stevoh

And yet, the northwest passage is somehow mysteriously opening up enough to allow transport and cause various contries to claim transport rights. Hmmm....

The trouble with applying that argument to health care, is that, unlike food and clothing, our individual need for health care is not related to our income. In the case of food, the more money you have, the more expensive food you can buy (or have someone else make). In the case of clothing, the more money you make, the "better" the brands you can buy. You may earn less than the poverty line in income, but can still afford the basics of food and clothing. However, in the case of the individually born expense of health care, it doesn't matter how much or how little money you make, you can be afflicted with a very expensive medical condition. If you are poor, and health care expenses are personally born, you have two choices, suffer, or go bankrupt if allowed, with bills you cannot pay. Unlike food and clothing, which you can get by with on cheap brands or basic food shopping, you get sick, your health care costs are high. No way around it. In the end, in any civilized country, health care is not going to be denied to any individual who's life depends on it, even if they can't afford insurance or hospital bills. Someone has to pay for it. We can all share that cost equally (in proportion to our income) through taxation, or we can allow either individuals health or financial status to be crippled. Or both. Public health care is a better alternative.

Instead of playing context games, why don't you clarify what your statement: Means?

So, when you say Canada's is the most expensive system in the world, and it turns out it is half the cost, per person, of the USA, what did you intend to say? So, as long as we "choose" to spend more, then its somehow less expensive? How does that make any sense at all? The canadian health care system is pretty good. Its not perfect, it needs work, all systems should be in a constant state of analysis for improvement, public or private. What if you can't afford it? Then you just go without. Too bad. Don't disagree with that. What choice do you have when you can't afford it? Of course there is a balance between providing the best service possible and attempting to keep control of costs, at least its not a balance between making the most profit possible while giving the perception of the best service possible. Without needing the profit layer, health care costs less. So, we should replace that system with a faceless insurance company that will determine who should and shouldn't get treatement based on profit? Hardly a better choice.

Considering that it costs, on average, twice as much for the american system, odds are, you would pay more. Sure, it may be possible that you are in a category that would pay less, but its unlikely. Yes, we disagree here on service segregation based on income. Don't confuse choice with better. And you may already be keeping more of your money, chances are, you are. So you want to choose your police departments, your fire departments, you want to call 911 and choose which emergency service provider you have? There are many instances of emergency measures that we remove "choice" from because economies of scale and people opting out make management and realistic use of the system impossible. You happen to draw the line at the health care system, why not draw it with those other emergency services as well? My argument is soley in the context of the health care system. That the type of care we get and the amount of money we spend it more than reasonable, and considering the other benefits, no-one without care, no non-insured emergency spending, no co-payments, by my reasoning, its more than worth it. Because health care is where I choose to stop and the people we vote into power reflect those choices.

So, if, for example, you discovered that the only slightly better care that you get in the US's for profit system than in Canada's state run system (even that point is highly debateable, depending on measures), costs almost twice as much, then you would agree that our system in the end is more efficient, due to performance per dollar? So, as Canada pays 9.9% of GDP for health care, as opposed to the US'S 15.2%, we are not in fact getting more for our money? And you are willing to almost double your personal expenditure on health care in order to access that system? For someone so concerned with keeping your own hard earned money, its seems odd to me that you would rather pay a private health care insurance company 6000 dollars a year than have 3000 dollars a year in taxes for the public system. It does seem indeed that your bias against state run systems is stronger than your personal interest in keeping more of your money. http://en.wikipedia.org/wiki/Health_care That has exceptions, caveates, and doesn't cover everyone. Not something I want in my health care system. Our decisions about what we support are a combination of moral and other factors. If you remove morality from health care, regardless of what conclusions you arrived at with another poster, then you remove a key reason that many people get involved in health care in the first place, helping people. You should not make the decision based soley on morality, nor should you completely remove morality from any decision concerning human health.

Aren't your points related to what YOU believe the role of the state should be? If we aren't debating points we believe in, I am not sure why we are debating at all. The state should play the role of insurance provider in the sole case of the health care industry because there are too many variables and factors in health care to leave to a company that has to, by nature of being a profit making company, consider profit over the best potential treatment of the patient. Well, the absolute judge of morality should surely reside where human lives are considered above any other consideration, wouldn't you think?

And I put in italics, so it was clear to see, the same quote, take a look "worst system in developed countries". Not a misquote. Canada' health care is not the most expensive in the world. The US's is. In fact, the American system costs, per person, almost double ours. Canada: Per capita expenditure: 2669 US: Per capita expenditure: 5711 http://en.wikipedia.org/wiki/Health_care_in_Canada What has happened to you in our system personally that has led to this belief?

Good debate Renegade, I understand you points, I just don't agree with them. I don't agree with segregating the quality of health care based on your income and insurance level. We aren't dealing with cars, vacations, expensive housing, items that, as much as we don't want to, can live without. We are dealing with human health, and human lives. I honestly can't look at a street person who gets appendicitus and believe that they are somehow less deserving of the quality of care that I received. I don't want a quick check of my insurance level before I am admitted to a hospital to determine the level of care I am getting for my heart attack. Add to that the potential of chance, that, like the dental industry, you may require some kind of treatment that isn't covered, despite your best attempts at getting the best insurance you can afford, and the risk is too high. Private insurance has its place, cars, housing, travel insurance, etc. When the items covered by insurance are easily valued in dollars and cents, and easily replacable for that value, private is best. When the items covered by insurance are priceless, your families health, then restricting that care based on insurance and income level is just plain wrong.

What your dental insurance covers you for, that is the same thing as what they are willing to pay for. I can think of no private insurance company that is willing to pay for something they have not specifically covered. There are limits and limitations, not something I want to run into in an emergency situation in a hospital. No thanks. My 28 page dental care insurance document, which I have reviewed, has limitations and limits on all kinds of care, some of which I understand, some of which I don't. No-one can predict which of these treatments I will require, so even if I knew all of the terminology I still wouldn't be able to predict if my coverage was adequate. With public health care insurance, I don't have to worry. One case in the dental industry I can mention has happened to me. I had a wisdom tooth where the root of my tooth was not straight up and down like normal teeth roots are supposed to be. The roots were curved, so they extended under the tooth in front of the wisdom tooth. I was presented with a bill for the extra cost that this procedure took, since it took extra time. Imagine if these costs were expanded in the health care industry! You go in with an ailment that the standard treatment doesn't work, or it takes significantly longer to heal than estimated. Your insurance will stop paying after a defined point or after a defined procedure. Not a risk I want to take. Well, I believe I should be able to find an insurer that will pay all of the bill. I had one up until a couple of years ago. I should be able, through choosing another insurer, have that complete coverage. What is the point of a private system if through choice I can't get better coverage? Also, if that bill increased greatly in size such as an operation in the medical industry, then I might just be hooped even if I was only paying a percentage. So, your solution for canada's health care industry's issues is one that: - May or may not cover me or my family for an emergency medical situation that occurs to me. - May or may not completely cover all of my expenses that occur in the hospital, leaving me with a "percentage" bill. - May or may not protect me from a financial situation, due to medical bills, that could lead to bankrupcy. And then reduces my care to "very basic welfare" coverage as I can't afford the insurance that I was formerly paying. - Gives only very basic care to those who cannot afford insurance, limiting the type of care they recieve even further. These are not compromises I am willing to make.

The dentistry industry does have those drawbacks, as I have already touched upon. First off, if your care goes beyond what the insurance industry is willing to pay for (root canal took longer), then you are stuck with the bill. They are not going to pay additional funds that will dig into their profits. Expand this to the astronomical bills that can occur with emergency situations, and you can be stuck with thousands of dollars of bills you may not be able to afford, even though you have insurance. And, if the care is determined not to be life threatening, such as loosing a finger, and you are only partially covered, then your only choice may be to not get the surgery at all. Because ensuring that the profit margin is retained is more important than human health. Secondly, that extra billing for work that IS covered by dental insurance, once again, will suffer from the issue of scale. 10% of a 60 000 dollar bill is a lot of money. Insurance is far from perfect, but it has its role. Particularly as it relates to non-life threatening insurance concerns. Extra billing in the dental industry is annoying, but for most people with insurance, at least affordable. When expanded to the scale of charges for emergency health care however, it can be financially debillitating, even leading to bankrupcies (as is so well demonstrated in the US health care system). One thing you haven't touched upon is people who don't have insurance. How do we pay for these people to get care?

Yes, I have had dental care in Canada. Usually as a benefit from my current employer. The care I get is excellent, as far as quality, but the billing sure is annoying. Here's why: 1. I have to pay 5 to 10 percent of the bill myself out of my own funds, this is new in the last two years. Suddenly, my company insurance won't pay all of the bill and I have to cover a portion. I would like to exersize my consumer freedom to find a new dental insurance company that covers all of the bills, but it seems this "user pays some" thing is quite popular. And I have to pay considerably more for personal private dental insurance than the money I get back from my company if I decide not to join their insurance plan. I am still looking into this. I am also afraid that this additional user billing will increase in proportion over time. 2. Each service has a maximum amount allowed. So, if something you have done takes longer than the insurance company has covered, you have to cover the rest. Another couple of hundred dollars because a root canal took longer than expected due to "unusual crowding of teeth" or some such. So, in short, the care we get as far as quality of product and service is excellent. But the billing and insurance part of it is annoying. Maybe that part should be publicly run ;-)

I have never claimed our health care couldn't be better. Of course it can, like any system private or public, constant assessment and improvement is necessary. We have pretty darn good health care though. I don't see it as "worst system in developed countries" at all. I have been to the doctor a fiew times, hospital a couple of times and haven't had any issues. Sure, the wait can be a bit painful (speaking as a person who had kidney stones and had to wait five hours for treatment), but once inside, the care is excellent. Have you had a personal horrible experience with our health care system that is tainting your view? I have no problem saving for the contingencies in my life. It helps that I don't have to pay high health care insurance fees for care that may not be complete. Get a higher paying job. There is nothing wrong with profit. Its just that when a choice between human health and profit errs on the side of profit, bad decisions are made. If the add on is as superfluos as you say, then there must have been another motivator to create and market it right? Like.... profit? And gosh, we wouldn't want our health products to be peer reviewed eh? I mean, that would be terrible health care.

Ok, I can accept that. I do believe they have other motivations beyond making money for choosing the occupation that they do, but I can accept they are equivalent to a small business owner. It seems that the main part of the canadian system that is public is the insurance itself. And I agree strongly with the component. That means the classic conflict between making money and providing care that exists in the insurance industry is negated.

So you will never be injured, never get sick, never have a family member in need of emergency care? Then you should try US style health care, where you don't have to purchase insurance at all, and just let chance take its course. It is in everyones interest to have good health care. http://heartburn.about.com/b/a/040371.htm Can the doctor open other clinics under his brand name? Can he franchise? Can he do a "better job" than anyone else at a specific treatment and therefore charge more? Can he pass additional costs onto the consumer? Can he have investors in his business that he then shares the profit with? None of the above. He has tight restrictions on how he can run his "business". Its a far cry from free market capitalism.

Ok, now we are getting somewhere. Do you agree that a system as we have now, the doctor who runs his own medical practice, is in fact the owner of his own business, and is incented to make a profit? Not in the capitalistic sense of business, where competition and the ability to expand is limitless. But in an individual sense, sure.

Individuals should be rewarded for good care and improved efficiency, including administrators. That can include monitary rewards, vacations, commendations, whatever. However, the health care system as a whole does not need to profit to meet its primary mandate, the best patient care possible. Since there are no investors, shareholders, or "owners" of the system, that profit layer is not necessary.

Every Canadian is.

Here: It seems like you honestly believe the only motivator that works for anything is profit. You are wrong. Individuals being fairly renumerated for the service they provide is different than the whole system being required to maintain a profit. Doctors and nurses should be paid well. Hospitals as a whole should not have profit as a primary motivator. Reward the people actually doing the work and making the system better, don't require that the system as a whole has to generate additional profit. For the insurance industry, all you have to do is deny just enough care so that your reputation as a whole does not suffer, perhaps through clever promotion by other means. So, someone cuts off their finger in a wood working accident. The insurance is denied as a safety guard was removed, so the applicant did not use "due diligence". The insurance company saves 60 000 dollars in medical bills, therefore increasing profit over having to pay the claim. You would think that customer complaints and issues with service against an insurance provider would eventually go out of business. But such is not the case. The largest supplyer of long term care insurance in the US, Conesco Seniors Health and its subsiduary, Bankers life and Casualty, have the highest rates of complaints against them of any long term care insurance company. This correspondence between great service and business success does not necessarily prove true. Because the ultimate measure of success is profit, not customer satisfaction. Examples of care denied?

The profit motive doesn't work because, as illustrated in the hospital surgery example above, patient care can be compromised when profit is the primary consideration. Good care is not mandated, in the medical profession, good care is provided by people genuinely interested in helping people and who take pride in the work they provide. I have never stated that a government run system cannot fail. Of course it can. You seem to feel that a government run system cannot be improved. Of course it can. Cops are a great example of how profit is a poor motivator. Taking bribes and profitting from them is one of the sources of corruption. Here, profit is a negative motivator away from the true purpose of the position. Profit is neutral, it has no morality. In some cases it is a motivator for the desirable, greater service, greater efficiency. In some cases it is a motivator for corruption, lack of ethics, making decisions that effect the bottom line over any human considerations. Altruism is one reason, yes. Pride in work. Fascination and passion towards the subject and human care. Compassion. Being part of highly effective team. Respect. Being able to make a real difference in many peoples lives. Don't underestimate these motivations. They are the primary reason many people join the medical profession, or they would all become lawyers or CEOs (or at the very least plastic surgeons). The canadian health care system is far from perfect, but its pretty damn good. How is it that it operates as well as it does without profit as a motivator?

A mechanic who makes life threatening repairs may not go out of business due to poor customer service, as they are shut down first by the government. Once again, intervention beyond simply "not earning profit" is necessary. Unsafe practices, such as sub standard food quality, life threatening repairs, go beyond the market model and require government intervention. Even in non-life threatening cases that choice can have exteme consequences, infection, wrong medication, health is just too important to play "better luck next time" with. Not if the market is strong enough, the demand high enough, and choice limited. Thanks to our housing boom, that crappy house builder can continue working and profitting, perhaps moving his location from time to time. Even government intervention for fraud might not prevent him setting up shop somewhere else under a different name. This kind of strong market influence can not be allowed to taint the quality of health care. A shortage of care in a region should not mean the "customer" has to tolerate life effecting poor service. Oh definitely, and I can site just as many examples of poor customer service in private industry. There are different ways of tackling these issues for each. One has market influences and regulation to assist. The other has regulation and various monitoring groups to monitor quality and deal with "customer" complaints. The NY city police system was improved through government (mostly civil and local I believe) intervention. Not the introduction of private competitive policing forces. Or through a profit making police force. If the primary incentive hospitals have to save lives and provide health care is profit we are indeed in trouble. If profit was a major motivator, then less profitable surgeries would be recommended less, and a more profitable one recommended instead, even if it isn't the medically most adventageous choice. Profit cannot be a primary motivator for human health services. The best choice for the health of the patient has to be the primary concern.

Your life, or the lives of those you care about, doesn't depend on getting good customer service in other industries. Once someone dies due to poor service or lack of coverage, the option to "make a better choice next time" rings pretty hollow. For critical services, police, fire, ambulance, and hospitals, customer service is not a nice to have, your life depends on it. So, human life has to take priority over profit. As it should.

I am not arguing against the desirability and planning benefits of profit. I am arguing that some businesses, most importantly, a hospital and health care system, can be viable without requiring a focus on profit. Many of the disasters you mention can be taken care of by insurance, which is a normal part of business expenses. Even the largest companies in the world don't have enough money squirrelled away to take care of major disasters, they rely on insurance. My argument is focussed on the health care system. There is a fundamental conflict between the desire to generate profit and the desire to provide the best care possible. If care can be denied, profit goes up. There is no way around that fundamental flaw. And the fact that those who can't afford it are denied care, that is unacceptable. He should have bought insurance. Or moved to Canada. Even in the US I fail to see the lower taxation creating a larger number of people saving successfully for the future. Lower taxation does not automatically create higher personal responsibility. I believe the balance swings back and forth. The people get tired of the higher taxes and excessive social spending, and vote in right wing. Then, they see programs they themselves value or are effected by being eroded, and they vote left wing. The beauty of democracy is that no "side" ever truly gets all it wants, it is always a compromise. And this meets the needs of more individuals than any system that is entirely left (communism) or right (fascism) wing.

Not necessarily, many "Ma and Pa" stores exist (or used to exist) that, as long as they maintained stock and made a reasonable salary, were content to simply exist. Hobby stores can also be run by enthusiasts that are not in it to make lots of money, but are in it because they love the hobby and being involved in the community. As long as they are making enough money to get by, they are quite happy to continue to run their businesses. If they are officially designated as non profits. Other businesses exist and survive without those tax breaks (see above) Capital re-invested in the business to allow growth is not the same as profit, ask any small startup business owner. If that is how the business is set up, fine. But profit and shareholder support are not necessary to create a viable business. And next on fox news...

On an individual level, everyone needs to make money to function in our society. On a larger level it is not necessary for an business to make further money to survive. If the workers and owners of that business are making enough money to earn a decent paycheck, and afford all overhead and expenses, the business itself does not need to make additional "extra" money (profit), to survive. Certainly, not a great incentive for investment, but possible. Lots of "not for profit" charities exist that do pay their employees a salary and continue to survive. It is not necessary to make money to be functional. Everyone in society needs to have an income source to survive. Not every organization in society providing a service or product needs to make additional funds (profit) over expenses to survive. I have no problem supplying doctors and nurses with a reasonable and competative salary. They deserve it. But further money for other reasons, such as investors or shareholders? Not necessary in the medical system. Never made that leap. Not for profit health care does not mean those working in that industry don't earn decent money. It means stakeholders and investors don't exist, so "additonal" money beyond the salaries and costs of the system aren't required. Every potential patient supports the system through taxation. Nothing is free.