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Health care - who fucked up?
VThornheart
Registered User regular
Registered User regular
So here's a question for the masses:
Who, if anyone, fucked up the American health care system?
There seems to be many theories floating around:
1) No one did, it's fine as it is.
2) Health Care providers did it.
3) Pharma companies/Drug manufacturers/Health equipment manufacturers did it.
4) The American citizen did it.
5) McDonalds (or other fat-filled product producer) did it.
6) Capitalism did it.
7) Communism did it.
8) The Tooth fairy did it.
So what do you guys think? And why?
Who, if anyone, fucked up the American health care system?
There seems to be many theories floating around:
1) No one did, it's fine as it is.
2) Health Care providers did it.
3) Pharma companies/Drug manufacturers/Health equipment manufacturers did it.
4) The American citizen did it.
5) McDonalds (or other fat-filled product producer) did it.
6) Capitalism did it.
7) Communism did it.
8) The Tooth fairy did it.
So what do you guys think? And why?
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Actually, the Canadian system is cheaper and more efficient per capita than the American system. Regardless, most of the problems you are talking about stem from the perfect storm of the Federal government cutting transfer payments significantly during the '90's (healthcare is a provincial responsibility, and it used to be funded 50-50 by the feds and provinces), and there being an aging population which lives significantly longer than previous generations. Most of the costs being incurred by the Canadian system are incurred during the last year of a patient's life, and because of the aforementioned increase in number of old people, the costs are going to naturally go up.
I'd still take the Canadian system any day of the week over the American one. Even if there has been mismanagement fiscally in the past, the benefits of having free, universal medical care far outweigh any drawbacks.
I don't want completely private. But saying that 100% coinsurance is the best way to go is not looking at price incentives. Any time the price is zero, there will be over-provision.
Ugh, you know nothing about how socialized medical insurance works do you? America pays more per capita then any other 1st world country. Why? Because competing insurance providers require massive bureaucratic overhead. Not to mention an entire province gives you significant bargaining power when your buying medication and other such things.
The problem Canada faces is the exact same problem every country faces. The Baby Boom has come to bite us in the ass.
Canada has one. While basic medical needs are fully covered by your provincial health plan, there's tons of companies out there to purchase supplementary coverage from, that goes above and beyond the standard.
Because the efficiency of socialized medicine comes from the lack of overlap. By allowing private insurance companies to cover that too, you undermine the thing that makes the system efficient. Suddenly hospitals and such have to figure out who's paying your bills, instead of automagically knowing it's the government. That requires bureaucratic overhead and THAT costs money.
Whoa! What were the odds that someone else chose the same icon as me? Wierd! I mean, Edgar's a popular character and all, but that's odd. I may have to switch mine... it's the equivalent of a woman being at a party and seeing someone else wearing the same outfit.
Anyways, on the subject, I figured option 2 was the same as "the insurance industry" (hence why I didn't explicitly say it in the OP). Are they different entities?
Fuck I hate when Canadians start shitting on a system that is there for them and raving about wait times. Yeah they can suck but guess what, it is TRIAGED NOT who can pay the most and the fastest. If you need anythign done it is prioritized by NEED! Most of the wait time problem is with having our poulation spread out and only have the big stuff in only the major centers. Yeah it needs to be worked on, and it is damn you. I work in an isolated community that is 5 hours from van if the ferries are running right, 1 hour by plan, a bit more when we have to heliccopter out apatient. and we are the major trauma center for our end of the coast.
But even though I could make way more in the states guess what, you would never get me to work in that kind of system. I want to work for all my patients notjust the ones with the right plans. I want my patients to concentrate on getting better, not selling thier life to pay for the procedure.
GRAAARR!!!!!!!!!!!!!! /me shaking in incoherent rage
There needs to be some allocation system that makes us wage competitive or else this "cheaper" healthcare is not actually cheaper.
The problem isn't whether we're private or not. What we have to do is stop deluding ourselves that we're wage-competitive, because we're not. Look at the demographics for doctors and see how many are about to retire in the next 5 years. There will be a wake-up call when you go to see one of two specialists in the whole country.
Thanks, I forgotten that other problem. Rural areas. Doctors don't wanna move to them. I can't blame them.
108 per month? Damn! I have to pay over 200 a month for my wife who's in perfect health in her early 20's, and that's with a BAD insurance plan here in the states (one where we have to pay 50% coinsurance and a copayment).
I've always felt that American health insurance has been bending us over. Hearing that figure makes me cringe thinking about how much money we throw out over here.
I would really be making about the smae if I moved to the states to work there.
We are fairly Rural here, but we have the added advantage of being resonably close to Vancouver/Vancouver Island and having fairly low housing and other costs. We have a large portion of foreign Doctors who come here to get in some service once they finally get out of our rediculous residency requierments for foreign Doctor's who end up staying and loving it.
That is another issue we need to address we have and would have more Doctors and Nurses quite willing to imigrate if we would streamline the process muh more.
When the health system is more concerned about money than patients then, in my rose-colored Canadian glasses, you have a problem.
That applies to any skilled workers. A friend of my mothers is a chemical engineer and it took him ages to get in. It would have been easier if he'd just clammed to be a skill-less refugee.
I mean Define "fucked up" here.
The Health Care providers would say things are fine. Of course the are Businesses and they are making money, the more money they make the better, thus things are fine.
From the Doctors perspective things are probably fine too. I mean they make money in various ways, salaries paid or profits from a family practice. Plus they get the benefit of knowing that they help people on a daily basis.
Now for the individuals, well that's a different story.
I, too, am inclined to blame Richard Nixon in most situations. ;-)
This may sounds economically naive, but as far as I'm concerned, if I get sick, the money should go from me to my doctor, to pay him for his services. Unfortunately, most Americans can't afford a simple Drs visit much less surgery.
I think a good step might be some kind of personal Health savings plan. The problem being that "we" can't be trusted to have our own savings for such a thing, and that even if we did, in a worst case scenario, it may not be enough.
Obviously in your theory you have forgotten to include the fact that in a non-universal system more people die from never receiving treatment or a procedure then those that die in a universal system from waiting. You also havent included the consequences of people seeking less medical treatment due to the costs they have to pay or the negative influence on your health from losing your house due to paying for medical bills(number 1 cause of personal bankruptcy in the USA is from paying for medical expenses).
I'm not arguing that our system in Canada is perfect because its not. However its a hell of a lot better then the USA's. There is definite inefficiency in our system and they need to spend considerable effort in streamlining the process in a more efficient way. The babyboomers are already fucking the system up and will fuck it up much more in the years to come. Just throwing money at the system isn't going to fix it.
Personally I think that there is only so much they can do without looking at some of our immigration policies most notably increasing immigration rapidly and putting alot more emphasis on the programs for getting immigrant doctors certified instead of having them drive cabs.
A variety of European countries have mixed systems, with varying levels of success, iirc.
I haven't fully read it, and I don't vouch for its accuracy or neutrality, but here's a Wiki article comparing US and Canadian systems.
If the majority of American citizen's had made this a large enough issue I would think that sometime in the last 50 years you would have elected a president that would have campaigned on this being his main issue. I'm not even sure you have had someone run let alone win with that mandate because they would also have to acknowledge increased taxes. Anything called taxes are the devil or something regardless of if they are cheaper then the alternatives.
Most people like to blame HMOs but honestly all they do is fuck you over like every other corporation does. HMOs could not exist nor exist in the way they do without your government's backing. Your government's laws cant exist past a term without the citizen's backing. To be fair your political system is fucked when you consider the interest of the average citizen so I would put some blame on your government as well.
I'm honestly really surprised there is no universal health care in the States. Fifty years from now hopefully there will be as its pretty backwards for you guys not to have it.
Eh. Different historical experience than other countries.
First of all, I'm not sure what you mean by overprovision. You mean there is overlap in services, or what?
Staff shortages in the medical industry are in many ways more complex than other industries. The most important members of the system (doctors and nurses) require higher than average amounts of schooling, and the lag time for increasing output from medical schools to churning out new doctors is close to a decade. So when there was a surplus of experienced doctors and nurses in the system in the early 90's, along with an overabundance of new graduates, all provincial governments (but especially BC) cut funding for spots at medical schools, sometimes significantly (10+ seats or more). Now, most of those experienced doctors and nurses are reaching retirement age (being themselves mostly baby boomers), and there isn't in place a viable replacement rate of new graduates, due mainly in part to the lack of space available at medical schools for a decade and a half.
On top of that, there is no national accreditation program for certified, foreign graduates and professionals (outside of the UK and the US) - so we have quite literally a plethora of skilled immigrant labour that is unable to step up and work in the system. Of those that are able to actually get in, we have the problem of incredibly high attrition rates (especially if they have to go through the stupidly long "upgrade" programs), which increases the lag time to make the original advantage of using skilled immigrant labour irrelevant.
Oh, come off it. Don't pull that stupid Canadian Taxpayer Federation bullshit. Your parents' money goes to a hell of a lot more than healthcare, and I'm sure that if that's all you wanted your tax money to go to, you'd be paying significantly less in tax. While getting boned by the lack of roads, police, and fresh water.
Their tax payments have no impact on MRI services. You are looking at the wrong side of the equation, here. You pay the government, and the government is supposed to organize, provide, and pay for the services we get. It's the fiscal and administrative mismanagement by previous governments, along with demographics shifts and bad immigration policy that cause the shortage of MRIs.
In fact, it's likely that it is your parents who are impacting my ability as a young, relatively healthy adult male to get timely medical service. Tell your parents to die quicker or stop bitching.
Yeah, France has the best system in the world, and it's a hybrid. But I'm fairly certain that for the average Frenchman, the system works very much like our own.
I agree that we shouldn't just pack it in and say things are all right because it is better then the US. Your argument gave me the impression that you were saying the hidden cost of wait times outweighed the benefits of a publicly funded system which it doesn't so I made a post regarding that.
As far as wait times are concerned I'm not convinced that your solution to just paying doctor's more money to keep them from going to the States would be viable. First you have to consider how much of the shortage it would deal with then have to consider its not just the ones you leave you have to pay more its the majority that are staying which you have to pay more as well. Unfortunate as it is with a public system there is a limit to how much your citizen's will bare spending on sustaining it. Any savings from streamlining the process would be better spent on capital investments for health care as that is the other area that has deficiencies. Extra doctors can be obtained as I mentioned through removing some of the red tape involved in getting them Canadian credentials. There are about 4000 trained doctors in Ontario unable to practice, and we can always poach more. I don't see much reason to pay someone that already makes an upper class salary more money, especially when its no guarantee that it would provide enough doctors to stop the shortage.
Increased immigration is the way to go. "Your a doctor?", bam "Welcome to Canada, here let us help you out with getting certified. Oh you say you have some healthy future tax payers to contribute to our pyramid
scheme health care,,,,err I mean children, bring them."
They're more complex because they're organized by a bureaucracy. "Well, you see, it's more complex because there were spots and we graduated too many and well now the glut is a shortage." I won't accept some bullshit history lesson as an excuse for lack of planning. Demographics cause a shortage, right. That's why there is a shortage in retirement homes... oh wait. You see the problem with that argument is that there's never a shortage in the market: the price just goes up. Don't distort the argument. Payments are still proportional to income tax. The point is that they pay a lot of money for a basket of services and one of the big ticket items is not as good as it should be.
Paying a government for the provision of a good should have no impact on the quality or quantity of the goods we receive? This isn't even an argument, it's just semantics with no economic grounding.
After all your insults you failed to mention the most central fucking point in the entire debate: we pay doctors less so they leave and we didn't save so we can't afford to hire more. Past government and current governments have failed on their promise of healthcare and blaming it on population demographics, some easily predictable phenomena, is a fucking scape-goat issue for the real underlying problem: our healthcare system is mismanaged.
HOWEVER, with a surplus of trained doctors we can capture them at lower wages, but we still have to pay more (reduced wages doesn't mean free). Your solution would result in more doctors at less cost, which is obviously better. Either way we expand the budget and take money out of transfers to Quebec (NEW ISSUE!).
Yes it is not debatable, however whether it would slightly fix the problem or significantly fix the problem is. My argument is based on my opinion that it would slightly fix the problem(mainly in the short term), and do absolutely nothing to address the capital shortage in our health care system which in your parents case was most likely the reason they had such a long wait time.
The issue is a cost versus care. These numbers are made up for simplicity. Say we pay doctor's 100K a year. To get more back we offer 120K which gives us 1 doctor for every 100 we have already . We are now paying over 12 million for 101 doctors instead of 10 million for 100. For one extra doctor we are paying 2 million dollars more a year. Basically that 2 million is going to have to come from somewhere, some from increased taxes but the majority would most likely come from health care capital improvements. Does the increased care from one doctor compare to the care we would receive from 2 million in equipment? Not even close when we are short on both. To be realistic you have to assume that their is a limit to how much of a burden the tax payers can bare. If that limitation didn't exist then fuck yeah lets build a money pool for any doctor that wants to come back here from the US.
So basically your solution of paying doctors more would slightly improve the bottleneck for service caused by doctor shortages but would make the bottleneck caused by shortage of equipment way worse. This would most likely have a very negative impact on care.
Yes it would still require more money as these new doctors would have to be paid. The solution I mentioned is a much better cost versus care solution then throwing money at doctors. It is also a much better solution in the long term whereas the higher wages would only work in the short term till the states upped their salaries even more. Basically we would be fucking ourselves and people in the states by doing that.
In normal economics I agree. In health care economics its not as clear cut. There is a certain savings in preventative medicine and people acquiring care earlier which does not generally happen to the same degree in a cost system. This is how the Canadian system works out cheaper then the American one.
Agreed, government involvement should not be an excuse for poor quality or quantity of service for the cost involved. Health care needs to be majorly reformed in this country. They need to look at some of philisopy involved in the private industry such as lean thinking and others and apply it to health care.
To be fair though its not a 100% sure that private industry would do any better. When Ontario de-privatized hydro I didn't exactly see improvements and the privatization of highway 407 was a rip off. The hydro situation mainly has to deal with the economics involved in huge capital costs. The 407 case was the government doing stupid shit to balance books and not being able to write a fucking contract. *NOTE to politicians* selling an asset to balance your books is bullshit. That's like selling your house to pay off bills and claiming you are better off homeless.
To save everyone alot of time I will sum up my opinion on that.
FUCK QUEBEC. Seriously fuck them.
Personally I think the Australian system is conceptually sound - Medicare for everyone, with the alternative to pay into the private system to skip the waiting lines. But that's about as good as it ever can be - to do medicare that was as fast as private for everyone we somehow have to actually be able to afford it - which means we need a better economy overall.
I can go on about preventative care being FAR cheeper and such.
But really, this comment doesn't deserve that kind of thought. Seriously you ARE Canadian. (Apparently anyway)
People don't go to the doctor all the time up here either. Hell, most people either don't like to or just can't be bothered. The only thing it being free does is prevent people from not going when they feel they need to, which is a good thing. Otherwise, people are just as adverse to going to see the Doctor as anywhere else.
The problem here is that the moment you mention something like that you start getting spied on by the NSA for potentially being a hostile Communist.
Seriously though, it's hard to have an honest conversation in America about Socialized medicine, because so many people are still alive today that were trained from youth to believe that Communists were out to kill/skullfuck them. At some point that may or may not have been true, but it's irrelevant now... except when you bring up a topic that someone might think is Socialistic in nature. All the sudden you're a "damn pinko commie", and no one's willing to talk about anything rationally anymore.
In short, a lot of people have been duped by fear tactics into undue irrationality.
O_o?
Reaming? You pay like less than a thousand a year for your courses.