Your predictions on how we will deal with the coming health care crisi

[Michael Hardner]

also this medical equipment it's not sold in the numbers(tens of millions) required to reduce cost like a video game console...

You're debating against basic economics. Productivity improves over time, peoples' lives improve, it all gets better.

[Michael Hardner]

and what have you shown? "not one f***** thing" ...other than many people flee from expensive private care they can not afford in the USA and for cosmetic surgery...

as evening star's link pointed out average grade for foreign students "58%, compared to 97% for the Canadians", so much for JCI's standards of acceptability which are much lower than ours...those JCI hospitals in India are accepting MDs from schools with an average of 58%, that's why they end up driving taxi's in canada...but you want Canadians to travel to India and potentially put themselves in the care of an MD who may have graduated with 58% and not even qualify for residency in Canada...

Why wouldn't a country with 30 times as many people as Canada not be able to produce equally qualified doctors ?

[bush_cheney2004]

Why wouldn't a country with 30 times as many people as Canada not be able to produce equally qualified doctors ?

Because they play cricket instead of hockey?

[pinko]

"Pinko was asking for examples of goods going down over times. Technology and machinery goes down in costs over time, and outsourcing is only part of that."

I was however the observation advanced suggests that the technological change you refer wouldn't necessarily result in lower costs over time.

[Michael Hardner]

I was however the observation advanced suggests that the technological change you refer wouldn't necessarily result in lower costs over time.

That in itself doesn't lower overall costs, no. Cost management, though, could take advantage of such savings ... if there is/were cost management.

[wyly]

Why wouldn't a country with 30 times as many people as Canada not be able to produce equally qualified doctors ?

Canadian standards of excellence in our medical schools are consistent right across our country...the US has many more schools that are equal to ours but it also has schools that do not produce graduates at our level and the same goes for India...I've stated repeatedly that the top MDs from many countries are the equal of ours it's the lower end of the scale that are not, these countries have practicing MD's that aren't good enough to be accepted into a residency program here...

[dre]

Pinko was asking for examples of goods going down over times. Technology and machinery goes down in costs over time, and outsourcing is only part of that. How much did VCRs cost in 1978 ? 1990 ?

Dre isn't looking to drive down wages, he's looking to reduce his own costs - there's a difference.

The cost of machines goes down initially through automation and scale of production. The real savings come though when you break the production process down into its individual stages and components then value-shop all the materials and processes. If we keep refusing to do the final and most important part, prices WILL keep going up until demand for medical services peaks in roughly 2050. Its not "maybe theyll go up", or they "might go up"... we KNOW they will go up and we know roughly how fast they will increase.

[dre]

Canadian standards of excellence in our medical schools are consistent right across our country...the US has many more schools that are equal to ours but it also has schools that do not produce graduates at our level and the same goes for India...I've stated repeatedly that the top MDs from many countries are the equal of ours it's the lower end of the scale that are not, these countries have practicing MD's that aren't good enough to be accepted into a residency program here...

None of that means anything. What matters is patient outcomes, and whether they are comparable. Theres no point in having certification standards so high or so ownerous that you create shortages. Its completely counter-productive. And the problem in Canada is that these standards are set by unions (medical associations) that have a built in interest in limiting the number doctors which drives up prices. The provincial medical associations have interests that conflict with that of the patients.

You act like having extremely high standards is some kind of panacea but it isnt. If those standards result in acute or chronic shortages the system everyone suffers, and thats exactly whats going on here.

[wyly]

Pinko was asking for examples of goods going down over times. Technology and machinery goes down in costs over time, and outsourcing is only part of that. How much did VCRs cost in 1978 ? 1990 ?

Dre isn't looking to drive down wages, he's looking to reduce his own costs - there's a difference.

he's stated a number of times he's out to drive down the costs here with foreign competition...

I did a short web search on medical tourism and JCI accreditation process of foreign hospitals...there is quite a list of horror outcomes for medical tourists who return only to have their own countries health care to pick up the cost of botched surgeries which in the end far exceeded the cost if the surgery was done at home initially...malpractice options slim and none...

some criticisms of JCI...

1999: Office of Inspector General of DHHS publishes report concluding that JCII was "unlikely to detect substandard patterns of care or individual practitioners with questionable skills."

2004: Government Accountability Office determined that 78% of time JCI surveys did not find serious deficiencies noted by state inspectors

Criticism that JCI suffers from "regulatory capture"and fails to identify substandard care, negligent caregivers & other deficiencies found by state and federal inspectors

JCI does not disclose survey results and basis for decisions for accredited international facilities...

JCI provides quality reports for US hospitals but not for international facilities...

JCI will release info about # of complaints for particular institutions but additional info is not disclosed...

JCI does not reveal which international facilities fail to receive accreditation, had accreditation revoked, or have accreditation under review...

direct payment by hospitals to JCI compromises quality of accreditation process

Edited January 24, 2011 by wyly

[dre]

he's stated a number of times he's out to drive down the costs here with foreign competition...

I did a short web search on medical tourism and JCI accreditation process of foreign hospitals...there is quite a list of horror outcomes for medical tourists who return only to have their own countries health care to pick up the cost of botched surgeries which in the end far exceeded the cost if the surgery was done at home initially...malpractice options slim and none...

some criticisms of JCI...

1999: Office of Inspector General of DHHS publishes report concluding that JCII was "unlikely to detect substandard patterns of care or individual practitioners with questionable skills."

2004: Government Accountability Office determined that 78% of time JCI surveys did not find serious deficiencies noted by state inspectors

Criticism that JCI suffers from "regulatory capture"and fails to identify substandard care, negligent caregivers & other deficiencies found by state and federal inspectors

JCI does not disclose survey results and basis for decisions for accredited international facilities...

JCI provides quality reports for US hospitals but not for international facilities...

JCI will release info about # of complaints for particular institutions but additional info is not disclosed...

JCI does not reveal which international facilities fail to receive accreditation, had accreditation revoked, or have accreditation under review...

direct payment by hospitals to JCI compromises quality of accreditation process

Every medical system produces a long list of horror stories and youll find plenty of those right here at home, and if the accreditation system needs to be strengthened then we should work it. Allowing domestic providers to use the government as an agent to protect itself from competition is NOT the answer (as you can see).

[Michael Hardner]

Canadian standards of excellence in our medical schools are consistent right across our country...the US has many more schools that are equal to ours but it also has schools that do not produce graduates at our level and the same goes for India...I've stated repeatedly that the top MDs from many countries are the equal of ours it's the lower end of the scale that are not, these countries have practicing MD's that aren't good enough to be accepted into a residency program here...

And as other posters have pointed out, it's quite possible to determine which are which.

[Michael Hardner]

With regards to Dre's suggestion:

Generally, isn't there a bit of a problem with saying that we will send some of our work offshore, and not other work ? The "standards" issue is a red herring, we could control for that.

Why is it that manufacturing is thrown to the wolves, when other occupations aren't ? Is that fair ?

[Bonam]

My idea is to simply open up the market to competition

Good idea. We can get this started right here at home in Canada. Allow private for-profit health clinics that compete directly with the public system.

[bush_cheney2004]

And as other posters have pointed out, it's quite possible to determine which are which.

Indeed it is....all of this hot air about "world's highest standards" rings hollow when only a fraction of Canadian medical schools are ranked in the world's Top 100:

There are 17 accredited medical schools in Canada with Ontario having the most at six. (Language of instruction: 13 in English, 3 in French and 1 in Bilingual). M.D. granting medical schools are accredited by the Liaison Committee on Medical Education (LCME).

According to the ranking of World Top 100 Clinical Medicine and Pharmacy (MED) programs by ARWU Broad Subject Fields 2008, a total of six Canadian universities made it to the Top 100 list, with U of Toronto ranked 1st in Canada and 27th in the world. McGill was ranked 2nd nationally and 40th globally, followed by McMaster and Alberta.

Further, it appears that some entrance exams (e.g. MCAT) and accreditations involve joint CanAm boards and "standards", including the joint LCME.

Edited January 24, 2011 by bush_cheney2004

[wyly]

And as other posters have pointed out, it's quite possible to determine which are which.

in our country yes, overseas no, as my MD friend tells me until they actually go through the process in canada we have no way of knowing if they're competent or not...we have no way to determine whether that Indian trained MD who is going to operate on some tourist is as qualified as a canadian trained MD...

[wyly]

With regards to Dre's suggestion:

Generally, isn't there a bit of a problem with saying that we will send some of our work offshore, and not other work ? The "standards" issue is a red herring, we could control for that.

Why is it that manufacturing is thrown to the wolves, when other occupations aren't ? Is that fair ?

medicine/patients is not like any other occupation...

that other countries can work at lower standards is that fair?...we can't control the standards other countries find acceptable they don't give a crap what we think...

[dre]

With regards to Dre's suggestion:

Generally, isn't there a bit of a problem with saying that we will send some of our work offshore, and not other work ? The "standards" issue is a red herring, we could control for that.

Why is it that manufacturing is thrown to the wolves, when other occupations aren't ? Is that fair ?

Thats a good question, and I often ask it myself. I can understand anti-globalist sentiment, and I can understand free trade sentiment. But to value-shop everything else and bring prices way down even at the expense of our own workforce and then protect a single industry from competition almost COMPLETELY is crazy. Especially when that one industry provides a service we cant live without and we are in the midst of a shortage and a cost crisis.

The first answer and probably the biggest factor is who has power in those various industries. In the manufacturing industry power was held by executives that reported to shareholders. Theyre profit centered, so whether the widgets get made here and create jobs here or in China is of little interest for them. Thats value shopping. All the power is in the hands of people who have nothing to do with the actual production. In the medical industry the people with the power in Canada are the doctors that negotiate and collaborate with the government through medical associations. They are incentivized to do the exact opposite of what manufacturing industry executives were incentivized to do.

Another factor is quality. Keeping the work here and under the jurrisdiction of medical associations is one way to establish and enforce standards and ensure high quality. This is Wyly's argument and while I think he treats it as way to much of a panacea, and doesnt do a good job balancing it with other factors, its a valid one. Thats really the whole consumer confidence issue. People see toys coming back from abroad with lead paint, baby food that kills the babies, dogfood with malamine filler, etc and theyre understandably nervous about the perception of the same thing happening with healthcare. Thats why we need to work more on the accreditation process, but the quality at accredited hospitals is already pretty close to being on par with ours.

[dre]

medicine/patients is not like any other occupation...

that other countries can work at lower standards is that fair?...we can't control the standards other countries find acceptable they don't give a crap what we think...

that other countries can work at lower standards is that fair?...

Who cares if its fair?

we can't control the standards other countries find acceptable they don't give a crap what we think...

The same economic rules apply and if we keep ignoring them we're gonna be real sorry.

medicine/patients is not like any other occupation...

Absolutely false. Countries like India are building an entire industry around providing health services to westerners and they absolutely DO care what we think. Consumer confidence is the biggest hurdle they face. Theyre hospitals are willing to work with us to improve standards, and theyre willing to allow us to inspect their facilities, research patient outcomes, and even define rules and standards for them.

Edited January 24, 2011 by dre

[Bonam]

Thats a good question, and I often ask it myself. I can understand anti-globalist sentiment, and I can understand free trade sentiment. But to value-shop everything else and bring prices way down even at the expense of our own workforce and then protect a single industry from competition almost COMPLETELY is crazy. Especially when that one industry provides a service we cant live without and we are in the midst of a shortage and a cost crisis.

The first answer and probably the biggest factor is who has power in those various industries. In the manufacturing industry power was held by executives that reported to shareholders. Theyre profit centered, so whether the widgets get made here and create jobs here or in China is of little interest for them. Thats value shopping. All the power is in the hands of people who have nothing to do with the actual production. In the medical industry the people with the power in Canada are the doctors that negotiate and collaborate with the government through medical associations. They are incentivized to do the exact opposite of what manufacturing industry executives were incentivized to do.

So the fact that doctors, who are highly skilled professionals who dedicate decades to education and training to become competent in their field, can earn enough to maintain an upper middle class lifestyle is bad in your point of view? Executives should be able to be rich, but professionals should not be adequately compensated for their work? That's what's wrong with our system according to you?

What genius! I can't believe I didn't think of it myself! What's wrong with Canada is we haven't eliminated enough of our middle class!

[dre]

So the fact that doctors, who are highly skilled professionals who dedicate decades to education and training to become competent in their field, can earn enough to maintain an upper middle class lifestyle is bad in your point of view? Executives should be able to be rich, but professionals should not be adequately compensated for their work? That's what's wrong with our system according to you?

What genius! I can't believe I didn't think of it myself! What's wrong with Canada is we haven't eliminated enough of our middle class!

So the fact that doctors, who are highly skilled professionals who dedicate decades to education and training to become competent in their field, can earn enough to maintain an upper middle class lifestyle is bad in your point of view?

I never said anything remotely like that. Was it bad that factory and auto workers got to be part of the middle class? Why didnt workers in the manufacturing sector have the same right to government protection from competition as workers in the healthcare system? Why not the engineering sector? (I already explained why).

Executives should be able to be rich, but professionals should not be adequately compensated for their work? That's what's wrong with our system according to you?

I dont have clue what youre talking about here. You appear to be replying to a post that I never wrote. Executives, professionals, and laborers alike have the right to sell their services for whatever they can get in the market place.

At some point the decision was made that the "market place" should be a global in scope instead of national. Business leaders wanted it because they could increase profits... consumers wanted it because they could have cheaper goods and services. I was and still am very suspicious about the whole idea to be honest.

But now weve outsourced entire industries and when I suggest we leverage some cheap foreign resources to save some money on healthcare, and alleviate the stress the aging generation will put on our system, suddenly Im attacking professionals and their right to be part of a certain economic class? Are you fucking kidding me? Where the hell have you been for the last 30 years. I dont recall a lot of rants from you about all the other professionals jobs being outsourced.

Did I miss it? Are you a protectionist? Its ok if you are, and theres merit to that viewpoint... i just wouldnt have guessed that about you.

Edited January 24, 2011 by dre

[Michael Hardner]

in our country yes, overseas no, as my MD friend tells me until they actually go through the process in canada we have no way of knowing if they're competent or not...we have no way to determine whether that Indian trained MD who is going to operate on some tourist is as qualified as a canadian trained MD...

That's ridiculous. Of course we can determine that. Why don't we try ?

[Michael Hardner]

medicine/patients is not like any other occupation...

that other countries can work at lower standards is that fair?...we can't control the standards other countries find acceptable they don't give a crap what we think...

If they're exporting professionals to us, then yes they will care.

[pinko]

"At some point the decision was made that the "market place" should be a global in scope instead of national. Business leaders wanted it because they could increase profits... consumers wanted it because they could have cheaper goods and services. I was and still am very suspicious about the whole idea to be honest."

I don't recall anyone seeking my input on globalization. Those decisions were made by the political and business elite. For the most part consumers were sold a bill of goods by those implementing these so called trade agreements ceding sovereignty and allowing large corporations extensive rights to the exclusion of the ordinary citizen.

[M.Dancer]

I don't recall anyone seeking my input on globalization.

The vote was taken at the register. Lower prices won by a landslide.

[Michael Hardner]

"At some point the decision was made that the "market place" should be a global in scope instead of national. Business leaders wanted it because they could increase profits... consumers wanted it because they could have cheaper goods and services. I was and still am very suspicious about the whole idea to be honest."

I don't recall anyone seeking my input on globalization. Those decisions were made by the political and business elite. For the most part consumers were sold a bill of goods by those implementing these so called trade agreements ceding sovereignty and allowing large corporations extensive rights to the exclusion of the ordinary citizen.

See the 1988 Federal Election. That was the decisive election on the topic of freer trade. From there, we went to NAFTA and more global agreements. The two main parties actively negotiate trade agreements around the clock. If you're against that, I suggest the NDP: they seem to be the most cautious world traders.

As was pointed out - "consumers wanted it because they could have cheaper goods and services"