Liberals talk Gutting health care

[Michael Hardner]

A point to add: the setting of standards may be something that will finally draw the interest of the electorate. I would say that whatever is put in place, the public system must be benchmarked at the time two-tier is introduced to ensure that services *improve* over time.

If they acutally use the term 'benchmark' then the public might say 'hmmm ?', they might wake up and actually start to wonder what service levels are being provided today, and at what cost.

[Shady]

This neglects something. MRIs and CTs are operated by technicians that are in short supply.

Training technicians to operate these machines isn't hard. If you allow private clinics to offer these types of services, many of them would invest in the training and education to see that they'd have qualified employees anyhow. I don't see why you're so ideologically ridgid and opposed to common sense solutions. You need to be a little more progressive in your thinking.

[waldo]

This isn't just a simple supply and demand curve. We are talking about institutions that have to provide adequate services with limited resources.

exactly... taking thousands of medical professionals away from the public sector... to be used for the exclusivity of private clinics... most certainly is more than just a simple supply and demand equation. Notwithstanding the obvious effect on quality.

[Smallc]

While I do like CIHI, they are inextricably tied to the healthcare establishment. I do trust them to be honest in their reporting. The problem is that literally nobody knows about CIHI, so why would governments really listen to them.

Please provide a link, in any case.

http://www.torontosun.com/news/canada/2010/03/24/13346061.html

I don't believe two-tier will change nothing. I already provided an example of one-tier failing to address service needs, and lacking innovation. If you can provide a link that explains that access problems are all due to lack of human resources then that might help your argument, but even then that would assume that private healthcare wouldn't do a better job of recruiting.

I can't cite it, because it is contained in letters I've received in response to questions I posed to Manitoba health. The question specifically related to MRI wait times. There is a shortage of technicians that run MRIs throughout North America. As for recruiting, you're assuming that the public sector does a bad job. I can't speak for other places, but Manitoba has increased nursing numbers by 2000 over ten years, and doctors by almost 400. They've also added enough CTs and technicians to bring the wait down to less than 1/3 of what it was.

This isn't just a simple supply and demand curve. We are talking about institutions that have to provide adequate services with limited resources. It takes motivated management to address these things.

And you're assuming they aren't motivated.

Again, a link would be helpful but ... probably in a limited sense. The studies that are out there are numerous, difficult to digest and sometimes contradictory.

The recent studies have not been contradictory at all. Even the Fraser Institute shows falling wait times for the last couple of years.

It was a general comment, but when politicans are in change of services, what drives performance and improvement ? McGuinty's awful leadership on eHealth is a symptom of a larger problem, it is not the problem.

Ah, so you're talking about Ontario. Maybe you should stick that. eHealth Manitoba is working well, from what I can tell.

[Michael Hardner]

exactly... taking thousands of medical professionals away from the public sector... to be used for the exclusivity of private clinics... most certainly is more than just a simple supply and demand equation. Notwithstanding the obvious effect on quality.

It's quality and cost, though. If the government sets their rates at the current levels, how could private industry offer these professionals more money ? By cutting costs, sure, which doesn't necessarily mean cutting quality.

[Smallc]

Training technicians to operate these machines isn't hard.

It takes years. You do realize that, right?

http://me.rrc.mb.ca/Catalogue/ProgramInfo.aspx?ProgCode=MEDRF-DP&RegionCode=WPG

http://me.rrc.mb.ca/Catalogue/ProgramInfo.aspx?ProgCode=MRISF-AD&RegionCode=WPG

You have to take the first before the second.

I don't see why you're so ideologically ridgid and opposed to common sense solutions. You need to be a little more progressive in your thinking.

There's nothing progressive about further increasing the cost curve and suddenly saying that people with more money matter more.

[Shady]

exactly... taking thousands of medical professionals away from the public sector... to be used for the exclusivity of private clinics

Nope. That's not correct at all. Leave the medical professionals in their current public sector jobs. Let private clinics operate and invest in the education and training of additional medical professionals. This doesn't have to be a finite pie we deal with. We can expand the pie, without government money.

[Smallc]

By cutting costs, sure, which doesn't necessarily mean cutting quality.

And how would costs be cut through the introduction of profit?

Edited March 28, 2010 by Smallc

[Shady]

And how would costs be cut through the introduction of profit.

Because government would no longer be paying for 100% of those services. Some would choose to USE THEIR OWN MONEY in private clinics.

Edited March 28, 2010 by Shady

[madmax]

That's simply not true. If you allow for for-profit health clinics, for people who want to spend their own money, it will cut down wait times significanntly.

And pigs can fly.

Private Health Clinics are allowed. Quite frankly Private Health Clinics CANNOT sustain themselves without government monies. So, short of cosmetic clinics which have no shortage of people taking risks the standard fare of clinics all want to be part of the public system but charge private rates, extra users fees and other practices in order to make a healthy profit.

They won't all be accessing the same system. Some people will access hospitals and government funded clinics, others will be accessing private clinics.

If that was a viable option, the private clinics would have been sustaining themselves for the last 50 years.

For example. If new private clinics opened up in every large city in Canada, offering only MRIs and CTs, and similar tests, wait times in hospitals would dramatically drop. And private clinics could fund themselves by people who wish to spend their own money to recieve a faster test or scan. And as a result of their faster test or scan, it will make others in line at hospitals and government clinics recieve a faster test or scan.

LOL!!!

You cannot reduce the number of people in need of a service by creating a private clinic nor does it increase the number of service providers. There is only so much money. What you could succesfully do is limit the ability of those with less finances ability to receive a service, or move them to an even longer waiting list.

We have private clinics and with user fees and quite frankly, these suckers pay a membership fee and feel priviledged to sit in a separate waiting room. And yes, then the little girl waiting with her mom for 2 hours gets to wait another 30 minutes as my U.S. boss runs in for a 30 minute examination after coming back from a business lunch with heartburn.

Tums for the tummy anyone? No worries, the Private coverage paid for that and the public system took a back seat.

Seriously.

SmallC has a point. It is all the same money.

[waldo]

It's quality and cost, though. If the government sets their rates at the current levels, how could private industry offer these professionals more money ? By cutting costs, sure, which doesn't necessarily mean cutting quality.

see Copeman Clinic model... where membership has it's privileges! The quality of public health declines in direct proportion to the number of preferred medical professionals choosing to align themselves, exclusively, with private access.

[Smallc]

Because government would no longer be paying for 100% of those services. Some would choose to USE THEIR OWN MONEY in private clinics.

It's all the same money. I don't see how you don't understand that. The same people pay for it no matter what. Introducing new levels of administration and bureaucracy wont' help with anything.

[eyeball]

I think the time has come to discuss two-tier.

...the system, as it is, is failing due to political management and due to the fact that the electorate do not pay enough attention to the details of what is happening.

I'd rather discuss ways to address political mismanagement before we start giving up on what it is they're supposed to be managing. The fact is the electorate doesn't have access to enough details of what is happening at the political level to conclude that management can't be improved on.

Adam Smith described the invisible hand that causes market forces to work for the benefit of all involved.

I wonder how Adam Smith would describe the culture of political secrecy that causes public policies to not work efficiently or always for the benefit of everyone.

[Shady]

If that was a viable option, the private clinics would have been sustaining themselves for the last 50 years.

Not ture. If Canada wasn't part of a few countries that makes private health insurance illegal, then the industry would be much easier to sustain. Right now government regulates its failure.

And now, it's not all the same money. I pay taxes, those taxes go to the government to fund healthcare. If you offer private clinics, I still pay my taxes, but if I choose to use my own money in addition to the taxes I pay to attend a clinic for treatment, it lowers costs of the government, because it's a patient they don't have to treat. It also lessens the waiting lines, because its a person no longer waiting line.

[waldo]

Nope. That's not correct at all. Leave the medical professionals in their current public sector jobs. Let private clinics operate and invest in the education and training of additional medical professionals. This doesn't have to be a finite pie we deal with. We can expand the pie, without government money.

you haven't a clue... you would presume that private clinics will be staffed without dipping into the existing pool of medical professionals working within the public domain... and that private clinics will staff their needs through the training of additional medical professionals. Yes, you haven't a clue!

[Michael Hardner]

http://www.torontosun.com/news/canada/2010/03/24/13346061.html

Not sure if you were around then, but at one point I tried to initiate a project wherein MLW members would try to agree to gather statistics on healthcare and even contacted CIHI about getting their help. The response was so underwhelming that I gave up. And this is on a forum where people actively discuss such things, so in that sense it's not surprising that the public doesn't pay attention.

At that time, I went extensively through CIHI's site and read many of their reports. The Sun article you linked is typical of their reporting:

Where data was available, 14 of 29 wait times measured decreased and 11 didn't change, but a clearer pictures is expected in 2011 after more measures for collection and reporting are standardized.

This really doesn't give enough information. I suspect if you go to the actual report, there is some improvement in some places along with a whole mess of footnotes at the bottom explaining why Eastern Ontario hospitals weren't included yet, or whether queue times for Saskatchewan include ultrasounds etc. etc. etc.

This project is 5 years down the line and they still don't even have consistent reporting standards. Can we discuss inertia ? Imagine a corporation not being able to report its performance to stakeholders for five years. Heads would roll.

CIHI is a well-intentioned institution, but they are a product of their environment: slow, complacent and too complicated to understand. This is what one-tier healthcare gives its stakeholders, i.e. us. The board of directors of CIHI, is a pile of people who came from provincial health ministries and general students of the system as it exists.

I can't cite it, because it is contained in letters I've received in response to questions I posed to Manitoba health. The question specifically related to MRI wait times. There is a shortage of technicians that run MRIs throughout North America. As for recruiting, you're assuming that the public sector does a bad job. I can't speak for other places, but Manitoba has increased nursing numbers by 2000 over ten years, and doctors by almost 400. They've also added enough CTs and technicians to bring the wait down to less than 1/3 of what it was.

I'm not really saying that they do a bad job of recruiting, specifically, but that management is generally not challenged - and that the entire system is managed with politics at the very top of the pyramid. So recruiting is one example, but a challenge from somewhere else would be helpful.

And you're assuming they aren't motivated.

They are not adequately motivated, as evidenced by the slow progress and debacles like eHealth. These problems are not so unsolvable: in my mind, they're symptoms of a monopolistic and uncaring system. When I deal with the healtcare establishment, I feel like I'm dealing with Rogers or Bell Canada - but worse as there's only one option not two.

The recent studies have not been contradictory at all. Even the Fraser Institute shows falling wait times for the last couple of years.

They certainly are contradictory. ER wait times aren't meeting target, and you can't find trend data either:

http://edrs.waittimes.net/en/Data.aspx?LHIN=7&city=&pc=&dist=0&hosptID=0&str=&view=0&period=23&expand=0

Ah, so you're talking about Ontario. Maybe you should stick that. eHealth Manitoba is working well, from what I can tell.

Well, that's good to hear. I would favour eHealth Manitoba taking over eHealth Ontario in a heartbeat.

[Shady]

It's all the same money.

It's not the same money! Are you people seriously this stupid? Private clinics pay for their own equipment. Private clinic patients pay for their treatment with their own money. They still pay taxes to the government.

[Michael Hardner]

And how would costs be cut through the introduction of profit?

Because external agencies would be motivated to innovate and find ways to do the same work or better with less money.

[Shady]

you haven't a clue... you would presume that private clinics will be staffed without dipping into the existing pool of medical professionals working within the public domain... and that private clinics will staff their needs through the training of additional medical professionals.

You could provide regulations to deal with that.

[Michael Hardner]

There's nothing progressive about further increasing the cost curve and suddenly saying that people with more money matter more.

Let's see if we can have this discussion without evoking images of greedy rich people going to the front of the line. The underlying purpose of improvements would be to ensure that the bottom line improves for all Canadians, nothing less.

The bottom line being quality health care service delivery at a reasonable cost.

[Smallc]

It's not the same money! Are you people seriously this stupid? Private clinics pay for their own equipment. Private clinic patients pay for their treatment with their own money. They still pay taxes to the government.

You are just not getting it. The same people pay for it, no matter if it's in the form of taxes or premiums or payments. This doesn't help decrease costs and this is what you aren't getting.

[Smallc]

Because external agencies would be motivated to innovate and find ways to do the same work or better with less money.

I see no evidence that they would be more motivated than the not for profit hospitals that aren't run by the government, btw. They would simply add more cost to administration.

[Smallc]

Let's see if we can have this discussion without evoking images of greedy rich people going to the front of the line.

Why avoid what is the reality of what you're proposing? You don't want to consider the negative connotations, but I have no incentive to avoid them.

[Michael Hardner]

I see no evidence that they would be more motivated than the not for profit hospitals that aren't run by the government, btw. They would simply add more cost to administration.

It just stands to reason. They have to be more motivated, or they will fail.

[Michael Hardner]

Why avoid what is the reality of what you're proposing? You don't want to consider the negative connotations, but I have no incentive to avoid them.

Then the entire discussion is a non-starter. We're basically saying "let's not discuss two-tier because it will favour the rich and provide less services to low income patients".

If that's the case, then how are we ever going to improve one-tier healthcare ? Propose a way to do that, because one-tier has had ten years to improve things since this debate started and they haven't done it.