[andyt]

Lemmy Lemmy:

In education, it's EASY to find the waste. I went to a secondary professional development day just this past Monday. Teachers were given a presentation by Ross Greene on "collaborative problem solving". Essentially the premise is that you can fix kids' behavioural problems by negotiating with them. Teachers were shown a series of ridiculous scenarios about how to negotiate with kids for classroom management. Watch this one about a kid tapping his pencil on the desk and Greene's solution to this "problem":

http://www.livesinthebalance.org/simple-plan-b

Are you kidding me? This is what we're spending our tax dollars on? This is what we're doing to help our teachers teach our children better? You don't negotiate classroom rules/disruptions with a teenager. You tell the kid to stop tapping his goddamn pencil on his desk or get the fuck out. Then you call his dad so his dad can kick his ass when he gets home. Take a guess what Greene pocketed for his appearance. Guess the highest number you can imagine then double it.

Then the teachers (180, approximately) had lunch provided for them. It was a buffet with potato salad, garden salad, pasta, chicken and roast beef sandwiches, pickles, cheeses, etc. Nice, but basically cafeteria fare. The bill for lunch was $4500. Yeah, $4500. That's $25 per person! They could have given every teacher $20 cash and been farther ahead.

So no, in education the waste isn't "what the next guy gets" it's what the powers that be piss away on lipservice, all the while lining their pockets with kickbacks. It's the dirtiest secret in public spending and I'm very near a complete 180 degree switch of my research efforts because the time I've spent learning about this system is only raging my desire to firebomb schoolboard offices.

No argument there. I'm sure other govt depts have similar problems, as do private big institutions.

But look at one example. The Fraser Institute is of the no govt is good govt ilk. They would privatise health care. But it turns out that not only is our system much fairer than the US one, it's much more efficient too. So just reflexively being against govt just creates a bigger mess.

The problem is that when govts cut, they usually just cut fat and meat to the same amount - just across the board cuts. Then when things go to hell they have to rescind those cuts, there's not saving at all. Drummond was at least smart enough to point that out and try something different. What works politically is something different tho, so McGuinty didn't follow Drummond's recommendations.

There will always be some govt waste. Just as there's waste in private big orgs. It would be nice to get a govt that's sophisticated and secure enough to tackle this problem in a proper way, but in the mean time we still need govt, and it costs money. Even in your example, what sort of savings could be had with rationalization? They're still going to have to pay teachers and own schools, I would assume that's where the big money is going in that department. So even if they found some savings, your tax bill for education would still be high.

Same with medicare. As I said above, our administration costs are less than the private system in the US. The costs are from advancing technology and an aging population. Do we want to go back to 1950's medicine, or throw old people under the bus to save money? There are things we can do there as well - for instance use more nurse practitioners instead of doctors. But that's opposed by the doctors which are a very powerful group. But either way, the bulk of healt care costs aren't going away. So you'll still have to contribute on April 30.

Pick pretty well any govt department - it will be the same story. There are probably some govt departments that don't accomplish much of anything and should be closed, but those will be small departments. Overall, it's still going to cost a good buck to run this country, there's just no getting away from it.

[DrCaleb]

Lemmy Lemmy:

So no, in education the waste isn't "what the next guy gets" it's what the powers that be piss away on lipservice, all the while lining their pockets with kickbacks. It's the dirtiest secret in public spending and I'm very near a complete 180 degree switch of my research efforts because the time I've spent learning about this system is only raging my desire to firebomb schoolboard offices.

I worked in the Alberta Ministry of Learning for a while, when Olberg was Minister. Most of the 'mind boggling waste' I saw in government I saw there.

I got your back. We'll be in jail together, and if Boots is willing, he can bail us out.

[DrCaleb]

andyt andyt:

Pick pretty well any govt department - it will be the same story. There are probably some govt departments that don't accomplish much of anything and should be closed, but those will be small departments. Overall, it's still going to cost a good buck to run this country, there's just no getting away from it.

Pick any province, and I think you'll find the smaller underfunded ministries tend to be; Immigration, Childrens' Services, Finance and anything to do with Research or the Environment.

The larger budgets tend to be Health and Justice related.

[BartSimpson]

andyt andyt:

But look at one example. The Fraser Institute is of the no govt is good govt ilk. They would privatise health care. But it turns out that not only is our system much fairer than the US one, it's much more efficient too.

Sure, it's more efficient.

If I go to my doctor today and she diagnoses me with a operable brain tumor they'll admit me today or maybe tomorrow and if I'm not in surgery tonight then no later than Tuesday I'd go under the knife.

In Canada, according to Health Canada's own statistics, I can anticipate an average 11.3 week wait before I see a surgeon and then I can anticipate waiting an additional 31.7 weeks for the surgery.

That's very efficient because in 43 weeks I'd probably be dead anyway and that would save a lot of money that my silly healthcare in the USA would pay without hesitation.

Now your system is fairer because the wait times I cited here hold true for all Canadians.

Oh, wait.

No, they don't.

Your wealthy people don't hesitate to come to the USA to get the same care I personally take for granted. Your government executives also do the same thing and then they turn around and make Health Canada foot the bill for treatments that most of you, equally, would be denied. I suppose that's fair.

In some areas like prevention, Canada tends to fare better against the USA. But when Canada is compared to the average US HMO those figures skew given that HMO's have a profit motive for keeping people healthy while a national health care plan has a vested interest in controlling costs. For instance, both native born and immigrant women have more frequent pap tests in the USA than in Canada...and around 40% of our people are uninsured and we still beat you in this category.

Going back to the topic of wait times the World Health Organization rates the responsiveness of US health care as #1 in the world with Canada being 7th.

This is where we leap ahead of Canada and that's on traumas and critical care incidents like heart attack and stroke. If you have a heart attack in Detroit your hospital mortality rate in 45-60 year olds is (2011) 8.9% while across the river in Windsor it is 18.2%

And that's for people who are at a hospital when they have a heart attack.

The Health Care Council of Canada 2010 study showed that 19.2% of heart attack patients in Canada have a wait time in excess of two hours before receiving treatment versus 3.67% in the US with the same wait time.

That same study also showed that access to diagnostics is far better in the USA. Canadians requiring an MRI or CT scan could expect a wait of three months while uninsured and indigents in the USA on public assistance had a wait time of 20.1 days. Insured people in the USA had a wait time of 3.2 days for the same services you can expect to wait three months for.

Again in that study 21% of your hospitals said that a woman would have to wait up to three weeks for a breast cancer biopsy versus less than 1% of US hospitals having the same wait. 50% of your hospitals admit to making seniors wait over six months for hip replacements while not one such case could be found in the USA of any patient waiting that long for a hip replacement (and that includes immigrants, uninsured, tourists, and etc.).

One of the other factors in the disparity of US & Canada healthcare statistics is that our per-capita and aggregate immigration rate utterly eclipses yours and due to 'fairness' we no longer screen immigrants for pre-existing medical conditions (I'm unable to find any info showing that Canada does or does not do such screening).

In the past year I posted an exhaustive post with statistics cited from the California Office of Statewide Health Planning and Development, UCLA, US Dept. of Health, US Dept. of Commerce, and etc. that showed US health figures rising to #1 across over 90% of WHO criteria when only US born individuals were included in the stats.

See, we get dinged statistically for every tourist and immigrant who sets foot on our soil and dies that same day of whatever condition they already had. Thanks to unscreened immigration we now have tuberculosis, whooping cough, German measles, mumps, rubella, and bed bugs back in the USA after seeing no index cases of any of those from 1989 to 1998.

If you folks took in the same per-capita immigrants as we did your numbers would be pretty bad. I can say that with authority because where we excel at trauma and emergency room treatment both trauma/ER and critical care are the weak links in your health care system and it is exactly those aspects of care that immigrants tend to use the most.

We also invest more heavily in our system than you do in yours and that helps account for the disparites in per patient aggregate spending.

Canada has 4.6 medical scanners per million. We have 29.5.

Canada has 11.8 automated external defibrillators (AED) per million. We have 218.1.

Canada has 4,897 licensed ambulances (including trauma, critical care, and transports) nationwide. California, with a similar population has 31,288.

Canada has 63 aircraft licensed (more or less) as air ambulances. Some are transports, some offer critical care, and six offer full trauma care.

Hawaii beats you with sixteen trauma helicopters, another twenty four critical care aircraft, and forty one air transports.

Kindly note this is not meant as a dig, but as a response to the dig that we spend more than you do while insuring fewer people. Which is true.

Yes, your system is more egalitarian and for some things it's better.

But if you have a heart attack, get hit by a car, bit by a shark, get breast cancer, get *any* cancer, you're better off doing so in the USA.

[fifeboy]

BartSimpson BartSimpson:

andyt andyt:

But look at one example. The Fraser Institute is of the no govt is good govt ilk. They would privatise health care. But it turns out that not only is our system much fairer than the US one, it's much more efficient too.

Sure, it's more efficient.

If I go to my doctor today and she diagnoses me with a operable brain tumor they'll admit me today or maybe tomorrow and if I'm not in surgery tonight then no later than Tuesday I'd go under the knife.

In Canada, according to Health Canada's own statistics, I can anticipate an average 11.3 week wait before I see a surgeon and then I can anticipate waiting an additional 31.7 weeks for the surgery.

That's very efficient because in 43 weeks I'd probably be dead anyway and that would save a lot of money that my silly healthcare in the USA would pay without hesitation.

Now your system is fairer because the wait times I cited here hold true for all Canadians.

Oh, wait.

No, they don't.

Your wealthy people don't hesitate to come to the USA to get the same care I personally take for granted. Your government executives also do the same thing and then they turn around and make Health Canada foot the bill for treatments that most of you, equally, would be denied. I suppose that's fair.

In some areas like prevention, Canada tends to fare better against the USA. But when Canada is compared to the average US HMO those figures skew given that HMO's have a profit motive for keeping people healthy while a national health care plan has a vested interest in controlling costs. For instance, both native born and immigrant women have more frequent pap tests in the USA than in Canada...and around 40% of our people are uninsured and we still beat you in this category.

Going back to the topic of wait times the World Health Organization rates the responsiveness of US health care as #1 in the world with Canada being 7th.

This is where we leap ahead of Canada and that's on traumas and critical care incidents like heart attack and stroke. If you have a heart attack in Detroit your hospital mortality rate in 45-60 year olds is (2011) 8.9% while across the river in Windsor it is 18.2%

And that's for people who are at a hospital when they have a heart attack.

The Health Care Council of Canada 2010 study showed that 19.2% of heart attack patients in Canada have a wait time in excess of two hours before receiving treatment versus 3.67% in the US with the same wait time.

That same study also showed that access to diagnostics is far better in the USA. Canadians requiring an MRI or CT scan could expect a wait of three months while uninsured and indigents in the USA on public assistance had a wait time of 20.1 days. Insured people in the USA had a wait time of 3.2 days for the same services you can expect to wait three months for.

Again in that study 21% of your hospitals said that a woman would have to wait up to three weeks for a breast cancer biopsy versus less than 1% of US hospitals having the same wait. 50% of your hospitals admit to making seniors wait over six months for hip replacements while not one such case could be found in the USA of any patient waiting that long for a hip replacement (and that includes immigrants, uninsured, tourists, and etc.).

One of the other factors in the disparity of US & Canada healthcare statistics is that our per-capita and aggregate immigration rate utterly eclipses yours and due to 'fairness' we no longer screen immigrants for pre-existing medical conditions (I'm unable to find any info showing that Canada does or does not do such screening).

In the past year I posted an exhaustive post with statistics cited from the California Office of Statewide Health Planning and Development, UCLA, US Dept. of Health, US Dept. of Commerce, and etc. that showed US health figures rising to #1 across over 90% of WHO criteria when only US born individuals were included in the stats.

See, we get dinged statistically for every tourist and immigrant who sets foot on our soil and dies that same day of whatever condition they already had. Thanks to unscreened immigration we now have tuberculosis, whooping cough, German measles, mumps, rubella, and bed bugs back in the USA after seeing no index cases of any of those from 1989 to 1998.

If you folks took in the same per-capita immigrants as we did your numbers would be pretty bad. I can say that with authority because where we excel at trauma and emergency room treatment both trauma/ER and critical care are the weak links in your health care system and it is exactly those aspects of care that immigrants tend to use the most.

We also invest more heavily in our system than you do in yours and that helps account for the disparites in per patient aggregate spending.

Canada has 4.6 medical scanners per million. We have 29.5.

Canada has 11.8 automated external defibrillators (AED) per million. We have 218.1.

Canada has 4,897 licensed ambulances (including trauma, critical care, and transports) nationwide. California, with a similar population has 31,288.

Canada has 63 aircraft licensed (more or less) as air ambulances. Some are transports, some offer critical care, and six offer full trauma care.

Hawaii beats you with sixteen trauma helicopters, another twenty four critical care aircraft, and forty one air transports.

Kindly note this is not meant as a dig, but as a response to the dig that we spend more than you do while insuring fewer people. Which is true.

Yes, your system is more egalitarian and for some things it's better.

But if you have a heart attack, get hit by a car, bit by a shark, get breast cancer, get *any* cancer, you're better off doing so in the USA.

Funny that. Despite the better optics of the U. S. system, where it really matters, health outcomes- Canada does just as well in many areas and better in some. I wonder why?

[BartSimpson]

fifeboy fifeboy:

BartSimpson BartSimpson:

One of the other factors in the disparity of US & Canada healthcare statistics is that our per-capita and aggregate immigration rate utterly eclipses yours and due to 'fairness' we no longer screen immigrants for pre-existing medical conditions (I'm unable to find any info showing that Canada does or does not do such screening).

In the past year I posted an exhaustive post with statistics cited from the California Office of Statewide Health Planning and Development, UCLA, US Dept. of Health, US Dept. of Commerce, and etc. that showed US health figures rising to #1 across over 90% of WHO criteria when only US born individuals were included in the stats.

See, we get dinged statistically for every tourist and immigrant who sets foot on our soil and dies that same day of whatever condition they already had. Thanks to unscreened immigration we now have tuberculosis, whooping cough, German measles, mumps, rubella, and bed bugs back in the USA after seeing no index cases of any of those from 1989 to 1998.

If you folks took in the same per-capita immigrants as we did your numbers would be pretty bad. I can say that with authority because where we excel at trauma and emergency room treatment both trauma/ER and critical care are the weak links in your health care system and it is exactly those aspects of care that immigrants tend to use the most.

Funny that. Despite the better optics of the U. S. system, where it really matters, health outcomes- Canada does just as well in many areas and better in some. I wonder why?

Answered and asked.

Our stats ding us for the health status of immigrants who come to the USA already in poor health.

If we put a moratorium on immigration our health care stats would rise significantly. That's not a reason to do so, of course, but it does explain a significant factor in health care outcomes.

[BartSimpson]

Oh, and another little quirk of our philosophies of data collection:

In Canada one becomes a 'patient' for statistical purposes after being admitted to a hospital. In the USA one becomes a patient per American Health Information Management Association practices the moment health intervention is initiated whether it is initiated by lay people, rescue personnel, or hospital staff.

So we count people who die in situ at trauma sites if they've received any treatment, we also count patients who die en route to a hospital while you do not. Your data practice is concurrent with Britain while ours is concurrent with France where 'hospital' includes their ambulances which are staffed with doctors.

[fifeboy]

BartSimpson BartSimpson:

Oh, and another little quirk of our philosophies of data collection:

In Canada one becomes a 'patient' for statistical purposes after being admitted to a hospital. In the USA one becomes a patient per American Health Information Management Association practices the moment health intervention is initiated whether it is initiated by lay people, rescue personnel, or hospital staff.

So we count people who die in situ at trauma sites if they've received any treatment, we also count patients who die en route to a hospital while you do not. Your data practice is concurrent with Britain while ours is concurrent with France where 'hospital' includes their ambulances which are staffed with doctors.

In response to both posts. According to Wiki our immigration rate is 5.65/1000 population, the U.S.is 3.62/1000. Perhaps you admitt sicker people. Also I suspect you have never been on a First Nation Reserve.

On the second count, by WHO World health stats(2011) the standardized mortality rate from injuries is 32/100 000 in Canada and 53 /100 000 in the U .S.

So our stats on emerg vehicles may be down, our outcomes are up.

[Zipperfish]

What wouldn't the Fraser Institute provide. The only time I've ever see them come out in favour of socializing anything is pollution. The risks of pollution, according to the Fraser Institute, shouldn't be borne by the company, but by the people. They don't even have the courage of their own convictions.

Government is inefficient. There's a lot of reasons for it, which have been analyzed in detail. Yet it has not measurably changed in decades despite the efforts of governments left and right.

[ShepherdsDog]

government and politics are iunherently corrupt as are the people drawn to it(especially politics). that is the nature of the beast. As i've said time and time before, we don't elect those who will benefit us the most, but those who will damage us the least.

[bootlegga]

BartSimpson BartSimpson:

Sure, it's more efficient.

If I go to my doctor today and she diagnoses me with a operable brain tumor they'll admit me today or maybe tomorrow and if I'm not in surgery tonight then no later than Tuesday I'd go under the knife.

In Canada, according to Health Canada's own statistics, I can anticipate an average 11.3 week wait before I see a surgeon and then I can anticipate waiting an additional 31.7 weeks for the surgery.

That's very efficient because in 43 weeks I'd probably be dead anyway and that would save a lot of money that my silly healthcare in the USA would pay without hesitation.

Now your system is fairer because the wait times I cited here hold true for all Canadians.

Oh, wait.

No, they don't.

Your wealthy people don't hesitate to come to the USA to get the same care I personally take for granted. Your government executives also do the same thing and then they turn around and make Health Canada foot the bill for treatments that most of you, equally, would be denied. I suppose that's fair.

In some areas like prevention, Canada tends to fare better against the USA. But when Canada is compared to the average US HMO those figures skew given that HMO's have a profit motive for keeping people healthy while a national health care plan has a vested interest in controlling costs. For instance, both native born and immigrant women have more frequent pap tests in the USA than in Canada...and around 40% of our people are uninsured and we still beat you in this category.

Going back to the topic of wait times the World Health Organization rates the responsiveness of US health care as #1 in the world with Canada being 7th.

This is where we leap ahead of Canada and that's on traumas and critical care incidents like heart attack and stroke. If you have a heart attack in Detroit your hospital mortality rate in 45-60 year olds is (2011) 8.9% while across the river in Windsor it is 18.2%

And that's for people who are at a hospital when they have a heart attack.

The Health Care Council of Canada 2010 study showed that 19.2% of heart attack patients in Canada have a wait time in excess of two hours before receiving treatment versus 3.67% in the US with the same wait time.

That same study also showed that access to diagnostics is far better in the USA. Canadians requiring an MRI or CT scan could expect a wait of three months while uninsured and indigents in the USA on public assistance had a wait time of 20.1 days. Insured people in the USA had a wait time of 3.2 days for the same services you can expect to wait three months for.

Again in that study 21% of your hospitals said that a woman would have to wait up to three weeks for a breast cancer biopsy versus less than 1% of US hospitals having the same wait. 50% of your hospitals admit to making seniors wait over six months for hip replacements while not one such case could be found in the USA of any patient waiting that long for a hip replacement (and that includes immigrants, uninsured, tourists, and etc.).

One of the other factors in the disparity of US & Canada healthcare statistics is that our per-capita and aggregate immigration rate utterly eclipses yours and due to 'fairness' we no longer screen immigrants for pre-existing medical conditions (I'm unable to find any info showing that Canada does or does not do such screening).

In the past year I posted an exhaustive post with statistics cited from the California Office of Statewide Health Planning and Development, UCLA, US Dept. of Health, US Dept. of Commerce, and etc. that showed US health figures rising to #1 across over 90% of WHO criteria when only US born individuals were included in the stats.

See, we get dinged statistically for every tourist and immigrant who sets foot on our soil and dies that same day of whatever condition they already had. Thanks to unscreened immigration we now have tuberculosis, whooping cough, German measles, mumps, rubella, and bed bugs back in the USA after seeing no index cases of any of those from 1989 to 1998.

If you folks took in the same per-capita immigrants as we did your numbers would be pretty bad. I can say that with authority because where we excel at trauma and emergency room treatment both trauma/ER and critical care are the weak links in your health care system and it is exactly those aspects of care that immigrants tend to use the most.

We also invest more heavily in our system than you do in yours and that helps account for the disparites in per patient aggregate spending.

Canada has 4.6 medical scanners per million. We have 29.5.

Canada has 11.8 automated external defibrillators (AED) per million. We have 218.1.

Canada has 4,897 licensed ambulances (including trauma, critical care, and transports) nationwide. California, with a similar population has 31,288.

Canada has 63 aircraft licensed (more or less) as air ambulances. Some are transports, some offer critical care, and six offer full trauma care.

Hawaii beats you with sixteen trauma helicopters, another twenty four critical care aircraft, and forty one air transports.

Kindly note this is not meant as a dig, but as a response to the dig that we spend more than you do while insuring fewer people. Which is true.

Yes, your system is more egalitarian and for some things it's better.

But if you have a heart attack, get hit by a car, bit by a shark, get breast cancer, get *any* cancer, you're better off doing so in the USA.

Sorry, Bart, but many of your numbers are suspect.

The fact that wealthy Canadians occasionally cross the border for care is irrelevant, because the numbers are so low (a few hundred - or even a thousand - out of 32 million is statistically insignificant).

Canada actually takes in more immigrants per capita each year than the USA does, even if you count the 300,000 or so illegals that cross each year. Canada takes in roughly between 250,000 - 300,000, or .75 - 1% per year, while the US takes in about a million legal immigrants, which after adding in illegals, still puts the US at LESS than 0.5% per capita.

Some of your other numbers are questionable too - like the number of air ambulances - Ontario alone has over 30 aircraft. I find it exceptionally hard to believe that the rest of the country only has another 30 air ambulances, especially considering that STARS operates another half dozen (with several spares and new helos on order) - and Alberta uses another four fixed wing aircraft as well. Another problem is that several provinces actually sub-contract the service out to private companies (for profit), and I wonder if your numbers reflect that.

Your numbers for AED are also way off - every government building in Edmonton has at least one on site - most have several. Same goes for most buildings on the university campuses and those run by the City of Edmonton. There are easily dozens in the Edmonton area alone, and given our population of less than a million, well, you can see why I take issue with it. At the number you cite (11.8 per million), Canada should have somewhere on the order of 389 or so, but I'd bet Alberta alone has that many. I believe it is possible that the US has more per capita than we do, but it's not nearly as slanted as your numbers suggest.

On the other medical equipment numbers, I have no doubt that the US has more per capita than Canada does. The difference is two-fold: the US suffers from much higher medical malpractice lawsuits than Canada, meaning physicians are more likely to send patients for more tests than maybe necessary; the other being that because it is a for-profit system for many patients, doctors tend to overtest to crank up diagnostic fees and therefore profit margins. I have a number of in-laws living in California who are regularly subjected to dozens of tests when they go see the doctor. So either your doctors are more incompetent than Canadian ones, or they have some alterior motive for ordering so many tests.

And yes, your system does spend more money per capita on health care than we do - the difference is that we don't spend a single penny of our health care dollars promoting drugs, HMOs or any other health services. There are lots of private clinics and labs in Canada which operate for profit (and are paid by the government), but they are not allowed to advertise on TV, newspapers or anywhere else. That's one of the key reasons your system spends more than ours does per person.


While it may be better to "have a heart attack, get hit by a car, bit by a shark, get breast cancer, get *any* cancer" in the USA, you'd better be able to spend up to $1000 per month on your health plan or the health care you get will be sub-par to those who can. The best health care in the US goes to those who can afford it - my sister-in-law pays just over $1000 a month for her health care plan (her employer pays about a $1000 too). So yes, it's great to get sick in the USA - if you can afford it.

Otherwise, expect your HMO to deny you health care due to actuarial tables, drop you the second they find out you do have health issues or simply not accept you in the first place. Barring that, you can always join the other two thirds of Americans in declaring bankruptcy to pay for your medical expenses. I'm glad you enjoy your system, but I prefer being thought of as a patient, not an income stream or profit centre.

And so on and so on and so on...

We could go back and forth for days, but comparing a public system and a private system is like comparing apples and oranges.

Both systems have their merits and their problems and neither one is perfect by any stretch of the imagination.

[herbie]

Efficiency is when there's more money spent on tv ads of how to sue your doctor/hospital than for quit smoking messages.
Or when there's a fat insurance policy and kickback referrals, you DO refer eveyone you can for an MRI to confirm they have zits.
Or when a good chunk of your premium goes to funding ads for brand name pharmaceuticals.
Where everyone, every step of the way from doctor to ambulance to hospital to hospital lab must turn a profit to continue operating.