Architect of Canadian Healthcare system admits it's 'broken', calls for privitization

[Regis Philbin]

http://www.ibdeditorials.com/IBDArticles.aspx?id=299282509335931

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

If only U.S. Democrats had as much sense... :noway:


Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

By DAVID GRATZER | Posted Wednesday, June 25, 2008 4:30 PM PT

As this presidential campaign continues, the candidates' comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few.

But no one will mention Claude Castonguay — perhaps not surprising because this statesman isn't an American and hasn't held office in over three decades.

Castonguay's evolving view of Canadian health care, however, should weigh heavily on how the candidates think about the issue in this country.

Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: "the father of Quebec medicare." Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

[LesterX]

If only U.S. Democrats had as much sense... :noway:

If only you and your fellow Rushbo lovers had the sense to recognize that the Canadian system is not the only model out there. Of course that will never happen, because you are narrow-minded, willfully ignorant and don't give a **** about anybody but yourselves.

[Richard Tafoya]

In 2001, the World Health Organization did a worldwide assessment of health care systems and ranked 191 countries.

Here's the top 40:

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei


The New York Times recently did an follow-up on this study:
http://www.nytimes.com/2007/08/12/opinion/12sun1.html?_r=1&oref=login
Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.

Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.

Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.

Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.

[LesterX]

Thank you, Richard. Throwing those pesky little facts around will probably result in the following:

1) Resounding silence from Regis
2) Connie claiming the WHO obviously is wrong because her mother's brother's uncle's cousin's daughter in-law is French and doesn't believe their health care system could be ranked highest

[DoubleEdgeSword]

I'd like to share my personal experience with the French healthcare system. Sinus infection. The hotel clerk directed me to a pharmacy within walking distance (there are pharmacies everywhere in Paris). The pharmacist looked in my ears, my nose, my throat, listened to my lungs, took some history and then prescribed some antibiotics and some decongestants. I paid only for the meds. She told me this was common practice in France. Pharamicists were trained to diagnose and treat minor illnesses and did not charge for thier services; it was considered overhead of the pharmacy. How do these pharmacies manage not to get sued, I inquired? Sued, she said, laughing. Americans like to sue. That is unheard of here in France. Everybody makes mistakes at times. She shrugged her shoulders. Yes, they do pay higher taxes than in the U.S. but there are no long waits to see a qualified healthcare professional. Minor illness are treated within neighbors, such as the local pharmacy or a clinic, while more serious illnesses are treated in regional hospitals, and there some 3000 throughout the country. I'm sure there are problems, as with any large, state-run program, but I made it a point to ask several French citizens what they thought about their healthcare system. I didn't get one negative opinion.

[db44]

Interesting... I'd always heard Cuba had one of the best systems in the world. Then again, considering the country's size and the sanctions, I guess being just two places under the U.S. isn't that bad. I'm not surprised at all that so many European countries are much higher than the U.S.

[DoubleEdgeSword]

Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.


This is interesting. We are always swamped in the ER on the weekends, and our busiest times start at around 5:30pm. Many doctors offices just flat out tell their patients to go to the ER. Yesterday, I had a woman go home, call an ambulance after leaving her doctor's office because, she said, "there were too many people in the waiting room and I would have to wait too long." She knew she would be seen more quickly by calling 911.

[Richard Tafoya]

Here's an interesting story on the Japanese system:
http://www.npr.org/templates/story/story.php?storyId=89626309

Click through to read and hear the full story. Lots of interesting details on insurance (low premiums), choice (see whoever you want), cost ($10/night for a hospital stay).
Japan produces cars, color TVs and computers, but it also produces the world's healthiest people. It has the longest healthy life expectancy on Earth and spends half as much on health care as the United States.

That long life expectancy is partly due to diet and lifestyle, but the country's universal health care system plays a key role, too.

Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. The government picks up the tab for those who are too poor.

It's a model of social insurance that is used in many wealthy countries. But it's definitely not "socialized medicine." Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business.

[pinky]

This is interesting. We are always swamped in the ER on the weekends, and our busiest times start at around 5:30pm. Many doctors offices just flat out tell their patients to go to the ER. Yesterday, I had a woman go home, call an ambulance after leaving her doctor's office because, she said, "there were too many people in the waiting room and I would have to wait too long." She knew she would be seen more quickly by calling 911.
My next-door neighbors (Bumpuses!!! Sons of B!tches!!! And I'm not kidding) routinely do that with their mother. She has a bad heart, I understand that, but they call for an ambulance EVERY single time she doesn't feel well, because they know they'll get bumped to the head of the line at the ER that way.

[DoubleEdgeSword]

One of the ERs in our area is triaging EMS patients at the door. If the patient is stable, they're sending them out to registration to be triaged just like everyone else. We aren't doing it, so EMS is telling us people are requesting to be taken to our ER now. Great.

You know what, though? It's partly the hospitals' fault. These days the patients are "customers" and management expects us to treat them like it's a hotel or something. People expect to be waited on just as quickly as if they were at a Burger King drive-through. Hello? It's an Emergency Room!

[SparkleHugs]

DES, what do you do in the ER again?

I honestly dont blame the other hospital, if anything, i think it would be a good policy to take up in your own hospital because the person coming in via ambulance could be ahead of someone who genuinely needs immediate assistance.

I like the French idea of the pharmacist helping with such minor things. It just seems so much more practical. It probably (and i truly have no basis of knowing this) would only take a couple of extra classes of schooling to be qualified to do such minor things.

[DoubleEdgeSword]

I'm an RN. I think it's a good idea what the other hospital is doing and I agree we should be doing the same thing. Patients should be treated according to the acuity of thier condition, not how they arrived at the ER. But, hey, I don't get paid to make those kinds of decisions. The big shots at the top do.

I loved the French system. The problem of instituting it in the US, I think, would be persuading people not to sue so that pharmacists wouldn't have to carry exhorbitant malpractice insurance.

[SparkleHugs]

I agree. we are a pretty letigious society (as i am currently contemplating a law suit myself...:laugh:) But I do wish i could just go down to CVS and see the pharmasist when i have a sinus infection, its far more convienant, if nothing else.

Hopefully the big shots at the top will see that the other hospital's policy is best for all the patients.

[DoubleEdgeSword]

Eventually, they will. The other hospital in the area is part of a very large corporate chain of hospitals. They pretty much set the standard for the community. We've followed thier lead because if we don't, we just aren't competitive. For example, a little over a year ago, this corporate hospital began weeding out minor complaints and asking for payment up front to be seen in the ER (either full payment for the uninsured or co-pay for the insured). We started doing the same this past March.

[SparkleHugs]

So what happens when an uninsured person without cash on hand comes into the ER with chest pain or a broken arm?? :confused:

[DoubleEdgeSword]

They are treated, of course and not asked for money. That process only applies to minor complaints, ones that could be handled at a doctor's office or walk-in clinic. Hospitals are trying to cut down on unnecessary ER visits, so each patient is triaged according to their presenting symtpoms, and the doctor or midlevel determines if they will been seen or if they will be QMP'd out. Some examples of a QMP patient would be runny nose, cough without fever (a cold); dental complaint without facial swelling or fever; request for pain medication (we get lots of those); chronic back pain with no acute injury. Basically, if they need any kind of diagnostic test, they're seen without having to pay upfront.

Someone who comes in with chest pain is seen immediately, ahead of anyone else. That is an "emergent" complaint, one that if not treated promptly may lead to severe consquences and/or death.

Some insurance companies, by the way, do not cover non-emergent care in the ER, but that doesn't stop people from coming in. And that's okay, because I'd rather have people come in if they're not sure than wait thinking they may not be covered.

[WannaBreatheYou]

They are treated, of course and not asked for money. That process only applies to minor complaints, ones that could be handled at a doctor's office or walk-in clinic. Hospitals are trying to cut down on unnecessary ER visits, so each patient is triaged according to their presenting symtpoms, and the doctor or midlevel determines if they will been seen or if they will be QMP'd out. Some examples of a QMP patient would be runny nose, cough without fever (a cold); dental complaint without facial swelling or fever; request for pain medication (we get lots of those); chronic back pain with no acute injury. Basically, if they need any kind of diagnostic test, they're seen without having to pay upfront.

The law firm I worked for in Seattle was defending against a woman in a personal injury suit who was one of those pain med shoppers. My attorney asked me to go through medical records of the four hospitals in the area, and her personal physician, and she had enough demoral in a month to take out a horse, I swear. She'd get two shots of demoral in two different hospitals and/or a hospital and her dr.'s office in one day, and three days later go to a different hospital's ER. They'd also give her a shot of an anti-nausea medication (started with an F...fiorinal, maybe? I don't remember), because she was always throwing up. Uhhh...withdrawal much?

By the time we got the lawsuit, she had been banned from all four hospitals from getting any pain medication, and her doctor wouldn't give her any either.

[SparkleHugs]

Someone who comes in with chest pain is seen immediately, ahead of anyone else. That is an "emergent" complaint, one that if not treated promptly may lead to severe consquences and/or death.



Out of curiosity, how often do people exaggerate their chest pain or just lie about it? We all know its the key into see the doctor. I have chest pain regularly, but it's anxiety. But if i want to be seen in an ER for something that might make me wait many hours, I could cite that as a symptom. Is that common?

[pinky]

Looking for an edge, Sparks? :tongue:

[DoubleEdgeSword]

Out of curiosity, how often do people exaggerate their chest pain or just lie about it? We all know its the key into see the doctor. I have chest pain regularly, but it's anxiety. But if i want to be seen in an ER for something that might make me wait many hours, I could cite that as a symptom. Is that common?

Ha! Pinky...

Pretty common, yeah. But not for being seen quickly in the ER, because that complaint is a guarantee for a lenghty stay. If that's your complaint in triage, before/or as the doctor even sees you, we'll hook you up to a monitor, run an EKG, take a chest xray, place an IV and draw blood. If the doctor suspects you lied about just to bring up some other minor complaint, well, let me put it this way, I've seen some doctors let patients just sit and sit while they treat other paitients who really are ill.

More common is people who are seeking morphine. It's the most common drug besides nitro given early on for chest pain. Those who seek it know the routine. And since we cannot just ignore any complaint of chest pain, they get the morphine. It's frustrating because we can discharge them, knowing that they were drug seeking, but if they come in the next day with the same complaint, we have to go through the whole routine again.

[DoubleEdgeSword]

The law firm I worked for in Seattle was defending against a woman in a personal injury suit who was one of those pain med shoppers. My attorney asked me to go through medical records of the four hospitals in the area, and her personal physician, and she had enough demoral in a month to take out a horse, I swear. She'd get two shots of demoral in two different hospitals and/or a hospital and her dr.'s office in one day, and three days later go to a different hospital's ER. They'd also give her a shot of an anti-nausea medication (started with an F...fiorinal, maybe? I don't remember), because she was always throwing up. Uhhh...withdrawal much?

By the time we got the lawsuit, she had been banned from all four hospitals from getting any pain medication, and her doctor wouldn't give her any either.

Oh yeah. I know that woman. lol We always give Demerol with an anti-nausea drug called Phenergan, that's probably the one you're thinking of. Demerol on it's on can make someone throw up.

[WannaBreatheYou]

Oh yeah. I know that woman. lol We always give Demerol with an anti-nausea drug called Phenergan, that's probably the one you're thinking of. Demerol on it's on can make someone throw up.
Yeah, that's the drug I was thinking of. I had that back on NYE when I had an inner ear infection that had me puking up my tonails from the vertigo. I knew it was an F sound. I'm so more into legal than medical.

[pinky]

My poor son, when he was just a little whippersnapper, used to have to take Phenergan pretty often because he had a really quirky stomach. When he would get anything that made him nauseous, he wouldn't be able to stop. Usually we could use a suppository (which he hated), but one time when he was about 15 months old he needed a shot to help him stop.

The doctor even said the shot was painful. :(

[SparkleHugs]

Looking for an edge, Sparks? :tongue:

No! :p I would never do that I just know i could easily cry chest pain, seeing as i often have chest pain. Usually when i see a doctor and its a current symptom, i'll tell them it hurts, but also tell them its probably my anxiety and that i'm not dying. If they tried to give me morphine i'd probably say no thanks, that would scir me. lol

I was given a pain shot once in the butt at the ER (i had a really severe sinus infection and one of my friends worked there and said to come in really early) and that did nothing for my pain. i think they just gave me a shot of nothing. lol

[DoubleEdgeSword]

This is a table of side-by-side comparisons of health insurance plans in a few countries, including the U.S., France and G.B.

http://www.npr.org/news/specials/healthcare/healthcare_profiles.html