As you know in Canada and in the US Medicare system the doctors aren't government employees, that is why I said I wanted Medicare for all. Why pretend that private insurance has no additonal overhead above single payer? There have been studies that show this additional overhead . Do you deny this? Maybe we can have an intelligent conversation once you just don't assume you kave all the answers and or knowlege.
Cohen was interested in some data about the excess administrative costs of ours system vis a vis say the Canadian system. It also some of the arguments from the health insurerer trade organizations along the lines made by Cohen ***** What premiums pay for David Lazarus Friday, January 16, 2004 ©2004 San Francisco Chronicle The United States squanders more money every year on health care bureaucracy than it would cost to provide medical coverage for the 43 million Americans now lacking insurance. That's the finding of two respected Harvard Medical School researchers, David Himmelstein and Steffie Woolhandler, in a study appearing this week in the International Journal of Health Services. They determined that of $1.6 trillion in total health care spending last year, at least $399 billion was eaten up by administrative costs such as clerical work in hospitals and processing a vast array of insurance forms. But if a national health care plan like Canada's were implemented in this country, the researchers found, administrative overhead would be slashed by about $286 billion This amount, in turn, would be sufficient to not only provide health coverage for every uninsured American nationwide but also allow millions of underinsured people to improve their quality of care. Himmelstein, who is also a physician, said in an interview that 10 percent of revenue at his Cambridge practice now goes to an outside billing firm that handles much of his insurance work. "That amount could be used instead to care for more patients," he observed. "It could be used to hire additional people and fund a huge expansion of care." Similarly, Himmelstein estimated that at least 15 percent of his time every day is spent dealing with paperwork. " That's 15 percent of my time that I'd much rather spend on patients or learning more about medicine," he said. Private health insurers, who would be decimated by taxpayer-funded universal coverage, oppose creation of a Canadian-style system in the United States. Instead, they prefer adjusting the existing system to expand the number of people covered. But Himmelstein and Woolhandler argue that the existing system is grossly inefficient and needs to be completely overhauled. The findings of their research may be speculative, but they say it points the way toward legitimate cost reductions. In California, they found, nearly $163 billion was spent last year on health care. Of that total, $45 billion, or about 28 percent, went to administrative costs. With Canadian-style universal coverage, the researchers concluded, Californians would save almost $34 billion annually on administrative overhead. This would provide more than $5,000 for each of the state's nearly 7 million uninsured. "As it stands," Himmelstein said, "you could insure all uninsured people for about $1,500 per person. The administrative savings would thus leave plenty of money to upgrade coverage for others." The Canadian single-payer system is frequently cited as a model for how the United States might go about offering health coverage to all citizens. The Canadian system, begun nationally in 1971, guarantees all citizens access to essential medical services regardless of employment, income or health. The system is administered regionally but overseen at the federal level. It's not perfect. A 2001 study found that patients requiring elective surgery wait an average of 16 weeks before reaching the operating table. Investment is slow in new technologies and equipment. On the other hand, Canadian hospitals and physicians spend substantially less time on administrative chores because the single-payer system is relatively streamlined. Hospitals receive lump-sum payments each year from local authorities but have wide discretion as to how their resources are used. Paperwork is minimal. Would Canada's system work in the United States? Probably not without some tweaking. Experts say a U.S. universal health care system probably would require strong regulatory oversight to ensure cost controls and quality (and such oversight likely would cut into at least some of the projected savings). Government authorities might also need more say over distribution of medical resources. Just as few communities would want or need two fire stations within a block of each other, regulators would help decide where hospitals are built to avoid wasteful duplication of expensive technologies. "Health care shares many of the same characteristics of fire departments and police departments," Himmelstein said. "Hospitals should be treated the same way." Karen Ignagni, president of AAHP-HIAA, the leading trade group for health insurers, challenged the methodology of Himmelstein and Woolhandler's study, and said administrative costs in the report "are wildly inflated." Many of the expenses included in the study, she said, "actually involve activities that improve the quality of health care. It's not just paper pushing." U.S. health insurers support extending coverage to all Americans, Ignagni stressed, but are "against a one-size-fits-all approach." For its part, the drug industry's leading trade group, Pharmaceutical Research and Manufacturers of America, also opposes creation of a single-payer health care system. Jeff Trewhitt, a spokesman for the association, said private insurance plans offer consumers more choice and "allow pharmaceutical and biotechnology research companies to avoid innovation-stifling, government-mandated price controls." Harvard researcher Woolhandler responded in an interview that the insurance and drug industries have resisted change for years. "They're extremely happy with how things are now," she said. "For them, it's a life-or- death struggle." Yet in the face of such politically powerful opposition, most experts agree it's unlikely nationwide universal coverage will be adopted in the United States anytime soon. Then again, Canada began its system more than half a century ago on a province-by-province basis. link
Originally posted by glynch Cohen, I think you misunderstood my first post. In addition why asume I am for no controls or audits. I have heard of games like the lab ownership issue with dotors. No doubt dotors and other health care providers try to defraud the system. Are you saying they don't try to do that with private insurers or the insurers with the doctors? On a much much smaller scale, because the bad docs know that the private companies are incentivized to identify and prosecute them. The feds were forced to implement specific laws to punish tyhose who try to defraud Medicare, yet you still hear of giant Medicare frauds. I agree that the HIPPA law at least with regard to privacy is a beast with every hospital having its own medical release forms. What a nightmare. How do they handle privay in Canada? The hospital forms are not even a fraction of the law. I certainly see a role for even private auditors if that is your main beef with single payer. My main beef is that market incentives achieve far more than the government can mandate. The market forces in healthcare were perverted. We should continue to fix them and help customers identify quality and value so that healthcare can improve. Are you aware of how inefficient the dissemination of information and knowledge is in this industry? This is the industry that deals with our lives, yet physician practice patterns correlate more closely with physicians' peer groups than with which Medical School they attended or which medical journals they read. Doesn't that concern you? They took a bunch of patients with identical back pain symptoms to physicians and not one had the same prescribed therapy as another. And they've performed that study with other conditions and had similar results. It's not just that the healthcare system is broken; the delivery of medical care is broken. We've all heard horror stories of missed diagnoses and misdiagnoses. Not all can be repaired but much of it can. Over 100,000 die each year from prescription drugs. In hospitals, 200,000 die each year from potentially preventable in-hospital medical errors, and adds billions in costs to try to repair such errors. http://www.medicalnewstoday.com/medicalnews.php?newsid=11856 I don't trust the government to repair this system. No way. The incentives will never be their. Additionally, It's bad enough when doctors, hospitals, pharmaceutical companies and insurance carriers lobby today for their own benefit; can you imagine what it would be like when all healthcare goes through the government? Uh uh.
Originally posted by glynch As you know in Canada and in the US Medicare system the doctors aren't government employees, that is why I said I wanted Medicare for all. Why pretend that private insurance has no additonal overhead above single payer? There have been studies that show this additional overhead . Do you deny this? That's beneath you...well...apparently not. I never said we don't have additional overhead, but I wanted to see you defend your 50% number which you have failed to do. I also argue, as does Ignani in your following article, that there are medical reasons for much of the paperwork (e.g. making certain that care is appropriate and necessary, safety controls in hospitals, etc) , that much of the paperwork will not go away under nationalized healthcare (only under socialized care, which removes all market forces), and that much of the paperwork is a result of the government's mandates. The best reduction in 'paperwork' costs will come from IT automation and advances in and the electronic dissemination of medical knowledge, and the biggest advances in these are made by private companies with market incentives. Maybe we can have an intelligent conversation once you just don't assume you kave all the answers and or knowlege. Again, putting words in other's mouths? Your favorite passtime? I never claimed to have all of the answers. My claim was that I am knowledgable on this complex industry and it's issues and that you were are ignorant of the same. You have done nothing to prove me wrong. If you hear ridicule, you're right. Folks like you have your uninformed agenda and don't understand how your proposals are going to hurt so many people. If your primary objective is coverage for all that is commendable. But don't run around willy-nilly and break the system more than it already is.
Cohen, I'm very interested in this topic and I think you provided some real food for thought. I have to say though, that your tone with Glynch really gets in the way of what you have to say.
yet physician practice patterns correlate more closely with physicians' peer groups than with which Medical School they attended or which medical journals they read. Doesn't that concern you? Over 100,000 die each year from prescription drugs. In hospitals, 200,000 die each year from potentially preventable in-hospital medical errors, and adds billions in costs to try to repair such errors. I really think you are switching subjects. There are other problems with the health care delivery system. However, the orignal topic and my post is that we need a government funded health care system so that 45 million uninsured Americans can have coverage and access to virtually ANY care. Now you are talking about how to improve care ASSUMING they have care. If you are implying that we do not give these people coverge till we solve alll imaginable problems with the system ( and I do agree poor care and malpractice , iincluding parmaceuticlal malpratctice etc. is an issue) I disagree and also think that this tactic sounds like the pr we see in politics and would be advanced by sophisticated private health insurers trying to hang on to their golden cow. Note this might not apply to you. The present system for the 45 million and growing uninsured can't wait for soloutions to all additional problems. I also believe that in Canada, Gemany, Sweden etc. they deal with these easy to recognize issues. The best reduction in 'paperwork' costs will come from IT automation and advances in and the electronic dissemination of medical knowledge, and the biggest advances in these are made by private companies with market incentives You always get back to "private companies" without and while your faith is common, I don't think this proves your point. In addition your knowlege of the complex details of a screwed up system does should not entitle you to feel you are right. As an example I would give you an example from the fielld of law. The Title Recording System that is complex, that is the reason why you have to buy title insurance and hire lawyers when you buy real estate. Britain for effcieciency sakes went to a more modern system like most of the rest of the world approximately 30 years ago. Once you do that a whole complex system with hundreds of millions if not more $ spent disappears and so does the importance of that knowlege. Complex schemes to reform it that try to maintain the role for title insurance would not be helpful. I disagree that the issue of whether Americans want to go to say some variant of the Canadian system is too complex for a reasonably intellgient and informed lay person to have opinions on. It is too importan to be left to only those with a financial stake in preserving much of the status quo.
Thanks for your opinion. Glynch and I have a long history. Would I jump-in w/ this tone if this was our first discussion? No. But I know what he's about. I no longer argue with glynch to change his mind since I don't think that's possible. But when he touches on such a serious subject and presents such a dangerous 'solution' to others, I admit that I'll get quite angry and do little to moderate the anger. No less than people's lives are at stake, and that is no exaggeration .. in fact, many more lives are at stake EACH YEAR than have died on all sides in Iraq. Glnych's 'solution' can save a few while taking many many others, in perpetuity. D*mn straight I'll be angry when I know there are real solutions than can save lives of not just the uninsured but the insured also. As for glynch's style, when defends his position he nearly always trys to put words in others' mouths. I believe that this occurs because in his mind, if you don't espouse the entire liberal view then you must espouse the entire opposite. He fails to see the middle ground. When I jump into a discussion with glynch, I am prepared for what's coming. That doesn't mean that I like it any more. And FWIW, here was the first potshot taken:
Originally posted by glynch I really think you are switching subjects. That's your problem. You don't understand how things work. These topics are all related; you cannot change one w/o effecting others. There are other problems with the health care delivery system. However, the orignal topic and my post is that we need a government funded health care system so that 45 million uninsured Americans can have coverage and access to virtually ANY care. The original topic discussed how one specific morbidity was treated better in the States than in our neighbor's socialized medicine. Your first comment to me was one disparaging managed care. Was I not to assume that you see no place for the 'evil' private sector? Now you are talking about how to improve care ASSUMING they have care. If you are implying that we do not give these people coverge till we solve alll imaginable problems with the system ( and I do agree poor care and malpractice , iincluding parmaceuticlal malpratctice etc. is an issue) I disagree and also think that this tactic sounds like the pr we see in politics and would be advanced by sophisticated private health insurers trying to hang on to their golden cow. Note this might not apply to you. The present system for the 45 million and growing uninsured can't wait for soloutions to all additional problems. Nonsense. I believe that these people should have had care yesterday. But the solution does not need to include the socialization of our healthcare. Healthcare topics may be related, but these are separate. Most Americans accept the employer-group based coverage as a given. It's not. It was actually an accident that never should have occurred. The government should always have been paying for it. Universal funding does NOT have to be socialized medicine. At the present time, who pays for it? We all do. Providers and hospitals all charge higher to cover uninsured uncollectables (for severe service that should have been handled in outpatient settings instead of the ER), Countys pay for their free clinics, and many unisured pay with ruined livelihoods and sometimes their lives. This is a most inefficient and painful way to (under)fund care for so many. My feeling on universal funding can be summed up as the government should be protecting these folks as if they are being attacked from a foreign entity. I also believe that in Canada, Gemany, Sweden etc. they deal with these easy to recognize issues. Not the way free enterprise is motivated to do. Those countries will benefit greatly by what the US private-sector 'learns'. You always get back to "private companies" without and while your faith is common, I don't think this proves your point. In addition your knowlege of the complex details of a screwed up system does should not entitle you to feel you are right. KNOWLEDGE does. Present some knowledgable insight and prove otherwise. As an example I would give you an example from the fielld of law. The Title Recording System that is complex, that is the reason why you have to buy title insurance and hire lawyers when you buy real estate. Britain for effcieciency sakes went to a more modern system like most of the rest of the world approximately 30 years ago. Once you do that a whole complex system with hundreds of millions if not more $ spent disappears and so does the importance of that knowlege. Complex schemes to reform it that try to maintain the role for title insurance would not be helpful. I disagree that the issue of whether Americans want to go to say some variant of the Canadian system is too complex for a reasonably intellgient and informed lay person to have opinions on. It is too importan to be left to only those with a financial stake in preserving much of the status quo. So we should leave it to those entirely ignorant of it to make it worse? There's some handy logic. And where did I espouse preserving the status quo? Again, assumtpions on your part against readily available evidence to the contrary. The very nature of my business is to change and [/i]improve[/i] on healthcare. I am against anything that removes incentives to improve on healthcare as we all should be, do you not agree? I have already said on many occassions that our system is broken and needs fixing.
Hi Cohen. Thanks for the welcome! I’m here more intermittently these days, but I’m still around. I’m not familiar enough with the US system to contribute much to this part of the discussion, and I’m not sure I understand Cohen’s definitions of “socialized” healthcare and “single payer” systems enough to know whether I’m agreeing or disagreeing with him, but I do have some general comments on some of the issues raised. While hospitals and doctors here get their cheques from a single source, their provincial government, in Canada as a whole there are 10 different provincial systems, and a significant portion of the funding comes from the federal government who are responsible for ensuring that certain standards are met. So there is in fact a lot of competition and scrutiny that occurs between provinces and by the different levels of government. In addition to this health care is always a hot election issue and general public has always had a major influence on high level spending issues. The increase in the length of the waiting lists that occurred through the 90’s was in large part due to the public’s increasing concern about the debt and consequently governments on all levels pinched their heath care budgets. In recent years this has become a source of increasing complaint and just recently a new deal between the federal and provincial governments was struck which will significantly increase health care spending and develop minimum standards for wait lists. So the system is very much held accountable and is changed when there is a demand for it to be changed. With regard to the “market forces” issue, I think that this is an argument that does not apply well to most aspects of health care. In every country in the world there are parts of the economy, government and other institutions that are better regulated by market forces, and there are parts that are better regulated essentially by the democracy itself. No one is calling for privatized fire departments, or sewage collection, or tax collection, for example. Health care is one the areas that generally is not well served by being left to market forces. Much of this is addressed in the sound clips in the links I provided above. Some of it is quite obvious I think. You wouldn’t want your politicians or policemen or professors to be driven primarily by the desire to maximise their own profit, for example. Income is not irrelevant but, once someone has accepted a position that will allow them to eat and take care of his/her family etc., doing the job to be best of one’s ability in respect of higher principles like justice, the Hippocratic oath, advancing societie’s knowledge base etc., and generally acting for the betterment of your fellow man, is what the best people are typically driven by. I don’t recall any direct comparison but other than wait lists and some specialisations that the critical mass of the US allows, I would expect that we get a higher standard of care in Canada than the US, simply because of the values that our system is based on and infused with. The best doctors are usually not the wealthiest doctors, they are the ones who genuinely care about their patients and are highly skilled. A previous poster mentioned what is sometimes referred to the Canadian “brain drain.” This is the phenomenon that occurs when young professionals head to the US for the lower tax rates. (This results from essentially a loophole that exists in our education funding that allows people to benefit from the strong Canadian educational and social funding and duck out to a lower tax climate when it comes to paying back what they’ve received in subsidised education, healthcare, etc. through taxes. We fund education as an investment in our people and to train people who will later become productive members of our society and economy. Essentially we get back what we invest monetarily in someone’s education through taxes they pay later on. What we need is a way to recoup those funds from those who choose not contribute back to our economy. I don’t have a fundamental problem with this choice, but if they’re not going to pay back what they received by paying Canadian taxes then they should pay it back directly out of their future earnings wherever that may be, but this is a separate topic.) My point here, which I’m taking a long time getting to, is that although many of these people have been tempted by the opportunity to take the best of both systems, many doctors come back within a few years. They typically say that although they can make more money in the US, they just can’t stomach not being able to offer a procedure or treatment to someone who needs it simply because they can’t afford it. In fairness, the litigious climate in the US and how that restricts what they can do is often also mentioned as a reason for returning, and it is really a separate issue. But my point is that the best doctors don’t seek to maximise their bottom line. They seek to be able to provide the best care possible for all their patients, and that can not be done in the US system, so they come back to Canada where they can provide the best care. And note that by no means are doctors poor in Canada. They do very well, but not as well financially as they could on average do in the US. For our doctors, however, while money is certainly part of the equation, it’s not the point of the equation. The patients are. Again, the Canadian system is not an untested one. Some variation of it is present in every first world country except the US. All of these countries came from a system similar to the US system and none of them is contemplating going back. That fact ought to speak pretty loudly on its own.
Originally posted by Grizzled ... I’m not sure I understand Cohen’s definitions of “socialized” healthcare and “single payer” systems enough to know whether I’m agreeing or disagreeing with him, but I do have some general comments on some of the issues raised. I advocate healthcare for all, paid for by the government. I do not advocating doing away with market forces. Let private companies battle for customer's dollars. Let them prove their value and improve upon it. While hospitals and doctors here get their cheques from a single source, their provincial government, in Canada as a whole there are 10 different provincial systems, and a significant portion of the funding comes from the federal government who are responsible for ensuring that certain standards are met. So there is in fact a lot of competition and scrutiny that occurs between provinces and by the different levels of government. That's not the type of 'competition' that is needed. Do you mean that heart patients would travel to the Northwest Territories from BC in the instance they had better outcomes there? In addition to this health care is always a hot election issue and general public has always had a major influence on high level spending issues. s c a r y. Medical issues become election topics. I'll use an example from the States: gov't mandated stays for normal (vaginal) births. It wasn't based on clinical research, but played to people's emotions. Just had a baby? You should get to rest in the hospital for at least X days. Problem: it is a waste of limited funds to mandate services when they're not needed. Additionally, most in the industry would argue AGAINST longer than nec stays since they expose patients to healthcare system-induced illnesses. Case in point was one of my Aunts who was permitted to 'rest' in the hospital after her last birth, and contracted a very very serious hospital-borne infection. ...With regard to the “market forces” issue, I think that this is an argument that does not apply well to most aspects of health care. In every country in the world there are parts of the economy, government and other institutions that are better regulated by market forces, and there are parts that are better regulated essentially by the democracy itself. No one is calling for privatized fire departments, or sewage collection, or tax collection, for example. Health care is one the areas that generally is not well served by being left to market forces. Much of this is addressed in the sound clips in the links I provided above. Some of it is quite obvious I think. You wouldn’t want your politicians or policemen or professors to be driven primarily by the desire to maximise their own profit, for example. Income is not irrelevant but, once someone has accepted a position that will allow them to eat and take care of his/her family etc., doing the job to be best of one’s ability in respect of higher principles like justice, the Hippocratic oath, advancing societie’s knowledge base etc., and generally acting for the betterment of your fellow man, is what the best people are typically driven by. That is not a satisfactory basis a life-and-death industry on. * Research shows that providers will act in conflicting ways, not always to the benefits of patients and sometimes to their extreme detriment. * No matter how high the provider's ethics and morals, they cannot overcome the severe dearth of knowledge in the industry and poor dissemination of information. They need help. This is an enormous topic that I've already touched on, but we can go there if you wish. * The sizable variations in the quality of healthcare rendered make it a prime example of an industry which should be allowed to have market forces do their duty. I don’t recall any direct comparison but other than wait lists and some specialisations that the critical mass of the US allows, I would expect that we get a higher standard of care in Canada than the US, simply because of the values that our system is based on and infused with. The best doctors are usually not the wealthiest doctors, they are the ones who genuinely care about their patients and are highly skilled. ... Cannot speak to that. I've never read anything that supports or refutes this argument. Again, the Canadian system is not an untested one. Some variation of it is present in every first world country except the US. All of these countries came from a system similar to the US system and none of them is contemplating going back. That fact ought to speak pretty loudly on its own. And what about the fact that the US economy pretty well trounces all others? What should other countries do, drop their tax rates? Implement our healthcare system? People are dying from avoidable medical errors and substandard care in all of these other countries also, maybe even at higher rates than in the US, as the aforementioned study argues. The best part of the Canadian system, IMO, is that all folks are covered. We can do that w/o having to resort to socialized medicine. Ultimately, the US system will evolve into a beast that will put enormous amounts of information and knowledge at providers' fingertips to help them practice the best care possible, and also provide information to consumers on who the superior provider is.
Not sure what you mean by socialized medicine. In Canada, the doctors are usually self-employed. They bill based on a fee schedule that's negotiated between the doctors assoc and the government (not sure how different this is from an insurance co. negotiating with a HMO), but they are responsible for paying their own expenses (for the most part) and hiring their own nurses. Hospitals are public, and doctors get admitting rights. The key difference, i think, is that they are not free to set their own rates -- but i don't know how you do that and have the government foot the bill. And the renumereration is much less. Also...the research opportunities are not as good. At least that's what i've been told by doctors who've moved from Canada to the US. More money...more research...better facilities. Balance that with concepts of 'fairness', the business model some HMO's work under, and preferences for lifestyle matters. Not all find the US sytem preferable...but many do.
Nonsense. I believe that these people should have had care yesterday. But the solution does not need to include the socialization of our healthcare. Healthcare topics may be related, but these are separate. As stated. Medicare is government funded. The healthcare providers are private. Hence not "socialization". You are still switching subjects. Talking about malpractice, computerization, quality control etc. and trying to claim without proof that these are not dealt with in Canada for instance. Universal funding does NOT have to be socialized medicine. If you would just understand that Medicare largely still has private health providers doing the health care or quit using an arcane definition of "socialized health care". So we should leave it to those entirely ignorant of it to make it worse? There's some handy logic. So you are back to name calling. The Harvard doctors I quoted are not "entirely ignorant" and support my position more than yours. Those countries will benefit greatly by what the US private-sector 'learns'. Something we can agree on. Nobody ever said government bureaucracies can't learn from accounting techniques or quality control technigques or as you said before computerization. You still never answered my initial question what percentage of the extra 5.0% approximately that we outspend the Canadians goes to wasteful, marketing, paperwork, and in this context profit. I am not against profit per se, but in this context when we claim to be unable to afford healthcare which you admit is a right it is an issue. Look you work in managed care. I expect you to defend the necessary role of it in any possible health care. You have not explained how this is not possible for Canada or Germany etc. Just a generalize paean to free enterprise doesn't strike me as a suffcient answer.
Good. We’ll agree on this point then and move one. For me this is the most important point. The rest of it is deciding on how best to accomplish this goal. In general I think the cost of administering such competing programs outweighs their value, but I suspect we’ll get into that further on. No. Every provincial health system and its health board wants to provide the best care and outcomes, within certain parameters, but each has slightly different ways to doing some things. So there are different approaches and they learn from each other. I think in one of the examples above the analogy to fire protection was made. We, and I presume you, don’t have private fire departments, but different departments in different parts of the country do things somewhat differently and try different techniques and equipment and they learn from each other. There are certain circumstances where the scenario you mention does arise, but those are situations where, for example, a new very expensive treatment for a rare condition exists and one province may have approved it under its program while another may not have done so yet, so in these typically high profile cases people do sometimes move from one part of the country to another where such a treatment is covered, but these are quite rare cases. The election debates don’t happen at this level. These debates would happen locally with the doctors and the local health board, but I don’t recall such debates happening at all. We leave such decisions up to the medical community and whatever the best practices of the day are. The electoral debates are about high level issues like increased funding, wait lists, sometimes issues like extra billing. They are about policy issues, not medical issues. Here are some links to info on the Alberta Department of Health and one of its Regional Health Authorities the CRHA. http://www.health.gov.ab.ca/regions/index.html#mandate http://www.calgaryhealthregion.ca/ Most people think its fine for fire protection or police services or the army. Why not healthcare? In Canada we think health care is an essential service like the above, and we are generally very happy with the way our system works. I think this may be an indictment of your system, perhaps due to the profit motive? Our systems are not perfect and sometimes bad decisions are made, but there is no systemic advantage to not acting in the patient’s best interest. The only one who would pocket extra cash is the government and it is politically very much not in their interest to be playing any shady games. The cost would far outweigh the benefits, even in Alberta. Even “King” Ralph, the current Alberta Premier and head of a party that has been in power for 30 years here, backs down when the pubic starts to get antsy about his talk about privatising parts of our heath care system. We’d toss that sorry mofo out on his can if he did what he and his party would like to do, for purely ideological reasons, to our heath care system. It’s ours baby. We the people own it, at least at a high level, and the politicians know it. And those who don’t become ex-politicians. I’d be interested in hearing more detail. As I mentioned the different provincial systems learn from each other, and as the first article in this thread shows the media and the various heath boards as well follow what goes on the US and Europe and elsewhere in the world. They seek to constantly improve on best practices. That’s their job and their desire. That’s what their trained for and it’s their service to the public. I’m sure every firefighting company wants to know of new and better ways to fight fires, and every health board wants to know of new and better ways to serve patients. It’s what they do. The issues arise around new and expensive treatments, and around some changes to traditional ways of doing things like introducing more home care, or the use of mid-wives for home births, etc.. Different provinces make different decisions around these issues and they watch each other to see how well they work and the media is there watching and reporting too. It’s our system and we feel we have influence over it. It’s not just “that damn government” for us. I don’t think the strength of your economy is related to your healthcare system. The economy of a country is influenced by many things that have nothing to do with policy. Alberta is the richest province in Canada, but it may well have the least competent government. We’re rich because we’re sitting on lakes of oil and gas. The economy is also only a measure of dollars and cents. Most standard of living measures rate Canada and these other nations higher than the US. Perhaps this speaks to a fundamental value difference that lies at the heart of this and other differences between our countries. The American Dream is very much defined by the bottom line. The Canadian dream I don’t think is. It’s a factor, but for most people not a primary one, I submit. I’m in interested in the information you refer to and why it would be available in your system of the future and not ours. Ultimately it’s up to the Americans to choose for themselves, of course, but with your political systems that essentially reserves power exclusively for the wealthy segments of society, with there ever be any other choice? Our system is extremely popular overall. I think one of the above articles talked about a satisfaction rating of 80%. Clearly this is what the people here want. I honestly believe that if the average American had the chance they would choose such a system and ultimately be just as happy with it, but I admit that we certainly do have significant cultural differences. “Resorting to socialized medicine” is not a phrase that will have any meaning to most Canadians. It’s loaded with meanings about how Americans view their government and how accountable and trust worthy you feel it is. If you asked a Canadian if they trust the government and politicians they would probably say no, but if you probed a bit and asked about how they felt about specific government run programs, like Medicare, old age security, and even public auto insurance, and asked whether they felt they should be run by the private sector most would give you an emphatic no and say that the basic structure of how they work is very good. I think maybe ultimately it boils down to how you feel about your democracy. Our politicians are almost never the unreachable, out of touch, upper crust. They are much more likely to be lawyers and school teachers and farmers who live in ordinary middle class neighbourhoods. We certainly have our gripes, but we trust them at a much higher level than I think Americans trust their politicians, and we trust that we can get rid of them if we lose that trust. Consequently the term “socialised medicine” doesn’t really have negative connotations here, which is why bnb and I are kind of confused by your use of the term. It would be like me talking about your “socialised fire departments” or “socialised police forces.” It doesn’t really make sense to your conception these services.
FWIW I still don't think Cohen really made his argument that expanding medicare with prescription benefits , which would be pretty similar to the Canadian system, for all Americans would be worse than the very vague complicated system, yet to be developed in the future, that he advocates. Americans understand medicare enough that they know it is vastly superior to being non-insured and aint that bad. Such a change could be made immediately with Congress passing a law. Americans could take their cards to the existing doctors and hospitals and even hmo's if they like. (BTW I go to an HMO by choice myself) Why should the unisured have to wait for a yet to be determined future system? Maybe Cohen has a more concrete vision that goes beyond advocating what IMHO are certain management or information systems techniques , (also applicable to medicare)or abstractly lauding the free enterprise system, but he hasn't shared it yet. ( I know he'll probably respond by rudely again decrying my total ignorance and his own civility )yet I still think the failure is his to put forth a coherent plan. In addition advocating a complicated system, too complex to be explained is a non-starter politically as we saw with Hiliary's proposal, which also tried to preserve the role of insurance companies, managed care outfits and other aspects of the present system. As I said initially, let those who prefer their existing insurance company paid health care keep it if they can still afford it and want to pay. If the as yet to be developed or at least exlained system touted by Cohen is so superior let it show this by competing with an expanded medicare system covering all who desire. After all I thought he advocated competition.
