B.C. lawsuit set to reignite debate about private health care

[WestCoastRunner]

A Vancouver surgeon is continuing his fight in BC Supreme Court to allow privatized health care. He is being accused of trying to gut the core of Canada's medical system by many across Canada.

http://globalnews.ca/news/2915355/vancouver-surgeon-challenging-b-c-s-ban-on-private-insurance/

Some highlights:

He argues the restriction violates patients’ constitutional rights by forcing them to endure gruelling wait times that often exacerbate their health problems.

Canada’s inefficient system is the product of a wasteful bureaucracy, a lack of competition and a misguided attachment to universal coverage, Day argues. He said opening the door for private insurance would ease pressure on the public system, freeing up resources to cut wait times and boost the quality of care for everyone, whether publicly or privately insured.

Adam Lynes-Ford of the B.C. Health Coalition, one of the interveners in the case, said making space for private health care flies in the face of the core Canadian value that people should have access to medical care based on need, not on ability to pay.

“This is such a profound threat to the health of everybody in Canada,” Lynes-Ford said.

He said a win for Day would lead to a more U.S.-style medical system, meaning longer wait times for the average Canadian and skyrocketing costs as limits are lifted on what doctors can charge patients.

The case is supposed to last for a month.

[cybercoma]

He's wrong on all accounts for one simple reason. We have a single-payer system. We don't have public healthcare in Canada. They have public healthcare in the UK with the NHS. If his arguments about access and resources were true, why would it be any different with a different payer?

[TimG]

A Vancouver surgeon is continuing his fight in BC Supreme Court to allow privatized health care. He is being accused of trying to gut the core of Canada's medical system by many across Canada.

The ship has already sailed. https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG)

Chaoulli v Quebec (AG) [2005] 1 S.C.R. 791, 2005 SCC 35, was a decision by the Supreme Court of Canada of which the Court ruled that the Quebec Health Insurance Act and the Hospital Insurance Act prohibiting private medical insurance in the face of long wait times violated the Quebec Charter of Human Rights and Freedoms. In a 4 to 3 decision, the Court found the Acts violated Quebecers' right to life and security of person under the Quebec Charter. The ruling is binding only in Quebec. Three of the seven judges also found that the laws violated section seven of the Canadian Charter of Rights and Freedoms.

He is right from a moral perspective too because the needs of the system often conflict with the needs of the individual and each individual should be allowed to spend their own money to access faster services even if the system claims it is not medically necessary to gave faster access.

Lastly, the government is hypocritical because the WCB and the RCMP are entitled to pay for faster access and thousands of Canadians are directed by doctors to US medical clinics that can provide services which they are not allowed to provide in Canada. The idea that we have a 'single tier' system today is a myth propagated by progressives who value meaningless gestures over substance.

Edited September 1, 2016 by TimG

[WestCoastRunner]

Doctors in the private health care system in Quebec can charge the govt for certain fees: (although it may have changed in the last few months)

At present, the Quebec Health and Social Services Act stipulates that doctors who practise in the public system can bill patients only for “medication and anesthesia agents.” In addition, the provincial government did negotiate with the medical federations a list of other fees that are permitted, such as the use of liquid nitrogen to remove moles ($10) or the use of a topical anesthetic for a minor eye wound (also $10).

Over the years, however, many physicians in private practice started billing for many more items and services, sometimes prompting investigations by the provincial medicare board, the Régie de l’assurance maladie du Québec (RAMQ). In response to a sharp increase in complaints, the College of Physicians decided to revise its code of ethics, but at the same time it called upon Barrette to update and expand the list of accessory fees.

http://montrealgazette.com/news/local-news/quebec-to-update-list-of-medical-fees-doctors-can-charge-patients-in-private-clinics

[dre]

Changing who the payer is will do nothing to solve our problems. The problem is medical inflation and artificial scarcity... doctors salaries are increasing in the entire western world, primarily because they are protected from foreign competition. Their patients on the other hand work in industries that are not protected in the same way.

The only way to fix this is to kneecap the medical associations, and create a mountain of new residency slots. This country is full of people that have already passed our medical exams, but cant practice simply because there's no residency slots. A lot of these doctors would be willing to work for 50k per year, because they are driving cab now.

Sames goes for Canadian graduates. They pass their exams but cant get residency.

Juggling around who the payer is will do nothing useful at all.

Right now there's millions of Canadians that cannot find a family doctor. We need to saturate the supply side so that its harder for doctors to find patients than it is for patients to find doctors. Then costs will go way down. But cash strapped provinces are actually CUTTING residency slots to save money. The other problem is that a lot of doctors are retiring, which exacerbates the problems caused by the chronic shortage of residency slots.

Quadruple the number of residency slots for a few years.

And if you look at how the system is set up, is specifically designed to increase costs and reduce access. Here's a snippet from Healthforce BC.

The College of Physicians and Surgeons of Ontario (CPSO) regulates the practice of medicine in Ontario and issues certificates of registration to physicians to allow them to practise.

Well guess what else the CPSO does! They negotiate doctors wages with the province! ROFLMAO.... Its a labor union, and regulatory authority, and a certification board at the same time! Its in their best interests to drive up salaries, and controlling cerfications and regulations gives them the perfect tools to do it.

Picture for example of the carpenters union got to control building codes and certifications. They could make all the work for themselves that they wanted through the regulatory process, and they could drive up their own wages by using the certification process to create fake scarcity... The result? Your house would cost way more to build. This is exactly whats happening with Doctors.

Trying to dumb these problems down into "Duh... we need to privatize it dude!" is just retarded.

Edited September 1, 2016 by dre

[?Impact]

Any doctor who practices in private healthcare should reimburse the government $7.5 million for his/her education.

Any patient who elects to use private healthcare should never be allowed to use the public system again - ever.

[Bonam]

He's wrong on all accounts for one simple reason. We have a single-payer system. We don't have public healthcare in Canada. They have public healthcare in the UK with the NHS. If his arguments about access and resources were true, why would it be any different with a different payer?

Not a different payer but an additional payer. Everyone would still be paying the same taxes. Those who wanted to, could pay additional money for additional/faster medical services. That means more total money is devoted to healthcare. So assuming more money can buy more equipment, more personnel, shorter wait times, then private health care could help to address the problem.

That said, as soon as you have private health care, then the richer parts of society no longer care as much about the quality of publicly paid health care, which could result in its eventual erosion. That is of course the main argument against it, and it has some validity.

The problem is medical inflation and artificial scarcity... doctors salaries are increasing in the entire western world, primarily because they are protected from foreign competition. Their patients on the other hand work in industries that are not protected in the same way.

The only way to fix this is to kneecap the medical associations, and create a mountain of new residency slots. This country is full of people that have already passed our medical exams, but cant practice simply because there's no residency slots. A lot of these doctors would be willing to work for 50k per year, because they are driving cab now.

How much of the increase in medical costs is a result of salaries? My impression is that most of the rising cost of healthcare can be attributed to increasing capital and operating costs for the most advanced latest equipment, increased costs of new medical infrastructure (hospitals and doctors clinics cost more to build than ever before), increased costs of pharmaceuticals, and longer lifespans where a greater number of years at the tail end rely on ever more medical interventions.

This link suggests that doctors salaries (in the US) make up only ~10% of overall healthcare costs.

http://blog.academyhealth.org/how-health-professional-salaries-figure-into-health-care-spending/

The figure is probably lower in Canada where doctors make less money than in the US.

[Bonam]

Any doctor who practices in private healthcare should reimburse the government $7.5 million for his/her education.

Any patient who elects to use private healthcare should never be allowed to use the public system again - ever.

Why? The doctor is still providing health care to Canadians. And the patient is still paying taxes to support the public system, in addition to whatever fees a private practice might charge them.

[?Impact]

Why?

The $7.5 million is a very low estimate of what it cost us to train that doctor to be part of the system providing universal healthcare. If they want to then beg out of that system in order to fill their pocketbook, then they need to repay it. They and the patient are contributing to the destruction of the public healthcare system. The tax paying patient will howl and cry to lower his/her taxes, and the doctor has elected to choose his patients on the basis of money.

[TimG]

The $7.5 million is a very low estimate of what it cost us to train that doctor to be part of the system providing universal healthcare.

So you are saying you want doctors to leave the country rather than set up a private practice here?

Canada is the only OECD country in the world that does not have a mixed system yet it is one the worst when it comes to cost. There is simply no rational basis for the prohibition. In fact, it is a prohibition that only exists because our hypocritical politicians know they can go to the US if the need any treatment that is denied to Canadians. It is time to end this hypocrisy.

Edited September 2, 2016 by TimG

[WestCoastRunner]

Changing who the payer is will do nothing to solve our problems. The problem is medical inflation and artificial scarcity... doctors salaries are increasing in the entire western world, primarily because they are protected from foreign competition. Their patients on the other hand work in industries that are not protected in the same way.

The only way to fix this is to kneecap the medical associations, and create a mountain of new residency slots. This country is full of people that have already passed our medical exams, but cant practice simply because there's no residency slots. A lot of these doctors would be willing to work for 50k per year, because they are driving cab now.

Sames goes for Canadian graduates. They pass their exams but cant get residency.

Juggling around who the payer is will do nothing useful at all.

Right now there's millions of Canadians that cannot find a family doctor. We need to saturate the supply side so that its harder for doctors to find patients than it is for patients to find doctors. Then costs will go way down. But cash strapped provinces are actually CUTTING residency slots to save money. The other problem is that a lot of doctors are retiring, which exacerbates the problems caused by the chronic shortage of residency slots.

Quadruple the number of residency slots for a few years.

And if you look at how the system is set up, is specifically designed to increase costs and reduce access. Here's a snippet from Healthforce BC.

Well guess what else the CPSO does! They negotiate doctors wages with the province! ROFLMAO.... Its a labor union, and regulatory authority, and a certification board at the same time! Its in their best interests to drive up salaries, and controlling cerfications and regulations gives them the perfect tools to do it.

Picture for example of the carpenters union got to control building codes and certifications. They could make all the work for themselves that they wanted through the regulatory process, and they could drive up their own wages by using the certification process to create fake scarcity... The result? Your house would cost way more to build. This is exactly whats happening with Doctors.

Trying to dumb these problems down into "Duh... we need to privatize it dude!" is just retarded.

I like this approach. Makes so much sense. Clearly something needs to happen.

[?Impact]

So you are saying you want doctors to leave the country rather than set up a private practice here?

Unfortunately we can't do anything about doctors who leave the country, but if they want to enrich their pocketbook with massive public welfare while here then we should ding them big time. There are many good reasons to stay in Canada, even for doctors.

[TimG]

That said, as soon as you have private health care, then the richer parts of society no longer care as much about the quality of publicly paid health care, which could result in its eventual erosion. That is of course the main argument against it, and it has some validity.

There is nothing stopping government from creating a system where private insurance is sold as a supplement to public insurance. This would ensure that everyone has an incentive to ensure as much as possible is covered under the public system because that means lower private insurance costs.

[TimG]

The only way to fix this is to kneecap the medical associations, and create a mountain of new residency slots. This country is full of people that have already passed our medical exams, but cant practice simply because there's no residency slots.

The cost of paying doctors is no more than 10% of the money paid out by the system.

http://www.longwoods.com/content/23135

The reason we have a shortage of GPs is the current pay rates are not sufficient to cover overhead and pay a reasonable salary. Doctors faced with a student loans choose to opt for positions with less overhead or leave the country entirely.

I also think it is fundamentally immoral to set up a system that depends on importing educated doctors from poor countries.

There is no magic bullet to reducing healthcare costs and it is worthwhile chipping away at the guild rules which create an artificial demand for doctors (how much of a GPs work could be done by a properly trained nurse?). But you are not going to fix the system by attacking 10% of costs.

[?Impact]

The cost of paying doctors is no more than 10% of the money paid out by the system.

Not sure where you get the 10% figure from. Following your link I see 20% less an overhead of 12-43%. Assuming every physician was at the high end then that would be about 12% net. I don't see enough detail to come up with an estimate, but it would be somewhere between 12%-19%

[bush_cheney2004]

There is no need to guess about Canadian health care expenditures or refer to foreign data (United States). The information is readily available from domestic sources like the Canadian Institute for Health Information.

https://www.cihi.ca/en/spending-and-health-workforce/spending/national-health-expenditure-trends

[TimG]

Not sure where you get the 10% figure from. Following your link I see 20% less an overhead of 12-43%. Assuming every physician was at the high end then that would be about 12% net.

I rounded down. 15% is a better guess-estimate but it does not change my point. Doctors fees are a small part of the cost structure and focusing on them is not going to deal with the unsustainable cost spiral.

But that is why the healthcare system can't be all things to all people and if it can't be all things to all people it has to allow for people to use their own money to pay for care without leaving the country.

[dre]

The cost of paying doctors is no more than 10% of the money paid out by the system.

http://www.longwoods.com/content/23135

There is no magic bullet to reducing healthcare costs and it is worthwhile chipping away at the guild rules which create an artificial demand for doctors (how much of a GPs work could be done by a properly trained nurse?). But you are not going to fix the system by attacking 10% of costs.

I'm not sure where those numbers come from. I read that doctor salaries were about 20%. I was looking at a study on whats driving healthcare cost increases...

https://secure.cihi.ca/free_products/health_care_cost_drivers_the_facts_en.pdf

Price inflation has also been a significant factor in the growth in hospital costs. Compensation constitutes 60% of the total cost of hospital budgets. Compensation for the hospital workforce has grown faster than compensation in non-health sectors since 1998.

Compensation for human resources is 60% of hospital budgets. And the cost of that labor is increasing faster than all non health related sectors.

Over the period from 1998 to 2007, prescription drug expenditures grew at an annual average rate of 10.1% per year.

The cost of prescription drugs is also increasing way faster than the rate of inflation and everyone else's salaries. Again privatization wont do anything here, and we are in fact headed for increasing costs if we sign bad deals like the TPP.

The study also says...

Price inflation is a significant cost driver. Managing health-specific price inflation for core medicare goods and services, including doctors, nurses, other health care professionals and advanced diagnostics, will be a challenge.

A rapid increase in physician remuneration places considerable cost pressures on all governments.

Changing who the payer is will not address price inflation. This phenomenon is happening across the entire western world, including countries with public UHC, private insurance, or hybrids.

There is no magic bullet to reducing healthcare costs and it is worthwhile chipping away at the guild rules which create an artificial demand for doctors (how much of a GPs work could be done by a properly trained nurse?). But you are not going to fix the system by attacking 10% of costs.

Its not 10 percent of the costs, its more like 70.

Edited September 2, 2016 by dre

[TimG]

Compensation for human resources is 60% of hospital budgets.

And when you combine with the number I provided we can deduce that about ~45% of the costs goes to non-doctors such as nurses, administration or cleaning staff. I agree that the cost of people is one of the reasons why healthcare costs keep rising but it is wrong to focus on doctors since the cost of doctors is only about 10-15%.

It is worth noting that doctors are not eligible for gold plated public pension plans but nurses and other staff are. Reducing the cost of pension plans could yield more savings than cutting doctors pay in half.

Edited September 2, 2016 by TimG

[dre]

And when you combine with the number I provided we can deduce that about ~45% of the costs goes to non-doctors such as nurses, administration or cleaning staff. I agree that the cost of people is one of the reasons why healthcare costs keep rising but it is wrong to focus on doctors since the cost of doctors is only about 10-15%.

It is worth noting that doctors are not eligible for gold plated public pension plans but nurses and other staff are. Reducing the cost of pension plans could yield more savings than cutting doctors pay in half.

Right and the issue with nurses is the same as with doctors. And those medical associations also end up making decisions that impact the number of administrative people needed as well.

And we have a chronic shortage of family practitioners. You don't need expensive equipment to be a family practitioner. You need an office, a secretary, a stethoscope, and a computer. The public pays the rest of the bill by allowing you access to hospitals for tests, surgeries, etc.

The chronic shortage of family physicians increases costs of the entire system because you have no real managed care. Millions of Canadians see doctors at walk-in clinics that don't even know them. Many of them just wait until things are so bad they need to go to the ER, and have much more serious illnesses than they would have had if they had proper medical care from a GP.

Private clinics wont change any of that. They cant do anything at all to streamline the certification of doctors or nurses. They cant lower the cost of prescription drugs or medical equipment either.

Edited September 2, 2016 by dre

[TimG]

And we have a chronic shortage of family practitioners. You don't need expensive equipment to be a family practitioner. You need an office, a secretary, a stethoscope, and a computer. The public pays the rest of the bill by allowing you access to hospitals for tests, surgeries, etc.

The overhead is the reason why there is a shortage of GPs because young doctors can make more working in a hospital or at a walk-in clinic (owned by someone else) where their overhead is small to non-existent. I think the fee-for-service model is wrong for GPs and we need something like capitation:

https://en.wikipedia.org/wiki/Capitation_(healthcare)

[dre]

I also think it is fundamentally immoral to set up a system that depends on importing educated doctors from poor countries.

Never mind poor countries. We wont accept residency from the Uk, Nordic countries, France, and other western European countries.

And if its "immoral" to employ foreign doctors why is it ok to use foreign manufacturing resources?

[eyeball]

Changing who the payer is will do nothing to solve our problems. The problem is medical inflation and artificial scarcity... doctors salaries are increasing in the entire western world, primarily because they are protected from foreign competition. Their patients on the other hand work in industries that are not protected in the same way.

The only way to fix this is to kneecap the medical associations, and create a mountain of new residency slots. This country is full of people that have already passed our medical exams, but cant practice simply because there's no residency slots. A lot of these doctors would be willing to work for 50k per year, because they are driving cab now.

Ditto for veterinarians. Vets in my region are requesting people bring in pets for examination and to be prescribed flea treatments that you could just come in and purchase. I can't get the special urinary diet cat food my male cat needs anywhere but a vets office. I've been buying it from the same place for years and now they're making noise about looking at the cat and requiring annual prescriptions.

We had a vet in our remote area who could handle emergencies and often did for free or whatever the hapless pets owner could afford and the veterinarians association had the government shut her down and threatened to sue the woman should she keep doing what she was doing. Now people have to drive up to a couple hundred km, usually just to put their pet down when they find out how much it'll cost to fix them up.

To me its just more evidence of how pathetic capitalism is when it can't make an honest buck.

Trying to dumb these problems down into "Duh... we need to privatize it dude!" is just retarded.

Yep.

Edited September 2, 2016 by eyeball

[dre]

Ditto for veterinarians. Vets in my region are requesting people bring in pets for examination and to be prescribed flea treatments that you could just come in and purchase. I can't get the special urinary diet cat food my male cat needs anywhere but a vets office. I've been buying it from the same place for years and now they're making noise about looking at the cat and requiring annual prescriptions.

Yup. Certification, Labor representation, and Regulation should be done by different bodies. Otherwise you're just handing a license out to print money.

If I'm a vet and I control regulation and standards? Fuck ya! Id like you to come in 10 times a year! If I control certification I don't want to compete against very many vets. If I represent a trade association Im going to try increase billing.

A good example of this, is that in many cases a radiology scan which is simply a DICOM image cannot even be read by a radiologist from another hospital in the same city. Never mind sent to the UK or the Netherlands, or India..

Everyone worries about health care costs, and everyone worries about stagnant wages, but people often don't put the puzzle together correctly and see that the No. 1 thing we could do to raise real incomes for the majority of working people is to alleviate some of the supply-side problems in the health care sector. That means opening the doors to foreign doctors, letting nurse practitioners do more, creating more slots in medical schools, reforming pharmaceutical patents, and encouraging the growth of medical tourism. Making access to doctors more plentiful bolsters the incomes of everyone who consumers medical services (which is basically all of us) and creates lots of complementary employment opportunities. Some kinds of resource constraints—on liquid fuels, for example—are hard to solve from a technical point of view. But like the shortage of houses in high-wage cities, the shortage of people legally authorized to provide medical services in the United States is largely self-induced

If you look into the medical system you find a vast web of protectionism. Medical associations make the rules, and they make those rules to benefit their members... Not patients.

Second, we would not treat patients worse than customers. The old excuse for Economic Protectionism is no longer valid: that if we treated patients like customers, it would steal their dignity. Actually, in this day and age, it would be a step up. Giving patients the same advantages as customers on Amazon would empower them like never before. Hospitals and clinics have been hiding behind this façade for decades, scared what would happen to their profit margins if doctors were held to the same level of accountability as businesses. If you’re not convinced, read President John F. Kennedy’s 1962 speech to Congress on the Consumer Bill of Rights — to safety, to be heard, and to choose.

[Argus]

Any doctor who practices in private healthcare should reimburse the government $7.5 million for his/her education.

Any patient who elects to use private healthcare should never be allowed to use the public system again - ever.

It doesn't bother you that many European countries pay less than us but have much more effective, efficient health care systems, does it?