[andyt]

They seem to work in Europe, with costs equal or less than ours and good medical care. What Europe also has are doctors working for a salary instead of being an independent business. They keep costs down that way.

But we're too close to the US. We have all sorts of pressures to go totally private if we open the door even a crack. With a guy like Harper in power, he'll game the system so that the public system is starved to create pressure for more and more private care.

[peck420]

andyt andyt:

But we're too close to the US. We have all sorts of pressures to go totally private if we open the door even a crack. With a guy like Harper in power, he'll game the system so that the public system is starved to create pressure for more and more private care.

Well said.

It won't matter which polictical party opens the door. We have the worlds largest private medical system just outside. And that needs to be factored in.

[andyt]

peck420 peck420:

andyt andyt:

But we're too close to the US. We have all sorts of pressures to go totally private if we open the door even a crack. With a guy like Harper in power, he'll game the system so that the public system is starved to create pressure for more and more private care.

Well said.

It won't matter which polictical party opens the door. We have the worlds largest private medical system just outside. And that needs to be factored in.

The only saving grace is that they're slowly (very slowly) realizing the error of their ways. Vermont just went to a single payer system, and I believe Mint Romney brought one in in Massachusetts when he was gov there. I don't know what a state health system is exactly, but it seems to be taking hold there too. What they do have is just insane and unsustainable.

What we need to do in Canada is see where we can find savings instead of trying to go more private. You still pay for the private system, more so in fact, just that the burden falls more on the individual. We need a national Pharmacare program with economies of scale for instance.

[OnTheIce]

Here's my suggestion...

1. Allow doctors to go into private practise and open clinics as they see fit. Fees will be regulated by the government. Hostpitals will only be run by the Government.

2. Allow patients to pay-per-visit or perhaps a yearly membership fee to use a particular facility.

3. Have strict triage rules at hospitals. Have a runny nose? Go to a clinic. Cut your finger on a soup can? Go away.

4. Keep tax rates the same & do not offer tax incentives/rebates for those who opt for private care.

4. Allow companies to open private imaging clinics. Fees will be regulated by the government and they can serve patients on a pay-per-visit structure.

If 1 in 4 people opt to pay $100 to visit a private clinic or $800 for a MRI, that will further reduce the waiting for those opting to use public services. My 3 month wait for a MRI would have been reduced to just over 2 months had this been the case.

Since you'd esentially be creating a new industry, you'd be creating more income from taxes charges at various facilities and yet people would still be paying into the public purse.

[dino_bobba_renno]

peck420 peck420:

Can a 2 tier health system work?

Maybe in the short term, but over the long term, probably not.

In case you haven't noticed, our current system won't be able to survive much longer unless some types of changes are introduced. We can't continue on with the status qou for much longer and still expect “affordable” health care.

peck420 peck420:

It will end up having the private tier take all of the best, and the public tier taxing the crap out of the population base to keep step. Then it will lead to opt out programs that will be taken by those that have...and those that also pay the most taxes (middle and upper class). Once that happens, public tier is dead

The private sector in the US is all ready taking up “all the best”. Having private involvement can help alleviate some of the pressure from the public system. We’re all ready doing it so it’s been proven that private involvement can successfully work in conjunction with a public system.

peck420 peck420:

Complete side: If people did use our system as it was designed (Family doctore -> medicentre -> emergency) an easy 65%+ of our current problems would vanish. Nothing like seeing a kid with a runny nose in emergency and an empty medicentre less than a block away...

The reason people go to the ER is because either there aren't enough family doctors available or they are going at night when their family doctor is working. You're blaming the people instead of the system. If the system worked properly people wouldn’t 't have to go to the ER when their kid runs a fever.

I think the one big thing that opponents to private sector involvement miss is that it doesn’t have to be an all or nothing type of deal. The argument “once you let the private sector in it’s all over” is a very poor and short sighted one. Since there all ready is private involvement I think the better discussion to have would be around how much and what limits are placed upon it.

*As for queue jumpers, we all ready have those. Politicians, athletes, film, tv and radio stars all have a tendency to get preferential treatment. Why should taxpayers have to fork out their money so a hockey player can get immediate treatment for a sports injury?

[DerbyX]

OnTheIce OnTheIce:

Here's my suggestion...

1. Allow doctors to go into private practise and open clinics as they see fit. Fees will be regulated by the government. Hostpitals will only be run by the Government.

We have that. Doctors do open their own practices and clinics. They bill the government for any covered services or bill the patient/insurance company for any uncovered services they do.

Hospitals are regulated and funded by the government but they aren't run by them vis a vis day to day operations. Hospitals have a board of trustees or other administrative arrangement to do that. Directly run by the government seems to be the opposite of your plan since your logic seems to be that private sector inclusion makes things better. Why wouldn't a privately run hospital do the same? Note: Of course they'd be require to provide ER treatment.

OnTheIce OnTheIce:

2. Allow patients to pay-per-visit or perhaps a yearly membership fee to use a particular facility.

We do have that. They just bill the government rather then the patient directly. A fee for service system is the anti-thesis of universal health care since it impacts the poorer strata of society.

OnTheIce OnTheIce:

3. Have strict triage rules at hospitals. Have a runny nose? Go to a clinic. Cut your finger on a soup can? Go away.

Hospitals CANNOT turn away patients like that. Hospitals do in fact continuously try to remind people of that. They publish literature about what should and should not be an ER visit but they cannot simply turn people away. What they do however is make those people wait longer since they push actual ER cases to the front. This is often the cause of patients grumbling about wait times.

OnTheIce OnTheIce:

4. Keep tax rates the same & do not offer tax incentives/rebates for those who opt for private care.

You were see lots of people who pay for private services DEMAND that at least a portion of their taxes go to the medicare facilities they keep going to and you can bet some party will adopt position as well.

It will end up being tax deductible in some form or another.

OnTheIce OnTheIce:

4. Allow companies to open private imaging clinics. Fees will be regulated by the government and they can serve patients on a pay-per-visit structure.

They do. Anybody can offer whatever services they want but the law requires them to provide those services for no fee to the patient. They need to bill the government. That is EXACTLY what my lab does. A private lab providing a very large range of tests and services. Anything covered under OHIP means we go to them for fees and anything not covered allows us to bill the patient/insurance company directly.

In the case of OHIP covered stuff we pretty much pay what they tell us to and in the case of non-covered stuff we get to set the price.

OnTheIce OnTheIce:

If 1 in 4 people opt to pay $100 to visit a private clinic or $800 for a MRI, that will further reduce the waiting for those opting to use public services. My 3 month wait for a MRI would have been reduced to just over 2 months had this been the case.

No, you think it will. What will happen is that once the government "delists" the service EVERYBODY will start charging the fee in all non-emergency cases.

Therin lies the flaw in your argument. Hospitals and clinics don't increasingly charge patients for more and more services because they are barred from doing so by law. Should that law be lifted you will see those fees get tacked on.

OnTheIce OnTheIce:

Since you'd esentially be creating a new industry, you'd be creating more income from taxes charges at various facilities and yet people would still be paying into the public purse.

No you wouldn't. You'd just be essentially getting more money from the wealthy for medical services that will allow them faster service at the cost of slower service (or non-existent service) to those who can't afford it.

Why not just tax the rich more and dedicate that to the health care to pay for more MRIs and stuff?

[andyt]

DerbyX DerbyX:

Why not just tax the rich more and dedicate that to the health care to pay for more MRIs and stuff?

Because then the rich will leave and quit giving us jobs, and we'll all be poor.

[DerbyX]

andyt andyt:

DerbyX DerbyX:

Why not just tax the rich more and dedicate that to the health care to pay for more MRIs and stuff?

Because then the rich will leave and quit giving us jobs, and we'll all be poor.

I can't tell if you are being sarcastic or not but my comment was pretty tongue in cheek.

[Brenda]

andyt andyt:

DerbyX DerbyX:

Why not just tax the rich more and dedicate that to the health care to pay for more MRIs and stuff?

Because then the rich will leave and quit giving us jobs, and we'll all be poor.

[andyt]

Brenda Brenda:

andyt andyt:

DerbyX DerbyX:

Why not just tax the rich more and dedicate that to the health care to pay for more MRIs and stuff?

Because then the rich will leave and quit giving us jobs, and we'll all be poor.

All right, Brenda. Tell us how it works in Holland? I believe they spend a little less per GDP than we do, and have decent health outcomes. But, on the whole the Europeans spend around the same amount per GDP on healthcare as we do - it's only the US that's the way more expensive outlier. Yet somehow that doesn't seem to penetrate and people keep wanting to go to a private system.

[Thanos]

I'd have to point out that we on this board don't have the right or the expertise to arbitrarily decide what is and isn't a worthy emergency. Only a sore throat? What if it's strep throat that can turn into flesh-eating disease PDQ? Cut yourself on a soup can lid? OK, treat it yourself at home and enjoy the septic infection that follows that results in blood poisoning or an amputation, because I'm pretty damn sure that most people aren't going around with a recent tetanus booster shot to help them out when these things happen. Unless someone actually has some medical experience on these things they should really keep their mouths shut on this until they get better informed.

In Alberta the clinics are only allowed to bill the province $30 per patient visit. I don't think that this has been revised since the 1980's or '90's, which is just plain stupid. As a minimum the clinics should be allowed to charge a $20 or $30 appointment fee directly to the patient. This alone would dramatically increase the income for the clinic, which would result in family medicine/GP work becoming more popular among the doctors, and would probably result in more clinics being opened. Tacking on this kind of fee at the emergency rooms as well would also eliminate a lot of the (allegedly) frivolous visits that apparently are such a time consuming problem for the system.

[OnTheIce]

DerbyX DerbyX:

We have that. Doctors do open their own practices and clinics. They bill the government for any covered services or bill the patient/insurance company for any uncovered services they do.

Hospitals are regulated and funded by the government but they aren't run by them vis a vis day to day operations. Hospitals have a board of trustees or other administrative arrangement to do that. Directly run by the government seems to be the opposite of your plan since your logic seems to be that private sector inclusion makes things better. Why wouldn't a privately run hospital do the same? Note: Of course they'd be require to provide ER treatment.

No, we don't have that. We don't have actual private clinics where doctors are paid per visit by the patient. There will be no billing to the public ensurer.

To clarify, hospitals should be funded by the government.

DerbyX DerbyX:

Hospitals CANNOT turn away patients like that. Hospitals do in fact continuously try to remind people of that. They publish literature about what should and should not be an ER visit but they cannot simply turn people away. What they do however is make those people wait longer since they push actual ER cases to the front. This is often the cause of patients grumbling about wait times.

Then we have to increase education. When you come in with your sore finger, you're told you'll be seen in 4+ hours but if you want faster service, goto a clinic like you should have in the first place.

DerbyX DerbyX:

You were see lots of people who pay for private services DEMAND that at least a portion of their taxes go to the medicare facilities they keep going to and you can bet some party will adopt position as well.

It will end up being tax deductible in some form or another.

Just speculation. You don't allow that to happen. Period.

DerbyX DerbyX:

They do. Anybody can offer whatever services they want but the law requires them to provide those services for no fee to the patient. They need to bill the government. That is EXACTLY what my lab does. A private lab providing a very large range of tests and services. Anything covered under OHIP means we go to them for fees and anything not covered allows us to bill the patient/insurance company directly.

In the case of OHIP covered stuff we pretty much pay what they tell us to and in the case of non-covered stuff we get to set the price.

No, they don't. I can't walk into CML and pay for my MRI. That's what we're talking about. Private business charging clients directly without public medicare insurance.

DerbyX DerbyX:

No, you think it will. What will happen is that once the government "delists" the service EVERYBODY will start charging the fee in all non-emergency cases.

Therin lies the flaw in your argument. Hospitals and clinics don't increasingly charge patients for more and more services because they are barred from doing so by law. Should that law be lifted you will see those fees get tacked on.

Again, pure speculation. Your argument on this is all about "if's" and "maybe's". None of that is on the table, so anything you have to say is just a guess at best.

DerbyX DerbyX:

No you wouldn't. You'd just be essentially getting more money from the wealthy for medical services that will allow them faster service at the cost of slower service (or non-existent service) to those who can't afford it.

Why not just tax the rich more and dedicate that to the health care to pay for more MRIs and stuff?

Thank you for proving my point. You'd be getting more money from those people while their taxes remain the same. = More taxes collected.

[DerbyX]

Thanos Thanos:

I'd have to point out that we on this board don't have the right or the expertise to arbitrarily decide what is and isn't a worthy emergency. Only a sore throat? What if it's strep throat that can turn into flesh-eating disease PDQ? Cut yourself on a soup can lid? OK, treat it yourself at home and enjoy the septic infection that follows that results in blood poisoning or an amputation, because I'm pretty damn sure that most people aren't going around with a recent tetanus booster shot to help them out when these things happen. Unless someone actually has some medical experience on these things they should really keep their mouths shut on this until they get better informed.

In Alberta the clinics are only allowed to bill the province $30 per patient visit. I don't think that this has been revised since the 1980's or '90's, which is just plain stupid. As a minimum the clinics should be allowed to charge a $20 or $30 appointment fee directly to the patient. This alone would dramatically increase the income for the clinic, which would result in family medicine/GP work becoming more popular among the doctors, and would probably result in more clinics being opened. Tacking on this kind of fee at the emergency rooms as well would also eliminate a lot of the (allegedly) frivolous visits that apparently are such a time consuming problem for the system.

The province can set the allowable amount to whatever they want. Bill the province $100 per visit and make the clinic really profitable.

Have to pay for it all with taxes though.

[Thanos]

andyt andyt:

All right, Brenda. Tell us how it works in Holland? I believe they spend a little less per GDP than we do, and have decent health outcomes. But, on the whole the Europeans spend around the same amount per GDP on healthcare as we do - it's only the US that's the way more expensive outlier. Yet somehow that doesn't seem to penetrate and people keep wanting to go to a private system.

Clearly the great mystery is in how to develop a fair two-tier system that keeps those rotten goddamn US insurance companies out of the equation. I'd rather see us having Soviet-era service than allowing those evil profiteering sons-of-bitches into Canada.

[andyt]

Thanos Thanos:

I'd have to point out that we on this board don't have the right or the expertise to arbitrarily decide what is and isn't a worthy emergency. Only a sore throat? What if it's strep throat that can turn into flesh-eating disease PDQ? Cut yourself on a soup can lid? OK, treat it yourself at home and enjoy the septic infection that follows that results in blood poisoning or an amputation, because I'm pretty damn sure that most people aren't going around with a recent tetanus booster shot to help them out when these things happen. Unless someone actually has some medical experience on these things they should really keep their mouths shut on this until they get better informed.

In Alberta the clinics are only allowed to bill the province $30 per patient visit. I don't think that this has been revised since the 1980's or '90's, which is just plain stupid. As a minimum the clinics should be allowed to charge a $20 or $30 appointment fee directly to the patient. This alone would dramatically increase the income for the clinic, which would result in family medicine/GP work becoming more popular among the doctors, and would probably result in more clinics being opened. Tacking on this kind of fee at the emergency rooms as well would also eliminate a lot of the (allegedly) frivolous visits that apparently are such a time consuming problem for the system.

You going to turn away a welfare mom with a sick baby because she doesn't have that $20 fee? How about a min wage worker who gets sick a lot and can't afford that fee every week?

Make health care a taxable benefit with some limits so that poor people pay nothing and the well off aren't bankrupted by a huge tax bill.