Do You Want Canadian Health Care?

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Lon
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Post by Lon »




  • OPINION

    JUNE 9, 2009

    Canada's ObamaCare Precedent

    Governments always ration care by making you wait. That can be deadly.



    By DAVID GRATZER

    Congressional Democrats will soon put forward their legislative proposals for reforming health care. Should they succeed, tens of millions of Americans will potentially be joining a new public insurance program and the federal government will increasingly be involved in treatment decisions.

    Not long ago, I would have applauded this type of government expansion. Born and raised in Canada , I once believed that government health care is compassionate and equitable. It is neither.

    My views changed in medical school. Yes, everyone in Canada is covered by a "single payer" -- the government. But Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system.

    The problems were brought home when a relative had difficulty walking. He was in chronic pain. His doctor suggested a referral to a neurologist; an MRI would need to be done, then possibly a referral to another specialist. The wait would have stretched to roughly a year. If surgery was needed, the wait would be months more. Not wanting to stay confined to his house, he had the surgery done in the U.S. , at the Mayo Clinic, and paid for it himself.

    Such stories are common. For example, Sylvia de Vries, an Ontario woman, had a 40-pound fluid-filled tumor removed from her abdomen by an American surgeon in 2006. Her Michigan doctor estimated that she was within weeks of dying, but she was still on a wait list for a Canadian specialist.

    Indeed, Canada 's provincial governments themselves rely on American medicine. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery -- described by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain."

    Only half of ER patients are treated in a timely manner by national and international standards, according to a government study. The physician shortage is so severe that some towns hold lotteries, with the winners gaining access to the local doc.

    Overall, according to a study published in Lancet Oncology last year, five-year cancer survival rates are higher in the U.S. than those in Canada . Based on data from the Joint Canada/U.S. Survey of Health (done by Statistics Canada and the U.S. National Center for Health Statistics), Americans have greater access to preventive screening tests and have higher treatment rates for chronic illnesses. No wonder: To limit the growth in health spending, governments restrict the supply of health care by rationing it through waiting. The same survey data show, as June and Paul O'Neill note in a paper published in 2007 in the Forum for Health Economics & Policy, that the poor under socialized medicine seem to be less healthy relative to the nonpoor than their American counterparts.

    Ironically, as the U.S. is on the verge of rushing toward government health care, Canada is reforming its system in the opposite direction. In 2005, Canada 's supreme court struck down key laws in Quebec that established a government monopoly of health services. Claude Castonguay, who headed the Quebec government commission that recommended the creation of its public health-care system in the 1960s, also has second thoughts. Last year, after completing another review, he declared the system in "crisis" and suggested a massive expansion of private services -- even advocating that public hospitals rent facilities to physicians in off-hours.

    And the medical establishment? Dr. Brian Day, an orthopedic surgeon, grew increasingly frustrated by government cutbacks that reduced his access to an operating room and increased the number of patients on his hospital waiting list. He built a private hospital in Vancouver in the 1990s. Last year, he completed a term as the president of the Canadian Medical Association and was succeeded by a Quebec radiologist who owns several private clinics.

    In Canada , private-sector health care is growing. Dr. Day estimates that 50,000 people are seen at private clinics every year in British Columbia . According to the New York Times, a private clinic opens at a rate of about one a week across the country. Public-private partnerships, once a taboo topic, are embraced by provincial governments.

    In the United Kingdom , where socialized medicine was established after World War II through the National Health Service, the present Labour government has introduced a choice in surgeries by allowing patients to choose among facilities, often including private ones. Even in Sweden , the government has turned over services to the private sector.

    Americans need to ask a basic question: Why are they rushing into a system of government-dominated health care when the very countries that have experienced it for so long are backing away?

    Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute.
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Post by spot »

Governments always ration care by making you wait. That can be deadly.

Quite true, Lon. On the other hand most people treated by a national health system get the care they need. Where their lives are at risk, their lives are saved.

The comparison in terms of numbers that I'd make is between the proportion of those the national health system lets down compared to the proportion of those who fail to gain access to health care in countries where there's no universal provision funded through taxation. I suggest that a higher proportion of people live healthier lives in developed countries under national health systems than where no such guaranteed access exists.

Anyone can cite instances of health care failing to succeed in particular cases. I don't think that's a helpful measure of success or failure. I think raw counts of the dead and injured are far more meaningful. The ultimate counter of such success would presumably be average lifespan for distinguished groups assuming one could compare like social cohorts with with like.
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Post by FUBAR »

spot;1202666 wrote: Governments always ration care by making you wait. That can be deadly.

Quite true, Lon. On the other hand most people treated by a national health system get the care they need. Where their lives are at risk, their lives are saved.

The comparison in terms of numbers that I'd make is between the proportion of those the national health system lets down compared to the proportion of those who fail to gain access to health care in countries where there's no universal provision funded through taxation. I suggest that a higher proportion of people live healthier lives in developed countries under national health systems than where no such guaranteed access exists.

Anyone can cite instances of health care failing to succeed in particular cases. I don't think that's a helpful measure of success or failure. I think raw counts of the dead and injured are far more meaningful. The ultimate counter of such success would presumably be average lifespan for distinguished groups assuming one could compare like social cohorts with with like.




You could also look at your family,friends and neighbours and pick which ones you would be willing to let die because they don't have the enough spare income for medical services or insurance. Is it really that bad that some of the poorer Americans will live a little bit longer with some medical care. Maybe when people go into a hospital they should have any cash or savings checked first and those without could just be put out of the nations misery and be mercy killed. Eventually only the better off would be left so the problem would go away, except for those pesky poor who don't get sick enough for hospitals......:sneaky:
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Post by gmc »

Why the comparisons with other countries find your own solutions but if you do at least be accurate.

In the United Kingdom , where socialized medicine was established after World War II through the National Health Service, the present Labour government has introduced a choice in surgeries by allowing patients to choose among facilities, often including private ones. Even in Sweden , the government has turned over services to the private sector.


Only on England thanks to support from Scottish MP's for legislation that didn't apply in the constituencies they represent.

The West Lothian question - Telegraph

It can be crucial to the running of services such as education and health. Several major Labour measures that only apply in England, including university tuition fees and the creation of foundation hospitals, were only passed by the Commons because Scottish Labour MPs voted for them.


Turn things around a bit. What kind of idiot would vote for healthcare system where profit is the primary motive? Would you be able to trust the doctor not to carry out unnecessary tests or procedures just to generate income?
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Post by Lon »

Tryng to compare different health care systems on a individual basis just doesn't work. Governments I guess, merely look at the OVERALL good that a health care plan does, like improving infant mortality. But I would guess that the number of deaths from things like Prostate Cancer, Lymphomas, Breast Cancer etc. might be of a higher proportion relative to population where there is single payer government care. It makes little difference if everyone has access to good care if that good care cannot be delivered in a timely fashion.
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Post by spot »

Lon;1202707 wrote: It makes little difference if everyone has access to good care if that good care cannot be delivered in a timely fashion.
It makes even less difference for those left unprovided for, where universal health care isn't an option. I note, which you seem not to, that around 10% of healthcare provision in the UK is private, most of that through personal insurance by the exercise of choice. The issue isn't whether the quality you're claiming is available to those with resources, it's whether any level of provision is guaranteed to all citizens.

Have you noticed I've become the voice of reason on this site? I never thought I'd see the day.
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Post by Lon »

spot;1202708 wrote: It makes even less difference for those left unprovided for, where universal health care isn't an option. I note, which you seem not to, that around 10% of healthcare provision in the UK is private, most of that through personal insurance by the exercise of choice. The issue isn't whether the quality you're claiming is available to those with resources, it's whether any level of provision is guaranteed to all citizens.



Have you noticed I've become the voice of reason on this site? I never thought I'd see the day.


I don't disagree with you. New Zealand is the same, with even a higher percentage with Personal insurance.

I don't know if you are always the voice of reason, but you are certainly a well read voice, which is refreshing.
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Post by QUINNSCOMMENTARY »

Lon;1202664 wrote:


  • OPINION

    JUNE 9, 2009

    Canada's ObamaCare Precedent

    Governments always ration care by making you wait. That can be deadly.



    By DAVID GRATZER

    Congressional Democrats will soon put forward their legislative proposals for reforming health care. Should they succeed, tens of millions of Americans will potentially be joining a new public insurance program and the federal government will increasingly be involved in treatment decisions.

    Not long ago, I would have applauded this type of government expansion. Born and raised in Canada , I once believed that government health care is compassionate and equitable. It is neither.

    My views changed in medical school. Yes, everyone in Canada is covered by a "single payer" -- the government. But Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system.

    The problems were brought home when a relative had difficulty walking. He was in chronic pain. His doctor suggested a referral to a neurologist; an MRI would need to be done, then possibly a referral to another specialist. The wait would have stretched to roughly a year. If surgery was needed, the wait would be months more. Not wanting to stay confined to his house, he had the surgery done in the U.S. , at the Mayo Clinic, and paid for it himself.

    Such stories are common. For example, Sylvia de Vries, an Ontario woman, had a 40-pound fluid-filled tumor removed from her abdomen by an American surgeon in 2006. Her Michigan doctor estimated that she was within weeks of dying, but she was still on a wait list for a Canadian specialist.

    Indeed, Canada 's provincial governments themselves rely on American medicine. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery -- described by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain."

    Only half of ER patients are treated in a timely manner by national and international standards, according to a government study. The physician shortage is so severe that some towns hold lotteries, with the winners gaining access to the local doc.

    Overall, according to a study published in Lancet Oncology last year, five-year cancer survival rates are higher in the U.S. than those in Canada . Based on data from the Joint Canada/U.S. Survey of Health (done by Statistics Canada and the U.S. National Center for Health Statistics), Americans have greater access to preventive screening tests and have higher treatment rates for chronic illnesses. No wonder: To limit the growth in health spending, governments restrict the supply of health care by rationing it through waiting. The same survey data show, as June and Paul O'Neill note in a paper published in 2007 in the Forum for Health Economics & Policy, that the poor under socialized medicine seem to be less healthy relative to the nonpoor than their American counterparts.

    Ironically, as the U.S. is on the verge of rushing toward government health care, Canada is reforming its system in the opposite direction. In 2005, Canada 's supreme court struck down key laws in Quebec that established a government monopoly of health services. Claude Castonguay, who headed the Quebec government commission that recommended the creation of its public health-care system in the 1960s, also has second thoughts. Last year, after completing another review, he declared the system in "crisis" and suggested a massive expansion of private services -- even advocating that public hospitals rent facilities to physicians in off-hours.

    And the medical establishment? Dr. Brian Day, an orthopedic surgeon, grew increasingly frustrated by government cutbacks that reduced his access to an operating room and increased the number of patients on his hospital waiting list. He built a private hospital in Vancouver in the 1990s. Last year, he completed a term as the president of the Canadian Medical Association and was succeeded by a Quebec radiologist who owns several private clinics.

    In Canada , private-sector health care is growing. Dr. Day estimates that 50,000 people are seen at private clinics every year in British Columbia . According to the New York Times, a private clinic opens at a rate of about one a week across the country. Public-private partnerships, once a taboo topic, are embraced by provincial governments.

    In the United Kingdom , where socialized medicine was established after World War II through the National Health Service, the present Labour government has introduced a choice in surgeries by allowing patients to choose among facilities, often including private ones. Even in Sweden , the government has turned over services to the private sector.

    Americans need to ask a basic question: Why are they rushing into a system of government-dominated health care when the very countries that have experienced it for so long are backing away?

    Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute.


    If you want to keep up on the debate and issues on health care in America, you may want to visit my new Blog where I will post all the latest developments. Part of my job is to follow the development of this legislation and its impact.
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Post by spot »

QUINNSCOMMENTARY;1202740 wrote: If you want to keep up on the debate and issues on health care in America, you may want to visit my new Blog where I will post all the latest developments. Part of my job is to follow the development of this legislation and its impact.


You wouldn't prefer to join in the thread's discussion instead?

The thing is, there's an opportunity to differ constructively here. On your blog you're rather protected from general facts rather than selective ones.
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Post by Lon »

I haven't a clue as to what is the best way to provide for all citizens health care or how to pay for it. From a personal standpoint here's what I want for me and mine. Choice of hospital, labs, clinics, doctors and procedures and access to the foregoing in a timely manner, sufficient to enable a favorable out come. I am 74 and my wife is 65. We currently pay $8,187.60 yearly between the government sponsered Medicare Plan Parts A & B and private insurance. The breakdown is $2,313.60 yearly to the government and $4,895.00 yearly to private. Now it makes little difference to me if the entire amount was paid to the government instead of a combination of government and private as long as I am able to get the same quality of benefits that I currently receive. Here's my concern----that under a Single Payer Govenment Plan my wife and I would pay more in some form of tax or deduction from income with the total being more than we currently are paying. And the government, although not a for profit company like those nasty insurers has not proven it's self by past and present programs to be terribly efficient and cost effecive, so much for the non profit argument.
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Post by QUINNSCOMMENTARY »

spot;1202743 wrote: You wouldn't prefer to join in the thread's discussion instead?

The thing is, there's an opportunity to differ constructively here. On your blog you're rather protected from general facts rather than selective ones.


Unfortunately, there is only so much time in the day and trying to keep up with all of this is hard.

However, first let me say that you can't easily compare the US with any other country in term of health care or the expectations for that care by Americans.

For 47 years I was an employee benefits executive providing health care benefits to a group of 10,000 employees, 8,000 retirees and their dependents. I have been involved in every aspect of providing health care benefits, including being on the board of directors of several health plans. I understand how people about their health care, their personal responsibility (mostly non-existent) and the fact they blame the insurance company for not paying more and very rarely ask why the doctor charged so much.

The problem in the US is cost, not the extent of people covered which is a result not cause of the problem. There are many reasons for the cost problem, including the notion that high cost means high quality (it doesn't), the insulation of most Americans from the real cost of health care, the structure of the delivery system including too many providers in an area and the fact that doctors can invest in health care facilities and then refer their patients to those facilities and there are many other factors, none of which will be solved by merely imposing a government run system on the existing health system.

The greatest danger for a government run, taxed financed system and this applies to all countries, is that the costs get buried in the taxes and become just like any other tax and people develop the mindset that health care is "free" It isn't and when it is government run controlling the cost means some form of rationing pure and simple, there is no other way, there is no competition, you simply must pay less for care, or pay for less care which is exactly what it happening in other countries and in the US Medicare system as well. That is not all bad of course as the problem of overutilization is as dangerous as under utilization, but people don't understand that.

The expectations for health care by Americans may be unrealistic, probably is too costly to sustain, but it is sure as hell different from the rest of the world.
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Post by spot »

The trick is, Quinn, to type a small paragraph or two each time and keep things conversational. Give it a try.
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Medicaid works rather well in the US if you're unemployed and broke...

I don't know what the solution is, but I know that it's going to be a complex one that is long overdue in both the US and Canada.


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Post by minks »

I have had the health care coverage all my life and have benifited greatly from it. I don't know what other coutries offer when you say health care. We here have our provincial health care program which covers our Dr and hospital bills, among other things, then our corporations supply our additional benifits which of course we pay a monthly fee for these cover our dental, perscription, ambulance physio etc. I do know our general Alta Health Care program has forced out many good doctors from this country because the government causes them to retain a lower wage, many go south to the USA. So we have had an influx of foreign doctors (both good and bad). But yes the wait time is gigantic!!! My father waited 3 years for back surgery. By the time he got his surgery it was too late, the damage was irreversable. That was most disheartening.

We have a huge doctor shortage here as well by the way. It is very difficult for people to find a family doctor now days.

Things like MRI's and CT scans take forever... as in 1.5 years... horrible isn't it.
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Post by spot »

QUINNSCOMMENTARY;1202784 wrote: people develop the mindset that health care is "free"You either don't understand the words or you twist them, I'm not sure which. The UK National Health Service provides healthcare "free at the point of delivery", that's the only sense in which anyone here uses the word "free".

It has nothing to do with the fact that it's paid for, of course it's paid for, that's one of the reasons we pay taxes here. Free means that nobody using any National Health Service is charged for access to its services regardless of how much access they require, though individual prescription charges are means-tested up to a universal cap of £7.20 per prescription and £110 per person per year. There are no access charges to general practitioners, to hospital consultants, for hospital stay or for operations.

There are very few in the UK who would want it abolished, no political party campaigns to abolish it, it's one of our great national assets. We fund it nationally, we pay no more individually whether we use it or we don't. There isn't a single citizen anywhere in the European Union who isn't permanently covered by the system, that's the reason it's considered so valuable. Equally, I have the same immediate cover wherever I go in the European Union since the terms are reciprocal over here.

As a point of interest it costs me £45 to buy six months' full medical insurance cover if I travel to the USA for that period, given which I'm surprised it costs you guys as much as you say.
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Post by QUINNSCOMMENTARY »

spot;1202874 wrote: You either don't understand the words or you twist them, I'm not sure which. The UK National Health Service provides healthcare "free at the point of delivery", that's the only sense in which anyone here uses the word "free".

It has nothing to do with the fact that it's paid for, of course it's paid for, that's one of the reasons we pay taxes here. Free means that nobody using any National Health Service is charged for access to its services regardless of how much access they require, though individual prescription charges are means-tested up to a universal cap of £7.20 per prescription and £110 per person per year. There are no access charges to general practitioners, to hospital consultants, for hospital stay or for operations.

There are very few in the UK who would want it abolished, no political party campaigns to abolish it, it's one of our great national assets. We fund it nationally, we pay no more individually whether we use it or we don't. There isn't a single citizen anywhere in the European Union who isn't permanently covered by the system, that's the reason it's considered so valuable. Equally, I have the same immediate cover wherever I go in the European Union since the terms are reciprocal over here.

As a point of interest it costs me £45 to buy six months' full medical insurance cover if I travel to the USA for that period, given which I'm surprised it costs you guys as much as you say.


I understand the words perfectly and I am not twisting anything. Let me illustrate. I was at a conference last year and the speakers were talking about health care reform in the US. the main speaker said that what the US needed was "free" government health care. As you well know there is no such thing, yet that is the slogan being used by many people to promote a new government health care system here. Frankly, I am not sure what people think when they use that term because they must know it will be paid for in taxes, premiums and out of pocket costs. I cannot fathom how a system can be efficient is there is no cost at the point of service as you suggest, that means over utilization to me and why not, it's "free" when you use it. So, the alternative to keeping costs under control has to be low fixed payments to health care providers or some control over health care utilization. Which is it?
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QUINNSCOMMENTARY;1203201 wrote: Frankly, I am not sure what people think when they use that term because they must know it will be paid for in taxes, premiums and out of pocket costs. I cannot fathom how a system can be efficient is there is no cost at the point of service as you suggest, that means over utilization to me and why not, it's "free" when you use it.How is "free access at the point of delivery" so hard to grasp? It means that anyone going along to use the system hands over no money, however much access they need. The costs are entirely borne by the nation as a whole through central taxation. The consequence is that being ill entails no more liability on the individual than the illness itself. When you're ill that matters a lot.
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Post by QUINNSCOMMENTARY »

G-man;1202790 wrote: Medicaid works rather well in the US if you're unemployed and broke...

I don't know what the solution is, but I know that it's going to be a complex one that is long overdue in both the US and Canada.


Actually it doesn't work so well. the government payments are so low that many providers simply do not want to take Medicaid patients. As result of the low payments, way below market the providers merely shift costs to everyone else.
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Post by QUINNSCOMMENTARY »

spot;1203220 wrote: How is "free access at the point of delivery" so hard to grasp? It means that anyone going along to use the system hands over no money, however much access they need. The costs are entirely borne by the nation as a whole through central taxation. The consequence is that being ill entails no more liability on the individual than the illness itself. When you're ill that matters a lot.


Do you actually read replies before you post an answer? What in my comments gives you any indication that I don't understand the concept of free at the access point?

The fact that a person hands over no money when going to the doctor or hospital still does not make it free and the lack of any concern for cost at the point of service can only encourage utilization and why not, if you are not paying the electric bill why bother to turn off the lights when you leave the room.

But as you point out, the cost is borne by the nation, which of course means all its citizens which begs the question why wouldn't the taxpayers care what health care really costs and why would they not care if a person goes to the doctor every week when it may not be necessary...but hey the office visit if "free."
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QUINNSCOMMENTARY;1204298 wrote: which begs the question why wouldn't the taxpayers care what health care really costs and why would they not care if a person goes to the doctor every week when it may not be necessary...but hey the office visit if "free."Because, in exchange for what you see as unnecessary overuse (and I dispute that it happens to any significant effect), the taxpayers know that every citizen in the country has health provision. That matters a great deal to the vast majority of us in Britain, which is why no political party here is campaigning to abolish it. If it were likely to win more votes than it loses you can bet it would have been adopted by one party or another by now.
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Post by Lon »

spot;1204307 wrote: Because, in exchange for what you see as unnecessary overuse (and I dispute that it happens to any significant effect), the taxpayers know that every citizen in the country has health provision. That matters a great deal to the vast majority of us in Britain, which is why no political party here is campaigning to abolish it. If it were likely to win more votes than it loses you can bet it would have been adopted by one party or another by now.


But Spot, most all those in Britain have not had the opportunity to live with another type of health care so how can they compare differences other than what they read about?
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Post by gmc »

posted by quinns commentary

However, first let me say that you can't easily compare the US with any other country in term of health care or the expectations for that care by Americans.


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Couldn't agree more. I think the comparisons detract from the debate-it's an american problem and will need an american solution. Most of the debate seems to be centred on arguing about the principal rather than the practicalities of it. Talking about the givt making the decisions about treatment when in reality it's the doctor making the decision but he's not sitting there wondering what the patient can afford. From what I can gather Americans seem to spend a lot of time having check-ups to prevent problems -here we go to the doctor if we're ill. Women visit the doctor more often than men. Here if you were to ask males in the 30-50 age group who their doctor was most wouldn't be able to tell you unless they have actually been ill. Maybe it's because you feel you need to get value for your money. It also seem to be pretty expensive with the constant worry that you might not be able to afford it. I think I read somewhere that medical expenses is an oft cited reason for bankruptcy.

posted by Lon

But Spot, most all those in Britain have not had the opportunity to live with another type of health care so how can they compare differences other than what they read about?


Kind of goes for americans as well does it not? Try watching a UK medical drama. In none of them will you see someone refused treatment because they can't pay and the gallant doctors work out a way round the system. It always seems to feature in american ones though-mind you haven't seen one for a while apart from house and Hugh Laurie is a well known anarchic british comedian.

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Post by spot »

Lon;1204421 wrote: But Spot, most all those in Britain have not had the opportunity to live with another type of health care so how can they compare differences other than what they read about?


We all already live alongside another type of health care in the UK and around 10% of the population uses it - private (mostly paid for through insurance) health care. It's here, it's always been here, it's always been an alternative for those with resources. Most of those who use it would still vote against any dismantling of no-fee access to health care for every citizen.
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