The larger problems with Accountable Care are as follows:

- no personal responsibility

- malpractice isn't addressed

- too many different EMRs are out there, none of them can talk to each other

Otherwise, I am not at all sure how healthcare costs are supposed to come down. The doctors are assuming more of the risks again. Who wants to be a physician under these proposed circumstances? So of course they're opting out.

Good examples doc!

Keep private insurance companies out of health care.

Keep fees for service out of health care.

Keep payments for results in health care.

Keep single payer in health care.

Keep everyone in one group in health care to distribute and reduce costs overall.

Block cherry picking of healthy patients in health care. Everyone in all ages should be in one group.

The American insurance run and insurance rationed health care system is vastly more complex and has 10 times the overhead and bureaucracy of any government funded health care system, including US Medicare and the Canadian health care system, which are totally funded by government.

The overhead of the Canadian system and Medicare deliver far better access, quality and medical outcomes than American insurance run and insurance rationed health care. Canadian health care and US Medicare have 10% of the overhead and 10% of the bureaucracy of the American insurance run and insurance rationed system.

Americans fail to realize, or maybe refuse to admit, that for every Canadian who crosses the border for health care in the US, that there are 1000 Americans who have to come to Canada to get the health care that some insurance company bureaucrat says they can't have in the US.

90% of Americans who have used both American insurance run health care and Canadian physician run, government funded health care far prefer Canadian health care to what they had in the United States.

In Canada, only physicians make health care decisions and anything a physician says you need, you get. In Canada, physicians and no one else, decides who gets treated and what treatment they get.

In the United States, insurance company bureaucrats make the medical decisions, so for Americans, insurance company bureaucrats, not physicians, decide who get treatment and what treatment they get.

Every Canadian resident has a credit card-like health card, and there is no paperwork whatsoever, except a ONE HALF-PAGE form to renew it EVERY THREE YEARS. The only system that has massive paperwork is American insurance run and insurance rationed health care. If you want less paperwork, a single payer system is the answer for that and the last thing you want is insurance run health care.

This is an American born physician. Listen to what she says.

http://www.youtube.com/watch?v=3LzQFMvoUug

I would love to see proof for any one of those claims you made.

The myth that medicare is somehow more efficient than private insurers is widespread--and comes from very misleading numbers

Lets examine the reasons one by one:

1)Outsourcing of accounts recievable--its called the IRS and if private companies could ignore the costs of their accounting and/or have another company do it for free you bet their overhead would be lower

2)Higher utilization of care--Medicare patients are among the sickest of the US population. They tend to be older and poorer--both independent risk factors for more health problems. Therefore, medicare spends more of every dollar recieved as benefits. Meaning if they take in $100, $90 gets spent. Compare this to a relatively healthier private insurance population--$100 comes in, $70 comes out. Is the rest taken in as salary? No, some of it is reinvested in other non direct health care spending, but not salary. Is too much taken as salary--probably, and something needs to be done about that. But don't believe the hype

3)Medicare is actually pretty good insurance, but very expensive--any doctor will tell you medicare reimburses well and hassles you less about ordering necessary tests. But health care spending is already 12% of GDP. It has climbed 8-fold in the past 20 years. It is expected to become 50% of GDP by mid century. We cannot spend at that level and stay solvent as a nation. While I think medicare for all is great, its just not affordable now

And for your comparisons to canada, I think regular care is at least as good there. But you better pray you don't need anything specialized. Witness Liam Neeson's wife who died unnecessarily because no neurosurgeon was immediately available

Also, Canada's supreme court ruled in 2005 that "access to a waiting list does not equal access to care" when it struck down Quebec's law banning private insurance

How do you reconcile that with your opinion?

Liam Neelson's wife died because she refused to go to the hospital when the ambulance arrived, and for no other reason, and only ended up in hospital six hours after the first ambulance was there. Are you telling me that Gary Coleman dying of the same injury IN THE MIDDLE OF AN AMERICAN CITY didn't happen in the United States? If you have that injury and don't go to the hospital, you die, and that applies in the United States as well as in Canada. That had nothing to do with a neurosurgeon being available, it had to do with her deciding to go to the hospital when she first had the chance. Some of the best neurosurgeons in the world practice in Canada and in Quebec.

Jean Chretien, former Prime Minister of Canada needed brain surgery and had it in Montreal. When asked if he had considered going to the US to have the surgery, he laughed at them, and said "you must be kidding. We have far better health care here (in Canada) than they have down there".

People in Canada are healthier and live four years longer than Americans because all Canadians get health care which is mostly unavailable to even middle class Americans. Health care which the POOR get in Canada is better than the health care which the average middle class person gets in the United States.

38% of Americans have inadequate access to the health care they need, and 45,000 Americans die each year from lack of adequate health care, which they would be guaranteed in Canada.

How do you reconcile that with your opinion?

By the way, I am 60 years old and on 4 occasions I need immediate specialist care and got it, as any Canadian would. If your faulty premises and faulty conclusions were true, why are death rates from serious diseases like cancer and heart disease 5% lower in Canada than they are in the United States.

I would, and any Canadian would, put our Canadian health care (general, specialist, surgery, EVERYTHING) head to head with your American insurance rationed health care anytime, anywhere, and ours would prove to be far better than yours.

The big question is this.... Why is it that, when a Canadian gets sick or injured in the United States, that they fly back to Canada for treatment rather than getting treatment in your "wonderful" American heavily rationed and downright pathetic health care system?

-although she initally refused, when she finally acquiesed, it was too late BECAUSE THERE WAS NO SPECIALIST immediately available.

Gary coleman died of an intracranial hemorrhage of unspecified type. Neeson's wife was a slower bleed, likely a subdural or possible epidural bleed--not sure that they died of the same cause, unless you have information I don't

Your example of Jean proves nothing. That is what he should say. If he said differently, that would be noteworthy. Plus, that's his opinion. Who cares? Anyway, anecdote, anecdote, anecdote. I would like to see evidence

People in canada live longer than americans. Clearly. But you are willing to atribute the ENTIRETY of this based on our choice of health care payer. The fact that our obesity rate is double yours--coincidence. Our higher murder/suicide rate--not important. Our higher proportion of minority/lower economic class patients--another completely unrelated fact.

Riiiight.....

The fact is, using very gross measures like life expectancy to judge a very specific factor such as health care system is just plain bad science. For example, if your car breaks down at 80K miles, and mine at 120K, did i take better care of my car? Did I have a better mechanic? Did I put higher quality gas/oil in the motor? Or was my car simply built sturdier? You see, there are a lot of factors--who knows which contributed

Please provide a source for your last statistics, they are nonsense

So that my friend, is how I reconcile that with my opinion

Show me the source of your statistics on lower mortality from heart disease/cancer.

1) I don't believe your numbers

2) The numbers Ive seen show OUR mortality from breast cancer and acute MI to be better than canadas due to increased number of specialists available at odd hours, especially for heart attacks

3) See my point above about trying to use a multivariable system to evaluate a single factor

4) Your health care is rationed. While ours is based on ability to pay, yours is based on need and time.

5) please provide evidence of your last statment. I disagree wholeheartedly

And please address why your supreme court ruled against your wonderful health care system in 05. I noticed you conveniently ignored that point. I probably would too since there is no rebuttal possible

Canadian health care is not rationed. Any Canadian has health care limited only by what their own physician says they need. On the other hand, American insurance company bureaucrats, run and ration the American health care system, and American insurance company bureaucrats, not physicians, decide who gets treated and what treatment they get. If and American insurance company bureaucrat says you don't get treatment, unless you are willing to pay tens and hundreds of thousands of dollars out nof your own pocket, and if you're going to do that, why pay for insurance?

No private insurance company would even be interested in insuraning the handful of Canadians who would even consider American style health insurance, even if the court decision you refer to considered, and had any effect outside of Québec, neither of which it does. Québec uses le Code de Napoléon, FRENCH law, not Canadian law, and any court decision in Quebec has no effect in the rest of Canada, and does not even CONSIDER the rest of Canada.

85.2% of Canadians reported that they were "satisfied" or "very satisfied" with the way health care services are provided in their country and an even higher number (89.8%) rated their physician in the same way though slightly lower ratings were awarded to hospitals (79.9% being "satisfied" or "very satisfied").

In the United States, in a similar study, only 26% of Americans with insurance were satisfied with their access to health care and only 48% of Americans with insurance were satisfied with the quality of their health care.

In a Canadian National Population Health Survey it was reported that only 0.5% of Canadians had sought medical care in the US in the previous year and that 0.5% of the patients treated in Canada by physicians and hospitals were Americans, who had crossed the border into Canada for Canadian medical care.

In 2007, Gordon H. Guyatt et al. conducted a peer reviewed meta-analysis, or systematic review, of studies that compared health outcomes for similar conditions in Canada and the U.S., in Open Medicine.

They concluded, "Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." Guyatt identified studies addressing conditions including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of the 10 studies with the strongest statistical validity, 5 favoured Canada, 2 favoured the United States, and 3 were equivalent. Overall, results for lower mortality favoured Canada with a 5% advantage.

The "numbers you've seen" are by biased right wing sources and have no validity in fact. If you had any idea oif the reality in Canada, you would realize that every premise you start with and every conclusion you come to is wrong in fact.

If you want the truth, check these out:

http://john-murphy-1281714.newsvine.com/_news/2011/05/12/6628236-americans-and-canadians-discuss-health-care

If you want to believe all that right wing fiction and outright lies, then you have no interest in the truth.

“Believe it or not — this was in the ’60s — we used to hustle on over the border for health care that we would receive in Whitehorse. I remember my brother, he burned his ankle in some little kid accident thing, and my parents had to put him on a train and rush him over to Whitehorse and I think, isn’t that kind of ironic now. Zooming over the border, getting health care from Canada,” Palin was quoted as saying by The Canadian Press.

Liberal MP Carolyn Bennett, who is also a doctor, said the Palin family’s story is not unique [of Americans coming to Canada for health care in preference to American health care].

“Certainly as a family doctor I treated lots of Americans [coming across the border from the U.S. for Canadian health care].”

When she testified before a U.S. Senate committee in September, Bennett told the story of a U.S. Vietnam veteran who had to go to Canada for cancer treatment because he couldn’t afford medical care in the country he fought for.

Bennett said Palin should bear in mind the high cost of medical care is a leading cause of bankruptcies in the U.S.

“Criticizing our system isn’t helping her fellow Americans.”

[The Canadian single payer health care system was instituted January 1, 1966, when Sarah Palin was 22 months old]

On 16 March 2009, Natasha Richardson sustained a head injury when she fell while taking a beginner skiing lesson at the Mont Tremblant Resort in Quebec, about 130 kilometres (81 mi) from Montréal. The injury was followed by a lucid interval, when Richardson seemed to be fine and was able to talk and act normally. Paramedics and an ambulance which initially responded to the accident were told by her that they were not needed and left. Refusing medical attention twice, she returned to her hotel room and about three hours later was taken to a small local hospital in the village of Sainte-Agathe-des-Monts after complaining of a headache. She was transferred from there by ambulance to l'Hôpital-du-Sacré-Coeur, Montreal, in critical condition and was admitted about seven hours after the fall. Neurosurgical intervention was available but futile, because of her decision to delay so long, she was essentially brain dead on being admitted.

let me address your comments point by point

Regarding richardson--no need to post a synopsis of the events--I'm aware. Even after refusing care, if she had been in the US, there would have been a neurosurgeon available to treat her, unlike in Canada. EVEN AFTER WAiting. Thats the key part you are not getting

Your newsvine link is just to youtube videos. That's laughable. Youtube is not a valid scientific source last I checked. Please give me some science, not youtube clips of some laypeople

The rest of post #2 is just anecdotal. I don't care about anecdotes. I thought I made that evident

Your first post is obviously wrong. Canada's care is rationed. That's not necessarily harmful in and of itself. Rationing is necessary with any limited resource, incluiding health care. However, Canada's care is rationed to a high degree AS EVIDENCED BY THE 2005 CANADIANSupreme court decision that you keep ignoring. NOT the quebec supreme court

hmm...I wonder why...maybe because it disproves your case. maybe....

As far as patient satisfaction surveys, I could show you as many that show the exact opposite of what yours say. I could show you stats that show canadians hate their health care

Are they biased? Probably. Are your stats from the Canadian government regarding the Canadian government run health care system biased. Well, come on...

But at any rate, patient satisfaction is far from the most important factor when evaluating health care. Its basically a surrogate measure for how nice of a guy the doctor is and how much time he spends with you. Not nearly as important.

here's a link to the decision. Im honestly a little suprised youre so ill-informed about your own country

http://www.cbc.ca/news/canada/story/2005/06/09/newscoc-health050609.html

I think we need to summarize, because I see the direction your posts are going:

1) Canada has overall higher life expectancy

True. But show me evidence that DIRECTLY links this to your health care system. I haven't seen any yet, but I'm very willing to look at anything. I don't think nationalized health care is always bad, nor do I think canada's system is bad--I'm just not convinced it could work here, nor do i think its perfect

2) Patient satisfaction is higher in canada

I don't know, and to be honest, i don't care. Not to completely dismiss it, but its a surrogate marker at best.

3) Survival for certain conditions is better in canada, such as breast cancer or coronary disease

Honestly, I think the opposite, but I'm not sure. I don't know that anyone really is. Its just so complicated to measure. If you have convincing data (not youtube videos) Id be interested

4) Canada's health care is highly rationed, causing harm to some people

clearly true. Look at that link. Its from the CBC, not some "right wing biased source". Is the US rationed? Definetely. does it cause harm--absolutely. Despite that fact, I think it needs to be MORE rationed, until we figure out how to make it affordable

I would put my health care against yours any day and mine would prove to be superior.

Because she refused medical treatment twice, and waited several hours before seeking treatment, Natasha Richardson, not the Canadian health care system, were responsible for her death. Montreal has dozens of world class neurosurgeons, so saying that a neurosurgeon was not available is totally false. If there were no neurosurgeons in Montreal, how could Jean Chretien have brain surgery there? If you mean that a little hospital in a village didn't have a neurosurgeon, no, nor would there be one in a little village in the United States either. Why didn't Denver have a neurosurgeon available to save Gray Coleman's life? It is exactly the same thing.

There is absolutely ni rationing in Canada. The only rationing in North America is done by insurance company bureaucrats in the United States. The only limit on my access to any form of health care, and it is the same for all Canadians, is that my physician has to think I need it. In the United States, I would only get it if an insurance company bureaucrat says I can have it. Your biased, right wing sources are wrong.

It is well documented in medical literature that survival rates for virtually any condition, including cancer, are equivalent to those in the United States and in many cases better. This is indisputable, no matter what your right wing, biased sources say.

All Canadians get tests, treatment, and surgery that is completely unavailable to a large portion of average middle class Americans. That is rationing in the United States which does not exist in Canad, which is the reason why Americans flood across the border (2 million a year) to get the health care that is denied or rationed fir them by American insurance company bureaucrats. The vast majority of Americans who have used Canadian health care prefer it to American insurance run health care.

There is nothing stopping Canadians from getting private health insurance, so long as they get treatment in the United States, which according to you, they should want to do anyway. The only constraint is that if they get private insurance they can't use it to get treatment in Canada. If American health care were as good as you claim it is, and supposedly so much better than Canadian health care (which it isn't), this should be what they would want, treatment in the United States, shouldn't it? Why would they not want that, if American health care is so much better and they would go there anyway?

I look forward to the day when an American insurance company bureaucrat denies or rations a medical treatment you need to save your life and you have to come to Canada to get it, and you realize that you get it in Canada, while you are denied it in the United States, and you realize which system is rationed. I would get the treatment in Canada that you would be denied by an insurance company bureaucrat in the United States, that tells which system is rationed, and it is the insurance run health care system in the United States, not the Canadian one.

Anyone you claim is harmed in Canada, would be left to die without even access to a physician in the United States. What part of denial and rationing in the United States do you not get? Health care in the US is rationed, health care in Canada is not. Canadians get treatment in Canada that they would be denied if they were Americans in the United States, what part of denial and rationing in the United States and not in Canada do you not get?

So the fact that only 26% of Americans with insurance are satisfied with their access to the health care they need and 85.2% of Canadians are satisfied with their access to health care doesn't convince you that health care in the United States is denied and rationed to even people WITH insurance, let alone the 38% who have no or insufficient insurance to get the health care they need? You really have drunk the kool-aid of American insurance company propaganda. I await the time when you have to come to Canada to get treatment that is denied you in the rationed American health acre system. Anyway, come to Canada when your health care is rationed in the US and you'll find that what you've been told and what you believe is totally false, and that you get better health care in Canada than what you have had in the United States.

Studies at Harvard University have found that 45,000 Americans die each year because of not having adequate access to health care. Number of Canadians who die from lack of access to health care ZERO.

New England Journal of Medicine states that 225,000 Americans die each year because of medical mistakes in the United States. Number of Canadians who die from medical mistakes each year is less than 1000.

The US Census states that 875,000 Americans a year declare bankruptcy because they have to liquidate all their assets to pay for health costs because health care they need is denied or rationed in the United States. Statistics Canada states that the number of Canadians who declare bankruptcy because of health costs is 10, and those are because of drug costs which are not covered by Canadian health care and by a couple of provinces, but are in most.

Which system is rationed? The American system clearly is, and the Canadian system is not.

Which system is best for all of its people? The Canadian system clearly wins hands down, and the American system falls flat.

Lets put aside the richardson case. Its anecdotal, and really proves nothing. But for your own medical knowledge, if someone falls and has a period of lucency that is usually a different clinical entity then someone falling down the steps and never regaining consciousness. There are many different types of intracranial hemorrhage, ie subdural, epidural, parenchymal etc. I don't have enough information to know which type each of them had, the relative severity, etc... Likely, richardson had a injury to her middle meningeal artery from a temporal fracture, as these patients may have a lucid period before they herniate, but again, I don't have enough info.

If its so well documented that canada is better "for virtually any medical condition" then please, please show me a source. I mean, if its well documented, it shouldnt be hard

You may not think you have rationing, but the supreme court of canada disagrees with you. You honestly strike me as an intelligent, articulate person--but clearly you ignore that the supreme court found the exact opposite of what you claim. I have no idea how you can reconcile those facts.

Maybe its a lack of understanding of the term. What does rationing mean to you?

wikipedia defines it as

Rationing is the controlled distribution of scarce resources, goods, or services. Rationing controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time.

How does needing something at time A, and being told that it is not available to you until a later time B not qualify??

The majority of the rest of your post is your opinion completely unsubstaniated by fact

No, as I explained, patient satisfaction is not the most important factor in my book. Is it in yours? I mean, I like hard numbers (ie, door to balloon time, number of patients that recieved chemo in a timely fashion, etc). Whether or not they were satisfied with their care is almost besides the point. I have delievered some top notch, expensive care to patients whom I KNOW thought it was inadequate. On the other end of the spectrum, I've dealt with resource poor folks and gave them the bare minimum they could afford, for which they couldn't be more happy. Satisfaction depends just as much on the patient as the doctor--believe me

Your second post is nonsense. Please, I beg you, look at the 2005 supreme court decision. It illustrates for you how wrong you are. I am not blind to the inadquecies of my system--i know the poor get screwed, I know people die needlessly. And I know people go bankrupt from health bills--a travesty that is being fixed as we speak, by the way. Yet you claim I have "drunk the kool aid" while you defend your system as PERFECT even though the highest court of your country disagrees with you. Just read the decision, then come back to me and I'll be happy to continue our debate

I just realized you posted something about medical mistakes.

PLease show me your souce!!! Less than 1,000 die from med mistakes--i call bullsh!t

1000 is a conservatively high estimate. It is actually probably far less. Basically the only place where people die from lack of access to health care and medical mistakes is in the United States. More Americans die each year of cancer caused by the excessive use of CAT scans in the US than die of cancer in a year in Canada.

You continually fail to acknowledge the fact that the only health care rationing in North America is conducted by insurance company bureaucrats in the United States, and that any Canadian has far better access, better quality, and better medical outcomes than any but the richest of Americans.

A Canadian who wanted private health insurance would have to pay anywhere from $3000 to $8000 a month because fewer than 2000 Canadians out of 34,000,000 would ever want American style insurance and the rationing associated with it. Canadians are used to not having their health care rationed, as is the only way American style health insurance is can work, by denying and rationing the health care of those who pay for insurance.

The 2005 case was before the Supreme Court of Québec, not the Supreme Court of Canada, and holds no water in any province but Québec, and when push came to shove, those who theoretically thought they wanted American style health insurance refused to buy it when they found out how many thousands of dollars a month it would cost to buy American style health insurance to insure the handful of people in Canada who would actually buy it.

The only travesty is the number of Americans who die as a direct result of the United States having insurance run health care and the rationing necessary tom make a profit from it. There are no travesties in Canada. You live in the nation with only travesty in health care in North America if you live in the United States.

Please look at this link:

http://www.cbc.ca/news/canada/story/2005/06/09/newscoc-health050609.html

It is the supreme court of CANADA. NOT QUEBEC!!!

honestly, how can you have a discussion about a subject you obviously are so un-informed about???

heres another link for you:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670923/

Basically, it says canada lies about medical errors. Even if your 1000 number was from a credible source (which you have yet to provide) it just means canada is great at hiding the truth

I've been trying to have a discussion with someone who is obviously uninformed about health care in both the United States and Canada.

So if all of these people are getting health insurance because of this court case you claim, WHERE ARE THEY? WHERE IS ALL THE ADVERTISING ABOUT ALL OF THIS HEALTH INSURANCE THAT CANADIANS ARE SUPPOSED TO WANT? NOBODY IS BUYING IT, AND THERE'S NO ADVERTISING BECAUSE ALMOST NOBODY IN CANADA WANTS IT, AND INSURANCE COMPANIES KNOW IT.

The only health insurance advertising you see advertised in any form of media in Canada is for dental care, vision care, and that portion of prescription drugs not covered by the health care system or by the provincial drug plan or employer provided plans, and covers nothing else but those three things. Nothing else is advertised, of the kind that health insurance in the US covers. US style health insurance is unwanted in Canada, and virtually no one would buy it and insurance companies know that.

you seem to make a big point of advertising...why? Sounds like a little misdirection to me

I don't care that people in canada don't advertise for private health care. I don't care that people don't want private health care. That is irrelevant

What is relevant is the court's decision:

As a result of delays in receiving tests and surgeries, patients have suffered and even died in some cases, justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority.

I don't care what your commercials are telling you. I don't care that canadians have been brainwashed into thinking their system is perfect. What I care about are facts.

And people are dying---fact

what am I so un-informed about by the way?

And where's your source on the 1000 deaths? Oh yeah, you made it up. I forgot

You think I make things up when 99% of what you say is made up and has no basis in fact? What studies back up your claims? What Universities back up your claims? What medical studies (not American propaganda) back up what you say? Tell me what academic and medical studies back up what you say!

In 2007, Gordon H. Guyatt et al. conducted a peer reviewed meta-analysis, or systematic review, of studies that compared health outcomes for similar conditions in Canada and the U.S., in Open Medicine.

They concluded, "Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." Guyatt identified studies addressing conditions including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of the 10 studies with the strongest statistical validity, 5 favoured Canada, 2 favoured the United States, and 3 were equivalent. Overall, results for lower mortality favoured Canada with a 5% advantage.

Show me an equivalent medical study that says the opposite............

You think Canadians are brainwashed when all you have tom offer is a brainwashed biased American view, which has no basis in fact or reality.

Anyway, you won't live as long as you would if you were a Canadian. Because you have American insurance run and rationed health care you'll die four years or more sooner than you would with Canadian health care. That's the only fact that counts.

i have provided nothing but evidence. Every statistic I gave was supported by evidence. Show me where I didn't do that (unlike you...i'm still waiting for the source of that 1000 death number)

So, the study you posted is basically a wash. Inconclusive. What is the opposite of inconclusive. Is the 5% difference meanigful? Is it statstically signficant--if so, what was the p value? Do you have any idea what I'm talking about

How is the decision of your OWN supreme court american brainwashing?

I have tried to explain to you why mortality isn't the only fact that counts. Lets say we both buy cars tomorrow--same cars, same dealer. You have the oil changed right on schedule, all maintence done right, drive only the speed limit, and put in premium gas. I, on the other hand, never change the oil, get in accidents at least weekly, drive the car 100 miles/hr wherever i go, and use my friend's moonshine for fuel.

At 30,000 miles, we both take our car to our own mechanics (mine is actually towed in) He says you owe 50 dollars for your scheduled mainatence, and your car will last another 10 years. Mine, on the other hand, will cost 2000 dollars to fix, and will only last another 10K miles before giving out

Does my mechanic suck? Do we need mechanic reform? I think we should copy your mechanic, because he obviously knows what he's doing--he gets better results for cheaper?

Do you see what I mean now? Do you still think mortality is the "only fact that matters?"

Not only that, but the fact that 9% of Canadians are disabled while 14% of Americans are disabled is significant.

Canadians not only live longer but are much healthier than Americans because Canadians have access to health care that most Americans don't is significant.

You seem to be patronizing enough to tell Canadians what is best for them, despite the fact that Canadians don't agree with you, while a significant number of Americans want single payer and the State of Vermont has already passed single payer, and it looks like California and Illinois want to institute single payer.

Many Americans want the health care system I have and virtually no Canadians want the health care system you have. That says volumes.

opinion, opinion, opinion

Any facts out there...there...there (insert echo sound effect)?

You obviously have no experience with scientific study. When I use the word "significant", I do not mean "important". I mean, are the results you claim to show from the variable in question, or do they arise purely from chance. A p value is a statistical tool used to analyze that fact.

Allow me to illustrate. I find 10 patients from canada and 10 from the US. Both groups have suffered a heart attack. 2 from the canadian group die, while only one from the US group dies. AHA! US care is superior I say--no wait, you mean 10 might not be enough patients? and a difference of only one death is not a SIGNIFICANT enough of a difference to make that conclusion. You mean I actually have to understand science to be able to communicate effectively?

If you are going to post a study, at least learn how to interpret it.

Except your heart attack scenario is not the case. I know dozens of Canadians who were about to have heart attacks who had bypass surgery within three hours of being admitted, my mother being one, and none of them would have been able to afford to have bypass surgery in the US. If they were Americans they would die. Medical studies have found this to be the case.

People in the US die who would be alive if they were Canadians, but the reverse is not the case. Canadians live with or are cured of conditions that kill Americans. Most American diabetics can't even see a physician let alone have the meds or insulin they need. Most American hypertensives can't even see a physician let alone get the meds they need to contro,l their hypertension. The complications of diabetes and hypertension are what account for the 5% higher disability among Americans more than exists in Canada, since people in Canada have those conditions under control, and most Americans can't see a physician once, let alone often enough to control diabetes and hypertension. If I were an American, with hypertension like mine, existing for over 15 years, would be uncontrolled and I'd have had a heart attack and died long ago. In Canada, I'm 60 and my BP is in perfect control. Tests show that I have only a 4% chance of having a heart attack in the next 10 years, that is by age 70.

Once Vermont, California, and Illinois adopt single payer, that will start the tidal wave which will sweep across the US, so that the US will have single payer nationwide in 5 to 10 years. This is analogous to Saskatchewan beginning single payer in 1962 and then it became national in 1966.

john,

my heart attack scenario was not stated to be factual, but was an example of the use of the terms "significant" and "p value" so you could understand them. Just to clear this up, I did not actually conduct a study with 10 american and 10 canadians.

What medical studies???? Please post them!!!! Its easy--look

Impact and inequity of inpatient waiting times for advanced cardiovascular services in community hospitals across the greater Toronto area.
Singh N, Gupta M, Fell D, Gangbar E.

Source

Rouge Valley Health System, Centenary Site, Toronto, Canada. narendra.singh@utoronto.ca

Abstract

OBJECTIVE:

To assess waiting times for inpatients requiring urgent transfer for advanced cardiovascular procedures from community hospitals; the magnitude of adverse events while waiting; and possible inequity among community hospitals in access to these services.

SETTING:

Seven representative community hospitals in the Greater Toronto Area (GTA).

DESIGN:

Prospective data collection over 12 months (May 1997 to April 1998).

PATIENTS:

One thousand, two hundred and three inpatients who waited a total of 7261 hospital days for advanced cardiovascular procedures.

MAIN RESULTS:

The average (+/- SD) inpatient waiting time, in days, for catheterization was 5.7+/-1.3, angioplasty 5.8+/-2.1, bypass surgery 7.0+/-2.1 and pacemakers 4.2+/-1.6. During this time there were 14 deaths (1.2%) and 12 (1.0%) morbid events in-hospital. Extrapolation of these data to all 21 community hospitals in the GTA suggests that annually 21,783 bed days are used by inpatients awaiting transfer for advanced cardiovascular procedures, during which time 42 fatal and 36 morbid events can be expected to occur. Of the seven hospitals, one had a catheterization laboratory (group 1), two had no laboratory but had catheterizing cardiologists (group 2), and four had no laboratory and no catheterizing cardiologists (group 3). None of these hospitals had on-site revascularization facilities. The average number of days spent waiting for catheterization in group 1 (3.1+/-0.4) was significantly less than that in group 2 (5. 4+/-1.3, P<0.001) and group 3 (6.5+/-1.3, P<0.0001). The catheterization wait in group 2 was significantly less than that in group 3 (P<0.02). There were no significant differences among the three groups in the number of days spent waiting for angioplasty or bypass surgery.

CONCLUSION:

Waiting times for inpatients requiring advanced cardiovascular procedures in GTA community hospitals are long, and are associated with substantial morbidity and mortality. These waiting times also promote inefficient bed use and increased health care costs. Furthermore, these data suggest that access to inpatient coronary angiography in the GTA is inequitable and appears to depend more on the presence of on-site catheterization laboratories or catheterizing cardiologists than on illness severity

Where are you getting the idea that MOST diabetics and hypertensives can't see a doctor in the US??? PLEASE CITE SOMETHING FOR YOUR NONSENSE!

right, it was the same place you saw the mortality by physician error number :)

Your risk for heart attack in the next 10 years is 12%, by the way, using the framingham method. That's assuming you are a nonsmoker, and have perfect cholesterol and bp control.

here's another:

Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting.
Sampalis J, Boukas S, Liberman M, Reid T, Dupuis G.

Source

Department of Surgery, McGill University and Montreal General Hospital, Que. mcsa@musica.mcgill.ca

Abstract

BACKGROUND:

A lack of resources has created waiting lists for many elective surgical procedures within Canada's universal health care system. Coronary artery bypass grafting (CABG) for the treatment of atherosclerotic ischemic heart disease is one of these affected surgical procedures. We studied the impact of waiting times on the quality of life of patients awaiting CABG.

METHODS:

A prospective cohort of 266 patients from 3 hospitals in Montreal was used. Patients who gave informed consent were followed from the time they were registered for CABG until 6 months after surgery; recruitment began in November 1993, and the last follow-up was completed in July 1995. Patient groups were classified according to the duration of the wait for CABG (< or = 97 days or > 97 days). We measured the following outcomes: quality of life (using the Medical Outcomes Study 36-item Short Form [SF-36]), incidence of chest pain (using the New York Heart Association angina classification), frequency of symptoms (using the Cardiac Symptom Inventory) and rates of complications and death before and after surgery.

RESULTS:

There were no differences in quality of life at baseline between the 2 groups. Immediately before surgery, compared with patients who waited 97 days or less, those who waited longer had significantly reduced physical functioning (change from baseline SF-36 score 0 v. -4 respectively, p = 0.001), vitality (change from baseline score -0.1 v. -1.3, p = 0.01), social functioning (change from baseline score 0.4 v. -0.4, p = 0.03) and general health (change from baseline score 1.1 v. -1.7, p = 0.001). At 6 months after surgery, compared with patients who waited 97 days or less for CABG, those who waited longer had reduced physical functioning (change from baseline SF-36 score 4.0 v. -0.1 respectively, p = 0.001), physical role (change from baseline score 0.8 v. 0.0, p = 0.001), vitality (change from baseline score 2.2 v. 0.9, p = 0.001), mental health (change from baseline score 1.2 v. 0.0, p = 0.001) and general health (change from baseline score 1.8 v. -0.3, p = 0.001). The incidence of postoperative adverse events was significantly greater among the patients with longer waits for CABG than among those with shorter waits (32 v. 14 events respectively, p = 0.005). Longer waits before CABG were associated with an increased likelihood of not returning to work after surgery (p = 0.08): 10 (53%) of the 19 patients with longer waiting times remained employed after CABG, as compared with 17 (85%) of the 20 with shorter waiting times.

INTERPRETATION:

The significant decrease in physical and social functioning, both before and after surgery, for patients waiting more than 3 months for CABG is an important observation. Longer waiting times were also associated with increased postoperative adverse events. By decreasing waiting times for CABG, we may improve patients' quality of life and decrease the psychological morbidity associated with CABG

how about another:

Health-related quality of life and mobility of patients awaiting elective total hip arthroplasty: a prospective study.
Mahon JL, Bourne RB, Rorabeck CH, Feeny DH, Stitt L, Webster-Bogaert S.

Source

Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON. Jl.Mahon@lhsc.on.ca

Abstract

BACKGROUND:

Waits for elective total hip arthroplasty for osteoarthritis are common in publicly funded health care systems, but they may lead to poorer postoperative outcomes and loss of health-related quality of life (HRQOL) through progressive pain and immobility during the wait. These issues have not been examined from the time of referral for surgery. Our primary objective was to test whether a longer wait was associated with poorer postoperative HRQOL.

METHODS:

Patients needing possible total hip arthroplasty for osteoarthritis were identified upon referral to a surgeon in London, Ont. Outcome measures, including the Western Ontario McMaster (WOMAC) Osteoarthritis Index and mobility in the 6-Minute Walk, were assessed at baseline and every 3-6 months thereafter until at least 3 months after the surgery.

RESULTS:

Of 553 potentially eligible patients referred for surgical assessment, 123 were placed on a waiting list for total hip arthroplasty; 114 underwent the procedure, and 99 of them returned for postoperative assessment. No significant differences in HRQOL or mobility were seen postoperatively between patients with short waits and those with long waits (a priori definitions < or = 6 months and > 6 months respectively). At referral, however, patients with short waits had poorer HRQOL and were less mobile than those with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score, 0.001 for pain, 0.009 for stiffness and 0.008 for function; p = 0.006 for 6-Minute Walk results). Patients with short waits experienced larger gains in these measures from the time of referral until the postoperative assessment than did patients with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score, < 0.001 for pain, 0.005 for stiffness and 0.005 for function; p = 0.06 for 6-Minute Walk results). For patients with long waits, increases in the WOMAC Osteoarthritis Index total score exceeded 10% and losses in walking distance exceeded 30 m from the time of referral to surgery.

INTERPRETATION:

The length of wait for elective total hip arthroplasty is not associated with postoperative HRQOL and mobility. However, patients who undergo the procedure within 6 months after referral have greater disability at referral, and realize greater gains in HRQOL and mobility after surgery, than patients waiting more than 6 months. Clinically important losses in HRQOL and mobility occur in patients waiting more than 6 months.

Yes, most diabetics and hypertensives in the US definitely can't see a physician, let alone have the treatment needed to prevent disability and death.

GTA is the Greater Toronto Area, which accounts for .071% of Canada.

You claim to know more than the physicians who did the heart and circulatory study on me? That's interesting that you know more than they do....sight unseen..

Once Vermont (which already passed single payer), and California and Illinois (who are leaning toward single payer) start the tidal wave, the US will have single payer within 5 to 10 years,and you'll be crying but will have no alternative, because insurance run health care, and the rationing associated with it, will be dead.

do you have any proof at all for your claims. I mean any proof?

By the most liberal of claims, 50 million americans are uninsured...that means that over 200 million ARE insured

You don't think insurance pays for a dang NP to treat someone's hypertension? Really? Really?

All I can tell you is there is no such thing as a "heart and circulatory study" And yes, I can predict your cardiovascular risk not having seen you, because others have seen hundreds of thousands of people just like you and compiled data from which we predict what happens to similiar patients. And it works. Google framingham

Why don't you comment on all the studies I provided that show the DETRIMENT of single payer on patient health?

Are you capable of understanding the difference between "opinion" and "fact"

Youve mentioned this tidal wave thing twice. Not that I say its true, which its not by the way, but so what? Have you watched the news lately--did you see the country's response to obama's new law? It was divisive at best--and it was infinitely more moderate than what you propose

Either way, so what? What if the US adopts it? Does that make it right? Im not sure how thats a persuasive argument

17% of Americans are uninsured. 21% are under-insured to the extent that their medical needs are not met. That's 38% or 127 million Americans whose medical needs are not met.

27% have Medicare, Medicaid, Military, or DVA government provided socialized medicine for military and DVA and single payer for Medicare and Medicaid, not insurance. That's 91 million Americans.

That leaves only 35% of Americans with insurance run and insurance rationed health care, only 26% of which are satisfied with their access to health care, and only 48% of which are satisfied with the quality of their health care. That's only 117 million Americans who have insurance run and insurance rationed health care that has even the slightest chance of meeting their medical needs.

Americans will find out for sure that single payer is the best system within 10 years, yes.

show me a source!!!

medicare is a great insurance. The military is a great insurance. How can you possibly count those people as not having a chance of meeting their medical needs?

Isn't our medicare the most similiar thing to YOUR insurance. So, by your logic, NO ONE in canada is covered

Youre a moron. Im done

Insurance in Canada only covers dental care, vision care, and the portion of prescription drugs not covered by the health care system. Everyone in Canada has access to health care, not insurance. The problem with Americans is that they equate health care with insurance, and there is no connection at all. Everyone in Canada has access to health care, and that has nothing to do with insurance. No one in Canada has or wants the kind of American style insurance you think about as insurance.

I don't equate them with not having most of their medical needs met, but they don't have insurance, they have government provided health care. Insurance has nothing to do with health care, and people with government provided health care do not usually have or need insurance.

Health care and insurance are not related at all, as anyone outside of the US knows.

I'm 60 and receiving great medical care, but if I were an American I would have died long ago. I'm only alive because I have Canadian health care and not American insurance run and insurance rationed health care (which I was forced to use while working in the US, so I know how bad US health care is compared to what I have in Canada).