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If America adopts Canada's health care system

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Fiver said:
Oh em gee, conflicting informations on 'teh intarwebz', which will you believe?

http://www.taipeitimes.com/News/taiwan/archives/2006/03/03/2003295475

Though I don`t blindly trust that article either, see http://www.youtube.com/watch?v=T69TOuqaqXI, which applies to more than science vs religion.

There is this problem about misleading or outdated health beliefs. For example, for a while, it was generally thought that low-tar cigarettes were less cancerous, but it was later said untrue by another study. And there's also much biased, conflicting or exaggerating studies.

And here's what happens if we look up Peanut Butter on wikipedia: http://en.wikipedia.org/wiki/Peanut_butterSadly, even this might be false or in part false, as there are no link referring to this statement.

What about aflatoxin? http://en.wikipedia.org/wiki/Aflatoxin#cite_note-1
My verdict would be that there's not enough of the stuff to be a direct cause of cancer and that studies suggesting that ingesting peanut butter is highly dangerous cancer-wise are exaggerating, a lot.

There's an argument for your side. There's somethings for mine. Since we are not authorities or specialists or doctors, let's call it a draw and move on.
 
mediocre1 said:
There's an argument for your side. There's somethings for mine. Since we are not authorities or specialists or doctors, let's call it a draw and move on.

You're moving on?  Wonderful. Have a nice life on your next forum.
 
Michael O'Leary said:
You're moving on?  Wonderful. Have a nice life on your next forum.

For a moment there Michael you made all happy... and then I realized you were day-dreaming. Sad, sad life...
 
TimBit said:
For a moment there Michael you made all happy... and then I realized you were day-dreaming. Sad, sad life...

I am not in this forum to start trouble, timbit. Actually to tell you the truth I am not even here to debate. My masters in Ottawa and Front Street, through body language, told me to stay. They use the truck with STAPLES printed on it and direct it to pass my way. In-place. Got any idea what I am talking about. I am here to behave and be in-place. Observe and report. You notice the number of pinko-communists sprouting and picking on me. They even get away with slander or libel. That is why I hate my God-saved masters Jim and Ward more than anybody else. I don't even hate you, timbit.
 
mediocre1 said:
I am not in this forum to start trouble, timbit. Actually to tell you the truth I am not even here to debate. My masters in Ottawa and Front Street, through body language, told me to stay. They use the truck with STAPLES printed on it and direct it to pass my way. In-place. Got any idea what I am talking about. I am here to behave and be in-place. Observe and report. You notice the number of pinko-communists sprouting and picking on me. They even get away with slander or libel. That is why I hate my God-saved masters Jim and Ward more than anybody else. I don't even hate you, timbit.

And that's the last straw.

Milnet.ca Staff
 
As the Obama administration moves to take control of the medical sector, they will run into real troubles since they will not be able to conceal the growing and self induced shortages of doctors and other medical staff, and Americans are not as prone to wait in the Emergency room for eight hours like Canadians.....

http://pajamasmedia.com/instapundit/  April 27 2009

HEY, I’VE GOT AN IDEA: Make the practice of medicine more rewarding! Shortage of Doctors Proves Obstacle to Obama Goals. Naah. That approach would make too much sense.

But when Obama says “We’re not producing enough primary care physicians,” he’s making a mistake. We don’t produce doctors. They’re not widgets. People choose to become doctors — or something else — based on their analysis of what will produce the best life. Medicine has gotten less pleasant, and less financially rewarding, really, over the past several decades as it’s become more bureaucratized and subject to the whims of third-party payors. So will Obama’s plan fix that? Seems doubtful. Will he recognize that you don’t produce doctors the way you produce, say, cars? That’s doubtful, too.

UPDATE: James Joyner emails:

While the things you cite may be causing more physicians to retire early we’re not having trouble attracting people to the profession. The problem is that the AMA has created a cartel with the medical schools, creating severe barriers to entry. The number of slots has remained essentially static despite a population that has nearly doubled in forty years. We’re having to import docs from abroad just to keep up.

That’s a fair point, and there’s no good justification for those limits. On the other hand, as the article linked above notes, poor working conditions and insufficient pay are pushing people out, and steering them to specialties other than the internist/family practice primary care doctors that we need the most.
 
Sneaking it in under cover of darkness. "Hope and Change" indeed:

http://hughhewitt.townhall.com/blog/g/85f5404e-a4de-4a1c-a9a6-60d10f2e590a

The Rush To Rationing, Cont.
Posted by: Hugh Hewitt at 10:57 AM

Yesterday I posted on the rush to pass a radical restructuring of American medicine that will result in health care rationing as surely as day follows night.

On yesterday's program Politico's Mike Allen confirmed that the negotiations are ongoing and very secretive, as the Democrats intend to avoid the mistakes of the HillaryCare fiasco of 1993-4.  Mike acknowledged what everyone who follows the subject kbnows --the Obama Adminstration is aiming for single payer by another name and introduced slowly rather than suddenly.  In today's Playbook, Allen reports that Frank Luntz has warned the GOP that "reform" is popular, and that they can't be caught opposing health care reform.  Luntz is righr, which is why the GOP must define the debate in true terms rather than get sucked in to the idea that the Obama plan is "reform."

President Obama's "Health Care Reform" = Single Payer = Rationing of Health Care. 

No fair minded observer can dispute that,or the experience of Canada or other single-payer systems.  Republkicans do indeed have to be for "reform that doesn't morph into rationing."

Perhaps the country wants to go to single payer and the rationing it guarantees, but I doubt it.  Which is why the MSM is simply not reporting on the negotiations and the direction in which they are headed with any sort of depth or with the detail that would ordinarily accompany such a major shift in American life.  The Hill leaks and leaks, but not on this subject, or at least those leaks aren't making their way to the front pages.  The AARP, AMA, Big Insurance and Big Pharma are also incredibly quiet, hoping perhaps to cut a better deal or waiting until they have a target.  Allen suggests the Chamber of Commerce is at the table, busy off-loading the cost of insurance on to the taxpayer, which will help their bottom lines but which will leave the quality of medical care in America rolling down a very steep slope.

The anti-single payer groups underestimate the speed with which this "compromise" will move once it is unveiled, and the willingness of the MSM to cover for their most favorite president ever.  If rationing is going to be defeated, the effort to explain to the American people what this package means and which Democrats are supporting rationing has to begin yesterday.
 
To the point of the topic:

"If America adopts Canada's health care system"...

...it may not be to Canada's advantage.  If our public health care system gives us half the competitive advantage (cost of health insurance) its defenders and enthusiasts claim, they should not wish the Americans to succeed.
 
I disagree,

I don't think the US's health system increasing, decreasing or reorganizing will have any effect on ours unless the cap their doctors salaries then maybe we'll see more doctors trained here staying in Canada, relieving those that work here now... a lot of doctors work their family practice, then do a shift at a hospital.

The US eliminating the incentive for Canadian doctors to emigrate would help us reduce ER wait times here.

Personally I think that the Government needs to take action on it's own anyway. What I would like to see is the Crown create a Corporate Division, it's goal would be to look for fields where a Crown Corp like SaskTel could compete against private business. If successful it could return dividends to the constituents or reduce income taxes.

This way we could have our cake and eat it too, if private business thinks they can provide healthcare for less than the current system, they are free to try, but we aren't going to sell them the current infrastructure at cut rate prices, and they will have to prove they can do it better, after 10 years of them doing better, we could start standing down the crown corp.

This would also provide an avenue to keeping more doctors in Canada, Private firms would pay more to attract them, and in competing with private businesses the Crown Corp would have to also trim some fat and create more incentives for doctors to work for it.

I would also like to see this corporate dept step up during problems like the softwood lumber issue... prefab housing is in high demand in other parts of the world, it could have bought up the closing foreign lumber companies and redirected their outputs to a new prefab housing company. They would have kept people working, reclaimed revenue that used to flow out of Canada, and created a new industry that potentially could have made a tidy profit.

Even if it didn't and broke even or took a small loss, the workers would still have been working, and paying taxes while the US would have been in a serious soft wood lumber shortage and the tariff issue would have been dealt with in our favour much more quickly.

Same with the mad cow scare, it could have instituted the regulations Japan and others wanted before they would accept our beef, ( hop scotching the inefficient bureaucracy that instead of just doing the increased testing, tried to convince the other nations that our random sampling was good enough),  and redirected outputs from the cattle industry again, and this would have prevented the board in he US to hold out until our ranchers were going bankrupt so it's board members could buy up the Canadian herds at cut rate prices before they reopened the border.
 
So you havn't considered the reason no one moved into the pre fab housing market (either here or for export) might be because it wasn't profitable?

The number of doctors might be constrained because people considering medical careers might not want to deal with complex bureaucracies or have their salaries/hours/conditions of work dictated to them and therefore never enrole in medical school (or drop out)?

That any taxpayer funded entity has no incentive to become efficient, and indeed has perverse incentives to become more inefficient in order to capture more tax dollars and expand the power and presteige of the bureaucrats who run  it?

That any taxpayer funded entity which only breaks even or runs at a loss is a net drain on the economy (and workers "paying taxes" on incomes that are just tax subsidies from people in the productive economy is simply recursive.) Indeed the monies diverted to these stagnet areas of the economy are directly subtracted from the pool of available resources that could have been invested to create real jobs (this means that these subsidized jobs you advocate would result in a net job loss in the economy)?

When I am Imperator, economics will be taught in primary school to stamp out this sort of nonsense once and for all!
 
So you havn't considered the reason no one moved into the pre fab housing market (either here or for export) might be because it wasn't profitable?

no, because there is HIGH demand for it in a country that has multigenerational mortgages. Even if it wasn't profitable, it's better than handing billions of dollars a year in tarrifs to the US economy while the surplus rots in the yard, and former tax payers begin drawing EI while looking for employment elsewhere.

the reason that the small lumber yard companies did not do this is they lacked the startup capital, weren't willing to risk shareholder ire, and felt their shareholder interests were better served closing their canadian operations in favour of focusing elsewhere. Their revenue stream was the profit off the sales of soft wood only, the Crown would have stopped a reduction of tax revenue directly from it's workers, and indirectly from the supporting local economy, directly off of new workers and indirectly off the supporting economy from those new workers, and potentially of a new revenue stream provinding exports to a high demand market.

Why would a private firm front the capital when for all intents and purposes it looked like the Canadian government would quickly solve the problem, it's easier to harvest raw resources and sell them for profit, than it is to provide finished products, however, the profit margin on finished products reflects that.

We sell our raw resources to the US at 10% profit so they can sell them right back to us as finished goods at 50-100% profit.

The number of doctors might be constrained because people considering medical careers might not want to deal with complex bureaucracies or have their salaries/hours/conditions of work dictated to them and therefore never enrole in medical school (or drop out)?

could be applied directly to the CF, is the solution to deprive areas of the CF just because some people would not rather work there?

Not to mention, this happens in the private industry as well, for example pilots need to get their hours in doing puddle jumps up north before they get their cushy milkruns in the bigger planes on main routes. 

As I mentioned in my post, I think the shortage of doctors is due to lower pay than competing employers and lower standard of living here, I'm all for paying doctors more to keep them in Canada and even poach some from other countries. the more Doctors we gain, the less overtime they will have to work, resulting in a better standard of living for them.

Selling the infrastucture to a private firm will not solve that problem, private firms will simply reduce services and/or charge more because just like every other privitization, they take 15% off the top, lay off a few of the more expensive employees and continue with business as usual.

Are you implying that in the US doctors put up with less bureacracy? keep in mind litigation against doctors is much higher, they have to directly deal with insurance companies to determine if the patient is covered for a particular treatement and prove that said treatment is required, rather than just let the front desk do card check before applying treatment.

And are you implying that doctors have no choice in their postings in Canada and have complete control in the US?

That any taxpayer funded entity has no incentive to become efficient, and indeed has perverse incentives to become more inefficient in order to capture more tax dollars and expand the power and presteige of the bureaucrats who run  it?

Some how SaskTel a crown corporation is managing to not only be profitable, it's expanding outside of Saskatchewan and Canada and proving that a crown corporation competing against private industry can be efficient, effective, and reduce the tax burden on the governments constituents. I certainly also don't hear residents of Alberta complaining about how the provinces oil concerns are a waste.

That any taxpayer funded entity which only breaks even or runs at a loss is a net drain on the economy

hogswash, this is simple arithmetic, if the government applies 10 million, and the crown corp returns 10 million, then there is a net cost of ZERO, and the employees taxes are gain for the local government, especially if those are new jobs that reduce the unemployment rate or draw workers from other areas.

if the government collects 1 million in tax revenue from new jobs, or from jobs that otherwise would cease to exist you have a 10% return on investment.

this provides an incentive to a government to attract workers to increase it's revenue collection, rather than charge more for less services.

(and workers "paying taxes" on incomes that are just tax subsidies from people in the productive economy is simply recursive.)

you can hardly exempt crown corp employees from paying incometax just so you don't have to tax them later. IF the crown corp can't make money while it's private competitors can, it's time to shut down the crown corp, regardless if there are tax revenues collected.

Indeed the monies diverted to these stagnet areas of the economy are directly subtracted from the pool of available resources that could have been invested to create real jobs

I fail to see how a job working for a crown corp that makes a profit is any different or less real than a job working for a private corp, other than in the former the shareholders are the people of that government and in the latter they aren't

(this means that these subsidized jobs you advocate would result in a net job loss in the economy)?

not quite sure what you are asking here, by doing nothing, several lumber firms closed down, packed up and left Canada, this resulted in those jobs being lost, and a loss in the economy.

I proposed that a crown corp be stood up to look into alternate markets for Canadian Softwood lumber, and suggested the highly lucrative prefab housing market, though in many european markets dimensional lumber and raw lumber go for a nice high price. 

The goals would have been:

-to keep the workers employed and paying into the public purse rather than drawing from it. Not that there is anything wrong with that but it is better for both the worker and the government to keep them working.

-preventing a local economy down turn by the workers continuing to spend their disposable income, rather than save every penny.

-reduce the likely hood of workers leaving the area in search of new work thus impacting the local economy and the public purse in a negative way - the fewer people working in an area the fewer people purchasing other services and goods, and the fewer paying taxes.


When I am Imperator, economics will be taught in primary school to stamp out this sort of nonsense once and for all!

I fail to see what nonsense you are talking about, perhaps if you re read my previous post a little slower and comprehended that I don't want to replace private industry with crown owned industry but pit them against eachother to prevent either from resting on their laurals.

the real nonsense is that unchallenged private industry can be trusted to provide the most efficient products and services anymore than unchallenged government organizations can be.

when private industry is small and compartmentalized it is more likely that it will compete, when it is large and monolithic it is more likely it will come to an understanding with it's competitors via the language of market actions to create a larger profit for all of them.

The difference between a crown corp and a private corp are their shareholders and the shareholder's desires.

Private corp's shareholders are interested in ROI.

Public Corp's shareholders are interested in the best products/services at the cheapest cost possible.

Pitting them against eachother should result in a modest ROI with very good products/services if there is a market for them to begin with.
 
>Some how SaskTel a crown corporation is managing to not only be profitable

A poor example, since all the telcos started with a de facto monopoly of infrastructure.  In holding up Sasktel's anemic performance, you overlook what might have been if Sasktel had been more like Telus or Bell from the outset of the opening of the playing fields.

But I agree: let's have more government involvement in profitable enterprises, as well as expose more public (government) monopolies and undertakings to open competition.  But ensure there is no legislation to tilt the competitive field to favour the government-owned bodies.
 
I have family working in SaskTel and have been a customer of all three, and worked for NBTel/Bell back in 96/97.

As a Crown Corp Sasktel a good example of a crown corp acting more like a business than a tax subsidized drain.

The fact that it returned dividends to the people of Saskatchewan, provides some of the best service I've seen and is branching out internationally as well as competing in other province's turf I don't see how it's performance is rated as anemic.

Telus has the worst service and infrastructure of any telco, and concentrates on sucking every dime out of it's customers. If it spent half the money it does on it's comercials on maintaining their infrastructre, maybe it would stop failing under normal expected call volumes.

Bell Canada I don't have customer experiance with outside Bell Express View

[incomming bad service rant]

this year I canceled my service with them because

1. they decided they needed to verify that each reciever I had was at the same location randomly and demanded I pay for 3 new phone ports, then tried to lie to me that I'd signed a contract stating I would, seeing as I wasn't even home when they set up the account in my name and couldn't produce a contract that I signed or a recording agreeing to it, I told them no.

2. they wanted me to activate 2 terminals that were on a shelf unused during renovations, I told them to just deactivate them, and I'd activate them when I needed them again, they seemed happy with that

3. then 2 boxes showed up on my doorstep, I called to inquire what that was about, they told me not to worry

4. my service was deactivated, I called got it reactivated

5. started getting automated messages threatning to charge me for the full cost of the terminals if I didn't return them ASAP, called in, they had no idea...

6. called in to remove a movie package that I wasn't using that cost 20 bucks a month, because their self help website kept crashing, the agent was unintersted and it took 3 tries to explain what I wanted.

7. after 3 months the package was still not removed and they couldn't explain it, and while they had a record of the order, refused to refund $$$

8. 2 more boxes show up.. repeat 2,3,4,5

9. I get billed 179 dollars for 2 terminals, takes them 6 weeks to credit my account

10. I finally have had enough, cancel the service, pack everything up, send it back takes 2 months to terminate the service, I wasn't on contract... they can turn it off and on at will but canceling service after being treated like that takes 2 months?

11. start getting messages to return equipment that has already been returned, call in, give them the tracking number and remind them they still owe me $74.95

12 after 3 months waiting for my cheque for the credit to my account, recive a bill with a charge of 74.95 for "Disconnection Recovery Adjustment"

[end rant]

not what I'd call stellar service, their retention department offered 3 months free service after stealing at least that much from me and treating me like a criminal after 3 years of business with them.

However another private firm, Rogers, has bent over backwards to provide me with top notch service.

I'm probably biased, but I don't find myself thinking of Sasktel as Anemic since it's gone international and has the potential to provide a lot of revenue to it's shareholders which is admittitly rare if not unheard of for a government branch.

I see the Government as a large corporation and each voter owns one share, why shouldn't it operate with it's aim in providing shareholders ROI rather than just redistribute our assets?
 
>Telus has the worst service and infrastructure of any telco,

Care to back that up with facts?  We all have anecdotes of people dissatisfied with one provider or another.

An anemic performance is just the opposite of a strong one; it doesn't mean a company is non-viable.  Not all viable companies perform strongly; some perform below potential relative to peers.  If SaskTel were a strong performer, I would expect to see it further ahead that where it currently sits.
 
I would expect to see it further ahead that where it currently sits.

Care to back that up with facts?

I fail to see how a provincial telco that has expanded into other provinces and into other countries, has the highest highspeed service avaliblity outside of major centers, and is known as a repository of some of the brightest minds in the business is anemic performance, what goal should they have that you think they haven't met? I don't see Aliant or Bell developing new wireless technology or establishing new customer bases in other countries. They are certainly one of the best places to work in the IT industry, - unionized and get every second friday off. Keep in mind they are also being hemmed in to provide service to those that it is very difficult to do so by government mandate, those that would not be targeted by private businesses as it's not economical to do so and yet SaskTel still succeeds.

http://www.gov.sk.ca/news?newsId=4de9ca55-6a05-4698-afbe-c02f088c30fc
http://www.sasktel.com/about-us/company-information/history/2000s.html
http://www.eluta.ca/top-employer-sasktel
http://www.lienmultimedia.com/itnewslink/article.php?id_article=2638
http://www.eboardoftrade.com/files/Productivity_Reports/12_04_SaskTel_Letter.pdf
http://www.gov.sk.ca/news?newsId=5bc2829a-3c67-4aab-9e70-7c3b8c392242
http://www.gov.sk.ca/news?newsId=f52db6b5-5daa-44e5-bb10-4e526b6bad95




you also have to keep in mind that a Crown corp is not going to go heavily in debt even temporarily to aquire capital for large incursions into competitors territory like a private firm will. This is because no Tax payer is going to accept that, while it is expected of a private firm.

SaskTel has managed to increase it's customer base, break into new markets, develop new infrastructure and revenue streams without borrowing into heavy debt while competing for those customers against private firms that will and do borrow to aquire capital and have many times the customer base SaskTel does to draw revenue from.


Now as for facts on Telus, it's a combination of my experiance as a customer and knowledge of the companies from working with them in the telecom industry (used to work for Genesys Labs) which is a subsiduary of Alcatel, which provides Call Center solutions to companies such as Telus, Sprint, Bell US and Canada, Telstra, Etc and has branches all over the world.

I've spent some time looking for customer satisfaction surveys but I didn't find anything, perhaps you have? I think the problem will be that only a handful of them are multi province so you end up with aliant vs rogers vs Telus for some and Sasktel vs Shaw vs Telus, or Bell vs Rogers vs Telus... so there really isn't an easy way to poll this across Canada.

I'm unclear about what performance indicator you are looking for anyway.


http://about.telus.com/awards/corporate-excellence.html, from a stockholder point of view they do very well, however, I'm not seeing much that shows confidence in them from a consumer point of view, while SaskTel provides satisfaction on both fronts.


More antecdotal evidence, ignore if you please...

Never had a problem with Aliant, or Bell during the weeks prior to or after the 23,24,25,26 of Dec calling family, Telus on the other hand I couldn't get through sometimes, and when subscribers from out of province called in we would repeatedly get a ring but no voice.

with Aliant and Bell I've had maybe 2 times I couldnt' call out of provice on the 23,24,25,26 of Dec and had no end of trouble during those days with Telus.




I think this has well and truely gone off the rails, perhaps some kind moderator could split this off into a viability of crown crop discussion thread.
 
Even assuming everything you say about Sasktel is true, the record of State owned companies in general is a dismal swamp of failure, political interference and a sucking drain on the taxpayers resources in favor of political rent seekers.

I'll see your Sasktel and raise you Bombardier, Via Rail, Ontario Hydro, "Government Motors" (formerly General Motors), Airbus Industrie, the "John Labatt Center" downtown sports arena (London Ontario), AECL...need I go on?

Sasktel would then stand out as the exception to the rule, and even then I would look very carefully at the political and economic environment to see why it should be exceptional; Saskatchewan's small population base would make private companies reluctant to go in if there is already a State owned competitor (who can raise unlimited funds to drive out competitors, what you don't see on your phone bill shows up on your tax bill).

WRT health care, I am trying to find a comparison which laid out the wait time for medical procedures between the United States, Europe and Canada. Needless to say, the comparison wasn't good for Canada's health care system; the wait time was (if I remember right) on the order of 62 days, far more than Europe or the US. Of course, if the US closes out the market, pressure for fast innovative healthcare from consumers will be replaced by pressure for large bureaucracies and corresponding salaries by the bureaucrats in charge of the system.

Hey, it worked so well here......

and for your viewing pleasure: http://www.onthefencefilms.com/video/deadmeat/
 
As I wrote, I would just expect to see SaskTel further advanced from the Stentor breakup if it were "strong".  If it's mandate is mainly to be a good supplier of services to Saskatchewan, that's nothing of which to be ashamed.  Some of the other telcos have simply pursued markets outside their traditional turf more aggressively.  It is clear there are militating factors which restrain SaskTel, but it is also clear that Saskatchewan is a smaller market which means it is less likely to be a marketplace battleground.

As a Telus employee (not directly involved in telephony), I have access to the internal web site and therefore can read the daily summary of all news related to Telus and telecomm issues in general - the good and the bad.  I have also read discussion threads on the WWW at large on which the topics were various gripes about Telus.  During the last TWU strike, I did have to work directly in telephony, in a capacity in which occasionally I had to interface with customer facing elements of other telcos.  I'm aware of the shortcomings the company has from time to time.  However, I'm also aware of some shortcomings of the other providers with respect to service, infrastructure, billing, etc, and the statement "worst service and infrastructure of any telco" won't pass muster.

Regarding crown corporations, it is not the case that they all must be failures.  I consider ICBC to be a successful corporation in BC.  However, it is also an example of how a crown corporation can be sheltered.  With enough protection, any company can thrive.

I don't really care if governments want to involve themselves in enterprises which generate a revenue stream; I just want all enterprises with a revenue stream to be open to competition with a level playing field for all.  It's easy to be enthusiastic about government-owned corporations run to generate revenues for public spending, but the proponents seem to be less enthusiastic that the government-owned corporations should face the same risks and pressures as competitors.
 
The results are so predictable that they are on offer right now before any bill is presented:

http://hughhewitt.townhall.com/blog/g/522f386d-e0f9-4d2e-ba51-ccd2c24054df

Obamacare Will Lead To A U-Turn On Life-Expectancy: What To Tell The Blue Dogs
Posted by: Hugh Hewitt at 9:24 AM

The disorganization among opponents of the "government option"/single payer/rationing that is at the heart of the Obama/Pelosi/Reid proposals to radically restructure health care in America is, well, non-existent.  Until a specific proposal is on the table, the big interest groups are holding back, in a classic display of the triumph of hope over experience.  When the Pelosi bill finally emerges from the House, even then the ostrich approach will continue as the groups tell themselves that the Senate will save them.

But the Senate won't save them because of the rule change that allows health care restructuring to pass with 50 Democratic votes.  If a terrible bill gets out of the House, a terrible bill will get out of the Congress.  The e-mail below illustrates --again-- that voters have no idea that woeful destruction to the amazing American system of medicine that are on the horizon.  But if you are one of those who do get it, look through this list of "Blue Dog Democrats" and contact one or more to urge them to reject "the government option"/single payer/rationing.  If a blogger has already come up with a comprehensive post with contact info for the Blue Dogs, especially their office phones in D.C. and their districts as well as e-mails, pleas send along the link or the info.  I will have my interns work on the contact list next week as well.  I think any even remotely aware consumer of health care services has got to realize that the Democrats are on the verge of a massive destruction of the American medicine delivery system.  There are problems in health insurance cost and coverage, but not in the quality of care and the innovation instinct, and the Democrats are going to kill the latter in the fruitless quest for improvements to the former.  The "government option" is the biggest threat of all, a thinly digusied lurch to Canada-style single payor with the hidden (and increasingly not-so-hidden) rationing and lousy care that Canada provides its people with complex diseases and conditions. 

Unless enough Democrats get the message that a vote for Obama/Pelosi/Reid is a marker that will attract enormous political payback in 2010.  They won't believe that unless they hear it from enough people, and hear it in such a way as to believe that their correspondents are serious about contributing to the Blue Dog's opponent in 2010 and even walking a precinct if necessary.  Saving health care has to be for Republicans what killing Social Security reform was for Democrats in 2005 --a line in the sand that, if crossed, will never be forgiven.

It is amazing that neither the D.C. GOP or any of the doctors' groups have yet organized such an effort, but the Beltway creates and reinforces an insiders' ethic that enervates otherwise sensible people.  But the peril to medicine is real, as the e-mail below indicates.  So do something about it.

    From Dr. L in Illinois:

    Dear Hugh,

    As a brief background, I am a board certified medical oncologist in private practice with a 22 physician group in Chicago and the adjacent suburbs. We see patients in ten hospitals, seven offices, and see nearly 5000 new patients per year. I finished training in 1993 and joined my practice that same year. I am a partner and practice manager, responsible for both patient care and 'nuts and bolts' financial and organizational management of the practice, along with our other officers.
   
    This weekend, the American Society of Clinical Oncologists will hold their annual meeting in Orlando Florida. While it is directed at the American cancer treatment community, it has become the de facto World cancer meeting. Much of that stems from the plethora of companies based in the US that have brought to the market a multitude of groundbreaking drugs, developed in US academic centers and thereafter applied to the American population at large who suffer from cancer.

    Reading the Meeting Proceedings between [visits with] patients in my office (not my turn to go this year), I've rarely seen an annual report that held such promise.  There are a multitude of both new drugs, and new applications of established drugs that promise to accelerate the 1-2% annual drop in cancer mortality that we've seen since the late 90's. It's a better time to have cancer than ever before---if, of course there was ever a good time for such misfortune.
   
    Alas, I think many of these advances will be stillborn. And yes, I expect the Obama administration to be the instrument of its destruction.

   
    I will be the first to point out that there is enormous waste in American medical care. There's plenty of blame to go around; physicians are rarely capable economists, and rarely consider the cost:benefit ration of that extra test or that extra day in the hospital; "Nothing's too good for my patient" is laudable, but is also a screen behind which too many of my colleagues hide their intransigence.  Greed is hardly unknown, though I believe far less widespread among physicians than their various suppliers. I admit to something less than objectivity on this. Medicare guidelines are often the perfect example of the adage "there's no problem that government can't make worse and more expensive".
   
    Despite the fact that perhaps 15% of healthcare expenditures go to physician compensation, it's the convenient target. Hospitals, private payors and Pharma are very effective in the political arena.  The AMA, looked upon by the uninitiated as the'voice of American medicine' is nothing of the kind. We, frankly haven't the time, nor often the inclination to participate in the political wrangling; many of the 'thought leaders' in medicine are academics, whose goals are often diametrically opposite the more than 80% of physicians who practice in the private, nonuniversity sector.
   
    Every analysis of oncology suggests that we have a 10-30% deficit of trained physicians staring us in the face by 2020.  Every academic analysis suggests one or another program, and bemoans the difficulty in attracting qualified medical students and residents to oncology. It's quite simple, really: very hard work, and declining income. Private practice physicians have seen a fall of approximately 30% since 2004. Worsening economics are right around the corner.  Given the extraordinary expense of chemotherapy and supportive therapies, combined with reimbursements that just exceed a wash, it will become impossible to deliver outpatient care in more than half the venues in the United States quite soon.  And then, simply put, the senior physicians will quit.
   
    Make no mistake: most of us enjoy the opportunity to do what we do. After all, we cure cancer for a living. Hard to top that on the "Useful Professions" scale.
   
We also, however endure just the stressors and personal strains that you might imagine. We trade time, and inconvenience, for money. Just like everyone else in the private sector, only more so---after ten years of training after college. With the prospect staring us in the face of working harder than the average internist, and earning less: well, if I were 58, and my kids were grown and my mortgage paid: well, I'd call it a day. At 48, I'm already working on an exit strategy by 55 in anticipation of this scenario.
   
    I could go on, but this note is far too long already.  Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They'll scarcely need to ration care: there just won't be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.
   
    Sincerely,
    Dr. L. MD FACP


Read that again.  Then go and call/write/e-mail some Blue Dog Democrats. Tell them to stand up to the left wing of their party or stand down in the next election.  Promise to support their opponent if they support the destruction of American medicine.
 
Even assuming everything you say about Sasktel is true, the record of State owned companies in general is a dismal swamp of failure, political interference and a sucking drain on the taxpayers resources in favor of political rent seekers.

the record in general for private companies is no better, at least when Crown Corps make a profit again after getting bailed out that money goes back into the public purse, while in Private companies it goes to the shareholders who allowed the Executives to run the company into the ground in the first place.

I say let both crown and private industries fail.

I'll see your Sasktel and raise you Bombardier, Via Rail, Ontario Hydro, "Government Motors" (formerly General Motors), Airbus Industrie, the "John Labatt Center" downtown sports arena (London Ontario), AECL...need I go on?

beg your pardon? Bombardier is a publicly traded corp, I owned shares in it. GM hasn't even been govwernment majority owned a month yet, and proves my point that a private company can be a dismal failure and suck more tax dollars than a crown corp. The public outrage if a politician ran a crown corp into the ground and took 20 dollars more than his salary would probably see them in jail let alone million dollar bonuses and golden parachutes. Ontario Hydro suffers from uneducated greenies screwing with them because they are afraid of nuclear power. Not to mention NBPower, a private corp is just as bad and has higher rates.

I'll raise you GM, Chrysler, Air Canada., Also raise you every single crown corp that has been privatized in Canada.

I'll raise you every public insurance company that seriously undercuts every private firm.




Saskatchewan is a smaller market which means it is less likely to be a marketplace battleground."

When the Government degerulate Telcos, they were required to provide free access to the existing infrastructure, therefore startup costs are minimal, and thats why it's not only Sasktel providing service there, yet while maintining the infrastructure the others piggyback on for free, Sasktel still is the top competitor.

Sasktel would then stand out as the exception to the rule, and even then I would look very carefully at the political and economic environment to see why it should be exceptional; Saskatchewan's small population base would make private companies reluctant to go in if there is already a State owned competitor (who can raise unlimited funds to drive out competitors, what you don't see on your phone bill shows up on your tax bill).

the reason it is exceptional is the province is full of no nonsense farmers who won't hesitate to vote out those who screw around, and will have them arrested, tried and convicted should they cross the line.

Unlimited funds do not exist, Political Entities cannot dump unlimited funds to drive out competitors without driving up taxes or going into debt, while large international telcos can and do command enough to decapitate Sasktel if the public were willing to abandon it.

private companies are there and are competing, there is no extra protection for sasktel

Saskatchewan pays some of the lowest taxes, and SaskTel returns a profit every year.

You keep going on about how privatization of the canadian healthcare system will make everything better and I'm calling BS.

privatization will end with the infrastructure no longer being owned by the people, meaning it will cost you money to go there. Private industry needs to make a profit, so that will also cost you more.

the industry's focus will be the bottom line, not providing service

and your But but but rationing! argument is horse crap, rationing means everyone gets equal access, in otherwords we won't let the poor die in a ditch. it doesnt' mean we're going to start hiding doctors. In fact if it weren't for our socialized system our wait times would be worse since doctors would be able to work more comfortable hours, and wouldn't have to put in 16 hour days.

the problem isn't socialized vs private, the problem is we pay half what the US does for the same level of healthcare.

If you think for one second turning over the riens of the healthcare system to a bunch of privatized companies will magicly fix the problem without drasticly increasing the cost to the system or shutting some people out, you are severly mistaken.
 
Frankly your arguments hold no water whatsoever. Simply looking at how other industries work in socialist nations vs capitalist or free market nations demonstrates the point conclusively; yes milk and rice may be very cheap in Venesuela or Zimbabwe, but this is moot if there is none in the stores.

Similarly, if higher levels of State ownership and interference intrude in the health care business, the nominal price may be lower, but the long wait times and poor service (and higher death toll as people simply are not treated for debilitating conditions in a timely or effective manner) simply substitute for monetary costs, and legions of sick people waiting for treatment are a drain on the productivity of whatever industry they work for.

A company might be notionally private (like Government Motors), but if they have been receiving large government subsidies in the form of (never repaid) loans, grants, single source contracts etc. then they are indeed no better than Crown corporations. As for the idea of a "public purse", there is no such thing: that is my money going to political rent seekers. I freely consent to paying for protection, and any government that limited itself to things like the police, EMS, military and courts of law would be a far better and more effective steward of the public purse (and create far more economic opportunity) than what we have today.

WRT the poor, they have been sustained for centuries by private and institutional (i.e. church) charity (and even today many people who need medical attention benefit from these charities, as I well know being involved myself); nothing stops you from getting out the door and helping people......
 
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