This is why socialist health care doesn't scare me at all

[maat55]

I'm not a neurosurgeon, but I'd venture to say that very few surgeries are done because of MRI findings. They are done because of intractable pain or symptoms indicative of neurologic compromise (weakness of legs, loss of bowel or bladder control, etc.). Yes, an MRI will be done as part of the work-up to make sure that the problem is a herniated disc and not a big spinal cord tumor, but it is generally already decided that the patient is heading for surgery. The MRI just gives the surgeon a good idea of what to expect when he gets inside.

I'm still left wondering how long it would take to get an important surgery in Canada as apposed to here in the US under the system they have in place.

IMO, with what I have seen, you could have a hard to diagnose problem in Canade and end up with the problem for a very long time as apposed to our system.

I question the quality of healthcare under an social system. I could be wrong, but It does not feel good in my bones what is going on. Maybe i'm just a pessimist clinging to my idea of real freedom.

[markusk]

Are you kidding me? Patients WANT diagnostic testing. They want MRI's. I have to argue with them why MRI's aren't needed or why I shouldn't order it from the ER and why they should see a primary physician.

Southerndoc, I agree with you. I was only coming from one important perspective of how the current incentives in the "fee for service" payment system CAN lead to certain behaviors by physicians.

I've been in situations where within 5 minutes of coming to see me for the first time visit for vague sensations of numbness, a patient declares to the effect "I want a brain MRI, as well as a C/T/L spine MRI because I know something is wrong with me. And if you won't order the studies, and later I find out something was missed, I am going to sue everyone who did not believe me." One problem here, I think, is that patients with good insurance do not know the true cost of their health care, so they want everything done. This of course, assumes that their insurance signs off on the imaging studies, otherwise the physican will have to justify why the studies are needed (this can still be turned down by the insurance companies).

I'm trying to figure out the final outcome of a person who needs back surgery in Canada as apposed to the US. Here, you could get the MRI quickly and have the surgery. What would happen in Canada?.

maat55, I don't have personal experience with the Canadian healthcare so not sure how to comment. But according to the article on the Denver Post (see my previous link), if it is an emergency it gets done fast.

Even in the US, there is a pecking order of sorts when ordering an MRI and getting an MRI done. Lets face it, if a hospital has two MRI machines, there are only a certain number of studies that can be done on any given day. If you were in a traumatic accident and you have an exam consistant with a spinal cord injury, you will be at the top of the list (and bump down whoever was ahead of you down the list). If you have back pain but your exam is essentially normal, then you will be lower down on the list. Think about it, why does it take so long to get an outpatient MRI? It certain cities it can take several weeks -- but some people don't want to wait so they go to the nearest Emergency Department hoping to get an MRI sooner. This happens all the time. People don't realize that when they are given a time slot for an MRI, they are taking a spot that someone else may need (perhaps more than you). The radiologist based on the information available makes a priority list which may change every hour due to trauma patients coming in to the ED, etc.

Wow, I'm rambling on. Sorry about that. Point is, it's complicated.

[snafu]

Originally Posted by pikey412
I don't like the idea of my wife having to wait 4-6 months to see a doctor if she's detected a lump in her breast.

Where did you get that idea? Anyone woman with a lump in her breast gets seen within days. If a biopsy proves cancer, surgery is DPQ. Electives like knee/hip replacement have waiting periods because as the population ages, living longer, more demand, the surgeons only can do a few each day and keep up with their practice, post op etc.

The patient leaves the hospital and move on to physio without a co pay. The Denver Post article was correct. Canadians see ourselves as a Nanny State; we've allowed the government to look after us from cradle to grave and pay for it with taxes including gasoline, cigarette/liquor tax.

In many ways it's similar to your public school system. Everyone pays for those schools, including renters indirectly, whether or not you have children enrolled in that system. You can elect to send your kids to a private school or home school but your tax dollars support the education system.

[disneysteve]

Are you kidding me? Patients WANT diagnostic testing. They want MRI's. I have to argue with them why MRI's aren't needed

Family docs have a little trick they can employ here. Most insurance companies require prior authorization for MRIs. I have to fill out a form documenting the reason for the test. If I feel the test is appropriate, I can word the request in such a way as to be pretty sure it will be approved. If I feel it is frivolous, I can word the request differently so that it will likely get denied. Then I can just tell the patient, "Sorry, the insurance company denied the MRI. Let's proceed with the treatment course I recommended and if things don't improve, then we can try again to get an MRI authorized."

Prior authorizations are the biggest joke and a huge waste of money. They approve upwards of 90% (probably over 95%) of requests. They spend far more money in administrative costs to process all of the authorization requests than they save in the handful of denials they issue. Plus, it wastes a huge amount of time and money on the doctor's end and unnecessarily delays treatment. Most experienced doctors know exactly what to say on the requests to get things approved. If they would just do away with the whole prior authorization system and let doctors decide what tests to order, they would save millions of dollars.

[elvacan10]

I am a cuban residing in the united states and let me tell you if there is one thing that i definitely miss if the health care system that's for sure.

[whitestripe]

I don't like the idea of my wife having to wait 4-6 months to see a doctor if she's detected a lump in her breast.

having personally done that (detected a lump) i can say it's not a nice feeling - though i did actually wait about two weeks because i was scared. thankfully i have never had to wait any longer than two days for an appointment with a doctor - if you looked around you could get one that day if you tried. i am thinking it's very different in australia to america!

[geojen]

having personally done that (detected a lump) i can say it's not a nice feeling - though i did actually wait about two weeks because i was scared. thankfully i have never had to wait any longer than two days for an appointment with a doctor - if you looked around you could get one that day if you tried. i am thinking it's very different in australia to america!

I saw a very interesting program on Bill Moyers Journal Friday night:

Bill Moyers Journal . Wendell Potter on Profits Before Patients | PBS

I was shocked when I saw the footage of all those people standing in line to get health care. It looked like a third world country. Shamefull.

[swanson719]

We all know I'm against nationalized health care. I think it's outside the jurisdiction of the federal gov't, and the inefficiency thereof isn't something I want to see spread to medicine. Regardless, healthcare does need to be reformed for the obvious reasons the medical professionals here brought up. It can be done outside of the realm of being controlled by the fed gov't.

[geojen]

We all know I'm against nationalized health care. I think it's outside the jurisdiction of the federal gov't, and the inefficiency thereof isn't something I want to see spread to medicine. Regardless, healthcare does need to be reformed for the obvious reasons the medical professionals here brought up. It can be done outside of the realm of being controlled by the fed gov't.

Swanson, I just find it so peculiar that you have socialized health care that takes care of your wife's very expensive medical condition, yet don't think everyone else should have that opportunity. To me it seems like cognitive disonance.

[swanson719]

Everyone does have the same opportunity that I have for socialized health care. If you go out and risk your life for your country and put yourself in harms way, then you should be compensated accordingly, and part of that compensation is free health care.

If you want socialized health care, go down to your local recruiting office, and have at it hoss.

[geojen]

Swanson, I wasn't trying to attack you or imply you don't deserve socialized health care. After rereading my post, I could construe how you might have taken my words as a personal attack. That was not my intent. I'm trying to reconcile the fact that you have care but don't think others should. No need to patronize me.

Coincidentally, I don't think you should have to join the military to have health care. The public still pays anyway and everyone is not cut out to be in the military, just like everyone is not cut out to be a teacher, accountant, etc.

[swanson719]

Geojen, I apologize for getting a little upset with you. You're right, I did take it as more an attack due to the cognitive disonance comment.

However, let me clarify. I think it would be awesome for health care to be available to everyone. That's part of my idea of Utopia. However, it is not our right to force those who excel in their life to hand over more than half of the fruit of their labor to others because they either cannot or will not take care of themselves. The news this morning cites a 57% proposed tax for those with a gross income of over a million as a way to support health care. If the government could come up with a way to have universal health care administered by private corporations in a manner that was affordable, but not mandatory to everyone, then I would support it.

I do not support an 8% tax on all small businesses with a pay roll over $400,000. I do no support a tax of 5.4% on the adjusted gross income of our best and brightest. I do not support any tax raises when we already have SSI, SSDI, disability, welfare, social security, social security survivors benefits, unemployment, medicare, medicaid, and all the state programs as well. If we were to reorganize and have a thorough audit of the federal gov't as a whole, and really, truly, cut the fat like spending $10 Million on the San Francisco Bay field mouse, then maybe. But when our country is in a recession already, the last thing we need is crippling tax hikes. Not a year into office and we're talking about raising taxes by 24%.

It's not a humanitarian issue to me - I support health care for all - I don't support this way of doing it.

[red92s]

The news this morning cites a 57% proposed tax for those with a gross income of over a million as a way to support health care.


It's not a humanitarian issue to me - I support health care for all - I don't support this way of doing it.

isn't it 5%, not 57%, to support this program?

[cschin4]

There is too much healthcare in this country. Everyone doesn't need a pill for every stupid thing under the sun. The whole idea that everyone from age 5 needs to take Lipitor or other money making anticholesterol pill is absurd and nothing but a money maker.

[disneysteve]

There is too much healthcare in this country. Everyone doesn't need a pill for every stupid thing under the sun. The whole idea that everyone from age 5 needs to take Lipitor or other money making anticholesterol pill is absurd and nothing but a money maker.

Yes and no. I agree that Americans are overmedicated, but I would also point out that we have treatments available now that didn't exist 10 or more years ago that are resulting in saving millions of lives and extending lifespans significantly.

You mentioned Lipitor. The statin drugs are a good example. Prior to Mevacor, the first statin, there wasn't much of anything to do for high cholesterol. Just wait for the patient to have a heart attack and hope they survived. The statins have reduced the death rate from coronary artery disease significantly. Of course, it is true that if people weren't so darned fat, there wouldn't be so much heart disease in the first place, but that doesn't lessen the value of drugs like Lipitor.

Many drugs also eliminate or at least greatly reduce the need for costly and risky procedures. For example, before Prilosec came along, I regularly had patients experience bleeding ulcers and getting endoscopies to evaluate their conditions. Once Prilosec hit the market, the rate of GI bleeds dropped off dramatically and the number of endoscopies being done also plummeted. So yes, a lot more people take a pill for heartburn/reflux/ulcer today but far fewer die of GI bleeds or get hospitalized for them and need surgery to repair them.