Should we adopt two-tier health care?

[Smallc]

If the system is short of cash. There is not really any evidence of that at the time, and there is no evidence that Canadians are dying en masse (or even frequently) because of it.

[Wilber]

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.

It is always about the money in any system. Unlimited money means unlimited health care. Wait a minute, the US spends between 50 and 60% more per capita than other developed nations on health care but 40 million have no insurance. Maybe not.

[Machjo]

It is always about the money in any system. Unlimited money means unlimited health care. Wait a minute, the US spends between 50 and 60% more per capita than other developed nations on health care but 40 million have no insurance. Maybe not.

Like I said, politics have to be taken into account too. The Swedish system is among the best in the world too, and it's a single-payer health care system. But just look at the tax rate in that country. Do you honestly think Canadians would be prepared to see such a tax hike just to have among the best systems in the world?

As for the US system, the government is fighting right now to get some kind of system passed. If it can't pass a single-payer system, then woudl it be preferable to abandon altogether or to adopt a two-tier system? In fact, Obama has already indicated support for a two-tier system.

I remember reading that the Swedish system is generally consdiered among the most efficient systems, giving the biggest bang for the buck. Looking at it that way, politics aside, looking only at economics, it woudl make sense therefore to adopt the Swedish system. But in reality, would the taxpayer/voter accept that in the US or even Canada?

Sure, the Swedish system is a marvellous system, if adequately funded that is. Otherwise, if politics won't allow for adequate funding, then two-tier is still preferable as a way to at least allow some private-sector money into the system to alleviate the pressure on the public system even if it isn't the most efficient system. At that stage, it has nothing to do with logic or efficiency, but with pure politics.

Then again, if the Swedish system adopted a two-tier system, chances are no one would opt for a private system simply because if the public system is sufficiently well funded, then everyone is happy with the public system anyway. Looking at it that way, a two-tier system simply allows for a pressure valve when the government of the day chooses not to fund the system adequately.

[benny]

The best ones have proven to be two-tier systems.

To date, the fairest providers of health care services are systems following the difference principle with its underlying maximin strategy.

http://www.sciencedirect.com/science?_ob=A...fd5e33ebeacf218

[Wilber]

Sweden spends less than half as much per capita than the US on health care and less than us.

Link

[benny]

Sweden spends less than half as much per capita than the US on health care and less than us.

Input should always be related to output.

[Machjo]

Sweden spends less than half as much per capita than the US on health care and less than us.

Link

So then let's adopt the Swedish system. The link did not explain how it keeps its costs down. Is it because it's more decentralized than ours? Or is it something else? Whatever it is, then let's adopt it. If it's so good, people won't want to opt for private, right?

[Machjo]

And if it's so good, we won't need to prohibit private health care, because no one will want private health care right?

[Wilber]

So then let's adopt the Swedish system. The link did not explain how it keeps its costs down. Is it because it's more decentralized than ours? Or is it something else? Whatever it is, then let's adopt it. If it's so good, people won't want to opt for private, right?

You tell me, I'm not the one saying how great it is.

[Machjo]

We should bear in mind too that Canada has a low population density. I wonder what role this plays in lowering efficiency or increasing costs in transporting patients, etc.

[Machjo]

You tell me, I'm not the one saying how great it is.

I was just reading on the sites I'd linked to above that it has consistently been voted among the best repeatedly for decades. I'd also posted the description on sites linked to above.

But essentially, regardless of the system adopted, if it's going to be sufficiently funded, then there will be no need to prohibit private health care because no one will want it anyway. And if it's underfunded, then we need to allow for it as a pressure valve. So either way, prohibiting privatization doesn't make sense.

But if the Swedish system is more efficient (assuming it doesn't just have to do with its advantage in having a higher population density), then we ought to adopt it. If it's advantge simply has to do with populaiton density, then we may have no choice but to either provide more funding or alternatively just accept that we can't ahve the best system.

[Smallc]

It also has to do with the fast that Canada has to compete with the US for people and equipment. That very much affects our cost base.

[benny]

We should bear in mind too that Canada has a low population density. I wonder what role this plays in lowering efficiency or increasing costs in transporting patients, etc.

Physicians have to receive incentives to practice in rural areas, that's for sure.

[bush_cheney2004]

It also has to do with the fast that Canada has to compete with the US for people and equipment. That very much affects our cost base.

No, it affects Canadian expectations. Private providers can purchase equipment from around the world if it chooses.

[benny]

No, it affects Canadian expectations. Private providers can purchase equipment from around the world if it chooses.

Attracting innovators with longer patent protection means, for the sick, short-term costs in exchange of anticipated long-term benefits.

[bush_cheney2004]

Attracting innovators with longer patent protection means, for the sick, short-term costs in exchange of anticipated long-term benefits.

Not true.....even if it made any sense.

[Machjo]

Essentially, here are what I see as the advantages of true two-tier health care:

1. It provides a pressure valve when government underfunds the public system.

2. It serves as a quality barometre for the public system, indicating when it may be time to increase funding.

3. It prevents Canadians from going abroad for private health care, thus keeping jobs in Canada.

If the public system is well designed and maintained, then the private system will exist only in the law, and nowhere else. So if we have that much confidence in the public system, thre is no reason to fear it.

[benny]

Not true.....even if it made any sense.

Montreal has big pharmaceutical research labs because Quebec government is not in a hurry to buy the cheapest generic drugs.

[Oleg Bach]

You can have a two tier health system within the system..for instance - If you find a bright and talented doctor - and you are articulate - and command respect..and you make FRIENDS..you will get the finest treatment - now if you are a bit on the unaware side - and your presentation is sub-servant...and the doctor assumes you belong to a lower class - he will utilize your body - perscribe drugs you don't need and turn you into a steady customer..It has nothing to do with handing over some extra cash - it has to do if the doctor understands if you are socially relevant or not..if not - you go to the bottom tier...If you are of substance -and of value - your visits will only be those of neccestity........

............for instance this one Greek doctor - said she hated the system - that she wanted to run off and work with "doctors without boarders" - then she said - "there is no heaven - you just get recycled" _ this conversation took place within 5 minutes...Her evaluation of me was one of spite and she attempted to shove me down to the bottom tier...Without warning or cause she stated "There are some wonderful compounds..let me perscribe this" - She attempted to give me some so-called anti-depressants - I looked at this person I knew for less than 5 minutes and was insulted - she was an ass hole - I suppose she must have hundrends of patients who are drugged and hundrends of people who visit her clinic to renew prescriptions they don't need - this is the bottom tier.

So the two tier system consists of this - and it has nothing to do with the people but with the doctors - some doctors are bright and intelligent--and are healers---they are the top tier - some doctors are fools - and governemed by a strange sense of power and greed - they are the bottom teir.

[benny]

Not true.....even if it made any sense.

About you making sense now!

[Oleg Bach]

About you making sense now!

Hi benny - what's up? - check out the concept of the two tier system that came to mind...It sort of came to me that the system has good doctors - and second rate ones - so in eccense, we have and have had for a long while..a two teir system...you get what you deserve - Just like politics, you deserve the government you vote in. On a personal note..as far as the Black thread...I will make it concise - it was just a mafia coup...and apparently Conrad was over thrown - with the help of the courts and some friends of his enemies in America...Yes there is a shadow government in all nations - and it seems you would like to be rid of ours - am I correct?

[benny]

Hi benny - what's up? - check out the concept of the two tier system that came to mind...It sort of came to me that the system has good doctors - and second rate ones - so in eccense, we have and have had for a long while..a two teir system...

Two-tier means discriminating the patients in function of their earning powers.

[Oleg Bach]

Two-tier means discriminating the patients in function of their earning powers.

Let the doctor assume - you are a person of means...They are not that bright - and you will get good treatment..Not all the good doctors are operating out of exclusive private clinics. It's sad - the best doctor I had eventually took a postion as the in house guy at a very wealthy retirement facility..He was brilliant..and a good human being - IF you are lucky enough to find a good one (and it's almost impossible to fine a family doctor) - YOU will have treatent that is NOT dependant on handing someone extra cash on top of public funding. I believe that...BUT for the average person- or as you say, those with "earning powers" - they can still get screwed - I knew a guy that set up the Kings Health Centre on Universtiy Avenue - a number of years ago ----He ran off with 30 million bucks in a suit case....I would not trust him or his fancey exclusive health centre...so it's not the money.

[Wilber]

I was just reading on the sites I'd linked to above that it has consistently been voted among the best repeatedly for decades. I'd also posted the description on sites linked to above.

But essentially, regardless of the system adopted, if it's going to be sufficiently funded, then there will be no need to prohibit private health care because no one will want it anyway. And if it's underfunded, then we need to allow for it as a pressure valve. So either way, prohibiting privatization doesn't make sense.

But if the Swedish system is more efficient (assuming it doesn't just have to do with its advantage in having a higher population density), then we ought to adopt it. If it's advantge simply has to do with populaiton density, then we may have no choice but to either provide more funding or alternatively just accept that we can't ahve the best system.

They certainly have a higher population density than us but that is misleading because most of us live within 100 KM of the US border. Sweden ranks 192 in density. We rank 227 but the US ranks 177 so I it is pretty hard to say how much density might have to do with it.

Percent GDP on health care by country

1. US 14.6%

13. France 9.7%

15. Canada 9.6%

23. Sweden 9.2%

[benny]

Here a good place to start, for comparing Sweden and Canada:

http://esr.oxfordjournals.org/cgi/pdf_extract/8/2/200