UFC's Lesnar berates Canadian health care...

[Smallc]

That has nothing to do with what we're talking about. Nice attempt at a deflection.

[bush_cheney2004]

That has nothing to do with what we're talking about. Nice attempt at a deflection.

If it pleases the court, it has everything to do with what "we're talking about". Canadians have plenty of reasons for emigrating from their CHA paradise to the USA.

[Smallc]

And, judging by the increasing numbers of Americans coming to Canada, so do Americans. Now, granted, the numbers aren't equal, but, the trend is in a particular direction.

[bush_cheney2004]

And, judging by the increasing numbers of Americans coming to Canada, so do Americans. Now, granted, the numbers aren't equal, but, the trend is in a particular direction.

I agree...the numbers sure as hell are not equal!

[Smallc]

It's about 2 to 1 now, much closer than it was only a short time ago. It's still irrelevant. You're arguing with no real point, as usual.

Edited February 5, 2010 by Smallc

[bush_cheney2004]

It's about 2 to 1 now, much closer than it was only a short time ago. It's still irrelevant. You're arguing with no real point, as usual.

Yet you persist out of national pride?

2 to 1 would be meaningful if populations were equal...how come you only use that trick when it's in your per-capita favor?

[Smallc]

You do the same in the opposite direction. I'm not the only one with nationalist pride....the difference is, I don't troll on American political forums.

[bush_cheney2004]

You do the same in the opposite direction. I'm not the only one with nationalist pride....the difference is, I don't troll on American political forums.

That's a good enough answer...I never claimed to be a "better" troll than you.

[Gabriel]

For one, the fact that excess American health care capacity, pharma R&D, CDC standards, etc. means that Canada doesn't have to invest as much, even though it is still very the most expensive compared to other universal systems. Also, provincial procedures are limited to an approved list, and only recently have insurance products been approved by court rulings. Add in lower compensation for medical professionals.....maybe that's why they left?

How much greater is that capacity, though? We need things to measure. I remember reading that the family physician to patient ratio was better in the USA, but not significantly. I guess for some other important things like MRI wait times we can do country averages. Based on the anecdotes I've seen, I'm unconvinced that the greater capacity in certain healthcare areas are significant. In other words, I'm not sure those things you've mentioned justify to twofold price increase.

I'm not sure how medical R+D fits into this, either. Are you suggesting that medical R+D costs are part of the reason that the USA spends so much per capita on healthcare? Surely you don't think R+D costs spend by industry expenditures are factored into the per capita expenditure equation. I sure hope they're not, anyways. When I see data regarding healthcare expenses per capita, I'm assuming this only measures end-user expenses. Actually, it'd be interesting to look at what costs are collected into this data.

With respect to the CDC (and other health monitoring organizations), certainly Canada and many other countries benefit from its research and findings. I don't imagine that Canada isn't on par with respect to its contributions to this collective research and work, though. I'm sure Canada's expenditures per capita towards such research is comparable to that in the USA, i.e. Health Canada.

Doctors still get paid well in Canada, but even the higher salaries for American doctors can't explain much of the nearly twofold increase in healthcare costs per capita in the USA.

In short, I'm still unconvinced that the higher costs of healthcare in the USA are justifiable by marginal improvements to things such as caring capacity and wait times.

[bush_cheney2004]

How much greater is that capacity, though? We need things to measure. I remember reading that the family physician to patient ratio was better in the USA, but not significantly. I guess for some other important things like MRI wait times we can do country averages. Based on the anecdotes I've seen, I'm unconvinced that the greater capacity in certain healthcare areas are significant. In other words, I'm not sure those things you've mentioned justify to twofold price increase.

Obviously they are not worth it in Canada, which struggles to control costs driven by just the close proximity to the wild circus below. The costs for incremental improvements is technology and/or capacity are rarely linear.

I'm not sure how medical R+D fits into this, either. Are you suggesting that medical R+D costs are part of the reason that the USA spends so much per capita on healthcare? Surely you don't think R+D costs spend by industry expenditures are factored into the per capita expenditure equation. I sure hope they're not, anyways. When I see data regarding healthcare expenses per capita, I'm assuming this only measures end-user expenses. Actually, it'd be interesting to look at what costs are collected into this data.

The costs are indirect....nobody disputes that Canada invests far fewer dollars in R&D on many fronts, not just health care technology.

With respect to the CDC (and other health monitoring organizations), certainly Canada and many other countries benefit from its research and findings. I don't imagine that Canada isn't on par with respect to its contributions to this collective research and work, though. I'm sure Canada's expenditures per capita towards such research is comparable to that in the USA, i.e. Health Canada.

I disagree...Canada didn't/doesn't even have a national organization and investment that compares. This became obvious during the SARS fiasco in Toronto.

Doctors still get paid well in Canada, but even the higher salaries for American doctors can't explain much of the nearly twofold increase in healthcare costs per capita in the USA.

Sure it does....malpractice insurance for an OBG/YN can run $150,000 per year.

In short, I'm still unconvinced that the higher costs of healthcare in the USA are justifiable by marginal improvements to things such as caring capacity and wait times.

And this is the same conclusion reached by provincial policy makers. Citizens are left to decide with their feet (and wallets).

[Smallc]

I disagree...Canada didn't/doesn't even have a national organization and investment that compares. This became obvious during the SARS fiasco in Toronto.

The PHAC (which didn't exist at the time), has about 1/2 the per capita budget of the CDC. It isn't exactly a small organization.

[bush_cheney2004]

The PHAC (which didn't exist at the time), has about 1/2 the per capita budget of the CDC. It isn't exactly a small organization.

Didn't exist as in there was something else prior to this, or didn'tr exist as in there was no national organization at all? What about Health Canada?

US CDC's budget is about $9 billion per year...that's about 1/2 half of Canada's entire (increased) defense budget.

Edited February 5, 2010 by bush_cheney2004

[Gabriel]

Obviously they are not worth it in Canada, which struggles to control costs driven by just the close proximity to the wild circus below. The costs for incremental improvements is technology and/or capacity are rarely linear.

I don't understand what you're saying. What does Canada's proximity to the USA have to do with our per capita healthcare costs?

The costs are indirect....nobody disputes that Canada invests far fewer dollars in R&D on many fronts, not just health care technology.

As far as absolute totals go, of course Canada spends less on medical R+D. As far as per capita expenditures in Canada and the USA on medical R+D are concerned, perhaps they're not so different? I still don't see how this is relevant, though. R+D costs borne by companies, which are mostly American, are still paid for by Canadian consumers. In other words, when products and services are purchased in Canada originating from America, we're paying our share for that R+D as the R+D costs are incorporated into the prices we pay. Companies obviously factor in their R+D costs in order to remain profitable. So as far as I can see, those R+D costs are proportionally borne by Canada. I still cannot see how increased spending in the USA with respect to medical R+D (total dollars or per capita) factors into the USA's twofold increase in per capita healthcare spending. You're gonna have to clarify further.

I disagree...Canada didn't/doesn't even have a national organization and investment that compares. This became obvious during the SARS fiasco in Toronto.

Perhaps. I'm not sure. I'm not under the impression that we don't have comparable infrastructure to deal with potential widespread health problems such as what the CDC provides. I wouldn't be surprised if America was making a larger contribution on a per capita in this regard, though. We do freeload on some American institutions, no secret there.

Sure it does....malpractice insurance for an OBG/YN can run $150,000 per year.

I understand, but at first you mentioned increased doctor salaries - I was waiting for you to bring up the much higher malpractice insurance rates that American doctors pay as opposed to their Canadian counterparts. Listening to the GOP, and I believe them on this, this is a big deal. Hopefully the USA will simply impose reasonable limits on what sorts of penalties can be levied on doctors found to be negligent. I imagine this is an important part of why healthcare costs are so much higher in the USA.

I'm surprised that when asked about why American per capita healthcare costs are higher than those in Canada, you didn't make one mention of insurance companies. In other words, don't you think the method through which access to healthcare is facilitated to so many Americans (through insurance companies/HMOs) is one the biggest factors contributing to America's sky-high per capita healthcare costs?

Edited February 5, 2010 by Gabriel

[Smallc]

Didn't exist as in there was something else prior to this, or didn'tr exist as in there was no national organization at all? What about Health Canada?

Health Canada is a different kind of organization, but it is under its umbrella that the PHAC falls. The reality is, in Canada, public health is a provincial matter. BC has it's own CDC for example, and all provinces have some kind of public health organization. There was no national organization because there really isn't allowance for one constitutionally. After SARS, it was thought that one should be started, and so after consultation with the provinces, the PHAC was formed.

US CDC's budget is about $9 billion per year...that's about 1/2 half of Canada's entire (increased) defense budget.

And about twice the PHAC per capita budget of over $400M.

[bush_cheney2004]

I don't understand what you're saying. What does Canada's proximity to the USA have to do with our per capita healthcare costs?

Discussed in older threads.....Canada sits right next door to the biggest medical market on the planet, and is influenced by market forces, all the way from medical staff salaries to the price of a penis pump. A majority of the prescription drugs under patent come from...you guessed it....US of A.

As far as absolute totals go, of course Canada spends less on medical R+D. As far as per capita expenditures in Canada and the USA on medical R+D are concerned, perhaps they're not so different? I still don't see how this is relevant, though. R+D costs borne by companies, which are mostly American, are still paid for by Canadian consumers. In other words, when products and services are purchased in Canada originating from America, we're paying our share for that R+D as the R+D costs are incorporated into the prices we pay.

Nope...your costs are often subsidized or reduced by threats of going generic (patent busting) on those evil American blood suckers!

Companies obviously factor in their R+D costs in order to remain profitable. So as far as I can see, those R+D costs are proportionally borne by Canada. I still cannot see how increased spending in the USA with respect to medical R+D (total dollars or per capita) factors into the USA's twofold increase in per capita healthcare spending. You're gonna have to clarify further.

See above....Americans pay way more for the exact same pharma product. Medicare Part D was passed in the US to help close part of that gap. Cross border pharma purchases are now way down.

Perhaps. I'm not sure. I'm not under the impression that we don't have comparable infrastructure to deal with potential widespread health problems such as what the CDC provides. I wouldn't be surprised if America was making a larger contribution on a per capita in this regard, though. We do freeload on some American institutions, no secret there.

Well, the point is that those costs are real and if Canada has escaped them by investing less and "freeloading" more, then it needs to be figured in to the argument. One of the reasons for Canadian brain drain has been the lack of R&D investment and opportunities.

I understand, but at first you mentioned increased doctor salaries - I was waiting for you to bring up the much higher malpractice insurance rates that American doctors pay as opposed to their Canadian counterparts. Listening to the GOP, and I believe them on this, this is a big deal. Hopefully the USA will simply impose reasonable limits on what sorts of penalties can be levied on doctors found to be negligent. I imagine this is an important part of why healthcare costs are so much higher in the USA.

It's a factor, but not the major one (e.g. fee-for-service payment structure). Politically, the American Trial Lawyers Association pumps big money into preserving the malpractice status quo (against tort reform).

I'm surprised that when asked about why American per capita healthcare costs are higher than those in Canada, you didn't make one mention of insurance companies. In other words, don't you think the method through which access to healthcare is facilitated to so many Americans (through insurance companies/HMOs) is one the biggest factors contributing to America's sky-high per capita healthcare costs?

Yes...that is well documented. Hence the glorious battle on your daily dose of American news.

http://www.pnhp.org/single_payer_resources/administrative_waste_consumes_31_percent_of_health_spending.php

...but to be fair, Canada has significant admin costs as well (17% vs. 31% in the US as of 2003).

Edited February 5, 2010 by bush_cheney2004

[bush_cheney2004]

Health Canada is a different kind of organization, but it is under its umbrella that the PHAC falls. The reality is, in Canada, public health is a provincial matter. BC has it's own CDC for example, and all provinces have some kind of public health organization.

Right...and props to British Columbia for not effing it up like Ontariario. Which really cuts to the chase...how can the CHA be equitably funded and enforced with such provincial disparities? Why do you consider a heart care center in Winnipeg to be a "national" asset in that context? Williams wasn't impressed.

There was no national organization because there really isn't allowance for one constitutionally. After SARS, it was thought that one should be started, and so after consultation with the provinces, the PHAC was formed.

Yup....good move. At first I thought you meant the Peruvian Horse Association of Canada:

http://www.phac.ca/

Edited February 5, 2010 by bush_cheney2004

[Smallc]

Right...and props to British Columbia for not effing it up like Ontariario. Which really cuts to the chase...how can the CHA be equitably funded and enforced with such provincial disparities?

That's what the Canada Health Transfer and Equalization are for. Patients in Newfoundland and Labrador have any access needed to advanced treatments in larger centres, as is the case in any other country. A province with a smaller population than any US state can't be expected to provide a full range of services. They do heart related procedures, but not the advanced ones that may happen in Halifax or Winnipeg for example, or the very advanced ones in Edmonton, Toronto, Ottawa, or Montreal. Most patients requiring advanced interventions would be transported by air ambulance to Toronto, Ottawa, or Montreal, which really aren't that far away.

Edited February 5, 2010 by Smallc

[bush_cheney2004]

That's what the Canada Health Transfer and Equalization are for. Patients in Newfoundland and Labrador have any access needed to advanced treatments in larger centres, as is the case in any other country. A province with a smaller population than any US state can't be expected to provide a full range of services.

But for CHA theory, that is the provincial burden. Whether it is sustained by aerial gymnastics is debatable, but my point is that the political and ideological requirement to do so cannot always be met in practice....quality of care does vary by location.

[Smallc]

quality of care does vary by location.

The CHA doesn't promise that it won't. it only promises that provincially insured services will be equally available to all citizens of a province.

[bush_cheney2004]

The CHA doesn't promise that it won't. it only promises that provincially insured services will be equally available to all citizens of a province.

No shit? Why hasn't somebody busted Ottawa's balls on this with a garden variety Charter Rights action in the courts? Hell, I doubt that services are even "equally available" in the provinces given some practical realities.

[Smallc]

Services are always equally available to all Canadians if they are covered by the provincial health plan. They just aren't always the same distance away.

[dizzy]

Consumer choice vs. provincial policy...very different ideas.

market vs. democratic agency. Both are designed for consumer input. And both have developed means to shirk it.

[dizzy]

You do the same in the opposite direction. I'm not the only one with nationalist pride....the difference is, I don't troll on American political forums.

I'm becoming quite curious about this, too.

[bush_cheney2004]

Services are always equally available to all Canadians if they are covered by the provincial health plan. They just aren't always the same distance away.

Oh, I doubt that...even today. Nunavut presents a particularly difficult challenge based on this 2002 linkee:

Nunavummiut want access to health-care services that other Canadians take for granted

http://www.nunatsiaqonline.ca/archives/nunavut020412/news/nunavut/20412_2.html

Edited February 5, 2010 by bush_cheney2004

[Smallc]

Like I said, they have access. In the case of Nunavut, that access can be difficult.