http://www.youtube.com/watch?v=qZt-rz2InVM
(part 1)
http://www.youtube.com/watch?v=RWTfliCABMs&
(part 2)
what do you guys think of this guys videos on Canadian healthcare?
(Full disclosure, I am a support of single payer universal healthcare, and will be voting for the California OneCare initiative, whenever it comes to the ballot here, inevitably.)
So... this is a video of some guy filming himself yelling at a video he is watching on his home computer?
So... this is a video of some guy filming himself yelling at a video he is watching on his home computer?
Pretty much yeah. He claims that because of the "system" in Canada, he's been on his deathbed twice, and anyone in Canada with a catastrophic illness, is not going to be well off. Maybe I should have simply typed out the gist of his arguments rather than posting his videos.
He is looking pretty spry for a dead guy.
He is looking pretty spry for a dead guy.
LOL! True. Apparently the system didn't fail him completley..
TiradeFaction, I have two members of my family who would either be dead or bankrupt now if it weren't for our health care system, both of cancer.
Both got immediate and excellent care as soon as their conditions were discovered (which they both were, early, because they had regular check-ups at the doctor, which are also covered by medicare).
I am not a fan of our health care system but all he offers is an incoherent tirade insisting that privatization is the way to go. I don't think there is much difference in regards to the quality of health care or even the availablity of health care between the U.S. and Canada, the main difference seems to be that in Canada illness will not bankrupt you in the same way it will in the U.S.
My niece, without medical coverage, in the U.S. went to the hospital in a crisis situation, because of the care she received or should I say lack of care she ended up with complications and many hosptial stays, she is now a half million dollars in debt.
People who are diagnosed with a serious illness are always going to find any waiting highly stressful, and there can always a bit of the grass-is-greener mentality creep in. I didn't watch the videos, because in general I don't like watching people rant.
However, I will say that our system often does not organize an individual's healthcare needs very well. In a lot of cases, you still have to navigate a lot of disparate elements of the system on your own, which can be incredibly intimidating if you have competing specialists with differing recommendations.
This is why I think we have to get serious about primary care reform. Our local community health centre not only provides front-line healthcare, but does an excellent job on so many related fronts, preventative and otherwise. I wish everyone had access to the kind of care we get.
@ ennir,
What don't you like about the Canadian system, and what would you do to reform it?
And sorry to hear about the niece, happens here (I live in California) every day, I too almost got into a similar situation, was in a hospital for probably less than 8 hours, and was charged 5000 USD...and there wasn't even any surgery. Luckily I qualified for a state insurance program that retroactively paid for it (and has covered future medical expenses of mine), but most people don't qualify for such a program here.
@Ottawaobserver
What would you change about primary care in Canada?
I tried to watch it-- it's almost incoherent painful.
I have had experience with our health care system. My family has had experience with it-- and some of them catastrophic.
Our system has some weaknesses to be sure. These include:
1) health professional shortages-- these are caused in part by cutbacks in the 1990s that drove away or did not train a generation of health care workers in order to save money at the time. There is still a short term bias in budgeting by politicians who want to balance this year's budget no matter what harm may come in future years as a result.
2) ideological fights where the system has to keep responding to experiments with a failed model of private care that is unfortunately so profitable that no matter how inefficient, no matter how unfair, no matter how unpopular it is amongst most Canadians there is huge money out there to pay for the propaganda and a great deal at stake for the ideological right wingers who cannot stand a public system on principle.
3) escalating costs are occurring in most areas of health care that remain in the private system including drug costs. These costs are a burden for the public system which must feed the profit-seeking greed of large corporations. Another escalating problem is the lack of home-care and long-term care, both largely private and causing huge backlogs in to the public system.
4) the desire by many doctors to work as specialists and a specific shortage of general practitioners causing inefficiency and a lack of continuity of care. As well we have a shortage of clinics in many cities so there is over use of emergency facilities at great cost than is warranted for minor urgent care requirements.
5) a culture of fixing ourselves when something is broken rather than promoting good health and illness prevention. Those who first designed our health care system recognized the need to provide illness prevention and health promotion in order to have a healthy population. It is difficult to expand our system because of the ongoing barrage of attacks from the right wing. Indeed this even complicates the regular tweaking of the system as any system needs as we are always trying to beat back attacks on the purpose and value of the system when we should be working to improve it. Unfortunately many who claim to want to improve it are actual wanting to undermine it for personal profit or ideological reasons.
We must Recognize that we have a huge challenge in our system that does not exist in all countries. We aim to provide health care as needed for all people based on need not economic means. Of course this means a system with more people in it because we are not using a wealth test to exclude any of our people. So in our case when we have x number of doctors for a 1,000 people we mean that those doctors serve all those people. In other countries like United States where there are economic barriers to access you limit the number that are seeking care and perhaps can make do with fewer health professionals-- so long as you are willing to live with a society that only cares for the better off or those who have not exhausted the patience of their insurers. Our challenge, to provide health care to all is a greater one. But we do it at much lower cost than in the US.
When compared to other countries, our system is fairly good. However, there are some systems that provide some user fees and appear to have more privatization in some areas of care than Canada and some appear to do well. On closer examination some of these same systems have much greater public involvement in other areas and overall Canada has one of the lowest rates of public involvement in our system because ours is centralized in the hospital sector. The lesson here might be not to expand private care in to our hospital sector as some have argued but to expand our public sector into the other areas of health care as have some of the European countries. However to do so we must fight a barrage of propaganda from all those making money.
You probably don't have time to plough through the entire Romanow Royal Commission on Healthcare, but the section on Primary Care Reform (Chapter 5) is the one most worth reading.
http://publications.gc.ca/pub?id=237274&sl=0
We go to a Community Health Centre, that uses a team approach of nurses, nurse practitioners, doctors, counsellors, nutritionists and dieticians, and social workers.
http://www.centretownchc.org/?id=3
I see a nurse practitioner most of the time, and a doctor if I need to. There are walk-in clinics every afternoon if something urgent comes up. I get my flu shots there, attended a diabetes education program with a family member there, have seen a counsellor when needed, and just can't say enough good things about the place, which is welcoming to people from all walks of life.
We have a community clinic staffed with a nurse in every one of our Lower North Shore villages, while the largest town, Blanc Sablon, has a small hospital. Doctors and specialists fly in from Sept-Iles, Quebec City, and Montreal. We have a physician here (the smallest village on the LNS) for two days every two weeks. Specialists are flown here maybe once or twice a year; the provincial (Quebec) health care will fly us out at taxpayer expense as often as we need for emergencies, treatments, and consults that can not be handled here. Most times when we are flown out, we take an extra day or two to do some shopping in the city before heading back to the coast.
Yes, Ottawaobserver, it is precisely in those places you mention where additional money could be effectively spent so that more people have access to these sorts of services. This is known to be a way to reduce costs and increase access.
Unfortunately, in many places these are not as accessible. In rural and remote and aboriginal areas there are major gaps in primary health care as well.
Actually, the Romanow report is worth reading-- Canadians interested in health care ought to read it. It actually lays out both the challenges we face and how to meet them in the most comprehensive way available.
I focused on the challenges because that is what people are interested in seeing but our system is an excellent one and as you read what I laid out as weaknesses our need is to build on the system not to tear it down.
I am extremely confident in our system. I am concerned about the shortages of health professionals: nurses and family doctors in particular however. This is one reason why additional privatization which draws on those scarce resources for those with more money and less need worries me. A system that directs scarce resources to greatest need is the most efficient. But we do need to address those resources and that is in part a question of money that needs to be spent in training. Once we stop accepting the bogus arguments that we cannot afford our health, we can get the job done.
We need to remember that the arguments against our health care system generally come from the same place as those who say that we cannot be concerned about the environment because that will put too great an economic burden on our grandchildren even though the failure to be concerned about the environment threatens the viability of their entire generation.
He is looking pretty spry for a dead guy.
Channeling offspring! :D
Anyways, welcome Tirade, this is a good conversation to have. Certainly we have our challenges in Canada. As has been mentioned, if you have a catastrophic illness, you will usually have that taken care of. There are still challenges with things like knee and hip replacements, and it's very understandably stressful.
Sean gave a good list, but I'll add another item:
Providing services in smaller communities is often a challenge. Partly because they are also competing with larger centres that are very specialised. Medical schools train people to work with the latest technology which may not necessarily be available in these centres. Doctors may also prefer the lifestyles of larger cities. Especially foreign doctors, as larger centres just due to numbers often have more to offer people from other countries than smaller centres. Many people who grew up in larger centres often don't want to go to smaller centres. Some smaller communities are getting around this by funding med school costs in exchange for them coming back and putting skills to use in smaller communities. There could also be better decentralisation of medical services into smaller communities. That would make services more accessible in these areas. Of course, you can't have high level brain or cardiac surgery in a small town, but I think more could be done in the smaller areas than is currently the case.
For the record, Canadians who can afford it do have access to private health care. During the debate on health deform in the US, the Republican/Drug/Insurance lobby would trot out a Canadian woman in Washington DC who would recite how she was "forced" to go to the US for faster care to treat some catastrophic illness. It was her argument that because she had to go to the US to "queue jump", the private system was better. For her. She is rich. She could fly to Washington D.C., Tokyo, Peking, or anyplace of her choosing to queue jump as her privileged life must come before the rest of us miserable peasants.
And so it would be her contention, that because she is rich, she should be able to queue jump at home, presumably because it would be a tad more convenient, through the miracle of free market, which is to say exclusive access, health care.
I would suggest to the fellow on the video (which I haven't watched) that if he is unhappy with Canada's public health care, he can do as the woman in D.C. and pay for his health care in the States. Then he can post a YouTube video of his happy, happy experience.
Frustrated Mess-- good post!
As you can see a big part of the problem with our system is the forces that wish to destroy it for profit.
The next greatest problem is the human resources which remains a problem for all countries and is nothing to do with our system.
The only problem we face that is caused by our system is that we seek to provide health care for all which I acknowledge is a bit harder than supplying it only for the rich but that is a question of values. It turns out that the greediest system with a focus on profit costs more than a more comprehensive system focused on equality of access. That is a great irony if you do not consider the fact that the entire capitalist system only preaches efficiency but actually is extremely inefficient in every respect except for the creation of profit for a privileged few.
I do acknowledge that profit has purpose and I really do not object to it when it is derived from luxury, for example the creation of a new video game etc. I have a lot more trouble when profit interferes in, and presumes to be more important than, the health of citizens. In our overly materialistic world, surely there are enough places for profit to thrive without having to exist in the health care system. For any Americans watching, Canada is not short of millionaires or billionaires. We have our share of people who have made a lot of profit off the rest of us. They have managed quite well without having unfettered access to our health for their profit-making ends.
Root problem, Doctor hate having more doctors. If there was 3 times as many doc in this country to service the under serviced areas and bring us up to a reasonable per capita of docs then we wouldn't be having this conversation. But you know what happens when you have a large supply of labour? Wages fall :( It also eliminates just how damn special you are while you scribble on your script pad for the 56th time before noon.
They created the "health crisis". They demanded lower enrollment in the early 90s because we had as the cma said a glut of doctors, then they spent the entire last 20 years telling us we are all sick and need the latest drug. Even if does the same thing as the other 5 pre existing ones.
Heck lets extend those patent and make generic drugs harder to be available.
Big Pharma and Doctors put us into any sort of mess we are in but want to claim the system of treatment and compensation is broke.
Wrong, what they did was criminal and people died for the greedy ones who run the show.
Thorin, you have exactly the right idea. Doctors are almost entirely responsible for the "doctor shortage". The motivation is the same one that is behind every price fixing scheme. Less supply equals higher prices.
The big shortage is more GPs (family docs).
In part this is caused by the size of gap in compensation between what a GP (family doctor) gets and a specialist.
Further still is a shortage of family doctors willing to work outside of banker's hours. That comromises the growth of urgent care centres and family practices.
The gap between generalists and specialists in compensation needs to be reduced and doctors need to make more when they go outside of business week hours. In addition perhaps all docs should have to do at least one shift a week outside of regular hours.
Things are even worse in many rural and remote parts of the country.
The big shortage is more GPs (family docs).In part this is caused by the size of gap in compensation between what a GP (family doctor) gets and a specialist.
Further still is a shortage of family doctors willing to work outside of banker's hours. That comromises the growth of urgent care centres and family practices.
Not to mention a culture within the medical community which looks down on general practice.
Very true-- It used to be that when you went in to medecine you accepted that you worked out of regular hours and were paid well because of it. Many doctors today think people should only get sick on schedule.
Another pressure is that with the cost of education and practice that they go to whatever pays best. Reducing the cost of education to be a GP or forgiving a certain amount of student debt for each year in either a place that needs it or working accessible hours might be sound policy.
Sean, your points are factual and reasonable, as usual. Still, if the medical schools in Canada started producing 2000 extra physicians every year, the economics of the situation would change in a way that I suspect would be beneficial to most Canadians.
Michael-- I would not dispute that at all-- However we need to look at the most cost effective ways of doing this -- while that would help we have to think about retention because 2000 new docs is great but if they find they can go south and get more money then that money will be lost.
I believe fogivable loans for service where we need them is the best way of making sure that kind of investment pays off
It is essential to focus on retention rather than just recruitment
We also have to address the nurses shortage in the same way--
But there is no question we need to train more as well
When we look at this trainign we also have to consider where-- for example if we train a 2000 people from rural, northern and aboriginal communities and then forgive loans for return of service in those communities we will achieve more than if we train the same number from major cities-- most of whom will want to remain in large cities or perhaps even consider leaving the country.
As usual it is combinations of policies that make sense that can resolve these problems
As a software developer, I understand very well the need for optimization. However, I also understand that no amount of optimization will be useful if the fundamental algorithm is wrong. That is a long winded way of saying that the shortage of doctors must be dealt with by an increase of supply. Once that is established, doing so in the most beneficial way is of course the next challenge.
Regarding nurses, my wife is a nurse, and the ONA rep for her ward. She tells me that hospitals across Ontario are cutting RNs from their staff, and replacing them with lower-paid RPNs and other workers. Also, her experiences have caused me to have severe doubts about the quality of hospital management, at least in Hamilton, but probably everywhere in the province. It seems that the same narcissistic culture which infects management in big business is now endemic in hospitals as well.
For the record, Canadians who can afford it do have access to private health care. During the debate on health deform in the US, the Republican/Drug/Insurance lobby would trot out a Canadian woman in Washington DC who would recite how she was "forced" to go to the US for faster care to treat some catastrophic illness. It was her argument that because she had to go to the US to "queue jump", the private system was better. For her. She is rich. She could fly to Washington D.C., Tokyo, Peking, or anyplace of her choosing to queue jump as her privileged life must come before the rest of us miserable peasants.
And so it would be her contention, that because she is rich, she should be able to queue jump at home, presumably because it would be a tad more convenient, through the miracle of free market, which is to say exclusive access, health care.
I would suggest to the fellow on the video (which I haven't watched) that if he is unhappy with Canada's public health care, he can do as the woman in D.C. and pay for his health care in the States. Then he can post a YouTube video of his happy, happy experience.
Do you mean the woman from Ontario who claimed to have had a brain tumor? It was actually a cyst on her pituitary, IIRC, and although it was uncomfortable and distressing, it was not life-threatening. She objected to having to wait for people who actually had brain tumors to be treated first.
@ ennir, What don't you like about the Canadian system, and what would you do to reform it? And sorry to hear about the niece, happens here (I live in California) every day, I too almost got into a similar situation, was in a hospital for probably less than 8 hours, and was charged 5000 USD...and there wasn't even any surgery. Luckily I qualified for a state insurance program that retroactively paid for it (and has covered future medical expenses of mine), but most people don't qualify for such a program here. @Ottawaobserver What would you change about primary care in Canada?
I think we made a seriously wrong turn when we decided to look for instant cures with medication and stopped paying attention to the vital role nutrition plays in our well being, we have doctors who know very little about nutrition prescribing medication for conditions which should be treated by nutrition. Basically, I think we now have pharmaceutical companies training doctors and dictating what treatments are available.
Michael-- you are right on there-- it is one of those ironies that while we have a nursing shortage we are letting nurses go.
The replacement of RNs with less skilled workers is especially frustrating given how many nurses are still doing non-nursing duties.
There will be serious repercussions on health if Ontario proceeds with reductions in nurses now. In addition the average age of nurses in the province is such that there is a looming shortage that is far worse than the one we are experiencing.
It is sad that rather than address the nursing shortage the response is to question the need for nurses in critical areas while pretending that patient care will not be affected.
There are several well reported studies showing that patient mortality increases when nurse patient ratios go down.
The reason I raise retention as needing to be in place before more recruitment is not just a question of ensuring value for money in the investments in further training, we also have a large number of nurses and doctors who are retiring or leaving the profession early. These people are trained and experienced (and indeed are an essential part of mentoring). When a nurse or doctor is convinced not to leave the profession the impact is felt right away (rather than later once training is completed for a new recruit). The person retained has a wealth of experience that a new person will take time to gain and the cost of retention is a fraction of training. As well the retention (and indeed working morale) of mentors is essential for new recruits to be successful. For these reasons if we have proper working conditions and retention strategies in place (including accommodation where needed) then once the new recruits are trained they are more likely to remain in the workplace.
For more information on a workplace focussed strategy you can go to thinknursing.ca. Have a look at some of the work being done in the Research to Action Project (link on the right hand side) -- you will see that recruitment is not forgotten but improving the workplace is the key component in making this work.
Michael, perhaps your wife may want to participate in the think.nursing.ca website which is calling for nurses to be involved in this discussion.
I would argue that proper retention strategies with a focus on the workplace is the foundation that you build your recruitment on and it must be in place. I do not deny that both need to happen especially since recruitment and training takes time but these two sides can be worked on at the same time.
Similar strategies as the Research to Action project must be done for family doctors.
