If America adopts Canada's health care system

[Edward Campbell]

Before someone asks: if, through private insurance, the "middle class" can jump the queue, as the rich already do, doesn't that just create a whole new, equally long queue?

No. The "miracle" of competition within the private sector is that it will, of necessity, add resources (doctors, nurses, acute care beds, etc) to meet demand until an acceptable price/availability "equilibrium" is achieved. That, adding resources - new money - is the one thing the public sector is unwilling to do.

 

[c_canuk]

I agree with the premise that private competition in the health care sector will inject new cash and infrastructure.

I am hesitant to agree that it will increase the number of personnel as it's a problem outside healthcare for the most part.

Also while I think it is unlikely that the public sector would inject more cash, it's certainly not impossible, just improbable

 

[c_canuk]

While the State must provide police protection as part of the States function of providing protection to citizens, it is also obvious that the modern State is not providing the protection service desired, as there are far more private security officers than police officers.

The state's police force's primary function is to enforce the states laws, protecting people falls second.

they provide protection to the people by making sure that those who break the law are apprehended and fed to the court system to be punished if found guilty.

private security's primary function is to provide protection to whoever has hired it.

Malls, Stores etc can't retain the services of a police officer to provide a visible deterant and on the scene peace officer, and thus private security fills that need.

This is why the theory that draconian gun control laws and allowing intruders to sue you for injury are reprehensible, forcing the citizens to rely only on the state police for protection, when that isn't their primary mandate, is sickening.

 

[a_majoor]

Common sense is breaking out in Canada, and it is ironic that we seem to be moving more towards the American system at the time the Administration wants to move towards "our" system. Perhaps there is a silver lining in this, "medical tourists" from the United States might find coming to a private Canadian clinic far more affordable and accessible than going to (say) Mumbai, which will provide the source of "new money" that Edward Campbell righty points out is needed:

http://www.nationalpost.com/news/story.html?id=1739758

Prognosis for profit
Private medicine gains ground

Tom Blackwell,  National Post
J.P. Moczulski for National Post

After eight months of gruelling treatment for colon cancer, it was the last news that Howard Steinberg wanted to hear. Tests indicated that there were two golf ball-sized tumours in his liver: the malignancy had spread, and now he would need another round of chemotherapy or potentially dangerous liver surgery.

That is when Mr. Steinberg took matters into his own hands, paying about $2,300 out of pocket to a little-known private clinic to receive a PET scan, a service that in Ontario, unlike in most other provinces, is still not covered by medicare.

The cutting-edge diagnostic tool indicated the 44-year-old Toronto man was, in fact, cancer-free and needed no more treatment, an assessment later confirmed by other tests.

"It would not have been healthy and could have been fatal," he said about the treatment he avoided. "I'm fortunate that I had the financial means to do this. I suspect that many don't."

The CareImaging LP clinic revealed this week it is expanding its unique, Mississauga, Ont.-based PET scan service to Windsor.

At the same time, British Columbia's new health minister just spoke out in favour of a separate, private tier of health care.

Quebec, meanwhile, is poised to implement a law that would encourage more private surgery clinics.

Opinions about the apparent trend diverge widely, but the notion of for-profit medicine -- so often a political taboo -- seems to be gaining ground in Canada.

"There does seem to be a lot of talk about pushing private clinics and private delivery," said Mike Mc-Bane of the union-backed Canadian Health Coalition.

"It is ironic that at a time when the United States is moving toward public health care, governments in Canada seem to want to go the wrong way."

In the long-running public-private health-care debate in Canada, the public side has made some recent gains. Non-profit hospitals and clinics have started chipping away at the lengthy wait times that fuel the sense of crisis in the system, while Ontario, Manitoba and Alberta actually pulled private clinics into the public fold a couple of years ago.

Yet the idea of harnessing the free market to make the still-troubled system run more efficiently is picking up steam.

Quebec, already the unofficial heartland of private medicine, is expected to soon implement Bill 33, a law that would pave the way for more private surgical clinics, carrying out procedures funded by taxpayers. Mike Murphy, New Brunswick's Health Minister, has said he will consider similar use of private clinics to deliver publicly financed operations and diagnostic tests.

For the second year in a row, the president of the Canadian Medical Association (CMA) -- the country's most powerful doctors' lobby -- is a private-clinic owner and is calling for the private sector to play a greater role.

Dr. Robert Ouellet's influence will fade soon, as an avowed defender of medicare, Ottawa's Dr. Jeffrey Turnbull, takes over the CMA's rotating, 12-month leadership.

But a report issued late last year by the Health Coalition said it found more than 120 for-profit diagnostic and surgical clinics across the country, and 89 possible violations of the federal legislation that governs the medicare system.

For Nadeem Esmail of the conservative Fraser Institute, further incursions by private health care are inevitable.

"Canadians are increasingly coming to realize the limitations of the public health-care system," he said. "There is a demand for privately financed services in Canada, which entrepreneurs have been stepping up and providing."

In B. C., Dr. Brian Day, last year's president of the CMA and owner of the private Cambie Surgery Centre, launched a lawsuit in January with other private clinics that argues it is unconstitutional to bar Canadians' access to private medicine. The province responded with a countersuit that accused the clinics of already charging patients direct fees for medicare-covered services.

And yet, the province's new Health Minister, Kevin Falcon, appeared to contradict his own government's position when he told the Vancouver Sun this week he has no "philosophical objection" to patients buying health care in the private realm. He later claimed he had not been referring to medically necessary services.

Citing the health-care budgets that gobble up more and more of the provinces' thinly stretched budgets, Dr. Day argues that a universal health-care system can only be sustained with help from the private sector. "Medicare will end without reform," he said in an email interview.

Not everyone is convinced private medicine is making any gains. For now it remains a phenomenon chiefly in Quebec and B. C., says Dr. Danielle Martin, a Toronto family physician and head of the group Canadian Doctors for Medicare.

"I think we need to guard against it.... [But] I don't think it's mushrooming all of a sudden."

In fact, the term private health care has a variety of meanings, and there is still little support for the concept of a totally separate private tier of medicine. Most commonly discussed, and less controversial, is the idea of private delivery, where governments pay for-profit clinics to perform certain procedures, in theory with greater efficiency than public facilities.

Mr. Esmail and Dr. Day predict the private sector will increasingly play such a role. Dr. Martin, though, says study after study has shown that such facilities end up costing governments more money, while often managing to charge user fees to patients.

The expanding CareImaging company fills a different, unusual role, offering a service the province has yet to decide whether to insure.

Positron emission tomography (PET) scans use "tracers" -- liquids carrying tiny bits of radioactive material that are injected into patients -- to provide an intimate view of parts of the body. Nuclear-medicine specialists call it the state-of-the-art for diagnosing and tracking change in some, though not all, cancers.

Dr. Jean-Luc Urbain, who practiced in his native Belgium and the United States before settling in London, Ont., said he has never seen as many advanced cancers as he has in Canada, and suspects the lack of PET scan service is to blame. "Ontario has been in total denial," he charges.

Others experts argue that not enough is known about when, exactly, using the expensive tool is most justified.

In the meantime, CareImaging has performed close to 2,000 scans in Ontario. Though it is a for-profit enterprise, no patient is turned away, even if it means doing scans pro-bono, said Ghassan Barazi, the firm's CEO. Ideally, though, he would like to see the province insure the service, and pay his company the same fees it would for the publicly-owned PET scans performed in hospitals.

"If it was covered by [medicare]," he said, "demand would be incredibly high."

 

[tomahawk6]

Canadian healthcare continues to ship critical care infants to the US for treatment. This might not be viable option for Helathcare Canada under Obamacare.

 

[observor 69]

New York Times

July 19, 2009
Why We Must Ration Health Care
By PETER SINGER
You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, “Americans will not put up with such limits, nor will our elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the proposed reform.

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages. In May, Medicare’s trustees warned that the program’s biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation. According to the Congressional Budget Office, it is on track to double by 2035.

LINK

 

[a_majoor]

The reasons that our health care system is in trouble are the same reasons that the proposed Obamacare will not work either:

http://www.reason.com/news/show/134987.html

The Arrogance of Heath Care Reform

Why do politicians with no business experience think they can run 15 percent of the economy?
John Stossel | July 23, 2009

It's crazy for a group of mere mortals to try to design 15 percent of the U.S. economy. It's even crazier to do it by August.

Yet that is what some members of Congress presume to do. They intend, as the New York Times puts it, "to reinvent the nation's health care system."

Let that sink in. A handful of people who probably never even ran a small business actually think they can reinvent the health care system.

Politicians and bureaucrats clearly have no idea how complicated markets are. Every day people make countless tradeoffs, in all areas of life, based on subjective value judgments and personal information as they delicately balance their interests, needs and wants. Who is in a better position than they to tailor those choices to best serve their purposes? Yet the politicians believe they can plan the medical market the way you plan a birthday party.

Leave aside how much power the state would have to exercise over us to run the medical system. Suffice it say that if government attempts to control our total medical spending, sooner or later, it will have to control us.

Also leave aside the inevitable huge cost of any such program. The administration estimates $1.5 trillion over 10 years with no increase in the deficit. But no one should take that seriously. When it comes to projecting future costs, these guys may as well be reading chicken entrails. In 1965, hospitalization coverage under Medicare was projected to cost $9 billion by 1990. The actual price tag was $66 billion.

The sober Congressional Budget Office debunked the reformers' cost projections. Trust us, Obama says. "At the end of the day, we'll have significant cost controls," presidential adviser David Axelrod said. Give me a break.

Now focus on the spectacle of that handful of men and women daring to think they can design the medical marketplace. They would empower an even smaller group to determine—for millions of diverse Americans—which medical treatments are worthy and at what price.

How do these arrogant, presumptuous politicians believe they can know enough to plan for the rest of us? Who do they think they are? Under cover of helping uninsured people get medical care, they live out their megalomaniacal social-engineering fantasies—putting our physical and economic health at risk in the process.

Will the American people say "Enough!"?

I fear not, based on the comments on my blog. When I argued last week that medical insurance makes people indifferent to costs, I got comments like: "I guess the 47 million people who don't have health care should just die, right, John?" "You will always be a shill for corporate America."

Like the politicians, most people are oblivious to F.A. Hayek's insight that the critical information needed to run an economy—or even 15 percent of one—doesn't exist in any one place where it is accessible to central planners.Instead, it is scattered piecemeal among millions of people. All those people put together are far wiser and better informed than Congress could ever be. Only markets—private property, free exchange, and the price system—can put this knowledge at the disposal of entrepreneurs and consumers, ensuring the system will serve the people and not just the political class.

This is no less true for medical care than for food, clothing, and shelter. It is profit-seeking entrepreneurship that gave us birth control pills, robot limbs, Lasik surgery, and so many other good things that make our lives longer and more pain free.

To the extent the politicians ignore this, they are the enemy of our well-being. The belief that they can take care of us is rank superstition.

Who will save us from these despots? What Adam Smith said about the economic planner applies here, too: The politician who tries to design the medical marketplace would "assume an authority which could safely be trusted, not only to no single person, but to no council or senate whatever, and which would nowhere be so dangerous as in the hands of a man who had folly and presumption enough to fancy himself fit to exercise it."

John Stossel is co-anchor of ABC News' 20/20 and the author of Myth, Lies, and Downright Stupidity. He has a new blog at http://blogs.abcnews.com/johnstossel.

 

[a_majoor]

Health care theater. Where do we get our tickets? A look at nationalized health care through the lens of public choice theory.

http://meganmcardle.theatlantic.com/archives/2009/07/a_long_long_post_about_my_reas.php

MEGAN MCARDLE: A Long, Long Post About My Reasons For Opposing National Health Care. Excerpt:

Basically, for me, it all boils down to public choice theory. Once we’ve got a comprehensive national health care plan, what are the government’s incentives? I think they’re bad, for the same reason the TSA is bad. I’m afraid that instead of Security Theater, we’ll get Health Care Theater, where the government goes to elaborate lengths to convince us that we’re getting the best possible health care, without actually providing it.

That’s not just verbal theatrics. Agencies like Britain’s NICE are a case in point. As long as people don’t know that there are cancer treatments they’re not getting, they’re happy. Once they find out, satisfaction plunges. But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.

So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure. Innovation benefits future constituents who aren’t voting now. . . . At this juncture in the conversation, someone almost always breaks in and says, “Why don’t you tell that to an uninsured person?” I have. Specifically, I told it to me. I was uninsured for more than two years after grad school, with an autoimmune disease and asthma. I was, if anything, even more militant than I am now about government takeover of insurance.

But you can also turn this around: why don’t you tell some person who has a terminal condition that sorry, we can’t afford to find a cure for their disease? . . . The other major reason that I am against national health care is the increasing license it gives elites to wrap their claws around every aspect of everyone’s life.

Read the whole thing.

 

[CougarKing]

A relevant update:

VANCOUVER, British Columbia (Reuters) - Canadian physician Robert Ouellet is tired of hearing Canada's healthcare system cast as the boogeyman in the vitriolic U.S. political debate over healthcare reform.

Critics of President Barack Obama's reform drive have accused him of trying to adopt the Canadian system of public healthcare funding, which they say endangers patients with lengthy waits for medical care.

Some advertisements feature Canadian citizens who say they were denied needed medical care or forced to seek treatment at their own expense in the United States because Canada's system was too slow to respond.

While Ouellet, president of the Canadian Medical Association, admits that Canada's system has its flaws, including excessive wait times for some medical services, he denies the accusation that it puts lives at risk.
"To say that the system is a complete failure is not fair. When people go to the hospital they get good quality medical care. ... People are not dying on the street," said Ouellet, who practices medicine in the French-speaking province of Quebec.

Canada's "national" system is actually a set of provincial and territorial insurance systems governed by a federal law that says coverage is universal, and ensures that taxpayers, not patient fees, pay for primary medical services so everyone can afford them..

"It's 14 systems," Ouellet said.

CULTURAL GAPS

Canadians are quick to cite healthcare as a cultural difference with their southern neighbor, describing it as inconceivable that 47 million Americans -- more than Canada's population -- live without health insurance.
"It's seen as something that separates us from the United States," said Mike Luff, a spokesman for the National Union of Public and General Employees.

The attacks on Canada's healthcare are also "ironic" because "Obama's plan doesn't come close to what the system is in Canada," Luff said.

White House-backed Bills now making their way through the U.S. House and Senate would overhaul rules for private health insurers, and offer them competition in the form of a government-run health program.

Private health insurance is also available in Canada, as a supplement to the government-funded insurance system, and Canadians face the same television advertisements as Americans about the risks of not having it.

Canadians can also pay private clinics for some procedures to avoid waiting, but major medical treatments must be done through the government-funded system.

Ouellet says each country has something to learn from the other about health care, and should also take lessons from European countries that provide universal care while reducing both costs and wait times.

Dr. Brian Day, a past CMA president who has advocated for a bigger private-sector role in Canada, is also dismayed that Americans and Canadians focus on one another and ignore the rest of the world when discussing healthcare reform.

"Clearly the Canadian system has problems, but the United States has more problems. ... Neither country is giving value for money," Day said.

The Canadian government has stayed quiet on the U.S. debate, but it may have no choice but to speak out if the Canadian public grows more upset at what it sees as unfair U.S. attacks on a source of national pride, said Mario Canseco, of the polling firm Angus Reid Strategies.

"Sooner or later someone from the federal government is going to have to stand up and say leave us out of this," said Canseco.

http://www.reuters.com/article/GCA-HealthcareReform/idUSTRE56S37T20090729?pageNumber=1&virtualBrandChannel=0

 

 

[Edward Campbell]

I don’t know enough about the Gilded Age to comment on one part of Prof. Bercuson’s thesis – that we are in another and that it, too, should breed a reform movement – but I do have a comment on the key part of the problem he enunciates in this article, reproduced under the Fair Dealing provisions (§29) of the Copyright Act from today’s Globe and Mail:

http://www.theglobeandmail.com/news/opinions/remember-the-gilded-age-a-progressive-morality-play/article1236807/

Remember the Gilded Age: a progressive morality play

David Bercuson

Friday, Jul. 31, 2009

History never truly repeats itself, but there are stunning parallels between the socio-economic and political history of the United States in the last decade of the 19th century and the past two decades.

In the United States, the end of the 19th century was known as the Gilded Age. In the era before income taxes, the welfare state and government regulation, powerful men such as banker J. P. Morgan, mining magnate Meyer Guggenheim, Standard Oil billionaire John D. Rockefeller and railway entrepreneur E. H. Harriman built massive industrial empires and monopolies and lived fabulously extravagant lives.

This was the high point of what American economist Thorstein Veblen called “conspicuous consumption,” which coincided with a besieged working class, a shrinking middle class, diminishing agricultural income and rampant political corruption in city, state and national government. It erupted in a sudden and significant banking crisis right after the turn of the 20th century, a crisis in which Morgan himself used his great wealth and power to essentially save the U.S. banking system at Washington's behest. (There was no Federal Reserve at the time.)

The decline of public morality and the rise of avaricious, concentrated wealth endangered capitalism and prompted a growing movement of “progressives” – people who believed, first, that government had to be cleaned up, and second, that incorruptible government at all levels was the only power great enough to bring American capitalism and democracy back into balance.

A host of new reformist political leaders, from the Far West to the Midwest to the Eastern Seaboard, led farmer, labour, middle-class and social-gospel movements to break monopolies, clean up government, establish child and female labour laws, campaign for female suffrage and use the power of government to fight the worst abuses of unbridled capitalism.

American progressivism gave way to war fever when progressive president Woodrow Wilson led the country into war in the spring of 1917, but it came roaring back under Franklin D. Roosevelt in the wake of the Great Crash of 1929 and the decade of Depression that followed. The progressives remade the United States – their legacy is still seen in accepted federal institutions, from the Federal Reserve to Social Security to anti-trust law.

The decline of the U.S. middle class over the past decade has resulted from a number of complex causes, but is connected to rising health-care costs, lower taxation, growing passivity in government, political paralysis and increased indebtedness. As in the Gilded Age, the process has been accompanied by the decline in trade unionism, a massive concentration of financial power on Wall Street, the accumulation of great wealth and the concomitant re-emergence of conspicuous consumption and political corruption. In last November's presidential election, millions of Americans called “Enough”, elected the country's first black president and gave the Democratic Party control of Congress.

But what now?

The post-Gilded Age progressive uprising largely succeeded in bringing the country a much greater degree of democracy, equality and fairness. But it did so largely because four presidents – Theodore Roosevelt (1901-1909), William Howard Taft (1909-1913), Wilson (1913-1921) and Roosevelt (1933-1945) – used the presidency to ride herd on Congress, change the political colour of the Supreme Court and wield the executive branch's tremendous power to confront trusts and monopolies and to curb bad behaviour in the public sphere. They also set a compelling example to reform leaders in both state and local government.

Last November's election didn't necessarily mark the start of a 21st-century progressive movement, but it certainly reflected a demand for change by a surprisingly large number of American voters. If Barack Obama now fails to launch a badly needed era of reform in response to that demand, the power of Big Pharma, Wall Street and the Moral Majority will continue to prevail.

Health-care reform is the battleground.

The new President has largely avoided direct confrontation with the leadership of the Republican Party. He has been accused of frittering away his great popularity and of making deals with Capitol Hill that undermine the drive for reform. And it is true that, up to a few days ago, he had not used that once-massive popularity to plunge into the fray, as his progressive forebears did.

He must now take centre stage in the fight. If he does not, there will be no significant health-care reform – reform that must include a government-operated alternative. In any era of great change, there must be a defining moment that clearly shows how the agents of transformation have won the struggle and the opponents of reform have been soundly defeated. That moment is at hand.

What is unfolding in Washington now is nothing less than a morality play. It is up to Mr. Obama himself to decisively bring down the curtain on a social, political and economic system that pretends to worship the free market but, in fact, institutionalizes oligarchy – or he will fall victim to political mediocrity.

David Bercuson is director of the Centre for Military and Strategic Studies at the University of Calgary.

I agree with Bercuson that “health-care reform is the battleground” in what he describes as “a morality play” that aims to “bring down the curtain on a social, political and economic system that pretends to worship the free market but, in fact, institutionalizes oligarchy.”

With specific regard to health care:

• The debates – two quite different ones - in Canada and the USA about American/”free enterprise” vs. Canadian/”socialist” medical care (there is not much to do with “health” in either system) is wholly specious, on both sides of the border. Canada and the USA have two of the worst medical care “systems” in the OECD. Both are in dire need of reform and neither offers much in the way of a useful model for the other.

• The primary role of the US in the Canadian debate is to provide a useless strawman, actually a bogeyman, that “activists” can use to frighten Canadians into supporting a high cost/poor quality system; Canada has now started to perform the same function for equally dishonest American “activists.”

Both systems are:

• Too expensive – far, far too expensive in the USA; and

• Inadequate in terms of “health” and “medical” outputs.

Neither system “works.”

Both countries need a 100% “public” insurance system that provides reasonably timely access to medically necessary services. This system, of necessity, involves rationing and waiting lists for those who have no other medical care insurance - probably the bottom 15-35% (in terms of income/wealth).

Both countries need a highly competitive system of private insurance programmes that provide a wide range of individual and group “solutions” for the other 65-85% of the population. These people will be able to use their gold cards to better faster and “better” medical care.

The Obama proposal, as I understand it – and that “understanding is, doubtless, imperfect, is too expensive and, therefore, fails to address one of the main problems with the current US system – the percentage of GDP devoted to medical are is already too high, that damages America’s competitiveness.

The Canadian system is also too expensive, so much so that key drivers for our competitiveness (which needs drastic improvement), like education and R&D, are sacrificed on the alter of “free” medical care.

I’m not sure that the ”defining moment that clearly shows how the agents of transformation have won the struggle and the opponents of reform have been soundly defeated” is at hand, as Prof Bercuson suggests, but it needs to be near – in both Canada and the USA.

 

[Shec]

What I find instructive is that the  re-engineering the US socio-economic system occured over a period that spanned the 3 decades that started and culminated with a Roosevelt presidency.  TR was I believe the first 'trust-buster' and FDR brought in the New Deal.  Thus, it was a multi-generational process. 

Therefore, I rather doubt that 1400 Pennsylvania Ave.'s current resident will be able to achieve his promise of "change" within the 2 terms that he could legally serve regardless of what beer he ordered yesterday or what his favorite hamburger joint is which seems to be more of more relevance to the MSM than the efficacy of his performance. When this chapter of history is written Obama will be viewed, at best, as a catalyst and his accession to power a symptom, of a societal trend towards reform rather than the "magic bullet" that he would like to be lionized for being.  And I base that comment on his obvious, and self-righteous, narcissism.

Having said that,  your "compare and contrast" of the two health system models is bang-on.

 

[tomahawk6]

For the Statists in Washington this debate isnt about healthcare,rather its a vehicle to control the lives of every American. No health care if you are too old or sick. No healthcare until you lose weight. Ultimately this is about control and if enacted it would be damn hard to reverse.

 

[observor 69]

Before someone asks: if, through private insurance, the "middle class" can jump the queue, as the rich already do, doesn't that just create a whole new, equally long queue?

No. The "miracle" of competition within the private sector is that it will, of necessity, add resources (doctors, nurses, acute care beds, etc) to meet demand until an acceptable price/availability "equilibrium" is achieved. That, adding resources - new money - is the one thing the public sector is unwilling to do.

Just a couple of quick thoughts. It is my understanding the British system of  "NHS" and private care has resulted in medical personnel moving to the better pay and working conditions of the private system. Resulting in a lower standard of care in the NHS.
Ref the OECD comments on Canada heath  I don't see any clear opinion yea or nah to be drawn from their stats of comparing us to other countries. OECD
And my overriding thought is, I have some familiarity with this topic and I have yet to see the country that can be pointed to as the role model.
I do find my thinking following with you in wondering if there could be a better funding model...private insurance for the middle class and up ??

Regards.

BG

 

[Edward Campbell]

I’m sure your “understanding” of the British situation is absolutely correct and, further, I fail to see why it would not or, indeed, should not be that way.

When public health care was started, including by Saint Tommy Douglas here in Canada, the intention was that no one should be forced into the poor house just in order to obtain access to medically necessary care. That’s not instant access and it’s not access to “first class” medical care; it’s just “free” access to an acceptable level of “medically necessary” care. (I suspect that there is, within the definition of “medically necessary” and implicit requirement for timeliness. Medical care delayed is medical care denied, à la justice, I think.)

I am not at all surprised that some medical professionals would not want to work in a slow, inefficient, dirty, under-funded, over managed public system; I am, equally, not surprised that so many (most?) medical professionals do work in the public system, even when they have choices, and that some then volunteer to work in the third world, too, during their vacations.

I agree there is no “best” model but I would suggest that, just for example, France and Sweden achieve “better” healthcare outcomes, for everyone, for a lower cost (as a percentage of GDP) than do either Canada of the USA. The only two models, from the OECD, that I believe offer no useful guidance for either Canada or the USA are the American and Canadian models. Both are failures.

 

[Old Sweat]

Regardless of whatever health care system is used, there are some factors that mean that the result will be less than ideal. I just had a procedure this morning involving a dye injection and a series of xrays in search of a pesky kidney stone. This included a fair amount of waiting which allowed me time to notice that the exray room in a hospital in a small city was well-equipped with expensive kit, and it was not the sole xray room in the diagnostic imaging department. Carrying the thought forward, the amount of money tied up in medical equipment in any first world country, and many others, must be staggering. Furthermore the costs can only rise unless we want to go back to leeches, straight razors and bowls for our medical professionals.

The money can only come out of private pockets, either directly via billing, or indirectly via taxes, or both. No matter what option is chosen, people - lots of people - are going to fall between the cracks or at best go to the bottom of a very long waiting list. What may vary, depending upon the nation's and the individuals' ability to pay, is who gets serviced and how quickly. In my opinion, the various health care systems are all at best not too bad when averaged across the serviced population.

I don't have the answer. I don't even know if I could ask the correct question. What I do know is that whatever system the US may adopt, it probably will not provide a major improvement in solving the ills (pun intended) of its population because there are only so many staff and so much infrastrcuture to go around.

 

[tomahawk6]

The US remains the destination of choice for folks that dont want to wait a year for a heart valve surgery. Anyone can be treated if they show up at an ER so no one goes without. They may not be able to pay afterward but they are treated. Insurance costs could go down if we allowed insurance companies to pool their risk over the entire country instead of state by state. If there were tort reform that limited a doctors risk as they do in California it would mean much lower malpractice insurance which in turn lowers overall cost..

 

[Roy Harding]

I think the argument breaks down something along the following:

Both the US and Canadian systems treat "catastrophic" medical emergencies.  The Canadian system does not "bill" the recipient, thus causing financial hardship for the patient.  The exception in the US, of course, is for those who have valid medical insurance.

I'd like to make an observation.  I reside in British Columbia.  Every 3 months, I receive and pay a bill of $288.00 for Health Care.  I used to reside in Alberta.  There I received a similar bill every 3 months (I THINK it was $256.00 there - no doubt the amount has changed since I left Alberta in 2006).  So - I think I'm paying a health care insurance premium. 

For what it's worth - in the past five years, I visited a health care facility ONCE (for a stupid industrial accident, which wouldn't have happened if I'd been paying attention) - the Doc stitched me up, gave me some cream to spread on the wound, some pills (about two weeks worth, as I recall) to swallow - told me I was stupid (he was right) - and sent me on my way.

It should be noted that, as a Canadian Forces pensioner - I submit those quarterly bills and recover the cost as part of pension coverage.  Nevertheless - I'm paying a health insurance premium for basic, catastrophic health care.

I ALSO carry extra medical/dental insurance (again - through the CF pension system) - which covers pharmaceuticals, eye glasses, extra frills if hospitalized - and so on - but I PAY for it.

The point being - to get a "satisfactory" outcome from the Canadian system - I pay a premium.

As I understand it - the Canadian system was initially set up to ensure that people did not suffer financial hardship for "medically necessary procedures".  We can argue all day long about what constitutes "medically necessary" - but I'm pretty sure it doesn't count EVERYTHING that folks currently get done.

As I see it - some citizens of the US are concerned about the slippery slope (which we in Canada have already slid down - although I'm not sure we've reached the bottom) wherein the public (read - the TAX paying public) pay for whatever an individual thinks they need from the medical system.  And they are FURTHER concerned, that access to medical care under such as system may be restricted based on "life style choices".

That last concern is not so far fetched.  I've met Doctors who refuse to deal with smokers.

So I think the concern is - WHAT, EXACTLY, will be covered by the "public health care system"?

And I think that's a valid question.

I've got a small growth on my arm (what used to be called a "wart" - and dismissed as insignificant).  It's benign - it don't mean nothin'.  I find that it upsets my personal equilibrium - why should YOU pay to remove it?  Perhaps there should be some way that I could have it removed at my OWN expense?

And that, I think, encapsulates the problem folks have with public health care.  And I don't blame them.

 

[c_canuk]

My wife gave birth on the 1st of July, everything went well.

While we were there (3 days) I made a point to look at the waiting room at the ER of the Saint John Regional Hospital everytime I went past it... now granted this was during the week, but it was over a holiday and I never saw more than 3 people at a time in the waiting room.

I figure they must have done something to improve response times since the last time I was there.

I spent some time pondering the pros's and con's of private vs public systems...

One thing that worries me about a private only system is that it's in the insurance companies best interests to try to screw you...

Any time I've dealt with insurance companies I've found that what they are willing to cover and what they lead you to believe they cover are 2 different things. I don't want to be in the position of having to prove my illness wasn't a pre existing condition, and having to sue them in court to avoid personal bankruptcy while in recovery stages, or worse, before I'm treated.

The thing that worries me about a public only system, is the strain put on the system by people who go and use up the resources because it's "free" even though they really don't need to be there, reducing everyone else's access to the resources, I don't worry about not getting access to rare expensive treatments that are deemed to costly for the system as I'm not financially able to purchase them on my own anyway.

Considering what I pay in taxes and the portion of that that goes to health care, I am very satisfied with the level of service my wife and son received since my wife went into labour.

 

[Rifleman62]

A couple of comments:

*  My wife went through at least 12 years of hell and very expensive drugs (including Enbrel @ $1600 per month) suffering from arthritis before the system would replace both of her knees. At the time in Manitoba, the surgeons ran out of funding to do surgeries for knee/hip replacements three months after the fiscal year started. This wait time has improved with federal government $$ from four years ago when she had her operations.

*  In Kelowna, BC, I waited in excess of three months for an X-Ray with dye injection for a different ailment than Old Sweat.

*  Emergency rooms are going to get a lot busier as the baby boomers age. In Manitoba, the NDP were elected on ending "Hallway Medicine". They didn't, and won't until emergency rooms are made larger and staffed.

*  Possibly it is time to have compulsory service in Canada for Canadian citizens who graduate from taxpayer subsidised Canadian universities as MD's, rather than allowing some of them to run off to the USA. Making them pay back the cost is a non starter, as they took up a space in the medical program.

*  Roy Harding: 50% of my BC Health premium is paid by me as a deduction from my pension, and the other is paid by the federal government. No need to submitt a bill. Maybe this is only done for recipients of the Reserve pension!

 

[Redeye]

There is nothing to suggest there is so much as an iota of truth to that statement.  It is not borne out anywhere.

For the Statists in Washington this debate isnt about healthcare,rather its a vehicle to control the lives of every American. No health care if you are too old or sick. No healthcare until you lose weight. Ultimately this is about control and if enacted it would be damn hard to reverse.