Political Roundtable Part XIII

[Induveca]

Former Montreal resident, agreed the "level" of hospital care there was very poor. The hospital queues were insane, and the entire hospital system had the feel of a 1990s DC area DMV.

I was only there a little over a year, but some of the local doctor offices were literally carpeted apartments with cheap plastic chairs.

Taking competition out of any profession always strips those in the profession of a desire to improve, and eventually leads to mediocre (or worse) service.

[Wizardspride]

Hey Nate,

You said you would change your tune on Trump if it was proven he lied about Obama wiretapping him....

bump

Another "bump"...

[tontoz]

Trump has done and said a lot of offensive things. Most of the time my reaction is like whatever Trump gonna Trump.

But to me the cheap shots against Obama are really out of line, for the obvious reasons.

[Wizardspride]

Trump has done and said a lot of offensive things. Most of the time my reaction is like whatever Trump gonna Trump.

But to me the cheap shots against Obama are really out of line, for the obvious reasons.

Yeah, it's one thing to lie about crowd sizes etc but accusing someone of a felony with no (apparent) evidence...

Though in retrospect, we shouldn't be shocked.

Trump has already questioned the man's citzenship, academic credentials etc etc

[sfam]

As someone who started off in the States, then moved to Canada later in life, I'll go ahead and provide more direct experience than simple anecdotes.

Universal healthcare in Canada means that the demand is extraordinarily high. I have had to wait for hours in an emergency room when my symptoms meant I might have a blood clot - and when I did get seen, I was placed on a spare bed outside of a room because they were full.

My wife has needed an MRI on her knee and probably surgery for years now, but we can't get a doctor to actually send her to a specialist. Since she can walk normally it's not serious enough to them. We could go to a lab out of pocket for the MRI, but then we'd still need a doctor to actually do something with the results. If we ever do get one to agree that the chronic pain she feels after exercising and the way her messed up knee twists and displaces her hip is medically significant enough to warrant a specialist, we will need to wait months before an appointment will be available.

There are many good things about the Canadian system. Medications are not terribly expensive in most cases. It seems that they've done a better job of bringing costs down then anywhere in the States that I am aware of. But there are weaknesses too, and some of them are more than just an annoyance.

For instance, right now I am actually unable to find a doctor within driving distance. That's not technically true - there is one family practice in my town taking on new patients. It's just that they have a terrible rating on every doctor review site I've found, so I made the call that it would be better to go without than to go with a legitimately bad doctor. But that's it. One guy taking on patients in a 50 KM radius around me. The healthcare is universal... if you can wait long enough, and if it's even available.

I really appreciate an actual testimony. Regarding your emergency room experience, I wish I could say we have different emergency room experiences, but that's pretty much the same here. Go to an emergency room at a bad time and you sit for a long time, especially if you have no insurance, but even if you do. Worse was my uncle experiencing a stroke.

Regarding your MRI problem, is that normal? If so, why do the vast majority state they are satisfied with their health care?

Also, do you ever have problems with them not paying for procedures? How many hours a year do you spend fighting administrative paperwork issues?

Also, do you live in a rural area, suburban or city? And do you think this impacts the quality of care at all?

Finally, are there "top-up" type insurance policies you can buy to get specialized care quicker?

EDIT: On the legitimately bad doctor in your area, I mentioned this in a previous post - there are real problems in the US with doctor ratings. Often a poor rating may just imply the doctor takes all patients whereas a high rating means the doctor is far more selective in their patients - meaning they are more concerned about receiving a positive rating than ensuring everyone gets good care. Just given your story, I would be worried the same dynamic might exist in Canada, but have not knowledge on this.

[sfam]

Trump has done and said a lot of offensive things. Most of the time my reaction is like whatever Trump gonna Trump.

But to me the cheap shots against Obama are really out of line, for the obvious reasons.

Really appreciate the comment. Even if he lines up perfectly on policy positions, basic decency is not conservative or liberal.

[sfam]

Former Montreal resident, agreed the "level" of hospital care there was very poor. The hospital queues were insane, and the entire hospital system had the feel of a 1990s DC area DMV.

I was only there a little over a year, but some of the local doctor offices were literally carpeted apartments with cheap plastic chairs.

Taking competition out of any profession always strips those in the profession of a desire to improve, and eventually leads to mediocre (or worse) service.

If it was 1990s DC area DMV, how on earth could there be more than 5% support for it? Instead we see quite the opposite. It sounds like for special care items there are shortages, and perhaps in certain areas. But if everyone is experiencing this, there is no way the surveys come out as they do.

And again, health care market dynamics just don't work like other industries. Its counter-intuitive but it doesn't. The insurance provider in the middle brakes the normal quality versus cost and service dynamic between buyer and seller. And unfortunately the competition most often revolves around the latest drug which may only be 6% better but costs 40% more, or the better imaging system at the other hospital in the area that is only 3% better but costs 30 million. Insurance companies pay for all of that, and sick people could care less because they aren't paying.

If you told someone they would pay 40% more for a 3% increase in care, would they do it? Of course not. But if the Cincinnati General Hospital can advertise their imaging system is performs better than their competition in industry tests, they get more doctors and more business, which forces the other hospital to "keep up with the jones' and buy the same system. Insurance companies are fine paying for both - if overall costs rise, this is not a problem for them as their percentage grows as well. This is not my story, but was one told to me by a CFO of a health care system.

[tontoz]

a sfam pretending like he knows what he is talking about by looking at surveys.

Single payer would have been great for me over most of my life because I rarely needed medical care that wasn't routine. But when you have a serious medical problem, single payer sucks.

That is why Canadians routinely come here for treatment. This has been going on a long time. People all over the country were being treated with proton therapy well before Canada got approval for their first machine. Same old story that has been repeated time and again.

[dckingsfan]

Former Montreal resident, agreed the "level" of hospital care there was very poor. The hospital queues were insane, and the entire hospital system had the feel of a 1990s DC area DMV.

I was only there a little over a year, but some of the local doctor offices were literally carpeted apartments with cheap plastic chairs.

Taking competition out of any profession always strips those in the profession of a desire to improve, and eventually leads to mediocre (or worse) service.

If it was 1990s DC area DMV, how on earth could there be more than 5% support for it? Instead we see quite the opposite. It sounds like for special care items there are shortages, and perhaps in certain areas. But if everyone is experiencing this, there is no way the surveys come out as they do.

And again, health care market dynamics just don't work like other industries. Its counter-intuitive but it doesn't. The insurance provider in the middle brakes the normal quality versus cost and service dynamic between buyer and seller. And unfortunately the competition most often revolves around the latest drug which may only be 6% better but costs 40% more, or the better imaging system at the other hospital in the area that is only 3% better but costs 30 million. Insurance companies pay for all of that, and sick people could care less because they aren't paying.

If you told someone they would pay 40% more for a 3% increase in care, would they do it? Of course not. But if the Cincinnati General Hospital can advertise their imaging system is performs better than their competition in industry tests, they get more doctors and more business, which forces the other hospital to "keep up with the jones' and buy the same system. Insurance companies are fine paying for both - if overall costs rise, this is not a problem for them as their percentage grows as well. This is not my story, but was one told to me by a CFO of a health care system.

Single payer doesn't work until you take care of the underlying cost issues.

1) Cost of employees
2) Cost of drugs
3) Cost of hospitals
4) Cost of implants and hardware
.
.
.
.
somewhere down there) Cost of insurance companies.

We still go bust.

[Induveca]

Former Montreal resident, agreed the "level" of hospital care there was very poor. The hospital queues were insane, and the entire hospital system had the feel of a 1990s DC area DMV.

I was only there a little over a year, but some of the local doctor offices were literally carpeted apartments with cheap plastic chairs.

Taking competition out of any profession always strips those in the profession of a desire to improve, and eventually leads to mediocre (or worse) service.

If it was 1990s DC area DMV, how on earth could there be more than 5% support for it? Instead we see quite the opposite. It sounds like for special care items there are shortages, and perhaps in certain areas. But if everyone is experiencing this, there is no way the surveys come out as they do.

And again, health care market dynamics just don't work like other industries. Its counter-intuitive but it doesn't. The insurance provider in the middle brakes the normal quality versus cost and service dynamic between buyer and seller. And unfortunately the competition most often revolves around the latest drug which may only be 6% better but costs 40% more, or the better imaging system at the other hospital in the area that is only 3% better but costs 30 million. Insurance companies pay for all of that, and sick people could care less because they aren't paying.

If you told someone they would pay 40% more for a 3% increase in care, would they do it? Of course not. But if the Cincinnati General Hospital can advertise their imaging system is performs better than their competition in industry tests, they get more doctors and more business, which forces the other hospital to "keep up with the jones' and buy the same system. Insurance companies are fine paying for both - if overall costs rise, this is not a problem for them as their percentage grows as well. This is not my story, but was one told to me by a CFO of a health care system.

I'm speaking from personal experience. My best answer is people are quite happy until they get truly ill and require more than basic care. At that point it's hell. Hard to complain about "free", if you haven't experienced the system.

It was easier much of the time to just drive 70 miles to Upstate NY and go to one of the copious walk-in clinics near the border which are full of Canadians. No need for the 1-2 month wait to see a doctor, and they'll do bloodwork on-site and call you the next day or same day.

Alternative was an 8 hour ER stay in Montreal, at which point they constantly declare something like a severe sore throat unworthy of antibiotics, and essentially prescribe you 3 weeks of slow unnecessary recovery in the name of humanity, and say treatment is not "medically necessary". Or even worse declare you "stable" for something like palpitations and perform zero blood tests or EKG in hospital, and make you a referral with a random specialist. You call said specialist, not available for 2-3 months.

Then again, free.

It was very frustrating at times. "Medically necessary"....it's a broad term many times used to just not provide care in Canada.

https://www.usnews.com/news/best-countries/articles/2016-08-03/canadians-increasingly-come-to-us-for-health-care

[Wizardspride]

Read on Twitter

[Illuminaire]

Regarding your MRI problem, is that normal? If so, why do the vast majority state they are satisfied with their health care?

Yes and no. Basically, doctors in Ontario (other provinces may vary) have a strong tendency not to send you 'up the chain' to a specialist if they can help it. Not with life-threatening issues, of course. But quality of life problems are very hit or miss, and you are at the mercy of your doctor to make that decision for you. There are very few options to find an alternative if your family doctor shuts you down. You often have to start by finding a new family doctor, and in most places those are in higher demand than there is a supply.

Also, do you ever have problems with them not paying for procedures? How many hours a year do you spend fighting administrative paperwork issues?

This is never a problem, and a very real strength of the system. When you have your OHIP card, if it's covered by Ontario healthcare, it's just covered. You don't do anything but give them your card and call it a day. I cannot complain about this part of the system.

Also, do you live in a rural area, suburban or city? And do you think this impacts the quality of care at all?

Suburbs. I'm not sure how this impacts things, to be honest. There is a hospital in my (little) city and several clinics. There is a real effort being made to provide care for everyone. And still, there is a shortage of doctors, nurses, and support personnel.

I will ask my friends that live in Toronto or it's immediate suburbs about their experiences and see what they have to say. I'll let you know when they get back to me.

Finally, are there "top-up" type insurance policies you can buy to get specialized care quicker?

You can buy private insurance coverage, yes. That will not get you access to specialized care quicker, though. You're just buying a different way of paying for the same product; the doctors and clinics you have access to are the same, and the rules they play by are the same no matter what your insurance is.

The main benefits of private coverage are for gaps that OHIP doesn't cover (dental, for example) or procedures that are only partially covered. Side note: the coverage provided by OHIP is pretty impressive, to be honest. In theory it's an excellent plan for the effective cost (in taxes). There just doesn't seem to be enough manpower to put the theory entirely into practice - I don't know if that's because the cost controls necessary also suppress people going into the health care industry, or if it's just not possible for there to be enough qualified doctors.

EDIT: On the legitimately bad doctor in your area, I mentioned this in a previous post - there are real problems in the US with doctor ratings. Often a poor rating may just imply the doctor takes all patients whereas a high rating means the doctor is far more selective in their patients - meaning they are more concerned about receiving a positive rating than ensuring everyone gets good care. Just given your story, I would be worried the same dynamic might exist in Canada, but have not knowledge on this.

In this case I read through the complaints. Lots of people saying this gentleman doesn't listen to what you are complaining about, gives the fastest possible advice/lowest common denominator prescriptions and shoves you out the door. That kind of thing. That is an issue you see here wherever the shortages are the worst... there are doctors who try to churn patients as quickly as possible, with no concern for quality. After all, who else are you going to see?

That's not an issue unique to Canada's system. It is pertinent to questions about what to do in the States, though. As demand is raised, supply has to keep pace or you will hit these kinds of issues. Of course, it's hard to raise supply without raising costs... the eternal dilemma of any economic system.

I'd like to see the US start by bringing costs down on medications, instead of systematically empowering a corrupt pharma lobby. After that, I wonder if marketplace style systems with transparent pricing, combined with universal access to affordable insurance policies, might bring together the best of both worlds.

That's getting into my own views on healthcare, though. I'll stop rambling and leave it at that.

[Illuminaire]

1) Cost of employees
2) Cost of drugs
3) Cost of hospitals
4) Cost of implants and hardware
.
.
.
.
somewhere down there) Cost of insurance companies.

We still go bust.

This is where I'm coming from, too. You need to build the infrastructure to supply the healthcare before you open those floodgates. That includes incentives for people to become doctors (plus nurses, pharmacists, people who fill out and process paperwork for medical records, etc...), and enough schools training them to meet those needs.

You also need to establish a competitive market for everything from MRI machines to antibiotics to the little plastic boxes they dispose needles in. Without driving all of those prices down (and giving suppliers a reason to innovate and increase efficiency) you can't pay for everyone to have quality healthcare in a reasonable time frame.

Insurance isn't really the biggest issue. Cost of healthcare is.

[dckingsfan]

1) Cost of employees
2) Cost of drugs
3) Cost of hospitals
4) Cost of implants and hardware
.
.
.
.
somewhere down there) Cost of insurance companies.

We still go bust.

This is where I'm coming from, too. You need to build the infrastructure to supply the healthcare before you open those floodgates. That includes incentives for people to become doctors (plus nurses, pharmacists, people who fill out and process paperwork for medical records, etc...), and enough schools training them to meet those needs.

You also need to establish a competitive market for everything from MRI machines to antibiotics to the little plastic boxes they dispose needles in. Without driving all of those prices down (and giving suppliers a reason to innovate and increase efficiency) you can't pay for everyone to have quality healthcare in a reasonable time frame.

Insurance isn't really the biggest issue. Cost of healthcare is.

This would be tough for any party - but here is part of what they need to do.

No Employer-based insurance through the tax code (including government) and treat it the same as individual plans

Greatly curtail medical malpractice by limiting remedies

Accelerate drugs available over the counter, don't allow for patent drugs that have already been patented (like mixing two patented drugs together).

Change antitrust laws on drugs and duration of patents

Offer a tax deduction for those providing health care services to indigents

Fix the FDA approval process

Tear down as many regulations as possible - especially the most costly ones

Fix or remove the specialty hospitals certifications

Break the AMA monopoly on medicine and prevention of for-profit healthcare and expand who can deliver care so health providers have to compete for the customer

Where possible, promote telemedicine and other modern delivery systems

Fix or repeal HIPAA

Force health care providers to post prices online (yeah, that one will be tough)

Government promoted health status insurance to deal with pre-existing conditions

Push Health Savings Account spending

Get rid of the limitation to purchase health insurance across state lines

Let individuals pool together to create their own group insurance

Make Medicaid work with the market (negotiate prices, etc.) don't let it get destroyed by deficits

Allow affluent seniors to opt out of Medicare

[dckingsfan]

And this is where Trump completely misses the mark on immigration:
https://www.nytimes.com/2017/03/18/us/doctor-shortage-visa-policy.html?_r=0

[Induveca]

+1 on telemedicine. It brings costs *way* down for everyone involved. I use it almost exclusively to manage a condition, and just upload my numbers prior to the chat session.

[Wizardspride]

Read on Twitter

Read on Twitter

[montestewart]

+1 on telemedicine. It brings costs *way* down for everyone involved. I use it almost exclusively to manage a condition, and just upload my numbers prior to the chat session.

Other than occasionally getting doctor or nurse advice by phone or email, I haven't really made use of telemedicine, but I'm frequently amazed how I am able to address my own medical issues using advice from my own friends and family in the healthcare fields, usually communicated via phone or email. Am currently addressing a disc issue following advice of a relative who is a physical therapist. Might as well see if the exercises and stretches can heal me before committing to a possibly protracted and expensive process within the medical system.

My favorite doctors in recent years are the ones who personally make the best use of information technology and have the best office management skills. We currently have a pharmacist who prompts doctors to refill prescriptions, mentions alternative meds we might bring to the attention of our doctors, and has caught instances of multiple doctors prescribing meds that should not be taken together. Related to some other comments in this discussion, it is worth noting that the best pharmacist I have ever had is an Iraqi native, underscoring the need to make sure immigration laws do not prevent quality contributors from resettling in the U.S.

I can imagine how much more efficient a lot of the healthcare delivery system might be incorporating better communication technology, eliminating a lot of waiting rooms, queueing, etc. That is progress to me. Preventive medicine is a crucial component to cutting healthcare costs, as is efficient use of technology and better healthcare education in general. It might be interesting to look at those cities and states that routinely score better across various healthcare measures (diet, exercise, obesity, smoking, etc.) and see what the connection is between such measures and healthcare costs in those areas. (Maybe someone has already started compiling such data.)

[FAH1223]

Tax cuts of 2001 and 2003.

Plus two wars launched in 2001 and 2003.

All put onto the National Debt.

Never forget.

Read on Twitter

[FAH1223]

Read on Twitter

Read on Twitter

Read on Twitter

Read on Twitter

Read on Twitter

Read on Twitter

Read on Twitter

Read on Twitter

Read on Twitter

As usual the Israelis are denying losing the plane, one is reported to have crashed in Jordan, the other damaged.

In December the supposed Israeli plane crashed on Israeli soil and the pilot was able to bail out, of course with the obligatory denial by Israel.

The Syrians in this incident used old S-200 missile system from the 70's, but this is confusing when you realize that its not the same weapons system. The missile carrier looks identical to the newer ones from a distance but this hides all the upgrades that were done making it an entirely new system.

The actual missiles are more compact and the radar and electronics are fully digital with the latest off the shelf components thanks to commercially available parts from Japan and Taiwan. This means that unlike its namesake used by the Egyptians in 1973, this is more resistant to jamming, much more capable and it cost peanuts to upgrade because it shares some of the stuff inside your iPhone and router.

The other thing that is usually overlooked by journalists is secure data-link technology.
The Israeli planes are painted by S-300 radars on Russian ships in Latakia and the S-400 at Khmeimim Air Base as soon as they take off deep inside Israel's border all the way into Syria. The data link allows S-300 and S-400 radars operated by the Russians to guide Syrian missiles covertly, allowing them to ambush the Israelis.

This is all due to Israeli arrogance. Next time they will use standard operating procedures which have dedicated electronic warfare planes, and Suppression of Air Defense (SEAD) aircraft in the package.

This level of jamming will not stop S-300/S-400 systems from targeting and hitting them, but it stops the data link that allows Syrians with their older systems to turn off their radars and sneak in some missiles in an ambush.

The Israelis will continue probing and poking, until they get their fingers burnt, they cannot help it.

The Syrian conflict is terrible due to the loss of lives and destruction, but for all the observers it is scary and exciting from a technological, and tactical point of view.

It raises A LOT of interesting implications and any new war fought in the future will look more like Syria 2012-2017 than the Gulf War 1. The same with the conflict in eastern Ukraine. Israeli military analysts are shytting their pants on Twitter.