On The Media

About 2 years ago I was working on a project just outside of Ottawa when I cut my hand in an industrial accident. No biggie I figured, it was bleeding pretty bad and I think I hit a tendon, but we were able to get the bleeding under control with some compression and I figured it might take about 15 stitches to close it.

When brought into the ER (it being Monday the local clinic was closed for budgetary reasons), I waited nearly 3 hours just to see a nurse. She then told me she could do nothing more for me, as I wasn’t Canadian and It wasn’t “life threatening”, until I ponied up a credit card as a deposit for care. I asked her what would happen if I didn’t have anything and she told me that I would be refused treatment so I whipped out my Visa. After paying for the “free” service I had to wait an additional 5 hours to see the doctor. A quick 18 stitches later he was done. I asked about connective tissue damage and he told me “it looked OK” and to take some aspirin or ibuprofen. My bill came to $1800.

Contd

When I got back home the following Thursday, I saw my GP the next day without an appointment. My GP also noticed I was running a low fever and suspected the wound was infected, so he lanced it, drained the pus and put me on a heavy dose of antibiotics. He was also concerned about some tendon damages he got me over to an orthopedic the same day who had me scheduled for an MRI the next morning. He called that following Monday, as a radiologist looked at my MR results that weekend, and asked me if I could be scheduled that week for some minor hand surgery to repair the tendons. He later informed me that this should have been done “immediately” and that I would need several more weeks of additional hand therapy because of the additional scarring caused by the delay.

Sure, the “private” American health care system is expensive, but you get results. And yes the Canadian system and all government run health care systems are “free”, but you better pray to God you don’t need to use them.

Mike-

I think what your comment reveals is not that one health care system is better than another, but how often we (citizens, media) act as though one individual's experience speaks for an entire "system" as a whole. It's great that you got excellent care in the U.S. The fact that you have a GP already says volumes about your level of coverage. Those who are uninsured, however, have vastly different experiences with American health care than the one you cite above. I had to have surgery a few years ago, and it was covered by my excellent insurance. However, if I had not had insurance, there's no way I could have paid the nearly $10,000 bill for the surgery and overnight stay (a relatively cheap one, by most standards). I have a friend who suffered a blood clot while in Germany. She had surgery to remove it, plus follow-up care, and her total bill (because she was a foreigner) was $2,000--far less than what it would have been for an uninsured person in the U.S. What's more, she felt she received better care there than she would have at the hospital in her area. Does this "prove" that government-run health care is amazing? No--just as your one experience in Canada doesn't prove that the entire system is inadequate. I think that's the point of the interview: to show how often any side of a debate tries to use one experience to speak for the whole of a complicated and intricate system, and how any one person's story can be presented in a variety of ways, depending on the message the communicator has in mind.

As a side note, I'd say your three hour wait in the Canadian ER doesn't sound all that long to me. I can think of five friends off the top of my head who've had insanely long waits (10, 14, even 22 hours in one case) in a variety of emergencies here in the States. Again, I think this highlights the problems associated with thinking our own experience stands as evidence of a whole. Of course, it could also suggest the need for health reform in our country: the uninsured often go to emergency rooms in non-emergency situations because they have no GP and they know they will eventually be seen by a doctor.

Without evidence, anecdotes about Canadian health care are suspect.

I've suffered several injuries in my life comparable to Mike H''s and I've never experienced what he did. For every hard-luck tale, they're are thousands that present the opposite.

Canadians are getting fed up with being dragged into American politics on this issue. It's an imposition. This is your problem, not ours.

A few notes for cleanup ... I waited 3 hours to see the triage nurse, and a total of 8 hours to see a doctor who then proceeded to do a third rate job at first rate prices. I don’t know anyone who would walk into an emergency room in the states and wait that long of they were bleeding. As someone who has the opportunity to work overseas (and Canada) quite often my counterparts in the host country always tell me to go to a private hospital or clinic for medical attention. This was the case when I had to use medical facilities in both Italy and Belgium.

I'll amen the comments that one experience doesn't speak for all. There are weaknesses in all health care systems. I have good health care insurance here in the U.S., and I have had good care and poor care. Competent doctors and not so competent.

My daughter lives in Canada, and she has seen good care and not so good care. I would suspect that you would find this true in most countries. Still, the U.S. could improve and it should. I agree with "A Canadian", leave Canada out of it. Let's deal with our problems and let Canada deal with theirs. Saying that it is not better in Canada doesn't fix the U.S.

Mike H,

You had a bad experience with a not very professional doctor and triage nurse. Happens and it is not fun. That said, an anecdote does not data make.

You don't know anyone who wait that long in US ERs? If you can type messages on this board, I'll assume you can google too.

Try this: "death" "waiting" "ER". Things much worse than waiting for an injured tendon have recently occurred, and will continue to do so as long as serious reform, be it public option, universal HC, insurance overhaul (take your pick) is not implemented.

I assume you are aware that under the Obama plan, those who want to keep the coverage they already have will be able to do so, right? So, in your case, everything should be OK.

I want to thank the team of OTM for the interview with Maureen Taylor. The stenographer syndrome in the US media in general is so widespread that I just heard a rebuke of reichpublithug sob sister's health care "case" *for the first time*!!

The statements made by Maureen Taylor about the Shana Holmes case are as misleading as the ad that she is criticizing. Based on Ms Taylor’s report I can not determine what the exact mass was, but here are some of the possibilities:

http://www.pituitaryadenomas.com/benignpituitarycyst.htm

It could have been a benign tumor, a cyst or a cystic tumor. Either way it can press on one optic nerve, chiasm where the nerves join or both optic nerves. This can irreversibly damage the vision. The more damage there is the quicker it will progress to blindness. Based on what I know I can not tell whether waiting six months would have resulted in blindness, but Ms Homes complaint of poor vision suggests an advanced case. In the US such a delay would be severe malpractice. Look under MORTALITY/MORBIDITY at the link below:

http://emedicine.medscape.com/article/1157189-overview

The tumor can hemorrhage suddenly into itself and swell. This is known as pituitary apoplexy. This can result in immediate blindness, loss of eye movements or loss of life. See below:

http://emedicine.medscape.com/article/1198279-overview

So for an expert like Ms Taylor to miss all these points and refer to it as “vision trouble” suggests politically biased medical reporting.

The story was an insightful look at the advertising campaign to stop US citizens from supporting change to health care. OTM shows the inability of the US press to play a true journalistic role. The interview pointed out a comparison between the US and Canada, the ability of the journalists to provide public policy reportage and the ability of PR and advertising to overwhelm and control what the public hears.

And in the reporting of the health care issues, the reportage tends to tilt toward the mechanics and outcomes when our system versus others. Little coverage is done about the philosophy or principles. To start that conversation, I would say that the current US system is an uneasy mix of some humane practices like emergency care for everyone and brutalizing and dehumanizing practices like rote denial or discontinuation of coverage, forcing insured, but ill and vulnerable into tougher financial times and bureaucratic paper blizzards.

I believe having a system with brutal aspects also leads to poorer care and worse results: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

Among my family living in Canada, care has been more humane and pleasant than in the US including several house calls and never any costs or denial of care.

The brutalities of our system have led to some odd current beliefs that may seem obvious to some, but odd to me. For example, paying copays and deductibles contributes to lower costs. That I believe is the opposite of reality and the experience of most countries. Then if everyone is tossed into the same system, somehow there will be rationing and the impossibility of bucking the system. Actually, by dividing us up it is easier to deny care because of individual and specific issues as opposed to a system that universally demands a certain standard of care. Even some proponents of single payer system seem fixated on the mechanics rather than the humanity of the system.

Daniel Bennett

Washington, DC

I couldn't help but notice the irony in your report "Blame Canada" which evaluated a commercial highlighting a Canadian patient who was forced to wait six months before being treated for a pituitary lesion. In the report, commentator Maureen Taylor was "angered" by the commercial and its coverage on Fox News because she felt that they exaggerated the potential health consequences of that delay. In your piece, however, Ms. Taylor describes those consequences only as "some vision problems". I am an ophthalmologist and surgeon with considerable experience with these lesions. While neither I nor Ms. Taylor knows the exact details of this patient's case, I know that a pituitary lesion, whether cancerous or not, that is pressing on the optic nerve can often result in permanent blindness in less than six months. In minimizing the potential consequences as "some vision problems" rather than permanent blindness, isn't Ms. Taylor guilty of the same bias that so angered her when committed by Fox News? She also claims that this lesion is not life-threatening. However, pituitary lesions can also lead to pituitary apoplexy, a condition which can result in stroke or death. Perhaps Ms. Taylor should have done more research on this condition, just as she implored "the media" to do.

I was surprised to hear that a reporter was able to obtain information about a patient's diagnosis, symptoms and treatment from the Mayo Clinic. Did the Mayo Clinic violate HIPAA, violating the patient's privacy? I doubt the patient gave permission for the hospital to reveal her diagnosis since this would negate the point of her public complaint against the Canadian healthcare system. What's the story here?

Nicholas Anderson:

Please listen to the segment again with Maureen Taylor. Her responsibility with respect the health reporting at CBC does not normally involve exceptional cases. She was addressing very specific claims about an advert that had no basis in fact.

Maureen Taylor was not providing medical reporting for NPR.

I was suprised to hear OTM lift a joke directly from the Daily Show. Please give credit where it is due, and play the entire clip of Lewis Black's segment on the Daily show, July 20. His delivery was much better and I appreciate his take on this entire ridiculous discussion.

SO i just checked out Lewis Black's joke - yep pretty similar, but it was a coincidence. He said "I've got news for you 5 out of 5 are going to die anyway!" I said "statistics show that 5 out of 5 Canadians will die sometime during their lifetime or soon thereafter" Its an example of a ripe premise (silly statement that 1 out of 5 Canadians have to die because they went to socialized medicine) with an obvious flaw in logic. But I wasn't ripping off Black, just riffing in a similar vein. And by the way, if you feel your veins riffing its like a 6 month wait in Canada.

Since Ms. Taylor is a reporter, could she have interviewed the patient on her return from the U.S.? Maybe that still happens in Canada. We know that "Main Stream Media" here doesn't do it anymore. Also, just how was the patient set up to do the ad?

How in the world did Maureen Taylor get into the Mayo Clinic web site to obtain private patient information? Ms. Taylor is a reporter and not a clinical person who has involvement with the patient's care. This sounds like a clear violation of patient confidentiality.

Mary (and others):

Ms. Holmes agreed to have her own story published on the Mayo Clinic website--no breaching of patient privacy or illegally procurement of patient files needed:

http://www.mayoclinic.org/patientstories/story-339.html

CONFIRMING SARAH ELLEN'S POST -

http://www.mayoclinic.org/patientstories/story-339.html

hence her MR was not compromised.

Left unsaid in the interview is that U.S. insurance companies don't usually cover experimental treatments, either; people here have to pay for them out of pocket as well. It's also not exactly unheard of for people in the U.S. to travel to other countries to get treatments that aren't approved here.

Well, I read the story on the Mayo Clinic web site and it seems to me that the Republican propaganda version was actually far closer to the truth than the version given on the air by the CBC reporter.

The patient had symptoms, she was given an MRI, the MRI showed a tumor, she was told she would have to wait 6 months for surgery.

The only way to tell whether the tumor was cancerous or not would be to biopsy it. The fact that it turned out not to be malignant is completely beside the point; it should have been removed and biopsied immediately.

I would hope that this would never be allowed to happen in the U.S. But, many will say, what if she didn't have insurance. But the fact is, she DID have insurance as does everyone in Canada.

I have all along been in favor of a Medicare style, single payer system, but this horror story is making me rethink my assumptions.

What's missing from Ms Holmes's story as published on the Mayo site is whether her provincial government picked up the tab for the consult or the surgery. If a case is sufficiently unique or critical, or if there are capacity issues that prevent timely treatment, the provincial government will foot the bill for treatment in the US. My mother-in-law had a heart condition that caused her to spend some time at the Rochester Mayo campus, gratis. I'd be curious to see whether OHIP (the Ontario health plan) paid some or all of her costs.

The honest bottom line is that there are pros and cons to the Canadian system (which is not socialized medicine but rather a single-payer system). Does a bureaucrat literally act as gatekeeper between me and my doctor? No. But bureaucrats can set budget targets, which translates into longer waits for non-essential procedures and tests. They can de-list certain treatments, such as chiropractor visits or fertility treatment, or certain drugs, which create heartbreaking stories about children dying because the family can't afford the off-list drugs. There can be capacity issues, which leads to prioritization and waiting for those tests when non-essential (though not necessarily a bad thing; a doctor friend of mine told me that MRIs are being ordered at a much higher rate not b/c they're diagnostically necessary but b/c they're cool.

On the other hand, I and my fellow Canadians -- all of 'em -- can walk into any doctor's office or hospital in the country and receive treatment without question. No pre-existing conditions to stop coverage, no choosing a hospital based on some HMO restriction, and no profit motive interfering with my medical care plan. I am willing to put up with a little frustration to have that peace of mind.

Is the removal of a brain tumor from someone who is suffering from "rapidly deteriorating vision" a "non-essential procedure" in Canada as Chris states? Is going blind "a little bit of frustration?" Seriously, I would like to know.

If removal of a brain tumor can be delayed for 6 months for "budgetary" reasons, how is that different from a U.S. insurance company denying insurance for "budgetary" reasons? At least in the U.S. you could just do the surgery anyway and then deal with the payment issues afterwards while, as I understand it, in Canada, NO means NO.

3. What was really disturbing about the broadcast piece was that On The Media bills itself as a media watchdog, but the quality of this report was so bad it makes Fox News look like the New York Times.

I'm betting Mr. Pesca didn't get a lot of lead time on his "guest" hosting. He has done better work "on the wing", substituting on Talk of the Nation on subjects with which he is more familiar. On the other hand, he has the sports reporter's handicap, a less than skeptical interview style.

Ooops:

http://www.youtube.com/watch?v=3EPd2i4Jshs