Why can't politicans talk about serious healthcare fixes?

[bloodyminded]

I'm quite content to shout as loud as I can to keep them under their rocks...and patriotism has nothing to do with it nor do canadian values, it's human values...

I agree. The whole notion, for me, has precisely zero to do with some idea of Canadian pride. I don't care about that at all.

[Shwa]

What do you think of the idea that tackling poverty and social inequalities could end up reducing demands on the health care system?

I think that is one of the main inputs for universal healthcare in the first place, don't you? But I think education goes hand in hand with those social efforts. For example, my Mom had 4 kids. When I had kids and they showed signs of illness, I didn't run to the emergency ward and clog the services because my kids had a cough or a fever. I called my Mom.

I think one of the big problems with health care is not the system itself, but user problems and the God-hood image of doctors. There is likely an untapped wealth of basic health care information and experience that exists within every community that could likely reduce a good deal of Emergency visits. Another good idea is th Nurse Practitioner. Now there are political considerations to all of this. For example, my calls to my Mom are free and no doctors, nurses or hospital administrators made any money off of that.

I have no problem with Michael's suggestions for better oversight and reporting on performance in the system.

Neither do I so long as it does not overburden the system with useless flights of fancy. Why spend millions on data that very few in the public will ever use and possibly misinterpret?

I have a very good friend who is a management nurse in a large hospital in the US and their performance data is contained within proprietary databases that are tightly controlled by the database owners and the government. This stuff is not available for public perusal.

[Shwa]

How much of the reason ? If there were a definitive authority that could explain these kinds of costs then that would be helpful, but there isn't one.

When was the last time you actually looked for a "definitive authority?" And even if you come up empty-handed, whose to say that means anything more than a lousy search?

I am certain there are some fairly well informed folks who can give you a good idea of those sort of costs. Have you actually looked for any?

[Michael Hardner]

which part??? living to 80? average was about 69-72 in the 60's, now it's 80.7...all because of better healthcare, treatment and screening which all costs more...Boomers? that's quite common knowledge...boomers that are MD's? reflects the population demographics...

Which part ? Your quote:a big part of that rise in cost is more expensive procedures

I didn't think you did but your response was odd, all healthcare ultimately is about saving lives...preventing small issues becoming life threatening issues...

Philosophically, I guess so. Then if taking Viagara is ultimately about saving lives, cutting funding for Viagara could philosophically be a discussion of saving one's life. If that's how the discussion is going to unfold, though, we should basically get rid of all expenditures except food and healthcare, and possibly toilet paper.

you know this how? when was the last time a government opened the books to show how it was doing?...hospitals,MDs chart everything

fair enough I don't know your situation in ontario but public(socialist) healthcare to a conservative is like holy water to a vampire...I've personally known enough hardline conservatives who see public healthcare as nothing more than communism...I'm not speaking of your garden variety moderate conservative but the hardline loons, we have a lot of those in alberta(wildrose party)

How do I know this ? Many hours spent looking for data. Guess what ? It's incomplete. It's terrible. And nothing more could be expected with a giant entity that is in charge of monitoring itself.

The point is, if we dig in our heels and continue to say "the system is fine" in response to conservative criticism, the system will ultimately fail and the only other solution in the public mind will be the private option.

agree a buffer has to put between politicians and healthcare, those managing the services need to be free of political bias and judged solely by the performance of the healthcare system under their guidance...that means not hiring ex MLAs /affiliated political stooges and people with a vested interest in seeing the system fail...actual medical experts in administration and MDs, not insurance brokers and lawyers...

Medical experts in administration is not on. There's no reason for that. They're key stakeholders, and have a say in the final answer but they should absolutely not run the system.

Edited December 10, 2010 by Michael Hardner

[GostHacked]

No one in power wants to fix the problem, this is why they don't seriously talk about serious health care fixes.

[Michael Hardner]

When was the last time you actually looked for a "definitive authority?" And even if you come up empty-handed, whose to say that means anything more than a lousy search?

I am certain there are some fairly well informed folks who can give you a good idea of those sort of costs. Have you actually looked for any?

Yes, I have spent lots of time - hours - looking for it. The fact that I can't Google it and see a clear resource that summarizes these things says something.

There's CIHI but they're not completely independent, nor do they publish timely regular and easy to read reports. But they're the best thing out there.

The Ontario government plays a cute game where they show selected statistics for a single month, versus a target - usually with missing data, and *****ASTERISKS******.

[Shwa]

Yes, I have spent lots of time - hours - looking for it. The fact that I can't Google it and see a clear resource that summarizes these things says something.

There's CIHI but they're not completely independent, nor do they publish timely regular and easy to read reports. But they're the best thing out there.

The Ontario government plays a cute game where they show selected statistics for a single month, versus a target - usually with missing data, and *****ASTERISKS******.

I am not sure what you are saying here. Are you saying that the "definitive authority" has to be on the web somewhere?

[wyly]

Which part ? Your quote:a big part of that rise in cost is more expensive procedures

it is, new technology costs major dollars...we're not living longer because MDs are better but because the technology/drugs they use are better...

Philosophically, I guess so. Then if taking Viagara is ultimately about saving lives, cutting funding for Viagara could philosophically be a discussion of saving one's life. If that's how the discussion is going to unfold, though, we should basically get rid of all expenditures except food and healthcare, and possibly toilet paper.

without our health we have nothing, it trumps everything ...

How do I know this ? Many hours spent looking for data. Guess what ? It's incomplete. It's terrible. And nothing more could be expected with a giant entity that is in charge of monitoring itself.

The point is, if we dig in our heels and continue to say "the system is fine" in response to conservative criticism, the system will ultimately fail and the only other solution in the public mind will be the private option.

the public employees just do what they're told providing what ever data that is requested...those doing the monitoring of that data are politically appointed party faithful with the Provincial health minister at the top...

Medical experts in administration is not on. There's no reason for that. They're key stakeholders, and have a say in the final answer but they should absolutely not run the system.

believe it or not there are people who are trained for public health administration and they are not MDs, the President of the AHS who was fired over a comment about a cookie was an expert in public health care administration not an MD...but MDs also must be involved in the administration process other wise there is a disconnect between administration and the actual everyday world of healthcare...I as a contractor do the same in my workplace, I make final decisions of procedure and financial decisions based on the advice of my sub-contractors who are experts in their field, I can't do it without their combined practical knowledge...

[Michael Hardner]

I am not sure what you are saying here. Are you saying that the "definitive authority" has to be on the web somewhere?

No, the authority is an entity - not a web page. But information management should include a web presence, yes.

[Michael Hardner]

it is, new technology costs major dollars...we're not living longer because MDs are better but because the technology/drugs they use are better...

Ok - let's see some numbers then.

without our health we have nothing, it trumps everything ...

But that doesn't mean we shouldn't manage it. In fact, we should manage it better than anything else - which is why healthcare is socialized and heavily regulated. We have to balance resources, because resources are always limited.

the public employees just do what they're told providing what ever data that is requested...those doing the monitoring of that data are politically appointed party faithful with the Provincial health minister at the top...

Exactly, and the people don't realize that it can be any other way.

believe it or not there are people who are trained for public health administration and they are not MDs, the President of the AHS who was fired over a comment about a cookie was an expert in public health care administration not an MD...but MDs also must be involved in the administration process other wise there is a disconnect between administration and the actual everyday world of healthcare...I as a contractor do the same in my workplace, I make final decisions of procedure and financial decisions based on the advice of my sub-contractors who are experts in their field, I can't do it without their combined practical knowledge...

Sure, I think you posted that example. I'd like to read the story of the cookie man.

[Michael Hardner]

A Toronto health administrator (high up on the food chain, former doctor) was on Metro Morning earlier this year talking about gains they made by consulting with engineers about facilities management. That discussion eventually led to 24-hour use of facilities.

He was talking about it as if it was a great innovation, but the flip side of it was the fact that it took years for this simple change to be recognized as even possible - all because this industry operates in a silo. I would like to see more operations experts looking at the system.

[jbg]

There is no reason that we cannot have universal access to some kind of universal health care, but it simply cannot be as extensive as it is now, no matter what. The numbers of boomers are too high, the numbers of their children are too low.

I see that as a strong possibility. But what about trying a more constructive solution of getting more people working so we have a bigger pie, and thus more ability to afford health care (notice I didn't say public health insurance) and other goods.

Most likely, universal health care will be greatly reduced in scope to cover only the most critical of care, and many services will be up to the citizen to buy on the open market. This situations already exists to some degree in several areas like chiropractic, eye care, dental care, drugs, etc. It will get worse, it has to.

Also, notice that dental care is far less costly on a per hour basis than medical care. If we eliminated all health coverage and the attendant paperwork I bet medical costs would plummet.

[wyly]

Ok - let's see some numbers then.

please that's just silly what you're impling is there is no research or new technology or what there is is free...we haven't seen a ten year increase in life expectancy due to better MD bedside manners...

Sure, I think you posted that example. I'd like to read the story of the cookie man.

stephan duckett

[Shwa]

A Toronto health administrator (high up on the food chain, former doctor) was on Metro Morning earlier this year talking about gains they made by consulting with engineers about facilities management. That discussion eventually led to 24-hour use of facilities.

He was talking about it as if it was a great innovation, but the flip side of it was the fact that it took years for this simple change to be recognized as even possible - all because this industry operates in a silo. I would like to see more operations experts looking at the system.

I am confident that if we dug in to make a real study of what is going on in the background, we would see plenty of operations experts analyzing the system. Like any institution. And yes I think the industry does exist in a 'silo,' but that term is so... 30-months ago. Now they talk about 'pillars.'

I digress...

I think there is no disagreement that something needs to be fixed within the health care system, however, there is a disparity between various factions as to what that something actually is. For any changes to the system, other than those changes that are the direct responsibility of - or within the power of - the systems administrators, the perception becomes less isolated and into the public arena. And thus political.

And even if we entrusted wide spread change - not the actual implementation, but the concepts of what needs to be changed - to those administrators, there is going to have to be some sort of consensus of what the changes should be and how they will be implemented among them. Even that limited degree of consensus making takes quite a bit of time.

Since we are the owners of the system, then even a political consensus will take much longer and with the health care system, no politician is going to suggest an immediate, radical alteration and stay long in office. Plus, I think that how we fix those somethings in the health care system will be under far more scrutiny from the public that the actual system is now. It is a touchy subject for sure.

But I believe you are on the right track with regard to information transparency. Health care is as important as justice and one of those societal pillars and it seems that there is far more information about how the justice system performs than the health care system. Perhaps what we need to start with is an oversight organ similar to the way that justice hierarchy is organized from the local to the supreme...

[Michael Hardner]

please that's just silly what you're impling is there is no research or new technology or what there is is free...we haven't seen a ten year increase in life expectancy due to better MD bedside manners...

I'm not implying anything. I'm asking you to source your claim from above.

[Michael Hardner]

Perhaps what we need to start with is an oversight organ similar to the way that justice hierarchy is organized from the local to the supreme...

That's an idea.

I think local is a good idea, with some kind of provincial or national standard. We have that now.

[Shwa]

That's an idea.

I think local is a good idea, with some kind of provincial or national standard. We have that now.

We do? I can go into practically any provincial court, read the docket and listen in to what the justice system is doing in those sessions. I am not sure if I have the same access to the local 'health corporation' boardroom, but to be fair I have never tried. Even the education system - another pillar - elect trustees...

[Argus]

No one in power wants to fix the problem, this is why they don't seriously talk about serious health care fixes.

Of course they want to fix it. But how? There are myriad problems, and all the solutions are expensive, and just as importantly from a political perspective - time consuming. The problems of health care aren't going to be solved during anyone's immediate term in office, and politicians look for immediate visible progress in order to wave it in front of the slavering herd before the next election.

Addressing health care is going to cost a lot in the short term, and the advantages aren't going to be immediately evident in time for an election. So a politician who makes a major effort suddenly is "responsible" for all the tumult and problems which will result in the short term, as well as the huge costs. And they won't get to point at the great and wondrous solution because that will be a decade down the road.

As it stands, no particular politician or government can be assigned ownership of the health care mess. And they all cringe at the thought of going at it head-on because then that ownership becomes theirs.

In addition, of course, health care is divided among the eleven provinces and the feds, divided, to my mind, disastrously. You have the feds with the money but the provinces making decisions. How do you bring in a wonderful new system when you need agreement between thirteen governments, governments which often are beholden to entirely different ideologies?

[Argus]

I think the issue is not more local control, but more national control. Decision making needs to be centralized with spending power, and that's at the federal level. As it stands now health care spending is becoming so large that provincial governments are basically spending half their budgets on it. And that is continuing to rise. Do we want provinces to be basically health care agencies with a few extras thrown in? What happens when 60%, 70% of their budgets are devoted to health care? It's absurd.

Centralizing control at the federal level also makes one group responsible, and allows them to be held responsible. No more shifting blame to the other guys. It's on YOU.

[Argus]

The costs keep going up, and because we don't have a good system of dialogue in order to prioritize things, and especially to manage change, a slash-and-cut mentality comes in.

There are a number of things pushing costs up, and quality of service down, but we have a reasonable handle on what they are - if not solutions.

An aging population.

This is number one. I don't think anyone will seriously argue. The system has done virtually nothing to address it. There needs to be an intensive undertaking to look after the aged. That used to be the responsibility of family. No more. We need much more funding for nursing homes for the elderly with serious health issues who are currently clogging up hospitals. Releasing those seniors early - which is done far more often than it should be - far too often just leads to more serious complications which send them right back to hospital for even more expensive treatment. In the end, it's cheaper to send them to nursing homes.

We also need much more funding for home care so seniors can stay in their homes and not in comparatively much more expensive institutions. That includes both home health care and home care services such as personal assistance. Trust me, it's way cheaper on a macro scale to look after them at home than in an institution.

As for pharmacare. That too is a rising cost, and unjustifiably so. It's already been documented that the vast majority of the costs of real R&D done by pharmaceutical companies is paid for by government. What then justifies the ridiculous prices pharmaceutical companies are charging for necessary medications? It certainly isn't the cost of production! I suppose a libertarian would say they get to charge whatever they want to, but that's just not in society's best interest. If necessary, and I know this goes against the spirit for small government types, the government can buy out some pharmaceutical companies and start manufacturing drugs to use in its own system. The savings would be phenomenal.

[Michael Hardner]

We do? I can go into practically any provincial court, read the docket and listen in to what the justice system is doing in those sessions. I am not sure if I have the same access to the local 'health corporation' boardroom, but to be fair I have never tried. Even the education system - another pillar - elect trustees...

Hospitals and regional health systems are controlled locally, I think, and ultimately controlled by provinces and the federal government.

[Michael Hardner]

There are a number of things pushing costs up, and quality of service down, but we have a reasonable handle on what they are - if not solutions.

Fair enough, but in fact I'm not debating whether there are such factors or what the specific factors are. Obviously something is getting more expensive, and Wyly and others have some ideas as to what they are. Many people do.

What I'd like to see, though, is some kind of actual breakdown of cost factors, that is independently produced, easy to access and read, and is factually correct. It would be great if they tried to project such increases into near term as well.

[Evening Star]

Quite like Argus's suggestions. I also find the system of 'feds pay/provinces decide' quite unfortunate. Sadly, I suspect that at least QC (and perhaps AB?) will stand in the way of greater centralized control.

[fellowtraveller]

Otherwise, we are in fine shape, most people want universal health care and there ya go.

No, we don't just go. There is a limit to how much of our GDP can be spent on health care or any public expense, and we are reaching it now. If you want to graduate doctors and hospice workers, you have to pay for their education too.... The demographics are inescapable, unless about half the boomers are killed now and the other half forced to never retire, we will not be able to fund the current system much less expand it in some sort of fantasy utopian future.

There is no choice but to cap the % of tax money dedictaed to our joint health and limit services to critical care. Everybody loves the benefits of practicing preventative medicine, and having all of us live longer, happier and healthier lives. That essentially changes nothing, since right now and in the future, the majority of money is spent keeping people ticking along in the last few years of their lives. Preventative nedicine just defers it for a few years for some people, the same intensive work is required at 85 years instead of 80 years, and the costs will have gone up-not down.

The route to future health care will have a large dose of self-help, and financed personally by those that can afford the extra care.

Wanting it just does not make it happen. If it did, we would all be driving a Mercedes.

[Shwa]

No, we don't just go. There is a limit to how much of our GDP can be spent on health care or any public expense, and we are reaching it now. If you want to graduate doctors and hospice workers, you have to pay for their education too.... The demographics are inescapable, unless about half the boomers are killed now and the other half forced to never retire, we will not be able to fund the current system much less expand it in some sort of fantasy utopian future.

Cite your source please.

There is no choice but to cap the % of tax money dedictaed to our joint health and limit services to critical care. Everybody loves the benefits of practicing preventative medicine, and having all of us live longer, happier and healthier lives. That essentially changes nothing, since right now and in the future, the majority of money is spent keeping people ticking along in the last few years of their lives. Preventative nedicine just defers it for a few years for some people, the same intensive work is required at 85 years instead of 80 years, and the costs will have gone up-not down.

Do you have this in politically independent source material you can refer me to?

The route to future health care will have a large dose of self-help, and financed personally by those that can afford the extra care.

Not sure what that means...

Wanting it just does not make it happen. If it did, we would all be driving a Mercedes.

Neither does wishful thinking fueld by an ideological imperative. Which is likely one of the reasons why politicians can't talk about serious healthcare fixes. But if you have the material and I have the time, I would be open to read through something that provides a rational view without screeching for one ideology or another.

Can you do that? Cite a source?