Two tiered health care system?

[Alastriss]

If you wanna see the future check out the Australian system. They out perform our system in many ways and it is two tiered. The way it was implemented over there caused a lot of problems. But after a decade the efficiency increase is quite impressive and the gap is widening.

 

A two tiered system is unavoidable in my opinion as health care costs continue to expand with emerging technologies. It isn't a matter of will it happen. It is a matter of when will it happen.

 

 

Gold. I think that the health-care sector is a huge area for economic growth too so the opportunity cost is hig. Public sector won't be able to keep up with this. You guys can check out Courchene T: medicare as a moral enterprise: The Kirby and Romanow perspectives.

[abcwxyz]

But they're not in the same spirit, and the Chaoulli decision only reflected a ruling against a ban on private insurance for publicly-insured services in Quebec. Such bans do exist in some other provinces, notably in Ontario, but that's not the case in Sask or NS, to take two examples. See here, especially before you go on about how private healthcare is "banned" (and, to be clear, that should be privately-funded healthcare, which is still not banned in any way shape or form).

 

So, privately-funded care isn't banned. Not by a long shot. Insurance for it is available for all sorts of extended care (private rooms, drugs, dental, optical, etc.) and in half the country it is theoretically available for publicly-insured services as well. But it's not subsidized and to take but one example, Halifax has a private MRI clinic which exists outside the system.

 

Well, I should clarify - there used to be such a clinic until it become insolvent due to lack of business and had to be taken over by Capital Health and so integrated into the public system.

 

 

I didn't say anything regarding their status quo as banned.

 

You also apparently knew what I meant: publicly insured services; your clarification was unnecessary.

[A-Stark]

So you stated that banning private healthcare is "unwarranted restriction of our freedom" in relation to what then? It's not banned - should it be subsidized, directly or otherwise? Just whose ideals do you mean when you suggest that vague legislative regulations (legislation or regulations?) "against privatization" are unfounded? On what practical or empirical basis is this so?

[abcwxyz]

So you stated that banning private healthcare is "unwarranted restriction of our freedom" in relation to what then? It's not banned - should it be subsidized, directly or otherwise? Just whose ideals do you mean when you suggest that vague legislative regulations (legislation or regulations?) "against privatization" are unfounded? On what practical or empirical basis is this so?

1.

Court ruled that the Quebec Health Insurance Act and the Hospital Insurance Act prohibiting private medical insurance in the face of long wait times violated the Quebec Charter of Human Rights and Freedoms.

2.

Six of the 10 provinces (Alberta, British Columbia, Manitoba, Ontario, Prince Edward Island and Quebec) prohibit contracts of private insurance to cover the kinds of services that are publicly funded.54,55,56,57,58,59 All of the provinces that prohibit private insurance do so by prohibiting any person from entering into a contract that covers publicly insured health services. Four of these provinces (British Columbia, Manitoba, Ontario and Prince Edward Island) also explicitly void any part of an insurance contract that covers the kinds of services covered by the public plan.

(Not sure how up to date it is, but my understanding is similar to yours; it's still prohibited in some provinces including Ontario (to my knowledge))

3. Legislative regulations -- prohibitory regulations imposed by legislation. The combination is fine. The ideals embodied in the Chaoulli decision and Canada's ideology as a left leaning but extremely free market capitalist society; we value personal liberties (very socially left, NOT very economically left) and the free-market (in addition to social support, which is why I didn't say eliminate the public system).

4. Read the constitution. Look at other aspects of society. Schools (two tier), jobs (getting a market wage vs. welfare), markets (free market capitalism vs. some subsidies and social supports).

[Grey Owl]

Just wanting to jump back to the topic on the Australian 2-tier model.

 

"The Australian experience suggests that Canadians should be wary about allowing a significant private sector to develop in Canada, particularly if it seeks the level of subsidy that the Australian private sector has been able to garner."

 

This opinion is very important for us to consider. While visiting family in Queensland over Christmas I had many opportunities to speak with medical service providers/managers and people on the receiving end of the care. Overwhelmingly, people avoided using the public institutions as they perception was of low quality care, understaffing and fear (use imagination here).

 

When asked if they would recommend Canada following their model, very few suggested we should. Simply because they felt that the public system should not be jeapordized, something they felt was unavoidable.

 

Just some thoughts.

[japlanet]

Just wanting to jump back to the topic on the Australian 2-tier model.

 

"The Australian experience suggests that Canadians should be wary about allowing a significant private sector to develop in Canada, particularly if it seeks the level of subsidy that the Australian private sector has been able to garner."

 

This opinion is very important for us to consider. While visiting family in Queensland over Christmas I had many opportunities to speak with medical service providers/managers and people on the receiving end of the care. Overwhelmingly, people avoided using the public institutions as they perception was of low quality care, understaffing and fear (use imagination here).

 

When asked if they would recommend Canada following their model, very few suggested we should. Simply because they felt that the public system should not be jeapordized, something they felt was unavoidable.

 

Just some thoughts.

 

Interesting viewpoint. Of course, no system will be perfect, there will always be trade-offs.

 

I guess the question is, at what point is the public system not worth saving? If the public system cannot adequately care for people (and I'm not arguing that it's there yet, but it certainly may be headed in that direction), then the argument that we cannot afford to jeopardize something which is already broken becomes quite weak.

[meme me]

I guess the question is, at what point is the public system not worth saving?

As long as the alternative is a consumer driven, profiteering venture where the provision of health care is no longer based on medical need, but rather the ability to pay, then there should never be a point when public health care isn't worth saving. I don't think anyone would argue that our health care system needs work, but a parallel system is a short-sighted fix where a small percentage of people stand to gain a lot.

[japlanet]

As long as the alternative is a consumer driven, profiteering venture where the provision of health care is no longer based on medical need, but rather the ability to pay, then there should never be a point when public health care isn't worth saving. I don't think anyone would argue that our health care system needs work, but a parallel system is a short-sighted fix where a small percentage of people stand to gain a lot.

 

I understand where you're coming from, but I think that with proper regulations a private health sector would not be so evil as you make it sound.

 

And with a parallel public system, relieved of the burden of caring for those who can and want to pay, those who medically need care will still be able to get it regardless of their ability to pay.

 

What I meant by asking at what point is the public system not worth saving was that, if the system is broken, and cannot provide medically necessary care, then attempting to preserve it based on the (unproven) idea that the alternative will not provide everyone with medically necessary care seems indefensible.

[A-Stark]

I understand where you're coming from, but I think that with proper regulations a private health sector would not be so evil as you make it sound.

 

And with a parallel public system, relieved of the burden of caring for those who can and want to pay, those who medically need care will still be able to get it regardless of their ability to pay.

 

That's an assumption that has time and again been proven to be false. Private parallel systems leach resources from not only the public system, but government funds through direct subsidies. I am absolutely opposed to any kind of subsidization of any kind of "privately" funded system. That, however, is the experience in Australia. Look at the evidence. It's there.

 

What I meant by asking at what point is the public system not worth saving was that, if the system is broken, and cannot provide medically necessary care, then attempting to preserve it based on the (unproven) idea that the alternative will not provide everyone with medically necessary care seems indefensible.

 

Well, the system isn't broken and does provide medically necessary care. Problems don't get fixed by government-financing or inducement of a private parallel system, something that would benefit physician-enterpreneurs, insurance companies, and a small minority of people (maybe), while decreasing access and quality of care for everyone else. And this is exactly what has happened elsewhere, no matter how much people harp on about (and misrepresent) the putative "European" model.

[Alastriss]

As long as the alternative is a consumer driven, profiteering venture where the provision of health care is no longer based on medical need, but rather the ability to pay, then there should never be a point when public health care isn't worth saving. I don't think anyone would argue that our health care system needs work, but a parallel system is a short-sighted fix where a small percentage of people stand to gain a lot.

 

The only evidence there is of this that I know of was a study done in alberta investigating the potential for a two tier system and it they found out that it only helped the high income/wealthy people.

 

What is shortsighted however is how people say "health-care for all" and then just stop right there.Health-care isn't like a Big Mac that you can enjoy now or 3 years from now, it is a time sensitive commodity. So giving health-care to everyone at the expense of long waiting lists is not health-care at all. I think this is where Kirby touches up on some seriously good points with the concept of "health care guarantee". If someone can't get the medical procedure done by a reasonable amount of time in canada then the government is forced to pay for his expenses when they get it elsewhere (such as in the US) so as to stimulate domestic physicians to schedule more patients in.

 

 

A quick note on the parallel system. Isn't it meant to benefit the high income people anyways (if we use a median voter theorem as the means to set the level of health provision)? So it may not be the best way to go here.

[A-Stark]

Are wait times better there? There isn't even an agreed standard for how they should be measured in Canada, so I'm not sure what you claim is being compared. I'm not clear on why greater hospital usage is a sign of efficiency and, in any case, some of these measures have little to do with the health care system (life expectancy) and probably vary year to year (medical errors - what kind?).

 

In what respect is this "more affordable"? What are co-payments like? Australians evidently pay more out-of-pocket. The fact remains that the so-called private sector in Australia is heavily subsidized by the government - what is just or efficient in that? See here:

 

Quebec has Dr. Jacques Chaoulli and British Columbia has Dr. Brian Day. With their misguided sense of righteousness, they have turned to the courts to obtain what political agitation failed to give them -- a large pool of commercially insured patients for their private clinics.

 

Note that private insurance isn't banned in NS, yet we probably have an even less developed private system than BC. As I mentioned above, private MRI clinics have a tendency here to go out of business - I suppose the public benefit is that one in Halifax was taken over by Capital Health, such that the capital costs never had to be provided by government funding. Of course, the average person has no need of an MRI except on very rare occasions. We probably lack adequate economies of scale for any kind of private system as envisaged by the likes of Brian Day.

 

In any case, all this talk about privatization is beside the point, as it does NOTHING to help fix problems in the public system. Setting aside the fact that experience shows that privately-funded clinics/hospitals are not particularly interested in acute care (do you seriously think that a tertiary care hospital would ever be a profitable enterprise?), instead focussing on more lucrative elective procedures, there is not so much a lack of acute care beds as there is a severe lack of long-term care beds. Consequently, acute care hospitals get clogged with ALC patients, and they run out of beds. Fix or reduce *that* problem. and we'll see improvement in many respects, right down to waits in Emerg.