10.25.2005

the wait

Yesterday it was announced that provincial health ministries will have set wait-times benchmarks for five health conditions by the December 31st deadline.
Health ministers from across the country say they will establish by a December deadline the first targets for how long people must wait to be treated for such ailments as cancer and joint replacements. But it was unclear how extensive the list will be and how much it will help patients.

"How many [benchmarks] there are will depend on the evidence in a number of areas that we have," federal Health Minister Ujjal Dosanjh said yesterday after a weekend meeting with his provincial and territorial counterparts.

"If you ask me if we'll have 20 benchmarks in the area of cancer, I will tell you no, from what I know now, because it is a very sophisticated, complex area," he said. "But we will have some benchmarks in all areas."

Provincial and territorial ministers committed in a health accord signed last year to establish scientifically based benchmarks for waiting times in five treatment areas -- cancer care, heart treatment, diagnostic imaging, sight restoration and joint replacement -- by Dec. 31. In return, the federal government agreed to give them an extra $41-billion over 10 years.
The waiting benchmark is a complex idea, and I'll be interested to see how it plays out. But I mention it for a specific reason. I've mentioned before that US media coverage of the Canadian health care system is uniformly negative. I'm not just talking about right-wingnuts. Even in moderate venues like The New York Times or Time magazine, articles about Canada's system always have a negative slant. Is it any wonder, then, that most Americans have a distorted view of the system, based on myths and lies?

Every American I've ever spoken to, except those who have researched the Canadian system on their own, believe Canadians wait dangerously long times for treatment and that anyone with any money travels to the US for health care. If I press for a source, it's a vague "I've heard...". They've heard. Yeah.

If the Canadian health care system was as bad as the American media reports, Canada would have shockingly high rates of untreated diabetes, heart disease and cancer, and millions of Canadians would be dropping dead while they waited for treatment. Somehow I think we'd hear about that.

Now, it would take an awful lot to convince me that a national single-payer system, no matter how problematic in reality, could ever be worse than the crazy non-system in the US. As Allan likes to say, there are 50 million Americans who would love to be waiting for an operation! (That is, the uninsured.) That number doesn't count the underinsured, and everyone who can't leave their dead-end jobs because they would lose their coverage, and all the folks paying increasingly gigantic amounts of their salary for insurance.

Suffice to say that I do not need convincing.

However, I understand there are problems - mainly caused, according to my progressive Canadian friends, by funding cutbacks that are now being restored. I've had uniformly good reports from wmtc readers, except for the serious shortage of doctors, especially in Ontario, and especially in the GTA. In another month, Allan and I will qualify for Ontario Health (Ontario being the only province without immediate coverage; there's a 90-day waiting period). Naturally I'm extremely curious to see how the system works in reality.

The recent focus on waiting benchmarks cuts to the heart of the most popular American myth about the Canadian system. On the Ontario Health website, there's a big section on wait times, including a page on wait time myths, and what is being done.

Part of me (the immature part!) feels like tracking down all the nut-jobs who've left comments here warning me that if I ever get sick, I'll die waiting for treatment, unless I come running back to TGNOTFOTE.

16 comments:

James said...

Now, it would take an awful lot to convince me that a national single-payer system, no matter how problematic in reality, could ever be worse than the crazy non-system in the US.

As it happens, there is no major single-player health care system in the world which costs more per person than the US's system.

The US system is incredibly inefficient because it's been fragmented and crippled to prevent it becoming "socialist". Enormous bureaucracies are needed to determine who isn't supposed to benefit, and HMOs more interested in pleasing stockholders than helping patients pick up the slack.

However, I understand there are problems - mainly caused, according to my progressive Canadian friends, by funding cutbacks that are now being restored.

Under the last Tory provincial and federal governments there was a huge "run things like a business" kick. Much of the fallout from that is still with us: homelessness in Toronto skyrocketted because of cuts to subsidized housing, for example.

RobfromAlberta said...

However, I understand there are problems - mainly caused, according to my progressive Canadian friends, by funding cutbacks that are now being restored.

Funding is only part of the story. A comparison of funding levels as a function of GDP shows Canada is comparable to many countries in Europe (as of 2002):

France 9.7%
Germany 10.9%
Denmark 8.8%
Sweden 9.2 %

Canada 9.6%
USA 14.6%

The bigger problem is that health care is the state religion in Canada. Its bureaucracy is hidebound and dogmatic. Every attempt at reform is met with the charge of "Americanization", even though many European countries mix private and public health care systems quite harmoniously.

Lone Primate said...

I think ultimately, it boils down to what kind of a society you want to live in... one where taxes are low but society is cruel, or one where taxes are high by human beings are secure in their expectations. While I admit there's a certain appeal to be able to accumulate more money than you can possibly butter and eat in an lifetime of gorging, I believe the future lies in shared responsibilities. I see the US as a failing society, one that, sooner later, needs to come into harmony with the rest of us if it's going to survive in the long term. A society based on the shoot-out attitudes of the Wild West where winnners are swaggering kings who rule by intimidation and losers are rotting corpses in the gutter is an unhealthy one indeed, even in a world not bristling with nuclear weapons. Ultimately, we're social primates, not crocodiles. We need to listen to "the better angels of our nature". Or perhaps the better lemurs, at least. :)

L-girl said...

Every attempt at reform is met with the charge of "Americanization", even though many European countries mix private and public health care systems quite harmoniously.

I can well understand the fear of the slippery slope towards privatization. Although it was not lost on me how many Canadians were crying "that's the end of our system! they're privatizing it!" after the Quebec ruling - grossly out of proportion to the ruling itself.

It does seem like a mix of public and private is inevitable in the future.

I think ultimately, it boils down to what kind of a society you want to live in... one where taxes are low but society is cruel, or one where taxes are high by human beings are secure in their expectations.

It does. It's not like taxes are low for most Americans anyway. But the tax base is not equitably distributed, with the middle-class overly burdened, and corporations flat off the hook. Most US corporations don't pay any taxes. That is a crime. Or it should be.

But certainly there is that anti-tax attitude in the US, this nasty "why should I?" attitude towards funding anything further than one's own backyard.

Unless of course you need the services, then you want it to magically appear...

Kyle_From_Ottawa said...

You might remember I passed around a somewhat dry but informative comparison of various options that was done by the Hong Kong government.

Basically, every system has major flaws, because essentially the ideal is unattainable (latest techniques, no wait times, for free).

I do agree with Rob though that every attempt at improvement is treated as though the whole system will crumble.

Part of the problem is that the word "private" is equated with the American non-system (as you call it). However, I think we're missing the forst for the trees here. I mean, yes its a for-profit system, but that's not the flaw. Televisions are for-profit too, but unlike American healthcare they get better and cheaper over time. The American non-system is consuming vasts amount of money, yet it seems like much of the money spent isn't being rendered for services, it's being consumed in overhead.

L-girl said...

Basically, every system has major flaws, because essentially the ideal is unattainable (latest techniques, no wait times, for free).

Sure. Just like systems of government - you have to strive for an ideal, knowing you're not going to achieve it.

Part of the problem is that the word "private" is equated with the American non-system (as you call it). However, I think we're missing the forst for the trees here. I mean, yes its a for-profit system, but that's not the flaw. Televisions are for-profit too, but unlike American healthcare they get better and cheaper over time. The American non-system is consuming vasts amount of money, yet it seems like much of the money spent isn't being rendered for services, it's being consumed in overhead.

I think the effects of that aspect is exaggerated. It exists, definitely, but there is overhead in a single-payer system, too.

But you know that health care can't be equated with the simple economic principles of selling televisions. There are no cheap materials. There's no cheap labour. There's universal need, which rises out of proportion to for-profit supply.

It's perfectly ok if some people can't afford TVs, if some can afford only small black and white sets, and if some can afford huge-screen high-definition plasma TVs. It's not ok to apply that to health care.

I think the bottom-line issue in the US is that HMOs and private insurance companies are profit-making corporations. What's necessary to turn a profit is not compatible with delivering quality health care to the maximum number of people.

It's not like the US has an alternative system that's delivering health care to all, but it costs more or less. That delivery isn't even an issue in the US. It's not even on the table. There's a shoddy safety net for the very poor, a burden on employers who increasingly can't or won't accept the responsibility, and other than that, sink or swim.

L-girl said...

I do agree with Rob though that every attempt at improvement is treated as though the whole system will crumble.

I see that too. That's what I meant by the reaction to the recent Quebec decision. Dozens of Canadians emailed me warning me that if I was moving here for health care, better think twice, the system is being Americanized. I read similar comments all over the internet and in newspapers. I remember posting asking for clarification.

Kyle_From_Ottawa said...

But you know that health care can't be equated with the simple economic principles of selling televisions. There are no cheap materials. There's no cheap labour. There's universal need, which rises out of proportion to for-profit supply.

I wasn't really trying to equate them, it was an oversimplification for the point of argument.

I mean, food is a universal need to, but the private sector does well in meeting 99% of that need. Healthcare, on the other hand, doesn't.

But it's beside the point. You said delivery isn't on the table, but that is what's important. All that matters is that we get affordable delivery of service, but people seem to focused on where the payment of that service comes from.

I mean, delivery of health care in Canada is private too. Doctors aren't employees of the government, but they deliver the same service as their American counterparts for far less. They had to figure out how to deliver the service for less because the single-payer insurance would only pay so much for a service. There is no such pressure to deliver more for less in the U.S., and I think is no real comptetive pressure in the for-profit U.S. system to drive costs down. It seems more equivalent to the railroad robber barons of the 19th century than the wonders of capitilism it claims to be.

L-girl said...

You're right, Kyle - good points. The comparison to 19th Century capitalism - which consisted of giant monopolies controlling everything - is very apt.

People in the US frequently say Canada has "socialized medicine". I always say, no, they have national health insurance.

That is, we. It. Whatever.

Evan said...

A nit: BC also has an approximately 3 month waiting period:
New residents or persons re-establishing residence in B.C. are eligible for coverage after completing a waiting period that normally consists of the balance of the month of arrival plus two months. For example, if an eligible person arrives during the month of July, coverage is available October 1. If absences from Canada exceed a total of 30 days during the waiting period, eligibility for coverage may be affected.

As another American transplanted to Canada I am in awe of the Canadian health system. The fact that it gets the job done with less government funding is also incredible.

It's not perfect. Waiting times can be a problem for non-life-threatening conditions (my wife has waited 10 months and will probably wait another 4-8 for a knee operation). But one of my blue-collar neighbors recently had a massive heart problem and was in ICU for abour 4 weeks. He's home now. He's alive, although he may never work as a carpenter again, and he's not going to lose everything he owns to medical bills. I'll endure wait times for that kind of tradeoff.

The American system is as it is for the benefit of politicians and health care companies, not for the benefit of the American people. It's going to stay that way until the American people decide it's got the change and make it a priority. You'd think that 50 million people (is it up to 50? I usually hear 40) would make it a priority and start telling their congresscritters that their vote is dependent upon healthcare reform, but apparently wasting money in Iraq is more important. :-(

Great blog item on Canadian Health Care at http://blogs.salon.com/0002007/2005/10/14.html#a1303

L-girl said...

Evan, thanks for this terrific comment. I'm going to post it as an entry later if you don't mind.

Where in the US are you from? How long have you lived in Canada?

Thanks for stopping by!

teflonjedi said...

I'm moving, changing jobs, etc., right now, and one of my first concerns was about health care coverage for those 5 days between end of job 1, and the start of job 2. What happened if something happened while I drive across the country?

Thankfully, it appears all worked out, but...I wish this wasn't something I have to worry about.

L-girl said...

Teflonjedi, didn't your former employer give you a Cobra option? You have at least a 90-day grace period. Not to defend the stupid non-system, but if you had a good job, there are safeguards in place.

Leaving Boston? Where are you moving to?

teflonjedi said...

Yup, there is Cobra, and I'll have some more comments on that when I get to my destination: Cupertino, CA. Check out my blog for more info...I'm writing here from work, and this is likely my last opportunity to say anything before heading westwards on Saturday!

L-girl said...

Check out my blog for more info...

Duh, should have done that in the first place...

I'm writing here from work, and this is likely my last opportunity to say anything before heading westwards on Saturday!

Good luck!! Have a great trip and see you from the west coast!

Rayne said...

Part of the reason why the Canadian healthcare system has suffered (which has been compounded by funding cuts in certain areas), is the skyrocketing cost of "new basic" medical technology. When the system was introduced, a far smaller proportion of funds were needed to go to technology, becuase it was simple. Nowadays there are MRIs, electric beds (rather than crank beds), computerized and network sensor systems, expensive stents, and medical science is capable of so much more that so health standards have risen. How common was bypass surgery 40 years ago? But nowadays it is fairly routine medical treatment. Think of how quickly personal IT changes, a 4 year old computer is obsolete, and keeping up costs $... same thing with medical technology, except it is far more specialised and costly.

I also agree that inflexibility of the Canadian system with respect to those who actually work in the field. Aside from waits to see specialists, or use equipement, the most common complaint is people sitting in the emergency wait room for hours on end. Fortunately it seems to be changing and there is a drive to create a new super-nurse level in the system to help handle routine things so doctors are able to tend to more serious cases (ie. if a tech can draw blood for a sample, then surely a nurse can do stitches on banged up knees, etc).