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

[jdobbin]

In today's Globe and Mail.

http://www.theglobeandmail.com/servlet/sto...PStory/National

Canada's doctors want to be able to work simultaneously in both the public and private systems, a flexibility that critics say could lead to queue-jumping and further depletion of public health care.

It's also a proposal that puts the medical community on a collision course with Prime Minister Stephen Harper, who argues that physicians would have an incentive to stream patients into the private portions of their practice.

In Charlottetown yesterday, the outgoing president of the Canadian Medical Association said his organization makes no apologies for sparking this "necessary debate."

Colin McMillan, who will be replaced as CMA head next month by a private-practice physician from British Columbia, said doctors - who already are in short supply - find they cannot provide the level of care they would like.

Looks like Harper is going to defend the public system.

[Pliny]

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

Yes, I may get sick and need health care. Yes, it is in everyone's interest to have good health care.

What I am asking is why you don't want good health care? Why are you interested in only the status quo which is one of the worst systems in developed countries? Never mind though, the questions are rhetorical, we already know.

Not allowing me to economically plan for contingencies in my life by crippling my ability to save due to inflation and heavy taxation is the crime. You decry profit and call it greed. I call it contingency planning and there is much difficulty in doing so because the government considers themselves first stakeholders in my labour.

What's with the ad for Pariet? It is just the pharmaceutical companies tagging on to a treatment with an acid blocker from what I can see. Seems a superfluous add-on which is no doubt gloriously peer reviewed and every doctor will assuredly prescribe as an aid in the treatment. This is good health care? And...as I mentioned, not a peep about stomach or pancreatic cancer.

[stevoh]

Yes, I may get sick and need health care. Yes, it is in everyone's interest to have good health care.

What I am asking is why you don't want good health care? Why are you interested in only the status quo which is one of the worst systems in developed countries? Never mind though, the questions are rhetorical, we already know.

I have never claimed our health care couldn't be better. Of course it can, like any system private or public, constant assessment and improvement is necessary. We have pretty darn good health care though. I don't see it as "worst system in developed countries" at all. I have been to the doctor a fiew times, hospital a couple of times and haven't had any issues. Sure, the wait can be a bit painful (speaking as a person who had kidney stones and had to wait five hours for treatment), but once inside, the care is excellent. Have you had a personal horrible experience with our health care system that is tainting your view?

Not allowing me to economically plan for contingencies in my life by crippling my ability to save due to inflation and heavy taxation is the crime. You decry profit and call it greed. I call it contingency planning and there is much difficulty in doing so because the government considers themselves first stakeholders in my labour.

I have no problem saving for the contingencies in my life. It helps that I don't have to pay high health care insurance fees for care that may not be complete. Get a higher paying job. There is nothing wrong with profit. Its just that when a choice between human health and profit errs on the side of profit, bad decisions are made.

What's with the ad for Pariet? It is just the pharmaceutical companies tagging on to a treatment with an acid blocker from what I can see. Seems a superfluous add-on which is no doubt gloriously peer reviewed and every doctor will assuredly prescribe as an aid in the treatment. This is good health care? And...as I mentioned, not a peep about stomach or pancreatic cancer.

If the add on is as superfluos as you say, then there must have been another motivator to create and market it right? Like.... profit? And gosh, we wouldn't want our health products to be peer reviewed eh? I mean, that would be terrible health care.

[Renegade]

I have never claimed our health care couldn't be better. Of course it can, like any system private or public, constant assessment and improvement is necessary. We have pretty darn good health care though. I don't see it as "worst system in developed countries" at all. I have been to the doctor a fiew times, hospital a couple of times and haven't had any issues. Sure, the wait can be a bit painful (speaking as a person who had kidney stones and had to wait five hours for treatment), but once inside, the care is excellent. Have you had a personal horrible experience with our health care system that is tainting your view?

stevoh, have you had the opportunity to get dental care in Canada? Would you say the dental care system works well?

[stevoh]

stevoh, have you had the opportunity to get dental care in Canada? Would you say the dental care system works well?

Yes, I have had dental care in Canada. Usually as a benefit from my current employer. The care I get is excellent, as far as quality, but the billing sure is annoying. Here's why:

1. I have to pay 5 to 10 percent of the bill myself out of my own funds, this is new in the last two years. Suddenly, my company insurance won't pay all of the bill and I have to cover a portion. I would like to exersize my consumer freedom to find a new dental insurance company that covers all of the bills, but it seems this "user pays some" thing is quite popular. And I have to pay considerably more for personal private dental insurance than the money I get back from my company if I decide not to join their insurance plan. I am still looking into this. I am also afraid that this additional user billing will increase in proportion over time.

2. Each service has a maximum amount allowed. So, if something you have done takes longer than the insurance company has covered, you have to cover the rest. Another couple of hundred dollars because a root canal took longer than expected due to "unusual crowding of teeth" or some such.

So, in short, the care we get as far as quality of product and service is excellent. But the billing and insurance part of it is annoying. Maybe that part should be publicly run ;-)

[Renegade]

Yes, I have had dental care in Canada. Usually as a benefit from my current employer. The care I get is excellent, as far as quality, but the billing sure is annoying. Here's why:

1. I have to pay 5 to 10 percent of the bill myself out of my own funds, this is new in the last two years. Suddenly, my company insurance won't pay all of the bill and I have to cover a portion. I would like to exersize my consumer freedom to find a new dental insurance company that covers all of the bills, but it seems this "user pays some" thing is quite popular. And I have to pay considerably more for personal private dental insurance than the money I get back from my company if I decide not to join their insurance plan. I am still looking into this. I am also afraid that this additional user billing will increase in proportion over time.

2. Each service has a maximum amount allowed. So, if something you have done takes longer than the insurance company has covered, you have to cover the rest. Another couple of hundred dollars because a root canal took longer than expected due to "unusual crowding of teeth" or some such.

So, in short, the care we get as far as quality of product and service is excellent. But the billing and insurance part of it is annoying. Maybe that part should be publicly run ;-)

Actually many of the billing and claims annoyances have been resolved. Many dentists submit a claim directly to your insurance provider, so you are reimbursed directly to your bank account. But, yes you usually will have to pay a small portion out of your own pocket.

Since you agree that you get quality and excellent service, how is it that dentalcare doesn't suffer all the drawbacks you ascribe to the "profit" motve?

[stevoh]

Actually many of the billing and claims annoyances have been resolved. Many dentists submit a claim directly to your insurance provider, so you are reimbursed directly to your bank account. But, yes you usually will have to pay a small portion out of your own pocket.

Since you agree that you get quality and excellent service, how is it that dentalcare doesn't suffer all the drawbacks you ascribe to the "profit" motve?

The dentistry industry does have those drawbacks, as I have already touched upon.

First off, if your care goes beyond what the insurance industry is willing to pay for (root canal took longer), then you are stuck with the bill. They are not going to pay additional funds that will dig into their profits.

Expand this to the astronomical bills that can occur with emergency situations, and you can be stuck with thousands of dollars of bills you may not be able to afford, even though you have insurance. And, if the care is determined not to be life threatening, such as loosing a finger, and you are only partially covered, then your only choice may be to not get the surgery at all. Because ensuring that the profit margin is retained is more important than human health.

Secondly, that extra billing for work that IS covered by dental insurance, once again, will suffer from the issue of scale. 10% of a 60 000 dollar bill is a lot of money.

Insurance is far from perfect, but it has its role. Particularly as it relates to non-life threatening insurance concerns. Extra billing in the dental industry is annoying, but for most people with insurance, at least affordable. When expanded to the scale of charges for emergency health care however, it can be financially debillitating, even leading to bankrupcies (as is so well demonstrated in the US health care system).

One thing you haven't touched upon is people who don't have insurance. How do we pay for these people to get care?

[Renegade]

First off, if your care goes beyond what the insurance industry is willing to pay for (root canal took longer), then you are stuck with the bill. They are not going to pay additional funds that will dig into their profits.

Expand this to the astronomical bills that can occur with emergency situations, and you can be stuck with thousands of dollars of bills you may not be able to afford, even though you have insurance. And, if the care is determined not to be life threatening, such as loosing a finger, and you are only partially covered, then your only choice may be to not get the surgery at all. Because ensuring that the profit margin is retained is more important than human health.

Do you have any evidence of this happening? Do you mean "what the insurance industry is willing to pay for" or "what your dental insurance covers you for"? I have never ever experienced dental insurance denying to pay some procedure I was legimitatly covered for. Nor am I aware of such a situation. So since you've made the allegation, provide some evidence.

Secondly, that extra billing for work that IS covered by dental insurance, once again, will suffer from the issue of scale. 10% of a 60 000 dollar bill is a lot of money.

So you have to pay part of the bill. So what? Afterall you get the biggest benefit from the procdure.

Insurance is far from perfect, but it has its role. Particularly as it relates to non-life threatening insurance concerns. Extra billing in the dental industry is annoying, but for most people with insurance, at least affordable. When expanded to the scale of charges for emergency health care however, it can be financially debillitating, even leading to bankrupcies (as is so well demonstrated in the US health care system).

Expensive healthcare is rationed no matter whch system you use. The fact that you have to pay part of the cost also gives you a financial stake in procedure. Once you have a financial stake it serves its purpose to force you to make more prudent decisions and choices for your healthcare.

One thing you haven't touched upon is people who don't have insurance. How do we pay for these people to get care?

I'd be ok with a very basic "welfare" type policy for those who couldn't pay the insurance premium.

[guyser]

The dentistry industry does have those drawbacks, as I have already touched upon.

First off, if your care goes beyond what the insurance industry is willing to pay for (root canal took longer), then you are stuck with the bill. They are not going to pay additional funds that will dig into their profits.

I think you are mistaking things.

The insurance co is not the decider of the extent/scope of your dental care , nor decider of the co-pay requirement.

That was decided by your employer , and the co-pay was put in by your employer to lesson the load on he/her. IOW, they didnt want to pay. I can also assure that those in mngmt will have 100% dental , but with a finite amount of care per calendar year or years.

Also,in the case of catastrophic care , your employer could ask for the care to be covered . It would mean that the "experience rating" upon renewal will take a hit, but it can be done.

Expand this to the astronomical bills that can occur with emergency situations, and you can be stuck with thousands of dollars of bills you may not be able to afford, even though you have insurance. And, if the care is determined not to be life threatening, such as loosing a finger, and you are only partially covered, then your only choice may be to not get the surgery at all. Because ensuring that the profit margin is retained is more important than human health.

You could go to a hospital. Then no bill will be presented. Yes, even dental.

As for your finger , I am confused. No bill there, but in fact your benefits at work will pay you for that finger. Maybe $2000-$5000 , depending on the job you have.

Secondly, that extra billing for work that IS covered by dental insurance, once again, will suffer from the issue of scale. 10% of a 60 000 dollar bill is a lot of money.

Extraordinary is a $60G bill , and frankly I cannot see it. It would be as a result of a medical condition, not your teeth, and therefor paid for by the govt health plan. (OHIP etc)

Insurance is far from perfect, but it has its role. Particularly as it relates to non-life threatening insurance concerns. Extra billing in the dental industry is annoying, but for most people with insurance, at least affordable. When expanded to the scale of charges for emergency health care however, it can be financially debillitating, even leading to bankrupcies (as is so well demonstrated in the US health care system).

Agian, I think you are confused here. Who is worried, because we all have prov health care.

One thing you haven't touched upon is people who don't have insurance. How do we pay for these people to get care?

There are many ways for low income to get work done. Social services has Dentists who work for them, ok contracted by them.

UofT has a huge dental programme and actually had to advertise for people to come in so that the students would have real people to work on, all supervised of course.

Outside of urban zones....is more of a problem. But I also know that many dentist in rural canada will fix you for next to nothing , or be felxible for payment. Maybe they need the house painted etc, a new deck installed.

It can be done.

[stevoh]

Do you have any evidence of this happening? Do you mean "what the insurance industry is willing to pay for" or "what your dental insurance covers you for"? I have never ever experienced dental insurance denying to pay some procedure I was legimitatly covered for. Nor am I aware of such a situation. So since you've made the allegation, provide some evidence.

What your dental insurance covers you for, that is the same thing as what they are willing to pay for. I can think of no private insurance company that is willing to pay for something they have not specifically covered. There are limits and limitations, not something I want to run into in an emergency situation in a hospital. No thanks.

My 28 page dental care insurance document, which I have reviewed, has limitations and limits on all kinds of care, some of which I understand, some of which I don't. No-one can predict which of these treatments I will require, so even if I knew all of the terminology I still wouldn't be able to predict if my coverage was adequate. With public health care insurance, I don't have to worry.

One case in the dental industry I can mention has happened to me. I had a wisdom tooth where the root of my tooth was not straight up and down like normal teeth roots are supposed to be. The roots were curved, so they extended under the tooth in front of the wisdom tooth. I was presented with a bill for the extra cost that this procedure took, since it took extra time.

Imagine if these costs were expanded in the health care industry! You go in with an ailment that the standard treatment doesn't work, or it takes significantly longer to heal than estimated. Your insurance will stop paying after a defined point or after a defined procedure. Not a risk I want to take.

So you have to pay part of the bill. So what? Afterall you get the biggest benefit from the procdure.

Well, I believe I should be able to find an insurer that will pay all of the bill. I had one up until a couple of years ago. I should be able, through choosing another insurer, have that complete coverage. What is the point of a private system if through choice I can't get better coverage? Also, if that bill increased greatly in size such as an operation in the medical industry, then I might just be hooped even if I was only paying a percentage.

I'd be ok with a very basic "welfare" type policy for those who couldn't pay the insurance premium.

So, your solution for canada's health care industry's issues is one that:

- May or may not cover me or my family for an emergency medical situation that occurs to me.

- May or may not completely cover all of my expenses that occur in the hospital, leaving me with a "percentage" bill.

- May or may not protect me from a financial situation, due to medical bills, that could lead to bankrupcy. And then reduces my care to "very basic welfare" coverage as I can't afford the insurance that I was formerly paying.

- Gives only very basic care to those who cannot afford insurance, limiting the type of care they recieve even further.

These are not compromises I am willing to make.

[Renegade]

What your dental insurance covers you for, that is the same thing as what they are willing to pay for. I can think of no private insurance company that is willing to pay for something they have not specifically covered. There are limits and limitations, not something I want to run into in an emergency situation in a hospital. No thanks.

My 28 page dental care insurance document, which I have reviewed, has limitations and limits on all kinds of care, some of which I understand, some of which I don't. No-one can predict which of these treatments I will require, so even if I knew all of the terminology I still wouldn't be able to predict if my coverage was adequate.

Your original allegation was that a carrier would deny to pay a claim which was legimitately covered. You have been unable to provide evidence of that for dental care. I agree that no organizaton will pay what is not specificly covered. This is true for public and private. (for example in Ontario the liberals de-listed physio and will deny paying for it). It is up to you to purchase the most comphrensive policy you need.

With public health care insurance, I don't have to worry.

Of course not, why should you have to worry about the cost when the taxpayer foots the bill. Do you understand one of the reasons why healthcare cost are skyrocketing?

One case in the dental industry I can mention has happened to me. I had a wisdom tooth where the root of my tooth was not straight up and down like normal teeth roots are supposed to be. The roots were curved, so they extended under the tooth in front of the wisdom tooth. I was presented with a bill for the extra cost that this procedure took, since it took extra time.

Imagine if these costs were expanded in the health care industry! You go in with an ailment that the standard treatment doesn't work, or it takes significantly longer to heal than estimated. Your insurance will stop paying after a defined point or after a defined procedure. Not a risk I want to take.

The solution is simple. Buy extra coverage.

Well, I believe I should be able to find an insurer that will pay all of the bill. I had one up until a couple of years ago. I should be able, through choosing another insurer, have that complete coverage. What is the point of a private system if through choice I can't get better coverage? Also, if that bill increased greatly in size such as an operation in the medical industry, then I might just be hooped even if I was only paying a percentage.

You might be able to find such an insurer but no doubt they would charge you a higher premium. See insurers learnt long ago that if you didn't have an incentive to curb costs you wouldn't.

So, your solution for canada's health care industry's issues is one that:

- May or may not cover me or my family for an emergency medical situation that occurs to me.

No I think you would be free to purchase as complete coverage as you wish so long as you are willing to pay the premium. If you want the "all you can eat lobster buffet" coverage plan, you should be willing to pay the premium.

- May or may not completely cover all of my expenses that occur in the hospital, leaving me with a "percentage" bill.

Absolutely. Why should the taxpayer be stuck with 100% of the bill and you the main beneficiary off scott free.

- May or may not protect me from a financial situation, due to medical bills, that could lead to bankrupcy.

If you want unlimited coverage pay the premium. Taxpayers don't owe you imdemnification against bankrupcy.

And then reduces my care to "very basic welfare" coverage as I can't afford the insurance that I was formerly paying.

- Gives only very basic care to those who cannot afford insurance, limiting the type of care they recieve even further.

Abolutely. People who can't afford it get the minimium. People who are starving because they can't support themselves shouldn't get fed steak and lobster on the taxpayer's dime.

These are not compromises I am willing to make.

I don't expect you would, because it is easier on your pocketbook to let other taxpayers subsidize healthcare.

Edited August 3, 2007 by Renegade

[guyser]

[

What your dental insurance covers you for, that is the same thing as what they are willing to pay for. I can think of no private insurance company that is willing to pay for something they have not specifically covered. There are limits and limitations, not something I want to run into in an emergency situation in a hospital. No thanks.

Again, the hospital will not bill you nor the dental plan. So, lets get that one outta here.

My 28 page dental care insurance document, which I have reviewed, has limitations and limits on all kinds of care, some of which I understand, some of which I don't. No-one can predict which of these treatments I will require, so even if I knew all of the terminology I still wouldn't be able to predict if my coverage was adequate. With public health care insurance, I don't have to worry.

Do the math, your dental care is costing you a good chunk of change. If your teeth are good, drop the dental and put that money in an earning account and accrue some more cash.

One case in the dental industry I can mention has happened to me. I had a wisdom tooth where the root of my tooth was not straight up and down like normal teeth roots are supposed to be. The roots were curved, so they extended under the tooth in front of the wisdom tooth. I was presented with a bill for the extra cost that this procedure took, since it took extra time.

In plain english, you got screwed. No bill should have been presented to you. Dentists work according to ODA rates and are not allowed to bill over that. They agreed to it as soon as they took your dental insurance form. Your Dentist was negligent, if not entirely illegal , in not letting you know up front that there are complications with your root canal.He did x-rays of your mouth to determine the problem, and the problem of crooked roots would have been obvious to even you. To hand you a bill 'due to problems' is abhorent. Had it been me , I would have laughed at him and said no thanks.

Ill give you one that occured to me. Root canal and wisdom teeth done in one visit.Tooth would not come out right and the Dentist says "whoops" and leaves the room. Comes back w 2 other dentist to look in my mouth. They confer, I sit and cant hear them.

Afterwards I get a bill to submit to my ins co . I asked him what was the "whoops" all about? He says nothing, not to worry. I say " hey Doc, tell me !" He load me with 50 Percodans and sends me home. Calls me at 10PM that night. Now I damn well know something is up.

Next day I visit him and ask again. He agains say "nothing at all to worry about" I told him flat out right then and there, "Ok, nothing to worry about, then I wont worry about submitting your bill and I also refuse to pay it" "Go ahead and tell me you will sue me, and I will inform you that the College of Dentistry will get in detail what went on . Your choice Doc." Never heard from him again.Never got another bill.

The same applies to a garage mechanic (well dealers anyway and most others) The time for a job is listed in the manual , say 1.5 hours for a tuneup/oil change. If a mechanic can do it in 20 minutes, good for him, you still have to pay the hourly rate times 1.5 .After all, a rusty bolt could slow a mechanic down and it may take him 3h to do the job.

As an aside, root canal is my forte. After having at least 20-30 hours of root canal,and comlications, I can confirm problems do arise. Never got a bill from anyone.

Well, I believe I should be able to find an insurer that will pay all of the bill. I had one up until a couple of years ago. I should be able, through choosing another insurer, have that complete coverage.

Talk to your employer. They decided this on your behalf. As for you getting an insurer to pay for everything, you can do that, after opting out of your subsidized plan, and you will pay thru the nose, much much more than you pay now.

Edited August 3, 2007 by guyser

[Pliny]

Yes, I may get sick and need health care. Yes, it is in everyone's interest to have good health care.

What I am asking is why you don't want good health care? Why are you interested in only the status quo which is one of the worst systems in developed countries? Never mind though, the questions are rhetorical, we already know.

I have never claimed our health care couldn't be better. Of course it can, like any system private or public, constant assessment and improvement is necessary. We have pretty darn good health care though. I don't see it as "worst system in developed countries" at all. I have been to the doctor a fiew times, hospital a couple of times and haven't had any issues. Sure, the wait can be a bit painful (speaking as a person who had kidney stones and had to wait five hours for treatment), but once inside, the care is excellent. Have you had a personal horrible experience with our health care system that is tainting your view?

Not allowing me to economically plan for contingencies in my life by crippling my ability to save due to inflation and heavy taxation is the crime. You decry profit and call it greed. I call it contingency planning and there is much difficulty in doing so because the government considers themselves first stakeholders in my labour.

I have no problem saving for the contingencies in my life. It helps that I don't have to pay high health care insurance fees for care that may not be complete. Get a higher paying job. There is nothing wrong with profit. Its just that when a choice between human health and profit errs on the side of profit, bad decisions are made.

What's with the ad for Pariet? It is just the pharmaceutical companies tagging on to a treatment with an acid blocker from what I can see. Seems a superfluous add-on which is no doubt gloriously peer reviewed and every doctor will assuredly prescribe as an aid in the treatment. This is good health care? And...as I mentioned, not a peep about stomach or pancreatic cancer.

If the add on is as superfluos as you say, then there must have been another motivator to create and market it right? Like.... profit? And gosh, we wouldn't want our health products to be peer reviewed eh? I mean, that would be terrible health care.

If you are working you are paying high insurance fees in Canada. I could do a lot better if my parasitic partner would let me keep more than fifty percent of my earnings.

You seem to misquote me a lot. I didn't say Canada's was the worst. I said it was rated one of the worst in developed countries. You are the one that seems to be denying the fact by constantly reiterating "we have pretty darn good health care". We are actually getting a pretty poor return on our dollar. Our health care system is the best in one respect only, and that is it is the most expensive of any nation in the world.

Yes, profit can be the sole motivator and when government sanctions quackery we are stuck with profit as the sole motivator.

[stevoh]

Good debate Renegade, I understand you points, I just don't agree with them.

I don't agree with segregating the quality of health care based on your income and insurance level. We aren't dealing with cars, vacations, expensive housing, items that, as much as we don't want to, can live without. We are dealing with human health, and human lives.

I honestly can't look at a street person who gets appendicitus and believe that they are somehow less deserving of the quality of care that I received.

I don't want a quick check of my insurance level before I am admitted to a hospital to determine the level of care I am getting for my heart attack.

Add to that the potential of chance, that, like the dental industry, you may require some kind of treatment that isn't covered, despite your best attempts at getting the best insurance you can afford, and the risk is too high.

Private insurance has its place, cars, housing, travel insurance, etc. When the items covered by insurance are easily valued in dollars and cents, and easily replacable for that value, private is best. When the items covered by insurance are priceless, your families health, then restricting that care based on insurance and income level is just plain wrong.

[Renegade]

I don't agree with segregating the quality of health care based on your income and insurance level. We aren't dealing with cars, vacations, expensive housing, items that, as much as we don't want to, can live without. We are dealing with human health, and human lives.

I honestly can't look at a street person who gets appendicitus and believe that they are somehow less deserving of the quality of care that I received.

I don't want a quick check of my insurance level before I am admitted to a hospital to determine the level of care I am getting for my heart attack.

Add to that the potential of chance, that, like the dental industry, you may require some kind of treatment that isn't covered, despite your best attempts at getting the best insurance you can afford, and the risk is too high.

stevoh, yes good debate and I appreciate the responses.

You started your position by implying what works best and what is most effective, but when it comes to the heart of the debate, it is what YOU feel the role of of the state should be. You have prefixed your positions in the all the statements above by what "you want" or what "you believe". What you are really saying is that the state should play the role of the nanny for those who cannot pull their own weight in society. That's fine, but it is not a view of the state I believe in.

Private insurance has its place, cars, housing, travel insurance, etc. When the items covered by insurance are easily valued in dollars and cents, and easily replacable for that value, private is best. When the items covered by insurance are priceless, your families health, then restricting that care based on insurance and income level is just plain wrong.

By saying its "just plain wrong" you are reducing it to a moral argument. That's a subjective assessment isn't it? I may feel it s "just plain wrong" for anyone to freeload on the taxpayers dime. Where it the absolute judge of morality?

[stevoh]

You seem to misquote me a lot. I didn't say Canada's was the worst. I said it was rated one of the worst in developed countries. You are the one that seems to be denying the fact by constantly reiterating "we have pretty darn good health care". We are actually getting a pretty poor return on our dollar. Our health care system is the best in one respect only, and that is it is the most expensive of any nation in the world.

And I put in italics, so it was clear to see, the same quote, take a look "worst system in developed countries". Not a misquote.

Canada' health care is not the most expensive in the world. The US's is. In fact, the American system costs, per person, almost double ours.

Canada: Per capita expenditure: 2669

US: Per capita expenditure: 5711

http://en.wikipedia.org/wiki/Health_care_in_Canada

Yes, profit can be the sole motivator and when government sanctions quackery we are stuck with profit as the sole motivator.

What has happened to you in our system personally that has led to this belief?

[stevoh]

You started your position by implying what works best and what is most effective, but when it comes to the heart of the debate, it is what YOU feel the role of of the state should be. You have prefixed your positions in the all the statements above by what "you want" or what "you believe". What you are really saying is that the state should play the role of the nanny for those who cannot pull their own weight in society. That's fine, but it is not a view of the state I believe in.

Aren't your points related to what YOU believe the role of the state should be? If we aren't debating points we believe in, I am not sure why we are debating at all.

The state should play the role of insurance provider in the sole case of the health care industry because there are too many variables and factors in health care to leave to a company that has to, by nature of being a profit making company, consider profit over the best potential treatment of the patient.

By saying its "just plain wrong" you are reducing it to a moral argument. That's a subjective assessment isn't it? I may feel it s "just plain wrong" for anyone to freeload on the taxpayers dime. Where it the absolute judge of morality?

Well, the absolute judge of morality should surely reside where human lives are considered above any other consideration, wouldn't you think?

[bush_cheney2004]

Canada' health care is not the most expensive in the world. The US's is. In fact, the American system costs, per person, almost double ours.

Canada: Per capita expenditure: 2669

US: Per capita expenditure: 5711

Ahem..if I may..Canada's system is the most expensive by far when universal access is the goal. The US system does not have such a goal. In fact, when provinces fail to meet that objective, they frequently turn to the US for-profit system's extra capacity (and expense).

[bush_cheney2004]

Well, the absolute judge of morality should surely reside where human lives are considered above any other consideration, wouldn't you think?

Human lives are not "priceless", starting with aborted "fetuses". But that's another thread. Canada (and the USA) throw away untold billions to extend human life for a few months, because it is profitable, not priceless.

[Renegade]

Aren't your points related to what YOU believe the role of the state should be? If we aren't debating points we believe in, I am not sure why we are debating at all.

No, I was not debating points I "believe" in. I was debating points I had evidence of. The original point was whether the profit incentive leads to better care. Regardless of whether I believe there should or should not be state intervention, I can show by evidence and examples the effect of profit on care.

As an example although I don't believe in state intervention, I am compelled to agree that a single-payer system is more efficient, and thus I am willing to support such a system.

The state should play the role of insurance provider in the sole case of the health care industry because there are too many variables and factors in health care to leave to a company that has to, by nature of being a profit making company, consider profit over the best potential treatment of the patient.

Dental care is simply a form of healthcare, and by your own admisson you get quality and timely care. What the state "should" do is a matter of opinion. What I have shown is that you can have a great (though not universal) healthcare system without it being state-run.

Well, the absolute judge of morality should surely reside where human lives are considered above any other consideration, wouldn't you think?

No, human well-being is just one consideration. The freedom for people to choose where their funds are best spent is also another. In many cases in society we don't choose "lives" over "freedom". For example, it is not mandatory that I donate my blood even if someone else's life depends upon it. That choice is mine alone to make. IMV the state is not capable of making moral judgements, and those judgements should be left for the individual to decide.

In this specific case, if left to the individual to decide, and you didn't want to see a street-person do without care, then you would be free to purchase his care for him.

In any case, as I had discussed with Riverwind (and he agreed) here, a moral argument is a very weak case to make in the case of healthcare.

[stevoh]

As an example although I don't believe in state intervention, I am compelled to agree that a single-payer system is more efficient, and thus I am willing to support such a system.

So, if, for example, you discovered that the only slightly better care that you get in the US's for profit system than in Canada's state run system (even that point is highly debateable, depending on measures), costs almost twice as much, then you would agree that our system in the end is more efficient, due to performance per dollar?

So, as Canada pays 9.9% of GDP for health care, as opposed to the US'S 15.2%, we are not in fact getting more for our money?

And you are willing to almost double your personal expenditure on health care in order to access that system? For someone so concerned with keeping your own hard earned money, its seems odd to me that you would rather pay a private health care insurance company 6000 dollars a year than have 3000 dollars a year in taxes for the public system.

It does seem indeed that your bias against state run systems is stronger than your personal interest in keeping more of your money.

http://en.wikipedia.org/wiki/Health_care

Dental care is simply a form of healthcare, and by your own admisson you get quality and timely care. What the state "should" do is a matter of opinion. What I have shown is that you can have a great (though not universal) healthcare system without it being state-run.

That has exceptions, caveates, and doesn't cover everyone. Not something I want in my health care system.

In any case, as I had discussed with Riverwind (and he agreed) here, a moral argument is a very weak case to make in the case of healthcare.

Our decisions about what we support are a combination of moral and other factors. If you remove morality from health care, regardless of what conclusions you arrived at with another poster, then you remove a key reason that many people get involved in health care in the first place, helping people. You should not make the decision based soley on morality, nor should you completely remove morality from any decision concerning human health.

[Renegade]

So, if, for example, you discovered that the only slightly better care that you get in the US's for profit system than in Canada's state run system (even that point is highly debateable, depending on measures), costs almost twice as much, then you would agree that our system in the end is more efficient, due to performance per dollar?

So, as Canada pays 9.9% of GDP for health care, as opposed to the US'S 15.2%, we are not in fact getting more for our money?

Sure, I would have no problem agreeing that as a general statement about efficiency. That doesn't mean I would necessarily agree that it is the best system. I can demonstrate to you that it is more efficient if eveyone drove exactly the same model and colour car, does it mean that should be the only criteria.

And you are willing to almost double your personal expenditure on health care in order to access that system? For someone so concerned with keeping your own hard earned money, its seems odd to me that you would rather pay a private health care insurance company 6000 dollars a year than have 3000 dollars a year in taxes for the public system.

Your math is completely faulty and riddled with incorrect assumptions. You assume I am paying the average amount in taxes. Maybe I'm paying $6000, $10000, or $100000, or zero in taxes toward healtcare. You assume I would pay the average cost toward private healthcare. Maybe I'm very healthy and woudl only pay $3000. Maybe I'm very old and would pay $15,000. You cannot take generalizations and extend them to specifcs.

I believe most of the efficiencies in our system comes from the single-payer system. I believe that we can improve our system by keeping the single-payer system, but adopt the insurance model to other areas of the system. We should open up the system to choice and levels of service, while still retaining the efficiency of a single-payer model.

It does seem indeed that your bias against state run systems is stronger than your personal interest in keeping more of your money.

No, not at all. I am at heart very practical. As I have shown you you can't apply average number to make you case, so show me how specificly a completely public system both gives me choice and lets me keep more of my money and you'll win me over.

Our decisions about what we support are a combination of moral and other factors. If you remove morality from health care, regardless of what conclusions you arrived at with another poster, then you remove a key reason that many people get involved in health care in the first place, helping people. You should not make the decision based soley on morality, nor should you completely remove morality from any decision concerning human health.

That people get involved in healthcare for moral reasons is their INDIVDIUAL choice. I don't have any issue with removing morality from individual choices. I do have an issue wth the state making moral judgements on my behalf. I don't think the state should have any right to dictate morality to me, not in where I spend my money, nor in my abortion choices.

BTW, why stop at healthcare. Based upon your reasoning, the state could petty much make you do anything it wanted under the sanction of it being "moral".

[stevoh]

Sure, I would have no problem agreeing that as a general statement about efficiency. That doesn't mean I would necessarily agree that it is the best system. I can demonstrate to you that it is more efficient if eveyone drove exactly the same model and colour car, does it mean that should be the only criteria.

Your math is completely faulty and riddled with incorrect assumptions. You assume I am paying the average amount in taxes. Maybe I'm paying $6000, $10000, or $100000, or zero in taxes toward healtcare. You assume I would pay the average cost toward private healthcare. Maybe I'm very healthy and woudl only pay $3000. Maybe I'm very old and would pay $15,000. You cannot take generalizations and extend them to specifcs.

Considering that it costs, on average, twice as much for the american system, odds are, you would pay more. Sure, it may be possible that you are in a category that would pay less, but its unlikely.

I believe most of the efficiencies in our system comes from the single-payer system. I believe that we can improve our system by keeping the single-payer system, but adopt the insurance model to other areas of the system. We should open up the system to choice and levels of service, while still retaining the efficiency of a single-payer model.

Yes, we disagree here on service segregation based on income.

No, not at all. I am at heart very practical. As I have shown you you can't apply average number to make you case, so show me how specificly a completely public system both gives me choice and lets me keep more of my money and you'll win me over.

Don't confuse choice with better. And you may already be keeping more of your money, chances are, you are.

That people get involved in healthcare for moral reasons is their INDIVDIUAL choice. I don't have any issue with removing morality from individual choices. I do have an issue wth the state making moral judgements on my behalf. I don't think the state should have any right to dictate morality to me, not in where I spend my money, nor in my abortion choices.

So you want to choose your police departments, your fire departments, you want to call 911 and choose which emergency service provider you have? There are many instances of emergency measures that we remove "choice" from because economies of scale and people opting out make management and realistic use of the system impossible. You happen to draw the line at the health care system, why not draw it with those other emergency services as well?

My argument is soley in the context of the health care system. That the type of care we get and the amount of money we spend it more than reasonable, and considering the other benefits, no-one without care, no non-insured emergency spending, no co-payments, by my reasoning, its more than worth it.

BTW, why stop at healthcare. Based upon your reasoning, the state could petty much make you do anything it wanted under the sanction of it being "moral".

Because health care is where I choose to stop and the people we vote into power reflect those choices.

[Renegade]

Considering that it costs, on average, twice as much for the american system, odds are, you would pay more. Sure, it may be possible that you are in a category that would pay less, but its unlikely.

Part of the reason that Canadian costs are lower are that prices are regulated. The state dictates to the medical profession how much it will pay for a particular procedure. I am not for the american system. I agree that there are thngs which drive up the cost. Similarily there are parts of the Canadian system which would benefit from change.

I am not proposing an Americn type system. I would propose modifications of the Canadian system where people pay a part of the actual cost, where contributions to the system are reflective of the risk of using the system, and that tiers of care are offered. I don't see that what I propose would change the Canadian cost structue at all and in fact may reduce costs. Your analogy that I would pay more, are way off base.

Yes, we disagree here on service segregation based on income.

People with better income buy better food, better shelter, and better clothing. It is completely consistant that is extended to healthcare. If you at least want to be consistent in your position, you should be against allowing any privlidege based upon wealth in society.

Don't confuse choice with better. And you may already be keeping more of your money, chances are, you are.

Actually it is irrelevant if I keep more or don't. I believe that one should pull their weight. If for me pulling my weight meant paying more, I'd be happy to do so.

So you want to choose your police departments, your fire departments, you want to call 911 and choose which emergency service provider you have? There are many instances of emergency measures that we remove "choice" from because economies of scale and people opting out make management and realistic use of the system impossible. You happen to draw the line at the health care system, why not draw it with those other emergency services as well?

Absolutely I'd like to have more choice in those areas too if it were possible. For example if I lived in a high-crime area, I may wish to purchase premium police protection. Isnt' that sort of what we do anyway, with the purchase of private securiy forces to supplement police protection?

Certainly I'll agree that it is a goal. We can discuss whether it is implementable in each of those areas. It certainly is implementable in healthcare.

My argument is soley in the context of the health care system. That the type of care we get and the amount of money we spend it more than reasonable, and considering the other benefits, no-one without care, no non-insured emergency spending, no co-payments, by my reasoning, its more than worth it.

The problem is while you may consider it worth it, I may not. Your system presumes you should be able to force me to accept a system which you consider acceptable. Personally I'd be ok with what you propose if it let me opt out and take me healthcare tax dollars and spend it at the provider I choose. But it doesn't, and it woudl likely collapse if it were an open system.

Because health care is where I choose to stop and the people we vote into power reflect those choices.

That's fine if the people you vote for actually get into power and act consistent with your choices, but then you shouldn't complain if some other party gets into power and forces its moral choices down your thoat, because afterall you have already agreed that the government should be imposing moral choices on people.

Edited August 3, 2007 by Renegade

[Pliny]

And I put in italics, so it was clear to see, the same quote, take a look "worst system in developed countries". Not a misquote.

Canada' health care is not the most expensive in the world. The US's is. In fact, the American system costs, per person, almost double ours.

Canada: Per capita expenditure: 2669

US: Per capita expenditure: 5711

http://en.wikipedia.org/wiki/Health_care_in_Canada

What has happened to you in our system personally that has led to this belief?

Are you a journalist or something? You have taken my statement completely out of context. How can you even pretend that is what I intended to say?

Statistics are a poor form of argument unless methodology and extraneous criteria are known AND knowledge of the interpretation of statistics is known. Comparing the per capita health care expenditure dollar for dollar is of little value. Much more can be spent in the US on health care than in Canada as a matter of choice. The many non-Americans who seek medical treatment in the US also skew that statistic.

The truth is, there are no shortage of people who wish to point out the failings of the American system, the WHO not excluded. I still maintain they get better value for their dollar. You are somehow implying that a government can run something efficiently, a hard point for anyone below the level of Marxist to believe.

The private system may have a basis in profit but exists only because it can provide a service at a cost people are willing to pay. The public system not concerned with profit concerns itself with cost and attempts to limit service according to cost, either way economics, the bottom line, factors in. Profit may be the private concern but limiting costs is the public concern. Choice being available to the consumer places a limit on profit. Attempting to limit costs serves to limit choice and quality to both the providers and ultimately the consumers of a public service and it only follows that limited choice results in a demand for better service which negates attempts to limit costs, and so the spiral goes.