Should we adopt two-tier health care?

Wilber · August 14, 2009

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?

Yes, if it ends up detracting from the public system. It doesn't have to be either or but you will have to convince me that it will not happen.

Machjo · August 14, 2009

Yes, if it ends up detracting from the public system. It doesn't have to be either or but you will have to convince me that it will not happen.

How would it happen? Pure logic. Ten people pay their taxes to the public system, and one would rather not use that system but pay out of pocket for his own. So you'd rather prohibit him from paying on his own and instead force him to use the limited resources of the public system? Of what logical benefit could this be? If we allow him to pay his own healthcare, then he's essentially paying twice, and of his own free will, thus essentially paying his own healthcare for himself and contributing through taxes to everyone else's. It would actaully free funds to help the rest. This woudl improve the quality of the public system. Straight logic.

Wilber · August 14, 2009

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.

You will pay one way or the other if you want good health care. The issue is who will have access to that care. When the WHO rates the quality of health care systems, it does so on the basis of access for the whole population, not just those who can afford it. The rich will always be able to get good care somewhere no matter how shitty the system is in their country of origin.

Wilber · August 14, 2009

How would it happen? Pure logic. Ten people pay their taxes to the public system, and one would rather not use that system but pay out of pocket for his own. So you'd rather prohibit him from paying on his own and instead force him to use the limited resources of the public system? Of what logical benefit could this be? If we allow him to pay his own healthcare, then he's essentially paying twice, and of his own free will, thus essentially paying his own healthcare for himself and contributing through taxes to everyone else's. It would actaully free funds to help the rest. This woudl improve the quality of the public system. Straight logic.

Where are you going to find all these people? The public system is short of doctors and nurses as it is. I am not against private access to health care in principle, but not at the expense of our present system.

Machjo · August 14, 2009

Where are you going to find all these people? The public system is short of doctors and nurses as it is. I am not against private access to health care in principle, but not at the expense of our present system.

Immigration. They can immigrate eitehr to the US or Canada. Why not bring them here?

Machjo · August 14, 2009

A two-tier system would put more money into medicare thus allowing us to take in more medically trained immigrants.

Machjo · August 14, 2009

Not to mention that the increase in demand might also encourage more to study medicine.

segnosaur · August 14, 2009

Where are you going to find all these people? The public system is short of doctors and nurses as it is. I am not against private access to health care in principle, but not at the expense of our present system.

You're assuming that the shortage of doctors and nurses is the only bottleneck in the system.

Yes, it does take a while to train new doctors, but in the short term, improved private health care options could help by:

- Encouraging doctors who MIGHT have considered moving to the U.S. to stay (This wouldn't help improve the situation, but it might keep it from getting worse)

- Improve the availability of infrastructure (e.g. more private MRI clinics, PET scanners, etc.)

In the long term, the possibility of improved pay and/or working conditions that would come from private health care funding might convince some people to become doctors/nurses that might otherwise have chosen other careers; however, even if that doesn't happen (and it might not, since medicine requires specific skills that are relatively rare), the short term benefits (infrastructure, stemming the 'brain drain') would still apply.

Edited August 14, 2009 by segnosaur

Machjo · August 14, 2009

You're assuming that the shortage of doctors and nurses is the only bottleneck in the system.
Yes, it does take a while to train new doctors, but in the short term, improved private health care options could help by:

- Encouraging doctors who MIGHT have considered moving to the U.S. to stay (This wouldn't help improve the situation, but it might keep it from getting worse)

- Improve the availability of infrastructure (e.g. more private MRI clinics, PET scanners, etc.)

In the long term, the possibility of improved pay and/or working conditions that would come from private health care funding might convince some people to become doctors/nurses that might otherwise have chosen other careers; however, even if that doesn't happen (and it might not, since medicine requires specific skills that are relatively rare), the short term benefits (infrastructure, stemming the 'brain drain') would still apply.

Add to that that those who opt for private health care might even have to pay taxes on it, part of that monty going towards the public system. It just doesn't make sense to sacrifice it to another country. The US must be laughing at us right now. We're giving them our best.

bush_cheney2004 · August 14, 2009

.....In the long term, the possibility of improved pay and/or working conditions that would come from private health care funding might convince some people to become doctors/nurses that might otherwise have chosen other careers; however, even if that doesn't happen (and it might not, since medicine requires specific skills that are relatively rare), the short term benefits (infrastructure, stemming the 'brain drain') would still apply.

Agreed.....the viability and sustainabilty of a vibrant health care industry (oops..is that a bad word) in Canada would be assured at all levels of services education and delivery. There would be much quieter "sucking sounds" from the "states".

Address the government funding uncertainties and variability by moderating with private pay, capital investment, and enhanced tax revenue.

Smallc · August 14, 2009

- Encouraging doctors who MIGHT have considered moving to the U.S. to stay (This wouldn't help improve the situation, but it might keep it from getting worse)

I don't know about your province, but mine has increased the number of doctors and nurses every year for the last decade. We're eating away at the problem.

bush_cheney2004 · August 14, 2009

I don't know about your province, but mine has increased the number of doctors and nurses every year for the last decade. We're eating away at the problem.

Well, at least you admit there is/was a "problem".....good luck with that.

Smallc · August 14, 2009

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

Polls this year don't agree:

http://www.harrisdecima.com/en/downloads/p...ses/071009E.pdf

Smallc · August 14, 2009

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.

So what? This isn't a libertarian states, and the majority rules within the law and the constitution. 70% of Canadians are quite supportive of our system and those who want change often want more public options rather than private ones. People who right to papers and call conservative talk radio (there is no other kind in Canada) are usually angry about something or another, and most of the time their opinion isn't much of one.

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.

Now that's just your opinion. Health is a necessity, and one that our government provides to us. We can't afford it at any price. You'll note that I was not talking about private funding, but rather for profit medicine paid for by the public system.

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?

Why? Because people should be treated based on need, not how much they can pay. Under the system you want, the value of life is determined by money, and that's just wrong. under our current system, everyone in this country is equal.

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

And you have proof that it isn't sustainable? In my province we're shrinking waiting lists and increasing our infrastructure and personnel. This seems to be reflected cross the country as CIHI shows shrinking waits. The only problem is the cost...and no matter private or public, we have to pay the cost. And yes, it could be better now....with more funding and efficiency.

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.

So you think that devoting large portions of income to out of pocket care or insurance is somehow better? You're making no sense whatsoever. We will pay for care one way or another. Better that we all share the cost so that it's spread out. Also, there are other ways to improve a system that don't involve money. Efficiencies can be found and resources can be re-allocated.

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.

Or, we could do like we're already doing. Putting more resources and attention into the system and allocating them as needed. You eem to think that the market will solve everything. I see no evidence of that.

Smallc · August 14, 2009

Oh, and:

http://www.commonwealthfund.org/Content/Ch...ealth-Care.aspx

Machjo · August 14, 2009

You will pay one way or the other if you want good health care. The issue is who will have access to that care. When the WHO rates the quality of health care systems, it does so on the basis of access for the whole population, not just those who can afford it. The rich will always be able to get good care somewhere no matter how shitty the system is in their country of origin.

Yes, and France was ranked first, and it's a two-tier system. Singapore was ranked sixth, and it's a ture two-tier system. Canada was ranked thirtieth. So it would seem that the WHO is indeed impressed with a few two-tier systems.

Machjo · August 14, 2009

OK, Smallc, you made reference to public funding for private health care, that's a whole different ballgame. Of course if you choose to opt out of the public system you should be on your own. I can fully agree with that. All I'm saying though is that it's ridiculour to force a person to use public services when he's willing to pay his own way and still pay taxes to the public ssytem. And rememebr, if the private system still charges HST/PST, then even it is funding the public system from which the private service taker doesn't benefit. I can't see how this hurts the public system.

Machjo · August 14, 2009

I should point out too that the Swedish system, also a one-tier sytem to the best of my knowledge, has proven to work well, but then again, it's very well funded too. We could opt for more funding I suppose. But if we're not willing to pay that tax, then go French. Eitehr system can work, as long as it gets the sufficient public funding. The French system will require less of course since some of the rich simply opt out, whreas the Swedish and Canadian systems need more funding. But the reason the Swedish system has proven more effective is because they've been more realistic in providing the necessary funding.

Either system can work, but we must accept the reality surrounding each. That's all.

Smallc · August 14, 2009

We do province the necessary funding now though. We simply have to catch up from the cutting years in the 90s. I've seen massive improvement where I live. It's happening...we simply have to be patient. Introducing private care now isn't suddenly going to make things better, and to think so is to drink from the cup of naivety.

Smallc · August 14, 2009

All I'm saying though is that it's ridiculous to force a person to use public services when he's willing to pay his own way and still pay taxes to the public system.

The idea is to improve care for all. Allowing the rich to get something better than the poor goes against what we've tried to do in this country.

bush_cheney2004 · August 14, 2009

.... It's happening...we simply have to be patient.

Yep.....we call that "waiting".

Machjo · August 14, 2009

We do province the necessary funding now though. We simply have to catch up from the cutting years in the 90s. I've seen massive improvement where I live. It's happening...we simply have to be patient. Introducing private care now isn't suddenly going to make things better, and to think so is to drink from the cup of naivety.

The best system in the world, France, is two-tier, as are a few other first-class systems. Two tier could work just as well as one-tier, or even better, depending on the funding provided.

Machjo · August 14, 2009

The idea is to improve care for all. Allowing the rich to get something better than the poor goes against what we've tried to do in this country.

Are you saying the poor in France and Singapore aren't getting the care they need because those are two-tier systems?

As for what we tried to do in this country, doyou have the same feelings towrds education? Should all post-compulsory education be publicly funded? If you're consistend, you'lll say yes, otherwise some other motive will have to be suspected.

Smallc · August 14, 2009

The best system in the world, France, is two-tier, as are a few other first-class systems. Two tier could work just as well as one-tier, or even better, depending on the funding provided.

If it could work just as well, why bother changing? Why would it be better? If we introduce private care today, and it were to fix the problems, it still wouldn't happen overnight.

Smallc · August 14, 2009

Should all post-compulsory education be publicly funded? If you're consistend, you'lll say yes, otherwise some other motive will have to be suspected.

It already is to a large extent...and yes, it would be great if we could fund it...though I'm seeing the parallel. I'd rather the money that would be used for education go to health care.