Wednesday, August 15, 2007

Sick, Sicker, and Sicko

Some patients just aren’t willing to sit back and take it anymore. The nation’s health system is long on promises and short on delivery. The litany of delays in care due to limited access grows by the day. In one instance, a patient sued her insurer because she was forced to wait four months for an MRI for her brain tumor and then months more to see a neurologist. In one metropolitan area, waiting times in the ER average four hours, while one in ten waits more than 12 hours.

One in three households surveyed tried and failed to gain timely access to at least one health service within the previous three months. And in one study, the total waiting time between referral from a general practitioner and specialty care averaged nearly 18 weeks. Even the Supreme Court has weighed in on the unacceptable delays in care. But the lawsuit is not against a dreaded American HMO and the events did not happen in the U.S. All were byproducts of the Canadian health care system.

In the movie Sicko by Michael Moore, several socialized health systems are held out as exemplars for the U.S., including those in Canada, Great Britain, France, and Cuba. The American health care system is a complete shambles, the sickest of the lot, according to Mr. Moore. Escalating numbers of uninsured, disproportionate access to health services, long ER waiting times, rapidly growing insurance premiums, denials of insurance coverage, high infant mortality rates, and profiteering by the greedy pharmaceutical companies fuel growing public dissatisfaction. U.S health care just doesn’t measure up when you look at all the money being spent according to Moore.

What you do not see in Mr. Moore’s movie are the inconveniences experienced by patients in those model socialized systems. In 2005, Canada’s Supreme Court ruled that, “access to wait lists is not access to health care,” which struck down key laws in Quebec that have prohibited private medical practice and private health insurance. Suits have been filed to enable Canadian citizens to “opt out” of the mandatory, government-run Canadian system, which some citizens even consider dangerous.

How dangerous? A cardiologist at the University of Ottawa reported on how delays affected Ontario heart patients. In a single year, 71 Ontario heart patients died before they were able to have surgery and 121 were removed from the surgery list permanently because they had become too ill to operate on. So for 192 people, the wait either led to their death or they became too sick to have surgery before they could work their way to the front of the line. Another 44 who could afford to bear the cost on their own left the province to have surgery – most in the U.S.

Since the mid-1980s a Vancouver-based think tank has been tracking how long patients are required to wait for medical care in Canada where by law many private alternatives have been banned. In its 16th annual report published in 2006, the Fraser Institute notes that the average time to receive treatment after referral from a general practitioner was 17.8 weeks. Patients waiting to see a neurosurgeon waited an average of 21 weeks, while actually getting treatment required another 11 weeks. The wait for an orthopedic surgeon averaged 16 weeks, and treatment required another 24 weeks. Total wait times are now 91 percent longer than they were in 1993.

Sicko holds the Canadian system out as a model for proponents of universal coverage where health care costs are lower and everyone has free care at the point of service. "While many proclaim Canada's Medicare program to be one of the best in the world, or suggest it should be the model for reform in the United States," says one of the Fraser Institute’s study authors, "the reality is that health spending in Canada outpaces that in most other developed nations that, like Canada, guarantee access to care regardless of ability to pay, and yet access to health care in this country lags that available in most of these other nations."

Because health care is largely free in Canada, demand is likely to exceed supply. It’s just human nature. Thus, waiting lists become the principal way of rationing medical care and holding down spending. And after 16 years of tracking growing waiting lists, the Fraser Institute observes that the problem is probably not a temporary one that can be fixed with a little more money or time. They note that provinces with higher spending per capita do not experience shorter wait times.

Just as we saw in the old Soviet system with its long lines for food and basic services, government central planning does not efficiently match supply with demand. And human beings will always seek more of something that is free. As one free market advocate states, "Long waits and widespread denial of needed care are a permanent and necessary part of government-run systems.”

And it’s not the care-givers who are at issue. Canadian physicians and nurses are among the best in the world. To paraphrase, “It’s the system, stupid.” That is, a mandatory system of care to which there are few alternatives. The rationale that no one is denied care when everything is free ignores the fact that everyone waits, and a considerable number even die in the process.

What about other socialized systems? Surely others have gotten it right and can serve as a model for America. In France, the health system failed spectacularly during the summer heat wave of 2003 when 13,000 people died, mostly from dehydration. Hospitals simply stopped answering the phones and ambulance services told citizens they were on their own.

Things are not much rosier in England which launched its National Health Service (NHS) in 1948. At that time, the government nationalized more than 3000 independent hospitals, clinics, and care homes. The government promised that it would provide its citizens with all the “medical, dental, and nursing care” needed so that “everyone – rich or poor – could use it.” It didn’t quite work out that way.


1 comment:

Zagreus Ammon said...

This remains a matter of perspective:

Yes a few hundred patients died due to shortcomings in OHIP.

However, a recent study published last month suggested 50,000 women would die in the US due to poor access to mammography.