Socialized Medicine

[Jermofoot]

I’m curious about opinions on the current system for US healthcare vs. socialized healthcare.  Please don’t post “that shit is for pinko bastards.”  Add something substantial, mmm kay?
However, before you answer, please check out this article:
http://www.rockymountainnews.com/drmn/local/article/0,1299,DRMN_15_5018786,00.html

It’s not to tug at your heartstrings, but compare this event happening here, to say, Canada.  Also remember that a good portion of the US doesn’t have any health insurance.

[Jennifer]

Actually, that’s a misquoted fact, Jerm.  A vast majority of the population does not have company paid or subsidized insurance.  Many of the uninsured are self employed and instead buy health insurance privately.  Many of the uninsured also use Medical Savings plans which allow for you to remove X% of your wages pre-tax and put them into a 401(k) style environment that can be used for medical expenses.  And almost everyone who is left are students and don’t “have” insurance because they’re still leeching off Mommy and Daddy’s insurance.

The few who do not fit in those above catagories can usually find free medical treatments at any emergency room or medical clinic near where their refridgerator box or homeless shelter is.

So in reality, the only people in this country that do not have ANY insurance or access to free medical facilities are those who choose not to have insurance or live in those areas with easy access to medical facilities.

To claim that

“a good portion of the US doesn’t have any health insurance”

is misleading at best, out-right erronious data at worst.

Now, if you want to amend that to read something closer to “a good portion of US Citizens are under insured when it comes to their health and autos and homes and life” you would be much closer to the truth.

For instance, my family health insurance plan costs $440/month.  I know that is under-insured because normally plans like this go for $600/mo, realistically.  (It’s the same rate corporations pay for BC/BS, it’s just they pay part of the cost, you pay part.  I’m not in a company, I don’t have one paying part for me as a fringe benefit.) However, I really don’t need insurance to subsidize the cost of immunizations for my children or annual checkups.  So I only get the insurance that covers disasters.  (Yea, insurance for shots, so instead of paying $7.50 you pay $5.00 co-pay and $600/month….how does THAT come out in your favor???)

[OLver]

Jen, 400 to 600$ a month is a huge amount for the poor people!

[Jermofoot]

Jen-

US Census Bureau concluded in 2005, 46.6 million people had no health insurance.  Zip.  Zilch.  Nada.  Included in the census was whether you had private (employer or individual) or government supplied insurance.  So, even your claim that “the uninsured are self-employed and instead by health insurance privately [and aren’t counted]” (which means they are insured…) are considered.  And flexible spending accounts aren’t the same as having insurance.  As for the uninsured, well that’s more fuel to the fire.

[Guest]

@Jermofoot:

Add something substantial, mmm kay?

Well, since you put it that way…

How about these nuggets:

1. Back in the early 90’s (when I was actually current on this topic  :-D), there were more MRI machines in the city of Seattle than in all of Canada.

2. When I was a kid Strep throat tests took overnight to process and they weren’t too cheap.  Now you get the results instantly from a swab in your doctor’s office run through a small plastic box.

3. Drugs that used to cost hundreds of dollars can now be bought for $4 at WallMart (at least in Florida).

What’s the common thread in these elements and how does it relate to socialized medicine?  Medicine is technology.  The market continually creates NEW treatments as well as brings the price down of existing treatments.  Every socialized system in the world is essentially a free-rider on the tech production of the countries with free market medicine.  The world, and Americans, are healthier because of US research and the market economy that creates it.Â

It is very easy to point to folks not covered by insurance and see victims; it is much harder to see the people who suffer from medicines not being researched in cases where state budgets don’t allow for sufficient research because you can’t SEE what doesn’t exist - i.e. hasn’t been invented.

That’s the tech argument; to me it is sufficiently compelling to ignore the social aspects of medicine.  Would impoverished people receiving cheap insulin be better off if we had socialized medicine long ago and lost the research for diabetes?  I don’t think so.

Peace

[Jermofoot]

@Jermofoot:

As for the uninsured, well that’s more fuel to the fire.

I meant underinsured here…

CrazyStraw - Fair enough.  I was asking for assessments and I appreciate your input on the subject.  I’m not sure I agree on that, but definitely a valid thought.  For one, I don’t think the market continually creates new treatments to bring the prices down - they are no doubt looking for the next profitable drug.  But medicine is more than just drugs as well.  You could be completely right, and perhaps better health care is at the expense of some who never see it.

[cystic crypt]

Welcome CrazyStraw.
First off:
Percent of Canadians fully covered by health insurance - 100%
Percent of Americans fully covered by health insurance - 66% (85% covered to some degree)

Percent of Canadian GDP spent on health care - 9%
Percent of Ameirican GDP spent on health care - 14%

@CrazyStraw:

@Jermofoot:

Add something substantial, mmm kay?

Well, since you put it that way…

How about these nuggets:

1. Back in the early 90’s (when I was actually current on this topic  :-D), there were more MRI machines in the city of Seattle than in all of Canada.

it’s true that we could use a few more MRI machines, however you have to consider that Americans are over-imaged in part because of fears of litigation. Â

2. When I was a kid Strep throat tests took overnight to process and they weren’t too cheap.  Now you get the results instantly from a swab in your doctor’s office run through a small plastic box.

i’m not sure how this is germaine to the discussion.  I use these rapid-strep tests frequently, however i use them in conjunction with a culture-and-sensitivity because of the poor sensitivity and specificity of the rapid-strep test.

3. Drugs that used to cost hundreds of dollars can now be bought for $4 at WallMart (at least in Florida).

I’m not sure what you are referring to . . . .  
But in order to make this fit:

1. Canadian pharmaceuticals are much cheaper in general than those in America.
2. Unless they are generic - i think that US generics are cheaper.

What’s the common thread in these elements and how does it relate to socialized medicine?  Medicine is technology.  The market continually creates NEW treatments as well as brings the price down of existing treatments.  Every socialized system in the world is essentially a free-rider on the tech production of the countries with free market medicine.  The world, and Americans, are healthier because of US research and the market economy that creates it.Â

Ummm . . . i think that the Canadians, Brits, Aussies, Swedes, Germans, French, South Africans, Italians etc. might take some umbrage at this.  “Evidence-based-medicine” was first developed here, as was insulin, MANY of the guidelines used in ERs, cancer-prevention etc.  Heck - in my tiny city alone Win-Rho was developed, prolactin discovered, important obs techniques were developed, AIDS research advanced to a remarkable degree (see Allan Ronald), important developments in type-2 diabetes, the most advanced level-4 microbiology lab in the world - all in the last 50 years in one small city.
America has done a lot for the world in areas of technology, but they stood on the shoulders of giants, with other giants.

It is very easy to point to folks not covered by insurance and see victims; it is much harder to see the people who suffer from medicines not being researched in cases where state budgets don’t allow for sufficient research because you can’t SEE what doesn’t exist - i.e. hasn’t been invented.

good point.  
I used to get irritated by charities that gave money to children who were dying of cancer and other diseases as i believed that this money should have gone into researching the irradication of these diseases.

That’s the tech argument; to me it is sufficiently compelling to ignore the social aspects of medicine.  Would impoverished people receiving cheap insulin be better off if we had socialized medicine long ago and lost the research for diabetes?  I don’t think so.

Consider that insulin was discovered and developed in Canada - your sociallized neighbour.  
Anyway, many of us believe that adequate medical care is a social right and every bit as important as any human right.  To deny people adequate medical care because of an inability to pay is IMO tantemount to forbidding them any degree of privacy, or the right to the right to a fair trial, etc.
Now the wealthy being able to have full body MRI’s with no appropriate indication while 40-odd million people do not have any medical insurance is bizaare. Â

(fyi - i am a Canadian family and ER physician who makes a fair bit less than an American physician and is taxed a fair bit more, and i believe that our system - problematic as it is - is better)

[Guest]

Hey CC.

Good post!  Here are some replies:

Percent of Canadians fully covered by health insurance - 100%
Percent of Americans fully covered by health insurance - 66% (85% covered to some degree)

There are a couple of questions that need to be answered here:

1. What is the proper measure of the “benevolence” of a health care system?  Is it the number of people insured or is it the percentage of people who need care that receive care?  Insurance is a useful proxy for the extent of coverage, but it is not the same thing.  Going by a utilitarian model, I’m favor helping the most people that need treatment, and the insurance figures don’t reflect that reality.  That’s not to say I don’t support greater insurance coverage; it is to say that I don’t accept that more insurance = morally superior.

And regardless of insurance, the vast, vast majority of folks that need healthcare treatment in the US receive it whether they are insured or not, and whether or not they are even citizens.

2. What percentage of the uninsured could be insured if they so chose?  This is no small question.  It is not popular to say it, but many of the uninsured are uninsured for the same reason they are unemployed: they prefer not to be bothered with taking responsibility for themselves.  My wife is a drug addiction counselor in Detroit.  I’ve been involved in Detroit for most of my life.  And I can say that many folks that suffer do so by their own choices.  Is it moral to take money from a middle-income family with two kids so that a crackhead can get treatment for STDs?  That is EXACTLY what happens, and it is far from moral.

Percent of Canadian GDP spent on health care - 9%
Percent of Ameirican GDP spent on health care - 14%

That is a point in our favor  :-D

In a society where there is dramatic wealth (relatively speaking), more money should go to health care just as it should go to greater charity, security, and education.  I would argue that there are few causes better than health for a wealthy country to invest in.  And the results of money spent on research spills over into poorer areas.  That transfer is certianly not perfect, but ultimately it is transferred in greater quantity than in controlled-economy systems.

You mentioned you didn’t know what I was talking about with Wal-Mart and cheap drugs.  That’s because it’s NEW news!
http://www.ocregister.com/ocregister/healthscience/healthfitness/article_1283812.php (that’s one article; dozens are on the web about it)

That’s not a bad piece of capitalism there.

1. Canadian pharmaceuticals are much cheaper in general than those in America.
2. Unless they are generic - i think that US generics are cheaper.

Generics are cheaper in the US.  And that’s the beauty of patent protection in a market economy: in time EVERYTHING becomes a generic.  If drug companies make good money for a few years because they invent powerful new medicines, good for them!  In time, the medicine will be cheap and plentiful.  That is how new treatments come about.  Let them make money; everyone benefits because invention is not a zero-sum game - everyone wins in the short run and in the long run.

Ummm . . . i think that the Canadians, Brits, Aussies, Swedes, Germans, French, South Africans, Italians etc. might take some umbrage at this.

Let 'em!  (they’ll take more umbrage when I point out that they also free-ride on American military spending)  In no way do I want to disparage the great work of phsyicians everywhere.  There are many talented folks that produce tremendous results.  But in sheer quantity and quality you can not compare the track record of American medicine with other nations; not because our people are better or smarter, but because our system rewards innovation.

Your point on insulin is well made; imagine how many more great discoveries those brilliant minds would have made if the system was better at encouraging it.

(FYI - I work at a top US hospital as a business analyst.  Every day Canadians stream into our facilities for healthcare; I will try to keep in mind that they’re only coming here because they don’t realize their system across the border is better.)

Side note - As a physician, would you say this guy has acute encephalitis :  :mrgreen:

[balungaloaf]

if you got some cash in middle class america, you can get a surgery done fairly quick.  Canada wait forever on a list, forever, those lists.

cc, we got a ton more people and the cost of health care we provide is alot due to the poor and especially illegal immigrants.

[Jennifer]

@Jermofoot:

Jen-

US Census Bureau concluded in 2005, 46.6 million people had no health insurance.  Zip.  Zilch.  Nada.  Included in the census was whether you had private (employer or individual) or government supplied insurance.  So, even your claim that “the uninsured are self-employed and instead by health insurance privately [and aren’t counted]” (which means they are insured…) are considered.  And flexible spending accounts aren’t the same as having insurance.  As for the uninsured, well that’s more fuel to the fire.

Yes, but I covered the majority of those under the Health Savings Plan and similar programs.  And yes, it most assuredly is the same as Health Insurance.  It is self funded, 100% your assets insurance.  Actually, you’re right, it’s not the same, it’s BETTER.

We’re talking a VERY small percentage of Americans that neither do not have health care insurance, nor do they have access to free medical clinics.

You want to sacrifice on the alter of communism the free market place for hospitals and insurance???

[Jennifer]

The problem is this:  Americans do not want universal medical coverage.  Some people honestly want to opt out or do their own protection plans.  What is with this communist view that the Govermnet is Mommy and the Government is Daddy?  That is NOT what this country was founded on and it most assuredly is NOT what the founders wanted this country to become!

You want to make health insurance more affordable?  That’s easy.  Make it illegal to sue a doctor, hospital or nurse for actions taken in good faith.  What that means is if the person or institution that was licensed to practice medicine did what they could for you given the materials at hand and were not adversely effected by their own actions (ie they were not drunk or high) then you cannot sue them.

This will drop medical rates, malpractice insurance, hospital bills, etc.  Not to mention free up the courts to try murderers and rapists instead of Billy who went to see a doctor for a tummy ache, the doctor dropped his reflex hammer on Billy’s thigh and now Billy’s mommy is sueing for $14 Million dollars for pain and suffering caused by the bruise.

[cystic crypt]

@CrazyStraw:

Hey CC.

Good post!  Here are some replies:

thank you.
It is gratifying to have a disagreement withsomeone without the word “liberal” and other labels get thrown at me.

Percent of Canadians fully covered by health insurance - 100%
Percent of Americans fully covered by health insurance - 66% (85% covered to some degree)

There are a couple of questions that need to be answered here:

1. What is the proper measure of the “benevolence” of a health care system?  Is it the number of people insured or is it the percentage of people who need care that receive care?  Insurance is a useful proxy for the extent of coverage, but it is not the same thing.  Going by a utilitarian model, I’m favor helping the most people that need treatment, and the insurance figures don’t reflect that reality.  That’s not to say I don’t support greater insurance coverage; it is to say that I don’t accept that more insurance = morally superior.

fair question.  I would say "both.  The number of people insured, as well as the percentage of people who need care that receive it both appeal to benevolance as even tho’ i think the 80/20 rule applies (i.e. 20% of the population consume 80% of health care resources), still the other 80% require medical attention at one time or another, if only for prevention.  As far as “morally superior” - it depends on what you consider to be “right”.  If you believe that not every person who needs medical care should receive it, then you will not consider this to be a morally superior model.  If you believe that the most needy are the most deserving, but yet everyone deserves medical coverage, well then you might consider the Canadian model “morally superior”.

And regardless of insurance, the vast, vast majority of folks that need healthcare treatment in the US receive it whether they are insured or not, and whether or not they are even citizens.

probably.  But they tend to have to pay for this service, even if it bankrupts them.

2. What percentage of the uninsured could be insured if they so chose?  This is no small question.  It is not popular to say it, but many of the uninsured are uninsured for the same reason they are unemployed: they prefer not to be bothered with taking responsibility for themselves.  My wife is a drug addiction counselor in Detroit.  I’ve been involved in Detroit for most of my life.  And I can say that many folks that suffer do so by their own choices.  Is it moral to take money from a middle-income family with two kids so that a crackhead can get treatment for STDs?  That is EXACTLY what happens, and it is far from moral.

fair enough - and i can appreciate this POV.  Still, that crackhead can easily go spreading these STDs, and overtime you have what happened to many hemophilliacs - HIV via blood transfusions. 
Finally - many non-physcians can not appreciate this, but those of us who follow the Hippocratic oath are bound to treat people irrespective of these consequences.  It’s like i was asked before - if i had OBL on the table, and i had to intubate him to save his life would i?  Yup.

Percent of Canadian GDP spent on health care - 9%
Percent of Ameirican GDP spent on health care - 14%

That is a point in our favor  :-D

In a society where there is dramatic wealth (relatively speaking), more money should go to health care just as it should go to greater charity, security, and education.  I would argue that there are few causes better than health for a wealthy country to invest in.  And the results of money spent on research spills over into poorer areas.  That transfer is certianly not perfect, but ultimately it is transferred in greater quantity than in controlled-economy systems.

Sadly this is a case in point of the relative efficiency of the Canadian model vs. the US one.  One would think that a society with a greater percentage spent on health care would have a larger proportion of its population covered. 
So where is the excess money going?  Well - Jen pointed out that a lot goes into dealing with a litigious population.  As a hospital adminstrator, i’m sure you are aware of payments to shareholders, money to advertisers etc.

You mentioned you didn’t know what I was talking about with Wal-Mart and cheap drugs.  That’s because it’s NEW news!
http://www.ocregister.com/ocregister/healthscience/healthfitness/article_1283812.php (that’s one article; dozens are on the web about it)

That’s not a bad piece of capitalism there.

1. Canadian pharmaceuticals are much cheaper in general than those in America.
2. Unless they are generic - i think that US generics are cheaper.

Generics are cheaper in the US.  And that’s the beauty of patent protection in a market economy: in time EVERYTHING becomes a generic.  If drug companies make good money for a few years because they invent powerful new medicines, good for them!  In time, the medicine will be cheap and plentiful.  That is how new treatments come about.  Let them make money; everyone benefits because invention is not a zero-sum game - everyone wins in the short run and in the long run.

as a scientist, i have a hard time with “generics”.  Don’t get me wrong - i realize that people NEED them, but i see generic drug companies as parasites for the most part.

Ummm . . . i think that the Canadians, Brits, Aussies, Swedes, Germans, French, South Africans, Italians etc. might take some umbrage at this.

Let 'em!  (they’ll take more umbrage when I point out that they also free-ride on American military spending)  In no way do I want to disparage the great work of phsyicians everywhere.  There are many talented folks that produce tremendous results.  But in sheer quantity and quality you can not compare the track record of American medicine with other nations; not because our people are better or smarter, but because our system rewards innovation.

Definitely disagree on the “free ride” with regards to US military spending (i.e. the US buys a bulls-eye, but we are in the next circle out)- but we can deal with that on another forum.
Other systems reward innovation.  Anyway, i will make a pointless argument that America does not (IMO) punch above its weight when it comes to medical technology.

Your point on insulin is well made; imagine how many more great discoveries those brilliant minds would have made if the system was better at encouraging it.

insulin is not the only development outside of America . . . but Yay for patriotism.

(FYI - I work at a top US hospital as a business analyst.  Every day Canadians stream into our facilities for healthcare; I will try to keep in mind that they’re only coming here because they don’t realize their system across the border is better.)

our system does have its shortcomings.  Still these patients are typically outpatients who are going to America for elective medical treatments.  This is not a coup for non-sociallized medicine, however it is a result of Conservative gov’ts in Canada replying in a short-sighted manner to reports that supply caused demand. 
And you might remind these that they have a much longer lifespan, improved perinatal and maternal mortaility, and many other important endpoints as a result of being Canadian (or in spite of . . . )

Side note - As a physician, would you say this guy has acute encephalitis :  :mrgreen:

normal pressure hydrocephalus . . . or cranial dystocia.

[Guest]

@cystic:

It is gratifying to have a disagreement withsomeone without the word “liberal” and other labels get thrown at me.

Ooh!  Good point!  I’ve been negligent in my duties.  Let me get caught up:

You liberal wacko, left wing nut job, communist, pinko, COMMUNIST, Cannuck, puck lover, socialist, tree hugging, granola chomping, eco-freak, Citizen of America Jr., did I mention COMMUNIST, American sidekick!

Whew, good to get that off my chest.  Let me know if I missed any.  If you need a rolling start for me, try: You jingoistic, smug imperialist…  I’ll let you take it from there.

A large part of our discussion centers around what the goal of a medical system should be.  I’m willing to be we are HIGHLY in sync on what we personally want to do for folks, but I bet we disagree on who should do it.  I dislike government involvement, but I love that so many hospitals have religious roots in serving the poor.  I’m a big believer in charity, just not in government mandated charity (which isn’t really charity, but you get the point…). Once the government pays for healthcare, can they tell you what to eat?  Legislate sexual practices?  Regulate a certain amount of exercise?  It’s an issue of freedom for me.  Should citizens pay for the health choices of other citizens?  Because I believe in freedom I must also believe in responsibility.  Health care is a privilege, not a “right” in any classic sense of the word.

And keep in mind I do believe the Canadian system has strengths; I just believe that A) freedom includes the freedom to fail and B) in the long run fewer people will be healthy because of socialized medicine due to slower research and fewer cheap medications.  The losers of the US system are simply more visible, and that is harder to address politically.

But they tend to have to pay for this service, even if it bankrupts them.

You know, I’ve read bankruptcy studies and medical expenses were a surprisingly small consideration.  Consider that the average credit card debt in the US is $9,200.  That’s the killer.  Sure the papers record horror stories of multiple hundred-thousand-dollar hospital bills, but those are statistical outliers.  Many expensive treatments are written off as losses for the uninsured and few people are actually expected to foot those bills.  Good for us for doing so.

Still, that crackhead can easily go spreading these STDs, and overtime you have what happened to many hemophilliacs - HIV via blood transfusions.

Ah, but now you’re not providing altruistic health care that is about the patient; you are spending money to protect everyone else.  That’s a very different type of consideration than insurance coverage.

those of us who follow the Hippocratic oath are bound to treat people

Dude.  DUDE!  I cannot believe you referenced the HO.  Is that the HO that swears by Aesclypius and Hygeia?  The same oath that forbids abortion?  The same oath that prohibits euthanasia?  Perhaps you do take it that seriously, but if that’s the case then why the heck have I not been invited to one of your toga parties?  You know followers of Panacea rock the house!

http://en.wikipedia.org/wiki/Hippocratic_oath

Well - Jen pointed out that a lot goes into dealing with a litigious population.

Yup yup.  But you can still have a market economy and cap liability claims.

Anyway, i will make a pointless argument that America does not (IMO) punch above its weight when it comes to medical technology.

Well, that is actually a question we could answer if we weren’t lazy :)  A little time digging up pharmaceutical and medical device patents would say a lot.  I don’t know if I’m quite that motivated though.  The internet is awfully far away and I have to go and…

these patients are typically outpatients who are going to America for elective medical treatments.

Generally true.  But then in a socialized system the term “elective” is determined by the state.  In England, are kidney transplants “elective” for old men?

And you might remind these that they have a much longer lifespan, improved perinatal and maternal mortaility, and many other important endpoints as a result of being Canadian (or in spite of . . . )

Very true.  But Canada is a different country in many respects with very different social issues.  If your only goal is health care, then totalitarianism can be very effective; witness good-by-dirt-poor-country standards in Cuba and Vietnam.  A higher value on freedom, however, may have a lesser outcome for healthcare but still be worthwhile.  It will be interesting to see the state of both systems in another generation.

Care to predict whether the US or Canadian system will change more?

Good debate.  Thanks for the replies.

[Jennifer]

CC

our system does have its shortcomings.  Still these patients are typically outpatients who are going to America for elective medical treatments.  This is not a coup for non-sociallized medicine, however it is a result of Conservative gov’ts in Canada replying in a short-sighted manner to reports that supply caused demand.
And you might remind these that they have a much longer lifespan, improved perinatal and maternal mortaility, and many other important endpoints as a result of being Canadian (or in spite of . . . )

But isn’t that the major downfall of any socialist program?  You’ll always end up with people who either get shafted by the program or go where they can get the benefits without contributing to the program, or just evade the program all together.

How much of our GDP spent on health care goes to cover Canadians going to Seattle for medical treatment?

[Guest]

BTW:  There is a US law that requires that any hospital receiving federal funds (read Medicare or Medicaid payments) must comit to providing 15% of their care per year gratis

It has been a logn time since I actually did any work researching this, but when i was in college, there was information about this requirement posted in the Emergency Room at Indiana Hospital.

Perhaps some of out other medical folks can dig up the details.  But 15% is a heck of a lot of coverage…

[cystic crypt]

@CrazyStraw:

@cystic:

It is gratifying to have a disagreement withsomeone without the word “liberal” and other labels get thrown at me.

Ooh!  Good point!  I’ve been negligent in my duties.  Let me get caught up:

You liberal wacko, left wing nut job, communist, pinko, COMMUNIST, Cannuck, puck lover, socialist, tree hugging, granola chomping, eco-freak, Citizen of America Jr., did I mention COMMUNIST, American sidekick!

Who are you calling an American Sidekick?!?!?!

A large part of our discussion centers around what the goal of a medical system should be.  I’m willing to be we are HIGHLY in sync on what we personally want to do for folks, but I bet we disagree on who should do it.  I dislike government involvement, but I love that so many hospitals have religious roots in serving the poor.  I’m a big believer in charity, just not in government mandated charity (which isn’t really charity, but you get the point…).

you were doing well, and i was on the same page until:

Once the government pays for healthcare, can they tell you what to eat?  Legislate sexual practices?  Regulate a certain amount of exercise?  It’s an issue of freedom for me.  Should citizens pay for the health choices of other citizens?  Because I believe in freedom I must also believe in responsibility.  Health care is a privilege, not a “right” in any classic sense of the word.

you realize that you are talking to someone in one of the socially free-est nations in the world, right?  Like, after Holland we’re number two, give or take.  I’m not arguing the pros or cons, but just saying that your argument completely falls apart on this point.  When a nation opens up the number of ideals it considers rights-and-freedoms, it’s not taking away other rights or freedoms.  It’s part of the same ideology.  Afterall - a Canadian was the architecht of the UN charter of rights and freedoms.  Not only are we front-and-center when it comes to human rights, but we include social rights (education and healthcare) under that same banner.

And keep in mind I do believe the Canadian system has strengths; I just believe that A) freedom includes the freedom to fail and B) in the long run fewer people will be healthy because of socialized medicine due to slower research and fewer cheap medications.  The losers of the US system are simply more visible, and that is harder to address politically.

i do not know how that we inhibit people’s freedom to fail.  My patient’s make the same choices as those across the border do.  We just have a broader net and can actually catch them if they need it.  As for (B) you are guessing and making stuff up.  Canada is a leader when it comes to evidence-based medicine.  And this is about more than just a bunch of “me too” drugs.  Many original drug patents come from pharma based outside of the US anyway - Switzerland, Germany, France and Britain each house several Massive pharma companies, and we have a few fairly large ones as well.  But if you think for a minute that all major medical research comes out of the US you are very mistaken.  Just look at the number of guidelines that come out of Canada, Britain, South Africa and Australia, for example.

Still, that crackhead can easily go spreading these STDs, and overtime you have what happened to many hemophilliacs - HIV via blood transfusions.

Ah, but now you’re not providing altruistic health care that is about the patient; you are spending money to protect everyone else.  That’s a very different type of consideration than insurance coverage.

doesn’t matter.  Altruism doesn’t work all of the time.  It’s a nice idea, but you can’t apply a very expensive system to a nation based soley on altruism unless your nation is comprised soley of altruistic people.  The fact is that sociallized medicine is practical and this is an example as to why.
This isn’t a morality argument (although i think i could win that one too), but as a physician, i often have to put my own morality aside TO A DEGREE in view of being practical.

those of us who follow the Hippocratic oath are bound to treat people

Dude.  DUDE!  I cannot believe you referenced the HO.  Is that the HO that swears by Aesclypius and Hygeia?  The same oath that forbids abortion?  The same oath that prohibits euthanasia?  Perhaps you do take it that seriously, but if that’s the case then why the heck have I not been invited to one of your toga parties?  You know followers of Panacea rock the house!

http://en.wikipedia.org/wiki/Hippocratic_oath

Strawman.
And yes - i am against abortion and euthanasia (and the death penalty and war and guns and things that kill other people on purpose).
Also the HO has been modified depending on the medical school, but they all include a section on helping people irrespective of ability to pay.

these patients are typically outpatients who are going to America for elective medical treatments.

Generally true.  But then in a socialized system the term “elective” is determined by the state.  In England, are kidney transplants “elective” for old men?

good point.
Mine was that medical diagnostics and treatments in Canada work in a “triage” type manner - availability based on medical need - not ability to pay.

And you might remind these that they have a much longer lifespan, improved perinatal and maternal mortaility, and many other important endpoints as a result of being Canadian (or in spite of . . . )

Very true.  But Canada is a different country in many respects with very different social issues.  If your only goal is health care, then totalitarianism can be very effective; witness good-by-dirt-poor-country standards in Cuba and Vietnam.  A higher value on freedom, however, may have a lesser outcome for healthcare but still be worthwhile.  It will be interesting to see the state of both systems in another generation.

Again you really have to stretch in order to demonstrate how our system (even under a Conservative gov’t) is more limiting or totalitarian than America (aside from people not being allowed to jump the queue and purchase medical care ahead of people who were ahead of them).
But what freedoms do you have that we do not?  We are not blessed by the Patriot act, and i can’t hear the RCMP on the other end of my phone yet, but hopefully i will be free enough to enjoy these things one day.
Also - you clearly need to be better educated on the “totalitarianism” of Cuba.  It does not extend to the degree that you seem to imply.

Care to predict whether the US or Canadian system will change more?

Good question.
America can’t afford to change, and Canada can not afford to not change.  Because of medical care in my country, people are living longer than ever, which has, along with shifting demographics, blessed me with an abundance of geriatric patients.  The VAST majority of our healthcare dollars go - not to those few crackheads, but rather to the octogenarians who define “frailty” and illuminate my stretcher bay with their attendant falls, dizzyness etc.  As this increases, and our governments continue to be so fiscally conservative (something like 10-or-so budget surpluses) in order to pay down our debt, our resources may well be outstripped.  Thankfully fewer and fewer of my colleagues are being poached by higher salaries south of the border, and some of our ex-pats are coming home.

[Guest]

@cystic:

Afterall - a Canadian was the architecht of the UN charter of rights and freedoms.  Not only are we front-and-center when it comes to human rights, but we include social rights (education and healthcare) under that same banner.

so YOUR nation is responsible for that?

The penultimate wiggle clause is included in that UN piece of tripe… read all the way to the end.

(3) These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.

See that next to last section, the one that allows the UN to ignore any and all of the “rights” if it would be contrary to what the UN wants to do at the time?

And that clause actually supports CS’s assertion that the government could indeed mandate any or all of those things by using the same type of wiggle clause.

[Guest]

Hey CC.

I must admit I was quite disappointed I didn’t get a list of American slurs thrown back my way.  Now I’ll have to find another Canadian willing to spill the secret list of American epithets…

If I may, I think I can sum up our argument thusly:
CrazyStraw believes the free market leads to better long term health care; Cystic Crypt believes providing a base level of care to everyone at no direct cost is preferable.
CrazyStraw emphasizes the responsiblity of the individual; Cystic Crypt emphasizes the role of the government.

Please correct that if you think it is not accurate.

I’d say those are not bad places to end up.  We both have valid reasons for thinking our system is “better”, but to really get to the bottom of it we’d have to grind through a heck of a lot core philosophy to shift either of our positions.  I could take a point-by-point look at your reply, but would any answer shift us from our basic positions?

I’m content to end the debate at: the Canadian system has strengths but the US system is better.  I suspect you’re content to end the debate with the reverse view.  If I felt STRONGLY that the Canadian system was much worse, I’d go the distance (like when someone equates Kim Jong Il and Bush).  But since I think there is much merit in both systems, I can respectfully disagree without resolution.

However, if you really want me to respond point-by-point I’d be happy to do so.  I’m betting, though, that I’ve already taken up enough pixels in the forum for the moment :)

Peace

[Jennifer]

@cystic:

1. Canadian pharmaceuticals are much cheaper in general than those in America.
2. Unless they are generic - i think that US generics are cheaper.

No offense or anything, but who is egotistical enough to believe they deserve name brand drugs?

Now, to be honest, I really shouldn’t be contributing much to this thread since I get all my drugs for $8/month, no exceptions.  All I have to do is go to the VA Clinic and get it perscribed and it’s mailed to me within 48 hours (not including Sunday.)

But let’s be honest here.  Acetometaphine and Tylenol are identical.  Gabapentin is identical to the name brand Neurontin (a major pain reliever for neurological pains).  The chemical formulation’s the same, the name’s different.  So why pay 5 times the cost for the name brand? :P

That’s like paying 5 times the taxes for Socialized Medicine then it would cost to just get Health Insurance for yourself like a responsible human being.

[cystic crypt]

CS - i believe that we may honorably walk away from the discussion with respect intact.

Jen - i think a new forum could open with regards to the “generic drug” question.  Oddly enough i am much more conservative on this issue than you.