If America adopts Canada's health care system

[I_am_John_Galt]

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

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

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

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

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

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

 

[I_am_John_Galt]

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

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

 

[Sheerin]

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

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

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

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

 

[I_am_John_Galt]

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

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

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

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

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

Yeah, sure: whatever Michael Moore says, right?

 

[Sheerin]

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

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

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

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

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

Yeah, sure: whatever Michael Moore says, right?

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

 

[Flip]

Funny you should mention this JG.

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

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

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

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

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

 

[Flip]

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

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

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

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

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

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

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

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

 

[CougarKing]

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

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

 

[observor 69]

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

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

 

[Flip]

The answers are simple.

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

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

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

To repeat myself.... ;D

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

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

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

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

Just a few thoughts--- ;D

 

[observor 69]

The answers are simple.

Oh really !

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

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

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

 

[Greymatters]

In reply to My comment:

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

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

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

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

 

[Flip]

Oh really ! 

I said simple - I didn't say easy 

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

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

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

How would the military run then?  ;D

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

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

 

[CougarKing]

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

Greymatters,

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

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

...


I do know that the more "corporate" and the less "institutional" healthcare
becomes the more profit driven it will be - There's NO upside.

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

 

[Greymatters]

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

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

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

 

[CougarKing]

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

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

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

Greymatters,

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

 

[Greymatters]

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

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

 

[I_am_John_Galt]

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

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

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

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

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

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

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

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

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

 

[Greymatters]

Cougardaddy:

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

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

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

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

 

[observor 69]

I_am_John_Galt:

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

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

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

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