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From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 24 Apr 1999 07:37:58 GMT

In <3720cf38.29949393@nntp.ix.netcom.com> mvp1@ix.netcom.com (Marcio V.
Pinheiro) writes:

>So nice to see you around Pat. I am always perplexed how people who
>live in America, especially the ones who want to push their ideologies
>down our throats, always "know" what is going on in other countries.
>
>Before the Internet they got way with this because they would spend
>millions in propaganda to push their agendas. Usually: money.
>
>Now, they come accross people like you and many others who are kind
>enough to let us know what the reality is.


   In my universe the Canadians seem to have come from a separate
reality, as they all seem to have rationed-medicine monstrosities in
their families to complain of, if they're from Canada for several
generations.  Perhaps tourists or young people who live there just a
few years, like it better.

    There is another effect, though, which should be mentioned.  The US
does far more medical research per capita, in both government and
private capacities, than does Canada.  These guys don't pull their
weight, information-wise, but wait for the U.S. to break ground for
them.  Then laugh at our pharmaceutical costs.  Through the mid-1980's
I could find off-hand only one Canadian Nobelist in medicine/physiology
(Banting of insulin fame).  There are something like 63 from the US.
The ratio should really be 10 to 1.  Even if you correct for natural
resources by using average per capita income in both countries, Canada
doesn't come close to pulling its weight.  But everybody can't be a
front-runner.  If the U.S. goes to doing things like Canada does, who
will then be our U.S.?  Shall we slip across the border to Switzerland
to get that newest drug?  What, Switzerland isn't across the border,
and is hard to slip into?  Oh, dear.  It doesn't look like it will
work, then.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 25 Apr 1999 02:51:36 GMT

In <37218fbf.278896049@news.smartt.com> struik@hotmail.com writes:

>On 24 Apr 1999 08:28:08 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>
>>   I guess they don't get those news programs in Sweden.  Shame about
>>your bad luck.
>
>What bad luck are you referring to Steve? getting cute are we?  Look
>if you don't like my country that's your problem but don't insult me.
>There is alot of research taking place in Canada but obviously you're
>not very interested in that fact.



  There's a lot of interesting research taking place in every developed
country, and even some in most of the third world.  That wasn't the
point.  The point is the quality and the amount.   We've been over
Nobel prizes in medicine.  How many useful drugs on the world market
were developed in Canada?  How many new medical devices?

   My point is that you don't get to be smug about your medical system
until you pull your own weight instead of living off other countries'
medical research.  Switzerland and Germany can be justifiably smug
about their medical systems, but darn few other countries can.  As far
as I can tell, many of them, including you guys in Canada, partly
finance your system through a kind of parasitism.  It's as if you had a
great public library system, filled with photocopied books.

                                         Steve Harris, M.D.



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 25 Apr 1999 03:24:35 GMT

In <7fshd7$85r$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>    The assumption that 'we have the best medical care in
>the world' is unproven by outcomes and merely an assertion
>used to make fun of foreign doctors.  It is mainly used to
>justify undeserved sky-high incomes.



    Outcomes are hard to compare unless you use truly comparable
groups.  For example, in the US we have one of the poorest long term
dialysis survival rates in the world.  But we also dialyze older
patients than any other country in the world.  In fact, we dialyze
anyone who wants it and needs it.  Tell me it's the same in Canada and
Europe.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 25 Apr 1999 10:02:53 GMT

In <3722A757.DA3FC9C3@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>struik@hotmail.com wrote:
>
>> On Sat, 24 Apr 1999 18:07:39 -0400, Andrew Chung <achung@emory.edu>
>> wrote:
>>
>> >In socialized medicine, decisions are made by the PTB (with your
>> >doctor out of the loop) with regards to what medicines and other
>> >treatments will be available for the entire population.
>>
>> Interesting thought Andrew ,but, it doesn't explain why I get the same
>> treatment choices in Canada that are offered to people with the same
>> medical condition as myself who live in the States.
>
>And what medical condition might that be ?
>
>End-stage renal disease perhaps?
>
>So you're getting three day a week hemodialysis at a center within 10
>miles of where you live? Don't think so.
>
>Inducible VT perhaps?
>
>So you now have a $40,000 US implantable defibrillator keeping you from
>having a lethal ventricular tachyarrhythmia? Don't think so.
>
>AIDS perhaps?
>
>So you are getting the full cocktail with protease inhibitors? Don't
>think so.


    No, it's somebody who needs both knees and both hips replaced, due
to severe arthritis.  Statistics show they're going to live just as
long in Canada as in the US.  Albeit going through life a tad more
slowly.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 25 Apr 1999 10:41:57 GMT

In <xd990bhkozz.fsf@fruitfly.i-have-a-misconfigured-system-so-shoot-me>
Teg Pipes <teg@fruitfly.berkeley.edu> writes:

>sbharris@ix.netcom.com(Steven B. Harris) writes:
>
>>    In my universe the Canadians seem to have come from a separate
>> reality, as they all seem to have rationed-medicine monstrosities in
>> their families to complain of, if they're from Canada for several
>> generations.  Perhaps tourists or young people who live there just a
>> few years, like it better.
>>
>>     There is another effect, though, which should be mentioned.  The
>> US does far more medical research per capita, in both government and
>> private capacities, than does Canada. These guys don't pull their
>> weight, information-wise, but wait for the U.S. to break ground for
>> them. Then laugh at our pharmaceutical costs. Through the mid-1980's I
>> could find off-hand only one Canadian Nobelist in medicine/physiology
>> (Banting of insulin fame). There are something like 63 from the US.
>> The ratio should really be 10 to 1. Even if you correct for natural
>
>I'm not certain about the other Nobels, but Physiology and Medicine
>can be terribly political.  Quite shockingly political, really, at
>least during years in which there hasn't been a lot of drama about
>one contender.  So, while there are interesting ways to quantify
>scientifc impact (various Science Citation Index "impact" scores,
>just raw # of papers in peer-reviewed journals, % of students in
>gov't-funded training programs who end up working in research, etc.)
>the number of Nobels over time is not very significant.  In fact,
>I think the only other times I've heard the Nobel Score brought up
>were during pissing contests between Stanford and Berkeley.


   Okay, it's political.  They were lax in giving a Canadian the prize
for the discovery of insulin.  Won't happen again.

    To be fair, I'll consider Canadian medical research achievements of
Nobel quality, which didn't get the prize, due to anti-Canadian
prejudice.  I think we recognize that the discovery of insulin rates.
Now I want the other, unrecognized stuff.  The US prizes were given for
things like the development of radioimmune assay, the discovery of
vitamin B12 and cure for pernicious anemia, the discovery of prion
brain disease and prions themselves, discovery of cancer-causing
viruses, the discovery of reverse transcriptase in viruses, discovery
of the genetic mechanism of mutation.  That sort of thing.



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 25 Apr 1999 14:18:13 GMT

In <372f13b2.3344842@nntp.ix.netcom.com> mvp1@ix.netcom.com (Marcio V.
Pinheiro) writes:

>On Sun, 25 Apr 1999 09:07:10 GMT, struik@hotmail.com wrote:
>
>>On Sun, 25 Apr 1999 01:25:54 -0400, Andrew Chung <achung@emory.edu>
>>wrote:
>>
>>
>>>And what medical condition might that be ?
>>>
>>>End-stage renal disease perhaps?
>>>
>>>So you're getting three day a week hemodialysis at a center within 10
>>>miles of where you live? Don't think so.
>>>
>>>Inducible VT perhaps?
>>>
>>>So you now have a $40,000 US implantable defibrillator keeping you from
>>>having a lethal ventricular tachyarrhythmia? Don't think so.
>>>
>>>AIDS perhaps?
>>>
>>>So you are getting the full cocktail with protease inhibitors? Don't
>>>think so.
>>
>>Making comments like the above Andrew has made me realize you really
>>don't know much about the Canadian system.
>
>
>I knew this along... too much TV in America.



 Did you, now?  Why don't you read the following article, which is not
from TV, and tell us which part you don't understand?  I would
especially like comment on the survey analysis statement: "Ten percent
and 12% of Canadian and British nephrologists, respectively, but only
2% of American nephrologists, reported refusing dialysis due to lack of
resources (P < 0.0001)."




Am J Kidney Dis 1998 Jan;31(1):12-8

Dialysis decision making in Canada, the United Kingdom, and the United
States.

McKenzie JK, Moss AH, Feest TG, Stocking CB, Siegler M

Department of Internal Medicine, the University of Manitoba, Winnipeg,
Canada. jmckenz@cc.umanitoba.ca

This study was designed to determine the extent to which differences in
criteria for dialysis patient selection and availability of financial
resources cause the wide variation in acceptance rates for dialysis in
Canada, the United Kingdom, and the United States. We also sought to
determine whether there is agreement among nephrologists in the three
countries on which patients should not be offered dialysis. We used a
cross-sectional survey of all members of the Canadian Society of
Nephrology and the Renal Association of Great Britain, and
a randomized sample of 800 members of the American Society of
Nephrology. Five case vignettes were presented asking for yes/no
decisions on offering or not offering dialysis, together with ranking
of factors considered important. We also inquired about dialysis
resources and physician demographics. We compared responses by country.
More nephrologists from the United Kingdom returned responses (83%)
than Canadian (53%) or American (36%) nephrologists. American
nephrologists offered dialysis more than Canadian or British
nephrologists (three of five cases; P < 0.04 to P < 0.001) and ranked
patient/family wishes (three of five cases; P < 0.057 to P < 0.0001)
and fear of lawsuit (P < 0.04 to P = 0.0012) higher than British or
Canadian nephrologists. Canadian and British nephrologists reported
their perception of patients' quality of life as a reason to provide (P
= 0.0019) or not provide (P = 0.068 to P = 0.0026) dialysis more often
than their American counterparts. Despite these differences,
nephrologists from each country did not differ by more than 30% on
any decision and ranked factors almost identically. Ten percent and 12%
of Canadian and British nephrologists, respectively, but only 2% of
American nephrologists, reported refusing dialysis due to lack of
resources (P < 0.0001). We conclude that the wide variation in dialysis
acceptance rates in the three countries is somewhat influenced by
differences in patient selection criteria and withholding of dialysis
by nephrologists based on financial constraints, but that other
factors, such as differences in rates of patient nonreferral for
dialysis, contribute more significantly to the variation. Generally
agreed on practice guidelines for dialysis patient selection appear
possible.

Comments:
  Comment in: Am J Kidney Dis 1998 Jan;31(1):131-2


PMID: 9428446, UI: 98088722

----------



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Disappointed and confused--don't know what to do
Date: 26 Apr 1999 05:03:14 GMT

In <3723c836.356099@nntp.ix.netcom.com> mvp1@ix.netcom.com (Marcio V.
Pinheiro) writes:

>On 25 Apr 1999 13:29:29 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>
>>In <372a1147.2724942@nntp.ix.netcom.com> mvp1@ix.netcom.com (Marcio V.
>>Pinheiro) writes:
>>
>>>Everything I read point to the fact that Medicare administrative costs
>>>are much lowed than private insurance. Also points to the fact that if
>>>we had a Single Payer in the USA this would save us millions of dollars
>>>and everyone would be covered.
>>
>>   A great idea. By the same token, we ought to have a national grocery
>>store to save the people the advertising costs that are wasted when
>>Ralph's competes against Reams or Safeway or Target. What do you
>>think?
>
>We are discussing here health care... please look for a group
>talk.food.politics. I hope there is one.


   We are discusing communism.  Which causes the same problems in
medicine as it does in agriculture, and for the same reasons.

   Please note that I understand that many medical systems are not
completely communistic-- for instance, the Canadian system resembles a
voucher system, although it has some unnecessary bells and whistles.
There's a vast difference between full socialism and a voucher system,
in which only payment is "public," but the service is provided by
private competition.  To the extent that patients are free to change
doctors in Canada, it benefits from many market forces which encourage
efficiency.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 29 Apr 1999 05:06:47 GMT

In <3727C3BC.6116430C@qualityteam.com> Marie White
<mariew@qualityteam.com> writes:

>And in Canada, regardless of how much you make, you go to
>your doctor and get treated.  No one asks, or cares, how
>much you earn, either before or after.  I'm not sure what an
>HMO is, but if that means your doctor, then, here in Canada,
>you choose your own doctor regardless of whether you make
>$8000 a year or $100,000 a year.  You go to the same
>hospital, and you receive exactly the same treatment.

    Yes, but you might have to go a heck of a long way to that
hospital.  It all depends on luck of the draw.  In the US, if you need
a lab test at your doctor's office, it can in almost all cases be drawn
there, and sent to a nearby lab, with results in a couple of hours to
overnight.  In Canada, you probably do without the lab, based on your
doctor's best guess.  I'd like to randomize people to the two types of
practice to see if this really is no more dangerous.  At the moment I
reserve judgement, but sounds rather scary to me.  And I'm on the other
side of it.  I can't look at you and guess your potassium level or your
prothrombin time, and I'm unaware of any special training Canadian
doctors get which allows them to substitute examination and history to
do the job.  Thus, I am skeptical.  Some tests are replacable with
better history and exam, and some aren't.  I'd be more impressed if all
doctors in Canada had the same lab access as US docs, but used it LESS.

>  And,
>in case you think I don't know both sides - my son was born
>ill and spent a week in the hospital having a slew of tests
>at a time when we were struggling to buy groceries.  In
>fact, I had a difficult delivery, and spent five days in the
>hospital.  Now, three years later, my husband has an
>executive position and we can afford whatever we want (what
>a difference three years makes!). But we still go to the
>same doctor, go to the same hospital, and wait an eternity
>in the same waiting rooms.  They don't care any more what we
>earn now than they did then.


   I'm not saying there are no advantages to a Canadian style voucher
system.  Canadians do very well (are very efficient) with the money
they spend on their medical care.  We would surely do less well in the
US if we had to cut our costs by 1/3rd.  I'm sure we would not get rid
of many of the MRI scanners, computerize doctor's offices, increase
"free" preventive medical care for the lower income bracket, and cut
doctor's paperwork so that they need only 2/3rds of their present
support office staff (the ratio between Canada and the US).  So, for
that, I admire the Canadian system.  On the other hand, I'm somewhat
amazed that a country which makes only 14% less per capita than the US,
doesn't choose to spend more of it on medical care.  Is it that if you
spent any more, that extra money would have to start going for the
latest drugs and devices?   Too many of which are made in the US and
Europe?  Canada, for all of its excellent efficiency and relative
wealth, still pinches pennies, and does not pay its own way in medical
research.   In a bicycle race, you can save a heck of a lot of energy
staying just behind the lead guy.  But somebody has to do that job.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 29 Apr 1999 07:33:17 GMT

In <3727ee7b.163835467@news.smartt.com> struik@hotmail.com writes:

>Steve do us Canadian'sl a favour and stop discussing our medical
>system since you seem to know so little about it.  Guess what Steve,
>Canada DOES have labs and the results come back just as fast as
>American labs.
>
>Making statements like above just show's us how ignorant of our system
>you truly are.


   I'm sure Canada has labs.  What you may not be aware of is that
nearly all doctors in the U.S. operate out of hospital-associated
clinics, so that every doctor's office has immediate access to lab
service.  No such thing is mandated in Canadian medical standards.
There are many group practices in Canada which are not hospital based
and at which blood is never drawn.  If you have to send your patient
down the road or somewhere else for a test, it gets much more
difficult.  Under such circumstances, the needed test may go undone.
The average American doctor can get a lab result stat within an hour
after drawing it in the office, and most within half an hour.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 2 Jul 2000 22:34:27 GMT

In <395F66D1.6E806155@home.com> The Fonz <fornssler@home.com> writes:
>
>Tom Staresinic wrote:
>> Perhaps the hospital would have charged the wife
>> money to keep him supported during this time. That's why I think she chose
>> to disconnect him ASAP.
>>
>I am assuming that you are referring to Ottawa, Ontario, and I would
>gather that you do not live in Canada. Costs are not charged to patients
>in Canada for hospital care -- there would likely be a charge (maybe $10
>or $20 a day) only if a private room were requested or if Ontario has
>some kind of hospital user fee. There is no way to charge more for any
>additional care even if the wife wanted to pay more or the hospital
>wanted to charge more -- that is not allowed under the Canada Health Act.


   One more reminder of the diaster the Canadian system is headed for.
Imagine what would happen to the restaurant business or the auto
business of consumers couldn't pay more for a better product, even if
they wanted to. This would remove all incentive for improved efficiency
and improved quality, and pretty soon you'd get the kind of socialistic
service one saw in the old USSR in restaurants.  And get the same kind
of cars you used to get in countries behind the "iron curtain."

  But Canadians love their healthcare system.  They love it even when
it kills them, or causes they grief.  They would no more give it up
than a Frenchman would his cigarettes.  It's an addiction.

   You have to be a peculiar kind of person to care so much that your
neighbor doesn't have a better yard or home or car than you do, that
you'd willingly live under laws that require you both to have crap. But
I've seen it. Envy has always been the basis of socialism in all of its
forms.





From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 3 Jul 2000 08:54:05 GMT

In <D440D02196FDCCCE.D4FB1CE4B6730AAE.421F31625E4B9A88@lp.airnews.net>
a@a.a (a) writes:

>On 2 Jul 2000 22:34:27 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>>
>>Envy has always been the basis of socialism in all of its forms.
>
>And greed the basis of capitalism.  U.S.A.!!!  U.S.A.!!!  U.S.A.!!!
>WOOHOO!!!
>
>Now if only there were economic systems based on pride, anger, lust,
>sloth, and gluttony...?



   "Greed" is one of those transitive words where the same action gets
described differently depending on who does it.  You know, as in "men
piss, women pee, children tinkle"; Horses sweat, men perspire, women
glow; you are stubborn, I am tenacious, he is bullheaded; he is greedy,
you are acquisitive, I merely want the best for my family.

  Take a deep breath and imagine an economic system whose motor is the
desire of people for a better life for themselves and their families.
If you want an economic system based on the idea that people should
work as hard and sacrifice as much for you, or some stranger, as they
do for themseleves and their spouses and children, I would suggest you
go back to the drawing board.  It won't work. Heck, even Aristotle had
THAT figured out with regard to Plato's proposed socialism. It's an old
argument, and has been tested by experiment many times since the
ancient Greeks. It is amazing that people keep proposing it, though.





From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 3 Jul 2000 08:56:26 GMT

In <396011f6.85633602@news.smartt.com> struik@hotmail.com (M. Struik)
writes:

>On 2 Jul 2000 22:34:27 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>
>
>
>>  But Canadians love their healthcare system.
>
>Darn right we do and for good reason, since you are neither Canadian
>or used the Canadian Health Care system you are NOT in a position to
>comment on it.


   I will if you make me a deal: when y'all come straggling across the
border wanting to pay for something special, you look a little more
embarrassed.  Okay?




From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 2 Jul 2000 22:59:57 GMT

In <8jnmiq$fgj$1@freenet9.carleton.ca> as488@freenet.carleton.ca (Tom
Staresinic) writes:

>It does not appear to be our choice. The doctor in charge refuses to
>give food even if the patient's body is able to receive it. He will
>only give fluid through IV; that's no help since you can't survive
>without food.


   Well, in other than a socialist setting, you could use the two most
powerful words a patient or family has in the health care system:
"You're fired."  However, in Canada, you may be screwed.  What can I
say?  Nobody forced the man to live in Canada.  You get what you pay
for.


>>What is your family members diagnosis? Why is this
>> person in a coma?
>
>Because the nursing home probably mishandled him ?! Only 10 days after
>being admitted, they stuck a catheter into his penis (are nursing
>homes allowed to do this?). For some unknown reason he pulled it out
>imself. I am told that it's very painful to removed a catheter. He
>hen became naseous and began vomitting. They say (but the family has
>o independent witness) he began choking on the vomit, and as soon as
>e did, his heart stopped. This is so hard to believe.

  Believe it.  Cardiac arrest from respiratory arrest from aspiration
of gastric contents happens every day.


>I think his heart stopped as a result of the removed
>catheter; perhaps fluid pressure build-up.

  Nonsense.

>And probably there was no staff
>around to respond to him in time. He was taken to a Ottawa hospital
>40 kms from the nursing home). The hospital doctor said his heart had
>ben stopped for 10 minutes before they had restarted it.

 Typical.  You usually can't restart the heart in an older man after a
primary cardiac event.  For a respiratory arrest, however, you
sometimes can.

  Ten minutes means that without advanced brain resuscitation of the
sort that is only done on animals at present (experimentally), he must
have suffered severe brain damage, if an elderly or middle-aged man.
There are many heart resuscitation drugs; not a single brain
resuscitation drug.  If he previously was in such poor mental shape as
to require a nursing home, and did things like pull his own catheters
out, any more brain damage would likely have been the end for him.
This is not something you recover from to a good quality of life.
Indeed, it sounds as though he didn't have much of a quality of life
BEFORE the event.  Be realistic.


>Then he was put on life support
>for 48 hours. During that they claim that 3 specialists examined him
>and they all concluded that they were 'reasonably' sure that  had
>severe brain damage; they say only the most primitive part of the
>brain was still alive (the one which controls some facial reflexes and
>major body organs).

  Sounds likely, even from a reading of just the circumstances.  So why
don't you accept this?


> I still say that he should have been left on full life support and
>given a fighting chance of a few weeks.

   You can SAY this all you like, particularly if it costs you nothing
to say it. But you don't know what you are talking about.  His chance
of returning to a decent life are next to nil.  Balance that against
$100,000 in ICU costs (which somebody has to pay, even if
the general taxpayer).  It's not fair.  In a purely capitalist system
they'd rightly just tell the family: "If you want to take a very
longshot chance like that, likely wasting all that money, YOU pay for
it."  In Canada, they don't even give you the chance to pay for it, the
basic reasons are the same: there's no money for tomfoolery.  In both
cases the decission is rational.




From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 4 Jul 2000 05:20:41 GMT

In <3960f15e.142833388@news.smartt.com> struik@hotmail.com (M. Struik)
writes:

>On Mon, 03 Jul 2000 15:07:00 GMT, a@a.a (a) wrote:
>
>
>>I don't know much about the patients, but why are there so many
>>Canadian nurses working down here in the U.S.?
>
>Simple actually, you have a shortage of nurses, you have a lower
>taxation rate, our nurses come down to work and stockpile earnings
>because your govt stands at the border with the doors wide open for
>them.



   In the bad old days it may have been true.  These days, post-NAFTA
if you want a new green card to nurse in the US, it's going to have to
be a job wetnursing Pandas at the zoo.  Anything less exotic and you'll
be laughed right back up over the 48th.  Don't blame me-- it was mostly
Canadians who wanted the draconian job protection laws.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 4 Jul 2000 05:15:08 GMT

In <8jqk4i$qte$1@bob.news.rcn.net> wright@nospam.clam (David Wright)
writes:
>
>In article <396011f6.85633602@news.smartt.com>,
>M. Struik <struik@hotmail.com> wrote:
>>On 2 Jul 2000 22:34:27 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>>wrote:
>>
>>>  But Canadians love their healthcare system.
>>
>>Darn right we do and for good reason, since you are neither Canadian
>>or used the Canadian Health Care system you are NOT in a position to
>>comment on it.
>
>And, Steve, you've never been shot to death, so you are in no position
>to comment on fatal gunshot wounds.


   Yep.  You could fill a book with medical problem I haven't had
personally, so what do I know?

   What really gets me about the Canadians is that they have nearly the
per capita income of Americans, but spend half as much as we do on
medical care, yet think that they are entitled to, and actually get,
just as good a benefit. Cheeky bastards.  On the day when the universe
mints free lunches for eveyone just for showing up, it may be true.  In
the mean time, I believe all those stories the Canucks tell me.  In the
two provinces that voted for full on straight-out medical socialism,
what can I say? They won't feel a thing?  Naw, that would be lying.
Actually, Manitoba, you'll feel jusssstt a little pinch, as the numbing
medicine goes in....

   Do I think the Canadians have a more efficient system, so that they
get considerably better than half as good health care?  Sure.  I admit
it.  Their population looks like Alaska's or Minnesota's, they spend
more money on younger people where it does more good, their inner
cities aren't falling apart, they don't do their share of medical
research, and a big single-payer system lends itself well to a
computerized database that saves a lot of time on information transfer
work. All this helps. However, none of these things require socialism.
We, too, could have a single patient medical database, if we could live
with the privacy implications. We can't. The Canadians, OTOH, have no
concept of privacy from their government, so far as I can see. As well
an infant be expected to have privacy from its mum. That's WHY they're
Canadians, most of them. They went thataway fleeing toward their
comforting government, and away from the American revolution.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 4 Jul 2000 09:18:17 GMT

In <396176bd.5880857@news.smartt.com> struik@hotmail.com (M. Struik)
writes:

>On 4 Jul 2000 04:47:38 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>
>
>>  In fact, I wanna know where Struik's posting from.  I certainly smell
>>either a rat or a discontinuum in space-time.
>
>From British Columbia since you are so curious!  Guess what Steve,
>that IS in Canada


   What, no NAFTA in your universe?  People just drift down across the
border to work in hospitals for a while, then take their greenbacks up
and exchange them for stuff with maple leaves?  Sounds idyllic.
Doesn't resemble the universe I live in, but it's nice.

   Hey, do you know Harry Potter?




From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 5 Jul 2000 06:44:28 GMT

In <39624394.27872307@news.smartt.com> struik@hotmail.com (M. Struik)
writes:
>
>On 4 Jul 2000 09:18:17 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>
>
>>
>>   What, no NAFTA in your universe?  People just drift down across the
>>border to work in hospitals for a while, then take their greenbacks up
>>and exchange them for stuff with maple leaves?  Sounds idyllic.
>>Doesn't resemble the universe I live in, but it's nice.
>>
>
>Obviously you have just proven how little you really know about NAFTA
>Steven.  Remember the person who originally made the statement about
>how many Canadian nurses were working in the US, how do you think they
>got jobs in the States?

  They got them before the current work and emigration laws.  They
DON'T do it now.

> Did they marry a Yank?

   Maybe.  Even this is not the direct route to a green card that it
used to be.

>
>If you don't know what you are talking about then certainly don't
>embarass yourself by making stupid statements.

  But I do know what I'm talking about.  It is you who seem to be 10
years behind the times, as regards moving from Canada to work in a
profession like nursing in the US.  Try again.  It's the year 2000 now,
not 1990.  Yes, three of those O's.  Almost the 21st century.  Smell
the coffee.



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 6 Jul 2000 11:37:41 GMT

In <396302f4.76872181@news.smartt.com> struik@hotmail.com (M. Struik)
writes:

>On 5 Jul 2000 06:44:28 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>
>
>>  But I do know what I'm talking about.  It is you who seem to be 10
>>years behind the times, as regards moving from Canada to work in a
>>profession like nursing in the US.  Try again.  It's the year 2000 now,
>>not 1990.  Yes, three of those O's.  Almost the 21st century.  Smell
>>the coffee.
>
>I am Steven, obviously you haven't (smelled the coffee and kept up
>with the times).   If you wish to continue to embarass yourself be my
>guest, but you really are making a horses ass of yourself.



COMMENT

Here is what Nicholas George, Attorney and Counselor at Law, P.S.,
Inc., has to say on a web article on the advantages of getting a green
card.  This is the section on post NAFTA work visas:


B. Employment-Based Relationships

If you do not have a close family member who is an American citizen or
who holds a green card, you may be able to obtain a green card through
a job offer from an employer in the United States-as either a priority
or a non-priority worker.

1.Priority workers

Because it appears that the United States may lack a sufficient number
of skilled professionals in the next decade, Congress created a new
immigration classification in the Immigration Act of 1990: priority
workers. Priority workers are people with extraordinary ability (such
as an internationally known artist), or outstanding professors and
researchers (an Einstein) or multinational executives and managers (of
such global corporations as SONY of Japan, Nestle of Switzerland,
Daimler-Benz of Germany). Such highly-skilled aliens are allowed to
circumvent the bureaucratic maze known as labor certification-the
procedure by which the Department of Labor determines that there are no
Americans or lawful permanent residents available and willing to do the
job for which the immigrating alien wishes to apply.

2.Non-priority Workers

Other aliens who seek employment in the United States need
certification from the Department of Labor to obtain green
cards.	Congress was able to meet the objections of the labor unions by
keeping this requirement of labor certification for the other groups of
alien workers and by giving the unions the right to notify the Labor
Department that an American or permanent resident is available, willing
and able to do the work of the alien. In this way, both the unions and
the aliens are given the opportunity to safeguard their interests. As
long as this requirement is met, applicants who have graduate degrees
in the arts or sciences or a profession (such as lawyers), or those
with Master's degree in business administration (MBA), or those having
specialized experience equal to a graduate degree, are eligible for
immigrant visas. But the Department of Labor also requires businesses
that need ordinary professionals (without graduate degrees), or of
skilled or unskilled workers (factory workers, plumbers, domestic
workers, carpenters) to apply for labor certification.

C.Enterpreneur Immigrants

An alien entrepreneur from any country who invests at least one million
dollars in a new business and employs at least 10 American citisens or
lawful permanent residents id eligible for a green card. Each year,
10,000 immigrant visas are set aside for this millionaire immigrant
category which is designed to create employment. The legislators
evidently intended to attract wealthy
investors, particularly from Asia and the Middle East, Canada and
Australia, among other countries, have had successful programs of this
kind for several years now.

D. Special Immigrants

Certain categories of people may obtain a green card by special laws-in
addition to certain provisions of the Immigration Act of 1990-intended
to benefit limited groups.

* Priests, nuns, pastors, ministers, rabbis, imans and other workers of
recognized religious denominations can come to the United States on a
non-immigrant visa.

* Former employees of the U.S. government, commended by the U.S.
Secretary of State for having performed outstanding service to the
government for at least 15 years, are also eligible to apply for a
green card.

* Medical doctors who have been licensed in the United States and have
worked and lived in the United States since January, 1978, are
eligible.

* Aliens who applied for amnesty under the Immigration Reform and
Control Act of 1986-having been in the United States illegally since
January 1, 1982-are eligible to apply for green cards. Their spouses and
unmarried children nder 21 years of age are also eligible to become
permanent residents.

*Political refugees and asylees who can prove that they fled their
country for fear of persecution owing to their race, religion,
nationality, membership in a particular social or political group, or
political opinions, may apply for green cards.

++++++++++++++++++++++++++++++++++++++++++++++

   That's it, except for the marriage stuff, in which you're subjected
to incredible scutiny, and don't get a green card for two years anyway.



   Please note that "priority workers" is a category meant to let
people like Enrico Fermi emigrate. "Non-priority workers" is there for
migrant fruit pickers, who do jobs that even the unions cannot argue
that there are enough natives workers to do.  The US has plenty of
nurses.  If you're a Canadian nurse you're going to wait until Hell
freezes over for a US work visa in the year 2000.  You said I was
making a "horse's ass" of myself for saying that lots of Canadian
nurses don't immigrate over the border to work in the US these days.

   Okay, now let's see YOUR argument that they do.  We shall see who is
the horse's ass.





From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: morphine & no food/water
Date: 7 Jul 2000 23:28:52 GMT

In <3964dc9c.6396360@news.smartt.com> struik@hotmail.com (M. Struik)
writes:

>On 6 Jul 2000 11:37:41 GMT, sbharris@ix.netcom.com(Steven B. Harris)
>wrote:
>
>>   Okay, now let's see YOUR argument that they do.  We shall see who is
>>the horse's ass.
>
>Guess you're not aware of this particular visa application?
>
>PROFESSIONAL VISAS (H1-B)
>Specialty Occupations, Bachelor's or Higher Degree
>
>§§ 214 (h)(1) the immigration and Nationality Act of 1952 ("Act"). Pub
>L. No. 82-414, 66 Stat. 163, 8 U.S.C. § 1184(h).


   Guess you're not aware that the INS denies all H-1B nursing
applications, on grounds that the profession itself doesn't require a
BS degree (even though all the nurses in the last suit, in which the
ciruit court upheld the INS, actually had 4 year degrees). In addition,
there are strict caps on numbers of H-1B workers, which are usually
filled long before the end of any given year (this is the category
under which all those Indian programmers and Chinese tech workers come
into the US). Also, your local nurses union will not be happy with your
local nursing employer who utilizes H-1B, even if the other problems
are fixed. The employer must specify that hiring under this category
does not hurt working conditions for local workers, and your local
nursing association will have something to say about that.  They are,
needless to say, the folks behind the recent INS decission and court
confirmation.

   Bottom line: it's very, very difficult for a Canadian nurse to work
in the US in the year 2000, as I said.  Also, you're indeed well on the
way to horse's asshood (ie, a peculiar combination of personal
ignorance combined with a willingness to point out a supposed lack of
knowledge in others).  Keep it up.


From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: misc.consumers.frugal-living,sci.med
Subject: Re: all about HMOs
Date: Mon, 1 Apr 2002 19:27:25 -0700
Message-ID: <a8b5ca$1k1$1@slb6.atl.mindspring.net>

"Victor Smith" <victorfsmith@earthlink.com> wrote in message
news:3cac02ba.13849803@news.earthlink.net...
> On Mon, 1 Apr 2002 11:57:50 -0700, "Steve Harris"
> >COMMENT:
> >There are several with regard to inappropriate use of emergency
> >departments, so either you haven't done what you say you've done, or
> >else your question was misunderstood, or else the economists you've
> >talked to were incompetent.
>
> Or else Lech, who is a Canadian, was talking about the Canadian system
> when he said "study that quantified this sort of abuse of the system".
> You have posted American studies.  America does not have the Canadian
> system.  Besides, ER's are not doctors' offices.

So?  You think the worried-well can tell the difference?  I have posted
American studies, assuming that human nature does not somehow change when
you cross the 54th parallel.  Because Canada has never experimented with
copayments, how would they know whether they have any effect on abuse of the
health care system or not?  If you never look, you never see.  But if your
society refuses ever to ever look at the issue, it's hardly fair to demand
studies from people in your society who HAVE looked at the issue. You've
made damn sure there aren't any. So?

> But I'm sure the Canadians are by now accustomed to Americans telling them
> all about the Canadian health care system.

No, I'm telling you about the American system.  I can't tell you much about
the Canadian system because the Canadians themselves have (with few
exceptions) refused to study it, possibly being afraid of what they might
find.

> >What holds true for ERs should hold true for other medical access as well.
>
> Besides not even coming close to challenging Lech's initial point, your
> cites have certainly not established your above supposition to be true.
> What is shown by the Brown U. study is that American ER's are subjected
> to "abuse" by the uninsured, because they have no other place to go.

They do have a place to go-- the doctor's office. Alas, they have to pay for
this. You may have some picture in your head that people who misuse ERs for
non-emergencies are street people who show up on foot. They aren't. They are
people with apartments, houses, cars.  They have money-- they just don't
want to spend it on doctors, you see. And they don't want to wait till
morning if care is "free" (ie, somebody else pays for it).

> I base this only on "Among the regular ED users, 68% desired a physician
> as their regular source of care", so if these people are actually insured,
> consider it retracted.

No, these people aren't insured in this particular study (though they are in
the other one I cited). Insurance costs nearly as much as your smoking habit
and the beer you buy, and the color TV you watch.  Why would you want to pay
good money for it when you can go down to the ER and see the doc free?

> Perhaps you have a Canadian study which says Canadian ER's are likewise
> afflicted?

How could I have that, when Canadian ERs have never tried charging co-pays?
And are Canadian ER's affected by such people?  Does Canada have stores
where people who run out of cigarettes and booze in the middle of the night,
and can't wait till the next morning, can go after hours and buy them at
higher prices?  If they do, then I can guess that their ERs in the middle of
the night are abused. By the same people. I can't prove it because you won't
look.

> Or more on target, a Canadian study which disproves Lech's
> contention that Canadian doctors' offices are NOT being flooded with cold
> sufferers?

I'm sure Canadian doctors see cold sufferers. What, you think they don't?
The question is what number would convince you.

> Other than making the American ER case for universal American insurance so
> that the uninsured don't flood American ER's, your cites only establish
> that people having heart attacks don't consider the copayment while
> rushing to the hospital, and that the existence of a copayment has a very
> slight effect in deterring patients from visiting the ER.

I wouldn't call a 15% drop in use a "slight effect".  And the study below
(read it again) is on people who belong to an HMO, so they ARE insured, so
now's your time to retract, as you promised. Being in an American HMO is the
closest US citizens get to Canadian style health care. They can see the
office doctor whenever they like, so long as it's during office hours.  For
other stuff there's the ER, but for 15% of them, whether they can wait till
Monday or not depends on whether it costs $25 or not.


> >N Engl J Med 1996 Mar 7;334(10):635-41
> >Comment in:
> >N Engl J Med. 1996 Mar 7;334(10):657-8.
> >
> >Effect of a copayment on use of the emergency department in a health
> >maintenance organization.
> >
> >Selby JV, Fireman BH, Swain BE.
> >
> >Division of Research, Permanente Medical Group, Kaiser Permanente Medical
> >Care Program, Oakland, CA 94611, USA.
> >
> >BACKGROUND. Use of the emergency department for nonemergency care is
> >frequent and costly. We studied the effect of a copayment on emergency
> >department use in a group-model health maintenance organization (HMO).
> >METHODS. We examined the use of the emergency department in 1992 and
> >1993 by 30,276 subjects who ranged in age from 1 to 63 years at the
> >start of the study and belonged to the Kaiser Permanente HMO in
> >northern California. We assessed their use of various HMO services and
> >their clinical outcomes before and after the introduction of a
> >copayment of $25 to $35 for using the emergency department. This
> >copayment group was compared with two randomly selected control groups
> >not affected by the copayment. One control group, with 60,408 members,
> >was matched for age, sex, and area of residence to the copayment group.
> >The second, with 37,539 members, was matched for these factors and also
> >for the type of employer. RESULTS. After adjustment for age, sex,
> >socioeconomic status, and use of the emergency department in 1992, the
> >decline in the number of visits in 1993 was 14.6 percentage points
> >greater in the copayment group than in either control group (P<0.001
> >for each comparison). Visits for urgent care did not increase among
> >subjects in any stratum defined by age and sex, and neither did the
> >number of outpatient visits by adults and children. The decline in
> >emergency visits for presenting conditions classified as "always an
> >emergency" was small and not significant. For conditions classified as
> >"often an emergency". "sometimes not an emergency", or "often not an
> >emergency", the declines in the use of the emergency department were
> >larger and statistically significant, and they increased with
> >decreasing severity of the presenting condition. Although our ability
> >to detect any adverse effects of the copayment was limited, there was
> >no suggestion of excess adverse events in the copayment group, such as
> >increases in mortality or in the number of potentially avoidable
> >hospitalizations. CONCLUSIONS. Among members of an HMO, the
> >introduction of a small copayment for the use of the emergency
> >department was associated with a decline of about 15 percent in the use
> >of that department, mostly among patients with conditions considered
> >likely not to present an emergency.
> >
> >PMID: 8592528 [PubMed - indexed for MEDLINE]


Here's an interesting study which tends to back up my suggestion that in a
society where doctor visits are "free," anxious people and somatizers tend
to use/abuse the regular doctor for what amounts to psychiatric care, and
this results in delay in making the diagnosis of primary anxiety, so that
they can receive mental health care instead of more tests and pills for
other medical ailments.

In the following study, Ontario Canada was better and faster at diagnosing
primary mood, anxiety and addictive mental disorders than the US, until it
passed a universal health care plan.  Then it got *worse* at finding these
people than the US. Fancy that.


Am J Psychiatry 1998 Oct;155(10):1415-22
Psychiatric disorder onset and first treatment contact in the United States
and Ontario.

Olfson M, Kessler RC, Berglund PA, Lin E.

Department of Psychiatry, College of Physicians and Surgeons, Columbia
University, New York, NY 10032, USA.

OBJECTIVE: The authors describe the timing of the first treatment contact
following new-onset DSM-III-R mood, anxiety, and addictive disorders in
community samples from the United States and Ontario, Canada, before and
after passage of the Ontario Health Insurance Plan. METHOD: The authors drew
data from the National Comorbidity Survey (NCS) (N=8,098) and the mental
health supplement to the Ontario Health Survey (OHS) (N= 9,953). They
assessed psychiatric disorders with a modified version of the Composite
International Diagnostic Interview; they also assessed retrospectively age
at disorder onset and first treatment contact. They used the Kaplan-Meier
method to generate time-to-treatment curves and survival analysis to compare
time-to-treatment intervals across the two surveys. RESULTS: The overall
time-to-treatment curves revealed substantial differences between disorders
that were consistent across the two surveys. In both surveys, panic disorder
had the highest probability of first-year treatment (NCS, 65.6%; OHS
supplement, 52.6%), while phobia (NCS, 12.0%; OHS supplement: 6.5%) and
addictive disorders (NCS, 6.4%; OHS supplement, 4.2%) had the lowest in both
surveys. Retrospective subgroup analysis suggests that before the passage of
the Ontario public insurance plan, the likelihood of receiving treatment in
the year of disorder onset was greater in Ontario than in the United States
but that this relationship reversed following passage of the Ontario plan.
During this period, the authors observed no significant between-country
differences in the probability of prompt treatment of adults with 12 or
fewer years of education. CONCLUSIONS: These results challenge the
assumption that the universal health insurance plan in Ontario promotes
greater access to mental health services than is available in the United
States for vulnerable groups. Marked differences between disorders in the
speed to first treatment suggest that in both countries, clinical factors
play an important role in the timing of the initial decision to seek
treatment.

Publication Types:
Multicenter Study

PMID: 9766774 [PubMed - indexed for MEDLINE]

----------------------------------------------------------------------------
----


In the next study, the authors took a look at people who do use Candaian
psychiatrists, to see if they could find the "worried well" in that group,
where they should be. They weren't there!  So where ARE they?  Perhaps they
don't exist in Canada? No, I don't think so. So where are these people
going? Draw your own conclusions.

Can J Psychiatry 1997 May;42(4):395-401
Comment in:
Can J Psychiatry. 1998 Jun;43(5):524-5.

A cross-sectional study of private psychiatric practices under a
single-payer health care system.

Anderson K, Catterson A, Gaudet M, Gautam M, Kerr PJ, Pecher M, Waiser D,
Kaji J, Fava M.

University of Ottawa, Ontario.

OBJECTIVES: To examine current concerns that in the Canadian single-payer
mental health care system, the "rich worried well" (that is, wealthy
individuals who are worried yet mentally well) may overuse psychiatric
services, while low-income, uninsured mentally ill individuals may remain
undertreated. The current study focuses on the mental health care in the
Canadian region of Ottawa-Carleton, where a single-payer system provides
universal access to mental health services, to assess how psychiatric
services are provided by psychiatrists in private practice. METHOD: One
hundred and seven private psychiatrists working in the region of
Ottawa-Carleton completed a questionnaire which contained questions about
the sociodemographic characteristics and background of the psychiatrists
themselves and which asked the psychiatrists specific questions about the
sociodemographic status, diagnosis, and treatment of each patient seen on
November 10, 1994. RESULTS: Approximately 93% of the patients seen met
criteria for one or more Axis I disorders, of which mood and anxiety
disorders were the most common. Wealthier patients were relatively
underrepresented among the patients treated by the private psychiatrists. In
addition, we found no significant differences in the distribution of Axis I,
Axis II, and Axis III disorders between patients earning below $30,000 per
year compared with patients earning above $60,000 per year. CONCLUSIONS: Our
results suggest that outpatient psychiatric care delivered by private
psychiatrists in a Canadian single-payer system targets primarily
individuals with major psychiatric disorders and does not seem to favour
"the worried well." Larger epidemiological studies with independent
assessments of psychiatric populations are necessary to confirm our
findings.

PMID: 9161764 [PubMed - indexed for MEDLINE]


SBH





From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: misc.consumers.frugal-living,sci.med
Subject: Re: all about HMOs
Date: Sun, 7 Apr 2002 12:10:47 -0600
Message-ID: <a8q23l$sd2$1@slb1.atl.mindspring.net>

"Lech K. Lesiak" <lklesiak@calcna.ab.ca> wrote in message
news:Pine.A41.4.05.10204070942530.7872-100000@srv1.calcna.ab.ca...
> I agree with your point, but will add one comment.  It's not just a matter
> of super-duper specialists and technology.  Dialysis is hardly a new and
> complex treatment, and yet the death rate among dialysis patients in the
> US is higher than in Canada, according to David Himmelstein of Harvard who
> looked at the data.
>
> He attributes it to the difference in how dialysis is done in for-profit
> and not for-profit systems.
>

COMMENT:

He may, but how would he prove it?  (It did find his 1993 article on
medline, but there is no abstact).  Canadians do have a lower dialysis
mortality, but they also have a lot smaller fraction of their population on
dialysis, so there's every reason to think the ones they do have are not
either not as ill, or are "fighters" who are a different subset of people
than we see here in the US (for example, the Canadian dialysis or renal
failure patient is twice as likely to get a renal transplant; I don't think
this affects mortality greatly, but it does point out the difference in
population and attitude).  Also, it's a fact that Canadian doctors are not
as likely to refer patients for dialysis (ie, they let them die), though at
best this only partly explains the higher use of dialysis in the US. One
suspects that Canadians are less likely to "refer themselves" or insist on
dialysis, than Americans. When they do go on dialysis, they hate it and are
twice as likely to get off it by getting transplanted.

> In the US, apparently, single-use filters are reused and patients receive
> shorter treatments.


The dialyzer preprocessing thing is a non-issue, and Himmelstein is blowing
smoke if he says it isn't. It's been looked at in prospective randomized
studies, and the results are mixed, and differences are small. If such
effects don't show up clearly in a gold standard randomized prospective
study where all the known variables are controlled, they certainly cannot be
responsible for gross effects in Himmelstein's messy post hoc
epidemiological analysis. If he thinks otherwise, he's a fool, but I can't
tell if you're properly representing him or not.


Am J Kidney Dis 2001 Jul;38(1):36-41 Related Articles, Books, LinkOut
Nonreferral and nonacceptance to dialysis by primary care physicians and
nephrologists in Canada and the United States.

Sekkarie M, Cosma M, Mendelssohn D.
Department of Medicine, Division of Nephrology, West Virginia University,
Morgantown, WV, USA.

Research from Canada and the United States suggests that not offering
dialysis to patients who might benefit still occurs. This study was
conducted to investigate nonreferral and nonacceptance to dialysis by
primary care physicians (PCPs) and nephrologists in these countries. We
surveyed a random sample of Canadian and US PCPs and nephrologists
concerning their attitudes toward and experience with withholding dialysis
in patients with advanced chronic renal failure. In response to a question
about whether the physician believes there should be an age beyond which
dialysis should not be offered, 12% of Canadian PCPs, 20% of US PCPs, 4% of
Canadian nephrologists, and 9% of US nephrologists answered yes. When asked
about their recommendations concerning dialysis initiation in 10 vignettes
of patients with impending end-stage renal disease (ESRD), the responses of
Canadian and US physicians were similar. PCPs compared with nephrologists
were less likely to recommend dialysis in cases with physical illnesses and
more likely to recommend it in cases with neuropsychiatric impairments. Over
a 3-year period, 13% of Canadian PCPs and 19% of US PCPs reported
nonreferral to dialysis at least once. Withholding rates were 25% for
Canadian PCPs, 16% for US PCPs, 13% for Canadian nephrologists, and 17% for
US nephrologists. We conclude that although nonreferral of patients who
might benefit from dialysis still occurs, it does not seem to be common, and
the attitudes of Canadian and US physicians toward this issue are similar
and could not entirely account for the much greater incidence of treated
ESRD in the United States. PCPs and nephrologists should continue to be
educated about the modern criteria for patient selection for dialysis.

PMID: 11431179 [PubMed - indexed for MEDLINE]






From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.econ,sci.med
Subject: Re: Catastrophic Collapse of Badly Insured Americans.
Date: Thu, 5 Jun 2003 20:43:15 -0700
Message-ID: <bbp2kk$6eg$1@slb9.atl.mindspring.net>

"David Lloyd-Jones" <dalj@rogers.com> wrote in message

> Patrick Sullivan, for instance, published an obvious lie on Brad
> DeLong's site a few months ago, about a Canadian who was taking out a
> mortgage on his house to ge his stomach cancer treated in the United
> States: his Canadian doctors were supposed to have put him on a waiting
> list so long that the cancer would have eaten him alive before he got to
> the front of the line.

COMMENT

Wanna hear MY Canadian stomach cancer story?  A Canadian
friend's mother was "diagnosed" with stomach cancer in
Canada about a decade ago, on the basis of X-rays and CT.
They sent her to hospice without bothering with a surgical
biopsy (shortage of surgical slots, and why waste one on a
gonner?).

Months later when her blood work started looking funny, they
did the biopsy to see what was up. Wups, not gastric
carcinoma, but a gastrically located lymphoma. Treatable
once, but not as treatable in the advanced stages. Anyway,
first round of chemo killed her in a jerkwater Canadian
hospital.

This lady would've gotten more appropriate therapy at the
County LA teaching hospital where I once did part of a
residency, if she'd walked in homeless and penniless off the
street.

So long as we're being anecdotal.... I also did a rotation
through the Wadsworth VA (veteran's hospital) in Los
Angeles, where once I watched a man die slowly over a week
from a perforated colon, because the perforation was from a
colon tumor and no surgeon would touch him. We didn't even
know if the cancer was resectable. He didn't get to find
out.  These and many other cases have convinced me that the
more the government gets involved, the farther the surgeons
flee.

Now, I'm going to admit that in specialties like surgery and
interventive cardiology there is a big (and direct)
incentive to overtreat. But removing all incentives give you
even worse problems the other way. And in many specialties
of medicine, including nearly all academic center medicine,
there is very little incentive to overtreat.

Would you go to a barber to ask if you need a haircut?
Would you go to an auto mechanic to see if your brakes need
changing? A lawyer to see if legal remedies are needed for a
problem? Do people go to radiologists to see if they need
X-rays?  Do doctors make any money from writing
prescriptions for expensive drugs vs cheap ones?  It's a
very gray world.

SBH




From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: sci.med.nutrition,sci.med.cardiology,sci.med,sci.med.nursing,
	alt.support.diabetes,misc.health.diabetes
Subject: Re: The Bullshit Parade
Date: 6 Aug 2004 14:03:42 -0700
Message-ID: <79cf0a8.0408061303.36b79652@posting.google.com>

tunderbar@hotmail.com (tcomeau) wrote in message
news:<b550f406.0408060618.3c843d34@posting.google.com>...

> Everyone in Canada gets health care. 100% of all Canadians have access
> to medical care. A few procedures may require a short wait, but it is
> available to all. Besides, if there is a wait, the choice is there for
> us to skip the line and to pay for it in the US, or not. That is if we
> are willing to pay thru the nose for inferior medical care.

Nobody would pay through the nose for clearly inferior care. Are you
saying all Canadians who cross the border for US surgery are idiots?



> No-one refused ANY necessary medical care in Canada. The overall
> quality of care is as good or better than the US.


Hard to prove that. Let's see you get proton therapy for your brain
tumor. Lets see you get a combined PET/CT to see if your lung cancer
or ovarian cancer has spread.


>Our doctors are
> better trained than the specialist-focussed system in the US.


Hard to prove. Nor do I believe it.


> Our
> death-at-birth rates are much lower than in the US.


Only if you count the overall US. But many of our states like Utah or
Hawaii beat Canada in all health ratings. Yet they have the same
medical care system the rest of the US does. Obviously regional
life-expectancy differences in the US are due to regional extra health
problems, not medical care delivery. If we sent the entire rotten
subculture of Washington DC to Ottowa, I think you'd have a strain
taking care of it, too.


> No-one has had to go into massive personal debt and/or bankruptcy to
> get necessary medical care in Canada.


Nor in the US. Once you get down to close to zero money in the US, you
qualify for Medicaid, and get a pretty good medical care system. It's
the working lower middle class that have a hard time, in the US. And
yes, I think this needs to be fixed.  And yes, for the record, I think
the US wastes a lot of health care dollars doing things like MRIs on
back pain. But I don't run it.


> And trust me, Canadians will not tolerate for-profit medical
> operations in Canada. Some idiotic politicians in some conservative
> provinces may make noise about it and may try to allow some for-profit
> companies to set up, but that crap will not fly for very long.
>
> We choose to spend out tax dollars on health. You guys choose to spend
> it on invading any foreign country that your president can lie about
> and somehow convince you suckers that it is in some unlikely and
> uprovable way even vaguely or remotely connected to Al-Qaida.


Now, now. I'm not arguing that the US invading Iraq was not a piece of
money-wasting stupidity. It was. Not that Iraq didn't need fixing, but
it was not the US's responsibility to do it, but rather the world's.
If the world wimped out (as most of it did), then the US should have
said it had better things to do with its military (which it did-- like
finding Bin Laden in Pakistan, so we can kill him for planning 9/11).

The US is a target of Al-Quida because we are involved with the
Saudis, and the Al-Quida and wahabists in general think that all
Westerners should stay out of the holy Muslim world. Which Canada can
afford to do, because you have more oil than you need. But the fact
that you do, is not due to some wise "choice" on your part. It's just
due to a great *&%$ peice of good luck related to *where* your
British-ass-kissing ancestors chose to go live, in an era before
petroleum and natural were known to be worth anything. Very much as in
the case of the Saudis.

So stop being so supercillious about it. You totally lucked-out on the
current set of world problems. B.F.D. Your time when you cross the
Muslim fundamentalists over some issue, will come. As it will for all
non-Muslim countries.

SBH


From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.cardiology,sci.med,sci.med.pharmacy
Subject: Re: Statins help prevent breast cancer, study finds
Date: 20 May 2005 18:27:17 -0700
Message-ID: <1116638837.174879.156260@o13g2000cwo.googlegroups.com>

>>A story from today's Globe and Mail Elgoog, and a website with a
terrific activist oriented links section.
http://www.pharmawatch.org
It's a disgrace not to have a strategy
By ANDRE PICARD
Thursday, May 19, 2005 Page A17
145,500: This many Canadians will be diagnosed with cancer this year
68,300: This many of us will die of cancer this year
1 in 4: This many of us will get cancer in our lifetime

420,000: This many more lives could be saved over 30 years with a
national plan <<

COMMENT:

Let's put it another way, shall we?  Cancer is a disease of old
mammals. Young ones get it, but rarely. If all cancer disappeared
tomorrow, the average life expectancy would go up between 2 and 3 years
in developed Western countries like the US and Canada. That's all you'd
get for a universal cancer cure. If you didn't die of cancer you'd die
of something else, because people who die of cancer are generally OLD.
By contrast, cardiovascular diseases take about 12 years of life.


>>Cancer costs the economy at least $14.3-billion annually, including
$2.5-billion in direct costs for treatment, care and rehabilitation,
and another $11.8-billion in indirect costs, principally lost
productivity.<<

COMMENT:

Yes, in the US we spend at least 30 times more treating cancer than
researching it. But that's the name of the game in medical research.
Nobody wants to spend the money until they themselves get the disease.

Plus, in the US we're really scared of those Arabs. We spend about 5
billion a year on cancer research, and 15 billion bailing out the
airlines (failing due to our terrorism laws and fears) and 50 billion
on the Dept of Fatherland Security, and etc. Don't even get me started
on the Iraqi war. None of which the Canadians do very much of. But
Saddam Hussein and a bunch of disgruntled people from Saudi Arabia and
Yemen are a lot less likely to kill you, than that nodule or polyp.
However, the average American does not have a very good view of
statistics.


>>"We're extremely disappointed the government has not spent any time
discussing the impending cancer crisis," Dr. Barbara Whylie, chief
executive officer of the Canadian Cancer Society, said yesterday in an
interview. "By focusing exclusively on the health of particular
members, they're really missing the point." The point being that at
least 50 per cent of cancer deaths are preventable. <<

COMMENT:
And most of those by not smoking.  Which doesn't cost much to do.


>>Yet there is no national strategy to reduce cancer or to bring down
deaths from the disease which, by 2007, will be the country's biggest
killer. <<

COMMENT:
Yes, but not the country's biggest cause of years of life lost. Which
is entirely a different thing. The canadian health care system, if it
wanted to increase life expectancy, would be best off 1) working to
prevent smoking, and 2) focusing on heart disease and stroke.

>>Canada is one of the few industrialized countries that does not have a
cancer strategy in place, though not for lack of trying by consumer
groups and health professionals.
Since 2002, a detailed strategy has been elaborated, including the
creation of cancer networks in every province, standardized data
collection, a process for establishing targets for reducing incidence
and mortality for specific cancers, clinical practice guidelines to
ensure similar care nationwide, and the creation of a cancer-prevention
network. <<

COMMENT:
Sound like a typical Canadian giant Nanny-bureaucracy to me. I'm
*amazed* they don't have it already.


>>(Research is a separate issue. Canada spends about $150-million
annually on cancer research, and the coalition that created the
strategy would like to see that bolstered by $50-million a year.
Another group, the Cancer Advocacy Coalition of Canada, has called for
$400-million research annually, as well as a dramatic shift in monies
to research on prevention, rather than on basic research.) <<

COMMENT:
Going to $400 billion a year would actually bring Canada into line with
what the US spends. The US has 9 times the population but at the
government funding level spends at least 35 times as much as Canada on
cancer research. The results of which research, Canadians are happy to
use free.  This, despite the fact that Canada has about the same
average per capita income as the US, and could certainly bear its share
of research spending, yet does not. I suppose this wouldn't fit in all
that well with Canada's idea of information socialism. Health care
should be free! Canadians are very proud of how much medical care they
get per dollar. And wimping out on their share of medical research is
part of how they manage it.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.cardiology,sci.med,sci.med.pharmacy
Subject: Re: Statins help prevent breast cancer, study finds
Date: 20 May 2005 18:37:46 -0700
Message-ID: <1116639466.143884.159020@g47g2000cwa.googlegroups.com>

>>Going to $400 billion a year would actually bring Canada into line
with what the US spends. <<

Wups, that obviously should be 400 M-illion not B-illion.  The Canadian
govt spends $150 million on cancer research, and the US with 9 times
more people spends 4.5 billion or so just at the NIH/NCI level, which
is 30 times more.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: clotting agent shows promise with worst strokes
Date: 9 Jun 2005 11:56:04 -0700
Message-ID: <1118343364.639619.220320@g49g2000cwa.googlegroups.com>

<<Within minutes, the 55-year-old was on his way to Foothills Medical
Centre. A CT scan revealed that he was suffering from an intracerebral
hemorrhage, the most deadly form of stroke, and a condition for which
there is no treatment. As it turns out, however, the Calgary hospital
was part of a trial testing the use of Factor VIIa, a clotting factor
used by some hemophiliacs to treat bleeding in the brain just like Mr.
Woon was suffering. <<

COMMENT

LOL. Then I guess it's a darned good thing he was suffering from the
worst kind of stroke, instead of the most common kind of stroke. Cause
CT would not have done him any good, *except* to treat hemorrhage. What
were they going to do with him if he had had a clot? How would they
know he even had a clot? He was in Canada where CT can be found
emergently, but the far more expensive functional MRI (fMRI, which you
really need to most effectively treat all *other* kinds of stroke)
usually cannot (the few fMRI machines in Canada since 1999 are research
tools). Even plain vanilla MRI is not easy to get in Canada (they have
fewer than 2 machines per million people), and certainly not if you
need one within a couple of hours, which you do, with 90% of stroke.
Canada ranks lowest of all developed countries in medical imaging
adoption-- which means it's worse than some of the third world.

http://strategis.ic.gc.ca/epic/internet/inmitr-crtim.nsf/en/hm00135e.html

My, but the propaganda machines up there seem to be working, though.
THEY don't need liquid helium-bathed superconducting magnets.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: clotting agent shows promise with worst strokes
Date: 9 Jun 2005 19:50:43 -0700
Message-ID: <1118371843.570395.146690@g44g2000cwa.googlegroups.com>

>>Calgary, with a population of almost 900,000, has nine MRIs.

The MRIs and 12 -plus CTs are in hospitals (all), free-standing
publicly-owned  imaging clinics, and privately owned clinics
(ka-ching).<<


Well, that's 6 times the national average frequency, which I suppose
isn't surprising for an urban center. Considering the number of strokes
expected in 100,000 people, it's still not enough.

And it's a matter of penny-wise and pound-foolish. The cost of stroke
is unbelievable because 75% of stroke patients don't die, and many of
them have huge rehab and chronic disability costs. These can be cut 20%
with rapid treatment in people who get to the hospital in time, and
realistically from 5 to 10% figuring in those factors. Even 8% of
annual stroke costs buys a lot MRI scanners. How much do 3000 or 5000
stroke patients a year kept out of rehab and chronic care save? I'm
guessing 25 K a person at least.  Call it $100 million a year. That's
20 new scanners a year bought in a country that only has 50 total.

Of course the problem is people who get MRI scanners tend to use them
to look at people with low back pain (we have this problem in the US)
so it's not just a matter of having the machines. They have to be used
wisely.


SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: clotting agent shows promise with worst strokes
Date: 10 Jun 2005 14:25:26 -0700
Message-ID: <1118438726.287544.309010@o13g2000cwo.googlegroups.com>

>>Ever been to Canada Steve? We have oh maybe six urban centres. This is
a vast country (about 11 of Texas will fit in my province alone). Your
solution isn't ours. What we do have are a lot of air ambulances, both
fixed and rotar wing, suberbly trained emergency physicians who work in

the back of STOL aircraft, doctors who get their hands dirty and EMTs
who do thrombolytic injections between Moose Jaw and Pukatawagan. What
else can we do? <<

COMMENT:

I've been to Canada many times. More importantly, I've seen population
distribution maps of Canada, which are quite comparable to what you see
when you look at the Country from space at night. Canada's a big
country, but 90% of the population is in the urban centers and also
distributed in a thin little line next to the US border. Yes, the small
fraction people who live very rurally aren't going to be helped much.
But they are a small fraction.

>>The information on the website was eight years old, at newest. Perhaps
that's the problem. Canada needs more web techies. <<

The last reference was 2000. But it's true that data about Canadian MRI
machines seems to be from 1999.



> And it's a matter of penny-wise and pound-foolish. The cost of stroke
> is unbelievable because 75% of stroke patients don't die,

>>They do here. It's a long way from the Belcher Islands to Poste de la
Balene and the nursing station. <<

COMMENT:

I'm using the Canadian figures from your Heart and Stroke Foundation.
Again, "vide supra" yourself. It doesn't matter that a relatively small
fraction of Canada's population is very far from a major city. Most of
it is not.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: desperately seeking doctors
Date: 20 Jun 2005 12:03:53 -0700
Message-ID: <1119294233.922534.204790@g43g2000cwa.googlegroups.com>

If you think it's hard to find a physician in Toronto, try recruiting
one for a small town outside the GTA

By PATRICIA LAUNT

Saturday, June 18, 2005 Page M1
============================


COMMENT:

LOL. An article about a town called Orangeville where the city budget
doesn't have enough money to pay a doctor an extra $20,000 or so a
year, as income incentive.  How many city jobs does the place have?
What's the city budget? Inquiring minds want to know.

The basic facts have been stated. Canadians have the same per capita
income as Americans. They pay HALF as much per capita for health care.
They say they can't afford more, and they refuse to pay more.  And
(surprise!) they have difficulty finding doctors for this price. So
they whine.  And whine.  But like the Scotsmen they are, they cannot
make their hands write out checks when it comes to medical care. They
have other priorities.

What are these priorities?  Well, it's not paying for a military.  The
Canadian doesn't have to pay nearly the per capita defense tax that the
average US citizen does. And yet the average Canadian pays just as much
total tax as the average American. It doesn't go for defense, and it
doesn't go for healthcare. Where does it go?  Well, there's a long list
of things, but suffice to say, these things are the Canadian TRUE
priorities. It's not that they're too poor to pay doctors. They have
the money. It's that they truely cannot make themselves pay it to a
doctor, no matter how badly they need one.

What can you say?

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: desperately seeking doctors
Date: 20 Jun 2005 13:43:10 -0700
Message-ID: <1119300190.211684.260860@g14g2000cwa.googlegroups.com>

>>Harris do you ever do anything but bitch whine and carp about Canada? <<

COMMENT:

Only when some dang Canadian posts messages that bitch and whine about
medicine in Canada. If you don't want me to comment on Canada's medical
system, then quit posting articles about Canada's medical system.

What do you want me to say? Canada is not Mexico. You guys have enough
money to fix your health system TWO times over. You're simply too CHEAP
to do it. I'm sorry you don't like me to say that. Some things in
medicine CAN be fixed by throwing money at them, and a doctor shortage
must head the list. I have no sympathy for you on that, at all.

In the US we don't have that excuse. We spend 20% of our health care
dollars on doctor salaries and have no shortage of them. BUT we do have
maldistribution because we (somewhat like you) forgot what happens when
don't pay doctors to look and think and study and give good and wise
advice, but rather to do *procedures*.  What happens, if you do that,
is that the procedures doctors do are far more costly than doctor
salaries, and they then bankrupt you. Which is why I've spent far more
time here criticizng the US system than the Canada system, over the
years. I've said more times than I can count that the US problem is we
spend twice as much on healthcare as Canada, and *don't* have even
close to twice as good a medical system.

I've complained of our Southern border immigration problem, which you
don't have, and which surely absorbs some of that extra money. I've
complained that Canada doesn't carry it's own weight in biomed research
(which is perfectly true, and also due to your national conviction that
medicine should be FREEEEEE), but biomed research is 5% or 10% of total
health care costs even down here, so that's not even close to the
reason for the US bad buy in healthcare. I've said this. And for the US
crappy system I've blamed US doctors, the FDA, the government, the
population, the insurance companies, the crappy records system in the
US, the drug companies, the wrongheaded incentive system in medicine,
and many other things. But you don't "hear" it.. I've been doing this
for a dozen years here, and you're a newbie. Hang around and learn.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: desperately seeking doctors
Date: 20 Jun 2005 14:51:06 -0700
Message-ID: <1119304266.410097.89810@g44g2000cwa.googlegroups.com>

> Did you READ it? Orangeville got their physicians. Two. (Women, of
> course).


I read it. So?  As salaries drop in medicine in the West, it's getting
to be more and more a woman's profession. Hard to say which is cause
and which is effect. The women will do the H&P scutwork, and the big
salaries will be drawn by "physician-managers."  See "Asshole."  A
shame. Management of course is much the same in all professions, but
only lately has it come to mine own.

> > In the US we don't have that excuse. We spend 20% of our health care
> > dollars on doctor salaries and have no shortage of them. BUT we do have
> > maldistribution because we (somewhat like you) forgot what happens when
> > don't pay doctors to look and think and study and give good and wise
> > advice, but rather to do *procedures*.
>
>
> Well mal-distribution is what this is about. You remember? That 90 per
> cent of the population that hugs the 49th parallel? Physicians do too,
> and up till now, they haven't wanted (or had the courage) to be removed
> from the teaching hospitals and specialists.

COMMENT:
I remember. Again, follow the money. Teaching hospitals are where they
do procedures. Specialists are often those who do MORE procedures.  If
you pay doctors a lot of do procedures, they're going to go where they
can do them, and to WHERE they can do them. If you want to get doctors
into rural areas, quit paying them huge amounts of money to do things
you can only do in a city.  This is not complicated. Or pay them the
difference.


>The internet helps that out. Once they get there (to the Orangvilles)
>they are estatic. Canada is very beautiful once you leave Yonge and
>Bloor.<<

> Most of your "total" health care costs are so tech-test driven. And
> me-too drug driven. So DTCA driven. It can be so here too, but less.
> That's where your excessive health care costs come from. Families USA
> has proven industry research costs are not research, but a huge whack
> to marketing and promotion.


COMMENT:

You're talking prescription drug costs, but they are only 20% of the
total healthcare bill in the US, again pretty much the same slice as
doctor's salaries. The complaining about drug costs is all
disproportionate to that 20%, because a larger fraction of it is out of
pocket. But don't be fooled. It's part of the problem, of course, but
far from most of it.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: cardiac waiting times in ONTARIO CANADA
Date: 14 Jul 2005 15:50:05 -0700
Message-ID: <1121381405.144179.54250@g14g2000cwa.googlegroups.com>

Robert wrote:
> If heart surgeries are 80% cheaper in Canada then why does anyone have to
> wait?

COMMENT:

Because even at that price, the Canadian government won't pay enough
for the facilities that would allow instant access, and the Canadian
people are too cheap to pay for it out of pocket, and too cheap to
allocate more tax money for it.

It's just incredible what Canadians will put up with, rather than pay
for medical stuff. Literally, they'd sometimes rather die. Some time
ago there was a news article about a sports star in Canada who had
"jumped over" a long MRI waiting line, by the simple expedient of
actually PAYING FOR THE MRI HIMSELF. The shock and awe at this, was
palpable. Nobody would have blinked twice if the guy had bought a Lear
Jet or a huge diamond, but you got the feeling that many people in
Canada felt that actually paying for an expensive medical treatment
with cash was not quite kosher-- was somehow CHEATING. But couldn't
quite explain why.  LOL.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: cardiac waiting times in ONTARIO CANADA
Date: 14 Jul 2005 21:48:33 -0700
Message-ID: <1121402913.560190.144520@g14g2000cwa.googlegroups.com>

ted rosenberg wrote:
> Boy are you in a different world
>
> In the US, at least 14%  would not even be diagnosed or sent for surgery
> - they couldn't afford to see a cardiologist.

COMMENT:

Go to a US hospital with chest pain, and if the hospital runs an ED
you'll see a cardiologist within 24 hours. Nobody in the US is turned
down because they can't afford one. Of course, you may have to
(EVENTUALLY) prove you really have no significant money other than
what's in your car and your house equity, but that comes later. In
Utah, if you show up with chest pain, you not only get immediate
medicade HMO coverage, but it comes with a 60 day lookback, so you have
least that much time to get treatment before anybody starts to look at
your finances. If you qualify, your medicaid bills get paid
retroACTIVELY. Different states have different programs (50 of them,
plus DC and dominions). Impossible therefore to generalize.

> > My hospital performs roughly  750 CABG's a year
>
> Yea, IF you have lots of insurance, or are on Medicare.  The latest
> cutbacks on medicaid make it substantially less likely that those on
> medicaid will get treatment..


No. There are never "cutbacks on medicaid".  There have never been
"cutbacks" and there never will be "cutbacks". Every year, the medicaid
budget goes up. It's a monotonic increase. Sometimes faster, sometimes
slower, but always the same direction. The only people talking about
"cutbacks" are those who think it should go up more than it does, and
believe it's been "cut back" from their personal utopian fantasies.
But medicaid is the great breaker of state budgets. It's not even K-12
anymore.


> THEN, even if they do get treated, 75% of all personal bankruptcies are
> from working people with insurance who STILL have more medical bills to
> pay [than] they have income,.


COMMENT:

Yes, there's no doubt that the working poor in America do get a good
screwing if they get sick. And yes, it can happen even to those with
medical insurance, unless they have disability insurance also. Without
every kind of insurance known to man, one might find oneself, if
suddenly badly ill, with little more than a mortgaged house and a car,
and that's if you're lucky. Once the mortage has been maxed out on
re-fi for living expenses, house goes also and you're in public
housing, trying to figure out how to deal with leukemia or heart
disease or AIDS. In many ways the people who've lived generations on
the dole and know how to work the system (including government
housing), actually do much better at this. In the US, as in Canada.
Yes, I agree this is monstrously unfair to those who work, or try to.
Or have worked hard at some job, in the past.

What to do about this?  I don't know. Nevermind transfer payment
issues. The present system in the US is monstrously *inefficient,*
because it provides universal insurance only for emergencies, and
prevention is much cheaper than treatment in EDs. And information
transfer in medical care in the US is a joke, and a huge waste of
dollars. And we waste money on a certain amount of surgery and fancy
instruments and expensive drugs that don't do much for the buck. If you
use your MRIs on back pain and not stroke, you're going to pay a lot of
money in rehab that you didn't need to. If you use your medical budget
buying people statins but not the best antihypertensives, then ditto.
So clearly, something has to be done. And something will be done. It's
just that nobody trusts a Democrat to do it, and the Republicans
invariably seem to have other priorities (like bombing some poor
innocent SOBs someplace far away). So here we are.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: cardiac waiting times in ONTARIO CANADA
Date: 14 Jul 2005 16:44:29 -0700
Message-ID: <1121384669.679719.187320@g44g2000cwa.googlegroups.com>

Bryan wrote:

> One of the categories was "elective surgery" I didn't realize there was
> such a thing as "elective CABG"


COMMENT:

In socialist medicine countries, there isn't. The People's Party
decides what it is, in the way of treatment that you NEED, verses what
you merely WANT, and the only thing you can "elect" to do, is turn that
down. Unless you want to pay out of pocket.

Of course, there's the problem of medical progress, so that the
standard of what people are supposed to NEED changes yearly. Sometimes
having been anticipated by well-informed readers of the literature by
quite a while. This tends to create consternation, but at least it
gives political activist-types something extra to do.

There are many CABG procedures you can do which result in increased
quality of life, but can't be proven to decrease mortality. What's it
worth to be able to walk a block without having to stop for a nitro
tab? Who says you NEED to do better, rather than just WANTING to?
Aren't you just being selfish to want a big expensive operation merely
for your COMFORT? In any case, you can wait. Read _War and Peace_ like
you've always wanted to.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: cardiac waiting times in ONTARIO CANADA
Date: 15 Jul 2005 14:55:42 -0700
Message-ID: <1121464542.853551.205250@g14g2000cwa.googlegroups.com>

ted rosenberg wrote:

> Typical phony bullcrap.
>
> Anyone with an ACUTE condition (if they are aware that they HAVE an
> acute condition) can go to an ER, and, must be seen.  They will NOT be
> seen by a cardiologist,or receive much testing.  As soon as they are no
> longer acute, they can (and will be) booted.
>
> They then will be hounded for medical bills till the end of time.
>
> The odds that they will receive a bypass are slim to none unless they
> are actually having a heart attack.  Then, even if they CAN get an
> operation, once they are discharged, they get no follow up care or have
> any way to get meds.

http://www.ahrq.gov/data/hcup/factbk1/


I wasn't able to get any medicade CABG stats immediately. However, I
was able to find that medicade pays for 54-35 = 19% of all hospital
stays in this country, and an additional 5% are people uninsurred (they
don't even have medicade). Here is how things were in 1997 in the US:


Government (Medicare and Medicaid) is billed for over half (54 percent)
of all hospital stays.
About 13 percent of the U.S. population is over 65, but about 35
percent of all hospital stays are paid by Medicare, the most common
insurer for the elderly.
About 17 percent of the U.S. population is uninsured, and about 5
percent of all hospital patients are uninsured.
Among uninsured patients, 3 of the top 10 conditions are for substance
abuse or mental health. It is not possible to determine if this is
because insurance does not pay for these conditions or if these
conditions occur more frequently among uninsured patients.
Nearly 20 percent of hospital stays for alcohol-related mental
disorders, and 23 percent of stays for substance abuse are uninsured.

Almost 12 percent of the U.S. population is covered by Medicaid;
however, Medicaid is billed for:
Over a third of all stays for babies born in the hospital.
Over a third of all stays for fetal distress.
Nearly 42 percent of all stays for complicated pregnancy.
Over a fourth of all stays for depression and half of all stays for
schizophrenia.


If I could summarize, it looks like there's a lot of hospitalization
paid for by medicade, but the single biggest medicade hospital use
group is pregnant women.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: cardiac waiting times in ONTARIO CANADA
Date: 16 Jul 2005 12:00:44 -0700
Message-ID: <1121540443.930995.106570@g47g2000cwa.googlegroups.com>

ted rosenberg wrote:
> Typical phony bullcrap.
>
> Anyone with an ACUTE condition (if they are aware that they HAVE an
> acute condition) can go to an ER, and, must be seen.  They will NOT be
> seen by a cardiologist,or receive much testing.  As soon as they are no
> longer acute, they can (and will be) booted.
>
> They then will be hounded for medical bills till the end of time.
>
> The odds that they will receive a bypass are slim to none unless they
> are actually having a heart attack.  Then, even if they CAN get an
> operation, once they are discharged, they get no follow up care or have
> any way to get meds.


COMMENT:

I'd like to know where you get your statitics for this. I can find
statistics easily enough for angioplasty and CABG rates by payor for
people who have had heart attacks, as you say. And they are lower for
Medicaid patients than Medicare and insurance, but not zero-- they are
lower by 30% or something. Indeed, rates of invasive heart procedures
like angio and bypass are lower for lower-income groups in every
country, including Canada

(Mea Culpa, see below, it seems Canadians who can pay out of pocket ARE
willing to pay for a few more angios and bypasses, though it does them
no good mortality-wise.  They didn't ask about quality of life, but
rich Canadians did generally complain more, so it's hard to tell ;).

So, how do YOU know what happens to the average medicaid person with
chest pain and EKG changes (or positive stress tests), but no acute MI?
 Hospitals I've worked at certainly bypassed a number of them.

=============

JAMA. 2004 Mar 3;291(9):1100-7.

Socioeconomic status, service patterns, and perceptions of care among
survivors of acute myocardial infarction in Canada.

Alter DA, Iron K, Austin PC, Naylor CD; SESAMI Study Group.

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
david.alter@ices.on.ca

CONTEXT: Some have argued that Canada's uniquely restrictive approach to
private health insurance keeps the socioeconomic elite inside the public
system so that their demands and influence elevate the standard of
service for all Canadian citizens. The extent to which this theory is a
valid representation of Canadian health care is unknown. OBJECTIVES: To
explore how patients with acute myocardial infarction from different
socioeconomic backgrounds perceive their care in Canada's universal
health care system and to correlate patients' backgrounds and perceptions
with actual care received. DESIGN, SETTING, AND PATIENTS: Prospective
observational cohort study with follow-up telephone interviews of 2256
patients 30 days following acute myocardial infarction discharged from 53
hospitals across Ontario, Canada, between December 1999 and June 2002.
MAIN OUTCOME MEASURES: Postdischarge use of cardiac specialty services;
satisfaction with care; willingness to pay directly for faster service or
more choice; and mortality according to income and education, adjusted
for age, sex, ethnicity, clinical factors, onsite angiography capacity at
the admitting hospital, and rural-urban residence. RESULTS: Compared with
patients in lower socioeconomic strata, more affluent or better educated
patients were more likely to undergo coronary angiography (67.8% vs
52.8%; P<.001), receive cardiac rehabilitation (43.9% vs 25.6%; P<.001),
or be followed up by a cardiologist (56.7% vs 47.8%; P<.001).
Socioeconomic differences in cardiac care persisted after adjustment for
confounders. Despite receiving more specialized services, patients with
higher socioeconomic status were more likely to be dissatisfied with
their access to specialty care (adjusted RR, 2.02; 95% confidence
interval, 1.20-3.32) and to favor out-of-pocket payments for quicker
access to a wider selection of treatment options (30% vs 15% for patients
with household incomes of Can 60 000 dollars or higher vs less than Can
30 000 dollars, respectively; P<.001). After adjusting for baseline
characteristics, socioeconomic status was not significantly associated
with mortality at 1 year following hospitalization for myocardial
infarction. CONCLUSIONS:  Compared with those with lower incomes or less
education, upper middle-class Canadians gain preferential access to
services within the publicly funded health care system yet remain more
likely to favor supplemental coverage or direct purchase of services.

PMID: 14996779 [PubMed - indexed for MEDLINE]



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: cardiac waiting times in ONTARIO CANADA
Date: 16 Jul 2005 11:45:04 -0700
Message-ID: <1121539504.853169.120520@g14g2000cwa.googlegroups.com>

ted rosenberg wrote:
> I am an actuary and an economist - I know quite a bit about the
> situation.  Among other things over the years, I have served as an
> officer of a few insurance companies, on a Hospital board, and been the
> controller of an HMO.
>
> probably the largest cost increase for Medicaid is the use of medicaid
> to provide wealthy medicaid recipients with nursing home care.  Elderly
> can transfer out their assets and qualify for medicaid.


COMMENT:

The "controller" of an HMO??  What did you "control"?

Elderly can transfer assets to a spouse to qualify for medicaid, indeed
(and to disabled children, sibs living with them, and a few other
groups). This is to keep the community spouse from having to sell the
house to pay for institutional care of the other spouse. You
disapprove?

But the remaining spouse can't just give the house to the children to
look "poor", before THEY are institutionalized, unless they did it 3
years before the fact (there'a a 36 month lookback, as you know-- up to
60 months for trusts).  Some elderly are farsighted enough to do that.
Most aren't.


> Steve Harris wrote:
> >
> > ted rosenberg wrote:
> >
> >>>COMMENT:
> >>>
> >>>Go to a US hospital with chest pain, and if the hospital runs an ED
> >>>you'll see a cardiologist within 24 hours.
> >>
> >>You are SURE not living in the real world
> >
> >
> >
> > Look, there must be 10,000 hospitals with EDs in the US, at least. They
> > see 100 million people a year, and admit about 14% of them.  EDs see
> > more medicaid patients than they do medicare patients. Medicaid
> > patients are big users of EDs.
> >
> > If you know some hospitals with ED's near you where people with chest
> > pain who need to see a cardiologist, can't see one, and aren't admitted
> > or transferred, please provide me with a specific hospital and place,
> > and I'll call them up and see what's up. You're beginning to piss me
> > off with your allegations that I don't know what I'm talking about (and
> > just who the hell are YOU, and how many ER/EDs have you worked in?), so
> > I'm asking you to provide some specific information, not just blather.
> > Do so, and will see who lives in the real world and who doesn't.
> > Provide me with some real world examples.


I'm waiting.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: cardiac waiting times in ONTARIO CANADA
Date: 15 Jul 2005 14:01:46 -0700
Message-ID: <1121461306.872845.303190@g47g2000cwa.googlegroups.com>

ted rosenberg wrote:
> > COMMENT:
> >
> > Go to a US hospital with chest pain, and if the hospital runs an ED
> > you'll see a cardiologist within 24 hours.
>
> You are SURE not living in the real world


Look, there must be 10,000 hospitals with EDs in the US, at least. They
see 100 million people a year, and admit about 14% of them.  EDs see
more medicaid patients than they do medicare patients. Medicaid
patients are big users of EDs.

If you know some hospitals with ED's near you where people with chest
pain who need to see a cardiologist, can't see one, and aren't admitted
or transferred, please provide me with a specific hospital and place,
and I'll call them up and see what's up. You're beginning to piss me
off with your allegations that I don't know what I'm talking about (and
just who the hell are YOU, and how many ER/EDs have you worked in?), so
I'm asking you to provide some specific information, not just blather.
Do so, and will see who lives in the real world and who doesn't.
Provide me with some real world examples.


>  >Nobody in the US is turned
> > down because they can't afford one.
>
> Makes a good story, but you obvious;y have no understanding of the FACTS


COMMENT:

I have a good understanding of the facts. Provide some examples, since
you're the one making the odd claim.


>  >In Utah, if you show up with chest pain, you not only get immediate
> > medicade HMO coverage, but it comes with a 60 day lookback, so you have
> > least that much time to get treatment before anybody starts to look at
> > your finances. If you qualify, your medicaid bills get paid
> > retroACTIVELY. Different states have different programs (50 of them,
> > plus DC and dominions). Impossible therefore to generalize.
> >
> Utah must be very different than most of the US

COMMENT:
I doubt it. But again, since I don't know the medicare structure of
every state, why don't you provide me with a state and some hospitals
who run EDs and turn away people with chest pain who can't pay? If it's
common, you should have no problem coming up with examples.

> There have been severe cutbacks in Medicaud BENIFITS - not costs

COMMENT:
That's because more people are using Medicaid. What do you expect?
Eventually the system will collapse.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.cardiology,sci.med,talk.politics.medicine
Subject: Re: Soaring healthcare costs hurting US economy, driving business to 
	Canada
Date: 18 Jul 2005 10:54:00 -0700
Message-ID: <1121709240.702031.57730@g14g2000cwa.googlegroups.com>

Grumpy Richard wrote:
> You're missing the simple bottom line: health care costs 30% or so less
> in Canada than in the US.  Thus, all other things being equal, products
> or services can be produced more cheaply there.

COMMENT:

We didn't miss a thing. To the extent that the government picks up the
tab for the difference, your business taxes will reflect it. A
government that robs Peter to pay Paul will always have the support of
Paul. And it will always have a lot of business in-migration by types
of businesses that tend to employ Pauls. So?

If Canada wants to be the blue collar manufacturing paradise by reason
of subsidising blue collar jobs through cheap blue collar health care,
that's FINE with me. I don't think it's a particularly great
macro-economic strategy for a country to take, but to each his own.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: They just finished doubling (corrupt) NIH funding over the last 
	five years
Date: 9 Aug 2005 16:13:44 -0700
Message-ID: <1123629223.982138.68440@g44g2000cwa.googlegroups.com>

TC wrote:
> > A system that has cut back to the bare bone any medical research in which
> > Canadian researchers are leaving Canada for the US.
>
> They stay to do useful but not ridiculously lucrative real research and
> they go to do lucrative but useless industry marketing research. You
> can have them.


COMMENT:
That's complete B.S.  A lot of smart researchers come out of Canada,
and the smarter they are, the faster they come out. Yes, do keep
sending you best minds. Immigration really is the sincerest form of
flattery.


COMMENT:
> > A system that has closed many specialists medical training in which the
> > doctors are forced to go to the US for that training.
>
> Specialists that are not needed. You can have them. We, and you, need
> family doctors, GP's. Specialists are a dime a dozen.

COMMENT:
The reason we both need GPs in Canada AND the US is that we refuse to
pay them well in either place. This is related to the basic problem of
how to document and bill for thinking, which is what GPs do, as opposed
to procedures, which is what specialists do. A problem which has not
been solved North or South.

> > The list is endless.
>
> In your fertile imagination, it probably is. When you come back to
> reality, feel free to visit us and see what is happening in the real
> world in Canada, where the average life span is longer than in the US
> and where everyone gets access to a pretty darned good health care
> system. It's really neat to leave the hospital with a limb in a cast or
> a newborn child without having had to mortgage the house.


COMMENT:

With the notable exception of Hawaii, life span in the US, FYI, is a
pretty direct function of latitude, and I don't think it has to do with
vitamin D. Most Canadians live pretty close to the 49th parallel, with
their antennas pointed South. And if you take the average life
expectancy of the 12 US states that border Canada, and add them up, you
get numbers very close to Canada's--- somewhere in the vicinity of 77
years at birth (averaging male and female figues).

So what is wrong with the Southern US?  A lot of things, including a
large and resistant underclass, and a very porous border with Mexico.
Both of which are killers for any medical system.

>It's really neat to leave the hospital with a limb in a cast or
> a newborn child without having had to mortgage the house.


COMMENT:

Yes, and if we could somehow connect Canada's southern border with
Mexico's via the 4th dimension, you'd find that a large fraction of
those people leaving the hospital with casts and newborns, are speaking
Spanish! And no, they won't have to mortage their houses; but after a
time of paying for this, you the Canadian taxpayer will need to mortage
YOURS.

Hawaii, BTW, escapes this, since these undocumented folks cannot swim
that far. Hawaii's average life expectancy is the US's highest: about
82. Its medicaid system is in fine shape. Do try to stick that data
point into your argument right where it belongs.

For a look at how ethnicity playes into this, you can take a look at a
state I'm familiar with: Utah. Mean life expectancy there at birth is
79 which is about what it is for Caucasions there (who afterall, make
up most of that state). Non-smoking Mormons do rather well, US
healthcare or not. Compare with Canada. But life expectancy at birth in
Utah ranges from 74 for African Americans and Native Americans, to 85
for Asians and Pacific Islanders. So there's a 9 year gap there, even
when these groups move right to the middle of the US. No medical system
can entirely cope with the residual effects of smoking, drinking, and
socioeconomic class. But at least Utah doesn't have to cope with a
Mexican border.

I'd be curious if you can come up with comparable figures for life
expectancy of ethnic groups in Canada. Do your "natives" make it to 74,
on average?  I'll bet not.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition,sci.med,sci.med.cardiology,talk.politics.medicine
Subject: Re: They just finished doubling (corrupt) NIH funding over the last 
	five years
Date: 10 Aug 2005 14:36:38 -0700
Message-ID: <1123709798.803163.249800@o13g2000cwo.googlegroups.com>

Robert wrote:
> <outrider@despammed.com> wrote in message
> news:1123685010.887709.297720@z14g2000cwz.googlegroups.com...
> >
> > TC wrote:
> > >
> > > You know that you've hit a real nerve with these shameless pharma
> > > apologists in this ng when they go nuts about where you are from and
> > > are completely unable to come up with anything to say about the content
> > > original post.
> > >
> > > Check and mate.
> > >
> > > TC
> >
> >
> >
> >
> > "Achieving the Steve; from polymath to ProtoGrunt in one small step."
> >
> > just say "canada".
> >
>
> Zee, the only way you will find any real relief is through research in
> the US such UCSD and other state and federal agencies paid by the US tax
> dollars. You will not find any help in Canada where they have abandoned
> you with your AE to statins. That was intentional on Canada's part to
> provide cheap health care and in providing heart operations for 10,000
> dollars. They transferred all the money out of health care.


COMMENT:

Christ, this is what I have to put up with. Zee's got her hopes pinned
on a well-funded NIH prospective study of statin effects at UCSD, which
wouldn't have been funded at all if the NIH was as much in the pharm
pockets as you all seem to think it is. And which (moreover) is a US
study which wasn't funded in Canada, because Canada doesn't *spend*
money for that kind of thing. They're into spending money on direct
patient care, you know. :)  I think Canada's buying Crestor for their
people, at the moment. But it's *cheap* Crestor. Yum. And it was
probably cheap Baycol, too, before Baycol got recalled. Maybe free
socialized Baycol, grunt, grunt. Me no understand why all this not
considered relevent.

As for you, TC, I'm commenting on all the messages in the thread in the
state in which I ran across it. Including your later ones. What, is it
illegal to do this without saying something about the OP message? Sue
me.

If you want a statement from me for the record, about conflicts of
interest at the NIH, then I can say it's like asking a preacher about
sin. I'm against it.  Okay?

I've been attacking the FDA for their stupidity and corruption here for
about a decade. Where have you been?  I'm no friend of the NIH, either,
but I was a little surprised to find they were being corrupted, too (I
shouldn't have been, that was naiveté. I admit it).

However, I wonder if you realize how little it matters that NIH people
get pharma money? NIH people don't control most NIH grant money, and
the reason for that is quite deliberate. Basically, it's so they aren't
in a position like the narcocops, or the FDA, where they're controlling
lots of money and are thus a TARGET for corruption.

NIH grants, you see, go through a "peer review system," and that's
exactly what it sounds like. NIH sends grant proposals (including SBIR
grants like the one you're complaining out on this thread) out to be
reviewed by scientists who don't work for the NIH, and then uses those
scores, without corrections. These are just other guys in the field,
who work anonymously, and without compensation (much like referreed
jounal reviewers). There are WAY too many of these people to be subject
to much corruption, unless drug companies could find out which
drug-related grants were being reviewed where and by whom. In theory
*that's* possible, but screwing with that by bribergy would be even
more difficult and dangerous than jury-tampering, and I have yet to see
any evidence that it's happened at NIH.

If we DO find that that kind of thing has been going on, then the
manure will hit the spreader down on the drug pharm, and much of US
pharm research, private and academic, will be found standing behind the
spreader, where one does not want to be.

As for the idea of SBIR grants to businesses to help them defray the
cost of drug or other technology development (many of which expenses
are mandated by government regulation), that basically is a form of
welfare like any other. You've heard of farm subsidies, oil industry
subsidies, and so on? Socialism doesn't just give tax money away to
individuals and non-profit corporations, you know. There's plenty of
social wealth transfer done through for-profit corporations in Canada.
Don't act like you've never heard of the idea.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: 46 million Americans without health insurance in 2004
Date: 3 Sep 2005 15:43:48 -0700
Message-ID: <1125787428.792774.327500@g49g2000cwa.googlegroups.com>

Robert wrote:
> "Kamalakar Pasupuleti" <p_kamalakar@hotmail.com> wrote in message
> news:832d27c1d67b8aaa18fcfd431d6502dc.67313@mygate.mailgate.org...

> >   Is it not possible to have a similar health plans
> > as Canada / Germany in US ?
> >
> > Kam
>
> Canada does not allow private health plans. It is all government controlled
> and you have to wait 3 years on a waiting list in order to have heart
> surgery.


COMMENT:

Yes, but part of that is because they spend only half as much per
capita on medical care as we do, despite the same per capita income.
Part of their waiting problems are due to simply underfunding.

One wonders, if we put in a Canadian-syle system, but funded it at 200%
of what THEY do (ie, spend the same fraction of *our* GDP as we already
do), if we might not get the best of both worlds?  Worth a try.

Our system is certainly screwed up, stuck halfway between privatism and
socialism. Our system does whatever is most expensive, driven by the
profit of procedures like nuclear heart scans, MRI, and angioplasty,
and the government and insurance companies PAY for it
semi-socialistically, without proper oversight. That's a presciption
for the WORST of both systems, and NONE of the benefits. If you let
people pay ALL their own bills (as for example, in the food and
transportation industries), they do their OWN oversight. But if the
government pays for it ALL (ie, police protection), then they a bit
less influenced by profits (not entirely-- see the US drug war), and
are more careful with rationing and allocation of resources and
preventive care, than our medical system is.

We need to go one way or the other. We're in deep do-do where we are.

SBH



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition,sci.med,misc.health.alternative
Subject: Re: Deficiency in omega-3 fatty acids tied to ADHD
Date: 10 Sep 2005 13:26:58 -0700
Message-ID: <1126384018.759199.38200@z14g2000cwz.googlegroups.com>

Matti Narkia wrote:
> Thu, 08 Sep 2005 01:48:57 +0300 in article
> <l1ruh1ds0p56or4odsviscql51sino6jti@4ax.com> Matti Narkia
> <mnng1@despammed.com> wrote:
>
> >7 Sep 2005 13:50:38 -0700 in article
> ><1126126238.318875.46880@g14g2000cwa.googlegroups.com> "montygram"
> ><nazztrader@lycos.com> wrote:
> >
> >> Eskimos die around the age of 40 on
> >>the omega 3 diet, if they're lucky.
> >
> >Traditional eskimos' leading causes of death were accidents and infectious
> >diseases. Their life was full of dangers and medical care was poor. But they
> >had much less chronic degenerative diseases such as coronary heart disease,
> >cancer and diabetes than any other tribe or country. If you want examples of
> >modern day fish eaters, have a look at the mortality figures of Japan and
> >Iceland, who lead the world's male life expectancy statistics
> >(<http://www.aihw.gov.au/mortality/faqs.cfm>).
>
> For Greenland Inuit the 1990 life expectancy for men was 58.5 years and 66.0
> years for women. Not high due the reasons I mentioned, but by far higher
> than 40 as "montygram" suggested. For Baffin Inuit in Canada 1992 life
> expectancy at birth was 66.6 years, approximately 10 years lower than that
> for the general Canadian population (76.3 years).



COMMENT:

The following reference claims average life expectancy at birth in the
US is 79 on average, and 71 for American Indians and Alaskan Natives
all considered as one group. Which is close to the gap I gave for Utah
between whites and non-whites (though Asians and pacific Islanders have
HIGHER than average LE's by nearly as much as blacks and Indians are
lower-- these folks generally live into the 80's no matter where they
reside, or under what system of government or health care, so long as
their society has money).

http://www.prcdc.org/summaries/amindiansaknatives/amindiansaknatives.html

I'm happy to see much the same figures, and disparities of "health care
delivery" (if you believe that) apply to Canada. We get pounded over
the head with their life expectancy figures so much that we forget that
most of the decrement in the US expectancy is in places as far away
from Canada as you can get. Canadian border US states do as well as
Canada in life expectancy (though they pay a lot more for it--
efficiency in the US sucks). And our "Natives" do about as well under
out system of health care as Canadian "Natives" do under THEIRs---
maybe better. Roll that up in your political belief system, and smoke
it.

The people who DON'T do as well in our system as Canadians, are
Southern African Americans and Hispanics.  But since the Canadians
don't have nearly as many of those folks as we do (a situation I'd be
happy to temporarily remedy if I could, just for the same of
lesson-teaching), you can't exactly use them to compare medical
systems. This are cultural problems which need to be controlled for. If
you want to use delivery of medical care to oppressed minorities as
your index of how well medical socialism works, you need to use
Natives, which we all have in North America. And when you do that,
Canada is no great shakes.

SBH


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