# Canadian Health Care System



## jutes85 (18 Aug 2004)

The LIEberals spend WAY too much money on healthcare. They think that buy just throwing money at it, it will get fixed. Why not get rid of our useless Social programs and spend it on something worth while. I just hope that the healthcare system will colapse soon so we can get a semi-private system like that of some European contries.


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## Freight_Train (18 Aug 2004)

You're kidding right?   Which health and social programs should we get rid of?   The healthcare system is broken and does need to be fixed, but hoping that it will collapse is ludicrous.   Canada, in 2000, spent $2,058 per capita on health care or 9.1% of GDP.   The Americans, for comparison sake, spent $4,499 or 13% of GDP in 2000!   Which European country should we model our new system after?   Germany who spent 10.6%, France at 9.5%, Switzerland at 10.7%?   Most developed, Western nations spend between 8% and 13% of GDP.   Stat's for 2000 here - http://www.who.int/whr/2002/whr2002_annex5.pdf
Greg


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## George Wallace (18 Aug 2004)

Perhaps he feels that if everyone in the country were in the Military, then there would be no problem of Healthcare costs, as then they would be 'serviced' by the Military.  Doctors would have fixed wages and not do 'Extra Billing' and we would be like Lenin dreamt of when he created Communism.

GW


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## jutes85 (18 Aug 2004)

Freight_Train said:
			
		

> You're kidding right?   Which health and social programs should we get rid of?   The healthcare system is broken and does need to be fixed, but hoping that it will collapse is ludicrous.   Canada, in 2000, spent $2,058 per capita on health care or 9.1% of GDP.   The Americans, for comparison sake, spent $4,499 or 13% of GDP in 2000!   Which European country should we model our new system after?   Germany who spent 10.6%, France at 9.5%, Switzerland at 10.7%?   Most developed, Western nations spend between 8% and 13% of GDP.   Stat's for 2000 here - http://www.who.int/whr/2002/whr2002_annex5.pdf
> Greg



Why do you think that some of the European healthcare systems are better then Canada's? The problem is not how much is spent, but HOW it is spend. We just throw money at it, without any control. If you give a hospital $10 million a year for example for its costs, it will use every cent, there is way too much socialism in Canada. The idiots in Ottawa seem to think that more money is the only solution, Europeans are smarter however, they make sure they pay for every bill seperatly and don't waist money.

Sorry it its off topic.


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## Freight_Train (18 Aug 2004)

Why do you think that some of the European healthcare systems are better then Canada's? The problem is not how much is spent, but HOW it is spend. We just throw money at it, without any control. If you give a hospital $10 million a year for example for its costs, it will use every cent, there is way too much socialism in Canada. The idiots in Ottawa seem to think that more money is the only solution, Europeans are smarter however, they make sure they pay for every bill seperatly and don't waist money.

Sorry it its off topic.

Sure it's off topic. Perhaps a mod could split this off?   Anyway, I don't know that any of the European healthcare systems are better than ours.   Show me some proof.   The countries I highlighted in my original post spend more per capita than we do.   Every system evolves over time and every funding decision has both intended and unintended consequences.   Healthcare is a HUGE business that has many stakeholders that all want a piece of the pie.   There are far too many special interests involved for a true system change and until the government grows some b a l l s, nothing will change.   So I do agree that they are throwing money at the system to keep it limping along.   BTW, Federal funding provides for only 16% of total public funding.   Source here - http://www.ccc-cce.ca/english/downloads/Funding.pdf 
Greg


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## Gunnerlove (18 Aug 2004)

Waste is inherent with any and all large organizations. To believe otherwise is to believe the neocon garbage that privatizing everything will fix everything. You can minimize waste but to eliminate it is dreaming.

When you break up every bill and expense you increase your accounting costs this could and would be considered waste by most people. 

But I am a just dick carry on with bashing my country. ;D


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## Infanteer (19 Aug 2004)

P.S.

Mr Jutes, if you had bothered to look, you would have found a perfectly acceptable thread to bring you health care issues to light here:

http://army.ca/forums/threads/18097.0.html


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## Yard Ape (19 Aug 2004)

jutes said:
			
		

> I just hope that the healthcare system will colapse soon so we can get a semi-private system like that of some European contries.


Things that work in one place do not always work in other places.  Why do you think private health care would work for us?  I would expect the gpvernment could run it cheaper because there would be no profits skimmed of to the private sector.


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## Bruce Monkhouse (19 Aug 2004)

That is the point that most people who advocate privatization miss, is that there must be a profit margin, where in the public there doesn't need to be.   I think the problem with the public sector is for years the money tree rained down and managers forgot how to manage cost-effective.   I do agree that throwing money at health care is not the answer because the way it it now it would just function as a bottomless pit.
I believe in the two-tier healthcare on a limited basis, I mean in reality only the foolish can't say we don't have it. Tonight Mats Sundin and I collide and hurt our knees, an hour later his MRI is done and I'm still sitting in emerg. waiting to be told mine is in 7 months, or if I have the money I slide across to USA and get it done right away. This is two-tier no matter how you look at it!
What I would like to see is better management were machines don't sit idle for 16 hours everyday while people wait 7 months for something.
Say like in Guelph were the CAT scan machine only gets used 8 hours a day due to lack of funding/techs, open it up to paying customers after normal working times to those who can afford to pay and keep those dollars in Canada. With the profit, expand the OHIP hours accordingly. Those who jump the Que still pay for the OHIP running of the machine with their taxes and help fund the extra running time of the machine. This will lessen the backlog two ways, more open time and people who are ahead of you but pay are also out of your way.
For me, its win-win. but it would require good management and right now thats where my concern would be.


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## Michael Dorosh (19 Aug 2004)

If jutes knew half as much about health care as he does about the Army...

...err, 1/2 nothing is still nothing isn't it...

I've worked for the Calgary Health Region for the last 4 years, perhaps jutes would like to explain exactly which programs money is being "thrown" at as I am unclear on what he is speaking about.  Unless we are supposed to only post vague generalities, in which case, well done.  I'll counter with my own generality that health care workers aren't paid nearly enough, there is little money for basic equipment like computers and printers, and while the nurses we have are peaches, there aren't enough of them.  Partly due to the "brain drain", which could, of course, be stopped by...more money.

Not that I disagree that throwing money at problems doesn't solve them, but I see no evidence that money is mis-spent.  Perhaps jutes can enlighten us with some actual examples.


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## Spr.Earl (19 Aug 2004)

Jutes,so what you mean too say is,I as a 51yr old am not allowed to have my annual bum inspection?
What? In your opinion I'm allowed to rot,waste away and die?
Just because I can't afford it?


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## Infanteer (19 Aug 2004)

Well, I've carried over the health care discussion to the existing forum.

http://army.ca/forums/threads/18097.0.html

Why don't we just kill this goat before it gets beyond silly.


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## Spr.Earl (19 Aug 2004)

Infanteer said:
			
		

> Well, I've carried over the health care discussion to the existing forum.
> 
> http://army.ca/forums/threads/18097.0.html
> 
> Why don't we just kill this goat before it gets beyond silly.


And it's Master.


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## tomahawk6 (26 Jan 2005)

The politicians sold out DND for national healthcare decades ago. National healthcare is the albatross around the necks of Canada and western europe. It will take a strong PM one day to make things right or a melt down in the system.


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## MagieNoire (27 Jan 2005)

I am interested in the Canadian healthcare system as viewed by its citizens.

I get the feeling this is a bad topic. Please do not take it out on me.

Is it basically a good concept that's being mismanaged or a bad concept altogether?

Your feelings?

Thanks.

PS- Americans need a healthcare makeover and we are always discussing Canada's but don't know as much as we should. Plus, I don't trust the media to provide the same information a Canadian citizen would. Okay, thanks again.


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## MagieNoire (27 Jan 2005)

jutes85 said:
			
		

> Why do you think that some of the European healthcare systems are better then Canada's? The problem is not how much is spent, but HOW it is spend. We just throw money at it, without any control. If you give a hospital $10 million a year for example for its costs, it will use every cent, there is way too much socialism in Canada. The idiots in Ottawa seem to think that more money is the only solution, Europeans are smarter however, they make sure they pay for every bill seperatly and don't waist money.
> 
> Sorry it its off topic.



This is what I am wondering. So, the system is a good one but is being mismanaged? Do you feel the money is going mostly for administration expenses? Perhaps, a revistion of your system with stricter guidelines to followed to end the waste and or profit of the administartions?

I am only guessing because I have no clue.

Our healthcare is going out of the roof!!! You do NOT want our healthcare system. No money, no healthcare. Period.


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## winchable (27 Jan 2005)

Well if the US were to adopt a universal healthcare system, would it not also need to implement a major tax increase?
It just doesn't sound like it would work in a country, where low taxes and limited government involvement in private citizens financial/business affairs, are some of the basic tenements of its foundation.


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## MagieNoire (27 Jan 2005)

Che said:
			
		

> Well if the US were to adopt a universal healthcare system, would it not also need to implement a major tax increase?
> It just doesn't sound like it would work in a country, where low taxes and limited government involvement in private citizens financial/business affairs, are some of the basic tenements of its foundation.



Sigh, I was wondering why you feel your system is failing and or requires improvement.

Our taxes are too low. Huge tax breaks and shelters are given to corporate America, not its citizens. No system will work if it is mismanaged and a front for profit making by the admins that are in control over it. 

*How* is your system not working? Plz, be specific. Thanks.


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## winchable (27 Jan 2005)

I'll level with you,
It works for me juuust fine, but I've avoided major surgery (knock on wood) up to this point in my life.

I'm sure like anything else in Canada it's a bearacracy rife with waste and could stand to be cleaned up.
If jutes85 is to be believed then the money is wasted because money is thrown as a large lump sum at whatever a desk driver decides they need for the quarter.
So it seems, based on all government activity in Canada, that any review or attempt to restructure would take a veyr long time and cost more in the long run.
So I suppose we either take the waste with a stiff upper lip or complain about it, either way, given the current administrations track record for waste and given the beauracracy inherent in a universal healthcare scheme things are not likely to change or reform.

All speculation.


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## Stefan Moxness (27 Jan 2005)

For the better part of my life I've had the blessing of not requiring any (actually no time at all) time in the hospital.  Until about 2 years ago when I dislocated my right shoulder.  Since that time it's popped out roughly 12-14 times.  the most recent was on a skiing trip to Colorado.  All of the times that I've dislocated it except the first occasion has been late at night goofing around waiting to go and party (say past midnight), when I arrive at the hospital I typically wait from 2-14 hours before my shoulder finally gets put back in place.  when it happened in colorado i was in and out within an hour.  I believe the major problem with our healthcare system is the lack of pay for most of it's workers and doctors, in Mississauga, a MAJOR suburb of Toronto there were 2 doctors in the ER at night time everytime I've been there (over 6 times), I would chalk this lack of docs up to funding but then again that's just an assumption.  The beauty of the American system is it's speedy, IF you have the money to pay for it (a simple shoulder reduction cost me upwards of 1000$ canadian).  Personally I love our system I'm willing to sit there with my arm out of it's socket for 2 hours if it's means that I needn't spend a grand everytime it happens (for me this would've worked out to over 12 000$ canadian in 2 years, quite a substantial sum).  Anyways my two cents.

Cheers, and be safe.


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## MagieNoire (27 Jan 2005)

John Doe said:
			
		

> For the better part of my life I've had the blessing of not requiring any (actually no time at all) time in the hospital.   Until about 2 years ago when I dislocated my right shoulder.   Since that time it's popped out roughly 12-14 times.   the most recent was on a skiing trip to Colorado.   All of the times that I've dislocated it except the first occasion has been late at night goofing around waiting to go and party (say past midnight), when I arrive at the hospital I typically wait from 2-14 hours before my shoulder finally gets put back in place.   when it happened in colorado i was in and out within an hour.   I believe the major problem with our healthcare system is the lack of pay for most of it's workers and doctors, in Mississauga, a MAJOR suburb of Toronto there were 2 doctors in the ER at night time everytime I've been there (over 6 times), I would chalk this lack of docs up to funding but then again that's just an assumption.   The beauty of the American system is it's speedy, IF you have the money to pay for it (a simple shoulder reduction cost me upwards of 1000$ canadian).   Personally I love our system I'm willing to sit there with my arm out of it's socket for 2 hours if it's means that I needn't spend a grand everytime it happens (for me this would've worked out to over 12 000$ canadian in 2 years, quite a substantial sum).   Anyways my two cents.
> 
> Cheers, and be safe.



They fix your shoulder and it costs nothing? Zero dollars? Do you have a limit of how many times you can go to the doctor?

What about going to the dentist? You get to go there for no out of pocket charge? I think you guys have the right idea but proably they are msimanaging it. I'm guessing. Wow, I can't imagine being able to go to a doctor for no out of pocket charge. I don't have insurance. I'm one of the working poor as they say. Self employed with two different jobs. Still, not enough. It's realllllly tough. Such is life.

Thanks for sharing about your healthcare system.

Colorodo was having a good day. People wait hours here as well. Only people who are in extremely bad shape go in right away. And some of those haven't made it in, in time.


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## Drummy (27 Jan 2005)

MN,

In Dec, 2003, I was in hospital for an anuerysm repair(aortic arch) and a double bypass. 6 weeks later, I was in for another anuerysm repair(abdomen). This didn't cost me one red cent other than the portion of my taxes which go to medicare.     ;D      I've had a couple of surgeons tell me that in the States, this might have cost about $75,000 or more. Not sure of that though.

What really surprised me and others was that it all started to happen within 3 weeks after getting X-rayed because of a very bad chest cold.

I don't pretend to understand the inner workings of the Medicare system, but my family doctor practiced somewhere in the States for about 12 years, and then decided to come back to Canada to practice because he didn't liike the system(?) down there.

All the best     Drummy


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## Armymedic (27 Jan 2005)

The problem with the health care system is not so much a problem of equipment of funding for facilites...its a personnel problem. Yrs ago gov't in order to cut cost, cut the largest $ burden, but unfortunately the most important part of our health care system...people.

So after yrs of minimum manning in the disguse of budget cuts (something we in the military can understand) those numbers are growing as gov't sees the need for more nurses and doctors in our hospitals as the first step in improving our health care. 

Doctors take 8-12 yrs to train so the improvements the gov't made the last couple yrs won't be seen for a few more.


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## sigpig (27 Jan 2005)

As a Canadian currently living in the US I have a few observations:

- I currently pay about $330/month for my HMO coverage. It's considered 'pretty good' by American standards. To keep the price that 'low'  ???, they have raised the co-pays this year to $25/per doctor visit, $15/prescription, $75/emergency room visit.

- For the above money, I get to pick out of the HMO's list of approved doctors and hope one is close to where I live and is a good doctor. Co-pay's go up and coverage comes in to question if you chose an out of coverage doctor.

- when I first moved to Louisville, I had to have a plantars wart taken care of. The wife had to use a company which locates doctors who are on your plan and who are taking new patients. Then see doctor - copay, go see specialist - another co-pay, yep there's a problem, come back another time - another co-pay.

- and I feel lucky to have the coverage I do. I know people on my street who have no coverage and don't get things taken care of. In Canada you don't see reports of people going bankrupt because of medical expenses, happens a lot here. 

Maybe Canada's system needs some tweaks and improvements, fine. Just don't look down here and think things are great. They aren't.


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## karl28 (27 Jan 2005)

How can any one person believe that the gov is spending to much on health care ?  Maby the should look into some one eyes that a Palliative care patient and tell them that they cant live any more because they cant afford it .     I am a P.S.W I look after the elderly and disabled and if it wasn't for the funding the gov gives to these people witch ant allot they would cease to exist .    Yes the health care is broken but it can be fixed going Private is not the answer .


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## Brad Sallows (27 Jan 2005)

1) Health care is in high demand, and there's an oversimplified but observationally borne out principle of economics that demand approaches infinity for anything which is perceived as "free".  We are unlikely to ever turn around one day and find that Canadians deem they have "enough" health care no matter how much we spend.  Health care in Canada is _not_ free; that is merely how it is perceived by people who fail to make the connection with their income tax return (or the income tax returns of those who pay the overwhelming majority of personal income taxes).  People overuse anything for which they don't have to pay, or for which they perceive the cost to be well below their margin of utility.

2) People in extreme discomfort or facing death will spare no expense, if they can.  Everyone dies but not everyone gets to slip away suddenly and peacefully while they sleep.

3) Generally in medicine it is best to intervene at the earliest opportunity.  A system with significant wait times is not much better than none at all.  If you miss a window of a few weeks during which your cancer might have been detected in time for treatment, it isn't going to matter that it costs you nothing to slowly waste away in a hospital bed with tubes leading in and out of you.  I frankly do not care if someone can buy Tier 1 Rolls-Royce health care if my Tier 2 publicly-insured health care is timely and competent, and the key to that is to have enough providers and facilities.

4) We have public health insurance and for the most part public care delivery.  The US has for the most part private insurance and care delivery.

5) Doctors have salary:work ratio expectations, and in Canada those expectations are not being met - too much time at work for too little take-home pay.

6) Other workers in the system wish to be well-paid and enjoy union-style benefits, pensions, and job security.

7) Ultimately the health care problem is the same one facing anyone who has ever done an administrative estimate: resources versus requirements.

Anyone who has worked a few different jobs with various health care and dental plans should have noticed that as a rule, the premiums are lower when the participating plan population (eg. the size of the company) is larger.  Typically self-employed people pay the highest premiums of all.  It suggests that in principle a public insurance scheme may in fact be the "cheapest".  Public insurance also removes the cost (to users) of the insurer's desired profit.  Against that must be balanced the lack of market mechanisms to prevent the insurance administration bureaucracy from becoming overborne.

If health care workers are dissatisfied with working conditions and remuneration, it strikes me the only way to establish proper expectations is by free market mechanisms.  I fully expect we will discover that health care costs "more".  The point of health care delivery is to have enough capacity to meet reasonable demand.  Since we are dealing with what is pretty much a personalized service and not an infrastructure megaproject, I think it safe to assume this is one area in which the usual free market mechanisms can meet demand.  There will be reasons for government to participate in that market - for example, to meet the needs of small or isolated communities - but I believe a government near-monopoly is harmful.

There is nothing rigorous about all of the above; but, in short, I believe the reason the Canadian and US systems are perceived by some as dissatisfactory is that the optimum path probably lies somewhere in the general direction of the public insurance/private delivery vector.


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## Gouki (27 Jan 2005)

Despite our healthcare problems, it is one of the things I am proud and feel lucky to be Canadian for. Our healthcare system is one of the bigger things attached t the country.

That being said .. it definately needs improvement. We've already acknowledge and talked about the latent problems it has, so no need to regurgitate anything. I just feel we need a more responsible Government making sure our healthcare money is pissed away down the drain. I think it's more than possible to overhaul it and give it new life just .. not how things are going now. The two tiered healthcare system, like in Toronto I believe ... I think that is a good idea. Everyone still gets healthcare but those that need it the fastest or can pay up front for the whole thing get in first. If the person can pay for it all with no cost to the system - then why not? It frees up more money and resources for those who cannot afford things and will rely on the socialized healthcare approach. I would like to see the PC's come into power next election, because from what listening to what Harper had to say about healthcare it sounds like him and his party could do much better than the Liberals and Martin - although really anybody could.

BTW, MN, I have had two surgeries on my MCL on my left knee, my father has been treated for kidney stones twice and my uncle has been treated for a heart attack, and in all circumstances it cost everyone of us not a single cent. This is why I love our healthcare system and to be in Canada.


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## Glorified Ape (27 Jan 2005)

My dad had a brain tumor (I can't remember for the life of me what the messed up latin name was for it) but it was the spider-type with the main body and all those pesky little tentacles that are near impossible to get rid of. He gets it identified and shortly thereafter he's in the hospital having it (or as much of it as possible) removed. Great - he's better and it didn't cost him a penny. 

Two years later, the tumor's come back and he goes in to get all the diagnostics done. Because of its fragmented, tentacle structure they can't physically cut the stuff out and would have to use radiation treatment... I'm sure I don't have to explain the problem with using radiation on someone's brain. The doctor says that there's nowhere in Canada that can do it but there's a treatment at John Hopkins (or somewhere) in Boston, using super-focused radiation and other things, that might work but my dad's thinking "yeah, right - at what cost".The government covered the ENTIRE treatment which, if my dad had paid, would have been about 250 000+ dollars. The only costs my dad had to pay were for the hotel he stayed at while he was getting the treatment and his other living costs (food, etc.). On top of that, he got to visit Cheers.   ;D

Sure, there are problems with the healthcare system just as there are problems with every institution. That doesn't mean we should cut our nose off to spite our face. 

There's an interesting comparison here: http://www.pnrec.org/2001papers/DaigneaultLajoie.pdf


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## Infanteer (27 Jan 2005)

Glorified Ape said:
			
		

> The doctor says that there's nowhere in Canada that can do it but there's a treatment at John Hopkins (or somewhere) in Boston, using super-focused radiation and other things, that might work but my dad's thinking "yeah, right - at what cost".The government covered the ENTIRE treatment which, if my dad had paid, would have been about 250 000+ dollars. The only costs my dad had to pay were for the hotel he stayed at while he was getting the treatment and his other living costs (food, etc.). On top of that, he got to visit Cheers.



2 points on the story:

1)   Most Americans, who is insured to some degree (some are not, but the same in Canada - I am uninsured right now), would get the treatment for free as well.   The only difference is that their insurance most likely provided by a big, bureaucratic private organization (HMO) while we are covered by a big, bureaucratic public organization (the Provincial Government) - either way, we both suffer from having our health care managed by the same type of organization.

2)   The alarming fact is that your Father was not able to get the treatment in Canada.   Morally, how can we sit back and condemn the private delivery of health services when our insufficient public system must send people to the US to provide lifesaving treatment?

I hope everyone is seeing that their is a difference between delivery of health services and delivery of health insurance.   It is possible to work with one without harming the other.   Here is my thoughts, that I still strongly stand by, from a previous Health Care discussion on this board:


_In a book on Health Care Reform, Dr. David Gratzer identifies a key problem with both ours and the American health care system, a break in the doctor patient relationship with regards to health care as a commodity.   Like the other essentials such as food or shelter, health care is a service in which the patient is a consumer and the doctor is the provider.   This occurs when the cost of health care is removed from the consumer and provider (patient and doctor) and taken up by a large bureaucracy removed from the relationship; in the US most Americans are covered by large HMO's while in Canada we have 10 huge HMO's (the provincial governments).   Grazer is keen to point out that our beloved system today cannot even provide the five pillars of Health Care set out in the Canada Health Act; those being *quality*, *timeliness*, *cost effectiveness*, *patient oriented*, and *universally accessible*.

With a centrally managed and subsidized system, the responsibilities for proper supply and demand are distorted, leaving perverse incentives for patients, doctors, administrators, and politicians to abuse the system, resulting in the gasping, wheezing system we have inherited today.

Patients can abuse the system by overusing services since they have no concern for the cost the public bears.

Doctors can abuse the system by encouraging return visits and to overservice patients with unrequired procedures (there is documented cases of this); they essentially have the power to right their own paycheck without any input from those providing the payment, the patient, who bears no direct payment.   As well, there are incentives to leave Canada to other, more lucrative areas to practice (the brain drain)

Administrators can abuse the system through fighting for pieces of the budget pie and increase the global budget they must spend in order to justify further financing.   They look up rather then down when taking the dollars and cents of health care into consideration.

Politicians can abuse the system through turning what ought to be a simple procedure (go and get your problem dealt with) into a complicated political issue.   Health Care is big bucks; with a large portion of the public purse dedicated to Health, you see various interests begin to take hold and ultimately political matters become as important as the health of citizens when decisions are made.   Look at the latest federal election for proof; all parties were willing to dump millions more into health care, but no one really seemed to care if dumping it was akin to "trying to fix a leaky hose by pumping more water through it".

Mark Milke makes a interesting observation of the way we choose to run our health.

"If governments ran grocery stores, bureaucrats in Ottawa and the provincial capitals would determine how many boxes of Corn Flakes were to be available in Halifax, Sarnia, and Kamloops.   Government unions would argue that because food is so vital for human survival only they should be allowed to run farms, grocery stores, and the transportation system that surrounds the provision of foodstuffs.   Lobby groups would spring up to decry the encroachment of "two-tier foodcare" where some rich folks could buy cavier while the rest of us make due with hamburger.   If Canada's governments controlled retirement in the manner that health care is regulated, retirees would not be allowed to save for their retirement outside of the Canada Pension Plan and the government would determine how many Winnebagos and trips to Florida could be bought every year.
The great accomplishment of Canada's health care system is that it is universal; the great failure is that funding decisions are forced through bureaucrats and politicians."

Ultimately, the decision on how you manage your personal health should belong to you and you alone.   In a private matter between the doctor and the patient, the decision should be free should be free of politics and bureaucratic entanglement.   The government's role should be to ensure abuses do not occur and that everyone has access to the advanced care available within a modern state.

A little more on health care reform.   The idea's can be found in Dr David Grazer's book Code Blue: Reviving Canada's Health Care System"

I would prefer the private delivery of health services if possible.   This can help Canada's system of health care because:

1) It eliminates the cost of managing a hospital and the large bureaucracy that is needed to do so

2) It gets the governments away from disputes with large public sector health unions. These are big-money, big-power unions that have guys sweeping floors for $18.00 an hour.

3) It allows doctors the ability to deliver care as they see fit. One of the biggest reasons for our "brain-drain" is government meddling in what the doctor can and can't do in treating his patient. This meddling is an effort to curb costs that unfortunately reduces service.

The main issue that faces both American and Canadian citizens is that there is no consumer/provider relationship in terms of cost. In the United States, most people are insured by their employer, who pays a large HMO to run their health care, while in Canada, we just have an even larger HMO, the provincial government, running ours. Neither is up to doing a good job. This dissatisfaction with HMOs is probably why some states are going to public delivery of service; however the divide between the patient and the doctor still exists.

The key to the consumer/producer issue is that health care can be prohibitively expensive. That is why I believe in a universal safety net for all Canadians. However, it must be managed by the people, not the bureaucrats. It is a system used in Singapore and by some corporations in the US called the Medical Service Account (MSA).

A simple way of explaining it for us would be this. Every Canadian is covered for hospital stays that cost over $2000 dollars. If you get cancer, get run over by a bus, or need a new organ, the public fund will pay for this. For any routine visits to the doctor, breaks, perscriptions, dental visits (alot of things are medically related, but not covered under the Canada Health Act) every Canadian has an account with a MSA Card. The government deposits $1,000 into that account every year. If you want to go to the emergency room for a sprain, fine, pay $150 instead of $30 at a drop in clinic out of your MSA. The decision rests with the patient on which doctor and which medical services he or she feels are necessary. You are the manager of your health funds.

The incentive for good use of our health care resources is that at the end of the year, a person can use any available funds in the MSA as he or she sees fit. You can leave it in the account to have a larger "pot" saved away for health care expenses, or you could elect to pay the taxes and withdraw it, gaining some expendable income; or you can transfer it to an RRSP to contribute to your private retirement fund, since the average return on CPP contributions for Canadians gets smaller and smaller every year with the changing demographics. 

In an MSA system, it wouldn't matter if the hospital was public or private, because you have the choice of spending your money where you want to. Private clinic charges too much? They don't get business and have to drop prices or it would go under.

Well, you can tell you've tickled an issue with me. I mentioned this system of health care to my MP (a Conservative) and he brushed it aside and ignored me. Unfortunately, I think it is good economic reforms like this that are needed to save our Health Care System. However, if I advocated a reform like this, I would just be attacked for wanting to "Americanize our Healthcare" system. This is what has been done to Ralph Klein, and I don't see any justifiable reason. Canadians just don't want to learn that their socialist system doesn't work, and they are willing to put up with mediocrity (long waits, poor and old machinery, fewer and fewer doctors and nurses) to sustain that belief.

Cheers,
Infanteer_


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## Brad Sallows (27 Jan 2005)

>I just feel we need a more responsible Government making sure our healthcare money is pissed away down the drain.

I think the Government we already have is able to piss healthcare money away with no difficulty at all.

>it cost everyone of us not a single cent

How have you all been able to skip out on paying taxes for so long?  Seriously, if you have no idea what the procedures have cost compared to what you and your family have paid into the system as your share of total government spending on health care, how can you possibly have any idea whether you are ahead or behind?

Everyone has a story about how they didn't have to pay on the spot for health care, except perhaps a token user fee.  Guess what: it's the same for people who have private health insurance, or who live in a jurisdiction (including the US) where they can't be denied essential care regardless of ability to pay or citizenship.  Quit deluding yourself that you don't have health insurance or that you're not paying for it (unless you are living "outside the system" and paying no taxes of any nature).

I re-emphasize what I believe to be important: stop being distracted by the myth that health care in Canada is free and focus on the real problem, which is that health care in Canada must be rationed because our delivery system is dysfunctional.


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## muskrat89 (27 Jan 2005)

I have lived (and been sick in) both systems. Brad has hit it on the head. Canadian health care is not free. I had far more taxes come out of my paycheque in Canada, than I do in the US. In New Brunswick, it seems that a lot of the rural hospitals are getting axed, in favour of "regional" centres. On the other hand, when I started with my current Company 7 years ago, they covered the cost of health insurance. Now I'm up to about 200 bucks per month. All things relative, I think that is still less than the tax dollars I contributed in Canada. Coincidentally the year that our Company President (sadly) announced that the Company would no longer be able to foot the entire bill for health care - the insurance Company showed record profits....


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## PPCLI Guy (28 Jan 2005)

tomahawk6 said:
			
		

> The politicians sold out DND for national healthcare decades ago. National healthcare is the albatross around the necks of Canada and western europe. It will take a strong PM one day to make things right or a melt down in the system.



Bollocks.

And yes, my post has just as much substantiation as the one that I have qouted.

Dave


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## tomahawk6 (28 Jan 2005)

It should be self evident PPCLI that national health care is gobbling up more and more resources. National health care is headed for a meltdown unless it is reformed. Fewer people are going into healthcare. Why ? Regulation and doctor's cannot make any money. The UK health care system has similar propblems as do those of other european countries. Its not a shock that all those countries are cutting defense spending [its the one area that they can cut to free up funding for healthcare]. But if you insist on supporting links I will provide some.

http://www.canada.com/national/story.html?id=e5a884af-1dc1-406d-8e85-c85603de1213


2004 Budget - $36.8 billion for healthcare

http://www.fin.gc.ca/budget04/bp/bpc4ae.htm


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## Glorified Ape (28 Jan 2005)

Infanteer said:
			
		

> 2 points on the story:
> 
> 1)   Most Americans, who is insured to some degree (some are not, but the same in Canada - I am uninsured right now), would get the treatment for free as well.   The only difference is that their insurance most likely provided by a big, bureaucratic private organization (HMO) while we are covered by a big, bureaucratic public organization (the Provincial Government) - either way, we both suffer from having our health care managed by the same type of organization.
> 
> 2)   The alarming fact is that your Father was not able to get the treatment in Canada.   Morally, how can we sit back and condemn the private delivery of health services when our insufficient public system must send people to the US to provide lifesaving treatment?



1) I don't disagree about the bureaucracy. As for insurance, there was some alarming figure about people in the US not having insurance. If people can't afford insurance, what then? I understand that, if you're really really poor and actually can't afford insurance by any stretch of the imagination, there is a public plan. I've heard the quality approaches somewhere near Somalia in terms of care, though. (Yes, I'm exaggerating). 

2) Well, the treatment wasn't a widespread thing - as far as I can remember (I was about 10-12 years old) the treatment was semi-experimental at the time. I agree with you that we need to increase the amount of MRI and other equipment but with a system motivated by profit vs. one motivated by availability, you're ALWAYS going to have the profit system produce new services faster as it provides another way to profit. I'm just glad that the government wasn't so idiotic and selfish to say "we're not paying for treatment that we can't give you".


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## camochick (28 Jan 2005)

I am a new brunswicker living in Alberta and I have to say that i would gladly pay 15 percent tax on things rather than have to fork out 44 dollars a month for my health care here. I am a student and money is tight, so right now i have no health care insurance. The good news is that Klein is probably going to eliminate the fee . There is a definate need for reforms to our system. Canadian's need to get our heads out of our arses about the whole private companies providing services. If you can get your (insert whatever diagnostic service you need) faster and still "free" then what is the big deal.


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## Glorified Ape (28 Jan 2005)

camochick said:
			
		

> I am a new brunswicker living in Alberta and I have to say that i would gladly pay 15 percent tax on things rather than have to fork out 44 dollars a month for my health care here. I am a student and money is tight, so right now i have no health care insurance. The good news is that Klein is probably going to eliminate the fee . There is a definate need for reforms to our system. Canadian's need to get our heads out of our arses about the whole private companies providing services. If you can get your (insert whatever diagnostic service you need) faster and still "free" then what is the big deal.



We already have problems enough retaining our health care professionals - if we created the 2-tier system, how likely is it that the public system will retain ANY decent personnel? I could be wrong, that's just seems a likely problem.


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## camochick (28 Jan 2005)

Well how are we going to keep our health care proffesionals if we dont pay them more, but if we pay them more the facilities will suffer it a lose-lose situation. I don't really think there is a solution to the health care problems. The government is too wrapped up with trying not to piss off the public so nothing is really getting done. If we use private companies, people freak out, if we dont have enough equipment or facilities, people freak out. You can't win with the canadian population. What most dont see is that we, the people have to take responsibility too. Taking better care of ourselves, not running to the hospital everytime we have the sniffles etc.


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## Cliff (28 Jan 2005)

Glorified Ape said:
			
		

> As for insurance, there was some alarming figure about people in the US not having insurance. If people can't afford insurance, what then? I understand that, if you're really really poor and actually can't afford insurance by any stretch of the imagination, there is a public plan.



The Mexican illegals and down-and-outers seem to benefit the most = since they don't have to fork over any money = unlike the working poor who have a limited income. Even a   Walmart door greeter would probably have to break loose with some change..or do without medical.


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## Infanteer (28 Jan 2005)

From what I've looked at, I agree with Tomahawk6.  I've seen figures from multiple sources demonstrating that the current rate of increase in Health Care expenditures to support a government-managed social system loaded with perverse incentives and a creaky system of Public delivery that would make the Politburo proud will eventually reach 100% of budgetary requirements in a decade or two.

Other things need government money, so the result is that our real-world access (in both coverage and available services) will become smaller and smaller.

Regardless of resources needed by the military or any other government department, the Health Care system needs to be fixed real quick.


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## Brad Sallows (28 Jan 2005)

>how likely is it that the public system will retain ANY decent personnel?

Do you think the public education system compares that disfavourably to the private one?  What a larger and more open private system will do is set the benchmarks against which the public system will have to compete.  Public health care delivery advocates in Canada insist the system is less costly than a private one would be.  Is that because we have chained the doctors to the hospitals and dictate how little they will be paid?


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## Jungle (28 Jan 2005)

A lot of discussion about the responsibilities of govts towards health care, but what about citizen's responsibilities ?? Some people, actually a lot, do not take responsibility of their own health. People eat way too much fast food, drink too much pop, smoke, do not exercise... then when they get sick, they have to be treated right away, and effectively !!
Another thing we need to look at: the reasons for ER visits. People go to the ER because they have a cold, or because they cut themselves on the finger while preparing food !! 
A couple of years ago, I went to the ER because on of my kids broke his arm playing. Well, we had to wait 2.5 hours to get treatment, but the lady before us was getting a pregnancy test   Pissed me off !!!  :rage:
We have to make people more responsible; unfortunately, I don't think it's possible.
As for the US, with the proportion of young people down there who are getting fat or obese, a public system likely could not support the costs of future treatment for these people.


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## Infanteer (28 Jan 2005)

With a Medical Service Account system, the inapproriate use of Emergency Room services should decline because people would be less willing to pay $350 out of their account for a cold, a sprain, or a pregnency test when they could go to a drop-in clinic and pay $30 out of their account.


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## ArmyRick (28 Jan 2005)

In specific reference to health care. We are hurting in our country and we will continue to burn excess dollars in that area. Why?
IMO (after talking to friends who are in the profession of keeping people healthy)
(1) There is next to no real encouragement on preventive health measures
(2) Pharmaceutical companies make cash off of sick people so they don't want people to get too healthy too soon (this is no bull) Some of these pharmaceutical companies are more powerfull in the USA and Canada than the major tobbacco companies ($$$ buys influence wether you want to beleive it or not)..In short sick people are good for some business.. 

Never mind, I have way more to say but it would require a different thread...


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## ArmyRick (28 Jan 2005)

Jungle is right on..
We have too many people who use and abuse our health care system.
Emergency room is for emergencies not sniffles or as he put it, pregnancy test.

Also how much does our government put into preventive health ? Beleive it or not alot of diseases or ailments could be beaten by avoiding poor health choices.
Some of the problems? Adult on set diabetes, some forms of cancer, obesity and all its related problems, excessive drinking and its problesm (cancers, car crash victims, abuse victims, etc), smoking (this is like the anti-holy grail of healthy life style), poor dietary habits, hell even most house hold and personal care products are way too dangerous, the list goes on and on...

An ounce of prevention is worth a pound of cure...

Also, pharmaceutical companies (who make wicked $$$) don't want people getting healthy too soon...

Another interesting point. 100 year years ago 1 in 100 people got cancer, now today 1 in 4 will get cancer in their life time...Too sad.


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## Bruce Monkhouse (28 Jan 2005)

Quote,
_Another interesting point. 100 year years ago 1 in 100 people got cancer, now today 1 in 4 will get cancer in their life time...Too sad._

Now I do have issues with a lot of the cancer research, in the sense that it seems to have become a HUGE industry that {my opinion] I'm not sure would really like to find a "cure"....more money to be had in "treatment options".
Now the reason I quoted your post is because I know how that fact is used to help fund raise but while listening to a program today about medical stuff where a Doctor predicted that it won't be long until our life expectancy is 150 years, he stated that at the turn of the century human life expectancy was 36, now its 74, makes sence that there is a better chance of getting cancer or any other disease, eventually something has to kill us.


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## Poppa (28 Jan 2005)

Glorified Ape said:
			
		

> We already have problems enough retaining our health care professionals - if we created the 2-tier system, how likely is it that the public system will retain ANY decent personnel? I could be wrong, that's just seems a likely problem.



One way would be to have health professionals working for the universal system for a set number of hours per day and if they want to..they can set up their own for profit clinic. As long as they provide the federally mandated service I see no issue with them having something on the side.
As for the patients/users we would have a choice...universal care as it is now *or* the option of paying. Same Dr. Same level of care..just choices.

Keep in mind this is a very simple explaination but I can think of no reason why it can't work.

Thoughts?


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## sigpig (2 Feb 2005)

Just another news article about the joys of health care in the US:

Study: Health costs spur bankruptcy
Researchers say 50% of filing caused by medical bills; most who file are insured middle class.
February 2, 2005: 6:05 AM EST

WASHINGTON (Reuters) - Half of all U.S. bankruptcies are caused by soaring medical bills and most people sent into debt by illness are middle-class workers with health insurance, researchers said Wednesday.

The study, published in the journal Health Affairs, estimated that medical bankruptcies affect about 2 million Americans every year, if both debtors and their dependents, including about 700,000 children, are counted.

"Our study is frightening. Unless you're Bill Gates you're just one serious illness away from bankruptcy," said Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School who led the study. "Most of the medically bankrupt were average Americans who happened to get sick. Health insurance offered little protection."

The researchers got the permission of bankruptcy judges in California, Illinois, Pennsylvania, Tennessee and Texas to survey 931 people who filed for bankruptcy.

"About half cited medical causes, which indicates that 1.9 to 2.2 million Americans (filers plus dependents) experienced medical bankruptcy," they wrote.

"Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness."

The average bankrupt person surveyed had spent $13,460 on co-payments, deductibles and uncovered services if they had private insurance. People with no insurance spent an average of $10,893 for such out-of-pocket expenses.

"Even middle-class insured families often fall prey to financial catastrophe when sick," the researchers wrote.
Specialists concur

Bankruptcy specialists said the numbers seemed sound.

"From 1982 to 1989, I reviewed every bankruptcy petition filed in South Carolina, and during that period I came to the conclusion that there were two major causes of bankruptcy: medical bills and divorce," said George Cauthen, a lawyer at Columbia-based law firm Nelson Mullins Riley & Scarborough LLP. "Each accounted, roughly, for about a third of all individual filings in South Carolina."

He said fewer than 1 percent of all bankruptcy filings were due to credit card debt. "That truly is a myth," Cauthen said in a telephone interview.

Cauthen said he was not surprised to hear that so many of the bankrupt people in the study were middle-class.

"Usually people who have something to protect file bankruptcy," he said. "The truly indigent -- people that we see on the street -- there is no relief that we can give them."

Dr. Steffie Woolhandler, a Harvard associate professor and physician who advocates for universal health coverage, said the study supported demands for health reform.

"Covering the uninsured isn't enough. We must also upgrade and guarantee continuous coverage for those who have insurance," Woolhandler said in a statement.

She said many employers and politicians were pressing for what she called "stripped-down plans so riddled with co-payments, deductibles and exclusions that serious illness leads straight to bankruptcy." 


Canada's system is not perfect but I think it is better than what has developed for a "health care" system down here. I think it is worth fixing rather than trying to make it more like the US system.


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## pbi (2 Feb 2005)

I am not very well-informed on the mechanics of how we administer the Canada Health Act, but I am a believer in the idea of some kind of public health protection as a "basement" or "safety net" to stop the sort of suffering described on the previous posts. I have no quarrel with the public purse footing most of the bill. What I do not understand is why the delivery means must also be publicly operated. Two cases in point:

a) drugstores are, IMHO, a vital part of our health care system. Yet nobody in his right mind suggests that the govt should take over Shoppers or London Drugs, do they? They operate for profit, with some portion of our prescription bill being paid by the public (which, as has been rightly observed, is all of us taxpayers)..If a drugstore wants to be open 24 hours, or offer all sorts of services, it does;  and

b) where I live in Manitoba, we have provincially run public auto insurance. You have to subscribe to it if you want to insure your vehicle in Manitoba. If you have an accident, MPI pays the various costs (and quite well, I might add, having wrecked my van a while back...). But, the actual repair work is done by privately owned body shops, repair shops, etc. The govt does not try to take over Speedy or Mike's Autobody, do they?


So, tell my why it is not possible to have a system for healthcare in which most or all services are delivered privately, but the public foots the bill? Or, the public is expected to pay a user fee (income dependent) to contribute to this process of private delivery. ?

Cheers.


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## tomahawk6 (3 Feb 2005)

pbi you may be on to something. The difference you cite is national vs province. If each province administered the healthcare system perhaps it would be more efficient ?


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## pbi (3 Feb 2005)

tomahawk6: Each province does administer the CHA. It is a Federal act, and comes with Federal funding, and the Federal govt sets the parameters and limitations, but the Provincial ministries of health actually put it into effect and run it through county, regional and municipal health boards. Where the tension is developing is over the nature of service delivery and the degree of privatization to be permitted while staying within the parameters of the Act. 

The CHA is not really an evil socialist boogeyman the way some people depict it. It has (or had...) a good heart. 

To give it some historical persepective, the CHA came in when this country was quite far from being the wealthy urbanized G8 member it is now. We were backward in many ways, including issues to do with health care. There were huge disparities in what was available to Canadians, from one province to another (some might argue there still are), and it was not at all uncommon for people to suffer or die from relatively simple complaints because either they could not afford care, or their community could not deliver it. 

The CHA was designed, in a well-intentioned way, to give all Canadians a basic level of health care, oriented primarily on hospital-based care. The trouble is that a system designed for Canada in the 1960s does not serve necessarily all that well in Canada of 2005: now the second most highly urbanized country in the world after Australia (IIRC). It needs overhaul, but that is where the agreement really seems to end. The provinces, the Feds, the health care folks, the public and various special interest groups are all hacking away at each other, fear-mongering and name-calling as hard as they can go. The thing can be fixed, IMHO, if we are ready to make some changes.
.
But, hey....I'm just a stupid Infantryman. Cheers.


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## a_majoor (14 Mar 2005)

Glorified Ape said:
			
		

> What specifically do you want to combat regarding socialism? Universal healthcare? Social support programs like welfare, etc?



Given these programs are deteriorating at a rapid clip due to the built in "perverse incentives", then yes, they should be combatted, scrapped and forgotten.

Universal healthcare has resulted in a system where patients are forced to wait months or even years for some types of treatments (imagine being in need of hip joint replacement and having a great deal of pain and limited mobility because of our "universal" system), and access to advanced medicine is very limited (our per capita supply of MRI machines is right up there with many third world nations). The key result of "universal health care" is health care is rationed, and the ideal outcome for the administrators of the system is that *you die*, rather than "consume" their scarce resources.

I will invoke the dark powers here: President George W Bush has proposed a system of individual "Health Savings Accounts" which citizens save their own money in tax free accounts to pay for most medical services, reserving Medicare and Medicaid for the truly destitute and as a medical emergency insurance for critical and life threatening illness (car crashes and cancer, for example).

One way to look at the cancerous growth of "poverty" and welfare is that the system is paying you to be poor, and the people who run the show get their empire by demonstrating their case load is increasing. What sort of incentives exist for a person to get off the dole, or for a case worker/empire builder to get you off the dole?

This does not even take into accout the negative effects of these programs consuming an ever increasing percentage of individual incomes on people, or the national economy.


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## couchcommander (14 Mar 2005)

Oh dear, 

How did this thread get onto health care?

Let me first make a few quick points so that we can get back onto the topic:

The New England Journal of Medicine (american) reported that private hospitals have a significantly higher per patient cost for the same procedure than did public ones. Further, that on average, for private hospitals administrative costs were twice that of public hospitals. 

In short, private health care is SIGNIFICANTLY more expensive than public health care. 

Secondly, despite the fact the United States spends twice as much per capita on health care, their basic health indcators (infant mortality rate and life expectancy) which are general indicators for health care preformance used in the WHO's World Health Report are both inferior to ours.

You'd think after spending twice as much they'd at least be a little better

Third, though you are correct that if you have insurance you can get a hip replacement quicker, the problem is that 50 million americans don't have health insurance.

No health insurance means a REALLY long wait... ie not getting it unless you get a REALLY big raise. 

Fourth. Even the socialists are saying that the system now has enough money, it's just up to the provinces to actually spend it correctly (Romanow about two weeks back). 

There is enough money in the system now for it to be the best there is, and it's still half of what the US spends (ie taking up a LOT less of our income and economy than would otherwise be the case)

Regarding the health savings account that Bush has proposed...... taxing is a lot more efficient. I mean, look at it. We can either take money from everyone and put it into a big pool which is then used to pay for everyones health care, or we can take money from everyone and put it into a little account with their name on it, use that money to pay for health care until you "spend" it all, then take more money from everyone and put it into a big pool to pay for heath care after that point.

In one case, we just have one pool. In the second, we have 30 million small pools and one big pool. The only measurable effect is that it will cost a hell of a lot more to administer the 30 million pools, and that while the money we are taking from you is sitting in the small pool it is not actually being used in the health care system, instead it is just sitting there doing nothing (whereas with taxation all the money we give is doing something). This translates into the fact that they would end up taking MORE money from us than we currently are giving for a less efficient and worse off system.

Now on the topic of this thread....

I have to agree with Edward Campbell's point

The CF should be organized to FIRSTLY address the needs of Canada, namely our safety and security (in terms of both war and civil needs), and SECONDLY the needs of others (ie foreign policy). Last I checked the reason a nation had an army was to protect itself.


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## a_majoor (14 Mar 2005)

> Regarding the health savings account that Bush has proposed...... taxing is a lot more efficient. I mean, look at it. We can either take money from everyone and put it into a big pool which is then used to pay for everyones health care, or we can take money from everyone and put it into a little account with their name on it, use that money to pay for health care until you "spend" it all, then take more money from everyone and put it into a big pool to pay for heath care after that point.



HSAs do not "take" money from anyone, you contribute your own money. Because you are spending your own money, the onus is on you to spend it wisely, ending the perverse incentives to eat all the "free lunch" Medicare and Medicaid (or Universal health care) offers.

The money flowing into the "big pool" is now unconstrained and unaccountable by the patient, hence the chronic crisis situation here in Canada. Notice how the "Big Pool" money is really flowing into Adscam, the gun registry, the Billion dollar boondoggle, etc. This is the "efficiency" of taxation.

If Canada is unable to get its internal priorites straight, how can we even hope to develop much less execute an effective foreign policy?


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## couchcommander (14 Mar 2005)

a_majoor said:
			
		

> HSAs do not "take" money from anyone, you contribute your own money.



Sorry, 

I was wrong, I got confused with the conservative proposal from a few years back.

Regardless, that still means you have the administration overhead, and the result of families paying out of their pockets for health care (I think the deductable was somewhere between 1000-3000 dollars). I don't know about you, but I can't really afford to have to pay 1000 dollars for health care. 

I think there is definately merit with what you are saying to eliminate the free lunch.

The idea of a user fee is actually not too bad, as long as it very reasonable (ie like 10 bucks to go to the doctor, not something to actually try and recoup the costs, but more just to make it not free).


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## PPCLI Guy (14 Mar 2005)

couchcommander said:
			
		

> I don't know about you, but I can't really afford to have to pay 1000 dollars for health care.



And how much do you think you are paying now?


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## couchcommander (14 Mar 2005)

On top of what I already pay (because it ain't going to go down, it's just gonna mean more money outta my pocket).


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## Infanteer (14 Mar 2005)

couchcommander said:
			
		

> The New England Journal of Medicine (american) reported that private hospitals have a significantly higher per patient cost for the same procedure than did public ones. Further, that on average, for private hospitals administrative costs were twice that of public hospitals.
> 
> In short, private health care is SIGNIFICANTLY more expensive than public health care.



You have to pay the bucks if you want the best care in the world.   We don't get the system we should be getting.   You are right, health care is more expensive in the States (I've read the same sorts of stats), but do you think it is better to spend less and have a system that is fraught with waiting lists, is falling behind in technological fields (we have an MIR per capita rate equivalent to Central American countries), and loses talent to better paying positions in the US?



> Secondly, despite the fact the United States spends twice as much per capita on health care, their basic health indicators (infant mortality rate and life expectancy) which are general indicators for health care performance used in the WHO's World Health Report are both inferior to ours.
> 
> You'd think after spending twice as much they'd at least be a little better



Is "Health Care" the reason for this?   I would think that the "inferior" stats stem from the problems facing US inner cities, and hence are related to specific issues such as race relations, etc, etc (when you take these areas out of the equation, statistics on violent crime are the same in both the US and Canada).   I don't know if Health Care is going to prove to be a big thing when kids are wheeled in with gunshot wounds from gangwars and drug abuse is rampant in urban ghettos. 



> Third, though you are correct that if you have insurance you can get a hip replacement quicker, the problem is that 50 million americans don't have health insurance.
> 
> No health insurance means a REALLY long wait... ie not getting it unless you get a REALLY big raise.



The "50 Million un-insured Americans" is really quite a myth in that it implies that these 50,000,000 Americans are the same people who are constantly looking for proper health care insurance.

This "50 Million" is a rapidly shifting population.   The poor are covered by Medicare and the Elderly by Medicaid (or is it the other way around?).   Most Americans have insurance through their employer.   The 50 million are people in between jobs, students not under their parents coverage, etc, etc.   Canada has the same problem at times - I was not covered by Health Insurance for about 6 months because I had lapsed from my parents plan and never really put the effort into signing into the provincial system.   As well, many important health care services are unavailable to many Canadians because the public adminstration has, in the effort to cut costs, eliminated them from basic coverage (ie: dental work - healthy teeth and gums is pretty important health wise, is it not?)   Don't have "Extended Coverage" through the private insurence of an employer?   Sorry, you're shit out of luck, just like an American.

What both the US and Canada need is a privately managed system that is truly universal and comprehensive - Canada's system is so fraught with exceptions, regulations, and loopholes (ie: inter-provincial service is tricky) that people slick through the cracks here as well (this is the "perverse incentive" that public administration has) 



> Fourth. Even the socialists are saying that the system now has enough money, it's just up to the provinces to actually spend it correctly (Romanow about two weeks back).
> 
> There is enough money in the system now for it to be the best there is, and it's still half of what the US spends (ie taking up a LOT less of our income and economy than would otherwise be the case)



I'm sure they are right as well. :   Just in the last election, everyone was bleating for more money for the Health Care system.   Since the 1970's, Canada's spending on health as a percentage of GDP has been steadily increasing.   I think the figure pointed out that if we continued on the trend that we've been on, we would be spending 100% on health care in a few decades.   Clearly, due to the fact that technology becomes more and more important in health care (driving up the average costs), demographics are shifting (meaning more elderly people are going to need the system), and that there never seems to be "enough" money for the system, the need for reform is staring us in the eyes.

History teaches us important lessons.   By looking at the Soviets, we should have learned that command economies (regardless of sector) don't work.   That's why we won and why China is moving with the times.



> Regarding the health savings account that Bush has proposed...... taxing is a lot more efficient. I mean, look at it. We can either take money from everyone and put it into a big pool which is then used to pay for everyones health care, or we can take money from everyone and put it into a little account with their name on it, use that money to pay for health care until you "spend" it all, then take more money from everyone and put it into a big pool to pay for heath care after that point.
> 
> In one case, we just have one pool. In the second, we have 30 million small pools and one big pool. The only measurable effect is that it will cost a hell of a lot more to administer the 30 million pools, and that while the money we are taking from you is sitting in the small pool it is not actually being used in the health care system, instead it is just sitting there doing nothing (whereas with taxation all the money we give is doing something). This translates into the fact that they would end up taking MORE money from us than we currently are giving for a less efficient and worse off system.



Read through this thread, the role of "perverse incentives" is quite important.   Abuse is widespread in our system, whether it be the politician, the health admin, the doctor, or the patient and is the main reason we aren't getting the health care system that we should be getting.

If, as you point out, there is one big pool, then nobody has any problem with treating it properly.   If every Canadian has their own pool (which can be privately funded off of income, publically funded from the tax base, or made up of a mix), then they will treat it like their own and recognize that Health Care is a resource that costs money and should be used wisely (ie: Go to the emergency room for the sniffles and you can pay $300 instead of $30 at a drop in clinic from your pool).

Don't compare the Canadian Health Care System to the Americans - it is a straw man theory.   We both suffer from the same debilitating problem in that we are stuck to large bureaucracies (public or private) to manage and direct how we approach our personal health and, in the process, create a false patient/doctor relationship that is full of perverse incentives.   I am all for a universal system of coverage - like vehicle insurance, the costs are too high to go around without it.   However, it needs to be done properly, resting responsibility for individual health in, surprisingly, the individual.

I'll leave you with a favorite Mark Milke (of the CTF) quote of mine:

_If governments ran grocery stores, bureaucrats in Ottawa and the provincial capitals would determine how many boxes of Corn Flakes were to be available in Halifax, Sarnia, and Kamloops.   Government unions would argue that because food is so vital for human survival only they should be allowed to run farms, grocery stores, and the transportation system that surrounds the provision of foodstuffs.   Lobby groups would spring up to decry the encroachment of "two-tier foodcare" where some rich folks could buy cavier while the rest of us make due with hamburger.   If Canada's governments controlled retirement in the manner that health care is regulated, retirees would not be allowed to save for their retirement outside of the Canada Pension Plan and the government would determine how many Winnebagos and trips to Florida could be bought every year.
The great accomplishment of Canada's health care system is that it is universal; the great failure is that funding decisions are forced through bureaucrats and politicians._


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## Brad Sallows (14 Mar 2005)

I would be inclined to take them seriously if proponents of our system could explain in detail why US health care expenditures are greater than Canadian expenditures, particularly in light of the facts that health care professionals here complain of underpay and overwork.  Do you suppose if we had more health care providers and paid them at least whatever fair wage a free market would set, that we might pay more per capita for health care? 

Do you suppose the quantity and health of immigrants, particularly illegal ones with poor health backgrounds, has any impact on the cost of US health care, infant mortality, and life expectancy?  I would sure like to see someone filter out that particular background "noise" from any comparison to Canada.

The fact we have waiting lists and that people with enough money can jump the lines by going to the US means we still have one of the problems public health care was supposed to prevent: unequal access.  Perhaps instead of worrying about whether we are better by some measures than the US, we should simply set high standards for short waiting times and explore any means to achieve them - even if it means increasing private delivery.  Forget the US and Europe exist: now, what are the objective standards?

A wait list on which you die is no health care at all.

Suppose there really is enough money now.  Will it be enough after the next round of wage demands, or the next 10 years of demographic change?


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## a_majoor (14 Mar 2005)

I just have to sneak in one more rebuttal against the shots at the HSA solution; the argument that "administrative overhead" will somehow consume the funds.

Since it is always your money, you will have incentives to save wisely and spend as little as possible, and that includes administrative overhead. A simple example many here can apprieciate, the administration costs of mutual funds is a very strong factor in how well you, the investor, do. Funds with high management charges (say 2%, which is common),  need to get real returns of 7% so you, the investor can brag about your 5% ROI. Index funds, on the other hand, have miniscule fees, so if the market gets 7%, you get 6.5% or more. 

Some funds are even lower, US civil servents are already on privateized Social Security savings accounts (Thrift Savings Plans and have been for years), and the sheer size of the customer base allows the management fees to be quite low, thereby preventing funds from being consumed by hidden fees. According to the Social Security administration actuaries, the administrative costs of the personal accounts would be only 30 basis points, compared to 88 to 125 basis points for bond and stock mutual funds.

Given the choice, I would take the 30 basis points administrative overhead to paying for personalized golf balls, expensive lunches, billion dollar boondoggles and other administrative overhead that we are paying now.......


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## Torlyn (14 Mar 2005)

Infanteer said:
			
		

> If, as you point out, there is one big pool, then nobody has any problem with treating it properly.   If every Canadian has their own pool (which can be privately funded off of income, publically funded from the tax base, or made up of a mix), then they will treat it like their own and recognize that Health Care is a resource that costs money and should be used wisely (ie: Go to the emergency room for the sniffles and you can pay $300 instead of $30 at a drop in clinic from your pool).



Infanteer, don't know if you wanted the numbers, but the current cost of a single visit to an Emergency room in Calgary is 287.50, not including medication, doctor's fees, or anything else.  That's just to be triaged, have a chart built, and 1.5 hours taking up a room in er.  You want to spend the night?  Try $4000 a night (again, just the bed, no meds, no doctors, no food, no nothing) for the Children's, and just around $2000 for the 3 adult hospitals.  

Working in ER at the Children's, if we were allowed to turn people away because junior has a fever of 37 degrees  : we'd save millions.  Perhaps once I'm elected supreme ruler and grand poo-bah of Canada...  

T


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## PPCLI Guy (14 Mar 2005)

Torlyn said:
			
		

> Working in ER at the Children's, if we were allowed to turn people away because junior has a fever of 37 degrees   : we'd save millions.   Perhaps once I'm elected supreme ruler and grand poo-bah of Canada...



Or you can be my Minister of Health - and Infanteer can be the Minister of Truth...

Dave


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## Torlyn (14 Mar 2005)

PPCLI Guy said:
			
		

> Or you can be my Minister of Health - and Infanteer can be the Minister of Truth...
> 
> Dave



Hmm...  It's a bit 1984, but I've always thought we should rename the health department as MiniHell...  Fits, wot?  

T


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## a_majoor (15 Mar 2005)

Who will be the Minister of Peace?


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## a_majoor (15 Mar 2005)

> *Bad things come to those who wait*
> 
> 
> Monday, 22 November 2004
> ...


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## couchcommander (15 Mar 2005)

You have to pay the bucks if you want the best care in the world.  We don't get the system we should be getting.  You are right, health care is more expensive in the States (I've read the same sorts of stats), but do you think it is better to spend less and have a system that is fraught with waiting lists, is falling behind in technological fields (we have an MIR per capita rate equivalent to Central American countries), and loses talent to better paying positions in the US?

The key point here was for the same procedure. That means if take a guy and do the exact same thing to him, once in a private hospital, once in a public, the cost in the private one will be significantly higher as a result of the administrative and mangerial costs associated with a for profit delivery system. As well, we WERE falling behind in technological fields, that was before the first 5 billion investment in diagnostic technologies back in the late nineties, then the health care deal under Chretien, and then this last deal under Martin. Services are improving. The fact that the University medical centre here in Edmonton has 4 new buildings going up is a testament to this (a heart centre, two research buildings, and yes, a diagnostic centre). 

Is "Health Care" the reason for this?  I would think that the "inferior" stats stem from the problems facing US inner cities, and hence are related to specific issues such as race relations, etc, etc (when you take these areas out of the equation, statistics on violent crime are the same in both the US and Canada).  I don't know if Health Care is going to prove to be a big thing when kids are wheeled in with gunshot wounds from gangwars and drug abuse is rampant in urban ghettos. 

These are the "basic indicators" that the WHO uses to measure the health care system. Further, I would add, though I am not 100% sure, so don't quote me on this, that the homicide rate in the US isn't high enough to really affect their average life span. Further, homicide doesn't usually factor into infant mortality rate, which IS indeed a very good measure of the level of care availible to a person. 

The "50 Million un-insured Americans" is really quite a myth in that it implies that these 50,000,000 Americans are the same people who are constantly looking for proper health care insurance.

This "50 Million" is a rapidly shifting population.  The poor are covered by Medicare and the Elderly by Medicaid (or is it the other way around?).  Most Americans have insurance through their employer.  The 50 million are people in between jobs, students not under their parents coverage, etc, etc.  Canada has the same problem at times - I was not covered by Health Insurance for about 6 months because I had lapsed from my parents plan and never really put the effort into signing into the provincial system.  As well, many important health care services are unavailable to many Canadians because the public adminstration has, in the effort to cut costs, eliminated them from basic coverage (ie: dental work - healthy teeth and gums is pretty important health wise, is it not?)  Don't have "Extended Coverage" through the private insurence of an employer?  Sorry, you're crap out of luck, just like an American.

All canadians are guaranteed a basic level of health care coverage free of charge. No canadian is without basic medical coverage (even you for those six months, had something happened to you, you would have been treated, no charge). And furthermore, I might add that this number, 50 million, represents Americans with no coverage, that INCLUDES medicaid. They have nothing, no government coverage, nadda. So no, it's not a myth but a terrible reality. 


What both the US and Canada need is a privately managed system that is truly universal and comprehensive - Canada's system is so fraught with exceptions, regulations, and loopholes (ie: inter-provincial service is tricky) that people slick through the cracks here as well (this is the "perverse incentive" that public administration has) 

The point was that a privately managed system will be MUCH more expensive and less efficient.

I'm sure they are right as well. :  Just in the last election, everyone was bleating for more money for the Health Care system.  Since the 1970's, Canada's spending on health as a percentage of GDP has been steadily increasing.  I think the figure pointed out that if we continued on the trend that we've been on, we would be spending 100% on health care in a few decades.  Clearly, due to the fact that technology becomes more and more important in health care (driving up the average costs), demographics are shifting (meaning more elderly people are going to need the system), and that there never seems to be "enough" money for the system, the need for reform is staring us in the eyes.

History teaches us important lessons.  By looking at the Soviets, we should have learned that command economies (regardless of sector) don't work.  That's why we won and why China is moving with the times.


Horrible predictions of health care taking up all of our money I think are a little unfounded. The point is that amazingly, right now, we actually do have enough money, and it's not going to break the bank.

I might add, the costs associated with having an elderly population willl be around whether or not there is a private or public system, the fact is that these costs will just be higher in a private system.

And I agree with a cost for health services (as I mentioned before, charge somebody like 10 bucks to go to the doctor... just enough so that it won't actually stop someone who is really sick, but so that it just not FREE). I just don't think that HSA are the best way to do it as I can already forsee skyrocketing inefficiences. 


Don't compare the Canadian Health Care System to the Americans - it is a straw man theory.  We both suffer from the same debilitating problem in that we are stuck to large bureaucracies (public or private) to manage and direct how we approach our personal health and, in the process, create a false patient/doctor relationship that is full of perverse incentives. 

The American system is big market economy example that acts as a counterpoint to our own system, and to which we are often compared by BOTH sides. Of course if we want we can start comparing to systems in France and Britain, which are mixed system, both have their highlights, and their horrible failures (notably the national health service in Britain). 

One tends to come to the conclusion that private delivery of health care results in better health care for those people who are able to pay for it, and unfortunately does it rather inefficiently. It does little to affect the plight of your low to middle income average joe. 


 I am all for a universal system of coverage - like vehicle insurance, the costs are too high to go around without it.  However, it needs to be done properly, resting responsibility for individual health in, surprisingly, the individual.

I couldn't agree more.


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## Infanteer (15 Mar 2005)

couchcommander said:
			
		

> The key point here was for the same procedure. That means if take a guy and do the exact same thing to him, once in a private hospital, once in a public, the cost in the private one will be significantly higher as a result of the administrative and mangerial costs associated with a for profit delivery system.



So, you are pointing out that price controls keep an artificial low cost to procedures - no news here.   Are you implying that low-balling our doctors and nurses, which is where the "lower price for the same procedure" come from (no profit and government set wages) is a good way to go about things?   I'm sure driving competent and highly skilled health care professionals to greener pastures is indicative of a strong system of health care delivery - we lost about 10,000 in the 1990's alone.

http://www.cato.org/dailys/07-24-04.html

As Brad Sallows said earlier:

_"I would be inclined to take them seriously if proponents of our system could explain in detail why US health care expenditures are greater than Canadian expenditures, particularly in light of the facts that health care professionals here complain of underpay and overwork.   Do you suppose if we had more health care providers and paid them at least whatever fair wage a free market would set, that we might pay more per capita for health care?"_

As well, I can't for the life of me figure out where you get "increased managerial and administrative costs" in a system of private delivery.   A private system will have no government administrative unit (only regulatory ones) and thus no "managerial and administrative costs" - the companies rather then the taxpayer are responsible for this.   Be careful not to confuse a system of publically funded universal coverage with publically delivered health services.



> As well, we WERE falling behind in technological fields, that was before the first 5 billion investment in diagnostic technologies back in the late nineties, then the health care deal under Chretien, and then this last deal under Martin. Services are improving. The fact that the University medical centre here in Edmonton has 4 new buildings going up is a testament to this (a heart centre, two research buildings, and yes, a diagnostic centre).



It's not so much a matter of what technology we have, as Canada is, by being a G8 country, liable to be at the cutting edge of technology, but rather an issue of the availability of this technology.   As I said before, we have an MRI per capita level on par with Latin American countries.   As the article above stated, waiting lists exist for MRI, CT and ultrasound exist in Canada and have been getting longer every year as these high-technology instruments become recognized as essential for adequate treatment with more and more health problems.

A privately delivered system is better equipped to deal with rising health care costs that are associated with technology:

_"Also, policy efforts should incorporate both the benefits and costs of new technologies. One typical argument is that a desire for high-technology care, coupled with the relatively low prices for medical care faced by well-insured consumers, tends to lead to the consumption of services whose value is much lower than the cost to society. However, effective price competition in health care markets, in which those receiving the benefits of services also have an appreciation for their cost, has the potential to reduce excess, inefficient use. For example, health plan policies that help consumers better identify the costs associated with their consumption choices, particularly for nonacute treatment decisions, may be effective policies to consider. In turn, these could affect the incentives associated with the purchase of new equipment."

http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.537v1/DC2_ 

If perverse incentives exist due to the structure of our system, how are we ever going to ensure that we can encourage high-technology growth in the health sector.   Raise the taxes, you say?



> These are the "basic indicators" that the WHO uses to measure the health care system. Further, I would add, though I am not 100% sure, so don't quote me on this, that the homicide rate in the US isn't high enough to really affect their average life span. Further, homicide doesn't usually factor into infant mortality rate, which IS indeed a very good measure of the level of care availible to a person.



You missed the point - I was pointing out that America possesses a far different problem with regards to large, inner city populations that face a gamut of problems from overcrowding, low education, rampant gang violence and drug abuse, etc, etc.   I fail to see how these issues, which are serious and weigh in on QOL issues (infant mortality rate, life expectency), are factored around the Health Care system.   I am willing to bet that, like the statistics on violence, once you remove outliers like poor inner-city conditions which simply do not exist on the same scale in Canada, the average statistics on QOL issues between Canadians and Americans isn't much different.

Again, as Brad Sallows pointed out (and you failed to address):

_"Do you suppose the quantity and health of immigrants, particularly illegal ones with poor health backgrounds, has any impact on the cost of US health care, infant mortality, and life expectancy?   I would sure like to see someone filter out that particular background "noise" from any comparison to Canada."_



> All canadians are guaranteed a basic level of health care coverage free of charge. No canadian is without basic medical coverage (even you for those six months, had something happened to you, you would have been treated, no charge). And furthermore, I might add that this number, 50 million, represents Americans with no coverage, that INCLUDES medicaid. They have nothing, no government coverage, nadda. So no, it's not a myth but a terrible reality.



It is a myth in that is presented as a large population of people (I remember it being 40 million - when did it go up?) that are constantly without health care coverage and are in need of health care services.   As I said, this isn't true, and most of these people move through the "uninsured" category and get insured in a short period of time, not really facing any problems what so ever.   Quit trying to depict the stats as some formless mob of people crying out for doctors - this is a highly fluid population of people who face a lack of insurance (usually for a short period of time) for a variety of reasons.

That being said, one cannot pick and choose when they need access to health care, which is why I don't dispute a publically funded system of universal coverage.   But don't confuse this with also keeping a system of public delivery of health care - just because the province of BC provides auto insurance to all motorists doesn't mean that they should or are capable of owning and managing every auto body shop.

As I've argued many times before, Dr David Gratzer addresses this issue along with many others you've presented in his book Code Blue

 http://www.chapters.indigo.ca/item.asp?Catalog=books&Section=books&Lang=en&Item=978155022393&N=35&zxac=1

Look at the book - it is meticulously researched and referenced - and decide if you are going to stick to your guns....



> The point was that a privately managed system will be MUCH more expensive and less efficient.



Bullocks.

_"A quick look back over the last 11 years provides additional perspective. Between 1993 and 2004, inflation adjusted health care spending per person increased by 27 percent, while waiting lists nationally grew by an incredible 92 percent. Statistical analyses of this bizarre relationship have confirmed that past increases in provincial spending, unless specifically targeted to physicians or pharmaceuticals, were indeed correlated with increases in waiting times, which is not all that surprising considering that provinces that spent more on health care were also found to be providing fewer major surgeries for patients. 

If we ended up with longer wait times and a reduction of services when we spent more in the past, why should Canadians expect any different this time around? 

*Dr. Max Gammon, after studying health expenditures and health services in the British National Health Service, formulated what he called â Å“the theory of bureaucratic displacement,â ? now known as Gammon's Law. The law states that an increase in expenditures in a bureaucratic system will be matched by a fall in production. As Dr. Gammon put it, â Å“Such systems will act rather like 'black holes', in the economic universe, simultaneously sucking in resources, and shrinking in terms of 'emitted production'.â ?*

Considering that the Canadian health care program was originally modeled on the now failing British NHS, it should not come as a surprise to anyone that we are subject to the same results from increases in health expenditures. That giant sucking sound you hear, and the related lightness you'll soon feel in your wallet, is Gammon's Law at work."_

http://www.fraserinstitute.ca/shared/readmore1.asp?sNav=ed&id=332



> Horrible predictions of health care taking up all of our money I think are a little unfounded. The point is that amazingly, right now, we actually do have enough money, and it's not going to break the bank.



Again, look at the Gratzer book.   The statistics are there to back the claims.   I don't have access to the book right now, or I would put them up here.



> I might add, the costs associated with having an elderly population willl be around whether or not there is a private or public system, the fact is that these costs will just be higher in a private system.



Just as the CPP will ultimately fall short of providing adequate incomes to people due to demographics, so will the publically delivered health care system.   The goal is, along with Pension reform, to ensure a system that structures the a persons income into private accounts (that may be also fed from public funds) rather then lumping their contributions into "General Revenue" (ie: Adscam, HRDC, pork-barrelling).   If you take this money (public, private, or a mix) out of Ottawa's hands and put it into the hands of individuals, you can get around the fact that in centralized command systems, providers support the elderly rather then "storing away" for their own senior years - this is something that will become a bigger factor in the future and that our system will be harder and harder pressed to deal with if it relies solely on the public purse. 



> And I agree with a cost for health services (as I mentioned before, charge somebody like 10 bucks to go to the doctor... just enough so that it won't actually stop someone who is really sick, but so that it just not FREE). I just don't think that HSA are the best way to do it as I can already forsee skyrocketing inefficiences.



If you think 10 bucks is going to eliminate the perverse incentives of our health care system and eliminate rationing of a limited and publically derived pool of resources, I think you're dreaming.

As for skyrocketing inefficiencies, all the research I've looked at (Gratzer, Fraser Institute, "Gammon's Law", etc) seems to point to the opposite direction.   Are you going to give me anything to substantiate your claims that Health or Medical service accounts or private delivery of health services will introduce radical inefficieny into our system?   Looking at the creaking edifice of our 1960's derived system as it stands right now, I'm doubting we could do worse, Comrade.

http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=658
http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=222
http://www.fraserinstitute.ca/shared/readmore1.asp?sNav=ed&id=330

Say what you want and dismiss the Fraser Institute on ideological grounds, but they do put up the numbers in terms of objective quantitative statistics and if you are going to prove to me that they way things are going now are ideal, you should start with these concepts and prove them wrong.



> The American system is big market economy example that acts as a counterpoint to our own system, and to which we are often compared by BOTH sides. Of course if we want we can start comparing to systems in France and Britain, which are mixed system, both have their highlights, and their horrible failures (notably the national health service in Britain).
> 
> One tends to come to the conclusion that private delivery of health care results in better health care for those people who are able to pay for it, and unfortunately does it rather inefficiently. It does little to affect the plight of your low to middle income average joe.



Alot of rhetoric, and not much in validation.   

Instead of arguing this, I will fall back to Brad Sallows' (usual) excellent analysis earlier in this thread:

http://forums.army.ca/forums/threads/28296.15.html

_" Generally in medicine it is best to intervene at the earliest opportunity.   A system with significant wait times is not much better than none at all.   If you miss a window of a few weeks during which your cancer might have been detected in time for treatment, it isn't going to matter that it costs you nothing to slowly waste away in a hospital bed with tubes leading in and out of you.   I frankly do not care if someone can buy Tier 1 Rolls-Royce health care if my Tier 2 publicly-insured health care is timely and competent, and the key to that is to have enough providers and facilities....

If health care workers are dissatisfied with working conditions and remuneration, it strikes me the only way to establish proper expectations is by free market mechanisms.   I fully expect we will discover that health care costs "more".   The point of health care delivery is to have enough capacity to meet reasonable demand.   Since we are dealing with what is pretty much a personalized service and not an infrastructure megaproject, I think it safe to assume this is one area in which the usual free market mechanisms can meet demand.   There will be reasons for government to participate in that market - for example, to meet the needs of small or isolated communities - but I believe a government near-monopoly is harmful.

There is nothing rigorous about all of the above; but, in short, I believe the reason the Canadian and US systems are perceived by some as dissatisfactory is that the optimum path probably lies somewhere in the general direction of the public insurance/private delivery vector."_



> I couldn't agree more.



Do you, you seem to be argueing here that a MSA system where people are responsible for management of their own health care expenditure (combined with "blowout" coverage for serious problems) is something that will be fraught with "high costs and inefficiency".   That's odd, as I've never heard this claim lobbed at private markets by the command-economy crowd.

You've yet to address the fact that perverse incentives at all levels of the health care system, which stem from a faulty doctor/patient relationship (which is based upon product/cost), are inherent in command economies.


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## couchcommander (15 Mar 2005)

lol, well firstly thank you for giving me something to do at this ungodly hour. 
So, you are pointing out that price controls keep an artificial low cost to procedures - no news here.  Are you implying that low-balling our doctors and nurses, which is where the "lower price for the same procedure" come from (no profit and government set wages) is a good way to go about things?....

As well, I can't for the life of me figure out where you get "increased managerial and administrative costs" in a system of private delivery.  A private system will have no government administrative unit (only regulatory ones) and thus no "managerial and administrative costs" - the companies rather then the taxpayer are responsible for this.  Be careful not to confuse a system of publically funded universal coverage with publically delivered health services.

No, what I was saying was that by virture of being a for profit hospital the costs of conducting the exact same procedure, even using equivalently paid staff, the same technology, etc. etc., are significantly higher than in a public hospital due to adminstrative and mangerial costs. To quote a NEJM study, "At for-profit hospitals, administrative costs averaged 34.0 percent of total cost...at private not-for-profit hospitals they averaged 24.5 percent.... and at public hospitals they averaged 22.9 percent."... this was done by an American by the by...


It's not so much a matter of what technology we have, as Canada is, by being a G8 country, liable to be at the cutting edge of technology, but rather an issue of the availability of this technology. 

It's availibility that these investments, especially the first I mentioned, are designed to deal with.


For example, health plan policies that help consumers better identify the costs associated with their consumption choices, particularly for nonacute treatment decisions, may be effective policies to consider."

I agree with him, the public should be more aware of the costs associated with deliverying health care. In Alberta here, in most doctor's offices that I have been too, there is a big chart hanging on the wall listing the costs of some of the common things you would have done at that office. I think that is a good start, but falls horribly short of what is needed.


"Do you suppose the quantity and health of immigrants, particularly illegal ones with poor health backgrounds, has any impact on the cost of US health care, infant mortality, and life expectancy?  I would sure like to see someone filter out that particular background "noise" from any comparison to Canada."


The fact that they are illegal immigrants makes me doubt that they would be counted in official US government census data. Further, we have many immigrants here in Canada. 

I am willing to bet that, like the statistics on violence, once you remove outliers like poor inner-city conditions which simply do not exist on the same scale in Canada, the average statistics on QOL issues between Canadians and Americans isn't much different.

Show me, and I shall believe    Just a note though, to quote the US Government, Infant mortality "is used to compare the health and well being of population within and between countries". It's used as one of the primary indicators of the effectiveness of health care systems by most governments and NGO's. 

For the record (regarding you statement about overcrowding), Japan, which has  a population density ten times that of the states, has an infant mortality rate one third of the US' (side note, this a country that has an interesting health care model, one which I suspect is close to what you are getting at, and is admittidly actually very efficient, though it could be more so as it still suffers from the costs of running a national insurance program that pays out to for profit health providers, as well it suffers from a lack of availibility of some of the more advanced technologies and procedures that makes the stuff here look plentiful). 

Considering that the Canadian health care program was originally modeled on the now failing British NHS, it should not come as a surprise to anyone that we are subject to the same results from increases in health expenditures. That giant sucking sound you hear, and the related lightness you'll soon feel in your wallet, is Gammon's Law at work."

I don't know where he is getting this from, the Canadian health care system is quite different NHS. In large part the reason the NHS is failing is because of the "internal market" reforms of the 80's that seem to be where a lot of conservatives want to push us. 

Regarding the CPP argument.... once again, the costs don't go away. People are either going to pay to the government, or pay themselves. I have not seen any material that can actually prove that the method you describe will actually be more efficient.

Are you going to give me anything to substantiate your claims that Health or Medical service accounts or private delivery of health services will introduce radical inefficieny into our system?

See the resposne from the NEJM (recapping, for profit or private hospitals are inherently more expensive). As well, go pick up a copy of Joseph Heath's (I think that's how you spell it...) "The Efficient Society", which goes into depth on the costs of for profit delivery, and the various sources of these horrible inefficiences  (I haven't even brought up the percentage points of GDP that the US spends on overhead for health insurance companies that we DO NOT have to pay for here, but would become a reality if we started using MSA's... you have to pay someone to administer them, which means more people and more money going to something other than actually providing health care... another expense that we presently don't have and are better off not having...further, a smal user fee will have the same positive effect... see below...)

Regarding the Frasier Institute stuff....

All the MSA's article from the Frasier institute proves is that people will use the health system less if there is a fee involved. You will notice there isn't much of a difference between 25%, 75%, 95%, and 100% (If I remember correctly, been a while since I read that..... and yes, this evil socialist does get the Fraser Forum everymonth and has done so for many years...). The thing to take from this is just by making something "not free" you will drastically reduce it's usage, which is why I am saying 10 bucks.

Regarding "How good is Canadian health care".... I don't even want to talk about. That report is so amazingly doctored (no pun intended) that I laughed the first time I read it. Just to mention one thing,  and one of the more important things for them to make their point, they list Canada as number 1 for percent of GDP spent on health care in OECD countries in "age adjusted dollars." Firstly, they've got some of their numbers wrong (not significantly, but still...). Secondly, I find it amusing how they have to "adjust" the GDP spending to make their point. lol. You can "adjust" dollars to pretty much do whatever it is you want them to do (for example, if too many people pass a class a prof will often "adjust" the marks so the proper amount fail....). 

And lastly, Kliens "Third Way" fails to deal with the issues I have outlined above with having for profit delivery system. Namely that they are more expensive.

So no, I don't dismiss them on ideological grounds. I dismiss them on the grounds that they don't prove their point. 

 Generally in medicine it is best to intervene at the earliest opportunity. 

I agree. However it has NOT been proven that private or for profit delivery of health care would be any better at solving these problems. Rather, it appears, at least to me, that we should work within the framework of our system (a publically ran system, which IS a VERY, if not THE, most efficient delivery model....further I might add that in NONE of this literature has the efficiency of a public hospital been questioned, rather it is the system as a whole and it's operation that has been challenged), to try and improve it's effectiveness by using a combination of modest funding increases (already done), minor changes to the structure and operation of the system to improve patient care (such as national treatment standards to ensure proper treatment, and acceptable wait time standards to ensure timely access), and minor changes to the delivery of health care to the patient to decrease abuse of the system (such as a small user fee). 

These changes, from my perspective, will result in a lot better care for patients than would switching to a drastically different model who's benefits cannot be proven and who's detractors are far too obvious.


----------



## Infanteer (15 Mar 2005)

couchcommander said:
			
		

> lol, well firstly thank you for giving me something to do at this ungodly hour.



No problem, that's really what the "Politics" forum is for...



> No, what I was saying was that by virtue of being a for profit hospital the costs of conducting the exact same procedure, even using equivalently paid staff, the same technology, etc. etc., are significantly higher than in a public hospital due to adminstrative and mangerial costs. To quote a NEJM study, "At for-profit hospitals, administrative costs averaged 34.0 percent of total cost...at private not-for-profit hospitals they averaged 24.5 percent.... and at public hospitals they averaged 22.9 percent."... this was done by an American by the by...



Okay.   As I said, I acknowledged that private delivery has higher costs; Gratzer addresses this specifically in his book, using a doctor that practices on both sides of the border as an example.   However, I'm wondering how much of the "administrative costs" in a public hospital are defrayed by government administrative units within the bureaucracy (ie: Provincial Health Department which manages hospitals)?

That being said, the prime concern is having an effective system, ensuring that people are dealt with promptly - something that a publicly managed system is proven to be incapable of doing (the wait list stats in Canada don't lie).   I'm sure people (or the Canadian Taxpayer if using universal health insurance) would be willing to pay 5 to 10 percent more for services if they got that important surgery within a month instead of maybe in a year.



> It's availibility that these investments, especially the first I mentioned, are designed to deal with.



If there are not enough of them or there are long wait lists, then they are not available when time is of the essence for treatment.   I'm looking for some more current stats, but I imagine that the wait lists for these things are still as bad as they were 5 years ago.   As high-technology becomes accepted as a treatment method for more and more ailments (ie: scans following a blow to the head, etc) the demand is only likely to increase.   Judging from our track record in the last 20 years, it appears that a public delivery system can't keep up.



> I agree with him, the public should be more aware of the costs associated with deliverying health care. In Alberta here, in most doctor's offices that I have been too, there is a big chart hanging on the wall listing the costs of some of the common things you would have done at that office. I think that is a good start, but falls horribly short of what is needed.



I'm sure that chart is about as effective as the Nutrition Chart the McDonalds puts up in their restaurants.   As long as the perverse incentive is there, people will abuse it.



> Show me, and I shall believe



Yeah, I would be satisfied by a statistic as well.   But the answer is kind of intuitive.   I go to my families place in the US (middle-class) and look at the same income class here and the QOL is the same.   If you take South Central LA, you will get a different story.   Canada has nowhere near the problems that the US has in these regards, both in locations - a few spots in urban centers (ie: East Hastings, which doesn't have gangland shootouts), and some Native reserves - and the number of people that live in these areas.



> Just a note though, to quote the US Government, Infant mortality "is used to compare the health and well being of population within and between countries". It's used as one of the primary indicators of the effectiveness of health care systems by most governments and NGO's.



I don't deny that it is important, I am trying to point out that when significant portions of society are not properly serviced by health care coverage (as well as suffering from a variety of other social issues) that you will see these segments taking up a disproportionate percentage of lower QOL numbers.   They are essentially outliers - and I would venture that problems in many US cities means more outliers then Canada.   Again, intuitive, is it not?

Universal coverage would help to eliminate outliers - which is why I support it in general - but it won't eliminate the fact that people living in a shitty environment won't live as long as others.



> For the record (regarding you statement about overcrowding), Japan, which has   a population density ten times that of the states, has an infant mortality rate one third of the US' (side note, this a country that has an interesting health care model, one which I suspect is close to what you are getting at, and is admittidly actually very efficient, though it could be more so as it still suffers from the costs of running a national insurance program that pays out to for profit health providers, as well it suffers from a lack of availibility of some of the more advanced technologies and procedures that makes the stuff here look plentiful).



Are you comparing population density of downtown Tokyo to the population density of certain quarters of Los Angeles, Detroit or Chicago?   Apples and oranges - one is due to space concerns (Japan has lots of people and no space) and the other is due to significant social problems for many Black and Hispanic communities in the United States.



> I don't know where he is getting this from, the Canadian health care system is quite different NHS. In large part the reason the NHS is failing is because of the "internal market" reforms of the 80's that seem to be where a lot of conservatives want to push us.



The theory seems to fit the economic trend that we've spent more per person in the last ten years and wait lists are growing more and more.   Where is the money going?   Probably the same place that other command-economies have seen there funds go....-flush-



> Regarding the CPP argument.... once again, the costs don't go away. People are either going to pay to the government, or pay themselves. I have not seen any material that can actually prove that the method you describe will actually be more efficient.



No costs don't go away, but as I've said, reducing perverse incentives should reduce the burden on the system.



> See the resposne from the NEJM (recapping, for profit or private hospitals are inherently more expensive). As well, go pick up a copy of Joseph Heath's (I think that's how you spell it...) "The Efficient Society", which goes into depth on the costs of for profit delivery, and the various sources of these horrible inefficiences   (I haven't even brought up the percentage points of GDP that the US spends on overhead for health insurance companies that we DO NOT have to pay for here, but would become a reality if we started using MSA's... you have to pay someone to administer them, which means more people and more money going to something other than actually providing health care... another expense that we presently don't have and are better off not having...further, a smal user fee will have the same positive effect... see below...)



I'll pick up "The Efficient Society" - I've glanced at it a few times in Chapters.   You should pick up Gratzer's book, it is a Canadian award winner and is worth the read.

That being said, the MSA system as I've proposed it doesn't involve private health insurance companies - HMO's are as bad as Government Health Departments (hence why I said don't compare the US and Canada).   Of course the Health Care system will require government agencies to overwatch both the accounts and to regulate the private users.   Just like auto insurance, the government makes sure you are insured against calamities and makes sure that the auto shops aren't bilking the system.   It doesn't mean yours or my tax dollars should go to paying bureaucrats to decide how much janitors should make in hospitals or how to ration the limited health resources that the government sees fit to provide.



> Regarding the Frasier Institute stuff....
> 
> All the MSA's article from the Frasier institute proves is that people will use the health system less if there is a fee involved. You will notice there isn't much of a difference between 25%, 75%, 95%, and 100% (If I remember correctly, been a while since I read that..... and yes, this evil socialist does get the Fraser Forum everymonth and has done so for many years...). The thing to take from this is just by making something "not free" you will drastically reduce it's usage, which is why I am saying 10 bucks.



Gratzer quotes a huge RAND report study in California that put families on a "free" system and a "not free system" and giving them universal coverage for the big stuff.   They observed these peoples consumption of health care over a long period of time (at least a decade if I remember) and found that, as you said, having to pay for something means it reduces its usage.   They found that people would think more about using the system for the routine health issues.

The important part of the study was that the quality of life for both groups remained the same.   People spent less when faced with a cost but suffered no adverse health problems from not using the doctor everytime they felt like it.   The perverse incentive of "free health" care was removed and resulted in a better system of delivery.

That being said, I don't think 10 bucks will be significant enough.   As I've proposed with the Medical Service Account system that Gratzer proposed, the government either provides all or matches private contributions (there is a few ways to do it) into the account.   The account can be used for the routine health care costs (checkup, prescription, etc, etc) or to cover the deductible of a serious problem.   People who are healthy receive an incentive in that, at the end of the year, the money in the MSA can be taken out and used as disposable income - there is positive reinforcement in an MSA system to use your health dollars wisely.



> Regarding "How good is Canadian health care".... I don't even want to talk about. That report is so amazingly doctored (no pun intended) that I laughed the first time I read it. Just to mention one thing,   and one of the more important things for them to make their point, they list Canada as number 1 for percent of GDP spent on health care in OECD countries in "age adjusted dollars." Firstly, they've got some of their numbers wrong (not significantly, but still...). Secondly, I find it amusing how they have to "adjust" the GDP spending to make their point. lol. You can "adjust" dollars to pretty much do whatever it is you want them to do (for example, if too many people pass a class a prof will often "adjust" the marks so the proper amount fail....).



It seems to me that if a specific age group relies on the health care system more then other groups, you would want to ensure that this is factored in when you compare costs/capita of states that may have different proportions of various age groups.



> And lastly, Kliens "Third Way" fails to deal with the issues I have outlined above with having for profit delivery system. Namely that they are more expensive.



It would be more expensive in terms of actual health care costs, I've agreed with this.   The aim with private delivery is for a more effective system that services people as soon as possible.   As well, if you took out the nickel-and-diming that perverse incentives create, I'm sure that you would get more "bang-for-the-buck" out of health dollars; this is a conclusion Gratzer comes to and supports.



> I agree. However it has NOT been proven that private or for profit delivery of health care would be any better at solving these problems. Rather, it appears, at least to me, that we should work within the framework of our system (a publically ran system, which IS a VERY, if not THE, most efficient delivery model....further I might add that in NONE of this literature has the efficiency of a public hospital been questioned, rather it is the system as a whole and it's operation that has been challenged), to try and improve it's effectiveness by using a combination of modest funding increases (already done), minor changes to the structure and operation of the system to improve patient care (such as national treatment standards to ensure proper treatment, and acceptable wait time standards to ensure timely access), and minor changes to the delivery of health care to the patient to decrease abuse of the system (such as a small user fee).
> 
> These changes, from my perspective, will result in a lot better care for patients than would switching to a drastically different model who's benefits cannot be proven and who's detractors are far too obvious.



I guess if you are comparing delivery systems (as opposed to coverage), looking at the US and Canadian systems serve a purpose.   From what I can understand, a properly insured patient will get superior services in terms of available treatments, wait times, care and attention, etc, etc in an American system then they would in Canada.   The example that the fellow used earlier on in this thread about his Dad going to the US for successful cancer treatment is a good example.   Sure, Canada payed more by sending him south, but he lived, and that is what is important.

I can see that the fundamental disagreement here is on a free market or a central-command system of delivery.   Proof is in the pudding on how well command economies do in meeting the demand of consumers.   Health Care, like food, clothing, or shelter is a essential commodity that has both supply and demand.   I don't disagree with certain government involvement in providing health care delivery in regions where demand may not be high enough to bring in an essential amount of service, but other then that, private delivery seems to have proved that it is able to give patients better health care in the end - the fact that Canada sends people to the United States for treatment is a testament to this fact.

I agree with a nationally funded and directed system of universal coverage for major services and a publicly or public/private, individually managed account system that is managed by the individual.   Adequate and universal coverage that contains incentives to use Heath Care dollars wisely, when combined with a superior system of private delivery, seems to be the best looking way to ensure that Canada meets the 5 Principles of the Canadian Health Care - *quality, timeliness, cost effectiveness, patient oriented, and universally accessible* - which aren't being met now to the degree that they could be when you consider that we are a G8 Country.


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## Brad Sallows (15 Mar 2005)

I fully expect that with a single public insurer - one point of contact for most billing - we should have lower administrative costs.  However, that tells us nothing about the desirability of public vs private delivery.

>The fact that they are illegal immigrants makes me doubt that they would be counted in official US government census data.

The numerator in the per capita fraction is the cost; I assume that when an agency provides services to a non-citizen (as required by law in some jurisdictions) it still bills the US government.  If the denominator - the number of people - excludes illegals, that merely causes the per capita cost to be inflated above its true value.

There are still factors unaccounted which I have not seen explored in any of the many articles and arguments on private vs public health care.  Are the costs of Canadians who seek health care outside Canada included as part of what should be the true cost of health care in Canada?  How do income levels of providers compare; if we had the same per capita numbers of doctors, nurses, etc and paid them approximately the same relative to other professions, what would our costs be?  Is equipment in Canada available on the same scales (ie. per person) and is it more or less up-to-date: what are the comparative costs of having enough, modern equipment?

Absent answers to all these questions, I see no compelling reason to accept the facile suggestion that public delivery is necessarily less costly than private delivery; unless it can be explained why health care is a unique service, it must also be the case that a government monopoly on grocery stores would provide the most food to the most people at the least cost.


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## Edward Campbell (16 Mar 2005)

Jeffrey Simpson, in today's _Globe and Mail_ at http://www.theglobeandmail.com/servlet/story/RTGAM.20050316.wsimpson16/BNStory/National/ gets it mostly right when he says:



> Where's productivity when you need it . . .
> 
> By JEFFREY SIMPSON
> 
> ...



Simpson, like his friends in government and the _commentariat_ in Ottawa is, however, afraid to go the final step and to lay the blame where it belongs: Stalinist health care.

Canadians have been conditioned â â€œ through 30 years of propaganda   â â€œ to believe that our national health care system is something other than a social and financial disaster.   Spending, way too much of it wasteful spending on health care consumes far, far too much public money - money from an already overtaxed population - and politicians are terrified at the prospect of spending less because they know that Canadians, the vast, overwhelming majority of Canadians, know little and care less about health care spending, except that it may not be cut, lest they have to pay something.

Really important programmes â â€œ the ones which may actually contribute to the future of the country are being cut and even abandoned as governments try to feed the insatiable health care monster, a monster which can never be satisfied.   The productivity gap is only one illustration of a flawed policy and hopeless priorities at 'work'.

We must stop adding to public health care spending; then we must begin to transfer most of the health care spending burden exactly where it belongs: individual Canadians, through competitive private insurance for most, through public subsidies for some, a few, to prevent _catastrophic_ health care bills â â€œ and catastrophic had better mean that personal bankruptcy is the *only* alternative, the kids' music lessons and the vacations in Florida had best be long gone, along with the cottage and second car before someone actually gets benefits from the public insurance _safety net_.

We must aim to reduce _public spending_ on health care to something less than 4% of GDP so that funds can be spent on R&D and education and things that matter to the country, rather than pandering to the groundless fears of too many ill-informed Canadians.   That means stop spending increases now and then begin to cut, deeper and deeper.   As Mrs. Thatcher used to say: There is no alternative.


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## mariomike (27 Nov 2009)

Hope there is not a DNR on this thread:

"Doctor supply outpaces population: The number of doctors practising in Canada is increasing at a faster rate than the population, according to a new report released Thursday.":
http://www.cbc.ca/health/story/2009/11/26/doctor-supply-canada.html


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## Antoine (29 Jan 2010)

I found this survey interesting, you can go on the Web site to find more, the PowerPoint presentation is also good.

www.canadaspeaks2010.ca/index.php

Canada Speaks! 2010: Canadians Go for Gold in Health and Medical Research



> The Association of Faculties of Medicine of Canada (AFMC), BIOTECanada, the Canadian Healthcare Association (CHA), Canada’s Research Based Pharmaceutical Companies (Rx&D), MEDEC and Research Canada: An Alliance for Health Discovery are pleased to release the results of their public opinion survey on health and medical research.  This survey builds upon two previous surveys undertaken by Research Canada: Canada Speaks! 2006 Research Canada’s First Public Opinion Survey on Health Research in Canada and Communicating Health Research in an Era of Headline News 2007  providing important tracking data on Canadians views of health research and the media and science relationship in Canada.
> Canada Speaks!  2010 demonstrates Canadians’ on-going commitment to Go for Gold in health and medical research and their desire to emerge from the middle of the pack even in the face of an economic recession.
> Health and medical research is a top Health Care priority for Canadians—84% say health and medical research makes an important contribution to the economy, recognizing that the economy is the most important issue facing Canadians today. Further, 90% of Canadians believe basic research should be supported by government even if it brings no immediate benefit.
> Even in recession, a large majority of Canadians would pay out of pocket to improve health and research capacity. Canadians would allocate 23 cents out of every health care dollar to health and medical research. Compared to 2006, a similar majority of Canadians are willing to pay $1 more per week out of their pocket to fund new health and medical research projects in Canada.
> ...


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## a_majoor (12 Jul 2012)

Here is an interesting look at how alternative systems work in Sweden. With "health care" spending closing in on 40% of government spending in Ontario alone, change is needed and soon for fiscal reasons. Patients might also apprieciate getting real healthcare as opposed to long wait times.

http://fullcomment.nationalpost.com/2012/06/28/tasha-kheiriddin-think-two-tier-health-care-would-be-a-disaster-ask-a-swede/



> Tasha Kheiriddin: Think two-tier health care would be a disaster? Ask a Swede
> Tasha Kheiriddin  Jun 28, 2012 – 8:28 AM ET | Last Updated: Jun 27, 2012 9:34 PM ET
> 
> Comments Email Twitter Hospital floors so clean you could eat off them. Wait times non-existant. Clinics designed with state of the art technology, much of it home-grown. Welcome to healthcare, Swedish style — which delivers quality universal care without many of the downsides we experience in Canada.
> ...


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## old medic (12 Jul 2012)

Here are some rebutals about private swedish companies operating 911 service:

http://www.thelocal.se/40608/20120503/
'Unlike Sweden, when you call an ambulance in the US, it comes'
03 May 2012


> After her child suffered a serious injury in Sweden and no ambulance was sent, US-native and parent Rebecca Ahlfeldt was left feeling especially vulnerable........



http://www.thelocal.se/39930/20120327/
Report slams denied ambulance call death
27 March 2012


> Health authorities in northern Sweden have come in for scathing critique for the death of 22-year-old Jill Söderberg, whose repeated calls for an ambulance were denied because she was “still talking”...........


alternate news source: http://www.foxnews.com/health/2012/03/28/woman-died-after-being-denied-ambulance-because-was-still-talking/

http://www.thelocal.se/39656/20120314/
Heart attack victim dies after ambulance denied
14 March 2012


> A 75-year-old Stockholm man suffering from a heart attack was forced to call three times and wait 13 hours before emergency services operator SOS Alarm finally sent an ambulance. He died in hospital the following day.
> The man called Swedish emergency number 112 at 10pm one evening last summer complaining of pain in his arms and breathing problems, but the nurse who took the call didn’t think an ambulance was necessary.
> 
> Several hours later, the man called again, telling the operator he felt extremely weak and was still having trouble breathing.
> ...



http://www.thelocal.se/33350/20110421/
Ignored ambulance call fatality 'a tragedy'
21 April 2011


> The nurse who refused to send an ambulance to a 23-year-old Stockholm man who later died had been reported several times prior to the incident.
> "Help me," 23-year-old Emil Linnell can be heard saying repeatedly in recordings of his January 30th call to SOS Alarm, Sweden's emergency response service.
> According to Sveriges Television (SVT), the nurse who took Linnell's call had several years of experience in the healthcare sector and had worked as an emergency call operator for more than a year.



There are many more to be found in swedish news sites.


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## a_majoor (12 Jul 2012)

It seems we have to take different poisions; I can get an ambulance and then wait six or more hours in an emergency room (and still end up paying the ambulance fee) or go to Sweden and wait for an ambulance...

I will admit that having access to a car or a neighbour does make it possible to apply a bit of self help to getting to the hospital, but sitting in the ER for six hours with my daughter (who was suffering a breathing emergency) provided powerful motivation to figure out and advocate for something that works better once you get in the door....


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## Edward Campbell (12 Jul 2012)

I rather like Singapore's system which features, in addition to private insurance, "health savings accounts" into which everyone pays something. In Singapore *no medical service is provided free of charge*, even within the public healthcare system. This reduces the over-utilisation of services, which is the norm in our fully subsidized universal health insurance systems. Charges vary enormously across the system but, as Tommy Douglas intended:

a. Everyone gets treated, eventually; and

b. No one goes bankrupt because of health care costs.

Outcomes are excellent - better than ours in every single measure last time I looked; hospitals are modern, clean and exceptionally well equipped; costs are low.

It is often said that Singapore's system would be hard to replicate in the liberal West; I suppose that's true because we are, really, neither very smart nor very imaginative.


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## old medic (12 Jul 2012)

Thucydides said:
			
		

> It seems we have to take different poisions.....



No, it's not a different position. My point is / was, no system is perfect. Sweden has
problems like everywhere else. I am just pointing out a logic flaw in Tasha Kheiriddin's 
post.


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## a_majoor (12 Jul 2012)

So there are problems, we address them. Our system is so dysfunctional and such a threat to the public treasury that many people would gladly take the Swedish system if offered (or the Singapore system, which is better yet). The prevailing attitude among the political and chattering class is that to ring up any alternative system or discuss the merits of alternative systems is heresy that should be met with a massive outpouring of public outrage to drown out the speaker (since burning at the stake is frowned upon these days).

If anything, fixing ambulance dispatch would be quite easy, since it is a small and separate "branch" of healthcare, if you will.


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## mariomike (12 Jul 2012)

Thucydides said:
			
		

> I can get an ambulance and then wait six or more hours in an emergency room (and still end up paying the ambulance fee) or go to Sweden and wait for an ambulance...



In Ontario, ( not sure which province you live in ) the fee for ambulance transport is normally $45.00.  
Your extended health care insurance ( if you have it ) will reimburse you the $45.00.

( There is no charge if 9-1-1 is dialed and paramedics respond to perform an assessment and patient care on scene, but do not transport. aka "Treat and Release". )




			
				Thucydides said:
			
		

> I will admit that having access to a car or a neighbour does make it possible to apply a bit of self help to getting to the hospital, but sitting in the ER for six hours with my daughter (who was suffering a breathing emergency) provided powerful motivation to figure out and advocate for something that works better once you get in the door....



Not sure if your daughter was in the waiting area or the treatment area of the Emergency Department.

If your daughter was transported by paramedics, and if she had unresolved shortness of breath, Transfer of Care ( patient transferred to an ED stretcher and report given ) would only take place inside the treatment area.


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## Infanteer (12 Jul 2012)

E.R. Campbell said:
			
		

> I rather like Singapore's system which features, in addition to private insurance, "health savings accounts" into which everyone pays something. In Singapore *no medical service is provided free of charge*, even within the public healthcare system. This reduces the over-utilisation of services, which is the norm in our fully subsidized universal health insurance systems.



Dr David Grazer has written two books about bringing a system like Singapore's to Canada - he sings high praise about the "health savings accounts".  I've ranted on about them here over the years.


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## MedCorps (13 Jul 2012)

I will second Dr. Grazer's books.  Good read and really get you thinking.  Also a nice guy in person and worth going out to hear speak if you get the chance. 

MC


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## Edward Campbell (25 Feb 2013)

The self described "non-partisan" but generally touted as "right wing" _Fraser Institute_ has published a new report a health care, a synopsis, with a link to the main report, is reproduced below under the Fair Dealing provisions of the Copyright Act from the _Fraser Institute's_ web site:

http://www.fraserinstitute.org/research-news/news/display.aspx?id=19381


> Australian health care system an example for Canada in reducing costs and waits for treatment
> 
> Media Contacts: Nadeem Esmail
> 
> ...




I have often noted that within the OECD, the "club of rich, advanced nations," two countries stand out has having poor health care systems (being both expensive to operate and providing poor health results): Canada and the USA. Almost every advanced, Western state, and several Asian ones, too, have health care systems that produce better results for more people than does Canada and they do so at lower costs. Even France, a country for which I have little regard, a place that I regard as the archetypical "shitty little country," has a better health care system than does Canada.

It is time for some big, Big BIG changes which the provinces must lead: ignoring the bureaucrats in Ottawa and, eventually forcing Ottawa to jettison the ill conceived, deeply flawed _Canada Health Act_.


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## OceanBonfire (7 Dec 2022)

Meanwhile in the US:



> A CBS News investigation found American health care institutions are being taken apart and shut down by investors looking for profits.




__ https://twitter.com/i/web/status/1600127420337635329








						"What they've done is extremely evil": Pennsylvania hospital shutdown spurs questions about private equity in health care
					

A for-profit California company saw windfall dividend — and patients scrambled for care, a CBS News investigation found.




					www.cbsnews.com
				












						Hospital closure leaves patients scrambling, owners collect millions
					

Private equity is piling into healthcare, snapping up everything from local doctors' offices, to specialty clinics, even hospices. A CBS News investigation looked at these deals and found the owners of one for-profit company made millions, before some of their community hospitals shut down...



					www.cbsnews.com


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## Bruce Monkhouse (7 Dec 2022)

OceanBonfire said:


> Meanwhile in the US:
> 
> 
> 
> ...


Guess you haven't gone to a Canadian hospital lately then??  Nice big one 10 minutes from me, that has had tons of renovations over the last few years, but right now I'd be driving 40 minutes to a tiny little village north of here and hoping I'm only sitting for a day or so before I get seen.....


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## lenaitch (7 Dec 2022)

What "tiny little village" in Ontario has a hospital?

We must be an outlier.  I've taken my wife to our local hospital emerg a number of times.  I will stay with her until she is 'taken in' to emerg then go home a wait for a phone call.  The hospital has a half-hour free parking grace period.  The last two times, I was under the half hour.  The last time, was for a hard fall.  In and out, examined, diagnosed, imaging, etc. in three hours.   I realize timing makes a difference.  Early morning seems golden.  Later on, the people with the sniffles, no family doctor, etc. start wandering in.


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## mariomike (7 Dec 2022)

Dropped off a bottle of scotch for the family doctor, and a box of chocolates for the receptionist, today.


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## Bruce Monkhouse (7 Dec 2022)

lenaitch said:


> What "tiny little village" in Ontario has a hospital?


Fergus - Mount Forest - Meaford keep going??


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## Brad Sallows (7 Dec 2022)

Meanwhile in the US, if you have health insurance you probably have a GP and can get almost any kind of imaging within a couple of days and a specialist's opinion shortly thereafter.  Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.

Our system is for sh!t right now and Squirrels! south of the border do nothing to improve it.


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## mariomike (8 Dec 2022)

Brad Sallows said:


> Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.



Post-retirement HCSA cover private MRI.



> Diagnostic tests – the cost of medical tests such as cardiographs, electrocardiograms, x-rays, ultrasounds, MRI, and CT scans (including the cost of any related interpretation or diagnosis). Deluxe or elective tests are eligible.


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## mariomike (8 Dec 2022)

Bruce Monkhouse said:


> Fergus - Mount Forest - Meaford keep going??



Smaller places ship a lot of their more serious / complicated cases to larger hospitals.


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## Good2Golf (8 Dec 2022)

mariomike said:


> Smaller places ship a lot of their more serious / complicated cases to larger hospitals.


Larger hospitals sometimes ship cases to smaller hospitals.  Some even have the docs shuttle around the region to practice in surrounding facilities.  My family has used ER *services and I’ve had specialist appointments in Kemptville and Winchester from docs based in Ottawa.  The facilities are actually not bad at all and less strained than the facilities, especially ER, in larger centres.


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## Edward Campbell (8 Dec 2022)

Brad Sallows said:


> Meanwhile in the US, if you have health insurance you probably have a GP and can get almost any kind of imaging within a couple of days and a specialist's opinion shortly thereafter.  Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.
> 
> Our system is for sh!t right now and Squirrels! south of the border do nothing to improve it.


This was, I hasten to point out, several years ago, but when (after I retired) I was undergoing some innovative treatment for a fairly serious problem the specialists and my GP, a firm believer in our national health care system, really wanted to see some images, like once a week or so. My GP finally said, "can you afford to go down to Syracuse, say every ten days or so, and pay a few hundred US dollars for a scan? I know the radiologist there quite well and I will certify it as medically necessary and your insurance might cover at least some of the costs."  I could, I did, and yes my insurance covered over half the costs but I was still a few thousand dollars out of pocket for what the physicians felt was necessary but our "system" could not provide.


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## OldSolduer (8 Dec 2022)

Brad Sallows said:


> Meanwhile in the US, if you have health insurance you probably have a GP and can get almost any kind of imaging within a couple of days and a specialist's opinion shortly thereafter.  Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.


Three months?? Luxury!!!

In Manitoba the wait to see a specialist can be 18 months, surgery if required 12-18 months AFTER that.

We are at least 405 doctors short in Manitoba.


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## lenaitch (8 Dec 2022)

Bruce Monkhouse said:


> Fergus - Mount Forest - Meaford keep going??


Ok.  We have a different definition of 'village'.  To me, places like Everett, Maxwell and Goodwood are villages.  It's matter of personal perspective since terms like 'city', 'town' and 'village' are undefined in Ontario.  Oakville calls itself a town; pop. around 220K.  Dryden calls itself a city; pop. around 7400.  It makes little sense.


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## Humphrey Bogart (8 Dec 2022)

OldSolduer said:


> Three months?? Luxury!!!
> 
> In Manitoba the wait to see a specialist can be 18 months, surgery if required 12-18 months AFTER that.
> 
> We are at least 405 doctors short in Manitoba.


I moved to Ontario six months ago.  I have been waiting six months for an appointment with a Nurse Practitioner (not even a Doctor).  The appointment was to be next week and I had arranged to have the day off with work.  

Got a call this morning:

"Sorry appointment cancelled, that NP is no longer with our clinic, we will reschedule you when we get a new one"  

Whenever that is 😄

I would much rather pay for insurance and get on-demand treatment than what we currently have.  Of course I have the money for it so maybe my opinion would change if that wasn't the case.


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## Halifax Tar (8 Dec 2022)

Humphrey Bogart said:


> I would much rather pay for insurance and get on-demand treatment than what we currently have.  Of course I have the money for it so maybe my opinion would change if that wasn't the case.



Maybe a buy in or buy out system.  Pay for your own health insurance and get a break on your taxes ?


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## mariomike (8 Dec 2022)

Good2Golf said:


> The facilities are actually not bad at all and less strained than the facilities, especially ER, in larger centres.



I'm sure they are not bad. 

But, that is not what I meant. I understand some ERs may have shorter wait times than others. 









						Rural Ontario communities hit hard by ER closures, hospitals face staff challenges
					

Doug Walsh remembers being rushed to the emergency department in his rural Ontario community when he had a stroke a decade ago and credits the urgent ...




					www.thestar.com
				




When a patient requires a higher level of care - such as a Level 1 Trauma Centre, for example - when "not bad" isn't good enough, they are transferred to an appropriate facility by land or air paramedics. Often Ornge.

When the patient is well enough, they are returned to their community hospital for recovery.


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## mariomike (8 Dec 2022)

lenaitch said:


> I realize timing makes a difference.  Early morning seems golden.



Our car count did not go into high gear until 11 A.M. 

Wasn't enough call volume to justify any earlier than that.


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## mariomike (8 Dec 2022)

lenaitch said:


> Dryden calls itself a city; pop. around 7400.  It makes little sense.



The funny thing is, Dryden is a single-tier city. On the other hand, Mississaga, with a population of 721,000, is two-tier.

Mississauga is still trying to get a divorce from Peel Region. To break free and become independent with all the autonomy and powers that Dryden has.
​


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## Colin Parkinson (8 Dec 2022)

My wife needed an MRI, 6-8 month wait list, we said we go private, the specialist said "I won't look at it till it's your turn" . We got wife's file from the family doctor, she flew to Malaysia got it done, 12 other tests, consults with doctors, all added to her file, spent time with her family and flew home for the cost of a private MRI here.
I just spent $2,000 on my daughters tooth yesterday (Thank god we have two insurance coverage). Otherwise I be shipping her over there for any major work. I really should get into medical tourism with my brotherinlaw.


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## RangerRay (8 Dec 2022)

OldSolduer said:


> Three months?? Luxury!!!
> 
> In Manitoba the wait to see a specialist can be 18 months, surgery if required 12-18 months AFTER that.
> 
> We are at least 405 doctors short in Manitoba.


By the time I get the call from the specialist I was referred to, I can’t remember what the original problem was that I went to the GP for.   😖


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## MJP (8 Dec 2022)

Humphrey Bogart said:


> I moved to Ontario six months ago.  I have been waiting six months for an appointment with a Nurse Practitioner (not even a Doctor).  The appointment was to be next week and I had arranged to have the day off with work.
> 
> Got a call this morning:
> 
> ...


Agreed.

Moved to Quebec this year and my wife and step-daughter can't get an appt to see a doctor in a major city.  It is absolutely wild and is pushing us down the road of looking at private pay for access medical centers which seem to be flourishing here.


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## Spencer100 (8 Dec 2022)

When "free" healthcare in the minds of Canadians is the most defining characteristic of the country....there will be no fixes.  Just more wait lists and taxes.  Trudeau's biggest healthcare innovation is MAiD.   That is where they hope to find the savings.


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## Brad Sallows (8 Dec 2022)

mariomike said:


> Post-retirement HCSA cover private MRI.


Health insurance is worthless if you can't get actual care before serious damage results.


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## Good2Golf (8 Dec 2022)

Colin Parkinson said:


> My wife needed an MRI, 6-8 month wait list, we said we go private, the specialist said "I won't look at it till it's your turn" . We got wife's file from the family doctor, she flew to Malaysia got it done, 12 other tests, consults with doctors, all added to her file, spent time with her family and flew home for the cost of a private MRI here.
> I just spent $2,000 on my daughters tooth yesterday (Thank god we have two insurance coverage). Otherwise I be shipping her over there for any major work. I really should get into medical tourism with my brotherinlaw.


Got a root canal in Jakarta during a business trip.  $110 USD.   Wasn’t even worth my time to try and claim against PSDCP.


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## Humphrey Bogart (8 Dec 2022)

Spencer100 said:


> When "free" healthcare in the minds of Canadians is the most defining characteristic of the country....there will be no fixes.  Just more wait lists and taxes.  Trudeau's biggest healthcare innovation is MAiD.   That is where they hope to find the savings.


My company has lots of openings in Iowa, Minnesota and North Dakota.  All promising places to eventually immigrate to 😁


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## Halifax Tar (8 Dec 2022)

Humphrey Bogart said:


> My company has lots of openings in Iowa, Minnesota and North Dakota.  All promising places to eventually immigrate to 😁



Im listening.


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## mariomike (8 Dec 2022)

Brad Sallows said:


> Health insurance is worthless if you can't get actual care before serious damage results.



Private clinics seem ( relatively ) prompt. It's pricey, but can be claimed on HCSA.




Humphrey Bogart said:


> My company has lots of openings in Iowa, Minnesota and North Dakota.



Saw this about North Dakota the other day. Arizona would be my choice.


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## OldSolduer (8 Dec 2022)

Halifax Tar said:


> Im listening.


I am too


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## OldSolduer (8 Dec 2022)

Halifax Tar said:


> Maybe a buy in or buy out system.  Pay for your own health insurance and get a break on your taxes ?


I like that idea but it will never happen here because its "two tier health care. We want everyone to suffer equally"


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## Quirky (8 Dec 2022)

Humphrey Bogart said:


> I would much rather pay for insurance and get on-demand treatment than what we currently have. Of course I have the money for it so maybe my opinion would change if that wasn't the case.



The answer to most problems: Don’t be poor.


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## Spencer100 (8 Dec 2022)

OldSolduer said:


> I am too


Many of my friends have moved to the USA and elsewhere.  Florida is the biggest draw.  One friend deemed everything sold paid his taxes and left for good. 

I need an MRI on my knee (skiing fall) I flew to Fort Lauderdale watched a Leafs Panther game and got a MRI  $340.00us no waiting.  Funny thing if I was a US insurance paying I would have to wait a little.  When I called they said two week wait. I said paying cash....they said tomorrow at noon.


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## Humphrey Bogart (8 Dec 2022)

Quirky said:


> The answer to most problems: Don’t be poor.


Money can't buy happiness but boy does it sure help 😉


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## Spencer100 (8 Dec 2022)

Spencer100 said:


> Many of my friends have moved to the USA and elsewhere.  Florida is the biggest draw.  One friend deemed everything sold paid his taxes and left for good.
> 
> I need an MRI on my knee (skiing fall) I flew to Fort Lauderdale watched a Leafs Panther game and got a MRI  $340.00us no waiting.  Funny thing if I was a US insurance paying I would have to wait a little.  When I called they said two week wait. I said paying cash....they said tomorrow at noon.


OT I think I still saved money by watching the Leafs in Florida than in TO.  Including the Flight, Uber and tickets.


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## Humphrey Bogart (8 Dec 2022)

Spencer100 said:


> Many of my friends have moved to the USA and elsewhere.  Florida is the biggest draw.  One friend deemed everything sold paid his taxes and left for good.
> 
> I need an MRI on my knee (skiing fall) I flew to Fort Lauderdale watched a Leafs Panther game and got a MRI  $340.00us no waiting.  Funny thing if I was a US insurance paying I would have to wait a little.  When I called they said two week wait. I said paying cash....they said tomorrow at noon.


Anyone I know who was really gifted or talented in some way is now living and working in the United States.

The opportunities there are just so much better.  They get hired by Big Companies or ThinkTanks.


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## Rifleman62 (8 Dec 2022)

A few years ago, I had a brain scan (no jokes plse) in Phoenix. Walk-In MD set it up, drove to the clinic, 20 minutes.  Informed the results would be sent to MD.  On the way home, MD phoned me with the results (no problem) and stated I could pick up the scan CD tomorrow.

I now have proof I have a brain.


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## lenaitch (8 Dec 2022)

mariomike said:


> Private clinics seem ( relatively ) prompt. It's pricey, but can be claimed on HCSA.
> 
> 
> 
> ...


He could have replaced "North Dakota" with 'northern Ontario" and most of the points would still apply.  Tedious travel time?  Try 24-hours, 2 time zones and still be in the same province.


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## dapaterson (8 Dec 2022)

Rifleman62 said:


> A few years ago, I had a brain scan (no jokes plse) in Phoenix. Walk-In MD set it up, drove to the clinic, 20 minutes.  Informed the results would be sent to MD.  On the way home, MD phoned me with the results (no problem) and stated I could pick up the scan CD tomorrow.
> 
> I now have proof I have a brain.


Had, not have, unless you have current proof.


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## dimsum (10 Dec 2022)

Humphrey Bogart said:


> Anyone I know who was really gifted or talented in some way is now living and working in the United States.
> 
> The opportunities there are just so much better.  They get hired by Big Companies or ThinkTanks.


A few folks I know are working for US companies, remotely, in Canada.


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## Colin Parkinson (10 Dec 2022)

dapaterson said:


> Had, not have, unless you have current proof.


Veterans Affairs would demand you fill out a form each year to prove you have a brain.


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## dapaterson (10 Dec 2022)

"Thank you for submitting your proof of having a brain.  Unfortunately, we will have to disqualify your application to come work for us."


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## RangerRay (10 Dec 2022)

mariomike said:


> Private clinics seem ( relatively ) prompt. It's pricey, but can be claimed on HCSA.
> 
> 
> 
> ...



North Dakota = America’s Manitoba 

But one can get killer deals in Grand Forks!


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## daftandbarmy (16 Dec 2022)

Would it kill you to wait a little bit?

The answer to that question is, apparently, yes.


Waiting List Deaths Hit Four-Year High​ 

*Government data shows 13,581 Canadians died last year waiting for everything from heart operations and knee surgery to MRI and CT scans*
*Surgical waiting list deaths up 24% over the past four years*
*CALGARY, AB:* SecondStreet.org released its fourth _Died on a Waiting List_ report today after gathering and analyzing government data on patients dying while waiting for surgery and diagnostic scans. The data shows waiting list deaths are at a four-year high since the organization began tracking this problem in 2018-19.

The data shows that over the past four years, there has been a 24% increase in surgical waiting list deaths. Information obtained from Ontario Health data shows an increase of over 400% when it comes to waiting list deaths for CT scans and MRI scans since 2015-16.

“The pandemic made a bad situation worse, but Canadians should know this was a growing problem well before COVID arrived,” said SecondStreet.org President Colin Craig. “It’s quite startling how governments aren’t tracking this problem. One would think a health minister would want to know how many patients died due to long waiting lists in their province, but no health minister in Canada knows the answer.”

SecondStreet.org gathered the data by filing Freedom of Information requests with hospitals and health bodies across Canada. Highlights from this year’s report include:

At least 13,581 patients died while waiting for surgeries, procedures and diagnostic scans in 2021-22. This year’s total is up from last year’s total of 11,581.
The cases include a wide array of services – everything from hip operations and heart surgery to CT and MRI scans. Before dying on a waiting list, patients had waited anywhere from less than a month to over eight years. Many died after waiting longer than the recommended wait time.
Surgical waiting list deaths are up 24% over the past four years.
Nova Scotia provided the most comprehensive data. They were able to note that of the 352 patients who died while waiting for surgery this past year, 28 were waiting for surgeries that could have potentially saved their lives. Over 60% had waited longer than the recommended wait time.
Alberta no longer collects data related to this problem and Saskatchewan did not provide data in time. However, SecondStreet.org did obtain some data from Newfoundland for the first time.
“Laura Hillier, Michel Houle, Jerry Dunham, Shannon Anderson, there are many cases of patients dying due to long waiting lists in Canada,” added Craig. “How can governments fix this problem if they’re not even looking into it? The first step is to start tracking the problem, then put in place solutions.”









						Waiting List Deaths Hit Four-Year High - SecondStreet.Org
					

SecondStreet.org has released its annual Died on a Waiting List report for 2021-22. Once again, a troubling trend continues: more people are dying while waiting for surgery or diagnostic scans.




					secondstreet.org


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## OldSolduer (16 Dec 2022)

Everyone suffers equally in this system UNLESS you are in jail or the pen.


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## IKnowNothing (16 Dec 2022)

Unpopular opinion, Canadian healthcare isn't facing a payment/system problem, it's facing a  "no one has cared to read a population pyramid and act accordingly in the last 20 years" problem.


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## Spencer100 (16 Dec 2022)

daftandbarmy said:


> Would it kill you to wait a little bit?
> 
> The answer to that question is, apparently, yes.
> 
> ...


It's not a bug it's a feature.

MAiD is the future of cost control.


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## Quirky (16 Dec 2022)

IKnowNothing said:


> Unpopular opinion, Canadian healthcare isn't facing a payment/system problem, it's facing a  "no one has cared to read a population pyramid and act accordingly in the last 20 years" problem.



I thought it was because people aren’t wearing masks?


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## Bruce Monkhouse (16 Dec 2022)

Quirky said:


> I thought it was because people aren’t wearing masks?


So you're saying you want us to go back??  Noted.....


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## mariomike (16 Dec 2022)

Spencer100 said:


> MAiD is the future of cost control.


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## Good2Golf (17 Dec 2022)

IKnowNothing said:


> Unpopular opinion, Canadian healthcare isn't facing a payment/system problem, it's facing a  "no one has cared to read a population pyramid and act accordingly in the last 20 years" problem.


Health care isn’t the only issue when people don’t pay attention to the pyramid inversion in the younger age segments…a society lets its pyramid base bend in on itself, at its own peril…


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## ModlrMike (18 Dec 2022)

IKnowNothing said:


> Unpopular opinion, Canadian healthcare isn't facing a payment/system problem, it's facing a  "no one has cared to read a population pyramid and act accordingly in the last 20 years" problem.


I have been saying this for years. I am also something of a modern day Don Quixote.


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