

      may be induced by pressure from the executives of drug companies to get the drug to market? In the global corporation where I worked, financial analysts were under great pressure to provide the "right" answer to support the decision already made upstairs.

      “when Democrats don’t vote, Democrats don’t win.” Alan Grayson

      by ahumbleopinion on Fri Dec 30, 2011 at 07:50:29 AM PST

      [ Parent ]

      •  This happens in lots of lab testing that meets EPA (3+ / 0-)

        regs too.  The last wastewater plant I worked at required testing of the water at the end point. We were required to deliver a near zero result whether it was or not. If it wasn't we had to recollect until we got a sample that met that requirement. Refusal to do so would lead to harassment and eventual firing for cause.

        When I worked in medical labs there was less jiggling unless it was to meet accreditation requirements.

        Fear is the Mind Killer

        by boophus on Fri Dec 30, 2011 at 10:04:00 AM PST

        [ Parent ]

      •  Less from outright pressure (0+ / 0-)

        and more from placebo/psychological effects.  Academic doctors don't respond to pressure from executives.  And as a former IRB administrator, I can assure you that my overworked answer to any pressures I got from drug companies was usually "Shove it, wait your g-ddmnd turn in line."  But docs DO respond to glowing pre-study synopses and research reports that assure them they are getting in on the ground floor of the Great New Thing in treating whatever their specialty is.  They have limited time, so a snappily-prepared summary that glosses over the potential problems is usually accepted at face value.  Investigators will lobby unmercifully for the removal of risks from clinical trial consent forms under the claim that they "don't want to alarm the patient" about . . . well, about anything.  Frankly, they think that anything that puts a potential participant off from joining a study is obviously unnecessary and alarmist.  Nobody gets hurt by Phase II-III trials, right?  If they have an adverse effect, you just drop them from the drug.  If you can't convince them that it's really trivial and get them to keep on, that is.  Losing subjects is bad for the study.  Similarly, once an investigator is committed, he/she/it will evaluate patients and results with the rosiest of rose-tinted glasses.  They WANT these things to "succeed", and Success isn't discovering the "truth", it's discovering a Cure.  Despite double-blinding, most patients and doctors quickly form ideas about who is on the active or new drug, and this affects their interpretations of any signs or symptoms that are subject to interpretation.  Which is pretty much all of them.  Blinding only helps; it can't eliminate the effects of investigator and patient bias, which are usually 100% positive towards the experimental treatment.

  •  In an ironic turn, hip implants... (5+ / 0-)

    So there was an article the other day reporting that hip implants are going to end up being the next big cost when it comes to medical care.

    The reason is that the metal on metal joints that are installed in the patient seem to wear very rapidly.  It is metal on metal, after all.  

    The irony in this is that hip implants are the main argument that conservatives use when it comes to claiming that the Canadian system rations care.  

    They always bring up some senior who had to wait 4 months to get a hip implant.  

    Hmmm, so you think they might have done some evidence based research on that in Canada?  

    I'm guessing that hip implants will be less ubiquitous in Canada, and as a result, they will not feel the same financial impact that we do.  

    I am an atheist for moral purposes. Seriously.

    by otto on Fri Dec 30, 2011 at 06:51:35 AM PST

    •  So, I'll jump in here and say that I support (3+ / 0-)
      Recommended by:
      erush1345, cailloux, VClib

      single payer in a very big way. It's the best system there is to my knowledge.

      That said, here's a non-repub rationing anecdote.

      Brother Lippy, a long-time Ottawa resident (about 4 decades) has kidney pain. Blood in urine. Long wait list to get diagnostic tests done. Eventually, a couple of months later, he gets the tests and he's got a >2cm stone. Pain is bad some days, not so bad on others, and the sporadic blood continues.

      He was told it would have to be removed surgically because of its size. Can't bust it up with ultrasound (lithotripsy). The wait for removal is 6-8 MONTHS! Because it's elective surgery.

      So he's going to experience serious, debilitating pain for many, many days, have blood in urine, etc., for almost another year. The system should work better than that, and it usually does. Not sure of the reasons for the long wait in his particular case, but he's making significant efforts to find a work-around, perhaps looking at other hospitals in the general area to see if he can move up in the line.

      Not the same as DENIED by a big insurance company, but not good, IMHO.

      So it ain't a bed of roses in some cases, although for the most part, it's far better than our profit-driven system.

      Just trying to be a vote of caution here. Vigilance is always called for.

      Fear is the mind-killer - Frank Herbert, Dune

      by p gorden lippy on Fri Dec 30, 2011 at 08:48:37 AM PST

      [ Parent ]

      •  People don't like those long waits (0+ / 0-)

        One solution that he bean counters never seem to find is to open the outpatient clinics for procedures like this, 24/7.

        There are not many people who would gripe about a 2am appointment if it meant getting treated faster.

        The hospitals are open 24/7 regardless so why not have them up at capacity the whole time?

        Mobile apps for small and local business MoLoSo

        by Bionic on Fri Dec 30, 2011 at 09:42:46 AM PST

        [ Parent ]

        •  I have to wonder about his doctor. (1+ / 0-)
          Recommended by:
          historys mysteries

          It's a bureaucracy, of course, and a certain amount depends on whether you have a doctor who can work the system in your favor. My mother's old doctor was like that: she and my late stepfather never waited for anything, since their doctor knew everyone and more important, everyone seemed to owe him favors. It didn't make a difference to billing, of course, but it was noticeable when it came to speed and convenience.

          When we are no longer children, we are already dead. (Constantin Brancusi) And whoever gave it, thanks for the gift!

          by sagesource on Fri Dec 30, 2011 at 10:50:51 AM PST

          [ Parent ]

        •  Hospitals might be open 24/7 (0+ / 0-)

          but doctors and nurses do have to sleep.

          There are not enough docs to do elective surgeries at 2 am, and no doc or nurse is going to want to do this.

          Also, do you want your elective surgery done by docs and nurses who have been up all night?

          •  It's not all elective surgery (0+ / 0-)

            Many procedures are done by techs and other medical professionals and many of them work around the clock.

            My sister assists in cardiac surgery amongst other things and they can have incredibly long days or days that go long into the night.

            You do know they do shift work too?

            Mobile apps for small and local business MoLoSo

            by Bionic on Fri Dec 30, 2011 at 04:52:23 PM PST

            [ Parent ]

            •  Right (0+ / 0-)

              If you are having a heart attack and need emergency surgery (CABG), there will be a cardiac surgeon (and team) there 24/7. Also, if a cardiac (or other) surgeon is doing a complicated procedure that takes 10-15+ hours, they will stay there to get this done.

              However, I think this diary was talking about a kidney stone that could wait. Not pleasant, but not an emergency (not life-or-death).

              Again, docs (and team) do need to sleep sometime. There are not enough docs to run everything 24/7.

      •  Our system triages; (3+ / 0-)

        a kidney stone, while painful, will probably not kill you.

        Those with more serious illnesses get treated first.

        I had a tumor in my thyroid removed in 2 weeks in Canada (luckily, it turned out to be benign).

        My partner's heart attacks get treated right away.

      •  lippy - as someone who has had kidney stones (1+ / 0-)
        Recommended by:
        p gorden lippy

        I don't think I could wait months to be treated.

        "let's talk about that"

        by VClib on Sat Dec 31, 2011 at 12:16:34 AM PST

        [ Parent ]

  •  Beat these costs (8+ / 0-)

    A single person making over 30k pays $60/mo.  A couple pay $109/mo.  A family of 3 or more pay $121/mo.  Drugs cost 1/4 to 1/3 of prices here.  There are subsidies for incomes below 30k.  Everyone is covered.  The same level of care is available to all.
    "Obamacare" now consists of 50 different state plans for most of us.  I think you can still move to the state you want.  There is another, better plan for members of Congress and the WH.  What could possibly go wrong?

    •  He (5+ / 0-)
      Recommended by:
      little lion, Losty, rsie, Chi, Hayate Yagami

      is unbelievable. We could have had great single payer or even a public option. But no, he gave us crap which is getting worse with their caves as the  months go by from his "victory".

      I sit here typing this sick, sick for 7 days now and scared to go to the doctor for the money it will cost even a I pay a fortune every month is what is called health insurance.

      Shouldn't have even looked at this diary. Obamabloodsuckers care is more accurate.

      •  I'm sorry you're sick.... (3+ / 0-)
        Recommended by:
        Sylv, historys mysteries, VClib

        ....but you also seem to be a bit delusional. Since when did the Executive Branch write and pass legislative bills?

        The only way Obama could have decisively denied you single payer or a public option would have been by vetoing the legislation for such. Did he?

        Perhaps you'd have a better health care system if you put the blame where it belongs instead of thinking the Presidency comes with a magic wand.

        You want single payer? Get it set up in a few states first. That's the way it happened in Canada, after all, at the beginning with a single province limiting hospital charges to a dollar a day. I'm sure there were people back then too who said this was a rotten compromise and useless, but we didn't listen to them, thank goodness.

        When we are no longer children, we are already dead. (Constantin Brancusi) And whoever gave it, thanks for the gift!

        by sagesource on Fri Dec 30, 2011 at 10:56:50 AM PST

        [ Parent ]

    •  Not much difference in the pricing for healthy (0+ / 0-)

      people in the US, under private plans. The value comes from not having debilitating deductibles, caps, and exceptions for pre-existing conditions.

      Justified anger does not grant you unrestricted license.

      by GoGoGoEverton on Fri Dec 30, 2011 at 08:24:54 AM PST

      [ Parent ]

  •  Another counter: (6+ / 0-)

    is the best drug to treat your illness the one with the most money spent generating sales on  it, via advertisements, sales pushes on doctors, and even paying doctors to attend symposiums to tout the benefits of it?  

    Republicans: if they only had a heart.

    by leu2500 on Fri Dec 30, 2011 at 07:11:15 AM PST

  •  Canada vs U.S. (9+ / 0-)

    One agency determining if a treatment has efficacy and works better.

    vs.

    Several entities each determining if a treatment produces better profits.

    ...

    And people are surprised when the pharma companies mostly produce sleeping pills and erection aids.

    What we have now strongly parallels the financial industry: it promotes devious (spun as "innovative") ways to get cash while creating as little real value as possible.

    "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

    by nosleep4u on Fri Dec 30, 2011 at 07:11:24 AM PST

  •  Speaking critically (11+ / 0-)

    Of the Canadian system, I think from the numbers (% of GDP, etc) it is probable that the French and Japanese systems perform better.  I'm not really 100% sure why though.  

    For one thing we do have a very far flung and frequently low density population.  It costs a lot to deliver care to small numbers of people distributed very widely in remote regions.  I don't know how much in the aggregate this costs us, but it has to be noteworthy.

    As David K noted above, we also have the magnet of the US draining away some of our top medical talent, particularly specialists.

    Then of course we have a very similar car-centric low activity suburbs-and-fast-food lifestyle/culture to the US - our obesity rates are significantly lower than the US, but still quite high compared to France or Japan.  

    So there is other stuff going on, but I only say this so that American liberals consider the other universal care models.  Our model works a lot like Medicaid (Provincially delivered but with significant funding support from Ottawa) but it isn't the end all of discussion.  The key is to provide universal public care free of market incentives to screw patients for profit.  Single payer is one way to get that, but there are others.  

    Obamacare probably won't work longterm.  I think it's better than the status quo, but not enough better to reach some kind of long term equilibrium on the health care question.  America will probably have another big health care fight in at most 10 years.  It's worth seeing the Canadian system's flaws as well its merits.

  •  Greed (5+ / 0-)

    Canadian doctors want to get bribed by drug and medical device corps to prescribe them, and the extensive diagnostic testing that comes with them whether they prescribe them or not, the the way US doctors get bribed.

    The Canadian health finance system is better than its US counterpart. Some Canadian doctors are no better than their US counterparts. Greed knows no boundaries.

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Fri Dec 30, 2011 at 07:19:49 AM PST

  •  The stuff about being hard to find a doc IS true (5+ / 0-)

    Im moving to Canada next year with my wife who already lives there. She's been there for about a year and a half and STILL can't find a regular doctor. She is on multiple practice's waiting lists for a regular family doctor. When she does need to go, she goes to a walk-in clinic... but that obviously isn't the same level of treatment one would get with a regular doctor.
    I've actually talked with people there and this really IS a widespread problem. It's hard to see most doctors and you really don't have to go too far to find a horror story.

    However, there is an apparently easy fix for this. As most of us Americans know, when you go to the doctor, that doctor has a PRETTY good chance of being from another country.
    Same goes for Canada, but... Canada apparently has a law where doctors from many countries need to be recertified or retrained. This is an apparently expensive process that takes at least two years and, as a result, means many otherwise qualified doctors wind up working menial jobs in the meantime or just giving up, instead of opening a new practice. As a result, it becomes hard to find a doctor.

    Si the rightwing fear mongering is true – there really is a shortage of doctors in Canada.
    What's not true is that it has to do with Canada having a single payer system.

    My style is impetuous.
    My defense is impregnable.
    YOU'RE NOT ALEXANDER!

    by samfish on Fri Dec 30, 2011 at 07:21:42 AM PST

    •  Actually, the 'walk-in clinics' are staffed by (6+ / 0-)

      "regular doctors". That's how we found our family physician in Vancouver. And he was from India. And outstanding. We were always able to see him within a day or two. My specialist was from Scotland. What province is your wife in?

      •  And medical records are electronic. (0+ / 0-)

        Any doctor you see is going to have your file.

        I suspect one reason for the extensive retraining is that it's partially a scam to make doctors more money. They get to restrict the supply of new doctors AND charge for helping with the retraining. What's not to like? < /snark>

        I know of one GP here who runs what we sarcastically call a "puppy mill," retraining foreign doctors who are already trained and need nothing but an introduction to the ins and outs of the Canadian system. I bet he makes a killing out of it, too.

        When we are no longer children, we are already dead. (Constantin Brancusi) And whoever gave it, thanks for the gift!

        by sagesource on Fri Dec 30, 2011 at 11:02:11 AM PST

        [ Parent ]

    •  It has a lot to do with xenophobia also... (2+ / 0-)
      Recommended by:
      Involuntary Exile, Ice Blue

      I knew a Mexican pediatrician who had practiced in Mexico CIty for 20 years.  They wouldn't even let this woman work as a nursing assistant.  She was working as a maid in a hotel!

    •  make sure you file in both countries every year. (8+ / 0-)

      Look into the taxes, you will need to find a  tax accountant that know both systems. THERE IS A DEPARTURE TAX should you return to the U.S. all assets are considered sold and then taxed on that value.
      Look before you leap.
      Canadian taxes are high to cover the health system.  Canadians don't complain about it, because remember these are the folks who supported the King during the Revolutionary war.
      They believe in paying for good government.
      Make no mistake about it Canadian taxes are high.  One way or the other you have to pay for the health care system.  They whack you at tax time but then you get to see the doctor whenever.
      Just that, then you don't have to worry about stuff.

      "How quickly these kids have affected the public dialogue. So proud of them." Clarknt67

      by TexMex on Fri Dec 30, 2011 at 07:46:33 AM PST

      [ Parent ]

    •  but we have shortages here also (13+ / 0-)

      It took my 3 years to find a pediatrician i liked for my kids. My daughter has epilepsy and our appoinments to see her nuerologist take 2-4 months to get. I dont know anyone who can see a specialist in the US without a 2-3 month wait. That's silly to act like we have immediate access.

      compassion for things i'll never know ~ david byrne

      by little lion on Fri Dec 30, 2011 at 07:46:39 AM PST

      [ Parent ]

      •  It takes us 3 months to get appointments (12+ / 0-)

        for physicals with our US doctor, but she is very good so we just try to plan ahead. In Canada, we could see our doctor within a few days to a week for physicals and same-day if we were sick. Because employers don't have to pay for healthcare premiums, many of them offer prescription drug benefits - we never paid a dime out of pocket for prescription drugs (and yes, the retail price difference on many meds is enormous) and I think the premium for that was about $7 a pay period or $14/month.

      •  And it's for the same reason. (2+ / 0-)
        Recommended by:
        cpresley, Sylv

        The US does not recognize medical licenses from other countries automatically. The procedure is very similar to the one described for Canada.

        I work in public health myself, but there's a med school and teaching hospital on our campus.  Immigrants have to pass phasess 1-3 of the US Medical Licensing Exam, and most states require at least 1 year of supervised US training. Specialists may have to re-do their entire residency at a US facility.

        Just because you're not a drummer doesn't mean that you don't have to keep time. -- T. Monk

        by susanala on Fri Dec 30, 2011 at 09:42:09 AM PST

        [ Parent ]

        •  Many (0+ / 0-)

          if not  most other countries have a completely different system for training physicians, so their "MD" and ours aren't directly comparable.  I helped hire "post-doctoral fellows" at our lab for years; while in the US this meant a person with a 4-year undergraduate degree plus a 4-year graduate degree, Chinese, Latin-American, and many Indian "doctors" had a total of 5 years of post-secondary school rather than 8.  Big difference of time, money, and training.  Not that I wouldn't just as soon get basic treatment from someone with a 5-year degree and a hell of a lot less Attitude than American MD's carry around, unless I need surgery on critical abdominal organs.  Fact is, I'd rather have surgery done by my old friend the vet -- I KNOW what she's capable of putting back together after a car smashes into it; she used to regale us over medieval dinners with the specifics.  But there is some justification for not considering the degrees equivalent.  Foreign docs have usually received a lot more practical training and a lot less theory they'll forget by their second year of residency.

    •  Depends where you are (1+ / 0-)
      Recommended by:
      lurkyloo

      Also if you go the the same walk in clinic the same doctors have scheduled clinic hours so yes even at a walk-in you could see the same doctor each time.

      It took me a bit to find a doctor, I moved 15 mins down the road and found one really quickly maybe in a week or two.

      The recert program for doctors from other countries generally only applies to countries where the medical board in Canada doesn't recognize the education as being at the same level as here in Canada.   SO yes if you come from England you'd have an easier path then if you came from India.   But the path is shorter for those that write qualification exams well.

      So no it isn't as bad as the right wing says....and yes I'm sure you could find some horror stories regionally.

      Canadian amazed by and addicted to US politics.

      by Mikecan1978 on Fri Dec 30, 2011 at 08:12:46 AM PST

      [ Parent ]

      •  and in the United States (2+ / 0-)

        I'd bet that at least 50% of us nationally have some sort of horror story whether from denied payment, dropped insurance, no insurance, no access to healthcare because of no insurance, inability to afford prescribed drugs, etc. Hopefully the ACA is indeed a foot in the door to single payer universal healthcare here.

  •  I will be a user of Canadian HC in about 10 yrs (11+ / 0-)

    When I retire, its off to Canada for part of the year and down to Mexico for the winters. Its not that expensive down there.

    As for the US, I refuse to continue to live in a country that demeans and degrades its own citizens.

    My Dad is very ill right now. My parents have Anthem insurance. They are on the hook for over $5,000 so far, which is manageable. If Dad has to be placed into a retirement facility, then all bets are off. Their income and savings - my inheritance - will go to the insurance companies.

    My college age kids are dual citizens and are hoping to move to Canada upon graduation. Canada isnt perfect, but the US is becoming a epic hellhole.

    "Seems like too many people in this country would rather be fucked by business (in many cases repeatedly) than helped by government." BF

    by A Runner on Fri Dec 30, 2011 at 07:27:02 AM PST

    •  as noted above, when your kids go back... (1+ / 0-)
      Recommended by:
      Chi

      The United States does not really recognize dual nationals but accepts that people may need to be in such situation.  So U.S. citizens shoud file every year  on world income. A good accountant will have to work with both Canada Revenue and the U.S. Tax system in order to file in both countries.  There are tax treaties that interact.

      plus provincial requirements of 6 months and a day consecutive living inside the province before healthcare is effect

      "How quickly these kids have affected the public dialogue. So proud of them." Clarknt67

      by TexMex on Fri Dec 30, 2011 at 08:14:40 AM PST

      [ Parent ]

  •  We lived in Canada for 3 years and found the (7+ / 0-)

    healthcare system to be wonderful. And we have some issues in our family that require meds and certain specialists. Never a dime out of pocket. Excellent care. People who demonize Canadian healthcare as a whole (obviously there will be problems in any broad system) are wrong. Period.

  •  What this demonstrates is that there are (4+ / 0-)
    Recommended by:
    rsie, valion, nextstep, VClib

    downsides to the Canadian health care system.  

    There are significant downsides to ANY healthcare system.  To pretend that one system -- single payer, for example --  is a panacea that solves all problems without creating any down side is just foolish and unrealistic.  I would never listen to a politician who preached that single payer would solve all problems, everything would be great, there would be no downside -- it would be obvious that (1) he or she does not know what he or she is talking about, or (2) he or she is deliberately misleading the voters.  

    Of course, there are also significant downsides to the health care system we operate under now, as well as significant downsides to the system we will have once the ACA fully kicks in.  Those have been discussed here over and over. We simply have not devised a way to have a health care system where (1) the out of pocket costs for everyone are kept low; (2) everyone gets as much health care as he or she wants; (3) everyone gets to see a doctor, or specialist, or get optional procedures, immediately; (4) there are significant financial incentives for people to spend a decade or more of their lives trying to become doctors; (5) there are significant financial incentives for private industry to innovate and try to develop experimental treatments and drugs (6) the overall spending by the government to support the system is kept under control for the long term (7) health care decisions are completely in the hands of the doctor and patient without oversight by a centralized body on which procedures/drugs will or will not be paid for.   (I could go on and on about things people want from a health care system.)  

    The bottom line is that, when a politician talks to me about changing the health care system dramatically, this is what I want to hear: we know there are significant problems with the system we have; we also know there are problems and downsides to any major overhaul; here's our proposed system; here are what we anticipate the upsides and the downsides will be; we believe that, considering the upsides and downsides, what we want to move to is better than what we have for these reasons; here's how we will take advantage of the upsides of the new system;  here's how we will try to ameliorate the anticipated downsides to the new system.

    Unless someone is realistic about things, they carry little credibility with me.  

    •  Any universal system will have problems... (2+ / 0-)
      Recommended by:
      Mikecan1978, VClib

      predicting demographic changes, even in Canada where you have a census ever 5 years instead of every 10.

      It's very hard to predict where needs will be and its even harder to train doctors and nurses accordingly.

      •  Exactly. Which is why pretending that single (5+ / 0-)
        Recommended by:
        nextstep, erush1345, BoxNDox, cynndara, VClib

        payer solves all problems (as some people here do) is just ridiculous. Yes, we have significant problems now.   Every time there's a diary on the health care system, there are always some posters saying (in essence), "single payer!  It fixes everything!"

         Yes, moving to something like single payer will also mean problems -- just different ones. If you want single payer, you have to convince the public that the problems it will bring are better than the problems we have now.  

        People need to look at any major change to the system with their eyes wide open.  

        •  Single payer would be far better for poor... (3+ / 0-)

          minorities, women and children in particular.

          This is why the Republican elite hates it.

          •  Sure, it would be better for those who don't (3+ / 0-)
            Recommended by:
            erush1345, cynndara, VClib

            have health insurance now.  There's no denying that.  

            But it's just silly to pretend that it has no downside for anybody.  

            That's why anybody who tells me "single payer solves all problems" has no credibility.  Someone who says, "single payer is better than what we have for these reasons, it has these problems, and this is how we'll deal with those problems" is somebody I'll listen to.  

            •  Single payer does not solve all problems, but... (3+ / 0-)
              Recommended by:
              cpresley, Calamity Jean, cynndara

              I think it makes it easier to get a handle on many of the problems we have.
              To give a couple of examples:  Right now, for all sorts of reasons, most Americans are ensured by many different entities over the course of their lives.  Preventive health care pays off very well, but the pay-off is long term.  So if your insurer spends money on better control of your blood pressure now, it's likely some other insurer will reap the savings.  A single insurer over the course of your life changes the financial incentives for the better.

              Also, the Medicare records provide some of the most powerful data sets we have for studying all sorts of health questions.  Things like: Do people who get more money spent on their health care live longer?  But we only have that massive data set available for Medicare patients - all the private insurers consider their versions of that data to be proprietary and don't share it.  So many questions would be easier to answer if we had comparable data available on everyone.

              Finally, speaking from the provider perspective: The massive amount of spending that is created solely by having a multi-payer system actually would be solved by having single-payer.  Every hospital and every doctor's office employs people to negotiate the maze of different payment forms, different coverage rules and different billing procedures of the various insurers - both governmental and private.  Just having a single set of rules really would produce big savings just on that process.  Of course there would still be the constant ongoing fight to make sure they were the right rules, but at least there would only be one set.
              So, single payer doesn't solve all problems by any means - but it does make the process of solving a lot of the problems easier and more manageable.

              "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

              by Chico David RN on Fri Dec 30, 2011 at 09:59:23 AM PST

              [ Parent ]

              •  While this may be true, it also generates problems (1+ / 0-)
                Recommended by:
                VClib

                of its own.  That's my only point.

                I completely welcome a discussion of the benefits of single payer.  All I am saying is that a realistic discussion has to include the detriments as well.  

                What I see most often from supporters of single payer is a discussion of benefits with no acknowledgement whatsoever that there is ANY downside.  And there clearly is -- going to single payer would be a trade-off, where we give up some things in certain areas to get things in others.  

                For example, most discussions of single payer talk about things like some limits on payments to doctors.  (See, above discussion of Canadian doctors, especially specialists, making significantly less in Canada than the U.S.)   The unrealistic approach is "They make too much money!  Let them take less!"  The realistic approach is:  "is this going to affect the number of people who go to medical school and the number of doctors we produce?  Let's at least consider that."   It may well be that we think the numbers are small enough that we can manage without fewer doctors, or that we can do things to ameliorate the fact that less financial compensation will reduce the number of people willing to devote a decade of their lives to school and the 80 plus hour work week under extremely stressful conditions that it takes for my dad's heart doctor to do what he does.  So let's at least consider that, consider what kind of numbers we're talking about, and consider whether other steps have to be taken to address that.   That's just one example.  

                Again, I am not arguing against single payer.  I am arguing against people who pretend that single payer will solve all problems without generating any of its own.  I am arguing in favor of a realistic debate of the pros and cons of any single payer proposal.    

                •  That's an interesting example (2+ / 0-)
                  Recommended by:
                  historys mysteries, cynndara

                  According to what most of the policy wonks think, and compared to the countries that get better results for sure, we have a moderate excess of specialty docs and a severe shortage of generalists.  I think what most people would say who look at it closely, is that we overpay (relatively) for procedures and underpay (relatively) for office time.  And our medical education is way too expensive (like all of our higher education, more and more).
                  The French system - which just on results and rational incentives is aguably the best in the world - has a far higher number of physicians per capita than we do - even though they pay them less - because they make medical education cheaper - much cheaper.  Still hard, still demanding, but not expensive.  And they have a much better balance of generalists to specialists than we do.  
                  The relative excess of specialists here means that we get more of what specialists do - expensive tests and procedures - and less of the best bargain in medicine: the doctor taking time in the office to talk to the patient about his health, his choices and his behavior.
                  So, based on the comparison to countries that get better results for a lot less money, having fewer specialists and more generalists would be a very good thing.  And even among the specialists, we should re-balance the financial incentives to make time in the office with the patient a lot more rewarding and time in the cardiac cath lab a little less so.
                  Cariology is the field I work with and I know that over and over, patients get the more expensive treatment or drug because the less expensive one requires more time discussing and educating the patient and that time doesn't pay at all well.  
                  There is also the interesting divide between the care people want and the care people need - not always the same.  
                  Here's an interesting one I see pretty much every day.  60 year old guy is out mowing his lawn and has chest pain.  A couple days later, he's climbing stairs and it happens again.  He goes to his doc who sends him to a cardiologist.  The cardiologist does a stress test, which turns out positive.  The pateint goes to the cardiac cath lab.  They find a single artery 90% blocked.  They put in a drug-eluting stent.  The doctor is happy, the patient is happy, the company that made the stent is extremely happy - maybe $10,000 happy just for one stent, a lot of patients get more than one - the hospital is happy (big charge).  So what's wrong?  There is a vast body of data going back many years showing that patient does no better with the stent than with medical treatment.  Different story if the patient came in having a heart attack, or if there were multiple arteries blocked.  But the evidence is clear that the patient in this scenario - tens of thousands of them a year - does no better by having that artery opened.  And in all the other rich countries with good health care technology, that patient would likely get medical therapy and do just as well for a lot less money.  But one of the reasons doctors don't do that here is that they would end up spending a bunch of time explaining the medical therapy to the patient, explaining why, yes you have a blockage, but no we aren't going to fix it and here's why.  And they wouldn't get paid worth a damn for all that explaining, while they get paid very well for putting in the stent.   Sometimes less care is better care - or at least no worse.

                  "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

                  by Chico David RN on Fri Dec 30, 2011 at 11:32:15 AM PST

                  [ Parent ]

                •  The surgeon who removed my thyroid (1+ / 0-)
                  Recommended by:
                  historys mysteries

                  had an income of well over a million bucks in 2009 (in BC)....

                  he's very happy with his compensation.

                  How much should a surgeon get paid?

          •  David - will it be far better for people (1+ / 0-)
            Recommended by:
            coffeetalk

            with good health insurance? My guess it that it will not be and THAT is the reason the Republicans don't support it.

            "let's talk about that"

            by VClib on Fri Dec 30, 2011 at 08:02:25 PM PST

            [ Parent ]

        •  You're right , single payer is not the answer (2+ / 0-)
          Recommended by:
          cpresley, cynndara

          All single payer will do is eliminate the extra 20% [or so] that is taken out of the current health care system as profit for the health insurance industry.

          It will definitely reduce the cost of health insurance in the short term, but it doesn't address the long term underlying problems of an aging population, demanding more health care, unnecessary testing and procedures (because health care providers don't get paid for doing nothing), and fraud.

          It's fee for service medicine that is the real culprit, and the only answer is what so many people dread to say "socialized medicine", where doctors are all paid a salary.

          Anything short of that will not solve the problem

          The future is just a concept we use to avoid living today

          by MetalMD on Fri Dec 30, 2011 at 10:07:13 AM PST

          [ Parent ]

          •  And does that reduce the numbers who (1+ / 0-)
            Recommended by:
            VClib

            go to medical school and become doctors, especially specialists?  

            For example, I have nothing but admiration and respect for my dad's heart doctor.  I know he's essentially worked miracles over the years and given us years with my dad that we otherwise would never have had.  But he devoted a decade or more of his life to preparing for that, plus he works extremely long hours -- there are many, many times when my dad has been there for him to perform a procedure at the crack of dawn, and he's seen him later that evening (8 p.m, or later) making rounds in the hospital.  How much is that "worth"?  And how do we set that amount so that the best and brightest go into medicine and become those kinds of doctors instead of other areas where they can make more money?

            Sometimes the "greed" motive does, in fact, contribute outcomes that we want.  Some people are motivated by money to do things like become doctors or innovate in health care, like money contributes to the incentives in other areas.  

            My point is not to say that "socialized medicine," where doctors are paid a salary, is or is not the answer.  It's just that, before I'd sign on to that, I'd want information on how to manage the fallout of that.

            •  Are you sure there will be a fall out? (0+ / 0-)

              Are there doctor scarcities in France, Germany or the myriad of other countries that have socialized medicine?

              I can't answer that with any evidence based facts, but my gut feeling is there isn't. Some have indicated there are shortages in Canada, but how many Canadians are going without health care [compared to that in the US]?

              And what would you think would have been a fair salary fot the doctor you described, $100,000, $200,000........$1,000,000?

              I don't really think that would be a problem!

              The future is just a concept we use to avoid living today

              by MetalMD on Fri Dec 30, 2011 at 10:32:30 AM PST

              [ Parent ]

              •  My gut tells me we'd lose some doctors (1+ / 0-)
                Recommended by:
                VClib

                at salaries of, say, $200,000.  A lot of other professionals without as much schooling and debt (CPA's, engineers, architects, for example), and without the onerous day-to-day situation can get to that level. I'd think it would have to be higher, especially when you consider the amount of debt many have to incur to go to medical school, and the malpractice insurance costs.  How many we'd lose at that level, I don't know.  In those other countries, do individuals have to pay the kind of high college and medical school costs that they do here?  What about malpractice insurance?  How many doctors we'd lose, I don't know.  And where the "sweet spot" is salary wise, I don't know that either.  

                Like you, I'm only guessing.  We both would need exactly what you said -- evidence based facts.

                My point is that doing a discussion of socialized medicine WITHOUT those kinds of evidence based facts is meaningless.

                •  Debt is the crux of it, I think. (1+ / 0-)
                  Recommended by:
                  VClib

                  If we change the pay scheme for physicians, we must also change the mind boggling cost of a medical education. Another commenter noted above that France has no shortage of doctors despite limits on doctor pay ... but France also heavily subsidizes medical education.

                  I work on a medical campus. In-state students at this public university pay almost $23,000 per year just for tuition. You may want to sit and hold on to something sturdy for the out-of-state price. $59,000 per year.

                  Tuition rises substantially each and every year due to dwindling state subsidies. Textbooks can run several hundred dollars apiece. Incidentally you need food, clothing, and a place to lay your head. Then there are nagging little things, like stocking your "black bag," that add up over time. The total bill is astronomical.

                  I think we'd also have to change the mentality about what doctors are charged for supplies and services. The attitude now seems to be that "doctors can afford it," even if there is no valid reason to charge the doctor's office more than some other kind of office for a similar item or task.

                  Just because you're not a drummer doesn't mean that you don't have to keep time. -- T. Monk

                  by susanala on Fri Dec 30, 2011 at 12:40:58 PM PST

                  [ Parent ]

                •  We'd lose some doctors (0+ / 0-)

                  that we'd do just as well to lose as soon as possible.  Anyone who is in THAT business for profit, should move along into business management or bank fraud.

                  Practically speaking, the main problem with finding enough doctors right now is the occupational birth control practiced by "selective" medical schools in both their admissions practices and their prices.  Subsidize medical school at a sufficient number of public schools, make the admissions criteria stiff but objective, transparent, and universal, and you'll have no problems recruiting doctors.  Especially if you do away with the "trial by lunacy" of residents being required to work 80-hour weeks with little or no sleep that has been adopted in this country as an initiation ordeal for the benefit of institutional profit margins.  You'll find you've always had plenty of people who wanted to be doctors, but didn't have the money or connections to get through a medical school system run for profit by clique in-groups.  Also people who would prefer to work like Canadian doctors, a reasonable number of hours for a reasonable paycheck, rather than running around like mad hornets trying to see a patient every five minutes in order to rack up fees.

                  Like most highly lucrative fields in this country, the problem is not a lack of people qualified to learn the work or willing to do the work.  It's the legacy of old European aristocratic classism that limits admissions to the training schools based on personal interviews and contacts that evaluate a candidate's "fit" with the existing class-structure, combined with a fee schedule that assures only the at least moderately-wealthy can afford it.  Egalitarian in theory, our system is quietly based on the privileges afforded to wealth, coded as "education".

  •  Same thing in the US... (2+ / 0-)
    Recommended by:
    Rogneid, Chico David RN

    ...only more so.

    Check your health insurance.  Prescriptions are handled differently than procedures (and nobody looks at how generic drugs are used since they don't cost the insurance company very much).  But your insurance won't cover any "experimental" procedure, and determines this not just by the procedure but by the diagnostic code that goes with it.  As we well know, "experimental" is determined very aggressively by for-profit carriers.  Same thing applies to expensive drugs, even the ones covered by my carrier, for example, get specific reviews.  If you are in an HMO, the standards are much more stringent than for a PPO, even if it's administered by the same carrier.  About 75% of the time, the carrier is behaving reasonably and preventing bogus expensive medicine.  The other 25% of the time, it's just plain greed.  

    •  Yep (0+ / 0-)

      I expect to be about 40k out of pocket for an "experimental" procedure next year.  That's with "good" health insurance and does not count premiums deductibles and copays for "covered" care.  The irony is if the procedure works it will save the insurance company several hundred thousand dollars over the standard procedure.

      Democrats give you the Bill of Rights; Republicans sell you a bill of goods!

      by barbwires on Fri Dec 30, 2011 at 08:50:33 AM PST

      [ Parent ]

    •  So true. (2+ / 0-)
      Recommended by:
      cpresley, cynndara

      Once any third party payer is in the mix, choices will be limited.  Overall, if I'm going to have my choices limited I'd rather it be by an entity that is interested in my health than an entity that is only interested in profit.

      "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

      by Chico David RN on Fri Dec 30, 2011 at 09:45:55 AM PST

      [ Parent ]

  •  the Dr. seems overall pretty effusive about (0+ / 0-)

    the Canadian system overall, whereas his comment about the downside doesn't seem to have much evidence to back his claim.  We are awasy in drugs that are at best - and for most of them this is really a stretch - somewhat more effective than a placebo or the generic equivalent that no longer yields a high margin.  I'll take evidence based medicine any day.  Perhaps it would have saved my poor Mom three rounds of fruitless and excruciating chemotherapy.

  •  We have a 30 year legacy of tainted evidence (3+ / 0-)
    Recommended by:
    Chico David RN, BeeDeeS, cynndara

    Unfortunately, the United States now has a 30+ year legacy of evidence tainted by corrupt research practices -- or more accurately, corrupt after-the-fact manipulation of research results that may have been (though not always) gathered in good faith and practice -- that began taking root during Reagan's FDA.

    Evidence-based anything sounds great -- and ideally, it would be great.  But you have to pay close attention to the gatekeepers of the evidence.

    We don't know the actual evidence about several of the most widely prescribed and profitable classes of drugs on the market today.  We don't know because the evidence was tightly controlled using proprietary-data clauses in research projects.  These clauses were so strict that you couldn't even discuss your results informally with a colleague down the hall (no matter how germane his or her expertise) who wasn't part of the contract and hadn't signed the appropriate non-disclosure.

    For decades, selective publication of only the most favorable results and withholding of "proprietary" data on adverse events, together with ghost-writing of favorable articles then signed by doctors who had very little to do with the actual research, has corrupted what ought to be our most sacrosanct pool of information: the full and unadulterated results of ALL research covering a medication.

    There have been some changes in the last few years that ought to start helping.  For instance, in principle it should no longer be possible to conduct secret trials and disclose them only when it comes time to publish.  But even if this and other reforms prove effective and not subject to manipulation, it will still take yet more decades before we can clean the mess the pharmaceutical industry has created.

    Slavish adherence to conclusions from manipulated evidence is just as harmful as failure to heed evidence in the first place.

    ------
    Ideology is when you know the answers before you know the questions.
    It is what grows into empty spaces where intelligence has died.

    by Alden on Fri Dec 30, 2011 at 08:52:21 AM PST

    •  Although really (1+ / 0-)
      Recommended by:
      Alden

      you mustn't take the letter of those contracts too seriously.  If you've ever been around academics, you KNOW that they don't.  You can't keep a scientist from gossiping with his peers about his work!  That's what it's FOR.  Secrecy clauses be damned, nobody believes in them in a university.  Even the government has to bring in armed guards and its own locked doors if it wants things locked-down.  Academics just don't DO that.

      No, more of a problem is the investigators who are "educated" and snowed by the PR departments of the manufacturers, who then go out and gossip to all their peers about how great this new drug is that they're just now getting their hands on and how it's going to change the game entirely.  And who then find themselves with their personal reputations and credibility invested in the project, which HAS to succeed accordingly.

  •  I consider it common sense. (0+ / 0-)

    In the United States we advocate for "new and different," often for the sole sake of newness and differentness (and profit, of course).  

    Case in point.  Dermatologist pushing a brand name drug (it was obvious the PharmRep had been around with the free lunch goodies for the staff, what with all the drug's posters on every wall).  Problem was, i have excellent insurance, but the co-pay on this drug was ridiculous, especially considering it did not treat a life-threatening condition of any sort.

    Also, I did not see the marked improvement that the drug claimed I would see.

    I decided to look deeper.  What I found was a warning letter from the FDA to the manufacturer - on the internet.  Seems the company had been misrepresenting the efficacy of the product, claiming something like a 48% improvement during clinical trials.  What they failed to mention that got them the warning, was that the fricking PLACEBO! got a 42% improvement, meaning as far as the FDA was concerned, the brand name drug's improvement in condition was...6%.

    I then looked up the clinical trials on another drug used for the same purpose and found that it's efficacy, per the FDA perspective, was considerably better.  And it was dirt cheap.

    So, it wasn't really the PharmRep supplying the free lunch, it was ME!

    In Canada I suspect this would have been done by the government and I would never have used the more expensive drug.

    The community of fools might be small were it not such an accomplished proselytizer.

    by ZedMont on Fri Dec 30, 2011 at 09:00:36 AM PST

  •  So, they don't get to experiment on the public (0+ / 0-)

    for free like we do?  Yes, I guess that could be a downside.  LOL

  •  What a concept. (snark alert) (0+ / 0-)
    We [the Canadian health care system] don’t get to give patients treatments unless they have proven benefit, so we have an entire system devoted to examining what evidence justifies which treatments.......

    What a fresh idea.  On the downside, how do they make the mega-bucks like their American counterparts?  

    Nevermind.  

    Republican presidential candidate Newt Gingrich: I'm loving it.

    by NyteByrd1954 on Fri Dec 30, 2011 at 09:09:18 AM PST

  •  Rational health care, instead of rationed care (1+ / 0-)
    Recommended by:
    cynndara

    What I mean by this is that the current system with its unbalanced distribution of health care resources leaves many with no care and a few with too much care for their own good.

    Case in point - my father had what is considered today a gold-plated situation being on Medicare and having my mother's retired state teacher's coverage taking care of virtually any deductible.

    He had a brain meningioma removed - a very lengthy surgery and thankfully recovered with no loss of motor or intellectual capacity.

    One year later, a scan detected a regrowth of an area that was not accessible in the surgery.  Now, in a rational care system, they would have considered his age (82) at the time and advised him not to have further surgery due to risk/benefit equation since it was likely that by the time the residual tumor grew to where it would be a problem, he would likely have passed from other reasons.

    Instead, (IMO), they made a recommendation to do a follow-up surgery and additional radiation because he had the means to do so.  Had he been indigent, I doubt they would have made that recommendation.

    He was never the same after that second surgery and difficult convalescence and died after a fall which I believe was set up due to his frailty and loss of motor coordination from that second surgery.

    My point is that our system encourages overuse of surgery, over prescription of expensive drugs and too much testing because doctors and hospitals have to pay bills and you go where the money is.

    It would make much more sense for medical care to be provided to all within a framework where enough resources are devoted to promoting healthy life styles, safe working conditions and then keep surgery and use of drugs to an absolute minimum.

    •  LOL (0+ / 0-)

      But that's impossible, doll.  The most useful thing Americans could do to prolong life and quality of life right now would be to cut the average work week by five hours so that people had the time to either cook dinner or exercise every evening.  But that would REDUCE PRODUCTIVITY!  It would take time away from MAKING PROFITS!  It would lead to people taking more time for themselves, and less for their OWNERS!

      We can't have that.  You know that.  They'd rather pay for the drugs to treat sleep disorders, high blood pressure, diabetes, and the host of mental illnesses deriving from high stress and insufficient sleep, than allow WORKERS enough time off WORK to actually lead healthy lives.

  •  Yet real innovation does come out of parts of the (0+ / 0-)

    US system and I remember when Canada's PM Mulrooney came to the US for his cancer treatment which was better than what they had to offer in Canada at the time.  

    And it feels like I'm livin'in the wasteland of the free ~ Iris DeMent, 1996

    by MrJersey on Fri Dec 30, 2011 at 09:33:47 AM PST

  •  Take a poll about how the PPACA affected you (0+ / 0-)
  •  "Evidence based" can be slippery concept. (3+ / 0-)
    Recommended by:
    cpresley, Calamity Jean, BoxNDox

    Open to interpretation in a variety of ways - neither all bad nor all good.
    Let's give a hypothetical example:
    For condition "X" there are two possible treatments.
    Treatment A and treatment B
    Good studies have shown that treatment A works better in 80% of patients, Treatment B works better in 20%.
    No study so far has defined which patients are likely to get better results with which treatment.
    Here are two ways to go wrong:
    1. The insurer says: "treatment A is better, you must always use treatment A.  We won't pay for treatment B.
    That happens.

    2. The doctor says: "I tried treatment A once and had a bad result, so I don't care what the evidence says, I'm using treatment B."
    That happens too.

    The right answer, of course is somewhere in the range of: "There is a presumption in favor of treatment A, but if you think you have a good reason - maybe even just clinical intuition - that Treatment B would be a better choice for a particular patient, you may use it."
    You have to take the evidence into account, but you also have to take account of the fact that the available evidence usually does not answer all questions.  

    There's been a big push lately in medicine to push standardization of treatment - an industrial model of care, in essence.  The literature on which it is based comes from manufacturing.  If you are making cell phones and you can reduce variation in your process you can improve your results and reduce error.  Humans are not like raw materials in an industrial process - you can perform the same procedure in the same way on multiple people and get very different results.  Messy.

    "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

    by Chico David RN on Fri Dec 30, 2011 at 09:42:13 AM PST

    •  And yet (0+ / 0-)

      research on experts versus expert-care AI's done in the 1980's showed pretty clearly that while 95% of doctors THINK that their individual judgments are more valid than the standard rules-of-thumb, they are only right 15% of the time.  85% of the time the AI does better than the human doctor's "experience" and "intuition".

      Just sayin'.  It's a pretty common fallacy for any human to believe that they are at least a little better than "average", or capable of unbiased judgment when they are in fact biased.

  •  The stories I could tell, as a Canadian (3+ / 0-)
    Recommended by:
    Bionic, cpresley, Agathena

    None of them have to do with denial of insurance coverage here. None of them have to do with personal bankruptcy post-treatment. None of them have to do with living with congenital conditions, like cleft-palate, because someone couldn't afford treatment.

    My physician friend sits on one of the "evidence based treatment" panels. His committee is one that looks into treatments, their efficacy, the cost-benefit analysis, and periodic re-evaluation. They also consider physician prescription patterns. (To prevent the type of problems encountered in Florida with oxycodone over-prescription.

    Beware, he says, of antacid medications, over the counter and otherwise, that may lead to addiction and long term side effects. Beware of pain medication abuse.

    The market system does not have the proper safeguards to protect or promote health.

  •  Dont Insurances do that too? (0+ / 0-)

    US Insurances dont pay for experimental procedures or drugs.

    Root of Job Loss: Low capital gains (tax incentive) for stock market casino compared to real businesses that produces Jobs. Great Business idea A Dept Store that sells only made in america goods

    by timber on Fri Dec 30, 2011 at 10:01:23 AM PST

    •  They do (0+ / 0-)

      And in many cases it IS a downside, both in Canada and the US.  Depends on just how "experimental" a treatment or drug is considered.  People have died because US insurance companies (and Canadian Provincial Governments, I assume) have refused to pay for treatments that have been shown to work, but have not  been officially approved.

      Pretending any health care system is perfect is a mistake.  I'd trade systems with Canada in an instant, but my Canadian relatives have plenty of complaints too.  

  •  yesterday (0+ / 0-)

    I met a US student preparing to take MCATs hoping for acceptance in either Canadian or Australian medical schools; because he wants to  eventually practice medicine in a universal health care system;

    Health care in Australia is universal.

    http://en.wikipedia.org/...

    If You Don't Like The Way Things Are Now - JUST WAIT - 2012 GOP favored to win control of Senate

    by anyname on Fri Dec 30, 2011 at 10:15:34 AM PST

    •  Canadian medical schools (0+ / 0-)

      When I worked in one of Canada's largest hospitals, The Montreal General, I met interns and residents from the USA. One of them told me he quit his ER residency in the USA because he was tired of treating gun shot and knife wounds, other US residents agreed that was a big problem in their country.

      I wonder if that is a general complaint of American emergency wards.

      ❧To thine ownself be true

      by Agathena on Fri Dec 30, 2011 at 11:46:23 AM PST

      [ Parent ]

      •  don't know (1+ / 0-)
        Recommended by:
        Agathena

        but I thought the student yesterday aligned his interests in medicine with the correct place for his future practice  - if he is typical of the brain trust in medicine leaving USA for single payers systems analysis I'd need a bigger sample than one nice young guy; but having had a conversation with him he seemed to be the kind of person who settled on  his options for launching his life-path after taking stock from people already in his field of interest; people with experience and good information to share with him; so he might have been carrying a fresh consensus from the university pre-med graduating class of 2011;

        If You Don't Like The Way Things Are Now - JUST WAIT - 2012 GOP favored to win control of Senate

        by anyname on Fri Dec 30, 2011 at 02:53:28 PM PST

        [ Parent ]

  •  As a doc, this is great. I'm old enough to have... (2+ / 0-)
    Recommended by:
    cailloux, Agathena

    lived through multiple turns of the great hamster wheel of medical "progress", wherein some new therapy (based on flimsy or non-existent evidence) is heavily touted as the greatest thing since pizza 'n beer...until a couple of years later it is conclusively proven to be utterly ineffective or even dangerous.

    This first happened in my career with the aggressive use of 'anti-arrhythmia' drugs to suppress dangerous heart rhythm disturbances after a heart attack. Based on almost no evidence, they were widely prescribed circa early 1980s. When a randomized clinical trial was finally done, they were shown to increase the death rate substantially.

    The same cycle has occured with the aggressive use of right heart catheter pressure monitoring, overly aggressive use of erythropoeitin for anemia, all-metal hip replacements, and a depressing number of other interventions. Typically each treatment was pushed heavily by prominent & influential specialists on the basis of personal experience or small trials with limited numbers of patients, long before there was sufficient experience and data to justify widespread adoption.

    To be fair, things are getting better. Most new interventions are now being much more carefully scrutinized prior to being widely adopted. This has caused howls of outrage from some specialists because it's "harming the advance of medicine". But that's simply not true. It's just preventing us from harming patients with new treatments that prove to be ineffective or dangerous.

  •  y'know how canadians are flooding across (0+ / 0-)

    the border to get bypass operations?

    well ... okay, maybe not so much ... but CABGs are much rarer in Canada than in the US. one of the reasons is that the evidence indicates that coronary bypass operations probably aren't the most effective -- or indeed, effective at all -- treatment for many of the people who receive them. in general, angioplasty + stent costs about half what CABG costs, and of course doesn't involve running a skilsaw down your sternum and leaving you with a long, long recovery. but nevermind that -- those damned sociamalists with their big words and their "science" and their "planning" and their "analysis" and their brainy ivory-tower eggheaded arrogance can't tell me whether or not i deserve to have CABG.

    To put the torture behind us is, inevitably, to put it in front of us.

    by UntimelyRippd on Fri Dec 30, 2011 at 10:21:20 AM PST

  •  The other side of "evidence-based" (1+ / 0-)
    Recommended by:
    Alden

    is who gets to decide what is evidence? In this country it's most frequently Big Pharma. For an interesting experience, see:
    http://documentarychannel.com/...

    Not only is it interesting, it's a free movie!

    Corruption is what keeps us safe and warm. Corruption is why we win. -Syriana

    by CarbonFiberBoy on Fri Dec 30, 2011 at 10:25:35 AM PST

    •  Few understand how true this is (1+ / 0-)
      Recommended by:
      CarbonFiberBoy

      The evidence shown to doctors and the public and, as it has turned out in court, even to the FDA has sometimes been less than half of the evidence known to manufacturers.

      Plus, as the NY Times was documenting so well in the 1990's, there is an awful lot of outright, brazen fraud in pharmaceutical research.  And it is often highly compartmentalized fraud, so that many clean hands don't realize what a small number of dirty hands have done.  In some cases, individuals at the FDA have been complicit.  As so often in any field where big government interfaces to big industry, problems have been covered up on both sides, honest boat-rockers have been punished, and dishonest fixers have been rewarded for keeping scandals under wraps.

      I'm all in favor of an evidence-based orientation -- who could be otherwise? -- but we need to be far more watchful of the chain of custody for evidence on which we're going to mandate large-scale changes in practice.

      Sometimes the dog barking loudest for evidence-based practice is the dog that fixed the evidence.

      ------
      Ideology is when you know the answers before you know the questions.
      It is what grows into empty spaces where intelligence has died.

      by Alden on Fri Dec 30, 2011 at 01:10:04 PM PST

      [ Parent ]

  •  Silly me (2+ / 0-)
    Recommended by:
    cailloux, Agathena

    I thought the downside was....

    Stephen Harper

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Fri Dec 30, 2011 at 10:34:31 AM PST

  •  I have been taking my chances on this (1+ / 0-)
    Recommended by:
    moira977

    health care system for a long time. It is not without flaws, especially since right-wing governments hate it and do everything in their power to cut back on it. There are waiting lists for elective surgery because the government cuts back on hospital staff and funding and that cuts back on surgical beds. Then right-wing propaganda will appear in the newspapers
    "our health care system is in crisis, it is not working, it is not sustainable."

    If you see headlines like that, check the source. Ask Canadians who have been served by their health care system if they would rather have the American system of care.

    By the way, it is not free where I live. It costs $60./month for the average working person.

    ❧To thine ownself be true

    by Agathena on Fri Dec 30, 2011 at 11:03:30 AM PST

  •  An experiment a friend tried (1+ / 0-)
    Recommended by:
    Agathena

    During the great health care debate one of my friends decided to call some randomized Canadians to get their take.  He looked up area codes, and then plugged some random numbers in and explained the reason for his call. He said the biggest problem was getting off the phone because the Canadians he talked to were so effusive in their praise for the current system (at least compared to ours).

  •  A bit of devil's advocating from me (0+ / 0-)

    My 74 y/o Mother has a very rare form of leukemia, so rare that there really wasn't any evidence based treatment to pursue. Luckily her Oncologist tried an "off label" treatment which put her into remission almost immediately. That was ten years ago.

    I agree that in many, if not most, cases, evidence based treatments are preferable, but there's something to be said for a physician who draws on his or her years of experience, confers with colleagues, and is willing to go beyond the norm to devise an untested treatment plan. My Mom wouldn't be here today if her doctor hadn't been willing or able to do that. We are so lucky.

    "The answer to violence is even more democracy. Even more humanity." Norwegian Prime Minister Jens Stoltenberg

    by poe on Fri Dec 30, 2011 at 11:31:16 AM PST

    •  I'm curious (0+ / 0-)

      What is that rare form of Leukemia your grandmother had, and what was the novel treatment she received?

      I'm curious because I have a very rare form of Lymphoma. The difference being there is evidence based treatments for it.

      The future is just a concept we use to avoid living today

      by MetalMD on Fri Dec 30, 2011 at 11:39:00 AM PST

      [ Parent ]

      •  My Mom has (0+ / 0-)

        hypereosinophilic leukemia - her eosinophil count was off the charts, which can lead to severe organ damage. Her spleen was enlarged, but shortly after starting the Gleevec it went back to normal size. She has been on Gleevec for almost 11 years, one pill daily. She did have radiation treatments early on after brain surgery to remove a large tumor, but no traditional chemotherapy. Her doctor says the Gleevec is chemo in pill form (approved for CML and maybe other types of leukemia?), but no side effects like traditional chemo.  According to him this was a real breakthrough and her case has been written up in medical journals, and he always brings his residents in to meet her and review her case.  

        I wish you all the best in your treatment and recovery.  

        "The answer to violence is even more democracy. Even more humanity." Norwegian Prime Minister Jens Stoltenberg

        by poe on Fri Dec 30, 2011 at 12:07:49 PM PST

        [ Parent ]

        •  Fortunate for your grandmother (0+ / 0-)

          Gleevec was around.

          I'm also sure, despite having no concrete evidence to back up my assertion, even in an evidence based health care system, if there was no evidence based treatments available, the doctor would be granted some latitude.

          The future is just a concept we use to avoid living today

          by MetalMD on Fri Dec 30, 2011 at 02:28:28 PM PST

          [ Parent ]

  •  I take some exception to the top post (0+ / 0-)
    "We [the Canadian health care system] don’t get to give patients treatments unless they have proven benefit, so we have an entire system devoted to examining what evidence justifies which treatments.......
    ..........I [Dr. Conners] cannot give a drug without evidence-based proof that the drug has efficacy and works better than the less-costly alternatives in the particular disease I’m treating. So the drawback to a centralized system is that it constrains innovative behavior, is resistant to change, and is slow to introduce new approaches. The system waits for adequate evidence before moving ahead......."

    In Canada, you can get into experimental treatments/clinical trials without it costing a patient. Family members of mine have. In my experience, the doctors also have significant latitude and know how to work the system.

    I can't say that everyone gets around it in every instance. They probably don't. But there are ample examples where Canadians can get less conventional/experimental treatments without mortgaging the house.

    Here's one article I just grabbed at a quick glance listing some of their medical discoveries:
    http://www.canadianmedicinenews.com/...
    Canadian patients got those first and none of them went bankrupt doing so that I'm aware of.

    The only bureaucracy I'm aware of is sometimes you have to apply for these experimental treatments but in part, that's because it's formally organized and a case has been made rather than someone just dreaming up wild schemes.

    So there's probably some merit to the criticism but it's far from black and white and I've never run into anyone who couldn't get what they needed - it's not a gigantic problem in my opinion.

  •  Quebec health care coverage (0+ / 0-)

    This is a long one..........

    Yes, there are some shortages of GPs in Canada and Quebec and there are excessive waiting periods for some procedures, but I would not trade the Canadian system for the US if you paid me.  

    I was in a position to see and feel the best and worst of our system and it works.
    Let’s take a look at an actual case.

    Two years ago, since I did not have a regular GP, I went to a walk-in clinic with a pain in the lower abdomen that got me worried about possible acute appendicitis (classic McBurney’s point pain). The doctor wrote a short prescription and instructed me to present it at the ER of the hospital of my choice,

    A 5 minute cab ride later, I was in the ER waiting room of the Montreal Hotel-Dieu hospital where I waited for all of 15 minutes for triage and another 15 minutes or so after triage at which point the system took me in.

    Within one hour, I had had an abdominal Xray and a thoracic scan, followed by a diagnosis of a large abdominal abscess located on the psoas muscle from the groin area to the top of the kidney.

    Next day, after a precision scan to determine the insertion angles, a drain was installed by percutaneous insertion (through the skin – no cutting).

    Then, because of the unusual content of the abscess, there began a thorough investigation by the entire microbiology department of the University hospital:

    It involved the following procedures:

    Over many weeks, I received seven or more intravenous antibiotics and anti fungal medications, several of which are unavailable in the US.      
    One full body MRI;
    One colonoscopy;
    Two ultrasound scans;
    Two nuclear two phase exams;
    Two or three EKGs
    Five more follow-up scans;
    A second drain insertion guided this time by ultrasound scanner;
    Because of its size, the abscess took 2 ½ months to fully drain;
    At least 70 blood tests;
    Installation of a PIC IV line (peripherally inserted central catheter)

    I was seen and examined by doctors and residents of the following departments:
    Microbiology (5 doctors, 3 residents);
    Internal Medicine (2 Doctors, 1 resident);
    Hematology
    Otolaryngology
    Ophthalmology‎
    Endocrinology‎
    Radiology‎

    I remained in the hospital for 2 ½ months in a spacious private room for which my private insurer paid approximately 6 000$.

    Upon my release from the hospital, I was admitted to a rehab centre for physical rehab and recovery therapy; 15 days in a private room, at no charge to me or my insurer.

    Total cost out of pocket fot those three months in hospital: 0.00$ except for rental of a TV set.

    Because I was diagnosed with diabetes, I take 2 glucose control tablets per day and one new drug per day (cost = $3.00 per pill).  Since Quebec govt insurance covers drugs, I actually pay a fraction of the actual costs. Glucose test strips are 100% covered.

    My annual health coverage costs:

    Govt health coverage:    $  310
    Govt drugs coverage:    $  563
    Employer retiree health:    $  611       the last two amounts are included in calculation of federal and provincial income tax credits;   
    Employer contribution:    $1,900    
    added to taxable income for     provincial income tax only; amount     is included in calculation of         provincial income tax credit;

    Monthly co-pay on drugs:    $ 16 + 32%    monthly max 80.25 (my 2011 cost: $255) included in calculations of federal and provincial income tax credits.                 
    My annual total health cost was under $1,750 in a year where my actual costs would have been anybody’s guess in the US whether insured or not………QED... (LOL)            

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