A Social Healthcare System Crashes and Burns

[TENAC]

I had several extended threads on another board regarding the status of healthcare is socialized countries.  My adversary insisted Canada had met and passed the Canadian Healthcare Act and all was soon to be working well.

If anyone has status on the other board, please send this with my regards:

Promise Of Choice


INVESTOR'S BUSINESS DAILY

Posted 2/26/2008

Socialized Medicine: Quebec's former health minister is tacitly admitting that the system he helped create is not sustainable. It has, as Claude Castonguay has succinctly noted, reached "a crisis point."

Actually, when 40% of the province's $60 billion budget is spent on health care, or when public health care costs in Canada are growing at twice the rate of the economy as a whole, we'd say the crisis point was reached long ago.

This is a valid point I continued to make (from the article, this nation refers to the USA):

Even the poor in this nation, where we allegedly have a crisis of the uninsured, benefit from the arrangement: They have color TVs, microwave ovens, cell phones, multiple cars, VCRs and DVD players, air conditioning and plenty of food, enough for obesity to be among the top health problems for those below the poverty line.

This from the Father of Canadian Healthcare:

"People can choose what car they want to buy, what suit they want to wear, what house they want to live in," Castonguay says. "But when it comes to their health, they don't have a choice. That's what I'm against. We are proposing to give a greater role to the private sector so that people can exercise a freedom of choice."

http://www.investors.com/editorial/editorialcontent.asp?secid=1501&status=article&id=288921903474479

 

[gluadys]

I had several extended threads on another board regarding the status of healthcare is socialized countries.  My adversary insisted Canada had met and passed the Canadian Healthcare Act and all was soon to be working well.

I don't understand this paragraph.  The Canada Health Care Act was passed in 1984 so it is not a matter of "soon to be working well".  It has been working, sometimes well and sometimes not so well for nearly a quarter of a century. 


As Roy Romanow said in his report on the Future of Health Care in Canada:  "The principles of the Canada Health Act began as simple conditions attached to federal funding for medicare. Over time, they became much more than that. Today, they represent both the values underlying the health care system and the conditions that governments attach to funding a national system of public health care. The principles have stood the test of time and continue to reflect the values of Canadians."
http://www.hc-sc.gc.ca/hcs-sss/medi-assur/cha-lcs/overview-apercu-eng.php

Even the poor ...have ...plenty of food, enough for obesity to be among the top health problems for those below the poverty line.

Maybe because they can't afford decent healthy food.  Poverty means having to rely primarily on starches and having little in the way of fresh fruits and vegetables.  It also means, in many cases, not having the know-how to prepare food oneself and so needing to rely on starchy, fatty pre-packaged food. 

This from the Father of Canadian Healthcare:

That should be (as correctly stated in the article) Quebec health care.  The Father of Canadian Health Care is Tommy Douglas. 

The article errs, however, when it says the Canadian system was modeled on the Quebec system.  The first public health care program in Canada was set up in Saskatchewan.  The Canada Health Act did not actually set up a health care system at all, but provided federal funding for universal health insurance to all provinces who wished to set up a similar system, as long as they met the principles of the act (see link above for the principles).  All  provinces except Quebec accepted.  Quebec decided not to accept federal funding directly for its public health care system, but did set up its own, with some arcane financial arrangements equivalent to a federal grant.  The Quebec system was not the historic model for other provincial systems. 

"People can choose what car they want to buy, what suit they want to wear, what house they want to live in," Castonguay says. "But when it comes to their health, they don't have a choice. That's what I'm against. We are proposing to give a greater role to the private sector so that people can exercise a freedom of choice."

He has a strange notion of what "freedom of choice" means to most average Canadians.  Unimpeded access to health care is the freedom most opt for.  One doesn't buy a needed hip replacement the way one buys a car.  When one cannot afford a Porsche one can opt for a Volkswagon, but if one needs a hip replacement one cannot substitute a less expensive tonsillectomy instead. 

I have seen many financial analyses of health care systems and I have not seen a single one that shows the private sector offering health care more efficiently and less expensively than public systems. 

[VLinvictus]

I wonder how the socialized health care systems are doing in Norway and Sweden...

[metis]

I wonder how the socialized health care systems are doing in Norway and Sweden...

From Wikipedia:

"The Swedish health care system is a socialized, public health care system. It is informally divided into 7 sections: "Close-to-home care" (primary care clinics, maternity care clinics, out-patient psychiatric clinics, etc.), emergency care, elective care, in-patient care, out-patient care, specialist care, and dental care.

A person seeking care first contacts a clinic for a doctor's appointment, and may then be referred to a specialist by the clinic physician, who may in turn recommend either in-patient or out-patient treatment, or an elective care option. All emergent cases are treated by an emergency department at a hospital.

The health care is governed by the 21 Landsting (County councils) of Sweden, which act on general recommendations of the parliament, and delegate local government to the municipalities. Regulations, waiting times and patient fees vary in the different Landsting.


 


 Financing
The state finances the bulk of health care costs, with the patient paying a nominal fee for examinations and some tests. The state pays for approximately 85 % of medical costs.

When a physician declares a patient to be ill for whatever reason (by signing a certificate of illness/unfitness), the patient is paid a percentage of their normal daily wage from the second day. For the first 14 days, the employer is required to pay this wage, and after that the state pays the wage until the patient is declared fit.

The state also reimburses patients for travel costs to and from the clinic or hospital.


 Examples of patient fees in Stockholm:
Appointment at a clinic - 140 SEK (ca €15)

Appointment at a clinic (child) - 0 SEK

Appointment with specialist - 260 SEK (ca €27)

In-patient care - 80 SEK (ca €8.50)/day


 Statistics
Swedish health care show relatively good figures compared to other health care systems, with a high number of physicians and nurses compared to the population, with a large amount of the health care costs paid by the state yet with a low health care spending compared to GDP

Country Life expectancy Infant mortality rate Physicians per 1000 people Nurses per 1000 people Per capita expenditure on health (USD) Healthcare costs as a percent of GDP % of government revenue spent on health % of health costs paid by government:
 
Sweden 80.5 3.0 3.28 10.24 3,149 9.4 13.6 85.2
 
USA 77.5 6.0 2.56 9.37 5,711 15.2 18.5 44.6


Waiting times
The national guarantee of care states that a patient should be able to get an appointment with a primary care physician within 5 days of contacting the clinic. If referred to a specialist by the GP, they should get an appointment within 30 days, and if treatment is deemed necessary by the specialist, it should be given within 90 days. However, urgent cases are always prioritized and emergent cases are treated immediately.


Criticism
 This article does not cite any references or sources. (February 2008)
Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed.

The main criticism leveled at Swedish health care is that the waiting times are too long.

Another criticism is that waiting times, quality of care and patient fees may vary in different counties, effectively meaning that patients may be treated better depending on where they live. Extreme cases of patients moving to another county just to get better health care has been shown as example of alleged injustice in the health care system.

The health care system has sometimes been criticized as being too conservative with expensive testing and treatment. A recent case tells of a young man in Stockholm who was denied treatment for Hunter's syndrome with a new experimental drug after the clinical trial for the drug ended and the hospital (Karolinska University) refused to pay for the expensive treatment (which cost approximately €840 000/year). When the case got media attention, the patient was however given the treatment, which was paid for by the Stockholm County Council. This has sparked a debate over if expensive treatments should be financed on a national basis instead."-- http://en.wikipedia.org/wiki/Healthcare_in_Sweden


Anyhow, obviously Sweden has some problems as well, which should be of no surprise since I don't think anyone is going to find the "perfect system" anywhere.  However, delays I tend to think are still preferable over no coverage whatsoever or coverage that is so limited that some people become bankrupt attempting to pay for their health care. 

The first time I was in the Netherlands (1991), I was standing in line just outside the Anne Frank House and I talked with a lady who grew up in the States but lived in the Netherlands, and we discussed this issue.  She mentioned that she just could not understand why a country as wealthy as the U.S. does not provide at least some basic coverage for its own citizens.  Why can the Netherlands do it, but the U.S. "can't"? 

A couple of months ago, I watched a program on PBS that compared five different countries that had universal health care, and when the reporter interviewed a spokesman representing the Japanese system and said that there are some people in the U.S. who may even lose their homes in order to pay for their health care, he laughed-- he thought the reporter was exaggerating.  When the reporter made it clear that she wasn't joking or exaggerating, the laugh stopped and he asked why do they allow this to happen?

And there's many of us here who are asking this as well. 

[gluadys]

From Wikipedia:


Country Life expectancy Infant mortality rate Physicians per 1000 people Nurses per 1000 people Per capita expenditure on health (USD) Healthcare costs as a percent of GDP % of government revenue spent on health % of health costs paid by government:
 
Sweden 80.5 3.0 3.28 10.24 3,149 9.4 13.6 85.2
 
USA 77.5 6.0 2.56 9.37 5,711 15.2 18.5 44.6

The last four figures are especially relevant.  The government share of health care costs in Sweden is 85% compared to only 44% in the US.  But this is offset by health care costs in Sweden being a) lower per patient $3,149 vs $5,711, b) a smaller proportion of GDP 9.4% vs 15.2% and c) a smaller proportion of government revenue 13.6% vs 15.2%.

This clearly indicates the Swedish health care system is much more efficient and less burdensome on the taxpayer than the US system.  While figures vary from one public health care system to another, this is typical of most national health care systems vis-a-vis free market health care systems.  The Swedish (and most public health care systems) cover more health care expenses for more of the population at less cost to the taxpayer. 

The fact that the US system is not only more expensive overall, but consumes more tax revenue than socialized systems is a fact little known or appreciated in the US.

[Thorolf]

Maybe because they can't afford decent healthy food.  Poverty means having to rely primarily on starches and having little in the way of fresh fruits and vegetables.  It also means, in many cases, not having the know-how to prepare food oneself and so needing to rely on starchy, fatty pre-packaged food. 

Of course, one word left out after "fatty" is "expensive."

Perhaps you are suggesting we fund cooking classes for those below the poverty line? That would be interesting.

It's never a situation of "can't afford decent healthy food." Unhealthy food tends to cost dramatically more... if they can afford unhealthy food, I'd suggest they certainly CAN afford healthy food. It's a choice they willingly made, not one they were forced into.

I notice you left out the other frills the poor in the US often enjoy. Cable television, cell phones, home ownership, car ownership, expensive shoes, computers with internet access, gold teeth, jewelry, tattoos, elicit drugs, cigarettes, alcohol... and junk food. Just to name a few...

[Thorolf]

The last four figures are especially relevant.  The government share of health care costs in Sweden is 85% compared to only 44% in the US.  But this is offset by health care costs in Sweden being a) lower per patient $3,149 vs $5,711, b) a smaller proportion of GDP 9.4% vs 15.2% and c) a smaller proportion of government revenue 13.6% vs 15.2%.

This clearly indicates the Swedish health care system is much more efficient and less burdensome on the taxpayer than the US system.

It doesn't say a single thing about efficiency. Neither does it actually indicate that it is "less burdensome" on the taxpayer. It does, however, say something about frivolous lawsuits and the litigious atmosphere we have allowed to develop in the US that dramatically increases costs for health care across the board... It does say something about the availability of care, and the frequency with which people utilize it. It's one of the side effects of NOT having to wait weeks or months to get things looked at and taken care of. We actually can GET care by calling the doctor's office and going in that same afternoon, for example.

While figures vary from one public health care system to another, this is typical of most national health care systems vis-a-vis free market health care systems.  The Swedish (and most public health care systems) cover more health care expenses for more of the population at less cost to the taxpayer.

With less care, longer wait times, and lower quality of care received.

I know a great way to control oil prices - ration and control it like these governments do with health care.

Which makes me wonder - with oil prices so ridiculously high in Europe, why hasn't anyone thought of doing that before? You need gas? Call to schedule an appointment as the petrol station. We'll get back to you within 5 days. If you actually need higher octane, most people can get their gas within 30 days.

But we'll fast-track you if it's an emergency. Then it will probably only been a couple of days to get low-octane fuel, and a couple of weeks for high-octane.

We'll need to schedule your oil changes 3 months in advance...

How long before people stop bothering with driving because they can't conveniently get gasoline?

I don't know... I think it just may be the answer!! Cut demand dramatically! Implement universal petrol care!!!

The fact that the US system is not only more expensive overall, but consumes more tax revenue than socialized systems is a fact little known or appreciated in the US.

No, it is both known and appreciated. The problem is that universal coverage would not make the slightest dent in costs without serious tort reform, as well as overhauls of several other areas.

I think, too, that the proponents of universal coverage, especially those in other countries, fail to recognize that a) the federal government sucks at just about everything, which is a big part of the reason why it was SUPPOSED to be limited, b)  just how good our medical care professionals are (except canadians, who come here all the time to get the quality and timeliness of care they can't receive in canada), and c) just how cumbersome and expensive it is to implement a similar program on a much larger scale, with a much more diverse population and realm of health concerns than sweden, norway, or canada.

[Thorolf]

http://www.readwriteweb.com/archives/our_kids_are_failing_-_and_its_wikipedias_fault.php

It seems that more than children are failing because of Wikipedia (which can be edited by ANYONE.)

LOL

[VLinvictus]

We actually can GET care by calling the doctor's office and going in that same afternoon, for example.

Really? That has never been my experience.

[VLinvictus]

I know a great way to control oil prices - ration and control it like these governments do with health care.

Which makes me wonder - with oil prices so ridiculously high in Europe, why hasn't anyone thought of doing that before? You need gas? Call to schedule an appointment as the petrol station. We'll get back to you within 5 days. If you actually need higher octane, most people can get their gas within 30 days.

But we'll fast-track you if it's an emergency. Then it will probably only been a couple of days to get low-octane fuel, and a couple of weeks for high-octane.

We'll need to schedule your oil changes 3 months in advance...

How long before people stop bothering with driving because they can't conveniently get gasoline?

I don't know... I think it just may be the answer!! Cut demand dramatically! Implement universal petrol care!!!

I know you meant this facetiously, but I think it is actually a brilliant idea and I would support it 100%.

[VLinvictus]

One final point:

All of the complaints of how socialized medicine is slow with long wait times and full of red tape and limited in scope and quality sound an awful lot like the complaints I have made myself and that I have heard from many other people about their private health insurance and HMOs.

I can't just go to any doctor I want: I have to go to one who is part of my insurance network. I can't just have any procedure done that I want: most things need to be cleared and authorized by the insurance company -- and if they don't deem it necessary they won't permit it.

It doesn't sound like socialized medicine systems are any worse than what is already available in the US. Maybe some of you are wealthy enough to be able to choose to see whatever doctor you want whenever you want -- maybe you even have your own court physicians to attend to you every need! But I don't, and I don't know anyone other than the billionaire I work for who does.

[metis]

I also want to mention the fact that our health care that is being provided by many of our companies and corporations is hurting our competitiveness nationally and internationally.  The (not so) "big three", for example, have made it clear that this burden is hurting them. 

IMO, we can do it, should do it, and I just don't see any excuse as why not to do it.  Since when does money take priority over human life and well-being-- especially from a religious or humanistic perspective?   

[metis]

It seems that more than children are failing because of Wikipedia (which can be edited by ANYONE.)

Then you might want to check out this website as I did before I posted the Wikipedia article: http://www.sweden.se/templates/cs/FactSheet____15865.aspx

It's from the official Swedish website that deals with the health-care there, including problems that they are encountering.  If one carefully read my Wikipedia posting, they would recognize that, near the end of it, there was criticism of the system due to wait times that supposedly affected certain individuals, which Wikipedia said could not be confirmed.  However, I decided to include it in my post anyway since I had, and have, no intent on just presenting a propaganda piece.

[jacknky]

Metis,
"Since when does money take priority over human life and well-being-- especially from a religious or humanistic perspective?"

I agree. Our blind faith in the capitalist system should recognize that the profit motive isn't best for all situations and healthcare seems to be one of them.

As for long waits, I remember seeing on the aforementioned PBS documentary that some if not all of the countries, although they provided basic healthcare to all, also allowed the purchase of additional insurance for those who wanted more and quicker service. That makes sense.

[metis]

As for long waits, I remember seeing on the aforementioned PBS documentary that some if not all of the countries, although they provided basic healthcare to all, also allowed the purchase of additional insurance for those who wanted more and quicker service. That makes sense.

Ya, but that becomes a rather slippery-slope whereas greater emphasis can be put on those with extra money to buy the insurance rather than on providing at least basic care for all.  However, in a free society, it would undoubtedly have to be allowed.   

[Thorolf]

We actually can GET care by calling the doctor's office and going in that same afternoon, for example.

Really? That has never been my experience.

Then you should consider finding another doctor.

Hey! There's something *ELSE* we can do that most "universal health care" systems can't!!!

[Thorolf]

One final point:

All of the complaints of how socialized medicine is slow with long wait times and full of red tape and limited in scope and quality sound an awful lot like the complaints I have made myself and that I have heard from many other people about their private health insurance and HMOs.

I can't just go to any doctor I want: I have to go to one who is part of my insurance network. I can't just have any procedure done that I want: most things need to be cleared and authorized by the insurance company -- and if they don't deem it necessary they won't permit it.

It doesn't sound like socialized medicine systems are any worse than what is already available in the US. Maybe some of you are wealthy enough to be able to choose to see whatever doctor you want whenever you want -- maybe you even have your own court physicians to attend to you every need! But I don't, and I don't know anyone other than the billionaire I work for who does.

You're overlooking one very important factor.... here in the US, we don't have to listen to our insurance companies.

We *CAN* go to any doctor we want. It's just that SOMETIMES our insurance companies won't pay for as much of it as they will if we go to one of their preferred docs.

We *CAN* have any procedure done that we want or need, regardless what the insurance company says. We just may have to take on a larger portion of the costs ourselves.

But... we have the CHOICE.

Maybe not always a pleasant choice, but a choice nonetheless.


For Canadians and other subjects of "Universal Health Care," that choice often involves going to another country (the US) for actual options in care.


Metis mentioned alternative insurance, and the reality is that this is not really available to all, nor is it inexpensive. Furthermore, doctors who accept private insurance will often *ONLY* accept private insurance, and those that accept the public system *ONLY* accept the public system - and those in the private system are forced to "opt out" of the public system.

Choices are severely limited...




Oh... and as for my oil consumption plan - I thought you might like it. 

[VLinvictus]

You're overlooking one very important factor.... here in the US, we don't have to listen to our insurance companies.

We *CAN* go to any doctor we want. It's just that SOMETIMES our insurance companies won't pay for as much of it as they will if we go to one of their preferred docs.

We *CAN* have any procedure done that we want or need, regardless what the insurance company says. We just may have to take on a larger portion of the costs ourselves.

But... we have the CHOICE.

Maybe not always a pleasant choice, but a choice nonetheless.

A choice one cannot afford to pay for is not a choice at all.

[gluadys]

We actually can GET care by calling the doctor's office and going in that same afternoon, for example.

Really? That has never been my experience.

Then you should consider finding another doctor.

Hey! There's something *ELSE* we can do that most "universal health care" systems can't!!!

I don't know about other countries, but in Canada we can go to any doctor available.  And we don't need permission from either the government or an HMO.  Doctors can also order any test or treatment they consider appropriate without having to clear that with the government, the College of Physicians or an HMO either. 

[gluadys]

Perhaps you are suggesting we fund cooking classes for those below the poverty line? That would be interesting.

An excellent idea.  You would be surprised how many adults don't know how to do the most basic cooking.   

Unhealthy food tends to cost dramatically more...

I see you haven't compared the price of Kraft Dinner against that of a fresh head of lettuce.  No, basic starchy foods are much less expensive than fresh produce.  That is why poverty-stricken people the world over rely on basic starches: rice, corn, pasta or bread for most of their calories.  Beans come next as the cheapest form of protein.  Only if one is very lucky can one add a little meat, fruit or vegetables.