Canadian Health Care System

[MagieNoire]

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

Cheers, and be safe.

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

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

Thanks for sharing about your healthcare system.

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

 

[Drummy]

MN,

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

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

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

All the best    Drummy

 

[Armymedic]

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

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

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

 

[sigpig]

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

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

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

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

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

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

 

[karl28]

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

 

[Brad Sallows]

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

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

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

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

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

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

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

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

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

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

 

[Gouki]

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

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

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

 

[Glorified Ape]

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

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

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

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

 

[Infanteer]

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

2 points on the story:

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cheers,
Infanteer

 

[Brad Sallows]

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

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

>it cost everyone of us not a single cent

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

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

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

 

[muskrat89]

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

 

[PPCLI Guy]

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

Bollocks.

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

Dave

 

[tomahawk6]

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

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


2004 Budget - $36.8 billion for healthcare

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

 

[Glorified Ape]

2 points on the story:

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

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

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

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

 

[camochick]

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

 

[Glorified Ape]

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

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

 

[camochick]

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

 

[Cliff]

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

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

 

[Infanteer]

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

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

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

 

[Brad Sallows]

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

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