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'Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of "socialized medicine." Two years ago the Conference Board of Canada - a who's who of the nation's corporate elite - issued a report urging fellow Canadians to bear in mind not just the "symbolic value" of universal health care, but its "economic contribution to the competitiveness of Canadian businesses."'
-- Paul Krugman for The NY Times
Thinking of our Canadian friends, one thought it might be nice to tag at least the latter portion of Mr. Krugman's discussion on healthcare policy. Krugman understands that our dominant ideology doesn't make the Canadian solution possible in any near term, going for the pragmatic solution of taking what steps we can in that direction - going for Kerry!
___ ___ ___
...The fact is that the mainly private U.S. health care system spends far more than the mainly public health care systems of other advanced countries, but gets worse results. In 2001, we spent $4,887 on health care per capita, compared with $2,792 in Canada and $2,561 in France. Yet the U.S. does worse than either country by any measure of health care success you care to name - life expectancy, infant mortality, whatever. (At its best, U.S. health care is the best in the world. But the ranks of Americans who can't afford the best, and may have no insurance at all, are large and growing.)
And the U.S. system does have very high overhead: private insurers and H.M.O.'s spend much more on administrative expenses, as opposed to actual medical treatment, than public agencies at home or abroad.
Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of "socialized medicine." Two years ago the Conference Board of Canada - a who's who of the nation's corporate elite - issued a report urging fellow Canadians to bear in mind not just the "symbolic value" of universal health care, but its "economic contribution to the competitiveness of Canadian businesses."
My health-economist friends say that it's unrealistic to call for a single-payer system here: the interest groups are too powerful, and the antigovernment propaganda of the right has become too well established in public opinion. All that we can hope for right now is a modest step in the right direction, like the one Mr. Kerry is proposing. I bow to their political wisdom. But let's not ignore the growing evidence that our dysfunctional medical system is bad not just for our health, but for our economy.
-- Paul Krugman, "America's Failing Health"
************
(September 12, 2004)
The following is a NY Times article on the shortcomings of Canada's healthcare system:
___ ___ ___
...The publicly financed health insurance system remains a prideful jewel for most Canadians, who see it as an expression of communal caring for the less fortunate and a striking contrast to an American health care system that leaves 45 million people uninsured. But polls indicate that public confidence in the system is eroding, although politicians remain reticent to urge increasing privatization of services.
During the recent closely fought election campaign, Mr. Martin promised to fix Canada's health care system "for a generation," focusing on trimming waiting times for diagnostic tests, cancer treatment and elective surgery like hip replacements. He is eager to use this televised gathering, billed as a health care summit meeting, to reverse the current view among many Canadians that his government is vacillating and may well fall next year.
But medical professionals and local officials say a major reason it may not be easy to address the problem of slow access to treatment is because doctors who do preliminary diagnostic work, refer patients to specialists and monitor the care of chronically ill people are less and less available - especially in small towns and rural areas.
A 2002 report from the Canadian Senate said that the actual number of family doctors had decreased only slightly in recent years but that the demands of an aging population were growing. Meanwhile, several recent studies have shown that family doctors are working shorter hours.
Young doctors are more likely to seek the most lucrative work in cities or go to the United States rather than start more modest practices in small towns because of growing debts when they leave medical school. That has set off an increasing competition among small towns to attract doctors.
Ms. Pacione's predicament is surprisingly common even in this upper-middle-class community on the north shore of Lake Ontario that seems to have everything going for it: immaculate lawns, a yacht marina, a downtown graced by vintage Victorian architecture and quaint parks and fruit markets.
Despite all its attractions, Whitby has trouble attracting enough doctors to take care of its residents. The town has only 63 family doctors to care for its 110,000 people (medical officials and local officials say at least 16 more are needed), and many residents drive 45 minutes or more to Toronto for basic medical care. Whitby is one of 136 communities with a total of a million people in Ontario, Canada's most populous province, that are not adequately served by family doctors, according to the Ontario Medical Association. That is up from 100 communities in 2000.
Whitby officials estimate that 22,000 people here have no doctor at all, forcing them to go to emergency rooms at overcrowded local hospitals to wait in line for up to four hours simply to refill a prescription, get a doctor's note for an employer or care for their flu symptoms.
"It's like winning the lottery to get in and see the doctor," Mayor Marcel Brunelle said. "This is a very wealthy country. What happened to bring the situation to this point?"
The government statistical agency estimates that more than 3.6 million Canadians, representing nearly 15 percent of the population, do not have a family doctor. That remains better than in the United States, where an estimated 20 percent do not have a regular doctor.
But there are signs that the doctor shortage in Canada is worsening. The Canadian Medical Association estimates that the country requires 2,500 medical graduates annually but is producing only 2,200 a year.
Mayor Brunelle formed a task force in June to recruit young doctors by introducing them to real estate agents and giving them advice on how to start new practices, and the town government is considering building a municipal clinic. The town of Peterborough is offering large monetary incentives and a grab bag of perks, including memberships at the Y.M.C.A. and cable television. Other municipalities offer moving expenses and the inside track on real estate next to golf courses.
But experts say those efforts may not be enough. "If the current trends continue we can anticipate a crisis," warned Joseph D'Cruz, a University of Toronto business school professor who specializes in health care. "People will actually find it impossible to get general medical services in their towns."
The doctor shortage is hurting the economies of small towns seeking to attract businesses. But it is also taxing the energies of the doctors who do live in those towns, as well as the resources of local hospitals - and patients often complain that their treatment is rushed.
Administrators at the nearby Lakeridge Health Oshawa, an acute care hospital, estimated that more than 30 percent of the patients who went to the emergency ward would go to a family doctor instead if they could do so quickly. It is a burden on the hospital's staff, space and financial resources.
One patient who went to the emergency ward recently, Crystal Bentley, 22, complained of cysts behind her ears. She said she would prefer to see her family doctor but would have to wait in his office for hours. She said she went to the hospital because the emergency room was faster.
"Seeing a doctor and not having to pay is phenomenal," she said, "but here I am taking up emergency time from doctors. I really do wish I could see my family doctor instead of coming here and talking to a total stranger."
-- Clifford Krauss for The NY Times
'Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of "socialized medicine." Two years ago the Conference Board of Canada - a who's who of the nation's corporate elite - issued a report urging fellow Canadians to bear in mind not just the "symbolic value" of universal health care, but its "economic contribution to the competitiveness of Canadian businesses."'
-- Paul Krugman for The NY Times
Thinking of our Canadian friends, one thought it might be nice to tag at least the latter portion of Mr. Krugman's discussion on healthcare policy. Krugman understands that our dominant ideology doesn't make the Canadian solution possible in any near term, going for the pragmatic solution of taking what steps we can in that direction - going for Kerry!
___ ___ ___
...The fact is that the mainly private U.S. health care system spends far more than the mainly public health care systems of other advanced countries, but gets worse results. In 2001, we spent $4,887 on health care per capita, compared with $2,792 in Canada and $2,561 in France. Yet the U.S. does worse than either country by any measure of health care success you care to name - life expectancy, infant mortality, whatever. (At its best, U.S. health care is the best in the world. But the ranks of Americans who can't afford the best, and may have no insurance at all, are large and growing.)
And the U.S. system does have very high overhead: private insurers and H.M.O.'s spend much more on administrative expenses, as opposed to actual medical treatment, than public agencies at home or abroad.
Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of "socialized medicine." Two years ago the Conference Board of Canada - a who's who of the nation's corporate elite - issued a report urging fellow Canadians to bear in mind not just the "symbolic value" of universal health care, but its "economic contribution to the competitiveness of Canadian businesses."
My health-economist friends say that it's unrealistic to call for a single-payer system here: the interest groups are too powerful, and the antigovernment propaganda of the right has become too well established in public opinion. All that we can hope for right now is a modest step in the right direction, like the one Mr. Kerry is proposing. I bow to their political wisdom. But let's not ignore the growing evidence that our dysfunctional medical system is bad not just for our health, but for our economy.
-- Paul Krugman, "America's Failing Health"
************
(September 12, 2004)
The following is a NY Times article on the shortcomings of Canada's healthcare system:
___ ___ ___
...The publicly financed health insurance system remains a prideful jewel for most Canadians, who see it as an expression of communal caring for the less fortunate and a striking contrast to an American health care system that leaves 45 million people uninsured. But polls indicate that public confidence in the system is eroding, although politicians remain reticent to urge increasing privatization of services.
During the recent closely fought election campaign, Mr. Martin promised to fix Canada's health care system "for a generation," focusing on trimming waiting times for diagnostic tests, cancer treatment and elective surgery like hip replacements. He is eager to use this televised gathering, billed as a health care summit meeting, to reverse the current view among many Canadians that his government is vacillating and may well fall next year.
But medical professionals and local officials say a major reason it may not be easy to address the problem of slow access to treatment is because doctors who do preliminary diagnostic work, refer patients to specialists and monitor the care of chronically ill people are less and less available - especially in small towns and rural areas.
A 2002 report from the Canadian Senate said that the actual number of family doctors had decreased only slightly in recent years but that the demands of an aging population were growing. Meanwhile, several recent studies have shown that family doctors are working shorter hours.
Young doctors are more likely to seek the most lucrative work in cities or go to the United States rather than start more modest practices in small towns because of growing debts when they leave medical school. That has set off an increasing competition among small towns to attract doctors.
Ms. Pacione's predicament is surprisingly common even in this upper-middle-class community on the north shore of Lake Ontario that seems to have everything going for it: immaculate lawns, a yacht marina, a downtown graced by vintage Victorian architecture and quaint parks and fruit markets.
Despite all its attractions, Whitby has trouble attracting enough doctors to take care of its residents. The town has only 63 family doctors to care for its 110,000 people (medical officials and local officials say at least 16 more are needed), and many residents drive 45 minutes or more to Toronto for basic medical care. Whitby is one of 136 communities with a total of a million people in Ontario, Canada's most populous province, that are not adequately served by family doctors, according to the Ontario Medical Association. That is up from 100 communities in 2000.
Whitby officials estimate that 22,000 people here have no doctor at all, forcing them to go to emergency rooms at overcrowded local hospitals to wait in line for up to four hours simply to refill a prescription, get a doctor's note for an employer or care for their flu symptoms.
"It's like winning the lottery to get in and see the doctor," Mayor Marcel Brunelle said. "This is a very wealthy country. What happened to bring the situation to this point?"
The government statistical agency estimates that more than 3.6 million Canadians, representing nearly 15 percent of the population, do not have a family doctor. That remains better than in the United States, where an estimated 20 percent do not have a regular doctor.
But there are signs that the doctor shortage in Canada is worsening. The Canadian Medical Association estimates that the country requires 2,500 medical graduates annually but is producing only 2,200 a year.
Mayor Brunelle formed a task force in June to recruit young doctors by introducing them to real estate agents and giving them advice on how to start new practices, and the town government is considering building a municipal clinic. The town of Peterborough is offering large monetary incentives and a grab bag of perks, including memberships at the Y.M.C.A. and cable television. Other municipalities offer moving expenses and the inside track on real estate next to golf courses.
But experts say those efforts may not be enough. "If the current trends continue we can anticipate a crisis," warned Joseph D'Cruz, a University of Toronto business school professor who specializes in health care. "People will actually find it impossible to get general medical services in their towns."
The doctor shortage is hurting the economies of small towns seeking to attract businesses. But it is also taxing the energies of the doctors who do live in those towns, as well as the resources of local hospitals - and patients often complain that their treatment is rushed.
Administrators at the nearby Lakeridge Health Oshawa, an acute care hospital, estimated that more than 30 percent of the patients who went to the emergency ward would go to a family doctor instead if they could do so quickly. It is a burden on the hospital's staff, space and financial resources.
One patient who went to the emergency ward recently, Crystal Bentley, 22, complained of cysts behind her ears. She said she would prefer to see her family doctor but would have to wait in his office for hours. She said she went to the hospital because the emergency room was faster.
"Seeing a doctor and not having to pay is phenomenal," she said, "but here I am taking up emergency time from doctors. I really do wish I could see my family doctor instead of coming here and talking to a total stranger."
-- Clifford Krauss for The NY Times
