If America adopts Canada's health care system

[c_canuk]

Frankly your arguments hold no water whatsoever.

Then it shouldn't be a problem for you to directly engage my arguments and disprove them in point form.

for example how do you refute that selling the infrastructure to our health system to a for profit corporation will solve the shortage of doctors, and lack of funds, while remaining a viable business without cutting services and/or increasing costs to the end users.

to do this you will have to prove that the existing administrative overhead is more costly and complicated than dealing with several separate insurance companies, several different coverage levels all tacking on an extra 15% for their shareholders.

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 Venezuela or Zimbabwe, but this is moot if there is none in the stores.

Crown Corps and a Government Department that controls resources are two very different things. Simply looking at a socialist nation and saying see governments can't run things, is comparing apples to oranges.

First many of those countries have very high levels of socially acceptable corruption.

Second, none of those are crown corporations, they are government departments, a crown corporation functions like a private corporation, except that the shareholders (the people) extract their ROI from services offered and/or reduction in taxes.

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.

exactly what state interference is resulting in a doctor shortage other than not enough funds... how many doctors are protesting that they have to treat all patients regardless of their personal worth... how many hospitals are complaining that the government is not letting enough private industry in their field?

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.

If a crown corp. turns a profit of 1 million dollars, and they don't just credit most of that to their customer's accounts (give it back to the constituents) like Sasktel does, they would then transfer that over to the government coffers.

At that point it can be reinvested into infrastructure, used to pay down the governments debt, increase other services, I see that as the public purse... are you implying that politicians just pocket the money?

What exactly is a political rent seeker? I fail to see why filling a job position in the public office is somehow negative; administrators are required, private or public. Politicians will spend tax dollars on pet projects; however it's up to the people to vote them in and out based on their behaviour.

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.

Private businesses fail all the time, we blame the executives responsible, when a crown corp. fails, some people blame socialism. Every crown corporation that I've heard of that has been privatized has become less effective and/or more expensive.

Provide me with an example of privatization of an entire crown corp. that has been a success, because I can't find one.

Bottled water is a private business sector, municipal water is largely government, yet bottled water is frequently no better and sometimes worse than municipal water.

Municipalities that have privatized their water supply have had increased outages and decreased service and quality because the private firm needs to turn a profit, and there just isn't enough fat in those departments, so they turn up the water pressure to deliberately blow weaker pipes to create more revenue through their maintenance contracts.

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......

WRT the poor until the last century they were allowed to die without care, starve to death or were imprisoned if they couldn't pay their bills. Many of them could not get access to properly trained doctors and instead relied on folk medicine as their only resort. This is why things like the Flu became pandemics that killed large swathes of the population.

Nothing stops me from going out the door to help them no, but saying let the poor survive on the kindness of strangers, after saying you think that you have more right to healthcare than they do because you make more money is a ridiculous concept.

Especially a large portion of low paying jobs come with an elevated risk of injury and sickness. Those jobs need to be done, someone has to do it. We relegate them to the people who can't or won't do anything else, it's only fair we provide them with protection from criminals, natural disasters, and disease.

Just because someone doesn't have the ambition or desire to obtain a position that has higher social status than a lower paying job doesn't mean they shouldn't have access to decent medical care.

Yeah the garbage man probably didn't pay attention in school, and dropped out, but if he stops picking up your garbage cause everyone is working white collar jobs now, you are screwed.

You need him, you can't live as you are without him, and relegating him to suffer without treatment for something that knows no social boundaries because you feel he's not worth protecting because he hasn't conformed to your standards it is a very selfish attitude.

Because no matter what the bar is set to, no matter what standards are met, someone will have to pick up the garbage, fix the sewers, dig ditches, and serve in the military.

Remember, as a service member, some of our fellow citizens feel we are nothing more than welfare in uniforms (fewer these days), how would you feel if they were entitled to decide if you should have access to health care?

If we start taking healthcare away from people based on their perceived social stature, it's not too far of a stretch to imagine our access being denied due to costs.

I can hear it now "They volunteered, why should we pay for their healthcare? so what if they can't afford procedures that cost half of their yearly gross pay, they should have picked a better career, it's not my problem, they should look to charity for help"

 

[Bane]

Medical bills underlie 60 percent of U.S. bankrupts: study

http://news.yahoo.com/s/nm/20090604/ts_nm/us_healthcare_bankruptcy

 

[a_majoor]

There really seems to be no lack of magical thinking on this topic: despite all historical evidence the "State" will be able to provide medical care for everyone without limit.

Yet the government (in Ontario) drastically reduced the number of positions in medical school during the Bob Rae government, resulting in the long term shortage of doctors. The government of Jean Chretien pulled billions of dollars from the provinces, resulting in dramatic underfunding throughout the 1990's (and the same government which refused to change the Canada Health act, preventing any possible market driven alternatives to emerge except for medical tourism to the United States and later India). The same government interference3 in the pharmacutical market means there is no Canadian pharmacutical industry that does groundbreaking R&D, limiting the choices of drugs that physicians can use (and ironically contributing to the astronomical costs of drugs in the US, since that is the one market where pharmacutical companies can recoup their costs).

The rationing that results essentially ensures everyone is left in the ditch. I have had reason to contemplate how the CEO of London Health Sciences (which runs the hospitals in London) gets all his funding from the State, pulls down a $400,000+ salary while I have been waiting in the emergency room for 6 hours waiting for a physician while my daughter has a breathing emergency (or I had to wait for 6 months on light duties to get a minor surgical procedure).

If Americans really want to see the future of Obamacare, they only have to revisit the VA hospital scandals of the recent past; that is the closest thing the US has to a single payer healthcare system, or they can take a close look at what we give up for a  notional dollar saving.

The argument may well be moot anyway; even without Obamacare, Medicare and Medicaid are set to become insolvent around 2016...

 

[c_canuk]

There really seems to be no lack of magical thinking on this topic: despite all historical evidence the "State" will be able to provide medical care for everyone without limit.

Yet another vague, I'm smarter than you, and you're wrong statment lacking in details that refute any of my points...

Our health plan gets national results similar to the US system at half the cost, this is fact, this is not disputable, read on and I’ll prove it.

I’m not arguing a state only health system, I’m proposing a hybrid public private system that competes for the same revenue.

government (in Ontario) drastically reduced the number of positions in medical school during the Bob Rae government, resulting in the long term shortage of doctors. The government of Jean Chretien pulled billions of dollars from the provinces, resulting in dramatic underfunding throughout the 1990's (and the same government which refused to change the Canada Health act, preventing any possible market driven alternatives to emerge except for medical tourism to the United States and later India). The same government interference3 in the pharmacutical market means there is no Canadian pharmacutical industry that does groundbreaking R&D, limiting the choices of drugs that physicians can use (and ironically contributing to the astronomical costs of drugs in the US, since that is the one market where pharmacutical companies can recoup their costs).

I agree with you that the Canadian health care plan has been badly mismanaged. It really is abysmal.

I disagree that turning the infrastructure over to private industry is the answer. Because as history has shown, simply turning our Crown assets over to a private firm does not increase service levels, reduce costs or increase reliability, it has historically resulted in the opposite.

I feel that you believe allowing private businesses to run governed only by market forces is the answer, and I feel that is as misguided as those that feel only the government knows best.

The rationing that results essentially ensures everyone is left in the ditch. I have had reason to contemplate how the CEO of London Health Sciences (which runs the hospitals in London) gets all his funding from the State, pulls down a $400,000+ salary while I have been waiting in the emergency room for 6 hours waiting for a physician while my daughter has a breathing emergency (or I had to wait for 6 months on light duties to get a minor surgical procedure).

Doctor shortage, yes, but do you think the CEO of a private firm isn’t also going to get massive salaries regardless of the speed of the ORs?

In 2008 the government collected about $600 billion and spent 115 billion on health(not just health care but health in general). That is about 19% of total revenue.

http://www40.statcan.ca/l01/cst01/govt48b-eng.htm

The average Canadian pays out about 11000 in tax, 19% of that is $2090, or $174 a month.


According to Towers Perrin's annual Health Care Cost Survey, the average corporate health benefit expenditure in 2009 will be $9,660 per employee-an increase of 6% over 2008 figures (source – Towers Perrin 2009 health care cost survey.

http://www.towersperrin.com/tp/showdctmdoc.jsp?url=Master_Brand_2/USA/Press_Releases/2008/20080924/2008_09_24b.htm&country=global


So if you cut that in half, in the US they pay $4800 a year while the average in Canada is $2090…

Unless we double the amount of money flowing into the Canadian health system, we can’t hope to compare the two… for the money that we do spend, I think it’s doing a hell of a job.



I feel that it should be mandated that the triage nurse must patrol the waiting room and continually check on those waiting, people who die in waiting rooms normally die because they aren’t being watched, most deaths could be prevented if there was someone qualified to increase and decrease priority of patients based on their changing status, that doesn’t seem to be happening now.

I believe we need to increase our spending on health care, find a way to end the shortage of doctors, and allow private industry to directly compete for the healthcare budget alongside the crown corps.

I also propose to allow insurance firms to sell health insurance that would cover private firm’s extra fees.

Allowing private competition will cause a few things:

It will force public hospitals to deal with problems quickly in order to compete. If it can’t get people through, it can’t keep up its revenue while preventing the private firms from charging all the market will bear. The two will have to come to a middle ground between service and cost. Those with more money will tend to go to private firms; those with less will tend to go to public firms. By allowing for this, the people will be able to choose. Private firms will be likely to set up shop where there are long waiting periods at ERs.

This however does not solve the doctor shortage problem, for that I propose the Government institute a program where it will pay for a doctors schooling provided they sign a 10 year contract to work for a hospital in Canada, Public or Private doesn’t matter. They would have to pay back any funds expended if they didn’t complete their program. Private firms could do the same.

I also propose that doctors from other countries need a way to challenge for their qualifications, so they don’t end up driving cabs in Toronto.

The problems with healthcare in Canada is much more complex than you make it out to be, simply dissolving the healthcare system and turning the infrastructure over to private firms is not going to solve any of them, and it will just like with every other state owned firm, make things worse.

The solutions will not come out of switching ideoligies that are equally flawed but actually identifying the individual problems and comming up with solutions engineered to solve them.

 

[a_majoor]

An example of another "single payer" system:

http://pajamasmedia.com/instapundit/  16 June 2009

ANOTHER NATIONAL HEALTH PROGRAM THAT DOESN’T WORK: PROMISES, PROMISES: Indian health care needs unmet.

CROW AGENCY, Mont. – Ta’Shon Rain Little Light, a happy little girl who loved to dance and dress up in traditional American Indian clothes, had stopped eating and walking. She complained constantly to her mother that her stomach hurt.

When Stephanie Little Light took her daughter to the Indian Health Service clinic in this wind-swept and remote corner of Montana, they told her the 5-year-old was depressed.

Ta’Shon’s pain rapidly worsened and she visited the clinic about 10 more times over several months before her lung collapsed and she was airlifted to a children’s hospital in Denver. There she was diagnosed with terminal cancer, confirming the suspicions of family members. . . . On some reservations, the oft-quoted refrain is “don’t get sick after June,” when the federal dollars run out.


This is what Obama wants for your family — or, at least, it’s what he’ll deliver in the end. Fix this — and Medicare — first!

UPDATE: Reader Col. Douglas Mortimer writes: “I’ve said it before, I’ll say it again, everything on an Indian reservation is run by a government - either tribal or federal. And everything there is pretty much always a f*cking disaster.”

Prophetic words from a brave man. Like the song says, They’ll turn us all into beggars ’cause they’re easier to please

 

[c_canuk]

so publicly paid doctors who are trained in the same schools as doctors in private practice wouldn't have misdiagnozed a patient if their paycheque had a private company's name on it?

BS.

the family is angry and looking for someone to blame, I feel for them, but they are accusing the doctors of deliberatly misdiagnosing a patient and letting her die due to lack of funds.

Misdiagnoses happens in the private field as well, if it didn't they wouldn't have so many malpractice suits.

The exact same thing happened to my grandfather, they thought he had pneumonia, turned out to be small cell lung cancer. My Wife had a cousin who died in the emergency room by bleeding out internally after a car accident because they thought he was find and he kept telling them he was fine and to take care of his severly injured brother.

neither or these deaths would have been preventable if the paycheques of the staff involved came from a private company or the government of Canada.

Misdiagnoses is a human error, and it's going to happen no matter who pays the bills.

 

[a_majoor]

Lets read the story shall we? The patient was seen 10 times over several months, not just once....

Managers in single payer systems like ours, the VA hospitals in the US or the Tribal system just described are encouraged to husband their "resources", with the perverse incentive that a sick patient is a "drain" on resources. Looking at the number of my contemporaries in the Combat Arms who exist on horse sized doses of Iboprufin and constant physiotherapy rather than getting (expensive) surgical procedures that would set them right is yet another marker of how the system is incentivized against service or innovation.

Human error is possible under any conceivable system, the trick is to find a system where human error is corrected. Angry customers who's car problems are misdiagnosed stop going to that particular shop or mechanic, and he either leaves the business or gets retrained so he stops making these mistakes. The same principles apply to any endevour, and even in socialized medicine, we see NHS patients try to move to the "private" half of NHS, or Canadians doing the "medical tourist" route to the United States or India to get surgical procedures that they are unable to get in a timely manner here.

Lets face it, an emotional attachment to socialized medicine simply isn't supported by observation or numbers. I'm pretty sure if you go back to page 1 of this thread you will see lots of examples of what really works and what doesn't

As for the United States moving towards a single payer system, this is now in the realm of politics, as the Administration can use this program to divert billions of dollars in funding to favored political rent seekers and the "underclass" the Democrats cultivate as part of their permanent voting alliance. Even when voters are lined up at threadbare hospitals wondering why their ration of health care is not being delivered, they can be whpped into a frenzy by diverting the blame on "the rich" or "greedy doctors" etc.

 

[c_canuk]

Lets read the story shall we? The patient was seen 10 times over several months, not just once....

exactly, so if funds were an issue why didn't they diagnose her properly the first time and off load her to the children's hospital that is not a drain on their funds?

in every publicly funded system I've ever seen, doctors get paid by the visit, therefor the more they see you the more they get paid, in private systems they get paid by the solution, so the faster they slap a diagnoses on you and get you out the door the more they get paid.

Managers in single payer systems like ours, the VA hospitals in the US or the Tribal system just described are encouraged to husband their "resources", with the perverse incentive that a sick patient is a "drain" on resources. Looking at the number of my contemporaries in the Combat Arms who exist on horse sized doses of Iboprufin and constant physiotherapy rather than getting (expensive) surgical procedures that would set them right is yet another marker of how the system is incentivized against service or innovation.

irrelevant, those managers aren't going anywhere, they exist in all systems, public or private, in a public system they exist in the hospital, in a private system they exist in the hospital AND in your insurance claims department.

Human error is possible under any conceivable system, the trick is to find a system where human error is corrected. Angry customers who's car problems are misdiagnosed stop going to that particular shop or mechanic, and he either leaves the business or gets retrained so he stops making these mistakes. The same principles apply to any endevour, and even in socialized medicine, we see NHS patients try to move to the "private" half of NHS, or Canadians doing the "medical tourist" route to the United States or India to get surgical procedures that they are unable to get in a timely manner here.

yes, they are mostly rich queue jumpers and you also see people served by the systems you favour, who are in our economic class, struggling to gain access to our system because theirs won't serve them.

Lets face it, an emotional attachment to socialized medicine simply isn't supported by observation or numbers. I'm pretty sure if you go back to page 1 of this thread you will see lots of examples of what really works and what doesn't

I have no attachment to socialized anything, I have a distaste for unregulated private companies being allowed to decide if you live or die based on how much money they can extract from you. Straw man argument by the way, I know you are capable of intellegent debate, I've seen you do it, but in this thread it's been straw man after straw man, evasion of every point you can't defend against and posting of badly written propaganda articles, you're going to have to step it up if you want to change my mind.

As for the United States moving towards a single payer system, this is now in the realm of politics, as the Administration can use this program to divert billions of dollars in funding to favored political rent seekers and the "underclass" the Democrats cultivate as part of their permanent voting alliance. Even when voters are lined up at threadbare hospitals wondering why their ration of health care is not being delivered, they can be whpped into a frenzy by diverting the blame on "the rich" or "greedy doctors" etc.

no one is blaming the rich or greedy doctors in Canada, infact I think the main argument in canada is to increase funding.

Again, where do you think this money is going?

what is a political rent seeker?

do you really believe politicians just embezzle all the money they can?

do you really believe that healthcare funds are being funneled away from health care, keep in mind healthcare is almost 1/5th of government spending and no other sector comes close, and yet we pay per capita less than the US does for healthcare. How do you explain this?

how do you propose private industry repair our healthcare system without placing a 115 billion dollar strain on businesses and the working class just to maintain the status quo?

do you really believe that other than the minister in charge of healthcare being replaced by a board of directors, that anything in the health care system will change, and how so?

 

[c_canuk]

the options I see for privatization of our healthcare system are as follows

1) complete dissolving of the current organization and auction off of infrastructure, a complete removal of government from health care, theoretically, putting $2090 a year back into your pocket on reduction of taxes (*laughing so hard my sides hurt*)  since the Gov would no longer be supporting health care.

At this point the hospitals would probably be bought up by the corps the own the US Hospitals, since the organization of what we have, and what they have are similar, the employee's working at canadian hospitals likely won't change much. However the will have to add more administration to deal with the insurance companies that will move in to take the place of government health care.

my projected result is an increase of operating costs due to an increased administrative overhead, ER wait times will be reduced due those that currently clog the ERs with things that could wait for a doctors appointment will refrain from being there, however due to the extra paperwork and phone confirmations with various insurance companies and plans, there will be an increased time between diagnosing a patient and treating them. This means that those that actually need quick action, will have to wait longer for their emergency to be treated.

Doctors and nurses may see a reduction in work as ER cloggers will not be there so much, however I don't see this as something that requires privatization to fix, a 100 fine for wasting ER resources instead of making a doctors appointment would  go a long way to solving this problem with our system.

2) allow private companies to buy up the infrastructure and attempt to streamline the current system, they would draw funds from the government in the same way the existing system does, but be privatly owned.

My projected result would be the same as every other public department that has done this, at first they will union bust, and trim down staffing levels to cut costs... this will result in lower moral and effectivness of those that remain. over time the firm won't be able to cut anymore as the decreases in service will be too much to justify, equipment to fall into disrepair and the government will be forced to increase funding to the infrastucture just to maintain status quo, or the firms will go bankrupt as they won't be able to provide a profit to their shareholders and or pay down their liabilities.

3) allow private firms to compete for government revenue alongside the existing system, and allow for top up insurance allowing for a broader two tier health system than what already exists.

this will allow firms to take some of the load off ERs and other departments by providing extra facilities that may or may not be specialized. Those that choose to pay more can go to these facilities, many companies may increase thier medical insurance top up programs to cover visits to these facilities without putting the entire burden of health insurance on them.

my projected result will be the decrease of wait times, increase of facilities and services, and allowing those with the extra funds to pay more for faster service without removing basic service from those falling on hard times. It also removes the motivation of companies to lay off those with more medical needs first during economic downturns, and does not let those between jobs to fall through the cracks. This would increase funding to the health care system without increasing taxes, resulting in greater attraction of doctors to stay within our borders, as they will have a much better quality of life.

the only problem I forsee is if the private companies pay more for doctors, they may be able to draw higher quality doctors from the public sector creating a disparity between the systems, experianced seasoned doctors are needed everywhere, however the government can compete by raising doctor' wages.

 

[Edward Campbell]

The problem is not with who “owns” the “system” it is rather, with how you and I pay for our access to it.

The “system” has two major parts: prevention and treatment.

Prevention is almost exclusively a government thing; mostly it does not involve people from the “health sciences” domain. Prevention is, particularly, the work of engineers, mostly employed by cities, who provide clean water and gather up and dispose of garbage and sewage. Take them (those engineers) out of the equation and all the doctors and medicines and what-have-you in the whole world will be powerless to prevent a sudden, steep decline our life expectancy.

Treatment is what most people discuss when we deal with the national health care system. And most of us deal with three parts of the treatment regime: hospitals, doctors and medications:

Hospitals are, by and large, all “public” now – even though most have “private” boards that raise a share of development money. You and I, as taxpayers, fund the day-to-day ‘operations’ of almost all hospitals. They are, rather, like schools: public buildings providing a public service at public expense. Yes, there are exceptions, but the existence of e.g. Upper Canada College does not have any measurable impact on the Ontario education system. So the bricks and mortar, the MRI machines, the cleaners and technicians and nurses are “public.”

Doctors, on the other hand, are – once again, by and large – private entrepreneurs  paid, mainly, by one (in each province) “insurance” scheme. Of course there are exceptions (I happen to be served to be served by a group practice) but most doctors are still “private.”

Medicine is provided by a third system – also, in the main, by private entrepreneurs (pharmacists) but paid for by a mix of cash, and many and varied insurance policies.

The unique thing about Canada’s healthcare system – compared to that in, say, Australia, Belgium, Chile, Denmark and so on down through the alphabet – is that it employs a “single payer” system. You and I pay for everyone else's health care (doctors’ services) and treatment (hospital care). In most countries most people have some wholly publicly funded health care and treatment. Some basic levels of essential health services are provided, without any form of payment being required, for all. In most countries many people are, however, allowed, indeed encouraged, to supplement the “free” healthcare with some combination of private insurance – which may provide either a wider choice of physicians or quicker access to a physician and/or faster or “better” hospital care (perhaps a nicer room, perhaps more advanced technology and tests, perhaps just a “better” hospital).

Most of the OECD countries (all of which (except Canada) have “mixed” payer systems) have two attributes compared to Canada:

• Lower costs (for 21 out of 30 OECD members); and

• Better ”outcomes” defined as e.g. physicians, nurses, acute care beds and diagnostic imaging systems per capita.

A single payer system can have one and only one “control” on expenditure: rationing. In Canada, for decades, we have rationed the “care” component: physicians, nurses, acute care beds and so on. Yet, despite some pretty severe and too often misguided rationing, cost continue to rise so fast that some civil servants and even a few brave politicians are beginning to ask how more important public services – like education – can be sustained, much less improved, in the face of insatiable demand for “free” healthcare.

(Parenthetically: a good (lower cost/better outcomes as in, e.g. Sweden or the UK) public healthcare system is an important net “contributor” to a nation’s productivity but not more important than e.g. public education and high quality R&D.)

There is a clear “safety valve” in “mixed” payer systems: since some/many/most people will want to buy insurance for “better” care or for faster access then the demand for the “basic,” publicly funded, insurance can be contained. The system is still “rationed,” especially for the poor, but the rationing is less noticeable for those most likely to be politically “active.”

One other thing that a “mixed” system provides is “competition” for quality of service. When privately insured patients receive clearly better care then there is a demand for improvements in the public system. The privately insured “clients” are not opposed to (paying for) improvements in the public system because it is not a zero sum game: improvements in the public system are not made at the expense of the private system’s services, in fact, often, the reverse is true – at least it is in countries where most doctors and most hospitals treat both publicly and privately insured clients.

More importantly, the mixed system provides competition for “management” of services. In my opinion the major failing in the various provincial health care systems is poor management. There is, as others have mentioned, a poor “attitude” regarding “clients.” Most private business leaders recognize that clients are important; many public administrators regard clients as an expense, a problem to be managed away.

We already have two tiered Medicare in Canada: people covered by e.g. workman’s compensation programmes are, in most jurisdictions, treated faster and “better’ than, say, the unemployed or retired. We have “private” care systems, too: the one that serves the CF, for example. There is no good reason why we could not allow private health insurance to “compete” with and “augment” e.g. OHIP. A “client” in Ottawa, for example, could use his private insurance to nip across the bridge to Gatineau and get a MRI scan the next day rather than waiting for weeks and weeks in Ontario. Who knows? Efficient and effective private MRI centers might open in Ontario to meet the medical needs of the underserved “problems” (AKA sick people).

My guesstimate is that the very rich will see little change in their medical care – they can already go to the USA or Europe when local, Canadian, doctors and hospitals cannot meet their perceived needs. Those who are simply “well off” are also, increasingly, going to Malaysia, India and China for complex medical treatments that have very, very long waiting lists in Canada. The bottom 20% will see no improvements, either. Their care will remain sporadic and will be beset by long waits in dirty hallways. The 65-75% in the “middle” will, I think, be able and willing to pay more (private insurance) for faster and “better” care. This “new” money will attract more doctors, nurses, acute care beds and diagnostic services – improving the quality of healthcare in Canada while, simultaneously, lowering the government’s share of the costs. Eventually increased competition throughout the entire system should, as it has done in ⅔ of the OECD, lower the overall healthcare costs – as a share of GDP - too.

 

[c_canuk]

ER Campbell, I think you've laid out the points I was arguing on the matter much more eloquently and completely than I have, thank you.

Edited to better match my intent and because I inadvertently came off as a pompus ass

 

[c_canuk]

the doctor will see you in 3 months.
http://www.businessweek.com/magazine/content/07_28/b4042072.htm


A systematic review of studies comparing health outcomes in Canada and the United States
http://www.openmedicine.ca/article/view/8/1

stumbled across these tonight on a different website... the second is a lot of reading.

 

[a_majoor]

As E.R.Campbell points out (yet again) the issue is how health care is "managed" and what sorts of incentives exist to improve management, provide timely and cost effective service etc. The overwhelming evidence is that using the State to provide "service" simply provides perverse incentives that favour "management" over the "clients", and there are 20 pages on this thread alone with examples, facts, figures, comparative analysis and observations to support that. Of course the outcomes of other "state" enterprises in other fields should make this no surprise. Only the fact that the State can enforce an monopoly makes these situations even possible, and wherever the State tries to force a monopoly when real competition is possible, the ultimate results are ruinous. British Leyland dissolved due to the ability of British buyers to buy foreign cars that actually worked, and the takeover of GM and Chrysler will have the same bitter ending for the US automotive industry.

Healthcare has seemed to be a "protected" or natural monopoly since it does not seem to be portable on the surface, but primary healthcare "can" be portable (i.e. medical tourists), and of course everything the bureaucrats forget to grab hold of goes to market, just look at all the private physiotherapists, chiropractors, dentists, foot care specialists, etc. etc. etc. who exist on the periphery of the State health care system providing goods and services to satisfy the demand for health care. I will also include "alternative medicine" in this category, since they also claim to supply health care and there is obviously a market for this.

In the United States, the situation is even worse, consider:

http://www.washingtonexaminer.com/opinion/Why-not-just-fix-Medicare-first.html

Why not just fix Medicare first?
By: Examiner Editorial

06/19/09 11:37 AM EDT
As Congress and the White House began to discuss health care reform, author and journalist Virginia Postrel offered a modest suggestion: If simple and decisive government action can curb costs in health care, as Obamacare advocates claim, why not begin by fixing Medicare before rushing in with sweeping changes to the entire system? The government already runs half of America's health care system. According to federal statistics, federal and state governments together spent virtually the same amounts on health care in 2007 as did all private insurers and patients combined -- $1.036 trillion and $1.045 trillion, respectively. Medicare, which serves the elderly, is the largest public program, accounting for 19 percent of all health care spending in the U.S.

President Barack Obama's Council of Economic Advisers issued a report earlier this month estimating that as much as 30 percent of Medicare spending is unnecessary for improving health outcomes. Given such opportunities for easy savings within government, and Medicare's weighty influence in the broader system (many private insurers set payments by adding a percentage to Medicare's rates), it would make sense to reform Medicare first, see what works and what doesn't, and then apply the lessons of that process later to any system-wide fix. Unfortunately, Obama and Democratic congressional leaders are hellbent on turning the system upside down with radical reforms that are sure to have vast and unexpected consequences.

The president's savings plan for Medicare offers one example of how an overly simplistic system-wide fix could go awry. Although it laudably seeks to improve efficiency, much of his savings plan involves simply tweaking the formulas that determine the reimbursements Medicare will pay doctors and hospitals. Medicare already underpays for most services (although it overpays for a few). This does not lower the cost of treatment - something that only efficiency and technology can do in the long run - but it does squeeze doctors and leave private patients and insurers to pick up the slack in the form of higher prices for other products and services. (Interpolation, at least there are private insurance companies to "pick up the slack", in the single payer system, you pay in the form of time)

Patrick Cobb, president of the Community Oncology Alliance, argues that Medicare's low reimbursement rate for cancer treatments "negatively impacts the quality of care provided to seniors... f Medicare rates become the standard, clinics would have to close their doors." If Obama's broader plans involve "bending the cost curve" for health care on the backs of medical professionals, it will lead straight to rationing health care. And the public option being discussed will undercut private insurers, which will put them out of business. Better to proceed carefully by fixing Medicare first and put the hasty risks on the shelf.

 

[c_canuk]

certainly there has been posted, a lot of theory and study done in isolation, comparing of apples to oranges to combination locks, as well as flat out propaganda from various ideologies.

You yet again dodge my key questions and assertions…

1) How will privatization of healthcare provide cheaper better service when every other privatization of government departments in Canada that I know of, has done the opposite? I haven’t found any cases of a positive outcome however I’m sure there have been some, if you have any success stories I’d like to hear them.

2) Why is it preferable to have many levels of private for profit administrative overhead than one public level that is motivated to provide good service in turn for political revenue?

3) If a private system like the US’s is supposed to be better than ours, why does it cost 2-3 times more than ours for the same level of service we are getting?

4) How to you envision our system being reformed once privatized in that it would provide better and/or cheaper service.

5) Your rationing comments are red herrings, they system in place is rationed by first come first serve, the same as a private business will be unless they allow the rich to jump queue. There are no hospitals, doctors, or nurses in our system that are not tasked beyond what would be considered normal work load.

6) How do you figure you yourself will benefit from a system that will cost you more money, and will only provide elevated service levels to those making you yearly salary in a month?

7) Why do you think the government should care that it has a monopoly on health? The Government’s role is to provide protection and services to its people. No one thinks privatizing fire and police departments would be a good thing because we developed past that dark time in history and know that allowing private business to make a buck off people who need help and have no where else to turn results in abusive practices that cause the less fortunate classes to suffer.

When the less fortunate classes suffer our society starts to grind to a halt as the less fortunate classes are those that keep our economy moving. The more you screw the lower working classes, the more you screw everyone else.  A healthy economy is made up of healthy happy people, you propose screwing over the lower class worker who is vital to our nations health, in favour of making health care more convenient for the upper class.

 

[Edward Campbell]

But you are propagandizing too, c_canuk.

First, you admit there are privatization “success stories” and then you ask questions that are philosophical nonsense.

There is one simple, compelling reason why communism and socialism always fail and always must fail. Stalinism/Marxism/commnism/socialism (all exactly the same “system,” just different implementations) espouse “from each according to his ability, to each according to his needs” and the model requires only one thing: perfect people. But human beings are NOT perfect or even perfectable so Stalinism/... socialism  can never succeed. Please, find me the "perfect" public sector bureaucracy that is ”motivated to provide good service in turn for political revenue.” I do not believe that such a thing exists. I did a little mental ‘survey’ of Anglo-American and Chinese history (subjects about which I have some, very modest, knowledge) and couldn’t come up with more than one or two very brief, transitory examples in each – always in what I would term interregna.

With regard to rationing: Your analogy is false, even worse. Our health care system rations by withholding, not by providing on a first come, first served basis. A retailer, faced with excess “demand,” raises prices and adds new stock. A government, faced with excess “demand,” reduces “supply.” And, the reason for governments’ economically illogical actions is that the “customer” is a problem, not a solution, a “cost,” not a “profit centre.” There is no way in all the gods' green earth that governments can make economically logical decisions – not, anyway, so long as we have a single payer system. Ministers and bureaucrats are not stupid. They know, already, that our Stalinist system threatens to suck up all the money and destroy e.g. infrastructure and education. More and more and more money is needed.   

The aim of allowing private insurance is to inject more money into the system.

The side effects of allowing private insurance – multi tiered medical care/treatment – are likely to include:

• Competition to “manage” the real “costs” and “profits” of health care and treatment. This may involve adding medical professionals, building new, private, hospitals or buying existing public hospitals and running them more and more efficiently; and

• A clear delineation of “medically necessary” services – which I would argue must be covered by the public insurance and must be “adequately” delivered to one and all – and all the other “services,” including the timeliness of service.

Contrary to your hyperbolic remarks, c_canuk, medical “tourism” is not the exclusive domain of the rich. I used to be one - I was/am a classical “middle class” person living, then, on a modest pension and an even more modest salary. Whenever a screening test – one with a reputation for false positives – gave me a positive (bad) result I was faced with a wait of months and months in Ontario. I used to jump he queue by making an appointment for the next test – the one with the long wait in Ontario - with a physician in a nearby US city. Fortunately, my results from those tests were always negative but had they not been I, armed with the US test results, would have moved up to the top of the treatment “list,” passing every “poor” person still waiting in the test queue. I made a choice: I spent a few hundred (>$1,000.00 but <$2,000.00 including hotels and expenses) to obtain a faster and “better” diagnosis. Others, many of whom could afford to choose, elected to wait in the queue. Medical tourism is the sole safety valve for the Canadian (Stalinist) system. Sometimes it is publicly funded – as when Ontario (regularly) sends cancer patients to the US for treatment. Sometimes it is private – as when Ontarians, mostly “poor” seniors, increasingly, spend $20,000+ going to Asia for hip replacements because they are unwilling to spend months and months, stretching into years, on rationed wait lists. Faced with a similar situation, I, a very “middle class” old fellow living on a modest pension and a few investments, would do exactly the same.

I do not need to wait – not so long as China has good private hospitals; I can spend my money as I see fit.  Do not need any politician or bureaucrat to tell me what is “medically necessary,” for me; nor do I give a damn about their views on acceptable wait times. I already have a “private insurance” plan: my savings.

Finally, “less fortunate” is a meaningless phrase, just more hyperbole. By many (nonsensical but commonly used) definitions I probably fall into that class. But even though I am retired and live off my investments I am certainly more “fortunate” and probably more “productive” than many employed Ontarians because, despite my very modest “consumption,” my investments (work) “earn”  more for the province than does the labour (also work) of a huge number of my fellow Ontarians. In a properly managed system, one with access to private insurance and private services, the “less fortunate” will be better off. Only the “least fortunate” will see no change to the inadequate levels of service they now “enjoy.”


--------------------
I’m not going to address the “red herrings” of police and fire. There is a special case for public police, and for all those who may use force on the sovereign’s (people’s) behalf. Fire protection could (used to be) private but public “management” turned out to be cheaper. But, private fire departments remain common; DND has one, so does e.g.  Boeing, because the public fire protection is sometimes “inadequate.” Some jurisdictions (rural New York and Connecticut, to my certain knowledge) continue to experiment with private fire services.

 

[c_canuk]

But you are propagandizing too, c_canuk.

stating that both socialism/communist and free market capitalist ideologies are flawed and stating that we need to identify the existing problems and fix them on a case by case basis rather than switching from one flawed plan to another is not propagandizing.

First, you admit there are privatization “success stories”

I said there probably are some (statistically there must be) but I’ve never heard of one.

If you have examples I'd genuinely be interested in reading about them because it would provide some insight to a problem I don't see a solution for. I'd like to know how they succeeded, what was different.

and then you ask questions that are philosophical nonsense.

beg your pardon?

question 1 is calling on Thucydides to explain exactly how he envisions privatization of the existing system in our existing economy in such a way that it does not reduce service and/or increase costs which he claims by virtue of privatization with no backing logic will magically make things better when I've illustrated that the problem with the system is lack of resources i.e. beds, doctors, nurses, not lack of middlemen pocketing their 15%

2 asks how the system involving at least 3x as many middle men can be considered more efficient (regarding selling off our health infrastructure to private business)

3 asks him to explain why his preferred system costs 3 times what ours does, and how he figures that won't be the case if we privatize

4 asks him to provide an outline of how we could succeed in privatizing our system so that we don't end up paying more for the service level we already have, or limiting access to the system.

5 is a statement that is fact that there is no rationing of health care resources beyond the fact that our existing infrastructure is overworked due to reduced government spending.

6 requests he personally explain how he, someone who would be stuck with an HMO would benefit from the ideological change that would likely see zero increase in XYZ, and start reducing A while charging a premium for those that are still within A just like the US system, and just like every other privatized gov department.

7 illustrates that some things cannot be privatized without the loss of integrity. Bad things happen when they are turned over to free markets. If fire fighting is free market, if you don't have the right fire insurance they don't save your house, if you privatize police departments, the rich don't go to jail, if you privatize health the less fortunate do without and H1N1 spreads in Canada just like Mexico.

right now, as we speak, Winnipeg hospitals are struggling with H1N1 because some of the less fortunate don't have the same shelter most people do, mostly due to certain types of ethnic council... however, under a private system these people wouldn't be in isolation wards, they'd be on the streets, spreading the disease, looking for back alley doctors or the big book of home remedies. Part of the reason we don't have the massive plagues of the previous centuries is because we have a system that caters to all.

He never engages any of these points he just dances around them by making vague comments about how history has proved him right even though I present an existing example that flies in the face of his comments.

Asking for someone who makes philosophical arguments based on vague statements to provide a framework of how they would put them into practice is hardly "philosophical nonsense"

There is one simple, compelling reason why communism and socialism always fail and always must fail.

Because they, in order to succeed need to control everything and distribute everything evenly. In order to produce goods and services since the Bronze Age you need division of labour. In order to provide what we need in this day and age the division of labour is such that it is so complex and numerous that it is impossible to compute even if you centralize distribution. Further to the point centralized distribution is inefficient and wasteful.

Capitalism solves both problems with money, which provides the ability to store the value of your labour in a finer granularity than is possible in any other system. And by allowing businesses to decide how much they will make and set the value for what they make, other businesses can decide how much they need and the problem of distribution is self solving for most things.

Please, find me the "perfect" public sector bureaucracy that is ”motivated to provide good service in turn for political revenue.” I do not believe that such a thing exists.

No, you are right, it doesn't exist, but neither does the perfect private sector bureaucracy. Especially within unregulated free markets that Thucydides implies magically is self correcting when what it actually does is slowly consolidate in to fewer and fewer larger entities with the monopolization of everything as it's end game. Especially when businesses find loop holes and twist the game so that they obtain a vast imbalance between what they have contributed and how much money they have… see Enron.

With regard to rationing: Your analogy is false, even worse. Our health care system rations by withholding, not by providing on a first come, first served basis.

There is no rationing in our healthcare system beyond the number of beds available and doctors/nurses available to treat patients. This is fact. This is not disputable unless you mean, it’s rationed because they won’t give you more priority over anyone else.

My comment is to illustrate that simply changing where their money comes from will not change the fact that there is still only X number of beds, y number of doctors, and z number of nurses, this is not philosophical masturbation this is fact.

the only way you can free up x,y,and z is by limiting the number of people accessing the system(A), or increase the number of x,y, and z. simply auctioning off our infrastructure to private enterprise will not do this, unless the private enterprise limits A, or increases X, Y, and Z.

Therefore privatization will not do anything that we can't do with the public system. I'm requesting from Thucydides and now you, how you propose a private enterprise increase x,y,z without raising costs, or limiting A in the taking over of our existing infrastructure.

I define raised costs and/or limited A as a failure of the privatization process as this would be WORSE that what we have now.

I submit we don't need to switch ideologies, I submit we need to add competition between private and public systems and increase funding.

A retailer, faced with excess “demand,” raises prices and adds new stock. A government, faced with excess “demand,” reduces “supply.” And, the reason for governments’ economically illogical actions is that the “customer” is a problem, not a solution, a “cost,” not a “profit centre.”

just because you say governments reduce supply doesn't make it so, I want proof that, (and this is what you claim the government is doing) that the Canadian government in direct response to longer wait times, is closing hospitals, laying off doctors/nurses and/or cutting funding.

There is no way in all the gods' green earth that governments can make economically logical decisions – not, anyway, so long as we have a single payer system.

Again, with statements that are not backed up with anything, just bold statement of propaganda as fact.

Accountants are accountants regardless if they are hired by private business or the public office. Claiming that no government departments are run efficiently is a flat out falsehood, and regarding history, both private and public corporations have failed and succeeded spectacularly.

The fact that our health system provides remarkably similar service to the US for 1/3 the cost is a huge success. It flies directly in the face of your comment.

The wait time argument was for the most part manufactured in the US by lobbyists who profit greatly from the system there as it is, the wait times in US ERs are roughly equivalent to ours unless you have the cash to jump the queue, and I would be greatly surprised if anyone in this website has the financial wealth required to jump queues in the US for convenience alone on a regular basis.

Ministers and bureaucrats are not stupid. They know, already, that our Stalinist system threatens to suck up all the money and destroy e.g. infrastructure and education. More and more and more money is needed.   

Due to budget restraints healthcare has been cut in recent years, and its increase in funding recently hasn't even accounted for inflation. Again, our system is 1/3 the cost of the US system which I proved using very conservative numbers that were cited.

The aim of allowing private insurance is to inject more money into the system.

Yes, the aim of allowing private insurance is to allow more money from outside the taxation system to be injected into the system.

I support allowing private clinics and insurance to cover the increased fees, as I posted previously, as it would add more X,Y,Z and not limit A, by providing another tier to the health system. I strongly object to turning our healthcare system over to the private industry and drinking the Kool-Aid that pure free markets will self regulate.

• A clear delineation of “medically necessary” services – which I would argue must be covered by the public insurance and must be “adequately” delivered to one and all – and all the other “services,” including the timeliness of service.

I agree, and support private enterprise entering the healthcare sector in Canada for these reasons, but I do not support the turnover of existing infrastructure to private enterprise.

I used to jump he queue by making an appointment for the next test – the one with the long wait in Ontario - with a physician in a nearby US city.

a system that solves it's wait times by limiting A to those that can pay yes... the solution is to add more x,y,z not switching who pays x,y,z

 

[c_canuk]

Fortunately, my results from those tests were always negative

*raises my beer in a toast*

but had they not been I, armed with the US test results, would have moved up to the top of the treatment “list,” passing every “poor” person still waiting in the test queue.

which shows that our system is flexible, and allowing private companies to run labs in Canada would add more X,Y,Z for those that can pay, and decrease the demand for A in the traditional system for those that can't.

I made a choice: I spent a few hundred (>$1,000.00 but <$2,000.00 including hotels and expenses) to obtain a faster and “better” diagnosis.

Is this a problem Canada wide or only in Ontario... there has been some bungling within the health care system (that would most likely would be left intact in a private takeover) and in the provincial government's health infrastructure (which wouldn't)

I agree with you that the solution to the problem is to allow private enterprise to compete, I just don't see any benefit, and a lot of harm to completely turning our existing system over to private firms.

Medical tourism is the sole safety valve for the Canadian (Stalinist) system.

I'm not sure medical tourism is a safety valve available to anyone under a Stalinist system, however I agree with you on this point in regards to Canada's system, which is not Stalinist due to the fact that it revolves around money something that doesn't exist in Stalinist style government.

As to your assertion that anything in the Canadian government outside the CHRC is Stalinist, who is using hyperbole now?

Sometimes it is publicly funded – as when Ontario (regularly) sends cancer patients to the US for treatment.

Temporarily accessing external XYZ to provide more A

Sometimes it is private – as when Ontarians, mostly “poor” seniors, increasingly, spend $20,000+ going to Asia for hip replacements because they are unwilling to spend months and months, stretching into years, on rationed wait lists.

Now here is where I have a concern... if we were to allow private enterprise to open hip replacement clinics, where would the doctors come from?  The waiting list isn't because some bureaucrat is not allowing more than H amount of hip replacements, its due to some lack of XYZ in the hip replacement process. I'm concerned that a private hip replacement clinic would just siphon off Y/Z from the existing system.

If the problem is X(lack of beds) problem solved, if it's lack of doctors(Y) then you just inadvertently made A smaller to those that can't pay and increased the cost to those that can.

Here you have a problem... you let those who are lower on the social ladder do without, so that those higher can have faster access... I don't find that ethical due to those on the lower social ladder typically did the harder jobs that are necessary for those higher on the social ladder to survive. It's a question of if you think hip replacements should be a universal right.

There may be a middle ground... I lack the knowledge if this is feasible, but could the division of labour within healthcare be further divided to increase the areas of specialties and in the process decrease the training needed for high demand treatments such as hip replacement? ie could a tech school train some sort of medical practitioner in say 3-4 years to be licensed to do just hip surgeries, thus increasing the y/z of hip replacements.

Faced with a similar situation, I, a very “middle class” old fellow living on a modest pension and a few investments, would do exactly the same.

As would I, however I would not personally be able to sleep at night if people who needed them couldn't have them because the system was altered to give me quicker access.

I do not need to wait – not so long as China has good private hospitals; I can spend my money as I see fit.  Do not need any politician or bureaucrat to tell me what is “medically necessary,” for me; nor do I give a damn about their views on acceptable wait times. I already have a “private insurance” plan: my savings.

I agree wholeheartedly with you on this issue.

Finally, “less fortunate” is a meaningless phrase, just more hyperbole.

I disagree.

The garbage man is a job that must be filled.
If no one does the job, then we smother under our garbage, extreme but true.
The job is seen as low on the social ladder because it is undesirable.
Because it is seen as low on the social ladder, and does not require a high level of training the benefits and compensation are lower. Therefore it is logical to conclude that he wouldn’t have access to very good healthcare, while filling a role within society that all other levels depend upon and provides the filler of that role with shortened life expectancy and many physical ailments.

Yes yes yes, he could have paid more attention in school and got a scholarship to university and become a stock broker, but what of those without the required intelligence to succeed in higher education? What of the fact that if everyone goes to university, then garbage men will now be university grads picking up garbage for the same wages with university debt load?

Someone has to do it, regardless of how they ended up there; I’m not willing to write them off as the detritus of society and therefore not as entitled to medical care as I am just because I’ve got a higher position on the social ladder.

By many (nonsensical but commonly used) definitions I probably fall into that class. But even though I am retired and live off my investments I am certainly more “fortunate” and probably more “productive” than many employed Ontarians because, despite my very modest “consumption,” my investments (work) “earn”  more for the province than does the labour (also work) of a huge number of my fellow Ontarians. In a properly managed system, one with access to private insurance and private services, the “less fortunate” will be better off. Only the “least fortunate” will see no change to the inadequate levels of service they now “enjoy.”

You are being intellectually dishonest. you know as well as I do that you've had access to more resources than most bottom to lower middle class people will, Yes how people plan for the future has a lot to do with their position on the social ladder and their financial well being, there are still those that are not able to break out for one reason or another. The majority still provide many required services and I find it unethical to deny them medical coverage so those higher on the social ladder can have faster access.

The problem becomes how much is enough, something that is not definable within the context of health care until the secret of immortality is discovered. There can always be more for some at the expense of others; you need to figure out how much you are willing to take from one group to provide more for another. The only alternative to that problem is to add more to the system, to do that in our health care system is to add more X,Y,Z something that privatizing alone cannot do, and may not do at all.


--------------------

I’m not going to address the “red herrings”

Thucydides stated that there was nothing that the government does that can't be done better by unregulated free markets to which I provided the examples of fire and police departments that are a classic historical example that has always been an unmitigated disaster when privatized.

Therefore this statement is misdirection, as you are addressing them, and red herring portion is a straw man.

of police and fire. There is a special case for public police, and for all those who may use force on the sovereign’s (people’s) behalf.

Why is it a special case? Could we not lay off the RCMP and hire a private security contractor to perform the exact same mandate the RCMP fill?

In theory you should be able to do it and tap into Brinks or Pinkertons scale of economy to provide a lower cost per set of boots on the ground.

Other than the fact that private entities first priority is not the well being of the public.

Fire protection could (used to be) private but public “management” turned out to be cheaper.

If public management of fire departments can be cheaper why not healthcare?

It was also turned public because you ended up having to buy service from all the departments, because if the wrong one showed up they didn't save your house, they protected those that had bought their service around yours, and in times of low amounts of fires, sometime unscrupulous administrators would light fires to drum up business. Also the rich guy's smouldering lawn was a priority of the low income apartment building that was billowing flames.

Also the infrastructure developed through public fire department interests developed the hydrant systems and increased fire codes, things that would have been counter productive to private fire systems

But, private fire departments remain common; DND has one, so does e.g.

DND is a public entity, therefore its department is also public. It's a redundant public department that serves a public department; it's no more private than the photocopy room in the department of transportation is a private copy business.

Boeing, because the public fire protection is sometimes “inadequate.” Some jurisdictions (rural New York and Connecticut, to my certain knowledge) continue to experiment with private fire services.

To supplement their public systems, there is nothing wrong with contracting private companies to supplement public services, it's a whole other kettle of fish to turn everything over to private interest.

 

[stealthylizard]

My argument against that is cancer can also be caused by bad eating habits. If you consume peanut butter to the maximum allowed by your body, you can have cancer. .

Peanut butter 'wards off heart disease', say scientists

http://www.dailymail.co.uk/health/article-1195453/Peanut-butter-wards-heart-disease-say-scientist.html

 

[Edward Campbell]

I’m not inclined towards line-by-line deconstructions so I will deal with just three points raised by c_canuk:

First: private fire services were too expensive because there was not (maybe still is not) an acceptable alarm/response system for competitive, private fire companies. A “public,” monopolistic system was adopted so that any alarm would result an acceptably prompt response by only the necessary number of fire fighting units. Some jurisdictions are exploring “private” solutions while still maintaining the monopolistic character because they think a private contractor can provide an acceptable grade of service for less money than can a “public” agency.

The premise, however, is that fire fighting is a “natural monopoly.” I’m not sure that is correct. I do not have any good examples of “competitive” fire departments but I do have models of competition in other traditionally “public” services that are, usually, thought to be “natural monopolies.” I refer, specifically, to “public transit” in Japan which is, often, provided by competing private companies – at costs and grades of service that Japanese municipal governments find quite acceptable. I cannot vouch for the costs (I’m neither a Japanese accountant nor a Japanese taxpayer) but I can vouch for the grade of service which rivals that of Hong Kong and is, therefore, far, far superior to any public transit I have used in North America and Europe.

Second: the private sector does, normally, do the same task as the public sector for less money. It does so, quite simply, by making its operations more “productive.” This often involves replacing highly paid public sector employees with more lowly paid contractors – something that does, indeed, “damage” the “social fabric” by taking well paid jobs out of the “system” and replacing them with less well paid jobs. BUT, the cost of a job ≠ value of that same job and the mismatch is often, but not always, most evident in public sector jobs. Most often high value jobs, like garbage collection, cost less (lower salaries) than low value jobs like health care economists, human resource managers and bilingualism coordinators. It is important to carefully and sensibly account for both the cost and value of labour. The public sector is chronically unable to do this and is (equally chronically) unwilling to try.

Third: the whole health care system need not be privatized – even though some of the most critical parts  (physicians and pharmacists) are, mainly, already private. There’s nothing horribly wrong with e.g. publicly owned hospitals – so long as they are well managed and, therefore, able to get somewhere near cost of labour ≈ value of labour. But I fear that public ownership and sound management rarely go together.

What is required – soon – is more, new money and that will come only from the private sector. It will come, principally, through private health care insurance which will allow the middle class to jump the qualitative and timeliness queues, as the rich already do and as the really poor can never hope to do no matter how much public money is wasted applied to the system. I’m guessing, based on examples in the UK, that private management can and will cut costs and improve efficiency and productivity in hospitals, the industrial component of health care.

Finally, the US does not provide the “right” model. We need to look to e.g. Australia, Britain, Czech Republic and Denmark and so on down through the OECD for models that provide qualitatively better health services than Canada does at (roughly) equal or lower costs.

 

[a_majoor]

WRT fire services, there are still more volunteer fire departments in the US than "public" or private ones combined. Obviously, people recognize the need, and organize accordingly.

While the State must provide police protection as part of the States function of providing protection to citizens, it is also obvious that the modern State is not providing the protection service desired, as there are far more private security officers than police officers.