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October 12, 2005

CanAmerica

Whenever the subject of health care reform pops up, there are a couple uninformed souls who dash forward armed, they believe, with the silver bullet of anti-scoailist arguments.  Canadian waiting lists.  Hoo boy do they shout, scream and caterwaul, the depth of their sorrow for these poor people being forced to wait on optional procedures -- it just tears them up.  Would that America's poor and uninsured receive the same outpouring of emotion!

So please, to all those who think that an operative, meaningful argument, fuck off.  And if you don't believe me, ask Kate.  Born with a genetic disorder that caused childhood rickets, she needs surgery to repair a warped and disaligned femur bone.  Not a huge deal, but frustrating.  She found this out a month before she was supposed to move to DC, and instead went home to Kansas to get treatment.  Now, after bouncing from doctor to doctor, she's finally found a surgeon potentially willing to look into the surgery.  First available appointment? Feb. 16th

Welcome to medical purgatory.  She can't move before she has the surgery as America's health insurance forces you to receive care where you bought the plan if you want full reimbursement (this is what they mean by in.out of network coverage).  Luckily, unlike so many Americans, she can pay for it, has excellent benefits, access to a slew of doctors, and is really at the top of the system.  And yet?  She waits.  And will likely be waiting for awhile yet.  This is what it's like when you're at the top of the system, imagine the hell that is the bottom.  And unlike Canada, America actually has a bottom.

October 12, 2005 in Health Care | Permalink

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» Waiting from Political Animal
WAITING....Via Ezra, Kate explains the reality of waiting lists for healthcare in America. Long waiting lists. For someone with good coverage and access to lots of doctors. Best healthcare in the world, baby, best in the world. Just keep telling... [Read More]

Tracked on Oct 12, 2005 5:47:00 PM

Comments

There is a sign in all of the "waiting rooms" at Oregon Health and Sciences University's Medical Clinic - to remind "patients" - as in 'be patient' -that if they cannot afford to pay, or have adequate insurance, that the clinics will only provide immediate paliative care - stopping the bleeding, so to speak - and not full treatment, which they must seek elsewhere.

The longest "waiting list" of all is the list of those who are uninsured, and have no financial resources: they can wait forever or until they are carried into the ER at the brink of death.

Our 'system' of medical coverage can only be described as shameful disregard for people's lives.

Posted by: JimPortandOR | Oct 12, 2005 1:54:47 PM

I don't know how useful Kate's situation is as a comparison. How long would she have to wait in Canada? Waiting a few months for a very unusual non emergency surgury doesn't seem like an unreasonable amount of time to me.

Posted by: Dave Justus | Oct 12, 2005 2:11:28 PM

It might seem a lot more unreasonable to you if YOU were the one waiting. She's outside your monkeysphere.

Posted by: Andrew | Oct 12, 2005 2:22:57 PM

Dave Justus,

I don't know enough about the Canadian system, which is administered provincially, but if Kate were British, had left university at Warwick or Bristol and gone on to get a job in London, she wouldn't have had to worry about her insurance benefits, because she could have gotten a GP in London and gotten the surgery there. She wouldn't have needed to put her life on hold.

Posted by: Bostoniangirl | Oct 12, 2005 2:24:10 PM

Andrew,

I am sure it is frustrating for her, and I feel bad for her difficulties. However, unless you can provide some convincing evidence that some other system could provide this service faster, I maintain that this amount of time does not seem unreasonable.


BostonianGirl,

That is true, and is also an entirely seperate issue from long wait times. Portability of health care is a serious issue I think, it is mostly a result of a state based regulatory system.

Posted by: Dave Justus | Oct 12, 2005 2:45:23 PM

I maintain that this amount of time does not seem unreasonable.

Implicitly, I assume that her need to move back to Kansas is something you consider unreasonable.

Lots of waiting periods for non-emergency surgery are considered "reasonable." That's why they exist. However, it seems that waiting periods are "reasonable" only when they're a product of the American health care system. Waiting periods for non-emergency surgery are considered reason for much beating-of-breasts and rending-of-garments when they occur in Canada and England. Those of us who've actually had to seek medical care in the US are well aware that waiting periods are part and parcel of the medical system.

Posted by: Constantine | Oct 12, 2005 2:52:09 PM

I was recently in a traffic accident and have very good insurance. I was able to follow up with my primary care doctor with only a week's wait, but after that, I needed to wait three weeks to get in to the orthopaedist to check on my knees. I've got a PPO, so it's not like I needed a referral for the ortho, either.

My Mom? Had to wait three months for her hysterectomy. My Aunt-In-Law? Noted some abdominal issues that might be ovarian cancer. Saw her doc and got x-rays and confirmed a large ovarian mass. She had to wait two weeks to get in to see the oncologist (which, if you know anything about ovarian cancer, any wait is very bad, indeed) and then another week to have the surgery. Both women had plenty of good medical insurance.

So, yes, in my experience, the the "long wait" argument is pure poppycock.

Posted by: Jill Slater | Oct 12, 2005 3:39:49 PM

It has nothing to do with whether it's unreasonable -- the problematic part is Kate's life circumstances, not the wait time. The key, though, is that we have obvious, long waiting times and less geographic mobility. The idea that Americans don't wait is idiocy.

Posted by: Ezra | Oct 12, 2005 3:45:18 PM

Jill's story seems to be one that is more ammenable to analysis. What is the average wait time in Canada between diagnosis and surgery for ovarian cancer?

Three weeks from diagnosis to surgery seems fairly quick to me, but I certainly don't claim to be an expert on that.

Ezra, when you start you post with a diatribe against those who talk about long wait times in Canada because we have long wait times in the U.S. it seems to me that your supporting anecdote should actually support the idea that we have wait times as long as it they have in Canada. Geographic mobility is a seperate issue, and might I suppose mitigate for a longer wait time. Certainly I think it would be a good thing regardless of whether we had single payer or a system much like our current one (with less 'lines'.) Those lines though are not related at all to the fact that we have a private insurance industry, they are related mostly to government regulations on that industry.

Posted by: Dave Justus | Oct 12, 2005 3:58:55 PM

Dave Justus,

That is true, and is also an entirely seperate issue from long wait times. Portability of health care is a serious issue I think, it is mostly a result of a state based regulatory system.

This is not entirely a seperate issue. Were someone stuck in, say Kansas, able to be covered in another place, thick with physicians, say, somewhere near the Eastern seaboard, presumably waits could be reduced.

Posted by: TJ | Oct 12, 2005 4:02:12 PM

Great, someone has an anecdotal story about waiting in line and I'm supposed to pay for Rosie O'Donnell's visits to the doctor in response (the dream of other people paying for his health care via single payer). Makes perfect sense.

Posted by: RW | Oct 12, 2005 4:17:53 PM

The regulatory system is the reason for portability? Dude -- that's just ignorance. Portability is a cost control mechanism. That's why I'm out of network in NorCal and in network in SoCal. Big though we may be, we're still but one state.

Posted by: Ezra | Oct 12, 2005 4:18:22 PM

Wait times are a problem in Canada (for some procedures and in some regions). But they're a fixable problem, one the government is working on -- fixable without radically changing the way we do health care (though radical change may be coming anyway...) But the comparable problem in the US -- the "bottom" -- can't be changed without radical overhaul. That's a big difference. From a human-welfare perspective, Canada's system needs tweaking, maybe fairly major tweaking. But the US system needs overhaul.

I'm white, middle class, healthy, and thank my lucky stars I don't have to mess around with private health insurance because of Medicare.

Posted by: tlaura | Oct 12, 2005 4:40:26 PM

I just wrote a post on healthcare the other day, and my British husband, who grew up with the NHS and would exchange it in a New York minute for the constant worry about keeping coverage and the wrangling with insurance companies to make sure claims are paid, left a splendid comment:

The Healthcare "system" in this country is one of the cruellest whips Corporate America has to wield upon the backs of its workers, and the fear of not having insurance is a major impediment to entrepreneurship. It is also the most inefficient system in the world, and the U.S. government is currently paying more per capita to prop it up via medicare and medicaid than Canada spends on its fully comprehensive and universal healthcare system.

It amazes me that there are some people who will become paralyzed with fear at the notion of government being in charge of their healthcare, but are quite comfortable with a gang of plutocrats and actuaries having control over what treatments they can and cannot receive.

The irony is that when America tries its hand at socialism it is spectaularly good at it. The Social Security system is the envy of the western world. I'd love to see what the U.S. could do with a nationalized helath care system.

Posted by: Shakespeare's Sister | Oct 12, 2005 5:11:28 PM

I'm not making the argument that it takes less time in Canada to get a procedure than it does here. What I'm saying is to people who go on and on about waiting in Canada is that it's bullshit! We wait here too! It may not be as long, but we get to wait here, and we get to constantly worry if we'll have health care, and we get to pay an increasing share of the premiums, and we get worse health outcomes for dollars spent and...on and on.

I've no doubt I'd have to wait in Canada as well (and I'll even admit I'd probably have to wait longer). It just irks me when people act like our system is perfect, because as a LOOOOOONNGGG time health care "consumer" in the US, let me assure you it's far from it.

Posted by: Kate | Oct 12, 2005 5:32:21 PM

I'm white, middle class, healthy, and thank my lucky stars I don't have to mess around with private health insurance because of Medicare.

I'm assuming you're of retirement age, since you're "middle class" yet on the public dole for your health care.

Posted by: RW | Oct 12, 2005 6:33:52 PM

Sorry, I reread the post. I differ with Ezra's analysis, so I'm supposed to "f*ck off". Very adult.

Does that sort of argument get street cred, somewhere?

Posted by: RW | Oct 12, 2005 7:14:39 PM

RW-- tlaura's Canadian. Medicare is what Canadians call their single payer system. Are you saying that no Canadians are middle-class since all of them are "on the public dole," to use your term, for their health care?

Posted by: Bostoniangirl | Oct 12, 2005 7:17:03 PM

Yup. You read the words, and since there's no such thing as a figure of speech, you must now fuck off.

Posted by: Ezra | Oct 12, 2005 8:00:28 PM

I live in Canada. I needed a heart operation. The surgeon told me they could arrange it for next week. I told them I wanted to go to Italy for a month for a particular scientific meeting where I had been invited to speak. They said okay, we'll make it for one week after you return.

Waiting lists do occur in Canada, but I have never experienced a wait for longer than I need or wanted. Knee and hip replacements sometimes take as long as a six-month wait in the city where I live -- but overall, people are quite satisfied with thhe system, and I have not known anyone who has complained about the health care system.

Posted by: Post-Toll | Oct 12, 2005 8:35:42 PM

Kate:

Have you tried working with the appointment schedulers to get a sooner time? Usually there is a "bump list" or a "cancellation list" and, if you are flexible about time, they'll work you into to one of the inevitable cancellations that occurs between now and February. (Hint: they are poorly paid and they take a lot of crap, so kissing up is important.) My guess is that you are trying to see somebody who is pretty cutting edge and they are a lot busier than the regular docs.

Posted by: J Bean | Oct 12, 2005 8:55:21 PM

I live in Canada, and when my father was diagnosed with bone cancer this year the doctors had him undergoing radiation treatment on the day they got the test results.

When it matters, the Canadian health care system moves very quickly indeed.

Posted by: Kevin Brennan | Oct 12, 2005 10:57:49 PM

I don't particularly care whether RW f***s off, but I hope he has the enlightening experience of getting hit by a bus, so that I can then refuse to pay for his healthcare. Being as how his political philosophy is all about self-reliance.

Jerk.

Posted by: brooksfoe | Oct 13, 2005 12:22:49 AM

someone has an anecdotal story about waiting in line and I'm supposed to pay for Rosie O'Donnell's visits to the doctor in response (the dream of other people paying for his health care via single payer).

You have an interesting fantasy about how, under the current system, you're not paying for Rosie O'Donnell's doctor's visits. Or, to turn the gem and show another facet, your fantasy extends, I expect, to the belief that you are somehow not currently paying for emergency room visits by people below the poverty level but you would be under single-payer.

Posted by: NBarnes | Oct 13, 2005 3:28:03 AM

RW: what part of "Single-payer systems are cheaper, fairer and have better outcomes" don't you understand?

Posted by: Ginger Yellow | Oct 13, 2005 8:45:20 AM

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