Canadian Health Care

[jpanhalt]

If the govt is footing a lot of the bill they look for ways to reduce costs, bring in accountability as to why things cost so much, and start looking at problems with the big companies supporting each others rip-off pricing.

@MrRB

Your concept that government control fosters accountability in contrast to free enterprise is more than a little surprising.

Was anyone in the Baby Joseph case held accountable for the errors?

John

 

[ronv]

It seems pretty intuitive to me that preventive medicine has helped us to live longer.

While it may be true that someone that is living in poverty without insurance may find money to buy beer instead of going in for a colonoscopy and dumping $4000, it's very hard to argue he couldn't have done both and lived longer.

I guess you are talking about medicare starting 50 years ago?

 

[ronsimpson]

Somewhere in all the reading on this subject....I found "When the public perceives government healthcare as "free" they demand twice as many services." No health system can handle 2x the work. No system can withstand the 2x cost. The system must restrict services back to a reasonable level. From my years in Canada there certainly are restrictions.

For sum of us cost limits services.
For sum of us a insurance company limits services.
For sum of us government restrictions limit services.

I can't imagine a system with out limits on services.....with out people dieing....with out somebody being unhappy.

 

[ronv]

Ron, I think you are right. One of the things I noticed when I went on medicare was that my doctor wanted to see me every 6 months. Back in those days I was very healthy and finally told him once a year was enough because I was used to every 4 or 5 years for a check up. Totally "free" is probably not a good idea, but I bet we would be amazed at how a small co-pay would bring it into line.
I had a similar situation with my mother that happened with that baby. The difference is she lived 13 months on a respirator. To be honest, though I loved her dearly, I'm not sure that was a good idea.

 

[ronsimpson]

Hi Ron, With 'free' the doctor knows that medicare will pay him only once/6 months so he strives for that. You would be happy moving from 48 months to 18 months.

I also have a relative that used up 2,000,000 in insurance in the first month of life. Then took all funds the family had. He is school age now but will never attend school. He will never be productive.

My grandmother was a nurse. She brought many babies into the world. She told me that it (is/was) common for a nurse, (when faced with a infant that had no chance of living a good life), they did not try very hard to save the child. I know it is hard when you baby dies before you get to hold it. It is much harder a month or year later, after you invest love, and the inevitable happens anyway. Or I know a 56 year old that has never stood or talked.

 

[Mr RB]

...Your concept that government control fosters accountability in contrast to free enterprise is more than a little surprising.
...

When the government has to pay for something itself there will be financial accountability when they start to take control of which big companies they are paying money to, and how much they need to pay (or if they can find a cheaper supplier).

When it is the end user (a citizen) who pays directly to the big company, the government doesn't give a damn how much the payment is. If anything, they prefer big payments as they can reap a higher amount of tax from that industry.

Which is exactly why costs of health care in the US are many times higher than the same quality of health care from other English speaking countries where the govt has to pay for the health care itself, and had spent years refining costs and keeping the big companies a little more honest.

 

[ronv]

So, lets see if we agree on a couple of things that might help.

- standadize paper work. This would save at both Dr. and insurance companies. (software etc.)

- buy drugs in bulk (like Canada) I don't know how to accomplish this.

 

[panic mode]

todays front page news in Toronto Star:
https://www.thestar.com/news/gta/mi...urgeon-must-inform-patients-of-his-misconduct

sadly this "Dr. Nick" is not character from some TV cartoon, he is a real life surgeon who botched numerous surgeries of which he admitted 22. one of the patients died as a result of his incompetence.

College of Physicians and Surgeons of Ontario, like any ethical professional organisation with strict code of conduct and public welfare as top objective, didn't stop him from practising, only ordered him to pay the standard fee of $3650 for covering his tracks. the did make him disclose his misconducts to patients in need of a major surgery - when he is "in the clinic where he works". Sounds that he does not make any disclosure if he happens to treat someone elsewhere (scene of an accident perhaps). Also other patients don't need to know that they are treated or cut open by a butcher. Guess who decides what qualifies as a "major surgery". At least patients in need of an elective surgery are in a slightly better position than those who need emergency surgery.

"the College" is doing what it can to "regulate" (protect) it's fellow members. the $3650 was the same fee all other 'professionals' had to pay:
https://www.cpso.on.ca/whatsnew/news/default.aspx?id=6712
https://www.cpso.on.ca/whatsnew/news/default.aspx?id=6990

They do what they can to conceal the truth (in the interest of public of course) and even in a rare case where where notice of misconduct is to be placed (Ian DePass for example), such notice is in the operating room, not in the waiting room. They would not want patients to be near such notice unless they are heavily sedated.

hearing schedule for the next few days:
https://www.cpso.on.ca/whatsnew/committeeschedule/default.aspx?id=1448

 

[jpanhalt]

It won't be an easy transisiton for the US going from the old system to a more civilised health care system, the powerful big corporations will be kicking and screaming trying to protect those easy, corrupt, megabuck profits that they have become so accustomed to.

Ah, I can't wait for "civilized" health care to hit the United States. Ireland has national healthcare, doesn't it? The only thing civilized about it is that civil servants are making medical decisions: https://www.foxnews.com/health/2012/11/14/how-bureaucracy-killed-woman/?test=latestnews

Oh well, what's one more preventable death, of course with extreme suffering too.

John

 

[KeepItSimpleStupid]

So, lets see if we agree on a couple of things that might help.

- standardize paper work. This would save at both Dr. and insurance companies. (software etc.)

- buy drugs in bulk (like Canada) I don't know how to accomplish this.

I agree with both of these, but I would like to add a third and possibly a fourth.


3 - Let's all input and retrieve Medical data into the same system for both doctors and patients. Patients can protect the data. e.g. determine sharing permissions. Under "emergency" conditions, data is open to any doctors. I won;t define "emergency". The government should create this system.

4. Create a Heuristic system that can access all of the data and test results which can suggest questions to ask, tests to perform and types of specialists to see to generate a diagnosis.

 

[jpanhalt]

So, lets see if we agree on a couple of things that might help.

- standadize paper work. This would save at both Dr. and insurance companies. (software etc.)

Presumably by "save," you mean time and money will be saved and/or efficiency will be improved by standardization per se. I don't agree.

There certainly have been effective efforts to standardize the way paperwork is done and the nomenclature that is used. SNOMED, which was developed by pathologists as a standardized approach to nomenclature, is one very successful example (https://en.wikipedia.org/wiki/Snomed). Formatting of laboratory results is another example. In neither case was a regulatory hammer needed for acceptance and widespread use. SNOMED is used worldwide today.

On the other hand, DRG's and CPT coding (https://en.wikipedia.org/wiki/Diagnosis-related_group ; https://en.wikipedia.org/wiki/Current_Procedural_Terminology) made delivery of care far more complicated. Much of the silliness one sees in billing practices in the US results from those two government efforts at standardization. (While the AMA is tasked with maintaining CPT coding, it is tightly controlled by government.) If you look at the list provided, you might think medicine is quite simple. What isn't evident are all the things that don't fit nicely into the codes and/or that get xx999 codes, and the effect of such assignments on patient care. In pathology, and I suspect in other specialties as well, 999 codes are effectively not reimbursed. Some hospitals try to play a game of cost shifting those procedures to others. Or, in worst cases, either not allowing such procedures to be done or trying to find "best fits." There is also a tremendous amount of time wasted on deciding between several similar codes, such as the 8830x codes.

Thus, the key to whether standardization will improve delivery of medical care is in how it is implemented. To me it is completely illogical to trust such implementation to an entity that has repeatedly failed in its efforts and whose true goal is not improved care, but reduced costs.

- buy drugs in bulk (like Canada) I don't know how to accomplish this.

I am not quite sure what you mean by buying drugs in bulk. If you mean buying large quantities of currently available dosage sizes, that is already being done. If you mean having drugs sold in larger multiple dose sizes, I assume you realize that the only impediment to doing that is government regulations, namely FDA approval. There are of course serious risks to having drugs distributed in multiple dosage sizes. With current technology, it is impossible to track and to ensure that such multiple use sizes are properly used. Microbiologic contamination, adulteration (both intentional and unintentional), outdating, and improper doses are just four of the problems. Single-use packaging reduces those risks.

Another problem with large bulk distribution is getting additional supplies when usage deviates from prediction. In the previous Soviet Union, for example, antibiotics were sent to hospitals in bulk. If use of one antibiotic exceeded standards of the central planner, the hospital had to do without until its usage was back in line with those standards. So what do you do when one hospital has an outbreak of staph infections and another has an outbreak of Pseudomonas infections?

I agree with both of these, but I would like to add a third and possibly a fourth.

3 - Let's all input and retrieve Medical data into the same system for both doctors and patients. Patients can protect the data. e.g. determine sharing permissions. Under "emergency" conditions, data is open to any doctors. I won;t define "emergency". The government should create this system.

Standardization of nomenclature and record keeping practices has been demonstrated to improve care, as the SNOMED and other examples show. As for confidentiality of medical records, governmental approaches have been abominable failures. Care givers who need access can't get the information they need; insurance companies on the other hand have unlimited access. As for maintaining confidentiality, to put that in the hands of the government is insane. Anyone recall Wiki-leaks? Leaks from Medicare, Veterans administration? How about unauthorized access to IRS records being used for political purposes? Does any woman who has had a pregnancy test want that information available to politicians?

Again, compare all of those failures to the success of places like the Mayo Clinic in maintaining patient confidentiality. I do not want my medical information in a national database. Since it is my information, I don't see why an uninformed electorate should be able to dictate otherwise.

4. Create a Heuristic system that can access all of the data and test results which can suggest questions to ask, tests to perform and types of specialists to see to generate a diagnosis.

First and foremost, that is being done and is part of every medical training program in the US. Most of you have probably seen at least one episode of House in which a list of potential diagnoses is made (differential diagnosis). And, there are handheld devices today that help in that respect. It needs to be implemented on a patient-to-patient basis by physicians, not by global checklists. As one example, taking a patient's temperature within 30 minutes of arrival in an ER is on a checklist for "quality of care" assessment. Do you really think that should apply in every case? It is a huge mistake to think than any government entity can substitute regulations and standards for judgement.

I don't think we will ever agree on how medical care should be delivered. What I don't understand is the basis for your argument that I should accept my care what you think is best for your care.

John

 

[ronv]

Yes KISS, I think you have a point. The data collection is the problem, but as you say a common set of software and codes would go a long way to make it fit into a database. I guess if the gov't can record all of John's telephone conversations they could also record all the doctors visits. But certainly only the gov't could do it or even want to do it.

John, Several people where I live get their drugs from Canada because they are much cheaper for the same drug. The difference is because Canada buys in volume. Canada buys US drugs then sells to US cheaper. Go figure.

 

[Mr RB]

... Several people where I live get their drugs from Canada because they are much cheaper for the same drug. The difference is because Canada buys in volume.
...

No, the price difference is because the in Canada the govt keeps the drug companies a little more under control, so they can't get away with as much extortion re pricing as they can in the US. Please see my previous posts.

Privatisation in an open market (for instance telco's) means the consumer gets lower prices as the telcos fight each other to offer cheaper better products to get the sales. Privatisation in a regulated or monopolised market (like the US health system) means prices skyrocket as the big corporations conspire to raise prices as high as possible, and then some more. People have to pay or die.

As I said previously, once the govt has to start paying for that instead of the consumer, they soon start to get those prices down.

 

[jpanhalt]

As I said previously, once the govt has to start paying for that instead of the consumer, they soon start to get those prices down.

I can't disagree that is what you have said. Can you give some examples where that hypothesis actually played out?

John

 

[Mr RB]

See that documentary movie I mentioned previously about the huge problems with the US health care system compared to health care systems in other white English speaking countries ie Canada, Britain, Australia. Much of the documentary covered pricing. Medicines we can buy here for a few dollars can cost a hundred dollars in the US. Those same medicines cost a few cents to make.

 

[ronv]

No, the price difference is because the in Canada the govt keeps the drug companies a little more under control, so they can't get away with as much extortion re pricing as they can in the US. Please see my previous posts.

So how do they do that? Why couldn't we do the same thing?

 

[Mr RB]

Well you could, and you should, in my opinion.

Of all the things the govt blows money on that it took in taxes from the people, free health care is one of the very best things. What else do they do with that money? Give billions of dollars to bail out evil bankers who then paid themselves in multi million dollar bonuses while they are screwing the entire economy?

I'm a capitalist in principle, in that people who work hard to build wealth have a right to enjoy that, but in the same sentence there is enough taxation taken already to pay for poor people's health care. So I'm for a world where people can get rich if they want, provided the poor are taken care of. The world at the moment is where the rich are a bit TOO rich, and the poor suffer. There's no need for that situation.

 

[tvtech]

Well you could, and you should, in my opinion.

Of all the things the govt blows money on that it took in taxes from the people, free health care is one of the very best things. What else do they do with that money? Give billions of dollars to bail out evil bankers who then paid themselves in multi million dollar bonuses while they are screwing the entire economy?

I'm a capitalist in principle, in that people who work hard to build wealth have a right to enjoy that, but in the same sentence there is enough taxation taken already to pay for poor people's health care. So I'm for a world where people can get rich if they want, provided the poor are taken care of. The world at the moment is where the rich are a bit TOO rich, and the poor suffer. There's no need for that situation.

And that Mr Roman Black is very well said. Good that you understand stuff like this.....like here in frigging Africa....where all is a shambles.

Those in power must stop stealing here. They will get caught out. And the stupid masses that voted them into power in the first place will probably take revenge "Africa Style". And realize that they have been taken for a ride by the very idiot they supported...

Only a matter of time. Hungry tummies and failed promises make people kill.

Gaddafi learn't it the hard way. From his own people. Enough is enough.

Rep for you Roman

Regards,
tvtech

 

[tvtech]

I feel bad. I killed this brilliant discussion with my post above with myself. Me and my flipping Politics

I have lot's to learn about people still. I believe I am as subtle as a bull in a China shop at times. Sorry guys.

Regards,
tvtech

 

[ronv]

We enjoy it! Keeps all the old hearts beating strong.