Monthly Archives: August 2009

Heath Care De-Cluttering

Since there is more utter nonsense being spewed south of the border regarding health care, it is incumbent on us to de-clutter the rants and peel away the fear-mongering.

First off, I’m Canadian.  That means I have cradle to grave health care.  I’m old enough to have used our health care system for chronic, elective and emergency reasons.  I have enough friends south of the border who use the private systems that I know how that side works and I can comment from a position of a consumer of health care.  Not a doctor, not a lawyer, not an insurance carrier.  Just a consumer.

Here’s how we did it:  In 1954 the people of Canada decided that everyone should have universal, comprehensive, no-charge, health care.  A combination of the Federal government and the Provincial governments would administer it.  In exchange for cradle to grave coverage, we pay higher taxes, federally and provincially, when compared to most Americans. 

The simple rule is this:  Medical care costs money.  How it is paid for and who gets covered are the questions.  In Canada, it is through taxes and everyone is covered. 

So let’s take a typical injury:  You trip over your own feet, fall and break your ankle.  So far, a basic, non-emergency kind of injury that happens all the time.  Your life is not really at risk, you need some x-rays, some plaster, Tylenol-3’s and a set of crutches.  You’ll need some physiotherapy in a few weeks.  And your lovely tan will be ruined.

In Canada, you go to Emergency at any hospital.  You are triaged by a nurse and after a bit, you get x-rayed.  A doc looks at the x-rays and says “You’ve broken your ankle.  We’re sending you for plaster and here’s a scrip for T3’s.  No dancing please.  Check in with your General Practitioner to get an appointment for physio.  Your GP will take it from here.  If you don’t have a GP, I’ll write you a referral for physio here at the hospital.” 

You get your plaster or fibreglass cast, a pair of crutches and you hobble away.  Cost to you?  Perhaps $20, as some hospitals cover crutches, or charge you a nominal fee for them.  You go to any pharmacy you want, hand over the Rx and pay about $11 for a wad of T3’s.  You go home, take the medicine, put your ankle up and cuss your lack of basic motor skills.  Done.

Notice something there?  Was there a “Death Panel” or rationed care, or some clerk coming by to measure your wallet?  Nope.  If you have supplemental coverage, through you employer for example, you probably have the Rx covered 100% and the crutches are likely covered as well.  The only thing you actually pay for is the parking at the hospital, which can be a nasty shock in some cities, but odds are if Emerg will stamp your parking ticket; even the parking might be free.

Did you get treated immediately?  Depends on how busy Emerg was.  If there was a bus-orphanage-propane tanker incident, you will be waiting for quite a while.  It is called Triage, meaning, doing the critical patients first.  This is decided by doctors and nurses using rules of Emergency medicine.  Got the sniffles and a sore throat?  You will be waiting longer. 

In many hospitals in the US, you get treated based on your insurance coverage.  Those well-covered go to the head of the line, even if their ailment is minor.  Those uninsured go to the end of the line, unless you have a spear through your head, at which point there might be some jiggery to move you up a bit.  Hospitals generally don’t like to see people with a spear through their head perched in the waiting room for several hours, bleeding all over the paying customers.  Tends to put people off.

Just to stretch it out a bit, let’s assume you’re an American tourist, in Canada, completely uninsured and you trip over your feet, fall and break your ankle.  Do you know how fast you’ll get treated? 

Exactly the same as any Canadian, with (or without) supplemental coverage.  You’re treated based on medical urgency.  After you’re patched up, someone from the hospital will want your particulars of course and will send you a bill.  They’ll charge at Medicare/Medicaid rates.  You won’t have your wallet measured.  You won’t have to fill out a credit application, or leave one of the children behind as collateral.  Somewhere between $500 to $1,000 would be my guess.  Not $16,000 or so, which is the going rate for a broken arm in the US. 

So far, any rationing of care, clerks telling the docs how and what to treat, or being refused service because you’re uninsured?  Nope.  Doesn’t happen here.  The medical decisions are made by medical people.  Clerks, actuaries and bean-counters make medical decisions in an HMO.

In simple language, America already has a group of self-appointed idiots telling doctors, nurses and hospitals what and how they can and cannot treat under the (chorus of angels here) Great Private Capitalist Health Care System.

Do we have problems with our health care system in Canada?  Of course we do.  Wait times are sometimes too long, but we’re working the problem.  Elective surgery can often be bumped by emergency surgery.  Funding for cosmetic surgery is tightly controlled.  If you were disfigured from a car accident (as an example) you’re fully covered, no question there.

However, if you want a set of 40 DD’s, you pay for them at going market rates, unless there is a real medical reason why you need the 40’s.  Being a pole dancer doesn’t count as a medical reason by the way.  We have a problem with hospital beds being occupied by people who should be in long-term chronic care facilities but that’s a problem of bureaucracy and foresight, not the actual delivery of health care.

Can you choose your own GP or specialist?  Sure can.  Can you go to any pharmacy?  Sure can.  Can you get an MRI on a moments’ notice because you have a sore arm from excessive self-pleasuring?  Nope.  If you came in with a spear through your head, absolutely, no problem and no question either. 

Again, the issue, specifically with MRI, was a failure of bureaucracy and foresight, not the actual delivery of health care.  We’re working the problem as best as can be expected in a system that is taxpayer funded.  It isn’t perfect, but it’s pretty good.

Is there ‘rationing’ of health care?  Nope.  There are limitations on funding for certain procedures, as the province can’t throw all money at all things, all the time.  My eye surgery two years ago saw me on a waiting list for nearly four years.  Adult cosmetic strabismus surgery is not critical; it isn’t a life-threatening situation, so I waited and I understand exactly why. 

If it was infant strabismus, it would have been done right away.  Even so, getting my eye squared up, didn’t cost me a cent.  My taxpayer funded cradle to grave health care covered the whole thing.  I even got free parking, as the day-surgery folks get their parking passes stamped by the hospital.

Do we cover alternative treatments?  Sort of.  If the alternative treatment is somewhat proven, then sure, it’s covered.  If the alternative treatment is watercress enemas four times a week to cure Multiple Sclerosis, then probably not.  Having said that, most of our cancer clinics are reasonably holistic in their approach to treatments, including mental imaging, diet, exercise and emotional support along with the chemo and radiation therapy.

Do we ‘penalize’ drug companies?  The health coverage for pharmaceuticals is big dollars, no matter how you look at it.  Generic drugs are used where medically appropriate.  Vancomycin is Vancomycin, if it is made by Lilly or Apotex, so unless there is a real, medical reason for a more expensive brand name that your doctor specifies in the prescription, then you’ll probably get a generic.  Note who decides:  The Doctor, not the insurance carrier.  All the brand-name pharmaceuticals like Celebrex, Cialis, Prilosec and the various statins (Lipitor, Zocor, Vytorin) all exist here and the pharmaceutical companies make good money off them.   

In our broken ankle case, the Rx will most likely be for Co-codamol or Atasol Codeine which is essentially Tylenol with Codeine, a good, effective pain killer for mild to moderate pain.  You can get OxyContin (from Purdue Pharmaceuticals) if the objective is to make hillbilly heroin and you lie through your teeth to the doctor. 

To sum up:  Is a cradle to grave health care system perfect?  No.  Do we have clerks and accountants telling medical staff how to treat people?  No.  Do we pay higher taxes?  Yes.  Is it better than an all-private system?  Now there’s a question that is answered by two questions.

If you believe that everyone should have health care coverage, regardless of income, then you’re in favour of it

If you believe that it’s their own damn fault they fell down/got sick/developed MS, then you’re not in favour of it. 

You tell me.




Swimsuit Records

With the World Aquatics Championships long over in Rome, the controversy over the swimsuits is persisting.  Here’s the short form:  Speedo, Arena and Jaked make swimsuits for competitive swimmers.  The objective of the swim apparel was ostensibly to cover the primary and secondary sexual characteristics of the human form with at least a scrap or three of cloth. 

When the science hobbits from the swimsuit companies got involved, the found ways to help high-performance swimmers go faster by applying the sciences of fluid dynamics and aerodynamics to the suits.  Essentially the new super-duper-wonder-suits use polyurethane and some serious squeezing to be more buoyant and to slim down the profile of the swimmer going through the water.  Smaller profile means faster times, at least theoretically and faster times means more World Records.

At the same time, if you don’t have the wonder-suit, you will not win, no matter how good a swimmer you might be:  They’re that much of an advantage at the high performance end of the spectrum. 

For me, who can swim, but only if confronted with drowning as an alternative, the wonder-suit would offer no advantage whatsoever, as well a $600 – $1,000 hit to the wallet and the half an hour to actually get into the suit.  Incidentally, the suits are estimated to last only three or four meets.  The wonder-suits are not especially durable.

The whole swimsuit issue brings up the question of what is an unfair advantage in sports?  One could argue that Michael Phelps is an unfair advantage, as even his eyebrows are fit, toned and super-efficient cardio machines.  The same could be said about any number of high-performance athletes at the lower levels of competition.  To get to those levels, your job is being an athlete, with the total dedication that only the obsessive can truly appreciate.

Some commentators have pressed the amateur button, conjuring up dreamy images of a Baron de Coubertin era of competition in the purest sense of amateurs seeking to achieve remarkable results. Note to self:  de Coubertin, the putative father of the modern Olympic movement, thought that coaches crossed the line into ‘professional’ sport. 

What Pete de Coubertin really wanted to do was to keep lower-class riffraff out of the competition.  His Olympic vision was a place for rich, white, upper-class sportsmen to mingle and occasionally dress up in sports togs.  Perhaps they might break a sweat, but that would be a bit declasse, as L’important dans la vie ce n’est point le triomphe, mais le combat, l’essentiel ce n’est pas d’avoir vaincu mais de s’être bien battu.  (The important thing in life is not the triumph but the struggle, the essential thing is not to have conquered but to have fought well.

Which is utter bosh according to our society:  We want winners.  We want them faster, higher, stronger, meaner and leaner than anyone else.  Coming second means you’re the first loser.  Bending the rules using anything that makes you win, is perfectly acceptable.  Then we get all coy about steroids, EPO, blood doping and all the other shenanigans.  Which is also utter bosh.

Here’s the real answer:  Do whatever you can do to win.  As long as the competitor can cross the finish line intact and survive long enough to reach the podium for the medal, then it’s done.  If you can find someone stupid enough to pump full of amphetamines, have implants powered by nuclear reactors and chemically jacked neurons that sound like a 12 gauge when they fire, so be it.  As long as they can get to the podium alive, then let the games begin. 

Yes, we might see 4 second 100 meter times, humans in a singlet out-gunning a Porsche at the stoplights.  We will also see some grisly implosions at the pool, or in the ring, but if that’s the price we pay for our ‘competition’ and ‘winning’ then it would seem that society is perfectly willing to pay that price.

There will always be parents who are willing to fund their kids’ pharmaceutical-medical-mechanical enhancements.  Their kid can be the first in junior rec league badminton to fatally impale an opponent with a serve.  They can cheer from the sidelines, pointing and hollering “That’s my daughter! She’s Number One!” as the paramedics drape the opponent’s lifeless form.

Unfortunately, my vision is all too possible.  Be it a wonder-swimsuit, a racing bike that weighs four ounces, or a regime of meds that shaves tenths off a competitor’s time, as long as we insist on winning only, someone will do it. 

Let’s at least be honest about it.  No more asterisks next to the records.