"Free" Health Care

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Registered: 03-27-2003
"Free" Health Care
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Wed, 07-21-2004 - 8:58am
http://www.townhall.com/columnists/walterwilliams/ww20040721.shtml

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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iVillage Member
Registered: 06-17-2004
Wed, 08-18-2004 - 9:35pm

"Canada's drug regulatory system, controlled by the Patented Medicines Prices Review Board -- Canada's version of the Food and Drug Administration -- is a complex web of federal and provincial bureaucratic barriers to entry for drugs such as Glucophage XR. The review board, established to ensure reasonable drug prices, strictly monitors the prices at which manufacturers may sell drugs to wholesalers and pharmacies, and at which pharmacies may sell to the public. In addition, each of Canada's 10 provinces also maintains a government-approved formulary, which determines which drugs will be available to Canadians. Once approved by the review board, medication must then get the nod from each of the provincial formularies. Many provinces approve fewer than half of all the new drugs the board has OK'd.


To save funds, Canadian health officials delay the introduction of new and more expensive drugs. As a result, it takes considerable time for new and more expensive medications to make it into Canadian medicine chests. Some never do. From 1997 to 1999, 100 new drugs were launched in the United States, while only 43 made it to market in Canada. Canadians are still waiting for many of them.


This process may save the government money, but it shifts costs to patients, who pay in the form of increased pain and a diminished life -- or in significant out-of-pocket dollars, if they seek the drugs over the border.


Dennis Morrice is chief executive of Canada's Arthritis Society and co-chair of Canada's Best Medicines Coalition, a group founded two years ago to ensure that patients get the drugs they need. According to Morrice, some 4 million Canadians suffer from arthritis, the nation's largest cause of long-term disability. Yet highly effective drugs such as Enbrel and Remicade, long available to U.S. patients, may or may not be available to Canadians, depending on which province they live in. As recently as 2002, only two provinces -- Saskatchewan and Ontario -- listed the drugs."


http://www.detnews.com/2003/editorial/0310/01/a09-283700.htm


Sounds remarkably similar to the situation we discussed before about the man who had to move to a different province to get a life saving transplant.

Renee ~~~

Renee ~~~

iVillage Member
Registered: 06-17-2004
Wed, 08-18-2004 - 10:08pm

The association representing Canada's doctors is calling on Ottawa to provide a whopping $1 billion to address the shortage of physicians and develop a strategy to ensure the country has enough health providers to care for patients....


"We need more doctors," Patel said, noting the most acute shortage is among general practitioners, leaving about four million Canadians without a family doctor.


An association report shows Canada has 2.1 physicians per 1,000 residents, ranking it 25th out of 30 countries in the Organization for Economic Co-operation and Development.



http://www.canoe.ca/NewsStand/LondonFreePress/News/2004/08/18/588158.html

Renee ~~~

Renee ~~~

iVillage Member
Registered: 08-07-2004
Wed, 08-18-2004 - 10:18pm
I wasn't trying to base the entire discussion on one individual. It was intended to be an anecdote, a single example, a starting point. I never expected to get so much negative feedback after posting it initially, from others too, not just you.

This is how I see the response; you insist that it cannot be true, the others insisting I should advise him to buy insurance(despite having lost his job), insistence that I should scold him for not buying insurance (despite no group plan being offerred to him), insistence that group health insurance thru employment is not the answer (but then what is?), repeated declarations that he deserves no sympathy (despite my pointing out he doesn't need it), etc.

This all sounds remarkably hostile for a topic that we actually agree on, our health care system needs reform. What is the source of this hostility if we agree reform is needed & we are discussing that need? What useful purpose is there in expressing this hostility?

But then, maybe I'm wrong, maybe it wasn't hostility, maybe everyone who responded to me was just sharing their thoughts on the problem & possible solutions? But I don't think so.

And obviously, you know more than I do, about nearly everything.



< I got that. You accused me of not being familiar with the plight of unskilled minorities. I responded by sharing with you some of my life experience, not a stereotype. I am not out of touch. Based on my education in economics, sociology, psychology, decades of personal observation of human nature and how businesses operate, and my extensive experience with the plight of unkilled minorities, I do not for one moment buy the senario you have presented. I don't know how much of it's true, if a portion of it is a crock, or a simple mistake, but I'm not about to discuss healthcare based on it. >

iVillage Member
Registered: 08-07-2004
Thu, 08-19-2004 - 12:40am
Canadian drugs aren't the cure

By Robert Kuttner August 18, 2004

THERE IS something quite lunatic about the entire debate on whether to permit imports of drugs from Canada. It's not as if Canada manufactures drugs more cheaply. Nor are drugs like trees, or bauxite, or hydro power, which just happen to be naturally plentiful in Canada.

No, the cheaper Canadian drugs are the same ones sold at higher prices in the United States, and either exported or licensed for manufacture in Canada.

Why are they cheaper up north? Because Canada has a policy of controlling drug prices through its national health insurance system. As Deborah Stone, a health policy expert at Dartmouth, has observed, it's not the drugs we should be importing, it's the policy.

But the pharmaceutical lobby has so much power in the United States that cheaper drug prices are off the political radar screen. In fact, the recent Medicare bill pushed through Congress by the Bush administration explicitly prohibits Medicare, the largest bulk purchaser of pharmaceutical drugs, from negotiating cut-rate bulk prices. A consequence of these sky-high drug prices is that seniors who elect to take the new Medicare drug coverage must pay thousands of dollars out of pocket each year before the coverage fully kicks in. (Senator Kerry, to his credit, would reverse this policy.)

Instead of debating head-on whether the United States should have a national health program like Canada's, or at least controlled drug prices, the news media have generally accepted the nonsensical premise that the battle is about imports and that the issue is the safety of drugs from Canada. This is the drug industry line, and it's a complete red herring. In fact, there is no documented case of an American getting sick because of tainted or adulterated drugs brought in from Canada. On the contrary, Canadian safety standards are at least as strict as our own. But Bush appointees at the FDA, as a service to their allies in the pharmaceutical industry, have tried to make the public focus on safety. Why? Because if drug imports from Canada became widespread, the domestic structure of drug overpricing would collapse. Everyone would buy from Canada.

If the administration were not hostile to the idea of drug imports or cheaper drug prices, it would be easy to set up safety spot checks. Indeed, in areas where the administration promotes free trade, it satisfies its safety concerns with spot checks of raw agricultural products imported from countries whose rudimentary sanitary standards are far less sophisticated than Canada's. To add insult to injury, the administration is actually pressing America's trading partners who have lower drug prices to raise those prices so that our high prices won't stick out like a sore thumb and tempt Americans to seek cheaper drugs from abroad.

The drug industry and its friends in the administration contend that the exorbitant prices are necessary to pay for research. You've probably seen the TV ads in which an idealistic research scientist at a drug company vows to find a cure for Parkinson's or Alzheimer's, mentioning in passing that it costs $800 million to "bring a new drug to market."

But as author Merrill Goozner documents in his book, "The $800 Million Pill," much of the money attributed to "research" goes to advertising and copy-cat drugs rather than true breakthroughs, and much of the actual research is financed by taxpayers through the National Institutes of Health). Economist Dean Baker has calculated that only about one dollar in five that US consumers spend on inflated drug prices go to finance drug research. Baker adds up all the money contributed by taxpayers to drug companies through Medicare, Medicare, the Veterans Administration, and NIH. He concludes that it would be more cost-effective to pay for all drug research through government grants and then put the results in the public domain. Manufacturers, as in the case of aspirin, doxycycline, and other off-patent drugs, would then earn only a normal profit, and all drugs would be far cheaper.

Scientists would still innovate. The pioneers of antibiotics weren't in it to get rich. Nor was Dr. Jonas Salk. Their breakthroughs quickly went into the public domain to help the greatest number at the lowest cost.

It's charming that the Republican governor of New Hampshire, Craig Benson, is suing the FDA to allow Canadian pharmacies to fill US prescriptions and that congressmen of both parties have sponsored bills to legalize imports. But these worthies are fighting the wrong fight and ducking the real one. Forget Canada. We need a national policy to lower drug prices right here in the USA.

Robert Kuttner is co-editor of The American Prospect. His column appears regularly in the Globe.

iVillage Member
Registered: 06-16-2004
Thu, 08-19-2004 - 9:37am
I will do some research about this, because I also had read that there are medicines available in Canada and not in the US.

The fact remains that the 'saves money' part of this is not applicable for most people, since we pay directly for our medication, not the government.

Something's missing from that article.... I live in Canada, and everyone I know pays for their medecine, and may get money back from the insurance company, if they have it. Our healhtcare system does not pay for medecines for most people, at least not in Ontario or Quebec. But of course there are other provinces that may. I'll have to look that up.

iVillage Member
Registered: 06-16-2004
Thu, 08-19-2004 - 9:39am
Yet the fact remains that we are way healthier and live longer than most.. including americans. Paradoxal, isn't it?

Must be that maple syrup and canadian bacon, eh?

iVillage Member
Registered: 07-05-2003
Thu, 08-19-2004 - 2:08pm
It may have to do with greater immigration as a percentage of the population and a much more diverse culture with respect to race and ethnicity in America vs. Canada.

If you look at the statistics for white Americans at http://www.infoplease.com/ipa/A0005140.html you'll note they are virtually identical to Canadian stats.

So no, it can't be the syrup and bacon... sorry :-)

iVillage Member
Registered: 06-17-2004
Thu, 08-19-2004 - 5:05pm

I think that's because of lifestyle issues rather than the healthcare system.


I've got links at home that I'll have to post later, but I'll tantalize you a bit by saying that as far as healthcare goes, it's better for a premature infant to be born an

Renee ~~~

iVillage Member
Registered: 06-16-2004
Fri, 08-20-2004 - 9:47am
Actually our ethnic makeup is similar, and we somehow smoke and drink more than americans. Link coming up soon...


Edited 8/20/2004 10:04 am ET ET by nicecanadianlady
iVillage Member
Registered: 06-16-2004
Fri, 08-20-2004 - 10:00am
You are soooo totally wrong on this one. The rate of premature babies is much lower in Canad (prevention) AND the survival rate is nearly identical, despite having many more doctors specializing in neonatal care in the US.

http://www.muhc.ca/media/ensemble/2002june/premature/

"Canadian prematurity rates are much lower than those of the United States. Barrington believes this is due to the relatively lower poverty rates and wider access to medical care in Canada."

http://bmj.bmjjournals.com/cgi/content/full/324/7350/1353

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