February 25, 2009

How will the US please stakeholders on both sides of the issue when it comes to health care

Will we get it right while everyone else got it so wrong
Universal Health Care For All

By Melvin J. Howard

As the US is about to experiment with reform to health these are my words of caution. I to believed in a "universal health care system". Who wouldn't support that goal? Doesn't everyone have a "right" to health care? Sounds goods "Affordable Health Care for All". Now for the hard part it takes a lot of research of the topic and understanding economic reasoning and history behind the promises of a single payor system. Having gained my experience of socialized medicine in London and Canada. I realized that government intervention in the market (e.g., Medicare, FDA regulations, physician licensing, insurance regulations etc.) is the reason for artificially high health care prices. It’s not the main reason but it’s up there on the list. What I witness in other countries will have the same effect on the US Health Care System.

Universal Healthcare amplifies all problems:

1) Reduces patient incentives to find the best possible prices for the best possible services/products available.

Patients in the U.S. who receive "free" (taxpayer-funded) health care will have no incentive to conserve their health care dollars. Care is "free" so they visit the doctor's office several times a month or request "free" prescriptions for over-the-counter medication such as Tylenol.

2) Reduces physician incentives to provide competitive care and reduces drug companies' incentives to provide new drugs and treatments.

With no incentive to provide quality care because they will be backed up or can't get efficent O.R. time, physicians and nurses leave the government-monopolized area for better opportunities in a freer country. Shortages will result. Drug companies will be hindered by price controls and regulations and soon cease research and development of new medication. In the U.S., start-up drug companies cannot afford to run the FDA gauntlet, so a few established corporations will dominate the market. Medical technology will be reduced and slow to come to market.

3) It comes from your wallet through higher taxes.

Yes, you do have a right to health care, just as you have a right to food, shelter and property. However, you have no "right" to force others to provide these things for you - All "free" medical care is subsidized through taxes made through compelling means. Believe me some will abuse this right repeatedly.

4) The quality of "free" health care will deteriorate and the average citizen will get sicker.

As the poor and middle-class wait in agony for simple procedures, those with resources can travel to other countries for treatment.

5) Destroys your privacy.

Suddenly your problems are mine and mine are yours. If you eat unhealthy foods or drive a motorcycle without a helmet, I have a direct interest in your business - you are going to see a provider on my tax dollars. Your neighbors might support government bans on smoking, "unsafe" sex or other "risky" behaviors to reduce costs. Politicians will use the federal bureaucracy to force you and your family to comply with programs such as the "New Freedom Commission on Mental Health". The Government will control your medical records therefore Patient doctor confidentiality could be compromised.

6) Destroys your liberty.

When you blindly support a system that bestows power on politicians and bureaucrats, they will receive their orders from those that have strong ties to Government and that won’t be you.

Physician shortages will be the norm:

TORONTO - An association of Canadian doctors is urging the government to provide $1 billion Canadian (U.S. $765 million) to help combat a national shortage of health care workers. By MSNBC

At its annual meeting in Toronto on Tuesday, the Canadian Medical Association said health-reform experts have identified shortfalls among all types of physicians, nurses and technicians as a major obstacle to reducing long waiting lists for procedures that include joint replacement, heart bypass and cancer care.

A report by the association analyzing the shortfall shows Canada has 2.1 physicians per 1,000 residents, ranking it 25th out of 30 countries in the Organization for Economic Co-operation and Development, a forum that assesses economic and social policy.

The medical association wants Canada's government to provide $1 billion Canadian (U.S. $765 million) over five years for a national Health Human Resources Reinvestment Fund to increase the number of openings for medical students and postgraduate training positions, while fast-tracking residencies for medical graduates from other countries and establishing a program to recruit and retain health care professionals.

The fund would also be used to set up an institute to map out the number of doctors, nurses and other care providers that will be needed in the future.

Health Minister Ujjal Dosanjh has said the resource issue will be a key item on the agenda when provincial premiers meet with Prime Minister Paul Martin on Sept. 13 to discuss health care. Health reform is meaningless unless we ensure an adequate supply of doctors and nurses with the infrastructure and tools that they need to attend to their patients," said Dr. Sunil Patel, president of the 58,000-member association. 

Increased waiting times that are inevitable when medical business in monopolized by the government.

Susan Warner swallows addictive painkillers every day to ease the crippling pain she endures waiting for knee-replacement surgery. By Jason Fekete Calgary Herald

One of her knees gave out in October and the Calgary woman has been waiting for the surgery since. However, Warner, 51, is lost in a lineup for the operation at the Rockyview General Hospital that she says could last 18 months.

"It's inhuman. The quality of my life is horrible and there's absolutely nothing I can do about it," she said Tuesday.

Waiting lists are crippling Canada's health-care system and frustrating patients and doctors alike. The Canadian Medical Association released a 10-point prescription on Tuesday that targets waiting lists for surgery and diagnostic procedures like MRIs and CT scans.

It proposes setting benchmark waiting times for surgery, hiring more health professionals, and expanding options for Canadians to get treatment in other jurisdictions.

In Calgary, as the city expands, so does the pressure to get people treated at local hospitals in a reasonable amount of time.

There are about 25,000 Calgarians waiting for surgery or scans at the city's four major hospitals. And the Calgary Health Region estimates waiting times for surgery are growing at an astronomical rate of 12 to 18 per cent every year.

Alberta Health's website says waiting times in Calgary are as follows:

- 62 weeks for a hip replacement at Peter Lougheed Centre;

- 62 weeks for general surgery at Rocky- view General Hospital;

- 30 weeks for MRI scans at Foothills Medical Centre;

- 54 weeks for knee replacement surgery at Rockyview General Hospital;

- 11 weeks for cardiac surgery at Foothills Medical Centre.

For Warner, the wait has come with a heavy price. She says she has become addicted to painkillers that are a daily staple to help her hobble through her workday.

Warner's a photographer, a job that keeps her on her feet most of the day, with or without her cane.

"I know I'm addicted. When I wake up in the morning, I'm shaking and have headaches," she said with a sigh. "I'll have to deal with that after the fact."

In their report, Canada's doctors and nurses are sending a direct message to premiers meeting this week in Niagara-on-the-Lake, Ont., for three days of talks largely on Canada's ailing health-care system.

In its report, titled The Taming of the Queue, the Canadian Medical Association and Canadian Nurses Association argue the Canada Health Act should be revamped to help Canadians get quicker access to better health care.

Waiting for care is part of the "normal functioning of any health system," the report says, but warns excessive waits can have "significant health and economic impacts."

During the June election, Prime Minister Paul Martin identified waiting lists as the top issue facing the medicare system.

He vowed to spend $4 billion over the next five years to reduce waiting times, including focusing on five specific areas: cancer care, joint replacement, heart surgery, diagnostic imaging and sight restoration surgery.

The medical association's report proposes a 10-point plan to fix waiting lists, including:

Establishing reasonable waiting times for different procedures;

Allowing hospital funding to expand or contract depending on pressures, so service delivery isn't constrained by budget caps;

Aggressively recruiting and retaining health-care professionals;

Prioritizing services and ailments through consultation with the public and health-care providers;

Improving the ability of Canadians to seek care in other provinces or out of the country.

The association's president said sustainable reforms -- not just more cash -- should be the premiers' focus if they hope to wean the system off its crutches. Access to health care in a timely manner is job No. 1 and Canadians expect nothing less," said Dr. Sunil Patel. "If (the premiers) focus on dollars alone, then we have lost everything. Canadians will lose confidence in their health-care system."

The report does say the system needs money."There is no doubt that the availability of resources does come to bear on the timeliness and accessibility of health-care services," the report says.The Calgary Health Region has thrown hundreds of millions of dollars into expediting care for residents.

In February, the CHR announced a $450-million plan to open new beds and operating rooms, and expand emergency and intensive care units at the Foothills Medical Centre, Peter Lougheed Centre and Rocky-view General Hospital.

"Our longest waiting lists are in orthopedics and general surgery," said Tracy Wasylak, the CHR's vice-president of surgical services. "We're hoping to put resources into both of those programs this year to drop those waiting lists."

Sick of waiting for her pain to be eased, Warner, meanwhile, said she looked to Montana to expedite the surgery. However, the procedure would cost $25,000 -- leaving her to wait and hope in Canada. It's brutal. I'm in constant pain," Warner said. "I can't work to full capacity. It's difficult to function."

Worldwide Experiments in Socialism

Varying degrees of problems with socialized health care

Great Britain By the Guardian

One in five patients who undergo a heart bypass operation are not receiving the best care while in hospital and some die who might otherwise have survived, according to a new report.

The study, funded by the Department of Health, found the shortcomings were not to do with the actual surgery. The problems lay most often in delays in recognising that a patient was deteriorating after the operation, delays in getting senior clinicians to see a patient and failures to recognise that a patient had other, potentially complicating, problems.

The study showed the importance of teamwork, as well as skill with a scalpel, to a successful outcome. Although the death rates, at less than 2%, are very low and heart surgery in the UK is well regarded internationally, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) says hospitals could do better.

"Two per cent mortality is very impressive," said George Findlay, an intensive care consultant and one of the study's authors. "This is a life-threatening condition, managed well. But for two out of 100 patients, that is a terribly bad outcome. The feeling is we could reduce that if there were attention to more organised teamwork."

One of the most disturbing discoveries for the study team was that half the patients who died had not been not told they were at risk of losing their life, even though the doctors knew it. "That is a big issue," said Findlay. "Even one in 10 did not have any potential complications explained to them. The issue of informed consent is quite a big one."

In two-thirds of the cases studied half of whom were patients who died poor organisation, communication and teamwork adversely affected care. The investigators found nearly half of health trusts do not follow Department of Health national service framework protocols, seven years after they were introduced.

The study was commissioned to look at the overall care of heart bypass patients, following much scrutiny of the death rates of individual surgeons. Cardiothoracic surgeons are the only specialist medical profession to have their individual death rates posted on a website, hosted by the Healthcare Commission. Its launch followed publication of individualised data by the Guardian, obtained under freedom of information legislation.

Sir Bruce Keogh, former president of the Society of Cardiothoracic Surgeons and now medical director of the NHS, asked NCEPOD to carry out the study. "It uncovered some systematic problems where there was room for improvement," he said. "As a speciality we are mature enough now to accept the criticisms and address them."

The spotlight will soon be on other areas of surgery. The Guardian revealed last week that data on death rates in a wide range of operations, taken from routinely collected statistics, will shortly be posted on the NHS Choices website.

Case study

The report cited the following case: "An inpatient waiting for urgent coronary artery bypass grafting had experienced new chest pain in the night prior to surgery. Surgery went ahead the next day as planned and the patient subsequently died. The operating consultant surgeon stated that the patient had clearly deteriorated overnight and that the cardiologists did not inform him of this fact. The [NCEPOD] advisers felt that it was the responsibility of the operating surgeon to ensure that the patient was still in an appropriate condition to undergo surgery and that a surgical review prior to operation would clearly have identified the problem in this case. However, the advisers also felt that this case highlighted a serious lack of communication between cardiology and cardiac surgery."

 Former Union of Soviet Socialist Republics

RZHEV, Russia -- Alexei Serov knew it was time to evacuate the pregnant mothers from his maternity hospital in central Russia when pipes began bursting and plaster started falling off walls. Health regulators closed the clinic, which hadn't been renovated in 40 years, and Dr. Serov moved his patients to a makeshift ward across the street. By Jeanne Whalen Wall street Journal.

Conditions there aren't much better. There is no elevator, so women must be carried upstairs to the operating room if complications arise during birth. A clinic for tuberculosis patients stands next door. And two children died last year because the hospital lacked a simple breathing machine that costs just $15,000.

"We physicians are working on the razor's edge," says Dr. Serov, who earns the equivalent of $130 a month. "All our problems boil down to a lack of financing."

The dire state of Russia's public-health system has helped create what President Vladimir Putin calls a national emergency: Every year nearly a million more Russians die than are born. Even with surging immigration, mostly from former Soviet republics, Russia's population has dropped from 147 million in 1989 to 145 million last year. Life expectancy among men -- who have been hit especially hard by alcoholism and heart disease -- has dropped by five years in that period to 58.5, the lowest level in the developed world. If current trends continue, many demographers predict Russia's population could fall to as low as 100 million by 2050.

These statistics have inescapable economic consequences. Economists say declining health will shrink the nation's labor pool and reduce its productivity, potentially complicating Mr. Putin's stated aim of doubling Russia's gross domestic product over the next 10 years. The cost of treating the nation's looming HIV crisis and the disease's drain on the work force, for example, will shave 10% off the country's GDP by 2010 if it isn't combated properly, according to a World Bank study.

In his first four years in office, Mr. Putin has introduced a number of tax and legal reforms that have helped strengthen state finances and ignite economic growth. But like many of the priorities he has set for the second term he is universally expected to win next month, improving the nation's health will be much harder. Beyond grappling with the widespread unemployment and low living standards that underpin the rise in illness, Mr. Putin must fix a broken-down health-care system largely untouched by the reforms that have swept other areas of society.

For decades before the Soviet Union collapsed in 1991, citizens received free health care, though the quality of service often depended on one's Communist Party connections. Though the system is still state-run, government financing has fallen by more than a third since Soviet times and covers only a fraction of patients' real medical costs -- forcing them to pay the rest out of pocket. Equipment is outdated; doctors and nurses earn barely enough to justify showing up to work. And a Soviet-era focus on in-patient treatment leaves far too many hospital beds and not enough general-practice doctors.

Russian officials are drafting a plan to overhaul the system, but many physicians criticize the Health Ministry in particular for moving slowly. The ministry didn't respond to an interview request, but in a report last year, Health Minister Yuri Shevchenko called health "an indicator of national prestige ... a necessary condition for high labor performance ... [and] the clearest measure of the effectiveness of government leadership."

In what Mr. Putin called a sign of hope, the birth rate began to rise last year for the first time since the fall of the Soviet Union. But being born in Russia is still a dangerous experience. Last month, six premature infants died in a regional hospital of a bacterial infection after nurses failed to sanitize machines that were helping them breathe. A state inquiry blamed the deaths in part on a lack of qualified personnel and equipment, and the chief doctor of the hospital was fired.

Because regional budgets fund the bulk of health-care costs, standards and health statistics vary drastically across Russia's economically diverse regions. Life expectancies can differ by as many as 16 years, according to a World Bank report published in October. And mortality rates in Moscow, home to most of Russia's new wealth, are now 55% lower than rates in some poorer regions, state statistics show.

A short drive out of Moscow reveals the rifts. Rzhev, population 70,000, produces most of the cranes building luxury apartment blocks and shopping malls 300 kilometers away in Moscow. But little of the capital's financial boom has trickled out to Rzhev. Local salaries are about $150 a month, compared with $380 in Moscow. Per-capita spending on health care is about $50 a year, or half what is spent in the capital.

Over the past 13 years, Dr. Serov has watched his maternity ward literally fall apart. He says the hospital has received no government funds for repairs or new equipment for more than a decade, forcing Dr. Serov to beg for grants from local businessmen to buy the occasional incubator. Across town, the chief doctor at Rzhev's main city hospital says he calls the crane factory when he needs an emergency infusion of cash.

Worsening standards of living, meanwhile, have damaged the health of local residents. "Earlier, women who gave birth were healthy, but now every other woman has some sort of pathology," says Galina Zuikova, an obstetrician at the hospital. Stress, unemployment and poor nutrition have helped lead to an increase in hypertension, kidney disease and infections in the women who come to the clinic. Smoking has climbed, too. Because of these problems, "there are more complications at birth than there were 20 or 30 years ago," Dr. Zuikova says.

Russia's constitution guarantees free health care for everyone, but very little is in fact free. Patients often pay the hospital or the doctor extra for better service or medicines. A recent study by the Independent Institute for Social Policy, a Moscow think tank, found that state financing covers only a third of health-care costs, with the rest paid by patients. Some Russians also have private health insurance, but this is still rare.

Where there is money, care can be quite good. Moscow's Center for Endosurgery and Lithotripsy, a private hospital founded 11 years ago by surgeon Alexander Bronshtein, offers Western-standard surgical and clinical care for Moscow's wealthy and upper-middle class residents. Heart surgery runs about $5,000. Top-notch physicians at the clinic earn $3,000 to $5,000 a month. "Patients come here for the high qualifications of our doctors, for the lack of lines -- they get things fast," says Mr. Bronshtein, 65 years old. "Unfortunately, not everyone can afford this clinic," he adds.

Sergei Shishkin, a health-care expert helping the state draft a plan for reform, says the government needs to scale back free care, boost the role of private insurance and drastically increase the number of general-practice doctors. He also advocates closing inefficient hospitals and reallocating funds to the best institutions and workers. Some of these changes will be introduced in draft legislation later this year, he said.

But cutting any of the cherished benefits could be a political minefield for Mr. Putin, who has been very protective of his sky-high approval ratings. One Moscow newspaper Wednesday reported that health-care reform will include the closing of some specialized clinics for children and women. The newspaper quoted Russia's chief pediatrician resurrecting a Soviet-era propaganda cliche in denouncing the move as "machinations of imperialism." The other countries are Cuba, New Zealand, Australia, but some other European countries are going the other way. Much of the pressure to experiment with privatization came from European Union regulations that forced reduced public taxation in Sweden. To function in a lower tax environment, Stockholm turned to the private sector with three goals in mind:

To remove the public monopoly on the delivery of health care services.To control the spiraling costs of public sector services by introducing market forces and competition.

To set new performance benchmarks (i.e., shorter waiting lists) for other Swedish hospitals to emulate. In every category, the experiment has been a success.

Removing the Public Monopoly on Service.

For decades, Stockholm relied on an underperforming civic health service monopoly characterized by long waiting lists, chronic overspending and flagging quality. Since the experiment began, virtually every sector of Stockholm's health system has undergone some form of privatization:Initially, the experiment included 150 private providers who were licensed to compete for health service contracts.

The contractors were originally allowed to compete for contracts in the non-medical services, technical services, ambulatory services, small hospital, home care and nursing home sectors.In 1998 the Council began the gradual privatization of all primary care.

In 1999 St. Göran's, one of Sweden's largest hospitals, was sold to the private company Capio AB.By the end of the experiment's first five years, all but one of the original 150 private contractors had survived and were flourishing. Likewise, by the end of the first year of its privatization, St. Göran's had shown significant improvements over its performance as a public facility. Somthing to think about as America tackles its health care issues learn from the mistakes that other countries have made. A mixture of public and private would be more on the right track than a purely Goverment run health care system.


February 19, 2009

Mr. Howard goes to Ottawa

A date has been set for consultations/negotiations with the Government of Canada under NAFTA Article 1118. This is a timely event coinciding with President Obama’s first foreign trip to Canada. His meeting in Ottawa with Prime Minister Steve Harper was to include talks about trade, energy, finance and the environment all important issues for both countries.    

February 13, 2009

Did You Hear The One About The Lawyer And The Doctor?

Some think the earth is still flat

 By Melvin J. Howard

In letter to the Government of Canada dated January 26, 2009. I advised the Government of Canada that I was open to mutual consultations after February 20, 2009. If after that time has passed and there has been no arrangement for consultations. I will begin the selection of the Arbitral Tribunal process. In so much as a physician has criticized me about my NAFTA claim this I have no problem he has a right to his opinion on this issue. The problem I do have with this particular physician is that he happened to bring my bi-polar condition into focus. I personally want to thank him for that you have managed to do what I could not do for over a decade. You have manages to galvanized and unite a whole segment of people with this issue this I thank you for. His name is Randall F. White, MD, FRCPC Psychiatrist, St. Paul's Hospital, Vancouver, Canada, British Columbia and a Fellow of the Royal College of Physicians and Surgeons Dr. White, has disclosed that he owns stocks in a number of health care companies. So he must not be a true socialist he likes profits interesting.

Dr. White I am ashamed that you made this personal as a doctor of psychiatry you should know better. Having bi-polar does not diminish your capacity for intelligence nor reason. As a matter of fact some research indicate otherwise. The problem is turning that computer in your head off. I just want to say I will not hold a grudge against you I am sure by now some of your colleagues have told you that was not cool (think Abraham Lincoln and Winston Churchill).

This being said thank you to my physician, which is my muse and friend and the many physicians that I talked to for their opinion on health care and where it’s going. Now lets us get to my other vocal critic on this issue his name is T.J. Grierson-Weiler a commercial arbitration Adjunct Professor at the University of Western Ontario Faculty of Law. He thinks my claim was amateurish this was in September when I filed a Notice of Intent to file for a formal arbitration. This was before he knew all of the details of the claim. I ask you what kind of lawyer would way in on a complex issue as this based upon so little information on a post by the Government of Canada’s website. I sense now that I have laid out a little more in details he is not so quick to jump at any conclusions. Most law firms would have not even given an opinion but when you are sole practitioner you can pretty much say what you want no liability to other partners. Well Dr. Randall F. White and T.J. Grierson-Weiler I am going to show you how serious I am about this trade issue. Now that I know you both Dr. White and T.J. Grierson-Weiler on a professional level sometimes a businessman is like a iceberg you only see the surface but there is a lot more underneath most corporate lawyers probably would tell you that.

You have underestimated my resolve in this issue you have further insulted my intelligence. I will not belittle you both in this endeavour I will let the general public do that. But I just want to say I hope I am not that naïve to judge people without really knowing who they are and what principals they stand for I want to see the whole iceberg. At this time there will be no further interviews about this trade issue. I will now prepare efforts on the Arbitration.

February 08, 2009


If you have been following the progress of our NAFTA claim you all know by now that Canada does indeed have a private health care sector. Now that it has been established that it does the question now is has Canada breached international and North American trade law. By not allowing US surgical centers to operate in Canada. In terms of most favored nations and expropriation clauses. We contend it most certainly has been breached; protectionism was brought up against the US last week by Canada against the buy American wording in the stimulus package that is being debated in the senate. I am now asking Canada the same live up to your trade obligations and don’t be protectionist. Trade is a two way street or in this case a three way street you have commercialized your health care system. It is no longer considered a social service you cannot put the rabbit back into the hat. He is out and hopping around and he is multiplying! Now that the world is watching this trade issue the spotlight is on Canada to do the right thing and not be a “hypocrite”!    


Sunday , July 22, 2007

In reversal, Canada dabbles with health

care privatization


Canada, once considered the bedrock of national health care systems, is in the beginning stages of change toward free-market health insurance. But in a country where free health care is an afterthought, change comes slowly. For the first time, private health care clinics are proliferating throughout Canada and arguments for allowing private physicians to practice freely are being heard. "You are seeing the Medicare orthodoxy of the last 30 years being questioned in Canada," said Dr. David Gratzer, a registered physician in Canada and the U.S., and senior fellow at the Manhattan Institute, a nonprofit public-policy think tank. "Over the last two years, the health care system has dramatically changed to allow more private health care."

 The Supreme Court of Canada, widely viewed as among the most liberal in the world, nearly two years ago allowed a man in Quebec to buy health care on his own — striking down 30 years of precedent and giving advocates for private health care a major victory.The case is known as the Chaoulli decision, after Dr. Jacques Chaoulli, who took action against the system after a patient was forced to wait nearly one year for a hip replacement.Chief Justice Beverley McLachlin and Justice John Major wrote in the decision: "The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care."But the high court's decision is only a springboard for change — a major privatization wave won't occur until each of the 10 provincial governments and three territories moves to align its legislation with the Chaoulli decision and insurance companies step into the arena with new products, said Dr. Zoltan Nagy, executive vice president of the Canadian Independent Medical Clinics Association.

 South of the border

 In the United States, the buzz for a national health care system is at a fever pitch as Democratic presidential contenders talk about implementing some form of a universal health care program, and Michael Moore's new documentary, "Sicko," shines the spotlight on inefficiencies in the U.S. health care model by comparing it with, among others, Canada's. The U.S. system, considerably more costly and innovative, stands in sharp contrast to its Canadian counterpart in many ways. The Canadian system's universal coverage with its lower costs and its public, nonprofit administration has been a subject of fascination to many Americans, particularly during periods when Congress flirted with the enactment of national health insurance legislation.The U.S. and Mexico are the only developed countries in the world not to have some form of guaranteed health insurance for all citizens. Federal and state government funding of medical care for U.S. citizens is limited to senior citizens and poor or disabled people through the country's Medicare and Medicaid insurance programs, respectively. 

In part because of the U.S. tax code, which gives individuals and businesses deductions for medical care, health insurance is uniquely tied to a person's employment status. Without a job, health insurance can be difficult to obtain. As a result, an estimated 45 million people have no coverage, according to the Centers for Disease Control and Prevention. Not only are there millions of uninsured, but also health insurance premiums for businesses continue to increase annually at double-digit rates, twice that of the rate of inflation, putting a drag on employers' ability to compete domestically and abroad.

 "Whether one agrees or disagrees with Michael Moore, the public interest in his new film demonstrates the growing anxiety that exists throughout the United States about health care costs and coverage. It is for this reason that health care reform has become the top domestic priority for America's voters," said Ron Pollack, executive director of Families USA, a national organization for health care consumers.

Swift Current experiment

In Canada, the gradual movement toward publicly insured medical care began in a small city in southwest Saskatchewan where, during the years following World War II, a Scottish-born Baptist minister who would eventually lead the country's first socialist government kick-started the drive. Tommy Douglas eventually become the province's premier and is remembered for his relentless pursuit of universal health care. The town, dubbed Swift Current by its first inhabitants — after a creek that winds across a hundred miles of prairie — became the epicenter of Canada's quest to implement government-run health services for all who lived within its borders.

During the early years of the Swift Current Health Region, as it is still called today, many crises occurred, including a polio outbreak that nearly derailed the experimental system. But persistence in support of a public health care system prevailed, and the number of doctors practicing in Swift Current rose from 19 in 1946 to 36 in 1948. Ultimately, its success provided a functioning model to the Saskatchewan government for a provincial medicare system, which was introduced in 1962 as the first universal hospital and medical care program in North America — two years ahead of the British Health Service. Six years later, in 1968 on Canada's 101st birthday, Saskatchewan's model of public health insurance was adopted throughout the country's 10 provinces and three territories — although Ontario held out until 1971. Several tweaks were made to the system over the years, but in 1984 the Canada Health Act cemented the country's approach to nationalized health care. The act established a protocol for public health services, allowing each province to create "medically necessary" services that the government would pay for. The law also set a strict tone for public health care by penalizing provinces that permitted hospital or physician user charges — known in the United States as co-payments.

"The first stage of Medicare has been very good to Canadians," said Dr. Michael Rachlis, a Toronto physician and author of four best-selling books on Canada's health care system. "Up until the late 1950s, Canadians and Americans had similar health status and similar health care systems with similar costs. Now Canadians are healthier and spend much less on health care. "Since the early 1980s, an estimated 70 percent of Canada's health care services have been paid for by the government. The remaining 30 percent, which include such medical services as dentistry, optometry, pediatrics and physical therapy, are administered in the private sector and are paid for out-of pocket.

Winds of change

 The Canadian provinces currently use various legal tools to discourage private insurance so that access is based on need, not a person's ability to pay. Six provinces — British Columbia, Alberta, Manitoba, Ontario, Nova Scotia and Quebec — outlaw private insurance for medical services. But as a result of the Chaoulli decision, the health care debate turned in favor of private financing."The largest impact of the decision has been to change the consensus on whether or not the health care system is sustainable. It has changed the consensus on whether it's even just," said Brett Skinner, director of pharmaceutical-policy research at the Fraser Institute, an independent research organization in Canada. "There's an evolutionary change that's under way that will be incremental, year over year — a slow expansion of private options, and the development of private insurance for those things," said Mr. Skinner. But despite a groundswell for more privatization in Canada, it remains illegal under federal law to pay for health care that is deemed medically necessary by a provincial government. Rick Anderson, a Toronto health care consultant, said that less than 1 percent of the health care deemed medically necessary by a province or territory is administered in the private sector.

"We're not there yet, and it's going to be a slow process," he said. "But there is more momentum than there has been in years." It is difficult to accurately gauge the growth rate of the private health care industry since the Chaoulli decision because no organization in Canada tracks the number of private health care facilities. The best guess, Dr. Nagy said, is that there are now 23 private surgical centers offering medical services nationally, as well as 17 cataract clinics.

 Patients must be patient

To stem the tide toward privatization, Canada will have to solve the national health care system's Achilles' heel: wait times to see physicians and for needed surgery. Following a referral from a general practitioner, between 1993 and 2006, it took an average of 20 weeks in the province of New Brunswick to see a specialist, according to an ongoing study by the Fraser Institute. New Brunswick had by far the longest wait time of the provinces, with Ontario and British Columbia tying for the shortest wait time to see a specialist at seven weeks. The average for the entire country was about nine weeks. The average wait time between a referral by a physician and an appointment with a neurosurgeon can take as long as 21 weeks, according to the Fraser Institute. Cancer patients in Canada experience the shortest wait times, generally waiting no longer than three weeks to see a doctor.

 "If you're healthy and willing to wait, it is the best system in the world," Dr. Gratzer said. "What you discover is there are wait times in Canada for any condition." Colin McMillan, president of the Canadian Medical Association, attributes long wait times to a lack of capacity in the health care system. During the 1990s in a money-saving effort, the federal government drastically cut back on medical training courses and cut off foreign doctors from legally practicing in Canada. "We thought there was a surplus of doctors at the time. We thought we could save some money," he said. "The chief problem our health care system faces today is access due to a lack of doctors, nurses, hospitals and technology." Turning around the problem of long wait times will not be an easy task, according to researchers.

 "We don't have the resources to lower them despite now spending more on health care than every other country with a universal health care system outside of Ireland," said Nadeem Esmail, director of health system performance studies and manager of the Alberta Policy Research Centre at the Fraser Institute.

 However, Dr. Rachlis, a staunch supporter of public health care, contends that while the wait time issue threatens the viability of the medical system, there are methods within the system to better manage wait lists. "The government needs to champion public wait-list reforms. Physicians must work in teams, including health care professionals and nurses, rather than on their own, and accountability for wait-list management must be transferred from individual surgeons to health authorities working with groups of surgeons," he said. According to Dr. Rachlis, these problems are related to a failure to move to a group medical practice and to organize modern patient-flow processes. "We're still using the Pony Express, but expecting communication at the speed of light," he said.

Innovation lags

 Critics of a national health program point to a dearth of innovation in medical technology and prescription drugs, which can lead to decreased access to life-saving medical equipment and medications. Throughout the 1990s, opponents of the Canadian system gained considerable political traction by pointing to the provincial governments that were increasingly constraining their health care budgets, which led to more rationing of services and facility shortages. For instance, Canada uses its medical-imaging scanners more intensively than do the U.S. or Britain, largely because it ranks low among developed countries in the number of imaging machines available throughout the country. At the beginning of 2005, Canada had 176 MRI scanners, magnetic resonance imaging machines used to provide clear pictures of the body to detect diseases. Compared with 20 developed countries reporting MRI data for 2005, Canada ranked 12th, with about five MRI scanners per 1 million people, according the Canadian Institute for Health Information. "The lack of MRI and CAT scan machines in Canada is a direct result of the single-payer system," said Sally Pipes, president and chief executive officer of the Pacific Research Institute, a San Francisco health care think tank. The U.S. reported the second-highest number of MRIs, behind Japan, with 27 machines per 1 million people. A paucity in medical-imaging equipment is not the only consequence of a national health system. Because Canada's government pays for prescription drugs, prices for the medications cannot reach as high as in a free-market system. Ms. Pipes points out that as the biotech industry heads toward major breakthroughs in life-saving medications, specifically for cancer, Canadians may not have access to the drugs as quickly.

 "There are very few Canadian drug companies, and American drug companies often don't sell their drugs there," she said. "Because of the enormous cost of developing a drug, businesses must first recuperate their costs before entering a market that dictates prices, which are lower than other places."

February 02, 2009

Centurion Submits Revised Amended Statement Of Claim For NAFTA Arbitration

Centurion Health Corporation and Melvin J. Howard submitted its revised amended statement of claim on February 2, 2008. As apart of our NAFTA claim against the Government of Canada. There is a lot of debate comparing American health care to Canadian health in terms of costs.

Americans spend more per capita on automobiles than do Nigerians. Is there an American car crisis? Americans spend more per capita on houses than do Chinese? Is there an American house crisis? If you look at American per capita spending on various goods you will often find that Americans spend more per capita than many other nations, if not more per capita than most nations.

Films, cosmetics, computers, cars, houses, pets, magazines, chocolate, the list is almost endless. If you take these items and compare per capita spending on them to the spending in other nations you will regularly find America in the lead.

But you don’t hear people talking about the chocolate crisis, the pet food crisis, the lipstick crisis, etc. We don’t do that because spending more is not necessarily a bad thing. If individual B spends $500 a year on cosmetics while individual C spends $0 that doesn’t mean that C is better off. It may mean that C can’t afford any cosmetics while B is well off. This is true for every consumer good you can think of including health care.

But when it comes to health care the advocates of socialist systems of care immediately reverse things. Americans are worse off because they spend more. And that is true. Americans spend more because they purchase more. The average American receives more health care than the average European.

The assumption in much of the world is that American health care is significantly inferior because Americans spend more per person than do people in other wealthy nations.

But no health care system anywhere in the world has been able to make health care available to everyone. Every state provider of care restricts services, often through the use of queuing. Canada’s health care is lauded by advocates of state systems yet Canadians wait significant periods of time for what care is available. One factor often ignored is that most Canadians live along the US border and that some of the for Canadians is provided privately in the United States.
There is little argument that American health care is among the best in the world when it comes to technologies and innovation. What is targeted for criticism is that costs are high and this restricts access. 

Economist Arnold Kling points out in his book Crisis of Abundance that in the last 30 years very highly sophisticated new medical procedures have been developed. And these are extremely expensive in themselves. Health care costs in the American government’s budget are a problem. But Kling notes, that if the same sort of care available in 1975 were what was available today, the budget would be safe. New technologies have driven up cost considerably. Costs have gone up because more expensive new technologies push up those costs. Many socialist systems don't have that problem because they decline to use the technology or severely restrict access to it.

Other nations ration these expensive technologies in ways that American consumers find unacceptable. And Klin suggests that this rationing has “also slowed the adoption of premium medicine” where practised.

These premium services do raise the cost of health care. And, as Kling notes, health care is not an exact science. Often a physician looks at a problem, tries his best to determine causes and takes actions which may, or may not, help. He has to make educated guesses but often still guesses none the less. With so many people ready to sue physicians for making the wrong educated guess it is in the benefit of physicians to take all reasonable precautions regardless of cost. A headache could be just a headache solved by a few cents worth of aspirin, or it could be something far more serious requiring tests costing hundreds of dollars just to rule out that possibility. Before the invention of such techniques the recommendation may well have been “Take two aspirins and call me in the morning.” Physicians may well be penalized today if they don’t over test.

Care is often provided by ruling out problems. A patient has specific symptoms which may indicate a number of problems. The physician begins to narrow down the options. Different problems require different solutions and what may work for one problem may make another worse. But imagine if no tests were available for this winnowing process. More patients would suffer from having their problems continue but health care costs would be significantly lower.


Today in the US there are about 25 million MRI scans performed per year. In 1990 it was 1.8 million and none were performed in 1980. This cost didn’t exist in the 80s because the technology didn’t exist. Abolishing new technologies would lower health care costs significantly. But people would suffer and there would be more deaths -- but it would be cheaper.

Today people want the best care that money can buy. That is the problem. New technologies come onto the market daily. These are often capital intensive services requiring highly skilled care givers. The physician of the old days, that some yearn for, could still exist provided patients are willing to accept the care provided in the old days. But they can’t have it both ways.

American consumers are facing higher medical costs due to procedures that are not as available in state-care systems. Kling notes: “Heart bypass surgery is about three times as prevalent [in the US] as in France and about twice as prevalent as in the U.K. Angioplasty is more than twice as prevalent... as in France and about seven times as prevalent as in the U.K.” And what is true for technology is true for personnel. America has the highest rate of medical specialists in the world. All this premium health care does make health care in total more expensive in the US than elsewhere. This is what Kling calls the “Crisis of Abundance.”

Is America overspending on health care? No doubt. But it is also likely that state systems are under spending as well. The extra money that Americans spend is one reason there aren’t queues for surgery. Clearly the third party payment system in the US has driven up costs through the use of premium care. But equally clear is that state systems attempt to reduce this tendency to over consume by rationing care. No central planner can ration health care in a way that optimizes care for all patients. They paint with a wide brush and that means needed care is not given and what is given often is in such short supply that patients die before they move to the top of the waiting list.

America is said to have a health care crisis because it spends more than any other nation per capita. But Americans also lead the world in spending on food, entertainment and automobiles. Yet no one speaks of the food crisis, entertainment crisis or automobile crisis. Of course the big difference is that Americans don’t have their food, cars or entertainment paid for by a third party such as insurance or government.

Some health costs were due to the explosion in demand for services, not due to increased illness. They were the result of the rise of new methods of paying for services.

Mostly the patient was put into a situation where he did not pay directly for the costs of his visit. Approximately 86% of health care costs for Americans is paid for by either government or insurance. This is actually higher than the coverage given under Canada’s state system.

One result of such high third party payments is that demand for care goes up which increases per capita costs as well..

Now patients are starting to pay a fairer share of these costs themselves. One result has been increased competition in health care and improved health services. The New York Times recently reported that in the US a “growing number of physicians... have streamlined their schedules and added Internet services, among other steps, to better meet the needs of patients. For physicians... it is simply good business.”

The reason for the improved services is that in recent years walk-in medical clinics and retail-store clinics have dramatically increased and “pose new competition, and as shrinking insurance benefits mean patients are paying more of their own bills, family care medicine is more than ever a consumer-service business. And it pays to keep the customer satisfied.”

Yes, it is true that Americans spend more per capita for health care and that is because they get more health care per capita. Socialist systems routinely forbid expensive health care to patients. And entire classes of patients are told they must suffer, or die, because the state refuses to provide the care they need.

In South Africa the government announced “free” health care for children under a certain age. How as that provided? One was by neglecting other patients who needed care. A second thing they did was arbitrarily limit that care to certain infants only. For instance if the birth weight was below a certain weight the child was denied life saving care even if it were available.

In one case a mother was told that the hospital would not save her infant’s life even though it had the ability to do so. It was a few grams below the weight limit set by the state. Press reports on the case brought in private donations; the mother and infant moved to a private hospital and the baby lived.

In England a winner of the Big Brother reality show was asked what he planned to do with his large cash winning. He said that a big chunk of it was earmarked to fly a friend to the United States for badly needed surgery. The surgery could be done in England but the socialist system refused to do it because it cost too much. Britain spends less per capita on health care than America does and denying needed surgeries like this is one reason. Deny people needed health care by bureaucratic edict and you can lower the costs per capita.

There is no denying that Americans consume more health care than they need. That is what third party payment schemes do. Nor can anyone deny that some Americans get less health care than they need. But the same is true in socialist systems. There are many people who over consume on small issues because the state covers the costs but who under consume on big issues because the state won’t provide the care at all.

America could match the other developed nations in per capita spending tomorrow but to do so it would have to do what they have done -- deny certain expensive treatments across the board.