44

Red (Maple) Menace: Health Care Edition


 

As the fight over Obamacare heats up, the bill’s opponents are pulling no punches. A reader in New Jersey points me to an anti-Canadian health care attack ad that is running down there. It features a Canadian woman who got a brain tumour; her “government health care system” told her to wait six months for a specialist, and she survived only because she was able to get to the US for treatment.

The message of the spot is that patients should never let “government” get between them and their health care, because that leads to wait times, rationing, and arbitrary decisions about what treatments you are entitled to. As a Canadian, she ends by imploring Americans, “don’t give up your rights.”

Is this accurate? Hardly. Wait times we can argue over. But my sense is that an HMO gets “between a patient and their care” in a far more intrusive way than a provincial plan like OHIP does; though as a bit of northern red-baiting, it’s pretty effective.

Here’s the video — it’s called “Survivor”.  Dissect away.


 
Filed under:

Red (Maple) Menace: Health Care Edition

  1. Andrew, you are completely missing the point. An HMO does not get in the way for a service you are willing to pay for.

    In this case, the woman was willing to pay money to save her life, and she needed to go to the US to do that, in Canada she had no alternative.

    One thing is for sure, Canadians are always trying to mix up these two issues:
    1. whether medical treatment is available in a timely manner
    2. whether medical treatment is affordable

    Whenever you bring up issue 1, Canadians will always ignore it and talk about issue 2. In America, issue 1 is never an issue, care is always available very quickly, it is always issue 2 that is discussed. So the ad is doing a service to Americans by actually raising and making them aware of issue 1. And Canadians like Andrew Potter fail to help, they would rather stick their heads in the ground and pretend that issue 1 does not exist, when in fact it is by far the biggest problem with Canadian health care, in almost every single aspect, whether access to GPs, access to ERs, access to diagnostic tests, access to specialists or access to surgery.

    • The insularity of American media will win this one. If you could get enough of the lowest common denominator to look outside and note that every single first world system has some sort of widely available publicly funded healthcare, the terms of the debate (not 'if' but 'how') would change quickly and dramatically.

      • Americans have medicare and medicaid, both publicly funded healthcare programs.

        • widely avaiable was the key there, kiddo.

    • "Andrew, you are completely missing the point. An HMO does not get in the way for a service you are willing to pay for. "

      What a crock! We are talking about the insurance industry, yes?

      scf, are you seriously suggesting that patients never get turned down by HMOs?

      • No, your reading comprehension needs a little work.

    • I don't understand. How did this woman get in to the U.S. to get the treatment she bought? Didn't our border guards stop her? Did no one tell her that the government bureaucrats had decided that it was her time to die? How did she slip through the cracks, and does our socialist government have a plan to eliminate her now that she managed to survive despite their best efforts?

      I think it should also be made clear that this isn't a case of "The U.S. System saved her, the Canadian System would have let her die". Leaving aside the fact that her tumor wasn't life-threatening (see below) at absolute worst this is a case of "The Canadian system couldn't help her, and the U.S. system, plus $96,000 did. Anyone in the U.S. with no insurance and no $96,000 sitting around would have been no worse off in the U.S. than up here.

      (I'd also add that her life <a href="http://www.ottawacitizen.com/health/reality+check+reality+check/1783177/story.html">wasn't apparently at risk, as she didn't have the type of brain tumor that would lead to death, though as it was apparently threatening her vision, I'll accept that that is somewhat moot point. If she had to go to the States to save her vision that's a problem in our system that needs to be fixed, but it seems apparent that she didn't, technically, have to go to the States to "save her life").

      • Wow, your powers of remote diagnosis are really something.

        • Just going on the published reports, including reports from the people who actual fixed the condition she was suffering from. Excuse me if I think it's more likely that a patient (quite understandably) became upset over a serious diagnosis and decided to act to have something done more quickly then it really needed to be, then that her doctors decided to just ignore a fatal problem and let it be.

  2. " On the Mayo Clinic's website, Shona Holmes is a success story. But it's somewhat different story than all the headlines might have implied. Holmes' “brain tumour” was actually a Rathke's Cleft Cyst on her pituitary gland. To quote an American source, the John Wayne Cancer Center, “Rathke's Cleft Cysts are not true tumors or neoplasms; instead they are benign cysts.”

    There's no doubt Holmes had a problem that needed treatment, and she was given appointments with the appropriate specialists in Ontario. She chose not to wait the few months to see them. But it's a far cry from the life-or-death picture portrayed by Holmes on the TV ads or by McConnell in his attacks."

    (H/t Ian Welsh: http://www.ianwelsh.net/lying-liar-attempt-to-mak

    • If true, I am not surprised, and feel it is entirely typical.

  3. oops, didn't mean to post this as a reply to the above post.

  4. Yeah, medical necessity determines how quickly someone gets seen, not government dictate. There's not a 1:1 ratio nof doctors to patients in the States either; Americans have to wait too.
    Of course, government's have to make the decision of how much they are willing to invest in providers of medical treatment, and that is a function of a number of factors not the least of which is available revenues. There is a cost benefit analysis on a macro level; doctors make the decisions at the micro level and based on necessity; prognosis, etc.
    But what exactly is her point? The rich will always be able to get better service in the US, an extension of coverage to everyone in the US would not eliminate that, so that would not negatively her -as an American or Canadian willing to shell out – at all in the future.

  5. "But my sense is that an HMO gets “between a patient and their care” in a far more intrusive way than a provincial plan like OHIP does;"

    Depends what you mean by 'intrusive', I think. I don't know much about HMOs but I do know that Obama is trying to sell this plan by saying it will save money. Obama is arguing that all the tests that HMOs allow people to have are what's bankrupting the nation and the tests/services need to be rationed. And I find it hard to imagine that anything can be more intrusive than OHIP, which decides what doctors you can see, what tests you can have and what meds you can take.

    • I don't know much about HMOs ….I find it hard to imagine that anything can be more intrusive than OHIP

      * * *

      yup.

      • So I assume you are an expert on HMOs vs OHIP. Please explain how rationing services/tests that people get regularly now in US is not 'intrusive'. I would also like to hear your thoughts on the 18% of Canadians who don't have a doctor, and good luck getting into see a specialist without GP referral, and how that's superior to US system which covers way more people than we do here.

      • So I assume you are an expert on HMOs vs OHIP. Please explain how rationing services/tests that people get regularly now in US is not 'intrusive'. I would also like to hear your thoughts on the 18% (and increasing every year) of Canadians who don't have a doctor, and good luck getting into see a specialist without GP referral, and how that's superior to US system which covers way more people than we do here.

        • I ain't gonna do your work for you. Google is your friend.

          • Yeah, you're too busy diagnosing brain tumours on blogs with smell tests.

    • You know, I've been using this system for over 3 decades now and, call me silly, but never once been told which doctors I can see, which tests I can have, or what meds I can take by anyone but my doctor.

      Which I just happened to have I chosen by myself in the first place as well.

  6. What a jerk. The issue is so much more complicated than she makes it out to be. If she really was as ill as she claims there is no way she would have had to wait 6 months.

    • How convenient that you know all the circumstances of her case, then, as well as the history, background and outcome of all bureaucratic decisions affecting her and that form of treatment in her local region as well as throughout the province and across the country, such that it's possible to make blanket statements of absolute certainty that she "couldn't really be that sick."

      Oh, wait; you can't possibly know all of that, and are simply attacking the messenger. Carry on.

      • Actually the guy a few posts above makes a pretty good case that it's Levant-level fabrication. I gotta admit it don't pass the smell test.

        • Perhaps you could elaborate what a "Levant-level fabrication" is, because the linked material suggests nothing more than minor sensationalism with non-medical use of the term "brain tumour," and much tut-tutting about how, as hardmouth above, she couldn't have really been that sick, so why the fuss about being given a several-month-long wait time, etc.

          The point isn't that she absolutely would have died otherwise; it's that a rationed public system offers no choice in the matter, and unless you're politically connected, you're likely at the mercy of public policy.

          • What nobody talks about is that there is, in fact, a way to get OHIP to cover stuff like this. Your doc presents evidence that a delay in treatment will harm the patient, and that the treatment is legitimate. If this is the case, OHIP says sure, go for it, and pays the bill. But, it works better if you ask ahead of time.

            She didn't want to wait the week to do the paperwork, or was concerned her condition wasn't serious enough to merit this program, or her doctor wouldn't file the paperwork because he wouldn't sign off on the urgency of the case.

            Now that she's being paid to do the circuit in the states, maybe she'll drop her lawsuit?
            http://www.law.utoronto.ca/healthlaw/docs/case_Mc

            This lawsuit, by the way, is being funded bythe nice people at the Canadian Constitution Foundation. I'll let you draw your own conclusion.
            http://www.canadianconstitutionfoundation.ca/

          • What nobody talks about is that there is, in fact, a way to get OHIP to cover stuff like this. Your doc presents evidence that a delay in treatment will harm the patient, and that the treatment is legitimate. If this is the case, OHIP says sure, go for it, and pays the bill. But, it works better if you ask ahead of time.

            She didn't want to wait the week to do the paperwork, or was concerned her condition wasn't serious enough to merit this program, or her doctor wouldn't file the paperwork because he wouldn't sign off on the urgency of the case.

            Now that she's being paid to do the circuit in the states, maybe she'll drop her lawsuit?
            http://www.law.utoronto.ca/healthlaw/docs/case_Mc

            This lawsuit, by the way, is being funded bythe nice people at the Canadian Constitution Foundation. I'll let you draw your own conclusion.
            http://www.canadianconstitutionfoundation.ca/

          • Or maybe surgery is not the best treatment for anxiety.

          • Yes, brain tumours are nothing really, just an itch that needs to be scratched. Your sympathy knows no bounds. Screw the patients, we have a medical system to uphold!

          • It, apparently, was not a brain tumour.

          • Maybe her doc was not willing to present evidence, and was wrong, and since getting an appointment with another specialist would take another 6 months, she decided to save her life instead. Just a thought.

          • Post a copy of your medical license with an added specialty in neurological
            surgery and I might be tempted to pay attention to your blather.

            Other than that you're talking about a paid political addie and apparently you
            think it is actually supposed to mean something beyond that.

          • By the way…it wasn't, actually a tumor. Feel free to did back into the news files from 2007 to see the original description. It was a cyst.

          • Hey, you're the one who decided to play a doctor on the internet, just like M_A_N below, who feels that having a cyst in your brain is no big deal, it's not like you need the space for anything else up there.

          • Not a doctor on the internet or otherwise. But I did spend 30-odd years working in
            health care and I've seen any number of situations where a person's reaction to
            diagnosis have made them react in irrational ways due to the anxiety provoked by
            the situation.
            And we're not talking about a tumor. We're about a benign ( non-malignant ) cyst
            causing a spectrum of endocrine system symptoms known as Cushing's Syndrome.
            Distressing. Upsetting. Non-life threatening. Treatable.

            Unless , of course , you're getting your information from fine upstanding, caring
            citizens ..http://www.washingtonpost.com/wp-dyn/content/arti… .. interested in the brotherhood of man

          • You're right that i don't know the specific details of her case. However, as I'm a Health Economics student I am quite familiar with the pros and cons of the canadian system. And her story just doesn't make any sense.

            In the canadian system 'Demand for health care services' is disconnected from 'willingness to pay', Because there are no price incentives(it's free) latent demand is unleashed on our healthcare system leading to shortages. The way we ration our health resoures is by need/urgency/severity of illness– which is often how hospitals in the united states are administered when HMO's are not interfering. Rationing will exist in any system where the patient doesn't pay up front for their health services.

            I might add, that family doctors are the gatekeepers to our sytem- they decide who gets what treatment, and where you go in the line. I'd much rather have independent doctors deciding this, rather than HMO boards, and HMO employed doctors/hospital admin staff.

          • Heck, if the line is long enough (like all wait lists in Canada), it doesn't matter what your doctor thinks, you are gonna wait, regardless of the pain and suffering you may be in. Granted, most of the time, they won't let you die while on a waiting list.
            And secondly, if you happen to disagree with your doctor, then you have no recourse in the Canadian system.
            I know what good service is, and I know we don't get it in the Canadian system.

          • Since doctors are the gatekeepers keeping costs down in our system, your claim that being politically connected gets you better care is beyond ridiculous. We're not the Soviet Union or some banana republic. Furthermore health care in Canada is delivered privately. Knowing politicians will get you nowhere; knowing a lot of doctors and medical professionals might hook you up.

          • Being politically connected does get you better care, your naivete is amusing.

  7. "It's a little worse than that. You see, many of those 47-49 million w/o insurance WILL be treated, often after a condition has worsened (and become more costly). "

    Amateur Hour, perhaps there are exceptions but, as a rule, these non-insured do not receive treatment. I personally know of a person who developped congestive heart failure and ended up needing a transplant but was refused care because he had no insurance to cover the cost.

    Healthcare is viewed as a priviledge as opposed to a human right in that country. Hospitals have absolutely no qualms at sending a person home to die if they cannot cover their expenses.

    • PolJunkie,

      I remember a friend in college being transported by ambulance to a top hospital, only to then be bounced — hours later — to "County" via a taxicab when they saw he had no insurance. Did he receive care? Yes, eventually. Was it the best? No. Did it cost the taxpayer? You bet. It's an anecdote, like the one you relate, but many anecdotes add up to data.

      Please note that, in my comment above, I said "many" of the uninsured receive care in the US — too late and at great cost to human health and to the economy. Many receive no care at all. In the first case, it makes the system costlier and less efficient and less humane. In the second case, it is a human rights tragedy.

      The point of my post was to correct those who think the US system presents a "private" alternative to Canada's, when in truth the US healthcare system is massively subsidized by taxpayers, yet still is the most costly in the world and fails to cover tens of millions. The core of my argument, perhaps too opaquely laid, is that universal coverage has to be the starting point of any just healthcare system. The next step is figuring out how best to pay for and administer it (public, private, or a mixed-delivery system). My suggestion is that the US debate is focused on the second question, giving short shrift to the first … and interest groups are being deceitful in presenting the choices Americans have.

      I agree with your statement about healthcare not being seen as a right in the US, and it is to Canada's great credit that it is seen as a basic right here.

  8. I gotta agree with scf (first commenter). In Canada, because the *delivery* of services is so highly regulated, we simply cannot walk into a diagnostic clinic, put a few thousand dollars down, and get an MRI (well, I think in spots in Canada, you can now, actually). But in the States this is common practice (why we fly injured CFL players to the states for diagnostics).

    The person in the advert was talking about the 6-month wait for *diagnostics* not treatment (which obviously requires to wait for results from diagnostics). She paid out of pocket for an MRI. Then she likely came back to Canada with those results to get treatment (or maybe not, I'm just guessing here).

    Now *delivery* and *payment* of medical services are highly connected, but they are distinct things. In the states, they have some Medicare. If you qualify, Medicare pays for your services. But Medicare does not regulate the delivery of those services.

    In Canada, our provinces (from our taxes) both regulate delivery and payment. And we usually, as users of the services, don't think about that. (our provinces are also in charge of quality assurance and reporting too – there are few independent healthcare quality assurance agencies with any power – which means the same people who determine the method of delivery and how much to pay for it are also responsible for deciding how well they are doing both of those things ).

    All that to say I hope that the USA does move forward with expanded healthcare. I suspect that it will help their businesses become more competitive and their workforce healthier and more productive. But they don't need to over regulate delivery of healthcare too much.

  9. 50 million people w/o the means to pay for an HMO. This means that should any of these 50 million require health services that cannot be taken care of at the ER, they are sh!t out of luck.

    That Americans would still be debating the need to provide for these 50 million citizens is just mind boggling.

    • It's a little worse than that. You see, many of those 47-49 million w/o insurance WILL be treated, often after a condition has worsened (and become more costly). The cost of treating those uninsured will be born by the taxpayer and also by higher premiums for those with insurance. These free riders help drive up the cost of insurance, which causes companies to cut back on benefits, tossing more into the ranks of the uninsured, keeping the cycle going.

      Healthcare in the US is greatly subsidized by gov't, through Medicare, Medicaid, Soc Sec, HHS and countless state programs, not to mention the gov't benefits of civil servants, members of the military and, ahem, politicians. Workers shield a portion of their income from taxation in healthcare savings programs, and companies offering benefits get big tax breaks, too — all a form of subsidy. Americans do not have a private system, but rather a mixed system that lacks universality.

      Universal coverage makes systems — public, private and mixed — more efficient. Sadly, insurance companies and profit-focus medical businesses have been fighting against universal coverage requirements since FDR. They have no problem providing profitable care to the healthy and heavily subsidized. They just don't want to deal with the costly sick or less profitable unsubsidized.

      Canada's system is less costly and achieves comparable or better outcomes because of universality. We have some degree of private-sector delivery, and it's fair to debate how far that can or should be expanded. But those debating the issue in the US are caught up in a cycle of deceit. They claim Canada has a purely public system when we do not. They claim America has a better, private system when that is not true either.

      If the debate were focused on universal coverage and not sophomoric arguments about socialists vs. corporate profiteers, then maybe things will improve south of the border. Right now, it doesn't look likely.

      PS: Very little coverage is given to the hundred-million or so with inadequate health insurance in the US. I was one of them, and even with insurance, a major health issue easily became a financial terror for my family. Canada's system warts and all, remains superior to the US — though it could use some improvements.

Sign in to comment.