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

[Bonam]

Some analysis and research, and some common sense. Some emergency patients cant fly. Emergency care has to be done where the emergencies are, and people will still need to see general practitioners. It WILL make a dent though because the saving on operations you can offshore are so huge.

None of that is specific enough to yield a quantitative result of 20+/-5%. Admit it, you pulled those numbers out your ass.

By the way, even if we assume your numbers are correct: 20% of procedures are offshored. In your proposal, we'd save roughly ~40% on those procedures (since half the cost difference is paid to the patient). Thus we save 40% of 20% of the cost of health care: that's 8%. You also claim that the rate that health care costs are to increase is 5-10% per year. Thus the savings generated by your scheme will be overshadowed by the growth of health care costs in a mere 1-2 years. So if the situation is as dire as you predict: then all your plan will do is delay that dire end by a year or two.

The only other option is to ration care more, or raise taxes.

No, there are other options.

No our system will just change like other industries did. We will still do emergency care, and some of the diagnostic work, and management work.

In other words, just like I said, we will no longer have the domestic capacity to provide a full range of health care to the population if some geopolitical events severe our ability to obtain health care elsewhere. I would be equally concerned if we decided to outsource our water production to another country. It is also a huge issue for the US now in terms of energy security and the somewhat compromised situation it finds itself in because they are so reliant on foreign nations for oil.

Just like with other industries the portions that get offshored will be the ones where it makes sense economically. Its idiotic for health canada to buy a service for 200 thousand dollars that it can get for 15 thousand somewhere else...

When $200,000 is spent in Canada, first of all, a big chunk of that comes back as taxes right away. Secondly, that doesn't immediately come back as taxes is spent in Canadian communities, generating more tax revenues when it is spent, and enriching Canadian private citizens and private enterprises with the portion that doesn't end up being taxed. Meanwhile, the $15,000 that is handed to a foreign hospital is gone from Canada's economy, incurring a trade deficit.

You seem to ignore this reality. Money spent has not disappeared, it has gone somewhere. Where that somewhere is can matter. Think of the F-35 thread for example. You don't think there would be a difference if we were paying those $16 billion to a Canadian company that did all the work in Canada, rather than an American company? It would be a completely different situation.

Edited January 25, 2011 by Bonam

[dre]

None of that is specific enough to yield a quantitative result of 20+/-5%. Admit it, you pulled those numbers out your ass.

By the way, even if we assume your numbers are correct: 20% of procedures are offshored. In your proposal, we'd save roughly ~40% on those procedures (since half the cost difference is paid to the patient). Thus we save 40% of 20% of the cost of health care: that's 8%. You also claim that the rate that health care costs are to increase is 5-10% per year. Thus the savings generated by your scheme will be overshadowed by the growth of health care costs in a mere 1-2 years. So if the situation is as dire as you predict: then all your plan will do is delay that dire end by a year or two.

No, there are other options.

In other words, just like I said, we will no longer have the domestic capacity to provide a full range of health care to the population if some geopolitical events severe our ability to obtain health care elsewhere. I would be equally concerned if we decided to outsource our water production to another country. It is also a huge issue for the US now in terms of energy security and the somewhat compromised situation it finds itself in because they are so reliant on foreign nations for oil.

When $200,000 is spent in Canada, first of all, a big chunk of that comes back as taxes right away. Secondly, that doesn't immediately come back as taxes is spent in Canadian communities, generating more tax revenues when it is spent, and enriching Canadian private citizens and private enterprises with the portion that doesn't end up being taxed. Meanwhile, the $15,000 that is handed to a foreign hospital is gone from Canada's economy, incurring a trade deficit.

You seem to ignore this reality. Money spent has not disappeared, it has gone somewhere. Where that somewhere is can matter. Think of the F-35 thread for example. You don't think there would be a difference if we were paying those $16 billion to a Canadian company that did all the work in Canada, rather than an American company? It would be a completely different situation.

Those are all the same arguments made for protectionism every time it comes up. Money from middle class manufacturing workers was taxed, and spent in the country as well. So was money in the engineering sector. Hope you made it to the G20 protests! Think I might have seen you on TV.

[Bonam]

Those are all the same arguments made for protectionism every time it comes up. Money from middle class manufacturing workers was taxed, and spent in the country as well. So was money in the engineering sector. Hope you made it to the G20 protests! Think I might have seen you on TV.

You fixate on "protectionism" to be able to use it as a slogan to shout down opposition to your idea (even though you claim to not be totally against the idea yourself) and yet fail to realize that a wide range of arguments have been presented that have nothing to do with protectionism:

• the national security issue of being able to provide critical services within the country
  
• the issue of uncertainty of standards in differing nations, which exists despite you shouting "JCI" over and over
  
• the issue of unresolved liability for complications arising from procedures carried out abroad
  
• the economic analysis of whether there is really a net economic benefit to Canada by spending money elsewhere
  

And no, I have no interest in being a hooligan on the streets of Toronto. I am busy making money in the supposedly outsourced engineering sector, which is alive and well and growing as it has been for decades.

Edited January 25, 2011 by Bonam

[bloodyminded]

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

Ah! Very good point.

[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. 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.

I would imagine my son and his partners are interested in areas of cost savings in running their business. In addressing the issue of technology my intent was to place the focus on the healthcare field. I am not in a position to say with or not the equipment required for the clinic results in a cost saving or not. The individuals employed in this enterprise are in high demand so, on the labour cost side of the ledger, it is essential to provide competitive wages and benefits to attract and retain employees. In such a business I don't see outsourcing as a viable option.

Edited January 25, 2011 by pinko

[M.Dancer]

None whatsoever. If I was in charge, our border would be every bit as open and inviting for the patients these doctors left behind as it is for their doctors.

So no solution then for our resource shortage than for adding more burden and assuaging your tortured soul

[Michael Hardner]

[*]the national security issue of being able to provide critical services within the country

That seems to me to be another red herring. We depend on other countries for, among other things, technology, defense and food. Nobody is suggesting that we become entirely dependent, either, only that we get assistance from offshore resources for a system that is expensive and inflexible.

[Michael Hardner]

The individuals employed in this enterprise are in high demand so, on the labour cost side of the ledger, it is essential to provide competitive wages and benefits to attract and retain employees. In such a business I don't see outsourcing as a viable option.

Those two sentences make no sense together.

"Labour costs are expensive, so outsourcing isn't an option." - is that what you're saying ?

[PIK]

Just imagine if we just spent our energies on waste. How much could the province save if it got tough on waste, we don't need grand plans to do anything ,unfortunitly some people think only a grand plan will work. I would start with ONT HYDRO.I grew up with hydro people and the waste and theft that goes on is pathetic and it has been going on forever and nobody ever seems to care. I had a tree down on wires up the road from me and 10 men should up, 3 did the work the others stood around and drank coffee ,til the others finished. Years back at one of the dams ,a hydro guy that was trying to stop the waste took my father up to a dam to show what happens when someone screws up and orders thew wrong motors. These were huge electric motors and they were being buried, still in the crates. I could go on and on at just what I seen thru the years , it would make you sick. Now I know this is not some huge grand idea, just something simple ,which we need to return to simple solutions. Just like this MS treatment, how much has been spent on it and now we could have the simplest operation to fix it.And I know 2 people personally that this operation has done wonders for them.

[Michael Hardner]

Just imagine if we just spent our energies on waste. How much could the province save if it got tough on waste, we don't need grand plans to do anything ,unfortunitly some people think only a grand plan will work. I would start with ONT HYDRO.I grew up with hydro people and the waste and theft that goes on is pathetic and it has been going on forever and nobody ever seems to care. I had a tree down on wires up the road from me and 10 men should up, 3 did the work the others stood around and drank coffee ,til the others finished.

It would cause a huge fight is all, and most politicians don't have the stomach for that.

[Michael Hardner]

It would cause a huge fight is all, and most politicians don't have the stomach for that.

Another idea might be to set up a new organization within the organization that has a mandate to improve efficiency. Put those who want real change into that group, and seed it with new hires from the union/non union world.

Offer the union a percentage of the cost savings as a bonus, for doing nothing other than agreeing to this new group existing.

[eyeball]

So no solution then for our resource shortage than for adding more burden and assuaging your tortured soul

The only solution that'll last will be an ethical one. Anything less will just sustain the dysfunction and spread it around.

[pinko]

Those two sentences make no sense together.

"Labour costs are expensive, so outsourcing isn't an option." - is that what you're saying ?

Not at all. I am stating, as a matter of fact, that nurses and other healthcare practitioners are in high demand in British Columbia and that the business wants to retain a stable and well qualified workforce.

As a former union representative I am well aware of the consequences of outsourcing. Outsourcing is quite often not cost effective should a business decide to go in such a direction. There are many examples of this should you decide to explore it further.

[pinko]

Another idea might be to set up a new organization within the organization that has a mandate to improve efficiency. Put those who want real change into that group, and seed it with new hires from the union/non union world.

Offer the union a percentage of the cost savings as a bonus, for doing nothing other than agreeing to this new group existing.

Apparently you are unfamiliar with successor rights and common employer provisions in most labour codes.

[Michael Hardner]

As a former union representative I am well aware of the consequences of outsourcing. Outsourcing is quite often not cost effective should a business decide to go in such a direction. There are many examples of this should you decide to explore it further.

No need to explore it. My line of work was globalized over the last decade, so I have lived it.

[Michael Hardner]

Apparently you are unfamiliar with successor rights and common employer provisions in most labour codes.

Such as ?

I don't see what in my suggestion would be objectionable. I'm not talking about contracting out here, I'm talking about working within the existing labour agreements.

[pinko]

That's nice but globalization and outsourcing are two different themes.

[pinko]

Such as ?

I don't see what in my suggestion would be objectionable. I'm not talking about contracting out here, I'm talking about working within the existing labour agreements.

I don't know what universe you live in but what appears evident from your posts is that you aren't familiar with legal obligations in a unionized workplace.

[M.Dancer]

Outsourcing is quite often not cost effective should a business decide to go in such a direction. There are many examples of this should you decide to explore it further.

And of course, outsourcing is often cost effective, otherwise it would not be considered.

[pinko]

And of course, outsourcing is often cost effective, otherwise it would not be considered.

Perhaps you will provide some examples. There are certainly many, especially in the public sector, that would suggest something contrary to what you suggest.

[Michael Hardner]

That's nice but globalization and outsourcing are two different themes.

They are related, though, I think. The idea is that labour costs in one area of activity (not geographic area) are higher than elsewhere. That creates pressure for evening them out.

[Michael Hardner]

I don't know what universe you live in but what appears evident from your posts is that you aren't familiar with legal obligations in a unionized workplace.

Ok. Then why not educate me ? What would be wrong with setting up a plan like this ? Would it be illegal, even with buy in from the union ?

[M.Dancer]

Perhaps you will provide some examples. There are certainly many, especially in the public sector, that would suggest something contrary to what you suggest.

There are thousands ..perhaps 100s of thousands of examples.

Here's one or two or three...

You have a credit card...you get a bill once a month, and you pay that bill...

Which would you think is more cost effective for the card issuer....having a dedicated department within the bank that prints the bills, mails the bills, collects the payments and balances the account.....or.....using an outsourcing service who through efficincies gained by concentracting only on one single business model, (printing, mailing, collecting, balancing) and doing so for every major credit card in canada?

Or how about..you are national retail chain that publishes 4 catalogues a year. Do you employ a dedicated in house graphics department complete with photographers, editors etc ect..or do you contract that out to a media firm who instead of being idle 4 months a year, are busy working on not just the catalogue, but colateral media for a number of clients?

Another..you are a large newspaper and because of union rules about hiring new staff, taking on risky new business is problematic and expensive. Do you hire the extra bodies anyway and if the venture doesn't fly, layoff the bodies and incur the expenses associated with buy out packages or do you hire on contract basis a media rep firm who takes the risk for you?

Last one...You are a national marketer of vehicles selling to all demographics. Do you employ your own advertising department that does market research, TV, radio, print and web production and media buying or do you use a advertising agency that specializes in the same?

All 4 a real cases....

[pinko]

They are related, though, I think. The idea is that labour costs in one area of activity (not geographic area) are higher than elsewhere. That creates pressure for evening them out.

I take it you mean moving the jobs offshore when you refer to outsourcing.

[pinko]

Ok. Then why not educate me ? What would be wrong with setting up a plan like this ? Would it be illegal, even with buy in from the union ?

I am not here to educate you. What I will say though is that once a collective agreement is in place both parties recognize that during the term of that agreement it remains in full force and effect. Prior to the nominal expiry date either party may give notice to commence collective bargaining with proposals being exchanged with respect to the terms and conditions of a prospective collective agreement. Under such circumstances there would be nothing preventing an employer from attempting to introduce a different method of compensation. If the union negotiating committee had a mandate to consider such a plan and provided it met the needs of the union membership at large and was ratified then certainly that may transpire. If, however, it was perceived to be not in the best interests of the union or its's memebership then obviously it wouldn't fly.