If America adopts Canada's health care system

[Fishbone Jones]

By legislation? When? Not before the 2012 elections, and there's a good chance not after that for another four years. The cost? Well, given CBO projections that's not really going to be an issue. This is a country that blew over a trillion on a war to stroke some egos, after all - not exactly penny pinchers.

So you're saying Iraq is better off under Hussien than what they are trying to accomplish now?

Maybe I missed which war you're talking about.

 

[cupper]

So you're saying Iraq is better off under Hussien than what they are trying to accomplish now?

Depends on whether you would prefer total anarchy or absolute fear and paranoia.

Toe-MAY-toe / Toe-MAH-toe

 

[a_majoor]

Given the convoluted nature of the political system right now, detailed predictions are becoming more and more difficut. The US Supreme court may make a ruling, the House budget (the Ryan Budget) essentially defunds Obamacare now (but since the Senate has failed to propose or pass a budget for over 900 days, there is little evidence the Democrat majority is ready to spring to action), and of course the real costs vs the CBO estimates are listed upthread in many different posts. Non financial costs include thousands of doctors "Going Galt" and retiring from practice rather than work under Obamacare. Many State govenments are also fighting Obamacare, and may eventually dismatle it piecemeal by simply by using courts or legislating against portions of Obamacare that they don't choose to pay for, with full voter support

http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/health_care_law

The latest Rasmussen Reports national telephone survey shows that 55% of Likely U.S. Voters at least somewhat favor repeal of the health care law passed by Congress in March 2010, while 35% at least somewhat oppose repeal. The intensity remains on the side of the law’s opponents since these findings include 42% who Strongly Favor repeal versus 26% who are Strongly Opposed. (To see survey question wording, click here.)

Of course, if controlled drawdowns are not going to happen, then an uncontrolled collapse will. Either way, the legal, legislational and financial pillars of Obamacare are founded on sand.

 

[Redeye]

So you're saying Iraq is better off under Hussien than what they are trying to accomplish now?

Maybe I missed which war you're talking about.

That one. And no, I made no comment on the disposition of the Iraqi people. Although those who survived the war in some ways are, but in many others aren't. The statement I made pertained to the fact that something being expensive isn't a determinant of the propensity of the United States Government to do it.

That said, here's a friend of mine who's Iraqi's take on the whole thing. She lives in Canada but has returned repeatedly. Not exactly a glowing assessment, and it jives with pretty much everything I've read:

So Iraq.... I loved being there and I can't wait for my next visit!

There's barely enough electricity. It goes on and off. People rely on private generators which burn out eventually, for which reason people subscribe to neighbourhood generators. So the "national" electricity goes off, then you turn on your generator (if you can afford it, of course). Once it burns off, the neighbourhood generator goes on once again, if you can afford that, too). There's so much spending on electricity, and yet you don't get much of it! I got to experience 51C in such circumstances while I was told that this is nothing compared to the heat in August, which is when Ramadhan will be this year!!

The Americans did not do much good, let's be honest. They destroyed the infrastructure which will take a loong time to rebuild. The roads have potholes. There's much reconstruction, but I wonder how on earth it will continue with such boiling heat. The Green Zone, where I went, is heavily fortified with reason. I met with a couple of judges and an MP, and they need heavy security around them 24/7 thanks to the assassination attempts taking place. Bombs these days are magnetic ones which are stuck beneath random cars. As usually said, necessity is the mother of inventions. You can buy this thing from garages or mechanics - it's a long metal stick with a mirror at the end. You use it to check if there is a magnetic explosive stuck to your car before getting into it.

I got to hear a bomb - not too far yet not too close to our place. Our house is in a safe neighbourhood because it's diverse in residents - Christians, Sunnis, Shia, etc. The more homogeneous an area is, the more likely it is to be at risk, most unfortunately. If there is any shooting, which I also witnessed, it is usually at a targeted person. Generally speaking, Baghdad is MUCH safer than it was 3-4 yrs ago. However, it's still not safe enough to be traveling alone (at least for a girl) and anything can happen - man or girl.

We see military deploys drive by all the time while on the road. They halt traffic which is frustrating, but people have learnt to live with that. They are amazingly patient and resilient. The things my cousin has told me - the things he has witnessed. He has been shot at more than once, he's witnessed explosions, he has had to climb over dead bodies in a morgue in order to retrieve one. It's very sad.

Things are improving, but at a snail pace, thanks to the corruption. Bribery galore in government offices, it's so bad. It was not this bad during Saddam's time, because there were horrible "disciplinary" measures. Now it's just "in your face".

Nevertheless, I'd still say there's much that can be done - if only the corruption is controlled or ended. Some people have hope and some not so much because they argue that the corruption wont allow any progress. I still think progress can take place. The 100 days of ultimatum to the Cabinet are over and meetings are taking place to discuss what progress has taken place (if any). The PM is actually doing hard work - my relatives in Iraq actually do not hate him and wish there were more people in the government like him. In the meantime, there are people who hate the PM and blame him for not getting much done over the past few years.

People want the US out, but at the same time are very aware and wary of the security gap when they leave. The Iraqi forces are not well prepared. The U.S. wants to extend its stay and seems to be confident that it will. However, every Iraqi knows that will never happen, despite the need for military help - it's just that they don't want it from the U.S. It's done enough damage. Members of the US Congress recently went to Baghdad and were requesting that the Iraqi government compensate US soldiers for the damage incurred in the 2003 war. In response, Al-Maliki kicked them out of the country. I'm sure everyone agrees to what he did. It's such a slap in the face.

Muqtada Al-Sadr seems to have quite the following, most unfortunately. His supporters tend to be less or uneducated people from lower class backgrounds. It's scary how loyal they are to him. Aside from his supporters, everyone hates his guts. He's caused nothing but violence and trouble.

Oh, another thing - there are MANY inspection and patrol points on the road and unfortunately they do not do much. If they conducted better searches there wouldn't be security breaches. God knows if they receive bribes - probably yes. It's sad.

But economically speaking, things are slowly improving. Cities like Najaf and Karbala are thriving from the tourism surrounding the religious sites. It's just Baghdad that really needs more work.

So that was my looong answer. I just wanted to give you a thorough idea - at least from what I saw. Despite all this, I miss Iraq SO MUCH and want to return. Somehow there's still some type of trust going on, acts of kindness which you wouldn't think would take place in a war-torn country, but people are understanding of each other and use terms of endearment in common conversations with random strangers. I'm Iraqi and I'm not used to that...haha. It's nice.

 

[Fishbone Jones]

That one. And no, I made no comment on the disposition of the Iraqi people. Although those who survived the war in some ways are, but in many others aren't. The statement I made pertained to the fact that something being expensive isn't a determinant of the propensity of the United States Government to do it.

That said, here's a friend of mine who's Iraqi's take on the whole thing. She lives in Canada but has returned repeatedly. Not exactly a glowing assessment, and it jives with pretty much everything I've read:

Thanks for giving us the bent from your side.

That doesn't make it gospel.

Everyone has an axe to grind.

 

[Redeye]

Thanks for giving us the bent from your side.

That doesn't make it gospel.

Everyone has an axe to grind.

I never claimed it was. But I think you'll have to forgive me for putting a substantially heavier weighting on the opinion of someone more closely connected to the situation that any of a myriad of armchair pundits who weren't there.

 

[Fishbone Jones]

I never claimed it was. But I think you'll have to forgive me for putting a substantially heavier weighting on the opinion of someone more closely connected to the situation that any of a myriad of armchair pundits who weren't there.

Then until you get to Afghanistan, you'll just have to believe, unconditionally, those of us who have been there.

Likewise those of us that spend more time Stateside than you.

And those of us that have weekly business dealings with those across the border.

Those of us that seen and had to deal with, first hand the implimentation of Obama's policies.

Right?

 

[Redeye]

Then until you get to Afghanistan, you'll just have to believe, unconditionally, those of us who have been there.

Likewise those of us that spend more time Stateside than you.

And those of us that have weekly business dealings with those across the border.

Those of us that seen and had to deal with, first hand the implimentation of Obama's policies.

Right?

Again, the more sources the better. Reports from Iraq show things are pretty rotten there, much of which are attributable to both years of sanctions and American military intervention. From a geopolitical perspective, the war was also a blunder, because it put power in the hands of Iraq's Shia population, giving Iran more influence in the region. It didn't do much of anything that I can see to further any of America's interests.

I have plenty of close friends and family in the US who augment anything I could read from pundits. They span a broad array of opinions.

 

[aesop081]

:argument:

 

[Redeye]

:argument:

:goodpost: :deadhorse:

 

[cupper]

:grouphug:

;D

 

[a_majoor]

The Prime Minister implicitly recognizes where the solution lies, but needs to find a way to release the provinces to explore different solutions before health care consumes all of our budgets:

http://freedomnation.blogspot.com/2011/12/harper-is-right-health-care-solutions.html

Harper is right: health care solutions must come from provinces but first he has to show leadership

In his end of year interview Stephen Harper said something on health care policy that is both useful and true. He said that it is up to the provinces to find the solutions to the problems in the health care system. This is not an abdication of federal leadership but a recognition that there are some things that the provinces are better at doing. Provincial governments are the ones that run the health care system and there is a limit to how much a federal bureaucrat can understand the details of each provincial system. Also provinces need to find solutions that work for their own particular circumstance and come up with political compromises that are acceptable to their own populace. Federalizing the issue of health care does nothing but hopelessly complicate an already complex policy dilemma.

So I am very happy to hear the Prime Minister admit the limitations of the federal government and encourage provinces to take action. At the same time he has to recognize that the federal government is preventing provinces from exploring any meaningful reform. The Canada Health Act severely limits the range of policy options that would be possible even while maintaining the goal of universal access.

Too many Canadians are stuck in a simplistic comparison between Canada’s and America’s health care system. Instead we should be looking at the policies in Europe and seeing how universal or near universal access can be achieved without the single/public-payer system. Models from the Netherlands or Switzerland, neither could be called havens of extreme capitalist thought, would be violations of the Canada Health Act.

The way that the federal government enforces the Canada Health Act is through the funding that they provide to the provinces. With health care spending eating up half or nearly half of provincial revenue, the provinces are reliant on the money that the federal government sends them. If any provincial government does anything that the federal government interprets as a violation of the Canada Health Act and that funding will dry up. The upshot is that if Ontario wants to take inspiration for solutions that have worked well in the Netherlands, they would face financial ruin at the hands of the federal government.

Despite Mr. Harper’s reputation for being open to reform in the health care system, his government has consistently reconfirmed its commitment to enforcing the Canada Health Act.

Mr. Harper is right that the solutions must come from the provinces but he has to allow them the tools to fine those solutions. Although it may be politically difficult, for reform to be possible the Canada Health Act cannot remain unchanged.

The most positive change that the federal government can make is to remove the requirement of a single/public payer as a condition for federal financing. Note that this is not the same thing as removing universal access as a principle of the act. As the Europeans show us, single/public-payer is not the same thing as universal access.

It is in reforming the Canada Health Act that Stephen Harper not only can but must show leadership.

 

[a_majoor]

An expanded look at how Canada's healthcare system is changing towards more flexibility and competition:

http://www.winnipegfreepress.com/canada/breakingnews/a-canada-with-no-health-accord-provinces-grapple-with-the-possibilities-136904598.html

A Canada with no health accord? Provinces grapple with the possibilities
By: Heather Scoffield, The Canadian Press
Posted: 01/8/2012 10:44 AM | Comments: 91 (including replies) | Last Modified: 01/8/2012 11:54 AM

OTTAWA - The provinces are grappling with the real possibility that they may soon be delivering health services without the guidance of a formal, national health care accord, The Canadian Press has learned.

They are scrambling to figure out how to move forward after Finance Minister Jim Flaherty took them by surprise last month when he handed them a 10-year funding package for health care with no policy strings attached.

Health Minister Leona Aglukkaq is now touring the country to see how her provincial counterparts want to proceed, with the official aim of stitching together a new accord that would set national standards and hold provincial governments to account for their spending.
And provincial premiers are preparing to hash out a some sort of plan when they meet in Victoria on Jan. 15 to 17.
But a no-accord approach is a distinct possibility, say provincial and federal officials.

"It's a possibility that we have no codified accord," said one federal source, who spoke on the condition of anonymity.

That's because the new funding arrangements for 2014 to 2024 were presented without negotiation, pleasing some of the Western provinces but upsetting the rest of the country. Now the federal government has signalled that it will be taking a back seat in setting health care policy.
Prime Minister Stephen Harper was asked this past week in a radio interview whether Ottawa is, in effect, telling the provinces to take full responsibility for health care.

"Well, that's partly what we're saying," Harper said during an appearance on the Rutherford Show, an Alberta-wide radio call-in program.
"Look, most provinces are already projecting reductions in their own growth rates and health-care spending. But the provinces themselves, I think, are going to have to look seriously at what needs to be done to make the system more cost effective."

Flaherty's fiat cements financing until 2024. It gives provinces some fiscal certainty about their levels of funding. But it also comes with no mechanism to ensure national standards or service improvements.

At the same time, the new 10-year funding arrangement will be allocated to the provinces based purely on a per-capita basis, eliminating any consideration for poorer provinces, fragile tax bases or higher costs in remote areas.

That means the distribution of the funding will swing heavily in favour of richer provinces west of Manitoba, to the detriment of Manitoba and east.

The equalization formula is also up for negotiation soon, so there is no guarantee poorer provinces will see additional federal cash to make up for the
health redistribution.

The concern is that without national standards, have-not provinces will see their health care systems deteriorate, as the health services in richer provinces flourish.

"Is it appropriate that the federal government just washes its hands of the country's most important social program?" asked one provincial official, who was not authorized to speak publicly.

Some of those have-not provinces are contemplating a co-ordinated push back against the unilateralist nature of Flaherty's funding.
They would argue that Harper promised a collaborative approach to health care during the last federal election campaign, and has also committed to reducing wait times and improving accountability and health care services more generally.

But they are far from united heading into their meeting in Victoria. And it's not clear Harper would have any obligation or incentive to listen to them anyway.

"There's not a hell of a lot the provinces can do about it," said University of Regina professor Greg Marchildon, who was the executive director of Roy Romanow's royal commission to reform health care a decade ago.

"They can complain publicly but they cannot force the federal government to come to the table and negotiate."
The provinces will have a difficult time forging a national accord as long as one of the key players — the federal government — is absent from those discussions, Marchildon said. And Harper has shown little inclination to join in.

"There can't be an accord unless there's an agreement to have a meeting," he said. "The federal government does not want a meeting so there can't be an accord."

The provinces could decide to take matters into their own hands and all go their separate ways on health care. Or they could decide to work together in some areas without the federal government, using the Council of the Federation as a secretariat.

Health care has not always been directed through a federal-provincial accord. That practice started in about 1999 with social-union talks that morphed into the more formal 10-year accord of 2004.

Poorer provinces or provinces that have mismanaged their finances like Ontario and Quebec will have a huge incentive to find efficiencies and reduce costs. Now they could use the "Washington Monument" strategy ("If our funding is cut we will close the Washington Monument to tourists"), but ironically, most provinces have already done tis repeatedly so voters are quite tired of threats of further cuts to emergency rooms and even longer wait times for surgury and specialist care.

My prediction; the province that figures out how to put patient needs ahead of the hospital administration and health care bureaucrats will become the hotbed of "medical tourism" from other provinces and perhaps the United States, which will force other provinces to follow suit and change their systems.

 

[GAP]

Having worked peripherally within the health care system, I can vouch for the massive empire building in even the remotest locations....get rid of that and the carpet bagging and you will have a decent system. It has to stop somewhere.....

 

[a_majoor]

A toxic combination of American government intervention in the market and Canadian governments ditorting the market with perverse incentives. Even if I had the ability to raise a processing plant from the ground, there is no incentive for me to create a "second line" facility to fill the market niche:

http://www.nationalpost.com/todays-paper/Trouble+with+cheap+drugs/6353030/story.html

Trouble with 'cheap' drugs

Ninety per cent of Canadian injectable drugs come from Sandoz. Revamping of the plant to meet U.S. regulations, and a fire, have led to a nationwide drop in supply since February.

Marni Soupcoff, National Post · Mar. 24, 2012 | Last Updated: Mar. 24, 2012 4:05 AM ET

While the House of Commons has unanimously passed an NDP motion to require drug companies to notify Health Canada in advance of potential shortages, such warnings don't address two potential underlying causes of the country's current dearth of drugs: overzealous regulation and short-sighted sole sourcing.

The sudden slowing of production of some medications at Sandoz Canada's Boucherville, Que., plant in February - combined with a subsequent fire that temporarily ground production to a halt at the same location - has left Canadian emergency rooms, intensive care units and operating rooms in the lurch.

Sandoz is the only supplier for approximately 90% of the injectable drugs the nation's hospitals use every day - in surgeries, emergency treatment and intensive and palliative care. The result has been an unnerving, if not yet critical, shortage of painkillers, anesthetics and other drugs.

But the Sandoz bottleneck did not start at home. It was the regulatory tentacles of the United States Food and Drug Administration (FDA) that sparked the initial slowdown (we can only assume the fire was God's work) when the agency warned the company about manufacturing deficiencies in Boucherville. Sandoz, whose Quebec plant also produces drugs for the U.S. market, responded with voluntary operational upgrades that necessitated pulling back on production.

This was not an isolated incident. For several years now, the FDA has been intensifying its enforcement of quality control measures on pharmaceutical companies - a move that sounds unimpeachable. Who wouldn't want to ensure the safety of drugs we count on to restore our health? Yet many government skeptics, such as Walter Olson, of the libertarian Cato Institute think-tank in Washington, D.C., believe the agency's stepped up enforcement is far exceeding what safety requires - and is creating record drug shortages in the United States, as well.

"In particular," Mr. Olson wrote of the FDA last year, "it now proclaims zero tolerance, barbed by tough fines, for many technical infractions whose actual impact on patient risk is at best doubtful, and it is unafraid of shutting down production lines again and again for retooling until its regulations are satisfied to the letter." He pointed out that there were then 246 drugs considered to be in shortage in the United States.

John C. Goodman, president and CEO of the National Center for Policy Analysis, a non-profit free-market research organization based in Dallas, Tex., has similarly criticized the FDA for "forcing manufacturers to abide by rules that are rigid, inflexible and unforgiving" - a practice he believes is contributing to the difficulty of getting lifesaving drugs to the patients who need them.

Of course, whether or not the FDA has become dangerously overzealous would be of much less consequence to Canadians if this country had more than one supplier to turn to for the vast majority of its injectable medications. But in the search for cost containment and less expensive drugs, the provinces have been moving toward a bulk purchasing model. Either on their own, or by joining a large group purchasing organization, they enter into agreements to buy drugs in large quantities to get a lower price per item. It reduces the governments' overall pharmaceutical costs, but tends to result in far fewer suppliers.

"It's a winner-takes-all approach," says Mark Rovere, associate director of the Health Policy Research Centre at the Fraser Institute. Which is fine so long as the "winner" is able to deliver the goods. But there's no incentive for other companies to invest in the infrastructure necessary to step in should the winner falter. Hence, when Sandoz slowed production to focus on revamping its plant, there were no other big pharmaceutical companies set to jump in and start producing the scarce injectables - or (even less likely) with the needed products already sitting around, gathering dust on their shelves.

How did this happen?

"A lot of it is rooted in the national pharmacare issue," Mr. Rovere says, referring to the decades-long push for universal government coverage of Canadians' prescription drug costs. The longing for a centrally planned, collectivist approach led to a focus on, as he puts it, "How do we get cheap drugs for everyone?" Bulk purchasing "does result in cheaper drugs," he says "but it has unanticipated consequences." Consequences such as the cancellation of non-essential surgeries and the rationing of painkillers.

HealthPRO Canada is a national health care group purchasing organization that buys drugs for 255 Canadian hospitals and health authorities. Its own promotional material does a good job of capturing the company's dominance on the scene: "HealthPRO brings together the most significant purchasing power ever assembled within our country's public health care system."

In February, HealthPRO released a statement saying that it had made changes to its contracting strategy in order to address concerns about ongoing drug shortages.

The announcement explained that the new plan "strives to strike the right balance between competition, purchasing power and a more reliable supply chain" and requires its suppliers to, among other things, provide "correction plans for drug shortages lasting more than 60 days for hospital-specific items."

That can't hurt. But given what a dramatic impact depending on barely more than one source of injectable drugs has proven to have on the country's supply of medication, bolder changes are surely in order.

Rather than focusing on adding reporting requirements to companies such as Sandoz, Canada would do well to learn its market lessons from this incident.

First, use the results of the FDA's purported regulatory nitpicking as a cautionary tale. Second, remember the complexities and distortions that arise when the focus shifts from the individual to the universal (cheaper drugs for everyone somehow leads to hardly any drugs for anyone). Finally, and of most immediate importance, when purchasing drugs on behalf of a province - or becoming a member of a purchasing group that will do the same - do your best impression of a truly responsible and self interested buyer by naming rational conditions that will protect you in the future.

One of these conditions might be: Never accept a deal that results in an entire class of drugs being supplied by a single source. It'll come back to bite you if you do.

 

[Edward Campbell]

I recognize that some (many?) people would not trust data from the Fraser Institute if it was simply a catalog of the time of sunrise, but this report, which is reproduced under the Fair Dealing provisions of the Copyright Act from the Fraser Institute website, looks OK to me:

http://www.fraserinstitute.org/research-news/news/display.aspx?id=20232

"Free" health care costs average Canadian family more than $11,000 per year

Media Contacts: Nadeem Esmail

Release Date: July 30, 2013

CALGARY, AB—A typical Canadian family with two parents and two children will pay $11,320 in taxes, on average, for public health care insurance in 2013, calculates a new report from the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“Health care is not free in Canada. The fact is, Canadian families pay thousands of dollars in taxes every year to cover the cost of public health care insurance. And that cost rose 1.5 times faster than average income over the past decade,” said Nadeem Esmail, Fraser Institute director of health policy studies and co-author of The Price of Public Health Care Insurance: 2013 Edition.

Using data from Statistics Canada and the Canadian Institute for Health Information, the report calculates the amount of taxes Canadian families will pay to all levels of government in a year and the share of their total tax bill earmarked for public health insurance:

    Family consisting of two parents with one child (average income: $108,609) will pay $10,989.
    Family consisting of two parents with two children (average income: $113,247) will pay $11,320.
    Family consisting of one parent with one child (average income: $49,619) will pay $3,905.
    Family consisting of one parent with two children (average income: $49,372) will pay $3,387.
    Family consisting of two adults with no children (average income: $99,226) at home will pay $11,381.
    Unattached individuals (average income: $39,039) will pay $3,780.

The report notes that since 2003, the cost of health care for all family types went up 53.3 per cent before inflation. The price of public health insurance increased more than 1.5 times faster than the cost of shelter and clothing, more than twice as fast as the cost of food, and nearly 1.5 times faster than average income over the decade.

In addition, the report calculates that the 10 per cent of Canadian families with the lowest incomes (averaging $13,011) will pay $482, on average, for public health care insurance in 2013. The 10 per cent of families earning an average income of $56,596 will pay $5,364, while families among the top 10 per cent of income earners will pay $35,309 towards public health care insurance this year.

We must recognize that although we spend less than the Americans, both we and the Americans share the sad distinction of being the top health care spenders spenders in the OECD and having the worst health care outcomes.

Readers will know that I think France is a pretty poor excuse for a country, but: we should look at the French health care system (amongst others) they spend less than we do and get better results. The only model of health care we should not look at as a potential replacement for ours is the Ameican one.

 

[pbi]

So, for the cost of considerably less than what a surgical procedure for one family member might cost, a family gets access to what is, for most of us, a pretty good median level of care? I agree that any Canadian who uses the term "free" is ignorant: it isn't free, but then no publicly funded program is. The main point to me and my family is that we don't have to worry about what things will cost when somebody needs serious care.

I also think that we might want to be honest about the use of the term "national health care system". Is that really what we have? Or do we have thirteen separate systems that get some of their funding from the centre, along with some riders and conditions? To me, a national system is more like what you see in the UK with the NHS, or in France as you mentioned. But, not being a unitary state like those countries, but instead a fractious confederation (like the US), that might be a pipe dream.

I have no desire whatsoever to see us scrap our "system": I find the idea of a universal access to good basic healthcare, and critical care in urgent cases, very democratic. I'm glad we have it. We do need to tune it up, though.

What we do need, IMHO, is a more pragmatic approach to more privately delivered health care. Private delivery is not The Big Satan. After all, doctors are private businesses, as are drug stores, homecare suppliers and stand-alone imaging clinics. Nobody questions this. Why shouldn't we have more private delivery, while still preserving the very fine and noble concept of public insurance, and public regulation of service quality?

I don't buy the argument that private medical care providers will just cater to the rich. Some will, of course. But, as in other things, most businesses will cater to most people, which in Canada means to the middle class. The rich will still look after themselves (as they always do...) and the poor will still be on the public purse for everything (just as they are in the "Bad Old USA"...)

Cheers

 

[Edward Campbell]

In my opinion (which is not as well as informed as those of many others) our 13 "systems" ought to be a strength. Thirteen systems, in a "network" should allow for extensive innovation and analysis of best practices. But, as far as I know, one element of the Canada Health Act, specifically § 7 and 8 related to public administration, appears to preclude any experimentation with any form of private insurance, for example. Private insurance, injecting private money into the system, seems to be a constant part of other cheaper, better (in terms of outcomes) systems.

Broadly, I think a comprehensive national health insurance plan ~ which is what we have ~ is a boon for productivity but I also think that ours can and should be both more efficient - cheaper, and more effective - better outcomes. If France can manage, why not Canada?

 

[Remius]

When my son was 3 he was diagnosed with a coordination disorder and problems with his core strength.  likely a result of being 4lbs at birth.  Physically he was a year or two behind kids his age for simple things like catching a ball or climbing stairs.  He needed to be assessed by an ergotherapist.  CHEO could do it but it was a year and a half long wait.  Or we good go to a private clinic and be seen in two weeks.  Not wanting to chance any delay or problems in his development at that early an age we opted to pay for a service, at a private clinic, that was otherwise provided for by the system.

By doing it we didn't wait and we didn't add to an already long queue of people that likely might not have been able to pay for the same treatment.  We weren't rich by any means (we were very much able to though)but we just had to change some priorities to get it done.

Our system can be improved and paying for some services might be one way.

 

[Brad Sallows]

>So, for the cost of considerably less than what a surgical procedure for one family member might cost, a family gets access to what is, for most of us, a pretty good median level of care?

Not necessarily.  All of the doctors in my area are "not taking new patients at this time", and that state of affairs has persisted for years.  I am given to understand that it is not merely a local issue.

Canadians have access to a pretty good median level of emergency care - once you have the documents to prove you need treatment, you can get on the queue; if you need treatment urgently, you will likely find yourself near the head of the queue.  Some queues are almost non-existent; some are long enough that the conditions for which they exist have a good chance of killing you before you reach the front (or worsening to the extent that your treatment consumes more resources than if you could be treated immediately).

The trick is proving you need treatment; access to a doctor is the gateway, and access to doctors for anything except one complaint at a time ad hoc is difficult (at least in some areas).  And if the gatekeeper agrees there is something worth looking at, then the queues to obtain the details are absurdly long.

I don't remember the last time I spoke to someone who actually waited for tests on the public queue despite being able to find the money to pay privately.  Everyone seems to know that if you can scrape up the few hundred or couple of grand to get the imaging (or whatever) done, then you are over the hurdle.

Medically, the most urgent needs are supposed to be met first.  But rationally, the country needs to make sure the people paying the most in taxes lead long, productive lives in order to fund the system.