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

[blackbird]

Not only is Canada being buried in self-destructive Socialism, but our Liberal government believes it is their duty to save the rest of the world.  They actually give more than 7 billion dollars to foreign aid per year.  Yes, that's 7 billion dollars, not 70 million, not 700 million, but 7 billions dollars or seven thousand million dollars of taxpayer money.  They dole out the money to every conceivable group and project one can think of in Canada as well.  

[blackbird]

It might be worth looking at western European health care systems to see how they work and how they are doing.

quote

Germany has a universal^[1] multi-payer health care system paid for by a combination of statutory health insurance (Gesetzliche Krankenversicherung) and private health insurance (Private Krankenversicherung).^{[2][3][4][5][6]}

The turnover of the national health sector was about US$368.78 billion (€287.3 billion) in 2010, equivalent to 11.6 percent of gross domestic product (GDP) and about US$4,505 (€3,510) per capita.^[7] According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.^[8] In 2004 Germany ranked thirtieth in the world in life expectancy (78 years for men). It was tied for eighth place in the number of practicing physicians, at 3.3 per 1,000 persons.^{[citation needed]} It also had very low infant mortality rate (4.7 per 1,000 live births).^{[note 1][9]} In 2001 total spending on health amounted to 10.8 percent of gross domestic product.^[10]

According to the Euro health consumer index, which placed it in seventh position in its 2015 survey, Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it.^[11] In 2017, the government health system in Germany kept a record reserve of more than €18 billion which made it one of the healthiest healthcare systems in the world at the time.^[12]    unquote

Notice it says because their health care system had a reserve fund of more than 18 billion pounds in 2017 which is more than 30 billion Canadian dollars, they were considered one of the healthiest healthcare systems in the world.

 

Edited April 21 by blackbird

[blackbird]

"

Italy's healthcare system is consistently ranked among the best in the world.^[1][2] The Italian healthcare system employs a Beveridge model, and operates on the assumption that health care is a human right that should be provided to everyone regardless of their ability to pay.^[3] Life expectancy is the 4th highest among OECD countries (83.4 years in 2018^[4]) and the world's 8th highest according to the WHO (82.8 years in 2018^[5]). Healthcare spending accounted for 9.7% of GDP in 2020.^[6]

The Italian state has run a universal public healthcare system since 1978.^[7] The public part is the Servizio Sanitario Nazionale, which is organised under the Ministry of Health and administered on a devolved regional basis, in consequence of the 2001 Italian constitutional referendum."

Healthcare in Italy - Wikipedia

[blackbird]

Canada spends 12.2% of GDP on healthcare.  This is more than every country in Europe.  Yet Germany, France, and Italy have very good healthcare systems.  Why is Canada's system more expensive while it is failing?

[Michael Hardner]

7 hours ago, blackbird said:

Canada spends 12.2% of GDP on healthcare.  This is more than every country in Europe.  Yet Germany, France, and Italy have very good healthcare systems.  Why is Canada's system more expensive while it is failing?

Because the arguments and public input Are absent and Canada does not have a management mindset.  We discussed Public services in terms of should they exist or not?

[blackbird]

This is an interesting news article which is of wide interest right now:

quote

It’s been among the most volatile and untouchable third rails in Canadian politics: The adoption, at any level, of a private health-care system.

In the last federal election, a Conservative statement about “public-private synergies” was all it took for Deputy Prime Minister Chrystia Freeland to brand it as a right-wing assault on the “public, universal health-care system.” 

But a new Ipsos report shows that “two tier health care” is not the threat it once was.

Among respondents, 52 per cent wanted “increased access to health care provided by independent health entrepreneurs,” against just 29 per cent who didn’t.

Perhaps most shocking of all, almost everyone agreed that private health care would be more efficient. Seven in 10 respondents agreed that “private entrepreneurs can deliver health care services faster than hospitals managed by the government” – against a mere 15 per cent who disagreed.

“People understand that the endless waiting lists that characterize our government-run health systems will not be solved by yet another bureaucratic reform,” was the conclusion of the Montreal Economic Institute, which commissioned the poll.  unquote

For the whole article:

FIRST READING: Canadians are so fed up, they’re abandoning political sacred cows (msn.com)

Tragically Liberals and NDP are committed to a failing health care system with its long waiting lists.  They prefer ideology to helping Canadians with serious medical issues.

[blackbird]

On 4/21/2024 at 4:50 AM, Michael Hardner said:

Because the arguments and public input Are absent and Canada does not have a management mindset.  We discussed Public services in terms of should they exist or not?

So does that mean you believe the public health care system can be reformed to provide good service for Canadians?

Polls show the overwhelming majority of Canadians don't think so.

"

Perhaps most shocking of all, almost everyone agreed that private health care would be more efficient. Seven in 10 respondents agreed that “private entrepreneurs can deliver health care services faster than hospitals managed by the government” – against a mere 15 per cent who disagreed.

“People understand that the endless waiting lists that characterize our government-run health systems will not be solved by yet another bureaucratic reform,” was the conclusion of the Montreal Economic Institute, which commissioned the poll. "

[Michael Hardner]

35 minutes ago, blackbird said:

1. So does that mean you believe the public health care system can be reformed to provide good service for Canadians?

2. Polls show the overwhelming majority of Canadians don't think so.

3. Perhaps most shocking of all, almost everyone agreed that private health care would be more efficient. Seven in 10 respondents agreed that “private entrepreneurs can deliver health care services faster than hospitals managed by the government” – against a mere 15 per cent who disagreed.

4. “People understand that the endless waiting lists that characterize our government-run health systems will not be solved by yet another bureaucratic reform,” was the conclusion of the Montreal Economic Institute, which commissioned the poll. "

1. Yes.  How can France - a nation with a union mindset - outdo us in public healthcare including lower costs ?
2. With respect, the public is part of any public healthcare system so there is some responsibility on the public engagement model in how things are done.  I don't think asking the public for vision of future public healthcare models is an exercise that tells us much... aside from "people are unhappy".  

Does the public even know about CIHI ?  Stephen Harper gave it focus, as I recall, as a way for "the" public to get information about service delivery.  And still the only argument I ever hear is public vs private as though there's no other thing to discuss.
 
3. Again - if the public doesn't pay attention ALL the time, vs during a crisis, how can we expect good answers ?

4. Commissioned polls by unheard-of institutes are actually currency of past discussions and not helpful  We aren't France but if we are going to have 2-tier then we have to be more like them in our publics as well as our delivery.  Otherwise the lower tier will go to garbage immediately.  I would tie the top tier to IMPROVED service levels on the bottom.  IN other words, if people can afford to pay more then that money will be used to fund public health too.  I don't care who provides the services but clearly new organizations need to be developed.  And unionizing them is cheaper than contracting out.

[blackbird]

5 minutes ago, Michael Hardner said:

2. With respect, the public is part of any public healthcare system so there is some responsibility on the public engagement model in how things are done. 

I am not sure what you mean by "public engagement".  Many people fear sticking their necks out will result in retribution against them personally.

Our system is not really set up for the public to engage and run the health care system.  We elect governments and people trust them, rightly or wrongly.  Once they are in control, the ordinary people don't have much or any control over how they run the public health care system.  

You seem to think there is a way the public can control it.  It doesn't exist and I don't think that is an answer to a failing system.

 

 

4 minutes ago, Michael Hardner said:

Does the public even know about CIHI ? 

What is CIHI?

 

[Michael Hardner]

5 minutes ago, blackbird said:

1. I am not sure what you mean by "public engagement".  Many people fear sticking their necks out will result in retribution against them personally.

2. Our system is not really set up for the public to engage and run the health care system.  We elect governments and people trust them, rightly or wrongly.  Once they are in control, the ordinary people don't have much or any control over how they run the public health care system.  

3. You seem to think there is a way the public can control it.  It doesn't exist and I don't think that is an answer to a failing system.

4. What is CIHI?

 

1. What ?  That's ridiculous if true.  The system depends on feedback from the basic publics: patients and the public, ministries and governments, healthcare workers.
2. This is exactly the problem.  Harper tried to address this.  But then people don't even know what CIHI is.  They track how well or not-well services are.
3. Why does it work in other domains ?  Why does it work in France ?  Why does it work for pizza ?  There is supposed to be a feedback loop.  IF people are unaware that it's even possible to have one then it's hard to imagine them asking for one.
4. See #2.  https://www.cihi.ca/en

When Harper started trying to move things forward with CIHI, I posted on here about it a lot.  Unfortunately, the function of politics as a kind of online entertainment supplanted any useful discussion and so we have chud vs chud...

[Michael Hardner]

56 minutes ago, blackbird said:

 

I know he "fires" patients.  He fired a relative.  I also heard reports of other people he fired as patients.  She now has a doctor that spends a couple minutes on an appointment; then she is out the door.  That is not medical care.

The fact is doctors have so many patients and there is a long waiting list of people waiting for a family doctor.  People don't criticize anything if they want to get a doctor.

Anyone knows if you say the wrong thing you might not have a family doctor any more.  Nobody or few publicly criticize the health care system.  That is just a fact.  We see the news reports where people on the television news do sometimes complain about something that happened to them.  But that is the extent of it.  Then the television reporters get the view of the minister of health who always has the good-sounding answers.  But little changes.

That's a symptom of a system that needs reform and it is a problem.  But I was talking about the system not individual doctors.  Doctors themselves are unjappy with the system.

[blackbird]

Here is a report showing the medical wait times is costing Canadians billions of dollars.  I don't see any kind of re-organization of the public health care system as the solution.  The public system is the problem.  Politicians and bureaucrats cannot fix a failing system that they themselves created. 

I see a mixture of public and private as a possible solution.  The longer people procrastinate and delay changing the system, the longer Canadians will suffer and incur costs.  Don't think this could affect you?  Think again.  As we age, we develop medical problems.  That is a fact of life.

"

Long wait times for medical treatment cost 1.2 million Canadian patients an estimated $3.5 billion in out-of-pocket expenses last year, according to a new study by the Fraser Institute.

The fiscally conservative think-tank said the estimate — averaging $2,871 per patient — is conservative because it only includes costs borne directly by patients waiting for treatment in terms of lost productivity during an average work week."

GOLDSTEIN: Long medical wait times costing Canadians billions, report says (msn.com)

[Michael Hardner]

1 hour ago, blackbird said:

1.  I don't see any kind of re-organization of the public health care system as the solution.  

2. I see a mixture of public and private as a possible solution.   

 

1. And 2. contradict each other.  You also pose a very serious problem with 2. that I agree with: how can those in charge execute this?

We have to start acknowledging that we don't think about MANAGEMENT enough in the public sphere.  There are public entities and non-profits that are well managed.  We need to make more.  Maybe we mandate private healthcare to form subject matter groups with public health.

[blackbird]

4 hours ago, Michael Hardner said:

1. And 2. contradict each other.  You also pose a very serious problem with 2. that I agree with: how can those in charge execute this?

We have to start acknowledging that we don't think about MANAGEMENT enough in the public sphere.  There are public entities and non-profits that are well managed.  We need to make more.  Maybe we mandate private healthcare to form subject matter groups with public health.

I don't see the public health system operating as a sole system as the solution.  I see unions, bureaucracy and politicians as not the right system to manage a large public health care system.  They have proven that a government run and controlled public system is not manageable.  

The only solution to this problem I see is a private health care system being established alongside the public system.

You must get it out of your head that government can do things better than private industry or private enterprise.  I don't think you grasp the fact that Socialist systems do not have the motivation to do well, innovate, improve, and be efficient, especially when there are powerful unions involved.  

Only private enterprise has the motivation to really produce efficiently and deliver the product.  That means there has to be rewards and penalties for the players.  In Socialist (government) run systems where everyone's job is guaranteed and protected by the unions and system, the same incentives and punishments do not exist.  We need to get back to reality and face it.  

But we could keep the public system for those who cannot afford to pay a basic fee for insurance and deductible for services and still create a strong private system as well.

 

"Thinking about management of the public system" is not going to solve the problem at all.  That will change nothing.  The general public can not be expected to run a public system.  It will never happen.

 

 

[Michael Hardner]

12 minutes ago, blackbird said:

1. I don't see the public health system operating as a sole system as the solution. 
2. I see unions, bureaucracy and politicians as not the right system to manage a large public health care system. 
3. They have proven that a government run and controlled public system is not manageable.  The only solution to this problem I see is a private health care system being established alongside the public system.

1. I guess you missed my point: offering 2-tier would necessarily mean a re-org.
2. These are part of any system - public or private.
3. I see your point, but as per my point 2. you will need to develop better management across the board  - in both the public and private system or the public system will collapse.
 
The rest of your post sort of restates your points again.  Canadians have a deep ignorance of management, and the public's role in it.  We are served by monopolies with bad service practices, which has transformed us into a society of consumers with low expectations.  Culture change is needed and - no - it's not impossible as you suggest.  Past failure is not evidence that it can never happen.  That's like saying the Leafs will never win the cup again because they haven't done it in 57 years.

[blackbird]

5 minutes ago, Michael Hardner said:

These are part of any system - public or private.

New laws need to be brought in to bring unions in essential services like health care under control.  Management should have the right to dismiss poor performing employees or re-assign them as management sees fit without the powerful union process that essentially destroys the ability to manage.

10 minutes ago, Michael Hardner said:

Canadians have a deep ignorance of management, and the public's role in it.

I don't see how you can have the public involved in management.  There needs to be a system in public and private that can actually make decisions and get things done without being buried in paperwork and bureaucracy.

12 minutes ago, Michael Hardner said:

Culture change is needed and - no - it's not impossible as you suggest.

Those are just Socialist left wing word bites.  Culture change is not going to do anything.

We see how the Liberal cabinet ministers and bureaucrats talk about "culture change" in the Canadian armed forces.  How has that worked.  Now they can't even find enough people to join and the military has been on a downward spiral.  

14 minutes ago, Michael Hardner said:

you will need to develop better management across the board  - in both the public and private system

I don't see adopting phrases like that as any kind of solution.  It is too vague and has no real concret meaning.

I think you still don't understand the basic foundational requirement.  There has be reward and punishment.  Only a private enterprise system can provide that.  Nobody invests their money and blood and sweat into something if there is not going to be a good return.  If you want good products, you must enable people to invest in it, run it, and reap some rewards for their efforts.  Those that produce get rewarded well and those who don't lose and don't get rewarded but are shown the door.  Socialism lacks that.  Only capitalism and free enterprise provides incentive and reward for doing a good job.

[Michael Hardner]

5 minutes ago, blackbird said:

1. New laws need to be brought in to bring unions in essential services like health care under control.  Management should have the right to dismiss poor performing employees or re-assign them as management sees fit without the powerful union process that essentially destroys the ability to manage.

2. I don't see how you can have the public involved in management.  There needs to be a system in public and private that can actually make decisions and get things done without being buried in paperwork and bureaucracy.

3. Those are just Socialist left wing word bites.  Culture change is not going to do anything.

4. We see how the Liberal cabinet ministers and bureaucrats talk about "culture change" in the Canadian armed forces.  How has that worked.  Now they can't even find enough people to join and the military has been on a downward spiral.  

5. I don't see adopting phrases like that as any kind of solution.  It is too vague and has no real concret meaning.

6. I think you still don't understand the basic foundational requirement.  There has be reward and punishment.  Only a private enterprise system can provide that.  Nobody invests their money and blood and sweat into something if there is not going to be a good return.  If you want good products, you must enable people to invest in it, run it, and reap some rewards for their efforts. 

7. Those that produce get rewarded well and those who don't lose and don't get rewarded but are shown the door.  Socialism lacks that.  Only capitalism and free enterprise provides incentive and reward for doing a good job.

1. Your assumption that bad workers are at the core of healthcare system problems is not substantiated and reflects the type of ignorance Canadians have about management, that I was thinking about.  Command and Control management is becoming extinct but the Canadian public is unaware.
2. But they are today.  They frame the debate and they are the ones who demand improvements and change.  Except this is done through Federal and Provincial elections - which are such a remote means of control that the system stays stuck.  I agree with your point about paperwork and bureaucracy.  But pulling bureaucracy out of public services is even harder to manager than just operating the system.
3. They're actually business terms.  
4. It's worked terribly but just because you can train a parrot to say "Culture Change" doesn't mean you can make the parrot a manager.  
5. Using such language is not a solution.  Actually changing things top down is.  That's what you want, and I agree.  And it's called Culture Change.  Unfortunately fake managers imitate the language of good ones, much as kids pull their grandparents' clothes out of the close and play dress-up.
6. Except you're going to have a private monopoly not much better than a public one.  Again, I didn't say I was against two-tier so I don't know why you're still discussing with me as though I am.
7. Your assessment is simplistic, but again I agree with the idea that two-tier can help.  But not if we have public attitudes that will essentially turn Healthcare into Rogers vs Bell Canada all over again.  You want a slightly better product at a much higher cost ?  Go that way.

Anyway, I don't think there's enough we disagree on here to continue the conversation.  I could explain some management scenarios I have been through but I don't think there's much point.

[PIK]

Yes 

[blackbird]

3 hours ago, Michael Hardner said:

Your assumption that bad workers are at the core of healthcare system problems is not substantiated and reflects the type of ignorance Canadians have about management

The fact people have died waiting in Emergency Rooms is of great concern. They don't always seem to act when people with urgent medical issues such as heart problems are brought in to the ER.  People have been sent home that should not have been.  We see reports regularly about people who died in ERs.  

These tragedies should be investigated by an impartial body and somebody should be held accountable.