This article sent to me by my Canadian ex-pat colleague Michael Krauss pretty much speaks for itself:
ST. JOHN’S, N.L. — Newfoundland Premier Danny Williams will undergo heart surgery later this week in the United States.
Deputy premier Kathy Dunderdale confirmed the treatment at a news conference Tuesday, but would not reveal the location of the operation or how it would be paid for.
“He has gone to a renowned expert in the procedure that he needs to have done,” said Ms. Dunderdale, who will become acting premier while Mr. Williams is away for three to 12 weeks.
“In consultation with his own doctors, he’s decided to go that route.”
Mr. Williams’ decision to leave Canada for the surgery has raised eyebrows over his apparent shunning of Canada’s health-care system.
“It was never an option offered to him to have this procedure done in this province,” said Ms. Dunderdale, refusing to answer whether the procedure could be done elsewhere in Canada.
AF says:
Deputy premier Kathy Dunderdale confirmed the treatment at a news conference Tuesday, but would not reveal the location of the operation or how it would be paid for.
Wonder if the operation’s taking place in Massachusetts.
February 3, 2010, 1:54 pmT Sawyer says:
6 years ago, I went to Cleveland to undergo heart surgery that was not available in Washington state.
February 3, 2010, 1:56 pmWhat prior opinion of yours does this support/rebut?
jcm says:
Canada has the best health care system in the world according to left wingers. But they need to refer patients to the USA for urgent treatment.
February 3, 2010, 2:05 pmWashington and Ohio have the same health care system
Tom in Houston says:
If the best surgeon is in, say, Boston, and the second best is in Toronto (which is further away), he’s supposed to go to Toronto as a matter of national pride? Please. I suppose doctors’ reputations, travel convenience, and price all play a role for such serious surgery. But it’s hard to draw a political conclusion out of this without more info.
February 3, 2010, 2:05 pmA. Criminal says:
FWIW, the World Health Org has declared that the US has the best medical care in the world. Their overall rating for US health care was lower than 1st because of the costs, not because of the results.
February 3, 2010, 2:09 pmIlec says:
I wonder to what extent this will prove to be a decision not driven by medical considerations but rather by privacy concerns. If he were to have his surgery in any hospital in Canada, there would likely be a media circus. Perhaps, he felt that he would be better off being anonymous in the U.S.? There does seem to be some indication that he could have gotten treatment in Canada had he wished –
http://www.theglobeandmail.com/news/politics/williams-could-have-had-surgery-in-canada-cardiac-experts-say/article1454023/
However, if it were driven by medical reasons, it simply points to something that I have long felt – the Canadian system can exist in the form that it does because it has the U.S. as an escape valve to relieve pressures on its system. The worst thing for the Canadian system would be if the U.S. were to reform its system into a Canadian-like system.
February 3, 2010, 2:12 pmNorthern Dave says:
One of the reasons that we up here won’t allow a two-tiered health care system is that we already have one that doesn’t start using public resources for private interests. To whit one can always get whatever done somewhere in your great US of A! Dad at one point picked up Mom and whisked her off to Mayo Clinic when the system up here was failing to meet her exceptional needs.
One of the main problems with two-teired up here is that as soon as the private clinics are open they start trying to rent time on the most expensive diagnostic equipment in the public system which – since those systems are already fully committed – leads to queue jumping. We Canadians think the proper punishment for queue jumping is summary execution. That’s what stopped the last experiment in Ontario from going forward for example.
Danny Williams comes from a have-not Province with limited resources and medical facilities (think of a frozen Puerto Rico with more moose than people). Queue jumping elsewhere in Canada (even if possible to schedule) would have been frowned upon.
While I don’t agree with everything the man has done, I am convinced he is a patriot to his own people of Newfoundland and serves them the best way he knows how (even if his axing of public services and positions is IMHO wrongheaded I’m sure he is convinced of it being the right thing to do).
May God grant successful treatment and a swift recovery.
February 3, 2010, 2:12 pmA. Criminal says:
For what it’s worth, the World Health Org has declared that the US has the best health care in the world. Their overall rating was lower than first because of the costs, not because of the results.
February 3, 2010, 2:14 pmLarryA says:
I’d guess price was a lot less of a consideration for a premier than a peasant. It would be interesting to know whether he’s paying personally.
Another factor may be timing. “You can have the surgery next week in Boston, or sometime after Christmas in Toronto.”
February 3, 2010, 2:15 pmAbdul Abulbul Amir says:
Canada keeps its health costs low by restricting capacity well below demand. That is why the Jepp kids were delivered in Billings (pop 50k) instead of Calgary (pop 1 million).
The Premier really had three choices.
Wait for a slot to open up in Canada and maybe die in the waiting line. Potentially slow motion suicide.
Use political clout to jump the line at significant political risk. Political suicide.
Go to the US for treatment. Politically risky, but not as risky as jumping a waiting line.
Clearly a trip to a country with world class medical treatment is preferable to either political suicide or physical suicide.
BTW, one measure of a country’s health care system is the degree to which it is a source or a destination for health care tourists.
February 3, 2010, 2:23 pmJPG says:
… they also need to refer their patients to other Canadian cities/provinces for some specific treatment. What does it tell us about Canadian healthcare? Well, I say it tells us more about this blog than anything else, since many VC bloggers show little concern for accuracy on this issue. No offense, but if you want to swarm this topic with convincing evidence our (Canadian) system is rotten, you’ll seriously need to search more.
February 3, 2010, 2:29 pmDotar Sojat says:
If we go full Obamacare, where will Canadians go then?
February 3, 2010, 2:30 pmAbdul Abulbul Amir says:
“Rotten” is a strawman. Restricting capacity to keep costs down makes a great deal of sense for Canada, because there is plenty of capacity right next door. Why spend on a sprinkler system when you live next door to the fire house? Sure a few more people with limited means suffer or die in waiting lines, but that number is small.
February 3, 2010, 2:45 pmHouston Lawyer says:
If we go full Obamacare, where will Canadians go then?
To the front of the line here. Don’t presume that foreign dignataries won’t rank before you here. Plus, Canadians wouldn’t care if he jumped the US line.
February 3, 2010, 2:46 pmAnthony says:
Broadly speaking, the US system is better at urgent care and worse at routine care. Since you get by far the most bang for the buck out of routine care, this results in the US system having fairly worse results per dollar spent. Of course, we spend a lot more.
February 3, 2010, 2:52 pmalex says:
It’s not exactly a secret that the great majority of the world’s top surgeons are concentrated in the US. In addition to the various reasons to stay (money, research, prestige) it’s unquestioned that the US has the best training in the world so people come for that and stay after. Canada isn’t actually that bad because it so strictly limits the number of doctors (doctors = expensive) that most of them end up getting solid training and being pretty good. The EU and UK are awful by comparison though, just horrendous training. Knew a guy who came here from “socialist paradise” and took a pay cut to work 80 hours a week instead of 37 because he’d do more surgery in a year here than three there. When you select for personalities like that it’s not terribly hard to understand where the surgeons you want operating on you are going to be.
Anyway, I don’t blame the guy for coming here. What are you going to spend your money on that’s more important than, um, the best heart surgeon?
February 3, 2010, 2:55 pmptt says:
In related news, a South Dakota gas station attendant died this morning as a result of an easily treated but pre-existing condition.
February 3, 2010, 2:56 pmLibertarian1 says:
If you were a really outstanding, highly skilled, world renowned surgeon and could practice in a country where your salary and benefits were fixed with no upside or you could practice in a location where you would be paid commensurate with your skills on a fee for service basis with unlimited upside, where would you go?
For the usual and customary normal every day practice of medicine you don’t need the best and the brightest. That is why our future here in the US will be nurse practitioners. But if you really do want the very best and money is no object you leave Canada and go to the place where you can get the best opportunity for success.
IANAL, but if I want the very best possible legal advice, with money no object, I would think a big city major law firm would be a better choice than John Q Lawyer in Podunk.
February 3, 2010, 2:57 pmRPT says:
This is really the conclusive point in the health care debate. Everything is settled. No further evidence or discussion is required. Americans who cannot afford to travel internationally should “not get sick” and if they do, they should “die quickly.” Conservative paradise.
February 3, 2010, 3:01 pmDave N. says:
ptt,
Didn’t quite understand your snark. Are you saying that somehow this hypothetical gas station attendant was denied emergency treatment? Or what? Or are you just spouting Kos-like talking points?
February 3, 2010, 3:02 pmDave N. says:
Quick, can you name the Governor of Wyoming? How about South Dakota, New Hampshire or Alaska? Would you recognize any of these people if they came up and shook your hand?
Didn’t think so. Why would the premier of one of the smallest provinces in Canada have any more recognition than the governor of any one of the smallest American states?
February 3, 2010, 3:05 pmBob from Ohio says:
In related news, a Newfoundland gas station attendant died this morning as a result of the lack of an adequate treatment available in his country.
Available in the US but he was not a senior government official, alas.
February 3, 2010, 3:07 pmCJColucci says:
So we have the dead South Dakota gas station attendant who could not get routine care because he didn’t have the money and the dead Newfoundland gas station attendant who could not get some kind of non-routine care in time because he had to wait — and wouldn’t have been able to pay for it if it were available. There’s plenty of room for arguing over which system is better or worse, but for large numbers of people, the choice is between no care and delayed care. And a non-trivial number of people will suffer either way.
February 3, 2010, 3:18 pmCarl Donath says:
ptt,
If it’s easily treated, why didn’t he get it treated? Did he discuss payment options with the doctors? Did he spend the equivalent amount on what amounts (for the bulk of humanity) luxury items? Did he walk into the emergency room, where there IS a sign saying “we will treat you regardless of cost”? What, BTW, was he paying for rent/car/food/entertainment/etc. – and why didn’t he include his own health coverage in that slate of essentials?
RPT,
The reverse snarkiness is: everything in the health care debate is settled – nobody is expected to put in the slightest personal effort at servicing their own health like they would service any of their own other necessities; be it employer or government, _somebody_ (other than the patient) is supposed to pay for all-or-nothing perfect leading-edge medical treatment without consideration of cost or alternatives (including “no, I really don’t need _that_ treatment”).
Come on now. Let’s see some effort put into addressing & solving the issues with something a bit more depth than all-or-nothing, taxpayer-expense, perfect-leading-edge-everything, no-personal-responsibility rhetoric. Yes people get sick, and no we don’t want them to die; how about we address solutions like payment plans, interstate insurance options, good-enough solutions, tort reform, etc.? Quit the demonization of the opposition already; no wonder “everything is settled”: anyone who thinks differently is wrong without further consideration.
February 3, 2010, 3:21 pmSteve says:
Sure a few more people with limited means suffer or die in waiting lines, but that number is small.
What’s amusing is that people draw conclusions about which system is better for “people with limited means” based upon anecdotes about members of the power elite going doctor-shopping.
February 3, 2010, 3:22 pmPubliusFL says:
Well, for one thing, the smallest province in Canada is different from the smallest state in the U.S. I can name about twenty governors off the top of my head. If I were Canadian, that’d be all of ‘em — twice! ;)
February 3, 2010, 3:23 pmMCM says:
And yet tens of thousands of Americans go to Mexico for health care.
February 3, 2010, 3:30 pmDNJ says:
Because there are only 10 provinces in Canada and Danny Williams has been involved in high profile political battles with Prime Minister Stephen Harper.
February 3, 2010, 3:32 pmSun Tzu's Nephew says:
I’m a physician, born and trained in the US, and licensed in both the US (5 states) and Canada (4 provinces, including Labrador and Newfoundland).
It’s somewhat unfair to compare the abilities of Canadian health care to that in the US…the population of the US is about 10x that of Canada, so there are many resources that the US has that Canada is simply not large enough to have: Particularly in terms of scale (it’s better to have surgery, for example, at a hospital that does a LOT of that type of surgery than only one or two a year)…
However, California (my home state, and where I was trained) is about the same size in population as Canada (both around 35-million).
How many people from California go anywhere in Canada for medical treatment? When I was an attending physician at “TBHWOTM” (the best hospital west of the Mississippi) I had several patients from British Columbia and Alberta who had flown down for treatment: Both self-referrals and transfers from the provincial health systems.
The reason that Canada can have the medical system they do (and I’m not saying it’s bad and the US’ is good – they each have serious deficiencies, just different ones) is because the US is here to pick up the slack. As long as political decisions govern medical treatment (and provincial budget decisions that define what resources are going to be available are political) then it’s a good thing that Canada has a relief valve.
What will happen when President zero has his way and ruins healthcare in the US? Where will Canadians go? Where will Americans go?
February 3, 2010, 3:33 pmsashal says:
and Germany beats USA and Canada.
February 3, 2010, 3:37 pmYeltsin went there for his heart surgery
James N. Gibson says:
I’m going to put my two bits into this debate.
Bit one: In 1993 my dad had a heart attack half way across the Atlantic on the QE2. Great medical care because it was the biggest ship in the cruiseline. But it took us forever to get him released to fly back to the US for bypass surgery. And to make matters worse, it seemed the Brits loved my father because his medical insurance paid for everything.
Bit two: a few years ago a co-worker was going to England to have a special surgery performed on her husband. It wasn’t that the surgery couldn’t be done in the US, it was that the surgery was not approved by the Federal government. So its not impossible that the type of surgery the NL Politician is having done isn’t approved throughout Canada.
February 3, 2010, 3:41 pmERH says:
I guess it would make no difference that CBC reports there’s no wait time for serious heart surgeries in Newfoundland?
February 3, 2010, 3:50 pmAbdul Abulbul Amir says:
Wait times in Canada are not mere anecdotes. This link is from the CBC.
Here is more recent data.
People with means, regardless of power, have the choice to “doctor shop” or accept the suffering and risk of death while waiting. Those without means don’t have that choice.
February 3, 2010, 3:51 pmChris Travers says:
One thing I would recommend in terms of an actual data point is looking at relative severity of the SARS outbreak in Canada vs the US.
February 3, 2010, 3:53 pmPaul Horwitz says:
It seems to me that virtually every commenter so far, whatever their position on matters of health care, has actually disagreed with Todd’s post, to the extent that it said that the story “speaks for itself.” Mirabile dictu, people from all points in the debate appear to agree on one thing: that a single anecdote, shorn of context, does not actually tell us all that much. The story might be illustrative of systemwide flaws in Canadian health care, or it might not; it might be illustrative of systemic flaws in Canadian health care, without saying anything about systemic flaws in American health care; it might say something about flaws in difficult cases in Canada but not about the delivery of routine or preventive care; it might just mean that the best available doctor for the care needed lived somewhere else; it might even just say something about the quirkiness of this particular individual’s choices. But, just about everyone seems to agree, it does not simply “speak for itself.”
Never say that consensus is impossible on divisive political issues!
February 3, 2010, 4:01 pmChris Travers says:
Cuba? At least for Canadians….. Maybe it would be a good time to lift the embargo….
February 3, 2010, 4:07 pmptt says:
How many people from California go anywhere in Canada for medical treatment?
I know of two couples who moved to Canada for medical reasons, one because they had a child with serious disabilities.
February 3, 2010, 4:11 pm1040 says:
This post, by Todd Zywicki, pretty much speaks for itself.
February 3, 2010, 4:13 pmVirginian says:
How quaint. You must be new to the internet.
February 3, 2010, 4:14 pmJPG says:
Can you please qualify what you mean by “next door”? Because, as a Canadian, I know no one who had to go to the US for specific treatment, while I do know of at least a handful of inidividuals who had to get treated somewhere else than their own locality in the Canadian public system to seek/get refered to for treatment.
The strawman, here, seems to be the whole idea that the Canadian system relies so much on the American one. It may be true locally (Windsor, ON – Detroit, MI, for example), while the phenomenon clearly is exagerrated by those who stress your point of view.
If you have, on hand, reliable data suggesting Canadian patients significantly rely on the US (other than anecdotal or geographical instances), feel free to share your findings with us.
The real problem here seems to be with waiting lists, but I don’t know that so many Canadians go south to speed things up. If you want to take anecdotes into account, you’ll have to consider how it appears to be the other way around, with many American immigrants with a specific medical condition moving up here in hope they’ll be have access to treatments they couldn’t afford insurance for in the States.
February 3, 2010, 4:23 pmyankee says:
Is there really any dispute that the best healthcare in the U.S. is the best healthcare anywhere in the world?
The average healthcare in the U.S., on the other hand, is the worst average healthcare in the developed world. It’s just another instance of the U.S.’s gross inequality.
February 3, 2010, 4:26 pmI Agree With Yankee. However . . . says:
Yankee, I agree with the sentiments expressed in your post.
However, I am conservative, and so I don’t care. I’d rather have healthcare suck for most people than suck for me.
February 3, 2010, 4:32 pmorca says:
Speaking of anecdotes, I saw a report recently on Americans going to China and India to have surgeries performed. Time and money were both given as reasons and their insurance companies are happy to foot (the cheaper) bill.
February 3, 2010, 4:33 pmChris Travers says:
Maybe, but if you try to supplant the existing system with a new one, it will take some time to get the bugs worked out. Average health care will degrade for this period of time.
February 3, 2010, 4:36 pmjervil says:
Right on Todd, America is the place where anyone who want’s it can just walk into any hospital and get their heart surgery done.
Is that what you mean by “speaks for itself”.
February 3, 2010, 4:38 pmnice strategy says:
Nothing in the current reform proposals will preclude people with the means from seeking out treatment in a secondary market, and if libertarian economic theory is remotely correct, supply will meet that demand.
“Obamacare” or whatever you want to call it is nothing like the Canadian system. Slippery slope arguments are fine and good, but treating possible future developments as assumptions to take great weight in a cost/benefit analysis is a farce.
February 3, 2010, 4:54 pmys says:
Yeltsin invited Michael E. DeBakey from Houston to come to Moscow to do his surgery. We are of course not discussing Russian single payer healthcare system here. Note: Yeltsin was president of a major power.
February 3, 2010, 4:59 pmThales says:
Yes, the article speaks for itself. It says that a single patient with a particular condition chose to go to another country and a particular doctor for treatment of that condition. It doesn’t say anything about whether the procedure was promptly available and of high quality in his own country. It’s anecdote, and the plural of anecdote is not data.
Also, the quality of health services professionals and the quality of a given country’s health care system (meaning how care is administered, planned, rationed and funded) do not have an obvious or necessary connection. In some cases they do, but the idea expressed in some comments that Canadian (or Japanese, or whatever) doctors are somehow substandard simply because the government rather than a private insurer foots the bill needs substance and evidence rather then innuendo. It may in fact be true that there are bad incentives in a given system which negatively affect doctor behavior, but you don’t prove it true by growling (in the voice of Phil Hartman’s Frankenstein’s monster), “government [or free market]bad!” France’s quality of care, routine and emergency, and health effectiveness per dollar (Euro) spent is on almost every available metric better than that of the United States–that is a verifiable (or falsifiable) empirical statement.
February 3, 2010, 5:01 pmChris Travers says:
“Obamacare” or more properly “HarryCare” is a horrible mess that is exactly what Congress excels at producing. Nobody I know of really wants heath care reform to take that shape. But since folks can’t agree on what shape it should take, we get this sort of monstrosity.
Prediction: Some elements of the current healthcare proposals will be passed, but nothing comprehensive.
February 3, 2010, 5:14 pmIlec says:
Actually Danny Williams would be recognized pretty much anywhere in Canada. He is a larger than life character who punches above the weight of his province politically. I do confess that I wouldn’t recognize Ed Stelmach though (Premier of Alberta). Does that count?
February 3, 2010, 5:19 pmGordo says:
And the flocking of thousands of Americans north to Canada to get affordable prescriptions also tells a story, doesn’t it Professor Zywicki?
This story tell us the pitfalls of a “single-payer” system – but there are quite a few other templates out there for provision of universal health insurance to a civilized nation’s populace.
February 3, 2010, 5:35 pmBrett says:
Moreover, the Premier of Newfoundland is hardly a typical heart surgery patient. Does anyone here think that what he’s probably getting is realistically available to the rest of the US population?
That was in Quebec, and it was for a very limited set of services that the Supreme Court determined to not be realistically available at anything resembling a reasonable time (funny story – no one is buying the duplicate private insurance offered for the services in question).
The claim that many Canadian patients are heading southward for anything other than non-vital (read: cosmetic) care is a myth. It’s actually a small handful, and usually only on very rare circumstances.
February 3, 2010, 5:37 pmSun Tzu's Nephew says:
And who went and supervised? DeBakey.
February 3, 2010, 5:56 pmSun Tzu's Nephew says:
Yeah. They’ve got great care there: When Fidel needed surgery (which, btw, wasn’t any big challenge) they had to import a surgeon from Spain.
February 3, 2010, 6:00 pmSun Tzu's Nephew says:
Physicians in Canada can recommend anything we want. Getting the province to approve payment in advance is a completely separate matter, and in many cases the approval process drags on so long that the patients lives are endangered.
February 3, 2010, 6:02 pmSun Tzu's Nephew says:
Money, perhaps…there’s no problem with getting surgery in the US because of scheduling.
The interesting problem is who’s responsible for follow-up? What happens when such a patient is on the plane home and has an adverse event? I’ve had to deal with patients like that in the hospital, even finding out what surgery they had is a challenge (“I had my stomach operated on”). Records may not even be in English, and are less than complete.
February 3, 2010, 6:05 pmSun Tzu's Nephew says:
Yep. Illegal aliens get heart-lung transplants, Canadian Prime Ministers, members of parliament, and premieres get whatever they want – and so do their families instead of waiting with the hoi-polloi serfs.
The United States protects Canadians in ways other than national defense, too.
February 3, 2010, 6:07 pmSun Tzu's Nephew says:
He’s confused with that guy on ‘This Hour has 22 minutes’ ;)
February 3, 2010, 6:08 pmSun Tzu's Nephew says:
It’s a true ‘myth’ then: Search for yourself and see how many high-risk pregnancies have been transfered from BC, Ontario, and Alberta (at a minimum) to the US because there aren’t enough suitable beds in provincial hospitals.
http://en.wikipedia.org/wiki/Health_care_in_Canada#Canadians_visiting_the_U.S._to_receive_health_care
David Gratzer is a Canadian physician: http://www.city-journal.org/html/17_3_canadian_healthcare.html
Here’s one (of several at least) Canadians who needed brain surgery and got it in the US:
February 3, 2010, 6:14 pmhttp://www.youtube.com/watch?v=X_Rf42zNl9U&feature=related
Sun Tzu's Nephew says:
And broadly speaking, Canada has the same problem with primary care as the US does: 20% of Canadians don’t have a primary care physician at all, which means they can’t access any medical specialists – without going to the Emergency Department. In the US, people who don’t have a primary care physician can book whoever they want for a specialist consult.
February 3, 2010, 6:17 pmThales says:
“there’s no problem with getting surgery in the US because of scheduling”
Clearly the author of this comment has never needed an organ transplant.
February 3, 2010, 6:18 pmSun Tzu's Nephew says:
I was working at a hospital in Kingston, Ontario when a US citizen truck driver came in, after a rather bad traffic accident. He didn’t get health care at all (we were stopped by admin) until he signed a waiver of his rights, and showed he had insurance that the hospital could bill.
Conversely, in the US a federal law (EMTALA) prevents us from asking about a patients ability to pay, and mandates that he be given emergency, stabilizing treatment (which often means full treatment).
February 3, 2010, 6:21 pmorca says:
The C.I.A. tells us Canada has the 7th best life expectancy in the world (81.23 years), the United States has the 49th best life expectancy (78.11 years).
February 3, 2010, 6:35 pmTom in Houston says:
About the Premier’s circumstances, not about the two countries’ respective systems. The urge to snark must be pretty strong, eh?
February 3, 2010, 7:17 pmNorthern Dave says:
That’s not exactly a whole lot of difference considering there are 10 times as many of you and your hot southern states and D.C. drag your average down……
February 3, 2010, 7:22 pmNorthern Dave says:
Sun Tzu said:
“Conversely, in the US a federal law (EMTALA) prevents us from asking about a patients ability to pay, and mandates that he be given emergency, stabilizing treatment (which often means full treatment).”
Really? My father-in-law was in Vegas a few years back and having heart trouble. Before they would admit him at emerge he had to produce proof of insurance or a gold card (he’s a Canadian). They did an OK job and 17K later he wandered out alive (thank you excellent Vegas doctors). Canadian doctors have saved his life, too (thank you excellent Canadian doctors).
Anecdotally most of the fellows I’ve known who go stateside for professional reasons come back to Canada for medical cost reasons :-) As one old friend said, “Medical care down here is better if you’re rich: I’m top 1% for earnings so for me it’s great!” – note: he’s still healthy……
Maybe the rules have changed…..
February 3, 2010, 7:30 pmNorthern Dave says:
PS – the CIA factbook – is it a conspiracy? :-) – indicates Bosnians also outlive the average American…is it a product of their marvelous health care system?
(Don’t get me wrong, all four of my wife’s and my parents are still alive due to excellent health care, doctors and amazing pharmaceuticals that inhibit strokes, allow heart surgery to work, etc., etc.)
February 3, 2010, 7:37 pmq says:
One of these days, I’d really like to see a controlled analysis. Life expectancy is more than just health care.
February 3, 2010, 7:44 pmArtemis says:
This hardly the first time a province’s Premier took off to the US for medical care. Just off the top of my head I recall Quebec’s Robert Bourassa heading to the US for his melanoma treatment.
February 3, 2010, 8:24 pmalex says:
“Moreover, the Premier of Newfoundland is hardly a typical heart surgery patient. Does anyone here think that what he’s probably getting is realistically available to the rest of the US population?”
Seriously? Do you really know this little about how US health care works? The guy he went to is probably at a Harvard, Hopkins or other leading academic hospital. While they have arrangements for VIPs who do not have insurance accepted by these hospitals, every one of these surgeons accepts some form of insurance. It is a strong point of the US system that we DON’T drive these people out into cash-only private practice, although the forces pushing them that way get a little stronger every year.
To throw some facts into the discussion: when I was on cardiac surgery at Harvard/Brigham, the number of uninsured patients was higher than the number of VIPs. Sorry to burst your bubble.
February 3, 2010, 8:40 pmChris Travers says:
Actually, EMTALA is one of the good things in US medical law. It means that if you go to the hospital in a full medical emergency they don’t wait for proof of payment. This saves lives not only of those who are uninsured but also of those who are insured and can pay because it means more timely care.
However, at this point I have to stop praising our system. Beyond that, things get really messy fast. We have remarkably few consumer protections regarding medical insurance and medical care outside of tort law, and often times insurance companies will reject valid claims on the theory that some people won’t reapply. Add to this language in most insurance contracts that allow insurance companies to arbitrarily (from the patient’s perspective) decide to refuse to pay and you have a mess. In short a patient today has no advanced way to know whether insurance will or will not pay the hospital bill.
I don’t think that medical care should be treated as a simple commodity. However a number of reforms are in order to make it behave more like one. The sad part is that you have more financial protections taking your car to the mechanic than you do going to the doctor for non-routine but non-emergency care. This has to change.
February 3, 2010, 9:02 pmzuch says:
Ummm, the province of Newfoundland and Labrador? Not exactly chock-full of top-flight research institutions (unless your academic specialty is aquaculture or such….)
Not to be too unfair; I’ve known a number of smart Newfies, but the fact remains it’s not exactly at the cutting front in medicine….
Cheers,
February 3, 2010, 9:23 pmCareless says:
Now that’s incredibly inaccurate and insulting to Newfies. Per capita GDP Newfoundland: C$61.7k. Per capita PR: $19.6k, and half the island is on food stamps. That’s like comparing Detroit and Manhattan, except a Manhattan with cheap land.
Yeah, because of the small population there aren’t a ton of medical specialists, but he still had to fly over NS and almost certainly past Quebec, and those three provinces combine for a third of Canada’s population.
February 3, 2010, 9:34 pmNorthern Dave says:
Unemployment rate for Newfoundland and Labrador for Nov. 2009: 15.9%
http://www.hrmguide.net/canada/jobmarket/canadian-unemployment.htm
Unemployment rate for Puerto Rico for Nov. 2009: 15.9%
http://www.bls.gov/eag/eag.PR.htm
(Dec. values for Puerto Rico are still preliminary)
I do like moose, but there’s a reason most Newfies live elsewhere in Canada.
February 3, 2010, 9:58 pmMark Buehner says:
Yup. You think maybe lifestyle has something to do with life expectancy? Heck, even genetics have a significant impact.
The life expectancy of Washington DC is 72 (dead last in the US), while Hawaii is 80, which dwarfs the difference between the US and Canada. Link
Sooo, is the healthcare in Hawaii compared to DC three times better than difference between the US and Canada?
February 3, 2010, 10:02 pmresh says:
Somebody check and make sure he’s not on the NO-FLY list. Just sayin’.
February 3, 2010, 10:03 pmCareless says:
I’m well aware of the problems of NFL, but saying that it’s similar to a bunch of people who mostly can’t afford to feed themselves is absurd.
February 3, 2010, 10:39 pmSun Tzu's Nephew says:
And lets not forget Belinda Stronach, too….
And Jean Chretien….
February 3, 2010, 11:01 pmhttp://ezralevant.com/2010/02/danny-williams-flies-to-us-hea.html
Careless says:
Newfoundland’s capital, for those who haven’t been, is sort of like some of the older, less densely populated parts of Boston, but with a native accent that’s a cross between Boston, Irish, and Pirate. It can be pretty amazing, although I don’t know anyone under 40 who had a strong form of it. Friendliest place I’ve ever been.
February 3, 2010, 11:02 pmDave Ruddell says:
I think it might be worth pointing out that Danny Williams’ nickname is Danny Millions. The guy is loaded. So, this isn’t a case of a politically well-connected Canadian going to the US for surgery, it’s a wealthy Canadian going to the US for surgery. That happens all the time.
February 3, 2010, 11:59 pmJPG says:
Yes, indeed, Robert Bourassa was headed to Maryland for experimental treatments that were then offered nowhere else than in Maryland at that point, at the expense of Quebec’s healthcare system.
So what’s your point again?
February 4, 2010, 12:14 am1040 says:
I think TZ makes a very convincing argument. The only way his argument could’ve been more convincing is if he had ended it with “Yeehaw!”
February 4, 2010, 12:24 amJPG says:
Danny Williams stopping by Nova Scotia for treatment? Why not Rhode Island while you’re at it? And if you knew any anything about Canadian politics and canuck journalism, you’d know bettew than for an Eastern provincial Premier stopping by in Quebec for anything else than a coffee, unless you assume highly politically suicidal tendancies to be at stake…
February 4, 2010, 12:29 amCareless says:
Is it better for him to go to the US for treatment? Are Canadian politicians expected to go to the US for treatment to such a degree that to visit a different, much more populous/urban province for surgery would be an insult? That would say quite a bit more about the state of the Canadian health care system than the OP
February 4, 2010, 12:50 amorca says:
It’s the difference between living long enough to see your grand kids enter high school and living long enough to see them graduate from high school…
February 4, 2010, 3:22 amJPG says:
Well, we know little about this story as of now. The type of surgery Danny Williams is seeking still remains undisclosed, yet we don’t even know where he checked in. Deputy Premier Kathy Dunderdale would have told reporters the surgery cannot be done in Newfoundland, but she didn’t mention if it could be done elsewhere than a specific location in the US.
Like other commentors previously mentioned, there already are many other reasons we can think of why it would be better for him to seek treatment far away from his constituency and from national attention, would the treatment be available for him in Canada. You understand that, do you? And what if the treatment was an experimental one, only available in, say, Mass. or NY? Would his decision truly be a slap in the face of the Canadadian healthcare?
Lets not jump to conclusions too fast. It would be wise to wait until we know at least a little bit more before we do. Seeing how Fox News and the conservative blogosphere jumped on this story, this debate taught us so far much more about the passionate nature of the critique of Canadian healthcare in the US. Of course, not all critiques are undeserved, but to see this blog jump on the wagon so fast, considering the little we know so far, is heartrending.
I think we all know where Zywicki is going when he leads this story, no matter what the facts may be.
February 4, 2010, 6:32 amAbdul Abulbul Amir says:
A stat that being posted in this thread presumably means that factors such as murder rates, illegitimacy rates, diet, obesity, smoking, drug use, motor vehicle use, etc. are either equal or have no effect on life expectancy. Not likely.
Canada’s health care system is so good that Canadian residents suffer tropical diseases at a much lower rate than US residents.
February 4, 2010, 9:25 amMark Buehner says:
No, its better for him to die quietly, that’s how the system ultimately works if your don’t have a US to bail you out in a pinch. Who would bail us out?
February 4, 2010, 9:25 amAbdul Abulbul Amir says:
That is why Canadian women with high risk pregnancies show up in US hospitals year in and year out. Pregnancies have their own timetables. The idea that you can tell a woman going into labor that there is a three month wait list just won’t fly.
Again, this makes good sense for Canada. It would be far more costly to maintain the capacity needed to cover every pregnancy that to send a dozen or so deliveries south every year.
This is kind of like electricity generation. Base load power is the cheapest to generate and peak load the most expensive.
The wait lists save the Canadian state money in two ways. One is that some folks will go to the US for treatment and pay for it themselves. The other is that some folks will die waiting for service.
Canada has opted for a defacto two tiered system. One tier involves a wait list in Canada, the other tier for those with means or connections is in the US.
February 4, 2010, 9:41 amRuralcounsel says:
That isn’t a scheduling problem. That’s a lack of transplant organ problem.
February 4, 2010, 9:46 amRichard Aubrey says:
rural.
February 4, 2010, 10:12 amShame you had to point that out.
Thales says:
Fair enough–I was conflating low supply and wait time, but they are both dimensions of non immediate availability (and either has the same effect of not getting a needed transplant to a patient). I’m not saying it’s necessarily better or worse in Canada or France (again, an empirical matter), just that our system doesn’t always deliver what’s necessary when it’s necessary. Before you accuse me of being a pinko, I’m also of the controversial but I think justifiable view that we should allow payment for organ donors to partially alleviate the supply problem.
February 4, 2010, 11:07 amRichard Aubrey says:
Thales,
February 4, 2010, 11:12 amUnless you think paying for donated organs will free up the supply, the difference is that wait times are an artifact of the system and organ availability is not.
So when discussing the system, conflating the two looks kind of odd.
Owen B says:
By my count, a full 73.4% of the comments above are composed of anecdotes. I thought this was a blog for serious, thoughtful people who came to opinions based on data and evidence. Guess not.
With that in mind, I submit the following 2002 study that showed that in three US border states, the population of Canadians coming over is negligible. I invite anyone with information to refute the study: “Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States,” found at http://content.healthaffairs.org/cgi/content/long/21/3/19. Abstract:
February 4, 2010, 11:17 amThales says:
Allowing a monetary price to be set by a market for organs ought to free up supply when there is currently a statutory price cap of zero, assuming the standard upward sloping supply curve. The lack of that feature is part of our system as well . . .
February 4, 2010, 11:26 amMark Buehner says:
Canada’s waiting times have increased radically in the last twenty years:
NYT
February 4, 2010, 12:06 pmJPG says:
Mark Buehner, your (and the NYT’s) analysis are based on data from the pre-Chaoulli era. Nowadays, if you absolutely want to skip waiting lists for your ambulatory care, you can have access to a myriad of resources offered by private institutions within Canada. If you were willing to pay for your hip replacement in Canada, you wouldn’t necessarily have to go south. Just google the clinics who will offer the surgery in your area.
Private care can’t be found equally in each of the ten provinces and three territories, and all services aren’t yet available locally, but all provincial governments have taken a step in that direction. But the assertion that those who seek to avoid waiting lines absolutely have to move to the US for treatment simply doesn’t stand. Canadians who wish to pay for quick high end services can do so, and they do, without relying on American institutions. It is a fairly new phenomenon, but it nevertheless is very true and more and more common.
February 4, 2010, 2:43 pmBleh says:
I hear ya.
A friend of mine just died because of an infection that spread to a valve in his heart. He had “good” insurance. that would cover the neccesary surgery to replace the valve. But since it was an HMO they “couldn’t” move him to the hospital where their surgeon was located until a “bed opened up”. By the time the bed did open up, he had a fever and couldn’t be operated on.
I mean, you can’t expect them to move him to another hospital, not within their network, just because he had a life threatening emergency condition, right?
Yeah, our medical system in the US really knows how to respond to emergency situations… if you have enough money that you don’t have to rely on insurance…
February 4, 2010, 3:35 pmBleh says:
Thread winner.
February 4, 2010, 3:49 pmMark Buehner says:
Raise your hand if your insurance requires you to go only to hospitals in your network for a life threatening emergency? Yeh, me either.
February 4, 2010, 4:15 pmBleh says:
I imagine a standard contract. The insurance was through his employer, but having worked at the same company for a while I know it was better than most employer provided insurance tends to be.
I didn’t even know about it until he was already in a coma, or I would have told his family to have him sent to another hospital. My point is that his insurance company should have done it on their own — since he was fully covered they should have sought out immediate treatment if they weren’t able to provide it — instead of taking advantage of his family’s ignorance on that issue.
Also of interest: at his funeral, I learned that he’d gone to the doctor a week before he had to be rushed to the hospital. He told the doctor he didn’t feel well and related his symptoms. The doctor sent him home with a mild antibiotic and no further tests.
I’m mainly throwing his story out there because some people on this thread seem to place a lot of weight on anecdotal evidence.
February 4, 2010, 4:18 pmBleh says:
Raise your hand if you think you can make good decisions about your health care after you’ve been placed in a medically induced coma by your insurance carrier’s hospital?
I should note that the insurance policy of his company allowed him to choose from several different providers (some PPO some HMO). It’s possible he made a bad choice.
February 4, 2010, 4:21 pmMark Buehner says:
February 4, 2010, 4:23 pmHere’s an update:
Mark Buehner says:
How can you make any decisions in a coma? I’m not sure what your point is. If your in your insurance carriers hospital, why does it matter? Are they keeping you in a coma against your will?
February 4, 2010, 4:25 pmNorthern Dave says:
Well, to be fair we were responding in kind to the anecdote about Premier Williams :-)
Scientifically, Owen, one would have to include the use of US medical facilities by “Snow Birds” – those older Canadians who spend 6 months less a day in Arizona, NM, Florida, Texas, etc. – and a whole host of other things to rate Canadian use of US facilities. The issue being raised by the blog is that there is obviously a superiority in a system which other systems must rely upon when push comes to shove. I appreciate the anecdotal comments of Sun Tzu etc very much as they are real cases relating to this issue.
Personally, I am convinced the Canadian system is better for the poor and middle class and the US is better for the rich. Since rich Canadians can access the US system, we Canadians have the best of both worlds :-)
February 4, 2010, 4:27 pmBleh says:
Allow me to elaborate. He was taken to his HMO’s hospital because he was disoriented. He coded, they had to stick a tube down his throat so that he could breathe. At that point they put him in a medically induced coma. They realized what was wrong with him and that he needed a new heart valve. But they couldn’t transfer him to Los Angeles, where the surgeon was, because there was no “bed open”. Instead they left him lying in the Inland Empire for two days before transfering him, by which time he’d developed a fever and couldn’t be operated on.
My assertion is, there were no other surgeons anywhere, that were less than two days away, that they could have taken him to?
Unfortunately, I wasn’t there, so I don’t know exactly what happened… But I think there’s as much damning evidence in this story as there is in the story about the Canadian Premier.
February 4, 2010, 4:36 pmMark Buehner says:
Bleh, i’m sorry about your friend, I didn’t realize this was a first hand account. But lets examine this- you say ‘they’ left him lying. Who do you mean? Certainly not the insurance company, they don’t make those kinds of decisions and I think we can all agree that’s a good thing. The hospital? I guess its a question of how dire they thought the emergency was. Obviously it was life threatening, and if they were negligent we have a system in place to try to provide some small measure of compensation for that. But the devil is certainly in the details. Was the family involved in the decision making? I’m not trying to point fingers either but I don’t see how this kind of tragedy couldn’t have happened under any health care system. If anybody knew at the time it was a death sentence to not operate, surely things would have been done differently. But ultimately the insurance company had no hand in the decision making. Would they have paid another physician to perform the surgery if it was a medical necessity, life or death? Yes, unless there was some policy i’ve never heard of they would indeed (at least the ‘unusual and typical rate’ or whatever they call it). This is a terrible tragedy, but you hear too many stories like this that mischaracterize the systems role in things.
February 4, 2010, 4:45 pmBleh says:
Thank you.
The fact that the insurance companies name is on the hospital makes me think they have some choice in the decision process.
True. Compensation seems somewhat less desirable though.
Yes. But we’re not talking about people of means here, or even well educated people here. When a doctor told them that their son needed surgery and that it had to be done in LA, but that they had to wait, I assume they had no idea there was an alternative or they would have probably taken it. Likely they just saw an authority figure in a white jacket and nodded at what he said.
Obviously there was something wrong. He’d already coded once. When they learned they didn’t have the facilities to treat him, they should have transferred him out of network. Instead they hesitated, and it cost him his life. My point is that if you’re going to claim that the US has the best emergency care in the world based on anecdotes, you have to take into account instances like this — where it seems like something could be done, but the system as it exists gets in the way.
I completely agree. No healthcare system is perfect, so lets not act like the one we have is and demonize every other healthcare system based on anecdotal evidence.
Do I support the current health care bill? Not really. Do I think there’s a lot of room for improvement? Yes. Am I willing to turn my nose up at a single payer system or some other option just because of some anecdotal evidence or because it smells a little of socialism? No, not until I’ve seen some actual data.
Our system works great for the rich. The answer everyone who is not rich is always given is: insurance. But where there’s such a strong profit motive, in my experience, health care becomes a secondary concern to most insurance companies.
PS: I apologize for personalizing this issue. I just felt like the hypotheticals you were dismissing as unlikely (South Dakotian) were very similar to something that I actually saw happen. And I assume, that my friend isn’t the only one it’s happened to.
February 4, 2010, 5:07 pmDawn Slagle says:
I am an Rn,living in Cleveland area.As for waits in healthcare…My father was diagnosed nasal polyps oin January 3 1/2yrs ago.Biopsy was negative. Dr office waited 2 months to get him into surgery. By the time he had surgery his biopsy was positive.Had the cancer removed while in surgery and was scheduled 3 weeks later for a PET scan to see if it had spread anywhere.Something came back as “suspicious” a 1 1/2 wks later.Results showed something on the liver that had just accidentally was exposed. 2 weeks later scheduled for lower body CAT scan. Showed micro tumors on his liver. Chemo and radiation started in June. (6 months after diagnosed w/ Ca.)He died a year later of Ca of the liver.EVEN THE CLINIC COULDN’T SAVE HIM AFTER ALL THE WAITING!
February 5, 2010, 9:06 amNorthern Dave says:
My condolences Dawn………thank you for sharing. Failures in the medical system happen up here in Canada, too. Wait times is a huge issue here.
See:
http://www.ncpa.org/pub/ba649
and especially,
http://www.cancercare.on.ca/ocs/wait-times/radiationwt/
Even with perfect care and everything done immediately my wife’s manager’s wife is dying with Stage IV cancer throughout. God grant a swift cure be found to this foul disease.
February 5, 2010, 10:33 pmRockinon says:
Danny Williams is a millionaire. I’m not. I stayed in Canada and had my robotic open heart surgery done in London, Ontario, at the London Health Sciences Centre. That was more than seven years ago and I have been left with almost no visible scar and I have no need for any meds because the surgeon directing the robot repaired my valve and did not put in a new one made of metal. This means that I don’t have to take blood thinners.
For people who are not millionaires, the Canadian health system is actually quite good. Not perfect but what in life is?
February 28, 2010, 11:48 pm