Informative, and scary


I can't help myself, really. The point almost makes itself, but I figured I'd make it explicitly.

Read this entire post over at Tall, Dark, & Mysterious.

An excerpt simply cannot do it justice.

Now, imagine these people are running your health care system. Imagine them doing it for a country with several times the population of Canada.

And remember it the next time someone cites Canada as an example of the wonders of universal health care.


Actually, this would have absolutely nothing to do with the experience of using Canada's health care system. When you see a doctor, or got to a hospital, there is little to no bureaucracy involved for the patient.

And even if you're visiting with no health insurance and go to the emergency room, it costs 1/10th what it cost me to do the same when I was in the US. I would have thought half or a third, but the difference is an entire order of magnitude.

I recall one American woman bemoaning how long Canadians have to wait for a surgery. Meanwhile her diabetes is completely unmanaged because she can't even afford an ordinary doctor's appointment. Thanks, I'll take what we have up here in Canada, thank you.

Now, imagine these people are running your health care system. Imagine them doing it for a country with several times the population of Canada.

You're right, it's pretty scary to imagine the EI folks running the health care system. Fortunately, even here in Canada we have doctors and nurses and stuff.

Seriously, though, I see your point: you don't want the quality of your medical care subordinated to impenetrable, poorly managed, piles of paperwork. One experience of mine comes to mind: I was accompanying a teenager who'd just suffered a concussion to the hospital. She was sent back to the waiting room, where she stayed for an hour, while the secretaries verified that her insurance (out-of-state) would pay. North of the border, meanwhile, we have this thing called triage, where patients get looked at right away to see if they need to be seen by a doctor immediately. This experience took place in Maine. One could argue that Maine is in New England, which is practically in Communist Canada anyway, but that would just be foolish.

Fascinating! In Canada the doctors and nurses run the bureaucracy? They're the ones processing claims, setting up the distrubution of medical equipment, determining the prices that can be charged for drugs, hiring the people in the customer service departments and answering phones when you want to schedule appointments? Truly a remarkable system.

The fallacy in both the above responses is that I've proposed the current US system as the appropriate alternative. This couldn't be further from the truth. Health care in the US is horrendously out of whack. The solution, however, is not to look longingly northward as though an increase of bureaucracy is the solution to the US system's ailments.

The point still stands, I believe. The quality of care isn't of issue. I'm fully willing to believe you can get quality doctors in lots and lots of places around the world. The trouble, as so aptly pointed out in the post by MS, is that the system is populated with people whose work incentives are divorced from performance. These are often people who cannot be fired for underperformance and whose pay is linked to mandated increases meaning that overperformance results in no tangible benefit, save longer hours and little reward. The EI system isn't atypical; it's stereotypical. Much of the US government works much the same way. Working through the federal system of regulations for any number of entitlements is an exercise in extreme fortitude and patience.

Each story of someone getting cheaper care for this or that problem can be met with another story of people waiting months for cancer treatment that, when it comes, comes far too late, simply because they had to wait in line. Or having to travel to find an MRI machine because they're so few and far between. Or drastic shortages of dentists. Or of medical tourism to India because the system has failed in BOTH the US and Canada. But even in the point you mention, diabetes and surgery, one (surgery) is most likely highly time-sensitive in relation to chronic problems like diabetes (not to belittle the diabetic; the comparison here is between say, an appendectomy that, untreated, could result in massive internal injury, and a disease that will require long-term monitoring and care). The trouble is not the illness -- the trouble is having one of those bureaucrats decide which one is more deserving of immediate care. That there has to be a trade off is the result of a system that is forced to ration.

The issue here isn't that someone can go to the emergency room for less. Emergency care is the most expensive kind, though it could well be the least used, if only people had a better ability to take advantage of preventative care. Diabetes can be stopped early, if only people would listen to doctors (a problem in itself, but not one for the government).

Why should we work to find and celebrate small victories in the bureaucratic morass when it's that very morass that creates the majority of the problems? The cost of healthcare in the US truly is ridiculous, but this is caused in large part by massive governmental regulation that has nothing to do with caregiver competency or safety.

Meanwhile, the profusion of care without direct link to payment (because, in the end, you DO pay for healthcare, even though the check to the hospital might say "Government of Canada") is likely to drive up the use of "just in time" care. Why worry about something when you know you can go later, if the symptoms get really bad? Doubt that this happens? If you prefer anecdotes, I can send you stories from a podiatrist friend who works with our Veterans Affairs hospitals. Some of the vets get free treatment, but only come in when their feet are, quite literally, near to falling off. This means that the more heavily used resources are those that are the most expensive, driving up the cost to the government (and thus to all the taxpayers).

Between the doctors and nurses doing their best for the patient would be (and is, in Canada) an ever-thickening layer of people who perform almost identically to those people MS had to deal with for EI.

Here is the principle you don't get:
Consider restarting from Gladwell.

your cheesy certitude about
Bureaucrac Bloat
Dead Canadians
Ever thickening layers of people etc etc...
trivializes everyones' medical plan except the one that serves you so well I think.

The above points deliver no diagnosis/prognosis/no recovery. It smells like dead carps.

The real issue is starving out the 30 or 40m lazy bastards than can't pay for (and should'nt need) medical/dental services until their teeth fall out.[read the article] You're views justify more socialism for the rich and capitalism for the poor.

I see no brains, no heart, no courage in your view. Find a little fact somewhere. Parse a theory. Start talking about whcih part the gaussian curve of medical benefits you live in. At least tell me about your insurance plan benefits and what you actually put and get for your money and what your insurance provider puts/gets -don't forget that part.

Or just tell me how you acquire the spectator balls to opinionate over the hollowing our of our so-called medical system that serves the United States with such simplicity and practicality and respect.

Snug it up to Gladwell,please, before you catch something else nasty from this drivel and pass it on to someone else.

EI and health insurance are fundamentally different. Specifically, health insurance in Canada is universal, hence there's no overhead involved in figuring what and how much you're entitled to. You present your card, get treated, and the health care providor goes after the government for the money. You never need to get your hands dirty dealing with the government.

I suspect that EI is complicated because they have a lot of rules about eligibility designed to make sure that only the right people get money and only in the right amount. In other words, they're worried about cheaters.

I haven't researched this, but I've read elsewhere that the U.S. health care system actually resembles the example you link to much more, in that private insurance companies create paperwork and inefficiency in trying to avoid paying more than they have to. Perhaps that overhead is part of the reason the American health care system is so expensive, without actually providing better results.


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This page contains a single entry by published on August 16, 2005 11:10 AM.

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