Wait Your Turn

[GenX]

"The Fraser Institute study "Waiting Your Turn: Hospital Waiting Lists in Canada," found patients waited 15 weeks in Ontario from the time of referral by a general practitioner to treatment.

The median wait time in Canada was 18.3 weeks in 2007, compared to 17.8 weeks last year."

LINK (http://www.cfra.com/headlines/index.asp?cat=2&nid=52752)

[Return of Too Many Daves]

You know a thought occurs, if some of those patients weren't able to afford the operation then the waiting lists would be much shorter.

[Return of Too Many Daves]

Not really sure that wait times are actually the be all and end all, but a brief google session turned up:

SOURCE: Ezra Klein

July 11, 2007
American Wait Times
Here's a fun puzzle. Fill in the blanks in the statement below:

In his talk, __________ conceded that "the ___ healthcare system is not timely." He cited "recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month."
If you said "Troy Brennan, CEO of Aetna," and "United States," you'd be right! If you said Canada, or Britain, you'd be wrong. The article goes on:

A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada. And, most of the Canadian data so widely reported by the U.S. media is out of date, and misleading, according to PNHP and CNA/NNOC.

In Canada, there are no waits for emergency surgeries, and the median time for non-emergency elective surgery has been dropping as a result of public pressure and increased funding so that it is now equal to or better than the U.S. in most areas, the organizations say. Statistics Canada's latest figures show that median wait times for elective surgery in Canada is now three weeks.

"There are significant differences between the U.S. and Canada, too," said Burger. "In Canada, no one is denied care because of cost, because their treatment or test was not 'pre-approved' or because they have a pre-existing condition."
A recent Business Week article arrived at similar conclusion:

[B]oth data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. Take Susan M., a 54-year-old human resources executive in New York City. She faithfully makes an appointment for a mammogram every April, knowing the wait will be at least six weeks. She went in for her routine screening at the end of May, then had another because the first wasn't clear. That second X-ray showed an abnormality, and the doctor wanted to perform a needle biopsy, an outpatient procedure. His first available date: mid-August.
The article continues on" "If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days."

One important note on our system's wait times is that, unlike in other countries, we don't collect the data. "There is no systemized collection of data on wait times in the U.S," says Business Week. "That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public." That's a side benefit of the universal systems, which due to their coherence and incentives, are actually quite transparent. That allows not only for an accurate assessment of the problems, but the effective deployment of resources to treat them.

And by the way, want to know which country has the lowest wait times in international comparisons? Hint: It's where sauerkraut comes from.

[Return of Too Many Daves]

And the referenced articles, 1st from Medical News Today

Waiting Times For Care? Try Looking At The U.S. - Nurses, Doctors Say It's Time To Debunk The Myths
Main Category: Public Health News
Article Date: 10 Jul 2007 - 1:00 PDT


Waiting times in U.S. hospitals and clinics are becoming so lengthy that even one of the nation's biggest insurers, Aetna, has admitted to its investors that the U.S. healthcare system is "not timely" and patients diagnosed with cancer wait "over a month" for needed medical care, said two leading organizations of doctors and nurses recently.

Lost in the recent flurry of attacks on Canada and other nations with publicly funded healthcare systems, spurred by the popularity of Michael Moore's "SiCKO," is the reality of the huge hurdles faced by many American patients, said the Physicians for a National Health Program and the California Nurses Association/National Nurses Organizing Committee.

"As the cost and service failures of the U.S. health system become unbearable, those who profit from the system - the private health insurance giants and big drug companies - are bringing out the propaganda attacks on the experience in the many countries which have chosen a public insurance plan. As always, half truths and lies are the scare tactics of these profiteers," said Quentin Young, MD national coordinator of PNHP.

"There's been a lot of clamor lately about delays in care in some other countries. But if you want to see some really unsightly waiting times, look at U.S. medical facilities," said Deborah Burger, RN, president of the 75,000-member CNA/NNOC.

While the problem has been largely overlooked by the major media, it was quietly exposed by the chief medical officer of Aetna, Inc. late in Aetna's Investor Conference 2007 in March.

In his talk, Troy Brennan conceded that "the (U.S.) healthcare system is not timely." He cited "recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable," Brennan said.

Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians' organization trying "to find appointments for people with doctors."

While Brennan's comments went unreported by the media, his data matches several studies and a report in a June 22 Business Week article which opened by citing the case of a New York woman who had to fight for a timely second exam following suspicious results from a first mammogram and then still had to wait a full month.

The article also noted a University of California San Francisco research report last year that documented average waits of 38.2 days to get an appointment with a dermatologist to examine a possibly cancerous mole.

A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada. And, most of the Canadian data so widely reported by the U.S. media is out of date, and misleading, according to PNHP and CNA/NNOC.

In Canada, there are no waits for emergency surgeries, and the median time for non-emergency elective surgery has been dropping as a result of public pressure and increased funding so that it is now equal to or better than the U.S. in most areas, the organizations say. Statistics Canada's latest figures show that median wait times for elective surgery in Canada is now three weeks.

"There are significant differences between the U.S. and Canada, too," said Burger. "In Canada, no one is denied care because of cost, because their treatment or test was not 'pre-approved' or because they have a pre-existing condition."

"Furthermore, when a service problem emerges in Canada, prompt analysis and resource deployment is mobilized to resolve the problem," noted PNHP's Young. "In the U.S., the situation only worsens each year, hence we are presently in an enormous crisis. That's why we a need a single payer system, such as HR 676 which is now before Congress, that can respond to new demands."

Furthermore, U.S. statistics fail to account for the even longer waits for the nation's 44 million uninsured and tens of millions of insured Americans who put off needed medical care due to their high co-pays or deductibles, CNA/NNOC and PNHP noted.

Canada also surpasses the U.S. in a broad array of health barometers, including life expectancy, infant mortality rates, adult mortality rates, deaths due to HIV/AIDS, mortality rates for cardiovascular diseases, and years of life lost to injuries and communicable diseases, according to data from the World Health Organization and the Organization of Economic Co-operation and Development.

"As nurses, we never worry about costs, billing, whether a procedure will be covered or anything like that. I never have to worry about whether one of my patients will get the treatment or care they need," wrote Bev [censored], RN, vice president of the United Nurses of Alberta wrote in a Portsmouth (NH) Herald commentary July 1. "That's the reason nurses are so supportive of our public system. And we have fought to protect it."

[GenX]

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">There is no systemized collection of data on wait times in the U.S </div></div>

The ridiculousness of that post is startling.

Saying there is a "wait time" in the U.S. is like saying there is a wait time to buy a car, or T.V., or anything else of a similar nature.

It's the free market, something Europeans forgot about long ago.

[Return of Too Many Daves]

And from Business Week

The Doctor Will See You—In Three Months

The health-care reform debate is in full roar with the arrival of Michael Moore's documentary Sicko, which compares the U.S. system unfavorably with single-payer systems around the world. Critics of the film are quick to trot out a common defense of the American way: For all its problems, they say, U.S. patients at least don't have to endure the endless waits for medical care endemic to government-run systems. The lobbying group America's Health Insurance Plans spells it out in a rebuttal to Sicko: "The American people do not support a government takeover of the entire health-care system because they know that means long waits for rationed care."


In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. Take Susan M., a 54-year-old human resources executive in New York City. She faithfully makes an appointment for a mammogram every April, knowing the wait will be at least six weeks. She went in for her routine screening at the end of May, then had another because the first wasn't clear. That second X-ray showed an abnormality, and the doctor wanted to perform a needle biopsy, an outpatient procedure. His first available date: mid-August. "I completely freaked out," Susan says. "I couldn't imagine spending the summer with this hanging over my head." After many calls to five different facilities, she found a clinic that agreed to read her existing mammograms on June 25 and promised to schedule a follow-up MRI and biopsy if needed within 10 days. A full month had passed since the first suspicious X-rays. Ultimately, she was told the abnormality was nothing to worry about, but she should have another mammogram in six months. Taking no chances, she made an appointment on the spot. "The system is clearly broken," she laments.

It's not just broken for breast exams. If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. "Waiting is definitely a problem in the U.S., especially for basic care," says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy.

All this time spent "queuing," as other nations call it, stems from too much demand and too little supply. Only one-third of U.S. doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world. Consequently, some 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn't get in to see their regular doctor, a significantly higher rate than in other countries.

There is no systemized collection of data on wait times in the U.S. That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.

The Commonwealth survey did find that U.S. patients had the second-shortest wait times if they wished to see a specialist or have nonemergency surgery, such as a hip replacement or cataract operation (Germany, which has national health care, came in first on both measures). But Gerard F. Anderson, a health policy expert at Johns Hopkins University, says doctors in countries where there are lengthy queues for elective surgeries put at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference," he says.

The Commonwealth study did find one area where the U.S. was first by a wide margin: 51% of sick Americans surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close.

Few solutions have been proposed for lengthy waits in the U.S., in part, say policy experts, because the problem is rarely acknowledged. But the market is beginning to address the issue with the rise of walk-in medical clinics. Hundreds have sprung up in CVS, Wal-Mart (WMT ), Pathmark, (PTMK ) and other stores—so many that the American Medical Assn. just adopted a resolution urging state and federal agencies to investigate such clinics as a conflict of interest if housed in stores with pharmacies. These retail clinics promise rapid care for minor medical problems, usually getting patients in and out in 30 minutes. The slogan for CVS's Minute Clinics says it all: "You're sick. We're quick."

[GenX]

Meanwhile, in the land of Charles ****ens...

"Today, the National Health Service costs the taxpayers some £50,000 million. Over one million people are waiting for treatment and surgery and often waiting reasonably lengthy times: months, and for some surgery, years. There are probably another 300,000 to 400,000 people waiting to get on the waiting list because, of course, there's a definition about waiting lists. If you're on a waiting list, when you've seen a consultant and you're waiting for surgery, you're not really on the government waiting list when you're waiting to move from the GP to see the consultant.

This is out of a population of some 60 million people. If there are a million, maybe a million and a half people waiting, when I wander around London, most people are well"

LINK (http://www.heritage.org/Research/HealthCare/HL702.cfm)

[GenX]

"Falling numbers of state dentists in England has led to some people taking extreme measures, including extracting their own teeth, according to a new study released Monday.
Others have used superglue to stick crowns back on, rather than stumping up for private treatment, said the study. One person spoke of carrying out 14 separate extractions on himself with pliers.

More typically, a lack of publicly-funded dentists means that growing numbers go private: 78 percent of private patients said they were there because they could not find a National Health Service (NHS) dentist, and only 15 percent because of better treatment. "

LINK (http://www.plnewsforum.com/index.php/forums/viewthread/24808/)

[GenX]

" Doctors in Britain are revealing for the first time that many health treatments will need to be rationed in the future.

The Observer reported on the move, which is expected to embarrass the government. The reason for rationing treatments, doctors have said, is that the National Health System cannot cope with skyrocketing demands from patients. "

LINK (http://www.physorg.com/news97738082.html)

[Return of Too Many Daves]

Dentistry is not in good shape in the UK, many people go private, we have the choice. But most people don't consider whiteness of teeth a priority (cue Speedy with a cheap shot about Brits' teeth, followed by a counter punch on fat Anericans).

From the Guardian (one of the best newspapers on the planet) a survey of the people who know:

A picture of health?


Michael Moore's new film, Sicko, which is out next month, contrasts the US's privatised healthcare system with Britain's free NHS. It shows Americans without insurance dumped in the street; children refused life-saving treatment because their parents can't pay; hospitals run for profit, not for patients. The UK, meanwhile, is a glorious place where everyone receives the treatment they need, whatever their income; where doctors earn high salaries and are paid extra for preventative care; where the public ethos is as strong as ever after almost 60 years. For this special G2 report we took 16 NHS workers to an advance screening of Sicko and asked them: is the British way of medicine really that good?

Interviews by Aida Edemariam, Jon Henley and Homa Khaleeli
Monday September 24, 2007
The Guardian


'It certainly left me feeling good about the NHS. I do believe it is a great institution'
Paul Smith, 34, learning difficulties nurse
It is a fear that we may be moving towards the American system, but I think in Britain we always fear things like that.

· Paul Smith works at Winchmore Hill, north London.

Doctors in the British system are very efficient in terms of the number of people they see, but they spend a lot less time with each patient than in the US'
Karim Ahmed, 34, A&E registrar


Article continues

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I really enjoyed the film, but in terms of the health service it is obviously showing just the very best side of our NHS and the very worst parts of the US system. I came away feeling that what we have here, the basic principle of the NHS, is a very good thing, and that it is up to all of us to work really hard to make it better. We need to concentrate on getting the quality up, but I think that is achievable.
Of course we don't fund the NHS properly. Americans pay far more for their health service than we do; the tax we pay here is really not much compared with what they pay in insurance premiums. In lots of ways we are a long way behind the US system. For example, we are pretty good at accessibility - doctors in the British system are very efficient in terms of the number of people they see - but they spend a lot less time with each patient than in the US. And my impression is that there are generally more resources per patient in the US than in the UK: more doctors, more nurses, more beds. The problem they have, of course, is that access to all that is just not equitable. Although there is a trend in terms of our overall economic ideas towards America there would be a lot of resistance to moving to an American system. The government may look towards it for getting extra funding in the short term, but there is a huge amount of resistance from the public and the NHS itself. Even though there are advantages in terms of pay and conditions people are still staunchly supportive of the NHS and worry about private finance initiatives.

·Karim Ahmed works at the Royal London Hospital.

'I don't think we'll end up going to the extremes of the American model; people simply wouldn't put up with it'
Zhaleh Khaleeli, 32, researcher

Overall the film is a good thing - Moore is bringing a lot of issues to the attention of the American public that they probably would not think about much otherwise. But it doesn't translate that well over here. We're used to a bit more sophistication, we want both sides of the picture. As far as the NHS goes, you can see he is glossing over all sorts of problems. That said, it makes you realise how lucky we are. We all moan about the NHS, but watching this film makes you realise how fortunate you are. By and large most UK doctors feel at home with the NHS model; you can treat whoever needs the treatment, without any monetary considerations. Doctors in the US must have to compromise their ethics; it would be hugely frustrating for us to work in an environment where you have to turn people away because they don't have the right insurance. And the other side of that coin is that in the US people who have good insurance are often over-investigated, to make money.

Of course there are many areas for potential improvement in the NHS; there has been an emphasis on making things "appear" better, by cutting waiting lists and improving performance targets and so on, rather than on improving medical care. And there are big problems building up because of the overhaul of medical training; a lot of people are worried that patient care will be compromised by faster training and less experience.

I think there is a danger that we could go more like the American system. There's certainly much more private involvement in the NHS now, and it hasn't been very successful. I hope people will resist any more moves in that direction. But I don't think we'll end up going to the extremes of the American model; people simply wouldn't put up with it.

· Zhaleh Khaleeli works at the Institute of Neurology in London.

'The NHS system where you pay £6.65 for virtually any drug is pretty amazing'
Muna Ahmed, 32, clinical genetics specialist

You get the point of the film pretty quickly: the US system is terrible unless you've got lots of money. I don't think I could be a doctor in a system like that of the US. The film reinforced my view that the NHS is a world-class system and I'm really proud of it and really proud to be working in it. But I can see that even for someone very pro-NHS, Moore's portrayal went a little over the top. It was very rose-tinted. But people do get very good treatment in the NHS. The service is absolutely fantastic. People complain, but it's usually about the waiting; once they've actually seen someone you hardly hear any complaints. A system where you pay £6.65 for virtually any drug is pretty amazing. From the doctor's point of view it is not bad either; there certainly are GPs who earn £85,000 and have the kind of lifestyle of the NHS GP in Sicko.

One thing I would say, though: all those caricatured American fears about "socialised medicine", with the government telling doctors where they have to go and what they have to specialise in, is becoming true here - the new applications system [for junior doctors applying for training] is an absolute nightmare. You have very little choice now. It wasn't like that in the past, and in the long run the NHS will suffer for it. I'm London born and bred, and I have no option but to move to Manchester for my career.

· Muna Ahmed will be working in Manchester from November.

'No one who works in the NHS would pretend it's perfect'
Ben Maguire, 28, capital programme manager

Moore does paint a very black picture of the US system and a very rosy one of the NHS. Even if we recognise what a great institution the NHS is, no one who works in it would pretend it's perfect. There are funding problems; there are issues around schemes such as PBR [payment by results] and referral thresholds and so on. Overall, I feel that in the US it often seems as if businessmen are trying to run medical clinics, and in Britain it can sometimes seem as if clinicians are trying to run businesses. I'm sure there's a happy medium to be found.

· Ben Maguire works in Lewisham, London.

'I don't know how American doctors can work in a system that means they have to turn people away'
Haseena Iqbal, 30, GP

The film was an amazing eye-opener. Of course you see things in the media, but you really get no inkling of what the US system is really like. It is astonishing that a country can be so advanced in some ways yet its health system can be so backward. Moore's basic point is very simple: the NHS is free at the point of use, and crucially, as a patient you will get seen. I don't know how American doctors can work in a system that means they have to turn people away. I've always thought the NHS was a very, very good system but, in fact, the way it's going, plenty of people are beginning to lose confidence in it. The core concepts are still absolutely valid, but doctors, for example, are beginning to get very disgruntled about the way jobs are allocated. You always used to be able to choose what specialism you wanted to pursue, what area you wanted to work in; these days government control over doctors' careers is increasing, as is the paperwork and the bureaucracy.

· Haseena Iqbal works in Cambridge.

'I really had no idea that US patients can just get kicked out of hospital, put in a taxi and dumped on the street'
Shazia Jalali, 29, GP

Some of the film was absolutely unbelievable. I found it really hard to understand how you can have such a different ethos in the same profession. You could never imagine anyone in a British accident and emergency department saying to a patient, 'You'll have to choose between us reattaching your ring finger and your middle finger according to how much you can afford." And I really had no idea that patients can just get kicked out of hospital, put in a taxi and dumped on the street. It was really tragic. But it certainly made me feel very good about the NHS, and about our society in general. We may moan, but by comparison Britain is so much more fair and egalitarian. It also made me feel very proud to work in the NHS: yes, there are waiting lists; yes, there are funding issues; yes, there are problems, particularly with patients with non life-threatening conditions. I have a patient who has been waiting for a hearing aid for three years and that is just unacceptable. But they are all relative.

On the other hand, American fears of "socialised medicine" and what it means for doctors' freedom to choose what they want to do and where they want to do it are beginning to be realised here. Nobody used to complain about not having a lifestyle choice; now they do. It is also true that there are some complex changes being made to the NHS with very little forward planning or thinking on the part of the government. For example, in Brent over the past couple of years a very large number of our new patients have been from eastern Europe, which is fine except that Brent council chose that moment to withdraw interpretation services. That kind of thing is just depressing.

· Shazia Jalali works in the London borough of Brent.

'I much prefer the British system. In spades. We have huge advantages, and a lot of people get treatment who wouldn't otherwise'
David Curtis, 47, consultant psychiatrist

The film was very one-sided, but a number of the points it made were valid, such as the advantages of a government-managed universal healthcare system as opposed to a patchier system provided by HMOs [health maintenance organisations, which provide healthcare to consumers for a monthly fee]. Healthcare can be so expensive that an individual can't really afford to manage that risk themselves. What we saw with the insurance companies is that they were only insuring low-risk people; in a government, tax-funded system, the risk is spread out evenly.

Having said that, the Republican party had perfectly valid objections too: do you want the government to be in charge of healthcare provision? Do you want the government deciding what treatment you can get, where a doctor can live, where a doctor can work? What we have now is a situation where provision of healthcare depends on political will. Take some of the American arguments about whether or not a treatment can be provided - one can see similar arguments in a government-funded system. There is still a drive to contain costs, and though it is not as intense, it does not disappear completely.

I much prefer the British system. In spades. We have huge advantages, and a lot of people get treatment who wouldn't otherwise. We have more emphasis on preventative medicine, so we have better overall levels of health.

It is true that Moore chose an easy target, because he used acute casualty departments - we've always known the NHS is good at casualty. If he had done this film 10 years ago and someone had an arthritic hip, he would have heard a completely different story. Things have improved an awful lot, although one of the areas where you still see the longest waits is in psychotherapy. I think that is one of the places where it is going to be most difficult to deliver target times, and where the biggest change will come. In America, you could see an analyst tomorrow, if your HMO would pay for it. In Britain there are quite long waits for psychological treatment.

A lot of good stuff about the NHS did not come through either. For example, working in psychiatry often involves working in a multidisciplinary team in the community - doctors, nurses and social workers thinking of every aspect of a patient's wellbeing. I think Britain's welfare state does a very good job of that sort of thing, and I'm very proud of that.

There was some talk about Kaiser Permanente (a US healthcare corporation) here a while ago. Some people talked favourably about the way these companies work and said the NHS should work like that and it was much cheaper. But doctors have less clinical freedom and there is an expectation that the patient should be out after an operation in three to five days and it is a problem if they are not. I think this is potentially worrying. British doctors feel unease about that and feel they would be under undue pressure if it was adopted.

· Professor David Curtis is consultant psychiatrist, clinical director, and honorary professor of psychiatry at the East London and City University Mental Health NHS Trust.

'The American system seems good only for the rich'
David Wilson, 20, pharmacy student

I found it shocking how bad the American system is. I knew they had challenges but I didn't realise you could be refused treatment. It seems unethical to me. The story of the little baby dying because the parent didn't have insurance for that hospital; it was terrible. That wouldn't happen in the UK.

The American system seems good only for the rich. I find it hard to find any positives in it. I've taken the NHS for granted in the past - now I realise how much we should appreciate it.

· David Wilson works at Robert Gordon University, Aberdeen.

'Especially in emergency situations, the NHS is really good. Kids are generally well looked after too'
Stephen Whyte, 22, hospital pharmacist

I've always thought the NHS was a really good thing but when you see the American health system against ours, it really makes you feel grateful for what we've got.

People are quick to complain about things, especially waiting times and things like that, but when you get it into perspective - for example the woman in the film with broken ribs who went to hospital, and just because she didn't have insurance she was flung out on to the street - you would never see that here. Especially in emergency situations, the NHS is really good. Kids are generally well looked after too.

Working for the NHS isn't the most financially viable thing to do: I've recently qualified and a newly qualified pharmacist can make £15,000 more working at Boots or Lloyds. It was a deliberate choice for me - I think job satisfaction is more important than money in the bank at the end of the day.

I think people should watch Sicko - especially people who are sceptical of the NHS. Hopefully it will make them proud of the system we have instead of constantly running it down.

· Stephen Whyte works at Great Ormond Street Hospital, London.

'You can imagine people putting up barricades in the streets to protect themselves against commercial greed. Healthcare ought to be a right'
Luke Murphy, 29, patient advice and liaison service

I loved Benn saying that even Thatcher wouldn't attack the NHS, and suggesting that if any party did do anything to attack the NHS there would be a revolution. There was a little cheer in our screening room when he said that. And you can imagine people putting up barricades in the streets to protect themselves against commercial greed. Health care ought to be a right.

· Luke Murphy works at Great Ormond Street Children's Hospital, London.

'Thank God for the NHS. Thank God the NHS didn't go the American way'
Ehsan Khondaker, 33, GP

It's incredible in this day and age, when we look to America for so much in the way of inspiration and ideas, that it should be ranked 37th in the world when it comes to healthcare. It shouldn't be in that position. Thank God for the NHS. Thank God the NHS didn't go the American way.

I see quite a lot of privatisation in my job as a GP - in referrals, in prescribing. GPs' surgeries are increasingly run along privatised lines. It worries me a little bit, but I think the basis of general practice is still intact. The doctor has clinical autonomy, and patients have a say to a large extent. They still have a voice.

A lot of complaints about the NHS are to do with the amount of bureaucracy, which is a mess because of decisions made by this government and previous governments.

There are still inequalities in healthcare. For example, waiting lists - we tell patients that because of the strain on resources they have to wait many months. But then you find other patients who are still somehow getting to the top of the waiting list because they can afford to. I know of patients who can see a consultant privately and still end up high up on an NHS waiting list. In very affluent areas where I've worked that can happen. It's not as equal as it looks.

I don't think there's anything positive to learn from the American system. Too much power lies in the hands of the HMOs and pharmaceutical companies - patients really are afraid and have no voice - and that's something I would not like to see happen here.

I am an NHS doctor, but I am contracted through a company called Chilvers McCrea. It is a private healthcare company and it has taken over 30 practices from the primary care trusts. For doctors, it makes no difference. I think the idea came from UnitedHealth, an American corporation. It started the process in this country. UnitedHealth has now withdrawn, but British companies are still doing it. From a clinician's point of view nothing has changed, but patients are mistrustful about what these companies are after. They have not been around that long.

I think we should be worrying about American influence. It is inching towards the American system. It is a very slow process, but ultimately it will become more and more acceptable. I think it is something we should fear.

· Ehsan Khondaker works in Nottingham.

'The US system really does have the best, the newest, the most advanced equipment and treatments available'
Mariam Pourshoushtari, 28, American patient

I fear many Americans will react defensively to this film, and British audiences may see this as another excuse to bash America. Personally, I've had good experiences with the US health system. I had meningitis when I was 20 and I happened to be in Minneapolis, which at that time was one of the only places in the world to have a brand-new machine that ended up saving my life. Of course I was maxed out on my insurance within about three weeks, but the government agreed to pick up my bills. I have also had very good experiences on the NHS, but then they didn't have to save my life - they've been involved in the clean-up stuff, as it were. The NHS is on a tightrope. Free healthcare means more British people will go to a doctor when perhaps they don't really need to; GPs are like gatekeepers, they need to asses the motivations of the person in front of them rather than their medical need. The specialists, when you get to see them, are great. As an ideology, universal free healthcare is obviously preferable. But the practicalities mean that the US and British systems are basically equal: medical care can't advance without money, and in a universal system that's always going to be a scarce commodity. As it stands, the NHS is unsustainable - maybe not now but at some stage in the future, it will hit a wall.

Doctors in the US system aren't corrupt or bad. They are still very good doctors trying to help and save lives. The problem is that the insurance companies are trying to tie their hands, trying to get out of paying for the care. But they can only get away with that because the government has pretty much stepped out of healthcare. The huge advantage of an element of privatisation is that it does bring in the money: the US system really does have the best, the newest, the most advanced equipment and treatments available. It's just that that private element has to be properly controlled and regulated, there have to be limits.

· Mariam Pourshoushtari works in London.

'Moore proves something that should be self-evident, that healthcare should be free, and is one of the basic pillars of a decent society'
Nikos Gorgoraptis, 26, junior doctor

In the film, Michael Moore proves something that should be self-evident, that healthcare should be free, and is one of the basic pillars of a decent society. Anything that's not based on that one idea is immoral. These things should be taken for granted but they are not.

What comes through from the film is that there are still some basic public benefits in Europe as opposed to the US, but having worked in this country, and also in France and Greece, I know that things are slowly but steadily changing towards privatisation, and it's really sad. I wouldn't expect a total abolition of public healthcare during my lifetime - at least I hope not. But public healthcare is becoming less good in Europe in general, and even public hospitals are sometimes managed as private enterprises, with medical decisions based on cost, which is not always moral. But we are still nowhere near the image presented by Moore of the US.

· Nikos Gorgoraptis is a foundation year two doctor working in oncology at Northampton General Hospital.

'The NHS has got its problems but, my God, it's one of the best things in the world'
Brian Belle-Fortune, 46, student nurse tutor

Before I saw the film, I had kind of thought, "Oh well, America's got this private system, and there's health insurance, and you pay and get treated." But when I saw what it was actually like, I was completely horrified. I was telling my partner about the film when I came home, and she said, "God, you're livid, aren't you?" I kept thinking of that song by Amy Winehouse that begins, "What kind of ****ery is this?" I was thinking that all the way through the film. It's just so wrong. America is supposed to be the world's greatest democracy, but what's happening is completely undemocratic. The NHS has got its problems but, my God, it's one of the best things in the world.

· Brian Belle-Fortune works at Great Ormond Street for Children NHS Trust.

'This film will alert people to the dangers of not cherishing and protecting the NHS from the ruthlessness and the worst excesses of the American system'
Karen Jennings, 54, head of health for Unison

The film really awakens you to what is extraordinary about the NHS, that we have a health system that we do need to cherish and protect. It blew out of the water some of the negative mythology about the NHS. For example, doctors in the US are taught that NHS doctors are not paid very well, and that the system within which they work is not exciting or dynamic. Yet doctors in the UK were interviewed and it is clear that they earned a good income and lived very comfortable lives. At the same time, the British public have a better infant mortality rate, a British person lives longer than the average US citizen, and doctors here are incentivised in terms of things such as public health.

The film brings into perspective what happens when you have a system that is fragmented, that is for profit, in what is really a very flawed market and business environment. It is important for Americans to see what is possible in countries where the systems are based on solidarity, a public sector ethos, and [where people] have principles about these things. It made me feel very proud that Britain was portrayed as a society that cares about the vulnerable.

The global situation around the marketisation of health means there is huge pressure to open up the NHS to provide profits. It is something we should resist as much as possible and this film will alert people to the dangers of not cherishing and protecting the NHS from the ruthlessness and the worst excesses of the American system.

· Karen Jennings is a former registered nurse.

'It does seem illogical to give undue attention to a country where the percentage of GDP spent on health exceeds most others, whereas its outcomes -such as life expectation - are well down the league'
Ian Gilmore, president of the Royal College of Physicians

It is very hard to judge the accuracy of the picture painted of the United States. I suspect there is more than an element of truth in it. Similarly, although the picture of the NHS was rosy, I thought it was reasonably fair - we are proud of the fact that our healthcare is free at the point of delivery.

Certainly there are always concerns about the rising costs of healthcare, and American models have been looked at in order to try to limit costs. But I think that all the models looked at in this country do stick to the principle of being free at the point of delivery, or certainly most of the models do. Some of the models of care that have been looked at do change the way healthcare is delivered quite fundamentally, but they don't move away from that fundamental principle. Our discussions are much more about what should be available on the NHS to everyone, rather than who can afford treatment. Every new form of treatment is scrutinised very closely as to whether it should be available, but availability is not judged solely on cost - it is judged on effectiveness. We haven't got it absolutely right, but the way we look at new healthcare developments, particularly drugs, through the National Institute of Clinical Excellence (Nice), is a model admired across the world.

In my view, undue attention has been paid to some aspects of healthcare policy in the US by UK government in recent years when there are many examples nearer home, within Europe, of alternative models of healthcare. All systems, wherever the funding comes from (taxation, personal insurance, etc) have been struggling with cost containment as technology and, in particular, new drug developments - especially cancer drugs - add to rising expectation and patient knowledge of what is available. It does seem illogical to give undue attention to a country where the percentage of GDP spent on health exceeds most others whereas its outcomes -such as life expectation - are well down the league. That doesn't mean that we shouldn't examine their solutions, but not to the exclusion of those of many other countries that are faring better.

· Ian Gilmore works as a liver specialist at the Royal Liverpool University Hospital.

· Project coordinated by Homa Khaleeli. Sicko is released on October 26.

[Hans]

I believe it has to do with the water. If I am not mistaken, it is or was common practice in Canada and the US to add fluor to drinking water?
I believe this could explain the difference in color of teeth between Europeans and Americans.
White teeth does not equal healthy teeth.

[gizmoguy]

Oddly, the Fraser Institute study noted by Speedy also found that the longest wait times were in Quebec, which has the largest per capita number of private clinics in the country... This is the same Fraser Institue that has been telling us for years that the best way to improve health care and shorten wait times is to increase the number of privatized clinics.

[GirlNextDoor]

i didnt read all of this long [censored] thread, but ill put my 2 cents in. i have a mangled ankle and right leg.(i got hit by a bus when i was 7, and than severley broke the ankle a couple of years later).but i had seen my dr numerous times to have something done about the ankle constantly breaking on me. finally i get a referral to a surgeon and i have to wait until FEB 3rd for a god damn consultation. so that means im going to have to go through my foot breaking at least 3 more times before someone will say " yep its ****ed, lets fix it" . I think its ridiculous to wait so long.