Shed some light on Canada's Healthcare system please

[drlexygoat]

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A friend of mine was asked in an interview to contrast and compare canada's healthcare vs the US. She was totally caught off guard and stumbled through it. I'm sure most of us would have done the same!

Can anyone fill me in on how Canada runs their healthcare? It's good to know not only for the question above but to throw into conversation during the interview (get some worldly-knowledge bonus points).

thanks everyone

 

[jeffsimz]

What we have here in Canada is "universal health care". Any Canadian citizen or landed immigrant (same as green card holder) is entitled to health care benefits whether at the hospital or at a local physicain's private practice. The cost of this health care is paid in your yearly taxes. In Ontario, where I am from, everyone has an OHIP card...whenever you go to the hospital or a doctor's office, you just show this card and everything is taken care of. That's the jist of the system. There is a problem with long waiting lists here for elective surgeries but it is nice to know that everyone is eligible to recieve healthcare regardless of how much money they make. Let me know if I can be of greater help.

Jeff

 

[Thewonderer]

Canada has a national health care system BUT at least 10 different adminstrative units.

Each province's and territory's ministry of health is responsible for insuring all its residents (hence, 10+ administrative units). The federal government agrees to give extra funding to these ministries of health if they come up with a scheme of universal coverage for its residents. Therefore, everybody is covered. However, some provincial governments are rich (such as Alberta) so you don't need to pay any premium. But some are not so rich (such as BC and Ontario) and they do charge some nominal premium if you make certain amounts of money. Nevertheless, the financial scheme they come up with has to guarantee "universal coverage" (i.e. affordable for people of all income levels) otherwise they don't get their payments from the federal governments. Therefore, there is slight difference in the way health care is provided and funded from province to province. But ultimately the bulk of the funding does come from the tax system.

One important difference between Canada's system and the one in UK and Germany and others is that doctors are entrepreuners. You can view it as a public system within which private entities compete.

Government (or each provincial ministry of health) sets the rate of reimbursements every year. Then hospitals and doctors are free to get their patients to come to them and charge per procedure/visit. However, there might be caps on how many patients you can see a day (quality control). But the details, again, are worked out by individual provinces. Therefore, you can NOT make a blanket statement on how health care is delivered in Canada OVERALL.....

 

[MeowMix]

I recommend that you read the recent proposal for single-payer national health insurance in the U.S., published in JAMA. This compares the US system to Canada and others, with useful stats, and gives a good foundation for understanding the problems with the US system.

If the link below doesn't work, it's in the Aug. 13 issue, p. 798.
http://jama.ama-assn.org/cgi/content/full/290/6/798

Then you can ponder the contradictions between this proposal and the AMA-endorsed Medicare bill.

 

[Treg]

Actually in Alberta we pay $38/month, so it is not free (almost).

Also, in Canada you need a top up plan to cover pres. drugs, ambulance rides, upgrades to semi-private/private hospital rooms, etc.

I have experienced both sides and I much prefer the Canadian system.

Treg

 

[drlexygoat]

You all are great - thanks so much for the useful input

 

[superdevil]

as a US resident, i think the long waits for non-emergency stuff would displease me. hopefully the canadians on this thread can shed some perspective on this anecdote of mine: i work in a lab with a dude from quebec. his mother is a psychiatrist there. she says that one of the chief reasons for the waits up there is the fact that doctors can only claim so much salary per year (for an arbitrary estimate, let's call it $200,000/yr--canadian dollars) until they are penalized in taxes to the extent that it is not worth their effort to see as many patients as american docs (kind of like the US's progressive tax scales, only much, much steeper). she says that she knows surgeons and such who work about 50 hours/wk for about 9 months, and once they reach that threshold, they take the rest of the year off!

like Thewonderer said, though, each province is different, and this is in quebec. can someone please attest to the validity of this (this fella is a really reputable source--maybe i just lost something in my memory)?

 

[perfectmoment]

i think it's got more to do with the fact that we don't have as many hospitals or as much technology. for instance, canada has like, ~30 MRIs (someone correct me on this), and when you've got so few, there are going to be waitlists for the use of such hightech equipment. unlike in the states where probably every decent-sized hospital has an MRI. but yeah, you're correct, many (if not all) docs are capped. i think as a family doc, you can only bill the government for 300k, after that, you can pretty much take a vacation because it's useless working any longer.

 

[jlee9531]

hey meow....

can you post the article in this thread because you gotta be a member to read the link.

thanks 😉 (that is whether or not you do it. no pressure or anything haha)

 

[jesswise]

Well, Canada's big. Things are different in different provinces.

I live in New Brunswick, in a small city that's a regional center.

One family doctor in my city bills $1 million annually. His nurse is my next-door neighbor and cousin. This number is reliable.

I lived in the US for 27 years, and moved to Canada 2.5 years ago. For the first time in my life, I now have a family doctor who knows me, my children, and "manages" my total care. I had a broken scaphoid (bone in wrist) that had not healed after 10 years. The local orthopedic surgeon declined to operate, but I found a guy in Toronto who does scaphoid reconstructions as a specialty. Medicare paid for me to go to Toronto and have the reconstruction done. I go to the ER, my family doctor, the shrink fror ADD, etc. and never make a co-pay, never spend a cent.

I am politically conservative. I believe socialism incentivizes laziness and dependence. But I know that the United States is wealthy enough as a country/society to provide for the health of its citizens and legal residents. I now believe Canada has it right, with regards to health care and universal coverage.

As an aside, malpractice judgements are VERY rare in Canada. I predict that as jury awards increase in the US, the flow of MDs will reverse, like the falls of Saint John, and Canada will experience an influx of doctors from the states seeking reasonable fees for reasonable work without insane insurance costs.

Gotta love long posts.

Jess

 

[MeowMix]

Originally posted by jlee9531
can you post the article in this thread because you gotta be a member to read the link.

It's way too long (8 journal pages). It's worth digging out of the library or seeing if you can find online somehow.

Here's the abstract:

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance
The Physicians' Working Group for Single-Payer National Health Insurance*
JAMA. 2003;290:798-805
The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care?the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least $200 billion annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage.

 

[ocean11]

As for our health care system here in Canada, yes it is 'universal' meaning that everyone has access to care no matter what salery they make, or if they are employed or not. The government pays most doctor's salaries (exp for a few... namely Plastic Surgeons or some Opthamologists/Dermatologists who have a semi-private practice). Doctor's salaries are usually 'capped' when they reach the 'maximum' amount of patients that they can see/day or per month.

The gov't dosn't have infinite resources and thus the amount of physicians in certain provinces, namely Ontario is capped to a certain extent too! It is very hard for foreign doctors to work here! (many are taxi cab drivers SERIOUSLY!) and ofcourse not enough spots in med schools... in addition ofcourse many physicians move down south... THEREFORE there is a problem with resources and amount of physicians and HENCE the whole system is suffering...

If you go to the ER, you'll likely wait an average of 4-5 hours just to be seen by a physician. I once had to wait 4 hours to get a cut on the side of my face stiched up.... I was bleeding the whole time. In addition, seeing a specialist might takes weeks or months because they are so booked up. Surgeries are usually booked MONTHS in advance, sometimes even a year in advance. Even cancer patients who need a tumor removed may wait several months...

However, when it comes to primary care access here is great! and yes in small towns or even large cities your GP usually knows you quite well. Although, you may wait months for your open heart surgery, you won't pay a dime after its completed and the hospital stay is 'free' (although usually very short.. they might discharge you the SAME day!!!).

The system is not wholly free though! Canadians are expected to pay for a fraction of several procedures. An ambulance ride will cost you $45 (the gov't pays the other 80% of the bill), some vaccinations may cost you $$$ like Hep B, and ofcourse you need to be insured for most OTC (Over The Counter) medication, other wise you're going to pay A LOT! so people who are very poor/uninsured get screwed when it comes to paying for their medication...

In conclusion, I wouldn't say that our health care system here is completely socialized BUT it is Universal and all have access to basic health care especially primary, but the system definetly has its shortcomings.

 

[birdie]

So what are the reasons that the US government has shied away from establishing a universal health care system? Why do they think it is not feasible here?

 

[Kashue]

The gov't dosn't have infinite resources and thus the amount of physicians in certain provinces, namely Ontario is capped to a certain extent too! It is very hard for foreign doctors to work here! (many are taxi cab drivers SERIOUSLY!) and ofcourse not enough spots in med schools...

No kidding. My aunt, whose currently a GP in Toronto, failed to make the cut off for the Canadian board exams like 6-7 times. Also, I know that the competition is stiffer for a spot in a Canadian Medical School - only 16 schools there. What's the average GPA/MCAT for a Canadian Medical School? Anyone know?

 

[PapaDosh]

Originally posted by birdie
So what are the reasons that the US government has shied away from establishing a universal health care system? Why do they think it is not feasible here?

There have actually been at least two occasions in U.S. history where there have been real plans to institute national healthcare. In 1934, President Franklin Roosevelt had a vision that every American should be able to get health, medical, and pension needs under Social Security. Even with all the supporters in Congressed voted in 1934, this wouldn't work however because Southern political leaders didn't like the idea of white taxpayers paying "Negroes to sit around in idleness on front galleries". Republicans used the S word to describe his plan- socialism, which in the US meant that they didn't want to vote for it. The real reason that plan wasn't voted for is that the AMA didn't want to have it- medicine was just to profitable.
The other time that the AMA defeated the idea of national health care was in the 1920s when a Dr. Pomeroy was planning for a national network of heatlh clinics because the AMA didn't want the competition from the goverment. Other people called "red baiters" didnt' feel like the poor deserved health care.

All of this came form Betrayal of Trust by Laurie Garret- its a good book on the history of health care in the US. Bodenheimer and Grumbach's Understanding Health Policy is a useful read as well.

One of the key things that nobody has yet mentioned is that there are three areas that all health care systems strive to excellece in but you can usually only get two of them: Cost, Access, and Quality. The US really doesn't have any, although I supposed quality could be arguable. For example: The US spends a lot to get new techonology which should theoretically give it better quality, however this reduces cost, which reduces access. Anyway this post has gotten way to long. I'll try to answer more questions on here as they come up.

 

[ocean11]

ok to get into med school here (ONTARIO), your GPA IS THE MOST important thing... you better have a 3.75 or above to be seriously competitive and the MCATS are usually used as a flag... you need a minimum of 9 or 10 in EACH section to just 'pass' to be considered, as for writing sample usually a min of an N (some schools its a P though). So yeah in Ontario alone there are usually annually 5,000 applicants for roughly 550 spots so approx. 10% of applicants get a spot (and obviously most are Canadian citizens). Let me put it this way... if your GPA is a 3.50 it is considered 'low' here and all the schools in Ontario will reject you EXEPT for McMaster if you have a killer essay (and thats a total crapshoot). NOW if you are from another province, its a little easier, if you're say from Manitoba, they'll consider you with a 3.00 and an MCAT score of 25, but the catch is YOU HAVE to be from Manitoba, as an Ontario resident I have little chance of getting accepted there with even a 3.9 GPA and 36T MCAT scores... so you see some provinces are relatively 'easier' to get into BUT you have to be FROM that province.

As for Ontario, most pre-meds often feel 'screwed' as they can't 'realistically' apply to other provinces and getting into Ontario is VERY VERY competitive. AND HERE they DO NOT look at trends... they look at your OVERALL GPA from all your years (some schools look at your last two) SO if you have ONE bad year... you are seriously screwed....

I personally had a 3.72 until my 3rd year (were I had thyroid surgery) and then it dropped to a 3.55 (I had a 3.1 in my junior year), that screwed me from getting into Ontario... we'll see about McMaster in March... but still... I'm not holding my breath.

 

[Kashue]

Originally posted by ocean11
ok to get into med school here (ONTARIO), your GPA IS THE MOST important thing... you better have a 3.75 or above to be seriously competitive and the MCATS are usually used as a flag... you need a minimum of 9 or 10 in EACH section to just 'pass' to be considered, as for writing sample usually a min of an N (some schools its a P though). So yeah in Ontario alone there are usually annually 5,000 applicants for roughly 550 spots so approx. 10% of applicants get a spot (and obviously most are Canadian citizens). Let me put it this way... if your GPA is a 3.50 it is considered 'low' here and all the schools in Ontario will reject you EXEPT for McMaster if you have a killer essay (and thats a total crapshoot). NOW if you are from another province, its a little easier, if you're say from Manitoba, they'll consider you with a 3.00 and an MCAT score of 25, but the catch is YOU HAVE to be from Manitoba, as an Ontario resident I have little chance of getting accepted there with even a 3.9 GPA and 36T MCAT scores... so you see some provinces are relatively 'easier' to get into BUT you have to be FROM that province.

As for Ontario, most pre-meds often feel 'screwed' as they can't 'realistically' apply to other provinces and getting into Ontario is VERY VERY competitive. AND HERE they DO NOT look at trends... they look at your OVERALL GPA from all your years (some schools look at your last two) SO if you have ONE bad year... you are seriously screwed....

I personally had a 3.72 until my 3rd year (were I had thyroid surgery) and then it dropped to a 3.55 (I had a 3.1 in my junior year), that screwed me from getting into Ontario... we'll see about McMaster in March... but still... I'm not holding my breath.

Do you have a centralized agency for applications like AAMC?How do you apply for Canadian Schools?

Btw, that sucks when it comes to GPA's/MCAT. Good luck tho.

 

[34440]

The five Ontario Medical Schools use the Ontario Medical School Application Service (OMSAS), which is very similar to the AMCAS system. The other Canadian schools handle their own applications.

Here are last year's stats for University of Toronto Medical School's entering class:

GPA cutoff: 3.6 (minimum to be allowed to apply)
Avg GPA: 3.83 (for those offered admission)
MCAT cutoff: 9/9/9/N (at least a 9 in EACH section)

applicants: ~1700
spots: 198

At one of their seminars, the admissions people at UofT said that although 3.6 is the minimum GPA to apply, you need around a 3.8 to be considered competitive.

One thing that seems different about the AMCAS system vs OMSAS is this idea of "secondaries". Here in Ontario, we do the whole shebang at once. Complete applications for all schools were due Oct 20. The next thing we hear from the med schools (hopefully) is invitations for interviews (which happen in March/April). Then we all wait, wait, wait until May 31, when ALL Ontario med schools mail out acceptances.

 

[ocean11]

Thats true about U of Toronto, there is one exeption though: IF you're a graduate/Phd student (WHO HAS COMPLETELY FINISHED their thesis/courses) you will be considered with a minimum of a 3.00; however as CanMan sais you probably have to have a much higher GPA to be considered competitive, so for someone who finished their masters/Phd I'd say a 3.50 is competitive.

I know a guy who got in with a 3.50 (after finishing his masters and Phd) he was 29 when he got in and applied literally 7 years in a row!!!! his MCAT in verbal was low: a 7, but they overlooked it (this was 4 years ago). However, TODAY you need at least 9's in every section... no exeptions... I think the 'flag' idea came in 1-2 years ago...

 

[jlee9531]

As for Ontario, most pre-meds often feel 'screwed' as they can't 'realistically' apply to other provinces and getting into Ontario is VERY VERY competitive.

so Ontario is at certain points like the California of the US. 😀

 

[perfectmoment]

"NOW if you are from another province, its a little easier, if you're say from Manitoba, they'll consider you with a 3.00 and an MCAT score of 25, but the catch is YOU HAVE to be from Manitoba, as an Ontario resident I have little chance of getting accepted there with even a 3.9 GPA and 36T MCAT scores... so you see some provinces are relatively 'easier' to get into BUT you have to be FROM that province. "

the average entering mark is a 4.02 on the UofM scale of 4.5 (so i'd say that it's roughly a >3.7 on the OMSAS scale) and the mcat average is a 10.33 or soemthing like that, so it's really not all that much different from the Ontario schools save for uwo and uoft. However, the uofm does have a special category for people in the other healthcare professions such as nursing, OT, etc, and these people get accepted with lower marks. As well, there is an AA type program for native americans. so these two special criteria in the selection process may be what is giving you the idea that the uofm is really easy for provincial applicants...

 

[dynx]

Yeah but how much does alcohol cost you up there?😉

 

[jesswise]

Here on the East Coast in Canada it's MUCH easier to get in.

There are two schools, Dalhousie in Halifax, NS and Memorial in Newfoundland, that accept applicants from 4 Maritime provinces: Nova Scotia, Newfoundland, New Brunswick, and Prince Edward Island.

Halifax receives approximately 200-250 applicants each year in the Maritime pool who meet the minimum requirements (3.3 on last 2 years or best 3 years, 24 MCAT with only one 7 allowed). They interview ALL Maritime applicants who meet the minimum quals, and accept around 80. So your numerical chances are 1 in 3 at Dalhousie if you meet the minimum requirements.

Memorial has NO minimum requirements, accepts 10 kids from New Brunswick, 2 from PEI, maybe 1 or 2 from everywhere else, and the rest from Newfoundland. If your from Newfoundland, you have the best chance in Canada of going to med school, I think. But anyone in the Maritimes has a decent shot at these two schools. Memorial gets around 60 New Brunswick apps for 10 spots, but all those kids 100% certain applied to Dalhousie, too, so they have the 1 in 3 shot there, plus the 1 in 6 shot at Memorial.

Moral of the story: move to New Brunswick or Newfoundland for a couple of years and you're a shoo-in.

Jess

 

[winstonm]

Originally posted by birdie
So what are the reasons that the US government has shied away from establishing a universal health care system? Why do they think it is not feasible here?

Very complex but check the article by Antonia Maioni in Comparative Politics (July '97, 411-431). It looks at the role of Canada's leftist political party (CCF, now the NDP) in the development of our system and the lack of such a party in the US.



The "socialism" thing was thrown about quite a bit. Also, the AMA and insurance companies, especially Prudential, strongly advocated against national coverage at crucial points. At first, the Canadian Medical Association also went against it but when it saw national insurance would come, it tried to make the best of it.Also see this

 

[redgrover]

So what are the reasons that the US government has shied away from establishing a universal health care system? Why do they think it is not feasible here?

For one thing, America is the most capitalistic country in the world. If you look at the US's per capita income, it's about 33% larger than any other moderately-sized industrial nation. Part of what produces this wealth are the incentives of a capitalist system. Americans pay far less taxes than Canada or European nations. This provides incentives to small businesses and makes it easier for them to hire additional employees.

My biggest problem with universal health care is that it almost always comes at the expense of a greater unemployment rate. "Okay, we're going to throw you out in the street because you lost your job, but you can now come into the doctor's office (for a nominal fee) to treat that case of pneumonia."

Another reason implementing Canada's system is not feasible in the US is that we run a military. Canada essentially has one provided for it along its south border. If the US decided to give up its military (yeah right), then universal health care in Canada would likely suffer as the resulting need for developping a defense system would increase and divert revenue.

There is also a great deal of instability in a universal health care system. Consider European nations. Their birthrates have been dropping for decades, and soon their populations are going to begin shrinking. All this while the average age of their citizens is growing older and older. There is no way they can support such a system unless they force people to work until they are 75.

Finally, the quality of healthcare is ultimately sacrificed in the name of universal care. The 5-year survival rate for colon cancer in the US is around 85%. It's 60% in the UK. In other words, people are dying in the name of universal care, and yes, these numbers extend across the board. Right now the UK is experiencing a rise in the number of private practitioners because the NHS doesn't pay enough and because demand for prompt care has escalated. Consider that the waiting list for an organ transplant is now to the point that donees have reached a critical stage and are having to be hospitalized before they receive their transplant.

 

[Treg]

As an American who has experienced both systems, I have to disagree with redgrover on a few points-

The tax brackets are not that different. In Canada, the $ goes to healthcare, in the US it goes to military. Canada has a vastly different approach to foreign policy than the US, consequently it does not need to spend a huge sum on the military. Yes, the military is a bit of a joke here, but who is going to attack Canada? 😉

Instability in the system=declining birth rates? Well, the US birthrate is at an all time low, and the % underweight babies is on the rise.

"Quality of healthcare is sacrificed"-I have received outstanding care here in Canada, with no big bill waiting on my doorstep when I got home. Just remember, *any* healthcare is better than none, which is the situation too many people in the US face.

The benefits of the social system are undeniable-people receive treatment when they are sick. Period. Now, down in the states, people who cannot afford good healthcare avoid going to the doctor at all costs, leading to unmanaged illness, which will end up costing the system way more. In Canada, you will not have to wait for treatment if you really need it. Elective/noncritical procedures do have waiting times, but they are still under the supervision of a physician.

Let me tell you my experience. During undergrad, I started having wicked headaches in one eye over x-mas break. Since I was not in the state of my university, my health plan did not cover me. I ended up in emergency with a detached retina. Went blind in my left eye for nearly three weeks. Saw opthalmologist during the break 3-4 times. Total cost: $7000, which was reduced to $2000 based on my lack of income. Also, numerous faxes, documents, etc. with campus-based health plan.

Last summer. 7:00 am: I awoke with sharp pain in my lower right quadrant. I knew it was probably gall bladder or appendix. Called the help line (not necessary but just to be sure), they told me to go to my primary care doc (it was a monday morning, so I went to campus health). 8:30 am-doctor sends me to emergency. 10:30 am: sent for ultrasound consult 1:00 pm-scheduled for appendix surgery 5:00 pm-coming out of surgery. Next day-went home. Total cost: $0. No bill, nada. Just "see you later, follow up with your surgeon in 2 weeks." The same goes for when I had my daughter.

There is definitely a benefit to knowing that you do not ever need to worry about health care for your family.

Whew, that got long 🙂

Treg

 

[bigbaubdi]

Originally posted by redgrover
If you look at the US's per capita income, it's about 33% larger than any other moderately-sized industrial nation....In other words, people are dying in the name of universal care....

In the US, the per capita income is relatively high but the US income distribution is incredibly skewed. The distribution of wealth in the US is even more skewed - something like 1% of the country has 40% of the wealth.

Also I think a much more convincing case can be made that people are dying b/c of private health care. There are gross inequalities in health care that could easily be prevented with expanded access to primary care. For example, life expectancy rates for African Americans are substantially lower than life expectancy rates for Europeans, Japanese or white Americans.

The US spends much more than other nations on health care - much of this is due to the fact that treating advanced, undetected diseases are much more costly than preventing them with basic health care.

 

[superdevil]

something like 1% of the country has 40% of the wealth

holy christ, exaggerate much? 🙄
what i learned in poly sci, at a very liberal state school, (although i still take ALL stats with a grain of salt) is that its more along the lines of 5% own 25% of the "wealth." although its still mind-boggling, you have to take into account people like bill gates and oprah winfrey. they're billionaires because they worked their asses of providing things that millions of people enjoy/use, while people with a B.A. in sociology make $16,000/yr working at Target--which is fine by me.

there are pros and cons to universal health care. the US system isn't as bad as people like to say it is, but canada's system is nice also. big deal.

also, redgrover's point about military spending is correct. canada spends very little on military personel/tech because they know that the good ol' US would never let any kind of foreign aggression come so close to our borders. they basically get a free ride off of our military, and are able to finance other things as a result. good for them.

 

[bigbaubdi]

I did a quick internet search and I found the following numbers on wealth inequality from the Fairfield University site:

http://www.faculty.fairfield.edu/faculty/hodgson/Courses/so11/stratification/income&wealth.htm

Basically it says that the top 1% of the country owns 39% of the wealth. Those numbers are from 1997 but I can't imagine that they have changed too much.

Also I'm not sure why ppl are implying that Canadian healthcare is more expensive than US health care. The US spends way more than any other industrialized country for its health care - this is made clear in the JAMA article.

 

[shawred]

One of the major drawbacks in a universal health system, is the number of dollars spent on research. The United States as of 2001 spends 9 times more on clinical research compared to Canada. This ratio has increased by a factor of one every 1-2 years. Without this much needed research, we would still be combating the plague. Moreover, health care in the United States for all practical purposes is universal. Ever volunteered in the ER? Half the patients are uninsured (exaggeration but you get the point)!!! The fact is, if you need a procedure to save your life, it will be provided under law. I don't know about the rest of you, but I don't see a problem with those who have no insurance not receiving care for a sore throat (yes I know that anything can be deadly, but lets be reasonable). Furthermore, my paycheck already gets the s**t taxed out of it, so why in the hell would I want to pay MUCH MUCH MUCH more to insure myself and others? Besides who the hell has the right to tell me that I am responsible for the care of others? There is no rational moral foundation for such a claim. I am responsible for myself and no one else. As a physician I should be ethically bound to treat the indigent, but you will never convince me of a moral component. With that said, I as a physician would be willing to treat those in need unless it negatively impacted me on a large scale. I also believe that most physicians feel this way. I am just arguing against the reasoning behind feeling that such service is obligatory. Do we have a RIGHT to health care? Simply stated: NO. Physicians are business men like anyone else. They provide a service at a premium. Does everyone have a right to have a car given to them? Nope they have to pay for it. Unless of course the government makes it their business to establish public transportation (sarcasm--yes I know there are other benefits to such a system; just making a point on how government perceives its power).

 

[superdevil]

Basically it says that the top 1% of the country owns 39% of the wealth. Those numbers are from 1997 but I can't imagine that they have changed too much.

interesting. oh well, i guess it just shows that different sources = different numbers. i suppose the lesson is...believe NOTHING!!

also, shawred makes a very good (and, considering an sdn audience that always seems to be very receptive to the idea of universal care, a very brave) point. health care is NOT a right. health care, as we know it today (pharmaceuticals, diagnostic methods-both clinical and technological, surgery, etc.) has only been around for at the most 100 years--and yet the history of man is much longer than that. does that mean that people in the 1200's were having their rights violated because they couldn't receive chemotherapy for those lumps in their armpits? hell no.

a lot of times, people abuse the english language and exploit the common usages of words and phrases, such as "i believe that people have the right to (fill in the blank)," without stopping to think exactly WHAT IT MEANS to have a right, and WHY we should have such "rights." most of the time, the basis for an answer to the latter question (from people that i ask) is something along the lines of "i just think that we should all (have access to free health care, for example)," and they fail to see that opinions are not tenable arguments and that using relativistic phrases like "i think" or "we should" invalidates any logical platform they thought they were maintaining.

or maybe i should take less philosophy classes! 😀

by the way, if you feel that people truly DO have the RIGHT to free health care, please voice your opinions (RATIONALLY-- no bleeding-heart sanctimonious posturing!). i have never heard a logically stable argument for this position, as people tend to just raise their voices and accuse me of being "cold-hearted" when i question thier beliefs. emotional people annoy me.

 

[bigbaubdi]

"The United States as of 2001 spends 9 times more on clinical research compared to Canada. "

No doubt this contributes to the cost of health care however much of this research has been done at or has been funded by public institutions. Also that argument doesn't address the fact that the overhead costs for Medicare are much lower than overhead costs for private insurers.

"The fact is, if you need a procedure to save your life, it will be provided under law. "

Spending time at an ER is much more expensive than spending a time with your local FP. Moreover, by the time someone goes to an ER, he/she might be at a much more advanced disease state, which can be much more expensive to treat.

"I don't know about the rest of you, but I don't see a problem with those who have no insurance not receiving care for a sore throat (yes I know that anything can be deadly, but lets be reasonable). "

The person who doesn't get treated for a sore throat may have some type of communicable disease that can be transmitted to other people. Moreover, if that person doesn't get treated properly, then he/she may develop drug resistant strains that can be transmitted to others. Finally, that same person's health might deteriorate and he/she may end up in the ER with some thing much worse (and more costly to treat) than a sore throat. These are just a few ways in which not treating the person with the sore throat affects you.

"Besides who the hell has the right to tell me that I am responsible for the care of others? "

heheh.... I wrote my personal statement on my rejection of Ayn Rand's philosophy. IMHO, people have an obligation to help others. Some people are born with certain advantages that others don't have - hence opportunities for advancement are unequal. A just society is one, IMHO, in which people have equal opportunities for advancement. Therefore, in order to ensure a just society, people with advantages should share some of those advantages with others who are not as fortunate.

With respect to health, I would argue that since doctors have been given a high social status, they should repay that obligation to society by treating the indigent. This to me is part of the social contract that every doctor signs when he/she decides to go into medicine.

 

[jlee9531]

Stage 1. Heteronomous morality...

Egocentric Point of View: doesnt consider the interest of others or recognize that they differ from one's own; doesnt relate 2 points of view. The reasons for doing right is to avoid punishment and follow the superior power of authorities.

Stage 2. Instrumental morality...

Concrete individualistic perspective: aware that all people haev their own interests to pursue and these interests conflict so that right is relative. The reasons for doing right is to serve one's own needs or interests in a world where other people haev their own interests.

Stage 3. Good-child morality...

Has perspective of an individual in relationships with other individuals: aware of shared feelings, agreements, and expectations. Ability to relate points through the Golden Rule. The reasons for doing right is the need to be a good person in one's own eyes and those of others. You care for others and you believe in the Golden Rule. You desire to maintain rules and authority that support stereotypically good behavior.

Stage 4. Law and order morality...

Has perspective of an individual in relation to the social group. The reasons for doing right is to keep the institution going as a whole.

Stage 5. Social contract morality...

Has a sense of obligation to law becauyse of one's social contract to act for the welfare of the group. You are aware that people hold a variety of values and opinions.

Stage 6. Universal ethical principles...

Simply a belief in the validity of universal moral principles.


Just some nice afternoon reading.

 

[Childe]

bigbaubdi makes a critical point. Though the right to healthcare can be argued eternally, the issue should be viewed from a public health perspective. The prevention of disease made possible by universal primary care would be a huge economic boon. This is why the government already provides free or low cost health clinics who provide preventative medicine and immunizaitons. The progression of this into general family practictioners could save the economy, and the nations health, much.

And yes, much ER work is uninsured. But much of it would be made unnecessary with proper prevention and education. And this would translate into lower costs.

I dont propose a total care system, as I dont think the US will ever accept one. But the current system, while providing high-quality (the best) healthcare for many (the upper/middle class), denies healthcare entirely for the poor through its extreme costs and general inaccessibility. It may not be your obligation to provide for them, but it is the governments to prevent the spread of disease.

 

[redgrover]

The discrepancy in the numbers is in a comparison of wealth v. income. The richest 1% don't earn 39% of the income.

When you have a large income, it's easier to stay out of debt (saving on paying interest) and to accumulate more savings. It's also easier to invest and earn dividends. Wealth begets wealth. The more money you have, the easier it is to make more.

 

[superdevil]

Though the right to healthcare can be argued eternally, the issue should be viewed from a public health perspective. The prevention of disease made possible by universal primary care would be a huge economic boon. This is why the government already provides free or low cost health clinics who provide preventative medicine and immunizaitons. The progression of this into general family practictioners could save the economy, and the nations health, much.

i like your public health angle. in my opinion, its the best reason to support some sort of "universal care."

the current system, while providing high-quality (the best) healthcare for many (the upper/middle class), denies healthcare entirely for the poor through its extreme costs and general inaccessibility. It may not be your obligation to provide for them, but it is the governments to prevent the spread of disease.

it doesn't deny healthcare "entirely" for the poor. you already mentioned seeing poor people in the ER. it IS the govt's job to prevent the spread of disease, but exactly how far can you apply that to universal care? flu shots? OK. sex ed/safe sex to prevent the spread of STDs? OK. giving chemo to poor people with cancer? hmm....not exactly "the spread of disease"...sending people with chronic pain to a rheumatologist? i dunno....

i support the idea of greater accessability to primary care, but i believe a comprehensive universal care system is impractical for a country like the US.

bigbaubdi, please realize that people should help others. i feel this way as well. you shouldn't, however, project "obligations" onto others. we all value our own opinions, but kind of thinking is more like a "if i were dictator of the universe..."-type musing as opposed to a constructive solution to a real world problem. the fact that you reject ayn rand is noble enough, but some people agree with her--although it doesn't make for as good of a med school personal statement!!

all in all, a fun topic 😉

 

[bigbaubdi]

"giving chemo to poor people with cancer? hmm....not exactly "the spread of disease"..."

Chemo is probably too late...How about free mammograms, pap smears, etc to prevent cancer in the first place?

Also I think "the spread of disease" refers to infectious diseases which can affect other people as well.

"you shouldn't, however, project "obligations" onto others. we all value our own opinions, but kind of thinking is more like a "if i were dictator of the universe..."

From a public policy perspective though, I think programs that redistribute wealth from the rich to the poor are absolutely necessary. Undoubtedly, this is imposing some people's opinions about charity onto others but few people would question the basic legitimacy of social welfare programs.

BTW, I got a lot of comments about my personal statement from my interviewers. I can't imagine someone writing a personal statement from a Randian perspective though...

 

[beastmaster]

You have to remember that Rand was a demagouge, her purpose to rile up the folks against the extremism of collectivism and socialism. To reach that end she was in many cases equally forceful in her critiques as were the situations and philosophers she was critiquing. In my opinion, the average advocate as well as the average loather of Rand both tend to be insane. It's very easy to nit pick her writings, since she was so prolific.

There will always be justification for some minor redistribution of wealth, and basic entitlements. (Rand et al, btw, merely aimed at explicating the results of slipper slopes). And being a member of society does carry some basic responsibilities. However, it is very easy to take this too far. "Free healthcare for all" is one such absurd extreme. The concept fails everywhere it is attempted. Over and over.

There are things that charity and such can do much more efficiently than any government program. It's very easy to label the financially successful as greedy scum, but that notion is destroyed over and over as we witness the charitable acts performed by them.

"Rejecting" Rand's philosophy is a very foolish endeavor. Her philosophy, however antiquated or inapplicable to modern day, is merely a groundwork for her defense of ethics and politics, namely a philosophical defense of capitalism and the free market economy. Academics far and wide have rejected such tried "rejections" in literature that spans equally far and equally wide.

Originally posted by bigbaubdi
BTW, I got a lot of comments about my personal statement from my interviewers. I can't imagine someone writing a personal statement from a Randian perspective though...

 

[superdevil]

hopefully, this will be my last post on this thread!

There are things that charity and such can do much more efficiently than any government program. It's very easy to label the financially successful as greedy scum, but that notion is destroyed over and over as we witness the charitable acts performed by them.

beastmaster, you and i must be the only two people left in america who believe this. first of all, when was the last time that people (seriously) said, "man, this is a big problem. what should we do? i know, lets hand over more money/power/autonomy to the US government! yes, that will surely clear up this convoluted and dangerous situation!!!"

also, would somebody like to check how much bill gates donates to charity? a hint: its more than any of us 😀

seriously, bigbaubdi, i'm all for public health, but i've heard this debated too many times:

programs that redistribute wealth from the rich to the poor are absolutely necessary

i go to a very liberal school, as i mentioned previously. in every humanities class i've ever taken, we've been indoctrinated to want to make love to an anatomically-correct statue of karl marx every sunrise and sunset, while at the same time, feeling ashamed of every characteristic (competition/entrepreneurship, profit motive, the pursuit of financial success) that has made the US what it is today (like it or not).

without getting too political, the vast majority of democratic candidates run on what i call the "robin hood fallacy." if you claim that income must be redistributed from the very rich to the very poor, no matter what the extent, YOU CAN'T LOSE. its a no-brainer principle that takes no thought at all. if you make these claims, what happens? you've alienated what, 1-5% of the population to look like a saint to the other 95%?

in your post you call that "charity." couldn't you also call such redistribution "stealing," if you are wealthy? yes, you probably could...but you would lose out to people whose tactful use of semantics to promote their ideals goes unnoticed by most.

for the record i am all for giving free mammograms and pap-smears to prevent cancer 😉 . and i'm sure that your personal statement drew lots of praise, but, as i said, your stance is pretty much a sentimental no-brainer/slam-dunk as long as ted turner isn't reading it! opposing randian sociology isn't exactly "going out on a limb" to demonstrate one's beliefs.

i appreciate all of your beliefs, bigbaubdi, and even agree with most of them, i just think its more invigorating to play devil's advocate (even at the expense of giving you a hard time!).


i'm such a long-winded ass sometimes!