Friday, May 23, 2008

Health Care?

This afternoon at the pharmacy I was in line behind two men.  One looked to be middle age, the other was elderly.  When the first man was told the price of his medications he just hung his head and walked away.  The pharmacist called after him, "You need this medicine, want us to keep it for you?"  He just muttered that he'd try to work something out and kept on walking.   The second man blanched at his payment of nearly $200 for four or five medications.  "What would it be if I didn't have insurance," he asked.  "Oh, around $400," she said.  He hung his head too, but paid - with a credit card.  How insane is this?  And yet I hear some of my friends brag about how the U.S. has the best health care system in the world.  What world do they live in?  Then they tell me about all the Canadians who come to the U.S. for treatment because they can't get it in Canada.  What treatment are they seeking?  Elective surgeries that are important to them but perhaps not urgent?  How much money do they have to spend whatever it takes to get what they want when they want it?  I can do that too, but it doesn't make it right that others have to suffer or go without!

6 comments:

H.M. said...

There are few issues that can get me more riled up than this one...that in the richest nation in the world, its citizens do not have a right to helath care. We should be ashamed. And why? Because like so much else in our society, it's really all about making money rather than truly caring aout and for people.

I had better stop before I go off on a rant. Good words, Parson, I think I'm with you on this one.

Country Parson said...

Rant away h.m. Saul Alinsky said that sometimes ranting was the only way to get the attention of decision makers.

Anonymous said...

A rant from anonymity - my question this week to someone was - "why are folks earning above a certain dollar amount allowed to cease contributing to Social Security funds when they've reached a certain level of pay?" It seems that they are the people who should continue to pay in - they can afford to do that. Why do we only love ourselves and where is the compassion that screams for healthcare and SS but is drowned out by the voices who are fiercely guarding their "things?"!!! Yeah, a rant is appropriate. Thanks, CP, HM.

Malcolm+ said...

The Canadian system is far from perfect, of course. But I am happy to have it - as compared to the horror stories I sometimes hear from my friends farther south.

Of course, the system we have is not precisely the same as the system first introduced in legislation in Saskatchewan.

The sorry tale of the doctors' strike - including, I note, the threats to kill the children of our then premier, Woodrow Lloyd - would be an apt subject for a very disturbing movie. But the eventual settlement of the strike required concessions - which included the retention of fee for service and profit taking within the system.

It has been established elsewhere that the single greatest determinant of health care spending in a jurisdictions with fee for service is not, as one might expect, the health of the populace, but rather the raw number of physicians.

Fee for service creates an incentive for doctors to increase demands on the system. "Come back and see me in two weeks," as opposed to "come back and see me if the symptoms haven't diminished in two weeks." References to specialists "just to be sure."

And now, the demands on the system and the resulting vulnerabilities create other perverse incentives. Patients being added to several waiting lists for the same procedures - though this has admittedly diminished with waiting list management in several provinces.

Turf protection adds to the problems, as doctors refuse to let nurses or nurse practitioners do things that are well within their competence and scope of practice. And now Registered Nurses use the same turf protection techniques against Licensed Practical Nurses and other technical professionals.

Of course, as a society, we have failed to grapple with the balance of the extension of life with the issue of quality of life. Procedures to keep the dying patient alive months, days or weeks longer, but with no real hope of improvement have become an increasing proportion of our health expenditures. I'm not suggesting that we run around unplugging life support, but at what point do we, should we cease offering false hope to patients and their families?

Finally, the biggest problem is that the system is inevitably managed to treat the sick as opposed to the prevention of sickness. Capitation systems, for example (where the doctor is paid based on the number of patients rather on the number of calls) would encourage doctors to keep us healthy, which is more efficient (and cheaper) than restoring us to health. (Capitation, of course, is not without its own problems, in that chronic patients have more trouble finding a physician to take them onto their list.)

None of this is easy, of course. But I'd rather have the issue of how long a procedure is continued to be based on a serious consideration of the quality of life issues - and the ethical issues - than on the size of the patient's bank account.

Country Parson said...

Thanks Malcolm, I was hoping you might wade in. I wonder, in view of your comments on end of life issues, if you might want to add more under the title of holy dying?
CP

Malcolm+ said...

I'm not sure I have anything to add to that discussion apart from the delineation of the uestion offered above.