"Free" Health Care
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| Wed, 07-21-2004 - 8:58am |
Free health care
Walter E. Williams
July 21, 2004
Let's start out by not quibbling with America's socialists' false claim that health-care service is a human right that people should have regardless of whether they can pay for it or not and that it should be free. Before we buy into this socialist agenda, we might check out just what happens when health-care services are "free." Let's look at our neighbor to the north -- Canada.
The Fraser Institute, a Vancouver, B.C.-based think tank, has done yeoman's work keeping track of Canada's socialized health-care system. It has just come out with its 13th annual waiting-list survey. It shows that the average time a patient waited between referral from a general practitioner to treatment rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003. Saskatchewan had the longest average waiting time of nearly 30 weeks, while Ontario had the shortest, 14 weeks.
Waiting lists also exist for diagnostic procedures such as computer tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Depending on what province and the particular diagnostic procedure, the waiting times can range from two to 24 weeks.
As reported in a December 2003 story by Kerri Houston for the Frontiers of Freedom Institute titled "Access Denied: Canada's Healthcare System Turns Patients Into Victims," in some instances, patients die on the waiting list because they become too sick to tolerate a procedure. Houston says that hip-replacement patients often end up non-ambulatory while waiting an average of 20 weeks for the procedure, and that's after having waited 13 weeks just to see the specialist. The wait to get diagnostic scans followed by the wait for the radiologist to read them just might explain why Cleveland, Ohio, has become Canada's hip-replacement center.
Adding to Canada's medical problems is the exodus of doctors. According to a March 2003 story in Canada News (www.canoe.ca), about 10,000 doctors left Canada during the 1990s. Compounding the exodus of doctors is the drop in medical school graduates. According to Houston, Ontario has chosen to turn to nurses to replace its bolting doctors. It's "creating" 369 new positions for nurse practitioners to take up the slack for the doctor shortage.
Some patients avoided long waits for medical services by paying for private treatment. In 2003, the government of British Columbia enacted Bill 82, an "Amendment to Strengthen Legislation and Protect Patients." On its face, Bill 82 is to "protect patients from inadvertent billing errors." That's on its face. But according to a January 2004 article written by Nadeem Esmail for the Fraser Institute's Forum and titled "Oh to Be a Prisoner," Bill 82 would disallow anyone from paying the clinical fees for private surgery, where previously only the patients themselves were forbidden from doing so. The bill also gives the government the power to levy fines of up to $20,000 on physicians who accept these fees or allow such a practice to occur. That means it is now against Canadian law to opt out of the Canadian health-care system and pay for your own surgery.
Health care can have a zero price to the user, but that doesn't mean it's free or has a zero cost. The problem with a good or service having a zero price is that demand is going to exceed supply. When price isn't allowed to make demand equal supply, other measures must be taken. One way to distribute the demand over a given supply is through queuing -- making people wait. Another way is to have a medical czar who decides who is eligible, under what conditions, for a particular procedure -- for example, no hip replacement or renal dialysis for people over 70 or no heart transplants for smokers.
I'm wondering just how many Americans would like Canada's long waiting lists, medical czars deciding what treatments we get and an exodus of doctors.

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Since I am not a doctor, I can't answer your specific questions about the meds. But, I know the drug reps will try to get the doctors to use their med, because that's what they do. They'll quote so-and-so study had these results, which makes our drug the best. But, if the doctor is worth their salt, they don't prescribe just because a drug rep says they should. They should be using their medical expertise to diagnose the problem and recommend the appropriate treatment, i.e. meds, counseling, both. I also know that certain insurance companies include certain meds in their formulary, which are the ones they'll pay for. I have no idea how they choose them. I suspect it's based on cost and how popular they are with the doc's. The doc's should also be being sensitive to any side effects. Some diagnoses have pretty straight-forward treatment, but some others do have some trial and error involved in the meds. Depression seems to be one of those trial and error ones. A lot of medicine is not an exact science, as we would like it to be. And I really believe there is a lot of art to being a good doctor, i.e. being a good listener, being able to ask the right questions, being able to read between the lines of what people say and don't say, etc. Once you find a good one, hang on as long as you can!
Here in Texas, mental health care is a whole lot of mess that I hope most other people don't have to experience. They just made it so that only the most severe diagnoses will be eligible for medicare, major depression, schizophrenia, bi-polar and I can't remember the 4th. But, it does not include anxiety, mild to moderate depression or any addictions. So all of the people who were getting services for anxiety disorders or drug/alcohol addiction will not be receiving them anymore. They've estimated that it's about 17,000-20,000 people, but aren't really sure how many people it will affect. So, where are all those people going to go when they start having problems, most likely to the ER, instead of having their usual visits with a case worker or someone else. And I'm not just talking about the high functioning people, who are actually able to work, it's everyone who doesn't fall into those 4 diagnoses. It's supposed to give the most care to those who are the sickest. So, the jury is still out on how this will work. My bet is not very well.
Sorry if I didn't answer your questions very well. It sounds like you're doing some pretty important work! I would ask some of the doctors you work with the same questions you asked me. I think, unfortunately, that medicine, and a lot of other professions, have some really good people and some not so good.
In the US today ANY child in a low income family, can get health care.
Check out http://www.insurekidsnow.gov/
In many states, including my own, ANY child can get coverage under the CHIP program, families earning over about $60,000 US do NOT get a subsidy and pay about $200 per child. Various states have divergent policies.
Potentially, the problem with a voluntary open system would be those who stand to get the greatest benefit will join the program. This means once someone has cancer, they will sign up, once they are diagnosed with a life threatening disease or suffer a severe accident they will sign up... this skews the pool, it pollutes it... rather than everyone assuming risk across a large pool, those severely afflicted will apply into the pool to take from it without contribution. Pool pollution is a major concern in the Kerry plan, the overall cost of the premiums would skyrocket this would NOT make federal workers happy.
Just today I talked to a woman who told me she now has the option to sign up for group health insurance thru her job, & she did sign up, & she is not chronically ill. She only makes 16 thousand a year, but she signed up & pays the premium. She also made it a point to tell me this happened because their union fought for it. The only down side to her story was that they did not include the family option, it is a single person policy only. And....once again, her daughter is on one of those government funded programs, not medicaid but similar, it's called My Child. Anyway, she would have paid for a family policy, if that option were available to her.
All I asked her was a yes or no question, does your daughter have health insurance. Somehow she knew I would like to hear the rest, LOL.
< Potentially, the problem with a voluntary open system would be those who stand to get the greatest benefit will join the program. This means once someone has cancer, they will sign up, once they are diagnosed with a life threatening disease or suffer a severe accident they will sign up... this skews the pool, it pollutes it... rather than everyone assuming risk across a large pool, those severely afflicted will apply into the pool to take from it without contribution. Pool pollution is a major concern in the Kerry plan, the overall cost of the premiums would skyrocket this would NOT make federal workers happy. >
Seems like the woman I talked to today disproved your theory, She didn't have to sign up, she's not seriously ill, yet she signed up. In fact, she did what has been stated repeatedly people should do. She is paying for insurance coverage.
< By voluntary I was referring to voluntary open enrollment... this permits those who suffer affliction to avoid paying into the pool UNTIL they become ill or suffer an accident, then to take from it. The function of insurance is to share risk, an open pool skews this, and many will not share risk but take the certainty of coverage once ill. Premiums for all will skyrocket, as mentioned earlier 10% of the population consumes a large percentage of medical costs... 10% of seriously ill people getting coverage inexpensively will work in year 1, once insurance companies go bankrupt or almost lose their shirts, premiums will skyrocket. The cost per capita of the average american is about $5,400 per year through life... this is cost, not premium... thus any cost much under about $100 per week represents some form of subsity OR some form of managed pool which doesn't represent fully the lifetime of the average person (for example a pool which excludes the elderly).>
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Renee ~~~
More Canadians fault service
CMA `report card' urges more funds
http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1092607810332&call_pageid=968332188492&col=968793972154
JOSEPH HALL
STAFF REPORTER
An increasing number of Canadians is giving the country's health-care system a failing grade, according to an annual "report card" on health care done for the Canadian Medical Association.
While the quality of medical care earned a B overall, the proportion of C and F grades jumped to 41 per cent from 33 per cent in a similar poll done for the CMA last year.
"The report card shows that things are getting worse," said Dr. Sunil Patel, president of the CMA, which released the national poll to coincide with its annual meeting in Toronto this week. "Year over year, Canadians have identified that their confidence in the health-care system is eroding."
The survey also found Canadians are almost unanimous — 91 per cent — in their belief that Ottawa can afford to spend more money on health care. As well, another 78 per cent of respondents said the provinces can afford to do a better job of funding health care.
The survey, the 2004 National Report Card on the Sustainability of Health Care, was conducted by Ipsos-Reid for the CMA. It was to be released today during the association's 137th annual meeting, which began yesterday at the downtown Sheraton Centre and ends Wednesday.
"There is a real belief that there is money there for the system," Patel said of the poll. Canadians, he said, "see the solution is available in the government's hands."
While Ottawa must support health care more generously, Patel said, Canadians want to see strings attached to any new money. In particular, he said, they want to ensure that any cash flowing to the provinces is earmarked exclusively for health care.
"More than that, it must go towards the number one issue facing Canadians, which is access to timely care."
The survey found that 97 per cent of respondents believe that the country's health-care system should guarantee quick access to essential services; 70 per cent agreed that quick access to essential services is more important that the availability of a comprehensive list of procedures and treatments.
"Governments must co-operate and focus on the number one issue, which is access to timely care, and not embark on a wide basket of services," Patel said.
In grading current plans for health-care sustainability, only 45 per cent of Canadians would give the system an A or B, according to the poll.
"Canadians have lost confidence in the system," Patel said. "As a practising physician, I've seen the constant erosion of health-care services for my patients, so this report validates what we as physicians of Canada have been saying consistently."
One particularly sore spot identified in the poll was a lack of co-operation between Ottawa and the provinces on the health-care issue, said Patel, a family physician from Gimli, Man.
Canadians "see the solution as governments co-operating as a team ... not as using our health-care system as a political football."
"Canadians have indicated that all levels of government must not only fund the health-care system appropriately, but must work together," he added.
At a meeting in Niagara-on-the-Lake last month, Canada's premiers called on Ottawa to raise its share of medicare funding to 25 per cent of overall spending from the current 16 per cent, a request that adds up to an additional $4 billion. They are to meet with Prime Minister Paul Martin next month.
The poll of 1,057 people was conducted in July and is considered accurate to within 3.1 percentage points, 19 times out of 20.
Renee ~~~
Renee ~~~
Don't you realize a large percentage of our population earns that little for their entire lives?
<< Mosts people in his income bracket haven't been in the job market for 20 years. Do you know if anyone else in his family worked? >>
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