Health care system needs to be reformed - NOW!

[Smallc]

I was unaware the majority of Americans are dieing in the streets due to their worlds worst healthcare system……

That's funny, because I just looked outside, and it wasn't happening here, either. Why is the US the only industrialized country without a universal system? Why do you assume that means they made the better choice, when they're the only ones?

[finnth]

the problem isn't why politicians don't get it, it's how to do it.

The conservatives have it gone, they don't give a damn about public health care, it costs way too much for not many results.

The only way to "reform" it is not necessarily to make people pay, but to literally "reform" or change how the system works. again the question is How, but it would take a complete systematic change, not just introducing fees.

One solution is to reform our public hospitals but also allow private hospitals to present themselves as options so people could decided to pay in full for their healthcare or risk waiting long for free health care.

My ideal system would be that we could let people choose either public or private, but i would never want to see a completely private system.

The best thing to do right now would be to start drawing up plans to change how our public system works without charging the public.

[Michael Hardner]

the problem isn't why politicians don't get it, it's how to do it.

The conservatives have it gone, they don't give a damn about public health care, it costs way too much for not many results.

The only way to "reform" it is not necessarily to make people pay, but to literally "reform" or change how the system works. again the question is How, but it would take a complete systematic change, not just introducing fees.

...

The best thing to do right now would be to start drawing up plans to change how our public system works without charging the public.

Hear, hear...

I like the idea - set up a new public system within the system... a system that works, is accountable and simplifies the complexity that burdens the system now.

That needs to be done first. All that our so-called dialogue achieves is political posturing, as evidenced by this thread.

[segnosaur]

Why does everyone assume adding a private component to Canada's health care system means tossing everything out and copying the US system? This is a blatant and extreme red herring. Many European health care systems, which routinely rank better than Canada, have both a public and a private component

It's the thin end of the wedge.

Ummm.... why are you assuming that?

The previous poster is right... pretty much every other country in the world successfully mixes private and public health care in some way (although many differ in the way they handle it). If others can have some private involvement, why can't Canada? Are we somehow inferior? Will we magically slip into an all-private system?

Quebec had been allowing certain services to be delivered privately for years (e.g. MRI services). Yet they never pushed to completely eliminate the Canada health act.

[segnosaur]

try understand some very simple math here, two systems cannot work in Canada...any MDs lost to a private system will leave those of us who cannot afford private care with longer much longer waits and with fewer MDs...

Not necessarily... There are options that can allow a mix of private/public options without increasing the need for MDs...

- We could allow doctors to charge for private service only as "overtime". (Something along the lines of "You can charge 40hours/week to the government. Anything else you can bill directly".) Doctors work longer hours, but we get more effort out of them

- Much of the delay in our health care system involves things like MRIs. Such facilities do not necessarily require a doctor to be involved. (Granted, an MD will be required to actually interpret the results, but rather than waiting 6 months for an MRI and another 6 months to see a doctor, the MRI could be done at a private clinic, so the doctor can get the results and act on them sooner.)

Of course there's also the possibility that if doctors can charge more under a private system, or have the greater flexibility that a combined private/public system offers, it may actually attract more medical professionals to Canada (or, alternatively, slow down any "brain drain" to the U.S.)

[Sir Bandelot]

Ummm.... why are you assuming that?

The previous poster is right... pretty much every other country in the world successfully mixes private and public health care in some way (although many differ in the way they handle it). If others can have some private involvement, why can't Canada? Are we somehow inferior? Will we magically slip into an all-private system?

Quebec had been allowing certain services to be delivered privately for years (e.g. MRI services). Yet they never pushed to completely eliminate the Canada health act.

A fully implemented two-tier system means that the public system will fall into neglect. But the cost will not go away. It means that we will end up having to pay exorbitant taxes to support nothing. Eventually it must be dropped. That's why it's the thin end of the wedge.

As I stated previously, I think you are all barking up the wrong tree. The problem is not funding or its sources, the problem is a lack of accountability. To my thinking a public system is best, but needs to undergo a drastic reform. Improve accountability and downsize bureaucracy.

May I point out that the system enjoys a tremendous success rate, but as is often the case we don't hear about the overwhelming majority of successes, only the complaints.

[Tilter]

because neither work...user fees only discourage those who need care the most from seeing an MD delaying treatment, delayed treatment is more expensive than early treatment...private pay will not increase the number of MDs...

Delayed treatment--- Let's talk spinal injury:

Spine deteriorates, caused by wear & tear, falls, & 25 years of working at a blue-collar job.

See Family doctor,(cost) get pain meds. 30 days-- see GP again, (cost) more pain meds 60 days, see GP again-- referred to Spinal surgeon--- with 8 months waiting period-- another 3 visits to GP for pain, miss 3 months of work-- on medical pogey (COST COST COST) (not paying income tax during medical pogey-- cost cost) See Spinal surgeon--- need operation on lower back, -------------in another 9 months due to waiting period,No income tax paid during More Medical Pogey (COST COST COST) Finally operation done--- and recovery time of 6 weeks (cost that should have been incurred about a year & 1/2 ago, avoiding all the interim costs incurred in that 1 & 1/2 year waiting period

[segnosaur]

A fully implemented two-tier system means that the public system will fall into neglect.

Once again, why are you assuming that?

As has been pointed out before, other countries have managed to maintain various mixtures of private and public health care. Why can they keep both systems going, but Canada couldn't?

The problem is not funding or its sources, the problem is a lack of accountability. To my thinking a public system is best, but needs to undergo a drastic reform. Improve accountability and downsize bureaucracy.

Ah yes, the "magic bullet" that will somehow cure all the problems. All you need is for them "somehow" to find the inefficiencies.

May I point out that the system enjoys a tremendous success rate, but as is often the case we don't hear about the overwhelming majority of successes, only the complaints.

Yup, there are a lot of successes, but you only hear the complaints. But guess what? The same also applies to the U.S. system too... you hear only about the "poor working stiff who goes bankrupt because he gets sick", but you never hear of the majority of the people who get decent quality treatment, usually faster than they would get in the Canadian system.

Not that I'm saying the U.S. system is actually better than Canada's. (Nor am I saying its worse). And I certainly don't want to go to an "all private health care" system.

[wyly]

Delayed treatment--- Let's talk spinal injury:

Spine deteriorates, caused by wear & tear, falls, & 25 years of working at a blue-collar job.

See Family doctor,(cost) get pain meds. 30 days-- see GP again, (cost) more pain meds 60 days, see GP again-- referred to Spinal surgeon--- with 8 months waiting period-- another 3 visits to GP for pain, miss 3 months of work-- on medical pogey (COST COST COST) (not paying income tax during medical pogey-- cost cost) See Spinal surgeon--- need operation on lower back, -------------in another 9 months due to waiting period,No income tax paid during More Medical Pogey (COST COST COST) Finally operation done--- and recovery time of 6 weeks (cost that should have been incurred about a year & 1/2 ago, avoiding all the interim costs incurred in that 1 & 1/2 year waiting period

that describes my back and many others as well...cost of lumbar fusion in the US can be between 90-110K how many blue collar workers have that kind of cash to fast track themselves into a private system...

[wyly]

the measuring sticks for healthcare, average lifespan and cost....Canada-81.38yrs, US-78.37yrs...% of GDP toward healthcare canada is placed comfortably among european countries, Canada-10.11% the most expensive USA-16%....we get a lot of value for our dollar much better than the americans, the bottom line is we live longer for less money despite a MD shortage...

[segnosaur]

Delayed treatment--- Let's talk spinal injury:

that describes my back and many others as well...cost of lumbar fusion in the US can be between 90-110K how many blue collar workers have that kind of cash to fast track themselves into a private system...

Well, according to the CDC, more than 85% of people actually have health insurance, so they probably wouldn't need to pay for that themselves. (See: http://www.emaxhealth.com/1506/cdc-number-americans-without-health-insurance-coverage-increases)

Of the remaining 15% who don't have insurance, some are wealthy enough to pay for their own health care directly, some were only uninsured temporarily (e.g. in the process of changing jobs). Only a minority have been without health care for a significant time.

So, it comes down to the following 2 options:

- everyone has to wait months and months to handle the back injury (along with the additional problems that come with waiting)

- The vast majority get treated right away, but a minority of people get really screwed

Both options are "bad" and neither one is objectively better than the other.

Of course, as I said before, for most of us pushing for private health care its irrelevant, since we don't want to eliminate the public option, we just want to find a way to provide a mixture that takes the best of both worlds. You know, like other countries (not Canada or the U.S.) have done.

[segnosaur]

the measuring sticks for healthcare, average lifespan Canada-81.38yrs, US-78.37yrs...%"

Lifespan is not necessarily an accurate measure of health care success, especially when you're comparing countries that are so close to each other.

- Lifestyle choices (e.g. diet, violence in society, geography, etc.) and accounting differences can have an impact. (e.g. I believe the U.S. has a different classification for 'live birth' than other countries, so a baby that would be considered still-born in some countries is counted as a live birth/death in the U.S.).

- It says nothing about the quality of life. i.e. is it better to have a few extra years, but to be subject to various ailments, or is it better to have a higher quality of life?

And consider this... Japan has an even higher life expectancy than Canada, yet according to Wikipedia their system is one where people have to pay a portion of their own health care! (See: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/)

...and cost.... of GDP toward healthcare canada is placed comfortably among european countries

While our costs are roughly near those of European countries, we actually rank 30th in the WHO 2000 survey, behind countries like France, Japan and the U.K. that all have some sort of user-pay system.

[Smallc]

While our costs are roughly near those of European countries, we actually rank 30th in the WHO 2000 survey, behind countries like France, Japan and the U.K. that all have some sort of user-pay system.

There was another, more recent study that dealt with the ability to prevent death, a survey that placed us near the top.

[segnosaur]

There was another, more recent study that dealt with the ability to prevent death, a survey that placed us near the top.

Do you have a reference for that? (Couldn't find anything on a quick search.)

"Preventing death" is a pretty strange term... what are they referring to as a "prevented death"? They considering only after-diagnosis situations? Do they look at total lives saved or years of life added? Do they factor in cost? Need a little context here to do analysis.

[punked]

I don't know why politicians don't get it. We need to reform our health care system or risk bancruptcy.

The Canadian Medical Association president says the same thing:

http://ca.news.yahoo.com/blogs/canada-politics/canada-health-care-system-needs-radical-change-survive-181334238.html

Why is everybody so afraid of introducing user-fees and private pay?

Really the head of the CMA the organization that fought the introduction of Medicare and which has said every year from the time it was created that it has been a failed model doesn't like Medicare? You going to tell me the Libyan rebels are losing their fight and cite Qaddafi next? Seriously.

[Smallc]

Do you have a reference for that? (Couldn't find anything on a quick search.)

I can't find it right now either, but it does exist. It is worth noting that both surveys were done before the massive cash injections that started in 2004, which have improved many of the metrics from what I've seen, though we still have a distance to go.

Edit: Here it is - http://www.guardian.co.uk/society/2003/nov/14/politics.medicineandhealth

Edited August 25, 2011 by Smallc

[Sir Bandelot]

Ah yes, the "magic bullet" that will somehow cure all the problems. All you need is for them "somehow" to find the inefficiencies.

Your magic bullet, my magic bullet. Your proposal for privatization will not accomplish anything. I am in the system, and have seen how it works not just in my own workplace, but in many others I've travelled to across this great land. I know.

I told you the problem is not as severe as it's hyped up to be, as supported by data. You may find such data "odd", because it is at odds with your beliefs.

[Michael Hardner]

I told you the problem is not as severe as it's hyped up to be, as supported by data. You may find such data "odd", because it is at odds with your beliefs.

That said, there is reform necessary - at least in the realm of accountability.

Costs rise, and service doesn't improve. The reporting of these things isn't done well enough, and the public is unaware of the issues.

[segnosaur]

I can't find it right now either, but it does exist. It is worth noting that both surveys were done before the massive cash injections that started in 2004, which have improved many of the metrics from what I've seen, though we still have a distance to go.

Actually, the "massive cash injections" may not actually improve our health care rankings, and may in fact harm them. (Not that I think adding more was a bad thing, just that if we're concerned primarily about rankings you may be disappointed.)

You see, the WHO rankings combine both the quality of health care and the cost. If costs rise proportionally to quality, you won't see us go up in the rankings (even if we are getting treated better.) Heck, since often the greatest improvements are often the cheapest (and the marginal improvements will be less for additional money spent) we can actually see our rankings go down.

The U.S. ranks at #1 in some measures of health care (according to the WHO). They drop in rankings largely because their system costs so much.

Edit: Here it is - http://www.guardian.co.uk/society/2003/nov/14/politics.medicineandhealth

Ah, ok. Thanks.

There's not a lot of details to go on here. However, I did find a few There is some validity in it, but I would add a few caveats before fully accepting their conclusions:

- They restricted their results to preventable deaths under 75. However, the life expectancy in most of those countries is closer to 80, and the amount of resources used in the last few years is often disproportionate to the individual's earlier years

- The report attempts to remove things like smoking and diet from the analysis (which is good), but they also remove things like accidents, which also consume health resources. I also have concerns that they make references to including "certain cancers/infections".... without knowing more, its hard to say if there was any sort of confirmation bias going on

- The article talks about extending life, but it says nothing about quality of life.

I should also point out that the earlier poster was dealing with costs (at least when this particular study was mentioned). It does not appear that this particular study was dealing with costs at all.

[Smallc]

I'm not saying that one ranking is better, or that either is any good, I just thought I should point out that there was a second, less known ranking.

[dre]

Why does everyone assume adding a private component to Canada's health care system means tossing everything out and copying the US system? This is a blatant and extreme red herring. Many European health care systems, which routinely rank better than Canada, have both a public and a private component. When people talk about a private option in Canada, that is the model we should be looking to. One that involves the private sector, saves public money, and improves the overall quality of healthcare.

Many systems that rank better than Canada dont have private HC as well.

The problem we have isnt with the payer. Its not a public vs private issue. The probably is healthcare costs are increasing fast all across the west.

Talking about public VS private is fun for idealogs on a message board but it complete misses the point.

[segnosaur]

Ah yes, the "magic bullet" that will somehow cure all the problems. All you need is for them "somehow" to find the inefficiencies.

Your magic bullet, my magic bullet.

Time and time again we get told by the government that they will find "effiecencies" that will save us money and make things better. Why are you automatically assuming that a government will actually find and implement those changes when they've had limited or no success so far?

Your proposal for privatization will not accomplish anything.

And with a mighty wave of your had you dismiss all who oppose you. Or was that a fart? Its hard to tell.

Not sure what "proposal for privatization" you're referring to. I've made a couple of suggestions where we can add private health care but haven't given any concrete proposals yet. What I HAVE done is pointed to other countries that have managed to combine public and private health care and the result was better success than Canada.

And none of those other countries have seen their public systems disappear.

I told you the problem is not as severe as it's hyped up to be...

Ummm... so? I never claimed the problem was severe either.

I admitted that most of the time the system functions successfully. The same can also be said for the U.S. (You know, the private system so many condemn.)

...as supported by data. You may find such data "odd", because it is at odds with your beliefs.

Ummmm.... my opinions are supported by data too. Such as the 'data' that systems that mix public and private health systems (in western economies anyways) rank higher that Canada (where we have greater restrictions on "private" care.)

[Michael Hardner]

The problem... is healthcare costs are increasing fast all across the west.

And the problem with the problem is that there's no public forum to discuss the problem and figure out what to do.

I suspect we're getting more treatments, and better treatments for our money but ... who knows ? If that IS the case, then it may make more sense for us to forgo some politically rewarding, but financially expensive treatments in favour of improving basic problems like ER wait times, and no family physicians in certain areas.

[Michael Hardner]

Time and time again we get told by the government that they will find "effiecencies" that will save us money and make things better. Why are you automatically assuming that a government will actually find and implement those changes when they've had limited or no success so far?

segnosaur - you're absolutely right about this, but perhaps a wholesale redesign of the system with good representation for the major stakeholders (workers, patients, and management) and less political interference could address the problem.

In any case, some kind of compromise needs to happen in order for this to move forward - that much is clear.

[punked]

Not sure what "proposal for privatization" you're referring to. I've made a couple of suggestions where we can add private health care but haven't given any concrete proposals yet. What I HAVE done is pointed to other countries that have managed to combine public and private health care and the result was better success than Canada.

And none of those other countries have seen their public systems disappear.

I just want to point out most the countries you mention on that list Japan, Spain, France etc. Yah 2008 had huge effects on them and I am willing to bet their models are decimated in the age of austerity. Sorry that is just how it is, the world changed in 2001, it changed in 2008 and citing studies from 2000 aren't helpful. Spain isn't the same country anymore it just isn't. I am willing to bet slow and steady wins the race here.