Sunday, August 23, 2009

Socialized health care: the equal right to wait, and wait, and wait.

While Americans were debating the Obama administrations attempt to have government grab the health care sector no one was paying attention to the news from Canada. Canada is one of those state-controlled health care systems that is lauded and praised by those who want a form of health care fascism in America.

The article in question appeared in the Vancouver Sun and mentioned a document that was leaked from the local Health Authority. In Canada, health care is run by the provinces on behalf of the federal government. I should mention that a couple of years ago the Canadian Supreme Court legalized private health insurance, which had been banned by the government, saying that the government was doing such a poor job of providing care, that banning private care on top of what they were doing, was a violation of the rights of Canadians. Since the state was unable to provide decent health care as promised it could not also ban private care as that put the lives of people at risk.

The document that the Sun mentioned was a report from the health authority on the number one problem of socialized care: the inability to pay for it. The problem is that once you announce care is “free,” by which they don’t actually mean free, just that payments are divorced from consumption, the numbers of people wanting more and more care explodes. The demand for care exceeds the supply of care. That is how it is with any good or service that people desire: demand will always exceed supply.

AS the demand explodes so do the costs. But the big slogan of the advocates of nationalized care is that they offer “cheaper” care. So, with exploding demands they have to ration the care to keep costs down. Unfortunately, as they keep trying to reduce the supply of medicine the demand continues to escalate. That leads to budget shortfalls. They don’t have the funds to pay for it.

The Fraser Health region in British Columbia is facing a $160 million shortfall so they were trying to figure out what health care they could end. The document discussed included more rationing of care. A representative of the New Democrat Party (socialists) said this indicated cuts to: “Diabetes clinics in Delta and Mission, regional maternity and pediatric services, and seniors’ aid and mental health programs….” The bureaucrats admit the report is genuine but say it is misleading to allow the public to read it. They admit discussing “a potential 10-per-cent drop in the number of elective surgeries… and longer waits for MRI scans.” Remember, that under government health care programs they decide what is elective surgery not you, not your physician.

Canada’s Health Minister Kevin Falcon said “We’re in the situation right now where there is no more money” and that cutting care is necessary to keep the system sustainable.

The article mentions one hospital that will be forced to close its emergency ward entirely requiring patents to be taken to hospitals another 20 minutes away.

One way that the state health systems keep costs down is to limit the number of people who can have care at any one time. The result is waiting lists, patients are told they are on the list for treatment or surgery and that in some week’s time they will get the care. If you only have one MRI machine, which is expensive, then only so many people can use it in a day. Reduce the capital expenditure on health care, which socialized systems do, and you end up with patients waiting, and suffering longer, in order to get that care.

In Canada the Wait Time Alliance monitors the waiting lists that result from rationed care. The WTA is not a batch of “right-wingers” or “tea party activists” or whatever other stereotype one may use to describe opponents of nationalized care. It is an alliance of groups like the Canadian Association of Emergency Physicians, Canadian Association of Radiologists, the Canadian Medical Association and ten other associations of health care professionals.

In their June, 2009 report, Unfinished Business: Report Card on Wait Times in Canada, they attempted to measure the average waiting time for patients. Under the Canadian system an individual must first see a family physician. That physician acts as a gatekeeper, you don’t get see a specialist unless you are recommended by your physician. The waiting period includes the time period between seeing your physician to get permission and the time you actually see the specialist. In addition a second layer of waiting is then measure: that is the period between seeing the specialist and having access to treatment. What is not included “is the wait patients may experience to access their family physician or the fact that nearly 5 million Canadians do not have a family doctor.” (p.3)

In particular they tried to measure the waiting time in comparison to “benchmarks” set by the government. WAT, however, notes that the government benchmarks for waiting periods “represent maximum acceptable wait-time targets and should not be viewed as desired wait-time targets.” In other words, the benchmarks the government set for itself are absolute minimum possible before getting a failing grade completely. Sometimes, what the government considers “acceptable” wait-times, are considered highly undesirable by the actual physicians involved. WTA and the Canadian Cardiovascular Society argued that, with cardiac bypass surgery, no more than six weeks should pass from the initial doctor’s visit and surgery. The government is quite happy with a target of 26 weeks. (p. 4)

Even with somewhat loose targets the government system fails: “Based on the… target of 18-weeks from initial referral by a family physician to start of treatment, a majority of patients had wait times that exceeded the 18-week target.” For cancer patients “the median wait for radical (curative) cancer care was 46 days or nearly 7 weeks… the majority of these treatments exceeded the CARO [Canadian Association of Radiation Oncology] benchmark for curative cancer treatment of 4 weeks (2 weeks for the consult wait and 2 weeks for treatment). This is troublesome given the clear link between delay in radiation therapy and a chance of cure.” (p. 7)

This sort of waiting is routine even for emergency treatment. The report said that “the media wait time for patient [in emergency care] presented at the ED to the time they were admitted to an inpatient bed was 19 hours (average is 23.5 hours or nearly one full day,) which is substantially higher than the CTAS [Canadian Triage and Acuity Scale] thresholds (e.g., more than three times the 6 hour guideline for high-level acuity patients). The longer wait for patients to be admitted is often due to the inability to find an available hospital inpatient bed.” That inability is because hospital beds are expensive to maintain (not just the bed but the care that goes with it) and one way to reduce costs is to limit availability to that care by limiting the available of hospital beds.

These wait-times are critical. Whatever flaws the US system has, and most of those are due to political interference, the US stacks up quite well for actual treatment needed and received, compared to Canada. A report by June O’Neill and Dave O’Neill, Health Status, Health Care and Inequality: Canada vs. the U.S., investigates the percentage of people, with particular conditions, receiving care for those conditions in the United States verses Canada. As previously reported here:
In Canada 84.1% of those with high blood pressure were receiving treatment for it. In the United States the number was 88.3%. Those with emphysema or related illnesses are far better off in the US where 72% are receiving treatment versus 52% in Canada. In the US 69.6% of individuals with heart disease receive treatment while in Canada the rate is 67.2%. When it comes to coronary heart disease 84.8% of American sufferers receive treatment as compared to 88.9% of Canadians with the problem. Out of eight conditions they investigated Americans have higher treatment ratios in six categories with Canada leading in asthma and angina. These were for individuals age 18 to 64.

But these differences remain fairly consistent for individuals over the age of 65 as well. The only change was for angina where the U.S. now has a higher treatment rate than Canada: 77.7% to 73%. The report noted that “the U.S. generally performs better with respect to treatment of all conditions except that of asthma.”

What about preventative procedures like PAP smears, mammograms and PSA tests for prostate cancer? Again higher percentages of the American public receive such tests than do Canadians. In the U.S. 88.6% of women ages 40 to 69 have had a mammogram. For Canada it was 72.3%. In the U.S. 74.9% of the woman had the test within the last two years where only 54.7% of Canadian women had a recent test. For PAP smears the rate was, over the last three years, was 86.3% for American woman versus 88.23% for Canadian women. The men get a worse deal in both countries when it comes to testing for prostate cancer. In the same age group, 54.2% of men have been tested while in Canada the rate was an abysmal 16.4%. And testing for colorectal cancer is done, both for men and women, about six times as often in the United States as in Canada.

When the study looked at survival for cancer in both countries they also found that Americans were slightly better off. They looked at the ratio of the mortality rate to the incidence rate for cancers and found that Americans are ahead. They concluded, “in terms of the detection and treatment of cancer, the performance of the U.S. would appear to be somewhat better than Canada’s.”

The use of MRIs and CT scans are also much, much rarer in Canada. Canada has 5.5 MRI scanners per million people as of 2005. The US, in 2004, had 27 per million. When it came to CT scanners the US had 32 per million in 2004 while Canada, for 2005, had 11.3.

Considering that one of the alleged virtues of Canada’s health system is the “equality” factor it is interesting to see that more individuals in the US, with specific conditions, are receiving treatment than do their counterparts in Canada. The report also found that the poor in the United States reported as much, or more health care, than those in Canada did.

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