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July 13, 2007

Waiting Lines

Mark Kleiman tells his story.

July 13, 2007 | Permalink

Comments

No comments there, so I'll say it here. Kleiman does a great job of actually using an anecdote to illustrate a discussion of the issues instead of trying to make it take the place of that discussion.

His experience is also important because of how the President of UCLA felt it necessary to get involved so that Kleiman would receive anything close to timely treatment. Even as this society has created and strengthened a class structure, many Americans hold onto the belief that we are classless, that everyone gets an equal shot. The reason is that most of the people who get preferential treatment - like Kleiman did - aren't willing to admit it and therefore jeopardize their status.

Posted by: Stephen | Jul 13, 2007 3:26:29 PM

I'm less interested in the degree to which we are measuring or not measuring rationing than I am in how Mr. Kleiman's ordeal would have played out in Canada, UK, France, Germany, Switzerland, Australia or Japan. How long would it have taken to diagnose his problem in those other countries compared to here? Would he have received the same treatment and achieved the same positive ultimate result? How much would taxpayers have paid on his behalf as compared to what insurers paid on his behalf here? Even within the U.S., how typical was his experience? Lots of policies don't require all those pre-approvals? Or, how would he have fared within the Kaiser system which many people would like to see replicated throughout the U.S.? I don't think wait times for hip replacements in other countries are terribly relevant in this context.

Posted by: BC | Jul 13, 2007 3:28:56 PM

BC,

Obviously his point isn't that hip replacements and cancer treatments are comparable procedures. What he is doing is dispelling the myth that we have this automatic no waiting lines system. This is particularly important example because for all purposes this was an emergency treatment.

Posted by: phil | Jul 13, 2007 4:00:14 PM

Phil,

I don't think the myth of no waiting is very widespread among those of us who had to actually seek treatment for significant medical issues, especially if you want an appointment with one of the better known doctors in the specialty that you need to access.

In Mr. Kleiman's situation, I would still be interested in how his ordeal would have played out in the other major countries.

Posted by: BC | Jul 13, 2007 4:10:28 PM

Single payer will do nothing to the supply (doctors and their time) and increases the demand for services.

Posted by: Dingo | Jul 13, 2007 4:34:32 PM

BC,

There is no answer to your question. However, if we look at larger datasets than just one person, might be able to.

It's not really true that there is no measurement of US wait times. Just the other day Ezra quoted the CEO of Aetna as saying, "people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month."

He also pointed out this:

A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada. And, most of the Canadian data so widely reported by the U.S. media is out of date, and misleading, according to PNHP and CNA/NNOC.

In Canada, there are no waits for emergency surgeries, and the median time for non-emergency elective surgery has been dropping as a result of public pressure and increased funding so that it is now equal to or better than the U.S. in most areas, the organizations say. Statistics Canada's latest figures show that median wait times for elective surgery in Canada is now three weeks.

"There are significant differences between the U.S. and Canada, too," said Burger. "In Canada, no one is denied care because of cost, because their treatment or test was not 'pre-approved' or because they have a pre-existing condition."

And there's some more, so you might want to follow the link.

We can, if we do some digging, look at patients of a particular specialty in certain cities, or certain insurance companies, or similar data. What we can't do is quickly and easily find statistics for the entire nation, which is another thing that people in countries with universal care can do.

Whatever data we look at, though, the conclusions are always the same: people in America wait longer, pay more and face more rationing (through cost and insurance company parsimony) than the citizens of almost every country in the world that offers universal healthcare.

Posted by: Stephen | Jul 13, 2007 4:38:31 PM

Single payer will do nothing to the supply (doctors and their time) and increases the demand for services.

Dingo even you have to see the moving logic in argumentation here by those opposed to universal health care.

Opponent: "UHC system's have long wait times!"

Supporter: Actually the US has some of the worst waiting times in industrial nations. In fact many countries with UHC have little to no wait times.

Opponent: Well that just proves that if we provide a universal system the US will have even WORSE wait times.

Amusing shifting advocacy there.

Posted by: phil | Jul 13, 2007 4:50:32 PM

I'm all for helping people out. Lord knows I've done more than my fair share over the years and I've never said that the uninsured shouldn't be covered by something. As long as you are realistic though and expect to wait longer I have no problem, but to think its going to be the same or less defies simple math and logic.

Posted by: Dingo | Jul 13, 2007 4:56:58 PM

phil,

Actually the US has some of the worst waiting times in industrial nations. In fact many countries with UHC have little to no wait times.

Both of these claims are false.

Stephen, quoting a statement from a news article cited by Ezra:

A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada.

This claim is also false. The woman who wrote that article is grossly misrepresenting the findings of the Commonwealth Fund study she is referring to. I know this because I actually looked up the study. You should try that too, instead of just uncritically accepting any assertion that is consistent with what you want to believe is true.

Whatever data we look at, though, the conclusions are always the same: people in America wait longer, pay more and face more rationing (through cost and insurance company parsimony) than the citizens of almost every country in the world that offers universal healthcare.

Utter nonsense. The data explicitly contradicts this claim.

Posted by: JasonR | Jul 13, 2007 5:02:28 PM

"Whatever data we look at, though, the conclusions are always the same: people in America wait longer, pay more and face more rationing (through cost and insurance company parsimony) than the citizens of almost every country in the world that offers universal healthcare."

Yeah and your point is?
What do you expect to happen when you add 45 million to the equation wait less?

Posted by: Dingo | Jul 13, 2007 5:13:49 PM

But the wait in American isn't caused by a supply and demand inequality. Kleinman's wait in America was caused by an insurance corporation deliberately extending wait times to force him to switch to a more expensive policy or die before they had to pay for his treatment.

Since there are two different sources of wait times, 1. supply and demand of doctors and patients, and 2. internal insurance company mechanisms, removing one of those mechanisms (insurance company malfeasance) may well overwhelm the change in the other mechanism (supply and demand) to reduce overall wait times.

Posted by: Megan | Jul 13, 2007 5:42:20 PM

The cause of the wait doesn't matter if there's no slack in the system, as Dingo claims.

Obviously we need to expand the system to accommodate increased demand, if we expand medical coverage.

Posted by: Sanpete | Jul 13, 2007 5:46:56 PM

The cause of the wait doesn't matter if there's no slack in the system, as Dingo claims.

Obviously we need to expand the system to accommodate increased demand, if we expand medical coverage.

Posted by: Sanpete | Jul 13, 2007 5:49:04 PM

Whats the problem here? Guy got diagnosed late and had to wait a month for the proper workup?

A month's wait in the scheme of things isnt all that bad. If he had to wait 6 months or a year for a workup then maybe you can say that affected his prognosis.

But cancers dont jump stages in one month.

This guy has some reasons to bitch, but hte month-long workup time aint one of them.

Posted by: joe blow | Jul 13, 2007 5:56:54 PM

Single payer -- or any other national system -- will do a better job of helping supply meet demand than today's fragmented private system. If there's a specialist who could do your surgery tomorrow, but that specialist isn't in your insurer's network, you can be stuck with specialists who have really long wait times.

National health care means that a nation full of doctors are in your network.

Posted by: Neil the Ethical Werewolf | Jul 13, 2007 5:57:28 PM

werewolf,

Single payer -- or any other national system -- will do a better job of helping supply meet demand than today's fragmented private system.

Ha ha ha ha ha! Good one. It must be why shortages and waiting lists are so much worse in Britain and Canada than the U.S.

Posted by: JasonR | Jul 13, 2007 6:16:06 PM

Someone above made a really stupid claim about cancer. I am hoping you were joking. Depending on the type of cancer it can spread rapidly. A month can be the differnce between life and death, and it doesn't even begin to cover the psychological issues.

I also notice some here keep flipping between non emergency, non life threatening care like hip replacement and diagnosing cancer without skipping a beat.

Posted by: akaison | Jul 13, 2007 6:35:46 PM

Single payer will do nothing to the supply (doctors and their time) and increases the demand for services.

Since there are no waiting periods in the USA, though, it is clear that doctors have an enormous amount of "slack time" available.

OR, doctors in the US are all operating way past capacity and can't possibly handle serving the tens of millions of uninsured, which means that the entire health system in the USA is highly defective compared to all other first-world nations, since it requires tens of millions to be excluded from the system in order to function.

Which is it?

Posted by: Tyro | Jul 13, 2007 6:41:28 PM

Sanpete: I eagerly await your side of things' cooperation in the neccessary task of breaking the AMA, then? There's a reason that we don't have enough doctors in the US.

Posted by: NBarnes | Jul 13, 2007 6:43:49 PM

Tyro:

Which ever one will scare you the most.


Akaison.

Posted by: akaison | Jul 13, 2007 6:47:08 PM

Its the 2nd Tyro.
My point exactly Sanpete. You have to build up the infrastructure by by doing things like addressing our incredible nursing shortage for one. We currently have a Yugo that goes 60mph right now. Throwing 5 people in the backseat ain't gonna make it go any faster unless we do some serious modifications to the car.

Posted by: Dingo | Jul 13, 2007 6:48:38 PM

I should note that somehow, someway, the United States went from having a population of 200 million 40 years ago to 300 million today AND added Medicare and Medicaid beneficiaries to the health care coverage roles and still, somehow doctors were able to deal. No doubt that universal health coverage would also contain provisions to handle the increase in business that doctors would face. This is America. We're not morons.

Its the 2nd Tyro.

Really? the US system is clearly in dire straits, then. I suggest we do something radical revamp the entire system in order to fix it. One of those fixes will involve universal coverage.

If all doctors believe that, "the US health care system is horribly broken because it cannot handle the capacity of universal coverage," then they need to stand up and say that. Alternately, they can argue that "the US health system is the best in the world only because we have to keep tens of millions of people shut out of the system and threaten them with bankruptcy in order to function," they should say that, too. Just so we all know that the class warfare lines are drawn clearly and so we know who is drawing them.

Posted by: Tyro | Jul 13, 2007 6:52:01 PM

The AMA has nothing to do with it. You can turn out as many docs as you like, if they don't have residency spots it doesn't matter. The residency spots were frozen more than a decade ago, because the government is short sided when it comes to spending money. It costs alot to train residents so they froze the program and they didn't think of the consequences. You can place the blame squarely on the shoulders of our government not the AMA. I don't know why anyone would think a single payer system would actually have the foresight to pay for things now that will cost us less in the future.

Posted by: Dingo | Jul 13, 2007 6:54:25 PM

wait- so its the governments fault that we have set up a nonsensical system based on less government?

Posted by: akaison | Jul 13, 2007 7:02:59 PM

What revamps would that be? The problem is Tyro is takes 8-11 years to train a physician. You can lower standards and dumb down your applicants and you will solve the problem in about a decade.

You can call it class warfare or whatever, but I don't disagree with either statement that you made. I don't cause people to be bankrupt however I have donated nearly 1 million dollars in free care during my career. Hospitals with their collection agencies and people that lack the foresight to plan for the catastrophic do.

Posted by: Dingo | Jul 13, 2007 7:03:04 PM

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