Why can't politicans talk about serious healthcare fixes?

[fellowtraveller]

Neither does wishful thinking fueld by an ideological imperative.

I am not aware of your ideology or what influences your opinions or imperatives. It would not influence the reality of the demographics we are now presented with in any case. My opinions are fueled by the facts. I have no wish to see the health of myself or other Canadians of any political view curtailed, but I am willing to acknowledge the mathematics we face.

Health care costs are running around 50% of total budgets in provinces, and climbing. Assuming that citizens still want such trifles as public education, police, military, roads, social services and a bit of cultural support from their governments they will have to accept either a cap on spiralling public health funding, or a dramatic cut in other services. The only one that ius escalating rapidly is health care. The only other option is continual tax increases to cover the upward spiral of health care costs. That is why I say that govts will have no choice but to put a % cap on what goes into our mutual health care, or it will consume all.

Not sure what that means...

It means that =like now- the wealthy will be able to afford better personal health care, and will do so regradless of what is provied by the state. Same as always, but it will be much more widespread. The simple reason for that is that govts will have no choice but to delist services now provided by the state as critical care costs for the boomer generation increase. You can either pay out of pocket for that sports injury or pay for the insurance for same. The public system won't cover voluntary damage. It has already begun in many places, for example all chiropracty was delisted in my province recently. Many provinces cap what they will pay for people travelling poutside the country, when that used to be more or less fully covered too. Dentistry is not covered here, eye care, drugs for the general population, therpautic massage, some physio, etec etc etc That list will certainly grow. The calls here for expanded services are complete fantasy. We can barely afford what is offered now, and that will get worse as the population ages and technology inceases.

Can you do that? Cite a source?

For the demographics of Canada, and health care funding? Sure, no problem: these guys are often reliable

In regard to this OP title, it is a bit misleading. It is not our politicians alone who will not discuss serious healthcare fixes, it is the people who fail themselves too. The demographics are unavoidable, yet we have so many who canot get beyond their emotion. Until that changes, we will stagger along unhappily and fail to leverage the obvious advantages this country enjoys, with universal access to health care being at or near the front of those.

[Smallc]

The thing is, whether private or public, ultimately the same people pay. We can't escape the demographics of the next twenty years no matter what we do.

[Shwa]

I am not aware of your ideology or what influences your opinions or imperatives. It would not influence the reality of the demographics we are now presented with in any case. My opinions are fueled by the facts. I have no wish to see the health of myself or other Canadians of any political view curtailed, but I am willing to acknowledge the mathematics we face.

Yet you fail to cite the source of your mathematics. So your outlook is culled from what? What you feel?

Costs?

Wiki - Health Care in Canada - Economics

The greatest proportion of this money goes to hospitals ($51B), followed by pharmaceuticals ($30B), and physicians ($26B). Total spending in 2007 was equivalent to 10.1% of the gross domestic product which was slightly above the average for OECD countries, and below the 16.0% of GDP spent on health care in the United States. The proportion spent on hospitals and physicians has declined between 1975 and 2009 while the amount spent on pharmaceuticals has increased.

Maybe cheaper drugs is what we need. Or maybe a significant portion of the population needs to find other ways to manage themselves, other than drugs. Which goes to show that components of the system can be reviewed.

Here go to town.

Health care costs are running around 50% of total budgets in provinces, and climbing. Assuming that citizens still want such trifles as public education, police, military, roads, social services and a bit of cultural support from their governments they will have to accept either a cap on spiralling public health funding, or a dramatic cut in other services. The only one that ius escalating rapidly is health care. The only other option is continual tax increases to cover the upward spiral of health care costs. That is why I say that govts will have no choice but to put a % cap on what goes into our mutual health care, or it will consume all.

I highly doubt that the government will allow us to be consumed by the cost of health care.

It means that =like now- the wealthy will be able to afford better personal health care, and will do so regradless of what is provied by the state. Same as always, but it will be much more widespread. The simple reason for that is that govts will have no choice but to delist services now provided by the state as critical care costs for the boomer generation increase. You can either pay out of pocket for that sports injury or pay for the insurance for same. The public system won't cover voluntary damage. It has already begun in many places, for example all chiropracty was delisted in my province recently. Many provinces cap what they will pay for people travelling poutside the country, when that used to be more or less fully covered too. Dentistry is not covered here, eye care, drugs for the general population, therpautic massage, some physio, etec etc etc That list will certainly grow. The calls here for expanded services are complete fantasy. We can barely afford what is offered now, and that will get worse as the population ages and technology inceases.

We can afford it just fine. See above. I am not saying that there couldn't be some changes made, perhaps pry a few people off the health care trough, but we are not doomed.

For the demographics of Canada, and health care funding? Sure, no problem: these guys are often reliable

In regard to this OP title, it is a bit misleading. It is not our politicians alone who will not discuss serious healthcare fixes, it is the people who fail themselves too. The demographics are unavoidable, yet we have so many who canot get beyond their emotion. Until that changes, we will stagger along unhappily and fail to leverage the obvious advantages this country enjoys, with universal access to health care being at or near the front of those.

Now what is worse is the people who can't get past their own laziness and post links to the Statcan homepage as a citation of demographics and health care. Should we just take your word for it?

Nope.

[Shwa]

The thing is, whether private or public, ultimately the same people pay. We can't escape the demographics of the next twenty years no matter what we do.

What demographics would you be referring to?

[fellowtraveller]

I highly doubt that the government will allow us to be consumed by the cost of health care.

Thanks for your support, though I am assuming you meant governments since the provinces pay for health care.

Any opinion on what an appropriate cap for health care as a % of provincial expenses will be? 100%?

[fellowtraveller]

and OK, I'll be your Google bitch just this once

Health care costs in Ontario currently at 46% of total expenses and rising at 6.5% annually, double or triple the rate of inflation and an utterly alarming trend repeated in every province. At the current rate of increase, it will be to 80% of total provincial expenses. And it does not make a bit of difference if it is due to hospitals, physician cost, drugs , whatever- unless you are speaking of delisting services, which you won't because it might stimulate a serious discussion about a serious problem.

[Shwa]

Thanks for your support, though I am assuming you meant governments since the provinces pay for health care.

Any opinion on what an appropriate cap for health care as a % of provincial expenses will be? 100%?

Who pays for health care?

[Shwa]

and OK, I'll be your Google bitch just this once

Thanks Google bitch, but I have already read that one. And it doesn't support what you are saying one bit.

Let's look at your first contradiction according to your "research:"

...There is no choice but to cap the % of tax money dedictaed to our joint health and limit services to critical care.

So tell me where in your citation above that it talks about "cap the % of tax money dedictaed to our joint health and limit services to critical care." It doesn't. It talks about efficiencies, which have already been discussed in this thread. As for the report, it looks like there are quite few other choices available than tax and service caps.

Health care costs in Ontario currently at 46% of total expenses and rising at 6.5% annually, double or triple the rate of inflation and an utterly alarming trend repeated in every province. At the current rate of increase, it will be to 80% of total provincial expenses. And it does not make a bit of difference if it is due to hospitals, physician cost, drugs , whatever- unless you are speaking of delisting services, which you won't because it might stimulate a serious discussion about a serious problem.

But according to the report you are citing, it most certainly does make a bit of difference - quite a bit, in fact. Here are the ten recommendations:

Take bolder action to promote healthy lifestyles - education

Expand information technology use in the system - expand technology

Establish a commission on quality and value in health care - more efficient oversight

Alter the way doctors are compensated - doctors

Change the approach of funding hospitals - hospitals

Re-allocate functions among health care providers - efficient organization

Scale back Ontario Drug Benefit (ODB) for higher income seniors - pharmaceuticals

Increase bulk purchases of drugs to lower costs - pharmaceuticals

Establish pre-funding of drug coverage to spread the growing costs of health care - pharmaceuticals

Incorporate a health-care benefit tax into the income tax structure - education

And it looks like the creators of the report actually did their homework and went a little bit further than their first google hit.

Edited December 14, 2010 by Shwa

[Evening Star]

The thing is, whether private or public, ultimately the same people pay. We can't escape the demographics of the next twenty years no matter what we do.

Ha, I kept trying to make this point too. It's why I'm unconvinced that privatizing health insurance in more areas is actually going to make things cheaper for anyone. No one listened to me either.

[wyly]

Ha, I kept trying to make this point too. It's why I'm unconvinced that privatizing health insurance in more areas is actually going to make things cheaper for anyone. No one listened to me either.

US healthcare is twice the cost of ours per person, delivering a less effective service based on our longer average lifespan, you can't argue with lifespan..how does anyone think if we move to an american system of private care will be less expensive or better...

and then there's that nasty demographic fact, we're getting older as a population, older people use healthcare more than the young...

[jbg]

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.

US healthcare is twice the cost of ours per person, delivering a less effective service based on our longer average lifespan, you can't argue with lifespan..how does anyone think if we move to an american system of private care will be less expensive or better...

and then there's that nasty demographic fact, we're getting older as a population, older people use healthcare more than the young...

The elephant in the room on health insurance is the exploding life expectancies. People are living longer. And most people who make it from the old 72 year life expectancy to the "new normal" of around or over 90 have at least one illness or hip fracture that requires care, if not more. Whether the "payer" is the Canadian federal government, the provinces, or in the U.S. Medicare or "employer paid" insurance makes little difference; the patient him or herself has no ability to pay, so the cost gets "spread".

I myself, as a healthy 53 year old, place no great stock in these long life expectancies. But they exist.

[Michael Hardner]

People keep quoting reasons for cost increases, but until I see independent and regular audits from the system, I won't believe it.

If healthcare is to remain public, then we have to ensure that the system over-communicates to the public. We have to publish the planning and the rationales for the plans, as well as measuring the outcomes of those plans. Otherwise, there is no way to build on what works and to cut back on what doesn't work.

[bush_cheney2004]

US healthcare is twice the cost of ours per person, delivering a less effective service based on our longer average lifespan, you can't argue with lifespan..how does anyone think if we move to an american system of private care will be less expensive or better...

This is a false notion...using such logic, Japan has a more effective healthcare system than Canada. Canada has the most expensive universal access system in the world, yet it does not have commensurate improvements to service. Furthermore, Canada's system uses the excess capacity, research, pharma, imaging technology, etc. found in America.

[Shwa]

People keep quoting reasons for cost increases, but until I see independent and regular audits from the system, I won't believe it.

If healthcare is to remain public, then we have to ensure that the system over-communicates to the public. We have to publish the planning and the rationales for the plans, as well as measuring the outcomes of those plans. Otherwise, there is no way to build on what works and to cut back on what doesn't work.

Which is all more or less in line with what most rationale folks are calling for, including that TD report cited above.

[Michael Hardner]

Which is all more or less in line with what most rationale folks are calling for, including that TD report cited above.

That's good to hear. Making the healthcare sector report to the numbers, rather than to their political bosses could potentially end all of this talk of privatization, if it works.

[jbg]

The elephant in the room on health insurance is the exploding life expectancies. People are living longer. And most people who make it from the old 72 year life expectancy to the "new normal" of around or over 90 have at least one illness or hip fracture that requires care, if not more. Whether the "payer" is the Canadian federal government, the provinces, or in the U.S. Medicare or "employer paid" insurance makes little difference; the patient him or herself has no ability to pay, so the cost gets "spread".

I myself, as a healthy 53 year old, place no great stock in these long life expectancies. But they exist.

Crickets to this point.

[bush_cheney2004]

Crickets to this point.

Far too many resources are expended in the last months of life you describe. Time for some hard decisions....the UK is already making them (e.g. renal care).

[jbg]

Far too many resources are expended in the last months of life you describe. Time for some hard decisions....the UK is already making them (e.g. renal care).

In the example I gave (yes, my family) the likely "extension" of life is 20 years or so, and that extension carries lots of additional expenses. I'm just pointing out that I gore my own ox with this point.

[Bonam]

The elephant in the room on health insurance is the exploding life expectancies. People are living longer. And most people who make it from the old 72 year life expectancy to the "new normal" of around or over 90 have at least one illness or hip fracture that requires care, if not more. Whether the "payer" is the Canadian federal government, the provinces, or in the U.S. Medicare or "employer paid" insurance makes little difference; the patient him or herself has no ability to pay, so the cost gets "spread".

I myself, as a healthy 53 year old, place no great stock in these long life expectancies. But they exist.

Life expectancy will continue to grow. The obvious answer is that people will need to start retiring later. When the 65 year age retirement age was instituted, the average life expectancy was only 62. That is, most people died before retiring. Today, life expectancy is far greater, and people are expecting to spend over a decade in retirement. If someone is gonna live to be 100, it doesn't make sense not to work for the entire last 1/3 of their life. That is a long time.

Like I've said before, I plan to still be working at 120, and people alive today need to start accepting that they won't be able to spend decades living a life of leisure on other people's dime.

[wyly]

The elephant in the room on health insurance is the exploding life expectancies. People are living longer. And most people who make it from the old 72 year life expectancy to the "new normal" of around or over 90 have at least one illness or hip fracture that requires care, if not more. Whether the "payer" is the Canadian federal government, the provinces, or in the U.S. Medicare or "employer paid" insurance makes little difference; the patient him or herself has no ability to pay, so the cost gets "spread".

I myself, as a healthy 53 year old, place no great stock in these long life expectancies. But they exist.

from CIA factbook average age of canadians is 81.29, for americans it's 78.24 well short of 90yr average...but the point made agrees with mine the longer the life expectancy the higher the cost to all of us...each new technology that increases lifespan adds to cost, an older screening for colon cancer a smear test which I believe costs $15-25 dollars, a newer high tech version costs $400+, now make this a regular screened test and you have a major cost increase to be spread, insignificant overall but added to other improved technologies for other illnesses the costs do add up...whereas 50-60yrs ago those with colon cancer would just die as there were few if any screenings...

[jbg]

from CIA factbook average age of canadians is 81.29, for americans it's 78.24 well short of 90yr average...

I believe though that the life expectancy of someone alive and well, say, at 50 is probably close to 90. I think the lower numbers crank in deaths in childhood or adolescence, which are more likely the result either of congenital diseases (at childbirth or in the first few years after) or violence in adolescence or early adulthood.

My point is that people in their working years really need to think about ways to work longer.

[wyly]

My point is that people in their working years really need to think about ways to work longer.

agreed... pension plan were never intended to support half the population from 65 until 80 or beyond...work until you drop or if medically unable to work...

[Evening Star]

This is a false notion...using such logic, Japan has a more effective healthcare system than Canada.

I see no reason to deny this possibility! No one here has claimed that our system is the world's best, just that it does seem to be more efficient and effective than America's and thus, we are not that eager to privatize insurance coverage. Life expectancy is certainly not the only measure of health but it is certainly one that is useful.

Canada has the most expensive universal access system in the world, yet it does not have commensurate improvements to service. Furthermore, Canada's system uses the excess capacity, research, pharma, imaging technology, etc. found in America.

You do seem to have a valid point there but I'm not sure that that is an argument in favour of privatized coverage either.

[bush_cheney2004]

I see no reason to deny this possibility! No one here has claimed that our system is the world's best, just that it does seem to be more efficient and effective than America's and thus, we are not that eager to privatize insurance coverage. Life expectancy is certainly not the only measure of health but it is certainly one that is useful.

This depends on what metrics are used to define "effective". For instance, diagnostic imaging in the US is much better than in Canada. Canada leverages the many advantages of excess capacity in the US through standing provincial contracts with American hospitals (e.g. neonatal care).

You do seem to have a valid point there but I'm not sure that that is an argument in favour of privatized coverage either.

Comparisons to the US are a fool's dodge...France has a much better system than Canada's but life expectancy is nearly identical. Canadians will always be satisfied with a struggling system as long as they can say/believe it is better than the USA.

[Evening Star]

This depends on what metrics are used to define "effective". For instance, diagnostic imaging in the US is much better than in Canada. Canada leverages the many advantages of excess capacity in the US through standing provincial contracts with American hospitals (e.g. neonatal care).

Comparisons to the US are a fool's dodge...France has a much better system than Canada's but life expectancy is nearly identical. Canadians will always be satisfied with a struggling system as long as they can say/believe it is better than the USA.

Who said we're satisfied with it? The fact that we're having this discussion in the first place suggests that we have concerns and doubts. However, when looking to other models to try to improve, it makes sense to look to the US as a model of privatized coverage. And health coverage in the US does not seem to be working better than our socialized insurance system. Perhaps France and Japan (and some would say Scandinavian or even British models) are good models to consider. Perhaps America is a good model to consider in other areas, such as technological development or the sheer capacity you mention. Do we need privatized insurance coverage for those things?

On what grounds do you judge France's system to be much better (despite the nearly identical life expectancy)? I'm not denying it. I'm just curious what criteria you're using and interested in more info.