We need more Canadians!

[a27mom]

These things are terribly complicated, and all the systems have deficiencies, flaws and outright stupidities associated with their execution in the real world. But...

 

This thread was asking how people's philosophies seem to differ specifically between the US and Canada.

 

In my opinion, a system can be flawed: and therefore create bad outcomes that might be discribed as unjust -- but that differs from a system that isn't oriented towards fair dustribution (or near it) in the first place.

 

If its not the case that all the people in a country can/will recieve excellent care all the time -- the question of justice focuses my mind on "Who experiences the problems, and why?"

 

In Canada, it's location factors, combined with blind bad luck that gets a person into a situation where their care is poor -- or else all the people are getting the same level of not-great care in a generally even handed fashion. These factors to me seem "fair" -- when it sucks, it sucks, but no one was singled out or chosen for bad care.

 

In the US it seems to me that people are experiencing the lesser end of care, of no care at all for actual, identifiable reasons: perhaps poverty, or that class where ends meet, but medical expenses are still terrifying. This feels like the poor (perhaps particularly the poor who also aren't intelligent enough to do research and seek options and think outside the box) are chosen by this social system to be the ones who recieve lesser care -- so that others recieve greater care.

 

 

This is an interesting point, and I will counter it with, I would much rather a system where the poor care has an identifiable reason than where poor care is random, or blind luck. Why? Because I can address an identifiable cause, I can't address blind luck.

 

I definitely do want better healthcare for the "poor". I just don't think the way to improve healthcare for the poor is to make healthcare crappier for everybody else, so that we will all have equally bad care, then the poor don't know what they are missing. There are better ways to address it. But a lot of those ways might cost some government bureaucrats their jobs so they can't seem to get any traction.

 

Besides wealthy Canadians do have access to better care. I used to live near the border, and work in healthcare, there were a lot of Canadians who utilized the US hospitals. In fact my family member was even advised by his Canadian doctor to get tested in the US quickly if one of his medical problems reoccurs. Although I do see that my Canadian family does find a lower standard of care acceptable, but I don't think they know what they are missing.

 

Maybe the issue isn't that Americans don't want everyone to have good healthcare, but we don't trust the government to actually provide good healthcare.

[Jane in NC]

In our community, the people going to the ER for a cold are folks who are covered by Medicaid (and have been before the ACA), and the patient does not pay a dime.

 

Many people who have insurance (private or Medicaid) don't have a primary doc for many different reasons. Some get sick so rarely that every time they go, the doc treats them like a new patient, or they can't get a quick appointment because the office can't find their file. Many of those folks do use urgent care, not all of them go the ER. Having a primary doc or not having a primary doc isn't always tied to insurance. Some of them see a specialist for allergies, for instance, so they access their primary doc very rarely.

 

If my community hospital publishes statistics on how many users are on Medicaid, private insurance, or are non-insured, I have not seen them.  So I can't report on who is using the ER and whether it is an appropriate decision. I will say that from my few experiences in going to the ER, most of the users are on Medicare. I live in a retirement area so it follows that the elderly are seeking medical services.

 

The statistics that I found on ER use were published by the CDC.  Page 2 of this PDF has an interesting chart. To be honest, only one of the ER visits of the five or six that my family has made in the last twenty five years resulted in a hospitalization. Not having an urgent care center required that we go to the ER for stitches.  But I thought that you might be interested in aggregate data since your hospital may be atypical.

[a27mom]

Reading some of these comments, anyone would think the Canadian system was third world!

Sorry, I am just really haunted by my teenage cousin's and my grandmother's deaths. The care they received in Canada would be considered malpractice here.

 

But that is very different than 3rd world.

[Azalea]

You can only have an HSA account if you have a qualifying High Deductible Insurance plan. What you are describing is a flexible spending account for healthcare.

 

Hmmm...Well I do have a high deductible plan. But the amount we save in premiums makes up for having to pay for our health care. It was a bit of a shock to get used to the high deductible plan. I am still waiting to see if one care provider will reimburse me as the insurance took a long time to pay the bill and I had to pay up front and we had met the deductible for one family member. That probably only makes sense to me...

[a27mom]

I'm very sorry to hear about your losses :(

 

It's completely true that even a system of universal health care will have incidents of malpractice. I guess the question is whether something about universal health care makes malpractice inevitable and systemic.

 

My experience of a non-Canadian system is that no, it does not make it inevitable or systemic.

 

Many, many people around the globe receive perfectly adequate universal health care.

I am glad to hear this and I do find it somewhat reassuring. :). Though I happen to live in a very poorly governed state, so it is only so reassuring.

 

But I also want to emphasize that non-universal healthcare also can be adequate, and good. So it is not inevitable and systemic that some people won't get healthcare either. Both systems can work and both can fail miserably. My community has good care available to people of all incomes. I have been told this is not the case everywhere in the US. I only have extensive experience in the healthcare system with 2 communities, and both provided quality care to people of all incomes. I do not personally know anyone who were denied or had delayed healthcare because of their income (except for people who are on the state government system).

 

The suffering I have seen among my family members was due to systemic problems. There are more than 2 incidents, just only 2 that haunt me due to hastened death. All of these incidents were due to 1 of 2 factors, either delayed care (systemic problem in their system) or a different standard of care for the elderly (also a systemic concept issue).

 

It would be interesting to see if Healthcare quality/availablility problems are related to large urban areas. It seems in Canada that the worst care may be in Ontario, which has the largest urban (only large urban?) area in the country. I would guess that it is the larger urban areas in the States as well where the issue is most pronounced.

[kbutton]

If my community hospital publishes statistics on how many users are on Medicaid, private insurance, or are non-insured, I have not seen them.  So I can't report on who is using the ER and whether it is an appropriate decision. I will say that from my few experiences in going to the ER, most of the users are on Medicare. I live in a retirement area so it follows that the elderly are seeking medical services.

 

The statistics that I found on ER use were published by the CDC.  Page 2 of this PDF has an interesting chart. To be honest, only one of the ER visits of the five or six that my family has made in the last twenty five years resulted in a hospitalization. Not having an urgent care center required that we go to the ER for stitches.  But I thought that you might be interested in aggregate data since your hospital may be atypical.

 

Our local hospital gets extreme ends of the spectrum. They have both a high rate of abuse of ER services and a really high rate of ER admits to the hospital. (Insider stats, not CDC information, though the link is interesting.)

 

For things like sutures, there is a wide range of what services are offered or not in the local urgent cares, particularly if the patient is a child. Pretty much no office around here will do sutures unless they also do vasectomies and the like in the office, and even then, they probably don't leave holes in their schedule for last minute stuff like that. It's a significant jump in malpractice insurance to do sutures because it's considered surgery. So, it would not be considered inappropriate in our area to go to the ER for sutures (and you really do want someone to do the sutures who gets a lot of practice!). It's best to call urgent care ahead because it often depends on what the doc on duty is comfortable with--some will suture, some will not. Some clinics have x-ray and ultrasound, some do not. Some ERs will do sutures and such for kids, some will not--nothing like getting TWO ER bills because no one at the front desk said, "they won't fix that here." Our local hospital is quite likely to take kids for all but really serious needs. They would stabilize a child if necessary and transport, but we have a couple of pediatric urgent care centers AND an pediatric ER within a few miles (depending if one is crossing the county or coming down the highway), so it would be unusual for kids to be brought in by squad unless there was a nearby accident (particularly one involving an entire family that they are trying to keep together). A few years ago, before these centers and ER were available, the hospital actually took fewer pediatric patients in the ER, and people had to drive a long way to a pediatric hospital just for sutures. It's really very odd all around.

 

As for ER admits to the hospital, it's probably higher because of the number of elderly folks who retire locally rather than heading south. The hospital is very happy to have an emergency department because, for them, it really drives business.