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February 10, 2009

Goodbye, Founding Fathers - Hello, Tommy Douglas!

Conservative bloggers in the US have been chattering about this find in recent hours;

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

[...]

Hospitals and doctors that are not “meaningful users” of the new system will face penalties.

If Obama screws up the American health care system, where the Hell are Canadians supposed to go?


Posted by Kate at February 10, 2009 12:11 AM
Comments

Stuff like that I believe to be totally unenforceable. I worked in the States for a year, and even in our institution it was just easily remedied by "finding an excuse on the chart to make the insurance companies stop bothering us".

You can say this compounding condition led to x, which led to y, which fits therefore into another treatment group, therefore you must also use diagnostic group code xxx, blah blah blah

And, what army is going to police that? To build a system to monitor that would require years of work, and when done, would be outdated.

So, nice to say, and it makes everyone happy, clap clap; but it's claptrap

Posted by: Erik Larsen at February 10, 2009 12:19 AM

Mexico?

Posted by: andycanuck at February 10, 2009 12:28 AM

Correct, Erik. Certainly they won't succeed, in the long run. The question is: how much of your money (which is a proxy for your time of life between birth and death) and of your health care (which is a proxy for your quality of life between birth and death) will they manage to pizs away in the process of failing, in the short run? Just remember: it's called Mumbai now, not Bombay (really, I must say: next thing you know they'll want to try to rename Ceylon).

Posted by: Vitruvius at February 10, 2009 12:34 AM

Yep Vitrivius. There has been far too much energy devoted to an electronic health record. Been there, seen it, done it. In the end, you don't really care what somebody's tests were years ago, it's not like a TV show where it turns up some forgotten clue - you're interested in the here and now - it's just easier to retest with what ya got now.

Posted by: Erik at February 10, 2009 12:44 AM

America you are screwed, Insurance Companies are one thing but nothing is as stupid as simple servants running anything, and with a "Great" leader that has never run anything himself, look out. What have you got? A black Alfred E Newman? Dumbo? Nero? I feel for you America.

Posted by: Western Canadian at February 10, 2009 12:45 AM

WC, 12:45am:

www.youtube.com/watch?v=iK-zN8h5VuM

Posted by: alfred e obama at February 10, 2009 12:55 AM

Its just another name for "rationed" Health Care, like Canada..

I had a close friend in Saskatchewan that could not get a Cancer specialist appointment in the province; he went to Brandon, Manitoba. He died of Cancer within two weeks of that appointment & diagnosis.

The thing that I found ironic is that his departed father had been a (Sask) CCF-MP during the late 40’s & 50's. It seems the children & grand children pay an unintended price!

Posted by: Phillip G. Shaw at February 10, 2009 12:57 AM

"it's not like a TV show where it turns up some forgotten clue"

Maybe that's where they got the idea from!

Posted by: allan at February 10, 2009 1:00 AM

Belgium? On my way back from London a few years back I sat beside a woman coming back from knee surgery in Belgium to beat the wait.

Posted by: Peter Jay at February 10, 2009 1:10 AM

And who is going to pay for the medical research for Canadians?
Just think; if the people who run Canada's Health Care System ran our food supply?
Long lineups for toilet paper anyone?
Only in Moscow, you say?

Posted by: Gunney99 at February 10, 2009 1:19 AM

Yep Allan - exactly - I can't help being quite impressed about the implausible databases maintained by people on CSI and 24 - with floor plans of every domestic dwelling, and detailed personal habits of every citizen. It just doesn't exist, and won't ever happen.

And, Peter Jay, we do have a two tier system as you allude - we are the population of Chile strung across a border where you can pay for your health care - you have the money, you can jump any queue by hopping across an easily passable border

Don't get me started on the Worker's Comp system - queue jumping extraordinaire - after all, we want people back at work, right????

Posted by: Erik Larsen at February 10, 2009 1:21 AM

Erik Larsen is describing what occurs now with "Information Technology, will monitor treatments to make sure your doctor is doing what the [insurance company] deems appropriate and cost effective."

I appreciate his comments on the medical end. Still, on the insurance end there is the soul-destroying profession of trimming coverage. At least this would be more public.
A single-payer system with open criteria would be ever better.

Posted by: dizzy at February 10, 2009 1:21 AM

Erik, I was thinking more along the lines of the show "house". Ever watch it?

Every time I watch that show, an image pops in my mind. About a half dozen or so of the top surgeons, etc.. get together and watch it every monday night complete with popcorn.

Every time one of the doctors on the show comes up with a possible "cause" or "disease" that explains everything, a flurry of popcorn gets tossed at the TV screen resembling Germany's assult on Britain during WWII.

Apparently the show is somewhat realistic, they actually hired a doctor to come up with the ideas and to "fact-check".

Posted by: allan at February 10, 2009 1:36 AM

The benefit for Canadians will be that we'll have to switch to a private health-care system so that we're "not like those wretched Americans". They'll start crossing the border to get out top-notch health-care, once Obama's socialism, and Canada's Chaouilli kick in.

Posted by: Shane O. at February 10, 2009 1:40 AM

At the end of the article the author says that the bill would make older people a low priority for treatment ('hopeless" would be used more often to diagnose older people). This is a backdoor to killing old, retired people. So get rid of babies (abortion) and old people (let them die, untreated). "Change" for America? Oh America, what have you done? My heart weeps for your country.

Posted by: Jema54 at February 10, 2009 1:40 AM

Allan - I've only caught a few episodes of House.

I would summarize TV drama by saying that they take a nation's worth of interesting stories, and then try to say that those events happen every week at one institution.

For example, in ER, yeah, those stories happen, but maybe only once twice a year, the rest of the time, you're stitching up drunks or hockey accidents or looking after people who stuck things where they shouldn't have.

In Chicago Hope, I saw one episode where they ruthlessly stole a story line from a Reader's Digest "Drama in Real Life".

There's the old saying "when you hear hoofbeats, look for horses instead of zebras". Sadly, to entertain the modern public, you have to employ a variety of exotic animals, week after week

Posted by: Erik Larsen at February 10, 2009 1:47 AM

The U.S.A is about to flip their health care 180 degrees. Younger people generally don't need it, but will have full access to it. Older people need it and will be denied. They are going to save sack loads of money, at the elders expense. Its to bad because the elderly of the U.S. are currently well taken care of. At least that's the way it looks to me. This type of stuff is not stimulus its social engineering. Just make sure your not late paying them taxes all your life.

Posted by: wuberman at February 10, 2009 2:21 AM

If this piece of totalitarian idiocy goes through I predict BO's popularity will go into a non-recoverable nosedive.

One thing I've found about Americans is that they have very high expectations from the medical system. Admittedly the people I used to see in Vancouver were probably better off than the average American, but the level of care they expected was far above what the average Canadian gets. They wanted everything immediately and couldn't understand how Canadians put up with a third world health care system. Fortunately for them Vancouver has private MRI clinics and specialists that are happy to squeeze in private patients for 4-5x their usual fee.

I had an interesting conversation with a couple of Democrats from Washington state last year which leads me to believe that BO is going to crash and burn with this proposal. They were both psychologists and praising the Canadian system in principle (and hoping for the same thing in the US when GWB was gone) until I filled them in on the details of Canadian health care. The shock on their faces was quite obvious when I told them of the walkin clinic that I work where people will wait for 4-8 hours for a 5 minute appointment with a doctor. They are used to long physician appointments to discuss their medical problems in excruciating (for the doctor) detail and had the idea that this system could be extended to the whole population.

The whole life-extension movement is on a collision course with this third-world medical proposal and a lot of Hollywood liberals are used to paying huge sums of money to retain their youth. A purely private system will continue and nothing will get the population pissed off faster than extremely high quality medical care for the rich and euthanasia for the poor.

Americans hate their HMO's and if the US government sets itself up as an uber-HMO, this hatred will be transferred to the Democratic party. If the matters being deal with weren't so serious, I'd consider the decline and fall of BO to be one of the most hilarious things I've seen in some time.

Posted by: loki at February 10, 2009 2:58 AM

Speaking as a medical student, Daschle can stick an endoscope up where the sun doesn't shine. "Learn to operate less like solo practioners? Give up autonomy?" I didn't know the government was in the business of diagnosing. Absolutely incredible - congrats America, you voted for it!

Posted by: Mark at February 10, 2009 7:10 AM

AHEM:

You guys should read my blog more often. I wrote about this back in early December:

http://is.gd/j1wT

Posted by: Kathy Shaidle at February 10, 2009 7:16 AM

There is nothing more dangerous than a doctor nervous about someone like Big Brother always looking over his shoulder while he treats patients, like during, say, neurosurgery... after all, distraction causes brainfarts...

The last place one wants Big Brother to be is in the operating room, making the surgeon have brainfarts and screwing one up because Big Brother keeps rudely tapping the doctor on the shoulder, saying "What are you doing? Why are you doing that? Is that necessary? How much will it cost?"

Looks like Obama is trying to Canadianize the American health care system. I know that that scares Americans...

Posted by: The Canadian Sentinel at February 10, 2009 7:57 AM

Nirvana will arrive when your voting record can be used help steer the right course of treatment.

Posted by: Shaken at February 10, 2009 8:06 AM

I had a close friend in Saskatchewan that could not get a Cancer specialist appointment in the province; he went to Brandon, Manitoba. He died of Cancer within two weeks of that appointment & diagnosis. -Phillip G. Shaw

I'm afraid I can confirm that getting cancer diagnosis, staging assessment and treatment takes so long in New Brunswick that one might as well not have bothered... it just takes so long as to pretty much condemn many to die anyway. Imagine waiting months for diagnosis, assessment and treatment, and dying just two days following the assessment, without even knowing what your stage was. True story for a family member of mine. As it is, the system is a failure!

The system is simply too slow, too unresponsive. When will Canadians finally open their eyes and see the crisis? Yes, it IS a crisis situation, and we're supposed to not worry???

In the meantime, the crisis worsens and we're blissfully unaware, thanks, in part, to a Big Media who could care less about looking into it themselves... Guess investigative journalism is RIP.

Is protecting and keeping firmly in place the dogmatic ideology of socialism vis-a-vis healthcare more important than healthcare itself??? Is it really just about being a socialist country, or is it about providing quality, dependable medical attention wherever, whenever it's needed?

Posted by: The Canadian Sentinel at February 10, 2009 8:15 AM

The stealth marxist in full glory.

Gawd help America.

Posted by: Fred at February 10, 2009 8:25 AM

Imagine if you're 75 and someone decides that seeing as you're almost dead anyway the treatment isn't "cost-effective".

DENIED!

Ohhhh. Mr X didn't believe in change?

DENIED!

Ohhhh. Mr X is a firearms owner?

DENIED!

Ohhhh. Mr X doesn't vote?

DENIED!

liberals. Heading for the wall at 100mph. This wreck is going to be more spectacular than a NASCAR smackup.

Posted by: oatmealeatincanuck at February 10, 2009 8:36 AM

This is effectively the Caanada Health Act. Do it our way or we withhold funds. Not sure about the US constitution but ours had Health in the provincial sphere. This stuff causes enormous wasted time in debates between two levels of government and acheives little.

As well, it gets used to prevent things like publically funded but privately delivered Health Care, which seems to work fine in numerous Eurozone countries but seems to be a problem here.

Nothing wrong with supplying Health care funding, it is a societal choice and some argue it is more effecient. Nothing wrong with electronic health care records. I am still amazed they are faxing and couriering mine around and 2/3 of the administrative space at my doctors is taken up with files.

But attatching torgan horses that get levered into government control is ridiculous. You'll end up with the worst of all worlds.

Posted by: Stephen at February 10, 2009 8:39 AM

What's scary is bureaucrats approving or rejecting treatments. These people have no medical training and yet can determine if a doctor is following the right treatment guidelines? Recipe for disaster.

Posted by: Nicole at February 10, 2009 9:43 AM

Creating a central health data system involves hugh costs to the physicians. A friend of mine who is an eye specialist (easier than spelling the professional name) says that downloading patient info into the central data bank can only be done if the software is compatible. If it isn't, and why would it be, new compatible software must be purchased and people hired to input patient info into the software which can then be downloaded to the central data bank.

Posted by: a different bob at February 10, 2009 9:48 AM

The problem with a public-run rather than private-run health care system is that it develops into a two-tiered system of direct care and indirect bureaucracy.

The latter increases in both staff and costs. The money shift from focusing on the doctor, tests, research..to the bureaucracy.

Posted by: ET at February 10, 2009 9:58 AM

I'm not sure if it is true in the US but you own your medical record. There is no reason you cannot keep your own record on a memory stick.If you carried a file with all your drugs and relevant history for example drug allergies. Perhaps if it was set up as a medical document it would be of use to a pharmacist for those that don't remember what drugs they are taking. I know I wouldn't want the government doing it. With the attempt to get the census away from Commerce to the White House I wouldn't feel any information was secure or above manipulation or abuse.

Posted by: Speedy at February 10, 2009 9:59 AM

Oh and to answer the question, India does really good multiple impregnations and someone else picks up the costs of the preemies that result.

Posted by: Speedy at February 10, 2009 10:06 AM

Most Canadians, and Americans even moreso, are totally unaware of the "inspiration" for Saskatchewan’s healthcare system, which later became Canada's.

A certain Henry Sigerist was for socialized medicine in his day to what Al Gore is for Global Warming today. Sigerist wrote a book called "Medicine and Health in the Soviet Union", was a frequent speaker on the subject, and was also a member of the commission that introduced socialized healthcare to Saskatchewan. I recommend reading his book, for it is essentially a blueprint for what we have in Canada today. Here are some choice quotes from that book:

"The general intent is to supervise the human being medically, in a discreet and unobtrusive way, from the moment of conception to the moment of death. Medical workers and medical institutions are placed wherever anyone in the course of his life may be exposed to danger. Medical supervision begins with the pregnant woman and the woman in childbirth, proceeds to the infant, the pre-school and school child, the adolescent, and finally the man and woman at work."

"Man has a duty to work but disease prevents him from working, from performing that duty. The state makes available to all the means of preventing and curing disease. Therefore, there is a duty to use those means, there is a duty to health. To spread disease becomes a social offence."

"There is much difference between a capitalist and Soviet health plan as there is between a capitalist and Soviet budget. Besides, since curative medicine escapes control, it cannot be planned. In the Soviet Union, five-year plans and yearly plans are established. The entire work of the nation is planned and the health plan is one part of the general plan."

Posted by: JTH at February 10, 2009 10:27 AM

"...You guys should read my blog more often."

---Kathy Shaidle

I do read your blog often and I love it, but I'm pretty sure more people would read it if you had a comment section...

Posted by: Friend of USA at February 10, 2009 11:57 AM

ET
Absolutely correct.
In Ontario there is a little thing on health cards called a version code.
If you move across the street, you have to notify the health ministry and a new card is issued with the same health card number but a new version code. If a senior moves into a nursing home or a care centre or a seniors' residence the same thing applies. The problem becomes more complicated because most people are not aware of this version code, and many people simply forget to notify the ministry when they move. As a result, their cards are invalid. It's an absolute nightmare.
Can you imagine what it would be like if our social insurance numbers were changed in this manner? Oops, I shouldn't have said that. Some bureaucrat may think it's a good idea.

Posted by: Ghost of Ed at February 10, 2009 12:04 PM

Yup, the database thing wouldn't work, so no worries; it would only cost.

Americans made a mistake the size of the rest of their lives in the last election. Obama's an "ideas" man, not a "reality" man. He's playing with America and it's institutions and principles like it's a board game, and he's the dicemaster wearing a cardboard hat. And he's just starting to find his groove.

Way to go, self-righteous race pimps. You really made America a better place, didn't you, white progressive race pimps?

Yup. Good choice. He's got the run of the place now.

Posted by: EBD at February 10, 2009 12:04 PM

"Not sure about the US constitution but ours had Health in the provincial sphere."

The US Constitution says anything not specifically granted to the federal gov't belongs to the States and health isn't mentioned. Of course being a "living document", that doesn't matter to anyone except the bitter, clingy types.

Posted by: Kathryn at February 10, 2009 12:10 PM

Yes,speedy.Our health records,here in Canada,belong to us.BUT......you have to remind some doctors of that little fact.When I changed docs,because my old one had become nothing more than a pill pusher,I asked for my records.He said yes,but at a cost of 30 bucks a page.Fortunately,the College of physicians sided with me,and told my old doc to fork them over,or face censure.My new doc automatically makes me a photocopy,and she makes sure I have them before I leave her office.

Posted by: Justthinkin at February 10, 2009 12:27 PM

I really doubt if the big zero's people can get such a system up and operating across the USA in his first and only term.

Think of the long gun registry and the bureaucrats that would be involved. Many meetings, many revisions to specs, dissatisfaction with one IT provider, searching for a new one, then reworking all the code, etc., etc.

It will be nothing but a money pit where the IT suppliers will make a killing and nothing will be produced.

Posted by: Niall Mor at February 10, 2009 2:19 PM

Electronic medical records (EMR) that are managed by the government are extremely dangerous and I would suggest that people refuse to have their medical information put into such databases. In BC the Campbell Lieberals have been pushing doctors to get EMR but the EMR software can only come from government approved vendors and the data must be stored on government managed servers. Their typical totalitarian reason for this is that doctors can't be trusted to properly store digital data.

The real reason governments want EMR is data mining. Right now it would take anyone who wanted to extract data on my patients years to sift through the paper charts in my office whereas the same information in electronic form could be analyzed in a few hours or less. Having EMR data available to governments would let them determine who wasn't toeing the party line and which patients were overusing the system. Governments are great fans of standardized treatments and the BC government sends out a seemingly endless number of clinical practice guidelines which most doctors relegate to the garbage without reading. The problem with clinical guidelines is that they ignore biochemical individuality. Doctors know that this Procrustean approach to medicine doesn't work and individualize medical therapy.

I'll be using EMR but it's going to be open source software (Oscar) with the patients records stored on my own server in my office with access to governments available only on a per-patient basis after a court order.

Posted by: loki at February 10, 2009 2:33 PM

a book written in about 1952 by frank g slaughter outlined what would begin to happen in a government run health care system. it was very prophetic. it can only get worse because the worst minds in the world are going to run it.

Posted by: old white guy at February 10, 2009 2:39 PM

Loki - I think you also raise the point of "garbage in/garbage out" with respect to data mining - I can't envision a country with 250M+ people (350M of whom are apparently unemployed) being coded accurately by legions of disparate health care providers.

The data mining there would not be as good as with a smaller uniform population such as Iceland.

Posted by: Erik Larsen at February 10, 2009 3:05 PM

Weren't all the leftard cretins making movies about the evils of HMO's?

Whis is a government monopoly HMO without accountability and the choice to decline it's "services" an improvement over a corporate HMO you can leave any time?

Posted by: Warwick at February 10, 2009 3:33 PM

"There is nothing more dangerous than a doctor nervous about someone like Big Brother always looking over his shoulder while he treats patients, like during, say, neurosurgery... after all, distraction causes brainfarts..."

I can think of one thing even worse than this: a democratic law firm chasing the ambulance which brought in your patient.

Why do you thin there are no OBG/YN's in Edward's state willing to deliver your baby?

Posted by: Warwick at February 10, 2009 3:40 PM

Having politicians decide medical matters has really helped Canadian. We see the results everyday. That is if you live, or are allowed to have a procedure that is. Heck there so wonderful they even decide if you die or not at a certain age. Tolerance in action. All brought to you by your loving Socialist elitists who get 24/7 care.
Have no medical knowledge while you become a number in a system. Yup its been just peachy for Canucks. God help America!!! You will need it from the ravages with greed from a heath system that becomes a government department. Nota choice you make.
JMO

Posted by: Revnant Dream at February 10, 2009 6:58 PM

What's scary is bureaucrats approving or rejecting treatments. These people have no medical training and yet can determine if a doctor is following the right treatment guidelines? Recipe for disaster.
Posted by: Nicole

Welcome to the Canadian Health system Nicole. When your productive working days are shot because the bureaucracy decides you are too old for a hip replacement and doom you to pain for your "golden years". As I've said ad nauseum, Canadian patients are not customers but a burden. Hell, when hospital beds and ERs are closed for weeks at a time in Nova Scotia, do people not get sick? Absurd.

Posted by: Texas Canuck at February 10, 2009 7:23 PM

So this is what it feels like to watch as your country plunges itself into madness? Any advice from my neighbors to the north on how to keep my sanity?

Posted by: SwampFox at February 10, 2009 8:07 PM

"So this is what it feels like to watch as your country plunges itself into madness? Any advice from my neighbors to the north on how to keep my sanity?

Posted by: SwampFox at February 10, 2009 8:07 PM "

SwampFox....one stiff shot of Canuck whisky,chased with a good Canuck beer,followed by keeping your gun well oiled.
OH.And kick a leftard anytime you see one.

Posted by: Justthinkin at February 10, 2009 8:49 PM

Couple of things:

1. The US government does pay a large number of health bills; there is already a socialist health care system in the US. It's just not a monopoly like in Canada.

2. The UK National Health Service (NHS) has spent billions on a yet-to-work national computer system.

Posted by: RW at February 10, 2009 9:25 PM

On health care:

Listen up folks. We can spend our entire GDP on health care and, you know what? we will still get sick and die. Now, it may be different in the future, and I certainly hope so, but that is the way it is now.

So, health care must be rationed. There are two ways to ration health care: By force or by price. I prefer the latter as it is much more fare than the former.

Posted by: RW at February 10, 2009 9:32 PM

Kate asks: "If Obama screws up the American health care system, where the Hell are Canadians supposed to go?"

New profit center for Indian reservations: private hospitals! Make a nice change from the cheap smokes and gambling, eh?

Posted by: The Phantom at February 10, 2009 10:40 PM

Phantom: I love that idea!!! I was thinking Mexico, but the res would be a lot more convenient. Casinos, fireworks, and hospitals ... Lummi Nation could make money hand over fist by providing private hospitals. Interestingly, the Northwest Indian College does offer a nurse's training program, I believe, so who knows?

By the way, first time to this blog but definitely bookmarking it.

Posted by: PeggyU at February 11, 2009 7:23 PM
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