Should we adopt two-tier health care?

Machjo · August 14, 2009

Or there could be one doctor for all of Mapleleaf land and rich man offers that doctor 2000 dollars to be his doctor exclusively, for the public sector to get him back everyone now has pay 300 dollars each. Ouch. Inflation in a competitive system it sucks.

But wouldn't that increase in demand eventually attract more doctors? So what you're describing could only be a temporary state of market disequilibrium owing to initial increase in demand. The increase in demand would raise the value which would eventually attract supply until equilibrium is met with more physicians than before. So do we sacrifice future potential just for short-term stability?

segnosaur · August 14, 2009

So what you're saying, in a rod about way, is that only studies that say the US is better are right. I got that.

No, what I'm saying is that if there IS proof, this study likely isn't it.

Kind of like the existance of alien life... there MAY be proof out there, but if someone takes a picture of an old hubcap they tossed in the air and claims "UFO", rejecting THAT evidence as faulty does not mean that ALL evidence will be rejected in the future.

My personal opinion is that the US system is probably better than Canada's and probably every other country in terms of its overall ability to treat patients, And the WHO rankings provide evidence of this. Patients can get access to the best possible medical technology, and can usually get treatment much faster than in other western countries. However, I do acknowledge that they have a much more expensive system, and that there is a disparity between treatments available to the wealthy and the poor. Whether you choose to judge a health care system based on the treatment available to the average person or the poorest person is a personal choice.

If I see convincing evidence showing that treatments available in the US are NOT better than in Canada or other developed countries, I will change my opinion. I just recognize that this particular study is not that evidence.

Topaz · August 14, 2009

I was watching Hannity the other night, and he had on Daniel Hannian, who is a British Conservative, which he didn't mention, just that he was from Britain, and he thought the US was crazy for going to universal healthcare, when its been proven in England, that cost are going up and patients are getting treatments they should. I think every country has problems with their healthcare, the point is what do they do to correct it. GP's are in short supply in Canada and the US and as they aged, both countries will have shortage even more than now. I think the only way a two-tier system could work is, that the people not paying for their own healthcare out of pocket, comes before, the person going to private healthcare. We don't have enough DRs and sot he public has to be first in line for treatment.

Smallc · August 14, 2009

No, what I'm saying is that if there IS proof, this study likely isn't it.

Of course not. You don't agree with it's methodology or findings. That doesn't make it's results untrue. Canadians live longer lives and in many areas have better medical outcomes (as do many other world citizens). A few in the US do have access to very advanced treatments not available in Canada, something that has more to do with population than system type, but often our system provides for Canadians to get those treatments as well. Our system isn't perfect, and still needs work, but it certainly isn't bad.

Machjo · August 14, 2009

I was watching Hannity the other night, and he had on Daniel Hannian, who is a British Conservative, which he didn't mention, just that he was from Britain, and he thought the US was crazy for going to universal healthcare, when its been proven in England, that cost are going up and patients are getting treatments they should. I think every country has problems with their healthcare, the point is what do they do to correct it. GP's are in short supply in Canada and the US and as they aged, both countries will have shortage even more than now. I think the only way a two-tier system could work is, that the people not paying for their own healthcare out of pocket, comes before, the person going to private healthcare. We don't have enough DRs and sot he public has to be first in line for treatment.

The birthrate is still high in some countries. Nothing immigration can't handle.

As for medicare being more expensive than a strictly private system, of course: after all, it's coverage is wider too.

segnosaur · August 14, 2009

Of course not. You don't agree with it's methodology or findings. That doesn't make it's results untrue.

Nor does it guarantee that the results are true either. At best, it makes the results irrelevant.

Canadians live longer lives...

You're right, they do (at least compared to Americans). But there may be reasons for that other than health care.

The U.S. has a higher murder rate than Canada. They also have a higher rate of automobile accidents. In many cases, those individuals will die before they ever get access to the medical system to handle their 'problem'. And both of those will reduce the 'average' life expectency.

(There may also be differences in diet, weight, etc. that can also be contributing factors).

... and in many areas have better medical outcomes (as do many other world citizens).

That may or may not be the case (I haven't seen any convincing evidence that it is.)

Even if some countries may be better at handling some diseases however, that doesn't necessarily mean that the health care system as a whole is better. A system that better handles the problems of 90% of all people is better than the system which better handles the problems of the remaining 10%.

A few in the US do have access to very advanced treatments not available in Canada, something that has more to do with population than system type,

It also has a lot to do with the extra money that they spend. Its given them more MRIs per capita, more PET scanners, etc. Its also attracted many doctors.

...but often our system provides for Canadians to get those treatments as well.

Yes, often it does. But if you're trying to compare government run vs. private health care, then you need to ask more than just "does the Canadian system usually meet our needs.

Our system isn't perfect, and still needs work, but it certainly isn't bad.

I never said it was bad. I also never said that the U.S. system is necessarily better than Canada's. I've already acknowledged the problems in the U.S system.

I think a mix of private and public health care (as is used in most of the western world) is the best way to go. Unfortunately, here in Canada we seem to have this deep-rooted fear of 'privatization' (usually assuming it means bringing in an American style system), when a better model can be found in places line Europe or Japan where private and public systems co-exist.

Smallc · August 14, 2009

There is no reason for further privatization. Canadians don't want it. Private delivery is fine, as long as it can be done cheaply. There is no reason that people should be able to buy care faster than others. Every system has its strengths and weaknesses. Ours is just like any other in that regard. There are some problems with our system, but overall, it works well. Making it better requires improvement, not wholesale change.

bush_cheney2004 · August 14, 2009

....A few in the US do have access to very advanced treatments not available in Canada, something that has more to do with population than system type, but often our system provides for Canadians to get those treatments as well.

Of course.....they go to the USA!

bush_cheney2004 · August 14, 2009

.....There is no reason that people should be able to buy care faster than others.

There are lots of reasons...you just don't agree with any of them. Other patients and providers feel differently than you, and that's OK.

Machjo · August 14, 2009

I think a mix of private and public health care (as is used in most of the western world) is the best way to go. Unfortunately, here in Canada we seem to have this deep-rooted fear of 'privatization' (usually assuming it means bringing in an American style system), when a better model can be found in places line Europe or Japan where private and public systems co-exist.

I think this is a problem in both Canada and the US. Americans look at the Canadian system of nearly totally public health care, and it just appears too extreme for them. And whenever Canadians think of any kind of privatization, they think US. Neither of these systems is a particularly good system because they both go too far in one extreme or another. Both countries should be looking not to each other, but beyond. If they should do that, they could both meet halfway. Most of it is just irrational fears and dogmatism on both sides.

Machjo · August 14, 2009

There is no reason for further privatization. Canadians don't want it. Private delivery is fine, as long as it can be done cheaply. There is no reason that people should be able to buy care faster than others. Every system has its strengths and weaknesses. Ours is just like any other in that regard. There are some problems with our system, but overall, it works well. Making it better requires improvement, not wholesale change.

Let's took at the practical reality. To have perfect healthcare for all would mean a sharp tax hike unlikely to occur even in Europe, let alone Canada. In Europe, instead of sacrificing the masses for their ideology, they were wiling to make practical compromises by increasing taxes as far as was politically feasible to improve public healthcare, and then allow for a two-tier system to allow the rich to step out if they want to so as to reduce the burden on the system for the rest, thus maximizing all healthcare. To make the poor suffer just to teach the rich a lesson is vindictive but with no pratical benefit for the poor whatsoever. In fact, the more the rich bow out of the public system, the more the poor benefit.

Machjo · August 14, 2009

We shouldn't aim at eqaulity at all cost even if it hurts the poor. If allowing the rich to bow out can help the poor, then we ought to let it happen. It's not up to us to sacrifice the poor to teach the rich a lesson.

segnosaur · August 14, 2009

There is no reason for further privatization. Canadians don't want it.

There are polls that disagree with you...

Of the 1000 adults polled..., 30% preferred scenario 3 and 29% preferred scenario 2, 26% the status quo and only 15% scenario 4.

http://www.cmaj.ca/news/08_06_06.shtml

So, when all options are clearly layed out, it seems that Canadains may not be that opposed to some private health care. (The other options in the article described various mixtures of public and private heatlth care.)

Private delivery is fine, as long as it can be done cheaply. There is no reason that people should be able to buy care faster than others.

Actually, there is a reason to allow people to buy care faster.

You see, when healh care is controlled by the central government, decisions are made based on what the government at the time thinks is important. And beauracracy is often slow to change, since there is often no incentive to do so.

On the other hand, when you allow privatization, it provides a much better measure of what the people themselves think is important. (i.e. if someone thinks hip replacement surgery is important, they can pay for it out of their own pocket, even if the government things (perhaps wrongly) that such surgery is not needed.

Every system has its strengths and weaknesses. Ours is just like any other in that regard. There are some problems with our system, but overall, it works well. Making it better requires improvement, not wholesale change.

Countries in Europe successfully mix private and public health care. Coverage is universal, and the responsiveness is usually ranked higher than that in Canada. So what would be wrong in adopting some of those methods?

bush_cheney2004 · August 14, 2009

We shouldn't aim at eqaulity at all cost even if it hurts the poor. If allowing the rich to bow out can help the poor, then we ought to let it happen. It's not up to us to sacrifice the poor to teach the rich a lesson.

True....because we can't teach the rich a lesson anyway.

They will always be able to buy another solution.

Machjo · August 14, 2009

True....because we can't teach the rich a lesson anyway.
They will always be able to buy another solution.

You have a point there. If we ban private healthcare altogether, they'll just go to the US anyway, thsu exporting medical jobs too. If we allow private healthcare, then at least those physicians stay in Canada, pay their taxes in Canada, and who knows, some of them might even work for the public system part time too. So it really woudl be a win win situation. Why would we want to flush that all away just over ideology?

bush_cheney2004 · August 14, 2009

....Why would we want to flush that all away just over ideology?

Because for some people, ideology is all that matters. Private-Public systems are arguably the best approaches for cost, access, and outcomes given empirical data (e.g. France) and practical realities. Your point about increased overall capacity is lost on those who want to teach the rich "a lesson" by limiting resources because of public funding constraints.

Bonam · August 14, 2009

There is no reason for further privatization. Canadians don't want it.

You keep making statements like this based on some poll which you claim supports it. So what if some majority in some poll don't want it? Many Canadians do. I constantly hear such opinions expressed, whether in person, in editorials in papers, on the radio, etc. In BC, even our health minister supports the expansion of private health care.

Private delivery is fine, as long as it can be done cheaply.

Private delivery is fine at any price that a patient is willing to pay, as determined by the market, just as it is for other goods and services.

There is no reason that people should be able to buy care faster than others.

According to what? I think there is every reason that one should be able to use the wealth they have earned to procure services which others can provide. Why should my money pay for the treatment of someone else while I wait in a queue?

Every system has its strengths and weaknesses. Ours is just like any other in that regard. There are some problems with our system, but overall, it works well.

Yes, it works adequately, for now. But it is not sustainable in the long run, and it could be better even now.

Making it better requires improvement, not wholesale change.

That is your oft-repeated adage, with you state with no supporting basis. Our system already costs a huge portion of all tax revenues. If we keep making "improvements", as the population ages, as new, more expensive and advanced medical instruments are developed and we acquire them, the cost will grow ever higher. Do you think devoting a greater and greater portion of our tax revenues to health care is sustainable for ever? Sooner or later something has to give.

The gradual improvement that is needed is not tinkering with our system, but the relaxation of restrictions against private care and the expansion of such care as demanded by the market.

Edited August 14, 2009 by Bonam

Wilber · August 14, 2009

Of course.....they go to the USA!

Perfect, we don't need a two tier system, we have you. Don't change anything.

Seriously, if the "rich" have the option of going to the US for whatever treatment they may want, why do we need a two tier system?

bush_cheney2004 · August 14, 2009

...Seriously, if the "rich" have the option of going to the US for whatever treatment they may want, why do we need a two tier system?

No, because you already have an n-tier system, but it is political suicide to admit it. So die Tommy Douglas die hards will persist in the fairy tale reality of public pay always being better than private. But that charade came tumbling down via the Supreme Court years ago.

Edited August 14, 2009 by bush_cheney2004

Machjo · August 14, 2009

Perfect, we don't need a two tier system, we have you. Don't change anything.
Seriously, if the "rich" have the option of going to the US for whatever treatment they may want, why do we need a two tier system?

So you'd rather chase the private healthcare system away to the US?

Why must it always be either or? Can we not learn from the best countries for healthcare and adopt their proven two-tier systems? Why would we want to chase private healthcare out of the ocuntry when our own economy could benefit from this, especially in a recession?

Wilber · August 14, 2009

No, because you already have an n-tier system, but it is political suicide to admit it. So die Tommy Douglas die hards will persist in the fairy tale reality of public pay always being better than private. But that charade came tumbling down via the Supreme Court years ago.

Most of our health care is privately provided, the issue is how it is paid for.

Bonam · August 14, 2009

Perfect, we don't need a two tier system, we have you. Don't change anything.
Seriously, if the "rich" have the option of going to the US for whatever treatment they may want, why do we need a two tier system?

Why do Canadians so apathetically accept being reliant on the US for everything, be it health care, defense, trade, etc? If we have the option and capability of being more self-sufficient in our delivery of health care, we should do so. Private health facilities located in Canadian cities would be much more convenient for Canadian citizens, and they would also cost less for those that wish to use them, as they would save considerably on travel expenses.

You might as well ask why the US needs a health care system at all if Americans can come to Canada and get their healthcare here. The answer should be obvious. Convenience, proximity, self-sufficiency, etc.

The US has no obligation to function as a relief valve for Canadian health service shortfalls. If they run into shortages of their own in the future, or if they adopt a system similar to Canada, or if relations between our countries deteriorate in the future, or for any number of other possible reasons, our relief valve will be shut. That's why we need our own system which caters to everyone, including the rich.

Wilber · August 14, 2009

Why do Canadians so apathetically accept being reliant on the US for everything, be it health care, defense, trade, etc? If we have the option and capability of being more self-sufficient in our delivery of health care, we should do so. Private health facilities located in Canadian cities would be much more convenient for Canadian citizens, and they would also cost less for those that wish to use them, as they would save considerably on travel expenses.
You might as well ask why the US needs a health care system at all if Americans can come to Canada and get their healthcare here. The answer should be obvious. Convenience, proximity, self-sufficiency, etc.

The US has no obligation to function as a relief valve for Canadian health service shortfalls. If they run into shortages of their own in the future, or if they adopt a system similar to Canada, or if relations between our countries deteriorate in the future, or for any number of other possible reasons, our relief valve will be shut. That's why we need our own system which caters to everyone, including the rich.

This isn't an issue of national pride it is one of pragmatism.

Dispite its faults, our system does cater to everyone, including the rich. That's the point. Who says we should be reliant on them? If some Canadians chose to use US facilities, they will do so regardless of what Canada has to offer.

Of course the US has no obligation to do so but their providers are doing it because there is money to be made. They are not doing us a favour. They don't care who is paying as long as they pay promptly. I am just saying that as long as the US continues to provide that option, why duplicate it here if it takes away from the public system in any way?

Of course, we don't know what reforms will take place in the US, if any, or how we may have to react if at all. They may come up with some very good ideas that we might be wise to implement ourselves. I hope they do and if so, I hope we are not too stupid or proud to learn something from them.

Edited August 14, 2009 by Wilber

Machjo · August 14, 2009

This isn't an issue of national pride it is one of pragmatism.
Dispite its faults, our system does cater to everyone, including the rich. That's the point. Who says we should be reliant on them? If some Canadians chose to use US facilities, they will do so regardless of what Canada has to offer.

Of course the US has no obligation to do so but their providers are doing it because there is money to be made. They are not doing us a favour. They don't care who is paying as long as they pay promptly. I am just saying that as long as the US continues to provide that option, why duplicate it here if it takes away from the public system in any way?

Of course, we don't know what reforms will take place in the US, if any, or how we may have to react if at all. They may come up with some very good ideas that we might be wise to implement ourselves. I hope they do and if so, I hope we are not too stupid or proud to learn something from them.

How would a two-tier system take away from the Canadian system in any way? Whether the rich man chooses to go to a private facility in the US or Canada, the only difference I see is whether that physician will pay his taxes to the US or Canada. Why do we want to give that tax money to the US?

It woudl also take nothing from the Canadian public ssytem. The French, British, Singaporean and many otehr systems are two-tier, and they provide better service to the poor than ours does.

Like I said before, if people choose to opt out of using public services, they're still stuck paying the taxes, so the money still flows in, but they alleviate the burden on the public system. In a pure public system, the rich pay their taxes and use the service. In a dual system, the rich pay their taxes and then pay again for private care and make no use of the public service. Essentially, it's like they're paying for the public system but not using it, thus simply freeing more funds for the rest. Honestly, how does that hurt the poor. I can see only how the poor could benefit from this.

How you see this hurting the poor is beyond me.

Machjo · August 14, 2009

Of course, we don't know what reforms will take place in the US, if any, or how we may have to react if at all. They may come up with some very good ideas that we might be wise to implement ourselves. I hope they do and if so, I hope we are not too stupid or proud to learn something from them.

And why only the US? What about the Swedish, French, Singaporean systems? I believe the Swedish system is a one-tier system, but heavily funded, and the Swedes pay high taxes for their quality healthcare. If we want to pay those kinds of taxes, then by all means have a one-tier system. Otherwise, let's allow two-tiers.