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The False Promise of Canada's Health Care System


Muda69

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https://mises.org/wire/false-promise-canadas-health-care-system

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Canada’s socialized health care is a failure, as measured against the service the government promised to provide. Tom Kent, the senior government policy person when the Medical Care Act was passed in 1966, described the government's objectiv : “The aim of public policy was quite clearly and simply ... to make sure that people could get care when it was needed without regard to other considerations.”

However, according to a Fraser Institute survey, the median waiting time for patients in Canada from a referral by a general practitioner to the date of actual treatment, was 19.8 weeks in 2018, compared to 9.3 weeks in 1993. Waiting for treatment has deadly consequences: “Justices of the Supreme Court of Canada have noted that patients in Canada die as a result of waiting lists for universally accessible health care.” The Fraser Institute “estimates that between 25,456 and 63,090 … Canadian women may have died as a result of increased wait times between 1993 and 2009.”

When the price of something falls, all else being equal, demand rises. Since socialized health care is funded with debt and taxes, the price at the point of service is zero, and demand explodes. Supply must be rationed because it can never keep pace with demand at a zero price. The government was fully aware of this basic economic principle in 1966. Its promise to provide care “when it was needed” was always a fake promise, a pretense for expanding the power and scope of government at the expense of thousands of dead Canadians.

Canada’s Socialized Health Care – A Simple Definition

Each year, the state forces you to purchase a product which you may not want or need, for a price which it dictates, raises, and confiscates annually. Then, the state often refuses to deliver the product without refunding your purchase price, while forbidding you from purchasing a replacement product elsewhere within its jurisdiction.

A False Premise

Kent described the impetus to universal health care : "... many poorer people just did not get care when it was needed."

In an imperfect world, it is probably true that some people did not receive care when it was needed. However, the increasingly poor performance of socialized health care gives us reason to doubt whether more people lacked access to care under a private system, than under the current system. Former U.S. Congressman Ron Paul, a medical doctor by trade, wrote:

Before those programs [Medicare, Medicaid] came into existence, every physician understood that he or she had a responsibility toward the less fortunate, and free medical care for the poor was the norm. Hardly anyone is aware of this today, since it doesn’t fit into the typical, by-the-script story of government rescuing us from a predatory private sector.”

“… thousands of privately funded charities provided health services for the poor. I worked in an emergency room where nobody was turned away for lack of funds.”

The Canadian experience mirrors the U.S. experience described by Paul.

Health Care Costs

In the early 20th century, medical care was private, and many Canadians contracted with doctors to provide annual medical care at a cost of one day’s wages.

In 2018, Canada’s socialized health care cost approximately $4,389 per capita.

Let’s consider a household of two working parents with two children, and conservatively (high estimate) assume this household had a median income of $100,000 in 2018. Annual income (260 working days) converts to $385 daily income or $193 per worker. Therefore, the cost of socialized health care for each parent is about 23 working days ($4,389 / $193), or about 1 calendar month. And between them, they must work another 46 days to pay for their children’s health care.

The cost of socialized health care in 2018 was twenty-three times the cost of private health care in the early 20th century, measured by how long a person must work to pay for health care. (Again, I am being conservative by not including private costs in 2018 for dentists, alternative practitioners e.g. naturopaths, prescription drugs, private health insurance for non-hospital/physician services, etc., all of which would raise the per capita cost by roughly 50% )

Moreover, between 1997 and 2019 , “the cost of public health care insurance for the average Canadian family increased 3.2 times as fast as the cost of food, 2.1 times as fast as the cost of clothing, 1.8 times as fast as the cost of shelter, and 1.7 times faster than average income.” Notably, government intervention in these four categories is much less severe than it is with health care.

A common objection to this analysis goes something like this: “The high price of health care is not caused by the government’s monopoly. Rather, it reflects the rising cost of modern medical technology.” This argument is unconvincing. There are many complex products — e.g. computers — where competition and technological innovation produce lower prices. Indeed, this is typical of unhampered markets.

Restricted Supply

Competition in the medical-care-market has been restricted — thereby raising prices — by politicians, bureaucrats, and the elitist medical establishment for so long that we have forgotten the lessons of our ancestors, who were not fooled by attempts to impose licensing criteria. As Ronald Hamowy wrote in Canadian Medicine, A Study In Restricted Entry (p 125):

“Despite the actions of the College to suppress unregistered physicians, the public continued to firmly oppose prosecution of these practitioners throughout the nineteenth century. Nor did they believe the College and the medical journals when they insisted that their campaign against “quacks” was designed to separate … educated from unqualified physicians.”

“… many, especially poorer, Canadians persisted in consulting unlicensed physicians, whose fees were lower and who appeared no less competent in prescribing medications than did their registered brethren. The profession’s attempt to suppress these doctors was not motivated out of a selfless interest in improving the quality of medical care offered the public, but out of a desire to lessen competition, which would in turn increase their incomes.”

Curiously, there were some principled politicians amongst our ancestors. In 1851, the medical establishment drafted a bill that would grant them the power of regulating, through licensing, the number of persons who would be legally permitted to practice medicine. Parliament rejected the bill, with one politician proposing a substitute bill, the opening paragraph of which read, in part (Hamowy, p 322):

“… experience has shewn that penal enactments have not deterred unqualified persons from practising Physic, Surgery, and Midwifery, but, on the contrary, such enactments have often had the effect of preventing benevolent persons, well qualified, from lending their aid to relieve physical suffering, and it is therefore expedient and proper to repeal such penal clauses as may exist in any Acts now in force in Upper Canada …”

The medical establishment eventually got what it wanted when principled politicians were relegated to minority status, where they remain today.

Voters, however, seem to believe the government’s performance is superior to that of market entrepreneurs. As long as they continue to ignore the wisdom of their ancestors, Canadian voters are ultimately responsible for the government’s fake promise and deadly stranglehold on health care.

Yes, it is simple economics.  You make something like health care "free" and demand skyrockets.  Then you have to ration to meet that demand.  And then people wait, and die, because of it.

 

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36 minutes ago, Muda69 said:

https://mises.org/wire/false-promise-canadas-health-care-system

Yes, it is simple economics.  You make something like health care "free" and demand skyrockets.  Then you have to ration to meet that demand.  And then people wait, and die, because of it.

 

Except in infant mortality; Canada has a lower infant mortality than the USA.

 

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42 minutes ago, Impartial_Observer said:

Do 600K+ abortions per year figure into this equation?

Please explain.

1 hour ago, Muda69 said:

So that justifies the huge costs to the taxpayers and the insane wait times.  Got it.

This “cost” and “wait time” BS is the single biggest straw man I’ve ever heard. Our “wait times” are lower because our doctors are idle.

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6 minutes ago, DanteEstonia said:

Please explain.

This “cost” and “wait time” BS is the single biggest straw man I’ve ever heard. Our “wait times” are lower because our doctors are idle.

It's self explanatory. 

Our doctors are idle..........do you just make this stuff up on the fly? 

Also (1)cost and (2) wait time are actually >single. 

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15 minutes ago, DanteEstonia said:

Please explain.

This “cost” and “wait time” BS is the single biggest straw man I’ve ever heard. Our “wait times” are lower because our doctors are idle.

Yes,  a straw man:

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The Fraser Institute “estimates that between 25,456 and 63,090 … Canadian women may have died as a result of increased wait times between 1993 and 2009.”

And I'd rather have a doctor "idle" so he can address a serious need in a timely manner than be beholden to a socialist system where he is treated like an automaton.

 

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51 minutes ago, TrojanDad said:

I have family members dealing with some health issues...I can promise you their doctors are not anything close to being idle.

Where do you come up with this stuff??

Remember, Dante claims to be an insurance expert.  Therefore he must know what medical professionals are doing during every minute of their work days.

 

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On 9/23/2019 at 9:36 AM, Muda69 said:

Yes,  a straw man:

And I'd rather have a doctor "idle" so he can address a serious need in a timely manner than be beholden to a socialist system where he is treated like an automaton.

 

The numbers you cited (over a 15 year period) for deaths in Canada estimated to have been due to longer wait times for accessing care under their system appear to be lower than the estimates for deaths in the U.S. attributed to the lack of healthcare insurance (if these mostly one-year figures in the below article are extrapolated over a similar 15 year period):

https://www.politifact.com/truth-o-meter/statements/2017/may/08/raul-labrador/raul-labradors-claim-no-one-dies-lack-health-care-/

So the "people die from the flaws in your system" argument is at best a wash. In looking to other quality of care factors, like infant mortality rates or over all life span, or to economic factors like per capita cost, the western nations with universal healthcare systems seem to have us beat. 

 

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3 minutes ago, Wabash82 said:

The numbers you cited (over a 15 year period) for deaths in Canada estimated to have been due to longer wait times for accessing care under their system appear to be lower than the estimates for deaths in the U.S. attributed to the lack of healthcare insurance (if these mostly one-year figures in the below article are extrapolated over a similar 15 year period):

https://www.politifact.com/truth-o-meter/statements/2017/may/08/raul-labrador/raul-labradors-claim-no-one-dies-lack-health-care-/

So the "people die from the flaws in your system" argument is at best a wash. In looking to other quality of care factors, like infant mortality rates or over all life span, or to economic factors like per capita cost, the western nations with universal healthcare systems seem to have us beat. 

 

But at what cost to the taxpayer?  

Do you believe unlimited universal healthcare for every man, women, and child in the United States of America should be a right?  

I just know that when my spouse was initially diagnosed with breast cancer in 2012, her treatment plan was setup, reviewed, and enacted with a week.  In Canada and other socialist countries I seriously doubt medical action would be that swift.   

When a close relative of mine this past June fell and ruptured his quadriceps tendon while hiking, he was taken from the state park by ambulance to a local hospital where surgery was performed to repair the damage in a matter of hours.   This occurred on a Friday.  In Canada and other socialist systems such a surgery would probably have waited until at least the following Monday, allowing the severed tendon to atrophy and making a successful reattachment much more difficult and the subsequent recovery longer and more painful.

No, you will never convince me socialist government "solutions" to healthcare are objectively better than the free market.

 

 

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https://www.nationalreview.com/magazine/2019/10/14/elizabeth-warrens-entitlement-plans-are-money-for-nothing/

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...

Senator Sanders’s “Medicare for All” plan would have everyone in the United States, including illegal immigrants, get their health benefits directly from the government. Coverage would be more extensive than what Medicare currently provides (vision and dental benefits would be included), and without any of the deductibles, co-pays, and premiums that Medicare currently involves. Sanders himself estimates that it would mean $30–40 trillion in additional government spending over the next decade. The private health insurance on which most Americans now rely would be illegal. The more than 20 million senior citizens in private Medicare Advantage plans would be placed in the new, fully government-run program, too.

Sanders is forthright in saying that taxes will have to rise to finance this plan, and not just for the rich. He has not, however, fully detailed which taxes would rise and by how much. He has also insisted that most people would see their total costs fall: The premiums and other health-care expenses they would no longer be directly paying would exceed the new taxes. Other countries, he points out, have been able to run national health-care systems while spending less money per person than the U.S. does.

What Sanders and Warren have proposed is, however, more generous than other countries’ systems, which often include out-of-pocket costs for patients or don’t cover some categories of care. When governments require patients to pay for a larger fraction of services, it does not just reduce the taxpayer’s share; it also restrains total expenses, since patients have some incentive to economize.

Perhaps more important, no other country has socialized and then attempted to downsize a health-care system as large as ours. Supporters of the Sanders-Warren plan have pointed to a conservative scholar’s low-end estimate of its cost to argue that it would reduce total spending on health care. But that estimate assumed that the government would be able to force health-care providers to accept a 40 percent cut in pay. Nothing in the history of federal spending on health care suggests this is possible. If anything like it happened, it would surely lead to reductions in the number of providers, increases in wait times, and the like.

Warren takes a different tack from Sanders when she is asked about whether middle-class taxes would rise to pay for the health-care plan. She neither admits nor denies it. She dodges the question while insisting that total middle-class costs will fall because the system will no longer have to accommodate insurer profits or administrative costs. (“Doctors won’t have to hire people to fill out crazy forms” is how she put it at the last Democratic debate.)

....

A hypothetical for the GID legal professionals out there:  Let's say some legislator's great new plan is to socialize legal services in the United States of America.  Everybody gets "free" legal representation. Not just court appointed public defenders mind you,  but "free" lawyers for things like divorces,  wills, etc.     Would you be willing to take a 40% cut in pay in order to practice law in this "universal legal care" system?

 

 

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16 minutes ago, Muda69 said:

https://www.nationalreview.com/magazine/2019/10/14/elizabeth-warrens-entitlement-plans-are-money-for-nothing/

A hypothetical for the GID legal professionals out there:  Let's say some legislator's great new plan is to socialize legal services in the United States of America.  Everybody gets "free" legal representation. Not just court appointed public defenders mind you,  but "free" lawyers for things like divorces,  wills, etc.     Would you be willing to take a 40% cut in pay in order to practice law in this "universal legal care" system?

 

 

No, but you’ve given me an idea for a great fantasy novel.

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5 hours ago, Wabash82 said:

The numbers you cited (over a 15 year period) for deaths in Canada estimated to have been due to longer wait times for accessing care under their system appear to be lower than the estimates for deaths in the U.S. attributed to the lack of healthcare insurance (if these mostly one-year figures in the below article are extrapolated over a similar 15 year period):

https://www.politifact.com/truth-o-meter/statements/2017/may/08/raul-labrador/raul-labradors-claim-no-one-dies-lack-health-care-/

So the "people die from the flaws in your system" argument is at best a wash. In looking to other quality of care factors, like infant mortality rates or over all life span, or to economic factors like per capita cost, the western nations with universal healthcare systems seem to have us beat. 

 

Wabash with the data.

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5 hours ago, Muda69 said:

https://www.nationalreview.com/magazine/2019/10/14/elizabeth-warrens-entitlement-plans-are-money-for-nothing/

A hypothetical for the GID legal professionals out there:  Let's say some legislator's great new plan is to socialize legal services in the United States of America.  Everybody gets "free" legal representation. Not just court appointed public defenders mind you,  but "free" lawyers for things like divorces,  wills, etc.     Would you be willing to take a 40% cut in pay in order to practice law in this "universal legal care" system?

 

 

The economic differences in the markets make your hypothetical pretty hard to answer, because (for the most part) legal insurance is not available to the average Joe, and outside of a murder defense, a person's not putting his life at stake if he decides to forego legal representation to avoid the costs.

But in any event, there wouldn't be a 40%+ cut across the range for all lawyers under such a system, because unlike the situation with doctors, where even those at the lowest end of the pay scale make substantial bucks, there are lots of "starving" lawyers who make less than $45-50k a year from their practice, who would probably enjoy the raise they'd get working for the Federal Legal Administration.   

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6 hours ago, TrojanDad said:

I believe that people in the US take our countries focus on medical innovation for granted....we lead the world.  Yet, as the article alludes, we are paying for it.......

https://arcdigital.media/u-s-health-care-reality-check-1-pharmaceutical-innovation-574241fb80ba

There are several important reasons why health care is so expensive in the United States, and Grossman points out perhaps the most important: the United States effectively subsidizes research and development of drugs and medical devices for the rest of the world.

As Grossman notes, other advanced nations “clamp down” on the profit motive in various ways, meaning that people who would normally make more money in a free market through developing new medical devices, medications, or procedures to produce better health care outcomes and perhaps drive down prices through competition have less incentive to do so in these more government-controlled health care systems.

That is, despite the many regulations and laws aimed at consumer protection and safety that do exist in the United States, our health care market is relatively freer and more dynamic than those of other developed countries. This leads to a high rate of medical and pharmaceutical innovation that ends up benefiting the rest of the world, particularly other rich countries, in a similar way that NATO nations, for example, benefit from close military alliance with the United States. In short and somewhat reductive terms: we spend more money so everyone else can be healthier.

 

Cool. Too bad no one can afford it. We're also the country with the most expensive insulin (and I’m betting Canada has equal QC to us, so the purity BS doesn’t hold water).

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6 hours ago, Wabash82 said:

But in any event, there wouldn't be a 40%+ cut across the range for all lawyers under such a system, because unlike the situation with doctors, where even those at the lowest end of the pay scale make substantial bucks, there are lots of "starving" lawyers who make less than $45-50k a year from their practice, who would probably enjoy the raise they'd get working for the Federal Legal Administration.   

Again, I’m glad I went into teaching.

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15 hours ago, Wabash82 said:

The economic differences in the markets make your hypothetical pretty hard to answer, because (for the most part) legal insurance is not available to the average Joe, and outside of a murder defense, a person's not putting his life at stake if he decides to forego legal representation to avoid the costs.

But in any event, there wouldn't be a 40%+ cut across the range for all lawyers under such a system, because unlike the situation with doctors, where even those at the lowest end of the pay scale make substantial bucks, there are lots of "starving" lawyers who make less than $45-50k a year from their practice, who would probably enjoy the raise they'd get working for the Federal Legal Administration.   

Ahh, so under the current system medical professional make too much money (aka "substantial bucks")  so a 40% pay cut is justified.   After all it may help to put them back in line with those poor "starving lawyers".  

I see medical professionals leaving a socialist system like the one advocated by Sanders in droves, attempting to setup practices outside of the socialist system (if they legally can do this). The end result?  A shortage of medical professionals working in the socialist system, resulting in longer and longer wait times for services.

https://www.heritage.org/medicare/commentary/how-medicare-all-bills-would-worsen-the-doctor-shortage

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Medicare for All" may sound good to some Americans – until they take a closer look at how it would actually work.

Take something pretty basic: how it would affect the number of medical professionals we have in this country. "Medicare for All" would drive out many doctors and nurses – and compromise the accessibility and quality of medical care for millions of Americans.

The reason: "Medicare for All" bills mandate major payment reductions for America's health care workforce. Vermont Sen. Bernie Sanders' bill, for example, would use today's Medicare payment system for reimbursing doctors, hospitals and other medical professionals. Medicare rates are fixed by law and regulation, not some private market-style "negotiation." Those rates are set significantly below private sector rates, and often do not cover the true costs of providing medical services.

...

Today, Medicare enrollment totals more than 58 million Americans. Sanders's bill, however, would expand Medicare's payment rates to the coverage of more than 300 million U.S. residents.

Projecting a dramatic 40 percent reduction in provider reimbursement relative to private insurance, Charles Blahous, a former Medicare trustee, observes, "The cuts in the Sanders M4A bill would sharply reduce provider reimbursements for treatments now covered by private insurance, which represent a substantially greater (more than 50 percent larger) share of national health spending than does Medicare."

True, American physicians are among the most highly paid medical professionals in the world. Overall, in 2018 the average American primary care physician earned $223,000, while specialists earned $329,000. In 2018, American staff nurses earned $73,287 on average, clinical nurse specialists earned $88,271, and nurse anesthetists earned $150,833.

Of course, liberals in Congress could cut American medical workforce compensation to "single payer" levels. Examining comparative 2016 data – including compensation in "single payer" Britain and Canada – researchers writing in the Journal of the American Medical Association found that American general physicians earn an average annual salary of $218,173. The comparable compensation for Canadian generalists was $146,286, while British generalists received just $134,671.

Medicine is, however, a tough and often stressful profession, and medical students routinely incur large personal debts. In 2018, according to the American Association of Medical Colleges, the median medical school debt amounted to $195,000.

Punitive payment cuts would surely be costly. By 2030, Americans already face a serious and potentially dangerous physician shortage, ranging between 15,800 and 49,300 primary-care doctors, and between 33,800 and 72,700 non-primary care doctors. Accelerated retirements, job-based burnout and growing demoralization fuel that shortfall.

Combining a mammoth pay cut with the abolition of private-sector alternatives would not only hurt morale. It would accelerate the shrinkage of the medical workforce.

Patients will suffer.

Blahous's Mercatus study of the Senate bill – projecting a 40 percent reduction in provider reimbursement – is thus far the only such estimate of its impact on medical compensation. The House bill – creating a global budget for American health spending and government fee systems for doctors and other providers – is yet to be subject to a similar econometric analysis.

There is an obvious candidate to undertake such an analysis: The Office of the Actuary at the Center for Medicare and Medicaid Services. The Actuary has regularly estimated the impact of Obamacare's scheduled Medicare payment reductions.

Congress and the Trump administration should ask the Actuary to conduct a similar analysis of the "Medicare for All" bills, not only assessing their impact on America's doctors and hospitals, but also Americans' access to high quality medical care.

Congress must secure the best and most authoritative estimates of the impact of the House and Senate bills. Silly political promises won't cut it. American doctors and patients – that is, all of us – deserve an honest prognosis.

 

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2 hours ago, Muda69 said:

Ahh, so under the current system medical professional make too much money (aka "substantial bucks")  so a 40% pay cut is justified.   After all it may help to put them back in line with those poor "starving lawyers".  

I see medical professionals leaving a socialist system like the one advocated by Sanders in droves, attempting to setup practices outside of the socialist system (if they legally can do this). The end result?  A shortage of medical professionals working in the socialist system, resulting in longer and longer wait times for services.

https://www.heritage.org/medicare/commentary/how-medicare-all-bills-would-worsen-the-doctor-shortage

 

Real world circumstances suggest otherwise, as the number of physicians per capita in the U.S. and in Canada currently is almost identical.  The per capita number of physicians should be much lower in Canada's "socialist" system, per your logic. 

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4 minutes ago, Wabash82 said:

Real world circumstances suggest otherwise, as the number of physicians per capita in the U.S. and in Canada currently is almost identical.  The per capita number of physicians should be much lower in Canada's "socialist" system, per your logic. 

I guess the Canadian doctors enjoy being poor, relative to their U.S. counterparts.  And the current crop of Canadian physicians have been "brought up" in the socialist system.  They simply don't know any better.

There is also the fact that the U.S. population is almost 10 times that of our Canadian neighbors.  The population of California alone is now greater than that of the entire Canadian nation.  How well does such a socialist system scale?

Is Canada the Right Model for a Better U.S. Health Care System?: https://knowledge.wharton.upenn.edu/article/lessons-can-u-s-learn-canadian-health-care-system/

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...

Despite its relative low costs, the Canadian health care system is not free of wasteful practices. An April 2017 report by the Canadian Institute for Health Information (CIHI) and Choosing Wisely Canada (CWC), a nationwide clinician-led campaign that develops recommendations about tests and procedures, found that up to 30% of tests and procedures in Canada are potentially unnecessary, waste health-system resources and increase wait times for patients in need. Highlights from the report include:

  • Almost one in three low-risk patients with minor head trauma in Ontario and Alberta underwent a head scan in an emergency department, despite CWC’s recommendation that this is unnecessary and potentially harmful.
  • One in 10 seniors in Canada use a benzodiazepine on a regular basis to treat insomnia, agitation or delirium. Several recommendations by CWC have highlighted the harms of long-term use of these medications.
  • In Ontario, Saskatchewan and Alberta, 18% to 35% of patients undergoing low-risk surgery had a preoperative test, such as a chest X-ray, ECG or cardiac stress test. Such tests are unnecessary, potentially harmful and can delay surgery, the report notes.
  • For children and youth in Manitoba, Saskatchewan and British Columbia, rates of low-dose quetiapine (likely used to treat insomnia) increased rapidly, although the use of this medication in children and youth to treat insomnia is not recommended by CWC.

Despite such imperfections, there is growing support in the U.S. for instituting a single-payer health care system based on the Canadian model. But it is far from certain that there is enough of a social and political consensus to bring it about. Notes Pauly, “There has been more of a consciousness [lately], and probably consensus on what ought to be some social objectives here [in the U.S.] What I don’t see, though, is a consensus on how to achieve them. [U.S. Senator] Bernie Sanders believes, I guess, that you should have a right to as much health care as you and your doctor agree on, and it should be paid for by millionaires and billionaires. But I don’t think we really have a national consensus on that… The real question is ‘How much health care does an individual person have a right to; and who has the obligation to pay for it? And who should pay for that?’ Those questions are not addressed by Sanders in a way that there would be a consensus on.”

What’s the most practical way of bringing to life Sanders’ dream of a single-payer, national health care system in the U.S.?  Perhaps, argues Pauly, by “letting it happen piecemeal, state by state, just as it happened piecemeal, province by province in Canada. Although there was an overarching federal plan there to get the individual provinces to coordinate and subsidize them, originally it was a provincial initiative. Maybe that’s the way that Senator Sanders ought to go. First, start back home — and see if he can get Vermont to do what he advocates for the rest of the country. And then New Hampshire should be easy and then work across the northern tier. Washington [State] should be a snap, rather than try to persuade the heart of Republican power in the South to go along with this; that’s never going to happen.”

For his part, Polsky argues, “It’s one thing to talk about the values that are consistent with the health system you want; it’s another thing to get there.” Sanders’ plan has resonated with many in terms of the values it embodies, he notes, “but the details of that plan have never been worked out…. And a lot of the challenges are in the details.”

 

Does the individual, let's call him Citizen A, who smokes two packs of cigarettes a day for 40 years then contracts lung cancer have the right to the same amount of health care as the individual, Citizen B, who has never smoked cigarettes and also contracts lung cancer?  Why should I, an American citizen who personally abhors the practice of cigarette smoking, have to be forced by the federal government to pay even a dime toward Citizen's A's medical care?

 

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On 10/2/2019 at 11:19 AM, Muda69 said:

I guess the Canadian doctors enjoy being poor, relative to their U.S. counterparts.  And the current crop of Canadian physicians have been "brought up" in the socialist system.  They simply don't know any better.

There is also the fact that the U.S. population is almost 10 times that of our Canadian neighbors.  The population of California alone is now greater than that of the entire Canadian nation.  How well does such a socialist system scale?

Is Canada the Right Model for a Better U.S. Health Care System?: https://knowledge.wharton.upenn.edu/article/lessons-can-u-s-learn-canadian-health-care-system/

Does the individual, let's call him Citizen A, who smokes two packs of cigarettes a day for 40 years then contracts lung cancer have the right to the same amount of health care as the individual, Citizen B, who has never smoked cigarettes and also contracts lung cancer?  Why should I, an American citizen who personally abhors the practice of cigarette smoking, have to be forced by the federal government to pay even a dime toward Citizen's A's medical care?

 

 

 

The whole "poor doctors will make less money" argument is odd from you, Muda, since you traditionally have argued for market-based approaches that, if they succeeded, would presumably have a similar affect on average income for doctors. (For the same market-based reasons that doctors made significantly lower incomes before employer-based group health insurance came along.)

With regard to the smokers getting lung cancer thing: if have group health insurance through your employer, you are already subject to that exact sort of cost shifting arrangement now. While insurers can and will impose premium surcharges on smokers in the group pool, those surcharged do not offset the additional actuarially-determined cost of having those people in the pool, and they this spread that cost to everyone else in the pool. 

Even uninsured smokers who contract lung cancer cost you money under our current system, because they still get treated under hospital "charity" programs or state emergency medical cost plans, and those charges are eventually "shared" with you via higher taxes, and higher overall medical costs at the hospitals.  

The moralistic aspects of this are interesting to hear from you as well. While slippery slope arguments are often illogical, I can't imagine you have absolutely no vices or habits (eating or otherwise) that are not associated in some degree with some negative health consequences. Yet you foist the potential cost of your vice or habit on others in your group health coverage pool.  Why should they have to carry part of the risk of your poor decision-making?

 

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On 10/2/2019 at 5:43 AM, Muda69 said:

Medicine is, however, a tough and often stressful profession, and medical students routinely incur large personal debts. In 2018, according to the American Association of Medical Colleges, the median medical school debt amounted to $195,000.

That says more about how higher education is structured in the USA than about how “special” doctors are.

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