(no subject)

[somedaybitch]

The New York Times reports that the Canadian system is imploding. A recent Candian Supreme Court decision allowed private health care (oh, the shame, the horror) and as a result, Canadians tired of waiting for radiation therapy, eye surgery and hip replacements have turned toward private alternatives springing up under the new legal environment.

i'm shocked. oh, wait.

article here.

the other relevant bit, and something i didn't actually know.

Canada remains the only industrialized country that outlaws privately financed purchases of core medical services.

i get why a society would want a nationalized health care system but i do not in any way understand then making private health care illegal. i would have thought that having both systems would help to keep prices, trends and "services" competitive, which keeps costs down. something that would both make sense, and save the government funded program money, which is generally considered a good thing. oh, sorry. that's capitalism. my mistake.

Comments

[lvp3.livejournal.com]

is it wrong that i snerked when i read the article? and the comments? oh socialism, how you make me giggle.

[samdonne.livejournal.com]

i would have thought that having both systems would help to keep prices, trends and "services" competitive, which keeps costs down.

Except that it doesn't. It only gives way to a two-speed system. One with top-of-the-line services for the rich (or the hopelessly indebted), and another one with long waiting queues for the not-so-privileged. See state of things in the UK.

We don't know what the outcome would be in a purely capitalistic, free market, as there is no such a thing in the world. And if there were, I'd probably move to Cuba rather than live in it. (Basic services -- e.g. health and security -- do not thrive in pure capitalistic environments. Imagine competing private police forces. Keep the cost of counterterrorism down! Fun? Not. Us crazy social democracies choose to place the right to medical care on par with the right not to be murdered, that's all.)

Protestant-hybrid social darwinism? Not what I want for my hypothetical kids. That's not what I deem a reasonable and ethical system. Which doesn't mean I won't fight tooth and nail for effective management of limited resources.

In that fight, outlawing private health care helps nothing. On that we agree.

[raincitygirl.livejournal.com]

SamDonne and MickieScaper both make points which have come up as justifications for keeping the system totally public, and not allowing private health-care alongside. And there's some validity to those points. Myself, I'm willing to explore public and private alongside each other as long as there are safeguards to ensure that the public system isn't hollowed out by the private.

However, there's a very large element to the battle which has nothing to do with health care and everything to do with federal v. provincial power struggles. This isn't mentioned by the NYT, probably because the reporter doesn't live here and isn't aware of all the political subtext. Essentially, paying for health care is a federal responsibility, but providing health care is a provincial responsibility. The vast majority of Canada's tax revenue is collected by the federal government, and then chunks of money are redistributed to the provinces. This has long been a bone of contention, with "have" provinces complaining about how the federal government is forcing them to subsidize "have-not" provinces. So the provincial governments have a lot of responsibility in terms of providing various services for their residents, but not much control over the revenue stream available to them.

Back in the early 1990's when the Liberals first took power, the federal budget was a mess. The Conservatives had been running major budget deficits and the national debt was very high. One of the ways the Liberal government balanced the federal books was to slash transfer payments to all the provinces. Therefore provinces had to decrease public spending on health care because the money just wasn't there. However, the Libs did not relax regulations on what the provinces had to provide to get federal money, despite the drastic decrease in federal money. So basically for well over a decade the feds have been trying to have it both ways: control the outcome without providing the funding necessary to achieve said outcome. They set the regulations in terms of what is and isn't allowed, but they're not the ones who have to deal with the budget headaches.

The demands by provinces to be allowed to provide private as well as public health services have been going on for a good ten years or more. Essentially it's a political pressure tactic. The provincial leaders are essentially saying, "Either give us enough money to fund the entirely public system, or make it legal for us to explore ways of generating new revenue to make up the shortfall." Neither of which the feds have wanted to do, because if they increase transfer payments to the provinces they jeopardize their own revenue stream without a corresponding benefit in terms of public goodwill. The provincial health care systems will end up taking a good portion of the credit. Why do you think they cut transfer payments in the first place when the federal budget was so bad? Because many of the services that would suffer were funded by the feds but actually provided by the provincial governments, so it wasn't the feds who would take the heat when standards declined.

And if they give the provinces the ability to raise new revenues, they decrease the provinces' financial dependence on them. Plus, if changes aren't instituted across the board, but only in some provinces or different private services in different provinces, then it'll be a mess both in terms of regulating it and in consistency of care (patients will be going cross-province to get private care, provinces with newly flush budgets will be luring health care workers with better salaries). So, yeah, it's not so much an ideological thing as it is the biggest front in a very long-running battle between federalism and centralized government. Yeah, for a few politicians it's a true-believer ideological battle, but for most of them it's a power thing, and has very little to do with health care. The provincial governments have been pissed off at their relative lack of power for quite some time, and the pissed-off-ness has gotten way worse since the feds realized they could clean up their own financial problems on the backs of the provinces. And of course, once having made that discovery, they never wanted to give that up.

[somedaybitch.livejournal.com]

Myself, I'm willing to explore public and private alongside each other as long as there are safeguards to ensure that the public system isn't hollowed out by the private.


yes. and that would seem like something very necessary to allow the whole thing to work as it should re cost.

The provincial leaders are essentially saying, "Either give us enough money to fund the entirely public system, or make it legal for us to explore ways of generating new revenue to make up the shortfall." Neither of which the feds have wanted to do, because if they increase transfer payments to the provinces they jeopardize their own revenue stream without a corresponding benefit in terms of public goodwill.

and this is essentially the entire reason why i think nationalized healthcare is a really bad idea. governments cannot afford it.

the federal government should not be put in the position of having to solely finance stuff like this simply because they do not have an unlimited money stream. it comes from taxes and the only way to increase that stream is to increase taxes.

[somedaybitch.livejournal.com]

We don't know what the outcome would be in a purely capitalistic, free market, as there is no such a thing in the world. And if there were, I'd probably move to Cuba rather than live in it. (Basic services -- e.g. health and security -- do not thrive in pure capitalistic environments. Imagine competing private police forces. Keep the cost of counterterrorism down! Fun? Not. Us crazy social democracies choose to place the right to medical care on par with the right not to be murdered, that's all.)

i don't think there should be a "pure" capitalistic market for precisely the reasons you mention. the absolute of anything is not conducive to a society. my point was the necessary amount of outside pressure that is needed. if the federal government, in this case Canada's, has no impetus to change, as raincitygirl discusses in her reply, then they won't. making illegal private sources of funding as an alternative to the absent public ones is simply a power play that has nothing to do with the health of its citizens.

[gingerwood.livejournal.com]

My only guess as to why private healthcare would be illegal would be to keep the cream of the physicians in the system.

[adafrog.livejournal.com]

Actually it doesn't. They come to the US, and other countries where they can actually make money. Doctors don't like working there.

[thevaliumsofalj.livejournal.com]

Yup! and canadians that can afford it come across the border to the states too, to get treatment because they can get better treatment quicker than if they stayed at home.

[somedaybitch.livejournal.com]

yeah...Mark Steyn, the journalist/pundit is a great example of that.

[arthurfrdent.livejournal.com]

i get why a society would want a nationalized health care system but i do not in any way understand then making private health care illegal.

weeel... think of the human factor and in a non-market way... If you can successfully pull this off, then there is no [or little] discrimination in healthcare, everyone gets it equally. You may argure that they all get equally bad or least common denominator. You may also argue that if everyone has the same stake, then they will DEMAND better care, pulling the system up. That would prolly work great for some place like a small town. Federally? not. There are too many people involved, people who dont care if old widow cuttler fell down. The very same people who live near me that resent having to pay for public schools, because their kids are grown. Well? Are they citizens or aren't they? They didn't have a problem taking the money when their kids were in school.

If you have a 2 tiered system then rich people in some ways get the short end, because they will go pay their own docs, but still pay for public health care they don't use, too. Thing is those still in the system, may not stand for the best services, because they will take what they can get. So those services decline. That is loosly based on the idea that if you are better educated, you will demand better services, and you will probably be making more money.

It's a conundrum, and no mistake. Hard to imagine how such a thing would work in the US, when we are orders of magnitude bigger.

[somedaybitch.livejournal.com]

again, my point isn't about whether it has value as a social construct or not. my opposition is solely based on the notion that the federal government is somehow supposed to provide every single thing a citizen might possibly need. that's ludicrous, impractical and smacks of nanny state. aside from that, there's a simple matter of funding, as in, there is none. what's the fed supposed to do, start dealing drugs or get into the bookie business to make up the difference?

[arthurfrdent.livejournal.com]

yeah, I think I posted at the same time as you posted some of your other explanations, and then I didn't see that till later... I understand your point.

I'm kinda heading to tangent land here... but, the way I look at it government itself is a social constuct. From that POV, I place the society, or perhaps the civilization another level up from government. The government we have flows from the society we are, and the decisions we have made. In a vacuum seems like certain things in a society are profitable for the society as a whole, but not individually or at a company level. Like schools for example. There isn't a profit margin in schooling because the worth of the product is payed out over a lifetime, rather than at one moment. Sure there are private institutions that school at different levels, but as a business model, it doesn't work the way a starbucks does. For the society at large, it is much better in general to pool resources and see to the education of members, because the payoff then filters to the whole, and over time. The share holders don't meet 4 times a year to demand metrics on how many A students are being produced, and why can't they all be that, and why is the cost per student going up over time?

I think there are other aspects of society in my opinion that share this sort of need. Healthcare, public transport, Space. The profit in these things is so nebulous and so long term, that it is difficult to make a business case to make a company for that.

The devil is in the details though, and that's the rub. I think that's WHY it doesn't work on the large scale. The upsides and the downsides are so diffuse, they're hard to measure. If I didn't have health ins. and I had a really bad asthma attack, I'd go to an emergency room. and they wouldn't turn me away to die. But, in all likelihood I would also never be able to pay the money back. Eg. when I went in for anaphylaxis, incl. the ambulance it was ~$8K. That's about what a friends bill was for life threatening asthma too [$6K/no ambl.]. So. Who pays for the kid from the southside of Chicago, whose parents both work 2 jobs, and so paradoxically doesn't qualify for medicaid, when he goes to emer. for a severe asthma attack? The taxpayer. Pay 8K for something that could have been prevented with basic medical insurance. How many years worth of premiums is $8k? Wouldn't it be better from the society or the taxpayer standpoint to just give the kid insurance? Maybe he wouldn't end up in the ER 4 times a year, sucking $32K out of a publicly funded Cook County Hospital.

Back to the devil in the details. If your neighbors barn burns to the ground, killing half his herd, is it a nanny state for all his neighbors to pitch in and raise him a new barn? It's on a small scale. Federally it looks like a nannystate because they're not even a friend of a friend. So there is no societal accountability, and it's very easy to game the system. Once you start gaming the system, then it is easy to rely on it, easy to never pay it back. THAT IMHO, is the problem. Not the funding so much. We spend a ton of money on the social, and tax funded programs we have, how much is wasted on an ER visit? A healthy citizen repays society over their lives far more than they ever take from it, but it is difficult to prove and close to impossible to administrate. Even HMO's don't necessarily see the forest for the trees... when I had anaphylaxis I happened to be at the Doc's office, so they took care of me, BUT my HMO wouldn't pay for an Epi. pen for either me or #1 son. Even though we both had prescriptions obviously, AND I HAD BEEN IN THE ER FOR THAT ONCE. "The likelihood is low it will happen again..." was the finding of the HMO's appeals process. Instead of spending $120 on an Epipen that would prevent an ER visit, or make it a visit to a you own doc for follow up, They'd rather spend $8k. Again.

You can imagine that I'm going to look for a balance. That I'm not comfortable saying every man for themselves, any more than I think that healthcare is an entitlement. Like many Q? for our govt. and society the answers are hard, but I believe we should continue to ask...