A “cultural genocide” in Canada is believed to have taken the lives of at least 6000 children studying in the residential school system during 1940s-1950s.
The revised death toll came to light after it was revealed by the Chief Justice of the Supreme Court, Beverley McLachlin, that Canada had attempted to commit genocide against aboriginal people, reported The Independent.
“The most glaring blemish on the Canadian historic record relates to our treatment of the First Nations that lived here at the time of colonization,” McLachlin said.
According to Justice Murray Sinclair, Chair of the Truth and Reconciliation Commission, who is responsible for studying the legacy of the residential schools, the figure is an estimate and the true figure could be much higher.
“We think that we have not uncovered anywhere near what the total would be because the record keeping around that question was very poor. You would have thought they would have concentrated more on keeping track”, Sinclair told CBC.
Sinclair agreed with McLachlin’s assertion that Canada had sustained an “”ethos of exclusion and cultural annihilation”.
The incident dates back to the 19th Century, when the Canadian government developed a policy of aggressive assimilation, advocating education of aboriginal children at church-run residential schools.
According to one estimate, 20 to 40 per cent of aboriginal children who attended the residential schools died shortly after leaving the school.
Most of the children died of malnourishment or disease. Those who attended the schools between the 1940’s and 1950’s were even subjected to science experiments in which they were deprived of basic nutrients and dental care.
“I think as commissioners we have concluded that cultural genocide is probably the best description of what went on here”, McLachlin said, adding further that if anybody tried to do this today, they would easily be subject to prosecution under the genocide convention.
U.S. insurers and providers spent more than $800 billion in 2017 on administration, or nearly $2,500 per person — more than four times the per-capita administrative costs in Canada’s single-payer system, a new study finds.
Over one third of all healthcare costs in the U.S. were due to insurance company overhead and provider time spent on billing, versus about 17% spent on administration in Canada, researchers reported in Annals of Internal Medicine.
Cutting U.S. administrative costs to the $550 per capita (in 2017 U.S. dollars) level in Canada could save more than $600 billion, the researchers say.
“The average American is paying more than $2,000 a year for useless bureaucracy,” said lead author Dr. David Himmelstein, a distinguished professor of public health at the City University of New York at Hunter College in New York City and a lecturer at Harvard Medical School in Boston.
“That money could be spent for care if we had a ‘Medicare for all program’,” Himmelstein said.
To calculate the difference in administrative costs between the U.S. and Canadian systems, Himmelstein and colleagues examined Medicare filings made by hospitals and nursing homes.
For physicians, the researchers used information from surveys and census data on employment and wages to estimate costs. The Canadian data came from the Canadian Institute for Health Information and an insurance trade association.
United States vs. Canada
When the researchers broke down the 2017 per-capita health administration costs in both countries, they found that insurer overhead accounted for $844 in the U.S. versus $146 in Canada; hospital administration was $933 versus $196; nursing home, home care and hospice administration was $255 versus $123; and physicians’ insurance-related costs were $465 versus $87 They also found there had been a 3.2% increase in U.S. administrative costs since 1999, most of which was ascribed to the expansion of Medicare and Medicaid managed-care plans.
Overhead of private Medicare Advantage plans, which now cover about a third of Medicare enrollees, is six-fold higher than traditional Medicare (12.3% versus 2%), they report. That 2% is comparable to the overhead in the Canadian system.
Why are administrative costs so high in the U.S.?
It’s because the insurance companies and health care providers are engaged in a tug of war, each trying in its own way to game the system, Himmelstein said. How a patient’s treatment is coded can make a huge difference in the amount insurance companies pay. For example, Hammerstein said, if a patient comes in because of heart failure and the visit is coded as an acute exacerbation of the condition, the payment is significantly higher than if the visit is simply coded as heart failure.
More and more paperwork required
This upcoding of patient visits has led insurance companies to require more and more paperwork backing up each diagnosis, Himmelstein said. The result is more hours that healthcare providers need to put in to deal with billing.
“(One study) looked at how many characters were included in an average physician’s note in the U.S. and in other countries,” Himmelstein pointed out. “Notes from U.S. physicians were four times longer to meet the bureaucratic requirements of the payment system.”
The new study is “the first analysis of administrative costs in the U.S. and Canada in almost 20 years,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins School of Public Health in Baltimore. “It’s an important paper.”
‘Inefficient and wasteful’ system
“It’s clear that health costs in the U.S. have soared,” Wu said. “We’re paying for an inefficient and wasteful fee-for-services system.”
“Some folks estimate that the U.S. would save $628 billion if administrative costs were as low as they are in Canada,” said Jamie Daw, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health in New York City.
“That’s a staggering amount,” Daw said in an email. “It’s more than enough to pay for all of Medicaid spending or nearly enough to cover all out-of-pocket and prescription drug spending by Americans.” (VOA)