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Universal Health Care - Still Not Possible in US

Running United State’s health system is four times as costly as Canada’s

From link.

Every year in the United States, insurers and healthcare providers spend more than $800 billion on administration costs. A massive system of employees, who are not directly involved in patient care, cost the average American a whopping $2,497 each year.

In comparison, the per capita cost of healthcare administration in Canada is $551. Prior to implementing a single-payer system, Canada’s healthcare costs closely resembled the United State’s. Now the gap in health administrative spending is large and growing even larger.

These findings come from a new study published in the Annals of Internal Medicine. The conclusions made from the research have political implications, here and abroad.

Conservative governments across Canada have been mulling the possibility of privatization in our healthcare system. Doug Ford in Ontario has kept many of his plans secret, though some have been brought to light. Meanwhile, Jason Kenney in Alberta is already moving forward with his plans to open the door to more private care. This new study debunks many of their assumptions about the effectiveness of private healthcare.

Of course, in the United States, the study is bound to fuel the debate surrounding single-payer healthcare. The issue has become a central one in the Democratic primaries, where contenders are offering competing visions for a more accessible healthcare plan.
 
The thing about America is they go from one extreme to the next.

Want to go from Private Healthcare to giving everyone free healthcare the moment they step into America legally or illegally.

We dont even do that
 
I agree. You don't build a popular consensus around public health care by saying you will provide equal care to Americans and foreign visitors/undocumented migrants.
 
Over a quarter of all Americans already have government-provided healthcare. Anyone over 65 years old, anyone who works for the State or Federal government or military and all their families has healthcare.
 
I did not think it worth starting a new 'health care' thread but this Report is quite interesting, and though US was at the bottom of the 'league tables;, Canada did not do well either!

 
I did not think it worth starting a new 'health care' thread but this Report is quite interesting, and though US was at the bottom of the 'league tables;, Canada did not do well either!


From the appendix to the above report:

1628084481716.png


We do well on care process and passably on efficiency, everything else is sub-par to poor.

Of course, the details matter.

1628084761966.png


Dental really stands out there as an issue in Canada

*****

We were 2nd to last in being able to see a doctor on a same-day basis; and 2nd to last on being able to access after-hours care.

1628085443972.png


^^^ good on life expectancy, 3rd from bottom on infant mortality and 2nd worst on people in middle years having chronic conditions.

1628085573488.png


Good chance of surviving a heart attack here if you get to or are in a hospital; but not great for stroke.

Maternal mortality skews kinda high too.
 
From the preceeding, my take-aways for priorities.

1) Extend dental coverage as the number one priority for uncovered services. Universal ideal, but absent that, coverage targeting anyone with lower-middle income or less

2) We need more doctors per capita, and better plans to ensure timely access to same

3) We should extend universal contraception coverage as this would affect many higher-risk pregnancies, reducing issues w/mortality.

4) Further evaluation of why maternal death and infant mortality are abnormally high, and improving practices accordingly

5) Investigate high level of stroke death in hospital.

6) Better encourage healthy lifestyles (Ban drive-thrus, ban 'combos', raise minimum wage, making fast food less attractive; invest in making walking and cycling more attractive options)
 
From the appendix to the above report:

View attachment 339220

We do well on care process and passably on efficiency, everything else is sub-par to poor.

Of course, the details matter.

View attachment 339221

Dental really stands out there as an issue in Canada

*****

We were 2nd to last in being able to see a doctor on a same-day basis; and 2nd to last on being able to access after-hours care.

View attachment 339224

^^^ good on life expectancy, 3rd from bottom on infant mortality and 2nd worst on people in middle years having chronic conditions.

View attachment 339225

Good chance of surviving a heart attack here if you get to or are in a hospital; but not great for stroke.

Maternal mortality skews kinda high too.

I would be very, very careful with using raw stats - especially health outcome ones - given a lot of them is not necessarily driven by issues with health care delivery, but by population.

AoD
 
I would be very, very careful with using raw stats - especially health outcome ones - given a lot of them is not necessarily driven by issues with health care delivery, but by population.

AoD

That is, of course an issue, which is why I noted the need for further study on these.

We need to ascertain what is driving the number.
 
That is, of course an issue, which is why I noted the need for further study on these.

We need to ascertain what is driving the number.

Which is why I don't particularly like these types of reports that lumps apples with oranges - just what is one measuring? Health system issues? Underlying population differences? Socioeconomic differences? Historically Canada always did poorly using the methodology from the Commonwealth Fund report.

AoD
 
Which is why I don't particularly like these types of reports that lumps apples with oranges - just what is one measuring? Health system issues? Underlying population differences? Socioeconomic differences? Historically Canada always did poorly using the methodology from the Commonwealth Fund report.

AoD

The overall scores like any survey of its type (serious attempt or otherwise) aren't particularly useful.

The drill-downs though can allow you to see what needs attention.

If, the issue w/infant mortality, for instance, is highly correlated with socio-economics, that's still notable, and still indicates something in need of attention. Its merely that the focus of that attention may not be hospital care at the time of birth.

It may be any number of other things, which led up to that circumstance.

Its just a jumping off point.

****

We know we have an issue in Canada with too many people not getting needed dental work due to cost being a barrier.

There's no novel discovery there, though we do get some numbers - 21% of Canadians overall, but 40% of low-income Canadians.

That's a jumping off point for something that requires action, to insure money, ideally, isn't a barrier for anyone accessing necessary care; but at the minimum, to drive that percent of people for whom it is an issue, lower.

****

We also get a pretty clear point of comparison on what % of people can access a family doctor the same day, and we don't score well.

That's not a surprise, as we have a relatively low number of physicians per capita; a poor distribution of them; and we do a lousy job of linking people who want a doctor to a doctor with room on their patient roster.

We also, however, have poor access to non-ER, after-hours care.

The metrics that underlie the report do have some value, even if they are selective, and not always comprehensively informative.
 
Physician access and after-hour clinics remain issues in many smaller communities as I assume it is in larger areas. With our doctor (who I think is a dink but that's beside the point) it takes about 2 weeks to get an appointment; heck, he even requires 2 weeks to renew a prescription, and takes the view that if you need attention sooner then go the emerg. I was actually in emerg yesterday around supper time and it was packed - people have no other option.
 
I was actually in emerg yesterday around supper time and it was packed - people have no other option.

Anecdotally, this seems to be the issue I hear people griping most often about (and also the one that I personally have most often bumped up against) in Ontario: you very often wait in emerg for hours to get triaged, hours to get seen by a doc, hours for any follow-up, and hours to get discharged. I'm not sure I've been in and out of emerg in fewer than 6 or 7 hours, ever, and that's not good. And on top of that, it's of course well documented that you'll often spend much or all of that time in a hallway. None of it is good.

Again anecdotally, it seems the second-most griped-about topic is the wait time for MRIs (and in cases other types of scans); it's kind of nuts that you can wait literally 6+ months for a medically necessary scan.

The other difficult thing, of course, in making Canada-wide assessments and, even more so, in prescribing solutions (pardon the pun), is that healthcare is administered by the provinces. In Ontario, there's lots of blame to go around: you've got one party (blue team) that typically wants to slash spending for ideological reasons, and another (red team) that typically makes hay about "investing in education and healthcare" without dramatically increasing spending levels or enacting reforms. (There's also of course an orange team carping on the sidelines.)

And that's the difficulty: Contemporary political dialogue/wisdom has made it effectively impossible for any party to raise taxes on anyone except the most wealthy (which is limited in its utility for various reasons), and so basically no one can plausibly come up with a plan to make big new investments in the stuff that is super expensive (healthcare and education). I'm not sure how that wheel gets broken, but I'm finding it hard not to despair in the meantime.
 
Anecdotally, this seems to be the issue I hear people griping most often about (and also the one that I personally have most often bumped up against) in Ontario: you very often wait in emerg for hours to get triaged, hours to get seen by a doc, hours for any follow-up, and hours to get discharged. I'm not sure I've been in and out of emerg in fewer than 6 or 7 hours, ever, and that's not good. And on top of that, it's of course well documented that you'll often spend much or all of that time in a hallway. None of it is good.

Ontario has run pilots to change this which showed strong promise.

They had one at a small community hospital in south-western Ontario which worked quite well, driving down average triage/admit to ER time to under 30m.

They had another in London, ON, which mostly worked, and set a standard of 20M as I recall; but it teetered because of backlogs in admitting people out of the ER and into the Hospital.

That process, as I recall, sent a doctor out into the waiting room to do the most cursory of exams so that people who just needed to be told, 'we can't do anything' or just need a prescription renewed could be dealt with there, and those who need real tests could get those ordered while still in the waiting room.

The problem was it could result in an overcrowded ER when they could get people in quickly, but not into hospital quickly.

We have a really good idea what the solutions are; many do require some additional funds; often, though, its more a procedural matter.

Or how we choose to integrate care.

Again anecdotally, it seems the second-most griped-about topic is the wait time for MRIs (and in cases other types of scans); it's kind of nuts that you can wait literally 6+ months for a medically necessary scan.

We can look at the number of MRIs per capita (machines) and see that we are too low; but we also have additional problems where we have machines, but no dedicated technician to run them.

The MOH in Ontario tends to approve funded hours in blocks, starting with 40-hours of weekly operation of a scanner (or your hospital doesn't get to have one).

But this sometimes means that hospitals with backlogs and sufficient numbers of trained staff aren't allowed to run the machine on a weekend, or evening or overnight unless its an emergency.

We also have issues around how to deal w/patients missing their scheduled scans, be that due to illness, injury, death, no longer needing one etc.

We do a poor job making sure patients who should show up do; and figuring out when that wont' happen and advancing someone else.

The other difficult thing, of course, in making Canada-wide assessments and, even more so, in prescribing solutions (pardon the pun), is that healthcare is administered by the provinces. In Ontario, there's lots of blame to go around: you've got one party (blue team) that typically wants to slash spending for ideological reasons, and another (red team) that typically makes hay about "investing in education and healthcare" without dramatically increasing spending levels or enacting reforms. (There's also of course an orange team carping on the sidelines.)

And that's the difficulty: Contemporary political dialogue/wisdom has made it effectively impossible for any party to raise taxes on anyone except the most wealthy (which is limited in its utility for various reasons), and so basically no one can plausibly come up with a plan to make big new investments in the stuff that is super expensive (healthcare and education). I'm not sure how that wheel gets broken, but I'm finding it hard not to despair in the meantime.

Agreed.
 
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Anecdotally, this seems to be the issue I hear people griping most often about (and also the one that I personally have most often bumped up against) in Ontario: you very often wait in emerg for hours to get triaged, hours to get seen by a doc, hours for any follow-up, and hours to get discharged. I'm not sure I've been in and out of emerg in fewer than 6 or 7 hours, ever, and that's not good. And on top of that, it's of course well documented that you'll often spend much or all of that time in a hallway. None of it is good.

Again anecdotally, it seems the second-most griped-about topic is the wait time for MRIs (and in cases other types of scans); it's kind of nuts that you can wait literally 6+ months for a medically necessary scan.

The other difficult thing, of course, in making Canada-wide assessments and, even more so, in prescribing solutions (pardon the pun), is that healthcare is administered by the provinces. In Ontario, there's lots of blame to go around: you've got one party (blue team) that typically wants to slash spending for ideological reasons, and another (red team) that typically makes hay about "investing in education and healthcare" without dramatically increasing spending levels or enacting reforms. (There's also of course an orange team carping on the sidelines.)

And that's the difficulty: Contemporary political dialogue/wisdom has made it effectively impossible for any party to raise taxes on anyone except the most wealthy (which is limited in its utility for various reasons), and so basically no one can plausibly come up with a plan to make big new investments in the stuff that is super expensive (healthcare and education). I'm not sure how that wheel gets broken, but I'm finding it hard not to despair in the meantime.
I always take along a novel or two to read when I take someone (or myself) to emergency.
waittimes.jpg
From link.

Haven't been in five years now, but would think with COVID-19, I'll take along a third book.

When I had my COVID-19 doses, went to Humber River's COVID-19 Downsview Arena site, after making an appointment on-line. First dose, I waited 5 minutes. Second dose, I waited 20 minutes.
 

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