Forum Home > Non-Gaming > Real Politik > Health Care in the U.K. and Canada ?
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Atrus
Board Admin
Posts: 259
Health Care in the U.K. and Canada ?
Posted: Aug 25, 2009, 17:15:09
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Here in the states we're told a variety of tales about how great health care is here in the U.S. compared to countries who have government run systems. Conservatives/Republicans call it socialism describing government involvement as a recipe for disaster. On the other hand the Liberal/Democrats would have us believe that social systems are as described in the film "Sicko" by Michael Moore --- no waiting, plenty of good well paid doctors, and a pharmacy with free or super cheap drugs on every block. As with most things that become political, I suspect the truth rests comfortably somewhere in the middle.

I'd appreciate it if some of you from up North and across the pond would take a moment to share your thoughts on your countries health care services.

Thanx,
~A

Raven
Member
Posts: 6361
Posted: Aug 25, 2009, 20:38:09
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The big concern about the NHS is the length of time it takes to wait for treatment because of health care “rationing”. It is implied that UK health care is rationed whereas US health care is not – nothing could be further from the truth! At a simplistic level, UK health care is rationed by need, and US health care is rationed by ability to pay.

The NHS provides treatment free at the point of delivery with the exception of Dentistry. Prescriptions are also subject to a flat £7ish fee in England, although they are free in Scotland and Wales. In other words, you will not suddenly find yourself paying a huge bill.

The real truth is that most people who need it can get treated whether they are in the US or the UK. Although if you are poor and in the US, your access is likely to be not quite so easy. Are there millions of people in the US who have no access to medical care ? Probably not, but there are enough indications out there that a significant number of the US poor find access to medical care difficult.

As for waiting times, it is easy to pick particularly bad examples of NHS waiting times and wave them around as examples of how bad socialist medicine is. Now the NHS did used to have a problem with waiting times and some people did die as a result of not getting the treatment that they needed. This was indeed a scandal, and was a direct result of a long period of chronic underfunding by the Conservative governments (1979-1997). The situation now is much improved and people do not have to wait so long for treatments.

In fact the NHS this year reached their target of having no patients wait more than 18 weeks (or more explicitly 18 weeks from referral to when treatments start). This is a bit on the high side, but the average wait for ‘inpatients’ is 8.6 weeks and 4.6 weeks for ‘outpatients’. Still too long, but this is far cry from claims of 18 month waits. And these statistics conceal something – for urgent treatment a certain amount of queue jumping goes on including going to non-local hospitals for treatment. Reducing waiting times would be a simple matter of increasing the amount of money invested in the NHS – and we pay a lot less than people in the US do – more on that later.

As a little personal example, my grandmother recently had to wait several weeks to be moved from a hospital to a rehabilitation clinic (for physiotherapy), but my Aunt (with cancer) was seen the same week by a specialist after her initial diagnosis.

Another story going around is that the treatment in the UK is very much worse than that in the US. One of the areas that people target is the cancer survival rates. Indeed the UK’s record of treating cancer is not ideal, but this is just one area. And sometimes simple comparisons can be deceptive. A little story from the US media about prostate cancer – the US has a much better rate of long term survival rate than the UK, but prostate specialists point out that the US does more testing for prostate cancer than anyone else.

That would be good except that once prostate cancer is found in the US, it gets treated despite the fact that many prostate cancers are slow and unlikely to cause death in many patients. The US system inflicts painful and uncomfortable treatment on patients who do not need it, and as a result they boost their long-term survival rates.

In fact if you look at a more widespread selection of conditions, the UK does not look quite as bad. Unfortunately the WHO statistics available are a little dated, but can be used to do a naive comparison.

Lets have a look at the mortality rates for all cancers – in 2002, the US had 134 deaths per 100,000 and the UK had 143. It is quite possible that the US rate has improved since then, but if so the UK is likely to have improved more – the NHS was asked to concentrate in this area because of the UK’s poor record here. Still even with the 2002 figures, the UK isn’t that much worse!

Now lets have a look at mortality rates for cardiovascular diseases – in 2002, the US had 188 deaths per 100,000, and the UK had 182. What’s this ? A country with a socialist health care system does better than the US? Obviously I am excluding lifestyle differences, but even so this does not look like the UK has a chronically bad health care system.

And now let’s have a look at mortality rates for mortality rates from injuries – in 2002, the US had 47 deaths per 100,000, and the UK had 26. That’s quite a big difference! The rates for deaths from non-communicable diseases were 460 (for the US) and 434 (for the UK). Again we have the UK apparently doing better.

If we look at more recent figures (2006) for rates of infant mortality, we see the US had 7 per 100,000 and the UK 5. Again the UK looks better!

Because of the lack of recent figures I am not going to say the UK health care system is better at keeping people alive than the US system … or visa-versa. But it should be clear that the UK system is not dramatically worse (or better) than the US system at actually treating people.

I very much doubt that Obama is planning on setting up anything that would come anywhere near the socialism of the NHS. The right-whingers (spelling mistake intentional) over there are spreading disinformation – not only in how bad the NHS is, but in what Obama is planning. Please just find out the facts for yourself and don’t count on so-called “facts” provided by people who have a vested interest in the status quo.

The lies about health care by the NHS are grossly offensive to people in the UK. However if I were a US citizen I would also be grossly offended by the spread of disinformation being spread in this campaign.

And as for the UK people, well we moan about the NHS amongst ourselves but as has been shown in the last week we certainly defend the NHS when it comes to outside attack. One way of judging the success of the NHS is that no sane political party would attempt to dismantle it – if they managed it, they would probably never be elected again. If you watch US media, you will probably be familiar with a certain Conservative politician (Daniel Hannan) who does attack the NHS. He belongs (at present – his future is quite possibly in doubt) to the lunatic fringe of the Conservative party and the party leaders have dismissed his views.

Whilst most people in the UK would greatly like to see the NHS improved by the investment of more money, there is no way that they would trade the system they have for the system in the US :wink:

gcomeau
Member
Posts: 2
Posted: Aug 25, 2009, 21:48:15
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Speaking as a Canadian who has lived in the US for 10 years.. you should only wish to have a health care system equal in quality to pretty much any other OECD nation. I'll start with some personal observations, but what the debate in the US needs is less anecdotes, more hard facts. So I'm spending most of my time there.

When I got a job offer in California I didn't even consider health care as a factor. It never occurred to me to. I'd lived in Canada my entire life, I'd never traveled in the US before, health care simply wasn't something I ever worried about... it's just, there.

It didn't hit me what I was getting into until I was at an HR orientation at my new job, we hit the part where we had to fill out all kinds of paperwork, and I got to the health care benefits section.

That was... unpleasant.

I of course decided I was going to track down the plan that gave me the closest thing to the comprehensive coverage I'd had back home... then I saw the price to actually do that. Not happy. But I did it anyway because, really, half-assing health care coverage to save a buck in the short term? Not an idea that appeals to a Canuck.

So I did that, crossed my fingers it would be enough to keep me out of any major medical trouble, and went about my business.

4 months go by, and something called "open enrollment" happens. I ignore it, like most mass e-mails that the HR department is constantly sending out. Next thing I know I'm getting a letter a few weeks later informing me my insurance coverage was changed to a different plan.

wtf?

Turns out, every damn year the company re-assesses which insurance plans it's going to offer, they'd dropped the one I was on, and since I didn't re-fill out new paperwork during the enrollment period to select a new plan myself they picked one for me. One that sucked but cost them less money.

I pay attention to those open enrollment e-mail now.

In the meantime I start getting an education in what "co-pays" and "deductibles" are like in the US. I'm shelling out money every time I get anywhere near a doctor's office. That's a joy. But at least I'm not paying the ridiculous full amount of the bill, so that's something. Yay insurance... I guess.

Then a couple years ago I take a header on my bike and whack my arm on the pavement. After a few hours it's really stiffening up, can't straighten it. I'm debating whether I want to go to a hospital or wait to see if it just gets better if I keep it iced down... something that never would have crossed my mind back home but I have no confidence left in how much this is going to end up costing me after my ever-so-helpful insurance agency is done figuring out what they refuse to reimburse. But I go in.

I spend a total of maybe 5 or 6 hours at the hospital, most of it sitting around waiting and trying to fill out a bunch of forms with one hand. But I eventually get to see someone, get a couple x-rays of my arm, get informed it MIGHT be a hairline fracture but the swelling is making it hard to see, get my arm put in a sling and handed some pain killers and anti-inflammatory medication and packed off and told to go see a specialist who could, I guess, read an x-ray better than the guy I was dealing with right then .

That ended up costing me like $300. AFTER insurance.

Then, confirming the fracture with the specialist the next week and getting a cast cost me like another $500 later.

It was at this point that I realized that if I had maintained my residency status in B.C., and thus my eligibility for health care there, I quite possibly could have hopped a flight to Vancouver, gone to the hospital THERE, got treated, and then hopped a flight back, and STILL spent less money than getting treated at the hospital 2 freaking miles from my apartment. And this was with "good" US insurance.

I was not in a good mood. And you may be able to tell I am not a fan of the US health care "system".

But, let's move beyond the anecdotes. It's a horrible way to judge huge complex systems like this.

COST:



http://graphics8.nytimes.com/images/2009/07/08/business/economy/08economix.chart.2.jpg

http://graphics8.nytimes.com/images/2009/07/09/business/econgraphic3.jpg


Does any of that REALLY need explaining? The US system is the most expensive on the face of the planet, and the worst at controlling cost growth. Which leaves me stunned that a prominent argument against implementing a universal coverage system like any other industrialized nation already has is "But, but, it's too expensive!!!" What planet do these people live on anyway?

Oh, actually, one part really DOES need explaining. It shouldn't, but like NOBODY in the US seems to know this.

See that first graph? Pay attention to the red part of those bars specifically. That's TAX spending on health care.

Take a look at how high the red part of the US bar goes.

Now look at Canada's. Take your time. Let it sink in.

That's right boys and girls, Americans and Canadians pay THE SAME amount in taxes towards health care. Canadians get universal major medical for their entire population for that money. Who thinks Americans are getting equivalent value for THEIR tax dollars with the system they have now?

PERFORMANCE:

A systematic review of studies comparing health outcomes in Canada and the United States | Guyatt | Array

That is a systematic review of DOZENS of scientific studies on the comparative outcomes of treatment of everything from cancer, to coronary artery disease to chronic illnesses to surgical procedures in Canada and the US. Canada achieves superior results in the clear majority of them.

And this is the recent Commonwealth Fund study on health care amenable mortality rates in industrialized nations:



That is a measure of how many people die each year who *could be saved* by the application of proper, adequate medical care. It is a direct indicator of how well a health care system keeps alive people who it should be able to keep alive. The US ranks dead last. Not exactly getting it's money worth considering it outspends every single other nation on that list.

Then there's the fact that the US is the only industrialized nation in the world that leaves like a sixth of it's population with no health insurance, and even more than that with insurance coverage so inadequate they're STILL facing potential bankruptcy over a serious medical illness or injury.

And don't get me started on "pre-existing conditions". Those don't exist in the Canadian insurance vocabulary. Neither does "policy rescission", the charming practice of US insurers where they take your premium payments month after month until you get really, seriously, EXPENSIVELY sick... then set their team of lawyers and quite possibly private investigators on you to see if they can get you on a technicality and dump you from coverage so they don't have to pay out. At which point, good luck getting re-insured by ANYONE else. See: "pre-exisitng condition".

And before anyone even thinks of saying "Oh yeah? Well then why do Canadians cross the border for care all the time???"

Phantoms In The Snow: Canadians' Use Of Health Care Services In The United States -- Katz et al. 21 (3): 19 -- Health Affairs

They DON'T. The US insurance lobby invented that fairy tale in the 90s to scare people out of supporting reform under Clinton. So someone studied it. the actual number of Canadians who seek care in the US was found to be so small it was damn near statistically immeasurable and nothing has changed to alter that since. But they'll keep repeating the lie year after year as long as people keep buying it. and whenever they can get their hands on one of those VERY FEW Canadians who actually get care in the US they'll drag them in front of a television camera and treat them like they're just an average Canadian making their regular weekend trip to a US hospital or something.

Ok... I think I'll rein it in there for now...

Oh wait! I forgot two biggies:

RATIONING

ALL SYSTEMS ration health care. It is dumbfounding to hear people in the US acting all terrified that their health care might be rationed if they reform the system. Hello? Tens of millions of uninsured people because they're been priced out of the system? Tens of millions more with inadequate insurance for the same reason? Doctors in the US asking insurance company accountants for permission to administer treatments or medications like a million times a day? What the heck do you think rationing looks like? Does it have a different definition in American English that I'm not aware of? US care is already currently HEAVILY rationed.

WAIT TIMES

Any time you see anyone telling you about short wait times in the US, remember this. They get those "short" wait times by NOT COUNTING all the people waiting the longest. People who simply are being denied access to care completely because they have no means to pay for it. People who have been effectively indefinitely wait listed (or at least wait listed until they turn 65 and qualify for Medicare).

If any other country on earth just threw millions of people out of line, pretended they didn't exist, then said "Behold! Our miraculously short waiting times and the amazing system that produces them!!!" you'd be insulted they clearly thought you were an idiot. But people just take it when they're told that by people coming up with US wait times stats. It's ridiculous.

Ok, now I'll rein it in.
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