Top recommended comments to NPR story about Canadian health care

Submitted by Lee Batdorff on Mon, 08/10/2009 - 23:55.

Find the initial story, these comments and active links plus more at:

http://www.npr.org/templates/story/story.php?storyId=111721651

All of the comments below had at least 11 recommendations by readers.

Grant Hurlburt (granth70) wrote:

I'm a Canadian citizen. I taught at 5 U.S. universities in 3 states (WV, Calif. and PA) over a 9-year period, & had health insurance at each institution. I'm back in Canada, where I was unemployed for 6 mos. before finding a job. Canada's system is better than that of the U.S. (the ONLY developed country lacking govt. health care). I saw few differences between U.S. & Cdn systems, except when uninsured in the U.S.! No Cdn. bureaucrat controls what doctor I see, whereas U.S. HMO's do tell people what doctor (etc.) to see. ER wait times were the same, & it was equally hard. to find a family doctor (good ones via personal contacts). I actually paid more out-of-pocket in the U.S. even with pretty good insurance, due to plans that paid "80%" up to certain amt., co-pays, deductables, etc. One year I paid %4500.00 out of pocket for MRI's and CT Scans in the U.S. My U.S. insurance co. required me to subst. a generic form of a name-brand pills. In Canada, the generics weren't available because Canada (or at least Ontario) requires a higher standard of bioavailability than the U.S., & I was back on the namebrands, which were better. I taught courses to U.S. nursing students, some of who were less qual. than any Cdn nurse I've encountered
 
Cris Kalangis (crisk) wrote:
In 2003 my father needed emergency heart by-pass surgery. He got it with no issues from one of the country's top hospitals. He recieved outstanding care before, during and after the procedure. He was a retired gentleman with no insurance. He didn't pay a dime. Why? Because he lived in Canada!
 
George Gekas (nicknora) wrote:
I’ll say it again. 
 
Why is this country so short on progressive action and long on hysteria and utter ignorance? We should be ashamed that we are even having this argument…and in front of the entire world no less. Canada is smarter, Germany is, France is, and the USA…well, just a bunch of dumb arse idiots. We are the laughing stock of the industrialized world, how embarrassing, embarrassing to call one’s self an American. Palin, Limbaugh, Beck, etc, the sewers of hate and disinformation, and ultimately the true subversives of democracy. We cower at the mere mention of the word terrorist, but here they are right in our midst, in our face, on the air, and funded in part by laxatives. Are they and their ilk who we really want as our collective voice? Get real.
 
And for those who are self employed and the rulers of their own creative domain; the artist, architects, inventors, musicians, the people who enrich our lives you better hope and pray every day that even with your expensive insurance policy you don’t become sick because the odds are stacked against you under the current health insurance system, not the health care system, but the system that is designed to take away all your dreams in the blink of an eye. Get mad.
 
If I sound pissed, well I am, and I make no apologies to anyone nor to this country, which I love dearly. Wake up, get in the street, and support your president who’s working his butt off to regain our rightful place as leaders in the world and as a nation of healthy, productive, and creative citizens. Get smart
 
Liz L (citygirl) wrote:
Only in the United States could we look at a system, our healthcare for example, that is far more expensive and much less efficient and call it the best in the world. 
 
I am not saying that universal/single payer is the answer our prayers and has no faults, but when you compare costs, life expectancy, infant mortality and see that we spend more, get less, have a lower life expectancy than France, Canada, Norway, Sweden, etc and have a higher infant mortality rate than Cuba, hardly the bastion of the wealthy, it only makes sense to least consider the option. That is unless you are bought and paid for by the healthcare insurance industry and big Pharma.
 
You would think the GOP and Blue Dogs would worry about the burden our businesses must bear that puts them at a competitive disadvantage with foreign companies that don’t have to fund the healthcare of their employees, but I guess not. Maybe they’re all bankruptcy lawyers on the side.
 
Lee Batdorff (Batdorff) wrote:
Who is paying for the apparently mis-informing ads being broadcast in the U.S.? It is likely the health insurance companies themselves, through proxies. Is it our health insurance payments paying for these ads? What about using the money to pay for the health needs of the people insured? Are these health insurance companies major backers of NPR? In which case don't look to NPR to cover this story.
Mon Aug 10 2009 14:02:49 GMT-0400 (Utech EDT (14))
 
Judi Grimsrud (JudiG) wrote:
Thank you for what I felt was a well-balanced perspective on the Canadian health care system. As a citizen of both Canada and the US and someone who has accessed healthcare services in both countries, my vote goes for the Canadian system. The only time I've had to ask permission to receive health services from a bureaucrat was when I lived in the United States. I chose a few years ago to move back to Canada with my young son. Among the reasons: more easily accessible health care with no concerns about how to pay for care as well as the education system. There are many things to like and admire about the United States; the healthcare system isn't one of them.
 
Kathleen Kelly (Turtlebox) wrote:
As an American living in Canada, all I can say is "THANK YOU NPR!" I have a six year old with a rare disease and we have had two years of top notch care in Canada without seeing a bill. Because I am self employed, I can never afford to return to the States because of my son's "pre-existing condition".
 
Here is a link to a video I made telling my story: http://www.youtube.com/watch?v=9TWuO5dBYjo
 
 
Iona Trailer (IonaTrailer) wrote:
All the people who are screaming they don't want socialized medicine should realize how many people already are covered by Medi-Care and the VA. 
 
I hope Obama doesn't whimp out and allow the insurance companies to derail this issue. They've already shown they can't be trusted with the public's health care.
 
 
robert hobbes (bobhobbes) wrote:
As a Canadian, I would like to add a personal perspective to this story. First of all, the notion that 1/2 of us are desperate for a private health insurance scheme doesn't wash; I don't know anyone in my extended family or network of friends for whom this applies. Dental care in Canada operates exactly like your health care system so we know how private insurance plays the game. I think the aformentioned statistic is suspect and should be fact-checked carefully. In all of my friends' and family's experiences with our medical system, there have been uniformly good experiences overall for a wide range of chronic and emergency related health issues. As an example, my cousin's pregnant wife had a health emergency which resulted in the delivery of twins at 9 weeks early. After a helicopter flight from Victoria over to the Vancouver Children's Hospital, the twins were kept in the preemie ward for the next 8 weeks with intensive medical care. Follow up care for the twins has been extensive and they are now healthy and hearty 11 year olds who do still have some minor underlying health concerns. Cost to family = 0$. Liklihood of coverage refusal or bankruptcy = 0%. Wait time = 0 days. The care is there when needed.
 
 
jc nettles (guade00) wrote:
about a year ago, NPR did a series of reports on health care systems around the world, which was instructive on how the US health care system might reform itself without "for-profit" insurance companies...
 
Germany: http://www.npr.org/templates/story/story.php?storyId=91971406
 
France: http://www.npr.org/templates/story/story.php?storyId=92419273
 
Switzerland: http://www.npr.org/templates/story/story.php?storyId=92106731
 
Netherlands: http://www.npr.org/templates/story/story.php?storyId=92641635
 
UK: http://www.npr.org/templates/story/story.php?storyId=92067101
 
On the whole, the United States has the least desirable system.
 
Dave Thomas (Kryten) wrote:
I'm a Canadian who moved to the U.S. about eight years ago. The situation described in the story is very similar to my own experience and that of my family. My father, who still lives in Canada, suffers from a chronic condition which has required several surgeries and ongoing pain management. He has had no problems.
 
But there is one aspect of this which some reporters have hinted at, but which nobody has really explored: when I moved to the U.S., I was struck by the sense of fragility, the sense that everything could fall apart if one is struck with a serious illness or injury. This chronic worry is part of my life and probably most other people's (although, never having experienced life without it, most people probably don't notice it). This is just a slight, nagging worry that leads to changes in behaviour: for example, I don't change jobs without considering medical insurance.
 
One could probably make the argument that lack of universal healthcare is hampering the operation of the free market: employees do not move freely and probably stay in jobs where they shouldn't.
 
Dave G (DaveMG) wrote:
 
 
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Remainder of comments which are not in the main message

Dave G (DaveMC) wrote:
I am a Canadian, and all discussion in American media about the Canadian system is just insane.

 
The Canadian system works great. All these stories of Canadians going south of the border for care or buying private health is just bizarre misinformation. Those instances probably happen, but in highly circumstantial, specialized situations.
 
I have been poor in Canada, I have been well-off in Canada. Whatever my circumstances, I have been fully covered and never spent a day in my life worried about my coverage, or paying too much.
 
I have also lived in two other countries with socialized medicine. There's a reason every single other developed nation other than the US has socialized medicine. It works and people like it.
 
Whatever you decide to do in the US is your business. Do whatever you want.
 
But stop bad mouthing the Canadian system. You have demonstrated beyond a shadow of a doubt that you have no idea what you're talking about.
 
 
Joe Goode (Capsrus) wrote:
It is shame that more people will hear the "scare" television ads about the Canadian health care system than NPR's informative reporting on the subject. Thanks you for this timely and relevant story.
 
Gus Snarp (snarp) wrote:
There are really 2 questions to ask when deciding whether a health care system is better:
1. Which provides better outcomes for the largest proportion of the populations.
2. Which costs lest.
 
Single payer wins at both, and statistics (as opposed to anecdotes) bear this out across the industrialized world. Which begs the real question: why isn't the current health care reform plan a single payer system (and rest assured, it is not). The answer can only be that the health insurance industry is too large, too powerful, and employs too many people to be challenged in a serious way.
 
Gus Snarp (snarp) wrote:
Mark - The question of why we have a large pharmaceutical and medical technology infrastructure and Canada doesn't has many answers, and chalking it up to single payer healthcare is an exaggeration at best. You could just as well ask why Canada does not have a significant auto industry, a significant silicone chip industry, etc. etc. etc. It all started back in 1776 when we had a little revolution here in America. Prior to that the American colonies and Canada were both governed by the British Parliament, and were expect to serve as sources of raw materials and markets for finished products for Britain. We were expected to buy their stuff and not to manufacture our own. After the revolution that changed and the United States began to develop its own manufacturing sector, while Canada remained a ward of Parliament. That gave the U.S. a major head start. One other reason, Canada has one tenth the population of the U.S., half the population of the U.K. or France, less than half the population of Germany.
 
Brian Wiebe (brianwiebe) wrote:
I really appreciated the report on Canadian medical. As a Canadian now residing in the US, I'm frequently frustrated by the boogey-man style commentary on Canada's medical system. It has it's weaknesses,and there are delays, but it's a system that works - and everyone is covered. Still, let's be honest - there is a cost. Taxes are higher, and the hospitals are not as posh. But the care is excellent and usually timely.
 
Rafael Celedon (RCeledon) wrote:
Thank you NPR for reminding me and bring me clarity of the Canadian system, the way you described it is how I remember it. 
I have lived in the U.S. for the last 9 years and I had good medical insurance all these years, but there are no good record keeping here, you always have to deal / fight with the insurance company on many charges.
In Canada every time I needed to go to the doctor I was able to get an appointment within days, If I needed urgent care the hospital were always there with waiting times similar to many US hospitals (only hours).
I feel the Democratic party is not doing a good job of explaining the content of the bill and the Republican party is very affraid this might actually work.
With more than 30% of the money spend in the US health going to administrative cost there are a lot of areas were fat can be cut. If in doubt check the administrative cost of many countries including Japan, taiwan, canada, etc.
 
Mark Barker (MaxHund) wrote:
It's such a pleasure to hear a balanced report rather than a biased advert that leaves out most of the facts. Thanks
 

Another Canadian speaks

Here's a interesting video by a Canadian woman: http://www.ted.com/talks/allison_hunt_gets_a_new_hip.html

She explains how she gamed the Canadian health care system so she wouldn't have to wait 18 months for a hip replacement. (This was after a 10-month wait for an initial appointment to see an orthopedic surgeon.) I'm not sure I'd be as willing as she to talk about my cleverness in jumping the queue.
 

Hip replacement in U$A - no waiting

DiffView,  

I didn't take the time to look at the video.  But I have one question:

How long a wait is there in the United States for a hip replacement if you don't have health insurance?

best,

jeffb 

Response to your question

> How long a wait is there in the United States for a hip replacement if you don't have health insurance?

With respect to your question, I do not know. However, let's suppose it's more than 18 months--or not at all. That means we need to do something about those without health insurance. (Actually, that should be those without appropriate health care, which is not the same as those without health insurance.) It does not mean that a Canadian-style single-payer system with 18-month waits as the standard is a good idea.

response to your question

I am in favor of a single payer system. I have worked in health care for a long time, and each year that I do, I become more convinced that this is the way to go.

I am really tired of the US medical system. I am disgusted with the number of MRI's, CT, and other machines that we have too many of but then the poor can't access when needed. The US medical system forces defensive medicine on providers, and many unnecessary tests are performed on the insured patients "just in case". We have lost the common sense conservative style of medicine and thanks to the media saturation, we have a public that demands the latest in technology at all times. 

We have turned health care into a huge profit maker for the health insurance industry.

All that is in danger here if we were to go to a single  payer health care system is that the insurance companies would be out of business.

The US population needs a real education in health care and doctor's need to say :no, you don't need a CT for your headache, but, yes, you need a mammogram right away for that breast mass. 

Some anti-single payer folks say that going to a single payer system would take away from the doctor-patient relationship but I believe that right now in the US that relationship is between the doctor, the health insurance company, and the malpractice attorneys. The patient is in the hallway.

Debbie

 

 

18 Month wait is not "standard" in Canada

Your example of hip replacement - which is clearly a non emergency procedure - perhaps taking 18 months in Canada -  has seqwayed in your present post so now all Canadian procedures are included in your statement "that a Canadian-style single-payer system with 18-month waits as the standard is not a good idea".
 
Sliding into hyperbole undermines the credibility of your argument.  
 
The facts in Canada and the USA also undermine your argument.  
 
FACT A very good friend of mine had their appendix removed in Toronto last year.  Every cost was covered by the Provincial health insurance system.   
 
I visited them in the hospital. From the time of their appendix pain, the hospital and doctor were ready to immediately remove the appendix, and then do further surgery if it was determined to be necessary.  The patient actually had to request that the hospital/doctor delay the surgery until the patient was able to obtain a second opinion, and to complete certain business before they were hospitalized and had to spend time recovering.
 
FACT   17% of the US GDP is associated with hospitals, pharma, or doctors.  Each of these three cartels exercise a geographic or copyright monopoly on their services and/or face no active price competition. Each of the 3 cartels works our state and federal legislators with massively funded lobbing efforts. Each of the 3 cartels is driven by profit, not the Hippocratic Oath.
 
FACT Employer supplied health care insurance is bizarre, and is used to trap employees.
 
FACT Living with no/low health insurance is scary and a national depressant affecting everyone.
 
FACT It is not healthy to get sick in the USA. Our health care quality is way down from the best served countries.  
 
FACT Only the disingenuous PR of the hospital, big pharma, and doctor’s lobbies brainwashes us Americans to have us believe the present system is  viable.
 
FACT  If you want to pay for private health care, just like some pay for private school, you can.
 
FACT  You are a Republican.  (just guessing, am I right?)
 
best, jeffb
 
 

re: 18 Month wait is not "standard" in Canada

Your example of hip replacement - which is clearly a non emergency procedure - perhaps taking 18 months in Canada -  has seqwayed in your present post so now all Canadian procedures are included in your statement "that a Canadian-style single-payer system with 18-month waits as the standard is not a good idea".
 
Sliding into hyperbole undermines the credibility of your argument.

I have no problem in changing "18-month waits" to "comparatively long waits." Why? Because waits for referral in Canada are significantly longer than those in the U.S. One 2008 survey found that for U.S. adults with chronic conditions, 86% got an appointment with a specialist within 4 weeks; 5% required 3 or more months. For Canada, comparable numbers were 56% and 20%. Source: http://www.commonwealthfund.org/~/media/Files/Surveys/2008/The%202008%20...

I might also point out that unreasonable waiting times and their effects were recognized by Canada's Supreme Court in the 2005 case Chaoulli v. Quebec (Attorney General). Part of the decision reads: "The evidence in this case shows that delays in the [Quebec] public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care. The evidence also demonstrates that the prohibition [by Quebec] against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness." Source: http://csc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

FACT A very good friend of mine had their appendix removed in Toronto last year.  Every cost was covered by the Provincial health insurance system.  [...]

I'm not quite sure what I'm supposed to conclude from this--that a single-payer system can provide emergency care comparable to U.S. emergency care in uncomplicated emergencies? Under U.S. law, a foreign visitor to the U.S. needing an emergency appendectomy would receive one. He would, of course, be billed for his care. However, visitors to the U.S. can generally buy medical insurance before coming, which is prudent. I'll add that free care for foreign visitors isn't a necessary characteristic of single-payer systems, e.g., there have been proposals to require visitors to the U.K. to have verifiable health insurance before they're allowed entry.
 
FACT   17% of the US GDP is associated with hospitals, pharma, or doctors.  Each of these three cartels exercise a geographic or copyright monopoly on their services and/or face no active price competition. Each of the 3 cartels works our state and federal legislators with massively funded lobbing efforts. Each of the 3 cartels is driven by profit, not the Hippocratic Oath.
 
Do you think there would be more price competition under single-payer? Wouldn't all prices be set by government, as is now the case with Medicare? Medicare already introduces distortions into the health care system. Why wouldn't single-payer planners introduce more distortions, particularly when those planners have few market signals to guide them? And why would a single-payer system run by non-physician government bureaucrats be driven by the Hippocratic Oath? (BTW, I don't know what you mean by "copyright monopoly." Perhaps you're talking about patent protection for drugs?)

FACT Employer supplied health care insurance is bizarre, and is used to trap employees.
 
I totally agree. I favor health insurance portability, with individuals buying and paying for their own health insurance with before-tax dollars. (Yes, I pay for my own health insurance.) Some provision would obviously have to be made for those without their own money to buy insurance.

FACT Living with no/low health insurance is scary and a national depressant affecting everyone.
 
I also agree because I've lived without health insurance. But that doesn't mean single-payer is a particularly good solution.

FACT It is not healthy to get sick in the USA. Our health care quality is way down from the best served countries.
 
It depends on which statistic we're looking at. For example, Canada's breast cancer mortality is 9% higher than in the U.S.; Canada's prostate cancer mortality is 184% higher. Source and more comparisons at: http://www.ncpa.org/pub/ba649 More comparisons, many showing U.S. care favorably, appear in a University of Pennsylvania paper at http://repository.upenn.edu/cgi/viewcontenst.cgi?article=1012%context=ps... The Penn paper also concluded, "[T]he low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system."

If you're thinking of the WHO report from 2000 that ranked the U.S. 37th in health care quality, I suggest looking closely at how that ranking was computed. Five factors were used to compute the rankings. The factors were given different weightings, and those weightings carried an inherent bias. Source: http://www.cato.org/pub_display.php?pub_id=9236 (Yes, I know Cato is a libertarian think tank, but that doesn't necessarily make their analysis wrong.)

FACT Only the disingenuous PR of the hospital, big pharma, and doctor’s lobbies brainwashes us Americans to have us believe the present system is  viable.
 
I agree that the current system has severe problems. However, I think it's unrealistic to think single-payer won't also have major problems. Medicare's 75-year $35 trillion unfunded liability does not convince me that politicans would somehow get it right if they made government-funded health care even extensive.

FACT  If you want to pay for private health care, just like some pay for private school, you can.
 
Actually, private payment wouldn't necessarily be an option if the U.S. were to adopt a Canadian-style single-payer system. Private practice has been illegal in some provinces.

As you may also be aware, Section 4507 of the Balanced Budget Act of 1997 allowed doctors to enter into private contracts with Medicare patients. However, it then prohibited those doctors from submitting any claims to Medicare for any patients for two years. In practice, Section 4507 meant that Medicare patients could not enter into contracts or pay for private health care. (Source: http://www.physiciansnews.com/law/898.html ) In 1999, the D.C. Court of Appeals ruled that Medicare patients could contract privately for certain purposes without onerous burdens on doctors. However, writing a law to eliminate private pay for Medicare (or single-payer) patients would not be difficult.

FACT  You are a Republican.  (just guessing, am I right?)
 
I happen to be a Republican, but I'm a conservative before I'm a Republican. (FWIW, I'm guessing that you're a Democrat or Green, but that's probably not much of an insight.) I'd still oppose single-payer if it were proposed by a Republican president or Congress. In general I favor non-intrusive government and maximum individual freedom. Because single-payer entails intrusion into everyone's life and the inevitable restriction of individual freedom, I oppose it.

This response took much longer than I'd planned. I probably won't have time for another.

The demands of Wall Street poison private health insurance

Debating anecdotes can be useless when trying to determine validity of an argument. Logic based on facts can help settle matters if one can follow fact and logic.

PBS must have heard from a lot of people about the Bill Moyers feature: Reforming Health Care because they ran it a second time on July 31st.

The following transcript portion spells out exactly why private health insurance doesn't work to provide good health care:

WENDELL POTTER: They (health insurance companies) spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

You can find the complete transcript at:

http://www.pbs.org/moyers/journal/07312009/transcript4.html