Pipe down

Health Business Blog readers know I’m amused when right-wing critics of the US health care system start pointing out problems in other countries to argue against reform in the US. There’s a classic example from right-wing blowhard Sally Pipes in last weekend’s Examiner. The headline: Obama-Daschle “reform” will cripple American health care tells you pretty clearly where she’s coming from.

Here’s a little taste:

Government reimbursement rates already discourage doctors from accepting patients with government coverage. As the government program slowly becomes the only game in town, what then of physicians?  Will they simply accept their fate?  We can look to our north for a possible answer.

Canadians have “enjoyed” universal health coverage since the 1970s. They also enjoy the rationing of care. Both drugs and physicians are in short supply…

Because there aren’t enough doctors, Canadians must wait in line. Wait times for referrals from primary care physicians to specialists in Canada exceed 18 weeks — twice what doctors consider clinically acceptable.

The unwritten assertion is that we don’t have wait times in the US. But if Pipes believes that she must be pretty healthy. She may also not read very much. Here are a couple of examples:

  • In Boston, the waiting time to see a dermatologist for a “changing mole” –perhaps the closest thing in dermatology to an emergency– is 10.5 weeks. It takes 3.5 months to arrange a routine visit to a dermatologist at the Brigham and Women’s Hospital in Boston.
  • At Children’s Hospital in Boston it takes 6 months to get an assessment for a child whose speech is delayed. I recently learned that there is a 10 month wait at Children’s to have a child assessed for cognitive development issues that affect performance at school. I guess parents just need to tell the teacher, wait till next year!

Don’t scare us with waiting list horrors, Sally. We already spend 2x what any other country spends and “enjoy” waiting times and limited access to care for the uninsured. Canada does not have a great system but at least there’s universal access and there’s no such thing as medical bankruptcy.

January 13, 2009

4 thoughts on “Pipe down”

  1. David,

    Respectfully, there is a fundamental difference between wait lists in Canada and the examples you’ve cited here.

    In Canada, the problem of waiting for care pervades nearly every specialty of medicine, nearly every kind of treatment, and most kinds of diagnostic testing.

    The waiting periods are extraordinary. Each province runs a web site that helps you figure out how long the wait is going to be for your care.

    The latest studies show that the median wait for medical oncology is nearly 6 weeks, elective cardiovascular surgery 7 weeks, and neurosurgery 31 weeks. Overall, Canadians waited an average of 17 weeks for treatment across all specialties in 2008.

    Waits for things as simple as an MRI can be just as bad — in Calgary, only 25% of people referred for an MRI were able to get one within a month and a half.

    The American system has serious flaws. But it is not correct that among them are delays in care that are in any way comparable to those experienced by Canadians.

    I enjoy your blog very much.


  2. Thanks, Evan. You have a valid point.

    I’ve often thought that one reason the US is slow to embrace health care reform is that our neighbor to the North has such a poor system. (See this Commonwealth Fund report, which showed the US and Canadian systems neck and neck for worst performance among the countries profiled: http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678)

    It’s worth keeping in mind that Canada spends just half per capita what the US spends. I bet if the Canadian government boosted spending to approach US levels that these waits would vanish.

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