Health care policy discussion thread!

[J2thaLE]

Hmm, the link didn't work, but i tried http://www.settlementswithoutstrikes.ca/

 

It's a political campaign really. The Nova Scotia government wanted to remove the right to strike from health care workers, as part of their election campaign last year, i think. It's old legislation that hasn't been enacted yet, but they will do it whenever a strike actually occurs. It's a lot of political stuff, and this only addresses the right to strike, it does not suggest that unions should be banned.

 

It's also very very one-sided, and superficial information on this topic IMO.

 

The majority of HCP do not want to strike, from my experience. We are all in the health care field because we care for and help total strangers just like we would our own family and friends. Therefore, none of us would want to see people suffering for 'our own gains'. The union I was in, voted to strike (which started this political hoopla), and there were very extensive plans to keep things running as best as possible. It is not as if a strike happens and the hospital shuts down. Not at all. People still go to work and help patients. The government started to drum up fear over the strike...

 

Anyway, like i said, i am not into unions, and i don't think striking is a reasonable option for health care workers... but i still do not get why you think unions are ruining the health care system??

[AdamP]

http://www.michaelrachlis.com/

 

Might be a cool website to check out on the issue, i'm sure some people here have heard of Dr. Rachlis, his book on this issue is now available for free on pdf.

 

His main points are that

Universal public access healthcare is a good idea

It is cheaper and more effective than a private system

The Canadian system can be saved (if you believe it needs to be, many don't)

[Guest begaster]

But i was also wondering why not just adopt a system by which everyone pays out of thier own pocket for primary care and have public funding fund tests (x-rays/ MRIs etc) and surgeries? We could also have the public sector fund ER services. This would keep alot of docs in Canada and promte innovation. Also it would take a huuuge load of the system and the waiting lists would decrease drastically. As for the poor and the chornically ill, perhaps there could be a separate program (publically funded) by which they can get some rembursement (ie 70% of the primary care fees).

 

 

This would do the exact opposite of reducing costs.

 

1) Without the FP (since people will be loathe to pay for one), people will wait until they need to be hospitalized. Simply strep throat which could have been caught and treated immediately will require hospitalization because people will wait and see more often.

 

2) The ER will become the FP for most people. This already happens in the States consistently. People who don't want to pay (or can't afford to pay) for a family physician just go to the ER, where they're covered.

 

The biggest reform we need in healthcare is to reduce patient/family autonomy. I don't know how doctors went from being in control to being liable for a lawsuit if they don't follow orders of a family member without any background in medicine. Let's face it, the most expensive people are the futile care elderly whose families force the doctor's hands into doing "whatever it takes" to squeeze out a few more meaningless days in which grandma will be reduced to little more than a lying husk, either comatose, consistently sedated, or writhing in pain. It's a waste of resources and it's altogether foul.

[thecoolest47]

This would do the exact opposite of reducing costs.

 

1) Without the FP (since people will be loathe to pay for one), people will wait until they need to be hospitalized. Simply strep throat which could have been caught and treated immediately will require hospitalization because people will wait and see more often.

 

2) The ER will become the FP for most people. This already happens in the States consistently. People who don't want to pay (or can't afford to pay) for a family physician just go to the ER, where they're covered.

 

The biggest reform we need in healthcare is to reduce patient/family autonomy. I don't know how doctors went from being in control to being liable for a lawsuit if they don't follow orders of a family member without any background in medicine. Let's face it, the most expensive people are the futile care elderly whose families force the doctor's hands into doing "whatever it takes" to squeeze out a few more meaningless days in which grandma will be reduced to little more than a lying husk, either comatose, consistently sedated, or writhing in pain. It's a waste of resources and it's altogether foul.

 

wow... I hope you take time to reflect on what you just wrote.

[Guest begaster]

Why?

 

I'm not talking about killing off the elderly. I'm talking about the cases where the patient has advanced dementia and multiple failing organ systems. Where an expensive procedure's prognosis is measured in hours and days, while quality of life is non-existent (ie - comatose, terminally sedated, or writhing in pain). Basically, cases where 99.9% of people would sign a DNR for themselves ahead of time if they knew that was how it would end.

[Vallinar]

This would do the exact opposite of reducing costs.

 

1) Without the FP (since people will be loathe to pay for one), people will wait until they need to be hospitalized. Simply strep throat which could have been caught and treated immediately will require hospitalization because people will wait and see more often.

 

2) The ER will become the FP for most people. This already happens in the States consistently. People who don't want to pay (or can't afford to pay) for a family physician just go to the ER, where they're covered.

 

The biggest reform we need in healthcare is to reduce patient/family autonomy. I don't know how doctors went from being in control to being liable for a lawsuit if they don't follow orders of a family member without any background in medicine. Let's face it, the most expensive people are the futile care elderly whose families force the doctor's hands into doing "whatever it takes" to squeeze out a few more meaningless days in which grandma will be reduced to little more than a lying husk, either comatose, consistently sedated, or writhing in pain. It's a waste of resources and it's altogether foul.

 

 

But since its ER case is charted you could make it so the hospital canbill patients that come to ER for onbivous non-emergency issues.

[medgirl08]

This would do the exact opposite of reducing costs.

 

1) Without the FP (since people will be loathe to pay for one), people will wait until they need to be hospitalized. Simply strep throat which could have been caught and treated immediately will require hospitalization because people will wait and see more often.

 

2) The ER will become the FP for most people. This already happens in the States consistently. People who don't want to pay (or can't afford to pay) for a family physician just go to the ER, where they're covered.

 

The biggest reform we need in healthcare is to reduce patient/family autonomy. I don't know how doctors went from being in control to being liable for a lawsuit if they don't follow orders of a family member without any background in medicine. Let's face it, the most expensive people are the futile care elderly whose families force the doctor's hands into doing "whatever it takes" to squeeze out a few more meaningless days in which grandma will be reduced to little more than a lying husk, either comatose, consistently sedated, or writhing in pain. It's a waste of resources and it's altogether foul.

 

So then with this reasoning I guess the next step would be to refuse treatment to the terminally ill?? That oughtta save a few dollars!!!! An even better plan would be having patients sign a waiver upon admission into the care of a physician or a hospital, allowing them to treat the patient as they see fit and cost-effective!!!!

 

I'm sure you didn't mean to offend anyone and I don't want to take away the focus of this thread but this overly simplified "plan" to save money and resources is quite appalling.

[Guest begaster]

That may very well be the worst slippery slope argument I have ever had the displeasure of reading. Honestly, you're trying to strawman me as some sort of hateful, greedy bastard, who only cares about the bottom-line, because I'm saying there comes a point when medicine needs to be withdrawn - that point being when quality of life is nonexistent and keeping someone's body artificially alive on eight different machines, while the mind is destroyed, is immoral.

 

This is not a debate about giving medicine to the terminally ill. I volunteer at a palliative care unit and damn-well know that the terminally ill are people and deserve whatever care we can provide them with. This is a debate about whether life at any cost is a worthwhile mantra. In my eyes, it most definitely is not. There comes a point where the humane thing to do is withdraw care and allow the person to naturally go. The economic advantages of doing away with this sort of care is just an added bonus, the real victory is that we no longer have to act inhuman towards others.

 

Val, what happens when the person gives false information (which is often the case in the USA)? You're still legally bound to treat the patient (and with good reason), but you're billing someone who doesn't exist.

[Vallinar]

That may very well be the worst slippery slope argument I have ever had the displeasure of reading. Honestly, you're trying to strawman me as some sort of hateful, greedy bastard, who only cares about the bottom-line, because I'm saying there comes a point when medicine needs to be withdrawn - that point being when quality of life is nonexistent and keeping someone's body artificially alive on eight different machines, while the mind is destroyed, is immoral.

 

This is not a debate about giving medicine to the terminally ill. I volunteer at a palliative care unit and damn-well know that the terminally ill are people and deserve whatever care we can provide them with. This is a debate about whether life at any cost is a worthwhile mantra. In my eyes, it most definitely is not. There comes a point where the humane thing to do is withdraw care and allow the person to naturally go. The economic advantages of doing away with this sort of care is just an added bonus, the real victory is that we no longer have to act inhuman towards others.

 

Val, what happens when the person gives false information (which is often the case in the USA)? You're still legally bound to treat the patient (and with good reason), but you're billing someone who doesn't exist.

 

 

how can they give false info if ID is required? they're being seen for the issue they;re describing and then that gets put into the records along with the infor from their Id (OHIP card for ex).

 

I regards to withdrawing treatment for old ppl with advances dementia and alzheimers... you simply can't do it unless the patient has made it clear to the doc that they would not want treatment under those circumstances OR if that didn't happen, it would be up to teh family.

 

SO really the only thing you can do is talk to the patient when they're still competent and then assess their wishes.

[medgirl08]

That may very well be the worst slippery slope argument I have ever had the displeasure of reading. Honestly, you're trying to strawman me as some sort of hateful, greedy bastard, who only cares about the bottom-line, because I'm saying there comes a point when medicine needs to be withdrawn - that point being when quality of life is nonexistent and keeping someone's body artificially alive on eight different machines, while the mind is destroyed, is immoral.

 

This is not a debate about giving medicine to the terminally ill. I volunteer at a palliative care unit and damn-well know that the terminally ill are people and deserve whatever care we can provide them with. This is a debate about whether life at any cost is a worthwhile mantra. In my eyes, it most definitely is not. There comes a point where the humane thing to do is withdraw care and allow the person to naturally go. The economic advantages of doing away with this sort of care is just an added bonus, the real victory is that we no longer have to act inhuman towards others.

 

Val, what happens when the person gives false information (which is often the case in the USA)? You're still legally bound to treat the patient (and with good reason), but you're billing someone who doesn't exist.

 

The fact is that the argument you present IS only concerned with the bottom-line “economic advantages” and arguing quality of life is the most fallacious justification I’ve ever had the displeasure of reading.

 

Quality of life has different meanings for different people and in fact if this argument is truly concerned with the "quality of life" for the patient how does limiting the family's autonomy with regards to the care given to the patient support that?? After all don’t you think the family would be a better judge of the quality of life of their son/daughter/uncle/grandma under care??

 

The point you're obviously missing is that the problems with the healthcare system will not be solved by "withdrawing care" to save a buck here and there. Cutting back on healthcare services to save money is band-aid fix on larger problems which are not going to be fixed unless alternatives federal and provincial resource allocations are considered and implemented.

[Alastriss]

The fact is that the argument you present IS only concerned with the bottom-line “economic advantages” and arguing quality of life is the most fallacious justification I’ve ever had the displeasure of reading.

 

Quality of life has different meanings for different people and in fact if this argument is truly concerned with the "quality of life" for the patient how does limiting the family's autonomy with regards to the care given to the patient support that?? After all don’t you think the family would be a better judge of the quality of life of their son/daughter/uncle/grandma under care??

 

The point you're obviously missing is that the problems with the healthcare system will not be solved by "withdrawing care" to save a buck here and there. Cutting back on healthcare services to save money is band-aid fix on larger problems which are not going to be fixed unless alternatives federal and provincial resource allocations are considered and implemented.

 

Begaster is upset about the economic inefficiency, and the circumstances he describe are in fact economic inefficiency and that cannot be argued

 

but medgirl is right in stating that quality of life has different meanings for different people. To simply look at medicine in economic terms is to strip it of its various dimensions that bring it to life: the humanitarian aspects involved.

It is not in the nature of medicine to deep this example as efficient.

 

If you want to find an area to cut costs, consider the point i mentioned earlier about obesity and how many billions of dollars it taxes our healthcare every year.

 

Finally, patient autonomy should NEVER be reduced. In fact if I am not mistaken, patient autonomy should be one of the most highly valued things. Stripping that away is IMO, an epitaph to medical ethics and the advancement of medicine.

 

 

Can we all agree that making a two tier system or any other healthcare strucur we can think of is pointless if we don't increase the number of practicing doctors we have in canada? I think that is a limiting factor that we must consider.

[Alastriss]

It is not in the nature of medicine to deem this example as 'in-efficient'

thats what i meant..been a long nite..

[DalNeuron]

Begaster, I'll start with the positive. I think that what you're trying to express is a legitimate concern in today's hospitals. There are cases where perhaps the most ethical course of action in the eyes of the doctor, hospital staff, the patient themselves and yes, even the taxpayer to some small extent, is to remove care and let the disease take its course.

However, if you were my doctor and EVER talked about my parent in such a cavalier and callous manner, you would quickly be removed from our services and reported to the board of physicians. You can make your point in far less inflammatory and inconsiderate terms than those that you chose... please just take a moment to imagine hearing those words about your own loved one.

 

To add my two cents to the private vs. public debate...

I am of the opinion that the public system can theoretically provide the type of care that some Canadians have had to find in the private sector. In fact, it SHOULD be providing this care, because 8 months on a waiting list to receive a hip replacement or the small-town BC example mentioned above are not even close to "reasonable access to medically necessary hospital and physician services" (as defined by Health Canada: http://www.hc-sc.gc.ca/hcs-sss/medi-assur/index_e.html). If it takes more money to achieve this, then the federal and provincial governments need to tax more and invest more in health care. I don't think that user fees are the answer, because at the end of the day they are just exclusionary and contrary to the principles of 'universal health care irrespective of ability to pay.' Our country seems to be running really well on the idea that we redistribute some of the wealth from where we can spare it to help those who need it. Thus, a minor tax increase to make sure that our fellow Canadians get the critical care they deserve and need would probably be a pretty easy pill for the tax-paying public to swallow (if not, maybe it comes as a suppository?)

I think that this is a big, incredibly complicated issue, and I think that discussions like this are crucial... Canada has it pretty good, but all you have to do is look to our Great Canadian North (Nunavut in particular) to realize that we need to get it together and make a good public health care system even better. I'm no expert, but it seems to me that that's what Tommy Douglas had in mind.

[ccc]

In response to medgirl's comment, I guess I'll kinda play the devil's advocate because I want to see this discussion continue.

 

Quality of life has different meanings for different people and in fact if this argument is truly concerned with the "quality of life" for the patient how does limiting the family's autonomy with regards to the care given to the patient support that?? After all don’t you think the family would be a better judge of the quality of life of their son/daughter/uncle/grandma under care??

 

I think there's room for argument as to what is an effective judgment of "quality of life". If we had established a concrete set of guidelines outlining what is "quality of life" and when should a futile patient be taken off life-extending support - well, that would make life a lot easier (doesn't mean its a good thing b/c it obviously devalues patient autonomy). On the other hand, letting the family make the decision often results in prolonging treatment even in multiple-organ failure, vegetative state patients, such as the one begaster mentioned. The family could be too biased to be an effective judge of the patient's "quality of life" and would be more concerned about keeping their loved one breathing as long as possible.

 

The fact is that the argument you present IS only concerned with the bottom-line “economic advantages”

 

But our health-care system is run with money. As much as we believe that health-care has an entire humanitarian aspect to it, resource allocation is fundamental to health-care and whether we are deciding who to give that hospital bed to, or where to spend those extra dollars... Begaster is arguing to make better use of those health-care dollars, and I think, sometimes, you have to make the decision of when to pull the plug and work on saving the person next in line.

 

The point you're obviously missing is that the problems with the healthcare system will not be solved by "withdrawing care" to save a buck here and there. Cutting back on healthcare services to save money is band-aid fix on larger problems which are not going to be fixed unless alternatives federal and provincial resource allocations are considered and implemented.

 

Preventing disease and illness is good and all but I think we can't just focus on that... saving a few dollars (or hospital beds) here and there may be the difference between life and death... Guess what I'm saying is that there is probably no single method to improve our health-care system but it make in fact involve numerous fundamental changes to resource allocation,etc along with some band-aid fixes.

[kimmiegibbler]

' Our country seems to be running really well on the idea that we redistribute some of the wealth from where we can spare it to help those who need it. Thus, a minor tax increase to make sure that our fellow Canadians get the critical care they deserve and need would probably be a pretty easy pill for the tax-paying public to swallow (if not, maybe it comes as a suppository?)

.

 

I kind of disagree here, first off I don't think our country is running well at the moment, but thats a different discussion. Maybe if Canada was still run with those ideals in mind it would be. Second, why would a tax increase be needed to increase health care funding. If my memory serves me, the current government has reduced the gst, twice. I don't know about you but I haven't noticed the extra two cents on the dollar, but I certainly noticed waiting three months for an ultrasound while passing kidney stones without a diagnosis or pain medication. Oh yeah and maybe if we stopped spending our money on a political war under the guise of humanitarianism we'd have even more cash floating around. But again thats a different discussion.

 

As far as two tier healthcare, in principle I am not entirely opposed to it, IF we have a healthy public system already in place. Why not allow rich people to be able to visit fancy clinics and drink pellegrino in the waiting room without leaving the country. Sure it goes against everything Canada stood for when Tommy Douglas fought for medicare, but I don't believe we are the same country. If we were we'd have a different prime minister.

 

What concerns me the most, is that with our current wait times people who can't really afford to pay for private health care will do so out of desperation. When people are ill or in chronic pain they are extremely vulnerable. Its not hard to imagine what people in those circumstances might do if they feel they can receive better care for cash. Re-mortgage their house? Postpone retirement? Borrow? I know I would have charged my ultrasound to a credit card.

 

Not in Canada right?

 

Regardless if you believe that legalizing private care will benefit the public (and I don't think it will), you have to admit that this wouldn't happen right away.

 

Given that legalizing private health care is pretty much an irreversible act (due to WTO) , I won't even think of supporting the idea until we have a healthy, accessible public system.

 

I don't see it happening though, at least not in every province. The federal government has made it clear they want it off their books. At least the liberals pretended to care with all the research they commissioned. (Actually I am not sure which is worse). Federal Government has the cash, they have research to act, they don't. They will hang the public health care system out to dry until we beg to be able to pay. Its all on the provinces.

 

Health care already differs quite a bit province to province. User fees? They already exist. In BC they pay (I remember it being like 50$ a month), in Alberta they pay lots of user fees that don't exist in most provinces.

Bottom line, the provinces aren't getting the money they need to manage health care from the federal government so it has to come from somewhere. I hate the BC government, I couldn't move fast enough......but if provinces need health care dollars than I prefer their method of fees as opposed to a fee for service model. That will be a deterrent, even in people who can afford the 10$ or whatever, lets face it some people are really cheap (and even cheap people deserve to stay healthy). Canadians shouldn't be assessing the severity of their symptoms ---thats what we have doctors for. So if fees need to be charged---I say let it be a mandatory monthly fee, that is determined by income.

 

Back to the variation in provinces ----thats Canada. When you compare BC to Newfoundland its like a two different countries. Our diversity, our size, the uniqueness of every province, its what makes Canada great, it also makes it ***** to run.

 

***

My 2 cents on begastar's comment:.....No , Never, Absolutely not. Doctors, managers, government, whomever should never decide when someone dies. I've seen similar arguments regarding extremely premature babies.

I do think that everyone (at any adult age) should be required to fill out a form indicating their wishes, and have everything on it thoroughly explained to them. My 90 year old grammy was asked when she was hospitalized if she wanted to be kept alive on a respirator. She responded 'well yes i want to live'...fortunately my aunt was there and took the time to explain exactly what that meant and she then amended her instructions. So I think it is possible to avoid most of the situations begastar described without pulling the plug against the family's wishes.

[Alastriss]

Before we discuss making multiple tiers, wouldn't we need to solve the doctor shortage problem?

[kimmiegibbler]

I still think that some of the healthcare should still be privatized. There are a ot of people out there who would pay for receiving the same quality of health care but just not wait as long, and for equality's sake the government can forumate a team that assesses the quality of hospitals to make sure they are all on par with each other.

 

I think that a lot of people use the US as a model to aniticipate what would happen if we push health care in the private sector. However I do want to bring to everyone's attention that Canada's med schools are on par with each other, while the US has a greater disparaty in doctor quality among its med schools, which can transate to a disparaty in the quality of healthcare that is received strictly from a physician-point-of-view

 

Government could do that, but since they aren't addressing the quality of public health care now, why would they after a private system is introduced?

 

Second, if the private and public systems were on par with each other, why would anyone in their right mind pay for private care?

 

Before we discuss making multiple tiers, wouldn't we need to solve the doctor shortage problem?

 

Yes, but I believe that the entire accessibility problem in the public system should be addressed, and the doctor shortage is only one part of that problem.

 

My thoughts on that : fund more medical seats in Canadian schools, Fund more residency spots for Canadian born IMGs studying in countries like Ireland, UK and Australia, and in the short term develop an assessment and retraining program to integrate FMGs from approved medical schools to get them practicing here. The FMGs theoretically should be able to trained to perform properly within the Canadian healthcare system in less time than completing an entire residency (provided they are allowed to practice their own specialty). Maybe the program could accept a greater number of FMGs in the short term from the pool that are already living in Canada and driving cabs and flipping pizzas. Then, as our own medical schools and the IMG pool are mostly filling our doctor needs, downscale the FMG retraining program so we aren't encouraging foreign doctor immigration thus bleeding developing countries of their doctors.

 

Theoretically isn't the doctor shortage pretty much a no brainer? I don't just blame the government for this one, there seems to be reluctance on the part of the doctor powers that be that goes beyond dr. quality concerns.

[Alastriss]

Government could do that, but since they aren't addressing the quality of public health care now, why would they after a private system is introduced?

 

Second, if the private and public systems were on par with each other, why would anyone in their right mind pay for private care?

 

 

 

Yes, but I believe that the entire accessibility problem in the public system should be addressed, and the doctor shortage is only one part of that problem.

 

My thoughts on that : fund more medical seats in Canadian schools, Fund more residency spots for Canadian born IMGs studying in countries like Ireland, UK and Australia, and in the short term develop an assessment and retraining program to integrate FMGs from approved medical schools to get them practicing here. The FMGs theoretically should be able to trained to perform properly within the Canadian healthcare system in less time than completing an entire residency (provided they are allowed to practice their own specialty). Maybe the program could accept a greater number of FMGs in the short term from the pool that are already living in Canada and driving cabs and flipping pizzas. Then, as our own medical schools and the IMG pool are mostly filling our doctor needs, downscale the FMG retraining program so we aren't encouraging foreign doctor immigration thus bleeding developing countries of their doctors.

 

Theoretically isn't the doctor shortage pretty much a no brainer? I don't just blame the government for this one, there seems to be reluctance on the part of the doctor powers that be that goes beyond dr. quality concerns.

 

 

 

I would pay for the same healthcare, and I am in my right mind. Id do it because I can afford to cough up 50$ to a doctor within the hour but I dont have 8 hours to wait in the ER. Hell I would pay 100 bucks to see a family doctor regarding a cold rather than wait if it meant waiting like 4-5 hours less.

The idea is let people tap into the resource u have the most for. A rich business man and have no time to wait so u dismiss a condition that doesn't seem serious, which you might consider treating if you can use money to see a doctor right away. I guess it can add to the accessibility issue. Some good points Kimmie..will discuss some more later in the day.

[The Law]

Our problem is that our government is not doing enough to address the issues at hand AND at the same time, we need more innovation in our approaches to health care.

 

We have a lack of doctors and resources - there are too many people using the limited resources at a given time, and this causes a back log. If our government is serious about their commitment to health care, they HAVE to address the issues immediately. It is clear that we need drastic changes to our health care system for it to remain viable - it's not as simple as just increasing # of doctors = wait times go down... first we have the temporal effect (they have to graduate first) and second, we need INNOVATION in the way we deliver health care (to create both short term and long term options for people needing to undergo treatment).

 

Wait times are such a major issue, and especially with something as time sensitive as health - how can our government justify its inaction? A huge portion of our doctors are going to be retiring in the upcoming years, what is our government planning to do then?

 

All the provinces need to come together to discuss how to improve our system. We need to break out of our traditional ways of viewing this problem and try to incorporate some real major changes. For example, instead of sending all tests to a lab, why not begin to use more point of care testing? Trying to incorporate more of this into our family health clinics would result in less specimens being sent to the lab, allowing tests that MUSt be done in the lab to get back quicker (due to the decreased use of the resource).

 

There are so many things our current health care system is failing to do.... and will continue to fail to do, unless our government wakes up and takes this issue more seriously.

[kimmiegibbler]

I would pay for the same healthcare, and I am in my right mind. Id do it because I can afford to cough up 50$ to a doctor within the hour but I dont have 8 hours to wait in the ER. Hell I would pay 100 bucks to see a family doctor regarding a cold rather than wait if it meant waiting like 4-5 hours less.

The idea is let people tap into the resource u have the most for. A rich business man and have no time to wait so u dismiss a condition that doesn't seem serious, which you might consider treating if you can use money to see a doctor right away. I guess it can add to the accessibility issue. Some good points Kimmie..will discuss some more later in the day.

 

Well if you are saying wait times would remain the same, the public and private system would certainly never be considered 'on par'.

 

Furthermore, just because someone is poor doesn't mean they have time. Many people without the money to spare work two jobs etc. ..they have families as well. I don't think it is fair to think that poor people have more time to give.

 

My issue is that when it comes to our health, it wouldn't just be people who can afford private health care paying for it if the wait times remain the same.

 

I really am enjoying this thread, it is certainly helping me identify my position on these issue.

[Alastriss]

Well if you are saying wait times would remain the same, the public and private system would certainly never be considered 'on par'.

 

Furthermore, just because someone is poor doesn't mean they have time. Many people without the money to spare work two jobs etc. ..they have families as well. I don't think it is fair to think that poor people have more time to give.

 

My issue is that when it comes to our health, it wouldn't just be people who can afford private health care paying for it if the wait times remain the same.

 

I really am enjoying this thread, it is certainly helping me identify my position on these issue.

 

 

just because someone is poor doesn't mean that they have time - you are right, but careful, I never said that. I merely gave an example of a way where we could extend the pool of resources available and so those can tap into whichever 'pool' they have more of.

 

With what I said, wait times would remain the same, at least initially.

 

Because lets look at a simple model. hospital A and B in the town of Hlth, which has a population of 20 people, so lets say 10 go to A and 10 go to B.

 

Lets say we do extensive economic studies and find a fee x, which makes it so that the utility that is brough by the service is at least equal to or greater than the utility given up by x (simply - ie Ice cream makes me happy and ill pay x for it, but healthcare makes me more happy so instead of icecream use the x towards healthcare). We institute the fee, x, at hospital B and keep hospital A for free - same services at each

 

So right now we still have 10 people at each hospital, same service same fee, except our healthcare is generating money, and I realize now that the system can't work with equality. I wont delete what I mentioned previously, but lets try a twist

 

Saw we find a fee x that is considered a 'good deal' by slightly (even infitesimally) less than 50% of the pop. For our model, 9 people find it affordable and 11 people dont. This can work from an economic point of view, because now your system is actually generating money, and can then be used to expand healthcare services in the long run.

 

there is only one problem, IMO, i think I just compromised some of the values of the healthcare system that we hold dear, and have taken 1 step closer to the system our southern neighbors have.

 

I will let someone else comment on this. Cept using a simplified model, i can't see how a 2 tier system is fair or can work. my latter exam, with the 9/11 split is close to two tier.

Is it not unfair? or is it simply unfair because there is inequality with the 9/11 split, and we take an unjustified leap to say its unfair? If those 11 people are receiving a good level of healthcare, just that it is a little slower, would it even be acceptable?

I am not sure what my grounds are. I want to say yes it is acceptable, after all there is inequality, even if its some, in education, yet that seems acceptable.

I think I am a little bit uncomfortable to say that I accept having an inequality in healthcare. I think our system is great, and i love bedrock of values it rests on. So maybe we ought to be troubled to work with it before throwing it out the window and starting from scratch.

 

 

I was thinking. Stop subsidizing med school education so much and let the students carry MORE (not necessarily most) of the burden, yet (and this is the important thing to keep in mind) make loans a lot more accessible.

With less subsidization more medical seats can be added, and the students bear the burden of loans, but they would make it all back. The only thing given up is the cash-in-hand and all the things that you have to 'wait' to buy.

of course maybe a debt like that of attending a US med school is ridiculous, but somewhere in between may work. Retreating subsidization would have be done gradually.

 

I think the pros would be:

-over a long period of time (and this is very long term) you would get an increase in the number of doctors AND an increase in the nation's GDP because a greater % of ur population can offer a valuable service

-more med seats and more doctors

 

cons:

- students would be in debt for longer, and they wont have the money to spend in the short term on products/goods/services (dubbed consumption in econ), so quality of life from that point of view may be lower.

 

 

I'll wait for someone else to build on this

[Vallinar]

The main problem with the HC are:

 

To much drain imposed by obesity/smoking and the elderly

Doc shortages/long waiting lists

Lack of innovation and "up to date" treatments.

 

 

To address the first issue we need to continue to expand on promoting health enhancing behaviours (ie exersise, diet), but i think that those who smoke and are obese (due to lfiestyle choice) should be forced to pay up 30% of the OHIP fee to the doc/hospital (this would be in addition to the fee/visit covered by OHIP). I think this kind of charge may motivate/provide incentive for ppl to change their lifestyle.

 

For the doc/shortages and lack of innovation i agree with Alastriss in that we should move towards a two-tiered system. But i think that in order to prevent degration of the public system, the two-teir system should be regulated such that a clinic/doc can only operate in a privatized manner for say 2 days/week at the most while the remainder of the week would have to be devoted to public care. What are your thoughts on this?

[kimmiegibbler]

just because someone is poor doesn't mean that they have time - you are right, but careful, I never said that. I merely gave an example of a way where we could extend the pool of resources available and so those can tap into whichever 'pool' they have more of.

 

With what I said, wait times would remain the same, at least initially.

 

Because lets look at a simple model. hospital A and B in the town of Hlth, which has a population of 20 people, so lets say 10 go to A and 10 go to B.

 

Lets say we do extensive economic studies and find a fee x, which makes it so that the utility that is brough by the service is at least equal to or greater than the utility given up by x (simply - ie Ice cream makes me happy and ill pay x for it, but healthcare makes me more happy so instead of icecream use the x towards healthcare). We institute the fee, x, at hospital B and keep hospital A for free - same services at each

 

So right now we still have 10 people at each hospital, same service same fee, except our healthcare is generating money, and I realize now that the system can't work with equality. I wont delete what I mentioned previously, but lets try a twist

 

Saw we find a fee x that is considered a 'good deal' by slightly (even infitesimally) less than 50% of the pop. For our model, 9 people find it affordable and 11 people dont. This can work from an economic point of view, because now your system is actually generating money, and can then be used to expand healthcare services in the long run.

 

there is only one problem, IMO, i think I just compromised some of the values of the healthcare system that we hold dear, and have taken 1 step closer to the system our southern neighbors have.

 

few things:

 

Back to the time vs money thing. There is no comparison unless we are talking stitches, ear infections and the like. If someone is waiting for diagnostic tests potentially they could lose their life or suffer considerably, you can't compare that kind of thing to dollars and cents.

 

Your simplified model: I know you said the 9 vs 11 figure is pretty unrealistic, but it becomes even more far fetched when we are talking about people with terminal or chronic disease. Who can afford to pay tens of thousands of dollars (its probably could be more than this, I really don't know what doctors bill or the cost of diagnostics scans etc) a year for health care , certainly nowhere near the 50% mark.

 

Also you said that money would be coming in when people are paying fees, but keep in mind these people would be paying their fees to the private hospital who is trying to make a profit, how much of this money would go towards the public system. I guess there would be taxes, theoretically this could help, but it doesn't appear that a lack of federal funds is what is stopping reformation of the public system, so who is to say that taxes on private health care would ever reach the public system.

 

When you have argued in terms of someone wanting to pay 100$ to see a doc rather than wait all day, I assume you mean for something not incredibly serious, in that case private health care doesn't seem so bad. But when we start to think about health issues that require ongoing care the potential (I want to say inevitable) disparity in care is a lot more distasteful.

 

As for the student paying more for medical education:

What you described is like the U.S.. Students there go into debt 300,000+ to pay for med school. 'primary care' as they call it physicians find it hard to live on the coastlines and service their debt. It further disadvantages women who may want to take time off to take care of their children but won't be able to afford to because of loan payments. I don't think doctors should be rich but I don't think they should be strapped for cash. Perhaps it would be doable with some good interest relief and debt management options.

 

Another idea would be allow under served communities pay for seats in medical schools and students that sign return to service contracts. Kind of like the military program. I don't know if this is realistic, but considering the incentives some regions pay out to attract doctors it seems within the realm of possibility.

[DalNeuron]

I've got a theoretical question: (although maybe there's a real answer)

 

If a two-tier system is put into place, do those people who decide to shell out their own money in order to jump the queue still get taxed to the same amount by the government? They'd be effectively double-paying for their helath care right? Are there tax breaks for those rich enough to use the private system? I'm wagering that we'd have a fight on our hands... the wealthy don't generally like to let their wealth go. (I guess this is similar to the catholic school system... parents of children going to catholic school are exempt from public education taxes)

 

To add to the discussion going on:

Alastriss, I appreciate the economic model, the trouble is that simplified models can't account for the myriad of economic factors that play into a problem like this... for example, the hospital B should be getting revenue from the government and taxes... hospital A, being private, wouldn't. My point is that the complexities are so numerous that modeling almost becomes pointless.. better, I think, to find examples of each case in other countries, like the US and in Europe and compare our level of care against theirs.

 

Oh, and there are currently bursary programs in place for Dal med students which have a conditional "you can have 6000$ for free, but only if you work in New Brunswick for a couple years" attached to them (values and times are estimates).

 

I agree entirely with TheLaw's points about government involvement and innovation, but just wanted to say that these issues rest on our shoulders... it's up to us to push health care as a major focus now and in the next election. As the aging doctors retire, we're headed for a crisis in this country and we need to start speaking up and making MPs realize that. Call your MP!

 

I also wanted to add something here to address the large focus in this thread on the doctor shortage... I was in the ER last month, and it was my experience that there were plenty of doctors available to see me within 15 minutes of my arrival, but the problem was lack of beds... the ER was full and no inpatients could be transferred because all the other wards were full as well, thus I waited 4 hours to be even seen... in this case (and it might not be typical) it seems like an investment in infrastructure (more beds, more buildings) would drastically increase the efficiency of health care delivery.

So, while a shortage of doctors might be the problem in some areas, it certainly isn't the case in every situation.

 

Good thread

[Alastriss]

few things:

 

Back to the time vs money thing. There is no comparison unless we are talking stitches, ear infections and the like. If someone is waiting for diagnostic tests potentially they could lose their life or suffer considerably, you can't compare that kind of thing to dollars and cents.

 

Your simplified model: I know you said the 9 vs 11 figure is pretty unrealistic, but it becomes even more far fetched when we are talking about people with terminal or chronic disease. Who can afford to pay tens of thousands of dollars (its probably could be more than this, I really don't know what doctors bill or the cost of diagnostics scans etc) a year for health care , certainly nowhere near the 50% mark.

 

Also you said that money would be coming in when people are paying fees, but keep in mind these people would be paying their fees to the private hospital who is trying to make a profit, how much of this money would go towards the public system. I guess there would be taxes, theoretically this could help, but it doesn't appear that a lack of federal funds is what is stopping reformation of the public system, so who is to say that taxes on private health care would ever reach the public system.

 

When you have argued in terms of someone wanting to pay 100$ to see a doc rather than wait all day, I assume you mean for something not incredibly serious, in that case private health care doesn't seem so bad. But when we start to think about health issues that require ongoing care the potential (I want to say inevitable) disparity in care is a lot more distasteful.

 

As for the student paying more for medical education:

What you described is like the U.S.. Students there go into debt 300,000+ to pay for med school. 'primary care' as they call it physicians find it hard to live on the coastlines and service their debt. It further disadvantages women who may want to take time off to take care of their children but won't be able to afford to because of loan payments. I don't think doctors should be rich but I don't think they should be strapped for cash. Perhaps it would be doable with some good interest relief and debt management options.

 

Another idea would be allow under served communities pay for seats in medical schools and students that sign return to service contracts. Kind of like the military program. I don't know if this is realistic, but considering the incentives some regions pay out to attract doctors it seems within the realm of possibility.

 

 

In reply:

 

Time vs money: agreed about the less serious ailments, and agreed about the more serious life changing diagnostic tests.

 

Right about that too, I realized that was a problme all along cept a system like this seemed in the end, nomatter how much i tried to avoid it, a two tier system prototype. You may as well end up having people crowd the free system because they dont want to have to pay the unbelievable fees you have described.

 

the fees I described would be government instituted, there is no room for private entities to invade the healthcare system, so the money generated is done so by the government investing its resources in healthcare and then reaping it back. If you think about it...its kind of like a tax.

 

FInally the US debt thing. If you reread my post, I mentioned that it would NOT be like the us, because i described a 300k debt as RIDICULOUS! and it is.

Also, doing this would be, as I mentioned a gradual process.

 

Will talk more later!