International Medicine

Current Issue

Canadian Medicare

           

The Price of Public Health Care Insurance | 2016 Report | The Fraser Institute

by Milagros Palacios, Feixue Ren, and Bacchus Barua

SUMMARY

Canadians often misunderstand the true cost of our public health care system. This oc­curs partly because Canadians do not incur direct expenses for their use of health care, and partly because Canadians cannot readily deter­mine the value of their contribution to public health care insurance.

In 2016, the estimated average payment for public health care insurance ranges from $3,620 to $11,795 for six common Canadian family types, depending on the type of family.

For the average Canadian family, between 2006 and 2016, the cost of public health care insurance increased 1.4 times faster than average income, 1.3 times as fast as the cost of food and at about the same pace as the cost of shelter.

The 10% of Canadian families with the low­est incomes will pay an average of about $443 for public health care insurance in 2016. The 10% of Canadian families who earn an average income of $60,850 will pay an average of $5,516 for public health care insurance, and the fami­lies among the top 10% of income earners in Canada will pay $37,361.  Read more . . .

Introduction

Health care in Canada is not “free.” While Cana­dians may not be billed directly when they use medical services, they pay a substantial amount of money for health care through the country’s tax system. Unfortunately, the size of these tax payments is hard to determine because there is no “dedicated” health insurance tax. As a re­sult, individuals and families often cannot fully appreciate the true cost they pay towards the public health care system.

The purpose of this research bulletin is to help individual Canadians and their families better un­derstand how much health care actually costs them personally so they can determine wheth­er they are receiving good value for their tax dollars.

Why the misunderstanding?

One reason why Canadians don’t know the true cost of health care is because the physician and hospital services that are covered by tax-funded health care insurance are free at the point of use.1 This situation leads many people to grossly underestimate the true cost of health care. When people speak of “free” health care in Canada, they are entirely ignoring the substan­tial taxpayer-funded cost of the system.2

Furthermore, health care in Canada is financed through general government revenues rather than through a dedicated tax,3 which blurs the true dollar cost of the service. Indeed, Canadi­ans cannot easily work out precisely what they pay to government each year for health care because there are many different sources of government revenues that may contribute to funding health care, including income taxes, Employment Insurance (EI) and Canada Pension Plan (CPP) premiums, property taxes, profit taxes, sales taxes, taxes on the consumption of alcohol and tobacco, and import duties, among others. Some Canadians might assume that in those provinces that assess them, health care premiums cover the cost of health care. How­ever, the reality is that these premiums cover just a fraction of the cost of health care and are paid into general revenues from which health care is funded.

The available numbers can be difficult to digest. For example, health spending figures are often presented in aggregate, resulting in numbers so large they are almost meaningless. For instance, approximately $144 billion of our tax dollars were estimated to have been spent on publicly funded health care in 2015 (CIHI, 2015).4

It is more informative to measure the cost of our health care system in per capita dollars: the $144 billion spent equates to approximately $4,024 per Canadian (CIHI, 2015; Statistics Canada, 2015; authors’ calculations). This would be the cost of the public health care insurance plan if every Canadian resident paid an equal share.

However, not all Canadians pay equal tax amounts each year. Some Canadians are chil­dren and dependents and are not taxpay­ers. Conversely, higher-income earners bear a greater proportion of the tax burden than low­er-income earners and thus contribute propor­tionally more to our public health care system. Various tax exemptions and credits also fur­ther complicate matters. Clearly, the per capita spending measure does not accurately repre­sent the true cost of public health care insur­ance for Canadian individuals and families. . . .

For the details go to the Fraser Institute . . . 

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Despite this huge hidden cost—

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Previous Issue

UK is banning 12 pack cigarette carton sales

           

New law banning 10-packs of cigarettes and making packaging bland comes in next week

The legislation will see cigarette packets covered in health warnings and designed in 'drab' colours

The laws on cigarette packaging are set to change by the end of the month, with 10-packs banned and boxes designed to be ‘drab’ and covered in health warnings.

New regulations, which come into effect from 20 May, will see packaging ‘standardised’ so they have the same colour, opening mechanism and font, and with 60 per cent of the casing covered by text and images showing how smoking affects your health. . . 

Tobacco companies have one year from 20 May to get rid of old stock and roll out new packs, following a decision in Parliament on 15 May last year on the EU Tobacco Products Directive that also saw MPs vote in favour of banning menthol and flavoured tobacco, which will come into effect from 2020.

They have also been told to get rid of any misleading information from cigarette packs, and have been prevented from using words such as ‘organic’, ‘natural’ or ‘lite’, which could lead consumers to believe there is a healthy smoking option.

The new law is an attempt to reduce the uptake of smoking in the UK following a review conducted by paediatrician Sir Cyril Chandler that suggested a change in packaging could make a small dent in the number of young people who tale up smoking; a figure that currently stands at more than 600 per day.

Tobacco companies had sought to overturn the decision, but the European Court of Justice ruled that the EU Tobacco Products Directive was lawful, confirming the changes would begin from 20 May.

http://www.independent.co.uk/life-style/health-and-families/health-news/new-law-banning-10-packs-cigarettes-packaging-bland-next-week-a7029826.html

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Medicare does not give timely access to healthcare, it only gives access to a waiting list.

International Medicine

Past Issue

‘Inviting boys to wear skirts is a dangerous frivolity.’

           

What started as a baffling skirmish on the wilder shores of victim culture has now turned into something more menacing

Melanie Phillips

Once upon a time, ‘binary’ was a mathematical term. Now it is an insult on a par with ‘racist’, ‘sexist’ or ‘homophobic’, to be deployed as a weapon in our culture wars. The enemy on this particular battleground is anyone who maintains that there are men and there are women, and that the difference between them is fundamental.

This ‘binary’ distinction is accepted as a given by the vast majority of the human race. No matter. It is now being categorised as a form of bigotry. Utterly bizarre? Scoff at your peril. It’s fast becoming an enforceable orthodoxy, with children and young people particularly in the frame for attitude reassignment. 

Many didn’t know whether to be amused or bemused when the feminist ideologue Germaine Greer was attacked by other progressives for claiming that transgender men who became women after medical treatment were still men. What started as a baffling skirmish on the wilder shores of victim culture has now turned into something more menacing.

The Commons Women and Equalities Select Committee has produced a report saying transgender people are being failed. The issue is not just whether they really do change their sex. The crime being committed by society is to insist on any objective evidence for this at all. According to the committee, people should be able to change their gender at will merely by filling in a form. Instead of requiring evidence of sex-change treatment, Britain should adopt the ‘self-declaration’ model now used in Ireland, Malta, Argentina and Denmark. To paraphrase Descartes, ‘I think I am a man/woman/of no sex, therefore I am.’

The committee’s chairwoman, the Tory MP Maria Miller, says there’s no need for gender categories on passports, drivers’ licences or other official forms because gender is irrelevant. ‘We should be looking at ways of trying to strip back talking about gender,’ she says. But it’s people like her and her committee who have made it a frontline issue.

In 2004, Parliament passed the Gender Recognition Act; in 2010, the Equality Act made gender reassignment a protected characteristic; in 2011, the government published its ‘Advancing transgender equality’ action plan.

The NHS has a National Clinical Reference Group for Gender Identity Services. The National Police Chiefs’ Council has a National Policing Lead on Transgender. Last November, the Department for Education flew the transgender flag to mark the Transgender Day of Remembrance.

In short, the political class is obsessed by gender issues. I trust you are, too. Surely you can reel off the differences between trans, intersex, polygender, asexual, gender–neutral and genderqueer? Do keep up. We’re all gender fluid now, no?

No. Gender is not fluid. What is fluid, however, is the language.

The notion that gender can be deconstructed in accordance with ideology started in the 1970s when (ironically, in view of the Greer row) it was promoted by feminists for whom gender was not a biological fact but a social construct. But it’s not. Gender derives from a complex relationship between biological sex and behaviour. And nature and nurture are not easily separable. Some unfortunates feel they are trapped in the wrong gender. Surgery may or may not resolve this confusion. Many who change sex still don’t feel comfortable; tragically, some even commit suicide.

Crucially, however, such people are desperate to make that change. That’s because for trans people gender is certainly not irrelevant but is of all–consuming importance. Yet Miller and her committee would deprive them of the ability to announce their new sexual identity on passports or other official documents.

Is this not, by Miller’s own logic, cruelty to trans people? But of course logic doesn’t come into this. Gender politics is all about subjective feelings. It has nothing to do with fairness or equality. It embodies instead an extreme egalitarianism which holds that any evidence of difference is a form of prejudice.

If people want to identify with either gender or none, no one is allowed to gainsay it. Objective reality crumbles under the supremacy of subjective desire. Those who demur are damned as heartless.

In fact, gender fluidity itself creates victims. Professor Paul McHugh is the former chief psychiatrist at Johns Hopkins hospital in the US. In the 1960s this pioneered sex-reassignment surgery — but subsequently abandoned it because of the problems it left in its wake. Most young boys and girls who seek sex reassignment, McHugh has written, have psychosocial issues and presume that such treatment will resolve them. ‘The grim fact is that most of these youngsters do not find therapists willing to assess and guide them in ways that permit them to work out their conflicts and correct their assumptions. Rather, they and their families find only “gender counsellors” who encourage them in their sexual misassumptions.’

In two states, any doctor who looked into the psychological history of a ‘transgender-ed’ boy or girl in search of a resolvable problem could lose his or her licence to practise medicine.

In line with such suppression of medical freedom, Miller’s committee also wants to dump McHugh’s ‘medicalised approach’. The MPs claim it ‘pathologises trans identities’ and runs ‘contrary to the dignity and personal autonomy’ of trans people. They note that a UK survey found about half of young and a third of adult transgender people said they had attempted suicide. The committee does not suggest this is most likely because of the unbearable mental conflict over their sexual identity. Instead, it blames ‘transphobia’ for driving them to this despair.

Thus Miller and her colleagues do two things: display callous denial of the tragic condition of such unfortunates, and set up the basis for state-mandated coercion.

Their prime target, of course, will be children, whose young minds can be so easily manipulated. Trans and gender issues, says the committee, should be taught in schools as part of personal, social and health education.

We can all predict what will happen. Gender fluidity will be actively promoted as just another lifestyle choice. Under the commendable guise of stopping the minute number of transgender children being bullied, the rest of the class will be bullied into accepting the prescribed orthodoxy — that gender is mutable, and any differentiation in value between behaviour or attitudes is bigoted and prohibited.

The intention is to break down children’s sense of what sex they are and also wipe from their minds any notion of gender norms. In American schools, last November’s Transgender Awareness Month was a festival of such indoctrination. Children were handed out ‘pronoun buttons’, badges which identified their own preferred personal pronouns as specific to any gender they chose or none.

Brighton College, one of Britain’s leading private schools, has abolished distinctions between boys’ and girls’ uniforms. All can now choose between wearing a blazer, trousers and tie or skirt and bolero jacket. The school’s head, Richard Cairns, says he only wants to make his transgender pupils happy. But inviting boys to wear skirts is a dangerous frivolity. Promoting gender fluidity is likely to make children confused or distressed. If a girl prefers to climb trees rather than play with dolls or a boy likes ballet, will they now wonder if they’re really not a girl or a boy at all?

Worse still, something most children grow out of may cause them to become — to use the Miller committee’s own boo-word — pathologised. According to Professor McHugh, prepubescent children who begin imitating the opposite sex are being treated by misguided doctors with puberty-delaying hormones to render later sex-change surgery less onerous — even though such drugs stunt children’s growth and risk causing sterility. These are the very drugs that the Miller committee wants the specialist Tavistock gender clinic to prescribe to children with less delay.

These MPs are turning gender confusion from a health issue into a political statement to be enforced. So of course they also want to turn denying or questioning gender fluidity into a hate crime. Certainly, anyone who attacks or threatens people on account of their gender should be prosecuted. But the committee wants ‘stirring up hatred’ against trans people to become a crime — which would include insulting them by saying they belong to the sex they deny.

The Law Commission didn’t support that, observing that ‘criminalisation might also inhibit discussion of disability and transgender issues and of social attitudes relating to them’.

You bet. The Miller committee wants ‘mandatory national transphobic hate-crime training for police officers and the promotion of third-party reporting’.

Heaven help us — Caroline Dinenage, a junior minister at the Ministry of Justice, meekly agreed to this sinister proposal and confessed the government was ‘very much on a journey’.

Indeed, you could say the West is very much on a journey. From divorce and lone parenthood to gay marriage, what was once regarded as a source of disadvantage or category error has been transformed into a human right. In the process, compassion has turned into oppression. . .

Gender cannot be at real risk because it is anchored in an immutable reality. What is on the cards is oppression, socially engineered dysfunction and the loss of individual freedom. And it is so-called Conservative politicians who are helping wave the red flag of revolution.

Melanie Phillips was on the staff of the Guardian for 16 years, three of them as news editor.
She is now a columnist for the 
Times.

http://www.spectator.co.uk/2016/01/its-dangerous-and-wrong-to-tell-all-children-theyre-gender-fluid/

WSJ | Jan 29, 2016 | Notable & Quotable: Gender Fluidity

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

‘Inviting boys to wear skirts is a dangerous frivolity.’

           

What started as a baffling skirmish on the wilder shores of victim culture has now turned into something more menacing

Melanie Phillips

Once upon a time, ‘binary’ was a mathematical term. Now it is an insult on a par with ‘racist’, ‘sexist’ or ‘homophobic’, to be deployed as a weapon in our culture wars. The enemy on this particular battleground is anyone who maintains that there are men and there are women, and that the difference between them is fundamental.

This ‘binary’ distinction is accepted as a given by the vast majority of the human race. No matter. It is now being categorised as a form of bigotry. Utterly bizarre? Scoff at your peril. It’s fast becoming an enforceable orthodoxy, with children and young people particularly in the frame for attitude reassignment. 

Many didn’t know whether to be amused or bemused when the feminist ideologue Germaine Greer was attacked by other progressives for claiming that transgender men who became women after medical treatment were still men. What started as a baffling skirmish on the wilder shores of victim culture has now turned into something more menacing.

The Commons Women and Equalities Select Committee has produced a report saying transgender people are being failed. The issue is not just whether they really do change their sex. The crime being committed by society is to insist on any objective evidence for this at all. According to the committee, people should be able to change their gender at will merely by filling in a form. Instead of requiring evidence of sex-change treatment, Britain should adopt the ‘self-declaration’ model now used in Ireland, Malta, Argentina and Denmark. To paraphrase Descartes, ‘I think I am a man/woman/of no sex, therefore I am.’

The committee’s chairwoman, the Tory MP Maria Miller, says there’s no need for gender categories on passports, drivers’ licences or other official forms because gender is irrelevant. ‘We should be looking at ways of trying to strip back talking about gender,’ she says. But it’s people like her and her committee who have made it a frontline issue.

In 2004, Parliament passed the Gender Recognition Act; in 2010, the Equality Act made gender reassignment a protected characteristic; in 2011, the government published its ‘Advancing transgender equality’ action plan.

The NHS has a National Clinical Reference Group for Gender Identity Services. The National Police Chiefs’ Council has a National Policing Lead on Transgender. Last November, the Department for Education flew the transgender flag to mark the Transgender Day of Remembrance.

In short, the political class is obsessed by gender issues. I trust you are, too. Surely you can reel off the differences between trans, intersex, polygender, asexual, gender–neutral and genderqueer? Do keep up. We’re all gender fluid now, no?

No. Gender is not fluid. What is fluid, however, is the language.

The notion that gender can be deconstructed in accordance with ideology started in the 1970s when (ironically, in view of the Greer row) it was promoted by feminists for whom gender was not a biological fact but a social construct. But it’s not. Gender derives from a complex relationship between biological sex and behaviour. And nature and nurture are not easily separable. Some unfortunates feel they are trapped in the wrong gender. Surgery may or may not resolve this confusion. Many who change sex still don’t feel comfortable; tragically, some even commit suicide.

Crucially, however, such people are desperate to make that change. That’s because for trans people gender is certainly not irrelevant but is of all–consuming importance. Yet Miller and her committee would deprive them of the ability to announce their new sexual identity on passports or other official documents.

Is this not, by Miller’s own logic, cruelty to trans people? But of course logic doesn’t come into this. Gender politics is all about subjective feelings. It has nothing to do with fairness or equality. It embodies instead an extreme egalitarianism which holds that any evidence of difference is a form of prejudice.

If people want to identify with either gender or none, no one is allowed to gainsay it. Objective reality crumbles under the supremacy of subjective desire. Those who demur are damned as heartless.

In fact, gender fluidity itself creates victims. Professor Paul McHugh is the former chief psychiatrist at Johns Hopkins hospital in the US. In the 1960s this pioneered sex-reassignment surgery — but subsequently abandoned it because of the problems it left in its wake. Most young boys and girls who seek sex reassignment, McHugh has written, have psychosocial issues and presume that such treatment will resolve them. ‘The grim fact is that most of these youngsters do not find therapists willing to assess and guide them in ways that permit them to work out their conflicts and correct their assumptions. Rather, they and their families find only “gender counsellors” who encourage them in their sexual misassumptions.’

In two states, any doctor who looked into the psychological history of a ‘transgender-ed’ boy or girl in search of a resolvable problem could lose his or her licence to practise medicine.

In line with such suppression of medical freedom, Miller’s committee also wants to dump McHugh’s ‘medicalised approach’. The MPs claim it ‘pathologises trans identities’ and runs ‘contrary to the dignity and personal autonomy’ of trans people. They note that a UK survey found about half of young and a third of adult transgender people said they had attempted suicide. The committee does not suggest this is most likely because of the unbearable mental conflict over their sexual identity. Instead, it blames ‘transphobia’ for driving them to this despair.

Thus Miller and her colleagues do two things: display callous denial of the tragic condition of such unfortunates, and set up the basis for state-mandated coercion.

Their prime target, of course, will be children, whose young minds can be so easily manipulated. Trans and gender issues, says the committee, should be taught in schools as part of personal, social and health education.

We can all predict what will happen. Gender fluidity will be actively promoted as just another lifestyle choice. Under the commendable guise of stopping the minute number of transgender children being bullied, the rest of the class will be bullied into accepting the prescribed orthodoxy — that gender is mutable, and any differentiation in value between behaviour or attitudes is bigoted and prohibited.

The intention is to break down children’s sense of what sex they are and also wipe from their minds any notion of gender norms. In American schools, last November’s Transgender Awareness Month was a festival of such indoctrination. Children were handed out ‘pronoun buttons’, badges which identified their own preferred personal pronouns as specific to any gender they chose or none.

Brighton College, one of Britain’s leading private schools, has abolished distinctions between boys’ and girls’ uniforms. All can now choose between wearing a blazer, trousers and tie or skirt and bolero jacket. The school’s head, Richard Cairns, says he only wants to make his transgender pupils happy. But inviting boys to wear skirts is a dangerous frivolity. Promoting gender fluidity is likely to make children confused or distressed. If a girl prefers to climb trees rather than play with dolls or a boy likes ballet, will they now wonder if they’re really not a girl or a boy at all?

Worse still, something most children grow out of may cause them to become — to use the Miller committee’s own boo-word — pathologised. According to Professor McHugh, prepubescent children who begin imitating the opposite sex are being treated by misguided doctors with puberty-delaying hormones to render later sex-change surgery less onerous — even though such drugs stunt children’s growth and risk causing sterility. These are the very drugs that the Miller committee wants the specialist Tavistock gender clinic to prescribe to children with less delay.

These MPs are turning gender confusion from a health issue into a political statement to be enforced. So of course they also want to turn denying or questioning gender fluidity into a hate crime. Certainly, anyone who attacks or threatens people on account of their gender should be prosecuted. But the committee wants ‘stirring up hatred’ against trans people to become a crime — which would include insulting them by saying they belong to the sex they deny.

The Law Commission didn’t support that, observing that ‘criminalisation might also inhibit discussion of disability and transgender issues and of social attitudes relating to them’.

You bet. The Miller committee wants ‘mandatory national transphobic hate-crime training for police officers and the promotion of third-party reporting’.

Heaven help us — Caroline Dinenage, a junior minister at the Ministry of Justice, meekly agreed to this sinister proposal and confessed the government was ‘very much on a journey’.

Indeed, you could say the West is very much on a journey. From divorce and lone parenthood to gay marriage, what was once regarded as a source of disadvantage or category error has been transformed into a human right. In the process, compassion has turned into oppression. . .

Gender cannot be at real risk because it is anchored in an immutable reality. What is on the cards is oppression, socially engineered dysfunction and the loss of individual freedom. And it is so-called Conservative politicians who are helping wave the red flag of revolution.

Melanie Phillips was on the staff of the Guardian for 16 years, three of them as news editor.
She is now a columnist for the 
Times.

http://www.spectator.co.uk/2016/01/its-dangerous-and-wrong-to-tell-all-children-theyre-gender-fluid/

WSJ | Jan 29, 2016 | Notable & Quotable: Gender Fluidity

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

Wait Your Turn

           

This report is an annual survey of physicians, from across the country, which examines the total wait time faced by patients across 12 medical specialties. The study reports a median wait time — from referral by a general practitioner (ie: a family doctor) to consultation with a specialist, and subsequent receipt of treatment — of 18.3 weeks, up slightly from 18.2 weeks in 2014. 

Waiting Your Turn

Wait Times for Health Care in Canada, 2015 Report

by Bacchus Barua

Waiting for treatment has become a defining characteristic of Canadian health care. In order to document the lengthy queues for visits to specialists and for diagnostic and surgical procedures in the country, the Fraser Institute has—for over two decades—surveyed specialist physicians across 12 specialties and 10 provinces. This edition of Waiting Your Turn indicates that, overall, waiting times for medically necessary treatment have not improved since last year. Specialist physicians surveyed report a median waiting time of 18.3 weeks between referral from a general practitioner and receipt of treatment—slightly longer than the 18.2 week wait reported in 2014. This year’s wait time is 97% longer than in 1993 when it was just 9.3 weeks.

There is a great deal of variation in the total waiting time faced by patients across the provinces. Saskatchewan reports the shortest total wait (13.6 weeks), while Prince Edward Island reports the longest (43.1 weeks). Results for the latter province should be interpreted with caution since data is not available for certain specialties because of either a lack of response or an absence of doctors practising some specialties.

There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (35.7 weeks), while those waiting for radiation oncology begin treatment in 4.1 weeks.

The total wait time that patient’s face can be examined in two consecutive segments. The first segment occurs from referral by a general practitioner to consultation with a specialist. The waiting time in this segment is 8.5 weeks this year, roughly the same as in 2014. This wait time is 130% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Saskatchewan (6.7 weeks) while the longest occur in Prince Edward Island (28.3 weeks).

The second segment occurs from the consultation with a specialist to the point at which the patient receives treatment. The waiting time in this segment is roughly the same as last year, 9.8 weeks. This wait time is 76% longer than in 1993 when it was 5.6 weeks, and almost three weeks longer than what physicians consider to be clinically “reasonable”. The shortest specialist-to-treatment waits are found in Saskatchewan (6.9 weeks), while the longest are in Newfoundland & Labrador (20.5 weeks).

It is estimated that, across the 10 provinces, the total number of procedures for which people are waiting in 2015 is 894,449.

This means that, assuming that each person waits for only one procedure, 2.5% of Canadians are waiting for treatment in 2015. The proportion of the population waiting for treatment varies from a low of 1.7% in Quebec to a high of 8.4% in Newfoundland & Labrador. It is important to note that physicians report that only about 12.5% of their patients are on a waiting list because they requested a delay or postponement. . .

Research has repeatedly indicated that wait times for medically necessary treatment are not benign inconveniences. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish. In certain instances, they can also result in poorer medical outcomes—transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities. In many instances, patients may also have to forgo their wages while they wait for treatment, resulting in an economic cost to the individuals themselves and the economy in general.

The results of this year’s survey indicate that despite provincial strategies to reduce wait times and high levels of health expenditure, it is clear that patients in Canada continue to wait too long to receive medically necessary treatment.

Read the entire report at the Fraser Institute. . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

Cost Sharing

            Of the 28 OECD countries that share Canada’s goal of providing care on the basis of need and not ability to pay, 23 have some form of cost sharing program for patients covering hospital and physician services, and in many cases emergency room visits. All of these countries have realized what economic experiments and international evidence have shown for years: making patients responsible for some of the cost of their care leads to more informed decisions about when and where the health care system is accessed. 

            Two nations have, in fact, expanded their cost sharing programs over the last year in order to take better advantage of the benefits generated by such reforms. Beginning just last month, the German cost sharing program has been expanded to include physician services in addition to hospital services. The Slovak Republic has taken an even larger step and gone from no cost sharing for hospital and physician services, to a full range of co-payments. The Slovak reforms have been remarkably successful at controlling costs: just six months after the new Slovak program, the government witnessed a 30 percent reduction in the number of visits to general practitioners and a 25 percent reduction in the number of hospital stays.

            Put another way, implementing a cost sharing policy as is done in France, Sweden, Japan, and Australia—all of whom do better on health care outcomes than Canada while spending less than we do [in Canada]—would have profound effects on the efficiency and cost of health care in Alberta. First, access to family physicians and clinics would be improved for those in need as some patients (25 to 30 percent in the case of Slovakia) will opt to save the charge and not seek medical attention. Second, remarkably long waiting times for emergency care would fall as patients requiring attention for non-critical conditions would seek care in more cost-effective settings. Third, resources freed up as a result of the first two effects could be used to treat the real health care problems that reside on the province’s waiting lists or allow for tax relief that would benefit the economy as a whole.

            ___________

Cost sharing appears to be a more acceptable concept, which is gaining acceptance in a number of countries with dramatic reductions in cost, than having the system of yearly deductibles and copayments on every service. However, the concept is identical. This has been the modus operendi in HealthPlanUSA, our research endeavor as the ideal HealthPlan for our country to counterman the enormous costs of Obamacare that we are now experiencing. We have shown up to 60 percent anticipated reduction in Emergency Care and a 40 percent reduction in Hospital Care with the HPUSA proposal—similar to the “cost sharing” concept which is teaching socialized countries that cost sharing (deductibles and co-payments) makes health care more efficient and saves huge amounts of costs.

However, in the United States we still have health plans that have no deductions and no copayments offered which are highly popular. What isn’t understood in these plans, that every significant cost has to be pre-approved by the insurance carrier and physicians are expected to be the medical policemen for utilization to keep costs low. Physicians are already experiencing administrative review the past several years with more stringent reviews promised in 2017. Doctors are experiencing reduced payments if their panel of patients exceeds a certain expected norm. This will become a severe cost reduction starting next year when additional penalties will be levied.  Doctors are leaving the HMO panels, the Obamacare Medicaid panels, and now even the Medicare panels in droves. We know of some physicians who have closed their practice and have become hospital and corporate employees and a few have joined the ranks of the skilled labor union type of job fearing serious retribution in medicine. We are in the process of closing our practice. We are unable to afford the costs of review, denials, rebilling, denials, and just giving up the entire process to bill Medicare for it is too expensive to finesse.

­­­­­­___________

What has been recommended for years is to have a high deductible health insurance policy to cover hospitalizations and surgery and then pay for the yearly small items such as physician visits and medications on a cash basis.

HealthPlanUSA, an Incubator Endeavor, proposes to have a yearly deductible equal to the average yearly cost of routine care with a graduated cost sharing mechanism such as a 10 percent copayment for hospitalization and major surgery, 20 percent copayment for Emergency and Surgical center care and a 30 percent copayment for outpatient care.

Our informal study on our patients have found approximately a 70 percent reduction in Emergency Visits when a 20 percent copayment was requested on registration, and a 30 percent reduction in hospital admissions when a 10 percent copayment was requested at the time of registration, which could be placed on a credit card. This is such a simple straight forward solution to our health care corundum, that no further health care reform would be required. Such a plan could replace standard health insurance, high deductible health insurance, and no health insurance because it would now be affordable to everyone.

Follow this dialogue at HealthPlanUSA.net 

Our data is strictly on an individual interview base, e.g. “If you had to pay the 20% of the average $600 fee for an ER visit, would you have gone?” More than two-thirds of the respondents say they would not have gone to the ER but made alternate arrangements such as an office visit the next morning.

“If you had to pay 10% of the average $2,000 a day hospital charge, would you have come to the hospital or made other arrangements.” Outside of a heart attack, stroke, or emergency, one-third stated that they would have made arrangements with members of their family to assist in their care, bringing them to the doctor, assisting them in their home, and follow up with their doctor. Thus only those that required hospital care would have come to the hospital. Thus on an average 5-day stay, $9,000 would have been saved.

These are huge savings not comprehended by the promoters of universal health care managed by a government which 80% of Americans don’t trust.

This data is now supported by several socialized medicine countries that now see a huge savings in cost by just such a cost sharing plan, which we call a yearly deductible and co-payment on each service. What is so difficult to comprehend that Hillary and Bernie don’t understand?

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

Why would American’s want this type of a costly system?

International Medicine

Past Issue

Canada still struggles to provide health care to all

Seeking relief outside Canada's borders

Nadeem Esmail and Bacchus Barua
The Fraser Institute

Appeared in Guelph Mercury and Waterloo Region Record posted December 20, 2013

One of the unfortunate realities of Canada's monopolistic health-care system is that some people feel they have no choice but to seek the care they need outside the country. And who can blame them?

Faced with waits for treatment that are often months long (sometimes stretching over a year), it should come as little surprise that many Canadians ultimately choose to be medical tourists. The question of course, is how many? 

While data on exactly how many patients seek treatment abroad are not readily available, it is possible to estimate this number using data from the Fraser Institute's annual waiting list survey and from the Canadian Institute for Health Information.

The Fraser Institute's annual waiting list survey asks physicians in 12 major medical specialties what percentage of their patients received non-emergency medical treatment outside Canada in the past year. In 2013, averaged across all medical specialties, almost one per cent of patients in Canada were estimated to have done so, the same as in 2012.

Putting these numbers together with data on the number of procedures performed in Canada from the Canadian Institute for Health Information reveals that a conservatively estimated 41,838 Canadians received treatment outside the country in 2013.

Interestingly, this year's estimate is a slight decrease from the 2012 estimate of 42,173. At the same time, the wait time from specialist consultation to treatment in Canada increased from 9.3 weeks in 2012 to 9.6 weeks in 2013. . .

Among the 12 medical specialties, the largest numbers of patients receiving care outside Canada were estimated for urology (6,635), general surgery (5,537), and ophthalmology (3,083). Patients were less likely to be receiving cardiovascular surgeries (114), radiation treatment for cancer (127), and chemotherapy for cancer (249) in another country.

Those numbers are not insubstantial. They point to a sizable number of Canadians whose needs and health care demands could not be satisfied in Canada. They also point to a large market of patients that might choose to remain in Canada (and in their home province) if only they had that option. One can only wonder how many more would have liked to join them, but couldn't afford the travel on top of the privately funded care.

There are a number of possible reasons why Canadians ultimately received the care they required outside of the country. Some may have been sent abroad by the public health care system because of a lack of available resources or the fact that some procedures or equipment are not provided in their home jurisdiction. Others may have left in response to concerns about quality, seeking out more advanced health care facilities, higher tech medicine, or better outcomes. Others may have fled Canadian health care in order to avoid some of the consequences of waiting for care such as worsening of their condition, poorer outcomes following treatment, disability or death. And some may have done so simply to avoid delay and to make a quicker return to their life.

That a considerable number of Canadians traveled and paid to escape the well-known failings of the Canadian health-care system speaks volumes about how well the system is working for them. It leaves open the question of just how many more Canadians might choose medical tourism outside Canada if given the opportunity.

Nadeem Esmail is director of health policy studies at the Fraser Institute.
Bacchus Barua is a Fraser Institute senior economist.

See more at: https://www.fraserinstitute.org/article/seeking-relief-outside-canadas-borders#sthash.bu0qDR7x.dpuf

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

Canadian Medicare isn’t really free

 

Canada’s health care system isn’t really free as there’s monthly premiums or yearly premiums to pay as well as taxes which pay for the entire health care system. There may also be some out of pocket expenses for non-insured services. In Canada there’s access to a waiting list for universal health care regardless of status, income, employment, health, or age. The administration of the heath care is done on a province to province basis. 

Most non-emergency surgeries will require wait times. These wait times may put the patient at risk while they wait for a surgery or their condition may deteriorate as they wait. Those that need priority care make the wait times for others very frustrating. Seniors, those with life threatening conditions, and other urgent cases will be looked after first while others can sometimes wait a long time.

http://www.formosapost.com/pros-and-cons-of-universal-health-care-in-canada/

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

The Long Road to Freedom in Canadian Medicine

 

Jacques Chaoulli’s, M.D.

The right of free citizens to spend their own money as they see fit on their own medical care is a moral precept that is fundamental to a free society. Recognizing what is moral and right, however, is often not sufficient to bring about a positive change.

Challenging a powerful state monopoly of medical services is not easy, but as I had reached the point where I could no longer tolerate seeing my patients suffer and die while on waiting lists, I had to do something.

The road to freedom in medicine in Canada was filled with disappointments, sacrifice, and personal hardships, and often very lonely. The philosophy of “live free or die” does not attract a large number of fellow travelers. Odds were against winning such an ambitious battle. I now see victory as part accident of history, and part miracle. Read more . . .

My journey began in May 1997 when I requested and was granted a meeting with officials of the government of Alberta. I knew that the Alberta government was more open to the concept of private medical care, and I set out to explore the possibilities. A representative of a large American health insurance company, Columbia HCA, accompanied me.

Unfortunately, the Alberta government was not very receptive to removing the prohibition against private insurance and private treatment. The Alberta official said that would require permission from the federal government. After I showed him that the prohibition was actually an Alberta statute, not a federal one, the official said: Oh, that would be a big deal. Social debate.

I replied: “If it is like this, then I will go to court to break down your law.”

He said: “Go ahead.”

So, I did, although at the time I had no knowledge or formal training in law.

When I returned to Montreal, I asked a few lawyers for help, but they provided little. So, I undertook the study of law by myself, in law libraries. I also studied medical service systems around the world. By the end of 1997, I was ready to launch the legal battle against Goliath, representing myself and pleading before the courts, eventually reaching the Supreme Court of Canada.

By 2000 I had achieved “troublemaker” status in the eyes of many Canadian scholars. It was at that point that I applied to the Montreal University School of Law to earn an LLB degree, so that I could be more effective in my goal to help more Canadian patients.

Since I had some free time before registering for law school, I took a few law courses in a separate program. I was very proud of the fact that I earned several A’s in those courses, particularly in constitutional law.

After the law school failed to answer my request to become a full-time law student, I realized that I had been blacklisted. I subsequently contacted a well-known Montreal newspaper and publicly declared my intention to attend the Montreal Law School in order to obtain a law degree so that I could help patients.

The following day, I was quoted in a major article, and soon afterward I was accepted to law school.

My time in law school was short. It seems that Canadian law professors do not appreciate questions that challenge socialist interpretations of the law. In Canada, the government not only has a monopoly on medical care, but a monopoly on law universities as well. The government pays law professors poorly, so they are often dependent on additional, more remunerative, contracts from the state.

I saw firsthand how socialist law professors were brainwashing impressionable young law students. Something had to be done.

After I challenged my law professors in class concerning their interpretation of the law, my grades went from A’s to D’s. Having learned a valuable lesson about tolerance as extolled by socialists, I left law school and pursued further study of the Canadian Charter of Rights and Freedom, the Canadian equivalent of the American Bill of Rights on my own. Ironically, five years later the Canadian Supreme Court would uphold my interpretation of the Canadian Charter of Rights and Freedom, as opposed to that of the socialist law professors.

Along the road to freedom I sought the help of Canadian physicians, naively thinking that they would fully support my legal challenge, for the benefit of our patients. Of course, I was wrong again. Most people seemed to care only about their own wallets. So, at the risk of alienating physician leaders, I subpoenaed presidents of certain key medical associations, including specialty societies for oncologists and ophthalmologists, without first talking to any of these physician leaders. As angry as some of these involuntary witnesses were, they told the truth when they got in the witness box, as I had hoped.

Hearing the truthful testimony about patients suffering and dying while on waiting lists of the Canadian Medicare program, the trial judge ruled that the prohibition against private medical care did, in fact, violate the rights to life, liberty, and security.

Nevertheless, she rejected my motion on the grounds that a two tiered health system would be unacceptable under the Canadian version of equality.

Ultimately, I took the challenge to the Supreme Court of Canada. On June 9, 2005, in a historic decision, the Supreme Court of Canada ruled that the Canadian single-payer medical system has led to situations whereby patients do, in fact, suffer and die on government waiting lists, in violation of the rights to life, liberty, and security under Section 1 of the Quebec Charter of Rights and Freedoms and under Section 7 of the Canadian Charter of Rights and Freedoms. The Supreme Court’s decision has invalidated the unconstitutional prohibition of a parallel private medical system in addition to the government-mandated Medicare program.

Interestingly, after this victory for freedom, the same Alberta official who had previously rebuffed any attempt at removing the prohibition on private medicine was quoted by the Canadian news wire as saying: The Alberta government is very pleased with this decision. Premier Klein fully supports any change that will allow Canadians more choice in getting timely access to the health care services they want.

Following my victory against socialism, I have been called a national hero, both in Canada and in the United States. The fact is that this battle would not have been possible without the love and support of my family. In 1997, my wife and daughter were staying with my father-in-law in Japan. I missed seeing my daughter grow up. In the early years of the battle, I was in Montreal, home alone, near bankruptcy, with barely enough money to buy food for myself.

Had it not been for the generous and gracious financial support of my father-in-law, the outcome of this journey would have been quite different. I was fortunate that my father-in-law saw in me a person who was dedicated to doing the right thing for people, and he felt a need to do whatever he could do to help.

I feel blessed to have a wife who demonstrated her love and support throughout very real hardships imposed by my pursuit of freedom. I also feel a sense of satisfaction knowing that I have taught an important lesson to my daughter about the value of fighting for freedom, and I am pleased that she is proud of her father. My father-in-law is now very old and no longer in a position to sacrifice further, but he can take pride in knowing that because of his support, the Canadian medical monopoly has come to an end . . .

Perhaps my victory in Canada might spark new debate about the constitutionality of the U.S. Medicare program. Both systems derive from the same socialist ideology, and both exist because of misinterpretation of constitutional rights . . .

Read the entire article by Dr. Chaoulli: http://www.jpands.org/vol10no3/chaoulli.pdf

Journal of American Physicians and Surgeons Volume 10 Number 3 Fall 2005

Jacques Chaoulli, M.D., is a family physician in Montreal, whose private emergency house call service was shut down by government for years because of a prohibition against private payment, while patients went without urgently needed care.

Contact: dr.chaoulli@videotron.ca

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc-csc.lexum.com/scc-csc/scc-csc/en/item/2237/index.do

International Medicine

Past Issue

Pot heads around the world

 

CZECHS LEGALIZE CANNABIS
Beginning January 1, ordinary Czechs can grow up to five marijuana plants or have several marijuana cigarettes in their pockets without fear of criminal prosecution.  Previously what constituted a small amount was not specified and the police and courts loosely interpreted the penal code case by case, often resulting in incarceration of home growers, says the Wall Street Journal.

The government's approval of a table specifying what amounts of drugs are permissible is a vital part of the country's new penal code that was last year approved by both houses of parliament and in January of this year was signed into law by President Vaclav Klaus.  Without the just-approved table of amounts that will be used by Czech police, the January decriminalization of the drug would be difficult to judge by courts and investigators, says the Journal:

·         The Cannabis plant still remains illegal, however, though from the New Year possession of five or less plants is merely a misdemeanor, and fines for possession will be on par with penalties for parking violations.

·         The Czech decision is in sync with the country's liberal, Dutch-like social attitudes and laissez-faire approach to civil liberties.

There is also an interesting lifestyle footnote:  Czechs are Europe's biggest drinkers of hops-infused beer and are also the continent's leaders in smoking pot, says the Journal:

·         Czechs consume 320 pints of the golden brew per person annually.

·         Also 22 percent of Czechs between the age of 16 and 34 smoke cannabis at least once a year, according to a recent report by the European Monitoring Centre for Drugs and Drug Addiction.

     Czech decriminalization of small amounts of cannabis possession does not, however, provide greater     clarity to the country's policy on medical marijuana, an issue which is gaining momentum both in Europe, North America and elsewhere around the globe.  The murky state of medical marijuana in the Czech Republic is akin to the legal limbo of the plant's medicinal uses elsewhere in Europe, says the Journal.

Source: Sean Carney, "Czech Govt Allows 5 Cannabis Plants For Personal Use From 2010" Wall Street Journal

See more at: http://www.ncpa.org/sub/dpd/index.php?Article_ID=18793#sthash.uwnJr95J.dpuf 

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International Medicine

Past Issue

A Swiss Shot Heard 'Round the World

Removing the government cap unleashed free enterprise – hidden value re-appeared

Deutsche Bank suffered about $150 million in losses Thursday after the Swiss National Bank abruptly removed the cap on the Swiss franc's value, sparking a massive franc rally, said a person familiar with the matter. Barclays also racked up tens of millions of dollars in losses, although they totaled less than $100 million, another person said.

Shares in FXCM, the biggest retail foreign-exchange broker in the U.S. and Asia, didn't open Friday for trading on the New York Stock Exchange . . .

A U.K. retail broker entered insolvency, and a New Zealand foreign-exchange trading house collapsed. . .

Read the entire report . . .

Can you imagine if the caps on HMO and Medicare medicine were removed, how health care would flourish on the open market? Who would benefit and who would go bankrupt?

Send answers or comments to medicaltuesday@earthlink.net

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International Medicine

Past Issue

The angel of good death opens up his surgery

 

Atul Gawande: The angel of good death opens up his surgery

The American surgeon and bestselling author begins his Reith lectures this week on why doctors sometimes do harm. And the nation is dying to hear them

The Sunday Times: 23 November 2014

As a senior surgeon who has become a bestselling author by writing about his day job, Atul Gawande has unusual advice for the medical profession: he thinks practitioners should talk to their patients more about death. The 49-year-old son of Indian immigrants to America, who studied philosophy, politics and economics at Oxford and influenced President Barack Obama’s healthcare reforms, is about to be hailed with a very British honour: he will deliver the BBC’s 2014 Reith lectures, entitled The Future of Medicine and to be broadcast on the next four Tuesdays.

It is not just the wonders of modern medical science that have fascinated Gawande for most of his professional and literary life, but the blunders that occur, the amount of money wasted and the way more effort goes into extending life expectancy than into the quality of life towards the end.

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, his most recent book, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

To read the rest of this article, subscribe at : http://www.thesundaytimes.co.uk/sto/comment/profiles/article1486740.ece

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International Medicine

Past Issue

NHS litigation claims double under coalition

NHS: The Observer

Scale of clinical negligence claims is now unprecedented prompting claims that reorganisation has harmed patient care

The number of litigation claims made against the NHS in a year has almost doubled under the coalition, prompting claims that the service is failing to deal with growing demands on its limited resources.

The scale of the clinical negligence claims is unprecedented, with 11,945 cases reported by NHS trusts over the last financial year compared with 6,562 in 2009-10. 

Such are the costs of dealing with the legal actions that the NHS has increased the amount of money it retains to deal with claims, up from £8.7bn in the first year of the coalition government to £15.6bn in 2013-14 – adding to the financial stresses within the service.

The analysis, based on figures published annually by the NHS Litigation Authority, comes as NHS England revealed that 35,373 patients waited more than four hours for treatment in the first week of December. That number was 66% higher than the same period last year. Meanwhile 7,760 people were kept on a trolley for between four and 12 hours before a ward bed was found – up from 3,666.

Amid a barrage of criticism on Friday, Dame Barbara Hakin, the national director of commissioning operations for NHS England, was forced to admit in interviews that the NHS was “under a huge amount of pressure”. “We are seeing far more patients than we ever have before,” she said. The Department of Health has insisted that the NHS was well prepared for winter and that an injection of £700m would pay for extra nurses, doctors and beds this winter. . .

Shadow health minister Jamie Reed said: “These figures provide indisputable proof that the NHS is heading seriously downhill.

“The vast majority of NHS staff now say David Cameron’s NHS reorganisation has harmed patient care. The sad truth is that, by turning the NHS upside down with a damaging reorganisation and causing a crisis in A&E, this government has made care problems more likely, not less.

“It is forcing the NHS to set aside soaring amounts for negligence claims – money that is desperately needed on the front line.”

It is believed that the rise of “no win, no fee” agreements has been another factor pushing up the number of people suing the NHS.

A change to the law in April 2013 might have been responsible for a rise in the number of claims in the period before the new law came in, but it is also likely to reduce the number of claims in the future. From April last year, the fee lawyers could charge was reduced from 100% to 25%.

The NHS Litigation Authority has also launched a new mediation service to resolve any claims “quickly and cost effectively”.

Its latest annual accounts said that maternity claims “represent the highest value and third highest number of clinical negligence claims reported to us”. It added: “The value of maternity claims can be very high (sometimes more than £6m) as the amount paid is for ongoing care, accommodation and specialist equipment needs. The NHS funds these settlements by way of a lump sum, followed by annual payments for life.

“This ensures that the child has financial security and that compensation that would otherwise be paid upfront is available for patient care.”

NHS England declined to comment.

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International Medicine

Past Issue

Why Poland Matters

Why Poland Matters:

Do Your Shopping in Paris, but Back Polish Entrepreneurs

by Julie Meyer CEO, Entrepreneur Country.

I started off the week with a lot of 'other stuff' on my mind. I boarded the flight to Warsaw on Monday morning sort of asking myself how it was that I was going to spend my entire week in Poland. My good friend, Pawel Tomczuk, who is a leading entrepreneur in Poland, having built a financial communications firm and sold it to Publicis, had graciously organised for me to speak at the Innovation Forum in Gdansk and then a series of meetings from Warsaw to Sopot at the annual financial conference EFNI. . .

But was Poland worth a week?

I didn't expect at all to have confronted some of the great questions of history in this country of 40 million people, or to be so massively impressed by its people. How did I miss this before, I was asking myself by Day 2?  

As I stood there in the shipyard where Lech Walesa led the Solidarity movement to bring freedom to Poland as I awaited giving my keynote on stage at the Innovation Forum in Gdansk, I met Anna Hejke, a leading venture capitalist, who happens to have been one of Walesa's interpreters. Now for Americans, Walesa is a hero of freedom, so I was already intrigued. Anna *did* *not* disappoint.

Anna soon realised I was a sponge for historical information, and history I got. Poles broke the Enigma code, and gave it to the Brits. They flew valiantly and to great effect in WWII, and in many cases, made the difference decisively in battles that otherwise would have been lost. They helped Jews to survive and get to freedom. On the 1 of September 1939, the Poles were invaded by Nazi Germany, and 17 days later by Soviet Russia, but despite being divided by these invading enemies, the Poles didn't surrender.

In fact, for 50 years, they didn't surrender. Their government went into exile in the UK for 50 years until it was returned to Lech Walesa in 1989 (less 1/3 of its treasury that the Brits took for the Polish use of British aircraft that the Poles had 'used' in defending Britain)!.. Throughout the entire cold war, the Poles never surrendered.

But this fighting spirit is not new. Despite having been wiped off the face of any map, for more than 120 years, the sense that there was a Polish nation and people continued to live on, only to re-emerge in the 20 century. Talk about living in a reality distortion field.

Many if not most people will say that their country has great people, but the Poles can say this with confidence. I have learned this week that the essence of being Polish is to be unbelievably persistent and determined: to never give up, never accept no, and never go away. Despite what the world may say.

That character has been forged through hardship and tragedy, and it makes a national character worth backing bigtime. As an investor who believes wholeheartedly that capital follows ideas and that history is changed only by ideas, and those who execute them, I will spend a disproportionate amount of my time backing Polish entrepreneurs as they have grit, ambition and stamina.

Oh, and I learned another thing too. This week while I would get ready in my hotel room each morning, there was a backdrop of Hong Kong protestors and French deficit reaching 98% of its GDP leading to strikes on the streets. The average Polish person loves free enterprise in a way that the average French person doesn't I am sad to admit. I lived in France for 7 years, and they don't get it. France manages to sell a vision of the country as a wealthy European leader despite being essentially bankrupt. Its people don't understand why it's got the wealth that it has. Through free enterprise hundreds of years ago, and through its entrepreneurs today and the ingenuity of its business people, France created wealth. But it has been sold a lie by its political establishment that government can take the rough edges off of life, and provide risk-free security. Today, that lie has been exposed. Instead of creating a national identity where its citizens pull together for the greater cause of building France, with everyone willing to sacrifice in order to create a country which works for all, the people squabble over how to 'protect' their rights, oblivious to how the world is changing around it, leaving it in the dust.

And this is why Poland matters.

They have had no silver spoon. Their freedom started in a shipyard. They were treated abominably in WWII and its aftermath. I had tears in my eyes, and I haven't even read Norman Davies and Edward Gibbons yet. Patton tried to march to Moscow, but Roosevelt wouldn't let him finish the job. They have no accumulated capital, so they must rely on their human capital. The world enjoys a Polish joke at their expense occasionally. But they have what Darwin says make you fit: adaptability. The Poles have had to. They know how to fight. They love their freedom. And they understand how wealth is created. . .

Poland is open for business. If we want to be optimistic about the future of Europe, look to Poland.

They are the future – of Europe and the world.

Read the entire article at EntrepreneurCountry . . .

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International Medicine

Past Issue

The Republic of Georgia chose to outsource regulation

How to Make Medicine Safe and Cheap

By Steve H. Hanke, Alexander B. Rose, and Stephen J. K. Walter

Assuring that affordable, high-quality drug therapies are available in poor countries is a priority for policymakers, scholars, and advocacy groups around the world. However, there is little agreement over how to achieve that goal. Some see international arbitrage as a solution. Its proponents would allow firms to buy patented, trademarked, or copyrighted goods in countries where prices are low (perhaps because of local price controls or lower wholesale prices set by manufacturers) and re-sell them in higher-price countries without the permission of the owner of the intellectual property rights attached to the goods.

They argue, among other things, that such behavior enhances competition in international markets and thus improves welfare, especially for lower-income consumers.

This view alarms many scholars, especially when such “parallel trade” (meaning the goods in question sometimes travel a parallel route out of the manufacturing country and then back again) involves pharmaceuticals. They note that developing and obtaining regulatory approval for new drugs frequently involve enormous fixed costs and low marginal costs of production. 

Recovering the fixed costs while maximizing the gains from exchange commonly requires not a uniform price across markets and countries but, rather, adept price discrimination. These scholars claim that “Ramsey pricing”—higher prices in affluent countries where demand for pharmaceuticals is inelastic, and much lower prices in poorer countries where demand is more elastic—would maximize welfare and be more likely to recover fixed and marginal costs. They warn that allowing parallel trade would cause prices to fall toward marginal costs everywhere, disrupting the Ramsey pricing scheme and reducing research and development investment and innovation. To avoid that, the scholars say, drug companies likely would stop giving discounts to low-income nations—or leave them unserved altogether.

As befits a topic that is both controversial and important, volumes have been written about the advisability of allowing parallel imports, but much of this work is theoretical. There have been few assessments of the actual effects of this phenomenon, especially in developing countries. In this brief case study, we contribute to this sparse empirical literature by examining the reasons for and consequences of international arbitrage of medicines in the Republic of Georgia, which encouraged the practice via regulatory reforms starting in late 2009.

We find that the regulatory environment and market conditions in a particular country will be key factors in determining whether parallel trade in pharmaceuticals (and presumably other goods for which intellectual property rights issues are important) might be welfare-enhancing. Specifically, Georgia’s experience demonstrates that the nature of institutions in a small, developing nation can lead to noncompetitive pricing in local markets, and that regulatory changes—in this case, outsourcing some key processes—that facilitate arbitrage can deliver major benefits to consumers without, apparently, disturbing manufacturers’ pricing policies or adversely affecting cost recoupment for R&D efforts. . .

Concluding Remarks

Though there are many reasons to be concerned about possible ill side-effects of expanded international arbitrage of pharmaceuticals, the regulatory reforms that enhanced such trade in Georgia must be counted as a success—at least thus far—and should be instructive for other developing countries.

Georgia did not simply jettison regulation and invite unfettered parallel imports of drugs. Rather, the country removed some regulatory barriers to competition that had, by creating and maintaining oligopoly power among its largest pharmaceutical firms, inflated domestic prices. By farming out some regulatory duties to bodies in larger, wealthier states, Georgia’s reforms quickly and significantly reduced prices of essential medicines to consumers by making market entry easier and less costly. Thus, price relief came in this case not because parallel trade disturbed an intricate international price discrimination scheme on which R&D cost recoupment and further innovation depend, but simply by enhancing domestic competition.

Of course, the efficiencies resulting from this reform should not be terribly surprising. As noted earlier, Georgia is about as populous as the Phoenix metropolitan area. If Phoenix officials decided they did not trust the U.S. Food and Drug Administration to regulate drug safety and efficacy, and the city set up its own regulatory apparatus, it would be obvious that such needless duplication would significantly increase costs for local distributors and retailers. The added (fixed) compliance costs would tilt the competitive playing field in favor of large-scale local enterprises.

There would be an immediate hue and cry to “open up the Phoenix market” to parallel trade, and doing so would likely have effects every bit as favorable as those demonstrated here for Georgia, and without adverse effects on the behavior of innovators. . .

Read the entire report at Cato . . . .

Steve H. Hanke is a professor of applied economics and co-director of the Institute for Applied Economics, Global Health, and the Study of Business Enterprise (IAEGHSBE) at the Johns Hopkins University. He is also a senior fellow at the Cato Institute. Alexander B. Rose is a research assistant at IAEGHSBE. Stephen J. K. Walters is a professor of economics at Loyola University Maryland and a fellow at IAEGHSBE

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International Medicine

Past Issue

Democracies Less Likely to Go to War

War has undoubtedly been a fixture throughout human history, and the battles raging in the Middle East today are just one example. But is war necessarily a permanent part of human civilization? In Scientific American, science writer Michael Shermer suggests that democracies are less likely to go to war. 

In 1795, philosopher Immanuel Kant first suggested that those in democratic republics were less likely to support wars, and -- despite the War of 1812, the American Civil War, the Israel-Lebanon war and others -- since then, scholars have continued to support the theory. In 2001, political scientists Bruce Russett and John Oneal analyzed 2,300 interstate disputes taking place from 1816 to 2001. For each country involved in a conflict, Russett and Oneal gave them a "democracy score" based on the nation's political process, system of checks and balances, electoral process, and the like. According to their research:

· Disputes would decrease by 50 percent between two countries with high democracy scores.
· The chance of dispute doubled when one of the countries had a low democracy score or was an autocracy.
· Countries more dependent on trade in one year were less likely to have a militarized dispute in the year following.
· The researchers also looked at membership in intergovernmental organizations (IGOs). For any two countries scoring in the top 10 percent in terms of democracy, trade and IGOs, they were 81 percent less likely to have a militarized dispute than a pair of average countries would be.

More recent studies have followed, says Shermer. In 2014, Havard Hegre, political scientist at Uppsala University, made similar findings, concluding that two democratic states were less likely to have conflicts.

Shermer writes that 63 percent of the world's 195 countries are democracies.

Source: Michael Shermer, "Perpetual Peace?" Scientific American

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International Medicine

Past Issue

Socialized medicine, same song, another verse

The Ugly Truth About Canadian Health Care

David Gratzer, MD

Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market.

I was once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care’s weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.

My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care’s growing crisis, I called my book Code Blue, the term used when a patient’s heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.

Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available.  . .

But single-payer systems—confronting dirty hospitals, long waiting lists, and substandard treatment—are starting to crack. Today my book wouldn’t seem so provocative to Canadians, whose views on public health care are much less rosy than they were even a few years ago. Canadian newspapers are now filled with stories of people frustrated by long delays for care:

back patients waiting years for treatment:

vow broken on cancer wait:

most hospitals across canada fail to meet ottawa’s four-week guideline for radiation therapy

patients wait as p.e.t. scans were used in animal experiment

As if a taboo had lifted, government statistics on the health-care system’s problems are suddenly available. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.5 million Ontarians (or 12 percent of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment. . .

Read more, including Dr Jacques Chaoulli’s famous case which he took to the Canadian Supreme Court and Won: Final verdict: Canadians don’t have access to healthcare, they only have access to a waiting list.

Thank GOD, that we had a DOCTOR who was willing to give up his PRACTICE and fight for our suffering PATIENTS who were denied relief from a compressed spinal nerve.

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

If Universal Health Care Is The Goal, Don't Copy Canada

Avik Roy, Forbes Staff

GUEST POST WRITTEN BY Jason Clemens and Bacchus Barua

Mr. Clemens is the executive vice-president and Mr. Barua is senior health economist at the
Fraser Institute in Canada.

The heated and often emotionally charged debate over the Affordable Care Act (aka Obamacare) hasn’t subsided despite it being the law of the land for more than four years. Indeed, with the VA scandal, continuing problems in the rollout of aspects of Obamacare and the upcoming mid-term elections, the likelihood of increased acrimony is high.

One aspect of the health care debate in the United States that is, unfortunately, riddled with misinformation is the state of Canada’s single-payer health care system. Too often advocates of Canadian-style health care in the U.S. present limited or even misleading information about the true state of Canada’s health care system and worse, often times present the ideal of Canadian health care rather than its reality. 

It’s first important to recognize that a single-payer model is not a necessary condition for universal health care. There are ample examples from OECD countries where universal health care is guaranteed without imposing a single-payer model.

Amongst industrialized countries — members of the OECD — with universal health care, Canada has the second most expensive health care system as a share of the economy after adjusting for age. This is not necessarily a problem, however, depending on the value received for such spending. As countries become richer, citizens may choose to allocate a larger portion of their income to health care. However, such expenditures are a problem when they are not matched by value.

The most visible manifestation of Canada’s failing health care system are wait times for health care services. In 2013, Canadians, on average, faced a four and a half month wait for medically necessary treatment after referral by a general practitioner. This wait time is almost twice as long as it was in 1993 when national wait times were first measured. . .

Long wait times in Canada have also been observed for basic diagnostic imaging technologies that Americans take for granted, which are crucial for determining the severity of a patient’s condition. In 2013, the average wait time for an MRI was over two months, while Canadians needing a CT scan waited for almost a month.

These wait times are not simply “minor inconveniences.” Patients experience physical pain and suffering, mental anguish, and lost economic productivity while waiting for treatment. One recent estimate (2013) found that the value of time lost due to medical wait times in Canada amounted to approximately $1,200 per patient.

There is also considerable evidence indicating that excessive wait times lead to poorer health outcomes and in some cases, death. Dr. Brian Day, former head of the Canadian Medical Association recently noted that “[d]elayed care often transforms an acute and potentially reversible illness or injury into a chronic, irreversible condition that involves permanent disability.”

New research also suggests that wait times for medically necessary procedures may be associated with increased mortality. A recent report concluded that between 25,456 and 63,090 Canadian women may have died as a result of increased wait times between 1993 and 2009. Large as this number is, it doesn’t even begin to quantify the possibility of increased disability, poorer quality of life, and mental stress as a result of protracted wait times.

As Americans struggle with determining the next steps for health care reform, whether that means continuing to tweak the ACA or “repealing and replacing it,” they should keep in mind that the success of any reform depends in part on the degree to which facts dominate fiction and ideology. Discussion of the Canadian model is worthy of inclusion in such a debate, but more in terms of “what to avoid” than as a model for reform. The reality of Canadian health care is that it is comparatively expensive and imposes enormous costs on Canadians in the form of waiting for services, and limited access to physicians and medical technology. This isn’t something any country should consider replicating.

Read the entire report in FORBES

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

The 10 leading causes of death in the world 2000-2012 - WHO

Ischaemic heart disease, stroke, lower respiratory infections and chronic obstructive lung disease have remained the top major killers during the past decade.

Noncommunicable diseases (NCDs) were responsible for 68% (38 million) of all deaths globally in 2012, up from 60% (31 million) in 2000. Cardiovascular diseases alone killed 2.6 million more people in 2012 than in the year 2000.

Lung cancers (along with trachea and bronchus cancers) caused 1.6 million (2.9%) deaths in 2012, up from 1.2 million (2.2%) deaths in 2000. Similarly, diabetes caused 1.5 million (2.7%) deaths in 2012, up from 1.0 million (2.0%) deaths in 2000. . .

Major causes of death

I: How many people die every year?

In 2012, an estimated 56 million people died worldwide. 

II: What kills more people: infectious diseases or noncommunicable diseases?

Noncommunicable diseases were responsible for 68% of all deaths globally in 2012, up from 60% in 2000. The 4 main NCDs are cardiovascular diseases, cancers, diabetes and chronic lung diseases. Communicable, maternal, neonatal and nutrition conditions collectively were responsible for 23% of global deaths, and injuries caused 9% of all deaths.

III: Are cardiovascular diseases the number 1 cause of death throughout the world?

Yes, cardiovascular diseases killed 17.5 million people in 2012 that is 3 in every 10 deaths. Of these, 7.4 million people died of ischaemic heart disease and 6.7 million from stroke.

IV: Do most NCD deaths occur in high-income countries?

In terms of number of deaths, 28 million (about three quarters) of the 38 million of global NCD deaths in 2012 occurred in low- and middle-income countries.

In terms of proportion of deaths that are due to NCDs, high-income countries have the highest proportion – 87% of all deaths were caused by NCDs – followed by upper-middle income countries (81%). The proportions are lower in low-income countries (37%) and lower-middle income countries (57%).

V: WHO often says that smoking is a top cause of death. Where does tobacco use affect these causes of death?

Tobacco use is a major cause of many of the world’s top killer diseases – including cardiovascular disease, chronic obstructive lung disease and lung cancer. In total, tobacco use is responsible for the death of about 1 in 10 adults worldwide. Smoking is often the hidden cause of the disease recorded as responsible for death.

Why do we need to know the reasons people die?

Measuring how many people die each year and why they died is one of the most important means – along with gauging how diseases and injuries are affecting people – for assessing the effectiveness of a country’s health system.

Cause-of-death statistics help health authorities determine their focus for public health actions. A country where deaths from heart disease and diabetes rapidly rise over a period of a few years, for example, has a strong interest in starting a vigorous programme to encourage lifestyles to help prevent these illnesses. Similarly, if a country recognizes that many children are dying of malaria, but only a small portion of the health budget is dedicated to providing effective treatment, it can increase spending in this area.

High-income countries have systems in place for collecting information on causes of death in the population. Many low- and middle-income countries do not have such systems, and the numbers of deaths from specific causes have to be estimated from incomplete data. Improvements in producing high quality cause-of-death data are crucial for improving health and reducing preventable deaths in these countries.

Read more at WHO . . .

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International Medicine

Previous Issue

Eliminating use of monetary policy to achieve country-specific goals

NATIONAL CENTER FOR POLICY ANALYSIS

Measuring the Unfunded Obligations of European Countries

Policy Report No. 319 by Jagadeesh Gokhale, PhD

Europe is undergoing two major transitions. On the demographic front, many European countries are undergoing rapid population aging as their Baby Boom generations enter retirement, senior citizens live longer and fertility rates remain well below the population replacement level. On the economic front, 15 European countries have adopted the euro as a common currency, eliminating the ability to use monetary policy to achieve country-specific economic goals. Both transitions will place tremendous, conflicting pressures on the domestic national budgets of European countries.

Executive Summary

These countries remain politically committed to maintaining fiscal discipline, but large portions of their government budgets are funded on a pay-as-you-go basis. That means that no real resources are set aside and invested each year by government or individuals to prefund future expenditures on such programs. Spending on promised retirement and health-care benefits for the elderly will increase. But there will be fewer workers to pay benefits as the bills come due, and the growth of income from which to extract taxes to support these programs will slow. As a result, all European countries have large unfunded liabilities — the difference between the projected cost of continuing current government programs and net expected tax revenues. In general:

■ The average EU country would need to have more than four times (434 percent) its current annual gross domestic product (GDP) in the bank today, earning interest at the government’s borrowing rate, in order to fund current policies indefinitely.

■ At the low end, Spain would need to have almost two and one-half times (244.3 percent) its annual GDP invested.

■ At the high end, Poland would need to have 15 times its GDP invested in real assets, forever!

No EU government has made the necessary investment. As an alternative, the next-best option is for these countries immediately to gradually but significantly increase saving and investment. In particular, the average EU country could fund its projected budget shortfall through the middle of this century if it put aside 8.3 percent of its GDP each and every year. Despite this adjustment, a budget shortfall is likely to emerge after 2050, requiring additional fiscal reforms.

What will happen if EU countries do not set aside these funds? Unless they reform their health and social welfare programs, they will have to meet these unfunded obligations by increasing tax burdens as the larger benefit obligations come due. Although spending averages 40 percent of GDP today:

■ By 2020, the average EU country will need to raise the tax rate to 55 percent of national income to pay promised benefits.

■ By 2035, a tax rate of 57 percent will be required.

■ By 2050, the average EU country will need more than 60 percent of its GDP to fulfill its obligations.

In some countries, the projected shortfalls are lower than the average. In other countries, they are higher. This is the result of several factors. For instance, life expectancy at birth (in 2004) ranges from a low of 71.2 years in Latvia to a high of 80.7 in Sweden, indicating higher age-related costs in older EU countries than in newer, Eastern countries. Another demographic factor is fertility, which is below the rate of 2.1 births per woman required to maintain populations. However, fertility rates in the EU range from a low of 1.18 in the Czech Republic to a high of just 1.93 in Ireland — indicating that the Czech Republic is closer to a population implosion. Partly as a result of these demographic differences, economic growth rates also differ widely, from a contracting economy in Malta, with a –1.6 percent rate of growth in GDP per capita (averaged over the period from 1996 to 2005), to a 5.7 percent growth rate in Estonia.

In comparison, the United States’ shortfall for Social Security and Medicare alone has been somewhat smaller than the EU average, at 6.5 percent of future GDP. But as a result of the expansion of the Medicare program to cover prescription drugs, the U.S. fiscal imbalance is now 8.2 percent of future GDP. Putting this in perspective, to close its fiscal imbalance:

■ The United States would need to save and invest an amount equal to 8.2 percent of its GDP beginning now and continuing every year forever to pay expected future benefits without future tax increases.

■ This could be accomplished by more than doubling the current 15.3 percent payroll tax on employers and employees, immediately and forever.

■ Alternatively, the federal government could immediately stop spending nearly four out of every five dollars on programs other than Social Security and Medicare — eliminating most discretionary spending on such programs as education, national defense, environmental protection and welfare — forever. Each year that the United States does not take action to reduce the projected shortfall, it grows by more than $1.5 trillion, after adjusting for inflation.


About the Author

Jagadeesh Gokhale is a senior fellow with the Cato Institute in Washington, D.C. His research focuses on U.S. fiscal policy, entitlement reforms, intergenerational redistribution, national saving, and labor productivity and compensation. He works with Cato’s Project on Social Security Choice to develop reforms for programs such as Social Security and Medicare. Dr. Gokhale served in 2002 as a consultant to the U.S. Department of the Treasury and in 2003 as a visiting scholar with the American Enterprise Institute (AEI). Earlier, he was senior economic adviser to the Federal Reserve Bank of Cleveland. His most recent book, Fiscal and Generational Imbalances: New Budget Measures for New Budget Priorities, coauthored with Kent Smetters, drew widespread attention when it was published by AEI. He has also authored numerous papers in such economic journals as the American Economic Review, Journal of Economic Perspectives and the Quarterly Journal of Economics. Gokhale holds a Doctor of Philosophy degree in economics from Boston University.

Read the entire policy report No 319 . . .

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

Health Care Reform: Do Other Countries Have the Answers?

John C. Goodman | National Center for Policy Analysis

Linda Gorman | Independence Institute

Devon Herrick | National Center for Policy Analysis

Robert M. Sade | Department of Surgery and Institute of Human Values in Health Care,

Medical University of South Carolina

Many arguments for the superiority of other health care systems have been repeated often: the United States spends more than any other country, but its health outcomes are often worse. Whereas no one is ever denied care because of an inability to pay in countries with universal coverage, as many as 18,000 people in the U.S. die each year because they are uninsured and more than half of all bankruptcies are caused by medical debts. Also, other countries avoid our high administrative costs.

Yet these and other assertions are debatable. Some are demonstrably false. 

The health care systems of all developed countries face three unrelenting problems: rising costs, inadequate quality, and incomplete access to care. Much analysis published in medical journals suggests that other countries have found superior solutions to these problems.

This conclusion is at odds with economic research that is published in journals physicians seldom read, using methodologies that are unfamiliar to physicians. In this essay, we attempt to shed light on topics frequently discussed in proposals for health care reform, drawing on the relevant medical and economics literature.

Does the United States Spend Too Much on Health Care?

International statistics show that 2005 United States (US) per capita health care spending was 2.3 times greater than the median Organization for Economic Cooperation and Development (OECD) country ($6,401 vs. $2,759, based on purchasing power parity) and 1.5 times larger than Norway, the country that followed Luxembourg in the spending ranking.2 However, normal market forces have been so suppressed throughout the developed world that purchasers rarely see a real price for any medical service. As a result, summing over all transactions produces aggregate numbers in which one can have little confidence. In addition, other countries more aggressively disguise costs, especially by suppressing provider incomes.

Economists have long known that international health care spending comparisons are fraught with potential error. Even for uncomplicated dental fillings, reimbursement data underestimate total costs by 50% in nine European countries.3 Countries account for long term care and out-of-pocket spending differently. The accounting treatment of overhead and capital costs also varies.4 An OECD project to harmonize national accounting methods began in 2000, but even when methods are harmonized, the choice of a price adjustment method can alter hospital cost estimates by as much as 400%. The US compares more favorably when real resources are measured rather than monetary accounts. Per capita, the US uses fewer physicians, nurses, hospital beds, physician visits, and hospitals days than the median OECD country.

Even taking the monetary totals at their face value, the US has been neither worse nor better than the rest of the developed world at controlling expenditure growth. The average annual rate of growth of real per capita US health care spending is slightly below OECD average over the last decade (3.7% vs. 3.8%), and over the past four decades (4.4% vs. 4.5%).7 Despite common perceptions, a country’s financing method—public vs. private financing, general revenue vs. payroll taxes, third-party vs. out-of-pocket spending—is unrelated to its ability to control spending.

For the US, the practical question is, can the adoption of another country’s health care system offer a reasonable chance of improving US private sector methods? An answer in the negative is suggested by a comparison of the British National Health Service and California’s Kaiser Permanente found that Kaiser provided more comprehensive and convenient primary care and more rapid access to specialists for roughly the same cost.

Finally, international spending comparisons typically ignore costs generated by limits on supply. In 2002-2004, dialysis patients waited 16 days for permanent blood vessel access in the US, 20 days in Europe, and 62 days in Canada.10 Waiting for care has economic costs in terms of sick pay and lost productivity, as well as negative health consequences. In the late 1990s, an estimated 5 to 10% of English waiting list patients were on sick leave. Norway is trying to reduce waiting times for patients “in order to reduce the cost of sickness benefits.” Finland calculates that the cost of waiting (sickness benefits, medicines, and social welfare expenses) can exceed the cost of treatment.

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

The Cost of “Free Health Care” in Canada

The Price of Public Health Care Insurance in Canada

August 16, 2013

Canadians often misunderstand the true cost of their public health care system. This occurs partly because Canadians do not incur direct expenses for their use of health care and partly because Canadians cannot readily determine the value of their contribution to public health care insurance, say Nadeem Esmail and Milagros Palacios of the Fraser Institute

In 2013, the estimated average payment for public health care insurance will range from $3,387 to $11,381 for Canadian families, depending on the type of family.

  • For the average Canadian family, between 2003 and 2013 the cost of public health care insurance increased more than 1.5 times faster than the cost of shelter and clothing, more than twice as fast as food, and nearly 1.5 times faster than average income.

  • The 10 percent of Canadian families with the lowest incomes will pay an average of about $482 for public health care insurance in 2013.

  • The 10 percent of Canadian families who earn an average income of $56,596 will pay an average of $5,364 for public health care insurance, while those families that are among the top 10 percent of income earners in Canada will pay about $35,309.

One reason why Canadians don't know the true cost of health care is because physician and hospital services covered by tax-funded health care insurance are free at the point of use. This situation leads many to grossly underestimate the actual cost of the health care delivered. One often hears people speaking of "free" health care in Canada, which is a statement that entirely ignores the substantial taxpayer-funded cost of the health care system.

  • For example, health spending numbers are often presented in aggregate, resulting in figures so large they are almost meaningless.

  • For instance, approximately $135 billion in Canadian tax dollars were estimated to have been spent on publicly funded health care in 2012.

  • It is more informative to measure the cost of the country's health care system in per capita dollars: the $135 billion spent equates to approximately $3,870 per Canadian.

This would be the cost of the public health care insurance plan if every Canadian resident paid an equal share. Canadians certainly do not pay equal tax amounts each year, however. Indeed, some Canadians are children and dependents and are not taxpayers.

Source: Nadeem Esmail and Milagros Palacios, "The Price of Public Health Care Insurance," Fraser Institute, July 2013.

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

Canadian-Style Health Care System

Coming Soon To America: A Two-Tiered, Canadian-Style Health Care System

Commentary by John C Goodman

May 23, 2013

Source: Forbes

I believe we are moving toward two different health systems. In one, patients will be able to see doctors promptly. They will talk to physicians by phone and email. They will have no difficulty scheduling needed surgery. If they have to go into a hospital, a “hospitalist” (who reports to them and not to the hospital administration) will be there to make sure their interests are looked after. They may even have an independent agency that reviews their medical records, goes with them when they meet with specialists, and gives them advice on every aspect of their care.

In the other system, waiting times will grow for almost everything ― to get appointments with physicians, to get tests, to obtain elective surgery, etc. Patients may find that they don’t have access to the best doctors or the best hospitals. They may find that the facility where they are treated does not have the latest technology. In terms of waiting times and bureaucratic hassles, health care for these patients may come to resemble the Canadian system. It may become even worse than the Canadian system. 

The evolution toward a two-tiered system was already under way before Barack Obama became president. But ironically, the Affordable Care Act (ObamaCare) is accelerating the pace of change. It is doing so in four ways.

First, ObamaCare is supposed to insure 32 million additional people by this time next year. If the economic studies are correct, these newly insured will try to consume twice as much medical care as they have been. In addition, most of the rest of us will be forced to have more generous coverage than we previously had. There will be a long list of preventive services that all plans will be required to cover ― with no deductible and no copayment ― and commercial insurance will be required to cover a great many services previously avoided (including, everyone must know by now, contraception). These two changes alone will boost the demand for care considerably.

On the supply side, there is really no provision under ObamaCare to create more doctors. In fact, the supply of doctor services is likely to decrease because of two more features of health reform. Doctors, who are already weary from third-party interference in the practice of medicine, will step up their retirement dates as they contemplate the prospects of even more bureaucracy. Also, hospitals are acquiring doctors as employees at a rapid rate. Indeed, more than half of all doctors are now working for hospitals. When doctors quit their private practices and start working for hospitals, they reduce the number of hours they work. (Forty hour work weeks and golf on the weekends replaces 50 and 60 hour work weeks.) Since they have a guaranteed income, they also become less productive.

These four changes add up to one big problem: we are about to see a huge increase in the demand for care and a major decrease in the supply. In any other market, that would cause prices to soar. But government plans to control costs (even more so than in the past) by vigorously suppressing provider fees and the private insurers are likely to resist fee increases as well. That means we are going to have a rationing problem. Just as in Canada or Britain, we are going to experience rationing by waiting.

Consider how much waiting there already is in the U.S. health care system. On the average, patients must wait three weeks to see a new doctor. In Boston, where we are told they have universal coverage, the average wait time is two months to see a new family doctor. Amazingly, one in five patients who enters a hospital emergency room leaves without ever seeing a doctor ― presumably because they get tired of waiting.

All this is about to get worse. Waiting times are going to be especially lengthy for anyone in a health insurance plan that pays providers below-market fees. The elderly and the disabled on Medicare, low income families on Medicaid, and (if the Massachusetts precedent is followed) people who acquire health insurance in the new health insurance exchanges will find they are financially less desirable to providers than other patients. That means they will be pushed to the end of the waiting lines.

Those who can afford to will find a way to get to the head of the line. For a little less than $2,000 a year, for example, seniors on Medicare can contract with a concierge doctor. These doctors promise prompt access to care and usually talk with their patients by telephone and email. They serve as an advocate for their patients, in much the same way as an attorney is an advocate for his client.

But every time a doctor becomes a concierge doctor, he (or she) leaves an old practice serving about 2,500 patients and takes only about 500 patients into the concierge practice. (More attention means fewer patients.) That means about 2,000 patients now must find a new physician.

Because the two tiers of health care will compete with each other for resources, the growth of the first tier will make rationing by waiting even more pronounced in the second tier. As a result, waiting times in the second tier could easily exceed those in Canada.

I also believe all this is going to happen much more rapidly than anybody suspects.

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

International News: We have entered the age of the individual capitalist

Capitalism Can Be Responsible

By Julie Meyer, Editor, Entrepreneurial Country

The phrase “responsible capitalism” is never going to set the world on fire. Movies will not be made about it, and MBA graduates may sneer. And yet, businesses that are built responsibly, particularly small and medium-sized companies, are destined to succeed.

Against a backdrop of sluggish economic growth on either side of the Atlantic, small businesses and entrepreneurs have created a disproportionate share of new jobs. You would be hard pressed to find bright young sparks under 30 who would not rather work for themselves. 

The digital world has enabled authors, artists and kitchen-table entrepreneurs to punch above their weight, and grab a share of revenue in transactions without needing the expensive infrastructure of a big company. Responsible companies are being created by individuals every day of the week.

We have entered the age of the individual capitalist, the natural entrepreneur working hand-in-hand with big business. The UK’s most successful small and medium-sized enterprises are defined by key relationships with large companies that provide access to the mainstream markets.

Ultimately, entrepreneurs have responsibilities – to shareholders, employees and customers – to ensure the integrity of their relationships with their corporate partners.

Accountability happens at the individual level, and the fluid nature of business relationships introduced by the internet enables people to act responsibly more easily than ever before. Today there is no trade-off: doing business responsibly is actually good business.

This article originally appeared in The Financial Times

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

Canadian Health Care

The Ugly Truth About Canadian Health Care
David Gratzer

Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market.

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada.

When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin’s favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab.

But if Canadians are looking to the United States for the care they need, Americans, ironically, are increasingly looking north for a viable health-care model. There’s no question that American health care, a mixture of private insurance and public programs, is a mess. Over the last five years, health-insurance premiums have more than doubled, leaving firms like General Motors on the brink of bankruptcy. Expensive health care has also hit workers in the pocketbook: it’s one of the reasons that median family income fell between 2000 and 2005 (despite a rise in overall labor costs). Health spending has surged past 16 percent of GDP. The number of uninsured Americans has risen, and even the insured seem dissatisfied. So it’s not surprising that some Americans think that solving the nation’s health-care woes may require adopting a Canadian-style single-payer system, in which the government finances and provides the care. Canadians, the seductive single-payer tune goes, not only spend less on health care; their health outcomes are better, too—life expectancy is longer, infant mortality lower. . .

I was once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care’s weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.

My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care’s growing crisis, I called my book Code Blue, the term used when a patient’s heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.

Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. And so on.

Read the entire report . . .

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

International Medicine

Past Issue

Single-Payer National Health Insurance around the World

by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick

As we move further into the twenty-first century, it is clear that we are living with a number of institutions that were not designed for the Information Age. One of those institutions is health care.

Virtually everyone agrees that our health care system needs reform. But what kind of reform? Some on the right would like to see us return to the type of system that prevailed in the 1950s. Some on the left would like to see us copy one of the government-run systems established in the mid-twentieth century and variously called socialized medicine, national health insurance and, more recently, single-payer health insurance. For example, Physicians for a National Health Program, claiming membership of 8,000 physicians and medical students, contends that "single-payer national health insurance would resolve virtually all of the major problems facing America's health care system today."

We believe that neither of these two alternatives will work. But before we explain why, let us stop to consider some central problems that every reform faces.

The complete book: http://www.ncpa.org/pdfs/livesatrisk/Lives-at-Risk_NCPA.pdf (PDF | 5MB)

Lives at Risk by John Goodman, was reviewed in the early days of MedicalTuesday. Review these 20 Myths of Single Payer Medicine starting in August 2002 for twenty issues at http://medicaltuesday.net/archives/Aug2702.htm

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

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