Tuesday, October 18, 2016

Medical wait times in Ontario

Some people I know who live in the States tell me my original post was grossly out of date. Thanks to what is being called ObamaCare, the coverage problems being encountered in the States have changed since my last visit to the States.

For instance, the big increase in premiums related to the Patient Protection and Affordable Care Act is big news. According to the Harvard Gazette, some ObamaCare premiums will rise 25 percent in 2017. This sounds scary but it isn't as bad as it sounds. The article reports the premiums going up are for a very specific subset of the insured: only those getting their coverage through the health insurance exchanges. It’s not about the premiums people pay for employer-run plans or for Medicare or Medicaid coverage.

The Gazette points out most people getting health insurance through the exchanges are heavily subsidized, with premium and cost-sharing subsidies. In other words, the cost to the federal government is increasing.

Hmmm. Increasing government health costs. Sounds like a familiar problem. One being faced by governments around the world.

I believe the right approach to solving our health care issues is to keep an open mind. And I am willing to admit that I too am guilty of closed-mind thinking. We must be both creative and willing to learn from others as we tackle the problem of providing health care in a world where the costs are constantly rising.

The Province of Ontario has a problem and the City of London has the same problem but bigger. The problem? Hospital wait times. The London Free Press has been running an excellent series looking at the lengthy wait times endured by patients waiting for hip replacement surgery.

But as bad as the problem is, and it is bad, I would not be too quick to toss the entire Canadian system and embrace the U.S. model. In 2010 my wife and I crossed the States by car. We stayed in bed and breakfasts and we chatted with a lot of Americans. One lady we met had been waiting more than a year for her joint replacement/repair surgery and she saw no end to the wait time. The boondoggle? Her insurance company.

On that same trip I had a heart event that put me in Marin County General outside San Francisco, California. I was lucky. Marin General is a great hospital serving one of the most affluent areas in the States. Although, I spent less than 48 hours under medical care, I ran up a bill of about $30,000 U.S. And all that money, all the sophisticated tests, didn't find the cause of my heart problem. I was given some pills, metoprolol, and discharged to drive the thousands of miles between me and home in another country on other side of the continent.

Back home, the doctors discovered the cause of my heart problem and an ICD/pacemaker was inserted into my chest. My direct cost in Canada: essentially nothing. My cost for treatment in the States? This too was essentially nothing but it took some eight months, or more, of back and forth with the insurance company and a U.S. based collection agency before all was settled. I had to take some long, difficult phone calls and I had to listen as I heard our retirement security threatened.

If I had been an American, even with insurance, it is possible the source of my heart problem would never have been discovered. I might have fallen through the cracks, as they say. The insurance folk would almost certainly have fought to find a way to drop me from any health plan and with no money there would have been no solution. (Today, with the Affordable Care Act in place, some of this has changed.)

To go full circle, let's return to the problem of wait times and hip replacement surgery. In London, Ontario, the wait time has become indefensible. But as bad as our system is when it comes to this surgery, I wouldn't be too fast to hold the much-faster-on-paper U.S. system up as a gold standard.

Please, follow the link to Free Money for All: A Basic Income Guarantee Solution for the Twenty-First Century by Mark Walker. (If the link fails, google the book and do a search on the word "infinite". You are looking for page 38.)

Walker points out that at the time he wrote his book a sizable percentage of Americans were unable to access the fine U.S. health care system. Being neither rich nor insured, they found themselves unable to pay when it came to elective surgery. They were trapped outside the Amercian health care system to suffer indefinitely. These people were sitting on what I have heard Americans refer to as the infinite wait-list. The wait times endured by these people were not measured in months, the times were not even measured in years. The wait could be infinite.

Has Obama changed the American medical system? Yes, but infinite wait times are still a problem for some Americans and the ranks may grow under a Trump presidency.

 Source of above graph: Commonwealth Fund (Wednesday, November 16, 2016)

Note: The above graph illustrates a complex problem. Use care when interpreting. 

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