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Maybe there's some other place named 'Canada'?

A quote from Paul Ryan, minority leader on the U.S. House of Representatives budget committee:

[Peter Orszag] believes you need to set up this über-bureaucracy—the institute of comparative effectiveness—which we’ll put smart people in, and they will design the metrics and the processes on how medicine is to be practiced. And then the federal government will impose and enforce those processes... It is precisely what they employ in England. It’s precisely what they employ in Canada.

So, Congressman Ryan, I'm guessing you haven't spent a lot of time here in our pleasant Dominion?


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Comments (10)

Garth Wood:

Nor in England, for that matter.



Surely, La Canada, California?


Oh, I don't know. I could see how a reasonable American might come up with that idea.

Über (health) bureaucracy? Check...1 federal and 10 provincial übureaucracies.

Is your quibble with the "smart people" being employed therein, or the fact that it's the provinces that enforce relevant health care processes?

Maybe the context isn't clear [link to the New Yorker piece from which the quote comes, which I neglected to include]. He is talking about the creation of ONE CENTRALIZED BUREAUCRACY that reaches and imposes conclusions about best clinical practices. Frankly, even the provinces themselves only do the kind of thing he is talking about very haphazardly and informally. It's an outlandish characterization of Canadian health care.

Hm. Given how minimally evidence-based so much of medicine is, a centralized bureaucracy working on best clinical practices sounds pretty good. Because right now a lot of the doctors are just finally working up to the whole "wash your hands every time between patients" thing.

But for all the time I spend trashing medicine, I have to say that antibiotics still rock. The missus had a little bump on the elbow that got infected, and an IV course of the good stuff made it go away in two days.

This is one of those things that, 60 years ago, would definitely have been a grave matter of life and limb. Instead, the worst of it was waiting 3 hours to get admitted at the hospital.

Crid [cridcridatgmail]:

Re the Twit: As with no other blogger, when Cosh says "Steve Howe's playing too loud over here", we can't guess which one he means. It's like the BOC financial thing.


We're supposed to shocked that a Republican congressman is overstating the degree of bureaucratic oversight in Canada's medicare system? Of course, HMOs are the real model for what he describes but doesn't quite match his ideological point.

Anyway, England is further along in terms of clinical guidelines and evidence-based care.


He's also forgetting that those "uber" systems don't perform as well as two-tiered systems like in Germany. Swedes treat the German system the way we treat the U.S. system: a place to go when your government decides it doesn't want to deal with your life-threatening condition.


"Anyway, England is further along in terms of clinical guidelines and evidence-based care."

Oh indeed.

There's even this charmingly named HM Government body to determine whether it's worth spending public money - sorry, whether it's "cost-effective" - to provide you with medical care:*


And I'm not just carping from the sidelines here; I recently returned to Canada after living in London for several years.

Because the UK still permits private medical care, there's an inherent irony in their healthcare system. The UK pioneered the National Health Service (NHS) concept to ensure millions would have access to public medical care. But it has now come full circle: if public medical care can't or won't help you, you can always spend your money getting comprehensive care from a private company.

* Even though, as a British taxpayer, you and your parents will have been contributing to the NHS your entire working lives.

Interesting how folks are quick to blast US HMOs that decline care to their customers but governments seem to be able to make such decisions with impunity.

I think Ryan was warning against the British and Canadian systems, not advocating for them.

Thanks to Chris for the heads-up on the German system. I have been searching for an alternative to whatever horror we have here when Obama is finished, and Germany sounds more convenient than Thailand.


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