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Sicko (Due Diligence)

Comments (62) | Posted July 10, 2007 in Politics

Comments

First of all there are 4 people that live in canada so it should be easy to fund it.

The big problem I have is that if you are really sick, you are left to die in many cases. Too expensive. remember the scene in raiders of the Lost ark where they wheel the ark of covenant into a huge warehouse....

Potentially the right idea for basic care. Than again, lets make our sneak ins to the country pay taxes.

Posted by: howard Lindzon | Jul 10, 2007 8:58:48 AM

CNN did a "fact check" of SiCKO as well and came back saying that it was greatly accurate in it's numbers.

http://www.cnn.com/2007/HEALTH/06/28/sicko.fact.check/index.html

Posted by: Rob | Jul 10, 2007 8:59:24 AM

My question regarding your aspirations for "universal healthcare" is, isn't it something that the states could (and perhaps should) take care of themselves, rather than the federal government?

One of the ideas behind American federalism is that ideas can compete between states, and the best can come out winning as a result. Whereas if the federal government does it, it'll get one solution tested, and if it isn't good, you're screwed.

Do remember that most states in the US have higher populations than some of the european countries with universal healthcare (Switzerland has 5 million, and the best healthcare system in the world).

Big, centralized central government solutions are bound to fail, just look at the UK, where the National Health Service lets people die if they have diseases that are "too expensive" to treat, or require advanced care, with no option to "top up" (apparently it is "fairer" if all people with a disease die, than if one can save themselves).

So my tip: leverage the American federal system, and let the ideas for best healthcare system compete on a state level!

Posted by: Wille | Jul 10, 2007 9:01:43 AM

He is staying at the w and squeezed into an elevator with my sisters this morning. squeeeeeezed. Small world

Posted by: howard Lindzon | Jul 10, 2007 9:03:18 AM

He is staying at the w and squeezed into an elevator with my sisters this morning. squeeeeeezed. Small world

Posted by: howard Lindzon | Jul 10, 2007 9:06:06 AM

A mult-tier system can work, that is grounded with some form of universal coverage. Ontario had something similar 15 years ago, before socialist provincial governments squeezed it - you could pay more to get better service, yet everyone had access. It meant the better doctors, surgeons etc did not have to go to the US to make a great living.

The Canadian system does not work for: long expensive fights with life-threatening disease and elective care. In California, I can treat my repeated soccer injuries with same-day MRI's, visits to three world-class knee surgeons within 72 hours and surgery the next week if I want. In Canada, you would have to drive to the US for that.

I am in Canada now on vacation, and had to visit a weekend clinic for one of the kids...it was full, all you needed was your 'blue health card', and you would be seen - no cash or credit cards required. And no clogging the ER instead, like the US. A little less Darwinian.

Posted by: greg | Jul 10, 2007 9:27:34 AM

This is an excellent and huge topic to tackle. I have dual (Canadian and U.S.) citizenships, granted, it would take filling out some paper work when and if I go back to Canada to fully re-instate my Canadian citizenship, and if I voted in Canada I would lose my U.S. citizenship. The older I get, the more I follow the political, health, business and overall status of both countries. There's always different positives and negatives! My mom is a retired nurse in Canada and she has often told me about elders who needed certain critical surgeries and replacements (i.e. hip replacement) who do not receive them. It's a scary thought, but so is thinking about the millions of American who suffer unnecessarily because they can't afford going to the hospital.

I also spent 10 years on active duty in the Marine Corps, where I didn't have to worry about any of my medical needs. It's not the best of systems all the time, but you live a life without worrying about your health care needs. Now, as an entrepreneur...it's an entirely different story. The health care industry is a multi-billion dollar business whether we like that or not, it's part of what makes our economy go round and round...so, how do you centralize it and turn it over to the government who can't even properly manage Social Security?

I think businesses and corporations of all sizes and profit margins need to play a bigger part in covering the health care benefits of employees...in return, they should get a much bigger tax break. Starbucks leads the way by offering even part time employees full health and dental benefits. Granted, I don't think there should be a three month waiting period, but it's a good start.

Posted by: Ann Bernard | Jul 10, 2007 9:35:27 AM

I think what's sick is the insurance companies. They do only ONE thing very well...VERY WELL...and that's billing. They are the best billers in the world. They know how to evaluate their customers, weed out bogus billing claims, carefully extend their A/P while shortening their A/R at every turn...but oh wait...they don't actually cure or treat anything. They've inserted themselves into the health care payment distribution channels in every way and do nothing for others while they profit for themselves. It's a mess. Someone please calculate this for me...if all the payments being made by Americans today for their health insurance were added up and you subtracted the insurance company payouts to doctors and hospitals, I'm pretty sure you're going to find that the insurance companies are simply keeping multiples more than what the doctors are getting. Now, going one deeper (and assuming my hip-shooting hypothesis is correct), the doctors still have to pay their overheads, employees and costs out of what they get from the insurance companies...and running a medical operation can be VERY technical and expensive. All the while the insurance companies only have to pay to do that thing they do so well...billing.

Am I wrong?

Posted by: Andy Ranley | Jul 10, 2007 9:40:45 AM

Howard's quirky sense of humour is the equivalent of a Canadian passport.

"The issues Canada has are the same issues we have in this country for anyone who doesn't have the means to pay for catastrophic care."

Except, in most cases, Canada won't allow the individual who can afford to pay for catastrophic care to do so. They're forced to wait like everyone else (a looong time), or head to another country that will accept payment for treatment.

Many wealthy individuals within Toronto are forced to travel to Buffalo for their needed care.

Posted by: Fraser | Jul 10, 2007 10:02:55 AM

> There's just not enough money for treating terminal diseases and so they "just let you die".

Well, this is certainly the discussion to have.

First, that's why they call them "terminal" – you're going to die. The economic question is how much money should a person, a family, or a country spend to keep someone alive another few weeks or months.

Then there's the moral question regarding the quality of life. If someone is "alive" in a coma, absent the world save for the corporal body, is that something society should pay for?

My mom works at a strip-mall medical clinic in FL, as an X-Ray tech. A few years ago, a doctor/owner's wife was diagnosed with bone cancer, a horrible disease. I understand that in the last three weeks of her life they spent $300,000 keeping her alive, in great pain despite the morphine, until she finally gave up the ghost. Is this a reasonable way to die? Is this a reasonable way to allocate resources? If a family "can afford it" – that is, pay the direct costs, should society still allow that to occur without regard for the indirect costs (hospital overcrowding, emotional drain on care staff means less care for people on the mend, etc)?

These are complicated issues, as you say, but until we are willing to discuss what a "good life" means, and face our mortality, it's all just a mess. No one who is comfortable with their own future death will allocate resources the way we currently do.

Posted by: Michael J. | Jul 10, 2007 10:13:54 AM

I'd like to expand upon the doctor's quote about fostering innovation in a health care system to a global context, as it is often overlooked in the largely domestic debate on universal health care.

The US (and its citizens) effectively subsidize the drug discovery and medical innovation costs of other nations that ignore drug patents or impose price caps on prescription medicines. Without our market-structured health care system and wealthy Americans and corporations willing to pay for the research behind these discoveries, medical innovation of the quality and pace we are accustomed to will not exist.

I'm not saying it's fair to those in the US that can't afford adequate coverage, but without the free-market system in the US, the quality of global health care would suffer immensely.

Posted by: Eddie LeBreton | Jul 10, 2007 10:28:01 AM

Look at the Australian system. My understanding is it's a hybrid of public and private insurance.

Posted by: Erik Schwartz | Jul 10, 2007 11:23:25 AM

Catastrophic insurance is available, and reasonably affordable ($50-$100/month, depending on your age, tobacco use, etc..). Consumer driven health care, despite all of it's detractors, is an amazing solution to this problem.

Posted by: HSA Truth | Jul 10, 2007 11:38:04 AM

Ahem, this is all you've done for "due diligence," talking to three people? Sheesh. If you were INVESTING, you'd do a TON more research.

Also: Given a single-payer system: Can't you be creative and try to imagine where the upside is? Why be so defeatist?

Posted by: john | Jul 10, 2007 11:39:52 AM

It should be noted that the Canadian healthcare system is moving towards some form of 2-tier - paying and non-paying. You can pay for some services, even if the question of whether it's totally legal or not is unclear.

You also have some private services that are legal. Take for example old age homes; there are some private ones and public ones.

Also, it's not quite a "universal" system across all of Canada, since the provinces control much of what happens. For example, in Quebec, the problems are worse than say, in Ontario.

What's particularly frustrating about the Canadian system is the lack of accountability. We spend an insane amount on healthcare, yet doctors and nurses still flee as quickly as they can, and services aren't great in a number of areas people have already mentioned. Where does all that money go?!?

Posted by: Ben Yoskovitz | Jul 10, 2007 11:48:46 AM

"The US (and its citizens) effectively subsidize the drug discovery and medical innovation costs of other nations that ignore drug patents or impose price caps on prescription medicines. Without our market-structured health care system and wealthy Americans and corporations willing to pay for the research behind these discoveries, medical innovation of the quality and pace we are accustomed to will not exist."

Unfortunately, a common fallacy. A great many pharmaceutical companies, and almost all of the big players, are European while Japan is a growing presence in the industry.

Also keep in mind that our healthcare dollars do very little to support R&D. Most drug compounds and devices were born in government-funded labs, largely university-based. At most we are paying for it indirectly, through our taxes, just as we are indirectly paying for research on nuclear weapons and the methane emissions of cows.

As for ignoring drug patents and imposing price caps, those actions are perhaps better described as "providing life-saving drugs to non-rich people" and "collective bargaining".

Posted by: Constance Reader | Jul 10, 2007 12:19:59 PM

For the most part - you are right. The Canadian system has its pros and cons.

However, saying people who have terminal diseases are just "left to die". Is a little overly dramatic. They still get care. They still try to lessen their pain in any way they can. You make it sound like they are booted right out of the system. They are not.

My wife is American and is still completely amazed she pays nothing when she goes to the doctor or the hospital. It's all perspective I guess.

However my dad needed an MRI and was on quite a long waiting list (about 3months for the freebie). He opted to pay at a private clinic so he could be treated faster. So yeah, it's not perfect.

Posted by: Mike | Jul 10, 2007 12:27:36 PM

you can't have universal without single-payer. We pay an exorbitant amout to the middleman-insurer in marketing, sales, exec pay, and administrative costs. I've studied the issue and have written legislation on it--you just can't do it.

The market system failed. It works for the wealthy, and not for anyone else in a safe, comprehensive manner.

Posted by: charlie crystle | Jul 10, 2007 1:12:02 PM

What is single-payer?

http://www.grahamazon.com/sp/whatissinglepayer.php

Posted by: charlie crystle | Jul 10, 2007 2:13:32 PM

I've pondered universal health briefly. The cynic that I am thought that as a member of this universal system wouldn't I want rules for others in this system such that they have less health problems in life so as not to strain the system.

Such as mandatory exercise, a daily allotment of the recommended daily value of calories, ban cigarettes, ban booze, everyone wear helmets and shoulder pads.

The people leading unhealthy lives will be burdening the system, and ultimately affecting the care I receive when I need it.

This is true now, but at least I have a choice.

I am all for freedom of choice, until that choice affects me, and in that system, you smoking 2 packs a day IS affecting me and I demand the government do something about it.

Posted by: DanFromMA | Jul 10, 2007 2:21:39 PM

My Canadian friends in Toronto (and expat American friends) told me that the key to getting an MRI or any high tech treatment is to make friends w/ a vet. It was half-jokingly said, but in a city the size of Toronto, access to high tech medical equipment is extremely limited. Vets, however, are not regulated by the same system, make a lot of money, and tend to have the latest gear.

The above-mentioned friends also go to Mallorca once per year to see German doctors and get any tests they need (they carry private insurance). Talk about globalization!

Posted by: scotty the body | Jul 10, 2007 7:16:02 PM

Canada has pretty good acute and terminal disease care. Coverage specialties vary from province to province but there is reasonably good regional equity. The notion that "they just let you die" is beyond absurd and a highly apocryphal American urban myth. Take a look at Derek K Miller's saga at http://www.penmachine.com to get a sense of the dedication amongst the medical professionals he has dealt with in Vancouver. Where the Canadian model breaks down is with chronic orthopedic conditions or "non-essential" surgeries. You may have to wait at a Canadian hospital -- like that never happens in America... -- but you will never be turned away. Americans have to get past their quaint notion that "socialized" or government sponsored means that the care is delivered in some kind of germ-filled communist laden den of the un-Godly. The American system needs to purge its inefficiencies, high costs and arcane service offerings.

Posted by: Brad Gibson | Jul 10, 2007 9:29:43 PM

The Amish go to South Carolina from PA for some medical care, pay with cash. 13 hours by train. That's how broken the system is.

The two biggest costs in our healthcare system are:

1) health insurance/insurers/everything associated with payment, admin, sales

2) defensive medical practices because of the tort system around healthcare.

Solution: go to single-payer, go to no-fault, no tort system.

Posted by: Charlie Crystle | Jul 10, 2007 11:02:04 PM

I am a Canadian and I can tell you from first hand experience that Canada has mediocre health care at best. It cannot be compared to modern health care system in France, Sweden and Germany.

Folks universal access to a waiting line does not equate to universal access
to health care. Canadian health care system suffers from massive inefficiency.

Up here always joke that a dog can get a hip replacement faster than a human in Canada. Well, it's actually tragic when you think about it.

Posted by: New West Living | Jul 11, 2007 2:03:06 AM

In addition to Canada three systems (at least) deserve attention: France, Sweden and the UK. (Some EU people feel the French system is superior to the systems in other member nations.)
The US will probably end up with a tiered service where basic needs will be provided for all through a single national, or a number of regional, systems. These will give good, but probably not the best care found in the US. For example, if you have high cholesterol you will be prescribed an off-patent drug as opposed to Lipitor.
A citizen/green card holder/who else(?) will be automatically enrolled.
For faster/better medical services the individual can go "private" as you can in the US, the UK and Sweden. (I don't know about France.) The countries do not pay for most extraordinary care procedures. But you are not prevented from looking outside the public system for a private option.
In the UK there is private health insurance that you can lay on top of its NHS coverage. I am uncertain about Sweden and France.
You aren't left to die anywhere. But these nations have implicitly concluded that terminally ill people should be permitted to die as comfortably as is reasonably possible and it is, in effect, hospice-like care that they seem to deliver.
In Sweden the national health system does not own all the the providors. It is not "socialized medicine". There are privately owned hospitals that bid for government contracts. In the UK the private sector, during the Blair years, began to be used for more NHS services. I believe here also the hospital bids for the business on a billed charge per defined procedure basis.
One of the big successes in Sweden is its national health information system. You can be in Kiruna or in Malmö and all your health info is online. A new doctor in a new city has all your medical history immediately available. No "first interview with errors" problems. This centralized information alone is a significant cost reducer for any health delivery system. To get the full benefit of a national or large region system we are going to have to lick this problem and that requires that every member have a unique identifying number. In Sweden this number is a combination of a person's birthdate and a four digit number. So, for someone born on February 12, 1960 the personal number would be 600212-xxxx. In the US a system would need a couple more places after the birth date. It does not have to be our social security number.
What we call the service matters. Calling it a "National Health Service" or anything similar is a loser. Perhaps the "American Basic Care Health Plan" moves in the right direction (the "ABC Health Plan"). The message is clear. It is a BASIC plan. It covers a defined list of procedures or indications and applies "best practice" in each. It will rely wherever possible and appropriate on off-patent drugs. At a patient's request a patented drug will be prescribed; but it is up to the patient to pay for it.
The charges for services and prescriptions within the ABC would be modest and would have a goal of reducing system abuse through over-use.
Companies could have an ABC facility on site to speed care delivery and minimize time away from work.
Private insurance from multiple sources and private practitioners would remain to provide more expensive services and "top up care".
But one major point remains. There would be a basic premium for every person, even if the person chooses not to use the ABC.

Posted by: Leon Liebman | Jul 11, 2007 2:57:26 AM

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