# Money for Health Care



## canuck101 (14 Sep 2004)

Well i hope there is some money left over after this meeting. He seems to be giving in to the premiers.  We better be sitting on a crap load of surplus money or he is going to ask every department to find savings. You know who is going to look at first.

here is the website. http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1095072266881_286/?hub=CTVNewsAt11


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## I_am_John_Galt (14 Sep 2004)

It's not the amount of money that is the problem, it's HOW the money spent (i.e., poorly) ... but it's much easier for the politicians to claim numbers (regardless of how creative the accounting to arrive at them was) than to actually address the systemic problems that will only be exacerbated by throwing more money at them..


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## dutchie (14 Sep 2004)

Does anyone else feel that while watching/reading about the debate, that it's kinda like watching a group of burglars divying up your possesions? Either way, we are not likely to see a marked improvement in the quality of our health care system. 

I do like the IDEA of universal Pharma-care though.....we'll see what happens there.


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## Kirkhill (14 Sep 2004)

I don't like the idea of a National Pharmacare Programme.   Please leave the money in my own pocket.   I'll handle the situation myself.

Greg Weston http://www.canoe.ca/NewsStand/Columnists/Ottawa/Greg_Weston/2004/09/14/628281.html argues that we spend on average $5500 per year per family on health care.   He is wrong.

$88,000,000,000 Government Spending + $38,000,000,000 Private Insurance and Direct from OUR Pockets

Total 

$126,000,000,000 spent on health annually

31,000,000 Canadians

Net Effect

$4,064 spent per Canadian per year

I have a family of 4. 

4x $4,064 =

*$16,258 per year for my family*


My wife and I control about $4000 per year of that expenditure (thankfully that is a lifetime average and not this year's expenditures).   The other $12,000 is spent by bureaucrats.

What am I getting for my money again?

Leave the 12k in my pocket.   Reduce the taxes and let me handle my own health plan.   

By the way on a per capita basis 4k per year, over 75 years, would leave me with a lifetime pool of $300,000 to invest.

Buy a fair chunk of care with that.


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## canuck101 (14 Sep 2004)

They are all grand standing and playing to the camera's.  There needs to be real reform in the health care system.  there is still to much administration and not enough front line workers.  My father has cancer and ever time he goes into the hospital he has to fill in the same forms over again even if they have him on file.  Not everyone needs a MRI when there are cheaper ways to get the information but people hear about a new piece of equipment and think it must be better when the old procedures work fine.


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## canuck101 (14 Sep 2004)

The provinces want new money and don't want any strings attached.  The Ontario government already has waivered on the way that they are going to use the new health care premium that they are charging everyone in Ontario. I don't think we can trust them with more money. the money will be used for other things that are not health related.


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## dutchie (14 Sep 2004)

Kirkhill:

I can appreciate your view on the large sum of money each Canadian spends on Health Care, and I won't even argue the numbers you used. But are you suggesting that we abolish universal health care? The reason why I ask this is that the link you provided was to an article that outlined the cost of medicare, not pharmacare. You seem to object to what you're paying now, ergo, I assume you would prefer to 'go it your own' regarding your and your families medical care costs. 

I for one like medicare, and feel it is THE integral social program of Canada, but certainly not free of its own problems (hence the reform needed). You might be able to afford your own medical bills now, but what happens if you or any other Canadian gets Cancer and can't work? As Canadians, we all pay a moderate amount so that those with huge expenses don't go without care and die. 

The costs might be high, and as individuals we might get lucky year to year and avoid huge bills, but the day one of us comes down with a bad disease or even has a car accident, most of us would be completely hooped. Insurance is not an option for most, the argument lies in whether we want private (US-style) or public (Canadian-style)insurance.


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## I_am_John_Galt (14 Sep 2004)

The Canadian Healthcare system is a disaster: it doesn't provide anywhere near 'universal' coverage and has come at an outrageous (and unsustainable) cost.  In a single word, it is Stalinist*: and the rest of his economic programmes haven't worked out too well, either.  Even the most hardcore Socialists seem to have abandoned their former claim that it is a "model for the world" as exactly zero other countries regard it as a model worth copying.

However American bus-tour seniors are grateful to Canadian taxpayers for subsidizing their drug costs.   :-[


*ie: bureaucratic, authoritarian exercise of state power and mechanistic application of Marxist-Leninist principles.


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## dutchie (14 Sep 2004)

I agree, more or less, with John  in that the Health Care system is in need on reform, but I still think it is worth saving. I certainly don't feel quite as offended as John seems to be. I guess I'll chalk it up to a wee bit of hyperbole on his part.

Interesting series on Global about some nation's health care system that ARE models. France was on last night, and their system seems to work for them......


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## Infanteer (14 Sep 2004)

Here is my thoughts on Health Care and needed reforms:

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


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## dutchie (14 Sep 2004)

Well said (again) Infanteer. For $20/hour, that shitter better shine like a diamond.

BUT-lets not shi*can the whole thing because we let the provincial govts (mostly left-wing) approve outrageous CBA's for non-health care hospital workers. I say, keep cutting the non-skilled worker's pay until it gets to something comperable to the private sector, and then the govt will be in a much better position to deliver good, affordable health care to everyone.


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## I_am_John_Galt (14 Sep 2004)

Caesar: Geez, you seem like a good guy, I'm glad we agree on at least one thing!   

But about the Heathcare System, I am more irritated than offended.  Without a word of exaggeration, we are talking about a system that any first-year economics student could tell you was bound to fail and yet the politicians (and the rest) scream blue murder if you try to change by doing anything other than throwing more money at the problem ...

Didn't see the TV special, but I'm not sure that France's health care system should be a model for anything other than how NOT to run one: how many thousands died from a "heatwave" that was about as bad as a typical August in Toronto?

Infanteer; I was going to mention Singapore's system (studied it briefly at school), but I see you've brought it up already (I didn't realize that US Corps. were using it, too)!  As well, I think they have coverage for "catastrophic" costs (i.e., over budget).  Caesar; are they covering Singapore on Global?  That might be worth checking out, in a Canadian context.


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## I_am_John_Galt (14 Sep 2004)

Caeser said:
			
		

> keep cutting the non-skilled worker's pay until it gets to something comperable to the private sector



A very good start: I've yet to hear a coherent defense of how outsourcing a hospital's laundry at half the cost of in-house service (for example) represents a deterioration in "quality" of health care.


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## dutchie (14 Sep 2004)

John: The Global thing will cover France (no wait lists, combo public/private), Germany (efficient hospitals), Holland (don't know what it's about, other than 'alternative thinking'), Britain (had similar problems to us, but fixed or is fixing them), Switzerland (can't remember their thing).....and I think that's it.

Last night was the first instalment. It's on the 6 o'clock news. If you're from BC, you should get it. Don't know if it is going to be on in other areas.

With the amount of cash being consumed by the system, we should have zero problem providing good health care, with minimal or no waiting lists, and still give health care workers a decent wage. We're are so far off that it's ridiculous. But I still want the service, I still think it's worth saving, and I still think that it's possible. Clearly, if we do nothing, the system will take that decision out of our hands, as it will collapse. 

Re:"_I've yet to hear a coherent defense of how outsourcing a hospital's laundry at half the cost of in-house service (for example) represents a deterioration in "quality" of health care_"........no kidding. I would prefer it be done by workers in the hospital, or at least in the province, but not at twice the cost. Those dollars could go to some sick grandma's heart pills, or some guys prostate surgery, etc, etc. Too many people are getting very sick and even dying so we can pay someone stupid money to wash poop from a sheet.
Oh, and I'm equally shocked at our agreement considering our last tete-a-tete.


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## Kirkhill (14 Sep 2004)

From Ceaser



> As Canadians, we all pay a moderate amount so that those with huge expenses don't go without care and die.



Ceaser, $16,000 a year is NOT a moderate amount.   I lived in the States for a couple of years and paid for personal health insurance and even with matching funds from my employer and personal out of pocket expenses I paid nothing like those types of sums.   I was the sole bread-winner at the time, my wife not being allowed to work in the States.

What $16,000 represents now, and that actually is less affordable under my current circumstances, is an insurance premium of $1300 per month.   The fact that a $1300 premium gets me and my family the type of care that it does is the cause of my "aggravation".

I am not against supporting those that are unable to pay the freight.   I would fully support, based on a means test, paying the premiums for the indigent and catastrophic costs for the many.   

What I have a problem with is this government insurance and supply monopoly, bureaucrats rationing care and denying me the opportunity to purchase such care as I wish to ensure my family's future.

Bottom line, I would rather have a choice of three or four private suppliers working for profit, sure in the knowledge that at least one of them is trying to gouge me, than trust some faceless, grey bureaucrat buried in some dungeon someplace rationing my family's care "dispassionately" and delivering it six months too late.

By the way I am 48 years old, have two teen-agers, have buried both of my parents and my father-in-law due to cancer.   I have had ample opportunity to see both the Canadian and US systems at work.

Notwithstanding the problems with car insurance, I would sooner use car insurance as   a model than the current mess in which we find ourselves.

Rant Ends, Over.....


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## unknownsoldier (14 Sep 2004)

canuck101 said:
			
		

> Well i hope there is some money left over after this meeting. He seems to be giving in to the premiers.   We better be sitting on a crap load of surplus money or he is going to ask every department to find savings. You know who is going to look at first.
> 
> here is the website. http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1095072266881_286/?hub=CTVNewsAt11



Oh! every governmet in power should treat itself like a business enterprise. To those who studied accounting and auditing, the accountant or the manager makes sure that the company will not suffer a loss. Common sense. If you keep on dangling welfare to the people [who would refuse welfare unless one is as patriotic as CF. No one unless they know what overspending can entail] In chicago public hospitals they treat malignant tumor free. Including morphine that calms down tremors. If we pass a law on economic SABOTAGE and Lee Kwan Yew will testify that Mike Harris ,Gordon Campbell and Brian Mulroney did the right thing, who is guilty then? Liberals, Conservatives, New Democrats,Socialists or Communists?? I am not sure of the first two mentioned. But i am sure of Communists!


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## childs56 (14 Sep 2004)

well we all know why us military folk in ont have pay health care prems now. got to love a gov't that takes form one pocket and puts in the other


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## Cloud Cover (14 Sep 2004)

Infanteer said:
			
		

> Here is my thoughts on Health Care and needed reforms:
> 
> http://army.ca/forums/threads/18097.0.html



Infanteer, have you effectively summarized and captured the essence of Code Blue in the above thread, and is the book worth while reading beyond what you have posted?


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## canuck101 (15 Sep 2004)

Every member of the CF has to pay into employment insurance and can not collect it if i remember right. :-\


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## Infanteer (15 Sep 2004)

> Infanteer, have you effectively summarized and captured the essence of Code Blue in the above thread, and is the book worth while reading beyond what you have posted?



I would pick it up.  Pretty interesting; the doctor is basically approaching Health Care reform from an economical viewpoint (hence the consumer/provider relationship).  If anything, it is a fresh idea as opposed to the current political discussions going on (we need more money!).


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## dutchie (15 Sep 2004)

canuck, CF members can most certainly collect EI. In order to collect EI, you need the following:

1) to have worked enough hrs in the last 52 weeks or since your last claim (they average a reg force members day to 7 hrs).
2) to have a separation from employment (layoff, fired without cause, quit with cause, illness, injury, pregnant, caring for newborn/adopted child, etc)
3) have all records of employment for the last year (or sometimes 2 yrs).
4) apply for benefits.

most reg force soldiers never collect EI only because they don't get a separation of employment....but if they did (either by layoff or for maternity/parental, sickness, compasionate care, etc), they can collect.

lots of reserve soldiers have collected EI (this one included), particularly after Roto, if they don't have a civie job to come back to.

but this is off topic - just thought I'd clear this up.

regarding health care, the beauty of this debate is that there will never be complete consensus. Views held by folks like Kirkhill are valid and sound, from one perspective. Others views that differ (as mine do), are also just as sound and valid. Each person has their own comfort level of what they want to pay for what service. One area we all will agree on is that we pay way to much for far too little. I believe the system can be fixed and remain exclusively public, although I am not adverse to some small amount of private care - we already have it now. 

To me, and to most Canadians I think, public health care is sacred. It may be 'broken', but it's possible to fix it and keep it public. Some would say the CF in the early-mid 90's was just as broken then as the health care system is now. Sure, the numbers aren't the same, but do you remember the situation back then? The CAR was disbanded, morale was rock bottom, soldiers were in food bank lineups due to poor pay, the Somalia inquiry made us all look like savages, scandals were so frequent and apathy among citizens was so high the media didn't really report them anymore, corruption stories (both real and gossip) were rampant, etc, etc.....we didn't get rid of the CF, did we? You might think it's crazy, but looking back, was it that far off? The CF is also sacred, so we fixed it. It isn't perfect, but I for one think it's better now than even 6 or 7 yrs ago. We can do the same with the Health Care system.


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## Infanteer (15 Sep 2004)

I can see this thread is falling into the common trap of confusing public-managed delivery with universal coverage.

I agree with universal coverage; nobody should be left to their own devices if faced with a medical catastrophe (my immediate family having two in the last few years, I can attest to this).

I do not agree with public-managed delivery.  Big government basically fucks up what ever it touches; that's why we have the problems we do today.  Look through my comments that I provided on the other thread, the principle of government delivered health care is silly; if anyone can offer up a good justification on why someone's personal health should be managed by a red-tape bureaucracy, then I'm all ears.

This is the essence of Grazer's book.  As long as proper health care is universal, it doesn't matter who delivers the service, as long as it is properly and professionally regulated.


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## canuck101 (15 Sep 2004)

As long as proper health care is universal, it doesn't matter who delivers the service, as long as it is properly and professionally regulated.

I agree with you totally.  As my father has always said if you can go into a privately built and operated hospital and they except your health card why are people getting upset. If they can do it for less money do it.  The government is not always the best.


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## dutchie (15 Sep 2004)

I agree with Infanteer in that I don't think that the government should _directly_ manage the health care system. But I also don't want to see private enterprise manage it without any accountability to the tax payer. I admit to not being fully informed on how it is managed right now. I know that when my wife was in St. Paul's Hospital not too long ago due to pregnancy complications, I saw indications that the hospital is being run by a company/organization called Providence....not sure if this is due to it's Catholic roots or not. I also know that technically, hospitals are not run by the provincial government, but regulated by them. 

I don't want to see a system where the government is involved in the day-to-day running of hospitals, or other care facilities. To my knowlege they don't do that now anyway. Doctor's offices are already private, but they are funded and regulated by the gov. Simply put, they are free to make money (obviously), but cannot do whatever they want, or charge what they want. They for instance must abide by a price list system for procedures and visits, and 'get in line' when scheduling surgeries at hospitals. The problem is funding. The government provides this funding, and if there isn't enough money to do all of the procedures that need to be done, a waiting list is created. I _think_ the gov funds each 'Health Authority' separately, and it's the regional health authorities that determine how and where the money is spent. 

So, in short, currently, Big Government, to my knowledge, does not manage the system, but regulates it and funds these quasi-government 'Health Authorities', and also sets guidelines and groundrules for spending in each region. Conversely, I definitely don't want a system where the government simply funds the system but private enterprise decides how to spend it. I don't want to give private companies (whose sole objective is making money) a blank cheque with no system of accountability to the tax payer. We need to reduce the fat (ridiculous salaries for non-skilled workers, endless redundancy and meaningless bureaucracy, etc), streamline the system administratively and fiscally, and increase funding........if you want all care facilities to be run and managed by completely private companies, fine, but god help them if they run a profit....that means I paid too much tax.


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## I_am_John_Galt (15 Sep 2004)

If a private health-care provider makes a profit, that indicates that they have provided the service at a lower cost than the mandarin's estimate.

In a competitive system, this would suggest that any number of private providers could offer the same service at a price less than the government's estimate.

In a socialist system, the profit motive is irrelevent and thus there is very little motive to produce at lower cost: it is actually inherently inflationary as there are a lot of DIS-incentives to producing at lower cost (i.e., 'why not pay myself more money and raise the price: it is not as if a competitor is going to undercut me').

Thus, in the absence of regulatory interference, the exact same service could be provided at lower cost AND at a profit in the competitive system (vis-a-vis the socialist system).

The quality of service is invariably better in the competitve system, too (by much the same rationale).


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## Kirkhill (15 Sep 2004)

Hear, Hear John.


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## Bruce Monkhouse (15 Sep 2004)

What you forget is they save money by undercutting the quality and if necessary the quantity of care you will receive.
That and the fact they will simply turn tail and leave if the profit margin isn't there and then your left with the same need and no one who really knows how it works. What is required is better public money managers.

All those who think about less wages being the answer to health care funding, remember, you pay peanuts, you get monkeys...........  monkeys looking after your surgery.


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## dutchie (15 Sep 2004)

If a private health-care provider makes a profit, that indicates that they have provided the service at a lower cost than the mandarin's estimate.: absolutely right.

In a competitive system, this would suggest that any number of private providers could offer the same service at a price less than the government's estimate.: right. this is ok as long as quality of care reduction is not used to create savings.

In a socialist system, the profit motive is irrelevant and thus there is very little motive to produce at lower cost: only if it is run privately. If it is run by a public organization, then cost concerns can be maintained. 

'why not pay myself more money and raise the price: it is not as if a competitor is going to undercut me').:my answer....."no problem, you're fired". the notion that you cannot have fiscal responsibility in government is understandable (based on past performance), but fundamentally wrong. Fiscal irresponsibility (in government) is something we have allowed to happen, but it's not something that has to continue. 

Thus, in the absence of regulatory interference, the exact same service could be provided at lower cost AND at a profit in the competitive system (vis-a-vis the socialist system).k....why not keep it public, reduce the cost, and eliminate the profit, thereby saving more, and reducing the chance patient care is compromised for the sake of profit? I am not completely against private delivery, but I think it should be primarily publicly delivered.......consider our vasty rural population. Not much incentive for the private company to provide good care in an area of low population, outside of the fishbowl of the city. This also leaves no options for the consumer. In the city, you could go to another hospital in the next suburb......but what do you do if the next closest hospital is 100 miles away? You take the crappy subpar care.

The quality of service is invariably better in the competitive system, too (by much the same rationale).: do you mean service in the sense of 'customer service' or service as in the quality of medical care? I will concede the former, but challenge the latter. A public system's priority should be quality of care first, financial responsibility a close second. A private systems priorities will be profit, with no real secondary priorities. Saving my tax dollars is definitely not even a consideration to the private entrepreneur, nor do I think it should be.


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## Bruce Monkhouse (15 Sep 2004)

Wed, September 15, 2004 

Money alone won't fix health care

It will take courage, leadership and a sense of reality, says Christina Blizzard -- and they're all in short supply 

By CHRISTINA BLIZZARD -- For the Toronto Sun


Pointing the finger at the salaries of cooks and cleaners as the reason for soaring health costs may cut some ice in some circles, but give me a break. 

In a report this week, the usually sensible Mark Mullins of the Fraser Insitute reveals that cooks and cleaners in Ontario hospitals make on average 30-60% more than those in the private sector and nurses earn at least 14% more than in other provinces. 

Okay, Mullins also pointed out also that the number of hospital workers earning more than $100,000 per year has tripled since 1996. 
  

The point, one supposes, is that hospitals should be privatized, thereby saving all that money on salaries -- and there may be some validity to that theory. 

But if you really want to find all the big salaries in hospitals, you might want to look a little higher and pick on the really big fish. Forget about those cooks and cleaners. Heck, forget about those hospital staff making $100,000 -- many of them are highly educated professionals such as microbiologists. 

The truly bloated salaries are those of hospital CEOs and other senior hospital bureaucrats, who regularly tip the pay scales at half a million dollars a pop. And we're worrying about cleaners? 

In the private sector, a person making half a million bucks is expected to perform to high standards. Certainly, he or she is expected to balance the books and deliver services in a timely fashion. Yet many hospitals in this province fail to do just that. 

Leadership by example 

In any organization, leadership is by example. And if you have an overpaid upper management level, chances are the people at the lower end of the pay scale are going to want a few crumbs. 

By all means, contract out services such as food preparation and cleaning if it's going to lead to substantial savings. But while you're at it, take a carving knife to the executive suite and pare back the fat there as well. 

In Ottawa, meanwhile, the country's premiers and Prime Minister Paul Martin are bickering about just how much isn't enough to run the country's health system. 

The answer, of course, is that as long as this country insists on sticking -- selectively -- to the narrow rules of the Canada Health Act, there will never be enough money in the pot to pay for all the services we demand from the system. 

You have to have sympathy for Martin. First, the premiers feel they have him over a minority government barrel. This isn't so much a negotiation as it is a health care holdup. 

But it isn't just money that's needed to make the health system work. Until governments at all levels can figure out a way to get costs under control, we might as well kiss goodbye half the provincial government. More than that, in fact, since the growth in health spending is spiralling out of control. 

And the numbers aren't chicken feed, as John Williamson of the Canadian Taxpayers Federation noted yesterday. 

According to the CTF, this year, provinces and territories will spend approximately $83.5 billion on health. Ottawa will write them a cheque for $24 billion for health, education and social services transfers. Add that to tax points the feds exchanged with the provinces in 1977, and Ottawa's total funding for health care is nearly one-third. 

"That's higher than the 25% benchmark the provinces are now demanding from the federal government," says Williamson. If Ottawa's $9.7-billion equalization payment is included as well as the $6 billion it spends on health services for natives, veterans and research, its contribution is higher still, at around 40%, he argues. That's not chump change. 

Nothing innovative 

It would be reassuring if the provinces were offering some innovative ways to get costs under control. Not a chance. 

In this province, Premier Dalton McGuinty's plan to buy back MRI and CATscan clinics from the private sector is an indication that he's going in exactly the opposite direction -- the typical Liberal all-things-to-all-people plan, that will result in even longer waits and even more money from the public purse. 

The kind of change that's needed doesn't take more money. It takes courage, leadership and a sharp dose of reality. Where, oh where are the politicians with those qualities? 


  


--------------------------------------------------------------------------------
Sums it up for me.


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## dutchie (15 Sep 2004)

bruce: 

re:All those who think about less wages being the answer to health care funding, remember, you pay peanuts, you get monkeys...........   monkeys looking after your surgery. - i suggest paying hospital workers not delivering care a far reduced wage, not the surgeons.......why should I pay someone $23/hour to scrub a toilet? That assinine.


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## Bruce Monkhouse (15 Sep 2004)

Maybe because that cleaner is also cleaning the same area where your innards might be exposed to some of the nasty things that breed in a less than sterile enviroment.


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## I_am_John_Galt (15 Sep 2004)

The competitive market will provide WHATEVER is demanded by the aggregate of general population.

If lowest-cost healthcare is desireable: ti will be supplied.
If highest-quality healthcare is diesireable: it will be provided.
If best customer service is desireable: it will be there.
If instead of lab coats, Doctors dressed like Elvis is desireable: sales of Blue Suede Shoes will skyrocket (and in the competitve market there will be MUCH Less Conversation and MUCH More Action).

While I will accept that it is theoretically possible (in the sense of an infinite number of monkees on typwriters...) that some lawyer might luck into the optimal allocation of resources (i.e., how much should a particular surgeon be paid, or a particular orderly) it seems *highly* unlikely, and the maket has proven time and time again to make MUCH better allocations (i.e., the better surgeons get paid more, and Bruce's 'monkeys' make no money and thus quit medicine and join the circus or whatever).

Despite the Special Interest's (and the CBC's) propaganda to the contray, the fact is that when a service is provided by a dynamic and active open market, consumer's needs (of which lower prices is only one aspect) are MUCH better met.  Private companies will simply cease to exist if they do not provide what, how and where is wanted.

The idea that "fiscal responsibility" can control costs is somehting that works in the VERY short term at best.  People don't get fired in crown corporations for anywhere near the same reasons they do in the private sector.  I used an outrageous example to make the point, here's another that perhaps is more realistic: who do you think will negotiate harder against a union looking for an unreasonable raise: a gov't lawyer who (worst case) will get paid a little less for agreeing to too much, or the entrepreneur who stands to lose his income, company, house, life savings, etc. (and which employees do you think are going to be more agreeable, the ones that have everything to gain and nothing to lose, or those that stand to lose their livelihoods)?  In the movie "Days of Thunder" Nicole Kidman said to Tom Cruise: "Control is an illusion, you infantile egomaniac!  Nobody controls anything." to which I would add: "especially if you are the government trying to control spending."

This has been proven to be empirically true: just look to the bread MRI lines in the USSR Canada that simply don't exist in competitive systems.  AGAIN, it is the Canadian provinces that are having to close hospitals and limit services: that the Provincial Governments have finally been forced to confront reality and defy the feds by allowing private treatment centres is only the very beginning (one can only hope!) of a very good thing.

I love my country  , but there are some pretty strange economic theories that are accepted by it's people without question!


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## Bruce Monkhouse (15 Sep 2004)

What most of you private health-care people are missing is the point that was brought up earlier, profitability.

I am not saying that we need to rework the health-care system, in fact in many threads I have argued we need to officially have two-tier healthcare so that the profit from that can be used to bolster the public system.
But to say the private system is so much better, etc, etc for the "general " public is amazingly stupid and short-sighted.
Example, McDonalds is a very well run corporation, however upon leaving Napanee, Ont and heading north on hwy.41 you will travel 124 miles before you encounter another Big Mac. If there isn't enough of a profit margin here for hamburgers how in the world will there be enough for a profit hospital?


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## I_am_John_Galt (15 Sep 2004)

Bruce Monkhouse said:
			
		

> Maybe because that cleaner is also cleaning the same area where your innards might be exposed to some of the nasty things that breed in a less than sterile enviroment.



What makes you think that same idgit working for the government with one of the strongest unions in the country protecting him is going to be any more diligent than a guy working for a private contractor, who stands to take his whole company under (let alone his own livelihood)?


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## Bruce Monkhouse (15 Sep 2004)

I don't consider 12 bucks an hour a" livlihood", thats a job you do untill you land the" real one"


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## I_am_John_Galt (15 Sep 2004)

Bruce Monkhouse said:
			
		

> Example, McDonalds is a very well run corporation, however upon leaving Napanee, Ont and heading north on hwy.41 you will travel 124 miles before you encounter another Big Mac. If there isn't enough of a profit margin here for hamburgers how in the world will there be enough for a profit hospital?



How many hospitals are there now?  How many do you think in another 10 years of Stalinist healthcare?  If it makes economic sense* for a (realtively expensive) publicly-run hospital to be located in any particualar place, it makes MORE sense for a (relatively cheaper) privately-run hospital to be located in the same place (regardless of who is foooting the bill)!

I hate to break it to you, but Government monopolies (on anything) do a really piss-poor job of providing services: nonetheless, the point is that spending in this type of system will *always* grow faster than inflation: it is the very definition of unsustainability.  There is no REAL incentive for government ministries and crown corporations to do anything other than increase costs!  Using private sector profits to subsidize a public system is merely delaying the inevitable: the public system will grow and grow and grow and quality and service will get worse and worse and worse ... (then you'll REALLY have two-tier healthcare).

*as in "utility" not just financial cost!


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## Bruce Monkhouse (15 Sep 2004)

QUOTE,
I hate to break it to you, but Government monopolies (on anything) do a really piss-poor job of providing services: nonetheless, the point is that spending in this type of system will *always* grow faster than inflation: it is the very definition of unsustainability.   There is no REAL incentive for government ministries and crown corporations to do anything other than increase costs!   Using private sector profits to subsidize a public system is merely delaying the inevitable: the public system will grow and grow and grow and quality and service will get worse and worse and worse ... (then you'll REALLY have two-tier healthcare).

No, please, feel free to break it to me as you obviously KNOW better than I.
In other words if your going to throw out kife like that last post without any meaningful backing than don't waste my time.
If you have any proof of things that have been privatised that have cost less,ie.private jail-oops-nope...hwy 407-oops,nope...


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## I_am_John_Galt (15 Sep 2004)

Bruce Monkhouse said:
			
		

> I don't consider 12 bucks an hour a" livlihood", thats a job you do untill you land the" real one"



Um, so your argument is now that an Electrician working in a hospital making $25/hour is a career, but an Electrician working anywhere else for $15/hour is a summer job?


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## dutchie (15 Sep 2004)

I have done some pretty shitty jobs for pretty shitty pay, so I feel for the guy scrubbing toilets for $12/hour. But the fact is that scrubbing toilets is unskilled labour, ie, anyone should be able to do a good job with minimal training. I wish we had an economy that allowed everyone to make a killing regardless of their duties....but that's not reality (unless your a communist). That type of economy doesn't exist and never will. 

There will always be those who make a small living, and those that make a large one. Most of the former are unskilled, most of the latter highly skilled and/or educated. Most of us fall somewhere in the middle, struggling to gain a large salary, while trying to avoid the small one. That is capitalism.

My capitalist views are trumped by my desire to ensure fair, affordable, and quality health care for every Canadian......so I am willing to sacrifice some capitalist abition for this.


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## Bruce Monkhouse (15 Sep 2004)

...as long as its not you?...nice


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## Bruce Monkhouse (15 Sep 2004)

Quote,
Um, so your argument is now that an Electrician working in a hospital making $25/hour is a career, but an Electrician working anywhere else for $15/hour is a summer job?  

 Stick with the discussion, I mean what I mean....12 bucks an hour is a job, not a livilyhood.


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## I_am_John_Galt (15 Sep 2004)

Bruce Monkhouse said:
			
		

> No, please, feel free to break it to me as you obviously KNOW better than I.
> In other words if your going to throw out kife like that last post without any meaningful backing than don't waste my time.
> If you have any proof of things that have been privatised that have cost less,ie.private jail-oops-nope...hwy 407-oops,nope...



I don't mean to offend, but I think you are confusing my argument: I think you are talking about government-sponsored/approved/regulated private monopolies (which really aren't a lot better than government-run & owned monopolies) with competition and consumer choice, which is what I am advocating.


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## I_am_John_Galt (15 Sep 2004)

Bruce Monkhouse said:
			
		

> Quote,
> Um, so your argument is now that an Electrician working in a hospital making $25/hour is a career, but an Electrician working anywhere else for $15/hour is a summer job?
> 
> Stick with the discussion, I mean what I mean....12 bucks an hour is a job, not a livilyhood.



I am trying to but I don't know where you are getting $12/hr from ... I used the example of the Electrician from Infanteer's post (which is linked earlier in this thread).


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## Bruce Monkhouse (15 Sep 2004)

That was in reference to Caesars post about hospital cleaners making too much. I brought it out of thin air but I would imagine thats about top rate for a cleaning company personal.


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## I_am_John_Galt (15 Sep 2004)

Bruce Monkhouse said:
			
		

> That was in reference to Caesars post about hospital cleaners making too much. I brought it out of thin air but I would imagine thats about top rate for a cleaning company personal.



Fair enough, and Infanteer's post (I hope he doesn't mind me referring to it so much!) suggests that you aren't far off ("Cleaner" average $12.51/hr in hotels; not(?) including tips), so your point stands: it's a crappy job (forgive the pun) that probably doesn't inspire a lot of dedication.

On the other hand, the hospital cleaner only makes $3.40/hr more (okay, $3.42), so I think my point stands, too: the wage difference is not enough to be a believeable reason to think that the hosptial worker is going to be a whole lot more dedicated to his job (but multiplied over the however-many thousands of hospital workers does add up to a significant "extra" burden on the healthcare dollar).


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## Bruce Monkhouse (15 Sep 2004)

Not to prolong the swerve we're taking but the hotel person is cleaning my room, the hospital cleaner is cleaning where I might be laying with opening's I'm not supposed to have.
I still stick with the "peanuts" theory but the problem, to me, is the fact that in order to fire somebody who isn't pulling the weight of their higher salary is almost impossible with the union strength the way it is. This would be a good place to start to save some tax dollars.


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## Infanteer (15 Sep 2004)

Wow, sure alot of horse caca flying around this thread.   Let's get back on track.

The crux of the question being debated here is whether "more money" is the solution to a strained health care system.

I've argued "no" and I firmly believe that the Health Act has to be reorganized.

I'll respond to some of the points I noticed following my earlier comments.



I don't think hospital cleaners will be sterilizing operating equipment, so that is a red herring.

Caesar



> But I also don't want to see private enterprise manage it without any accountability to the tax payer.



Nor do I.   As I shall argue, the MSA removes the notion of "tax-payer" from the equation and puts the decisions of health care firmly in the hands of the patient, who is backed up by a system of universal coverage for catastrophe and manages their own incidental needs (which are nickel and diming the system to death) on their own.



> I don't want to see a system where the government is involved in the day-to-day running of hospitals, or other care facilities. To my knowledge they don't do that now anyway. Doctor's offices are already private, but they are funded and regulated by the gov. Simply put, they are free to make money (obviously), but cannot do whatever they want, or charge what they want.



They operate under global budgets which force them to make choices (many which involve perverse incentives) tied not to the health of a patient, but to the fickle nature of the budget.   I'd advise you to look at Grazer's book to see how messy health care budget decisions get once it hits that level.



> The problem is funding. The government provides this funding, and if there isn't enough money to do all of the procedures that need to be done, a waiting list is created. I think the gov funds each 'Health Authority' separately, and it's the regional health authorities that determine how and where the money is spent.



In many cases problems arise when doctors are constricted in their ability to practice due to, you guessed it, budgetary concerns.   Doctors are limited in the actions they take and the clients they see by the government managed budget.   You are put on a waiting list due to the fact that some bureaucrat has decided that "X dollars and Y amount of patients will be seen today"; centralized decision making inhibits the ability of hospitals to make decisions based on the needs of their patients.



> Conversely, I definitely don't want a system where the government simply funds the system but private enterprise decides how to spend it. I don't want to give private companies (whose sole objective is making money) a blank cheque with no system of accountability to the tax payer.



That is why I've advocated a the MSA system (read my other thread).   You, the citizen and patient, do not require the government to hold accountable a private practice due to the fact that you manage your (daily health care costs) health care costs.   

As well, you assume that the sole objective of the private market is to "make money".   I would urge you not to adopt such an extreme position.   I would like to believe that private business also has an interest in providing a service to the community.   My family owns a hotel, and we are not only "driven to make money"; we keep the costs low so we can make a living at it (which we've done for 25 years), we keep the prices low to attract customers, and we go out of our way to ensure our customers are satisfied, because a poor reputation is disaster in the private industry.

I would think a hospital would be no different.   If people managed their own funds through an MSA, and hospitals existed only "to make money" at the cost of efficient and effective health care for the patients, wouldn't you think that their market (ie customers) would dry up pretty quick and be replaced by someone who is willing to deliver health care in a better way?   It is that "invisible hand" thing....

Bruce Monkhouse



> What you forget is they save money by undercutting the quality and if necessary the quantity of care you will receive.



That is baloney.   We didn't save money in our Hotel business by firing the Chambermaids and closing down half of our hotel rooms.   We innovated and adapted until we found something that worked right (in our case, new good managers and a new business draw for customers).   If people are held accountable for their own health care funds (as in an MSA), poor health care delivery will be starkly evident when the waiting room is empty.   With a perverse consumer/provider relationship in a government run system, the ability of the Health Care industry to adapt and change according to the needs of the patients just isn't there.

I believe that we will find big savings through the elimination of big government bureaucracies that exist to determine how Canadians should manage their own health and the elimination of big Public Sector Unions that constantly hold the government (and by extention, the public) hostage with outrageous demands.



> That and the fact they will simply turn tail and leave if the profit margin isn't there and then your left with the same need and no one who really knows how it works.



On this point I do agree with a part of the thrust of your argument.   I would not want to see the government suddenly say "You are all private, go".   It would need to be a structured move.   If the market is not strong enough to support private practices in certain areas, the government should provide services in order to cover basic health needs (ie: a local practice and/or emergency capabilities to transport people easily to larger facilities).   If private industry proves to provide better and more efficient health service to an area, the need for government intervention is non-existent and the publically funded services can be reduced.



> What is required is better public money managers.



Thanks but no thanks, haven't really seen such a thing yet, most likely due to the fact that any sense of fiduciary responsibility seems to fade the further away the "public money manager" is from the source of the money he manages (ie: the tax dollars of your labour).   I can manage my own health care (and my own finances).



> All those who think about less wages being the answer to health care funding, remember, you pay peanuts, you get monkeys...........   monkeys looking after your surgery.



The Fraser Institute wage study only refers to hospital jobs that had a direct equivalent to the unionized Hotel Industry.   It does not pertain to employees in the Health Care sector that possess specialized training and deal directly with patient needs; these people deserve the higher wages they earn due to the fact that they've educated themselves and they preform a vital service.   In no place did I argue that we should pay Nurses, X-ray Techs, or Doctors less money (if anything, they need more).

Caesar (again)



> Fiscal irresponsibility (in government) is something we have allowed to happen, but it's not something that has to continue.



It is my opinion that bureaucracies possess an innate characteristic of bungling public funds; to disprove my idea please find me a well run, efficient and effective government bureaucracy that leaves the Canadian taxpayers satisfied.
Moving away from these fundamentally unsound organizations seems to be the necessary step; you can't change the beast.   Of course, this is only my opinion, so feel free to shoot it down if you think it is based upon faulty logic.



> A public system's priority should be quality of care first, financial responsibility a close second. A private systems priorities will be profit, with no real secondary priorities. Saving my tax dollars is definitely not even a consideration to the private entrepreneur, nor do I think it should be.



I've argued above that this analysis of the private market is unfair and unrealistic.   A private entrepreneur wouldn't be concerned with "saving your tax dollars" in an MSA system; he would be concerned with delivering a profitable service to the community (which means it must be efficient and effective or he will go broke).

Bruce Monkhouse (again)



> Maybe because that cleaner is also cleaning the same area where your innards might be exposed to some of the nasty things that breed in a less than sterile enviroment.



I don't think unskilled janitors are going to be sterilizing operation equipment, so that argument is a red herring as well; these are people who sweep the floor, take out the garbage, clean the bathrooms, etc.   The Fraser Institute is keen to compare these employees to their counterparts in the Hotel Industry; both Hospitals and Hotels depend on clean facilities in order to keep customers (guests or patients) happy.   So why is it that the Public Sector cleaners deserve 3 dollars more an hour?   The Hotels pay an acceptable and reasonable wage to their (unionized) employees in return for services provided (ie: nothing too specialized), and I don't see every hotel in Vancouver turning into an East Hastings crackhouse.



> I don't consider 12 bucks an hour a" livlihood", thats a job you do untill you land the" real one"



No, but does this mean that we get inferior services from the person because they are not a professional "health care facility maintainer".   Should we encourage people to consider their sole source of income to be the night shift at the local hospital by giving them an unusually high wage for the services they provide?   I believe in paying people a reasonable wage for their labour.   Obviously, if their labour is dangerous or more specialized (soldier or chemist), then they deserve more as opposed to someone who does the same thing as a pimply-faced 15 year old at McDonalds.


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## unknownsoldier (15 Sep 2004)

Infanteer said:
			
		

> I would pick it up.   Pretty interesting; the doctor is basically approaching Health Care reform from an economical viewpoint (hence the consumer/provider relationship).   If anything, it is a fresh idea as opposed to the current political discussions going on (we need more money!).



Swedish model? or other Scandinavian countries? That would capture the essence......? I am confused. One has to pay "900 dollar premium" according to Sorbara. divided by 12? you pay only 20-25 dollars for private insurance in USA. still confused . enlighten me. All I am concerned has been the 800 billion debt. "You gotta to be tough , isn't it. still confused. 800 billion debt and singapore worked. 1.01 Singaporean dollar to 1 canadian dollar. currency exchange. And one thing more. There got to be 100 percent foreign equity like singapore to get investments. Nationalists capitalists hate that. And one thing more. If a conservative government comes into power, what makes one sure that other provinces dominated by liberals would not overspend to bancruptcy or not tax their provinces to the detriment of investment opportunities. still confused


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## unknownsoldier (15 Sep 2004)

Infanteer said:
			
		

> I would pick it up.   Pretty interesting; the doctor is basically approaching Health Care reform from an economical viewpoint (hence the consumer/provider relationship).   If anything, it is a fresh idea as opposed to the current political discussions going on (we need more money!).



FROM AN ECONOMICAL POINT OF VIEW (To quote reasonable infanteer)LOL

what liberal carolyn parrish has sayeth
were all said honestly and in good faith
poverty nowadays has been a valid concern
likewise to racists and commies she has been stern
but what she is ignorant of and unwitting
has been that socialists and commies are scheming
overflowing welfare programs they adopt
with secret motives for canada to go bankrupt
paving the way for a communist takeover
oh that would make centrist liberals turn sober
bankrupt? then there will be no health care
the devil commie will then be there to snare
bankrupt? then IMF creditors will lose confidence
and chretien and martin will lose credence
bankrupt? then there'll be no unemployment insurance
ladies then will lose money for the dance
all that mike wanted was to balance the books
while maintaining the liberals' healthy looks
take a crash course, carol in accounting and economics
instead of contenting yourself with home economics
instead of pitting yourself with mike harris
why not against howard hampton whom commies kiss
closets* who had themselves endowed with abundant prosperity
while inflicting on impoverished CF soldiers dismal poverty

closets-closet communists posing as new democrats, liberals, conservatives and socialists


COMPUTER ETHICAL HACKER who had his computer programmed to automatically download another's computer whose user attempted to hack into his. Considered lawful


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## canuck101 (15 Sep 2004)

If the provinces can not deliver a suitable health care system with the money they already have then there is something wrong with them.  Kirkhill said in a earlier post:

$88,000,000,000 Government Spending + $38,000,000,000 Private Insurance and Direct from OUR Pockets

Total

$126,000,000,000 spent on health annually

31,000,000 Canadians

Net Effect

$4,064 spent per Canadian per year

I have a family of 4.

4x $4,064 =

$16,258 per year for my family

With that amount of money in there hands there should not be any problems. When you find your back up against a wall you look around for alternative ways of delivering care.  The governments ability not to look at alternatives is very sad.  Different systems around the world have dealt with the same issues that we are dealing with now.  I am not saying we have to follow to the letter what they are doing but putting blinders on and just putting more money in will not solve the problem. 

 Prime Minister Martin said that he wanted to form a different kind of government for the people instead of the same old liberal ways well to me it seems to be the same old tune coming from him.  You want to believe there is going to be change but there has not been any in this country since the early sixties.  Mr. Martin gave us surpluses which is great but he has failed in changing the way government is structured and the way it works.  You have to make priorities that are most important to you and stick to them, make the investment that is needed.


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## dutchie (16 Sep 2004)

Infanteer:   You made some excellent points. The only point you made that I don't agree with to some degree is: "I would like to believe that private business also has an interest in providing a service to the community.":If that is you and your families attitude regarding your business, then I commend you for your selfless and enlightened mindset. I am sure that this attitude may very well be common in small business, but I think you might be a little naive if you think the CEO of a string of hospitals across the country would share this view (well, maybe in front of the media cameras). I also would not expect any private citizen in business to care about anything until it affected his bottom line......but regardless.......

I would like to point out that the main 'fear' I have of any private delivery of health care without direct public control is the 'slippery slope' idea. I fear, rational or not, that if we allow Johnny Bigbucks to get out of the lineup for a new knee (public system) and go to a private clinic where he can get it immediately, that eventually the best doctors will work strictly private clinics, where the supply of paying patients (who pay more than those stingy government-types) is endless and they can do 125 surgeries a year, rather than 80. Eventually, Joe Citizen needs a new knee, but the only doctors left are old farts about to retire and new docs still wet behind the ears. Obviously this is an exaggeration, but you see my point (I hope). 

On Global tonight, the news hour featured the medicare system of Germany. In Germany, medical insurance is mandatory. The average citizen pays the government, and the premiums are based on income. If you wish to opt out of the publicly insured system, you can purchase private insurance. This private insurance varies in cost depending on the level of care you want. The more you pay, the more comfort and service you get. Here was the interesting thing for me. All Doctors are on salary, and are REQUIRED TO PROVIDE CARE IN A PUBLIC FACILITY. If they choose to do 'overtime' for a private facility, have at 'er. As well, private hospitals are allowed and compete for patients with public ones. All hospital funding is based on quality of care delivered, time in recovery, and patient satisfaction (public only I assume, but private facilities might get some?). How they measure this I have no clue.

Oh yeah, Germany has no surgery waiting lists, and the government is reducing basic premiums next year because lots of hospitals (public and private) are making money.

Interesting.


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## Fishbone Jones (16 Sep 2004)

It seems to me we already have something that connotates a two tier, public\ private system. If I need a knee replacement, I'll wait who knows how long, maybe months. If Paul Martin needs one he'll get it tomorrow. We just kid ourselves when we think we're all on an even keel and the system treats ALL fairly and timely. If the politicians had to wait in line like Joe Civvie, there'd be major changes to the system pronto.


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## Infanteer (16 Sep 2004)

> "I would like to believe that private business also has an interest in providing a service to the community.":If that is you and your families attitude regarding your business, then I commend you for your selfless and enlightened mindset. I am sure that this attitude may very well be common in small business, but I think you might be a little naive if you think the CEO of a string of hospitals across the country would share this view (well, maybe in front of the media cameras). I also would not expect any private citizen in business to care about anything until it affected his bottom line......but regardless.......



I didn't mean "provide a service to the community" in an altruistic manner, I meant it in a business sense, so don't go giving me any enlightenment awards yet.

By "service to the community" I meant strictly that; a business provides some sort of service that others in the community desire.   In my families case, a place to stay for visitors; in a doctor's case it is health care.   Either way, they are providing services that people in the community desire.   Hell, that avatar for globalization, McDonalds, provides a service to the community by selling junk food.

Services are dependant on the wants of the community.   People want healthier choices, McDonalds introduces salads.   If one does not adapt ones business to the desires of the community, the outcome is financial ruin.

However, in a artificial economic system in which the patient/doctor relationship is ruined (in terms of product delivery), this cannot take place.   People want a better cancer treatment facility; sorry, no can do - the resources and the authority to do so is managed by a government bureaucracy and the only way to change that is through politics with the end result being the fruitless debate we are seeing played out on national TV.

In a system of government managed health care where the notion of cost is removed (with its implications of demand) their is no incentive for the either a doctor or a patient to improve and adapt health care delivery.   End result, doctors move south to greener pastures and patients are forced to toil with waiting lists and limited options under an increasingly strained health care system (due to demographics and the increasing costs of medical technology) or to follow the doctors south to better chances at effective treatment.

(Disclaimer, I am not claiming the American system is the route to take as it suffers from the same consumer/provider perversion as we do, I only point out that access to efficient and effective health care is more readily available there for the reason that the Department of Homeland Defence does not manage every American's health).



> It seems to me we already have something that connotates a two tier, public private system. If I need a knee replacement, I'll wait who knows how long, maybe months. If Paul Martin needs one he'll get it tomorrow. We just kid ourselves when we think we're all on an even keel and the system treats ALL fairly and timely. If the politicians had to wait in line like Joe Civvie, there'd be major changes to the system pronto.



You're right on there, recceguy.   Canada's system of Health Care according to the Canada Health Act fails on all accounts.   I feel the MSA system seems to provide the most suitable alternative to public health; it maintains the universal nature ensuring that all Canadians are covered and yet allows the private market to innovate and adapt to deliver the best health care to all Canadians.   With the resources we dedicate to our Health Care system, we deserve no less.


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## Bruce Monkhouse (16 Sep 2004)

QUOTE
I don't think hospital cleaners will be sterilizing operating equipment, so that is a red herring.

..and the room its being used in miraculously sterilizes itself upon entering?

What is required is better public money managers.


Thanks but no thanks, haven't really seen such a thing yet, most likely due to the fact that any sense of fiduciary responsibility seems to fade the further away the "public money manager" is from the source of the money he manages (ie: the tax dollars of your labour).  I can manage my own health care (and my own finances).
That is baloney.  We didn't save money in our Hotel business by firing the Chambermaids and closing down half of our hotel rooms.  We innovated and adapted until we found something that worked right (in our case, new good managers and a new business draw for customers).

Sounds like suck and blow to me. Which is it?

No, but does this mean that we get inferior services from the person because they are not a professional "health care facility maintainer".  Should we encourage people to consider their sole source of income to be the night shift at the local hospital by giving them an unusually high wage for the services they provide?  I believe in paying people a reasonable wage for their labour.  Obviously, if their labour is dangerous or more specialized (soldier or chemist), then they deserve more as opposed to someone who does the same thing as a pimply-faced 15 year old at McDonald's. 

How often do you tell YOUR staff they are the same as the"  pimply-faced 15 year old at McDonald's" ?

Listen I'm the first to say that changes are required but anyone who thinks that the place to start is with the "peons" in the medical system really doesn't pay attention to the real fiscal world of survival and maybe should move out in the world of financing a life without the family safety net.


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## dutchie (16 Sep 2004)

So there is a deal.........what do you guys think?


http://www.canada.com/national/story.html?id=eba4d728-5117-464a-9751-cb8ec4f1f1a0

Premiers, PM sign $41B health deal
  
Alexander Panetta and Joan Bryden 
Canadian Press 


Wednesday, September 15, 2004



Prime Minister Paul Martin (centre) signs the health agreement as Finance Minister Ralph Goodale (second from left) and Health Minister Ujjal Dusanjh (right) look on. (CP/POOL/Jim Young) 

ADVERTISEMENT 

  

OTTAWA -- A health system starved by years of chronic under-funding got a significant cash injection Thursday as Paul Martin announced a $41-billion "deal for a decade.''  
A beaming prime minister strode triumphantly to his seat at a conference table after a final night of marathon federal-provincial talks produced a much-coveted agreement aimed at sustaining medicare. 

"(This is) a 10-year plan, a deal for a decade that will lead to better health care for all Canadians,'' Martin said. "People around this table stood up for health care and Canadians. 

"There was determination to secure a long-term deal that will stop the annual ritual of federal-provincial disputes and start the process of renewal.'' 

The prime minister significantly ratcheted up his funding offer over the three-day talks -- ultimately by about 50 per cent -- in his eagerness to reach a deal seen as crucial to his political success. 

In exchange, the provinces agreed to Ottawa's demands for reforms aimed at reducing waiting times for medical procedures such as cardiac and cancer care and joint replacements. 

Martin won re-election three months ago largely on a promise to meet with premiers and "fix medicare for a generation.'' 

While premiers lavished praise on the deal and some hailed it as a 10-year agreement, they would be ending years of past practice if they abandoned future demands for more cash. 

True to form, many of the premiers described the package as "a good first step.'' 

Previous federal-provincial health care agreements in 2000 and 2003 did nothing to quell persistent demands for more money as provinces struggled to fund cash-starved health systems. 

The new accord commits Ottawa to spending: 

$3.5 billion over two years in additional transfers. 
Billions on a so-called escalator clause that boosts transfers six per cent annually to keep up with spiralling health costs. 
$4.5 billion over six years to reduce wait times for treatment. 
Although provinces were obviously pleased with the final deal they didn't trumpet it as the generational cure-all Martin had wanted. 

Ontario Premier Dalton McGuinty said he could see returning to ask for more money before the decade is over. 

"There are still enormous challenges ahead. Today, we have made progress.'' 

Martin allowed Jean Charest to sign on with an asterisk, protecting him against nationalist charges of permitting federal intrusion into a jealously guarded provincial jurisdiction. 

The agreement included a separate statement asserting Quebec's right to fashion its own wait-list reduction plan according to its own objectives and standards. 

But Quebec agreed to work with the other provinces in developing ways to compare wait lists across the country and to co-operate in producing an annual national wait-list report card. 

Charest said the agreement would help turn the page on much of the bitterness towards the federal government that has lingered since the failure of the Meech Lake accord. 

"This (asymmetrical federalism) is part of what Canada is about,'' he said. "It's something we should value, something we should identify more clearly as part of our Canadian federalism.'' 

To Pat Binns of P.E.I., the deal was a ``world-class'' agreement. 

Roy Romanow, who headed the 2002 royal commission on health care, gave the deal a good review. 

"This is, I think, a very positive step forward for reform, I have no doubt about that,'' he said. 

"And I have to congratulate the first ministers, I think they did a good job. It's not perfect but there is a form of accountability there.'' 

Observers from the Canadian Medical Association said the funding boost restores -- and surpasses -- federal cuts imposed in the mid-1990s. Ironically, Martin was the finance minister who imposed those draconian cuts in an effort to erase the federal deficit. 

B.C. Premier Gordon Campbell was equally effusive in his praise for the agreement and said it responds to longstanding provincial demands for a significant cash increase. 

"Tonight the longest waiting list of all has come to an end,'' he said. 

Alberta Premier Ralph Klein called the deal a helpful gesture but nowhere near resolving the country's health care woes. 

"That's a long way from where the premiers were, but it closes the gap,'' said Klein, who left the summit early. 

Alberta Health Minister Gary Mar said Klein would sign the deal. 

Provinces have agreed to set targets for acceptable wait times by Dec. 31, 2005 and to have those benchmarks established by independent medical experts. 

They have also agreed to co-operate in establishing a common set of criteria to measure wait times across the country, also by the end of 2005. That move is seen as a crucial step in pushing provinces towards ever-shortening waiting lists. 

The agreement postpones a provincial request to enrich the equalization system, pushing that discussion over to another federal-provincial conference Oct. 26. 

It took long, tense negotiations to pull both sides toward an eventual compromise. 

Earlier this week, the federal side initially offered an agreement worth only $12.2 billion over six years. 

The provinces responded angrily and asked for more than $90 billion over six years. They drastically reduced that demand by dropping their $64-billion proposal for a comprehensive national drug program, agreeing instead to set up a task force to develop a national drug strategy by mid-2006.


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## I_am_John_Galt (16 Sep 2004)

The "new" health deal amounts being told what kind of bread we are getting our s**t sandwich served-on.  Give me a break: I guess because the 5-year plans worked so particularly well for the Communists, a 10-year plan will work that much better! Also, rather ironic (yet fitting) that we are going to have the measures of success determined by the same people that are responsible for delivering them (in a non-public system this would be a pretty enormous conflict of interest).  This is assinine in the extreme.

In BC we already have had Doctors operating clinics in their off-hours to address the backlog surgeries.  Hospitals are already outsourcing various services to private companies who deliver the same quality of service at significantly lower cost.  

The Romanow report (which was endorsed by both Paul Martin and his predecessor) laid-out a rehash of the same old tired socialist propaganda: NO private clinics, NO extra services, NO incentives beyond what the 'government' (read: money taken from the taxpayer) can provide, and (oh yeah) throw gobs of money at the system (did anyone expect otherwise from an NDP ex-premier? - I can't believe we paid money for that 'report'!)!!  Of course the provinces are welcoming new money (which really just represtents part of the money Chretien took OUT of the system), but if Martin sticks-by his previous promises (i.e., outlawing  private delivery per the Romanow report, let alone competition and consumer (patient) choice) and his party's ideology (centralization) we will be back to where we started in a few short years: the private clinics will be closed and public system will be back to delivering inferior-quality care at higher cost.

The WHOLE system is in need of massive reform (at the bottom, but more particularly at the top): this amounts to buying a little time.


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## dutchie (16 Sep 2004)

_from the Vancouver Sun article today: BC's $400 million average injection (from the feds) over six years represents a little over 3% of the current BC health budget, which comes in at just under $12 billion this year."_
12 _billion_ dollars! Holy crap! PM Martin is pretending this deal is a windfall for the provinces. He promised to 'fix health care for a generation", but if he's giving BC a 3% raise in funding, my math says that equates to 'fixing the health care system for 10.95 days'. 

Obviously massive reform is required, in addition to more funding. This seems to me to be kinda like giving a patient massive amounts of blood while ignoring the 4 inch hole in his chest.

It will be interesting to see what King Ralph does in Alberta (for you Ontario folk, that's the province you guys refer to as 'backwards').


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## Infanteer (16 Sep 2004)

Bruce



> ..and the room its being used in miraculously sterilizes itself upon entering?



No, but are you assuming that the guy who does the toilet sterilizes specialized surgical equipment?  I would assume their is some form of specialized training in the handling of sensitive stuff.  I am not sure exactly who is responsible for it, I'll ask a few friends who are health care specialists.



> Sounds like suck and blow to me. Which is it?



You're comparing apples and oranges here.

In our case, we brought in a new kitchen manager who was a decent chef and is constantly refineing the menu in our restaurant; it has worked, as our dining facility is one of the best in town.  We also streamlined alot of functions in our restaurant.  We are maximizing the utility out of what we got.

You are advocating better bureaucrats.  Canada is served by some pretty smart people, however, these people can do nothing when they operate in what is essentially a flawed system.  New bureaucrats will do nothing to fix the problem that is systemic in nature.



> How often do you tell YOUR staff they are the same as the"  pimply-faced 15 year old at McDonald's" ?



It is not neccessary to do that.  However, I'd say our staff is realistic about the job they do;  we don't (and can't afford to) pay them much more then a McDonalds employee (somewhere in the 8-9 dollar range) because they don't really provide a specialized service that warrants a 15 dollar salary.



> Listen I'm the first to say that changes are required but anyone who thinks that the place to start is with the "peons" in the medical system really doesn't pay attention to the real fiscal world of survival



I'm not argueing that this is where the crux of health care reform is at, only that it is one of the glareing deficincies of a public delivered system that has no realistic grasp on the nature of a consumer/provider relationship.  The end result is that you and me end up paying ridiculous amounts of taxes for sub-par service.



> and maybe should move out in the world of financing a life without the family safety net.



What are you implying?


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## Bruce Monkhouse (16 Sep 2004)

Nothing personally to yourself[ I'll save that for other means ;D]  ..unless you are one of the people who think its possible to keep a roof, have a spouse and raise a couple of children on 12 bucks an hour. Those days are gone.


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## Infanteer (16 Sep 2004)

You're right, those days are gone.   A person could live off of an entry level job half a century ago because they didn't require anything near the level of luxuries which we in the West would consider normal.   People should understand that they can no longer live comfortably doing entry level jobs, if they want to, they should move to a country with a developing economy like Mexico that allows for this.   I am not too sure if I like the work ethic that seems to be developing in our economy in which I fear people may settle with being Starbucks workers.   People should recognize that they must be responsible to better themselves to provide for the standard of living they desire and remain competitive in a global economy.

Doesn't mean we should subsidize mediocrity for the sake of "equality".   That just harkens back to Marxism.


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## thesaurus (17 Sep 2004)

Infanteer said:
			
		

> You're right, those days are gone.   A person could live off of an entry level job half a century ago because they didn't require anything near the level of luxuries which we in the West would consider normal.   People should understand that they can no longer live comfortably doing entry level jobs, if they want to, they should move to a country with a developing economy like Mexico that allows for this.   I am not too sure if I like the work ethic that seems to be developing in our economy in which I fear people may settle with being Starbucks workers.   People should recognize that they must be responsible to better themselves to provide for the standard of living they desire and remain competitive in a global economy.
> 
> Doesn't mean we should subsidize mediocrity for the sake of "equality".   That just harkens back to Marxism.



YOU ARE THE BEST IN ARGUMENTATION AND DEBATE , INFANTEER! I have 4 cousins. When they first came here from a third world country, they started working 13-14 hours a day. They have two or three jobs. While the husband pays the rent and spends the rest on food with some contribution from their spouses, they save the rest to buy a house. You know what. They were able to buy their houses in 5-6 years cash. Budget your money. Do not spend it on crap like beer, strip bars etc. So that was the moral of the story. Because you are such a superb debater, I recommend that you attend this conference on October 14-16, 2004. CASIS conference. Your comments will be highly appreciated. I wish I can cultivate you but I have no authority. I am just one of those food servers.


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## thesaurus (17 Sep 2004)

Bruce Monkhouse said:
			
		

> Nothing personally to yourself[ I'll save that for other means ;D]   ..unless you are one of the people who think its possible to keep a roof, have a spouse and raise a couple of children on 12 bucks an hour. Those days are gone.



 sir! i beg to disagree but i am still subservient to you. If you give me orders to jump from a building. My answer will be: WHAT FLOOR DO YOU WANT, SIR!!


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## thesaurus (18 Sep 2004)

I have a suggestion, some sort of middle ground. The reason behind the law that covered universal coverage of health care quoting jean chretien, was that 'some people have to sell their houses if they get cancer". But the counter argument nowadays is that it is budget consuming. If in chicago public hospitals they treat your cancer free and that if ever by call of nature you get confined in a private they put you on charity ward or charity case[which i think is degrading], why not a middle ground. These have not been ttested but since the governmente is willing to spend on this no matter how much and that rich people wants some state of the art medical equipment which private hospitals can afford but all government hospitals sometimes can ill-afford, why not compensation for emergency cases. Two tier but in case you land in a private under emergency circumstances the goverment pays. Or a law passed which ssays to treat it as a charity case but quotas have to be imposed. WE ALL KNOW THAT WITHOUT USA MEDICAL RESEARCH , STATE OF THE ART MEDICAL TECHNOLOGY IS NOT POSSIBLE. WE ALL KNOW THAT THOSE US MEDICAL BOOKS WERE DONE USING PAINFUL RESEARCH. WE ALL KNOW THAT WE OWE MEDICINE TECHNOLOGY TO PRIVATE DRUG COMPANIES IN USA WHO SWEATED IT OUT , GAMBLED THEIR WAY AND INVESTED MONEY WHICH ITS RETURN STAYED UNCERTAIN. WE ALL KNOW THAT FIDEL CASTRO PLAGIARIZED ALL THOSE US MEDICAL BOOKS. WE ALL KNOW THAT AMERICA IS THE BEST IN INVENTING VACCINES. WE EXPLOIT THEM BY BEING RECIPIENTS OF MEDICAL TECHNOLOGY BY THEIR FREE RESEAARCH JOURNALS. PAY AMERICA BACK AND DO NOT PENALIZE THE RICH BY TAXES BECAUSE THEY ARE RICH. PENALIZE THEM IF THEY DO NOT PAY THEIR TAXES.!!   

MY line of argument presumes that under two tier hybrid universal coverage law it also covers provisions for purchase of state of the art medical equipment

"Charity is biblically inspired. Matthew 6 "do not let the left hand know what the right is doing. " My father's doctor in USAnever uttered a word about it nor proclaimed it to the whole world that he was the one who sponsored my father for treatment. I gave him a wooden figurine. He said thank you! I said thank you too.


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