It Doesn’t Take A Political Genius To Fix A Medica

[Renegade]

So I guess in your own way, you're admitting your orignal analogy was unrepresentative.

So let's disect your new analogy:

Let's get the analogy a little more in line with the situation.  If you want the pie, but don't have your own money to pay for it, what are you going to do...  Your mom has offered to bake the pie for you. 

I'm following you so far.

She tells you that if she lends you $8 to buy the pie at the private bakery, there won't be enough money in her wallet to bake a pie for the rest of the family.... What are you going to do... force her to give you the money and make your family starve, or work within a framework that will allow everyone to eat pie...

Who is asking mom to lend the $8? Not I. If I can't afford the $8 on my own, I wait for mom's pie.

Alternately, if you do have enough money (of your own) in your pocket to buy a pie at the bakery, then who's stopping you (from going to the USA for your pie)...

So your ok that I go to the USA and buy it. So why can't I buy it in my local bakery (as in your original scenario)

But it would be ridiculous to ask your mom for a refund on the ingredients she paid for that went into the family pie because you bought your own pie...

WOAH!! Who is asking mom for a refund? Not I. All I want to do is go to the local bakery and plunk down my $8 and buy a pie. How does that stop mom from doing what she was originally going to do for everyone else anyway?

[JOVIAC]

And since the $8 got spent locally there is a chance that some of that money will get re-spent at your father's shoe store, or your Uncle's meat shop.

[Argus]

Comparison of Efficiency of Private vs. Public

A major part of the diference in efficiencies of the US system vs. the Canadian system is that the US has higher administrative costs.  The US system has around 1500 private insurance companies.  Each hospital has to devote enormous clerical, professional time and office space... often an entire hospital floor to the job of billing patients and collecting from insurance companies... which all offer different insurance plans... Often more than one insurance company is involved, and it is necessary to assess the amount of payment covered by each insurer, and that owed by the patient.

In Canada, where the provincial government is the only inusurer, the processing of health claims is much less complicated, and less labour-intensive.  Add the fact that private insurers take a profit out of their revenues.... In 1987, the administrative costs were beetween $400 and $497 per person (Woodlander & Himmelstien, New England Journal of Medicine, 1991).  The equivalent cost in Canada came to $117 to $156 (US) per person.  The (American) authors concluded "Reducing our administrative costs to Canadian levels would save enough money to fund coverage for all uninsured and underinsured Americans."

In 1990, Blue Cross of Massachusetts, which provides coverage for 2.7 million subscribers, employed 6682 workers.  By contrast, British Columbia managed to administer its health-care system for more than 3 million residents with a much leaner staff.... less than 1 fifteenth of the size.... 435 civil servants.

Excerpt borrowed from Linda McQuaig's "The Wealthy Banker's Wife"

<{POST_SNAPBACK}>

That's real impressive, Err, and if I or anyone else had advocated we have seven thousand private insurance companies and imitate US style health care you might have a point. However, since no one has, this is all pretty irrelevent.

[Argus]

International comparison by Fraser Institute

Canada spends more on health care than most European and Asian nations but has some of the longest waiting times and worst access to physicians

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The Fraser Institute's opinion on social services... That's like asking Hitler for an opinon on Jewish innovation.

<{POST_SNAPBACK}>

One could say the same of asking Socialists their opinion about the most economical or efficient way to run any organization, system or economy.

And as we are dealing with the economics of health care systems I think I'll trust the Fraser Institute over Socialists.

[Nemo]

deleted

[BHS]

"I think a major factor in US health care costs arises from American tort law." - BHS

B.S.

http://www.makethemaccountable.com/myth/Ri...ceInsurance.htm

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Nice website. Tort lawyers blaming everyone but themselves. I'm sure that enormous multi-million dollar payouts to guys like John Edwards for lawsuits based on dubious claims of malpractice (but with heartrending stories to foist on a credulous jury), and huge billion dollar class action suits had nothing at all to do with the rise in cost of malpractice insurance and pharmaceuticals. There's no connection there at all. Well, none that a gang of semi-HTML-savvy lawyers can see, at any rate.

[err]

But it would be ridiculous to ask your mom for a refund on the ingredients she paid for that went into the family pie because you bought your own pie...

WOAH!! Who is asking mom for a refund? Not I. All I want to do is go to the local bakery and plunk down my $8 and buy a pie. How does that stop mom from doing what she was originally going to do for everyone else anyway?

<{POST_SNAPBACK}>

If you borrow money from your mom for the pie, (analogous to getting public funding for a private service), thereby leaving her short of funds to make pies for the rest of the family, there is a problem. The "refund on ingredients" is analgous to a "tax deduction" as a result of use of the private service....

If you want to plunk down your own money for a pie, good for you.... enjoy it..

[err]

Just to throw this into the mix

International comparison by Fraser Institute

Canada spends more on health care than most European and Asian nations but has some of the longest waiting times and worst access to physicians in the world, concludes a report comparing 27 countries that all guarantee access to health care, regardless of ability to pay.

Spending High, Services Poor

<{POST_SNAPBACK}>

Canada has far less expensive health care than the USA, and its waiting lines are infinitely long for millions and millions of Americans... How about throwing that into the mix....

And I love how you can compare Canada's spending to most European nations... Because you didn't explicitely say "per capita", I trust that it is not "per capita", and it is a bogus statistic to help lie to the public to steer them into believing their right-wing tripe....

Did the neo-cons at the Fraser institute fail to mention that the Europeans are accustomed to, and accept paying much higher taxes in return for the excellent "socialist" benefits that they get in return.... the article compares Canada's health care with Sweden's, but fails to mention that Swede's pay more than 40% tax.... and have probably the best social services of any country in the world.

[Riverwind]

And I love how you can compare Canada's spending to most European nations... Because you didn't explicitely say "per capita", I trust that it is not "per capita", and it is a bogus statistic to help lie to the public to steer them into believing their right-wing tripe....

Canada spends more "per capita" than most other industrialized countries this is a fact that is available from various sources that don't necessarily have a political adgenda.

It is possible to design a mixed private and public system that ensures that the private system will not undercut the public system - this fact is proven in countries from France to Japan. However, the left in this country seem to be obessed with the idea that there are only two types of health systems: Canada and the US. As time goes on more and more Canadians are realizing how false this argument is and will accept a dual system. Unfortunately, by refusing to consider a dual system, the left shuts themselves out of the dicussions about reform and, as a result, it is more likely that the system we end up with will look more like the US instead of the European model.

[JOVIAC]

It is very interesting how some people in this discussion are satisfied with our system by comparing crappy other systems, or focus on the crappy side of a system without trying to learn from the benefits. We all know that we can do better by looking at ways to improve. Those that don't look for ways to improve will always be left behind - or in the case of our healthcare, be left waiting for treatment.

I cannot imagine telling a patient who cannot get in to see a doctor for months how lucky they are because Canada is running one of the most efficient systems. Meanwhile your dog breaks their leg and you go and get it treated the same day at the vet.

The point is that we need to improve our system. Canada used to be a leader in healthcare, but if this current system is the world's best, then god help the world.

I think the right direction is considering as many options as people can generate. We must be open-minded to improving healthcare. The fact of the matter is that over the next 15-20 years, our aging population is going to put a strain on the system, the likes of which we have never seen before. Those that are happy with the status quo today are in for one whopping surprise tomorrow!

[BHS]

Good points all, JOVIAC.

[Guest eureka]

There are European systems that spend as much as Canada and their are European systems that spend more; Switzerland is an example of one that spends as much as the US as a proportion of GDP. Some of the European systems that spend less are those that are emerging into Western style democtacies and economies.

Joviac, I don't know who says the Canadian system is the best. It is, however, no secret that the best systems, historically, were those that used similar models to that we retain. They have all deteriorated under the neocon ideology.

We certainly need to improve ours since it has also deteriorated with the advent of that same ideology as a guiding economic (and social) principle. That means improving and not setting off down the same path to destruction.

The idea that the future of healthcare is unsustainable is, itself, not sustainable. There have been many articles to that effect over the past several years. An aging population is a convenient prop for those who would destroy what we have and, at the same time, push for privatization that would be unaffordable for that aging population.

The popualtion has been aging for a number of years now and the costs of healthcare have not growm at all out of sync. The costs that have increased are those of drugs and technological advances. Healthcare, like the Pension plan, is quite affordable.

[Renegade]

Let's be clear why Canada has an "efficient" healthcare system.

1. Lower administative costs as a result of the government being the single payer.

2. Controlling costs by being able to dictate payment terms to health care professionals

3. Rationing services resulting in long wait times, only covering certain services, and restricting use of the system.

The public debate on multi-tier healthcare seems to be narrowly focused on either a public (ie the current) system or a private (ie a US style) system. There are many other options which seem to be ignored or overlooked.

For example, why not retain the government as single payer but have it offer different levels of service. The basic service would be offered to everyone, however enhanced level are offered at a cost. This is similar to a single insurance company offering different levels of policy at correspondingly increased levels of premiums.

[Argus]

Let's be clear why Canada has an "efficient" healthcare system.

But Canada does NOT have an efficient health care system.

I think that's the whole point.

[Renegade]

Its all relative. Perhaps I should have said "more efficient"

[BHS]

Just like to interject here to add that I think Yaro (I believe) was technically correct about the definition of "efficiency" from an economics standpoint: if everyone got the service they required without delay, this would indicate that the service providers were being under-utilized, and this indicates inefficiency (and the converse holds that long lines indicate a more efficient use of resources). I don't think that this is what you guys are trying to say.

[JOVIAC]

One of the problems with your definition of efficiency is that you are only looking at it from one point of view, when clearly there are two; a service provider, and a service user. From the service provider's point of view your definition of efficiency stands whether we are talking about widgets being processed or people. The problem with this point of view is that widgets don't care whether or not they should wait in storage at some point in the process if this improves efficiency as a whole.

I would like to 'bump-up' what I suggested earlier...

(Yaro) Long Lines, slow treatment

As any efficiency expert will tell you long lines are a sign of efficiency, they are a primary signal of low downtime. Systems with no lineups are the ones that tend to be inefficient as workers have a great deal of downtime.

(Joviac) Yaro - Would you call a corroded pipe an efficient way to transfer water from one container to another? By your definition, because it creates a ‘line-up’ of water before going through the pipe, it should be efficient.

In my opinion, cleaning out the corrosion will transfer a lot more water without the need for another pipe.

From the second point of view, which is from the service user’s point of view, are they being processed in an efficient way if they are waiting to get through a corroded pipe? You can quote all the documents and surveys which have been written about how efficient our healthcare system is compared to others, but the truth of the matter is there is corrosion slowing up the flow. This reduces efficiency from the user's point of view. How bad is it? Well, just try and get an MRI done, surgery performed, or get through an emergency room.

[Yaro]

One of the problems with your definition of efficiency is that you are only looking at it from one point of view, when clearly there are two; a service provider, and a service user. From the service provider's point of view your definition of efficiency stands whether we are talking about widgets being processed or people. The problem with this point of view is that widgets don't care whether or not they should wait in storage at some point in the process if this improves efficiency as a whole.

I would like to 'bump-up' what I suggested earlier...

You are leaving the term efficiency and going into the nature of customer care. I have no problem with people arguing that better service is needed but the term efficiency should not be used as it’s not relevant.

From the second point of view, which is from the service user’s point of view, are they being processed in an efficient way if they are waiting to get through a corroded pipe? You can quote all the documents and surveys which have been written about how efficient our healthcare system is compared to others, but the truth of the matter is there is corrosion slowing up the flow. This reduces efficiency from the user's point of view. How bad is it? Well, just try and get an MRI done, surgery performed, or get through an emergency room.

I agree, and I stated as much there are inefficiencies in our system because of under funding and underutilization. Everyone knows this but it doesn't matter whether we have a public or a private system without more funding we aren't going to improve this. Again this has nothing to do with efficiencies other then as they apply to underutilization and capitalization. Regardless of what level we fund our public system to the comparative ROI is going to be better then a private system. There are literally hundreds of papers showing that public healthcare is more efficient and there’s literally a couple by organizations like the Fraser Institute who show otherwise.

The public debate on multi-tier healthcare seems to be narrowly focused on either a public (ie the current) system or a private (ie a US style) system. There are many other options which seem to be ignored or overlooked.

For example, why not retain the government as single payer but have it offer different levels of service. The basic service would be offered to everyone, however enhanced level are offered at a cost. This is similar to a single insurance company offering different levels of policy at correspondingly increased levels of premiums.

This is also another area which can create many issues, I have no problem with a private parallel system competing with the public system but in the full private-competitive models there are costs which come into play which make the system impossible to run as efficiently as a public system. Advertising, Administration, and profit margin make competing on efficiency with a public system impossible.

It is possible to design a mixed private and public system that ensures that the private system will not undercut the public system - this fact is proven in countries from France to Japan. However, the left in this country seem to be obsessed with the idea that there are only two types of health systems: Canada and the US. As time goes on more and more Canadians are realizing how false this argument is and will accept a dual system. Unfortunately, by refusing to consider a dual system, the left shuts themselves out of the discussions about reform and, as a result, it is more likely that the system we end up with will look more like the US instead of the European model.

The reason we will look more like the US is pretty simple really, markets in logistical proximity tend to develop along similar lines. Canada being so close to the US that we are nearly fully integrated means that we face many of the same forces from lobbyists to high practitioner costs (health care professionals in Europe make almost 1/2 as much as they do in Canada). Unfortunately because there is so much disinformation and there is nobody arguing with self interest for the public system I think we will probably end up with a US style system which will just end up hurting us all.

[Argus]

One of the problems with your definition of efficiency is that you are only looking at it from one point of view, when clearly there are two; a service provider, and a service user. From the service provider's point of view your definition of efficiency stands whether we are talking about widgets being processed or people. The problem with this point of view is that widgets don't care whether or not they should wait in storage at some point in the process if this improves efficiency as a whole.

I would like to 'bump-up' what I suggested earlier...

You are leaving the term efficiency and going into the nature of customer care. I have no problem with people arguing that better service is needed but the term efficiency should not be used as it’s not relevant.

I disagree. Health care is one of the major support services of a given society. The efficiency of the system can thus be measured not merely in its utilization of services but how capably it performs its primary function. Is it serving society efficiently if, for example, members of that society are sitting around doing nothing because they have to wait long periods of time for neccessary medical sercvies? Is it serving society efficiently if many members of society are in pain and discomfort, forced to take medications for lack of neccessary operations? Is it serving society efficiently when members of that society die in the waits for neccesary services?

Regardless of what level we fund our public system to the comparative ROI is going to be better then a private system. There are literally hundreds of papers showing that public healthcare is more efficient and there’s literally a couple by organizations like the Fraser Institute who show otherwise.

If you have a definitive study I'd like to read it. However, most studies would not be relevent. We are the only western nation which has this kind of system, so it's unlikely the conditions found in studies in other nations could be consistently applied to ours. And most of the local studies I've seen were basically conducted by people determined to "defend" the public system. Certainly the kind of biased nonsense we witnessed from Romanow, so utterly predictable and blinkered, is of no use. You can't compare the efficiency of our public system with, for example, the efficiency of the US private system. Yes, certainly, with thousands and thousands of Insurance organizations and the mess of red tape they generate the US system is inefficient - even compared to our public system. But who's to say our public system is as efficient as some private systems in Europe (or even the US). Generally speaking private systems ARE more efficient than public systems. Why should health care be different?

[Yaro]

I disagree. Health care is one of the major support services of a given society. The efficiency of the system can thus be measured not merely in its utilization of services but how capably it performs its primary function.

You’re not talking about efficiency, your talking about outcomes. There’s a very substantial difference, and I agree that both are important but it’s absolutely not efficiency.

Speaking from pure standpoint efficiency is measure in man-hours and resources consumed/occupied and outcomes. Nothing else is consumptive and thus nothing else has to do with efficiency.

If you have a definitive study I'd like to read it. However, most studies would not be relevent. We are the only western nation which has this kind of system, so it's unlikely the conditions found in studies in other nations could be consistently applied to ours. And most of the local studies I've seen were basically conducted by people determined to "defend" the public system.

There is no such thing as a definitive study on the matter unfortunately. Any institution that commissions a report is likely to be at least somewhat biased. The closest I think I can think of is the 1998 US governments evaluation of the Canadian system which spelled out pretty distinctly that the Canadian system was far more efficient then the US one.

Yes, certainly, with thousands and thousands of Insurance organizations and the mess of red tape they generate the US system is inefficient - even compared to our public system. But who's to say our public system is as efficient as some private systems in Europe (or even the US). Generally speaking private systems ARE more efficient than public systems. Why should health care be different?

I certainly agree with you that even privatized our system wouldn't be as bad as the US's because we tend to have more sanity with adjacent issues but no, generally speaking there is no evidence to suggest that private systems are more efficient then public ones, more cost effective yes, more efficient no.