Of course, a really easy solution is to require non-profits to have a clinic where they will see all patients, and then make sure there’s a non-profit within 20 miles of every citizen.

As to waiting times. People complain about the waiting times in Canada, then say that’s what would happen here if everyone had health coverage.

What they’re really saying is they think people without health insurance shouldn’t be able to get medical care. Even if the reason the person doesn’t have health insurance is because the employer doesn’t pay for it, and even if their own employer pays theirs.

My mother-in-law went for colonoscopy on a Friday morning, they found cancer, gave her a cat scan and two blood transfusions, had surgery by noon the next day, and also removed a hernia.

My Dad had leukemia, had my aunt in the UK tested, discovered she had a blood disorder, found a match in germany, flew the bone marrow stem cells over, and cured my Dad. Sure, he has ongoing issues (it’s been 5 years) but he is alive.

Never saw a bill, have no clue on the cost for either of these.

Just two of many shining examples of what the Ontario Health Insurance Plan health care can do.

As a side note, I broke my hand early in the year, waited two hours in emergency (they were busy) and my issue was less severe than some of the later arrivals who (rightly) were looke at first.

In a nutshell, the one feasible way to achieve significant savings in medical care in the US I can think of is to create a separate group of practioners with less strict licensing requirements who get to specialize in the most common aspects of a general doctors or surgeons work: hand out antibiotics and painkillers, fix major fractures and suture/bandage flesh wounds, forward to more specialized care if the patient is showing no improvement or the symptoms are outside of typical bounds.

Swamp the market with cheap and plentiful specialists who routinely take care of the 80% cases, idemnify them against anything but criminal charges in cases of death and dismemberment (we’ve got great insurance to take care of personal health and disability claims) and you’ll have both higher availability and lower cost.

Yes, there’s going to be the occasional case of something complex being misdiagnosed as a common disease, but I’d bet we’d not see much higher percentages of that are happening now already, and the higher availability of care might offset that entirely.

As a privately practicing practicioner of that sort, I might even chose not to elect the hospital that just added a $50M ward and a $800M administrative wing with marble offices but a smaller facility that meets my needs.

It’s likely that you could replace 90% of the work of today’s practicioners with a simple computerized decision tree (with a few nodes reading ‘go fetch a specialist’) and a nurse.

Medicare is a lost cause because the ratio of sick to healthy is high. IMO, the quickest way to change that is to bring more healthy people into the pool at the expense of quality. I would and have paid for my dad’s health but I don’t want to pay for yours.

The one time I drove myself to an ER in Seattle, I had to make a detour to a private parking lot because the hospitals lot was closed due to construction, walk 5 minutes back to the ER, got my blood pressure taken by a nurse, sat in the waiting room with 3 other people from 10PM until 4AM, all the time doubled over with pain, saw a doctor at 4, got some painkillers, went into surgery at 11AM the next day. I had to wonder if someone in Administration had pointed out that burst appendices can generate an order of magnitude more income than an ordinary appendectomy.

I saw the bills to my insurance in all cases; cost of care was 3600 and 1200 Euro for the procedures in Germany and 46000 USD for the appendicitis in the US. Off the net and for a more current comparison, the maximum cost for an appendectomy in Germany was up to 2740 Euro in 2005 (state run system with a master list for max cost). Germans tend to complain a lot about the unreasonably high cost of these procedures, so clearly nobody is ever real happy with the cost of healthcare, but there’s a marked difference here.

While in my case, both quality and cost of care were atrocious compared in the US compared to a European socialized system, I realize that it’s a rather small sample base.

My personal impression derived from these and many Dr visits is that the US healthcare system is neither particularly great on waiting times, quality of care, efficiency or cost of care. I’d be interested in opinions about why that is – how do the costs typically break down on the hospitals side?

My layman view of things is that I believe that emergency care represents a problem where the typical interplay of market forces is concerned – by the time a patient has made it to an ER, their bargaining power is rather limited (“Ha – you want to charge me what? I’ll take my broken leg to a hospital in Florida instead unless you give me at least a 10% discount” (limps out)). There is no backpressure in the system – the parties in the system administer cost based on standard rates and don’t mind those creeping higher because the cost is passed on.

Why these two figures are different is partly explained on page 7 of the Canada report:

acceptable length of stay. For example a higher acuity patient i.e. multiple injury car accident may be seen quicker but ultimately is waiting longer to get into an inpatient bed in the hospital. These higher acuity patients usually require a barrage of medical interventions to stabilize them before they are
admitted to an inpatient bed (that has to be available or
found) in the hospital, which is when their measured wait stops. This is why the maximum length of stay is longer for higher acuity patients.

In short, I believe the four hour figure includes all the chronic back pain patients who are sent home immediately, while the 24 hour figure includes only the very severe cases who are actually admitted into an inpatient bed.

I have been to the ER twice for stitches. My wait time was about six hours and three hours, but I was never admitted into the hospital. So I would count in the Press Ganey average, but not the Canadian average.

I do favor letting in many more qualified physicians. England, Canada, Germany, France, Spain, Italy, Israel, Australia, and a few other countries have equivalent medical training. Most US clinicians work 60-80 hours a week, and many of them won’t mind losing some patients (to immigrant MDs) and gaining some free time.

If an ER’s patient mix is mostly nonsense such as chronic back pain plus minor trauma and minor illnesses, then wait times can be long without endangering patients. However, if the mix of illnesses and injuries is more severe, then long wait times definitely endanger patients.

The problem in both Canada and the USA is that hospital ERs are being used for routine care instead of true emergencies. There are a handful of ‘urgicare’ centers that try to fill this need, but government and private health insurers many not reimburse for getting ‘urgicare.’ ER visits always are covered, even when they were not needed.