Sunday, February 25, 2007

So you think you want Universal Healthcare?

While the United States lurches towards some kind of Universal Healthcare plan, the alternative is not always palatable.

From Britain's Telegraph Daily
A NHS surgeon today exposed how cash-strapped hospitals were being barred from operating on cancer patients who had not waited long enough.

Wayne Jaffe laid the blame for the appalling state of affairs at the feet of Tony Blair, with his vision of reduced waiting times and 24-hour surgery. In a withering assessment of the financial management of the health service, Mr Jaffe said that doctors were being restricted in getting waiting lists down by financial limitations and ever-changing targets.

The consultant plastic and reconstructive surgeon, who specialises in skin cancer and breast reconstruction, said he and his colleagues are being prohibited from operating in non-urgent cases
unless the patient has been waiting for a minimum of 20 weeks.


Anonymous said...

Those of us who have gone without health insurance WANT and NEED universal health coverage. Perhaps you missed the word non-urgent in the blurb you posted. I'm sorry you're not earning the income you think you deserve but universal health coverage will come to the U.S.. You can't stop it.

Dr. Rob Oliver said...

I think you misunderstand the gist. Touched on briefly in the linked article & in a number of other recent articles from the UK & Canada are the consequences of these wait lists in "non-urgent" oncology patients. Namely, a number of tumors are being reported progressing during these increasingly common wait lists to advanced or incurable stages.

While everyone agrees in principal with the goal of universal coverage, the series of tough choices involved is at odds with the American expectations from the long-ago "fee for service" era of American Medicine from the 1940's until the late 1980's when the corporate HMO movement strip-mined the money out of health care.

We're going to end up with (I think) some 3 tiered system of "universal" health coverage equivalent to Medicaid (for the poor), Medicare (the baseline coverage for most people), & a thriving supplemantary insurance industry for those who can afford it and wish to avoid aformentioned wait-lists and the like.

DrDiSaia said...

Anonymous seems to believe as many Americans believe that it is somehow the government's duty to provide health coverage. The government made the mistake of entering health care some thirty years ago with Medicare and look at the result: increased costs for less health care. The only ones making money in insurance medicine in the Untied States today are the insurance companies. And the "common man/woman" believes the greedy doctor is standing in the way. If your health care can’t at least be rendered at a small profit, who do you think will provide it?

As plastic surgeons, we have cosmetic surgery to subsidize our practices but other specialists do not. When I care for a cancer patient it is because I did that cosmetic case yesterday. In this sense, insurance medicine is my hobby. Cosmetic surgery makes me my living.

I believe that when universal health care comes, the people crying for it will be unhappy with that for which they have waited...a long wait for a band aid.

Dr. Rob Oliver said...

I agree. People have a lot of misconceptions about healthcare and a physcians' role in the cost of it. Doctors' salaries are not what drive the cost of healthcare. In fact (as you know) our reimbursement has fallen by as much as 80% for many procedures since the late 1980's as it was the "low lying" fruit for cost-containment in the HMO movement 20 years ago.

Anonymous said...

How do you explain the better health outcomes and less spending per capita in other countries as compared to the U.S.?

Dr. Rob Oliver said...

I think you misunderstand the weakness & strengths of our system versus a system like Canada. We spend a tremendous amount of money on care in areas that other countries refuse to due to budget concerns (eg. tranplantation, renal dialysis, end of life care). However, try explaining actuarial data rationales for limiting care on some elderly patients and watch the AARP go ballistic.

Other nations provide better baseline care and run rings around us in terms of medical records and the efficiency of coordinating care. However when you look at some tertiary outcomes like survival rates from certain cancers, we blow them away because access to subspecialty oncology treatment is much better here then where it is heavily rationed.

For better or worse, Americans have expectations that will not be met with what is provided by many nations health systems. The example used in this post (skin cancer treatments) was merely to demonstrate the fact that there are compromises with these choices we're going to be making

Anonymous said...

Right, Canada is a good case and point - they spend about half per capita on health care and get better outcomes. U.S. surgeons spend too much time with active intervention approaches (
instead of choosing medication which are cheaper and work just as well (according to this study for a particular problem).

Dr. Rob Oliver said...


food for though for you about how compatiative western health systems do with tertiary care outcome data.

Using the North American Association of Central Cancer Registries data, regional comparisons between the United States and Canada revealed worse outcomes for breast, prostate, colon, and other cancers in the Canadian system. In addition, the group noted that in some provinces Canadians can wait up to 10 weeks longer than they would in the United States for radiation therapy.

A few years ago data was also reported that suggested 6 in 10 British women diagnosed with breast cancer would be alive after 5 years, compared to nearly 8 in 10 in the United States and that only 15 to 30 percent of British patients with small-cell lung cancer will survive for two years, compared with 40 to 50 percent in the US.

The point being, that we will be giving something up for what we gain by adopting the rationing mandatory in universal health coverage. Is that a price we'll accept? We'll see.