# If America adopts Canada's health care system



## a_majoor (22 Oct 2007)

Ever notice that the Americans who are most ardent about their adopting the Canadian health care system are wealthy Democrats who would probably have private doctors on retainer for their own use no matter what? (Then again, lets imagine if you or I were to feel chest pains on the golf course and imagine how long it would take to get medical attention and bypass surgury, compared to, say, a former politician).

Happily, some people get it:

http://www.daybydaycartoon.com/2007/10/22


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## geo (22 Oct 2007)

Is the Canadian health care system the "cat's meow"?  Nope, it has good & bad.
Is the US health care system the cat's meow?... Nope, it has good & bad.

Would a hybrid of the Canadian & US health care system be the solution?... probably not, but it would be a good start.


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## observor 69 (22 Oct 2007)

PROVIDING HEALTH CARE FOR KIDS WILL PAY OFF OVER TIMEMon Oct 22, 9:48 AM ET


Just four years ago, President Bush and the Republican Congress joined with Democrats to champion a program giving prescription drug coverage to senior citizens. It was poorly conceived and expensive, an added entitlement for a group of Americans who already had good medical care. But Bush and Congress insisted that seniors deserved it.

http://news.yahoo.com/s/Lucas/20071022/cm_Lucas/

On line Health Care Poll

Apparently a lot of Americans are in favour of public health care.

http://www.citizenshealthcare.gov/recommendations/appendix_c.php


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## tomahawk6 (22 Oct 2007)

The problem with socialized medicine is that it results in rationed care. Those that have the means go to the US for treatment. A few states have tried this approach and have found that the concept just doesnt work. There is no free lunch.

http://www.opinionjournal.com/editorial/feature.html?id=110005987
http://www.americanthinker.com/2007/01/governor_schwarzenegger_should.html


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## observor 69 (22 Oct 2007)

America is spending more on Health care than Canada and other countries in the world and getting an inferior outcome.

Please read the link.
http://www.oecd.org/dataoecd/29/52/36960035.pdf


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## Brad Sallows (22 Oct 2007)

When Canadians spend money in the US (or anywhere other than in Canada) on health care, is that counted as what Canadians spend on health care?

How much more would Canadians spend if the system had the capacity to provide more?

Apples and oranges.

[And what exactly is an "inferior outcome"?  Life expectancy - how many variables are involved?  Infant mortality - the report points out that few countries use the strictest definition of live birth, which the US does?  Obesity - whose responsibility is that?]

If 45% of the US spending is governmental, and the portion of the population covered happens to amount to less than 45%, I wish them luck offering full coverage at public expense without spending yet more per capita overall.  Well, the answer to that is the same as it is here: delisting.


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## RangerRay (23 Oct 2007)

I've said it before, and I'll say it again...we should be exploring European "mixed" models that are far less expensive and provide better outcomes than our outdated Soviet-style system.  And no one has to pay out of pocket for treatment.


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## observor 69 (23 Oct 2007)

http://www.nytimes.com/2007/10/23/opinion/23herbert.html?ref=opinion
subscription required


The Long, Dark Night 

By BOB HERBERT  New York Times
Published: October 23, 2007
Nashville 


I was making small talk with Dan and Sharon Brodrick in a waiting area filled with anxious-looking patients on the first floor of St. Thomas Hospital. Mrs. Brodrick seemed tired, but she managed a smile. Her husband, a former truck driver who is now an ordained minister, was the talkative one.

“We found out five days after her 56th birthday,” he said. “How’s that for a happy birthday?” 

While maintaining a pleasant facade for the outside world, the Brodricks, married 37 years and still deeply in love, are spinning toward the abyss.

“We’re in big trouble,” said Mr. Brodrick.

Mrs. Brodrick learned last May that she had cancer of the duodenum, and it had already spread to her liver and pancreas. Not only is the prognosis grim, but the medical expenses will soon leave the couple destitute. Mrs. Brodrick has no health insurance.

The emotional toll has been nearly as devastating as the physical. Mrs. Brodrick told her husband that she wasn’t ready to leave him. “I don’t want to die,” she said. When he told her they had to cling to their faith in God, she replied, “I know that God can take care of this. But how’s he going to do it?” 

The American Cancer Society has been campaigning to raise awareness of the desperate plight of people trying to deal with cancer without health insurance. I offer Dan and Sharon Brodrick as Exhibit A. 

The Brodricks never had much money, but they raised two boys and managed to buy a modest home in Gainesboro, a rural town about 90 miles east of here. Dan Brodrick severely damaged his back in an accident at work several years ago and is disabled. His wife has suffered from a variety of illnesses.

But by carefully managing their meager income, they have lived in reasonable comfort. “With a little bit of savings,” said Mr. Brodrick, “and with what I’ve been drawing in disability, we figured we’d be all right.”

But the absence of health insurance for Mrs. Brodrick left a gaping hole in their financial plan, and they knew it. She had been covered by her husband’s health insurance while he was driving a truck. But that coverage ended when he was forced to retire.

“We tried to buy insurance for her,” said Mr. Brodrick. “We applied to dozens of companies. But they wouldn’t touch her because she already had health problems.”

Without insurance, Mrs. Brodrick received treatment for her various ailments under a special program for uninsured patients at St. Thomas. But the cancer diagnosis was an entirely different story, a step for the Brodricks into a realm of dizzying, unrelieved horror.

First came the biopsy, accompanied by reassuring comments from doctors. Then came word that the tumor was indeed malignant. That was followed by surgery.

“They opened her up, and then they closed her right up again,” said Mr. Brodrick.

Not only had the cancer metastasized, it was moving very aggressively. Various estimates were given, each one shorter than the last, about how long Mrs. Brodrick might live.

While his wife was being prepped for chemo, Mr. Brodrick sat in the corner of another room and spoke about what it was like to have one’s life all but literally blown apart.

“It tears you down,” he said. “You’d like to fight this with your bare hands, but you can’t. We’ve been married 37 years Sept. 2, and when I think about it, it was the quickest 37 years I’ve ever seen go by in my life. It went by in a flash. And we have leaned on each other that whole time.”

The hospital is not billing the Brodricks for its costs. “But,” said Mr. Brodrick, “I’ve still got to pay the doctors’ bills and pay for the drugs. And the drugs are very expensive.”

He reeled off a long list of charges that are coming at him like machine-gun fire, bills that he cannot afford to pay.

“So we’re selling the house,” he said. He sat quiet for a moment, then added in a soft voice, “You shouldn’t have to go live in a tent somewhere just because you don’t have insurance.”

He said he wanted to tell his story publicly because he knew there were millions of others without health insurance, and that there are many families, like his own, facing the long, dark night of devastating illness.

“Something has to be done,” he said.

Mr. Brodrick was able to get his wife into a renowned cancer center in the Midwest to get another opinion on the course of treatment she was receiving.

“They said it was the perfect treatment for her and they wouldn’t change a thing,” he said. “They said the success rate with that treatment was 5 percent or less.”

He looked at me. “We’ve got faith in God,” he said. “Without that you might as well throw yourself off a cliff, because there’s nothing else left.”


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## Bruce Monkhouse (23 Oct 2007)

_Quote,
“They said it was the perfect treatment for her and they wouldn’t change a thing,” he said. “They said the success rate with that treatment was 5 percent or less.”_

Not to be insensitive to this couples plight, but there is a good chance that by the time she started treatment up here she would already be dead and even if she "made the list" that would mean someone with a much higher chance of success would be held back.......................its not a bottomless pit.


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## geo (23 Oct 2007)

Have noticed in the US media that the Republicans have started to hammer away at Hillary.

Guess they feel it is best to get her out of the way right now cause they feel they have a better chance facing off against someone like Obama.


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## a_majoor (23 Oct 2007)

While this is the sort of story that is always used to "justify" government run health care, there are several things to keep in mind:

In Canada, patients have actually died as a result of being put on waiting lists for tests or treatment. As heartless as it sounds, this is actually the preferred outcome for the system, since the patient is not drawing on scarce resources.

Reading the article carefully, you see that there are charitable institutions which are offering help. Often, even patients with insurance find their coverage is not enough, and charity becomes the source of support.

The reason that treatment is so expensive and the Americans spend so much of their GDP on health care has more to do with distortions of the market place. Medicare and Medicaid provide virtually unlimited coverage, and insurance companies carefully "wargame" the system to ensure they can receive the maximum possible payout from the taxpayer.

The "ideal" system would be a combination of Medical Registered Savings Plans to save for the routine costs and some sort of catastrophic coverage from insurance, charity and government sources. Smart consumers would look to save their money, forcing the costs of medical care to come down.


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## tomahawk6 (23 Oct 2007)

Some US experts think that if health insurance companies were able to expand their pool nationwide that would drop private insurance rates. Right now the pool is limited to a particular state, I might be wrong though.


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## geo (23 Oct 2007)

WRT waiting lists...
I know that Quebec medicare has indicated that, if someone is left on a waiting more than 90 days, then the Quebec medical system will see about having the patient treated outside the province.  Starting with neighboring provinces but not excluding northern US states.  As long as it works, I have no problem with it.

My sister has only just recently been diagnosed with a brain tumor... +/- Cdn Thanksgiving.  They did a biopsy on her yesterday - and results expected by early next week....  Will see how prompt service is tendered.


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## Brad Sallows (23 Oct 2007)

The reason for public catastrophic insurance is simple, and Fred Reed makes it.  Pay particular attention to his admonition in the last paragraph.

But argument by anecdote is barely one step above resorting to personal insults.  Regardless, our provincial health care systems will not prolong life at any cost, and will refuse life-extending treatment in some cases.  In a publicly-funded system, the value of your life is explicitly measured in dollars just as it is by private insurers, and sometimes all you will get is a course of pain management until the end.

But public catastrophic insurance doesn't mean every medical service must be covered, or that nothing may be means-tested, or that medical services should be insulated from a free market.  Canada does not have as good a health care system as is affordable.  Those willing and able to spend more should have every opportunity to do so, in Canada.


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## Greymatters (23 Oct 2007)

tomahawk6 said:
			
		

> The problem with socialized medicine is that it results in rationed care. Those that have the means go to the US for treatment. A few states have tried this approach and have found that the concept just doesnt work. There is no free lunch.



Definately no such thing as a free lunch which is why so much of our provincial taxes goes towards health care.  Very few actually go to the US for expensive treatment where your money can get them pushed to the front of the line.


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## observor 69 (23 Oct 2007)

geo said:
			
		

> Have noticed in the US media that the Republicans have started to hammer away at Hillary.
> 
> Guess they feel it is best to get her out of the way right now cause they feel they have a better chance facing off against someone like Obama.



Lot's of luck with that one! Hilary has such a serious lead that it is approaching a done deed ref becoming the Democrat presidential nominee.
I find it fun to follow this lnk at Slate. http://www.slate.com/id/2175496/
Open the "Nation" to see how Hilary is doing versus Obama.


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## geo (23 Oct 2007)

Yup, that's why the Republicans have started hammering away at her.
Some survey published today or yesterday that claims 56% of voters would not vote for Hillary... 
Question is... who the survey was targeted at?


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## a_majoor (24 Nov 2007)

Once again, examining the metrics gives a different story:

http://jr2020.blogspot.com/2007/11/healthcare-canuckistan-versus-america.html



> Friday, November 23, 2007
> *Healthcare - Canuckistan versus America*
> 
> As all Canadians are reminded almost daily -‘American-style’ health care is B A D. It’s a given that the Canadian/Cuban/North Korean/Soviet universal healthcare model is the best in the world.
> ...


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## Scoobie Newbie (24 Nov 2007)

$28,000 grand for a broken leg.  Thanks I'll pass on the American system and wait in line to have my leg fixed.


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## a_majoor (24 Nov 2007)

While the American system has its issues, be very careful what you wish for:

http://www.freerepublic.com/focus/f-news/900134/posts



> *Mark Steyn: The system infected us*
> National Post ^ | April 24 2003 | Mark Steyn
> 
> Posted on 04/25/2003 6:47:59 AM PDT by knighthawk
> ...



Given the literally billions of dollars pumped into Canadian "Health Care" over the preceding decades, it defies belief that the system could be "_chronically harassed, understaffed, underequipped_", but since we don't spend the money directly on our own health care, we have no control or accountability over how it is spent by bureaucrats, whose prime interest is to increase the size and power of their bureaucracy, _not_ to actually achieve a solution (which by definition eliminates the need for their services).


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## Nemo888 (24 Nov 2007)

I have no idea about bureaucrats and above but all the hospitals I've worked for have been cutting corners to save money. Old equipment, lack of trained staff, unhygienic and unsanitary conditions for patients, excessive wait times and rationing are systemic in Ontario. There are hospitals that are so dirty I refuse to work in them, let alone go to them for treatment. Our health care system needs more money, public or private is irrelevant to me. If I could pay for real health care I would. I’m a lefty wack job and private health care is starting to look good to me. People are dying that could easily be saved. America’s system of social Darwinism is not really worth emulating though. US health care is even more messed up than ours.


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## TCBF (24 Nov 2007)

"If the U.S. adopts Canadian-style health care, where will Canadians go when they get sick?"

- Fred Dalton Thompson

We should have enacted the reforms Doctor/Senator Keon's commission recommended a decade ago, but our health care bureaucracy could not stand the idea of competing internally with itself.

The choice is not just Canadian or American health care.  The French have a very good system.


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## a_majoor (24 Nov 2007)

Nemo888 said:
			
		

> I have no idea about bureaucrats and above but all the hospitals I've worked for have been cutting corners to save money. Old equipment, lack of trained staff, unhygienic and unsanitary conditions for patients, excessive wait times and rationing are systemic in Ontario. There are hospitals that are so dirty I refuse to work in them, let alone go to them for treatment. Our health care system needs more money, public or private is irrelevant to me. If I could pay for real health care I would. I’m a lefty wack job and private health care is starting to look good to me. People are dying that could easily be saved. America’s system of social Darwinism is not really worth emulating though. US health care is even more messed up than ours.



The things you report are a *result* of our current system. If the "system" isn't called to account for the billions they get already, then giving them more money will not change things.

In areas where you can directly control where you spend your money, results are vastly different. Shopping at Wal Mart is a perfect example, you go there because you know you will get more for your money. Wal Mart has lots of incentives to keep administrative and other costs as low as possible, and also to maintain their stores so they are as clean and attractive as possible; they want you to come back. If a private health care hospital wasn't run like a Wal Mart; they would quickly go out of business.

US style health care, with it's government distortions creating a powerful perverse incentive for insurance cartels to charge for everything that isn't nailed down could also use a dose of privatization.


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## Bruce Monkhouse (24 Nov 2007)

Lone Wolf Quagmire said:
			
		

> $28,000 grand for a broken leg.  Thanks I'll pass on the American system and wait in line to have my leg fixed.


Yup, isn't it nice to have a job that will still pay you as you wait to get 'fixed'.......most do not.


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## Flip (24 Nov 2007)

Geo,

Best wishes and good luck for your sister!

Proximity to the American system has provided some innovation that 
could not occur in a publicly funded system.  Hospital and health care 
have changed a-lot in the last generation.  Much of this change
is a result of changes in management methods.

Hospitals used to be run by doctors.
We don't trust doctors with our money anymore, so
we now have hospital management administrators.
So, in my opinion the system is less patient centred.

There are some issues that many people are not aware of.

Outcomes are far better if you have a regular "family" doctor.
You get treatment and diagnosis sooner.

Most of the employees of the healthcare system are not medical.
There is much more paper in the system than there used to be.
Costs have risen for reasons that have nothing to do with patient care.
In the US the paper burden on health care is far larger due to 
insurance companies requirements.

Most of a physicians' ongoing education is actually provided by
drug companies.  So naturally the public ends up with shopping 
bags full of meds.

To tie it all up - Your (public) money isn't going where you think.
If you took all of patients out of the system, the system would cost a bundle. 

America would do well to provide some universal standard of health-care.
Many people in the US have no insurance coverage at all.
That means cheap problems turn into expensive ones before they get
attention.  This is emerging trend in Canada for different reasons.
The delay to getting treatment costs more in the long run........

2 sisters are nurses - Dad was a doctor. Yea, I've got opinions  ;D


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## Scoobie Newbie (24 Nov 2007)

Bruce Monkhouse said:
			
		

> Yup, isn't it nice to have a job that will still pay you as you wait to get 'fixed'.......most do not.


And with that reasoning they wouldn't have the $28,000 to pay for it either.


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## geo (24 Nov 2007)

Flip,
Wishes much appreceated.
"sister sitrep"
From Montreal, sister consulted MDs in Montreal, Boston & NewYork
was advised that Montreal Neurological has cutting edge equipment & MDs on leading edge of treatment for condition.
Sooo.... back to Montreal & has started treatment
Chemo for the last 3 weeks + Radiation treatment for the last one... this is expected to continue thru to early January.

Excluding the trips to the US, all this has been paid for by Quebec Medicare.
No line jumping, no influence peddling, nada....

All things being equal in the world, my sister will pull thru and be +/- "as good as new" in 2008


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## observor 69 (24 Nov 2007)

Flip, right on .
+1


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## Bruce Monkhouse (24 Nov 2007)

Lone Wolf Quagmire said:
			
		

> And with that reasoning they wouldn't have the $28,000 to pay for it either.



I wouldn't be too sure of that...................maybe smart people invest that money every year that they don't pay in taxes instead of crying for big brother to bale them out.


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## Bane (24 Nov 2007)

I'll keep my 'communist' public system thanks very much.  It might suck in a thousand different ways, but on principle alone I prefer it.  I am also perfectly happy with half of my substantial tax bill going to the health care system.  Private health insurers make more money the less care they provide. If they can shave down the amount of coverage (via denial of benefits, legal action or policy technicallity) there is a strong incentive for them to do so.  Not that all companies do this, but the bottom line is the bottom line. Compaines exist to make money, not anything else.  Obviously there is a role, an important one, for private business to play in health care and in society. Each society must choose in this case whether it prefers the vast benefits to helping the aggregate, at a substantial cost I might add, or prefer the liberty of the individual over society, also at substantial cost but of a very different sort.  Could Canada's system be improved, 100% it could, there is lots of room for improvement.  The U.S., however, is need of a health care revolution. 



An interesting photo essay.  I've never needed health care in extremely remote or areas in Canada, we could have clinics like this running also, I really don't know.  But this is in the middle of Virginia. 
http://www.nytimes.com/slideshow/2007/11/18/magazine/20071118_HEALTHCARE_SLIDESHOW_index.html


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## Flip (24 Nov 2007)

No doubt about it!



> The U.S., however, is need of a health care revolution.



" Socialized medicine" is one the ugliest misnomers that exist.
While health care workers agree that they carry a sacred trust,
There's lot's of opportunity in the public system for profit.
If it was approached less as an industry and more like an
institution, like national defense, things could get sorted out.
Delays and wait times are largely a figment of over management.
Perhaps analagous to civilian oversight?

What is clear in this country - Private vs. public is the wrong 
question to the wrong answer.


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## Brad Sallows (24 Nov 2007)

Health care workers do not carry a sacred trust.  If people didn't make it into med school because daddy was a doctor, and I didn't know any workers who are pretty much just there for the money, then I might concede it's a sacred trust.  It's a business.  Treat it like one.


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## Bane (24 Nov 2007)

The individual workers might not carry a sacred trust, but the system does. Just like the CF, some may be there just because its a job and some money in the pocket, or for other direct personal benefits; some might get more advancement on account of personal connections, but does that make it just a 'military business' and nothing more? What about the federal government, some are surely there for perks alone, but does that mean that it carrys no roll beyond captial accumulation?


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## Scoobie Newbie (25 Nov 2007)

Bruce Monkhouse said:
			
		

> I wouldn't be too sure of that...................maybe smart people invest that money every year that they don't pay in taxes instead of crying for big brother to bale them out.


Or perhaps some people can't save their money to invest because they have nothing left after they pay the bills and feed themselves.  Must be nice to live in your world where everyone has had the opportunity to put money away while meeting their other financial obligations as well as their own basic needs.


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## I_am_John_Galt (25 Nov 2007)

Bane said:
			
		

> Compaines exist to make money, not anything else.  Obviously there is a role, an important one, for private business to play in health care and in society. Each society must choose in this case whether it prefers the vast benefits to helping the aggregate, at a substantial cost I might add, or prefer the liberty of the individual over society, also at substantial cost but of a very different sort.  Could Canada's system be improved, 100% it could, there is lots of room for improvement.



In the competitive market, "companies" have to deliver the best combination of cost and quality, while maximizing quantity, or be replaced by a better provider.  There is no such incentive to improve quality or quantity, or reduce costs, in the public system: only to 'justify' budgets.  One is left to rely solely on the supposed wisdom and benevolence of industry and politicians.   :


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## Brad Sallows (25 Nov 2007)

>but the system does

The "system" is just the sum of its own legislative and administrative overhead and service delivery mechanisms.  If the "sacred trust" (the "system") vanished tomorrow, profit-seekers would step in to fill the vacuum.


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## Bane (25 Nov 2007)

I_am_John_ Galt:   
        First, I did point out that competitive markets and private firms have an important role to play in health care and society; "It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own self-interest."  Secondly, this notion that 'competitive markets' always produce, or gravitate towards, the most beneficial outcomes for society is one of the biggest fallacies of neo-classical economics.  Imagine GE was your health care provider, how responsive to a slight shift in the 'market winds' is a 3/4 trillion dollar company going to be?  Aside from the fact that the neo-classical model says that markets favour smaller, independent firms that cannot, individually, distort the market.  Most major industries have only 3 or 4 big players, quasi-monopolies.    
         I don't want to get into a giant essay about this to take the thread way off track, but there was a good solid reasons for the great backlash against un-regulated market capitalism to begin in the 19th century, and why our more modern regulated capitalism is much more palatable and tends to work 'better' for society.  You also malign government, suggesting that their lack of competitive impulse makes them 'slack and idol', yet they must remain responsive to the electorate, and some government departments are run very well.  So does everybody make a reasonable effort to help their neighbour, thus helping to alleviate some inequality? And yes, with a bigger tax bill  Or do we assume and pretend that people are individual particles, ‘homo economicus’, rational actors that aren’t steeped it a dense network of social connections, but people that make rational choices at every turn with perfect information for balanced, mutually beneficial, outcomes?


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## tomahawk6 (25 Nov 2007)

The biggest obstacles to HillaryCare are the American voter and money. The American voter see's how screwed up our Social Security system is and adding a national healthcare program will just follow down that same path. A national healthcare program will not be free it will be paid for by higher taxes at a time that state and local governments are increasing sales taxes/property taxes/personal income taxes. Historically Americans have gotten their healthcare benefits from their employer. The examples of European national healthcare and Canada actually make the case against national healthcare. High personal taxes and increasing healthcare costs take up huge chunks of the national budgets of these countries which has seen a shift from national defense to healthcare/social security. Every nation has an obligation to protect their citizens from foreign attack. These governments dont have an obligation to actually "take care" of their citizens. What ever happened to the individual's responsibility to provide for his own retirement/healthcare ? If the nations of Europe wanted to be able to compete with the US economically they would privatize national healthcare and reduce taxes. Shift the burden back to individuals and the employer. They could retain their senior citizen benefits pension/healthcare.


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## Long in the tooth (25 Nov 2007)

As members of the military we are in a favourable position.  Whenever we are referred for a procedure - I just had MRIs done for my knees - we go to the front of the line.  Most medical facilities have a set annual budget and therefore do ration care.  When we show up with a military referral it's like cash in hand.  Although the procedure may be completed at midnight, we free up surplus capacity.   It's not uncommon for surgeons and diagnostic equipment to be working at 50-60% efficiency.

On another note, my wife will shortly be employed in the US as a skilled manager.  Both she and I will be FULLY covered under health care plans in the US and Canada.  It will be interesting; we asked questions of immigration lawyers that they could not answer... and $400/hr to boot.  (For example, if I move to the US will by tax free disability pension be taxable in the US? - no answer).

Cheers


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## Flip (25 Nov 2007)

In Edmonton we have excellent health care and oddly, two systems.

The UofA health group that also takes care of education and research,
and the Caritas Health group that owes it's beginning to the Catholic Church.
The differences in these two groups is remarkable.  While the UofA health group
enjoys far greater resources their focus is somewhat diluted.  Caritas patients
benefit from a different attitude and greater focus on their individual needs.

All other conditions being equal - the difference is the management.  
More doctors in the Caritas example.

Hospitals are only a fraction of the health care system, however.
I know a physician who opted not to have an office or staff.
The money he saved allowed him to provide far superior care to his
few patients.  I also note that many people prefer female doctors.
This is not because their fingers are smaller. 
This appears to be a result of being motivated differently than many 
of their male counterparts. 

I am fortunate to have known a great many doctors who take their 
obligation to society so very seriously.  This obligation is what drives them
to do research, attend hopeless cases, do international aid work etc.etc.
This is why our healthcare system works.

If you want a system that exists as a profit centre.  Our heathcare system
as we know it - will not work.  This why the suits up in the big offices
have done so much damage in the last generation.

One last anecdote as evidence.

I see my doctor every three monthes or so.  I know
that he knows me.  I suggest you all do the same.

I see my dentist only when something hurts.  This is stupid
But, it's all I can afford.

Which is better?


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## Bane (25 Nov 2007)

tomahawk6 said:
			
		

> Every nation has an obligation to protect their citizens from foreign attack. These governments dont have an obligation to actually "take care" of their citizens.


I don't even know what to say to that...




			
				tomahawk6 said:
			
		

> What ever happened to the individual's responsibility to provide for his own retirement/healthcare ?


Many live pay check to pay check, or worse, in the biggest economy in the world. And the reality is is that many can't provide for their own care. It is not just personal defects that make the poor.


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## Flip (25 Nov 2007)

P.S.  I failed to make my point in my last post.

The delivery of healthcare matters.

The current administration is what we do a lot less of.
Administration and overhead are where the money goes anyway.
This is what has grown the most in the last few years.

Public vs. private is the wrong question.
How do we fix the problems we have?
How can the Americans, with a totally different system fix their problems.

The Americans spend 10 times the amount we do on admin. and 
overhead because it's all done by insurance ,HMO and healthcare
companies.  Apply that money instead to delivery of service........
Then Americans will have healthcare.  All Americans.


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## tomahawk6 (25 Nov 2007)

Otto your benfit may indeed be taxable. Best bet would be to talk to a tax professional when you get to the US.



> The Internal Revenue Service (IRS) considers disability benefits under your employer sponsored plan a continuation of your salary; better known as a Third Party Sick Pay plan. Whether your disability benefits are taxable depends on your level of premium contribution. In general, if you pay 100% of the premium for your coverage with post-tax dollars, your disability benefits are tax-free. If your employer pays 100% of the premium, benefits are taxable. If you and your employer each pay a share of the premium, benefits are taxed proportionally based on applicable IRS rulings. Each claim is unique and your taxability will be dependant on the information provided to us by your employer at the time your claim is submitted



http://www.irs.gov/pub/irs-pdf/p15a.pdf; pg.13, Section 6: Third Party Sick Pay


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## Bruce Monkhouse (25 Nov 2007)

Lone Wolf Quagmire said:
			
		

> Or perhaps some people can't save their money to invest because they have nothing left after they pay the bills and feed themselves.  Must be nice to live in your world where everyone has had the opportunity to put money away while meeting their other financial obligations as well as their own basic needs.



If I were paying half the taxes I was now that might actually be possible.....


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## Blackadder1916 (25 Nov 2007)

Flip said:
			
		

> The Americans spend *10 times the amount we do on admin*. and overhead because it's all done by insurance ,HMO and healthcare companies.  Apply that money instead to delivery of service........



Actually the numbers are more like 31% of US health care spending on administration vice 17% for Canada.  (those figures from a 2003 study)


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## Brad Sallows (25 Nov 2007)

People don't have to make rational choices or be perfectly informed for the free market to still provide the most beneficial outcome, because the benefit of an exchange is only the recipient's to judge.  The measure of market success isn't what you or a group which thinks like you decide others should have; it's what others decide for themselves they should have.  The only thing intervention has the potential to do is improve economic efficiency - not the same thing as benefit - but the intervenors likewise lack information and are burdened by their own biases and political obligations and dogma and extended decision cycles which tend to make interventions even worse.

All Americans do have access to health care; not all Americans have health insurance (many by choice) or access to all the health care they might like.  But, with respect to the latter, neither do we.

People who live paycheque to paycheque are simply not planning their finances well.  2 weeks out of 52 is a little under 4%.  Set aside 4% of your gross pay each year for 6 years and you will have more than a 3-month cushion of the expenses you pay out of your after-tax income.


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## Bane (25 Nov 2007)

Brad Sallows said:
			
		

> People who live paycheque to paycheque are simply not planning their finances well.  2 weeks out of 52 is a little under 4%.  Set aside 4% of your gross pay each year for 6 years and you will have more than a 3-month cushion of the expenses you pay out of your after-tax income.


 :


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## aesop081 (25 Nov 2007)

Bane said:
			
		

> :



Care to elaborate on you  : or are you just going to leave it at that ?


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## Scoobie Newbie (25 Nov 2007)

I think he means that the only thing more diverse then people are their finances and its a little to easy to say a person should simply do this and they will be fine as EVERY family and their personal finances are different.  Kids, medical bills, age, income etc.


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## Bane (25 Nov 2007)

What Quagmire said. 

I thought it was just a little bit ignorant on the subject of poverty.


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## Brad Sallows (26 Nov 2007)

A person living right on the edge of his paycheque is effectively living beyond his means - inflation is practically assured and wage gains are not.

What's a deck of smokes now - $5.00 or more?  What's minimum wage in most provinces - $8.00 or so?  5 / 64 > 4%.

I have yet to meet someone who has not a single luxury (any non-necessity) he could deny himself to save a little security.  Please don't pretend the nation is full of virtuous poor people who spend money only on rent, simple clothing, and fresh groceries.


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## Brad Sallows (26 Nov 2007)

>the only thing more diverse then people are their finances

Yes, but my prescription isn't to spend in an exact way - it's to illustrate that with a little bit of planning and self-denial one need not live "one paycheque away from the streets" in the hope or certain knowledge that a safety net exists.  Each person needs to do his own arithmetic and make his own plan.  The problem of saving for the rainy days is wholly within a person's control.


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## Scoobie Newbie (26 Nov 2007)

Brad Sallows said:
			
		

> Please don't pretend the nation is full of virtuous poor people who spend money only on rent, simple clothing, and fresh groceries.



Full, no.  Enough people that can't afford to fix a broken leg at $28,000.  Yes


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## Scoobie Newbie (26 Nov 2007)

Brad Sallows said:
			
		

> The problem of saving for the rainy days is wholly within a person's control.


To make sweeping generalizations about peoples ability to save money is asinine.  Life is full of so many surprises and inconsistencies that there are situations that some people can't prepare for.  Should they try?  Absolutely.  Should they be penalized with refusal of treatment?  Absolutely not.


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## Reccesoldier (26 Nov 2007)

Brad Sallows said:
			
		

> What's a deck of smokes now - $5.00 or more?  What's minimum wage in most provinces - $8.00 or so?  5 / 64 > 4%.
> 
> I have yet to meet someone who has not a single luxury (any non-necessity) he could deny himself to save a little security.  Please don't pretend the nation is full of virtuous poor people who spend money only on rent, simple clothing, and fresh groceries.



Try almost $9.00 a pack (even bought as a carton) Since I quit smoking last January 1st, calculated at $8.00 per pack at a pack a day I have saved my family a total of $2640.  Roughly equivalent to a car payment, $240.00 per month.


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## Flip (26 Nov 2007)

Brad,

What you have failed to account for, and it's a biggie...
Bad luck.  I'm all for personal responsibility but, stuff happens
and good people lose their homes, cars and health.
Sometimes it's not their fault.

And by the way while were talking about personal responsibility
and healthcare.....Reccesoldier......Congratulations!!!!!!!
I'm very glad for anyone who quits.
I've seen far too much of what happens when you don't.
Smoking has killed most of mature males of my family.
Smoking and it's effects are my favorite cause.

Oh, by the way  ....ever try to get life insurance while you're a smoker?
Try medical insurance in the US.
What happens when your HMO decides that you caused your own
treatable but likely to be fatal disease.
In the US, your choice might come down to selling the farm or skip treatment.
That's exactly the choice our healthcare is designed to prevent.   
In my opinion the Canadian healthcare system has it's warts but is
far more humane - all that stuff about market forces doesn't mean much.

The very people who need the most from the healthcare system
are usually the least able to afford it.

If you want to challenge my position, I can provide meaningful examples.


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## Reccesoldier (26 Nov 2007)

The problem with our healthcare system is not that it exists but that regulation and legislation by government negates the possibility of any alternative.  

The point isn't to deny people the right to enter into a system where they can have their "universal" healthcare but is rather to allow people to make that determination on their own.  

Should I choose to be a member of the system some 30% (approximately) of my taxes can be taken and placed into the healthcare system, should I decide not to that 30% should be mine to do with as I wish.  If I decide it's going to beer and popcorn so be it.  If I break my leg and don't have the $28,000 to pay for it then I will have to go into debt for whatever services are rendered.  That is my choice, the freedom is mine to make rational decisions based on what I see/feel/think are the necessities of my life.


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## Flip (26 Nov 2007)

On the face of it ....fine.

But there would be a finanacial premium on finite resources.
The private system would tend to do what has been demonstrated south of the
border.  Huge inflation and some profiteering.  The insurance companies would suddenly get to say how things are treated, not your doctor.

Breaking your leg at 28k would be cheap.
My step dad knows a former multimillionaire in California.
His cancer wiped him out.  He'll probably die in a public
hospital anyway.

Canadians do have the option to go south for treament if they want.
I don't think we should destroy our superior public system to
go all free-market. Your taxes wouldn't come down anyway.... ;D


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## observor 69 (26 Nov 2007)

Again +1 Flip. I got tired of fighting this argument a while ago but you're doing a good job.


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## Bruce Monkhouse (26 Nov 2007)

Reccesoldier said:
			
		

> Should I choose to be a member of the system some 30% (approximately) of my taxes can be taken and placed into the healthcare system, should I decide not to that 30% should be mine to do with as I wish.  If I decide it's going to beer and popcorn so be it.  If I break my leg and don't have the $28,000 to pay for it then I will have to go into debt for whatever services are rendered.  That is my choice, the freedom is mine to make rational decisions based on what I see/feel/think are the necessities of my life.



Now this is where I disagree with you......oh, we all still  pay our taxes. I just want a system where if you {I] have the coin, and are willing to pay extra, then you {I] can go private.
This takes some of the burden of the public system and still keeps it financed.

We already have it anyway if you are a "somebody" ala Mats Sundin, Paul Martin, Steven Harper, Chris Bosh, etc.......why shouldn't *I * be able to spend my after tax dollars in Canada if I wish?


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## Flip (26 Nov 2007)

> why shouldn't I be able to spend my after tax dollars in Canada if I wish?




Again, on the face of it......No problem

Real world....The government arbitrarily decides to chop some funding.

Shift the burden onto individuals. Declare the public system is unsustainable.

Now here's the scary part.......People will believe it.

Naw, couldn't happen right?
Especially in Alberta or Ontario!  (Sarcasm)

Hey - I'm a seriously conservative guy.
Just don't bugger with my institutions.... ;D


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## Reccesoldier (26 Nov 2007)

Flip, consider this.  With both a public and private system operating side by side the two would end up in competition for the "finite resources" of the population, forcing each to provide more value for money.  

The thing that makes the public system so unresponsive is the fact that no one else is out there competing for your tax money, and the thing that makes the private system so expensive in the US is that there is no government plan for them to compete with to reduce cost.

There is no crystal ball that anyone can look into and say definitively that this, or that is what you would have but in Canada today, we're not even allowed to try to discover a new way.  It's good money after bad, with no possibility of change.


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## Flip (26 Nov 2007)

Reccesoldier,

The biggest difference between the two countries is how healthcare is paid for.
This IS the sacred cow.  A lot of your services are provided privately.
The price is set by the payer.  It's up to the service provider to do his best
profit margin wise.  Your family doctor and the diagnostic test labs are private companies.

That being said, I can compare this debate to the energy deregulation that happened here a few years ago.
Now we are free to sign a contract with more than one retailer and pay more for utilities than we used to.
We can say we pay the same for natural gas as Al Gore. In Tennessee natural gas is a comfort.  In Alberta
it's life support.  I digress.....

Your presumption that things can't change in the public system is patently false.
They do - Proximity to the US allows a great deal of cross pollination.
A constant two way exchange of ideas and methods.
The spear carriers in this exchange tend to be healthcare professionals.
I've never met a physician who didn't want to improve things.
I have however, met managers and bureaucrats who resist change.
Health care unions are the immovable objects in this argument.
This is what Canadians should want fixed.
This can be fixed - politically. Don't believe your MLA when he says they are doing their best.
Don't buy into dealing with the wrong problem on ideological grounds.

When Alberta slashed healthcare budgets in the 90s we assumed Dr West knew what he was doing.
Most of us didn't realize the man was a veterinarian!


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## observor 69 (26 Nov 2007)

Flip said:
			
		

> The spear carriers in this exchange tend to be healthcare professionals.
> I've never met a physician who didn't want to improve things.
> I have however, met managers and bureaucrats who resist change.
> Health care unions are the immovable objects in this argument.
> ...



Steady now Flip!   I mean I'm with ya  but here in good ol' Ontario the OMA , Ontario Medical Association = doctors,  is one of no make that THE most powerful group feared by the provincial government.  Any threat to their "billable hours"  results in OMA talk of strike.  I mean these guys scare the poop out of the government. 
The Min. of Health has tried a number of new ideas such as use of Nurse Practitioners and more innovative structures of care. I was in the states and their is lots of innovation going on in the private system to save the HMO's a buck. Nurse  practitioners, physicians assistants, some of these ideas were good and could be tried up here but it is/has been a long hard battle to get the OMA to accept change.
Like you I have family all around me in health care. So that makes two of us who constantly hear all of the issues and arguments. ;D


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## Blackadder1916 (26 Nov 2007)

Baden  Guy said:
			
		

> ...in the states and their is lots of innovation going on in the private system to save the HMO's a buck. Nurse  practitioners, physicians assistants, some of these ideas were good and could be tried up here but it is/has been a long hard battle to get the OMA to accept change.



While there may be a lot of different ideas being employed in the USA to save a buck, many of these innovations have been employed to increase the profit margins of the HMOs or other provider entities and not necessarily used to decrease the cost to the insured.  

For info sake, NPs and PAs in private practice settings (working outside of government run health organizations such as VA, IHS, or BofP hospitals) bill in much the same manner as physicians.  Using Medicare/Medicaid rates as an example (private insurance companies don't publish the terms of their reimbursement rates) NPs and PAs who submit billing under a physician's billing number are reimbursed at the same rate as the physician, with the physician usually pocketing the whole amount and the NP/PA working as a salaried employee; an NP or PA who bills under his own billing number is reimbursed (according to rates a few years ago) at 85% of an applicable physician's rate.  Of course the NP/PA in the latter case is also responsible for his expenses' so the physician under whose cover he is working usually ends up with a percentage of that.


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## Bruce Monkhouse (26 Nov 2007)

Blackadder1916 said:
			
		

> While there may be a lot of different ideas being employed in the USA to save a buck, many of these innovations have been employed to increase the profit margins of the HMOs or other provider entities and not necessarily used to decrease the cost to the insured.



If this is true than we [the taxpayer] can save a buck or use that buck to have more health care.....


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## Blackadder1916 (27 Nov 2007)

I would say that many of these "innovations" could probably fall under the category of "Managed Care" which has produced many critics (myself included) as it attempts (not very successfully) to control rising health costs.  While I rarely say 'never", I don't think that Canada should look South for examples in managing a health system.  For all the faults we have (and there are many), I think we've done it a lot better than they have. 

For those interested try this link (pdf - 520kb) for 'Trends in Health Care Costs and Spending' that provides a brief look at health costs in the USA.


> This September 2007 fact sheet on health care costs presents key statistics about the growth, level and impact of rising U.S. health care costs. It covers spending on various medical services, sources of health spending, employer-sponsored health coverage and the impact on businesses and people.


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## Brad Sallows (27 Nov 2007)

I don't propose that people be refused treatment if they have no savings or that no-one has bad luck.  If you stop skimming through biased lenses and read carefully, you may be able to comprehend my point: living one paycheque away from insolvency is easily corrected.  I'm not focused on the small fraction of people who have genuinely low incomes; I also see the large fraction of Canadians at all income levels who are financially imprudent.

Routine health care is something most people can and should pay out of their own pockets.  Somehow protection against medical catastrophe morphed into a gimme.


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## Flip (27 Nov 2007)

Baden..........





> Steady now Flip!   I mean I'm with ya  but here in good ol' Ontario the OMA , Ontario Medical Association = doctors


Yea, here in Alberta we have the AMA who constantly bleat about privatization.
I think there is an activist element in both camps.....May not be that representative?
I dunno. :

Thanks Blackadder....


> I don't think that Canada should look South for examples in managing a health system.


We do, for better or worse and I think that is where the public  vs. private debate comes from.  The good examples come from a practical or medical level.  The admin. bits we can do without.  Many Canadian physicians spend time in the US in their training etc.
Too be fair, physicians also stay in touch with others around the world.



> Routine health care is something most people can and should pay out of their own pockets.  Somehow protection against medical catastrophe morphed into a gimme.



Oh my, we just have to disagree on this.

The problem with covering yourself for routine healthcare is, that if
cash is tight, people are simply not going to  the doctor.
That funny little mole will grow to the size of a fist before it gets removed,
Of coarse by then it's a metastatic disease than will require hospitalization.
In this case the public isn't saved anything as it would have been cheaper to 
pay the $35 for the doctors visit 2 years ago.  In short, a larger burden exists
because of a lack of early diagnosis.  Early and accurate diagnosis saves money.
As for your second sentence,  That is whole point of having the Canada health act.
Does it really serve the public interest for farmer Brown to lose the farm because
he is ill?  What does his newly homeless and unemployed family do for society?
This is the whole object of the Canadian exercize in healthcare.

I say, get the focus back on the patient - not on some experimental corporate model.


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## muskrat89 (27 Nov 2007)

> The problem with covering yourself for routine healthcare is, that if
> cash is tight, people are simply not going the doctor.



Who's choice is that?

I chose not to get a degree. Instead I chose a trade. My family income is limited (or boosted) by that choice. If I had chosen neither, and the only job I can get is flipping burgers, that was my choice. If my vehicle is leaking tranny fluid, and cash is tight, and I don't get it fixed, that's my choice. If the transmission falls out next week, and instead of a $25 seal, I need a $2200 transmission, that was my choice. I ate out last night instead of whipping up some KD - that was my choice. Sorry, but I just don't get it :-/


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## Blackadder1916 (27 Nov 2007)

Flip said:
			
		

> Thanks Blackadder....We do, for better or worse and I think that is where the public  vs. private debate comes from.  The good examples come from a practical or medical level.  The admin. bits we can do without.  Many Canadian physicians spend time in the US in their training etc.
> Too be fair, physicians also stay in touch with others around the world.



While I appeciate the thanks and though we may agree on the benefit of a (primarily) publically funded universal health care system versus a (primarily) private enterprise (where solely market forces dictate access, availablity, cost), you seem to place much more hope and assign much more credit to physicians than I do.  Maybe I've been jaded by my dealings with them (much professional not as a patient, and some social).  While I won't fault many doctors for their professional medical knowledge and skills (though I do have some minor issues with my current GP - however he's a good gatekeeper), I have found few that I would trust as the guardian of my cheque book, either personal or public.  Most I have known, while they may have some altruistic tendencies and concern that reform is needed in the system, seem to have the belief that any change to the system that would decrease their compensation by one cent is evil.


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## Flip (27 Nov 2007)

Muskrat, love that avitar!

Yes people make bad choices BUT by and large the expensive patients are either so 
in spite of their choices or are simply the type of people that don't have as many choices 
in the first place.  Will dumb people cost the system more than people with foresight? Yes.
Doesn't change the fact that they WILL need care.

To get back to my original point.........

The little old lady who comes into the doctor's office because she lives alone is NOT where the big money goes.
The single mom who's kid always has a cold is NOT where the money goes.

MRI machines that sit idle all weekend - ARE where the money goes.
The purchasing agent who buys scrub dresses from Taiwan and finds out
the hard way that they are too small for NorthAmerican nurses IS where the money goes.
The MHA who pulls down 400k a year and decides to subcontract hospital food services and finds out 
that the private company costs more than the unionized workers he got rid of, IS where the money goes.

As a genral rule the faster you give a patient what he wants - the sooner he goes away.( and cheaper)
Creation of barriers to patient care to fit some business model(ideology) the more expensive it gets.
Then we should pick the patients pocket because the system is running out of money?

In short - I don't think the taxpayer is getting what he is paying for.


Blackadder- I'm glad you have a GP.
Many many people don't.
Then they go to the mini-mall doctor (who doesn't know them) when they are really sick.
Usually a less than optimal outcome - Usually costs everyone more.
My wife was mis-diagnosed 4 times in a row. (before we had a GP)
A grocery bag of meds that didn't work.
We won't make that mistake again.


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## TCBF (27 Nov 2007)

In the early sixties, when Pearson's cabinet was debating the medicare model, Walter Gordon's proposals were looked at by the MND - Paul Hellyer.  Hellyer, unlike most of his cabinet colleagues, was a businesman.  He was shocked:  he saw Gordon's plan as eventually bankrupting the country.  It had the government paying ALL up front costs, then rationing later care.  Hellyer re-wrote it and submitted it so the initial costs would be borne by the citizen and the government would then have the resources to do the expensive stuff rather than being nickel and dimed to death.  Pearson said no to Hellyer and yes to Gordon, and that is why thousands are dying for no reason today.


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## Brad Sallows (28 Nov 2007)

>The problem with covering yourself for routine healthcare is, that if cash is tight, people are simply not going to  the doctor.

If it isn't important enough to that person to pay, it surely isn't important enough to me to pay for him.  I'm sure there are all sorts of things people would do if someone else paid the costs, but I do not see it as my role to play "parent" to people in this regard any more than I do with respect to any of the other choices they make to live their lives.

>In this case the public isn't saved anything as it would have been cheaper to pay the $35 for the doctors visit 2 years ago.

Yes, but so what?  The public carries the cost for most stupid decisions people make: ignoring safety gear, high-risk outdoor activities, unsafe sexual practices, substance abuse, poor diet.  I see no reason to interfere with genuine liberty here: the existence of a public insurer is not an excuse to guide or manipulate people's freedoms.

>As for your second sentence,  That is whole point of having the Canada health act.

You evidently misunderstood what I wrote.  I'm not against public insurance for catastrophic (highly expensive and unusual) health needs; I observed that somehow the desire to protect people against financial blowout morphed into that and more.  It's the "more" - the routine care which is not going to cost someone the farm or job - which is at issue.

But I frequently encounter the objection: if routine health care were not free, people would stop going to see doctors.  Bullshit.  Most people are not that foolish.  Of the people I know who would not see a doctor if it cost $150 out of pocket (or on an extended health care plan, or out of a pre-tax health spending account, etc), most do not go to see a doctor right now when it costs nothing.  Apathy and indifference are the dominant factors, not finances.


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## Scoobie Newbie (28 Nov 2007)

"But I frequently encounter the objection: if routine health care were not free, people would stop going to see doctors.  Bullshit."
I seem to have heard that this IS the case in the US from different sources.


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## Blackadder1916 (28 Nov 2007)

As I read this thread, I see some whose suggestion for reform of Canada's health system includes client payment (no public funding) for "routine" care.  While this, at face value, may be a disincentive for individuals to present to the "system" for minor problems, I don't think that this will produce the immediate savings and reduce the overall dollar cost growth that most are demanding.

First, how do you define routine?  Does this include only visits to a GP?  Does it include initial visits to a specialist?  Does it include diagnostic procedures ordered by the GP or first visit specialist?  Is it tied to an annual dollar cost, income percentage, or minimum income threshold of the client?  Is it tied to the diagnosis of the client?  Are any hospital based services included or excluded?  When does routine become not-routine?

If we base "routine" on GP visits only as most of the comments here seem to place it ( e.g. $35 or even $150 a visit) what could the potential savings be? 

from Canadian Institute for Health Information report "National Health Expenditure Trends 1975 - 2007" (_for those interested in reading the complete report you can download a pdf copy from their website_)


> • Hospitals have traditionally occupied a prominent place in health care provision. In the mid-1970s hospitals accounted for approximately 45% of total health expenditure. During the past 30 years, the share of hospitals in total health expenditure has fallen. In 2007, hospitals make up the largest component of health care spending, accounting for 28.4% of total health expenditures. Since 1997, drugs have accounted for the second largest share. In 2007, drugs accounted for 16.8% of total health expenditure, while *physicians are expected to make up the third-largest share, with 13.4%*.


and the definition for their methodology


> Physicians—expenditures include primarily professional fees paid by provincial/territorial medical care insurance plans to physicians in private practice. Fees for services rendered in hospitals are included when paid directly to physicians by the plans. Also included are other forms of professional incomes (salaries, sessional, capitation).
> 
> The physician expenditure category does not include the remuneration of physicians on the payrolls of hospitals or public sector health agencies; these are included in the appropriate category, e.g. hospitals or other health spending. Physician expenditures generally represent amounts that flow through provincial/territorial medical care plans. Provinces/territories differ in terms of what the medical care plans cover. CIHI has not attempted to make adjustments to physician expenditures to reflect these differences because only a few provinces, to date, can net out these differences from their data.


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## Reccesoldier (28 Nov 2007)

Lone Wolf Quagmire said:
			
		

> I seem to have heard that this IS the case in the US from different sources.



Ask how many of those people who refused to pay for their own healthcare managed to go to movies, dinner out, clubbing or any other form of entertainment.  Ask how many of them own a big screen TV or a play station. Ask if they buy designer jeans or spend money on flashy Bling.


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## Scoobie Newbie (28 Nov 2007)

Tell me how long it would take to just live without any joy in life to save up the amount of money you would need to cover expenses incured in a car accident with the US system?


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## Flip (28 Nov 2007)

Brad,


> Of the people I know who would not see a doctor if it cost $150 out of pocket (or on an extended health care plan, or out of a pre-tax health spending account, etc),


You kinda bent the nail here; The government pays about $35 for a doctors visit.  If the tab were paid by a private insurer I think the result would be the same as for a new windshield.
The price would go up.


> most do not go to see a doctor right now when it costs nothing.


On this I agree completely - It's a large problem in the grand scheme of things.


> Apathy and indifference are the dominant factors, not finances.


Fine, but why add an obstacle, when "most people" don't go.......?

We're arguing semantics and ideology here and what we need to do ( In this country ) is fix what's actually wrong.
A system that kinda works is coming off the rails a bit - I would rather attack the real issues.

Stupid bureaucratic waste.....Bending a public system to fit American business practices.
I would rather provide healthcare to those who need it - based on need rather than
to try to ration it based on a foreign financial model.  I think it would be cheaper in the longer run.

What is fundamentally wrong with American healthcare is that those most in need are the least in have.
This is the way their system fails.


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## Flip (28 Nov 2007)

We have also framed this discussion in terms of consumption. A mistake I think.

It serves the public good to maximize access to healthcare - not just a benefit to the individual.

If someone's employablity is maintained (especially through prevention) there is an obvious benefit.

If retired people can stay in their own homes rather than go to extended care facilities, another benefit.

Mental health is only now in recovery here in Alberta.
In the 90's King Ralph chucked a bunch of people out of hospitals in this area.
The result was that any chance of recovery was gone and no one could recieve help until
they came in contact with the police.  Denial of mental health care was the worst kind of shortsightedness.

In short - Our health care system is not just a liability but also an assett of considerable value.


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## muskrat89 (28 Nov 2007)

> I seem to have heard that this IS the case in the US from different sources.



Well, I have LIVED here for well over 15 years. My family is currently a single-income family, and my wife has some very significant health issues. We're not experiencing any of these horror stories.


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## a_majoor (28 Nov 2007)

The arguments about not being able to afford health care after a car accident or in event of a serious illness are non sequiters; you could make the same arguments about replacing your car after a bus hits it or your house burns down, but most people would look at you and say "what about your insurance?"

Perhaps we need to ask ourselves what is different between accident and casualty insurance and health insurance? Since the basic principles are the same, there are obviously extraneous factors in the US system which distort the use of insurance. Government funding is one obvious reason, insurance companies wargame the system to extract as much from Medicare and Medicaid as possible. The truth of this can be seen where experiments in Medical Health Savings plans have demonstrated that consumers do make rational choices for less expensive care when they can see and control their own expenditures.


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## Brad Sallows (28 Nov 2007)

>I seem to have heard that this IS the case in the US from different sources.

Interesting.  When did the US provide free routine health care, and when did it stop?


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## Brad Sallows (28 Nov 2007)

>Tell me how long it would take to just live without any joy in life to save up the amount of money you would need to cover expenses incured in a car accident with the US system?

If you're foolish enough to not purchase any health insurance at all, probably a long time.  But even high-deductible insurance would cover that.


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## Brad Sallows (29 Nov 2007)

>First, how do you define routine?

We could beat this around for days and not achieve a concensus.  Leave it to the profession.  Dentists and dental service insurers seem to have figured out how to calibrate their system.

Whenever insurance includes routine care, you may be assured that on average people are paying more than the cost of the routine care.  The insurer doesn't pay part of those costs as charity.  Even a public insurer has overhead expenses to meet.  If you pay your dentist or doctor or other provider directly, you're not paying for insurer's profits or expenses.

Private insurers tend to insist on the same kind of "discounts" that government insurers do.  It may just mean that overcharging is done elsewhere to make up the difference.  I'm sure the egalitarians would be all over that if they got so much as a sniff it was going on - surely they wouldn't freeload on others.


----------



## Blackadder1916 (29 Nov 2007)

Brad Sallows said:
			
		

> >First, how do you define routine?
> 
> We could beat this around for days and not achieve a concensus.  Leave it to the profession.  Dentists and dental service insurers seem to have figured out how to calibrate their system.



The intent of my previous post was to point out that savings to the public purse would not be as great as some seem to imagine should individuals be responsible for "routine" or basic health services, however, since the cost of a "routine" visit would be borne by by us whether through public funding, private insurance, or personally, there is significant difference in routine care between the medical world and the dental world.

When I see a dentist for a routine visit, it is very clear what will be done and therefore it is relatively easy to forecast the cost.  It is not so easy when someone presents to the medical system, with what may be a routine problem.

I will use a personal example that involves both the American and Canadian system.  Several years ago, I was in Northern California (on business, and incidentally it involved a hospital).  Having concluded my business activities that day,  I was in my hotel when I started feeling particularly unwell.  I hadn't been feeling great during the day, either.  Among my symptoms was chest tightness and SOB, also there was some aching in my left arm.  Though not concerned that I was having an MI, I did feel that I should seek medical advice since I was flying in the morning.  The problem, however, was finding a doctor to see me.  The hotel wasn't able to provide me with a referral and DIAB (doc in a box) clinics are not common down there as they are here.  My only recourse was to visit the emergency dept at a local hospital (not the one where I had been on business).  After spending about 2 hours in the waiting room, another hour with the admission (finance) clerk & a screening nurse, an hour sitting in a hallway, I was put into an exam room where I finally met what I first took to be the doctor (turned out he was both nurse practitioner and physician assistant ex US Navy).  After my history and a physical exam, he suggested that that an EKG and some blood work was necessary.  Techs came in to do these and the NP/PA returned to discuss the EKG with me.  He said that he didn't see anything grossly abnormal  with it, but he wasn't that great with EKGs and it would officially be read by a doctor.  I had a look at it (recalling some of what I remembered from my MA days) and was able to point out a couple of things to him though they were not of any great clinical significance.  After having another listen to my chest, he asked me how I felt and then stated he wasn't sure what was wrong with me (also said that he had reviewed my case with the attending doctor in the ER), but that I should take it easy that evening and see my family doctor when I returned home the following day.  Before leaving the hospital I managed to get photocopies of all the records that had been generated on me so far and tried to get a bill for the services rendered.  I was told that a bill would be sent to me.  I knew that it would be more than for comparable service in Canada, but PSHCP (at that time) would cover three times the reimbursement rate from OHIP SOB.  This sticker shock is now lessened since PSHCP is now using an emergency travel assistance provider.

The next day I saw my GP who listened to my chest, said I had pneumonia, prescribed an antibiotic, ordered an XRay as a precaution and I started feeling better by the next day. 

Now the fun began as I started receiving the bills from my American adventure.  By the time they were all in (from the hospital, the ER subcontractor, the ER doctor, the lab/EKG subcontractor) they totaled in excess of $5500(US).  Ahh, the free enterprise system at work.  As this was somewhat just up my alley,  I first checked what would be reimbursed by PSHCP, around $2100(Cdn).  By the time negotiations finished with the Americans, I was out of pocket about $100 and they had not "waived" one charge but they were not able to "justify" all.

Two "routine" visits.  Both for the same problem.  Significant difference in outcome and costs.

PS:  The amount that was paid by PSHCP (reimbursed to me) was also significantly lowered.

_edited to include the PS_


----------



## Flip (29 Nov 2007)

> Well, I have LIVED here for well over 15 years. My family is currently a single-income family, and my wife has some very significant health issues. We're not experiencing any of these horror stories.



I am very pleased to hear that you have no horror stories .

I could mention that Dad did his residency in Cleveland. - It wouldn't matter anyway....

My wife's grandmother is a pretty telling example.
She found herself in hospital. when she was in her early sixties. Had to move from a private hospital
to a public hospital when her insurance ran out.  She languished there until things started looking desperate.
She had someone call her son - My father in law.
When she was transported to Edmonton she had double pneumonia and she was in dreadful shape.
It was pretty clear that she would not have survived that American hospital where she spent most 
her time just getting sicker in the hallway.  Grandma almost didn't survive being put on the plane in
the condition she was in. Personal care had not been provided in weeks. It was grim. 

After a stay at the UofA Hospital she went on to live another 40 years here.

Still we go round and round.

I would rather have a system with a healthcare motive than a profit motive.


----------



## observor 69 (29 Nov 2007)

"Still we go round and round.
I would rather have a system with a healthcare motive than a profit motive."

Ain't it the truth.


----------



## Brad Sallows (1 Dec 2007)

>When I see a dentist for a routine visit, it is very clear what will be done and therefore it is relatively easy to forecast the cost.  It is not so easy when someone presents to the medical system, with what may be a routine problem.

When I see a dentist for a routine visit, there is no way until the "clear what will be done" procedures are complete to know whether there will be non-routine work required.  Same-same doctor: the examination and a basic workup of other tests (at whatever intervals, ranging from semi-annual to every N years) can be forecast.


----------



## Roy Harding (1 Dec 2007)

Brad Sallows said:
			
		

> ...
> But I frequently encounter the objection: if routine health care were not free, people would stop going to see doctors.  Bullshit.  Most people are not that foolish.  Of the people I know who would not see a doctor if it cost $150 out of pocket (or on an extended health care plan, or out of a pre-tax health spending account, etc), most do not go to see a doctor right now when it costs nothing.  Apathy and indifference are the dominant factors, not finances.



My experience tells me that you are right.  

Using myself as an example, I contracted a skin infection in mid-September.  I didn't see a Doctor until mid-October (after both my father and wife gave me hell for not doing so).  By the time I saw the Dr, it had become a very serious matter.  I lost six weeks of work because of it.  (And the visit to the Dr cost me nothing up front - my taxes paid for it - and the prescriptions are covered by my medical plan, so they cost me little).  Why are we like that?

Perversely, I think I would be MORE apt to see a Doctor for "minor" complaints if I were paying for it up front.  The present system makes me feel like I shouldn't be "bothering" the Doc for minor stuff.  If I were PAYING (up front - I know that I'm paying for it through my taxes) for the visit, I'd feel more "entitled" to the visit - maybe that's just me.


----------



## Flip (1 Dec 2007)

> If I were PAYING (up front - I know that I'm paying for it through my taxes) for the visit, I'd feel more "entitled" to the visit - maybe that's just me.



Yup, It's just you  

In Alberta, that visit cost the tax payer $35 the lab work we can guess at $100
A user pay system would create a range of costs above those numbers. ( I think )
maybe $55 to $105 and the lab work might go to $150 ??
I suggest an increase because of what happened when King Ralph allowed extra billing.
Line item 57......paper clip on attached bill.   ;D

Ever go to the vet and find out that it's $60 bucks for the exam the labs
can run from $100 to $200 and you leave with the feeling that you might 
try to "wing it" at home with leftover meds or a home remedy?

People do the same.......

My Dad once knew a farmer who injected himself with veterinary antibiotics
and the same needle he used for the cows.  He died of course, but not before
a bunch of his farmer friends came into the hospital and made fun of him.
Covering theselves with bedsheets and making ghostie noises was what
they regretted most.
(This story was usually told with a rather vivid ethnic slur attached.)
This was before I'd ever heard of the Darwin awards.


----------



## Blackadder1916 (1 Dec 2007)

Brad Sallows said:
			
		

> When I see a dentist for a routine visit, there is no way until the "clear what will be done" procedures are complete to know whether there will be non-routine work required.  Same-same doctor: the examination and a basic workup of other tests (at whatever intervals, ranging from semi-annual to every N years) can be forecast.



The majority of (adult) patients present to a dentist on a scheduled basis (usually annually, though business savvy dentists would like you in as often as your insurance will cover it) for a "routine" check and cleaning.  If problems are discovered during such a check (or if the patient is one who presents with a problem), the dentist will (or should) be able to provide at that time a reasonably accurate estimate of the work involved and the cost.  
From the Pensioners' Dental Services Plan (the one available to us retired old farts) Members Booklet


> It is strongly recommended that you send Sun Life an estimate, before the work begins, for any major treatment or procedure that will cost more than $300.  You should send a completed dental claim form that shows the treatment the dental practitioner is planning along with the associated cost to Sun Life.  Both you and the dental practitioner will have to complete parts of the claim form.  Sun Life will tell you how much of the planned treatment is covered under the PDSP, and how much of the cost you will be responsible forbefore proceeding with the services.



The majority of (adult) patients present to a medical practitioner or encounter the health system when they have a medical problem.  Most physicians of my acquaintance, while they acknowledge some benefit of annual physical check-ups, note that it is the exception rather than the norm when a medical condition is discovered during such an exam.  While in many cases the problem can be diagnosed and appropriate treatment (of the symptoms at least) initiated by visiting a general practitioner, often (especially as technology increases) it requires additional encounters for specialized diagnostic services or consultations.  From my experience (not as a patient) few medical practitioners would (or even could) give a prognosis until all diagnostic steps have been completed.


----------



## observor 69 (1 Dec 2007)

Blackadder1916 said:
			
		

> From my experience (not as a patient) few medical practitioners would (or even could) give a prognosis until all diagnostic steps have been completed.



Well from my experience as a patient, and as an old fart, receiving an annual medical checkup from my medical practitioner a digital diagnosis is possible.   ;D


----------



## Blackadder1916 (1 Dec 2007)

Baden  Guy said:
			
		

> Well from my experience as a patient, and as an old fart, receiving an annual medical checkup from my medical practitioner a digital diagnosis is possible.   ;D



I won't comment on the possibility that you are starting to look forward to that annual digital encounter and are developing a  "special" relationship with your physician.  It is, though, a very important routine procedure for us old farts to have on a regular basis.  Always look for a doctor with long, slender fingers (and well trimmed nails).


----------



## Edward Campbell (1 Dec 2007)

Just to help this thread drift _waaaaaaay_ off topic, I, another old fart, will contribute my doctor's opinion (she's a Chinese lady with small fingers): digital rectal exams are only necessary if there are some other indications. They are invasive and rarely useful. But, we are to have the full colonoscopy (two days of fasting plus that horrible series of enemas) every five years, beginning at age 60. So say, she says, the medical gods.


----------



## Blackadder1916 (1 Dec 2007)

Okay, it is getting off topic but does bring to mind when Generals had to be admitted to NDMC annually for their medical (is it still as comprehensive?).  It was always amusing (sometimes hilarious) to assist the MO performing the mandatory rigid sigmoidoscopy (referred to as the General Officer's brain scan).


----------



## geo (1 Dec 2007)

Roy Harding said:
			
		

> My experience tells me that you are right.
> 
> Using myself as an example, I contracted a skin infection in mid-September.  I didn't see a Doctor until mid-October (after both my father and wife gave me hell for not doing so).  By the time I saw the Dr, it had become a very serious matter.  I lost six weeks of work because of it.  (And the visit to the Dr cost me nothing up front - my taxes paid for it - and the prescriptions are covered by my medical plan, so they cost me little).  Why are we like that?



Interesting,
In Holland, dental services are covered by their national health care system BUT, if you have been naughty & have skipped your cleanings & routine visits, then your 1st return visit is going to be on your nickle.  Once you have been certified "top shape", then you get back on the national healthcare bandwagon.... Preventive medicine is always better.


----------



## Roy Harding (1 Dec 2007)

geo said:
			
		

> Interesting,
> In Holland, dental services are covered by their national health care system BUT, if you have been naughty & have skipped your cleanings & routine visits, then your 1st return visit is going to be on your nickle.  Once you have been certified "top shape", then you get back on the national healthcare bandwagon.... Preventive medicine is always better.



Interesting concept - perhaps worth pursuing here, both Dental and Medical??


----------



## geo (1 Dec 2007)

Not sure about the medical... friend of mine had dental problems .... and that's how the subject came up... 

I am a fervent believer in the mandatory you do your part & we'll do ours... so long as everyone is pulling his own share, then everything is okie dokie.  The minute someone starts to expect being carried - with little or no effort on his part.... the buck stops here.


----------



## Roy Harding (1 Dec 2007)

geo said:
			
		

> Not sure about the medical... friend of mine had dental problems .... and that's how the subject came up...
> 
> I am a fervent believer in the mandatory you do your part & we'll do ours... so long as everyone is pulling his own share, then everything is okie dokie.  The minute someone starts to expect being carried - with little or no effort on his part.... the buck stops here.



I've got to admit that as an "old school" soldier I hesitate to attend the "MIR" - but I stand by my contention that a nominal fee would actually prompt me to attend MORE - perverse, I admit - but true - at least in my case.

I like the Dutch example as you posted it.  Do your bit, and you'll be taken care of - DON'T do your bit, and it'll cost you.


----------



## Brad Sallows (1 Dec 2007)

>From my experience (not as a patient) few medical practitioners would (or even could) give a prognosis until all diagnostic steps have been completed.

Yes; and there are some ailments for which no proper answer is obtained no matter how far the chain of diagnoses is escalated, with the usual result of some diagnosis of last resort - a best guess.  At some point even a minimal (catastrophic coverage) plan would kick in.  None of what you write strikes me as an objection to user-pay at the point of entry.

Once in a while a family may have a bad year with the house, or a car, or health care.  How does any rational and honest person expect to make an "argument" based on an imagined fear factor that paying health care expenses up to a reasonable deductible limit is going to cripple a family in a way that other uninsured expenses of life rarely do?  $2,000 for car repairs or $2,000 for health care - the money doesn't know the difference.


----------



## Blackadder1916 (1 Dec 2007)

Brad Sallows said:
			
		

> Once in a while a family may have a bad year with the house, or a car, or health care.  How does any rational and honest person expect to make an "argument" based on an imagined fear factor that paying health care expenses up to a reasonable deductible limit is going to cripple a family in a way that other uninsured expenses of life rarely do?



Because (also based on my experience, but I may no longer have access to some of the statistics I've seen) a significant percentage of those who access health services (especially the elderly, the very young and the poor) have a bad year, every year.


----------



## Flip (1 Dec 2007)

> Interesting concept - perhaps worth pursuing here, both Dental and Medical??



Excellent idea!!

Dental and medical are not isolated.
And makes alot of us a little more responsible.


----------



## Greymatters (2 Dec 2007)

Blackadder1916 said:
			
		

> Okay, it is getting off topic but does bring to mind when Generals had to be admitted to NDMC annually for their medical (is it still as comprehensive?).  It was always amusing (sometimes hilarious) to assist the MO performing the mandatory rigid sigmoidoscopy (referred to as the General Officer's brain scan).



While amusing, brains scans and mental tests should be mandatory for any general, or for an elected official who sits as PM or Minister.


----------



## Blackadder1916 (3 Dec 2007)

Greymatters said:
			
		

> > Okay, it is getting off topic but does bring to mind when Generals had to be admitted to NDMC annually for their medical (is it still as comprehensive?).  It was always amusing (sometimes hilarious) to assist the MO performing the mandatory *rigid sigmoidoscopy* (referred to as the General Officer's brain scan).
> 
> 
> 
> While amusing, brains scans and mental tests should be mandatory for any general, or for an elected official who sits as PM or Minister.



The "general officers brain scan" had nothing to do with with cerebral, nervous or mental conditions.  The amusing and hilarious part is that a sigmoidoscopy (back in the day before flexible versions) involved inserting a rigid metal tube into the rectum and advancing it to have a look at the sigmoid or descending colon.  All the ones I assisted had the patient in the knee-chest position, a particularly humiliating posture with the chest and knees on the exam table and the rump stuck up in the air.  Sometimes the doctor (if he knew the general) would make jokes and on rare occasions a general with a sense of humor would make fun of his own predicament.  The best line I heard from a general was "I knew I had to bend over and take it from the CDS but I didn't expect this".  

A explanation of the procedure with photos is at  http://www.wales.com.au/rigid_sigmidoscopy_procedure.html


----------



## Brad Sallows (3 Dec 2007)

>Because (also based on my experience, but I may no longer have access to some of the statistics I've seen) a significant percentage of those who access health services (especially the elderly, the very young and the poor) have a bad year, every year.

I already wrote that exceptions should be made for those on low income.  I don't recall anyone here has proposed that people on low incomes be squeezed for the same amount of money - or, really, any significant amount of money - as the majority of Canadians whose incomes are just fine.  I especially find it amusing to see the "very young" raised as an objection, unless adults under 30 are "very young" and uniformly underpaid.  I have never, anywhere, heard or read a suggestion that the truly "very young" (ie. children) be presented with bills.  Can we move past the straw-clutching now?


----------



## Flip (3 Dec 2007)

> Sometimes the doctor (if he knew the general) would make jokes and on rare occasions a general with a sense of humor would make fun of his own predicament.  The best line I heard from a general was "I knew I had to bend over and take it from the CDS but I didn't expect this".



When my little sister was checked for polyps, all she could find to take as
a "clear liquid" was blue Jello. When the doctor asked what all this intense
green color in her colon was about she said "happy St Patricks day" ( It was ). ;D


----------



## geo (3 Dec 2007)

I always considered the Sigmoidoscopy akin to checking someone's "Pilot light".


----------



## Flip (3 Dec 2007)

> I always considered the Sigmoidoscopy akin to checking someone's "Pilot light".




Sure, 

On your knees in a dark basement - trying to avoid the puddle
faint smell of gas - looking for some faint glimmer - wondering how 
you're going to get a match in there  ;D


----------



## geo (3 Dec 2007)

.... OMG... he farted!


----------



## TCBF (3 Dec 2007)

geo said:
			
		

> .... OMG... he farted!



- I sure hope the Gerbil is okay.

 ;D


----------



## George Wallace (3 Dec 2007)

Lemmiwinks?


----------



## Blackadder1916 (4 Dec 2007)

Brad Sallows said:
			
		

> I already wrote that exceptions should be made for those on low income.  I don't recall anyone here has proposed that people on low incomes be squeezed for the same amount of money - or, really, any significant amount of money - as the majority of Canadians whose incomes are just fine.  I especially find it amusing to see the "very young" raised as an objection, unless adults under 30 are "very young" and uniformly underpaid.  I have never, anywhere, heard or read a suggestion that the truly "very young" (ie. children) be presented with bills.  Can we move past the straw-clutching now?



Before I continue, may we clarify the subject that this “sub-argument“ deals with.  My post (what is routine care?), which seemed to initiate this current discussion, was an attempt to show some on this means that user fees would not realize the savings that they seem to think it could, when used either as a negative incentive or an income generator.  

My impression as this discussion continued was that you count yourself among those who feel that market forces should be a (or the) primary factor in the evolution of a Canadian health care system; those that can afford to pay directly for their health care should do so either through personal spending or private health insurance.  But those few (those rare unhappy few) who cannot fend for themselves may be supported by a public system.  However, I could be mistaken in my impression.



			
				Brad Sallows said:
			
		

> … 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.


 Or am I?


			
				Brad Sallows said:
			
		

> … If health care is a right, then I'm just about ready to quit my job and enjoy my leisure.  Welfare is a right, too.  That looks after pretty much everything I need.  Now, where do I collect my rights?


Well, maybe not.


			
				Brad Sallows said:
			
		

> ...  But, while we may surely dispute the number of programs we need which provide benefits, the key should always be that the benefits are at least in principle universal - for example, education and health insurance.


So we may see eye to eye on some things, but maybe not on others.


			
				Brad Sallows said:
			
		

> … no, I'm not proposing "survival of the fittest" or that no government be involved in any of those areas.
> 
> What I would do, for example, *is to have _everything_ associated with health care delivery turned over to the province*, with a consequent strong pressure to further devolve spending responsibilities to whatever constitutes regional health authorities.  This would probably result in different approaches to providing health care, and different standards of care.  Some see this as a bad thing.  What I see is that different provinces and regions need different types of care - …



However, maybe instead of asking “what is routine”, I should have asked “what is catastrophic” or “what is in between”.  Is this the point at which you think that health insurance benefits should begin?



			
				Brad Sallows said:
			
		

> The reason for public catastrophic insurance is simple, and Fred Reed makes it.  Pay particular attention to his admonition in the last paragraph.



I did like the blog piece by Fred Reed so I’ll post the last paragraph here.  
http://www.fredoneverything.net/SocializedMedicine.shtml


> But let’s at least have the dignity to say what we mean. The truth is that large numbers of people cannot take care of themselves beyond showing up at work every day and spinning lug nuts on the assembly line. They aren’t going to invest wisely from youth because they aren’t smart enough. Employers aren’t going to provide retirements unless forced to. Hospitals won’t take them if they can avoid it. Do we say, “Screw’em, let’em croak”? Apparently. Then let’s say so plainly.



You appear to suggest that my view is flawed and I assume that you believe that I have reached such a conclusion solely on an ideological basis.  Most discussions on this subject (both here and in the USA) are hampered by ideological bias on both sides of the debate.  Do I have some biases?  Sure, otherwise I would be the only person in the world without them.  But, have I developed my opinion solely on altruistic, touchy-feely motives?  No, I’m like most other people in this country; I don’t want to pay taxes that go for services others use and for which I (currently) have limited need.  I could ***** about public education the same.  Why should I (without children) be paying local school (property) taxes when I have no need of the services.  Damn the rest of them who decided to procreate.  What is the benefit that accrues directly to me.  And what about fire protection, public transportation, roads, etc?  We long ago realized that there was a common social and economic benefit to these services being funded in common by all (through taxation).  The same should hold for health care.

On what do I base my viewpoint.  Some of the sources I used were found in reports or studies from the following organizations:  (I recommended both for relatively un-biased information)
The Canadian Institute for Health Information http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e


> The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential data and analysis on Canada’s health system and the health of Canadians.
> CIHI tracks data in many areas, thanks to information supplied by hospitals, regional health authorities, medical practitioners and governments. Other sources provide further data to help inform CIHI’s in-depth analytic reports.



The Henry J. Kaiser Family Foundation http://www.kff.org/


> A leader in health policy and communications, the Kaiser Family Foundation is a non-profit, private operating foundation focusing on the major health care issues facing the U.S., with a growing role in global health. Unlike grant-making foundations, Kaiser develops and runs its own research and communications programs, sometimes in partnership with other non-profit research organizations or major media companies.
> We serve as a non-partisan source of facts, information, and analysis for policymakers, the media, the health care community, and the public. Our product is information, always provided free of charge – from the most sophisticated policy research, to basic facts and numbers, to information young people can use to improve their health or elderly people can use to understand their Medicare benefits.



In reaching my conclusion I asked myself some of the following questions.

*How much of Canada’s health care spending is from public funding?*



> Total Health Expenditure by Source of Finance 2005 and Outlook for 2006 and 2007
> In 2005, governments and government agencies in Canada (the public sector) spent $99.1 billion. Public sector expenditure is forecast to be $105.7 billion in 2006 and $113.0 billion in 2007. The growth rates associated with these increases are 6.7% and 6.9%, respectively. In 2005, private health insurers and households (the private sector) spent $42.2 billion. Private sector expenditure is forecast to reach $44.6 billion in 2006 and $47.1 billion in 2007, assuming growth rates of 5.7% in 2006 and 2007.
> 
> Since 1997, the public sector share of total health expenditure has remained relatively stable at around 70%. It accounted for 70.1% of total expenditure in 2005 and is forecast to account for 70.3% in 2006 and 70.6% in 2007.















*What percentage of total (public and private) funding is used for what we characterize as providing sickness services. i.e.  physician services, diagnostic services, hospitalization, drugs*

















*Who uses these services the most?*











One interesting comment regarding utilization from an American perspective.  While it may not be the exact situation in Canada, there are similarities in utilization patterns between the two countries.



> Concentration of Health Spending
> While discussions about the costs of health care often focus on the average amount spent per person, spending on health services is actually quite skewed.   About ten percent of people account for over 60% of spending on health services; over 20% of health spending is for only 1% of the population. At the other end of the spectrum, the one-half of the population with the lowest health spending accounts for just over 3% of spending .




*Does socioeconomic factors (income and education) determine access and use?*

Several studies that researched this question had results similiar to this study. 

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1829158


> We found that lower income was associated with less contact with general practitioners, but among those who had contact, lower income and education were associated with greater intensity of use of general practitioners. Both lower income and education were associated with less contact with specialists, but there was no statistically significant relationship between these socioeconomic variables and intensity of specialist use among the users. Neither income nor education was statistically significantly associated with use or intensity of use of hospitals.




*Do dual insurance systems improve access and increase the availability of services to augment the public funded system?* 

I’ll refer you to this paper.  Some of its findings mirror other studies of the subject, but I haven't quoted the findings here due to space limitations. 
http://www.parl.gc.ca/information/library/PRBpubs/prb0571-e.htm


> This paper examines the experience of Australia, New Zealand and the United Kingdom – where duplicate private health care insurance is permitted – to assess the potential implications of duplicate private insurance for Quebec’s (and Canada’s) health care system.



*But don’t user fees work well in other countries?* 

Some cite other countries as examples of publicly funded health systems that are more efficient than ours and have user fees.  Sweden is one that is often so described. (Recently discussed in a Frasier Institute report)
http://www.sweden.se/templates/cs/FactSheet____15865.aspx


> Financing
> Costs for health and medical care amount to approximately 9 percent of Sweden’s gross domestic product (GDP), a figure that has remained fairly stable since the early 1980s. In 2005 care and services provided by the county councils, including the subsidization of pharmaceuticals, cost SEK 175 billion (USD 25.4 billion). Seventy-one percent of health care is funded through local taxation, and county councils have the right to collect income tax, the average level being 11 percent. Contributions from the state are another source of funding, representing 16 percent, while patient fees only account for 3 percent. The remaining 10 percent come from other contributions, sales and other sources.
> 
> Most county councils use some form of purchaser–provider system, in which a council negotiates compensation agreements with health care units – for example, performance-based compensation determined by diagnosis-related group (DRG), that is, a system to classify hospital cases into one of approximately 500 groups expected to have similar hospital resource use. This allows hospitals to become more independent of political bodies. In some cases hospitals have become corporations owned by the council. It is now more common for county councils to buy health care services – 10 percent of health care is financed by county councils but carried out by private health care providers.
> ...



1.0 CAD = 6.25518 SEK



> Organization
> Primary care has traditionally played a less important role in Sweden than in many other European countries. However, the aim is now to make it the basis of the health and medical care system. Today most health care is provided in health centers where a variety of health professionals – doctors, nurses, midwives, physiotherapists and others – work. This should simplify things for patients and foster teamwork. Patients should be able to choose their own doctor. Around 25 percent of health centers are privately run by enterprises commissioned by county councils. There are special clinics for children and expectant mothers as well as family planning clinics for teenagers.
> 
> Sixty hospitals provide specialist care with emergency room services 24 hours a day. Eight are regional hospitals where highly specialized care is offered and where most teaching and research is located. Since many county councils have small service areas, six health care regions have been set up for more advanced care. Furthermore, as Sweden only has nine million inhabitants, the entire country must serve as one service area for the most advanced specialist care. This is coordinated by a newly formed committee, Rikssjukvårdsnämnden, within the National Board of Health and Welfare.
> ...



Yes, the Swedish model does offer some good points, but to make an example of their user fees in isolation as a panacea for what ails our system is disingenuous.  The Swedish system works well for Sweden and there may be things we could adopt from them, but you also have to look at it in conjunction with the Swedish “welfare state’ (and high tax) mentality (though that is changing).  Also they have complaints similar to ours with regards to “waiting times” and physician shortages especially in primary care.  One of the factors that may be related to the last issue is that steps taken to control use (costs) included regulating the working volume and income levels of GP’s, forcing older doctors to retire to reduce “surplus output” and banning doctors from opening a new practice without a council agreement.  Now that would be a major paradigm shift for Canadian doctors.  Of course, if one of the benefits of a “Swedish” system were an increase in the availability of tall, slender, blonde women, I am all for it.

Clutching at straws, I think not.  My review of the question led me to the conclusion that simply imposing user fees would not substantially reduce public health care spending and thus lowering my taxes without, at the same time, increasing my out of pocket health costs.  So I’ll stick to my conclusion as you haven’t provided any evidence to the contrary, other than a mantra that everyone should pull themselves up by their bootstraps and take care of themselves.  “Routine health care is something most people can and should pay out of their own pockets”.   Actually they already do, it’s just that they feel that their share of the cost (their taxes) is inequitable.


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## stealthylizard (4 Dec 2007)

I donated a kidney back in 2003.  I had to pay for travel to and from Vancouver (the Kidney foundation covered half the air fare for return home), and $12 for a prescription of Tylenol 3.  Personally, I had no complaints about care rendered, except the T-3's weren't a strong enough pain med for post hospital release, but I made it through.  All the medical tests and surgery itself were "free".  I wouldn't even want to fathom how much the same procedure would have cost in the US........ A&W (my employment at the time) doesn't offer medical benefits.


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## observor 69 (5 Dec 2007)

Some  good news:  http://www.cbc.ca/canada/toronto/story/2007/12/03/ot-ont-military-071203.html

More at link.

Ontario to offer instant health coverage for military families
Last Updated: Monday, December 3, 2007 | 12:33 PM ET 
CBC News 
Military families transferred to Ontario from other provinces or overseas will no longer have to wait 90 days to receive benefits under the Ontario Health Insurance Plan if a proposed new law passes, the province has announced.

Premier Dalton McGuinty said the proposed legislation would be introduced  Monday afternoon, along with other legislation that guarantees Ontario workers who leave their civilian jobs to serve in overseas conflicts with Canada's military reserves won't lose those jobs while on tour.

George Smitherman, deputy premier and minister of health and long-term care, said the elimination for military families of the three-month waiting period that typically applies to all new residents of Ontario will help up to 8,500 people each year.

During the waiting period, patients who aren't covered by other provinces' insurance plans must sometimes pay physician fees up front.

Cathy Priestman, whose husband and two children just spent three years in Europe with the military and are moving on to Alberta in June, called the premier's announcement "fabulous.

"Even if we just leave Ontario for a year and then come back, the 90-day waiting period just kills us," she said.


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## 2 Cdo (5 Dec 2007)

Nothing but smoke and mirrors from Dalton. If you were posted from another province(I don't know about overseas) you were still covered by that province up to 90 days, at which point Ontario's health care coverage would kick in. Having moved from other provinces to Ontario(twice), I have never had to pay doctors fees upfront or had any other problems with health care issues.

The other part about job protection could end up being a double-edged sword. Job interviews might now ask if one is a reservist and if answered yes one finds themselves not quite as qualified as the next guy. Lie about it and then ask for time off due to reserve obligations, now the company has grounds for dismissal. I like the _*idea*_ of job protection but I don't think the _*reality*_ will be near as good as some hope.


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## Blackadder1916 (5 Dec 2007)

2 Cdo said:
			
		

> Nothing but smoke and mirrors from Dalton. If you were posted from another province(I don't know about overseas) you were still covered by that province up to 90 days, at which point Ontario's health care coverage would kick in. Having moved from other provinces to Ontario(twice), I have never had to pay doctors fees upfront or had any other problems with health care issues.



Correct, another politician jumping on the publicity bandwagon of "supporting the troops".  All the provinces have a (maximum) 90 day waiting period when coverage remains with the previous province of residence.  With the exception of Quebec there is no problem with reciprocal billing.  Some of the provinces also have the same waiting period if you move from outside the country, some start coverage the date you arrive, Ontario being one of them.  There are two provinces (AB & BC) in which monthly premiums are paid for provincial health insurance and must be continued for that waiting period after you leave them.  Will Ontario now reimburse members these amounts.  There was no problem before, but he may have started one.


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## observor 69 (5 Dec 2007)

2 Cdo said:
			
		

> Nothing but smoke and mirrors from Dalton. If you were posted from another province(I don't know about overseas) you were still covered by that province up to 90 days, at which point Ontario's health care coverage would kick in. Having moved from other provinces to Ontario(twice), I have never had to pay doctors fees upfront or had any other problems with health care issues.
> 
> The other part about job protection could end up being a double-edged sword. Job interviews might now ask if one is a reservist and if answered yes one finds themselves not quite as qualified as the next guy. Lie about it and then ask for time off due to reserve obligations, now the company has grounds for dismissal. I like the _*idea*_ of job protection but I don't think the _*reality*_ will be near as good as some hope.



I didn't know about the other provinces, thanks for the info. A friend of mine moved from Quebec to Ontario a few years back and it was a miserable experience.
The job protection part is a can of worms and way out of my lane.


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## geo (6 Dec 2007)

Baden  Guy said:
			
		

> I didn't know about the other provinces, thanks for the info. A friend of mine moved from Quebec to Ontario a few years back and it was a miserable experience.



Really?.... how so?
Have moved out of & into Quebec several times... (Nfld, NWT, NB & Ont) and have never had much of a problem with Health care services for me & significant other...
Does your friend have any forinstances?


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## retiredgrunt45 (8 Dec 2007)

Well I must say that people will complain about nothing until they "have nothing". When and if public health care in Canada gets up and walks out the door, I'm sure the people who complained the loudest while they had access, will no doubt complain even louder, when they don't have it. It seems some people are "never satisfied". For those oppopsed to social health care, have fun paying your bills. 

As for those wishing for a US style system, well I hope you have a very good secure job, plenty of credit at the ready, because your going to need both, until of course you or someone in your family get sick, lose your jobs and then you have no credit. Vicious circle isn't it?

My daughter was diagnosed with non-Hogkins lymphoma 7 years ago at the the age of 16.The health care system "WORKS GREAT". It only took 10 days, by the time she was diagnosed to the time she had her first treatment. The total care was outstanding, nurses doctors, hospital staff, etc. And now 7 years later she's cancer free, because of our health care system and I didn't have to go bankrupt. I have a new appreciation for the system, because even with its faults, it is still a great system. In the US, she would have had a 50/50 chance of surviving, not because the care us substandard, but because of ones ability to pay for the treatment, because I would have had to fork out $50 to $100,000.00 for the same treatment down there. I would have found the money, that’s not the question, but it would have ruined my family. 

So the next time you find yourself complaining about our system, check your mailbox and see if there’s ever a huge hospital bill in your mail. I’ve never received one and the bill for my daughters care was over $75,000.00.

Something to think about…


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## Brad Sallows (9 Dec 2007)

How do you figure you'd be liable for all that money?  Would you not buy health insurance for your family if taxpayers didn't do it?


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## retiredgrunt45 (9 Dec 2007)

Fine for the people who can afford insurance or are covered through their work. What about the millions who aren't or can't afford insurance? Low wage earners, jobless people, etc. How do they pay for their care? The good will of others, charity, handouts?

Just because you have insurance in the U.S, doesn't mean your of the hook for fees. Theres the Co-payment and depending on the % of the co-Payment and the amount of the bill, it could still be in the thousands.

Up here in Canada, everyone is covered, rich, poor, jobless etc. I really wish people would get their heads out of the sand, have good look around and see how good we have it up here. I do think that unless someone is confronted with a serious illness in their family, that they will contiinue to take our system for granted and will never really know the real benefits of a system like ours has.


Heres some interesting stats completed in 2004, done by the (STATE COVERAGE INITIATIVES PROGRAM), showing how many americans aren't covered. The numbers speak for themselves. 

 (PDF)http://www.statecoverage.net/pdf/coverage.pdf

 (HTML) http://72.14.205.104/search?q=cache:O0Brajp4bbcJ:www.statecoverage.net/pdf/coverage.pdf+Health+care+in+the+united+states&hl=en&ct=clnk&cd=9&gl=ca


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## Edward Campbell (9 Dec 2007)

retiredgrunt45 said:
			
		

> Fine for the people who can afford insurance or are covered through their work. What about the millions who aren't or can't afford insurance? Low wage earners, jobless people, etc. How do they pay for their care? The good will of others, charity, handouts?
> 
> Just because you have insurance in the U.S, doesn't mean your of the hook for fees. Theres the Co-payment and depending on the % of the co-Payment and the amount of the bill, it could still be in the thousands.
> 
> ...



Everyone *is* "covered" in the USA, too. No one is turned away from hospital emergency rooms.

The problem is that treating everday, minor medical problems in hospital emergency rooms is hideously expensive - that's one of the reasons (not the only one, to be sure) why the US has the most expensive health care system in the Western world.

But, the fact (and it is a fact) is that the USA also has the most "effective" health care in the world - in terms of "outcomes" when the healthcare system is utilized. The US system is not very "efficient," however, because a whole bunch of people, for a whole host of reasons, don't use it when and as they should. That's why there are such shocking statistics around some medical situations.


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## Flip (9 Dec 2007)

RG45 Glad to hear of the happy outcome - For me, it's all I can take when one
of my cats get sick.

Brad,


> How do you figure you'd be liable for all that money?  Would you not buy health insurance for your family if taxpayers didn't do it?



It's pretty fair bet that the tab would have been higher than 75k in the US.

There is also some possibility of denial of coverage.
Insurance companies don't always pay out when they should.  They have been
known to lie cheat and steal to try to wiggle out from under a liability.

I would also be loathe to allow some insurance adjuster to participate
in the decision making process as they do in HMOs.

E.R.


> Everyone is "covered" in the USA, too. No one is turned away from hospital emergency rooms.



I have a very hard time disagreeing with you - But respectfully, I have to say
this is a flawed statement.

Just because you have access to a band-aid or stitches does you are not ""covered"".

In some regions, emergency facilities are forced to provide non-emergency care
as when someone is in the emerge. and there is no currently available alternative.
This happens in Edmonton too, but at least insurance coverage is not a factor.

When a patient presents himself in an emergency room and is not an emergency
case the patient is forced to wait until services are available and, these services
can be anything from what should be taken care of in routine care to palliative care.

It's a lousy way to use the most expensive resource in the healthcare system.

In Edmonton - closing beds "upstairs" to save money, saves nothing because
patients pile up in the emergency.  This happens south of the border too, 
but for different reasons.  I wouldn't want insurance company issues thrown
into the mix.  They are in it for the money after all.


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## retiredgrunt45 (9 Dec 2007)

> RG45 Glad to hear of the happy outcome - For me, it's all I can take when one
> of my cats get sick.



Thanks Flip for the kind words and believe me I have a new appreciation for my daughter and our health care system. In fact it changed me to the point, were now I don't take anything for granted. There's nothing as life changing, as looking into your childs eyes and thinking that they may be taken away from you, nothing.

Yes I do know how you feel about the cats, I have three and now that my girls are on their own, i've found myself treating then like my children. Must be the empty nest syndrome. But afterall they are family. 

 Here in London Ontario, we have one of the best cancer centres in Canada, doctors, nurses, staff, they are all as my daughter would put it "Awesome". 

Mr. Campbell, not everyone is covered in the U.S. There are people everyday who are turned away from hospitals, because they have no insurance only to be sent to a charity centre for treatment, even then treatment is not guaranteed.


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## Edward Campbell (9 Dec 2007)

Flip said:
			
		

> ...
> 
> It's a lousy way to use the most expensive resource in the healthcare system.
> ...



That's exactly what I said. The US system is highly effective (outcomes) when it's used but it is, at the same time, woefully inefficient because it "covers" people with the most expensive method and the _rationing_ (which is characteristic of all emergency rooms, I think) discourages use of any of the healthcare system alternatives - meaning it isn't used when it should be.


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## Brad Sallows (9 Dec 2007)

1) "What about the millions who aren't or can't afford insurance?"  What about them?  How many times must I repeat the concession that there needs to be some sort of provided care for people on low incomes, so that we can meaningfully discuss the responsibilities of people on medium and high incomes?  If the only response people can come up with is, "But what about poor people?" and the poor have already been seen to, I conclude there are no persuasive arguments against a greater role for private insurers and private acquisition of services and products.

2) "It's pretty fair bet that the tab would have been higher than 75k in the US."  So what?  Some people seem to believe that "efficiency" is an effective argument for public control.  It is not.  Even were we to assume away the problem that government gets shafted in matters of health care as routinely as it does in others, it is not a sufficient argument.  Just because "government" might be able to do something more efficiently, is not sufficient cause that it should legislate restrictions on a freer market in able to do so.  The fact that government must legislate the playing field to its advantage tends to negate the "efficiency" argument - if it were "efficient", it would be competitive in a freer market and wouldn't need to make rules to suit itself.

3) We might collectively - public and private - spend more on health care.  So what?  There are no controls on the amounts of money people are permitted to spend on their housing or automobile choices, and there is no suggestion that people be protected against their money management problems as a result.  If we allow people to spend more on health care and they do so, thereby expanding the capacity of the system overall, it is a feature, not a bug.

4) Some private insurers may deny coverage.  But if payment is due, then the service was received.  That is a better prospect than not being allowed to buy the service at all because of legislative restrictions.  Our system doesn't have to lie or cheat or wiggle when the bill is due; it just says "No" to the service which would drive the billing in the first instance.

5) "Everyone is covered" leaves out the most important part: "Everyone is covered for what the system will cover".  We all have equal access to a lower level of coverage than one might aspire to elsewhere.


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## Reccesoldier (9 Dec 2007)

> There are no controls on the amounts of money people are permitted to spend on their housing or automobile choices, and there is no suggestion that people be protected against their money management problems as a result.



But a lot of the same people who praise our healthcare system would dearly love to be able to tell everyone what kind of car or house you should be allowed to buy.

"There is no greater tyranny that to force a man to pay for what he does not want merely because you think it would be good for him."  Robert Heinlein


----------



## Blackadder1916 (9 Dec 2007)

E.R. Campbell said:
			
		

> But, *the fact (and it is a fact) is that the USA also has the most "effective" health care in the world - in terms of "outcomes"* when the healthcare system is utilized. The US system is not very "efficient," however, because a whole bunch of people, for a whole host of reasons, don't use it when and as they should. That's why there are such shocking statistics around some medical situations.



What is your measurement of "effective" and "outcome"?

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care


> Overview
> Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—*the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives*. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
> ...
> Summary and Implications
> ...



A systematic review of studies comparing health outcomes in Canada and the United States


> Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.
> 
> Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.
> 
> ...



Practitioners in the United States may have made impressive (individual) technical advances in medicine (but they are not the only ones) and it may be a "go to" place for those few who can afford the latest, fastest, shinyest (and most publicized/advertised) care, but it has not translated into better (best in the world?) clinical outcomes on the whole.


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## Edward Campbell (9 Dec 2007)

Blackadder1916 said:
			
		

> What is your measurement of "effective" and "outcome"?



That those who (can) make proper use of the system get first rate and timely treatments. Those who fail to make good and proper use of the system don't - and I suspect that large, poor, ill-educated, frightened (of authorities) _underclasses_ (there's more than one) pull all those statistics way down.

Broadly, US "healthcare" is below par while their "medical care" is first rate.

But I think that applies here, too. We offer good if often slow "medical care" but we provide little in the way of real, meaningful "healthcare." We, like the Americans, are in the business of treating the ill and injured, not in preventing illness or injury. On that basis the Americans do it faster and better for most people.


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## Roy Harding (9 Dec 2007)

My youngest son is an RN.  He has worked Emergency, and is currently employed in the ICU at the U of A Hospital.

For such a fresh faced young whipper snapper, he has an impressive amount of knowledge and experience regarding access to, and consumption of health care.  The opinions I will express below are nothing more than distillations of his remarks to me.

There's something "broken" in our system.  Folks shouldn't be presenting at Emerg because they have a head cold.  If they do, they shouldn't be surprised at having to wait ten or more hours while the emergency staff take care of EMERGENCIES (what's up with THAT?)

We (Canada) have a decent system for treating traumatic conditions - we have a lousy system for "normal, run of the mill" health concerns.  Of course, "normal, run of the mill" health concerns are often (but not always) indicators of serious health issues.

The system we've built is fairly good at addressing serious health issues - it's not so great at addressing "normal, run of the mill" health problems.  Perhaps if it was better at that, there would be less pressure on the Emergency services available.

My son, Gawd love him, has the same answer to health issues that I have to defense issues - namely; more money, more emphasis, and more CONSIDERED THOUGHT regarding the issue.  We can't BOTH be right - or perhaps we can be.


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## Blackadder1916 (9 Dec 2007)

E.R. Campbell said:
			
		

> That those who (can) make proper use of the system get first rate and timely treatments. Those who fail to make good and proper use of the system don't - and I suspect that large, poor, ill-educated, frightened (of authorities) _underclasses_ (there's more than one) pull all those statistics way down.
> 
> Broadly, US "healthcare" is below par while their "medical care" is first rate.
> 
> But I think that applies here, too. We offer good if often slow "medical care" but we provide little in the way of real, meaningful "healthcare." We, like the Americans, are in the business of treating the ill and injured, not in preventing illness or injury. On that basis the Americans do it faster and better for most people.



If only the world worked that way, exclude all the underclasses because they drag down our statistics.  I don't deny that you can usually find adequate (I use that word deliberately) medical care in the United States, but the studies I've seen do not indicate that "clinical" outcomes are significantly improved simply because the patient is in the United States as compared to other industrialized countries.

In one of the studies I referenced above, one point noticeably struck me.



> Quality: The indicators of quality were grouped into four categories: right (or effective) care, safe care, coordinated care, and patient-centered care. *Compared with the other five countries, the U.S. fares best on provision and receipt of preventive care, a dimension of "right care." However, its low scores on chronic care management and safe, coordinated, and patient-centered care pull its overall quality score down.* Other countries are further along than the U.S. in using information technology and a team approach to manage chronic conditions and coordinate care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to identify and monitor patients with chronic conditions. Such systems also make it easy for physicians to print out medication lists, including those prescribed by other physicians. Nurses help patients manage their chronic diseases, with those services financed by governmental programs.



If their provision of preventive care scores the best, how much worse are the others factors of quality (in comparison to the other countries)?


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## Edward Campbell (9 Dec 2007)

Blackadder1916 said:
			
		

> ...
> If their provision of preventive care scores the best, how much worse are the others factors of quality (in comparison to the other countries)?



My, personal, short answer to your question, Blackadder1916, is: Dunno.

I’ve strayed _waaaaay_ out of my lane.

----------

To scramble back into it: My experiences with our health/medical care systems have been, thankfully infrequently, as a patient. But, three times over the past decade, and each with the full knowledge and support of my Canadian physician (Gp and specialist) I have taken my “business” (and my gold card) to the USA because either:

1.	The care (tests, actually) I needed were unavailable in Canada (some, less than adequate tests were available); or

2.	The care (test, again) I needed were available in Canada only after a long, long wait; or

3.	The best possible care (treatment) was only available in the USA.

In situations 1 and 3 we see the essential nature of _rationing_. In a single payer system there is *no alternative* to rationing; we have a single payer system.

In situation 2 we have another form of rationing. Although the test was approved there were so few test facilities and so little money that everyone had to wait. Such waits can be worrisome. I decided not to wait for situation 2 and I also decided, for 1 and 3, that I should have the “right” care, so off I went to the USA, gold card in hand.

Had my tests (1 and 2) turned out badly I would have jumped the queue in Canada because the American physician sent everything up to the specialist in Canada and he (Canadian specialist) assured me that a “bad” test result would see me in a hospital bed, receiving urgent and excellent treatment, within hours of my return. 

Equally, had my US treatment (3) resulted in problems I know I would have been treated quickly and competently in Canada.

The nature of our system is that it must be rationed.  The nature of the US system is that anyone with “good” insurance or a healthy bank balance can have whatever care good physicians and informed patients agree is necessary or even desirable.


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## Flip (9 Dec 2007)

Today on Cross Country Checkup Rex Murphy had 
a Dr Day on as a guest ( I think the CMA pres.)

The point made by Dr Day was that funding was provided in
a budgetary process that is unique in it's disfunction.

A hospital is given X number of dollars at the start of the year.
Every patient represents X-1 and removes some of those resources.

A more appropriate method is to make the patient into a Y+1 
commodity. The more patients you treat the greater the billing.

Unfortunately some specialties have had severe limits placed on 
billing so that doctors are golfing more than they want to and
patients are stacking up in the ER.

In a nutshell................

It's the way the suits do it. (management )

It was a good listen........ Cheers all.


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## Bane (9 Dec 2007)

The Commonwealth Fund 2003 International Health Policy Survey -  its a bit old, but interesting to look through. 

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=239252

There were some surprises for me in it, both good and bad.


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## Blackadder1916 (9 Dec 2007)

E.R. Campbell said:
			
		

> My, personal, short answer to your question, Blackadder1916, is: Dunno.


It was a rhetorical question.

While rationing occurs in Canada, so it does in the USA, even for people with insurance, however it is often hidden under the name of managed care.  The basis for extolling the virtues of the American system is often due to anecdotal evidence.  And your experience, luckily, was mainly limited to diagnostic procedures, with the full expectation that any further treatment and costs would be borne by your public funded health plan in Canada.   My experience (as a patient) with the American health system has been limited to one exposure (two, if you count a visit to the TMC at Fort Sam Houston). 

If all the anecdotal evidence of Canadians going to the USA for health care were accurate, my expectation would be that busloads of Canadians would be crossing the border each week heading to the nearest American medical provider in the same manner that they now head to the outlet malls.  But I don't think that south of the border medical use is as great as most people imagine.  

Now this is also anecdotal evidence, but a few years back I managed a fairly large group of physicians (primarily GPs but some specialists).  In one of our clinics, patient encounters in the first year that I was there totaled over 74,000 (this equates to approx 14-15,000 patients).  Though I was not directly involved in all referrals outside the clinic, I was usually aware of any that were "outside the box".  During that year, there was one (1) patient that was referred to a medical facility in the US for his condition (and that was mainly because the US doctor was doing some experimental work in that specific field).  The following years that I worked there had similar numbers.  

Incidentally, during that first year, I recall receiving at least 5 letters from Americans who had been seen at our facility and wanted to commend the staff and our health care system for its excellent service.  As a business oriented manager, I even looked at the potential for “medical tourism” both ways across the border.  My research led me to the conclusion that there were greater numbers of Americans coming up here for limited use of our health services (but my location did not fit a good business opportunity) than there were Canadians going there for usually more specialized elective procedures.

Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States


> PROLOGUE: Over the past three decades, particularly during periods when the U.S. Congress has flirted with the enactment of national health insurance legislation, the provincial health insurance plans of Canada have been a subject of fascination to many Americans. What caught their attention was the system’s universal coverage; its lower costs; and its public, nonprofit administration. The pluralistic U.S. system, considerably more costly and innovative, stands in many ways in sharp contrast to its Canadian counterpart. What has remained a constant in the dialogue between the countries is that their respective systems have remained subjects of condemnation or praise, depending on one’s perspective.
> Throughout the 1990s, opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that "refugees" of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.
> This paper by Steven Katz and colleagues depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system. ….
> 
> ...


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## TCBF (10 Dec 2007)

We can't make a 'business case' if we don't operate like a business.  We have people waiting for MRIs and the MRI machine sits unused 120 hours a week.  So, Thunder Bay Ont sends people to Duluth Minn. for MRIs and they get appointment times like 2230 hrs and 0430 hrs because the Americans amortize the cost of their MRI by crewing it 24/7 and selling the day shift to Americans and the 4-12 and graveyard shifts to us.

Why can't we do that?


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## Brad Sallows (10 Dec 2007)

>But a lot of the same people who praise our healthcare system would dearly love to be able to tell everyone what kind of car or house you should be allowed to buy.

I know; but the campaign to have them declared morally unfit to vote (ie. exercise power over others) is making very little headway.


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## retiredgrunt45 (10 Dec 2007)

> But a lot of the same people who praise our healthcare system would dearly love to be able to tell everyone what kind of car or house you should be allowed to buy.
> 
> I know; but the campaign to have them declared morally unfit to vote (ie. exercise power over others) is making very little headway.



Since when does praising our health care system turn us into the former soviet union? I smell conspiracy theory here coming on. The government and the rest of us socialist pigs are out to get you and control your every move, is that it?.  :

 I have a doctors appointment his afternoon, I must go and have my monthly mind control and brain washing session, free of charge of course...

I will then go down to our "state run" care dealership and buy that nice little pre-approved Lada that only comes in black and be really happy about it, because I don't want to anger the big bad Harper for fear of being sent to a gulag somewhere on Greenland for 20 years, by the big evil Canadian political bureau.


----------



## TCBF (10 Dec 2007)

retiredgrunt45 said:
			
		

> ... I have a doctors appointment his afternoon, I must go and have my monthly mind control and brain washing session, free of charge of course...



- How did you get those mind control sessions so fast?  I have been waiting years for mine.  I'm beginning to smell a big fat commie rat!

 ;D


----------



## Reccesoldier (10 Dec 2007)

retiredgrunt45 said:
			
		

> Since when does praising our health care system turn us into the former soviet union? I smell conspiracy theory here coming on. The government and the rest of us socialist pigs are out to get you and control your every move, is that it?.  :
> 
> I have a doctors appointment his afternoon, I must go and have my monthly mind control and brain washing session, free of charge of course...
> 
> I will then go down to our "state run" care dealership and buy that nice little pre-approved Lada that only comes in black and be really happy about it, because I don't want to anger the big bad Harper for fear of being sent to a gulag somewhere on Greenland for 20 years, by the big evil Canadian political bureau.



Save your sarcasm.

Never underestimate the power/stupidity of people who claim to have our best interests at heart...
http://www.thestar.com/News/article/201960
http://www.ndp.ca/page/3007


----------



## a_majoor (19 Dec 2007)

An American MD who worked under "Canadian Style Health Care" (Medi-Cal) describes her experience:

http://www.victorhanson.com/articles/halderman120607.html



> *Poor, Not Dumb*
> A New Model for Sensible Reform of Healthcare
> by Linda Halderman, M.D., FACS
> Private Papers
> ...


----------



## Blackadder1916 (19 Dec 2007)

Thucydides said:
			
		

> An American MD who worked under "Canadian Style Health Care" (Medi-Cal) describes her experience:



To equate Medi-Cal to any of the provincial health insurance plans is similiar to equating a "Durian" to an "orange".  Both are fruit, but a comparison of 'scent' and ease of use ends any further similiarity.  I would suggest that you review the Medi-Cal webpage along with one of the provincial health insurance plans.

Dr. Halderman, who did not make a comparison in her article, well describes the frustration that many health providers in California have with Medi-Cal reimbursement; it is not a provider friendly entity.  And when providers have a problem it is ultimately the patient who suffers.  I did get an impression from reading the piece that, while the writer may care about her patients, she is just as concerned (or maybe more) that she earn as much as possible. (Not that there's anything wrong with that.)  Also, (in my opinion), her proposal may be overly optimistic with regard to acquiring (equal or better) coverage at the rates quoted.


----------



## CougarKing (19 Dec 2007)

TCBF said:
			
		

> We can't make a 'business case' if we don't operate like a business.



Because any business's main goal is profit...  : Of course you get the efficiency and quick access to care you want, but not everyone gets treated (especially those who can't pay) and can come at quite a price. Anyways, to each his own... :blotto:

RetiredGrunt,

Like you, I am probably am sick to death of the same "more govt. is bad because it leads to inefficient bureaucracy" argument and the "why the h*ll should I pay for those who can't afford with my taxes" argument when it comes to our health care system, but of course I've heard enough of this thread...


----------



## I_am_John_Galt (20 Dec 2007)

CougarDaddy said:
			
		

> Because any business's main goal is profit...  :



Not if it's successful:  *"Profit is like health.  You need it, and the more, the better.  But it's not why you exist."* Peters & Waterman, _In Search of Excellence_


----------



## observor 69 (20 Dec 2007)

I_am_John_Galt said:
			
		

> Not if it's successful:  *"Profit is like health.  You need it, and the more, the better.  But it's not why you exist."* Peters & Waterman, _In Search of Excellence_



[sarcasm]I read the business page of the G&M every day and profit seems to be what it is about. [/sarcasm]


----------



## I_am_John_Galt (20 Dec 2007)

Baden  Guy said:
			
		

> [sarcasm]I read the business page of the G&M every day and profit seems to be what it is about. [/sarcasm]



That's what you get for reading the Grope 'n' Flail!   :


----------



## Greymatters (20 Dec 2007)

An interesting piece on the subject I came across the other day.  Although it is Wikipedia, it is verifiable:

http://en.wikipedia.org/wiki/Universal_health_care

*The United States is the only industrialized nation that does not provide universal health care.[1]*

I thought this interesting as there is quite a bit of dirt-slinging from the US reference our Canadian health care system, as mentioned in earleir posts.  However, it is not we who have the 'weird system', it is the US that has a system different from most other Western countries.  Not that there's anything wrong with that....


----------



## I_am_John_Galt (20 Dec 2007)

Greymatters said:
			
		

> An interesting piece on the subject I came across the other day.  Although it is Wikipedia, it is verifiable:
> 
> http://en.wikipedia.org/wiki/Universal_health_care
> 
> ...



Keep reading ... *Canada is the only industrialized country that has banned private medical insurance for services covered by the public health plan.*


----------



## Greymatters (20 Dec 2007)

That will change eventually...


----------



## I_am_John_Galt (20 Dec 2007)

Greymatters said:
			
		

> That will change eventually...



As any socialist system will always fail.

*"Government is the great fiction through which everybody endeavors to live at the expense of everybody else."* Frederic Bastiat, _Government_


----------



## CougarKing (20 Dec 2007)

I_am_John_Galt said:
			
		

> As any socialist system will always fail.
> 
> *"Government is the great fiction through which everybody endeavors to live at the expense of everybody else."* Frederic Bastiat, _Government_



Comparing our health system to the failed "Socialist" economies of the East bloc is not a realistic comparison. You don't see the socialist economies of Scandinavian countries and the "Socialist" health systems of the Brits and the French flopping over and failing. Oh well...some people really distrust more govt., in the same way some people are unwilling to trust a private entity who is more concerned with profit at your expense...

I would never trust my money to a private health insurance company- such as the one called "Humanitas" described in Michael Moore's "Sicko" documentary which counts any denial of care to its clients when a sickness or emergency as a profit gain; it sickens me that such a company would give doctors bonuses for a monthly quota for the number of their clients they successfully investigated a claim they ended not paying for.

But of course, you don't care, since you see health care as a PRIVILIEGE, not a right. Anyways that's it...officially sick of this thread...


----------



## I_am_John_Galt (20 Dec 2007)

CougarDaddy said:
			
		

> You don't see the socialist economies of Scandinavian countries and the "Socialist" health systems of the Brits and the French flopping over and failing.



Actually, our system is MORE socialist than any of those mentioned, and many of theirs are on the brink of failure as well.

A word to the wise: if you are planning to highlight the supposed virtues of socialized healthcare, you would do well to *NOT *mention the UK: I just did a quick google search for "NHS +crisis" and got 149,000 hits ... remember the first 3 weeks of August 2003 (when nearly 15,000 French died waiting for treatment)?  Even the Scandinavian countries are starting to recognize that socialized healthcare is doomed to failure:

Abstract: https://bora.uib.no/handle/1956/1377
Article: http://www.ub.uib.no/elpub/rokkan/N/N05-04.pdf

P.S> If Michael Mooreon is against something, it's probably pretty good: ever wonder why he has to lie and stretch the truth so much in his moves?


----------



## Greymatters (20 Dec 2007)

The greatest threats to the system are twofold: the top-heavy beaurocracy that overbalances every government system if left unchecked, and the increasing number of 'free riders' who do not pay into the system yet siphon off benefits.


----------



## CougarKing (20 Dec 2007)

Greymatters said:
			
		

> The greatest threats to the system are twofold: the top-heavy beaurocracy that overbalances every government system if left unchecked, and the increasing number of 'free riders' who do not pay into the system yet siphon off benefits.



Ahh yes...the classic argument of the fear of an inefficient bureaucracy and the fear of freeriders...well that's still not good enough of a reason to completely dismantle the health care system and replace it with for-profit health insurance companies.  A better system of differentiating those who have "genuine need" and the "freeriders" should still be considered- any alternative- without having to resort to leaving those with lower incomes at the mercy of market forces. 

I'll even consider the option of private health insurance providers, though, provided there is a safeguard that prevents the  type of abuse of clients, as Moore pointed out in the film, where those companies would try to find any loophole or instance of incriminating medical history that would justify their denying their clients' care. The prosperity of the United States economy is not due to pure, unfettered capitalism, but because it has a MIXED economy with some govt. regulations like labor and anti-trust laws; using the same logic, if we do decide to privatize our health system on a massive scale, then it should be done so with laws and independent oversight groups that prevent such client abuse. 



> P.S> If Michael Mooreon is against something, it's probably pretty good: ever wonder why he has to lie and stretch the truth so much in his moves?



Okayyy...would you mind pointing out some instances in "Sicko" (or any of his other movies) that can be considered as just plain lies? Otherwise, something tells me that one is letting their bias against a particular liberal director cloud their judgement that they believe that person is still wrong even when presented with evidence. The "Swiftboating" of Sen. Kerry in the 2004 US Pres. elections come to mind as an example of this bias, since this group of veterans who had served on other boats in his Vietnam-era squadron smeared the circumstances in which Kerry earned his combat decorations, even when Kerry's own PBR/Swift Boat crew endorsed him, as well as enlisted veterans on other boats.  

http://www.factcheck.org/article231.html



> A group funded by the biggest Republican campaign donor in Texas began running an attack ad Aug. 5 in which former Swift Boat veterans claim Kerry lied to get one of his two decorations for bravery and two of his three purple hearts.
> 
> But the veterans who accuse Kerry are contradicted by Kerry's former crewmen, and by Navy records.



So please, before you lecture me about how "broken" the UK and France health systems are with simply a "quick google" search as evidence, please try to objectively consider his position (did you even watch the movie?) without resorting to the usual diatribes like calling Moore "Mooreon" and bury me with the usual statistics that can be manipulated to serve either side of the health care debate. 

Otherwise, remember what Blackadder said earlier:



> If all the anecdotal evidence of Canadians going to the USA for health care were accurate, my expectation would be that busloads of Canadians would be crossing the border each week heading to the nearest American medical provider in the same manner that they now head to the outlet malls.  But I don't think that south of the border medical use is as great as most people imagine.



The only "steady stream of busloads" of Canadians who have been going over the border recently are people who have been taking advantage of the bargain purchases to be made due to the strong Looney vs. the US dollar, even if it has been going up and down.


----------



## Sheerin (20 Dec 2007)

The thought of trusting my life to a for profit health insurance corporation makes me a tad nervous.  Particularly when those corporations that are set there to "help you" spend significant amounts of money each year on finding ways not to cover their policy holders' claims.  If I should ever come down with a serious illness, I don't want some desk jockey combing through my medical records trying to find any evidence that either A) I 'lied' about my health history by omitting something as minor as having food posioning when I was 20, B) That anything in my past could indiciate that whatever illness I developed was a result of a preexisting condition.


----------



## I_am_John_Galt (21 Dec 2007)

CougarDaddy said:
			
		

> Okayyy...would you mind pointing out some instances in "Sicko" (or any of his other movies) that can be considered as just plain lies?



Okayyy ... Sicko: http://www.reason.com/news/show/120998.html
another of his movies: http://www.davekopel.org/terror/59Deceits.pdf



> Otherwise, something tells me that one is letting their bias against a particular liberal director cloud their judgement that they believe that person is still wrong even when presented with evidence.


Evidently, you are wrong: the falsehoods and misleading information (sometime grossly misleading) in his "documentaries" are well documented (I just provided you with two examples).



> The "Swiftboating" of Sen. Kerry in the 2004 US Pres. elections come to mind as an example of this bias, since this group of veterans who had served on other boats in his Vietnam-era squadron smeared the circumstances in which Kerry earned his combat decorations, even when Kerry's own PBR/Swift Boat crew endorsed him, as well as enlisted veterans on other boats.
> 
> http://www.factcheck.org/article231.html


 Uh yeah, sure ...I thought this thread was about healthcare.



> So please, before you lecture me about how "broken" the UK and France health systems are with simply a "quick google" search as evidence,


 Actually, I'm not lecturing you: I was gently trying to point out some basic information that anyone  with a passing familiarity with the subject (or even recent European current events) would be familiar-with.



> please try to objectively consider his position (did you even watch the movie?) without resorting to the usual diatribes like calling Moore "Mooreon" and bury me with the usual statistics that can be manipulated to serve either side of the health care debate.


 
The NHS liquidity crisis is very well documented (I had hoped you might google it yourself): as it is, many of the trusts are massively in debt ... more than 10% are actually bankrupt! http://politics.guardian.co.uk/publicservices/tables/0,,1967876,00.html

Nearly 15,000 died in France in the August 2003 heatwave: the French Parliament _itself_ blamed the deaths "on a complex health system, widespread failure among agencies and health services to coordinate efforts, and chronically insufficient care for the elderly." http://www.cbsnews.com/stories/2003/08/29/world/main570810.shtml

These are not _manipulated statistics_: "bankruptcy" is a legal term; the 14,802 deaths (I looked it up) are verifiably recorded.  The only thing here that is manipulated is Moore's audience!



> Otherwise, remember what Blackadder said earlier:
> 
> The only "steady stream of busloads" of Canadians who have been going over the border recently are people who have been taking advantage of the bargain purchases to be made due to the strong Looney vs. the US dollar, even if it has been going up and down.


 Yes, because we've paid so much for our "free and universal" healthcare (that doesn't provide the quality of service available in the US), we can't afford it. Besides, those who can, DO: http://www.thestar.com/News/Canada/article/256600 And, according to that article, we don't know how steady the stream is (only that it exists):


> The Canadian Cancer Society also says it is impossible to determine how many citizens of this country travel each year to the United States for private cancer treatment, since records are only kept if they apply in some way for compensation.


----------



## a_majoor (21 Dec 2007)

On the other hand, My children routinely have to wait 6+ months to see an allergist, and after sustaining an injury in Sept of this year, I will finally have corrective surgery at the end of Feb 2008. This is hardly unusual, other members of my family have also had prolonged waiting times for medical treatment, as have people who I am in contact with on a day to day basis (both through work and socially).

"Work arounds" include sending me or other people needing treatment to other cities (and sometimes even the United States), since there were no doctors or treatment options available.

This *might* make sense if we lived in some third world nation, but since government spending on health care consumes such a vast portion of the provincial budget, I think the argument for inefficient bureaucracy seems to be pretty well established.


----------



## CougarKing (21 Dec 2007)

Galt,

Thanks in particular for the Dave Kopel link; it was especially informative.


----------



## observor 69 (21 Dec 2007)

I_am_John_Galt said:
			
		

> As any socialist system will always fail.
> 
> *"Government is the great fiction through which everybody endeavors to live at the expense of everybody else."* Frederic Bastiat, _Government_



It has been said that democracy is the worst form of government except all the others that have been tried. 
Sir Winston Churchill
British politician (1874 - 1965) 

I have been exposed to studies on most of the western health care systems. Ours isn't perfect but it is debatable if there are countries with one that is considerably better. It is a worthy work in progress.


----------



## I_am_John_Galt (21 Dec 2007)

Sheerin said:
			
		

> The thought of trusting my life to a for profit health insurance corporation makes me a tad nervous.


The thought of trusting my life to an organization committed to minimizing their costs scares the hell out of me (moreso than an organization whose long term survival depends on its ability to provide me with the goods and services I demand at a price that is acceptable to me).



> Particularly when those corporations that are set there to "help you" spend significant amounts of money each year on finding ways not to cover their policy holders' claims.


Particularly when the employees of those organizations "help me" by ensuring that my healthcare is not undermined by the horrors of such things as private companies providing linen service.



> If I should ever come down with a serious illness, I don't want some desk jockey combing through my medical records trying to find any evidence that either A) I 'lied' about my health history by omitting something as minor as having food posioning when I was 20, B) That anything in my past could indiciate that whatever illness I developed was a result of a preexisting condition.


 But "some desk jockey" allowing you to die because you forgot your health card is just fine with you? http://www.cbc.ca/canada/story/2004/04/23/Medicaredeath_040423.html


----------



## I_am_John_Galt (21 Dec 2007)

Baden  Guy said:
			
		

> I have been exposed to studies on most of the western health care systems. Ours isn't perfect but it is debatable if there are countries with one that is considerably better. It is a worthy work in progress.


I'm not sure how "worthy" it is, and while there's certainly lots of room for debate, I would start by looking at what is being accomplished in Singapore ... _very _ brief overview here: http://www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850


----------



## Sheerin (21 Dec 2007)

I_am_John_Galt said:
			
		

> The thought of trusting my life to an organization committed to minimizing their costs scares the hell out of me (moreso than an organization whose long term survival depends on its ability to provide me with the goods and services I demand at a price that is acceptable to me).


And a private insurance company isn't going to do that?  How do you think private insurance companies make profits?  





> But "some desk jockey" allowing you to die because you forgot your health card is just fine with you? http://www.cbc.ca/canada/story/2004/04/23/Medicaredeath_040423.html



Not exactly an endemic problem.  The above case resulted from a clerk who made a lazy decision to send someone home to get their health care so they wouldn't have to fill out extra paper work.  Whereas in the US insurance companies will do just about anything to not have pay for your health care.


----------



## I_am_John_Galt (21 Dec 2007)

Sheerin said:
			
		

> And a private insurance company isn't going to do that?  How do you think private insurance companies make profits?


Not in the long run ... economics 101: profits depend not on minimizing cost, but rather on maximizing the difference between cost and REVENUE.  In the public case (where revenue is fixed) the only ostensible incentive is to minimize costs (to whatever the legally-mandated minimum level of service is) ... the private case is predicated on revenue: you cannot cut costs without considering the impact on revenues!




> Not exactly an endemic problem.  The above case resulted from a clerk who made a lazy decision to send someone home to get their health care so they wouldn't have to fill out extra paper work.


You might have a point, except (from the article): *"The director of the St. André medical clinic in Montreal says her staff did nothing wrong, and followed proper procedure. "*



> Whereas in the US insurance companies will do just about anything to not have pay for your health care.


Yeah, sure: whatever Michael Moore says, right?


----------



## Sheerin (21 Dec 2007)

I_am_John_Galt said:
			
		

> Not in the long run ... economics 101: profits depend not on minimizing cost, but rather on maximizing the difference between cost and REVENUE.  In the public case (where revenue is fixed) the only ostensible incentive is to minimize costs (to whatever the legally-mandated minimum level of service is) ... the private case is predicated on revenue: you cannot cut costs without considering the impact on revenues!


Yeah and the best way to maximize the difference is to get people to pay premiums and then once they make a claim, make it exceedingly difficult for them to actually collect.  And of course, once you make a claim your rates go up, just like with car insurance.  Not exactly a user friendly system.  

And yeah, they can cut costs without true impact on revenue.  Once you get sick and have a claim denied it's not like your provider is going to lose any money.  You've already paid X amount since you purchased the insurance.  The only way the insurance company loses money is if they have to pay Y amount for treatment (assuming Y is greater than X).  If Y>X what makes you think the insurance company will want to pay, when they can pay less fighting it?  Plus they have the added advantage in that if it's an acute life threatening illness, it won't be a long drawn out fight.  





> You might have a point, except (from the article): *"The director of the St. André medical clinic in Montreal says her staff did nothing wrong, and followed proper procedure. "*


Valid point, till you remember litigation is a likely outcome of this incident, therefore to protect themselves the director would say anything that would minimize their culpability.  Last thing they need is for her to say "Oh yeah, we're completely at fault for this" and then have to defend that statement in a deposition.   
While we're discussing this, do you actually believe something like this wouldn't happen in a US style system?  What do you think would happen if you showed up at a private hospital without your insurance card?   



> Yeah, sure: whatever Michael Moore says, right?



Michael Moore is a pompus ass.  I saw Sicko over the summer and I could go on for hours about how bad it was.  He's lazy, and he doesn't like showing the full truth.  There many things in his movie that I didn't agree with.
But whatever, just because my political views more to the left that means you can lump me with idiots like Michael Moore.  So since you're more to the right can I lump you with the morons on your side?


----------



## Flip (21 Dec 2007)

Funny you should mention this JG.


> Particularly when the employees of those organizations "help me" by ensuring that my healthcare is not undermined by the horrors of such things as private companies providing linen service.


In Alberta the laundry has been done privately for many years.
The net result isn't that positive.
$15/hr jobs have been converted into $8/hr jobs with the difference
going to the business owners. Because the laundry leaves the hospital
and the staff have very little training, there is some measurable risk to the outside world.

In the US your insurance claim often is made AFTER the cost of your care is 
already on your plastic.  The insurance industry WILL lie cheat and steal
if they can get away with it. That means the patient WILL often pay for his own 
care in spite of having the mistaken notion of having coverage.
This part of the American system is barberic.

I can't speak to Micheal Moore's Sicko - I haven't seen it.
I do know that the more "corporate" and the less "institutional" healthcare
becomes the more profit driven it will be - There's NO upside.

Would you like Canada's national defense to go corporate?
Could a corporation do the job?  Would we trust them?
There are some things corporation just don't do well.


----------



## Flip (21 Dec 2007)

Thucydides said:
			
		

> On the other hand, My children routinely have to wait 6+ months to see an allergist, and after sustaining an injury in Sept of this year, I will finally have corrective surgery at the end of Feb 2008. This is hardly unusual, other members of my family have also had prolonged waiting times for medical treatment, as have people who I am in contact with on a day to day basis (both through work and socially).
> 
> "Work arounds" include sending me or other people needing treatment to other cities (and sometimes even the United States), since there were no doctors or treatment options available.
> 
> This *might* make sense if we lived in some third world nation, but since government spending on health care consumes such a vast portion of the provincial budget, I think the argument for inefficient bureaucracy seems to be pretty well established.



I'll agree with your last comment wholeheartedly.  You are are victim of healthcare rationing.
There's no excuse for it.  There are restrictions placed on specialists so they don't dent the budget. Sometimes it has nothing to do with shortages.

In a previous post I described the way the budgetary process needed to be changed.
As allergies have health effects beyond the symptoms - seeing an allergist sooner
rather than later might actually save money and time.

I had a relative in Calgary who desperately needed a CAT scan.
He was told to wait six weeks.
Since he had a rather aggresive cancer that seemed like a non-starter.
He paid for a scan to be done privaely. - $300

Here's the kicker - He wandered into the radiology department of his local 
hospital one weekday afternoon. Not a soul around.
The scanners were just sitting there depreciating.
No scans were being done because that department had run out of money.
Since scans save time, money and lives......You can call this a case of mismanagement.

I've said it before - Private vs. public is a specious and incorrect arguement.
Change the management and budgetary process to suit the need.
In short, have healthcare run by people who actually have some
understanding of healthcare and some professional interest in
making the system work - instead of making the system "profitable".


----------



## CougarKing (21 Dec 2007)

Flip said:
			
		

> I've said it before - Private vs. public is a specious and incorrect arguement.
> Change the management and budgetary process to suit the need.



+1 Flip. This particular point of yours deserves more consideration, since it changes the focus of the whole debate from the type of system to be used to the actual problems with the process of providing health care.


----------



## observor 69 (21 Dec 2007)

Flip said:
			
		

> I've said it before - Private vs. public is a specious and incorrect arguement.
> Change the management and budgetary process to suit the need.
> In short, have healthcare run by people who actually have some
> understanding of healthcare and some professional interest in
> making the system work - instead of making the system "profitable".



I know a number of people in the healthcare system and most of them match your recommendation. 
Now the big question "What would you do to improve our public healthcare system?


----------



## Flip (21 Dec 2007)

The answers are simple.

Don't do budgeting the way other government departments do.

Return the control of the system from MHAs to MDs.
Or at least train MHAs differently so they don't think like
bean counters.

http://forums.army.ca/forums/threads/67371/post-646164.html#msg646164

To repeat myself.... ;D

If you run a car dealership, you would be wise to make sure EVERYONE in the place
understood tha SALES was the main effort.  The guy who pushes the broom to
the mechanic in the back HAS to understand that SALES is everyone's paycheck.
I robbed this example from Dale Carneghie's Live for Success.

Hospitals are the same - but more so.
Healthcare is what the place is there for - Nothing else.
The laundry workers and house keeping staff have to 
kept in that loop and made to understand cause vs effect 
of everything they do.

The role of management in all this is obvious.
If the president of a hospital has no medical background,
how can he lead down the right path?  Why would he care 
about any medical issues? How can he judge which
physicians departments need more or less?  The physicians
will advocate for their own.  If management doesn't trust them
how can the right answers be acheived?

Of course unions are in the mix. Change policy to
promote on merit - Not seniority.

Just a few thoughts--- ;D


----------



## observor 69 (21 Dec 2007)

Flip said:
			
		

> The answers are simple.




Oh really !  

This guy tried and there is still controversy about whether he got it right.

http://www.hc-sc.gc.ca/english/care/romanow/hcc0086.html

I respect and admire your replies on this topic Flip. You obviously are well acquainted with all the issues involved.
But after all the studies by some very smart people we still are struggling to get it right.


----------



## Greymatters (21 Dec 2007)

In reply to My comment:


			
				CougarDaddy said:
			
		

> Ahh yes...the classic argument of the fear of an inefficient bureaucracy and the fear of freeriders...well that's still not good enough of a reason to completely dismantle the health care system and replace it with for-profit health insurance companies.



In repoly to I.A.J.Galt's comment:


			
				CougarDaddy said:
			
		

> So please, before you lecture me about how "broken" the UK and France health systems are with simply a "quick google" search as evidence, please try to objectively consider his position (did you even watch the movie?) without resorting to the usual diatribes like calling Moore "Mooreon" and bury me with the usual statistics that can be manipulated to serve either side of the health care debate.



Im a bit confused as to where you stand - you seem to be arguing against both sides of the issue?


----------



## Flip (21 Dec 2007)

> Oh really !



I said simple - I didn't say easy  

To use a crude analogy, and please understand I am civilian.

What if senoir officers in the military were from a different academic and career path
than everyone else? That is, some guys go through a specific course, graduate
and become a Major without any previous mil. experience.

In effect that's how hospital management are hired.
King of the heap, is an MHA or Master's in Hospital Administration degree.
The doctors in my analogy would be relegated to juniour officer ranks.
To make my example more extreme - Warrant officers are never sergents first.
They would be trained as Warrants.

How would the military run then?  ;D

I hope you see my point.
Not easy......

Just because Romanow caused controversy didn't mean he got it right or wrong.
My opinions anyway.....You got what you paid me for..... ;D


----------



## CougarKing (21 Dec 2007)

Greymatters said:
			
		

> Im a bit confused as to where you stand - you seem to be arguing against both sides of the issue?



Greymatters,

I am for improving our current health care system, though I would prefer NOT to have it totally privatized, as you would prefer. Privatization seems to be your universal panacea or "cure-all" for any lack of efficiency such as in this case. And Flip makes an important point by saying that there are some things that are better not left to privatization, as he says here:



> In Alberta the laundry has been done privately for many years.
> The net result isn't that positive.
> $15/hr jobs have been converted into $8/hr jobs with the difference
> going to the business owners. Because the laundry leaves the hospital
> ...


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## Greymatters (21 Dec 2007)

From CougarDaddy:
I am for improving our current health care system, though I would prefer NOT to have it totally privatized, as you would prefer.  

Ah, I see.  Let me clarify - I am not in favor of privatization, as the current health care system (if run effectively and efficiently) should logically be able to support the current population using teh current level of funding we pay into it.  

However, I see a two-tiered health care system as inevitable based on current trends, those being (in addition to those already mentioned): the number of doctors available as general practitioners is not keeping pace with the increasing population; an increasingly longer waiting period for specialist services; the willingness of the middle and upper classes to pay for faster medical care in other countries rather than wait their turn; the ongoing change to centralized health care administration centres that leave small communities isolated and without a dedicated health care practitiioner; and the unwillingness of physicians to work in isolated areas unless they get lots of compensatory money in return.


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## CougarKing (21 Dec 2007)

Greymatters said:
			
		

> I am for improving our current health care system, though I would prefer NOT to have it totally privatized, as you would prefer.
> 
> Ah, I see.  Let me clarify - I am not in favor of privatization, as the current health care system (if run effectively and efficiently) should logically be able to support the current population using teh current level of funding we pay into it.
> 
> However, I see a two-tiered health care system as inevitable based on current trends, those being (in addition to those already mentioned): the number of doctors available as general practitioners is not keeping pace with the increasing population; an increasingly longer waiting period for specialist services; the willingness of the middle and upper classes to pay for faster medical care in other countries rather than wait their turn; the ongoing change to centralized health care administration centres that leave small communities isolated and without a dedicated health care practitiioner; and the unwillingness of physicians to work in isolated areas unless they get lots of compensatory money in return.



Greymatters,

Thanks for clarifying- weren't there problems though with having a two-tier health system mentioned earlier, either here or in the news? I'll just do a little more research into the subject before I go back to this thread.


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## Greymatters (21 Dec 2007)

CougarDaddy said:
			
		

> Greymatters,
> Thanks for clarifying- weren't there problems though with having a two-tier health system mentioned earlier, either here or in the news? I'll just do a little more research into the subject before I go back to this thread.



Yes, and I'll take a look myself for some more info on this as well...


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## I_am_John_Galt (22 Dec 2007)

Sheerin said:
			
		

> Yeah and the best way to maximize the difference is to get people to pay premiums and then once they make a claim, make it exceedingly difficult for them to actually collect.  And of course, once you make a claim your rates go up, just like with car insurance.  Not exactly a user friendly system.


 Only the irretrievably stupid would pay premiums to an insurer that does pay not claims (Darwin might argue that this is another benefit).   



> And yeah, they can cut costs without true impact on revenue.  Once you get sick and have a claim denied it's not like your provider is going to lose any money.  You've already paid X amount since you purchased the insurance.  The only way the insurance company loses money is if they have to pay Y amount for treatment (assuming Y is greater than X).  If Y>X what makes you think the insurance company will want to pay, when they can pay less fighting it?  Plus they have the added advantage in that if it's an acute life threatening illness, it won't be a long drawn out fight.


 More socialist B.S./dogma.  The simple fact of the matter is that any insurer will not last if they cannot deliver the product that is demanded by consumers*: the same cannot be said of our legislated monopoly. 

*Anecdotally, I'm sure you can find examples of people "screwed" by that system, but our existing system is worse (people are NOT receiving timely treatment for time-critical illnesses) AND is unsustainable in any event.



> Valid point, till you remember litigation is a likely outcome of this incident, therefore to protect themselves the director would say anything that would minimize their culpability.  Last thing they need is for her to say "Oh yeah, we're completely at fault for this" and then have to defend that statement in a deposition.


Which acutally brings up another problem: the only recourse of the family of the victim is to sue the government, in a court ruled by the government.
  


> While we're discussing this, do you actually believe something like this wouldn't happen in a US style system?  What do you think would happen if you showed up at a private hospital without your insurance card?


What I think is totally irrelevant: in the U.S. unlike in Canada, it is _illegal _for hospitals to refuse care.


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## Greymatters (23 Dec 2007)

Cougardaddy:

I looked up some papers on two-tiered health care and was a bit disappointed to find most papers from Canadian sources are against two-tiered health care, so that's a point in your favor.  The only solid thing in my favor was public opinion, with polls identifying that regardless of arguments, 55% of people are out there with cash in hand ready to pay for faster medical care.  

In regard to arguments against two-tiered health care, I noted that despite the terms 'research' and 'investigate' and a lot of MD and PhD initials, theres not a lot of meat behind their arguments. The general line is 'its a bad idea' and 'they had problems whenever anyone else tried out', or the big one, 'the US already has it and look how bad their system is'.  You would think such educated minds could give a better argument which only indicates to me that they don't have any solid information to back up their argument other than personal reservations and opinions.  

In summary, if they cant find credible reasons to convince the public its a bad idea, then public opinion will eventually create change.  Its only a matter of time...

Interesting papers:
http://www.healthcoalition.ca/chaohc.pdf - interpretations for Ontario
http://www.afmc.ca/pdf/ACMC_Brief.doc - ACMC response to the idea
http://www.pollara.ca/Library/News/PayforHealth.html - Canadians vote with their opinions on the issue
http://www.thirdworldtraveler.com/Health/PrivateCare_Canada.html - US viewpoint of our system circa 1998
http://www.cbc.ca/news/background/healthcare/public_vs_private.html - CBC article on the issue
http://www.cbc.ca/news/background/healthcare/ - another CBC article on the issue


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## observor 69 (23 Dec 2007)

I_am_John_Galt:

While we're discussing this, do you actually believe something like this wouldn't happen in a US style system?  What do you think would happen if you showed up at a private hospital without your insurance card?

"What I think is totally irrelevant: in the U.S. unlike in Canada, it is illegal for hospitals to refuse care."
-----------------------------------------------------------------------------------------------------------------------------
In the US Emerg will do the absolute minimal to deal with your medical emergency. Then they will get rid of you as quickly as possible. 
Based on many personal observations.
I hope you aren't trying to say that a Canadian hospital will refuse emergency care to anyone who presents them self in Emerg. That would be a tremendous insult to the members of the Canadian medical profession who on a daily basis provide the best care possible to any and all. Again I am talking from personal experience.
In Toronto the two trauma hospitals, Sunnybrook and St.Michaels, provide excellent emergency care. 

http://en.wikipedia.org/wiki/Toronto_St._Michael's_Hospital

http://en.wikipedia.org/wiki/Sunnybrook_and_Women%27s_College_Health_Sciences_Centre


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## Blackadder1916 (24 Dec 2007)

I_am_John_Galt said:
			
		

> What I think is totally irrelevant: in the U.S. unlike in Canada, it is _illegal _for hospitals to refuse care.



My supposition is you are referring to the Emergency Medical Treatment & Labor Act (EMTALA) in the US, however you are only correct as regards a legislative mandate (with the exception of one province).  The Canadian requirement of "duty of care" is based primarily on common law.  It is notable though that the problem of refusing treatment and "patient dumping" was so severe in the U.S. (20 years ago) that Congress felt it necessary to enact legislation as an attempt to curb the practise.  It has not been such an issue (then or now) in Canada.

http://www.emtala.com/faq.htm
http://www.cms.hhs.gov/EMTALA/


> In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.



The legal duty of physicians and hospitals to provide emergency care (CMAJ • February 19, 2002)


> Duty of care
> 
> The duty of care is one component of the law of negligence. In order to establish a defendant's liability in negligence, 4 requirements must be met: the defendant must owe the plaintiff a duty of care; the defendant must fail to meet the standard of care established by law; the plaintiff must suffer an injury or loss; and the defendant's conduct must have been the actual and legal cause of the plaintiff's injury.
> 
> ...



The example provided in post #160 concerned an individual presenting to a "medical centre" in Montreal.  Some cursory research indicates that that this "medical centre" is not a public hospital but more likely a private clinic (doctor's office) probably offering some sort of walk-in service (DIAB).


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## observor 69 (1 Jan 2008)

Brad Sallows said:
			
		

> The reason for public catastrophic insurance is simple, and Fred Reed makes it.  Pay particular attention to his admonition in the last paragraph.
> 
> But argument by anecdote is barely one step above resorting to personal insults.  Regardless, our provincial health care systems will not prolong life at any cost, and will refuse life-extending treatment in some cases.  In a publicly-funded system, the value of your life is explicitly measured in dollars just as it is by private insurers, and sometimes all you will get is a course of pain management until the end.
> 
> But public catastrophic insurance doesn't mean every medical service must be covered, or that nothing may be means-tested, or that medical services should be insulated from a free market.  Canada does not have as good a health care system as is affordable.  Those willing and able to spend more should have every opportunity to do so, in Canada.



Thanks for the column by Fred Reed, very interesting.
I must add that there are many  in Toronto area hospitals like those Fred mentions in his article who don't know or care how to take care of themselves. The norm is to spend thousands to deal with their medical problem and to realease them to repeat it all over again.
While I support our health care system I am always plagued by the comment you make "Those willing and able to spend more should have every opportunity to do so, in Canada." I have watched many very welloff people in line waiting for care for a loved one. Makes you wonder.
Actually I was reminded of this thread by this story in the local paper where I used to live.
http://news.galvestondailynews.com/story.lasso?ewcd=6504490e797f8ba6


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## a_majoor (7 Jan 2008)

Just back from a trip from the States and saw something that pretty much sums it up: a sign on the Windsor side for their regional hospital saying "*No Emergency Services Available*"; while on the US side there are no end of huge billboards extolling vast numbers of hospitals and their services.

"Free" service which is simply unavailable is no service at all.


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## Blackadder1916 (7 Jan 2008)

Thucydides said:
			
		

> Just back from a trip from the States and saw something that pretty much sums it up: a sign on the Windsor side for their regional hospital saying "*No Emergency Services Available*"; while on the US side there are no end of huge billboards extolling vast numbers of hospitals and their services.
> 
> "Free" service which is simply unavailable is no service at all.



My guess is you saw a sign at the "Western Campus" (closer to main route to/from Detroit) of the Windsor Regional Hospital.


> Windsor Regional Hospital is a large *multi-site* health service organization providing Acute Medical and Surgical Services including Emergency, Family Birthing Centre, Neonatal Intensive Care, Paediatric Services, Critical Care (ICU/CCU/Telemetry), Regional Cancer Services (Inpatient Oncology, Windsor Regional Cancer Centre, Breast Health Centre), Children’s Mental Health, Complex Continuing Care, Long Term Care, Mental Health/Addictions and Physical Rehabilitation Services to 400,000 people in Windsor and Essex County.
> 
> The *Met Campus* of Windsor Regional Hospital provides *Acute Care Services* in a modern hospital setting that include:
> 
> ...


 I recall (not too fondly) of transporting a patient in the early 80s from NDMC to the psychiatric facility at what was then the Windsor Western Hospital where his release from the CF was to be effective when I turned him over to that facility.  

As regards the billboards extolling the virtues of Detroit hospitals this piece from The Detroit News may be of interest.


> *Hospitals wage ad war; critics call it unhealthy*
> 
> By Sharon Terlep / The Detroit News Sunday, May 22, 2005
> 
> ...


 more at hyperlink


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## I_am_John_Galt (7 Jan 2008)

The U.S. system is not perfect; I suggested below that we should look more along the lines of Singapore's if we are to be committed to universal healthcare (the wisdom of which I am ignoring for now). Our biggest problem might be the mindless "model for the world" mantra/attitude: fortunately, the rest of world realizes just how crappy our system really is (AFAIK, exactly 0 of them have copied our "model").  A recent posting by MarkOttawa/Mark C. on Daimnation (quoted with his approval):



> *The best health care system in the world...*
> 
> ...is certainly not Canada's. Just Right gives us the guts of a British study:
> 
> ...


 http://www.damianpenny.com/archived/010609.html

And from _his _source:





> Like the NHS to Britons, medicare is a quasi-religion to Canadians. Both systems are regularly subject to the claim that they are the best in the world.
> [...]
> Comparison with the US is ... understandable, but unfortunate. Firstly because opinion of US health care is largely based on myth (many Americans believe these myths too)...
> [...]
> ...


 http://jr2020.blogspot.com/2007/12/canadian-healthcare-lessons-for-britain.html

And from an earlier MarkC post: 





> The time that paramedics spend waiting to hand over patients at Ottawa hospitals continues to get longer, mirroring trends across Canada, despite recent efforts to unplug the bottlenecks that keep ambulances off the road.
> 
> Emergency crews in the first half of 2007 waited an average of 57 minutes and 38 seconds to return to service after arriving at a hospital, according to a report being tabled this week at the community and protective services.
> 
> ...


http://www.damianpenny.com/archived/010199.html quoted from http://www.canada.com/ottawacitizen/news/story.html?id=652f0a76-4315-4195-8009-41361279530b&k=30455


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## tomahawk6 (11 Jan 2008)

We have seen anecdotal evidence of immigrants in Canada leaving their families to work in the US to take advantage of Canadian healthcare/other benefits,they then send money from the US to their family in Canada.


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## geo (11 Jan 2008)

tomahawk6 said:
			
		

> We have seen anecdotal evidence of immigrants in Canada leaving their families to work in the US to take advantage of Canadian healthcare/other benefits,they then send money from the US to their family in Canada.



That sounds more like a fairy tale..... 
Certainly if he is currently an immigrant to Canada he does not have the papers to legaly work in the US.
If he is a landed immigrant to Canada and applies to immigrate to the US, wouldn't he fall under the "quota" of unsponsored immigrants from Canada - and we're pert far down the list of countries US immigration publishes.

If the gent is working in the US, his company would / could / should have it's own health care package... so what's the point of keeping the wife on this side of the border.... or is it a case of having a wife on both sides of the border?


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## observor 69 (11 Jan 2008)

geo said:
			
		

> That sounds more like a fairy tale.....
> Certainly if he is currently an immigrant to Canada he does not have the papers to legaly work in the US.
> If he is a landed immigrant to Canada and applies to immigrate to the US, wouldn't he fall under the "quota" of unsponsored immigrants from Canada - and we're pert far down the list of countries US immigration publishes.
> 
> If the gent is working in the US, his company would / could / should have it's own health care package... so what's the point of keeping the wife on this side of the border.... or is it a case of having a wife on both sides of the border?



Having spent some time in the States Geo the story makes sense. 
If he is working there as an undocumented worker then he has no health care, SOL, so it is best to leave his wife in Canada. Plus he is always living in fear of getting kicked out.
 If he is legal in the US many companies, small and large find it very expensive to pay for coverage for their employees. So they provide a very stingy amount of plan coverage.  For many Americans the decider on whether to move to a better paying job is the new company health care benefits package.


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## geo (14 Jan 2008)

Ahh... the undocumented worker!
But, if he is not "landed" in Canada and is working in the US..... then, the fella would be placing even his Cdn citzenship in jeapordy... could find himself thrown out of both countries.

WRT US companies and their HMOs and their stingy health plans.... that's what makes us social democrats different from those capitalist profit mongers i gusee


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## tomahawk6 (27 Jan 2008)

A shocking development from the UK NHS - doctors want to cut off care for the elderly,heavy drinkers and others who have an unhealthy lifestyle.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/27/nhs127.xml

Don't treat the old and unhealthy, say doctors
By Laura Donnelly, Health Correspondent
Last Updated: 11:52pm GMT 26/01/2008

Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives.

Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.

doctors say should not be funded by the state.

The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "outrageous" and "disgraceful". 

About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt.

Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.

The Government announced plans last week to offer fat people cash incentives to diet and exercise as part of a desperate strategy to steer Britain off a course that will otherwise see half the population dangerously overweight by 2050.

Obesity costs the British taxpayer £7 billion a year. Overweight people are more likely to contract diabetes, cancer and heart disease, and to require replacement joints or stomach-stapling operations. 

Meanwhile, £1.7 billion is spent treating diseases caused by smoking, such as lung cancer, bronchitis and emphysema, with a similar sum spent by the NHS on alcohol problems. Cases of cirrhosis have tripled over the past decade.

Among the survey of 870 family and hospital doctors, almost 60 per cent said the NHS could not provide full healthcare to everyone and that some individuals should pay for services.

One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements.

Tony Calland, chairman of the BMA's ethics committee, said it would be "outrageous" to limit care on age grounds. Age Concern called the doctors' views "disgraceful".

Gordon Brown promised this month that a new NHS constitution would set out people's "responsibilities" as well as their rights, a move interpreted as meaning restrictions on patients who bring health problems on themselves. The only sanction threatened so far, however, is to send patients to the bottom of the waiting list if they miss appointments.

The survey found that medical professionals wanted to go much further in denying care to patients who do not look after their bodies.

Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant, while one in five said taxpayers should not pay for "social abortions" and fertility treatment. 

Paul Mason, a GP in Portland, Dorset, said there were good clinical reasons for denying surgery to some patients. "The issue is: how much responsibility do people take for their health?" he said.

"If an alcoholic is going to drink themselves to death then that is really sad, but if he gets the liver transplant that is denied to someone else who could have got the chance of life then that is a tragedy." He said the case of George Best, who drank himself to death in 2005, three years after a liver transplant, had damaged the argument that drinkers deserved a second chance.

However, Roger Williams, who carried out the 2002 transplant on the former footballer, said doctors could never be sure if an alcoholic would return to drinking, although most would expect a detailed psychological assessment of patients, who would be required to abstain for six months before surgery.

Prof Williams said: "Less than five per cent of alcoholics who have a transplant return to serious drinking. George was one of them. It is actually a pretty successful rate. I think the judgment these doctors are making is nothing to do with the clinical reasons for limiting such operations and purely a moral decision."

Katherine Murphy, from the Patients' Association, said it would be wrong to deny treatment because of a "lifestyle" factor. "The decision taken by the doctor has to be the best clinical one, and it has to be taken individually. It is morally wrong to deny care on any other grounds," she said.

Responding to the survey's findings on the treatment of the elderly, Dr Calland, of the BMA, said: "If a patient of 90 needs a hip operation they should get one. Yes, they might peg out any time, but it's not our job to play God."


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## Brad Sallows (27 Jan 2008)

So a public health care system has become so constrained by finances that it is reduced to perverting triage.  Nowhere in the article did it mention that the uninsured should no longer have to pay insurance (taxes).


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## Flip (27 Jan 2008)

When Canadians talk about a "two tiered health system" I think this is our future.
The notion that the upper tier won't affect the existing system is specious.
Clearly, in the UK there is a funding issue but in Canada decisions like this are made
quietly every day.  You miss appointments, you get bumped to the bottom of the list.
The article sounds more egregious than it really is, IMHO.

I would suggest that in the US the distortions of uniformity of care are more telling.

The rich guy with a shot liver has a far better chance of receiving care than 
the migrant worker or the victim of an HMO.  The insurance people decide
what's possible. If a condition is deemed to be pre-existing, you have a problem.
To that end, I hope the next president of the US shows some leadership with 
respect to healthcare.  My vote would go to a republican but it's a fair bet
a democrat gets to sit in the oval office.  Here's hoping.....Cheers all!  ;D


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## tomahawk6 (27 Jan 2008)

The democrats are socialists. They want national healthcare to control people live's and you do that by taking more money to fund the system. We have social security which will be bankrupt in a few years. The politicians cant decide on cutting benefits because to do so may hurt them at the polls so they dont make a decision. Samething would happen to national healthcare.There is no free lunch. At some point there would be rationing of healthcare and waiting lists. There is a trend in the US that if you pay your medical bills at the time of service you get a 50% discount off the bill. Medicare/Medicaid tell doctors what they will charge for any given procedure. I think if we went back to a pure free market system medical bills would be reduced.


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## Flip (27 Jan 2008)

> I think if we went back to a pure free market system medical bills would be reduced.



Sorry T6  - I agree with you on just about every other topic.

I have to disagree here.  Ever walk into a plastic surgeons office?
Not like most doctor's offices - very posh and lots of fashion mags around.

My point is there is a profit motive here and demand is created and not simply 
met in this environment.  In a pure private system the object is NOT to fill a need.
The object of an enterprize is to separate people from their money.

Health care is too important to leave to a forces of a free market.


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## a_majoor (27 Jan 2008)

Flip, in any private or free market system, supply is created to meet demand. This is true for every conceivable product or service, from cars to healthcare.

While there is an element of marketing to create greater demand for products and services, this is also true for any good or service. Think about Coke vs Pepsi or the adds you see for fast food. Perhaps your objection stems from the idea that plastic surgery is a discretionary expenditure, and people could/should make wiser choices. Well who are you or I to say what is a "wise" choice?   

The market can provide the signals for rational allocation of resources to various wants and needs (there is no "Dental Care Crisis" in Canada), so we should advocate for a reduction in the role of governments and bureaucracies in health care.


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## I_am_John_Galt (27 Jan 2008)

Flip said:
			
		

> I have to disagree here.  Ever walk into a plastic surgeons office?
> Not like most doctor's offices - very posh and lots of fashion mags around.
> 
> My point is there is a profit motive here and demand is created and not simply
> ...



Spare us the propaganda: in any private system, profit is what you are left with when you can produce a good or service for less cost than someone else is willing to pay for it!  Fundamentally, a *GOOD *thing.  The object is without a doubt to fill a need: if no-one needs or wants what you have to sell, you *have* to produce something else (that people want or need) or you will be out of business.  This is the essence of free enterprise and it's that simple.



> Health care is too important to leave to a forces of a free market.


Health care is too important to leave to the whims of the politicians!


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## Flip (27 Jan 2008)

> Health care is too important to leave to the whims of the politicians!



We can at least agree here.

When I contemplate maximizing my profits ( I'm self employed ). I have two choices.

1. Reduce costs - ie. services rendered
2. Increase revenue - ie. push the price up

All business will do a combination of the above.
In a pure business model ( which you are advocating ) The physician is in the position
to avoid expensive procedure and bleed the hell out of people on the simple stuff.
When competition prevents this we would move toward services they cannot.
ie. plastic surgery.
Ultimately, you advocate reducing healthcare to a simple equation in which there is
little motive or room for improving peoples lives.

Add the complication of insurance companies and drug companies and you have
more hands out for a limited consumer dollar.  In spite of flashy adds that promise
more, the game is to actually deliver less. Ever suffer buyer's remorse?
Ever have an insurance adjuster deny a claim?  
Ever find that a drug fails to provide the benefits promised?
I can say yes to all three.
I can also say I don't want to have this happen when I'm in Hospital


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## Reccesoldier (27 Jan 2008)

> 1. Reduce costs - ie. services rendered


 - or become more innovative and find practical methods of delivering the SAME services.  This makes much more sense from a business standpoint as you will not loose your clientele to someone who does not think with the same pessimism as you demonstrated in the original summation.


> 2. Increase revenue - ie. push the price up


 - again, this is not the ONLY solution as you have implied.  There may be scope to work more, or work smarter to provide the SAME revenue (or higher) without having your business pushed out of the market by demanding an unwarranted increase in price.


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## Flip (27 Jan 2008)

In the context of insufficient resources and too few physicians, I think my examples stand.

If a GP is payed $35 per visit in a highly regulated system, it's reasonable to assume 
removal of regulation will bring about a price increase.  I suggest Alberta's energy
deregulation as an example.  My gas and electricity costs have doubled since deregulation.
These are costs I have to pass along.  Removing regulation in the complex context of health 
care is likely to have a cascading effect.


----------



## a_majoor (27 Jan 2008)

Flip said:
			
		

> When competition prevents this we would move toward services they cannot.
> ie. plastic surgery.



I don't know where you studied economics, but that statement doesn't make sense. 

Monopoly situations attract new competitors who are after the perceived monopoly rents. Monopolies can only persist with the backing of State power to prevent the entry of competitors.

Competition does not prevent the creation of innovative new goods and services (which you seem to be implying), but in fact is the driving force for creating new goods and services. It also brings common goods and services to low income people, since these items become commodities. (Think about the price of computers in 1981 compared to today).

So it would seem that market forces would work to increase innovation available in the medical world and commodify medical practices and services. I'll take the deal.


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## Flip (27 Jan 2008)

> I don't know where you studied economics, but that statement doesn't make sense.



Sorry-You are correct.  I should have said    that ratcheting up prices will not happen where there are many practitioners and this will cause some to move into more specialized fields where the margins are better.  Does that fix it?

Remember, it takes about a decade for a specialist to be trained and given current 
conditions I wouldn't expect any free market miracle. 

There has been a deliberate effort on the part of government to hold costs down.
If these controls are removed we will find a new normal.

I don't think we can compare computers to health care.
Computers are designed to sold.  As such, longevity of computers and all 
consumer products have declined somewhat we can reasonably expect to
 replace a computer in a short time. 
This time frame has grown shorter. 
The other issue is that computer purchases are largely optional.  
Healthcare is not. To make your commoditization comment more relevant 
I think we would have to consider flying to India for a kidney transplant, or
China for a hip replacement.

I think it's more reasonable to compare healthcare to public utilities that have 
been privatized.  The results here have not been beneficial.


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## Flip (27 Jan 2008)

> Quote
> 1. Reduce costs - ie. services rendered
> - or become more innovative and find practical methods of delivering the SAME services.



Recce Soldier,

What methods do you imagine they would develop that they are not free to develop
now?  I can describe several initiatives that have occured in the existing system.


----------



## Reccesoldier (28 Jan 2008)

Flip said:
			
		

> Recce Soldier,
> 
> What methods do you imagine they would develop that they are not free to develop
> now?  I can describe several initiatives that have occured in the existing system.



A great deal of what we spend on Healthcare is currently eaten up by a huge and inneficcient bureaucracy.  I'm not a Doctor so I was not commenting on medical advancements.

Also is the lack of Doctors that you alluded to a result of not enough doctors being trained or is it that the doctors that are being trained are exercizing their choice in a free market and going where they can make more money and pay less tax?  It's interesting to note when considering this that 30% of our taxes in this country go to healthcare... 

Cause, meet effect.


----------



## Flip (28 Jan 2008)

So, I think we can agree that the trouble with healthcare today is -
drum roll please - The suits who are mis-managing it .......

The bloated bureaucracy and the shortage of training can be directly
linked to bad choices made by government in the 80's and 90's.

The trend to train fewer nurses and doctors was a collective 
NorthAmerican wide mistake.  There's why they could make so 
much more by emigrating.

My point has always been that if we manage the system more
responsibly we can have the healthcare system we are paying for.

The drive to privatize(in my opinion) has been a very destructive 
distraction from the real issue.  As a tax payer, I'm not getting what 
I'm paying for and I wanna talk to the management! :rage:


----------



## Reccesoldier (28 Jan 2008)

Flip said:
			
		

> As a tax payer, I'm not getting what
> I'm paying for and I wanna talk to the management! :rage:



And the management has heard your complaint, but because you can't vote not to pay your taxes they just smile and nod.

Thanks for participating.  See you next election where you will have the opportunity to repeat your first mistake and relinquish control to a new set of officials who will also smile and nod when you complain.


----------



## Flip (28 Jan 2008)

> See you next election where you will have the opportunity to repeat your first mistake and relinquish control to a new set of officials who will also smile and nod when you complain.


 :cheers:

Actually, we might get some change here in Alberta.
King Ralph is gone and we might just NOT continue the
PC dynasty.

Sorry, I don't assume a large corporation is going to be any
more responsive to my issues or any one else's.
Just like the energy deregulation - I'm free to sign
a contract and pay someone else more if I don't like
how my gas is packaged.  ;D


----------



## a_majoor (28 Jan 2008)

Many of the privitizations were botched because governments remained large and intrusive partners in the enterprise. Perhaps the biggest "booby prize" goes to California, which wrote degegulation rules in such a way as to privitize PG&E but prevent the entry of competitors to the energy market. (Most of the energy sector deregulations across N America suffer from similar flaws, but not to the same extent). ENRON discoverd a loophole when PG&E was unable to keep up with demand, and "wheeled" power from neighbouring states to the California grid at peak prices. Regulatory failure rewarded ENRON with great profits, but of course the spin wasn't against the stupid State Representatives and Bureaucrats who created the situation in the first place, but against the company which exploited their mistake.

Suggesting hapless Canadian politicians and bureaucrats would not make similar errors of comprable magnitude is a touching expression of faith, but real world evidence is not in favor of that proposition (to say the least).


----------



## Reccesoldier (28 Jan 2008)

Flip said:
			
		

> :cheers:
> 
> Actually, we might get some change here in Alberta.
> King Ralph is gone and we might just NOT continue the
> ...



You continue to refer to the energy deregulation do you honestly believe the price you pay for energy is significantly and artificially inflated today?  I don't.  To do so is to disregard the fact that our energy consumption has outpaced our supply.


----------



## Flip (28 Jan 2008)

> You continue to refer to the energy deregulation do you honestly believe the price you pay for energy is significantly and artificially inflated today?


At my business and at home I have been offered contracts rather than to continue with the default program set out by government.
Consumers in Alberta have been badgered and pressured for years to sign on the dotted line.
One scheme even mailed out $100 cheques - if it's cashed , we have a deal!

In EVERY instance and example, the deal offered would have cost me significantly more.

I also see actual consumption figures removed from bills and user fees increased.
So, Yes I would expect to pay more for an alternate health care system, 

Edit to add;

Last month my wife and I bought life and critical care insurance.
Last week we got the contracts from the insurance company.
We had 10 days to cancel - We got the papers after many changes to 
our application and long after the cancelation date.

We got boned.
We now have to pay significantly more than we signed on for.

If you think this is a good thing to add to our healthcare riddle - I Don't agree.


----------



## Reccesoldier (28 Jan 2008)

Flip said:
			
		

> At my business and at home I have been offered contracts rather than to continue with the default program set out by government.
> Consumers in Alberta have been badgered and pressured for years to sign on the dotted line.
> One scheme even mailed out $100 cheques - if it's cashed , we have a deal!
> 
> ...



So you have a choice to lock in or ride the market price and you _*choose*_ not to lock in.  Good for you. 

Now as far as healthcare is concerned you prefer to be locked in to a system that does not provide what it says it will, will not give you a choice about what is covered and what is not and can not give you more (or less) value for your money based on your choice.  It will not show you the actual consumption figures and every year your user fees (taxes) are increased without a proportionate increase in service.

You're beginning to sound a little bi-polar there Flip.


----------



## RangerRay (28 Jan 2008)

Ok...I've seen the back-and-forth of Canadian vs. American systems...

Now what I would like to know, is why can we not adopt European mixed systems with low public costs and superior treatment, care and outcomes?  In places like France, Germany and Switzerland, everyone has quick access to private and public facilities, paid for by public funds.  No one goes without, and public healthcare costs are under control, compared to our fair Dominion.

If I recall correctly, last week a study compared our outcomes to other industrialised nations.  We were near the bottom and European countries were at the top.  And we spend a far greater chunk of our government budgets on healthcare than the Europeans do.

I'm sick of this asinine "us and them" debate.  As far as I'm concerned, it's not an either/or (100% public/100% free market) debate.  Why will European solutions not work here?


----------



## George Wallace (28 Jan 2008)

Well, for one thing, they aren't burdened by incompetent bureaucracies creating newer more efficient ways to mismanage our files, money and services in creating even more bureaucracies who hire consultants to study why they haven't become more efficient, only to not pay any heed to said papers or to create more consulting jobs to study what has already been studied in order to find a different solution, thus needing an even larger bureaucracy to administer creating even more jobs, sucking up more from the Public Purse.    ;D


----------



## Flip (28 Jan 2008)

> I'm sick of this asinine "us and them" debate.  As far as I'm concerned, it's not an either/or (100% public/100% free market) debate.  Why will European solutions not work here?



That's probably a fair point.  We have turned this into a public vs. private debate
and I have said that it's the wrong question in addition to the wrong answer.

To be honest I don't know much about the european systems of healthcare.
But I do know "Americanizing" our system is a non-starter.

I guess it's worth more study.

I hit the "post" button and George has jumped in!

I think there is an issue of proximity - The American system is bound to have some 
effect on ours. Many Canadian physicians have worked in the American system and 
many of the supplies come from the same sources.  In a sense our system is in 
competion with theirs. And there is also the simple truth that outcomes have been affected by 
artificial means.  Chop the budget = close the beds = people die out in the hall.


----------



## Reccesoldier (28 Jan 2008)

RangerRay, your answer is found in Flip's post.  

Flip, I'm sorry but I'm going to incorrectly use this for a moment 



			
				Flip said:
			
		

> But I do know "Americanizing" our system is a non-starter.



That line, and that line alone would be used by (in my opinion) every special interest and all three opposition parties in the current HOC to beat the Canadian population about the head and shoulders until they believed that was indeed what it is all about.

If you don't believe me recall if you will the Harris governments plan to have a private for profit company to build and administer the new Royal Ottawa Hospital.  I can't tell you how many times I heard that phrase or sound bites with that sentiment during the election.  Hell there were even claims that the buildings private ownership would encourage two tier healthcare.  :blotto:

I'd like to see what the free market could do, but I would not be against a compromise like, it seems, the left is.


----------



## Flip (28 Jan 2008)

Damn!


> That line, and that line alone would be used by (in my opinion) every special interest and all three opposition parties in the current HOC to beat the Canadian population about the head and shoulders until they believed that was indeed what it is all about.


You got me!

I think compromise is not so much the issue as information is.

Let me rephrase if you would. 

Privatization for privatisation's sake is the practice of idiology - miss spelling intended  
In Alberta that's exactly what's gone on.

Sorry if I come out like a knob, That's my perspective.


----------



## observor 69 (29 Jan 2008)

Flip said:
			
		

> Damn!You got me!
> 
> I think compromise is not so much the issue as information is.
> 
> ...



Flip, once again thanks for the time and energy you are devoting to this discussion on universal health care. 
I find your contributions clear and informed.


----------



## Blackadder1916 (29 Jan 2008)

This position paper by the American College of Physicians recently published in Annals of Internal Medicine may be of interest to some.  It is a comprehensive (and lengthy) article.  While it is from an American perspective, some of it can be applied to the Canadian debate on health care reform.

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries


> This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. *The second compares it with health care in other countries.* The concluding section proposes lessons that the United States can learn from these countries and recommendations for achieving a high-performance health care system in the United States. The articles are based on a position paper developed by the American College of Physicians' Health and Public Policy Committee. This policy paper (not included in this article) also provides a detailed analysis of health care systems in 12 other industrialized countries.
> 
> Although we can learn much from other health systems, *the College recognizes that our political and social culture, demographics, and form of government will shape any solution* for the United States. This caution notwithstanding, we have identified several approaches that have worked well for countries like ours and could probably be adapted to the unique circumstances in the United States.



The "political and social culture, demographics, and form of government" is, in my opinion, a  very significant factor (maybe the most important factor) in the how and why the health care system of the United States (and other countries) developed as it has.  It should be kept in mind that this also applies to Canada, maybe more so than any other country.  Not only do we see ourselves in our own mirror, we (more than any other country) have a background reflection of our neighours to the south to which we always compare ourselves.  Yes, there are better performing health care models in other countries and yes, some of the things they are doing may be the answer to some of our problems.  But keep in mind that their systems (like ours) developed from their political and social culture and must be examined in that light.


----------



## Flip (30 Jan 2008)

Baden Guy, Thankyou for your encouragement and support!

Backadder thankyou for the most relevant post on this thread in a while!  

This thread is the only one where I don't feel like I might as well be
in the silly buggers club. 

I'm not a troll, I am a human being!   ;D
( with humble apologies to John Merrick )


----------



## observor 69 (30 Jan 2008)

Thanks for the link Blackadder, very interesting article. Maybe there is hope for those dam Yankees yet. 

As you say heath care that Americans receive is particular to their cultural and historical background.

It is sad that a country of such wealth has so many receiving inadequate care as cited in the article.


----------



## observor 69 (22 Feb 2008)

Now this I find interesting. A lot of this article hits on the conundrum a universal care system faces.
You haave the money to buy appropriate timely care for your loved one but our system has no means to allow that to happen.

http://www.nytimes.com/2008/02/21/world/europe/21britain.html?em&ex=1203829200&en=4080ecd5da2fc01c&ei=5087%0A

--------------------------------------------------------------------------------

February 21, 2008
Paying Patients Test British Health Care System 
By SARAH LYALL
LONDON — Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service. 

Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.

One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment. 

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor. 

“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview. 

“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford. 

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones. 

Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.

“That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said. 

But Mrs. Hirst, 57, whose cancer was diagnosed in 1999, went to the news media, and so did other patients in similar situations. And it became clear that theirs were not isolated cases. 

In fact, patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free. 

“Of course it’s going on in the N.H.S. all the time, but a lot of it is hidden — it’s not explicit,” said Dr. Paul Charlson, a general practitioner in Yorkshire and a member of Doctors for Reform, a group that is highly critical of the health service. Last year, he was a co-author of a paper laying out examples of how patients with the initiative and the money dip in and out of the system, in effect buying upgrades to their basic free medical care. 

“People swap from public to private sector all the time, and they’re topping up for virtually everything,” Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor.

“Or they’ll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.,” Dr. Charlson said.

In his paper, he also wrote about a 46-year-old woman with breast cancer who paid $250 for a second opinion when the health service refused to provide her with one; an elderly man who spent thousands of dollars on a new hearing aid instead of enduring a yearlong wait on the health service; and a 29-year-old woman who, with her doctor’s blessing, bought a three-month supply of Tarceva, a drug to treat pancreatic cancer, for more than $6,000 on the Internet because she could not get it through the N.H.S. 

Asked why these were different from cases like Mrs. Hirst’s, a spokeswoman for the health service said no officials were available to comment. 

In any case, the rules about private co-payments, as they are called, in cancer care are contradictory and hard to understand, said Nigel Edwards, the director of policy for the N.H.S. Confederation, which represents hospitals and other health care providers. “I’ve had conflicting advice from different lawyers,” he said, “but it does seem like a violation of natural justice to say that either you don’t get the drug you want, or you have to pay for all your treatment.” 

Karol Sikora, a professor of cancer medicine at the Imperial College School of Medicine and one of Dr. Charlson’s co-authors, said that co-payments were particularly prevalent in cancer care. Armed with information from the Internet and patients’ networks, cancer patients are increasingly likely to demand, and pay for, cutting-edge drugs that the health service considers too expensive to be cost-effective. 

“You have a population that is informed and consumerist about how it behaves about health care information, and an N.H.S. that can no longer afford to pay for everything for everybody,” he said. 

Professor Sikora said oncologists were adept at circumventing the system by, for example, referring patients to other doctors who can provide the private medication separately. As wrenching as it can be to administer more sophisticated drugs to some patients than to others, he said, “if you’re a doctor working in the system, you should let your patients have the treatment they want, if they can afford to pay for it.” 

In any case, he said, the health service is riddled with inequities. Some drugs are available in some parts of the country but not in others. Waiting lists for treatment vary wildly from place to place. Some regions spend $280 per capita on cancer care, Professor Sikora said, while others spend just $90. 

In Mrs. Hirst’s case, the confusion was compounded by the fact that three other patients at her hospital were already doing what she had been forbidden to do — buying extra drugs to supplement their cancer care. The arrangements had “evolved without anyone questioning whether it was right or wrong,” said Laura Mason, a hospital spokeswoman. Because their treatment began before the Health Department explicitly condemned the practice, they have been allowed to continue. 

The rules are confusing. “It’s quite a fine line,” Ms. Mason said. “You can’t have a course of N.H.S. and private treatment at the same time on the same appointment — for instance, if a particular drug has to be administered alongside another drug which is N.H.S.-funded.” But, she said, the health service rules seem to allow patients to receive the drugs during separate hospital visits — the N.H.S. drugs during an N.H.S. appointment, the extra drugs during a private appointment. 

One of Mrs. Hirst’s troubles came, it seems, because the Avastin she proposed to pay for would have had to be administered at the same time as the drug Taxol, which she was receiving free on the health service. Because of that, she could not schedule separate appointments. 

But in a final irony, Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all — paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense. 

Mrs. Hirst is pleased, but up to a point. Avastin is not a cure, but a way to extend her life, perhaps only by several months, and she has missed valuable time. “It may be too bloody late,” she said. 

“I’m a person who left school at 15 and I’ve worked all my life and I’ve paid into the system, and I’m not going to live long enough to get my old-age pension from this government,” she added. 

She also knows that the drug can have grave side effects. “I have campaigned for this drug, and if it goes wrong and kills me, c’est la vie,” she said. But, she said, speaking of the government, “If the drug doesn’t have a fair chance because the cancer has advanced so much, then they should be raked over the coals for it.”


----------



## Flip (22 Feb 2008)

Baden,

So sad, but there are two thoughts that occur.......

The first and obvious. This is a case where the system is being managed to death.
Thank an MHA. >

Second and parhaps a little cold. If you take the flip side of her argument and 
consider the many more people who are or would be denied treatment because 
they can't pay for it......

Well the calculus is grim, but patient mortality is reduced from anecdotes to 
numbers for a reason.


----------



## observor 69 (22 Feb 2008)

Flip said:
			
		

> Baden,
> 
> So sad, but there are two thoughts that occur.......
> 
> ...



Of course this is with the appreciation that many people in Canada are already going across the border to practice their own version of two tier care.
And second that many provinces are delisting many parts of the health program that require out of pocket expense.
Oh and third, someone real close to me is a MHA.


----------



## a_majoor (22 Feb 2008)

Socialized medicine in the UK: meeting their targets

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=515332&in_page_id=1770



> *A&E patients left in ambulances for up to FIVE hours 'so trusts can meet government targets'*
> By DANIEL MARTIN - More by this author » Last updated at 01:01am on 18th February 2008
> 
> Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets.
> ...


----------



## Flip (23 Feb 2008)

> Oh and third, someone real close to me is a MHA.



Sorry Baden, It was probably an unfair comment.
It's probably more appropriate to blame the way the budgetary process works 
and the level of government funding.

Mismanagement  is what is wrong - and it occurs in private healthcare too.
The difference is that denial of patient care has different consequences.

In a public system, the failures make news.


----------



## a_majoor (24 Feb 2008)

Flip said:
			
		

> Mismanagement  is what is wrong - and it occurs in private healthcare too.



In private business (of any kind), mismanagement is punished by loss of market share, profits and eventually the jobs of the mismanagers. In "public sector" there are very few consequences for mismanagement, hence no action to correct deficiencies.


----------



## a_majoor (4 Mar 2008)

Canada needs "American health care" in order to be able to provide health care to Canadians. Too bad if you live too far from the border:

http://www.theglobeandmail.com/servlet/story/RTGAM.20080301.wheart01/BNStory/National/home?cid=al_gam_mostview



> *Why Ontario keeps sending patients south*
> 
> LISA PRIEST
> 
> ...


----------



## J.J (4 Mar 2008)

It is a daily event in Windsor to shut down a lane in the Tunnel for an ambulance which is going to a Detroit area hospital with a priority patient, lights and sirens etc. It is also not uncommon to have an ambulance with an American patient from Detroit going to a Windsor hospital for treatment. Much much more common for the patients to go south than north though.


----------



## Edward Campbell (5 Mar 2008)

*Apologies* in advance to some members, but:  Bingo!

This article, reproduced under the Fair Dealing provisions (§29) of the Copyright Act from today’s _Ottawa Citizen_, pretty much sums up what I think is wrong with Canada’s health care ‘system’ – ineptitude of a _high_ order:

http://www.canada.com/ottawacitizen/news/city/story.html?id=e2e7ebe6-7066-42ee-801b-30f0ab2c9067&p=2


> Injured? just try getting a bed
> 
> Kelly Egan, The Ottawa Citizen
> 
> ...



The ineptitude starts at the level of the _ordinary Canadians_ who, thanks to a poor education mixed with Lliberal doses of Marxist propaganda believe that the ‘problem’ with healthcare is overpaid doctors. If only, Joe Lunchbucket thinks, we could conscript those rich doctors, all would be well. Codswallop!

The sundry governments, advised by legions of absolutely useless Marxist _health-care economists_ (who *are* a total waste of money), are so terrified of the ill-informed ‘people’ that they spend most of their time pursuing inane and wasteful solutions to non-problems.

The Ontario Hospital Association is right: the solution to hospital overcrowding, which is also the solution to many of the wait time issues is home care. The existing home care regime is madness – “a tale told by an idiot” and so on. It is ‘designed’ with a huge dose of old fashioned Scottish niggardliness as its guiding principle: the aim is to ensure that no one gets ‘something for nothing’ (thus it appeals to the peasant-like greed and cunning that are at the heart of all Canadian social programmes). A few years ago, when my mother was dying at home, I accepted the 14 hours per week of “home care” simply because that represented $15,000/year I did not have to pay (in cash, under the table) for private duty nursing – which ended up costing well in excess of $175,000 in the final year of her life.

(She was “admissible” as one of those “bed blockers” but we (my mother, herself, my ex-wife, leader of the private duty nursing team, and I) were not persuaded that she would receive anything like “proper” _*care*_, even at $35,000+/year for a private room and another $70,000/year for extra nursing staff for in hospital day-by-day care. The ‘system’ estimated a three year wait for anything like what we and her physician regarded as adequate or even minimally acceptable care.)

I remain convinced that, under normal circumstances, bureaucrats, however smart and well intentioned, are *incapable* of providing operationally and cost effective management to large, complex enterprises – like health care systems. (Yes, bureaucrats ‘won’ the 2nd World War, but those were not normal circumstances and I doubt anyone thinks we they ran WWII in anything like a cost effective manner.) I am equally persuaded that even the most poorly managed public/private system – but, anything but the US model – would provide better care for more people at lower costs.

I know that some Milnet.ca members work in the ‘system’ and I have no doubt you are capable and you work hard but, while I intend no offence, I am convinced that you are failing because the ‘system’ within which you work is fundamentally flawed in its design (Canada Health Act) and management (provincial ministries/bureaucracies).


----------



## Edward Campbell (11 Mar 2008)

Further evidence, reproduced under the Fair Dealing provisions (§29) of the Copyright Act from today’s _Globe and Mail_ that the health care _system_, in Ontario at least, isn’t systematic:

http://www.theglobeandmail.com/servlet/story/RTGAM.20080311.wtumourr11/BNStory/specialScienceandHealth/home


> Even huge tumour can't secure care in Ontario
> Woman must cover cost of U.S. surgery
> 
> LISA PRIEST
> ...



In this case there is too much system and not enough health care including, I’m *guessing*, too few gynecological oncologists – probably a result of the frustrations of practicing medicine within the Canadian _system_.

Why do countries as diverse as France, Italy, Japan and the UK spend less (per capita) than we do on health care but have, according to the World Health Organization, better overall healthcare system performance? There’s something wrong with the _system_ and, at the very heart of the system we find the Canada Health Act. Canadians, like everyone else in the OECD, want and are willing to pay for a efficient, effective *public* (universal) healthcare system; the pity is they don’t have one and governments (the plurality of actors being part of the problem) are unable to manage such a large, dynamic and complex creature.


----------



## I_am_John_Galt (11 Mar 2008)

E.R. Campbell said:
			
		

> Why do countries as diverse as France, Italy, Japan and the UK spend less (per capita) than we do on health care but have, according to the World Health Organization, better overall healthcare system performance?



That's easy ... it's because there are so damn many 'experts' around that _feel _that outcomes should take a back seat to socialist dogma!  Case in point: 





> P*rivate waiting list illegal, health critic says*
> Vancouver Sun
> Published: Tuesday, March 11, 2008
> 
> ...


 http://www.canada.com/vancouversun/news/westcoastnews/story.html?id=bc0b2090-d363-491c-9292-4cfeda079582


----------



## observor 69 (11 Mar 2008)

E.R. Campbell said:
			
		

> Further evidence, reproduced under the Fair Dealing provisions (§29) of the Copyright Act from today’s _Globe and Mail_ that the health care _system_, in Ontario at least, isn’t systematic:
> 
> http://www.theglobeandmail.com/servlet/story/RTGAM.20080311.wtumourr11/BNStory/specialScienceandHealth/home
> In this case there is too much system and not enough health care including, I’m *guessing*, too few gynecological oncologists – probably a result of the frustrations of practicing medicine within the Canadian _system_.
> ...



More recent states do not show a significant lead in performance. Just a quick look using this table, we appear to be on par in most areas with the UK.

http://www.who.int/whosis/whostat2007_1mortality.pdf


----------



## a_majoor (19 Mar 2008)

Debt or taxes:

http://westernstandard.blogs.com/shotgun/2008/03/a-matter-of-lif.html



> *Canadian health care: a matter of life or debt?*
> 
> Often in Canada, we hear fear mongering about an "American-style" health care system: "We don't want an American system. Health care should be free! You shouldn't have to make the decision to mortgage your house or die!" they'll say.
> 
> ...


----------



## CougarKing (1 Apr 2008)

Apparently, the majority of America's doctors- about 60%- reportedly now support Universal Health Care Coverage in the United States.

http://www.reuters.com/article/healthNews/idUSN3143203520080331



> *Doctors support universal health care: survey*
> Mon Mar 31, 2008 5:14pm EDT
> WASHINGTON (Reuters) - More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea, according to a survey published on Monday.
> 
> ...


----------



## observor 69 (6 Apr 2008)

http://www.nytimes.com/2008/04/05/us/05doctors.html?em&ex=1207627200&en=7e890db1d78a1061&ei=5087%0A

April 5, 2008
In Massachusetts, Universal Coverage Strains Care 
By KEVIN SACK
AMHERST, Mass. — Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients. 

Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinson’s next opening for a physical is not until early May — of 2009. 

In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role. 

Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance. 

Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.

Here in western Massachusetts, Dr. Atkinson’s bustling 3,000-patient practice, which was closed to new patients for several years, has taken on 50 newcomers since she hired a part-time nurse practitioner in November. About a third were newly insured, Dr. Atkinson said. Just north of here in Athol, the doctors at North Quabbin Family Physicians are now seeing four to six new patients a day, up from one or two a year ago.

Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months.

“It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.” 

Whether there is a national shortage of primary care providers is a matter of considerable debate. Some researchers contend the United States has too many doctors, driving overutilization of the system. 

But there is little dispute that the general practice of medicine is under strain at a time when there is bipartisan consensus that better prevention and chronic disease management would not only improve health but also help control costs. With its population aging, the country will need 40 percent more primary care doctors by 2020, according to the American College of Physicians, which represents 125,000 internists, and the 94,000-member American Academy of Family Physicians. Community health centers, bolstered by increases in federal financing during the Bush years, are having particular difficulty finding doctors.

“I think it’s pretty serious,” said Dr. David C. Dale, president of the American College of Physicians and former dean of the University of Washington’s medical school. “Maybe we’re at the front of the wave, but there are several factors making it harder for the average American, particularly older Americans, to have a good personal physician.”

Studies show that the number of medical school graduates in the United States entering family medicine training programs, or residencies, has dropped by 50 percent since 1997. A decadelong decline gave way this year to a slight increase in numbers, perhaps because demand is driving up salaries.

There have been slight increases in the number of doctors training in internal medicine, which focuses on the nonsurgical treatment of adults. But the share of those residents who then establish a general practice has plummeted, to 24 percent in 2006 from 54 percent in 1998, according to the American College of Physicians.

The Government Accountability Office reported to Congress in February that the per capita supply of primary care physicians actually grew by 12 percent from 1995 to 2005, at more than double the rate for specialists. But the report also revealed deep shifts in the composition of primary care providers.

While fewer American-trained doctors are pursuing primary care, they are being replaced in droves by foreign medical school graduates and osteopathic doctors. There also has been rapid growth in the ranks of physician assistants and nurse practitioners. 

A. Bruce Steinwald, the accountability office’s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44. 

Numerous studies, in this country and others, have shown that primary care improves health and saves money by encouraging prevention and early diagnosis of chronic conditions like high blood pressure and diabetes. Presidential candidates in both parties stress its importance.

Here in Massachusetts, legislative leaders have proposed bills to forgive medical school debt for those willing to practice primary care in underserved areas; a similar law, worth $15.6 million, passed in New York this week. Massachusetts also recently authorized the opening of clinics in drug stores, hoping to relieve the pressure.

“It is a fundamental truth — which we are learning the hard way in Massachusetts — that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society, told Congress in February. 

Jon M. Kingsdale, executive director of the agency that oversees the Massachusetts initiative, said he had not heard of major problems, but acknowledged “the prospect of a severe shortage” as newly insured patients seek care in doctors’ offices rather than emergency rooms.

Given the presence of four medical schools and Boston’s dense medical infrastructure, it might seem difficult to argue that Massachusetts has too few doctors. The state ranks well above the national average in the per capita supply of all doctors and of primary care physicians.

But those measures do not necessarily translate into adequate access, particularly in remote areas. Annual work force studies by the medical society have found statewide shortages of primary care doctors in each of the last two years.

The share who accept new patients has dropped, to barely half in the case of internists, and the average wait by a new patient for an appointment with an internist rose to 52 days in 2007 from 33 days in 2006. In westernmost Berkshire County, newly insured patients are being referred 25 miles away, said Charles E. Joffe-Halpern, director of an agency that enrolls the uninsured. 

The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs. 

Clinic administrators in western Massachusetts report extreme difficulty in recruiting primary care doctors. Dr. Timothy Soule-Regine, a co-owner of the North Quabbin practice, said it had taken at least two years and as long as five to recruit new physicians.

At the University of Massachusetts Medical School in Worcester, no more than 4 of the 28 internal medicine residents in each class are choosing primary care, down from half a decade ago, said Dr. Richard M. Forster, the program’s director. In Springfield, only one of 16 third-year residents at Baystate Medical Center, which trains physicians from Tufts University, plans to pursue primary care, said Jane Albert, a hospital spokeswoman. 

The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs.

Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice. 

Officials with several large health systems said their primary care practices often lose money, but generate revenue for their companies by referring patients to profit centers like surgery and laboratories. 

Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.

“I calculated that every time I have a Medicare patient it’s like handing them a $20 bill when they leave,” she said. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”


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## CougarKing (27 Apr 2008)

by Aden Gatling:


> That's easy ... it's because there are so damn many 'experts' around that feel that outcomes should take a back seat to socialist dogma!  Case in point:



Socialist dogma? You tell that to this guy who's featured in this article below; don't tell me it was his fault that he did not get a lower income to qualify for Medicaid (and please don't tell me I won't read it just because it's CNN). It's about ACCESS, regardless of income, but of course from the way this thread has been steered, you'll probably answer me with "It's not my problem". 

http://www.cnn.com/2008/HEALTH/04/25/cancer.windsor/index.html



> *Dying for lack of insurance*
> Story Highlights
> Cancer society: Uninsured 60 percent more likely to die within 5 years of diagnosis
> 
> ...


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## Brad Sallows (27 Apr 2008)

The "socialist dogma" is in fact still part of the problem because the "socialist dogma" impedes solutions which might provide health care to those who lack it without significantly reducing the health care of those who already have it.  A person who has health care for his family is unlikely to look favourably on anyone whose proposals amount to lessening it.  2- or 3- or N-tier health care is better than 0-tier.


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## Blackadder1916 (29 Apr 2008)

An example of some changes in the USA.  Recent changes in Massachusetts means most residents of that state must now have health insurance.  For those who don't, tax penalties can be as high as $912 if you stay uninsured for the whole year.  The state has made an effort to provide affordable heath insurance for those who do not qualify for subsidized coverage.  As this is probably one of the few places on the internet where a price is quoted for health insurance, I submitted a form  to see what would it cost to get health insurance in Boston.  The rates quoted are for an "individual", are in the "bronze" (low premium/service) category and are per month.  The 'silver' and 'gold' level coverage were much more.  I don't know if there would be any restrictions for pre-existing conditions as the only questions asked (on the internet form) were age, zip code and work industry.


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## a_majoor (8 Feb 2009)

Having been with family members in the ER for over six hours myself (try sitting six hours and waiting for help while your daughter is suffering from a severe asthma attack and can't breath), this story *isn't* an aberration. Sadly, since there is no accountability, this is the wave of the future:

http://ragingtory.blogspot.com/2009/02/wrha-and-ndp-cover-up-continues-to-get.html



> *WRHA and NDP cover up continues to get worse*.
> 
> The cover up of Brian Sinclair's murder continues to thicken. Now it is known that security requested help for him over and over again, and the calls went unanswered.
> 
> ...


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## a_majoor (7 Apr 2009)

Just wait until the Obama administration secures this sort of healthcare in America!:

http://thesecretsofvancouver.com/wordpress/blame-canada-our-healthcare-kills/free-health-care



> *CANADA CARE MAY HAVE KILLED NATASHA*
> 
> COULD actress Natasha Richardson’s tragic death have been prevented if her skiing accident had occurred in America rather than Canada?
> 
> ...


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## c_canuk (8 Apr 2009)

the problem with the canadian healthcare system is apathy of bueruacrats and underfunding

1. The best doctors tend to go to the states where they can get paid more, who can blame them? the solution is increase their pay, if there is an encentive to stay they will, thus we will have more doctors for shorter workshifts resulting in less mistakes, shorter waiting times, and a drastic improvement in overall effectiveness.

2. The current model of ER Waiting rooms is BS, the triage nurse sits behind a plate glass window which seperates them from the patients while they play solitare on their computer between patients checking in.

first, triage/reception nurse's office should be the waiting room, they should be constantly monitoring their patients until a doctor takes charge of them, they should be more than a secretary in scrubs, they should have all the qualifications and equipment to provide emergency crash support

3. too much meddling in the operation of the system by dogmatic socialists that are concerned with centralized assets preventing the spread of large equipment.

4. we need to increase our healthcare budget by 50%, to aquire more equipment to better kit out all hospitals.

5. No penalties for abusing the system... you bring little johnny in cause he has a sniffle, and you should be fined for the wasted time.

The problem with the american system is:

1. is shortens wait times by not treating people - too poor, you get emergency only service if at all, make some money but not enough for health insurance - you are stuck with bills in the tens o thousands.

2. it provides encentives to doctors to do as little as possible.

3. dollar for dollar, americans pay almost twice what we do for the same service. (I think we should increase our funding to bring us within 75% of what americans pay, we underfund, and they get gouged)

4. yes privatization allows those with extra coin to jump the queue, however we're talking people making several 100 thousand a year or more, not many on this board if any at all would have access to that level of service.


the difference between socalized medicine and privatized medicine is not capitalism vs communism as so many seem to think it is, it's non profit, centralized equal access organized insurance and service in one cohesive organization vs for profit decentralized insurance seperate from the service with profits to shareholders at every step of the way.

Universal healthcare is crown health insurance rolled into your taxes. If you privatize Canadian health care the same thing will happen as every other crown asset that has been privatized.

1, 25% or more of the staff will be laid off
2, services will be cut
3, services will never again be upgraded
4, contracts will be violated by the international corps at will as there is no way to really bring them back under the leash
5, the costs will migrate up, and accidents will be manufactured to support requirements in funding increase.

the privatization of water and other crown services prove this... look at private auto insurance... in provinces where it's privatized, the lowest level of insurance is as much as twice what standard insurance in provinces that have a public system, and some of those public systems are underwritten by the same private insurance companies.

the bottom line is, do you want the administrators who control healthcare worried about getting your vote, or worried about how they'll squeeze 10% out of the existing budget to make profit. In times of hardship it's perfectly fine for a government dept to run into deficit, the same is not true of private firms


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## pbi (12 Apr 2009)

To me the debate often misses the belief that underlies our public health care scheme: that nobody should suffer or die simply because they lack the means to pay for health care. Unfortunately, that very honourable and morally indisputable belief has become lost under a welter of inadequate and badly administered programmes, soaring medical care costs, the vested interests of bureacracies, professions and businesses, an increasingly obese and aging population, political squabbling between Right and Left, provincial and federal, private and public, to the point at which discussing health care in Canada can be almost as explosive as talking about gun control in the US.

To me, we are squabbling about the "how" and losing sight of the "what and why". What matters is that people's quality of life is supported by a guaranteed and dependable quality of care, and that all people who need care can get it without fear of financial ruin. Beyond that, it really doesn't matter to me who delivers the care. For example, we talk about Canada's "public" system, yet what about drug stores? Tell me that drug stores aren't an important part of the total health care system? Yet does anybody seriously propose that the government run drug stores? What about all the hundreds of privately operated clinics across the country? 

I think that there is too much fear mongering about market delivery of medical care. Let me draw an analogy. Food is vital for life, right? Probably even more vital than health care, if you get down to it. But does the government run food stores? No, it doesn't. We trust the market to deliver the food we need. If the fear-mongers' logic was correct, then food stores would sell only to the rich and the poor would starve in the street. Of course, this isn't what happens. The great majority of food stores sell to the great majority of Canadians: middle class, with middle class budgets and concern for value for bucks, who want to take care of their families' needs. Are there food stores for rich people? Yes, obviously (Whole Foods comes to mind...) Are there food stores for people with less money to spend? Yes to that, too. The point is that the market does a very good job of delivering a vital necessity of life: food.


So where does the government fit into that? It inspects food stores and food suppliers (perhaps not always as well as it should, but just try the food safety standards in 90% of this world and you'll come right back to Canada every time...). It regulates safety and working conditions in stores. And, for those people who can't afford food, it provides financial assistance through various programs. (Is that financial assistance always adequate? As somebody who has had two close relatives try to survive on govt allowances at different times, the answer is :"not always")

And that, to me, is where the govt should be in the health care game. Working to make sure that all Canadians have access to an excellent basic quality of safe health care, all the time. Help out when people's circumstances prevent them from getting the care they need, so that nobody has to sell their home as a choice against providing care for a child. Investigate and punish the quacks, scammers and rip-off artists, on both sides of the counter. But, except in very particular cases where there is a void, leave the actual delivery of health care to the market. The market, if it's properly regulated, will function by doing what it usually does: by giving most people what they need.

Cheers


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## tomahawk6 (12 Apr 2009)

We are seeing care in Britian being rationed by their NHS. I see this as the ultimate failure of this system. The purpose of national healthcare is to provide care by controlling costs which is an epic fail. Even today in the US the government's involvement prevents the market place from working. Anytime you have a free market prices are controlled by the law of supply and demand. We havent seen this in the US for a very long time.


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## Tom_Swift (13 Apr 2009)

Here's how I see it I like Ted Nugents way of thinking how can people ask for health care if we don't care about our health. We have fluoride in our water and eat food full of words we can't pronounce people are poisoning themselves and then asking the government to solve every problem they create. If more people were in top physical condition rather then being lazy couch potatoes Canada's health care system would be Grade A and need half the funding. Banning this or calorie counting that isn't gonna solve some obesity problem. The people that abuse should pay to use it, disregarding genetic histories of people and concentrating on fitness doctors should put a 1 to a 100 point system together then people get taxed based on how they score. I have a couple of other ideas to promote healthy living but some might not like them like giving raises to the healthier teachers as they often have influential roles over children they should set example in taking care of one's body.

I dunno this is really just my 2 cents I didn't bother to read the whole thread but health care is something I have a strong opinion on. I hope I don't get flamed or anything.


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## Kat Stevens (13 Apr 2009)

And how soon after that do we start sterilizing the disabled, and fire up the eugenics labs, Mein Fuhrer?


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## Tom_Swift (13 Apr 2009)

I was simply suggesting we set aside the uncontrollable genetics and work on creating an accountability for the lazy fast food eaters. Yea sure people have the freedom to be fat but not at the cost of my freedom to be rich. If I don't use the system because I am healthy why should I pay the same amount into it as the guy who east McDonald's for breakfast lunch and dinner and must see a doctor for any number of health problems associated with poor nutritional habits.


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## Kat Stevens (13 Apr 2009)

And if that fat bastard is genetically blessed and lives to be 100, but you go on a run to get healthy and get hit by a bus, should he then have to pay to keep you alive and blowing into a straw for mobility?  And, if the difference between being rich or not is your annual contribution to health care, I'd suggest you ask CRA for an audit, you're paying way too much.


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## Bruce Monkhouse (13 Apr 2009)

Then after we can shoot skiers, and those that play rugby need to be exterminated, and......


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## Kat Stevens (13 Apr 2009)

Bruce Monkhouse said:
			
		

> Then after we can shoot skiers, and those that play rugby need to be exterminated, and......



"...and I stayed silent, for I was not a Skier."    ;D


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## Another Mom (13 Apr 2009)

The irony is that fat, out of shape guys never visit the doctor and often die of a heart attack at age 50  which is less of a drain on our health care system funds than someone who lives to 100 in extended care with old age related chronic problems.


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## Loachman (13 Apr 2009)

We should tax the stupid, too.


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## FastEddy (13 Apr 2009)

Tom_Swift said:
			
		

> I was simply suggesting we set aside the uncontrollable genetics and work on creating an accountability for the lazy fast food eaters. Yea sure people have the freedom to be fat but not at the cost of my freedom to be rich. If I don't use the system because I am healthy why should I pay the same amount into it as the guy who east McDonald's for breakfast lunch and dinner and must see a doctor for any number of health problems associated with poor nutritional habits.




The same reason my Super Healthy Nut, that you could go out tomorrow and get hit by a snow removal vehicle and spend the rest of your days on Life Support.

Need I quote or list countless other reasons, by your reasoning  should I pay the same, because you were too careless or stupid to watch out while stepping off the curb.

Edited: Sorry "Kat" , I didn't continue reading before replying.


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## Edward Campbell (13 Apr 2009)

Loachman said:
			
		

> We should tax the stupid, too.



We do. That's what lotteries are: voluntary taxes for those who feel that the governments don't get quite enough of their money.


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## mariomike (13 Apr 2009)

E.R. Campbell said:
			
		

> That's what lotteries are: voluntary taxes for those who feel that the governments don't get quite enough of their money.



Lotteries, and other government taxed gambling, have been described as, "A tax upon imbeciles".


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## Tom_Swift (13 Apr 2009)

FastEddy said:
			
		

> The same reason my Super Healthy Nut, that you could go out tomorrow and get hit by a snow removal vehicle and spend the rest of your days on Life Support.
> 
> Need I quote or list countless other reasons, by your reasoning  should I pay the same, because you were too careless or stupid to watch out while stepping off the curb.
> 
> Edited: Sorry "Kat" , I didn't continue reading before replying.



I'm saying everyone pays x amount to cover annual checkups and accident insurance like system. People who abuse the system pay x+y


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## c_canuk (15 Apr 2009)

the more you break our monolithic healthcare system down into seperate business models, the more levels of interaction there will be between private businesses. At each level of interaction there will be money syphoned off for profit.

no business will do things at a loss or for free.

in the current system, tax dollars go in, service and salaries come out.

in a private system, Tax dollars will go into the government regulated system, and more money will come out of your pocket to pay for your insurance.

right there is the first increase in cost to you the tax payer... the lowering of taxes that feed healthcare won't be dropped as much as we pay in if at all.


then when you have an accident, the insurance company will spend some of your premiums on investigating if they have to pay out... ie you might be faking, you might have had a pre existing condition, you might not be who you say you are.

then they will have to pay the hospitals to take care of you, and the hospital being a private business with shareholders will have to also charge a profit margin.

the doctors and nurses hired by the hospital won't get a profit margin above their wages, but what if all the doctors and nurses develop their own contracting agency, they also now get a profit margin.

there is 4 levels of new money's being taken out of the system where none were before, while making it more difficult for the less fortunate to get healthcare.

where is this money going to come from? some directly from your pocket, the rest will come from DECREASING services.

we will be left with a more costly and less effective service.

Only the rich, ie people making 500 000 a year or more will be able to afford top notch service, just like they do today, and the middle class will be left with a more expensive and less capable system while the owners of the new system get a little bit richer.


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## mediocre1 (15 Apr 2009)

tomahawk6 said:
			
		

> We are seeing care in Britian being rationed by their NHS. I see this as the ultimate failure of this system. The purpose of national healthcare is to provide care by controlling costs which is an epic fail. Even today in the US the government's involvement prevents the market place from working. Anytime you have a free market prices are controlled by the law of supply and demand. We havent seen this in the US for a very long time.



Here in Canada, sir tomahawk, private health insurance are allowed under commercial laws to thrive. But my private insurer is partially reimbursed by national health care. I clung to my private insurer as provider of my disability because government insurance is low. What my private insurer did is to have my disability insurance partially paid by the government. All my medicines are also reimbursed to private insurer. My private used to shoulder all expenses. Now it's between them and the government.

I believe that market forces should also be allowed to determine premiums. There is a law which states that if you're smoking and you get ill and your sickness is related to your smoking, you have to reimburse the government for all the expenses which amount to hundreds of thousands. That's what good about having a private insurer if one is smoking.

My argument against that is cancer can also be caused by bad eating habits. If you consume peanut butter to the maximum allowed by your body, you can have cancer. If you consume fats all the time, you become vulnerable to cancer.


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## Fiver (16 Apr 2009)

mediocre1 said:
			
		

> My argument against that is cancer can also be caused by bad eating habits. If you consume peanut butter to the maximum allowed by your body, you can have cancer. If you consume fats all the time, you become vulnerable to cancer.



Uh, what? Eating a lot of peanut butter causes cancer? That sounds a lot like the kind of misinformation spread on the internet like the factoid that we eat 8 spiders in our sleep during a year that was made up in '94. It is not the diet high in fats in itself that is cancerous, it's the lack of grains, fruits and vegetables in such a diet that could reduce the risk of cancer, as well as the fact that people eating a lot of fats tend to be less physically active. Correlation does not imply causation.

So far studies only show that fats can help spread tumors in mice, not that they are the cause.


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## Fishbone Jones (16 Apr 2009)

mediocre1 said:
			
		

> My argument against that is cancer can also be caused by bad eating habits. If you consume peanut butter to the maximum allowed by your body, you can have cancer.



You better have some substantive proof to back that up. Oh, and include the links.


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## mediocre1 (16 Apr 2009)

recceguy said:
			
		

> You better have some substantive proof to back that up. Oh, and include the links.



I read it in a health book about 10 years ago. If I stand corrected, I can make up by saying that 'not only cigarettes can cause of cancer.'


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## Fiver (16 Apr 2009)

mediocre1 said:
			
		

> I read it in a health book about 10 years ago.



Oh em gee, conflicting informations on 'teh intarwebz', which will you believe?

http://www.taipeitimes.com/News/taiwan/archives/2006/03/03/2003295475

Though I don`t blindly trust that article either, see http://www.youtube.com/watch?v=T69TOuqaqXI, which applies to more than science vs religion.

There is this problem about misleading or outdated health beliefs. For example, for a while, it was generally thought that low-tar cigarettes were less cancerous, but it was later said untrue by another study. And there's also much biased, conflicting or exaggerating studies.

And here's what happens if we look up Peanut Butter on wikipedia: http://en.wikipedia.org/wiki/Peanut_butter


> The peanut plant is susceptible to the mold Aspergillus flavus which produces a carcinogenic substance called aflatoxin.[5] Since it is impossible to completely remove every instance of aflatoxins, contamination of peanuts and peanut butter is monitored in many countries to ensure safe levels of this carcinogen. Average American peanut butter contains about *13 parts per billion of aflatoxins, a thousand times below the maximum recommended safe level*.


Sadly, even this might be false or in part false, as there are no link referring to this statement.

What about aflatoxin? http://en.wikipedia.org/wiki/Aflatoxin#cite_note-1


> Aflatoxin-producing members of Aspergillus are common and widespread in nature. They can colonize and contaminate grain before harvest or during storage. Host crops are particularly susceptible to infection by Aspergillus following prolonged exposure to a high humidity environment or damage from stressful conditions such as drought, a condition which lowers the barrier to entry.
> [...]
> Crops which are frequently affected include cereals (maize, sorghum, pearl millet, rice, wheat), oilseeds (peanut, soybean, sunflower, cotton), spices (chile peppers, black pepper, coriander, turmeric, ginger), and tree nuts (almond, pistachio, walnut, coconut, brazil nut).
> The toxin can also be found in the milk of animals which are fed contaminated feed.



My verdict would be that there's not enough of the stuff to be a direct cause of cancer and that studies suggesting that ingesting peanut butter is highly dangerous cancer-wise are exaggerating, a lot.


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## mediocre1 (16 Apr 2009)

Fiver said:
			
		

> Oh em gee, conflicting informations on 'teh intarwebz', which will you believe?
> 
> http://www.taipeitimes.com/News/taiwan/archives/2006/03/03/2003295475
> 
> ...



There's an argument for your side. There's somethings for mine. Since we are not authorities or specialists or doctors, let's call it a draw and move on.


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## Michael OLeary (16 Apr 2009)

mediocre1 said:
			
		

> There's an argument for your side. There's somethings for mine. Since we are not authorities or specialists or doctors, let's call it a draw and move on.



You're moving on?  Wonderful. Have a nice life on your next forum.


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## TimBit (16 Apr 2009)

Michael O'Leary said:
			
		

> You're moving on?  Wonderful. Have a nice life on your next forum.



For a moment there Michael you made all happy... and then I realized you were day-dreaming. Sad, sad life...


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## mediocre1 (16 Apr 2009)

TimBit said:
			
		

> For a moment there Michael you made all happy... and then I realized you were day-dreaming. Sad, sad life...



I am not in this forum to start trouble, timbit. Actually to tell you the truth I am not even here to debate. My masters in Ottawa and Front Street, through body language, told me to stay. They use the truck with STAPLES printed on it and direct it to pass my way. In-place. Got any idea what I am talking about. I am here to behave and be in-place. Observe and report. You notice the number of pinko-communists sprouting and picking on me. They even get away with slander or libel. That is why I hate my God-saved masters Jim and Ward more than anybody else. I don't even hate you, timbit.


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## Burrows (16 Apr 2009)

mediocre1 said:
			
		

> I am not in this forum to start trouble, timbit. Actually to tell you the truth I am not even here to debate. My masters in Ottawa and Front Street, through body language, told me to stay. They use the truck with STAPLES printed on it and direct it to pass my way. In-place. Got any idea what I am talking about. I am here to behave and be in-place. Observe and report. You notice the number of pinko-communists sprouting and picking on me. They even get away with slander or libel. That is why I hate my God-saved masters Jim and Ward more than anybody else. I don't even hate you, timbit.



And that's the last straw.

Milnet.ca Staff


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## a_majoor (27 Apr 2009)

As the Obama administration moves to take control of the medical sector, they will run into real troubles since they will not be able to conceal the growing and self induced shortages of doctors and other medical staff, and Americans are not as prone to wait in the Emergency room for eight hours like Canadians.....

http://pajamasmedia.com/instapundit/  April 27 2009



> HEY, I’VE GOT AN IDEA: Make the practice of medicine more rewarding! Shortage of Doctors Proves Obstacle to Obama Goals. Naah. That approach would make too much sense.
> 
> But when Obama says “We’re not producing enough primary care physicians,” he’s making a mistake. We don’t produce doctors. They’re not widgets. *People choose to become doctors — or something else — based on their analysis of what will produce the best life.* Medicine has gotten less pleasant, and less financially rewarding, really, over the past several decades as it’s become more bureaucratized and subject to the whims of third-party payors. So will Obama’s plan fix that? Seems doubtful. Will he recognize that you don’t produce doctors the way you produce, say, cars? That’s doubtful, too.
> 
> ...


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## a_majoor (6 May 2009)

Sneaking it in under cover of darkness. "Hope and Change" indeed:

http://hughhewitt.townhall.com/blog/g/85f5404e-a4de-4a1c-a9a6-60d10f2e590a



> *The Rush To Rationing, Cont.*
> Posted by: Hugh Hewitt at 10:57 AM
> 
> Yesterday I posted on the rush to pass a radical restructuring of American medicine that will result in health care rationing as surely as day follows night.
> ...


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## Brad Sallows (9 May 2009)

To the point of the topic:

"If America adopts Canada's health care system"...

...it may not be to Canada's advantage.  If our public health care system gives us half the competitive advantage (cost of health insurance) its defenders and enthusiasts claim, they should not wish the Americans to succeed.


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## c_canuk (22 May 2009)

I disagree,

I don't think the US's health system increasing, decreasing or reorganizing will have any effect on ours unless the cap their doctors salaries then maybe we'll see more doctors trained here staying in Canada, relieving those that work here now... a lot of doctors work their family practice, then do a shift at a hospital.

The US eliminating the incentive for Canadian doctors to emigrate would help us reduce ER wait times here.

Personally I think that the Government needs to take action on it's own anyway. What I would like to see is the Crown create a Corporate Division, it's goal would be to look for fields where a Crown Corp like SaskTel could compete against private business. If successful it could return dividends to the constituents or reduce income taxes.

This way we could have our cake and eat it too, if private business thinks they can provide healthcare for less than the current system, they are free to try, but we aren't going to sell them the current infrastructure at cut rate prices, and they will have to prove they can do it better, after 10 years of them doing better, we could start standing down the crown corp. 

This would also provide an avenue to keeping more doctors in Canada, Private firms would pay more to attract them, and in competing with private businesses the Crown Corp would have to also trim some fat and create more incentives for doctors to work for it.

I would also like to see this corporate dept step up during problems like the softwood lumber issue... prefab housing is in high demand in other parts of the world, it could have bought up the closing foreign lumber companies and redirected their outputs to a new prefab housing company. They would have kept people working, reclaimed revenue that used to flow out of Canada, and created a new industry that potentially could have made a tidy profit.

Even if it didn't and broke even or took a small loss, the workers would still have been working, and paying taxes while the US would have been in a serious soft wood lumber shortage and the tariff issue would have been dealt with in our favour much more quickly.

Same with the mad cow scare, it could have instituted the regulations Japan and others wanted before they would accept our beef, ( hop scotching the inefficient bureaucracy that instead of just doing the increased testing, tried to convince the other nations that our random sampling was good enough),  and redirected outputs from the cattle industry again, and this would have prevented the board in he US to hold out until our ranchers were going bankrupt so it's board members could buy up the Canadian herds at cut rate prices before they reopened the border.


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## a_majoor (22 May 2009)

So you havn't considered the reason no one moved into the pre fab housing market (either here or for export) might be because _it wasn't profitable_?

The number of doctors might be constrained because people considering medical careers might not want to deal with complex bureaucracies or have their salaries/hours/conditions of work dictated to them and therefore never enrole in medical school (or drop out)?

That any taxpayer funded entity has no incentive to become efficient, and indeed has perverse incentives to become more inefficient in order to capture more tax dollars and expand the power and presteige of the bureaucrats who run  it?

That any taxpayer funded entity which only breaks even or runs at a loss is a net drain on the economy (and workers "paying taxes" on incomes that are just tax subsidies from people in the productive economy is simply recursive.) Indeed the monies diverted to these stagnet areas of the economy are directly subtracted from the pool of available resources that could have been invested to create real jobs (this means that these subsidized jobs you advocate would result in a net job loss in the economy)?

When I am Imperator, economics *will* be taught in primary school to stamp out this sort of nonsense once and for all!


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## c_canuk (25 May 2009)

> So you havn't considered the reason no one moved into the pre fab housing market (either here or for export) might be because it wasn't profitable?



no, because there is HIGH demand for it in a country that has multigenerational mortgages. Even if it wasn't profitable, it's better than handing billions of dollars a year in tarrifs to the US economy while the surplus rots in the yard, and former tax payers begin drawing EI while looking for employment elsewhere.

the reason that the small lumber yard companies did not do this is they lacked the startup capital, weren't willing to risk shareholder ire, and felt their shareholder interests were better served closing their canadian operations in favour of focusing elsewhere. Their revenue stream was the profit off the sales of soft wood only, the Crown would have stopped a reduction of tax revenue directly from it's workers, and indirectly from the supporting local economy, directly off of new workers and indirectly off the supporting economy from those new workers, and potentially of a new revenue stream provinding exports to a high demand market.

Why would a private firm front the capital when for all intents and purposes it looked like the Canadian government would quickly solve the problem, it's easier to harvest raw resources and sell them for profit, than it is to provide finished products, however, the profit margin on finished products reflects that.

We sell our raw resources to the US at 10% profit so they can sell them right back to us as finished goods at 50-100% profit.



> The number of doctors might be constrained because people considering medical careers might not want to deal with complex bureaucracies or have their salaries/hours/conditions of work dictated to them and therefore never enrole in medical school (or drop out)?



could be applied directly to the CF, is the solution to deprive areas of the CF just because some people would not rather work there? 

Not to mention, this happens in the private industry as well, for example pilots need to get their hours in doing puddle jumps up north before they get their cushy milkruns in the bigger planes on main routes.  

As I mentioned in my post, I think the shortage of doctors is due to lower pay than competing employers and lower standard of living here, I'm all for paying doctors more to keep them in Canada and even poach some from other countries. the more Doctors we gain, the less overtime they will have to work, resulting in a better standard of living for them.

Selling the infrastucture to a private firm will not solve that problem, private firms will simply reduce services and/or charge more because just like every other privitization, they take 15% off the top, lay off a few of the more expensive employees and continue with business as usual.

Are you implying that in the US doctors put up with less bureacracy? keep in mind litigation against doctors is much higher, they have to directly deal with insurance companies to determine if the patient is covered for a particular treatement and prove that said treatment is required, rather than just let the front desk do card check before applying treatment.

And are you implying that doctors have no choice in their postings in Canada and have complete control in the US?



> That any taxpayer funded entity has no incentive to become efficient, and indeed has perverse incentives to become more inefficient in order to capture more tax dollars and expand the power and presteige of the bureaucrats who run  it?



Some how SaskTel a crown corporation is managing to not only be profitable, it's expanding outside of Saskatchewan and Canada and proving that a crown corporation competing against private industry can be efficient, effective, and reduce the tax burden on the governments constituents. I certainly also don't hear residents of Alberta complaining about how the provinces oil concerns are a waste.



> That any taxpayer funded entity which only breaks even or runs at a loss is a net drain on the economy



hogswash, this is simple arithmetic, if the government applies 10 million, and the crown corp returns 10 million, then there is a net cost of ZERO, and the employees taxes are gain for the local government, especially if those are new jobs that reduce the unemployment rate or draw workers from other areas.

if the government collects 1 million in tax revenue from new jobs, or from jobs that otherwise would cease to exist you have a 10% return on investment.

this provides an incentive to a government to attract workers to increase it's revenue collection, rather than charge more for less services.



> (and workers "paying taxes" on incomes that are just tax subsidies from people in the productive economy is simply recursive.)



you can hardly exempt crown corp employees from paying incometax just so you don't have to tax them later. IF the crown corp can't make money while it's private competitors can, it's time to shut down the crown corp, regardless if there are tax revenues collected.



> Indeed the monies diverted to these stagnet areas of the economy are directly subtracted from the pool of available resources that could have been invested to create real jobs



I fail to see how a job working for a crown corp that makes a profit is any different or less real than a job working for a private corp, other than in the former the shareholders are the people of that government and in the latter they aren't



> (this means that these subsidized jobs you advocate would result in a net job loss in the economy)?



not quite sure what you are asking here, by doing nothing, several lumber firms closed down, packed up and left Canada, this resulted in those jobs being lost, and a loss in the economy.

I proposed that a crown corp be stood up to look into alternate markets for Canadian Softwood lumber, and suggested the highly lucrative prefab housing market, though in many european markets dimensional lumber and raw lumber go for a nice high price.  

The goals would have been:

-to keep the workers employed and paying into the public purse rather than drawing from it. Not that there is anything wrong with that but it is better for both the worker and the government to keep them working.

-preventing a local economy down turn by the workers continuing to spend their disposable income, rather than save every penny.

-reduce the likely hood of workers leaving the area in search of new work thus impacting the local economy and the public purse in a negative way - the fewer people working in an area the fewer people purchasing other services and goods, and the fewer paying taxes.




> When I am Imperator, economics will be taught in primary school to stamp out this sort of nonsense once and for all!



I fail to see what nonsense you are talking about, perhaps if you re read my previous post a little slower and comprehended that I don't want to replace private industry with crown owned industry but pit them against eachother to prevent either from resting on their laurals.

the real nonsense is that unchallenged private industry can be trusted to provide the most efficient products and services anymore than unchallenged government organizations can be.

when private industry is small and compartmentalized it is more likely that it will compete, when it is large and monolithic it is more likely it will come to an understanding with it's competitors via the language of market actions to create a larger profit for all of them.

The difference between a crown corp and a private corp are their shareholders and the shareholder's desires.

Private corp's shareholders are interested in ROI.

Public Corp's shareholders are interested in the best products/services at the cheapest cost possible.

Pitting them against eachother should result in a modest ROI with very good products/services if there is a market for them to begin with.


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## Brad Sallows (26 May 2009)

>Some how SaskTel a crown corporation is managing to not only be profitable

A poor example, since all the telcos started with a de facto monopoly of infrastructure.  In holding up Sasktel's anemic performance, you overlook what might have been if Sasktel had been more like Telus or Bell from the outset of the opening of the playing fields.

But I agree: let's have more government involvement in profitable enterprises, as well as expose more public (government) monopolies and undertakings to open competition.  But ensure there is no legislation to tilt the competitive field to favour the government-owned bodies.


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## c_canuk (27 May 2009)

I have family working in SaskTel and have been a customer of all three, and worked for NBTel/Bell back in 96/97. 

As a Crown Corp Sasktel a good example of a crown corp acting more like a business than a tax subsidized drain.

The fact that it returned dividends to the people of Saskatchewan, provides some of the best service I've seen and is branching out internationally as well as competing in other province's turf I don't see how it's performance is rated as anemic.

Telus has the worst service and infrastructure of any telco, and concentrates on sucking every dime out of it's customers. If it spent half the money it does on it's comercials on maintaining their infrastructre, maybe it would stop failing under normal expected call volumes.

Bell Canada I don't have customer experiance with outside Bell Express View

[incomming bad service rant]

this year I canceled my service with them because

1. they decided they needed to verify that each reciever I had was at the same location randomly and demanded I pay for 3 new phone ports, then tried to lie to me that I'd signed a contract stating I would, seeing as I wasn't even home when they set up the account in my name and couldn't produce a contract that I signed or a recording agreeing to it, I told them no.

2. they wanted me to activate 2 terminals that were on a shelf unused during renovations, I told them to just deactivate them, and I'd activate them when I needed them again, they seemed happy with that

3. then 2 boxes showed up on my doorstep, I called to inquire what that was about, they told me not to worry

4. my service was deactivated, I called got it reactivated

5. started getting automated messages threatning to charge me for the full cost of the terminals if I didn't return them ASAP, called in, they had no idea...

6. called in to remove a movie package that I wasn't using that cost 20 bucks a month, because their self help website kept crashing, the agent was unintersted and it took 3 tries to explain what I wanted.

7. after 3 months the package was still not removed and they couldn't explain it, and while they had a record of the order, refused to refund $$$

8. 2 more boxes show up.. repeat 2,3,4,5 

9. I get billed 179 dollars for 2 terminals, takes them 6 weeks to credit my account

10. I finally have had enough, cancel the service, pack everything up, send it back takes 2 months to terminate the service, I wasn't on contract... they can turn it off and on at will but canceling service after being treated like that takes 2 months?

11. start getting messages to return equipment that has already been returned, call in, give them the tracking number and remind them they still owe me $74.95

12 after 3 months waiting for my cheque for the credit to my account, recive a bill with a charge of 74.95 for "Disconnection Recovery Adjustment"

[end rant]

not what I'd call stellar service, their retention department offered 3 months free service after stealing at least that much from me and treating me like a criminal after 3 years of business with them.

However another private firm, Rogers, has bent over backwards to provide me with top notch service.

I'm probably biased, but I don't find myself thinking of Sasktel as Anemic since it's gone international and has the potential to provide a lot of revenue to it's shareholders which is admittitly rare if not unheard of for a government branch.

I see the Government as a large corporation and each voter owns one share, why shouldn't it operate with it's aim in providing shareholders ROI rather than just redistribute our assets?


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## Brad Sallows (28 May 2009)

>Telus has the worst service and infrastructure of any telco,

Care to back that up with facts?  We all have anecdotes of people dissatisfied with one provider or another.

An anemic performance is just the opposite of a strong one; it doesn't mean a company is non-viable.  Not all viable companies perform strongly; some perform below potential relative to peers.  If SaskTel were a strong performer, I would expect to see it further ahead that where it currently sits.


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## c_canuk (28 May 2009)

> I would expect to see it further ahead that where it currently sits.



Care to back _that_ up with facts?

I fail to see how a provincial telco that has expanded into other provinces and into other countries, has the highest highspeed service avaliblity outside of major centers, and is known as a repository of some of the brightest minds in the business is anemic performance, what goal should they have that you think they haven't met? I don't see Aliant or Bell developing new wireless technology or establishing new customer bases in other countries. They are certainly one of the best places to work in the IT industry, - unionized and get every second friday off. Keep in mind they are also being hemmed in to provide service to those that it is very difficult to do so by government mandate, those that would not be targeted by private businesses as it's not economical to do so and yet SaskTel still succeeds.

http://www.gov.sk.ca/news?newsId=4de9ca55-6a05-4698-afbe-c02f088c30fc
http://www.sasktel.com/about-us/company-information/history/2000s.html
http://www.eluta.ca/top-employer-sasktel
http://www.lienmultimedia.com/itnewslink/article.php?id_article=2638
http://www.eboardoftrade.com/files/Productivity_Reports/12_04_SaskTel_Letter.pdf
http://www.gov.sk.ca/news?newsId=5bc2829a-3c67-4aab-9e70-7c3b8c392242
http://www.gov.sk.ca/news?newsId=f52db6b5-5daa-44e5-bb10-4e526b6bad95




you also have to keep in mind that a Crown corp is not going to go heavily in debt even temporarily to aquire capital for large incursions into competitors territory like a private firm will. This is because no Tax payer is going to accept that, while it is expected of a private firm.

SaskTel has managed to increase it's customer base, break into new markets, develop new infrastructure and revenue streams without borrowing into heavy debt while competing for those customers against private firms that will and do borrow to aquire capital and have many times the customer base SaskTel does to draw revenue from.


Now as for facts on Telus, it's a combination of my experiance as a customer and knowledge of the companies from working with them in the telecom industry (used to work for Genesys Labs) which is a subsiduary of Alcatel, which provides Call Center solutions to companies such as Telus, Sprint, Bell US and Canada, Telstra, Etc and has branches all over the world.

I've spent some time looking for customer satisfaction surveys but I didn't find anything, perhaps you have? I think the problem will be that only a handful of them are multi province so you end up with aliant vs rogers vs Telus for some and Sasktel vs Shaw vs Telus, or Bell vs Rogers vs Telus... so there really isn't an easy way to poll this across Canada.

I'm unclear about what performance indicator you are looking for anyway.


http://about.telus.com/awards/corporate-excellence.html, from a stockholder point of view they do very well, however, I'm not seeing much that shows confidence in them from a consumer point of view, while SaskTel provides satisfaction on both fronts.


More antecdotal evidence, ignore if you please...

Never had a problem with Aliant, or Bell during the weeks prior to or after the 23,24,25,26 of Dec calling family, Telus on the other hand I couldn't get through sometimes, and when subscribers from out of province called in we would repeatedly get a ring but no voice.

with Aliant and Bell I've had maybe 2 times I couldnt' call out of provice on the 23,24,25,26 of Dec and had no end of trouble during those days with Telus.




I think this has well and truely gone off the rails, perhaps some kind moderator could split this off into a viability of crown crop discussion thread.


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## a_majoor (29 May 2009)

Even assuming everything you say about Sasktel is true, the record of State owned companies in general is a dismal swamp of failure, political interference and a sucking drain on the taxpayers resources in favor of political rent seekers.

I'll see your Sasktel and raise you Bombardier, Via Rail, Ontario Hydro, "Government Motors" (formerly General Motors), Airbus Industrie, the "John Labatt Center" downtown sports arena (London Ontario), AECL...need I go on?

Sasktel would then stand out as the exception to the rule, and even then I would look very carefully at the political and economic environment to see why it should be exceptional; Saskatchewan's small population base would make private companies reluctant to go in if there is already a State owned competitor (who can raise unlimited funds to drive out competitors, what you don't see on your phone bill shows up on your tax bill).

WRT health care, I am trying to find a comparison which laid out the wait time for medical procedures between the United States, Europe and Canada. Needless to say, the comparison wasn't good for Canada's health care system; the wait time was (if I remember right) on the order of 62 days, far more than Europe or the US. Of course, if the US closes out the market, pressure for fast innovative healthcare from consumers will be replaced by pressure for large bureaucracies and corresponding salaries by the bureaucrats in charge of the system.

Hey, it worked so well here......

and for your viewing pleasure: http://www.onthefencefilms.com/video/deadmeat/


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## Brad Sallows (29 May 2009)

As I wrote, I would just expect to see SaskTel further advanced from the Stentor breakup if it were "strong".  If it's mandate is mainly to be a good supplier of services to Saskatchewan, that's nothing of which to be ashamed.  Some of the other telcos have simply pursued markets outside their traditional turf more aggressively.  It is clear there are militating factors which restrain SaskTel, but it is also clear that Saskatchewan is a smaller market which means it is less likely to be a marketplace battleground.

As a Telus employee (not directly involved in telephony), I have access to the internal web site and therefore can read the daily summary of all news related to Telus and telecomm issues in general - the good and the bad.  I have also read discussion threads on the WWW at large on which the topics were various gripes about Telus.  During the last TWU strike, I did have to work directly in telephony, in a capacity in which occasionally I had to interface with customer facing elements of other telcos.  I'm aware of the shortcomings the company has from time to time.  However, I'm also aware of some shortcomings of the other providers with respect to service, infrastructure, billing, etc, and the statement "worst service and infrastructure of any telco" won't pass muster.

Regarding crown corporations, it is not the case that they all must be failures.  I consider ICBC to be a successful corporation in BC.  However, it is also an example of how a crown corporation can be sheltered.  With enough protection, any company can thrive.

I don't really care if governments want to involve themselves in enterprises which generate a revenue stream; I just want all enterprises with a revenue stream to be open to competition with a level playing field for all.  It's easy to be enthusiastic about government-owned corporations run to generate revenues for public spending, but the proponents seem to be less enthusiastic that the government-owned corporations should face the same risks and pressures as competitors.


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## a_majoor (31 May 2009)

The results are so predictable that they are on offer right now before any bill is presented:

http://hughhewitt.townhall.com/blog/g/522f386d-e0f9-4d2e-ba51-ccd2c24054df



> *Obamacare Will Lead To A U-Turn On Life-Expectancy: What To Tell The Blue Dogs*
> Posted by: Hugh Hewitt at 9:24 AM
> 
> The disorganization among opponents of the "government option"/single payer/rationing that is at the heart of the Obama/Pelosi/Reid proposals to radically restructure health care in America is, well, non-existent.  Until a specific proposal is on the table, the big interest groups are holding back, in a classic display of the triumph of hope over experience.  When the Pelosi bill finally emerges from the House, even then the ostrich approach will continue as the groups tell themselves that the Senate will save them.
> ...


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## c_canuk (2 Jun 2009)

> Even assuming everything you say about Sasktel is true, the record of State owned companies in general is a dismal swamp of failure, political interference and a sucking drain on the taxpayers resources in favor of political rent seekers.



the record in general for private companies is no better, at least when Crown Corps make a profit again after getting bailed out that money goes back into the public purse, while in Private companies it goes to the shareholders who allowed the Executives to run the company into the ground in the first place.

I say let both crown and private industries fail.



> I'll see your Sasktel and raise you Bombardier, Via Rail, Ontario Hydro, "Government Motors" (formerly General Motors), Airbus Industrie, the "John Labatt Center" downtown sports arena (London Ontario), AECL...need I go on?



beg your pardon? Bombardier is a publicly traded corp, I owned shares in it. GM hasn't even been govwernment majority owned a month yet, and proves my point that a private company can be a dismal failure and suck more tax dollars than a crown corp. The public outrage if a politician ran a crown corp into the ground and took 20 dollars more than his salary would probably see them in jail let alone million dollar bonuses and golden parachutes. Ontario Hydro suffers from uneducated greenies screwing with them because they are afraid of nuclear power. Not to mention NBPower, a private corp is just as bad and has higher rates.

I'll raise you GM, Chrysler, Air Canada., Also raise you every single crown corp that has been privatized in Canada.

I'll raise you every public insurance company that seriously undercuts every private firm.






> Saskatchewan is a smaller market which means it is less likely to be a marketplace battleground."



When the Government degerulate Telcos, they were required to provide free access to the existing infrastructure, therefore startup costs are minimal, and thats why it's not only Sasktel providing service there, yet while maintining the infrastructure the others piggyback on for free, Sasktel still is the top competitor.



> Sasktel would then stand out as the exception to the rule, and even then I would look very carefully at the political and economic environment to see why it should be exceptional; Saskatchewan's small population base would make private companies reluctant to go in if there is already a State owned competitor (who can raise unlimited funds to drive out competitors, what you don't see on your phone bill shows up on your tax bill).



the reason it is exceptional is the province is full of no nonsense farmers who won't hesitate to vote out those who screw around, and will have them arrested, tried and convicted should they cross the line.

Unlimited funds do not exist, Political Entities cannot dump unlimited funds to drive out competitors without driving up taxes or going into debt, while large international telcos can and do command enough to decapitate Sasktel if the public were willing to abandon it.

private companies are there and are competing, there is no extra protection for sasktel

Saskatchewan pays some of the lowest taxes, and SaskTel returns a profit every year.

You keep going on about how privatization of the canadian healthcare system will make everything better and I'm calling BS.

privatization will end with the infrastructure no longer being owned by the people, meaning it will cost you money to go there. Private industry needs to make a profit, so that will also cost you more.

the industry's focus will be the bottom line, not providing service

and your But but but rationing! argument is horse crap, rationing means everyone gets equal access, in otherwords we won't let the poor die in a ditch. it doesnt' mean we're going to start hiding doctors. In fact if it weren't for our socialized system our wait times would be worse since doctors would be able to work more comfortable hours, and wouldn't have to put in 16 hour days.

the problem isn't socialized vs private, the problem is we pay half what the US does for the same level of healthcare. 

If you think for one second turning over the riens of the healthcare system to a bunch of privatized companies will magicly fix the problem without drasticly increasing the cost to the system or shutting some people out, you are severly mistaken.


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## a_majoor (2 Jun 2009)

Frankly your arguments hold no water whatsoever. Simply looking at how other industries work in socialist nations vs capitalist or free market nations demonstrates the point conclusively; yes milk and rice may be very cheap in Venesuela or Zimbabwe, but this is moot if there is none in the stores.

Similarly, if higher levels of State ownership and interference intrude in the health care business, the nominal price may be lower, but the long wait times and poor service (and higher death toll as people simply are not treated for debilitating conditions in a timely or effective manner) simply substitute for monetary costs, and legions of sick people waiting for treatment are a drain on the productivity of whatever industry they work for.

A company might be notionally private (like Government Motors), but if they have been receiving large government subsidies in the form of (never repaid) loans, grants, single source contracts etc. then they are indeed no better than Crown corporations. As for the idea of a "public purse", there is no such thing: that is _my_ money going to political rent seekers. I freely consent to paying for protection, and any government that limited itself to things like the police, EMS, military and courts of law would be a far better and more effective steward of the public purse (and create far more economic opportunity) than what we have today.

WRT the poor, they have been sustained for centuries by private and institutional (i.e. church) charity (and even today many people who need medical attention benefit from these charities, as I well know being involved myself); nothing stops *you* from getting out the door and helping people......


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## c_canuk (2 Jun 2009)

> Frankly your arguments hold no water whatsoever.



Then it shouldn't be a problem for you to directly engage my arguments and disprove them in point form. 

for example how do you refute that selling the infrastructure to our health system to a for profit corporation will solve the shortage of doctors, and lack of funds, while remaining a viable business without cutting services and/or increasing costs to the end users.

to do this you will have to prove that the existing administrative overhead is more costly and complicated than dealing with several separate insurance companies, several different coverage levels all tacking on an extra 15% for their shareholders.




> Simply looking at how other industries work in socialist nations vs capitalist or free market nations demonstrates the point conclusively; yes milk and rice may be very cheap in Venezuela or Zimbabwe, but this is moot if there is none in the stores.



Crown Corps and a Government Department that controls resources are two very different things. Simply looking at a socialist nation and saying see governments can't run things, is comparing apples to oranges.

First many of those countries have very high levels of socially acceptable corruption. 

Second, none of those are crown corporations, they are government departments, a crown corporation functions like a private corporation, except that the shareholders (the people) extract their ROI from services offered and/or reduction in taxes.



> Similarly, if higher levels of State ownership and interference intrude in the health care business, the nominal price may be lower, but the long wait times and poor service (and higher death toll as people simply are not treated for debilitating conditions in a timely or effective manner) simply substitute for monetary costs, and legions of sick people waiting for treatment are a drain on the productivity of whatever industry they work for.



exactly what state interference is resulting in a doctor shortage other than not enough funds... how many doctors are protesting that they have to treat all patients regardless of their personal worth... how many hospitals are complaining that the government is not letting enough private industry in their field?



> A company might be notionally private (like Government Motors), but if they have been receiving large government subsidies in the form of (never repaid) loans, grants, single source contracts etc. then they are indeed no better than Crown corporations. As for the idea of a "public purse", there is no such thing: that is my money going to political rent seekers.



If a crown corp. turns a profit of 1 million dollars, and they don't just credit most of that to their customer's accounts (give it back to the constituents) like Sasktel does, they would then transfer that over to the government coffers. 

At that point it can be reinvested into infrastructure, used to pay down the governments debt, increase other services, I see that as the public purse... are you implying that politicians just pocket the money? 

What exactly is a political rent seeker? I fail to see why filling a job position in the public office is somehow negative; administrators are required, private or public. Politicians will spend tax dollars on pet projects; however it's up to the people to vote them in and out based on their behaviour.



> I freely consent to paying for protection, and any government that limited itself to things like the police, EMS, military and courts of law would be a far better and more effective steward of the public purse (and create far more economic opportunity) than what we have today.



Private businesses fail all the time, we blame the executives responsible, when a crown corp. fails, some people blame socialism. Every crown corporation that I've heard of that has been privatized has become less effective and/or more expensive. 

Provide me with an example of privatization of an entire crown corp. that has been a success, because I can't find one.

Bottled water is a private business sector, municipal water is largely government, yet bottled water is frequently no better and sometimes worse than municipal water.

Municipalities that have privatized their water supply have had increased outages and decreased service and quality because the private firm needs to turn a profit, and there just isn't enough fat in those departments, so they turn up the water pressure to deliberately blow weaker pipes to create more revenue through their maintenance contracts.



> WRT the poor, they have been sustained for centuries by private and institutional (i.e. church) charity (and even today many people who need medical attention benefit from these charities, as I well know being involved myself); nothing stops you from getting out the door and helping people......



WRT the poor until the last century they were allowed to die without care, starve to death or were imprisoned if they couldn't pay their bills. Many of them could not get access to properly trained doctors and instead relied on folk medicine as their only resort. This is why things like the Flu became pandemics that killed large swathes of the population.

Nothing stops me from going out the door to help them no, but saying let the poor survive on the kindness of strangers, after saying you think that you have more right to healthcare than they do because you make more money is a ridiculous concept.

Especially a large portion of low paying jobs come with an elevated risk of injury and sickness. Those jobs need to be done, someone has to do it. We relegate them to the people who can't or won't do anything else, it's only fair we provide them with protection from criminals, natural disasters, and disease.

Just because someone doesn't have the ambition or desire to obtain a position that has higher social status than a lower paying job doesn't mean they shouldn't have access to decent medical care. 

Yeah the garbage man probably didn't pay attention in school, and dropped out, but if he stops picking up your garbage cause everyone is working white collar jobs now, you are screwed.

You need him, you can't live as you are without him, and relegating him to suffer without treatment for something that knows no social boundaries because you feel he's not worth protecting because he hasn't conformed to your standards it is a very selfish attitude.

Because no matter what the bar is set to, no matter what standards are met, someone will have to pick up the garbage, fix the sewers, dig ditches, and serve in the military.

Remember, as a service member, some of our fellow citizens feel we are nothing more than welfare in uniforms (fewer these days), how would you feel if they were entitled to decide if you should have access to health care?

If we start taking healthcare away from people based on their perceived social stature, it's not too far of a stretch to imagine our access being denied due to costs.

I can hear it now "They volunteered, why should we pay for their healthcare? so what if they can't afford procedures that cost half of their yearly gross pay, they should have picked a better career, it's not my problem, they should look to charity for help"


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## Bane (5 Jun 2009)

Medical bills underlie 60 percent of U.S. bankrupts: study

http://news.yahoo.com/s/nm/20090604/ts_nm/us_healthcare_bankruptcy


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## a_majoor (5 Jun 2009)

There really seems to be no lack of magical thinking on this topic: despite all historical evidence the "State" will be able to provide medical care for everyone without limit.

Yet the government (in Ontario) drastically reduced the number of positions in medical school during the Bob Rae government, resulting in the long term shortage of doctors. The government of Jean Chretien pulled billions of dollars from the provinces, resulting in dramatic underfunding throughout the 1990's (and the same government which refused to change the Canada Health act, preventing any possible market driven alternatives to emerge except for medical tourism to the United States and later India). The same government interference3 in the pharmacutical market means there is no Canadian pharmacutical industry that does groundbreaking R&D, limiting the choices of drugs that physicians can use (and ironically contributing to the astronomical costs of drugs in the US, since that is the one market where pharmacutical companies can recoup their costs).

The rationing that results essentially ensures everyone is left in the ditch. I have had reason to contemplate how the CEO of London Health Sciences (which runs the hospitals in London) gets all his funding from the State, pulls down a $400,000+ salary while I have been waiting in the emergency room for 6 hours waiting for a physician while my daughter has a breathing emergency (or I had to wait for 6 months on light duties to get a minor surgical procedure).

If Americans really want to see the future of Obamacare, they only have to revisit the VA hospital scandals of the recent past; that is the closest thing the US has to a single payer healthcare system, or they can take a close look at what we give up for a  notional dollar saving.

The argument may well be moot anyway; even without Obamacare, Medicare and Medicaid are set to become insolvent around 2016...


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## c_canuk (5 Jun 2009)

> There really seems to be no lack of magical thinking on this topic: despite all historical evidence the "State" will be able to provide medical care for everyone without limit.



Yet another vague, I'm smarter than you, and you're wrong statment lacking in details that refute any of my points...

Our health plan gets national results similar to the US system at half the cost, this is fact, this is not disputable, read on and I’ll prove it.

I’m not arguing a state only health system, I’m proposing a hybrid public private system that competes for the same revenue.



> government (in Ontario) drastically reduced the number of positions in medical school during the Bob Rae government, resulting in the long term shortage of doctors. The government of Jean Chretien pulled billions of dollars from the provinces, resulting in dramatic underfunding throughout the 1990's (and the same government which refused to change the Canada Health act, preventing any possible market driven alternatives to emerge except for medical tourism to the United States and later India). The same government interference3 in the pharmacutical market means there is no Canadian pharmacutical industry that does groundbreaking R&D, limiting the choices of drugs that physicians can use (and ironically contributing to the astronomical costs of drugs in the US, since that is the one market where pharmacutical companies can recoup their costs).



I agree with you that the Canadian health care plan has been badly mismanaged. It really is abysmal.

I disagree that turning the infrastructure over to private industry is the answer. Because as history has shown, simply turning our Crown assets over to a private firm does not increase service levels, reduce costs or increase reliability, it has historically resulted in the opposite.

I feel that you believe allowing private businesses to run governed only by market forces is the answer, and I feel that is as misguided as those that feel only the government knows best.



> The rationing that results essentially ensures everyone is left in the ditch. I have had reason to contemplate how the CEO of London Health Sciences (which runs the hospitals in London) gets all his funding from the State, pulls down a $400,000+ salary while I have been waiting in the emergency room for 6 hours waiting for a physician while my daughter has a breathing emergency (or I had to wait for 6 months on light duties to get a minor surgical procedure).



Doctor shortage, yes, but do you think the CEO of a private firm isn’t also going to get massive salaries regardless of the speed of the ORs? 

In 2008 the government collected about $600 billion and spent 115 billion on health(not just health care but health in general). That is about 19% of total revenue.

http://www40.statcan.ca/l01/cst01/govt48b-eng.htm

The average Canadian pays out about 11000 in tax, 19% of that is $2090, or $174 a month.


According to Towers Perrin's annual Health Care Cost Survey, the average corporate health benefit expenditure in 2009 will be $9,660 per employee-an increase of 6% over 2008 figures (source – Towers Perrin 2009 health care cost survey.

http://www.towersperrin.com/tp/showdctmdoc.jsp?url=Master_Brand_2/USA/Press_Releases/2008/20080924/2008_09_24b.htm&country=global


So if you cut that in half, in the US they pay $4800 a year while the average in Canada is $2090… 

Unless we double the amount of money flowing into the Canadian health system, we can’t hope to compare the two… for the money that we do spend, I think it’s doing a hell of a job. 



I feel that it should be mandated that the triage nurse must patrol the waiting room and continually check on those waiting, people who die in waiting rooms normally die because they aren’t being watched, most deaths could be prevented if there was someone qualified to increase and decrease priority of patients based on their changing status, that doesn’t seem to be happening now.

I believe we need to increase our spending on health care, find a way to end the shortage of doctors, and allow private industry to directly compete for the healthcare budget alongside the crown corps. 

I also propose to allow insurance firms to sell health insurance that would cover private firm’s extra fees.

Allowing private competition will cause a few things:

It will force public hospitals to deal with problems quickly in order to compete. If it can’t get people through, it can’t keep up its revenue while preventing the private firms from charging all the market will bear. The two will have to come to a middle ground between service and cost. Those with more money will tend to go to private firms; those with less will tend to go to public firms. By allowing for this, the people will be able to choose. Private firms will be likely to set up shop where there are long waiting periods at ERs.

This however does not solve the doctor shortage problem, for that I propose the Government institute a program where it will pay for a doctors schooling provided they sign a 10 year contract to work for a hospital in Canada, Public or Private doesn’t matter. They would have to pay back any funds expended if they didn’t complete their program. Private firms could do the same.

I also propose that doctors from other countries need a way to challenge for their qualifications, so they don’t end up driving cabs in Toronto.

The problems with healthcare in Canada is much more complex than you make it out to be, simply dissolving the healthcare system and turning the infrastructure over to private firms is not going to solve any of them, and it will just like with every other state owned firm, make things worse.

The solutions will not come out of switching ideoligies that are equally flawed but actually identifying the individual problems and comming up with solutions engineered to solve them.


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## a_majoor (16 Jun 2009)

An example of another "single payer" system:

http://pajamasmedia.com/instapundit/  16 June 2009



> *ANOTHER NATIONAL HEALTH PROGRAM THAT DOESN’T WORK: PROMISES, PROMISES: Indian health care needs unmet.*
> 
> CROW AGENCY, Mont. – Ta’Shon Rain Little Light, a happy little girl who loved to dance and dress up in traditional American Indian clothes, had stopped eating and walking. She complained constantly to her mother that her stomach hurt.
> 
> ...


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## c_canuk (16 Jun 2009)

so publicly paid doctors who are trained in the same schools as doctors in private practice wouldn't have misdiagnozed a patient if their paycheque had a private company's name on it?

BS.

the family is angry and looking for someone to blame, I feel for them, but they are accusing the doctors of deliberatly misdiagnosing a patient and letting her die due to lack of funds. 

Misdiagnoses happens in the private field as well, if it didn't they wouldn't have so many malpractice suits.

The exact same thing happened to my grandfather, they thought he had pneumonia, turned out to be small cell lung cancer. My Wife had a cousin who died in the emergency room by bleeding out internally after a car accident because they thought he was find and he kept telling them he was fine and to take care of his severly injured brother.

neither or these deaths would have been preventable if the paycheques of the staff involved came from a private company or the government of Canada.

Misdiagnoses is a human error, and it's going to happen no matter who pays the bills.


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## a_majoor (17 Jun 2009)

Lets read the story shall we? The patient was seen 10 times over several months, not just once.... 

Managers in single payer systems like ours, the VA hospitals in the US or the Tribal system just described are encouraged to husband their "resources", with the perverse incentive that a sick patient is a "drain" on resources. Looking at the number of my contemporaries in the Combat Arms who exist on horse sized doses of Iboprufin and constant physiotherapy rather than getting (expensive) surgical procedures that would set them right is yet another marker of how the system is incentivized against service or innovation.

Human error is possible under any conceivable system, the trick is to find a system where human error is corrected. Angry customers who's car problems are misdiagnosed stop going to that particular shop or mechanic, and he either leaves the business or gets retrained so he stops making these mistakes. The same principles apply to any endevour, and even in socialized medicine, we see NHS patients try to move to the "private" half of NHS, or Canadians doing the "medical tourist" route to the United States or India to get surgical procedures that they are unable to get in a timely manner here.

Lets face it, an emotional attachment to socialized medicine simply isn't supported by observation or numbers. I'm pretty sure if you go back to page 1 of this thread you will see lots of examples of what really works and what doesn't

As for the United States moving towards a single payer system, this is now in the realm of politics, as the Administration can use this program to divert billions of dollars in funding to favored political rent seekers and the "underclass" the Democrats cultivate as part of their permanent voting alliance. Even when voters are lined up at threadbare hospitals wondering why their ration of health care is not being delivered, they can be whpped into a frenzy by diverting the blame on "the rich" or "greedy doctors" etc.


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## c_canuk (18 Jun 2009)

> Lets read the story shall we? The patient was seen 10 times over several months, not just once....



exactly, so if funds were an issue why didn't they diagnose her properly the first time and off load her to the children's hospital that is not a drain on their funds?

in every publicly funded system I've ever seen, doctors get paid by the visit, therefor the more they see you the more they get paid, in private systems they get paid by the solution, so the faster they slap a diagnoses on you and get you out the door the more they get paid.




> Managers in single payer systems like ours, the VA hospitals in the US or the Tribal system just described are encouraged to husband their "resources", with the perverse incentive that a sick patient is a "drain" on resources. Looking at the number of my contemporaries in the Combat Arms who exist on horse sized doses of Iboprufin and constant physiotherapy rather than getting (expensive) surgical procedures that would set them right is yet another marker of how the system is incentivized against service or innovation.



irrelevant, those managers aren't going anywhere, they exist in all systems, public or private, in a public system they exist in the hospital, in a private system they exist in the hospital AND in your insurance claims department.



> Human error is possible under any conceivable system, the trick is to find a system where human error is corrected. Angry customers who's car problems are misdiagnosed stop going to that particular shop or mechanic, and he either leaves the business or gets retrained so he stops making these mistakes. The same principles apply to any endevour, and even in socialized medicine, we see NHS patients try to move to the "private" half of NHS, or Canadians doing the "medical tourist" route to the United States or India to get surgical procedures that they are unable to get in a timely manner here.



yes, they are mostly rich queue jumpers and you also see people served by the systems you favour, who are in our economic class, struggling to gain access to our system because theirs won't serve them.



> Lets face it, an emotional attachment to socialized medicine simply isn't supported by observation or numbers. I'm pretty sure if you go back to page 1 of this thread you will see lots of examples of what really works and what doesn't



I have no attachment to socialized anything, I have a distaste for unregulated private companies being allowed to decide if you live or die based on how much money they can extract from you. Straw man argument by the way, I know you are capable of intellegent debate, I've seen you do it, but in this thread it's been straw man after straw man, evasion of every point you can't defend against and posting of badly written propaganda articles, you're going to have to step it up if you want to change my mind.



> As for the United States moving towards a single payer system, this is now in the realm of politics, as the Administration can use this program to divert billions of dollars in funding to favored political rent seekers and the "underclass" the Democrats cultivate as part of their permanent voting alliance. Even when voters are lined up at threadbare hospitals wondering why their ration of health care is not being delivered, they can be whpped into a frenzy by diverting the blame on "the rich" or "greedy doctors" etc.



no one is blaming the rich or greedy doctors in Canada, infact I think the main argument in canada is to increase funding.

Again, where do you think this money is going? 

what is a political rent seeker?

do you really believe politicians just embezzle all the money they can?

do you really believe that healthcare funds are being funneled away from health care, keep in mind healthcare is almost 1/5th of government spending and no other sector comes close, and yet we pay per capita less than the US does for healthcare. How do you explain this?

how do you propose private industry repair our healthcare system without placing a 115 billion dollar strain on businesses and the working class just to maintain the status quo?

do you really believe that other than the minister in charge of healthcare being replaced by a board of directors, that anything in the health care system will change, and how so?


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## c_canuk (18 Jun 2009)

the options I see for privatization of our healthcare system are as follows

1) complete dissolving of the current organization and auction off of infrastructure, a complete removal of government from health care, theoretically, putting $2090 a year back into your pocket on reduction of taxes (*laughing so hard my sides hurt*)  since the Gov would no longer be supporting health care.

At this point the hospitals would probably be bought up by the corps the own the US Hospitals, since the organization of what we have, and what they have are similar, the employee's working at canadian hospitals likely won't change much. However the will have to add more administration to deal with the insurance companies that will move in to take the place of government health care.

my projected result is an increase of operating costs due to an increased administrative overhead, ER wait times will be reduced due those that currently clog the ERs with things that could wait for a doctors appointment will refrain from being there, however due to the extra paperwork and phone confirmations with various insurance companies and plans, there will be an increased time between diagnosing a patient and treating them. This means that those that actually need quick action, will have to wait longer for their emergency to be treated.

Doctors and nurses may see a reduction in work as ER cloggers will not be there so much, however I don't see this as something that requires privatization to fix, a 100 fine for wasting ER resources instead of making a doctors appointment would  go a long way to solving this problem with our system.

2) allow private companies to buy up the infrastructure and attempt to streamline the current system, they would draw funds from the government in the same way the existing system does, but be privatly owned. 

My projected result would be the same as every other public department that has done this, at first they will union bust, and trim down staffing levels to cut costs... this will result in lower moral and effectivness of those that remain. over time the firm won't be able to cut anymore as the decreases in service will be too much to justify, equipment to fall into disrepair and the government will be forced to increase funding to the infrastucture just to maintain status quo, or the firms will go bankrupt as they won't be able to provide a profit to their shareholders and or pay down their liabilities.

3) allow private firms to compete for government revenue alongside the existing system, and allow for top up insurance allowing for a broader two tier health system than what already exists.

this will allow firms to take some of the load off ERs and other departments by providing extra facilities that may or may not be specialized. Those that choose to pay more can go to these facilities, many companies may increase thier medical insurance top up programs to cover visits to these facilities without putting the entire burden of health insurance on them.

my projected result will be the decrease of wait times, increase of facilities and services, and allowing those with the extra funds to pay more for faster service without removing basic service from those falling on hard times. It also removes the motivation of companies to lay off those with more medical needs first during economic downturns, and does not let those between jobs to fall through the cracks. This would increase funding to the health care system without increasing taxes, resulting in greater attraction of doctors to stay within our borders, as they will have a much better quality of life.

the only problem I forsee is if the private companies pay more for doctors, they may be able to draw higher quality doctors from the public sector creating a disparity between the systems, experianced seasoned doctors are needed everywhere, however the government can compete by raising doctor' wages.


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## Edward Campbell (18 Jun 2009)

The problem is not with who “owns” the “system” it is rather, with how you and I pay for our access to it.

The “system” has two major parts: prevention and treatment.

Prevention is almost exclusively a government thing; mostly it does not involve people from the “health sciences” domain. Prevention is, particularly, the work of engineers, mostly employed by cities, who provide clean water and gather up and dispose of garbage and sewage. Take them (those engineers) out of the equation and all the doctors and medicines and _what-have-you_ in the whole world will be powerless to prevent a sudden, steep decline our life expectancy.

Treatment is what most people discuss when we deal with the national health care system. And most of us deal with three parts of the treatment _regime_: hospitals, doctors and medications:

Hospitals are, by and large, all “public” now – even though most have “private” boards that raise a share of development money. You and I, as taxpayers, fund the day-to-day ‘operations’ of almost all hospitals. They are, rather, like schools: public buildings providing a public service at public expense. Yes, there are exceptions, but the existence of e.g. _Upper Canada College_ does not have any measurable impact on the Ontario education system. So the bricks and mortar, the MRI machines, the cleaners and technicians and nurses are “public.”

Doctors, on the other hand, are – once again, by and large – private entrepreneurs  paid, mainly, by one (in each province) “insurance” scheme. Of course there are exceptions (I happen to be served to be served by a group practice) but most doctors are still “private.” 

Medicine is provided by a third system – also, in the main, by private entrepreneurs (pharmacists) but paid for by a mix of cash, and many and varied insurance policies.

The unique thing about Canada’s healthcare system – compared to that in, say, *A*ustralia, *B*elgium, *C*hile, *D*enmark and so on down through the alphabet – is that it employs a “single payer” system. You and I pay for everyone else's health care (doctors’ services) and treatment (hospital care). In most countries most people have some wholly publicly funded health care and treatment. Some basic levels of essential health services are provided, without any form of payment being required, for all. In most countries many people are, however, allowed, indeed encouraged, to supplement the “free” healthcare with some combination of private insurance – which may provide either a wider choice of physicians or quicker access to a physician and/or faster or “better” hospital care (perhaps a nicer room, perhaps more advanced technology and tests, perhaps just a “better” hospital).

Most of the OECD countries (*all* of which (except Canada) have “mixed” payer systems) have two attributes compared to Canada:

•	Lower costs (for 21 out of 30 OECD members); and

•	Better ”outcomes” defined as e.g. physicians, nurses, acute care beds and diagnostic imaging systems per capita.

A single payer system can have one and only one “control” on expenditure: rationing. In Canada, for decades, we have rationed the “care” component: physicians, nurses, acute care beds and so on. Yet, despite some pretty severe and too often misguided rationing, cost continue to rise so fast that some civil servants and even a few brave politicians are beginning to ask how *more important* public services – like education – can be sustained, much less improved, in the face of insatiable demand for “free” healthcare.

(Parenthetically: a good (lower cost/better outcomes as in, e.g. Sweden or the UK) public healthcare system is an important net “contributor” to a nation’s productivity but not more important than e.g. public education and high quality R&D.)

There is a clear “safety valve” in “mixed” payer systems: since some/many/most people will want to buy insurance for “better” care or for faster access then the demand for the “basic,” publicly funded, insurance can be contained. The system is still “rationed,” especially for the poor, but the rationing is less noticeable for those most likely to be politically “active.”

One other thing that a “mixed” system provides is “competition” for quality of service. When privately insured patients receive clearly better care then there is a demand for improvements in the public system. The privately insured “clients” are not opposed to (paying for) improvements in the public system because it is not a zero sum game: improvements in the public system are not made at the expense of the private system’s services, in fact, often, the reverse is true – at least it is in countries where most doctors and most hospitals treat both publicly and privately insured clients.

More importantly, the mixed system provides competition for “management” of services. In my opinion the major failing in the various provincial health care systems is poor management. There is, as others have mentioned, a poor “attitude” regarding “clients.” Most private business leaders recognize that clients are important; many public administrators regard clients as an expense, a problem to be managed away.

We already have two tiered Medicare in Canada: people covered by e.g. _workman’s compensation_ programmes are, in most jurisdictions, treated faster and “better’ than, say, the unemployed or retired. We have “private” care systems, too: the one that serves the CF, for example. There is no good reason why we could not allow private health insurance to “compete” with and “augment” e.g. OHIP. A “client” in Ottawa, for example, could use his private insurance to nip across the bridge to Gatineau and get a MRI scan the next day rather than waiting for weeks and weeks in Ontario. Who knows? Efficient and effective private MRI centers might open in Ontario to meet the medical needs of the underserved “problems” (AKA sick people).

My guesstimate is that the very rich will see little change in their medical care – they can already go to the USA or Europe when local, Canadian, doctors and hospitals cannot meet their perceived needs. Those who are simply “well off” are also, increasingly, going to Malaysia, India and China for complex medical treatments that have very, very long waiting lists in Canada. The bottom 20% will see no improvements, either. Their care will remain sporadic and will be beset by long waits in dirty hallways. The 65-75% in the “middle” will, I think, be able and willing to pay more (private insurance) for faster and “better” care. This “new” money will attract more doctors, nurses, acute care beds and diagnostic services – improving the quality of healthcare in Canada while, simultaneously, lowering the government’s share of the costs. Eventually increased competition throughout the entire system should, as it has done in ⅔ of the OECD, lower the overall healthcare costs – as a share of GDP - too.


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## c_canuk (18 Jun 2009)

ER Campbell, I think you've laid out the points I was arguing on the matter much more eloquently and completely than I have, thank you.

Edited to better match my intent and because I inadvertently came off as a pompus ass


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## c_canuk (18 Jun 2009)

the doctor will see you in 3 months.
http://www.businessweek.com/magazine/content/07_28/b4042072.htm


A systematic review of studies comparing health outcomes in Canada and the United States
http://www.openmedicine.ca/article/view/8/1

stumbled across these tonight on a different website... the second is a lot of reading.


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## a_majoor (20 Jun 2009)

As E.R.Campbell points out (yet again) the issue is how health care is "managed" and what sorts of incentives exist to improve management, provide timely and cost effective service etc. The overwhelming evidence is that using the State to provide "service" simply provides perverse incentives that favour "management" over the "clients", and there are 20 pages on this thread alone with examples, facts, figures, comparative analysis and observations to support that. Of course the outcomes of other "state" enterprises in other fields should make this no surprise. Only the fact that the State can enforce an monopoly makes these situations even possible, and wherever the State tries to force a monopoly when real competition is possible, the ultimate results are ruinous. British Leyland dissolved due to the ability of British buyers to buy foreign cars that actually worked, and the takeover of GM and Chrysler will have the same bitter ending for the US automotive industry.

Healthcare has seemed to be a "protected" or natural monopoly since it does not seem to be portable on the surface, but primary healthcare "can" be portable (i.e. medical tourists), and of course everything the bureaucrats forget to grab hold of goes to market, just look at all the private physiotherapists, chiropractors, dentists, foot care specialists, etc. etc. etc. who exist on the periphery of the State health care system providing goods and services to satisfy the demand for health care. I will also include "alternative medicine" in this category, since they also claim to supply health care and there is obviously a market for this.

In the United States, the situation is even worse, consider:

http://www.washingtonexaminer.com/opinion/Why-not-just-fix-Medicare-first.html



> *Why not just fix Medicare first?*
> By: Examiner Editorial
> 
> 06/19/09 11:37 AM EDT
> ...


_


_


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## c_canuk (24 Jun 2009)

certainly there has been posted, a lot of theory and study done in isolation, comparing of apples to oranges to combination locks, as well as flat out propaganda from various ideologies.

You yet again dodge my key questions and assertions…

1)	How will privatization of healthcare provide cheaper better service when every other privatization of government departments in Canada that I know of, has done the opposite? I haven’t found any cases of a positive outcome however I’m sure there have been some, if you have any success stories I’d like to hear them.

2)	Why is it preferable to have many levels of private for profit administrative overhead than one public level that is motivated to provide good service in turn for political revenue?

3)	If a private system like the US’s is supposed to be better than ours, why does it cost 2-3 times more than ours for the same level of service we are getting?

4)	How to you envision our system being reformed once privatized in that it would provide better and/or cheaper service.

5)	Your rationing comments are red herrings, they system in place is rationed by first come first serve, the same as a private business will be unless they allow the rich to jump queue. There are no hospitals, doctors, or nurses in our system that are not tasked beyond what would be considered normal work load.

6)	How do you figure you yourself will benefit from a system that will cost you more money, and will only provide elevated service levels to those making you yearly salary in a month?

7)	Why do you think the government should care that it has a monopoly on health? The Government’s role is to provide protection and services to its people. No one thinks privatizing fire and police departments would be a good thing because we developed past that dark time in history and know that allowing private business to make a buck off people who need help and have no where else to turn results in abusive practices that cause the less fortunate classes to suffer.

When the less fortunate classes suffer our society starts to grind to a halt as the less fortunate classes are those that keep our economy moving. The more you screw the lower working classes, the more you screw everyone else.  A healthy economy is made up of healthy happy people, you propose screwing over the lower class worker who is vital to our nations health, in favour of making health care more convenient for the upper class.


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## Edward Campbell (24 Jun 2009)

But you are propagandizing too, c_canuk.

First, you admit there are privatization “success stories” and then you ask questions that are philosophical nonsense.

There is one simple, compelling reason why communism and socialism always fail and always *must fail*. Stalinism/Marxism/commnism/socialism (all exactly the same “system,” just different implementations) espouse “from each according to his ability, to each according to his needs” and the model requires only one thing: perfect people. But human beings are *NOT* perfect or even perfectable so Stalinism/... socialism  can never succeed. Please, find me the "perfect" public sector bureaucracy that is _”motivated to provide good service in turn for political revenue.”_ I do not believe that such a thing exists. I did a little mental ‘survey’ of Anglo-American and Chinese history (subjects about which I have some, very modest, knowledge) and couldn’t come up with more than one or two very brief, transitory examples in each – always in what I would term _interregna_.

With regard to rationing: Your analogy is false, even worse. Our health care system rations by withholding, not by providing on a first come, first served basis. A retailer, faced with excess “demand,” raises prices and adds new stock. A government, faced with excess “demand,” reduces “supply.” And, the reason for governments’ economically _illogical_ actions is that the “customer” is a problem, not a solution, a “cost,” not a “profit centre.” There is no way in all the gods' green earth that governments can make economically logical decisions – not, anyway, so long as we have a single payer system. Ministers and bureaucrats are not stupid. They *know*, already, that our _Stalinist_ system threatens to suck up all the money and destroy e.g. infrastructure and education. More and more and more money is needed.    

The aim of allowing private insurance is to inject more money into the system.

The side effects of allowing private insurance – multi tiered medical care/treatment – are likely to include:

•	Competition to “manage” the *real* “costs” and “profits” of health care and treatment. This may involve adding medical professionals, building new, private, hospitals or buying existing public hospitals and running them more and more efficiently; and

•	A clear delineation of “medically necessary” services – which I would argue must be covered by the public insurance and must be “adequately” delivered to one and all – and all the other “services,” including the timeliness of service. 

Contrary to your hyperbolic remarks, c_canuk, medical “tourism” is not the exclusive domain of the rich. I used to be one - I was/am a classical “middle class” person living, then, on a modest pension and an even more modest salary. Whenever a screening test – one with a reputation for false positives – gave me a positive (bad) result I was faced with a wait of months and months in Ontario. I used to jump he queue by making an appointment for the next test – the one with the long wait in Ontario - with a physician in a nearby US city. Fortunately, my results from those tests were always negative but had they not been I, armed with the US test results, would have moved up to the top of the treatment “list,” passing every “poor” person still waiting in the test queue. I made a choice: I spent a few hundred (>$1,000.00 but <$2,000.00 including hotels and expenses) to obtain a faster and “better” diagnosis. Others, many of whom *could* afford to choose, elected to wait in the queue. Medical tourism is the sole safety valve for the Canadian _(Stalinist)_ system. Sometimes it is publicly funded – as when Ontario (regularly) sends cancer patients to the US for treatment. Sometimes it is private – as when Ontarians, mostly “poor” seniors, increasingly, spend $20,000+ going to Asia for hip replacements because they are unwilling to spend months and months, stretching into years, on rationed wait lists. Faced with a similar situation, I, a very “middle class” old fellow living on a modest pension and a few investments, would do exactly the same.

I do not need to wait – not so long as China has good private hospitals; I can spend my money as I see fit.  Do not need any politician or bureaucrat to tell me what is “medically necessary,” for me; nor do I give a damn about their views on acceptable wait times. I already have a “private insurance” plan: my savings.

Finally, “less fortunate” is a meaningless phrase, just more hyperbole. By many (nonsensical but commonly used) definitions I probably fall into that class. But even though I am retired and live off my investments I am certainly more “fortunate” and probably more “productive” than many employed Ontarians because, despite my very modest “consumption,” my investments (work) “earn”  more for the province than does the labour (also work) of a huge number of my fellow Ontarians. In a properly managed system, one with access to private insurance and private services, the “less fortunate” will be better off. Only the “least fortunate” will see no change to the inadequate levels of service they now “enjoy.”


--------------------
I’m not going to address the “red herrings” of police and fire. There is a special case for _public_ police, and for all those who may use force on the sovereign’s (people’s) behalf. Fire protection _could_ (used to be) private but public “management” turned out to be cheaper. But, private fire departments remain common; DND has one, so does e.g.  Boeing, because the _public_ fire protection is sometimes “inadequate.” Some jurisdictions (rural New York and Connecticut, to my certain knowledge) continue to experiment with private fire services.


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## c_canuk (26 Jun 2009)

E.R. Campbell said:
			
		

> But you are propagandizing too, c_canuk.



stating that both socialism/communist and free market capitalist ideologies are flawed and stating that we need to identify the existing problems and fix them on a case by case basis rather than switching from one flawed plan to another is not propagandizing.



> First, you admit there are privatization “success stories”



I said there probably are some (statistically there must be) but I’ve never heard of one.

If you have examples I'd genuinely be interested in reading about them because it would provide some insight to a problem I don't see a solution for. I'd like to know how they succeeded, what was different.



> and then you ask questions that are philosophical nonsense.



beg your pardon? 

question 1 is calling on Thucydides to explain exactly how he envisions privatization of the existing system in our existing economy in such a way that it does not reduce service and/or increase costs which he claims by virtue of privatization with no backing logic will magically make things better when I've illustrated that the problem with the system is lack of resources i.e. beds, doctors, nurses, not lack of middlemen pocketing their 15%

2 asks how the system involving at least 3x as many middle men can be considered more efficient (regarding selling off our health infrastructure to private business)

3 asks him to explain why his preferred system costs 3 times what ours does, and how he figures that won't be the case if we privatize

4 asks him to provide an outline of how we could succeed in privatizing our system so that we don't end up paying more for the service level we already have, or limiting access to the system.

5 is a statement that is fact that there is no rationing of health care resources beyond the fact that our existing infrastructure is overworked due to reduced government spending.

6 requests he personally explain how he, someone who would be stuck with an HMO would benefit from the ideological change that would likely see zero increase in XYZ, and start reducing A while charging a premium for those that are still within A just like the US system, and just like every other privatized gov department.

7 illustrates that some things cannot be privatized without the loss of integrity. Bad things happen when they are turned over to free markets. If fire fighting is free market, if you don't have the right fire insurance they don't save your house, if you privatize police departments, the rich don't go to jail, if you privatize health the less fortunate do without and H1N1 spreads in Canada just like Mexico. 

right now, as we speak, Winnipeg hospitals are struggling with H1N1 because some of the less fortunate don't have the same shelter most people do, mostly due to certain types of ethnic council... however, under a private system these people wouldn't be in isolation wards, they'd be on the streets, spreading the disease, looking for back alley doctors or the big book of home remedies. Part of the reason we don't have the massive plagues of the previous centuries is because we have a system that caters to all.

He never engages any of these points he just dances around them by making vague comments about how history has proved him right even though I present an existing example that flies in the face of his comments.

Asking for someone who makes philosophical arguments based on vague statements to provide a framework of how they would put them into practice is hardly "philosophical nonsense"




> There is one simple, compelling reason why communism and socialism always fail and always *must fail*.



Because they, in order to succeed need to control everything and distribute everything evenly. In order to produce goods and services since the Bronze Age you need division of labour. In order to provide what we need in this day and age the division of labour is such that it is so complex and numerous that it is impossible to compute even if you centralize distribution. Further to the point centralized distribution is inefficient and wasteful.

Capitalism solves both problems with money, which provides the ability to store the value of your labour in a finer granularity than is possible in any other system. And by allowing businesses to decide how much they will make and set the value for what they make, other businesses can decide how much they need and the problem of distribution is self solving for most things. 



> Please, find me the "perfect" public sector bureaucracy that is _”motivated to provide good service in turn for political revenue.”_ I do not believe that such a thing exists.



No, you are right, it doesn't exist, but neither does the perfect private sector bureaucracy. Especially within unregulated free markets that Thucydides implies magically is self correcting when what it actually does is slowly consolidate in to fewer and fewer larger entities with the monopolization of everything as it's end game. Especially when businesses find loop holes and twist the game so that they obtain a vast imbalance between what they have contributed and how much money they have… see Enron.


> With regard to rationing: Your analogy is false, even worse. Our health care system rations by withholding, not by providing on a first come, first served basis.



There is no rationing in our healthcare system beyond the number of beds available and doctors/nurses available to treat patients. This is fact. This is not disputable unless you mean, it’s rationed because they won’t give you more priority over anyone else.

My comment is to illustrate that simply changing where their money comes from will not change the fact that there is still only X number of beds, y number of doctors, and z number of nurses, this is not philosophical masturbation this is fact.

the only way you can free up x,y,and z is by limiting the number of people accessing the system(A), or increase the number of x,y, and z. simply auctioning off our infrastructure to private enterprise will not do this, unless the private enterprise limits A, or increases X, Y, and Z. 

Therefore privatization will not do anything that we can't do with the public system. I'm requesting from Thucydides and now you, how you propose a private enterprise increase x,y,z without raising costs, or limiting A in the taking over of our existing infrastructure.

I define raised costs and/or limited A as a failure of the privatization process as this would be WORSE that what we have now.

I submit we don't need to switch ideologies, I submit we need to add competition between private and public systems and increase funding.



> A retailer, faced with excess “demand,” raises prices and adds new stock. A government, faced with excess “demand,” reduces “supply.” And, the reason for governments’ economically _illogical_ actions is that the “customer” is a problem, not a solution, a “cost,” not a “profit centre.”



just because you say governments reduce supply doesn't make it so, I want proof that, (and this is what you claim the government is doing) that the Canadian government in direct response to longer wait times, is closing hospitals, laying off doctors/nurses and/or cutting funding.



> There is no way in all the gods' green earth that governments can make economically logical decisions – not, anyway, so long as we have a single payer system.



Again, with statements that are not backed up with anything, just bold statement of propaganda as fact.

Accountants are accountants regardless if they are hired by private business or the public office. Claiming that no government departments are run efficiently is a flat out falsehood, and regarding history, both private and public corporations have failed and succeeded spectacularly.

The fact that our health system provides remarkably similar service to the US for 1/3 the cost is a huge success. It flies directly in the face of your comment. 

The wait time argument was for the most part manufactured in the US by lobbyists who profit greatly from the system there as it is, the wait times in US ERs are roughly equivalent to ours unless you have the cash to jump the queue, and I would be greatly surprised if anyone in this website has the financial wealth required to jump queues in the US for convenience alone on a regular basis.



> Ministers and bureaucrats are not stupid. They *know*, already, that our _Stalinist_ system threatens to suck up all the money and destroy e.g. infrastructure and education. More and more and more money is needed.



Due to budget restraints healthcare has been cut in recent years, and its increase in funding recently hasn't even accounted for inflation. Again, our system is 1/3 the cost of the US system which I proved using very conservative numbers that were cited. 



> The aim of allowing private insurance is to inject more money into the system.



Yes, the aim of allowing private insurance is to allow more money from outside the taxation system to be injected into the system.

I support allowing private clinics and insurance to cover the increased fees, as I posted previously, as it would add more X,Y,Z and not limit A, by providing another tier to the health system. I strongly object to turning our healthcare system over to the private industry and drinking the Kool-Aid that pure free markets will self regulate.



> •	A clear delineation of “medically necessary” services – which I would argue must be covered by the public insurance and must be “adequately” delivered to one and all – and all the other “services,” including the timeliness of service.



I agree, and support private enterprise entering the healthcare sector in Canada for these reasons, but I do not support the turnover of existing infrastructure to private enterprise.




> I used to jump he queue by making an appointment for the next test – the one with the long wait in Ontario - with a physician in a nearby US city.



a system that solves it's wait times by limiting A to those that can pay yes... the solution is to add more x,y,z not switching who pays x,y,z


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## c_canuk (26 Jun 2009)

> Fortunately, my results from those tests were always negative



*raises my beer in a toast*



> but had they not been I, armed with the US test results, would have moved up to the top of the treatment “list,” passing every “poor” person still waiting in the test queue.



which shows that our system is flexible, and allowing private companies to run labs in Canada would add more X,Y,Z for those that can pay, and decrease the demand for A in the traditional system for those that can't.



> I made a choice: I spent a few hundred (>$1,000.00 but <$2,000.00 including hotels and expenses) to obtain a faster and “better” diagnosis.



Is this a problem Canada wide or only in Ontario... there has been some bungling within the health care system (that would most likely would be left intact in a private takeover) and in the provincial government's health infrastructure (which wouldn't) 

I agree with you that the solution to the problem is to allow private enterprise to compete, I just don't see any benefit, and a lot of harm to completely turning our existing system over to private firms.



> Medical tourism is the sole safety valve for the Canadian _(Stalinist)_ system.



I'm not sure medical tourism is a safety valve available to anyone under a Stalinist system, however I agree with you on this point in regards to Canada's system, which is not Stalinist due to the fact that it revolves around money something that doesn't exist in Stalinist style government. 

As to your assertion that anything in the Canadian government outside the CHRC is Stalinist, who is using hyperbole now?



> Sometimes it is publicly funded – as when Ontario (regularly) sends cancer patients to the US for treatment.



Temporarily accessing external XYZ to provide more A



> Sometimes it is private – as when Ontarians, mostly “poor” seniors, increasingly, spend $20,000+ going to Asia for hip replacements because they are unwilling to spend months and months, stretching into years, on rationed wait lists.



Now here is where I have a concern... if we were to allow private enterprise to open hip replacement clinics, where would the doctors come from?  The waiting list isn't because some bureaucrat is not allowing more than H amount of hip replacements, its due to some lack of XYZ in the hip replacement process. I'm concerned that a private hip replacement clinic would just siphon off Y/Z from the existing system. 

If the problem is X(lack of beds) problem solved, if it's lack of doctors(Y) then you just inadvertently made A smaller to those that can't pay and increased the cost to those that can.

Here you have a problem... you let those who are lower on the social ladder do without, so that those higher can have faster access... I don't find that ethical due to those on the lower social ladder typically did the harder jobs that are necessary for those higher on the social ladder to survive. It's a question of if you think hip replacements should be a universal right.

There may be a middle ground... I lack the knowledge if this is feasible, but could the division of labour within healthcare be further divided to increase the areas of specialties and in the process decrease the training needed for high demand treatments such as hip replacement? ie could a tech school train some sort of medical practitioner in say 3-4 years to be licensed to do just hip surgeries, thus increasing the y/z of hip replacements.




> Faced with a similar situation, I, a very “middle class” old fellow living on a modest pension and a few investments, would do exactly the same.



As would I, however I would not personally be able to sleep at night if people who needed them couldn't have them because the system was altered to give me quicker access.



> I do not need to wait – not so long as China has good private hospitals; I can spend my money as I see fit.  Do not need any politician or bureaucrat to tell me what is “medically necessary,” for me; nor do I give a damn about their views on acceptable wait times. I already have a “private insurance” plan: my savings.



I agree wholeheartedly with you on this issue. 



> Finally, “less fortunate” is a meaningless phrase, just more hyperbole.



I disagree.

The garbage man is a job that must be filled.
If no one does the job, then we smother under our garbage, extreme but true.
The job is seen as low on the social ladder because it is undesirable.
Because it is seen as low on the social ladder, and does not require a high level of training the benefits and compensation are lower. Therefore it is logical to conclude that he wouldn’t have access to very good healthcare, while filling a role within society that all other levels depend upon and provides the filler of that role with shortened life expectancy and many physical ailments.

Yes yes yes, he could have paid more attention in school and got a scholarship to university and become a stock broker, but what of those without the required intelligence to succeed in higher education? What of the fact that if everyone goes to university, then garbage men will now be university grads picking up garbage for the same wages with university debt load?

Someone has to do it, regardless of how they ended up there; I’m not willing to write them off as the detritus of society and therefore not as entitled to medical care as I am just because I’ve got a higher position on the social ladder. 



> By many (nonsensical but commonly used) definitions I probably fall into that class. But even though I am retired and live off my investments I am certainly more “fortunate” and probably more “productive” than many employed Ontarians because, despite my very modest “consumption,” my investments (work) “earn”  more for the province than does the labour (also work) of a huge number of my fellow Ontarians. In a properly managed system, one with access to private insurance and private services, the “less fortunate” will be better off. Only the “least fortunate” will see no change to the inadequate levels of service they now “enjoy.”



You are being intellectually dishonest. you know as well as I do that you've had access to more resources than most bottom to lower middle class people will, Yes how people plan for the future has a lot to do with their position on the social ladder and their financial well being, there are still those that are not able to break out for one reason or another. The majority still provide many required services and I find it unethical to deny them medical coverage so those higher on the social ladder can have faster access.

The problem becomes how much is enough, something that is not definable within the context of health care until the secret of immortality is discovered. There can always be more for some at the expense of others; you need to figure out how much you are willing to take from one group to provide more for another. The only alternative to that problem is to add more to the system, to do that in our health care system is to add more X,Y,Z something that privatizing alone cannot do, and may not do at all.


--------------------


> I’m not going to address the “red herrings”



Thucydides stated that there was nothing that the government does that can't be done better by unregulated free markets to which I provided the examples of fire and police departments that are a classic historical example that has always been an unmitigated disaster when privatized.

Therefore this statement is misdirection, as you are addressing them, and red herring portion is a straw man. 



> of police and fire. There is a special case for _public_ police, and for all those who may use force on the sovereign’s (people’s) behalf.



Why is it a special case? Could we not lay off the RCMP and hire a private security contractor to perform the exact same mandate the RCMP fill?

In theory you should be able to do it and tap into Brinks or Pinkertons scale of economy to provide a lower cost per set of boots on the ground.

Other than the fact that private entities first priority is not the well being of the public.



> Fire protection _could_ (used to be) private but public “management” turned out to be cheaper.



If public management of fire departments can be cheaper why not healthcare?

It was also turned public because you ended up having to buy service from all the departments, because if the wrong one showed up they didn't save your house, they protected those that had bought their service around yours, and in times of low amounts of fires, sometime unscrupulous administrators would light fires to drum up business. Also the rich guy's smouldering lawn was a priority of the low income apartment building that was billowing flames. 

Also the infrastructure developed through public fire department interests developed the hydrant systems and increased fire codes, things that would have been counter productive to private fire systems



> But, private fire departments remain common; DND has one, so does e.g.



DND is a public entity, therefore its department is also public. It's a redundant public department that serves a public department; it's no more private than the photocopy room in the department of transportation is a private copy business.



> Boeing, because the _public_ fire protection is sometimes “inadequate.” Some jurisdictions (rural New York and Connecticut, to my certain knowledge) continue to experiment with private fire services.



To supplement their public systems, there is nothing wrong with contracting private companies to supplement public services, it's a whole other kettle of fish to turn everything over to private interest.


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## stealthylizard (26 Jun 2009)

mediocre1 said:
			
		

> My argument against that is cancer can also be caused by bad eating habits. If you consume peanut butter to the maximum allowed by your body, you can have cancer. .




Peanut butter 'wards off heart disease', say scientists

http://www.dailymail.co.uk/health/article-1195453/Peanut-butter-wards-heart-disease-say-scientist.html


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## Edward Campbell (26 Jun 2009)

I’m not inclined towards line-by-line deconstructions so I will deal with just three points raised by c_canuk:

First: private fire services were *too expensive* because there was not (maybe still is not) an acceptable alarm/response system for competitive, private fire companies. A “public,” monopolistic system was adopted so that any alarm would result an acceptably prompt response by only the necessary number of fire fighting units. Some jurisdictions are exploring “private” solutions while still maintaining the monopolistic character because they think a private contractor can provide an acceptable grade of service for less money than can a “public” agency.

The premise, however, is that fire fighting is a “natural monopoly.” I’m not sure that is correct. I do not have any good examples of “competitive” fire departments but I do have models of competition in other traditionally “public” services that are, usually, thought to be “natural monopolies.” I refer, specifically, to “public transit” in Japan which is, often, provided by competing private companies – at costs and grades of service that Japanese municipal governments find quite acceptable. I cannot vouch for the costs (I’m neither a Japanese accountant nor a Japanese taxpayer) but I can vouch for the grade of service which rivals that of Hong Kong and is, therefore, far, far superior to any public transit I have used in North America and Europe.

Second: the private sector does, normally, do the same task as the public sector for less money. It does so, quite simply, by making its operations more “productive.” This often involves replacing highly paid public sector employees with more lowly paid contractors – something that does, indeed, “damage” the “social fabric” by taking well paid jobs out of the “system” and replacing them with less well paid jobs. *BUT*, the cost of a job ≠ value of that same job and the mismatch is often, but not always, most evident in public sector jobs. Most often *high value* jobs, like garbage collection, cost less (lower salaries) than *low value* jobs like health care economists, human resource managers and bilingualism coordinators. It is important to carefully and sensibly account for both the cost and value of labour. The public sector is chronically unable to do this and is (equally chronically) unwilling to try.

Third: the whole health care system need not be privatized – even though some of the most critical parts  (physicians and pharmacists) are, mainly, already private. There’s nothing horribly wrong with e.g. publicly owned hospitals – so long as they are well managed and, therefore, able to get somewhere near cost of labour ≈ value of labour. But I fear that public ownership and sound management rarely go together.

What is required – soon – is more, new money and that will come only from the private sector. It will come, principally, through private health care insurance which will allow the middle class to jump the qualitative and timeliness queues, as the rich already do and as the really poor can never hope to do no matter how much public money is wasted applied to the system. I’m guessing, based on examples in the UK, that private management can and will cut costs and improve efficiency and productivity in hospitals, the _industrial_ component of health care.

Finally, the US does not provide the “right” model. We need to look to e.g. *A*ustralia, *B*ritain, *C*zech Republic and *D*enmark and so on down through the OECD for models that provide qualitatively better health services than Canada does at (roughly) equal or lower costs.


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## a_majoor (26 Jun 2009)

WRT fire services, there are still more volunteer fire departments in the US than "public" or private ones combined. Obviously, people recognize the need, and organize accordingly.

While the State must provide police protection as part of the States function of providing protection to citizens, it is also obvious that the modern State is not providing the protection service desired, as there are far more private security officers than police officers.


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## Edward Campbell (27 Jun 2009)

Before someone asks: if, through private insurance, the "middle class" can jump the queue, as the rich already do, doesn't that just create a whole new, equally long queue?

No. The "miracle" of competition within the private sector is that it will, of necessity, add resources (doctors, nurses, acute care beds, etc) to meet demand until an acceptable price/availability "equilibrium" is achieved. That, adding resources - new money - is the one thing the public sector is unwilling to do.


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## c_canuk (29 Jun 2009)

I agree with the premise that private competition in the health care sector will inject new cash and infrastructure.

I am hesitant to agree that it will increase the number of personnel as it's a problem outside healthcare for the most part.

Also while I think it is unlikely that the public sector would inject more cash, it's certainly not impossible, just improbable


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## c_canuk (29 Jun 2009)

> While the State must provide police protection as part of the States function of providing protection to citizens, it is also obvious that the modern State is not providing the protection service desired, as there are far more private security officers than police officers.



The state's police force's primary function is to enforce the states laws, protecting people falls second.

they provide protection to the people by making sure that those who break the law are apprehended and fed to the court system to be punished if found guilty.

private security's primary function is to provide protection to whoever has hired it.

Malls, Stores etc can't retain the services of a police officer to provide a visible deterant and on the scene peace officer, and thus private security fills that need.

This is why the theory that draconian gun control laws and allowing intruders to sue you for injury are reprehensible, forcing the citizens to rely only on the state police for protection, when that isn't their primary mandate, is sickening.


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## a_majoor (29 Jun 2009)

Common sense is breaking out in Canada, and it is ironic that we seem to be moving more towards the American system at the time the Administration wants to move towards "our" system. Perhaps there is a silver lining in this, "medical tourists" from the United States might find coming to a private Canadian clinic far more affordable and accessible than going to (say) Mumbai, which will provide the source of "new money" that Edward Campbell righty points out is needed:

http://www.nationalpost.com/news/story.html?id=1739758



> *Prognosis for profit*
> Private medicine gains ground
> 
> Tom Blackwell,  National Post
> ...


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## tomahawk6 (5 Jul 2009)

Canadian healthcare continues to ship critical care infants to the US for treatment. This might not be viable option for Helathcare Canada under Obamacare.


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## observor 69 (17 Jul 2009)

New York Times

July 19, 2009
Why We Must Ration Health Care 
By PETER SINGER
You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, “Americans will not put up with such limits, nor will our elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the proposed reform. 

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable? 

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals. 

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages. In May, Medicare’s trustees warned that the program’s biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation. According to the Congressional Budget Office, it is on track to double by 2035. 

LINK


----------



## a_majoor (24 Jul 2009)

The reasons that our health care system is in trouble are the same reasons that the proposed Obamacare will not work either:

http://www.reason.com/news/show/134987.html



> *The Arrogance of Heath Care Reform*
> 
> Why do politicians with no business experience think they can run 15 percent of the economy?
> John Stossel | July 23, 2009
> ...


----------



## a_majoor (29 Jul 2009)

Health care theater. Where do we get our tickets? A look at nationalized health care through the lens of public choice theory.

http://meganmcardle.theatlantic.com/archives/2009/07/a_long_long_post_about_my_reas.php



> MEGAN MCARDLE: A Long, Long Post About My Reasons For Opposing National Health Care. Excerpt:
> 
> Basically, for me, it all boils down to public choice theory. Once we’ve got a comprehensive national health care plan, what are the government’s incentives? I think they’re bad, for the same reason the TSA is bad. I’m afraid that instead of Security Theater, we’ll get Health Care Theater, where the government goes to elaborate lengths to convince us that we’re getting the best possible health care, without actually providing it.
> 
> ...


----------



## CougarKing (29 Jul 2009)

A relevant update:



> VANCOUVER, British Columbia (Reuters) - *Canadian physician Robert Ouellet is tired of hearing Canada's healthcare system cast as the boogeyman in the vitriolic U.S. political debate over healthcare reform.
> 
> Critics of President Barack Obama's reform drive have accused him of trying to adopt the Canadian system of public healthcare funding, which they say endangers patients with lengthy waits for medical care.
> 
> ...



http://www.reuters.com/article/GCA-HealthcareReform/idUSTRE56S37T20090729?pageNumber=1&virtualBrandChannel=0


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## Edward Campbell (31 Jul 2009)

I don’t know enough about the _Gilded Age_ to comment on one part of Prof. Bercuson’s thesis – that we are in another and that it, too, should breed a reform movement – but I do have a comment on the key part of the problem he enunciates in this article, reproduced under the Fair Dealing provisions (§29) of the Copyright Act from today’s _Globe and Mail_:

http://www.theglobeandmail.com/news/opinions/remember-the-gilded-age-a-progressive-morality-play/article1236807/


> Remember the Gilded Age: a progressive morality play
> 
> David Bercuson
> 
> ...




I agree with Bercuson that _“health-care reform is the battleground”_ in what he describes as _“a morality play” that aims to “bring down the curtain on a social, political and economic system that pretends to worship the free market but, in fact, institutionalizes oligarchy.”_

With specific regard to health care:

•	The debate*s* – two quite different ones - in Canada and the USA about American/”free enterprise” vs. Canadian/”socialist” medical care (there is not much to do with “health” in either system) is wholly specious, on both sides of the border. Canada and the USA have two of the *worst* medical care “systems” in the OECD. Both are in dire need of reform and neither offers much in the way of a useful model for the other.

•	The primary role of the US in the Canadian debate is to provide a useless strawman, actually a bogeyman, that “activists” can use to frighten Canadians into supporting a high cost/poor quality system; Canada has now started to perform the same function for equally dishonest American “activists.”

Both systems are:

•	Too expensive – far, far too expensive in the USA; and

•	_Inadequate_ in terms of “health” and “medical” outputs.

Neither system “works.”

Both countries need a 100% “public” insurance system that provides *reasonably timely* access to *medically necessary* services. This system, of necessity, involves rationing and waiting lists for those who have no other medical care insurance - probably the bottom 15-35% (in terms of income/wealth).

Both countries need a highly competitive system of private insurance programmes that provide a wide range of individual and group “solutions” for the other 65-85% of the population. These people will be able to use their gold cards to better faster and “better” medical care.

The Obama proposal, as I understand it – and that “understanding is, doubtless, imperfect, is too expensive and, therefore, fails to address one of the main problems with the current US system – the percentage of GDP devoted to medical are is already too high, that damages America’s competitiveness.

The Canadian system is also too expensive, so much so that key drivers for our competitiveness (which needs drastic improvement), like education and R&D, are sacrificed on the alter of “free” medical care.

I’m not sure that the _”defining moment that clearly shows how the agents of transformation have won the struggle and the opponents of reform have been soundly defeated”_ is at hand, as Prof Bercuson suggests, but it needs to be near – in *both* Canada and the USA.


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## Shec (31 Jul 2009)

What I find instructive is that the  re-engineering the US socio-economic system occured over a period that spanned the 3 decades that started and culminated with a Roosevelt presidency.   TR was I believe the first 'trust-buster' and FDR brought in the New Deal.  Thus, it was a multi-generational _process_.  

Therefore, I rather doubt that 1400 Pennsylvania Ave.'s current resident will be able to achieve his promise of "change" within the 2 terms that he could legally serve regardless of what beer he ordered yesterday or what his favorite hamburger joint is which seems to be more of more relevance to the MSM than the efficacy of his performance. When this chapter of history is written Obama will be viewed, at best, as a catalyst and his accession to power a symptom, of a societal trend towards reform rather than the "magic bullet" that he would like to be lionized for being.  And I base that comment on his obvious, and self-righteous, narcissism.

Having said that,  your "compare and contrast" of the two health system models is bang-on.


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## tomahawk6 (6 Aug 2009)

For the Statists in Washington this debate isnt about healthcare,rather its a vehicle to control the lives of every American. No health care if you are too old or sick. No healthcare until you lose weight. Ultimately this is about control and if enacted it would be damn hard to reverse.


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## observor 69 (6 Aug 2009)

E.R. Campbell said:
			
		

> Before someone asks: if, through private insurance, the "middle class" can jump the queue, as the rich already do, doesn't that just create a whole new, equally long queue?
> 
> No. The "miracle" of competition within the private sector is that it will, of necessity, add resources (doctors, nurses, acute care beds, etc) to meet demand until an acceptable price/availability "equilibrium" is achieved. That, adding resources - new money - is the one thing the public sector is unwilling to do.



Just a couple of quick thoughts. It is my understanding the British system of  "NHS" and private care has resulted in medical personnel moving to the better pay and working conditions of the private system. Resulting in a lower standard of care in the NHS.
Ref the OECD comments on Canada heath  I don't see any clear opinion yea or nah to be drawn from their stats of comparing us to other countries. OECD
And my overriding thought is, I have some familiarity with this topic and I have yet to see the country that can be pointed to as the role model.
I do find my thinking following with you in wondering if there could be a better funding model...private insurance for the middle class and up ??

Regards.

BG


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## Edward Campbell (6 Aug 2009)

I’m sure your “understanding” of the British situation is absolutely correct and, further, I fail to see why it would not or, indeed, *should* not be that way.

When public health care was started, including by _Saint Tommy_ Douglas here in Canada, the *intention* was that no one should be forced into the poor house just in order to obtain access to medically necessary care. That’s not instant access and it’s not access to “first class” medical care; it’s just “free” access to an acceptable level of “medically necessary” care. (I suspect that there is, within the definition of “medically necessary” and implicit requirement for timeliness. Medical care delayed is medical care denied, à la justice, I think.)

I am not at all surprised that some medical professionals would not want to work in a slow, inefficient, dirty, under-funded, over managed public system; I am, equally, not surprised that so many (most?) medical professionals do work in the public system, even when they have choices, and that some then volunteer to work in the third world, too, during their vacations.

I agree there is no “best” model but I would suggest that, *just for example*, France and Sweden achieve “better” healthcare outcomes, for everyone, for a lower cost (as a percentage of GDP) than do either Canada of the USA. The only two models, from the OECD, that I believe offer no useful guidance for either Canada or the USA are the American and Canadian models. Both are failures.


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## Old Sweat (6 Aug 2009)

Regardless of whatever health care system is used, there are some factors that mean that the result will be less than ideal. I just had a procedure this morning involving a dye injection and a series of xrays in search of a pesky kidney stone. This included a fair amount of waiting which allowed me time to notice that the exray room in a hospital in a small city was well-equipped with expensive kit, and it was not the sole xray room in the diagnostic imaging department. Carrying the thought forward, the amount of money tied up in medical equipment in any first world country, and many others, must be staggering. Furthermore the costs can only rise unless we want to go back to leeches, straight razors and bowls for our medical professionals.

The money can only come out of private pockets, either directly via billing, or indirectly via taxes, or both. No matter what option is chosen, people - lots of people - are going to fall between the cracks or at best go to the bottom of a very long waiting list. What may vary, depending upon the nation's and the individuals' ability to pay, is who gets serviced and how quickly. In my opinion, the various health care systems are all at best not too bad when averaged across the serviced population. 

I don't have the answer. I don't even know if I could ask the correct question. What I do know is that whatever system the US may adopt, it probably will not provide a major improvement in solving the ills (pun intended) of its population because there are only so many staff and so much infrastrcuture to go around.


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## tomahawk6 (7 Aug 2009)

The US remains the destination of choice for folks that dont want to wait a year for a heart valve surgery. Anyone can be treated if they show up at an ER so no one goes without. They may not be able to pay afterward but they are treated. Insurance costs could go down if we allowed insurance companies to pool their risk over the entire country instead of state by state. If there were tort reform that limited a doctors risk as they do in California it would mean much lower malpractice insurance which in turn lowers overall cost..


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## Roy Harding (7 Aug 2009)

I think the argument breaks down something along the following:

Both the US and Canadian systems treat "catastrophic" medical emergencies.  The Canadian system does not "bill" the recipient, thus causing financial hardship for the patient.  The exception in the US, of course, is for those who have valid medical insurance.

I'd like to make an observation.  I reside in British Columbia.  Every 3 months, I receive and pay a bill of $288.00 for Health Care.  I used to reside in Alberta.  There I received a similar bill every 3 months (I THINK it was $256.00 there - no doubt the amount has changed since I left Alberta in 2006).  So - I think I'm paying a health care insurance premium.  

For what it's worth - in the past five years, I visited a health care facility ONCE (for a stupid industrial accident, which wouldn't have happened if I'd been paying attention) - the Doc stitched me up, gave me some cream to spread on the wound, some pills (about two weeks worth, as I recall) to swallow - told me I was stupid (he was right) - and sent me on my way.

It should be noted that, as a Canadian Forces pensioner - I submit those quarterly bills and recover the cost as part of pension coverage.  Nevertheless - I'm paying a health insurance premium for basic, catastrophic health care.

I ALSO carry extra medical/dental insurance (again - through the CF pension system) - which covers pharmaceuticals, eye glasses, extra frills if hospitalized - and so on - but I PAY for it.

The point being - to get a "satisfactory" outcome from the Canadian system - I pay a premium.

As I understand it - the Canadian system was initially set up to ensure that people did not suffer financial hardship for "medically necessary procedures".  We can argue all day long about what constitutes "medically necessary" - but I'm pretty sure it doesn't count EVERYTHING that folks currently get done.

As I see it - some citizens of the US are concerned about the slippery slope (which we in Canada have already slid down - although I'm not sure we've reached the bottom) wherein the public (read - the TAX paying public) pay for whatever an individual thinks they need from the medical system.  And they are FURTHER concerned, that access to medical care under such as system may be restricted based on "life style choices".

That last concern is not so far fetched.  I've met Doctors who refuse to deal with smokers.

So I think the concern is - WHAT, EXACTLY, will be covered by the "public health care system"?

And I think that's a valid question.

I've got a small growth on my arm (what used to be called a "wart" - and dismissed as insignificant).  It's benign - it don't mean nothin'.  I find that it upsets my personal equilibrium - why should YOU pay to remove it?  Perhaps there should be some way that I could have it removed at my OWN expense?

And that, I think, encapsulates the problem folks have with public health care.  And I don't blame them.


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## c_canuk (7 Aug 2009)

My wife gave birth on the 1st of July, everything went well.

While we were there (3 days) I made a point to look at the waiting room at the ER of the Saint John Regional Hospital everytime I went past it... now granted this was during the week, but it was over a holiday and I never saw more than 3 people at a time in the waiting room.

I figure they must have done something to improve response times since the last time I was there.

I spent some time pondering the pros's and con's of private vs public systems...

One thing that worries me about a private only system is that it's in the insurance companies best interests to try to screw you... 

Any time I've dealt with insurance companies I've found that what they are willing to cover and what they lead you to believe they cover are 2 different things. I don't want to be in the position of having to prove my illness wasn't a pre existing condition, and having to sue them in court to avoid personal bankruptcy while in recovery stages, or worse, before I'm treated.

The thing that worries me about a public only system, is the strain put on the system by people who go and use up the resources because it's "free" even though they really don't need to be there, reducing everyone else's access to the resources, I don't worry about not getting access to rare expensive treatments that are deemed to costly for the system as I'm not financially able to purchase them on my own anyway. 

Considering what I pay in taxes and the portion of that that goes to health care, I am very satisfied with the level of service my wife and son received since my wife went into labour.


----------



## Rifleman62 (7 Aug 2009)

A couple of comments:

*  My wife went through at least 12 years of hell and very expensive drugs (including Enbrel @ $1600 per month) suffering from arthritis before the system would replace both of her knees. At the time in Manitoba, the surgeons ran out of funding to do surgeries for knee/hip replacements three months after the fiscal year started. This wait time has improved with federal government $$ from four years ago when she had her operations. 

*  In Kelowna, BC, I waited in excess of three months for an X-Ray with dye injection for a different ailment than Old Sweat.

*  Emergency rooms are going to get a lot busier as the baby boomers age. In Manitoba, the NDP were elected on ending "Hallway Medicine". They didn't, and won't until emergency rooms are made larger and _*staffed*_.

*  Possibly it is time to have compulsory service in Canada for Canadian citizens who graduate from taxpayer subsidised Canadian universities as MD's, rather than allowing some of them to run off to the USA. Making them pay back the cost is a non starter, as they took up a space in the medical program.

*  Roy Harding: 50% of my BC Health premium is paid by me as a deduction from my pension, and the other is paid by the federal government. No need to submitt a bill. Maybe this is only done for recipients of the Reserve pension!


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## Redeye (7 Aug 2009)

There is nothing to suggest there is so much as an iota of truth to that statement.  It is not borne out anywhere.



			
				tomahawk6 said:
			
		

> For the Statists in Washington this debate isnt about healthcare,rather its a vehicle to control the lives of every American. No health care if you are too old or sick. No healthcare until you lose weight. Ultimately this is about control and if enacted it would be damn hard to reverse.


----------



## Blackadder1916 (7 Aug 2009)

Roy Harding said:
			
		

> I've got a small growth on my arm (what used to be called a "wart" - and dismissed as insignificant).  It's benign - it don't mean nothin'.  I find that it upsets my personal equilibrium - why should YOU pay to remove it?  Perhaps there should be some way that I could have it removed at my OWN expense?



Unless there have been recent changes to most provincial health insurance schedules of benefits (fee guide), your "wart" (in most cases) would be removed at your expense.  (I am most familiar with Alberta Health fees - and OHIP years ago) 

The simple explanation is, unless it is on the plantar or palmar surface (and interfering with gait or mechanical function) or on exposed surface of the face (causing gross disfiguration or interfering with airway, vision or mastication) removal is not an insured service.
(_edited to add_) There is another situation where "wart" removal would be an insured service - if it was on your pecker - also due to interference of function (but not "mastication") and potential for transmission to a partner.



			
				c_canuk said:
			
		

> The thing that worries me about a public only system, is the strain put on the system by people who go and use up the resources because it's "free" even though they really don't need to be there, reducing everyone else's access to the resources, I don't worry about not getting access to rare expensive treatments that are deemed to costly for the system as I'm not financially able to purchase them on my own anyway.



While there are certainly people who make a greater than average number of contacts with the health care system (including for "trivial" reasons), most of these (unnecessary*) contacts are confined to interaction with a primary care physician.  In my experience, the numbers are not significant enough that it would overwhelm the system or deprieve resources.  GPs generally function well as gatekeepers and though the amount spent on doctors' fees is quite significant, it is far from being the major item in total health care spending.

*There was even an ICD9 code (the diagnostic code used to identify the reason for the visit/billing) for persons seeking health services without any legitimate (or discernable) complaint.  Sometimes AHC would send these back as non-paid.

As an example of the difference in utilization between "public" and "private" funded health care system:

Consultation with doctors by country

Japan: 14.4 per person per year
*United States: 8.9 per person per year*
Belgium: 7.9 per person per year
France: 6.9 per person per year
Austria: 6.7 per person per year
Germany: 6.5 per person per year
Australia: 6.3 per person per year
*Canada: 6.3 per person per year*
Denmark: 6.1 per person per year
Italy: 6.1 per person per year
Netherlands: 5.9 per person per year
United Kingdom: 4.9 per person per year
New Zealand: 4.4 per person per year
Finland: 4.3 per person per year
Sweden: 2.8 per person per year


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## Redeye (7 Aug 2009)

My favourite ridiculous argument (leveraging longstanding xenophobia and the "illegal alien" strawman) is that "Obamacare" means that good ol' honest hardworking American taxpayers would have to fund healthcare for the legions of illegal aliens in the USA.

They don't seem to realize that they already do.  Those people - and the uninsured - tend not to seek medical attention unless the situation is dire - and in most cases that means going to the emergency room where they cannot be refused treatment.  They get treated, get handed a bill they cannot pay, and then what?  Well, the hospital has to recover those costs somehow, so the price of everything goes up accordingly.  That's why tylenol pills cost a few bucks in a hospital.  That cost then is borne by all because those with insurance have their insurers paying this higher cost.

An American friend of mine who runs a small business had the premiums he pays to cover his employees soar by 24% last year. That's the sort of inflation involved in insurance costs now, and if it continues, he and many other employers will not be able to provide benefits anymore because of the cost.  

The other great boogieman for Americans is "socialism" - as in taking away my "right" to private insurance is socialist!"  First off, nothing in any proposal removes the ability of a person to choose to continue to have private insurance (though if a viable public option exists it will eventually force private insurance out of business, most likely).  Second of all, the entire concept of insurance is about socialization of risk!  That's why it exists in the first place and how it got started as a business.

Some anti-reform twit on a blog I follow said something to the effect of "why should I have to pay for your dermatologist appt like will happen with Obamacare".  I said, well, if you pay health insurance premiums and aren't being treated for anything, you are already paying for someone else's treatment, as someone else will pay for yours if you develop a catastrophic illness and your care is covered by your insurance.  It's like they just don't get the concept at all.


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## CountDC (7 Aug 2009)

Roy Harding said:
			
		

> I've got a small growth on my arm (what used to be called a "wart" - and dismissed as insignificant).  It's benign - it don't mean nothin'.  I find that it upsets my personal equilibrium - why should YOU pay to remove it?  Perhaps there should be some way that I could have it removed at my OWN expense?



there is - it's called go to the pharmacy, buy the stuff and put it on yourself. You can go cheap at under $10 but may take 2 weeks to complete or you can get the new one day treatment for around $25. see here: http://www.drscholls.ca/english/products/condition?d=Warts

or try this:  http://www.cbc.ca/health/story/2002/10/15/duct_tape021015.html

back to your regular schedule.


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## tomahawk6 (8 Aug 2009)

I am a real fan of the conservative blog Flopping Aces. Linked below is a great discussion of the current healthcare debate. I wont paste it all as there are a number of charts. Best way to view the article is just to hit the link.

http://www.floppingaces.net/2009/08/08/obamas-health-care-czars-to-seize-congressional-power-key-to-achieving-a-single-taxpayer-system/#more-25953



> SOLUTIONS
> 
> Since everyone whines those that criticize do not offer alternatives, I’m going to lay out some of the obvious reforms based on the aforementioned information.
> 
> ...


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## a_majoor (8 Aug 2009)

A link to a 4 page memo showing the playbook being used by "pro Obamacare" groups to frame the narrative:

http://www.talkingpointsmemo.com/documents/2009/08/hcan-playbook-for-thwarting-town-hall-protesters

Note the protesters are to be protrayed as paid agents of lobbiests and insurance companies, while HCAN is to form walls around the members of congress to prevent voters from expressing concerns and also to bombard the MSM with the pro Obamacare message.

A very interesting look at the motives and tactics of the Progressives.


----------



## Redeye (8 Aug 2009)

The right wing's playbooks have also been leaked and are insidious documents.  I'm on my iPhone right now and don't have the links handy but a few right wing turncoats have released those key documents.  Both sides are playing games.


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## a_majoor (9 Aug 2009)

tomahawk6 said:
			
		

> For the Statists in Washington this debate isnt about healthcare,rather its a vehicle to control the lives of every American. No health care if you are too old or sick. No healthcare until you lose weight. Ultimately this is about control and if enacted it would be damn hard to reverse.



Indeed:

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html



> CHARLES LANE, IN THE WASHINGTON POST: House Bill Oversteps on End-of-Life Issues.
> 
> I was not reassured to read in an Aug. 1 Post article that “Democratic strategists” are “hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors.”
> 
> ...


----------



## a_majoor (9 Aug 2009)

Redeye said:
			
		

> The right wing's playbooks have also been leaked and are insidious documents.  I'm on my iPhone right now and don't have the links handy but a few right wing turncoats have released those key documents.  Both sides are playing games.



And the MSM is playing right out of the progressive playbook (although after ABC's Obamacare fiasco, I doubt anyone with even a half open mind would disagree)

http://www.aim.org/on-target-blog/the-media-take-aim-at-the-mob/



> *The Media Take Aim At ‘The Mob’*
> 
> BY K. DANIEL GLOVER  |  AUGUST 7, 2009
> 
> ...


----------



## Redeye (9 Aug 2009)

And here's the scoop Right Wing's playbook.

http://www.alternet.org/healthwellness/141833/right-wing_turncoat_gives_the_inside_scoop_on_why_conservatives_are_rampaging_town_halls/?page=entire


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## a_majoor (10 Aug 2009)

Obamacare is certainly facing an uphill battle. I suspect that despite pressure from the administration and dishonest reporting from the MSM most members of the Congress will read the direction the wind is blowing and eventually vote in the most cosmetic of changes.

http://www.newsherald.com/articles/obama-76464-henry-focus.html



> *RON HART: Obama discovers that health reform is a hard sell*
> 2009-08-07 17:59:24
> ATLANTA
> 
> ...


----------



## The Bread Guy (10 Aug 2009)

Thucydides said:
			
		

> .... dishonest reporting from the MSM ....



Or, in some cases, mathematically challenged....
http://mediamatters.org/mmtv/200907270052


----------



## muskrat89 (11 Aug 2009)

Some people are uncomfortable wit this - 





> Sec. 1442 of H.R. 3200 (commencing at page 622) that by passage would amend the Social Security Act, Part E, Title XI, by creating and contracting with "consensus-based entities" with which the Secretary would consult to "assess outcomes and functional status of patients (including) continuity and coordination of care transitions for patients across providers and healthcare settings, including end-of-life care." These consensus-based entities would assess "efficiency and resource use in the provision of care."


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## a_majoor (11 Aug 2009)

And note her point on diffusion of responsibility via rules.

UPDATE: Also, the market doesn’t deny you a hip replacement or a pacemaker because someone in government thinks your political views are “un-American.” Given the cronyism and thuggery we’ve seen with the bailouts, etc., I’m not confident this would hold true under a government health program. And I’m absolutely certain there would be a special track for insiders and favorites.

http://meganmcardle.theatlantic.com/archives/2009/08/rationing_by_any_other_name.php



> *Rationing By Any Other Name*
> 
> 10 Aug 2009 05:42 pm
> Robert Wright notes that "we already ration health care; we just let the market do the rationing."  This is a true point made by the proponents of health care reform.  But I'm not sure why it's supposed to be so interesting.  You could make this statement about any good:
> ...


----------



## a_majoor (12 Aug 2009)

Redeye said:
			
		

> There is nothing to suggest there is so much as an iota of truth to that statement.  It is not borne out anywhere.



Except by the President's own words:

http://www.slate.com/blogs/blogs/kausfiles/archive/2009/08/11/a-debate-we-didn-t-have-to-have.aspx



> MICKEY KAUS:
> 
> If, as Harold Pollack argues, “rationing of life-saving or life-extending care” would not really be a priority for the “effectiveness” panels–such as the Obama-endorsed IMAC–then it was all the more stupid to bring the topic up, no? Here’s the first graf from a Bloomberg account of an early Obama health care foray back in April:
> 
> ...


----------



## a_majoor (13 Aug 2009)

Here are some ideas which would work in Canada as well, vastly improving health care and saving billions of tax dollars:

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html



> *The Whole Foods Alternative to ObamaCare*
> Eight things we can do to improve health care without adding to the deficit.
> Article
> 
> ...


----------



## Blackadder1916 (14 Aug 2009)

It seems that it is not only (some?) Canadians that resent being used as the negative example in the US health care debate.

http://news.yahoo.com/s/ap/20090814/ap_on_re_eu/eu_britain_us_health_care


> *Britons defend their health care from US criticism*
> By MEERA SELVA, Associated Press Writer Meera Selva, Associated Press Writer Fri Aug 14, 8:02 am ET
> 
> LONDON – Britons reacted with outrage Friday at American criticism of the country's health care system and defended their cradle-to-grave medical coverage on Twitter, television and in the tabloids.
> ...


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## Redeye (14 Aug 2009)

Really?  Really really?  You actually believe that to be even a remote possibility?!

I can only shake my head, that has to be certifiably the most ridiculous thing I've read in a long while.



			
				Thucydides said:
			
		

> And note her point on diffusion of responsibility via rules.
> 
> UPDATE: Also, the market doesn’t deny you a hip replacement or a pacemaker because someone in government thinks your political views are “un-American.”  Given the cronyism and thuggery we’ve seen with the bailouts, etc., I’m not confident this would hold true under a government health program. And I’m absolutely certain there would be a special track for insiders and favorites.


----------



## observor 69 (14 Aug 2009)

Trying to have a rational conversation with Republicans who are busy bashing Obama's attempts to bring Health Care to even the poorest Americans.
 :brickwall:

 A country that by any international standard of health care is inferior to most of the western world.  :


----------



## Redeye (14 Aug 2009)

That's the biggest problem - there is no rational debate to be seen in the United States because those opposing the current proposals seem to have very little in the way of rational thought to discuss, instead they spout the talking points that the very powerful, very threatened insurance lobby is feeding them.  And people like Sarah Palin making comments about "death panels" is just making it worse.

The closest thing to a death panel I've heard of was Cigna (a major health insurance provider) refusing to cover a liver transplant for Nataline Sarkisyan, a 17 year old stricken with leukemia.  Cigna refused the treatment, and only relented after massive lobbying against them publicly.  Problem is that within hours of their relenting, Nataline died.



			
				Baden  Guy said:
			
		

> Trying to have a rational conversation with Republicans who are busy bashing Obama's attempts to bring Health Care to even the poorest Americans.
> :brickwall:
> 
> A country that by any international standard of health care is inferior to most of the western world.  :


----------



## tomahawk6 (14 Aug 2009)

The Obama plan wont insure every american millions will be left out.


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## muskrat89 (14 Aug 2009)

I guess the ACoS are RTFO too... 


Statement from the American College of Surgeons Regarding Recent Comments from President Obama


CHICAGO—The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make  about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight. 

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.

Three weeks ago, the President suggested that a surgeon’s decision to remove a child’s tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what’s right for the patient.

We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President’s remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients. 

We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 74,000 members and is the largest organization of surgeons in the world. 

Web site: www.facs.org


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## tomahawk6 (15 Aug 2009)

I have been perturbed by professional organizations that throw their members under the bus. This so called reform isnt good for doctors,patients or anyone else. Now that pharma's deal with Obama is out in the open I would expect doctors to shut their doors to the pharma reps. We can easliy make changes that will improve coverage without going to Obamacare. This bill will even give the government access to a citizens bank account.


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## Blackadder1916 (15 Aug 2009)

tomahawk6 said:
			
		

> I have been perturbed by professional organizations that throw their members under the bus. This so called reform isnt good for doctors,patients or anyone else. Now that pharma's deal with Obama is out in the open I would expect doctors to shut their doors to the pharma reps. We can easliy make changes that will improve coverage without going to Obamacare. This bill will even give the government access to a citizens bank account.



I will accept that as a resident of the USA, you have been exposed to more of the rhetoric from both the multiple sides of the debate than those like me who really listen to it on the margins since it won't have a direct effect (unless I can get some consulting contracts with doctors down south to show them how to make money from evil socialized medicine).  While I respect your opinions as presented above, perhaps you can provide some background (with links to legitimate comment, if possible) on why you arrived at those conclusions.

Admittedly, I haven't reviewed any drafts of proposed legislation concerning this matter, but that probably puts me in the same boat as the majority of Americans including (most likely) some members of your legislative branch.  As for the (financial) effect this will have for doctors, my gut reaction is that it will be similar to that which occurred following implementation of most of the provincial health insurance plans here in Canada (late 1960s) - doctors (especially GPs) started to see their incomes increase.  Though recognizing that there are many differences (regulatory and business models) between the USA and Canada, my expectation is that with a greater percentage of the population having basic health insurance, more patient/doctor contacts will be generated and thus doctors' incomes will increase.

As for doctors shunning pharmaceutical reps - !!! - who would pay for their lunches, golf trips, provide them with free samples of medication (like Viagra, which they give only to patients) or most importantly (and seriously) provide information about new developments and reminders about current prescribing indications, counterindications, dosages, interactions, etc.  Though reps are in the business of hawking their company's drugs (and they can be a pain in the rear sometimes) they do have some legitimate use.


----------



## 1feral1 (15 Aug 2009)

Watched the POTUS in Montana live this am our time, and heard his 'only bull' in Washington joke, ya, I actually laughed.

This plan he has is truly controversial. Here in Australia we have a two tiered health system. Public and private.

There is a joke here in Queensland, and goes as fol: "Going to Mexico? Don't drink the water. Going to Queensland? Don't get sick."

This being said there is some serious healthcare issues in this state alone, but with public you wait, and with private you pay, first a entry fee into the hospital, say $500, then a gap payment between each service. Say tonsilectomy costs $2000 and the insurance pays $1200, you cough up the remainder.

A mate who had open heart surgury had private insurance, but went in under public as he could not afford the $$ for the surgery. He got top treatment and is still with us today.

Does public work? Yes but our hospitals are so overcrouded one often is shuffled from place to place by the ambos for a bed.

It scares me.

I don't know how the US will make their plan work, but there is lots of opposition to it, adn that being said, how will Mr Public be covered if he becomes sick?

Public heath is funded by a nationwide medicare levy on all working people, I think its 1.5% of your gross annual income. Defence Force pers are exempt.

Regards,

OWDU


----------



## tomahawk6 (15 Aug 2009)

Pharma-Obama deal 

http://www.huffingtonpost.com/2009/08/13/internal-memo-confirms-bi_n_258285.html


----------



## Rifleman62 (15 Aug 2009)

The White House talking to Lobbyists!!! I thought there was going to be "Change", a new way in Washington??


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## GAP (15 Aug 2009)

I'm not able to discern all the ramifications of the various details, but what I can see is the Public getting screwed one way or the other, price wise....


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## Blackadder1916 (15 Aug 2009)

tomahawk6 said:
			
		

> Pharma-Obama deal
> 
> http://www.huffingtonpost.com/2009/08/13/internal-memo-confirms-bi_n_258285.html



So what?
Is your objection that a politician made a deal with a special interest for their support? (_What else is new? - regardless of political stripe_)   or 
Is your objection that he got caught, sort of? (_What else is new?_)    or
Is your objection that pharmaceutical companies may be able to sidestep returning some money and continue to make profits? (outrageous profits though probably less in the future) -  With the exception of not having to return some, they were probably going to anyway.  My take after a cursory review is that pharma may benefit from this initially but it will level out in the end. 



> . . . but what I can see is the Public getting screwed one way or the other, price wise....


It's likely they would will be screwed price wise whether there was a deal or not . . . we are talking about pharmaceutical companies here.

While the optics of this deal are not favourable to Obama from a strategic political point of view, it would be naive to think that he (or any other politican) could reform the American health care system industry without making some sort of deal with either the drug company bloc or the private health insurance block (they are the groups that have the real money needed to grease the wheels of any political play down there).  Since insurers will be the ones that may eventually take the biggest hit after reform, it's unlikely they would want to deal (because basically it's about reforming radically changing the health insurance system).


----------



## a_majoor (15 Aug 2009)

Since this is really all about accumulating political and economic power, then the attempts by Pharmacutical companies to make a deal is only common sense; do you want to be the guy sitting at the same table as the King, or the guy waiting for scraps to be thrown your way?

I notice that any attempts to question the attempts to "reform" healthcare elicit hysterical opposition usually based on ad hominem attacks; even the CEO of Whole Foods, hardly a paragon of right wing thought, is under attack in the US for his WSJ Op Ed piece which simply points out a selection of low cost or cost saving options to improve health care, none of which require government intervention in the health care market and most which actually have the effect of removing government and ending regulatory failure.

As for numbers, the Canadian Institute for Health Information discovered that: (paraphrase)

*Age standardized rates of surgery outside the priority areas are about the same as they were in 2004-2005" despite the fact that provincial health spending grew $16.5 billion or @ 25%.* 

So we have increased spending 25% in 5 years without any increase in surgeries? I remind the reader that the wait time for referral to a specialist was 17.3 weeks (45% longer than the median wait time in 1997. Sorry, their baseline seem all over the place) so where is all this money going? It does not seem to be in patient care.

US Medicare/Medicaid, the "National" element of UK National Health and so on show similar outcomes as bureaucrats rather than doctors and patients capture the increase in tax dollars, so there is plenty of  examples to demonstrate that nationalizing health care will have negative outcomes for patients. With a record like that, is it any wonder that ordinary Americans are now uniting against health care "reform" as being proposed?


----------



## muskrat89 (15 Aug 2009)

> it would be naive to think that he (or any other politican) could reform the American health care system industry without making some sort of deal with either the drug company bloc



I would argue that Obama got elected _because he said, and many people believed_ - that *he* would be different. Now when things are not going well, defenders say "Well, what did you expect?"


----------



## a_majoor (16 Aug 2009)

For those of you who argue that health care "reform" in the United States is not about extending the power of the State:

http://legalinsurrection.blogspot.com/2009/08/irs-new-health-care-enforcer.html



> *IRS The New Health Care Enforcer*
> 
> People often joke that government-run health care will have the efficiency of the motor vehicle department, and the compassion of the Internal Revenue Service. This joke will become reality if present Democratic health restructuring proposals are enacted.
> 
> ...


----------



## a_majoor (18 Aug 2009)

Democrat party tactics are now being used against them, and they don't like it one bit. The end of the article demonstrates the weakness of the State providing any contractual service:

http://online.wsj.com/article/SB10001424052970204683204574356512455523766.html



> *Rules for Republicans, Too "Community organizing" comes back to bite President Obama.*
> 
> JAMES TARANTO
> 
> ...


----------



## Long in the tooth (19 Aug 2009)

I have a very personal stake in this, being in the US under an L2 NAFTA designation (spouse is L1 so has SS# and can work).  Currently I'm covered under her private health and dental, though haven't had to test it yet.

Obama's main plank of his policy is to enact a NATIONAL public system at NO COST.  Currently 300 million Americans are covered.  He will pay for the rest by taxing the health benefits the others receive.  This could create a perverse situation by both employers and employees ditching private insurance (and take the cash) and falling back on public insurance.

Interestingly, this perversity would be good for Canada, vastly increasing our competitiveness.  Once the US federal Gov't assumes health care risks taxes will have to rise to Canadian levels.  The brain drain will stop, and Canadian goods will become cheaper compared with American.  We'll regain our auto sector.

Interesting times ahead.  BTW, Americans seem to believe the Canadian health care rainbow includes drugs, dental and vision.  Just had a visit from a future American surgeon, and he had no idea of the complexity of the issue.

This is a prime example of politics at its worst, but both Canada and the US ignore the success of any European models.


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## a_majoor (19 Aug 2009)

Otto, I believe the perverse effect of causing people to ditch private healthcare plans is exactly the desired outcome of this crowd: no possibility of turning back or opting out.

More here:

http://oceanaris.wordpress.com/2009/08/18/the-banality-of-evil-the-health-care-debate-takes-a-dangerous-turn/



> *The Banality of Evil – The Health Care debate takes a dangerous turn*
> 
> Posted on August 18, 2009 by Matt Holzmann
> This evening the New York Times is reporting that the President and Congressional leaders plan to go it alone on their health care bill. Since this leadership includes Henry Waxman, Nancy Pelosi, and Harry Reid, and we have seen their hysterical response to the growing concerns of many in the electorate with the various bills introduced so far, I am deeply concerned. Despite massive and growing resistance and incontrovertible declines in the popularity of their positions, they plan to take the gloves off and pass something, anything to be able to declare victory. For that is what this is all about now. Better, more widespread health care is not the issue any more. This is the most craven of partisan politics.
> ...


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## retiredgrunt45 (19 Aug 2009)

> So we have increased spending 25% in 5 years without any increase in surgeries? I remind the reader that the wait time for referral to a specialist was 17.3 weeks (45% longer than the median wait time in 1997. Sorry, their baseline seem all over the place) so where is all this money going? It does not seem to be in patient care.



I'm not sure were your getting these numbers from, but I didn't have to wait no 17 weeks to see an Oncologist when I was diagnosed with colan cancer. From the time it was diagnosed to my first treatment was 12 days here at the London Ontario cancer centre at Westminister hospital. Have you ever visited a cancer centre recently and asked the patients how long they had to wait for treatment. Maybe next time before quoting someone elses facts, do yourself a favour and learn some facts yourself. Hundreds of others myself included are recieving treatments every week at the cancer centre come visit and we'll enlighten you on these fictional wait times which someone seemed to pull from their hat. 

It really pisses me of when I hear people talk about something in which they obviously have no clue as to what their talking about. Get a clue and you'll find our system works just fine for the majority of us everyday. I wish people would stop comparing our system to the Americans, because it seems everytime they do, they make up some fictional story of how bad the Canadian system is. 
The next gime you get sick with a life threatning illness ask yourself who are you going to call first, your accountant to see if you can afford it or your doctor who can cure it? Right now i'm in my 11th week of treatment and the treatments have cost I figure roughly around the $50,000.00 mark so far, I still have 4 months to go before my treatments are finished, do the math, my portion "Zippo" Nada" also included are my drugs because I have home care so all my meds are also paid for and I have a nurse coming in once a week and if I can't drive myself to my weekly treatments because i'm to ill, they pick me up and drop me off back at home at no extra charge. 

Some people like to complain for the sake of complaining...


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## Edward Campbell (19 Aug 2009)

retierdgrunt45 is exactly correct: In Canada most of the time, *most* people receive the _most_ appropriate care within a *medically acceptable* time-frame. The same is true for _most_ Americans when _most_ ≈ 85%. 

Let us begin by acknowledging that many (<5%) of Americans and Canadians receive lousy medical care: they are, almost universally poor, homeless, drug addicted  and so on; there is almost nothing, affordable, that can or *should* be done to try –and inevitable fail – to relieve their lot in life.

Most Americans and Canadians would benefit, materially, from a medical care system (it’s not, really, a *health* care system) that costs less (we have two of the most expensive systems in the world) and works better (we have two of least well performing systems in the world).

The very worst thing the Americans could do is to adopt the Canadian health care system.

The very worst thing the Canadians could do is to adopt the American health care system.


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## a_majoor (19 Aug 2009)

Facts and figures are available for RG45 and everyone else right here: http://secure.cihi.ca/cihiweb/splash.html

As for anecdotal evidence, I am very glad that you were diagnosed and treated quickly RG45; however there are cases where patients did not get the treatment in a timely manner (and I will have to Google this but I can recall a Canadian woman who was sentenced to death because she was consistently given painkillers to treat a sore back when the cause turned out to be a tumor. By the time she managed to persuade the physician to send her to a specialist, and then waiting to see a specialist for the diagnosis, the cancer had spread to the point there was no possibility of survival)

Personal anecdotes are also subjective; my own dealings with long wait times for what should have been a minor surgery (and prolonged time on medical category as a result) or waiting in an emergency room SIX HOURS while my daughter has a breathing emergency certainly colour my views...


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## tomahawk6 (19 Aug 2009)

You dont know how good your healthcare is until you need it at which point you may find there isnt a bed for you, they dont want to run expensive tests,ect. Plenty of Canadians get sent south for medical treatment because either the system cannot handle the medical condition in a timely manner or there isnt a bed available. The people with money will generally be able to afford to go outside the system. Obama's healthcare would eliminate private insurance entirely leaving citizens at the mercy of the bean counters. I like the French system where private and public medical insurance exist side by side.

Mark Steyn told a story yesterday about his mother in law that came to visit from the UK. She had been struggling with a painful medical condition with her arm for 10 years. Ecvery month her NHS doctor prescribed the equivalent of tylenol. On her recent trip to the US her arm became acutely swollen so Steyn took her to their local New Hampshire hospital. They ran the tests on her that they never did in the UK because of cost. Her US doctor discovered that the woman had gout and treated it.


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## the 48th regulator (19 Aug 2009)

tomahawk6 said:
			
		

> You dont know how good your healthcare is until you need it at which point you may find there isnt a bed for you, they dont want to run expensive tests,ect. Plenty of Canadians get sent south for medical treatment because either the system cannot handle the medical condition in a timely manner or there isnt a bed available. The people with money will generally be able to afford to go outside the system. Obama's healthcare would eliminate private insurance entirely leaving citizens at the mercy of the bean counters. I like the French system where private and public medical insurance exist side by side.
> 
> Mark Steyn told a story yesterday about his mother in law that came to visit from the UK. She had been struggling with a painful medical condition with her arm for 10 years. Ecvery month her NHS doctor prescribed the equivalent of tylenol. On her recent trip to the US her arm became acutely swollen so Steyn took her to their local New Hampshire hospital. They ran the tests on her that they never did in the UK because of cost. Her US doctor discovered that the woman had gout and treated it.




Acetaminophens are used in the treatment of Gout, AKA Tylenol, BTW.

dileas

tess


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## tomahawk6 (19 Aug 2009)

While your point is valid I wasnt doing anything more than relate the anecdote. In long term gout sufferers the goal is to address the lowering of uric acid levels which evidently is done with medicines like Probenecid or Allopurinol. I think that Steyn's point is that in any national healthcare there is rationing of care to achieve cost savings[rarely accomplished]. From what I have read the UK's NHS is a growing disaster that is affecting their other government programs and that is a country with 50m people and one of every 7 people are employed by NHS. Providing national healthcare to a country the size of the US hasnt been successfully accomplished. India,China and Russia are not shining examples in this area.


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## the 48th regulator (19 Aug 2009)

tomahawk6 said:
			
		

> While your point is valid I wasnt doing anything more than relate the anecdote. In long term gout sufferers the goal is to address the lowering of uric acid levels which evidently is done with medicines like Probenecid or Allopurinol. I think that Steyn's point is that in any national healthcare there is rationing of care to achieve cost savings[rarely accomplished]. From what I have read the UK's NHS is a growing disaster that is affecting their other government programs and that is a country with 50m people and one of every 7 people are employed by NHS. Providing national healthcare to a country the size of the US hasnt been successfully accomplished. India,China and Russia are not shining examples in this area.




But relaying the anecdote, in which he implies that simple "Tylenol" equivalent is was only used, and it was not until the American Doctor treated it, that it got better, is creating a myth surrounding proper procedure in helping the Gout.

I would be interested in hearing the complete story, as opposed to him picking and choosing the parts that suits his story.  I am sure the English doctor treating the woman for ten years, has more to offer than telling her to buy off the shelf Tylenol to relieve her gout.

dileas

tess


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## Blackadder1916 (20 Aug 2009)

tomahawk6 said:
			
		

> . . . From what I have read the UK's NHS is a growing disaster that is affecting their other government programs and that is a country with 50m people and *one of every 7 people are employed by NHS*. . . .



1 in 7 (or roughly 14.3%) employed by the NHS which makes up the majority of health sector workers (and includes what would be considered health insurance sector and public admin workers in the USA) - I think you misread something.  Granted public sector employees in the UK make up a significant portion of workers (approx 1 in 5) however the NHS is not the only public sector employer (think armed forces, police, prisons, fire, garbage, etc - and below garbage collector in the chain of respect, tax collector)

This is probably closer to the mark:

England 
NHS employees 1.33m in a population of 51m - 2.6%

USA
Health Sector Workers (not including insurance, public admin and possibly pers without direct patient contact e.g. clerical and housekeeping)
12m 16.1m in a population of 307m - 3.9% 5.2%

(found some more recent stats)


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## a_majoor (22 Aug 2009)

"There's a taste in my mouth, as desperation takes hold..."

http://althouse.blogspot.com/2009/08/obama-would-like-you-to-see-government.html



> *Obama would like you to see government as religion.*
> He addresses a group of religious leaders:
> 
> “I know there’s been a lot of misinformation in this debate, and there are some folks out there who are frankly bearing false witness,” Mr. Obama told a multidenominational group of pastors, rabbis and other religious leaders who support his goal to remake the nation’s health care system.
> ...



BTW, God neither needs or wants a partner.....


----------



## a_majoor (29 Aug 2009)

Instapundit with a great analogy:

http://www.pajamasmedia.com/instapundit/  



> DELL 1, APPLE 0. Okay, so I bought a new MacBook Pro a while back. The old one, meanwhile, has died of a hard-drive problem. No sweat, I’ve got the 3-year AppleCare, and it says I can just drop it at the Apple Store. So when I went by at lunch today, they tell me I have to make an appointment at the “Genius Bar” before I can drop it off. No appointments til Monday; first appointment I can actually arrive at, Tuesday Night.
> 
> Dell, meanwhile, sent a guy to my house the day after I called, fixed things in 15 minutes. Advantage: Dell. Having the old Macbook out of service for a while is no big deal to me — I have, ahem, other computers. Most people don’t have multiple backups like I do, though, and given how expensive the 3-year AppleCare contract is, the service ought to be better. Apparently, I”m not the only one to feel that way . . . .
> 
> ...


----------



## tomahawk6 (29 Aug 2009)

Ronald Reagan's view on socialized medicine.

http://www.youtube.com/watch?v=fRdLpem-AAs


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## Redeye (31 Aug 2009)

The analogy isn't bad - but it seems to want to continue to propogate a great myth that Canadians en masse seek health care in the United States.  The only number I've seen is that 38,500 or so Canadians did so in a particular year (I think it was 2007).  That sounds like a big number.  Until you realize that in a country of 33,000,000 that's only a little more than 0.1%



			
				Thucydides said:
			
		

> Instapundit with a great analogy:
> 
> http://www.pajamasmedia.com/instapundit/


----------



## a_majoor (7 Sep 2009)

We don't talk a lot about _other_ models besides Europe, Canada and the United States. Maybe it is time to look farther afield:

http://reason.com/blog/printer/135906.html



> *A Different Sort of Health Care System*
> 
> Jesse Walker | September 4, 2009, 4:46pm
> Writing in Salon, Aruna Viswanatha describes India's health care system as "an anarchic hodgepodge, with little insurance, little regulation and a range of services offered by hundreds of government-run, trust-run and corporate hospitals." It is by no means a purely free-market approach, but it's much more market-oriented than the American model. Among the results:
> ...


----------



## tomahawk6 (7 Sep 2009)

As India has a class system I wonder what kind of healthcare if any is available to the poor ? In the US at least if you are sick and you show up at a hospital you have to be treated.


----------



## Redeye (7 Sep 2009)

And that's precisely why all these arguments about reform in the US making everyone have to pay for illegal immigrants' healthcare, or for other peoples' in general.  You already do.  When an illegal immigrant's health finally deteriorates so much from lack of proper care that they have no other option, they go to a hospital ER, get treated in the most expensive manner possible, and then who pays the bill?  Everyone - through the inflated costs of just about everything consumers are charged for in US hospitals.  That's why the argument is so hilarious to watch from the outside looking in.



			
				tomahawk6 said:
			
		

> As India has a class system I wonder what kind of healthcare if any is available to the poor ? In the US at least if you are sick and you show up at a hospital you have to be treated.


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## muskrat89 (8 Sep 2009)

Do you actually know any illegal aliens? I do. Most of the folks I know (well) that are here illegally (in Arizona) don't wait until *their health finally deteriorates so much from lack of proper care that they have no other option* before going to the emergency room. Rather, they go to the emergency room for emergencies and everything that the rest of us go to the doctor or a clinic for. The problem is that the government is NOT consistently reimbursing hospitals for illegals care - and hospitals are closing because of it.

http://www.wnd.com/news/article.asp?ARTICLE_ID=43275

http://www.newswithviews.com/Cosman/madeleine.htm

http://www.nytimes.com/2004/08/21/national/21hospitals.html

http://lornakismet.wordpress.com/2009/08/24/illegal-aliens-could-close-your-hospital/

http://thelibertyjournal.com/2009/07/23/rejected-heller-amendment-opens-door-to-free-health-care-for-illegals/

http://www.tucsonweekly.com/tucson/catastrophe-in-care/Content?oid=1080476





> The threat illegal immigration poses to American public health plays out every day at Arizona's hospitals. Until recently, the issue remained only marginally public, a problem medical people batted around among themselves, not with the media. Even today, several hospitals contacted for this story declined comment.
> 
> The Copper Queen Hospital in Bisbee, one of the hardest hit, helped break that barrier when CEO Jim Dickson began returning reporters' calls, even though the subject, as he puts it, has become "like the third rail. You don't want to touch it."
> 
> But his problem had grown severe. Dickson's uncompensated costs for treating illegals rose from $35,000 in 1999 to $450,000 in 2004. His total shortfall now sits at about $1.4 million, a hefty deficit for a 14-bed hospital. To make ends meet, he had to close, in June 2000, the Copper Queen's long-term care facility, and cut back on staff and hours, forcing some employees to take second jobs to survive.



If this was a thread about health care in New Brunswick - I'm at the mercy of what I read and see on TV. You start talking about illegals, I have lived on the front line for 13 years. Sorry, but you know not of what you speak.


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## a_majoor (8 Sep 2009)

tomahawk6 said:
			
		

> As India has a class system I wonder what kind of healthcare if any is available to the poor ? In the US at least if you are sick and you show up at a hospital you have to be treated.



Re-reading the article carefully shows that there are many "layers" of health care and the competitive system allows the poor to access health care on a reasonable basis. As well, there is no reason to suppose that charitable institutions in India do not provide higher levels of health care to poor people that they might not be able to afford (just as charities provide health care support to poor people in Canada and the US, another datum suspiciously lacking in the debate)

This is no different from any other market; rich people might like to shop at IKEA while poor people buy their furniture from Wal Mart. What works in any market from cars to groceries _will_ work in health care as well.


----------



## Redeye (8 Sep 2009)

That's actually an even more compelling argument for reform - because those who are considered "outside" the system really aren't.  There's already a massive free rider problem resulting from the fact that hospitals cannot deny treatment at ERs.  To suggest that a public option (or single payer system) will create such a problem is belied by the fact that the problem already exists!

As you may recall, my parents have started wintering in AZ (they are presently negotiating the purchase of a condo in Yuma), and they were appalled to see things like car washes to fund medical bills for those who couldn't pay.  A country like the United States, which has spent billions of dollars to fight a war that was based entirely on lies (Iraq) is a little hard to take seriously when it claims it cannot provide a system to ensure reasonable access to all for healthcare.

I note the same extremes occur on any debate when it comes to illegal immigration.  The US has millions of illegals, and to suggest that any policy will get them to leave and/or stop coming is rather silly.  Far better, thinks I, to work on a system which can regularize those that are there, accept that the US economy relies on low cost unskilled labour (it seems Americans aren't lining up to work on farms or in meat packing plants) in such a way as they can pay taxes and participate in society.

The US has a tremendous opportunity to look at every delivery system for healthcare in the world, cherrypick the best features of every system, and create something brilliant.  Instead, lobbyists obfuscate the debate, use ridiculous and fallacious arguments, and depend on the ignorant masses to fail as usual to really question anything.



			
				muskrat89 said:
			
		

> Do you actually know any illegal aliens? I do. Most of the folks I know (well) that are here illegally (in Arizona) don't wait until *their health finally deteriorates so much from lack of proper care that they have no other option* before going to the emergency room. Rather, they go to the emergency room for emergencies and everything that the rest of us go to the doctor or a clinic for. The problem is that the government is NOT consistently reimbursing hospitals for illegals care - and hospitals are closing because of it.
> 
> http://www.wnd.com/news/article.asp?ARTICLE_ID=43275
> 
> ...


----------



## muskrat89 (8 Sep 2009)

> The US has a tremendous opportunity to look at every delivery system for healthcare in the world, cherrypick the best features of every system, and create something brilliant.  Instead, lobbyists obfuscate the debate, use ridiculous and fallacious arguments, and depend on the ignorant masses to fail as usual to really question anything.



On that we can agree on.

I can't speak to your parents' experience, but most community fundraisers I see are for either funeral expenses, or miscellaneous expenses related to special care required for rare or unusual conditions. Those situations may require lodging, travel, etc to another city. Also, parents often need to take time off (often unpaid) for care, travel, etc. I can't say personally that I have seen fundraisers to specifically pay for medical bills. Maybe that happens, but I can't say that I have seen it.


----------



## Bruce Monkhouse (8 Sep 2009)

Redeye,

I've been involved with a few fundraisers in Canada to help families with the cost of illnesses.
So your parents being appalled is rather a mute point......................


----------



## Redeye (9 Sep 2009)

The funeral fundraisers they have seen too - as have I, one was done for my mother-in-law who died suddenly with no life insurance when we were younger and totally, utterly broke.  Bruce does have a point that such drives happen here - but they're for less lofty goals generally I suspect than trying to pay bills.

There was an excellent op ed type piece in the Rolling Stone (of all places!) about why healthcare reform in the United States is basically doomed from the outset.  It's unfortunate but also, sadly, inherently logical.  It's a http://tinyurl.com/lo6zao .  It's long but it is very, very insightful.  It explains why current proposals won't work, and why the process of developing reform are so complex and make it virtually impossible for any progress to be made.



			
				muskrat89 said:
			
		

> On that we can agree on.
> 
> I can't speak to your parents' experience, but most community fundraisers I see are for either funeral expenses, or miscellaneous expenses related to special care required for rare or unusual conditions. Those situations may require lodging, travel, etc to another city. Also, parents often need to take time off (often unpaid) for care, travel, etc. I can't say personally that I have seen fundraisers to specifically pay for medical bills. Maybe that happens, but I can't say that I have seen it.


----------



## Bruce Monkhouse (9 Sep 2009)

Redeye said:
			
		

> Bruce does have a point that such drives happen here - but they're for less lofty goals generally I suspect than trying to pay bills.



Actually most were to help folks raise enough money to send sick children down to the States to receive a "humane" level of care or to receive treatments not available here.

Now I'm not defending or attacking either system, the health care problem is way above my puny frontal lobe capability, but I'm just saying.............


----------



## a_majoor (16 Sep 2009)

Of course the idea of the State controlling health care might fail if there are no health care providers. Calling Dr Galt...

http://www.investors.com/NewsAndAnalysis/Article.aspx?id=506199



> *45% Of Doctors Would Consider Quitting If Congress Passes Health Care* Overhaul
> 
> By TERRY JONES, INVESTOR'S BUSINESS DAILY
> Posted 09/15/2009 07:09 PM ET
> ...


----------



## Edward Campbell (22 Sep 2009)

Here, reproduced under the Fair Dealing provisions (§29) of the Copyright Act from todsay CBC web site, is another Canadian health care horror story:

http://www.cbc.ca/canada/british-columbia/story/2009/09/22/bc-prince-rupert-boat-crash.html


> Prince Rupert crash survivor battles for hospital bed
> 
> Tuesday, September 22, 2009
> 
> ...



There are always two (or more) sides to every story – maybe a neurosurgeon has determined that Mr. Culver should remain in Prince Rupert for a while.

But, most likely, this is the outcome of the only real control mechanism we have on health care: rationing.

We ration by limiting supply, in terms of both active care beds, the most expensive kind, and physicians.

We could ration by limiting services but it is hugely complex – what is “medically necessary?” – and politically difficult when a suffering person goes on TV and says, _“The cruel, heartless government minister will not save my life because his faceless bureaucrats say_ [disease] _does not qualify as ‘medically necessary.’ I have to go to the USA and pay for my treatment and I will have to sell my house and I’ll be homeless and sick.”_


----------



## a_majoor (28 Sep 2009)

Canada adops America's health care system:

latimes.com/news/nationworld/nation/la-na-healthcare-canada27-2009sep27,0,5111855.story

latimes.com



> *In Canada, a move toward a private healthcare option*
> 
> In British Columbia, private clinics and surgical centers are capitalizing on patients who might otherwise pay for faster treatment in the U.S. The courts will consider their legality next month.
> By Kim Murphy
> ...


----------



## Edward Campbell (28 Sep 2009)

Therein lies the _public_ insurance dilemma. And let’s be clear we, Canadians, do NOT have _public_ health medical *care*, we have public medical *insurance*.

The *explicit* promises of the public medical insurance regime are:

•	You will not be denied medically necessary treatment;

•	You will be treated in order of *medical* priority – no one can _jump the queue_ with their _gold card_;

•	Your insured treatments, no matter how long and involved, are all, always covered – you will not be forced into bankruptcy because of medical bill.

There is NO promise of _timely_ treatment; there is no promise that _pain_ will get you faster treatment; there is no promise that you will be treated near your home and so on.

The opponents of _private_ insurance are, almost certainly, right: _private_ insurance *WILL* provoke more and more _private_ care options and many health care professionals will abandon the under-funded public system and will work, exclusively, in private facilities, thereby making _public_ medical care even slower and more problematical.

But the alternative is to *conscript*_ doctors and nurses and so on.

I am sure the alternative appeals to many of the proponents of public medicare everything. It cannot and will not happen.

What will happen?

Left unconstrained, with insufficient rationing, the demand for “free” medical care will rise, higher and higher until it completely outstrips the public’s *ability* and *will * to pay – that’s what always, without fail, happens when supply appears to be infinite, i.e. *free*. Medical care is NOT free, we all pay for it; “we” are unwilling to pay too much. Therefore, eventually, a single payer system - which we have - will, either:

•	*Contract* until it provides treatment at *affordable* levels; or

•	*Collapse*.

Hence we ration care. Those who want to jump the queue may do so, easily, albeit not cheaply, because we live next door to the USA. We have gold card Medicare and sometimes the users of that private safety valve come home and then sue the government for the costs and sometimes they win. That’s wrong but it happens. It’s wrong because no one forces you to suffer but the implicit national ‘agreement’ is that all users of the “free” service suffer along together. Those who feel they must jump the queue are free to do so, but at their own, private expense.

“What about the poor, little dying baby?” you ask, “the one with the incurable disease whose parents want to take her to Los Angeles for some faint hope care that is not covered here? Surely,” you say, “we can pay a bit for her care.” *Nope*, she must suffer and die in pain and despair here or *you* and her friends and neighbours can have bake sales and so on to try and help her parents from paying for the guilt by losing their house. But it is NOT a public responsibility – nothing in our “national agreement” mandates compassion.

The argument isn’t for or against American or Canadian health care. On any list of medical care regimes they are going to at the bottom: one is too expensive and the other provides less than adequate outcomes. The argument is for an *affordably*, medically effective, universal system of medical insurance – something neither country has.
_


----------



## Redeye (30 Sep 2009)

I don't see a problem with more private capital going into infrastructure.  If I was more wealthy, I'd open an MRI clinic and probably make a fortune in no time, provided I could find someone to staff it, which seems to be as big a choke point as the availability of the machines.  What I worry about, being an avid reader of the UK satirical magazine Private Eye, is that PPP/PFI schemes tend to fail.  They've been the darling of the Labour government (who have used private financing initiatives for everything from the NHS to defence) and the results tend to be less than optimal.

While I saw this LA Times article being batted around by the right wingers on Twitter over the last couple of weeks, I wonder how widespread it will end up - and then what the result will be - if the private system will wind up being essentially incorporated into the single payer system - what I mean is, if all the docs shift to work in private clinics - or a significant proportion thereof, will provincial insurance schemes then wind up directing people to their care?  That, I understand, is what happens with the Shouldice Hospital in Toronto, which is a world leader in hernia treatments.


----------



## a_majoor (30 Sep 2009)

The issue with the hybrid systems is they tend to attract the worst of both systems, rather than the best.

What is needed is market incentives, which can easily be put in place by having consumers pay diorectly for their health care (just lioke they pay directly for their bread, dental care etc.). Registered Medical Savings Plans where the consumer keeps any residual monies are a good way to incentivise routine medical care (checkups, minor conditions, vaccinations etc.) since consumers will shop around for where they get the best value for money.

Catastrophy insurance for car crashes, debilitating illness shoudl also be a no brainer, the big problem in the US is tax laws and various regulations by both the Federal and State governments impedes the insurance market and prevents "portable" healthcare. The Federal funding through Medicare/Medicaid also distorts the system by stimulating demand, and causing insurance companies to game the system to get the most money from the Federal system as well.

If doctors and providers are more "private" but still need to deal with complex and inefficient bureaucracies to receive payment, then they will become more efficient at gaming the system to get their payments, which is not the desired outcome.


----------



## a_majoor (10 Oct 2009)

See how easy it "could" be?

http://www.technicalbard.com/archives/444



> *On eHealth and Medical Accounting*
> Oct 9th, 2009 by Taliesyn in Business, Canadian, Economics, Politics, Provincial
> No Comments Comments
> 
> ...


----------



## a_majoor (11 Oct 2009)

And what happens when money follows the bureaucrats instead:

http://volokh.com/2009/10/10/fined-for-inadequate-insurance/



> *Fined for Inadequate Insurance*
> 
> Jonathan H. Adler • October 10, 2009 9:42 am
> 
> ...


----------



## a_majoor (13 Oct 2009)

The truth emerges for all to see (although many people had seen this through the smokescreen long ago):

http://www.commentarymagazine.com/blogs/index.php/rubin/125022



> *Taxing Our Patients*
> Jennifer Rubin - 10.13.2009 - 7:45 AM
> 
> As the New York Times reports, there is a jumbo fight brewing among Democrats over just how much they’re going to tax the middle class in the name of health-care reform. Senate Democrats want to tax so-called Cadillac health-care plans to pay for the gargantuan health-care bill, while House Democrats don’t think it’s a good idea to whack middle-class voters, and especially union members. Well, on this one, House Democrats have a point:
> ...


----------



## a_majoor (21 Oct 2009)

More on why healtrh care costs are rising rapidly. Note the effect of lessening competition; by implication if the Canadian system allowed and encouraged competition, our costs would go down:

http://reason.com/archives/2009/10/20/health-care-nihilism



> *In Health Care, Nobody Knows Anything*
> Two new industry studies reignite the debate about what makes health care so expensive.
> Ronald Bailey | October 20, 2009
> 
> ...


----------



## a_majoor (20 Nov 2009)

Nothing to worry about...

http://online.wsj.com/article/SB10001424052748704204304574545733826430664.html



> *Great Moments in Socialized Medicine*
> 
> If women are discouraged from getting mammograms, as a U.S. government panel recently advised, some will die, but at least others will be spared the discomfort of getting mammograms. There isn't a similar upside to the following decision by Britain's socialized medical system, described by London's Daily Mail:
> 
> ...



I wonder how eager Mr Krugman would be to have himself or his family at the mercy of the UK's health system? He is awfully eager to impose it on others in the United States, though.

And just in case we feel smug:

http://www.cbc.ca/canada/toronto/story/2009/09/30/ontario-health-drug-plan-ombudsman851.html



> *Ont. cancer drug plan almost cruel: watchdog*
> Last Updated: Wednesday, September 30, 2009 | 11:45 PM ET
> 
> CBC News
> ...


----------



## a_majoor (29 Nov 2009)

Another data point for people thinking about socialized medicine:

http://www.telegraph.co.uk/comment/columnists/simonheffer/6672409/Want-to-fix-the-NHS-Go-private.html



> *Want to fix the NHS? Go private*When a hospital fails in the way that the Basildon and Thurrock Trust has, it should be turned over immediately to a private-sector hit squad to sort it out, writes Simon Heffer.
> 
> By Simon Heffer
> Published: 7:22PM GMT 27 Nov 2009
> ...


----------



## mariomike (29 Nov 2009)

"Palin: Canada should scrap public health care: “Canada needs to dismantle its public health-care system and allow private enterprise to get involved and turn a profit.”:
http://www2.macleans.ca/2009/11/25/palin-canada-should-scrap-public-health-care/


----------



## a_majoor (18 Dec 2009)

Health care dynamics (long post, edited to fit):

http://www.zombietime.com/zomblog/?p=1224



> *Why America Hates Universal Health Care: The Real Reason*
> Tue, Dec 15, 2009 at 2:41 pm
> 
> I watch the debate over health care with amazement. A million words are spoken on the topic with every passing minute, and as far as I can tell no one has ever addressed the real issue that’s upsetting everyone.
> ...


----------



## a_majoor (21 Dec 2009)

How to get the votes to socialize medicine:


----------



## a_majoor (26 Dec 2009)

Jerry Pournelle:

http://www.jerrypournelle.com/view/2009/Q4/view602.html#Friday



> *Change You Can Believe In, Chicago Style*
> 
> Today's Wall Street Journal has an editorial worth your attention. There is no better term for the ObamaCare Bill than Despotism. It's all very well for Congressmen and Senators to look out for their states, but this bill is a pure transfer payment from Republicans to Democrats. There is built into the bill a 40% tax on the most comprehensive -- and thus most expensive -- health care plans: But it does not apply to everyone. Longshoremen, for instance, are exempt -- and of course their unions have negotiated some of the most comprehensive healthcare short of what Congress gets. Other lines of work, nearly all heavily unionized, are exempt from the 40% tax (which will pretty well eliminate these plans for those who aren't exempt from the tax). Also, 17 States will be exempt; for the rest it's just too bad. There is no attempt at an explanation for these arbitrary transfers from those taxed to those not taxed. There is no logical reason why some are taxed and some are not. It's simply a set of earmarks, rewards to those supporting the "plan" and punishment for those who don't.
> 
> ...


----------



## a_majoor (27 Dec 2009)

And Mark Styen:

http://article.nationalreview.com/print/?q=YjU5OTJmODE4MGM5YmNiZDEyZDU5ZWU3NThhYjdmNGY=



> *Cross the River, Burn the Bridge*
> Obamacare is the fast-track to a permanent left-of-center political culture.
> 
> By Mark Steyn
> ...


----------



## Bruce Monkhouse (21 Jan 2010)

I'm sorry we don't have NFL teams up here so we aren't as used to dealing with the complications that arise from being a juiced-up space monkey.....


http://www.edmontonsun.com/sports/othersports/2010/01/20/12549166.html
Brock Lesnar calls Canadian health care system "Third World"

By Neil Springer, QMI Agency

Following Wednesday's announcement of a miraculous recovery from a career-threatening intestinal disorder and a planned return to the octagon, UFC heavyweight champion Brock Lesnar ripped into the Canadian health care system.

Lesnar said the worst part of his ordeal, which led to him being forced to pull out of two heavyweight title defences against Shane Carwin, was getting medical treatment in the Great White North.

"Probably the lowest moment was getting care from Canada," Lesnar said on a UFC conference call Wednesday. "They couldn't do anything for me. It was like I was in a Third World country...I had to get out of there.
"Canadians, don't get me wrong here. I love Canada; (it has) some of the best people and hunting in the world. But I wasn't at the right medical facility."

After being admitted to an undisclosed Canadian hospital, Lesnar realized his needs would not be met. He and his wife, Rena, then made a run for the border.
"The hospital that I was at, it wasn't their fault," Lesnar said. "They had some machinery that wasn't working and couldn't do its job. I needed to have (tests) done, so we went where they could be done.

"I knew that I had to get out of there and my wife saved my life. She got me out of there and drove 100 miles-per-hour to get me down to Bismark, N.D.”
When pressed further, Lesnar declined to name which Canadian medical facility he had been admitted to.

"I'm not going to disclose anything," Lesnar said. "The only reason I'm mentioning this -- and I'm mentioning to the United States of America -- is because President Obama's pushing this healthcare reform and obviously I don't want it. I'm a conservative republican...and I'm speaking of behalf of Americans. I'm speaking on behalf of our doctors in the United States that don't want this to happen.

"We don't need socialistic healthcare in America."


----------



## a_majoor (31 Jan 2010)

The problem was in the _message_. Now I get it:

http://www2.timesdispatch.com/rtd/news/opinion/op_ed/article/ED-HINKLE29B_20100128-182402/320790/



> *Hinkle: Talking Down to the Public Will Surely Work . . .*
> A. BARTON HINKLE TIMES-DISPATCH COLUMNIST
> Published: January 29, 2010
> » 12 Comments | Post a Comment
> ...


----------



## a_majoor (2 Feb 2010)

Another vote of confidence for Canadian style health care [/sarcasm]. If Obamacare ever passes, where will people like Preimier Williams go for their health care?

http://www.theglobeandmail.com/news/politics/danny-williams-to-undergo-heart-surgery-in-us/article1452524/



> *Danny Williams travels to U.S. for heart surgery *
> 
> Newfoundland Premier leaves province for undisclosed location south of the border
> 
> ...



and via Instapundit:



> UPDATE: Reader Geoff Coghlin writes:
> 
> 
> I’m a Canadian in Australia, and a great fan of your blog.
> ...


----------



## Edward Campbell (2 Feb 2010)

Thucydides said:
			
		

> Another vote of confidence for Canadian style health care [/sarcasm]. If Obamacare ever passes, *where will people like Preimier Williams go for their health care*?
> ...




Singapore (if they are fortunate enough (rich enough) to qualify for permanent residency), Malaysia, India and China: thousands, yes thousands, five or ten a day, almost every day of the year,* already do so for e.g. joint/hip replacements, organ transplants, heart surgery, post-stroke treatment, and, and, and ... and the _flow_ is increasing, steadily, and not just amongst Asian born Canadians either. 


-----
* According to a report I read several months ago (cannot remember where) which said that day-after-day, month in and month out, two or three people left Vancouver and three or four or more left Toronto every single day bound for _medical tourism_ destinations in Asia. India _has been_ the most popular but both Malaysia and China are catching up. I, personally, found brochures for one service planted in an Ottawa medical waiting room and there were posters in the Asian travel agency window just a few doors away.


----------



## observor 69 (3 Feb 2010)

And  more opinion from the medical community:

http://www.theglobeandmail.com/news/politics/williams-could-have-had-surgery-in-canada-cardiac-experts-say/article1454023/

Williams could have had surgery in Canada, cardiac experts say 

Steven Chase and Lisa Priest

Ottawa and Toronto — From Wednesday's Globe and Mail 
Published on Tuesday, Feb. 02, 2010 9:50PM EST

 Fellow politicians are loath to criticize Danny Williams's decision to forgo Canada's medicare system and pay for heart surgery in the U.S., but cardiac experts insist the Newfoundland Premier could easily have received top-notch care in this country instead.

Mr. Williams, thus far a staunch champion of medicare, has reignited debate about the adequacy of Canada's single-payer system and given opponents of health-care reform in the U.S. ammunition to vindicate their claims.

Arvind Koshal, a prominent Alberta cardiac surgeon, said virtually all heart procedures available in the U.S. are provided in Canada and he thinks Mr. Williams is sending the wrong message by travelling across the border for surgery.

“The optics are very poor, especially for people who are proponents of the Canadian health-care system,” said Dr. Koshal, director of development and external affairs at the Mazankowski Alberta Heart Institute in Edmonton. “It also says if you can buy your way out, then you can go to the U.S. and get it done right away.”

Mr. Williams's office is tight-lipped on the Premier's medical trip, refusing to disclose the location of his treatment or what procedures he will undergo this week. They said he is leaving Newfoundland because the treatment was not available in his home province, but refused to say if Mr. Williams could have been treated elsewhere in Canada.

Wilbert Keon, a heart surgery pioneer in Ottawa and a Conservative senator, said there's “no question” Mr. Williams could have been cared for in Canadian facilities.
“He's going to have to admit that when he recovers and has to face you guys,” he said.

Mr. Williams could get emergency surgery “tonight or tomorrow” in Canada and urgent procedures performed “in a couple of days,” Dr. Keon said. Elective procedures – medically-required but not an emergency – could take weeks.

But the Ottawa doctor doesn't begrudge the Newfoundland Premier for heading south for health care. “If he can afford to pay for that, who can deny somebody the right to drive a Mercedes as opposed to a Honda?”

Dr. Keon said he thinks one reason Canadians might favour U.S. hospitals is their more luxurious facilities.

“If for example he came to the Ottawa Heart Institute he would be in a little private room where there's just a chair for his wife to sit on and his family [would] have to stand around the end of the bed. He goes to one of the American luxury institutions and he gets a suite for his wife and family and so forth.”

Mr. Williams's trip became fodder for opponents of President Barack Obama's proposed reform of the U.S. health care system, which is aimed at extending coverage to most of the country's 47 million uninsured. Although the latest version of Mr. Obama's plan does not include a state-run health plan for Americans under 65, the U.S. right has warned further government involvement in the American system would lead to “Canadian-style” rationing and wait times.

The Newfoundland Premier's move sheds “light once again on the shortcomings of his nation's single-payer system,” charged Americans for Prosperity (AFP), a libertarian advocacy group founded by billionaire oilman David Koch.

Brian Day, a past president of the Canadian Medical Association, said he doesn't begrudge Mr. Williams for paying for care, but wants more private-sector incentives in Canada's health-care system to eradicate waitlists. “It was urgent enough for [Mr. Williams] to be worried about it and if you're worried about [health] you should have the right to do something about it.”

Canada's political class, from St. John's to Victoria, had only sympathy for Mr. Williams as he faces serious surgery.

“I don't think we should read more into this than the fact that Danny Williams, unfortunately, is going to have to have a significant operation,” B.C. premier Gordon Campbell told reporters.

One exception was former Prime Minister's Office director of communications Kory Teneycke who attacked Mr. Williams as a hypocrite for accepting U.S. medical care after his 2008 campaign against Mr. Harper where he warned the federal leader was a threat to medicare. “It's a clear case of hypocrisy,” Mr. Teneycke said. He no longer works for the government and said Ottawa clearly wants to take the “high road” in this instance. “That doesn't prevent others from pointing out the hypocrisy.”

With reports from Konrad Yakabuski, Karen Howlett, Rod Mickleburgh and Dawn Walton


----------



## Redeye (5 Feb 2010)

Where will they go?  To hospitals in Canada, like Premier Williams could have, according to a variety of sources.

Ironic that King Danny, who's in the past been a strong defender of universal healthcare, is being held up by the rabid right in the US, before anyone even knows why he went to the US. 



			
				Thucydides said:
			
		

> Another vote of confidence for Canadian style health care [/sarcasm]. If Obamacare ever passes, where will people like Preimier Williams go for their health care?
> 
> http://www.theglobeandmail.com/news/politics/danny-williams-to-undergo-heart-surgery-in-us/article1452524/
> 
> and via Instapundit:


----------



## VinceW (5 Feb 2010)

A reason why Williams went to the US for his surgery,might be because he was continuing the feud between him and Harper,and use this as a way to embarass the Federal government.


----------



## a_majoor (5 Feb 2010)

VinceW said:
			
		

> A reason why Williams went to the US for his surgery,might be because he was continuing the feud between him and Harper,and use this as a way to embarass the Federal government.



Since health care is a Provincial responsibility, Danny has lots of explaining to do.


----------



## VinceW (5 Feb 2010)

Yes it is,but since Harper still hasn't fulfilled his promise to get"wait time guarantees" done like he promised,Williams might use this move as a way to try and make Harper less popular,by bringing attention to it,or it could be due to the cuts to his Province.

But since I don't know,I'll wait till Williams gets better to explain why he did what he did,
it wouldn't surprise me.


----------



## Redeye (6 Feb 2010)

A Provincial responsibility, funded by a Federal transfer payment, and controlled subject to a Federal law.  Whether what Vince suggested was King Danny's play, I'm not sure, but interesting idea at least.



			
				Thucydides said:
			
		

> Since health care is a Provincial responsibility, Danny has lots of explaining to do.


----------



## a_majoor (19 Feb 2010)

Why let little things like the supreme law of the land get in the way of a good idea?

http://blog.american.com/?p=10601



> *Why the Healthcare Overhaul Is Almost Surely Unconstitutional
> *
> By Douglas Smith
> February 18, 2010, 3:36 pm
> ...


----------



## a_majoor (2 Mar 2010)

History 101:

http://cafehayek.com/2010/02/open-letter-to-two-npr-reporters.html



> Ms. Chana Joffe-Walt and Mr. David Kestenbaum
> All Things Considered
> National Public Radio
> 
> ...


----------



## a_majoor (4 Mar 2010)

Americans quietly adopt _America's_ health care system:

http://mjperry.blogspot.com/2010/03/from-only-200-in-2006-retail-clinics.html



> *From 200 in 2006, Retail Clinics Now Top 1,200 For First Time Ever; An Amazing 6X Increase in 3 Years*
> 
> Total Retail Clinics on March 1: 1,205 (up 8 from Feb. 1)
> Total Number of States: 40
> ...


----------



## a_majoor (7 Mar 2010)

The example of National Health is rather chilling....

http://www.dailymail.co.uk/news/article-1255858/Neglected-lazy-nurses-Kane-Gorny-22-dying-thirst-rang-police-beg-water.html



> *Neglected by 'lazy' nurses, man, 22, dying of thirst rang the police to beg for water*
> 
> By Emily Andrews
> Last updated at 2:19 PM on 06th March 2010
> ...


----------



## a_majoor (18 Mar 2010)

Obamacare will be the gift that keeps on giving for the Dems for years to come:

http://www.powerlineblog.com/archives/2010/03/025855.php



> *These are the good old days*
> 
> March 17, 2010 Posted by Paul at 8:37 AM
> 
> ...


----------



## a_majoor (15 Apr 2010)

More MD reaction. How many are not openly saying this?

http://hotair.com/archives/2010/04/14/arizona-doctor-goes-galt/



> *Arizona doctor goes Galt*
> posted at 10:12 am on April 14, 2010 by Ed Morrissey
> 
> Last month, a urologist in Florida told patients that he’d prefer ObamaCare supporters go elsewhere for treatment.  Today, a dermatologist in Arizona warns that he’ll be elsewhere if ObamaCare comes fully into law.  Joseph Scherzer says the penalties for dealing with Medicare patients, along with more top-down government control of health care, will drive him to close his doors:
> ...


----------



## a_majoor (26 Apr 2010)

Obamacare looks pretty familier to us in the Great White North. Our action plan should be to capitalize on Obamacare by overhauling our own system to lower costs and increase accessibility; I would suggest allowing private hospitals to open in Canada to cater to American patients practicing healthcare tourism. We would get lots of business, these hospitals would serve as great teaching/training hospitals for our own medical practitioners (and attract lots more people to join the medical profession, the real crunch point in our system) and the one minimum condition I would add to the program is every one of these private hospitals have a functioning 24/7 emergency ward.

http://healthcare.nationalreview.com/post/?q=Y2U5YjAzMjkxODY1YTViYmNjN2JjNGZjYWY4ZjliNDc=



> *Obamacare’s Danger Signs*
> 
> [Grace-Marie Turner]
> 
> ...


----------



## a_majoor (5 May 2010)

Without comment:

http://www.calgaryherald.com/Carpay+Unrolling+Alberta+health+care+debate+eyeing+toilet+paper/2982259/story.html



> *Carpay: Unrolling Alberta's health care debate by eyeing toilet paper*
> 
> 
> By John Carpay, Calgary Herald May 3, 2010
> ...


----------



## Edward Campbell (29 May 2010)

Every so often the _Good Grey Globe’s_ Jeffrey Simpson gets it exactly right.

First: consider this, reproduced under the Fair Dealing provisions (§29) of the Copyright Act from the _Globe and Mail_:

http://www.theglobeandmail.com/news/national/british-columbia/hst-backlash-could-prove-to-be-bc-liberals-waterloo/article1585119/


> HST backlash could prove to be B.C. Liberals’ Waterloo
> *After three consecutive election victories, Premier Gordon Campbell is facing his toughest fight ever*
> 
> Justine Hunter and Ian Bailey
> ...




Now consider this:

http://www.theglobeandmail.com/news/national/british-columbia/hst-backlash-could-prove-to-be-bc-liberals-waterloo/article1585119/


> We can’t afford to live in health-care denial
> *The public has been blissfully ignorant that budgets are growing at an unsustainable pace*
> 
> Jeffrey Simpson
> ...



I don’t know what frightens me more: the venality of politicians, especially those on the political _left_ for whom no lie is ever too large, or the *stupidity*, coupled with plain old fashioned greed, of the overwhelming majority of Canadian voters. They want their “free” health care; hell’s bells they *demand* their “free” health care but they are too bloody thick to appreciate that the HST is absolutely necessary to raise the money to pay for it. Jesus wept!


----------



## mariomike (29 May 2010)

This is an ambulance bill from San Francisco.:
http://www.flickr.com/photos/subvert/333397249/

( S.F. Giants Stadium to San Francisco General Hospital:  $1,339.23 USD )
They even charged her $75.00 to turn the red lights on! 
"You want lights with your saline drip?"  

That ride, with the ( very basic ) trimmings listed, and many more not listed, would have cost her $45.00 in Toronto.

The lady who received the bill had this to say:
"Getting to the hospital in the United States - $1,339.23
Getting to the hospital in Canada - $48
Not bleeding to death on the bridge - priceless
Thank you United States, for teaching me the financial worth of my life."

Here's a 'nuther:
"The AMR charged me $2100 for the 11 mile trip and all they gave me was O2!":
http://answers.yahoo.com/question/index?qid=20090227154120AAXhdbk

Comments:
"Same thing happened to me and it was less than a mile and 3,000. They did nothing for me, just brought be to the ER. Sorry but I had to suck it up and pay it."

"You should not have gotten on the abmulance ( sic ) if you didn't want to pay for it."

"let you have your seizure at work" 

"Must I pay for a $1,261 Ambulance Bill, if I was forced by police to take the ambulance?
I was tazered, and then forced to take an ambulance to the hospital,":
http://answers.yahoo.com/question/index?qid=20090909161618AAJxR73


----------



## PPCLI Guy (29 May 2010)

Six weeks ago my wife had a roller blading accident, and was admitted to George Washington University Hospital in DC.  She was taken there in an ambulance, received trauma care, had a Cat scan and other x-rays, and spent a night in hospital (just as she would have back home).  She a minor cut to her chin, deeply bruised legs, and a fractured vertebra.  

The bill?  $26,000.

My so called gold-plated insurance seems prepared to pay less than half of it.  Although the rest will be paid by a combination of PSHCP and GOC funds, the fact remains that if I was an American citizen, I would be trying to scrape together over 13 K right now.

Quite happy to pay my taxes, including the GST (that should in my mind have remained at 7%).

My 26K worth.

Dave


----------



## Infanteer (30 May 2010)

Chasing bad policies with more money isn't a good way to come about a solution to the problem.  Unfortunately, politicians seem unable to come up with good solutions whether they have the money or not.


----------



## a_majoor (17 Dec 2010)

From Forbes. Canadian style health care comes to America:

http://www.forbes.com/2010/12/15/fda-avastin-breast-cancer-opinions-contributors-sally-pipes_print.html



> *The Fatal Move From The FDA*
> Sally C. Pipes, 12.16.10, 10:00 AM ET
> 
> On Dec. 17 the Food and Drug Administration is expected to take the radical step of revoking approval for an advanced drug in the treatment of one of the country's most deadly diseases.
> ...


----------



## a_majoor (18 Dec 2010)

Irony:

http://www.outsidethebeltway.com/a-cuban-hospital-is-no-place-to-be-sick/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+OTB+%28Outside+The+Beltway+|+OTB%29



> *Michael Moore’s Sicko was banned in Cuba:*
> 
> The revelation, contained in a confidential US embassy cable released by WikiLeaks, is surprising, given that the film attempted to discredit the US healthcare system by highlighting what it claimed was the excellence of the Cuban system…
> 
> ...



Of course "widely shown" in a place like Cuba means widely shown to people the government is willing to show it to, so take the distribution with a few grains of salt.


----------



## The Bread Guy (18 Dec 2010)

Besides, if Cuban health care is so great, why are volunteers collecting old hospital equipment to send there?  I guess Mike never got to deal with that question, eh?


----------



## Nemo888 (18 Dec 2010)

Tools are just that, tools. Cuba has better outcomes than the American system with no tools. Just saying. The American system is much more broken than the Cuban one from a statistical outcome point of view. The America system of social Darwinism only does well for the top tier, not the average citizen. (Unless social Darwinism is your thing. Then it is working great.)


----------



## Brad Sallows (19 Dec 2010)

To what statistical outcomes do you refer?  I assume you are already acquainted with the incidental reasons why measures of infant mortality and life expectancy are skewed and useless and have some other pertinent measurements in mind?


----------



## Infanteer (19 Dec 2010)

Nemo888 said:
			
		

> Tools are just that, tools. Cuba has better outcomes than the American system with no tools. Just saying. The American system is much more broken than the Cuban one from a statistical outcome point of view.



 :rofl:


----------



## Edward Campbell (19 Dec 2010)

Nemo888 said:
			
		

> Tools are just that, tools. Cuba has better outcomes than the American system with no tools. Just saying. The American system is much more broken than the Cuban one from a statistical outcome point of view. The America system of social Darwinism only does well for the top tier, not the average citizen. (Unless social Darwinism is your thing. Then it is working great.)




I would not disagree if you had said something like "_American Social Darwinism_ rewards the upper tiers and punishes the bottom ones." My (fairly close) view of *one part* of the American middle class indicates, to me that the US system is very, very 'fair' if you accept, as I do, that fair means hard work, a bit of risk taking and a lack of really bad luck are rewarded.

With specific regard to health care: a decent job = decent health care; a poor job or no job = second rate health care, at best. *But*: there are mechanisms for the working poor and unemployed, even though they, the poor and unemployed, are often ill equipped to understand and use those mechanisms.

What is interesting is to watch someone change jobs and to understand that the employer's health care plan is a major determinant in deciding which job offer to take.


----------



## brihard (19 Dec 2010)

Nemo888 said:
			
		

> Tools are just that, tools. Cuba has better outcomes than the American system with no tools. Just saying. The American system is much more broken than the Cuban one from a statistical outcome point of view. The America system of social Darwinism only does well for the top tier, not the average citizen. (Unless social Darwinism is your thing. Then it is working great.)



Citation needed.

The American system actually does quite well for the 'average' American. Those who it fails to serve well are the 20 or 30 million at the bottom who have no coverage, and this is where my biggest objection to the American system is.

Personally I'm a fan of a two tier system where free market healthcare (and insurance) is available to those who can get it, and the government provides healthcare for the rest in the same manner that we do now. I consider it unconscionable that an economically prosperous western state should have 20+ million people without basic healthcare, and I view that as a gap appropriate for government to fill, as it's an obvious social deficit that cannot be remedied by the normal free market dynamics. It's one of those 'common goods' that does require some state presence to work, because there's no real way to freely generate profit off treating the bottom 10% or by providing preventative care.

The hell of it is, America spends fully half again as much of a percentage of their GDP on healthcare as we do, and they spend more per capita as well. It baffles me what inefficiencies must exist that this can be the case without those at the bottom being covered...


----------



## Edward Campbell (19 Dec 2010)

Brihard said:
			
		

> Citation needed.
> 
> The American system actually does quite well for the 'average' American. Those who it fails to serve well are the 20 or 30 million at the bottom who have no coverage, and this is where my biggest objection to the American system is.
> 
> ...




I am, broadly, in agreement with you both two tier health-care for Canada and the mismanagement (I guess that's what it is) of the US system (if you can call it that).


----------



## Brad Sallows (19 Dec 2010)

I doubt that the use of the measure of percentage of GDP expended on health care is a measure of inefficiency, any more than a greater expenditure on food and cars in a plentiful economy versus a rationed and restricted one is an indication of inefficiency on the part of the former.


----------



## Edward Campbell (19 Dec 2010)

Brad Sallows said:
			
		

> I doubt that the use of the measure of percentage of GDP expended on health care is a measure of inefficiency, any more than a greater expenditure on food and cars in a plentiful economy versus a rationed and restricted one is an indication of inefficiency on the part of the former.




I agree that simple spending indicates nothing much but when, as several US and international organizations have done, spending and various measures of 'outcome' are examined together then the US and Canada both appear to be inefficient.


----------



## a_majoor (19 Dec 2010)

Many of the people who have no health insurance in the United States are young and healthy individuals who "game" the system in the expectation that they will not need to use it. Millions more are "undocumented" workers, who pay no taxes or inputs into the system but feed off it anyway. Most of the "problems" Obamacare was supposed to address are not even addressed in any meaningful or efficient way by the current bill. Much of the explosive growth in US healthcare spending is from (surprise!) Government health care in the form of Medicare/Medicaid and the perverse incentives built into the system. Regulatory failure isn't an excuse to create more regulatory failure...

OTOH, the administration is still trying hard to sell the idea to a population who is against it:




> *Team Obama Propaganda Department Buys Google’s “Obamacare” Search Records*
> Posted by Jim Hoft on Saturday, December 18, 2010, 7:13 PM
> 
> The most open and honest administration in history.
> ...




Time to switch over to Bing...


----------



## Nemo888 (20 Dec 2010)

Brihard said:
			
		

> Citation needed.
> 
> The American system actually does quite well for the 'average' American. Those who it fails to serve well are the 20 or 30 million at the bottom who have no coverage, and this is where my biggest objection to the American system is.
> 
> ...



What you said.


----------



## newbie2011 (21 Dec 2010)

The fact remains that as a percentage of GNP, our healthcare system costs about 4% less per capita, yet our infant morality rate, and life expectancy is better than the US. Other healthcare outcomes are better, if you look at research from the Canadian Institute of Health Information for example.

You could find many horror stories about the US system, but to me the key issue is its lack of egalitarianism. Sure, wait times are an issue in Canada, but for urgent care typically you get seen very quickly. We should be focussing our efforts on primary care,  because this is where our problems lie. 

There is no doubt that if you are rich you can better healthcare in the US, but on average, 99% of the population gets very good healthcare here. Our system needs to change, but adopting the expensive US system which eats up a lot more in administrative costs (double to triple per capita than our system) would be a bad idea. Internal incentives and more competition within our system would work.

In my opinion, we should be proud of our system, and realize that the grass isn't greener on the US side of the border. We should be looking to Japan or Europe for examples of how our system can change, positively, but keeping the equality of access is imperative.


----------



## Edward Campbell (21 Dec 2010)

newbie2011 said:
			
		

> The fact remains that as a percentage of GNP, our healthcare system costs about 4% less per capita, yet our infant morality rate, and life expectancy is better than the US. Other healthcare outcomes are better, if you look at research from the Canadian Institute of Health Information for example.
> 
> You could find many horror stories about the US system, but to me the key issue is its lack of egalitarianism. Sure, wait times are an issue in Canada, but for urgent care typically you get seen very quickly. We should be focussing our efforts on primary care,  because this is where our problems lie.
> 
> ...




The data, at least the data I have seen over the past several years, says you are wrong. We do spend a lesser percentage of GDP than does the US and our 'outcomes' - and every study measures them somewhat differently* - are almost always slightly better, but we are not 'good' and 99% of Canadians do not get 'good' care.

You are correct that the USA is not the best a good a useful model for Canada. We need to examine e.g. France, Italy, Singapore, Austria and Japan to see how they fund and deliver health care to their citizens. See this report from Tower Watson, a risk and financial management consultancy, which explains how Singapore provides *better* (in pretty much every respect) health care than does Canada for only 3% of GDP, only 1/3 of that being taxpayer's money. The Singapore model would be very, very hard for e.g. the US or UK to emulate but Canada could follow the Singapore plan because we already have a _universal_ public insurance plan intended, by Tommy Douglas, to cover _catastrophic_ health care expenditures. What Singapore manages to do is:

1. Put the onus and burden for _normal_, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual.
2. Allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employers.
3. Rely extensively on the competitive private sector for health care provision. 

The Singapore example puts paid to the argument screams and cries by _public_ health care advocates that a private plan must cost more because profits must be made. that was, still is, always a lie told by some fairly smart people to the economically illiterate majority. 

----------
* See, e.g. http://www.photius.com/rankings/world_health_systems.html


----------



## GAP (21 Dec 2010)

1. Put the onus and burden for normal, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual. (I can hear the Dippers et al moaning into the wind on this one, Tommy would be rolling over in his grave, the hew and cry would be VERY loud....What, you want us to be responsible?)

2. Allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employers. (See!! I Told YOU!!! they have an adgenda !!! Private Healthcare!!!....or along those lines...)


3. Rely extensively on the competitive private sector for health care provision.
(repeat #2)

No ER, Canadians will not accept anything like that, because those with a vested interest in NOT changing it will tell us how to think.....it's what we are best at.....not thinking for ourselves.....(/sarcasm)


----------



## Edward Campbell (21 Dec 2010)

GAP said:
			
		

> 1. Put the onus and burden for normal, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual. (I can hear the Dippers et al moaning into the wind on this one, Tommy would be rolling over in his grave, the hew and cry would be VERY loud....What, you want us to be responsible?)
> 
> 2. Allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employers. (See!! I Told YOU!!! they have an adgenda !!! Private Healthcare!!!....or along those lines...)
> 
> ...




Having lived, and paid attention, through the TC Douglas era, I am satisfied that what Mr. Douglas wanted was _universal_ insurance to protect against *financially catastrophic* health care problems. Events, including actions by physicians and _radicals_ in his own party, forced his hands and a 100% public (single payer) system was the result - a system which must always and everywhere, without fail, no exceptions, involve *rationing* as its *primary* control mechanism.

Our single payer system doesn't work - it doesn't work financially and it doesn't work operationally. Eventually, sooner rather than later, it will be amended to "put the onus and burden for normal, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual, allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employer," and "rely extensively on the competitive private sector for health care provision." At a point in the not too distant future the most senior bureaucrats, the bankers and the back-room political strategists will tell prime ministers and premiers that _"Now's the day, and now's the hour,"_ and the requisite changes will happen because no one with real power cares about the misguided views of the uninformed Canadian majority.


----------



## GAP (21 Dec 2010)

Now that I agree with. 

So long as the masses resist the pharmacare, homecares, dentacare's being proposed by the Dippers and Libs as vote getting measures.....

edited to add: The only one that makes any fiscal sense is homecare, but even that is being twisted into something that was never intended.....


----------



## Edward Campbell (21 Dec 2010)

I don't care which of _n_ 'cares' we have so long as we recognize that we, individual Canadians, pay 100% of the bill for everything. We need to aim to _regulate_ that spending so that about ⅓ comes out of our provincial taxpayer pockets and the remaining ⅔ comes from our _private_ pockets – either as “pay as you go” fees or, for a slight fee, as insurance premiums.

Now even staunchly capitalist and self-reliant Singaporeans allow for programmes like _eldercare_ because they recognize that "pay as you go" only works when one has a steady income from which to pay, so I expect that we will all end up paying to subsidize some minority groups.


----------



## GAP (21 Dec 2010)

Ontario has health care premiums, do they not? Is it helping allay the costs of healthcare, or is it just another piggy bank for the government?


----------



## Edward Campbell (21 Dec 2010)

GAP said:
			
		

> Ontario has health care premiums, do they not? Is it helping allay the costs of healthcare, or is it just another piggy bank for the government?




Yes, ON has a health fee. Given that healthcare costs are rapidly approaching 50% of all ON public expenditures all revenues, including fishing licenses, are used to allay those costs. The problem is that, soon, health care spending will begin to do real, serious harm to ON (and BC and AB and QC and NL, and, and, and ...) because they will deprive us of opportunities to spend _productively_ on things like education and infrastructure. Health care spending is _productive_ when it promotes good health, it is counter-productive when it treats illness. About 98% of 'healthcare' spending is, therefore, counter-productive.


----------



## observor 69 (21 Dec 2010)

"Health care spending is productive when it promotes good health, it is counter-productive when it treats illness" Quoting E.R.

Most members of the health care community agree. But nurses working in Emerg and ICU constantly complain about patients who show no regard for their health. Overweight, drugs, alcohol and just plain poor life style represents too many  patients. Treatment costs taxpayers millions.
In the military we are required to be fit and for many this carries on after they become civies.
As these nurses keep saying "We don't see those kind of patients." Proper BMI range, diet and exercise keeps most fit people out of the hospital.
I agree with E.R. but changing the lifestyle of Canadians is no easy matter.


----------



## a_majoor (4 Jan 2011)

Can't have competition and people shopping for the most affordable health care now, can we?

http://www.weeklystandard.com/blogs/obamacare-ends-construction-doctor-owned-hospitals_525950.html



> *Obamacare Ends Construction of Doctor-Owned Hospitals*
> 2:50 PM, JAN 3, 2011	 • BY JEFFREY H. ANDERSONSingle
> 
> Under the headline, "Construction Stops at Physician Hospitals," Politico reports today that "Physician Hospitals of America says that construction had to stop at 45 hospitals nationwide or they would not be able to bill Medicare for treatments." Stopping construction at doctor-owned hospitals might not seem like the best way to boost the economy or to promote greater access and choice in health care, but that exactly what Obamacare is doing.
> ...


----------



## Edward Campbell (4 Jan 2011)

Thucydides said:
			
		

> Can't have competition and people shopping for the most affordable health care now, can we?
> 
> http://www.weeklystandard.com/blogs/obamacare-ends-construction-doctor-owned-hospitals_525950.html
> ...
> ...




<rant>
Sen Baucus' name and and/or vote can be bought by almost any lobby group to support or oppose almost any issue. He has long been a paid proponent of *illegal* actions by the US government in the never-ending softwood lumber dispute. The US softwood lumber industry is grossly uncompetitive - producing a consistently inferior product at a consistently higher price - but it survives and prospers because Baucus _et al_ break every international trade law with the impunity that only a US senator enjoys.
</rant>






Sen. Max Baucus (D. MT)


----------



## a_majoor (18 Jan 2011)

A critique of Obamacare offers some solutions that would have a very positive effect on the Canadian health care system:

http://freedomnation.blogspot.com/2011/01/10-problems-and-solutions-of-obamacare.html



> *10 problems and solutions of Obamacare*
> 
> John Goodman of the National Center for Policy Analyses (US based) has written an interesting blog post about what is wrong with Obamacare and what can be done to fix it. I encourage you to read the whole thing but here is the last two of his ten points:
> 
> ...


----------



## mariomike (19 Jan 2011)

Jan 17th, 2011
Front Page Magazine:
"Emergency Services to Suffer Under ObamaCare: With the enormous increase in patient coverage proposed in the supposedly all-encompassing act, not enough money is provided for the expected huge increased need for EMS, a Jan. 11 analysis by the National Center for Policy Analysis (NCPA) explains.":
http://frontpagemag.com/2011/01/17/emergency-services-to-suffer-under-obamacare/


----------



## a_majoor (21 Jan 2011)

Repeal and replace; what the Congres is proposing to replace Obamacare with. Any bets the combined new bils won't total 2000+ pages?

http://washingtonexaminer.com/politics/2011/01/house-gop-begins-long-slog-dismantle-obamacare



> *House GOP begins long drive to dismantle Obamacare*
> TAGS: 1099 provisions ben nelson Byron York claire mccaskill David Dreier Health care reform health insurance House Republicans insurance Kent Conrad obamacare Republicans Senate Democrats
> COMMENTS (16)  SHARE  PRINT
> By: Byron York 01/20/11 8:05 PM
> ...


----------



## Redeye (24 Jan 2011)

What does it matter, though?  GOP doesn't control the Congress, their repeal bill is utterly meaningless, and their replacement will be as devoid of useful ideas as they were during the original debate.

Oh, and according to a slew of polls, despite the GOP's assertions, the American people don't want it repealed.  The GOP are apparently out of touch with the electorate.  They want the economy and employment addressed.  So first this pointless waste of time on a repeal bill, and now apparently they're debating about abortion, something else where nothing they pass well go anywhere?!

Bring on 2012.  It'll be interesting.



			
				Thucydides said:
			
		

> Repeal and replace; what the Congres is proposing to replace Obamacare with. Any bets the combined new bils won't total 2000+ pages?
> 
> http://washingtonexaminer.com/politics/2011/01/house-gop-begins-long-slog-dismantle-obamacare


----------



## Rifleman62 (24 Jan 2011)

Redeye, please review you post. It is full of errors.
Hint: what party controls the Congress and why in the US system is that important?
        what % of the US economy does health care represent, and effect does a government "take over" create?
        what party "won" the 2010 election?


----------



## Redeye (24 Jan 2011)

Neither party controls the Congress.  The Democrats control the Senate and the Republicans control the House of Representatives.  The House technically controls the purse strings and that does give them some ability to impact funding of government programs.  However, any bill they pass must be passed by the Senate and then signed by the President.  Since the Democrats control that, there's really no way any repeal bill means anything, since the Senate likely won't even bring it to a vote.  If they did, it would fail.  If by some miracle it passed the Senate, then the President would simply veto it, and there's no way there's enough votes to overturn the veto.  America's system is rather brilliant that way.  And that's why the GOP's "repeal bill" is either a total failure, or potentially, if there's public backlash over it, a Pyrrhic victory of sorts.

As for "what %"?  That's a nonsensical red herring.  ACA/"Obamacare" doesn't "take over" anything.  It leaves the provision of insurance and delivery of healthcare primarily to the private sector as always.  It does however mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it (shifting them from having to resort to the most expensive interventions like ER care far too late to having reasonable access to care, which should save money and improve outcomes), and restricts insurers from effectively denying coverage to those who have "pre-existing conditions", which happens to be about 119 million Americans if I remember right.  (out of 307 million, that's well north of 1/3).

As for who won, well, yes the GOP took the House.  And it will be an interesting couple of years.  It happened to Clinton too.  And he was re-elected.  And the GOP doesn't seem to have much in the way of really electable candidates for 2012, unless they pull off some kind of economic miracle (doubt it) they aren't in for any sort of an easy ride in 2012.





			
				Rifleman62 said:
			
		

> Redeye, please review you post. It is full of errors.
> Hint: what party controls the Congress and why in the US system is that important?
> what % of the US economy does health care represent, and effect does a government "take over" create?
> what party "won" the 2010 election?


----------



## Rifleman62 (24 Jan 2011)

And what effect will there be from  





> mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it


, when nobody but the very rich can afford health insurance?


----------



## Fishbone Jones (24 Jan 2011)

Rifleman62 said:
			
		

> And what effect will there be from  , when nobody but the very rich can afford health insurance?



Millions of middle class Americans carry, and pay for, health insurance. You don't have to be 'very rich' to afford it.


----------



## Rifleman62 (24 Jan 2011)

Yes, of course I realize that. The question was: And what effect will there be from mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it, when nobody but the very rich can afford health insurance?

The key here is _*mandate all, subsidizing it*_, and the increasing costs to insurance companys leads to........

Down here, the insurance companys are already substantially increasing premiums. Business are not hiring due to employee costs.


----------



## Redeye (24 Jan 2011)

Rifleman62 said:
			
		

> Yes, of course I realize that. The question was: And what effect will there be from mandate all to carry insurance (increasing the risk pool), subsidizing it for those who cannot afford it, when nobody but the very rich can afford health insurance?
> 
> The key here is _*mandate all, subsidizing it*_, and the increasing costs to insurance companys leads to........



Actually, expanding the risk pool should lower the costs for all.  Part of what started driving up insurance costs in the US was the cherrypicking of the "best risks" by certain insurers leaving making the pool smaller and causing a much larger adverse selection problem (one of the biggest problems in insurance markets) and driving up costs.



			
				Rifleman62 said:
			
		

> Down here, the insurance companys are already substantially increasing premiums. Business are not hiring due to employee costs.



Well, the extent to which that is true there's been some debate on - but that actually strengthens the argument for a "public option" - or better, a single payer system - unhooking health insurance from employers.


----------



## Rifleman62 (24 Jan 2011)

Redeye, I regret not being to be able to refute your latest ramblings. My personal policy is to not post more than three my  .02 cents comments to the currently posted discussion by an individual.

I will of course, continue to follow your discussion.

Why, oh why is the Left always, always Right???


----------



## Redeye (24 Jan 2011)

Rifleman62 said:
			
		

> Redeye, I regret not being to be able to refute your latest ramblings. My personal policy is not post more than three my  .02 cents to the currently posted discussion by an individual.
> 
> I will of course, continue to follow your discussion.
> 
> Why, oh why is the Left always, always Right???



Facts have a known liberal bias as Stephen Colbert once said.  Healthcare economics and policy has been a very significant interest of mine for a very long time.  The fact is that no "side" has all the answers, but without a decent sharing of ideas through a civil discourse, you might be able to fuse together something workable.

What galls me most in the US healthcare debate though is the shift from a practical discussion of how to reform or fix a clearly broken system to debating utter nonsense not supported by fact (death panels, for example), when there's really a great opportunity to learn from the strengths and weaknesses of the various systems for delivering universal healthcare throughout the rest of the industrialized world, choose the best features, and built an excellent, cost effective system.  The American system spends more money than any of those countries and still manages not to cover a huge swath of the population, and without the reform in place now, even those with coverage, particularly those who bought in the individual insurance market rather than through a group plan (ie employer benefits), faced a risk that insurers would go back through their history and look for any excuse to rescind coverage or exclude a condition.

The problem is a simple one - a company which has as its sole rational goal the maximization of profit must seek to limit its costs in every reasonable way possible.  Insurers do that, and employ huge underwriting teams to limit their "medical losses" where practicable, without crossing the line of failing to deliver the service paid for.  The massive amount of overhead the insurance company creates drives costs up, which is why there are so many costs.

My other favourite canard is "No one gets denied medical treatment.  They can go the ER and it's illegal to refuse to treat someone there.".  That's right.  ER care is also, generally, the most expensive.  And when Johnny NoInsurance comes in and gets treatment there, who pays?  Well, they'll bill him.  He'll pay what he can, maybe, or like a not-totally-insignificant number of Americans, declare bankruptcy.  So then who pays?  Everyone, because the care providers pass the cost on to everyone else, which is part of why it costs $10 for a Tylenol at some hospitals if you get an itemized bill.

Anyhow, that's enough for one post... but it's somewhere to start.


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## observor 69 (25 Jan 2011)

For many Americans the fear is that they can't afford proper early treatment hence the patient will end up going to ER too late with an illness that is advanced and now expensive to treat.
Or the patient simply can't afford proper treatment of their serious illness and eventually dies. 
Yes this happens !


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## Brad Sallows (25 Jan 2011)

Repeal isn't meaningless.  The point is to have every politician who might stand for re-election in 2012 on record with a particular vote.  And any assertion that the Republican politicians are "devoid of ideas" militates heavily against the possibility that the speaker/writer has learned much from holding a significant interest for a very long time.  I suggest you as well look more deeply into recent election results below the federal level and the mix of senators due for re-election in 2012 to understand the electoral ground.

>utter nonsense not supported by fact (death panels, for example)

A characterization of "utter nonsense" is pure rhetorical bilge unbecoming of an "informed" person, unless you genuinely don't understand that the issue is health care rationing, which no one actually disputes except when it is referred to (hyperbolically) as death panels.  The hyperbole doesn't negate the issue/criticism.

>Actually, expanding the risk pool should lower the costs for all. 

Simply expanding the risk pool increases the costs.  Expanding the paying insured pool is what lowers the costs.

The US system can indeed benefit from practical discussions of reform, but that's sort of impossible when some people have managed to convince themselves that the Republicans are "devoid of ideas" and the other political side instead focusus on passing legislation before understanding it in pursuit of the rather simple goal of forcing a breakdown of the system into single-payer public insurance by default.


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## Redeye (26 Jan 2011)

Given that going into the vote several polls showed repeal was wildly unpopular, it's not really a record I'd think many will want.

As for rationing - basic economics here - it exists in any system.  And while the term is in the eyes of those informed in the debate mainly a rhetorical device, to the "ignorant masses" it seems to be getting interpreted far more literally, and that's both counterproductive and just plain wrong.

What are the Republicans' ideas - the ones that haven't been highlighted as being useless by a myriad of sources?

Incidentally, there are non-single-payer universal healthcare systems, which the US could draw many ideas from - Germany, Switzerland for example.



			
				Brad Sallows said:
			
		

> Repeal isn't meaningless.  The point is to have every politician who might stand for re-election in 2012 on record with a particular vote.  And any assertion that the Republican politicians are "devoid of ideas" militates heavily against the possibility that the speaker/writer has learned much from holding a significant interest for a very long time.  I suggest you as well look more deeply into recent election results below the federal level and the mix of senators due for re-election in 2012 to understand the electoral ground.
> 
> >utter nonsense not supported by fact (death panels, for example)
> 
> ...


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## Brad Sallows (26 Jan 2011)

Prior to the election date some polls showed outright repeal in the 35% to 60% range.  I am not sure what the exact percentage threshold for "wildly unpopular" should be, but I suppose it to be lower than that.

Of course there is rationing in any economic system; usually, it is established by price signals.  The problem with current reform in the US is that a large fraction of Americans have become accustomed to at least having the option to decide whether to pay the price.  Again, you seem to want to ignore the customary meaning of common terms.  When people talk about health care "rationing", they tend to mean direct government yes/no decisions.

A couple of useful Republican ideas are to remove the interstate red tape which restricts insurers and to allow the formation of larger pools composed of individuals and smaller business.  Since you already acknowledged the advantage of expanding risk pools, I don't expect you to try and walk that one back as being useless, no matter how many myriads of contrary opinions you deploy.

The biggest problem the US has is that they are 40 to 50 years late joining the party.   The overall level of health care to which most Americans have become accustomed is much more advanced and costly than it was when most countries locked down expectations a few decades ago.  The second biggest problem is that the US already has made publicly funded promises to itself that it can't afford at levels people are willing to pay.  And, when the numbers are crunched, the actual expected efficiency gains are a very small number alongside a very big number; the gap isn't going to simply disappear.  The third biggest problem is that a practical person should expect the costs to be greater than predicted, and the revenues to be smaller.


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## Redeye (27 Jan 2011)

Brad Sallows said:
			
		

> Prior to the election date some polls showed outright repeal in the 35% to 60% range.  I am not sure what the exact percentage threshold for "wildly unpopular" should be, but I suppose it to be lower than that.



I'll have to go hunting for it - but I believe it was a Gallup (or possible Opinion Research) poll that suggested almost 70% of Americans opposed repeal immediately before the vote in the House.



			
				Brad Sallows said:
			
		

> Of course there is rationing in any economic system; usually, it is established by price signals.  The problem with current reform in the US is that a large fraction of Americans have become accustomed to at least having the option to decide whether to pay the price.  Again, you seem to want to ignore the customary meaning of common terms.  When people talk about health care "rationing", they tend to mean direct government yes/no decisions.



The "customary meaning" in this case is being used to suggest to the average voter, who doesn't have the grasp of economics you or I do, that rather than restructuring rationing that exists regardless, it is being imposed where it doesn't exist.  The term "death panel" takes this to the extreme as a rhetorical device.  In the case of healthcare services, rationing by price signals has a pretty simplistic implication - if you cannot pay, you die.  Most people in society seem to be of the opinion that such a system isn't optimal.  Why does the US provide Medicare for senior citizens?  Because most don't have the resources to "self-insure", and no insurer could effectively provide insurance for that particular market at a price that would make it acceptable to most because the risks they're insuring against are so high.[/quote]




			
				Brad Sallows said:
			
		

> A couple of useful Republican ideas are to remove the interstate red tape which restricts insurers and to allow the formation of larger pools composed of individuals and smaller business.  Since you already acknowledged the advantage of expanding risk pools, I don't expect you to try and walk that one back as being useless, no matter how many myriads of contrary opinions you deploy.



It's not "red tape" per se, it is an actual outright prohibition that they propose removing.

In theory, that isn't a bad idea, because expanding risk pools does make sense.  The nature of the market for insurance, however, makes this one much more difficult.  There's actually a number of reasons why, and I have some pretty good reads on them I'll have to go looking for, but some work with Google will show you that this is not really as great an idea as it sounds.  The key points are that regulations and risk assessments are based on community assessments both of risks, and the cost associated with those risks as they vary from state to state (and theoretically, insurers could migrate as well to US jurisdictions with less requirements - perhaps like the Marianas Islands for example - offering "discount" insurance which actually might not cover anything of value.  If consumers had the information to make informed decisions about that, perhaps it'd be okay, but given the collusion that goes on in the insurance market (and the incredible barriers to entry for new competition), information asymetry will remain a huge problem.

I'll see if I can find all the sources I used to debate this a while back and post them.  There was one brilliant paper in particular that was both really detailed and really accessible, I just can't recall who produced it.  In short competition is good, in theory, but it also allows cherrypicking of risk pools by the competitors and creates a massive adverse selection program.  One of my better healthcare economics texts from university explained how this happened and undermined BC/BS in the US in the 1960s fairly thoroughly, the best risks were offered insurance cheaper than the community rating, driving up the risks to the remaining pool and therefore leaving its premiums to soar as well.  The other problem has to do with networks which are critical parts of many insurance plans.  If you buy an out-of-state plan which doesn't put you close to preferred providers you're not necessarily better off.

Further, a big general problem is age-based adverse selection, which is why an individual mandate/universal coverage is important.  Many of the uninsured/underinsured who face risks are younger people for whom it seems rational not to purchase insurance because of price (self insurance seems cheaper) - but these younger, healthier people in the risk pool are what helps keep cost down.  If adverse selection drives them out of the insurance market, then the problem becomes self-reinforcing.  Competing insurance markets can accelerate this problem.  Adverse selection is one of the reasons we mandate car insurance for all drivers, for example.



			
				Brad Sallows said:
			
		

> The biggest problem the US has is that they are 40 to 50 years late joining the party.   The overall level of health care to which most Americans have become accustomed is much more advanced and costly than it was when most countries locked down expectations a few decades ago.  The second biggest problem is that the US already has made publicly funded promises to itself that it can't afford at levels people are willing to pay.  And, when the numbers are crunched, the actual expected efficiency gains are a very small number alongside a very big number; the gap isn't going to simply disappear.  The third biggest problem is that a practical person should expect the costs to be greater than predicted, and the revenues to be smaller.



I agree.

There are massive, massive inefficiencies now in the US healthcare system that aren't easy to tackle but somewhere has to be the start.  I guess the main point I'd make is that instead of looking for the perfect solution all at once, it's far better to look for incremental improvements with a broader vision in mind.  Given the penchant for keeping some semblance of competition, the Swiss or German systems, or even the Dutch system, all of which use multiple providers with fairly strong regulation, might be worth looking at.


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## a_majoor (27 Jan 2011)

As one commenter notes, Obamacare is either a boondoggle and these are the payoffs, or it so badly written that it should be repealed and replaced. Given the amount of back room deals and other secretive goings on required to pass Obamacare, I suspect the answer is closer to "badly written", but you can read upthread and in other places about waivers being granted to prominent supporters of both the bill and the Democrat party which begs the question; if the bill is supposd to be so good, why would supporters be so keen to bail?

Regardless, stage one (repeal) has been taken, now we will see the Congress work to defund, eliminate or dismantle Obamacare a section at a time to bypass roadblocks by the Senate, bureaucracy and the Executive Branch. With more than half the States now mounting legal challenges against Obamacare on the other flank, and unions and corporations asking for waivers to be exempt from Obamacare, it is clear that this bill no longer has any real institutional support, and as noted, it was never supported by the American people either. The bill is finished.

http://thehill.com/blogs/healthwatch/health-reform-implementation/140533-hhs-grants-new-reform-waivers-amid-heightened-scrutiny



> *HHS grants 500 new healthcare waivers*
> By Jason Millman - 01/26/11 04:50 PM ET
> 
> A week after Republicans announced plans to investigate waivers granted to organizations for healthcare reform provisions, President Obama’s health department made public new waivers for more than 500 groups.
> ...


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## Redeye (27 Jan 2011)

Thucydides said:
			
		

> As one commenter notes, Obamacare is either a boondoggle and these are the payoffs, or it so badly written that it should be repealed and replaced. Given the amount of back room deals and other secretive goings on required to pass Obamacare, I suspect the answer is closer to "badly written", but you can read upthread and in other places about waivers being granted to prominent supporters of both the bill and the Democrat party which begs the question; if the bill is supposd to be so good, why would supporters be so keen to bail?
> 
> Regardless, stage one (repeal) has been taken, now we will see the Congress work to defund, eliminate or dismantle Obamacare a section at a time to bypass roadblocks by the Senate, bureaucracy and the Executive Branch. With more than half the States now mounting legal challenges against Obamacare on the other flank, and unions and corporations asking for waivers to be exempt from Obamacare, it is clear that this bill no longer has any real institutional support, and as noted, it was never supported by the American people either. The bill is finished.



I highly doubt that.  A gentleman's wager?


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## Brad Sallows (27 Jan 2011)

If the argument is about how useful something is rather than whether it is net better or worse, then by default it's worth adding to the mix.

>but these younger, healthier people in the risk pool are what helps keep cost down

That basically gets to the nut of it.  This isn't insurance we're talking about; it's a publicly funded entitlement.  And that is the point I think most people sense but don't want to talk about (whether they are for or against it): the PPACA is an awkward if not egregious body of legislation that isn't so much a step toward health care as it is a bold attempt to tip the fiscal scales irreversibly (other entitlements already having pushed things to the edge of disequilibrium) toward higher levels of taxation, spending, and government activity.


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## Redeye (28 Jan 2011)

Brad Sallows said:
			
		

> If the argument is about how useful something is rather than whether it is net better or worse, then by default it's worth adding to the mix.



The thing is - and I didn't have time to try to run down the best most thorough read on it - I'm not actually convinced it's net better - there are arguments that it is actually long term net worse.



			
				Brad Sallows said:
			
		

> That basically gets to the nut of it.  This isn't insurance we're talking about; it's a publicly funded entitlement.  And that is the point I think most people sense but don't want to talk about (whether they are for or against it): the PPACA is an awkward if not egregious body of legislation that isn't so much a step toward health care as it is a bold attempt to tip the fiscal scales irreversibly (other entitlements already having pushed things to the edge of disequilibrium) toward higher levels of taxation, spending, and government activity.



Really?  It's not insurance?  A reform plan that doesn't include any sort of publicly delivered universal care?  Sorry, this is just wrong.  It is in fact completely an insurance system - built around private insurers having some regulatory direction such that every single person can be covered.  Yes, for some it will become an "entitlement" as they will receive subsidies or tax credits to have a comprehensive insurance policy.  It is, however, misleading to suggest this is really new.  The poorest Americans have some access through Medicaid and its variants, and as I outlined, those who aren't covered by Medicaid but still desperately require care still have an "entitlement" which in the end is often paid for by everyone.  So what changes?  Well, earlier interventions and access to the medical system should help raise general levels of health, reduce reliance on more expensive forms of care, and that will ultimately save money (hey, I'm not the only making this claim, the CBO that does far more in-depth research also studied this and found that "Obamacare" will in fact reduce the cost to taxpayers of the healthcare system).

Even Canada's healthcare system - which is, recall, a _a single-payer, universal health insurance system_ - isn't really well described as an "entitlement" (which is, in broad terms, in my opinion a deceptive misnomer to begin with for most programs) - most people with a schmeck of intelligence of course realize that it is paid for out of taxation.

My biggest concern about the method of delivering insurance in the USA is the linking of it to employment - meaning that its spiralling costs is a burden on those employers, and that when one loses a job, they can lose coverage.  There's the "COBRA" system that allows them to carry on, but the costs are such that many cannot afford them, particularly if their transient unemployment becomes less transient than they'd like, which has been the case.  While important extended healthcare benefits here are tied to my employment, I at least know I have my basic needs covered regardless of what may happen to my employment situation.


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## Rifleman62 (31 Jan 2011)

Just announced: the ruling is that the Bill is unconstitutional and the cannot be enforced. 

U.S. District Judge Roger Vinson's ruling will be the biggest judicial decision to come down the pike since groups began filing lawsuits against the bill passed by Congress last March. Twenty-six states are parties to the suit, which claims a mandate to insist Americans purchase a product is unconstitutional.

To the U.S. Court of Appeals,  then probably to the  Supreme Court.


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## Rifleman62 (31 Jan 2011)

http://www.bloomberg.com/news/2011-01-31/obama-health-care-reform-act-unconstitutional-judge-says-in-26-state-suit.html

Link has more. Underline emphasis for Redeye.
*
Obama Health-Care Reform Act Ruled Unconstitutional*

U.S. President Barack Obama lost the second of four court challenges to his health-care law as a federal judge in Florida ruled that the measure went beyond the power of Congress to regulate commerce.

U.S. District Judge Roger Vinson in Pensacola declared the entire law invalid today in a 78-page opinion in a suit brought by 26 states. He said a provision requiring Americans over 18 to obtain insurance coverage violated the U.S Constitution. The U.S. Justice Department said it will appeal.

Florida sued on behalf of 13 states on March 23, the day Obama signed into law the Patient Protection and Affordable Care Act, legislation intended to provide the U.S. with almost universal health-care coverage. Seven states joined the suit last year, and six this year. Virginia sued separately on March 23 and Oklahoma filed its own suit on Jan. 21.

“Regardless of how laudable its attempts may have been to accomplish these goals in passing the act, Congress must operate within the bounds established by the Constitution,” Vinson, 70, wrote. “This case is not about whether the act is wise or unwise legislation. It is about the constitutional role of the federal government.” He declined to issue an order blocking enforcement of the law.

The ruling by Vinson, who was named to the federal bench in 1983 by President Ronald Reagan, a Republican, would be appealed to the U.S. Court of Appeals in Atlanta. An appeals court in Richmond, Virginia, is already slated in May to hear challenges to two conflicting lower-court rulings in that state, one upholding the legislation, the other invalidating part of it.


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## Redeye (31 Jan 2011)

And the point of the emphasis was?

Great, it's off to the Supreme Court.  We'll see what happens there.  Though, given their record (like Citizens United) and what seems to be a disturbing lack of actual judicial independence, I'll really have to watch and see what happens.

All I can say is I'm very, very glad my wife moved from the US to Canada, and not the other way around.



			
				Rifleman62 said:
			
		

> http://www.bloomberg.com/news/2011-01-31/obama-health-care-reform-act-unconstitutional-judge-says-in-26-state-suit.html
> 
> Link has more. Underline emphasis for Redeye.
> *
> ...


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## Rifleman62 (1 Feb 2011)

Point: Republican appointed Judge.


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## a_majoor (1 Feb 2011)

A legal analysis of the ruling. I suppose very convoluted arguments can be raised against the ruling, but the essential argument against Obamacare is quite elegant and hard to refute:

http://www.professorbainbridge.com/professorbainbridgecom/2011/01/obamacare-hoisted-on-obamas-petard.html



> *Obamacare hoisted on Obama's petard*
> 
> From the Washington Times:
> 
> ...


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## a_majoor (4 Feb 2011)

Parliamentry moves to repeal Obamacare. The interesting question for us should be what provisions of Canada's health care act and various Provincial acts are the "worst" in terms of stifling supply, restricting access or otherwise raising costs and waiting times. Perhaps a similar approach to jettisoning the most dysfunctional parts of Canadian legislative and regulatory apparatus could provide incrimental improvements to patient care and roll back the huge costs that are crippling government (healthcare spending in Ontario will soon reach 50% of the budget).:

http://online.wsj.com/article/SB10001424052748703652104576122520508633078.html?mod=WSJ_newsreel_opini



> *ObamaCare's Repeal Has Begun*
> This week's Senate vote to scrap an IRS reporting requirement is the start of a piece by piece approach.
> By KIMBERLEY A. STRASSEL
> 
> ...


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## Brad Sallows (5 Feb 2011)

>It's not insurance?

Insurers will just be middlemen.  Once everyone above certain means is forced to pay in (either by paying for their own, or paying a penalty), it shouldn't take long for the arguments to remove the middlemen to prevail - unless they are preserved due to misguided corporate welfare policies.  I understand that the mechanism is and may continue to be "insurance".  I understand also that people without insurance are able to get care, but status quo ante has the overwhelming majority of people either paying for their own insurance or paying their own care costs directly without any legal compulsion to do either.

>(hey, I'm not the only making this claim, the CBO that does far more in-depth research also studied this and found that "Obamacare" will in fact reduce the cost to taxpayers of the healthcare system).

I'd like to see the numbers.  I'm aware that overall the US deficit position is supposed to improve, but that happens by definition whenever a spending program includes a mandate to increase takings by a greater amount - which can be done with any public spending program, with no complexity at all.  If you mean that literally the dollar cost of public spending by the federal government on healthcare is going to decrease, those are the numbers with which I'm unfamiliar.

Why is "entitlement" a misnomer?  It just means people have a civil right to make claims against the program.  As far as I can tell, all entitlements provided by government are essentially paid for out of taxation.

I agree that the US system has problems with portability of insurance.


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## Redeye (7 Feb 2011)

Brad Sallows said:
			
		

> Insurers will just be middlemen.  Once everyone above certain means is forced to pay in (either by paying for their own, or paying a penalty), it shouldn't take long for the arguments to remove the middlemen to prevail - unless they are preserved due to misguided corporate welfare policies.  I understand that the mechanism is and may continue to be "insurance".  I understand also that people without insurance are able to get care, but status quo ante has the overwhelming majority of people either paying for their own insurance or paying their own care costs directly without any legal compulsion to do either.
> 
> 
> 
> ...


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## BrianHarris (7 Feb 2011)

At present, we almost have a two-tier healthcare system. My doctor accomodates patients who are on the waiting list only he they can pay him out of their pockets. And he has lots of clients who pay him either cash or private health care benefits. We have private health insurance companies exisiting side by side with universal health care. They even charge the government 33% for the patients' disability benefits excluding the drug plan. There is some sort of confusion and this is due to ignorance..We now have a perfect system.


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## Redeye (7 Feb 2011)

BrianHarris said:
			
		

> At present, we almost have a two-tier healthcare system. My doctor accomodates patients who are on the waiting list only he they can pay him out of their pockets. And he has lots of clients who pay him either cash or private health care benefits. We have private health insurance companies exisiting side by side with universal health care. They even charge the government 33% for the patients' disability benefits excluding the drug plan. There is some sort of confusion and this is due to ignorance..We now have a perfect system.



Okay... so what your doctor is doing is illegal, I'm 99% sure.  There's been much debate about this with the Cambie Clinic in BC.  Private health insurance companies sell extended benefits - that is, things that are not covered by the basic universal health care system.  That has always been the way it was intended to work.


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## Scott (7 Feb 2011)

"Brian Harris" has been banned. He had his say, we had our fun, now it's time to move on.

No need for responses to his tripe.

Staff


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## a_majoor (12 May 2011)

The model for Obamacare is failing in a most dramatic fashion. given Healthcare threatens to consume 50% of Ontario's budget, and other provinces in the near to mid future, perhaps we need to look at this as well and see how costs can be constrained or if the model is even vialbe anymore:

http://pajamasmedia.com/blog/massachusetts-the-canary-in-the-coal-mine-for-obamacare/?print=1



> *Massachusetts: The Canary in the Coal Mine for ObamaCare*
> Posted By Paul Hsieh On May 12, 2011 @ 12:12 am In Uncategorized | 14 Comments
> 
> Five years ago, Massachusetts adopted its “universal health care” plan, which served as the template for President Obama’s subsequent national health care legislation. However, Massachusetts’ problems of rising health costs and worsening access foreshadow similar problems for the rest of America — as well as how to avoid them.
> ...


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## mariomike (24 Jun 2011)

A new American film on the subject of health care.

Everyone in EMS knows the seriousness of hospital overcrowding and diversion, but the public may be unaware that there is a problem in their own backyards.
In July, "Firestorm" will have its premiere on the Documentary Channel. 

"Firestorm" trailer:
http://www.firestormmovie.com/index.html

"This is the canary in the mine of healthcare throughout the United States. The system is broken, and it's not a have versus have not problem anymore."

"The nation's nearly 4,000 hospital emergency departments are a portal for as many as three out of four uninsured patients admitted to U.S. hospitals.
    Approximately 500,000 ambulances are diverted (turned away by an overcrowded hospital) annually in the United States. This is about one ambulance diversion per minute.
    Fire departments nationwide went on about 15.8 million medical calls in 2008, up from about 5 million in 1980, a 213% increase.
    50 years ago, half of the nation's doctors practiced primary care. Today, almost 70% of doctors work in higher paid specialities; it's estimated that in 10 years, the shortage of family doctors will reach 40,000.
     In 38 states, health insurance companies can deny coverage because of a pre-existing condition, and nearly 4 out of 10 Americans has at least one chronic medical condition.
    Every year, the deaths of at least 22,000 people can be attributed to a lack of health insurance. This makes uninsurance the sixth leading cause of death, ahead of HIV/AIDS and diabetes.
    Between 2000 and 2007, the average premium for job-based family coverage increased by more than 90%, rising from $6,351 to $12,106.
    More than 3 out of 5 adults who report having problems paying their medical bills had insurance.
    78% of those with private insurance and medical debt work full-time.
    Medical bills are involved in more than 60% of U.S. Bankruptcies, an increase of 50% in just six years, and more than 75% of these bankrupt families had health insurance but still were overwhelmed by their medical debts.
    In the past 10 years, 90% of medical school graduates have entered higher-paid sub-specialities, while only 10% have chosen primary care.
    The amount of uncompensated care provided by hospitals has increased by $14.8 billion in eight years, from $21.6 billion in 2000 to $36.4 billion in 2008."

"So much of this could be alleviated if people had ongoing access to primary care. That was a resonant theme: So many people need to be able to go to a doctor, and if they can't, they end up in the emergency room. They end up calling 9-1-1 for pretty much everything, because they don't know where else to go."


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## mariomike (26 Jun 2011)

Reply to add to the above. 

"The legal duty of physicians and hospitals to provide emergency care":
http://www.cmaj.ca/cgi/content/full/166/4/465

2002:
"The family has recently commenced legal actions against the Government of Ontario alleging negligence, breach of contract and breach of fiduciary duty, and against the ambulance service and the hospital that was on critical care bypass alleging negligence and breach of contract."

"Critical care bypass: coming full circle: A tragedy in Toronto early this year became the flash point for a health care system in crisis. On Friday, Jan. 14, 2000, the emergency department (ED) medical director at the Markham Stouffville Hospital, Dr. Anne Clarke, called to inform me about a teenaged boy with asthma who was on life support after a severe asthmatic attack early that morning. Because the nearest Toronto hospital had been on critical care bypass, the boy's ambulance transport time was 18 minutes -- 15 minutes longer than it would have taken to reach the closer facility.":
http://www.cjem-online.ca/v2/n3/p212

"Critical care bypass, a state previously utilized only under the most extraordinary conditions, became commonplace. It was unclear to EMS whether hospitals on CCB were truly unable to resuscitate patients brought to their door, whether CCB status reflected overflowing critical care units, or merely that it indicated staff frustration."


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## Brad Sallows (26 Jun 2011)

If we're committed to 6% annual growth in expenditures in an economy which does not grow at the same rate, then in a short while we're f*cked.  That is the way things are.  And the response from the centre and leftward parts of the political spectrum is to ignore that disparity and try to think of new excuses to cut ribbons (program spending); if asked whether any other spending could be cut to make up the difference the response is inevitably "oh no, not that one".  In my view, they have abdicated their responsibility to their own signature/keystone program and do not merit serious consideration for the reins of government.


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## mariomike (28 Jun 2011)

June 27, 2011
Time Magazine:  
"How ER Crowding Kills"
By Dr. Jesse M. Pines and Dr. Zachary F. Meisel
http://www.time.com/time/health/article/0,8599,2079935,00.html
"This number is expected to increase further when health reform is implemented and more than 30 million Americans get health insurance. And the supply of ERs is shrinking. Over the past 20 years, more than a quarter of the ERs in the U.S. have permanently closed."

Same story of lawsuits in the U.S.A.:
"If you or a loved one was injured or died due to a delay in care because of emergency room overcrowding or ambulance diversion, you need to contact a law firm that has the experience in investigating all the possible reasons on why there was a delay in diagnosing or treating you or a loved one.":
http://www.beasleyfirm.com/blog/medical-malpractice/an-ambulance-ride-can-kill-you-especially-if-the-ambulance-was-diverted-away-from-an-overcrowded-emergency-room/

Meanwhile in Ontario this month, "Ontario NDP Leader Andrea Horwath says she will eliminate the $45 ambulance fee if her party is elected to power in October.":
http://www.cbc.ca/news/canada/toronto/story/2011/06/15/ambulance-ndp-fee-promise.html

That - combined with the shortage of family doctors* - would put even more pressure on the health care system in Ontario. Toronto EMS** alone is now processing a call for help almost at an average of every 60 seconds, 24 hours a day ( 425,700 per year and rising ). 

*June 27, 2011 
"Aging baby boomers and more chronic illnesses are at the centre ( sic ) of the problem.
It's the second national report in the space of a week warning that chronic illness is pushing Canada's health care system to the brink.":
http://chch.com/index.php/home/item/4255-doctor-shortage-in-canada

** "The 'Baby Boom' generation is aging. As it does so, all of those 'boomers' become net consumers of health care, driving up demand for services. Simultaneously, all of those 'boomers' employed by the service in the early 1970s are reaching the end of their careers and retiring. Since subsequent generations are typically much smaller, the service is experiencing difficulty in recruiting suitably trained replacement staff, just as demand for services is increasing.":
http://en.wikipedia.org/wiki/Toronto_EMS#Challenges

From what I remember, at a local level, this emergency health-care storm has been a long time coming. It has been studied by various experts.
Emergency Room overcrowding and ambulance Off-Load Delay OLD:
"Multiple stakeholders and various levels of government are currently seeking solutions to this problem, but have, so far, experienced only limited success."


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## a_majoor (28 Jun 2011)

The real issue is that there are no alternative solutions being offered. Increasing funding is not the answer, Canadian health care has been receiving billions of dollars without improvement (indeed you could say there is a perverse incentive not to improve service, since ever more funding is being diverted towards the health care system because it is bad). Since health care promises to crowd out all other spending in the near future, throwing more money at the problem is not the answer.

Market forces do work, and switching health care back to consumer pay will force consumers to choose health care options that are of the lowest cost/highest benefit ratio to them. I particularly like the idea of registered health care savings plans, where the consumer keeps the monies not spent on health care (which can then be used at a future date for health care. Over time, an astute person can save a considerable sum for their old age health care needs). Catastrophic health care insurance for unforeseen events (car accidents, being hit by a bus) and long term care insurance for chronic illness  are the other legs of the plan, and charity and government support as last resorts complete the picture.


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## FoverF (29 Jun 2011)

nm


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## FoverF (29 Jun 2011)

Market forces _can_ work.

I am in Ireland at the moment. Where economic theories go to die. 

And it is painfully clear that market forces only work if everyone plays along. 

One of the crucial problems with health care spending is that medicine is one of the few professions where incompetence is frequently rewarded. Wrong diagnoses, incorrect and unnecessary medications, unneeded investigations, more visits, all of these things are more profitable than doing your job correctly. Inefficiency isn't going to be rooted out by competitors, the competition will be to see who can charge for the most scans, the most drugs, the most interventions. And just  like women can routinely expect to be charged more than men by auto mechanics, medical customers in private clinics can expect to get 'the best possible care', because they are generally not knowledgeable enough to realize they're being ripped off. The financial incentive for health care providers in a private system is to be less efficient. 

I think that the only way to control costs in MOST (but not all) of health services is to have them government regulated. You have to de-incentivise spending money. A fee-for-service system will never do this.  

In some cases, where services are reasonably uniform, there may be room for competition. For example, the private radiology clinics, because an out-patient knee MRI is going to be more or less the same procedure every time. Anything that's fairly routine and done in large volume on an outpatient basis can reasonably fall into this category (dentistry being another reasonable example).

At the moment, I work in a two-tiered healthcare system, and it is a complete failure, which has done nothing but drive up costs to the public, and create gross inefficiency. The public money simply subsidizes the consultant physicians' private work, which is done at a greater cost than the same physician's public work (that's why they do private work, after all, to get more money). It is shockingly corrupt, administrative costs are through the roof, and the desire here is to move to an all-public health care system more or less analogous to the Canadian model. 

I think the biggest failing of the Canadian health care system is not the service delivery model, or the source of payments, or the amount of money being spent. It is simply poor management and administration, by the armies of people who are administering the system. This starts pretty much at the top of the totem pole at the ministerial level. 

Given the level of administrative competence shown in Canadian health care, I think attempting to implement a two-tiered system would be catastrophic. We would be much better served by firing 50% of the people with the word "health" in their job title.


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## a_majoor (29 Jun 2011)

But why are people poorly managing the system? Because they are paid to do so and not held to account.

The "everyone plays along" model is nonsense; if it was true then the costs of everything from bread to diamonds would be totally incalculable, but this is clearly not the case in any market, from commodities to professional services. Ask yourself about how accountants, plumbers or RMT's charge for their services?

I strongly suspect that many of the perverse mechanisms that drive up costs and drive down quality that you cite in Ireland are similar to the NHS model in the UK, where private care providers can "dump" their problems onto the government funded service and are not penalized for doing so (indeed the incentive is greater, since they no longer incur expenses but pass them on to the taxpayer). A fully private system does not have these perverse incentives. What is needed is a system which minimizes perverse incentives (any system can be gamed), while providing maximum accountability to the consumer.


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## FoverF (30 Jun 2011)

Thucydides said:
			
		

> But why are people poorly managing the system? Because they are paid to do so and not held to account.


Agreed 100%. Which is why I think THIS is where the least change csan do the most good. 



> The "everyone plays along" model is nonsense; if it was true then the costs of everything from bread to diamonds would be totally incalculable, but this is clearly not the case in any market, from commodities to professional services. Ask yourself about how accountants, plumbers or RMT's charge for their services?



Before I submitted this post, I had a string of example of exactly this kind of market failure. We all see them every day. But it was too long. So instead, the example I'll use is the elephant in the room, the fully privatized system running just south of the border. If privatization is the key to lowering costs, why is the poster child of private health care never the less the most expensive system in the world? You can make all kinds of arguments in favour of a private system, don't get me wrong, but it seems pretty clear to me that lower costs is not one of them. The test case is even more expensive than what we have now. 




> I strongly suspect that many of the perverse mechanisms that drive up costs and drive down quality that you cite in Ireland are similar to the NHS model in the UK, where private care providers can "dump" their problems onto the government funded service and are not penalized for doing so (indeed the incentive is greater, since they no longer incur expenses but pass them on to the taxpayer).



Sometimes it's the opposite. There are basket-case patients who have a medical history at tall as you are, and these patients are guaranteed to spend a small fortune in health care costs before they die. 80% of medical costs are incurred in the last 3 months of life. If you can admit a patient to your private hospital 3 months before they die, you will see 80% of the health care dollars that will ever be spent on that person. 




> A fully private system does not have these perverse incentives.



But it does, that's my whole point. They are incentivized to do something for the sake of doing something, because they get paid whether it was beneficial or not. Pretty much every Canadian kid I know between the ages of about 5 and 25 has been told at some point in their life that they need braces on their teeth. Because if you tell every kid they need braces, some of them are going to pay you to get braces. And it doesn't matter that competitors are driving the price of braces down, the braces themselves are a completely superfluous cost for which you are being rewarded. 

Walk into a hospital in the USA without getting a CT  scan. Go ahead and try. You will get CT'd. And you will get billed for it.



> What is needed is a system which minimizes perverse incentives (any system can be gamed), while providing maximum accountability to the consumer.



This is definitely true, I agree 100%. But the devil is in more that the details here. In private health care practice, the method of accountability is legal litigation. Which is another factor that directly contributes to high costs in a private system. The biggest problem, however, is that the wrong doctors get sued. It's a complete crapshoot. Good doctors get sued for stupid reasons by patients who are angry at their illness, and bad doctors don't get sued because the patients don't know enough to realize that they've been horribly mismanaged. You get all of the costs of a system that should promote accountability, but without the benefit of incompetent doctors being held accountable. 

I think the closest-to-ideal system is a fully public system, funded exclusively by the taxpayer, which is well managed and administered. The management and administration part is what we're missing in Canada, and I think we would be best served by attacking that problem, rather than rebooting the whole method of health care delivery. 

This is, of course, ignoring all the ethical issues surrounding the problem ("I don't want to pay for fat people's bypasses", and "I don't want to die because the government won't let me spend my own money on a better drug") which muddy the waters a bit. I'm basing this purely on my opinion of what would provide best value for dollar towards maintaining a healthy population. It also happens to be that I think it is the most ethically preferable as well, but that is a whole different discussion.


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## Redeye (30 Jun 2011)

Thucydides said:
			
		

> What is needed is a system which minimizes perverse incentives (any system can be gamed), while providing maximum accountability to the consumer.



Disregarding everything else said here, in what way does a fully privatized system provide accountability to the consumer.  Private sector actors are accountable to their shareholders, not to their customers.

While we're happy to beast the adminstration of our healthcare system, it seems to be nowhere near as bad as the American system (their overhead and administration costs are orders of magnitude higher).  Can we do better?  Probably, yes.  But by looking south as a model for anything?  No.


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## a_majoor (30 Jun 2011)

Medicare, Medicaide and the "Part D" drug plan are federal intervention in the medical system. Federal tax law also impacts the provision of employee health care plans and benefits.  Federal and state regulations impact the insurance industry; particularly the prevention of sale of insurance policies "cross border"; limiting the ability of the consumer to shop for better policies. Obamacare imposes massive new regulatory burdens on the system.

The American system is in no way "private".....


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## Edward Campbell (30 Jun 2011)

I'm afraid that both the _macro_ (privatize or _communize_ everything) and _micro_ views (picking the fly shit out of the pepper of each system) leads us into futile discourses.

I think we can all agree that:

1. The current Canadian model is inefficient and ineffective - it costs too much and will, soon, crowd more productive spending (education, R&D, infrastructure) out of provincial budgets;

2. The US model - which is anything but _private_, having HUGE public components in Medicare and Medicaid - is, if anything,l worse; and

3. So are some, (most?) European models?

But maybe that thought is only the triumph of hope over experience.

We need a system that produces:

1. Better health outcomes - meaning we life longer, 'better' lives while needing less medical care;

2. Better medical outcomes - almost all _medically *necessary*_ services are provided to almost all Canadians in a timely manner; and

3. Lower costs for both health and medical care - as a percentage of GDP.

My guess is that such a system needs a mix of:

1. Funding sources, including taxes, public and private insurance and medical savings accounts; and 

2. Treatment options, including government owned and operated and privately owned and operated facilities (clinics, hospitals, etc), the former being available to all, but care being rationed - as it *must* be, always, in a public system - and the latter being available to all who can pay, from whatever sources, including their public insurance.

The system also needs less and less political and bureaucratic control - especially from that most useless form of (sub) human life: the health care _advocate_.


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## Infanteer (30 Jun 2011)

As usual, I think Edward is on the money.

Point 1 - Yes

Point 2 - Yes

Point 3 - Yes

The American and Canadian systems of coverage are so similar in form and it is only the ideological crowd that blurs the issue.  You have a huge bureacracy, either an HMO or a goverment-run HMO (provinical health ministries) making all the decisions and citizens just showing cards at hospitals.  Something to take away the negative incentives of this setup while promoting the positive incentives of a citizen managing their own health care dollars is, to me, a workable solution.  From my own readings, I find Medical Savings Accounts in a fully-publically funded, privately delivered system to be a pretty good setup.  The writings of Dr David Gratzer, a Canadian critic of our system, are pretty damn good:

http://www.amazon.ca/Code-Blue-Dr-David-Gratzer/dp/1550223933/ref=sr_1_8?ie=UTF8&qid=1309446619&sr=8-8

http://www.amazon.ca/Better-Medicine-Reforming-Canadian-Health/dp/1550225057/ref=sr_1_9?ie=UTF8&qid=1309446619&sr=8-9


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## mariomike (30 Jun 2011)

"Suck it up, America:
We have become a nation of whining hypochondriacs, and the only way to fix a broken health-care system is for all of us to get a grip":
http://www.post-gazette.com/pg/09284/1004304-109.stm#ixzz0px12ePbN

"It's obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not health-care reform. It's only health-care insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why."

"In a single night I had patients come in to our emergency department, most brought by ambulance, for the following complaints: I smoked marijuana and got dizzy; I got stung by a bee and it hurts; I got drunk and have a hangover; I sat out in the sun and got sunburn; I ate Mexican food and threw up; I picked my nose and it bled, but now it stopped; I just had sex and want to know if I'm pregnant."

It's funny, cuz it's true.


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## Redeye (30 Jun 2011)

Thucydides said:
			
		

> Federal and state regulations impact the insurance industry; particularly the prevention of sale of insurance policies "cross border"; limiting the ability of the consumer to shop for better policies.



There are a fairly good number of studies that explain in detail why "cross-border" insurance sales are a complete non-issue, though the right frequently trundles this canard out.  Insurance pricing and care delivery are innately tied to the particular markets, and to provider networks established therein.  While there's little scope for substantial improvement there, the potential impacts are significant - first - a race to the bottom with providers constantly undercutting each other for less and less quality policies, generally operating in the most permissive jurisdiction possible, or a cherrypicking effect that undercut the community rating systems used in the USA before about the 1960s, where companies sought to poach the best risks from BC/BS pools, causing the medical loss factor in those pools to increase and driving premiums up to the point they have a problem now.


Mr. Campell's post is generally good but I'd highlight that medical services - like any other scarce good or service are _*ALWAYS*_ rationed, regardless of the form of delivery.  This is a term that has been introduced in the colloquial sense as a sort of wedge to steer debate into corners.


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## Edward Campbell (30 Jun 2011)

Redeye said:
			
		

> ... I'd highlight that medical services - like any other scarce good or service are _*ALWAYS*_ rationed, regardless of the form of delivery.  This is a term that has been introduced in the colloquial sense as a sort of wedge to steer debate into corners.




I agree that price is a form of rationing - "no gold card, no medical care" is just as effective as "no ration card, no meat this week." But I think that rationing by bureaucratic fiat is of a different order that rationing by price.


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## a_majoor (30 Jun 2011)

Preventing consumers from being able to access all available markets drives up costs, since the amount of competition is artificially limited. In the case of insurance, the advent of on line quotes and price comparison dropped my car, house and medical insurance premium costs because I was able to find who would provide the service (coverage) I desired at the lowest cost. Wal-Mar does the same in the physical world by providing consumers with a wide array of consumer goods at low costs, which causes competators to either try to match prices or migrate to niches where they don't face competition, saving consumers huge amounts of money. (For another example of niche marketing, look at how Starbucks is different from Tim Horton's).

Since Americans cannot buy health care coverage from a company located outside their state, they cannot quote shop and buy the coverage at the cost they want if no company in their State does not offer this. Since every State has this restriction (so far as I know), all American consumers are limited in this reguard. Imagine if you were physically prevented from buying coffee from a Tim Horton's on the other side of the city limits; would the coffee shops in town have any incentive to lower prices or raise service to draw your business away from the unavailable Tim's?

Really, trying to claim the principles of Economic's 101 (most of which were discovered by Adam Smith in the 1700's and David Ricardo in the 1800's) somehow don't apply to health care even though they apply in every other single human enterprise is totally disingenious and prevents the discovery and application of real reform in this area.


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## Redeye (30 Jun 2011)

Thucydides said:
			
		

> Preventing consumers from being able to access all available markets drives up costs, since the amount of competition is artificially limited. In the case of insurance, the advent of on line quotes and price comparison dropped my car, house and medical insurance premium costs because I was able to find who would provide the service (coverage) I desired at the lowest cost. Wal-Mar does the same in the physical world by providing consumers with a wide array of consumer goods at low costs, which causes competators to either try to match prices or migrate to niches where they don't face competition, saving consumers huge amounts of money. (For another example of niche marketing, look at how Starbucks is different from Tim Horton's).



Unfortunately, the market for health insurance isn't at all like the market for widgets (consumer goods of any description).



			
				Thucydides said:
			
		

> Since Americans cannot buy health care coverage from a company located outside their state, they cannot quote shop and buy the coverage at the cost they want if no company in their State does not offer this. Since every State has this restriction (so far as I know), all American consumers are limited in this reguard. Imagine if you were physically prevented from buying coffee from a Tim Horton's on the other side of the city limits; would the coffee shops in town have any incentive to lower prices or raise service to draw your business away from the unavailable Tim's?



A complete inept comparison, to say the least.  Why would I go across town (at some cost) for a coffee?  The cost and hassle of doing so wouldn't really justify the supposed savings, just as would be the case in such an insurance market  If I lived in, let's say, Maine, what good would an insurance policy from Mississippi be to me if its network providers are all in Mississippi.  Why would underwriters apply their cost estimates and pricing models for a Mississippian to me in Maine if there was a difference?  Even if such regulations were removed, it would do little to solve the problem, and could mean that people wound up with even worse insurance policies than before.



			
				Thucydides said:
			
		

> Really, trying to claim the principles of Economic's 101 (most of which were discovered by Adam Smith in the 1700's and David Ricardo in the 1800's) somehow don't apply to health care even though they apply in every other single human enterprise is totally disingenious and prevents the discovery and application of real reform in this area.



Actually, any economist who works in the field of healthcare economics - or anything to do with insurance really - will tell you the opposite.  That's why it's a distinct field in economics, and one that fascinated me when I was a student.  Insurance markets have a number of complexities to them which make them nothing like a market for a regular good - specifically the fact that the cost of providing the service is not clear at the time of purchase.  Tim Hortons has a pretty good model for its costs, an insurer doesn't really, they have to develop much more specialized models, and then, as private insurers are apt to do in the US, find as many ways as possible to get out of paying on claims, including retroactively rescinding policies.  There's also the two most common problems of insurance markets, moral hazard & adverse selection, which don't exist in goods markets and play havoc with pricing and equilibria.


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## Brad Sallows (30 Jun 2011)

And I've never heard of a government agency trying to weasel out of paying compensation for something either.  True story.


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## toyotatundra (1 Jul 2011)

http://www.calgaryherald.com/business/Canada%2Bhealth%2Bspending%2Bamong%2Bworld%2Bleaders/5034376/story.html



> Canada's health-care spending as a percentage of the nation's wealth stabilized in 2010, though spending remains among the highest for western industrialized countries, according to statistics released here Thursday.
> 
> The Organization for Economic Co-operation and Development (OECD) said spending as a percentage of gross domestic product fell slightly to 11.3 per cent, down from 11.4 per cent in 2009.
> 
> ...



Free health care isn't proving very cheap.


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## Redeye (6 Jul 2011)

toyotatundra said:
			
		

> http://www.calgaryherald.com/business/Canada%2Bhealth%2Bspending%2Bamong%2Bworld%2Bleaders/5034376/story.html
> 
> Free health care isn't proving very cheap.



Well, no one really ever claimed it was free.  It is one of the most expensive universal systems around though, and that's something that certainly makes it worth discussing improvements.


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## Redeye (6 Jul 2011)

Brad Sallows said:
			
		

> And I've never heard of a government agency trying to weasel out of paying compensation for something either.  True story.



Of course.

But at the same time, I've never worried that an army of claims investigators would tear through my records to find a way to rescind my insurance, for example.


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## muskrat89 (9 Jul 2011)

> But at the same time, I've never worried that an army of claims investigators would tear through my records to find a way to rescind my insurance, for example.



And you call the right alarmist..

I have worked in the United States for over 15 years, in 2 states and have had probably at least a dozen different insurance companies. That has never happened to me, or anyone I know.


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## Redeye (9 Jul 2011)

muskrat89 said:
			
		

> And you call the right alarmist..
> 
> I have worked in the United States for over 15 years, in 2 states and have had probably at least a dozen different insurance companies. That has never happened to me, or anyone I know.



There are numerous documented cases of rescissions, including cases where rescissions have caused the death of people who could not afford medical care they needed to survive.  There's plenty of stories out there of people dying while insurance companies deliberated on whether to pay for surgeries.  Is that exclusive to the USA? Probably not.  However, only there is it basically an institutionalized process.  Just because it's never happened to you or anyone you know (which is a tiny proportion of the population) doesn't mean it's never happened.


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## Edward Campbell (9 Jul 2011)

Redeye said:
			
		

> There are numerous documented cases of rescissions, including cases where rescissions have caused the death of people who could not afford medical care they needed to survive.  There's plenty of stories out there of people dying while insurance companies deliberated on whether to pay for surgeries.  Is that exclusive to the USA? Probably not.  However, only there is it basically an institutionalized process.  Just because it's never happened to you or anyone you know (which is a tiny proportion of the population) doesn't mean it's never happened.




Whereas here, in Canada, some bureaucrats decide that "we" cannot afford this, that or the other treatment so many ill people must travel to the USA to buy the drugs and/or treatments they need to save their lives or, at least, make their lives worth living.

Don't get me wrong: I believe we should all be insured for "medically necessary" treatments, only, but I reject the notion that a bureaucrat, without an MD, or a minister, also without an MD, can make a decision about anything being or not being "medically necessary." They can decide that it's unaffordable but then they need to come out and say so - they need to stop hiding behind the medical community's skirts and admit to Canadians that we cannot provide anything like the standards of care found in e.g. France or Sweden, even though we spend a greater percentage of GDP on health care than they do.

It is the dishonesty which infects about 95% of the health care 'establishment' that sickens me - that and the stupidity that infects about 90% of the general public.

Our Canada Health Act has created a monster that costs way too much and does far too little. It is time to:

1. Repeal the Canada Health Act - and don;t bother replacing it with anything;

2. Reduce federal transfer payments for health care back to the bare minimum required (Constitutionally) under the equalization formula; and, thereby

3. Force the provinces to redesign their medical insurance systems, top to bottom and make them efficient and effective. That will, I am 100% certain, require a mix of private and public insurance schemes, as are found in almost all of the many successful (better outcomes/lower costs) systems in e.g. Europe and Asia - two (actually multi) tiered health care, gold card health care and so on. So sad, too bad, it's time we all grew up and learned to live in the real world.


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## muskrat89 (9 Jul 2011)

> Just because it's never happened to you or anyone you know (which is a tiny proportion of the population) doesn't mean it's never happened.



And just because there are "numerous cases" doesn't mean it's reasonable to worry that "an army of claims investigators would tear through my records to find a way to rescind my insurance, for example."

There are numerous documented cases of hurricane deaths too. That doesn't mean it's a routine occurance.


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## Redeye (9 Jul 2011)

muskrat89 said:
			
		

> And just because there are "numerous cases" doesn't mean it's reasonable to worry that "an army of claims investigators would tear through my records to find a way to rescind my insurance, for example."
> 
> There are numerous documented cases of hurricane deaths too. That doesn't mean it's a routine occurance.



Hurricanes are natural occurrences.  Medical losses and claims investigators are how the insurance injury works.  Paying out any benefits cuts into their profits, and any way they can reasonably find to reduce the amount they have to pay, they will avail themselves of.  That's the problem - the interests of insurers are necessarily, diametrically opposed to those of consumers.


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## Edward Campbell (9 Jul 2011)

The fear mongering about American medical care, which is just about the only system in the OECD with higher costs and worse outcomes than ours, doesn't help anything. No one in their right mind is suggesting that Canada adopt the US model: we need to look at some European and some Asian countries for guidance. But first we have to understand that the Canadian, single payer, medical 'insurance' system is senseless.


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## Redeye (9 Jul 2011)

E.R. Campbell said:
			
		

> The fear mongering about American medical care, which is just about the only system in the OECD with higher costs and worse outcomes than ours, doesn't help anything. No one in their right mind is suggesting that Canada adopt the US model: we need to look at some European and some Asian countries for guidance. But first we have to understand that the Canadian, single payer, medical 'insurance' system is senseless.



Absolutely - no one in their right mind would look to the American system as a model for anything - but there are a number of European systems which could provide us with insight.  It is precisely this opportunity to look to other systems to build a new system that the Americans seem intent on squandering.


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## toyotatundra (9 Jul 2011)

Right wing, left wing. Doesn't matter. Health care is never going to be cheap in Canada, as long as we're a Timbits Nation.


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## toyotatundra (9 Jul 2011)

Another defeat for Trudeaupia?



> An illegal immigrant has no right to free medical intervention or ongoing health care under the Charter of Rights, the Federal Court of Appeal has ruled in a precedent-setting decision.
> 
> The ruling will help protect Canada from medical tourism, when people come to Canada expressly to get medical treatment paid for by the government, an immigration specialist said.



http://news.nationalpost.com/2011/07/08/illegal-immigrants-have-no-right-to-free-health-care-court/


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## muskrat89 (9 Jul 2011)

> Hurricanes are natural occurrences.  Medical losses and claims investigators are how the insurance injury works.  Paying out any benefits cuts into their profits, and any way they can reasonably find to reduce the amount they have to pay, they will avail themselves of.  That's the problem - the interests of insurers are necessarily, diametrically opposed to those of consumers.



My point was (and I'm sure you know it) that you were making it out like the rule, rather than the exception. A common occurrence. Regardless of the sampling size, my real-life experience, almost two decases' worth - and of every person I know or work with - doesn't demonstrate your assertion to be true.

Anyway, I'm done with you. Back on "Ignore".


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## Redeye (11 Jul 2011)

muskrat89 said:
			
		

> My point was (and I'm sure you know it) that you were making it out like the rule, rather than the exception. A common occurrence. Regardless of the sampling size, my real-life experience, almost two decases' worth - and of every person I know or work with - doesn't demonstrate your assertion to be true.
> 
> Anyway, I'm done with you. Back on "Ignore".



Never did I assert it to be universally true - for routine claims in most casees there's no issue - and realistically only a small percentage of a population will find themselves in a catastrophic health case.  So when it happens rarely, but would only apply to rare cases to begin with it's worth looking at - and there's a rational economic argument as to why it's done.

My wife grew up in the US - and remains in contact with most of her friends there, including a couple who've battled serious health issues which have led them into struggles with their insurers to get things covered.  From that I can't say it happens to everyone, but similarly, I can't say it happens to no one.


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## a_majoor (12 Jul 2011)

There are indeed things insurance companies won't cover. Considerr:

http://washingtonexaminer.com/politics/2011/07/fresh-doubt-cast-obamas-health-care-story



> *Fresh doubt cast on Obama's health care story*
> Read more at the Washington Examiner: http://washingtonexaminer.com/politics/2011/07/fresh-doubt-cast-obamas-health-care-story#ixzz1Ru2ZbW7r
> By: Byron York | Chief Political Correspondent Follow Him @ByronYork | 07/11/11 8:05 PM
> 
> ...


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## muskrat89 (13 Jul 2011)

> including a couple who've battled serious health issues which have led them into struggles with their insurers to get things covered



My wife is a quadriplegic with SMA. My daughter was a preemie and for a time they thought she had megalencephaly so she was tested extensively for the first few years of her life. (She's fine). Not trying to out-do your friends, just saying that in my own micro-sampling of the healthcare system, over the past decade and a half with several different insurance companies - there have been plenty of opportunities for us to get jerked around and it hasn't happened. Nor has it happened to anyone I know personally.


----------



## toyotatundra (13 Jul 2011)

We need to be careful about pretending that Canada and the U.S. represent examples of the public versus the private model. Canadian health care has a lot of capitalism in it. And American health care has a lot of socialism in it. Neither is pure. Either system could have its faults ascribed to the capitalistic influences, or to the socialistic influences.


----------



## cupper (30 Jul 2011)

toyotatundra said:
			
		

> And American health care has a lot of socialism in it.



Please explain to me where the American system has "Socialism" in it?


----------



## Brad Sallows (30 Jul 2011)

Ever hear of Medicare or Medicaid?  Aware that hospital emergency departments are required to treat irrespective of ability of patients to pay?


----------



## cupper (30 Jul 2011)

Medicare and Medicaid are only part of the American health care system. And I wouldn't say that would constitute "a lot of socialism". Those of us who pay for health care insurance would definitely prefer a more socialist model that the free enterprise model we have now.

As for hospitals, the are only obligated to provide as much care as is necessary to stabilize the patient to a point where they can move on to find an affordable means of care from another facility. And if you cannot cover the cost of treatment, arrangements for payment are made through payment plans, or sent to collections, etc. when the patient fails to pay for coverage, the cost is passed on to the other patients.


----------



## a_majoor (12 Aug 2011)

The US 11th circuit court has ruled that Obamacare is unconstitutional. Perhaps this will break the logjam and innovative new ways of looking at healthcare (besides huge centralized bureaucracies) can be entertained:

http://pajamasmedia.com/tatler/2011/08/12/breaking-11th-circuit-rules-individual-mandate-in-obamacare-unconstitutional/?print=1



> *Breaking: 11th Circuit Rules Individual Mandate in ObamaCare Unconstitutional (Updates)*
> 
> Posted By Bryan Preston On August 12, 2011 @ 10:23 am In Politics | 29 Comments
> 
> ...


----------



## cupper (12 Aug 2011)

Thucydides said:
			
		

> The US 11th circuit court has ruled that Obamacare is unconstitutional. Perhaps this will break the logjam and innovative new ways of looking at healthcare (besides huge centralized bureaucracies) can be entertained:
> 
> http://pajamasmedia.com/tatler/2011/08/12/breaking-11th-circuit-rules-individual-mandate-in-obamacare-unconstitutional/?print=1



Read it again, what the court said was that the personal mandate was unconstitutional, but the remainder of the law was.

"The Appeals Court for the 11th Circuit, based in Atlanta, found that Congress exceeded its authority by requiring Americans to buy coverage, but also ruled that the rest of the wide-ranging law could remain in effect."

It over ruled the lower court's finding that the individual mandate could not be separated from the rest of the law and that invalidated the entire law. The Appeals Court found that the individual mandate could be separated from the rest of the law. As such. it now limits the overall question to whether the individual mandate violates interstate commerce laws and states rights. All other challenges either upheld the entire law, or declared only the individual mandate to be invalid.

About the only thing the quoted text had right is that this will be going to the Supreme Court, and then it will be anyone's guess as to the final outcome.


----------



## a_majoor (13 Aug 2011)

Since the law, as written, has no severability, the effect of the ruling is to kill the law either way. Read "The Merchant of Venice" (Act IV, Scene 1) and the entire concept will become clear....


----------



## Redeye (13 Aug 2011)

Thucydides said:
			
		

> Since the law, as written, has no severability, the effect of the ruling is to kill the law either way. Read "The Merchant of Venice" (Act IV, Scene 1) and the entire concept will become clear....



Since this is one of many rulings going either way, its impact, like the others, will likely be nil.


----------



## a_majoor (7 Sep 2011)

More actual costs. The best part about this report is it comes from Obamacare backers; who demonstrate how it will bend the curve upwards...

http://reason.com/blog/2011/09/06/whoops-obamacare-backers-in-wi



> *Whoops! ObamaCare Backers in Wisconsin Produce Report Showing That the Health Care Overhaul Will Make Health Insurance More Expensive*
> 
> Peter Suderman | September 6, 2011
> 
> ...


----------



## a_majoor (26 Sep 2011)

The sad reality of Ontario after multiple *billions* have already been spent:

http://www.healthzone.ca/health/article/1058357--seniors-languish-in-hospital-beds-waiting-for-proper-care-hushed-report-says



> *Seniors languish in hospital beds waiting for proper care, hushed report says*
> September 22, 2011
> 
> Comments on this story Comments(0)
> ...


----------



## a_majoor (29 Sep 2011)

Shoving health care providers into "ACO's" will be as ineffective as HMO's or other bureaucratic trickery, this article in the Atlantic Monthly shows why:

http://www.theatlantic.com/national/archive/2011/09/poster-children-for-new-health-care-model-wont-participate-in-model-program/245840/



> *Poster Kids for New Health-Care Model Won't Participate in Model Program*
> By Megan McArdle
> 
> Sep 28 2011, 12:10 PM ET 68
> ...


----------



## Sythen (15 Oct 2011)

http://www.cnn.com/2011/10/14/politics/health-care-program/index.html?hpt=hp_t2



> WASHINGTON (CNN) -- Citing cost concerns, the Obama administration said Friday it has halted a long-term care insurance program that was part of the massive health care law passed in 2010.
> Called the CLASS Act (Community Living Assistance Services and Supports), the program was canceled by Health and Human Services Secretary Kathleen Sebelius after a 19-month effort to find a way to make it financially viable.



That didn't take long...


----------



## muskrat89 (14 Nov 2011)

I know Americans buy Rx Drugs from Canada (or used to) also, in addition to Mexico. It's no wonder why.  Here's an interesting article, Reproduced under the Fair Dealings provisions of the Copyright Act


http://www.azcentral.com/business/articles/2011/11/10/20111110scorpion-drug-cost.html



> When the federal government approved a scorpion antivenom in August, it was hailed as an important tool to protect vulnerable victims from scorpion stings.
> 
> But as doctors and patients are now discovering, the fast-acting serum for those who are stung by scorpions comes at a very steep price.
> 
> ...


----------



## cupper (15 Nov 2011)

Well, we'll find out in about 8 months if "ObamaRomneyGingrichcare" is constitutional or not.

http://www.washingtonpost.com/politics/supreme-court-to-hear-challenge-to-obamas-health-care-overhaul/2011/11/11/gIQALTvrKN_story.html

The Supreme Court decided on Monday to review President Obama’s 2010 health-care overhaul, promising a high-profile hearing on the question dominating American politics: the constitutional limits of the federal government’s power.

...

Next March, around the second anniversary of the act’s passage, the nine justices will hear arguments in the case, taking on the role of constitutional referee between those who see the law as a trespass on individual and states’ rights and those who consider it an extension of a safety net to Americans regardless of where they live or work.

...

As a mark of the case’s importance, the justices said *they will hear 5 1/2 hours of oral arguments* on the constitutional question and related issues. That appears to be a modern record: In 2003, the court devoted four hours of oral arguments to the McCain-Feingold campaign finance act, a sweeping law aimed at controlling the influence of money in elections.



One point to note about how important the court is viewing this, typically only an hour is given for oral arguements, split between the two sides.

They will consider the following issues:

●Whether Congress was acting within its constitutional powers by requiring all Americans to have at least a basic form of health insurance by 2014. Those who do not will be required to pay a penalty on their 2015 income tax returns.

●Whether other parts of the law can go forward if the “individual mandate” is found unconstitutional. Lower courts have differed on the question. The administration says the law’s more popular features cannot work financially without the mandate that all Americans join the system.

●Whether Congress is improperly coercing states to expand Medicaid, the subsidized health-care program for the poor and disabled.

●Whether the issue is even ripe for deciding. Some lower-court judges have said that the penalty paid for not having insurance is the same as a tax and, under the federal Anti-Injunction Act, cannot be challenged until someone has to pay it in 2015.


----------



## a_majoor (16 Nov 2011)

The lineup in the coming Supreme Court battle:

http://pjmedia.com/blog/supreme-ironies-obamacare-and-the-court/?singlepage=true



> *Supreme Ironies: Obamacare and the Court*
> Recall then-Senator Obama's "no" vote for Justice Roberts' confirmation?
> 
> by
> ...


_

and one of the Justices is also a player in the game:

http://news.investors.com/Article/591798/201111151910/Justice-Kagan-Recuse-Thyself.htm




*Elena Kagan Must Be Recused In ObamaCare Case*

 Posted 11/15/2011 07:10 PM ET

Supreme Court: Should a justice who participated in ObamaCare's creation recuse herself from the court's review of that law? Of course. But then a nominee who lies in confirmation hearings shouldn't be on the court anyway.

If Justice Elena Kagan were a person of character, she would sit out the Supreme Court's hearing of the challenge to the Patient Protection and Affordable Care Act.

But during her confirmation hearings in June of last year, she indicated she would not. And since this Monday, when the court announced it would take the case, she has done nothing to suggest she will recuse herself after all. Nor has the court made any statement about her recusal, a convention it usually follows when a justice takes himself or herself off a case.

Here are the facts on Kagan: She was the administration's solicitor general when ObamaCare became law last year. She has acknowledged that she was at a meeting in which state litigation against ObamaCare was discussed, though she said she was not involved in any legal responses concerning the states' litigation.

We also know that Kagan enthusiastically supported ObamaCare. This is made clear in emails released last week by the Justice Department.

"I hear they have the votes, Larry!! Simply amazing," Kagan wrote on the day ObamaCare passed the House in an email to Laurence Tribe, the Harvard law professor who was working at that time in the Obama Justice Department.

On the same day that note was sent, an associate attorney general emailed Justice Department lawyers to organize a health care litigation meeting. A Kagan deputy later emailed her suggesting that she attend.

While nothing in the chain of emails indicates Kagan was at the meeting, neither is there any evidence that she said she was not going to attend.

Nearly lost in this is the possibility that Kagan lied during her confirmation. She told the Senate Judiciary Committee that she had not been asked about the legal issues of ObamaCare nor had she offered any views on them. The emails, however, seem to tell a different story. Two exclamation points plainly show that in her legal opinion, ObamaCare was constitutional.

A Kagan recusal would not secure a finding against ObamaCare. Even if she were recused, it's plausible the case could end in a 4-4 vote, which isn't enough to overturn it. But her recusal would be necessary if Justice Clarence Thomas were to recuse himself. If he's out and she's not, ObamaCare is upheld at 4-4 if not 5-3.

The case against Thomas, however, is weak. He didn't work for a White House that pressed for the law. Nor is there a record of his disclosing an opinion on it. His only link is his wife, who's been involved with groups opposed to ObamaCare.

Thomas should stay. There's no conflict of interest. Kagan, though, has to recuse herself if for no other reason than to protect the integrity of the court.
		
Click to expand...

_


----------



## a_majoor (23 Nov 2011)

The real costs of Obamacare coming into view:

http://pjmedia.com/blog/what-else-is-wrong-with-obamacare/?print=1



> *What Else Is Wrong with Obamacare?*
> 
> Posted By Jeffrey H. Anderson On November 22, 2011 @ 12:27 am In Uncategorized | 2 Comments
> 
> ...


----------



## a_majoor (18 Dec 2011)

A bipartisan initiative to introduce elements of competition and market initiatives into Medicare. A similar plan in the "Part D" drug plan has worked well to date, keeping costs below estimates:

http://campaign2012.washingtonexaminer.com/article/democrat-reaches-across-aisle-medicare/263321



> *A Democrat reaches across the aisle on Medicare*
> 
> It's highly unusual in a presidential debate for two Republican candidates -- the two leading in current national polls -- to heap praise on a liberal Democratic senator.
> 
> ...


----------



## a_majoor (20 Dec 2011)

Markets unweave the tangle by simplifying the transactin to "buyer" and "seller". The more people who are interposed the worse everything becomes:

http://www.powerlineblog.com/archives/2011/12/hayek-vindicated-again.php



> *HAYEK VINDICATED AGAIN*
> 
> Way back on the Federal Page of today’s Washington Post is an article that ought to be on the front page above the fold, and its deep placement on the boutique page of the bureaucracy shows how the Post, like most everyone else, doesn’t understand what a big story it is.  And it is a clinical study of Hayek’s “knowledge problem”—the impossibility of centralizing fundamentally dispersed knowledge in a timely and accurate way—that we’ve discussed at various times here over the past few months.
> 
> ...


----------



## cupper (21 Dec 2011)

I don't see a problem here. When they elect a GOP president in 2012, and they finally gain full control in the Senate and House, they will repeal Obamacare, and eliminate HHS. So what's the problem? :sarcasm:

It would be nice if you also provided the link to the Post article, which has the following closing quotes:

http://www.wpost.com/politics/concern-growing-over-deadlines-for-health--care-exchanges/2011/12/16/gIQA51cX3O_story.html

It is possible to set up exchanges fairly fast, said John McDonough, one of the principal authors of the Massachusetts law that created a similar site. In that state, the exchange was running within about six months of the law’s enactment, he said.

“Massachusetts had a head start because it had already done a modernization of its data system, so it’s not completely analogous,” said McDonough, director of the Center for Public Health Leadership at the Harvard School of Public Health, “but it doesn’t take as much time to get an exchange up as a lot imagine.”


----------



## a_majoor (21 Dec 2011)

While the repeal of Obamacare is a given (either by legislation or because the incredible cost cannot be absorbed), the primary argument of the posted article was that central bureaucratic structures cannot process information or price signals in an accurate or timely manner.

Even if the exchange can be set up "fairly fast" (which does not seem to be the case), it will be slow, cumbersome and inaccurate. Users will be subject to constant revisions and adjustments as the exchange tries to react to information, and there should be no surprise to see a "black market" developing to bypass these exchanges (think medical tourism. Now imagine being or finding a broker who can get you medical attention and treatment in a hospital in (say) Mumbai).

I suggest you read The Use of Knowledge in Society, since it covers the topic in greater detail, and also shows how it applies to _any_ bureaucratic structure (both government and private or industrial)


----------



## Redeye (23 Dec 2011)

Thucydides said:
			
		

> While the repeal of Obamacare is a given



On what basis do you make this bold assertion? In what timeline? By what mechanism?


----------



## Fishbone Jones (23 Dec 2011)

Redeye said:
			
		

> On what basis do you make this bold assertion? In what timeline? By what mechanism?


You know. 

The same ones you use.

Informed minority\ majority.

Great swaths of the informed\ unwashed.

Etcetera, etcetera, etcetera.

Just from the other side. 

Goose, gander, all that other bird shit.


----------



## Redeye (23 Dec 2011)

I don't think I've ever made a statement about something being given as a basis to launch an argument. This particular "line of reasoning" crops up commonly on the right, and I find it rather amusing. Especially when you look at what's going on politically in the USA. Barring some major changes, President Obama will cruise to a second term without much trouble, and the public's disgust with the performance of the GOP majority, Tea Party-deadlocked House in particular is sure to have an impact on the 2012 elections, and probably not a good one. Many Tea Partiers, and GOP supporters in general seem to think they'll have no trouble doubling down on their 2010 success, but when I ask how they plan to do that given what polls say, what the mood of the country says... crickets.


----------



## PuckChaser (23 Dec 2011)

Redeye said:
			
		

> Barring some major changes, President Obama will cruise to a second term without much trouble



He's down to below 50% in approval rating... I see that as a dice roll whether he gets a second term or not.


----------



## aesop081 (23 Dec 2011)

PuckChaser said:
			
		

> He's down to below 50% in approval rating... I see that as a dice roll whether he gets a second term or not.



He will get a second term......due to lack of a palatable opponent. If the Republicans had someone more personable, Obama would be gone next November.


----------



## Redeye (23 Dec 2011)

PuckChaser said:
			
		

> He's down to below 50% in approval rating... I see that as a dice roll whether he gets a second term or not.



It fluctuates. His major advantage is that the GOP doesn't have a single credible candidate to oppose him.


----------



## Fishbone Jones (23 Dec 2011)

Redeye said:
			
		

> It fluctuates. His major advantage is that the GOP doesn't have a single credible candidate to oppose him.



Does he need a credible opponent when he's not credible himself?

Inquiring minds want to know.


----------



## Redeye (23 Dec 2011)

recceguy said:
			
		

> Does he need a credible opponent when he's not credible himself?
> 
> Inquiring minds want to know.



Given that there isn't a single electable Republican in the field at the moment, and that polls show that he'd beat any of them handily, well, I don't see much reason for concern. And if the GOP keeps making gaffes like blocking the payroll tax cut extension, well, that bodes well for him indeed.


----------



## Fishbone Jones (23 Dec 2011)

I think the polls last April said Harper was going to get his ass handed to him. The next one called for another slam dunk McGuinty majority.

I don't think polls are where you want to put your money. We all know they're the same and pander to the person that paid for it. They're straw dog, smoke and mirrors, statistics. The country doesn't matter.

They haven't been right or even very good for the last few years.

And you, you of all people, should know better than to quote a poll as substantiation.

Between them, your outraged masses, your (un)intelligent minority, the swaths of the degraded and trod on, I'm starting to think you have nothing but extremist left wing blogs to fall back on. The MSM (at least the majority of them) are way to left partisan to includes I'm wondering where that leaves you.

Just so you know, I couldn't give a fiddler's fornication about Obama. History will write him for the socialist that he is and he'll be paid due with his failed legacy.


----------



## Redeye (23 Dec 2011)

recceguy said:
			
		

> I think the polls last April said Harper was going to get his *** handed to him. The next one called for another slam dunk McGuinty majority.
> 
> I don't think polls are where you want to put your money. We all know they're the same and pander to the person that paid for it. They're straw dog, smoke and mirrors, statistics. The country doesn't matter.
> 
> ...



I don't put that much stock in polls. The fact is that the GOP primary process is giving the Democratic Party plenty to work with against any contender. As for how how history records President Obama, well, we'll only see in days to come.

As for "far left blogs" - nope. The far left "emo prog" set repulse me just about as much as the right - they're as hysterical, as ridiculous, as dogmatic, etc etc. I form opinions from reading as many points of view as I can find and trying to discern what the real story is . It doesn't always come through clearly though.

I tend to disregard the slurs against the mainstream media, because they're ridiculous. The right is entitled to their own opinions, but not their own facts, which they have a tremendously effective machine to manufacture. Corporate media, in general, tends to learn to the right - if perhaps only right of the centre. The left doesn't have the sort of corporate sponsorship they'd like, but they do a decent job of trying to harness things like social media, and so on. Media is what it is - and the news is yet another vehicle to sell advertising after all. I have no expectation that any will report anything particularly objective. But taken together you might get the right idea.


----------



## Fishbone Jones (23 Dec 2011)

Redeye said:
			
		

> I don't put that much stock in polls. The fact is that the GOP primary process is giving the Democratic Party plenty to work with against any contender. As for how how history records President Obama, well, we'll only see in days to come.
> 
> As for "far left blogs" - nope. The far left "emo prog" set repulse me just about as much as the right - they're as hysterical, as ridiculous, as dogmatic, etc etc. I form opinions from reading as many points of view as I can find and trying to discern what the real story is . It doesn't always come through clearly though.
> 
> I tend to disregard the slurs against the mainstream media, because they're ridiculous. The right is entitled to their own opinions, but not their own facts, which they have a tremendously effective machine to manufacture. Corporate media, in general, tends to learn to the right - if perhaps only right of the centre. The left doesn't have the sort of corporate sponsorship they'd like, but they do a decent job of trying to harness things like social media, and so on. Media is what it is - and the news is yet another vehicle to sell advertising after all. I have no expectation that any will report anything particularly objective. But taken together you might get the right idea.



I've always espoused that 'blood sells' and the media's sole goal is advertising revenues, and to get as much thereof as they can, no matter the cost to the truth. You'll get no arguement there.

Centrist right and left, again no arguement.

Quit advocating for useless fringes and I think some here can find some common ground.

Just a guess, mind.


----------



## a_majoor (23 Dec 2011)

Redeye said:
			
		

> On what basis do you make this bold assertion? In what timeline? By what mechanism?



http://Forums.Army.ca/forums/threads/67371/post-1099703.html#msg1099703



> While the repeal of Obamacare is a given (either by legislation or because the incredible cost cannot be absorbed), the primary argument of the posted article was that central bureaucratic structures cannot process information or price signals in an accurate or timely manner.


----------



## Redeye (23 Dec 2011)

Thucydides said:
			
		

> http://Forums.Army.ca/forums/threads/67371/post-1099703.html#msg1099703



By legislation? When? Not before the 2012 elections, and there's a good chance not after that for another four years. The cost? Well, given CBO projections that's not really going to be an issue. This is a country that blew over a trillion on a war to stroke some egos, after all - not exactly penny pinchers.


----------



## Fishbone Jones (23 Dec 2011)

Redeye said:
			
		

> By legislation? When? Not before the 2012 elections, and there's a good chance not after that for another four years. The cost? Well, given CBO projections that's not really going to be an issue. This is a country that blew over a trillion on a war to stroke some egos, after all - not exactly penny pinchers.



So you're saying Iraq is better off under Hussien than what they are trying to accomplish now?

Maybe I missed which war you're talking about.


----------



## cupper (23 Dec 2011)

recceguy said:
			
		

> So you're saying Iraq is better off under Hussien than what they are trying to accomplish now?



Depends on whether you would prefer total anarchy or absolute fear and paranoia.

Toe-MAY-toe / Toe-MAH-toe


----------



## a_majoor (23 Dec 2011)

Given the convoluted nature of the political system right now, detailed predictions are becoming more and more difficut. The US Supreme court may make a ruling, the House budget (the Ryan Budget) essentially defunds Obamacare now (but since the Senate has failed to propose or pass a budget for over 900 days, there is little evidence the Democrat majority is ready to spring to action), and of course the real costs vs the CBO estimates are listed upthread in many different posts. Non financial costs include thousands of doctors "Going Galt" and retiring from practice rather than work under Obamacare. Many State govenments are also fighting Obamacare, and may eventually dismatle it piecemeal by simply by using courts or legislating against portions of Obamacare that they don't choose to pay for, with full voter support 

http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/health_care_law



> The latest Rasmussen Reports national telephone survey shows that 55% of Likely U.S. Voters at least somewhat favor repeal of the health care law passed by Congress in March 2010, while 35% at least somewhat oppose repeal. The intensity remains on the side of the law’s opponents since these findings include 42% who Strongly Favor repeal versus 26% who are Strongly Opposed. (To see survey question wording, click here.)



Of course, if controlled drawdowns are not going to happen, then an uncontrolled collapse will. Either way, the legal, legislational and financial pillars of Obamacare are founded on sand.


----------



## Redeye (23 Dec 2011)

recceguy said:
			
		

> So you're saying Iraq is better off under Hussien than what they are trying to accomplish now?
> 
> Maybe I missed which war you're talking about.



That one. And no, I made no comment on the disposition of the Iraqi people. Although those who survived the war in some ways are, but in many others aren't. The statement I made pertained to the fact that something being expensive isn't a determinant of the propensity of the United States Government to do it.

That said, here's a friend of mine who's Iraqi's take on the whole thing. She lives in Canada but has returned repeatedly. Not exactly a glowing assessment, and it jives with pretty much everything I've read:



> So Iraq.... I loved being there and I can't wait for my next visit!
> 
> There's barely enough electricity. It goes on and off. People rely on private generators which burn out eventually, for which reason people subscribe to neighbourhood generators. So the "national" electricity goes off, then you turn on your generator (if you can afford it, of course). Once it burns off, the neighbourhood generator goes on once again, if you can afford that, too). There's so much spending on electricity, and yet you don't get much of it! I got to experience 51C in such circumstances while I was told that this is nothing compared to the heat in August, which is when Ramadhan will be this year!!
> 
> ...


----------



## Fishbone Jones (23 Dec 2011)

Redeye said:
			
		

> That one. And no, I made no comment on the disposition of the Iraqi people. Although those who survived the war in some ways are, but in many others aren't. The statement I made pertained to the fact that something being expensive isn't a determinant of the propensity of the United States Government to do it.
> 
> That said, here's a friend of mine who's Iraqi's take on the whole thing. She lives in Canada but has returned repeatedly. Not exactly a glowing assessment, and it jives with pretty much everything I've read:



Thanks for giving us the bent from your side.

That doesn't make it gospel.

Everyone has an axe to grind.


----------



## Redeye (23 Dec 2011)

recceguy said:
			
		

> Thanks for giving us the bent from your side.
> 
> That doesn't make it gospel.
> 
> Everyone has an axe to grind.



I never claimed it was. But I think you'll have to forgive me for putting a substantially heavier weighting on the opinion of someone more closely connected to the situation that any of a myriad of armchair pundits who weren't there.


----------



## Fishbone Jones (23 Dec 2011)

Redeye said:
			
		

> I never claimed it was. But I think you'll have to forgive me for putting a substantially heavier weighting on the opinion of someone more closely connected to the situation that any of a myriad of armchair pundits who weren't there.



Then until you get to Afghanistan, you'll just have to believe, unconditionally, those of us who have been there.

Likewise those of us that spend more time Stateside than you.

And those of us that have weekly business dealings with those across the border.

Those of us that seen and had to deal with, first hand the implimentation of Obama's policies.

Right?


----------



## Redeye (23 Dec 2011)

recceguy said:
			
		

> Then until you get to Afghanistan, you'll just have to believe, unconditionally, those of us who have been there.
> 
> Likewise those of us that spend more time Stateside than you.
> 
> ...



Again, the more sources the better. Reports from Iraq show things are pretty rotten there, much of which are attributable to both years of sanctions and American military intervention. From a geopolitical perspective, the war was also a blunder, because it put power in the hands of Iraq's Shia population, giving Iran more influence in the region. It didn't do much of anything that I can see to further any of America's interests.

I have plenty of close friends and family in the US who augment anything I could read from pundits. They span a broad array of opinions.


----------



## aesop081 (23 Dec 2011)

:argument:


----------



## Redeye (23 Dec 2011)

CDN Aviator said:
			
		

> :argument:



 :goodpost: :deadhorse:


----------



## cupper (24 Dec 2011)

:grouphug:

 ;D


----------



## a_majoor (26 Dec 2011)

The Prime Minister implicitly recognizes where the solution lies, but needs to find a way to release the provinces to explore different solutions before health care consumes all of our budgets:

http://freedomnation.blogspot.com/2011/12/harper-is-right-health-care-solutions.html



> *Harper is right: health care solutions must come from provinces but first he has to show leadership*
> 
> In his end of year interview Stephen Harper said something on health care policy that is both useful and true. He said that it is up to the provinces to find the solutions to the problems in the health care system. This is not an abdication of federal leadership but a recognition that there are some things that the provinces are better at doing. Provincial governments are the ones that run the health care system and there is a limit to how much a federal bureaucrat can understand the details of each provincial system. Also provinces need to find solutions that work for their own particular circumstance and come up with political compromises that are acceptable to their own populace. Federalizing the issue of health care does nothing but hopelessly complicate an already complex policy dilemma.
> 
> ...


----------



## a_majoor (8 Jan 2012)

An expanded look at how Canada's healthcare system is changing towards more flexibility and competition:

http://www.winnipegfreepress.com/canada/breakingnews/a-canada-with-no-health-accord-provinces-grapple-with-the-possibilities-136904598.html



> *A Canada with no health accord? Provinces grapple with the possibilities*
> By: Heather Scoffield, The Canadian Press
> Posted: 01/8/2012 10:44 AM | Comments: 91 (including replies) | Last Modified: 01/8/2012 11:54 AM
> 
> ...



Poorer provinces or provinces that have mismanaged their finances like Ontario and Quebec will have a huge incentive to find efficiencies and reduce costs. Now they could use the "Washington Monument" strategy ("If our funding is cut we will close the Washington Monument to tourists"), but ironically, most provinces have already done tis repeatedly so voters are quite tired of threats of further cuts to emergency rooms and _even longer_ wait times for surgury and specialist care. 

My prediction; the province that figures out how to put patient needs ahead of the hospital administration and health care bureaucrats will become the hotbed of "medical tourism" from other provinces and perhaps the United States, which will force other provinces to follow suit and change their systems.


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## GAP (8 Jan 2012)

Having worked peripherally within the health care system, I can vouch for the massive empire building in even the remotest locations....get rid of that and the carpet bagging and you will have a decent system. It has to stop somewhere.....


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## a_majoor (24 Mar 2012)

A toxic combination of American government intervention in the market and Canadian governments ditorting the market with perverse incentives. Even if I had the ability to raise a processing plant from the ground, there is no incentive for me to create a "second line" facility to fill the market niche:

http://www.nationalpost.com/todays-paper/Trouble+with+cheap+drugs/6353030/story.html



> *Trouble with 'cheap' drugs*
> 
> Ninety per cent of Canadian injectable drugs come from Sandoz. Revamping of the plant to meet U.S. regulations, and a fire, have led to a nationwide drop in supply since February.
> 
> ...


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## Edward Campbell (2 Aug 2013)

I recognize that some (many?) people would not trust data from the _Fraser Institute_ if it was simply a catalog of the time of sunrise, but this report, which is reproduced under the Fair Dealing provisions of the Copyright Act from the _Fraser Institute_ website, looks OK to me:

http://www.fraserinstitute.org/research-news/news/display.aspx?id=20232


> "Free" health care costs average Canadian family more than $11,000 per year
> 
> Media Contacts:	Nadeem Esmail
> 
> ...




We must recognize that although we spend less than the Americans, both we and the Americans share the sad distinction of being the top health care spenders spenders in the OECD and having the worst health care outcomes.

Readers will know that I think France is a pretty poor excuse for a country, but: we should look at the French health care system (amongst others) they spend less than we do and get better results. The only model of health care we should not look at as a potential replacement for ours is the Ameican one.


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## pbi (2 Aug 2013)

So, for the cost of considerably less than what a surgical procedure for one family member might cost, a family gets access to what is, for most of us, a pretty good median level of care? I agree that any Canadian who uses the term "free" is ignorant: it isn't free, but then no publicly funded program is. The main point to me and my family is that we don't have to worry about what things will cost when somebody needs serious care.

I also think that we might want to be honest about the use of the term "national health care system". Is that really what we have? Or do we have thirteen separate systems that get some of their funding from the centre, along with some riders and conditions? To me, a national system is more like what you see in the UK with the NHS, or in France as you mentioned. But, not being a unitary state like those countries, but instead a fractious confederation (like the US), that might be a pipe dream.

I have no desire whatsoever to see us scrap our "system": I find the idea of a universal access to good basic healthcare, and critical care in urgent cases, very democratic. I'm glad we have it. We do need to tune it up, though.

What we do need, IMHO, is a more pragmatic approach to more privately delivered health care. Private delivery is not The Big Satan. After all, doctors are private businesses, as are drug stores, homecare suppliers and stand-alone imaging clinics. Nobody questions this. Why shouldn't we have more private delivery, while still preserving the very fine and noble concept of public insurance, and public regulation of service quality?

I don't buy the argument that private medical care providers will just cater to the rich. Some will, of course. But, as in other things, most businesses will cater to most people, which in Canada means to the middle class. The rich will still look after themselves (as they always do...) and the poor will still be on the public purse for everything (just as they are in the "Bad Old USA"...)

Cheers


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## Edward Campbell (2 Aug 2013)

In my _opinion_ (which is not as well as informed as those of many others) our 13 "systems" ought to be a strength. Thirteen systems, in a "network" should allow for extensive innovation and analysis of best practices. But, as far as I know, one element of the _Canada Health Act_, specifically § 7 and 8 related to _public administration_, appears to preclude any experimentation with any form of private insurance, for example. Private insurance, injecting private money into the system, seems to be a constant part of other cheaper, better (in terms of outcomes) systems.

Broadly, I think a comprehensive national health insurance plan ~ which is what we have ~ is a boon for productivity but I also think that ours can and should be both more efficient - cheaper, and more effective - better outcomes. If France can manage, why not Canada?


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## Remius (2 Aug 2013)

When my son was 3 he was diagnosed with a coordination disorder and problems with his core strength.  likely a result of being 4lbs at birth.  Physically he was a year or two behind kids his age for simple things like catching a ball or climbing stairs.  He needed to be assessed by an ergotherapist.  CHEO could do it but it was a year and a half long wait.  Or we good go to a private clinic and be seen in two weeks.  Not wanting to chance any delay or problems in his development at that early an age we opted to pay for a service, at a private clinic, that was otherwise provided for by the system.

By doing it we didn't wait and we didn't add to an already long queue of people that likely might not have been able to pay for the same treatment.  We weren't rich by any means (we were very much able to though)but we just had to change some priorities to get it done.

Our system can be improved and paying for some services might be one way.


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## Brad Sallows (2 Aug 2013)

>So, for the cost of considerably less than what a surgical procedure for one family member might cost, a family gets access to what is, for most of us, a pretty good median level of care?

Not necessarily.  All of the doctors in my area are "not taking new patients at this time", and that state of affairs has persisted for years.  I am given to understand that it is not merely a local issue.

Canadians have access to a pretty good median level of emergency care - once you have the documents to prove you need treatment, you can get on the queue; if you need treatment urgently, you will likely find yourself near the head of the queue.  Some queues are almost non-existent; some are long enough that the conditions for which they exist have a good chance of killing you before you reach the front (or worsening to the extent that your treatment consumes more resources than if you could be treated immediately).

The trick is proving you need treatment; access to a doctor is the gateway, and access to doctors for anything except one complaint at a time ad hoc is difficult (at least in some areas).  And if the gatekeeper agrees there is something worth looking at, then the queues to obtain the details are absurdly long.

I don't remember the last time I spoke to someone who actually waited for tests on the public queue despite being able to find the money to pay privately.  Everyone seems to know that if you can scrape up the few hundred or couple of grand to get the imaging (or whatever) done, then you are over the hurdle.

Medically, the most urgent needs are supposed to be met first.  But rationally, the country needs to make sure the people paying the most in taxes lead long, productive lives in order to fund the system.


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## pbi (3 Aug 2013)

> But rationally, the country needs to make sure the people paying the most in taxes lead long, productive lives in order to fund the system.



Since most of the taxes in this country are probably paid by the middle class (since that's who most of us are), this makes a kind of sense, and still (more or less) gets us to where we are now in terms of access to basic good care. However, if by this you mean that people who have difficulty paying shouldn't have access to care, that's a bit too Darwinian for me. Not everybody who is short of money is necessarily a congenital welfare layabout: believe me. The thinking that underlies our public health care is, to me, noble and deserving of respect: nobody should be denied medical care because of  lack of money. The fact that over half a century we have managed, in just about every Province, to run the "system" into the ditch is IMHO no reflection on the underlying principle.

If we focus all our health care dollars on what happens inside the hospital doors, I think we are missing the point. More money spent on home care, on community clinics, on developing physician's assistants and nurse practitioners to take the load off doctors, and on encouraging people to do a better job of looking after themselves, would help to lighten the load. As much as possible, imaging and clinical services should be available privately (as they often are now).

Here in Frontenac County (which includes Kingston) we have experienced some cuts to the County EMS, which has resulted in at least one of the ambulances being taken off  the road for lack of crews. But, the EMS Chief has come up with an innovative idea: to divert some effort into "pre-ambulance" care and education around the County, to reduce the need for an ambulance call in the first place. That way, when criticall 911 calls come in, ambulances are available instead of hauling people with less critical conditions.

Thinking like that is, I believe, part of the solution. The solution is not (and I hope never will be...) to bin our "system" and try to create a fully privatized system in all respects.


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## GAP (3 Aug 2013)

The biggest solution to the problem is to kill/deflate/disassemble/etc. the empire builders. 

They are the drain on the health dollar.

Not everything needs a special board, an executive director, administration staff, et al .....all this to make department heads/specialists feel special...


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## mariomike (3 Aug 2013)

pbi said:
			
		

> Here in Frontenac County (which includes Kingston) we have experienced some cuts to the County EMS, which has resulted in at least one of the ambulances being taken off  the road for lack of crews. But, the EMS Chief has come up with an innovative idea: to divert some effort into "pre-ambulance" care and education around the County, to reduce the need for an ambulance call in the first place. That way, when criticall 911 calls come in, ambulances are available instead of hauling people with less critical conditions.



Community Paramedicine provides "added value" for the community. T-EMS has had it since 1999. The only real health care system many of these people know is EMS.

It can include Community Referral by EMS (CREMS), Community Agency Notification, Hot and Cold Weather Response Programs, Influenza Vaccination, flagging of "hoarders", Bed Bug Identification and Prevention Safety programs (e.g., Window and Balcony Safety).

Most of the Paramedics assigned to Community Cars ( usually mini-vans ) are WSIB accommodation type placements. Although removed from Operations, the program allows them to remain productive.

Toronto CREMS reports a 50% or more decline in ambulance use for referred patients.


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## Edward Campbell (3 Aug 2013)

Part 1 of 2

A little more anecdotal evidence re: why medical costs are so high in the USA in this article which is reproduced under the Fair Dealing provisions of the Copyright Act from the _New York Times_:

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?_r=0
My emphasis added


> For Medical Tourists, Simple Math
> 
> By ELISABETH ROSENTHAL
> 
> ...



End of Part 1


----------



## Edward Campbell (3 Aug 2013)

Part 2 of 2



> *No Gift Shop*
> 
> There are, of course, a number of factors that explain why Mr. Shopenn’s surgery in Belgium would cost many times more in the United States. In America, fees for hospitals, scans, physical therapy and surgeons are generally far higher. And in Belgium, even private hospitals are more spartan.
> 
> ...



Here is just one example of the many (thousands of?) online advertisements for joint replacement overseas. Note the price: $11,511 for exams, tests, medications and supplies as required and ordered by the physicians while the patient is admitted:

     Single Room accommodation for 7 nights in the in-patient ward (inclusive room & regular patient meals, nursing and other standard service charges);
     Doctors’ fees:
     Operating room charges (OR & recovery rooms, facilities, equipment and nursing services);
     Procedure-related laboratory tests and radiology;
     Medical equipment and supplies necessary for the procedure (excluding the prosthesis; see separate estimate following);
     Procedure-related medications;
     Post-operation physiotherapy.

Prosthesis prices range from under $3,000 to over $6,000, thus the overall bill for a joint replacement is something in the range of $16,000+/-.

Mr. Shopenn was looking at a bill of at least $78,000, including his "at cost" artificial joint. I'm not sure what the costs might be in Canadian hospital - a Canadian patient, as far as I know, does not see a bill - but my (uneducated) guess is that it will not be as high as in America nor as low as in Belgium ($13,000+).


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## GnyHwy (3 Aug 2013)

I wish I could remember the show or news program I watched, or perhaps the article I read, but it was about American doctors closing practices and sometimes declaring bankruptcy, mostly due to treating patients with "sketchy" insurance.  The doctors, while performing what they believed to be their ethical duty, found themselves unpaid when insurance companies decided to litigate the crap out of things.  

The sick and twisted part was, the same doctors or colleagues, in an effort to feed themselves took on jobs with the insurance companies that essentially put themselves out of business.  *Very much a snake eating its own tail.*

I realize that a capitalistic and private approach to health care makes sense to the part of society that is prosperous.  I like to call this the "Libertarian Right Wing Utopia".  For us, the middle class, if it even exists as a majority anymore, need the guarantee provided by our current medical system; as slow and shitty as it may be.


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## Brad Sallows (3 Aug 2013)

>However, if by this you mean that people who have difficulty paying shouldn't have access to care

No, the rational policy position is that everyone _should_ have access to care, but the "10%* of taxpayers who pay 50%" of income taxes _must_ have access to care (specifically, more timely access to early detection and intervention) during their working lives.  A civil entitlement is worthless if there isn't enough funding for it.  It is disturbingly elitist, but pragmatic.

*or whatever the fraction


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## a_majoor (4 Aug 2013)

The Medical Registered Savings Plan (MRSP) combines most of the benefits of the market with the stated desire of allowing productive people to access health care when needed.

The essential basis of the system is to allow people to bank monies for health care: what is not spent during the year on health care (such as regular check ups) is banked, and allowed to compound. In general, young and healthy people will not use much of their allowance, which will grow and compound as they age. The compounded amount are available when the MRSP owner ages and generally requires more healthcare services. Since people have incentive to save, this will drive down prices of most medical services, medicine and devices, since the patients purchase them directly and will shop around for the best deal.

For people who are unable to save for their MRSP, due to unemployment or being in school, (for example) a certain amount of make up room can be provided, and recourse to charity, insurance and other means made as well for people who are marginalized.

The other leg of the MRSP system would be a comprehensive system of medical insurance, and catastrophic coverage should be one of the few things that the government will cover through either subsidized insurance or direct payment. While catastrophic illness and accidents are costly for the victims, in actual fact they do not make up the majority of patients. One of the great "sins" of the US system is the rampant cronyism of the Insurance industry; people cannot shop for the best deal on insurance because the vast majority of States prevent "cross border" shopping, limiting competition. A Canadian system would need to allow interprovincial shopping, and indeed might even need to allow international companies like ING to enter the market to provide enough competition to keep prices reasonable.


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## pbi (6 Aug 2013)

I agree that one of the things we need to encourage is the assumption of greater responsibility for Canadians to provide for their own future and wellbeing through savings, or perhaps through increased health contributions, or maybe even a reasonable user fee. I think the illusion of "free health care" is one of the things that has brought us to our present situation.

To me, these would all be reasonable and acceptable measures, provided that the underlying good intent and universality of our "system" are preserved.


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## Edward Campbell (6 Aug 2013)

pbi said:
			
		

> I agree that one of the things we need to encourage is the assumption of greater responsibility for Canadians to provide for their own future and wellbeing through savings, or perhaps through increased health contributions, or maybe even a reasonable user fee. I think the illusion of "free health care" is one of the things that has brought us to our present situation.
> 
> To me, these would all be reasonable and acceptable measures, provided that the underlying good intent and universality of our "system" are preserved.




My favourite _system_ is Singapore's: everyone is covered, no one gets "catastrophic" medical bills, but nothing is free. Here, from the government's web site is an outline of it:
_________________________
Singapore Healthcare System

*Our Philosophy*

     The Ministry of Health believes in ensuring quality and affordable basic medical services for all.

     At the same time, the Ministry promotes healthy living and preventive health programmes as well as maintains high standards of living, clean water and hygiene to achieve better health for all.

*Structure and Budget*

     Singapore’s healthcare system is designed to ensure that everyone has access to different levels of healthcare in a timely, cost-effective and seamless manner. 

*Healthcare Services and Facilities*

     Healthcare services are accessible through a wide network of primary, acute and step-down care providers. More

*Healthcare Regulation*

     The Ministry of Health and its statutory boards regulate both the public and private providers of healthcare in Singapore. More

*Quality and Innovation*

     To ensure that patients are treated safely with good healthcare standards, the Ministry strives to promote better quality and innovation through various initiatives. More
_________________________

Singapore has a universal healthcare system (as we do in Canada) within which affordability of care is ensured through a system of compulsory savings, subsidies and price controls. It uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalized health insurance plan known as Medisave. Within Medisave, each citizen accumulates funds that are individually tracked, and such unds can be pooled within and across an entire extended family. Most Singaporeans have substantial savings in this scheme. A level of subsidy is chosen by the patient at the time of each healthcare action.

A key principle of Singapore's national health scheme is that no medical service is provided free of charge, not even within the public healthcare system. This mechanism is intended to control the _demand_ for healthcare ~ uncontrolled demand is almost always seen in fully subsidised universal health insurance systems. Out-of-pocket charges vary considerably for each service and level of subsidy. For the wealthy, although each out-of-pocket expense is typically small, costs can accumulate and become substantial for patients and families. For the poor, the subsidy is in effect nonexistent, and patients are treated like private patients, even within the public system.

I have seen the system as reasonably close range and I am mightily impressed with the quality of healthcare, overall, for ordinary, working class, Singaporeans. The rich - and there are a good many rich Singaporeans - can care for themselves, just as they can anywhere in the world. That the rich, including the very rich, get their medical care in Singapore rather than going to e.g. London or Los Angeles, suggests that care is of the best quality. What is impressive is that the working class folks are treated by the same doctors in the same hospitals with, I am told, the same care and concern. Maybe the working class don't get private suites and gourmet meals, but that not why they we go to the hospital, is it?


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## cupper (8 Aug 2013)

Until they decide to address the high (read outrageous) costs for health care in the US, a Canadian style system won't do much to improve the situation.

There have been several decent investigative reports into the high cost of health care services in the US, from Time Magazine devoting a full edition to an expose entitled "Bitter Pill: Why Medical Bills Are Killing Us", to the New Your Times series "Paying 'till it Hurts",

http://www.time.com/time/magazine/article/0,9171,2136864,00.html#ixzz2bLR5p8MP  (subscription required)

to the New Your Times series "Paying 'till it Hurts".

http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?ref=elisabethrosenthal&_r=0


An interview on NPR with Elisabeth Rosenthal, author of the NY Times series.

*'Paying Till It Hurts': Why American Health Care Is So Pricey*

http://www.npr.org/2013/08/07/209585018/paying-till-it-hurts-why-american-health-care-is-so-pricey



> It costs $13,660 for an American to have a hip replacement in Belgium; in the U.S., it's closer to $100,000.
> 
> Americans pay more for health care than people in many other developed countries, and Elisabeth Rosenthal is trying to find out why. The New York Times correspondent is spending a year investigating the high cost of health care. The first article in her series, "Paying Till It Hurts," examined what the high cost of colonoscopies reveals about our health care system; the second explained why the American way of birth is the costliest in the world; and the third, published this week in The Times, told the story of one man who found it cheaper to fly to Belgium and have his hip replaced there, than to have the surgery performed in the U.S.
> 
> ...


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## ModlrMike (8 Aug 2013)

E.R. Campbell said:
			
		

> ...uncontrolled demand is almost always seen in fully subsidised universal health insurance systems.



As someone who sees patients at the most frequent first point of contact I can tell you that this is the most pressing issue for healthcare in Canada. Unrestrained demand coupled with an institutionalized fear of litigation or of being cast as racist, classist etc will be the undoing of the system as we know it.

We see everyone who walks through the door, notwithstanding that probably 50% don't need ER care. That it costs 10 times as much to get treatment from an ER as it does from a walk in or family MD is of no consequence. "I'm entitled to my entitlements."


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## Canadian.Trucker (8 Aug 2013)

ModlrMike said:
			
		

> As someone who sees patients at the most frequent first point of contact I can tell you that this is the most pressing issue for healthcare in Canada. Unrestrained demand coupled with an institutionalized fear of litigation or of being cast as racist, classist etc will be the undoing of the system as we know it.
> 
> We see everyone who walks through the door, notwithstanding that probably 50% don't need ER care. That it costs 10 times as much to get treatment from an ER as it does from a walk in or family MD is of no consequence. "I'm entitled to my entitlements."


Nail firmly hit on the head.

My wife and I have had many a discussion about healthcare and we like to think we're reasonably informed when it comes to when it would be required to go to the hospital E.R. and when we can sort the issue out at home.  I think your "entitlement" statement is bang on where people believe that it is their right to go in and access the E.R. for immediate care whenever they have a sniffle or a cough, and while techinically they are correct it's draining our system.  Unfortunately unless we come up with a pill that gives you common sense the only way I see to change this is if there is a cost associated with seeking out care in a hospital.  I'm not talking privatized care, but a percentage of the cost that is born by the individual seeking the care so that it does make you sit and think "do I really need to go get this looked at?"


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## Cbbmtt (8 Aug 2013)

Canadian.Trucker said:
			
		

> Nail firmly hit on the head.
> 
> My wife and I have had many a discussion about healthcare and we like to think we're reasonably informed when it comes to when it would be required to go to the hospital E.R. and when we can sort the issue out at home.  I think your "entitlement" statement is bang on where people believe that it is their right to go in and access the E.R. for immediate care whenever they have a sniffle or a cough, and while technically they are correct it's draining our system.  Unfortunately unless we come up with a pill that gives you common sense the only way I see to change this is if there is a cost associated with seeking out care in a hospital.  I'm not talking privatized care, but a percentage of the cost that is born by the individual seeking the care so that it does make you sit and think "do I really need to go get this looked at?"




Going into emergency because your shoulder is sore, because your kid has a very mild fever or you have thrown up a couple times is a crazy waste of money. These are the same people sitting next ripped quadriceps, people needing stitches and people with concussions.

I work for a Health Insurance provider most of you have and it's funny how people abuse systems of health care. If the $66 individuals pay in B.C. for our health care has the definition of "see a doctor no matter what", I guarantee you that there are people (especially seniors) that will go in once a week for minor aches and pains. These are the people causing 3 hour wait times in the Emergency ward, 2 hour wait times at the clinic and I don't think it's the fault of the system we have in Canada.

I have a strong belief that everyone should have a set amount of check up visits and maintenance visits per year for things like removing warts, colds and doctors notes and if you go above you have to pay for the visit. Obviously emergencies would not count towards this total. I'm sure there are people that have not been to a doctor in years, and that persons rates are going up every year because of Mr/Mrs "I go to the doctor once a week".

I have so much to say on it, but not enough time.


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## GAP (8 Aug 2013)

Canadian.Trucker said:
			
		

> Nail firmly hit on the head.
> 
> My wife and I have had many a discussion about healthcare and we like to think we're reasonably informed when it comes to when it would be required to go to the hospital E.R. and when we can sort the issue out at home.  I think your "entitlement" statement is bang on where people believe that it is their right to go in and access the E.R. for immediate care whenever they have a sniffle or a cough, and while techinically they are correct it's draining our system.  Unfortunately unless we come up with a pill that gives you common sense the only way I see to change this is if there is a cost associated with seeking out care in a hospital.  I'm not talking privatized care, but a percentage of the cost that is born by the individual seeking the care so that it does make you sit and think "do I really need to go get this looked at?"



In the last 10 - 15 years a huge section of the ER population has migrated to local clinics. They have done more to save $$ for the healthcare system than any other program. 

Now what the ER has to start doing is shooing people off to them instead of servicing them at an inflated cost. 

One of the big stumbling blocks has been the mantra of "find yourself a family doctor". They are in short supply and even then when you need to see them, it's 3 weeks to get an appointment. You are either dead or healed by then.

 :2c:


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## The Bread Guy (8 Aug 2013)

ModlrMike said:
			
		

> We see everyone who walks through the door, notwithstanding that probably 50% don't need ER care. That it costs 10 times as much to get treatment from an ER as it does from a walk in or family MD is of no consequence. "I'm entitled to my entitlements."


I understand where you're coming from at your particular coalface, but how many folks coming into your ER come in because:
1)  they don't have a doctor;
2)  the only walk-in clinics available will only allow patients on their roster; or
3)  there's no nurse practitioner clinics available to go to?
Admittedly, in Ontario, these excuses are shrinking a bit, but where I live (a city the size of Burlington, but nowhere near Toronto), an accepted stat is that 1 out of 4 folks don't have a family physician.  I've had my primary care (professionally) handled by one NP or another since my own family doctor died 20 years ago.

So, while _some_ ER visitors may be malingerers or hypochondriacs, there are other reasons for excess ER use that need to be addressed as well.


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## ModlrMike (8 Aug 2013)

milnews.ca said:
			
		

> I understand where you're coming from at your particular coalface, but how many folks coming into your ER come in because:
> 1)  they don't have a doctor;
> 2)  the only walk-in clinics available will only allow patients on their roster; or
> 3)  there's no nurse practitioner clinics available to go to?
> ...



You raise some valid points, and I can address them, but solely as my own opinion:

The shortage of family MDs in Canada is well studied and current research points out that while there are sufficient MDs to attend the population, many young family doctors are opting to work short hours with a low patient census; putting quality of life ahead of dedication to practice. This phenomena is not confined to MDs, but can be seen in the young workforce regardless of industry. 

Fewer NPs are opting to work in primary care for the same reasons as MDs, particularly as many are in their prime child bearing years and are more focused on family. In addition, the tax regime here in MB is punitive, even for professional corporations. This stifles entrepreneurial spirit and prevents the opening of more walk in clinics. 

We also have a large immigrant community who prior to living in Canada would have to pay out of pocket for healthcare. Now that it's "free" their consumption of healthcare resources is greater than a similarly sized non-immigrant sample. Understand that the foregoing is not an anti immigrant rant, but rather a reflection of direct observation.


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## The Bread Guy (8 Aug 2013)

ModlrMike said:
			
		

> The shortage of family MDs in Canada is well studied and current research points out that while there are sufficient MDs to attend the population, many young family doctors are opting to work short hours with a low patient census; putting quality of life ahead of dedication to practice. This phenomena is not confined to MDs, but can be seen in the young workforce regardless of industry.


Understood - the newer docs out of med school aren't the "die in the harness" workhorses that are retiring.  That said, I've seen the same stats showing we have enough docs _across Canada_, but remote and rural locations aren't helped much by docs deciding to live in major centres that aren't reasonably accessible from said remote/rural areas.  There are lots of ideas to fix doc distribution problems out there, but none that the docs as a whole would like.



			
				ModlrMike said:
			
		

> Fewer NPs are opting to work in primary care for the same reasons as MDs, particularly as many are in their prime child bearing years and are more focused on family. In addition, the tax regime here in MB is punitive, even for professional corporations. This stifles entrepreneurial spirit and prevents the opening of more walk in clinics.


Didn't know about the tax regime having such an impact.  It sounds like Ontario's done a bit more than MB to encourage/help NPs get up and running in clinics like these.



			
				ModlrMike said:
			
		

> We also have a large immigrant community who prior to living in Canada would have to pay out of pocket for healthcare. Now that it's "free" their consumption of healthcare resources is greater than a similarly sized non-immigrant sample. Understand that the foregoing is not an anti immigrant rant, but rather a reflection of direct observation.


THAT isn't as much of an issue that I can see here, but it would likely add up pretty quickly in larger centres with loads more immigrants.

Thanks for a bit more of the rest of the story.


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## mariomike (8 Aug 2013)

milnews.ca said:
			
		

> So, while _some_ ER visitors may be malingerers or hypochondriacs, there are other reasons for excess ER use that need to be addressed as well.



Some people used to tell us that if they went to Emergency via ambulance, that they believed they would see a doctor sooner than if they went on their own. 

That tactic used to delay service to higher priority calls. Apparently, it still does.


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## pbi (9 Aug 2013)

mariomike said:
			
		

> Some people used to tell us that if they went to Emergency via ambulance, that they believed they would see a doctor sooner than if they went on their own.
> 
> That tactic used to delay service to higher priority calls. Apparently, it still does.



And this, I understand, is the reason why some provinces charge for ambulance service, as opposed to providing it "free" under Provincial Health. I have paid for EMS in both AB and ON, which is fine because I could afford it, and I understand the reasoning.

The question of the "entitlement" mentality is one that worries me.  Although I probably come down a bit to the Left of many people on this site when it comes to some social issues, this thing is one where I tend to the Right.

The "blame-entitlement" mentality is sickeningly prevalent in this country. (Sadly, I ran into it far too often in the military...) In my experience, in society at large it is most common amongst people with lower incomes, education and social status (the biggest consumers of various "entitlements"), but not exclusively. To me it s a product of an excessive focus on rights that is not balanced by a respect for responsibilities. There is a happy medium that I would call "good citizenship".


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## mariomike (9 Aug 2013)

pbi said:
			
		

> I have paid for EMS in both AB and ON, which is fine because I could afford it, and I understand the reasoning.



As you likely know pbi, in Ontario, ambulance service is billed at a rate of $240.00, of which all but $45.00 is covered by provincial health insurance.

Patients can claim the $45.00 on their private insurance. 

Persons receiving benefits under the Ontario Works Act, the Ontario Disability Support Program Act or the Family Benefits Act or provincial social assistance (general welfare assistance or family benefits) are not billed.

Cheers


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## Cbbmtt (9 Aug 2013)

In B.C. ambulance service is not covered, that's one of the selling points to my job as we provide those benefits. 

Ambulance is around $100 in B.C. and an Air Lift is approximately $1000. 

I believe very low income also do not pay for these services.


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## Infanteer (9 Aug 2013)

Amb in BC is $500.  Had to pay it before.


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## Cbbmtt (9 Aug 2013)

Infanteer said:
			
		

> Amb in BC is $500.  Had to pay it before.



*Non-MSP Beneficiaries*: All the above Ambulance Transport Categories

persons with no valid BC Care Card (e.g. visitors to BC/non-residents, as well as work related injuries, claims under RCMP, and other federal agencies).

$530 flat fee (ground service)
$2,746 per hour (helicopter)
$7 per statute mile (air plane)

I was talking about if you are a B.C. Resident, it's $80 bucks.


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## Bruce Monkhouse (9 Aug 2013)

...and if someone really, really needs an ambulance then that is cheap.


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## observor 69 (10 Aug 2013)

Heard in ER " Can I get the ambulance to drive me home?"


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## Edward Campbell (28 Aug 2013)

E.R. Campbell said:
			
		

> My favourite _system_ is Singapore's: everyone is covered, no one gets "catastrophic" medical bills, but nothing is free. Here, from the government's web site is an outline of it:
> _________________________
> Singapore Healthcare System
> 
> ...




Walter Russell Mead looks at Singapores system in this post which is reproduced under the Fair Dealing provisions of the Copyright Act from his blog _viaMeadia_:

http://blogs.the-american-interest.com/wrm/2013/08/28/singapore-where-affordable-care-is-a-reality/


> Singapore: Where Affordable Care is a Reality
> 
> August 28, 2013
> 
> ...




One model Americans need not examine is Canada's, we, like them, spend too much and get too little for our money in terms of "outcomes."

Equally, Canadians, must stop fixating on American health care ~ there are, indeed, lessons to be learned there but they are, by and large, related to what not to do.

As to medical innovation: there is lots in America, but there is lots, too, in e.g. : Canada, the Czech Republic, Britain, South Africa, Germany, France and Singapore. The issues is to share knowledge and, for a country like Canada, to follow a model that works ... ours doesn't; America's doesn't; Singapore's does.


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## dapaterson (28 Aug 2013)

An interesting article from a year ago suggests that The Cheesecake Factory may be the model the US health care system should emulate.

http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande


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## Colin Parkinson (28 Aug 2013)

I always get tired of the either or argument. I have seen the Malaysian Health care system up close and have a sister inlaw deeply involved in policy making in it's regards. A useful model to look to.

_Healthcare in Malaysia is mainly under the responsibility of the government's Ministry of Health. Malaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government-run universal healthcare system and a co-existing private healthcare system. Infant mortality rate – a standard in determining the overall efficiency of healthcare – in 2005 was 10, comparing favourably with the United States and western Europe. Life expectancy at birth in 2005 was 74 years_

http://en.wikipedia.org/wiki/Healthcare_in_Malaysia


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## a_majoor (27 Oct 2013)

Well plenty of people have said "told you so", but DBD lays out the cause and effect in a very compact form. Notice the consequences of government intruding even farther in an already dysfunctional system: 300,000 people dumped from their coverage, premiums rising rapidly (even doubling) for most people (that is, people who were even able to get on the system....) and intrusive busybodies "acting in the bset interests of applicants assisted" (they are working for someone's best interest, but it isn't the customer buying insurance....)

http://www.daybydaycartoon.com/2013/10/27/


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## a_majoor (2 Nov 2013)

More on the US healthcare mess. Apparently only 6 people were able to navagate their way through the website and actually purchase insurance (vs 300,000 who got their insurance cancelled in Florida alone). Don't worry, the person responsible has a new plan!


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## a_majoor (20 Nov 2013)

WSJ nails it, and in the process outlines a plan that would work well for Canada as well. Like our cousins to the south, we spend an inordinate amount of money for a very poor outcome. This proposal brings back the element of competition and market forces to control costs and prioritize resources, the only thing missing is transparency in how tings are priced (i.e. you not only know how much you pay for insurance, but also how much the doctor or hospital is going to charge you before you decide to fork over insurance or deductable money).

http://online.wsj.com/news/articles/SB10001424052702304439804579208020624280740



> *How the GOP Should Fix ObamaCare*
> Along the way Republicans can create real choice, real competition and real savings while protecting those who need help.
> 
> By HOLMAN W. JENKINS, JR.
> ...


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## a_majoor (11 Dec 2013)

As more and more details bacome apparent to the American people (things that commentators identified would happen long ago BTW), the idea of "Potempkin websites and "onions of fail" begin to take root. This article identifies some of the root issues with why Obamacare will fail (there are other articles that ignore the structural failures here and focus on the transactive failure: young people are refusing to sign up for overpriced "Healthcare" to subsidize the sick and poor). What is interesting is Obamacare induces the same failures we already experience in Canadian healthcare into the already expensive American system:

http://www.the-american-interest.com/blog/2013/12/10/aca-increases-deductibles-by-42-percent/



> *ACA FAIL FRACTAL*
> 
> The Deeper You Get, The More Dysfunction You See
> Deductible shock is here. The WSJ reports that many Americans will experience serious deductible increases as the Affordable Care Act plans go into effect:
> ...


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## a_majoor (28 Dec 2013)

While the WSJ is making an observation about the American heath care market, virtually all of the observations apply in spades to our own dysfunctional system as well, and adopting policies like this would deliver a massive shock to the ossified current system and break barriers that stifle competition. With health care consuming 40% or more of provincial budgets, this is really the only way to go:

http://online.wsj.com/news/article_email/SB10001424052702304866904579265932490593594-lMyQjAxMTAzMDIwNjEyNDYyWj?cb=logged0.8838936918363806



> *What to Do When ObamaCare Unravels*
> 
> Health insurance should be individual, portable across jobs, states and providers, and lifelong and renewable.
> 
> ...



As to why Obamacare is so totally dysfunctional; you need to understand it has nothing to do with "healthcare" and everything to do with forced intergenerational transfers of wealth (healthy young people subsidizing sick and older people's insurance) and control over a large portion of the American economy  by political crony capitalists. In those respects it should work quite well (except that young people see through the scam and are not signing up on the "exchanges").


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## a_majoor (19 Jul 2014)

Interesting observation from Bloomberg, costs have actually been falling across the English speaking world since 2005, and the rest of the developed world as well. Given the dramatic differences in how systems are organized, it is difficult to determine why this should be happening, although the spread of technology, and in particular communications and IT technologies may have something to do with this (new procedures and discoveries can pass through the medical community much faster than before, allowing for better and more cost effective treatments to spread rapidly). As the author points out, there can also be negative factors leading to cost reductions, so it is important to identify what is actually going on.

http://www.bloombergview.com/articles/2014-07-17/obamacare-isn-t-what-s-slowing-costs



> *Obamacare Isn't What's Slowing Costs*
> JUL 17, 2014 5:25 PM EDT
> By Megan McArdle
> 
> ...


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## ballz (17 Aug 2014)

http://www.theglobeandmail.com/globe-debate/apples-to-apples-canadas-health-system-underperforms/article19351870/?utm_content=buffer3d879&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

*Apples to apples, Canada’s health system underperforms*



> Relatively expensive and underperforming. These words describing Canada’s health-care system are now widely accepted in political and medical circles – in contrast to what we heard as recently as a decade ago, when “experts” and politicians still insisted that Canada had one of the best systems in the world.
> 
> But is Canadian health care underperforming as badly as the Commonwealth Fund believes? We can only hope not, because if the U.S.-based foundation is even remotely correct, Canada’s system needs even more work than had been feared.
> 
> ...



I have put a bit of thought into healthcare reform. There is no doubt that that the private market would be more efficient. That said, there is something to be said about leaving the less fortunate completely out to dry. While a "pure" libertarian approach would suggest that with all the extra wealth in a libertarian society, people would be free to support various charities and community organizations or churches to support the less fortunate in their community in a way that they see more fit, this part of the utopia never actually plays out in the real world.

For healthcare reform, I would like to hear your thoughts / critiques / queries on this:

1. Completely privatize the market.

2. Allow all citizens the choice to choose any private insurance package they want from any insurance company.

3. Have the provincial governments select an insurer from the private market through a competitive process. This will:

        a. Mean the provincial governments are able to select an adequate level of care, at the most competitive price; and

        b. With 13 provincial governments plus all private citizens looking for insurance, keep the market competitive.

4. All persons under 18 will be, at minimum, covered by the provincial policy.

*5. All persons making under 20k per year will be covered by the provincial policy for free, and can purchase additional insurance if they wish.

*6. All persons making between 20k - 30k a year can pay 25% of the premium to be covered by the provincial plan, and can purchase additional insurance if they wish, - or - can choose their own policy on the private market and pay the full premium.

*7. All persons making between 30k - 40k a year can pay 50% of the premium to be covered by the provincial plan, and can purchase additional insurance if they wish, - or - can choose their own policy on the private market and pay the full premium.

*8. All persons making between 40 - 50k a year can pay 75% of the premium to covered by the provincial plan, and can purchase additional insurance if they wish, - or - can choose their own policy on the private market and pay the full premium.

*9. All persons making over 50k a year can pay 100% of the premium to be covered by the provinicial plan, and can purchase additional insurance if they wish, - or - can choose their own policy on the private market and pay the full premium.

The effect here is as follows:

1. Private insurers would want the provinces to choose their package because of the potential to make HUGE profits, so the provincial plan would be of great value.

2. The provincial plan has basically become a "group insurance" plan, but you have the option to shop elsewhere if you so choose.

3. Obviously, because the provincial plan is subsidized for certain people (minors, the poor, and the lower-middle class), there will still be some taxation of the rich. However, the tax burden on the wealthy will be a fraction of what it is now because the private market will be much more efficient at providing insurance, and because a much smaller amount of Canadians receive coverage. The world isn't perfect or else there would be no gov't subsidies required, but this is much better than what we currently have.

*Note for points 5 - 9... I haven't actually crunched any numbers on this. The idea is simple, a graduated expectation on the individual, based on their income, that they will look after themselves. Brackets would probably need to be adjusted, and method of subsidizing may also. For example, why would someone making $19,999 want to earn another dollar if it means they will have to pay 25% of their healthcare premium. Certainly, the details of points 5 through 9 are not ironed out, but the point is to demonstrate the intent.

EDIT: I originally posted this on the Libertarian Party of Canada Facebook page, so I had to take out some of the wording that was meant for that audience that does not necessarily apply on this forum.


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## a_majoor (17 Aug 2014)

As a contrast to what you are proposing, the real situation on the ground in the U noted States is that larger numbers of doctors have simply abandoned the bureaucratic (Medicare/Medicaide) and health insurance/Obamacare markets entirely and have set themselves up as exclusively private practitioners. These cash only practices (often known as Concierge Medicine) are generally smaller, run at a slower pace (no 15 minute "in and out" appointments) and the doctors control the patient intake as a means of setting their own quality of life.

The point here is that heavily regulated and bureaucratized systems have large negative incentives for the people trapped within, as well as lots of seams for people to "game" the system (much like your example of a person making $19,999 not wanting to advance to the next bracket). There is no one solution, and indeed there should not be any consideration of a "one size fits all" market. It does not work in any other field, from buying groceries to hiring skilled labour, so why should it be expected to work in medicine?

As a checksum, you can consider the situation in Ontario, where there is a huge shortage of doctors and medicinal support staff (many families cannot get a doctor at all), to the relatively less regulated field of dentistry, where new dentists set up practice all the time and "New Patients welcome" signs grace most dental practices. I suspect that if the Canada Health Act were abolished there would be a 10 year period of flux (mostly because it takes about that long for new doctors to get through the pipeline) and then a multi tier system of practices would have settled in place, ranging from low cost clinic settings to individual private practices, and many things in between.


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## Colin Parkinson (9 Sep 2014)

I think you find that the large companies once established will be the first to push for regulations to prevent competition. Free market is not going to touch anyone who will cost money and has little of it. That's why we went with healthcare in the first place, because we had private healtcare and it underperformed for the average person. That's not to say that the current system is sustainable, but I would rather see more mixing of the 2 and reducing bureaucracy both within government and business. If you do deregulate, you will need a robust regulatory unit that can investigate and punish those who screw people. That will require political stones, which generally are lacking, because as soon as you come down hard on the wankers, they will go bleating to the politicians about big bad regulators.


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## Edward Campbell (4 Nov 2014)

A new _infographic_ from _The Economist_:






Now, clearly, we would like to spend like Finland and have outcomes like Japan but, look at Australia, a country much like us - they spend less than us, by a full 2% of GDP and they have somewhat better outcomes in deaths per 100,00 from both non-communicable diseases and accidents. What are they doing right? Look at Fig 2.1 here; there is substantial *private* money in all segments. Private funding tends to create efficiency, _in my opinion_.


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## pbi (4 Nov 2014)

I tend to agree, cautiously. While I still believe that the principles underlying our health care concept (I hesitate to call it a "system") are very fine and honourable Canadian ones, I think that more private service provision is good, provided we have appropriate regulation to ensure that the bottom line doesn't become the driver for everything. 

After all, isn't the drugstore a vital part of the healthcare system? But who, in their right mind, proposes that drug stores should be run by the Govt?

 As long as standards are met, and the same level of access is available, and nobody lacks for care because they don't have the means, then I have no problem that health care services are delivered by private operators.


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## a_majoor (26 Dec 2014)

Vermont discovers that "Canadian Style" single payer health care is simply too expensive to sustain:

http://www.bloombergview.com/articles/2014-12-23/vermonts-lessons-for-fans-of-singlepayer-health-care



> *If Single Payer Can't Work in Vermont...*
> 1436 DEC 23, 2014 1:07 PM EST
> By Megan McArdle
> 
> ...



The other factor which the author overlooks is that many health care systems are not transparent i.e. you (the consumer) have no idea what the actual costs of medical goods and services are. Systems where the consumer is an active participant in the market and has good quality price data do keep costs down.


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## a_majoor (24 Jun 2015)

Pricing data for cancer drugs is coming on line, and the effects of developing a market mechanism are expected to be startling in both the cost and quality fo healthcare. This is the sort of thing that Canada needs to bring our health care costs under some sort of control:

http://www.the-american-interest.com/2015/06/24/bringing-healthcare-into-the-21st-century/



> *Bringing Healthcare into the 21st Century*
> 
> Price transparency is coming to cancer drugs. The New York Times reports that the American Society of Clinical Oncology is working on a “‘value framework'” system to make both the cost, including out-of-pocket costs to the patient, and the effectiveness of drugs more accessible:
> 
> ...


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## cupper (24 Jun 2015)

There was an interesting discussion yesterday on NPR regarding the cost of newer drugs for treating the more difficult illnesses such as AIDS and Hep C.

http://www.npr.org/2015/06/24/417045119/calif-health-officials-aid-people-facing-astronomic-drug-bills

They focused specifically on the Hep C drug, and how the significant cost for treatment to cure the disease is prohibitive for most. And how it can jack the cost for government drug programs to astronomical levels. For the Hep C drug a round of treatment runs around $1000 per pill, and a full course could cost $140,000.

The argument for having drugs like these covered is that the alternatives are drug cocktails that are not as effective, and only limit or slow down the progression, or treat symptoms not the underlying illness, and may require the patient to go on the cocktails for long term or lifetime. And the long term effects of the diseases such a organ damage or failure could potentially cost far more than the more expensive drug. The one caveat being that there is a certain population for which these drugs are ineffective as well, as was the case for the person in the interview.


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## Brad Sallows (25 Jun 2015)

My usual question still stands: if $X per year is an amount we are willing to pay to cure someone or keep him alive for one year, should that not be the benchmark minimum for any person with any ailment?


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## cupper (25 Jun 2015)

Brad Sallows said:
			
		

> My usual question still stands: if $X per year is an amount we are willing to pay to cure someone or keep him alive for one year, should that not be the benchmark minimum for any person with any ailment?



No specifically, No. It comes down to a cost-benefit analysis of the various scenarios, and getting an acceptable outcome for the least expense. And the insurance companies here love to make it as difficult as possible to get to that outcome.

For example, if you suffer from gastric reflux, your doctor can't just prescribe the best thing on the market. You need to try the least expensive option first. Then the move to the next one if that doesn't work, and so on. Step Therapy as it is known. Which is understandable to a certain degree. However, if you have already used that medication before and know it works, you need to provide your insurance company documentation and appeal the decision and could wait days or weeks before you get the medication you need. This happened to me twice. The first time it took 6 months before I finally got on a med that worked because the insurance company insisted on step therapy, and 3 months on each drug before they finally allowed the more expensive drug, which was the only effective treatment for me for what I was dealing with. I knew it was the only effective one available because I was given the same med when I was living in Canada. Then 3 years later the same ailment came up, but because I had a new insurance provider, they required the same process to be followed. This time it took a week to get the correct meds, but we had to jump thorough many hoops and submit records and documents to get it.


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## Brad Sallows (25 Jun 2015)

I expressed myself too vaguely.

Basically, if we have a bunch of people in hand with completely different requirements and an upper bound determined by the cost of the most expensive course of treatment covered, I'd like the guiding principle to be that every treatment costing less is also covered - certainly every more necessary treatment.


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## cupper (25 Jun 2015)

One problem with that is insurance companies will still be able to set different levels as to how much each medication is covered.

Most plans down here are based on a tiered system. You typically have 3 tiers - generics - preferred (lower cost brand names) - and non-preferred (higher cost brand names or newly released meds / drug combos), and each tier has a separate rate of coverage or copay. Sometimes you have a 4th tier where high cost specialized drugs for things like cancer treatment, HIV, Hep C and so on.

The insurance company may set coverage limits based on that upper bound, but then set the out of pocket cost to you at a rate that would still make it prohibitive, or incentivizing lower cost generics over more effective brand names.


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## fullflavor (23 Jul 2015)

One psychiatric counselling visit is charged $40 dollars each at the expense of the government. Imagine the taxes that the government can generate if a rich patient can pay $200 to $300 with or without his health care insurance under two-tier. A two-tier health care system does not mean that counselling would be denied to a poor patient. That is why it is called two-tier to serve both the 'rich (word repeated 40 times in the Quran, Bible and Torah) and the "poor" (word repeated 200 times in the Quran, Bible, and Torah). The problem lies on how the (moles) of the Conservative and Liberal governments aggravate the situation by denying them to the poor or charging them enormous amount of monies under the so-called 'austerity programs to discredit the Harper government'. No wonder we are 1 trillion in debt! Economic sabotage is not a long gone concept.


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## DBA (18 Aug 2015)

Brad Sallows said:
			
		

> My usual question still stands: if $X per year is an amount we are willing to pay to cure someone or keep him alive for one year, should that not be the benchmark minimum for any person with any ailment?



I am not sure if your trolling or think this would work.

There is no infinite pile of money - costs have to be kept down or it will run out. That some very expensive treatments can be provided for those in dire need of them is precisely because the majority can be treated less expensively. 

An example would be having an infection for which an antibiotic is prescribed. Those allergic to Penicillin would usually get treated with an alternative that costs more while the majority get Penicillin. Without a medical need for the more expensive treatment providing it is just wasting money that could be used in situations where a more expensive treatment is medically neccessary.


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## mariomike (10 Jan 2017)

Don't know if this is legit or not, but I thought it was funny,

Man celebrating vote to repeal Obamacare learns he is on Obamacare.
http://imgur.com/gallery/rWIhcx6


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## cupper (11 Jan 2017)

It's not legit. Nothing has been voted on, and the GOP suddenly came to the realization that if they repeal it, they own whatever they replace it with. 

And they are also getting pushback within their own ranks about repealing without having an acceptable plan to replace it at the same time.

To get anything through as a replacement will take 60 votes in the Senate. Which means they would have to convince 8 Democrates to vote with them. Can you say "Snowball's chance in hell" ?


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## Blackadder1916 (11 Jan 2017)

cupper said:
			
		

> It's not legit. Nothing has been voted on, and the GOP suddenly came to the realization that if they repeal it, they own whatever they replace it with.
> 
> And they are also getting pushback within their own ranks about repealing without having an acceptable plan to replace it at the same time.
> 
> To get anything through as a replacement will take 60 votes in the Senate. Which means they would have to convince 8 Democrates to vote with them. Can you say "Snowball's chance in hell" ?



Whether the Facebook(?) thread shown in the screen-grab is a legitimate exchange or made up to highlight the idiocy of many voters is another matter.  It wouldn't surprise me either way.  As for the need for sixty votes, that is the vote the possible idiot(?) is celebrating, the first stage in the Republicans' path to essentially overturning the Affordable Care Act - making use of Senate rules so that they can get their way.  It is better explained here.

http://www.vox.com/policy-and-politics/2017/1/9/14213702/senate-obamacare-repeal-budget-resolution


> The Senate is voting to make sure 51 votes, not 60, will be necessary to pass Obamacare repeal
> 
> Most ordinary bills in the Senate can be filibustered. It takes 60 senators to overcome a filibuster and advance a bill, and since there are only 52 Republican senators this year, that means Democrats can block the vast majority of bills if GOP leaders can’t win their cooperation.
> 
> ...


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## cupper (11 Jan 2017)

Blackadder1916 said:
			
		

> Whether the Facebook(?) thread shown in the screen-grab is a legitimate exchange or made up to highlight the idiocy of many voters is another matter.  It wouldn't surprise me either way.  As for the need for sixty votes, that is the vote the possible idiot(?) is celebrating, the first stage in the Republicans' path to essentially overturning the Affordable Care Act - making use of Senate rules so that they can get their way.  It is better explained here.
> 
> http://www.vox.com/policy-and-politics/2017/1/9/14213702/senate-obamacare-repeal-budget-resolution



But as I pointed out, It will take 60 votes to pass any proposed replacement. The repeal is inserted in a budget bill which arcane rules allow only a simple majority to pass under the reconciliation rules. But the replacement cannot be introduced under that process, so it can be filibustered indefinitely.

And the current mood is that they need to have a replacement ready to go at the same time. No delay between repeal and replace.


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## a_majoor (17 Jan 2017)

Which is rather ridiculous. The market has already developed several work around solutions for people who lost their doctors and healthcare plans under Obamacare, and allowing market mechanisms to operate is the only way to bring costs down. For the most part, the reason costs are astronomical are the extra requirements inserted by the government (such as transferring patient data to electronic formats), interference in the insurance market (people were constrained to buy insurance from companies in State, hence each company has a much smaller pool and each customer has a more restricted number of providers to choose from. So making the insurance market truly "national" will also provide more competition and choices.

The other issue which distorts the market and makes it difficult to control costs is the market isn't transparent. Few patients know the costs of their treatments, Medicare and Medicaid distort the prices and of course without tort reform, doctors are pretty much forced to order every test imaginable to cover their butts in case of malpractice suits. Opening the market (such as with "cash and carry" Doctors) can do wonders when people can "shop around" for the best prices for routine care, and the best prices for "catastrophic" insurance coverage.


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## The Bread Guy (17 Jan 2017)

Thucydides said:
			
		

> ... For the most part, the reason costs are astronomical are the extra requirements inserted by the government (such as transferring patient data to electronic formats) ...


Also, because the private sector would _ever_ take advantage of increased demand via a _mandatory_ requirement for coverage by jacking up prices, right?  Sort of like gas prices going up over long weekends?


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