Oh no! I'm going to die because of socialized health care!

[velvetpage]

The last thing I did before leaving this morning was post a debate in booju_newju asking if the U.S. should socialize their health care system. As a result, I haven't read much of my friends page - I've been replying and managing discussion over there ever since I got home.



I'm wondering about the perceived connection between long wait times and socialized medicine. There is a connection, certainly, but it's not, "Oh no! If the government is paying for it, we'll have to wait!" From my point of view, it appears to be mostly about infrastructure. We do not have enough doctors or other specialists, and if we did, we would lack some of the operating theatres, hospital beds, and other necessary things to reduce wait times. This is a systemic problem, certainly, but it is not one that would appear immediately upon instituting socialized medicine. The U.S. already has the infrastructure, and they certainly have enough doctors. (They could send back a few of the ones they've borrowed from us, actually. We need them ourselves.) There might be some shortages when all the currently-uninsured suddenly had access to the whole system, but they'd be manageable, and probably much of it would be absorbed by the current system. After all, everyone would have a lot more time to see patients if they weren't filling out dozens of forms and attempting to get blood from a stone payment from people who have no money.

Also, what's with this idea that "The government will tell me which doctors I have to see!" That is totally, categorically false. In fact, I have more choice of doctors than many insured Americans whose insurance companies tell them which doctors they're willing to pay for. I can see any doctor in Ontario by presenting my health card, if I have a referral. And, while I know many people who have to wait, I never have. It depends on the specialty how long you'll wait, and once you're on their patient roster, you won't have to wait again to see the doctor - though you may have to wait for your surgery. See previous comment about infrastructure.

Last complaint I have little patience with - "Our taxes will be too high for us to afford to eat!" Okay, maybe your taxes would go up - though it should be possible to do it for the amount already being paid for Medicare - but your health premiums would (almost) disappear, and the savings would be rather greater than the increase in taxes. No, the rich are not going to flee to places where they don't have to support the poor. There aren't a whole lot of those places left, at least not places where the rich would actually want to live.

Okay, I'm done now.

Comments

[merlyn4401.livejournal.com]

Re: wait times. I get that from the number of complaints I have heard from both RL friends and online acquaintences about how long they have to wait to see a specialist. I *get* that you didn't in your case. I also *get* that it is an infrastructure problem.

But. One of the big reasons we have so many doctors and so many hospitals is that you can make so much money at it. Isn't that one of the reasons your docs are headed down here? So remove that incentive to become rich, or at least extremely well off, and you are going to lose a lot of future doctors. There are not a lot of people willing to work for the government, number one, and even fewer who are willing to work at a very set wage. Especially when they can go free market and make a lot more money. So a lot of docs will quit being docs becasue they don't want to deal with the government in their pocket, and a lot more won't even go to med school. And we'll be in the same place as Canada with having too few doctors.

[thebitterguy]

Yes. Our doctors are poor. Congratulations on that observation.

[merlyn4401.livejournal.com]

Where did I say that?

[thebitterguy]

Somewhere in that blather, you said that doctors go there because they can't become well off here.

[pyat.livejournal.com]

The "brain drain" is exaggerated - not that many Canadian doctors go to the states. The disparity in number of doctors per population existed before Canada had socialized medicine, IIRC, primarily as a function of the fact that the US has a lot more medical universities. And, according to recent studies, more doctors moved TO Canada than move FROM Canada.

Both the US and Canada have relatively few doctors when compared to the socialized medicine states in Western Europe. Italy has somthing like twice as many per captia than the US, or nearly that.

And we'll be in the same place as Canada with having too few doctors.

That didn't happen in any other Western country that adopted nationalized health, so far as I know.

[velvetpage.livejournal.com]

Besides, any other country where people actually want to live, already has socialized medicine. Where would they go to practise?

[merlyn4401.livejournal.com]

I honestly have no idea about the brain drain. I was going off a couple comments posted in booju about the exodus of doctors from Canada to the US. I'm happy to sit corrected on that. :)

[velvetpage.livejournal.com]

Me too - I didn't know that.

[velvetpage.livejournal.com]

Have you got a link on that, dear?

[pyat.livejournal.com]

To the brain drain stuff? Yeah.
http://www.irpp.org/archive/policyop/sep99/emery.pdf

It's a PDF file.

[velvetpage.livejournal.com]

Judging from the doctors I know, it's not the difference between middle-class and rich - it's the difference between a bit rich, and very rich. The doctors I know live in the nicest parts of town in houses that are worth three or four times what mine cost. My SIL once overheard the doctor she works for telling her banker to pay off the rest of a mortgage on a house she'd only owned for a few years.

You can still make an excellent living as a doctor in Canada.

[merlyn4401.livejournal.com]

Good to know. I'm glad docs do well there, I really am.

I just think that there are going to be an awful lot of docs here who are going to get super pissy when they have to work for the gov't, and essentially have a cap on their earnings.

I'd be happy to be proven wrong, because it would prove people are more altruistic than I give them credit for. :p

[velvetpage.livejournal.com]

I can imagine there will be a few who will be happy not to have to change their preferred line of treatment based on what the patient's insurance is prepared to pay for, too. What are they called - Health Management Offices - are the worst idea in the history of health care. The only person who should be making those decisions is the patient on the recommendation of the doctors involved in their care. Period.

[dornbeast.livejournal.com]

Health Maintenance Organizations.

Although I liked one person's rewrite of that, to "Healthy Members Only."

[dornbeast.livejournal.com]

I'd like to think that the doctors who are ticked about not having tons of money will be outnumbered by the doctors who are happy to have the freedom to practice medicine, instead of being restrained by bean-counting HMOs.

[dagoski.livejournal.com]

Does the Canadian government do anything to subsidize or otherwise support medical education? One reason why doctors in the US are under so much pressure to make money is the level of debt as they come out of medical school.

[velvetpage.livejournal.com]

Medical school is subsidized, but not as much as it used to be. Hopefully doc_mystery will chime in here - he knows more about that than I do.

[neebs.livejournal.com]

I have no idea about Canada and I have no actual facts to back me up (so it sounds like I would fit right in with this Booju community =P) BUT I DO have friends in med school and vaguely remembering reading in a few places (washingtonpost.com comes to mind) that with the rate that malpractice insurance is going up, being a doctor isn't all that lucrative anymore. (Except for plastic surgery, which apparently is booming.)

So, really, if the gov. covered malpractice stuff, it might be even more incentive to go into medicine.

AS I SAID, though, I have no facts to back this up. So nobody yell at me. I'll cry. ;)

Also are people complaining that if we go to socialized health care they'll have to wait? Because I waited one hour and thirty-f-ing-two minutes last time I went to see my doctor. Granted, she's a f-ing moron, but still...that's outrageous.

[velvetpage.livejournal.com]

I think they mean waiting for surgeries or getting an appointment with a specialist, either of which can take months depending on who and why you're trying to see. My friend's mother waited six months for her hip replacement, and my aunt will wait most of a year for her double knee replacement.

Canadians are less inclined to sue, and I think judges are less inclined to find malpractice, so there are fewer malpractice insurance costs in Canada.

[neebs.livejournal.com]

Ahh, my apologies, I see now that I missed the "specialist" in that sentence.

Amen for Canadians being less likely to sue. *Another plus for moving to Canada*

[anidada.livejournal.com]

...also where, when, and how desperately the surgery is needed. For instance, knee surgeries in Toronto (Alex's mom) and Kingston (our friend M), it seems, have very short wait times -- at the moment. Six months from now, who knows? Go west, it might be better, or not!

It's all a rich tapestry. ;)

[velvetpage.livejournal.com]

Meanwhile, I know a lady who went for her first "routine" checkup in a long time a few years ago. The doctor was very concerned. He got her in for tests, and she was on the table for major cancer surgery within the week. That probably meant that someone else had to wait a day or so longer - but it was the doctors' judgment that they could afford to, and this lady clearly couldn't.

[pyat.livejournal.com]

One more point - Canada doesn't have "too few" doctors, we just have fewer than the US. We have 2.1 per thousand, the US has 2.8.

Japan has 2.0, New Zealand has 2.1., the UK has 2.1, Ireland is 2., and so on.

Slovakia has 3.6. Italy has 4.4. All the raging leftie Western European nations have more than 3.0

[urban-homestead.livejournal.com]

The raging leftie Western European nations are all less lefty than Canada on health care - "two-tier" care is the norm in some, and in the rest there are user fees. So there is still a general pattern of higher numbers of doctors in countries with a partially-private health system. What's the number in Cuba, do you know? I believe that's the only country in the world that bans private health care as strictly as Canada.

I'm in favour of socialised health care, don't get me wrong. But I think the concern that exclusively socialised health care lowers the number of doctors per capita in the population is a fair one.