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Would a mixture of public and private health care solve the health care crisis?


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A lot of people have the money to pay for extra private health care services in Canada.

Perhaps that is the solution to the failing health system we have.  Perhaps it is something Canadians should seriously look at.  Something must be done about the terrible situation with health care.

 Right now the health care system is in a crisis and around a million people in B.C. alone don't have a family doctor.

Emergency rooms close sometimes in some places.  There are not enough beds in some hospitals and not enough necessary services.

Long waiting lists for some surgeries.   People sometimes wait a year for a procedure.

That is not health care.

If we had a mixture of private and public, then those with money could use private for some things if they so choose.  That would take the pressure off the public system and reduce waiting times, etc.  I am sure lots of people would be willing to pay for their own health insurance for certain procedures when they need it.   Why deny people the choice if they have the money for insurance and maybe a deductible for a procedure?

That is a possible solution to the failing health care system. 

Government is under pressure to fund all kinds of services in society and just can't seem to fix the broken health care system. 

Does anyone have a solution that is better?

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Indeed, the French system works this way to a degree. 

I don't have enough confidence that our Healthcare public is mature enough to monitor the system. 

Continued suggestion for me is to create online Public groups, busy bodies, to monitor and discuss delivery of service and costs. 

And above all, we have to instigate a revolution of management in Canada's Public services. Management today is beholden primarily to their bosses, not the public.

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1 hour ago, Michael Hardner said:

Indeed, the French system works this way to a degree. 

I don't have enough confidence that our Healthcare public is mature enough to monitor the system. 

Continued suggestion for me is to create online Public groups, busy bodies, to monitor and discuss delivery of service and costs. 

And above all, we have to instigate a revolution of management in Canada's Public services. Management today is beholden primarily to their bosses, not the public.

System? Public and private medical? What is there to monitor?

Online groups like the ones we have here on repolitics?? LOL You know that they say a camel is a horse deigned by committee. LOL

Public service and it's management is beholden to policy, rules and regulations. The poor folk that work there cannot and are not allowed to waiver from that. Where the shitstorm happens is when th epublic do not like what is going on, the public for the first time actually find out what the rules and regulations really are. :)

 

 

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35 minutes ago, ExFlyer said:

1. System? Public and private medical? What is there to monitor?

2. Online groups like the ones we have here on repolitics?? LOL You know that they say a camel is a horse deigned by committee. LOL

3. Public service and it's management is beholden to policy, rules and regulations. The poor folk that work there cannot and are not allowed to waiver from that. Where the shitstorm happens is when th epublic do not like what is going on, the public for the first time actually find out what the rules and regulations really are. :)

 

 

1. Service levels, all right wait times, costs... If we don't care then the politicians who go stateside for services won't carry either. 

2. Democracy is not a committee, it's a voice of the people. Town Hall meetings are not a committee, it's the public voicing ideas and questioning those who make the decisions. But these things are not anonymous. That's one thing I would do differently. 

3. And the feedback cycle for that is about.. what 10 years? Too slow 

 

 

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11 hours ago, blackbird said:

If we had a mixture of private and public, then those with money could use private for some things if they so choose

I've wondered about this myself but admittedly, I have little in the way of supporting facts to defend an opinion on the subject.

Given a finite amount of personnel resources though, would the private system detract from a public one already in shambles? Perhaps the best and brightest would migrate there to the detriment of the masses.

In other words, if we only had 10 doctors and they were split evenly between the two sectors would those who couldn't afford private care suffer more than they are now?

I don't know...

In some locations mobile clinics and empowering pharmacists with increased authority to write prescriptions has worked pretty well (I think). 

I haven't looked into the idea of there being a true shortage of practitioners either. Do we really have less doctors per capita now than we did when the system worked or has it become bloated and fat; something akin to a corn fed Meat King chicken that collapses under its own weight?

If it truly is a shortage, and if we were to start now (like today) the solution may be 5 years away assuming maximum effort, no attrition, and no more immigration/aging population creating increased demand; tough conditions to navigate I think.

Attrition, operational tempo and recruiting in experienced based occupations requires close scrutiny and an eye on the horizon. Training times are long and costs high.

As to the solution, assuming my province had a medical school, I would lean toward paid tuition (books and subsidized housing) in return for an obligatory period of service wherever needed (in the province). Something like pilot training in the RCAF except a whole lot cheeper.

But beware, it needs a steady hand on the controls and good weather radar. The military has taken its eye off the attrition, tempo and recruiting equation to such an extent that attrition has made personnel deficits (the ability to out train them) and mentoring (at operational units) a huge problem. I think collapse is looming without immediate action, sort of like the chicken thing.

IMO, it's now a "pull pole" lock and load moment not to be squandered. 

 

 

 

 

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55 minutes ago, Michael Hardner said:

1. Service levels, all right wait times, costs... If we don't care then the politicians who go stateside for services won't carry either. 

2. Democracy is not a committee, it's a voice of the people. Town Hall meetings are not a committee, it's the public voicing ideas and questioning those who make the decisions. But these things are not anonymous. That's one thing I would do differently. 

3. And the feedback cycle for that is about.. what 10 years? Too slow 

 

 

1. Service levels. Well, the person with an ailment certainly has a different opinion of their ailment that the service providers and perhaps others with ailments. Who is to decide?

2. Democracy?? Your comment was "suggestion for me is to create online Public groups, busy bodies", I say that is a committee as it holds no authority.

3. I am not sure what you mean. That the public service is not fast enough to respond to issues? Understand that the public service does  not respond to individuals and only regurgitates policy. If it is not to your satisfaction, that is not their fault.

I said "Public service and it's management is beholden to policy, rules and regulations. " in retort to your comment "Canada's Public services. Management today is beholden primarily to their bosses, not the public.". The thing is they only have rules to go by. You have opinion and personal issues and reasons. they do not know you nor care too much about you.

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2 hours ago, Michael Hardner said:

And above all, we have to instigate a revolution of management in Canada's Public services. Management today is beholden primarily to their bosses, not the public.

Who do you figure the bosses are?  That seems like a pretty facile explanation for why our Public Service is so bloated, yet still ineffective.  It's just upper management's fault?  

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Today in Canada many people with lots of money, politicians, and the elite can get on a plane and fly down to the U.S. and get immediate medical care.  If they stayed in Canada and waited on the long waiting periods, they might wait a year or two for serious surgery or other procedures.  Some of these delays could be endangering or shortening people's life.  This is against human rights.

Because of politics, Canada's politicians are denying the human rights of Canadians by refusing to allow private health care that people who are willing to pay extra for medical insurance and obtain care in Canada.   However, they can't block people with the money from flying outside Canada to some other country for treatment.  So the Canadians solution of denying private care to exist within Canada is only giving an illusion of equity.  It is not really equal medical care of all.  The failing health care system is affecting lower income and poor people more negatively.

If Canada allowed and encourage private care, the government would have less pressure on the public system and could speed up and improve the public health care system.  That should be the objective.  Give Canadians better health care whatever way it can be done.

There is just not enough money to provide an efficient, and effective public health care system for everyone.  It is time to look at this and do something concrete to fix the system.  I would expect the government to act to fix the public system at the same time as a private system is allowed.  A private system would enable people with money to pay for extra medical insurance and thereby overall contribute much more money to the health care system and reduce the pressure on the public system.

 

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1 hour ago, ExFlyer said:

1. Service levels. Well, the person with an ailment certainly has a different opinion of their ailment that the service providers and perhaps others with ailments. Who is to decide?

2. Democracy?? Your comment was "suggestion for me is to create online Public groups, busy bodies", I say that is a committee as it holds no authority.

3. I am not sure what you mean. That the public service is not fast enough to respond to issues? Understand that the public service does  not respond to individuals and only regurgitates policy. If it is not to your satisfaction, that is not their fault.

4. I said "Public service and it's management is beholden to policy, rules and regulations. " in retort to your comment "Canada's Public services. Management today is beholden primarily to their bosses, not the public.". The thing is they only have rules to go by.

5. You have opinion and personal issues and reasons. they do not know you nor care too much about you.

1. The decision makers might not change but the discussion around what is happening, priorities, etc. likely would.
2. Is the public a committee of millions then ?  I don't have a problem with you using such a word but I don't see how it's different than a public.
3. Yes, I wouldn't blame the public service.  Indeed I think they would be emancipated by such a system.  My understanding is that there was an internal web discussion forum for the public services at some point, perhaps years ago, and there were great ideas and solutions that were put forward.
4. Well... maybe that's a quibble.  After all it's the bosses that set the rules, and more importantly form the culture.  I worked for the public service 40 years ago.  I was young so I didn't understand the problems at play the way I do today.  
5. I also have ideas and criticisms... and suggestions.  They should care.  There was a revolution in customer care in the 1980s, in marketing, and in the 2000s - in IT - a new revolution behind the scenes, flattening management and making direct links between the consumer and the provider.

It's actually more natural and understandable than the rubric of mirrors that our bureaucracy is, in practice.

1 hour ago, Moonbox said:

 It's just upper management's fault?  

Looking for blame is a distraction from fixing it.   It's a "culture" and we all own it, to varying degrees.

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2 hours ago, Moonbox said:

Who do you figure the bosses are?  That seems like a pretty facile explanation for why our Public Service is so bloated, yet still ineffective.  It's just upper management's fault?  

Upper management is EXTREMELY risk-averse. I've said it before, but if it costs $100 to monitor how spending is being done in order to avoid $1 being misspent senior management will approve that in an instant. 

In addition, to avoid ever being blamed for anything, any new project of whatever size has to have massive buy-in from as many 'clients and interested groups within the public service as possible. This requires innumerable reports, documentation, meetings, and time-consuming changes and alterations before anything sees the light of day. All of which is designed to shield management from blame, not to make sure the eventual project works. Witness Phoenix, which is a disaster and has been for years. No one was ever disciplined for it either. 

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6 minutes ago, I am Groot said:

 In addition, to avoid ever being blamed for anything, any new project of whatever size has to have massive buy-in from as many 'clients and interested groups within the public service as possible. This requires innumerable reports, documentation, meetings, and time-consuming changes and alterations before anything sees the light of day. All of which is designed to shield management from blame, not to make sure the eventual project works. Witness Phoenix, which is a disaster and has been for years. No one was ever disciplined for it either. 

I worked on the initial stages of a few government initiatives in the past.  I can verify that I witnessed what you are talking about.  The preventative measures to waste end up wasting far more than the problem they're designing to solve.

When I worked for the civil service, I saw a massive internal effort put into effect because a Globe and Mail article detected a somewhat minor error.  It doesn't matter that nobody cares, they can't have the risk of a perception of something going wrong.

Question Period is the symptom: Poilievre finds out about a guy whose truck was stolen, and detected that it was on an outbound ship.  The layman thinks " if that were my truck, I should be able to just go down there, show my ownership and get the dock master to give me my truck" ...  ah well....

We had initial meetings only because they would invite so many people to meetings and ask for revisions to our proposal over and over again... new people would attend the next meeting and insist more changes.  We figured out that this would be unworkable, so we insisted our proposal limit the structure and number of revisions to the product as well as timliness.

Well, guess what... that didn't work because only the Deputy Minister could have final say and he wouldn't have the time to meet with us with any kind of predictability.  We saw where this was going and told them we weren't going to work with them anymore.

I'm not sure if they recognized what was happening, or whether they they just thought we weren't flexible enough.  Anyway I got very curious over how the companies that dealt with this operated.  I guess the unbelievable ArriveCan costs explained it.

 

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The solution for our healthcare crisis has to start with more doctors, nurses and other medical personnel. Nothing else, no changes to how the system functions will work well with the existing shortage. 

And that shortage is created by government.

There are far more qualified applicants for medical and nursing schools than those schools can accommodate. The number of nursing/medical school spaces was frozen by governments for decades. They were only recently increased in Ontario. But from what I have read they can only be increased so fast so far due to the lack of instructors, classrooms, and then on the far end, the number of supervising doctors and nurses for the mandatory hands-on coop period for nurses and residency periods at hospitals for doctors. 

I don't know if the number of spaces has been increased in other provinces. 

I would suggest the numbers be increased nationwide as fast and far as possible. To this end they should be actively recruiting RNs and doctors who have retired or left the profession to help as instructors. The lack of family physicians can be remedied by increasing their fees or lowering tuition for those who elect to take family medicine or both. 

Doctors should not be forced to be businessmen. It's a waste of time which could be devoted to seeing patients. Family doctors prefer to work in team setting where there are colleagues in both family medicine and varied specialties to consult with. More of these organizations should be set up.

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1 hour ago, Michael Hardner said:

1. The decision makers might not change but the discussion around what is happening, priorities, etc. likely would.
2. Is the public a committee of millions then ?  I don't have a problem with you using such a word but I don't see how it's different than a public.
3. Yes, I wouldn't blame the public service.  Indeed I think they would be emancipated by such a system.  My understanding is that there was an internal web discussion forum for the public services at some point, perhaps years ago, and there were great ideas and solutions that were put forward.
4. Well... maybe that's a quibble.  After all it's the bosses that set the rules, and more importantly form the culture.  I worked for the public service 40 years ago.  I was young so I didn't understand the problems at play the way I do today.  
5. I also have ideas and criticisms... and suggestions.  They should care.  There was a revolution in customer care in the 1980s, in marketing, and in the 2000s - in IT - a new revolution behind the scenes, flattening management and making direct links between the consumer and the provider.

It's actually more natural and understandable than the rubric of mirrors that our bureaucracy is, in practice.

Looking for blame is a distraction from fixing it.   It's a "culture" and we all own it, to varying degrees.

I have gone back and re-read your posts.
Honestly, I have lost the handle on your points.  :)

Are you trying to blame someone for something??

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6 minutes ago, I am Groot said:

The solution for our healthcare crisis has to start with more doctors, nurses and other medical personnel. Nothing else, no changes to how the system functions will work well with the existing shortage. 

And that shortage is created by government.

There are far more qualified applicants for medical and nursing schools than those schools can accommodate. The number of nursing/medical school spaces was frozen by governments for decades. They were only recently increased in Ontario. But from what I have read they can only be increased so fast so far due to the lack of instructors, classrooms, and then on the far end, the number of supervising doctors and nurses for the mandatory hands-on coop period for nurses and residency periods at hospitals for doctors. 

I don't know if the number of spaces has been increased in other provinces. 

I would suggest the numbers be increased nationwide as fast and far as possible. To this end they should be actively recruiting RNs and doctors who have retired or left the profession to help as instructors. The lack of family physicians can be remedied by increasing their fees or lowering tuition for those who elect to take family medicine or both. 

Doctors should not be forced to be businessmen. It's a waste of time which could be devoted to seeing patients. Family doctors prefer to work in team setting where there are colleagues in both family medicine and varied specialties to consult with. More of these organizations should be set up.

Yes.  I find the idea that 'classrooms' is a limit, and Ford's subsequent plan to create a new building to be mind boggling.  There are empty offices everywhere ... get some solutions people.

Following up on my previous post, the other group of know-nothings I had to deal with in management were doctors' committees.  As stakeholders in any problem, the senior groups refused to move with any urgency whatsoever and would throw roadblocks to progress on anything.  I found the same problem with other non-profits such as academic groups, and charities.  Say what you want about capitalism, and putting a dollar sign on everything but it moves things forward at least.

When you add that the biggest problems are with family doctors, who can be provided with the least training and lowest costs it absolutely boggles my mind even more.

Bring in family doctors from overseas who have been certified at the best schools, and get them working NOW.   Hire doctors who have set up clinics and pay them well to set up publicly funded walk-ins NOW.  Then foster a culture where these vital facilities are created/supported.

What Agile management in IT taught us is that excessive planning is a cancer.  The costs are lost lives, despite the intuitive strangeness of the idea.  Taking too long to test a new drug means the successful drugs aren't saving lives now.  Not testing means lives are lost needlessly.  Finding the balance requires intelligent discussion.  Fail fast

Just now, ExFlyer said:

 Are you trying to blame someone for something??

No, it's a question of culture.  If you want me to single out one group that needs to change it would be the public.  They have to start imagining a new model.  Maybe populism is the start of that.

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3 minutes ago, Michael Hardner said:

Bring in family doctors from overseas who have been certified at the best schools, and get them working NOW.   Hire doctors who have set up clinics and pay them well to set up publicly funded walk-ins NOW.  Then foster a culture where these vital facilities are created/supported.

Yes, this, absolutely. It is mind-boggling that Canadians who trained as doctors and nurses in the US, who have been working in that capacity in the US, can't come to Canada and work without an enormous amount of time-consuming paperwork, testing, and mandatory training. Doctors can't even more between provinces and set up shop! And the people in the way are all doctors. It is the doctors associations, the CMA and provincial medical licensing groups that are steadfast in demanding processes that take years and years before foreign-trained doctors can work here. Even if they're from the US, UK, or other 1st world countries. And it's not much easier for nurses. 

Maybe set up one national licensing group for doctors as a privately operated organization but operating under federal government guidelines and oversight to license a doctor to practice anywhere in Canada. How many provinces will object to such doctors practicing in their province? It isn't the provincial governments right now that license doctors and nurses, after all. It's their own associations but backed by law. I don't think Ontario, for one, would object, and would probably amend their law to allow for such people to practice. medicine there.

 

 

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1 hour ago, I am Groot said:

 

Maybe set up one national licensing group for doctors as a privately operated organization but operating under federal government guidelines and oversight to license a doctor to practice anywhere in Canada. How many provinces will object to such doctors practicing in their province? It isn't the provincial governments right now that license doctors and nurses, after all. It's their own associations but backed by law. I don't think Ontario, for one, would object, and would probably amend their law to allow for such people to practice. medicine there.

 

 

A national licensing group - that would do it.  I'm hoping Poilievre can think outside the box on such things.

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5 hours ago, Moonbox said:

Who do you figure the bosses are?  That seems like a pretty facile explanation for why our Public Service is so bloated, yet still ineffective.  It's just upper management's fault?  

I should have said middle management. I meant that there's a lack of customer focus. And it's the overall culture that has to be changed....

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18 minutes ago, Michael Hardner said:

I should have said middle management. I meant that there's a lack of customer focus. And it's the overall culture that has to be changed....

The lack of customer focus is unquestionable, but blaming it on middle managers, or their managers, is silly. 

Almost 1/4 working Canadians now works for the public service.  That's absurd, and it's pretty much become a political class of its own in Canada.  The Federal (and at least in Ontario) Provincial Liberals have feasted on this demographic during elections, and they've enjoyed a feedback loop that's symbiotic between them, but parasitic for the overall population. 

We have a bloated, ineffective and overpaid public sector that views the perpetuation of this arrangement as its primary goal, rather than the delivery of services to Canadians. Blame the middle managers if you want, but that's very Putinesque.  Responsibility flows up, not down.  Standing at the top are the Liberal governments, buying and paying for the votes that keep them in government.   

 

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17 hours ago, blackbird said:

A lot of people have the money to pay for extra private health care services in Canada.

Perhaps that is the solution to the failing health system we have.  Perhaps it is something Canadians should seriously look at.  Something must be done about the terrible situation with health care.

 Right now the health care system is in a crisis and around a million people in B.C. alone don't have a family doctor.

Emergency rooms close sometimes in some places.  There are not enough beds in some hospitals and not enough necessary services.

Long waiting lists for some surgeries.   People sometimes wait a year for a procedure.

That is not health care.

If we had a mixture of private and public, then those with money could use private for some things if they so choose.  That would take the pressure off the public system and reduce waiting times, etc.  I am sure lots of people would be willing to pay for their own health insurance for certain procedures when they need it.   Why deny people the choice if they have the money for insurance and maybe a deductible for a procedure?

That is a possible solution to the failing health care system. 

Government is under pressure to fund all kinds of services in society and just can't seem to fix the broken health care system. 

Does anyone have a solution that is better?

First,  as I often react to your posts in a negative way,  I must commend you and say I couldn't agree more with you on this topic. 

 

From what I've been told by people much smarter and more informed than me,is that the way the Canada health act is currently written, allowing "official" private health care to come in would be a slippery slope to denying essential health care to the average person.  *see what happens in the U.S*

We do have private health care in ways though. 

My girlfriend broke he wrist (hair line fracture) we didn't want to sit in an emergency waiting room for 16 hours,  so i found a private clinic that did everything but put the cast on( there are clinics that do that though,  I just didn't know to ask) after that we went to the hospital and were fast tracked straight to orthopedics. The whole process from when we walked into the clinic,  to when we left the hospital,was under 2hours and it was a 30 minute walk between the two .

It cost us 480$ but we were refunded by the government for 400$  of that . 

Again I agree with you but I think one of the major problems is m9st people don't actually know what resources are available not just in health care either 

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19 hours ago, blackbird said:

A lot of people have the money to pay for extra private health care services in Canada.

That's what it boils down to: the money. Let's legitimize the idea that having money deserves you more than the next person.
If you can. fly somewhere else and pay all you want, let some drug addict or welfare Mom use your bed. Feel all the anger you wish.

In reality, many Provinces already do this. So long as the private services can provide for what the medical plan will pay (or less). And no one can pay extra to jump their queue.

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2 hours ago, Moonbox said:

1. The lack of customer focus is unquestionable, but blaming it on middle managers, or their managers, is silly. 

2. Almost 1/4 working Canadians now works for the public service.  That's absurd, and it's pretty much become a political class of its own in Canada.  The Federal (and at least in Ontario) Provincial Liberals have feasted on this demographic during elections, and they've enjoyed a feedback loop that's symbiotic between them, but parasitic for the overall population. 

We have a bloated, ineffective and overpaid public sector that views the perpetuation of this arrangement as its primary goal, rather than the delivery of services to Canadians. Blame the middle managers if you want, but that's very Putinesque.  Responsibility flows up, not down.  Standing at the top are the Liberal governments, buying and paying for the votes that keep them in government.   

 

1. I don't know that I did that. I did blame the culture though.

2. Really not too much controversy in what you posted there. What did you mean? Responsibility flows up? You mean that the deputy ministers... People who have never generally worked in a real organization, who have massive amounts of power and are unknown to the public May be an issue?

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3 hours ago, herbie said:

That's what it boils down to: the money. Let's legitimize the idea that having money deserves you more than the next person.

The problem is the government is not willing and may not be able to put more money into the public health care system to make if function properly.  Politics determines how much money is spent on various government services.  Health care is just of many services.  It is becoming a disaster for millions of Canadians.

I never said anybody who can't afford it should go to the end of the queue.  You misinterpreted what I said.

I said if we had a private system as well as the public system, the people with lots of money could get the care they need in a timely manner.  Not like now, where many people are being denied treatment for long periods of time.  If a good private system existed, then that would accomplish several things:

1.  It would enable people to get treatment rapidly instead of sitting on a waiting list or flying to another country.

2.  It would increase the availability of health care options for people who could afford the extra health care insurance and possible deductions to pay for rapid treatment.  Therefore it would reduce the burden on the public health care system.  That should speed up service for everyone who uses the public system.  The goal would be to eliminate the long waiting periods for everyone for urgent treatments and surgeries.

3.  It should provide faster and better care for poor people and everyone with the public system. 

I never said the system should make things worse or put low income or poor people on a longer queue.  That is a total misinterpretation of what I said.  You haven't thought about the fact a private system must reduce the burden on the public system and enable everyone to get faster health care.  That would be the basic idea of adding a private system.  The government is not willing to add the billions needed to fix the public system.  But a private system would essentially be adding billions of more dollars to health care by people who can afford to spend it.

4.  The public system cannot afford to pay to provide an efficient, fast health care for the population and politicians don't want to put enough money into the public system because they are under pressure for many other demands.  The private system would help to alleviate that pressure and provide much more money for health care overall.  That is one of the important advantages of adding a private system alongside the public system.

5.  The public system may be overburdened with bureaucracy and administration.  That may be one of it's major problems.  Adding a private health care system alongside it might also help to provide health care with less bureaucracy and overhead costs.

6.  Holding to Socialist ideology and claiming its not fair to let some people pay for their health care will not fix the failing public health system.  It will only prolong and add suffering to millions of people unnecessarily.

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37 minutes ago, herbie said:

If you can. fly somewhere else and pay all you want, let some drug addict or welfare Mom use your bed. Feel all the anger you wish.

If the system is not changed, you will be stuck with a failing health care system.  You are living under an  illusion if you think it is fair to make people who need urgent care to not get it in a timely fashion.  Many people suffer serious consequences for not being treated in a timely manner.  People getting proper timely treatment is hit and miss now in the public health care system.

It is a Socialist lie to claim everyone is being treated equally under the present system.  That is not how it is working.  The system is failing.  Millions don't even have a family doctor.  If you have one, it is just by accident.  Many do not.  That is not equitable health care.  So clinging to the present failing system is not sensible.  

Do you have a better solution on how to fix the failing health care system?

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The best systems around the world are generally a blend.

As previously mentioned - france is frequently held up as a world leader in excellence and value for dollar and it's a public private blend. Others have somewhat similar systems and they all do better than we do.

But honestly - i don't think you'll see it in Canada.   The idea of 100 percent public run health care has become a sacred cow never to be discussed unless you want to suffer complete political death . (despite the fact we actually have a reasonable amount of private health care now).

Practically and demonstrably it just makes sense.  Politically it's death. 

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Nope.

Most European countries have better health care than Canada, but the expenditures are not as great. It's a case of reforming the system. A 2-tier health system would be a disaster, opening the way to American style health care, which is the worst system in the developed world.

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