Thursday, July 12, 2012

Universal Coverage, Substandard Care

Kerri Toloczko has a piece in the Washington Times that compares our current health care system to the Canadian system which Obamacare will soon approximate. Her story is about an elderly family member named Martin who lived under the Canadian system for thirty years before finally heading south for the States. Martin's story is intended to illustrate that where health care is "free" and universal it's woefully substandard:
"Martin" is an American who lived in Canada for 30 years under the Maple Leaf version of Obamacare. In 2011, Martin and his family became increasingly concerned about access to care for the octogenarian, and he fled "free" health care in favor of a system that requires payment for health services and actually provides them.

Martin always saw the biggest problems with universal health care as diminished access and long waits. But after visiting multiple specialists and an easily accessed American geriatric internist (nationwide, Canada has fewer than 190 geriatricians), Martin learned the real problem was quality. As he received care in America and talked with his doctors, he quickly grew weary of hearing the phrase "well below the standard of care" in reference to his Canadian health care history for issue after health issue. The phrase incensed his loved ones.

I know - I am one of them.

Martin was fortunate to have had a family physician in Canada - 20 percent of Canadians do not, and it is nearly impossible for new patients to find one. The average wait to see a specialist in Canada is five months.

For years, Martin had suffered falls with serious injuries, including facial and rib fractures. His family doctor in Canada had done nothing to investigate the cause. When his family, who suspected Parkinson's, insisted he see a Canadian specialist, he waited 11 months for a neurologist who also did nothing to diagnose or treat the problem. After waiting two days for an appointment with a neurologist in Virginia, Martin was diagnosed with Parkinsonian Syndrome and provided medications. Falls are down from weekly to only three in the last year.

In Canada, Martin was told he had kidney cysts, but was never given a sonogram - a procedure with an average eight-month wait. His Virginia nephrologist (next-day appointment) told Martin he needed one. Martin asked, "How long will it take to get that?" Looking perplexed, the physician answered, "about three minutes," pointing to the machine in the corner of his exam room.

After his American gastroenterologist reviewed his medical records, he informed Martin that he had not had the regular colonoscopies in Canada as he had been led to believe. Instead, Martin had sigmoidoscopies, which are inadequate in detecting colon cancer, but cheaper. Again he heard that this was "below the standard of care." The average wait for a colonoscopy in Canada is 16 weeks with 7,000 patients waiting for one on any given day. In the United States, Martin waited four days.

The American ophthalmologist looked in Martin's eyes and exclaimed, "Who the hell is your eye doctor? You should sue him!" His Canadian ophthalmologist refused to release Martin's records; the American doctor was sure she knew why. Martin has now had one standard cataract surgery and another delicate one requiring a subspecialist because his cataracts went untreated for so long.

The wait for cataract surgery in Canada is 16 weeks, except for seniors, for whom it appears to be forever.

Martin had a serious eye infection in 2008, causing burning pain, itching and redness, eventually infecting one side of his face. A Canadian clinician told him to wash it with baby soap. His family doctor told him to get an appointment with the dermatologist (average wait three to six months.) When Martin arrived for a visit in Virginia, a doctor at a local urgent care facility (30-minute wait) gave Martin oral and topical medication for what was determined to be a staph infection. Within 48 hours, his months of agony ended.

As a health care policy analyst, I have often compared the American free-market health care system with Canada's government-run plan. Numbers relating to wait times, rationing and substandard care are staggering. Personal anecdotes are heartbreaking.
After pointing out that Obamacare will give us a similar government-run system Toloczko finishes with this:
America has the best health care system in the world, but a dysfunctional coverage system. Canada and the United Kingdom have universal coverage and rationed, substandard care. Which would you rather have?
Good question. What I'd like to know is how typical Martin's experience is for Canadians, or people living in the U.K. Perhaps some of our readers from these precincts will share their thoughts with us on this.

Magnetite and Migration

Investigators have long believed that fish, birds and other migrating creatures oriented themselves along the earth's magnetic field and that they used magnetite crystals to aid in the process, but it was never clear how this was done. Now scientists have isolated the cells in anadromous trout that contain the mineral and are making headway in solving the riddle of how the earth's magnetism effects the crystals and how that interaction translates into instructions from the brain as to the direction in which the animal should move.

I wonder if they'll also make headway in explaining how such a system could have evolved by unguided forces and random mutations in most of the major phyla, but be employed by only some representatives of those phyla. Since, for example, not all butterflies or birds migrate do they all possess the magnetite system but only some of them use it, or do only some species in a taxon possess it? Whatever the answer, it raises the question why that should be.

Perhaps there's a compelling story of how this marvelous phenomenon could have evolved naturalistically. If so, I'd like to hear it.