Socialized Medicine

[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.

[Jennifer]

How do you feel about it, CC?

I know that pharmecitical companies need to recoup the moneys invested in developing the drugs.  I also understand that is why they charge a premium and get soletary rights to the drug for a number of years.

But after that period has ended, I see no reason, what-so-ever, a person needs to get the name brand drug instead of the generic version.  Especially when you can get 20 pills of Gabapentin for $12 and 20 pills of Neurontin for $157 and they’re identical (except 1’s stamped Gabapentin, the other Neurontin).

[Jermofoot]

Even though I created this thread, I have been neglecting it.  I still need to read some points, but I appreciate everyone’s POV (I also appreciate that it hasn’t turned into a slugfest).

[Guest]

Jermo, for the record, I TRIED to make it a slugfest.  CC let you down, not me.  :-D

Regarding patent law and the impact on society, here’s a good link that has is a fairly direct analogy to drug patents.  It’s not about socialized medicine per se, but it does address a critical concept in creating new things and the role of the marketplace and government:
http://www.cjr.org/issues/2006/5/Vaidhyanathan.asp

It talks about fair use under copyright law, which is the media equivalent of manufacturing generic drugs.  The patent for a drug is on a “recipe”, not the end product.  You can’t use the recipe without permission, and that is an intellectual construct rather than physical property.

And as you would expect from my links, it is wicked long.

Peace

[Jennifer]

Oh yea, and isn’t there this thing called the Hippocratic Oath that says something along the lines of “I’ll help anyone in need to the best of my ability regardless of if they are insured or not.”  (I added parts in, obviously.  But you get the drift.  A doctor who receives a gun shot victem pretty much has to treat the injuries first, then worry about getting paid.  At least in the United States.  I can’t speak for other nations.  Maybe the nation of Ik (a nation commonly invented by historians/sociologists to play devil’s advocate) would video tape the gun shot victem bleeding to death since he isn’t insured???)

[cystic crypt]

My thoughts on generics . . .
As a scientist, i do have a problem with an entity lifting the results of my labor, and using them for their own gain without any assistance.  Generic companies do not develop the original molecule, they do not do any of the phase i-iv trials, they do not provide physicians with ANY new indications, safety or other data.  Furthermore they remove the impetus for the original pharma companies to continue to do trials and testing when their patent runs out, which causes us to rely on academic and gov’t institutions to provide this research (which i understand Jen is against).  Furthermore, i am not sure how it works in the US, but just because a company claims to provide a “generic version” of a medication does not mean that we are, in fact, receiving the equivalent of the developer’s product (in Canada the product only has to contain 85% of the product).  Also the generic company does not carry responsibility for its product (when i worked for Novartis, our medical director was subpoened to attend an inquiry related to the effect of the generic version of the product as the generic company did not have a medical director.  Finally these companies rarely provide any original research, and often they do not sell their product at a low enough price to warrant a switch from the original product, however they gift the pharmacies in order to persuade a switch.

Don’t get me wrong - i can understand the need for a “cheaper alternative” - especially for low-income and seniors, however this could easily be facilliated by gov’t.

[Jennifer]

Hmm, no idea how it works in Canada.  But the Food and Drug Administration - if it is working properly, and it probably isn’t because it’s a federal program and most federal programs don’t work well to begin with, being filled with crooks and sharlatans most of the time - in the United States is supposed to guarentee us that if it’s a Generic Drug then it is equivalent to the name brand, just as if Keebler says their Grasshopper Cookies have 40 calories per serving and a serving size is half a cookie, then it is an accurate report.

But as I said, that’s how it’s supposed to work.  However, I am so anti-federal it isn’t even funny.  My Political Science and my Advanced History Courses are just making me even more anti-federal government as I study exactly what the fore-fathers of this nation said, did and wrote.

Basically, until FDR, just about every US Politician was for weak central governments and strong state governments in so much as who actually weilded the power, not who had override authority.