If America adopts Canada's health care system

[Flip]

why shouldn't I be able to spend my after tax dollars in Canada if I wish?

Again, on the face of it......No problem

Real world....The government arbitrarily decides to chop some funding.

Shift the burden onto individuals. Declare the public system is unsustainable.

Now here's the scary part.......People will believe it.

Naw, couldn't happen right?
Especially in Alberta or Ontario!  (Sarcasm)

Hey - I'm a seriously conservative guy.
Just don't bugger with my institutions.... ;D

 

[Reccesoldier]

Flip, consider this.  With both a public and private system operating side by side the two would end up in competition for the "finite resources" of the population, forcing each to provide more value for money. 

The thing that makes the public system so unresponsive is the fact that no one else is out there competing for your tax money, and the thing that makes the private system so expensive in the US is that there is no government plan for them to compete with to reduce cost.

There is no crystal ball that anyone can look into and say definitively that this, or that is what you would have but in Canada today, we're not even allowed to try to discover a new way.  It's good money after bad, with no possibility of change.

 

[Flip]

Reccesoldier,

The biggest difference between the two countries is how healthcare is paid for.
This IS the sacred cow.  A lot of your services are provided privately.
The price is set by the payer.  It's up to the service provider to do his best
profit margin wise.  Your family doctor and the diagnostic test labs are private companies.

That being said, I can compare this debate to the energy deregulation that happened here a few years ago.
Now we are free to sign a contract with more than one retailer and pay more for utilities than we used to.
We can say we pay the same for natural gas as Al Gore. In Tennessee natural gas is a comfort.  In Alberta
it's life support.  I digress.....

Your presumption that things can't change in the public system is patently false.
They do - Proximity to the US allows a great deal of cross pollination.
A constant two way exchange of ideas and methods.
The spear carriers in this exchange tend to be healthcare professionals.
I've never met a physician who didn't want to improve things.
I have however, met managers and bureaucrats who resist change.
Health care unions are the immovable objects in this argument.
This is what Canadians should want fixed.
This can be fixed - politically. Don't believe your MLA when he says they are doing their best.
Don't buy into dealing with the wrong problem on ideological grounds.

When Alberta slashed healthcare budgets in the 90s we assumed Dr West knew what he was doing.
Most of us didn't realize the man was a veterinarian! 

 

[observor 69]

The spear carriers in this exchange tend to be healthcare professionals.
I've never met a physician who didn't want to improve things.
I have however, met managers and bureaucrats who resist change.
Health care unions are the immovable objects in this argument.
This is what Canadians should want fixed.
This can be fixed - politically. Don't believe your MLA when he says they are doing their best.
Don't buy into dealing with the wrong problem on ideological grounds.

When Alberta slashed healthcare budgets in the 90s we assumed Dr West knew what he was doing.
Most of us didn't realize the man was a veterinarian!   

Steady now Flip!  I mean I'm with ya  but here in good ol' Ontario the OMA , Ontario Medical Association = doctors,  is one of no make that THE most powerful group feared by the provincial government.  Any threat to their "billable hours"  results in OMA talk of strike.  I mean these guys scare the poop out of the government.
The Min. of Health has tried a number of new ideas such as use of Nurse Practitioners and more innovative structures of care. I was in the states and their is lots of innovation going on in the private system to save the HMO's a buck. Nurse  practitioners, physicians assistants, some of these ideas were good and could be tried up here but it is/has been a long hard battle to get the OMA to accept change.
Like you I have family all around me in health care. So that makes two of us who constantly hear all of the issues and arguments. ;D

 

[Blackadder1916]

...in the states and their is lots of innovation going on in the private system to save the HMO's a buck. Nurse  practitioners, physicians assistants, some of these ideas were good and could be tried up here but it is/has been a long hard battle to get the OMA to accept change.

While there may be a lot of different ideas being employed in the USA to save a buck, many of these innovations have been employed to increase the profit margins of the HMOs or other provider entities and not necessarily used to decrease the cost to the insured. 

For info sake, NPs and PAs in private practice settings (working outside of government run health organizations such as VA, IHS, or BofP hospitals) bill in much the same manner as physicians.  Using Medicare/Medicaid rates as an example (private insurance companies don't publish the terms of their reimbursement rates) NPs and PAs who submit billing under a physician's billing number are reimbursed at the same rate as the physician, with the physician usually pocketing the whole amount and the NP/PA working as a salaried employee; an NP or PA who bills under his own billing number is reimbursed (according to rates a few years ago) at 85% of an applicable physician's rate.  Of course the NP/PA in the latter case is also responsible for his expenses' so the physician under whose cover he is working usually ends up with a percentage of that.

 

[Bruce Monkhouse]

While there may be a lot of different ideas being employed in the USA to save a buck, many of these innovations have been employed to increase the profit margins of the HMOs or other provider entities and not necessarily used to decrease the cost to the insured. 

If this is true than we [the taxpayer] can save a buck or use that buck to have more health care.....

 

[Blackadder1916]

I would say that many of these "innovations" could probably fall under the category of "Managed Care" which has produced many critics (myself included) as it attempts (not very successfully) to control rising health costs.  While I rarely say 'never", I don't think that Canada should look South for examples in managing a health system.  For all the faults we have (and there are many), I think we've done it a lot better than they have.

For those interested try this link (pdf - 520kb) for 'Trends in Health Care Costs and Spending' that provides a brief look at health costs in the USA.

This September 2007 fact sheet on health care costs presents key statistics about the growth, level and impact of rising U.S. health care costs. It covers spending on various medical services, sources of health spending, employer-sponsored health coverage and the impact on businesses and people.

 

[Brad Sallows]

I don't propose that people be refused treatment if they have no savings or that no-one has bad luck.  If you stop skimming through biased lenses and read carefully, you may be able to comprehend my point: living one paycheque away from insolvency is easily corrected.  I'm not focused on the small fraction of people who have genuinely low incomes; I also see the large fraction of Canadians at all income levels who are financially imprudent.

Routine health care is something most people can and should pay out of their own pockets.  Somehow protection against medical catastrophe morphed into a gimme.

 

[Flip]

Baden..........

Steady now Flip!   I mean I'm with ya  but here in good ol' Ontario the OMA , Ontario Medical Association = doctors

Yea, here in Alberta we have the AMA who constantly bleat about privatization.
I think there is an activist element in both camps.....May not be that representative?
I dunno. :

Thanks Blackadder....

I don't think that Canada should look South for examples in managing a health system.

We do, for better or worse and I think that is where the public  vs. private debate comes from.  The good examples come from a practical or medical level.  The admin. bits we can do without.  Many Canadian physicians spend time in the US in their training etc.
Too be fair, physicians also stay in touch with others around the world.

Routine health care is something most people can and should pay out of their own pockets.  Somehow protection against medical catastrophe morphed into a gimme.

Oh my, we just have to disagree on this.

The problem with covering yourself for routine healthcare is, that if
cash is tight, people are simply not going to  the doctor.
That funny little mole will grow to the size of a fist before it gets removed,
Of coarse by then it's a metastatic disease than will require hospitalization.
In this case the public isn't saved anything as it would have been cheaper to
pay the $35 for the doctors visit 2 years ago.  In short, a larger burden exists
because of a lack of early diagnosis.  Early and accurate diagnosis saves money.
As for your second sentence,  That is whole point of having the Canada health act.
Does it really serve the public interest for farmer Brown to lose the farm because
he is ill?  What does his newly homeless and unemployed family do for society?
This is the whole object of the Canadian exercize in healthcare.

I say, get the focus back on the patient - not on some experimental corporate model.

 

[muskrat89]

The problem with covering yourself for routine healthcare is, that if
cash is tight, people are simply not going the doctor.

Who's choice is that?

I chose not to get a degree. Instead I chose a trade. My family income is limited (or boosted) by that choice. If I had chosen neither, and the only job I can get is flipping burgers, that was my choice. If my vehicle is leaking tranny fluid, and cash is tight, and I don't get it fixed, that's my choice. If the transmission falls out next week, and instead of a $25 seal, I need a $2200 transmission, that was my choice. I ate out last night instead of whipping up some KD - that was my choice. Sorry, but I just don't get it :-/

 

[Blackadder1916]

Thanks Blackadder....We do, for better or worse and I think that is where the public  vs. private debate comes from.  The good examples come from a practical or medical level.  The admin. bits we can do without.  Many Canadian physicians spend time in the US in their training etc.
Too be fair, physicians also stay in touch with others around the world.

While I appeciate the thanks and though we may agree on the benefit of a (primarily) publically funded universal health care system versus a (primarily) private enterprise (where solely market forces dictate access, availablity, cost), you seem to place much more hope and assign much more credit to physicians than I do.  Maybe I've been jaded by my dealings with them (much professional not as a patient, and some social).  While I won't fault many doctors for their professional medical knowledge and skills (though I do have some minor issues with my current GP - however he's a good gatekeeper), I have found few that I would trust as the guardian of my cheque book, either personal or public.  Most I have known, while they may have some altruistic tendencies and concern that reform is needed in the system, seem to have the belief that any change to the system that would decrease their compensation by one cent is evil.

 

[Flip]

Muskrat, love that avitar!

Yes people make bad choices BUT by and large the expensive patients are either so
in spite of their choices or are simply the type of people that don't have as many choices
in the first place.  Will dumb people cost the system more than people with foresight? Yes.
Doesn't change the fact that they WILL need care.

To get back to my original point.........

The little old lady who comes into the doctor's office because she lives alone is NOT where the big money goes.
The single mom who's kid always has a cold is NOT where the money goes.

MRI machines that sit idle all weekend - ARE where the money goes.
The purchasing agent who buys scrub dresses from Taiwan and finds out
the hard way that they are too small for NorthAmerican nurses IS where the money goes.
The MHA who pulls down 400k a year and decides to subcontract hospital food services and finds out
that the private company costs more than the unionized workers he got rid of, IS where the money goes.

As a genral rule the faster you give a patient what he wants - the sooner he goes away.( and cheaper)
Creation of barriers to patient care to fit some business model(ideology) the more expensive it gets.
Then we should pick the patients pocket because the system is running out of money?

In short - I don't think the taxpayer is getting what he is paying for.


Blackadder- I'm glad you have a GP.
Many many people don't.
Then they go to the mini-mall doctor (who doesn't know them) when they are really sick.
Usually a less than optimal outcome - Usually costs everyone more.
My wife was mis-diagnosed 4 times in a row. (before we had a GP)
A grocery bag of meds that didn't work.
We won't make that mistake again.

 

[TCBF]

In the early sixties, when Pearson's cabinet was debating the medicare model, Walter Gordon's proposals were looked at by the MND - Paul Hellyer.  Hellyer, unlike most of his cabinet colleagues, was a businesman.  He was shocked:  he saw Gordon's plan as eventually bankrupting the country.  It had the government paying ALL up front costs, then rationing later care.  Hellyer re-wrote it and submitted it so the initial costs would be borne by the citizen and the government would then have the resources to do the expensive stuff rather than being nickel and dimed to death.  Pearson said no to Hellyer and yes to Gordon, and that is why thousands are dying for no reason today.

 

[Brad Sallows]

>The problem with covering yourself for routine healthcare is, that if cash is tight, people are simply not going to  the doctor.

If it isn't important enough to that person to pay, it surely isn't important enough to me to pay for him.  I'm sure there are all sorts of things people would do if someone else paid the costs, but I do not see it as my role to play "parent" to people in this regard any more than I do with respect to any of the other choices they make to live their lives.

>In this case the public isn't saved anything as it would have been cheaper to pay the $35 for the doctors visit 2 years ago.

Yes, but so what?  The public carries the cost for most stupid decisions people make: ignoring safety gear, high-risk outdoor activities, unsafe sexual practices, substance abuse, poor diet.  I see no reason to interfere with genuine liberty here: the existence of a public insurer is not an excuse to guide or manipulate people's freedoms.

>As for your second sentence,  That is whole point of having the Canada health act.

You evidently misunderstood what I wrote.  I'm not against public insurance for catastrophic (highly expensive and unusual) health needs; I observed that somehow the desire to protect people against financial blowout morphed into that and more.  It's the "more" - the routine care which is not going to cost someone the farm or job - which is at issue.

But I frequently encounter the objection: if routine health care were not free, people would stop going to see doctors.  Bullshit.  Most people are not that foolish.  Of the people I know who would not see a doctor if it cost $150 out of pocket (or on an extended health care plan, or out of a pre-tax health spending account, etc), most do not go to see a doctor right now when it costs nothing.  Apathy and indifference are the dominant factors, not finances.

 

[Scoobie Newbie]

"But I frequently encounter the objection: if routine health care were not free, people would stop going to see doctors.  Bullshit."
I seem to have heard that this IS the case in the US from different sources.

 

[Blackadder1916]

As I read this thread, I see some whose suggestion for reform of Canada's health system includes client payment (no public funding) for "routine" care.  While this, at face value, may be a disincentive for individuals to present to the "system" for minor problems, I don't think that this will produce the immediate savings and reduce the overall dollar cost growth that most are demanding.

First, how do you define routine?  Does this include only visits to a GP?  Does it include initial visits to a specialist?  Does it include diagnostic procedures ordered by the GP or first visit specialist?  Is it tied to an annual dollar cost, income percentage, or minimum income threshold of the client?  Is it tied to the diagnosis of the client?  Are any hospital based services included or excluded?  When does routine become not-routine?

If we base "routine" on GP visits only as most of the comments here seem to place it ( e.g. $35 or even $150 a visit) what could the potential savings be?

from Canadian Institute for Health Information report "National Health Expenditure Trends 1975 - 2007" (for those interested in reading the complete report you can download a pdf copy from their website)

• Hospitals have traditionally occupied a prominent place in health care provision. In the mid-1970s hospitals accounted for approximately 45% of total health expenditure. During the past 30 years, the share of hospitals in total health expenditure has fallen. In 2007, hospitals make up the largest component of health care spending, accounting for 28.4% of total health expenditures. Since 1997, drugs have accounted for the second largest share. In 2007, drugs accounted for 16.8% of total health expenditure, while physicians are expected to make up the third-largest share, with 13.4%.

and the definition for their methodology

Physicians—expenditures include primarily professional fees paid by provincial/territorial medical care insurance plans to physicians in private practice. Fees for services rendered in hospitals are included when paid directly to physicians by the plans. Also included are other forms of professional incomes (salaries, sessional, capitation).

The physician expenditure category does not include the remuneration of physicians on the payrolls of hospitals or public sector health agencies; these are included in the appropriate category, e.g. hospitals or other health spending. Physician expenditures generally represent amounts that flow through provincial/territorial medical care plans. Provinces/territories differ in terms of what the medical care plans cover. CIHI has not attempted to make adjustments to physician expenditures to reflect these differences because only a few provinces, to date, can net out these differences from their data.

 

[Reccesoldier]

I seem to have heard that this IS the case in the US from different sources.

Ask how many of those people who refused to pay for their own healthcare managed to go to movies, dinner out, clubbing or any other form of entertainment.  Ask how many of them own a big screen TV or a play station. Ask if they buy designer jeans or spend money on flashy Bling.

 

[Scoobie Newbie]

Tell me how long it would take to just live without any joy in life to save up the amount of money you would need to cover expenses incured in a car accident with the US system?

 

[Flip]

Brad,

Of the people I know who would not see a doctor if it cost $150 out of pocket (or on an extended health care plan, or out of a pre-tax health spending account, etc),

You kinda bent the nail here; The government pays about $35 for a doctors visit.  If the tab were paid by a private insurer I think the result would be the same as for a new windshield.
The price would go up.

most do not go to see a doctor right now when it costs nothing.

On this I agree completely - It's a large problem in the grand scheme of things.

Apathy and indifference are the dominant factors, not finances.

Fine, but why add an obstacle, when "most people" don't go.......?

We're arguing semantics and ideology here and what we need to do ( In this country ) is fix what's actually wrong.
A system that kinda works is coming off the rails a bit - I would rather attack the real issues.

Stupid bureaucratic waste.....Bending a public system to fit American business practices.
I would rather provide healthcare to those who need it - based on need rather than
to try to ration it based on a foreign financial model.  I think it would be cheaper in the longer run.

What is fundamentally wrong with American healthcare is that those most in need are the least in have.
This is the way their system fails.

 

[Flip]

We have also framed this discussion in terms of consumption. A mistake I think.

It serves the public good to maximize access to healthcare - not just a benefit to the individual.

If someone's employablity is maintained (especially through prevention) there is an obvious benefit.

If retired people can stay in their own homes rather than go to extended care facilities, another benefit.

Mental health is only now in recovery here in Alberta.
In the 90's King Ralph chucked a bunch of people out of hospitals in this area.
The result was that any chance of recovery was gone and no one could recieve help until
they came in contact with the police.  Denial of mental health care was the worst kind of shortsightedness.

In short - Our health care system is not just a liability but also an assett of considerable value.