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Canadian healthcare: more bang for half the bucks...

Okay, so a cross-national study of health care in the United States and Canada has discovered that (drum roll, please...):

"The data is clear and really irrefutable: Canadians are healthier than Americans and they have better access to medical care," Dr. Steffy Woolhandler of the Harvard Medical School said Tuesday.
Not only that, but the study also determined that the American system costs nearly twice as much per year per person than the Canadian, while at the same time providing poorer service and less of it to much of the population.

Isn't it time to expose once and for all the motivations of those for whom "two tier" health care is a priority. Let's see, could it be doctors with a yen for yachting? Big pharma's drug dependency? Drug companies collecting politicians with their kids' allowance? Or maybe it's just wealthy tax payers that are sick (sic) of paying for the healthcare of others?

So what is it, NCC - greedy doctors, rich druggies, corrupt politicians, or ingrateful, tight taxpayers?

h/t to Greg at Sinister Thoughts.

1) Picture a spectrum:

100% Private(USA)-----------------100% Public(Canada)

This study has compared two types of health care systems. There are an abundance of systems that lie in between these two systems, i.e. essentially all of the European countries. This study does nothing to denounce the much feared and often misunderstood two tier health care.

2) How thorough of a study is this when it didn't look at wait times, arguably the biggest issue facing our country's health care system?

Actually Adam, if you look at the original AP Wire story, and not the story as presented by CTV News, you'd see that wait times are addressed - 1% of Americans dissatisfied versus 3.5% of Canadians, which does point to the need for some improvement, but frankly it's a pretty small advantage. Besides, I don't recall that Kev even mentioned two-tier health care, he just linked to the NCC, whose members have made it plain on many occasions that they'd much rather prefer the American system, where being poor, a minority and sick is the Deadly Trifecta.

Adam, your little dichotomy is way wrong. Canada does not have 100% public health services, and the US does not have 100% private.

You're right Adam in that the European systems were not part of the study, however the article did refer to a similar study released earlier in the month comparing the British and American systems. I'll prowl around and see if I can find something on that study today. (I just found reports here and here, but they just comment on the relative health of the citizenry, not on the effect of the systems. And as in the second article, there are so many other factors that can effect health other than the system that measures of possible indirect results of the healthcare system might be problematic.)

They did in fact study wait times and said that just over 3% of Canadians, compared to 1% of Americans had to wait for treatment. That is three times as many, but still not a large number. If I was one of those people waiting for a hip or something, I'd say differently, naturally, but I'm not sure that any system can be perfect.

However, the important stats that I see here are the overall cost and the number of people that get treatment. Our system, which I should point out is not 100% public is better than the American system, which is not 100% private.

The sky is indeed not falling.

The Australian system, which is approximately 50/50 private/public, has been the case study which demonstrates that the introduction of private elements into a public system has no effect whatsoever on wait times.

I have this to say about wait times and having had some fairly serious health problems in the recent past I known from whence I speak. I am much happier knowing that with socialised medicine the overcrowded waiting room will see me in six hours than I would be under a private system, where my lack of cash means that I either bankrupt myself or hope the problem goes away. The people whining for two-tier care are those who'll make money from it and those who are pissed that they have to wait their turn or scared that it'll be to late when it comes up.

Ok, the numbers in my dichotomy are wrong, but the concept is right. When it comes to health care systems, USA is among the most private in the world, and Canada is among the most public in the world (I believe only Cuba and North Korea have comparable systems to ours).

Now, in most studies that I have seen both our system and the USA's rate lower than the blended two tier systems. Kev, your links comparing the British and American systems are certainly informative, but the point of the article is that two tier is better than a predominantly private system. When people are pushing for two tier health care in Canada, they are pushing for a system more like the British system, NOT the American system.

Regarding your claim of the motivating factor behind health care providers being able to afford a second yacht or whatever, I would say that you are making a rather contemptous statement regarding the people in our health care system. I think that the motivation lies in the realm of it being very difficult to repeatedly tell patients that they have to wait ridiculous amounts of time for procedures or to see a certain specialist. What about the problem of more and more people becoming addicted to pain-killers while waiting for their surgery? If you were the doctor caring for this person, wouldn't you want something to be done too?

Doug said: "scared that it'll be to late when it comes up."


I would be interested to see a study that compares some of these "middle" systems you suggest, but the fact of the matter is that there is nothing inately broken with our system as it is. We have some wait time issues, but as Flash points out, there is no evidence that wait time is addressed in parallel private systems either. Also, referring again to the Australian example mentioned above, there is evidence that a private system tends to cherry pick profitable procedures from the public system and the costlier, longer-term procedures still end up in the public system; so little is gained except a few pockets lined. One study that I found here, although seven years old, found that procedures with a private parallel system actually experienced longer wait times than those that were purely public.

As for general contempt and snottiness, I actually posed my snot cleverly (I thought, but I guess not) as a question. "Is one of the motivating forces behind privatized health care the desire for more money for the practitioner?" is qualitatively different than "those greedy doctors want more money". My point was that someone somewhere in the system wants to make more money, not that it is the dirty, greasy, chiseling doctors.

My personal theory is that the problem is not the doctors and nurses, rather it is a combination of misuse (or non-use) of expensive equipment, gouging by drug manufacturers, and an inherent reluctance by the monied to give away anything without seeing a return. There is nothing here that a government needs to fix by fundamental changes to the system, I don't think. Systemic changes, yes, but I don't think that it's necessary to introduce private-parallel.

Call me a commie!


Now that that's out of the way...

Kevvyd, you're right that the private system 'cherry-picks' procedures, normally the elective ones, which are optional by their very nature. But, if you can afford to have those webbed toes fixed, more power to ya.

What is missing from the debate as a whole are some realities that aren't necessarily related to health care as you may think:
1) There will always be accidents, there will never be private emergency rooms. ER's will likely be crowded regardless of the fact that the system is private/public. That is peripheral to this particular discussion, but I thought I'd throw it in.

2.) There are poor people. Those least likely to be able to afford private health care are those most likely to need health care because of poor nutrition, terrible living conditions, violence, addictive behaviours, overcrowding and so on. This, in my opinion, represents a rather significant level of demand for health services that will never get eliminated, regardless of what the system's payment plan is.

So, the people who can afford it will have primarily elective procedures in private facilities, and those who cannot afford it will continue to wait for the necessary procedures. If you do create more avenues of access, you will create more demand as people access the public system at a greater rate thanks to the perception that the wait has decreased. Therefore, the problem is not solved, it is perpetuated.

What is the solution? A health system that truly operates 24 hours a day would help, but unless they start turning out android doctors soon, I don't see that happening.

Thanks for jumping in - I was starting to get dizzy. You brought up a good point when you mentioned the poor. The study in question, when reported at cnn here mentioned that Americans that had health insurance in the study were basically just as healthy as Canadians, however the overall numbers are brought down when they consider the > 45,000,000 mostly poor people that have no health insurance.

Naturally that doesn't exactly place full blame on the healthcare system as stated in the study -> the effects of poverty on health is likely not positive. Lack of medical coverage can't be healthy, however.

I owuld like to add another point of consideration to the discussions above. Another issue our health care system has to deal with is the lack of doctors/nurses. If we were to go the route of a two tier system we are going to stretch our numbers even thinner and I would hazard a guess that this would increase wait times rather than lessen them. A second point would be that there might be a disporportionate number of better doctors in the private side than the public side because the salary would invariably be better and I would not blame a doctor or nurse doing the same job but at a higher pay (and I suspect a lesser amount of stress).
By this, the poor would have a greater chance of receiving a lower quality of service for a certain procedure than the rich using the private side for that same procedure.

My two cents.

I wrote a comment yesterday that died in the ether. The gist of it was this: the people who get rich off a privately insured system are the lawyers. Why? Because private insurance companies routinely refuse to honour legitimate claims. 98% of the dishonoured claims get settled out of court, which tends to save the insurance companies money (the settled claims are smaller) while lining the pockets of lawyers on both sides.

This happens in Canada, too, but not so much with publicly insured services (as the government doesn't tend to dishonour claims too often). The insurance frauds certainly keep many lawyers employed up here just mishandling legitimate injury and home claims. Imagine the boom in the lawyering industry if we completely privatized health as well.

This thread has probably died off by now but I want to clarify my position so here goes: Adam, being scared that you'll run out of time to be fixed doesn't allow you to butt in line or draw off resources because you can pay for it. Private health care doesn't make new doctors. It does draw them from the existing system.

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