I prefer facts above opinion, however, you stated you are a nurse which explains why health care might be more important to you than other political stuff, so I apologize.

Josie, then I propose that the U.S. federal govn't do something really radical/entrepreneurial/cost recovery, so that the U.S. taxpayers' databases spent on developing these databases for the world, start exacting a fee for database searches. (There are millions of journal article citations, not all full-text journal articles which there are different payment requirements from journal publishers.)

That would prevent all laypeople and all health care professionals do their initial research if they question opinion of their lst doctor's opinion:

http://www.ncbi.nlm.nih.gov/pubmed/

So that the U.S. can funnel the funds for health care. How about that? Why be generous to the rest of the international health care community to give initial database searches for free?

Then the rest of international community can start viewing the U.S. differently in situations of real need and care.

(Now if folks haven't figured out how satirical I am...)

Queue Up in the United Kingdom by Ronald Bailey
Health care rationing

Facing lengthening waits at hospitals, the British government has set a targeted turnaround time of four hours from arrival in an emergency room to treatment by a medical professional. Apparently this standard has proven too stringent for the National Health Service.

The Guardian reports that U.K. emergency rooms are meeting the four-hour goal through a simple, quintessentially British expedient: queuing. Thousands of seriously ill patients have been forced to wait outside of emergency departments in ambulances before they can be admitted, thus delaying the start of the four-hour timer. The practice is called “patient stacking,” and various investigations have found people with broken limbs or breathing problems stuck in ambulances for as long as five hours.

In U.S. emergency rooms, the average length of time it takes a patient to see a doctor has increased from 22 minutes to 30 minutes during the last decade. In nonurban hospitals, the wait averages just 15 minutes. And there’s no extra waiting in the ambulances outside.

http://www.reason.com/news/show/126059.html

A Canadian Expression
June 29, 2009

Falcon on Queue Jumping

"I don't have an objection to people using their own money to buy private services," he declared, in reference to patients paying for their own expedited surgery and other treatments at private clinics.
"Just as they do with dentists, just as they do with other decisions they make -- you know, sending their kids to private school or what have you. I think choice is a good thing actually -- reducing choice I don't think is a good thing."
Health Minister Kevin Falcon as quoted by Vaughn Palmer

Falcon's suggestion that people should be able to buy medical services just as they do dental or private school services, deserves more than derision. Nothing stops those who can afford it from going to the Mayo Clinic in the U.S., or to any other clinic in the world. Why shouldn't Canadians be able to spend their money at home to jump the queue since they can do it by leaving home? Apart from the costs of travel and accommodation, going abroad for health services can also mean isolation from support networks. There can be no doubt that more convenient queue jumping at home would mean much more queue jumping.

Anyone who needs care, from the removal of a cataract to organ replacement, can personally benefit by moving to the top of the queue. The question is whether queue jumping shortens the wait for anyone else. What harm to society justifies reducing or eliminating the ability of individuals to queue jump?

Queue jumpers within B.C. delay care to those with higher medical needs, the opposite of the claim that private services shorten the queue for those that need care. This could happen in two ways: 1) by bidding away scarce resources, including doctors, nurses and technologists, and 2) by reducing the incentive for government to fund public care.

One difficulty in the debate is how to quantify how many resources are diverted from public care, what the consequences are of any diversion and if and by how much government reduces public funding when private alternatives are available. One might think that answers to these questions would be the subject of substantial research, but such research is hard to find. Often arguments hinge on the fear that any adverse consequences would be the beginning of a slippery slope.

Medicare in Canada is built on the principle that access to medically necessary services should not depend on ability to pay. The Canada Health Act was adopted in 1985, as a result of pressure to stop extra billing by physicians in Alberta and Ontario and hospital user fees in B.C. It succeeded in those goals, and it remains in force even though a lot has changed in 24 years. The principles affirmed by the Act have been confirmed repeatedly. Currently B.C. is subject to fines under the Act for allowing clinics to charge for medically necessary services. The Act provides authority for the federal government to withhold $1 in federal transfer payments for each $1 charged to patients in violation of the Act's principles. The penalties under the Act are much clearer than quantification of any of the adverse social consequences mentioned above.

An attempt was made to challenge the principles of the Canada Health Act in Chaoulli v. Quebec (Attorney General), [2005] 1 S.C.R. 791, 2005 SCC 35; however, that case focused on whether private health insurance could cover private health care and hospital services. The Supreme Court of Canada ruled that Quebec's prohibition of private health insurance infringed the Quebec Charter of Human Rights and Freedoms. That doesn't mean private clinics are free to operate without regulation, nor does it answer the market question on whether any issuer would offer coverage for private clinics. The cases before the B.C. Court may offer further clarification on whether it is constitutional for a province to restrict private clinics, but once that issue winds its way to and through the Supreme Court of Canada it will still not resolve the policy questions of what the consequences are of allowing queue jumping.

A report in the Vancouver Sun in June 2005 indicated that about 1% of all surgeries that are covered by the Medical Services Plan (MSP), were being done in private surgery centres. When surveying the extent of private health insurance, called voluntary health insurance (VHI) in some jurisdictions and private medical insurance (PMI) in others, and the extent of the private provision of health services, it is important to separate queue jumping from private provision of services that are publicly paid (e.g. most doctor's offices and some contracted surgeries) and from private insurance or provision of services that are not covered publicly (most dental services and some drugs). Queue jumping is when quicker access to service is obtained through alternatives to public health insurance, as is done in B.C. with clients of ICBC and WorkSafe and as is alleged to be done by some who pay surgery fees at private clinics. In B.C. the queue jumping done by ICBC and WorkSafe is legal, but privately paid queue jumping is not. That difference, and apparent inconsistency, is before the court, the matter on which Falcon was apparently not briefed (to put it most generously).

According to a 2006 study published by the European Observatory on Health Systems and Policies, between 11% and 12% of the population in the United Kingdom have some form of private medical insurance, with about two-thirds of those covered obtaining coverage through work (a fringe benefit). The principal form of PMI in the UK is for queue jumping, insurance as an alternative to the National Health Service. According to the study, in 2002 an estimated 16.6% of UK health expenditures were from private sources, but private medical insurance accounted for only 3.6% of total UK health expenditures. Most of the 13.0% of expenditures that are private but not insured are for services not covered by the NHS, part of the 3.6% of expenditures that are from PMI are also for services not covered by the NHS. A precise estimate of how much is spent for queue jumping in the UK is consequently unavailable, but it would appear to be less than 5% of total health expenditures and possibly as little as 3%. The UK's Office for National Statistics reported that private spending accounted for 20.1% of total health spending in 2002, falling to 18.3% in 2007. There is no obvious explanation for the difference between 16.6% and 20.1%, other than all of these figures have to be taken as approximations.

There is much opinion but little evidence on whether up to 5% of total spending for queue jumping significantly distorts the public sector's ability to obtain scarce resources. Leverage may make the extent of queue jumping in the UK underestimated. A patient can shorten wait times by using PMI to queue jump for an initial consultation and then go back to NHS for any surgery, just like British Columbians can expedite their care by purchasing a private MRI scan.

Voluntary health insurance is more common in continental Europe but, according to a 2004 study published by the European Observatory on Health Systems and Policies, it is primarily for goods and services not covered by public insurance, rather than for queue jumping. When it covers user fees or co-insurance attached to public programs it can affect access to care without directly funding queue jumping. In Canada we have not had such co-payments since the implementation of the Canada Health Act.

If Falcon wants more discussion he should have paid attention during his government's $10 million "Conversation on Health Care". If he wants to push a queue jumping agenda, he should have said so during the election campaign. His job now is to guarantee that through public health insurance (Medicare) British Columbians get the health care they need when and where they need it.

Queue Jumping in Canada: http://www.strategicthoughts.com/record2009/Falcon1.html

Ah, I see what you are talking about. The difference here, of course is these people in GB who are waiting for an average of 4 hours!!! (which IS outrageous) at least can go to the hospital any time they want.
The long lines of Americans are waiting to see doctors who have volunteered to come to their neighborhood ONCE.. Too bad if they needed the help 2 weeks ago or a year ago, because they can't afford to go to their community health care or doctor.

Queueing and Medical Waiting Times in all areas of Canada (Dozens of links to check out)

http://web2.uwindsor.ca/math/hlynka/qhealth.html


A UK Blogger Weighs IN: "From Cradle to Queue":

http://www.insuranceblog.co.uk/2009/07/uk-health-insurance-from-cradle-to.html

Whether you are an Italian citizen or an expatriate, this is one of many web sites which will give you a micro-view of what Italian PUBLIC health care is like:

http://www.expatforum.com/articles/health/health-care-in-italy.html

The supporters of queue jumping would quickly sing a different tune if their employer didn't offer supplemental health care coverage benefits as part of their work benefit pkg.

If I may be allowed to explain, if one does not wish to wait the next day for a doctor's appointment, and if it's a non traumatic / non-threatening illness, ie. sniffle of flu, cold and if one chooses to go to emergency services at a hospital, of course there would be a line-up. I explained this near the beginning of this long thread.

Just to give real life examples, I had an employee who reported to me, who did get sick several times last year, where most times she was able to get a hold of her doctor's office before it closed. She always managed to get an appointment on the next day. Situations were: a bit of food poisoning, a strained back muscle, flu.

As for a woman in labour, she would get immediate attention at the hospital upon arrival or en route in ambulance/wherever who can respond.

What cracks me up Madelaine, is some people like my wayward young adult nephew with his 2 girlfriends and his SEVEN children....all collect monthly government checks for their 3 separate apartments, utilities, food, liquor, cigarettes, etc etc, not to mention the CONSTANT trips to the ER, the surgeries, expensive drugs, you name it.....that you and I are paying for.

They represent just a few of the significant number of extended family members who know how to play the system to not have to be personally self-sufficient.

They think I am rich because I "have money." (I worked full time since age 15)

As I have said before, as a nurse, I always felt badly for the REALLY poor-but-working-class who are sometimes made to wait long periods in ER rooms while the people who know how to work the system make sure they get FAST priority treatment. Create a major ruckus and I guarantee you will be seen QUICKLY! lol

I think we need to make a few changes in our current system, which includes the shady government and their lobbyists, and then there will be a LOT more money to help the truly needy.

yes, but you know why they are going to the ER?
because they can't go to the doctor. They can't afford to!
I have a good friend that was an ER doctor. He actually changed professions (now he works for a healthcare clinic) because he got tired of treating chronic disease with band-aids instead of doing emergency medicine; which is what he was trained for. He lamented that the working poor (and the non working poor) had no other means of taking care of themselves, so they'd let minor ailments get dangerous; go to the ER, get fixed up, and then after the bottle of medication ran out, they'd wait until things got so bad they couldn't manage again and they'd go back to the ER.


I feel sorry for your nephew's children. So let's say we take away the benefits that your deadbeat nephew gets. Who will be hurt the most? Him? no his kids.

Yup, it's the kids who suffer when their parents make poor choices. If only our social agencies could MAKE the 3 adults in this situation work for their benefits, especially since our nusing homes and hospitals are so very understaffed and could use the help....I opt for a reform whereby able-bodied young adults who are allowed to get free housing, free food, and free medical care, be trained to do road work, hospital work, daycare, and any other type of work which can teach them self-sufficiency so they can serve those who are making their freeloading lives possible.

Let me add that any government or company employee who steals in any way from the taxpayers, be fined heavily with mandatory jail time if the situation is serious enough.

Yes, I do know some doctors who will not accept government cards or if they do, they charge the government inflated fees. And I know A LOT of people who over the years have learned they can get service faster if they go straight to the ER, simply because their doctor does not work 24/7.

One really great OB-GYN doc I know said he was giving up his practice because his malpractice costs were through the roof. He said some people are so sue-happy nowadays and greedy lawyers are too glad to sue for a gazillion dollars if the baby was born with a forcep mark on his head. Sometimes forcing the baby out saved the baby's life but no matter. "Lottery fever" seems to rule when some think you can make money from an insurance company. After all, it's not like suing a real person, right? lol

I swear, sometimes I think I could write a book on all the corruption in companies, from individuals, and from government I've seen in almost 60 years of living.

And one answer to changing this current dynamic is so simple: re-teach important values starting in utero. lol Seriously. Mommy-to-be-experts advocate playing tapes near your pregnant tummy to make your kids smarter before they are born. Why not make some of those tapes about being honest, respecting your elders, working hard, studying diligently, treating your fellow man as you yourself would want to be treated, etc.