Private Health Care Options vs. Government

Curiosity

Senate Member
Jul 30, 2005
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http://www.ibdeditorials.com/IBDArticles.aspx?id=270338135202343



A Canadian Doctor Describes How Socialized Medicine Doesn't Work

By DAVID GRATZER | Posted Thursday, July 26, 2007 4:30 PM PT
I was once a believer in socialized medicine. As a Canadian, I had soaked up the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people.
My health care prejudices crumbled on the way to a medical school class. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute.
Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care.
Dr. Jacques Chaoulli faces the media in Montreal in June 2005, after he got Canada's Supreme Court to strike down a Quebec law banning private insurance for services covered under Medicare — a decision the rocked the country's universal health care system.

I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic — with a three-year wait list; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.
Government researchers now note that more than 1.5 million Ontarians (or 12% of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment.
These problems are not unique to Canada — they characterize all government-run health care systems.
Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled — 48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave — when many doctors were on vacation and hospitals were stretched beyond capacity — 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.
Single-payer systems — confronting dirty hospitals, long waiting lists and substandard treatment — are starting to crack, however. Canadian newspapers are filled with stories of people frustrated by long delays for care. Many Canadians, determined to get the care they need, have begun looking not to lotteries — but to markets.
Dr. Jacques Chaoulli is at the center of this changing health care scene. In the 1990s, he organized a private Quebec practice — patients called him, he made house calls and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.
Eventually, Chaoulli took on the government in a case that went all the way to the Supreme Court. Representing an elderly Montrealer who had waited almost a year for a hip replacement, Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. A majority of the court agreed that Quebec's charter did implicitly recognize such a right.
The monumental ruling, which shocked the government, opened the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of Canada for now, at least two people outside Quebec, armed with Chaoulli's case as precedent, are taking their demand for private insurance to court.
Consider, too, Rick Baker. He isn't a neurosurgeon or even a doctor. He's a medical broker — one member of a private sector that is rushing in to address the inadequacies of Canada's government care. Canadians pay him to set up surgical procedures, diagnostic tests and specialist consultations, privately and quickly.
Baker describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion — he had no family history of epilepsy, but he did have constant headaches and nausea, which aren't usually seen in the disorder — he requested an MRI.
The government told him that the wait would be 4 1/2 months. So he went to Baker, who arranged to have the MRI done within 24 hours — and who, after the test revealed a brain tumor, arranged surgery within a few weeks. Some services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him.
Other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week.
Canadian doctors, long silent on the health care system's problems, are starting to speak up. Last August, they voted Brian Day president of their national association. Day has become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center and challenging the government to shut him down.
And now even Canadian governments are looking to the private sector to shrink the waiting lists. In British Columbia, private clinics perform roughly 80% of government-funded diagnostic testing.
This privatizing trend is reaching Europe, too. Britain's Labour Party — which originally created the National Health Service — now openly favors privatization. Sweden's government, after the completion of the latest round of privatizations, will be contracting out some 80% of Stockholm's primary care and 40% of its total health services.
Since the fall of communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany.
Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money.
Politicians like Hillary Clinton are on board; Michael Moore's new documentary, "Sicko," celebrates the virtues of Canada's socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance.
One often-heard argument, voiced by the New York Times' Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.
Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall or a car accident. Such factors aren't academic — homicide rates in the U.S. are much higher than in other countries.
In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.
And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England — a striking variation.
Like many critics of American health care, though, Krugman argues that the costs are just too high: health care spending in Canada and Britain, he notes, is a small fraction of what Americans pay. Again, the picture isn't quite as clear as he suggests. Because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M.D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.
That said, American health care is expensive. And Americans aren't always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.
But such initiatives would push the U.S. further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs — but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment.
America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home — in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.
Gratzer, a physician, is a senior fellow at the Manhattan Institute. This article is adapted from the forthcoming issue of City Journal.
 

MikeyDB

House Member
Jun 9, 2006
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Yes every person should be permitted to seek the medical attention of whomever they choose and if there are more doctors competing for business, we can expect, special discounts and deals on surgery and diagnosis. We can have Tonsilectomy Tuesday where patients get a voucher for special deals on air fare and oil changes when they book their tonsilectomy. Clinics could offer sweatshirts and T shirts to advertise their services... Membership cards to particular clinics would be wonderful, particularly if you can collect "points" that can be applied against purchases at different stores and pharmaceutical companies. In fact, it would be a great step forward if doctors clinics were supervised by pharmaceutical companies.... The same great deals that pharmaceutical companies now offer folk could be discounted for cancer meds and antibiotics prescribed through particular clinics. It would save a good deal of time if a system like that used to rate movies was applied to people with ill-health and you could earn "stars" every time you go to a specific clinic that would provide patients with preferred service based on how frequently and of course how much they spend per month on health services....

Recycling stations could be attached to clinics so colostomy sacs and catheters could be recycled, undoubtedly saving people enormous amounts of money. Clinics and hospital ER's could base their decisions on "past performance" of patients pay histories and if you've missed a payment your name goes to the bottom of the list.

The benefits of a "free-market medical system are enormous. Almost dead anyway we could get entirely free of the Hippocratic Oath and hospitals and private clinics could compete for surgical instruments and ambulance service. Yes let's open the health care monopoly up and we can enjoy prompt service from a deregulated qualification system. You don't need a doctor to diagnose your ills, a good friend or distant nephew of a doctor running a private clinic could do the job much cheaper and we'd save a fortune!

We could have Mortuary Monday, a special for patients booking their heart surgery that would give the families a break on burial services and associated costs when the patient dies....

The possibilities are mind-boggling....
 

Niflmir

A modern nomad
Dec 18, 2006
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Leiden, the Netherlands
This anecdotal evidence is propaganda from a growing trend to demonize public health care in order to keep the door open for private obsolescence in the USA. A private health care system has no interest in preventing health problems, which is the biggest aspect of keeping people happy. Even with the backlogs in Canada, we have a higher percentage of our citizens who actually get to see a doctor and our costs are substantially less.

" These problems ... characterize all government-run health care systems." Red flag. I notice he didn't mention Germany (other than "modest market reforms"), or Italy, or poland, or other dozens of nations with public systems.

Prevention is one of the most important aspects of health care and this is something that a private, market-driven health care system will never accomplish. No business acting in its self interest would ever start up a prevention program. Furthermore, private health care has huge advertisement costs that do not exist in Canada or other public health care countries that I have seen. Private health care companies must spend enormous amounts of money on advertising in order to differentiate themself, this is an unnecessary cost to a health care system and necessarily makes it less efficient.

The only thing that we are missing in Canada is a higher number of doctors. The reason for this being that the market of doctors is heavily controlled in order to inflate wages. There are plenty of qualified immigrants in Canada who are not allowed to practice due to the influence of our flaky immigration policies.

As for family physicians, I am one of those persons that don't have a family physician. This is a personal choice and I have never suffered for it.

"Across Europe, state-of-the-art drugs aren't available." This is because pharmaceutical companies refuse to allow governments to cover their drugs in their national health plans. If there were not exclusive right interventions inherent in the General Agreement on Tariffs and Trade governments would be able to force coverage of these drugs on humanitarian grounds. Their hands are tied by the pseudo-free trade acts.

Those are just a few of my complaints.
 

MikeyDB

House Member
Jun 9, 2006
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Niflmir

You're still laboring under the misconception that something other than a "pay as you play" would work in health care. Just think about all the trouble we'd be in if we let the government be responsible for inspecting our slaughter houses and ensuring products were safe.... We'd never have the great advances made in nearly every sector of human enterprise we have today if we tried to limit the "free market". Since the "free market" has worked so well everywhere else, why shouldn't medicine and patient care benefit from the same boon to humanity that has given us unrestrained consumption and a disposable attitude toward everything?
 

ottawabill

Electoral Member
May 27, 2005
909
8
18
Eastern Ontario
For the life of me, I can never figure out what would be wrong with a hybrid system. If you can afford it then buy private coverage..if not then the government pays. Paying the same rates as private but for many less people.

Have any of you ever looked at the Ireland system? It appears to work very well. It is not the U.S> way..it is not the Canadian way, but somewhere in the middle.

As well the funding model in the country is flawed. A hospital gets money at the begining of it's year based on the amount of people it is expected to serve. The way they can make their money is to have less people and less services....This doesn't work in a service industry!! A U.S. private hospital makes it's money by seeing more people, using more services and doing more testing, hence the reason you can have a cat scan next week instead of 5 months from Tuesday!!

The unfortunate part of all this in Canada is that the second you look at any change, you are labeled as wanted the U.S. private system wholy..I do not!! But sticking our head in the sand and waiting for the Canadian system to collapse (remember all these Baby boomers are getting on) is not the route we should follow.

There is something terribly wrong when last month my Son needed an ultrasound. The local clinics and hospitals couldn't provide on till late Aug at best and some said October, well a clinic in upstate New York, just across the river from me, booked him in 2 days later, and test results were back to our family Doctor before the next morning.....If I can get that service why should I not pay for private insurance to cover it...as long as less fortunate members of our country can still be covered?
 

Niflmir

A modern nomad
Dec 18, 2006
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Leiden, the Netherlands
MikeyDB, I can't figure out what you are trying to say to me. I am not sure if you are being cynical about the effects of the free market or advocating it. I am not sure what you mean by "pay as you play" but I certainly advocate for a progressive system much like our income tax rates. Certainly the greatest majority of medical advancements are made by hard working compassionate individuals in academic laboratories. Has there been any greater advancement than genetic theory, penicillin, insulin, vaccines and preventive care? Those certainly don't fall out of any free market, that is for sure, but cheaply manufactured drugs certainly do. It is unfortunate that the market for manufacturing drugs is not truly free but is subject to heavy government interventions to prevent the manufacture of cheap drugs. However, it is very fortunate that the government sets up public research institutions that do amazing research without the need for patents - which is also not a free market. So aspects of it are good for the people and bad for the people. Right now we get the bad and none of the good. Again, I am not quite sure what you are driving at.

Ottawbill, imagine a simplified system with three clinics: two private and one government run. The government run clinic will have equipment costs and training costs. The private clinics will need to compete with each other and will have advertisement costs, necessarily making them less efficient. In the real world, the companies will complain that they cannot compete with the government and that the public clinic should be shut down or that the private clinics should be subsidized in order to give the the private firms the opportunity to compete. Look at what is happening with private schools in Ontario right now. Alternatively, the private clinics can use their influence in medical associations to limit the number of licensed doctors and raise their wages. Then the public clinics cannot afford as much staff and their equipment is idle for a certain amount of time allowing the private clinic the opportunity to rent it at a lower cost. In any case what you certainly don't want is a system dominated by advertisement expenditure and no preventive health care.

I mentioned Germany and Poland. Both of these countries have mixed systems. In fact, Canada has a mixed system! We are in the case where doctor's wages are artificially high and our equipment has a substantial amount of idle time. Also, our system does not cover all forms of medication. We do not have a pure public system, and the parts of our system that are private are the inefficient parts due to heavy handed regulations like the GATT I mentioned above, TRIPS and NAFTA that prevent the development of cheaper methods of manufacturing and distribution. The only aspect of our system that is public is the payment method for the parts that are universal: citizens are taxed at a progressive rate and the universal system is paid for out of the government coffer: the rich pay more.
 

Curiosity

Senate Member
Jul 30, 2005
7,326
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California
Niflmir

I am a neophyte on this topic but something you wrote caught my eye:

Prevention is one of the most important aspects of health care and this is something that a private, market-driven health care system will never accomplish. No business acting in its self interest would ever start up a prevention program. Furthermore, private health care has huge advertisement costs that do not exist in Canada or other public health care countries that I have seen. Private health care companies must spend enormous amounts of money on advertising in order to differentiate themself, this is an unnecessary cost to a health care system and necessarily makes it less efficient.

I can only speak on U.S. medical care as that is because I have been a chronic consumer of this service for the last ten years - and while I enjoyed good medical care in Canada, I rarely had need
to test out its response times and waiting periods, etc. When one is young and healthy little thought is given to medicine.

Prevention by all medical practitioners is provided - even to people who are on government assistance, no assistance, the elderly, the wealthy and if one is interested in partaking the annual
shots, X-Rays, bloodwork - BP monitoring these can be arranged as they are available to the public. Even a person who cannot pay would not be refused prevention - such as a flu shot as an example. I think some tests would be charged for but a nominal amount and often never paid anyway because so many people aren't even on any documentation regarding population stats and they cannot claim any salaries or wages legally.

My own doctor's staff are absolute nags and keep my records updated with looks of scorn if I have been remiss in getting what is offered and available.

I don't understand what you mean by advertising. Most people belong to insurance providers (just as you would insure your residence or vehicle or life)....and there are offered to the membership a list of providers who agree to certain stipulated medicine, procedures, etc., and these can be expanded to meet individual need for a slightly higher price. I have one medicine which is $5.00 more (for a 90 day supply) than the others I take - but is still offered by my insurance provider because the person who has the final say is my primary care doctor (an internist) and the specialty pulmonologist who is also on the list of providers along with many other specialty MDs.

Extensive advertising in the US is done by pharmaceuticals and many providers who do not belong to group plans such as cosmetic surgeons (excepting accident repair or birth defect)....Dentists and Optometrists also advertise down here, but excepting the announcement of a new practice inviting new patients...I rarely see a regular medical doctor advertising....

The group is sort of a mini-plan similiarly run by governments, but run by doctors who rule the roost and will argue with insurance providers if necessary. I believe the government also have a say in regulation and monitoring of rogue practitioners, as well as pharmaceuticals which have not been
effective or in some cases have harmful side-effects over a long period of time.

I witnessed one pharmaceutical rep getting hell from my own mild mannered doctor because of a medication he used on a trial he felt was worthless and even asked for a monetary refund for his patients who were prescribed it.

I can only speak from my individual experience however - and my membership runs approximately $100.00 a month - some years a bit higher - some years a bit lower - and most of my prescriptions are $5.00/$10.00/$20.00 for generally a three month supply.

I don't know who's running the show in the U.S. but I have an appointment Monday at 8am. I phoned for it last Monday this week. I'll be out of there in time to start work at 9am. It's called prevention and ongoing care/monitoring.
 
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Avro

Time Out
Feb 12, 2007
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Oshawa
The French and many other European countries have it figured out and don't have wait times.....

The French Health Care System



-- HEALTH INSURANCE AND ACCESS TO CARE --

To best understand how the French health care system works, I think it is best to begin with a look at the French health insurance system.

First of all, all legal residents of France are covered by public health insurance, which is one of the social security system's entitlement programs. The public health insurance program was set up in 1945 and coverage was gradually expanded over the years to all legal residents: indeed, until January 2000, a small part of the population was still denied access to the public health insurance.

The funding and benefits of the French public health insurance system (PHIS), much like Germany's, were originally based on professional activity. The main fund covers 80% of the population. Two other funds cover the self-employed and agricultural workers.

Once varying depending on the fund, disparate reimbursement rates were replaced by uniform rates. The funds are financed by employer and employee contributions, as well as personal income taxes. The latter's share of the financing has been ever-increasing in order to:

? compensate for the relative decrease of wage income,

? limit price distortions on the labor market,

? and more fairly distribute the system's financing among citizens.

Most health insurance funds are private entities which are jointly managed by employers' federations and union federations, under the State's supervision. The joint labor/management handling has always sown discord within the funds' boards, as well as between the boards and the State.

As a consequence, the responsibilities of the various actors in the system are not always shared in the most coherent manner.

For example, the parliament's budget provisions determine how much public money will go to health expenditure, the cabinet decides reimbursement rates and sets the amount of contributions earmarked for the funds, while the funds themselves negotiate with health care professions to set tariffs designed to ensure the system operates at the breakeven point. Responsibilities are frequently redefined, but never to satisfaction of all involved.

1 Permanent Working Group of European Junior Doctors, October 2001.

2 1 rue Paul C麡nne 75008 Paris France. couffinhal@irdes.fr, www..fr, Tel: 33(0)153934318.

The views expressed here are those of the author, and they do not necessarily reflect the views of the IRDES.

Agn賠Couffinhal - IRDES October 2001 2

The public health insurance system covers about 75% of total health expenditures. Half of the outstanding amount is covered by patients' out-of-pocket payments and the other half is paid by private health insurance companies. These supplementary health insurance policies can be taken out by individuals or groups.

About 85% of the population own such policies.

An important peculiarity of the French PHIS is that the funds cover a very wide range of goods and services, including for example, stays in thermal spas.

In the hope of curbing consumption and expenditures, copayments were implemented and have increased over time. These copayments are relatively high for many out-patient services.

For example, patients must pay 30% of Social security's tariff for a physician's visit, moreover, roughly 40% of specialists and 15% of GPs are allowed to charge more than the tariff. Copayments are also high for dental prostheses and eye-ware. This tended to deter the poorest citizens (few of whom had supplementary insurance) from seeking care. Concerns grew over the system's inequity.

In January 2000, a means-tested, public supplementary insurance program called CMU (Couverture maladie universelle) was implemented to ensure the poor access to health care.

For those whose income is below a certain threshold (about 10% of the population is eligible), this insurance covers all public copayments and offers lumps-sum reimbursements for glasses and dental prostheses. Health professionals are not allowed to charge more than the public tariff or the lump-sum for CMU beneficiaries, which means that in theory, access to care is free of charge.

In passing, I'd like to mention that many experts advocate a change in the way health insurance covers care. They think it would be more efficient and equitable to clearly define a set of indispensable goods and services which should be available to everyone and which should be 100% publicly financed. The remaining goods and services would be available to those who desire and can afford them, with or without relying on private insurance.

To close this aside on access to care, I'd like to add that, as far as I know, France is the only country in which access to care is unlimited: patients can see as many physicians as often as they like. Patients do not need referrals to see specialists, and in general, there is no gatekeeping system of any kind. This may partially account for the World Health Organization's high ranking of France's health care system last year: the rating system emphasized the system's responsiveness (a measure of patients' freedom and flexibility), a quality the French system provides, undeniably at the expense of overall efficiency.

Agn賠Couffinhal - IRDES October 2001 3

-- THE STATE'S ROLE --

1. The State decides on what care is to be reimbursed and to what extent, defines the responsibilities of the various actors, and ensures that the entire population has access to care.

2. The State defends patients' rights, drafting and enforcing relevant policy. The State is thus responsible for safety within the health system. The disaster and subsequent cover-up of the contamination of the nation's hemoglobin supply with HIV-tainted blood resulted in the revamping of public health policy. New agencies were created to oversee safety measures concerning the nation's blood supply, organ donor programs, food, and medical goods and services. The recent handling of the mad cow crisis indicates that these changes have improved public safety.

3. The State is also in charge of planning. Health authorities decide on the size and number of hospitals, as well as the amount and allocation of highly technical equipment (MRI, CTscans...). It organizes the supply of specialized wards (transplants, neurosurgery...) and ensures the provision of care at all times, like emergency rooms.

Since 1991, some of the planning has taken place at the regional level. Indeed, more and more policy-making and negotiation are undertaken at the regional level, and this tendency is likely to continue in the coming years.

-- THE CARE SUPPLY HOSPITALS --

In France, hospitals have always been the core of the health care system. This probably accounts for the extremely specialized, technical, curative nature of our care, arguably to the detriment of prevention and community services.

The number of hospital beds has decreased over time: it currently stands at 8.4 per 1,000 inhabitants, which is close to the European average. Hospitals can be roughly divided into two categories: public, and private for-profit.

? The public sector represents about 65% of the beds. Public hospitals have specific obligations such as ensuring the continuity of care, teaching, and training. They receive a budget which is largely based on a historical basis.

? Private for-profit hospitals concentrate on surgical procedures and rely mostly on fee-forservice remuneration for their funding.

A uniform hospital information system has been implemented to monitor the various establishments activity. Gradually, all public and private establishments are to switch to DRG payment systems.

Agn賠Couffinhal - IRDES October 2001 4

-- HEALTH PROFESSIONALS --

Of the many types of health professionals, I would like to focus on physicians, as they play a key political role in the system. There are currently about 200,800 physicians licensed to practice in France. In the last thirty years the number of physicians has tripled, but the rate of increase is now very slight. Indeed, since 1971, the Ministry of Health has limited the number of medical students, a measure which, along with the retirement of currently active doctors, will result in a decrease in the number of physicians in the near future.

Half of the physicians are specialists.

In France, physicians (and other professionals) generally work in two kinds of environments: public hospitals and private practices. 25% of physicians work in public hospitals (another 11% work in other types of public establishments). They are in essence public servants and paid an amount that is fixed by the government. Today, many physicians feel that the prestige of working in a hospital does not compensate for the trying working conditions. 56% of physicians work in private practices3, and are paid on a fee-for-service basis.

The relative weight of the procedures is set by experts and the prices are negotiated by physicians' unions and public health insurance funds4.

Since the creation of Social Security, the relationship between private practice physicians and the State and public insurance funds has always been strained. A contract (convention) which sets the general regulatory framework and the remuneration of the profession is supposed to be signed every 5 years by physicians unions. The first one was signed in 1971, 26 years after public health insurance was created. Subsequent conventions allowed some physicians to charge more than social security tariffs (1980), limited this right (1990) and implemented official medical practice guidelines (RMO, R馩rences m餩cales opposables) in 1993.

The current situation is particularly strained: negotiations between doctors' unions and the funds have stalled, leaving the specialists without a convention and isolating the GP union which signed a convention in 1998. The root of the problem is that private practice physicians are strongly opposed to the setting caps on outpatient expenditures. They have always had a great deal of freedom over where they set up shop, how they practice, and what they prescribe (compared to their counterparts in other countries). Yet the bulk of their income is paid by public funds. This contradiction has become more glaring as the concerns about soaring health expenditures grew.

http://www.medicalnewstoday.com/articles/9994.php

They have problems with doctors but who dosen't.:lol:
 

Impetus

Electoral Member
May 31, 2007
447
33
18
One of the problems with Canada's system is the governemt is not increasing doctors' earnings to match those in the private sector south of the border, so we're losing them (along with many nurses).

This is compounded by the huge number of immigrants they are letting in, with no control over where in Canada they settle. They are settling in the already stressed big cities and surrounding suburbs in such numbers that the health system cannot keep up with the growth.

This is a "one hand doesn't know what the other is doing" scenario. We bring in all the immigrants to build the tax base, but for some reason it isn't being spent on expanding the services (be it health, roadways, education, or municipal services) to meet the increased population.

We are basically being screwed over by a government "ponzi scheme" where they are having to bring in new people to support the few at the top of the pyramid.

Muz
 

Niflmir

A modern nomad
Dec 18, 2006
3,460
58
48
Leiden, the Netherlands
Yar, I said a lot, and not all of it applies to the same thing in the same way. Ever see a product with "Approved by the American Medical Association" or Dental association? That's advertisement in action. The fewer doctors there are, the higher their wages are, that is why NAFTA didn't make it easier for doctors to move around North America, the AMA wants to keep doctors in short supply. If Mexico could train doctors who are just as qualified and work for half the price, American doctors would be SOL. So the AMA invests in advertisements and quality assurance so long as it makes it seem like the low entrance numbers to medical programs are for quality and not salary purposes. We could benefit from more free trade on this aspect, true Canadian/American doctors would lose wage a bit, but the social benefit of cheaper doctors who are equally qualified and less overworked is enormous.

Now insurance providers are where the real advertisement counts. A lot of money is spent sending out presents, gifts, golf trips, products and so on in order to entice people into the insurance program whether it be employers or the actual consumer. They strike up special deals which amount to kickbacks with some employers to ensure that they have a larger market share. Those special deals are a form of advertising. In a public system none of these shenanigans go on. There is no bidding war. The service is provided at the lowest cost possible. They don't advertise on the internet, buses, park benches, news papers or anything else to reach customers. This is definitely an area where you don't want free trade. Advertisement is unnecessary effluence, if you can name multiple insurance providers, their advertisements have worked and that is money wasted on names that could be spent on lives.

As for prevention programs, the insurance companies aren't funding those. The disease control and prevention programs of the government pay for that. As you say, "Even a person who cannot pay would not be refused prevention" and that is a beautiful form of socialism that I am happy you guys have. An insurance company has no interest in prevention programs, they can be exploited by everyone, always and can't lead to profits. Has anyone ever received an insurance handout for physiotherapy before they injured themself? Free trade will never want to touch this one, or at most it will only want to prevent a limited number of cases.

As for drugs, I am sad to say that in Canada, that aspect of health care is mostly privately controlled. As such it isn't accountable to the public and we too have attrocities like the one you mention (doctor getting mad at ineffective drugs). Furthermore, our hands are tied by NAFTA and our public health care is not allowed to cover certain drugs because the pharmaceutical companies refuse to allow it. They don't want their medication to be considered very important because than they can lose control of it. Freer trade with public controlled innovation would do wonders here. Drugs can be made for pennies a pop, $2000 a prescription is ludicrous, the exclusive rights are hurting a lot of people on this issue.
 

Niflmir

A modern nomad
Dec 18, 2006
3,460
58
48
Leiden, the Netherlands
One of the problems with Canada's system is the governemt is not increasing doctors' earnings to match those in the private sector south of the border, so we're losing them (along with many nurses).

This is compounded by the huge number of immigrants they are letting in, with no control over where in Canada they settle. They are settling in the already stressed big cities and surrounding suburbs in such numbers that the health system cannot keep up with the growth.

This is a "one hand doesn't know what the other is doing" scenario. We bring in all the immigrants to build the tax base, but for some reason it isn't being spent on expanding the services (be it health, roadways, education, or municipal services) to meet the increased population.

We are basically being screwed over by a government "ponzi scheme" where they are having to bring in new people to support the few at the top of the pyramid.

Muz

Not really. Consider pumping up the number of doctors incredibly. Now you have a pile of well qualified doctors. They would like to go to the USA and work there, but the USA doesn't want to grant them visas because it would create a wage war which would drive the salaries down. Because jobs would then be scarcer than doctors, you could get a lot of good doctors at a really good price. There is a limited number of positions for doctors at any given time, and there are constantly people turned away from medical school simply on the basis that there aren't enough seats.

Similarly, consider immigration. What exactly is our acceditation for medical practitioners in Canada? Why can't another nation perform the test for us? Then all the immigrant doctors that we have would be qualified. Then they wouldn't have to settle in a big city to get a decent job as a taxi driver, they could live as a doctor in a small town. As it stands now, we refuse to accredit them until they basically go through medical school all over again.

The problem is not that doctors don't make enough money in Canada, it is that their wages are kept artificially high here and in the USA and we do not have real free trade at the labour level in these areas.
 

Zzarchov

House Member
Aug 28, 2006
4,600
100
63
If we are going to have pay health care, I want to choose whoever I want to treat me. If they are a carpenter who watche ER alot, my money my choice.

None of this "You have to pay, but can only pay us, a rate we decide and you have to pay cause your dying".

If I want a doctor trained in India who's otherwise driving a cab, thats who im going to see, even if he only charges me $20 for heart surgery.



Otherwise the first article is 1.) Bias'd from the get go. IT would be like asking a minimum wage employee if minimum wage should go up, little bit of conflict of intrest.

The doctor wants a private system that results in him having more money. Maybe its the truth, either way, from him its worthless since he's got a conflict of interest.

My problem is this isn't a solution, its a carpet over a mess.

They talk about the build up of sick and injured patients clogging the waiting room. Well a private system doesn't magically make more doctors come out of nowhere and be fully trained, we can only train so many at once.

So they can't treat these people any faster can they? So how are they going to keep them from being sick in the waiting room? Tell them they are too poor and have them be sick and dying at home.

Thats like saying "I know how to cut down on highway congestion! I'll tell poor people they aren't allowed to drive under penalty of death!"

Until someone shows me how Private health care creates more doctors its a completely indefensible position as "cutting down wait times"

I have yet to ever hear this master plan of HOW this would fix our problems of a manpower shortage for doctors.
 

#juan

Hall of Fame Member
Aug 30, 2005
18,326
119
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As one who has seen and experienced our health care system over virtually the whole spectrum, I don't see a problem. My wife received health care when she was carrying, and then giving birth to our children. Our children had the usual run of things like Measles, Chicken Pox, etc. plus our son had a bout with pneumonia when just a month old.
Now that our children have grown up and have children of their own we have watched our grandchildren go through most of the same things their parents did.
Throughout all of this our medical care system has done well by us and we have no complaints. In my life I have broken bones and had other injuries while playing sports and our health care system was there for me. My wife had her gall bladder out a few years ago, again, without a hitch..
Now that I'm older, I've recently had heart surgery that went smoothly without any long waits and generally, I was pleased with the care I received. My two children and their families have family doctors and I have no reason to believe that they won't get the same, quality care that I have received.
I know there is a problem with joint replacement surgeries, but I also understand that more and more of those surgeries are being done in Canada.
All in all, I don't think our health care system is broken and it is not in any danger except from blind politicians bending to private health care lobbyists who don't give a damn about anything but money.
 

Impetus

Electoral Member
May 31, 2007
447
33
18
Not really. Consider pumping up the number of doctors incredibly. Now you have a pile of well qualified doctors. They would like to go to the USA and work there, but the USA doesn't want to grant them visas because it would create a wage war which would drive the salaries down. Because jobs would then be scarcer than doctors, you could get a lot of good doctors at a really good price. There is a limited number of positions for doctors at any given time, and there are constantly people turned away from medical school simply on the basis that there aren't enough seats.
Why do they want to go to the US? Better wages, lower taxes. So we improve their wages to net out after taxes to par with the USA. Problem solved.
How do you figure the number of doctors positions (in the USA) is limited, and how does that affect us here where doctors are a scarcity?

Similarly, consider immigration. What exactly is our acceditation for medical practitioners in Canada? Why can't another nation perform the test for us? Then all the immigrant doctors that we have would be qualified. Then they wouldn't have to settle in a big city to get a decent job as a taxi driver, they could live as a doctor in a small town. As it stands now, we refuse to accredit them until they basically go through medical school all over again.
I agree with that being another issue, but we'd have no control over that part of the testing process with that model. If their standards for med school are not up to ours, how can we be sure the testing is? And why would the country of origin want to set up such a system so their doctors can then leave? That's the problem we have here...

The problem is not that doctors don't make enough money in Canada, it is that their wages are kept artificially high here and in the USA and we do not have real free trade at the labour level in these areas.
How are they artificaially high? In contrast to the countries of origin?
We don't have true free trade at any level. Why do I have to pay duty to buy something from the USA over the internet?
See above...
Muz
 

ottawabill

Electoral Member
May 27, 2005
909
8
18
Eastern Ontario
High Doctors wages..there's a joke!!

Outside of cosmetic specialist Doctor's wages are hardly exceptional.

Remember the cost of school, plus years of training. Remember that a Doctor's fee's are not his wages but must pay for the total operating cost of his office, nurse salary, rent, power etc etc... He maybe lucky to take home 90,000 for 70 hour work week..you do know that a bus driver working 70 hours will make $100,000!!!

We have no fees attached to using medical treatment, it makes people consider that it is free, Tommy Douglas demanded that there be a user fee when he put health care in place. He considered that it would fall apart if people considered it a welfare instead of a co-payment..well we got what he warned about!!

btw what is wrong at all with private clinics /labs etc, as long as everyone has access either through their private insurance or public insurance??
 

Zzarchov

House Member
Aug 28, 2006
4,600
100
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Doctors do not have it rough by any means.

If your worried about us losing doctors, fine, lets let some of the many qualified doctors who want to emigrate to Canada practice, problem solved.
 

Impetus

Electoral Member
May 31, 2007
447
33
18
The standard reply is that private clinics will get all the best doctors and nurses while the lower wages in the public system will ensure they are left with the rest.

Muz

High Doctors wages..there's a joke!!

btw what is wrong at all with private clinics /labs etc, as long as everyone has access either through their private insurance or public insurance??
 

ottawabill

Electoral Member
May 27, 2005
909
8
18
Eastern Ontario
but if payments were equal then what is the problem. As it sits right now there are private clinics, private labs etc that are paid by fed medical insurance in some provinces..they bill at the same rate.

What I am talking about is having the private sector supply the services and supply the insurance to all who can afford it and have the government supply the insurance for those how can't. A private system where people don;t fall through the cracks...This is the model they have in Ireland..and it appears to work
 

Zzarchov

House Member
Aug 28, 2006
4,600
100
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So does our system.

Solution: If you want private care, buy insurance and just go the USA.