Why we do not want the Canadian system
I have many medical friends who decry our health care system. We do have 40 million uninsured patients. We have patients who cannot afford their medications. Advocates of universal health care (a euphemism for socialized medicine) point out how unfair our system is. They rant that health care is a right (and one wonders why not legal care, why not a nice house, why not a nice suit). Then they often point to the Canadian system.
I too would like a better solution to insuring the uninsured, but please do not change the system so much that we have a Canadian like system. Long Lines Mar Canada’s Low-Cost Health Care.
Waiting times have also increased because an aging population has put more demands on the system, while the current generation of doctors is working fewer hours than the last.
Waiting can occur at every step of treatment. A study by the conservative Fraser Institute concluded that patients across Canada experienced average waiting times of 16.5 weeks between receiving a referral from a general practitioner and undergoing treatment in 2001-2002, a rate 77 percent longer than in 1993. The recent Senate report noted that waiting times for M.R.I., C.T. and ultrasound scans grew by 40 percent since 1994.
“Waiting lists are the hornets’ nests that are jeopardizing the system,” said Dr. Tirone E. David, professor of surgery at the University of Toronto. He noted that Ontario residents needed to wait an average of two months to see a cardiologist unless it was an emergency, queues for angiograms took four to six weeks, and waiting times between initial examination and micro-valve repairs could take as long as six months.
“It wasn’t that way 15 years ago,” Dr. David added. “It does not alter the ultimate outcome, but there’s an anguish and uncertainty when a person feels their life is in a holding pattern for up to a year.”
What are the real consequences of changing our health care system? Would it influence how hard physicians work? Would it effect who becomes a physician? Would you have to wait?
As I was saying
New Study Stokes Blood Pressure Debate. This lead article in the NEJM asks the question of the best initial BP medicine and gets a different answer. In this article the ACE inhibitor (enalapril) outperformed the diuretic (hydrochlorothiazide). The greatest positive effect occurred in the men (all patients in this Australian study exceed 64 years).
But a large study from Australia, published Thursday in the New England Journal of Medicine, found that ACE inhibitors are somewhat better at preventing heart attacks — at least in men.
The new study is unlikely to end the debate, however — partly because of differences in the two studies, but also because the question is more complex than which drug is better. Many patients, in fact, need two or three drugs to control blood pressure.
For nearly two decades, the question hasn’t been “is drug A better than drug B. The question is: Do you have to use A and B, or A, B and C to control blood pressure?’’ said Dr. James Reed of Morehouse University, a participant in the U.S. study.
As I was saying when I criticized the ALLHAT study, the monotherapy question may not be the right question. I could say from the previous study that diuretics were better than ACE inhibitors. I cannot say from this study that ACE inhibitors are better.
Thus, I stand by my previous rants. Diuretics are an excellent choice for monotherapy when the patient has no specific indication for another class. When one starts with and ACE inhibitor, and does not achieve excellent BP control, then one should add a diuretic. Fortunately, we do not have to choose between ACE inhibitors and diuretics, rather we often appropriately use them together. Once again we do not have data on the combination, but can only assume that the synergistic effect on BP control leads to a synergistic effect on outcomes.
