Hsieh Forbes Column on The Great Canadian Sperm Crisis

My latest Forbes piece is now up: "The Market Solution To The Great Canadian Sperm Crisis".

A couple of facts:

* There is an enormous shortage of donated sperm in Canada, such that infertile couples have to rely on (gasp) imported sperm from the US.

* The Canadian government outlaws paying Canadian sperm donors for their product.

Hmm....  Could there possibly be any connection between these two facts?

For more details, read the full text of "The Market Solution To The Great Canadian Sperm Crisis".

Quick Links: Canada, Medicaid, Doctors Switching Careers

"The Doctor Will See You in 18.2 Weeks". Update on waiting times in Canada's single payer system.

CNBC: "The great Obamacare-Medicaid bait 'n' switch"

Forbes: "1 In 4 New Doctors Would Change Careers If They Could Start Over"

Canadian Surgeons and Patients End Runs Outside The System

The Calgary Herald reports, "Have scalpel, will travel: Alberta surgeons operate abroad to bypass wait times".

More Canadian doctors are practicing outside the country's borders (e.g., in the Caribbean) to provide patients with faster, better service.

In this case, a Canadian woman chose to have her knee surgery by a Canadian doctor in the Caribbean with only a 2-week wait (rather than a 7 month wait in the government socialized system).

This was after she got a private MRI scan (rather than waiting 8 months for a government-approved MRI scan.)

The article notes it's not merely the "super rich" exercising this option, but also many ordinary people who don't wish to wait.  In the case, the patient was totally reliant on her husband to get around, requiring pain medications that made her woozy.  For her, spending money to receive faster medical care made perfect sense.

This two-tiered system may be the future of American health care in a few years.

Cancer Crisis for Canadian Women

The 11/13/2012 Montreal Gazette reports on lengthening wait times for female patients: "It's a crisis for Quebec women".

Some chilling excerpts:

A leading Montreal gynecologist said that these days, she cannot look her patients in the eye because the wait times are so shocking...

The worst cases are gynecological cancers, experts say, because usually such a cancer has already spread by the time it is detected. Instead of four weeks from diagnosis to surgery, patients are waiting as long as three months to have cancerous growths removed.

“It’s a crisis for Quebec women,” said Lucy Gilbert, director of gynecological oncology and the gynecologic cancer multi-disciplinary team at the McGill University Health Centre.

(Read the full text of "It's a crisis for Quebec women" for more details.)

Sure, the medical care may be "free".  But what this means is that patients pay in time, rather than money -- time they may not have when the cancer clock is ticking away.

(Link via Docs4PatientCare.)

Canadian Rationing Strikes Again

From Ontario Canada: "Last-hope prostate drug not funded".

Here's the opening of the article:

There are two tiers of men with advanced prostate cancer in Ontario: Those who get access to a remarkable drug through private insurance, and those who get a death sentence.

The grim news is often delivered at the London Regional Cancer Program to men whose shoulders sag and jaws drop when told Ontario's Health Ministry has for 15 months refused to pay for a medication covered by every other Canadian province.

"There's shock, fury and dismay," said oncologist Kylea Potvin. "Everyone thinks we have this wonderful universal health care system, but this is absolutely not the case. We've increasingly become a two-tier health care system where if you have money, you have access."

(Read the full text of "Last-hope prostate drug not funded".)

The US isn't there yet.  But we're moving there.

(Via Instapundit.)

Another Canadian Warns Americans

James Hancock (an Canadian who now lives in the US) made the following comments about Canadian health care on Diana's blog.

He has graciously given me his permission to repost this slightly edited version here:

Welcome to Canadian healthcare folks, where 80% of all taxes from all levels of government got to healthcare and related fields. Where a hip replacement takes more than a year. Where chemotherapy takes 1 1/2 months of your 6 months to live. Where they're considering death panels like the father of socialized medicine, the UK.

By 2020 Canada's healthcare system will consume 120% of taxation. There are virtually no family doctors left because the pay is horrible and if you go to emerge and you're not dying on the gurney, it will take you at least 3 hours to see a doctor.

I sprained my ankle once. It took 4 hours to see the doctor to have him send me to x-ray. It took 2 hours in radiology to get the x-rays and then another 4 hours to see the doctor to look at the x-ray and tell me it wasn't broken (very bad sprain that might have been more).

Cut in my hand that got infected, 3 hours to see a doctor for a prescription for antibiotics.

2nd degree burns to my foot because of a corn pot tipping over, 3 hours to see a doctor for which the doctor prescribed pain killers that I'm allergic too, for which I told him directly I was allergic and my file also said so.  Another 3 hours to get a different prescription because I refused to leave until he fixed it. In the mean time, I'm just about passing out in pain.

The only people that get good medical coverage in Canada are celebrities. Even rich people have to come to the US for good healthcare because it's illegal to buy private healthcare in Canada. (soon to be overturned by the supreme court as a violation of our freedom of association, so Canada is about to get more free healthcare while the US gets less!) Everyone else waits, and waits and waits.

Get your passports ready folks! You're going to be going to Singapore and India for healthcare in the US soon.

James also pointed me towards this related recent news story: "Wait times for patients 'worsening'" (CBC News, 6/19/2012).

We have been warned.

Saad: Don't Romanticize Canadian Health Care

Professor Gad Saad of Concordia University shares his insiders' perspective on Canadian health care for Americans in this 6/14/2012 piece for Psychology Today, "Don't Romanticize the Canadian Healthcare System".

Here is the opening:

As a Canadian, I am often bewildered by the American Left's utopian albeit perfectly incorrect views of the Canadian healthcare system. The general notion, as exemplified in Michael Moore's 2007 film Sicko, is that countries such as Canada and Cuba offer compassionate universal free healthcare to its citizenry while a diabolical consortium of capitalists headed by Dr. Evil runs the American system.

Let me share some important realities regarding our "free" Canadian healthcare.

He discusses 5 points, three of which are briefly summarized as follows:

1. Canadians pay exorbitant taxes for their "free care"

3. It is extremely difficult to find a family physician willing to take on new patients. Getting to see a specialist is even harder.

4. Even if you have a medical emergency, you may have to wait 8-14 hours for care.

(Each of these points, and two others, are discussed in greater detail in "Don't Romanticize the Canadian Healthcare System".)

Of course, those with special "pull" in Canada  can "jump the queue" and receive their MRI or surgery ahead the others on the waiting list. But this merely replaces "political pull" as the currency for medical services, rather than money.

Quick Links: Canada, Nanny State, MLR

Ontario government "slashes" fees paid to doctors, in order to save money.

(Because the government is the "single payer", the physicians basically have two choices: Like it or lump it.)

Nanny state update: "Utah High School Fined $15,000 for Selling Soda".

(But it's for the children, so it's ok.)

"Medical Loss Ratio" (MLR) mandates under ObamaCare are driving private insurance agents out of business.  (Via Brian Schwartz.)

Linking Licensure to Mandatory Service

The 5/1/2012 New York Times reports that new lawyers in New York state must work 50 hours for free, on terms specified by the government in order to get their licenses to practice.

From the article:

Starting next year, New York will become the first state to require lawyers to perform unpaid work before being licensed to practice, the state’s chief judge announced on Tuesday, describing the rule as a way to help the growing number of people who cannot afford legal services.

The approximately 10,000 lawyers who apply to the New York State Bar each year will have to demonstrate that they have performed 50 hours of pro bono work to be admitted, Chief Judge Jonathan Lippman said. He said the move was intended to provide about a half-million hours of badly needed legal services to those with urgent problems, like foreclosure and domestic violence.

The Freakonomics Blog asks a very natural question: "What would happen if newly minted doctors were similarly seconded into pro-bono work?"

Given the anticipated upcoming physician shortage, I would not be surprised to see similar proposals mandating physician service as a requirement of medical licensure.

It might take the form of mandatory pro bono work or mandatory acceptance of Medicare/Medicaid patients. Both Canada and the state of Massachusetts have proposed variations in the past, although they were never enacted into law.

Or to paraphrase the old saying: "First they came for the lawyers. But I wasn't a lawyer so I didn't speak out..."

Future Doctors in Canada and the US

The Canadian newspaper Globe and Mail warns that, "The professional-class bubble is bursting".

With respect to physicians in Canada they note:

But young doctors face the same squeeze as young lawyers. Like law school, medical school is so competitive that today’s students need advanced training and graduate degrees in order to get in. By the time they qualify as doctors, they’re well into their 30s, with $180,000 in debt.

And the expectations of medical students are also disconnected from reality. The trouble is that doctors have just one big client – government – whose ability and willingness to pay is shrinking fast. The booming consumer demand for medicine doesn’t necessarily translate into jobs. Even though hospitals need extra surgeons, they aren’t hiring them because they can’t afford to expand operating-room time.

Of all the general surgeons who finished medical school at the University of Toronto in the past two years, only 15 per cent have found work. The rest are pursuing further training, in hopes that something will eventually open up.

Things aren't quite this bad in the US. But as government directly or indirectly imposes further restrictions on how doctors can practice and what they can get paid, we'll see more bright young people decide not to become physicians.

As a current benchmark, Huffington Post reports that already, "Nearly Half Of Doctors Regret Going Into Medicine: Survey".

And if we keep discouraging the best young minds from becoming doctors, who will take care of you when you get sick in 10 years?

Perry: Mayo Clinic Offers Insurance For Canadian Patients

Mark Perry notes, "U.S.-Based Mayo Clinic Offers Three Medical Insurance Programs for Canadian Patients".

From his blog post:

The Mayo Clinic in Rochester, MN, has introduced two new insurance programs. That wouldn't be very newsworthy except that the insurance programs aren't being offered to Americans, they're being offered to Canadians, who already have access to "free" medical care in their home country...

According to the Mayo Clinic, 25% of the international patients they serve every year are from Canada. And why is an American hospital/clinic serving so many Canadians?

According to this news report about Mayo's insurance programs for Canadians, "the publicly funded health system in Canada decreases the choices available to patients, and can also result in delayed diagnosis and treatment. That's why, within the national system, it's good to offer choices for those who need diagnosis confirmation or even treatment for serious illness."

Curious how the Mayo Clinic recognizes the problems in Canadian health care that apologists like Michael Moore fail to mention...

Quick Links: Discounted Surgery, Canadian Laundry, Faux Transparency

Economist Mark Perry discusses a nice innovation, "Markets in Everything: Market-Based, Deeply-Discounted Surgery for Cash, Payable in Advance". (Via Kelly V.)

Canadian health care update: "Hospital tells patients to do own laundry". (Via Dr. Art Fougner.)

Drs. Scherz and English of Docs4PatientCare: "Obamacare: We Need a Earmark to Treat that Disease". Faux "transparency" will be a vehicle for stealth rationing.

Quick Links: Death Spiral, E-Smoking, Canadian Drugs

Investor's Business Daily: "ObamaCare Is Designed To End Private Insurers" (3/2/2012)

Ryan Krause: "Bureaucrats Demand You Stop Smoking... and Stop Not Smoking, Too"

Globe and Mail: US FDA interferes with Canadian patients' drug supply. Note that, "Health Canada completed its own inspection later that month, and found no issues with the company’s Canadian products." (2/19/2012)

(Here's a copy of the FDA warning letter to Novartis, the parent company of Sandoz Canada.)

Pipes On Socialized Medicine

In her 12/19/2011 Forbes column, Sally Pipes reminds us that "The Ugly Realities Of Socialized Medicine Are Not Going Away".

In her critique of the UK National Health Service she notes, "The British healthcare system may 'guarantee' access to care -- but that doesn’t mean patients actually receive it."

In addition to the poor quality care and rationing, there are indiginities such as:

A report released in October by Britain's health regulator found that a stunning 20 percent of hospitals were failing to provide the minimum standard of care legally required for elderly patients.

As part of the study, inspectors dropped by dozens of hospitals unannounced. They found patients shouting or banging on bedrails desperately trying to get the attention of a nurse. At one hospital, inspectors identified bed-ridden patients that hadn’t been given water for over 10 hours.

The upcoming austerity measures will only amplify maladies like these.

The NHS is broken -- and not in some superficial way that a simple tweak would fix. The incentives are wrong. The government's main priority is keeping costs low -- not providing quality care. Patients can't choose how they receive their care -- it's one-size-fits-all medicine. And the entrenched NHS bureaucracy has no reason to improve efficiency.

For more details (and implications for the US), read the full text of "The Ugly Realities Of Socialized Medicine Are Not Going Away".

Kurisko on Canada and ObamaCare

Dr. Lee Kurisko discusses "Why Obamacare Will Be Worse than Canadian Healthcare":



Dr. Kurisko is a radiologist who used to practice in Canada before he relocated to the US.

One of his key themes is the "fatal conceit" of the central planners in both Canada and the US who think they can devise top-down health care "systems" more efficiently than the marketplace. Of course, the inevitable result is shortages.

Another is the difference between genuine insurance (to protect against expensive but rare unforseen problems) and the current US system of inefficient 3rd-party prepaid care masquerading as insurance.

Dr. Kurisko also discusses a variety free-market reforms as an alternative to ObamaCare.

Waiting to Find a Family Doctor in Canada

In the 8/22/2011 Globe and Mail, Gloria Galloway reports on the "The soul-destroying search for a family doctor".

Basically, it took her years to find a primary care doctor who would accept her. And now she has a doctor, she will of course still have to deal with any waiting lists for complex care such as surgical procedures or MRI scans.

Again, "coverage" does not equal actual medical care...

(Via Carpe Diem and Kelly V.)

Quick Links: Snitching, Collectivism, Meaningful Use

The National Post reports how Ontario's health ministry has established a "snitch line" where people can report on doctors who engage in private-pay health care without government approval.

Dr. Rich Fogoros discusses the latest attempts to argue against direct-pay medicine on the grounds that "opting out" of the system increases the burdens on the rest of doctors and patients.

(Of course, those arguments omit the fact that those burdens are caused by government restrictions of the free market in the first place -- including licensing requirements for practitioners -- and would be easily alleviated by permitting a free market in health care services.)

Physician-blogger "NotDeadDinosaur" discusses how "Meaningful Use Requires Meaningless Data".

(The government will be requiring physicians to collect and submit data that doesn't have any relevance to their clinical practice -- but could be used in the future for political purposes. Via @rlbates and @sonodoc99.)

Learning From McDonald's

In the 8/12/2011 Canadian newspaper Globe and Mail, Andrew Steele wrote an interesting piece entitled, "What the health care system can learn from McDonald's".

Steele makes the point that innovations from the free market (such as the fast food industry) can also be applied to save money and improve quality in health care.

He notes that:

...[T]he Aravind Eye Care System has become the largest provider of eye care in the world. They perform hundreds of thousands of cataract surgeries a year, restoring sight to millions of people.

For the poorest of the poor, their services are the difference between starvation and a job, misery and dignity, death and life.

The inspiration of their model is not the Harvard Medical School or Johns Hopkins. It's McDonald's.

Steele's article also links to this TED talk about the Aravind Eye Care System:



Unfortunately, the article doesn't go far in enough in advocating privatization of Canada's current government-run system. In particular, if a government-run system attempted to create a network of such clinics, they would likely become ossified bureaucratic dinosaurs in short order -- precisely because the clinics would no longer have the freedom to innovate and respond to market forces in the same fashion as if they were privately owned.

But if the article gets people thinking more broadly about the merits of private-vs.-government health care, it will be a good start.

(Read the full text of "What the health care system can learn from McDonald's".  Link via R.B.)

Our Friend the FDA

The FDA says walnuts are drugs.

Also, "The Food and Drug Administration has banned the only over-the-counter asthma inhaler, Primatene Mist, on the grounds that it releases chlorofluorocarbons (CFCs) and is thus bad for the ozone layer."

Fortunately, some people are speaking out against the nanny state mindset. For instance, Scientific American recently urged the FDA and our politicians to "End the War on Salt".

Today's Canadian Horror Story

This Canadian patient was told he must wait 12-18 months for spinal surgery, at the risk of developing paralysis. (Via @DaveSolsberg.)

Maybe he'll find another doctor who can help him "work the system" and get the surgery sooner. Or maybe not. Stuart Browning once noted that some Canadian doctors have been pressured by hospital administrators not to perform too many surgeries -- at the risk of losing some of their already-limited operating room time. (Unfortunately, the original link is now off-line.)

Fortunately, the US is not yet in such dire straits. Yet.