Two tiered health care system...

[Mitch Cronin]

I have a brother in Australia who's telling me about his experiences with health care where he lives...

...the delays and waits leading up to where he is now aside.... :

He's got something in his lungs that needs to get sucked out with a syringe and examined so they'll know what it is. So he finaly gets into the hospital for that to happen... they stick one needle in his back for a pain killer, they stuff a longer one through his back to his lung and say "hmmm there's nothing here, we must have missed. You'll have to come back next week and we'll do an ultrasound first then we'll try again"... Then they tell him after that the results wouldn't be ready 'til Good Friday... but since the Doctor - who only works Monday and Friday - won't be in then, he'll have to wait until the following Friday to get the results. (might be cancer, so he's worried)

So Mitch sez, "I thought you lived in a city?" (He lives in Brisbane)

"Ya, but I don't have private health care"

The doctor at the hospital only works Monday and Friday if you don't have private health care eh? ... the things you hear when you don't have a flippin' bazooka!

So some folks think that's how we should be here? Well son of a gun... I wonder if it isn't all the folks who could afford the private stuff who think that way?! grumble-grumble-grumble grumble-grumble....

[GDR]

Hello Mitch

I believe that the vast majority of the talk about private health care is only about the actual delivery of health care. The funding would still be public.

In other words Mrs. Mitch could go to a private clinic or hospital and get treatment by paying with the same health care card that she would use at a public clinic or hospital.

I know that some people advocate for a parallel private system that is paid for privately which is similar to what they have in Europe. Maybe that would improve service in the public system by off-loading it but that point is open for debate.

The one thing I am convinced of though is that something has to change. I don't believe that our present system is operating at the level of service that it should. I also don't believe that the present system is financially sustainable over the long haul.

Cheers

Greg

[Mitch Cronin]

Howdy Greg... good to hear from you... you've been quiet lately.

I'm not that well versed in this topic, like many, but I'm thinking our present system has been somehow sustainable for a good long while now... There surely are valid complaints with it as it is, but it seems to me that it's worth an awful lot to maintain something better than a system that looks after folks with money or good fortune, while leaving those without to the winds of chance... or a Mondays and Fridays only waiting list?

I hope whatever we wind up changing our health care into doesn't ever lead to a time when some people have to stay sick, or get worse, just because they don't have enough money. Call me a pinko commie socialist wacko if that's what that makes me, but I don't reckon that should ever happen.

Cheers to you... and happy April (or something )

Mitch

[Guest rattler]

Mitch: the way I understand it, even here in Alberta, the idea is to continue with the Public Plan we now enjoy and enhance it by allowing private providers to provide services with the cost being paid by the patient. Doctors would be able to work in both systems.

This would allow those with cash to take advantage of the private facilities but more importantly would reduce the number of folks using the public facilities thereby, at least so it has been suggested, reducing the public wait time.

Additionally, the two tier system is touted to increase the number of doctors in the province by making it more attractive to work here.

Most provinces, including Ontario have some form of private priority health care now. When was the last time you heard of a football player, with a knee injury, being on a waiting list vs the average joe who is waiting for his surgery? A worker injured on the job also gets priority treatment for the same injury suffered by a worker on his day off (rehabilitation including surgery). etc. etc. etc

I am in favour of the two tier system, as long as our public system continues as it does today. In other words, if you have the money to pay for the Cadillac service - you should be allowed to do so, as long as it takes you out of the public line up and does not reduce the services available to those using the Public Health Care services.

[GDR]

Howdy Greg... good to hear from you... you've been quiet lately.

I guess it's just that the older I get the less I have to say.

Nah that can't be it.

I agree Mitch that we want to see everyone looked after, and well. However, our current system is not looking after each of us equally as it is.

WCB patients and prisoners for instance get preferential treatment. Active AC employees get preferential treatment to retired AC employees because the AC doctors know who to call to get you moved up because they would rather have you well at work than sick at home. How about relatives of doctors? It’s who you know. The military have their own system that is also available to MP's. We don't have a single tier system now.

The population is aging and is going to put further strains on the system.

There is another issue that bothers me. I spent over the last few years considerable time in hospitals with my mom who had a massive stroke. The care ranged from great to terrible. In one instance they dropped her on her face and they made the comment that they don't catch falling patients because it can cause them back problems. In another case they burst her colon with too many enemas. Nobody had to answer for those incidents. The system protects the people that should be doing something else.

I would hope that a private hospital would at least have its employees answerable for the work they do.

Cheers to you as well Mitch.

[Specs]

I still believe we could have the worlds best universal system but we would need to re-organize from top to bottom to remove all of the self serving advisory interests out of the system because they are bleeding it dry.

eg: From my own personal experience I can build you a manual wheelchair from scratch for less than $150.00. I can sell it to an individual walking into the store for $300. Here's the abuse - provided that the person getting the chair pays $200.00 of their own money I can sell that same chair to that same individual through the provincial gov't's (OHIP)system for $700.00 Needless to say, most people go through the gov't system, As the chairs become powered and more customized, the taxpayer's rip off becomes even greater. Contoured foam seat = $500.00 vs $150.00 in the store. Contoured backrest = $450.00. vs $125 in the store.

I wish I could say that's the only example of abuse but it isn't, not by a long shot. How can we expect a system to run efficiently when it's abused like that.

I especially like the foreign doctors driving driving taxi stories. If blows me away that the politicians can't see the abuse in having the CMA in complete and sole control of licencing. The very people with the most vested interest in keeping the supply of doctors low is charged with governing the number of admissions into the profession? Sheesh! 20 yrs of practice in Russia or India means nothing? Get real!

Before we switch to a two tier system I'd like to see what would happen if we put a non medical business professional in charge and pay him/her on performance. A little dose of hard medicine for the sytem so to speak. Heck, I'd like to suggest RM or CB but it being April 1st and all I'll refrain but that might give you an idea of what I mean. At least the shareholders (us) will get rewarded.

(Aside- (more idiotic ramblings) And what about only paying if the patient is cured or the outcome of a patient's treatment meets some prescribed target. eg - You go to the doctor for what turns out to be a cold. He can't cure it so he won't get paid and he will stop seeing those types of patients. Well what if it was TB you say? Ok then, if you still have the cough after 2 wks then you haven't got a cold so now the doctor will see you. There's pitfalls within that example obviously but they can be addressed by C1 passes or something lke that.

-And why does the doc have to do my stitches? why can't a nurse do it - heck I'd prefer that. Heck I'd go to the hospital more often if I knew there was a cute nurse in the .........DOH! stupid! stupid! )

[Guest rattler]

Specs: Regarding foreign Doctors

Unless there is a formal accreditation system I would not want to open the door to foreign Doctors. A degree from Mcgill is valid and we know the level of training, a Doctor trained at XSY medical school in a third world country may not have received the same level of training. I don't care how long they practiced in their country of origin if their training is not at the same level as Doctors trained in Canada or the USA. I do however, believe that it would not be hard to establish a list of countries that do produce Doctors trained to our standards along with a program to validate their credentials (that might be the hardest).

For example the UK, Australia, New Zealand, Japan come to mind and I am certain there are many others. So in short, while I don't believe that an open door policy would be wise, I do believe a policy of accepting Doctors from specific countries would be. The only other issue that would need to be ensured is that they must be proficient in one of our official languages (not both).

Interesting article on the subject as published in the Canadian Medical Journal

Program for licensure for international medical graduates in British Columbia: 7 years' experience

[Specs]

Rattler,

Lets not forget that here in Canada we ourselves have licenced some absolute incompetents and bumblers. Our system ain't perfect and suing your doctor or bringing an action against him/her here isn't quite as easy here as it is in the states. (Funny how that never seems to mentioned in the two tier debate up here.)

Now nobody want's a grad from timbuktu performing neurosurgery his first day in and there are simple and safe methods that could easily and effectively be put in place to ensure the ongoing quality of our medical system. Instead we let the CMA manage it and what do we get-

Now I'll admit my bias up front - In light of the recent editorial dismissals or whatever you want to call them, I have to view the CMJ as a political organ for the CMA and a tool for promoting their own political agenda. From what I've read elsewhere that's a point of view that seems to be gaining acceptance in quite a few domestic and foreign medical academic circles. I'll also admit to being fairly ignorant of many of the specifics.

Having said that, I skimmed the articles and all I picked up on was stuff like ...

-No single national standard for IMGs (Int'l med grads).

-Newoundland - costs of this assessment and training are covered by the physicians themselves.?

-"British Columbia has funded a program for licensure for IMGs .......Each year 25–35 candidates are eligible for the program, 13–16 enter the evaluation process, 4 go on to a clinical evaluation and 2 are offered funding by the Ministry of Health. - That's not free enterprise at all. It's elitism.

I could go on but all I'm trying to say is that we are being shortchanged by the CMA. We appear to have a shortage of qualified medical practitioners and while the CMA pretends to be working towards a solution, it's really just window dressing. All they seem to do in reality is put up obstacles to IMGs. It's in their best interests to do so, not ours. It simply seems to me that the CMA, further to their own benefit, would rather see Universal Health care collapse than adapt to the world changing around them and represent the real interests of the taxpayer.

[YYC I/C]

Universal health care is an affront to civil liberties.

Why can't one be free to spend one's money where one wants?

Do we all drive in a universal car? No, some have Honda Civics and some have BMW's.

Do we all live in a universal house? No, some rent, some have a $350,000 house, and some have a house in excess of $1 million.

The role of government is becoming so ecompassing that it's stifling. What has happened to freedoms? In my opinion, liberty is a much better ideal than democracy.

[Specs]

The role of government is becoming so ecompassing that it's stifling. 

Absolutely - couldn't agree more. I might also add that my own personal opinions for economics are also of the extreme right wing kind and I believe in a true free market approach which is why I refrain from a lot of the discussions on here unlike some of the braver individuals we all know and love.

At some point though, I recognize that there is more to gain economically from working together than there is from leaving everybody to fend for themselves. I believe in Universal health care, though preferably with somebody like RM or CB in charge instead of doctor this or the right honourable that. (I could also live with the US style of Health care provided that the vested interests had their lobbying activities drastically curtailed).

Canada was built on immigrants in the latter part of the 20th century and they came in large part because of the Health Care system. Maybe that's not the case so much anymore but now we need to let the next generations of those immigrants, and thus the rest of us, to prosper. UHC lets that happen and I'm willing to pay for it - at a reasonable cost with proper oversight.

Everything else in this country though (excl. education)should come down to simple supply and demand. Nothing else!

As to your other comment:

What has happened to freedoms?In my opinion, liberty is a much better ideal than democracy.

Freedom is fine but do we want to abandon Collective rights. Without them we'd be a third world country.

[plankspanker]

Universal health care is an affront to civil liberties.

Do we all drive in a universal car?  No, some have Honda Civics and some have BMW's.

Do we all live in a universal house?  No, some rent, some have a $350,000 house, and some have a house in excess of $1 million.

Are you for real?

An affront to civil liberties?

How can you compare healthcare to your choice of car or home? In a humane society you shouldn't have to make choices about healthcare, you should just get treated, period.

[Trader]

Foreign doctors are a huge issue. The latest estimate is that 75% of ALL Indian graduates are unfit for work in India, never mind the rest of the world (this is from an Indian study as well). Other countries have their own issues.

The shortage in Canada is due to our making. I graduated in 1994 and had a friend who could not make it into medical school due to a poor average-- in the low 90's!! Anyone who took science at that level knows that that is a bloody tough score to make.

So he went to the US where he now lives rather comnfortably and successfully!! We lost a fabulous doctor with a brilliant bedside manner and the compassion that a doctor needs - which, by the way, is why his practice is so successful.

WE have to ensure we graduate enough of our own into the system.

[GDR]

How can you compare healthcare to your choice of car or home? In a humane society you shouldn't have to make choices about healthcare, you should just get treated, period.

Just as a thought we might compare it to education. People have a choice of sending their kids to private schools and yet we still have an good public system.

I tend to think that the private system actualy challemges the public one to do better.

The bottom line is that we want to have the best possible system available for everyone. I believe that the current system isn't run as well as it should be now, and costs too much for what we get. Ask people in the system about how many administrators there are as compared to those who directly do health care. There is no incentive to do things efficiently.

[plankspanker]

The bottom line is that we want to have the best possible system available for everyone. I believe that the current system isn't run as well as it should be now, and costs too much for what we get. Ask people in the system about how many administrators there are as compared to those who directly do health care. There is no incentive to do things efficiently.

I would have to agree with those sentiments. But I don't think it's remotely fair to compare healthcare to cars, homes or other material items because it plainly isn't a material item. It's far more important than that.

[Canus Chinookus]

So they want to reduce the number of tiers that currently have down to 2? That would be better, IMHO

[Mitch Cronin]

Universal health care is an affront to civil liberties.

Hooooweeee....!

...I don't know you at all, so I won't claim to know what makes you say that, but I'm hoping you didn't mean that to sound the way you made it sound.

Universal health care is a part of what life in a civilized community is about. Would you sit and do nothing if your neigbor had fallen off his roof and was stuck in the roses with a broken leg? My guess is you'd do what you could to help. ...if you wouldn't, you belong with the aligators or something, but not within the society that most of us want.

It's not about flippin' BMW's vs. Chevy Vega's, or roast beef vs. spaghetti... It's about health or not, which, as it turns out, is something akin to life or death.

You go ahead and tax me to pay for keeping my neighbors healthy, or helping them when they're not.... I'm fine with that. And so are most folks.... And by the time we're due, or maybe even sooner, we'll be spending some of those tax dollars ourselves.

[Seeker]

Would you sit and do nothing if your neigbor had fallen off his roof and was stuck in the roses with a broken leg?

That depends on who the neighbor is right? By that I mean that our altruistic system subsidizes irresponsible lifestyle choices and ineffiencies on a huge scale. It's an interesting moral question; maybe the way to encourage people to make healthy choices in their lives is to have them carry more of the financial burden that not making those choices entails. I've heard it suggested that the best way to improve the medical system would be to charge 5 bucks to visit a doctor or emergency room - not enough to prevent anyone that actually needs to be there but enough to coax people into finishing their prescription the first time it is given to them or perhaps make them pay attention to the doctors instructions the first time.

[Specs]

That depends on who the neighbor is right? By that I mean that our altruistic system subsidizes irresponsible lifestyle choices and ineffiencies on a huge scale. It's an interesting moral question; maybe the way to encourage people to make healthy choices in their lives is to have them carry more of the financial burden that not making those choices entails. I've heard it suggested that the best way to improve the medical system would be to charge 5 bucks to visit a doctor or emergency room - not enough to prevent anyone that actually needs to be there but enough to coax people into finishing their prescription the first time it is given to them or perhaps make them pay attention to the doctors instructions the first time.

But where do you draw the line on lifestyle choices.

Broken leg - well you shouldn't have climbed that tree young young man. This''ll cost your folks plenty.

Hip Replacement - sorry son but that's what you get for skiing bumps instead of taking the bunny trail.

And it also presupposes excellent care from the medical staff which we know doesn't happen.

I'd prefer that we just pay the docs/nurses/hospitals for how well their patients recover, not for how many they see or take in. Service improves, inefficiencies disappear, good medical people get rewarded, bad ones don't, etc.

[Guest rattler]

But where do you draw the line on lifestyle choices.

Broken leg - well you shouldn't have climbed that tree young young man. This''ll cost your folks plenty.

Hip Replacement - sorry son but that's what you get for skiing bumps instead of taking the bunny trail.

And it also presupposes excellent care from the medical staff which we know doesn't happen.

I'd prefer that we just pay the docs/nurses/hospitals for how well their patients recover, not for how many they see or take in. Service improves, inefficiencies disappear, good medical people get rewarded, bad ones don't, etc.

And who would then look after the terminally ill??? Under your plan they would be shoved into a corner as no one would want to look after them !

[handyman]

Canadians get so worked up about “Private Healthcare” and really what does it mean? Are we afraid of an entirely private system or one that utilizes private facilities? IMO, Private or Universal encompassing 2 or 10 tiers doesn't really matter. What does matter is that the current system doesn't work and needs to be changed. Money alone will not fix what we have. The Europeans have a very good system comprising of a blend of Government and Private Facilities working together to increase efficiency and decrease wait times. Why aren't they listening in Ottawa?

Yup, some people only see black or white!

[Mitch Cronin]

Bring out your dead... ....Bring out your dead....

.... 'ang on! I'm not dead yet! ...

BOP! ...

[CD]

DENNIS:

Ah, now we see the violence inherent in the system.

ARTHUR:

Shut up!

DENNIS:

Oh! Come and see the violence inherent in the system! Help! Help! I'm being repressed!

ARTHUR:

Bloody peasant!

DENNIS:

Oh, what a give-away. Did you hear that? Did you hear that, eh? That's what I'm on about. Did you see him repressing me? You saw it, didn't you?

[Specs]

And who would then look after the terminally ill??? Under your plan they would be shoved into a corner as no one would want to look after them !

Sorry Rattler. I didn't mean to imply that at all. If we can't look after the weakest then what's the point of having a universal system at all.

I meant that medical staff would be paid on performance, which would include the efficacy of the treatment, responsiveness, care, service, and whatever other measures or stds that were put in place to prevent misuse. Renumeration would be per established fee schedules but also subject to the patient having some say in the matter of quality of care provided and service level. In the case of the terminally ill, the docs nurses and institution would get paid the base fees but the guardian would also have some input on the quality of the services provided and thus have some control over the final full remittance to the medical service.

So in the case of the terminally ill, the medical organization would get the base fees for all services provided, but if on every visit bedpans were full or sores were untreated, then you can bet that the service quality portion of the remittance would be small.

[YYC I/C]

Hooooweeee....! 

...I don't know you at all, so I won't claim to know what makes you say that, but I'm hoping you didn't mean that to sound the way you made it sound.

Universal health care is a part of what life in a civilized community is about. Would you sit and do nothing if your neigbor had fallen off his roof and was stuck in the roses with a broken leg? My guess is you'd do what you could to help. ...if you wouldn't, you belong with the aligators or something, but not within the society that most of us want.

It's not about flippin' BMW's vs. Chevy Vega's, or roast beef vs. spaghetti... It's about health or not, which, as it turns out, is something akin to life or death.

You go ahead and tax me to pay for keeping my neighbors healthy, or helping them when they're not.... I'm fine with that. And so are most folks.... And by the time we're due, or maybe even sooner, we'll be spending some of those tax dollars ourselves.

I just want to be free to spend MY money where I want. I work hard, I make good money, and if and when I need medical attention, I believe I should be able to get the best medical attention my money can buy.

I'm not saying there should not be a minimum universal standard available to all citizens - there should be. But if I want to go above and beyond the minimum standard, I should be free to do so. Once the government starts telling me that I can not spend MY money where I want, then they're indeed supressing my civil liberties.

[Guest rattler]

Sorry Rattler.  I didn't mean to imply that at all.  If we can't look after the weakest then what's the point of having a universal system at all.

I meant that medical staff would be paid on performance, which would include the efficacy of the treatment, responsiveness, care, service, and whatever other measures or stds that were put in place to prevent misuse.  Renumeration would be per established fee schedules but also subject to the patient having some say in the matter of quality of care provided and service level.  In the case of the terminally ill, the docs nurses and institution would get paid the base fees but the guardian would also have some input on the quality of the services provided and thus have some control over the final full remittance to the medical service.

So in the case of the terminally ill, the medical organization would get the base fees for all services provided, but if on every visit bedpans were full or sores were untreated, then you can bet that the service quality portion of the remittance would be small.

I guess we could apply the same standard to everything if there was a non-subjective method of scoring.

Would aircrew be happy if their salary had deductions based on passenger dis-satisfaction? I would bet not and from my experience with health services (4 major surgeries over the years), the folks receiving the treatment are not always good judges of the services received (based on the action/reaction of fellow patients) and their relatives are even less qualified to judge. I grew tired of listening to the complainers who seemed to believe that the nurses were their indentured servants. But maybe I am just easy to please.