A solution for health care?

[Argus]

There is precious little talk about health care, as if it's off the radar now. That's because none of the three parties has any ideas or solutions, or if they do, they're keeping them quiet because health care is such a dangerous and expensive topic. It's also immensely complicated in that the feds pay for most of it, yet the provinces have control. getting everyone's agreement on fundamental change is almost impossible.

So here's my solution. First, take health care responsibilty away from the provinces. The costs of health care are now so overwhelming that they are overwhelming provincial budgets. As Randal Denley said in the Citizen last week, the provinces are faced with becoming little more than big health care insurance corporations with a few sidelines. They're looking at 60%-70% of their budgets having to go to health care.

Form one national Crown Corporation which will be, in effect, our national health insurance corporation with universal coverage and have them funded by a seperate, clearly defined health care tax.

Allow private clinics and hospitals. If people want to pay their health care tax and also pay for their own health care, so be it.

So who funds hospitals?

Well who funds doctors offices and clinics now? They are in fact, privately owned and operated, and they get their funding by providing services to the public and charging the government. Clearly it would be a careful balancing act on the part of the corporation to ensure it pays enough to support each type of service that hospitals will be able to supply those services, but that is not an insurmountable task.

Proposals for opening new hospitals, for construction and startup costs, would be made by local municipalities who would oversee these insitutions, and they could apply for funding from the national Crown Corporation.

It might be necessary to raise taxes to pay for this if we decide that we wish to increase services, ie, more MRIs, faster opreations, etc. I'm okay with that so long as things are done with reasonable efficiency.

[Moxie]

Adding service fees and paying a concise "Healthcare tax" would help fund a modern healtcare system but I doubt those who currently don't pay for their healthcare via taxes would be willing to shill out a dime whilst the rest of us are forced to fund rationed healthcare.

[Bonam]

I think I would oppose putting direct control of health care in all provinces in the hands of one Ottawa agency. You just know that as soon as this happens, we'll see a greater and greater portion of health care dollars flowing to provinces like Quebec, which are drastically over-represented in the federal government, while forgotten backwaters like BC will be sucked dry. Moreover, even if the system is set up to explicitly prevent such preferential allocation of funding and efforts, small, local, issues, will undoubtedly fall through the cracks more frequently in a federal agency which administers the entire nation than in a provincial agency that answers only for the province.

That being said, a separate, clear, health care tax which is used only on health care (along with a drastic reduction in the general tax) would make it easier for citizens to understand how much of their money goes where, and I do favor greater clarity and transparency.

[jdobbin]

So here's my solution. First, take health care responsibilty away from the provinces. The costs of health care are now so overwhelming that they are overwhelming provincial budgets. As Randal Denley said in the Citizen last week, the provinces are faced with becoming little more than big health care insurance corporations with a few sidelines. They're looking at 60%-70% of their budgets having to go to health care.

I don't know that the provinces would give authority. They may allow 100% funding but they will never give up responsibility to administer the program. And this could be a problem for the Feds if provinces show no restraint or divert the money as they so often do to other priorities.

Allow private clinics and hospitals. If people want to pay their health care tax and also pay for their own health care, so be it.

I think they are allowed already. Some provinces restrict doctors from working in both systems though. Not enough doctors can make a go of it outside the public system.

It might be necessary to raise taxes to pay for this if we decide that we wish to increase services, ie, more MRIs, faster opreations, etc. I'm okay with that so long as things are done with reasonable efficiency.

We now have gotten into the problem that no one will talk about taxes except to say they will cut them.

[Molly]

A shudder ran up my spine at the thought of federal administration.

The first thought to mind was the insistence of provincial health authourities that everyone should be following the same rules and procedures--so rural ambulance services had to follow the same highly restricted protocols as those that would be appropriate in the cities... The problem was that the hospitals, with their more active care, were hours instead of minutes away....

The bigger the administrative unit, the less responsive it is to local needs.

[punked]

You want to fix health care that is easy how about the Feds pay the 50% they promised instead of the 12-16% Paul Martin cut it back too. There your problem is solved. Yes you have to cut some federal programs for that but it is worth it.

[Argus]

I don't know that the provinces would give authority. They may allow 100% funding but they will never give up responsibility to administer the program. And this could be a problem for the Feds if provinces show no restraint or divert the money as they so often do to other priorities.

It is perfectly constitutional for the federal government to declare this an area of national interest and simply take over. If the provinces don't like it, they can lump it.

I think they are allowed already. Some provinces restrict doctors from working in both systems though. Not enough doctors can make a go of it outside the public system.

One of the problems we have is not enough doctors. That is not strictly related to there being not enough seats in medical schools, but also to there being not enough internships. Why? Because our hospitals have set aside as much as 1/3rd of their internships for the training of foreign doctors whose governments are paying the hospitals substantial fees. Again, a national health care service which would fund hospitals properly would obviate the need of hospitals to do that (and if not then this could simply be restricted by law).

We now have gotten into the problem that no one will talk about taxes except to say they will cut them.

I think people are willing to pay extra for health care if they know the money will actually go to health care. That is one of the reasons why I'd like to try a dedicated tax and a dedicated agency. Ontario instituted a dedicated tax but then put the money into general revenues and never spent any of it on health care.

[Argus]

A shudder ran up my spine at the thought of federal administration.

The first thought to mind was the insistence of provincial health authourities that everyone should be following the same rules and procedures--so rural ambulance services had to follow the same highly restricted protocols as those that would be appropriate in the cities... The problem was that the hospitals, with their more active care, were hours instead of minutes away....

The bigger the administrative unit, the less responsive it is to local needs.

Maybe, maybe not. Depends on the agency. What we have now is not working, and is not responsive. Maybe this would work - maybe not. But I'm willing to try, at least, and see what can be managed. Right now, with all the provinces going their own way, there's no way of getting the agreement necessary to institute needed changes.

[Machjo]

There is precious little talk about health care, as if it's off the radar now. That's because none of the three parties has any ideas or solutions, or if they do, they're keeping them quiet because health care is such a dangerous and expensive topic. It's also immensely complicated in that the feds pay for most of it, yet the provinces have control. getting everyone's agreement on fundamental change is almost impossible.

So here's my solution. First, take health care responsibilty away from the provinces. The costs of health care are now so overwhelming that they are overwhelming provincial budgets. As Randal Denley said in the Citizen last week, the provinces are faced with becoming little more than big health care insurance corporations with a few sidelines. They're looking at 60%-70% of their budgets having to go to health care.

Form one national Crown Corporation which will be, in effect, our national health insurance corporation with universal coverage and have them funded by a seperate, clearly defined health care tax.

Allow private clinics and hospitals. If people want to pay their health care tax and also pay for their own health care, so be it.

So who funds hospitals?

Well who funds doctors offices and clinics now? They are in fact, privately owned and operated, and they get their funding by providing services to the public and charging the government. Clearly it would be a careful balancing act on the part of the corporation to ensure it pays enough to support each type of service that hospitals will be able to supply those services, but that is not an insurmountable task.

Proposals for opening new hospitals, for construction and startup costs, would be made by local municipalities who would oversee these insitutions, and they could apply for funding from the national Crown Corporation.

It might be necessary to raise taxes to pay for this if we decide that we wish to increase services, ie, more MRIs, faster opreations, etc. I'm okay with that so long as things are done with reasonable efficiency.

I do agree with two-tiered healthcare. As for taxes, I'd like them to be relevent. Carbon taxes make sense since it relates to asthma. Taxes on tobacco and alcohol make sense too owing to their health effects. This woudl still ensure universal coverage while still ensuring that those who are most likely to contribute to the burden will still pay more for it. We cold possibly consider extending the tax to junkfoo? Just an idea. After all, no one would be forcing us to buy it, right?

[August1991]

What you describe Argus is largely what we have now. You make two suggestions: federal control and dedicated (earmarked in the US) money.

I agree with Molly that a federal health insurance scheme would be a disaster, worse than EI. As to dedicated funds, there are many ways for politicians to get around such so-called fenced in funds. The proposal is meaningless. In any case, we elect representatives to make decisions. I would love to see taxpayer's money spent more wisely but this is not the way to do it.

You also make the suggestion that the private sector provide all health services. While that's not excatly the case now, it's quite close. Each province decides how its central bureaucrats play around with the system. I agree with you however that provinces coudl experiment more with private delivery and lesser bureaucratic interference.

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In cost terms, we in Canada have a big advantage over Americans in that our tort laws are not so liberal. (OTOH, we also have horrendous cases of malpractice in Canada.)

At the same time, I don't think you will see much of any reform in Canada as long as public sector unions/professional associations dominate the health sector.

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You want a radical idea? Here's one. I just learned that Americans who benefit from Medicare can ask the government to divert the effective premium to a private insurer. (Maybe I have this wrong.) Imagine if you could pick your own insurer but have the government pay the premium?

That's sort of how our school system operates where you choose your school board (and school taxes) according to where you choose to live.

[Topaz]

Argus, so you think we should follow what Obama is doing in the US with the Feds taking charge? I guess it would be easier to united to the countries in the future, wouldn't it? I don't think many Canada can could afford to pay for their own. As I said before, our family was forced to take over medical payments because of a end contract with the company until the talks and a settlement is reached and its 300.00, and I don't that may seem cheap but on one-cheque then down to EI, along with mortgage and other bills, its very rough. I would think it would cost more like between 1000-2000 yrly and we wouldn't see our taxes go down any. I'm for the provinces and not the Feds.

[Alta4ever]

You want to fix health care that is easy how about the Feds pay the 50% they promised instead of the 12-16% Paul Martin cut it back too. There your problem is solved. Yes you have to cut some federal programs for that but it is worth it.

Yet that does nothing to solve the problem of ballooning health care costs as the tax payer still has to pay for it. The money still comes from the same place, my wallet your wallet everyones wallet. Lets see some ideas to acutally reduce healthcare costs.

[punked]

Yet that does nothing to solve the problem of ballooning health care costs as the tax payer still has to pay for it. The money still comes from the same place, my wallet your wallet everyones wallet. Lets see some ideas to acutally reduce healthcare costs.

Actually as a % of GDP health care costs have stayed about the same across the board. We have seen a 1.6% increase from 1970 until now or there abouts and that is below average of other countries. You are making up problems that aren't there.

http://www.cmaj.ca/cgi/content/full/177/1/51/F118

[Alta4ever]

Actually as a % of GDP health care costs have stayed about the same across the board. We have seen a 1.6% increase from 1970 until now or there abouts and that is below average of other countries. You are making up problems that aren't there.

http://www.cmaj.ca/cgi/content/full/177/1/51/F118

Your graph shows it going from 7% to 10%

[jdobbin]

It is perfectly constitutional for the federal government to declare this an area of national interest and simply take over. If the provinces don't like it, they can lump it.

I'm not sure you are right about that. Administration is the provincial responsibility. I think anything else would be constitutionally challenged.

One of the problems we have is not enough doctors. That is not strictly related to there being not enough seats in medical schools, but also to there being not enough internships. Why? Because our hospitals have set aside as much as 1/3rd of their internships for the training of foreign doctors whose governments are paying the hospitals substantial fees. Again, a national health care service which would fund hospitals properly would obviate the need of hospitals to do that (and if not then this could simply be restricted by law).

One of the main reasons why there were problems is how deep the cuts were to medical school slots. I agree internships also have to be expanded.

One thing we know for certain is that education is a provincial responsibility. The Feds had no hand in the cuts to the medical school slots. Many provinces believed it would control costs.

I think people are willing to pay extra for health care if they know the money will actually go to health care. That is one of the reasons why I'd like to try a dedicated tax and a dedicated agency. Ontario instituted a dedicated tax but then put the money into general revenues and never spent any of it on health care.

I think the debate is necessary. I just don't know if it will withstand the hysteria as soon it is talked about.

[jdobbin]

You want to fix health care that is easy how about the Feds pay the 50% they promised instead of the 12-16% Paul Martin cut it back too. There your problem is solved. Yes you have to cut some federal programs for that but it is worth it.

Which ones?

[punked]

Your graph shows it going from 7% to 10%

And if you look we do better then all other countries. US increase of 8%, Spain 5%, UK 5%, France 6%. Yes we have put a little more into health care but your assertion that costs are ballooning is a bit silly over the last 35 years we have seen both a dip and climb in % of GPD but nothing like the the US or even France.

[Alta4ever]

And if you look we do better then all other countries. US increase of 8%, Spain 5%, UK 5%, France 6%. Yes we have put a little more into health care but your assertion that costs are ballooning is a bit silly over the last 35 years we have seen both a dip and climb in % of GPD but nothing like the the US or even France.

It doesn't matter the cost still comes out of mine and your taxes, shifting the tax burden from provincial to federal does nothing to help ruduce the cost of health care, nor does it do anything to increase the quality of the care.

[punked]

Which ones?

Depends on what we value as a country. I hear we spend 500 million on Canadian athletics.

[punked]

It doesn't matter the cost still comes out of mine and your taxes, shifting the tax burden from provincial to federal does nothing to help ruduce the cost of health care, nor does it do anything to increase the quality of the care.

It puts more money into health care.

[Alta4ever]

Depends on what we value as a country. I hear we spend 500 million on Canadian athletics.

I hear we spend 30 million on policical parties, I also hear we will be spending another 300 million on an election this fall because the liberals NDP and Bloc think going back to the polls will bring about a different result. Will the NDP vote against the comming liberal motion of non confidence to save the tax payer 300 million on another election that will return the same result.

[Alta4ever]

It puts more money into health care.

It does not, it sifts the burden from provincial to federal, the same amount will still be put in.

[punked]

I hear we spend 30 million on policical parties, I also hear we will be spending another 300 million on an election this fall because the liberals NDP and Bloc think going back to the polls will bring about a different result. Will the NDP vote against the comming liberal motion of non confidence to save the tax payer 300 million on another election that will return the same result.

See tough choices but we can agree 300 million for an election when a PM has set a fixed election date and just lied about it, is silly that money can go to health care.

[punked]

It does not, it sifts the burden from provincial to federal, the same amount will still be put in.

We both know that isn't true their are plenty of provinces who would love to put more money into rural hospitable, and doctors that can't becuase they still need roads, schools, and so on.

[Alta4ever]

We both know that isn't true their are plenty of provinces who would love to put more money into rural hospitable, and doctors that can't becuase they still need roads, schools, and so on.

They will take tyhe fifty percent of the funding but reduce the contributon they make to so they have more money for other projects.