Tuesday, January 20, 2009

Can single payer health care be patient centered (or evidence based)?

Dr. Wes had this conversation at the Boston Atrial Fibrillation Symposium:

At lunch the last day, I sat with some nice nurse practitioners from Canada and asked them about how things work at their hospital in the electrophysiology department - after all they worked for a big regional hospital outside a major metropolitan city like mine. I asked how many electrophysiologists they had there: three - two of whom do afib procedures and one who does more device rather than ablation work. I asked how many defibrillators performed a year and asked who paid for them, and she said the
government. "But we got authorization to do five more devices next year," she said.

"Only five?" I asked in disbelief."

Yep, and we were lucky. Other centers got fewer. They're expensive, you know. We have to be very careful about who we select to get one of those. It's not like America - people here are used to waiting."

"But what about SCD-HeFT and MADIT-II and the other trials?"

She smiled and looked down at her plate. "We have no choice, people up here don't have to pay for their care, so we have to choose who we think the best candidates are and do the best we can."

Those of you advocating for patient centered health care and single payer health care have some serious ‘splainin’ to do!

(For that matter, can you even practice EBM under single payer)?


smartalyk said...

Here's my argument for single-payer. Right now, I have no insurance (despite working 2 jobs) and haven't had insurance for about 8 years. Under the current system, I can't get any health care, because I can't afford it. Under the Canadian system, I can get health care without paying out of pocket. I don't understand what's confusing about that. The US might have great health care, but it's only available to people who can afford it.

Insurance Canada said...

Things are not so black up here. Yes, you often have to wait, especially in big cities like Toronto. On the other hand, you finally always get the treatment, especially when it's an emergency. But I am not telling you it's 100% working. Yes, there have been cases with people getting late treatment, resulting in health damage. But every system has its disadvantages. The worst thing here is, you can't pay even when you want! I am professional life insurance broker who sells health insurance too - we have such thing, but it covers only few, generally minor things (dental treatment, drug prescriptions etc.). There have been efforts to spread it, but all blocked. Why not to pay for better standard, if the base treatment is secured??

mulp said...

With the taxes paid for health care in the US, we should be covering everyone in the US with the level of care in Canada.

Then, the even greater amount spent privately in the US can then double the equipment, patient care, and such delivered at Canadian levels by the taxes going for health care in the US.

That the US spends so much for health care, about 80% more per person than in Canada, every one in the US should be covered and everyone getting better care than in Canada.