Should we adopt two-tier health care?

Machjo · August 14, 2009

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.

What I meant was, should we prohibit people from paying their own way through college just to ensure all are equal? It could be done, but only through either a very emaciated system or through a major tax hike for the government and more government funding.

To allow people to pay for their own education but not healthcare is an inconsistent argument. What about private elementary and secondary schools? If you're consistend, then you oppose that too, right.

Smallc · August 14, 2009

I do oppose those. There's no reason for them.

Machjo · August 14, 2009

I do oppose those. There's no reason for them.

If you should oppose private schools, then parents sending their children to them would then have to send them to public schools, thus stretching public funding even more thinly.

So, would you be prepared to pay higher taxes to compensate for the additional strain on the school system of prohibiting parents from sending their children to private schools?

And what about college and university? Would you be prepared to pay a substantial tax hike to fund a public higher education system funded 100% through public funds?

Craig1 · August 14, 2009

I like how old people think my generation should fend for ourself (by getting a education) and still subsidize their sorry behinds at the same time....Are old people really that useless come on'

Smallc · August 14, 2009

Would you be prepared to pay a substantial tax hike to fund a public higher education system funded 100% through public funds?

You're stretching. Health and education are two different things. I support anything that will make this country better without dismantling its institutions.

Machjo · August 14, 2009

I like how old people think my generation should fend for ourself (by getting a education) and still subsidize their sorry behinds at the same time....Are old people really that useless come on'

Of course there's a double standard. If we want a publicly funded health care system, then we'll need a highly educated pupulation. This might not necessarily mean total government control but certainly more government funding. In Sweden for instance, they use a school voucher ssytem, with about 10% of elementary and high schools being privately owned. But it is unquestionably very generously funded by the government.

France and Singapore, and many other countries allow for private participation i their medicare, but government funding is also very high. Sweden's healthcare is one-tiered, but again, very well funded.

But to pay for the healthcare, we need a solid tax base, and that means invensting in education too. This does not mean socialist dogmatism though.

Bonam · August 14, 2009

So what? This isn't a libertarian states, and the majority rules within the law and the constitution.

We have plenty of protections for and special privileges for various minorities. Democracy is not just "majority rule". It is majority rule that is tempered by provisions that make sure that the majority does not profit at the expense of various non-majority groups.

70% of Canadians are quite supportive of our system and those who want change often want more public options rather than private ones.

I don't know what poll you are quoting but I'll take you on your word for now. Feel free to state "many Canadians" or "most Canadians" support the current system, but don't make blanket statements that "Canadians" support the system. 30% is quite a large dissenting voice, 10 million people.

People who right to papers and call conservative talk radio (there is no other kind in Canada)

There is plenty of left wing radio. If you think that ALL radio in Canada is "conservative", you must be WAY left of the typical Canadian. I've only found one radio station where I live that seems at all "conservative".

are usually angry about something or another, and most of the time their opinion isn't much of one.

Of course, people need to be riled up about something to bother calling into a show. What do you expect, people that are totally neutral on a subject to call in and be like "hmm, I dunno"? And just because you do not agree with their opinion does not make it "not much of one".

Now that's just your opinion. Health is a necessity

Health care is a privilege. Where does our charter say that every Canadian is guaranteed full health care at no personal expense? It doesn't. Doctors, hospitals, and equipment cost money, and someone has to pay for it.

Why? Because people should be treated based on need

Need doesn't pay for hospitals, doctors, or medical equipment. Money does.

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.

A two-tier system still provides full health care to all members of the population. There is no draconian inequality here. The poor don't get denied medical service because they can't pay. But those who can pay and want some extra luxuries and better service can get it, like a private room, or a happier, higher paid, nurse, or a more advanced new procedure, such as robotic surgery, or a shorter wait for an MRI machine. What is so terrible about that?

And you have proof that it isn't sustainable?

What kind of proof can I have? There can only be estimates, forecasts, predictions, when talking about the future. Do you deny that we have an aging demographic? Do you deny that the costs of medical equipment are going to continue to rise? These factors will obviously make health care take a bigger % of our budget. How high of a % can we devote to health care while still adequately funding everything else?

In another thread where I mentioned that we could use more military spending for arctic sovereignty, you repeated over and over that raising spending in a given area means cutting other programs. Well, it's your turn, what are you gonna cut to keep raising our health spending?

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.

Sounds like your province is increasing health care funding. That's great. Now how much higher can they keep increasing it. And yes, the cost has to be paid either way. Except that in a two-tier system the rich pay twice, once for everyone else, and once for themselves in their private health care. You get MORE money out of the rich for health care in a two-tier system, freeing up more funding for everyone else.

I don't understand on what basis but pure, unreasoned, ideology, you could possibly oppose that.

So you think that devoting large portions of income to out of pocket care or insurance is somehow better?

For those that can afford it (those you call "rich"), why not? Meanwhile, the rest of the system will end up with more funding/person as well.

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.

Hah! Better for who?

Also, there are other ways to improve a system that don't involve money. Efficiencies can be found and resources can be re-allocated.

There is only a finite amount of waste that can be trimmed, representing some % of the current funding. Meanwhile as medical technology continues to get both better and more expensive, and as more of the population gets older, the costs of health will grow exponentially. You can't raise the money to build new hospitals, buy advanced equipment, and hire doctors by laying off a few administrative assistants.

Machjo · August 14, 2009

You're stretching. Health and education are two different things. I support anything that will make this country better without dismantling its institutions.

How would allowing private healthcare dismantle public healthcare? In fact, have you not considered the possibility that we could adopt a two-tier system and also increase taxes and government funding for public health care? The two needn't necessarily be mutually exclusive.

Let's consider the Swedish school voucher system introduced in 1992 for instance. Even though to the Canadian eye it looks akin to Republican-style school voucher proposals, it is very different on a number of fronts:

1. It has many restrictions, such as all participating schools can't charge more than the values of the voucher,

2. all participating schools must accept students on a first come first serve basis, and

3. they must still implement the national curriculum.

yet, in spite of the idea of a voucher being akin to a US Republican idea, let's not forget that the Swedish government still funds its voucher system more generously than we fund our schools. And since it allows private investment, that means that in addition to government funidng, private funding goes into the system too.

So we shouldn't think so much in terms of black and white, capitalist and socialist. Though Sweden is generally considered more socialist than the US when it comes to government spending, the Swedish government owns a smaller %age of the GDP than the US does, even though Sweden is generally considered among the most socialist democracies.

We should't think that the relationship between private and public must always be confronttional.

Smallc · August 14, 2009

We have plenty of protections for and special privileges for various minorities. Democracy is not just "majority rule". It is majority rule that is tempered by provisions that make sure that the majority does not profit at the expense of various non-majority groups.

Those rights are guaranteed within the Constitution and the law...as is health care.

I don't know what poll you are quoting but I'll take you on your word for now. Feel free to state "many Canadians" or "most Canadians" support the current system, but don't make blanket statements that "Canadians" support the system. 30% is quite a large dissenting voice, 10 million people.

70% is a much larger voice. You can never please everyone.

There is plenty of left wing radio. If you think that ALL radio in Canada is "conservative", you must be WAY left of the typical Canadian. I've only found one radio station where I live that seems at all "conservative".

There is very little Liberal biased radio in Canada. We make due with the CBC, but it certainly isn't Liberal radio.

Of course, people need to be riled up about something to bother calling into a show. What do you expect, people that are totally neutral on a subject to call in and be like "hmm, I dunno"? And just because you do not agree with their opinion does not make it "not much of one".

Often the opinions are based on a single case or have no factual basis..believe me, I listen enough to know.

Health care is a privilege. Where does our charter say that every Canadian is guaranteed full health care at no personal expense? It doesn't. Doctors, hospitals, and equipment cost money, and someone has to pay for it.

Canadians are guaranteed life in the Constitution. We can't always keep that promise but we do try for the most part.

Need doesn't pay for hospitals, doctors, or medical equipment. Money does.

That's right. Then we allocate the care based on need...and not money.

A two-tier system still provides full health care to all members of the population. There is no draconian inequality here. The poor don't get denied medical service because they can't pay. But those who can pay and want some extra luxuries and better service can get it, like a private room, or a happier, higher paid, nurse, or a more advanced new procedure, such as robotic surgery, or a shorter wait for an MRI machine. What is so terrible about that?

We have robotic surgery in Canada...and MRIs...we need more of those though. I know my province is buying more.

What kind of proof can I have? There can only be estimates, forecasts, predictions, when talking about the future. Do you deny that we have an aging demographic? Do you deny that the costs of medical equipment are going to continue to rise? These factors will obviously make health care take a bigger % of our budget. How high of a % can we devote to health care while still adequately funding everything else?

We still have to pay for it no matter what. Might as well cover everyone equally while we do it.

In another thread where I mentioned that we could use more military spending for arctic sovereignty, you repeated over and over that raising spending in a given area means cutting other programs. Well, it's your turn, what are you gonna cut to keep raising our health spending?

Well, I'd raise taxes....but you'll note that health has little to do with federal programs. It is the most important program of most provincial government, as it should be.

Sounds like your province is increasing health care funding. That's great. Now how much higher can they keep increasing it. And yes, the cost has to be paid either way. Except that in a two-tier system the rich pay twice, once for everyone else, and once for themselves in their private health care. You get MORE money out of the rich for health care in a two-tier system, freeing up more funding for everyone else.

Oh boy, I can't wait to hear all the complaining about having to pay twice. I have an idea...we should take twice as much from the rich and put it into the public system. According to you, they're quite willing to part with it.

I don't understand on what basis but pure, unreasoned, ideology, you could possibly oppose that.

It's not ideology. It's the idea that all people should get the same care and that they shouldn't be able to buy more because we have more. We should improve the system for everyone as equally as possible.

There is only a finite amount of waste that can be trimmed, representing some % of the current funding. Meanwhile as medical technology continues to get both better and more expensive, and as more of the population gets older, the costs of health will grow exponentially. You can't raise the money to build new hospitals, buy advanced equipment, and hire doctors by laying off a few administrative assistants.

The government doesn't pay the full price for all of that though. Hospitals have to raise money, and they do. We'll be just fine in the end, we imply have to work it out.

Wilber · August 14, 2009

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.

Fine, let's go to the French system then. How does it work?

Machjo · August 14, 2009

Oh boy, I can't wait to hear all the complaining about having to pay twice. I have an idea...we should take twice as much from the rich and put it into the public system. According to you, they're quite willing to part with it.

I'm not necessarily against increasing taxes on the rich, but you seem to be proposing a false dichotomy. You seem to be suggesting that we can either increase taxes and restrict private health care, or free private health care and forfeit taxes on the rich. If that is what you're suggesting, that is a false dichotomy. Why would it not be possible to double taxes on the rich as you say, and still allow them to pay for their own private health care if they want to?

Smallc · August 14, 2009

We can already do both. They can go wherever they want to buy care...they can even do it here for some things.

Machjo · August 14, 2009

Fine, let's go to the French system then. How does it work?

http://en.wikipedia.org/wiki/Health_in_France

I won't type it all here because the link is detailed enough as it is. You can also look here for other models:

http://en.wikipedia.org/wiki/Two-tier_health_care

You can look up the Singaporean model as a good one too, ranked sixth in the world:

http://en.wikipedia.org/wiki/Healthcare_in_Singapore

If you absolutely insist on a strictly public system, then consider Sweden's:

http://en.wikipedia.org/wiki/Health_care_in_Sweden

It is not a two-tier system, but unlike Canada's, it's more decentralized, but is fully funded by public funds. Another diffrence is that Sweden has a high tax rate and consdierable government funding of healthcare. Sweden's is considered high quality too. However, it would seem that a purely public system works well only if sufficiently funded, otherwise it woudl be preferable to go to two-tiered.

Then again, I don't see why we could not go two-tiered and increase taxes and government funding simultaneously. This way, the rich could opt out if they wanted to, but would likely choose not to owing to both the quality of the public system and the high taxes making it difficult for the rich to do so.

I really don't see why it must always be so black and wite all the time.

Machjo · August 14, 2009

We can already do both. They can go wherever they want to buy care...they can even do it here for some things.

Bold added. Why not as they wish? If they're paying for it, does it matter?

Bonam · August 14, 2009

Oh boy, I can't wait to hear all the complaining about having to pay twice. I have an idea...we should take twice as much from the rich and put it into the public system. According to you, they're quite willing to part with it.

So much hostility towards some people, just because they are successful and have made a lot of money. Why should the rich agree to pay twice as much if they aren't gonna get anything out of it? Paying twice is for the privilege of getting better health care, not for the privilege of getting the same health care.

Canadians are guaranteed life in the Constitution.

Are you honestly trying to say that the "right to life" is the same as guaranteed top quality health care? Seriously? You don't know in what context "life" was meant?

Well, I'd raise taxes...

You know, once you drive all these evil rich people out, who already pay more tax than anyone else, who is gonna pay for your poor needy users of health care?

It's not ideology. It's the idea that all people should get the same care and that they shouldn't be able to buy more because we have more. We should improve the system for everyone as equally as possible.

That's precisely why it IS ideology. You would oppose those willing to pay getting the best health care, even if it meant everyone else also getting better health care than they do now. You place your ideological need for equality, your need to prevent the rich from benefiting from their wealth, ahead of everything else.

Edited August 14, 2009 by Bonam

Machjo · August 14, 2009

Another thing yuo'll find if you read up on the link for Sweden avbove, is that their system is more democratic too, decentralized at the county or even municipal level, with the health board elected every foru years at the same time as the national government. Democratization of the health system might explain the greater success rate. It's closer to the general population. Also, the health board is responsible for overall health of the community, and so I take it that means it can also make recommendaitons regarding pollution and other factors in the local environment, thus making fora more wholistic approach.

I'm not necessarily against a one-tier system, as long as it's so wll done that no one would be interested in paying out of his own pocket anyway. And the best way to ensure that is to allow people to pay out of their own pocket and then when people do, take that as a warning sign. You'll also notice that the Swedish model intertwines medical care and income due to illness. It's indeed an impresive and high-quality system, but I doubt the Canadian taxpayer would be prepared to pay the money for such a high-quality system. I can't see it being politically feasible, and so the next best thing would seem to be the French or Singaporean models.

Smallc · August 14, 2009

So much hostility towards some people, just because they are successful and have made a lot of money. Why should the rich agree to pay twice as much if they aren't gonna get anything out of it? Paying twice is for the privilege of getting better health care, not for the privilege of getting the same health care.

As an upper middle class person who lives with parents who are considered to be top income earners.....no, but nice try.

Are you honestly trying to say that the "right to life" is the same as guaranteed top quality health care? Seriously? You don't know in what context "life" was meant?

I believe that the Supreme Court of Canada interprets it that way, actually.

You know, once you drive all these evil rich people out, who already pay more tax than anyone else, who is gonna pay for your poor needy users of health care?

Oh please...where are they going to go?

That's precisely why it IS ideology. You would oppose those willing to pay getting the best health care, even if it meant everyone else also getting better health care than they do now. You place your ideological need for equality, your need to prevent the rich from benefiting from their wealth, ahead of everything else.

It doesn't mean that everyone else ill get better care though. The dynamics here are different. We have the largest private system in the world right beside us to compete with. All the private system in Canada would do is rob the public system. You have no way in knowing that things would get better. My opinion has nothing to do with ideology, but rather the value of all human life equally. If my view is ideological, your's is definitely so.

Smallc · August 14, 2009

Another thing yuo'll find if you read up on the link for Sweden avbove, is that their system is more democratic too, decentralized at the county or even municipal level, with the health board elected every foru years at the same time as the national government.

In most provinces, the system is quite decentralized. It certainly is here.

Machjo · August 14, 2009

It doesn't mean that everyone else ill get better care though. The dynamics here are different. We have the largest private system in the world right beside us to compete with. All the private system in Canada would do is rob the public system. You have no way in knowing that things would get better. My opinion has nothing to do with ideology, but rather the value of all human life equally. If my view is ideological, your's is definitely so.

Again, the false dichotomy. You seem to be suggesting that it would not be possible to increase taxes on the rich and allow them access to private healthcare. You seem to be suggesting that it must be one or the other.

Why such an insistence on this false dichotomy?

Machjo · August 14, 2009

In most provinces, the system is quite decentralized. It certainly is here.

Do you vote for the local health board every provincial election?

Machjo · August 14, 2009

In Sweden, all the central government does besides most funding, is to lay basic guidelines. The details are decided at the local level, and the local leverl can supplement central government funding through its own taxes too.

Doesn't even compare to the decentralization here.

Wilber · August 15, 2009

Interesting article on the French system. Obviously not without its issues as well.

Wall Street Journal

Machjo · August 15, 2009

Interesting article on the French system. Obviously not without its issues as well.
Wall Street Journal

But you'll notice that the main criticism is money, cost. Imagine how much more it would have cost if private insurance were banned. Of course sooner or later there is no choice but to either allow for more private care or a tax increase, or a combination of the two. But to ban private care would logically push the cost of public care up, thus increasing costs even more.

Wilber · August 15, 2009

But you'll notice that the main criticism is money, cost. Imagine how much more it would have cost if private insurance were banned. Of course sooner or later there is no choice but to either allow for more private care or a tax increase, or a combination of the two. But to ban private care would logically push the cost of public care up, thus increasing costs even more.

Increasing what costs? You seem to think the cost of private and public health care are somehow separate. They are not when it comes to providing care to the population as a whole. Providing universal health care costs money, it really doesn't matter how you divide it up. You will also see that unlike ours the French public system doesn't provide 100% coverage except for life threatening conditions. Perhaps we shouldn't either but that is another debate.

Edited August 15, 2009 by Wilber

Machjo · August 15, 2009

Increasing what costs? You seem to think the cost of private and public health care are somehow separate. They are not when it comes to providing care to the population as a whole. Providing universal health care costs money, it really doesn't matter how you divide it up. You will also see that unlike ours the French public system doesn't provide 100% coverage except for life threatening conditions. Perhaps we shouldn't either but that is another debate.

The question here is political. If the public health care system is short of cash, there are two options:

1. increase taxes, or

2. allow for a parallel private system for those who can afford it.

If a candidate in an election can convince the electorate to support a tax increase to pay for this, all well and dandy. Otherwise, the next best option is to allow those who don't want to participate in the public ssytem beyond paying for it to opt out with their own money so as to alleviate the burden for the rest.

Sure we could argue that tax increases are necessary. But that is conditional on convincing the electorate. That is not a decision made by the government itself. Now, if the elctorate refuse to raise taxes and refuse to allow private healthcare, then all suffer.