# National Health Care is about to CHANGE!



## MacNutt (Jan 16, 2002)

I checked back in here tonight expecting to see a VERY heated debate about today's monumental Supreme Court ruling about private health care access in Canada.

But..nothing. Only dead silence. Odd about that, eh?

Okay....for those of you who may have been in a distant cave for the past day or so, I will present a quick recap of the recent earth-shaking events:

Today, the Supreme Court recognised the consitutional right of a Quebec medical patient to recieve _TIMELY_ medical attention for a serious condition. In other words....the Supreme Court has enshrined in law the rights of Quebecers to pay for their medical care at private clinics, if they so choose. And if they can afford to do so.

Which means that, at least in Quebec, a person who is suffering from an injury or medical condition no longer has to wait for weeks or months or years for the failing public health care system to get around to treating them. That person can now pay up front, and get the matter dealt with almost immediately. At a PRIVATE _FOR-PROFIT clinic!   

Just like in most of Europe. Where lineups are pretty much a thing of the past. And where medical care is the very best in the world. And where per-capita medical care costs are actually the same...or even LESS than they are here in Canada.

Let's make no mistake about this...what we are talking about here is clearly a Canadian approved TWO-TIER health care system. Which has long been the rallying cry of derision for a lot of die-hard Left/Liberal types around here.

Paul Martin himself has loudly declared that this is something he will FIGHT against while he is in power. (Despite the fact that Paul Martin and his whole family use private for-profit medical care exclusively. As did Jean Chretien and HIS whole family. Stephen Harper and his clan use ONLY public hospitals, BTW).

Anyone care to comment on this? Anyone care to explain to all the rest of us why Quebec should be able to have this parallel private/public system and no waiting lines while all of the rest of us suffer in pain for months or years? Also care to explain how this new parallel system will NOT be coming to a "Province near you?" Rather soon? 

This should be interesting. To say the least.  _


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## ArtistSeries (Nov 8, 2004)

MacNutt, check over at www.macmagic.ca...

ohh wait, you can't post there.... no wonder it's more civilized.... 
(just joking my friend)

Sorry MacNutt - you are grossly misinformed about the situation in Quebec. We have some of the worse waiting lines and poorest health care in Canada. 
Get informed and please try again.


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## bopeep (Jun 7, 2004)

Before anyone gets into the 'right to access' argument: 

Healthcare is not just about treating the symptoms, it's about prevention too. 
That being said, without privatising [sp?] healthcare, every Canadian should then have the right to consume organic produce at a price equal to other produce, they should have the right to pursue 'alternative' healthcare without additional costs to the patient, they should have the right to drink clean water... and so on. 

I do hope that this is a step in the right direction. I hope that it does, in fact, push the rest of theprovinces to find ways to enrich our failing, unsustatinable health care system, but I am truly afraid that it won't remedy the problem at all. 

Cheers
Bo


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## MacNutt (Jan 16, 2002)

ArtistSeries said:


> MacNutt, check over at www.macmagic.ca...
> 
> ohh wait, you can't post there.... no wonder it's more civilized....
> (just joking my friend)
> ...


Considering the fact that the judgement has just come down...I don't doubt that you still have some pretty long lineups.

And you might just want to get a bit more "informed" yourself. This decision changes EVERYTHING!

Watch and see.


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## MacNutt (Jan 16, 2002)

BTW...I am at "magic" on occasion. Lots of people drop by there while using pseudonyms. But I'm not there very often. It's a bit slow...to say the least.

I like it here much better. (I use a PC once in a while..but I prefer a Mac. Same thing.)


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## ArtistSeries (Nov 8, 2004)

Let's get some disinformation that I'm expecting out of the way first Mr. MacNutt.


> The World Health Organization ranks Canada's health system 30th in the world and the United States 37th. France, which allows private services to complement its universal system, is ranked first.


http://abcnews.go.com/International/wireStory?id=834633&page=3


- Quebec still has long lineups - there has been no magic-no more lineups- wizard that came overnight and cured all that.

- This blow only affects medically necessary services. Quebec is already well ahead in many private heath care ventures.

- no political party advocates a two-tier health system.


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## MacNutt (Jan 16, 2002)

I don't ever recall comparing our system to the one in the USA. Nor do I advocate adopting a US-style health care system here in Canada. Never have.

But I do think that, now that this Supreme Court decision has been handed down, we are now heading toward a European style system that has parallel private and public delivery of publicly funded health care. This means private hospitals and private clinics. For-profit.

And the Big Unions would not always be a part of it. Nor would they be able to strike and shut the whole thing down, since they wouldn't have total coverage of all the labor force.

A parallel system that includes for-profit hospitals and clinics that operate freely in each province would be a HUGE change for Canada.

One that Paul Martin has publicly said he will fight to the death to prevent. (while using just such a system himself, BTW).

The Labor/NDP have been dead set against this since day one, as well. And the NDP is pretty much all that's standing between Paul Martin and political oblivion these days. Without the NDP, Martin's Liberals would be sunk the day after tomorrow.

I wonder what sort of fragile eggshells Paul Martin will have to walk over in order to please everyone THIS time?

Should be interesting. To say the least.


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## MannyP Design (Jun 8, 2000)

I'll say this: I'll welcome any change at this point -- my wife and I had to wait approx. 5 years to find a family doctor... only to finally settle for one in Ontario (which means we pay for everything because this one doesn't accept QC health cards.) The Quebec healthcare system will only reimburse around 55% of the amount spent (because they're bastards... you'll get more if you're lucky.) When we had to get blood-work done, my reimbursement cheque, for the same thing mind you, was 15 dollars less than my wife's. We still can't find a pediatrician for our soon to be born son, so in the meantime we have to, again, settle for going to walk-in clinics for whatever problems he'll have.

We wanted to have our son born on Ottawa, but alas, that would have cost us $1100 after the reimbursement. Wow. Universal healthcare at best.

So much for free healthcare.


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## SINC (Feb 16, 2001)

Our medicare has been in decline for far too many years now. And the very worst problem we have? Waiting lists. YEARS of waiting for sick and dying people.

Somewhere there is middle ground where the private sector can provide minor procedures to reduce that wait time so Canadians can get timely health services.

The government now must be innovative enough to develop a firm policy on who can do what, where and when. They also must strictly regulate health delivery so that no private health care giver is paid by anyone but the government of the province in which it operates, and paid at fees acceptable to that government as well.

Think of it as reverse tender where the government offer $2000 for a knee replacement procedure. If private companies can make money doing the procedure, why not?

Until Canadians take off their blinders, they cannot see that simple plan will benefit all of us.


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## Dr.G. (Aug 4, 2001)

I personally agree with this "middle ground" approach that Sinc talks about in his last posting. I worry about the migration of doctor's, especially specialists, into the private sector, leaving the public health care system with longer wait times. Still, just as I would not want to be restricted as to where I went to work, I can't see forcing doctors to remain in the public health care system.


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## NewBill (May 29, 2005)

Who's investing in private medicare?

The debate about the quality of care is a constant cover for those investing in private health care with an expectation of great profit.

If the so called second tier cannot bill the public system in whole or in part and the revenues to the public system remain intact there would be no problem. What are the chances?

The idea that since public services always lose money then let a private entrepreneur do it and make a profit while at it, makes me quake. The private entrepreneur will carve off the most profitable service delivery to the most well healed client and leave the dross to the public system, and receive kudos from his fellows, encouragement from his investors and accolades from the naive.


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## ArtistSeries (Nov 8, 2004)

« MannyP Design » said:


> We wanted to have our son born on Ottawa, but alas, that would have cost us $1100 after the reimbursement. Wow. Universal healthcare at best.


This is nothing compared to how much it is in the US. So how would you propose it be improved and how to you think a two tier system will help your situation?


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## MannyP Design (Jun 8, 2000)

ArtistSeries said:


> This is nothing compared to how much it is in the US. So how would you propose it be improved and how to you think a two tier system will help your situation?


If this was the U.S. my wife and I would have been fully covered as we both have jobs that have/would have benefits including medical coverage. End of story.

Two tier system would effectively take _some_ of the stress and cost of the current system is going through. What would you propose -- do nothing at all? Canadians are taxes up the a$$ yet our healthcare is abysmal. What are we doing wrong compared to other countries?

(Don't answer that MacNutt -- I already know.)


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## Paul O'Keefe (Jun 3, 2005)

*Equality*

I like a universal system where everyone gets the same treatment. A two-tier system means that the rich deserve and will get better medical services because they can pay for it.

I don't think someone should get better medical services than another just because they are wealthier. And vis versa, a less well off individual shouldn't get inferior health care.

Wait times are long. Finding a doctor is difficult. Even when you find one, keeping one is difficult.

I'm not sure what the solutions are. I'm pretty sure though that every one has the right to timely health care... though I don't think we have it yet. I'm not even sure we have a "universal" system if they are all administered differently in each of the provinces.


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## Paul O'Keefe (Jun 3, 2005)

« MannyP Design » said:


> If this was the U.S. my wife and I would have been fully covered as we both have jobs that have/would have benefits including medical coverage. End of story.


At least in Canada, it doesn't matter, or is not supposed to matter if you have a job or not. If it's a good job with good benefits or not. In the US, many people go without coverage. Many employers in the US cite health care as a cost to them that must be cut... GM anybody. Employers don't want to provide these benefits.

I like a system where it doesn't matter who I work for. Where it doesn't matter if I have a job. Where it doesn't matter how much I make. Where I am a equal citizen, a human being with an equal right to equal care. We take care of each other, not just ourselves.


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## ArtistSeries (Nov 8, 2004)

« MannyP Design » said:


> If this was the U.S. my wife and I would have been fully covered as we both have jobs that have/would have benefits including medical coverage. End of story.


Your montly insurance fees would pay for that, yes. But can you afford 1000$ a month insurance premiums? 
Then her stay in the hospital would be limited to half a day. Your wife would be back to work in less than a week. And speaking of procedures they would select the one they want to give your wife that would save the money.


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## MannyP Design (Jun 8, 2000)

Paul -- that's the problem. We're not supposed to have to pay, yet If I can't get a pediatrist for my son in Quebec, I will have to go to Ottawa where I will pay _anyway._ Where's the benefit in that? Where's the universal healthcare? We've paid over 300 dollars (each so far) for tests and medical-related appointments that were needed... how is this better than the U.S.?

EDIT: AS: I can guarantee you that if we lived in the U.S., we'd be making a _lot_ more money and have better coverage. Enough to guarantee better healthcare than what we're getting here... not to mention spend less time waiting.

I'd like to see some sources to the premiums you're saying U.S. folk have to pay. I have several friends here reading this who think you're insane.


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## ArtistSeries (Nov 8, 2004)

Dr.G. said:


> I personally agree with this "middle ground" approach that Sinc talks about in his last posting. I worry about the migration of doctor's, especially specialists, into the private sector, leaving the public health care system with longer wait times. Still, just as I would not want to be restricted as to where I went to work, I can't see forcing doctors to remain in the public health care system.


Sinc's solution is to outsource. That's not a middle ground.

In Quebec the cost of a doctor's studies are funded by my tax dollars. He should stay in the province for a little while. Try getting a MD in the US, and you will see why it's so expensive there.


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## Paul O'Keefe (Jun 3, 2005)

MannyP, yes it appears we don't have "universal" heath care. It shouldn't matter if I'm I'm from Newfoundland and I get health care services in British Columbia, Manitoba, Ontario, etc. No one should be expected to pay extra fees because provinces won't reimburse other provinces 100%.

But as for your particular issue, if you've been living in Ontario for a while and have been paying taxes there, presumbably wouldn't you have some sort of Ontario health card/plan?


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## Paul O'Keefe (Jun 3, 2005)

*Who pays for the HMO?*



> I'd like to see some sources to the premiums you're saying U.S. folk have to pay. I have several friends here reading this who think you're insane.


Who pays for the HMO if you don't have a job? Who pays for your health benefits if you work at a crappy WalMart job? I have an online buddy who's been working at a Walmart in Wisconsin for the past seven years. I think the government actually pays most of his benefits, because you know WallyMart, they don't really give out great benefits. Even then, he still has to pay out of pocket for some things.


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## MannyP Design (Jun 8, 2000)

That's the problem, I don't live in Ontario -- I live in the Gatineau-Outouais region (which is on the border of Quebec/Ontario) where it's impossible to get a family doctor (as well as a pediatrist.) We have to go to Ottawa, because there's where we could find a family doctor. I have to pay $35 for every visit, and get 1/2 back from the Quebec government.

Yay for free healthcare.


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## Clockwork (Feb 24, 2002)

One point I heard on the news from a doctor kinda made sense. He was saying if we open up to private health care than waiting times will decrease because those who can afford it probably wont wait. 

The only problem is it may end up swinging all the way to the private side some day. I just worry about poor people who may get stuck with more burdens if they can't get jobs with good health care. You hear of people in the States that can't even afford medication cause they need to eat. That is a terrible inhumane way to treat people in the ritchest country in the world. 

Our health care sucks. My wife is a nurse and can attribute to how bad it really is. I work in the mental health field and the government has cut funding in almost every community based organizations. It seems like we have a backward system. Wait until it's to late and then help people which costs more.

We need to focus on prevention, treatment and putting money into the most important area in all our lives our health at least in my opinon. What are we paying high taxes for when our health care has went down the toilet over the last decade or longer. 

Sure you can live in the Sates and get a good job and have good benefits but what about the people that don't have good jobs. Then they get sick in the long run due to not being able to get proper medical treatment. In the long run the government pays more. 

Im not completely against private health care. Reducing waitng times, having an option, but that still doesn't fix the free health care we are intitled to. Health care is something that Tommy Douglas fought hard to have and I am sure he is rolling in his grave. Instead of giving corporations tax free billon dollar loans with our money they should be putting it into hospitals and community agencies that in the long run help to prevent long term ilness. Im not saying the Government shouldn't help our economy but we as citizens need to come first. 

Ive just so tired of the Liberals, NDP, Con's, and all the other parties that break promises. We seem to live in the era of bs.


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## Paul O'Keefe (Jun 3, 2005)

« MannyP Design » said:


> That's the problem, I don't live in Ontario -- I live in the Gatineau-Outouais region (which is on the border of Quebec/Ontario)


Ah... The info on the side said you were locaated in the Nation's capital, so I assumed that meant Ottawa. I guess your place is near enough there to work there or something.


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## Dr.G. (Aug 4, 2001)

Paul, sorry to tell you "reality check", but there are 45+ million Americans without any sort of health care benefits. If I am working at Walmart, and they don't have a medical plan (I cannot say if they do or do not, so I am just using this as a hypothetical situation), but I am working for a wage, then I am not entitled to either Medicare or Medicaid. These are government supports for those on social assistance programs (i.e., people not working receive help under Medicaid) and those on Social Security (i.e., those people over 65, or receiving Social Security benefits receive Medicare). So, if you work for a company that cannot or will not provide any sort of health insurance coverage, and you cannot afford to pay for this insurance (e.g., Blue Cross) on your own, you are out of luck. This was a big issue in the 2004 presidential election, and while Bush made some vague promises, the billions for the war in Iraq have dashed any sort of help for these 45+ million uninsured persons in the US.


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## MannyP Design (Jun 8, 2000)

Paul O'Keefe said:


> Ah... The info on the side said you were locaated in the Nation's capital, so I assumed that meant Ottawa. I guess your place is near enough there to work there or something.


Yes, It's close enough that I could bike to work.


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## SINC (Feb 16, 2001)

ArtistSeries said:


> Sinc's solution is to outsource. That's not a middle ground.


If a compromise of delivering services by the private sector under government supervision is not middle ground, then what is?

It will reduce waiting lines for sure.

The court's decision is a timely warning to government that unless they address long waiting lines, the public has the right to seek other solutions.

Middle ground solutions like outsourcing.


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## Clockwork (Feb 24, 2002)

We seem to be following the States more and more. Can anyone say for certian that we won't have a private health care system in the future. This is just one step in that direction. As Dr G was saying, many Americans are suffering and the Goverment could care less. I hope we continue to have at least a bit more compassion for those who are less fortunate. The Government has caused this problem and now they need to fix it, or perhaps this is just an excuse to cut health care?


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## ErnstNL (Apr 12, 2003)

Our critcism of healthcare services should be directed at the correct source:
Our Provincial governments. It's the Federal government's fault for not enforcing the Canadian Healthcare Act.
Universal Healthcare 


I agree with the Quebec court on this ruling.
Quebec healthcare needs to be fixed. 
My relatives in Montreal say Nfld healthcare is much better than what they've experienced in Quebec. 
The money is given to the provinces as healthcare transfers based on a number of factors; population, geography, etc. What the province does with the money is hardly questioned. 

2 tier healthcare has been around for 30 years. As examples: 

What about the funding for terminating pregnancies. The law says it should be available to everyone, funded by our healthcare system.
Why did private clinics spring up in major cities? Paid for by patients and partially re-imbursed by medicare? That's 2 tier healthcare. 

Why can I get physiotherapy, therapeutic massage, blood drawn for labwork by mobile vampire units, drugs, all paid for by Blue Cross and others without insurance have to pay full cost? That's 2 tier healthcare.

Why are there private laboratories performing routine diagnostic testing for a fee throughout Ontario, Quebec, Alberta etc. You pay your money up front and get your labwork done faster than going down to the Blood Collection dept and waiting at the hospital. That's 2 tier healthcare again.

2 tier healthcare is here already. It's subtle but here.


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## MacGYVER (Apr 15, 2005)

Yes, finally!!!

I welcome a private sector in our health care system. Health care across Canada is not free in every province like most Ontarion's like to believe. When I moved out to B.C., I was slapped with paperwork that told me I had to pay out of my own pocket so much a month for provincial health care costs. I didn't have health care being looked after through the B.C. provincial tax system like we do in Ontario. I was given a few choices, I could either pay it all myself every month by sending them a cheque for an amount of $56 for having health care, or I could see if my employer would cover at least 50% of the cost for having health care. Well my employer covered 50% of the health care costs, but every pay cheque, so much came off for health care costs. It truly sucked to see that amount come off my pay cheque on top of my regular taxes. Luckily I didn't have a family as the costs are even more per month when you have children etc... I believe there are quite a few provinces in Canada like B.C., A.B. I think Manitoba that charges as well right out of your pocket.

One thing I have to say I liked was, I could walk into any doctors office and not have to wait in line to get looked after. I also had the same experience when I had to take a friend to the hospital. Was it luck? Perhaps.

One problem I see that has happened in Ontario is that so many people run to a walk in clinic for the dumbest things these days. Or they end up going to the hospital for very stupid things. Why should I a person who is seriously injured have to wait in line because someone thinks the common cold they have is something that will kill them? People now go to the hospital or walk in clinic if they have a cut on their finger. Give me the opportunity for a private health care system and I will be glad to pay up front for speedier service and better care over all. This way I can by pass all those with finger cuts taking up precious time and resources at these walk in clinics and hospitals.


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## ArtistSeries (Nov 8, 2004)

ErnstNL said:


> Our critcism of healthcare services should be directed at the correct source:
> Our Provincial governments. It's the Federal government's fault for not enforcing the Canadian Healthcare Act.
> Universal Healthcare
> I agree with the Quebec court on this ruling.
> ...


Thank you ErnsNL -


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## Paul O'Keefe (Jun 3, 2005)

Yes ErnstNL, that was excellent post.

Dr. G, yes my Walmart in Wisconsin friend does indeed depend on various government funded services... such a low income housing. Basically he is the working poor. There are many experimental Working/Welfare programs in the States.


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## used to be jwoodget (Aug 22, 2002)

I fail to see anyone explaining how this ruling will shorten waiting lines in general. Waiting times are caused by two factors. A lack of MDs and nurses and secondly by a lack of funding. The second issue, which is much less of an issue than the first, will allow private clinics to charge patients to have certain procedures performed. However, who will do these? They will recruit doctors and nurses from the public system. Does anyone think these people will simply be working overtime? They are already over-worked.

Moreover, the private clinics will stay well away from complicated procedures, and should they botch an operation, who do you think will do the clean-up? As a consequence, unless these clinics are somehow able to train professionals or recruit them from other countries, they will actually increase waiting times. One MD on the National last night said he liked the fact that he could spend more time with private patients. So would everyone but the reason our MDs have little time is because their patient load is so high. One way to get around that would be to exclude a large fraction of the population from accessing an MD - which is exactly what private healthcare does.... 

Your financial well being is a result of a complex algorithm of good luck, hard work, ability, frugality, inheritance, etc. A strong financial position has lots of benefits and rewards. Why should it allow you to push a fellow Canadian to the back of the line? We are all equal as citizens and if you believe we have equal rights as humans, then equal access to healthcare is a principle worth fighting for. 

As has been pointed out, we DO have private provision of healthcare but it is under the single payer model when it comes to actual operations, medications, etc. Services are different. In addition the Workers Compensation Boards in several provinces will pay the public system for treatments, MRIs, etc. This maintains the right to equal access and provides the provinces with options to contract out services to the most effective suppliers. What this ruling starts nudging towards, is simply queue jumping by those who can personally afford it. It's very simple. The fact is that no one is stopping you queue jumping right now - just go to a private US hospital with your credit card.

Our healthcare system needs a lot of work and reform but it is by no means unique and it is by no means worse than many two-tier systems. Working to reduce our waiting times is a far better solution than opening the door to profiteers who answer to shareholders, not patients.


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## MacNutt (Jan 16, 2002)

NOW we have a discussion here! A good healthy debate! Too cool. 

I haven't much time this morning to really get into this....but I would like to gently re-direct everyone's attention _AWAY_ from the US example and _TOWARD_ the European systems of national and universal health care delivery.

No one goes without timely (pretty much instant) top grade health care in most of the modern European countries. And the very same doctors and hospitals accept both poor and rich, according to what I've been told. The rich pay, and that covers the medical costs for the less than rich. The rich can get a fancy room or a certain doctor if they'd like...but they pay dearly for it. This finances lots of cool stuff that the less than rich can take advantage of. For zero cost to them, BTW. No one is ever turned away because they don't have money.

And I'm told that some of the public hosptals are actually turning a PROFIT these days! Pretty much all of the private ones do...or they'd shut down.

Let's see here...a Universal Nationalised Health Care System that provides the very best medical care on the planet to ALL citizens..and the actual cost per-capita is the same or LESS than the failing and unsustainable Canadian one.

Hmmmmmm...so why do so many here keep on referring to the American system? Why not have a good look at the sucessful private/public systems in France, Germany, Switzerland, etc?

I think we might just learn something from them. If we just shed our fears and open our eyes a bit.


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## ErnstNL (Apr 12, 2003)

UTBJW, I agree completely.
We need more qualified staff.
BUT when the NF Gov't and the Medical Association says there can only be a certain amount of GP's in the St. John's area so that there is a so-called balance of MD to patients, where does that leave the patient?
It's hard to find any GP in St. John's that will take on any new patients. Good luck to anyone moving here.

We need walk-in facilities with around the clock access to better utilize our emergency depts. 
That's what they are there for, to save our lives when we need them! 
The overworked GP's around St. John's close up on Friday afternoons, so where are ya gonna go with your cut finger? Migraine? Twisted ankle?
Emerg. 
There isn't any where else to go.

There are 2 models for care here in St. John's. 
The Janeway pediatric hospital has it down pat. It's efficient, hardly any wait times, accessible. Excellent care. New equipment everywhere. It works very well.
On the other hand....attached to the same building...
The adult system is a wonky mess that trips along, hoping to not to cause harm as it discharges drugged up patients hrs after minor surgeries so that Mr. Levon Time can say that we are following patient care guidelines developed in some office on Bay Street.
One system works and the other is dangerous.


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## GratuitousApplesauce (Jan 29, 2004)

Health care in Canada is an extremely complex subject. I really can't claim to understand all the ins and outs.

Personally I don't really care too much about the mechanics of it, as long as it works and as long as the idea of universality is never abandoned. I think the angst that people have is that if we change something this may present a toehold to those who don't care about universality. 

This is why there's so much angst about yesterday's court decision. I haven't yet heard one person in the media, who can say what exactly that decision means and how it will affect the principle of universality, that Canadians hold dear.

To those who say, if we have private delivery or private insurance it will work for me - well that's great for you. What may not be so great for you is if because the working poor and even the lower middle class start to sink downwards because of the financial burdens of lack of healthcare, which will result in even more social disintegration, a la the USA.

Two comments from above that I agree with:


NewBill said:


> The idea that since public services always lose money then let a private entrepreneur do it and make a profit while at it, makes me quake. The private entrepreneur will carve off the most profitable service delivery to the most well healed client and leave the dross to the public system, and receive kudos from his fellows, encouragement from his investors and accolades from the naive.





Paul O'Keefe said:


> I like a system where it doesn't matter who I work for. Where it doesn't matter if I have a job. Where it doesn't matter how much I make. Where I am a equal citizen, a human being with an equal right to equal care. We take care of each other, not just ourselves.


Amen, Paul and Bill!


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## MacNutt (Jan 16, 2002)

And it's only going to get worse. MUCH worse. A whole bunch of doctors are about to enter retirement age...just like the rest of their baby-boomer generation. Just about the same time as that whole huge cohort (the largest single age group in Canada) begins to really NEED a whole lot more medical care.

And the Liberals have no idea or plan on the books that could possibly deal with this looming crisis. They won't have the luxury of simply "throwing more money at the problem" because tax revenues will be down signifigantly due to the masses of people from this generation leaving their jobs for retirement.

You think we got troubles in health care land _NOW??_  

Wait ten years. You aint seen NOTHIN yet!


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## MacNutt (Jan 16, 2002)

Interesting article in "Macleans" about this.

Check it out (scroll all the way down when you get there.)

http://www.macleans.ca/topstories/health/article.jsp?content=20050516_105668_105668


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## PosterBoy (Jan 22, 2002)

MacNutt said:


> A whole bunch of doctors are about to enter retirement age...just like the rest of their baby-boomer generation.


I'm sorry, but when exactly are the baby boomer going to destroy health care/ruin the economy/create a huge void in the work force? I've been hearing about them being "about to retire" since I can remember, but it's yet to happen.

When, exactly, will it? Just curious.


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## MacNutt (Jan 16, 2002)

The very first members of the massive baby boomer generation are expected to begin to retire in the last year of George W's Presidency. Over the next twenty years pretty much all the rest will begin to leave the workforce and take a much deserved rest. The fact that so many are already preparing a nice place to spend their "golden years" is a goodly part of what is driving the property boom out here on the best coast. Ask any realtor. 

And this massive demgraphic shift will affect EVERYTHING. Ask any economist.


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## Dr.G. (Aug 4, 2001)

Paul, your comment that "I like a system where it doesn't matter who I work for. Where it doesn't matter if I have a job. Where it doesn't matter how much I make. Where I am a equal citizen, a human being with an equal right to equal care. We take care of each other, not just ourselves." is quite astute. Right on!!! I also feel that if we are all in the same boat together that there is a greater chance for real and positive change. If we have a two-tier system, there shall be a lessening of demands from part of the population. We shall see.


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## MacNutt (Jan 16, 2002)

Dr.G. said:


> Paul, your comment that "I like a system where it doesn't matter who I work for. Where it doesn't matter if I have a job. Where it doesn't matter how much I make. Where I am a equal citizen, a human being with an equal right to equal care. We take care of each other, not just ourselves." is quite astute. Right on!!! I also feel that if we are all in the same boat together that there is a greater chance for real and positive change. If we have a two-tier system, there shall be a lessening of demands from part of the population. We shall see.


I'm not sure how a two-tier system would result in a "lessening of demands from part of the population".

Especially with a sudden expected rise in demands from the largest single segment of the population only around the corner.

Countries like France, Germany, Switzerland, etc. seem to have solved most of the problems with their national (and universal) health care systems by allowing private medical care to exist alongside the public one. No one is turned away, no one has to wait more than a few days for care, and some public hospitals seem to be actually turning a profit. All of the private ones do.

Their health care systems do not appear to be on the brink of disaster. Ours most certainly IS. We already know what we are doing wrong...and we know that more money will not solve it.

Perhaps it's time to park the fear and have a good hard look at Europe for some new answers.

The corrupt Liberals certainly don't have any.


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## GratuitousApplesauce (Jan 29, 2004)

MacNutt, technically the baby boom generation started at the end of WWII, when the soldiers came home, settled down and started makin' babies. Those first boomers, started retiring a decade ago. I was born in '57 and I am still considered part of the boomers by some, although I feel more like a Gen-Xer, since the hippy era was dead and buried by the time I was out of high school. I won't likely be retiring (if ever) for another 17 years. Everything may be very different by then.

I think that this boomer retirement thing is way too overstated, especially since many people don't totally retire anymore. They start up small businesses after retirement or some just keep working, because many are very healthy, well into their late 70s and early 80s.

Interesting MacNutt, when you talk about the European systems. I heard on the radio yesterday that most of the European countries have higher proportions of public health delivery than Canada does. The one figure I remember is 75% public in Canada, 80% in France. Funny that you would support this, since that efficient public delivery is founded on a vision of the welfare state and the higher taxes that Europeans pay to support it. Turning into a democratic socialistic, MacNutt?


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## MacNutt (Jan 16, 2002)

Nope. Just a guy who is looking for some new answers to one of the biggest questions of our day.

And, since I'm about the same age as you are, I will also be looking for some good medical care about the same time as you do. I certainly do NOT want to be faced with lineups that stretch into years...or a system that is breaking down even worse than our current one is, due to the massive influx of baby boomers in their latter years.

Age is a very real thing. No one escapes the ravages. To simply write off the looming crisis is pure nonsense. Canada has an aging population. This is an indisputable fact. The current health care system cannot handle the present load. Also a fact.

What the HECK do you think will happen when a more than a third of the population begins to suffer from the ravages of old age? And expects timely medical care?

We need to fix this. NOW!


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## IronMac (Sep 22, 2003)

Interesting...a lot of people bemoan waiting times but I can attest to one time when I needed to see a proctologist for a suspected condition. Got an appointment within a couple of weeks and was done with it. Although, not sure if I should be happy or upset about that. 

Another thing, and I know that we don't want to talk about the U.S. system, but I am on DealChat a lot and I always see posts from people there asking if they should see a doctor or not. Their main fear is being able to afford a specialist. If you're lucky enough to have a job that pays for the insurance premiums (an indirect tax) then you're all set. Otherwise, you're a goner.


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## IronMac (Sep 22, 2003)

As for MacNutt being an SD...please, it's been proven before that he's more of a closet Commie than anything else.


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## used to be jwoodget (Aug 22, 2002)

> MacNutt: No one goes without timely (pretty much instant) top grade health care in most of the modern European countries. And the very same doctors and hospitals accept both poor and rich, according to what I've been told. The rich pay, and that covers the medical costs for the less than rich. The rich can get a fancy room or a certain doctor if they'd like...but they pay dearly for it. This finances lots of cool stuff that the less than rich can take advantage of. For zero cost to them, BTW. No one is ever turned away because they don't have money.


I think you need to visit europe and ask your relatives about the state of healthcare in these countries. My father-in-law (a staunchly Conservative Scot - yes there are two of you) bemoans the delapidated NHS in Scotland every week. It would help to provide facts and figures rather than to simply assert that the rest of the world is in a better state than we are.

The simple fact is that the aging populations of the western world are placing an increasing demand on their healthcare systems. Add to this, the escalating costs of new drugs (the drug budget is increasing at 4X the rate of inflation) and you have a deadly mix. How this is paid for makes no difference except in terms of fairness of delivery. Indeed, given the current dearth of healthcare professionals (thanks to various governments over the past 15 years reducing enrollment in medical schools - the U of T intake was cut by 35% about 8 years ago!) creating a for-profit parallel system will simply cream off professionals from the public system.

We should stop politicising and recognize the need to do something about the underlying causes. 
1. Aging, sedentary population - emphasize healthier lifestyles. 
2. Lack of professionals - train and incentivise. 
3. Geographic discrepancies in service and wait times - coordinate care and guidelines.
4. Escalating drug costs - evidence-based evaluation of efficacy and value

You'd be surprised and shocked how few evidence-based decisions are used by MDs to guide their treatments. In this era, its wholly unacceptable. Medicine is both an art and a science but its high time more of the latter was applied where its available.


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## MacNutt (Jan 16, 2002)

Funny JWoodgett...I don't recall mentioning Scotland as being a great example of a functional health care system.

But I DID mention France Germany and Switzerland as having a working system that provides timely high-quality health care at about the same (or less) per capita cost as we pay here in Canada. There are several others, as well.

And NO lineups!

Care to comment on these countries...and how they have dealt with the two-tier system? As a doctor, and as someone who comes from that area (more or less) I suspect that you might have some real insights on this.


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## GratuitousApplesauce (Jan 29, 2004)

MacNutt said:


> But I DID mention France Germany and Switzerland as having a working system that provides timely high-quality health care at about the same (or less) per capita cost as we pay here in Canada. There are several others, as well.


Care to enlighten us on exactly how these amazing health care systems work? Who pays, how do they pay? Is coverage universal or are the less advantaged left with no coverage or poor coverage? Some info might help.

BTW, I just read, on a Fraser Institute page no less, that the three countries you mentioned actually spend more per-capita on health care than Canadians, so it would be nice to see some specifics, MacNutt. Got links?

Could it be that our so-called health crisis is no more than just perpetual underfunding?


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## PosterBoy (Jan 22, 2002)

GratuitousApplesauce said:


> Could it be that our so-called health crisis is no more than just perpetual underfunding?


I seem to recall reading that there were moneys transferred from the federal government to the provincial governments which were earmarked specifically for health care, and that this is no longer the case (as in, the provinces get to decided where what money goes). If that's true, I'd be willing to wager that that is a major part of the "crisis."


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## MacNutt (Jan 16, 2002)

The Canadian system will ALWAYS be underfunded. That's because it's _UNSUSTAINABLE_. Just like the only two other countries who still have a monopolistic government-only public health care system on the planet. (Cuba and North Korea).

It aint workin out too terribly well THERE, either. To say the least! 

And, to be honest GA, all I know of the European systems is what I've been seeing on TV during a week long report on European health care that has been done by BCTV. (and what I've read in magazines)

It's about the third one they've done on this subject...and they have been interviewing doctors and patients galore. From all over Germany, Switzerland, France, the Netherlands, etc. And pretty much EVERYONE that they interview is always saying the very same thing:

That it WORKS! That there are NO waiting lines. That it is the best care available...and that EVERYONE gets treated in a timely fashion. No exceptions.

And they are ALSO saying that private for-profit medical facilities are a key part of this newly reformed national universal health care system that has taken hold in many of the European countries.

Is it all a giant crock of Sh#t? Are the magazine articles and such that claim the very same thing all lying to us as well??

I don't honestly know. 

But I was hoping that JWoodgett could give us a bit more insight on this (which is why I asked him about it a bit earlier on this thread). Especially being as how he is both a medical doctor, and has recently moved here from Europe (sort of).

I know for sure that he has toured Europe in the past few years because he is always reporting back here from some old country capital. He MUST have something to say about the situation.

Does it really work? Or is it falling apart just as fast as our Canadian health care system?

One thing is for sure...we Canadians can't fix our system by simply throwing more money at it. Especially since we will have quite a bit LESS money to throw at it, in the very near future.

And, at the very same time, demand for services will be going through the roof because of the aging population.

We need some answers. We need them NOW!

Maybe Europe can teach us something? It's certainly worth a look!


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## used to be jwoodget (Aug 22, 2002)

Sorry MacNutt, I was under the assumption you knew that Scotland was part of europe..... 

The issue here is that someone has to pay for healthcare. People fund it, whether publically through taxes or privately through insurance. The issue is simply whether we want a person's ability to pay to determine the quality of care. Yes or no?


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## MacDoc (Nov 3, 2001)

Who was complaining about activist judges???










....course there is always this aspect.










did we ever get a NAFTA insight.???


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## Paul O'Keefe (Jun 3, 2005)

I have a solution. But in the the words of Deep Thought, "I don't think you're going to like it".

Okay, I read somewhere before that the biggest drain on the health care system is people in their last two years of life. Like old people. Geriatrics. Terminal cases, etc.

Perhaps some of the old folks.... and I mean old folks should not be getting complex, risky expensive surgeries/treatments when they know they don't have long to go. I'm not saying we cut them off, but just that there should be a dignity to accept old age, the complications that come with it, and accepting death as a part of life.

I'm just a young guy, so I'll probably change my mind about all this as I age. 

I'm not sure if I'm explaining this right, or doing the idea justice, but perhaps health care for the extremely elderly or terminal patients isn't about prolonging life, but about making them comfortable as their bodies break down and they journey towards death.



That and *we need more doctors*. An education system that churns out telemarketers and insurance salesmen needs to rethink where the skills demand is. More Incentives are needed for bright students to become medical practitioners.


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## MacNutt (Jan 16, 2002)

So...I take it that most of us are simply choosing to ignore what might be a very good answer to our failing health care system? And make jokes instead? 

Too sad. Especially dissapointing when it comes from someone like JWoodgett. 

Here is someone who is very much a part of the medical community, and he has been all over Europe and seen the health care systems in many of those countries from the inside. He could tell us if the private/public dual systems are actually working as well as we are being told they are.

I'm going to be VERY specific here, Jim:

France, Germany, Switzerland (possibly even the Netherlands) all have private/public health care systems. There are for-profit private hospitals operating alonside the public ones in all of these countries. From what I have heard, this is working out very well indeed. No lineups, state of the art equipment, and NO ONE is ever turned away or forced to wait in pain for care.

In fact, I've heard that in France and Germany at least, some of the public hospitals are actually making a profit! (which, one assumes, they would return back into general government revenue).

There is no doubt that all of the private medical facilities in these places make money. They would not last long if they didn't.

I have heard nothing to indicate that the national health care systems of France, Germany, or Switzerland are in any sort of a crisis these days. No massive strikes, no bed closures, no funding cuts by governments strapped for cash (the way our Canadian system seems to be).

So...I ask again. Can we learn something (anything?) from the experiences of _SOME_ of the European counties when it comes to delivering timely universal health care while utilising a combined public/private system?

Or do we just ignore the lessons that some of these places can teach us and continue to make silly jokes. Perhaps about Bulgaria or Luxembourg, this time. Or some other place I haven't used as an example. 

Your call.


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## used to be jwoodget (Aug 22, 2002)

Actually MacNutt, the healthcare systems in France, Germany and Switzerland are not much different in terms of overall service provision than ourselves. They are better in some areas and worse in others. But the issue is that they are not part of NAFTA. If we allowed private healthcare in Canada, it would rapidly become owned and operated by the US private health insurers. They'd probably be happy to run at a loss for a decade just to "equalize" drug costs. You have said that you don't want an American system. But that is exactly what we'd get. There's an excellent lead letter to the editor in the Globe today that spells this out. There is no getting around NAFTA on this issue.

If you want an Americanized healthcare system, then introducing two tier medicine is the way to go.

Personally, I do think we need to evaluate patients needs at end-of-life. I'm not talking about people who have premature illnesses but those who are likely to die from one condition if another is treated aggressively. It should always be their choice - we can never withdraw treatment when it could do good - that is ethically unacceptable, but many people have literally had enough of invasive procedures and wish to die with dignity. We, as a society need to address this and not burden physicians with having to act "compassionately" often against the wishes of the family but for the wishes of the patient.

However, the underlying motivation for such a debate SHOULD NEVER be to save money. Rather, it is preservation of the dignity of patients.


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## MacNutt (Jan 16, 2002)

Not sure I agree with you on NAFTA. Or on the "inevitability" of the American health care insurers taking over our private medical services. 

And it's not so much about "making a profit" as it is about NOT making a loss. One that must either be paid by funnelling even more money from our taxpayers or finaced by debt. Which will likely be left to our children to pay.

From what I've heard, the national health care systems in France Germany and Switzerland all cost their respective citizens the very same as our own Canadian one. LESS in some cases.

But they have better care, better facilities, and NO waiting in pain for months or years.

Can we not learn SOMETHING from this?

And...what do you predict is in store for the future of our Canadain system after the momentous Supreme Court ruling last week?

Will our government overrule the Supreme Court? Will Qubec be allowed "special status" and have it's own public/private system? Will other provinces use this as an excuse to mount similar court cases?

Any thoughts on this?


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## GratuitousApplesauce (Jan 29, 2004)

MacNutt said:


> Not sure I agree with you on NAFTA. Or on the "inevitability" of the American health care insurers taking over our private medical services.


Why not? The way NAFTA works is that the government cannot restrict a private company from entering an open market, whether that company is from Canada or the US. If we open up healthcare to the private market, under NAFTA any large US firm has the legal right to walk right in and compete.


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## used to be jwoodget (Aug 22, 2002)

The percent of GDP costs of healthcare in France and Germany are actually a bit higher than here.

Canada 9.6% France 9.7% Germany 10.9% .... US 14.6% Illness is the #1 cause of personal bankruptcy in the US.

I think the supreme court decision will put extra pressure on the provinces to reduce waiting times. This is a good thing as it will reduce the ability of the provinces to weasel out of funding operations and docs by diverting the money elsewhere.


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## MacNutt (Jan 16, 2002)

used to be jwoodget said:


> The percent of GDP costs of healthcare in France and Germany are actually a bit higher than here.
> 
> Canada 9.6% France 9.7% Germany 10.9% .... US 14.6% Illness is the #1 cause of personal bankruptcy in the US.
> 
> I think the supreme court decision will put extra pressure on the provinces to reduce waiting times. This is a good thing as it will reduce the ability of the provinces to weasel out of funding operations and docs by diverting the money elsewhere.


I see...so France spends one tenth of one per cent more per capita than we Canadians do on our health care system...and is listed as having the very best in the world. They have NO waiting lists at all. You get treated right away. Just like in Germany, Switzerland, et al.

Soooo.....does that mean that if we Canadians simply increased our per capita contributions to the national health care system by one tenth of one per cent, then all of those long lineups would just dissappear? No more hospitals would be closed? Our doctor shortage would just vanish? Canadians with wealth would no longer be heading south to the USA in droves in order to get timely treatment?

And, most importantly, our own Prime Minister would stop using private health care clinics and begin to rely on Canadian public hospitals for treatment?

Is it the fact that France and germany spend a tiny fraction more than we Canadians do on health care? (BTW, many sources say they actually spend less than we do).

Is that it?

Or does the question go quite a bit deeper than that? Is there something here that you are not willing to admit, Jim? Something to do with how well the private/public systems are working in parts of modern Europe? And how no one in any of those places could even CONCIEVE of turning back the clock and regressing to the sort of crippled monolithic system that we Canadians still stubbornly cling to?

C'mon Woodgett...fess up.Tell us the truth. You _KNOW_ I'm not going to leave this alone.

And yeah, you can "trust me on this".


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## IronMac (Sep 22, 2003)

MacNutt said:


> I see...so France spends one tenth of one per cent more per capita than we Canadians do on our health care system...and is listed as having the very best in the world. They have NO waiting lists at all. You get treated right away. Just like in Germany, Switzerland, et al.
> 
> Is it the fact that France and germany spend a tiny fraction more than we Canadians do on health care? (BTW, many sources say they actually spend less than we do).
> 
> Something to do with how well the private/public systems are working in parts of modern Europe? And how no one in any of those places could even CONCIEVE of turning back the clock and regressing to the sort of crippled monolithic system that we Canadians still stubbornly cling to?


You say all of this but can you bring up sources? That's the crux of the matter. Otherwise, how can we trust you on this?


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## Vandave (Feb 26, 2005)

GratuitousApplesauce said:


> Why not? The way NAFTA works is that the government cannot restrict a private company from entering an open market, whether that company is from Canada or the US. If we open up healthcare to the private market, under NAFTA any large US firm has the legal right to walk right in and compete.


For the sake of discussion, let's assume that NAFTA isn't in place. If this were the case, how many people (particularly Applesauce and Jwoodget) would agree with a mixture of public/private health care?

It seems to be working well in Europe right now. Why turn our backs on something that works? If NAFTA is an issue, then let's think of a way to solve that problem.


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## NBiBooker (Apr 3, 2004)

As MacDoc likes to say (and is right) when he talks about IBM / Intel processors, choice is always a good thing. 

Medicare isn't going away, however a market exists for those with serious medical concerns to shell out their own dollars to get looked at and fixed. I for one don't feel right denying anyone that chance. 

Unlike other "activist" court rulings, security of the person is in fact in the charter and is a right that must be upheld. I love how many of the same people who support same sex marriage being forced in by the courts are balking at this decision. You can't have your cake and eat it too. 

BTW, for the record, I support having parliament decide one way or the other on same sex marriage. I object to having unelected officials set the agenda and direction for society. I also believe parliament should have had the courage to acknowledge that private health care existed before this decision and is in fact not a threat to medicare. 

Bottom line: the courts wouldn't have to do all the heavy lifting in Canada society if we had politicians with the courage to talk hot button issues. Democracy isn't pretty, but I like it when our elected officials at least try.


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## MacDoc (Nov 3, 2001)

Hmmm choice to a point - I think certain institutions such as public water systems are best left in the public venue, armed forces, firefighters ( hmmm let's see WHICH shall I call...oh they're much cheaper but oops 9-5 only  )

The issue strikes right to the heart of how Canadians view their society. MY take is that in this aspect Canadians do NOT want wealth to play a part.
Wealth is okay in getting a fancier car but not in getting fancier firefighting OR healthcare.

IF you applied the same thinking to firefighting would you stand for your wealthier neighbour to be serviced first.......or policed ..or have water when you don't etc.

There IS a role I feel for private in providing financing and ancilliary services to the government program - just as firefighting equipment is often leased and private companies provide better boots, and suits and airbreathing gear.

But in the delivery, I sorry but healthcare and firefighting and policing fall in the same realm......essential core services where a citizen is just that - not a wealthier or poorer citizen.

Somebody else hit it earlier on taxes - governments are reluctant - look at the McGuinty backlash but governments MUST to provide timely services and if taxes are increased so be it as long as they are well adminstered.
The current system CAN be better and private interests can have a role in making it so but not as provider except under the direction of the public system as it is now ( labs, X-rays etc ). ( For instance the ludicrous practice of allowing doctors to book public operating space at a nominal fee ( $100 or so ) to perform cosmetic surgery for large fees )
That's just plain poor management.

Where I run into some issue on this stance is fundraising for local hospitals - if we look at the system as a whole as being a part of Canada's "wealth" or "common weal" then freely given donations to a specific place like sick kids increases the wealth of the asset as a whole - and no one could argue Sick Kids does not live up to being a crown jewel.

The court has tossed te ball to politicos.
The "marriage issue" could be solved easily by eliminating the term entirely from the government/legal documents so it becomes gender neutral like the definition of a corporation or trust or guardian.

I'm not sure why the gov does not pursue this - the court is simply saying you cannot have TWO terms covering the same area of venue based purely on a sexual difference.
I don't beleive it's activist in this - it's pragmatic - under the charter sexual orientation must be eliminated regarding the law.

I'd say the court is being MORE activist in the medical decision. It opens a Pandora's box that could apply say to firefighting - a gov could get sued if the firefighters did not arrive in a "reasonable time".

I suspect the decision will be challenged and perhaps overturned.


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## MacDoc (Nov 3, 2001)

Good article in the Globe



> A steadying hand placed on Ottawa's third rail
> ANALYSIS: Judges put onus on governments to deliver proper care, KIRK MAKIN writes
> By KIRK MAKIN
> Saturday, June 11, 2005 Page A4
> ...


http://www.theglobeandmail.com/servlet/story/LAC.20050611.MEDANALYSIS11/TPStory/TPNational/


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## GratuitousApplesauce (Jan 29, 2004)

MacDoc said:


> IF you applied the same thinking to firefighting would you stand for your wealthier neighbour to be serviced first.......or policed ..or have water when you don't etc.


Excellent point, MacDoc.

Many of the wealthier folks aren't overly concerned about whether health care for the less advantaged or working poor is more difficult for them. Many harbour the opinion that being poorer is their own damn fault, failing to recognize that good luck, family money or simply the fact that they've had a life that has managed to endow them with a positive healthy mental outlook might have as much to do with their financial success as their hard work has. Of course I'm not talking about the vast majority of wealth that is just inherited. When those people talk about the sins of the poor, I want to vomit.

Anyway MacDoc, there are many who also wouldn't mind privatizing water, fire fighters and police too. But this is really the nub of the whole issue, do you believe in universality or not? 

As I said before in this thread, I don't really care about the details about how the services are delivered. As long as they are there when I need them and they are universal, equally accessible by poor and rich. If a system such as one of European ones can do that better, while maintaining universality, great.

As far as Vandave's suggestion that NAFTA not be considered as part of the issue, well it is part of the issue. There are massive insurance companies and health care interests south of the border, just licking their lips at the thought of their available market suddenly growing by 10%. We could solve the issue of NAFTA by getting the hell out of it, or renegotiating it to become an agreement that both sides have to comply with, not just us. While we don't seem to have the jam to ignore a NAFTA judgement that goes against us, the USians do it all the time, as we've seen in recent years.


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## used to be jwoodget (Aug 22, 2002)

MacNutt, the statistics I quoted were to point out that these countries spend similar amounts on healthcare. I would like you to provide evidence of the fact that there are no waiting lines for any procedures in France and Germany. To initiate your research on this matter, the waiting times for various cancer treatments in Ontario can be found here:

Radiation therapy
Systemic/Chemotherapy

It is critical to compare like with like. Orthopaedic wait times (e.g. hip replacements) and access to scanners in Canada leave much to be desired. But most life-threatening procedures are accessible within international guidelines. There is room for improvement and for more efficiency. It is not acceptable for anyone to experience pain for a minute longer than necessary but no one seems to be talking about the efforts to reduce wait times or the need to train more MDs and nurses.

BTW, I have a PhD not an MD. I am not a medical doctor. I work in a hospital research institute. There is at least one oncologist on these boards and he's far better equipped than I to answer these questions. However, I do try to base my arguments on facts.

I found the following web log from Ezra Klein which compares the systems in the UK, Canada, France and Germany (links are within the German system article). It's was meant to point out the poor value for money the US system has, but its a good backgrounder. http://ezraklein.typepad.com/blog/2005/04/health_of_natio.html The story is complex and the systems are based on long histories. Cherry picking the best of each is not a practical option and few people are really satisfied with any of the systems. Moreover, the demographic problems are placing all under stress.

Vandave, what's the point of answering a hypothetical question? We are part of NAFTA and that is the reality. Our only option, other than throwing our system into the hands of US insurers is to maintain the single-payer system. The basic question here is (and I repeat):


> The issue is simply whether we want a person's ability to pay to determine the quality of care. Yes or no?


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## SINC (Feb 16, 2001)

The answer to the question is obvious.

No.

Having said that, I still believe there is middle ground between public and private delivery of services as long as payment for same is maintained as a responsibility of the provincial government allowing the private service.

That in itself should reduce waiting times for sure.

Canadians need to get their heads out of the sand and wake up to the fact the current system will implode unless radical change is made.

Part of that change has to involve controlled private delivery or we go nowhere, IMHO.


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## MacDoc (Nov 3, 2001)

It would appear we need the equivalent of an Auditor General for Health Care delivery to render judgement on how well it's being delivered.

I guess the Romanov report was a start but I suspect it's oversight on the regional local level.

From my understanding on of the issues in the US in the very high per capita amount is administration costs which pull money away from front line services.

I see these issues.

Drug costs

Triage on expensive limited effect treatments

Inefficient or ill concieved IT

Lack of addressing lifestyle/environmental causes of rising hospital visits ( smog etc )

Lack of recognition that universal health care is a strong incentive to businesses and like having reliable cost effective power it's akey to regions well being far more than just the health aspects.
( GM is cutting far fewer jobs in Ontario as a result of this )

Lack of "progress" reports........people like to see their dollars being utlilized effectively.
The discussion zone is too negative.

How many people here seriously attempt to limit their load on the hospitals by actively managing their own health, getting regular checkups and avoiding marginal visits??

Prevention is a huge factor in reducing costs and only each one of us can take responsibility for that.


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## SINC (Feb 16, 2001)

MacDoc said:


> Prevention is a huge factor in reducing costs and only each one of us can take responsibility for that.


:clap:

Wish I had quit smoking 10 years before I had my heart attacks. Likely would not be an issue today, but better late than never and the smoke free life is just dandy.


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## MacDoc (Nov 3, 2001)

Look I'm no saint either BUT it always seems WE are pointing at some OTHER entity - the health care system is OUR national wealth.

What was the Pogo line...."I have seen the enemy and he is us."

Never more true than with healthcare.

Personally I'd like to see more positive stories and progress than the continual whining..after all we could be a citizen down south where it's just a lottery whether you can afford coverage.....or get it.......or keep it.

You expect roads, firefighting, police etc - in my mind universal healthcare is equally part of Canada - intrinsic - not up for negotiation.

Doing it better is always a goal but I THINK WE'VE DONE DAMN WELL :clap:

THINK about the past -even the early 1900s when my dad was growing up. What we HAVE is a marvel.

I'd say the cup is 90% full.


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## Vandave (Feb 26, 2005)

used to be jwoodget said:


> Vandave, what's the point of answering a hypothetical question? We are part of NAFTA and that is the reality. Our only option, other than throwing our system into the hands of US insurers is to maintain the single-payer system. The basic question here is (and I repeat):


There is plenty of point in answering such a question. It tells me whether you are against private sector delivery of health care, or whether you only oppose foreign involvement in the delivery of health care. 

If I understand your point of view (along with other Canadians), then we can move the debate forward and find different solutions.

Yes, NAFTA is a reality, that's why I asked a hypothetical question. If you can't pinpoint the issue, you can't find the solution. If your issue is NAFTA, then say it. If your issue is private sector delivery, then say it. If it is the later, then your whole point about NAFTA is irrelevant.

Now... what if there were ways to get around the NAFTA issue, but still have private sector involvement in health care? What if we could classify private sector companies as being part of the government? Maybe this could keep everything as Canadian.

Personally, I think competition is a good thing. I don't have a problem with American companies competing in our market.


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## Paul O'Keefe (Jun 3, 2005)

MacDoc said:


> How many people here seriously attempt to limit their load on the hospitals by actively managing their own health, getting regular checkups and avoiding marginal visits??


My old doctor and her practice was great for this sort of thing. But I had to move for school and work. When I came back she was retired and sold her practice. I've since moved again and it was next to impossible to find a doctor... let alone a doctor one actually liked or felt comfortable with.

The foreign doctor I eventually did get left several months ago and the clinic has not even informed me that he was leaving, if I wanted to make new arrangements, or who the replacement physician would be. I haven't actually gone to the clinic since. But not for lack of need or lack of trying.

Getting an appointment is always a problem. Often times I've tryied making an appointment only to face a busy signal for days on end. The hospital emergency ward is my primary source of health care for the past half a year now.


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## MacDoc (Nov 3, 2001)

Errata - Cross Country Check Up is on right now and discussing this.


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## used to be jwoodget (Aug 22, 2002)

Vandave,

I have nothing against private delivery of publically funded healthcare. I do have an enormous problem with an Americanized model of healthcare as quality of healthcare is based on ablility to pay and it is enormously inefficient compared to any other western medical system. I also seriously doubt the massive lobbying power of the US health insurance industry would fail to achieve equal access to our patient's dollars, while having no intent to provide equal access to services for the entire population. Moreover, such companies are hardly likely to provide local resources for geographically isolated areas and will exacerbate the divide in community healthcare access to physicians. Indeed, they are likely to drain resources from such outlying communities. Tell me I'm wrong!


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## Dr.G. (Aug 4, 2001)

Jim, you are certainly NOT incorrect when you state your concerns with "Moreover, such companies are hardly likely to provide local resources for geographically isolated areas and will exacerbate the divide in community healthcare access to physicians." I still have friends in rural Georgia. They are financially well-to-do and can afford health care. But access to this care is limited in that they have to travel nearly as far as Atlanta to access the specialists needed for various conditions.


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## Vandave (Feb 26, 2005)

used to be jwoodget said:


> Vandave,
> 
> I have nothing against private delivery of publically funded healthcare. I do have an enormous problem with an Americanized model of healthcare as quality of healthcare is based on ablility to pay and it is enormously inefficient compared to any other western medical system. I also seriously doubt the massive lobbying power of the US health insurance industry would fail to achieve equal access to our patient's dollars, while having no intent to provide equal access to services for the entire population. Moreover, such companies are hardly likely to provide local resources for geographically isolated areas and will exacerbate the divide in community healthcare access to physicians. Indeed, they are likely to drain resources from such outlying communities. Tell me I'm wrong!


I'm not advocating an American style system, nor do I think many Canadians are. I heard today that the US spends the most on health care, but ranks 30th in quality of health care services in the world. I definately don't want that.

I think we need universal coverage that would be provided by the government. But, I think the delivery of health care should be opened up to private sector companies. I don't think this should happen overnight though I think we need to try it slowly in isolated jurisdications to see what works and what doesn't.


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## MacNutt (Jan 16, 2002)

I've just gotten back from a hard day filming the Top Fuel drag races. When I do this, I put my life on the line. The bikes are hurtling past my right elbow at ridiculous speeds. About three feet away from my fragile bod. (my best spot is about ten feet beyond the end of the finish line. With my tripod planted on the very edge of the track.)

Sometimes, they are out of control when they fly past me at terminal velocity. And the meat wagon is parked just back a bit from where I stand with my camera. There have been numerous "near misses" over the past few years. I have ALL of them on hi def digital 3CCD videotape, BTW.

So...sometimes, I think about health care at these moments. Go figure.

When I get home...I think about it even more. 

Today, when I got home from the races, I decided to check in here and see what sort of sh*t I'd stirred up with my hard questions about the widely advertised success of the European private/public health care systems.

Know what I found?

A fleeting reference to it...and then a quick de-evolution back to the old and tired mindset of "more money means better health care and poor people won't get the care they need under a private/public system" and the old tried and true "we DON'T want an _AMERICAN_ system here in Canada!!" 

So now...I just _GOTTA _ ask...

Are some of you so TOTALLY brainwashed that you won't even LOOK at a successful universal national health care system?? Despite the fact that it seems to be WORKING??  

Europe started out with the very same thing that we did. Copied from the same British model. But, since those early days, some of the countries in Europe seemed to have moved on to a more successful way of doing things. And they can now guarantee their citizens very rapid and super high quality care. At a per-capita price that is either comparable to our own...or even slightly less!

And they would seem to be having NO major health care crisis the way we Canadians are at the moment. On the contrary, new hospitals are being built and new equipment bought. And there is quite a bit of medical research happening in some of these countries as well.

And the government isn't forced to dig deep into the taxpayers pockets for ANY of this, either. In fact...in some places (like Germany) even the public hospitals are now turning a profit!

Now THAT looks like a sustainable health care system to me. Unlike our own Canadian one...which is floundering and failing. Despite huge injections of scarce tax dollars.

Time to cast off the brainwashing, people. Time to look outwards and to consider some alternatives. Time to learn from some successes in countries that, like our own, also have a universal national health care program.

Or...you could choose to turn your backs on all of this, and just point to the "American system" and shriek NO WAY!!

Your choice.


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## used to be jwoodget (Aug 22, 2002)

MacNutt, try reading some of the links I posted. You are seriously lacking in both facts and credibility. Europe is as fragmented in terms of systems as anywhere. There is not a single country on this earth that does not consider it's healthcare system to be in significant trouble. If you care to actually compare, you'll find hospitals being built here and hospitals being closed down in europe - that's life and progress. You can't generalize these issues and you are not helping the debate by saying that "it's better over there". You keep reiterating past comments such as some hospitals making a profit. You know what? Some hospitals here are doing a pretty fine job, but they don't measure it in share-holder profits.

Please, do as asked and read the information provided and do some actual research and describe how our system can be improved with direct references and not reiterations of personal opinions. Otherwise, I'd suggest standing in the line of fire of a racing bike might be a safer pursuit.....


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## smilecentral (Jan 27, 2005)

I struggle with this ruling - what would a parallel system mean for Canadian health care? As someone who will be entering the fray as the baby boom retires, I wonder what it will mean for me to serve in this system which is rapidly collapsing under its own weight (I just finished 1st year medicine at U of T).

The status quo is simply unacceptable - as I think most would agree, and yet, would privatization fix this? I don't know. I don't think anyone can realistically know without it happening. Yes, universality is most important. They've really preached that to us this past year, and why not? It really is one thing all Canadians hold near and dear. We love our healthcare. I am grateful every day for access to physicians, nurses and hospitals, without leaving with a bill. It is just one thing that makes our country unbelievably wonderful.

Things must change. They must. In my limited exposure to the hospitals, I've seen how busy things can be. We've all waited in the ER for hours for one thing or another. Physicians are overworked, patients are losing patience and costs keep skyrocketing. With all the wonder drugs and treatments coming out, people are living longer - and costlier. 

As for utlizing evidence-based medicine in treatments, I think this is becoming more and more important, and is finally being focused on. We, the newer generation, are being schooled on the importance of choosing procedures with high diagnostic value, and understanding that you MUST do right by your patient, but understand that resources are LIMITED. Part of our duty is to be resource managers, and I think it will be increasingly important for us to take that role seriously.

To "fix" healthcare in this system, the number one need is more people. Ultimately healthcare is about people helping people. There are a vast number of international medical graduates just begging to work, but instead are doing other things (I'm even working with one this summer). Policies need to change, more residencies need to be made available, and kinder hours need to be made the standard for medical staff. The number of mistakes a physician will make increases with each hour without sleep past a certain point. Do you want the physician who hasn't slept in 36 hours prescribing your medication? A happy worker is more efficient, and does a better job. The same is true for physicians. Even the most dedicated ones burn out. And nobody wants that.

If policies change allowing more people into the system, and privatization can pay for these physicians to work and decrease the load for everyone - then maybe we don't have a choice. Certainly wait times need to decrease. A private hip replacement clinic can help people just as the public system can. A private system certainly needs to be managed properly - and the public system will have to be watched closer than ever to ensure it doesn't erode (further). So yes, parallel systems could work - though I have to say, I'm still uneasy at my core.

BTW - primary health care is our first line of defense, but many wait until it's too late, and then rely upon costly measures to save themselves. Perhaps businesses should be contracting physicians and mandating that their workers get checkups at least annually. Finding early cancer is much easier to treat than later on. It would likely save both businesses and healthcare a lot of money.


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