Medicare "Choice" in New Orleans

[Chantal]

Winnipeg Free Press Article
By Frances Russell
Friday, September 16, 2005

Alberta’s on-again, off-again musings about opening all public health services to competition from Canadian and American insurance companies are daggers pointed directly at Medicare’s heart. And they come less than two weeks after hurricane Katrina underlined the deadly results of private medicine. Alberta, the Canadian Medical Association, four Supreme Court justices and growing chorus of special pleaders insist that “choice” or “two-tier” healthcare poses no threat to Medicare and indeed will improve it. The justices go even further and say the absence of “choice” in healthcare denies Canadians their right to Security of the Person under the Charter of Rights and Freedoms. They should think again.
As the flood waters poured into New Orleans, two hospitals across the street from one another brought into sharp relief what “choice” in healthcare means. The rich live and the poor die. All 1000 plus patients and family members at private Tulane University Medical Centre were helicoptered from the hospital’s rooftop helipad before access to the helipad was offered to New Orleans’s largest public hospital, Charity, located right across the street. By then, flooding and sniper fire made it impossible to transfer patients from Charity to Tulane. The Associated Press carried a series of stories on the frantic efforts by the staff at Charity Hospital and another nearby public hospital, University, to keep patients alive as power went out, generators failed and food, water, and medical supplies dwindled. Dr. Norman McSwain, Charity's chief of trauma surgery, phoned AP because he had exhausted all other avenues. "there is no food at Charity hospital...there's minimal water. Most of the power is out. Much of the hospital is dark."
Charity and University hospitals waited another two days before the National Guard evacuated them by boat. By then Charity had 12 bodies in its morgue and another five stacked in a stairwell, in both cases under water. Other bodies were in other parts of the hospital. The total number of fatalities at the two hospitals is unknown.
New Orleans demonstrated something else about “choice” in healthcare. Two-tier quickly becomes multi-tier with widely divergent standards in the private-for-profit system. More than 40 mostly elderly patients were found dead Sunday at the private 317 bed Memorial Medical Centre owned by Tenet Healthcare Corp., the highest hurricane death toll in a single place. Contrast this reality with the rosy platitudes of Alberta Premier Ralph Klein in an article published last month in Toronto Star. Claiming his government “has a moral responsibility “to end the “rationing” of healthcare, Mr. Klein vigorously applauded the Supreme Court judgement. The Supreme Court’s answer “demolished the myths” surrounding Medicare, he said. “The hollow rhetoric and pointless scaremongering are over,” the premier wrote. “An Alberta Justice analysis of the court’s decision found: ‘The evidence demonstrates that a monopoly is not necessary—or even related—to the provision of quality healthcare.’ Case closed.”
The only way to “move out of the line” and into the healthcare market is to raid the existing supply of healthcare professionals, Atkinson Foundation Economist Armine Yalnizyan wrote in a response published in The Star. “This is a straight trade off between who gets seen first and who has to wait longer.”
While the alternative Mr. Klein suggests will provide some people more choice, “it will come at the expense of many others having less choice,” she continued. “Given the higher price tag of faster care and presumably higher rates of pay, lower stress or shorter hours of work—get ready for the giant sucking sound of siphoned from the public sector to the private market,” Ms. Yalnizyan concluded. No, Mr. Klein, the case is not closed.
It is not closed because the only Canadians to enjoy “choice” will be those who can afford—or qualify for –private insurance at $2000 to $5000 a year. It is not closed because the Right to security of the Person will be denied to the majority of Canadians in clear defiance of the charter’s universality and equality rights clause. It is not closed because “choice” doesn’t end rationing. It merely ushers the rich through the front door---on Tulane University Medical Center’s helipad, for instance—while everyone else waits in a now hopelessly long line at the back.

[LH]

As usual, Frances Russell has "some" of the facts correct and is missing other to properly "fill out" the story. Example: We don't have "Two Tier healthcare in Canada"? I fail to see where she or anyone else gets those supposed facts. The facts that can be obtained from government is that 30% of our healthcare services at present are peovided and contracted out to private companies. So we already have it. So what's this....."Lord, we can't have that because then only the rich will get proper medical care"

Sorry gal, but 9 people died in Manitoba waiting to have heart operations last year and most had waited over a year yet. If I have the money and my living or not depends on that badly needed heart operation, then who has the Right to deny me that operation if I'm willing and able to pay for it? I'm supposed to sit around and hope I don't die before they get to me.......I think not. If I can't get it here, I'll go down over the border and get it.........the exact same place that OHIP sent 37% of Ontarians last year.....at OHIP's cost.....and the exact same place 17% of Manitobans were sent also.....again at our cost.

Somewhere along the line people forgot what Tommy Douglas's ideas were on the need for National HealthCare in the first place. His aim was to get proper healthcare for those Canadians who were not covered by private or employer programs for same.....and couldn't afford "diddley" in that regard themselves. In order to cover those Canadians "in desparate need" of healthcare, he wanted to have ALL Canadians come under it then. That's fine, but if I'm a Canadian millionaire or very wealthy person, then why are less rich Canadians required to pay for my operation. Hell, maybe I have enough money to buy the bloody hospital and yet all of Canada has to foot the bill for that operation. I should be told...."Sorry, but your income indicates that you can pay for all or half of that operation and it wasn't meant for people in your income tax bracket anyway.....it was meant for those who can't afford to buy private insurance that you can". It should be "pro-rated" to one's yearly income, otherwise we are fast reaching the point where the country can't afford the way it is now.

[Dust Devil]

Good Post

[grimey]

We already have two-tiered health care, due to the border being so close to most of our population. Robert Bourassa, the former premier of Quebec, went to the US in the 90's so that he could get the cancer treatement he wanted. So what happen when others do the same? Our economy (and therefore our own health care system) is weakened because the money that could have gone to a private canadian clinic, and back into our economy, instead went to the US. Private clinics and non-emergency hospitals should be allowed, with the condition that the public health care system maintains it's current level of funding, indexed for inflation and population growth.

[Guido]

LH... I can honestly say you've just about convinced me that "two-tier" healthcare would be a reasonable idea. But we still need the rich to help pay for the lower tier in taxes. How do we keep the government from changing the rules, like TC, and charging "only the people who use the service"?

[Dust Devil]

If people could realize two tier health care doesn't mean the "American System". I think we would be alot closer to solving the health care issue.

[Chantal]

Most people I know use public services and I hear good stories most of the time and Frances probably does too. These good experiences are possible and should be for everyone. If Terry Fox is really a hero in this country then we will have the same attitude which I think he would say healthcare should be for everyone not just you because you were lucky and you got the bucks to pay for it. We all know people can get rich in all kinds of ways and its not because they earned it, sometimes.

The economists know what problems we are having because of two-tier system, and Frances mentions this in her article.
This was another interesting read,
http://cnews.canoe.ca/CNEWS/Canada/2005 ... 26-cp.html

[LH]

Guido -----heard that position and argument before and here's my answer....."you ever been on Welfare?.......I haven't.....and yet I help to pay for it , JUST IN CASE I too, might have to use it someday". Another example......if I'm retired and make over a certain amount per year, I can't claim the Old Age Supplement to supplment my Old Age Pension. Why not?.......because I make too much money per year and it wasn't designed or put in place for people like me anyway. It's for those with no retirement plan and no money saved-up for old age.......BUT we ALL pay into the government coffers for that Plan, don't we?

According to StatsCan, the everage Canadian salary for a man, wife and two kids is $48,000/yr. Take all those that make less then $25 -$27,000 (which is supposed to be the "National Poverty Line" and have HealthCare totally available to them at no charge at all. From that point on-up, through the income levels, make the different income levels pay an increasing percentage of their own healthcare. Most employee and personal health care policies would cover that gap anyway just like Blue Cross does at present anyway. That way, of my total family income reaches, say $180,000/yr , then I pay 90% of the bill and only have a bigger percentage or 100% of it paid for some very serious and very expensive healthcare.......and that would be very limited.

It otherwards, those that the system was designed for in the first place would get the full benefits and those that had the income levels to support part of their own healthcare, would carry more of the load themselves. I grew-up before national Healthcare and I wasn't born with any "silver spoon" in my mouth either.....nor those families around us. WE paid for our own private insurance like our own private house insurance or auto insurance. The cost wasn't outlandish and the average Canadian lived just fine. The problem came for those Canadians that couldn't afford that (and they were the minority) or who weren't covered by an employer-supplied plan. THOSE were the ones that Tommy Douglas had in mind when he brought forth the idea of National HealthCare. If I'm making $500,000/yr, what am I doing asking you and others like you, to pay any of my personal bills for?

[Chantal]

As if Rich People Mind taking Freebies, gimme a break! Listen to some and you'll see how strange they can be.

Further if Canada wants to be a leader then saving Healthcare/Medicare should be first, not finding ways to make it hard on people. What about all the people that don't have high incomes or incomes at all or all the people with no health plans. I'm saying you and all the people on waiting lists should get their surgery isn't that more right? You should of heard this man last night on David Letterman, his name was Ted Turner, he said he read a book, called B6 or G6, and this author said with all the money in the world or with all the military budgets together we could have healthcare for everyone on the planet as well as food, water and education.

[Dust Devil]

Further if Canada wants to be a leader then saving Healthcare/Medicare should be first, not finding ways to make it hard on people. What about all the people that don't have high incomes or incomes at all or all the people with no health plans.

Then you go to the hospital as you normally would. Why don't people understand this?

[LH]

Healcare in Canada is disorganized in general and for many reasons. The fact of the matter though, is that it is underfunded and always will be underfunded until we change the way that it is dispersed. By that I refer anyone to my last post because with the cost of MRI machines and other extremely expensive items, we cannot afford to keep up with the costs as it is done now. We are a nation of approximately 31M-32M peopla and of that amount approximately 19-20M bear the tax burden for all this. The money we need to run this country is more than the population can afford and so we have to do things in other ways. WE can afford to offer and pay for the healthcare of those who cannot afford any, pay part of it for those that can pay part of it themselves and for those that can afford $2M houses and a Condo in Spain, then they foot their own bill. Those folks aren't waiting in any line-up here in Canada anyway and they're gone south of the border in their private jets anyway.

We need a functioning, but have to understand that those with the deep pockets will have the aircraft carriers, tank armies and massive amounts of other hardware.......because we cannot afford it just like the healthcare cannot afford the way we are doing it now. Our healthcare is getting like our military and we are starting to fall behind there also. We need a small, extremely well-trained and extremely well equipped military. We need that military to be small and to "get in, hit hard and then get out quickly" like Special Forces or Commandoes. We have to forget about the all-out battles on sea, in the air or on the land. Those days are gone and we can't afford that until we get a larger tax base someday in the future. We are like somebody living in a very large house that they can't afford and pouring all their money into it.....and then finding out that they can't even keep that up and the house is starting to shows signs of neglect. The Canadian military are being paid anyways to practice and the Corps of Engineers should be used in peacetime just like the Americans use theirs. That cuts down costs of contracting all that work out to private enterprise and duplicating what the Corps of Engineers can do and is getting paid for anyways.

[EI-EIO]

Seems that that article is using a very specific case to slant a particular view - here's two questions for a start:

who did the heli flying? If a private charter, then of course their patients get first dibs. If the Louisiana NG, then they should have commandeered the helipad to allow equal access to all persons in need of evac, with patients first and family later.

why didn't "Charity" have a helipad as the largest public hosp in NO?

[Guido]

I think the first step in all this would be to fix all the damn loopholes in the tax law and labour laws - i.e. crewing your ships with foreigners to save on the pay... I'm talking to you, Mr. Martin.

[LH]

Guido ----- when you check you will find that ALL crews are paid tha same and they are covered by the International Seafarer's Union. So whatever his crews get paid is dictated not by him, but by the Locals wherever the crews are hired. So if the crews are Phillpino, then you have to go to the Phillpines to crap on them because you have no more power in that regard than Martin does. He needs personnel and puts out the need to the Unions and it goes on a senority scale worldwide.

The lower decks get paid the least because they have the positions requiring less education and have not the skilled or formerly-trained personnel. ALL foreigners are not paid on the lower end of the scale because some have positions of skill on the upper decks. Paul Martin's shipping firm is not a member of any Canadian Merchant Marine because we don't have any.As a result his company's vessels are registered in Liberia, Bermuda and Panama........like 90% of the rest of the merchant marines worldwide.

[Expat]

What I like about Canadians is that we are all dream about this Utopia that is a universal good medicare for all people.
If we compare to the dental system, the people who are ready to invest their hard earned dollars(after taxes) into an insurance plan can use it for good dental work. Others, like me, prefer to use their hard earned dollars to pay the dentist that they choose, for work that they want, when they want it!
Ditto for the eye care! If I want Gucci glasses, I pay for them, and my plan refunds me a portion.
This is what I call having a choice. I am not asking the government for anything. I am not depriving any one from having services. If someone on welfare wants glasses, they are refunded by the government. The difference is that they get $2.00 frames.
If I pay for private insurance, either through my employer, or privately, and subsequently use the services of a first class medical clinic, am I depriving poor people of their public benefits? Actually, I help this poor guy, because I am not in the same waiting room, and he will get faster treatment.
A one tier sytem wants all people to use the over-abused system that is in place now. The choice that people want to make now is to use their own funds for their own benefits. There is nothing wrong with that and people that think that it can be stopped are dreaming.
Medicare, like education will always be available to the masses, but those who can afford top quality will pay for it and get it!

Now, if the government cannot afford to make the public system better, like in America, it clearly demonstrates that they should get out of this business and give it all to the private sector.
Remember that all people have access to eye care and dentists, and these systems are private...
Cheers,

[Hedley]

I remember reading that with all the money the government is wasting on the gun registry, we could have bought 933 new MRI machines.

Canadians are taxed plenty enough. It's just that the politicians don't want to spend it on the taxpayer.

[LH]

Expat -----agree totally. The problem we have is that with the overhead (salaries, cost of equipment, cost of operating large buildings) required to supply that national healthcare, we do not have a large enough population and tax base to afford the way it presently is anymore. We have to change something and if that change means that those that can afford it, start to pick-up part of their own medical care, then why not? I lived under the old system and contrary to much popular belief, fostered by politicians for whatever reason, the vast majority did not suffer because they had their own private plans at reasonable and affordable prices. All that was fine and nobody in my average Canadian family sufferedm one iota and we didn't refrain from vising the doctor at all....in fact, we went as much then as we do now. That's all fine, BUT the poor Canadian or those that could not afford that were not covered. Tommy Douglas plan was to negate that situation so that even the poor were covered. That all involved something called "votes" and without those votes the average Canadian was maybe not liable to "buy into it" if it didn't affect him/her. So it was made available to ALL and we are where we are now.

Hedley -------- you "don't want to go there" sir because it opens up too many "cans of worms". Try $5B and increasing....for "Multi-Culturalism.....and thats' just the cost to the Federal coffers. To those that agree with that cost, then remember that every product that enters Canada from the US does not get the same labelling as it's Canadian counterpart........it MUST have a French translation on that label. So your tin of Campbell's Tomato Soup is exactly the same as the one in the States, EXCEPT for the added cost of re-labelling........and "No", it ain't cheap. So could American products ever be as cheap in Canada as their exact same cousin is in the US, even with our dollar at par someday?.........no way............and that's one of the reasons why.

[Expat]

Good post LH,
The pricing difference between countries is sometimes a mystery to me.
When I buy a bottle of Head and Shoulders on sale at Wall Mart, I think this should be the best price one can find in the world, right?
No, I can find this same bottle in a small store in Uzbekistan for cheaper.
Confusing? You bet...
Cheers,

[Chantal]

LH,The economists have spelled it out why two-tier is hurting the former way, where did you get your information?
Today the media actually printed something useful, the medical people have spoken out and said we need more medical care for people with diabetes (keyphrase:not only lifestyle changes)
This is a positive thing.
Tell me how its supposed to work with two-tier for all the people getting treatment for diabetes?
Actually, I don't like your tone because I'm not the "Poor" as you put it, and I think it's shitty to look down on people.
Some People are going to ruin it for the rest of us.

[Expat]

The reality is different on the ground. I have witnessed an increase in the budget of our local hospital/local service center.
They added two union jobs in an office...
The whole system is rotten...
Only the private sector can get us out of this mess. The government is incapable of managing anything. Why are people so afraid of having a private company run a hospital?
Cheers,

[North Shore]

Expat Wrote:

Why are people so afraid of having a private company run a hospital?

Because private companies have a duty to their shareholders to maximise their profit - so their best interest lies in spending as little as possible on your medical care. Or even neglecting it a little so you come back more often....

I'd assume that salaries of Drs and Nurses will stay the same, and costs of tests won't get any cheaper, so if a private company gets in there, where is their profit going to come from? Either the standard of care will decrease, or the costs to the user will increase. Also (and I have to refer to my father's recollections of the National Health Service in England here) it wasn't unknown for practitioners in the NHS to double-dip into the private sector, leading to statements like this:"Well, Mr. Jones, I can fix your knee in about three months, but if you wish to pay me privately, I can do it tomorrow."

I don't have a solution, but I'm not sure that privatisation will help...

[LH]

Chantal -----I'm sorry to tell you that 35-40% of our National Healthcare System is now serv8ied by the private medical care industry. Where do you suppose al the needles, CPAP machines, linens, beds and other essential medicare equipment comes from. The bids to supply same are submitted under tender and the proicess starts.

Yes, it would be very nice indeed, if we could supply every single Canadian with total and ample complete healthcare as many would like and dream about. It's a goal we should always try to attain. Unfortunately at this present time with our present national tax-base, it is just one of a number of items that we have to do differently because to put it bluntly, we are living in a country that is too expensive to support with our presnt budgets and tax sources. Could we do things a little different and set different priorities?......yes we could, but at the end of the day, we would be left with the same original problem that we still have now. We are akin to a man and wife who buy or attain a house and find that their incomes will not pay for the cost of up-keep and rising taxes. They must now "pare-down" some of their necessities and forget some of the luxuries. They are now termed "house poor" and have little left over.

I would like us to return to the "spirit" of Tommy Douglas's intent which was to provide ample and complete healthcare to those who could not afford it. The healthcare plan that he envisaged was not meant for the likes of Sir Kenneth Thompson of Canadian and worldwide nespaper fame whose last reported weathj was $17B. It also was not meant for the likes of people such as myself who can afford to pay for all, but the most expensive of operations. Whether or not there was a healthcare plan in existence or not, I am more than amply covered by employer and private plans.......I would suffer not in any departemt. Tommy Douglas was not thinking of people like me when he put forth his plan.........he was concerned and rightly so, about those Canadians who had little of that or nothing at all. If my family income was to be $100,000+ per year, then there is no reason that I should be "sucking on the healthcare tit" that was meant for others. I should have to pay for at least PART of what healthcare I receive. By your definition, that makes me part of a two-tier healthcare scheme. So what?.......it wasn't intended for the likes of me in the first place.........'CAUSE I can pay part or all the "the ticket" myself.

[Chantal]

Sorry LH, (zzzzzzzz..)

I didn't think the problem was suppliers of medical equipment and supplies, thought we meant the Doctor, Nurse, and Bed space shortages causing long waiting lists, and specifically the major surgery ones. But presently we can walk into any clinic and see a doctor or get a referral to see a certain doctor. This is what we risk losing if private clinics open up, all over the place. There is now, some doctor services you have to pay where you will see the doctor promptly, that could help you out.

And you're saying our tax base is not large enough but it probably is. (Stupid, corrupted government caused the breakdown, all these years.) But I'm wondering does that mean, there are not enough people in the workforce to pay taxes? That's another can of worms, for another thread perhaps.

You want to pay for healthcare, what is stopping you? Go to the States, but it's too far? Minnesota is not that far.

[LH]

Chantal -----I know not what part of Canada that you live in, but it is not in mine. You will wait a very long time to be taken care of at any walk-in clinic and you may well be referred to another doctor..........but be prepared to wait for up to 6 months for a GP and at least a year for a Specialist. That is all fine and good if you just want a toe nail removed, but waiting for a year plus for urgent heart surgery is another matter. In my part of Canada, NINE people died last year waiting for urgent heart surgery (and THAT'S from healthcare sources). Another five could not wait and went to the US to pay for their own surgeries and are alive today because they did. They could have stayed at home and paid for that surgery at a privately-run clinic, but "oh no, God forbid that anyone be allowed to pay for their own healthcare bill". If they would have stayed at home and paid for those heart surgeries with their own monies, it would not have effected me one little bit and that would have another operation that the healthcare system (and my taxes) didn't have to pay for. What Right does any Canadian have to tell another Canadian that they cannot go elsewhere in Canada or within their province to pay for the healthcare of their own bodies? The National Healthcare System envisaged by Tommy Douglas was not meant for people with those resources anyway because those kind could always pay their own way. It was meant for those Canadians who cannot afford $14,000 for the birth of their child for example, nor any part of that bill.

[francisjohonson]

I have read an article a while ago that Medicare is changing their rules about the cpap supplies.