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Health Canada -- It's Health USA If You Can Afford It
A Canadian MP with breast cancer seeks treatment in the US says a CTV story:

Liberal MP Belinda Stronach, who is battling breast cancer, travelled to California last June for an operation that was recommended as part of her treatment, says a report.

Stronach's spokesman, Greg MacEachern, told the Toronto Star that the MP for Newmarket-Aurora had a "later-stage" operation in the U.S. after a Toronto doctor referred her.

"Belinda had one of her later-stage operations in California, after referral from her personal physicians in Toronto. Prior to this, Belinda had surgery and treatment in Toronto, and continues to receive follow-up treatment there," said MacEachern.

He said speed was not the reason why she went to California.

Instead, MacEachern said the decision was made because the U.S. hospital was the best place to have it done due to the type of surgery required.

Stronach was diagnosed last spring with ductal carcinoma in situ (DCIS). The cancer is one of the more treatable forms but Stronach still required a mastectomy -- which was done in Toronto -- and breast reconstruction.

Stronach, who announced last April she would be leaving politics before the next election, paid for the surgery in the U.S., reports the Star.

A commenter on the story writes of the difference in simple breast cancer detection measures:

Kim While living in the USA several years ago I found a lump in my breast. I went to the doctor the next day, she had me in for a ultrasound and mam the very next day. We are now living in Canada again, this time my doctor here found a lump, she sent me to a specialist ( 10 1/2 weeks it took), still haven't had a mam. This Canadian system is scary, and needs to be fixed! I too if I had the money would seek treatment in the USA.

From an editorial in the Harrisburg, VA, Rocktown Weekly

What would you think of a person who, say, continually and effusively praised the Sundown Medical Clinic but, when he or she was ill, hastened to the Sunrise Treatment Center?

Would this raise questions as to the person’s integrity, as well as the quality of the Sundown Clinic?

Canadian Liberal MP Belinda Stronach is a strong supporter of the national health care service of that nation. The Canada Health Act mandates that no one should pay for a health service if others get it free; no matter how bad they need surgery, they must wait in line.

Anything different, said Ms. Stronach would be “a two-tiered health system and … I’m not in favor of a two-tiered health system.”

She’s not in favor of waiting either, and long medical waits are common in Canada.

When Ms. Stronach developed breast cancer, she traveled to California last June for an operation that was recommended as part of her treatment. However, she denied the speed of medical care in the United States was the reason for her quick trip to California.

So, the Labor MP believes in a two-tiered health system … as long as she doesn’t have to use it?

Of course, if the United States had the same type of health care plan as Canada had, Ms. Stronach would still be waiting. There would have been no place to go for her operation.

As a Kaiser Permanente member, I walk down the hall after my physical and get a routine mammogram in about 15 minutes. When I once needed a biopsy (I'm fine, thanks!), I had to wait from Friday until Monday. As opposed to 10 1/2 weeks...just to get a mammogram. Be very, very sure you really want national health care.

Posted by aalkon at November 6, 2007 11:15 AM


Brenda is a spoiled rich kid. I think she went to California only because there are better plastic surgeons there for her breast reconstruction.

I live in Toronto, Canada (Newmarket-Aurora is north of Toronto, where Belinda is). I got a mammogram, ultrasound and MRI with practically no wait time, so I don't know what she's bitching about.

Posted by: Chrissy at November 6, 2007 6:34 AM

I don't know - I went to an Emergency room in Canada, waited 3 hours for a chest X-Ray. They found a mass, admitted me right away. A day later I was in a CT scanner and then transferred to another hospital for surgery. Within a week I was diagnosed with Hodgkins Lymphoma and started on chemotherapy. Just like any other system out there, I would say that Canadas' has its good points and its bad points. I was treated in no time, but that doesn't mean that others don't fall through the cracks. I am quite sure that the system fails in the US just as often.

Posted by: KDR at November 6, 2007 6:41 AM

"I too if I had the money would seek treatment in the USA." That's exactly the point. You don't have the money, but still get treatment. If you didn't have the money and were in the US, you'd be screwed.

Posted by: flighty at November 6, 2007 6:49 AM

Actually, flighty, that's not true. People here are not turned away for an inability (or unwillingness) to pay.

Posted by: Amy Alkon at November 6, 2007 7:21 AM

Canadians aren't the only ones to travel abroad for health care. I have no idea if the numbers quoted in the site below are accurate, but a google search on "health+tourism" listed plenty of agencies willing to take my American dollars in exchange for providing me cheap surgery in another country.

Maybe this is an area in which the grass is always greener on the other side of the border.

Posted by: Stephanie at November 6, 2007 7:40 AM

In my experience, yes, if you go to an emergency room or walk-in clinic and put in the wait time and they find something wrong, you can get it fixed right away. But just try and do that with your regular doctor. If you try NOT to be a strain on the system you'll wait and wait.

I posted my 4 month waiting period anecdote on a previous item so won't bore you with it again, but I do have another example of where, if you'll "burden" the emergency rooms, you do get what you need.

Two weeks before my wedding, I had cut my foot on a broken piece of CD case (dancing barefoot and naked in our know standard, Friday night stuff). I thought everything was fine as I'd washed out the cut quite well. Five days later though, it still wasn't healing and I was getting red lines running from the cut into my foot. I called my own doctor, with a very specific complaint and symptoms that were obvious. She could squeeze me in 10 days later (3 days after the wedding at which I also intended to dance around barefoot, but clothed, thank you very much). So off I went to our local emergency walk-in clinic. I felt pretty guilty about being there. I mean, I have a doctor, I'm clearly not dying (yet) but it seemed like the only option. Four hours later (good thing my job is flexible!) the doctor saw me, agreed it was infected and determined there was still a shard inside the cut. She did mini surgery right there....local anesthetic, cut it open, pulled out the piece, put a stitch in it and sent me on my way. It took less than 15 minutes for her to diagnosis and fix the problem. Fifteen minutes which my own doctor couldn't make for me, but which I took out of "real" emergency care.

I'm pretty sure that's not exactly what Tommy Douglas had in mind.

Posted by: moreta at November 6, 2007 7:50 AM

> People here are not turned away for an inability (or unwillingness) to pay.

Depends. If you can somehow stagger into the ER under your own steam, they have to at least examine you, and probably treat you. If you arrive in an ambulance, however, triage is quite entitled to wave you off if they don't like your insurance info (or lack of it).

Posted by: Stu "El Inglés" Harris at November 6, 2007 7:58 AM

If you arrive in an ambulance, however, triage is quite entitled to wave you off if they don't like your insurance info (or lack of it).

Nope. There's signage all over most of the hospitals here in North America that say you have a RIGHT to be treated, regardless of insurance, or lack thereof. Especially if you're brought in in an ambulance. Only privately funded (not open to the public) hospitals are allowed to refuse people treatment. Unless you're pegged as a repeat offender or abuser of services (as was my nephew), the hospital has to treat you. And even if you are pegged as a repeat, they really can't deny you service if they can see you need help. Walk-in clinics, however, are different, because they can refuse you service if your insurance provider isn't in their network.

Posted by: Flynne at November 6, 2007 9:10 AM

Moreover, I've seen indigents carried through several courses of expensive treatment of cancer and then to a well-tended death by Southern California hospitals. (I don't know what's the better thing to do: name the hospitals to salute their valor, or not name them to protect them from others seeking to exploit.)

Posted by: Crid at November 6, 2007 9:45 AM

Sorry, it's Belinda. I think I've blocked her & her dad from my brain because they got too much media coverage around here.

Emergency rooms are a different story as far as wait times. I've heard people waiting for 6 hours. I think it's because people come in with every little booboo (or their kids little booboos) because they know it's free. A better triage system would probably fix that, or charging a $20 user fee to cut down on nuisance visits.

Posted by: Chrissy at November 6, 2007 10:17 AM

I find it amusing that everyone brings up Canada as the reason to avoid some form of UHC. Why do people assume that we have to do it that way? I am a firm believer in national health care, but not the way that Canada does it.

I think the best way to go, would be a multi-tiered system. One that provides a baseline minimum for care. Want better? Either get supplemental insurance to go up, or pay out of pocket.

The whole using the ER for care, is expensive and leads to people waiting until they are in dire straits. I wandered about with pneumonia for three weeks before finally going in to the ER a few years ago. Had I gone in earlier, I wouldn't have lost more than a days work and would have avoided passing it around. I also wouldn't have accrued over a thousand dollars in debt. The cost for initial care would have been under two hundred.

Happily, I am getting into a position to actually get insurance. I am getting an HSA, for my family and I after the first of the year. Yeah for me. Monthly premiums will be little more than seventy dollars a month. Of course, this is with a two thousand dollar deductible, which I have to have in the account from the get-go. If I raise the deductible, I can get even lower rates, which I hope to do.

This is just not an option for a lot of people. It hasn't been for me, for most of my adult life. I am finally in a position to do it, but it has taken me years to get here and the only reason that I can, is that I have a lot of marketable skills.

If we had a form of UHC, I would still get the supplemental. This doesn't make me a hypocrite in the least. I have worked hard and learned hard, so that I can make the money to do it. At the same time, I recognize that many people do not have the combination of luck, intelligence, opportunities and skills that I do. They deserve some form of healthcare, no less than I do. That doesn't mean they should have the best of the best. Nor does it mean that those who have the ability to afford better shouldn't get better.

And if you want to take it from a purely financial perspective, unless you support turning people away from the ER, who haven't the ability to pay, the current system is grossly inefficient and far more expensive than providing baseline coverage.

Posted by: DuWayne at November 6, 2007 10:20 AM

I should also clarify that I didn't get stuck with the bill for my pneumonia. The hospital required that I apply to get it covered through a lowincome program, so the doctors could get paid, without having to come after me in collections. I would have happily made arrangements for payment, but I qualified for help and wasn't given that option. So other healthcare consumers covered the bill for me.

I.e. even if someone is willing to take care of it themselves, the option doesn't always exist.

Posted by: DuWayne at November 6, 2007 10:28 AM

I think the challenge with the tiered idea (which I think is good in principle) is how do you determine the level of service. The testing and treatment for most ailments is pretty standard. You've got a broken arm? Set it and put it in a cast. You've got pnemonia? Antibiotics, bed rest. And so on.

So how do you make a tier? We put the doctors that are really crappy at their jobs in basic care and those that are good at it in the higher tiers? And those that are better at it get paid they should. If those crappy doctors are paid from some publicly funded system, does that really work out being economical?

Or is it some set dollar amount per procedure. You can then pick your doctor based on those that charge the set amount and those that charge extra which you can either pay yourself or through some supplementary insurance? Again, there's no control in there to prevent those "basic" doctors/patients from getting unecessary stuff done.

Whatever way you go with public funded health care, you've got some political body making the decisions on how to administer it -- who gets what treatment, how much they can spend and how much doctors can make.

I don't know if there is a system that works really well out there, but it certainly isn't the Canadian one.

Posted by: moreta at November 6, 2007 10:56 AM

I think this is what Michael Moore's movie "Sicko" is about. Doesn't he go to Cuba for their 'excellent' health care?

I think the focus should be on keeping people well in the first place. It's a lot cheaper.

Posted by: Chrissy at November 6, 2007 11:36 AM

moreta -

But things aren't that standard across the board. When I was a child and needed to get my tonsils removed, I went straight from the doctor's office to the hospital and they were out three hours later. This, in spite of the fact that a week wouldn't have made much of a difference. When I got injured on my bike, I was in a bed within minutes of getting into the our clinic. In the ER, I would have waited a minimum of an hour. My dad worked for the state and we had really great insurance.

Someone on bare min coverage, might have to wait. They might be cared for by residents and nurse practitioners. But they would get care. I wouldn't have waited long enough that the care cost far more, for pneumonia. Sure, I might have sat in a waiting room for several hours, but it would have been dealt with.

Someone with bare min coverage might have to take generics and may not get the newest and best treatments. But they will get treated. They may have to schedule check-ups and preventative care consults, months in advance and not at their preferred schedule, but they could get the consults and preventative care.

They might have to wait a few weeks to get tests that are necessary but not critically timely, but they would get them.

And yes, somewhere in there, the state will have to make decisions about public health care. So what? The only way this would be a problem, is if they are not making them, based on what the medical profession recommends. Indeed, it is bureaucrats making those decisions now, the difference being that those making them now have a profit margin in mind with every decision. Now it's important to keep costs in mind in any case, but taking the profit margin out isn't going to hurt anything.

It's always going to be the case that those with money, will get better care than those without. This happens now. It's just that the status quo is grossly inefficient and seriously broken. I am not averse to a non-state funded solution. But I am seriously averse to anyone going without healthcare coverage or shitty insurance that doesn't really do anything for them.

Posted by: DuWayne at November 6, 2007 12:16 PM

"I think the focus should be on keeping people well in the first place. It's a lot cheaper."

yes, and this is much more feasible when everyone has equal access to regular preventive care. this doesn't happen when a significant portion of the population is uninsured. the US may be able to offer some people the most advanced health care in the world, and we definitely spend more per capita than any other nation in the world, but our national health outcomes don't reflect this. clearly there is something wrong with the system.

oh, and the article regarding the Canadian politician doesn't prove or disprove anything; it is one example of one person's care. the first two comments are two examples of people who had entirely different experiences.

Posted by: let's be realistic at November 6, 2007 12:27 PM

> doesn't happen when a
> significant portion of the
> population is uninsured

The public seem to think insurance will create wealth that can somehow be used to care for people who are otherwise penniless (and unproductive). I doubt it. Insurance is just pooled risk. It doesn't actually change the outcome of the roll of dice, it just makes the casino a more agreeable place

Posted by: Crid at November 6, 2007 12:59 PM

"The public seem to think insurance will create wealth that can somehow be used to care for people who are otherwise penniless (and unproductive). I doubt it. Insurance is just pooled risk. It doesn't actually change the outcome of the roll of dice, it just makes the casino a more agreeable place"

i understand that insurance is pooled risk. this isn't what i was referring to, but it is a relevant point, because as people drop out of the pool, rates go up for the people who remain.

however, my point is that being uninsured is a significant barrier to receiving regular health care. people without health insurance often don't receive preventive care because of this barrier. our health system has to direct nearly all resources towards caring for people who are already very ill, when it seems to me that any logical person would agree widespread preventive care would make more sense. and people who are uninsured don't get regular, preventive care, which means they are more likely to get sick, in which case (as you all point out all the time) they get cared for anyway, at higher cost. i think in that sense, health insurance can affect the outcome.

Posted by: c'mon at November 6, 2007 3:15 PM

> as people drop out of the
> pool, rates go up

As people drop out of the pool, risks go down, right? Rates only go up when people aren't paying their way or when new risks are added to the list.

I think you're not getting this. Deciding to insure people doesn't add value to anything. Somebody's got to invest. And if a participant can't cover their own piece of the risk, someone else has to step up with some booty, or the participant has to go find a new risk pool. It ain't being uninsured that hurts people in modern healthcare... It's poverty. (Or negligence.)

Yeah, a system that provided care for everyone would be a wonderful thing. As would a system that gave each participant a new Ferrari. (I want a red one!)

(Is there an economist/insurer who wants to step in here?)

Posted by: Crid at November 6, 2007 3:31 PM

> As people drop out of the pool, risks go down, right?

No, up is correct. Imagine a pool of one. That one person gets cancer and needs $75,000 of chemo and radio. Result -- misery for the insurer, because he can't collect enough premiums to cover that.

Now imagine a pool of 20,000, all paying premiums. If one member of the pool gets that same cancer, the $75,000 can be covered.

Posted by: Stu "El Inglés" Harris at November 6, 2007 3:48 PM

"however, my point is that being uninsured is a significant barrier to receiving regular health care"

I suppose that's true, but it shouldn't be and therein lies the crux of the problem. Why does it cost so much to go to the doctor (or dentist) and pay out of pocket? I have a friend who puts off his dental work until he returns to India. If he gets one piece of major work done, the cost difference pays for his flights. I think that medical/dental costs were much better only 20 years ago.

I have strong suspicion that this is because the market for medicine has become progressively more and more distorted by regulation. Yet most people see how messed up medicine has become and want more regulation.

Posted by: Shawn at November 6, 2007 3:51 PM

> If one member of the pool
> gets that same cancer

The cancer is 20,000 times as likely.

Posted by: Crid at November 6, 2007 4:35 PM

Shawn -

It gets worse. My family doctor while I was growing up, charged $45 dollars for an exam. That went up to $65 by the time I was off the insurance. He was kind enough to drop his rate to $30 for me, when I needed to come in, so I could afford it - he also gave me samples to fill my scripts.

I tried to get into a doctor here, paying cash n the barrel. Seventy dollars a visit was the best I could find. I wouldn't have been able to get scripts filled if I did go. On top of that, the only doctor that I could find, who would accept cash payment, was over a hundred dollars an exam. The cheaper ones, wouldn't take any new patients that wanted to pay in cash.

As for the dental, I had a friend drill out a cavity for me about eight years ago. Filled it myself. It was a little lumpy, but it has held. Dental work is easier than one would think. Hurt like hell though, in spite of an injection of cocaine (couldn't find Novocaine on the street) into the nerves, but it worked. Gods forbid I need any major work before I get the insurance going.

Posted by: DuWayne at November 6, 2007 4:38 PM

(Is there an economist/insurer who wants to step in here?)

I'm such a nerd. If I had more time, I'd start building a little model of this in Excel. I tried googling it and can't find online any interactive examples. I'm very disappointed in the Internet right now. I want instant gratification, damn it.

Posted by: justin case at November 6, 2007 5:00 PM

Well, I think some of you are hoping that insurance has magical power to make pain go away, and that's not how life works. We really need to hear from an Econ major.

Also, we should note that Ms. Stronach is a Stone Fox. And by this youthful foxitude and her prominence as a North American politician, it has been presumed that she and Bill Clinton like to fuck each other. (Note the suggested link on the Yahoo page.)

Her Wikipedia page is interesting too (and presently in lockdown). I've never paid too much attention to Canadian politics, but her shenanigans in recent years have made it clear that Canada is not a political paradise.

This was a great blog post, Amy.

Posted by: Crid at November 6, 2007 5:34 PM

One last thing: Stronach is rich.

Another last thing:

Posted by: Crid at November 6, 2007 6:59 PM

Thanks, Crid - and this comment of yours is key:

The public seem to think insurance will create wealth that can somehow be used to care for people who are otherwise penniless (and unproductive).

Posted by: Amy Alkon at November 6, 2007 8:25 PM

Yes, who needs an economist when we have Crid.

> As people drop out of the pool, risks go down, right?

It depends who drops out: high or low risk people. Politicians solemnly talk about the 45 million, or whatever, who are uninsured. But, these are often young people who have a below average risk for medical needs. The plan here is to get them paying into the insurance pool, thus lessening the cost for those with above average risk.

Posted by: doombuggy at November 6, 2007 8:52 PM

For Crid and others wondering about the costs and benefits of some of things, here's a nugget on preventative care and savings from a rather tedious article in the European Journal of Health Economics (2002 - 3:1-2).

"In essence, the two studies show that most preventive services increase health care costs but also point out a number of preventive interventions that are economically highly attractive, such as immunizations, vaccinations, and screening tests for cardiovascular disease."

I.e., the stuff we already do routinely is worthwhile economically, but lots of the other stuff, not so much.

Posted by: justin case at November 7, 2007 7:42 AM

I'm all for giving preventive care to the homeless and mentally ill, and the truly poor, which is both humane and a cost-savings (over waiting for them to go to the emergency room). Everybody else can pay for their own damn preventive care!

Posted by: Amy Alkon at November 7, 2007 8:01 AM

Belinda's dad owns Magna International and he enjoys buying race horses. Like I said, the only reason she's going to the US is for the plastic surgeons. She wants nice titties after her procedure, and who can blame her? She's hot! And she has the money to pay for the best, so why not?

Posted by: Chrissy at November 8, 2007 8:46 AM

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