Canadian Hospitals suffer from Overcrowding in British Columbia

Posted by PITHOCRATES - March 22nd, 2014

Week in Review

The left likes to say we’re idiots here in the United States.  Because every other advanced economy has national health care.  Of course, every other advanced economy doesn’t have the best health care system in the world.  No.  That honor goes to the United States.  And perhaps NOT having national health care is the reason why we have the best health care system in the world.  For those national health care systems have their problems.  Even the system north of the border the American left yearns to have.  The Canadian single-payer system (see New B.C. seniors advocate to focus on needs of growing elderly population by ROB SHAW posted 3/19/2014 on The Vancouver Sun).

Isobel Mackenzie, a longtime Victoria seniors care administrator, was named Wednesday as the province’s first seniors advocate, more than 16 months after the office was first announced…

There are more than 700,000 seniors in B.C. and that’s expected to double to 1.4 million over the next 20 years…

Mackenzie said she’s not sure if her office will get involved in how hospital overcrowding is affecting seniors care, and sidestepped a reporter’s question at her press conference Wednesday about the case of an elderly man who had spent eight hours waiting in a hospital emergency room…

“Obviously, health care is a priority and home care – giving support to people so they can stay at their home and healthy,” she said.

Logan said the government tried an “experiment” of providing funding to United Way but they’ve been “overloaded with requests.”

All of the advanced economies share something in common.  They all have an aging population.  Thanks to birth control and abortion people in the advanced economies stopped having babies after the Sixties like they used to have.  Which is why the seniors are now the largest growing sector of the population.  We have fewer people entering the workforce to pay the taxes that support a greater number of people leaving the workforce.  And thanks to modern medicine, these people are living long into retirement.  Which is why Canadian hospitals in British Columbia are overcrowded.  Which lead to longer wait times and the rationing of care.  Things common with national health care.  And these things are only going to get worse as their aging populations age further.

This is the future of Obamacare.  For the Affordable Care Act is already proving unaffordable to those who have to pay.  And people are losing the health insurance and the doctors they liked and wanted to keep.  A lot of doctors are opting out of Obamacare.  Leaving fewer in the system to treat a larger number of patients.  Which will, of course, lead to longer wait times and the rationing of care.  Just like in Canada.  And in every other advanced economy with a national health care system.  Which is why the United States is the only advanced economy without a national health care system.  Because Americans don’t want longer wait times and the rationing of care.  And they don’t want the Affordable Care Act.

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The Canadians are Cutting Doctors’ Medicare Reimbursements due to the Costs of an Aging Population

Posted by PITHOCRATES - May 5th, 2013

Week in Review

The United Kingdom has national health care.  Which is struggling to meet the demands of an aging population.  And is currently working on cutting their health care spending by £20 billion ($31.8 billion) to help stretch their limited resources meet the demands of their aging population.

Canada has private health care providers but a single-payer system.  So it’s not quite national health care.  But it is somewhat universal.  And something the proponents of Obamacare would settle for if they can’t get national health care.  But like the UK the Canadians are struggling to meet the demands of an aging population (see ‘Future of health care’ hangs on medicare talks posted 5/3/2013 on CBC News).

More than 200 doctors have voted in favour of supporting a lawsuit against the provincial government over medicare cuts, says the head of the New Brunswick Medical Society.

The doctors, who gathered for an emergency meeting in Fredericton on Friday to discuss the matter, were unanimous, other than one abstention, said president Dr. Robert Desjardins…

Desjardins said doctors are still willing to help Health Minister Ted Flemming find ways to cut $20 million from the health budget, but first things first.

“First and foremost importance is respect of the actual signed agreement,” said Desjardins.

“There’s not much of an incentive to discus the future of medicare when there’s no plan on the table and the signed agreement isn’t respected. So from there, what are we talking about?”

In March, the government announced plans to cut funding for doctors who bill medicare for each service by $18.8 million to $425 million and to cap that amount for two years.

The medical society, which represents about 1,700 doctors, contends that violates a fee agreement that expires next March.

Cutting doctors’ Medicare reimbursements?  That’s how Obamacare plans on bringing down health care costs in the United States.  Guess cutting doctors’ Medicare reimbursements isn’t the panacea they thought it would be.  As Canadian doctors actually want pay commensurate with their education, skill and experience.  Imagine that.

Becoming a doctor isn’t easy.  That’s why few people in the population become doctors.  And why countries that don’t pay their doctors well have doctor shortages.  Like they often do in countries with national health care.  Or in countries with a single-payer system.  Who look to break contracts to pay their doctors less.  To help stretch their limited resources meet the demands of their aging population.

Just something to look forward to under Obamacare.  People will at first praise the government for punishing those who choose to make a profit off of other people’s suffering.  But when doctors start leaving the profession and these people have to wait months for an appointment because of the doctor shortage they will long for a return to the old days.  When we had the finest health care system in the world.  And doctors got rich for being the best in the world.  How it once was.  Before Obamacare.

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Canada does Health Care right even if they do Dental Care Wrong

Posted by PITHOCRATES - March 9th, 2013

Week in Review

Canada does health care right.  They have a single-payer system.  Which is not quite national health care like the National Health Service in Britain.  But it’s the next best thing.  Sort of like Obamacare.  It’s not the national health care the Left wants.  But it’s the next best thing.  And a stepping stone to getting what they want.   So they can do health care right.  Like in Britain.  And like in Canada.  Where they put people before profits.  And everybody has everything they could ever want (see Bite out of dental program will hurt, says dentist posted 3/6/2013 on CBC News Health).

The president of the Newfoundland and Labrador Dental Association says cuts to the adult dental program will cost the province more in the long run.

In a news release Tuesday, the government said it is putting a per person cap of $150 on basic dental services and $750 on denture care, starting on April 1. Dentists will have to get approval from MCP before treating most patients.

“One hundred and fifty dollars is not going to cut it for people that need pain management,” said Dr. Jason Noel.

Valid point.  So why in a country where they do health care right would they do dental care so wrong?

The government set up the Adult Dental Program in January 2012 for people on low incomes, including seniors. At that time, dentists praised the program for its accessibility…

“The program budget was for $6.7 million. In actual fact, it ballooned to something that we never anticipated at all – it was closer to $21 million…”

That’s why.  Because free health care is very expensive.  And government bureaucrats are very bad at making cost projections.  For what government program didn’t exceed government projections?

Just something to think about as Obamacare starts paying the bills.  A potential 213% cost overrun.  Or more.  Because Canada has been doing health care right for a lot longer than the United States.  So if they miss a target by 213% you just know a novice at doing health care right will do a poorer job.  But one thing we’ve learned from the recent sequester debate government doesn’t like cutting spending.  They don’t even like reducing the rate they will increase spending by.

So will the Americans be as responsible as the Canadians in fixing something they screwed up.  Probably not.  Instead they’ll rely on raising taxes.  And when they can raise taxes no more they will resort to rationing, longer wait times and denial of care.  As in those death panels that aren’t technically in Obamacare.  But a government bureaucrat deciding who gets health care and who doesn’t is a death panel.  Even if you don’t call it a death panel.  Something else to think about as Obamacare starts paying the bills.

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Medicare Cost Savings are Cost Transfers to Private Sector Businesses

Posted by PITHOCRATES - June 12th, 2011

Private Health Insurance Costs rising Faster than Medicare Costs

Looking at graphs makes problems easy to see.  They can make you jump to the wrong conclusions, but you can see the problems more clearly.  And the good news is that Medicare doesn’t have any problems.  At least cost-wise.  It’s the free market that does.  Because it operates without the keen and wise oversight of government.  As a result they can charge whatever they want for their insurance.  Well, the government doesn’t allow this in Medicare.  Therefore, the government way is the better way.  Just look at the graphs (see It’s the Health Care Costs, Stupid by Paul Krugman posted 6/12/2011 on The New York Times).

The larger point is that we don’t have a Medicare problem, we have a health care cost problem. And Medicare actually does a better job of controlling costs than private insurers — not remotely good enough, but better…

If Medicare costs had risen as fast as private insurance premiums, it would cost around 40 percent more than it does. If private insurers had done as well as Medicare at controlling costs, insurance would be a lot cheaper.

But graphs can be misleading.  Looking at them does support everything he says.  However, the graphs don’t explain why.  And if you want to know the ‘why’ talk to a doctor.  Ask about his or her Medicare billings.  You won’t hear a happy story.  The government keeps cutting the amount they will pay.  Because they can.  And every year further ‘automatic’ cuts have to be postponed by Congressional action.  Which usually happens.  Because these future cuts are so steep that, if enacted, will make a lot of doctors stop seeing Medicare patients.

But if the government isn’t paying doctors fairly, how can they stay in business?  Isn’t the fact that they are staying in business prove that the government-determined prices are fair?  No.  Costs are costs.  Those unpaid by the government still have to be paid.  And guess by who?  That’s right.  Private insurance.  That’s one reason why private insurance costs are so high.  They’re picking up the unpaid Medicare costs.  And unpaid Medicaid costs.  And a large part of costs incurred by people using the emergency room in lieu of buying health insurance.  Through inflated billings to private insurance companies.  Because costs are costs.  And someone has to pay them.

Of course, it’s the people who pay for private insurance who end up paying.  And because health insurance is an employee benefit, the employers ultimately pay.  Businesses.  And the more unpaid Medicare costs are passed on to businesses, the higher their health insurance premiums get.  Forcing them to make cuts elsewhere.  Make the employee share in part of the costs.  Or they simply quit providing health insurance.  So these remarkable cost savings the government achieves are nothing more than an additional Medicare tax.  That private sector businesses pay.

And when businesses have to pay more for unpaid Medicare benefits, they have less to pay their employees.  Or simply can’t afford to hire more people.  Which means a net reduction in consumer spending.  Either through lower wages.  Or less job creation.  So the more the government ‘saves’ on Medicare, the less economic activity there will be.  And possibly the less Medicare there will be (if further cuts make doctors drop out of the system).

So, yes, the graphs are accurate.  But they don’t tell the whole story.  They show a smaller rise in Medicare costs than private insurance costs.  But it’s just smoke and mirrors.  Misdirection.  A magician’s trick to make us look one way.  So we don’t see what’s really happening elsewhere.

Health Care Costs are Rising in the Military, Too

About 60% of government spending covers Social Security, Medicare/Medicaid and defense.  Each at approximately 20%.  We continue to spend more and more on Social Security and Medicare/Medicaid.  And yet these programs are projected to go bankrupt.  Defense spending has gone up, too.  But it is the only one of the three programs that ever sees any real cuts.

The U.S. population is a little over 300,000,000.  And about 40% of the federal budget covers the elderly (approximately) of that 300 billion.  About 13% of the U.S. population.  Or about 39 million people.  It’s this 39 million that is bankrupting America with their Social Security and Medicare benefits.  Those who passed Obamacare want universal single-payer health care for all 300,000,000 people.  You don’t need a higher degree in math to see that adding some 260 million more to the 39 million is going to make a bad financial situation worse.

Meanwhile the U.S. military has approximately a million and a half people on active duty and another million and a half in the reserves.  In addition to this 3 million there are about another 2 million in retirement (850,000 who are collecting a pension).  So that’s about 5 million (approximately) in our military health care and retirement programs.  These numbers are very approximate.  But the order of magnitude is accurate.  And telling.  Because even though 5 million people are a whole lot fewer than 39 million people, the health care and retirement costs in the military are unsustainable (see Panetta: Military healthcare costs are on my radar by John T. Bennett posted 6/12/2011 on The Hill).

The Obama administration is proposing increasing TRICARE fees for retirees of working age, which have remained the same for a decade. Specifically, the proposal would raise premiums for family plans by $5 per month, and by $2.50 for individuals…

“Even with the estimated savings from the healthcare efficiencies proposed in the … 2012 budget, the cost of the Military Health System continues to increase as a percentage of the DOD budget and will exceed 10 percent of the budget in just a few years,” Panetta told the committee…

“Part of this is understanding where the money is,” Mullen said. “Two of the big places the money is is [sic] in healthcare, and it’s in pay and benefits.”

First you increase the beneficiaries’ cost.  And when that no longer works you start the rationing.  The ultimate result of any single-payer system.  Just like in the UK.  Where one of the goals of their ongoing NHS reform debates is cutting wait times.  Because with the high costs of their single-payer system, people have to wait a long time for some medical tests or procedures.  Because their costs prevent them having a lot of these tests or procedures available to the UK citizenry.

Destroying the Private Health Insurance Market

Social Security and Medicare Light (military health care and retirement) isn’t working with only some 5 million people in the system.  Regular Social Security and Medicare isn’t working with only some 39 million people in the system.  And expanding Medicare-like health care to another 260 million people probably isn’t going to help.  Unless your goal is to destroy the private health insurance market.  Which will happen.  Because private insurance (i.e., businesses) simply cannot afford to pick up the unpaid medical costs of another 260 million people.

And once you’ve destroyed the private health insurance market, all those unpaid Medicare costs (and the new unpaid Obamacare costs) will have to be transferred somewhere else.  To the taxpayer.  Both businesses.  And consumers.  Which will further reduce consumer spending.  Which will reduce economic activity.  Despite all the promises of a single-payer system.  Because costs are costs.  And someone has to pay them.

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LESSONS LEARNED #21: “The reason why health insurance is so expensive is because it is not insurance.” -Old Pithy

Posted by PITHOCRATES - July 8th, 2010

THE LONGER YOU live, the more you see and hear.  Here’s a smattering of our collective experiences.

YOU CAN LEARN a lot working in a small business.  I did.  I did about everything you could in a small business.  Including keeping the books.  And getting fired.  Over money.  It’s always about money, isn’t it?  And broken promises.  But I digress.

The business owner had a couple of kids.  As did some other ‘key’ employees.  I didn’t.  I was a young, single man.  Rarely went to the doctor.  So the ‘Cadillac’ health care plan we had meant little to me.  But it was important to them.  So important that it was a serious financial burden to the company.  The owner scrimped and saved elsewhere to maintain it.  Including my salary.

I helped to bring us through a difficult time.  I did my part.  Now it was time for the owner to do his part.  But he forgot those promises.  (Important life lesson?  Get things in writing.)  We had words.  I considered my options all the while dealing with one of the ‘key’ employee’s wife.  Who was always calling to bitch about the medical plan.  She didn’t like her co pays, that the non-generic drugs cost more, being billed for something that SHE thought should have been covered, etc.  I talked to her (it seemed like) at least once a week.  So and so who worked at such and such didn’t have to pay for this or that or the other thing.  And, perhaps, in some fairyland, they didn’t.  Our plan was good.  Above average.  She just didn’t want to pay for anything.  In fact, she wanted the business to pay for the things the plan didn’t cover.  She wanted it all.  But didn’t want to pay a dime for any of it.

She thought it was an outrage that she had to pay her bills.  But she took the health care.  Just wanted others to pay for it.  Even if cuts had to be made elsewhere.  Even if others didn’t get promised raises or bonuses.  As long as the cuts didn’t affect her. 

My experience is only a microcosm, but it applies to the big picture.  Our health care system is the best in the world.  But the way we go about paying for our health care is threatening to destroy that great system.  We’re voting ourselves the treasury.  We want more and more things but forget that old saying.  There’s no such thing as a free lunch.  Costs are costs.  And someone has to pay them.  If we don’t, others have to.  Until they choose not to.  And then what are we going to do?  Run to government?

Well, yeah.  There has to be someone we can take more money from.  Make those young and healthy people buy insurance so more people contribute into the big insurance pot and bring down the cost per person.  If they pay more, I wouldn’t have to pay as much.  Or my fair share.

Don’t like that?  Why, then let’s just nationalize it.  Wait a tic, nationalize care sucks.  So let’s not nationalize it.  Let’s do that other thing.  It’s just like nationalizing but we get to keep the things we have now.  Single payer.  Yeah, that’s it.  Let’s go with a single-payer system.  We keep the care we have and tax the rich to pay for it.

Or let’s be like Canada.

I DROVE INTO Quebec once from upstate New York.  At Canadian customs, the guy asked if I had any cigarettes. 

“No,” I said.

“Really?” he asked.

“No,” I said.  “I don’t.”

“Come on.  You must have some cigarettes.”

“No.  I don’t have any cigarettes.  I don’t smoke.”

“I don’t believe you.”

“Well, I don’t.”

He stared at me, smiling.  Waiting for me to break, I guess.  I didn’t.  I was confused.  Customs never interrogated me like that before.  He kept staring.  And smiling.  I looked backed.  Befuddled.

“Okay,” he finally said.  “You can go.”

And I did.  Found out later what that was all about.  Obscene cigarette taxes.  In an effort to stop people from smoking cigarettes.  But it opened a huge black market.  Drug dealers switched from smuggling in drugs to smuggling in cigarettes.  It was as profitable.  And less punishable.  If caught.

CANADA HAS A large tourism industry.  And high taxes.  They tax everything.  Making it costly to be in Canada.  They have a Value Added Tax (VAT).  It’s called the Goods and Services Tax (GST).  That means they tax most goods and services you pay for from the first level of being to its final delivered form.  They tax the thing you buy. And they tax the things that made that thing you buy.  At every level, when someone adds value, they add another GST.  Taxes upon taxes.  They can collect a lot of money.  But they also raise prices.  Which makes everything more expensive.  So Canadians can’t afford to buy as much as they once did.  Less demand contracts supply.  Lays people off.  They spend less.  Pay less in taxes.  Collect unemployment benefits.  Government collects less and spends more.  Deficit spending.  They raise taxes to offset the deficit spending.  And the cycle repeats.

There’s been talk about establishing a VAT in the United States.  Because of out of control government spending.  Those who support it say it will help the economy.  They lie.  Taxes don’t help economies.  At least, they haven’t yet.

In order not to hurt their tourism industry the Canadians (for a time, at least) let tourists get a refund on the provincial and GST taxes paid while in Canada.  Canadians have no choice.  But tourists do.  They could choose not to go Canada.  So they allowed the refund because they knew that higher taxes don’t stimulate consumer spending.  And they wanted stimulated consumers to come to Canada to spend.

SOME CANADIANS DO have a choice, though.  Those who live near the US-Canadian border.  I’ve worked with Canadians who traveled to America to work.  They love their country.  Believe America could learn a lot from her.  But they buy their gasoline in the States.  And everything else they can to escape their own high taxes.

WHEN MY DAD was in the hospital for quintuple bypass surgery, a few of his nurses were Canadian.  They said a lot of Canadian doctors and nurses crossed the border into the United States for better paying jobs.  My dad had no complaints.  They were good nurses.  He was grateful for their care.  That’s what high paying jobs do.  Attract high quality talent.

I SAW A fund drive once while in Canada.  There was a sign on the lawn with a colored-in bar showing where they were in achieving their goal.  A hospital was raising money to buy something.  An MRI machine.  For there was none in this medium-sized Canadian city.

I WAS AT a small community hospital (in an American city) walking the grounds with the facilities manager.  He had to close a small road intersection on campus that doubled as the helipad.  The university hospital’s medical helicopter was making a test flight to this small hospital.  I asked him if they flew in many patients here.  He said no.  But they flew critical patients at this hospital to the university hospital (about 30 miles away) where they had a better chance for survival.

I ONCE WENT on a skiing vacation throughout New England and Quebec.  I skied Jay Peak, Mont Tremblant, Mont-Sainte-Anne, Sunday River, Stowe and Killington.  I remember a helicopter flying overhead at one.  (It’s been awhile, but I think it was in Canada).  There was a sanctioned FIS ski event there.  Part of the requirements for a high-speed ski event is a readily available rescue helicopter to immediately air-lift a seriously injured skier off the hill.

NATASHA RICHARDS HAD a freak accident while taking a ski lesson at Mont Tremblant in Quebec.  She fell.  Like we all have while skiing.  She got up.  Like most of us do.  Laughed it off.  She felt fine.  But there was now a silent killer at work.  She declined immediate medical attention.  After awhile, she started to feel ill.  She would subsequently die from an epidural hematoma due to a blunt impact to the head.  A shame it was only blunt.  Had it knocked her unconscious, she may have survived.  That would have demanded immediate medical attention.

She died because her initial injury was not painful enough.  She therefore had little cause for concern.  As many of us no doubt would have if we were in her place.  Critical time was lost.  Time that she couldn’t get back.  There’s no one to blame.  It was a freak accident.  What made the headlines, though, was an interesting fact.  The province of Quebec did not have a single medical helicopter (probably wouldn’t have made a difference for Richardson).  The province had determined that the cost of a helicopter system was greater than the perceived benefit.

SO THERE’S A smattering of health insurance, tax and health care anecdotes.  A small smattering, but nevertheless a smattering you can draw some conclusions from.  First and foremost, people are cheap bastards.  And they have an entitlement mentality.  Put the two together and you’ve got an ever-expanding, under-funded, welfare state.  And that can only lead to one place.  Bankruptcy.

You can’t keep raising taxes on people to solve problems.  They’re just not going to whistle a happy tune and keep paying.  They will make efforts to evade those taxes.  Or they’ll simply cut back on their spending.  And when they do, they will create other problems in the process.  Those unintended consequences that have bedeviled government planners since the dawn of government planning.

The Canadian health care system is not the utopia some claim it to be.  It’s big.  And costly.  Bureaucrats conduct cost-benefit analysis.  It’s cold and impersonal.  What is the cost per unit life saved by having a medical helicopter system?  Does the mean wait-time justify adding another MRI in a geographic region?  Or would the resultant excess capacity from a second MRI be too wasteful?  And what is the acceptable mean wait-time for a procedure?  Would a 2% cost savings from a reduction in staff be acceptable if the corresponding rise in mortality rates is kept at or below 1%?  It’s all very analytical and rational.  But when it’s your loved one in a critical condition, you’re rarely analytical and rational.  And you’ll do just about anything.  Even go to the United Stated and pay out of pocket for medical care.

Of course, if the United States adopts a Canadian system, the Canadian system should improve.  Without those better paying jobs a short drive from the border, those doctors and nurses would probably stay in Canada and work within the Canadian system.

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