I think you need to see what Dr. Danielle Martin[1] a Canadian doctor had to say when she testified to the U.S. Senate defending the Canadian system.
The reference was to Newfoundland Premier Danny Williams’ controversial 2010 decision to undergo heart surgery at a Miami hospital.
“It’s actually interesting,” replied Dr. Martin, “because in fact the people
who are the pioneers of that particular surgery … are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.”
She then hinted that Mr. Williams was of the mistaken belief that simply paying more for something “necessarily makes it better.”[2]
As a Canadian in the healthcare field perhaps I can chime in as well.
When you talk about Canadian healthcare, it is a provincially run program (not federal) so let's talk about it at the provincial level. As I am an Ontario resident I'll be discussing this from an Ontario perspective, talking about all of the provinces and their differences would entail several posts.
Ontaio is currently going to institute (or plans to at least) pay freezes on physicians due to the rising cost of healthcare in a non-booming economy. However it is currently one of the best provinces in wait times. The provincial median is 6.7 weeks to see a specialist after being referred and another 7.1 weeks to being treated. This has increased 3 years compared to last year and about doubled from 20 years ago. For some specialties like orthopaedics the total duration is ~40 weeks. This is in contrast to the US where ~90% see the specialist within 4 weeks. Internationally we are considered to be amongst the worst nations when it comes to wait times.
Another big problem with the Ontario system is unemployment. 1/3 specialists, especially surgeons, are unemployed due to a lack of operating rooms and jobs available - even in rural areas. There is a definite need but with the single payer system we have, the aging population pyramid, and increasing healthcare costs we have there is no money left to pay physicians - who make less on average (at least in the surgical specialties) than the US physicians. So we're graduating surgeons who can't work and are forced to go the US to find jobs.
To address one of Dr. Martin's comments btw, someone jwo develops a surgery/technique/game isn't always the best person at solving it. Developing a mitral valve replacement survey using MIS techniques doesn't mean you're the best person to technically achieve it (you could be, but it's not a given as she phrases it). The US has a system that rewards exceptionalism and excellence, the Canadian system generally rewards mediocrity (this is even evidence in other fields such as law and even academia). The US is famous for having premier surgeons and state of the art equipment. A prominent example I know is in the field of limb lengthening, where until very recently there was not a single surgeon in Canada who could do internal limb lengthening, they all used the external fixator pioneered in the USSR. Even in medical education you are seeing prominent US schools teaching the use of hand held ultrasound devices which are supposed to one day replace stethoscopes. The US also has far more specialized medical fellowships focused on advanced techniques and tools such as using tne da Vinci robot system.
I can provide references if necessary (I typed this up on my phone) but most of these facts are readily google-able.
TLDR: Our system isn't as perfect as you might think and is actually teetering on financial instability at the moment with up to 1/3 new physicians unable to find a job in the country due to funding issues.
>The US has a system that rewards exceptionalism and excellence, the Canadian system generally rewards mediocrity (this is even evidence in other fields such as law and even academia).
That sounds like a Polandball-grade national stereotype, and I'd really prefer to hear some justification.
Interesting, how she did not have numbers, when asked, for Canadian fatalaties owing to protracted wait times and instead slyly diverted the discussion to the wait times at the security line to enter the Senate building. She seemed a tad petulant and more than a tad eager to please Sen. Sanders and offer a markedly animated and rosy account of her country's system than the rest of the representatives from Taiwan, Denmark and France.
Anyway here are some unvarnished facts about the share of things that plague the Canadian system.
"In 2011, a significant number of Canadians—an estimated
46,159—received treatment outside of the country."
...
"At the same time, the national median wait time for
treatment after consultation with a specialist increased from
9.3 weeks in 2010 to 9.5 weeks in 2011. Among the provinces,
wait times from consultation with a specialist to treatment
decreased in six provinces, rising only in Manitoba, Ontario,
New Brunswick, and Nova Scotia."
...
"In some cases, these patients needed to leave Canada due to
a lack of available resources or a lack of appropriate
procedure/technology. In others, their departure will have
been driven by a desire to return more quickly to their lives,
to seek out superior quality care, or perhaps to save their
own lives or avoid the risk of disability. Clearly, the
number of Canadians who ultimately receive their
medical care in other countries is not insignificant."[1]
"Wait times for health care in Canada have stalled at historically
high levels, in spite of current government strategies aimed at
improved timeliness. Canadians wait longer than citizens of many
other OECD countries with universal access health care systems,
from emergency room visits to physician consultations to elective
surgeries, despite Canada’s relatively large health expenditures."
...
"Failing to fix wait times has affected the economic well-being of
Canadians in a number of important ways. One estimate, from the
Centre for Spatial Economics assessing just four procedures –
total joint replacement surgery, cataract surgery, coronary
artery bypass graft surgery, and MRI scans – found that excessive
waits were costing Canadians $14.8 billion, plus another $4.4 billion
($19.2 billion,together) in lost government revenues from reduced
economic activity."[2]
I dislike offering anecdotal evidence because it appeals to emotion and not reason.
All I can say is I'm acutely familiar with the Canadian system on more than one level.
All of this is not to put too fine a point on how single payer systems are terrible in their own way.
It is to indicate that no matter which system we side with we are confronted with a more or less
equally (depending on who you ask) dreadful trade-off of horrors.
I'm not going to dump links here to the scores of Daily Mail reports, to offer as proof of how
"efficiently", the British system under the auspices of the NHS, works. You can Google it yourself
"NHS site:dailymail.co.uk" )
The point is that vested interests on either side always make the other option look barbaric.
Some prefer a system where every manner of medical malady can be treated skillfully and
expediently, right here within our shores without extended wait times, by distinguished medical
experts with a tremendous case experience in a given line of treatment, be it Hodgkin
lymphoma or Parkinson's or Multiple Sclerosis.
Some prefer that everyone last person in the country has an "on-paper" access to free and need-based
healthcare.
Some like David Goldhill want to entirely scrap the insurance model in favor of a radical direct pay model - where everyone pays out of pocket for most common procedures and office visits and thereby largely expunging the role of insurance companies. In 2007, David Goldhill's father was admitted to a New York City hospital with pneumonia, and five weeks later he died there from multiple hospital-acquired infections.
[3]
Your outlook is shaped by how healthy you are or how diseased you are. How your family coped with various medical hardships in the past or how everyone you know has always been blessed with bountiful health. How a certain system excludes things that you think should be offered by any self-respecting medical system, for the well-being of its public.
At the end of the day, most sensible people anywhere in the world would want to pay for a system that they see some utility out of, without adverse consequences.
A sick person's utility is different from a hale one's.
A salaryman's utility (with his cautious life choices and lifestyle) is structurally different from a
freewheeling thrill seeker's.
After all how is it fair that you are admitted into a ward for a routine fracture and contract some deadly MRSA bacterium from a guy who just returned from a safari in Belize? (This is quite a charitable example and is intentional. There are much worse examples that I could use, that will immediately invite censure and rebuke.
Funny how just earlier today I was reading one of the comments to PG's "What You Can't Say" piece - https://news.ycombinator.com/item?id=7443715 and how it strikes a resemblance to what I'm saying here.)
These are some - JUST A TINY TINY FRACTION - of the vast number of things that go UNSAID during a national debate
concerning healthcare systems.
Because no politician, policy expert, insurance company executive, medical professional or even an electorate would want to be seen holding borderline prejudicial views, in this context.
Hence they find other ways to verbalize their opposition to a single-payer system, using societally acceptable narratives and scenarios.
The reference was to Newfoundland Premier Danny Williams’ controversial 2010 decision to undergo heart surgery at a Miami hospital.
“It’s actually interesting,” replied Dr. Martin, “because in fact the people who are the pioneers of that particular surgery … are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.”
She then hinted that Mr. Williams was of the mistaken belief that simply paying more for something “necessarily makes it better.”[2]
[1] http://youtu.be/iYOf6hXGx6M?t=1m22s
[2] http://news.nationalpost.com/2014/03/12/toronto-doctor-smack...