Michael Moore's 'Sicko' Scrutinizes Canada's Healthcar

[bush_cheney2004]

...Under the circumstances, I think it was perfectly understandable that I would find your preference to live in the States interesting. Furthermore, your husband wasn't born in the United States and he didn't live here all of his life and I'm guessing he must love where he lived, etc, so again, my finding your choice "interesting" is not deserving of rudeness.

It was a fair question given all the volunteered information and negative will expressed about the USA, particularly the proposed decision if democratic election results fall short of a "supermajority", which is all but guaranteed.

I work with several Canadians who have made America home and prize their "green cards". This is not to say they don't disagree with American politics or policies (even amongst themselves), but none are fickle enough to pee on our rug (LBJ reference).

My slave ancesters wouldn't go back to Africa either.....so I'm sure as hell not leaving over healthcare.

[SkyhookJackson]

...Under the circumstances, I think it was perfectly understandable that I would find your preference to live in the States interesting. Furthermore, your husband wasn't born in the United States and he didn't live here all of his life and I'm guessing he must love where he lived, etc, so again, my finding your choice "interesting" is not deserving of rudeness.

It was a fair question given all the volunteered information and negative will expressed about the USA, particularly the proposed decision if democratic election results fall short of a "supermajority", which is all but guaranteed.

I work with several Canadians who have made America home and prize their "green cards". This is not to say they don't disagree with American politics or policies (even amongst themselves), but none are fickle enough to pee on our rug (LBJ reference).

My slave ancesters wouldn't go back to Africa either.....so I'm sure as hell not leaving over healthcare.

Of course you're not leaving over healthcare. You obviously have access to healthcare and enough wealth to cover the deductibles, co-pays and uncovered 20% without landing in a Maytag box on the street. Gosh, golly, gee whiz. Sorry if I sounded rude, folks. It had something to do with that tone of "love or leave it" in response to why I don't move to Canada. I'm sorry, but I have little patience with people who can't take what they're dishing out. A person who truly loves their country speaks out when it's going down the wrong path. To remain silent in the face of all that has gone wrong since the Bush 43 regime took over would be to relegate the United States to the trash pile. We're better than that. We can fix it. I've been politically active for a long, long time and, quite honestly, I'm tired. I'd like to live out my life doing the things that really bring me joy rather than arguing with the small percentage of Bush supporters who would follow him off a cliff. For that reason, I look to the north. It's not just healthcare. The Canadians seem to have different priorities. The stock portfolio doesn't appear to be god. When I go there I'm reminded of how happy I felt decades ago and I always leave wishing we'd set up our life there when we were married in the 70's - we thought about it. Maybe I'm wrong about Canada. I've never lived there, I don't know. Maybe some Canadians will chime in and take my rose-colored glasses off.

[bush_cheney2004]

I'm sorry, but I have little patience with people who can't take what they're dishing out. A person who truly loves their country speaks out when it's going down the wrong path. To remain silent in the face of all that has gone wrong since the Bush 43 regime took over would be to relegate the United States to the trash pile. We're better than that. We can fix it. I've been politically active for a long, long time and, quite honestly, I'm tired. I'd like to live out my life doing the things that really bring me joy rather than arguing with the small percentage of Bush supporters who would follow him off a cliff. For that reason, I look to the north. It's not just healthcare.

If you think that America's "issues" start and end with the current Bush administration, then best to leave right now. Why didn't you leave when Reagan was president? Or Nixon? I suppose you loved Carter despite the record "misery index".

WRT healthcare, I wouldn't leave if completely destitude and without insurance. I live in the US, and I plan to die there too, like millions of Ameicans before me. I often wonder what would make Canadians pick up their lives and transplant to the USA...then I remember how the nation was built in the first place. And it wasn't over "free" healthcare.....it was over "free-dom" (which isn't free).

[jbg]

I often wonder what would make Canadians pick up their lives and transplant to the USA...then I remember how the nation was built in the first place. And it wasn't over "free" healthcare.....it was over "free-dom" (which isn't free).

Perfect post.

[Riverwind]

I often wonder what would make Canadians pick up their lives and transplant to the USA...then I remember how the nation was built in the first place. And it wasn't over "free" healthcare.....it was over "free-dom" (which isn't free).

Perfect rubbish. You forget that there are many Americans who transplant to Canada - many off them seeking fredom from the oppressive military culture in the US. Edited July 27, 2007 by Riverwind

[Pliny]

The balk will come in the form of "voting".

If I want to balk, who should I be voting for to save me from the plague of taxation?

The Messiah has not yet appeared. In Canada you are out of luck right now. In the States there are a few people but they still won't win, just influence slightly.

My argument is focussed on the health care system. There is a fundamental conflict between the desire to generate profit and the desire to provide the best care possible. If care can be denied, profit goes up. There is no way around that fundamental flaw. And the fact that those who can't afford it are denied care, that is unacceptable.

Why do you think this conflict exist only in healthcare? Any other customer service industry also can reduce cost by providing reduced customer service. If the relationship that less customer care = more profit, why is healtcare unique in that relationship?

Steve,

Renegade has made some good points against your arguments.

I can't wrap my mind around the statement that, "if care is denied profit goes up". There is, of course, a continuous effort and ever-vigilant quest to trim costs and enhance the bottom line. However, there is no long term benefit to reducing quality or denying service. Loss of market share will be the result. There is an exception though and that is if there is no competition, such as a monopoly - in that perspective what you say makes perfect sense as there is no alternative for the consumer.

Building or sustaining a business means cultivating a clientele and a customer base. It is not a "fundamental flaw" to attempt to reduce costs. It is a flaw to reduce service or quality, a company may see some short term benefit but will not be building a future.

Health care in Canada is pretty much a monopoly. There is no penalty or reward for quality of care. Care can be denied, and it is denied in our system, in order to cut costs. If care were denied to increase profits you would have reason to complain. It is in no ones long-term interest to decrease or deny service except in the instances I mentioned - under a monopoly as a cost cutting measure, or if you wish to close your business.

Must be off.

[stevoh]

I have no idea what example you are talking about.

Here:

If profit was a major motivator, then less profitable surgeries would be recommended less, and a more profitable one recommended instead, even if it isn't the medically most adventageous choice.

Most government run systems provide at mediocre service because there is very little incentive to improve it. Government bureaucrats don't get fired and will get paid regardless if the system runs well or badly, so why bother to put in the effort to improve it.

It seems like you honestly believe the only motivator that works for anything is profit. You are wrong.

I'll skip the other response because this gets to the heart of the issue. The Canadian system does use profit as a motivator. Doctors and health-care providers are not employees of the state. For the most part they are self-employed individuals who essentially run a business who's motive (at least one motive) is profit. The only thing the state does, is pay the bills. IOW, profit has not been taken out of the system because it serves a useful purpose.

Individuals being fairly renumerated for the service they provide is different than the whole system being required to maintain a profit. Doctors and nurses should be paid well. Hospitals as a whole should not have profit as a primary motivator. Reward the people actually doing the work and making the system better, don't require that the system as a whole has to generate additional profit.

I can't wrap my mind around the statement that, "if care is denied profit goes up". There is, of course, a continuous effort and ever-vigilant quest to trim costs and enhance the bottom line. However, there is no long term benefit to reducing quality or denying service

For the insurance industry, all you have to do is deny just enough care so that your reputation as a whole does not suffer, perhaps through clever promotion by other means. So, someone cuts off their finger in a wood working accident. The insurance is denied as a safety guard was removed, so the applicant did not use "due diligence". The insurance company saves 60 000 dollars in medical bills, therefore increasing profit over having to pay the claim.

You would think that customer complaints and issues with service against an insurance provider would eventually go out of business. But such is not the case. The largest supplyer of long term care insurance in the US, Conesco Seniors Health and its subsiduary, Bankers life and Casualty, have the highest rates of complaints against them of any long term care insurance company. This correspondence between great service and business success does not necessarily prove true. Because the ultimate measure of success is profit, not customer satisfaction.

Health care in Canada is pretty much a monopoly. There is no penalty or reward for quality of care. Care can be denied, and it is denied in our system, in order to cut costs.

Examples of care denied?

Edited July 27, 2007 by stevoh

[Guest American Woman]

So evidently, in spite of what you think about the U.S. and the war and healthcare, etc., you've found it preferrable to live in the States rather than in Canada. I find that interesting.

Well . . . duh. I was born in the United States. I've lived in the United States my entire 58 years. I've lived in the same home in the same place for years and years. I love the place we live - my gardens, the wild life, our surroundings. It's called "life." Until 3 years ago I could (barely) afford health insurance. Until 6 years ago we had presidents who didn't belong in an insane asylum. God! I look back on the Nixon years as the "good old days" at this point. I do have hope that once the "evil doers" at 1600 Pennsylvania Avenue are gone, the U.S. might head in the right direction again. Maybe not. Who knows at this point? In any case, Canada is a wonderful place and I can see myself living quite happily there. By the way, what exactly do you mean by what I think of the U.S.?? The country is separate from the sorry leadership. It's a shame we don't have a parliamentary system, we could throw the bums out now. The majority of Americans are just as pissed off as I am, if not more. You must see the polls. It's not that we don't love the country, it's that the country has changed and not for the better. Outsourced jobs, unaffordable college tuitions, health care. And, worst of all, we've gone from a "we" mentality to a "me" mentality. "I've got mine, to hell with you." That's not the way it should be.

Seems I wasn't so far off with my thoughts after all, eh? In fact, seems as if my comment was totally justified:

It's not just healthcare. The Canadians seem to have different priorities. The stock portfolio doesn't appear to be god. When I go there I'm reminded of how happy I felt decades ago and I always leave wishing we'd set up our life there [emphasis mine] when we were married in the 70's - we thought about it. Maybe I'm wrong about Canada. I've never lived there, I don't know. Maybe some Canadians will chime in and take my rose-colored glasses off.

Like I said, there was no call for your rudeness -- as you criticize others.

[bush_cheney2004]

Perfect rubbish. You forget that there are many Americans who transplant to Canada - many off them seeking fredom from the oppressive military culture in the US.

One doesn't exclude the other. Still, it's millions vs. many thousands for permanent residency and citizenship...remarkable given the huge population differences (but the same thing happens with China). "Brain drain" doctors and other health care professionals once led the list (getting back on topic).

Edited July 28, 2007 by bush_cheney2004

[Riverwind]

Still, it's millions vs. many thousands for permanent residency and citizenship...remarkable given the huge population differences

The US is 10 the size of Canada and benefits from economies of scale. This creates opportunities for career advancement that many Canadians don't want to turn down (i.e. a TV series made for 300 million people will _always_ pay more than a series made for 30 million people). You should never assume that these Canadians have any love for so called 'freedom' of the US and the myriad of social problems it creates. Edited July 28, 2007 by Riverwind

[bush_cheney2004]

The US is 10 the size of Canada and benefits from economies of scale. This creates opportunities for career advancement that many Canadians don't want to turn down (i.e. a TV series made for 300 million people will _always_ pay more than a series made for 30 million people). You should never assume that these Canadians have any love for so called 'freedom' of the US and the myriad of social problems it creates.

But they do....many want to vote in elections and "make a difference" (e.g. Michael J. Fox). "Freedom" means many different things to different people, and there is plenty of it to be had in the USA. Canada has "freedom" as well, but as you have admitted, it is not Supersized.

The USA (population...Canada is larger than the US) is not "10 times the size" of China", but the same paradigm exists. They found another would be immigrant frozen to death in an airliner wheel well last week.

BTW, a television production is never made for the entire American population....our media markets are far more diverse than that. But I understand how you could think that given the CRTC.

[Renegade]

If profit was a major motivator, then less profitable surgeries would be recommended less, and a more profitable one recommended instead, even if it isn't the medically most adventageous choice.

Even a public system needs to consider the cost of the procedure. You are implying that in a public healthcare system that cost of of a procedure is irrelevant. It is and hard decisions will be made regardless of if it is visible to the public or not. I do agree however that where profit is the incentive, checks need to be in the system to make sure that the profit doesn't unduly influence the medical decison.

It seems like you honestly believe the only motivator that works for anything is profit. You are wrong.

No, what I've repeatedly said is that incentive system needs to be in place or the system will not provide the best results. That incentive doesn't necessarily need to be profit but must be substituted with something equally powerful as a motivator. Money is frequently used as the motivator because it can reasonably assumed to appeal to a broad segment of the healthcare providers. I don't believe altruism, pride in work, (ie self-motivation) provides the same incentive.

An example of a public system which a subsititue incentive is provided over profit, is the military. The military uses patriotism, machoism, and even racism as motivators. It has a tangible incentive system of medals, parades, which reinforce this incentive system. It has taken centuries to create this system because it would be unaffordable rely on money as a motivatior. A similar powerful motivator is requred in order to provide an effficient and quality healthcare system.

Individuals being fairly renumerated for the service they provide is different than the whole system being required to maintain a profit. Doctors and nurses should be paid well. Hospitals as a whole should not have profit as a primary motivator. Reward the people actually doing the work and making the system better, don't require that the system as a whole has to generate additional profit.

When a doctor operates an office, collects the revenue from the government for services rendered, and pays out office expenses is that any different from profit? You seem to be fine with profit as a motivatior at an individual level or at a small level but have a problem with it at an organization level.

When you say that "Doctors and nurses should be paid well", are you agreeing that doctors and nurses shoud be paid incentives for adding efficiency into the system? If not why would they bother to do so?

In your view, what is the motivator to get the head administrator at a non-profit hospital to improve the efficiency of the system? I would argue that even in a public system, as an obligation to the taxpayer, there needs to be a motivator for constant improvement and efficiency. It is clear what the motivator is in a for-profit hospital.

[jbg]

The US is 10 the size of Canada and benefits from economies of scale. This creates opportunities for career advancement that many Canadians don't want to turn down (i.e. a TV series made for 300 million people will _always_ pay more than a series made for 30 million people). You should never assume that these Canadians have any love for so called 'freedom' of the US and the myriad of social problems it creates.

It's more fundamental than that. Trudeau wanted draft dodgers. Chretien wanted South Asians. The US wants productive citizens of any stripe.

[Pliny]

Examples of care denied?

Ask anyone who has died on a waiting list or is on a waiting list. You can probably find a few anecdotal cases if you care to search which I know is not in your interest to do so.

It is rather plain to see Steve that you are a stakeholder in the health care industry in Canada. Either as an employee or as a recipient of benefit or perhaps both.

I don't want to be long winded about this but an institution that is built, then has to have administrators to administer the system which means protecting it's authority. When it has blanket authority, i.e., it has become a monopoly, then it begins to protect its authority above serving its purpose. The interests involved will then crush opposition that makes it appear to be on the wrong side of any issue, becoming even dictatorial in nature. Unfortunately, the purpose then becomes secondary to the interests of the stakeholders.

I can site many examples of when authority and the interests of the stakeholders in maintaining authority overrides its primary purpose and of the people it serves. Union demand to not tamper with the system in Canada is such an example. Diabetic associations on the forefront of diabetic management have long refused dietary advice that could eliminate diabetic symptoms in many cases. Some of the most prescribed drugs in the seventies and eighties were acid-blockers for ulcers. Those interests attacked research on the true cause of 90% of ulcers which was the heliobactar pylori bacteria. Although discovered in 1982 it wasn't until the late nineties that treatment became available. The medical establishment almost buried the claim except for the persistence of its discoverer. And I have not heard a peep about heliobactar pylori being a source of some stomach and pancreatic cancers although it has been proven to be a contributor.

So defending a system that one has a vested interest in is not necessarily in the interests of the public it is supposed to serve. I would weigh heavily upon any information from sources that have a vested interest in the status quo. It is fairly easy to see who it is in any side of a debate that has an interest or stake in the status quo.

Skyhook Jackson:

You would be happy in Canada. No one here thinks about themselves either. They only think of the collective good - "we". As individuals they attempt to remain as transparent and anonymous as possible, favouring to blend into the crowd and think of themselves as the crowd. Like most democracies they never vote for helping themselves or improving their lives unless it benefits everyone. They know their individual vote is a useless and futile exercise but collectively they can make a difference. So they form groups to lobby government, write slogans and carry placards because they don't really care about themselves, they want social justice and equality but only because it benefits everyone. In all of this, they have no concern about themselves whatsoever. They always think in terms of "we" and not "me". Like you, they have been disabused of the concept that "me" can be effective in bringing about change and only "we" or "us" can accomplish anything of any merit - including looking after themselves. So do you now see why you must move to Canada? It is impossible to live as an individual here, as you so desire. In the US some idiots still think you should be able to live as an individual and have the right to make individual choices in the management of your life and that it is a duty to look after yourself, your family, your environ, despite government attempting to make it easy on you by alleviating those responsibilities for you to do so. Once they do completely relieve you of them then you can think entirely about catering to the needs of everyone and not have to worry about yourself at all - Canada is oh, so close.

Or maybe you would just like to have all those responsibilities that come with living to be shifted to the State so you can think about yourself for a change? Crime, healthcare, education, food, shelter, clothing - all provided for and at last time to think about "me".

Edited July 29, 2007 by Pliny

[jbg]

Examples of care denied?

Ask anyone who has died on a waiting list....

If you succeed in making that inquiry, it will be a first, at least since Prime Minister William Lyon Mackenzie King held seances with his grandfather (link) and mother (link).

[stevoh]

It is rather plain to see Steve that you are a stakeholder in the health care industry in Canada.

Every Canadian is.

[stevoh]

When you say that "Doctors and nurses should be paid well", are you agreeing that doctors and nurses shoud be paid incentives for adding efficiency into the system? If not why would they bother to do so?

In your view, what is the motivator to get the head administrator at a non-profit hospital to improve the efficiency of the system? I would argue that even in a public system, as an obligation to the taxpayer, there needs to be a motivator for constant improvement and efficiency. It is clear what the motivator is in a for-profit hospital.

Individuals should be rewarded for good care and improved efficiency, including administrators. That can include monitary rewards, vacations, commendations, whatever.

However, the health care system as a whole does not need to profit to meet its primary mandate, the best patient care possible. Since there are no investors, shareholders, or "owners" of the system, that profit layer is not necessary.

[Renegade]

Individuals should be rewarded for good care and improved efficiency, including administrators. That can include monitary rewards, vacations, commendations, whatever.

However, the health care system as a whole does not need to profit to meet its primary mandate, the best patient care possible. Since there are no investors, shareholders, or "owners" of the system, that profit layer is not necessary.

Ok, now we are getting somewhere. Do you agree that a system as we have now, the doctor who runs his own medical practice, is in fact the owner of his own business, and is incented to make a profit?

[stevoh]

Individuals should be rewarded for good care and improved efficiency, including administrators. That can include monitary rewards, vacations, commendations, whatever.

However, the health care system as a whole does not need to profit to meet its primary mandate, the best patient care possible. Since there are no investors, shareholders, or "owners" of the system, that profit layer is not necessary.

Ok, now we are getting somewhere. Do you agree that a system as we have now, the doctor who runs his own medical practice, is in fact the owner of his own business, and is incented to make a profit?

Not in the capitalistic sense of business, where competition and the ability to expand is limitless. But in an individual sense, sure.

[Renegade]

Not in the capitalistic sense of business, where competition and the ability to expand is limitless. But in an individual sense, sure.

I'm really not following your response. How is a self-employed doctor with his own practice, any different than any other small-business owner. It is just as much a capitalistic enterprise as is any other.

[Pliny]

It is rather plain to see Steve that you are a stakeholder in the health care industry in Canada.

Every Canadian is.

You didn't quite finish my quote. I am a stakeholder because I currently pay into it. You are currently on the receiving end. If you are arguing from the point of view of a health care provider you are certainly doing consumers a disservice by refusing to admit change, above tinkering and increased funding, is necessary. If you are arguing from the point of view of a current consumer I can understand your wish to continue being a beneficiary of this "free" service.

I don't want to hear about "greed and profit" when it is clear your claim to altruism is tainted by your own personal interest.

[stevoh]

You didn't quite finish my quote. I am a stakeholder because I currently pay into it. You are currently on the receiving end. If you are arguing from the point of view of a health care provider you are certainly doing consumers a disservice by refusing to admit change, above tinkering and increased funding, is necessary. If you are arguing from the point of view of a current consumer I can understand your wish to continue being a beneficiary of this "free" service.

So you will never be injured, never get sick, never have a family member in need of emergency care? Then you should try US style health care, where you don't have to purchase insurance at all, and just let chance take its course.

I don't want to hear about "greed and profit" when it is clear your claim to altruism is tainted by your own personal interest.

It is in everyones interest to have good health care.

And I have not heard a peep about heliobactar pylori being a source of some stomach and pancreatic cancers although it has been proven to be a contributor.

http://heartburn.about.com/b/a/040371.htm

I'm really not following your response. How is a self-employed doctor with his own practice, any different than any other small-business owner. It is just as much a capitalistic enterprise as is any other.

Can the doctor open other clinics under his brand name? Can he franchise? Can he do a "better job" than anyone else at a specific treatment and therefore charge more? Can he pass additional costs onto the consumer? Can he have investors in his business that he then shares the profit with? None of the above. He has tight restrictions on how he can run his "business". Its a far cry from free market capitalism.

[Renegade]

Can the doctor open other clinics under his brand name? Can he franchise?

As far as I know, there are no governmental restrictions which prevent him from doing so. Are you aware of any?

Can he do a "better job" than anyone else at a specific treatment and therefore charge more? Can he pass additional costs onto the consumer?

No, but as with many industries where the price is fixed by government regulation, he can skimp on the quality of the procedure to reduce cost.

Can he have investors in his business that he then shares the profit with?

Yes, as far as I know he can. I doubt he would though because he'd want to keep the entire profit.

Its a far cry from free market capitalism.

So what. Even the banks and telcos have restrictions on price and ownership yet they are considered part of the capitalist system. Despite your denial, the doctor is indeed a capitalist.

I don't know of any restriction in the Canadian system which prevents the opening of a shareholder owned healthcare facitilty (on any scale). The reason no shareholder would likely do so, is that the returns are not sufficient to endure the risk and more lucrative returns are to be found elsewhere.

[stevoh]

So what. Even the banks and telcos have restrictions on price and ownership yet they are considered part of the capitalist system. Despite your denial, the doctor is indeed a capitalist.

Ok, I can accept that. I do believe they have other motivations beyond making money for choosing the occupation that they do, but I can accept they are equivalent to a small business owner.

It seems that the main part of the canadian system that is public is the insurance itself. And I agree strongly with the component. That means the classic conflict between making money and providing care that exists in the insurance industry is negated.

[Renegade]

Ok, I can accept that. I do believe they have other motivations beyond making money for choosing the occupation that they do, but I can accept they are equivalent to a small business owner.

Yes I agree and accept that their other motivations besides money for them choosing their healthcare profession, however their profession is hardly unique in that aspect

It seems that the main part of the canadian system that is public is the insurance itself. And I agree strongly with the component. That means the classic conflict between making money and providing care that exists in the insurance industry is negated.

The government plays several roles in the Canadian system:

1. Insurer. Since we provide universal coverage we don't have the overhead a private insurer would
   
2. Single Payor. No doubt a single payor system is more efficient
   
3. Price Regulator. The is probably the most important aspect of keeping cost controlled
   

The downside is even if the government doesn't have a mandate to create a profit, they do have a mandate to control cost. That means they can unilaterally delist medical procedures (not unlike a private insurance company can refuse to pay a claim). That also means in effect that they ration many medical procedures. As I have pointed out, profit as a motivation has not been completely taken from the system, and provides a useful incentive for the system to continue functioning.