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Mar 21, 2009

Begging for Medical Care

Natasha Richardson and "Medical Capital"
03/21/09 - Blog.Mises.Org by William Anderson

The famous actress Natasha Richardson hit her head in a minor fall while skiing. She developed an increasing headache and serious symptoms that required emergency treatment.

She died from an epidural hematoma, bleeding between the skull and the tough membrane (dura) surrounding the brain. The blood pools, clots, and puts pressure on the brain, contained by the rigid skull. Pressure eventually pushes down on the brain stem enough to shut down neurological functions controlling heartbeat and breathing.

Montreal does not have fast transportation to a primary hospital, even near a ski area. Why not? Patients are a cost to the system.

[edited] Canada has socialist medical care. Socialist systems tend to be undercapitalized, because equipment costs money, but doesn't increase reimbursements from the state. For example, the county where I work in the U.S. has 80,000 residents and has as many MRI machines (internal imaging) as does Montreal with millions of residents.

It took three hours to drive Natasha Richardson from the Mount Tremblant ski area to the trauma center in Montreal, because Quebec has no medical helicopter system. Helicopters are common in the USA.

In Canada, no medical device or advanced service produces income for the hospital, because no one can charge medical consumers for anything. An MRI machine or helicopter is purely a cost in a budget. Medical facilities have only so much money, and the purchase of costly machines removes funds from paying medical workers.

When a hospital in the USA (for now) purchases an MRI, that machine provides an income to the provider as patients use it. It pays for itself by delivering superior care.

Lack of medical helicopter cost actress
03/21/09 - News.Yahoo by Mesfin Fekadu (via Econlog.Econlib) by David Henderson.

[edited] Tarek Razek is Director of Trauma Services for the McGill University Health Centre, representing six of Montreal's hospitals.
Driving to Mont Tremblant from Montreal is a 2 1/2 hour trip. That is the closest trauma center. Our medical system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States. Not being airlifted directly to a trauma center could have cost Richardson crucial moments. [This is what is available near a busy ski area -amg]
Richardson's initial refusal of medical treatment cost her two hours. Someone called 911 twice from her hotel room at the Mont Tremblant ski resort. She was driven to a local hospital that could not handle head trauma, then to a specialized hospital in Montreal, arriving about four hours after the second 911 call.

David Henderson:

[edited] The essence of "single payer" medicine in Canada is that only the government is allowed to pay for medical care. Thus the term "single payer."

The more serious the ailment, the more stringent the ban, with a few exceptions. So, if you want special treatment for cancer, you can't get it legally, and any doctor or hospital that tries to charge you faces serious penalties, up to and including a prison sentence. In that sense, Canadian health care is one of the most totalitarian systems in the industrialized world. It is far more extreme than the National Health Service of Britain.

That is what the world is like when you are a cost rather than a customer. When you go to an emergency room under socialized medicine, you are a pure cost. Your treatment may be directed by caring people of good will, but the institution is treating you only to raise its statistics, within the budget set at the annual (say) Medical Cost Process Review.

The bureaucracy sees you as a cost, especially if you have already paid. All people and organizations seek income and avoid costs. Socialized or centralized healthcare is paid up-front and delivers services after the fact. How hard will a system work to earn the money that they have already been paid? This is something that everyone can understand in his gut. A customer is lost without competition for his dollar.

Another thought. What would the food be like at a socialized "free" gourmet restaurant run by the government? Would they even wipe the tables? Of course, tipping is forbidden, and please eat everything on your plate.

Did the Canadian health system fail Natasha Richardson?
03/20/09 - KevinMD

[edited] Would Natasha Richardson be alive today if she had gone skiing in the United States instead? I don't think it would have made a difference.

Epidural bleeds are treated by drilling a hole in the skull to relieve the pressure. This often results in complete recovery. However, time is of the essence, and some are wondering if Ms. Richardson would have fared better Stateside.

Community hospitals would likely lack neurosurgical coverage in remote resort areas in the United States. In fact, because of the huge malpractice risk associated with the field, a neurosurgeon might not respond to an emergency call at a community hospital.

It is very likely that Ms. Richardson would have been transported to a tertiary care center if her accident happened here. The difference is that she would have been flown by helicopter, rather than taking hour-long drives by ambulance.

Dr. Crippen in the UK  blames the American wussification of today's doctor. A brave physician would have drilled the burr holes without the benefit of a CT scan (explanation and typical x-rays at the link):

It would be a career making or breaking decision. Few American doctors are brave. Defensive medicine is the order of the day. You cannot have a migraine in the USA without someone ordering an MRI scan.

Had this accident happened at base camp on Mt. Everest in a helicopter-blocking snowstorm, a doctor would likely have drilled. Had this accident happened in a ski resort forty years ago, before CT Scanners had been invented, a doctor would likely have drilled.

Then, a subdural/epidural haemorrhage was a clinical diagnosis. Apparently minor head injury, lucid interval, headache, sudden deterioration in consciousness, a dilated pupil, all adds up to an obvious diagnosis.

Medical technology has deskilled doctors.

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