Tag: Canada

Quantifying the Rural Access Problem: Emergency Cardiac Care as a Window into American Healthcare

Apr 10, 2026

By ANISH KOKA

I was listening to a conversation between two critical thinkers I respect greatly: geneticist/technologist/blogger Razib Khan and Washington Post columnist Megan McArdle. Their discussion was a freewheeling rant about the problems they see with the rise of populism on the left and right, but a throwaway comment related to the US physician shortage in the context of needing high skilled immigrant labor towards the end of the almost two-hour conversation made me realize how little people really know about healthcare in America. Of course, everyone knows certain aspects of healthcare as a consumer very well, but even if you are a high-IQ individual who can make use of the vast information at all of our fingertips, it is hard to really know what the reality on the ground is without living it / having deep knowledge. Interestingly enough, early on Megan and Razib both acknowledge the impossibility of commenting on the situation in Iran, because the Iraq war taught them the folly of making conclusions from the available information. Bottom line, it doesn’t matter how smart you are if your conclusions are based on reading Colin Powell on the weapons of mass destruction Saddam Hussein must have. The public may not realize it, but health policy has a similar problem. The vast majority of academics “covering” American health policy, and in charge of describing healthcare, are ideologues whose main goal is not to describe reality, but to fashion a story. And as any screenwriter will tell you — do not let the facts get in the way of a good story.

What follows is an examination of what happens when you pull one of the important healthcare threads that forms the bedrock of many healthcare opinions that smart people like Megan and Razib hold: Rural access to healthcare in America.

First, here’s what a Google search reveals — and notice the sources. I assure you that PubMed is not much different. Rural healthcare access in America must be bad, right?

Once we establish that healthcare access in rural America is “bad”, there are all sorts of conclusions that are downstream from that like funding of rural hospitals, and management of the physician labor supply.

But the strange thing about the rural healthcare access problem that should strike anyone over a certain age that has followed/lived healthcare is that we have been talking about this and passing legislation on the matter forever, and yet if you are to believe those who should have the most knowledge about these things, we continue to fall short.

The Anti-Hypocrisy Rule

Dec 10, 2014• 24

By MARTIN SAMUELS, MD

Pundits abound when it comes to health care plans. They come from many different backgrounds: conservatives, liberals, academics, business people, doctors, politicians and more often all the time various combinations of these. But they all have one characteristic in common. They all want a different kind of health care for themselves and their families than they profess for everyone else.

I am acutely aware of this as I am in a position that demands that I find special appointments for them. A day virtually never passes when I don’t receive requests (often many in a single day) for me to either see these people myself or arrange for their special care elsewhere, including other parts of the county and the world. My own personal ethical code of conduct prevents me from mentioning their names or anything that could identify them. Suffice it to say that I have yet to see a single exception to this principle.

The Canadian Health Care System I Disparaged

May 6, 2014• 50

By Wendell Potter

When I recently returned home after a two-week speaking tour of Canada and began catching up on news about Obamacare, I was angry and upset, and not just at politicians and special interests that benefit from deception-based PR tactics.

I was — and still am — mostly angry and upset with myself. And I know I always will be.

Over the course of a two-decade career as a health insurance executive, I spent hours and hours implementing my industry’s ongoing propaganda campaign to mislead people about the Canadian health care system.

We spread horror stories about “rationed care” and long waiting times for medically necessary care. Our anecdotes were not at all representative of most Canadians’ experiences, but we spent millions of dollars to persuade Americans that they were.

At every stop between Halifax and Vancouver last month, I explained how the United States had achieved the dubious distinction of having both the most expensive health care system on the planet and also one of the most inequitable.

While Canadian lawmakers in the 1960s were implementing a partnership between the federal and provincial governments to create the country’s publicly funded universal health insurance system — known as Medicare — our lawmakers in Washington were establishing America’s own single-payer Medicare program, but only for folks 65 and older and some younger disabled people.

Congress also created the federal and state-administered Medicaid program for the nation’s poor.

Ever since, most of the rest of us have had to deal with private insurance companies and pay whatever they felt like charging us for coverage.

Driving Front Line Innovation In Health Care

Apr 19, 2013• 1

By David Duncan

Jennifer Stinson was a nurse at The Hospital for Sick Children (SickKids) in Toronto who enjoyed brainstorming new ideas for improving care, especially for the kids with cancer she treats. But even as she gained status by getting her PhD and becoming a clinician scientist, she came up against persistent bureaucratic and organizational barriers to innovation.

Stinson’s challenge is common at big organizations, but overcoming bureaucracy and breaking down silos is especially critical in healthcare. To tackle these obstacles at SickKids, CEO Mary Jo Haddad in 2010 elevated innovation to a “strategic direction,” and engaged Innosight to help devise a full system needed to spur innovation. The resulting system has three major components:

An Innovation blueprint detailing the types of innovations the organization wants to encourage. SickKids prioritized encouraging doctors, nurses and clinicians to look for unmet needs they could address, rather than wait for solutions from IT or top management. That required creating a focus group with 25 front-line healthcare workers to discover and catalog key “jobs to be done” (like reducing the length of hospital visits), surveying all 5,000 employees, and training most of them on how to integrate the innovation system into their daily practices.
An innovation pipeline to reliably take ideas from concept to reality. This involved establishing a new 18-member Central Innovation Group of leaders from different areas of the hospital, a team that was tasked with prioritizing and advancing ideas and projects through various stages. The team helped innovators test prototypes, make adjustments, and then scale to a wider population.
An innovation culture that features the right people, in the right roles, speaking a common language of innovation. A key enabler of this culture was the establishment of a $250,000 Innovation Fund to provide seed money for promising ideas. Now, instead of being stalled by permission hurdles that suppress initiative, promising new ideas could be funded, fast-tracked and prototyped.

Consider how the new system helped Stinson bring a transformative innovation to life. Every year at SickKids, thousands of children are battling various forms of cancer. It’s vital that they keep accurate diaries tracking their pain, but if it’s not done daily the data are virtually worthless. Typically these diaries must be filled out by hand, an annoying task that children with cancer aren’t motivated to do. The result is poor reporting and suboptimal pain management.

How I Lost My Fear of Universal Health Care

Jul 20, 2012• 22

By Young Mom

When I moved to Canada in 2008, I was a die-hard conservative Republican. So when I found out that we were going to be covered by Canada’s Universal Health Care, I was somewhat disgusted. This meant we couldn’t choose our own health coverage, or even opt out if we wanted too. It also meant that abortion was covered by our taxes, something I had always believed was horrible. I believed based on my politics that government mandated health care was a violation of my freedom.

When I got pregnant shortly after moving, I was apprehensive. Would I even be able to have a home birth like I had experienced with my first 2 babies? Universal Health Care meant less choice right? So I would be forced to do whatever the medical system dictated regardless of my feelings, because of the government mandate. I even talked some of having my baby across the border in the US, where I could pay out of pocket for whatever birth I wanted. So imagine my surprise when I discovered that Midwives were not only covered by the Universal health care, they were encouraged! Even for hospital births. In Canada, Midwives and Dr’s were both respected, and often worked together.

Is My Canadian Online Pharmacy Really in Canada?

Dec 7, 2010• 8

By ED PULLEN, MD

Maybe Not.

I practice in Washington State, and have a number of patients who travel to Canada to purchase their medications. Why drugs are so much less expensive in Canada than in the US is primarily related to the single payer system in Canada, where drug companies have to negotiate prices with the Canadian health plan.

In the US with so many different insurers none have the where-with-all to negotiate steeply discounted prices because to remain competitive they have to offer all the popular drugs or risk losing patients to plans that do offer those drugs. This leads to a situation where many patients simply cannot afford some of the expensive branded drugs that they are prescribed. Admittedly we have a nice variety of inexpensive generic medications for most conditions, but in some situations there is no good alternative to expensive drugs. Don’t think the Discount Drug Coupons are going to save you in the long run.

Of my patients who get drugs from Canada, many of them see a physician there who does a brief evaluation and re-prescribes the medications prescribed for them by me or other US physicians. Others find pharmacists who will fill prescriptions written by US doctors. At the border crossing coming home rarely patients are searched and have their prescriptions confiscated, but the prices in Canada are enough less than US drug prices that it is worth the trip and risk of confiscation that patients using expensive branded meds find the trip worthwhile. I don’t have a big concern for these patients. I have no reason to believe that the drugs dispensed in Canada by pharmacists to visiting Americans are not the same medications they get in the US.

Canadians? Not as good as us!

Jun 10, 2009• 5

By MATTHEW HOLT

Several of my friends in the blogosphere are getting very excited because eHealth Ontario has pissed away a few million dollars and the now fired CEO got more bonus than was seemly. So she gave Accenture and Price Waterhouse Coopers low 7 figure no-bid contracts and it’s now transpired that consultants billed food and random travel for expenses. MrH at HISTalk gives it two separate mentions in his section of the news and Inga piles in as well.

But I must remind you that as in all things Canadians pale in comparison to how we do it here.Continue reading…

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