Overeaters, smokers and drinkers: the doctor won't see you now

Macleans ^ | April 18, 2006 | NICHOLAS KOHLER AND BARBARA RIGHTON

[USFRIENDINVICTORIA]

At issue: health care for patients with self-destructive vices -- overeating, smoking, drinking or drugs. More and more doctors are turning them away or knocking them down their waiting lists -- whether patients know that's the reason or not. Frightening stories abound. GPs who won't take smokers as patients. Surgeons who demand obese patients lose weight before they'll operate, or tell them to find another doctor. Transplant teams who turn drinkers down flat. Doctors say their decisions make sense: why spend thousands of dollars on futile procedures? Or the decision is the product of frustration: why not make patients accountable for their vices? {snip} But in a health system with more patients than doctors can treat, where doctors have discretion over whom they'll take on, some say it's inevitable that problem patients will get shunted aside in favour of healthier, less labour-intensive cases.

So here's the question: if people won't stop hurting themselves, can they really expect the same medical treatment as everyone else? Health care in Canada is supposed to be about equal treatment for all comers. [snip]

Doctors across the country told Maclean's of colleagues who would not take "unhealthy patients" -- smokers, drinkers and the obese -- because caring for them would be too complicated, and too much of a burden for their already overcrowded practices. Such patients might, in other words, take longer to treat, reducing the number of patients a doctor can see and bill for. The consequence is an entrenched tendency to choose the gym-goer, the moderate connoisseur of red wine and the non-smoker. Says Dr. Edward Schollenberg, the registrar of the College of Physicians and Surgeons of New Brunswick: "The idea that smoking or drinking or excess weight impacts on your health care is just the way the world is.

[freepatriot32]

ping

[RSmithOpt]

I understand your comment. Just remember with that kind of logic as an example: If you drive tomorrow, and God forbid,you have an accident that's your fault (lot$ of damage and injury), then your decision to drive tomorrow is a good enough reason for no insurer to ever cover you as a driver again in your lifetime. It was your choice to drive, right? Your mistake is good enough for denial of coverage forever, right?

[USFRIENDINVICTORIA]

"Those who are intent of committing suicide by overeating or drinking themselves to death, then I personally have no problem with having them placed on lower priority then someone who wants to live."

To a certain extent, I agree with you -- there are caveats though:

(1) If the public health care system intends to deny a person, or category of persons, service; then those affected should have the option of opting out of the system. They should not be required to continue to support a system, which will not help them -- and, they certainly should not be prohibited from buying health care insurance from any company willing to actually care for their health.

(2) Anyone setting the priorities must so so on the basis of absolutely proven health statistics. For instance, very recently the CDC revealed that the actual number of deaths caused by obesity is less than 1/4 of the number they were using previously. Similarly, small amounts of red wine are good for you -- should total teetotalers be denied care?

[synbad600]

One accident, no. If I am prone to accidents and the ins. co. warns me of the consequences of another accident or failure to take precautions and change my (driving) habits, and I don't, then it is my fault if I can't get ins.

[traviskicks]

Wow, very interesting stuff. This happens in Britian too: No Knees and Hips for Fat Patients too. More stories on Canada: Here.





Libertarian ping! To be added or removed from my ping list freepmail me or post a message here.

[CaptainCanada]

For instance, very recently the CDC revealed that the actual number of deaths caused by obesity is less than 1/4 of the number they were using previously. Similarly, small amounts of red wine are good for you -- should total teetotalers be denied care?

The issue is at the doctor level. If he/she has several patients
waiting for care, then THAT doctor has to make a decision as to who
is going to get his/her attention.
I'd rather the doctor make that decision than leave it to a politician.
In the USA it's an easy call - it's whoever has the fatest wallet.

[USFRIENDINVICTORIA]

The doctor shortage can be pinned on the health care system, and governments.

Governments across Canada conspired, in the late 1980's, to cut and cap medical school spaces, in order to ration health care. These caps have only recently been lifted.

The payment system used punishes doctors for taking on "problem" patients, and rewards them for taking only young, healthy patients. It's not just the "unworthy" who are having problems -- increasingly, elderly people are unable to find a regular doctor.

Doctors can earn considerably more in the U.S. -- hence many leave Canada -- thus exacerbating the doctor "shortage".

BTW, I don't smoke, drink little, exercise, eat well, and am not obese; and I think that people should take personal responsibility for their health. However, no matter how hard I try to avoid it, I still seem to be getting older. I would like to think that medical care will be available when I need it.

"In the USA it's an easy call - it's whoever has the fatest wallet."

That's certainly what we hear all the time here. According to the OECD, Canada spends 6.7% of its GDP on public health care while the U.S. spends 6.6% of its considerably larger per capita GDP on public health care. We spend only 2.9% of GDP on private health care -- compared to 8.1% in the U.S. Most of that private health care expenditure is for insurance -- which we Canadians are not allowed. If we weren't taxed to pay for the public insurance, we could afford to pay for the private insurance.

[CaptainCanada]

Maybe doctors don't like to live in your area, cause where I live
in Ontario, I've never had to wait for medical care, nor has any
(more than 100+) of my relatives within 100 miles of here.
My son lives in the States and he says that except for the cost (much higher)
he hasn't seen any significant difference in the health care systems.
So I remain somewhat skeptical that all these stories are being fed
to serve someones agenda (and it ain't mine)...

[USFRIENDINVICTORIA]

Doctors love to live here (Victoria, BC) -- but there are still shortages. It's worse in rural and remote areas.

For several years (before I moved here) new doctors were required to move to rural or remote areas to practice -- they needed a special (and rationed) certificate to allow them to open practices in the urban areas. Now, special incentives are used to encourage them to go to remote areas.

The biggest difference in the health care systems between Canada and the U.S. is CHOICE. Americans have it, we don't. I'm skeptical about any and all monopolies.

[Fair Go]

I don't think anyone should be denied treatment. However, people who smoke, eat and drink too much etc, might be charged an additional tax for the extra burden they place on the health system. Perhaps the tax might be placed on the "dangerous goods". The revenue raised could then go into improving the health system.

[truth_seeker]

"Canadians don't have any alternative to the public monopoly."

Change the government, change the laws.

Have a Revolution.

[CaptainCanada]

The biggest difference in the health care systems between Canada and the U.S. is CHOICE. Americans have it, we don't

I'm a tad confused by the term "choice".. What choice do Americans
have that I and other Canadians supposedly do not?
I can choose whichever doctor I want (and have done so many times).
Or I can go to any walk-in clinic for any ailment and get free care.
Where's the lack of choice under our system???

[ConservativeMind]

Well, I don't know what the "Hypocritical oath" says, but the Hippocratic Oath doesn't seem to say that one must provide help to everyone.

[Snowyman]

"Canadians don't have any alternative to the public monopoly."

Buloney. Public monoply to do what? Nothing , other than pay the bill.

You can choose your doctor, You can choose what hospital to go to . What procedure to use. You can choose not to do anything .

Fat people die on operating room tables. No doctor wants to kill a fat person . Do what the doctor tells you and get in shape, loose some weight . You just might survive.

That donated liver might just do more good in someone who respects it . Not some drunk whose over all health has so deteriorated they need another smoke to calm their shakes.

Where's the lack of choice under our system???

That's what I'm wondering too.

[USFRIENDINVICTORIA]

We have just such taxes -- on alcohol and tobacco at any rate (see earlier postings on "sin taxes" in this thread). A large part of the justification given for these extraordinarily high excise taxes is to cover the increased "social costs" of consumption of these products. Health care is obviously one of those social costs.

So far, there aren't any extraordinary costs on fattening foods -- but, it's not for lack of supporters. If we were to tax "fattening" foods -- which foods should those be? Advocates of the Atkins diet would even include whole wheat, which is otherwise touted as a health food.

What about dangerous activities? When you think about it, just about anything we do can be dangerous -- so, where do we stop? Actually, not doing anything is dangerous too -- so we'd have to tax couches and Lazy-boy recliners.

If we had a competitive market for health insurance, rather than a government monopoly; various companies could offer different premium schedules, according to whatever health factors they thought were important. Then, we could chose the policies that work best for us, individually. In that way, there would be a market test of the "extra burden".

[Fair Go]

We have competing private health insurance here. The government even gives a rebate to people who take out private health insurance. People who don't take out private health insurance have to rely on the public system. As in Canada, the public system has very long waiting lists. However, if you have private health insurance you can get treated very quickly.

[USFRIENDINVICTORIA]

"Where's the lack of choice under our system???

"That's what I'm wondering too."

(1) We lack the choice of medical insurance provider.

(2) We lack the choice to buy supplementary private insurance. (I.e. any insurance which would be considered as creating "two-tiered" medical care.)

(3) We lack the choice to go to a competing service, even when the wait-list for an operation is months or years long.

(4) We lack the choice to obtain timely MRIs, or other modern, effective (and expensive) diagnostic tests. (According to the OECD, in 2002, Canada had 4.5 MRI machines per million people. There were 8.6 per million in the U.S. and 35.3 per million in Japan.)

[USFRIENDINVICTORIA]

Canadians are slowly (very,very slowly) waking up to the fact that we'll have to move to a system that's more like yours.

[Snowyman]

"That's what I'm wondering too."

(1) We lack the choice of medical insurance provider.

Why would I want to have such a beast? I've got one now.

(2) We lack the choice to buy supplementary private insurance. (I.e. any insurance which would be considered as creating "two-tiered" medical care.)

I'm not sure what you're referring to here but anything that isn't covered by , in my case by OHIP, I can buy insurance for.

(3) We lack the choice to go to a competing service, even when the wait-list for an operation is months or years long.

Other than any elective operation you care to choose , I'm not aware of having to wait for anything . otoh , You want a no cost knee or no cost cataract removal and new eye sight, , waiting a couple of months for it seems like a good deal to me.

(4) We lack the choice to obtain timely MRIs, or other modern, effective (and expensive) diagnostic tests. (According to the OECD, in 2002, Canada had 4.5 MRI machines per million people. There were 8.6 per million in the U.S. and 35.3 per million in Japan.)

No , I can go to private clinics for a MRI, CT or blood work . MRI in Hull Quebec is something like 700 bucks , same day service. Then there are private hernia and eye clinics . And , although it happens much less than advertised , I can go to America. With my credit cards .That too is a choice. :)

[John W]

I smoke and enjoy a drink once in awhile.I do not expect to ever have any problem finding health care.There is way too much money available from my insurance company and myself for you all to turn me away.So, enjoy the challenge and the jack.