Healthcare Reform Thread

[Ramo]

Yes.

Dr. Albert Schumacher, former president of the Canadian Medical Association estimates that 75 per cent of health-care services are delivered privately, but funded publicly.

http://www.cbc.ca/news/background/healthcare/public_vs_private.html

At any rate, I strongly suggest that Americans not compare to Canada, and that Canadians do not compare to the US.

I agree that it's far from the best model (but still much better than ours). I like the French model (with all that socialized medicine!), though a good number of other models are also appealing. I was using the Canadian example to explain what "single payer" actually means.

[notyoueither]

I agree that it's far from the best model (but still much better than ours). I like the French model (with all that socialized medicine!), though a good number of other models are also appealing. I was using the Canadian example to explain what "single payer" actually means.

I don't know if you understand ours though, and I'm not really up for reading all of this thread to find out.

Single payer here is one of the ways that private health care for covered procedures is strangled. It is/was (unclear of status at the moment) illegal for Canadians to get private insurance for a condition covered by the public system.

That, along with doctors and providers having to be totally in the public system or totally outside it has meant that we have had no wide-spread, meaningful private system (for covered conditions) for a very long time.

Even the subject of private, for-profit corporations running hospitals for the general public is controversial. Our problems go beyond single payer, although the way that is implemented is part of it.

There are two extremes in health care, with Canada being on one end and the US being on the other. I agree you'd gain more by looking at the French, or just about any other significant industrialised country.

[Ramo]

There are two issues wrt the private/public distinction: funding and delivery. The US and Canada are at opposite poles in funding (and I do think ruling out supplementary private insurance is extreme), but are much closer in delivery (see the quote above). The British NHS, for example, would be the opposite extreme in delivery.

[Ben Kenobi]

Do you believe that every clinic in Canada is publicly run?

Very few 'clinics' per se are publicly run. Hospitals are publicly run. Some private clinics get government funding and operate for profit. Some operate for profit. Some are privately owned and goverment funded not for profits.

As NYE stated it is illegal to 'jump the queue' by seeking private insurance here in Canada for conditions that are publicly funded.

As for the bogeyman, I've seen both systems, and I believe the US to be superior. For one, if I am healthy I don't have to pay for coverage if I don't want to, and two, the coverage and delivery of care is timely and effective.

The difference is between paying for full freight or for part of it. Sure, it's more costly in the US, but you pay for quality.

[Ramo]

Very few 'clinics' per se are publicly run.

Yes, that appears to be the correct answer.

Dr. Albert Schumacher, former president of the Canadian Medical Association estimates that 75 per cent of health-care services are delivered privately, but funded publicly.

[notyoueither]

There are two issues wrt the private/public distinction: funding and delivery. The US and Canada are at opposite poles in funding (and I do think ruling out supplementary private insurance is extreme), but are much closer in delivery (see the quote above). The British NHS, for example, would be the opposite extreme in delivery.

I'm not sure why you say that.

Private delivery here is very limited, aside from the prof corporations of some doctors themselves. Even there, they have to choose. Either they treat the public and collect from the government 100%, no exceptions, or they go 100% outside the public system. There are some very few, exclusive practices that treat high-paid executives and athletes. That's it.

There is the option, supposedly, for private providers in hospitals and other larger institutional care. That is largely lip service when it comes to hospitals as 'private hospital' is a dirty word, and whenever they try to sprout up they are driven out under one guise or another at some point.

There are private outlets for some niches, like testing and smaller clinics, but the main stream is public provision, by and large.

AFAIK, the Brits have dropped the private/public divide.

[notyoueither]

Very few 'clinics' per se are publicly run.

Yes, that appears to be the correct answer.

Dr. Albert Schumacher, former president of the Canadian Medical Association estimates that 75 per cent of health-care services are delivered privately, but funded publicly.

I think he is referring to doctors who have their own prof corporations.

75% in private facilities (like ORs and general hospital wards) is completely not the case. Try 98% of ORs are public. There are some private that do niche procedures.

[notyoueither]

Like I said, it would be best for Yanks to ignore Canada, and Ben.

It is not conceivable that Washington would be able to get away with transplanting our screwed up system to the US. There's just too much you'd have to screw up, and the doctors would never go along with it, as they did here in a different time. There's no way they could enact it here from scratch now either. Our continuing problem is there are too many special interests who benefit from the status quo and wink at each other to keep it going.

[Drake Tungsten]

Good Brooks column on healthcare reform in the NYT today.

If you did think that, you are mistaking the Senate for a rational organism. For while there are brewing efforts to incorporate a few Wyden-Bennett ideas, there is stiff resistance to the aspects that fundamentally change incentives.

The committee staffs don’t like the approach because it’s not what they’ve been thinking about all these years. The left is uncomfortable with the language of choice and competition. Unions want to protect the benefits packages in their contracts. Campaign consultants are horrified at the thought of fiddling with a popular special privilege.

So the process is moving along as it has been. There is a great deal of talk about the need to restrain costs. There’s discussion about interesting though speculative ideas to bend the cost curve. There are a series of frantic efforts designed to reduce the immediate federal price tag. Some senators and advisers suggest cutting back on universal coverage. Others have come up with a bunch of little cuts in hopes of getting closer to the trillion-dollar tab. The administration has ambitious plans to slash Medicare spending.

But there is almost nothing that gets to the core of the problem. Under the leading approaches, health care providers would still have powerful incentives to provide more and more services and use more expensive technology.

We’ve built an entire health care system (maybe an entire government) on the illusion of something for nothing. Instead of tackling that basic logic, we’ve got a reform process that is trying to evade it.

This would be bad enough in normal times. But the country is already careening toward fiscal ruin. We’ve already passed a nearly $800 billion stimulus package. The public debt is already projected to double over the next 10 years.

Health care reform is important, but it is not worth bankrupting the country over. If this process goes as it has been going — with grand rhetoric and superficial cost containment — then we will be far better off killing this effort and starting over in a few years. Maybe then there will be leaders willing to look at the options staring them in the face.

http://www.nytimes.com/2009/06/23/opinion/23brooks.html

[Ramo]

I think he is referring to doctors who have their own prof corporations.

75% in private facilities (like ORs and general hospital wards) is completely not the case. Try 98% of ORs are public. There are some private that do niche procedures.

Like Schumacher, I was characterizing administration of health care in general, not specifically large-scale facilities (FWIW, the Wiki entry on Canada's Medicare characterized the hospitals as mostly "semi-private"), as largely private. Dunno what your point here is, but I still don't see any source contradicting Schumacher.

Like I said, it would be best for Yanks to ignore Canada, and Ben.

Again, I'm not arguing that we should adopt the Canadian system (Ben quoted Zkrib). I was using the Canadian example specifically to characterize what "single payer" actually refers to.

[Ben Kenobi]

Ramo, listen to NYE, when he says 98 percent of ORs are public.

Private care up here is only for stuff that's not covered by medicare.

The US does not want our system at all. Please don't screw up your medicare the way we did ours.

[Ramo]

I'm still waiting for a source contradicting this.

Dr. Albert Schumacher, former president of the Canadian Medical Association estimates that 75 per cent of health-care services are delivered privately, but funded publicly.

http://www.cbc.ca/news/background/healthcare/public_vs_private.html

[Ben Kenobi]

Of that, just over $98.8 billion was spent by governments delivering public health care. About $43.2 billion was spent on private health care.

That shows that 70 percent of dollars spent are spent on delivering public health care.

Now, let's see what 'private' means.

What is private health care?
Anything beyond what the public system will pay for. For instance, should you have to spend some time in the hospital, the public system will cover the cost of your bed in a ward, which usually has three other patients. If you want a private room, the extra charge will come out of your pocket,

So lets be clear here, having a private room in a public hospital is 'private health care'.

I don't see where your source says what you claim it does Ramo.

It says 70 percent of the dollars spent go to Public health care.

[Ramo]

I am not referring to the funding mechanism. I am referring to the delivery services. Which are largely private.

[Ben Kenobi]

Frontline practitioners whether they're GPs or specialists by and large are not salaried. They're small hardware stores. Same thing with labs and radiology clinics …The situation we are seeing now are more services around not being funded publicly but people having to pay for them, or their insurance companies. We have sort of a passive privatization.

Clearly this man has little understanding of 'private health care'. What he means is that they aren't paid by the government, and they aren't part of a union. What happens in reality is that the clinic bills the province per procedure, and the clinic pays their staff.