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Universal Health Care - Still Not Possible in US

Anecdotally, this seems to be the issue I hear people griping most often about (and also the one that I personally have most often bumped up against) in Ontario: you very often wait in emerg for hours to get triaged, hours to get seen by a doc, hours for any follow-up, and hours to get discharged. I'm not sure I've been in and out of emerg in fewer than 6 or 7 hours, ever, and that's not good. And on top of that, it's of course well documented that you'll often spend much or all of that time in a hallway. None of it is good.

Again anecdotally, it seems the second-most griped-about topic is the wait time for MRIs (and in cases other types of scans); it's kind of nuts that you can wait literally 6+ months for a medically necessary scan.

The other difficult thing, of course, in making Canada-wide assessments and, even more so, in prescribing solutions (pardon the pun), is that healthcare is administered by the provinces. In Ontario, there's lots of blame to go around: you've got one party (blue team) that typically wants to slash spending for ideological reasons, and another (red team) that typically makes hay about "investing in education and healthcare" without dramatically increasing spending levels or enacting reforms. (There's also of course an orange team carping on the sidelines.)

And that's the difficulty: Contemporary political dialogue/wisdom has made it effectively impossible for any party to raise taxes on anyone except the most wealthy (which is limited in its utility for various reasons), and so basically no one can plausibly come up with a plan to make big new investments in the stuff that is super expensive (healthcare and education). I'm not sure how that wheel gets broken, but I'm finding it hard not to despair in the meantime.

Our local hospital has a so-called 'sit and stitch' room which seems to work reasonably well. A lot of the backlog is folks showing up with colds and the flu - if I was king of the world I would empower the staff to just tell them to go home. Triage is fairly quick, it's what happens after that where the problems start.

Our experience yesterday:
- Took the wife in around noon with dizziness. There were about 4 or 5 waiting. Passed thru triage and got into emerg around 1330 (at this point I was told to go home). Around 1830, she called and said she had a CT scan and other assorted tests and was going to be admitted. They were pretty sure it was benign paroxysmal positional vertigo but out of 'abundance of caution' wanted to rule out a TMI or micro-bleed. Our hospital doesn't have an MRI and it was faster to get her one at the regional health centre as an in-patient.
- I took a care package incl. e-reader and tablet, plus a tea. Emerg was packed. Not fed, and I couldn't get any advice that she could be fed. I snuck her a chocolate bar from the vending machine. She was moved from emerg to a floor around midnight. She is convinced it was a 'special care' ward given some of the patient (I suppose a bed is a bed). She was woken on several occasions by various staffers doing various things. Apparently, sleeping at night, and doing things as quietly as practicable - just in case people are sleeping - is foreign to them.
-This morning around 1100, she said she now was not going for an MRI. Here symptoms had subsided quite a bit and they re-assessed their abundance of caution in light of the problem of booking transport and a transfer nurse. Silly me, I dropped everything and waited for the immanent call to go get her - which came at 1500 (on one occasion a few years ago she did, in fact, walk out. Does that ever cause a kerfuffle).
- She is currently sleeping.

Although modern imaging devices are expensive, I agree that staffing is a huge issue. A former neighbour was i/c of the imaging department at a local hospital and said they could run all devices 24/7 (with downtime for maintenance) if they had the staff. There was a bit of a scandal a number of years ago when it was learned that hospitals were allowing veterinary use during off hours, which led to the joke that if you had an early morning appointment, just brush off the pet hair.
 
I hope everything is ok. My DIL does imaging. She works all shifts.
Seems ok. It's caused by calcium crystals in the inner ear dislodging and migrating from where they are supposed to be. There are actually 'exercises' to move them back, but it is often recurrent.

I imagine large hospitals run their departments 24/7, although whether they operate all devices all the time probably varies.
 
She actually works in a small hospital outside of the GTA, but they are a trauma centre so that may be why.
 
Most X-ray techs are capable of operating the various scanners.

At a certain GTA hospital, with which I am very familiar, the policy is that 'scheduled scans are early morning to late early/late evening depending on the scanner, M-F.
Weekends have scheduled CT Scan service, but not MRI.
But the CT tech can operate the MRI if there's a STAT request.
The dedicated CT Staff are all gone by 11pm each night.
But the E/R X-Ray dept staff are all trained on those scanners.

However, those scanners are in a different part of the hospital than the E/R.
So only an emergency gets them over there; and if they leave, the ER has no X-ray techs until they come back.

Its a poorly thoughtout system.
 
As to the number of MRI machines available, I found this over at Statista. They are not famous for precision accuracy, but I'll assume that at 2019 this was vaguely about right.

1628120273502.png



I don't think we need to be in the proverbial 'Top 3'..............

But I would suggest that if Austria has 70% more MRI machines per capita and #3 Germany has 200% more capita ++ that that does suggest we need to buy a few more.
 
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Anecdotally, this seems to be the issue I hear people griping most often about (and also the one that I personally have most often bumped up against) in Ontario: you very often wait in emerg for hours to get triaged, hours to get seen by a doc, hours for any follow-up, and hours to get discharged. I'm not sure I've been in and out of emerg in fewer than 6 or 7 hours, ever, and that's not good. And on top of that, it's of course well documented that you'll often spend much or all of that time in a hallway. None of it is good.

Again anecdotally, it seems the second-most griped-about topic is the wait time for MRIs (and in cases other types of scans); it's kind of nuts that you can wait literally 6+ months for a medically necessary scan.

The other difficult thing, of course, in making Canada-wide assessments and, even more so, in prescribing solutions (pardon the pun), is that healthcare is administered by the provinces. In Ontario, there's lots of blame to go around: you've got one party (blue team) that typically wants to slash spending for ideological reasons, and another (red team) that typically makes hay about "investing in education and healthcare" without dramatically increasing spending levels or enacting reforms. (There's also of course an orange team carping on the sidelines.)

And that's the difficulty: Contemporary political dialogue/wisdom has made it effectively impossible for any party to raise taxes on anyone except the most wealthy (which is limited in its utility for various reasons), and so basically no one can plausibly come up with a plan to make big new investments in the stuff that is super expensive (healthcare and education). I'm not sure how that wheel gets broken, but I'm finding it hard not to despair in the meantime.

The other thing to add to this, lest it be interpreted as an argument for making any part of our healthcare system more like the US system (as I also hear often in certain corners of my circles): a few anecdotes from my time living in the US for a number of years until 2016:

Despite both me and my wife having top-of-the-line, employer-sponsored private insurance, we had to pay roughly $5,000 out of pocket (plus deductible) for her surgery to repair a torn meniscus, in addition of course to the relatively expensive monthly premiums that came off every paycheque and a high deductible. We also, despite being in generally good health, regularly paid $500-700 out of pocket for blood work/lab work every single time, and about $75 for every GP visit (the principle pissed me off on that one more than the cost).

And then younger employees at the company I worked for -- Ivy League graduate-types at good jobs -- would routinely avoid getting care for ailments up to and including broken bones. Just a bad, bad system unless you are super rich.
 
Most X-ray techs are capable of operating the various scanners.

At a certain GTA hospital, with which I am very familiar, the policy is that 'scheduled scans are early morning to late early/late evening depending on the scanner, M-F.
Weekends have scheduled CT Scan service, but not MRI.
But the CT tech can operate the MRI if there's a STAT request.
The dedicated CT Staff are all gone by 11pm each night.
But the E/R X-Ray dept staff are all trained on those scanners.

However, those scanners are in a different part of the hospital than the E/R.
So only an emergency gets them over there; and if they leave, the ER has no X-ray techs until they come back.

Its a poorly thoughtout system.

An additional bottleneck might be (and I say might as this is way out of my scope) is the availability of folks to read and interpret the images. They used to be called radiologist when the only device was x-ray; I don't know if that is still the case. I suppose it's easier to determine the way forward when you are seeing a broken bone in an x-ray, but likely more challenging for neurological scans.
 
I just remembered this - clearly the solution to our healthcare delivery issues:

When my twins were being delivered at Women's College back in 2003 the doctor at my end of the table (away from the business end, C-section) was from the UK. As soon as I sat down I saw the machine and asked, is that the machine that goes bing. We both had a chuckle, my wife beside us not so much.
 
When my twins were being delivered at Women's College back in 2003 the doctor at my end of the table (away from the business end, C-section) was from the UK. As soon as I sat down I saw the machine and asked, is that the machine that goes bing. We both had a chuckle, my wife beside us not so much.
We have a Premier here in Ontario that says "NO!" to health care improvements.
 
I just remembered this - clearly the solution to our healthcare delivery issues:


When my twins were being delivered at Women's College back in 2003 the doctor at my end of the table (away from the business end, C-section) was from the UK. As soon as I sat down I saw the machine and asked, is that the machine that goes bing. We both had a chuckle, my wife beside us not so much.
In the US, it's the Machine that goes Ka-Ching!
 
A number of years ago an acquaintance got in a serious motorcycle accident in the US. A couple of days in Emger and ICU before he was stable enough to fly him back. I no longer recall the cost but do recall it was phenomenal (and it wasn't even Florida!).
 

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