Questions It Would Be Really Great to Hear

[electricland]

the next time the CBC does a story about "fixing" the health care system, I would love it if, instead of the weak-ass questions they asked in today's segment, they would ask the following:

To proponents of more privatization:

• What, in your opinion, is the best health-care system in the world?


• How will private clinics increase access to care without sucking resources out of the public system?


• Do you think it's possible, before resorting to private clinics, to improve access through administrative improvements such as the Alberta Hip and Knee Replacement Project?

To no-privatization-ever people:

• Given that doctor's offices are already private enterprises, why do you object in principle to having other specialized private clinics?

Gotta run. Suggest your questions here!

Comments

[jaanquidam.livejournal.com]

How about: why on earth would you put people whose only economic incentive is to not pay for health benefits in charge of paying for health benefits?

Oooh, or: how would you like to watch your country's manufacturing sector collapse because nobody in the private sector can afford to provide health insurance?

Okay, well, that's all I've got for now. :)

[monkeycommando.livejournal.com]

I think its interesting that your responses deal exclusively with not having single payer insurance, and that doesn't even register in the spectrum of debates right now on health care in Canada.

[monkeycommando.livejournal.com]

I just re-read that, sitting as it does under the smirking monkey image, and it was not meant as snippy, at all.

Just made me realize that the US and Canadian systems are probably the two most different systems in the developed world, yet each country feels compelled to compare itself primarily with its neighbour.

[electricland.livejournal.com]

:D

Luckily, as MC said, scrapping single-payer isn't really on the table at the moment. (And I hope it never will be.)

But you are so right.

[jaanquidam.livejournal.com]

Oh. I was actually being snarky. But, I'm confused, too--we apparently mean something different by privatization. Is there an assumption that a single-payer system can't be private?

[electricland.livejournal.com]

Well, there's some feeling that it's a thin edge of the wedge. It's a bit silly really, because after all (a) doctor's offices are private enterprises, (b) hospitals are set up on all kinds of models, mainly but by no means exclusively not-for-profit corporations.

I've taken so long answering this that I can't remember exactly what the kerfuffle was about this time, but it's probably related to the Supreme Court decision about buying private insurance if one's wait for public care is unreasonably long (http://www.cbc.ca/news/background/healthcare/index.html).

...I should probably read up on the stuff in that section. It seems full of useful info.

[jaanquidam.livejournal.com]

Okay, that makes more sense...I tend to be saddled with economists definitions, which often don't capture how we talk about stuff. Also, I just saw MC's comment, too. As you probably noticed, in the US, we're very anti-public, so we end up with the equivalent of private "single-payers" (monopolies) in many industries....But it sounds like you're talking about private providers, not privatizing the industry...?

[electricland.livejournal.com]

Well, the concern usually comes when provincial governments say vague things about "allowing more private care" without specifying what they mean. The big issue with the Supreme Court decision was that it opened the door for people to buy supplementary (private) coverage if they weren't getting timely care, which in theory could lead to two-tier health care (good speedy care for the rich, slow crappy care for the poor, doctors and other providers sucked out of the public system because they can make more in the private system), which violates the universality principle of the Canada Health Act. And probably the accessibility one too, actually.

But no, there's certainly no move (well, except on the lunatic fringe) to privatize the whole industry.

[jaanquidam.livejournal.com]

Okay, I think I get it now. :) It's unfortunate that the two-tier system is potentially the slippery slope toward gutting health care, because it can actually work well. In theory. Paul Krugman's written a lot of popular stuff comparing health systems...I'll see if I can find one of his articles....

[electricland.livejournal.com]

thanks! that would be great!

we do get locked into this mindset in Canada where we look at the U.S. system and shudder and think that any change is a step towards that and we must avoid it at all costs. Unproductive. (OK, some people look at the U.S. system and think it's the greatest thing ever, but they're just insane.) And anybody who tries a creative suggestion gets shouted down. i'm guilty of it myself to some extent.

Another option, at least for those of us near the border, is potentially shipping patients across the border for things like MRIs. Take advantage of the excess capacity over there, shorten wait times. But do you think it'll happen? It would take a brave politician to suggest it, that's for sure...

[jaanquidam.livejournal.com]

Well, I think you should look south and shudder. I mean, the scope of our health care crisis is pretty mind-boggling. People are so desperate for health care that it gives American bosses a degree of economic power unseen since the days of the "satanic" industrial mills. It's a truism--one that's studiously ignored in American rhetoric--that capitalism is anti-democratic because workers cede their civil rights when they enter the workplace. The idea that one's health is tied to capitalism should give people pause. IMO. To some degree, in all of the western/anglo countries, property rights trump civil rights, and it seems to me that the real debate should be about how we value those two rights relative to each other, e.g. whether health is a civil right or a property right. If you think of it in those terms, then any movement toward privatization can seem disturbing.

God, I'm totally spamming your LJ today. Sorry about that. I posted part of an article below. Here's another one: http://www.truthout.org/docs_2005/101705M.shtml

[electricland.livejournal.com]

don't be sorry! I love this stuff!

Although we probably shouldn't get into that whole consumership-vs.-citizenship thing if either of us is going to get anything done today...

[jaanquidam.livejournal.com]

LOL I should probably come clean and admit that I'm a US-educated economist with a big fat chip on his shoulder about health care and capitalism in general. ;) Actually, Raithen and I were talking about this earlier, that I really thought I could help people if I learned this stuff, only to find out that nobody in power cares. So I tilt at windmills, and spam LJs.

[electricland.livejournal.com]

well, keep on trucking. Your time will come. At least, I hope so...

[monkeycommando.livejournal.com]

I don't know that I fit into either of your two categories, but I'll throw out a few under-informed assumptions.

1. I don't know for sure what the best is, but I doubt its Canada's. I believe the US provides better care overall to those who are really poor (enough to qualify for Medicare/medicaid), but about 1 tenth of the population, when between jobs, live in a precarious state for a few months or couple of years, and other people get screwed by their insurance companies (which is a problem, specifically, with the insurance system, which is only part of their otherwise pretty darn good health care system). I have read the US gvt spends way more per capita on health care than Canada does, but I don't know if that takes into account wealth differences, exchange rates, the difference between federal and provincial/state jurisdictions, and what have you. But it could be evidence that while inferior in care delivered, our system actually uses money more efficiently.

I know lots of people complain about it there, too, but can the UK system be worse than ours?

How 'bout Sweden?

2. The Canadian health care system is held back (in part) by a lack of capital, the argument for privatization of providers is to tap in to a huge potential well of capital with the lure of profit from efficient performance, the agility to meet demands that comes with entrepreneurship and a lack of the inertia that comes from public decision making. That's significantly romantic hogwash, mixed with a good helping of union busting, but partly true, and I don't see why the monopoly government insurer couldn't set the price it will pay for procedures, and let the private sector find out, through trial and error, where there are opportunities to make a profit.

Unlike with, say, public vs. private schools, I don't see why people assume that some privatization would necessarily "bleed" anything from the public system. To me it looks like it could free up many resources. Oh, wait, I guess by "resources" people may mean skilled workers (doctors on through). If there's money and profits flowing in, that should increase he supply of people who want to work in those fields and stay Canada, providing the training and accreditation system can keep up.

Now, if what people are worried about are private and economically _exclusive_ clinics, then obviously there's little reason to allow them.

Well, except for the fundamental "freedom to do what you like without the government getting up your nose" argument, but that doesn't get a whole lot of traction around these parts.

3. Why not do both? I just don't see "privatization" per se, as necessarily bad. I think the provinces should be encouraged to experiment with different approaches, as long as we maintain a single payer, to discover what works best in different circumstances.

The reason I'm for single payer in all cases is that I don't believe there can be a true free market for medical treatments, since tfms(tm) require informed, rational consumers making economically wise decisions for themselves, and I don't think that's really possible when it comes to health care issues.

[electricland.livejournal.com]

See? Doesn't one get good and interesting answers this way?

I've seen the uninsured-or-underinsured figure in the U.S. as higher than 10%. I forget the details. One problem is that more and more employers are not providing health insurance, as it's so expensive, and a lot of things are not covered or come with high deductibles. And the working poor can't afford coverage, and a lot of jobs simply don't come with health insurance. (The fact that employers don't need to pay for basic health coverage is a major competitive advantage for Canada, as you know.)

Administrative costs are HUGELY higher in the U.S. than here. One advantage of single-payer is it cuts down on admin costs for individual doctors -- no trying to figure out the intricacies of Medicare, Medicaid, and a dozen individual plans. Billing in the U.S. is a full-time job for someone.

I don't think it's the government that pays more, I think it's the system overall (including individuals) that pay more.

I'd love to know more about other systems. People do complain about the NHS, but unfortunately I usually skip those articles in BMJ so I'm not as clear on the issues as I could be.

I too am cautiously pro some private delivery of care. Or at least I'd like to see it tried and assessed. The provinces make a great natural laboratory for these experiments, and I hope that we can learn from them.

The reason I'm for single payer in all cases is that I don't believe there can be a true free market for medical treatments, since tfms(tm) require informed, rational consumers making economically wise decisions for themselves, and I don't think that's really possible when it comes to health care issues.

Amen. And your health shouldn't be something that depends on what you can pay.

[jaanquidam.livejournal.com]

Okay, found something:

The fact is that the mainly private U.S. health care system spends far more than the mainly public health care systems of other advanced countries, but gets worse results. In 2001, we spent $4,887 on health care per capita, compared with $2,792 in Canada and $2,561 in France. Yet the U.S. does worse than either country by any measure of health care success you care to name - life expectancy, infant mortality, whatever. (At its best, U.S. health care is the best in the world. But the ranks of Americans who can't afford the best, and may have no insurance at all, are large and growing.)

What he doesn't say here is that not only do we do much worse at caring for the poor than all industrialized and many non-industrialized countries, but many of our poor fail to get care at all due to copays, premiums, and job instability. Generally speaking, the French system seems the most viable in the long term, whereas the German system, like ours in the US, is likely to collapse sooner or later.

[electricland.livejournal.com]

rats -- can't read it. Stupid Times firewall. But thank you -- if I ever upgrade, I'll check it out! and will look out for other stuff he's written as well.

[jaanquidam.livejournal.com]

Okay, I think I'll just post the whole thing in my LJ. Stay tuned....