Canada: Pettigrew flatly dismisses privatized health care

[Canadian_moderate]

http://www.globeandmail.ca/servlet/story/RTGAM.20040428.wpetti0428/BNStory/National/

I work in employee benefits consulting. With the spiraling healthcare costs, there is no better cost-containment than publicly-administered, universal healthcare.

We may have our problems too, but at least we're all coverage for most major healthcare expenses. Most of us have private supplemental health insurance (through employee) to cover such medical expenses as drugs, dental, semi-private hospital room, chiro, physio, massage therapy, etc.

I know all about first-payer private US health insurance. It wouldn't trade Canada's healthcare delivery system for the USA's. Our's costs (total costs - public and private) about 10% of GDP, while the USA's is nearly 16% of GDP. Meanwhile, our life expectancy is higher. I wonder which is more efficient?

As for stats on public admin, Canada's admin costs are less than 1/3 of those in the USA's private health insurance arrangements.
http://www.pnhp.org/news/2003/august/administrative_costs.php

[papau]

1. Your stats are correct - but our politians fear the Ins companies - but I

agree we'd save so much money with universal health, we might even generate a few jobs - in the US!

:-)

[Canadian_moderate]

2. One little thing though...

The dems have to stop siding with the rabidly litigious lawyers. Malpractice lawsuits and settlements are driving up the cost of healthcare in the USA. The unlucky individuals might land a jackpot, but everyone ends up paying for it in the long run.

Physicians in Canada may earn less, but they spend less on malpractice insurance and administrative costs (direct and indirect).

[Frederic Bastiat]

3. LOL Private healthcare already exists in Quebec

CAD $2,500 will get you a PET scan in 2-4 days, a procedure that has a 2-6 month wait here.

(PS: My wife and her partners own a private clinic so clearly Pettigrew is talking out his @ss)

[Canadian_moderate]

6. I don't see anything wrong with private clinics.

As long as people still have universal access to healthcare. The governments do not need to be involved on all levels of the delivery system.

[Frederic Bastiat]

10. But isn't that the makings of a two tiered system?

I brought up the PET scan issue because private clinics in Montreal are "renting" public PET scans for a fee (paid by the patient),in essence those that have the money get to jump the line. (The workaround being that they have access to the PET scan after hours and use their own nuclear medicine physicians)

[Canadian_moderate]

18. Sure, but as long as the public system has guranteed access

to the private clinics, how is this a bad thing?

If they want to extend hours and make a little extra money on the side doing privately-paid procedures, let them do it.

Better to allow it in Canada than to force people to travel to the USA for similar treatment. That is a direct flow of money from the Canadian economy and it hurts Canadian clinics.

Yeah, we all want equal access, but that'snot always a reality. Let's not cut off our noses to spite our face.

[eridani]

25. Back to the fire department analogy

We expect them to respond to a burning $100,000 house just as rapidly as a one million dollar house. But do we care if some rich guy puts a sprinkler system in his house that not many people can afford? Hell, no!

[outinforce]

4. "Publicly-Administered"?

Here in the USA, there is a lot of dis-satisfaction with "managed health care" -- HMO's, primarily.

The dis-satisfaction comes from the fact that non-medical people make what in essence are medical decisions.

In order to "manage" health care costs, many HMO's will say that they will pay for "X" number of days of hospitalization when a patient has a particular operation. If the patient's doctor determines that the patient needs more than "X" days to recuperate, the doctor must first obtain the permission of the HMO. Otherwise, the patient becomes completely liable for the costs of the additional days in the hospital.

In other words, bureaucrats are making the calls regarding health care.

Isn't that about the same thing as "publicly-administered" health care??

[Canadian_moderate]

5. Not exactly

Publicly -administered means that a non-profit, government insurance plan (single-payer) is administering the claims.

The decisions are still primarily made by physicians.

[outinforce]

7. But Aren't You Really Then Saying

"Publicly -administered means that a non-profit, government insurance plan (single-payer) is administering the claims."

But isn't that the same thing as saying that government employees (or, to use the less complimentary tem, "bureaucrats") are deciding on the validity and necessity of certain medical procedures?

Isn't that what claims administrators do?

And, while it may be good that the people making those decisions are not employed by a "for profit" organization, doesn't the fact that they are employed by your government mean that it is in fact the government (and not physicians) who ultimately decide how medicine is to be practiced in your country?

I kind of shudder at the notion that a Republican-controlled government here in the USA could have that sort of power.

[Canadian_moderate]

9. I can see your concern, but...

The decisions are based based on consultation (standard practice and procedures) with the various associations of medical practitioners.

The main problem in Canada is that the government has tended to limit supply in order to curb costs. Obviously, there needs to be legsilation that ensures that certain guidelines are met at all times.

[Frederic Bastiat]

12. The problem is that there is no money...

The main problem in Canada is that the government has tended to limit supply in order to curb costs. Obviously, there needs to be legsilation that ensures that certain guidelines are met at all times.

...and one can only tax people so much.

[Canadian_moderate]

13. That's why...

Universal healthcare should be available for the basic necessities and people can opt to purchase supplemental insurance (privately or through an employer).

One way or another, people will have to pay for it if they want all the bells and whistles.

[outinforce]

14. A System Like That Already Exists in Some Places in the USA.

What you are describing, I think, is s two-tiered system.

One tier is for those wealthy enough or lucky enough to have adequate private insurance coverage to get the best quality health care that they can. Many people here in the USA are in this tier.

The second tier is for those who are not wealthy enough, or who choose not to enroll in a health insurance plan, or who cannot afford health insurance that would provide them access to high quality health care.

Many counties or local jurisdicitions here in the USA meet the basic health care needs (what I think you mean when you say healtb care without all the bells and whistles) through local, taxpayer-funded (at the local level) or probono health clinics. In the county in which I happen to live (Arlington County, Va.), the county government makes a point of informing all 200,000 or so residents that basic health care is available without charge at a local free clinic.

Similarly, within the District of Columbia, there are a number of free clinics run by the DC government. DC also happens to have, primarily for the health care needs of gay people, a privately-run non-profit health clinic that survives, I think, on private donations and on some money from the DC government. Not health care "with all the bells and whistles", but health care that is basic.

But it is still two-tiered. And that, I think, deeply bothers some people, who really feel that there should be just one tier of health care. That one issue, I think, did more to sink the health care plan proposed by Pres. and Mrs. Clinton in the early 1990's.

[Frederic Bastiat]

17. Healthcare is a moral issue in Canada

It's almost impossible to discuss the practical benefits of a two-tiered system (like relieving an already stretched public system) without being condemned as a profiteer.

[Frederic Bastiat]

16. Yup, and the bureaucrats get to decide...

...what constitutes the bells and whistles.

[Canadian_moderate]

20. like you said...

You can only tax people so much. If people want the bells and whistles, some one has to pay for it.

Good health care is important, but so is cost-containment. Health care has to be affordable in order to be fully universal. With the ageing population and rising health care costs, cost-containment must be taken seriously to keep basic health care universal and accessible.

[outinforce]

21. But Doesn't That Then Mean

"Good health care is important, but so is cost-containment. Health care has to be affordable in order to be fully universal. With the ageing population and rising health care costs, cost-containment must be taken seriously to keep basic health care universal and accessible."

But isn't that the same thing as saying that, in order to ensure that the health care needs of all people are met, the quality of health care must dmininish for some?

Because it appears as though you are saying that "cost-containment" is a necessity in order to provide health care for everyone. That would seem to be the case, because it is true that a government will reach a point at which it can no raise taxes on its people. But, if cost-containment, rather than high quality health care, is the goal, then the result, especially if government is involved, will indeed be a health care system in which costs are controlled and concern for quality health care is at best secondary.

I noticed in an earlier post to this thread, you assured me that payments for health care claims in your system are based upon "consultations" with physicians and physicians groups. That's nice, but it still means that physicians are in a merely consultative role, and that non-medical people -- whose concerns are, I take it, "cost containment" and not necessarily the medical needs ot any individual -- make the decisions.

Do physicians or private citizens in your system have any rights to appeal decisions made by the administrators of your health care system? How long does an appeal normally take? Are the appeals usually sustained -- or does the government tend to uphold its own decisions?

[Cleita]

26. And your objection to people having access to health care

as contrary to not having it is....?

I don't understand your argument. If you fall off a ladder and an ambulance is called for you, do you have to worry whether you can afford it or not? Or can you rest assured that the ambulance will be paid by the government, as well as the hospital and the doctors who take care of you, like in the Canadian system.

On the other hand, in the American system, you'd better have that insurance card or cash on hand. If it's an HMO, you may have to call to get approval for the emergency, and even then if the t's aren't crossed properly or the i's dotted, your claim can be denied and you will have to pay for this out of your pocket. Your doctors won't do more than necessary until they call your insurance up to find out exactly what they will pay for so you may not get the quality of care you should because of the restrictions and decisions made by a bean counter in your particular health plan.

Why would you want to keep our inferior system going?

[outinforce]

29. Single Payer System

In a single payer system, the "single payer" gets to determine what types of procedures will be used and when.

For instance, if I have a medical condition and my physician thinks that I could benefit from having an MRI to assist her diagnosis, she may or may not be able to direct that I have an MRI done now.

The decision of whether an MRI for my condition could be authorized under a single payer system would rest not with my doctor, and certainly not with any private insurance company (because there would be none). Rather, the u ltimate decision would be up to a group of claims examiners somehwere in some governmental bureaucracy.

They might determine that an immediate MRI for me would fall into the category of "bells and whistles". Their concern would be "cost containment" -- not deleilvery of the best possible medical care to meet my specific and individual needs. They could dtermine that an MRI for me might be indicated, but say that I would have to wait for six months, while others, whom they consider to be "in greater need" get their MRI's first. Of course, in six months, the condition I might have might go from curable to hopeless, but that's the price one must be willing to pay in order to "contain costs" so that everyone can be covered.

Under the current system, my doctor can direct that I get an MRI right now.

[Canadian_moderate]

30. At least a two-tier system would

give people the option of getting an MRI done immediately.

The main goal is to ensure a minimum standard for all people. It's a basic need. If people want coverage over and above that, they should have the option of a second tier of private insurance.

[outinforce]

32. Not if The Real Goal is Cost Containment

and not if some non-medical bureaucrat decided that, for a given condition, an MRI was in the category of "bells abnd whistles" instead of being a "basic need".

You may consider an MRI to be a "basic need", and even your physician may consider it a basic need for a condition that yo might have.

But all that is really unimportant as long as what drives the medical decisions is the need for "cost containment" in order that everyone may have access to some medical care.

[Cleita]

33. How nice your insurance does that. Mine doesn't.

A three thousand dollar deductible insures that I pay for all these tests out of my pocket, not to mention I still have to pay the premium. Therefore a bone density test that I need right now isn't done because I can't afford the cash outlay. Therefore, the hundred dollars a month pills that I need for Osteosporis and can barely afford, won't be prescribed by my doctor.

On the other hand, my husband who is on Medicare, a singlepayer government program, gets all the MRI's, lab tests, expensive epoitin shots and his dialysis supplies and clinic visits paid for. He even gets his toenails clipped at a podiatrist and it is covered. All this on a government program that you say won't be making the right decision.

Actually, his doctor does make the decisions according to Medicare guidelines, which up until now have been for the benefit of the patient. What the Republicans are going to do to this life saving program I fear very much. It won't be good I know that.

[outinforce]

34. I, Too, Pay A Deductible

and a premium and a co-pay after I meet the deductible.

I'm glad that your husband gets the benefit of a gold-plated system like Medicare. I can't wait until I am his age, so that I, too, can get my toenails clipped free of charge.

Still, I do have this uneasy fear that by the time I reach Medicare age, I (and a good portion of my fellow baby-boomers) will have stopped working and will therefore have stopped making contributions to the Medicare system.

And, of course, that will mean that the next couple of generations -- smaller in size than us baby boomers -- will have to pay, via their taxes, in order that we can enjoy the same benefits under Medicare that you husband now enjoys.

I do so hope that they are willing to pay the increased taxes that will be necessary to maintain the cureent level of Medicare services to those of us that will be more in number and who will live longer and who will DEMAND that our medical services -- including the clipping of our toenails -- by folks like your step-daughter and her children.

[Cleita]

35. You and many others have been given a snow job by the

private health care for profit industry. There is plenty of money to cover everyone with a single payer health system, with what we spend on health care today. Cutting the waste of a multi-tiered system would make efficient use of health dollars. Including health care professionals as part the decision making part of the system, like in Canada, makes sure the doctors, other professionals and hospitals are fairly reimbursed and that patient care is quality care.

Remember that the government runs not only Medicare but also the military health system and Veteran's Hospitals. They do a decent job IMHO when they have decent funding. I think a system could be worked out with single payer, but also private insurance to cover what the NH don't cover. Incidentally, the toenail thing for my husband is a surgical procedure because of his neuropathy. If he didn't have this procedure done, I would have to do it and I could easily wound and infect him if things don't go right.

[outinforce]

36. I Do Not Share Your Faith

in the ability of the US Government to control the health care system.

You mention the military system.

My dad was a veteran of WWII. He was able to use the VA hospital system. It was OK, but certainly not a system that I would ever choose to use. When he was hospitalized in a VA hospital, for instance, he was in a ward -- not even a semi-private room.

The District of Columbia used to run a hospital for its residents. Conditions there became so awful that the hospital is now closed.

[Cleita]

37. Well, my husband had a friend who would have died

in a ditch someplace if it weren't for the VA. Ward or no ward he died in a bed with a saline drip delivering morphine to him. I guess you think the ditch would have been better.

If a system is allowed to deteriorate from inadequate funding like the Republicans like to do, then it doesn't work. This is why it's necessary to involve the medical community in the decision making.

Incidentally, in my county, the Tenet owned hospitals are a nightmare of understaffing and inefficiency. And this is supposed to be a superior market-based system?

[outinforce]

38. Anecdotes Make

poor policy.

You and I can trade anecdotes about the care our loved ones did or did not receive at the hands of government doctors all day and all night.

But that is all we are doing -- trading anecdotes.

It is something that Ronald Reagan used to do with great relish, if I recall correctly. He would call up a story, and then say "See, Welfafre Doesn't work!". Policy from anecdotes.

I think it is pretty much a given that in order to provide something like health care, there needs to be in place a system to "contain costs". I believe even our friend from Canada acknowledges that fact.

My only point is that if you have a system that is available to all, then the decisions that are made become more and more based upon containing costs (so that the system can be made available to all) and les and less about the best quality medical care.

You and I simply disagree. Let's leave it at that.

[Canadian_moderate]

8. further...

The big difference is that rather than a mish-mash of various private insurance providers, the claims for primary healthcare are handled by a single-payer. The stats indicate it is more effeicient administratively, reduces the need for gross profits on the backs of the sick, and it provides a system that can more effectively control healthcare expenditures.

[outinforce]

11. It Sounds As Though

I may be mistaken, but it rather sounds to me as though the primary concerns of the Canadian Government in establishing such a system are efficient administration and effective control of health care expenditures.

This makes me even more uncomfortable.

I would think that the first and foremost concern would (or should) always be providing the best quality health care.

If you are more concerned with "effecitve control of costs" than with providing the best quality health care, then it seems to me that you will end up with a system in which the quality of the health care will take second or third place behind concerns of administrators and bureaucrats.

[Canadian_moderate]

15. Let me ask you this...

How do you propose to have "best quality health care" and have it be universally accessible and affordable. Sounds like utopia to me.

If you, indeed, know the solution, I suggest you share it with everyone.

[Frederic Bastiat]

19. The Stockholm healthcare model

Do a Google on it.

[Canadian_moderate]

23. I found this...

http://www.iedm.org/library/policyfrontiers2.PDF

It sounds wonderful, though it think it's tough to compare the average Stockholm Swede to the average overweight and out-of-shape North Americans.

In general, Swedes tend to live much healthier lifestyles.

[outinforce]

22. I'm Not The One Suggesting Such A System

I agree with you.

Such a system is "utopia".

Therein lies the problem -- the political problem -- of Universal Health Care in the USA.

There are many, many, many people here who truly feel that health care in the United States is among the best in the world. And they have access to the health care system through private insurance.

But many of these same people understand what you and I understand -- that having "the best qulaity health care" and having it be universally accessible might just be an impossibility.

So, they ask themselves, do I want to have a system in which my children and I have to participate in a health care system that provides lower quality care so that all can participate in the health care system?

Most folks who already have access to the system here will, if that is the choice, say "No" -- if that is what is invovled in getting Universal Health Care, then let's stick with what we have.

It seems to me incumbent on those who propose universal health care to explain it in such a way that does not threaten the high quality health care system the USA already has -- or at least the system most Americans fell we have.

[Cleita]

27. The fatal fallacy with this reasoning is what my stepdaughter said

to me recently. She too didn't think that quality care could be had with a government system. So I asked her what she would do if she didn't have health insurance? But she said, between her husband and her they have good health care. Then I asked her what would she do if she got cancer? Well, her health insurance would pay for it. But what if she couldn't work anymore? Well she could opt for Cobra.

When I explained to her that she would have to pay for this out of her pocket, then she stopped, but she still didn't get it. Then I told her that her insurance would jack up the premium to the point it would be unaffordable to cover their expenses. But doesn't the government have some kind of insurance for people who can't afford it? Yes, I said to her, it's called medicaid, but that at first she would have to spend all her assets down to $2,000 before she could qualify. Then she said I can't worry about that right now.

So now do you see why we need single payer universal health care?

[outinforce]

28. Why Would Your Step-Daughter's Premium

You mention that in the event that your step-daughter were to get cancer, and then become unable to work, her only option for private health insurance would be COBRA.

And you said that "her insurance would jack up the premium to the point it would be unaffordable to cover their expenses"

Do you happen to know why that is?

Is it because health insurance companies like to jack up the prices of their premiums for people who have cancer?

[Cleita]

31. I have private insurance and they jack up the price every year

as you get older. If you try to get cheaper insurance you have to submit your medical records. They base the price on these and your records. It used to be that they could deny you coverage, but somewhere someone in Congress did the right thing for a change and now they have to give you coverage, but they can charge whatever they feel they need to to make a profit. So if you can't afford it you go uninsured.

You see, people who are young and healthy really don't need health insurance except for the unexpected, so insurance is fairly affordable before you are forty. After that, the insurers know that the older you get the bigger risk you are. Young people don't realize that at a time in their lives when they are going to need medical insurance the most, most likely they won't have decent coverage if any.

I speak from experience. I also could tell you what a horror privatization of Medicare is. But maybe some other time.

[Cleita]

24. Yes, you Canadians are most fortunate in your health care.

Unless the medical professionals though come to the table and fight the for profit health care industry tooth and nail, because that is what it will take, single payer, universal health care will only be a pipe dream for Americans in the years to come. I favored Dean or Kucinich for the Presidential nomination because I felt they would be the most committed to bringing this issue to the forefront. I don't feel it is as an important issue to John Kerry, but I hope I am wrong.