Monday, June 29, 2009

Healthcare Debate or The War of Misinformation?

I must confess that I missed President Obama's televised "Questions for the President: Prescription for America", apparently a town hall-style event in which Obama answered questions on health care posed by audience members. I would have liked to have seen it, if for no other reason than to finally get a real sense of exactly what he is proposing and exactly what it is that has so many riled-up.

However, I am less much interested than what (if any) reforms Americans may ultimately make to their healthcare system than in defending all the misinformation which appears to proliferate like rabbits about the Canadian system.

Although I must admit that from over here it looks like the majority of Americans seem to neither really appreciate nor understand what an enviable position they are could be in at the moment - presented with an opportunity to take a close look at all the various systems around the world (none of which work perfectly, I would posit) and pick and choose what might work for them, in the process creating something entirely new, something entirely American. Pity that.

I found this video over at Take Five and although quite long, as Punky says it is definitely worth the time to watch. Although, personally, I think more for what is doesn't say than what it tries to say. Or should I say, what it purports to say.

Many, many moons ago I did a piece over at the Flight Deck (two pieces actually) about the Canadian healthcare system. Which, by the way, in heading over there to get the links, I reread, including all the comments on Part I. Might I suggest, if you have the time, you do the same? It really was a good discussion.

But I digress. What I want to specifically comment on is the End of Patients' Rights video, above.

On the surface, the video shows the many errors with both the Canadian and UK systems of healthcare. These two systems (and their stated flaws, accompanied by heartbreaking personal antidotes) are held up as examples of why and how a government/national healthcare could never work and should never be tolerated by US citizens.

We are accompanied on the tour by Mr.Rick Scott (who although not said to be an actual doctor, certainly comes across as the trusted medical professional) who helps to point out (in case we somehow can't see it for ourselves) the faults of nationalized healthcare. And why US healthcare is so much better.

I will give Mr. Scott this- he does actually (twice I believe) refer to reform of the American system (and thus, by implication, I suppose) the need for reform and states that this is " a great opportunity to improve healthcare in America".

And he points out what he sees as the four key components to such reform; namely, choice, competition, accountability and personal responsibility. None of which I, personally, have any problem.



Primerica said...

Nice article, nice video. I also missed the "Questions for the President". I need to find out if it has been recorded and posted somewhere. Thanks for the article!

Take care, Lorne

Kris, in New England said...

I'd hazard that most of us Americans understand that we are blessed with one of the world's finest health care systems - yet we acknowledge at the same time its flaws and the fact that it needs to be changed.

But what we don't want is a hybrid between Canadian and U.K. health care systems - both of which I'm sure you acknowledged are deeply flawed, moreso than the current American system.

As a recent hip replacement recipient, I know for a fact what my case would look like under the U.K. model - endless waits for appointments, sickeningly long wait for surgery. And an ever-degenerating condition that would leave me confined to a wheelchair before I'm 50 - all because the system believes that hip replacements are non-urgent.

And the current story about Canadian parents having to send their premature baby to an AMERICAN hospital because the Canadian system - in fact the entire country - did not have the NICU bed available.

That speaks volumes to what Americans are afraid of in health care - a government run system (which is what Obama is proposing) that will leave our politicians determining who has access to what health care.

Rationing of health care should never be the answer - and quite frankly I'm surprised that Canadians and Brits allow it to continue. Sure, it's free but look at the built in costs.

The American system needs reform, but not to a single-payer system.

MMC said...

I said all systems are flawed, I am far from suggesting or agreeing with the idea that the Canadian system is much more deeply flawed than the American one. They are just flawed in different areas, I would say.

So give me the details (or better yet, a link) to the NICU story you are talking about. I keep hearing this one floating around but I would like to see the specifics of at least one case, because if it is the one I am thinking about our healthcare system actually paid for that mother's care at the US hospital. So while that's far from perfect, I wouldn't call it rationing if the single payer system ultimately provided her with the care she and her baby needed. Rationing would look much like Sorry, no available bed therefore no care for you.

And I still submit that most Americans really don't know enough facts about the Canadian system to make any reasonable assessment of it. Because any time the subject comes up, there is way too much misinformation spouted by those on both sides of the debate.

Kris, in New England said...

Here is a link to the story about the Canadian premature baby.

Ava Stinson was born Thursday at St. Joseph’s Hospital, 14 weeks premature.

A provincewide search for an open neonatal intensive care unit bed came up empty, leaving no choice but to send the two pound, four ounce baby to Buffalo.

What about this doesn't say rationing and "Sorry, no available bed therefore no care for you."

Even in our imperfect health care system, that would never happen. Even without insurance that baby would be cared for by a hospital - at no charge.

The stats that are constantly quoted about the number of people in the U.S. wihtout health care are grossly misstated. There is a deep analysis of the stats that I can't put my fingers on at the moment. But it does say that of the reported 86 million Americans without health care, nearly 70% fall into these categories:

---illegally in this country so can't be traced whether they have insurance or not
---have household income of over $50,000/year and decline health care
---have insurance thru their spouse so decline health care (like me)
---are between the ages of 18-35 and don't have health care because they don't believe they need it

I wish I could find the damn link that gives the actual numbers. But it's not anywhere near as high as is being reported as a lump figure.

And even those who can't afford health care are cared for - they use emergency rooms as a clinic and are never turned away for any reason.

Yes, our system needs fixing. But it will be people like my husband and I who will bear the burden of cost. And frankly, we bear enough cost for many other things at present - 45% tax bracket isn't just a number on a page.

Pogue said...

Hi Michelle!
Actually, I don't have any problem with the Canadian health care system, I also don't have any problem with the system we have in the states. I do have a deep distrust of the level of competency our government brings to the table. I see us exchanging one set of problems for a different set, and entropy being what it is I expect a net loss.

MMC said...

Thanks for the link, Kris.

So who do you think is paying that enormous NICU bill? Your government? I think not.

The baby's parents? If you can show me that, I will fall down in a state of shock and promise to shut up about the whole healthcare debate from hereon. Wouldn't you like that? :D

No way, knock me over with a feather if you can show me otherwise, but I am willing to bet... all I have? (isn't much, I'm afraid)... that the province is picking up the tab. They have to, it's as simple as that.

Because (although I will give you the problem this story highlights which is the shortage of NICU beds in Ontario, in this case) our system doesn't have a choice, doesn't have the luxury of saying Sorry, no bed. It has to find one if it's required, even if that means the system has to pay the cost of paying to go out of province or out of country. Dig deeper, I am positive that's what you will find. That baby is being cared for in a hospital at no charge to the parents. There was also be no charge to the parents for getting him down there. There will however be a huge charge to the province. A charge which could have been a lot smaller had they had an appropriate number of NICU beds in Ontario, I imagine. So the story highlights a fault in our system but not the one you think.

Also remember too, that each province runs it's own healthcare system. So in a sense you have ten (or more?) healthcare systems running kind of under one umbrella, but not even really under one umbrella because the federal goverment only provides money and really has very little to say in how each province and territory runs their system. Meaning wait times vary by province, as do number of NICU beds, as does everything else. Which is why I found it interesting that the video focused only on BC. Perhaps they had the worst wait times so that's where they went??

Do Americans actually think when they hear these stories of premie babies being sent to the US for NICU care that the families are paying? Well, if so, that would explain a lot of what I see online. But the answer is No way.

BTW this is why I said in my post that I would like to see the US included in the EuroCanada report. Because I have no doubt that we are not receiving much accurate info (good or bad) about your system either. What's needed is to study/compare them all and put the results in one place so that as far as possible we are comparing apples and apples and oranges and oranges. I think that would be useful for everybody. Instead of all this misinformation (some of which I have no doubt is deliberately put out there) and making of assumptions on both sides of the border.

This comment is turning into it's own post so I guess I better stop now.

Pogue said...

"Do Americans actually think when they hear these stories of premie babies being sent to the US for NICU care that the families are paying?"

Most likely Americans think we (the American tax payer) are paying for it. (Not saying I think that, just that's kind of the impression people get down here.) I know this is apples to oranges, but in the southern border states one of the big issues on medical costs are the illegal aliens that hospitals are required to treat, the key word being required.

MMC said...

Yeah, right, I hear you.
But what I don't get is why in the world they would think your government would agree to pay? You mean they think we just show up at your hospitals like the Mexicans do?

Oh. My. God.
Talk about No Compute. It never, ever would have occurred to me for one minute that they would ever think that... Yikes! Talk about Misinformation...

Pogue said...

Well, first of all the government doesn't pay, it requires the hospitals to treat "indigents" at their own cost or risk losing federal funds. When the phrase "socialized medicine" is used around here that's kind of the picture people get, and is one reason why it's such an emotional issue.

I don't personally, and I don't thing in general Americans think of it in those terms as far as Canada goes - it's more like the old saying about two countries separated by the same language. I don't know enough about your system to really feel qualified to comment on it, just as you probably don't know that much about how ours actually works. We bring our experience and assumptions with us when we look at these things and frequently they don't apply and we don't realize it.

Kris, in New England said...

Michelle: none of the articles I read about that story indicated that Canada would be paying for it. Therefore, what other choice do we have but to think that family will be treated like all other uninsured families and illegals in this country. The American hospital would pay. Not the government.

And Pogue is right on about why this is such a huge issue in this country. Our government can't even take care of itself and they want to take over healthcare too?!

MMC said...

Wow, Kris, I can't believe that Americans are really thinking this way. I can tell you with certainty that's not how it is. Believe me, if Canadians were showing up at US hospitals like other insured, the Canadian media would be all over it.

So a quick internet search found me this. It's from Manitoba but it would be the same in all the provinces.

Sometimes you require specific medical treatment that isn’t available in Manitoba. When that happens, your doctor can apply to have treatment provided in another province or the U.S., paid for by Manitoba Health.

The treatment must be a necessary, specific medical service recommended by an appropriate Manitoba specialist. The specialist must write a letter to Manitoba Health for review. Manitoba Health will let you and the specialist know whether coverage is approved.

It's not exactly the situation we're discussing but it is the same idea. If a medically necessary service is not available to you in your province, the province will pay the cost of you going to another province or the US for care.

Here's a better one:

When waiting lists have grown too long, provincial governments have in some instances
offered patients the option of going to the U.S. for treatment. The British Columbia
Ministry of Health, for example, contracted with hospitals in Seattle to provide 200 heart
surgeries. It took more than a year before Canadians filled all 200 slots, raising the
question of whether the delays were indeed life-threatening.

Critics like to portray the availability of treatment in the U.S. as a safety valve for
Canadians. However, that says as much about the overcapacity of the American system as it does about poor planning on the part of Canada. The British Columbia Health
Ministry received many calls from U.S. hospitals eagerly soliciting its heart-surgery business.

That's quite a good article actually, worth reading if you're interested in accurate (althoug likely somewhat dated)info on Canada's healthcare system. The quote is on p. 6.

Another one:
"Canadian taxpayers also bear transportation costs
and medical protocols in U.S. dollars as provinces
regularly send cancer, orthopedic and cardiac patients
to American facilities for treatments not available in

"De Vires is far from unusual in seeking medical treatment in the U.S. Even Canadian government officials send patients across the border, increasingly looking to American medicine to deal with their overload of patients and chronic shortage of care.

Since the spring of 2006, Ontario's government has sent at least 164 patients to New York and Michigan for neurosurgery emergencies — defined by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain." Other provinces have followed Ontario's example."

Okay, now do you believe me?

Kris, in New England said...

Michelle - it's not that we don't believe you. It's that the American public sees these kinds of stories - without any statements about who is paying for it - and assume treatment will be given as it is for all those who are uninsured in this country - for free.

And it highlights our worries for the healthcare plan that Obama is going to try to ramrod thru. Lack of care when we need it, forcing us to seek alternative measures that may well endanger our lives and the lives of our loved ones.

In the end, how cost efficient is it for Canada to have to pay for the care of someone who can't find treatment in their own country? Which sounds to me like it defeats the purpose of nationalized (read, socialized) healthcare.

MMC said...

Of course, it's not efficient. But one point at a time, at least now you know the truth. We're not your next-door neighbour repeatedly knocking on your door to demand a bag of sugar for which you will never be repaid.

As for the rest of it, you're right, it's a bit more than ineffiecient, it's a real problem. Although at least the patients aren't forced to "seek alternative measures"; the system takes care of doing that, setting it all up and paying for it directly. So in that way, it does still work. Still, it's something that, like other things (particularly wait times), needs to be fixed.

As Pogue said earlier, the US adopting a sysem modeled on Canada's might well be just exchanging one set of problems for a different set. I'm not saying that you should go our way. In fact, if your government ever was to consider doing that (although as I understand it, that's not what Obama is talking about - he is looking more at mandatory health insurance, isn't he?), they would be well-advised to look at what doesn't work so well here and ponder how they would fix those issues (or at least manage them) first.

What I am saying (and what this whole comment thread proves, I think) is that the misinformation floating around is a big problem. Not only is is just about impossible for anyone to have a reasonable useful discussion about anything when both sides are speaking different languages, it's all made so much worse when some out there are deliberately spinning and perpetuating misinformation. And I have no doubt that is happening, likely a fair bit.