OH OH, don't forget to be politically correct.

[Michael Tee]

<<Wasn't that the theroy under which the Union of Soviet Socialist Republicks operated?>>

No, the reverse.  That communism was a necessary condition for the emergence of a truly socialist society at which point the state would "wither away" since it would no longer be necessary.

The Communist Party as the vanguard of the proletariat is a necessary class war instrument of the working class, but with the triumph of the Revolution, under the dictatorship of the proletariat, true socialism will be realized and the classes will dissolve.   The Class War will finally disappear.  The state, originally conceived as the Class War vehicle for the ruling class to maintain its control over the proletariat, will no longer be necessary for any purpose, and will therefore "wither away."

[Michael Tee]

<<In other words, those who needed care, were without any other recourse, and with the excruciating pain not being managed, or the condition simply unbearable to wait for the government bureacracy to run its course, would come to America to get the needed treatment/surgery/CARE they they were not able to get elsewhere>>

Well, assuming these are people who have exhausted every reasonable alternative under the Canadian system, yes.  These would be the failures of the system.  Every system has its failures, and you are seeing some of the failures (and none of the successes) of ours.

<<But hey, at least they were covered, right??  That's what's important.>>

Yes, when you rate the overall effectiveness of the systems, the number of people covered is a legitimate, and even important, element to be taken into account.  It's important that every citizen be covered, which means, entitled as of right to decent medical treatment.  At least that's how we see it, according to our values.  And it would be important to know, in assessing any system of coverage, to know that the current system was leaving 47 million citizens without any coverage at all.

<<  That, and that someone else pay for it>>

I pay for it, sirs.  My wife pays for it.  Every fucking dollar of tax I ever paid to the Minister of National Revenue  had some part of it invested in health care.

[sirs]

News flash Tee, when you're in pain....debilitating, excruciating, dysfunctional pain, you're not looking to exhaust every other lesser tx approach, dragged out insidiously behind the bureacrcy that will decide when that next treatment is going to take place.  If the Docotor knows, and it can be taken care of, that's it.  This isn't some foreign diplomacy approach, where you exhaust every conceivable lesser option.  This is also not an advocation that surgery should be the 1st and formost choice.  Only that CHOICE is the key, and in your system, that key is WAY down in the priority box.  So, for every one of your anecdotal examples to validate Canadien healthcare, I have an equal, if not far more set of examples, that trump yours

And by all means......pay for it yourself

[Xavier_Onassis]

The Class War will finally disappear.  The state, originally conceived as the Class War vehicle for the ruling class to maintain its control over the proletariat, will no longer be necessary for any purpose, and will therefore "wither away."
===============================================
That is the theory, but what tends to happen is that those in power, even though they may have been party stalwarts, never like to relinquish power, and tend to want to pass it on to their heirs. Note what has happened in North Korea.

If the USSR had been run according to this theory, it would not have dissolved. The Chinese are among the most successful Communist countries in the world, but this seems to be due to the uniformity of the population, mostly Han Chinese, and the collectivist nature of Chinese society. The Great Leap Forward and the Cultural Revolution were utter disasters, but the leadership introducing capitalism to sell manufactured goods at bargain rates to the West seems to have been the most successful in the world. The Communist governmnt of China has been better at capitalism than any capitalist or sort of capitalist nation.

I think I would vastly prefer to be a Dane in semi-Socialist Denmark than to be Chinese in the PRC or a Cuban in Cuba. I can't imagine anyone wanting to be a Korean in North Korea.
 
==================================
Sirs thinks his unmentioned anecdotes about the Canadian health care "trump" anything that Tee can present, but this is just in his mind aqnd should not be taken seriously, even by him.

[Michael Tee]

<<News flash Tee, when you're in pain....debilitating, excruciating, dysfunctional pain, you're not looking to exhaust every other lesser tx approach, dragged out insidiously behind the bureacrcy that will decide when that next treatment is going to take place.  >>

News flash for sirs and all the wimps of America - - we don't need a lecture from sirs or anyone else to know that pain is bad.  If that woman really were in "debilitating, excruciating pain" without any alternative remedy, she would have been operated on.  I don't believe a consult or a second opinion on either or both pain management or a reconsideration of the urgency of the case for surgery imposes any undue hardship on the woman and could probably be accomplished in equal or less time than her trip to the States for surgery.

I think, and if you are honest, you will admit, that you were dealing with a highly self-indulgent, me-first type of patient who has the typical personality of a queue-jumper and as long as she has the money in her pocket fits in well with the instant-gratification culture of greed and selfishness that is the United States of America.  In all probability, her pain was manageable pending the operation; if not, there was simply medical incompetence in not recognizing the intractable nature and the severity of the pain and the need for fast-tracking whatever had to be done.

Canada does not hold the monopoly on medical incompetence.  Here as in the U.S.A. and elsewhere, there is, unfortunately, the occasional bad doctor.  We are not about to sacrifice the basic benefit of free health care for each and every citizen regardless of the thickness of his or her wallet, either because one or two wimps can't put up with the inconvenience of getting second opinions or reconsulting their doctors on pain management or because some unfortunate patients encounter poor doctoring from one or two guys who slipped past their medical schools' filters.  The latter circumstances, unfortunately, can occur anywhere and in any system.  Human error is a universal constant.

<<If the Docotor knows, and it can be taken care of, that's it.  This isn't some foreign diplomacy approach, where you exhaust every conceivable lesser option.  >>

Neither is it a "one shot" deer hunt.  Every system, capitalist or communist, has to allow for doctor error in diagnosis and treatment.  I doubt, even in a capitalist system, that an HMO is going to pay for fast-track surgery merely due to unmanageable pain, when the patient's own primary care-giver has not ordered fast-track surgery and when alternative means of pain-control have not been looked into.  This woman got the surgery on HER terms at HER time only because she was wealthy enough to pay for it herself, by-passing not only the English or Canadian system but the HMO system that most Americans have to satisfy.

<<This is also not an advocation that surgery should be the 1st and formost choice.  Only that CHOICE is the key, and in your system, that key is WAY down in the priority box. >>

There was a trade-off.  If the rich could buy their choice of treatment, the non-rich (all the rest of us) would not have the high standard of free medical care we now enjoy.  The system that caters to the rich would absorb a significant portion of our health-care resources.  This was apparent not only from the exhaustive analyses of the Romanow Report but also in actual Ontario experience when our last Conservative government permitted the operation of private, for-profit MRI clinics, allegedly to take the strain off the public system and reduce overall wait times.  Although the operators of the clinics had promised not to hire away technicians from the existing public sector, in actual fact, every single technician in every single private MRI clinic was hired away from the public sector.

I agree with you completely.  Instant gratification and instant satisfaction are preferable to long waiting periods.  But can we afford that and STILL offer free health care to every citizen?  The answer is NO.  So a choice has to be made, and we made ours in favour of all our citizens.  You made yours in favour of the rich.

<<So, for every one of your anecdotal examples to validate Canadien healthcare, I have an equal, if not far more set of examples, that trump yours>>

You may have an equal set but they don't trump mine.  All they prove is either that doctors make mistakes or that people with money can jump to the head of the line.

[crocat]

Michael,

I have to disagree with you in regards to socialized medicine.  My aunt had cataracts and she could only get one eye done at a time.  Nothing to do with the medical procedure - everything to do with scheduling and 'turns.'

When I was a kid, I got to go and have a tooth pulled on socialized medicine.  I came out sans 14 of them.

[Michael Tee]

<<I have to disagree with you in regards to socialized medicine.  My aunt had cataracts and she could only get one eye done at a time.  Nothing to do with the medical procedure - everything to do with scheduling and 'turns.'>>

Well, once again, cro, we come up with some inconvenience to your aunt.  Sure it's bothersome to come back for a repeat if both could be done at once.  Suppose you're in a queue with 2,000 bilateral cataract cases ahead of you.  If you're no. 2,000 in the queue and the doctors do only 4 cases a day, 2 eyes at a time, you'll wait 500 days blind in both eyes till your turn comes up to be cured.  If they do it one eye at a time, say the doctors do 8 cases a day, one eye per patient, and in only 250 days, you'll at least have your sight in one eye. 

If the system had to pay for more eye doctors and operating rooms and equipment so that 200 cases, 2 eyes per patient, could whip through the system, there would be no funding for other treatments or perhaps no coverage for some patients.

The system is not perfect.  It's a compromise.  Your aunt's waiting time was not ideal, but she put up with the inconvenience so that a system which covered the entire population without user fees would be viable.  With your aunt, you saw one facet of the National Health.  Somewhere someone else got treatment that wouldn't otherwise have been available to her, had your aunt been provided with two-eye visits and shorter wait periods.  Think of a system whose primary objective is universal access to good quality health care, not instant gratification of every medical need.

When our kids were small, we had a succession of French Canadian au pairs stay with us to look after the kids in exchange for room and board and the chance to learn or practice their English.  These girls, some of them very attractive, were usually the product of big Catholic families and most of them had had all their teeth already pulled in their early teens to spare the families the cost of dentistry.  It was a shock to us, sure it was sad but we understood the logic behind it.  I don't know if National Health had a policy to yank every kid's teeth to avoid future costs of dentistry, I don't know if your family had to consent, or even whether you just had extraordinarily bad teeth, so I can't really comment on your story.  I assume it was a National Health dentist who removed your teeth, otherwise there would be no point in telling the story.  In Canada, dental is not covered by our universal health care plan (but it should be.)

[crocat]

<<I have to disagree with you in regards to socialized medicine.  My aunt had cataracts and she could only get one eye done at a time.  Nothing to do with the medical procedure - everything to do with scheduling and 'turns.'>>

Well, once again, cro, we come up with some inconvenience to your aunt.  Sure it's bothersome to come back for a repeat if both could be done at once.  Suppose you're in a queue with 2,000 bilateral cataract cases ahead of you.  If you're no. 2,000 in the queue and the doctors do only 4 cases a day, 2 eyes at a time, you'll wait 500 days blind in both eyes till your turn comes up to be cured.  If they do it one eye at a time, say the doctors do 8 cases a day, one eye per patient, and in only 250 days, you'll at least have your sight in one eye. 

If the system had to pay for more eye doctors and operating rooms and equipment so that 200 cases, 2 eyes per patient, could whip through the system, there would be no funding for other treatments or perhaps no coverage for some patients.

The system is not perfect.  It's a compromise.  Your aunt's waiting time was not ideal, but she put up with the inconvenience so that a system which covered the entire population without user fees would be viable.  With your aunt, you saw one facet of the National Health.  Somewhere someone else got treatment that wouldn't otherwise have been available to her, had your aunt been provided with two-eye visits and shorter wait periods.  Think of a system whose primary objective is universal access to good quality health care, not instant gratification of every medical need.

When our kids were small, we had a succession of French Canadian au pairs stay with us to look after the kids in exchange for room and board and the chance to learn or practice their English.  These girls, some of them very attractive, were usually the product of big Catholic families and most of them had had all their teeth already pulled in their early teens to spare the families the cost of dentistry.  It was a shock to us, sure it was sad but we understood the logic behind it.  I don't know if National Health had a policy to yank every kid's teeth to avoid future costs of dentistry, I don't know if your family had to consent, or even whether you just had extraordinarily bad teeth, so I can't really comment on your story.  I assume it was a National Health dentist who removed your teeth, otherwise there would be no point in telling the story.  In Canada, dental is not covered by our universal health care plan (but it should be.)

Michael, I am NOT foisting my Aunt up without reason.   Your argument  is like a poor quality diamond unable to withstand many cuts because it will never shine.   I base my argument on several things.

1.  Cataract surgery takes 15 minutes per eye though the time in the hospital is 4 to 5 hours.  2000 times 4 hours is 8000 hours.  Allowing that the person that is going to occupy 4 hours of hospital time the hours for one eye actually would be 8000 hours but those same 2000 people will be back for another 8000 hours.  Even if you gave the time an extra hour (generous by two) it would only take 10,000 hours versus 16,000 hours.

2.  When we go into the hospital for surgery we subject ourselves to problems with anesthesia, staph infections or incompetence.

3.  The clean up crew will have 37.5% percent more work doing one eye at a time.

4. An O.R. is booked for surgery and it has to be scrubbed and sterile for each patient.   The doctors and nurses have to be scrubbed and sterile.  Even if it only takes 1 hour  for that .... 2 eyes takes 2 hours - 1 eye takes an hour and one half.  If you figure an O.R. is used for 10 hours per day  you can do 5 double eyed surgeries or 6 and 2/3  one eyed surgery were they will be back again .

5. recovery time and inconvenience is doubled.

I don't know.... I think I have made my point here.

I didn't have bad teeth.... I had a butcher.

[Michael Tee]

Look, cro, I wasn't trying to give you any precise estimation of cataract surgery times, I was trying to illustrate a principle with concrete numbers.  If you adjust my numbers to the actual instead of the hypothetical, you will still have an illustration of the principle that I was attempting to articulate.

The point is that if you do one eye at a time, the guys at the end of the queue will have a shorter wait for partial vision to be restored to them, and if you don't, then the guys at the end of the queue will wait longer for just partial vision.

The extra time of the cleaning staff is a total red herring.  Presumably the system operates for the convenience of the patients, not the cleaning staff.  Somebody has totted up the extra costs in cleaners' wages against the wait time of the patients and found a fair balance.

<<When we go into the hospital for surgery we subject ourselves to problems with anesthesia, staph infections or incompetence.>>

Valid point as far as it goes, but the actual rates of infection, anaesthetic problems, human error are probably a lot closer to 1% than they are to 100%, so again it's a slight risk balanced against a perceived gain in wait time for all the patients.  Not a perfect system, but again the best you can get for the money you have to spend on it.  Some inconvenience as you described exactly, but that buys universal coverage.  That's the price of universal coverage.  That's what you have to put up with to be able to afford universal coverage.  Without universal coverage, the horror stories among those without any means of providing for decent health care would dwarf anything you and your aunt have come up with.

<<An O.R. is booked for surgery and it has to be scrubbed and sterile for each patient.   The doctors and nurses have to be scrubbed and sterile.  Even if it only takes 1 hour  for that .... 2 eyes takes 2 hours - 1 eye takes an hour and one half.  If you figure an O.R. is used for 10 hours per day  you can do 5 double eyed surgeries or 6 and 2/3  one eyed surgery were they will be back again.>>

Again, seems like a valid point to me, certainly one that I had not foreseen.  It's too late for me to get involved in the math, I did a graphic representation of the problem and it looks to me like 3 patients a day if both eyes are done and four patients a day if only one eye is done.  So when you're dealing with thousands of patients, there is probably a significant reduction in wait time by doing one eye at a time.  Whether it's worth the negative consequences you've described so well would depend on data we don't have - - the number of extra infections and complications etc.  I expect that in Britain, the boffins wouldn't just blindly pick policies out of a hat, they must have done some kind of study that justifies the course they took.  The English I've met are very fair people and they must have tried to be fair to everyone, your aunt included, and this system probably represents the best they can do for all users of the system, within the limits of the funding they have.

[crocat]

Look, cro, I wasn't trying to give you any precise estimation of cataract surgery times, I was trying to illustrate a principle with concrete numbers.  If you adjust my numbers to the actual instead of the hypothetical, you will still have an illustration of the principle that I was attempting to articulate.

The point is that if you do one eye at a time, the guys at the end of the queue will have a shorter wait for partial vision to be restored to them, and if you don't, then the guys at the end of the queue will wait longer for just partial vision.

The extra time of the cleaning staff is a total red herring.  Presumably the system operates for the convenience of the patients, not the cleaning staff.  Somebody has totted up the extra costs in cleaners' wages against the wait time of the patients and found a fair balance.

<<When we go into the hospital for surgery we subject ourselves to problems with anesthesia, staph infections or incompetence.>>

Valid point as far as it goes, but the actual rates of infection, anaesthetic problems, human error are probably a lot closer to 1% than they are to 100%, so again it's a slight risk balanced against a perceived gain in wait time for all the patients.  Not a perfect system, but again the best you can get for the money you have to spend on it.  Some inconvenience as you described exactly, but that buys universal coverage.  That's the price of universal coverage.  That's what you have to put up with to be able to afford universal coverage.  Without universal coverage, the horror stories among those without any means of providing for decent health care would dwarf anything you and your aunt have come up with.

<<An O.R. is booked for surgery and it has to be scrubbed and sterile for each patient.   The doctors and nurses have to be scrubbed and sterile.  Even if it only takes 1 hour  for that .... 2 eyes takes 2 hours - 1 eye takes an hour and one half.  If you figure an O.R. is used for 10 hours per day  you can do 5 double eyed surgeries or 6 and 2/3  one eyed surgery were they will be back again.>>

Again, seems like a valid point to me, certainly one that I had not foreseen.  It's too late for me to get involved in the math, I did a graphic representation of the problem and it looks to me like 3 patients a day if both eyes are done and four patients a day if only one eye is done.  So when you're dealing with thousands of patients, there is probably a significant reduction in wait time by doing one eye at a time.  Whether it's worth the negative consequences you've described so well would depend on data we don't have - - the number of extra infections and complications etc.  I expect that in Britain, the boffins wouldn't just blindly pick policies out of a hat, they must have done some kind of study that justifies the course they took.  The English I've met are very fair people and they must have tried to be fair to everyone, your aunt included, and this system probably represents the best they can do for all users of the system, within the limits of the funding they have.

o 0 O tries this again...... (posted a reply but not chat worthy and lost it)


Ok….. my point is missed.

Criteria of free healthcare – availability and cost (let’s not pretend that we are really not paying for said healthcare through our tax dollars)

2000 - 1 eye patrons @ 8 per day = 250 days.

2000 – 2 eyed patrons @ 6  2/3 per day = 300 days

even if you figure double surgeon costs, the price of the anesthesia and room would be minimal for the second eye.

Doing one eye versus two is an exorbitant waste of money and the person with 2000 people in front on of him (if they are all two eyed surgeries) is only stall 50 days…. Not 500.

[Michael Tee]

I don't know the reasoning and I don't know all the numbers, but I would assume that the boffins at National Health do.  So when you tell me yourself that the official reason for the "One Eye One Visit" policy is <<Nothing to do with the medical procedure - everything to do with scheduling and 'turns.'>> I have to give it sense in the only way I can figure out - - that the guy at the end of the line waits in total darkness for the longest period in a "Two Eyes One Visit" system and gets at least partial vision faster in a "One Eye One Visit" system.

We're playing with figures that are only rough approximations trying to come up with end-result figures that mean something but in fact the end-result figures we get are useless. 

The only thing I know with absolute certainty is that the closer you are to the end of the line, the longer you wait in total darkness under "Two Eyes One Visit" and the shorter you wait in total darkness under "One Eye One Visit."  Gotta be.

How much time one is spared from waiting in total darkness, we don't know.  Days?  Weeks?  Obviously it depends on data we don't have, including total caseload, total physician hours available for servicing the caseload, etc.  It would not be a simple calculation and it is beyond our abilities at present.

My point is, the system you complain of is not as capricious or arbitrary or silly as you seem to think it is.  There are clearly reasons for it, and there may also be reasons against it.  We just aren't in a position to know.

And there's a larger point as well - - even were the policy you complain of clearly inefficient, oppressive and stupid, it's one factor to consider, along with all the other rules, regulations and practices that may be equally offensive.  BUT all of that, the sum total of NH's inconveniences, has to be balanced against the immense benefit of universal accessibility regardless of means for all citizens.  That is a phenomenal benefit.  Everyone is covered. 

As annoyed as you and your aunt may be over the inconveniences of the National Health, wouldn't it be infinitely worse for your aunt to be out of money and in need of services which would have been provided by the National Health, when the National Health is no longer there for her?

[crocat]

I don't know the reasoning and I don't know all the numbers, but I would assume that the boffins at National Health do.  So when you tell me yourself that the official reason for the "One Eye One Visit" policy is <<Nothing to do with the medical procedure - everything to do with scheduling and 'turns.'>> I have to give it sense in the only way I can figure out - - that the guy at the end of the line waits in total darkness for the longest period in a "Two Eyes One Visit" system and gets at least partial vision faster in a "One Eye One Visit" system.

We're playing with figures that are only rough approximations trying to come up with end-result figures that mean something but in fact the end-result figures we get are useless. 

The only thing I know with absolute certainty is that the closer you are to the end of the line, the longer you wait in total darkness under "Two Eyes One Visit" and the shorter you wait in total darkness under "One Eye One Visit."  Gotta be.

How much time one is spared from waiting in total darkness, we don't know.  Days?  Weeks?  Obviously it depends on data we don't have, including total caseload, total physician hours available for servicing the caseload, etc.  It would not be a simple calculation and it is beyond our abilities at present.

My point is, the system you complain of is not as capricious or arbitrary or silly as you seem to think it is.  There are clearly reasons for it, and there may also be reasons against it.  We just aren't in a position to know.

And there's a larger point as well - - even were the policy you complain of clearly inefficient, oppressive and stupid, it's one factor to consider, along with all the other rules, regulations and practices that may be equally offensive.  BUT all of that, the sum total of NH's inconveniences, has to be balanced against the immense benefit of universal accessibility regardless of means for all citizens.  That is a phenomenal benefit.  Everyone is covered. 

As annoyed as you and your aunt may be over the inconveniences of the National Health, wouldn't it be infinitely worse for your aunt to be out of money and in need of services which would have been provided by the National Health, when the National Health is no longer there for her?

I am not annoyed and my Aunt only told us that she was having one eye done and then the other in ten months.  You keep trying make this a personal dislike it is not.  It is simply that I don't think that government health is a good thing period.  Regarding the numbers those were your numbers that you put up and you claimed 500 and I am telling you that based on the surgery is 50.   Wasting money is never a good thing no matter whose money it is.  The surgery takes 30 minutes and the prep time is between 3 1/2 and 4 1/2 hours.

I think that in this instance we have found our complete opposite foundations and why I will never be a liberal.

[Michael Tee]

<<Regarding the numbers those were your numbers that you put up and you claimed 500 and I am telling you that based on the surgery is 50.   Wasting money is never a good thing no matter whose money it is.  The surgery takes 30 minutes and the prep time is between 3 1/2 and 4 1/2 hours.>>

Did you not understand those were hypothetical numbers meant only to illustrate a point?  That I could have picked any other set of numbers and still illustrated the same point with them? 

The point was that the guys at the end of the line get partial vision restored earlier with a one-eye visit than a two-eye visit.  And that point is established no matter WHAT number I use for the time of a single operation as long as it's recognized that two eyes take longer than one.

Similarly whether you are annoyed at the system is not the point - - you obviously had some criticism to make, and the issue is the validity of the criticism, not whether or not you were annoyed at the system.

<<Wasting money is never a good thing no matter whose money it is.>>

The extra costs incurred were incurred in the interests of fairness, to shorten the waiting period for the guys at the end of  the line, who could enjoy at least partial vision earlier than if both eyes were done at once.  Money spent on fairness is not wasted - - just ask the guy at the end of the line about that.

[Xavier_Onassis]

I don't think this is about liberalism or conservatism.

Different people react to laser surgery in different ways. If this person's eyes were to react in an extremely negative way, she could be left blind by two-eye surgery. No treatment is or ever will be 100% effective, and a good doctor allows for the odd contingency. In any event, in Canada, she got the work done eventually, and it was affordable. In the US it is unaffordable for many, many people.

There may be reasons for not being a "liberal", but I fail to see how the results here would be one of them.

[Michael Tee]

That is an excellent point.  One eye at a time in case the procedure is not tolerated well by the patient.  That in itself justifies the wait.