[William_H_Dougherty]

P.S. profit-making universal health care is essentially the same as a corrupt socialist system of universal health care, where people who are higher up skim from the top, isn't it?

Eh? Well, first off, Canada doesn't have a socialist healthcare system for the reasons I've outlined (hospitals are not government owned, doctors are essentially independent private corporations operating on a fee-for-service model).

I'm also a little bit confused by what you mean by "skimming from the top". Just because there is a phenomenon discussed in health economics whereby physicians have an incentive to treat only the most healthy patients..."crop skimming".

Fee-for-service models in Canada and the US have the exact oppositve incentive, to treat the most worse off (as their treatments will cost more). Which I suppose is a good thing if you are REALLY sick, but not if you are MARGINALLY ill (in both Canada and the US, many health economists lament the fact that there isn't enough emphasis on preventative medicine & disease management, that both systems are designed to help people after they get really sick and not really preventing them from getting sick or getting at them when their diseases are in the early stages).

E.g. how much more reasonable would health care costs be if nobody smoked? Or nobody drank excessively? Or everybody exercised? If there were less fat-asses?

Was that what you were referring to?

If physicians and hospitals were really profiting by prescribing unnecessary treatments as the liberals are claiming, there would be a much larger profit opportunity for private consumer advocacy groups to expose them.

I have a high opinion of physicians, so I would argue rather that physicians in Canada and the U.S. generally offer treatments/diagnostics that are "necessary", there may however be "less expensive" alternatives that are neglected because of a profit-motive.

Yet somehow our government is going to magically lower costs in some way other than stifling demand (that's right...death panels). Puh-lease.

There are no death panels in Canada, yet our healthcare to GDP ratio is far less than the United States with no statistically significant population health differences.

- WHD

[grassroots1]

Eh? Well, first off, Canada doesn't have a socialist healthcare system for the reasons I've outlined (hospitals are not government owned, doctors are essentially independent private corporations operating on a fee-for-service model).

I understand that it was a bit of a strange statement, and I wasn't referring to Canada's system at all. In a system of universal health care, if it is designed to make a profit, then it will sell its services and attempt to function at a profit. If a system of "free" universal health care was managed by bureaucrats with very inflated salaries, or if those same bureaucrats somehow appropriated resources for their own use, then that is essentially the same effect as "profit-making" universal health care. That's not to say the organizations would be run similarly, but they might.

(in both Canada and the US, many health economists lament the fact that there isn't enough emphasis on preventative medicine & disease management, that both systems are designed to help people after they get really sick and not really preventing them from getting sick or getting at them when their diseases are in the early stages).

E.g. how much more reasonable would health care costs be if nobody smoked? Or nobody drank excessively? Or everybody exercised? If there were less fat-asses?

That is something we talk about here.

In the end, Americans and Canadians both pay for their healthcare (out-of-pocket/Extended Health Benefits in the United States, through taxes in Canada). The money in each system is not sufficient for the demand for services, so both results in some form of rationalization of service.

In America, people who can't afford care are turned away, in Canada people have to wait for care.

A one-time, $10,000 hospital bill (and that is low) is far more destructive to the life of a person than a steady rate of taxation from year to year... especially if that taxation guarantees the person medical care. I'm sorry but being turned away for lack of payment is far worse than having to wait a little while if your case isn't very serious.

Again, rationalization of care has resulted in much the same situation in Canada. A shortage of doctors plus the pure FFS model means your surgeon just doesn't have the time to spend very much one-on-one time with the patient. Like in the US, Canadian surgeons rely on junior-level doctors to do much of this stuff for them.

So is it rationing, or is it FFS? If they are choosing their customer then certainly there isn't very much rationing going on. And besides, again, I don't know how you can compare a system of 40 million people without any sort of care whatsoever, while the rest of us pay $10,000 hospital bills WITH insurance, somehow equal to your Canadian system where neither of those things happen. Just because rationing exists? I'm sorry, but I don't buy the argument and there really is no reason to.

There are advantages and disadvantages to our approach vs. yours.

Fair enough. Ours seems to have VERY significant disadvantages. What have we come up with? Grants? I can say this: our economy is far larger than yours. There is bound to be more money in general floating around for research here than in your country.

[William_H_Dougherty]

I understand that it was a bit of a strange statement, and I wasn't referring to Canada's system at all. In a system of universal health care, if it is designed to make a profit, then it will sell its services and attempt to function at a profit. If a system of "free" universal health care was managed by bureaucrats with very inflated salaries, or if those same bureaucrats somehow appropriated resources for their own use, then that is essentially the same effect as "profit-making" universal health care. That's not to say the organizations would be run similarly, but they might

Well, the average citizen (making what, $30,000 a year?) is always going to think that hospital administrators are making too much money. Just like that average citizen thinks that the CEO of any medium sized corporation is overpaid so I don't put any stock in this.

However, it was widely known in Canada that should you have a spouse who is a doctor or nurse, your wait times would be magically smaller (or non-existant) as compared to regular citizens.

My understanding is hospitals are clamping down on these sorts of activities. It isn't suprising though, if you are a doctor and your child gets sick, of course you are going to try to pull a few strings...

Perhaps not "fair" to the rest of the public, but understandible...

I'm sorry but being turned away for lack of payment is far worse than having to wait a little while if your case isn't very serious.

I would agree.

So is it rationing, or is it FFS? If they are choosing their customer then certainly there isn't very much rationing going on. And besides, again, I don't know how you can compare a system of 40 million people without any sort of care whatsoever, while the rest of us pay $10,000 hospital bills WITH insurance, somehow equal to your Canadian system where neither of those things happen. Just because rationing exists? I'm sorry, but I don't buy the argument and there really is no reason to.

You don't buy the argument that you can compare the two systems? Of course you can. I'm not saying they are equivalent systems, just that in any system (prviate or publicly-based) there is going to be rationalization of healthcare. This is because there is (practically) an infinite demand for healthcare services but a limited supply of those healthcare services.

Fair enough. Ours seems to have VERY significant disadvantages. What have we come up with? Grants? I can say this: our economy is far larger than yours. There is bound to be more money in general floating around for research here than in your country.

I'm not defending your system at all. However, if you'd like me to, it would be fair to say that the biggest benefit to the American system are the centres of medical excellence "available" to all. The only problem is, that care is not "accessible" to all because of the fees necessary involved. Just like your educational system, healthcare in the United States is really a sea of mediocrity with a few islands of excellence. How much money you have in your wallet decides which you access.

In the end, we are really approaching this from two different angles. I'm a fan of the Canada Health Act, but I am concerned with some of the failings of our system so I'm looking elsewhere (the UK, France, Sweden, and even the US) for ideas on how to address these failings without undermining the principles of our system (#1. publicly funded, #2. publicly delivered, #3. portable, #4. universal, and #5. accessible).

- WHD

[grassroots1]

My understanding is hospitals are clamping down on these sorts of activities. It isn't suprising though, if you are a doctor and your child gets sick, of course you are going to try to pull a few strings...

Perhaps not "fair" to the rest of the public, but understandible...

Yes.

You don't buy the argument that you can compare the two systems? Of course you can. I'm not saying they are equivalent systems, just that in any system (prviate or publicly-based) there is going to be rationalization of healthcare. This is because there is (practically) an infinite demand for healthcare services but a limited supply of those healthcare services.

First, I don't agree that the demand is infinite, and second, the rationing of care in a system like yours is fundamentally different from the profit-driven decision-making that goes on in America. In a well-funded public health system, rationing could potentially be nonexistent. You can compare the systems, yes, but I don't think those things can be equated.

I'm a fan of the Canada Health Act, but I am concerned with some of the failings of our system so I'm looking elsewhere (the UK, France, Sweden, and even the US) for ideas on how to address these failings without undermining the principles of our system (#1. publicly funded, #2. publicly delivered, #3. portable, #4. universal, and #5. accessible).

Those are basically my priorities for health care as well.

[William_H_Dougherty]

First, I don't agree that the demand is infinite, and second, the rationing of care in a system like yours is fundamentally different from the profit-driven decision-making that goes on in America. In a well-funded public health system, rationing could potentially be nonexistent. You can compare the systems, yes, but I don't think those things can be equated.

Practically infinite. Of course there is a limit because there are a limited number of people. However, you touched on the importance of this concept in your answer. You said, a "well-funded" public health system. What exactly is well funded?

The Canadian experience has been a steady increase in public health spending above and beyond the growth of the tax base, the growth of the economy, yet below the growth of demand for services given the increasing wait times for certain core services.

It is extremely concerning. Right now, 50% of all Government spending is on healthcare and hospitals are still running record deficits. Twinkling around with payment models for physicians is not going to make it any more sustainable considering that physician and other health professional spending are not the largest drivers of costs.

Again, I'm a fan of our system but the reality is it is not sustainable as is. So I, and other people who study these issues for a living, are open to exploring what the other developed worlds are doing in regards to healthcare. The reality is, we will need to make some pretty comprehensive changes over the next decade. If I knew what those were, I'd be a millionaire.

Those are basically my priorities for health care as well.

Those are the five criteria of the Canada Health Act. Provinces, who are responsible for delivering healthcare, have to meet these criteria in order to recieve Federal-Provincial Health Transfers. In other words, the Provinces, who are are typically more conservative in mindset (regardless of party), were and are still bribed into providing universal healthcare through billion dollar transfers.

These transfers ceased being sufficient to pay for a large portion of the healthcare a decade ago, but they do make a difference between a balanced budget and a deficit.

Read it, it is only 14 pages. Much shorter (yet more comprehensive) than that bizarre monstrosity your Congress got through on health care reform. What is it with your legislators? Do they make things complicated on purpose?

http://laws.justice.gc.ca/en/C-6/

- WHD