• Tag Archives healthcare
  • America Outperforms Canada in Surgery Wait Times—And It’s Not Even Close

    Canadian Medicare, our northern neighbor’s universal health care system, generally receives rave reviews from proponents of nationalized or socialized health care, but the Fraser Institute found that more than 63,000 Canadians left their country to have surgery in 2016.

    As Americans contemplate overturning our health system in favor of one similar to Canada’s, we must ask why so many leave.

    The Canadian system consistently ranks low or lowest across numerous metrics in the Commonwealth Fund’s extensive survey on health care. With regards to specialists and surgeries, the United States ranked best or nearly best.

    The Fraser Institute study did not examine where Canadians traveled for surgery, but given proximity and our much better metrics, most probably came here.

    Surgeries are scheduled after patients are seen by the surgeon, and most people see surgeons only after a referral by either their primary care physician in America, or their general practitioner in Canada. In the United States, 70 percent of patients are able to be seen by specialists less than four weeks after a referral. In Canada, less than 40 percent were seen inside of four weeks.

    After being advised that they need a procedure done, only about 35 percent of Canadians had their surgery within a month, whereas in the United States, 61 percent did. After four months, about 97 percent of Americans were able to have their surgery, whereas Canada struggled to achieve 80 percent.

    America is significantly outperforming Canada in surgery wait times even as it’s likely that tens of thousands of Canadians come here to use the American system.

    General surgery, procedures such as appendectomies, cholecystectomies, and hernia repairs, make up the largest portion of those who leave Canada for care. Based on the latest available date from the Organization for Economic Cooperation and Development, the total Canadian caseload for many of these procedures is about ten percent of America’s.

    America’s health system is certainly flawed and in need of reform, but there is clearly something working well enough that our system, despite already treating ten times more cases of appendicitis, can absorb the dissatisfied Canadians.

    This has been a consistent trend since at least 2014 when an estimated 52,513 Canadians left for their medical care. In 2015, the number went down slightly to 45,619. 2016 exceeded the 2015 number with an estimated 63,459 patients seeking care elsewhere.

    Moreover, both countries have had comparable rates of private health insurance coverage for the past 20 years, roughly 60-70 percent. But the Canadian private insurance market is entirely supplemental—it covers co-payments for services not covered or not entirely covered by the provincial insurance.

    Primary coverage, which is the predominant form of insurance in America, is all but illegal in Canada and would be under “Medicare for All” as well.

    In the United States, government insurance covers gaps left by the private market. Private insurance is the norm and Medicare and Medicaid provide a health insurance safety net for elderly or low-income Americans.

    In Canada, government-provided Medicare is the primary form of insurance, and private plans merely fill in gaps in coverage for those with more disposable income or employee benefits. The two systems are mirror opposites of one another.

    Health care is a product of the labor of physicians, nurses, technicians, and a whole ecosystem of health care workers. If making the government the primary payer for these services is so smart, why does the universal system next door shed patients by the tens of thousands to ours?

    American health care can be improved and should be; American health care performs about middle-of-the-pack for many other items on the Commonwealth Fund survey.

    There are many inefficiencies, often government-imposed, that increase the cost of health care and restrict the insurance market.

    The administration already has loosened some regulations that will give employers more flexibility in providing health benefits and has begun to push for price transparency, which also should bring down costs.

    Whatever the case may be, reforming American health care should focus on enabling our strengths. Under no circumstance should we tear it down and build it anew to resemble the system whose citizens escape by the tens of thousands just to be treated in a timely manner.

    This article is republished with permission from The Daily Signal. 



    Kevin Pham

    Kevin Pham, a medical doctor, is a contributor to The Daily Signal and a former graduate fellow in health policy at The Heritage Foundation.

    This article was originally published on FEE.org. Read the original article.

  • Why a Free Society Cannot Transform Wishes into Rights


    Any careful observer of American politics must be struck by the ever-expanding roster of things people have asserted rights to. But when such arguments are seriously considered, there is little to them beyond shared desires or wishes for certain things, which supposedly implies that there ought to be rights to them.

    From there, it is but one further step to legislative, executive, or judicial attempts to create such rights, promoted as social improvements guaranteed by government.

    This “ought implies is” argument about rights reverses the claim that “is implies ought,” which David Hume famously shot down. It ignores that in a world where scarcity is inescapable, our desires always outpace what is producible, which means that newly asserted rights may well be impossible delusions. Further, it ignores that making good on any particular newly created right must violate other’s existing rights to themselves and their efforts. And it, too, deserves rejection.

    Few have thought as carefully about this confusion between wishes and rights as Leonard Read. His insights are particularly well developed in his “Doctor, Whoever You Are,” section in his 1969 Let Freedom Reign. In a world where turning one wish into a political right leads to still more attempts to use the same magic on another wish, and every such step further erodes liberty, Read’s views are worth serious consideration on their 50th anniversary.

    “Now in vogue is a fearful combination of wishes and methods, as fanciful as Aladdin’s lamp…the transmutation of wishes into rights! Do you wish for better housing? Then better housing is a right. Do you wish for…higher returns for goods and services, shorter hours of labor, protection from competition? Then these are rights. Do you wish for free medical care? Then free medical care is a right!”

    “And what is the nature of the jinni called upon to transmute wishes into rights?… government. It extorts from all, allocating the legalized loot to those who effectively make their wishes heard.”

    “How do we go about healing this sickness? We must acquire an understanding that wishes, regardless of how numerous, do not constitute a right. I have no more right to your professional attention than you have a claim on me to wash your dishes. We are dealing with an absurdity.”

    “We live and prosper by specialization and exchange…others tend to encourage me to specialize at what is of value to them, and I tend to encourage them to specialize at what is of value to me. This is how people in a free society exert their wishes. But note that these wishes do not carry with them any right on my part to command what others shall produce or any right to force on them the terms of exchange.”

    “When the notion that a wish is a right is put into effect by police force—the only way it can be done—then specialization is no longer guided by consumer wishes nor are the terms of exchange…Other citizens are then forced to perform labor for which they receive absolutely nothing in return. Exchange is by coercion rather than by free choice.”

    “The fact that many of us wish more medical attention than we can afford does not give us a right to your [physician] services or a right to force others to [finance them]…wishes to the contrary notwithstanding!”

    Benjamin Franklin is said to have written, “If man could have half his wishes, he would double his troubles.” He was referring to the problems our wishes would cause ourselves. But we go far beyond causing ourselves problems whenever we try to transform our wishes into rights.

    We cause all our fellow citizens problems because our efforts to create rights for ourselves must pick their pockets—assert our ownership of their resources rather than acknowledging their self-ownership—despite lacking moral or ethical justification. Leonard Read rightly recognized this as no different than looting enforced by a “might makes right” mentality.

    If not for the corrupting lure of something for nothing, people would long ago have rejected the idea that wishes imply rights. But as ever-more goodies have been added to bait the lure, most Americans seem to have decided to stop thinking about the burdens borne as a result of these invented rights.

    Our reasoning has been warped by a too-narrow view of our self-interest, which ignores what we can achieve jointly only by defending voluntary arrangements, which respect one another’s self-ownership. That makes it particularly important to revisit Leonard Read’s wisdom about wishes and rights, for otherwise our coveting will corrupt and punish us further and further.

    Gary M. Galles

    Gary M. Galles is a professor of economics at Pepperdine University. His recent books include Faulty Premises, Faulty Policies (2014) and Apostle of Peace (2013). He is a member of the FEE Faculty Network.

    This article was originally published on FEE.org. Read the original article.

  • Socialized Medicine Is “Free” But Leads To Really, Really Long Wait Times

    Last November, CTV News in Canada ran this incredible story about growing wait times for medical care in Canada due to its socialized medical system: “‘It’s insane’: Ont. patient told she’d have to wait 4.5 years to see a neurologist.” Here’s a slice:

    An Ontario doctor says health-care wait times have reached “insane” lengths in the province, as one of her patients faces a 4.5-year wait to see a neurologist. When Dr. Joy Hataley, a family practice anesthetist in Kingston, Ontario, recently tried to send a patient to a neurologist at the Kingston General Hospital, she received a letter from the specialist’s office telling her that the current wait time for new patient referrals is 4.5 years. The letter said that, if the delay is “unacceptable” to Dr. Hataley, she should instead refer the patient to a neurologist in Ottawa or Toronto.

    Dr. Joy Hataley said she was shocked when she received this letter from a neurologist’s office. Dr. Hataley, who has been outspoken about wait times and other issues plaguing Ontario’s health care system, said the wait time “shocked” her. She wanted to shock others as well, so she tweeted a photo of the letter above and tagged Ontario Health Minister Eric Hoskins and Kingston-area MPP Sophie Kiwala. Dr. Hataley said she’s used to hearing back from specialists who are unable to see her patients for months, and even up to 2.5 years.  But a 4.5-year wait is “insane,” she told CTVNews.ca in a telephone interview. “This is an alarm bell,” she said. “What it is to me is a red flag to the system.”

    “When Dr. Hataley first pulled up the response from the referral, both of us were just seeing the wait time first hand, I was just in disbelief and shocked,” Wooldridge, a 40-year-old developmental service worker, told CTVNews.ca in an email. “The more I thought about it after leaving her office I was just annoyed and felt that this is ridiculous and not in any way okay.” Wooldridge said she will continue to live with chronic pain and be cared for by Dr. Hataley until she can see a neurologist. She said she shouldn’t have to travel outside of Kingston to see a specialist.

    “I don’t honestly feel that I should have to go to another city when we have a neurologist 4.5 minutes up the road and I’m a resident of the city in which my taxes help go towards,” she wrote. “I don’t think it’s right or fair to drive to another city…it’s financially not easy for me to just pick up and go, as much as I would like to.”

    (h/t Peter Krieger)

    Related: This is from the executive summary of Canada’s Fraser Institute’s most recent annual report “Waiting Your Turn: Wait Times for Health Care in Canada, 2017 Report” (emphasis added):

    Waiting for treatment has become a defining characteristic of Canadian health care. In order to document the lengthy queues for visits to specialists and for diagnostic and surgical procedures in the country, the Fraser Institute has—for over two decades—surveyed specialist physicians across 12 specialties and 10 provinces. This edition of Waiting Your Turn indicates that, overall, waiting times for medically necessary treatment have increased since last year. Specialist physicians surveyed report a median waiting time of 21.2 weeks between referral from a general practitioner and receipt of treatment—longer than the wait of 20.0 weeks reported in 2016. This year’s wait time—the longest ever recorded in this survey’s history—is 128% longer than in 1993, when it was just 9.3 weeks (see graphic above).

    In the video below, Ronald Reagan tells the joke about waiting ten years to get a new car in the Soviet Union. Here’s my variation of that joke for the Canadian medical system.

    A patient in Canada is told by a hospital administrator that there will be a five-year wait for an appointment with a neurologist. The patient asks, “Will that be in the morning or the afternoon.” The hospital administrator asks, “What difference does that make, it’s not until five years from today.” The patient says, “Well, I have my next dental appointment on that day in the morning.”

    Reprinted from the American Enterprise Institute.

    Mark J. Perry

    Mark J. Perry is a scholar at the American Enterprise Institute and a professor of economics and finance at the University of Michigan’s Flint campus.

    This article was originally published on FEE.org. Read the original article.