Healthcare, Alberta versus Canada

[maplesyrup]

Martin's bid may tempt Klein to fight

Conservative Leader Stephen Harper will plead with Mr. Klein not to take the bait; the last thing the Tories need is to fight an election with their Alberta counterparts advocating private health care. But Mr. Klein does not care all that much about what happens to his federal cousins. He'll make up his mind, based on what he perceives is best for his province.

So let's see what happens on the weekend. We may get our first taste of how far Ralph Klein is prepared to go to confront Paul Martin for the future of health care. In which case, Pierre Pettigrew will have about the most thankless job in politics: getting Ralph Klein and Paul Martin to agree.

Never mind that Ibbitson does not completely make sense with his musings - Liberals do not want to agree with Klein, this is going to be the hot button election issue.

[willy]

This doesn't make much scene.

The Alberta government has developed a three way partnership between the health regions, the province and the physicians. They are moving aggressively to a primary health care model.

They are the most progressive province in the delivery of health care.

They are not going towards a private insurance system or private hospitals. I would say they are trying to get people out of hospitals and back to a GP who is their gateway to the rest of health care.

[maplesyrup]

I would challenge the view that Albertas approach to healthcare would be considered progressive by most Canadians.

[willy]

Details, Maplesyrup.

Compare their waiting lists, specialists access, infastructure and labour agreements. Best in the country.

Why are they not progressive? Because they are Conservatives.

Fiscal responsibility does not mean lack of social responsibility.

They are ahead of the curve, and I am open to be proven wrong but I don't think it is likely.

[Black Dog]

They are not going towards a private insurance system or private hospitals. I would say they are trying to get people out of hospitals and back to a GP who is their gateway to the rest of health care.

That's not what's coming out of Gary Mar.

Mar says Alberta wants broader reforms, including a bigger role for the private sector and patients who pay more of the cost directly either through user fees or supplementary health insurance.

Mar wants federal health money with no strings

The Alberta government wants increased private involvement in health care for two reasons:

one is ideaological (the mistaken belief that private health is cheaper and more efficient) and the other is just greed (Alberta government officials enjoya pretty cozy relationship with insurance companies, that's why folks like Don Mazenkowski end up shilling for the private sector after their political careers end). Ultimately, the Cons are simply trying to put a bullet in the head of a once-effective public system that they've been starving for more than a decade.

[willy]

1/3 of all provincial government revenues is not starving a system. The system is one we can not afford to have.

I personally don't want public health care if it endangers my health when I need to rely on it.

The Alberta government is looking at delisting non essential services and you are right they have talked about a nominal fee for service. This is not to generate revenue but to communicate to the public that this is not a free service. They want to curb the misuse of the public system.

GPs run private offices and are paid by public insurance. Is this the privatizing that has you so concerned?

Alberta still has the best run health system in the country. As I said, compare them. If Alberta is starving the system and that is the problem what is the problem in Saskatchewan and Manitoba with good NDP governments.

When health care started we did not have the expensive new technology, and drugs to afford. We need a rethink on this one.

[maplesyrup]

Why is Alberta lookin at private involvement in healthcare when there has never ever been any evidence to show that it is more economical? This is just a sop to their supporters in the business community.

[willy]

Again,

They are going from a hospital based system to a primary care based system.

New system.

Teams of physicians in the community working with nurses as a team. Radical and just happens they will probably own there own practices.

Not a private public debate. Not that simplistic. This does offer a real positive change for you or me who need help from someone who knows them, when they need it. What they have also done with electronic health records is also very progressive.

[Black Dog]

1/3 of all provincial government revenues is not starting a system. It is one we can not afford to have.

No. Alberta (and the feds) chopped funding to the health system dramatically. In three years (1993-1996), Alberta went from having the second highest level of spending per person on health care to the second lowest. Recent boosts to health care funding have not kept pace with the explosion in the province's population and corresponding need for services as well as inflation.

Cuts also led to massive staff cutbacks, which remains a chronic problem in the system. There's just not enough staff, bed's and cash to meet the needs of the growing population.

In the end, it's not a matter of affordability (that the system is inherently unsustainable is merely a canard), but of funding. Remember, Alberta is the richest province in Canada: howall those riches are spent is a matter of priorities. The KleinCons lack the political will to make sustainable, well-funded health care one of their key prorities. As for the "1/3 of provincial revenue"claim: it's not how the money is being spent, but what it's spent on. In other words, health care eats a bigger chunk of the pie not because of spending increases (which have been negligible; Alberta spent about 25 per cent of revenues on health in the '80s compared to roughly 35 per cent today), but because of reduced spending in other program areas.

They are looking at delisting non essential services and you are right they have talked about a nominal fee for service. This is not to generate revenue but to communicate to the public that this is not a free service. They want to curb the misuse of the public system.

Delisting services isn't new. As for service fees: we already have 'em: they're called health care premiums, themselves a form of hidden taxation.

GP run private offices and are paid by public insurance. Is this the privatizing that has you so concerned?

By public insurance, I assume you mean the Alberta Health Care Insurance Plan (y'know, the same one the KleinCons are eager to turnover to the greedy buggers in the insurance industry). In that case, yeah, I have a problem with profit motivated private operators raking it public dollars.

If they are starving the system and that is the problem what is the problem in Saskatchewan and Manitoba with good NDP governments.

Revenue.

When health care started we did not have the expensive new technology, and drugs to afford. We need a rethink on this one.

Then we need to look at how th esystem can address specific challenges like the one's you cited. Not throw the public model baby out with the bathwater of unjustified hysteria over rising costs.

[willy]

"There's just not enough staff, bed's and cash to meet the needs of the growing population."

Staff is a North American/the world problem in health care. Not enough nurses and physicians are available.

It is not the support staff that limit surgeries or services available. It is cheaper to operate than it is to wait but they can’t because of the limited human resources.

They are moving away from a bed model and into community care model. I know I would rather be sick at home and not in the hospital.

"In the end, it's not a matter of affordability (that the system is inherently unsustainable is merely a canard), but of funding. "

Here we will have to agree to disagree. With the aging population resources will be stretched to the limit. It is about affordability. If we only invest in health care the education systems, transportation, etc. will negatively affect our ability to pay for healthcare. (Reduced revenues)

"As for the "1/3 of provincial revenue"claim: it's not how the money is being spent, but what it's spent on."

Health and Wellness program spending will increase by 8.4 per cent to $8 billion in 2004-05. With a population of 2.5 million that is $3200.00 per person every year.

Total budget is 23 Billion and that makes it 35 percent of the budget. That would make it look important to me.

Alberta did reduce spending in the early 90's to get out of the position that Getty put the province in. Now they will be debt free next year. Think of the long term resources they will have to invest into their communities. This took 12 years to accomplish and they did it. What an amazing accomplishment.

"As for service fees: we already have 'em: they're called health care premiums, themselves a form of hidden taxation."

Insurance premiums (which are not paid by people who make less than $20 000.00) are not the same as user fees. User fees are thing people who use the system pay, unlike a premium that is paid by most tax payers.

As for this notion of profit, when was the last day you worked for nothing. Should those that provide a valuable service not get paid? Put another way should they not profit.

The public model as it is, is sick and needs some medicine. The union contracts make is harder to change and are restrictive to management decisions. Contracting out is not staff reductions, it gives managers the ability to organize work more efficiently and hopefully reduce cost effectively.

Nuff said.

[August1991]

Ultimately, the Cons are simply trying to put a bullet in the head of a once-effective public system that they've been starving for more than a decade.

I like that one BD. Blame the Cons for the collapse of socialized medicine.

In the end, it's not a matter of affordability (that the system  is inherently unsustainable is merely a canard), but of funding.

But it is inherently unsustainable. And I agree that for now it's a question of funding. We spend about 8% of GDP on health whereas the Americans spend about 12%. Of course, they're richer so they can afford to spend more on luxuries like health. (BTW, the rich spend proportionally more of their income on health than the poor. Health services are like airline tickets.)

The Alberta government wants increased private involvement in health care for two reasons: one is ideaological (the mistaken belief that private health is cheaper and more efficient) and the other is just greed

A GP is in the private sector. What's wrong with privately provided services paid for publicly? Our military works that way. (Dare I say it? That's how the government buys flags for post offices.)

There are more fundamental points in my view:

The demand for health services is much larger than the supply for the simple reason that health services are free. This is unsustainable.

The only reason our health system has been sustained is because we have a two-tier system - our second tier is the US. The wealthy in Canada go to the US and pay for medical services. They avoid all these waiting lines and so on. (This explains in part why health is a bigger portion of US GDP. The US exports health services to foreigners.)

Do you believe that Canadian citizen hockey players use their health cards as you and I do? Do you think that Paul Desmarais even has a Quebec health card?

Black Dog, do you really believe that PM PM and his family go through the same hassles as you and I do when going to a doctor? (PM PM is over 65 and I'm sure he sees a doctor often.)

IMV, state funding of health services is critical to a civilized society; and state funding is the best way to organize them. But how?

It's the insurance scheme that should be State organized. And that's it, that's all.

IOW, I think the federal government should pay each Canadian's health insurance premium using money collected from all Canadians. The government should get out completely from health except to say to Canadians, "You're covered. We Canadians pay premiums the Canadian way. That's Canada. To be Canadian, it means that we share the risk."

Last Point. While Canadians say health is an important electoral issue, I suspect that it's not. When Canadians say "health system", they mean many things ranging from "I'm not American" through "We need a good government" to "I'm afraid of dying". Eyes glaze over with the nitty-gritty.

[maplesyrup]

healthcare is nowhere near collapsing.

Most Canadians realize, backed by Canwest, the right wing politicians just want a little graft, or maybe a lot of graft, for their financial backers.

[willy]

"healthcare is nowhere near collapsing."

We have a huge age bubble that will retire and use our health care system to the max. Boom then bust.

New procedures and drugs are very expensive.

We have a skilled human resources shortage. We have to few doctors and when they are becoming doctors they don’t choose family medicine.

Nurses are also in shortage. Especially nurses with specialties like surgery or trauma.

We have an aging infrastructure that is centered around hospitals that do not reflect the needs of our changing population.

Is this a system that you would want to get sick in? We have good doctors and nurses but they are overwork and don't have the tools to do the job. Our governments don't have endless pockets as 1/3 of the provincial budget is already allocated to health care.

Maplesyrup, do you not see any problem with this? No pressing need for a change? Anything at all?

Example in one province. They are all similar with the issues.

By DARREN YOURK

Globe and Mail

An interim report into the SARS outbreak calls Ontario's public health system "woefully inadequate" and says the province was saved from further disaster by the heroic efforts of dedicated front line health care and public health workers.

"SARS showed Ontario's central public health system to be unprepared, fragmented, poorly led, uncoordinated, inadequately resourced, professionally impoverished, and generally incapable of discharging its mandate," the report, written by Mr. Justice Archie Campbell, says. "The SARS crisis exposed deep fault lines in the structure and capacity of Ontario's public health system."

[August1991]

Willy, everything you say, applies in the US also. So, what is the best way to deal with these problems? The Canadian way seems good, no?

[playfullfellow]

Just wondering what is wrong with a two tier type medical system? In Alberta, we have laser eye surgery set up in private clinics. The success of this system seems pretty good as the cost has dropped over the years, the waiting time is minimal and the succes rate extremely good. Why can we not see more non-essential services privatised? What is wrong with people having a choice? We have a choice now, Canada or the US, is it not better if we had more services here in Canada and keep the money here at home?

[Black Dog]

With the aging population resources will be stretched to the limit. It is about affordability. If we only invest in health care the education systems, transportation, etc. will negatively affect our ability to pay for healthcare. (Reduced revenues)

No where did I say we had to abandon everything else to invest in health care. Indeed, underfunding of infrastructure, municipalities and public services other than health care is chronic as well. The problem is we have a province that has thrown billions away on debt-elimination (as oppossed to a sensible debt management policy) and still accumulated vast surpluses while drastically slashing programs and costs. This has, predictably, led to a decline in quality across the board.

Insurance premiums (which are not paid by people who make less than $20 000.00) are not the same as user fees. User fees are thing people who use the system pay, unlike a premium that is paid by most tax payers.

Problem is, they want user fees in addition to premiums (themselves a regresssive tax). This in a province that boasts of low taxes?

But it is inherently unsustainable. And I agree that for now it's a question of funding. We spend about 8% of GDP on health whereas the Americans spend about 12%. Of course, they're richer so they can afford to spend more on luxuries like health.

Consider the U.S. spends more on health car per capita, yet 43 million people have no health coverage and another 50 million have inadequate coverage.

That's the "private" system in action.

Just wondering what is wrong with a two tier type medical system? In Alberta, we have laser eye surgery set up in private clinics. The success of this system seems pretty good as the cost has dropped over the years, the waiting time is minimal and the succes rate extremely good. Why can we not see more non-essential services privatised? What is wrong with people having a choice? We have a choice now, Canada or the US, is it not better if we had more services here in Canada and keep the money here at home?

The problem with two-tiered health system is that not everyone can afford to pay for health services on their own. In a two tier system, doctors and other medical staff could make more money in the private system. With fewer doctors available to work in the public system, waiting lists grew longer. The government was also forced to dramatically increase the amount it pays doctors in order to keep them working in public hospitals. The result: rising costs for taxpayers.

Another problem with two-tiered medicine: it doesn't work. Britain, the U.S., Australia, Sweden have all tried the private model and, in every case, costs have increased while quality has deteriorated.

I guess my final point about health care is that the health of citizens is a tremendous asset to a country. Health care services are simply too important to be given into the hands of those who's only interest is to maximize profits.

[Hugo]

Another problem with two-tiered medicine: it doesn't work. Britain, the U.S., Australia, Sweden have all tried the private model and, in every case, costs have increased while quality has deteriorated.

I want to see a source for that information, because I have heard the exact opposite.

The Guardian of the UK reports that, only 3 years into a 10-year plan, heart disease deaths were reduced 14%, cancer deaths by a similar amount, waiting lists are down, there are increases in staff, increasing availability of hospital beds and decreasing reliance on expensive hospitals.

According to research by Margit Gennser, in Sweden, since the moves towards privatisation beginning in 1975, healthcare professional numbers have increased vastly - 200% more nurses and doctors and 600% more assistant nurses - despite no growth in GDP during the same period. In addition, since doctors began being paid a flat rate rather than a per-patient fee, hospital productivity has dropped sharply. The biggest complaint in Sweden right now is that there are not enough private clinics which denies their superior services to many people and removes consumer choice!

The Canadian system is fundamentally broken. Did you know that not a single country in the entire world has replicated Canada's Pearson healthcare scheme? Would this be the case if it was inherently better?

Healthcare is a good like any other. As you increase availability and lower prices, demand increases. Look at foodstuffs, cars, televisions, as the prices dropped and availability rose, consumption of all has risen.

Now, what happens when you make the availability unlimited and the price, nothing? You have a situation where supply can never meet demand, because demand will be infinite. This is the inherent problem in state-run healthcare. In other fields, such as the aforementioned foodstuffs, cars, and televisions, consumer demand is being met. There is neither a glut of these goods rotting in warehouses nor queues of disgruntled customers trying to buy more than there are available.

It doesn't take a brain surgeon to figure out the answer to that one.

[willy]

“No where did I say we had to abandon everything else to invest in health care. Indeed, under funding of infrastructure, municipalities and public services other than health care is chronic as well. The problem is we have a province that has thrown billions away on debt-elimination (as opposed to a sensible debt management policy) and still accumulated vast surpluses while drastically slashing programs and costs. This has, predictably, led to a decline in quality across the board.”

BD, do you have a personal budget? If you do you might pay 1/3 to housing. Say you own your own house and you thought the cost were fixed. Then your roof went, your boiler, and you had mold. No problem you borrowed the money and now the house is up to ½ you budget (must pay the banker). Do you now drop your car, your clothing, or your food budget? When more of you revenue focuses on one area others will be reduced. Scarcity is real.

This example is too simple but it really isn’t much different. The only answer to your riddle is to increase taxes. When you increase taxes you run the risk of shrinking your economy and then not necessarily increasing revenue.

August1991, yes the US has similar problems. The one common element that most of the western world has was an evolution into a healthcare system. At no time was it planned. Hospitals were made by the churches a lot of the time and then the state got involved. Hospitals were where you went to die. Family doctors used to be fixtures in the community and were where most people went for health care. Now it has evolved and the system focuses around hospitals. Now weather it is private or public we have a cultural system of how we use health care.

Solutions for the challenges in Canada. (will always be some problems but you either get better or worse, nothing stays the same)

Have your family physicians as the major entry point into the health system. Have them work in small teams who know each others files (24 hour care). Have nurses treat and diagnose simple cases and the physician’s just check their work. (Similar to the dentist model) Have the government run grant programs to help these physicians buy and maintain equipment. This will help reduce multiple tests for the same patients. An electronic health record that can be accessed will also cut down on expensive testing.

With expensive equipment have private run clinics for MRI, CTs, ect. Quick access and investors pay the bill for a return over time. Regulate prices in the industry to insure the public insurance will not be taken advantage of.

Private or public hospitals are not a useful debate. We need hospitals for surgeries and long term care. How they are run and paid for should be based on a pragmatic situation. If you have a hospital in Vancouver that will always be busy, a private company could offer all services and make money. The NWT need hospitals and they may not ever be profitable; the government has a responsibility to ensure access to health care.

The services that are not profitable should be provided by the government. (run and paid for)

Have a clear set of civil litigation and realize a good Doctor or clinic will attract patients.

Charge a small user fee but don't refuse service. (chronically ill could get exempted)

I would also reduce the patent laws on drug companies. Right now from my understanding they get 10 years of monopoly. I don’t know the number but 4 or 5 years should suffice and where it doesn’t drug research should be subsidized by the government.

These aren’t my answers, they come from many sources. We just need the political will to have it happen.

[Black Dog]

The only answer to your riddle is to increase taxes. When you increase taxes you run the risk of shrinking your economy and then not necessarily increasing revenue.

Another canard. There are other ways for the government to generate revenue, such as increasing revenues collected from resource industries. (The Klein government has killed that golden goose: Alberta takes in less than half of the revenue per unit of oil and gas produced in the province than the Lougheed government did 15 years ago. Alberta also claims a much smaller share of the resource pie than governments in other major oil and gas producing regions. So there's billions of dollars out there, waiting to be tapped.)

Raising taxes (or more specifically, establishing a progressive taxation system) is still the best way to raise revenue.

But let's talk a few solutions:

• A national Pharmacare program. A national plan would help control drug expenditures, which are one of the fastest rising health costs.
  
• A national home care program
  
• Increased focus on health education and promotion - both to promote healthy lifestyles and to address broader social factors like poverty and inadequate education that are linked to poor health.
  
• Stable funding at teh both the federal and provincial levels.
  
• Increase efficiency by establishing alternatives to fee for service practices and explore cooperation between health service providers
  

"It's high time that we in the private sector went on record to make the case that Canada's health care system is an economic asset, not a burden, one that today, more than ever, our country dare not lose the fact is that the free market, as desirable as it is, cannot work in the context of universal health care." - Charles Baillie, CEO Toronto Dominion Bank

[August1991]

Willy, I largely agree with your post although I'm no expert on health care.

The services that are not profitable should be provided by the government. (run and paid for)

It seems to me that if the government offers health insurance, then it will always pay the costs.

Consider government auto insurance. Nobody suggests that the government should also run car repair garages - even in distant, small towns.

Have your family physicians as the major entry point into the health system. Have them work in small teams who know each others files (24 hour care)....

These proposals make sense but I wonder if any single institution should plan or organize health care. It implies "State Planning Committee". I recently visited someone in a hospital in Montreal. I was struck by the ancient computer "system". Various portions of the hospital were undergoing renovations but the work sites seemed "abandoned". I was reminded of a centrally-planned economy where bureaucrats make arbitrary decisions.

what happens when you make the availability unlimited and the price, nothing? You have a situation where supply can never meet demand, because demand will be infinite.

So, so, true but it's even worse. Without a price, all the "internal" prices don't work either. Hospital administrators have no way of knowing how to organize their operation. I suspect that many use American practices as a benchmark and then fudge around it.

The problem with two-tiered health system is that not everyone can afford to pay for health services on their own. In a two tier system, doctors and other medical staff could make more money in the private system.

BD, we have all of that now. The second tier is the US. It is one reason that our Canadian health system has survived as long as it has - the US offers an escape route for many people.

I guess my final point about health care is that the health of citizens is a tremendous asset to a country. Health care services are simply too important to be given into the hands of those who's only interest is to maximize profits.

The general well-being, happiness, standard of living are assets to Canada. And we are a successful country precisely because we let profit-maximizers provide for us.

BD, is "profit" a dirty word? Is it bad to maximize profits? Because underneath it, "profit" is simply a numerical test to ensure that a benefit provided is of greater value than the cost of producing that benefit.

[Black Dog]

BD, is "profit" a dirty word? Is it bad to maximize profits? Because underneath it, "profit" is simply a numerical test to ensure that a benefit provided is of greater value than the cost of producing that benefit.

Prtofit, in and of itself, is not necessarily a bad thing. But, contrary to what some might think, health care is not a commodity to be sold and paid for, like cars, TV's and dishwashers. It's a vital public service and, as such, the focus should be on providing the best possible service to everyone, regardless of income or ability to pay. Take a look at the profit-driven U.S health care system where more than 40 million people are uninsured and tell me if that's really a road we want to go down.

[willy]

BD, you are full of rhetoric. No where in this post has anyone argued for the American system. I argue for a new system. Enough with the who owns the delivery argument. Focus on outcomes.

In Canada right now you have to wait two years for most none life threatening surgeries. These include extreme back pain, hip replacements, knee surgeries, ect. Should our system be defended as the one to keep? What is the difference between no insurance and no access? The only difference is that no access happens to everyone. Public prevision is a mandate not a prescription.

[Hugo]

health care is not a commodity to be sold and paid for, like cars, TV's and dishwashers. It's a vital public service

Are power and potable water not also vital public services? Are they not sold and paid for?

tell me if that's really a road we want to go down.

The road we are going down is much worse. The Canadian council of radiologists has condemned the Canadian system and urges anyone needing a CAT or MRI scan to scrape up the cash and go south of the border if they value their health. They say that the obsolescence of Canadian equipment leads to many false diagnoses and the poor availability of that equipment and of staff trained in its use lead to long waiting times, in which people can actually die of the disease they were waiting to have diagnosed, let alone treated. This is because, without any competition, the Canadian service has absolutely no incentive to provide better or more timely service.

The Canadian council of cardiology has joined them in condemnation, because American heart-attack survivors have, on average, a longer and higher-quality life than Canadians. They cite an example of a finger-sized device that is used to monitor the cardiac state and can advise the patient if they need to take medication before the situation worsens. They cost a few thousand dollars, and virtually every American heart-attack survivor has one. They are invaluable in preventing repeat attacks.

The Canadian service does not provide these. Instead, they wait for the patient to keel over at his desk or behind the steering wheel, drag the guy back into the ER for defibrilation and recovery priced per incident at about 20 times the cost of one of the American devices. Ironically, these devices are actually manufactured in Canada. Once again, with no competition, the Canadian system has no incentive to save money by investing in these devices (infinite supply of tax money) and no incentive to provide better service (they are the only providers).

the profit-driven U.S health care system where more than 40 million people are uninsured

Did you ever inquire as to why they are uninsured? A great many fit and healthy 18-30-year-olds don't bother with health insurance, they don't feel it's necessary and they would rather spend the cash on something else and just pay out of pocket should the untoward happen. I wouldn't buy health insurance, I'm in perfect health and I haven't had to see a doctor in 5 years, but thanks to the Canadian system, my choice is removed and I pay anyway.

[August1991]

Did you ever inquire as to why they are uninsured? A great many fit and healthy 18-30-year-olds don't bother with health insurance, they don't feel it's necessary and they would rather spend the cash on something else and just pay out of pocket should the untoward happen.

Good point.

There has been some suggestion that the government should provide only "catastrophic health insurance".

Not to change the subject but there are a few other variables ignored in this thread.

1) Unhealthy taxes. We do that now with cigarette taxes/regulations.

2) Women use health service much more than men.

3) Employees in Canada's health sector are entirely unionized or "associationized".

[willy]

Politicians need to stop the "dance of the dollars" and free up money for health care now, says the president of the Canadian Medical Association. Dr. Sunil Patel was skeptical whether Prime Minister Paul Martin's promises of more money as well as a health summit with the premiers this summer would produce the kind of results the system needs.

Global News Service

I am not the only one who doesn't trust PM PM to put the money where his mouth is.