Canada, U.S. waits

So again, what is it with the Canadians and knee surgery?

Their knee surgery rates are up 20 percent in 2005-2006 from the previous year.

Here in the United States, single-payer activists hear about Canadians’ waits for knee surgery almost on a daily basis. To hear “socialized medicine” critics, there are entire provinces of crippled Canadians who have been on waiting lists for decades.

Don’t get me wrong. I understand that while knee and hip surgeries aren’t life-savers, they are quality-of-life-savers.

My grandmother, who lived alone in the house she’d raised her children in, fell off her back porch on New Years Eve in the late 1980s. She came to with her foot next to her head. Being one tough old lady, she dragged herself up the stairs, back into the house, through her kitchen and to the phone in the livingroom. She was never the same afterwards — something that doctors say is often the case for seniors after breaking a hip.

After the actually-elected President Bush had his hip surgery a while back, CNN quoted a doctor saying, “Some patients can't walk from a chair to a bed, but with surgery we can make them almost normal and take away their pain."

So I’m glad the Canadian prime minister and provincial premiers targeted hip and knee surgery as being two of the country’s five “priority” surgeries — reducing waiting times by increasing surgeries.

But I’m also thankful because those waits gave ammunition to the enemies of equitable healthcare — leaving people like me sputtering that no system can possibly be perfect, considering that humans are in charge, but that Canada is doing a lot better than we are.

CNN noted that the cost of a hip replacement was $25,000 in the U.S. in 2000:

A major study published in the Journal of the American Medical Association in 1996 found the operation was cost effective. It found the average lifetime savings of a hip replacement is $117,000. The difference is largely due to savings in nursing care.

“Unless, of course,” muses the health insurance CEO, “you simply eliminate the nursing care...”

That increase in surgeries in Canada was part of a $41 billion agreement between the provinces and the national government that brought wait times down by 20 percent in Ontario, according to a Globe and Mail story.

Some Canadians are traveling abroad for surgery. Bob McDonnell, a high-school teacher, decided to have his surgery done in “the popular medical tourist destination” of Chennai, India.

He paid $7,000, plus $4,000 travel expenses.

The Ontario government reimbursed McDonnell for his surgery, but not for his transportation and lodging. Seems like he should have been reimbursed for that as well, considering he’d been quoted a two and a half year wait:

However, waiting times vary widely, with the queue at St. Joseph's Health Care, London, being the shortest in the province, with 90 per cent of patients obtaining their hip-replacement surgery in 41 days. Compare that to Lakeridge Health Corporation in Oshawa, where Mr. McDonnell was queued: 90 per cent of patients had their surgery done in 370 days, during the same period.

SadButTrue over at Friendly Neighbour and Les Enragés notes that it would be interesting to compare the out of pocket costs for patients on either side of the border who both had hip replacements.

I can’t find the average cost for a hip surgery for an American citizen, but the biggest medical tourism company, MedRetreat, is U.S.-based. Don’t think those Indian surgeons only operate on Canadians.

MedRetreat sends customers to Brazil, India, South Africa, Thailand, Malaysia, and Agentina. They say:

Incredible Savings Why do people travel abroad to undergo medical procedures? The answer is simple...Affordable healthcare. Not to mention a little peaceful relaxation in complete anonymity.

Christian Science Monitor quotes Alain Enthoven, senior fellow at the Center for Health Policy in Stanford, Calif., saying that "Global healthcare is coming and American healthcare, which is pricing itself out of reach, needs to know there are alternatives…"

For critics, Americans heading overseas for care shows the severity of the country's healthcare crisis - especially as employers' health insurance premiums have risen 73 percent while average employee contributions have risen 143 percent since 2000, according to the NCHC [the National Coalition on Health Care]. Rising costs stem from poor management, inefficiences, waste, fraud, and lack of competition, critics say.

"We're seeing some employers who are seriously beginning to think about doing [global healthcare] and not giving employees an option," says Joel Miller, vice president of operations at the NCHC. "And that has implications for quality of care, and what recourse people have if something goes wrong overseas."

Hospital officials say only a sliver of business will be lost to overseas providers. Yet going overseas for expensive medical services, such as heart bypass surgery, cut into US hospitals profit centers - such as heart units - that are used to underwrite emergency rooms and indigent care.

"[Global healthcare] will limit the amount of money that's available for everybody else to have access to the system and starts to jeopardize access to healthcare for everybody in the community," says Don Dalton, a spokesman for the North Carolina Hospital Association.

The Americans who won't know about this, as always are the politicians, many of whom — ex-presidents and Indiana lawmakers, for instance — enjoy gold-plated coverage for life. Now if it's good enough for public servants, wouldn't it be good enough for us too?