To all those who voted for OBAMA, what is your reaction to the following article? Are you surprised? You shouldn't be. He will leave our healthcare system in shambles. Read on...
'Too Old' for Hip Surgery
As we inch towards nationalized health care, important lessons from north of the border.
By NADEEM ESMAIL
President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of Schip -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience.
Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.
Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.
In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.
Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.
Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.
On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.
These constitutional challenges, along with one launched in British Columbia last month, share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health-insurance system.
The cases find their footing in a landmark ruling on Quebec health insurance in 2005. The Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health-care system, and that the government monopoly on essential health services imposes a risk of death and irreparable harm. The Supreme Court ruled that Quebec's prohibition on private health insurance violates citizen rights as guaranteed by that province's Charter of Human Rights and Freedoms.
The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance.
In the wake of the 2005 ruling, Canada's federal and provincial governments have tried unsuccessfully to fix the long wait times by introducing selective benchmarks and guarantees along with large increases in funding. The benchmarks and the guarantees aren't ambitious: four to eight weeks for radiation therapy; 16 to 26 weeks for cataract surgery; 26 weeks for hip and knee replacements and lower-urgency cardiac bypass surgery.
Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.
Mr. Esmail, based in Calgary, is the director of Health System Performance Studies at The Fraser Institute.
Posted by jeff, a resident of the Birdland neighborhood, on Feb 17, 2009 at 7:09 am
When it comes to your health, aren't you big enough to make decisions on your own? Why do you need Obama to make decisions for you? Or are you part of the entitlement crowd. That's the problem with you dem/libs, you need big government to take care of you from cradle to grave. Grow up. Make decisions for yourself.
Posted by Mary, a resident of the Castlewood neighborhood, on Feb 17, 2009 at 8:25 am
Right On Jeff!
Hey John...do you have to wait for Obama to have a "plan" for your grocery shopping decisions?
How about buying a car, do you need "Obama" to have a "plan" for you?
And your clothes, boy you sure need "Obama" to make your decisions here as well.
How about items around your house...say lightbulbs (oh, sorry...the democrats have already made that decision for you).
Yes, you must need Obama to make the majority of decisions in your life. That is called Socialism, John. Socialism (like Hugo Chavez's Venezuela) is a stone's throw away from communism, tho your public school history books will not tell you this.
I thought we lived in a "free country" John...with limited government and rugged individualism rules. Sounds like you are not that rugged and depend upon the government to be your nanny.
Please understand...I am not an anarchist because I believe in limited government...namely for the national defense of this country above all else. But what you apparently believe is that government should take care of all your other needs from cradle to grave. Yes, you are the definition of a democrat, liberal, potential or real socialist.
Posted by Stacey, a resident of the Amberwood/Wood Meadows neighborhood, on Feb 17, 2009 at 9:05 am
The topic seems to be about choice in medical care. I'm honestly not understanding the points trying to be made here. What's the difference supposed to be in choice between what we have now and Canada's health system? It isn't even fair to post an anecdote about a health system in a foreign country with the implication that that same system would be implemented here. People get denied coverage a lot by their private health insurance company. I'm guessing that the above posters don't have the experience of not having a choice to get hip surgery due to not being able to afford it instead of due to socialization. But hey, that's what our socialist-based Medicare program is for because otherwise the people on Medicare would not only not be able to afford health insurance coverage by private companies, but those same companies wouldn't even touch those that truly need medical care with a 30 foot pole. Costs are lower when risk is spread out over a larger pool of insurance participants. That's the power of economy of scale. Yet private insurance companies continuously make arbitrarily small pools of insured. If you're a "high risk" participant you're put into a small pool with other "high risk" participants and you pay through the nose for coverage. It's a joke now. Seniors buy medication from Canada because the cost is lower. Others jet off to foreign countries where they can have certain medical procedures done (where the cost of flying and hotel and the procedure STILL ends up being LESS than what it would cost if they had it done here).
Posted by Peg, a resident of the Bridle Creek neighborhood, on Feb 17, 2009 at 9:26 am
I agree with those opposed to a nationalize health system, like the one Obama (and Hillary) will likely push thru.
First, I do not agree with the premise that there is a "crisis" . Well, let me amend that statement. The only crisis is that we allow illegals and other uninsured. Health care should be a commodity like everything else we purchase. Why is it a right?
If you believe there is a health care crisis, I can fix it in four simple words.
"LET THE CONSUMER DECIDE."
(In other words, get the government out of the way and let the consumer decide. This will bring down the cost of medical care substantially.)
Posted by Stacey, a resident of the Amberwood/Wood Meadows neighborhood, on Feb 17, 2009 at 9:57 am
P.S. I can play the anecdote game too... There's lots of stories out there about people dying due to lack of access to health care or cases where the insured have problems. What's more emotionally effective? Someone considered too hold for hip surgery or the tragedy to children when private health insurance companies control their access to quality health care?
"the annual cost of military healthcare has more than doubled from $19 billion to $39 billion since 2001, according to Defense Department data. That number is expected to climb to $64 billion by 2015, Pentagon officials estimate, consuming roughly 12 percent of the defense budget.
"Without relief, spending for healthcare will . . . divert critical funds needed for war fighters, their readiness, and for critical equipment," Dr. William Winkenwerder , assistant defense secretary for health affairs, recently told Congress. "Healthcare costs will continue to consume a growing slice of the department's budget."
The biggest increases are from the same basic-care expenses that have weakened General Motors and other corporations that have agreed to cover large numbers of retirees. And the Pentagon's plan is far more generous than most."
"Employers, on average, have seen their health insurance premiums increase nearly 120 percent since 1999. ... the number of Americans without health coverage has been climbing with nearly 8 million people losing their coverage between 2000 and 2007."
"What people may not realize is that health costs are crimping their cash flow in two ways. First, employers are trying to trim health insurance costs by raising deductibles and out-of-pocket payments. This has been going on for several years, and it will continue.
Second, rising health insurance premiums -- in spite of costs shifted to employees -- are reducing wage growth. Businesses can pay people in benefits or in cash. If benefit costs are rising rapidly, then cash wages will be squeezed."
"the dramatic increases in health care spending and the share of GDP devoted to health care have raised concerns about the negative impact of health care cost inflation on the U.S. economy. In an era of global economic markets, these concerns are reinforced by the status of the U.S. as a spending outlier among competing nations. The major concern is that rapid increases in health care spending can affect major economic indicators such per capita GDP, employment and inflation. The effects are likely to occur across all sectors of the economy – governments, businesses and households – as all these interrelated sectors play an important role in the provision, financing and consumption of health care in the US.
Similarly, US companies faced with rapidly growing health care costs might reduce employment and investments in the US economy. Rising health care costs could also fuel inflation in the U.S. and make U.S. goods and services less competitive in international markets over time, because increasing health care costs might eventually be reflected in higher product prices. Since most other nations do not have employer-sponsored health insurance, companies in those nations may be better able to keep prices low. Finally, high health care costs could reduce access to health care, bankrupt consumers and deplete retirement savings."
Regardless of what opinion one may have on possible solutions, I hope that those who agree with Peg and question if there is a health care crisis have a different outlook now.
Posted by Linda, a resident of the Another Pleasanton neighborhood neighborhood, on Feb 17, 2009 at 1:03 pm
Who will pay the bill for the octuplets born in Southern California? Who paid for the births of her other six children? Who is paying now for their care? It's certainly not the mother, father or doctor. It's the taxpayers because she's on welfare, and that's the reason she had to other kids so she could receive more money.
It's not military healthcare that's causing this problem. It's not totally greed on the part of the corporations and doctors, although that's a part of it. The welfare system is a mess, a huge hole that we keep throwing money into. And I would bet that stimulus package Obama just signed will throw more money at the problem --- not in a productive way like getting people to work (even if they don't WANT to go to work). Therein lies the problem - we're paying people to be lazy!
Posted by More Welfare Please!, a resident of the Birdland neighborhood, on Feb 17, 2009 at 1:14 pm
"...we're paying people to be lazy!"
That is why we voted for Obama! Its about hope and change to better the lives of the average American, equal footing for those who choose to work or not. Rich folks need to open their wallets and "share the wealth". Hope is alive today!
In the 40 years since it was created to provide medical care to the needy, Medicaid has expanded far beyond that original mission. In 2004, Medicaid spending totaled $309 billion. The program now consumes a larger share of state budgets than elementary and secondary education.
'Crowds Out' Private Coverage
Supporters often claim Medicaid "picks up the slack" when the number of Americans with private health coverage declines. In reality, Medicaid crowds out private coverage.
As states expand their Medicaid programs to cover more benefits for more people, employers of low-income workers often drop the coverage they previously offered. In addition, many low-income workers decline coverage offered through their workplace and opt for Medicaid instead, which is virtually free to them at the point of service.
More than a dozen studies show Medicaid eligibility expansions reduce the number of low-income Americans with private coverage. In some cases, increases in Medicaid enrollment are completely offset by the reductions in private coverage.
A corollary to the crowding out is dependence: Allowing 50 million Americans to consume health care as if it were free encourages many to avoid productive behaviors that might get them off the Medicaid rolls, like working or saving more in order to purchase private coverage.
Aaron Yelowitz of the University of Kentucky and Jonathan Gruber of MIT found non-elderly Medicaid-eligible households increased their economic consumption to stay eligible for benefits by reducing their personal wealth. In 1993, Medicaid eligibility was associated with reduced wealth accumulation equal to $1,600 to $2,000 in today's dollars.
Another study, by Jeffrey Brown of the University of Illinois and Amy Finkelstein of the National Bureau of Economic Research, found Medicaid--which finances a large proportion of long-term care for the elderly and disabled--discourages between 66 and 90 percent of seniors from purchasing insurance for long-term care needs.
Spurs Higher Spending
Furthermore, Medicaid's joint federal-state financing mechanism gives states an incentive to spend as much as they can on the program. Each dollar a state spends on Medicaid is matched by an average of $1.30 from Washington. Thus, $1 of a state's budget spent on Medicaid yields $2.30 (or more) in total benefits, which encourages states to expand their Medicaid programs beyond what is truly necessary to help the poor.
The Urban Institute found close to one-fifth of Medicaid-eligible adults and children have private coverage--strong evidence Medicaid has grown far beyond its original purpose.
Hikes Private Costs
Finally, Medicaid increases the cost of health care for those with private coverage. States set below-market reimbursement rates for providers, who then make up the difference by charging private payers more. This, in turn, leads to higher premiums for those with private coverage.
This cost-shifting affects prescription drug spending, too. Mark Duggan of the University of Maryland and Fiona Scott Morton of Yale University found Medicaid increases the price of non-Medicaid prescriptions by 13.3 percent.
As an open-ended entitlement program that is obligated to reimburse all services for which beneficiaries are eligible, Medicaid must rely on cost-shifting rather than cost-containment strategies. Most of the reform proposals being floated on the state and federal levels--reducing reimbursements, capping utilization, increasing co-payments--merely tinker around the edges of this massive program.
Real Medicaid reform would mimic 1996's successful welfare reform law. Congress should let states set their own rules for eligibility and benefits; freeze federal payments at the 2006 amount and block-grant them to the states instead of matching all state spending dollar-for-dollar; and give states the flexibility to use federal Medicaid funds for a few broad goals, such as targeting assistance to the truly needy, reducing dependency, reducing crowd-out of charitable care, and promoting competitive markets for private coverage.
Posted by Cholo, a resident of Livermore, on Feb 17, 2009 at 3:44 pm
Hi Mary, why not just wait until the pain is excruciating so that everybody can post on this blog and tell you that you're in their prayers?
If you're so committed to the defense of this country, why not just move to Iraq and help out with the war effort? That way, you could get your hip fixed for free at a VA hospital if you return!
As for Chavez, the world better get ready for what's coming. My advice to the Jews is to get out now and don't waste a second. Mary, maybe you and Lindi can sound the alarm. You're about the closest thing to Henny Penny in decades!!!
"There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value.
We've found new ways to help people, and are spending more to take advantage of the opportunity. Why not view rising medical spending, like rising spending on, say, home entertainment systems, simply as a rational response to expanded choice? We would suggest two answers.
The first is that the US health care system is extremely inefficient, and this inefficiency becomes more costly as the health care sector becomes a larger fraction of the economy.
What makes it literally fatal to thousands of Americans each year is that the inefficiency of our health care system exacerbates a second problem: our health care system often makes irrational choices, and rising costs exacerbate those irrationalities. Specifically, American health care tends to divide the population into insiders and outsiders. Insiders, who have good insurance, receive everything modern medicine can provide, no matter how expensive. Outsiders, who have poor insurance or none at all, receive very little. To take just one example, one study found that among Americans diagnosed with colorectal cancer, those without insurance were 70 percent more likely than those with insurance to die over the next three years.
So the only way modern medical care can be made available to anyone other than the very rich is through health insurance. Yet it's very difficult for the private sector to provide such insurance, because health insurance suffers from a particularly acute case of a well-known economic problem known as _adverse selection_.
Insurance companies deal with these problems, to some extent, by carefully screening applicants to identify those with a high risk of needing expensive treatment, and either rejecting such applicants or charging them higher premiums. But such screening is itself expensive. Furthermore, it tends to screen out exactly those who most need insurance.
Employer-based insurance has historically offered a partial solution to the problem of _adverse selection_. Rising health costs have also ended the ability of employer-based insurance plans to avoid the problem of _adverse selection_. ... employers are starting to make hiring decisions based on likely health costs. For example, an internal Wal-Mart memo, reported by The New York Times in October, suggested adding tasks requiring physical exertion to jobs that don't really require it as a way to screen out individuals with potential health risks.
Providing health insurance looked like a good way for employers to reward their employees when it was a small part of the pay package. Today, however, the annual cost of coverage for a family of four is estimated by the Kaiser Family Foundation at more than $10,000. One way to look at it is to say that that's roughly what a worker earning minimum wage and working full time earns in a year. It's more than half the annual earnings of the average Wal-Mart employee.
Health care costs at current levels override the incentives that have historically supported employer-based health insurance. Now that health costs loom so large, companies that provide generous benefits are in effect paying some of their workers much more than the going wage—or, more to the point, more than competitors pay similar workers. Inevitably, this creates pressure to reduce or eliminate health benefits. And companies that can't cut benefits enough to stay competitive—such as GM—find their very existence at risk.
Fortunately, some of the adverse consequences of the decline in employer-based coverage have been muted by a crucial government program, Medicaid. But Medicaid is facing its own pressures.
Medicaid has grown rapidly in recent years because it has been picking up the slack from the unraveling system of employer-based insurance. Between 2000 and 2004 the number of Americans covered by Medicaid rose by a remarkable eight million. Over the same period the ranks of the uninsured rose by six million. So without the growth of Medicaid, the uninsured population would have exploded, and we'd be facing a severe crisis in medical care.
The result is that, like employer-based health insurance, Medicaid faces a possible unraveling in the face of rising health costs.
We spend far more on health care than other advanced countries—almost twice as much per capita as France, almost two and a half times as much as Britain. Yet we do considerably worse even than the British on basic measures of health performance, such as life expectancy and infant mortality.
One might argue that the US health care system actually provides better care than foreign systems, but that the effects of this superior care are more than offset by unhealthy US lifestyles.
the main source of high US costs is probably the unique degree to which the US system relies on private rather than public health insurance, reflected in the uniquely high US share of private spending in total health care expenditure.
all of that evidence indicates that public insurance of the kind available in several European countries and others such as Taiwan achieves equal or better results at much lower cost. This conclusion applies to comparisons within the United States as well as across countries. For example, a study conducted by researchers at the Urban Institute found that
per capita spending for an adult Medicaid beneficiary in poor health would rise from $9,615 to $14,785 if the person were insured privately and received services consistent with private utilization levels and private provider payment rates.
The cost advantage of public health insurance appears to arise from two main sources. The first is lower administrative costs. Private insurers spend large sums fighting _adverse selection_, trying to identify and screen out high-cost customers. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.
The second source of savings in a system of public health insurance is the ability to bargain with suppliers, especially drug companies, for lower prices. Residents of the United States notoriously pay much higher prices for prescription drugs than residents of other advanced countries, including Canada. What is less known is that both Medicaid and, to an even greater extent, the Veterans' Administration, get discounts similar to or greater than those received by the Canadian health system.
We're talking about large cost savings. Indeed, the available evidence suggests that if the United States were to replace its current complex mix of health insurance systems with standardized, universal coverage, the savings would be so large that we could cover all those currently uninsured, yet end up spending less overall. That's what happened in Taiwan, which adopted a single-payer system in 1995: the percentage of the population with health insurance soared from 57 percent to 97 percent, yet health care costs actually grew more slowly than one would have predicted from trends before the change in system."
Posted by frank, a resident of the Pleasanton Heights neighborhood, on Feb 18, 2009 at 8:57 pm
Stacey's extensive posts above obviously exceed the ability of many readers to respond in kind.
But I find the mention of Fox news interesting. They are an example of radical right wing republican (rrr) propagandists using publicly owned airways to channel only their ideology while censoring the access of those who oppose.
"Republican politicians have claimed that the stimulus bill requires that doctors follow government orders on what medical treatments can and can't be prescribed. But the bill doesn't say that.
* Rep. Tom Price of Georgia says the measure creates "a national health care rationing board." Not true. What it creates is a council to coordinate research into which treatments work best, and are most effective for the money. And in fact, the new law states quite specifically that the council has no power to "mandate coverage" and that its recommendations are not to be construed as "clinical guidelines for ... treatment."
* Betsy McCaughey, a Republican former lieutenant governor of New York, claims that the bill creates a "new bureaucracy, the National Coordinator of Health Information Technology." Not true. The office was created in 2004 by President Bush. McCaughey also says the office "will monitor treatments" and " 'guide' your doctor's decisions." But that's nothing new. Bush's initiative called for creating a health IT system to transmit information to "guide medical decisions."
Critics of comparative effectiveness research, which the government has been funding for decades, claim that it will lead to treatment being approved or denied based on costs. Proponents say it will improve the quality of care and can, in some cases, show that more costly treatments aren't as effective as less expensive alternatives.
We can't predict what will happen in the future, but we can say that several claims being made about the impact of the bill are simply opinions being passed off as facts."