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Medical Forum / General / General / November 2005the over-utilization of American hospitals
High-utilization of American hospitals doesn't prove out for better healthcare. Not even in Utah.... Americans are overtreated to push profit not health outcomes. ~~~~~~~~~~~~~~~~~ Putting Consumers in the Driver's Seat? With the evidence mounting on overutilization and "supply-sensitive" care, can better-informed consumers help control costs and improve the quality of health care? By Shannon Brownlee Schwartz Senior Fellow www.newamerica.net If you want to know the moment when the era of consumer-driven health care took off, look no further than April Fool's Day, 2005. With TV cameras rolling and flash bulbs popping, Mark B. McClellan, MD, administrator of the Centers for Medicare & Medicaid Services (CMS), announced to a gathering of health care journalists in Durham, N.C. the government's opening gambit in the latest scheme to improve the quality of American medicine. It's Hospital Compare, a report on how well over 4,200 hospitals measure up on 17 different standards of good medical practices. Hospital Compare, says McClellan, "gives consumers and health professionals quality of care information to help them make more informed decisions about their health care, while providing stronger rewards and support for high-quality, efficient care." Behind this initiative lies the belief that medicine can function like a true market, one where consumers can drive quality. Right now, a dearth of outcomes data leaves payers and consumers in the position of being unable to distinguish between high quality and poor quality providers, and for the most part, hospitals that do a good job of caring for patients are paid no better than those that do a lousy job. CMS is hoping that if patients know enough about the care being delivered, they will choose higher quality providers-and thus encourage the poor quality hospitals to get their acts together and improve. As McClellan put it, "Consumers are a powerful force for change." Maybe so, but what McClellan did not say at the press conference was perhaps even more interesting than what he did. For instance, there was no mention of the fact that CMS has wanted hospitals to submit data on outcomes for at least two decades, and that hospitals have long resisted requests for such information, fearing that they will be penalized for taking on more complex cases, which can be expected to have worse outcomes. "My hospital takes care of sicker patients is the argument," says Chas Rhodes, a hospital industry analyst for the Advisory Board Company, a consulting firm in Washington, D.C. A few hospitals simply refused to participate in Hospital Compare, while those that did were given a small bonus on their Medicare payments. McClellan also did not point out some glaring omissions in the new data. While the 17 measures on the CMS report card represent a good start toward improving the quality of care, they all track the underuse of proven treatments. For example, hospitals reported how consistently patients with an acute myocardial infarction receive a thrombolytic agent within 30 minutes of arrival and a prescription for a beta-blocker at discharge. Participating hospitals also released data on whether they offered smoking cessation counseling to patients with heart failure and assessed pneumoccal vaccination status of patients with pneumonia. What's missing from this hospital report card, of course, is information about overutilization, the vast amount of unnecessary or redundant care that drives up costs, but fails to contribute to patients' health. Overutilization has been widely documented, yet many hospital administrators and physicians still argue that it plays only a minimal role in the poor quality and high cost of American health care. CMS and private insurers have an uphill battle ahead if they hope to tackle overutilization, which accounts for an estimated 30 percent of the nation's total health care bill, or more than $500 billion out of the $1.7 trillion spent last year. Geography Lessons For health plans, the fact that patients often receive unnecessary care probably doesn't seem like front-page news. Yet it's worth examining the scope of the problem and some of the economic and cultural forces that drive it. In a series of landmark papers dating back more than two decades, John Wennberg, MD, and his colleagues at Dartmouth's Center for Evaluative Clinical Sciences have documented wide and persistent variations in usage and quality health care, as well as spending, in different regions of the country. These geographic variations represent a natural experiment, which has opened a window on the extent of overutilization and the factors that contribute to it. Using Medicare patient records, Wennberg's group has shown that per capita spending on Medicare recipients can vary by as much as 300 percent among the more than 300 Medicare hospital catchment regions of the country, with no better outcomes in the high utilization regions. Take the areas surrounding the cities of Miami and Minneapolis, for example, which represent the high and low ends of Medicare spending in many categories. Total lifetime Medicare outlays for a typical 65 year-old in Miami amount to $50,000 more than for a 65 year-old in Minneapolis. Each year, Medicare shells out nearly twice as much for a citizen in Miami as it does for the Minneapolitan-about $7,847 in Miami, versus $3,663-and Miami and Minneapolis are by no means the only regions delivering disparate levels of medical services. The region around Palm Springs, in California, sits at the high end, while Richmond, Va., is low, along with Mason City, Iowa, and Honolulu. Critics of Wennberg's work have long argued that these variations among regions represent differences in underlying illness of the resident populations. Wennberg's group has addressed this criticism in two ways, first by examining the records of Medicare recipients in the last six months of life, when it's safe to assume that everybody is quite ill. In a recent paper in the BMJ (formerly the Britisih Medical Journal) Wennberg and his colleagues looked at the rates of utilization at 77 individual hospitals around the country for Medicare patients in the last six months of life. The number of days dying Medicare recipients spent in the hospital ranged from an average of 9.4 at the low end, at Hannepin County Medical Center, in Minneapolis, to 27.1 days at the high end, at New York University's hospital. The average number of physician visits per patient at Stanford University Hospital was 22, while the average patient at NYU saw a physician a whopping 76.2 times. That's a physician visit every 2.5 days during a patient's last six months of life. Looking at hospital catchment regions, underlying illness fails again to account for the variation. The region around Provo, Utah, for instance, one of the healthiest in the country, ought to get 14 percent fewer Medicare dollars than the national average, because its citizens are less likely to smoke, be obese or suffer from strokes, heart attacks and diabetes. Instead, Medicare spends seven percent more on Provo recipients than the national average. Elderly people in the region around Richmond, Va., by contrast, tend to be sicker than most elderly Americans and would receive 11 percent more than the national average if underlying illness dictated how much Medicare spends. Instead, they see 21 percent less. Nor are those regional differences explained by variations in the cost of care. Provo physicians are not charging significantly more for office visits or lumpectomies than physicians in Richmond, and their patients aren't getting more expensive artificial hips. Rather, the variation across regions-about 41 percent of it-correlates with hospital resources and the number of physicians. In other words, health care in the United States turns the most fundamental of economic principles on its head, so that the amount of care delivered is driven more by the medical resource supply than by medical demand. At the clinical level, that means patients get more diagnostic tests in regions where there are more MRI and CT machines; they receive more angioplasties and stents where there are more catheterization labs; and they see more specialists where more specialists set up practice. During the last six months of life, a Medicare beneficiary in the region around Miami sees on average 25 specialists in a year versus two in the region around Mason City, Iowa, largely because Miami is home to significantly more specialists. Regions with an overabundance of medical resources are not delivering higher-quality care, they are simply providing more of it, and wasting Medicare dollars in the process. As Harvard health care economist David Cutler puts it, "There's a lot of evidence out there that using more of what's good is not of incredibly high value. It's like going to a really nice restaurant and overeating. The food was worth it, but it would have been even better if you didn't overeat." The evidence is in the outcomes. Medicare recipients in high-cost regions suffer as many disabilities as citizens of low-cost regions; they are not more satisfied with their care; and rates of underuse of proven treatments, like beta blockers on discharge after an acute myocardial infarction, are no lower. Nor does the population in high-use regions live any longer-although with all that invasive medical treatment they receive, including days in the intensive care unit at the end of life, it might seem like it to some patients. In fact, according to a recent study published in the Annuals of Internal Medicine, mortality in high-cost regions appears to be about two to five percent higher than in the lowest cost regions of the country. The most likely explanation for this is that elderly people who live in high-cost regions spend more time in hospitals than citizens in low-cost regions, and hospitals are risky places, where patients are exposed to the possibility of medical errors, drug interactions, and life-threatening infections. Upside-Down Economics What's driving all this overutilization? Many physicians have stated patient demand and defensive medicine are to blame. They're only partly right. Physicians order more tests in regions of the country where malpractice suits are more common, and patients do ask for tests and prescription drugs, particularly those that are most heavily advertised. Patients can also push up rates of overuse by self-referring to specialists. When they don't get what they want, say physicians, patients will often go to another doctor, and there isn't enough time during an office visit to explain to them why they don't need antibiotics for a viral infection, and how an MRI is not really going to help in the diagnosis of Alzheimer's. But patient demand and malpractice worries are clearly not the whole story when it comes to overutilization. First, there is the 41percent of geographic variation that correlates with supply of resources. Differences in malpractice law, on the other hand, can account for only about 14 percent of the variation, a finding that suggests that malpractice is not as important a driver of overutilization as physicians would like to believe. Then there is the question of why the physician, the person who spent several years in training, would order a test or perform a surgery simply because patients think they need it. A better place to look for the source of overutilization is fee-for-service reimbursement. Medicine is the ultimate piece-work industry; physicians and hospitals are paid for what they deliver, not for keeping patients as healthy as possible, a system that creates a host of perverse incentives. For instance, cutting costs by slashing reimbursement rates can rein in health care inflation for a time, but eventually providers find ways to maintain their incomes, generally by delivering more services. One former managed care administrator has a telling story about a group of radiologists in Northern California who maintained their income in the face of falling reimbursement rates from Medicare. It was the early 1980s, and CMS had given notice it would cut reimbursement for X-rays. The average income for each radiologist in the practice, about $400,000 a year, would go down by $50,000 when the new rates went into full effect. So the physicians decided that a certain number of films would go back to the referring physician with the note, "Normal, but suggest retake within 30 days to be sure." Of course, physicians are not always so calculating when it comes to finding ways to maintain their incomes in the face of falling reimbursement rates. Indeed, a great deal of overutilization, it turns out, results in areas with high concentrations of physicians-and the majority of variation between regions comprises what the Wennberg group calls "supply-sensitive" care. While big-ticket surgical procedures, like carotid endarterectomy and back surgery, are overused and misused, says Elliott Fisher, MD, a professor of medicine at Dartmouth and co-author of the study in the Annals of Internal Medicine, "most of this stuff is minor procedures, office visits, diagnostic tests. If there is only one doctor in an area, he or she tells patients to come back for my next available appointment, which is in six months. If there are two doctors in the area, and the doctor says come back for my first available appointment, that's in three months." Elliott's observation seems to be borne out by the most recent estimates of 2004 Medicare costs. In March, CMS actuaries revised their estimate of 2004 increases from 12 percent upwards to 15 percent, nearly a third of which stemmed from growth in the number and intensity of physician office visits. A quarter was a boost in minor procedures, and a fifth came from greater use of imaging services. In a recent paper in Health Affairs, Barbara Starfield, MD, of the Johns Hopkins Bloomberg School of Public Health, looked at the effect of specialist supply on health outcomes. There is considerable evidence that quality of care is better when a hospital performs at least a certain number of procedures per year, and the same appears to be true for individual surgeons. Patients of high-volume surgeons have lower death rates for heart bypass surgery, carotid endarterectomy, and five other cardiovascular procedures when compared with surgeons who have low volume. But as more surgeons move to a particular area, there are fewer patients available per surgeon-unless they perform more non-indicated procedures. Finally, overutilization is driven by a patchy overabundance of hospital resources, particularly new technology that offers high profit margins to hospitals, which are constantly struggling to stay ahead of the uncompensated care they deliver to the uninsured and underinsured. Think of it as the Willie Sutton School of Hospital Management: Hospitals invest in new technologies because that's where the money is. "Hospitals say, if we can build it, we are going to bill it," says Stan Borg, MD, chief medical officer for Blue Cross Blue Shield of Illinois. All hospitals, including not-for-profits, are in an arms race of sorts, where new technology not only brings in higher margins, it also helps attract well-insured patients and retain specialists. This competitive environment pits the true medical needs of the surrounding population against the need for margin when it comes time for a hospital to decide whether or not to invest in a new technology. As an example, Borg points to the rise in the number of bariatric surgery centers. Hospitals say the building boom is a response to projected increases in need; Americans are getting fatter, and their health is suffering as a result. That's not the only reason, says Borg: "Bariatric surgery is a popular surgery, and hospitals are going into the business for revenue enhancement." When multiple hospitals in a particular region decide to open a bariatric surgery center, the likely result is overuse, because each individual hospital in town must do whatever it takes to find enough paying patients in order to recoup its investment. Hospitals run ads on TV and billboards, touting their bariatric centers and other high-margin departments, while surgeons use other methods of keeping their volumes high. "We had members telling us there were weight requirements, and that what they understood from their interviews with their surgeons was, you need to go home and gain weight because you don't qualify for surgery yet," adds Borg. Conscious Consumers Not surprisingly, Americans undergo many high-tech-and high-profit-procedures far more often than their counterparts in western European countries, where health care resources are limited by state budgets. For instance, Americans were given 388.1 angioplasties per 100,000 people in 1999, double the per capita rate in Belgium, the next highest rate among countries in the Organization for Economic Cooperation and Development, more than four times the rate in Canada, and eight times the rate in the United Kingdom. Yet there's not much to suggest that the huge volume of angioplasty performed in this country has led to significant health benefits; the longevity at age 65 and health outcomes in Western Europe are no lower than in the United States. At the most fundamental level, overutilization everywhere stems from the pervasive lack of evidence for most medical practices. One of the fathers of evidence-based medicine, David Eddy, MD, estimates that more than three quarters of health care that's delivered has no real scientific basis. That means physicians perform procedures, prescribe drugs, call patients in for follow-up visits and send them off for hospitalization and diagnostic tests on the basis of solid evidence only a quarter of the time. Even when evidence exists, physicians are not always aware of it, or they may not know how to apply it to an individual patient, lending a degree of uncertainty to most medical decisions, either because the evidence for what works and what doesn't simply does not exist, or because it has not been gathered, analyzed, and then disseminated in a way that physicians can use. Given all the forces driving the American health care system toward overutilization, and the entrenched political interests of physicians, hospitals, drug companies and medical device manufacturers, it's understandable that policy makers and many private health plans have decided to start small and tackle patient demand first. Call it "cost sharing," or "consumer-driven medicine," the idea behind health savings accounts, tiered benefits, high deductibles and high co-payments is the same: get consumers to feel at least a little of the sting of health care costs. If patients have a more direct financial stake in their health care decisions, goes the thinking, they will become more prudent buyers of medical services, choosing prevention over discretionary care, and investing the time and effort that's needed to mange chronic illnesses. To make more prudent decisions, consumers need more information. Health plans have begun to couple cost-sharing plans with disease management services, aimed at educating the 20 percent of the workforce that generates 80 percent of health care costs. Blue Cross Blue Shield of Illinois, for instance, offers members a personalized, interactive Web-based source of information about their own health conditions. Members can take a health risk assessment and receive reminders for physician appointments, and they have free access to registered nurses, who can help them manage such chronic conditions as asthma and diabetes, or answer questions about pregnancy. Other health plans, like CIGNA, provide members with Web-based information about their conditions and ways to monitor their own health. CIGNA's online service offers best practices-based information for about 35 different ailments, and sets up graphs members can fill in, to help them track medication schedules and such health indicators as blood pressure, lipid levels, and blood glucose levels. Targeting high-volume users of emergency departments (ED) and specialists is allowing other companies to tackle overutilization more directly. Two years ago, AmeriHealth Mercy Health Plan, a Philadelphia Medicaid managed care organization that serves about 80,000 Medicaid recipients in 19 counties, launched a program aimed at identifying its "frequent flyers," members who go to the ED four or more times a year and rack up charges that often toped $1,000 a visit for even minor complaints. One member visited the emergency department 56 times in a year, not once for a true emergency. AmeriHealth Mercy contacted its frequent flyers, either in person or by phone, referring those with chronic conditions to case managers. For some members, reducing the number of ED visits was as simple as teaching a family how an asthmatic child should use an inhaler. AmeriHealth Mercy helped other members find a primary care physician. "A lot of folks just didn't know they needed to have a primary care doctor," says Sherry Knowlton, senior vice president and general manager at AmeriHealth Mercy. The savings to AmeriHealth Mercy thus far is about $350,000 per year. Programs like AmeriHealth Mercy's will undoubtedly improve care for many Americans, but how big a bite they will take out of the high cost of American health care, and the enormous amount of excess care it delivers, is debatable. Borg acknowledges that getting patients more involved in their own care is only a first step. "It's more than a nibble," he says, "but instead of these being surgical approaches, it's whacking at things with a butter knife." Still, what health care observers should know from witnessing the result of Medicare price controls in the 1980s and the HMO era of the 1990s, is that health care providers have myriad ways of maintaining their incomes. It's not a stretch to predict that if cost-sharing plans result in significantly lowered revenue streams for hospitals and physicians, providers will likely respond by increasing their volume, just as they did in the face of lowered reimbursements in the 80s and 90s. If the United States hopes to rein in health care inflation and reduce overutilization, it's going to take more than getting patients on the Web and asking them to share more of the costs. Copyright: 2005 AHIP Coverage quel suprise! > High-utilization of American hospitals doesn't prove out for better > healthcare. Not even in Utah.... Americans are overtreated to push [quoted text clipped - 383 lines] > Web and asking them to share more of the costs. > Copyright: 2005 AHIP Coverage > quel suprise! Over-treating! That a strong argument for making them wait for three years for heart surgery. Either they need the surgery or they don't. There is no need to wait for three years my Canadian friends. Nice try immigrant boy. Don't change the subject. Overtreatment is just as unproductive as undertreatment but it costs more. > > quel suprise! > > Over-treating! That a strong argument for making them wait for three years > for heart surgery. Either they need the surgery or they don't. There is no > need to wait for three years my Canadian friends. > Nice try immigrant boy. Don't change the subject. Overtreatment is just as > unproductive as undertreatment but it costs more. Those are all points that should be looked at in choosing which program you want. It is only effective when choice exists. In Canada there is no choice. If you wait too long can you change insurance? No. Is it cheaper yes, as it is always cheaper to deny services. Again you always talk about cost. You value money as much as "for profit" corporations. Canadian Health scares me as much as the "for profit" corporations. In a free market most people stay away from both extremes which is why in Canada you can not opt out. It could not exist in a free market. What a fatuous argument. Do you have a choice over what illness or disease you have? I don't think so. Do you really have a choice to be wealthy or poor? Not really, if you are stupid the odds of being wealthy are pretty slim. If you are a disenfranchised minority from a low socio-economic strata of society the odds are very much against you. Something like 10% of the poor escape from the ghetto. You can rail all you want about opportunity but the odds are slim. America is on its way down. It may take a 500 years but it will eventually end up like the Roman empire, decadent and destitute. > > Nice try immigrant boy. Don't change the subject. Overtreatment is just > as [quoted text clipped - 11 lines] > In a free market most people stay away from both extremes which is why in > Canada you can not opt out. It could not exist in a free market. So much for American for-profit healthcare resulting in better treatment, even for those who *do* have coverage. 50 million don't even have that. > quel suprise! > > High-utilization of American hospitals doesn't prove out for better [quoted text clipped - 384 lines] > > Web and asking them to share more of the costs. > > Copyright: 2005 AHIP Coverage > So much for American for-profit healthcare resulting in better > treatment, even for those who *do* have coverage. 50 million don't even > have that. Canadians have no choice and thus can change nothing as no competition is in place. They have no voice. The conclusion or purpose of this analysis is: Behind this initiative lies the belief that medicine can function like a true market, one where consumers can drive quality. Right now, a dearth of outcomes data leaves payers and consumers in the position of being unable to distinguish between high quality and poor quality providers, and for the most part, hospitals that do a good job of caring for patients are paid no better than those that do a lousy job. CMS is hoping that if patients know enough about the care being delivered, they will choose higher quality providers-and thus encourage the poor quality hospitals to get their acts together and improve. As McClellan put it, "Consumers are a powerful force for change." > > quel suprise! > > > High-utilization of American hospitals doesn't prove out for better [quoted text clipped - 384 lines] > > > Web and asking them to share more of the costs. > > > Copyright: 2005 AHIP Coverage Canadians have every choice if they have the money. They even get looked after without going into bankruptcy if they are so-called poor. I can leave the country anytime and get treatment. I just have to pay for it. No matter how much you protest the fact that USA pays more and gets less AS A WHOLE than Canada is not altered. Why pray tell should medicine not function as a true market? More important though is why should it? There is nothing magic about capitalism or so-called free markets. Every day USA makes a lie of the argument that it is an unfettered capitalist country. How many billions have the feds pledged as aid to the victims of Katrina? It is in the billions. How is that capitalism? > > So much for American for-profit healthcare resulting in better > > treatment, even for those who *do* have coverage. 50 million don't even [quoted text clipped - 443 lines] > > > > Web and asking them to share more of the costs. > > > > Copyright: 2005 AHIP Coverage > Canadians have every choice if they have the money. They even get looked > after without going into bankruptcy if they are so-called poor. I can leave > the country anytime and get treatment. I just have to pay for it. No matter > how much you protest the fact that USA pays more and gets less AS A WHOLE > than Canada is not altered. I am not interested in the "WHOLE". I am interested in the individual and not the state's conception of the "WHOLE". How would you like a dictatorship in the US that determines what is best for the whole? You need to protect the individual from the whole. The whole takes away rights as Canadians have learned. The individual is no longer recognized because the whole is more important. > Why pray tell should medicine not function as a true market? It is a commodity like any other. More important > though is why should it? Why not take food and remove it from a market economy? Let the government decide what you will eat because it is cheaper as "a whole" to do so. Tax all food and let the government provide it and let the poor eat. Why single out healthcare? There is nothing magic about capitalism or > so-called free markets. Every day USA makes a lie of the argument that it is > an unfettered capitalist country. How many billions have the feds pledged as > aid to the victims of Katrina? It is in the billions. How is that > capitalism? It's not. N.O. was built below sea level and will flood again. The government can provide cheap loans but insurance will cost? Some residents will never go back. When ever the government replaces a free market then the people lose. Native Americans were forced onto reservations and they were a beaten people and dependent on the government for hand-outs. Casinos were brought in and now the Casinos have contributed not only to the natives with resources but have an excess and give to outside organizations with their profits. So you are a member of the "I'm all right f.ck you Jack" school of management eh? It is a great attitude. There is already a dictatorship in the USA which is running the country into the ground. The govt already decides to some degree what you eat . The govt at the behest of the beef producers in the USA banned Canadian beef for a couple of years. That wasn't free market and individual decision making . You let your govt decide for you. You make your govt decide for you what drugs are good and what are bad. Why should't you be able to buy heroin on the street corner and OD if you want to? YOU let your govt "Protect" you with such draconian things as the Patriot act and secret prisons in foreign countries. Get with the program man your about as independent as a 6 month old baby. You know I love casinos I think they're just great . I don't gamble. I win the lottery every week because I don't buy tickets. I really like the idea of taxing the stupid. Unfortunately the PC (that's politically correct types ) seem to have a fit of conscience and want to protect the addicts from their own greed and stupidity. I like smokers too just as long as I don't know them. I've seen people die from cancer and it ain't pretty. Light up a camel for me! > > Canadians have every choice if they have the money. They even get looked > > after without going into bankruptcy if they are so-called poor. I can [quoted text clipped - 39 lines] > the Casinos have contributed not only to the natives with resources but have > an excess and give to outside organizations with their profits. > So you are a member of the "I'm all right f.ck you Jack" school of > management eh? It is a great attitude. There is already a dictatorship in > the USA which is running the country into the ground. We don't need them to run healthcare and that is true. We don't reward government with our healthcare like you canadians did. Different countries so don't compare. I don't even think Canada has a nuclear bomb. > The govt already decides to some degree what you eat . The govt at the > behest of the beef producers in the USA banned Canadian beef for a couple of [quoted text clipped - 3 lines] > corner and OD if you want to? YOU let your govt "Protect" you with such > draconian things as the Patriot act and secret prisons in foreign countries. The Patriot act was contrived as stated. The other contrived aspect is that there are millions of people going bandrupt and we need a national heatlh payer system. Ohhhhh, scary. They are going bandrupt because they need financial planning. What's the scare tactic in Canada about private non-profit healthcare? Oh the only want money. They will sell your children to rich Americans. Let the government, big brother, take care of you as you are to stupid to figure out how to live on your own. We don't have nuclear weapons at least not officially. We just helped the Americans develop theirs and we quietly supply a large amount of the Uranium used. Robert tell me how you would financially plan for breast cancer where some of the new drugs run $100,000 a year? Just tell me. Something like 10% of the population in both countries has 90 % of the assets and income. So are you saying that the rest should just die off because they are poor or unable to afford insurance to a sufficient level? If you are, I suggest you chose your second and go do Seppeku tonight! > > So you are a member of the "I'm all right f.ck you Jack" school of > > management eh? It is a great attitude. There is already a dictatorship in [quoted text clipped - 25 lines] > government, big brother, take care of you as you are to stupid to figure out > how to live on your own. > We don't have nuclear weapons at least not officially. We just helped the > Americans develop theirs and we quietly supply a large amount of the > Uranium used. > Robert tell me how you would financially plan for breast cancer where some > of the new drugs run $100,000 a year? Just tell me. I think they should raise it to $500,000 a year and see what happens. Somebody is obviously paying that amount. Wait until you have generics so what's the hurry on trying something unproven. You are watching too many TV commercials by drug companies telling you that you must have it. I am interested in your concept that if someone can't afford it then they have a right to it. Something like 10% of > the population in both countries has 90 % of the assets and income. So are > you saying that the rest should just die off because they are poor or unable > to afford insurance to a sufficient level? If you are, I suggest you chose > your second and go do Seppeku tonight! You ration care already. We ration care as Medicare doesn't pay for all drugs. Only approved drugs are provided to Medicare patients and some are expensive antibiotics that they won't pay for. There are drugs that cost in the $300,000 range. I wonder if you would be so quick to say "let em die" if you were the one doing the dying? No one has real rights. They have privileges. One can't even die as a right. Why shouldn't people try for the privilege of staying alive? What is the difference between a citizen clamouring for govt to pay for drugs and people clamouring for someone to go and die for the privilege of freedom? None in my book. In Ontario where I live (that is north of the great lakes you do know where then are think Detroit if you can't mentally cross the border), the govt pays for drugs for the poor and those over 65. It has a list or formulary which covers most drugs but and this is the kicker, there is a special exemption called a section 8 that allows doctors to prescribe and the govt pay for drugs which are not on the formulary. This is used to cover special needs. > > We don't have nuclear weapons at least not officially. We just helped > the [quoted text clipped - 21 lines] > drugs. Only approved drugs are provided to Medicare patients and some are > expensive antibiotics that they won't pay for. > There are drugs that cost in the $300,000 range. They are termed experimental and not paid for by insurance. I wonder if you would be > so quick to say "let em die" if you were the one doing the dying? People die all the time. If you are referring to cancer treatments then show me the survival rates on what you are talking about. How much does it cost to cure cancer. If you have to pay $3000,000 a year for years then maybe it's not a cure. You might spend 5 million dollars on keeping the patient in pain and poor life quality for an extra 3 months. Sometimes it's more compassinate to let them go quickly rather than prolong the agony. Technology is such today that we can keep people alive longer but not in terms of quality of life. Wrongo boy. Get with the program. I'm not talking about cures. I'm just talking about potential drug costs. Beside the cost of premature babies runs into the hundresds of thousands of dollars in the course of a year so its not just drugs. You are asking a valid question and I'll give you a valid answer: if it is my life it is worth millions as it that of people I know and care for. If it is your life or others I don't know or care about it is only worth pennies! > > There are drugs that cost in the $300,000 range. > [quoted text clipped - 12 lines] > the agony. Technology is such today that we can keep people alive longer but > not in terms of quality of life. You're so f.cking trite. >>There are drugs that cost in the $300,000 range. > [quoted text clipped - 13 lines] > the agony. Technology is such today that we can keep people alive longer but > not in terms of quality of life. > You're so f.cking trite. We all see the world according to one's own experiences. I came from a country that doesn't enough money to pay for IV antibiotics for everyone. Family members take care of the sick in the hospital and provide food etc. The elderly are taken care of at home until they pass-away. I come to this country and people are demanding a $300,000 a year drug as a right and the elderly are sent to nursing homes for a cost of $100,000 a year. Comatose patients are kept alive for years because medical science can. The topic was "over-utilization of American hospitals". So you moved to a better world? Good for you. Do you want to know why people spend money on drugs and probably wasteful procedures and keep people alive beyond their "remove from shelf" dates? It is BECAUSE THEY CAN. That is the way of the human animal. If we were as horribly practical as you suggest it might just be that your a.s would be on the next plane back to where you came from. Tell me would you like it if I went to your homeland and told those you left behind how they should run and organize their affairs? > > You're so f.cking trite. > [quoted text clipped - 8 lines] > > The topic was "over-utilization of American hospitals". > Tell me would you like it if I went to your homeland >and told those you left behind how they should run and organize their >affairs? That implies that he would know about their affairs (which he probably does), he's somewhat out of his element when he's chatting about ours though. HC is a pretty big fish in Canada, instead of discussing wars and a lot of other stuff, that's what Canadians talk about. Our election issues, our complaints and our triumphs. I find that its easy to have a well informed debate or discussion about the subject when I'm talking to my countrymen. It's not the same with most Americans. > I find that its easy to have a well informed debate or discussion about the > subject when I'm talking to my countrymen. It's not the same with most > Americans. Tell that to your Canadian friends who post about US healthcare issues here. By the way ask your well informed countrymen why prolonged home health care isn't covered by the government. You seem to always cry about the uninsured in the US and that is why that got universal coverage in Canada. I guess you forgot about the elderly and prolonged home healthcare. That's right you can't afford it. You would rather cover the young who don't get sick than the elderly with home health care. So much for socialism. Why not raise the GNP to cover these people to where it was before instead of transferring the money out of healthcare? You can't because you must always justify the cost by always saying that it is lower than the US. The dollar is the bottom line that controls Canadian health. This guy is just a run of the mill liar ..... a fuckin' bore. >>I find that its easy to have a well informed debate or discussion about > [quoted text clipped - 15 lines] > than the US. > The dollar is the bottom line that controls Canadian health. > This guy is just a run of the mill liar ..... a fuckin' bore. This guy has been listening to me. Look at all the points he covered and I covered. I am waiting on the report on Dec of this year. They mention an increase in short term home health care spending and long term care is not even mentioned. The Canadian Supreme Court did have some say in it. http://pm.gc.ca/eng/news.asp?id=260 All jurisdictions have taken concrete steps to address wait times. Building on this, First Ministers commit to achieve meaningful reductions in wait times in priority areas such as cancer, heart, diagnostic imaging, joint replacements, and sight restoration by March 31, 2007, recognizing the different starting points, priorities, and strategies across jurisdictions. The Wait Times Reduction Fund will augment existing provincial and territorial investments and assist jurisdictions in their diverse initiatives to reduce wait times. This Fund will primarily be used for jurisdictional priorities such as training and hiring more health professionals, clearing backlogs, building capacity for regional centres of excellence, expanding appropriate ambulatory and community care programs and/or tools to manage wait times. First Ministers agree to collect and provide meaningful information to Canadians on progress made in reducing wait times, as follows: Each jurisdiction agrees to establish comparable indicators of access to health care professionals, diagnostic and treatment procedures with a report to their citizens to be developed by all jurisdictions by December 31, 2005. Evidence-based benchmarks for medically acceptable wait times starting with cancer, heart, diagnostic imaging procedures, joint replacements, and sight restoration will be established by December 31, 2005 through a process to be developed by Federal, Provincial and Territorial Ministers of Health. Multi-year targets to achieve priority benchmarks will be established by each jurisdiction by December 31, 2007. Provinces and territories will report annually to their citizens on their progress in meeting their multi-year wait time targets. The Canadian Institute for Health Information will report on progress on wait times across jurisdictions. There is a need to increase supply of health care professionals in Canada, including doctors, nurses, pharmacists and technologists. These shortages are particularly acute in some parts of the country. First Ministers agree to provide first dollar coverage by 2006 for certain home care services, based on assessed need, specifically to include: short-term acute home care for two-week provision of case management, intravenous medications related to the discharge diagnosis, nursing and personal care; short-term acute community mental health home care for two-week provision of case management and crisis response services; and end-of-life care for case management, nursing, palliative-specific pharmaceuticals and personal care at the end of life. Politicians would stuff your bullshit back down your throat if they thought it would get votes. Addressing issues is the same as addressing a golf ball it don't matter f.ck all until you swing and hit the ball or act and resolve problems. Simply throwing cash at problems does not always work. My guess is wait times is one of those problems. Why don't you go solve America's problems? Maybe you could help out with the shortage of gardeners or pool boys! > > This guy is just a run of the mill liar ..... a fuckin' bore. > [quoted text clipped - 48 lines] > end-of-life care for case management, nursing, palliative-specific > pharmaceuticals and personal care at the end of life. Does USA provide for long term home healthcare? I don't think so. What is your point? Dollars are a controlling factor in healthcare everywhere, not just in Canada. You cannot escape the fact that Canada spends less per capita and has overall better outcomes in terms of longevity and general health of its citizens than USA or whatever shithole you came from. If your home land was so good why did you leave? > > I find that its easy to have a well informed debate or discussion about > the [quoted text clipped - 13 lines] > than the US. > The dollar is the bottom line that controls Canadian health. > Does USA provide for long term home healthcare? It doesn't have socialized medicine either and in Canada's it is a convenient one that doesn't include it. See the problem with your system in the CMAJ below as it will cause your system to collapse. They are asking to reduce services and modifiy the charter. I don't think so. What is > your point? Cherry picking much like insurance companies do down in the US. Dollars are a controlling factor in healthcare everywhere, not > just in Canada. You cannot escape the fact that Canada spends less per > capita and has overall better outcomes in terms of longevity and general > health of its citizens than USA or whatever shithole you came from. Try saying that to the PM's point on how poor the health within aboriginal groups is. What is their longevity? Cherry picking again as you gotta keep that per capita down. Tell us what you know about abo healthcare. DO you fly your niggers 2000 kilometers to get their teeth fixed? I doubt it. > > Does USA provide for long term home healthcare? > [quoted text clipped - 17 lines] > > Cherry picking again as you gotta keep that per capita down. > Tell us what you know about abo healthcare. DO you fly your niggers 2000 > kilometers to get their teeth fixed? I doubt it. Again we don't pretend to have socialized medicine. Ask your PM what he knows about aboriginal care and why he is increasing funding. Don't ask me ask him. Are you complaining about the charter? Change it instead of standing on a soap box and telling me how great your system is. You get people on welfare and then they don't get off of it as they have a right to it. And lets not forget we would let a whiner like you into our country also. I'm just grateful you are in USA. How about volunteering for Iraq? Maybe you can get to ride back in one of the nifty aluminum cans they keep flying into Dover AFB. > > Tell us what you know about abo healthcare. DO you fly your niggers 2000 > > kilometers to get their teeth fixed? I doubt it. [quoted text clipped - 6 lines] > You get people on welfare and then they don't get off of it as they have a > right to it. > And lets not forget we would let a whiner like you into our country also. > I'm just grateful you are in USA. How about volunteering for Iraq? Maybe > you can get to ride back in one of the nifty aluminum cans they keep flying > into Dover AFB. Your racism noted. American blacks have fought with valor and distinction in Iraq and in other wars including the Civil War. Immigrants have also distinguished themselves in service to their new country. Rascon is not the first immigrant to receive the Medal of Honor. Immigrants received one in five of the 3,427 medals authorized since the honor was created in 1861. There are 166 living Medal of Honor recipients. That day, Rascon's platoon came under attack in a Vietnamese jungle. The young medic ignored orders to stay down and ran past flying bullets to get to Haffey, who was wounded. Rascon was shot in the hip and suffered several shrapnel wounds. A grenade exploded in his face. Still, Rascon dragged Haffey to safety. Despite his wounds, he went out again to deliver ammunition to a machine gunner. He then covered Compton and Gibson with his body to protect them from harm as he treated their wounds. "Through this extraordinary succession of courageous acts, he never gave a single thought to himself," Clinton said. "Except, he admits, for the instant when the grenade exploded near his face, and he thought, 'Oh God, my good looks are gone.'" Rascon was so badly wounded that last rites were administered. He nevertheless recuperated at an Army hospital in Japan and was discharged in May 1966. Rascon went on to be graduated from college and the Army's Infantry Officer Candidate School. A native of Chihuahua, Mexico, Rascon was naturalized an American in 1967 and returned to Vietnam for a second tour in the 1970s, this time as a military adviser. Rascon is not the first immigrant to receive the Medal of Honor. Immigrants received one in five of the 3,427 medals authorized since the honor was created in 1861. There are 166 living Medal of Honor recipients. http://www.mishalov.com/Rascon.html Where is the racism? I just said if you are such a lover of USA you should be in the military saving the world for America. BTW just heard about a study that suggests that it is easier for immigrants to succeed in Europe and Canada than it is in the USA Go to France! Please please don't come here. We have whiners of our own breeding to look after. Canadians would help even whiners like you to survive! > > And lets not forget we would let a whiner like you into our country also. > > I'm just grateful you are in USA. How about volunteering for Iraq? Maybe [quoted text clipped - 40 lines] > created in 1861. There are 166 living Medal of Honor recipients. > http://www.mishalov.com/Rascon.html > BTW just heard about a study that suggests that it is easier for > immigrants [quoted text clipped - 3 lines] > after. > Canadians would help even whiners like you to survive! Yes, there's nothing like 11 days of rioting to underscore the success of immigrants in France. HMc > Where is the racism? I am not going to repeat your racist remarks. I just said if you are such a lover of USA you should > be in the military saving the world for America. Those without insurance who need help should very much join the military. They provide benefits that they have earned. They can get job training there and when they leave the military can go to college with the GI bill benefits. They also have VA medical benefits they qualify for. During the draft days, those not wanting to serve ended up in Canada. YAh I saw a guy in Seattle this morning who was an ex airforce officer-- on a breadline. BTW he was not white either! > > Where is the racism? > [quoted text clipped - 10 lines] > > During the draft days, those not wanting to serve ended up in Canada. > Tell us what you know about abo healthcare. DO you fly your niggers 2000 > kilometers to get their teeth fixed? I doubt it. Our what? > > Tell us what you know about abo healthcare. DO you fly your niggers 2000 > > kilometers to get their teeth fixed? I doubt it. > > Our what? Baiting provocative statements that undermine his position. He basically wants me to go gutter and present myself in those terms. He's not the first nor will he be the last to try that type of technique. I see it as the Howard Stern Shock approach. Most Canadians are turned off by that type of racism and would disavow it in private. I would encourage he continue to put out his true beliefs out there for people to see. I can take any cuss or slander out there. Bring it. "Robert" <Robertsononlin@hotmail.com> wrote in >> > Tell us what you know about abo healthcare. DO you fly your niggers >> > 2000 [quoted text clipped - 5 lines] > wants me to go gutter and present myself in those terms. > He's not the first nor will he be the last to try that type of technique. Correct. > see it as the Howard Stern Shock approach. Then you don't know Howard. moo Taking the moral high ground are you? How morally highground is acquiescing to a policy that lets fellow citizens die or even suffer from neglect purely on economic status? As you say politically incorrect words cannot hurt you. The term nigger is widely used by niggers in reference to one another. Why do you find it offensive or unreasonable when I use the word? How do you know I am not a nigger myself? Are their special words that only belong on the tongues of certain select groups? You protest about discrimination. Is that not discrimination? White trash is a perfectly acceptable though pejorative term. > > > Tell us what you know about abo healthcare. DO you fly your niggers 2000 > > > kilometers to get their teeth fixed? I doubt it. [quoted text clipped - 8 lines] > private. I would encourage he continue to put out his true beliefs out there > for people to see. I can take any cuss or slander out there. Bring it. > Taking the moral high ground are you? > How morally highground is acquiescing to a policy that lets fellow citizens > die or even suffer from neglect purely on economic status? How does it feel to have a government system do it with people dying and being damaged through waiting as documentated by the Canadian Supreme Court? The difference is I don't justify it but you certainly do not only in the system you have but in the words you use. The supreme court documented nothing. Dead people can't and dying people usually don't attempt to take cases through the supreme court or any other for that matter at least not in Canada. Besides the SCC ruling regarding what provinces can and cannot do in their areas of jurisdiction is tabled for a year pending further investigation. It is quite likely that it will be overturned by parliament. You flatter yourself, without justification, I might add in thinking that I am attempting to justify anything to you. I'm pulling your chain boy! > > Taking the moral high ground are you? > > How morally highground is acquiescing to a policy that lets fellow [quoted text clipped - 6 lines] > The difference is I don't justify it but you certainly do not only in the > system you have but in the words you use. The supreme court documented nothing. Dead people can't and dying people usually don't attempt to take cases through the supreme court or any other for that matter at least not in Canada. Besides the SCC ruling regarding what provinces can and cannot do in their areas of jurisdiction is tabled for a year pending further investigation. It is quite likely that it will be overturned by parliament. ~ Robert I have SCREAMING my f.cking lungs out for a year! And no one wants to hear. People go mute. The brain loses connections. Lives are destroyed. Mine is. And I am not saying anything new. This stuff is in the literature, If not the courts. > So much for American for-profit healthcare resulting in better > treatment, even for those who *do* have coverage. 50 million don't even > have that. COMMENT: Your article skewers the US overtreatment problem, all right. I was actually born in Provo, Utah. It is one of two epicenters of Mormondom, and a lot of specialist Mormon doctors from Utah congregate there because they want to live with Mormons. And this no doubt does lead to overtreatment, an epidemic problem in America, particularly when it comes to high-tech imaging and related procedures. Medicare billing is no doubt exacerbated in Provo by lack of a university medical program there, so private specialists for the elderly have to make their bucks almost without academic support of any kind. That can lead to brutal testing and medicare billing. In New York City and Maimi, there's a similar situation, save that it is Jewish medical specialists --- Newflash: of which there are a great many--- that congretate in these areas. Billing of medicare to over-scan their patients follows, as a sort of 8th plague of Pharoh. Or perhaps a better analogy is the exiled Hebrew worship of the golden calf (not that Mormons aren't in on the running for that award, too). So what is the answer? We could maybe mount a mass Luddite style attack on angioplasty suites and MRI machines. But we do need them for some stuff. It's the inappropriate use of them, that is killing us. Nor is rationing that, the answer, since who's going to do that? Turning over these decisions to doctors dosen't work, because doctors get paid for overtreating. It's very easy to make a virtue of that which enriches you. Turning these decisions over to government doesn't work well, either, because that merely removes money from patients and returns it to them from politicians, with strings attached. And politicians use every dollar that flows through "public programs" to buy votes with (yes, in Canada, too, shocking as the idea is). None of this particularly helps the problem of allocation of medical resources to where they are needed (though it does help to ration them away from centers of overcongratation of specialists). In Canada, they don't have enough of this stuff. In the US, we have too much. There needs to be a meeting of minds, here. There's no way to keep specialists from congregating. You'd have to exile a of religious doctors from where they want to live, and if you did, they'd all scream about Nazis. What you CAN do, is remove some of the incentive for doctors to specialize, so you don't care where they do. Much of this is financially driven. If you quit paying specialists all that money and give it instead to family practitioners (so that generalists make a comparable salary per hour, per year of "generalist" post grad training), the specialist glut will die on the vine. I'd like to see it. The patient has a role, too. We need good coverage for everybody in the country, not just the minimum provided by medicaid. But along with that, we need healthy deductables for everyone for every test and procedure (perhaps with a means test, so it's a fraction of your income) to make sure that patients keep a lively economic interest in whether or not that next heart scan will tell them anything they're interested in knowing THAT badly. Consumerism driven by out of pocket expense is a powerful force, indeed (and one that is lacking in BOTH Canada and in Medicare in the US). Nor do consumers need to be exposed to any but a moderately painful part of what they pay for medical care, to begin to employ their brainpower on the problem. With a means-test, nobody need go without something he or she really feels they need badly enough to spend a fraction of their income on it. There is no need for medical care to bankrupt anybody, and yet co-payments for SPECIFIC specialist procedures, can still play a major role. Specialists have a hard time overcharging and overtreating where it hurts the consumer pocketbook, and where the government is poor at paying good rates also, for use of high tech. Overuse is a disease of government payment guarantee without government oversite. Time to scale back on the first, and increase the second. Both can be done without anything like the Canadian system. SBH > > So much for American for-profit healthcare resulting in better > > treatment, even for those who *do* have coverage. 50 million don't even [quoted text clipped - 77 lines] > > SBH Since you don't actually know anything about the Canadian system you wouldn't know it is heavily reliant on diagnosis and course of treatment laid out by relevant specialists. > Since you don't actually know anything about the Canadian system you > wouldn't know it is heavily reliant on diagnosis and course of > treatment laid out by relevant specialists. I know more about your system than you think. It matters not a whit what specialists you have, if they can't get their fancy machines or O.R. time for their expensive procedures. You also pay specialists relatively less, with the result that you have a smaller specialist fraction and 50% primary care providers (a fraction we only *wish* we had). Alas, you pay THEM crap---instead of giving them what the specialists don't get, you just keep it--- so you get an absolute undersupply EVEN of primary care. Your problem is not enough money into the system. We don't have that, obviously, but we do have maldistribution problems. As I said, you need to quit being skinflints to your primaries, and we need to quit being sugar daddy to our specialists. We'll both come out better. SBH > > Since you don't actually know anything about the Canadian system you > > wouldn't know it is heavily reliant on diagnosis and course of [quoted text clipped - 3 lines] > what specialists you have, if they can't get their fancy machines or > O.R. time for their expensive procedures. There is no problem of access here. And virtually every gp appointment will result in an intitia (at least) specialist referral, with the specialist ordering tests and scans. I think you forget each province is almost autonomous on healthcare. You also pay specialists > relatively less, How again, would you know? Have you checked with all the provincial colleges? with the result that you have a smaller specialist > fraction and 50% primary care providers (a fraction we only *wish* we > had). Alas, you pay THEM crap--- You've have to have done a canvas of all the 10 provinces and three territory college pay schedules to know that. Since you haven't.... instead of giving them what the > specialists don't get, you just keep it--- so you get an absolute > undersupply EVEN of primary care. Again, like your system and country, that differs for region. Your problem is not enough money into > the system. No the problem is refusing to fund infrastructure so that it can be privatized as solution. We don't have that, obviously, but we do have > maldistribution problems. As I said, you need to quit being skinflints > to your primaries, and we need to quit being sugar daddy to our > specialists. We'll both come out better. > > SBH I have a rough idea what my last gp made. Based on her patient load and work hours, I'd say she was underpaid. Based on her method of practise--medical education by detailer, I'd say she owes the system money. > You also pay specialists > > relatively less, > > How again, would you know? Have you checked with all the provincial > colleges? These are averages we're speaking of. GP earnings vary from state to state in the US, but it's the US average which counts in comparing countries. > with the result that you have a smaller specialist > > fraction and 50% primary care providers (a fraction we only *wish* we > > had). Alas, you pay THEM crap--- > > You've have to have done a canvas of all the 10 provinces and three > territory college pay schedules to know that. Since you haven't.... I don't need to, since the average is known and available. I have checked a few provinces and they fit. But since I'm tired of doing your homework for you, I'll let you look it up on the web yourself. Tell me it's not there. When you do, I'll show you were it is. No? Then quit being lazy. FYI, average Canadian full time FP/GPs bill 100 to 120 K a year. But have overheads about a third of that, so their real gross business income (before tax) is about 75 K (75% of them are over 60 K, and 25% under). Just about half what US "primary care" GP/FPs, internists and pediatricians make. Canadian specialists make a little more than the GPs but not much. In the US, for incomes tack on 100 K for even cardiologists and much more for radiologists. I'm leaving surgery out, since it's not fair to compare it to non-surgical specialties. In the US, there's about a 100 K bonus over primary care for being a any kind of surgeon, and tack on more for the surgical subspecialties (none of which I have a problem with--- I don't fume about surgical salaries, only radiological ones). > Again, like your system and country, that differs for region. Again, the differences within country aren't significant when comparing the very large difference between countries. > I have a rough idea what my last gp made. Based on her patient load and > work hours, I'd say she was underpaid. Based on her method of > practise--medical education by detailer, I'd say she owes the system > money. LOL. But try not to be too influenced by your n of 1, even if you saw her income tax return (which, due to the overhead, might have shocked you). SBH > > You also pay specialists > > > relatively less, [quoted text clipped - 18 lines] > it's not there. When you do, I'll show you were it is. No? Then quit > being lazy. I'm not interested. You are. > FYI, average Canadian full time FP/GPs bill 100 to 120 K a year. But > have overheads about a third of that, so their real gross business > income (before tax) is about 75 K (75% of them are over 60 K, and 25% > under). Just about half what US "primary care" GP/FPs, internists and > pediatricians make. It's higher. But I don't care whether you get it right or not. > Canadian specialists make a little more than the GPs but not much. In > the US, for incomes tack on 100 K for even cardiologists and much more [quoted text clipped - 19 lines] > > SBH I wish I knew what your point was. I wish you did too. > I wish I knew what your point was. Why, you might actually have to go back closer to the beginning of the thread and read what I wrote. > I wish you did too. I wish you didn't try to interpret what I write, for me. SBH > > I wish I knew what your point was. > [quoted text clipped - 6 lines] > > SBH You run this risk when you're engaging with someone. They interpret what you say. I know it's more fun when you log on, deliver your monologue and move on, no-one disagreeing. You were doing fine then up thread. Actually petulantly conceding I'd made a point. That book you're gonna owe me...make it hers autographed. Cry me a river. I think you are making the numbers up! > > You also pay specialists > > > relatively less, [quoted text clipped - 48 lines] > > SBH > > Since you don't actually know anything about the Canadian system you > > wouldn't know it is heavily reliant on diagnosis and course of [quoted text clipped - 14 lines] > > SBH Pardon. There is a problem with, for example, surgery time. Surgeon's hours are doled out. This has been going on in my province since 1993, when the incumbent premier was first elected. His first act was to cut funding to universities, and this of course affected the university medical schools. He then cut funding for infrastructure and operational costs of same. Every budget has had deeper and deeper cuts to education and healthcare. The undersupply of primary care providers is an engineered one. I remember when the OMA and the CMA told both levels of govt that here would be too MANY doctors in a decade.It was bullshit but the govts had faith and curtailed university funding to fit the medical trade's predictions. Most people don't know that or coveniently forget it. Cnada has hundreds of foreign trained doctors who are unable to practice because of artificial licensing barriers that eh medical unions are manning with great vigor. How much money is enough. USA's GDP figures are alot higher than Cnada's yet it has 50 million peole qwho have financially restricted access to primary care. That's about what, 1/6th of the population? Which is better some getting none or everyone getting a bit? > > Since you don't actually know anything about the Canadian system you > > wouldn't know it is heavily reliant on diagnosis and course of [quoted text clipped - 14 lines] > > SBH > Cnada has hundreds of > foreign trained doctors who are unable to practice because of >artificial licensing barriers that eh medical unions are manning >with great vigor. That's another Canadian thing is unions. Most professionals here in the states don't belong to unions and find it abhorrent that they can actually strike. By far most of the people belonging to unions are the private for profit organizations that abuse their workers similar to Canada. I find the connection interesting. Robert, You should get out a bit more! All doctors belong to a medical association. It is the way things are. The medical associations are effectively guilds which for all intents are the same as unions In Canada Medical associations negotiate rates with the payer i.e. the govt. It is efficient and relatively simple for both sides. Workers are only abused if they let themselves be abused. I sincerely hope you do not have US citizenship you shouldn't even have green card you are not ready for it. And for heaven's sake don't come to this country we don't need another ignorant body to educate. > > Cnada has hundreds of > > foreign trained doctors who are unable to practice because of [quoted text clipped - 7 lines] > organizations that abuse their workers similar to Canada. > I find the connection interesting. >I sincerely hope you do not have US citizenship you shouldn't even have >green card you are not ready for it. And for heaven's sake don't come to >this country we don't need another ignorant body to educate. But he does such a good job telling everyone in Canada how our system works! He's an authority on everything we do! A complete medical encyclopedia. I haven't learned so much about Canada's medical system in all my 50 years living here since I talked to Robert (I spent 20 of them in the US)! I can't imagine how he knows so much about a place where he's never been, but HE KNOWS IT ALL! My guess is that he's even read some websites to become the absolute authority on Canadian health care! His knowledge is right up there with the American idiot who saw Les Invasions barbares on Showtime and used it as conclusive proof that Canada's health care system was like in the movie! If he ever visits Canada on a Saturday night and watches TV, he'll probably end up thinking that everyone here talks like Don Cherry. > But he does such a good job telling everyone in Canada how our system works! > He's an authority on everything we do! A complete medical encyclopedia. [quoted text clipped - 3 lines] > imagine how he knows so much about a place where he's never been, but HE > KNOWS IT ALL! Henry, I understand your point completely. My point in even being on the topic is not because I even care about Canadian health issues which I don't. My intent is on having Canadians like you, like Zee, like TC, and others to be named later, which continue to post hundreds of times about the FDA, NIH, corruption on US healthcare. My intent is to refocus their interests in their own country where they can do more good. You really haven't noticed by I am not an OP on any of these topics. Zee posts an article about a Harvard professor who thinks the US system is expensive, inefficient and inequitable. How does this help Canada? If you say that people should comment on their own healthcare and not in another countries then you have a deal. Go tell your fellow Canadians. Once again the little one is unable to see the relationship. Ill explain to you in as simple a fashion as I can so that you have at least a faint hope of understanding. Here we go. The USA system is important because of NAFTA. Canada unlike the USA seems to believe that honouring agreements that it (Canada) has signed is an important part of international relations. You should read the NAFTA agreement as it relates to trade practices and healthcare. Basically what it amounts to is IF Canada permits private healthcare it will have to permit AMerican companies to compete. Most Canadians believe would not be good for them and unfortunately there is no proof either way except by permitting it to occur. It is too important an issue to be dealt with in that fashion. As you may be aware of AMerican trade practices particularly farm subsidies are not admired nor acceptable to a majority of people in the Americas. What it boils down to is when it comes to trade Americans are lying cheating miscreants of the first water. > > But he does such a good job telling everyone in Canada how our system > works! [quoted text clipped - 21 lines] > another countries then you have a deal. > Go tell your fellow Canadians. > Once again the little one is unable to see the relationship. Ill explain to > you in as simple a fashion as I can so that you have at least a faint hope > of understanding. So are you saying that I have a right to comment about Canadian Health practices because of NAFTA? Ok I'll take that as an excuse. I will also use that as an excuse for American intervention in Canadian affairs. USA doesn't need an excuse. It interferes in everyone's affairs. It is part of the culture that is what makes UGLY AAAAAMericans so popular around the world. You can comment all you want on certain things like NAFTA. > > Once again the little one is unable to see the relationship. Ill explain > to [quoted text clipped - 6 lines] > Ok I'll take that as an excuse. I will also use that as an excuse for > American intervention in Canadian affairs. > Robert, > You should get out a bit more! All doctors belong to a medical association. > It is the way things are. These are not unions. There are doctor groups, who belong to a small association and bargain with the hospital or insurance groups for services. Doctors are not forced into joining the AMA or joining any association. Services are contracted out to associations depending on your medical specialty. You just don't know do you boy? For all intents and purposes there is no difference between an association that acts as a bargaining agent and what is called a union. Doctors in Canada must belong to a professional association usually the provincial medical association to be licensed and acredited. They cannot legally practice without a license and accreditation. I'm pretty sure the same rules apply in the USA. Stop being so silly! > > Robert, > > You should get out a bit more! All doctors belong to a medical [quoted text clipped - 6 lines] > Services are contracted out to associations depending on your medical > specialty. > You just don't know do you boy? For all intents and purposes there is no > difference between an association that acts as a bargaining agent and what > is called a union. Doctors in Canada must belong to a professional > association usually the provincial medical association to be licensed and > acredited. I wasn't talking about Canada. I was talking about medical associations in the US. In Canada that is a different story. It is identical to unions as you state. All medcial personnel are forced to join a union with strikes and all of that. That is the exception in the US. IS it an exception? Can anyone practice medicne in a majority of states without a license or being a member in good standing of a medical association? I would have though that being a state's rights issue it would be very important for individual states to control their licensed medical practioners. BTW no one is forced to join a union they just can't bill without a license and a billing number that requires a license. JUt from the common sense aspect I would imagine that insurance companies or medicare doesn't just pay anyone who submitsa bill. However you seem to know all the answers so you tell me! > > You just don't know do you boy? For all intents and purposes there is no > > difference between an association that acts as a bargaining agent and what [quoted text clipped - 7 lines] > all of that. > That is the exception in the US. >IS it an exception? Can anyone practice medicne in a majority of states >without a license or being a member in good standing of a medical >association? I would have though that being a state's rights issue it would >be very important for individual states to control their licensed medical >practioners. I know that you can be a Lawyer in one state and be Disbarred, then move to another one and practice law. I don't know if it applies today, but there was a time where you could write the Bar Exam in Georgia without attending Law School. When it comes to medical, I was surprised to hear about an Australian MD who moved to Canada and found that the CMA didn't accept his credentials. He ended up driving a Taxi Cab to support his family, then after 1 year retured to Australia. That's deplorable. It's not like he was a butcher in Senegal! > >IS it an exception? Can anyone practice medicne in a majority of states > >without a license or being a member in good standing of a medical [quoted text clipped - 14 lines] > > That's deplorable. It's not like he was a butcher in Senegal! A real tragedy concerning their is many, many doctors from Canada coming to the US for residency programs and GP's coming here to practice medicine. I have met a few and they are not driving cabs here. That's a problem with Doctor Unions there and they don't exist here in the US. What exactly constitutes many many? If you ever did post grad work (which I very much doubt) you would know that no-one does their post doc where they got their PhD or MD., It is just not done or very rairley. Experts are by definition the guy from 50 miles down the road. USA loves Canadian degrees since our standards are usually higher. > > >IS it an exception? Can anyone practice medicne in a majority of states > > >without a license or being a member in good standing of a medical [quoted text clipped - 22 lines] > have met a few and they are not driving cabs here. That's a problem with > Doctor Unions there and they don't exist here in the US. There are apparently hundreds of out of country qualified doctors wh are driving cabs or making pizza. It is one of the major complaints of the current licensing system in ONtario. The OMA argues that it is to protect the consumer. It is possible that it is to protect income since the pot of money to pay doctors is fixed and more doctors = less per doctor.. > >IS it an exception? Can anyone practice medicne in a majority of states > >without a license or being a member in good standing of a medical [quoted text clipped - 14 lines]< |
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