The great debate of healthcare, private or public? [Archive]

Mark in Oshawa

21st January 2010, 21:10

Ok...I am sure I am just supplanting a thread we had on this topic as the US was in their healthcare woes, but I didn't bother digging into the archives for this addition.
http://www.torontosun.com/sports/othersports/2010/01/21/12550836-sun.html

The UFC heavyweight Brock Lesnar was recently treated, or rather NOT treated for his diverticulitis condition while up in Manitoba on a hunting trip. Brandon, the city where he went for treatment is a decent sized city by Canadian standards, and the second biggest city in the province. It SHOULD have the facilities to handle a case like this, yet the scanner required for this man was not working. NOT working? IN a similar sized US city, there would be 3 or 4 scanners that would likely be in use. THAT is where the public system has let people down.

That said, in reading the article and hearing him tell his woes on the Jimmy Fallon show, he bad mouthed Canada a bit and I know the man isn't the sharpest knife in the drawer, but lets face the reality that people when sick do NOT want excuses, they want results, and he drove south to Bismarck North Dakota to get them.

Here was a guy who is accumsted to having his health issues taken care of, and couldn't get the service he wanted for what is a pretty common condition. I suggest that those who keep saying the American system is too expensive and faulty are ignoring the one large problem with public healthcare: It is often behind the private sector in utilizing and obtaining the latest equipment, and government mentality almost ensures that there is a lot of bureaucracy getting in the way of letting the doctors have the tools they need.

Malbec

21st January 2010, 21:21

The UFC heavyweight Brock Lesnar was recently treated, or rather NOT treated for his diverticulitis condition while up in Manitoba on a hunting trip.

Diverticulitis is not a radiological diagnosis but a clinical one, ie he didn't need a scan. A CT scan is nice but only an idiot would withhold treatment for lack of one, and a normal CT doesn't exclude diverticulitis either.

Sorry but my bullometer has just gone off the scale already, looks like a case of a celebrity patient not understanding their condition and a politically loaded media willing to jump on anything regardless of the facts.

Brown, Jon Brow

21st January 2010, 22:18

This question will always come down to whether you think health care is a given right or not. I think it is a right and the poorest should be given the same healthcare as the richest. If the richer want extra then they should be able to pay extra for it.

So in short public with the option of private.

I would expect that you would see a bigger protest in the UK if they tried to take our NHS away than the pro-private healthcare Americans are doing.

Sonic

21st January 2010, 22:36

My thoughts are very similar to Jon's. Healthcare should be available to all as a basic human right and if you've got some extra cash then go ahead and pay for private if you wish.

Rollo

21st January 2010, 22:48

This question will always come down to whether you think health care is a given right or not. I think it is a right

SO does the UN:
United Nations Universal Declaration of Human Rights:
Article 25.1
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The United States doesn't believe in listening to the UN though. That's why they've never adopted it, despite voting in favour for it in 1948. Then again the USA frequently ignores the UN.

Brown, Jon Brow

21st January 2010, 22:57

Mark in Oshawa

21st January 2010, 23:55

Mark in Oshawa

21st January 2010, 23:58

But what does Medicare offer?

Jon...you would have to grill one of the Americans, but I have been told more than once it is minimum care at any hospital.

I am torn in this debate. I am comfortable with the reality of the medical system we have here yet the principles upon much of what I believe says that a private system should be available and I wont knock the Americans who don't want a public system....

janvanvurpa

22nd January 2010, 03:53

Diverticulitis is not a radiological diagnosis but a clinical one, ie he didn't need a scan. A CT scan is nice but only an idiot would withhold treatment for lack of one, and a normal CT doesn't exclude diverticulitis either.

Sorry but my bullometer has just gone off the scale already, looks like a case of a celebrity patient not understanding their condition and a politically loaded media willing to jump on anything regardless of the facts.

Poor thing can't pinch a loaf, eh?

Yep that's incontrovertible proof Canadians Stalinsit Dachau like so called health care system is kaput!

And that Americans everywhere would not be sitting pretty if the Maoist Regime in Washington headed by Hussien O destroys the entire country by forcing thru Health care form at the point of a gun!!!
Americans in American have a right to a CT scan whenever they can't poop!

Maybe if said celebrity patient would have eaten more "roughage", he wouldn't be , so to speak, full-of-shît..

Of course the media in question is also so full that they spew up loads and many people happily eat what is served...

Glad I don't need a CT scan when I need to lay a trans-Atlantic cable.....

Hondo

22nd January 2010, 05:03

Here's the real down and dirty. This is the real issue and you won't see it in the newspapers. First, some preconditions. Jon you are correct. The majority of Americans were raised within the culture of America being a land of opportunity not entitlements. Amongst that, you do not have a right to healthcare but you do have the right to attempt to get all the healthcare you want by purchasing it, begging for it, bartering for it, conning them out of it, and you name it. In the case of an immediate, life threatening condition you can go or be taken into any hospital emergency room and be treated. In areas where there are charity hospitals, they may stabilize you at one and then transport you to the charity hospital. Either way, when you leave, you'll be presented with a bill before you go. Arrangements will try to be made for you to pay the bill over a long period of time but each and every month, you'll get that bill. The options hospitals have in trying to enforce collection of an indigent bill will vary from area to area. The key word here is indigent. If instead you have a good job and make decent money you can bet that hospital is going to expect you to pay. If you are flat on your back broke and are the scum of the earth, you will receive treatment for immediate life threatening conditions, including broken bones! Is that clear now? Are you going to receive long term out patient care? Nope. Boob job? Nope long term cancer treatment? Sorry. New kidney? Don't hold your breath. If you are poor or broke, you get the very basic stuff. That's all.

Rollo, I can appreciate you rolling out the underachiever's classic, good old Article 25.1. The UN is another one of those institutions people and nations embrace or dismiss depending on how views their current cause. No nations are ruled by the UN. They are ruled and governed by their constitutions. Article 25.1 specifies many things as rights that are not recognized as rights by the US Constitution. Therefore, in the USA, 25.1 loses. Article 25.1 is warm, fuzzy, feels good, utopian, completely unsustainable in the real world, and ridiculous. Who can afford to pay for 25.1? Since I know your answer already, what happens when you finally whittle the "rich" down to nothing? Just for fun. let's assume the the UN has oodles of money and can pay. Pretty soon there won't be anything left to buy. 25.1 offers a Garden of Eden lifestyle so why would any farmer, powerplant operator, factory worker, miner, or fisherman want to go bust his butt for 8 to 16 hours a day to earn a living when he can stay home, enjoy life, and have everything he needs? To have more? You have already decided he is not worthy of more. He was your final definition of "rich". Rich meant he was one of the few still working and producing valuable goods and services. You finally taxed him down to where he realized that people with no jobs were better off than he was. So he quit working too. Who is going to produce the food, goods, and services to sustain the lives of the professional poor basking in the glow of 25.1? You gonna do it Rollo?

Onwards. Just to make things easy, we'll accept the figure of 30 million Americans without health insurance. You can split that into 2 other groups, those that cannot afford insurance and those that refuse to afford insurance.

Before getting too deeply into this some personal opinions are:

The fact that this whole discussion is about medical insurance would lead one to believe that any medical treatment is too expensive to obtain without medical insurance. Thats not true , but even so, the medical profession should have it's feet held to the fire (or waterboard) to justify some of their fees and charges along with the insurance companies. Every place I've lived in this country has had clinics of every medical art that offered long term, low payment plans for those that desired care but did not have insurance. One year, I opted out of my group insurance because when you're young, strong, and bullet proof, you do stuff like that now and then. 9 months into the year I ended up limping into a hospital ER with a huge red boil the size of a golf ball on my thigh that had failed to respond favorably to my ignore it method of treatment. It was a slow day so 2 young doctors spent about an hour gleefully slicing, squeezing, and digging all manner of exotic looking white and green crap out of it before packing it with gauze and sewing it up. Staph infection. Bill $800.00 with follow up to remove gauze and stiches included at no extra charge. I paid the bill and left. When I went back for the follow up one of the same doctors worked on me again. He thanked me for paying the bill and told me they figured I was just another person probably giving them a fake name and address and they'd never see me again. That was my only medical adventure that year and even paying out of pocket, I still came out $600.00 ahead of what I would have spent on insurance that year. The point is that there is care available and there are those that will do their utmost, short of giving it away, to help a family afford it.
Is there a need for insurance reform? Yes, I think so but it needs to be done with understanding on both sides of the table. Hospitals and insurance companies are businesses and are in business to make a profit and that needs to be understood and not seen as evil. So what's the problem? There are two major problems. One is that everything our government touches becomes an out of control money consuming pit that never delivers what was promised. Doesn't matter if it's a Democratic program or a Republican program. If any of these clowns could survive in a real business, they wouldn't have to be politicians. Their previous attempts, Medicare and Medicaid are both broke. For what ever reason, they are absolutely terrified of us seeing or having any input into what their new program is and what it will do, what it won't do, what sort of restrictions it will have, how much it will cover, how long it will cover, and most of all WHO IT COVERS.

Thats right, who it covers. Americans are very generous people. If there is a disaster, we are there. If you hate us, spit on us and kill us from time to time we are still going to come and feed you, water you, aid you, and help you rebuild until you're feeling better and are able to spit on us again. Thats the kind of stupid bast@rds we are. Unless, You're an American. Go back and see opportunity and culture.

End of part one. I need a break. last part coming shortly.
Back to insurance and insurance reform.

anthonyvop

22nd January 2010, 05:16

My thoughts are very similar to Jon's. Healthcare should be available to all as a basic human right and if you've got some extra cash then go ahead and pay for private if you wish.

But it isn't a right. It is a luxury.
The ability to access Healthcare is a right.

Hondo

22nd January 2010, 06:08

Rightly or wrongly most Americans view poverty in this country as self-inflicted. Decades of government poverty programs have only expanded poverty as people learned to eke a pretty good existence out of government benefits enhanced with some minor crime on the side. you have an entire class of Professionally poor and constantly unemployed. In a city near me, there is a grocery store that always has a parking lot full of nice cars and very stylish people coming out it's doors pushing cartloads of groceries. This state issues a card like a debit card to it's poor people to buy food. The values of the cards vary depending on the benefit level of the card holder. At the beginning of each month the card is restored to it's full value. Before you can turn your engine off, someone will be offering to shop with you and put the purchases on their card if you will pay them .50 cents on the dollar in cash. They'll take their cash and go buy cigarettes, beer, lottery tickets and go hit the casinos. The vast majority of the poor are black and hispanic. There's isn't a large gray area in benefit qualifications and there are a fair number of people working their butts off whose life style isn't much better than the benefit crowds who could use some help but don't qualify. They have too much.
Illegal immigrants. We don't mind them coming over here and picking produce. We mind them coming here and working as carpenters, brick layers, concrete finishers, mechanics, and other higher paying jobs. In addition, if you want to come pick our lettuce thats fine, but don't bring your wife and 4 children with you because we don't want to pay for any benefits they may get or medical treatment they may need.

In a nutshell, this bill is being kept in secret because it provides decent healthcare to the poorest of the poor, who also happen to be minorities and illegals, at a cost to the working people of either going to the "universal plan" which they suspect, probably rightly, will be inferior to what they enjoy now or keeping what they have now but having to pay a massive tax to opt out of the "universal plan".

Thats it. People are sick of the constant barrage of tax increases, they are tired of new taxes (New York has a tax bill out to levy a one cent per ounce on soft drinks for "health reasons") and they don't want to pay the health care costs for a bunch of poor minorities. Thats all there is to it.

The money we are spending in Haiti alone could've gone a long way for American healthcare.

Mark in Oshawa

22nd January 2010, 06:21

Fiero, your points are excellent and I cant disagree with them based on the fact I am not there, and b) I don't know enough about the good or bad in the way healthcare is provided in the USA other than to say, Most Americans when pushed like what they have. Polls have said that.

I have said it before, the biggest misconception Americans have about healthcare in Canada is that it is FREE. It is FREE if you are not paying any taxes, but to do that, you are not having much of an income. If you have a job, it isn't free, nor should it be. You pay more in taxes in Canada per person on average than the average American pays in taxes AND health insurance. We Canadians get fleeced pretty good. If our system worked as well as the average American's does in terms of wait times and the type of treatment available, then I wouldn't want better. The thing is, this is my health, I want the BEST, and instead, I hear lots of news of how my healthcare system is undersiege by rising costs and technologies (we don't have the malpractice insurance issue the Americans have), and how my system is VERY lacking in GP's and some specialists.

Bureaucratic bumbling has created shortages where a free market system would have ensured supply. IN THat, instead of some bureaucrat deciding how many spots in medical schools would be provided, they stayed out of it and let the universities take as many students as they could handle and let the market settle things. OH no...cant do that...they were scared of too many doctors in Ontario not 20years ago when the average GP was 50!! Only an idiot would mess with the numbers going through the medical school, but in a cost cutting binge (too little too late) the local Ontario premier chopped funding for medical schools. Again...politicians being clueless.

You guys in the UK if you are truly honest will find small issues with your public system, and the ONLY thing that mitigates this is the private system is there to bring up the slack, innovate and invigorate. In Canada, we took on the Cuban model...and THAT is what many Americans thought Obama was going to lead them towards.

F1boat

22nd January 2010, 07:10

IMO it should be public. If a doctor turns his back on a sick poor man, the vow of Hippocrates is being destroyed.

Mark in Oshawa

22nd January 2010, 08:39

IMO it should be public. If a doctor turns his back on a sick poor man, the vow of Hippocrates is being destroyed.

IN the US, a doctor in a hospital is by LAW supposed to treat the person. That vow is to "First, do no harm"...not take "every one who asks to be a patient is my patient". It is simplistic at best to say doctors have to treat everyone all the time.

The thing is, you can be anyone in the US, an illegal or a citizen, or a tourist, and if you were hit by a car or caught in some horrific accident, you would be rushed to hospital and treated. They may at some point during all of this try to find out who you were and whether you had insurance, but you would be treated and looked after. The billing comes after......

The point I heard best was we as a society (in the developed world) are willing to pay for almost ANYTHING, except what is most valuable to us, our health. Then we are always trying to cut corners or sucker someone else into paying it. That is fine, but society as a whole starts paying for everyone's healthcare, and then society will therefore have some claim on what you eat, what you smoke, what you do for exercise and other lifestyle choices. If I am going to pay for your healthcare, I don't want you eating fatty foods, not going to the gym or smoking 3 packs a day and drinking on the weekends. You would then be upset at these demands by me, but hey, I am paying too....

Americans look at it this way: You are free to not look after yourself, live with poor choices, but YOU only will pay for that, not I. The inverse is also true. Now in modern day times insurance companies get in the way of that partially, but no one says you have to join one.

I wont knock anyone for having government healthcare or having the US style of healthcare. We all live in our our soverign nations where the people of those nations made decisions a few decades back on how they would structure and pay for healthcare. Just because I live in a socialized system doesn't mean I think it is better than most, but I wont think it totally inferior than most. I decry the waste and mismanagement, and I get mad if I have to wait for care, but I am sure if I had first hand experience with the US model ( as opposed to talking to umpteen Amercians about its pros and cons) I could pick. THAT is the problem. Those of you in the UK or Finland are ripping the Americans up as stupid for their healthcare reform foibles, yet you miss the point. THey like what they have, and the US has a pretty good record in research, development and putting out Nobel Prize winners in medicine. YES they spend a lot on it, but it is THEIR business.....and as we saw in Massachusetts, there is a backlash for trying to fool people with a healthcare bill that will be the worst of all worlds. A private system paying for a very badly run public system that civil servants and politicians WONT participate in. At least in Canada, the pols have the balls to have to access the same system as I do....

Mark in Oshawa

22nd January 2010, 08:46

SO does the UN:
United Nations Universal Declaration of Human Rights:
Article 25.1
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The United States doesn't believe in listening to the UN though. That's why they've never adopted it, despite voting in favour for it in 1948. Then again the USA frequently ignores the UN.

Read the US Constitution. It is unconstitutional for any US President to be subservient to any body outside the US.

As for ignoring the UN, when it got hi jacked by a bunch of little tinpot nations that don't respect human rights while flaying others for not having them, you lose all credibility.

When it comes to what the UN dictates, it isn't anything but nice thoughts. Just ask the Rwandans how well the UN protected them. Ask the Bosnian Serb's how well they were stopped by the UN if they attacked on a Friday afternoon. UN staff in NY wouldn't answer the phones for orders from the UN commanders of the member nations involved in trying to stop the genocide there. Apparently that weekend in the Hampton's had to be had, and they waited til Monday to return calls.

The UN's thoughts on what is proper healthcare is feckless and useless. No nation should give up its sovereign rights to this useless bunch of idiots. The UN is a great place to talk about human rights and debate issues, but it was bypassed in the 50's as a truly useful organization on a lot of things.

That UN dictate if followed means there is NOT ONE NATION on the planet has followed it 100%

Hondo

22nd January 2010, 10:54

For the "poor" in the USA, any service or benefit provided that is paid by any sort of income tax generally is a free benefit. What taxes they do pay are refunded at the end of the year. In an ironic sense, Obama is not good for the black American male. Obama is the stereotype gone wrong that kicks the crutches of self-pity out from under oh-so-many people. Obama is half white, half black, a condition not cheerfully accepted by either side. Obama's daddy ran off and left them. On top of that, his momma dumped him on the grandparents and left him too. Statistically, Obama ought to be putting on a ski mask and robbing liquor stores with a pistol for a living. But he's not I wonder what Obama would be now if he had been raised by another government poverty program instead of the loving grandparents that remained interested and focused on him?

Sonic

22nd January 2010, 11:01

But it isn't a right. It is a luxury.
The ability to access Healthcare is a right.

I can see your position but I don't agree. At present I have private health cover because I am fortunate enough to afford it. However if my luck changed and I found myself unemployed and therefore insuranceless through no fault of my own I would still want to be treated should I suffer from a serious illness.

By getting me well and back to work the gov regains a tax paying worker. Whereas without the public health service I couldn't recovered an therefore would become a drain on other public services without being able to work and contribute towards their costs.

All hypothetical, granted, but I still feel happier knowing whichever way my life works out my health is as well protected as it can be.

anthonyvop

22nd January 2010, 14:04

Mark in Oshawa

22nd January 2010, 16:30

I can see your position but I don't agree. At present I have private health cover because I am fortunate enough to afford it. However if my luck changed and I found myself unemployed and therefore insuranceless through no fault of my own I would still want to be treated should I suffer from a serious illness.

By getting me well and back to work the gov regains a tax paying worker. Whereas without the public health service I couldn't recovered an therefore would become a drain on other public services without being able to work and contribute towards their costs.

All hypothetical, granted, but I still feel happier knowing whichever way my life works out my health is as well protected as it can be.

I will agree with you on a lot of this Sonic. It is very comforting to know that yes, the state is "rich" enough to cover me when I am unemployed. I think that as someone who espouses conservative ideals in Canada, the public healthcare system is one thing that we have lived with feeling slightly hypocritical. We know state healthcare isn't a right of any one by our definition of what rights we have, yet we tolerate the idea and there is no great hue and cry to scrap it. We do however want accountability by the citizenery and do want a private option. IN the UK, you have that private option.

I see having a public healthcare system as a very expensive entitlement that the citizens of a nation, no matter how "smart" or "misguided" they may be (depends on what side of the political fence you sit) would elect to do. In Canada, up until 1960, Canadian values and concepts of rights pretty much dovetailed Americans, and without a Roosevelt and his "New Deal", Canadians really were MORE conservative than our American cousins. Yet, in the late 40's, Provinces began a state healthcare system, starting from Saskatchewan and spreading out until in the 60's, the Canada Health Act was passed and all healthcare was run through the provincial governments and their tax bases.

We used to think it worked pretty well, or at least that was the prevailing view of the chattering classes and we the public bought it. However, when MRI's were coming out, it was a big deal for a community to raise money to buy one, and there were long waits for MRI's to be done, but people who needed the service were running across to Buffalo NY where umpteen clinics were taking almost same day appointments for cash and giving the results to you to run back to the doctor in Canada with. NOW, what is wrong with that picture? IT taught me that our governments, no matter how well intentioned couldn't fund the upgrades in technology as fast as the private sector for one, and it taught me that maybe all I had assumed (as a teen and young man I rarely gave it much thought) that the Canadian system wasn't as GREAT as I had it rammed down my head by the prevailing wisdom. If dumpy ole Buffalo had 8 times the MRI's per 1000 of population as the city of Toronto, the richest city in Canada, then this public healthcare system must be wasting a lot of money.

What people have to remember always is the public system, no matter how well intended is run by government, and government can do less with 1000000 dollars than the private sector can. They tend to have more money tied up in redtape, and the accountability that should be there isn't there. IN the private sector, when a company sets out to provide a service, they know they have to do it right, and they have to minimize waste. THey also know though that they will have to pay for the right people or they wont get them, so they will pay decent wages for the right people, hold them accountable, and have the flexability to fire them if they dont' do the job. Government? They will see a task, appoint 3 committees to figure out how to do it, put out tenders, make sure everyone passes muster, hire civil servants to run it, hire people to work in it while putting them in a very militant public service employee union, and when the services offered either run behind or don't work, scream they are underfunded. Well of course they are, because money was spent wildly and wasn't on anyone's mind until it ran out. The waste is just ridiculous in publically run operations, whether it be in healthcare, or collecting garbage.

What I would like to see is for the Government to prove to me they can run a health insurance system available to the poor and actually use some business principles and make it work on that level....and as we see in the US, Medicare and Medicaid are BROKE. So there you go, why would you let them take over all healthcare?

Hondo

22nd January 2010, 17:50

Hondo

22nd January 2010, 18:33

Mark, I just read your last book at the end of page one. Nicely done and well put.

Along with better administration of government programs, I feel we should be much, much more hard hearted in dealing with the people using them. Especially aid and poverty programs. Call me Max but I think anyone caught abusing the system should lose their benefits for 30 days on the first offence and lose them for life upon a second offense.

Nobody knows America's professional poor like Americans. When construction companies started cleaning up and rebuilding New Orleans after Katrina they ended up having to recruit and import laborers from other parts of Louisiana and other states. Of course they had to import skilled labor and craftsman too, but you should never have to import basic pick up debris labor. They were paying guys $12.00 an hour plus $50 per diem and providing lodging for their crews that were filling wheelbarrows with debris and dumping it into dumpsters. You see, all those angry black men you saw on the news standing around demanding help, were drawing government benefit checks and couldn't be bothered to work for a living. The work paycheck would have put 3 times the money of the benefit check in their pocket and they would have started learning skilled crafts that would have moved them into higher paying jobs. Nah, don't want it. They did supplement their benefit checks by robbing some of the workers early on but gave that up when they started getting shot for their efforts.

Mark my words, if Obama gets his "health insurance" down to the professional poor, the very first and most lucrative abuse wil be these people wandering in complaining of horrible pain in hard to dispute areas like the lower back and then skipping merrily on out to sell on the street that new bottle of perscription painkillers they got for free.

Malbec

23rd January 2010, 00:20

What people have to remember always is the public system, no matter how well intended is run by government, and government can do less with 1000000 dollars than the private sector can.

Really?

In the UK the private sector can compete to supply services to GPs against NHS hospitals in particular sectors.

One area they tried to get into was hip replacements. Problem was, none of the private suppliers could match the price the NHS hospitals routinely did it for, and that was with the private suppliers merely cherrypicking the healthiest least complicated patients. I believe private suppliers promised the whole service for about £2800 a patient whilst NHS hospitals did it for £2200 or so with a proven track record.

The problem got so bad for the government which had essentially promised private suppliers contracts if they bid for them, that orders were sent directly from Whitehall to local hospitals to defer to the private suppliers in their locality regardless of the cost involved. This ensured business for the private suppliers and took it away from the NHS hospitals, reducing their income.

In fact if you look at some of the sweeteners the government has included in contracts to entice private suppliers, they have clauses you simply wouldn't believe, including no penalty for failing to deliver what has been promised in the contract. Essentially these private suppliers can't compete with publicly owned and run establishments without government subsidies. Thats private efficiency for you.

Unfortunately this whole thing about private being better than public doesn't hold true in many countries. I can think of quite a few places where public owned hospitals are a guarantee of first rate care whilst private is less secure.

Brown, Jon Brow

23rd January 2010, 00:47

Unfortunately this whole thing about private being better than public doesn't hold true in many countries. I can think of quite a few places where public owned hospitals are a guarantee of first rate care whilst private is less secure.

Such as the US, where the best health care package is the government funded offering to the US Army. :p

Hondo

23rd January 2010, 02:25

Such as the US, where the best health care package is the government funded offering to the US Army. :p

The package may be good, but...well, every system has it's little problems.

Mark in Oshawa

23rd January 2010, 14:36

Really?

In the UK the private sector can compete to supply services to GPs against NHS hospitals in particular sectors.

One area they tried to get into was hip replacements. Problem was, none of the private suppliers could match the price the NHS hospitals routinely did it for, and that was with the private suppliers merely cherrypicking the healthiest least complicated patients. I believe private suppliers promised the whole service for about £2800 a patient whilst NHS hospitals did it for £2200 or so with a proven track record.

The problem got so bad for the government which had essentially promised private suppliers contracts if they bid for them, that orders were sent directly from Whitehall to local hospitals to defer to the private suppliers in their locality regardless of the cost involved. This ensured business for the private suppliers and took it away from the NHS hospitals, reducing their income.

In fact if you look at some of the sweeteners the government has included in contracts to entice private suppliers, they have clauses you simply wouldn't believe, including no penalty for failing to deliver what has been promised in the contract. Essentially these private suppliers can't compete with publicly owned and run establishments without government subsidies. Thats private efficiency for you.

Unfortunately this whole thing about private being better than public doesn't hold true in many countries. I can think of quite a few places where public owned hospitals are a guarantee of first rate care whilst private is less secure.

Dylan, let me ask you something? Do you think government spends the tax dollars you give it in an efficient manner? If you say yes, then there is no point in debating you on this, because I likely will say nothing that will change your mind. If you say no, then ask youself WHY governments who routinely waste and make billions disappear into a giant mass of bureaucracy would all the sudden make a system to provide the most vital services financially efficient?

Dylan, I live with public healthcare. IN the Province on Ontario, close to half of the provincial expenditures in the budget are for healthcare. At last count, I believe it was in the 47% range. This in one of the most highly taxed jurisdictions in North America. Yet we are short of doctors, short of some of the things Americans can get to and have waiting times issues in our emergeny wards, and for a lot of procedures. There is a shortage of GP's and this is completely due to the Province cutting back on the funding of medical schools because of budget issues from the mismanagement of the budget when the left wing NDP was in power. We have to face the reality. You have a giant bureaucracy that pays lipservice to efficiency, but the hospitals are forever fundraising for equipment that would already be in use in smaller centers of the same size in the US. We are not in the 3rd world, you sometimes wonder.

I see shortages in lab techs, I see shortages in services, often due to bureaucratic bunglling. You don't see this in a the US. THere, the services are often created through private healthcare companies reacting to the demand and opening up the door to new treatments. You have new technologies being developed because someone realizes their idea could make them RICH and therefore have a great incentive to provide them. That R and D pressure to make money creates new treatments and no ideas. No bureaucrat will do that.

Is private healthcare perfect? No...likely not, but spare me this fiction that the government can run an effcient excellent healthcare system. They run one that chews through a lot of money to get the effciency up to just ok. OK is fine for most countries, but in my mind should NEVER cut it. Canada has a pretty good or "ok" system. We have no worries as citizens about getting treatment, but we are going to wait for certain procedures, we may have to search high and low for a few years to find a new GP if we don't like the one we have, and there is a general sense by many who have sat in an hospital ward that the system is broke. We have ambulances being shuttled to hospitals farther away often because there is a lack of beds or a shortage of doctors available at certain hours. This is NOT a system that should be tagged as world class...but I can tell you when I saw my paycheck, I know I was paying for one when I saw what I was paying in provincial taxes, and with a special levy that was put on my pay to go for healthcare. I wasn't given a choice either.....

The instances you state are something I cannot comment on, but I do know this much: I have public healthcare, it is run by the government of Ontario, and it chews through one hell of a lot of money to give me ok service at best. I have no options if I don't like it because they outlawed private care. My best healthcare option if I have money is to go to the US if I don't like what is offered here. Many RICH Canadians do.....

Mark in Oshawa

23rd January 2010, 14:39

Such as the US, where the best health care package is the government funded offering to the US Army. :p

It isn't the best package at all. And how much does it cost per patient? None to the patient, but the money spent to provide that service is likely more and yet 60 minutes and other US news programs have done scathing reports about the conditions in VA hospitals. Spare me the fiction about how it is the best system....it has bureaucratic bumbling all over it...

Hondo

23rd January 2010, 14:48

On paper, the package looks great. Active duty people wouldn't be in the VA system for the most part. They would be treated at on base facilities.

Malbec

23rd January 2010, 15:33

Dylan, let me ask you something? Do you think government spends the tax dollars you give it in an efficient manner? If you say yes, then there is no point in debating you on this, because I likely will say nothing that will change your mind. If you say no, then ask youself WHY governments who routinely waste and make billions disappear into a giant mass of bureaucracy would all the sudden make a system to provide the most vital services financially efficient?

Dylan, I live with public healthcare. IN the Province on Ontario, close to half of the provincial expenditures in the budget are for healthcare. At last count, I believe it was in the 47% range. This in one of the most highly taxed jurisdictions in North America. Yet we are short of doctors, short of some of the things Americans can get to and have waiting times issues in our emergeny wards, and for a lot of procedures. There is a shortage of GP's and this is completely due to the Province cutting back on the funding of medical schools because of budget issues from the mismanagement of the budget when the left wing NDP was in power. We have to face the reality. You have a giant bureaucracy that pays lipservice to efficiency, but the hospitals are forever fundraising for equipment that would already be in use in smaller centers of the same size in the US. We are not in the 3rd world, you sometimes wonder.

I see shortages in lab techs, I see shortages in services, often due to bureaucratic bunglling. You don't see this in a the US. THere, the services are often created through private healthcare companies reacting to the demand and opening up the door to new treatments. You have new technologies being developed because someone realizes their idea could make them RICH and therefore have a great incentive to provide them. That R and D pressure to make money creates new treatments and no ideas. No bureaucrat will do that.

Is private healthcare perfect? No...likely not, but spare me this fiction that the government can run an effcient excellent healthcare system. They run one that chews through a lot of money to get the effciency up to just ok. OK is fine for most countries, but in my mind should NEVER cut it. Canada has a pretty good or "ok" system. We have no worries as citizens about getting treatment, but we are going to wait for certain procedures, we may have to search high and low for a few years to find a new GP if we don't like the one we have, and there is a general sense by many who have sat in an hospital ward that the system is broke. We have ambulances being shuttled to hospitals farther away often because there is a lack of beds or a shortage of doctors available at certain hours. This is NOT a system that should be tagged as world class...but I can tell you when I saw my paycheck, I know I was paying for one when I saw what I was paying in provincial taxes, and with a special levy that was put on my pay to go for healthcare. I wasn't given a choice either.....

The instances you state are something I cannot comment on, but I do know this much: I have public healthcare, it is run by the government of Ontario, and it chews through one hell of a lot of money to give me ok service at best. I have no options if I don't like it because they outlawed private care. My best healthcare option if I have money is to go to the US if I don't like what is offered here. Many RICH Canadians do.....

Mark, as I've mentioned Canada is not the centre of the universe and what applies to Canada does not necessarily apply to the rest of the world. The reverse is also of course true. We differ in our opinions because you appear to see things in plain black and white, in this case public bad private good.

I'm aware of the shortages of staff you have there, in my field a large proportion of that shortage is because of a migration of doctors and other staff to the US next door where they can earn more. Of course the Americans pay for that, they pay more overall for their healthcare than you do.

Also, regarding healthcare advances, why is it that a significant proportion of medical advances in current use are/were developed in Britain with a state funded healthcare system (depending upon your definition up to half of medical patents over the past century were registered in the UK)? Why is it that Japan is a leading power in medical technology despite again having an entirely publicly reimbursed system?

Again, comparing public systems in different countries is an exercise in futility. The American governments both at federal and state level spends more on healthcare (proportionately) than is spent on the NHS in the UK yet the latter provides pretty good universal healthcare while the former can only patchily provide care for the most vulnerable segments of American society. How are the two comparable in any way, whether looking at efficiency, funding or even organisationally?

I'm afraid that until you realise that your gripes with your local public funded system are not necessarily universal then there isn't any point carrying on this 'debate' either.

Mark in Oshawa

24th January 2010, 05:55

Mark, as I've mentioned Canada is not the centre of the universe and what applies to Canada does not necessarily apply to the rest of the world. The reverse is also of course true. We differ in our opinions because you appear to see things in plain black and white, in this case public bad private good.

I'm aware of the shortages of staff you have there, in my field a large proportion of that shortage is because of a migration of doctors and other staff to the US next door where they can earn more. Of course the Americans pay for that, they pay more overall for their healthcare than you do.

Also, regarding healthcare advances, why is it that a significant proportion of medical advances in current use are/were developed in Britain with a state funded healthcare system (depending upon your definition up to half of medical patents over the past century were registered in the UK)? Why is it that Japan is a leading power in medical technology despite again having an entirely publicly reimbursed system?

Again, comparing public systems in different countries is an exercise in futility. The American governments both at federal and state level spends more on healthcare (proportionately) than is spent on the NHS in the UK yet the latter provides pretty good universal healthcare while the former can only patchily provide care for the most vulnerable segments of American society. How are the two comparable in any way, whether looking at efficiency, funding or even organisationally?

I'm afraid that until you realise that your gripes with your local public funded system are not necessarily universal then there isn't any point carrying on this 'debate' either.

Well Dylan, We can all use our local public healthcare or lack thereof as an example, but UN healthcare surveys were putting Canada on a pedestal for years. Yet all the issues I raised have been around. So someone isn't accurate.

Also, the Americans pay more for healthcare directly, but they pay much less in taxes, so it is a wash except they have more choice in how their dollars are spent. So I hardly say the true cost of healthcare in any nation is honestly appraised when the cost of public healthcare is masked in political smoke and mirrors. The much vaunted NHS has had all sorts of horror stories said about that in the press, so What is real? What is just myth? If the NHS is so wonderful, why would anyone take private healthcare? I would wager you do have a good system, but I am not there to judge. I am also going to say you are not here to judge our system either. I can just say this: IF the Canadian system was rated so highly by the UN not long ago, then why am I finding fault with it? Trust me, I have no desire to start paying for private insurance unless my taxes get cut, but I KNOW There is no going back.

As to your record of the UK and Japan's public system doing such wonderful innovation, understand this: Americans have provided most of the Nobel prize winners in Medicine in the last few decades. They must be doing something right there also.

I am not against the public system, but I refuse to by the myth it is BETTER. I am for a system that supports both, but the public system must never be bloated and run to the favour of those who work in it, as opposed to the patients.

Rollo

24th January 2010, 11:07

Do you think government spends the tax dollars you give it in an efficient manner? If you say yes, then there is no point in debating you on this, because I likely will say nothing that will change your mind. If you say no, then ask youself WHY governments who routinely waste and make billions disappear into a giant mass of bureaucracy would all the sudden make a system to provide the most vital services financially efficient?

Well I hope not. Efficiency is an anathema when it comes to the well being of a patient. Patients are not customers and nor are they economic units. A hospital's job should be about making people well again, and the second you start introducing the need for efficiency into the system, you start putting value judgements, not necessaily on the costs of care, but on the worth of people.
Sorry, but if you want to speak of efficiencies in hospitals, then you immdiately admit that you have no heart.

An inefficient medical system where people are made well, is far better than an efficient one where people are sent away because they are an economic problem; besides which, if the United States already spends more per capita on healthcare and still doesn't cover 50 million people, then the system is neither efficient and certainly not equitable.

Hondo

24th January 2010, 11:44

Well I hope not. Efficiency is an anathema when it comes to the well being of a patient. Patients are not customers and nor are they economic units. A hospital's job should be about making people well again, and the second you start introducing the need for efficiency into the system, you start putting value judgements, not necessaily on the costs of care, but on the worth of people.
Sorry, but if you want to speak of efficiencies in hospitals, then you immdiately admit that you have no heart.

An inefficient medical system where people are made well, is far better than an efficient one where people are sent away because they are an economic problem; besides which, if the United States already spends more per capita on healthcare and still doesn't cover 50 million people, then the system is neither efficient and certainly not equitable.

Except for charity and non-profit hospitals, the rest of them are businesses designed to make a profit in the USA. All of them are going to send you a bill and all of them will expect you to pay that bill. The charity hospitals will deeply discount or even forgive a bill completely depending on your ability to pay. That Americans pay more per capita is not necessarily a sign of lack of efficiency as much as it is an indicator of options. The price of services available, the prices of services used, and the cost of utilities, consumables and staff salaries will vary in different regions. In addition, cosmetic and vainity surgery is big business in the USA along with all manner of beat-your-favorite addiction hospitals. Private and semi-private rooms are popular in the USA. Patients can frequently choose the level of comfort they desire.

Malbec

24th January 2010, 12:26

Well Dylan, We can all use our local public healthcare or lack thereof as an example, but UN healthcare surveys were putting Canada on a pedestal for years. Yet all the issues I raised have been around. So someone isn't accurate.

They can both be right don't you think? Canada may deliver pretty good healthcare to its citizens yet people can still find faults with the system, do you understand that the two are not contradictory?

Also, the Americans pay more for healthcare directly, but they pay much less in taxes, so it is a wash except they have more choice in how their dollars are spent.

I'm talking %age of GDP when I compare spending between different countries. On that scale America spends more than any country on earth except France.

So I hardly say the true cost of healthcare in any nation is honestly appraised when the cost of public healthcare is masked in political smoke and mirrors. The much vaunted NHS has had all sorts of horror stories said about that in the press, so What is real? What is just myth? If the NHS is so wonderful, why would anyone take private healthcare? I would wager you do have a good system, but I am not there to judge. I am also going to say you are not here to judge our system either. I can just say this: IF the Canadian system was rated so highly by the UN not long ago, then why am I finding fault with it? Trust me, I have no desire to start paying for private insurance unless my taxes get cut, but I KNOW There is no going back.

The NHS is NOT a one-size-fits-all answer to people's healthcare problems around the world. I believe I have always been open about that.

See, this is the problem, for you it has to be black and white. I MUST be arguing that the NHS is the best system in the world if I'm defending public healthcare right? WRONG.

You compare private healthcare in America with public healthcare in Canada yet the former is hardly viewed as perfect by Americans themselves, even the most ardent supporters on this forum would acknowledge that the system has major flaws.

As to your record of the UK and Japan's public system doing such wonderful innovation, understand this: Americans have provided most of the Nobel prize winners in Medicine in the last few decades. They must be doing something right there also.

Am I talking to the same Mark that derided the Nobel prize for awarding a peace prize to Obama? Why is the Nobel prize suddenly a gold standard for comparing research?

Do you read medical journals Mark? Do you deal with new medical developments? Do you keep track of the amount of research produced by each country? Don't you think the volume of quality research produced by each nation is a better indication of innovation than cherry picking the 'best' each year by a Swedish board that you rubbished not so long ago?

America does produce a lot of quality research but is hardly the only player in the system as you portray it to be. In fact I'd argue it produces less than its size and economic prowess would suggest it would compared to Britain with a fifth of its population and Japan with half. The amount of research the USA produces is neither an endorsement or indictment of privately funded healthcare. It is an independent factor, more a reflection of the state of the American pharmaceutical and other medically related industries than the state of American healthcare itself.

I am not against the public system, but I refuse to by the myth it is BETTER. I am for a system that supports both, but the public system must never be bloated and run to the favour of those who work in it, as opposed to the patients.

I am not arguing that public is better than private. I'm trying to get you to understand that your sweeping statement that public is worse than private makes as much sense as saying that wheeled transport is rubbish compared to flying.

Why don't you go away and read up about the Canadian, British and French systems, how they differ in concept, execution and organisation. Why don't you go and research the difference between reimbursement at the point of use compared to a fully state owned healthcare system, both of which are publicly funded. Why don't you then go on and research the strengths and weaknesses of each system, and what the public complain about with each one, because those systems are as different from each other as cars, motorbikes and trains are (all wheeled transport, see?).

Once you do that you'll realise how simplistic your comparison between public and private healthcare is.

Mark in Oshawa

24th January 2010, 16:55

They can both be right don't you think? Canada may deliver pretty good healthcare to its citizens yet people can still find faults with the system, do you understand that the two are not contradictory?.
We are having this debate in this country right now because unlike Britain, where the citizen has a choice, in Canada we do NOT, and it is the 3rd rail of Canadian politics. We have people in the healthcare system telling us it is the BEST possible system in the world, while there are numerous issues we see in our own lives and anchedotal evidence, and then stories in the press comparing what we have happening here to other nations. It is a VERY current debate here, and while I have always acknowledged we have pretty good care, it is terribly expensive in the sense we are paying a large tax load to support it. I know from my experiences with government that the money likely is NOT being used effciently. A Health minister here resigned in disgrace over a billion dollar boondoggle in just the registry program to make all medical records electronic.

I'm talking %age of GDP when I compare spending between different countries. On that scale America spends more than any country on earth except France..

That is fine, but I don't think that GDP per person number is accurate when you have a state run system. Maybe it is. I would like to see how the number is calculated in each case. I am not by the way saying Americans don't pay a lot. You do remember I made the analogy of how the US are the fat guy with lots of money buying all the new technology first....

The NHS is NOT a one-size-fits-all answer to people's healthcare problems around the world. I believe I have always been open about that.

See, this is the problem, for you it has to be black and white. I MUST be arguing that the NHS is the best system in the world if I'm defending public healthcare right? WRONG.

You compare private healthcare in America with public healthcare in Canada yet the former is hardly viewed as perfect by Americans themselves, even the most ardent supporters on this forum would acknowledge that the system has major flaws..

The Americans also are turning themselves inside out to stop the creation of a public option. Polls there say a majority don't want it. Many on here cant figure it out. I am telling you I thiink I know why after talking to many of them over the years, they don't TRUST the government.

Am I talking to the same Mark that derided the Nobel prize for awarding a peace prize to Obama? Why is the Nobel prize suddenly a gold standard for comparing research?.

Outside of the contentious Nobel prize for peace, the Nobel committees for medicine, physics, literature and the like award actual achievements and have rarely if ever been seen as a political football. Even you have to admit that the Nobel prize for "peace" being given to a man who just got elected and did nothing else was a bit ridiculous.

Do you read medical journals Mark? Do you deal with new medical developments? Do you keep track of the amount of research produced by each country? Don't you think the volume of quality research produced by each nation is a better indication of innovation than cherry picking the 'best' each year by a Swedish board that you rubbished not so long ago?

America does produce a lot of quality research but is hardly the only player in the system as you portray it to be. In fact I'd argue it produces less than its size and economic prowess would suggest it would compared to Britain with a fifth of its population and Japan with half. The amount of research the USA produces is neither an endorsement or indictment of privately funded healthcare. It is an independent factor, more a reflection of the state of the American pharmaceutical and other medically related industries than the state of American healthcare itself..

I do not read medical journals. I resent you holding that over a lay person such as myself. I know you are in the medical professions so on this I am going to be at a disadvantage having this part of the debate. I am just telling you that I am of the opinion ( and I am entitled to have one last I looked) that the public funded medical system often isn't as efficient with the money spent. There is no profit motive from management to try to keep costs down, but like most bureaucracies under most governments, it will often have managers more concerned by the number of people they are in charge of than the job they do. The hospital right here in this town is one where my mother worked as a nurse for years, and I know the fact that any time the budgets tightened, the people laid off were often the front line staff while it seemed the bureaucracy that ran it often were unscathed. It isn't to say that this is uncommon or cruel either, but I find it astounding that the bureaucrats who run institutions such as hospitals always find ways to ensure their jobs and salaries, while the people who deal with the realities of providing healthcare often are forced to cope with less. THAT is where I base my distrust of the public system.

Trust me, I may not like the American system if Ihad to pay for healthcare either, but at least I know I would have choices there.

I am not arguing that public is better than private. I'm trying to get you to understand that your sweeping statement that public is worse than private makes as much sense as saying that wheeled transport is rubbish compared to flying.

Why don't you go away and read up about the Canadian, British and French systems, how they differ in concept, execution and organisation. Why don't you go and research the difference between reimbursement at the point of use compared to a fully state owned healthcare system, both of which are publicly funded. Why don't you then go on and research the strengths and weaknesses of each system, and what the public complain about with each one, because those systems are as different from each other as cars, motorbikes and trains are (all wheeled transport, see?).

Once you do that you'll realise how simplistic your comparison between public and private healthcare is.

It isn't a simplistic argument at all. By the way, I have to keep stating this. I live in a public system world. I am not given a choice to have a real point of comparsion. I have read many news articles and there is endless pontificating in the press here because as I stated, it is part of the debate in Canada. Have I done the miles of research you wish ? No, but I read all I can on the subject.

My point in this thread was not really to condemn the public system entirely, and it is to my discredit I let it go that way, but I do want to know more about things as the NHS from people who live in it, and the American system from people who live there. I stated a few times, I am not given the option. THAT is what really galls me. I think if there was a private option at least in my nation, maybe the public system would be forced to compete and maybe be the system that the NHS seems to be to those of you living In Britain.

Malbec

24th January 2010, 18:27

We are having this debate in this country right now because unlike Britain, where the citizen has a choice, in Canada we do NOT, and it is the 3rd rail of Canadian politics. We have people in the healthcare system telling us it is the BEST possible system in the world, while there are numerous issues we see in our own lives and anchedotal evidence, and then stories in the press comparing what we have happening here to other nations. It is a VERY current debate here, and while I have always acknowledged we have pretty good care, it is terribly expensive in the sense we are paying a large tax load to support it. I know from my experiences with government that the money likely is NOT being used effciently. A Health minister here resigned in disgrace over a billion dollar boondoggle in just the registry program to make all medical records electronic.

I am not going to question this paragraph at all, except to say that your original posts attack public healthcare systems in a sweeping generalisation without trying to make it Canada-specific. Some of your criticisms clearly are Canada specific as you are now clarifying.

That is fine, but I don't think that GDP per person number is accurate when you have a state run system. Maybe it is. I would like to see how the number is calculated in each case. I am not by the way saying Americans don't pay a lot. You do remember I made the analogy of how the US are the fat guy with lots of money buying all the new technology first....

%age GDP spend is pretty accurate when looking at overall healthcare spend, both public, private separately or together. I suspect there isn't a better way of quickly comparing different countries' spend.

Sure, the Americans are first to buy new tech, along with the French and Japanese who are also renowned for adopting new medical technology and drugs quickly. Both the latter run state funded systems. Your point is?

BTW, the Americans are often overcharged for their new technology, precisely because they don't negotiate en-bloc but as individual hospitals with little negotiating power. Thats not subsidising poorer countries like Canada or the UK, thats merely being ripped off and not something to be proud about.

Outside of the contentious Nobel prize for peace, the Nobel committees for medicine, physics, literature and the like award actual achievements and have rarely if ever been seen as a political football.

This is incorrect. The awards for medicine and literature certainly are often political in nature. There have been quite a few years when American writers for example have been passed over when American foreign policy hasn't been internationally popular.

Certainly in the medical field the awards are often a joke with seemingly random members of research teams being awarded but the rest forgotten, or again research groups from politically unfavourable countries being passed over. Often, the groups that are awarded tend to be the ones the media have recognised as being worthy which is hardly the same as having the best research at a particular time being rewarded.

I do not read medical journals. I resent you holding that over a lay person such as myself. I know you are in the medical professions so on this I am going to be at a disadvantage having this part of the debate. I am just telling you that I am of the opinion ( and I am entitled to have one last I looked) that the public funded medical system often isn't as efficient with the money spent.

Then perhaps you may avoid using condescending tones in informing me about US research as measured by Nobel prizes? Touche.

There is no profit motive from management to try to keep costs down, but like most bureaucracies under most governments, it will often have managers more concerned by the number of people they are in charge of than the job they do. The hospital right here in this town is one where my mother worked as a nurse for years, and I know the fact that any time the budgets tightened, the people laid off were often the front line staff while it seemed the bureaucracy that ran it often were unscathed. It isn't to say that this is uncommon or cruel either, but I find it astounding that the bureaucrats who run institutions such as hospitals always find ways to ensure their jobs and salaries, while the people who deal with the realities of providing healthcare often are forced to cope with less. THAT is where I base my distrust of the public system.

I am not a fan of bureaucracy either, but here again you point to something that appears to be specifically worse problem for Canada than many other places. Other countries with entirely state funded healthcare have found ways of avoiding this situation by leaving hospitals etc in private hands and reimbursing the patient for any healthcare costs. Those systems are entirely state funded too, yet you dismissed them earlier because of course public funded services are not efficient right?

In fact most countries, the NHS included, involve some kind of competitive system at some levels in order to ensure cost-control. If Canada does not have such a system then perhaps that would be a reform worth adopting.

It isn't a simplistic argument at all. By the way, I have to keep stating this. I live in a public system world. I am not given a choice to have a real point of comparsion.

What is a real point of comparison?

In the UK there is a movement (not big at the moment) talking about privatising the NHS. They claim the private sector is more efficient, yet they fail to acknowledge how the NHS subsidises the private sector which is free to cherrypick what services it provides and what it doesn't. Outside a small part of London there is no emergency private care, get knocked down by a car and you have no choice but to go to the NHS, the private sector isn't interested in a high investment low profit area like emergency care. The private sector does not have to pay for training staff at all either, thats the job of the universities and NHS, both state funded. If the NHS wasn't there, private healthcare costs would escalate.... The picture is always more complicated than it looks.

Rollo

25th January 2010, 04:15

Except for charity and non-profit hospitals, the rest of them are businesses designed to make a profit in the USA.

The basic profit motive that drives businesses suggests that in order to maximise profits, you either need to charge more for the goods and/or services, or reduce your input costs to produce those goods and/or services.

This might be fine if you're trying to make consumer products or possibly a motor car, but do you really want that as a patient? How is patient care improved by either lowering costs or charging higher prices?

Alternatively you've just told me that richer people are actually a better class of people and deserve better treatment; if that's the case, well done:
We hold these truths to be self-evident, that all men are created "equal",
Separate but equal!

Mark in Oshawa

26th January 2010, 03:03

Dylan, I guess Iam torn. I am not dismissing your points, but you are not pointing to ANY waste in any public system, and I find it hard to believe we are the only nation in the western world with wasteful public spending. I refuse to believe that but I also refuse to buy the argument that major HMO's in the US are not buying technology or developing it for a good price either. Remember, they want that margin to be in their favour.

I do agree 100% that the private sector will cherry pick under a mixed system, but that is up to the regulators and government to set out the areas where the public and private system compete. I think there are areas where private care is superior. For instance the one concession in our public system is in dental care. It is HEALTH care but it is all private. I can go into my wife's office (she is a hygienist) and do a cash deal to get a filling done. Or I can go through insurance. I can negotiate price. THAT is the kind of flexability have across the board in their healthcare, and I would love to see more of that. I suppose there some expensive things to be done that wouldn't be really a good plan for, but the goal for me in my mind is to see more choice for the 'consumer'.

Hondo

26th January 2010, 04:54

The basic profit motive that drives businesses suggests that in order to maximise profits, you either need to charge more for the goods and/or services, or reduce your input costs to produce those goods and/or services.

This might be fine if you're trying to make consumer products or possibly a motor car, but do you really want that as a patient? How is patient care improved by either lowering costs or charging higher prices?

Alternatively you've just told me that richer people are actually a better class of people and deserve better treatment; if that's the case, well done:
We hold these truths to be self-evident, that all men are created "equal",
Separate but equal!

Nowhere here, and at no time anywhere, have I stated that richer people are a better class of people. For you to sit there declaring to the world that I told you that as a fact tells me you need to spend more time on reading comprehension.

While all men are created "equal", there's nothing in the rulebook that says they have to stay or finish that way.

What a patient cares about is getting out of there as fast as possible, while feeling better than they did when they came in. The patient wants a nurse or staff to respond promptly when the call button is pushed.

The only area I could see patient care being improved by cutting costs would be by firing an incompetent, abusive, uncaring staff member and replacing them with a superior employee at a lower beginning salary. That would be a short term example until the new staff members catches up in the pay scale. I can't speak for the medical folks, but in other business, very seldom are people hired in at top dollar. Companies like to be able to monitor a new employee and step up their pay scale as they prove their ability and willingness to work within the system. I can easily see however, where lowering costs would also lower a patients bill if those savings were passed on.

Higher costs can easily mean an improvement in patient care or the potential of improved care. A small example would be a crash cart being available for each wing as opposed to one to a floor. Xray or MRI equipment being available. You may not use it, but you're going to pay for a little bit of it. Theres all kinds of stuff at hospitals you get to pay for that you'll never see. On the other hand, if you do need it, you'll be happy they already have it instead of having to wait for them to go buy one.

Rollo, you seem to like your NHS and thats fine but the majority of Americans have said they don't want the plan Obama is trying to force them to take. Why should you get all ramped up over the American medical system?

Now if you're just an angry, international socialist who believes in enforced equality for all, might I suggest prison. Prison is the closest thing to utopian socialism that the West offers. You have the guards, responsble for law enforcement, rule enforcement, and your protection. Then you have the equal. All of you get the same rulebook, the same clothes, the same food, and the same medical care. You'll be provided with a roof over your head, a place to sleep, 3 meals a day, and recreational and educational opportunities. But you won't like it. Human nature is alive in prisons too. So there's an unofficial "class" system in prison because there will always people that are willing to do more and risk more in order to have more. And there will always be the bottom feeders, barely willing to do the minimum in a low skill or no skill job that somehow figure they are entitled to that Ferrari too or nobody should have one.

Mark in Oshawa

26th January 2010, 16:12

Fiero, I wondered when you would respond. Nice rebuttal. It has been my contention for years that the myth that life was fair has to be killed. You get what you want to work for and in America, you can buy better healthcare. Still doesn't change the fact that there is a defacto national healthcare already, it is called Medicare and it is going broke. I think if Obama had not done anything but improved that, he would be past all of this; but alas he wants national healthcare for all and was willing to build a flawed foundation to get there.

Malbec

26th January 2010, 19:17

but you are not pointing to ANY waste in any public system, and I find it hard to believe we are the only nation in the western world with wasteful public spending.

No Mark, and here we return to that black and white thing again. I've not argued that public healthcare doesn't waste more than private, I've argued that the situation is more complex than that and that other countries have taken measures to limit waste by introducing competition.

I refuse to believe that but I also refuse to buy the argument that major HMO's in the US are not buying technology or developing it for a good price either. Remember, they want that margin to be in their favour.

HMOs don't tend to develop, they tend to purchase technology and utilise it. They may act as partners for research but don't drive it. Research is done by universities and drug/medical technology companies.

You may not believe that HMOs pay more, it may be worth trying to look up how much drugs cost but ultimately there are few organisations that can compete with an entire country negotiating en-bloc. Its the principle of economy of scale, you pay less per unit if you buy lots of units.

I do agree 100% that the private sector will cherry pick under a mixed system, but that is up to the regulators and government to set out the areas where the public and private system compete. I think there are areas where private care is superior. For instance the one concession in our public system is in dental care. It is HEALTH care but it is all private. I can go into my wife's office (she is a hygienist) and do a cash deal to get a filling done. Or I can go through insurance. I can negotiate price. THAT is the kind of flexability have across the board in their healthcare, and I would love to see more of that. I suppose there some expensive things to be done that wouldn't be really a good plan for, but the goal for me in my mind is to see more choice for the 'consumer'.

I don't want you to think I disagree with your personal criticisms of Canadian healthcare, if anything they tally with what I've heard from other people. Where I disagree is where you seamlessly go from your criticisms of your local experience and apply it to public healthcare worldwide. Thats where you go wrong.

Frankly I do find it incredibly odd that in Canada there is no private healthcare option, I even suspect that in the EU that would be illegal under free competition regulations (assuming there is legislation banning private healthcare) and I agree that freeing that sector up would be beneficial to most parties. That is where the debate should be in Canada, and I'm surprised that the political debate hasn't gone that way.

Mark in Oshawa

26th January 2010, 19:22

Frankly I do find it incredibly odd that in Canada there is no private healthcare option, I even suspect that in the EU that would be illegal under free competition regulations (assuming there is legislation banning private healthcare) and I agree that freeing that sector up would be beneficial to most parties. That is where the debate should be in Canada, and I'm surprised that the political debate hasn't gone that way.

As I said before Dylan, it is the third rail of Canadian politics. The dimwits who pass for politicians have yet to figure out a way to even bring up the topic of privatizing some aspects of it without the public service unions, left of center parties going on a major PR campaign stating how we would be more "American" and people would be left without care. Utter rot....

Even the most Conservative Conservatives in this country will NOT put that plank on the platform because the hysteria and lies will derail their electoral hopes. If they are in power and they voice such ideas, it consumes them. WE have this wacky idea in this country that it is all or nothing.....and as you have very adroitly explained, it doesn't have to be that way. It probably explains my frustration with the debate because much of what is out there in this country is clouded by this myth.

Malbec

26th January 2010, 19:24

As I said before Dylan, it is the third rail of Canadian politics. The dimwits who pass for politicians have yet to figure out a way to even bring up the topic of privatizing some aspects of it without the public service unions, left of center parties going on a major PR campaign stating how we would be more "American" and people would be left without care. Utter rot....

There is no need to privatise portions of public healthcare, merely legalise third party suppliers to build hospitals and provide insurance cover. Is this currently illegal?

Mark in Oshawa

26th January 2010, 19:34

There is no need to privatise portions of public healthcare, merely legalise third party suppliers to build hospitals and provide insurance cover. Is this currently illegal?

Hospitals can be private/public partnerships but they are run not-for-profit and basically might as well have the provincial badge on them. No private insurance can be used in place of the provincial system, but the benefits can be used to upgrade things such as private room vs a shared one, and pay for thearpy or aids such as crutches or wheel chairs. The thing is, a private corporation cannot open a hospital, and accept patients and bill the province. A private insurance company cannot take their client ( the patient ) and put them ahead of the line for treatment. So if there is a 3 month delay for surgery for a new knee, too bad....you wait.

The doctors cannot take money from patients. The doctors are limited in how many patients they can see a week, and they have to bill the government for payment. There is no essential competition for medical care in the core services. If you have cancer, it is a provinically funded hospital you go to, and you wait in the line if there is one for the treatment. If you want a new treatment, if the bureaucrats haven't ok'd that service for whatever reason, you are denied it. IN the US, if you have the money, you can get whatever treatment you want if it is offered legally. Not in Canada. We have to wait on bureaucrats to keep up to the medical community.

Hondo

26th January 2010, 23:10

Some of this may have it's roots in the "is it a right or is it a privilege?" argument. As a general rule, one shouldn't be allowed to purchase additional rights or a better set of them.

Mark in Oshawa

26th January 2010, 23:15

Brown, Jon Brow

26th January 2010, 23:23

Some of this may have it's roots in the "is it a right or is it a privilege?" argument. As a general rule, one shouldn't be allowed to purchase additional rights or a better set of them.

This is being abused here in our debate. Those for public healthcare treat those who would want to opt out of the public system are somehow wrong for wanting to pay more for the best.

I fail to see you point here.

An analogy:
We should all have the right to clean drinking water. If everyone has access to clean drinking water then it is fair. This doesn't mean that you have to drink water if you have the money and desire to buy Coke.

Most of the people on here seem to like a public system for all with a private option.

Mark in Oshawa

27th January 2010, 00:05

I fail to see you point here.

An analogy:
We should all have the right to clean drinking water. If everyone has access to clean drinking water then it is fair. This doesn't mean that you have to drink water if you have the money and desire to buy Coke.

Most of the people on here seem to like a public system for all with a private option.

Jon, you missing what is happening here. In Canada, you cant HAVE Coke. They give you water no matter what you want. One size fits all. The only 3 nations to have nationalized health care are North Korea, Cuba and CANADA. Now I don't know about you, but I don't want to be in any club with those two.

Malbec

28th January 2010, 13:54

This is being abused here in our debate. Those for public healthcare treat those who would want to opt out of the public system are somehow wrong for wanting to pay more for the best.

That is what they are telling you, the public. Given how you have described the layout of Canadian healthcare I suspect the real issue is a concern about how liberalising the system would affect private investment in public healthcare and how current services could be maintained if they pulled out, or how current vested interests would be threatened. Politics isn't so different from F1, always follow the money.

Hondo

28th January 2010, 16:31

e
That is what they are telling you, the public. Given how you have described the layout of Canadian healthcare I suspect the real issue is a concern about how liberalising the system would affect private investment in public healthcare and how current services could be maintained if they pulled out, or how current vested interests would be threatened. Politics isn't so different from F1, always follow the money.

Glad to see you back Dylan and I'm hoping you'll take the time to address this as you appear to work in the field.
This is not about health insurance, that has been flogged to death.

My biggest gripe is with the cost and attitudes of the healthcare business in general. To some degree, it's kind of like diamonds. With some exceptions, diamonds are not rare at all, and the price of the finished product is that of propaganda and a very controlled market.

In my opinion, the cost of many medical services is way out of line. In addition take someone with say, prostrate cancer. Maybe after 5 years of treatment and removals with the cancer returning each time, it's time the medical profession quit charging this man for the privilege of being able to experiment on him and started paying him for using him as a test bed. Nobody gives the profession lab rats for free, they have to buy them.

I worked with a guy that had an irregular heartbeat. He had always had it. His doctor, mainly by working through horror stories to his wife, finally got him into a hospital for a week of tests. End result, after insurance he still had to pay $1500, the doctor still didn't know what was causing it, and hot dogs, cheetos, and cigarettes did not make for a healthy lifestyle. No sh!t Rick, I would have warned you about the cheetos for $100. You can bet your life that the data from all those tests Rick paid for is being used for free by all those that track that condition in search of a profit.
You are correct about following the money and the same applies to medicine. If people didn't go running to the doctor for every littlt thing nowadays, the prices would fall as doctors tried to attract patients. I think the health industry has done a great job of selling itself as something far more knowledgeable and necessary than they truly are.

Jag_Warrior

28th January 2010, 17:32

Malbec

28th January 2010, 19:49

In my opinion, the cost of many medical services is way out of line. In addition take someone with say, prostrate cancer. Maybe after 5 years of treatment and removals with the cancer returning each time, it's time the medical profession quit charging this man for the privilege of being able to experiment on him and started paying him for using him as a test bed. Nobody gives the profession lab rats for free, they have to buy them.

I'll assume that paragraph isn't a joke.

The problem there is that your expectation is too high. You are not a car, replacing a faulty part does not mean the problem goes away. You're lucky the prostate cancer disappeared in the first place, unlucky that it came back.

No you (or the hypothetical you) aren't being experimented upon, otherwise you'd have had to fill in a battery of ethical questionnaires and consent forms. You are merely being moved on to the next battery of treatments available now that the first line has failed.

Medicine isn't a precise science and neither is it as effective as anyone wants it to be. It is also far far more expensive to run than you give credit for, the cost comes from the expense of researching the treatments you receive, and the running costs of medical establishments with all the equipment they require.

In the UK it costs £500 a night for a stay in a normal ward with just basic monitoring, no treatment. There's no profit there, that is what it costs per patient. Stay in intensive care for one night and you're looking at £5000 per night, again no treatment, just staying there and being monitored with nothing on top. No profit there either, just cost price. American costs won't be much different.

Those drugs you get, someone has to pay for researching them and the approximately 1000 or so others that get some way along the research pathway before they end up proving useless or dangerous. How much do you think it costs to research those drugs? How much of the profit gets taken away by losing court cases when drugs end up being riskier than initially projected? Entire drug companies have disappeared over the past few decades or have had to be bought out because the market is so tough. And its getting tougher as drugs get more expensive to research and fewer and fewer governments are prepared to pay for them.

I worked with a guy that had an irregular heartbeat. He had always had it. His doctor, mainly by working through horror stories to his wife, finally got him into a hospital for a week of tests. End result, after insurance he still had to pay $1500, the doctor still didn't know what was causing it, and hot dogs, cheetos, and cigarettes did not make for a healthy lifestyle. No sh!t Rick, I would have warned you about the cheetos for $100. You can bet your life that the data from all those tests Rick paid for is being used for free by all those that track that condition in search of a profit.

Are you also willing to put your career on the line and face millions in damages if your opinion turned out to be wrong?

I have to say though that the case you presented is something that is wrong with private healthcare (and I speak as someone who practices it too). The doctor has an incentive to go for expensive tests or procedures because he will get paid some of that. Your friend probably had tests that are either marginally useful for detecting the cause of his problem or totally irrelevant and he doesn't know better, purely for profit. Thats human nature I'm afraid, and something you can't get rid of if you give doctors incentives for generating more expensive tests and procedures. If you want a private free market healthcare system you'll have to live with its side effects.

You are correct about following the money and the same applies to medicine. If people didn't go running to the doctor for every littlt thing nowadays, the prices would fall as doctors tried to attract patients. I think the health industry has done a great job of selling itself as something far more knowledgeable and necessary than they truly are.

You might reduce charges a little but you won't fundamentally change the fact that medicine is an incredibly capital intensive industry. If you want truly cheap healthcare then abandon any pretence at wanting cutting edge treatments and settle for stuff thats twenty years old.

Mark in Oshawa

28th January 2010, 20:18

Dylan, in my situation, you said follow the money. Well here, the money is all in the public funded system. The public sector unions that have all the workers in the system are the ones with the most to lose. They do not want any private care, because they assume they alone are capable of compassion in the system. Listen, my mother was a nurse, and worked in the hospital for a very nice wage, but she also worked free lance for a year or two part time (she was in the hospital part time as well) with a nursing service outside of the public system. She was paid maybe 80% of her wage from the hospital BUT when you factor in income tax, the take home pay was a lot closer. So how is it the private sector couldn't do the job cheaper? Sometimes I know they may not, because alas, I know they want a profit, but there is no accountability to the public sector unions. They accept no responsbility for trying to save the taxpayer money, and consider public healthcare a sacred cow, except if they are at contract time, then they consider that right to strike (not nurses, but the support staff) sacred.

You have done a lot to educate and make me think about some of the hitches and conventions in healthcare, but one thing I am sure on is there is still room for more efficiencies in public healthcare, at least here...but the conversation isn't really allowed to start because of the fear of "American style healthcare" AS I have explained, this threat is the 3rd rail of Canadian politics.

Hondo

28th January 2010, 20:42

Hondo

28th January 2010, 21:34

I once lived in an area where a state issued "certificate of need" had to be in hand before, I thought, a hospital could be built. It may have applied to government financing. It was a long time ago.

A local board was created and construction was begun on a 400 bed community hospital. Everybody was thrilled until the local doctors realized the new hospital was to be a nonprofit hospital. They quickly formed an association and started building their own 300 but expandable to 600 bed unit about 10 miles away. There is nothing like working within or in close proxcimity to a profession to realize there is no nobility in any of them.

The local doctors boycotted the nonprofit unit. If the doctor's hospital was full, patients were sent to a city 35 miles away. A few doctors ignored the boycott and used the nonprofit hospital but not very many. Working at a hospital meant I got to learn quite a bit about how they operate. Doctors were expected to fill x amount of beds a month to maintain their priviiges. Bonuses for exceeding that amount. If a supplier came up with a really good deal on sterile, pre-packaged surgical kits for tonsils, then tonsils was the surgery of the month and each doctor was expected to deliver x amount of tonsil surgeries. Mind you, the nonprofit hospital wasn't playing by those rules. The nonprofit never had enough business to get that cocky.

The nonprofit went bankrupt and closed within 2 years.

Mark in Oshawa

28th January 2010, 22:22

Alexamateo

29th January 2010, 00:40

What frustrates me is that my dental plan will not cover braces. I don't need braces. And I don't have a child that needs braces. But what if I marry a woman with crooked teeth, and we have a child with crooked teeth. What then?!

Funny you should ask. My 33 year old wife got braces 6 months ago. (She had couple of wisdom teeth removed and her teeth started seperating). Adult Orthodontia is not covered of course, so we treated it like you might an addition on your house. We went to three different orthodontists with good references and took bids.

It was instructive, one mentioned that the prices also included the retainer she would need after they are removed, so we checked and found the others had not included that in the price and yes she would need them. On the basis of their thoroughness and a 15% discount for lump sum payment up front, we went with them.

Now, does that mean actual market competition is the solution for what ails medical costs? I don't know, but I believe that like the funeral industry, medical practitioners also count on you not knowing the costs, and not negotiating because it's "unseemly"

My daughter was born with a congenital heart defect (repairable, thank Goodness) and had heart surgery at 4 days old. I got bills for all sorts of things from doctors I never met, related to all of this. I started questioning a few things, but was told not to worry about it, I was already at calendar year maximum out-of-pocket, and everything was 100% covered. Now, it may have all been on the up-and-up (i.e. doctors on rounds would review her chart and send us a bill.), but I've always had my doubts.

That said, I still prefer private as opposed to government run health care. I would like to see insurance treated a more as an emergency type service not unlike home or auto insurance, where people would know costs and pay for basic services out of pocket. I would also like insurance de-coupled from work. I think it keeps people in jobs that sometimes don't like, but feel like they cannot leave because of the benefits they'll lose. It's complicated, and there are no easy answers.

Rollo

29th January 2010, 06:38

As a general rule, one shouldn't be allowed to purchase additional rights or a better set of them.

Amongst that, you do not have a right to healthcare but you do have the right to attempt to get all the healthcare you want by purchasing it, begging for it, bartering for it, conning them out of it, and you name it.

Which is it? How do you explain this paradox?

Hondo

29th January 2010, 08:36

Which is it? How do you explain this paradox?

I don't see a paradox per se. If you believe it to be a right, then you believe that from cradle to the grave, regardless of what you do or don't do, some third party is obligated to care for your health needs even if you never contribute one penny to the system.

Is voting a right or a privilige? You have one vote and the rich guy you absolutely hate has one vote. Neither one of you can go to the government and buy extra votes. Both of you enjoy the privilige of aiding and assisting your favorite candidate beyond casting your one vote for him. But, even if you do volunteer work 40 hours a week for his campaign and contribute thousands of dollars, when you walk into the polls, you'll still only have your one vote.

If health care is a right and the system is obligated to provide for your needs (the very definition of "needs" is a can of worms in itself), then it will attempt to do so fairly. If somebody makes more money and ends up paying more NHS taxes, that doesn't qualify them for any better care than the poorer guy gets. In other words, the extra money he paid in didn't buy him anything extra. Of course, since I don't know how the NHS works and is funded, I could be just talking out my ass here. But, if a man pushed a little harder and made and saved more money and wants to use it to enhance his health care options and services outside the system, then thats his privilige to do so. He might even work out a barter arrangement for additional care.

There will always be people that want more and are willing to work more, save more, and risk more to achieve their goals. And there will always be people that want more and intend to get it by taking it away from you.

Hondo

29th January 2010, 14:28

AS for the non-profit, well if the gov't subsidized it, you would have: Voila, a public healthcare system.

In a way, that was the problem. Full control of the hospital was to remain with the non-profit board and not The doctors. So even though the doctors could still scam their patients on their personal charges, the hospital refused to play the bonus game and of course by law, no profit sharing. It was a wonderful hospital, state of the art and no patients were ever turned away. It died of greed all the way around, from the doctors that couldn't milk it to the former patients who felt like they didn't need to pay an honest bill once they were feeling better.

Malbec

29th January 2010, 19:04

There is nothing like working within or in close proxcimity to a profession to realize there is no nobility in any of them.

Hmmm I'm getting a strong whiff of hypocrisy here.

Fiero, you've been arguing over and over again that healthcare isn't a right, it is something that should be bought. You've talked about the benefits of a market system and how profit motivates hospitals to be efficient.

Then you've seen doctors firsthand playing the game not only by its rules but by the spirit of the rules as you want it to be played and you don't like it.

Which is worse, the doctor who works the system as its meant to be or the guy who demands that the system is the way it is?

Mark in Oshawa

30th January 2010, 05:34

Malbec

30th January 2010, 10:54

I don't think he has a problem with it. The non-profit hospital admins did....

That is not the interpretation I made, Fiero has criticised the profit seeking behaviour of doctors he has seen in two posts now which is odd for someone who supports the profit seeking nature of private companies to keep his costs down.

Hondo

30th January 2010, 20:47

Hmmm I'm getting a strong whiff of hypocrisy here.

Fiero, you've been arguing over and over again that healthcare isn't a right, it is something that should be bought. You've talked about the benefits of a market system and how profit motivates hospitals to be efficient.

Then you've seen doctors firsthand playing the game not only by its rules but by the spirit of the rules as you want it to be played and you don't like it.

Which is worse, the doctor who works the system as its meant to be or the guy who demands that the system is the way it is?

Good Afternoon Dylan, sorry I'm late.

I've been known to confuse folks from time to time and part of that is what I am and part of it is what I isn't.

I would describe myself as a realist, with a sometimes uncomfortable side order of pragmaticism. Hypocrisy, although I am unconvinced of my guilt in the manner to which you point or whiff, is a lady that all of us end up having to dance with at one time or another. Still, there is much to be said for hypocrisy. Hypocrisy led directly to rationalization and without rationalizations, human beings couldn't survive.

I'm not sure, but I don't believe I'm one of those that constantly praise the market system but I do appreciate the benefits it offers and saddened by those that fail to acknowledge it's limitations. In addition, I can't remember where I said profit motivates a hospital to be efficient. I think Rollo accused me of that via a misquote. However, back in post #10 I did say that insurance companies and hospitals are both businesses and entitled to make a profit.

I have stated my opinion that I believe that some medical services are over priced and the actual need for constant health care is oversold through a good marketing campaign. Some doctors charge vastly more than their services merit but so do some lawyers, auto mechanics, and building contractors. I asked you to address some questions along those lines and you did, thank you. By the way, the guy in the first paragraph wasn't a joke, he was my Dad. You and I could argue all day long, but at the end of the day you, as a man of integrity and education, would have to admit some services and doctors fees are overpriced and I, as a man of integrity and education, would have to admit that some of the high costs are justified. Even with me thinking costs are too high, nowhere have you seen me advocating the regulation or imposition of artificial price controls on doctors or hospitals. I believe it's the patient's responsibility to explore other options, up to and including, going to a different doctor.

As far as the 2 hospitals go I really wasn't condemning one or the other. I was merely pointing out that working there turned me on to how the game is played. The doctor's hospital was built by the doctor's through a corporation they formed. They invested in their business, built it, and deserved to make a profit from it. They could have lost their butts for starting the construction without a "certificate of need" but the state board ruled that since no public money or money insured by public funds was used for it's construction, it was legally a huge private clinic and a "certificate of need" was not required. Although I don't know what the prices were compared between the two, they were both in business to make a profit, the only difference being the profits made by the non-profit hospital had to be put back into and used for the benefit of the hospital. To say either hospital was above gamesmanship would be inaccurate. This would have been going on about '73-'75. The private pysch hospitals for addiction, depression, etc were just starting to rear their ugly heads. We were on the cutting edge of a new profit center. We converted the entire 3rd floor to a psych floor and the local shrinks started filling it up with disobedient teenagers, wives that, now that the kids were gone, were lost. They didn't know anything about areospace and their husbands didn't know jack about Big Bird. Not to mention the rare patient that was milking the system for a free vacation. Any way, all these people presented such a danger to society and themselves that they were locked up on the 3rd floor, except for lots and lots of supervised field trips and outings, until such time as their condition improved and they could be released back into mainstream society. You'll be glad to know that each and every one of them were fit enough to return to society on the same day their insurance ran out, usually 30 days.

If a society wants to make health care a right, that's their business. That I know of, nobody in the USA is telling the UK or any other nation they can't have a national health care plan.

In the USA, we have 2 national health care plans now, both broke. Massachusetts has a state plan thats a complete mess. The majority of Americans have let Obama know they don't want his health plan and that is a right they have.

In all honestly, I'm puzzled by the mindset of any individual that thinks they have the absolute right, by virtue of the fact that they exist, to obligate other individuals to care for them.

Lastly, I have no objection to how any doctor conducts himself as long as it is legal. They are free to charge what the market will bear and partake of any incentives offered. Thats business and business is what they are in.

Thyroid and COPD have finally taken me down to where I can't work. I managed to work 3 weeks in Feb, but thats been it. When I told my doctor I no longer had medical insurance he immediately cut his fee to me by 37 % so please don't go thinking I'm down on doctors. Because of years of self-directed investments, I've gotten on quite well without public assistance.

anthonyvop

2nd February 2010, 13:46

Apparently the healthcare system in Canada is great unless you are the Newfoundland Premier......Then it isn't good enough.

http://www.nationalpost.com/news/story.html?id=2510700

Mark in Oshawa

2nd February 2010, 16:17

Apparently the healthcare system in Canada is great unless you are the Newfoundland Premier......Then it isn't good enough.

http://www.nationalpost.com/news/story.html?id=2510700

Believe me Tony...it goes on all the time. The Premier of Newfoundland at least flew down on his own dime. Prime Minister Chretien used to fly to the Mayo Clinic using the plane from the Air Force that I help pay for. But of course...our healthcare system is GREAT. Just ask Danny Williams or Jean Chretien.

Healthcare is truly the 3rd rail of Canadian politics if you threaten it but at some point, the electorate will wake up...

steve_spackman

3rd February 2010, 01:17

Apparently the healthcare system in Canada is great unless you are the Newfoundland Premier......Then it isn't good enough.

http://www.nationalpost.com/news/story.html?id=2510700

Medical tourism..check it out.

People from all over the world go to different countries for treatment, including people from the USA.

Most people that go abroad for treatment actually come from the USA. They go to other countries as its cheaper and get the same if not better treatment and care.....

anthonyvop

3rd February 2010, 04:23

and get the same if not better treatment and care.....
You Funny!

Sure some American's go offshore for treatment. Most of those go for treatments that aren't allowed in the US.
Those that go for cheaper treatment are idiots because if they had been actually paying for insurance it would have come out cheaper than going offshore.

The thought that Americans go offshore for better treat is laughable. Even a High Canadian Government official came to the US for treatment. He could have seen the best Canadian doctors free of charge but yet he hopped on a plane to the US.

Mark in Oshawa

3rd February 2010, 05:33

Tony...apparently it was some specialist. The spin doctors are in full spin, but if you are from St. Johns Newfoundland, a not big city in a small outpost that is about 550000 people, you know you are going to need special care elsewhere for some treatments. I guess he figured he would get a little sun and pay for it. Since Danny Williams was a millionaire before he entered politics, he whistled up his private jet and went south. No one is saying, but he has some weird cardiac thing.

I don't care that he is getting treatment in the US, heck, it probably is as good or better than what he got in Toronto or Montreal but the weather would be nicer BUT this is one of the politicians who is always blathering about how good our health care is. Well you know what, if you are going to go out on that limb, than suck it up and stay home. The truth is Tony, we are not using leeches and amputating limbs up here. We have a decent enough healthcare system but the fact remains it could be that little bit better and polticians like Williams keep getting in the way of discussing how we can do that.

Contrary to what you think Tony, it aint a third world country up here and our healthcare is in most cases as good as anywhere, but if you want specialists and the BEST possible care money can buy, than ya, maybe you will end up going to the UK or the US of some place exotic.

steve_spackman

3rd February 2010, 22:58

You Funny!

Sure some American's go offshore for treatment. Most of those go for treatments that aren't allowed in the US.
Those that go for cheaper treatment are idiots because if they had been actually paying for insurance it would have come out cheaper than going offshore.

The thought that Americans go offshore for better treat is laughable. Even a High Canadian Government official came to the US for treatment. He could have seen the best Canadian doctors free of charge but yet he hopped on a plane to the US.

You simply have no idea what your on about do you? I really pity you sometimes.

chuck34

3rd February 2010, 23:07

Here's something that I honestly don't know about, I'm sure you all will educate me.

Aren't you sort of stealing if you are a US citizen and you go abroad for some sort of treatment? I mean that care is cheaper because it's subsidized by that government. And since I, as a US citizen, didn't pay taxes in country X, aren't I stealing from those taxpayers?

Boil the question down a bit: Is treatment in other countries cheaper because it is subsidized by the government? At least to some extent?

Brown, Jon Brow

3rd February 2010, 23:12

Rollo

3rd February 2010, 23:55

Aren't you sort of stealing if you are a US citizen and you go abroad for some sort of treatment? I mean that care is cheaper because it's subsidized by that government. And since I, as a US citizen, didn't pay taxes in country X, aren't I stealing from those taxpayers?

The key word in that is "stealing", and no you aren't. It is impossible to steal something which is provided to you out of duty.

In the UK, the National Health Service Act 1946 and it's replacement in 2006 (as well as equivalent Acts in Scotland) explicitly state that is the "Secretary of State’s duty to promote the health service".

In Australia section 51 of the Constitution provides that the Federal Government has the power to enact laws with regards "The provision of medical and dental services" and even the National Health Act 1953 states that "the duty is encumbant on the Federal Government to ensure the provision of healthcare services".

Duty in common law extends from a moral commitment, which in this case is by the government to look after its people.

Besides which other than Accident and Emergency departments you'd still be liable as a US Citizen to charges for services.

chuck34

4th February 2010, 00:06

The key word in that is "stealing", and no you aren't. It is impossible to steal something which is provided to you out of duty.

In the UK, the National Health Service Act 1946 and it's replacement in 2006 (as well as equivalent Acts in Scotland) explicitly state that is the "Secretary of State’s duty to promote the health service".

In Australia section 51 of the Constitution provides that the Federal Government has the power to enact laws with regards "The provision of medical and dental services" and even the National Health Act 1953 states that "the duty is encumbant on the Federal Government to ensure the provision of healthcare services".

Duty in common law extends from a moral commitment, which in this case is by the government to look after its people.

Besides which other than Accident and Emergency departments you'd still be liable as a US Citizen to charges for services.

Ok so it's not really stealing. But aren't the costs lower, at least in part, because the government (through taxpayer money) is subsidizing the services?

Rollo

4th February 2010, 00:23

Ok so it's not really stealing. But aren't the costs lower, at least in part, because the government (through taxpayer money) is subsidizing the services?

I'd hazard a guess that the overall costs are lower because:

1. The Government actually owns the hospitals and doesn't therefore need to charge expenses like rent, or rates.
2. The level of bureaucracy and management isn't duplicated nearly to the degree it is in America because there is a single blanket organisation.
3. A single blanket organisation has bigger purchasing power through economies of scale both in terms of hardware and labour costs.

The government for the most part doesn't subsidise the sector, it owns it. Is actually possible for the government subsidise an industry if it owns it?

chuck34

4th February 2010, 01:46

I'd hazard a guess that the overall costs are lower because:

1. The Government actually owns the hospitals and doesn't therefore need to charge expenses like rent, or rates.
2. The level of bureaucracy and management isn't duplicated nearly to the degree it is in America because there is a single blanket organisation.
3. A single blanket organisation has bigger purchasing power through economies of scale both in terms of hardware and labour costs.

The government for the most part doesn't subsidise the sector, it owns it. Is actually possible for the government subsidise an industry if it owns it?

How does the government own anything? Answer, it doesn't. The taxpayers do.

1. The government doesn't own the hospitals, the taxpayers do. Therefore the taxpayers are paying to build, maintain, etc. the buildings. In effect, the taxpayers are paying the rent.

2. You don't think there is a high level of bureaucracy involved in government work? What planet are you on?

3. Ah, so the the government has "buying power". Is that why toilet seats cost $600?

The government does own the system, but that doesn't mean that it doesn't still cost something. That appears to be the dirty little secret here. Sure medical costs (when looked at in isolation) are lower in countries like Canada and the UK than they are in the US. But when you add in the tax burdon associated with the medical industry I would bet the TOTAL costs are close to the same.

Rollo

4th February 2010, 03:01

1. The government doesn't own the hospitals, the taxpayers do. Therefore the taxpayers are paying to build, maintain, etc. the buildings. In effect, the taxpayers are paying the rent.

Wrong.
The Government DOES own the hospitals, specifically through the legal person of the Crown, via the NHS. Not only is the Crown the legal owner of the hospitals but it also owns the land upon which it sits, and the buildings themselves.
There is zero rent because as the owner of the land, buildings and the services inside, the Crown doesn't pay rent, rates or taxes to itself.

2. You don't think there is a high level of bureaucracy involved in government work? What planet are you on?

In the UK there is ONE NHS which runs and overseas the lot. Sure, there is a level of bureaucracy but again I wager that the total number of administrators and managers on a per capita basis is far less than the great swathe of HMOs and hospital owners in the US, which as separate entities certainly do not share the same administration.

3. Ah so the the government has "buying power". Is that why toilet seats cost $600?

http://www.diy.com/diy/jsp/bq/nav.jsp?a ... egories%3C (http://www.diy.com/diy/jsp/bq/nav.jsp?action=detail&fh_oneslice=true&fh_view_size=10&fh_reffacet=categories&fh_location=%2f%2fcatalog01%2fen_GB%2fcategories%3 C){9372171}&fh_refview=search&fh_search=toilet+seat&fh_refpath=facet_159016185&fh_secondid=10246484&fh_eds=%C3%9F&ts=1265251670419
I could get a whole toilet for 130 quid. $600 for just the seat? You're getting done.

But when you add in the tax burdon associated with the medical industry I would bet the TOTAL costs are close to the same.

According to the OECD the average spending per person (USD):
US - 7290
Can - 3895
Oz - 3137
UK - 2992

By rights if the costs were the same, the Dept of Health in Britain running on a US cost basis should be £240bn instead of the £98.7 billion which it currently costs.

chuck34

4th February 2010, 12:46

Wrong.
The Government DOES own the hospitals, specifically through the legal person of the Crown, via the NHS. Not only is the Crown the legal owner of the hospitals but it also owns the land upon which it sits, and the buildings themselves.
There is zero rent because as the owner of the land, buildings and the services inside, the Crown doesn't pay rent, rates or taxes to itself.

So the Crown has some magical pile of money somewhere that hasn't been taken or "earned" from sources, that it uses to pay people to build and maintain the buildings? That's cool, you'll have to explain how that works.

In the UK there is ONE NHS which runs and overseas the lot. Sure, there is a level of bureaucracy but again I wager that the total number of administrators and managers on a per capita basis is far less than the great swathe of HMOs and hospital owners in the US, which as separate entities certainly do not share the same administration.

So you are honestly telling me that the government is run more effeciently than private industry? Wow, I've never seen that before, how does that work? You're really going to have to put up some sort of numbers to prove that one to me. Not that I'm saying that insurance companies are some sort of beacon of efficency, far from it, but the government? Really?

http://www.diy.com/diy/jsp/bq/nav.jsp?action=detail&fh_oneslice=true&fh_view_size=10&fh_reffacet=categories&fh_location=%2f%2fcatalog01%2fen_GB%2fcategories%3 C{9372171}&fh_refview=search&fh_search=toilet+seat&fh_refpath=facet_159016185&fh_secondid=10246484&fh_eds=%C3%9F&ts=1265251670419
I could get a whole toilet for 130 quid. $600 for just the seat? You're getting done.

Your link doesn't work for me, but I'm assuming that you are giving me a link to some sort of do it yourself, go buy a toilet and put it in your house type of deal? That's not what I'm talking about at all. I'm talking about the government buying things at outragous prices.

http://councilfor.cagw.org/site/PageServer?pagename=getinv_gotwaste
"Since our founding in 1984, CAGW has helped expose such high-profile symbols of federal profligacy as the Department of Defense's $640 toilet seat and $436 hammer and the National Park Service's $797,400 outhouse."

According to the OECD the average spending per person (USD):
US - 7290
Can - 3895
Oz - 3137
UK - 2992

By rights if the costs were the same, the Dept of Health in Britain running on a US cost basis should be £240bn instead of the £98.7 billion which it currently costs.

I have no idea what the OECD is, can you give me some info on them, or a link to where you got these numbers? I am highly sceptical of this.

But even if these numbers are correct, does it take into account quantity and quality of care? I mean does the US number throw in all the plastic surgury, and other elective surguries that Americans have? Or how about the cost of quality? I can probably get somebody to cut out my appendix with a knife making a big insision and yanking the thing out. Or I can do it with a scope, no scar, and little recovery time. Which do you think is more expensive?

Mark in Oshawa

4th February 2010, 19:07

Chuck, the OECD number is interesting...but I do think there is a bit of a controversay how those numbers per capita are arrived at.

My contention is that some of the cost of publilc healthcare systems is hidden when those numbers are calculated. As you illustrated, the US Gov't has overspent wildly at times for things like Toilet seats, and I can tell you that the Canadian gov't isn't that stupid.....but god knows they can be close.

I have through this thread wavered one way or the other on the merits of public/private care, but I do know that public healthcare isn't the pancea for all ills, but it isn't leeches and amputations either....the Danny Williams going to the US controversay up here had some of the top Cardiac doctors in Canada up in arms. He isn't getting anything done that Mt. Sinai hospital in Toronto isn't doing or any number of top flight Cardiac hospitals.

The one thing people do have to realize tho is this Premier is coming from a sparsely populated and remote part of Canada. For any major specialists, he almost has to get on a plane, and if a poor father in St. John's needed the same care, he too would have to leave home...but in the poor father's case, it would be to Montreal, Toronto or Ottawa and NOT Florida..

Rollo

4th February 2010, 19:36

So the Crown has some magical pile of money somewhere that hasn't been taken or "earned" from sources, that it uses to pay people to build and maintain the buildings? That's cool, you'll have to explain how that works.

The Crown is technically a corporation sole, that is, it is a separate legal enitity consisting of one office and one officer. The person who operates both the office and the corporation is the Crown*.
It is the Crown who owns both the NHS and the land and the buildings etc for which the institution sits inside.

Obviously if the Crown operates and owns the NHS, it isn't going to assess itself for land taxes, rates, income tax, payrol tax etc, which every private entity ergo the company which owns a private hospital would be liable for.

So no. The Crown does not have "some magical pile of money somewhere", and not does it need to because the expenses which it would need to pay out of this magical pile of money never exist either.
You've presented a converse error which is a formal fallacy.

People are still paid and buildings are still maintained because these are "real" events arising from "real" circumstances.

*NB: The Crown operates itself. The Monarch is a separate legal person.

Hondo

4th February 2010, 19:52

Does the Crown generate no income? Who actually forks out real money to pay for real building and land maintainence?

chuck34

4th February 2010, 20:20

The Crown is technically a corporation sole, that is, it is a separate legal enitity consisting of one office and one officer. The person who operates both the office and the corporation is the Crown*.
It is the Crown who owns both the NHS and the land and the buildings etc for which the institution sits inside.

Obviously if the Crown operates and owns the NHS, it isn't going to assess itself for land taxes, rates, income tax, payrol tax etc, which every private entity ergo the company which owns a private hospital would be liable for.

So no. The Crown does not have "some magical pile of money somewhere", and not does it need to because the expenses which it would need to pay out of this magical pile of money never exist either.
You've presented a converse error which is a formal fallacy.

People are still paid and buildings are still maintained because these are "real" events arising from "real" circumstances.

*NB: The Crown operates itself. The Monarch is a separate legal person.

This makes no sence at all. The land costs someone something, be it the Crown or whoever. If it is "government land" there is still a cost involved because it isn't generating income from it's sale, taxes, etc. And in order to put up the buildings and maintain them someone had to pay somebody for the work. Same with maintenence. And in this case apparently the someone is the Crown. So my question still stands: Where does the Crown get it's money from? I'm assuming that the answer is taxes.