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Thread: Health care costs

  1. #1

    Default Health care costs

    While I generally admired Ralph Klein, one comment he made a few years back was that the government's share of health care cost increases should be limited to inflation. While I don't work in the health care field and have no great like or dislike of our system (except it's better than the US's system), years later that comment irritates me and worries me that the average busy person might, in a weak moment, agree.

    Now, since I was a little kid I've heard about the various effects the aging baby boom population was going to have on Canada. It's probably been a widely known issue since the early 1960s, almost five decades, so for year after year after year anyone with a brain has known that health care costs would start to rise right about now. (Of course, anyone that takes just a moment to think about it will also realize that much of the rising expenditure will circulate right back into the economy as salaries and domestic purchases. Pretty stable ones at that. Hopefully technology will cut core costs but technology can't be relied upon.)

    So, how can anyone then say with a straight face, that healthcare costs should now start to increase at no more than the inflation rate? The older age cohorts will double in size in a few short years!!! When you know for about 50-years that a problem is on the horizon and you do nothing and then say health care costs are rising at an unreasonable rate - what's wrong with that picture?
    Last edited by KC; 18-05-2009 at 08:08 PM.

  2. #2

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    I think the problem is that health care must be rationed somehow, or we will end up spending an unlimited amount on it.

    Doctors (and other medical professionals, pharmaceutical executives, medical equipment suppliers, etc), while admirable people who work very hard, earn a lot of money. If there is no cap, then they will earn even more. While I'm happy to see them build up a nice nest egg as a reward for saving lives, the rest of us are paying for that nest egg.

    I remember my wife being treated a while ago, the doctor opened a new packed of equipment, then changed his mind, and decided not to use it, throwing it in the waste basket. That's the sort of mindset that has to be avoided - that lives are worth any price. They are not, for it is simply taking from one group of hard working people, and giving to another.

    Health care is important - just like Education (which IMO is just as important to society). But at the end of the day, we are all going to die, and while it is important to keep people alive and living healthy lives when practically possible, it can't grow to the point where it eats into the wealth of society in general (for example, forcing us to spend less on education). Priorities have to be set - and putting a cap on the rate of growth of health care spending, sounds a reasonable way to me, to force some decisions on those priorities. For me, children and young people are a greater priority than seniors (who have lived a life already and are closer to natural death), and accordingly, I don't see the aging population as a reason to change the rate of increase of health care spending, even if it means that the latest greatest piece of lifesaving treatment for an 85 year old is not implemented. As I age, I' hope the spare money gets prioritized to my future grand kids, so they can have a great education. At some point, what is spent on me, will just result in a diminishing return, but what is spent on my children and their children will be priceless, and I think its the same with society in general - we should focus public spending where possible, on young people - I don't think endless health care spending growth due to an aging population is consistent with that.
    Last edited by moahunter; 18-05-2009 at 09:23 PM.

  3. #3
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    So after waiting an hour and twenty at the Medicentre today I was pleased that my prescription was only $4.12....I was shocked. I was ready to toss out 50 bucks.
    $2.00 $2.25 $2.50 $2.75 $2.85 $3.00 $3.20 $3.25

  4. #4

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    ^why do people always wait at the medicenter? I always ask the staff hour long - often it is more than 2 hours, so I leave my name on the list, and go home / come back later (rather than sit in a packed room full of sick people).

  5. #5

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    We could solve most of our health care issues by immediately instituting a policy where if you don't even try to take care of yourself, you're cut off. Growing numbers of family practitioners worldwide are, in an effort to give better care and save their sanity, cutting patients that don't make good lifestyle choices loose. Have breathing issues and won't quit smoking? Gone. Obese but won't switch to veggies? Gone. The 80/20 rule applies to healthcare, in that 20% of losers take up 80% of our healthcare capability.

    Another serious issue we have is the complete ignorance towards the fact we age. Increasingly our healthcare system is less about keeping us healthy, and more about trying to prevent death in the elderly/terminally ill. Go to any long-term-care unit and just look at the hundreds of folks that we're drugging and mechanically keeping alive for selfish reasons.

    If we changed our thinking about healthcare, we really would be able to tie healthcare budget increases to inflation.
    "Men never do evil so completely and cheerfully as when they do it from religious conviction" - Blaise Pascal

  6. #6

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    Can we please also factor in that Alberta's population has exploded.

    Trying to care for a million new people and all the babies for the same amout as a few years ago (plus inflation) is crazy talk.

    Sometimes I swear that people cannot see how things relate to each other... (That was a comment to the universe and not to anyone in particular)
    Last edited by edmonton daily photo; 19-05-2009 at 07:16 AM.

  7. #7

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    ^When I used the word inflation, in my own head I assumed that meant both dollars and population fluctuation.
    "Men never do evil so completely and cheerfully as when they do it from religious conviction" - Blaise Pascal

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    Quote Originally Posted by Chmilz View Post
    We could solve most of our health care issues by immediately instituting a policy where if you don't even try to take care of yourself, you're cut off. Growing numbers of family practitioners worldwide are, in an effort to give better care and save their sanity, cutting patients that don't make good lifestyle choices loose. Have breathing issues and won't quit smoking? Gone. Obese but won't switch to veggies? Gone. The 80/20 rule applies to healthcare, in that 20% of losers take up 80% of our healthcare capability.

    Another serious issue we have is the complete ignorance towards the fact we age. Increasingly our healthcare system is less about keeping us healthy, and more about trying to prevent death in the elderly/terminally ill. Go to any long-term-care unit and just look at the hundreds of folks that we're drugging and mechanically keeping alive for selfish reasons.

    If we changed our thinking about healthcare, we really would be able to tie healthcare budget increases to inflation.
    I like this idea.

    Another one, while it may seem a bit radical, is to discontinue coverage of lung cancer effective a certain date in the future (15 yrs from now). Would have to be some way to cover those that received it from second hand smoke, but nowadays, that would only be from family members.

  9. #9

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    ^I think with all cancers, it is possible to simply get them genetically - especially as we age, our cells mutate more. There isn't always a triggering factor.

  10. #10

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    I'm no expert but I've heard experts talk about this subject and it seems to me painfully obvious. We need to mimic what successful countries have done. Stop comparing ourselves to the U.S. and stop thinking of our current system as the golden calf.

    We realize we have a problem with health care costs yet we're too stubborn, or too afraid, or too stupid to change our system. There are lots of countries over seas that have a much more successful public health care systems than we do (costs less and no such thing as waiting lists), yet we refuse to copy what they're doing. That's stupid.

  11. #11

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    ^what is even more stupid is that if anyone even suggests change, someone yells "2 tier health" and "Americanizing the health system", without considering systems in Europe or elsewhere. There is this stupid assumption, that if it is not the system we have, it must be slippery slope to a horrible American system.

    Interestingly, the only province where the population seem open to change, is Quebec. I have seen it written that the reason Quebecois are more open to this, is that unlike many English speaking Canadians, they have more to their personal/national identity than simply "we are not Americans because we have free health care unlike the US." A lot of people equate the current health care system to being Canadian, and accordingly, it is dangerous for politicians to even suggest change.

  12. #12

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    Exactly. I think the US and Canada are at the extreme and opposite ends of the health care spectrum, and it's ridiculous to compare the two models like they are the only two that can possibly exist.

    I think both countries will eventually adjust their systems over time until they both get closer to public/private mixed systems.

  13. #13

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    Not too long ago, David Suzuki (wrongfully) went on record to say that our abuse of the environment has created the plague known as cancer. While this may seem true seeing as how cancer is relatively new, it's not. Other medical marvels have prolonged human life and eradicated most previous causes of death (other than aging) to the point where cancer is one of the only things left to kill us.

    One day we'll find a way to solve the cancer problem, and our healthcare issues will only multiply since even more people will be living longer, and we'll be trying to save them all from their eventual death.
    "Men never do evil so completely and cheerfully as when they do it from religious conviction" - Blaise Pascal

  14. #14

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    Just cut off everyones head and freeze dry them at a certain age until we pefect the ability to create cybermen

    Thats a little DR. Who for ya ;-p

    Last edited by edmonton daily photo; 19-05-2009 at 05:39 PM.

  15. #15

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    Oh, Oh. One Canadian study mentioned on the radio a few years ago found that maternity and early childhood care costs the health care system as much or more than seniors.

    Anyway, demographics are going to drive up the demand and likely the associated costs simply through the baby boomers' large numbers. (Of course, all those following the boomers may create even more problems assuming each generation benefits from the cheapest lowest cost advances leavign the more expensive fixes for the future. Sort of Hubert's Peak Oil Hypothesis of health care. i.e. all the cheap and easy pools of health advances may soon have been found leaving only the higher cost solutions. Actually, as with energy there's no saying that the future has to be more costly - maybe better, cheaper technologies will come to the fore. )

    Assuming technology progesses slower than hoped - costs will rise. Still, costs can be cut or off loaded in numerous ways and maybe benchmarking everything against inflation is as good at anything else but it sure seems nonsensical to me. Individual salaries sure, but higher demand will trigger longer hours or require more staff to meet the demand and so costs/spending would have to rise.
    Last edited by KC; 19-05-2009 at 10:41 PM.

  16. #16

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    kill all babies!

    it just idiotic how we view these problems..

  17. #17

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    I'd rather see hospitals full of babies than old people spending their last days/months/years slowly wasting away in a hospital bed, pumped full of meds until they're drooling, in an effort to give them a few more miserable years when they could instead live slightly shorter, better lives until they die comfortably in their sleep at home.
    "Men never do evil so completely and cheerfully as when they do it from religious conviction" - Blaise Pascal

  18. #18
    grish
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    to die comfortably, you often need proper pain management which can only be provided by a trained physician. when you say "pumped full of meds" you must understand that meds have a purpose (certainly there are instances where medicine is not administered properly for no fault of physicians--something like "cascading" for example, where more and more meds are being used to deal with side-effects of other medications). not to get into a long debate on pharmaceuticals, living at home is not so peaceful as you think when you consider the impact on the elderly's quality of life and the impact on the family. Caring for an elderly person is neither easy, nor fun and many people do not have a natural ability to provide such care. People who do care for an elderly family member require enormous amount of support from the health care professionals including mental health and counseling. Whether this support is done at a long-term care facility or at home, it costs money and needs to be done well.

  19. #19

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    ^
    Grish, too bad the government is trying to force us into taking care of our elders instead of having homes or funding that can handle that task.

    2 tier is already happening in our province since there's a private hospital in Calgary. Next to Harper's riding. Go figure. Sure, those guys can afford things like doctors and checkups and such and are just given a bill like joining a country club.

  20. #20

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    I have no problem with someone paying extra money out of their own pocket to receive better service. It is possible to do that almost everywhere with almost any service imaginable, and I see no reason why it shouldn't apply to health care, too. I mean if a person WANTS to pay through the nose, why shouldn't they have the freedom to? I never understood that.

  21. #21

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    ^That's the way it was in the country I came from. You paid a little more, if you wanted private insurance that provided the option of a private hospital. A private hosipital gave fringe benefits, like the choice of a glass of wine with a meal. All those people who paid, took pressure off the public system - less people to care for, everyone wins.

  22. #22
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    ^ Isn't a part of the problem, though, that we have enough trouble recruiting and keeping doctors and nurses in our public system without them being poached by what would likely be higher-paying private facilities?
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  23. #23

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    I also fail to see why a person getting a hip replacement, for example, cannot opt to pay more for a newer, more expensive, state-of-the-art hip joint out of their own pocket. Instead, everyone must receive the same replacement hip joint, even if it is inferior to newer types, just because it's what our system can afford.

    I don't understand people's reluctance to accept private services. I suppose many people would never choose to pay more out of their own pocket for their own health care and are jealous of those who could, therefore they think nobody else should be allowed to.

  24. #24

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    Quote Originally Posted by RTA View Post
    ^ Isn't a part of the problem, though, that we have enough trouble recruiting and keeping doctors and nurses in our public system without them being poached by what would likely be higher-paying private facilities?
    Medicenters are privately owned. I don't see them poaching medical staff from hospitals. There are also private facilities (not-for-profit) who have nurses working there for LESS than what they would make at a unionized Alberta Health Services hospital.

  25. #25

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    ^If you think about it, most GP's / speciailists are private business providers as it is. There never was a "pure" public health system, Canada's is just distorted too much to one extreme.

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    Quote Originally Posted by MrOilers View Post
    Medicenters are privately owned. I don't see them poaching medical staff from hospitals. There are also private facilities (not-for-profit) who have nurses working there for LESS than what they would make at a unionized Alberta Health Services hospital.
    Medicentres are small though...I'm thinking that if the floodgates were opened, the impact would be much greater.

    I'm also not sure that a not-for-profit facility compares at all to a for-profit one.
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  27. #27

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    RTA - I think you will find, that many of the health care providers in the US are not for profits. It is all academic though, whether there is a:

    1. 100% government run system,
    2. Government system with the choice of private health if you want to pay more (which is what most countries have), or
    3. 100% private system (sort of the US),

    gp's / specialists will be privately selling their business / making profits, and consumers will be paying for those profits (either through their government, directly, or some combination). There is not such a thing as a system that does not have a private element - it is just political rhetoric.

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    I don't understand the benefit to operating a private health care facility, then, if it is not for profit anyway.
    Strathcona City Separatist

  29. #29

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    Everyone in the health care sector is working for profit.

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    ^ Clever, but that still doesn't answer how it's beneficial for an operator of a private not-for-profit health care facility to do so. I'm genuinely curious to know how that works.
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  31. #31

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    Quote Originally Posted by RTA View Post
    I don't understand the benefit to operating a private health care facility, then, if it is not for profit anyway.
    Go have a look at the systems in Europe. As explained earlier:

    1. it gives people a choice (like the glass of wine example I provided above)
    2. without choice, some people are going to fly to US or Mexico and spend their money there (our health care loses then, as that money could have been spent in Canada)
    3. if people want to pay for better service - why not let them? The "wealthy", are then subsidising the poor / paying more for their health care, for there are this many fewer people that public health has to pay for.

    Mixed systems work the best, they provide choice, competition, and universal coverage. The best of both the US and Canadian systems, and per the European / Austraisian experience, for a lower overall cost to.

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    ^ You're answering the question of "how does it benefit us" not the question I asked of "How is it beneficial for a private operator to operate as a non-profit?"
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  33. #33

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    ^Well it happens, just like charities happen. I think the non-profit health care providers typically have in their history, some benefactor who built a hospital, or similar. It grows from there. Or it may just be a bunch of doctors who get together, and decide, they can run a hospital better than government burecracy can. For the people at the top - it is equally as fun (and well paying) to run a non-profit hospital for members as it is to run a profit one for shareholders.

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    ^ I was hoping to see something a little more concrete than conjecture, and agree those could be factored in somewhere, but I don't see something as bureaucratic and regulated as a hospital being "fun" to operate by "a bunch of doctors."
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  35. #35

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    Quote Originally Posted by MrOilers View Post
    I have no problem with someone paying extra money out of their own pocket to receive better service. It is possible to do that almost everywhere with almost any service imaginable, and I see no reason why it shouldn't apply to health care, too. I mean if a person WANTS to pay through the nose, why shouldn't they have the freedom to? I never understood that.
    So let them go to another country for the services. Every person who is allowed to jump the queue by paying more is pretty much butting into line, which makes people already waiting forced to wait longer.

    How is that fair to people who can't afford to skip ahead?

  36. #36

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    Quote Originally Posted by RTA View Post
    but I don't see something as bureaucratic and regulated as a hospital being "fun" to operate by "a bunch of doctors."
    Well, that's why I would do it - it would be fun to have that sort of power I think. But - you are probably right... I think the non-profits more likely come about because the people who set them up, really care about providing better health care for people. They are not allowed to do that in Canada though, because some ignoramus will yell "2 tier health!!!", even though that is the type of system that works best in the world, per Europe.
    Last edited by moahunter; 21-05-2009 at 07:20 PM.

  37. #37

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    Quote Originally Posted by armin View Post
    So let them go to another country for the services. Every person who is allowed to jump the queue by paying more is pretty much butting into line, which makes people already waiting forced to wait longer.

    How is that fair to people who can't afford to skip ahead?
    Nobody is suggesting giving rich people the right to queue jump. If they went to a private hospital the line up at the public hospital would just get shorter. Everybody would get serviced faster, not just the rich people.

  38. #38

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    Quote Originally Posted by IKAN104 View Post
    Nobody is suggesting giving rich people the right to queue jump. If they went to a private hospital the line up at the public hospital would just get shorter. Everybody would get serviced faster, not just the rich people.
    Except for the fact that we have a shortage of Doctors.
    Also, look how many graduates move to the US where they can make more money. If we allow private hospitals, the doctors wil head there leaving a staff shortage for others who don't have the private memberships.

  39. #39
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    Quote Originally Posted by armin View Post
    Except for the fact that we have a shortage of Doctors.
    Also, look how many graduates move to the US where they can make more money. If we allow private hospitals, the doctors wil head there leaving a staff shortage for others who don't have the private memberships.
    I have very strong opinions on various professionals having the Canadian taxpayer subsidize their education so they can immediately run off to make bank in the US. I don't know if it's possible to do, Charter Rights and all that, but IMO professionals that are in shortage in Canada should have to sign an agreement when they enter schooling that they agree to work in Canada for at least 5 years after the completion of their schooling should they want subsidized education, otherwise they can pay the full price and then run off to LA to augment boobs.

  40. #40

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    Quote Originally Posted by raz0469 View Post
    I have very strong opinions on various professionals having the Canadian taxpayer subsidize their education so they can immediately run off to make bank in the US. I don't know if it's possible to do, Charter Rights and all that, but IMO professionals that are in shortage in Canada should have to sign an agreement when they enter schooling that they agree to work in Canada for at least 5 years after the completion of their schooling should they want subsidized education, otherwise they can pay the full price and then run off to LA to augment boobs.
    I don't think that trying to enforce doctors into staying will work.
    But I guess it comes down to if they want to be greedy capitalists or helpful socialists. Really, if the schools and the communities put more emphasis on our need for health care professionals, including the idea that we need them and they're helping be better citizens by staying here.

    What we also should look at is these companies from the US enticing our doctors with dream jobs that only the private industry can provide. They steal our grads from us and for every doctor that goes accross the border, literally thousands of people here will end up suffering because of it.

  41. #41
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    "Subsidise their education and leave " We all recognise that we all go where the water is deepest
    What about all of the skilled "new Canadians" that we have who cannot get licenced in a timely manor, so we (happily ?) leave them to slave away in our service industry ?
    Ever had a cab ride with a Geneticist, Radiologist or Surgeon ?
    Things like this add to our costs

  42. #42
    grish
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    a few quick thoughts against two parallel medical systems.

    every person should have the same high standard level of basic health care. if there is a better hip replacement procedure--it should be available to all. a better heart medication--available to all. a better imaging option--available to all. healthcare done fast and well--available to all. etc. what should not be available to all are things like a glass of wine at dinner--that can be an extra charge.

    to make sure that the latest advancements in healthcare done in a timely manner are available to all, there should be a single, well-supported system that is well staffed, and well equipped. there should be no need for someone to pay a bit extra to do something faster as the public system should be run to a high standard. there should be no need for paying extra for better imaging or better procedure etc.

    the reason people suggest there should be que-jumping for a fee (by going to a private clinic) is because current system is under-supported. there should be no for-profit health care as decisions are then made based on the bottom line and not for health care considerations.

    fund public health care properly, and nothing else is needed.

  43. #43

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    Quote Originally Posted by grish View Post
    a few quick thoughts against two parallel medical systems.

    every person should have the same high standard level of basic health care. if there is a better hip replacement procedure--it should be available to all. a better heart medication--available to all. a better imaging option--available to all. healthcare done fast and well--available to all. etc. what should not be available to all are things like a glass of wine at dinner--that can be an extra charge.
    Why is that an argument against "2 tier health"? In most places of the developed world, that allow both, you have a guaranteed high standard of basic service for everybody, and the option for those who want something more, to pay more. Everyone wins then - more money for public system (as fewer patients to spend money on), and more choice for consumers (instead of having to fly out of the country, per the current stupid situation).

    Most countries use 2 tier. It doesn't automatically mean US system though, health care in Germany, Netherlands, Denmark, etc.

    http://en.wikipedia.org/wiki/Two-tier_health_care

    People get confused, because the US is the only developed country that does not have Universal health care. That is why the system is terrible there. It is not a reason to say 2 tier does not work though - that is false, two tier systems can and do work better than Canada's system, per the experience of many countries in the world.

    As an example (and there are many models), if you look at a country like Germany, which has the oldest universal health care in the world (older than Canada's). "Despite" being "2-tier", Germany still has an excellent public system - better than Canada's (which is 2nd most expensive in the world behind the US, but does not deliver as good results as Germany or other European countries).

    http://en.wikipedia.org/wiki/Universal_health_care
    Last edited by moahunter; 23-05-2009 at 12:41 AM.

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    Health care costs a LOT of money. Annual budgets are simply incredible. Where does this money go? My guess is, much of it is to support the unneccessary bureaucracy that takes place to so-called "support" the system. Front-line workers (eg: nurses/Doctors/technicians) as well as up-to-date equipment could be top-notch if so much money wasn't funnelled to the bloated "support system" that over-sees every nickel and dime.

    My 2 cents worth. Mileage may vary.

  45. #45

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    Quote Originally Posted by grish View Post
    a few quick thoughts against two parallel medical systems.

    every person should have the same high standard level of basic health care. if there is a better hip replacement procedure--it should be available to all. a better heart medication--available to all. a better imaging option--available to all. healthcare done fast and well--available to all. etc. what should not be available to all are things like a glass of wine at dinner--that can be an extra charge.

    to make sure that the latest advancements in healthcare done in a timely manner are available to all, there should be a single, well-supported system that is well staffed, and well equipped. there should be no need for someone to pay a bit extra to do something faster as the public system should be run to a high standard. there should be no need for paying extra for better imaging or better procedure etc.

    the reason people suggest there should be que-jumping for a fee (by going to a private clinic) is because current system is under-supported. there should be no for-profit health care as decisions are then made based on the bottom line and not for health care considerations.

    fund public health care properly, and nothing else is needed.
    Do you really believe if we throw more money at the system that it will work? How much money is enough? Haven't we been going down this road to no avail for the last 50 years? If lack of money is really the problem then why is it that other countries can spend much less per capita and still end up with better care?

    How much longer do we increase health care budgets before we have the balls to try something else? Are we really that stupid that we can't learn from what other countries have done? Or is it arrogance? Are we too proud of our system to makes changes?

    And to suggest that patient care would suffer in a for-profit hospital is not only insulting to health care professionals but also incorrect. Doctors are already privately incorporated and are doing business for profit. That doesn't mean they don't care about the patient.

  46. #46
    grish
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    Quote Originally Posted by moahunter View Post
    Why is that an argument against "2 tier health"? In most places of the developed world, that allow both, you have a guaranteed high standard of basic service for everybody, and the option for those who want something more, to pay more. Everyone wins then - more money for public system (as fewer patients to spend money on), and more choice for consumers (instead of having to fly out of the country, per the current stupid situation).

    Most countries use 2 tier. It doesn't automatically mean US system though, health care in Germany, Netherlands, Denmark, etc.

    http://en.wikipedia.org/wiki/Two-tier_health_care

    People get confused, because the US is the only developed country that does not have Universal health care. That is why the system is terrible there. It is not a reason to say 2 tier does not work though - that is false, two tier systems can and do work better than Canada's system, per the experience of many countries in the world.

    As an example (and there are many models), if you look at a country like Germany, which has the oldest universal health care in the world (older than Canada's). "Despite" being "2-tier", Germany still has an excellent public system - better than Canada's (which is 2nd most expensive in the world behind the US, but does not deliver as good results as Germany or other European countries).

    http://en.wikipedia.org/wiki/Universal_health_care
    the detail here is important. what do you mean when you say "basic"?

  47. #47

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    Quote Originally Posted by grish View Post
    the detail here is important. what do you mean when you say "basic"?
    I was quoting what you wanted "the same high standard level of basic health care". As said - there is better care in a public health care system in Germany, than in Canada. And, it costs Germany a lot less. How do you explain that, given that Germany is an evil 2 tier system? Could it be (oh no, horror the thought that rich people will pay more for health care), that maybe 2 tier systems can work much better than Canada's system if they include universal health care, and are designed right?

  48. #48
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    Quote Originally Posted by moahunter View Post
    I was quoting what you wanted "the same high standard level of basic health care".
    yes, but are we using the word in the same sense? To me "basic" means latest and best medical care available to all and fast as I have outlined with my examples in that post. To someone else it may mean treatment for only the life-threatening conditions, but once that is done, the rest is extra and a choice to be made.

    but then if my standard of "basic" is met, is there really a need for private? most postings on private health care on here have to do with getting better procedures done fast. If best procedures done timely are the standard to which public system is held, then what need does private health care serve?

  49. #49

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    ^Well, per Germany, "2 tier" will result in a higher quality health care for people under the public system, with less cost to society. That's the need. We can stick with the current system based on ideology of those who are afraid of improvements (or have a vested interest in maintaining status quo) and settle for expensive mediocre, or we can improve every body's health care by learning best practices from other countries. Sadly in Canada, many people care more about ideology, more than health care results for society - it is costing lives (per Canada's health ranking), and costing dollars (2nd most expensive system in world).
    Last edited by moahunter; 23-05-2009 at 01:13 PM.

  50. #50
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    /\ if the high quality public health care is available, who in Canada do you see using the "other" health care? Is this essentially an ideological argument in providing a "private" or somehow exclusive care to those who have something against being treated at a hospital available to the general public? Do we have enough health care professionals to sustain two equally good health care infrastructures?

    To me, if there is a reason to have a private health care, then the public system is not being run properly.

  51. #51

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    Does anyone have any thoughts my original posting on the demographic effects vs CPI?

    By comparison, if you initially have one child in you household and then you add a second, I'd imagine that trying to keep your child upbringing costs pegged to inflation would be difficult. Moreover, making pronouncements that that is what you are going to do may be wonderfully aspirational, but it may ignore a good bit of reality.
    Last edited by KC; 29-05-2009 at 07:49 AM.

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    installing a 2 teir system does not change the fact there is a doctor and nurse shortage. healthcare needs to change the way it opperates as a whole, not just how it's funded

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    Agree, we will very likely see demand growth via demographics and off loading costs onto individuals will of course be one method that's proposed if not attempted.

    Off loading costs onto another tier and/or directly onto the individual, creates a lot of uncertainties. It might reduce costs simply through a failure to treat those that would otherwise receive treatment (creating uninsured, uninsurable, those forever bumped down the waiting list, etc.)

    Much like not counting all crime statistics makes your city look more respectable, reducing demand makes your books look more respectable. There's always loads of tricks that can be employed by accountants, statisticians and policy makers.
    Last edited by KC; 31-05-2009 at 10:09 PM.

  54. #54

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    The Laser Prostate debaucle in Calgary is a prime example..

    We can do more surgeries, in less time with less complications requiring less meds, but it is axed because the old way of cutting open is initially cheaper.

    It's these short sighted, disasterous decions keep our medical system hobbeling along.

  55. #55
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    and then a knight in shining armor will appear with a brand new laser machine in Calgary and offer the good people an option. All they have to do is lobby the government to be allowed to operate. Now, is the problem the system being "public" or is the problem with not enough funds from the government, or is the problem the make up of the health board? I think the biggest problem at the moment is the staffing of the health board. There are not enough medical professionals on it making their choices more "bottom line" driven which in the long run makes the system more expensive. The second problem is funding.

    As I have said it before, if public system is run properly, I don't see a need for 2nd tier health. Conversely, if there is a perceived need for 2nd tier health, then public system is not run properly.

  56. #56

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    You should hear the rumblings from nurses (many who I know personally) right now.

    There is a mass hiring freeze across the province, grad nurse positions have been reneiged, and anyone who was here in the 1990s are expecting to lose their jobs to cutbacks. And ones who aren't afraid of losing their jobs can't imagine trying to work in with even less staff than there are right now.

  57. #57
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    this is "manufacturing of crisis". Alberta government should patent it. They have done it before, and they are doing it now. When Alberta elects them next in the next elections, they will do it again.

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    As long as all of our health care is in the government's control there is NOTHING that can be done about it.

  59. #59
    grish
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    This is the sort of statement that does not really make much sense.

    What do you mean by "government" control? There is no such thing as health care not in government control as government regulates health care regardless of how it is funded.

    Currently, Alberta health is delivered through the Alberta Health Board, but funded through the government. So, who controls it? The government can always point its finger at the board to say "they are the ones who are doing a bad job". It is easier to do so now that you only need one finger to point with. If the government selects the people to be on the board who they know will not point their fingers back or simple give the government the finger, then the government is in full control of health care.

    So, does that mean we have no control over health care? No, we can change the government to one who will do things in our best interests. If having a good, strong, public health system is important to us, then lets get the government who will ensure that happens.

    In the end, we need a strong public system with strong public health boards who act in our best interests by providing excellent health care. These health boards need to be advocates on behalf of health care and they need to act appropriately in that capacity no matter who the government is. The health boards need to have a good number of health professionals who understand what good health care looks like.

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    My point is, if the public health boards are not offering us the best health care, what can someone do? Absolutely nothing, except suck it up. There's nothing a person can do because we are all at mercy under the current system.

    You say we can change the government? In theory we can, but can you send a message to them until the next election? No, you can't. Especially since the next election is several years away, and you might need health care tomorrow. Even if we elected a different government, does that mean we'll get better health services? Not at all. And then you have to wait for another election. You shouldn't have to wait for another election and cross your fingers that the health care will be good, but that's exactly what we do in Canada. It's not like you can take your business elsewhere.

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    Until the next election, you can tell the government what you want them to do:
    http://alberta.ca/home/mla_contacts.cfm

    if enough people tell the government, they will do something.

    If a health board does not do its job in being proactive and advocating on behalf of the health system, then you should be able to appeal to the government to remind the health board of its mandate and to audit it. There needs to be a strong system where the health board is held to a standard of care. At the same time, health boards need to have in their mandate to remind the government of responsibilities to fund health care. It is a relationship that need to be protected.

    Dissolution of health boards and establishing a puppet board is not one a healthy relationship.

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    Quote Originally Posted by grish View Post
    Until the next election, you can tell the government what you want them to do:
    http://alberta.ca/home/mla_contacts.cfm
    It's sad that if we want state-of-the-art health care in this country that we have to beg and plead. And the government doesn't have to listen nor do anything, no matter how many people complain.

    This system traps us.

  63. #63
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    what is going to be your next illness? If a girl is born tomorrow, what is her most challenging health issue during the span of her life? Is what she is going to get--the big illness--dependent on her ability to pay for the procedure or treatment or cure? Under what system do most people not have to beg and plead to get appropriate health care?

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    I hope my next illness isn't any type of cancer, because there's a chance I'll be put on a waiting list for treatment whether I can afford to pay for it out of my own pocket, or not.

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    are you sure you can pay for your treatment? isn't this a very interesting game of chance? what if you and people you care about are not so fortunate either? can you pay for all of their treatments? there could be a point when you might have to go beg and plead.

    I for one do not want to play that game. I want my government to act in all of our best interest and set up a system when all illnesses are treated to the best standard available. The best standard available includes timely health care. No, I don't wish to beg or plead. I want to demand and I am very annoyed that there are people out there who are willing to let the government off the hook of their responsibility to provide best health care by saying "it's ok, you don't need to provide me with the healthcare I deserve because I will pay for it out of my pocket." that is not an individual decision. it shouldn't be. we need to pull all of our resources together so that no matter the fortune in life--be it cancer, a car accident, ulcerative colitis, multiple sclerosis, or a bad case of toe fungus--the cost to individual is reasonable and the care available is best possible. I now health care costs, but the cost and the quality of health care should not depend on the procedure. What we pay through taxes or health premiums should be the only cost we pay.

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    When our quality of health care suffers, it's too bad there is nothing you or I can do about it. It is out of our power. Yes, you can write an angry letter and vote Liberal in the next provincial election, but is there any way for you or I to go and seek out better care? Nope.

    And yes, it's nice that we all are guaranteed access, yadda yadda. But if you die while waiting to get your care is it really the best system?

  67. #67
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    ok. should we also expect private police force? Private army to fight our own, private wars? Parallel banking system? Individual set of judges and individual set of laws? Every person who can afford it, should not wait for the public system to act on their behalf! Why is health care so special?

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    Or private dentists, builders of shelter, private optometrists (what? whats that? We do have private those, and the sky hasn't fallen in)? Why is health care so special? It is special, like those other items, because it matters. That's why we shouldn't settle for second best (or 10th best, or whatever it is for Canada right now). The need to fund it effectively is also why, those who can afford to pay more, should. We can learn from the rest of the world - we don't have to settle for the worlds 2nd most expensive, but not second most effective, system - we can aim a lot higher by listening and learning, instead of ignoring the opportunity to improve the "untouchable" becuase it might offend an idealist notion.

  69. #69
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    Umm, there are private security companies that you can hire to protect your person or property. There are private roads all over the country, private jets, and so on. You're trying to make a pretty poor analogy.

    I don't know what the answer to our health care system is precisely, I don't know enough about it to really say. What I do know is that it's absolutely ridiculous that our health system isn't even able to put a reasonable cost estimate together for what a particular surgery or procedure is in a lot of cases. Instead of viewing patients as a "customer" that will bring in X amount of funding for the procedure they require, patients are instead viewed by hospitals as burdens that will draw down precious resources and use up their budget. The system needs some pretty huge reform in a lot of areas, because red tape and bureaucracy are eating up huge amounts of health budgets as well.

    The fact is, many if not most European countries have mixed models of health care provision, and in a lot of cases they are getting far better value for their money. Of course the opposite situation in the US, with nearly exclusive private delivery has resulted in them spending more on health care as a percentage of GDP than pretty much any other nation on the planet, much of it (paradoxically when you first think about it) tied up in administrative costs.

    I personally think it's absolutely ridiculous that a doctor in this country cannot set up a private clinic to perform most medical procedures. If some doctor wants to set up a clinic to do joint replacements, why should it be illegal for him to do so? You may claim that it will result in a flight of talent from the public industry to the private one, but I'd counter by saying that they can already do so by going to the US or nearly anywhere else in the world.

    Further, if said clinic can do joint replacements cheaper than the public system, why would it be a bad idea for the public system to "outsource" those procedures to the clinic? Just because the doctor might be making a bit more money than if he was doing it in the private system? Even if the net cost to the tax payer is less? How much sense does that make?

    And the rhetoric amongst politicians about "private health care" whenever reform is brought up is just flat out disgusting. Even Jack Layton has been to private clinics for god's sake: http://www2.canada.com/montrealgazet...5-44963b8058da

    And he said union leader Buzz Hargrove, president of the Canadian Autoworkers, proved a master at "queue jumping" when he got in for an MRI within 24 hours of injuring his leg.
    Oh the irony. Took me 3 months to get an MRI, as I didn't feel the need to pay $400 or whatever the cost is as the problem was fairly minor.

    Hell, my company pays extra through the WCB's OIS program to get better, more timely treatment for injured workers: http://www.wcb.ab.ca/providers/ois.asp . It's the very definition of queue jumping, yet it's encouraged by the WCB. Our guys are seen by a doctor at an OIS registered Medicentre (which are private companies!) within 15-30 minutes instead of waiting for hours.

    Oh noz, private health care! The end is near! The end is near!

    The reality is there's private health care all over the place in this country, and our public system isn't going to die because of it.
    Last edited by raz0469; 01-06-2009 at 02:30 PM.

  70. #70
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    there is no such thing as a private law enforcement and there is no such thing as a private judiciary. that was my argument. no, the sky hasn't fallen because of private dentists and optometrists, but the overall health care system would be stronger if those services were included in the overall health standard of care.

    the sky will not fall if individual health care aspect is spun off to private access. dermatology can be spun off and the sky will not fall because only those suffering with skin problems will be affected. then allergy specialists can be spun off and only allergy sufferers will complain. then all hip replacements can be spun off. it is just one little aspect of all surgeries. then...


    pretty soon we will find that our public health bears the weight of the most expensive to treat--oncology, cardio, hemotology, etc with no facilities as every time you spin off a less essential service that can operate as a private clinic without sky falling, the nurses and building facilities go with them.

    How about we stop fooling ourselves and realize that health care is not restricted to a particular body part or particular amount an individual is able to pay. We need to demand from our government that no matter what health issue, an individual should have access to best health care, timely without an additional cost. We have paid and continue to pay the cost of health care--our taxes. If there is still a need for private health delivery, the public system needs to be fixed.
    Last edited by grish; 01-06-2009 at 02:33 PM.

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    Why though is privately administered, yet publicly funded health care a bad thing? Can you explain to me why the private clinic example I used would be a "bad thing"? If a private clinic can perform a procedure cheaper, more timely, and as safely as the public system, why would it be bad for the public system to outsource to this clinic? Because as it stands for the most part such a clinic is technically violating the Health Act if it performs most procedures.

    Quote Originally Posted by grish
    How about we stop fooling ourselves and realize that health care is not restricted to a particular body part or particular amount an individual is able to pay. We need to demand from our government that no matter what health issue, an individual should have access to best health care, timely without an additional cost. We have paid and continue to pay the cost of health care--our taxes. If there is still a need for private health delivery, the public system needs to be fixed.
    You seem to be missing my point. People would be sent to these clinics, or outright hospitals, by the public system and there would be no additional cost to them.
    Last edited by raz0469; 01-06-2009 at 02:35 PM.

  72. #72
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    because, like the case in Quebec, a private clinic is not necessarily concerned with providing the most accurate results of cancer testing, rather they worry about the biggest profit. So, if they get the same amount of money from the public purse for running a test, they would rather run the test as cheap as possible to get the best profit margin rather than going after the best technology that, even though costs more, will give the most accurate results. When you have private delivery, each private aspect does not see the bigger picture of the entire health care from access to diagnostics to treatment to follow up. Their worry then is the immediate profitability of an individual procedure. Only a public health board can be in the position to have that big picture vision.

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    Our hospitals right now have to think about costs all the time.

    I'll give you an example - right now in hospitals in Edmonton in rooms where patients are quarantined for MRSA, many of them are using the cheap, regular gauze for wound dressings instead of the gauze that contains silver. I know this for a fact. Wound dressings that contain silver can actually kill these antibiotic-resistant bacteria and allow these MRSA positive patients to recover sooner and with less antibiotics. But the managers who are responsible for keeping everything within budget don't like to use them because the gauze that contains silver is too expensive. So they use plain sterile gauze and band-aids, which don't work nearly as well as the silver ones. But they are cheaper, and help them stay within their strict budgets!

    So don't give me the nonsense that government-ran facilities won't short change their patients by doing things cheaply as possible, yet a privately-ran facility would.
    Last edited by MrOilers; 01-06-2009 at 03:13 PM.

  74. #74
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    What is this an example of? A properly run public health system or the one we have in Alberta? There is a lot of difference between the two. I have been saying all along that as long as there are people who think there is a need for a private health care delivery, the public system is not run properly and needs to be improved.

    the problem you describe is with the restriction of funds by the government, not the "managers". If you put a manager in a position to choose between special gauze and more cardiac surgery time, the manager will likely choose more cardiac surgery time hoping that patients requiring gauze will not get an infection. This is not the problem with public health, this is the problem with the alberta version of healthcare.

    Same reason as why RAH is canceling so called "elective" surgeries and Rockyview shipping off the laser surgery equipment. Some financial bonehead in the newly created super board decided that health care should not cost more than so much. What the bonehead does not realize is that such choices defer health costs to a later day and that these costs will only escalate.

    This is where I expect a properly functioning health board to step in and to advocate on behalf of health care provision and demand the government to fund health properly. Publicly run facilities have as much funding as the government is willing to give it. We have the responsibility to ourselves to demand from our government to allocate appropriate amounts and this is where a responsive, independent and effective public health board can be so effective. A puppet board with a mandate to keep costs down will not do the same.

    Don't give me this "public health boards are not effective" because we haven't seen a properly run or at least adequately run public health board in Alberta for some time.

  75. #75
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    Quote Originally Posted by grish View Post
    there is no such thing as a private law enforcement and there is no such thing as a private judiciary. that was my argument. no, the sky hasn't fallen because of private dentists and optometrists, but the overall health care system would be stronger if those services were included in the overall health standard of care.

    the sky will not fall if individual health care aspect is spun off to private access. dermatology can be spun off and the sky will not fall because only those suffering with skin problems will be affected. then allergy specialists can be spun off and only allergy sufferers will complain. then all hip replacements can be spun off. it is just one little aspect of all surgeries. then...


    pretty soon we will find that our public health bears the weight of the most expensive to treat--oncology, cardio, hemotology, etc with no facilities as every time you spin off a less essential service that can operate as a private clinic without sky falling, the nurses and building facilities go with them.

    How about we stop fooling ourselves and realize that health care is not restricted to a particular body part or particular amount an individual is able to pay. We need to demand from our government that no matter what health issue, an individual should have access to best health care, timely without an additional cost. We have paid and continue to pay the cost of health care--our taxes. If there is still a need for private health delivery, the public system needs to be fixed.
    although if your argument was to be accepted in its extreme - and why not, you are arguing the extremes - there is nothing that affects our health either individually or as a society more than the need for adequate food and shelter. yet i do not hear any great hue and cry in favour of a "public" food distribution system or for the "public" provision of shelter to the exclusion of the private sector. and please do not take that as an abandonment of those that are not able - for whatever reason - to secure those things on their own. it is those who are the most needy that need "public" assistance - that is no reason to dilute it's provision by attempting to publicly provide it for all.

    as for there being "no such thing as a private law enforcement and there is no such thing as a private judiciary", what role do you think all of those security guards and services that seem to have proliferated in the last few decades undertake to provide? and what about the proliferation of mediation and arbitration services taking on roles and task previously fulfilled by our courts? the "private sector" is no more evil and inefficient than the "public sector" is amoral and wasteful. they are complementary parts of society at large and there is no reason they can't co-exist in health care just as they do across our society in general. it's not "how" that should be in question but "how well" that we need to pay attention to.
    Last edited by kcantor; 01-06-2009 at 03:25 PM.
    "If you did not want much, there was plenty." Harper Lee

  76. #76
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    Ken,
    very good point about food etc. actually, public health institutes have been taking a look into the access of nutritious food and shelter as a basic health care necessity and there are many efforts out there to do research in that area as a pre-cursor to changes in government policies. In general, such intervention has been common for years (fluoride in water as an example).

    Public health studies is a very common and growing phenomenon and we will be hearing more and more from that general group of health professionals in the future.

    The examples you provide of mediation and security guards would be along the lines of birthing assistants (dulas) in health care. By all means, hire private security guards. But they do not have the right to enforce and interpret law in any more meaningful way than a private citizen who chooses to pick up the phone to call the police to report crime. This is common sense law enforcement.

    Mediators do not create their own laws, they are people with skills to get two people to talk to each other. If you and I are in an argument and we have committed to resolve it, we can either pay someone to help us out or sit down and work out our differences. This is not about creating our own laws to suit our personal disagreement, this is finding an understanding between two people.

    When it comes to public health, I would rather the people who set the standards for health care and who collect money (taxes) from us to act in our common best interests actually act in our common best interest by providing access to excellent health care in such a way that no matter what you are born with or what misfortune happens to you, you have access to the most appropriate health care possible. I do not want any decisions made on my behalf to be out of financial considerations. All such decisions have to be medical. That can only be ensured in a non-for profit setting with a strong, committed group of advocates (efficient public health board) overseeing the healthcare.

  77. #77

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    Quote Originally Posted by grish View Post
    I do not want any decisions made on my behalf to be out of financial considerations. All such decisions have to be medical.
    That is a pipe dream. It does not work this way, and I wish people would stop pretending that it could under our system.

  78. #78
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    So, we agree that our system needs to be improved. You are yet to convince me that adding a private heath care tier is the best way to improve it. In fact, you are yet to present a single argument in favour of private health option.

  79. #79

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    Quote Originally Posted by grish View Post
    In fact, you are yet to present a single argument in favour of private health option.
    I mostly would just be repeating what moahunter, raz0469, and kcantor summarized, but here are the advantages that I see that private health care offers over our 100% public system:

    1. The right to choose/no dictated medical practices - right now if you needed prostate surgery in Calgary, you couldn't opt for the laser surgery (which carries fewer risks and has a shorter recovery time for the patient). Nope, EVERYBODY gets the old-fashioned and higher-risk procedure, simply because it's cheaper. You can't even offer to pay for it yourself unless you wanted to go out of the country and make the US health care system richer. Why not keep that money and business in Canada? Why eliminate a patient's or doctor's right to choose and have the better type of care?

    2. Eliminates the monopoly - this ties into the first point. Why do we not allow monopolies? Just think about that for a second, and ask yourself why is it acceptable for such an important service such as our health care system to be run like a monopoly?

    3. Up-to-date medical technologies - if there is a new cutting-edge medical test or procedure available and has been proven to work safely and effectively in other countries, our doctors cannot even direct us to it unless the government or health boards bring it in themselves. That can take an extraordinarily long time - just look how long it took for MRI clinics to be used in Canada versus almost everywhere else.

    4. Treats health care like a growth industry - right now our governments treat health care like a cost problem instead of a growth industry. Just imagine the government limiting growth of other sectors of the economy the way they stifle health care. Our public system is letting us down (even you agree to that, grish), but why don't they change? The short answer is that they don't have to. There is no innovation to offer better services required on their part, only to cut costs. Private health care encourages better services in addition to cutting costs.

  80. #80
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    Quote Originally Posted by MrOilers View Post
    1. The right to choose/no dictated medical practices - right now if you needed prostate surgery in Calgary, you couldn't opt for the laser surgery (which carries fewer risks and has a shorter recovery time for the patient). Nope, EVERYBODY gets the old-fashioned and higher-risk procedure, simply because it's cheaper. You can't even offer to pay for it yourself unless you wanted to go out of the country and make the US health care system richer. Why not keep that money and business in Canada? Why eliminate a patient's or doctor's right to choose and have the better type of care?
    first of all, you will always get "dictated" practice as it is the standard of care dictated by the college of physicians and surgeons, not any one system. your example of laser prostate surgery to me is not an option of one over the other. If it is a better way to do the surgery that cuts down on recovery and reduces the risk of complications, then it should be the standard basic care of any system. Any hospital should have this equipment. Public hospitals should have it regardless of how many other health providers are allowed to operate.

    Quote Originally Posted by MrOilers View Post
    2. Eliminates the monopoly - this ties into the first point. Why do we not allow monopolies? Just think about that for a second, and ask yourself why is it acceptable for such an important service such as our health care system to be run like a monopoly?
    Having more than one system means more than one overhead on administration. Having more than one system also means fractioning of funding. Say there is a $10 million piece of equipment. If one system can only afford to spend $7 million and the other can afford to spend $6 million, neither one of them gets it. A unified system is able to get that and more.

    If your argument of benefit is choice to the people, make the different hospitals within the same public system be that choice. There is your competition.

    Quote Originally Posted by MrOilers View Post
    3. Up-to-date medical technologies - if there is a new cutting-edge medical test or procedure available and has been proven to work safely and effectively in other countries, our doctors cannot even direct us to it unless the government or health boards bring it in themselves. That can take an extraordinarily long time - just look how long it took for MRI clinics to be used in Canada versus almost everywhere else.
    Why is there an expectation of public system lagging behind? The effective health boards need to advocate for implementation of the most current technology and training.

    The reason treatments from other countries are sometimes not being offered has nothing to do with public or private and that will not change regardless of what type of health provision we have. Any medical procedure has to be approved by health canada and accepted as standard practice of physicians. These rules will always be in force regardless of whether you pay for the procedure out of pocket or through provincial health coverage.

    Quote Originally Posted by MrOilers View Post
    4. Treats health care like a growth industry - right now our governments treat health care like a cost problem instead of a growth industry. Just imagine the government limiting growth of other sectors of the economy the way they stifle health care. Our public system is letting us down (even you agree to that, grish), but why don't they change? The short answer is that they don't have to. There is no innovation to offer better services required on their part, only to cut costs. Private health care encourages better services in addition to cutting costs.
    Health care is basic necessity, not an industry. You cannot make an industry out of illnesses, births, or deaths.

    Your overall concerns have nothing to do with not having an access to private health. They have everything to do with funding of health care and having in place effective leadership in health care to put the health of people at the forefront.

    You look at our semi-broken, alberta version of health care following the 1990's under Klein and recent removal of health boards with a large and ineffective one as what public health care is. What we are experiencing is not what public health is or should be. What we see is broken. I am suggesting that we should demand it be fixed. You're saying that lets someone else come in and provide options INSTEAD of fixing what's broken with the public health.

    My question is: If the public system gives you access to all the laser surgeries you need and gives you all silver-laced gauze you require, and sends you to every MRI you need quickly all at no additional cost to you, would you go to a private clinic? If the answer is "no", then demand from your government that level of care. Demand they fix public health to the point where you do not need to contemplate paying out of pocket for something you expect as a basic level of health care.

  81. #81

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    Quote Originally Posted by grish View Post
    Having more than one system means more than one overhead on administration. Having more than one system also means fractioning of funding.
    If that were true Grish - why is it that Eurpoean countries with "2-tier" health have health systms that cost the public less, and deliver better health care? I mean, by your argument - the government should buy up absolutley everything - oil service companies, local grocery store, ... That will elimnate overhead and administration won't it? It doesn't work that way - you only have to look at the former USSR to see what a burecratic wasteful mess that results when choice is artificially restricted. We have a little USSR in our health care right now - I'd rather we opened it up a little, just like education has been opened up to allow private providers.

  82. #82

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    Quote Originally Posted by grish View Post
    My question is: If the public system gives you access to all the laser surgeries you need and gives you all silver-laced gauze you require, and sends you to every MRI you need quickly all at no additional cost to you, would you go to a private clinic? If the answer is "no", then demand from your government that level of care. Demand they fix public health to the point where you do not need to contemplate paying out of pocket for something you expect as a basic level of health care.
    But I HAVE demanded that level of care from my government yet I still have sub-par health care that costs each and every one of us an arm and a leg, and STILL seems to be deteriorating and not getting any cheaper.

    Now what?

  83. #83
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    Quote Originally Posted by MrOilers View Post
    Quote Originally Posted by grish View Post
    My question is: If the public system gives you access to all the laser surgeries you need and gives you all silver-laced gauze you require, and sends you to every MRI you need quickly all at no additional cost to you, would you go to a private clinic? If the answer is "no", then demand from your government that level of care. Demand they fix public health to the point where you do not need to contemplate paying out of pocket for something you expect as a basic level of health care.
    But I HAVE demanded that level of care from my government yet I still have sub-par health care that costs each and every one of us an arm and a leg, and STILL seems to be deteriorating and not getting any cheaper.

    Now what?
    now change the government to the one that listens.

  84. #84
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    Quote Originally Posted by moahunter View Post
    Quote Originally Posted by grish View Post
    Having more than one system means more than one overhead on administration. Having more than one system also means fractioning of funding.
    If that were true Grish - why is it that Eurpoean countries with "2-tier" health have health systms that cost the public less, and deliver better health care? I mean, by your argument - the government should buy up absolutley everything - oil service companies, local grocery store, ... That will elimnate overhead and administration won't it? It doesn't work that way - you only have to look at the former USSR to see what a burecratic wasteful mess that results when choice is artificially restricted. We have a little USSR in our health care right now - I'd rather we opened it up a little, just like education has been opened up to allow private providers.
    such as? If your example is Germany, for example, then it is not as simple as you make it sound:

    http://www.civitas.org.uk/pubs/bb3Germany.php (a little bit dated, but not so bad)
    With the exception of about 2 million permanent civil servants, and the self-employed, Germans who earn below Euro 3,862 gross salary per month in 2004 must join one of the 300 statutory sickness funds. Those above the mandatory insurance threshold may opt out of the state system and buy private insurance instead but many opt to remain in the state system - 10 per cent of the population are voluntarily insured.

    German sickness funds are required to be financially self-sufficient and premiums are set as a percentage of income. This percentage varies from fund to fund, with an average of 14 per cent, to fall to 13 per cent under Schroeder reforms. The premiums are deducted from pay packets with employer and employee paying half each.
    First of all, Germans as a society made a commitment to the state run "sickness" funds.

    Secondly, premiums in these funds are calculated as a percentage of salary. Wait a second! What else is calculated as a percentage of salary?! Taxes. Basically, Germany has established several public health systems for which people pay with taxes. I guess Alberta and Canada can do the same, but we already have a public health system for which we pay with taxes. Why not have more? Because we do not have the population. From the little blurb above, they have 2 million civil servants. That is the population of Edmonton and Calgary combined and nearly all of Alberta.

    Thirdly, do you know how much Germans pay for their health care through health care insurance (i.e. the percentage of their salary i.e. a tax)? Remember that this is in addition to the taxes they pay anyways.

    http://www.justlanded.com/english/Ge...h/Introduction

    The downside is that medical costs are high. Health care costs - for doctors, hospital stays and even medicines - are among the most expensive in the world. There is no such thing as "free" treatment in Germany, not even in state hospitals. All care, including emergencies, has to be paid for by you or your health insurance!
    Basically, if Alberta government made a commitment to pay for a comparable system through appropriate level of taxation, we would have as strong a public health system as the one in Germany.

    What the different sickness funds provide in Germany is an extra level of bureaucracy. There is no evidence that these sickness funds make the system more efficient. There is evidence, however, that if you fund health care sufficiently, you get a very good quality system. Go figure!

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    Quote Originally Posted by grish View Post
    Quote Originally Posted by moahunter View Post
    Quote Originally Posted by grish View Post
    Having more than one system means more than one overhead on administration. Having more than one system also means fractioning of funding.
    If that were true Grish - why is it that Eurpoean countries with "2-tier" health have health systms that cost the public less, and deliver better health care? I mean, by your argument - the government should buy up absolutley everything - oil service companies, local grocery store, ... That will elimnate overhead and administration won't it? It doesn't work that way - you only have to look at the former USSR to see what a burecratic wasteful mess that results when choice is artificially restricted. We have a little USSR in our health care right now - I'd rather we opened it up a little, just like education has been opened up to allow private providers.
    such as? If your example is Germany, for example, then it is not as simple as you make it sound:

    http://www.civitas.org.uk/pubs/bb3Germany.php (a little bit dated, but not so bad)
    With the exception of about 2 million permanent civil servants, and the self-employed, Germans who earn below Euro 3,862 gross salary per month in 2004 must join one of the 300 statutory sickness funds. Those above the mandatory insurance threshold may opt out of the state system and buy private insurance instead but many opt to remain in the state system - 10 per cent of the population are voluntarily insured.

    German sickness funds are required to be financially self-sufficient and premiums are set as a percentage of income. This percentage varies from fund to fund, with an average of 14 per cent, to fall to 13 per cent under Schroeder reforms. The premiums are deducted from pay packets with employer and employee paying half each.
    First of all, Germans as a society made a commitment to the state run "sickness" funds.

    Secondly, premiums in these funds are calculated as a percentage of salary. Wait a second! What else is calculated as a percentage of salary?! Taxes. Basically, Germany has established several public health systems for which people pay with taxes. I guess Alberta and Canada can do the same, but we already have a public health system for which we pay with taxes. Why not have more? Because we do not have the population. From the little blurb above, they have 2 million civil servants. That is the population of Edmonton and Calgary combined and nearly all of Alberta.

    Thirdly, do you know how much Germans pay for their health care through health care insurance (i.e. the percentage of their salary i.e. a tax)? Remember that this is in addition to the taxes they pay anyways.

    http://www.justlanded.com/english/Ge...h/Introduction

    The downside is that medical costs are high. Health care costs - for doctors, hospital stays and even medicines - are among the most expensive in the world. There is no such thing as "free" treatment in Germany, not even in state hospitals. All care, including emergencies, has to be paid for by you or your health insurance!
    Basically, if Alberta government made a commitment to pay for a comparable system through appropriate level of taxation, we would have as strong a public health system as the one in Germany.

    What the different sickness funds provide in Germany is an extra level of bureaucracy. There is no evidence that these sickness funds make the system more efficient. There is evidence, however, that if you fund health care sufficiently, you get a very good quality system. Go figure!
    it's not as simple as you make it sound either grish. yes you will get a very good quality system if "you" fund it adequately. and that is completely independent of whether it is public or private or a combination of both. you seem to forget that goverment "has" no money. every penny it spends must ultimately be collected from you the taxpayer. so to simply say "we have to demand more" and expect that to happen as a result of your demanding without having to take that additional funding from you and from me demonstrates a basic disconnect. if it is funded sufficiently, it will be with your money and mine regardless of whether it is public or private or a combination of both. to infer that government can simply "do it" relying only on the "public" provision of healthcare without raising that money by raising more taxes is delusional - it's not free regardless of which sector pays the bill and that bill will always come back to us. so for me it is less a matter of which sector provides as to which sector - or combination thereof - is the most efficient provider of the greatest level of service without bankrupting us all - at which time no-one will receive adequate health care or anything else.
    "If you did not want much, there was plenty." Harper Lee

  86. #86
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    I agree. I have not said that I would not have to pay for it. I would not pay out of pocket, but I would through taxes. I just don't want my health care to be a game of chance--live healthy and pay little or be sick and pay lots. I accept that there are costs.

    I also accept the premise that a government does not "have" money. But the government is our agent in that it has been designated by us to act in our collective interest by charging us taxes to provide for us in the way of safety, security, health, education.

    Government raises money, as you very well know, through taxes, fees, and royalties. Our Alberta provincial government, however, has decided to use our royalties not to raise funds, but as a competition tool to attract industry. In that way, the government places the presence of industry ahead of immediate raising of funds. I disagree with this, but it is only tangentially relevant to present discussion. The only reason I mention this is because of the theme I have been trying to develop that health care as we have experience with is not the ideal version of health care, and it needs major improvements. Amongst such improvements is the shift in financial priorities within our government towards funding of health care better (perhaps at the expense of using our royalties as a competition or perhaps by taxing us appropriately to cover the shortfall in health care spending). Another improvement is the establishment of good, accountable health boards with medical professionals making decisions based on sound medicine, not financial considerations.

    Now to the point of public versus private. I guess we need to define what we see as public and as private. There are many types of private including not-for-profit private. What do you see as private? What will the "private" system use as its core decision maker?

    If there is a way to ensure that all choices are made for the health of the patient first and foremost, and profit a distant second, we may find a common ground. However, even if the profit does make it into the equation, I would like the profit to be entirely reinvested back into the system (making it a non-for profit) for continual improvement.

    One of the reasons people mention "competition" as being somehow good is because of the belief that the desire to get ahead and to be first or best, people will make choices to make the operation as efficient and cost-effective as possible. If you accept that this is a motive to get ahead, it is certainly possible that such motives may lead to choices made that are not in the best interests of the patient, rather in the best interest of the corporation. I believe "profit" should not ever be allowed to enter into health care equation unless under a non-for profit scheme. I agree with cost-effective delivery of health care, but not profit. I think "business" is not always the best analogy. Health care should not be seen as a business. (Education should not be seen as such either, but that is a different topic).

  87. #87

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    ^The point also, is that we can look at systems like Germany, the UK, France, and Japan, Australia, etc. - and make improvements based on what we learn. I think the fundamental difference in many countries, is that you are given a choice between the government, or whoever else it is you want to provide your health care. People, have the option to pay for more if they so choose (choice is IMO a fundamental human right, just as universal health care is a human right). In many countries, wealthier people are even required to pay more for insurance. Or in many systems, people can choose different packages depending on the level of service they demand (and we don't all demand the same level, be we poor, or rich). The point being - when some people choose to pay more, then it frees up money so that other people (e.g. public in general), get better care for the same health dollar spend. You can try to proxy that all through taxes, but the nexus between what people require, what they are willing to pay, what they are able to pay, and who they want to provide the service, is simply not direct enough to be efficient - self serving bureaucracy takes the place of patient service (as we see right now in Canada).
    Last edited by moahunter; 02-06-2009 at 05:45 PM.

  88. #88
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    when you require a person to pay more based on their wealth, it is a tax just like the federal tax in Canada. The example of Germany is an example of tax-supported health care much like tax supported Public and Separate School boards in Alberta. Pay the tax, but designate which system gets your money. That is what German system essentially offers. We could do the same, but we have to be careful with this choice as it may split the funding to the point where individual systems cannot afford that which a unified system can. We do not have the population of Germany or Britain or what ever other country and we do not have the density.

    You also have twice the overhead paid with essentially tax money--a big criticism of split public school systems. I am not convinced that Separate school system makes public education any better. Teachers, principals, and students still come from the same population pool. I am not convinced that split medical system will offer benefits in terms of care. All doctors, nurses and patients will still come from the same population pool, but funds to get better equipment will be split.

    I cannot get past the point that in Germany, people pay a lot in this tax they call sick fund contribution, and by collectively and individually paying a lot, they get a very good health care. Lets see if we can get the same level of care in our system by funding it properly (including taxes and/ or fees). If that does not work, then we can see what competition will offer us.

    I think it is unfair to claim that public system has no possibility of working properly until we commit to try and fix the public system.

  89. #89

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    So I'm not following - all you all saying that there IS A WAY to keep health care costs at the inflation rate in light of the demographics?

    I'm assuming we're talking total health care costs - not just the gov't's portion of them (should they offload risk and cost onto the individual).

    One thing I've ignored is possible lower costs arising from the proportion of the population of low healthcare using ages - maybe it will offset demand and keep costs down.

    Systemic and technological changes are sure to create change but they are too complex for me to understand.

  90. #90
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    I did not say anything about inflation rate. I am saying that we cannot expect the same results as in germany. I am also saying that it is not clear whether it is having the many options of sick funds or paying a higher health premium which is also tied to the level of income that is making health care more advanced and of higher quality. Finally, having a more dense and more populous country makes it easier and cheaper per person to create a more comprehensive health care. Perhaps when Alberta is 12 Million people we will need several "sick funds" or health boards to make them more accessible to the people.

  91. #91

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    Quote Originally Posted by grish View Post
    You also have twice the overhead paid with essentially tax money--a big criticism of split public school systems. I am not convinced that Separate school system makes public education any better.
    As a parent, I disagree with that. I see two school systems competing for my children - and it helps both of them. We have been offered a variety of innovative programs from both the separate and public systems. I have no doubt, if we only had one of those two systems, none of those programs would exist, and our education choices would be lessened.

    In the same way, when a new store moves into the neighborhood, other stores have to raise their game. If a group of doctors, feed up with the bureaucracy they work under, set up a new clinic, it would raise standards. At the end of the day, people like having choice - I'd rather decide with my spouse what level of health care we do or don't want for our family (2 tier systems allow that, while providing universal health), rather than leaving that decision to the faceless bureaucrats in health boards you feel can be so perfect in making all decisions for us.
    Last edited by moahunter; 05-06-2009 at 09:22 AM.

  92. #92
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    I feel that the greatest cost to Healthcare in this region is the Leipert Factor
    I am also pretty tired of the Conservative party using the Corus / CHED figure dave rutherford as their spokesperson

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    ^ Rutherford is another character high on my disgust-o-meter, although he seems to be better educated and more lucid than your L-word guy.

  94. #94
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    Quote Originally Posted by moahunter View Post
    Quote Originally Posted by grish View Post
    You also have twice the overhead paid with essentially tax money--a big criticism of split public school systems. I am not convinced that Separate school system makes public education any better.
    As a parent, I disagree with that. I see two school systems competing for my children - and it helps both of them. We have been offered a variety of innovative programs from both the separate and public systems. I have no doubt, if we only had one of those two systems, none of those programs would exist, and our education choices would be lessened.

    In the same way, when a new store moves into the neighborhood, other stores have to raise their game. If a group of doctors, feed up with the bureaucracy they work under, set up a new clinic, it would raise standards. At the end of the day, people like having choice - I'd rather decide with my spouse what level of health care we do or don't want for our family (2 tier systems allow that, while providing universal health), rather than leaving that decision to the faceless bureaucrats in health boards you feel can be so perfect in making all decisions for us.
    moahunter,
    while I understand that you feel that, the fact is that each school is in competition with the other within edmonton public schools. that is because of the way funding following the student. in fact, when you say you are being offered innovative programs, it is done so because individual schools look for innovations. not districts necessarily. I didn't want this to become a schools thread. I think we already had one or two on this very topic. So, I'll bring it back to hospitals and health care.

    If people call on some sort of competition as the means to ensure innovation and improvement (which is more important than innovation), first of all I would like someone to prove through research that competition in the health care leads to innovation. While some people or many people accept that as a given, it isn't so straight forward. Particularly in the health field, the risks of competition (such as cutting corners where corners should not be cut) may outweigh the benefits (using the business model of looking at things). There are, of course, many different ways of evaluating medical programs.

    Secondly, assuming such research is conducted and the positive link between competition in the health care system does lead to improvement, the outcome maybe competition within hospitals (not for emergency patients, but for all others) is sufficient rather than competition between separate whole health groups (or tiers or sick funds--what ever we want to call them).

  95. #95

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    Quote Originally Posted by grish View Post
    Particularly in the health field, the risks of competition (such as cutting corners where corners should not be cut) may outweigh the benefits (using the business model of looking at things).
    Cutting costs is not the same thing as cutting service. Why can't some people understand that? There is always a minimum standard that must be met, and if doctors, surgeons, hospitals, and clinics can all meet these standards in quicker and cheaper ways shouldn't that be encouraged? The thing is, it is not. Ther in ZERO incentive to improve anything.

    One problem is that everyone is so dead-set against any kind of changes or innovation in our current system. Your attitude throughout this thread exemplifies this.

    For example, if a clinic figures out a way to do surgeries in half the time it takes to do elsewhere, they get slapped for spending their money too fast. Meanwhile, all they are doing is giving patients the same service more efficiently. Yet the clinic is forced to slow down or only do half as many surgeries with this new procedure, and as a result the patients have to wait longer for their surgeries. Meanwhile, no money is saved, the operating room was sitting empty some days, and many patients' health deteriorated while waiting twice as long for surgeries, and as a result their care needs become more complex (i.e. more expensive surgical procedures and more difficult recovery).

    For the record, that is not a hypothetical scenario. I worked in one position in public health where I saw that EXACT scenario unfold. I gained a new level of disgust with our health care system that day.

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    Province having difficulty to pay RN's ever-increasing salaries, yet recruiting more and more.
    Something has to give. RN's working part-time basis, yet collecting overtime, double-overtime in some cases.

    There is no way RN's can keep demanding more and more $$$, and hire more RN's at the same time. There is only so much money to go around.

    I feel that there is more than what is reported. Alberta Union of Nurses like to put an emotional spin on this issue.

  97. #97

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    Of course if there were enough nurses the part time ones wouldn't be called in to work overtime now would they?

  98. #98

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    Every full-time nurse I know (as well as part-time ones) gets called at home every other day off to work an overtime shift.

    I think the Unions are partly to blame for the mess as well. After all, unions and employers (in every industry) tend to treat each other like adversaries instead of partners.

    I personally know a lot of nurses (RNs and LPNs), and none of them complain about their salaries, hours, or jobs. When they do complain, they complain about exhaustion, stressful work environments, having to do things beyond their scope of training and expertise, and not having enough help to do their job as well as their patients deserve. It doesn't matter how much you pay the nurses, there will still be 2 or 3 patients lying in their feces-soiled beds for an hour, while all the nurses have their hands full trying to get medications distributed and attending to the call bells are going off for other emergencies. Most of these things are a product of increased work demands because of a lack of adequate staffing.

    But there is plenty of blame to go around for the problems in our health system.

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    Quote Originally Posted by Tiran View Post
    Of course if there were enough nurses the part time ones wouldn't be called in to work overtime now would they?
    According to the Nurses Union, there will never be enough nurses.

  100. #100

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    According to the nurses I know there aren't enough nurses, porters, health care aides, and doctors either.

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