Windsor Star: Threat across border our Achilles heel in pandemic

[davewindsor]

Cheapskate should have spent a few bucks for a Nexus card.

She couldn't get a Nexus card because from the article, "According to court records, in 2007, she was cited by CBP for possessing 5.8 grams of marijuana at the border."

I have a Nexus card and know many others from the yacht club who have one and border guards. Any issues with the CBP, even forgetting to declare a $5 knick knack from Walmart at the border and getting caught, forget it, you'll never get a Nexus card again.

[Wesley Mouch]

So why do Canadians have longer life expectancy [by over three years] and lower infant mortality rates than the US?
...

Single stats like this mislead, I believe. Yes, Canadians have longer life expectancy. There's a non-medical reason for this. Lies in demographics and accident rates. I've seen stats that say if you make it to 40, your Life Expectancy is about the same. But that's just my hand-selected stat to refute your point. Truth is that there are differences between the two systems.

Canada values centralized control. In many provinces, a doctor can't open a clinic and bill someone for a service. The province has monopoly on billing. So when I get a colonoscopy in the States, I wait 4 days and get excellent care in an outpatient setting in and out in an hour. Meanwhile my relatives in British Columbia wait 5 months for an appointment, and get treated in an expensive hospital environment where it took half a day and a trip into town to where the province runs their colonoscopy department. One isn't necessary better than the other at care, but they are different.

The posters comment was that Windsor nurses have great options. Ontario provincial medical care, but when they need private care they can take their much higher US nurse wages and buy it -- an option not so available to most Canadians.

How many Canadians have been bankrupted by medical bills vs. the US?

No argument from me here. The US medical billing world is a complete steaming mess. Needs to be fixed, mostly be eliminating the tax deductions for health insurance and what President Trump tried to do with requiring fee disclosure [[that was struck down by the courts in their lust to get Trump more than concern for citizenry.)

btw, AFAIK, there's little/no pharmacy coverage in Canada [[except seniors and illegals? and in-hospital care). So death by inability to afford your meds is possible in Canada, AFAIK.

[401don]

So when I get a colonoscopy in the States, I wait 4 days and get excellent care in an outpatient setting in and out in an hour. Meanwhile my relatives in British Columbia wait 5 months for an appointment, and get treated in an expensive hospital environment where it took half a day and a trip into town to where the province runs their colonoscopy department. One isn't necessary better than the other at care, but they are different.

I'm shocked to hear this in British Columbia. Here in Ontario I have several private clinics to choose from within a couple miles of my house for a colonoscopy. I had the same one week appt. and excellent care.

[Don K]

I doubt I could get an appointment with my PCP in under four days. Any procedure? There never seem to be appointments available less than two months in the future. I suppose if i had Bill Gates' [[or even Jimmy Kimmel's) money, and was able to pay list price out of my pocket, I could get in right away, but that's not for us mere mortals [[kind of like Republican tax cuts - they're only for people whose AGI includes the word "million").

Forget Canada for a minute - life expectancy in the U.S. is the lowest in the entire developed world. Now I'll grant some of this is because of our wide-open spaces, where the nearest hospital might be two hours away, but still, we [[either directly or through lower salaries and wages) pay huge amounts for health care that's not all that great. The best U.S. hospitals are among the best in the world, but on the whole the U.S. healthcare system is at best mediocre.

[CassTechGrad]

“Smoking weed and coronavirus: Even occasional use raises risk of Covid-19 complications
By Sandee LaMotte, CNN
Updated 8:22 AM ET, Fri April 10, 2020”

“If you're smoking weed to ease your stress during the coronavirus pandemic, experts say it's time to think twice.
“Smoking marijuana, even occasionally, can increase your risk for more severe complications from Covid-19, the disease caused by the novel coronavirus.”

How many hospital beds are being occupied by otherwise healthy patients who contracted the virus because of their marijuana addiction??

[401don]

“Smoking weed and coronavirus: Even occasional use raises risk of Covid-19 complications
By Sandee LaMotte, CNN
Updated 8:22 AM ET, Fri April 10, 2020”

“If you're smoking weed to ease your stress during the coronavirus pandemic, experts say it's time to think twice.
“Smoking marijuana, even occasionally, can increase your risk for more severe complications from Covid-19, the disease caused by the novel coronavirus.”

How many hospital beds are being occupied by otherwise healthy patients who contracted the virus because of their marijuana addiction??

I would also love to know the percentage of people over/under age 60 who end up on ventilators/die that are smokers. My sister and brother-in-law are both smokers over 60 and don't think their immune systems are much different than non-smokers.

[Lowell]

Regarding Canadian health care what this pandemic exposes in glaring contrast is the failure of the American Lose-your-job-Lose-your-healthcare system.

Forget Covid19 for a minute and think about millions who have suddenly lost their jobs and coverage [on top of the 27 million+ already uncovered].

What happens to them if they have a heart attack, or just a broken arm, or an EMS-delivered emergency room visit that easily top $10,000?

With 40% of America said to be in crisis if they get bill over $500 the result will be a flood of bankruptcies.

On the other hand are the many who do not seek healthcare out of fear of costs allowing preventive illnesses to grow to more expensive ones, or worse yet avoidable fatalities. Hence our abysmal outcomes in spite spending nearly twice or more than advanced nations with national healthcare for all.

The chief whine I hear about Canadian health care is how people have to wait in line for procedures.

Well guess what? At least there is a line--always a line whether you lose your job or not. Here there is none.

[401don]

Regarding Canadian health care what this pandemic exposes in glaring contrast is the failure of the American Lose-your-job-Lose-your-healthcare system.

Forget Covid19 for a minute and think about millions who have suddenly lost their jobs and coverage [on top of the 27 million+ already uncovered].

What happens to them if they have a heart attack, or just a broken arm, or an EMS-delivered emergency room visit that easily top $10,000?

With 40% of America said to be in crisis if they get bill over $500 the result will be a flood of bankruptcies.

On the other hand are the many who do not seek healthcare out of fear of costs allowing preventive illnesses to grow to more expensive ones, or worse yet avoidable fatalities. Hence our abysmal outcomes in spite spending nearly twice or more than advanced nations with national healthcare for all.

The chief whine I hear about Canadian health care is how people have to wait in line for procedures.

Well guess what? At least there is a line--always a line whether you lose your job or not. Here there is none.

I hear that too Lowell when I talk with people when I visit Florida. You really only wait for minor procedures. In the past 10 years I've had a heart attack and my wife had an aneurysm just behind her eye. I was rushed to the hospital, stent placed and no damage. My wife had 3 surgeries and is fine. They even flew a new non-FDA approved stent [[the stent itself was 40K) in from California along with a surgeon from the U.S. manufacturer to observe her procedure. We never waited an extra minute.
Now for my sore tennis elbow I waited about 6 months to see an orthopedic surgeon but eventually it got fixed. It's so funny these guys in Florida I play tennis with saying "I don't know how you can live with that socialized medicine." I try to explain that the U.S. is pretty much the only country in the world without it but to no avail.
One other thing, part of the reason we wait to see specialists is because so many have gone to the U.S. for the higher pay. If the U.S. had gov't healthcare probably the pay would level somewhat and fewer Canadians would leave.

[Richard]

That is a state by state decision,every year the federal government allocates billions of dollars in healthcare funds for the state oriented healthcare options.

Many states do have an income based healthcare option,both in state and county based clinics and Medicaid plans.

ninsured immigrants who are unauthorized likely receive about $4.6 billion in health services paid for by federal taxes, $2.8 billion in health services financed by state and local taxpayers, another $3.0 bankrolled through “cost-shifting” i.e., higher payments by insured patients to cover hospital uncompensated care losses, and roughly $1.5 billion in physician charity care.

[Wheels]

Ok, I've had enough of this misinformed bullshit.

Go have a look at the Newsweek list of the best hospitals in the world........several are in Ontario,

3 in the top 30 in the world; only 1 from Michigan.

Toronto General #4 in the world.......

U. Mich, Ann-Arbor #15

Ok I can tell you I am not misinformed or bullshitting! I spent nearly a year in and out of Henry Ford hospital and I know at least 30 nurses from Windsor. I have heard many stories of the struggle to get basic medical service in Windsor!

[Canadian Visitor]

Ok I can tell you I am not misinformed or bullshitting! I spent nearly a year in and out of Henry Ford hospital and I know at least 30 nurses from Windsor. I have heard many stories of the struggle to get basic medical service in Windsor!

That is called an 'anecdote'.

You could, instead, consult this site, which shows the waits times for most procedures, at hospitals throughout Ontario.

https://www.hqontario.ca/System-Perf...and-Procedures

You search by procedure type; then you can filter for priority level and by hospital or City.

Priority levels are 1,2,3 and 4.

One is generally not shown, as that typically means emergent, level 2 is just below that, 3 is urgent and 4 is non-urgent.

You'll see a fairly wide range of procedures available in Windsor, and most have reasonable wait times. Some could certainly be shorter, particularly for level 4 patients [[non-urgent).

But in the Ontario system, nothing prevents you from getting a referral to any doctor in Ontario, choosing your own family physician or accessing a walk-in clinic; or going out of town to a different hospital.

Though high-demand hospitals may decline a referral if they feel that a patient could be better served elsewhere. [[non-emergent, obviously)

[Canadian Visitor]

It is certainly true, in the U.S. that if you have money and/or connections and you're willing and able to travel, that you can get non-urgent care more quickly.

But that is offset by all those who lack money, connections, and ability to travel getting stuck w/whatever care they can afford or their insurance will cover; which is often no more timely than what you'd see in Canada; and sometimes, you just don't get care at all.

[softailrider]

I spend a lot of time with Canadians when I’m in Florida. Heath care is a big topic of conversation. Most are from Toronto or close by, in Pompano Beach there is also a huge amount of people from Montreal, some are from Winnipeg. Most are satisfied or very satisfied with their heath care coverage. Also I would like to point out most seem to harbor some resentment towards Americans. It’s underneath the surface, but it’s definitely there.

[Richard]

^ I do not notice resentment,more so a sense of entitlement and feeling of superiority,the resentment probably comes from the unwillingness of others to bow in their presence.

The ones that filter down that are not from the major cities are pretty cool though and actually know how to drive fast in the fast lane.

Its really no different then in the states.

The US is considered a leader in acute care.

[Lowell]

^A leader in acute care--if you can get it and if you can get it without being bankrupted because your coverage got dropped.

The American health care system is an over-priced embarrassment.

If Canada's health care system is so terrible why is there no major party calling for its abolition? Any politician who did would be kicked so hard out of office he wouldn't know what hit him.

Ditto for any American politician who tried to abolish Medicare.

[Richard]

Canada’s largest province is projected to see health-care costs soar to the point where they will consume 80 percent of the entire provincial budget by 2030, up from 46 percent in 2010.

https://www.nationalreview.com/2017/...utionary-tale/

the question remains,how sustainable is it and the provinces that see a reduction in tax revenue with job loss,who makes up the difference?

[Canadian Visitor]

Canada’s largest province is projected to see health-care costs soar to the point where they will consume 80 percent of the entire provincial budget by 2030, up from 46 percent in 2010.

https://www.nationalreview.com/2017/...utionary-tale/

the question remains,how sustainable is it and the provinces that see a reduction in tax revenue with job loss,who makes up the difference?

That simply is not happening, will not happen, there is no evidence to support that, period full-stop.

The TD report, which is from 2010, assumed increases in costs that have never materialized.

Appropriate actions were taken to restrain cost growth, which has generally been held to under 3% per year.

[Canadian Visitor]

I spend a lot of time with Canadians when I’m in Florida. Heath care is a big topic of conversation. Most are from Toronto or close by, in Pompano Beach there is also a huge amount of people from Montreal, some are from Winnipeg. Most are satisfied or very satisfied with their heath care coverage. Also I would like to point out most seem to harbor some resentment towards Americans. It’s underneath the surface, but it’s definitely there.

On healthcare; satisfaction will obviously vary with experience.

Money still matters too.

Generally speaking government healthcare [[which varies by province) covers almost all hospital-based services, and most outpatient prescriptions for seniors, or those on social assistance.

But generally omits most dental care, most prescriptions for working age adults, most physiotherapy and most non-emergent mental healthcare.

So there are gaps here and there.

Wait times are mostly reasonable but vary by province and procedure and one can always find some unacceptable waits for non-emergent care.

But overall, healthcare related debt is not a thing in Canada and no one fails to see a doctor or get a required surgery or chemo etc. for lack of funds/coverage/debt worries.

******

On resentment.

Obviously individual Canadians as with Americans will vary.

But overall, I wouldn't say Canadians resent Americans.

I would say its quite common to express disbelief at the election of Trump; the lack of a proper system of health insurance in the U.S. or proper gun control.

People respect its another country, and you can all make your own choices; but that doesn't mean we can rationally understand those choices.

I would add, that American exceptionalism does provoke a negative response in Canadians.

This often seems to surprise my American friends.

Let me offer, if you went to another country and were constantly told how awesome it was, how much better it was than the U.S. even in ways you knew weren't true............how would you feel about that?

That's exactly how Canadians feel when they hear [[some) Americans put down Canada or any other country.

With great respect, The U.S. is in many ways a very awesome country with some very bright and wonderful people, and many great achievements and beautiful spots.

But it certainly isn't the best at everything.

[Richard]

That simply is not happening, will not happen, there is no evidence to support that, period full-stop.

The TD report, which is from 2010, assumed increases in costs that have never materialized.

Appropriate actions were taken to restrain cost growth, which has generally been held to under 3% per year.

So are you saying that the media printed false information,or TD is considered a sketchy institution when it comes to financial reports?

They are after all a numbers crunching institution and not assumptions..

I knew it was from 2010,I left the door open for you to post the 2019 numbers that show the difference in the 9 years.

How exactly do you restrain cost growth?

If you have X amount of people putting into a system and have a drop off of those who cannot afford through job loss or bad economy and the ratio of those putting into the system is greater then those unable to.

The cities here that tried to implement their form of “socialized”
health care with hospitals ended up collapsing.

Charity hospital in New Orleans,closed and never re-opened,the hospital in Queens that recently became an epicenter because of restrained cost growth.

The UKs system operates on a fine line and is over 40 full hospitals short of being able to serve the needs,it does not take much to overwhelm the system.

I agree that the cost per person is cheaper in Canada but it is catching up pretty fast.

When that hospital receives the notice that it is nearing the line of funding and needs to reduce services,while retaining the same level of care for the same level of those needing that care.

Keystone pipe line is shelved
The oil sands fields are devastated by the drop in prices and higher cost to transport the product.
Auto factory’s are closing

That equals billions in revenue loss along with 10s of thousands more entering into the non paid sector that are still going to need the same amount of care.

How do they cut costs?

I know the answer and you sugar coated it by posting

Appropriate actions are being taken to restrain cost growth.

You cannot change the fixed infrastructure costs you can only alter the number of non fixed costs by limiting services.

Which brings us back to the theory of the age group of 15 to 50 are considered worth investing more health care into verses the age group 51 to 100 because they are no longer considered that productive to society as an investment.

But yes you can call it,appropriate actions being taken to restrain cost growth.

[Gistok]

Richard... certainly you have heard of Americans in border states going to Canada to get prescriptions refilled [[at least before the pandemic). They seem to have better controls on cost increases than Americans can get [[our pharma lobbyists see to that).

[Canadian Visitor]

So are you saying that the media printed false information,or TD is considered a sketchy institution when it comes to financial reports?

No, TD is fine.

They had an agenda; to scare politicians in to addressing healthcare costs that were rising faster than inflation, around 6% per year back then.

They took those numbers, assumed they would never come down, that with an aging population they would in fact rise, and they assumed no productivity gains, no innovations, no wage restraint and relatively low government revenue growth, which was easy to do having just come out of the 2008-09 financial crisis.

They got what they wanted, government acted. The story changed.

Nothing more, nothing less.

How exactly do you restrain cost growth?

The first thing you do is restrain wage growth, and discretionary hospital spending [[non-medical).

Hospital executive compensation was capped, a tighter lid was kept on capital projects, and a harder line taken in billing fee negotiations with doctors.

The second thing you do is review structural costs...........so you change the way you calculate a fair price when granting a patent for a prescription drug.

Previously, Canada had a formula that considered the average price of several other countries for prescriptions.

That group included the U.S. which is a high-price outlier. The decision was made to eliminate the U.S. from the reference price group, lowering the cost for a new drug.

Also decided was that the provinces would negotiate with drug companies together, instead of one by by one.

So all ten provinces started using their combined buying power to drive down the cost of commonly used drugs.

Third, you evaluate whether there are cheaper ways to do things.

There was innovation in several areas, notably, flu shots and some vaccinations can now be delivered by pharmacists instead of doctors.

Midwives can now deliver [[if a woman wishes it) a low-risk birth instead of a doctor.

We also merged several hospitals together to slim administrative costs.

There was a move to evaluate whether some patients could recover from certain surgeries at home sooner, if given the right support.

Money was spent to send a nurse to someone's house 1-2x daily, to loan out equipment that could monitor vitals to patients and to have virtual check-ins with doctors.

That allowed some patients to go home 1-3 days sooner after a procedure; and the system spends $200 a day keeping them home, instead of a $1,100 a day in an acute care hospital.

I'll now ignore the rest of your incoherent rant.

[Wheels]

When that hospital receives the notice that it is nearing the line of funding and needs to reduce services,while retaining the same level of care for the same level of those needing that care.

Are you serious? They just slip into discount mode with no reduction in service. We need to apply that to all services!

[Canadian Visitor]

When that hospital receives the notice that it is nearing the line of funding and needs to reduce services,while retaining the same level of care for the same level of those needing that care.

Are you serious? They just slip into discount mode with no reduction in service. We need to apply that to all services!

How it actually works.........

Hospitals in Ontario are independently run.

Their budgets are composed in several different ways.

Revenues come from - Base Allocation

This is the number the government notifies hospitals they have ahead of the fiscal year to cover, core, fixed-costs.

So routine building maintenance, janitorial, the lab, the c-suite/admin. etc.

As well as performance spend, this may apply to certain elective procedures, so, for instance a hospital in a small rural area, may have dedicated funds to staff their MRI 40 hours per week.

There is always someone in the hospital [[X-ray tech) who can run it for the E.R.; but the appointments would be limited to the agreed hours.

The next layer of funding is the funding that covers all other medical services.

Here the government is simply the insurer, and directly pays fee-for-service for all medically necessary care, period.

Third, the hospital will have non-government revenues, including retail [[many hospitals have stores and a food court in them), as well as parking revenues, and ancillary services, such as TV and Phone. They are also free to and do sell services into the international market, several countries pay our top hospitals to act as consultants designing their new hospitals, that is done for profit.

Fourth, they fundraise, every hospital is a registered charity and takes donations, runs lotteries and the like.

Finally, while hospitals are strongly discouraged from running deficits, they are in fact able to do so.

So hospitals which do run into an unexpected hiccup near fiscal year end do not stop providing care, they file a request for more funds from government, and if necessary, bridge that with debt.

Medical care decisions for priority 1, 2 or 3 patients [[anyone deemed urgent) is not deferred for money, ever. Some minor waits may occur for structural reasons from time to time.

Priority 4 patients still are never 'delayed' to save money, rather general fiscal restraint may mean that if there's no compelling reason you need that knee-surgery right this moment, then you may wait a bit longer.

But no doctor is laid off, and no one specifically delays a particular patient, rather what may happen is that additional O/R time isn't approved [[beyond base levels), or the overtime budget for elective procedures gets capped, and that may mean fewer slots for that surgery. Since all patients are triaged, lower-priority patients may find the wait a bit longer.

[Canadian Visitor]

It occurs to me you might actually want to see what a real hospital system budget looks like.

So I'll post the simplified one for UHN. That's the University Health Network, affliated with the University of Toronto, and includes Toronto General Hospital among many others.




You'll notice that revenue from government is only slightly over 1/2 of the overall budget.

Also, the hospital ran a surplus of 16M for the year.

[Wesley Mouch]

...snip...
Forget Canada for a minute - life expectancy in the U.S. is the lowest in the entire developed world. Now I'll grant some of this is because of our wide-open spaces, where the nearest hospital might be two hours away, but still, we [[either directly or through lower salaries and wages) pay huge amounts for health care that's not all that great. The best U.S. hospitals are among the best in the world, but on the whole the U.S. healthcare system is at best mediocre.

I'm not expert here, but I understand three things:

1) Our life expectancy stats are significantly lowered by our inclusion of most to all infant deaths -- where much of the rest of the world does not count most infant deaths.

2) Our stats for life expectancy once you are adult are comparable to the developed world.

3) The 'life expectancy' stat is a war horse trotted out to argue that our healthcare is substandard. Yes, the financial part of our healthcare is a 'hot mess'. But the actual healthcare is excellent by international developed-world standards.

These are just my prejudices, based on what I've heard. If you listen only to CNN or Fox News -- you may have a different impression. I'm open to hearing from someone better informed than I am.