A Canadian Comments on Experiences with Single Payer System in Canada

While this story is a few months old, it speaks to a lot of the misdirection the right is using to keep single payer off the table, out the door and buried in a deep hole.

Found at PNHP

Posted By Chris Dinn
March 5, 2009

http://prospect.org/csnc/blogs/ezraklein_archive?month=03&year=2009&base_name=let_single_payer_free

As a Canadian who watched and helped his sister go through 5 years of elite treatment medical treatment for a rare brain tumor, I consider myself experienced with the single-payer approach and I have generally great things to say about it.

First things first, and this is a hugely important factor, Canada’s health care system is PROVINCIALLY RUN. That is to say, constitutionally, it’s not the purview of the federal government, it’s the explicit responsibility of the provinces. Over the years, various federal governments have issued transfers to the provinces explicitly for health care, but the responsibility for delivery remains with the provinces.

Additionally, as Ezra noted once upon a time in a review of international health care systems, the providers in a single payer system are private. This is an important distinction. Doctors in Canada are small business-people competing for customers. Canadians choose which doctor to visit and the doctor with the most visits gets better reimbursement from the province.

Get that? That’s provinces competing to do the best job on health care management (keeping costs down) with doctors and hospitals competing to get the most visitors, to keep business booming and government reimbursements coming.

The upside of this is that it promotes competition for efficiency of delivery. In fact, Canada’s entire system evolved that way, beginning as a Saskatewan program pioneered by Tommy Douglas.

Now, before you write off the single payer system (I’m looking at you wisewon), keep in mind that not only did Canadians recently vote Tommy Douglas the greatest Canadian in a recent CBC reality show (http://www.cbc.ca/greatest/), but he’s also Keifer Sutherland’s grandfather (no lie).

We should be honest about the downsides of a single-payer system. Despite the sundry downsides you may here from US commentators, criticisms in Canada come from mainly two areas.

First is equal access. In Canada it doesn’t really matter how rich you are or how much money you have to throw at your medical problems, you get treated in the same line as the poor farmer, the homeless guy and the suburban middle-class family who need the same treatment. To you, maybe, this is a bug. To me, it’s a feature. The idea that in Canada we treat our poor in the same order we treat the rich seems an impressive display of equality when it matters the most.

The second is for wait times. This is not a material concern to this discussion. If you want to know why read http://www.prospect.org/cs/articles?article=the_health_of_nations.

While there are some exceptions to these rules, such as Canada’s rare and controversial private clinics, the system generally works as advertised.

As an example, in 1996, when she was 10 years old my sister was diagnosed (in Newfoundland) with a rare brain tumor. She was treated in Newfoundland, but when a better treatment became available in Toronto the provincial government sent her to Toronto for the care and covered its cost. Had a better program existed in an American children’s hospital, she could’ve been treated there.

My family was middle class for our rural community, but would hardly qualify as rich. My parents had a combined income of under $100,000 yearly, but my sister received three rounds of neurosurgery, three rounds of chemotherapy and a three-weeks-in-isolation bone marrow transplant. All without my parents paying out of pocket for anything.

In the US people go bankrupt in situations like this. In Canada, they live through it. My parents are now happily in retirement and relatively well financed.

Meanwhile an exgirlfriend of mine from Wisconsin needed her wisdom teeth out. Her plan was to go get the treatment and stiff the hospital on the bill. She said future creditors would understand, since medical bills are often skipped out on.

I’m not an American, and I don’t know how typical or a-typical that is, but it definitely happened.

Are you still telling me the Canadian approach is completely the wrong solution? I’m sorry, but I just can’t take Americans with a straight face on that point.

Volunteers Needed

Daily Kos and Fire Dog Lake are teaming up to go to Washington to attend the Markup of the House Health Care bill. They need volunteers to go to Washington and they need donations to help us get the Health Care bill we want. A good Public option.

Here's some info from myceve at Daily Kos:

UPDATE:

It's official, we're off to the races. Just received word from Speaker Pelosi's office as follows. This means we need all hands moving toward Washington for the markups.

Please check back for additional details and read the comments of Jane Hamsher.

Pelosi, House Leaders, Committee Chairs to Hold Press Conference on Introduction of Health Care Legislation

Washington, D.C. – Speaker Nancy Pelosi, House Democratic Leaders, and Committee Chairs will hold a press conference in the Rayburn Room of the Capitol today, July 14, at 2:45 p.m. to discuss legislation introduced today by the Tri-Committees on health care reform.

Okay, so now we have certainty on the legislation. Now, we must remove the vice-like grip of the lobbyists. The way we do this is by having the American people sit in the mark up room and fight for a good bill as hard as the lobbyists will try to destroy it.

But before I go any further, a little bit of housekeeping. A lot of you asked how you could help, especially if you can't get to Washington. We're starting to run up some big expenses, so Jane Hamsher has put up a FIGHT THE LOBBYISTS DONATIONS PAGE:

https://secure.firedoglake.com/page/contribute/PublicPlan

The lobbyists have countless millions. If you can throw in a few dollars to help with the mounting costs of this undertaking that would be a great help and we thank you for your generosity.

IF YOU HAVE ANY DOUBT WHAT WE'RE FIGHTING, PLEASE LOOK AT THIS. LOBBYISTS BUY ALL THE SEATS AT THE TABLE.

Nataline Sarkisyan's parents coming to Washington to sit front and center in markup room.

One of our expenses among many, is getting Nataline Sarkisyan's parents to Washington and putting them up in a hotel for four nights.

It's huge that Nataline's parents have agreed to come from Los Angeles to sit in the front row during the markup. They are the living embodient of this national catastrophe, and Hilda Sarkisyan will tell the Congresspeople that no other American family should ever lose a child to a murderous for profit insurance company.

URGENT CALL FOR VOLUNTEERS.

PLEASE SIGN UP HERE. CAN YOU COME TO WASHINGTON? THERE ARE OTHER THINGS YOU CAN DO, PLEASE GO TO THE SIGN UP SHEET AND LET US KNOW HOW YOU CAN HELP. AND THANK YOU! ALL THESE RESPONSES ARE GOING DIRECTLY TO JANE HAMSHER.

IF YOU CANNOT COME TO WASHINGTON THEN COULD YOU DONATE A FEW DOLLARS TO FIGHT THE LOBBYISTS MILLIONS?
YOU CAN DONATE HERE:

https://secure.firedoglake.com/page/contribute/PublicPlan

The lobbiests are ready and already on their way to DC. Help if you can any way that you can.

Myth Busters

Found at The Seminal

As the health reform fight moves forward, the issues people are talking about change. While it once seemed like our biggest battle was over whether we are going to get a strong public health insurance option as part of reform, that question has now joined a host of others in the debate.

Predictably, these new arguments come with their fair share of myths that need to be pushed back on. So here we go...

Myth: Health reform will be paid for by "cutting" Medicare and Medicaid

This is the latest line trotted out by conservatives and picked up by the media, that we're going to cut Medicare and Medicaid to pay for health reform. We're not cutting Medicare or Medicaid, if by cut you mean doing anything that will lower people's benefits. We're finding savings in the program. And that's not just spin.

Here's an example: Right now, Medicaid pays hospitals a sum of money (which varies geographically) to help make up the losses they incur for treating patients that show up in the emergency room without insurance (who hospitals are legally required to treat). After health reform is passed, the number of uninsured in this country will diminish. These payments will therefore become redundant and can be phased out, yielding savings without cutting anyone's benefits.


Myth: We're just waiting for reconciliation on health care so we only need Democratic votes to pass it

This one isn't true...yet.

Right now, the Senate is still operating under regular order, which means we will need 60 votes to end a filibuster and cut off debate over a health care reform bill. (Aside: Which Senators are going to be the ones to filibuster health care? People should start asking them that.) There is, however, an October 15th deadline. If the Senate is unable to move a health reform bill under regular order, they must move one under reconciliation by October 15th. So, right now, Harry Reid and other Senate leadership are giving Republicans every opportunity to come on board and vote for real health reform. If they don't come on board, that's what reconciliation is for.

Myth: Health reform will cost too much and put a burden on families

This is the most insidious of the right-wing lies. In reality, the cost of doing nothing on health reform will bankrupt families, and reforming health care will save the average American family thousands per year.

If we don't reform our health care system and bring down skyrocketing costs, the average family will be paying almost $10,000 more per year for health care by 2016 than they do now. Our government will be bankrupt. And we'll spend one in every five dollars in our entire economy on health care, up from the already astronomical one in seven that we spend now. The cost of doing nothing is simply unacceptable, and those against reform are willing to bankrupt families, government and our entire country to serve their obstructionism.

Not to mention that reforming health care will reduce costs for families. According to the Commonwealth Fund [pdf], health care reform that puts everyone in, gives people affordable options, and includes a strong public health insurance option (like that proposed by the House of Representatives) would save the average family $2,228 per year.

Plus, health reform will be fully financed. In the House, it will be paid for by a combination of Medicare and Medicaid savings, a public health insurance option that saves money, and a 1% tax on those that make over a quarter of a million dollars per year.

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Even though these myths are fairly prevalent in the debate right now, there's a silver lining here. The Frank Luntz messaging that was supposed to be the GOP's silver bullet - the health care reform is a Washington takeover leading to rationed care - is largely failing to take hold. And so, we're forced to combat that latest set of conservative talking points. We'll just have to do to these points what we did to Luntz - discredit and bring the truth.

No Laughing Matter

Found at TPM

Al Franken probably has the "big fat idiot" overdosing on anxiety prescriptions after giving an excellent opening statement in the Sotomayor hearing. Just goes to show any comedian can be a radio or TV talk show host but only a select few can be a functioning senator.

My favorite part of his statement came towards the end:

Second, I am concerned that Americans are facing new barriers to defending their individual rights. The Supreme Court is the last court in the land where an individual is promised a level playing field and can seek to right a wrong:

• It is the last place an employee can go if he or she is discriminated against because of age, gender, or color.
• It is the last place a small business owner can go to ensure free and fair competition in the market.
• It is the last place an investor can go to try to recover losses from securities fraud.
• It is the last place a person can go to protect the free flow of information on the internet.
• It is the last place a citizen can go to protect his or her vote.
• It is the last place where a woman can go to protect her reproductive health and rights.

Yet from what I see, on each of those fronts, for each of those rights, the past decade has made it a little bit harder for American citizens to defend themselves.

Illinois Political News

Mark Kirk Denies Report He's Out Of Senate Race, Deciding Over Weekend

U.S. Rep. Mark Kirk is denying a report that he has decided not to run for the Senate in part to avoid a primary with the Illinois Republican Party Chairman.

The Washington Post's Chris Cilliza reported Friday afternoon that Kirk would not make a Senate bid, despite signaling to party leaders just days ago that he was planning to run.

The North Shore Republican appeared set to enter the race after Illinois Attorney General Lisa Madigan announced she would not run. A potential sticking point for Kirk, Cilliza reported, is his vote for the administration's climate change bill and a potential primary with state GOP chairman Andy McKenna:

[Kirk's decision] followed a meeting of the Illinois Republican congressional delegation on Thursday in which his colleagues refused to back Kirk in a primary against Illinois Republican Party Chairman Andy McKenna due, in large part, to his vote in favor of President Barack Obama's climate change bill.

This is the idiot guy that told the Chinese not to believe the US Budget



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Quinn Shelving Tax Increase Push Until Fall

Illinois Gov. Pat Quinn is putting aside his call for an income tax increase until November.

In an interview Friday with The Associated Press, Quinn said he now wants to pass a state budget with significant spending cuts. Then in November, he would ask lawmakers to choose between balancing the budget by cutting even further or by raising taxes.

Quinn said delaying the decision for five months would provide time to study Medicaid spending, pension reforms and other cost-cutting measures.

Then officials would be in a better position to decide the best way to finish erasing a roughly $11.6 billion budget deficit.

The Democratic governor says he'll ask lawmakers to consider the idea when they return to Springfield next week.

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Giannoulias takes lead in fund-raising for a Senate bid

Illinois Treasurer Alexi Giannoulias has raised $1.8 million for his Senate bid, while his likely Democratic rivals have zero dollars in their war chests.

Giannoulias has been fund-raising since March. Federal fund-raising reports, public next week, will show that Giannoulias raised about $670,000 in the second quarter of 2009.

Giannoulias is also in a position to pour some of his own money into his campaign; his federal financial disclosure statement will show that he is worth between $13 million and $62 million, I'm told.

Lisa Madigan is running again as State's Attorney but will Have Joe Birkett, from DuPage County as her opponent again. My opinion...Birkett doesn't have a chance!

Medical Liability - The Debate

Medical Liability is constantly pushed by the GOP as a reason medical costs have skyrocketed. The cost of liability insurance is very expensive for Doctors and Hospitals. But if you are permanently disfigured or die because of a mistake a doctor or hospital made, what other alternative does the patient have or the patient's family?

I have long thought that doctors don't police themselves enough and hospitals, like the Catholic Church covered for their wayward priests, cover for their doctors.

The New York Times has an OP-ED today written by Tom Baker that delves into medical liability:

Liability = Responsibility

OUR medical liability system needs reform. But anyone who thinks that limiting liability would reduce health care costs is fooling himself. Preventable medical injuries, not patient compensation, are what ring up extra costs for additional treatment. This means taxpayers, employers and everyone else who buys health insurance — all of us — have a big stake in patient safety.

Eighty percent of malpractice claims involve significant disability or death, a 2006 analysis of medical malpractice claims conducted by the Harvard School of Public Health shows, and the amount of compensation patients receive strongly depends on the merits of their claims. Most people injured by medical malpractice do not bring legal claims, earlier studies by the same researchers have found.

On the other hand, medical liability has improved patient safety — by leading hospitals to hire risk managers, for example, and spurring anesthesiologists to improve their safety standards and practices. Even medical societies’ efforts to attack the liability system have helped, by inspiring the research that has documented the surprising extent of preventable injuries in hospitals. That research helped start the patient safety movement.

When it comes to rising medical costs, liability is a symptom, not the disease. Getting rid of liability might save money for hospitals and some high-risk specialists, but it would cost society more by taking away one of the few hard-wired patient safety incentives.

Besides, there’s a better answer for doctors worried about high malpractice insurance premiums.

He goes on to say:

The research shows, overwhelmingly, that the real problem is too much malpractice, not too many malpractice lawsuits.

And:

Evidence-based liability reform would give these institutions the incentive they need to cut back on the most wasteful aspect of American health care: preventable medical injuries.

This medical liability issue is a straw man issue by the GOP. Any excuse to avoid giving the American people good, afordable health care.