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Medical Forum / General / General / July 2005two-tier systems have longer wait times
"But in two-tier systems private insurance typically does not cover the tough stuff like cancer care and cardiac treatments." "The private tier covers the relatively easy, high-volume procedures, and typically covers more intensive interventions only when required to do so by law or when they are heavily subsidized by government." "Across all {two-tier system} countries, the people who buy private insurance are generally the wealthiest, who are the healthiest in society. Medicare in Canada was created precisely to eliminate distinctions between rich and poor in access to health care. "To repeat, it appears that countries with two-tier systems appear to have longer, not shorter, wait times." http://www.cmaj.ca/cgi/content/full/173/2/142 References 1. Tuohy C, Flood C, Stabile M. How does private finance affect public health care systems: marshalling the evidence from OECD nations. J Health Polit Policy Law 2004;29(3):359-96.[Medline] 2. Timothy T, Hall J, Preston I. Private and public health insurance in the UK. Eur Econ Rev 1998;42:491-7.[CrossRef] 3. DeCoster C, Carrière KC, Peterson S, Walld R, MacWilliam L. Waiting times for surgery in Manitoba. Winnipeg: Manitoba Centre for Health Policy and Evaluation; 1998. Available: www.umanitoba.ca/centres/mchp/reports/pdfs/surgwait.pdf (accessed 2005 Jun 17). 4. Colombo F, Tapay N. Private health insurance in OECD countries: the benefits and costs for individuals and health systems. Working paper No. 15, p. 24, fn 38. Available: www.oecd.org/dataoecd/34/56/33698043.pdf (accessed 2005 Jun 17). 5. Flood CM, Archibald T. The illegality of private health care in Canada. CMAJ 2001;164(6):825-30.[Abstract/Free Full Text] >"To repeat, it appears that countries with two-tier systems appear to >have longer, not shorter, wait times." > 2. Timothy T, Hall J, Preston I. Private and public health insurance >in the UK. Eur Econ Rev 1998;42:491-7.[CrossRef] [quoted text clipped - 7 lines] >paper No. 15, p. 24, fn 38. Available: >www.oecd.org/dataoecd/34/56/33698043.pdf (accessed 2005 Jun 17). So, let me see if I understand this. The doc sits down to prove for probably the most prestigious Canadian medical journal that two-tier systems are inherently bad. (This is labelled as an opinion piece, so I have no problem with that). He meticulously pours over the available the literature in search of articles, spending long hours and risking terminal eye strain in his looking for his Holy Grail. And the best he can do to underpin his argument are three outdated studies from 1998? That alone indicates the strength of the argument. -- "No nation would be so dumb as to say that we all want to go one point, we just don't know how to get there. What we are finding is some want to go to San Diego, some to Seattle. We are ashamed to admit this so we pretend we all want to go to San Francisco." Uwe Reinhardt on the health care debate. > >"To repeat, it appears that countries with two-tier systems appear to > >have longer, not shorter, wait times." [quoted text clipped - 21 lines] > outdated studies from 1998? That alone indicates the strength of > the argument. So, let me see if I understand this. The Kurt sits down to prove that the article on two-tier systems posted to the most widely read sci group is not strong enough. (This is usenet so I have no problem with that.) He meticulously pours over... . No he doesn't. Back up. He hastily scans the article, spending about 26 seconds and risking his reputation as a sci.med pundit of some note, the Kurt makes the first of his many mistakes. He thinks the doc who wrote the article is a man. The article doesn't have a sole writer, but was authored jointly; by a woman and a man. But the best is yet to come. The Kurt underpins his argument getting the number and date of the cites wrong. That alone indicates the strength of his argument. > So, let me see if I understand this. The Kurt sits down to prove >that the article on two-tier systems posted to the most widely read sci >group is not strong enough. (This is usenet so I have no problem with >that.) Your understanding of this is flawed, as usual. I actually sat down to read it to see what it said. > He meticulously pours over... . No he doesn't. Back up. He hastily >scans the article, spending about 26 seconds and risking his reputation >as a sci.med pundit of some note, the Kurt makes the first of his many >mistakes. He thinks the doc who wrote the article is a man. The article >doesn't have a sole writer, but was authored jointly; by a woman and a >man. Your lack of understanding continues unabated. I read the article, looked up the original articles when I could and looked at the abstracts when I couldn't. Gee, the best you could come up with to refute me is that I got a little too generic in the authors. Is to guffaw. Sorta the moral equivalent of a spelling lame. > But the best is yet to come. The Kurt underpins his argument >getting the number and date of the cites wrong. That alone indicates >the strength of his argument. Completes the sweep. The three articles that actually discuss the two-tier systems, are all from 1998. When I write newsletters or white papers for people, the cut-off for most things is 2000. Later than that (except of course for landmark articles, which this doesn't even pretend to be). Of the other two, the one from 2004 is a more general version and the fifth one is a discussion of Canadian law that, while interesting and well written from that standpoint, isn't addressing the idea at hand. BTW: OR, you still did nothing to actually refute my claims and you certainly did not come up with anything newer. This alone indicates your LACK of argument. -- "No nation would be so dumb as to say that we all want to go one point, we just don't know how to get there. What we are finding is some want to go to San Diego, some to Seattle. We are ashamed to admit this so we pretend we all want to go to San Francisco." Uwe Reinhardt on the health care debate. > > So, let me see if I understand this. The Kurt sits down to prove > >that the article on two-tier systems posted to the most widely read sci > >group is not strong enough. (This is usenet so I have no problem with > >that.) > Your understanding of this is flawed, as usual. I actually sat > down to read it to see what it said. Whoa! It's worse than I thought. You read it and still came up with all those boners. > > He meticulously pours over... . No he doesn't. Back up. He hastily > >scans the article, spending about 26 seconds and risking his reputation [quoted text clipped - 6 lines] > article, looked up the original articles when I could and looked at > the abstracts when I couldn't. Vida Supra. > Gee, the best you could come up with to refute me is that I > got a little too generic in the authors. Is to guffaw. Sorta the > moral equivalent of a spelling lame. Generic in the authors. Wrong in the date and number of cites. Grammatical and spelling errors... . > > But the best is yet to come. The Kurt underpins his argument > >getting the number and date of the cites wrong. That alone indicates > >the strength of his argument. > Completes the sweep. The three articles that actually discuss > the two-tier systems, are all from 1998. When I write newsletters or [quoted text clipped - 4 lines] > law that, while interesting and well written from that standpoint, > isn't addressing the idea at hand. Two for 1998, one for 2001, one for 2004, and one for 2005. Number of cites appropriate for the length of the article. Do you have other cites you think should have been included? Let's have them. > BTW: OR, you still did nothing to actually refute my claims and > you certainly did not come up with anything newer. This alone > indicates your LACK of argument. Repeating my previous refutation of your claims: So the system should pay for your CABG when you refused to eat properly, get enough exercise, quit smoking, change your couch potato lifestyle? Why should only certain addicts be the only ones hit? Eh? Eh? Oh sorry. Forgot your propensity for jumping to conclusions. Lotsa exercise there. BTW.. your *claims* for both articles were bogus, just abuncha oldguy carping again, no refutation. And you haven't responded to my comments regarding yours on addicts. What about it? Do we draw the line at the addicts you don't like? What about the addicts someone else doesn't like... The overweight couch potato who expects us to pick up the tab for the CABG after a lifetime of excess. >And you haven't responded to my comments regarding yours on addicts. >What about it? Do we draw the line at the addicts you don't like? What >about the addicts someone else doesn't like... Note: Usually helps if you include some indication that it is my stuff you are replying to... I did not have any comments on addicts. I merely asked the question as to where we draw the line. If the consensus is that we transplant them and give them alcohol by saline lock every two hours afterwards as part of a paid-for treatment protocol, go for it. But as of yet, I can see no societal consensus emerging as to what constitutes care. These kinds of questions are ones that will have to be answered before we can realistically look at any kind of systemic change in the US. >The overweight couch potato who expects us to pick up the tab for the >CABG after a lifetime of excess. Being one, I have no problems with that and I am quite comfortable in my hypocrasy (g). But that doesn't necessaril -- "No nation would be so dumb as to say that we all want to go one point, we just don't know how to get there. What we are finding is some want to go to San Diego, some to Seattle. We are ashamed to admit this so we pretend we all want to go to San Francisco." Uwe Reinhardt on the health care debate. > >And you haven't responded to my comments regarding yours on addicts. > >What about it? Do we draw the line at the addicts you don't like? What [quoted text clipped - 16 lines] > Being one, I have no problems with that and I am quite comfortable > in my hypocrasy (g). > But that doesn't necessaril I'm not sure if you finished your comment here. I would say there is no societal concensus on this in Canada either. Picard's opinion will be lauded by some and derided by others. Herceptin is horrendously expensive with an absurdly damaging risk profile. But governments here are being pushed to provide and they probably will. I expect it will be given without cost to the patients. So our considerations are a bit different than yours. Zee Zee, interesting comment. You appear to be in Edmonton. Seems that you have a somewhat weird idea about what is important. I'm not a woman so it is unlikely I will ever get breast cancer though it does happen. The standard outcome for untreated breast cancer is death, whereas the outcome of treated breast cancer may not be . For most rational people this would tend to drive their decision in favour of treatment There are many drugs available particularly in the area of cancer that have horrendous side effects and some people make the decision to discontinue them with the usual outcome, they end up dead. There are also many drugs that are very, very expensive. I believe herceptin is in the $25k to $30k a year range not at the top of the list I can assure you. Although they do not yet cover herceptin as far as I know, the Ontario govt already pay (on an income based pro-rated basis) for drugs in that price range as do private insurance companies. Your final line seems to indicate that it will be unfortunate if that happens in Alberta. As a relevant aside the price of a particular drug has very little to do with development costs. It is more usually based on what conventional treatment with similar outcomes costs. $30k is not big money for hospital care. > > >And you haven't responded to my comments regarding yours on addicts. > > >What about it? Do we draw the line at the addicts you don't like? What [quoted text clipped - 30 lines] > > Zee |
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