Antoinette's Page

Vol. 3, No.19, Monday, August 20, 2012

TITLE: “HEALTH (MEDICAL) CARE & INSURANCE: I want you and I to make it better!*”

INTRODUCTION

In my home province, Quebec, Canada, we are currently having a general election. Health (medical) care & insurance is a major topic. In the United States, Medicare is a key issue in the U.S. presidential election now in full swing. I am not sure whether it’s what the doctor ordered, but I have SOMETHING to say on the subject. Here it is

Politicians have a lot to say about health (medical) care & insurance … with good reason – it plays such a crucial part in our lives.  And everyone is concerned about it. If we have a system, people ask if it will collapse in the next years when Baby Boomers are really going to need it especially in their declining years. In Quebec, while our system has many good points, we have complaints.  In the U.S., some of the buzz words are: “controlling spending” and “providing a safety net.” There are commercials shouting the differences between the main parties. When it comes to health care, Romney and Ryan want to cut from the system, 700 billion – yes, that’s right … with a “B” … that’s a lot of money … I think that it’s more than many many million times what I spend weekly at the grocery store.  If I understood correctly,Republicans want to take it and keep it in Medicare to fund it longer and differently. On the other hand, Obama and Bidon also want to cut 700 billion, but shift it to ‘ObamaCare’.

I therefore can’t help, but think about health care.  Hence, my subject is the health insurance system. My book of the week is “Making Medicare: New Perspectives on the History of Medicare in Canada” [Paperback] by Gregory Marchildon (Author).  (Editor’s Note: This is a part of a continuing series on health.)

 ANTOINETTE’S LIFE & TIMES*

My Health: In Quebec, Canada, we have a universal public health insurance system. It’s good, but it could be better…, a lot better. There are many issues. Wait times is a huge problem. Also, while I have a General Practitioner (GP) – it’s not easy to find a family doctor as many exceed their cap and therefore will not take anymore patients.  In addition, it’s difficult to get many tests without cost. A friend had to pay $1000+- for an MRI.   Finally, funding for health care is a biggie! People are concerned that it won’t last as we Baby Boomers age.   

My Mother’s health: My experience with my mother was a real eye-opener!

Hospital: Last January 2010, my mother became very ill and she spent most of the year in a hospital.  The medical and nursing care that she received was excellent … all professional and dedicated.   Not only was she given every test possible to determine her health issues, but she was kept in the hospital until it was safe to discharge her. This is the positive part!

Home care: Our local community health service centre followed up, visiting weekly. (This was at NO cost except for some home care medical equipment.) This service was to check into mother’s medical condition, ensuring that she was properly cared for and looking for signs of abuse.  One day, I received a call from the nurse who had my mother’s case.  He asked questions about the bruises she had on her arms and chest.  Needless to say, I was there instantly to verify how my mother was doing and if she was being properly looked after.  At first, I imagined the worse, but soon it came to mind that she had fallen during the weekend.  I also remembered that I got a call about it when it happened. So much for the good news. 

Emergency: When my mother needed to go to the hospital, we did not want to call 9-1-1 and ask for an ambulance. Instead, we first drove her in our own car. Big mistake!!!! Since at triage, it was determined that she wasn’t going to die in the next ten minutes, we waited and waited. One time, we waited about SEVEN hours and finally gave up, leaving without care being administered. The long hours in an emergency at a hospital for my mother were very irritating.  It seemed that the only way to get around this was to call an ambulance.  Then once at the hospital, she would be brought from the back directly to the care station area and then reasonably quick into the patient care cubicles, this without having to pass the waiting room lounge!

Family Doctor:  I was unhappy with the GP that my Mom had. I thought that his treatment was weak and in part, her poor condition was his fault. Finding a new GP for my mother was very difficult.  I called every clinic that I could find within ½ hour drive, but to no avail.  Finally, I found a doctor who was taking new patients.  It was winter and I waited in line for one hour outside the clinic in freezing cold temperatures – my mother waited in the car.  When we were admitted, there was at least 3-4 hours wait before we were seen by the doctor.  By the way, there was a staircase to the basement, which was so hard for Mom to use. I have always said that doctors should make house-calls for seniors who are housebound. 

Prescriptions: Almost all seniors in Canada have some form of public or private sector drug coverage plans.  The cost of prescriptions is covered. There is an amount allowed per month.  Although this helps but due to the high cost, some seniors, needing on-going medication, do without. How sad is that?  

THE AUTHOR:  Gregory Marchildon  

 Gregory P. Marchildon thinks about health systems – he sees them in continuous change. He is a professor in the Johnson-Shoyama School of Public Policy at the University of Regina. He is also Canada Research Chair in Public Policy and Economic History

He was recognized with major awards and honors: (a) Institute of Public Administration of Canada Lieutenant Governor’s Gold Medal, 2006; (b) Distinguished Alumni Award (Professional/Business), University of Regina, 2003; (c) Saskatchewan Book Award for Scholarly Writing, 2002.  Indeed, he wrote the book: Health Systems in Transition. When this guy speaks … we should listen.

SERIES/COLLECTION

Books/Articles:

Several are:

• 2009 – Immigration Settlement 1870-1939 [History of the Prairie West Series] (Hardcover)
• 2008 – The Early Northwest [History of the Prairie West Series] (Hardcover)
• 2006 – Health Care Systems in Transition Canada [European Observatory on Health Systems and Policies] (Paperback)
• 1996 – Profits and Politics Beaverbrook and the Gilded Aage of Canadian Finance (Hardcover)
• 1992 – Canadian Multinationals and International Finance [Business History] (Hardcover)

 THE BOOK:  Making Medicare: New Perspectives on the History of Medicare in Canada [Paperback] by Gregory Marchildon (Author)

Medicare in Canada was a very hard fight. It was and is a huge accomplishment. It still is a big deal! Tommy Douglas, Premier of Saskatchewan initiated the Canadian health care system – he thought that it was the right thing to do. The federal government decided to implement the Saskatchewan health care model, from Newfoundland through to British Columbia.  In this book, there are  numerous essays by key individuals who implemented Medicare and the Royal commission on Health Services.

CONCLUSION

HEALTH (MEDICAL) CARE & INSURANCE (we call it Medicare) is still our most popular program … it’s an essential need for every citizen in our country. Health care is VERY important!

Personal Comments

I say:

1.      That I’ve always considered myself fortunate to live in a country where everyone is covered by a medical insurance program.  No matter what the income, employment status, age or state of health, if you meet residency requirements, you have access to health care. I believe that no Canadian resident has been turned away from our hospital doors due to lack of money.

2.      That while it may seem to many that our health care is free, they’re wrong…VERY WRONG. It costs a lot. We pay taxes …. I think the taxes in Quebec are the highest in North America. There are also many services that are non-insured – therefore, these are out-of-pocket payments.

3.      That although I complain about our health care system and there has been a lot of talk about its flaws and needing improvement, I do realize that overall, we have a good one.

4.      That the emergency room is a big problem as patients must wait and wait. And when they are treated, and as there is insuffient patient cubicles, patients on gurneys are in the hall ways and even the waiting room. Now how sick is that?  I cannot stomach when a senior person in pain is left unattended in a hospital for long periods of time – we must fix this!

5.      That Canada’s Medicare is transportable. If we are travelling anywhere in Canada, we are also covered for necessary medical care.

6.      That in the future, I foresee:

6.1  That there will be more and more out-of-pocket payment for treatments that will no longer be covered by the government health insurance. 

6.2  That people, who can’t afford to have the treatments, will probably do without. 

6.3  That seniors will be affected the most. 

7.  That every citizen in need should have access to medical assistance. 

8.  That doctors and nurses should not be overworked. 

The Point

When it comes to heath care, we must do much better and fast! It is true that more information is required on the development and implementation of Medicare. However, we all must tell the politicians to cut ot the ‘blah blah’ and make REAL improvements NOW!

ANTOINETTE’S TIP SHEET*

Here are my pros and cons to the Quebec version of HEALTH (MEDICAL) CARE & INSURANCE:

Pros: 

• No hospital bills or doctor bills
• Everyone has access to Medicare
• Doctors do not recommend unnecessary surgeries
• Free home nurses for the elderly and chronically ill
• Free mammograms, colonoscopy, etc.
• Free ambulance transportation for the elderly

Cons:

• Long waiting periods for elective procedure
• Must get a referral from a family doctor to see a specialist
• Basic hospital rooms
• Shortage of doctors and nurses
• Doctors are allowed to opt out of Medicare
• VERY HIGH TAXES

I don’t know whether this post is what the doctor ordered, but I hope that it will make the medicine go down easier! Oh by the way … before I leave, since I gave you an appointment to come today and you came, now I can assure you there won’t be a charge … You thought that I was just kidding … well you’ll never know!

And that’s my thought of the week on books, what’s yours?*
Take it out for a spin and tell me if you agree.
ALP
“Books are life; and they make life better!*”

PREVIEW (now, tentatively Monday, August 27th 2012): With Labour Day next week, I thought that it would be interesting to look into the history of this holiday- it is celebrated in many parts of the world. Of course, I will share some of my feelings about this day, more or less,  as a season changer and a time to getting down to work. I would like you to come by. Don’t worry…it will not be too serious and dry. We’ll relax and get into the easy-going mood for Labour Day.  (Editor’s Note: This is another post in a continuing series on holidays and special dates.)

PREVIEW (now, tentatively Monday, September 17th 2012): I will return to the romance theme. I am hearing a lot about Fifty Shades of Grey by T.L. James. I say: “Now, that’s a VERY spicy  meat ball!” I want to add my two cents to the discussion. (Editor’s Note: This is another post in a continuing series on dating, relationships and marriage.)

P.S. WOWEE the first big changes have FINALLY come to www.saveandread.com and thus to my blog. Check them out on the home page. I am told that there is much more coming: images, videos, book links and even an on-line  store selling products under my very own brand. I can’t wait! Please stay tuned.

P.P.S. #1 I have a TWITTER page. Consider becoming a follower? Visit www.twitter.com –   saveandread
P.P.S. #2 I also have a FACEBOOK page. Consider becoming a friend? Visit: www.facebook.com – Alp Save Andread – please check it out.
P.P.S. #3 I am on Linkedin. Consider becoming a connection? Visit  www.linkedin.com – Antoinette La Posta

CREDITS

-Web Tech:  richmediasound.com

The above is a new media production of Valente under its “United Author*” program.
*TM/© 2012 Practitioners’ Press Inc. – All Rights Reserved.
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NEED SOMETHING FURTHER? TRY SAVE AND READ* (S&R*) BACKGROUNDER: ANTOINETTE’S 1, 2, 3, 4 & 5

ONE – “I SHOULD HAVE SAID THAT!*” – QUOTES
S & R* QUOTE #1: Albert Einstein

“It’s not that I’m so smart, it’s just that I stay with problems longer.” (Source: Wisdom Quotes) –  http://www.wisdomquotes.com/topics/wisdom/)

S & R* QUOTE #2: Benjamin Franklin

“Early to bed and early to rise, makes a man healthy, wealthy and wise.” (Source: Wisdom Quotes) – http://www.wisdomquotes.com/topics/wisdom/)

S & R* QUOTE #3: Theodore Roosevelt:

“Nine-tenths of wisdom consists in being wise in time.”

(Source: Wisdom Quotes) – http://www.wisdomquotes.com/topics/wisdom/index3.html)

TWO – “IT WORDS FOR ME!*”
For today, my word/phrase(s) are: “health diet”; “health care”; Medicare; etc.

Healthy Diet

“A healthy diet is one that helps maintain or improve general health. It is important for lowering many chronic health risks, such as obesity, heart disease, diabetes, hypertension and cancer.^[1] A healthy diet involves consuming appropriate amounts of all essential nutrients and an adequate amount of water. Nutrients can be obtained from many different foods, so there are numerous diets that may be considered healthy.”

Health Care

“Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care, secondary care and tertiary care, as well as in public health.”

Medicare

“Medicare (French: assurance-maladie) is the unofficial name for Canada‘s publicly funded universal health insurance system.^[1] The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.” (Source: Wikipedia the free encyclopedia) – http://en.wikipedia.org/wiki/Medicare_(Canada))

THREE – STUDY/STATISTICS:

Under the terms of the Canada Health Act, all “insured persons” (basically, legal residents of Canada, including permanent residents) are entitled to receive “insured services” without copayment. Such services are defined as medically necessary services if provided in hospital, or by ‘practitioners’ (usually physicians).^[2] Approximately 70% of Canadian health expenditures come from public sources, with the rest paid privately (both through private insurance, and through out-of-pocket payments). The extent of public financing varies considerably across services. For example, approximately 99% of physician services, and 90% of hospital care, are paid by publicly funded sources, whereas almost all dental care is paid for privately.^[3] Most doctors are self-employed private entities.

The first implementation of public hospital care in Canada came at the provincial level in Saskatchewan in 1946 and in Alberta in 1950, under provincial governments led by the Co-operative Commonwealth Federation and the Social credit party respectively ^[4]. The first implementation of nationalized public health care -at the federal level- came about with the Hospital Insurance and Diagnostic Services act (HIDS), which was passed by the Liberal majority government of Louis St. Laurent in 1957 ^[5], and was adopted by all provinces by 1961. Lester B. Pearson‘s government subsequently expanded this policy to universal health care with the Medical Care Act in 1966.^[6] Some have argued^{[citation needed]} that these developments towards public national health care came as a result of the Saskatchewan government’s health plan in 1961-1962 by Douglas and Woodrow Stanley Lloyd, who became premier of the province when Douglas resigned to become the leader of the new federal New Democratic Party, though the medicare legislation itself was actually drafted (and first proposed to parliament) by Allan MacEachen, a Liberal MP from Cape Breton ^[7]. (Source: Wikipedia the free encyclopedia) – http://en.wikipedia.org/wiki/Medicare_(Canada))

Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees access to health insurance for Americans ages 65 and older and younger people with disabilities as well as people with end stage renal disease.

In 1965, Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.

In 1972, Congress expanded Medicare eligibility to younger people who have permanent disabilities and receive Social Security Disability Insurance (SSDI) payments and those who have end-stage renal disease (ESRD). Congress further expanded Medicare in 2001 to cover younger people with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). Initially Medicare consisted exclusively of Part A, which covers hospital and other inpatient services, and Part B, which covers outpatient care, physician visits, and other “medically necessary services.” Congress then added Medicare Part C (originally called Medicare+Choice, then later changed to Medicare Advantage), which allows enrollees to receive their Medicare benefits through a private plan, under the Balanced Budget Act of 1997, while Medicare Part D was created under the Medicare Modernization Act of 2003. (Source: Wikipedia the free encyclopedia) –http://en.wikipedia.org/wiki/Medicare_(United_States))

FIVE – BONUS ARTICLES

S & R*NEWS ALERT*#1: Cuts to neurologists’ fees could mean longer wait times

“If you are the 1 in approximately 100 Ontarians with epilepsy, you may find yourself waiting longer than ever for essential medical tests thanks to recent cuts to the OHIP fees payable to the province’s neurologists.

In addition to a 10 per cent decrease in technical fees, the government is proposing a 50 per cent reduction in fees for tests it deems self-referrals, which in reality are just tests being done by doctors in their own practices.

The chair of the Ontario Medical Association (OMA) Section of Neurology says that while the Liberal government talks about a commitment to improving the quality of care in Ontario, the new changes being implemented unilaterally suggest the opposite.

If the only timely way to provide care is for a doctor to do the test himself, I don’t see how cutting the fees for a test done in a doctor’s office rather than somewhere else is going to improve care, says Dr. Edwin Klimek.

While the wait time to see a neurologist in Ontario varies, six months is not unheard of. Quite often, doing the test in the specialist’s office speeds things up, and also saves the patient from having to travel to a different clinic, to a hospital, or in smaller communities not getting the test at all.

Neurologists care for patients with a range of illnesses such as Alzheimer’s disease, stroke, headache, Parkinson’s disease, Lou Gehrig’s disease and of course, epilepsy. To diagnose and treat a patient with epilepsy, a neurologist must conduct a 20-minute test called electroencephalography, or EEG, which can identify seizure-prone areas of the brain.

The technical fee reduction claws back the fees for EEGs to the same rate payable in 1992. Dr. Klimek calls this a real bone of contention for his members, who say technical fees have been inadequately funded for years, with many neurologists paying out-of-pocket to purchase the necessary equipment and subsidize lab expenses so their patients get the care they need. He says it’s possible some neurologists simply won’t be able to afford the tests anymore.

A neurologist is already going to break even or lose money on a test, and now they are going to be subject to a further 10 per cent reduction, says Dr. Klimek. Why would they choose to keep providing that test, aside from loyalty to their patients and their technician? Can you really keep providing a service at a loss? At some point you have to say ‘uncle’.

Neurologists are calling for the Premier to rescind the fee cuts to physician services and to resume negotiations with the OMA. They say they are willing to work with the government to find savings in the health system, but never at the expense of patients.

I’m professionally accountable every time I talk to a person. They should expect the best care possible, every time I see them, says Dr. Klimek. Poor outcomes cannot be justified by inadequate infrastructure.”www.newscanada.com

S & R*NEWS ALERT*#2:Surgical assistants says cuts could jeopardize patient safety, access to care

“The doctors who help make surgery safer in this province by acting as an extra pair of hands and eyes for lead surgeons, are deeply concerned recent cuts to OHIP fees unilaterally imposed by the government will jeopardize patient safety and access to care.

Our surgical assistants are alarmed about the impact these changes could have on patients and the care that is provided to them, says Dr. David Esser, Chair of the Section of Surgical Assistants at the Ontario Medical Association (OMA). When a mother is in trouble at 2 a.m. because her baby is in distress, the surgeon needs to have qualified assistants on hand to provide the care that will save both their lives.

The government’s decision to eliminate funding for neural monitoring during surgery on or near the spinal cord is one area surgical assistants believe will seriously impact patient safety and quality of care. This monitoring of critical nerve pathways is done to identify early, any damaging operative technique that the surgeon cannot detect, helping prevent paralysis and other irreversible damage.

Another key issue is the cut in the premiums payable to those who work in the evening and overnight hours: a 20 per cent reduction for the 5 p.m. to midnight shift, and 13.5 per cent for midnight to 7 a.m.

Dr. Esser and his colleagues say the reduction means fewer doctors may sign up to be on call, when patients often need them the most. This could lead to gaps in schedules and a push to do in the daytime, emergencies from the night before, resulting in longer waits for patients needing either emergency or elective surgery.

There is currently a shortage of surgical assistants in the province. A recent survey of 340 Ontario surgeons by the OMA Section of Surgical Assistants showed a high percentage of these surgeons having to either postpone or cancel surgeries after hours, or use unqualified staff to perform emergency surgeries, a situation some of them describe as dangerous.

I believe the majority of surgical assistants will continue to work in spite of the cuts because they care about patients, says Dr. Esser. But the impact of a few who may reduce or stop doing evening and weekend on call may be irreparable.

Dr. Esser says surgical assistants want the government to rescind the cuts and get back to negotiations with the OMA before the changes impact patient access and erode the quality of care in Ontario.” www.newscanada.com

*TM/© 2012 Practitioners’ Press Inc. – All Rights Reserved.

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