Rock 'em Sock 'em Health care

[Black Dog]

Continued from here.

Let's start with the claim that increased private sector involvement in health service provision would be cheaper. Not so says this 2004 study.

Devereaux and colleagues from six universities across the country did what's called a meta-analysis to come to their conclusions. They took data from eight similarly designed studies comparing health-care costs in not-for-profit and for-profit hospitals in the United States.

By crunching all that data together - it represented 350,000 patients from several thousand hospitals over a 15-year period - they were able to get a clearer picture of the situation. What they found was that the cost of services in for-profit hospitals was 19 per cent higher than in those run on a non-profit basis.

Set in the context of the Canadian system, a 19-per-cent increase in costs would drive up the current $38.4 billion a year spent onhospital care to a whopping $45.6 billion - without buying any additional services.

Other claims:

It does not have to take money away from the public system. The whole theory of a 'private' system is that it will generate its own money though greater efficiency (as is part of capitalism or 'private' economy). More patients served under private system = less patients filling up waiting lists and emergency rooms. There's no proposal to dismantle part of the current system in order to build the new one. The proposal is to have an alternative for those who can afford such things so that those who cannot afford them will be able to move more quickly through the public system.

Hmm. let's see. We have people claiming that private health care doesn't take anything away from the public system and, in fact, it would relieve pressure on the public system as a whole.

Theoretically, that's possible...assuming the public system continues to be well-funded. But that's a big assumption to make. propionents of private health like to cite examples of private facilities having shorter waiting lists, better facilities, yadda yadda. But this is never reconciled with the parrallel idea that the public system is going to hell. If the private system is so good at correcting these problems, why aren't we seeing the results in the public system? For example, look at Alberta, where (we're told) private providers of services such as MRI's have shorter wait lists and faster times than the public system. That's super for the people who choose that system (if they can afford it), yet the waiting times for the same services in the public system are still significant. Why is that?

[Redneck Yokel]

I stand corrected....

I'll sit by and learn for now.

[Conservative1]

It also introduces increased costs: capital costs, marketing, administrative costs etc.

A private systems capital costs could be funded by a stock offering. Why would administrative costs go up?

[Cameron]

What if you allowed private health care in, kept the same ammount of funding for the public system and over the years reassess the funding needs to the public system so that it is run efficiently and cost effective.

EG: Keep the same budgets and keep the public system competative so it can compete with the private sector. Evaluate the public needs every year and adjust budgets accoding to the ammount of people using the system. Over the years as more people move to private system and you can make the public system still as competative by adjusting the budgets accordingly.

You can have competition between private and public in regards to the ammount of money that is being pushed in to the public sector.

[Black Dog]

A private systems capital costs could be funded by a stock offering. Why would administrative costs go up?

I'm not clear on what you mean.

What if you allowed private health care in, kept the same ammount of funding for the public system and over the years reasses the funding needs to the public system so that it is run efficiently and cost effective.

Possibly. But I question whether the political will exists to do so (ensure parralelle, competitive systems). We've already seen that centre-right politicians are perfectly willing to cut health care. Now, I believe that the ruling elites (the same people who took the axe to the public system in the first place, as well as folks like Stephen Harper who would, if given the chance, chop even further) did so in a deliberate effort to weaken the public system and pave the way for an expanded for-profit prescence. In short, I don't trust the people who benefit most from chopping the system (people who don't really depend on public health care anyway) to be trustworthy guardians of the public system. Foxes and henhouses, don't you know.

[The Terrible Sweal]

A private systems capital costs could be funded by a stock offering. Why would administrative costs go up?

Splitting the heath care system into public and private systems would raise costs in the public system by creating resource competition: e.g. both systems would need to bid for the same doctors.

Also, if you think of health care as an insurance/risk sharing thing, then keeping it all in one pool should be the least expensive option, actuarially speaking.

[willy]

In Ontario, the overcrowding at some hospitals has become so severe that patients are openly encouraged to cross the border into the United States for cancer treatment.

Dr. Glannon said that political ideologies need to be put aside to solve the health care crises both in Canada, where hospitals have become so overcrowded that patients wait days in emergency rooms, and in the United States, where about 44 million people go without basic health care coverage.

This is the strategy that the public system is causing now.

If you were ill would you wait or travel.

[Argus]

Continued from here.

Let's start with the claim that increased private sector involvement in health service provision would be cheaper. Not so says this 2004 study.

Devereaux and colleagues from six universities across the country did what's called a meta-analysis to come to their conclusions. They took data from eight similarly designed studies comparing health-care costs in not-for-profit and for-profit hospitals in the United States.

Right off the bat I see a major problem with relevence to our situation. No one is asking for a US style health care delivery system. The reason US health care costs are higher in private hospitals are many. And none need be transplanted to Canada. To begin with, they're in competition with each other. That means every hospital HAS to have the most modern equipment, even if it's rarely used. In addition, there is massive paperwork involved for hospitals in adapting their treatment to the demands of literally scores of private insurers, all of whom have different coverage policies and requirements.

And, of course, there is the upkeep in trying to appeal to an upscale clientelle; much nicer rooms, beds, tvs, services, food, etc.

No one is talking about that system here. What people are talking about, for example, are private/public partnerships in building/running hospitals and clinics, private money building clinics for clients who pay through public health care plans, and probably a mixture, such as the Germans have, of health care funding/plans offered by government, employers, and unions, under tight government regulation. In all likelihood, public health care would remain universal, and people would be given the option of topping up their coverage through union, employer, or private fees. In a sense, we already have something similar. My employer/union health care coverage, for example, will cover me for extras in hospital, including a semi-private, or private room, if I pay a monthly fee. There's no reason that can't be extended to increase coverage for such things as private MRI clinics (current wait up to 2 years).

And if I choose to pay my money on that rather than beer or cigarettes or cars or cabins, why in hell should anyone be able to say no?

[I Miss Trudeau]

EG: Keep the same budgets and keep the public system competative so it can compete with the private sector. Evaluate the public needs every year and adjust budgets accoding to the ammount of people using the system. Over the years as more people move to private system and you can make the public system still as competative by adjusting the budgets accordingly.

You can have competition between private and public in regards to the ammount of money that is being pushed in to the public sector.

Sometime last summer or fall, either Rutherford or Primeau (I don't recall which) of 630 ched had a guest on who was involved in a study that looked at parallel private/public systems in various countries. The result was actually a considerable increase in cost to the public system on a per person basis.

Basically what happened was the private providers, in order to maximize profit, only took the "easy" cases that were virtually guaranteed of being in and out affairs. They went about this in many ways; for example, they would claim that the expensive or complicated procedure was "too dangerous" to do, or they would increase the cost to such a point as to make it unaffordable, or provide a similar profit to the easier procedures. Note though, that it wasn't that they lost money on the complicated procedures - they were still profitable. It was that they didn't make as much profit doing them.

Well, I think you can all guess who got all the people that the for profit clinics refused to see.

Long story short: such a system actually cost more, on a per person basis, as well as a sizeable increase in overall health care costs.

At any rate, I don't recall the name of the researcher, or the study, and I don't feel inclined to search it out.

So take this as you will, I guess.

[Argus]

EG: Keep the same budgets and keep the public system competative so it can compete with the private sector. Evaluate the public needs every year and adjust budgets accoding to the ammount of people using the system. Over the years as more people move to private system and you can make the public system still as competative by adjusting the budgets accordingly.

You can have competition between private and public in regards to the ammount of money that is being pushed in to the public sector.

Sometime last summer or fall, either Rutherford or Primeau (I don't recall which) of 630 ched had a guest on who was involved in a study that looked at parallel private/public systems in various countries. The result was actually a considerable increase in cost to the public system on a per person basis.

Basically what happened was the private providers, in order to maximize profit, only took the "easy" cases that were virtually guaranteed of being in and out affairs.

How complex do you think it is to take an MRI? The wait in Ontario can be 2 years. If I needed one, I would go to the US or a private clinic in Quebec. It would simply be easier if one was available locally.

The wait for CT scans, MRIs and other diagnostic tools is unacceptablhy long in this country, and has been for over a decade. And it is only going to get worse with the aging population.

[I Miss Trudeau]

The wait for CT scans, MRIs and other diagnostic tools is unacceptablhy long in this country, and has been for over a decade.

If that is the case, the simple answer is to raise taxes (or clean up waste) to purchase more equipment and hire more people to do the MRI's quicker.

Unfortunatly, there is an ideological hatred of taxation in this country, even when it is in everyones best interest to increase taxes.

As a side note, there is no evidence to suggest that private clinics could provide MRI's for less than the public system can.

[Guest eureka]

Utilities and services of every kind are less expensive in public hands. The so-called, and questionable, benefit of competition does not apply to the supply of these necessities.Quality is also not sustained when they are in private hands.

A good example of this is the water supply in the U>K. This was privatized by Thatcher and prices have not dropped nor has quality of service improved. In fact, a few years ago, it was estimated that it would require $30 billion dollars to repair the infrastructure that the private owners had allowed to deteriorate and restore it to the standards that existed before privatization.

Public everything would be cheaper. The reason that it is not and that it is not a good way to run a society, has to do with all kinds of other factors that are not necessarily related to competition

In health care, let's suppose that there are 100 doctors now in the public system. Ten of those move into private care for the higher remuneration. That leaves 90 for the public system. Resources lost.

As Black Dog has written, those doctors in the Private sector will handle less serios cases in the main - the only exception to that is in the case of the very wealthy sick who will pay whatever it takes, as in the USA. They also, since they are now better paid, will handle a smaller load in order to enjoy the "finer" things of life. That increases the load on the public system.

This applies also to nurses and other professional and semi-professional staff. Resources lost.

The amount of money available to the publicly funded part of the system will also be decreased. The experience of every system where there is a private sector shows that the tax burden will be adjusted so that those who are users of the private sector will not be contributing to the care of the great unwashed. And they will have a good case for such an adjustment.

It defies comprehension that so may can say that competition in the private sector will lead to lower prices and better care. It cannot. Health care is not a commodity or manufacture susceptible to price adjustments dependent on market forces. Pricing is almost inelastic. Savings can only be obtained through lower wages and, obviously, that is not likely in this area, or lowering of service standards.

Health, like government, can not be run like a busines. Business practices are suitable only for administration of the system. The administration costs associated with private delivery will be higher as was covered in Black Dog's position.

The only business model that could be applied to this, or to government, is Enron. But that is what the Right Wingers want, isn't it. A great big pot for a very few to dip in.

[Black Dog]

Right off the bat I see a major problem with relevence to our situation. No one is asking for a US style health care delivery system. The reason US health care costs are higher in private hospitals are many. And none need be transplanted to Canada. To begin with, they're in competition with each other. That means every hospital HAS to have the most modern equipment, even if it's rarely used. In addition, there is massive paperwork involved for hospitals in adapting their treatment to the demands of literally scores of private insurers, all of whom have different coverage policies and requirements.

And, of course, there is the upkeep in trying to appeal to an upscale clientelle; much nicer rooms, beds, tvs, services, food, etc.

I guess the question I have to ask is: where will this new breed of private health care service providers come from if we alllow a greater for-profit component to our system? Will they spring whole from the earth, or will they cross the border, bringing with them the same business pratcices that have resultd in the U.S.'s health care system becoming such a gawdawful mess.

Something to consider, anyway.

No one is talking about that system here. What people are talking about, for example, are private/public partnerships in building/running hospitals and clinics, private money building clinics for clients who pay through public health care plans, and probably a mixture, such as the Germans have, of health care funding/plans offered by government, employers, and unions, under tight government regulation. In all likelihood, public health care would remain universal, and people would be given the option of topping up their coverage through union, employer, or private fees. In a sense, we already have something similar. My employer/union health care coverage, for example, will cover me for extras in hospital, including a semi-private, or private room, if I pay a monthly fee. There's no reason that can't be extended to increase coverage for such things as private MRI clinics (current wait up to 2 years).

Frankly I have no desire to see public dollars eaten up by private sector inefficienceis any more than what is already occurring. private health, while wholesal like the U.S. or two-tiered as in some European countires, has failed. No matter where you look the private system costs more and, as a result of the higher costs and limited competition (it's hard to argue that a few select service providers, operating inder tight government restriction can truly be considered a free market environment), the public system ends up subsidizing the private one.

And if I choose to pay my money on that rather than beer or cigarettes or cars or cabins, why in hell should anyone be able to say no?

I'd be happy allowing to spend your money on going elsewhere for care. But in a situation where expanding the role of for-rofit health care providers leads to an inevitable decline in public services for the rest of us, I don't see why those who can afford to seek extra services should be alowed to ruin it for everyone else.

[Hugo]

So many fallacies, so little time.

Unfortunatly, there is an ideological hatred of taxation in this country, even when it is in everyones best interest to increase taxes.

A perfectly reasonable hatred of taxation. Taxation is theft, and I regard hatred of taxation as hatred of theft. When we embrace taxation as a society we have become a society of thieves.

Again, I ask anyone to take up the challenge of defining taxation in such a way that does not also describe high-minded theft.

Utilities and services of every kind are less expensive in public hands.

First I will demonstrate how this is self-contradictory. If what Eureka says is true, then we should hand the entire economy over to public hands, because they are cheaper, and who wants to pay more? We need only look at the dismal poverty of nations that have actually done this to see that it is a nonsense.

Secondly, the point is just plain wrong. Public delivery is never, ever cheaper because it lacks an economic mechanism for linking supply to demand. The huge gap between supply and demand in public enterprise leads to chronic inefficiency, which manifests itself as increased cost to the consumer.

A good example of this is the water supply in the U>K. This was privatized by Thatcher and prices have not dropped nor has quality of service improved.

This is wrong. My family lives in the UK, and power and water are now more reliable and cheaper there than they were when nationalised.

In fact, a few years ago, it was estimated that it would require $30 billion dollars to repair the infrastructure that the private owners had allowed to deteriorate and restore it to the standards that existed before privatization.

I would like to see some proof that it was the private owners who had allowed deterioration, and not the public bureaucrats, as they did with Ontario Hydro, Hydro Quebec, the army, etc. etc.

I would also like you to show me that the power market is truly free, as opposed to being a cartel backed by the government. The fact that government defines geographical areas of monopoly is enough to dispel this myth.

It is very disingenuous to pretend that socialism is capitalism and then use the failures of that socialism to decry capitalism.

Public everything would be cheaper. The reason that it is not and that it is not a good way to run a society

This is self-contradictory. "Public everything would be cheaper. It would not be cheaper."

It defies comprehension that so may can say that competition in the private sector will lead to lower prices and better care.

Why not? Competition in the private sector has led to cheaper and better food, cars, televisions, computers, shoes, clothes, household appliances, wall-to-wall carpeting, exotic pets, you name it.

Find me an example where competition in a free market did not lead to lower prices and/or better quality goods or services.

Health care is not a commodity or manufacture susceptible to price adjustments dependent on market forces.

No, healthcare is a service, like plumbing, veterinary care, dentistry, roofing, car repair, IT consultancy, etc. And in all those fields the free market has successfully delivered better quality at less cost over time.

Savings can only be obtained through lower wages and, obviously, that is not likely in this area, or lowering of service standards.

So savings in the free market have never been obtained with, for example, new technology? All inventions from the spinning jenny to computerised inventorying systems have had absolutely no impact on prices?

Health, like government, can not be run like a busines.

Government is unlike any enterprise since it is the exercise of arbitrary and coercive power. Business is the exercise of trade and co-operation. You cannot compare the two. Ever.

Business practices are suitable only for administration of the system.

Business practices are suitable for everything. The law of scarcity dictates that we cannot possibly have all the healthcare we want. Human preferences dictate that we wouldn't want it anyway. The free market simply lets people choose what healthcare they want, rather than allowing bureaucrats and politicians to choose for them.

The only business model that could be applied to this, or to government, is Enron. But that is what the Right Wingers want, isn't it. A great big pot for a very few to dip in.

Yes, that's right. And all you left wingers just want to round up people and shoot them, like Lenin or Mao.

Will they spring whole from the earth, or will they cross the border, bringing with them the same business pratcices that have resultd in the U.S.'s health care system becoming such a gawdawful mess.

The US healthcare system is just another example of how state-run business doesn't work. Canada and the US are two different ways for government to try and run healthcare, and both have (unsurprisingly) failed. Compare to Singapore, where a total lack of public healthcare has not stopped the populace from having an average lifespan in excess of both the USA and Canada.

Frankly I have no desire to see public dollars eaten up by private sector inefficienceis

Private sector inefficiencies? Don't make me laugh. Was the Soviet Union efficient? It should have been - no private sector there!

The difference is that inefficiencies in the private sector are ultimately borne by investors, who choose to bear them of their own free will. Inefficiencies in the public sector are borne of everyone, usually against their will.

[The Terrible Sweal]

A perfectly reasonable hatred of taxation. Taxation is theft, and I regard hatred of taxation as hatred of theft. When we embrace taxation as a society we have become a society of thieves.

Dogma.

[Hugo]

Then by all means, take the challenge. Should be easy, if this is just 'dogma.'

[Guest eureka]

Respond to what I wrote, Hugo, if you want a dispute. Stop switching sentences around and omitting the ones that counter your beliefs.

You can put more rubbish into one post than leaves Toronto for Michigan every day.

My family also lives in Britain. I did not ask them for an opinion, though. I prefer to use the information that is known to anyone who does not shut it out with dogma.

[Hugo]

Respond to what I wrote, Hugo, if you want a dispute. Stop switching sentences around and omitting the ones that counter your beliefs.

Where have I done this? Please refer specifically to the instances in question.

I prefer to use the information that is known to anyone who does not shut it out with dogma.

What information? You did not cite a single authoritative source, study, experiment, book, website, TV programme, oracle, gypsy seer, beheaded chickens entrails, anything! For all we know you pulled all this "information" out of your Magic Socialist 8-Ball. And until I have any evidence to the contrary I will treat it as such.

[Chimera]

Hugo, before you continue extolling the virtues of a private healthcare system, I would highly recommend that you read this book . Private healthcare is not as pretty as right wingers seem to think.

And for the dreamers that seem to think we will be able to import a "european" style of healthcare, wake up.

U.S. suppliers are in the best possible position, due to close proximity and the Free Trade Agreement (FTA) to take advantage of healthcare opportunities as they come on stream.  In the past five years, U.S. manufacturers of healthcare products, services and technologies have successfully cornered the import market in Canada, satisfying over 75% of total demand.  With a strong federal and provincial financial commitment to healthcare, coupled with increased healthcare needs for a growing and aging population and a growing number of public/private partnerships, the healthcare market in Ontario will continue to be viable for U.S. suppliers.

That from a government of Canada website . Also thanks to FT, U.S. companies will enjoy a preffered country status when quoting to destroy, er save, our Health system.

Of course, perhaps we wouldn't be in this mess if the jolly old Liberals had not cut the healthcare budget so drastically.

God, I wish I was a Quebecer just so that I could vote for a party who stands up for their constituents.

[Hugo]

Hugo, before you continue extolling the virtues of a private healthcare system, I would highly recommend that you read this book

In Profit Is Not the Cure, Maude Barlow traces the history of medicare in Canada. She compares it with both public and private systems in other parts of the world. And she contrasts it with the brutally divisive system that exists in the United States

What the heck did I just say???

The US healthcare system is just another example of how state-run business doesn't work. Canada and the US are two different ways for government to try and run healthcare, and both have (unsurprisingly) failed.

I would say to you that, before you attack my argument, you ought to make sure you've read it first.

[Black Dog]

Public delivery is never, ever cheaper because it lacks an economic mechanism for linking supply to demand. The huge gap between supply and demand in public enterprise leads to chronic inefficiency, which manifests itself as increased cost to the consumer.

Okay, let's disregard hard data showing for-profit health care is actually more costly in favour of economic theories! Awesome! Of course, you could try arguing for solutions within the parameters of the current system which, by all indications, isn't going anywhere.

Hugo, you know bloody well that, under the curent system of state sponsored capitalism, there's no free market, and the state picks the winners in business.

Arguing for an incerased free market prescence in the health care system is like arguing for an increase in the number of unicorns.

Compare to Singapore, where a total lack of public healthcare has not stopped the populace from having an average lifespan in excess of both the USA and Canada.

Singapore

Another key focus of the Government has been to ensure that overall health expenditure does not fall victim to the significant inflationary pressures that have been evident throughout the world. This has been achieved by actively regulating the supply and prices of healthcare services in the country.

[Hugo]

Okay, let's disregard hard data showing for-profit health care is actually more costly in favour of economic theories! Awesome!

What hard data? All this "hard data" is basically just comparing various statist, socialist methodologies to one another. The US isn't all that capitalist. The US Government is running over one-third of the US economy. The two biggest Federal expenditures are Healthcare and Social Security.

Do you get the point yet?

Link to OECD data

Hugo, you know bloody well that, under the curent system of state sponsored capitalism, there's no free market, and the state picks the winners in business.

This is completely irrelevant to the debate. The fact that it is extremely hard - if not impossible - to find a purely free market in any nation these days does not stop me advocating one.

Singapore

OK, so not a totally free market. Nevertheless, freer than here, and more effective too. It would work better if they stopped price-fixing. Price fixing basically hinders the mechanism that relates supply to demand.

With the price mechanism, the economy tends towards an equilibrium of peak efficiency. Without it, it becomes inefficient. The more supply and demand are divorced, the more inefficient it becomes, until you approach the Soviet system where the economy was basically paralyzed by wasteage.

Of course, you could try arguing for solutions within the parameters of the current system which, by all indications, isn't going anywhere.

Why bother? The current system is broken and cannot be fixed. The only solution is to abandon it and I do nobody any service by pretending that that is not the case!

[Black Dog]

What hard data? All this "hard data" is basically just comparing various statist, socialist methodologies to one another.

So you think your unicorns can run faster than the curent crop of horses and mules?

This is completely irrelevant to the debate. The fact that it is extremely hard - if not impossible - to find a purely free market in any nation these days does not stop me advocating one.

If we want to talk about things that are irellevant to the debate, let's talk about an economic philosophy that does not reflect reality, and will not reflect reality. It's great that you have firm convictions and I respect your views, but if you want to start talking about how the free market will save health care, you should first explain how you propose to pull down the current political/economic system and rebuild the new one in its place.

OK, so not a totally free market. Nevertheless, freer than here, and more effective too. It would work better if they stopped price-fixing. Price fixing basically hinders the mechanism that relates supply to demand.

The fact that there's only 4 million people in a tiny landmass doesn't hurt either. That's the problem with free market thinking: it tends to assume the market is the only factor to consider.

[CAGERATTLER]

Read this maybe public healthcare wouldn't be so expensive if they'd stop using public funds to support private healthcare!!!!!

http://www.web.net/~ohc/docs/030204.htm

[Chimera]

QUOTE 

In Profit Is Not the Cure, Maude Barlow traces the history of medicare in Canada. She compares it with both public and private systems in other parts of the world. And she contrasts it with the brutally divisive system that exists in the United States

What the heck did I just say???

WOW. I guess you just read the whole book so damn fast that you forgot to read the quote below it from the GOVERNMENT OF CANADA.

Dream all you want of a Singaporean solution, you ain't gonna get it.