Here's a video that plays to the kind of sensationalism and fear-mongering that we've all seen with the coronavirus. It's called "The truth about healthcare."
So, what's the truth, really? A huge question. I'm in a similar position of having worked in both systems extensively. I would still much prefer the Canadian system, both because everyone is covered without question, and because it costs less per capita in terms of percent of GDP. Sure taxes are higher in Canada. In my income tax bracket, my tax rate is a little higher than 35% in Canada, and a little lower than 30% in the US. A small price to pay for universal health care, and there's the apples to oranges of the cost of housing and living, cost of long-term care, cost of insurance and so on between the two countries.
Waiting lists for elective orthopedic surgery in Kelowna were typically 13 months, but highly variable, and shorter if there was a compelling reason.
Waiting a few months for screening colonoscopy is typical in Canada, and wait times are shorter in the US. The typical growths found at colonoscopy are a few mm, but yes, there would be occasional substantial tumors caught a little earlier in the US. Is this worth spending twice as much as other G7 countries on health care? I don't think so.
https://medium.com/@GregCampNC/enlightened-self-interest-and-the-healthcare-debate-20ef0d94b032
My wife might have been diagnosed a few years earlier with her breast cancer, but would she have lived longer? Maybe, maybe not. It's a relentless disease no matter what treatment, perhaps having spread at the time of diagnosis no matter how early the diagnosis, for triple-negative tumors like hers. Breast cancer may be a systemic (body-wide) disease from the outset.
1) in Canada, an on-call team of ultrasound or other radiology personnel is available, but has to be warranted. Pain during pregnancy is best discerned with a history and physical, a laying on of hands, and if warranted based on this assessment, a diagnostic study. Despite any amount of whining from patients or meddlesome husbands, the call team aren't called in unless needed. At any point if her symptoms had worsened, suggesting an abruptio or other disaster, things would've happened fast in both the Canadian or US system. Sure, you can get an ultrasound 24/7 at any small hospital in the US, but is this worth spending twice as much on healthcare? I don't think so.
2) operating on back pain in the absence of neurological deficit is definitely not recommended and can lead to a lifetime of regret. I almost went down that path myself, and have seen colleague's and patient's lives ruined by surgery. Sure you can find a surgeon willing to operate tomorrow in the US, but at what cost?
Even when the reason for operating on back pain is justified, the results are poor. Looking to the Cochrane library, an impartial source I trust on such matters, they say
"Proposed advantages of these [back surgery] techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies."
3) colonoscopy earlier: routine screening for colon polyps is spread out every ten years for normal risk, every 5 years for people with a family history as he had, and there's good reason people don't get a colonoscopy every month. Waiting a year versus a month may have very little difference in outcomes (though anyone would acknowledge the anxiety that keeps people up at night during the wait.)
The long wait times in Canada have, of course, been subjected to careful scrutiny. Waiting longer does not significantly increase risk, or the size of tumor at time of diagnosis.
"There was no effect of time to endoscopy on the presence of lymph node positivity or distant metastatic disease at the time of diagnosis"
They actually found the opposite result in this study - if you waited longer there was less chance you had substantial disease. Clearly what was happening here was the doctors were moving people up in the queue if their symptoms were worrying, also called triage.
"Forty-six per cent of patients waited longer than CAG targets, with a mean (± SD) wait time of 79±101 days. Higher cancer stage was associated with shorter wait time, likely as a result of triaging."
So I think the fellow who made this video is fear-mongering, and I would much prefer the Canadian healthcare system over the US one.
No comments:
Post a Comment