The Shotgun Blog
Thursday, September 03, 2009
Member of European Parliament, Daniel Hannan, on the British NHS
Here's Reason TVs interview with Daniel Hannan, a politician I like a great deal, about the British NHS (easily convertible into a conversation about Canada's health care system):
Monday, July 13, 2009
Speaking of health care...
David Gratzer, a Senior Fellow at the Manhattan Institute, testified before the US Congress last month on the subject of the Canadian health care system. Gratzer's personal experience as a physician in Canada certainly injects a bit of local knowledge into the current US congressional health care debates.
Monday, July 06, 2009
John Stossel on Canadian health care and free lunches.
John Stossel disagrees with President Obama's view that government can make health care cheaper and better for Americans. The truth is that free lunches, including the sorts handed out at soup kitchens, are rarely sought out for their quality and consumer-friendliness. In Stossel's words:
In England, health care is "free"—as long as you don't mind waiting. People wait so long for dentist appointments that some pull their own teeth. At any one time, half a million people are waiting to get into a British hospital. A British paper reports that one hospital tried to save money by not changing bedsheets. Instead of washing sheets, the staff was encouraged to just turn them over.
Obama insists he is not "trying to bring about government-run healthcare."
"But government management does the same thing," says Sally Pipes of the Pacific Research Institute. "To reduce costs they'll have to ration—deny—care."
"People line up for care, some of them die. That's what happens," says Canadian doctor David Gratzer, author of The Cure. He liked Canada's government health care until he started treating patients.
"The more time I spent in the Canadian system, the more I came across people waiting for radiation therapy, waiting for the knee replacement so they could finally walk up to the second floor of their house." "You want to see your neurologist because of your stress headache? No problem! Just wait six months. You want an MRI? No problem! Free as the air! Just wait six months."
Polls show most Canadians like their free health care, but most people aren't sick when the poll-taker calls. Canadian doctors told us the system is cracking. One complained that he can't get heart-attack victims into the ICU.
In America, people wait in emergency rooms, too, but it's much worse in Canada. If you're sick enough to be admitted, the average wait is 23 hours.
"We can't send these patients to other hospitals. Dr. Eric Letovsky told us. "Every other emergency department in the country is just as packed as we are."
More than a million and a half Canadians say they can't find a family doctor. Some towns hold lotteries to determine who gets a doctor. In Norwood, Ontario, 20/20 videotaped a town clerk pulling the names of the lucky winners out of a lottery box. The losers must wait to see a doctor.
Shirley Healy, like many sick Canadians, came to America for surgery. Her doctor in British Columbia told her she had only a few weeks to live because a blocked artery kept her from digesting food. Yet Canadian officials called her surgery "elective."
"The only thing elective about this surgery was I elected to live," she said.
It's true that America's partly profit-driven, partly bureaucratic system is expensive, and sometimes wasteful, but the pursuit of profit reduces waste and costs and gives the world the improvements in medicine that ease pain and save lives.
"[America] is the country of medical innovation. This is where people come when they need treatment," Dr. Gratzer says.
"Literally we're surrounded by medical miracles. Death by cardiovascular disease has dropped by two-thirds in the last 50 years. You've got to pay a price for that type of advancement."
Canada and England don't pay the price because they freeload off American innovation. If America adopted their systems, we could worry less about paying for health care, but we'd get 2009-level care—forever. Government monopolies don't innovate. Profit seekers do.
We saw this in Canada, where we did find one area of medicine that offers easy access to cutting-edge technology—CT scan, endoscopy, thoracoscopy, laparoscopy, etc. It was open 24/7. Patients didn't have to wait.
But you have to bark or meow to get that kind of treatment. Animal care is the one area of medicine that hasn't been taken over by the government. Dogs can get a CT scan in one day. For people, the waiting list is a month.
Friday, January 30, 2009
The Hook mischaracterizes the Charter-based health care challenge
Crawford Killian over on The Hook (the blog of The Tyee newspaper), appears to be unhappy about the latest Charter-based challenge to British Columbia's health care system. In writing about the challenge, Killian starts with this: "A new attack on public healthcare was launched yesterday in the Supreme Court of BC."
Killian then mentions a whole host of absolutely trivial and irrelevant things that have nothing to do with the actual legal challenge:
CIMCA’s own website seems to have been in a coma before this latest news release. The site’s previous releases include none in 2008, one in 2007, and five in 2006.[...]
The Cambie Surgery Centre, a “proud member of CIMCA,” isn’t up to speed on the case it’s now involved in. Its news section hasn’t seen an update since August 2004. But the head of the Centre, Dr. Brian Day, is well known to Tyee readers.
As for the text on its home page, The Hook would like to refer the Centre to a good punctuation expert at the Editors’ Association of Canada.
They need to fix their grammar? Golly! They haven't updated their website? Oh dear.
Honestly, who cares? What about the substance of the complaint and the real issue at hand?
Killian provides only a description of the challenge as an "attack on public health care." But it isn't an attack on public health care, it's an attack on the prohibition on the kind of medical insurance that would permit regular B.C.ans to take advantage of places like the Cambie Surgery Centre, or other independent clinics in British Columbia. It is an effort to permit regular B.C.ans to do what the RCMP, federal prisoners, and people on worker's compensation can do right now -- access private clinics.
It is also an effort to ensure that Canada's health care system is in keeping with the Charter of Rights and Freedoms, which it isn't. And not just in Quebec, Canada's entire health care system is unconstitutional, according to a document that Killian probably approves of (I'm guessing, correct me if I'm wrong).
Like I wrote in the comments to Killian's posting, we don't say that permitting independent schools is an "attack on public education." It is therefore incorrect and misleading to characterize this Charter challenge, and others like it, as an "attack on public healthcare."
(I should say this, too: I really enjoy The Hook. It's a great blog, even if the political viewpoints aren't exactly ones I agree with).
CIMCA challenges legal ban on access to independent clinics
Here's a press release from the Canadian Independent Medical Clinics Association:
The Canadian Independent Medical Clinics Association (CIMCA) along with a group of independent BC medical clinics, today launched a lawsuit in the Supreme Court of B.C. to have legal restrictions on access to independent clinics struck down because they deprive patients of rights guaranteed by section 7 of the Canadian Charter of Rights and Freedoms.
"The Supreme Court of Canada decision in the Chaoulli case was clear - access delayed is access denied. Patients are suffering and dying as a result of waiting for care in B.C.," said Dr. Brian Day, Medical Director of the Cambie Surgery Centre, one of the independent clinics launching the suit. CIMCA is going to court to ensure that B.C. laws are modified to conform to the laws of Canada, as set forth by the Supreme Court of Canada.
The CIMCA challenge argues that sections of B.C.'s Medicare Protection Act effectively force patients to remain on unacceptably long wait lists, no matter what the degree of pain, suffering or disability they are experiencing.
The Medical Services Commission, the Minister of Health Services, and the Attorney General of British Columbia are all named as defendants in the action.
"The crux of the problem is this - if the public health care system cannot provide care to patients in a timely manner, then it is simply wrong to throw up road blocks to patients seeking the health care they need," Dr. Day added. "The Supreme Court of Canada has stated this in no uncertain terms, and we intend to ensure that B.C. provincial law complies with the laws of Canada. Patients in British Columbia should not have their constitutional rights overridden by Draconian laws that deny them access to care."
CIMCA is a non-profit organization that represents medical clinics, patients, health care workers and their advocates and supporters. Its mission is to promote improved access to high quality, timely health care for all Canadians.
Thursday, January 29, 2009
Brian Day and private health clinics take B.C. government to court to expand Chaoulli ruling
Dr. Brian Day, of the private Cambie Surgery Centre and former president of the Canadian Medical Association, along with other private surgery clinics in British Columbia, have leveled a lawsuit against the provincial government in an attempt to make it legal for regular folk to spend their own money on their own health care. Currently, the Canada Health Act permits RCMP officers, federal prisoners, recipients of workers compensation, and a few others, to make use of private surgery centres. The rest of us can't. And the rest of us wait. And wait. And wait.
The goal is to expand the 2005 Supreme Court Chaoulli ruling where the Court ruled that Quebec's prohibition on regular people spending their own money of private medicine violated the Quebec Charter of Rights and Freedoms. I wrote the Western Standard's cover story, entitled "Freedom Fighter," about the Chaoulli case (published before the ruling came down). You can also read our Question Period with Dr. Jacques Chaoulli here.
The Vancouver Sun reports:
The plaintiffs will argue that the 2005 Chaoulli Supreme Court of Canada case should be applicable in B.C. In that case -- brought by appellants Jacques Chaoulli, a doctor, and George Zeliotis, a patient -- the highest court struck down Quebec's ban on private insurance for medically necessary services. The private clinics are expected to argue that citizens should be allowed to buy private health insurance to use in private clinics if their operative care is not delivered in a timely manner in the public system.
The action against the health minister, attorney-general and the medical services commission is expected to ask for a declaration that sections of the Medicare Protection Act violate the rights of citizens.
Health Minister George Abbott declined to comment Tuesday, but in the past he has pointed to Quebec's private clinics to argue that private clinics already existing in B.C. may not be seen by the federal government as breaching Canada Health Act statutes. The Chaoulli ruling found that Quebecers' rights under the Quebec charter of rights were being violated by long waits for medical care in the public system.
"In essence, the question is whether Quebecers who are prepared to spend money to get access to health care that is, in practice, not accessible in the public sector because of waiting lists may be validly prevented from doing so by the state," read Justice Marie Deschamps's reasons for the decision. "I find that the prohibition infringes the right to personal inviolability and that it is not justified by a proper regard for democratic values, public order and the general well-being of the citizens of Quebec."
This new court case brings the number of current legal cases attempting to expand the ruling in Chaoulli to three. The Canadian Constitution Foundation is currently working on expanding the ruling in Ontario (McCreith & Holmes v. Ontario) and Alberta (William Murray v. Alberta). You can contribute to the CCF here.
Meanwhile, you can watch a video of Brian Day's brilliant final speech as president here. It's worth watching and listening to.
Tuesday, January 13, 2009
Universal health insurance: A disaster in Canada, disastrous in Massachusetts
U.S. president-elect Barack Obama has hinted that he'll move in the direction of universal health insurance, much like the system we schleps have in Canada. The system that is unconstitutional in Quebec, and soon to be found unconstitutional across Canada if we dig deep in our pockets and throw the Canadian Constitution Foundation some money (please do).
But before Obama jumps headlong into this disaster, he should take a much closer look at how wonderfully it functions in Canada (it doesn't, not in comparison), or how it "functions" much closer to his home in Massachusetts. Apparently, the jury is in, and the results are pretty awful.
The DC Examiner has a lovely editorial on the subject, with this gem of a line:
If this sounds just like Canadian-style socialized medicine, that’s because it is. Massachusetts residents now pay more for less access to health care, yet their state still has an uninsured problem!
And here's some of the evidence:
Just a year after the universal coverage law passed, The New York Times reported, state insurers were already jacking up rates to twice the national average. According to Dr. Paul Hsieh, a physician and founding member of Freedom and Individual Rights in Medicine, 43 mandatory benefits — including those that many people did not want or need, such as invitro fertilization — raised the costs of coverage for Massachusetts residents by as much as 56 percent, depending upon an individual’s income status. So much for “affordable” health care.
Read the whole (short) piece, and remind yourself how socialized medicine works. It works just like socialized anything. It doesn't.
Friday, January 09, 2009
New study: "Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children"
The set up: Give one group of children from Ghana "free" medical care, compare that to those without health care coverage, as well as a third group who purchased the same insurance as the first group.
The outcome: "In the study setting, removing out-of-pocket payments for health care had an impact on health care-seeking behaviour but not on the health outcomes measured."
Here's the more technical explanation:
2,194 households containing 2,592 Ghanaian children under 5 y old were randomised into a prepayment scheme allowing free primary care including drugs, or to a control group whose families paid user fees for health care (normal practice); 165 children whose families had previously paid to enrol in the prepayment scheme formed an observational arm. The primary outcome was moderate anaemia (haemoglobin [Hb] < 8 g/dl); major secondary outcomes were health care utilisation, severe anaemia, and mortality. At baseline the randomised groups were similar. Introducing free primary health care altered the health care seeking behaviour of households; those randomised to the intervention arm used formal health care more and nonformal care less than the control group. Introducing free primary health care did not lead to any measurable difference in any health outcome. The primary outcome of moderate anaemia was detected in 37 (3.1%) children in the control and 36 children (3.2%) in the intervention arm (adjusted odds ratio 1.05, 95% confidence interval 0.66–1.67). There were four deaths in the control and five in the intervention group. Mean Hb concentration, severe anaemia, parasite prevalence, and anthropometric measurements were similar in each group. Families who previously self-enrolled in the prepayment scheme were significantly less poor, had better health measures, and used services more frequently than those in the randomised group.
We really do need an explanation here. Why would health care outcomes remain roughly the same in spite of cheaper access to health care? And just what general conclusions, if any, can we draw from the findings in this study?
As Megan McArdle points out, it isn't too surprising when, in countries like Canada and the U.S., lowering or eliminating direct payment for health care has little to no impact on health care outcomes (but has a large effect on health care consumption). After all, we're relatively rich, and we do have charity hospitals and other avenues for the relatively poor to get access to health care (and it is illegal for hospitals to turn people away when they arrive at the emergency room). But in countries like Ghana? Wouldn't we expect better health care outcomes? (I know I did).