Canadian doctors want YOUR views on healthcare

[Michael Hardner]

I'm looking at the forum in the OP now.

My first comment:

The layout of this site makes it difficult to use.

There are a few web forums out there that are tried & true and have been successfully implemented, and many are inexpensive or free to use. Instead, somebody has gone out and done it their own way, without consulting with experts.

We have 3 official topics with up to 187 comments on them ? How can that setup facilitate progressive discussion ?

In fact, it's making me think that this site encapsulates what's wrong with our health care industry in Canada. A 'design and defend' attitude tends to occur in areas where the culture isn't geared towards soliciting public input.

[Wild Bill]

Healthcare VS Police + Courts + Prison System + Military?

I betcha it would be pretty close, but Im not really sure.

The point is we ALL pay for things that we dont like and things that get used by other people. Not sure if you can escape that unless you dont live in a society.

Now this was interesting, Dre. There are charts from StatsCan in Bill Gairdner's book The Trouble With Canada that show healthcare to take up more than all the other items combined!

This was the early 90's and Gairdner was making the point that the rate of growth of health care spending was unsustainable.

I figured that today with Google and the Internet there would be lots of sites showing easy pie charts or whatever to breakdown the federal budget but after editing my query a number of times and spending half an hour on it all I could find was references to percentage of GDP. This of course won't show anything very clearly.

I did find this site:

http://www.cmaj.ca/cgi/content/full/177/1/51

"One view maintains that our publicly funded health care system is unsustainable because health care expenditures are accounting for an ever-increasing share of government spending. In Ontario, for example, health care spending accounted for just over 30% of the provincial government's expenditures in 1981/82, but 45% in 2004/05. Assuming that current trends will continue, the Ontario government has projected that the share will increase to 55% by 2025.8"

This only covers Ontario but I'm sure other provinces would be similar. The article immediately retreats to dealing only in GDP numbers and percentages by capita, which at least to me are not as clear and thus not as scary. The site is run by the Canadian Medical Association and the purpose of the article is to make the claim that things ARE sustainable! Perhaps that is the reason.

Maybe someone else can do a better google. Still, before google can find a site someone must compile the info in the desired fashion. Perhaps few are paying attention and publishing results in that manner.

Whatever. At least we have a cite that shows Ontario paying nearly half of its budget for just the one line item of health care, with a history of increases. Surely that's an indicator of a cause for concern!

[Michael Hardner]

Whatever. At least we have a cite that shows Ontario paying nearly half of its budget for just the one line item of health care, with a history of increases. Surely that's an indicator of a cause for concern!

Wild Bill, you are going down the same path I started down 5 years ago. You will find out very quickly that our government does a terrible job of communicating how the health care system works. The strange thing is that the system needs to be better at communicating than any other industry because of its importance, and the lack of competition to keep costs in check. Instead, they are worse.

There is an entity called CIHI - Canadian Institute for Health Information, however they are painfully slow at working through this, and tend to produce ad hoc reports and infrequent performance checks.

[Shady]

I like your logic...

It's false logic, because nobody has suggested we not still pay taxes for health care. It's just the knee-jerk, stereotypical fallback position that every flat-earther relies on to oppose health care reform.

[bloodyminded]

It's false logic, because nobody has suggested we not still pay taxes for health care. It's just the knee-jerk, stereotypical fallback position that every flat-earther relies on to oppose health care reform.

Nobody opposes health care reform. They're just wary of the fringe minority view that it be totally or near-totally privatized.

[Michael Hardner]

Nobody opposes health care reform. They're just wary of the fringe minority view that it be totally or near-totally privatized.

And because of that fringe view, it seems that no talk of reform ever moves forward. I can't come up with any other reason for it.

[bloodyminded]

And because of that fringe view, it seems that no talk of reform ever moves forward. I can't come up with any other reason for it.

Maybe you're right, I don't know. Perhaps if sincere, reform-minded people are immediate in their rebuttals of the "all-privitization-is-good" voices--that is, if "reform" doesn't equal "the total end of this" in people's perceptions--they might be more willing to listen.

[Shady]

Nobody opposes health care reform. They're just wary of the fringe minority view that it be totally or near-totally privatized.

I don't think anybody's called for a total or near total privatization. Just an option. Which is hardly a fringe minority view, more like a majority.

[bloodyminded]

I don't think anybody's called for a total or near total privatization. Just an option. Which is hardly a fringe minority view, more like a majority.

You don't think there are people wishing for total privitization?

I've talked with them on this board.

I'd personally be fine with a private option...but no "opting out" of the taxes needed to keep the public option alive and well.

Edited December 16, 2010 by bloodyminded

[Shady]

You don't think there are people wishing for total privitization?

Of course there are. There are small groups of people wishing for many things. But nobody in this thread has mentioned an entire privatization to my knowledge.

[Michael Hardner]

There seems to be more interest in this topic than in the past. Maybe some proverbial tipping point has been reached ? I hope so.

[dre]

And because of that fringe view, it seems that no talk of reform ever moves forward. I can't come up with any other reason for it.

Its because nobody wants to tackle the 800lb guerilla in the room... medical protectionism. Im not comfortable with any reforms that dont treat this as the central issue, because I know they will never work. We need to partially deregulate the industry, and make it super easy for doctors and other medical professionals from around the world to practice here, and easier to offshore as much of the work as possible.

India for example produces doctors that are as competent and well trained as Canadian doctors, but MORE THAN HALF OF THE INDIAN DOCTORS LIVING IN CANADA ARE DRIVING CAB, because Canadian medical associations have lobbied for the government to protect them from that competition.

Theres really no point in talking about reform until youre ready to address that skyrocketing costs are not some "accident" that happened. They are what the system was DESIGNED TO PRODUCE, and that the various components of the system actually ACT with the intention of inflating prices.

Luckily, its extremely EASY for us to drastically reduce healthcare costs if we ever decide to get serious about it, and everyone knows exactly how to do it (even though for some reason they dont like to talk about it).

Edited December 16, 2010 by dre

[Bonam]

Its because nobody wants to tackle the 800lb guerilla in the room... medical protectionism. Im not comfortable with any reforms that dont treat this as the central issue, because I know they will never work. We need to partially deregulate the industry, and make it super easy for doctors and other medical professionals from around the world to practice here, and easier to offshore as much of the work as possible.

India for example produces doctors that are as competent and well trained as Canadian doctors, but MORE THAN HALF OF THE INDIAN DOCTORS LIVING IN CANADA ARE DRIVING CAB, because Canadian medical associations have lobbied for the government to protect them from that competition.

Theres really no point in talking about reform until youre ready to address that skyrocketing costs are not some "accident" that happened. They are what the system was DESIGNED TO PRODUCE, and that the various components of the system actually ACT with the intention of inflating prices.

Luckily, its extremely EASY for us to drastically reduce healthcare costs if we ever decide to get serious about it, and everyone knows exactly how to do it (even though for some reason they dont like to talk about it).

One: people from other countries with proper educations and experience CAN get certified as doctors in Canada. Yes it takes a while and is quite a hassle, but it can be done. Those who come to Canada with the so called "qualifications" to be a doctor but who are too lazy/unmotivated/incapable to go through the paperwork of being certified in Canada, and instead accept life as cab drivers, I'm not sure I'd want as my doctors anyway. Certainly, we can and should streamline the certification process, but gutting medical professional bodies is not the answer.

Two: the cost of paying doctors is only a small part of overall health care costs. Hospitals, support personnel, medical technology, etc all add up to a much bigger portion. If we could reduce the costs of doctors by driving down their salaries by importing lots of doctors, yes, we could maybe cut health care costs by a few % overall, perhaps as much as ~10% at the very upper end if doctor's salaries end up being ~halved, but this would still not really alter the reality of health care costs growing over time to consume an ever bigger portion of our economy.

Three: if wages for doctors in Canada are driven down in the manner you propose, there would be an even bigger incentive for doctors to migrate south to the US, where doctors salaries are already much higher. People don't become doctors to be lower-middle class. This would in turn reduce the number of doctors here and drive salaries back up, coming back to an equilibrium not very far from where we are today, resulting in very little if any final reduction in healthcare costs.

So, I don't think this issue which you like to harp on in these healthcare threads is really as central or important as you make it out to be.

Edited December 17, 2010 by Bonam

[bloodyminded]

Three: if wages for doctors in Canada are driven down in the manner you propose, there would be an even bigger incentive for doctors to migrate south to the US, where doctors salaries are already much higher.

Actually, that's a big oversimplification. Canadian doctors are paid very well; in many cases, more than their American counterparts.

The "Brain drain" is already beginning to reverse itself.

I know the Americaphiles don't like such inconvenient facts, but there they are....

Edited December 17, 2010 by bloodyminded

[dre]

Actually, that's a big oversimplification. Canadian doctors are paid very well; in many cases, more than their American counterparts.

The "Brain drain" is already beginning to reverse itself.

I know the Americaphiles don't like such inconvenient facts, but there they are....

Yeah thats another urban legend.

But medical recruiters and migration statistics suggest a surprising new trend has emerged over the past few years: a net movement of physicians from the United States to Canada.

The reasons they are coming are equally unexpected: pay that is reportedly much better in some specialties; more freedom in their practices; and uncertainty about the impact of health reform in the United States.

“Canada is the number one spot in the world for doctors to come and work, live and play,” said John Philpott, CEO of CanAM Physician Recruiting in Halifax. “Talking to physicians in the United States, they’re shocked how much more money they can make in Canada.”

Read more: http://www.nationalpost.com/Doctor+drain+turns+gain+Physicians+move+north/3497414/story.html#ixzz18KzjhBd1

[Bonam]

Actually, that's a big oversimplification. Canadian doctors are paid very well; in many cases, more than their American counterparts.

The "Brain drain" is already beginning to reverse itself.

I know the Americaphiles don't like such inconvenient facts, but there they are....

Sounds like good news. Anyway, doesn't change the fact that if salaries of Canadian doctors were driven down through "increased competition" as dre suggests, the "brain drain" process would start up again until we reached an equilibrium again.

[Guest TrueMetis]

I'm fine with trying to increase the amount of doctors we have (which seem to be happening) as long as we don't decrease our standards, even slightly.

[wyly]

Its because nobody wants to tackle the 800lb guerilla in the room... medical protectionism. Im not comfortable with any reforms that dont treat this as the central issue, because I know they will never work. We need to partially deregulate the industry, and make it super easy for doctors and other medical professionals from around the world to practice here, and easier to offshore as much of the work as possible.

sure those who want the unqualified foreign MDs can have them, starting with you...

India for example produces doctors that are as competent and well trained as Canadian doctors, but MORE THAN HALF OF THE INDIAN DOCTORS LIVING IN CANADA ARE DRIVING CAB, because Canadian medical associations have lobbied for the government to protect them from that competition.

complete myth if not an outright lie...if they're driving a cab they're not qualified...

Luckily, its extremely EASY for us to drastically reduce healthcare costs if we ever decide to get serious about it, and everyone knows exactly how to do it (even though for some reason they dont like to talk about it).

we spend half as much as the americans per person, what we spend is quite similar to what is spent in other leading countries, so explain to us how we're going to drastically reduce costs, what do you know that every other countries medical experts don't?

[wyly]

I'm fine with trying to increase the amount of doctors we have (which seem to be happening) as long as we don't decrease our standards, even slightly.

the problem is training space, universities have x amount of space for new trainees, want more spaces you need more teachers more facilities, here our local university has had to slash programs..it can be done but it comes at a cost and you can hear the protests as soon it's suggested we need to raise taxes to do it...

[Michael Hardner]

Do family practice doctors really need so much medical school ? Should we start looking at having simple check-ups handled by some kind of health practitioner ?

[Bonam]

Do family practice doctors really need so much medical school ? Should we start looking at having simple check-ups handled by some kind of health practitioner ?

A good family doctor needs to be able to accurately diagnose various conditions and diseases, to be able to correctly prescribe medications, to know when to refer a patient to a particular specialist, to be able to stay up to date with the latest advancements in medical science and technology, and in some cases to be able to perform certain medical and surgical procedures themselves, among other things. In fact, a family doctor is the first health professional that many people will see about a given problem and they will generally set the track and method that the problem will be dealt with. This is not something that can be delegated to lesser-educated individuals, it is a critical function which requires extensive knowledge, expertise, and intelligence.

[wyly]

Do family practice doctors really need so much medical school ? Should we start looking at having simple check-ups handled by some kind of health practitioner ?

yes...I could tell a number of anecdotal stories involving my own family where the MD missed something obvious, I can't imagine someone less knowledgeable being trusted...

[Michael Hardner]

A good family doctor needs to be able to accurately diagnose various conditions and diseases, to be able to correctly prescribe medications, to know when to refer a patient to a particular specialist, to be able to stay up to date with the latest advancements in medical science and technology, and in some cases to be able to perform certain medical and surgical procedures themselves, among other things. In fact, a family doctor is the first health professional that many people will see about a given problem and they will generally set the track and method that the problem will be dealt with. This is not something that can be delegated to lesser-educated individuals, it is a critical function which requires extensive knowledge, expertise, and intelligence.

Ok, but most complaints are pretty basic. I`m just suggesting that the system could be re-thought, is all.

[Michael Hardner]

yes...I could tell a number of anecdotal stories involving my own family where the MD missed something obvious, I can't imagine someone less knowledgeable being trusted...

Well, mistakes will always happen. There`s a trade-off in any system. You can spend twice as much money to reduce the number of errors from .2 % to .1 % but is it worth it ?

[Bonam]

Well, mistakes will always happen. There`s a trade-off in any system. You can spend twice as much money to reduce the number of errors from .2 % to .1 % but is it worth it ?

Would you still say that if a family member of yours got a bad diagnosis which led to severe complications or death because the person they went to see wasn't a fully trained doctor? Health care is one area where we cannot compromise on quality. People that are sick already have enough to worry about without also wondering whether the person they are seeing can tell a lymphatic cyst from a cancerous tumor. The solution to our health care system is most definitely NOT to reduce the quality and education of the people staffing it.