News Most US doctors now support a national health plan

[Moonbear]

I don't particularly object to them mandating physician participation, but to me, it's more that there is an imbalance of which physicians are being given the mandate. Basically, those already taking in medicare patients will be given the extra burden of also taking in patients on this plan, regardless of whether they can handle the extra patient load. It seems more likely to harm than help if the only way physicians have out is to drop their medicare patients.

If, on the other hand, they mandated ALL licensed physicians have to take in some small number of patients on this plan before they can take in any other new patients (i.e., if you have a full patient load now, okay, but as soon as you can take in a new patient, you have to take in three people on this plan before you can take in another with private insurance), it would distribute the burden and be more equitable.

The biggest problem, though, is that a lot of the people without insurance also live in areas where there are physician shortages. I've been learning more about the rural communities in WV, and there really is minimal access to physicians. One of the rural clinics I visited, which charges fees based on what people can afford, with the minimum for an office visit being $5 (I don't think people there would accept anything free), their patients can drive as much as 40 min to get there. And that clinic doesn't even have an x-ray machine! If a patient needs x-rays, or more emergent care, it's another hour by ambulance to the nearest fully-equipped hospital. Providing health insurance to the uninsured living out there isn't going to do them a spot of good, because they still don't have a doctor nearby to see. Someone first needs to do something to encourage physicians to move out there...and there's not a lot of incentive to do that unless someone grew up in those areas and wants to move back where family is. We can get med students out there, mainly because we REQUIRE they do a rural rotation, but that's no substitute for a fully licensed, experienced physician. We try to admit some "high risk" med students if they come from these areas, just because we know that's the best chance the state has to get physicians into those places, but it's a gamble and those students often can't make it through med school.

So, yes, lack of insurance is an obstacle to health care, but it's the second obstacle, not the first. The first is simply having a health care provider nearby. That problem needs to be addressed before offering insurance is going to help.

 

[mheslep]

...

So, yes, lack of insurance is an obstacle to health care, but it's the second obstacle, not the first. The first is simply having a health care provider nearby. That problem needs to be addressed before offering insurance is going to help.

My first suggestion for the rural physician shortage is to break the lock the medical associations and industry have on medical schools and residencies. The cost of medical training is so high that I imagine new physicians can't help but pursue higher wages in metropolitan areas to cover the debts.
E.g.:

Abstract
Non-primary care physicians earn considerably more than primary care physicians in the United States. I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating a shortage of non-primary care physicians. Entry barriers exist due to cartel behavior by residency review committees, regulation that until recently required residents in all specialties to receive the same wage, and/or scarcity of teaching material. I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents’ salary of $34,000. In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated $0.6 to $1.0 billion per year in labor costs.

http://www.ftc.gov/be/workshops/heal...olsonpaper.pdf

 

[gravenewworld]

Hope you don't get cancer (1/3 women and 1/2 men will) 'cause insurance isn't going to pay up...http://health.usnews.com/articles/h...e-coverage-caps-hit-cancer-patients-hard.html
God I love health care in this country. It is top notch...as long as you don't become catastrophically ill.

What's worse—being diagnosed with cancer or discovering that your health insurance won't go the distance in covering your treatment? These days, with earlier detection and better therapies, cancer isn't the death sentence it once often was. But treating it is expensive, and employers and health plans are increasingly placing caps on the maximum benefits they will pay, as well as other restrictions on coverage that hit cancer patients particularly hard. If the tumor doesn't kill you, it seems, the medical bills just might.

The policy limits on coverage typically apply to all illnesses, not just cancer. But experts say that cancer patients are particularly likely to bump into annual caps on doctor visits or drugs, say, because the disease often requires intensive treatments—including surgery, chemotherapy, and radiation—in the months after diagnosis. Even if patients avoid the initial pitfall, they may eventually run afoul of lifetime benefit caps.

When will people learn that having insurance does NOT equate to having health care? Insurance companies like to take your money, but then are stingy when it comes time to pay up. Why are insurance companies dictating which procedure/medicines/doctors people can and can not have?

 

[gravenewworld]

Another interesting article I found during my hours of insomnia

http://www.latimes.com/business/la-fi-rescind17-2009jun17,0,5870586.story

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses

 

[bleedblue1234]

I really, really like this Ron Paul video and I think it sums it up nicely:

(he is also a well known doctor himself)

https://www.youtube.com/watch?v=<object width="560" height="340"><param name="movie" value="http://www.youtube.com/v/foXQbmZxWYY&hl=en&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/foXQbmZxWYY&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object>

 

[mheslep]

I agree w/ 95% of what Rep. and Dr. Paul has to say there. Couple items unrelated to the healthcare problem that I could have done without
- mention of the "money supply", a reference to his back to gold rants.
- licensing for doctors? Yes antitrust action should be taken but I don't understand the libertarian take on licensing.

On the rest he's profoundly right, my opinion.
-MSA/HSAs
-Costs drop w/ 'managed care' out of the way
-Socialized medicine doesn't work well elsewhere.
-There has been less and less competition.
-Get the attorney's out of the game through arbitration.
-Freedom works, socialized medicine doesn't.
-When "third parties pay the bill, doctors labs ... charge the most, not the least"

 

[a4mula]

I do not personally agree with this concept. I feel as though our healthcare system is in the shape it is today directly because of the Medicaid act of '65. The federal government has shown an undeniable skill at corrupting and bloating everything they touch. To have faith that they can properly manage the single largest expenditure of this nation is expecting alot. As it stands the government drops over 17pct of our gdp on healthcare. That still represents less than 20pct of the total cost. For all the complaints we have about defense spending, the government spends 4 times as much on medicaid and medicare.

We already have socialized healthcare, it's a failure and a huge one at that. Are we really prepared to hand over the single largest economic issue to the same government that has failed on every level of economic management?

This isn't a left/right issue regardless of how much some want it to be. This is an issue that affects every single person in this country, and generations of people that won't have the ability to have their voices heard for years.

Public Education is a disgrace. Social Security is a complete failure. Welfare, Freddie Mac, Fannie Mae... the list just goes on and on of epic failures one after another.

I wish I would have had stronger advocates in the '60s. My voice couldn't be heard then. We went from a strong industrial nation that was coming off of WWII to the "Great Society". Those that could didn't speak up for me then. They didn't fight and oppose giving our country away. Now we face the single greatest economic challenge that we've ever seen. The adoption of government aid has lead directly to the inflation that we witness across the board. The next twenty years are either going to revive this country, or finish it off. This single conversation is the cornerstone of that balance.

To often we hear politicians abusing the rhetoric of children and our future. This isn't one of those instances. Much as the decisions of the '60s have directly influenced our society today, our choices today are going to dictate tommorow's future. We cannot continue to give away our freedom for promised security, especially when those promises have been and always will be empty.

 

[jal]

HEALTH CARE IS TOO EXPENSIVE
So what do you do?

Option #1
You save money

As an individual, you place some of your extra income into savings for that eventual day.
If your savings are not sufficient, then the banks will lend you money to pay for it.

If you cannot save and you cannot get a loan then you do without the medical service.

Option #2
You pay for an insurance.

It’s a pooling of surplus income/money from a large number of people who are putting their money in a “trust” for the day when they will need to cover medical expenses. If the individual has not put in enough money to cover his medical expense then the shortfall will come from the other contributors. Everyone will eventually get sick. Therefore, when you need medical help you will get financial help to pay for it.

If you cannot pay for an insurance and you cannot get a loan then you do without the medical service.

Option #3

You pay the government, (a tax), to administer the pool of money.

The government will pay for the specified medical expenses for everyone and collect money from those who are above a determined minimum level of income.
If you wish to take out more “coverage” then you save/pay a private insurer to administer that pool of money and to payout when you get sick for the specific medical treatment that you are paying for.

If it is too expensive for the individual then it will be too expensive for the government.

If you cannot pay for medical treatment then you do without.
---------
Can the cost of medical treatment be lowered?
NO! Not without a bloody battle with losers from the medical, (and legal), establishment.

The present systems have too many interlocking monopolies.
The systems need to remove intermediaries and break the monopolies that have set up “fee schedules”.
Since there are a growing number of people who must do without medical services because of the cost, those medical service providers have concluded that they must get the government to collect money for them so that they can continue operating without loosing any advantages.

Jal

 

[drankin]

HEALTH CARE IS TOO EXPENSIVE
So what do you do?

Option #1
You save money

As an individual, you place some of your extra income into savings for that eventual day.
If your savings are not sufficient, then the banks will lend you money to pay for it.

If you cannot save and you cannot get a loan then you do without the medical service.

Option #2
You pay for an insurance.

It’s a pooling of surplus income/money from a large number of people who are putting their money in a “trust” for the day when they will need to cover medical expenses. If the individual has not put in enough money to cover his medical expense then the shortfall will come from the other contributors. Everyone will eventually get sick. Therefore, when you need medical help you will get financial help to pay for it.

If you cannot pay for an insurance and you cannot get a loan then you do without the medical service.

Option #3

You pay the government, (a tax), to administer the pool of money.

The government will pay for the specified medical expenses for everyone and collect money from those who are above a determined minimum level of income.
If you wish to take out more “coverage” then you save/pay a private insurer to administer that pool of money and to payout when you get sick for the specific medical treatment that you are paying for.

If it is too expensive for the individual then it will be too expensive for the government.

If you cannot pay for medical treatment then you do without.
---------
Can the cost of medical treatment be lowered?
NO! Not without a bloody battle with losers from the medical, (and legal), establishment.

The present systems have too many interlocking monopolies.
The systems need to remove intermediaries and break the monopolies that have set up “fee schedules”.
Since there are a growing number of people who must do without medical services because of the cost, those medical service providers have concluded that they must get the government to collect money for them so that they can continue operating without loosing any advantages.

Jal

But, you have to convince those who think they have a freakin Constitutional right to have a doctor treat them at government determined rates.

If I can't afford a doctors services then I don't get a doctors services. If joe blow can't pay me for my technical services, then joe blow does not get my technical services. If people were more concerned about there own health, they would take better care of themselves. But not only do they not take care of themselves, they expect the rest of the world to support them in their self destructive lifestyles. If you make it easy for someone to not work, not take care of themselves and their families, then they have no incentive to survive on their own.

Blah freakin blah. Those who actually work will end up support those who... don't feel like it.

 

[mheslep]

...As it stands the government drops over 17pct of our gdp on healthcare. That still represents less than 20pct of the total cost. For all the complaints we have about defense spending, the government spends 4 times as much on medicaid and medicare. ...

Those figures are way off a4mula and easy to look up: US defense spending is ~$516B/yr (2009), Medicaid+Medicare ~ $630B/ yr (2009), though health spending is increasing at a much faster rate than defense. There are other government health programs like Veterans care, but they are minuscule in comparison. Thus govt health spending is roughly 5% of US GDP ($14 trillion). The total of _all_ health care related spending in the US economy, both private and public, is about 17% of GDP (1/6th).

 

[turbo]

There is too much reliance on insurance-company propaganda and not enough fact here. The reason that Medicare is hugely expensive is that is has to pay for care under a system in which the insurance companies are siphoning off billions a year in denied and delayed payments and dropped coverage for sick people. We have by far the most expensive health-care system in the developed world, and we are getting less benefit than Canada, European nations, etc. A real, public, single-payer system would be far cheaper and would cut overhead for providers, who would be able to maintain their current incomes while charging less for services. This is basic economics, not rocket-science.

 

[mheslep]

I believe it has been reestablished in the past few weeks that the public in the US is highly skeptical of government directed or run health care. I certainly am. However we see more than ample criticism of public plans, to the point that doesn't add much to the debate. The US health system never the less has some serious cost problems, and I'd like to see more discussion on what can be done, rather than spending large amounts of time on what shouldn't be done, because the status quo is not acceptable either.

I still favor the ideas proposed by McCain's adviser Holtz-Eagin during the campaign which unfortunately the Senator Biden put out a lot of bad information about during the campaign. The biggest part of the McCain plan is killing the employer tax deduction, and moving the tax breaks to the individual. Sen. Baucus recently revisited the employer tax break (without individual breaks in lieu of). Either way, the employer deduction has got to go to re-enable a free market for health care, and make Americans health shoppers, not health suckers.
http://money.cnn.com/2008/03/10/news/economy/tully_healthcare.fortune/
http://www.heritage.org/Research/Healthcare/bg2198.cfm

 

[mheslep]

There is too much reliance on insurance-company propaganda and not enough fact here. The reason that Medicare is hugely expensive is that is has to pay for care under a system in which the insurance companies are siphoning off billions a year in denied and delayed payments and dropped coverage for sick people.

What does that have to do with Medicare, since it operates without insurances companies in the loop?

We have by far the most expensive health-care system in the developed world,

yes

and we are getting less benefit than Canada, European nations, etc.

no

 

[turbo]

What does that have to do with Medicare, since it operates without insurances companies in the loop?

The insurance companies drive up the cost of health care by imposing administrative overhead on health-care providers, and Medicare has to pay for services under these inflated prices.

 

[mheslep]

Today's NYT Brooks column:

Something for Nothing
By DAVID BROOKS
June 22, 2009

On May 12, the Senate Finance Committee held a hearing on health care reform. There was a long table of 13 experts, and a vast majority agreed that ending the tax exemption on employer-provided health benefits should be part of a reform package.

They gave the reasons that experts — on right or left — always give for supporting this idea. The exemption is a giant subsidy to the affluent. It drives up health care costs by encouraging luxurious plans and by separating people from the consequences of their decisions. Furthermore, repealing the exemption could raise hundreds of billions of dollars, which could be used to expand coverage to the uninsured.

Democratic Senator Ron Wyden piped up and noted that he and Republican Senator Robert Bennett have a plan that repeals the exemption and provides universal coverage. The Wyden-Bennett bill has 14 bipartisan co-sponsors and the Congressional Budget Office has found that it would be revenue-neutral.

The Finance Committee’s chairman, Senator Max Baucus, looked exasperated. With that haughty and peremptory manner that they teach in Committee Chairman School, he told Wyden and the world that this idea was not going to happen.
...

The problem with the committee plans is that they don’t do much to change the underlying incentives, and consequently don’t do much to control costs. “The single most expensive option is to build on the existing system,” says the health care costs guru John Sheils of the Lewin Group.
...
The committee staffs don’t like the approach because it’s not what they’ve been thinking about all these years. The left is uncomfortable with the language of choice and competition. Unions want to protect the benefits packages in their contracts. Campaign consultants are horrified at the thought of fiddling with a popular special privilege.

KILL IT already.

So here comes one of those tough moments for a President. No substantive health care reform is going to happen unless Obama gets off the I-support-whatever-works fence and takes the heat for getting behind McCain's original proposal: repeal the employer based tax cut. But that is not going to happen. Instead we'll see a lot of blame thrown on Republicans as the 'party of no', despite overwhelming Democratic majorities.

 

[turbo]

The problem with the committee plans is that they don’t do much to change the underlying incentives, and consequently don’t do much to control costs. “The single most expensive option is to build on the existing system,” says the health care costs guru John Sheils of the Lewin Group.

This is the reason that Medicare and Medicaid are so horrendously expensive. They are publicly funded, but they are forced to obtain services from a private system that is terribly expensive, inefficient, and laden with administrative overhead. The insurance companies have bought Congress (both sides of the aisle) to prevent the establishment of a single-payer or public-option program.

 

[mheslep]

This is the reason that Medicare and Medicaid are so horrendously expensive. They are publicly funded, but they are forced to obtain services from a private system that is terribly expensive, inefficient, and laden with administrative overhead. The insurance companies have bought Congress (both sides of the aisle) to prevent the establishment of a single-payer or public-option program.

We have examples of single payer elsewhere in the world; as has been documented in these forums they have huge problems the US doesn't want. Health outcomes are inferior to the US. Care is rationed. Innovation suffers. The Health Minister becomes the most important ministerial job in the government; foreign minister and defense become minor positions in comparison. And several countries that used to go single payer, like the Netherlands, have dumped it.

The way to drive to down costs, as it has always been, is to have competition for services that people actually have to buy themselves (in most cases), not to have big brother take care of it all for us.

 

[turbo]

Well, I know a lot of Canadians due to my geographic location, and naturalized US citizens with extended families in PQ and NB. I don't know a single one of them that would prefer the US system to the Canadian system. By the way, when insurance company proponents cite the fact that some Canadians seek treatment in the US, they never mention that most of the procedures done in the US are paid for by the Canadian health insurance system. Much of Canada is very rural, and like in the US, it may be necessary to travel quite a distance to get to be diagnosed and/or treated by a specialist instead of a general practicioner. Their public health-care insurance system is set up to be able to respond to such situations.

The fact that it can be easier to go cross-border and be treated in the US is not a condemnation of the Canadian system, as it is usually portrayed by the insurance company lackeys, but is a practical response to uneven distribution of medical resources. For the same reason, people in Maine often have to travel all the way to Boston to get special treatments that are not available in Maine.

 

[drankin]

Well, I know a lot of Canadians due to my geographic location, and naturalized US citizens with extended families in PQ and NB. I don't know a single one of them that would prefer the US system to the Canadian system. By the way, when insurance company proponents cite the fact that some Canadians seek treatment in the US, they never mention that most of the procedures done in the US are paid for by the Canadian health insurance system. Much of Canada is very rural, and like in the US, it may be necessary to travel quite a distance to get to be diagnosed and/or treated by a specialist instead of a general practicioner. Their public health-care insurance system is set up to be able to respond to such situations.

The fact that it can be easier to go cross-border and be treated in the US is not a condemnation of the Canadian system, as it is usually portrayed by the insurance company lackeys, but is a practical response to uneven distribution of medical resources. For the same reason, people in Maine often have to travel all the way to Boston to get special treatments that are not available in Maine.

I live in WA state and have many Canadian friends and colleagues. This article reflects the opinions I've heard from Canada.

http://seattletimes.nwsource.com/html/opinion/2001977834_cihak13.html"

Basically, their government run system is not ideal by any means.

 

[turbo]

From a peer-reviewed scientific paper:

ABSTRACT
Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

http://www.openmedicine.ca/article/view/8/1

 

[mheslep]

From a peer-reviewed scientific paper:



http://www.openmedicine.ca/article/view/8/1

I note that the OpenMedicine editorial board is 100% Canadian.

Edit: I am at a loss to explain the logic of this statement:

...For instance, we excluded studies of national rates of death from cancers because lower mortality may be due either to a lower incidence of cancer or to better care for those with the disease...

First, we don't need to look at national death rates, we have figures for survival rates for those who have contracted the disease which is what's important to me. Second, excluded results because of 'better care for those with the disease'? Isn't that an outcome we want?

 

[turbo]

I note that the OpenMedicine editorial board is 100% Canadian.

is the nationality of the authors of a peer-reviewed scientific paper an issue? Their analysis seems quite rigorous and controlled, and their conclusions bear consideration. I certainly wouldn't invalidate a peer-reviewed paper on the basis of the nationality of the people conducting the study.

 

[mheslep]

is the nationality of the authors of a peer-reviewed scientific paper an issue? Their analysis seems quite rigorous and controlled, and their conclusions bear consideration. I certainly wouldn't invalidate a peer-reviewed paper on the basis of the nationality of the people conducting the study.

Individually no it is not an issue, but when nationality is pervasive yet it is. For comparison, the NEJM editorial board is composed of physicians from http://content.nejm.org/misc/edboard.shtml" .

Their conclusions bear consideration, I just don't know how much. I see for instance that in some of the outcomes reported as favourable to Canada, it used other factors such income, as in Table 3:

..Breast and prostate cancer ...Canada: significantly higher 5 yr survival in low income groups..."

where 'low income groups' would seem to trigger Medicaid, an already US/state government run program, or race:

renal transplant recipients ... US: 1y and 3y graft survival rates significantly lower among black recipients...

Given the large black population in the US, I doubt this means black Americas would statistically obtain a better outcome in this category by heading North.

Also, there is peer review and then there is peer review. Several of the OM board members were fired just a couple years ago from CMAJ and have just started up OM. It is a new publication and it doesn't have much standing yet that I can see, based on the few cites of that two year old article.

Edit: I also see this:

Canadians had longer wait times for surgery, longer post-operative lengths of stay, and higher inpatient mortality. Differences in mortality were not, however, attributable to differences in wait times for surgery. Furthermore, the increase in mortality did not persist over time, and Canadian outcomes proved superior for several other surgical procedures

I can not fathom how this can be the case, that wait times for surgery for life threatening illnesses do not impact outcomes.

 

[turbo]

Is there any chance that graft survival rates among black recipients might be affected by the quality of care available to them? If you have evidence that medical outcomes are affected by race when income levels and access to health-care are equal, please drag it out. Otherwise that red-herring argument holds no water. A prime reason to go to a public-health care system is to provide the same access to regular check-ups and preventive care, so that patients do not enter the health-care system with their survivability already seriously compromised by lack of access to prior care. When poorer patients cannot get easy access to preventative coverage, it is a slam-dunk that too-late surgical interventions and treatments will not be as successful as earlier procedures performed when the patients are healthier.

 

[mheslep]

http://www.nber.org/papers/w13429"
June E. O'Neill, Dave M. O'Neill
NBER Working Paper No. 13429

Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys. We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs. We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

http://www.ncpa.org/pub/ba596#footnotes"

* For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
* For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

 

[mheslep]

Paper focused mainly on cancer survivability in Europe, but compares to US data:
http://www.thelancet.com/journals/lanonc/article/PIIS1470204507702462/abstract"
The Lancet Oncology, Volume 8, Issue 9, Pages 784 - 796, September 2007

Background
Traditional cancer-survival analyses provide data on cancer management at the beginning of a study period, and are often not relevant to current practice because they refer to survival of patients treated with older regimens that might no longer be used. Therefore, shortening the delay in providing survival estimates is desirable. Period analysis can estimate cancer survival by the use of recent data. We aimed to apply the period-analysis method to data that were collected by European cancer registries to estimate recent survival by country and cancer site, and to assess survival changes in Europe. We also compared our findings with data on cancer survival in the USA from the US SEER (Surveillance, Epidemiology, and End Results) programme.
Methods
We analysed survival data for patients diagnosed with cancer in 2000—02, collected from 47 of the European cancer registries participating in the EUROCARE-4 study. 5-year period relative survival for patients diagnosed in 2000—02 was estimated as the product of interval-specific relative survival values of cohorts with different lengths of follow-up. 5-year survival profiles for patients diagnosed in 2000—02 were estimated for the European mean and for five European regions, and findings were compared with US SEER registry data for patients diagnosed in 2000—02. A 5-year survival profile for patients diagnosed in 1991—2002 and a 10-year survival profile for patients diagnosed in 1997—2002 were also estimated by the period method for all malignancies, by geographical area, and by cancer site.
Findings
For all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 2000—02, especially for patients with colorectal, breast, prostate, and thyroid cancer, Hodgkin's disease, and non-Hodgkin lymphoma. The European mean age-adjusted 5-year survival calculated by the period method for 2000—02 was high for testicular cancer (97·3% [95% CI 96·4—98·2]), melanoma (86·1% [84·3—88·0]), thyroid cancer (83·2% [80·9—85·6]), Hodgkin's disease (81·4% [78·9—84·1]), female breast cancer (79·0% [78·1—80·0]), corpus uteri (78·0% [76·2—79·9]), and prostate cancer (77·5% [76·5—78·6]); and low for stomach cancer (24·9% [23·7—26·2]), chronic myeloid leukaemia (32·2% [29·0—35·7]), acute myeloid leukaemia (14·8% [13·4—16·4]), and lung cancer (10·9% [10·5—11·4]). Survival for patients diagnosed in 2000—02 was generally highest for those in northern European countries and lowest for those in eastern European countries, although, patients in eastern European had the highest improvement in survival for major cancer sites during 1991—2002 (colorectal cancer from 30·3% [28·3—32·5] to 44·7% [42·8—46·7]; breast cancer from 60% [57·2—63·0] to 73·9% [71·7—76·2]; for prostate cancer from 39·5% [35·0—44·6] to 68·0% [64·2—72·1]). For all solid tumours, with the exception of stomach, testicular, and soft-tissue cancers, survival for patients diagnosed in 2000—02 was higher in the US SEER registries than for the European mean. For haematological malignancies, data from US SEER registries and the European mean were comparable in 2000—02, except for non-Hodgkin lymphoma.

 

[Alfi]

Debunking Canadian health care myths

By Rhonda Hackett
Posted: 06/07/2009 01:00:00 AM MDTRelated
canadian health care perspective
Jun 7:
What do we pay for, anyway?As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it.While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in anyone geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

 

[Evo]

If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise),

That's a problem, IMO, if Canadians have to go to the US to get proper care in some cases.

Also, I don't know why the personal opinion of some psychologist would have any partiular merit in weighing these issues.

 

[Alfi]

Also, I don't know why the personal opinion of some psychologist would have any partiular merit in weighing these issues.

As a Canadian living in the United States for the past 17 years.

That, plus her professional standing, should merit more than someone that has not experienced both systems.

 

[mheslep]

Debunking Canadian health care myths

By Rhonda Hackett
Posted: 06/07/2009 01:00:00 AM MDT

...

Alfi do you have a link for this source? Was this published in a major news source or is it a personal blog page or the like?