AHS/healthcare system debacles

[suntan]

Hippopotamus Oath, man.

[Misterman]

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Hippopotamus Oath, man.

Which creates a bit of a paradox. We keep giving help to valueless people, but for every one of those we help we are essentially denying care to someone else.

They need a system that brings up your tax payments with your file. Then triage people based on who pays to support the system. A lot of the waste would just clear itself up over time.

[rage2]

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They need a system that brings up your tax payments with your file. Then triage people based on who pays to support the system. A lot of the waste would just clear itself up over time.

so basically privatized health care on a payment plan?

[ZenOps]

Healthcare at the very least should cover communicable diseases for everyone. Realistically, if you deny basic health to a person who ends up coughing into the air or puts their hand on a doorknob anywhere in the city - you have just made it worse for everyone regardless of health coverage of any expense.

If you can cure the guy before he can pass on that preventable communicable disease, you might have just saved thousands of people worth in cures, and the misery of downtime and productiveness as well.

You can't just triage people who are poor either because rich people can also get communicable diseases before everyone else. Germs do not know rich from poor. One situation that comes to mind: Rich tour group takes a trip to an exotic location at a jungle waterfall, they bring back a dozen different communicable diseases that only manifest in the cities they visit weeks later. Poor people never get the dieseases because they are in such rare locations that no one other than rich people can afford to see, by helicopter or the like.

Like spending $10 trillion to go to Mars, picking up an alien lifeform and then bringing it back to earth. Noone has actually done the science to prove that man on mars may not ultimately be the worst idea in human history. Not to poo poo on Elon, but these things must be taken into account.

Canadian spending is significantly less than the USA almost by a factor of 10x. Yet USA citizens are near 2 years less lifespan for its 350 million citizens. Again, I blame the above ground nuclear tests in Nevada for this - although Alberta and Saskatchewan did have measureable notable nuke fallout back in the 1980's even at the Nevada to Canadian border distance (Nuke explosions no doubt shoot particles at speeds and distances inconceivable, and can remain airborne through the jet stream)

Mo money, mo nukes, Mo health problems. I think we are at a turning point, where if you got money - You've got smokes, you've got pepperoni pizza with triple cheese, you've got a car that breeds toxic gases, and you've got nukes. The people that are living the longest and healthiest are not necessarily the richest anymore.

https://www.healthsystemtracker.org/...ec-2019-update

As a nation, 700 million year less human life. How the USA has fallen. Said it before, 1970's was peak for sure for the USA.

[Misterman]

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so basically privatized health care on a payment plan?

No. I'm fine with everyone having access to care. I just don't think that some homeless heroin junky should be prioritized over a contributing member of society.

[TurboMedic]

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Wouldn't that be Healthlink?

But they're pretty useless given usually telling you to seek immediate medical attention...

I wish they'd deal with the reserve transport issue. I know one crew that'll tell ya which "patients" they'll be transporting which day. Really just a free (to them) taxi ride. Claim some condition, free ride to hospital, half the time nope the eff out before even being seen.

Not really, Nursing and Paramedicine utilize entirely different mindsets and resource allocation. This is evidenced by the reaction or decision differences made by an RN at a triage desk about an individuals condition vs. ours. I really strongly feel we are much more practical and realistic with our clinical judgement and thats a result of having to be individually accountable and to be judicious with our use. RN's are accustomed to having hands, personnel, spaces to put people, etc. Our environment is chaos comparatively and so we have a very level approach to nearly all presentations.

And to your second point, yes we are all very familiar with a very small group of individuals that we can all name across multiple services that use the system the same way. This has been an issue for as long as I've known, as time goes on the only thing that changes as they eventually pass away is the new names replacing them. Its funny pulling up to a scene and having some bystander rush up to tell you some story about why they called and we just walk up and give a "hey _____, where do you want to go, do you want us to call DOAP", and the caller goes, oh, you know him? Uh yah, this is my 2nd time today seeing them, probably 5th this week, 10th this month, etc etc. Those particular people don't necessarily tie up a resource for long like in a hospital, its a solve their problem for 30 min and then carry on type of deal.

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ya, healthlink is useless. Probably just a way to employ nurses that aren't actually doing any nursing.

They have their place, but the problem with them is the same problem that's endemic to AHS, risk aversion. They give fluff advice that does the best to CYA. I don't have the numbers to say "they divert x amount of calls from 911", I'm sure its significant though. The problem is that the ones they do kick to 911 are by the vast majority non emergent as well

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I can still phone 911 if I've burnt my steaks though, right?

You laugh, but there's been worse

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As s society we need to start considering that for the greater good, we will need to accept for uncomfortable compromises. Abusers will need to be identified and see their services reduced. This will result in the deaths of abusers when they actually need help. But that's the price we will pay as a society, and we should be fine with it. Perhaps Canada should start billing First Nations bands directly when their members abuse the system. (I presume I am not mistaken when I make the assumption that a disproportionate amount of abuse comes from First Nations people.)

FN full coverage is a factor for sure, we can see that in a number of cases. The issue is that again by the numbers its a small group of individuals that are repeatedly the issue, there are significantly more that don't use or abuse the system any more than anyone else. This group has the disadvantage of being more visible than others, and so it causes people to react in a way assuming all FN are the same. Again, its a small group, even on the reserve itself more of a handful of repeat users. Devils advocate, they are a higher risk subset by their socioeconomic status, and typically have poorer health and more health issues than nearly anyone else, I'm not going to discuss the semantics of who's at fault for that, but many of them would benefit from the care they're entitled. The issue is with self awareness, and they often don't complete or remain in care long enough to achieve a healthy lifestyle.

I will also say the greatest abuse comes from the boomers at the moment. They don't correctly use their primary care networks, they expect instant results from medications they're prescribed for issues and when they don't achieve that they go back in, they don't use pharmacists, OTC medications, and always want to be "safe than sorry", they can't manage minor aches, they are really bad at understanding internet sources of health information, and they're at that crossroads in their life where they see others around them being diagnosed with issues so they're concerned about it as well. They are the largest population base, so the stats will skew that way for sure, but they are easily 4 or 5-1 vs anyone else

[Tik-Tok]

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No. I'm fine with everyone having access to care. I just don't think that some homeless heroin junky should be prioritized over a contributing member of society.

Your plan sounds good on paper until you're at the ER with a limb falling off, and someone slightly wealthier than you skips the line for the sniffles.

[e31]

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Your plan sounds good on paper until you're at the ER with a limb falling off, and someone slightly wealthier than you skips the line for the sniffles.

At least "patient societal value" could be used as a weighted factor. It may not tip the scales in your scenario, but it acknowledges that some peoples time has more value (inb4 not PC).

Maybe adopt some kind of "Airport Lounge" model for our hospitals. I'd pay extra to not be around all the riff-raff in the ER. We all fly the same planes right?

[Buster]

as @rage2 just said - you're just describing privatized health care. Which isn't such a bad idea franky. We've tried the version fully funded by the public coffers and, as predicted, it simply suffers from the free-rider problem.

The human costs of our current system are enormous - the average user has their healthcare seriously degraded by the abuses of a relatively small minority. This degradation is relatively diffuse, however, so it doesn't trigger our Canadian guilt-reflex as much as seeing some ultra-poor person suffer.

In other words, we allow the majority to suffer a moderate amount because we refuse to allow a tiny minority to suffer a lot.

I think it is a terrible way to do things - but Canadians are an impractical people by nature.

[Misterman]

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as @rage2 just said - you're just describing privatized health care. Which isn't such a bad idea franky. We've tried the version fully funded by the public coffers and, as predicted, it simply suffers from the free-rider problem.

The human costs of our current system are enormous - the average user has their healthcare seriously degraded by the abuses of a relatively small minority. This degradation is relatively diffuse, however, so it doesn't trigger our Canadian guilt-reflex as much as seeing some ultra-poor person suffer.

In other words, we allow the majority to suffer a moderate amount because we refuse to allow a tiny minority to suffer a lot.

I think it is a terrible way to do things - but Canadians are an impractical people by nature.

I'm all for fully private healthcare. It's no different than car insurance, if you can't take the risk then get full coverage and pay a pre-determined monthly cost for it. I just know that something so logically efficient would never fly with heavy majority of Canadians. So if we could at least get a compromise by allowing junkies and street folk to use our services, but triage them down the ladder, it would at least allow the people that fund the system out of their own pockets to get some half decent quality of care when needed.

I've seen first hand how much resources someone like my meth'd out brother can utilize, and I know there is an abundance of others just like him. No hope for them at all, but we keep shoveling money into the fire for the sake of "helping" these people. It's a guaranteed failure of a premise long term.

[Buster]

Yes, moving towards privatized healthcare is the way forward. We can do this transition well, or we can do it kicking and screaming. Unfortunately, the misguided concept of universal, public-paid healthcare has been ingrained through generations as a part of the Canadian identity. It's now a sacred cow, and impossible to discuss without people (usually left wing people) losing their shit. You can tell, because people start to use typical left wing style personal attacks to vilify the person suggestion an alternative, rather than using logic. "You're a greedy Hitler if you want to take away my free healthcare." etc etc.

It's an idea that is no longer sensible, but Canadians can't be convinced that we never really moved out of experimentation phase, and the experiment has failed. The law of unintended consequences, which usually is what bites socialist thinkers, made the system economically unviable.

Critical services like healthcare are best left exposed to market forces. The grocery industry is more critical than the healthcare industry, and it functions very well under a pure market system. We help the most destitute with charity, like the food bank and shelters. It works much better. Much of our critical energy/fuel delivery is private, also with excellent results.

Some critical services, like fresh water delivery, electricity, and roads have a last-mile problem which requires modifications to a pure market, and we have to constantly be tweaking those things. But healthcare doesn't suffer from a last-mile problem, and so would be better served by a more market focused approach.

[ZenOps]

As far as I'm concerned Canada is doing just as well as most everyone else, not great but not bad.

The USA totally destroyed their system, and is not even worth looking at as a model of general health of the greater populace. If you want to fix your teeth, go to Mexico.

I'd say USA healthcare is about on par with North Korea per dollar spent. Anyone that says Canada should follow US style healthcare is completely ignorable to me. The USA is great for making money, but you absolutely under no circumstances want to get sick there.

[ZenOps]

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No. I'm fine with everyone having access to care. I just don't think that some homeless heroin junky should be prioritized over a contributing member of society.

Thing is, drugs can be accidental and involuntary. A smaller than grain of salt sized Fentanyl crystal may have accidentally entered the system of a EMT, knocking him/her unconscious. If its off hours with no immediate ID just walking along the street, unless you know the person - how do you actually know whether its a junkie or a doctor or any other person for that matter. This is also why EMTs always wear masks on suspected OD calls.

Prioritize care first, bring the person back up to humane conditions and then figure out what to do from there. If he/she ends up being a junkie then treat according to whatever laws are at the time. But never deny treatment to start.

[ZenOps]

I will say the US system and administration of care is definitely a strange system.

If you have an allergy, should you be treated as "weak" and have to pay extra for care (EpiPen)? If you have a proneness to alcohol or drugs should you have to pay extra for care? If your bones are a little bit thin because of genetics, should you have to pay extra for exotic drugs? Its great if you actually own the medicine company (lots of dollars) but ultimately if you are talking about long life and health - it can be absolutely diasterous.

The question that most people ask is that "lets say its ok for health companies get lots of money" Then you have to ask yourself is that money going to the person that actually created the drug in the first place or intends to create more beneficial medicines in the future. Because if it is "no" then all you have is Martin Shkreli taking a trip to Vegas for hookers and coke. Because for sure in the USA you cannot force anyone to do anything with their hard earned money that they do not want to do, its the very foundation of the USA.

[Misterman]

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I will say the US system and administration of care is definitely a strange system.

If you have an allergy, should you be treated as "weak" and have to pay extra for care (EpiPen)? If you have a proneness to alcohol or drugs should you have to pay extra for care? If your bones are a little bit thin because of genetics, should you have to pay extra for exotic drugs? Its great if you actually own the medicine company (lots of dollars) but ultimately if you are talking about long life and health - it can be absolutely diasterous.

The question that most people ask is that "lets say its ok for health companies get lots of money" Then you have to ask yourself is that money going to the person that actually created the drug in the first place or intends to create more beneficial medicines in the future. Because if it is "no" then all you have is Martin Shkreli taking a trip to Vegas for hookers and coke. Because for sure in the USA you cannot force anyone to do anything with their hard earned money that they do not want to do, its the very foundation of the USA.

You seem to be trying to intermingle drug supply and healthcare as if they are one thing.

[suntan]

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Critical services like healthcare are best left exposed to market forces. The grocery industry is more critical than the healthcare industry, and it functions very well under a pure market system. We help the most destitute with charity, like the food bank and shelters. It works much better. Much of our critical energy/fuel delivery is private, also with excellent results.

Wanna piss off a leftie? Tell them the government should manage the food supply. Then every single fucking argument you hear from gun nuts comes out.

[Buster]

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Wanna piss off a leftie? Tell them the government should manage the food supply. Then every single fucking argument you hear from gun nuts comes out.

It tends to be a showstopper in these conversations.

"you want an AHS-like organization to manage your kids food?"


"........"

[suntan]

I said it once to an ardent NDPer.

Her face got beet red, her eyebrows curled, she opened her mouth, closed it without saying anything and then walked away.

[Waldi]

As a spouse of family physician, I can see every day ho3w much her free time is donated to work (reviewing all the results etc. is done after hours at home). When patient come to the office and test are ordered, someone has to go and review the result of each and every test. There is no time to do that while working in physician office as priority is to see patients and there is no time to deal with results. It time taken from family life when making calls to patients after hours to provide results of the tests.
It is primary care physicians (family docs and GP) who have direct impact on managing cost. Once you get to situation that is will be hard to see family doctors (as it happened few years back) as they will leave family practice for more financially beneficial or more balanced lifestyle, patients will have to go to emergency and tax system even more. One more thing, none pays doctors back for ordering tests!!!

[ZenOps]

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You seem to be trying to intermingle drug supply and healthcare as if they are one thing.

Its definitely a strong part of it. Without chemical medicines what healthcare would there be? It can and does also apply to non-chemical healthcare, like a patented wooden tongue depressor that costs $5 and is thrown away after single use. Great for the guy who makes tongue shaped popsicle sticks, not so great for everyone else.

There is no point talking about doctors and education, because - they can move countries in a heartbeat. If the USA was forced to pay its doctors a lower wage to pay down national debts - I can imagine the USA life expectancy might drop to five years behind other countries as they migrate to other countries. Its *that* bad.

Having an all you can eat of the most expensive cheese in the market, just means you get a heart attack all that much faster.

US healthcare is run an awful lot like its military and the combustion engine. Throw money at it whether or not its more effective or not. I believe this is what will ultimately be the downfall of the American empire, if its not already in a terminal state.

Realist: Make America good again.