Health care system needs to be reformed - NOW!

[wyly]

Still, it could be good if at least one of the major stakeholders in this morass had a fire lit under them.

part of the problem is mis-information or lack of information which I believe you've mentioned before...this is very complex issue and most canadians have little idea how complex it is, what they go by is anecdotal evidence an opinion pieces by media types who don't know much more (if any) than they do...if was such a simple matter to improve it would have been done long ago...

[dre]

and let's not forget residents are practicing MDs so what's the point of fast tracking anyways...

That makes no sense at all. The point of fast tracking is remove the gigantic bottleneck, and get all the doctors that have passed their exams but cant get residency slots into the system... Its really simple.

[Smallc]

I never said that......I'm in favour of having both public and private options…..

I think that we should fix the system we have. Some things outside the system are whatever, but we should make our system work for as many people as possible at the best possible value. Whether that means private of public delivery within the system, I really don't care.

[wyly]

That makes no sense at all. The point of fast tracking is remove the gigantic bottleneck, and get all the doctors that have passed their exams but cant get residency slots into the system... Its really simple.

more MDs without funding for residency is going to work how? are you proposing residents now work for free?...

it's really simple... more money needs to be put into education and expanding the healthcare system to accommodate changing demographics... we don't need to recruit foreign MDs we only need to make room for the surplus of canadian applicants that can't even get into our med schools...

[dre]

more MDs without funding for residency is going to work how? are you proposing residents now work for free?...

it's really simple... more money needs to be put into education and expanding the healthcare system to accommodate changing demographics... we don't need to recruit foreign MDs we only need to make room for the surplus of canadian applicants that can't even get into our med schools...

What we need is to put downward pressure on prices, and stop a trend of healthcare costs increasing faster than average incomes that has lasted for about 30 years already.

I bet ya that we can find good doctors willing to work for 200K per year instead of 450K, which would allow us to not only spend less money but have way more doctors. And if we cant bring those doctors here we should move the patients to them whenever possible.

[Guest Derek L]

I think that we should fix the system we have. Some things outside the system are whatever, but we should make our system work for as many people as possible at the best possible value. Whether that means private of public delivery within the system, I really don't care.

As was said already, our system and the American system has it’s ups and downs, but there is no reason we can’t cherry pick the good points from both systems (added to successful methods used in Europe) to improve these flaws, well keeping expenses reasonable and benefiting all Canadians.

[waldo]

But when we talk about "private vs. public health care" and "single payer", we are using it as a short form to refer to the issue of delivery of basic health care services such as appointments with your M.D., specialists, and hospital visits. (Its just easier than bringing up the whole issue of dental/eye care thing.)

although I agree with MLW member dre... that the real issue is cost not private vs. public, for all intents and purposes what you've just described is available in (select and growing areas of) Canada. I'm most directly familiar with the operations of the Copeman Healthcare Centers... you pay to join and you pay an ongoing yearly fee - above and beyond that, all costs are covered by Copeman as they direct bill back to provincial health departments (there are specific exceptions where costs are charged to members of the Copeman centers (e.g., fitness trainer costs). Of course, by billing back to the provincial health departments, they are... presumably... not technically breaching the Canada Health Act. Certainly, there are many other similar type operations to Copeman across Canada. As alluded to earlier, all professionals associated with Copeman (nurses, doctors, technicians, etc.) and the like, are no longer working within the public domain... no longer available to the general public who haven't paid the join/yearly fees.

segnosaur, on a point of clarification... let me provide an example link to one of the type of existing facilities I described; in this case, to the specific reference I offered - Copeman Healthcare Centers...... in relation to the type of services offered within these type of 'private' clinics, just what are you lobbying for... that isn't available within these type of existing 'private' clinics?

[segnosaur]

What we need is to put downward pressure on prices, and stop a trend of healthcare costs increasing faster than average incomes that has lasted for about 30 years already.

Of course, if you're too aggressive in "putting downward pressure on prices" you run the risk of costing lives, either by curtailing use of existing technology, or by putting a damper on new technology.

The problem is, most medical problems are actually pretty cheap to solve (vaccinations, simple operations, etc.). However, we (as a society) want to squeeze out every last possible year of life. That means new (and possibly more expensive) treatments.

I bet ya that we can find good doctors willing to work for 200K per year instead of 450K, which would allow us to not only spend less money but have way more doctors.

On the other hand, if one of those "good doctors" can earn 450K going to the U.S., we might loose them.

And keep in mind that many of the reasons we loose doctors to the U.S. is not because of money, but because the U.S. gives them more flexibility/resources (e.g. more access to diagnostic tools, operating rooms, etc.) But having such options available costs money (one of the reasons health care is more expensive in the U.S. is the "excess capacity".)

[segnosaur]

segnosaur, on a point of clarification... let me provide an example link to one of the type of existing facilities I described; in this case, to the specific reference I offered - Copeman Healthcare Centers...... in relation to the type of services offered within these type of 'private' clinics, just what are you lobbying for... that isn't available within these type of existing 'private' clinics?

To be honest, I do not know enough about the Copeman centers to really make any useful statement.

I have to admit, I am surprised that they would be charging "out of pocket" membership fees. (Not saying its a good thing or bad thing... just that I had assumed the federal government would have tried to stop them.) Perhaps they do offer a degree of "private" health care, in which case I'm wondering why I don't hear more of an uproar from the more left-wing groups. (Then again, I am in Ontario, and it looks like the Copeman centers are based out west.)

And I never really stated what exactly I'm "lobbying" for... I do have a few ideas that I think might improve the system e.g. allow for-pay MRI clinics (while keeping existing public facilities), bring in a co-pay for certain services for those earning more than a certain income, and allow doctors to charge extra if they work "overtime". All of those might improve the system (without requiring the need for additional MDs, without requiring a massive over hall of the system, and while continuing to provide the same level of care for the "poor".)

[waldo]

although I agree with MLW member dre... that the real issue is cost not private vs. public, for all intents and purposes what you've just described is available in (select and growing areas of) Canada. I'm most directly familiar with the operations of the Copeman Healthcare Centers... you pay to join and you pay an ongoing yearly fee - above and beyond that, all costs are covered by Copeman as they direct bill back to provincial health departments (there are specific exceptions where costs are charged to members of the Copeman centers (e.g., fitness trainer costs). Of course, by billing back to the provincial health departments, they are... presumably... not technically breaching the Canada Health Act. Certainly, there are many other similar type operations to Copeman across Canada. As alluded to earlier, all professionals associated with Copeman (nurses, doctors, technicians, etc.) and the like, are no longer working within the public domain... no longer available to the general public who haven't paid the join/yearly fees.

segnosaur, on a point of clarification... let me provide an example link to one of the type of existing facilities I described; in this case, to the specific reference I offered - Copeman Healthcare Centers...... in relation to the type of services offered within these type of 'private' clinics, just what are you lobbying for... that isn't available within these type of existing 'private' clinics?

To be honest, I do not know enough about the Copeman centers to really make any useful statement.

I have to admit, I am surprised that they would be charging "out of pocket" membership fees. (Not saying its a good thing or bad thing... just that I had assumed the federal government would have tried to stop them.) Perhaps they do offer a degree of "private" health care, in which case I'm wondering why I don't hear more of an uproar from the more left-wing groups. (Then again, I am in Ontario, and it looks like the Copeman centers are based out west.)

technically, the membership fees (join/yearly costs) are not being directly applied to actual services offered - "membership has its privileges"! All services offered, save a few exceptions, are billed back to the respective provincial health organizations... and are billed at the available rates set; i.e., technically, there are, as described, "no breeches to the Canada Health Act". Of the exceptions directly billed, none are applicable and/or contrary to the Canada Health Act. I will also reemphasize that all the professionals working in association to the centers are no longer available to the general public who have not paid the join/yearly fees; again, "membership has it's privileges". Whether still current or not, as I was aware at one point, it cost $3900 to join the Copeman centers with ongoing yearly fees of $2900.

[segnosaur]

technically, the membership fees (join/yearly costs) are not being directly applied to actual services offered - "membership has its privileges"! All services offered, save a few exceptions, are billed back to the respective provincial health organizations... and are billed at the available rates set; i.e., technically, there are, as described, "no breeches to the Canada Health Act". Of the exceptions directly billed, none are applicable and/or contrary to the Canada Health Act. I will also reemphasize that all the professionals working in association to the centers are no longer available to the general public who have not paid the join/yearly fees; again, "membership has it's privileges". Whether still current or not, as I was aware at one point, it cost $3900 to join the Copeman centers with ongoing yearly fees of $2900.

Well, I have to say, its an interesting concept.

Looking at their web site, they seem to offer certain services (e.g. CAT scans) that might otherwise have a waiting list in other provinces, so it appears that at least some of those membership fees are going towards giving people better care. (And I could also add that when individuals use those facilities at the private center, they no longer have to use the public facilities, so people sticking to the public system end up better off too.)

That said, I don't know enough about the quality of care/services to say whether this is a good organization or not. All I can say is that it appears to be going in the right direction.

[Michael Hardner]

part of the problem is mis-information or lack of information which I believe you've mentioned before...this is very complex issue and most canadians have little idea how complex it is, what they go by is anecdotal evidence an opinion pieces by media types who don't know much more (if any) than they do...if was such a simple matter to improve it would have been done long ago...

I agree entirely. It serves the individual stakeholders to perpetuate the status quo, but not the public.

Individual stakeholders make their case via public relations, each telling their part of the whole. The government is paternalistic about the situation, and wraps the situation in politics.

But the system deteriorates slowly and there is no public body to keep the stakeholders in check.

[wyly]

What we need is to put downward pressure on prices, and stop a trend of healthcare costs increasing faster than average incomes that has lasted for about 30 years already.

I bet ya that we can find good doctors willing to work for 200K per year instead of 450K, which would allow us to not only spend less money but have way more doctors. And if we cant bring those doctors here we should move the patients to them whenever possible.

you prove my earlier point canadians are convinced they have healthcare issues all figured out but the truth is most are very uninformed....you clearly have no idea what MD's are paid...

Gross and net earnings rose in 2005 Canada

Gross - Net - Overhead

Dermatologists: $360,000 - $240,000 - 33.0%

Internists: $310,000 - $200,000 - 35.5%

Ob/gyns : $320,000 - $195,000 - 40.4%

Pediatricians: $250,000 - $160,000 - 36.0%

Psychiatrists: $190.000 - $160.000 - 15.8%

GPs: $260,000 - $155,000 - 40.4%

when you consider how many years of study required and the value of the service provided one could easily argue they are underpaid. I've known electricians, plumbers and framers with similar incomes...

Edited August 26, 2011 by wyly

[wyly]

I agree entirely. It serves the individual stakeholders to perpetuate the status quo, but not the public.

Individual stakeholders make their case via public relations, each telling their part of the whole. The government is paternalistic about the situation, and wraps the situation in politics.

But the system deteriorates slowly and there is no public body to keep the stakeholders in check.

you make it sound as if it's a conspiracy...

[Michael Hardner]

you make it sound as if it's a conspiracy...

It's not a conspiracy at all, it's just a case of inertia and lack of public motivation to try to make change. When situations like this happen, the pressure slowly builds up until there's a catharsis.

[wyly]

It's not a conspiracy at all, it's just a case of inertia and lack of public motivation to try to make change. When situations like this happen, the pressure slowly builds up until there's a catharsis.

the change needed is funding... everyone wants better quicker service from healthcare...to do that requires expanding educational facilities and medical facilities, politicians don't want to fund those changes because that would require cutbacks in other areas or raising taxes...and taxpayers get pissed when they have to pay more they're pisssed when there are cutbacks in other services and then politicians don't get re-elected, politicians don't like that...so nothing gets done...

here in alberta we have educational cutbacks, we have medical cutbacks and people bitch about both and rightly so but if anyone even mentions adding a PST like every other province to broaden taxation base politicians run for cover...

nothing is for free if want better services we should be prepared to pay for them...

Edited August 26, 2011 by wyly

[Sir Bandelot]

I think also there should be a concerted effort to re-establish accreditation between medical colleges across different nations. I haven't seen a convincing reason yet why it can't be done, in this day and age. Doing this would allow us to fast-track the residency program.

And then bureaucracy needs to be really streamlined. That would free up money that's already in the system now and make it available for providing actual services.

[wyly]

I think also there should be a concerted effort to re-establish accreditation between medical colleges across different nations. I haven't seen a convincing reason yet why it can't be done, in this day and age. Doing this would allow us to fast-track the residency program.

And then bureaucracy needs to be really streamlined. That would free up money that's already in the system now and make it available for providing actual services.

I'm meeting up with my MD friend tonight I'll get back to you on the accredittation issue...

the bureacracy everyone thinks is a problem is quite good ours operates a fraction of the US system does and I know from mrs wyly they are understaffed 10-12 hr days for management is not unusual and there's no overtime pay that goes with it...

how do figure fast tracking accreditation will save up money?... residents are not well paid, fast tracking them will put them on their own sooner and their wages will go up accordingly, we pay those wages through billing...we save money with a longer residency...

no matter how you twist it around improving the system requires more MDs, more MDs either our own through education or immigration will cost us more...

Edited August 26, 2011 by wyly

[Sir Bandelot]

I'm meeting up with my MD friend tonight I'll get back to you on the accredittation issue...

Look forward to hearing about it.

how do figure fast tracking accreditation will save up money?... residents are not well paid, fast tracking them will put them on their own sooner and their wages will go up accordingly, we pay those wages through billing...we save money with a longer residency...

no matter how you twist it around improving the system requires more MDs, more MDs either our own through education or immigration will cost us more...

True, fast tracking won't save money but gives us more MD's. This in turn will cost more. They are two different problems, somewhat at odds. We don't want a system where there are too many MD's, raising costs without benefit but we're not close to that point yet.

Residents save the system money, and I'm sure that is attractive in its own way. In some professions they have introduced 'Assistants', whose role is to deal with less complicated medical issues while reporting to higher qualified staff (who are better paid, but fewer in number). RNA's, for example.

[Michael Hardner]

the change needed is funding...

Costs are already going up, and there isn't a good mechanism for public collaboration around that issue so to increase funding without fixing the information side would be a bad move IMO.

everyone wants better quicker service from healthcare...to do that requires expanding educational facilities and medical facilities, politicians don't want to fund those changes because that would require cutbacks in other areas or raising taxes...and taxpayers get pissed when they have to pay more they're pisssed when there are cutbacks in other services and then politicians don't get re-elected, politicians don't like that...so nothing gets done...

Because 'taxpayers' are viewed as a mass voting blob who respond to announcements of expensive side projects, but don't vote against the mundane problems such as increasing wait queues or lack of family doctors.

Fix the public, then start talking about the problem.

[dre]

you prove my earlier point canadians are convinced they have healthcare issues all figured out but the truth is most are very uninformed....you clearly have no idea what MD's are paid...

Gross and net earnings rose in 2005 Canada

Gross - Net - Overhead

Dermatologists: $360,000 - $240,000 - 33.0%

Internists: $310,000 - $200,000 - 35.5%

Ob/gyns : $320,000 - $195,000 - 40.4%

Pediatricians: $250,000 - $160,000 - 36.0%

Psychiatrists: $190.000 - $160.000 - 15.8%

GPs: $260,000 - $155,000 - 40.4%

when you consider how many years of study required and the value of the service provided one could easily argue they are underpaid. I've known electricians, plumbers and framers with similar incomes...

you prove my earlier point canadians are convinced they have healthcare issues all figured out but the truth is most are very uninformed....you clearly have no idea what MD's are paid...

Horse shit. You proved your OWN point with your claims that all these doctors being prevented from working are unqualified. And you just proved it again by posting data from 2005. Almost 7 years old.

when you consider how many years of study required and the value of the service provided one could easily argue they are underpaid

The market should determine what doctors get paid. And the market is being artificially manipulated due to the fact that the medical industry is the largest protected workplace in the entire country.

[dre]

Of course, if you're too aggressive in "putting downward pressure on prices" you run the risk of costing lives, either by curtailing use of existing technology, or by putting a damper on new technology.

How many people will die if the system collapses completely because it cant sustain ? A lot more.

A certain ammount of deaths and malpractice is acceptable. Quality is NOT a panacea, its only 1 of 3 important metrics, and if you set standards too high you will have a system thats cost prohibitive and that does nobody any good.

Costs are increasing faster than both our GDP and average income and if the trend continues half of Canadian provinces will be spending more than 1/2 of their entire budget on healthcare by 2020.

[wyly]

Horse shit. You proved your OWN point with your claims that all these doctors being prevented from working are unqualified. And you just proved it again by posting data from 2005. Almost 7 years old.

don't be naive wages don't go up that quickly...here are BC MD'sgross 2010 wages before overhead the the vast majority fall into the 2005 range, for every MD in the range you claim they all make there are others that make less than 50K-60K...any MD making the kind of wages you claim they make are highly specialized experts usually involved in surgical procedures...

The market should determine what doctors get paid. And the market is being artificially manipulated due to the fact that the medical industry is the largest protected workplace in the entire country.

now you're into conspiracy theories, making assumptions on with zero evidence....

[wyly]

Look forward to hearing about it.

True, fast tracking won't save money but gives us more MD's. This in turn will cost more. They are two different problems, somewhat at odds. We don't want a system where there are too many MD's, raising costs without benefit but we're not close to that point yet.

Residents save the system money, and I'm sure that is attractive in its own way. In some professions they have introduced 'Assistants', whose role is to deal with less complicated medical issues while reporting to higher qualified staff (who are better paid, but fewer in number). RNA's, for example.

how do we increase speed of delivery for services without more MDs and nurses?...here in Calagry we have wards closed down for lack of nurses and MDs, ER wait times can be excessive due to the lack of walk-in clinics again insufficient MDs...to equal US MD patient ratio per thousand would require nearly 30% more MDs than we have now, to equal Norways we would need to double our number of MDs...there is no way that can be accomplished without significant increase in cost to taxpayers...

[dre]

don't be naive wages don't go up that quickly...here are BC MD'sgross 2010 wages before overhead the the vast majority fall into the 2005 range, for every MD in the range you claim they all make there are others that make less than 50K-60K...any MD making the kind of wages you claim they make are highly specialized experts usually involved in surgical procedures...

now you're into conspiracy theories, making assumptions on with zero evidence....

I read that the average in my province is 304K. But even going by your numbers my origional suggestion would save a mountain of money.

Its not a conspiracy theory that the medical industry is a protected workplace its an objective fact. Its no less protectionism than if we only allowed Canadians to buy television sets made here. You would create artificial scarcity and very few people would be able to afford TV sets.