Socialized Medicine: Survival of the Fittest (Addendum)

See, you folks don’t get it. If all you expect the government to provide is crappy and relatively inexpensive primary care and would be content to eschew the expensive, admittedly low-yield technological and labor intensive medical care that we currently waste on the elderly, the terminally ill, and those with extremely complicated health problems like they do in most of the Socialist Freeloader Kingdoms…if this is what you want then why do you need the government to provide medical care? After all, in the big scheme of things a visit to your family doctor two or three times a year is not going to bankrupt the large majority of Americans. Surely even most of my poor patients could but give up their cell phones and instantly have the wherewithal to afford to take their children to a pediatrician now and then.

It’s the ICU stays, the heart caths, the chemotherapy, and half a hundred other treatments and procedures not typically associated with primary care that suck up most of the money. If you eliminated most of these things, none of which are even remotely available to most of the people in an advanced but highly socialized country like Greece, we too might be able to brag about our low per capita spending on health care. As an additional benefit, after a brief period of turmoil in which the usual helpless and useless patients who consume the lion’s share of medical care dollars died out in a Darwinian mass extinction, we could at last get down to the serious business of making our statistics look good.
The point is that what you want and expect from the government, the thing that sends you into fits of rapture as you justify the more advanced priorities of the Nanny-States-Across-the-Water which stress primary care and prevention over our highly advanced reactive medical care, is so ridiculously easy to provide for yourself that it would be criminally stupid to structure society to provide it as an entitlement if for no other reason than it would involve shoveling even more of the personal wealth of the productive sector into the voracious maw of government. Your money, money that is not just paper or electrons but a voucher for your hard work, will be frittered away in the usual bureaucratic orgy of waste and inefficiency and contribute nothing to the prosperity of the nation.

All for the sake of avoiding having to pay for a couple of lousy doctor visits.

90 thoughts on “Socialized Medicine: Survival of the Fittest (Addendum)

  1. You are a liberal. That’s right! -no typo here.
    A true conservative doesn’t believe that freeloaders who neither contribute to society nor accept early (ie, preventative medicine) intervention deserve end-stage, crazy-expensive therapies.
    So, a true conservative would then be in favor of socialized medicine. For socialized medicince, as you have explained in pages, provides endless, unproven preventative and/or primary care but does not cover futile wastes of dollars for those who are infarcting their myocardium after showing no personal responsibility for 61 years. Perfect!
    And, you know what’s better for the conservative? She probably has enough money to pay for her own PCI at a private hospital.
    I can’t now get the image of the Guiness boys screaming “BrILLant” out of my mind.
    By promoting the satus quo, you continue to define yourself as a liberal. (Actually, promoting the status quo is the definition of conservatism-PB)
    (note to other readers: it is damn fun calling the Panda a liberal).

  2. One of the residents I used to work with lived in England for awhile. He told me that the NHS has a point system for intesive care. If you get to like 26 points, no ICU.

    Dementia is worth like 20 points.

    Almost no one truly understands what nationalized health care would mean. They seem to think that EVERYONE will get EVERYTHING.

  3. No. I’m a radical, not a liberal. And I most certainly believe people need to pay their own way for as much of their medical care as they possibly can.

    I am just pointing out that medical care is expensive. The only reason that everybody in our country can get a heart cath when they need it is that there is enough private money in the system to maintain the infrastructure that allows an interventional cardiologist to take a few cases here and there at a loss and still make a good income.

    While medical care is rationed just like every other good or service where demand exceeds supply, it is not as severely rationed as it is in societies where it is free.

  4. “No. I’m a radical, not a liberal. And I most certainly believe people need to pay their own way for as much of their medical care as they possibly can.”

    Well said. Some of us don’t wish to be forced into a box (be it “liberal” or “conservative”) where from then on “the box” does your thinking for you.

    Some of us are indepedent. Some of us are individuals. Some of us are “radicals.”

    Excellent articles on the pitfals of socialized medicine Panda Bear. Very well written and logically presented.

  5. And of course, some of us are just freaks of nature..

    This post is too full of hard questions to really digest quickly.

    As usual the last quiet flame of hope in my political perusings landscape flickers and then glows…the internet.

    Information gathering and web-born political coalitions may finally tip a few things. Like rational guideline development for end-of-life care, etc.

    What is happening in the blogosphere portends
    these developments.

    Check out the polemic, “The Radical Center”.
    It was published a month after 9/11, didn’t get much attention.

    You know, I was all passionate after 9/11, “we have to reform our government, how could it be possible the FBI has wildly outdated computer systems. Isn’t anyone responsible here? Not a single freaking resignation? Why is Rice getting away with saying we never could have dreamed it when the Israelis have had cockpit doors for 40 years?. And for the love of God, where are the spies???!

    Hell, you go to the Arab quarter in Paris and half the people you see are spies. 2 weeks after the London bombings, I put my backpack down on a London subway train seat and walked 2 feet away to look at the map, 5 seconds later a lord-of-the-rings-like character with long grey hair to his waist and a walkie-talkie swooped up out of nowhere-
    “OY!!! MISS!!! IS THAT YOUR BAG???”

    Then the other day I thought about 9/11. Just seemed like an average mishap, no worse than a bad earthquake, or a tsunami which takes 50,000 children into its breast….

    OK, I’ll stop now.

  6. nicely written, however ponder this people who try to defend the cost of medical care in the us…

    if we have such good care what good is it to those who cant afford it?

    and who can’t afford it? – people who are to rich or honest for medicaid and medicare and too poor to pay insurance premiums, as many jobs now provide no healthcare nebefitsd whatsoever…

  7. Everybody gets medical care in the United States whether they can afford it or not. Our so-called uninsured get better and faster access to the entire panoply of advanced therapies and procedures than most of their counterparts in the Freeloader Kingdoms.

    That’s the fact. The rest is propaganda. I repeat. Primary care for most people most of the time is mostly pretty cheap and there are few people who could not afford it out of pocket without insurance except that there is no incentive to buy it when it will be provided for free at any hospital to which they care to present.

  8. Hm…. I do think that people should have to pay at least a portion of their medical care. I read my insurance statements when they come back. I recently needed a foot xray (painful, swollen, hot MTP..not gout), and reading the insurance statement, I found that they paid the radiologist $9 for reading it. They paid the ED $200 for the rest of my care. And thinking about this, I figured that I could have afforded the xray without the insurance. Actually, almost anybody could afford $9 for an xray.

    Which got me thinking about your plan to use insurance as insurance to only cover expensive stuff. And thinking about it, I realized that although on my fellow’s salary the $200 is a bit steep, if we could pay the insurance company reimbursement + the $10-$15 copay, for most things it wouldn’t be that bad. My internist sees me for migraines, gets paid $30 by my insurance companies (I look at all of the statements). If I paid her that + my copay ($45) in exchange for a decreased insurance premium and more MD choices, it wouldn’t be a bad bargain. And then my internist wouldn’t have to deal with insurances for visits which would decrease her costs while keeping her reimbursement the same. Then you need some sort of charity care program for the really indigent (to insure that their children can get care, etc.).

    Hm…. might just work.

    I also think that people who come to the ED for completely non-emergencies out to have to pay for their visit. We used to have people who came in (occaisionally by ambulance) for a freaking pregnancy test. Send them the $400 bill for the ambulance and the $200 for the ED eval. For the people that take the ambulance to the ED for actual problems that could be emergencies (asthma exacerbations, injuries, etc.) no harm, no foul, let insurance/medicaid/medicare cover them.

  9. It is interesting that everyone gets care regardless. maybe nothing should change except for curbing all the futile things…

    One of my more flaming family members with no health insurance had obvious symptoms of a bleeding polyp close to the anal verge for at least a year before he saw someone.

    Got a great surgeon (who, by the way, was the second surgeon he saw for a second opinion, after the first surgeon was ready to put him on his OR scehdule) who did his subtotal colectomy. One year later his surgeon took care of a complication of his radiation treatment and resected his stricture.

    I doubt seriously that this family member ever paid a penny for his care, other than for his colostomy bags. Last email I had from him, 13 years out from care for Duke’s C rectal CA, described how beautiful the sky was in Patagonia.

  10. One reason why European-style socialized medicine won’t work in the USA is because we’re just too damn heterogenous–genetically, culturally, and socially. It’s *EASY* and efficient to plan for population-based health care in Scandanavian countries, the Netherlands, and even Germany because the overwhelming majority of population has the same cultural understanding of health and illness. For the most part, they all get the same kinds of diseases!

    In a very diverse and pluralistic society such as ours, socialized medicine is bound to fail. Here we have to treat individuals and families who can trace their roots back to the Mayflower and people who just got here 2 days ago!

    Ultimately, the American solution to the health care problem (and it is a problem) will be one that reflects our pluralistic values: Everyone will get some bare-bones basic health care that will cover things like immunizations, preventive medicine, and catastrophic care (likely financed through municipal and government “trust funds” — ie taxes), the midlings will get mid-level insurance probably Kaiser-style (financed through employers and tax credits — ie taxes), and the rich will have Cadillac health care and private health insurance financed through out of pocket pre- and post- tax dollars.

    It’s essentially what we have now but with some tweaking and “cost-shifting” and ultimately accepting the idea that life is not fair. The poor will get poor health care. The rich will get rich health care. Everyone else: something in between. That’s America!

  11. In Norway (I’ve been there, know people there, etc), one fun concept is the helicopter triage system (there are many difficult-to-get-to places there). They’ll just tell people they’re too old for a helicopter pick up (the remote mountain equivalent of an ambulance) and they need to find their own way to a hospital.

  12. witness the dichotomy.

    the mind leading the heart represented by panda bear’s posts.

    the heart leading the mind represented by the angry but illogical screams.

    the mind leading the heart brought us out of caves. the heart leading the mind will put us back.


  13. So this is rather off topic, but I agree with you on the folly of socialized medicine, so not much point to say “way to go!” or somecrap…but given the fact that the socialized medicine in Canada and Europe is failing miserably, do you think people will ever wake up in those countries and push for the privatization of medicine? I find it curious that socialized medicine is so pathetic yet I see no evidence so far of people breaking out of it’s uncaring and decrepit talons.

  14. I think that the administrative BS, cost shifting, and medical-legal issues add a huge amount of cost to our health care system. HUGE. If we could figure out how to fix some of those problems, we’d truly have a great healthcare system without having to leave the 80 year olds on a mountain to die.

  15. Many of the socialized countries have recently instituted some market reforms. In France, individuals above a certain income can opt out of government insurance and purchase their own privately. In Britain, the NHS has been farming out an increasingly large percentage of its work to the private hospital sector. In Canada, a recent court decision that allowed for the creation of some private health industry has seen a surge of private imaging centers spring up around the country. Also in Canada, people have been coming across the border for years, taking advantage of the US healthcare marketplace.

  16. But…but…why would people want to buy private health insurance if their socialized systems are so good?

    Something doesn’t add up.

  17. Because the classic approach to analysis in health policy looks at issues with respect to the “the three legged stool” of: Access, Cost, and Quality. In an ideal world, everyone would have easy access to low cost/high quality health care.

    But, those analyses don’t capture a whole set of other things that patients say they value when they purchase health care: Convenience, service (bed-side manner), and efficiency (getting timely lab results, on-the-spot specialty consults, etc).

    You see health care is fundamentally a service sector industry. I bring my car to the dealer to get fixed though it costs me more and is on the other side of town. Why? Because, I’m greeted warmly by my first name, the dealer maintains a state of the art electronic integrated electronic service record for my vehicle that would put existing EMR’s to shame (except for the VA), my wait is minimized and I’m given a refreshing beverage, I’m offered a ride to my job, the technician who looks at my car *personally* calls me and tells me what is wrong, he then hands the phone to the service manager who gives me a repair estimate, and the thing is fixed, detailed, and vacuumed by 5PM when the courtesy shuttle picks me up at work and brings me back to the dealer!

    That’s what people want from their doctors, hospitals, and emergency departments! How many places provide this kind of *SERVICE* in health care?

    Few. I trained at the Mayo Clinic, where I think that the service approached the best in the country, and am now working in a more traditional public academic setting with a mission to service the underserved. The contrasts are striking. The *SERVICE* that most patients receive at the county teaching hospital from nurses, technicians, and ancilliary staff is perfunctory to say the least—though of very good quality with respect to the expertise of the physicians who practice and train there.

    So, those who can afford it will pay out of pocket for health care that is convenient, efficient, and timely. The rest of you will have to wait in line…

  18. If a country with a socialized medical system allows private healthcare by those rich enough to afford it, why would any doctor want to work for the government? I will for some years, yet, but I do it out of patriotism, love of country, and some inclination to retire with the surety and security of the military retirement system (although I know I’m losing money on the deal).

  19. Okay, I will try again.

    And I will address both my side and your side of the issues in order to show you that I’m not a knee-jerk-responsin’, temper tantrum-throwin’, close-minded person and that I do actually consider all of the factors you have talked about.

    I guess by now everybody has figured out that I take offense when doctors criticize poor/uninsured people for “having cell phones”, etc. I also didn’t like the sentence which included the phrase “…labor intensive medical care that we currently WASTE on the elderly,…” And okay, while I’m on a roll, I’ll also say I didn’t like the phrase “Nanny-States-Across-the-Water”.

    My reasons:

    Although I know that tons of people on Medicaid (or not) totally abuse the system, and tons of people with no insurance use the system inappropriately, I think if you did them math you might reconsider a little.

    I work and make good wages as an RN. But I’m uninsured per my cheap company. Per your words, “a few lousy doctor visits” is starting to add up, and is eating its way into my income in a big way. It can cause me to live paycheck to paycheck. It’s worse for people older than me who needd to go to the doctor more often.

    But yes, I “waste” money on a cell phone and some “luxuries” such as cable TV, internet service, and whatever. (A road nurse has to have a cell phone anyway.) But in the grand scheme of things, those “luxury” expenses really don’t much affect my ability to pay for medical care. Becauase I simply can’t afford adequate medical care–luxuries or not, Panda!

    (I’ve managed to save $6,000 but that wouldn’t even begin to touch one major hospital stay.) Doing the math, EVEN if I were to use every last dime of my extra money after bills, it would still be a struggle financially and I wouldn’t be able to afford more than the “measly few doctor visits” I ration myself right now.

    And I hate to think how it is for people who don’t make RN wages. Lord, the average wage in this Podunk town for people in non-professional fiels is $7.50 an hour—and $10/hour is considered “good money”. (I’m considered “rich”, heh.) I have blogged about the fact that one of my co-workers has shorted herself on insulin because she can’t afford it. I sneak her syringes and glucometer strips from my own company’s stock and I’ve made deals with DME reps to get doctors to give her free samples of insulin. She’s 20, uninsured, has Type I, and is pregnant. There’s no county hospital or free programs here or within 300 miles.

    As for your comment on the elderly: I don’t consider it a “waste” to spend money on the elderly. Geez, we’re talking about people’s parents here. And yes, I’ve heard doctors saying that it’s “not worth it” to spend zillions on giving an elderly person “5 more years” but dang it, have a heart. I have no father and I want every dang year my mother has left.

    Okay, to address your side of stuff:

    YES, I know you doctors don’t get paid for all those people who don’t pay their ER bills. But I saw an article on MSNBC yesterday stating that doctors are still among the highest paid professions, so you’re not suffering. Sometimes, at my brokest moments, I almost wish I’d stayed with the doctor I used to live with. He drove me nuts but at least if I’d married him I’d have insurance and wouldn’t have to work. (But he drove me crazy and I ran off with a biker man. He was more fun. See? Uninsured people DO make unwise decisions, HEH.)

    Here’s my big accusation: I will admit that I think that some (notice I said SOME) doctors in America’s biggest reason for not wanting universal health care is that it would lower many of their salaries in the ensuing division between working for “the state” vs. having private pay rich patients being able to buy extra insurance coverage.

    Okay, there, I said it. Let the doctors begin to slap the bejeezus out of me for that accusation (if they can find me). At least I admitted it.

    But….also in your defense, I also believe that you are entirely correct in your point that “socialized” medicine/universal health care, or whatever you call it, ALSO has many BIG and serious downfalls of its own—I realize that, okay?

    And let me throw in that I don’t thnk that you should call the countries with universal health care that ridiculing term “Nanny-States-Across-The-Water”. That was rather crass and offensive to our buddies overseas, okay?

    But I don’t have the dang answers and it seems that nobody else does, either. And there seems to be no Oracle to help us figure out what to do. I don’t like Hilary either.

    There you go, Panda. My worthless lecture for the day. And I didn’t even say the F-word, alright? Happy now?

    (Although….I do have a terrible urge to say some other biker-chick stuff, because you aggravate the heck out of me, but I’ll refrain— because I would be embarassed to death to have two of my comments deleted in one weekend.)

    Happy now?

  20. BRN, re-read my post(s) with your indignation blinders taken off and point out where I said that care for the eldery was a waste of money.

    Your jerking knee and your deep sense of self-righteousness has obscured your critical reading ability.

  21. Universal health care would probably significantly RAISE the salaries of ER docs. Since about half of our patients don’t pay anything, if we got reimbursed for those patients even at Medicare rates it would be a bonus.

    I’m against it because I hate both bureaucracy and socialism. And I’m pretty sure that most of the producing class will have to pay more for the same level of care we have now (if it is still available) to finance an even lower level of care for the dependent class.

  22. I think I read things correctly, although heavy sarcasm and attempts at being witty tend to blur messages greatly.

    Incidentally, speaking of my reading skills, I scored perfectly on my SAT reading/comprehension and my IQ is 154.

    I’m finished commenting on your blog because you make the whole thing so tiresome and unpleasant. I think you don’t like outspoken women who aren’t intimidated by your criticism. Wasn’t it you who stated that you “eat your critics for lunch”? You didn’t succeed in doing that with me. You simply annoy me.

    Go in peace.

  23. BRN, Jesus, you are self-righteous. You made some good points, but if you were actually reading Panda’s comments clearly, you’d have seen that he has repeatedly defended the use of our limited medical resources for the elderly. Personally, I find that heavy sarcasm is easier to spot than subtle sarcasm, and his is rarely too difficult to spot. And many people think he is pretty damn witty. I don’t doubt that you scored perfecly on the reading section of the SAT and have a 154 IQ, but that simply shows that you’re capable of greater comprehension than you’ve exercised in your recent posts. And I have no idea what he’s said to imply he’s upset by outspoken women who fail to cringe before him. Frankly, you’re helping to support his accusation of you as self-righteous when you make such unfounded criticisms.

    Anyway, enough of my own self-righteousness. 🙂 Please continue with the previously scheduled debate.

  24. Hey, you are an ER doc, or a resident at least, and I respect your opinion there. What the heck makes you qualified to re-work the health care system?

    People in England, Canada, Scandinavia and France are healthier and live longer than people here, and good access to primary care has alot to do with it. People in Australia as well….read the latest FREE article in the BMJ and get a clue why.

    We waste enough money on the administrative aspects of health care in this country to fund primary care AND necessary secondary and tertiary care. A single payer system, even if it is Medicare, would save us a tremendous amount of money. And no one tells Medicare patients where to go or who to see. And you don’t see alot of docs optioning out of Medicare, although it is their right to do so.

    Wouldn’t you like to see 85% appropriate patients in your ED instead of 25%?

    I spent my sabbatical in England in GP surgeries, teaching practices and A&Es (EDs), and that’s what I saw there. I spend weekends in an urgent care here, and that’s not what I see, and I don’t see a pattern of appropriate utilization. I see a pattern of EXPENSIVE utilization. I see women with hard masses in their axillae who were afraid to go to the doctor for their breast lumps because they had no insurance.

  25. is anybody qualified to comment? And I don’t believe I have really proposed anything, just pointed out some facts about our system, the Greek system, and the Freeloader Kingdoms in general.

  26. QUOTE:
    If a country with a socialized medical system allows private healthcare by those rich enough to afford it, why would any doctor want to work for the government?

    – Because in some countries there are no private medical schools and no private teaching hospitals. The whole medical education system is in the hands of the government and teaching spots are scarce, meaning you sometimes have to wait a couple of years to even begin specialist training. Private hospitals will only employ expert physicians so you have nowhere else to go than to “serve your time” in state hospitals.
    – Paying your way (as a patient) through the official system is much more cost-effective than abiding by the law. People rich enough to pay are not dumb to pay more than they absolutely need to.

    – In some countries the taxes are so high that doctors choose to work less so that they have more $$ per hour.

  27. “As for your comment on the elderly: I don’t consider it a “waste” to spend money on the elderly. Geez, we’re talking about people’s parents here. And yes, I’ve heard doctors saying that it’s “not worth it” to spend zillions on giving an elderly person “5 more years” but dang it, have a heart. I have no father and I want every dang year my mother has left.”

    There is spending money, and there is wasting money. Shelling out a few thousand dollars for an operation that will keep my grandma alive for several more GOOD years (high quality of life) is SPENDING money. Had we tried every last little measure to keep my grandpa alive for another week in the ICU with a $30,000 tab would have been WASTING the money.

    You really should re-read Panda’s “Dawn of the Dead” entry to differentiate the two:

    And good God, you might as well tell us your credit score and bra size. Who cares what your SAT score was? Don’t be so defensive.

  28. to Pat – You don’t see a lot of academic or hospital-based docs opting out of Medicare because their hospital would go under without Medicare dollars. Taking low pay or being out of a job isn’t much of a choice.

    I also contest your postulate on people in the UK being healthier. Women with breast cancer have trouble getting care. Midwives are replacing OB/Gyns at the government’s request, and the mortality rates have risen (reversing, incidentally, one of the crowning achievements of the NHS). And they have perfect access to care…

    People from the EU come here to learn trauma surgery. Why? Because we have a violent, speed-obsessed, fast-food culture, not because we have a poor health care system.

    And from my personal experience, making a resource free only increases the likelihood that people will use it more, and not use it more responsibly.

  29. Yeah, BHR, too much information. The other thing is that I know how much travelling nurses make and it is a pretty respectable wage. the fact that you can’t afford to pay for your doctor visits on what you probably make is inexplicable.

  30. (Last comment, I swear, and then I’m outta here for good…)

    “I love the smell of a pack of misogynists in the morning….”

    Were I a man and had “MD” behind my name, I doubt that y’all would have jumped on me so mercilessly for my outspokenness and my own variety of humor, which apparently went over like a lead brick.

    That said, Mr. Prowler, whoever you are—my bra size is 34D, and I weigh 118. Doc’s usually can’t keep their eyes off me (they usually slobber and fawn over me). However, I don’t rely on my bra size to gain respect from docs. The ones I work with think well of me because I work very hard and follow their orders to the T–quickly, efficiently, and without a hassle. I’m a doc-advocate and rarely have any disagreements with them.

    I just didn’t think that a spirited conversation on a blog comments section would bring out the worst in some people. I’m truly surprised at those of you who have jumped on this bandwagon of Panda’s habit of railing against those who disagree with him. If you knew me in person you’d know that I’m a very nice person. But sorry, guys— I am not one intimidated by those who brag about “eating their critics for lunch”.

    As to you, Panda, perhaps I should be honest and tell you the real reason I started the argument. I don’t like you. And the reason I don’t make good wages (enough to pay for medical bills) is that I work in Podunk, where NO RN makes good wages. You’d die laughing if you knew what we make compared to “big city” nurses. In fact, if you must know the truth, I am thinking of leaving my beloved area for JUST this reason—returning to the “big city”, with its money and its insurance. It will probably kill my mother, but then, at least I won’t have to deal with that sneer from doctors when they find out I’m uninsured….

  31. Goodness, BHR, I’m sure Panda’s feeling are hurt-HURT I tell you-that you don’t like him. I really don’t get where the whole “Panda doesn’t like women” feeling is coming from.

    Otherwise, Panda, I tend to agree with most of what you say, but was hoping you could have a post about what makes one a strong candidate for residency. I know you have several posts, but perhaps some with numbers behind it. You state that GPA is important to a point, but what is a strong GPA? 3.0? 4.0? And what board scores to shoot for, and all that jazz.

  32. BHR, I think you’re mixing up people who rail against those who disagree with Panda, and those who rail against those mischaracterizing his arguments. I myself disagree with some of what he says, but I respect him enough to listen to what he says with as little bias as I can, and to respond to what he’s actually written. The fact that you started out disliking him, and seem to have a chip on your shoulder for male doctors regardless of being a “doc-advocate,” makes it seem more likely that you were blinded by your own biases. Though you deserve credit for admitting to them. I don’t doubt that you’ve probably faced sexism in your life, but I honestly don’t believe that was the case here.

    I just don’t think it’s possible for an exchange of ideas to progress anywhere unless everyone is willing to openly listen to what the other person is saying, and respond to what they’ve actually written. Which is why most discussions on internet forums suck. Let’s try to keep this about the issues. I don’t care if someone points out that I’m wrong, as long as they explain well why what I said actually is wrong.

  33. I’m going to opt out of the pissing contest here, so I would like to suggest a post on Sicko. I for one downloaded it the other day and just finished watching it. It was thought-provoking in some parts, but I have all sorts of things to vent about it and would be curious as to what the Panda thinks about Moore’s latest crockumentary.

  34. An intelligence quotient of 154 is almost 4 standard deviations above the mean (100). That would put you above the top 1% of all of humanity in intelligence.
    Given that, why are your posts almost always self-righteous rants loaded with straw men and insults instead of reasoned arguments?
    If people read your writing and think “that’s genius”, marvelous. If people read your writing and you feel the need to tell them afterwards “by the way, I’m a genius”, it’s not quite as impressive. Bragging about IQ, SAT scores, and bust size/sex appeal on the internet isn’t exactly impressive and makes you look insecure.

    (As an aside, I’ve never met anyone on the internet who admits to having an IQ below ~130, despite the fact that the majority of people should be in the 85-115 range. Are we surrounded by geniuses or what?)

  35. I second the request for a Sicko post. I haven’t seen it yet, but I imagine it’s full of fake blue-collar guy Moore ragging on physicians’ incomes. He’s a regular guy (you can tell by his ball cap and frumpy attire), just disregard the fact that he lives in a mansion and has more money than any Dr. you’ll ever meet.

  36. i think all the healthcare professionals on here should spend time to actually talk to people outside of the field on what they think of the price of healthcare – hint they aren’t to concerned about the declining medicare compensation for dr’s. they do care about the huge bills and long wait times and lack of care and compassion. but on the other hands they are impressed when the compassion is there, when they feel personally cared for and they dont mind paying thousands for things like hip/knee replacements, cosmetic procedures generally things that produce observable results in the improvement of their healthcare

  37. BHR,

    There are all sorts of positions down here for nearly $40/hour with people begging for nurses. If you put in some OT, you could make six figures. If you can’t pay your bills in podunk, leave podunk. If you don’t want to leave podunk, don’t blame other people that you can’t pay your bills. If the city is a horrible place to live, then the individuals who make most of the money in America and live there should be entitled to keep the rewards of that sacrifice. For yourself, there is an easy solution to your problem, and any failure on your part to utilize it is really a perfect example of what’s wrong with America in the first place.

    If you’re going to say that those people need your help in podunk (wherever that is), then that’s fine. However, it isn’t everyone else’s responsibility to take care of you because you made a conscious decision to sacrifice yourself for other people. Maybe you should leave such sacrifice to someone healthy enough to engage in it. In any event, we’ve got some nice jobs all over the state, and any failure on your part to accept one is your own choice.

  38. To Rxnman

    You said “I also contest your postulate on people in the UK being healthier. Women with breast cancer have trouble getting care.”

    There is a two week “imperative” to get someone in for definitive treatment after diagnosis of a mass or an abnormal mammogram in the UK. The rates of adherence to this standard are very good. They go to specialized centers where the treatment is very uniform and evidence-based and the equal of anything in the US. Herceptin and the aromatase inhibitors are now standard of care, and sentinel node biopsies are available at all of the centers. Speaking with one of the best breast surgeons in Scotland, and I will paraphrase, “I feel so bad about the women in the US who go to any old joe schmo surgeon without the benefit of a second opinion or organized treatment”. I have seen insured women in the US wait a long time and still get suboptimal treatment. I have also personally seen uninsured women with breast cancer forgo needed care and die.

    I hate to tell you, but the epidemiologic M and M stats speak for themselves.

  39. pat:

    While the breast cancer treatment statistics may be wonderful, I watched my grandmother in Leeds bounce from ER to ER to specialist, waiting months at a time, for three years of slow decay. My parents, who moved to England years ago, have recently purchased an expensive long-term care policy rather than entrust their sunset years to the NHS (which I believe Panda’s analysis of an age limit to socialized medicine described perfectly).

    They didn’t even bother to try and obtain NHS dental care — all the good dentists are either private or practicing in the US. Or they have a wait time that makes an inner-city ER here look like an award-winning McDonald’s drive-thru.

    As for my other relatives, who are most definitely at the mercy of indifferent socialized medicine, I’ve seen the kind of preventative care they receive. While the plural of anecdote is certainly not data, I’ll happily sit right here in the US with my cushy health insurance system, and send the money I’m not paying in extra taxes to my family so they can see private doctors.

  40. Pat – If you could provide me a link with these M&M stats, I’ll look at them and come to my own conclusions.

    Nothing stops women (or men) in the US from getting a second opinion, and we do have standards of care.

    It is good that the latest treatments are available for cancer patients in the UK, but what are the wait times like? How easy is it for people to qualify for those treatments? How are they in the NHS hospitals, compared to the private ones?

    What about my other points? Or what about British teeth being a punch line? Or French doctors being paid less per visit than their plumber? That’s not the way things should be, but there it is.

  41. If it makes you feel any better BRN, I thought you were a male nurse, Gregg Focker style, until I read about your bra size, and I really don’t think anyone has said anything out of line or even remotely sexist to you. There have been plenty of male MDs that comment here in disagreement with Panda and the rest of us who have been treated exactly the same way.

    As a female, I detest when women pay the “genderism” card when it is unwarranted. From one woman to another, GET OVER YOURSELF and continue to participate in the debate if you choose or as you choose not to. Don’t accuse those that comment here of something Panda wouldn’t allow. We disagree with you because we think most of your arguments are weak, not because we think you’re a weak woman.

  42. Actually, with her 150 IQ BHR is in the top .008% of humanity. Yes, that’s right – rocket physics was denied the chance at having one of the smartest people in the world when she didn’t go into it. Plus being a 34D who weighs 118 pounds probably puts her in the top 1% of female figures so she’s just eating excellence for breakfast.

    You see, on the internet we’re all one in a million. Sometimes it’s difficult for me to get out of bed in the morning with my ten foot long schlong, but I do it. For my patients. Because that’s the kind of guy I am. I don’t mean to brag or anything; it’s not anybody here’s fault that your arguments are weak and unable to compete with my massive endowment.

  43. What do you mean you don’t agree with me? I’ll have you know I counted to infinity. Twice. I also happen to be 9 feet tall and plated with solid gold. Women swoon over the very mention of my name. Rumors of my presence make men tremble in fear.
    Can’t handle me? I guess you just have a bias against 9-foot-tall gold plated men.

  44. Well, okay, I’ll comment AGAIN, simply to defend myself against some comments that bug me. And yes, I know I said I wouldn’t comment again but I’m “goad-able”. (Is goad-able a word?) To all my critics: at least allow me to explain myself. (But Panda won’t like it….)

    First: To those who complained about “too much info about my bra size.” I only responded to a sarcastic remark from “The Prowler”, okay? He asked. I told.

    Secondly: Yes, I do have an unrealistic high IQ. It was found by accident in the second grade, confirmed in high school, then later in adulthood. And it surprised everybody because I’m a weird flake (truly). (And I can’t spell, dang it.)

    And I didn’t reveal it (or my SAT score) to “brag”—I simply revealed them in anger, to “tell off” those up there (including Panda) who accused me of not being able to “read” and “understand” Panda’s posting correctly— and then accused me of lying about said SAT reading/comprehension score. (They didn’t notice that I didn’t “brag” about my SAT math score…heh…it was awful!)

    And To Wolfgang: No, I don’t think Panda gives a rat’s patooty about me “not liking him” but I said it because it’s the truth. It began when every SINGLE dang time that I have disagreed with Panda he accused me of “not reading his posting” correctly, thus insinuating that I’m some sort of dunce. That is WRONG, I tell you, WRONG. I read his posts just fine, thank you! But I frequently disagree—yet I don’t see him verbalizing as rudely to male disagree-ers. (I still can’t spell, can I?) (I make up words, too.)

    And I have a belief about men who go only go ballistic when women disagree with them….well I’ll go into that in a minute.

    I am not an idiot babe in the woods. I am a damn good trauma nurse, a valedictorian, have multi degrees, and I wrote my damn thesis in my undergraduate years, okay? I can READ, okay????

    Anyway, my problem with Panda is NOT HIS OPINIONS. I RESPECT HIS OPINIONS AS I RESPECT ALL OPINIONS. IT’S HIS TONE, dang it. He ridicules the population of people that I love. And while doing it he is pompous, arrogant, condescending, and a real….well, I won’t say it here because he’ll delete my comment.

    Look, I have a soft heart. I was raised a diplomatic brat with tons of money, privilege and servants. And I saw plenty overseas while I grew up in the comfort of my air-conditioned chauffeured car. Plenty! I saw hopeless poverty, ignorance and disease like YOU’LL never see in your naive lifetimes!

    Yeah, I get HURT when I see the “poor/uninsured” of our own country get laughed at and despised by doctors—and yes, I mean the ones you call “ignorant/drunk/stupid/Medicaid”—the ones I champion the most.

    They are disadvantaged. And they are treated badly daily by doctors, ridiculed and treated cruelly. These people have had little education, few chances at “opportunities”, were raised by idiots with crummy values/mores/morals, and have thus developed poor attitudes and “entitled” behaviors.

    How DARE any of you criticize them? They are God’s kids like we are. Woe betide those of you who treat one badly—it might be an angel. (You think I’m kidding, don’t you?

    It says in the Bible that the way we treat the “least ones” is the way we’d treat the Lord….

    And as far as pulling the “gender card”, well….let’s look at it. I read umpteen medical blogs. What I see is this: some nurses don’t have the balls (literally and figuratively, heh!) to take on doctors. They get that “nurse/doctor intimidation” and hem/haw around the subject, trying to sound agreeable (which really means SUCK UP), and RARELY flat out disagree with a male doctor. Or female, for that fact. Why is that? Are they afraid that the doctor in question can do what they could maybe do in person—yell at them? PANDA DOES IT EVERY DAY ON HIS BLOG. Some nurses are afraid of that. I’m not.

    And let me tell you this, docs—you couldn’t do your job without ME. Yes, ME. Try it for 24 hours sometime…you’d come back BEGGING me to help you.

    And I’ll suffer greatly for admitting this fact from some nurses who read this, but I tell it like I see it, okay? And those people who know me know it. So I’m not afraid. I am one who isn’t afraid of taking a stand, dang the consequences. (And dang the torpedos or anything else for that matter…)


    And hey, Random MSII? You proved my point about women trying to bow down to male doctors. And also, the term “Get over yourself” is sooooo passe. (Dang, I can’t get the accent mark for the word “passe” to work on this computer here…)

    And Mr. aflak? Because you irked me I’m cancelling my aflak policies in the a.m.— simply because of your rudeness. Your…uh…member… doesn’t interest me in the least. Although I was going to cancel them for other reasons, I’m going to point out to my Aflak rep that it was YOUR comment that pushed me over the edge—and then I’m going to get my 120 other nurse buddies in this town that she services to do the same— and I’ll tell her WHY we’re cancelling, heh! (She’ll have a heart attack. But we’re close to the ER….and hopefully she’s insured!)

    Lord, you people are so easy to irritate!

    This time, I’m outta here…..

  45. Sexism is a bore, even the real kind….

    When a pediatrics attending tells you that women are more emotional than men, and that is why Eve ate the apple, and when
    an OB attending says that women are more self-centered than men, you can yawn and talk about sexism, and have some funny stories to tell later.

    Please don’t conjure sexism up on these pages. There is enough real stuff to worry about..

    Hillary Clinton, anyone? I mean really, we shudder at them all, why not pick a woman for a little diversion? Watch the press talk about her appearance 24/7…

    What’s depressing, in addition to the nation’s general total unpreparedness to vote in any woman, is that the other candidates are all unelectable for other reasons involving prejudice. While McCain and Obama are both acceptable candidates because they have at least a semblance of understanding, really, when are enough Americans going to vote for an albino octogenarian or a debonair well-dressed smoker intellectual with a middle name of Hussein? Ain’t happening.

    And Sir Giuliani is Italian, with likely fishy closet stuff because, well, he’s from New York. I don’t even think enough Americans are willing to vote for an Italian.

    We’re basically really fucked in 2008 is the take-home.

    And please, shut down the hissies. It gets very very mind-numbing.

  46. And I forgot to add something else irrelevant to the topic of discussion.

    If anyone is following education, (I am
    an activist, helped found a charter school,etc), you will be appalled at the reverse sexism that goes on. Men can barely survive working in many of the schools, and the boys TOTALLY suffer from the stifling sit-your-ass-on-the-chair-and-be-good like the girls environment created by “certified” teachers.

    Check out “Real Boys”.

  47. This is genius? This ranting, insecure, accuse-others-of-what-we-feel attitude?

    No, it’s not. Sorry. IQ tests are flawed and you haven’t a handle on logic or argument.

    I disagree with Panda all the time. I’m just a med student and sometimes I feel he dismisses me. He does that to most people who disagree with him. It’s his blog. If you don’t like how he argues, deal with it. Criticize him, but how does that end up with IQ/SAT/Bra size arguments? That’s because you’re insecure.

    Or a troll, which is another possibility. This resembles someone’s idea of humor, but I never get what’s funny about trolling, so I could be wrong and truth could be stranger than fiction.

    “I saw hopeless poverty, ignorance and disease like YOU’LL never see in your naive lifetimes!”

    Don’t assume you know what my life has been like. As far as naivete, assuming you’d seen more as a soft-hearted rich brat than anyone who might read your words… that’s naivete. I’ve seen plenty and I’m still left with the opinion that some poor are there because of bad luck, but most are there or stay there due to many bad choices on their part. Don’t deny them responsibility for their lives. You can’t take that away from a human being. We all have free will and we make choices. Good or bad we all deserve some credit for that and it’s not up to you to take that away from anyone!

  48. Gaye: You said: the boys TOTALLY suffer from the stifling sit-your-ass-on-the-chair-and-be-good like the girls environment created by “certified” teachers.

    Many girls suffer from this attitude as well.


    I thought your post was interesting Panda, and your one about purgatory damn hysterical. Like you, I’m not sure why everyone thinks that providing free preventive care to the masses will solve all of our problems. Somehow, we need to convince people that it’s worth paying the money to take care of themselves. Somehow I don’t see that happening on it’s own, so I was thinking tying preventive care measures to employment. As in, you don’t get your bonus if you don’t get your colonoscopy for instance (provided colonoscopy was shown to be cost-effective, of course). It is a bit nanny state though….

    I do like the idea of catastrophe insurance, in theory. In practice it seems like it might be difficult to figure out what constituted a “catastrophe” though.

  49. Hey, I know this it is inappropriate to post this unrelated question here, but I was wondering if someone could clarify what a call schedule means when it is written as q3d-2mo or q4d-4wk. Call every third day for two months and call every fourth day for four weeks?

  50. I would guess that it would mean q (every) 3 (third day – Wednesday) either for 2 months or every two months. Same for the latter.

  51. ” I am a former United States Marine Infantryman.”

    Honest question: Do you pay for your own health care policy and/or use government-provided health care/supplements for vets/retirees?

    If yes for the latter – why?

  52. Dude. I was only in for eight years. I get nothing from the military by way of benefits except that when I die the Marine Corps will provide a burial detail if I want it (which I will once a Marine, always a Marine).

    But that’s just a courtesy.

    I pay for my own heath insurance. (It is part of my compensation at my current job)

    I got nothing from the military except a paycheck for eight years. They did not have the MGIB when I enlisted and I wasn’t eligable when it was started so I didn’t even get help paying for college.

    People think that the military provides wonderful benefits to former servicemen but it does not, unless of course you retire which when I enlisted required twenty years of service. That’s the way it should be of course. I even think twenty years is too short a time to retire (you get half pay). If you enlist at 18 you could conceivably retire at 38 and draw retirement pay for the next forty years, twice as long as you were actually in.

  53. BRN, I’m not certain how agreeing with a male doctor on a particular point regarding the nature of healthcare and health insurance in our country means I’ve “bowed down” to a male doctor. But hey, you’ll interpret it however you choose. The fact that you are so insecure that you feel the need to fire out comments “in anger” that promote your intelligence, figure, priviledged upbringing, broad nature of the world and it’s problems, etc. just weakens your ability to participate in the debate in a way that people take seriously. You’re better off not posting here anymore simply because I think you’ve shot most of your credibility. Its a shame because I think you have the capability of being an interesting participant in the conversation until this latest ridiculousness.

    As somewhat of an afterthought, I have to add that I don’t believe I’ve read anywhere on here where Panda has insinuated or said blatantly that doctors could do their jobs without nurses. I’ve seen him use obvious over-the-top sarcasm about nurses pay to make a point that was somewhat the opposite of a “we don’t need nurses” argument.

    Lastly, I grew up a member of the class of people you lay claim to in “love.” Actually I have a somewhat better vantage point than most as my mother (with whom I lived) was of one social and economic class and my father of the opposite end of the spectrum. You really out to be careful when making obtuse comments suggesting you have a better vantage point on poverty, lack of education, and other social ills than ANYONE else here. You don’t really know who you’re talking to on here and such comments reak of arrogance and self-importance. I think you add something to the conversation until you start in on that. I respect that you speak your opinions but it’s ridiculous that you feel the need to “speak for the nurses that are afraid.” Total BS. This is the internet! Speak with impunity except for someone suggesting you didn’t correctly interpret their writing. Sticks and stones, and all that. GET OVER YOURSELF may be passe to you, but if the shoe fits…

  54. Uh… BRN? On the second most recent post on your so-called blog, it’s “bucolic”, not “buccolic”.

    Given your intelligence, your bra size, and your position as a woman fighting for the rights of nurses, I’m surprised you’d make such a mistake.

    You seriously are scraping the bottom of the barrel when you rag on spelling after someone tears you apart.

    Promise you’ll come back to complain about this comment too.

  55. My apologies BRN. I will surely watch my tricky left hand whilst typing in the future, for fear of offending your delicate sensibilities. OH TYPOS, I RAIL AGAINST THEE! Surely, my right hand does not know what my left hand is doing!

  56. You also missed that I misspelled “privileged” as “priviledged.” I’ve always had trouble with that one. And as long as we’re putting all of our spelling woes on the table, I should add that I have trouble with “vacuum.” I have a hard time convincing myself that it really has two ‘u’s and not two ‘c’s.

  57. As to why BRN thinks me a mysogynist or a nursophobe I have no clue except perhaps her towering intellect, brain power that is truly frightening to those of us who struggle to put one word in front of the other, missed the not-so-subtle sarcasm in my recent post about nurse’s salaries.

    But I swear that woman has an axe to grind, a chip on her shoulder, and a bee in her bonnet about something that is only peripherally related to my articles.

    I want to point out to my readers, about 1000 per day, that BRN probably makes more money than me, a poorly compensated and overworked resident, and her accusations that I am somehow a captain of medical industry with a haram of captive nurses in my thrall couldn’t be more removed from the truth.

    PS: I would like to ask for a moritorium on correcting spelling. I do not have a spell checker for WordPress so while I appreciate the corrections, you all have to concede I do pretty well when it comes to spelling.

  58. I am an American living and working in Canada. I am a nurse. I have lived and worked in both countries for most of my life. I have a vast amount of experience with both health care models.

    Socialized medicine is wonderful. Does it have problems? Of course. Is it perfect? Of course not. However, the quality of care is excellent. The wait times are vastly exaggerated. I prefer the Canadian health care system hands down.

    Blanket statements that it is ‘failing’ in the UK or Canada are ignorant. I cannot speak for the UK, but the medical system in Canada is successful and the people fight bitterly to keep it despite heavy pressure from those who hope to profit from a private system. If you ask any Canadian about the healthcare, the VAST majority will vote to keep it the way it is. No one wants their health system to follow the path of the US. Canada, the UK, France, etc are all democratic countries people!!! If they wanted it to change, they would change it. Fact is, socialized medicine works.

    Yes, there are some movements to privatize clinics in Canada. But they are not private like you think of in the US. They still have to devote much of their bookings to national healthcare. Yes, wealthy people sometimes do go down to the States for treatment. That is fine, it takes people off the patient lists up here. Statistically though, the people that do go down report minimal satisfaction and universally state that if they could have bought the same services in Canada, they would have preferred to stay here.

    I realize that people of the US are scared to change. But that is mainly because the people who profit most from the US system provide the greatest amount of anti-propaganda and fear-mongering possible.

    The bottom line is that the US spends more money on their health system (as well as their education system, incidentally) than any other country in the world, and yet ranks among the lowest in almost every category possible on almost every account.

    What is going wrong??

  59. Thank you Sally, for another perspective, which actually is refreshingly on topic. No bra sizes here.

    Panda and most of his readers appear to range from virulently anti-, to sceptical about, socialized medicine, period. I am in the camp that asks: where’s the information before I form an opinion either way.

    Because really, just because Greece has fekalaki-whatchamacallit, doesn’t mean that every socialized system is bad. Greece emerged relatively recently, in terms of communications and infrastructure, telephones, computers, etc

    How do we find out three things:

    1)what the canadians really say, think and feel compared to what americans say think or feel about their healthcare

    2)what the professional say, think, ditto

    3)how to accurately assess the relative quality delivered by the 2 systems.

    4)how to assess fair compensation for what physicians do and how the take-home stacks up on both sides of the border, both for nurses and doctors. I would take a small cut in pay not to have to practice so defensively and spend my time and mind on BULLSHIT.
    Like I could spend more time on people and information than on forms. I mean, in Canada, when someone is being sent to the ED, does the doctor need to tick a box on a form to the effect that one of the risks the patient faces from transfer is a traffic accident? Jesus Christ, the administrators and the lawyers have us, as TS Eliot described, “pinned to the wall spitting out the buttends of our days and ways”.

    I suspect that what is going on is related to 2 quintessentially American problems: lawyers and out-of-control unions. But that is just a gut feeling, I’m too busy suffering through paperwork and raising my children to have figured out what the hell is wrong with our system, or even if anything really is wrong with it, compared to say, Greece..

  60. Hi Panda – Interesting post and comments. I just posted on my questions on socialized medicine and do want to understand it all.

    Everyone complains about our system but no one seems to have answers.

    I hope it is alright that I linked this post to my post. If not – let me know and I will remove it.

  61. I have a question for Sally. What do you mean by waiting lists? For important procedures/surgeries?

    I am not as informed as most of you are about socialized health care vs free enterprise but admittedly, after viewing Sicko last night – I am curious about the pros and cons of socialized medicine.

    I know Mr Moore misrepresents the facts and he sure had Canada, England, France and Cuba looking like a utopian system. I do take issue with the Cuban representation though.

    His political beliefs are the antithesis of mine but I wanted to give him the benefit of the doubt. I did appreciate the humorous moments. I felt compassion for the suffering people. His documentary was the catalyst for me writing about my own concerns and questions and I have spent a lot of time today reading other sites looking for answers.

    Panda – I agree with the others in requesting that you please do a post on Sicko.

    I feel like such a mental midget here but this girl is sticking around. Great site Panda and interesting comments.

    Hi BRN – I know you are someone with a warm heart – you just get a bit sassy sometimes – by your own admission.

    I understand what you are all saying about the MDCD/uninsured population. In the inner cities and perhaps other areas too, it is generational and their are reasons for that. That’s not to excuse it.

    Then there are people who need the program just because they fell into some difficult circumstances and are able to get off the assistance and give back when they are back on their feet. And some can’t get off. They aren’t deadbeats. They actually worked hard all their lives but then can’t make ends meet for whatever reason.

    I hit catastrophic with my medical bills last year while simultaneously losing both jobs due to my illness at the time and so the co-pays and deductibles added up – quickly. I am grateful for my insurance which has paid most of it. Entire nite in the ED and then admitted into hospital for 1 week, 7 OR procedures, 5 renal scans, 3CTs (2 w/contrast),2 IVPs, 3KUBs and a partridge in a pear tree! Then there were office procedures, labs, drugs, etc and thank God for my urologist who worked hard to facilitate my healing. I can’t imagine not having insurance for all of this. My insurance company paid thousands!

    I feel for the people who fall in between the cracks who don’t qualify for assistance because they aren’t poor enough yet don’t have insurance either. YIKES!

    I vehemently disagree with having a system that denies deserved coverage to patients or appropriate and timely reimbursements to doctors and by so doing, they are financially compensated or advance through the corporation. This can’t be good. We need some checks and balances here.

    It really has been interesting to read everyone’s comments.

  62. SeaSpray – the waitlists are only for non-critical procedures. The vast majority of these are for knee/hip replacements. No one who has a critical condition is forced to wait for anything. They are put at the front of the line, hence the waitlist.

    I could give numerous examples from the hospital I work at, however, I do not believe it is professional to speak about cases merely to prove my own point, so I will give an example of my own. I was way overdue with my second child. It was decided that I should be induced (for a number of reasons). However, I was not critical. I was scheduled for a Tuesday inducement, and was bumped, and bumped and bumped until Friday evening because they had a bunch of emergencies. Was it inconvenient? Yes. However, not life threatening, and I came in every day to be monitored and the baby was not in stress. However, if it became critical, I would have been induced immediately. I had a choice to stay in hospital or go home. Because I am a nurse (peds no less) I opted to go home. But I could have stayed if I chose.

    As for health care facilites/equipment.. well, I have worked in both places – Canada and the US. Keep in mind that Canada is teeny tiny in population, massively huge in geography – less people than the state of California, more land than any country in the world. Vancouver has an incredible hospital system. (I currently live on the West Coast). Children’s is possibly the best hospital I have ever, ever worked in. It is amazing. But I have also worked in remote, rural areas where the nearest doctor is a good 3 hours away and the nurses run everything and the facilities are old and it feels like a step back in time. However, when you are dealing with a population of less than 6000 in a 4 hour radius, I don’t know how anyone would expect primo facilities.

    As I mentioned, there are problems. Abuse of the system is rampant. Everyone is constantly reminded of the need to conserve costs. Patients are actively encouraged to go home as early as they can manage. Home care is pushed perhaps a little too hard. BUT everyone gets the exact same care regardless of income or social status. Some things can be bought – for instance, if you want a private room you can pay for an upgrade, and if there is space you can have it. Everything is paid for, no one has to worry about insurance or approved doctors. Prescriptions are paid by the patient unless they are financially unable to do so. However, the price of medication up here is much, much less than down there. Perhaps you have heard all the hoopla about people buying their prescription medication in Canada? Well, because it is vastly cheaper. My mother in law came to visit (she pays $700 per month for insurance) and she could not believe how cheap her medication refill was. I think she said it was about a quarter of the cost in Sacramento (where she lives). Once a patient or a new mother returns home, a public nurse is right there following up on them. The resources to the public are amazing. I have never seen such support for the patient in the US. But then, I have not lived there for a few years so maybe it is different now.

    As for pay, nurses start at $27/hr and in two years they will start at $30/hr. Doctors as far as I understand make fairly comparable for some areas. For instance family practice is around $150,000/yr to start not including bonus and incentives for a public practice. I have also seen family practice doctor’s positioned advertised at $300,000. I had the privilege to work with the most amazing paediatric surgeon. I felt honoured just to be in the same room as him at times! He was beyond amazing. I asked him once why he does not go to the States. He could easily be the top in the field and make zillions of dollars. He told me that he is head hunted regularly, but he would not touch the American system with a ten foot pole. I was too much in awe to really get into it with him, so I do not honestly know why he felt that way, but I have heard it from many, many doctors. I assume the ones that do not feel that way have already left to go down south…

    Hope this answers some questions. Whew. What a lot of writing…Sorry to take up so much room.


  63. Thank you for shedding more light on this topic Sally. Also thanks for sharing the geographical facts about your country as well. Very interesting.

    The son of a dear friend of mine loves the Vancouver area and was hoping to get work out there and then he settled in the Seattle area for a year but could not get work in his field and ended up coming back to NJ. Your area was one of his favorite places out there.:)

    It does sound like your health system has it’s perks. Why is the SAME medication so much cheaper up there?

  64. Hey Sally,

    Growing up in S. Florida, my next door neighbor and best friend was French Canadian. His mother was a nurse. The picture that you paint of the system is not at all what has been conveyed to me by them. As you went north of the border to escape the American system, they came south to escape the Canadian system.

    I don’t know where you work. From what I hear, location is very important in both wait times and quality. Politics, as in many things, has a lot to do with this. My friend was fortunate enough to live in Sherbrooke, where they had the medical school and its associated resources. With his mother working within the system, he had more expedient care than most.

    P.S. $300,000 Dollars in Canada doesn’t mean what it does here, primarily because the combination of Provincial and Federal Taxes, not to mention the atrocious GST, eat that kind of salary alive. A fundamental difference culturally between Americans and Canadians is probably summed up in my friends words, “Though we bitch about it sometimes, Canadians don’t really mind paying their taxes.” I assure you that doesn’t apply here.

    Also, I don’t understand why most people think that socialized medicine = No Malpractice Problems. They are two seperate issues. Malpractice is currently becoming a bigger problem in socialized systems all over the world, depending on limitations on it within the system. Most of these countries are less litigious in general however. One statistic I saw showed a per person lawyer average of 3x higher in the US versus most of Europe and 10x higher in the US versus Japan. That really explains that problem better.

  65. Hi Miami-med-
    Actually, I did not go north to ‘escape’! I married a Canadian and his job was up here. I love my native state, California, and go visit family and friends every year.

    At any rate, I live in the Vancouver, West Coast area. I don’t know when your friend (I assume they are from Quebec) lived here. I know that 1) socialized medicine in Canada is relatively new (developed in the 60’s) and had a rocky start. So perhaps they had troubles then. And 2) Quebec is it’s own animal. They often hold themselves apart from the rest of Canada and do things their own way. I cannot speak at all for Quebec. If you think the US is several different countries within a country, just try living in Canada. The west coast is so completely different and isolated from the east coast there is no communication or comparison.

    At any rate, I also cannot really speak for wages. Right now the Canadian dollar is almost at par for the US. The GST is currently 6% for BC (British Columbia). Alberta does not pay GST, I do not know what the other provinces (states) pay. That is for everything you buy. I was just in California for a month visiting. State tax there was 7%.

    After having worked in California for 14 years before moving here, I did not notice any significant difference in take home pay after taxes. I remember it was slightly higher, but not bad.

    I do not know anything about malpractice comparisons. We don’t seem to hear very much about it up here. I remember in the States it was a huge worry.

    I don’t mean to say that everything is golden glowing roses in Canada. But statistically and personally, the Canadian health care system is ahead on all fronts.

  66. Sea-Spray-

    I am not certain but I believe the cheaper meds are because 1) generic brands are used more often. and 2) There is no real competition for brand names and physician incentives. The government buys the drugs and sends them on. They go for the most cost effective drug. There is no free market competition. It is a not for profit situation whereas the US system is all about profit.

  67. Too many generations of formula feeding and sub-par schooling have left Americans too sedated to revolt against the RIDICULOUS prices that pharmacies charge for generics in the US. When I was in training over a dozen years ago, we thought it was bad that Keflex cost 25$ for a typical Rx. The pharmacies jacked up their prices over the last couple of year, now it costs 40-50$!!!!! For a drug
    that is, like 50 years post-introduction!!!

    That is changing, however….thanks to my hero, Walmart. Suddenly, you CAN buy anti-hypertensives and antibiotics for the same price as in France.

    Vive Walmart!

  68. Free market competition by and large pushes prices down. The distinction between the US and Canada, is that they have caps on their prices. As of now, US companies still find it profitable to sell there, albeit at smaller amounts than necessary to maintain research and development. However, this has by and large pushed most R&D costs back into the US. If anything, Americans should be up in arms about how the rest of the world gets their drugs below market value because of the cost shifting to Grandma over here in the states. As pointed out, Walmart would actually be a prime example of capitalism lowering prices.

    Sally, you’re right that I’ve never been to the West Coast of Canada, and things may be different there in some way. As California has the highest taxes in the US and shares a dubious distinction with a couple of other states as being significantly higher than the rest of the country, California to Canada isn’t really like comparing the US at large to Canada. Also, at $30/hour, the heavily progressive Canadian tax system wouldn’t be as different from the US system as it is at $100-$150/hour. I won’t argue that the citizens of Quebec are a bit different than the rest of the country.

    The malpractice crisis that by and large doesn’t exist in Canada has little to do with socialized medicine. That’s really a point I’m trying to get across. The US is just MUCH more litigious. There is nothing about having the government as a payer that would stop lawsuits without malpractice reform. With malpractice reform, the government wouldn’t have to be a payer to stop malpractice.

    My friend moved to the US in the mid-80s. He has a lot of family back in Canada however, and nothing that he has heard from them has conveyed any significant change. Since this is all in Quebec, I will refrain from applying it to BC. As an aside, I thought that most of Canada now had 15% GST, with half going to the province and half going to the Feds. Is that not the way it is where you are? I probably need to look into it a bit more.

  69. lol at aflak… BRN is trolling, alright.

    Nothing of real value to add here. I guess the adage ‘you get what you pay for’ is apt, but I did want to note that the rest of the world is riding on the coattails of the US’s R & D into new pharmacological therapies. If it were not for US R & D we’d be at -least- 20 years behind where we are right now.

    So, yes, you get what you pay for. We in the US pay for it… the rest of the world gets it. Huh. Can we convince Canada to pick up this tab in the future?

  70. I’m a bit of a middle-grounder on this one. I read the excerpts of your blog over at Dean Moyer’s blog and jaunted over here to view the whole shebang…. it’s an interesting debate certainly.

    Over there, I’d asked if it’s completely fair to compare Greece and the U.S. given the economic differences. I wondered if Japan would be a better comparison. But I’m not sure that it makes a statistical difference. Either way, this debate has moved on to other nations that I know less about.

    I’ve seen healthcare at work in several countries – both the “tourist-version” and the “real version,” in three specific and memorable life-threatening chronic disease cases and several smaller ones, and I definitely agree that there’s no perfect system and the word “socialized” does not automatically equate to “good.” Then again, I don’t think anyone here has suggested that our system is working smoothly as it is (you weren’t, were you? I didn’t read it that way).

    That said, what irks me (in general) is that political debate in this country tends to view it as an “either-or” debate. Either we have the same system as other “developed” nations or we have exactly the status quo with no changes. What a silly idea!

    We have a system, and yes it’s of debatable functionality. In its dysfunctional state, however, my PKD sister-in-law got her dialysis, iatrogenic-diabetes care, and kidney transplant. Has the process been horrible? Many times – money from family has been required, much railing against the lack of government support for people who aren’t technically “disabled,” but can’t work has gone on, paperwork nightmares have ensued, and multiple people have lost months of sleep (and medical school study time) worrying about money. Would it have been possible without family members sacrificing for her benefit? Probably not. (is that a bad thing? hard to say). But the healthcare did happen, and was paid for through a combination of public and family funds, with a lot of sacrifical choices and a little charity from the Hospital. Is her case statistically irrelevant? Probably, but I submit it as a case study regardless.

    Is the system really so irretrievably flawed that it needs to be chucked completely? Is it even remotely reasonable to think we could wipe the slate clean and start again? Is it just as resonable to think we could do a better job than everyone else at designing a brand new system from scratch?

    There are much more reasonable endpoints for the system that we could be aiming for rather than a “it doesn’t work, so throw it out” mentality, and I suspect that’s what you’re getting at in these posts. How do we improve intial point-of-care systems so that ERs are less crowded with unnecessary patients and medical staff is properly reimbursed for time spent? How do we improve rural access to medical care, and how do we improve access to necessary treatments for the debilitatingly ill? How will we define those conditions and people? How do we streamline our health systems to maximize access without over-inflating costs? Is it reasonable to suggest that perhaps enacting some of those changes would result in a more socially-equitable system than a newly minted socialized medicine system would?

    As I said, I’ma middle-grounder, and I’m not sure of very much, but these are the questions I’ve pondered.

    These problems are quite large enough, and would take both the private and public sector to correct – better government programs for those who need them (admittedly, I am a fan of everyone at least paying something – and for the record, my sister-in-law is too), but also better private structures. Tiered systems may be inherently inevitable, as no matter how philosophically depressing it is, economic disparities (regardless of effort/inherent worth) will always exist. But I don’t understand why we can’t talk more about smoothing out the giant wrinkles in the given system than trashing it and starting again.

    Oh wait, I can understand – smoothing never buys as many votes as complete overhaul. It’s just not dramatic enough.

  71. I’m not comparing Greece to the United States. I’m just giving you an example of a typical Freeloader Kingdom and how care is managed and rationed when it is controlled by the state.

  72. Your opinions of “waste” and “inefficiency” are not actually based on actual economic facts. Countries running universal care typically run per capita costs 50-70% less than the U.S., administrative costs per capita are even lower, (yes, lower than 1/3 of what we spend here in the U.S.). The comparisions are dollar adjusted.

    Even though less is spent per person, typically a country with universal care, take for example Canada, reports more physician visits, more surgery per capita, more days in nursing homes, more days in hospitals, more bone marrow transplants, and more lung transplants per capita. They do get less heart surgery and fewer M.R.I. scans.

    If there are problems, maybe it is just because they underspend.

    Also, just for comparison, I listened to a British lady expound her taxes and health care costs. She said, in Britain one can buy a certificate, about £98 a year, that covers unlimited meds. The first part of income is untaxed, 10%, 22%, 40% for anything you earn over £33,000 (about $66,000). I didn’t get a chance to grill her on the fine points of British Tax Law, but she did say it was only slightly more than she paid in the U.S. (in a moderate tax state). She also said she felt better off in Britain now because her 20-something daughter living in the U.S. had to declare bankruptcy due to medical bills.

  73. And just for the record, I favor a mixed system as well: create a backdrop of universal care, but allow insurance companies to offer supplemental insurance for wealthier clients who want the option of convenience scheduling.

  74. Oh, one more thing, if I roll in federal tax, state tax, self-employment tax, SDI+M/C+SS, plus what I pay for health insurance + deductible co-pays, my tax+health bill is greater here than it would be in Britain.

    And that does not include the price I would like to put on the headaches and time wasted by insurance hassles.

    The only thing that saves this situation from complete economic meltdown is that there is no VAT in the US.

  75. one more thing, I pay 250$ a year for health insurance (drugs plan with dental). GST is 6% with an additional 7% going to my province on top of that. Gas is 1.16/liter (approx 4.39/gal) and I pay 3.50 for a 2 liter of milk. not sure why i am telling you this but hopefully you can compare this to what hidden taxes you pay. we are not reamed on income tax as well. they come for the wealthy people first in Canada!

    (Hooray! Screw the rich!  It’s not as if the poor in the United States, or even the lower middle class, pay any income tax.  They most certainly do not.  Sorry.-PB)

  76. Very well stated Panda Bear. I for one agree that people should pay for their medical care as much as possible.
    I also don’t mind the option that a public health plan will give us. That does not mean that the one that is in legislature is a good one.
    The problem I have with healthcare is not the cost… it’s the point of service charting theory that seems to have taken off recently.
    Most healthcare providers know that the therapy departments in most SNF’s are switching to point of service charting while providing therapy to patients.
    It’s a little bit disturbing to watch a therapist be forced to chart while they should be giving their attention to the patient. Production, Production, Production, Money, Money, Money seems to be the theme these days. What happened to focusing on the patient during treatment sessions?
    I can see where PoS can be a positive thing for Doctors for reasons such as helping prevent malpractice issues, but come on people….. let the therapists be therapists and spend quality time with patients.
    They should rewrite the healthcare plan to address quality vs. production and stop PoS in certain healthcare fields.

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