Thursday, November 08, 2007

Two-Tier Health Care kills

Avi Lewis has an excellent piece in today's Globe and Mail about how two-tier health care in Ireland murdered a woman named Susie Long. It's behind a firewall unfortunately, so here's the whole piece cross-posted at Common Dreams, thus losing The Globe and Mail Internet readers who could have added advertising revenue. Learn from the Gray Lady guys.
Susie Long couldn’t believe it. Sitting in the clinic, waiting for her dose of chemotherapy, she’d been making small talk with the wife of a fellow patient. The man’s doctor had recommended a colonoscopy, and just three days later, he was having the procedure. That day, Susie finished her own treatment, went home and turned on the TV. The first commercial was from the Ministry of Health: Beat colon cancer with a timely colonoscopy! And that’s when Susie Long lost it. She had waited seven months for her colonoscopy, and it came too late. Now she was 39 years old, and she was dying of colon cancer.

So when Dr. Brian (profit over people) Day and the usual suspects at the Fraser Institute wax rhapsodic about the benefits of two-tier health care, without of course ever admitting that's what they are proposing, remember Susie Long, 39 and mother of two, dead because the Irish system now lets you buy your way to the front of the line.

This is what lies at the heart of calls for private sector 'innovation' in our public system.


Steve said...

You could also argue that without the private sector, the 'rich' guy would have died as well, as they both would have had to wait, while it is sad about the death of the women, at least one life was saved, Avi Lewis is not really qualified to write on this, as he as usual has an axe to grind, the point is that the present system does not work in Canada, a combination of both is the only answer unless you want to bankrupt the country.

Cliff said...

Where do you think the doctors and resources for the man who got the private test came from? Their absence from the public system is what caused the long wait. With a single public system both the poor and rich have to use the rich have an incentive to keep the public system functional rather than agitate for tax cuts with no consequences for their health.

As for Lewis not being 'qualified to write on this, as he as usual has an axe to grind' does that mean anyone with an 'axe to grind' to promote private sector sollutions also isn't qualified to comment on the subject?

Anonymous said...


This article somehow attacks the two tier system of Ireland while ignoring the progressive social policies of the Emerald Isle such as a homemaker's allowance and policies design to overcome social exclusion.

Using the health care system to attack European social democracies is something which we Canadians love to do. Why don't you propose proactive social policies instead.

Cliff said...

So regressive social policies should be ignored?

Anonymous said...

Why are things such as private delivery of health services regressive when it is covered by government? What is wrong with creating "foundation hospitals" so that it can use market forces to reduce wait times? What is wrong with forcing employers to buy private health insurance to part time employees so they do not have to wait in a emergency unit for hours?

All these have been dismissed as regressive by you. Yes, only Cuba has the most practical solutions to improving health care standards, not European social democratic states.

Adam said...

Using individual cases to argue for or against change for an entire health care system just doesn't make sense. It may be effective at tugging at heart strings, but unless it is all too common (and even Avi Lewis doesn't indicate it to be so) then it is simply a sad story.

There are also a lot of sad stories floating around of Canadians dying on wait lists.

For what its worth, the WHO ranked Ireland's health care system as 19th overall. Canada sits at 30.

Cliff said...

Susie Long. Dead at 39.

Adam said...

"More MDs: the solution to wait times


Patricia Vepari, a 21-year-old chemical engineering student, was told by her Kitchener, Ont., hospital that doctors couldn't see her for eight hours or more. Had wait times been shorter, they might have diagnosed the meningococcemia that killed her the next day. Her story highlights the importance of how Canada's system is failing to grant patients speedy access to doctors."

From the Globe and Mail last year.

Patricia Vepari. Dead at 21.

Cliff said...

Yep and fifteen years ago there was a big fuss about the mistaken belief that we were going to have too many doctors and policy steps were deliberately taken to reduce medical school enrollment. We're seeing the results now.

But the evidence is clear that two-tier healthcare increases wait times by removing doctors from the public system. In Australia a study showed a 'perverse incentive' for doctors in the private sector to cherry pick the simplest most lucrative cases for their private practice leaving wait lists for less lucrative more complex cases to pile up in the public system and make wait lists longer and longer.

Giving the rich an escape hatch from the public system removes their incentive to maintain and improve it. Who cares if that juicy tax cut you're getting means somebody who can't afford the private insurance you can has to wait longer and longer in the public system?

Two-tier is a dead end. It's the medical gated community that allows those with means to write off those without.

Adam said...

If we did open up to private delivery of care and poaching of cases did occur, I believe that would be countered by the return of Canadian trained doctors that have moved to the US. If doctors were able to make more money here it would remove a lot of the incentive to practice in the States. At the very least, less graduating doctors would leave in the future. You have already stated that there aren't enough doctors here, it seems reasonable that if there was more money to be had then they would be more likely to stay here.

I don't know much about Australia's situation, but I do know that the highest ranked systems in the world are public-private blended systems. We can learn from these higher ranked systems as much as we can learn from the errors made by some countries.

"It's the medical gated community that allows those with means to write off those without."

Are you saying that that is what is happening in France, Italy, Germany, Japan, etc.? These countries all have two tier health care, and all of them are rated higher than Canada.

One thing I do know is that proclaiming that "Two-Tier Health Care kills" doesn't really help improve the system; it does create a culture of fear where people aren't willing to look at ways to improve the system. Don't propagate fear just so we can struggle with the status quo.

Cliff said...

Once again, the doctor shortage is not an inherent flaw of the public only system, it's the specific result of a specific set of short-sighted policy steps taken in the early 90's when policy-makers got it into their heads that they needed to reduce the number of doctors. We're paying for those policy steps now.

But a survey of Canadian doctors in the US shows many are already thinking of returning - it isn't just the Canadian dollar, or money at all, but being able to provide care based on their own medical judgment rather than what a penny-pinching insurance company will allow with a specific patient.

There are ways of improving the system within the public system. A lot of countries that experimented with two-tier have come to regret it. Sweden attempted it in one district - basically just one hospital and found it increased wait times, and like with Australia, led to doctors cherry-picking the public system for the easy money-making cases and leaving the more expensive difficult cases to line-ups that grew ever longer. The government that brought in the private sector experiments was voted out and the changes frozen or ended.

In Britain they discovered that private sector experiments like P3s ended up being vastly more expensive with huge over-runs.

Here in Calgary wait times for orthopedic cases were slashed, not by bringing in two-tier but simply by more efficient use of the public system.

When Ralph Klein talked about allowing doctors to work in both the public and a private system, rural Albertans, his natural base, thought about their doctors streaming out of small town Alberta to the more lucrative potential of the cities - and the Klein dynasty ended. What happens to the already strained supply of medical professionals in the far north or small communities when doctors can charge what the market will bear in the big city?

Bye bye Doc, be sure to write.

I repeat, if everyone has to use the same system and the same wait lists, than maybe people will think twice the next time some political snake-oil salesman tells them he can keep cutting their taxes forever with no ill-effect. If they can flee the public system and leave its increasingly crumbling remains to those who can't get insurance they have no incentive to maintain it.

Cliff said...

Re: The specific policy steps taken in the 90's to actively reduce the number of doctors. - Link is a pdf.

Adam said...

My experiences learning about the practices of US doctors (with the penny pinching insurance companies behind them) is to order every test under the sun (including many that are not easily accessible in Canada like MRI, PET, etc) in order to make a diagnosis. Whereas, in Canada physicians are trained to first try and sort things as much as possible based on clinical signs and symptoms and then order tests (so as not to bog down waiting lists even more than they already are).

Just wanted to clarify that.

Also, you should read more about the Swedish health care system. Try this:

Thanks for proving my point though ;)

Cliff said...

Sweden actually only experimented briefly with real two tier care, in one hospital. A lot of the European examples two-tier advocates point to, are not in fact two-tier. St Goran's Hospital in Stockholm was caught turning away difficult cases and making wait lists longer and Swedish experiments with private care were ended.

Here's some explanations for why two-tier is such a bad idea:

Longer wait times.

An Irish doctor lays the blame for longer wait lists firmly at the feet of two-tier.

There's a lot of reasons to avoid any further privatization in Canadian health care - one of the biggies is that it would leave us open to NAFTA challenges from the American health insurance industry to open up more of our system to help their profit margin.

So thanks, but no thanks.

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