Heath Care too expensive?

[Wilber]

2 hours ago, Machjo said:

The state in most cases.

That would be you and I. Thing is, we all use public infrastructure, even if it is indirectly.

[Zeitgeist]

I'm not sure where turningrite gets treatment, but generally when you have a serious illness in Canada, the system kicks in quite well.  I do think it depends to some extent on where you live.  Toronto hospitals such as Princess Margaret or Sunnybrook are very strong in treatment of certain cancers.  I know when a close relative of mine had a serious accident at a country hospital in another province, he was flown by air ambulance to Toronto, partly paid for by private insurance.  So yes, some regions have more medical capacity than others.  As always, the north is underserviced.

[Wilber]

4 hours ago, turningrite said:

My perception is that public sector wages tend to converge toward the middle, with less skilled workers enjoying better compensation than that paid in comparable private sector roles while more educated and skilled workers often face lower compensation than that paid in comparable roles in the private sector. During my career, I worked on both sides of the divide and this perception was pretty much confirmed for me. The biggest difference between the two kinds of workplaces related more to quality of work and performance, where I believe the private sector was vastly more consistent in comparison to the public one and this applied to performance expectations at all job levels, albeit there were still some outstanding performers in the public sector who were mainly driven by personal pride, intelligence and good work habits. The prevailing mentality in the public sector, however, was that there was little point in working too hard to accomplish much because you got the same pay as those in your position who accomplished little and the work not done by non-performers was often foisted on the productive staff. In other words, it was a system governed by disincentives.

I have no experience working in the public sector. My contacts with it have ranged from mediocre to excellent.

[Centerpiece]

Perhaps this has already been posted but according to the World Health Organization (WHO), we're ranked 30th in the world - the US is #37.........the usual subjects are so arrogant and sanctimonious on this topic. Do they actually understand the term "evidence based"?

Quote

 

Some people fancy all health care debates to be a case of Canadian Health Care vs. American. Not so. According to the World Health Organization’s ranking of the world’s health systems, neither Canada nor the USA ranks in the top 25.

Improving the Canadian Healthcare System does not mean we must emulate the American system, but it may mean that perhaps we can learn from countries that rank better than both Canada and the USA at keeping their citizens healthy.

 

Link: http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

[Michael Hardner]

2 hours ago, Argus said:

Well I guess I'd do a better job of it since you only seem to be interested in posturing.

No doubt from me.

[Michael Hardner]

9 hours ago, turningrite said:

1. The problem is that it's getting worse. And others among my friends and my broader group of acquaintances have had similar experiences.

2. My impression of the system is based on the ongoing treatment over the past three years of a serious, degenerative and likely genetically-based medical condition, which has resulted in serious functional impairments and overt disability. It's not based on occasional or "once-in-awhile" contact. I was referred to the U.S. for necessary medical assessment and treatment but that fell through for reasons entirely beyond my control, including the fact that Ontario's coverage for such care (as I was informed by a rep for the American institution to which I was being referred) is minimal and has been declining for more than a decade. If you get sick in this province, especially with anything rare or unusual, you're essentially left to your own devices. As I was told, and quite contrary to our propaganda about "universal" coverage, Canadians are just "uninsured" patients when dealing with U.S. institutions, even when no equivalent care or expertise is available in Canada. My on practical option now, essentially, is assisted death, when I reach the point where I can no longer tolerate the effects of my illness.

1.  THAT's systems thinking !  Good for you but you need a metric to support your claim.

2. It's just one case so it doesn't speak to the overall trend.  Still you have my sympathy.

[turningrite]

4 hours ago, Zeitgeist said:

I'm not sure where turningrite gets treatment, but generally when you have a serious illness in Canada, the system kicks in quite well. 

I'm in Toronto, the country's largest city and based on my experience those who believe our health care system is either "universal" or even adequate are fooling themselves.

[turningrite]

2 hours ago, Michael Hardner said:

1.  Good for you but you need a metric to support your claim.

2. It's just one case so it doesn't speak to the overall trend.  Still you have my sympathy.

1.) Where your own health is in question, I believe a perfectly valid metric is established. Whatever the case, based on recent reporting, my experience is hardly unique. And the wider world is taking notice. (See link below.)

2.) See above response.

https://business.financialpost.com/opinion/william-watson-why-canadas-best-health-care-system-just-got-ranked-last-again

[turningrite]

4 hours ago, Wilber said:

My contacts with [the public sector] have ranged from mediocre to excellent.

This is precisely my point.

[Wilber]

3 minutes ago, turningrite said:

This is precisely my point.

I could say the same about the private sector.

[turningrite]

48 minutes ago, Wilber said:

I could say the same about the private sector.

The two differ in important systemic aspects. A poorly run business is ultimately accountable to its owner(s) or shareholders, who bear the risks of tolerating poor customer service. This same logic simply doesn't apply to the public sector. The public sector, including the health care system, isn't generally designed to reward excellence, initiative or innovation, particularly on the front lines, and there are few risks when members of the public aren't satisfied with the services they receive. In my experience, the biggest problems Canadians face when dealing with private businesses generally arise from interaction with companies in heavily protected and oligopolistic sectors. In this regard, my late mother, an immigrant, used to sarcastically describe the private sector bureaucracy often apparent in some sectors of the Canadian economy as "Canadian service." She believed that Canadians simply didn't complain enough. Maybe she was right.

Edited October 17, 2018 by turningrite

[Michael Hardner]

7 hours ago, turningrite said:

1.) Where your own health is in question, I believe a perfectly valid metric is established. Whatever the case, based on recent reporting, my experience is hardly unique. And the wider world is taking notice. (See link below.)

2.) See above response.

https://business.financialpost.com/opinion/william-watson-why-canadas-best-health-care-system-just-got-ranked-last-again

1) "It happened to me but it's not unique." ... Cites, my friend.  Start with Googling "CIHI".  You are welcome

2) There you go !

Wait times are well documented in CIHI by the way.  And they sometimes get very bad.  And ambulance wait times too: there were people in the Hamilton area who called 911 and died waiting for service, as I recall.  It really didn't come up in the provincial election.

Why is that ?

I'm a liberal, but I have to lay the blame at the feet of liberals.  It's considered traitorous to criticize the system, because the assumption is that you are attacking our values.  The dumb thing is, a non market based system is MORE reliant on public discourse and criticism because there is no profit motive to drive improvements.  But somehow people assume you are advocating for an American system when you criticize ours.

It's shameful.  It's our duty to make public systems work.  Liberals should be doing it even more, if they care.  Without criticism the system will break down and a pay-per-use system will replace it.

But the first thing people will tell you if you give them anecdotes is that they have another anecdote that disproves yours.  So use CIHI stats.  You're welcome, again.

[Centerpiece]

In Canada, we have "rationed health care" with a triage component to identify those who need critical and immediate care. The rest wait as long as necessary. There is no "pressure release valve" to the system - other than waiting. It is what it is. The false comparison of universal "free" healthcare versus private is disingenuous. Canada ranks 30th in the world (the US is #37) in healthcare effectiveness for a reason - we certainly put enough money into it. The majority of countries ahead of Canada mix in some private healthcare and THAT becomes the pressure valve. As with so many other issues, our left-leaning intelligentsia shout down and shut down any such rational discourse. While the Left constantly brays that the rich should pay "a little more", how does this square with "free" healthcare for everyone? I am so sick of this discussion (no pun intended). How about starting by sending everyone a semi-annual INVOICE of exactly what it costs for their medical care? At least then, we can start to appreciate that Healthcare is NOT free. 

[turningrite]

1 hour ago, Centerpiece said:

In Canada, we have "rationed health care" with a triage component to identify those who need critical and immediate care. The rest wait as long as necessary. There is no "pressure release valve" to the system - other than waiting. It is what it is. The false comparison of universal "free" healthcare versus private is disingenuous. Canada ranks 30th in the world (the US is #37) in healthcare effectiveness for a reason - we certainly put enough money into it. The majority of countries ahead of Canada mix in some private healthcare and THAT becomes the pressure valve. As with so many other issues, our left-leaning intelligentsia shout down and shut down any such rational discourse. While the Left constantly brays that the rich should pay "a little more", how does this square with "free" healthcare for everyone? I am so sick of this discussion (no pun intended). How about starting by sending everyone a semi-annual INVOICE of exactly what it costs for their medical care? At least then, we can start to appreciate that Healthcare is NOT free. 

We should admit that our health care "system" (such as it is) is neither free nor "universal" and then objectively look at ways in which it might be fixed, including opening our minds to private insurance and other options. It's clear that Canadians won't pay increasing taxes to support a system that doesn't guarantee them access to good or even adequate care when they need it. We don't just have a two-tier system, rather, we have a multi-tiered system in which access and outcomes are essentially dictated by connections, chance and luck. Why not just spend your money on lotto tickets rather than pay taxes if you can end up being told that you have a serious medical condition for which you can't be treated in this country and have to draw on your (limited) retirement savings to pay for assessment and care elsewhere? Our system does the easy stuff, although unevenly at best. But you can be left on your own where the difficult stuff is concerned, just as uninsured Americans are (as Canadians often smugly point out). Isn't this precisely the nightmare Canada's public monopoly health care model was supposed to resolve? Think again if you believe it's working. I used to support the Canadian public "system" - until bitter reality forced me to realize that it's a crock.

Edited October 17, 2018 by turningrite

[Zeitgeist]

On ‎10‎/‎17‎/‎2018 at 11:17 AM, turningrite said:

We should admit that our health care "system" (such as it is) is neither free nor "universal" and then objectively look at ways in which it might be fixed, including opening our minds to private insurance and other options. It's clear that Canadians won't pay increasing taxes to support a system that doesn't guarantee them access to good or even adequate care when they need it. We don't just have a two-tier system, rather, we have a multi-tiered system in which access and outcomes are essentially dictated by connections, chance and luck. Why not just spend your money on lotto tickets rather than pay taxes if you can end up being told that you have a serious medical condition for which you can't be treated in this country and have to draw on your (limited) retirement savings to pay for assessment and care elsewhere? Our system does the easy stuff, although unevenly at best. But you can be left on your own where the difficult stuff is concerned, just as uninsured Americans are (as Canadians often smugly point out). Isn't this precisely the nightmare Canada's public monopoly health care model was supposed to resolve? Think again if you believe it's working. I used to support the Canadian public "system" - until bitter reality forced me to realize that it's a crock.

I think you have to reference specific illnesses/diseases if you're going to say that these aren't well treated in Canada.  I agree that the care is uneven, but it's hard to address the overally problem without addressing specific problems.

[turningrite]

29 minutes ago, Zeitgeist said:

I think you have to reference specific illnesses/diseases if you're going to say that these aren't well treated in Canada.  I agree that the care is uneven, but it's hard to address the overally problem without addressing specific problems.

That's an outrageous requirement. We all retain a right to privacy. You should simply acknowledge that the views of those who do express well-founded outrage at the well-documented shortcomings of our system should be respected. Furthermore, I'd probably have to write a book to explain all the problems I've experienced in the health care system. I don't think this site/forum intends to serve such a purpose. 

Edited October 18, 2018 by turningrite

[Zeitgeist]

23 hours ago, turningrite said:

That's an outrageous requirement. We all retain a right to privacy. You should simply acknowledge that the views of those who do express well-founded outrage at the well-documented shortcomings of our system should be respected. Furthermore, I'd probably have to write a book to explain all the problems I've experienced in the health care system. I don't think this site/forum intends to serve such a purpose. 

Without evidence claims cannot be validated.  I respect your right to privacy for medical matters.  You certainly don't have to share anything, but if you're going to level heavy criticism, I think it's important to go beyond generalities to specifics about quality of care.  I've heard some very positive stories about people's experiences with cancer care teams.  Our diagnostic tools are generally very good.  Treatment is prescribed in accordance with level and nature of need.  Wait times are generally an issue for the small stuff, which is why I NEVER go to the hospital for anything minor (cold/flu, minor injuries).  I know I won't get out of there in under four hours.  That's where family doctors and walk-in clinics come in (walk-ins are more costly than family doctors).  The availability of doctors and certain types of treatment/equipment is an issue in remote areas, so transportation is an added cost.  You can see why costs can mount.  Our doctors make good money but less than they'd make in private practice.  The reason for fear of allowing much private practice is that it will impact the universality of care, such that the haves will be able to jump the cue, especially for non-essential reasons.  These doctors would be pulled from the public system, impacting care and creating a two-tier system.  I don't think it has to be all one way or the other.  I'm sure there's room for integration of some private practice, but government has to look at the system as a whole and how it meets the needs of all Canadians, not just the Muskoka set.  

[turningrite]

21 hours ago, Zeitgeist said:

1.) Without evidence claims cannot be validated.  2.) I respect your right to privacy for medical matters.  3.) You certainly don't have to share anything, but if you're going to level heavy criticism, I think it's important to go beyond generalities to specifics about quality of care.  4.) I've heard some very positive stories about people's experiences with cancer care teams.

1.) Huh? The purpose of this forum is not to permit others to question the validity of the experiences of those who post here. If we're referencing studies or statistics we have an obligation to reference our sources. Logically, however, our own experiences are self-validating and any assertion that they're not is entirely presumptuous.

2.) Really?

3.) I don't feel comfortable about going into "specifics" as I've raised some of these myself with the health care providers and institutions with which I've had to deal. In one case, the institution responded that it was aware of the issues underlying some of my concerns, however no solution or remedy was proposed. In other instances, I've obtained apologies from medical providers. The problems are so deeply ingrained in the system that it's difficult to imagine that anything other than a complete overhaul will help.

4.) Cancer care seems to be one area, in particular, where politicians have responded to public concerns, perhaps because due to an ageing population cancer has become a pervasive health issue. Even so, a friend of mine who died last year, who was happy with his cancer care for the most part, also had significant criticisms. And at the end he chose assisted death over returning to hospital or entering institutional palliative care because he felt he'd lose control and dignity were he to choose either option.

Edited October 20, 2018 by turningrite

[cannuck]

19 hours ago, Zeitgeist said:

  Our doctors make good money but less than they'd make in private practice.  The reason for fear of allowing much private practice is that it will impact the universality of care, such that the haves will be able to jump the cue, especially for non-essential reasons.  These doctors would be pulled from the public system, impacting care and creating a two-tier system.  I don't think it has to be all one way or the other.  I'm sure there's room for integration of some private practice, but government has to look at the system as a whole and how it meets the needs of all Canadians, not just the Muskoka set.  

The secret IMHO is in having universal INSURANCE and letting the client choose to have service delivered by either private or public practicioners.  There already IS a "two tiered" (or more) system, so the idea of trapping Canadians who can not afford to travel out of their region or country is disgusting, to say the least.  If they want care that public employees can not or will not provide, they should be able to use their insurance money and anything else they chose to use to get what they want.  Many other countries have no trouble with private and public service delivery co-existing - nor should they or we.  We tend to put our political ideology well ahead of the actual need to deliver sick care to our citizens or their rights to self-determination.

Also: que jumpers who go outside of the public delivery system open up a slot for those behind them in line to move forward.  That is a win-win.

[Zeitgeist]

6 hours ago, cannuck said:

The secret IMHO is in having universal INSURANCE and letting the client choose to have service delivered by either private or public practicioners.  There already IS a "two tiered" (or more) system, so the idea of trapping Canadians who can not afford to travel out of their region or country is disgusting, to say the least.  If they want care that public employees can not or will not provide, they should be able to use their insurance money and anything else they chose to use to get what they want.  Many other countries have no trouble with private and public service delivery co-existing - nor should they or we.  We tend to put our political ideology well ahead of the actual need to deliver sick care to our citizens or their rights to self-determination.

Also: que jumpers who go outside of the public delivery system open up a slot for those behind them in line to move forward.  That is a win-win.

In that case there should be private medical schools.  Only doctors who pay a non-subsidized tuition of, for example, $30000.00 a year should be permitted to work exclusively in private practice in Canada.  Why should the public subsidize their education?  I don’t want to see the doctors in whom we’ve invested leave the public system where all Canadians have equal access. 

[cannuck]

16 hours ago, Zeitgeist said:

In that case there should be private medical schools.  Only doctors who pay a non-subsidized tuition of, for example, $30000.00 a year should be permitted to work exclusively in private practice in Canada.  Why should the public subsidize their education?  I don’t want to see the doctors in whom we’ve invested leave the public system where all Canadians have equal access. 

THAT would be a recipe for genuine "two tier" problems.  "free" schools would probably segregate into second tier quality while full cost schools would up their game to attract students who could see more $$ in private practice.   If you stick with the simple business of having government monopolize and genuinely make universal the sick care insurance - as well as being the source of actual health care - the payment for service delivery would remain as it is now - from a prescribed list of approved/in scope procedures covered under insurance.  Anything outside of that would, as now, be fee-for-service, but why would you limit the ways and means that patients seek to get service delivered how, when and where THEY choose to get it?????

[Argus]

21 hours ago, Zeitgeist said:

In that case there should be private medical schools.  Only doctors who pay a non-subsidized tuition of, for example, $30000.00 a year should be permitted to work exclusively in private practice in Canada.  Why should the public subsidize their education?  I don’t want to see the doctors in whom we’ve invested leave the public system where all Canadians have equal access. 

What about tuition for lawyers, architects and software engineers? Should it be raised if they don't agree to work for the government?

[Zeitgeist]

8 hours ago, Argus said:

What about tuition for lawyers, architects and software engineers? Should it be raised if they don't agree to work for the government?

Health is a necessity and should be a right.  Have as many private universities as you like for any of those other lucrative fields in addition to the publicly funded universities.  

[Zeitgeist]

13 hours ago, cannuck said:

THAT would be a recipe for genuine "two tier" problems.  "free" schools would probably segregate into second tier quality while full cost schools would up their game to attract students who could see more $$ in private practice.   If you stick with the simple business of having government monopolize and genuinely make universal the sick care insurance - as well as being the source of actual health care - the payment for service delivery would remain as it is now - from a prescribed list of approved/in scope procedures covered under insurance.  Anything outside of that would, as now, be fee-for-service, but why would you limit the ways and means that patients seek to get service delivered how, when and where THEY choose to get it?????

My point is, if you want to make hundreds of thousands more than you would as a doctor in our universal system, doing something like giving women big fake breasts in a private clinic, you’re welcome to do so, but not on the public teet. Pun intended. 

[cannuck]

8 hours ago, Zeitgeist said:

My point is, if you want to make hundreds of thousands more than you would as a doctor in our universal system, doing something like giving women big fake breasts in a private clinic, you’re welcome to do so, but not on the public teet. Pun intended. 

While I agree in principal, it would be hard to do in practice.  You start into medicine with the same degree and don't become a tit doc until and if you choose to specialize.  The differences don't end there, but are related to whether or not the procedure is cosmetic for the sake of vanity, or is restorative due to trauma or disease.  It would seem to be more equitable and workable to simply tax cosmetic procedures to recover some of the public costs in putting the beneficiary in a position to profit from vanity - and to defer some of the risk costs of the possible medical costs due to malpractice or complications.  What I do NOT want to see is anything that could interfere with someone with a medical need from seeking ANY solution to their wants and needs.