If America adopts Canada's health care system

[Infanteer]

Tools are just that, tools. Cuba has better outcomes than the American system with no tools. Just saying. The American system is much more broken than the Cuban one from a statistical outcome point of view.

:rofl:

 

[Edward Campbell]

Tools are just that, tools. Cuba has better outcomes than the American system with no tools. Just saying. The American system is much more broken than the Cuban one from a statistical outcome point of view. The America system of social Darwinism only does well for the top tier, not the average citizen. (Unless social Darwinism is your thing. Then it is working great.)

I would not disagree if you had said something like "American Social Darwinism rewards the upper tiers and punishes the bottom ones." My (fairly close) view of one part of the American middle class indicates, to me that the US system is very, very 'fair' if you accept, as I do, that fair means hard work, a bit of risk taking and a lack of really bad luck are rewarded.

With specific regard to health care: a decent job = decent health care; a poor job or no job = second rate health care, at best. But: there are mechanisms for the working poor and unemployed, even though they, the poor and unemployed, are often ill equipped to understand and use those mechanisms.

What is interesting is to watch someone change jobs and to understand that the employer's health care plan is a major determinant in deciding which job offer to take.

 

[brihard]

Tools are just that, tools. Cuba has better outcomes than the American system with no tools. Just saying. The American system is much more broken than the Cuban one from a statistical outcome point of view. The America system of social Darwinism only does well for the top tier, not the average citizen. (Unless social Darwinism is your thing. Then it is working great.)

Citation needed.

The American system actually does quite well for the 'average' American. Those who it fails to serve well are the 20 or 30 million at the bottom who have no coverage, and this is where my biggest objection to the American system is.

Personally I'm a fan of a two tier system where free market healthcare (and insurance) is available to those who can get it, and the government provides healthcare for the rest in the same manner that we do now. I consider it unconscionable that an economically prosperous western state should have 20+ million people without basic healthcare, and I view that as a gap appropriate for government to fill, as it's an obvious social deficit that cannot be remedied by the normal free market dynamics. It's one of those 'common goods' that does require some state presence to work, because there's no real way to freely generate profit off treating the bottom 10% or by providing preventative care.

The hell of it is, America spends fully half again as much of a percentage of their GDP on healthcare as we do, and they spend more per capita as well. It baffles me what inefficiencies must exist that this can be the case without those at the bottom being covered...

 

[Edward Campbell]

Citation needed.

The American system actually does quite well for the 'average' American. Those who it fails to serve well are the 20 or 30 million at the bottom who have no coverage, and this is where my biggest objection to the American system is.

Personally I'm a fan of a two tier system where free market healthcare (and insurance) is available to those who can get it, and the government provides healthcare for the rest in the same manner that we do now. I consider it unconscionable that an economically prosperous western state should have 20+ million people without basic healthcare, and I view that as a gap appropriate for government to fill, as it's an obvious social deficit that cannot be remedied by the normal free market dynamics. It's one of those 'common goods' that does require some state presence to work, because there's no real way to freely generate profit off treating the bottom 10% or by providing preventative care.

The hell of it is, America spends fully half again as much of a percentage of their GDP on healthcare as we do, and they spend more per capita as well. It baffles me what inefficiencies must exist that this can be the case without those at the bottom being covered...

I am, broadly, in agreement with you both two tier health-care for Canada and the mismanagement (I guess that's what it is) of the US system (if you can call it that).

 

[Brad Sallows]

I doubt that the use of the measure of percentage of GDP expended on health care is a measure of inefficiency, any more than a greater expenditure on food and cars in a plentiful economy versus a rationed and restricted one is an indication of inefficiency on the part of the former.

 

[Edward Campbell]

I doubt that the use of the measure of percentage of GDP expended on health care is a measure of inefficiency, any more than a greater expenditure on food and cars in a plentiful economy versus a rationed and restricted one is an indication of inefficiency on the part of the former.

I agree that simple spending indicates nothing much but when, as several US and international organizations have done, spending and various measures of 'outcome' are examined together then the US and Canada both appear to be inefficient.

 

[a_majoor]

Many of the people who have no health insurance in the United States are young and healthy individuals who "game" the system in the expectation that they will not need to use it. Millions more are "undocumented" workers, who pay no taxes or inputs into the system but feed off it anyway. Most of the "problems" Obamacare was supposed to address are not even addressed in any meaningful or efficient way by the current bill. Much of the explosive growth in US healthcare spending is from (surprise!) Government health care in the form of Medicare/Medicaid and the perverse incentives built into the system. Regulatory failure isn't an excuse to create more regulatory failure...

OTOH, the administration is still trying hard to sell the idea to a population who is against it:

Team Obama Propaganda Department Buys Google’s “Obamacare” Search Records
Posted by Jim Hoft on Saturday, December 18, 2010, 7:13 PM
 
The most open and honest administration in history.
Team Obama purchased top billing to divert internet surfers away from hostile anti-Obamacare websites.

Your tax dollars at work…
The Blaze reported:

Type in a search of “ObamaCare” into Google — the world’s most popular search engine — and the results may surprise you. According to Politico’s Ben Smith, the Obama administration has purchased top billing to divert internet surfers away from antagonist websites to a new “sponsored link” — the Department of Health and Human Service’s (HHS) healthcare.gov:

“We are using a bunch of search term to help point people to HealthCare.gov. Part of our online efforts to help get accurate information to people about the new law (i.e. also use Facebook, Twitter, blogs and webcasts),” an HHS official confirmed by e-mail.

The ad buy represents a kind of recognition that the Administration has, to a degree, lost a battle over defining its terms, and that “ObamaCare” — coined and used largely by detractors of the plan — is in wide circulation. A search for the term on Google yields 2.5 million results.

Time to switch over to Bing...

 

[Nemo888]

Citation needed.

The American system actually does quite well for the 'average' American. Those who it fails to serve well are the 20 or 30 million at the bottom who have no coverage, and this is where my biggest objection to the American system is.

Personally I'm a fan of a two tier system where free market healthcare (and insurance) is available to those who can get it, and the government provides healthcare for the rest in the same manner that we do now. I consider it unconscionable that an economically prosperous western state should have 20+ million people without basic healthcare, and I view that as a gap appropriate for government to fill, as it's an obvious social deficit that cannot be remedied by the normal free market dynamics. It's one of those 'common goods' that does require some state presence to work, because there's no real way to freely generate profit off treating the bottom 10% or by providing preventative care.

The hell of it is, America spends fully half again as much of a percentage of their GDP on healthcare as we do, and they spend more per capita as well. It baffles me what inefficiencies must exist that this can be the case without those at the bottom being covered...

What you said.

 

[newbie2011]

The fact remains that as a percentage of GNP, our healthcare system costs about 4% less per capita, yet our infant morality rate, and life expectancy is better than the US. Other healthcare outcomes are better, if you look at research from the Canadian Institute of Health Information for example.

You could find many horror stories about the US system, but to me the key issue is its lack of egalitarianism. Sure, wait times are an issue in Canada, but for urgent care typically you get seen very quickly. We should be focussing our efforts on primary care,  because this is where our problems lie.

There is no doubt that if you are rich you can better healthcare in the US, but on average, 99% of the population gets very good healthcare here. Our system needs to change, but adopting the expensive US system which eats up a lot more in administrative costs (double to triple per capita than our system) would be a bad idea. Internal incentives and more competition within our system would work.

In my opinion, we should be proud of our system, and realize that the grass isn't greener on the US side of the border. We should be looking to Japan or Europe for examples of how our system can change, positively, but keeping the equality of access is imperative.

 

[Edward Campbell]

The fact remains that as a percentage of GNP, our healthcare system costs about 4% less per capita, yet our infant morality rate, and life expectancy is better than the US. Other healthcare outcomes are better, if you look at research from the Canadian Institute of Health Information for example.

You could find many horror stories about the US system, but to me the key issue is its lack of egalitarianism. Sure, wait times are an issue in Canada, but for urgent care typically you get seen very quickly. We should be focussing our efforts on primary care,  because this is where our problems lie.

There is no doubt that if you are rich you can better healthcare in the US, but on average, 99% of the population gets very good healthcare here. Our system needs to change, but adopting the expensive US system which eats up a lot more in administrative costs (double to triple per capita than our system) would be a bad idea. Internal incentives and more competition within our system would work.

In my opinion, we should be proud of our system, and realize that the grass isn't greener on the US side of the border. We should be looking to Japan or Europe for examples of how our system can change, positively, but keeping the equality of access is imperative.

The data, at least the data I have seen over the past several years, says you are wrong. We do spend a lesser percentage of GDP than does the US and our 'outcomes' - and every study measures them somewhat differently* - are almost always slightly better, but we are not 'good' and 99% of Canadians do not get 'good' care.

You are correct that the USA is not the best a good a useful model for Canada. We need to examine e.g. France, Italy, Singapore, Austria and Japan to see how they fund and deliver health care to their citizens. See this report from Tower Watson, a risk and financial management consultancy, which explains how Singapore provides better (in pretty much every respect) health care than does Canada for only 3% of GDP, only 1/3 of that being taxpayer's money. The Singapore model would be very, very hard for e.g. the US or UK to emulate but Canada could follow the Singapore plan because we already have a universal public insurance plan intended, by Tommy Douglas, to cover catastrophic health care expenditures. What Singapore manages to do is:

1. Put the onus and burden for normal, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual.
2. Allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employers.
3. Rely extensively on the competitive private sector for health care provision.

The Singapore example puts paid to the argument screams and cries by public health care advocates that a private plan must cost more because profits must be made. that was, still is, always a lie told by some fairly smart people to the economically illiterate majority.

----------
* See, e.g. http://www.photius.com/rankings/world_health_systems.html

 

[GAP]

1. Put the onus and burden for normal, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual. (I can hear the Dippers et al moaning into the wind on this one, Tommy would be rolling over in his grave, the hew and cry would be VERY loud....What, you want us to be responsible?)

2. Allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employers. (See!! I Told YOU!!! they have an adgenda !!! Private Healthcare!!!....or along those lines...)


3. Rely extensively on the competitive private sector for health care provision.
(repeat #2)

No ER, Canadians will not accept anything like that, because those with a vested interest in NOT changing it will tell us how to think.....it's what we are best at.....not thinking for ourselves.....(/sarcasm)

 

[Edward Campbell]

1. Put the onus and burden for normal, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual. (I can hear the Dippers et al moaning into the wind on this one, Tommy would be rolling over in his grave, the hew and cry would be VERY loud....What, you want us to be responsible?)

2. Allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employers. (See!! I Told YOU!!! they have an adgenda !!! Private Healthcare!!!....or along those lines...)


3. Rely extensively on the competitive private sector for health care provision.
(repeat #2)

No ER, Canadians will not accept anything like that, because those with a vested interest in NOT changing it will tell us how to think.....it's what we are best at.....not thinking for ourselves.....(/sarcasm)

Having lived, and paid attention, through the TC Douglas era, I am satisfied that what Mr. Douglas wanted was universal insurance to protect against financially catastrophic health care problems. Events, including actions by physicians and radicals in his own party, forced his hands and a 100% public (single payer) system was the result - a system which must always and everywhere, without fail, no exceptions, involve rationing as its primary control mechanism.

Our single payer system doesn't work - it doesn't work financially and it doesn't work operationally. Eventually, sooner rather than later, it will be amended to "put the onus and burden for normal, day-by-day, non-catastrophic healthcare squarely on the shoulders of the individual, allow extensive private insurance companies to ease (actually spread) the day-by-day healthcare costs through a variety of profit making programmes - sometimes co-funded by employer," and "rely extensively on the competitive private sector for health care provision." At a point in the not too distant future the most senior bureaucrats, the bankers and the back-room political strategists will tell prime ministers and premiers that "Now's the day, and now's the hour," and the requisite changes will happen because no one with real power cares about the misguided views of the uninformed Canadian majority.

 

[GAP]

Now that I agree with.

So long as the masses resist the pharmacare, homecares, dentacare's being proposed by the Dippers and Libs as vote getting measures.....

edited to add: The only one that makes any fiscal sense is homecare, but even that is being twisted into something that was never intended.....

 

[Edward Campbell]

I don't care which of n 'cares' we have so long as we recognize that we, individual Canadians, pay 100% of the bill for everything. We need to aim to regulate that spending so that about ⅓ comes out of our provincial taxpayer pockets and the remaining ⅔ comes from our private pockets – either as “pay as you go” fees or, for a slight fee, as insurance premiums.

Now even staunchly capitalist and self-reliant Singaporeans allow for programmes like eldercare because they recognize that "pay as you go" only works when one has a steady income from which to pay, so I expect that we will all end up paying to subsidize some minority groups.

 

[GAP]

Ontario has health care premiums, do they not? Is it helping allay the costs of healthcare, or is it just another piggy bank for the government?

 

[Edward Campbell]

Ontario has health care premiums, do they not? Is it helping allay the costs of healthcare, or is it just another piggy bank for the government?

Yes, ON has a health fee. Given that healthcare costs are rapidly approaching 50% of all ON public expenditures all revenues, including fishing licenses, are used to allay those costs. The problem is that, soon, health care spending will begin to do real, serious harm to ON (and BC and AB and QC and NL, and, and, and ...) because they will deprive us of opportunities to spend productively on things like education and infrastructure. Health care spending is productive when it promotes good health, it is counter-productive when it treats illness. About 98% of 'healthcare' spending is, therefore, counter-productive.

 

[observor 69]

"Health care spending is productive when it promotes good health, it is counter-productive when it treats illness" Quoting E.R.

Most members of the health care community agree. But nurses working in Emerg and ICU constantly complain about patients who show no regard for their health. Overweight, drugs, alcohol and just plain poor life style represents too many  patients. Treatment costs taxpayers millions.
In the military we are required to be fit and for many this carries on after they become civies.
As these nurses keep saying "We don't see those kind of patients." Proper BMI range, diet and exercise keeps most fit people out of the hospital.
I agree with E.R. but changing the lifestyle of Canadians is no easy matter.

 

[a_majoor]

Can't have competition and people shopping for the most affordable health care now, can we?

http://www.weeklystandard.com/blogs/obamacare-ends-construction-doctor-owned-hospitals_525950.html

Obamacare Ends Construction of Doctor-Owned Hospitals
2:50 PM, JAN 3, 2011 • BY JEFFREY H. ANDERSONSingle
     
Under the headline, "Construction Stops at Physician Hospitals," Politico reports today that "Physician Hospitals of America says that construction had to stop at 45 hospitals nationwide or they would not be able to bill Medicare for treatments." Stopping construction at doctor-owned hospitals might not seem like the best way to boost the economy or to promote greater access and choice in health care, but that exactly what Obamacare is doing.

Kenneth Artz of the Heartland Institute explains, "Section 6001 of the health care law effectively bans new physician-owned hospitals (POHs) from starting up, and it keeps existing ones from expanding." Politico adds, "Friday [New Year's Eve] marked the last day physician-owned hospitals could get Medicare certification covering their new or expanded hospitals, one of the latest provisions of the reform law to go into effect."

This little-noticed but particularly egregious aspect of Obamacare is, by all accounts, a concession to the powerful American Hospital Association (AHA), a supporter of Obamacare, which prefers to have its member hospitals operate without competition from hospitals owned by doctors.  Dr. Michael Russell, president of Physician Hospitals of America, which has filed suit to try to stop this selective building-ban from going into effect, says, "There are so many regulations [in Obamacare] and they are so onerous and intrusive that we believe that the section [Section 6001] was deliberately designed so no physician owned hospital could successfully comply."

Artz writes, "According to Russell, the AHA, along with Sen. [Max] Baucus (D-MT) and Congressman Pete Stark (D-CA), are responsible for the language in Section 6001."  But the responsibility for all aspects of the overhaul primarily lies with outgoing-House speaker Nancy Pelosi, Senate majority leader Harry Reid, and, particularly, Obamacare's principal champion, President Barack Obama.

 

[Edward Campbell]

Can't have competition and people shopping for the most affordable health care now, can we?

http://www.weeklystandard.com/blogs/obamacare-ends-construction-doctor-owned-hospitals_525950.html
...
..."According to Russell, the AHA, along with Sen. [Max] Baucus (D-MT) and Congressman Pete Stark (D-CA), are responsible for the language in Section 6001." ...
...

<rant>
Sen Baucus' name and and/or vote can be bought by almost any lobby group to support or oppose almost any issue. He has long been a paid proponent of illegal actions by the US government in the never-ending softwood lumber dispute. The US softwood lumber industry is grossly uncompetitive - producing a consistently inferior product at a consistently higher price - but it survives and prospers because Baucus et al break every international trade law with the impunity that only a US senator enjoys.
</rant>

Sen. Max Baucus (D. MT)

 

[a_majoor]

A critique of Obamacare offers some solutions that would have a very positive effect on the Canadian health care system:

http://freedomnation.blogspot.com/2011/01/10-problems-and-solutions-of-obamacare.html

10 problems and solutions of Obamacare

John Goodman of the National Center for Policy Analyses (US based) has written an interesting blog post about what is wrong with Obamacare and what can be done to fix it. I encourage you to read the whole thing but here is the last two of his ten points:

9. Over-Regulated Patients

Problem: The ACA forces people to spend their premium dollars on first-dollar coverage for a long list of diagnostic tests. Yet if everyone in America takes advantage of all of the free preventative care the ACA promises, family doctors will be spending all their time delivering care to basically healthy people — with no time to do anything else. At the same time, the ACA encourages the healthy to over consume care, it leaves chronic patients trapped in a third-party payment system that is fragmented, uncoordinated, wasteful and designed for everyone other than the patient.

Solution: 1) Instead of dictating deductibles and copayments, give patients greater freedom to save for their own small dollar expenses in health savings accounts, which they own and control; and let them make their own consumption decisions. 2) Allow the chronically ill access to special health accounts, following the example of Medicaid’s highly successful Cash and Counseling program, which allows home-bound, low-income disabled patients to control their own budgets and hire and fire those who provide them with services.

10. Over-Regulated Doctors

Problem: The people in the best position to find ways to reduce costs and increase quality are the nation’s 778,000 doctors. Yet today they are trapped in a payment system virtually dictated by Medicare. The ACA promises to make this problem worse by encouraging even more unhealthy government intervention into the practice of medicine.

Solution: Providers should be free to repackage and reprice their services under Medicare. As long as their proposals reduce costs and raise quality, Medicare should encourage resourceful, innovative attempts to create a better health care system.