From the Denver Post. Click on title above to link to article.
As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.
Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.
Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.
Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.
As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.
Myth: Taxes in Canada are extremely high, mostly because of national health care.
In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.
Myth: Canada's health care system is a cumbersome bureaucracy.
The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.
Myth: The Canadian system is significantly more expensive than that of the U.S.Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.
What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.
Myth: Canada's government decides who gets health care and when they get it.While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.
There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.
Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.
Myth: Canadians are paying out of pocket to come to the U.S. for medical care.Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.
Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.
Myth: There aren't enough doctors in Canada.
From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.
And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.
It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.
Rhonda Hackett of Castle Rock is a clinical psychologist.
Wednesday, July 22, 2009
Wednesday, July 15, 2009
Saturday, July 11, 2009
Japan Flashback
Thought that I'd flashback to Japan for a second. This is Harijuku, one of the more fashion-forward parts of Tokyo and it is overflowing with youth trying to find the next, best and hottest items. This is a pretty typical day on the street, no special event or anything, just PACKED.
Friday, July 10, 2009
Wednesday, July 1, 2009
Gotta Love the Kiwi's!
Air New Zealand flight attendants bare all in the making of their newest inflight safety video. I hope no one at NWA gets a bright idea from this.
Friday, June 12, 2009
Well, this is disconcerting. AA cutting 1600 jobs, Delta may follow soon.
By Mary Schlangenstein and Mary Jane Credeur
June 12 (Bloomberg) -- AMR Corp.’s American Airlines will eliminate 1,600 jobs and Delta Air Lines Inc. may pare its payroll again as waning travel demand spurs deeper cuts in seating capacity.
American’s reductions equal about 2.4 percent of the workforce, while Delta said it would “reassess staffing needs” without giving a figure. US Airways Group Inc. said it wants 400 flight attendants to take leaves or it will resort to layoffs.
The cutbacks in flights and jobs announced yesterday may herald similar steps by other U.S. airlines. Revenue is vanishing as they trim fares to lure customers who are flying less because of the recession, especially in premium-class cabins on overseas routes.
“Unless there is a huge upturn in business travel propensity and spending, it’s inevitable there will be further cutbacks in capacity on the international side,” said Robert Mann, who owns consulting firm R.W. Mann & Co. in Port Washington, New York.
Delta, the world’s largest airline, will slash available seats as much as 4 percentage points more than planned, for a cutback of 10 percent from 2008 levels, Chief Executive Officer Richard Anderson told employees. American, the second-biggest carrier, said it would shrink flying by 1 percentage point more than projected, to 7.5 percent.
American may have to shed more jobs as it analyzes the “full impact” of the latest capacity moves, said Jeff Brundage, senior vice president for human resources. The Fort Worth, Texas-based airline eliminated 6,840 jobs last year and has a workforce of 67,000.
‘Trying Times’
“These are trying times in the airline industry and our economy,” Brundage said in a message to employees. “The recession has taken a disproportionate toll on airlines and there is no easy way to announce yet more bad news.”
About 75 percent of the positions being dropped, or 1,200, would be flight attendants, American said.
New reductions at Delta would expand on 2,100 jobs shed earlier this year through buyouts and 6,000 dumped in 2008 by the Atlanta-based carrier and Northwest Airlines, acquired by Delta in October. Delta said it has more than 70,000 employees.
“While the challenges of the current environment preclude us from making guarantees, our goal remains to try to avoid any involuntary furloughs of front-line employees,” Anderson said in his message to employees.
American and Delta said their capacity reductions would start taking effect in September, after the U.S. summer travel season.
US Airways
US Airways, the smallest of the so-called full-fare airlines, has 6,700 attendants -- too many, it said, after attrition didn’t thin their ranks as much as forecast. The Tempe, Arizona-based carrier has targeted capacity cuts of as much as 6 percent, and hasn’t announced new reductions.
Delta fell 6 cents to $6.62 at 9:47 a.m. in New York Stock Exchange composite trading. AMR rose 4 cents to $4.63, and US Airways gained 7 cents to $2.74.
US Airways disclosed the proposed leaves in an employee newsletter and in meetings with attendants, much like Delta and American commented on their plans in messages to workers issued separately from presentations yesterday at a Bank of America airlines conference in New York.
UAL Corp.’s United Airlines said premium-class travel to Asia is down and Southwest Airlines Co. said June revenue for each seat flown a mile will be worse than in May.
United’s Watch
United, the third-biggest U.S. carrier, is assessing capacity and demand on its routes daily, CEO Glenn Tilton said after the Chicago-based airline’s annual meeting. United “is not predisposed” to make additional capacity cuts now, he said.
Travelers flying overseas, particularly those who buy first- and business-class tickets, typically generate the most profit for U.S. airlines because discounters don’t compete on those routes.
“You can clearly fill up the airplane with cheap fares, but that doesn’t get you the economics you want,” said Mann, the airline consultant. “The maximum revenue is just less than you’d hoped. It doesn’t necessarily get you to a positive bottom line.”
Weak travel demand is eroding Delta’s revenue, overwhelming the $6 billion in benefits the airline had expected in 2009 from lower fuel prices than a year earlier, merger savings and previous capacity reductions.
With international travel down “significantly,” Delta said it will cut overseas capacity by an additional 5 percent from what it announced in March, for a 15 percent total reduction on those routes.
Traffic, or miles flown by paying passengers, on overseas routes dropped 10 percent at Delta through May and 8.7 percent at American, according to the airlines’ monthly traffic reports.
American said yesterday it will buy 8 more Boeing Co. 737- 800s than planned by 2011. American now will take 31 of the jets by December, up from 29, and 45 in 2010, up from 39, according to a U.S. regulatory filing. The planes are replacing less-fuel- efficient models being removed from American’s fleet.
To contact the reporters on this story: Mary Schlangenstein in Chicago at maryc.s@bloomberg.net; Mary Jane Credeur in Chicago at mcredeur@bloomberg.net
Thursday, June 11, 2009
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