G West:
How 'bout adding that link you provided on another thread the other night - about what some Americans are saying about private/public medicare.You were looking for an appropriate place for it. Maybe this is the spot worth waiting for.

All you have to do to see the path we're headed is to look south. The mess that claims to be the US health care system is a significant reason why I'm moving north. The lowest 20% income earners in the US enjoy health care below the average health care in Belize. Is this what Canadians want? Don't blink -- that's where we're headed!

"for profit medical care was tied into high mortality rates",NO KIDDING !

that's the way the right wing gets your cash faster,killing off your parents or other family members in their care, with neglect.

just ask campbell why he is too busy to answer a few question...that's because he's too busy shearing sheep for his masters.

Campbell & Co. have already made their drcission on health care for this province, their problem is how to sell it to the province. The last election came as quite as a shock to Campbell, as he nearly lost and certainly showed how fickle the BC voter is. Certainly they do not warm to Campbell and his cronies and a misstep on health care may vault (Wet Noodle) James into the Premier's chair.

Certainly some private health care is welcome and is not the doom and gloom, predicted by the radical left. My recent brush with the health care system demonstrated to me that something needs to be done.

No Cambell did not learn anything on this junket, as it is all smoke and mirrors. Change is needed, but I do not think it is the changees that Campbell wants!

Dozens of Ontario doctors are urging the Provincial Liberals to keep hospitals public. Argue privatization will cost the system more in the long run ...

Mar.Â*20, 2006. 04:48Â*AM
ROBERT BENZIE
QUEEN'S PARK BUREAU CHIEF

In an open letter to Premier Dalton McGuinty being made public today, dozens of doctors from across the province are urging Queen's Park to "stop the privatization of Ontario's hospitals."

"We call on the government to act in the public interest and to use citizens' dollars responsibly," says the letter opposing hospitals built by private-public partnerships, or the so-called P3 hospitals.

"Hospital construction and services must be publicly funded and hospitals must remain fully publicly managed and serviced," says the letter, written on behalf of the left-leaning Ontario Health Coalition, a lobby group opposed to two-tier health.

It was signed by 69 doctors, including University of Toronto researcher Nancy Olivieri and health consultant Michael Rachlis.

"The solution is for hospital redevelopment to be funded publicly. Governments can obtain much more favourable borrowing terms than can the private sector.

"The public will pay for our hospitals either way. But with public funding, we avoid the higher costs of P3s and keep hospital management, property and services in public hands," the missive says.

"And we stop the growth of a for-profit health industry that has an interest in two-tier health care from which they can take profit, further increasing the cost of health care."

When the previous Progressive Conservative government first broached P3 hospitals several years ago, the Liberals promised to curb the trend.

One week before the Oct. 2, 2003 election, McGuinty attacked then-premier Ernie Eves for proceeding with P3 hospitals in Brampton and Ottawa.

"I'm calling on Mr. Eves to halt any contract signing when it comes to P3s in the province of Ontario. I stand against the Americanization of our hospitals," McGuinty said at the time.

But since winning the election, McGuinty has triggered 22 new private-public hospital projects.

The Liberals, who forbid the public use of the term "P3" by government officials, refer to their P3s as "Alternative Funding and Procurement," or AFP, and claim their model is tantamount to paying a mortgage on a new hospital while the Tories' plan was like paying a lease.

But the doctors say in the letter that "AFP is a version of a ... P3, in which for-profit consortia take over financing, construction, facility management, maintenance and some hospital services for long term deals stretching up to 40 years."

What nobody seems to appreciate that Campbell's plan, based on brother Mikey's and the Fraser Institute's propaganda, is to bring in US and other foreign service providers, who's profit demands will then, under WTO and NAFTA rules, overrule all public decision making rights.

The privatized system could be overruled in Sweden, because the public voted against it, but in BC, or Canada it will be permanently entrenched, with special rights under NAFTA Chapter 11 rules, to kill the publicly owned and controlled system.

I wish, people who write these articles would finally come to term with and start talking about the realities for the reasons of so called "free trade".

Ed Deak, Big Lake.

Ohmygawd
Good idea. The first one is in the current issue of the New York Review of Books, you can find it here: http://www.nybooks.com/articles/18802

The second one is the New Republic but I don't think it's on line any longer. I will see if I have a copy of the article and post it in later when I have a minutes.

Cheers

Here's the second one:
This is long, so it'll have to be spread over 2 or 3 posts:

Such widespread insecurity might be understandable (though not necessarily forgivable) if it were the unavoidable consequence of an otherwise well-functioning health care system. After all, economics teaches us that tradeoffs between efficiency and equity are inevitable. But medical care in this country is inequitable and inefficient. The United States pays more for its health care than any other nation on the planet: 16 percent of our national wealth, at last count. Money spent on health care is money not spent on other things, like corporate investment and wages. That's an exorbitant cost that even Americans with secure health insurance pay.

"Exorbitant," to be sure, is a subjective word: Money spent on well-applied medical technology might be worth it. But, perversely, our extra spending doesn't seem to buy us better medical care. According to virtually every meaningful statistic, from simple measures like infant mortality to more carefully constructed data like "potential years of life lost," Americans are no healthier (and are frequently unhealthier) than the citizens of countries with universal health care. Nor do Americans always get "more" medical care, as is commonly assumed. The citizens of Japan, for example, have more CT scanners and MRI machines than we do. And the French, whose system the World Health Organization recently declared the planet's best, have more hospital beds. They get more doctor visits, too, perhaps because their access to physicians is nearly unfettered--a privilege even most middle-class Americans surrendered with the spread of managed care. In fact, aside from cost, the measure on which the United States most conspicuously stands out from other advanced nations may be public opinion: In a series of polls a few years ago, just 40 percent of us said we were "fairly or very" satisfied with our health care system, fourth worst of the 17 nations surveyed.

The last time a Republican president presided over a nation with serious health care problems, in the early '90s, he had little of consequence to say until he was about to lose reelection. And, while this Republican president talks about health care more frequently, none of what he says is particularly encouraging. To conservatives, it is axiomatic that the private sector can deliver health insurance better than the public sector. It was precisely such thinking that led Bush and the Republicans to insist that private insurers, not the government, be put in charge of providing drug coverage to seniors. The result has been chaos, with seniors baffled as they try to figure out which plans cover which drugs and, even worse, with many of the sickest and poorest Medicare beneficiaries unable to get their prescriptions during the program's early days. The only benefits the program delivers effectively, it seems, are enormous subsidies to insurance companies.

But the Medicare drug benefit is just a taste of things to come. The right's real hope for health care is to radically transform health insurance altogether, so that risk is gradually transferred away from large groups (i.e., the government and large employers) and onto individuals (i.e., you). And, while Bush promises that this approach will empower consumers by offering them more choices, the effect would be just the opposite. Insurance works best when large numbers of people share risk, so that modest premiums from a large number of healthy people cover the very high medical costs incurred, at any one time, by just a few. Enacting the conservative agenda would unravel such arrangements, shifting the burden of paying for care back from the healthy to the sick. The worst-off would be those left to buy insurance on their own, directly from insurance carriers rather than through their employers or the government, since they will be at the mercy of underwriters who screen out bad medical risks. Beat cancer? Have your diabetes under control? Well, no matter. The commercial insurance industry still wants nothing to do with you--at least not at a price you can bear.

And the final paragraphs, if anyone is still with it:

Not that the corporate elite and the right-wing politicians who they have in their pockets like so many nickels and dimes will ever allow it, BUT do we not have the ability to disolve nafta and simply walk away from it?

p.s.- did anyone notice how similar harper "the plump"'s afhganistan 'cut and run' speech was to idiot non-savant bush's??
Actual multi-word segments including the now infamous "cut n' run" were simply transplanted.
I guess corporate/fascist mouthpiece david
frum(p)has found himself a new speech writing gig!!

JesterJogger, love your touch with names -

harper "the plump"
and
bush the "idiot non-savant" are priceless.

Frum(p) is worthy as well, I miss Barbara, and wonder how David grew up so retarded, he was most likely a whiney child. Axis of Evil, my ass, what does he mean, Cheney, Rumsfeld and Rice? Actually it's bigger than that and includes Alberto "the Geneva Conventions are Quaint," Tom DeLay, the devil's own emissary to Texas, Scooter "go to jail already" Libby, Karl "Turdblossom" Rove and I could go on all day and still never get around to Victoria. By the way will we ever know anything about the Search Warrants on the Legislature or has that been filed away with "Drunk on Maui?"

rkewen
I think the explanation for 'David' is Murray Frum, not Barbara - but that's another story. I think the warrant is now scheduled to be made public on the 28th.
Still think PeeWee Rambo is in the running - for Harper, I mean.

Ohmygawd
You'll notice the Tyee has now posted the same NYReview article on the sidebar. It's the same one I mentioned elsewhere on this site some time ago and posted earlier this morning - word's obviously getting round.
Hope some people take the time to read it!
Cheers.

Excellent and defining point, Fiat Lux.

Do we really live in a democracy anymore?...when the real power in capitalist democracies is being entrenched in ways, like NAFTA that represent, preserve... and further facilitate the interests not of the majority but of the priviliged few.

...as we see with "Harper the Plump"'s (thanks jesterjoggger) current US wannabee foray into Afghanistan.... Where is the consent of the Canadian people in this?

Where is the consent of the Canadian people for privatized health care?

It's really not necessary any longer, because the power of consent..."the consent of the people" no longer resides in parliament anymore, but in the power of the backrooms, boardrooms, the stock markets... and their vehicles like NAFTA, Chapter 11 etc....set up by the relentless betrayals of our publically elected officials in the interests of that small oligarchy who use our economy for their private profits.

It is no longer about the democratic, collective wish of the people, of the majority... but about the collective wish of the few.

So for Campbell there will be no learning curve, he's already showed us a zillion times in whose interests he works... it's all a little song, a little dance...a little Swedish martini down his pants....

: Bytesmithsposted: 5 Hours Ago

Ok, having been down there and seeing just how corrupt they are, I would really like to see where you came up with this little gem, any links?

OK
I think I am going to give up and go home, my brain is not functioning.

this is the full quote,

Some great anti-American ideological blabber. Once again just fall back on the Americanization argument when in doubt. Through in a couple profit is the death of society barbs and your done.

The best title is the "Profit motive upped death rates" PROFITS ARE KILLING PEOPLE!!!!!!!!!!!!!!!!

This article constantly mentions failure within the Swedish system. Yet gives no example of what these failures were. I guess it failed because a switch of ideologies in government. Please all mighty issuer of propaganda tell us why the Swedish experiment in privatization failed?

An article about the abysmal failure of privatization in Sweden with no examples of how privatizing went wrong. Nice propaganda. I wouldn't expect anything less.

JIm:

http://www.healthcoalition.ca/truth-about-sweden.pdf

One of my Canadian-born relatives moved to California and now he's a U.S. citizen. Last time he visited Vancouver, we had lunch together. We discussed politics. He generally votes Republican.

He grumbled about rising gasoline taxes in California. I pointed out that smog in Los Angeles and other cities is largely caused by automobiles. I suggested that when people in Los Angeles and elsewhere wind up with massive hospital bills as a result of smog-induced pneumonia, athsma, cancer, etc., perhaps automobile owners should be responsible for paying those hospital bills instead of dumping medical costs onto victims and innocent bystanders. I was very surprised when he agreed. Up until then, he was usually opposed to any form of universal public health insurance.

Preventing smog-induced pneumonia, athsma, cancer, etc. to begin with is much more humane and financially responsible than torturing victims with chemicals, surgery and radiation after the fact - regardless of who pays for the instruments of torture known as "health care."

The main benefit of transferring health care costs to those who cause health problems is that it encourages prevention. When smog producers have to pay for the health effects of their smog, they will want to find ways to reduce smog production. If smog-related health care costs are added to fuel taxes, that will increase the pressure to replace smog-producing buses, trucks and cars with much cleaner hybrid vehicles. And it'll increase the pressure to rationalize zoning laws and other laws to make it easier for people to live closer to where they work, shop, attend school etc.

I am not claiming to know the answer - and nobody on this board should either.

Not one of us here is any kind of health care delivery expert.

That being said, it is clear that our system is NOT working. If you socialists, want to hammer for profit health care, go ahead. However, PLEASE provide some feasible alternatives.

Swedes are different than Canadians - they apparently support paying 75%+ income tax to support their social infrastructure.

Well - although many posters on this forum would prefer the Swedish alternative, Canadians at large do not.

mabellbc
Have you actually read what many 'Americans' are saying about their own messed up system? You might want to check out those tax rates in Sweden too.
JIm - you obviously haven't because the only thing you've mentioned is Sweden - wake up man!
Talk about mindless drivel.

In response to you, mabellbc, I'm going to post an excellent comment made by someone named "bun" on a recent Tyee article on healthcare:

The article is about Sweden's failure in privatized health care. So it makes sense to mention Sweden, unlike the author. Going off on tangents about the US health care system when discussing Sweden's doesn't make sense to me. Once again your just falling back on anti-Americanism whenever you can't properly defend a point. Easy.

Lynn provides some info, it's too bad the author couldn't do that when he was concocting his propaganda. I'm very skeptical of the source you provided, but at least it's something.

This article is about Sweden's privatization failure. It doesn't say why it failed. The supporting arguments for the failure of Sweden's privatization where a Canadian example and an American example. This is poor journalism. Very poor, Grade 2 level. Maybe lower. It show the only way to defend your position is through rhetoric.

JIm
Did you read the piece from th New York Review of Books? Are you suggesting that the New Republic is poor journalism?
Man, give your head a shake. I'm not sure you can actually read. Perhaps it's that grade 2 education that's letting you down.

If you can cite cases where private for profit health care is delivering good results to the whole population of a jurisdiction then go for it. In the absence of anything but the kind of stuff you've just posted I'll continue to ignore you - the only one spouting rhetoric is you, dude.

cycling commuter gave a succint example of what we as citizens should be expectant of when we are a society...

you drive i ride a bicycle,how come i don't get a tax break for not polluting ?

how come when you pollute and cause illness to me, i have to pay?

get real,this is a system that people like mabellbc make money off by parasitic means...we subsidize people like mabellbc,they can poison us without recourse and then say it's our fault and we should pay.

another campbell acolyte disembling in our midst...

Better check on Swede's tax rates. Not 75% but closer to what we pay in total taxes but they get considerable return for their taxes compared to our own.

Once again, anti-American rhetoric. That's all you have. It's funny actually.

And again going off on tangents. I've never said that we need use 100% private care and that has never been suggested by anyone. Once again a debate can never happen because the anti American rhetoric needs to get in.

The dude remark really emphasizes your deep thinking solutions.

Let me guess you'll respond with an anti American statement.

I'm looking forward to the article on the private role within Frances health care system. Of course no French information will actually be used in that article. Supporting research and examples will be limited to information from the United States and Canada only.

mnlogger,look at the RATIO PER TAX PAYER AND COUNTRY POPULATION.

it amazes me to no end when people talk of small countries versus large countries,population wise and then expect us to agree with their findings.

canada approximately 32million people

united states approximately 350 million people

now just on these figures make a valid representation of what we spend and they spend

and then justify going to private health care with numbers you can get from all the countries the campbell clan went to that pushed private health care.

YOU CANNOT DO IT.

last time i checked how many americans were unable to afford health insurance...

45 million americans without health insurance.

that's private health care for you and the numbers are right under your fingers at any time .

JIm
When you get that grade 3 graduation certificate and can prove you actually know what rhetoric means come on back. You're obviously here on some kind of a mission and haven't got a clue. That's not rhetoric, that's a conclusion from demonstrated fact.

Sandborn writes...

What the hell does that mean? Does Apoteket manufacture the drugs and sell them to the public? If so, it sounds like cloning to me. Didn't we have somewhat the same thing before Mulroney sold us out in the "free" trade agreement? Poor U.S. drug companies - all that research expense. Isn't that why the selling price of drugs is about 10,000% more than the manufactured cost?

Let's be fair, though, JIm does ask relevant questions. I too would like to know about the Swedish failure and WHY the Swedes rejected the privatization model.

jacks, I guess you cannot remember back to when MULRONEY sold the farm to BIGPHARMA all them years ago.

if you like chasing your tail,keep asking questions that the PHARMACOMPANIES have the answers to...and i suggest you brush up on your history concerning the low prices we USED TO PAY,and the high prices we now pay thanks to SCUM like LYIN BRIAN MULRONEY and his FREETRADERS.

AND A LOT OF THOSE SCUM ARE WORKING FOR THE HARPER CREW ,BENT ON THE SALE OF CANADA.

thank them for the DESTRUCTION of one of the best health care systems in the world.

grub
That's not what I was objecting to. I was appalled by his attitude that it was anti-american to look at what Americans are actually saying about their own health care system. As for what happened in Sweden, I think it's pretty clear that the voters rejected the move toward privatization.

Isn't that precisely what's in danger of happening here?
But, no doubt Premier Campbell will be letting us know if that's not true.

It's off topic but the gauntlet has been thrown and I must answer!!!
Just heard on the CBC harper's response to shapiro's ruling.
What an arrogant pr!ck!!!
Same go's for the lame, so called "day-care" program.
You might've fooled some of the people harper but you're exactly who I always knew you were.
Exactly. Arrogant hypocrit, liar and petty dictator with delusions of granduer.
Same as your buddy bush.

Another forum falls victim to JIm and mabellbc an their ilk. It was really quite interesting till they joined in, mostly about the issues with a little rhetoric thrown in here and there. Then JIm shows up with his uncanny ability to take a statement out of context, extrapolate it to an absurd conclusion and apply vitriole to anyone with a contrary opinion. Suddenly the whole thing becomes about personal criticisms and insults. JIm, I admire that talent, although it always seems to result in a distinct drop in the tone of the forum. An object lesson for us all: Don't Feed The Trolls!

Thanks, grub for trying to refocus things. As for the reason that the Swedish people rejected privatization of health care, it seems to me that they became aware of the inequities that the system was providing and voted with their collective conscience. Hard to believe, huh?

Excuse me for repeating this ... but it seems like a significant insight into an area which (admittedly) I had often blamed for the urge to privatize health care:

In an open letter to Premier Dalton McGuinty being made public today, dozens of doctors from across the province are urging Queen's Park to "stop the privatization of Ontario's hospitals."

"We call on the government to act in the public interest and to use citizens' dollars responsibly," says the letter opposing hospitals built by private-public partnerships, or the so-called P3 hospitals.

"Hospital construction and services must be publicly funded and hospitals must remain fully publicly managed and serviced," says the letter, written on behalf of the left-leaning Ontario Health Coalition, a lobby group opposed to two-tier health.

It was signed by 69 doctors, including University of Toronto researcher Nancy Olivieri and health consultant Michael Rachlis.

"The solution is for hospital redevelopment to be funded publicly. Governments can obtain much more favourable borrowing terms than can the private sector.

"The public will pay for our hospitals either way. But with public funding, we avoid the higher costs of P3s and keep hospital management, property and services in public hands," the missive says.

"And we stop the growth of a for-profit health industry that has an interest in two-tier health care from which they can take profit, further increasing the cost of health care."

When the previous Progressive Conservative government first broached P3 hospitals several years ago, the Liberals promised to curb the trend.

One week before the Oct. 2, 2003 election, McGuinty attacked then-premier Ernie Eves for proceeding with P3 hospitals in Brampton and Ottawa.

"I'm calling on Mr. Eves to halt any contract signing when it comes to P3s in the province of Ontario. I stand against the Americanization of our hospitals," McGuinty said at the time.

But since winning the election, McGuinty has triggered 22 new private-public hospital projects.

The Liberals, who forbid the public use of the term "P3" by government officials, refer to their P3s as "Alternative Funding and Procurement," or AFP, and claim their model is tantamount to paying a mortgage on a new hospital while the Tories' plan was like paying a lease.

But the doctors say in the letter that "AFP is a version of a ... P3, in which for-profit consortia take over financing, construction, facility management, maintenance and some hospital services for long term deals stretching up to 40 years."

Its good to see Sweden had the sense to stop their private health care experiment before their public system was destroyed.

The neo-jerks won't convert our system to a private system all in one go, it'll take at least a decade. They'd like us to believe that they'll just start with a couple P3's and let a few dozen more Coupland clinics establish themselves.

We'll continue to see the demise of our public system which will acclerate as doctors, nurses and other trained professionals move out of the public system for the more lucrative private system.

The right wing has thier ducks in a row and has developed all the policies, law, and agreements they need to strip us of our most valuable resource, public health care. So long as we keep voting for the likes of Harper and the as of yet unknown Liberal, we continue to put our future in jeopardy.

"and their ilk"... Somebody call?

JIm, keep on! You know that with this bunch, where there's a will, there's willful misunderstanding.

While the readers are paying attention, the peanut gallery just isn't constituted to deal with a challenging argument. They'll just make up something ridiculous and claim that's what you said.

As you noted, This article started to be about Sweden (and wasn't all that accurate or informative while it lingered briefly in that region) but was never really about anything but a re-hashing the ideology of public monopoly on Health Care.

Canadian Health Coalition. Sounds reasonable, and maybe they are, but they are not impartial about private health care.

From their mission statement....
http://www.healthcoalition.ca/10_goals.html
"7. Eliminate profit-making from illness. Public administration of medicare has saved Canadians billions of dollars. The practice of "deinsuring" health services by eliminating them from Medicare coverage, the move to user fees, the creation of profit-making clinics - all these changes create a two-tier health care system where private insurance companies profit. There is no room for profit and inequity in health care."

How obliging for Mr Sandborn to allow them another kick at the cat.

tcahill
Speaking of 'ilk' - I thought you didn't indulge in that kind of stuff except when you were attacked personally.
Haven't noticed anybody attacking you - just discussing ideas: In fact, nobody was attacking you ‘cause you've just been lurking in the weeds.
So, where's the ad hominem stuff coming from? You might be surprised at what this 'bunch' with their 'willful misunderstanding' are actually capable of – things like reading, reasoning and debating guys like you to a fare thee well.

Last time I accept your claims that you're only interested in rationally debating ideas. I'd have thought a fellow who thinks the sun rises and sets with Liberal ideas would be out here defending the health care system that was the cornerstone of Mr. Martin's recent and ineffective and losing election campaign.
CHeers.

If the free enterprise system, and private health care are the 'cats meow', then shouldn't health care in Alberta be the best in all of Canada?

Here's a province that has bought into the neocon dream in a major way. But the 60,000 residents of Fort MacMurray and the tens of thousands of construction workers have extremely limited access to health care.

Rather than having a government that invests in public infrasturcture, the people of Alberta were bought off for$400, their profit sharing gift. Individually, small amounts of money don't have a significant impact on peoples lives. But combined, that amount of money could create better health care and education for the people of Alberta.

But then I realized, you can't move to a private system unitl you completely screw up the public system, and that's going to take a bit more time.

Right now, I'm opposed to privatizing healthcare. But, is there any doubt that it's getting ever-more expensive and seemingly unresponsive?

Are there any creative ideas out there about how to improve the system without necessarily throwing buckets of money at it?

It would be nice if people could recognize the benefits that both types of systems have to offer. We all sit here and throw around statistics out of contenxt so that they mean nothing (45 million without healthcare in the US for example - nowhere near this number goes without health services). This solves nothing and fails to address the problems our system faces. However, a system that fails to penalize people for the aweful health choices they make isn't likely to solve our current health budget crisis.

And if I want to spend $3000 dollars on surgery instead of buying that big new TV, then why should this service not be provided in Canada and by a Canadian doctor?

And doesn't it trouble anyone in here that surgery rooms in hospitals are not running full time?

grub
Yep, read the Romanow report. It was no way a defence of the status quo and was full of recommendations (particularly in the area of preventative care) that would begin to turn this thing around. I can't believe how anyone, looking at what the situation is in the states, would want to go that route. Americans are desperate to find a way out of the mess that corporate health care and big pharma have backed them into - we need to learn from that and move carefully. Take the cumulative impact of Campbell's tax cuts and plow them back into an intelligent and modern version of the system we've got now, by all means, but don't go to a two tier system where private enterprise will poach the high value, low risk stuff for profit and leave the rest of the problems for the public system. Then we’ll really be in trouble with an ageing population and crumbling infrastructure.

It seems that some are confused about the distinctions between 1) Canada and US Health systems, 2) universal and private health insurance, and 3) public and private health providers .

Canada has a universal health (insurance) plan and a mix of public and private health providers. For those who missed the obvious, many, if not most Canadian doctors are self-employed or involved in private practice. The system is a hybrid of public and private health care. Public Health organizations collect premiums, set rates and priorities and manage the overall system, making payments to private and public health service providers. Any Questions?

The United States has a few targeted public health programs, many private health insurance businesses, and a bunch of people with little or no coverage. It also has a wide mix of health providers, both public, non-profit, and for profit. The United States has proven incapable of adopting anything near a universal health plan.

The significant distinction between the Healthcare systems of the USA and Canada, is that Canada has universal health insurance. If you are a resident, you must pay premiums, and your health care, for better or worse, is covered.

It is way beyond Science Fiction to suppose that either Canada or the USA will adopt the other's medical system. For myself, I'm really tired of all the fake patriots who seem to think Canada is perennially on the verge of Collapse and assimilation into the US.

G WEst:

I'll put that on my reading list.

The preventative angle sounds good... in the long term. But what do we do right now, with obese, cigarette-smoking, cancer-ridden citizens, never mind the rapidly aging populous?

Are there "thinking out of the box" solutions to our healthcare system. I have some expertise in the educational sector, but am willing and open to learning about healthcare solutions.

RightLeftIdeologue
Then take your 3k to the states and get it done there. Permitting queue jumpers in the public system will ruin it. There needs to be much better management of resources and utilization of the available professionals. In Saskatchewan several private clinics have eliminated their backlogs just through more efficient planning and scheduling. The studies are out there. Even computerization of medical records would go a long way to increasing efficiencies and reducing costs. This is not rocket science. Education is another thing that needs change now and fast – both for doctors and nurses – the system now is absurd. Student doctors all across Canada spend much of their last term at university flying back and forth across the country to interviews for residency positions. In this day and age that is totally absurd considering they are really just going to be students for at least another two years (in the case of general practice) or longer for other specialties. What an incredible waste of time and money. There are lots more examples of anomalies in medical education too.

It troubles me RightLeftie. There's a lot of efficiency which could be integrated into the present health care system; vast numbers of middle managers cause waste and complexity that is unneeded. Hospital administrators, for example, are vastly overpaid and renumerated with outrageous severance packages when let go. Supervisory staff spend nearly all their time covering their butts, and shuffling responsibilities back and forth. The privatization agenda Campbell has in mind requires that the present system must first be sabotaged, which isn't really that hard, given the demographics of Canada today.
There are great gains to be made in proactively promoting HEALTH. Simple yet effective exercise regimens, such as those offered by physiotherapists, have been de-listed by Campbell et al, yet these alone, if available to the general public with minimal fees, would serve to greatly reduce our need for health care. Many of today's yuppies are hypochondriacs, overly concerned with vague and disturbing ailments which waste doctors' time, necessitate unneeded medical imaging etc etc ad nauseam..heh, heh..

Why will permitting Queue jumpers ruin the public system? Is this self evident?

It is astonishing how much noise a vacuum makes. We've just read one local wag urge Canadians who can afford top quality health care to take their money to the US! Why, because queue jumping will ruin the system! So it would be better to syphon off Canadian funds to enrich the US system?

Such nonesense!

Say you have a public health care facility, open 12 hours a day. The public system will only fund 12 hours of surgery per day. Why shouldn't I be able to purchase the services of a surgeon to work on my knee after hours?

tcahill, someone sees the futility of dogma... if I take my $3000 to the US, it is $3000 that is going to fund the US health care system, not ours. We lose in the end, all in the name of ideology.

the ageing population is what the freemarketeers want to exploit.

our system ran great for years until garbage like LYIN BRIAN MULRONEY came to town,he and his cronies set canadians up for REAL EXPLOITATION.
when you pay exorbitant amounts for medications made for pennies,you get into the realm of those $700.oo hammers and whatnot expenditures,that you find doing government contracts.the rip off mentallity when they think no one is looking and they just go crazy with greed.

remember how much money was put into the system.

ask yourself why the provincial and the federal governments cannot explain where the money went,yet it was their responsibility to see that monies properly designated...and it never was.

they can tell you the monies were spent...but nothing else.

Thanks for the uninformed opinion thomas49... I hate Mulroney as much as the next guy, but your argument doesn't make any sense.

RightLeft: Calling it dogma is unfair to dogma! At least dogma is usually consistent. Most of this knee-jerk stuff is just simmering ill-will disguised as moral superiority.

tcahill and grub
You're right about it being obvious - everyone knows that. Doctors operate mostly private professional corporations. This is hardly news.
If they want to operate outside the public system, let's say for things like cosmetic surgery, let 'em do it. As long as it's not an insured service covered by the Canada Health Act so be it.
But if the service is a covered service then the provisions of the Canada Health act apply. The point is that once you let private surgery facilities into the market for the public health dollar they will skim off the cream and leave the costly and risky stuff to the public system. In the states, Medicare patients on kidney dialysis frequently get to share dialysis diaphragms with as many as 2 dozen other patients - that's one reason why chronic kidney disease in the states has a much higher morbidity and mortality rate than here in Canada. The information is out there if you want to find it.
My son is just finishing a 5 year residency and he's turned down offers of salary in excess of 300k /year with 22 weeks holidays from more than one health district in Alberta. Moreover, no, he's not going to the states and he's not looking for more money. He, and many of his colleagues (like some to the doctors quoted in the piece from the Star up above) actually care about the future of the system and they're trying to help save it. The problem lies elsewhere, in my opinion.

22 weeks holidays? That's like 5.5 months off per year...

People seem to lose sight of the fact that the government can step in to regulate things like kidney dialysis. You create a law and make it contrary to the law to use the diaphragm more the once.

As well, if you can tie the any infection back to the use and re-use of diaphragms, you have may also have a solid tort claim.

RightLeft:

Whoaa! Hold on a sec. I suspect there's merit to thomas49's assertion that pharmaceutical costs are higher due to Lying Brian kissing corporate a$$es.

Seal-his-own-doom apparently did not read the New York Review he shared with us earlier, and says, sure, doctors can moonlight, but not as part of univeral care delivery.

That's just another form of self-inflicted damage. If you do not permit the regulatory environment and priority management of the universal health system control the private delivery of health care, then the funds will bleed out of the system, making it absolutely (as opposed to relatively) poorer.

The NYReview has an excellent section on the concept of "adverse selection". Perhaps some of us could go back and review that part, then consider the implications of driving the affluent and those who would service them out of the universal health plan.

Grub... it is true, he may have been on to something, but there was substance, only assertion. Arguing costs is only effective if you can illustrate how much worse off we are because of some action he took when he was in office. Without knowing any of that, I would say Canada does pretty well by way of its generic drug industry...

Do I really have to explain why permitting queue jumpers will tend to ruin the public system? I do think it's self-evident.
That doesn't mean that there aren't great efficiencies to be had by reorganizing the current mess and there's no doubt that savings from administrative changes are important too. But going the other way is fatal. Look, I'm on my way out for the evening - read the stuff that's already referenced in this thread; read the Romanow report; think about what happens in any for profit situation - corporations and shareholders don't invest in enterprises that don't have a chance of making a reasonable return - so, where does the return come from?

That's why the American system is so much more costly than the one we have now and it's also the reason so many people don't have health insurance down there – they can’t afford it. It's one of the reasons that major illness is the main cause of personal bankruptcy in the US.
Gotta go.

damn, that hurt...I meant "no substance"

No one can explain why queue jumping will damage the system eh?

Let me try... if we allow Dr. Martin to purchase his way into surgery for his knee 6 weeks ahead of time, for an extra $5000 dollars, this would be called "jumping the queue" I assume. Because his knee bothers him so much, he can't perform surgery himself, so he basically wastes his time shuffling paper waiting for the queue to move forward. In the meantime, because he is out, all the surgeries he has missed are being backed up, this includes a couple of doctors who are now not seeing patients.

Well, he figures to himself, "I like being a surgeon" so he flies to the Mayo Clinic and gets it done in a day, for $10k. Because there are so many Canadians doing this, the Mayo Clinic is able to hire 2 additional surgeons just to keep up with the Canadian demand. Ironically, both were enticed from Canada. Now they pay taxes to Uncle Sam, instead of John A.

RightLeft: Good response to the kidney dialysis issue. I'd just like to point out again the fallacy we see so often from those who seem to think Canada is perennially on the verge of Collapse and assimilation into the US. You can see it in the point you were responding to.

Here, the implication is that the Canada Health act is this rigid, fragile thing that would collapse if the slightest change were attempted. For some, the fear is so intense that even the slightest movement in the Canadian system is mistaken as a quick slip and fall into a US Medicare dialysis ward.

You can't reason with this kind of paranoia. Some people just can't, or don't want to, admit that our universal systems management, regulation and oversight role would continue unchanged, because we already have a mix of private and public service providers.

RightLeftIdeologue
Just thought I'd refresh before I shut the computer off and left for the evening - you haven't got it, by the way - the reason why queue jumping is bad. And, tcahill, my example of services permitted outside the system was deliberate - cosmetic surgery - I thought you'd have the wit to realize I meant things like nose jobs that aren't in any way medically necessary. As for gov’t regulation - there are regulations in the US now. That didn't stop a medical facility in NY State from harvesting Alistair Cooke's bones for transplanting into a patient - look it up if you like.
Anyway, everything I've told you is true - not that you ideologues care.

rightleftideologue,you probably have read of the defence contracts where contractors overpriced their services,their tools and just about anything they thought they could get away with.

like you liberals...

you and tcahill sound pretty rehearsed in your dialog.

ripping off people never makes sense to a psychopath,they always see things as doing business their way...like campbell...like you

uninformed,me? not with a computer and the ability to use dozens of search engines.

you liberals should really get better help,that tcahill is really a detriment to your cause,his little blurb up top contains nothing we don't already know,and a snotty attitude doesn't turn us into converts...

then again it shows your disdain for common folk when you talk down your nose at us...

you are so easy to spot,the odour of your hypocrisy precedes you.

Nobody who posts to this site is common folk.

As I said before, most of this knee-jerk stuff is just simmering ill-will disguised as moral superiority.

But, I don't need to pull out the word "psychopath" to make a point though. Examples and facts work so much better, which is why I would urge you to use some the next time you put forward an argument.

G West still hasn't provided that reason for why queue jumping is so bad. And the plastic surgery market is no worse than the fast food industry--it fills a craving. Interestingly, without the advances development in cosmetic surgery, we wouldn't be nearly as advanced in related forms of treatments for burn victims.

And again, in response to this Alistair Cooke's bones example for why everything in the US is going to hell... didn't the facility receive a massive fine and jail time for the individuals involved? Hmm... smells like another red herring. Our perfect system has had its share of problems my friend... have a read of the Krever Report (tainted blood).

All I ask for is perspective. Ours is not so perfect, and theirs is not so aweful.

Rightleft: Unfortunately, most of the time posting here is like trying to debate Chimps who have learned how to throw feces. Luckily, on the internet, nothing gets on you.

hey tcahill,hows the gout ?

hope you are well medicated,got a good buzz on ?

you guyz are so well rehearsed,practise at the club ? did we ?

This could happen in Canada...it has nothing to do with having a private healthcare system.

http://news.bbc.co.uk/1/hi/world/americas/4742844.stm

US authorities have charged four men with looting bones and body parts from more than 1,000 corpses and selling them for medical transplants.

geeze ,rlideologue,g west has been providing those links forever.

talk about uninformed...

The three P approach should be amended to:

Public + Private = Pain

I had the experience of working in the U.S. health care system a while ago. I had to do a week of field work with the L.A. sales rep for the company I worked for. I had to go down there, instead of working in Edmonton in the dead of winter. Tough choice.

The big surprise was that half of this guy's accounts were on the verge of bankruptcy. Those large glass-walled hospitals, the pride of the U.S. healthcare system, could not even pay their bills for routine medical supplies. My colleague spent about half of his time in the accounts payable departments, getting them to write cheques for suplies bought and used, a full year previously. Then and only then, would Head Office in Boston, release product to fill current purchase orders.

A week later, back in Edmonton, I had to listen to then premier Peter Lougheed, as he expounded on the advantages of private medicine in the U.S. That day, I relaised how well some people can cope with microcephaly.

So, if you want the Vancouver Hospital to folow their model, you had beter be prepared for longer waiting pewriods for your MRI. The hospital may not be able to buy thew basic lab supplies to do it.

Some provinces are already there of course. In Quebec, for example, it was standard practice, 10 years ago, to sit on all invoices for six months before processing them. It may have improved since then, or it may be worse. I say go for it. You have nothing to lose but your life.

RightLeftIdeologue: Thanks for trying to keep it interesting and honest. I think at this point, it's just you and me and the troll. I'm signing out...

Fish-counter: Sorry! didn't know you were with us.

On this fish-counter's last point, there are also issues with the public assuming the risk when the private actors involved in a 3P become insolvant. It bothers the hell out of me that the true cost for things like the Abbotsford Hospital partnership are never released to the public ahead of time. And then, even when they are, the numbers are skewed. Perhaps there should be an interprovincial audit agency that handles this kind of thing...

Thomas...scroll to the top and point out where he provided the link that I listed. And if he did provide this link somewhere at sometime then it wasn't evident that he read on to inform himself of the consequences in the US of stealing bones.

hey genius,didn't one of those NDP wonks ask for a forensic audit on that abbotsford hospital deal...

years ago?

how uninformed are you ?

You are welcome. For the few who don't know this, or may have forgotten, there are 40 million people in the U.S. system who have no health care coverage at all. There aren't that many Canadians living in Canada. It would translate into about 3 million north of the border.

One farmer who was diagnosed with kidney disease went home and put a bullet through his head, rather than put his family through bankruptcy-by-catastrophic-illness. That isn't just a story; it is a fine example of for-profit healthcare in action.

G West has been providing links for the past month since i have been here posting...and as to being informed as to what happens in america when you rob graves ,is DIFFERENT IN EVERY STATE...GET REAL.
you want to flame me get a brain first,as you can see tcahil knows better and has cut and run,like a typical liberal,too afraid to fight and not intelligent enough to really know how.

just empty rhetoric...yadda...yadda...yadda

Ideologues love to use names too. Yes, the NDP did ask for an audit, which should have been provided. Just because I ask questions that challenge your stance doesn't mean I subscribe to a particular political party. I just don't agree with some of the points you are making, though maybe I would if you made them clearer. The point of this exercise is to debate the issues.

rlideologue,you are no challenge at all.

Again, thomas49, your facts are wrong.

The bones issue is not a state matter--harvesting bone tissue is regulated by the Food and Drug Administration, which is a federal agency. As well, issues that cross state lines, which this one might, are investigated by the Federal Department of Justice and the FBI.

rightleft: the troll you are arguing with posts under many different IDs, but the same desperation for attention and delight in side-tracking. You'll find his moronic antics all over this site under one name or another.

rlideologue,those were not presented as fact,you been hanging around the overfed and gout ridden tcahill too much...you on meds too?

and you can see the old guy is really short on temper,he loses it real easy...

I've lost more than you'll ever find, UNDERSTANDME.

METROPOLITAN DESK New York Times

Dentist Surrenders in Inquiry Into a Scheme to Loot Corpses
By MICHAEL BRICK AND ANDY NEWMAN (NYT) 512 words
Published: February 23, 2006

A dentist at the center of a broad investigation involving corpses plundered for bone, tissue and other marketable parts turned himself in last night to the Brooklyn district attorney after receiving an order to surrender, the district attorney's office said.

The dentist, Dr. Michael Mastromarino, turned himself in at 10 p.m. The charges against him could not be learned last night. His lawyer, Mario Gallucci, said that he had not been told the charges but that his client was innocent.

''They've told me nothing,'' he said. ''They've told me once he's in custody, like I told you earlier, they may give me more information.''

A report of forthcoming indictments appeared in The Daily News on Sunday, and The New York Post reported yesterday that four people had been indicted. The Brooklyn district attorney's office declined to confirm or deny those reports, but scheduled a news conference for today to address an ''announcement regarding illegal tissue harvesting.''

The investigation began in 2004, after a business dispute involving the sale of the Daniel George & Son Funeral Home in Bensonhurst, Brooklyn, law enforcement officials have said. In a series of interviews with the police, the funeral home operators, Robert Nelms and Debora Johnson, made an escalating array of accusations against a trade embalmer. They have since left the city and have not been asked to surrender, said their lawyer, Eric Franz.

In one meeting with investigators, Ms. Johnson accused the embalmer, Joseph Nicelli of Staten Island, of removing bones and replacing them with pipe. Mr. Nicelli has business connections to Dr. Mastromarino, whose dentistry license has been suspended. Dr. Mastromarino operated Biomedical Tissue Services of Fort Lee, N.J., which sold human tissue to processing companies, until the business was shut down by the government this month.

As medical technology has advanced, the tissue-processing industry has developed quickly to fill a demand for muscle, bone, tendon and skin to be used in transplants, therapies and research. The industry is regulated by the Federal Food and Drug Administration.

After the investigation was reported in newspapers in October, bereaved relatives began coming forward to complain that their loved ones' bodies had been plundered. Some charged that Biomedical Tissue had altered paperwork, changing death certificates to show heart attacks where there was cancer, for example. Several of the company's customers, including a New Jersey company, Tutogen Medical, issued recalls.

In December, as the investigation continued, the district attorney's office notified the family of Alistair Cooke, the British broadcaster and commentator who died in 2004, that Mr. Cooke's body had been plundered.

On Feb. 3, the Food and Drug Administration shut down Biomedical Tissue, charging that it had listed inaccurate information on the ages and causes of death of people whose tissue it offered for sale.

Photo: Dr. Michael Mastromarino, left, surrendered at the Brooklyn district attorney's office last night in an inquiry into illegal tissue harvesting. (Photo by Seth Wenig for The New York Times)

wrong id tcahill,colin tried that on me as well,but you mental midgets never think someone lurking can have similar politics...

then again that's probably why you have no friends and spend your pathetic existence typing out your life instead of living it.

http://www.gao.gov/new.items/d0463.pdf

http://www.post-gazette.com/pg/04219/357527.stm

Funny how the troll knew I was talking to him!

http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1

Alcibiades: excellent reference material. Were you going to give us your context on this?

I see we've been visited by an ancient Greek

Just asked a friend of mine to drop by with a little supporting documentation I understand you gentlemen were looking for.

tcahill,reading your posts are educational and downright enlightening to the UBERMENSCH mentality,so it's no big deal understanding your narrow minded stance and your grossly overinflated ego.

your rhetoric is that of a real elitist,but your execution is rife with insecurities...you really are nothing more than a little ,little man,puffed up behind your keyboard...like the wizard of oz

Supporting of what, exactly?

The context should be obvious. If you want more I'll arrange for my friend to provide it. I assume you've figured out, while I was gone, the reasons why queue jumping is fatal to a universal system with equitable access. You can't allow folks to bid up the price for a scarce resource because that will inevitably affect its availability and cost for those whose freight is paid by the public system.

Next time , don't accuse me of dissembling or trying to pull the wool over your eyes. My time here is too valuable to waste it on those kinds of stupid games. If people in this country want to sabotage their health care system I can show them how to do it and I only have to look across the border.

I assume you still haven't reviewed "adverse selection" in the article you claim to have read.

And your other friend, mr ideology or whatever he calls himself, if you run into him tell him he's wasting my time too.

Of course I have. THe Americans have different problems than we do because they're starting from a different point of departure. It requires different analysis and a different set of solutions.

It wasn't our eyes you are pulling the wool over, it is your own. Your fear of change is palatable, and indeed...

Yes, you can, and have already. Recommending Canadians take their health dollars south of the border will certainly accomplish that.

No, you haven't. Adverse selection...

You can see where this is going. The insurance company would quickly find that because its clientele was tilted toward those with high medical costs, its actual costs per customer were much higher than those of the average member of the population. So it would have to raise premiums to cover those higher costs. However, this would disproportionately drive off its healthier customers, leaving it with an even less healthy customer base, requiring a further rise in premiums, and so on.

tcahill your twisting and taking out of context statements show the kind of troll you really are.

like i said,you are a little,little man

Substitute Wealthy people for Healthy people, and what remains is a de-funded system, no longer universal, and two-tiered in fact, because you've insisted, quite inconsistently, that the pool of providers cannot be broadened to include private sources.

As long as universiality is maintained, you've got nothing substantial to complain about. The private clinics, if permitted to fully function in the universal health care system, would have to take the rates set by the system.

What the for-profit crowd would love is for people like GWest to prevail in the debate. They would have a non-universal health system removing itself from the high-value added services that more and more Canadians want and can afford to pay for.

Adverse selection applies in an insurance system although there are ways around it but not without an enormous regulatory burden. That's the advantage of a single-payer universal program - you don't have selection going on among possible consumers and providers of services with insurers trying to select the 'best' clients from the point of view of generating profit. It's so elementary I assumed it required no further explication. That's simply why a private for profit system doesn't work, why it always ties to limit its risks and its costs and why it won't lead to a decent health care program for anyone.

This discussion is about an insurance system. That is what the Canada Health Act delivers. You are the one who is trying to break the universal program.

You can't maintain universality if some members are more equal than others. If you permit the wealthy to jump queue and get services out of turn you have to charge them more for the privilege. If you charge them more then the incentive for the dr is to do slightly more patients from the paying group and fewer from the public group. One thing leads to the other and nudge/nudge wink wink pretty soon the public system is either starved or less well remunerated. More Docs decide to do more for pay work and less public work and pretty soon the average guy and the poor are further down the list than they are now. That's the system we used to have - we don't need to return to it.
Do you really think the fiddle wouldn't be in - give me a break.

More equal that others....
Jump queue...
get services out of turn...

That's three red herrings in a row.

tcahill states"the private clinics,if permitted to fully function in the universal health care system,would have to take rates set by the system"

mister you are so vacant,it is unbeleivable...when did you last see a doctor say that he/she would list their services for any less than they could ask...supply and demand ! they can ask/charge what they want for as long as they want because we have a short supply of doctors,or haven't you noticed.

your rhetoric is as empty as it comes.

no substance whatsoever in your debate.

Universality is not the only important element of the system. It also has to provide equity and you can't have an equitable system if well-off people are permitted to pay for services and avoid the line-ups. That's just a matter of definition. I don't want my rich neighbour getting his hip transplant before my dad does just because he happens to have the extra $10,000. Once you permit that the system is dead and if you have any sense you know that.

THose aren't red herrings. That's reality. If you want to jump a queue head south - I give you my permission. It's your soul after all:But I won't stand by and let people like you who think money is the only way to evaluate a person's worth destroy the one thing that really makes this country unique and special.

The line ups exist because demand is greater than supply. The market is not allowed to respond to demand. Universality it the indispensable component. The public monopoly on provision of services is a myth and an absurdity: it posits that only unionized workers can conscientiously deliver health care.

Oh, you'll stand there alright, and flap your arms and make a lot of silly noise. GWest: defender of all that is good.

I suppose you'll accuse me of being an affront to God next.

Unlike some, I don't evaluate people's worth.

tcahill your last post is really absurd,been into the scotch have we.

Like hell it does. Doctors aren't unionized - they're professionals paid by a single payer system that tries, according to specified criteria, to see that their scarce but valuable and universally needed services are distributed equitably. The system needs more money and it can surely use more planning and better utilization of resources. Making it possible for the rich to subvert the system every time they feel like it won't do anything but make it worse. You are a myth and an absurdity.

Once again tchill you can't handle a real discussion without starting to call people names. That's it, you're not worth the powder man.

This myth can type. Doctors are, by and large, private practitioners. That is something you just won't wrap your head around. You're just going on and on, but Canada's health system is already and always has been, a mix of private and public providers. How often can you blink past that?

What the hell did you think you were doing after I left this post and shut off my computer? Do you think I can't read? You are such a piece of work, I read what you said. I told you that everything I'd written was true - apart from the opinions obviously - and you went right ahead and said you thought I was spinning and hadn't read material that I posted here days or even weeks ago. Before this story was even posted. Give me some credit. You may not agree with me but don't tell me I don't have the information to support what I believe.

if i remember correctly tcahill was a member of the council of canadians that debated free trade.didn't you brag about that tcahill?

small wonder we got free trade hanging around our necks like a millstone with the kind of reason you see in this debate.

absurd positions and empty rhetoric.

and he actually thinks he's some kind of intellectual ! a real UBERMENSCH this guy!

wipe the drool off your chin there and take your meds...and thank god you have the health care you have.

I never denied it. Look back at what I've posted. I give up. THere is no point talking to a stone.

OK. I'm sorry I called you defender of all that is good.

like i said,you got a real snotty attitude,tcahill and reading your posts makes me smile at the emptiness of your positions and the real vacancy of any substance.

the same bull$hit,over and over and over...

what a joke !

Yeah, don't do me any favours. But don't 'ever' try to tell me I've made something up, haven't done my research, or posted anything that wasn't a fact which could be supported by real data and real-world experience. I consider what I'm doing here to be important work - hopefully some others do too - my objectives would be totally subverted if I didn't know what I was talking about. I don't have all the solutions for health care in this country but I know pretty clearly what won't work. And letting one class of people buy better or prompter care than every other class of people in this country will kill the one essential thing that keeps this unlikely place together. It may not happen all at once, but I am convinced that if it does happen it'll be one of the main reasons why this little Canada experiment doesn't endure. And that would be a real shame, just so my neighbour can jump my dad's position in the queue.

GWest said:

If universality of coverage is extended to private surgery facilities, then you've alleviated delays. Those facilities tend to invest heavily in the costly and risky stuff. The difference is they invest without tapping the public purse. If they invest wrong, they're gone, without a loss to public funds.

Actually, you do make stuff up. Not as in fibs, just in the great leaps you make from a premise to a conclusion. You suffer from the delusion that Canada about flush it's medical system down the toilet and make a flying embrace of the medical disaster down south.

Baloney.
These guys do day surgery kinds of things. Stuff that requires techinical expertise. I have no problem with bringing them in as part of the system as long as they don't facilitate queue jumping or charge more for ready access. The Romanow report has no problem with these too as long as the services are covered by the Canada Health Act and paid for just like any other specialist service. But that's not what these guys want to do...they want to have the ability to operate both in and outside the system at the same time and that's where the problem lies. If they perform services for hire they are not, then, obviously available to perform publically funded services and the public system suffers. SO, as long as the clinic only performs covered services, no problem. The minute it tries to do both there is a big potential problem.

The fuss is over queue jumpers but the problem is that there are queues. Private health providers have the means to alieviate queues. The Canada Health Act, in whatever form emerges from the Supreme Court of Canada, will hopefully defend universality. Meanwhile, let universal access and competition encourage the best providers to flourish, and the worst to wither away.

Tom, thanks for such a brilliant article!

Did you read what I said? Of course opinions are opinions. What's your point? You accused me, up thread, of doing something quite different from that and you did it in a mealy-mouthed supercilious kind of way, need I remind you:

Every single premise is backed up by evidence. Of course no one knows the future, that's why the call it the future. I may be wrong but I don't think I'm wrong not to rely on looking through the world with rose-coloured glasses.

And need I remind you of your silly, self-rightous hubris?

Yep, that's exactly what you want in matters of health care. Incompetent doctors providing cut-rate services to the poor and Cadillac care for the rich. How do you think Medicare in the States got into such a mess? Not to mention the potential for enormous litigation costs and the attendant rise in overall expenses. Think man!
I’m sorry, I shouldn’t say this but that comment is beyond stupid. Good night!

There you go again.

You 'don't' think money is the only way to evaluate someone's worth?

How crazy is that? Why would someone purse the exchange of ideas, if the only medium of exchange they valued was money?

What does a person's worth have to do with money? What do you mean by worth?

My point, obviously, is that if money provides the key to unlock the health system for some, it won't be available for others - or at least not as soon and maybe not as professionally. You seem to want to let people jump the queue if they've got the money to do so. THat is, in my opinion, putting some kind of price on their relative worth. WHat would you call it? If you have the money and I don't; and if money is the deciding factor - would you be surprised if I soon began to think of myself as somehow less good or worthy than you are? And if not, why not?

I acknowledge that happens already in all sorts of ways in a capitalist and materialist culture. But in matters of health, that, in my opinion is different - or ought to be different. That's the kind of essential human equity that the system was designed to reflect and, in my opinion, it has made this a better country than it was before we got universal health care. I really believe that we mess with it at our peril. We all start out helpless and most of us end up helpless, more or less, at the other end of our human journey. At one time or another, some more than others, we all rely on the help, assistance and good will of out fellow man. It is one thing that enables all of us to share in some common experience of our humanity and I don’t think guaranteeing a basic standard of good health care for everyone is too big a price to pay for that. If it’s rationed according to monetary measures then you lose that small but essential sense of shared humanity and community forever.

I have to line up to take a ferry to leave or come home. Generally speaking, I don't like queue jumpers. You've made up the assumption that I am otherwise. If anyone is going to jump to the head of the queue, it ought to be the one with the greatest need.

When I had my surgery, I was deemed critical, and I was wheeled right through pre-op, passed a dozen or so others waiting for their turn, straight into the O.R. I was very suprised by this, as I'd been led to expect long delays and cancelations. It turned out that I was wisked through because my condition was thought to be life-threatening. No body asked if I had any money, and I didn't pay more or less than anybody else.

What I think we need to consider very carefully is that a huge wave of conspicuous consumers (the baby boomers and the follow on waves) are about to become heavy consumers of health care. They have a lot of money and they are used to buying what they want when they want it. They are willing to pay for it.

We need to ask how we are going to deal with that. Many people sense that there is a great opportunity to enrich the entire system by following wise policies that allow these health consumers to put their money into the health care system to the benefit of all.

I do not know right now how to let the system take their money. That does not mean there isn't a way to do it while preserving universiality. It just means we need to keep our minds open and active until somebody figures it out.

Back for a second... the one thing everyone leaves out is how we will pay for this baby boomer generation as it moves towards consuming greater and greater levels of health services. We are heading for a collision course provided by a smaller tax base and more demands made on existing services. Unless the public system can figure out a way to manage its costs affordably...and by passing costs on to users somehow, there is no way that our younger generation is going to be able to bear the tax burden they have coming.

So if it isn't about private health care, there had better be another solution built in somewhere. Anyone have some ideas?

Well, we have premium assistance for those who would otherwise have difficulty paying. These people don't get less access. Perhaps we need to look at a progressive premium (like a progressive tax). You pay based upon what you can afford to pay, and everybody gets the same service.

tcahill, you've brought up a point that I've tried to make many times. the way we pay for our healthcare is not up to par with the way others, such as France, Switzerland and Germany who all pay a percentage of their income 14-20%.Nor is as understandable (ambigious taxation). Most of the righties who respond seem to believe that they pay too much already or that if they are going to pay more they'd rather have it go to a "private type" insurance system. My thoughts on it are why they'd be willing to pay more to profit but not to help your fellow citizen. I've developed my beliefs from decades of exposure to the healthcare system here ,first as I watched my dads slow, painful death and then as a lowly union support worker.... You are wrong about nobody on this site being a "common folk" I am and I'm also one of the strongest supporters of our system....

perhaps a solution is as obvious as adjusting the premium upward to reflect the total system cost of health care, then raise the cut-off for premium assistance to some upper-middle class threshold ($75,000 - $$100,000 per year). Phase out the assistance as incomes rise, until at the upper-middle levels, users are paying full price. The thrust of the government contributions could be assuring everyone can afford the premium.

tcahill, RightLeft, G West: interesting discussion, although I'm not sure I caught whatever it was that caused the rancor.

I have no real issue with the system as it is now except that, as tcahill pointed out, if there are queues, there are problems.

I also have difficulty with what I see to be logcal inconsistencies in some of the arguments for the status quo; but I'm willing to have that straightened out. As several have pointed out, the current system is already a public-private mix. First, doctors operate privately. Further, when I need tests done, my doctor writes a "work order" and I take it to the nearest lab -- close to home or close to work -- without making an appointment, and I take a number just like at the deli, and then wait a few minutes. This seems like good service. Where's the down-side to these labs?

What about dentists? [just an aside, I've never understood why dentistry -- or optometry, for that matter -- is considered to be "outside" of the medical system] Don't we get decent service from our dentists working in a very private sector (so long as you have dental insurance -- but that's a different matter)?

So, I've been thinking, what would be wrong with private clinics for things like cataract surgery? I understand this is now a very routine procedure. Why wouldn't this work like the labs: pick up a "work order" from my GP, head to my neighborhood Midas Muffler of Retinal Care, take a number, and have the procedure done? What am I missing in this?

tcahil,has been flogging the same argument since i first started reading this sites articles,two months ago.

in a nutshell he wants YOU TO PAY for a system you have already paid for a long time ago.his position on the public/private mix is old schtick,the que jumping is a non issue as he pointed out and no one has caught,because if you are deemed life threatening in need ,you get it immediately.

what he wants and poorly disguises is the ability to pay for QUE JUMPING on the medically necessary life threatening issues,but you have to get QUE JUMPING into the mind of the public as innocuous,so they don't scream when daddy dies because tcahill got his surgery first by paying for it.

the man is a patronizing ,manipulative liberal hack playing all that come with the same arguments and no real substance,just long winded empty rhetoric.

if you read anything into his postings that even come close to helping the health care system,post it for all to see.

and i mean the system we have and want to clean up from the abuses of the past politicians and their acolytes,like tcahil.

he points out time and time again,he wants you to pay regardless,so how many times are you going to pay for something you have already paid for.

subsidies,are a dirty word and you note tcahill has never used that word,but the intent is all through his posting.

subsidise,me says tcahill,cause i been supersized one to many times and i need immediate care and i got the money,SO ME FIRST.

Chavez in Venezuela is using Cuban Doctors and technicians in exchange for Oil.

Doesn`t Cuba have an excess of Doctors and medical technicians..many of whom drive cabs or work as waiters etc. in the tourist industry.

What about bringing in a bunch of Cuban Doctors in exchange for..wheat? Lumber?

we have doctors here from other countries driving cabs and cleaning floors as janitors.

there was a segement on the tube recently about how long it took them to get accredited here and the blocks and hurdles canadian doctors put up to stop them.

and canadian doctors know letting in out of country doctors reduces demand and that means less money for the doktors here.

so its about the market?

Grub
The rancor, frankly, was a result of the fact that tcahill and his ideologue friend didn't want to accept as factual any description of the shortcomings of the current American status quo and insisted upon the pretence that I was somehow fudging the evidence. Obviously there are problems with the current mess - not least the fact that there is a clinic in Vancouver now offering 'world class' (whatever the hell that is) health care at a premium for anyone who wants and can afford to pay for it. What is going on south of the border is infinitely worse. I believe we shouldn't go that way because there be dragons, so to speak. My opponents last night weren't prepared to discuss those issues on the merits and the moment I left the discussion for an hour or two they decided to question whether or not my evidence was factual. I haven’t got time for that sort of garbage and it pisses me off. They do want to be able to manipulate the queues in one way or another – as their initial remarks plainly indicated. Thomas’ summation of their point of view, in my opinion, is pretty accurate.
Bob, as for Cuban doctors, I’m all for it. Two of my kids were born in Ottawa and their pediatrician was a doctor who had fled Chile after Allende was overthrown – he was great – if the Cuban doctors are as well-trained they’d be an ornament to our system.

tcahill, it might be obivious to you and I but something tells me it would be a tough sell to the upper earners.

Grub, good dental health is vital to your physical health. It has been directly proven to contribute to heart disease as well as linked to kidney , liver, GI type problems. Eye exams can alert you/your doctor to high blood pressure and other health risks, so you are quite correct in your confusion on why they are not included in healthcare. It must be because of the costs; a root canal (such fun! NOT!!) cost is based on the amount of root(s), molars have four, I believe, front teeth one. My root canals cost about $600 each. thankfully I have a good dental plan but it costs dearly.

one point people keep forgetting is that the health care system was put in place so we would not,LOSE THE FARM.

it was to cover basic and LIFE THREATENING ILLNESS',but somehow it was called upon(by doctors and clients)to encapsulate things that were never designed to be in the system.

the BASIC PREMISE still works but it has gotten bloated by GREED and those looking for MIRACLE CURES for their loved ones,at our expense.

Gw
The Cuban doctors are good from what I`ve heard.
There are a lot of Cuban Doctors in Africa as well as Central and South America.
The Canada Health Act is left to the Provinces to administer? Am I correct in that? Undoubtedly the systems needs an overhaul..how much of the present situation (mess) has been intentionally created i.e. starved by Martins cuts in transfer payments?
How much are our Doctors undermining the Universal system from within ..if at all?
Where do the majority of Doctors stand? There are a few vociferous Doctors from both sides of the debate but what are the views of the majority? They are such a tight-lipped group, they keep their cards pretty close to the vest but they wield a lot of power. What are their ideas on solutions?

What concerns me is being thrown to the ideologically driven Gordo/Klein wolves.

I guess everybody is free to decide where the rancor comes from. Some people, and it is the very same ones who are most strident about Canada's differences with it's southern neighbour, seem to think that a mere wave of some right-wing wand is all that it would take to transform us into the clone of the US.

Rather than discuss Canada's health needs, they would rather obsess over what the US does wrong.

If anybody is so confused as to mistake my instance that our health system is not and will not become anything like the mess the americans have -- to confuse that as some endorsement of the US system, that comes out of a profound feebleness of argument and limited ability to comprehend anything contrary to cherished prejudices.

tcahill,people need only read your previous posts to see your attitude of the UBERMENSCH talking down to the simpletons.

your last post proves your manipulations are trite and ill thought out.

your patronizing manner to those who agree is laughable,but,it is the way you debate.

rather pathetic,as i said before, you have some notion you debate well,so deflate the superego and go tend things you can do well,whatever that may be.

BLONDE PITBULL: There is always resistance to paying more, but there is usually acceptance of paying more, for more value. Most of the wealthy in Canada have more in common with the Bill Clinton type "my government thinks I pay too much tax, but I'm willing to pay more".

A full-cost premium borne by the rich would still be an averaging out of the cost spread over the population. The deal is attractive at any income level if it means that one would wind up paying much less through universal premiums than one would face in a serious health crisis.

No body would argue that the rich get their medical services for free. The usuall argument is that they are able to pay much much more and get the best service and care. A full cost premium would mean that the average rich user would pay no more or less than they already do for health care. They would simply be covered, just like everybody else, if their health deteriorated.

Gw

I met a chemical sales/person (polymers) from Washington State back when I was working at the Pulp Mill..I asked her how she got into the very tough Chemical Sales racket...She said she`d worked in the Medical Insurance racket down south but had to get out of it. I asked her why. She looked me very straight in the eye and said softly "Because they KILL people"

I went whaaa...she repeated .."Because they Kill people and I wanted no part of it"

btc
There's actually some interesting stuff - including some from a docs group in Ontario - back up this thread a ways. Many of the young docs are idealistic and open to new and innovative approaches. Many of them don't buy into the drug company mantra that starts pounding on them from first year on and they do a lot more practical hands on stuff in med school right from the start now than they used to. The McMaster model has pretty much permeated medical education.

That's not to say that many of the older guys aren't idealistic too - not everybody is out to maximize their profits. A lot of docs from our generation do wonderful things with their time and knowledge in a number of places in the third world – and in isolated Northern communities in Canada too. There is a big battle coming though and there's no doubt ideology plays a big role. The guys who want to cut up the system will use the frailty of our parents and their increasing dependence upon a system that isn't capable of coping with the bulge that's going to be passing through it soon to impose so-called market discipline.

I just think it's germane to look at what the market's done down south before we go that way.

Obviously, a reversal of the Campbell first term tax cuts and more bucks spent smartly and in the right place would make a difference. Clearly, the feds are as much to blame as anyone but at least the Liberals seemed to have a genuine philosophical commitment to the program - some of the time at least. Harper, on the other hand, is philosophically inclined the other way and is only saying the right thing now because he hasn't had time to soften up the electorate yet for what he really has in mind. In my opinion that's the market option and, as I said, like those 15th century maps - there be dragons!

In fairness, citizens do have to step up and pay more attention to their own health and the lifestyles they lead and it wouldn’t be right to imply that we can’t help ourselves quite a bit in finding ways to get out of the mess and to look after our own health into the bargain.
Cheers.

Why are you lefties so obsessed by whether it's public or privately owned? Is it because that's what the unions tell you to think?

The most important measures are whether sick people are treated well, and quickly. Public or private is irrelevant.

The sacandalously-long waiting lists in Canada (example: one year to get an appointment in the chronic pain clinic) show that our system needs substantial improvement.

I think Premier Campbell should be congratulated for not falling into the ideological trap that you lefties find yourselves in.

Down south, they have pure unmitigated capitalism ruling over the health care debate. It may not be much of an exaggeration to say they have more regulation and control over their capital markets than they have over the delivery of their health services.

Up here, we have de facto and de jure public control over health care in a mixed public/private system. Our polity accepts a much larger government role over all aspects of our lives. Why isn't there any comfort and confidence in that fact over there on the left? Why is there this intense vitriol and paranoia whenever anybody wants to examine the public/private mix?

i remember looking at some maps of some mariner when i was at the louvre in paris years ago.
they were exquisite drawings and cartography was an art form back then,even today amongst some folk.anyways,your little quote"there be dragons" was in calligraphy in some foreign language and one of the visitors asked the atendant what the writing meant.

thanks for that little reminder of how really simple the human mind is."THERE BE DRAGONS ".

like the unknown,we are expected to swallow from politicians,who don't know what they are doing ,but it's not their a$$ on the line ,is it ?

they always send someone expendable to do their dirty work.

Tcahill's idea about having those in the upper income bracket pay full price is abhorrant. What does this entail, that if I am making $120k per year that I am going to have to pay for all my healthcare costs to the point of bankruptcy? IF this is the case, then why should I be denied the right to by insurance? Actually, if thats the case, you'll see high income Canadians flying south.

That's easy. Because during the time that various kinds of right wing parties - Liberals or Conservatives have been in power - basically forever in this nation - they've managed to take a country that they should have been able to manage successfully even if they were idiots and screwed it up. Why wouldn't the left be upset?
As to the anger, my observation is that most of it comes from the right wingers and not the leftists after all.

And then HaraldKann... complaining about politicians but likely unwilling to get out and make any difference yourself eh? Quite whining unless you are willing to work to change the system. And posting your complaints here doesn't count.

RightLeftIdeologue

Bye!

Though I should say, at least Tcahill has ideas beyond simply maintaining the status quo. Its not the right that has "destroyed" the public system. Which is a ridiculous thing to say, but whatever. It is demographics that has changed the way things have to be addressed. As the bulk of the population ages, the system is becoming more and more unstable, it doesn't matter if you are right, left, or whatever, this fact is key.

RightLeftIdeologue:

Simmer down, that isn't what I meant. By "full price", I mean, just like with any insurance plan, you pay a full-price premium that actuaries derive based upon the full cost of payouts accross the client base. In other words, the full cost of the health delivery system wide would be the basis for determining the premium everyone would be required to pay.

No, you have paid your premiums and you are covered for health costs. Just like everybody else.

So, you see, you'd not be denied any such thing.

RightLeftIdeologue
Destroyed is your term. I said screwed up but I'll change that to benign neglect if it makes you feel better. If Premier Campbell hadn't been so hot to reward his buddies with a tax windfall when he came to power we might not be having this discussion. But there's lots of blame to go around. Paul Martin and Jean Chretien built their surplus by cutting essential transfers to the provinces and rewarding their friends too. The problem is that Peewee Rambo believes in more of the same and is determined to turn this country into a republic - just watch. If we're all still around in 5 years and he gets a majority in the next federal election, don't come crying to me.

The full idea is (and I'm saying it's right. Its and idea). Set the premium at the price where premium times users equals full cost of health care. Then you adjust premium assistance to cover more people at higher incomes, progressively phasing out assistance as users reach higher income levels. This idea should be revenue neutral at implementation. The government is already subsidizing health care, it is just an accounting adjustment to book that subsidy to premium assistance instead of payments to providers.

Hmm. that's interesting ...

I meant to type "The full idea is (and I'm not saying its right. Its just an idea):

Instead I wrote this:

G West:

Agreed.

But this discussion is ill-served by simply pointing out that the US system has flaws. I'd rather discuss how our system might be improved. That's what makes this Tyee series interesting: let's NOT look at the USA for change.

tcahill

I have to profess ignorance to a lot of the detail about how our Canadian system works. I filled out the Romanow questionnaire but confess I haven`t read the report..I would prefer to read a hardcopy edition as reading from a screen for very long doesn`t suit me.
Most of what I know about the system is my own experience within it.
Know where I can obtain a hardcopy?
Why do you folks always play the "You Lefties"
card?
Just asking.
Hell I`m a Realistic Utopian..is that a leftie?

To continue: I'm offering this full-price premium idea as a means for the universal health care system to capture the ready funds more wealthy Canadians have for enhanced medicine.

While the idea is supposed to be revenue-neutral, the implementation would mean an increase in revenue to the system. The actuarial objective would be to set the premium such that all users would have access to the enhanced services (deemed medically (un)necessary - an intersting loop hole) currently only available to the rich.

Cahill, sorry about the misunderstanding and your point is taken. But isn't this what the government already does with progressively higher MSP rates?

GWEST: Hey, I agree with you completely that Campbell's tax cut was completely assinine. But then, so was paying 500million for ferries that were unusable. The point is, bad decisions are made by governments of all stripes. I search for solutions, not ideology.

bob the cat:

I am reasonably well-acquainted with about 10 doctors. Interestingly (although it's likely a function of the kind of people I hang out with), 5 of them work for various gov't agencies and are fully salaried EMPLOYEES.

They may not be representative of all doctors, but perhaps there's a "market" for doctors to be hired as civil servants to staff major medical organizations. My acquaintances "just want to do medicine", they're not interested in running offices, hiring staff, billing, and all that is associated with a practice. They want their pay check, benefits, and a pension.

RightLeftIdeologue
No question or disagreement from me that mendacity and waste takes many forms. I do, however, take umbrage at the claim by anyone (and tcahill's the current offender) that the left doesn't have a perfect right to criticize the actions of a succession of federal incompetents who've had the reigns of government since before the flood and now tell us they have the solution to all our problems.

Spare me.

There's never any shortage of current criticism in this province for everything the NDP did or didn't do as long as, what is it now, 34 years since Barrett was first elected. I'd like the right wing to be honest about its boondoggles and believe me there are a bunch of them, from BCRIC to BCRail with a lot of stops in between. Nobody in the 'dirty' game has clean hands.

44 posts for tcahill ,25 for rightleftideologue and 9 posts for haraldkann.

i don't really see where you are coming from rightleftideologue,you say my 9 posts are whining about the system and that i dont partake in really doing anything of merit.well,sorry i cannot hang around the computer all day like you and tcahill trolling for someone to debate vacuous ideas.

then again,i am not tcahills toady either

and seeing how you two attack any that don't buy into your simplistic posturing and vacuous ideas proves thomas49 right in saying your ubermensch mentality really is sickening.

grub
One small, interesting, and more or less unrelated factoid that I picked up a while ago. Martha Piper, then president of UBC, stated that students hoping to get into UBC's medical school needed a minimum 94% average in their undergraduate work - among other things. The new docs aren't, as a result, short of brain power. Whether or not they have character and good sense to go along with that is another matter. One hopes marks isn't the only fact looked at.

The ferries..we always come back to the ferries..

B.C. governments have always been into mega Projects..W.A.C. Taking over and building the ferry system.. (an extension of the highways) Hydro Dams etc. etc. Making B.C. Electric public.

Barrett...I.C.B.C...
Bennett jr. Tumbler Ridge, Coquihalla
Harcourt...parks
All the buzz (Bill Bennett) was of the Mighty Forest Industry becoming a sunset industry...we have to diversify our industry..we need more secondary industry..

Glenn Clarke... attempted to revitalize our once strong ship building industry.
The intentwas honorable. Misguided? Perhaps..but the intent was honorable.

(I didn`t like Clarke and his coterie particularly..but I think the mistakes of the Fastcats were honest ones..he took a chance and lost)

Bingo...and time to spend with their families no doubt..

BEWARE - BEWARE - BEWARE
Minister Abbot just announces that he is going after the private clinic in Vancouver. Can you imagine? Obviously a ploy to look like he and gov't are defending Medicare against these for-profit types. Give us a break! Does the right hand know what the left hand is doing?
This will get big news coverage, but what is really going on behind the scene? We will not know til it is too late.

then again that's probably why you have no friends and spend your pathetic existence typing out your life instead of living it.

Thomas I take it that you think I am accusing you of being “understandme”? If I remember correctly, I did no such thing.

To the others, well an interesting read, I certainly prefer the Canadian system, still one of the best but needs a lot of work. Tcahill touched on to the one thing that I think has caused most of the problems and that is the population bulge moving through the system right now. The planning to deal with this problem should have been done 20 years ago, but successive governments avoided the issue as it is was “not on our watch” The present system also suffers from bureaucratic gout, which every system seems to get and needs careful trimming to ensure healthy & useful tissues remain. Thomas also pointed out that the original health care system was never designed for what we are using it for and that is a valid point. However that also brings up the argument about whether it should be purely a reactive system or a proactive system. I personally think the NDP’s plan of providing the “good living health guides” as inspired and have been using ours as a reference tool for dealing with our kid. The hotline has been less so and everytime we have called it, you get a less than a useful response, followed by a statement that you should get it checked at emergency or a doctor (liability purposes no doubt) and then a number of question on the theme of: “Have you abused your child recently?”

G West:

Therein lies part of the problem, IMHO. tcahill points out that queues are a fnction of demand out-stripping supply. Quite correct.

With the demographics of the baby-boom, there's not much we can do about demand. So the answer must lie in supply.

But it needs to be a supply that is affordable. So let's import doctors and facilitate and expedite their credentially process.

And let's train more doctors (and nurses, techs etc). In theory, increased supply ought to lead to lower wage demands. Further, training could be made contingent upon "serving" the community for a certain number of years -- enlisting in the healtcare system as it were.

And I need to add to my comment about "And let's train more doctors (and nurses, techs etc).", the extrance requirements to med school need to be scaled down. We don't need friggin' geniuses as doctors, just reasonably bright people.

bob the cat:

hey, bob, do you know these docs as well ? But you're absolutely right. They didn't become doctors in order to act like little entrepreneurs.

I'm curious, what do the defenders of the status quo have to say to my scenario above?

Bob
Reference the ferries, I agree the concept was honourable but totally mucked up by the politics, as soon as he indicated that he was pitching his political tent on the ferries success, I knew he was screwed.

It should been sold as a do or die attempt to save the industry, a calculated roll of the dice. Actually I got to read some of the surveyors reports on them. They praised the quality of construction, but they also suffered from the problems of the class of vessel. Such as weight creep, ambient heatbuild up, fuel consumption. It didn’t help that they were also at the cusp of needing to move up to turbines instead of diesels.

Then Gordon came along and scuppered any chances or recuperating some of our monies from them, remind me never to hire him to sell my real estate.

In Europe the Swede’s HS900 (I think that’s the name) high speed ferries were so bad that they had full time welders on them to keep up with the cracking. Most companies running them either use them to supplement summer runs, tying them up for winter or moving them from the Baltic to the Med in winter to maximise them.

Another unique BC factor is woody debris, no other place in the world has to contend with the woody debris that we have to.

grub
No unfortunately...my milieu was ..ahhh very "other side of the tracks"

grub
Couldn't agree more. The supply side of the equation does need a lot of work. Which was my reason for posting Piper's comment: Many of the current graduates of UBC's med school (and class sizes were downsized twice during the 1980s before the recent increase in intake size) either have parents who are doctors, parents who are wealthy or they have huge student loans. It doesn't take an MBA to figure out there's a way to address the shortages of staff in smaller communities in the interior, on the Island and up the coast and find a way to help new graduates meet their financial problems to the mutual benefit of both parties. By all means increase the input size of classes - but that takes time - a minimum of 6 years for a GP - because most residencies have to be in bigger centres. Right now, tomorrow if necessary, the health ministry could offer to forgive new doctors all of their student loan indebtedness for a commitment to work where doctors are needed for, say, three years (terms would obviously vary). Some docs wouldn't go for it, obviously, but for others - especially those with husbands and families - it would be a godsend. And it'd be cheap at twice the price, probably. Another wrinkle is to make better use of locums whenever there is a shortage. As bob the cat noted above, not all doctors these days are interested in a permanent posting but would like to rotate through several different kinds of challenges over time. More can be done to accommodate this. Thomas' suggestion that there are foreign-trained docs who aren't practicing is undoubtedly true as well.
There are solutions available - but only if we wake up.

bob the cat:

I'm the only "you folks", I've ever met. I'd be pleased to meet others like me, but there are not too many.

As for "lefties", I am simply respecting the choice of those who have refered to themselves as being on the left. Personally, I don't have much use for seeing the political spectrum in terms of left and right. Politics are far to multi-dimensional to see things only on two dimensions.

Up until now I didn't know there could be such a thing. I've always supposed Realistic and Utopian to opposites. My hunch is that configuration doesn't necessarily map to left or right.

ok point taken ..I did the same thing I accuse you of..

but it would seem many posters come here to "take on the lefties"..and are constantly prefacing their arguments with "You lefties"...this does become tiresome and definitely stifles any chance of reasoned debate.

Realistic Utopian..

"Democracy is fundamental, and not only because of the horrors committed in the Soviet Union, allegedly in the name of socialism. The Soviet experience has shown how precious the so-called "formal" freedoms-of expression, assembly, election-really are. And yet just to restore them, without filling them with social content, cannot be enough. Democracy has to be reinvented on the shopfloor, in the office, on the campus, at all levels from the local neighbourhood to the very top, if power is really to be given to the people and planning turned into the self-organization of society." continued next post

Realistic Utopia...Realistic since it must be rooted in current conflicts and in the potentialities of existing society.

Utopian ...because that is how any attempt to look beyond the confines of capitalism is branded.

Whose Millenium?
Theirs or ours?

Daniel Singer

GWest: You're making it up again....

I've said it before and I'll say it again:
http://finance.groups.yahoo.com/group/BCRealEstatecourse/cal///group/BCRealEstatecourse/?v=2&t=1164960000

If you are going to take umbrage, at least be accurate about it.

Let's stop pretending that there is a "left" and a "right". These are useful, albeit stereotypical labels that are points on a continuum:
far right - right - center - left - far left. The ugliness of extreme positions (far-left, far-right) need to be constantly exposed, not dismissed by saying there is no right and left.
We need to be fully informed of the philosophies, agendas,values and strategies of political parties and be able to realize where on this continuum a party or individual sits.
Not being aware can result in unwanted results - a far- right-wing or farleft wing party pretending to be moderate, just to get elected.
Gee, anyone recall this happening?

tcahill
So, is that where you cadge your ideas - I thought maybe you'd been coming up with them yourself. Perhaps you and others should go back 18 hours on this thread and read again what you were writing last night - let me post a few examples to save you the trouble - then others might understand the context of my first comment about you, above:
First, this is how your discourse began, remember now:

Followed by:

And a little later:

Such nonesense!

What exactly am I making up? Anyone who wants more evidence - there's almost equally offensive things from Mr Tchill's companion of last night if you're interested - is free to look for themselves.

tcahill
Your moral superiority is a little threadbare fellow.

I've always been more than willing to discuss ideas and listen to rational thoughts from anyone but I expect not to be treated, from the outset, as the kind of twit you so obviously have turned out to be.

GWest: Thank you for highlighting the issues you really need to deal with. I couldn't have put it better myself. Its as though you're in a competition for who can best misinterpret what others are saying.

I take you to task for confusing the situation in the US with the situation here in Canada. How is that on any planet, in any language the same as

????

You just made that up, and you don't get it.

Baloney. You know exactly what I'm talking about - don't expect any respect from me if your comments, as highlighted above, are the kind of attitude you bring here at the outset. You are a phony and no gentlemen, and truth to tell, a second-rate intellect
Good bye

So I refer to you and others on the left as:

and you call me a twit. So long and thanks for all the fish.

i like how you bury something like an underhanded compliment,out of context, in the background and then dredge it up after posting insult after insult.

you think no one reads these posts carefully tcahill,you are some piece of work.last time i saw someone so full of hot air and nothing else to offer ,it was ? i cannot remember,really !

i have to say,you are one of a kind,i really hope they broke the mould.then again i figure it must be that medication/alcohol mix that keeps you so hot ,cause i have yet to see any rationale in your postings.

Well, I've gotten on haraldkann's bad side. Reviewing his writing, I can see that was probably inevitable, and not altogether unfortunate, based upon his manner with others he chooses to disagree with. (Perhaps Harald knows something specific about mabellbc's propensity for parasitic poisonings from some source I am unaware of?)

On the other hand, he makes an excellent point about the unfair and arbitrary hurdles that foreign trained doctors confront trying to get accredited here. I have often railed (not on this site, but in frequent conversations) against the cabal that calls itself the Canadian Medical Association.

I'd like to see a legislative push to either force the CMA to change its ways or loose the right to certify doctors for practice in Canada.

As for "ubermensch", I really do need to take the time to read Nietzsche, he is so often quoted and misunderstood.

bob the cat

Yes, I'm sure that does happen.

Yes, I feel the same way. I had a crew come and drain my septic tank this morning, and I am feeling challenged to keep that experience seperate in my mind from some of the sh*t that flies here.

Thank you for your reference to Daniel Singer,and his (what seems to be a ) very important book. I have added it to my reading list (ahead of Nietzsche -- that is always happening to him!)

I am a perennially neophyte buddhist, and what I took to be your formulation of 'Realist Utopian" sounded to me like one of those koans used by Zen masters to wear down and shatter the rational impediments to enlightment in people like myself. you know, like "what is the sound of one hand clapping?".

I appreciate you just stepping up and describing yourself that way. Why can't utopia be realistic? Why isn't it realistic to be utopian? The next time I feel like calling something utopian, I'll remember what you said.

I just love the comments from the pro-private medical system ranters who are upset because there was nothing in this article about horrible examples of the private medical care system in Sweden.

I would urge them to go back and read the article once more. It was not about examples. it was about the population of Sweden rising up and demanding a return to fiscal and medical sanity.

Everyone knows that private care costs more.

Why is it that capitalists and capitalist wannabees spend so much energy trying to educate us about the creative genius of capitalists?

Yet, when the rubber hits the road the best they can come up with is to try to milk the public by lobbying and buying political support to steal the public system away.

That's not genius. That's plain greed and a clear case of lack of creativity.

Good article and good decision making by Swedish voters who tossed the health care profiteers out the door, I'd say.

The only thing wrong with public health care in Canada is that so many politicians are trying to starve it of proper funding.

The majority of Canadians want it and apparently the majority of Americans do as well and we don't need more horrow stories like the one about the 95 year-old woman who was yanked away from her spouse of over a half century by people who are supposed to be on her side only to die alone in another city.

Clearly Allan, the article was written expressly to please readers like you, and I'm glad you enjoyed it. I think that was the point of the

.

isn't that the purpose of the articles and threads,to guage the waters ,so to speak.

people who post are exercised in thought about the opinion piece and either accept or reject,and i see a lot of health care and union issues lately,so i would assume by reading and partaking there are many here who are concerned about our societal needs.

the KAMPBELL KLAN is one dangerous bunch and we know el gordo is a little jaded already about running the province,hell,he has been an absent landlord.

so he has bigger designs in mind,and that is really scary,especially for health care,because down the road as many have mentioned there will be a real change in our health care and KAMPBELL will be jockeying for the prime ministers office.

so,what he starts here now,he can finish in ottawa.get a grip it's going to be a wild ride folks.

allan:

Everyone knows that private care costs more.

I generally find your posts thoughtful and informative. In this case, however, you seem to be stifling discussion.

Would it not have been useful if we'd had some examples of the failure of Swedish private medicine to provide insight into why the electorate rejected privatization?

As to "Everyone knows that private care costs more." -- well I might be inclined to believe that, but I don't think it's a given.

By way of furthering the discussion, let's consider dental care. In a sense, every dental office is a tiny surgery center. Do you think dental care would be more cost effective if we required dentists to follow the medical model; no more dentistry to be done in "private clinics"?

What do you think?

You can't improve care by taking money away from care to pay profits to owners. There are no ways to increase production levels, or increase productivity of workers. You can only reduce services for the fees you charge, and reduce the number of providers without reducing yoiur billing.

It's a conman's dream. You bill whatever you want, and they have to pay you or they...wait for it......die.

The market has no mechanism to increase efficiency in such a system. If anybody knows of one, they should trot it out, because all I hear here is ideological twaddle.

Bailey:

That's just plain WRONG!

Of course you can increase the productivity levels of workers. That's what good managers do.

That doesn't have to mean that workers need to work more. It could mean using better equipment or just working smarter.

A few years ago, the Vancouver Sun featured a series of articles written by an Industrial Engineer who was dying of cancer. While in VGH, she observed the "industrial processes" the medical staff engaged and, using her training, made numerous recommendations about how the staff could work smarter and how the hospital management could streamline procedures.

I'm hoping, through this discussions of the healthcare system, that those are exactly the sorts of solutions we'll consider.

The earth is flat. The sun and universe revolve around the earth. The Pope is infallible. The king has a divine right to absolute rule. Nothing is better than eternal happiness. Eating a hamburger is better than nothing. Therefore, eating a hamburger is better than eternal happiness.
What? Sorry? I must have fallen asleep.

Grub, bringing up dentistry is interesting as it highlights one of the drawbacks or weaknesses built into our medical system.

Of course I think dental could be delivered more effectively through a public run system.

I happen to think medicine would also be cheaper if Canadian politicians had bitten the bullet when the introduced public health care and made doctors public servants.

I truly believe it was a bad compromise and, if anything, stopped any chance at least so far to extend public health care to include dentistry.

I don't labour under any illusions that medical doctors, had they won the Saskatchewn fight, would have compromised one iota. In fact they would have continued to hammer away at Tommy Douglas until he was finished as a politician.

In my estimation, that olive branch to the doctors was a terrible mistake.

Let's face it, having your teeth fixed is a medical procedure whether you call it that or not.

I am not talking about cosmetic dentistry. I mean cavities, wisdom tooth extractions and a long list of other tooth issues that affect your health and well being.

Grub, I wasn't trying to stifle debate. The fact that the Swedes tossed out the profiteering model because of a public backlash is certainly big news, especially as that news comes as our wannabee profit takers have been, until now, trying to use Sweden as a model for Canada.

A point of clarification:
In the absence of any detailed data - apart from that given in the article, which is, as stated several times, primarily a consequence of Swedish democratic choice - an attempt was made yesterday to point out several examples of failures in the US system. Given the current controversy surrounding the future of universal single-payer medical care in this country and the suggestion, from several sources, that a move here toward a program more in line with what is going on in the States, I still maintain that was a reasonable strategy.

Examples were given or posted; as those who've taken the time to read the appended comments from start to finish will acknowledge. At that time, certain posters began - rather than dealing with the substance of those examples - to preoccupy themselves with critical characterizations of the individual(s) who posted the material – to wit, moi.

I also posted a considerable amount of additional personal material I felt was germane to a discussion of finding ways to correct or remediate the Canadian system(much of this in response to grub's queries). Immediately I found myself in a slanging match with tcahill over his ‘analysis’ and opinions (also cited above) of me. Almost never, especially in the material dating from last night, actually dealing with the substance of the message. I apologize to anyone who found this a poor way to deal with the fundamentals at issue. I extend this to anyone, apart from tcahill, who came here expecting to find a rational discussion about the subject at hand. To him, and for his ad hominem attacks, which are not - to anyone familiar with his work attached to an earlier discussion concerning the potential of a Liberal /NDP coalition (John Ryan's article of a couple of weeks ago) - anything new, I will not extend any apology.

And for those of you who missed the earlier exercise in futility, you can catch it here:
http://thetyee.ca/Views/2006/03/03/NDPandLibs/

GWest: I accept your non-apology.

That's like making several attempts at shooting fish in a barrel. Why can't my injured opponent just come out and say: "Any further attempt to adjust the mix of Public/Private participation in Canada's Health System will immediately and inexorably flush us directly into the free market chaos afflicting the US."

His argument is just FUD. That's Fear. Uncertainty. And Doubt. It is a tactic used by desperate opponents who want to suppress any possibility of change that does not conform to their own sacred pre-conceptions. The real problem is that my opponent isn't sure of what he believes, and isn't able to make clear distinctions regarding what should be on or off the table in a discussion on the future of Canada's health system.

Anyway, this whole intensely personal aspect of our bitter discourse has me very uncomfortable. Behind all of the rhetoric and recriminations I am very troubled about my causing emotional harm to a man that I feel is intensely caring about his country, is the proud father of a Canadian Doctor, and may be very old. (Well, at least he's probably a year or two older than me)

I am not proud of this feeling of having troubled someone who is trying to do good.

Hi guys,
It's been a while since I have had a chance to look into some of the postings. What the heck has happened since I was away. TCahill and GWest did you guys get up on the wrong side of the bed the last little while. You have both been great posters in the past with decidedly different points of view but you seemed to have some respect for each other. Now, my god you seem to be out for blood. From other postings you both have been able to put together some well reasoned arguments some I agree with and some I don't but this level of debate that you have fallen to is somewhat disturbing. Bailey and Redriver Girl where are you we seem to need a referee to cool the rheroric.

Several posts in response to my last article ask why the Swedes took the decision they did this year to prohibit for profit privatization of hospitals and to sharply limit other forms of privatization in health care. ( Government Bill 2004/05:145 Forms of Operation for Publicly Financed Hospitals . Ministry of Health and Social Affairs Fact Sheet No. 10, May 2005)

In short, the answer is they've "been there, done that, and didn't like it." The Stockholm county experiments, including the privatization of St. Goran's hospital, sparked a country wide debate and were important talking points in ensuing elections that defeated the centre right county government that had brought in the experiments in privatization and returned a strong coalition of Social Democrats and centre left parties to national power. This government proceeded to pass the new law that discouraged privatization. Why did they take this position? Well, first of all they were acting on the madate given them by the voters, and secondly, they were acting on their understanding, as noted in the fact sheet cited above, that "The Government believes that hospital care run for the purpose of making a profit may risk being in conflict with medical and social goals, which are the main functions of medical care. Care should be financed exclusively with public funds and care fees. The Government believes that regulation is important to minimize the risk of financial resources taking precedence over medical needs." Health minister Lars Engqvist, a Social Democrat, said that new legislation would end the practise of private patients "buying their way past" hospital waiting lists.

So one simple answer to why the Swedes implemented legislative blocks to any further hospital privatization is that they made a democratic choice, turfing out of office the party that had brought in the experiments with privatization and rewarding the parties that opposed it with a stronger national coalition government . The voters may have been influenced by the fact that the Stockholm experiments didn't seem to be delivering on the bottom line promise of more fiscal discipline. At the height of the experiment, Standard and Poors lowered the county's debt rating, hardly a vote of confidence from the world of high finance. Or perhaps they were concerned about reports that the privatized hospitals were "cherry picking" easier patients and that it was getting harder for difficult cases to get treatment in the modified Stockholm system. Or perhaps, again in the words of the governement's fact sheet on the new legislation, they wanted to avoid any further danger of "a conflict of interest between the players in the market and the people in need of care."

tcahill:
Don't do me any favours.

You are quite a piece of work; apparently incapable of actually discussing an issue without resorting to personal comments and innuendo even, as shown just now, in your sophomoric attempt to appeal for sympathy and understanding. You came here yesterday to cause havoc - as your own words from last night show. I’m only sorry, as I said above, that I succumbed to your provocation.

If you're ever ready to actually discuss an issue, whether it's your loyalty to your Liberal roots, or your apparently boundless confidence in the ability of public health in this country to continue to absorb the insults of events which many think threaten its future, kindly learn how to do it without casting aspersions before you like poison. The next time you do, believe me, I'll reply in kind.

As to my advanced age, don't assume too much - I'll wager I'm more than 10 years your junior and I run between 6 and 8 kilometers every day. It keeps my head clear.

In the interim, I want, as I said, nothing more to do with you.
Cheers.

Thanks for that Tom. It will be very interesting to see what the new approach (or return to the old approach) will be able to demonstrate. It seems that they have identified a few metrics: improved debt ratings, reductions in waiting lists. Let's see how it works out!

You are reporting that they have a new clarity in the ideology, or core assumptions, that should govern health care. It is interesting that the mere risk of conflict, rather than conflict itself, is seen as sufficient to preclude a role for profit motive.

So Canadians are lucky in that we have two very different experiments being conducted by the Swedes and the US on what constitutes the appropriate governance of national health.

Speaking of experiments, my hypothesis is that both approaches, exploring opposite extremes, will be found lacking.

Thanks, Tom, for the piece as well as for the extra information and especially for this statement of principle:

Seems a sensible starting point for a new discussion of how one ensures that the current Government in Victoria moves to adopt a similar motto in this province.

One wonders if Premier Campbell and his brother in law got 'that' information while they were in Sweden.

GWest: I welcome enthusiastically your determination to have nothing more to do with me. Perhaps now we will both be free to be more productive.

A members-only clinic is operating in Vancouver for people willing to pay a an initiation fee plus $2,300 a year for no-waiting access to doctors.

The Vancouver Sun called the Copeman Healthcare Centre a "toe in the door" for private medicine. The government still pays the bill for approved services.

Dr. Peter House, says people are signing up because they aren't happy with long waits to see a family doctor and with getting just a few minutes once they get into the doctor's office.

Seems to me the real danger in the continued operation of this type of facility is precisely what Tom Sandborn's post above indicates, that is, the risk of financial resources taking precedence over medical needs. This is two-tier, queue-jumping health care at its most flagrant, in my opinion.

Apparently the Health minister is 'investigating' - I'm not sure one should take much comfort from that.

Grub:

I noticed in the messages you've posted a few things I've been meaning to ask you about. In your first post you say:

You speak of "high value, low risk" health services, then in another post, you write:

Would you consider the Midas approach as delivering low-value retail healthcare, i.e., as something different from the high-value providers you were previously arguing against? Or was there a change in your opinion?

I'm no defender of the status quo, but I think your scenario deserves to be explored. Sure, there would be quality concerns with retail healthcare, but there are quality concerns with any solution. I feel something just doesn't sit right in my head when I think about MacDonalds offering a blood pressure and cloresterol check up with a Big Mac and Fries. But perhaps that might be the only way to cure the fast food addiction.

I wish I'd said that. : )

The fact that the ministry is 'investigating' and hasn't already shut the place down or withdrawn the clinic's billing numbers would appear to indicate a great deal about the government's actual intentions and where its sympathies really lie.

So far as I know, the federal ministry has not taken any notice of the situation - at least since Peewee Rambo came to power - and I think there is at least a prima facie case for action against the province for violating the Canada Health Act.

The feds apparent, willful or otherwise, silence on the issue also speaks volumes about where we're headed, IMO.

Meanwhile, Dr. Brian Day, Founder of the private Cambie Surgery Cenre in Vancouver, and "One of the country's most outspoken proponents of private health care"

has been nominated by BC physicians to run the Canadian Medical Association. You can read all about him here: http://www.brianday.ca/

Oh well, so much for posting a properly formatted URL.
Here is the quote again, in english: "One of the country's most outspoken proponents of private health care".

Here is the link again, in computer gibberish:
http://working.canada.com/toronto/news/story.html?s_id=0NrSNy0c0Dm1re2tvJc2sozYEl%2Bgmq08ph72NzyBr65Hf2waXxgGzA%3D%3D

Notice: I'm not cheering this development. He is yet to be confirmed at the convention in August, but it would be very unusual for his nomination to be overturned.

Please don't bounce me, I'm just trying to see if I can get a properly formatted URL to display correctly....

News & Press

Let's see how that looks.

tcahill, for the record, I DID NOT say the following:

I may agree with that sentiment, put I'm very open to discussions about how we might reduce queues in a cost effective manner while maintaining the general philosophical thrust of universal healthcare.

tcahill commenting on my proposed (for discussion purposes) Midas Muffler approach to catarach surgery:

Quality might be a concern. However, leaving aside for a moment how we feel about the current state of dental care from a philosophical perspective, isn't dental care currently essentially "retail healthcare"? I don't hear the public up in arms about quality issues in dentistry, so I have to assume that everything is in order. Would it be wrong to assume that retail cataract surgery would be any different.

allan:

I think you may be right. However, I fear that horse has left the barn, and I can't see any political party on the horizon that has the stomach to revisit that issue.

It is evident that the ministry is reluctant to yank the billing number(s) of the Copeman Clinic.

Is that because it is involved in 'discussions' (announced yesterday) with the operators of the clinic - which is apparently planning to open more branches - or because it has very little philosophical problem with the trend which the clinic apparently heralds - a clear move into the area of two-tier medicine?

Without some positive action by the government soon, observers, and the opposition, would be unwise not to draw the appropriate conclusions.

To suggest that the way around these problems is for individuals to buy additional insurance to cover extra costs that may eventually attend to a move away from the current single payer system. The kind of yearly and/or ‘initiation’ fees that Copeman charges, for example. One would hope this suggestion wouldn't gain much traction with anyone who has considered its implications. Such action would be, arguably, just the first move in a slide toward the kind of program that currently obtains in the United States - where a good number of families (in fact about 20% of the total population) have no coverage at all and must rely, in cases of illness, upon their own resources or upon a clearly second class ‘public’ or charitable system. Is it true, as supporters of less diligence in protecting the quality and inclusiveness of the program we have today say, that a few chinks in the armor of inclusive and equitable care are not terribly important and can be largely ignored?

I think not.

The public ought to listen closely to the spokesperson for the Copeman clinic when he speaks to the media and 'welcomes' the investigation that Minister Abbott has initiated. What a surprise? The ministry has been sitting on its hands since at least November and has not even taken the minimal actions to deal with the problem that the Ontario Government did with the passage of Bill 8 in early February. Under the terms of this law companies like Mr. Copeman’s clinic can be fined up to $25,000 per incident if patients are charged for access to provincially covered health services and individuals can be subject to fines of $10,000 per incident.

Anyone who heard Don Copeman's response to Mr Abbott yesterday would be hard pressed not to take note of something else he said, 'That he was in the business of operating a service to bring 'world-class medicine' to the members of his (exclusive) practice.' Anyone who thinks that kind of service to the folks who can afford to join Don Copeman’s club is an example of equitable access for all is whistling in the wind, I’m afraid.

All British Columbians would be well advised to take note.

Can someone explain to me how private clinics will cure the problem of long wait times to see a family doctor? When doctors move to private clinics is there a cache of other doctors waiting to fill the void left in the public system? I'm really struggling with the concept that moving a doctor from point a (public) to point b (private) will improve the lot of people using the public system.

Maybe I'm missing something?

Grub said:

Sorry, my mistake.

dj2
Correct! It won't.

Private clinics will make the situation worse. Looking at the American experience is the perfect example of that. All private clinics, which operate outside the system, or those that pretend to still comply with the terms of the Canada Health Act - as the Copeman Clinic pretends to be doing - herald the advent of two-tier care. That is, a system where patients who can afford the 'best' care pay extra for it and the rest of the citizens put up with a system that is being starved by a Provincial Government that cares more for one class of British Columbians (in most cases the same people their tax cuts benefit) than the average working woman and man.

dj2: I don't think the idea of private clinics wat put forward by grub specifically to address long wait times. The intent was just to explore legally and ethically (right grub?) why if A is OK (dental surgery) why isn't B (cataract surgery).

As dj2 brings up, the issue of long wait times isn't just one big line up. While the problem of not enough family doctors (here on Salt Spring the problem is critical) is clearly significant in the debate over private/public health, that shortage of doctors doesn't specifically address the question grub has raised.

I was speaking to what G West posted -

"A members-only clinic is operating in Vancouver for people willing to pay a an initiation fee plus $2,300 a year for no-waiting access to doctors.

Dr. Peter House, says people are signing up because they aren't happy with long waits to see a family doctor and with getting just a few minutes once they get into the doctor's office."

As for cataract surgery, same thing applies. How does moving cataract surgeons into a private practice speed up the wait time for public patients? They will have a longer wait period as there are less cataract surgeons in the public sphere.

Gwest
While I realize you are no fan of Harper, don’t you think it is a little unfair to be attacking their record at this early stage? Hell I doubt they even know where the bathrooms are in their new ministries at this point.

I also find your use of a nickname for Harper surprising, your posts are normal well measured and without fanciful rhetoric.

tcahill:

Correct. Right now, I'm a tepid supporter of the status quo.

However, I'm bothered by logical inconsistencies in arguments for the status quo and welcome dialogue on these issues.

In some sense, I see dental care as some sort of parallel universe to other medical care (recognizing full-well that the scale of operations is not even close). In this dental parallel universe, I sense overall satisfaction with the way things work (I'm willing to be proven wong). My first reaction is thus: "if it ain't broke..."

My next reaction is: "might this work for other medical services?"

And, thirdly, I'd like to suggest that if there are drawbacks to the current state of dentalcare -- retail medicine -- then, whatever those drawbacks are, they would provide insight into what would be wrong with privatizing clinics.

Allan would have the dental system brought under the wing of the overall healthcare system as he thinks that's be more effective. Perhaps.

Colin

G West knows what Harper thinks about two-tier health care, most of us do.

I took the following off StephenHarperSaid.ca -

During his time at NCC, Harper strongly promoted the NCC agenda, including its bedrock issue, privatizing health care:

“GLORIA MACARENKO: Stephen Harper, what do you think of a parallel private health care system in Canada?
STEPHEN HARPER / V.P, NATIONAL CITIZENS' COALITION: “Well I think it would be a good idea. I think we're headed in that direction anyway. We're alone among O.E.C.D countries in deciding that we'll have a two-tier system but our second tier will be outside the country where only the very rich and powerful can access it and will be of absolutely no benefit to the Canadian health care system. So I think this has been the wrong way to go. And clearly we're moving in another direction.”” [53]

Colin
You obviously haven't been reading everything I've posted. The Peewee Rambo is not mine. I borrowed it from the title of a Le Devoir editorial about Harper's sojourn in Afghanistan. You'll find it in the "Iran, Nukes and Propaganda" thread - probably about 3 days back. Translation appended.

Harper, if you don’t know, has been working in Ottawa on the Hill since his youth. He started there as a gopher for Deborah Gray (is that the right spelling?) when she became the first MP elected for the Reform Party – before, even, Preston Manning.

He knows exactly where the bathrooms are and he's taken no time at all to make it clear that the members of his caucus aren't meant to have any meaningful communication with the press other than in seriously circumscribed conditions.

He has also directed, apparently, and this is anecdotal because the evidence has disappeared, that certain members of his caucus (Monte Solberg is the most egregious example) remove the racist and highly inflammatory remarks about certain categories of Canadians that he had posted on his website (Solberg's) before and subsequent to election day. If you've been following along here at the Tyee you'll have seen them; if you haven't you'll have to take my word (which your kind remarks above indicates you think means something) for it. Is this because Solberg has changed his prejudices? Or is it because, in my opinion much more likely, Mr Harper is extremely concerned about the 'impression' his new government creates among Canadians?

In any case, I think the PM is a very dangerous and extremely clever ideologue. He has been planning, and is now executing almost to the exact schedule I (and in fairness several others) predicted on this site (and in other places) prior to the election, the Republicanization and emasculation of the federal system in this country.

This is a place I love and celebrate and care very much about and it has qualities of fairness and equity and inclusiveness in its institutions and history that I think (even fear) are under attack and in severe danger from Mr Harper and many of the narrow minded ideologues who support him and who are being facilitated by corporate interests that I know you understand. I'm going to use whatever means I can to convince you, and anyone else who cares to listen and still has the ability to think for themselves, that that is the case and that we all need to get up in arms about it.

You have an open and generous spirit, at least that's the impression I get from what you write here and I've tried to communicate with you in that spirit. I'm glad and flattered that you noticed and I'm pleased to read your assessment of my posts above.

But, in conclusion, I think the label Le Devoir attached to Mr. Harper is both apt and descriptive and I'm actually hoping a lot more people start using it.

There appears, with a few notable exceptions, few members of the professional press willing to ask difficult questions or to lower their eyes from the viewfinders of their cameras to actually look beyond the figure of that rotund fellow going through his carefully programmed motions in Afghanistan.

Cheers, as always. Hope that explains it.

dj2:

I don't want to defend my suggestion, but let's just deal with issues of specialization and division of labor. Analogies are sometimes dangerous, but bear with me.

I can get my muffler changed at my local version of Gasoline Alley, where my mechanic is fully qualified to do so, but there's a good chance he doesn't have my model in stock. So I join a queue, drinking his bad coffee, waiting for the parts to arrive. There's a chance grubtoo is doing the same thing (waiting) at another service station.

Alternatively, I can go to Midas Muffler and be out of there in a flash.

All I'm questioning is if we ought not to be looking for efficiencies. Heck, if these specialized clinics could be set up within the public sector, that would be great as well.

But, tangentially related to my last point: large organizations (public healthcare, for example) often innovate with all the speed of a dinosaur.

grub

Your analogy only works if Gasoline Alley is gov. owned & operated and is giving free muffler service to everyone. Those on a fixed or limited income will join a queue, drink bad coffe, and wait for the parts to arrive.

Alternatively, those of higher income can go to the privately owned Midas Muffler and be out in a flash.

This only makes the muffler situation efficient for those with money to spare.

A better analogy might be people waiting in line at the food bank as compared to those at the local grocery store. Those lacking cash at the end of the month have to stand in a food line for a longer period than those with a pocket full of cash.

dj2:

Alternatively, those of higher income can go to the privately owned Midas Muffler and be out in a flash.

HOLD ON!

In my scenario, EVERYBODY has the same medical (muffler?) insurance. EVERYONE can go to the Midas care center and be fully covered. Further, NOBODY could jump the queue; there'd be no "extra-billing". It's be like dental care today, except that everyone would have coverage.

The question I'm putting out for discussion is: "Would that be so bad?"; looking for efficiencies in specialization, that is.

Although some posters say they think looking at the American experience is not a valid exercise to be subsumed under this heading, I still maintain that we can learn a good deal from our southern neighbours if only as a cautionary exercise.

There is quite a bit of interesting dialogue going on down there as the impact of record deficits and skyrocketing debt (created under a supposedly fiscally-conservative administration) begins to interest citizens and pundits in the area of health care financing and reform.

The other day I came across a conversation which implied that if the US were to replace its current complex mix of health insurance systems (and various charitable and social welfare models) with standardized, universal coverage, that the savings would more than cover the cost of extending coverage to those who are not currently insured and that the actual budgetary outlay for health related costs might actually go down and would not necessarily rise at the rate that doom and gloom analysts are fond of suggesting.

Apparently, and I've not done anything yet to confirm this, Taiwan moved to a single-payer system in around 1995. Immediately thereafter, its insurance participation rate increased from about 57% of the population to almost 100 % but health-care costs themselves grew at a rate far less than the nearly 43% one would have expected or predicted from the data available prior to the adoption of single-payer health care.

Of course, Taiwan is a much smaller geographic jurisdiction than either the United States or Canada and equally, its population (at about 23 million) is a lot less than America’s. Still, it would be interesting to explore the phenomenon a little more closely if anyone is interested.

The point is, clearly, that any suggestion that our own system – which clearly needs reform – would benefit from moving away from equity and universality – may be both wrong-headed and economically unwise.

G West :

I, for one, would never suggest moving away from the principles of equity and universality. But what I'm trying to grapple with is whether or not permitting alternate delivery models is necessarily bad (or good). So long as we ensure equity and universality, does it matter from whom our citizens get their care?

grub

Sorry I misunderstood your muffler analogy.

I fully agree with finding alternative solutions, my concern is that the powers that be tend to think the only option is to add, pay as you go, private models. Probably accounts for my knee jerk reaction to you!

Thanks for explaining.

grub
I know that man. You're aware of what's been going on around here so I'm sure you know what I'm talking about. I think there are many interesting ideas and things to discuss but one had to get over the kind of egocentric stuff that happened here the other night.

You must know I take this seriously. I had to find some way to disengage from what was obviously turning into a zero-sum game. I hope we've done that and you should know that I wasn't criticizing you, or your ideas – or dismissing your reasonable questions. They deserve a response.

I think there are certain fundamentals that have to be observed in a humane society that doesn't rely on dollar bills to do all the Darwinian sorting, that's all.

Romanow's report is open to all sorts of different ways and means and the very nature of the country kind of dictates that we have to operate with that kind of flexibility in mind. What’s efficient in the city will often be a disaster in smaller communities and rural areas and I clearly can’t deal with them all at the same time. I do come from a small prairie community originally and I know what’s happened there has been disastrous so I’m no authority about what might work better there.

I do have a real problem with the Copeman clinic option where 'members' pay an additional 2 - 3 grand per year for 'services' that, I'll wager, the bugger is going to bill MSP for anyway. It's a scam and it should be stopped.
Let me give you one example of how, maybe, some clear thinking about the nature of the problem at hand may begin to suggest some solutions:

I think, for the vast majority of men from, say 20 to probably 55, there is not much need for a formal relationship with a single doctor (absent some dread illness or accidental injury) and their needs could be more than adequately met at public walk-in clinics where the docs are 'public' employees. Probably young guy and girl docs with a lot of them being locums working between one or another placement or posting. Loosey-goosey kind of stuff that, if properly organized could be cheap like borsht and just as effective as tradition care for most guys.

Women (especially if they're having children) have different and, pardon me, more plumbing and reproduction-related problems during those years and children need special and more personal care too. So you need to design a system or structure the point of delivery in such a way that these needs can be met with doctors that can provide the continuity of care these citizens need at those times of their lives. Some of these things are pretty functional too and nurse practitioners (as long as they aren’t the only resource available for new mothers and people seeing themselves through the difficulties and learning curve of a first child or a first pregnancy) could deliver a lot of them at sharply reduced costs. I hate to get into this very deeply because it’s generally a women’s concern (not so much these days with kids too) and I’d prefer not to step needlessly on anybody’s toes.
(more, sorry!, follows)

(conclusion, again, sorry! - way too long winded!)
And of course, as we age, the needs are going to change again for everyone. As for specialty services, surgery, oncology, chronic disease and the like there are obviously concerns there that require a different kind of analysis. One thing that’s always disgusted me is the way a few medical corporations have gobbled up much of the laboratory work into the for-profit sector. There are very few doctors involved in all those walk in clinics where you go for blood tests or to drop off your urine for analysis anywhere except in the board rooms where they count their profits at year end. Why aren’t those services offered by public servants attached to hospitals and clinics ? Because there’s a deal between the government and the doctors that permits them to continue to make a killing on the business – could be!

So, at least from my point of view, there are lots of innovations and different approaches possible to respond to the costs and availability problems that have thrown the economics into a crisis. Clearly, I don't have all the answers but I know to a lead-pipe certainty that turning this mess over to the careful and generous public-spirited natures of free-enterprisers will be a huge disaster for everyone.

Put resources and clear-headed people with a generous and open attitude who give more than two shakes for their fellow men and women together with some appropriate professionals and a lot will happen.
Even in terms of records handling and systems analysis we're still using 20th century technology (files and things piled like cordwood along the back wall of every GP's office) when we should have abandoned those things a decade ago.
Hang around a hospital ward for a day or two - try not to get in the nurses' way and you'll see a lot more. Talk to a few young doctors, as I have to my son: It's not rocket science, but it does require open minds.
Cheers.

G West,you have to remember that records of the patients that fill those back walls in doctors offices are there for a reason .SECURITY.
having HARDCOPY when the computers go down saves the medical system/doctors, time and litigation from making mistakes.so much for using less paper as we were told when computers take over,now we have copies of copies and rarely any originals in our offices.

but you are right,another system should have been initiated long ago,but we are so slow to change.

open minds,yes! but where to find them?hmmm

thomas49
I reckon there is a security feature in keeping a hardcopy - archiving it - but there's no need to keep it on site surely. In my doctor's office the bloody files take enough space to create two additional examining rooms, I kid you not. And the docs still use the bloody things (paper files) - the only thing that's computerized is the billing system that ties them into MSP so the $s keep pouring in.

Another costly item I thought about since I posted all that stuff above pertains to the walk-in clinics that proliferate these days. Virtually all of these are staffed daily on a rotating basis by docs who have their own offices elsewhere. I remember once I went in to get a tetanus shot after I’d slashed my finger in the garden and I was surprised to find my own GP was there. I'll bet you dollars to donuts they're not donating their time and are charging full tick for the patients they see while they're on duty there. Wouldn't it be a lot cheaper, and more efficient, to employ a full time staff doctor or five to work as employees in several of these places...or use locums and rotate them through 4 or 5 month postings and try to save some money rather than making sure the old codgers make extra money for their retirement by what amounts to 'extra' billings?

I don't know exactly how you'd do it, but it would certainly meet a need when there are apparently many people attending these clinics, not because it's an after-hours minor emergency, but because they can't find a family doctor who'll take them.

And in hospitals, have you noticed how the medication orders are filed? In loose-leaf binders. Not only is that inefficient, it's dangerous and I'll bet it leads to prescribing errors from time to time. Why not get the tech staff to post the data on a computer and use a laptop with a wireless connection to go along with the meds chart when pills are distributed?

G West:

Hey, you're describing my relationship with the healthcare system.

That's a thought I have as well. To go with my automobile analogy, weak though it might be, when I need my tire fixed, the kid in the back of the garage can cope with that job -- I don't need the master mechanic for that.

Great question. Right now, my only response, simply as a consumer, is that those labs are damned convenient; no appointments, close to either home, work, or shopping, virtually no wait time... I like them from that perspective. Once attached to hospitals and the bureaucracy that usually surrounds such large organizations, I'm not so sure I'd find them nearly so convenient.

grub
No problem! Attach labs to the walk in clinics, which are also all over the place these days anyway. The ones I mentioned in my response to Thomas' post above. But for god's sake don't lets pretend that they have to stay inside the old boys monopoly. As it is now, technicians are all that's there anyway. Attached to clinics there'd be a doc available when I faint after they've taken my blood. That can't be a bad thing either!

The point is, as you obviously recognize, that anybody who throws up their arms and says I give up - turn it over to the private for profit sector - is just not trying very hard.

G West:

This is exactly the sort of dialogue I find useful.

Thanks.

GW, those paper files are legal documents. I can tell you in the hospitals little to nothing is done without written orders. Everything is also computerized but the Dr must put it writing. Nursing can take verbal orders for some things but eventually it must be, for legal reasons, put in writing. I suspect the same for your GP's office. I don't want to interrupt y'alls thinking but what do you think could be done for the increasing bulge of the elderly going through the system?

Blonde pitbull
I'm on my way out the door so this'll have to be short.

No disagreement on the legal thing, but it's about time we fixed that. Million dollar deals are legally executed on the internet with proper encryption - no reason we can't create a secure and legal system electronically too. Archive the paper files, save 'em forever if you want, but not where they're occupying important high-cost real estate. As to docs signing off on meds orders - same answer - passwords and encryption. And, the software can be designed with several levels of failsafe security to protect against someone making stupid mistakes by accident. I’ll bet there’s something in the works, if not already being used, that links meds orders electronically to actual dispensing technology to make it even more secure and it’ll free up nurses from the tedium of doing meds rounds two or three times a day.

The elderly. That's a much bigger problem but I think, if you look at the statistics, even in that demographic, much of the need for the high cost acute care facility by that demographic comes during the last year of life. Lots of acute care beds are probably being used inappropriately much of the time. I was just trying to think last night about what kinds of care many elderly people really want and need. My Dad is in a home and one of his big beefs is that he can't get a doctor to come and see him. He doesn't need a high cost diagnostic system, MRIs CAT scans and the like. He's old and he has questions and concerns he'd like someone to listen to. I bet a lot of elderly people are the same.
In the end, the solutions we're looking for may not always be something flashy and new and high cost.

That's probably pretty trivial as a response to what you've mentioned but it's all I have time for this morning. There was a continuing series in the New York Times last year on the subject of innovations for problems in health care. I'll see if I can find some more information.
Cheers.

Blonde:

And the bulge is getting bigger by the week. That's a huge problem.

One thing that comes immediately to mind is the cost of drugs. One step must surely be to negotiate bulk quantity purchase discounts on pharma products. However, watch for goevernments like Campbell's to down-load those cost onto the elderly.

And, as a society, we'll need to provide a huge stock of housing and, in time, assisted living complexes.

Which brings me to something that may be off-topic to an extent: how to pay for all of this. I'm an advocate of equity and universality, and "user pay" too often flys in the face of those principles.

However, I have considerable difficulty with the notion of universal funding which leaves the seniors' hiers with, collectively, millions in inheritances. My solution would be a significant inheritance tax (perhaps even linked to the medical system). As an aside, I've never understood the great resistance to inheritance taxes: I'll be dead and gone, si I couldn't give a fig.

why not create our own pharmacanada ?

one of the lower mainland universities just sold the rights to a painkiller they just developed.

WHY WAS IT NOT DEVELOPED AND SOLD HERE,THAT IS OUR INTELLECTUAL PROPERTY BEING DEVELOPED IN OUR UNIVERSITY...?

now anybody else got an out of the blue idea ?

haraldkann:

I can't argue with that.

On the links, and the perfidy of drug companies and medical professionals, there is an interesting piece in the April Atlantic by Carl Elliott. It's called The Drug Pushers. Unfortunately it is not available online if you don't have a subscription to the paper edition.

Here's a re-hash of my earlier postings on reform presented as a 9 point suggestion on how to halt and roll back the emergence of a two-tier health system in Canada:

1) No medical services permitted outside the terms of the Canada Health Act.

2) No restrictions on either the public or private provision of health service other than the provider must be accredited.

3) All medical services (public and private) are available to all Canadian residents. All Canadian residents are covered.

4) The process for admitting new services and service providers must be quick, transparent and predictable. Rate negotiation and adjustment are on-going to reflect the dynamics of health care innovation.

5) medical service rates use a sliding scale that payout premiums to providers that deliver high (fast) turn-around and verifiable quality simultaneously, and penalize providers who fail to conform to mandatory acceptable wait times and standardized methods (this latter provision would not apply during significant medical emergencies such as pandemics or earthquakes or other unanticipated disruptions of medical service delivery).

6) All medical service charges are negotiated between the providers and the plan administrators and are then paid according to the negotiated rate.

7) User fees (and equivalents) are forbidden and punishable by fines.

8) User premiums are set at the level where premiums times the number of users = full cost of delivering health care in canada. Progressive premium assistance is used to ensure affordable health care for all. The total government contribution to the Canada Health Act system (excluding capital expenditures?) is delivered through premium assistance. Governmental contributions/transfers are guarenteed through constitutional ammendment. Additional government committments are established to drive preventative health initiatives.

9) Quality of life metrics supercede actual-time-to-deliver benchmarks in determining mandatory acceptable wait times and standardized methods.

tcahill: i'm liking it....

OK, Grub, while everybody else is solving the water crisis, what do you say we two implement this plan ourselves?

That last post was supposed to be accompanied by mad-scientist type cackling. i.e, "Bwa-ha-ha-ha"

1) You really mean this? Public health care should pay for nose jobs and vanity tummy tucks; in vitro fertilization for 65 year old women who wnat another child; heart transplants for 90 year olds; unlimited experimental interventions. Think about it. The objective was to reduce costs not increase them. Not to mention private hospital rooms for everybody?
2)Doesn't address the high cost of drugs.
3)No provision for budget certainty and forward planning if you permit constant revision of rates.
4)Are you a doctor? Doctors would love this - how do you determine quality of delivery standards on items like heart transplants and hip replacement? Who's going to pay for the litigation?
5)Administratively would be far more costly than the present system - look at no 8 - that item alone would require an army of bean counters.
6)How do you reconcile no 6 and no 4? You can't have it both ways.
7)Completely silent on training and supply issues, not to mention capital funding and research costs.
8)Ignores current shortages of physicians and services in rural areas.
10)Would probably increase medicare costs by a minimum of 40 % within two years of implementation.
11)Doesn't address acute vs long-term care costs and attendant issues at all.

Not a very good start.

Alcibiades, a very good start. With you pointing out possible deficiencies, tcahill can go back to the drawing-board and re-tune. That's the only way this issue can be tackled.

1)Did I say "medical" services? Cosmetic surgery can be for medical reasons. I'm not possessing the wisdom of solomon. We've already got the scandal of our medical plans paying for silicon brest enhancements.

2) I started to deal with pharma, but that is currently outside the Health Act, and I didn't want to drown in detail. That is a very worthy topic...

3) I don't have an answer for that right now.

4) No, I'm not a doctor. Litigation (malpractice) is currently supressed isn't it? Otherwise, good question: how do you determine standards? Shall we just give up?

5) Yes, it would be more costly, but it would also capture more revenue. More of the people currently "jumping the queue", or taking their health dollars south would be served within the system, and their dollars would be captured by the full premium.

6) I'm sorry, could you elaborate on the contradiction you see?

7) I had an additional bullet dealing more extensively with preventative health, but that was outside the pervue of the CHA. Additionaly, yes, training and supply are not addressed. (I assume you mean the supply of doctors?)

8) rural shortages are currently addressed with all kinds of bonuses and subsidies (under different names). The current system doesn't fix this, does mine have to to be worthy of consideration of what it does do?

9) ?

10) increase medicare costs? OK. Why?

11) That's true.

I'm sorry if I missed your suggestions on how we fix the two-tier dilemna. Could you remind me?

Alcibiades makes a very good point about cosmetic surgery and enhancements. I believe we are just seeing the thin edge of the wedge on this issue. The future I see has the distinction between humanity and machine blurred beyond meaningful distinction. I'm leaning towards a need to strictly firewall the health system from "cultural " modifications, be they circumsision, liposuction or brain/data interfaces...

Wouldn't it be great if this blog had a spell checker?

The issue of high drug costs is just huge. We've made a start with generics, but we've gone the wrong way with extending the life of patents. Then there is the whole stink around the issue of the CMA in bed with pharma, to the point that they fire their journals editorial board to try to supress the taint. Where to start?

Can a reform adjenda not get started in the meanwhile. I'd just love to see the drug question get the thorough treatment it deserves...

Rates:
You can't have both adjustment in rates to reflect dynamic change and cost certainty and stability at the same time. The concepts are mutually exclusive.
Areas not considered:
Why not address rural shortages and the causes of the current crisis; if these are important elements of the problem, isn't it contingent that that proposed solutions actually address them?
Costs?
I would have thought it would be obvious. This set of proposals covers more services than are covered now. Many of them are very costly. There is no consideration in this proposal for triage and judgment so anything would go, presumably. The country says it can't afford Chevrolet care now and you're suggesting we buy a Rolls Royce.

Assume you agree that drugs aren't trivial.

Suggest this is no improvement on the current system and might, in the end be much worse.
THanks for trying though.

Don't have a two-tier policy. I'm just a critic. Others have posted their suggestions above, I think.

Some provision is necessary, but we don't have certainty now.

If you have an emotional response to the word "Competition" I don't think my ideas will find a happy home with you. I'm not sure I'm fully comfortable with the implications my self. Despite that misgiving I'll attempt to describe a way forward.

First: my own philosophy. If the expectation is driven into the system that the status quo isn't -- we're not going with change for change's sake (only consultants love that) -- but we are embracing constant review and adaptation. Not in everything and everyway, all the time. But in as managed and controlled manner as events make possible. Change is a fact and not always for the better. We all have to cope with that as best we can. Can we insulate our institutions from changes we cannot escape ourselves?

Now for practical matters. The experience of modern industry has been cheaper, faster, smaller. Except in Health care. We've all got computers that we are using to share this experience of thetyee.ca. Computers whose abilities blow multi-million dollar supercomputers of the late 1980's out of the water. Competition has played a role in that. But Innovation has been the driver of the phenomenon.

I cannot predict what innovation and competition would produce in the health system. No doubt there would be painful adjustments and dislocations within the ranks of service providers. I think we can also expect cost savings.

I know there are always concerns about a race to the bottom. I think it is interesting to note that the BC Health Guide book is written and published in the USA. I hope the BC government isn't reading this, because I keep wondering if the nurse I'm talking to on the 1-800 health line printed in the book is here in BC or somewhere in India.

At the same time, the one kind of employment that has continued to earn top dollars has been the skilled worker. These highly productive workers, no matter if they are electricians, plumbers, or doctors, need to be were the demand is, and are difficult, if not impossible to out-source. They need to be where the wire, pipe, or bad cough is.

Other skills we've taken for granted can be just as well performed by a specialist in Bangalore who downloads our lab results at night and has the analysis ready for the doctor the next morning. That specialist hasn't even needed to pull a night shift, and is thrilled to work for a fraction of what a local person could afford to.

There have been some good suggestions regarding rural shortages. I honestly don't remember if I read it somewhere or if I thought of it myself, but it makes sense to me that if we can break the stranglehold the CMA has on accredidations and get the many, fully-competent foreign trained physicians addmitted to the system -- with the contractual stipulation that their pay rate will be the inverse of the distance of their practice from a major urban center. I know it isn't fair. I think our own domestically trained doctors should have to accept the same dea.

We need to be clear on which causes and problems we are refering to. I framed my suggestion to deal with 1) two-tiered medicine and 2) wait times.

What I'm trying to weave together is a) the otherwise discordant influence of a wealthy baby boom with emerging health problems, lots of money to throw at those problems, and no patience for an overwhelmed system. and b) the springing up like mushrooms of the specialty private clinics catering exclusively to those wealthy baby boomers.

With my suggestion, we say you can be privately owned and operated but you may not have private clientel. You may target the fees that your business plan suggests, but we will maintain a monopoly on user fees (called a premium), and we will negotiate with you what those fees will actually be. If you can turn your cases around at the same or higher quality and faster than the norm, you will be paid a pre-negotiated premium for that. That same premium will be available to any competing provider that can deliver the same quality and turn-over.

We cannot look at health care costs in isolation from the rest of the economy. A Hip replacement delay of 24 months is a huge cost. Lost wages, medical expenses, re-habilitation.

I'm not an expert, but I think if we have to pay more, but get better health from the deal, we'll wind up ahead.

1. You have to consolidate and strengthen what exists, try to correct and respond to current problems and shortcomings, before adopting a radical approach such as you're suggesting.
2. The taxpayer is upset by how much he or she sees being spent on health care now, any solution that hits the pocket book very hard, and your suggestions will hit them very hard, is stillborn, in my view.
3. Competition has no place in the provision of essential services. Everyone deserves good quality care, not cut rate fly by night operations that are trying to increase their share of the available market. That's fine for widgets, not good for people.
4. Sometimes even the current system isn't very sensible, I will agree with that. Reproductive health is a good example. Poorer people now can't access the most expensive and modern in vitro techniques - they're only available to people who pay for them privately. Therefore, poorer people who want children use the cheap, public approved service that implants several eggs at a time. This results in multiple births - many of these children are premature and of low birth weight and cost the parents, and the health system, enormously more (in total) than the original cost would have been for the more expensive method. Canada now has the highest rate of multiple births, per capita, in the world as a result.

So, it's not enough to say that the old way is always the best even if the new method is nominally more costly.

Research and an open mind are always important.

It is a very complex area but I don't think you can sell a system, such as you're suggesting, that will, almost guaranteed, be much more expensive than what we've got now. Further, there has to be a profit for private care to be interested. You haven't said anything about where that's going to come from except in a general way. I don't see where it will come from if you're also serious about regulatory integrity. Further, how will you establish reference criteria for comparing results? Aren't the wide variety of possible human variables and outcomes going to make that difficult if not largely impossible?

Perhaps you could clarify what litigation you refer to? Again, I'm no expert, but the Canadian constitution does empower parliament as supreme to make law. If Parliament says no litigation will be admitted, that legislation may be challenged in court, but no litigation will proceed in the meanwhile.

Otherwise, how could quality be defined? Results, obviously. Patient feedback. No medical errors. It may not be easy, but it certainly isn't impossible.

Alcibiades: I'm glad to see I've got you engaged. I'm needing to get back to some other matters, and I'm getting tired and risk getting sloppy (sloppier?) and slapdash. You've got some very constructive criticism here and I'd definitely want to follow up on these...

Here, I've got to challenge your pessimistic assumptions characterizing of what is inevitable or not with competition. I fully agree the everyone deserves good quality care, and I'll go further and say those providers who cannot deliver that must be punished or shut down. We know there are entrepreneurs who are willing to take big risks for big rewards. No system is immune to con artists.

I don't accept that the profit motive is incompatible with health care. Nor is it incompatible with a strictly regulated environment. We're talking about a very big business with huge budgets. We're seeing some early signs that there are significant amounts of capital ready to commit to the market if a playing field can be established. I also don't rule out co-ops or non-profit organizations. There is almost always a way to operate with revenue higher than costs. It doesn't matter how your organization is structured. The thing is there are more good ideas than there are good managers.

At this time of night a high degree of subjectivity seems like a plausible answer. Perhaps I'll do better in the morning...

I had to come back to chip in one more thing. If it must be accepted that lessons from the USA are relevant to this discussion, then we should not overlook things the US does right.

I suppose for some, I could only make this argument with any hope of credibility if I prefaced it with a long list of complaints about US medical care. I leiu of that I have just typed "problems us medical care" in the google search bar and have found that there are 331,000,000 search results corresponding to the query. So, in the interests of credibility I can say here that there are more documents relating to problems with US medical care than there are US citizens, and I can't possibly cover them all.

Moving on. We've all heard the tales of woe, but if we're going to acknowledge those, we should also acknowledge that some of the world's very best hospitals are located in the USA. For example, my sister-in-law works at Johns Hopkins in Baltimore, the #1 rated Hospital in the USA.

My point. It is possible to obtain good health care from a private (non-profit) institution. There is evidence that for-profit hospitals come at a fatal price: http://bmj.bmjjournals.com/cgi/content/full/324/7350/1351

The evidence seems very strong that for-profit hospitals are a bad idea, but other is not nearly so clear for other for-profit providers. Labs have been mentioned.

tcahill:

And I, for one, commend you for that.

I have the same misgivings, but creative solutions can never be arrived at if the solution is already predefined not to include alternate means of delivery.

tcahill:

If you use the Firefox browser, you can download a spell-checker extension that places the spell-check icon on your browser toolbar.

I confess, in the heat of exchanges, I often forget to use it.

tcahill

A good starting point, as that defines just about every human institution.

tcahill:

I too have had concerns about doctors not wanting to practice in rural areas. I always thought the solution was simple (but apparently, some years ago, the courts disagreed). My solution; if you want a billing number, then you take the billing number where it is available. I can't see why doctors should be any different than other workers; teachers may all prefer to work in Vancouver, but if there are no vacancies: tough luck! out to the boondocks you go.

tcahill:

I like the idea, but wonder if the bureaucracy required to "police" this might be too cumbersome and open to distortions.

Alcibiades:

I beg to differ: not if what exists is not functioning very well -- waiting lists (in any system) are usually the net result of a long series of things that have gone wrong over a longer period of time.

Alcibiades:

A very valid point. My radical solution would be a hefty inheritance tax, perhaps exclusively targeted towards healthcare.

As has been pointed out, a person's major medical expenditures usually occur in the last few years of life. In a system based on equity and universality we wouldn't want user pay, but why not pay once you've left this world. Philosophically, I have some difficulty with a society that provides hundreds of thousands of dollars in medical care to a person, only to see their heirs walking off with millions in inheritance (but, I guess that's just my hang-up).

Alcibiades:

I'm not sure that's exactly the spirit of tcahill's suggestion.

By way of example, let me go off on a tangent (this scenario was told to me by someone closely associated with the computer industry in the former East Bloc). Over the past 25 years, improvements -- spurred on by the sort of competition tcahill alludes to -- in the PC industry have been rapid and regular (086, 286, 386, 486, 586 of all versions, etc). In the communist East, it took them quite some time to decide that PC's were even worth building (there was not competitive impetus). When they finally got their act together, they put together a very fine 086-style PC. Unfortunately, Intel/Microsoft had moved well past that iteration. My acquaintance tells me that, in the boardrooms of this East bloc computer concern, the word was: this constant improvement was a western conspiracy to screw their Easter enterprise.

The point is: necessity can indeed be the "mother of invention", and competition can indeed create that kind of necessity.

tcahill:

Brilliant! That should be the motto for this entire discussion.

Alcibiades:
Quote:
2. The taxpayer is upset by how much he or she sees being spent on health care now, any solution that hits the pocket book very hard, and your suggestions will hit them very hard, is stillborn, in my view.

grub:
Quote:
A very valid point. My radical solution would be a hefty inheritance tax, perhaps exclusively targeted towards healthcare.

Not to discount your inheritance tax idea (I've yet to really meditate on it), but my intuition is that the baby boom expendable health budget is far larger than anything we've dealt with to date. Look at what the baby boom did to the music, automobile, then construction industries. At least that amount of money (probably more) is comming into the health market.

tcahill:

Correct on the magnitude.

Allow me a small but significant correction: At least that amount of money (probably more) is coming out of the health market.

The baby-boomers will, I think, be a drain on the system, the same way they (me included) were in the 50's, 60's and 70's as society built maternity wards, schools, and universities to accommodate us.

Grub:

I think we are looking down different ends of the same pipe perhaps. You are refering to the vast cost of looking after baby-boomer ailments.

I am referning to the discretionary income that baby-boomers have grown used to applying to whatever they desire. Those boomers have a lot more money than they did when they made the Beatles rich. They will willingly spend it on what makes them feel better, be it a new tune, a $70,000 automobile, a grand new 5000 sf house, or a new hip. They will demand it, and they will purchase it, no matter what mode of delivery they need to work through.

Our system, already overstreched, will be overwhelmed by their demands if it is not permitted to expand to the level their needs will require. The public purse can contribute to the infrastructure creation required, but the rapid investments needed would really be helped along with non-government funds.

So there is the gap, and there is the means to fill it.