Physician Shortage vs. Surplus

[BoyInTheBubble]

Tell that to the 80 year old guy who is on ALTC basically indefinitely or the frail elderly lady with the fractured hip who was in the emerg hall for 32hrs, no beds, no OR. Or how about the people being flown via Ornge to Buffalo for surgery, on the tax payer dime I might add, because we have no neurosurgical beds in the entire province... Demographics are fact and the trend towards a more elderly more resource demanding population is not changing any time soon.

 

Don't get me wrong, there is a lot that is great about our system. But the system unsustainability argument is real if you believe what I mentioned above is unacceptable.

 

You either tax people more and potentially weaken the whole economy and also not get elected, accept resource limited care for all and maybe not get elected, or offload and open up the second tier. Heck, the second tier already exists informally. The move towards this started long ago.

 

 

That ALC patient needs a nursing home bed, not an acute care hospital.

 

Guess what?! The private sector is already there. Lots of people can't pay. Others don't want to because public nursing homes are available. Either way, the private sector hasn't done much. There is a huge lack of infrastructure.

[rogerroger]

That ALC patient needs a nursing home bed, not an acute care hospital.

 

Guess what?! The private sector is already there. Lots of people can't pay. Others don't want to because public nursing homes are available. Either way, the private sector hasn't done much. There is a huge lack of infrastructure.

 

You are missing the point. I'm not saying private industry is where the solution lies for ppl who are stuck in regards to long term care placement. I'm talking about overall expenses and strains on the public system secondary to a multitude of issues. These types of cases won't go away, they will only increase over time. The demographic mathematics of the situation says so. The ALC patient is taking up a $2000/day bed in the hospital... Unless you open up the system, or increase taxes to pay for such situations how can one say that the future sustainability debate is mere "right-wing" rhetoric? Some here have been making just such a claim. Such thinking is detached from the real situation on the ground.

 

There is no ideal solution. However, an expanded regulated two tier system, which is already here in many respects as some have correctly pointed out, is the logical first stop-gap solution IMHO. Reduce strain on the public system. Improve the health of all. This is the inevitable future of health care.

[rogerroger]

So your solution is simply to "open up" the second tier without fixing the clear capacity problems in the public system? How does that fix anything or help the 80-90% of the population that will still rely exclusively on the public acute care sector?

 

What government fired nurses, merged/closed hospitals, and cancelled transit expansion in the mid-90s in Ontario to pay for tax cuts? Are you suggesting that taxes have not been steadily reduced at the expense of public services since at least 1998? Total government program spending as a percentage of GDP is at its lowest level and decades and we can't afford to fund the system properly?

 

It off loads a percentage of expenses from the public into a private system. Do you have any idea how much savings would be involved in offloading 10% of users as you suggest? This by default reduces total public system budget needs. It also increases jobs strengthening the economy. It splits user burden on both systems and thereby improving both.

 

Today the average Canadian family has record debts. This is due to a multitude of issues such as historically low interest rates etc. With the work force becoming younger and the aging population getting larger it is pretty clear that increasing taxes further is not going to make many people healthier economically. In the future nearly half of the income of many here on this forum will go into taxes... For what? To maintain a system clogged with ALC beds, flying patients to the states for care because we can't find beds here, or making fracture hips sit in halls for days... We can and should demand a better system. Tossing tax money at the public system does not fix the problem. If it did it would have been fixed long ago.

 

The public system plays a part in the future. But a strong and regulated private system would improve care in both systems. Better metrics is possible and it's only a matter of time. Once the situation gets rough enough and the political climate is primed we will see an explosion of private healthcare services in many a province. Heck, it has already begun.

[ralk]

You are missing the point. I'm not saying private industry is where the solution lies for ppl who are stuck in regards to long term care placement. I'm talking about overall expenses and strains on the public system secondary to a multitude of issues. These types of cases won't go away, they will only increase over time. The demographic mathematics of the situation says so. The ALC patient is taking up a $2000/day bed in the hospital... Unless you open up the system, or increase taxes to pay for such situations how can one say that the future sustainability debate is mere "right-wing" rhetoric? Some here have been making just such a claim. Such thinking is detached from the real situation.

 

There is no ideal solution. However, an expanded regulated two tier system, which is already here in many respects as some have correctly pointed out, is the logical first stop-gap solution IMHO. Reduce strain on the public system. Improve the health of all. This is the inevitable future of health care.

 

A secondary private system seems like a logical next step until you dig into the unique economic properties of health care. Because of the unique economic properties of health care, it doesn't respond well to traditional market forces; a private institution is not likely to become more efficient than a public institution while maintaining standards of care and access. What we see more often - and the US is a clear example of this - is rising prices, along with efforts to avoid providing useful services which are not clearly profitable.

 

Current private institutions in Canada already make their money along these lines. One example is diagnostic services. Many clinics are popping up providing access to diagnostics, but often only provide the most well-established, profitable diagnostic services. More difficult, more obscure, or less profitable ones are left for hospitals who have to provide those services - putting additional costs and inefficiencies on public services. A clinic with an MRI scanner can be quite profitable so long as you never have to do unexpected inpatients or complicated cases.

 

Furthermore, saving the government money doesn't really make health care on the whole sustainable. If, hypothetically, the government saves $100,000 by eliminating services, yet private citizens now have to spend $100,000 to make up for that service, nothing has been gained - it's just been shifted. That's equally unsustainable. Additionally, because of the ineffectiveness of market forces on health care, international and historical investigations of private health care indicate that in this hypothetical, citizens would likely have to spend MORE than $100,000 to pay for those lost services. Again, we see this quite clearly in the US, where the government pays almost as much per person for health care as we do in Canada, yet private citizens still have to pay large amounts out-of-pocket just to get to the same level of care.

 

Using private health care to solve problems in public health care seems logical, but isn't.

[A-Stark]

It off loads a percentage of expenses from the public into a private system. Do you have any idea how much savings would be involved in offloading 10% of users as you suggest? This by default reduces total public system budget needs. It also increases jobs strengthening the economy. It splits user burden on both systems and thereby improving both.

 

How exactly are we going to offload these costs? Private nursing homes exist now and long-term care is NOT part of medicare. So you will still have ALC patients sitting in acute-care floor beds for months because they can neither afford private health insurance nor private nursing homes. Privately-funded care will skim off profitable ambulatory procedural ("value-added") cases in healthy patients, and little else.

 

Otherwise we already have private imaging clinics and a variety of other services delivered in the community by various providers. In Halifax there is a private imaging clinic. If you are referred for an MRI, you can get one for $795. Ultrasounds cost $250. I don't know whether this sort of thing exists in all provinces, but the point is simple - private healthcare is already here.

 

I don't *really* like that from a social equity angle, but more capacity is generally to be encouraged one way or another. My point is not that we should prohibit such clinics, but that they are absolutely not any kind of solution to the current problems facing (in particular) the acute care sector. You certainly don't see investors clamouring to build tertiary care hospitals or open medicine beds. They certainly are permitted to do so. There just isn't any market for it, since (in Nova Scotia anyway) economies of scale are not present to make it remotely profitable.

 

In Vancouver, there is the Cambie Surgery Centre, which performs pretty much exclusively low-risk ambulatory procedures. As I said before, inpatients are expensive and unprofitable, so they will select for people who will be candidates for same-day surgery. I doubt that were a similar centre to open in the GTA it would operate any differently.

 

So, simply put, we already have private health care. It's not going to offload healthcare "users" for the simple reason that there is no incentive to do so.

 

Today the average Canadian family has record debts. This is due to a multitude of issues such as historically low interest rates etc. With the work force becoming younger and the aging population getting larger it is pretty clear that increasing taxes further is not going to make many people healthier economically. In the future nearly half of the income of many here on this forum will go into taxes... For what? To maintain a system clogged with ALC beds, flying patients to the states for care because we can't find beds here, or making fracture hips sit in halls for days... We can and should demand a better system. Tossing tax money at the public system does not fix the problem. If it did it would have been fixed long ago.

 

So if people are overconsuming and running up record debts, the appropriate response would be to, say, increase the GST back to where it was only a few years ago. That way the money they would have spent on their cellphone upgrade will go to the general social insurance pool rather than on private (over)consumption. The reason why ALC patients sit on the floor for so long is a perfect example of market failure. They can't afford private nursing homes, so they must wait for a subsidized public bed. Yet the market fails to provide for them because LTC is expensive and has fairly high-fixed costs that are entirely inelastic.

 

And, really, funding dedicated to OR time, stepdown beds, and home care would go a long way to dealing with the bottlenecks. We could be running 5pm rooms instead of 3 or 4pm rooms, organize bed utilization differently... it goes on. We need better management at all levels and, sometimes, more funding. The answer does not lie in assuming the private sector will be ready - or willing - to "offload" costs. That is simply not the experience elsewhere. And it isn't in any part of Canada that permits (or tolerates) full-on private healthcare.

 

The public system plays a part in the future. But a strong and regulated private system would improve care in both systems. Better metrics is possible and it's only a matter of time. Once the situation gets rough enough and the political climate is primed we will see an explosion of private healthcare services in many a province. Heck, it has already begun.

 

So, once again, how are you going to convince private investors that they should build an acute care hospital where they can expect to have to provide beds for ALC patients or the usual medical trainwrecks that inhabit the medicine wards across the country?

[jock2doc]

You either tax people more and potentially weaken the whole economy

 

I like a lot of the ideas you have on this issue, but higher levels of taxation do not necessarily weaken the economy, especially if those taxes are progressive. Reason being, is that using the additional revenue to bolster the size of the middle class leads to more consumers capable of buying products. In turn, you lessen the burden on our welfare system and increase GDP via the sale of more goods and services. Like everything else, taxes, when used correctly, can help the economy. However, I understand no one likes giving more of their paycheque to Big Brother, hence the political lightning rod this issue has become.

[jock2doc]

A secondary private system seems like a logical next step until you dig into the unique economic properties of health care. Because of the unique economic properties of health care, it doesn't respond well to traditional market forces; a private institution is not likely to become more efficient than a public institution while maintaining standards of care and access. What we see more often - and the US is a clear example of this - is rising prices, along with efforts to avoid providing useful services which are not clearly profitable.

 

Current private institutions in Canada already make their money along these lines. One example is diagnostic services. Many clinics are popping up providing access to diagnostics, but often only provide the most well-established, profitable diagnostic services. More difficult, more obscure, or less profitable ones are left for hospitals who have to provide those services - putting additional costs and inefficiencies on public services. A clinic with an MRI scanner can be quite profitable so long as you never have to do unexpected inpatients or complicated cases.

 

Furthermore, saving the government money doesn't really make health care on the whole sustainable. If, hypothetically, the government saves $100,000 by eliminating services, yet private citizens now have to spend $100,000 to make up for that service, nothing has been gained - it's just been shifted. That's equally unsustainable. Additionally, because of the ineffectiveness of market forces on health care, international and historical investigations of private health care indicate that in this hypothetical, citizens would likely have to spend MORE than $100,000 to pay for those lost services. Again, we see this quite clearly in the US, where the government pays almost as much per person for health care as we do in Canada, yet private citizens still have to pay large amounts out-of-pocket just to get to the same level of care.

 

Using private health care to solve problems in public health care seems logical, but isn't.

 

I mostly agree with all of the above. This is a tricky issue in terms of private provision because health care does introduce market failures. However, a two tiered system is different because the public sector will be operating without the objective of earning a profit. Theoretically, this would limit the private sector's ability to overcharge because the demand would be more elastic than in a US styled model. Therefore, the best way for the private providers to profit would be to increase their efficiency. Unleashing the entrepreneurial (greedy) spirit of mankind can be beneficial, as long as someone (ie the Gov't) is there to keep everything in check.

[rmorelan]

I like a lot of the ideas you have on this issue, but higher levels of taxation do not necessarily weaken the economy, especially if those taxes are progressive. Reason being, is that using the additional revenue to bolster the size of the middle class leads to more consumers capable of buying products. In turn, you lessen the burden on our welfare system and increase GDP via the sale of more goods and services. Like everything else, taxes, when used correctly, can help the economy. However, I understand no one likes giving more of their paycheque to Big Brother, hence the political lightning rod this issue has become.

 

This is an interesting debate

 

I will mention that upping taxation can reduce the economy directly as it introduces a disincentive to work. As I lower your taken home pay effectively for each hour worked with more going to tax you are probably less inclined to work as hard or for as long. This is a real effect that is well studied - and is the macro effect of people complaining that the government takes so much of their pay you probably here all the time.

[jock2doc]

This is an interesting debate

 

I will mention that upping taxation can reduce the economy directly as it introduces a disincentive to work. As I lower your taken home pay effectively for each hour worked with more going to tax you are probably less inclined to work as hard or for as long. This is a real effect that is well studied - and is the macro effect of people complaining that the government takes so much of their pay you probably here all the time.

 

Haha I have always wondered about the disincentive to work. I find economic studies very different from the natural sciences. Reason being is that there are too many variables to account for. Take for instance the fact that the American Tax system was much more progressive in the 50's and 60's but GDP was also growing at a much faster rate. This could serve against the disincentive to work argument. Now there were some incredible tech advancements that allowed this to happen, but also the middle class was born during this period. Ultimately, the policy maker should seek the greatest good for the greatest number, without putting unfair restraints on others (IMO).

[rmorelan]

Haha I have always wondered about the disincentive to work. I find economic studies very different from the natural sciences. Reason being is that there are too many variables to account for. Take for instance the fact that the American Tax system was much more progressive in the 50's and 60's but GDP was also growing at a much faster rate. This could serve against the disincentive to work argument. Now there were some incredible tech advancements that allowed this to happen, but also the middle class was born during this period. Ultimately, the policy maker should seek the greatest good for the greatest number, without putting unfair restraints on others (IMO).

 

that is exactly what makes it tricky So many variables and because it is a real system you cannot freeze it and start just manipulating one of them.

 

Plus I have to say I am not total in agreement with some of the underlying assumptions of economics - that was one of the reasons I also did a degree in psych among other things - econ assume people are perfectly rational, pysch tries to determine exactly where, how and why they are not.

[jock2doc]

Have you read Kahnman? Thinking Fast and Slow was an awesome read on exactly that subject.

[aaronjw]

that is exactly what makes it tricky So many variables and because it is a real system you cannot freeze it and start just manipulating one of them.

 

Plus I have to say I am not total in agreement with some of the underlying assumptions of economics - that was one of the reasons I also did a degree in psych among other things - econ assume people are perfectly rational, pysch tries to determine exactly where, how and why they are not.

 

Good ole bounded rationality.

 

Never understood how Smith could arrive at the theory of humans being perfectly rational when plenty of evidence in everyday life shows that's complete absurd thus making his claim of capitalism being rational also absurd.

[rmorelan]

Good ole bounded rationality.

 

Never understood how Smith could arrive at the theory of humans being perfectly rational when plenty of evidence in everyday life shows that's complete absurd thus making his claim of capitalism being rational also absurd.

 

 

 

hehehehe I think part of it is SO much philosophy centres around us being rational beings above all else. To be rational is to be moral under so many of those schemes.

 

and secondly we mainly are rational - I mean economics doesn't say your preferences, likes, dislikes etc are rational (those can be completely illogical as far as economics is concerned) - only that once you figure out what those preferences are you are rational for the most part towards getting them, and for the most part we are. If you like chocolate more than potato chips you will buy more chocolate than potato chips. Our greed makes us rational in a sense.

 

Economics is based on us seeking the maximum happiness within our constraints. I think the main problem it has is it fails to actually use as proper proxies what makes us happy - it isn't a linear relationship with GDP for example - and how happiness is dependent on others around you (people seem to be happiest in general when we are a bit better off than everyone around us but not TOO much better off - which is part is why people seek out social groups roughly of equal social standing). Economics built up these towers of rational thought upon the shifting sands of some poor assumptions (money isn't really a great proxy for happiness, some resources are not particularly rare or exhaustible, and people are not perfect judges of what will make them happy so assuming they are is a mistake, and people memories of past good and bad events are flawed)

 

ha- I still find all this pretty interesting.

[bloh]

That has always been one of the long term arguments FOR a two tier system. You are shunting economic resources outside of the country by refusing to do it here. Associated jobs, skills development and taxes are thus lost to the Canadian economy.

 

Profit doesn't stop economic modelling, or even one good with profit and one without. Gosh we must have ground through 100s of those with every possible variation

 

Huh? Maybe you misunderstood. If you as a patient are willing to pay and want a 2-tier system, drive down a couple of hours south of the border and pay.

 

The brain drain (ie. physicians leaving the country) has stopped being a problem once we started paying our physicians appropriately.

[rmorelan]

Huh? Maybe you misunderstood. If you as a patient are willing to pay and want a 2-tier system, drive down a couple of hours south of the border and pay.

 

The brain drain (ie. physicians leaving the country) has stopped being a problem once we started paying our physicians appropriately.

 

sure but then Canada just lost thousands (likely) in revenue. In theory if Canada allowed you do to the same thing here some argue that money would be put to work in Canada - giving Canadians jobs, helping support our hospitals.

 

What you are describing DOES happen, and happen all the time. People who are pro two tier inside of Canada point at that any say hey look we are already losing a crap load of cash because we aren't operating a full internal two tier system. Wouldn't it be nice if we had that money to fight our hospital deficits instead of some US hospitals bottom line? Why are we throwing that money away?

 

Plus some one has to do that operation/procedure/scan whatever for Canadians in the US - because some of us are going there we require the US to get more doctors to service us. Those doctors and supporting staff have to come from somewhere, and they could have been working in theory here in Canada instead if we opened it up - paying taxes, developing their skills, doing research etc, etc. You effectively created a brain drain where some doctors of skills enough that you go out of your way to pay for it (ie good doctors) are not working here but would have been if we removed barriers.

 

or so goes the argument at least

[Der Kaiser]

 

Plus some one has to do that operation/procedure/scan whatever for Canadians in the US - because some of us are going there we require the US to get more doctors to service us. Those doctors and supporting staff have to come from somewhere, and they could have been working in theory here in Canada instead if we opened it up - paying taxes, developing their skills, doing research etc, etc. You effectively created a brain drain where some doctors of skills enough that you go out of your way to pay for it (ie good doctors) are not working here but would have been if we removed barriers.

 

or so goes the argument at least

 

I think they call that argument the "if you can't beat them you might as well join 'em" argument.

 

A two tier system could work if the market was flooded with doctors. Maybe not so great for a lot of doctors though. It also wouldn't be equal care for everyone, but maybe "fairness" should not be part of the thought process.

[rmorelan]

I think they call that argument the "if you can't beat them you might as well join 'em" argument.

 

A two tier system could work if the market was flooded with doctors. Maybe not so great for a lot of doctors though. It also wouldn't be equal care for everyone, but maybe "fairness" should not be part of the thought process.

 

Sure - I guess you could call it that There is a negative connotation with that of course but usually in the real work you lose out in the long run if you don't adapt to unequal systems. Canada could actually mess with it quite a bit by applying a tax to it - ha, the logistics of that are hard of course but I actually saw someone propose that once.

 

Why do you think a two tier system would work better if the market was flooded? I am probably missing something simple

[Der Kaiser]

Why do you think a two tier system would work better if the market was flooded? I am probably missing something simple

 

The argument against two tier is that doctors would simply not work for the public system because reimbursement is better in the private system. If we had a surplus of doctors some would be forced to work in the public system in order to find employment. Most likely these would be the less entrepreneurial types. If you made public insurance a more stable option (but less remuneration) then some docs would work for the public system. (Or alternatively, some docs would just go to work in the states causing the whole thing to backfire).

[bloh]

sure but then Canada just lost thousands (likely) in revenue. In theory if Canada allowed you do to the same thing here some argue that money would be put to work in Canada - giving Canadians jobs, helping support our hospitals.

 

What you are describing DOES happen, and happen all the time. People who are pro two tier inside of Canada point at that any say hey look we are already losing a crap load of cash because we aren't operating a full internal two tier system. Wouldn't it be nice if we had that money to fight our hospital deficits instead of some US hospitals bottom line? Why are we throwing that money away?

 

Plus some one has to do that operation/procedure/scan whatever for Canadians in the US - because some of us are going there we require the US to get more doctors to service us. Those doctors and supporting staff have to come from somewhere, and they could have been working in theory here in Canada instead if we opened it up - paying taxes, developing their skills, doing research etc, etc. You effectively created a brain drain where some doctors of skills enough that you go out of your way to pay for it (ie good doctors) are not working here but would have been if we removed barriers.

 

or so goes the argument at least

 

Here we go again: "revenue", "losing a load of cash", etc

 

How many times must it be said?

 

Healthcare is not here to provide a profit or revenue to anyone.

[aaronjw]

Here we go again: "revenue", "losing a load of cash", etc

 

How many times must it be said?

 

Healthcare is not here to provide a profit or revenue to anyone.

 

I agree with that but part of the problem with this philosophical view is that without profit factors, there's little incentive to be efficient.

 

I do not advocate for any type of profit oriented style of health care in Canada but I do advocate for an efficient health care model but it's difficult for people in HC to adopt a need to be efficient because frankly, they don't understand the complexities and demands of business which is why gov't policies tend to focus on cost cutting/containment over improving efficiencies.

 

The model of cut that the gov't uses to create efficiency doesn't really do that, it simply lowers the value of the service.

 

If I could trust business in establishing a market model to health care then i'd be in favour because the reality is such a system should provide the most efficient, competitive and economically viable health care system but sadly we cant trust business leaders to act in any way other than with greed.

[bloh]

I'd rather be inefficient in a public sector with no profit than "efficient" in a private sector that monetarily rewards parties to cut corners for the sake of efficiency.

 

The only and the best way to improve our current system is to tune it and make it more efficient. And there's a ton of fairly easy ways but someone needs to get their **** together. The solution is not to introduce a private tier and then all the baggage associated with it. The medical analogy for the latter option is to "cure HIV" by getting a bone marrow transplant from an immune person.

[rmorelan]

Here we go again: "revenue", "losing a load of cash", etc

 

How many times must it be said?

 

Healthcare is not here to provide a profit or revenue to anyone.

 

I guess I would say it is not here to provide unreasonable revenue or profit etc. Don't want to see anyone taking advantage off but even asking to get paid for one's work violates that statement.

 

but A LOT of others don't agree with that even. For the sake of debate - 12% of Canada's GDP is in health care spending directly and even more if you factor in related industries that depend on it - that is a HUGE section of the economy - filled with thousands of businesses but big and small all in it for profit and revenue and correspondingly a massive number of employees. If there was no profit or revenue to be had it could be easily argued the entire system would collapse rather rapidly actually (even as simple as almost every doctor is a business in of themselves, and yeah they are interested in revenue and profit like any one else). When something is that big of an industry - yeah the government is going to look at it in those terms and you are going to hear things like loss of revenue, unemployment, and return on investment all the time.

[rogerroger]

 

Healthcare is not here to provide a profit or revenue to anyone.

 

Huh? No. As romantic as it might sound healthcare is not one big charity detached from the essential rules of human nature. It operates in close concert with numerous aspects of a market based economy. Thus, it darn well provide profit and return a cost-benefit, quality of care and the economy is dependent on it.

 

Ha, then again I pretty much work for free already, so maybe you are onto something...

[bloh]

Huh? No. As romantic as it might sound healthcare is not one big charity detached from the essential rules of human nature. It operates in close concert with numerous aspects of a market based economy. Thus, it darn well provide profit and return a cost-benefit, quality of care and the economy is dependent on it.

 

Ha, then again I pretty much work for free already, so maybe you are onto something...

 

Who exactly makes a profit on that 78year old lady that's just admitted for sepsis? I don't see the government snickering at the 1500$/day for her bed. Just because there's money turned over between several parties (government to physician and allied staff) doesn't mean it's considered revenue or profit. It's a necessary expense to keep the society together, just like firefighters, policemen and teachers. I don't see anyone yelling to to have a second tier of police officers to keep the riffraff off our streets.

[rmorelan]

Who exactly makes a profit on that 78year old lady that's just admitted for sepsis? I don't see the government snickering at the 1500$/day for her bed. Just because there's money turned over between several parties (government to physician and allied staff) doesn't mean it's considered revenue or profit. It's a necessary expense to keep the society together, just like firefighters, policemen and teachers. I don't see anyone yelling to to have a second tier of police officers to keep the riffraff off our streets.

 

 

Philisophically I think I understand where you are coming from and not disagreeing with your classification of health care. It is just that the argument is that exactly because money is turned over it can be viewed as revenue/profit.

 

The doctor would call it profit. He/she would bill for that care and his/her medical corporation would record that as revenue. Ultimately he/she would use that to afford something nice.

 

The drug company that sold the hospital the drugs would call it revenue. They certainly like the boost to their bottom line.

 

The medical supply company that build the bed and provided all the disposables would call it revenue.

 

The entire staff would call it jobs as well - of all kinds of descriptions etc.

 

The government collecting income tax on all of this would call it revenue back again.

 

It is essential? Necessary? I would say so - but of course so it food and shelter and a thousand other things the government provides money for one way or the other. They often get a LOT of inefficiencies when they ignore looking at things in economic or even business terms. The government could be view just as another business - it has revenue from taxes and expenses in the form of services.

 

Plus the fact that other countries DON'T have it as an essential service makes it messy as well. Our system is relatively unique after all in the world.

 

If the government could somehow stop people from going to the US for health care and instead have that money spent in Canada in theory would have the health care budget rise. Part of that additional revenue could actually partially pay for the 78 year old's care and allow perhaps in theory as well more staff and improve wait times in general. Ha - again I am not exactly pro two tier but we are all aware of these arguments of course and they are not exactly trivial to dismiss - and there is a huge movement based on these ideas out there including a lot of doctors. It is a rather dangerous time in Canadian health care.