The Great Health Care Debate

There's a good debate going on in the comments section of my healthcare post a few days ago. Since my health care knowledge is limited to "the knee bone's connected to the ankle bone. The ankle bone's connected...", I'm going to save myself some time and effort and re-post some of the better observations from those comments and from around the web.

First, I'd encourage everyone to check out Ezra Klein's blog which has an outstanding country by country comparison of different health care systems. So if you're like me and don't know the intricacies of the Japanese health care system, this is mandatory reading. I'd also point people towards Scott Tribe's post at Progressive Bloggers which is very thorough and brings together comments from around the web. And Andrew Spicer has a suggested plan, complete with diagrams and everything.

Now, a sampling from the comments section of this blog. If you read all the way to the end, I may throw a few of my own thoughts in:

According to the health organization, the higher costs of private insurers are "mainly due to the extensive bureaucracy required to assess risk, rate premiums, design benefit packages and review, pay or refuse claims." Public insurance plans have far less bureaucracy because they don't try to screen out high-risk clients or charge them higher fees.

And the costs directly incurred by insurers are only half the story. Doctors "must hire office personnel just to deal with the insurance companies," Dr. Atul Gawande, a practicing physician, wrote in The New Yorker. "A well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That's how a doctor makes money. ... It's a war with insurance, every
step of the way." [...]

The resources spent by private insurers don't reduce overall costs; they simply shift those costs to other people and institutions. It's perverse but true that this system, which insures only 85 percent of the population, costs much more than we would pay for a system that covered everyone.
-Paul Krugman (NY Times)

Bottom line, we have to realize that:

1-quality health care is not link with the amount of money spend. Many countries with smaller spending than Canada have a better system.

2-quality health care is not link with the involvement of private. Many countries with less private than Canada have a better system.

In fact, when you look the OECD stats, Canada have one of the most privatise system. Except for Australia, all country with high privatisation has a poor health care quality.

David

I would rather see the continued support of a Public universally available health care system with one tweak. The tweak is that the existing Public infrastructure lease space and their capital equipment for use at the public facility by private companies.

A private company can only provide, say, an MRI at a Public facility. There would not be PPP partnerships or private hospitals built. Thjere would be no need for the private sector to have to expend dollars on creating the infrastructure. They would lease time on the public equipment and lease the space at the public facility and charge the going rate as set by the Canada Health Act for procedures they perform. The private leasing company is administered by the existing public facility administration which operates under the Canada Health Act.

The private company does not have to expend dollars to buy capital equipment, nor do they have to build facilities/infrastructure. They use the infrastructure that exists and which they lease. They offer MRIs at, say, 2pm through to 10pm Mon-Fri and 8am to 4pm Sat and maybe even on Sundays. In this way they are not taking away from the need of the public to use the existing universally available public infrastructure because the use of the equipment is leased and only available at scheduled times by the private company.

Anonymous

Second, we already have two tiers, Quebec silently left the Canada health Act several years ago and Mr. Dithers formalized that last year. We have two tiers for WBC claimants, federal convicts, members of the RCMP, non-citizens of Canada, aboriginals and anyone with enough money to cross the border for an MRI.

What the Liberals have done for years is characterized anyone who actually points this out as advocating "American style health care" and the stooges in the Canadian media obediently clap their flippers together and bark at the nasty people who would suggest such a thing.

The SCC decision injects a degree of reality into a discussion which was mired in partisan fantasy.


Jc

Then Paul Martin gets in and takes the Conservative\Alliance \PC mantra of slashing spending to his heart. 15 years of deep, drastic cuts to our system, all the while costs for real things like nurses, doctors, equipment supplies and energy cost to run hospitals climb. Guys like Mike Harris go further and slash even more. Fire nurses, close hospital beds, then give us a $200 dollar per person tax refund? Great.

You think they might have cut in other places perhaps, or stopped cutting when it was obvious things were getting bad, like in 1996.

Imagine that for 15 years and we have outrageous wait times. Who'da thunk it?

And now, the same people who have been angry at Paul Martin for years for not cutting spending enough have the gall to stand up in the House of Commons and claim he should have spent more on Health Care? Now that is the CPC fantasy - we can cut taxes and increase spending at the same time. Look how well its worked in the US.

Mike

That's just a cross-section of opinions. As for my take? I don't mind a role for some private delivery in the system although I can't really understand how private delivery can be cheaper than public due to the profit component. Regardless of that, the debate we're having now is squarely on two tier health care. And once you set up a competing private system, it by default hurts the public system. There's a doctor shortage in Canada right now and I imagine a lot of doctors would leave for the private system. I know I'm being dogmatic on this but if you believe that all Canadians deserve the same health care treatment, then you can't be in favour of two tier health care - it's that simple. And I believe that all Canadians do deserve the same health care treatment.

This ruling pointed out the problem with the current system and because of that, it's likely a good thing. I think we're better off debating this than Gurmant Grewal and it would be naive to say the current system is perfect. But as for two tier health care, I really haven't heard a compelling argument in favour of it.

There's also been a lot of talk about bringing in user fees and I'd be really hesitant to go that route too. One of the biggest failings of our system is that it doesn't address prevention of disease enough and user fees would simply provide a disincentive for checkups and visits to the doctor that catch problems before they become serious.

The house may need renovations but that's not a good reason to blow up the house.