THE VIEW FROM UP NORTH

The ‘excitement gap’ bodes well for Democrats. Or so concludes the Toronto Star.

BREATHE DEEP

But only in certain areas, according to this map. (Thanks, Roger, who thanks Alan.)

MORE SiCKO

Brad: ‘I am a practicing physician and have spent a lot of my career with lower income patients. Scott got his MRI done the next day because his insurance would pay for it. The doctor ordered it because he knew the result would come quickly and to cover himself for litigious reasons. The hospital was eager to do it because that is income for them. The majority of ‘pinched nerves’ do not require an MRI, they resolve with rest, analgesia, and time. Doing the MRI so quickly is highly unlikely to affect the treatment decision, so that was almost certainly another unnecessary cost to our healthcare system. But if you can get the test done in 24 hours and it doesn’t cost you or the physician anything, then why the hell not? Of course, it is difficult to get an uninsured patient a medically necessary MRI because of all the patients with insurance getting their medically unnecessary MRIs the next day.

Michael Irwin: ‘The empire strikes back (softly). [Here is a Blue Cross internal memo.]’

Ed: ‘I don’t know where Sam goes to the hospital, but clearly he has never gone to a hospital in a major metropolitan/suburban area. A six-hour wait is a bargain, and gurneys lining the halls are not an uncommon site in the US. As an EMT, this is a problem that I face almost every day. We have five primary hospitals surrounding our community within 15-minute transport times and two more within 30 minutes. Frequently, our ambulance crews struggle to find a hospital that is not on ‘divert’ or ‘bypass’ because no beds (that includes extra hallway beds) are available. Dispatch reports now come with the list of hospitals that are on ‘bypass.’ Sometimes, ER beds are available but no bed space is available in the hospital to admit patients from the ER. The ER doesn’t want the patients it can’t admit because they ‘board’ in the ER tying up ER beds. In winter, the problem is tremendously worse as people without insurance begin using the ER under EMTALA (Emergency Medical Treatment and Labor Act) as their primary care provider. Some of it is poor administration of the hospitals but a lot is inappropriate patients (uninsured) crowding the ER trying to get basic medical care. I’ve waited 20-30 minutes in a line of ambulance crew stretchers as the hospital staff tried to find beds for the influx of patients. This impacts our ability to care for our community because crews are tied up waiting in hospital ERs to transfer care instead of being available for the next run. This isn’t a problem just in my area but in many areas – and has been discussed frequently in the industry journals.’

Carl: ‘You shouldn’t assume wealthy Canadians are coming to the US for surgery and other care: when I was researching the issue of medical tourism last year, I discovered that many US citizens, as well as Canadians and others in countries with waiting lists for non-emergency procedures, had started traveling to places such as India, Thailand, Costa Rica and South Africa to save huge amounts of money, for approximately the same quality of healthcare. PS – The definitive article on what’s wrong with the US healthcare system, IMO, is Paul Krugman’s in the New York Review of Books, here (‘the evidence clearly shows that the key problem with the US health care system is its fragmentation’).’

From Paul Krugman’s column yesterday:

. . . every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries – even Britain, which spends only about 40 percent as much per person as we do.

Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian’s access to health care is as good as that of the average insured American – and much better than that of uninsured Americans, many of whom never receive needed care at all.

And the French manage to provide arguably the best health care in the world, without significant waiting lists of any kind. There’s a scene in ‘Sicko’ in which expatriate Americans in Paris praise the French system. According to the hard data they’re not romanticizing. It really is that good.

So . . . have you seen the movie?

 

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