The great debate of healthcare, private or public?

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Originally Posted by Mark in Oshawa

Do you think government spends the tax dollars you give it in an efficient manner? If you say yes, then there is no point in debating you on this, because I likely will say nothing that will change your mind. If you say no, then ask youself WHY governments who routinely waste and make billions disappear into a giant mass of bureaucracy would all the sudden make a system to provide the most vital services financially efficient?

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Well I hope not. Efficiency is an anathema when it comes to the well being of a patient. Patients are not customers and nor are they economic units. A hospital's job should be about making people well again, and the second you start introducing the need for efficiency into the system, you start putting value judgements, not necessaily on the costs of care, but on the worth of people.
Sorry, but if you want to speak of efficiencies in hospitals, then you immdiately admit that you have no heart.

An inefficient medical system where people are made well, is far better than an efficient one where people are sent away because they are an economic problem; besides which, if the United States already spends more per capita on healthcare and still doesn't cover 50 million people, then the system is neither efficient and certainly not equitable.

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Originally Posted by Rollo

Well I hope not. Efficiency is an anathema when it comes to the well being of a patient. Patients are not customers and nor are they economic units. A hospital's job should be about making people well again, and the second you start introducing the need for efficiency into the system, you start putting value judgements, not necessaily on the costs of care, but on the worth of people.
Sorry, but if you want to speak of efficiencies in hospitals, then you immdiately admit that you have no heart.

An inefficient medical system where people are made well, is far better than an efficient one where people are sent away because they are an economic problem; besides which, if the United States already spends more per capita on healthcare and still doesn't cover 50 million people, then the system is neither efficient and certainly not equitable.

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Except for charity and non-profit hospitals, the rest of them are businesses designed to make a profit in the USA. All of them are going to send you a bill and all of them will expect you to pay that bill. The charity hospitals will deeply discount or even forgive a bill completely depending on your ability to pay. That Americans pay more per capita is not necessarily a sign of lack of efficiency as much as it is an indicator of options. The price of services available, the prices of services used, and the cost of utilities, consumables and staff salaries will vary in different regions. In addition, cosmetic and vainity surgery is big business in the USA along with all manner of beat-your-favorite addiction hospitals. Private and semi-private rooms are popular in the USA. Patients can frequently choose the level of comfort they desire.

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Originally Posted by Mark in Oshawa

Well Dylan, We can all use our local public healthcare or lack thereof as an example, but UN healthcare surveys were putting Canada on a pedestal for years. Yet all the issues I raised have been around. So someone isn't accurate.

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They can both be right don't you think? Canada may deliver pretty good healthcare to its citizens yet people can still find faults with the system, do you understand that the two are not contradictory?

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Originally Posted by Mark in Oshawa

Also, the Americans pay more for healthcare directly, but they pay much less in taxes, so it is a wash except they have more choice in how their dollars are spent.

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I'm talking %age of GDP when I compare spending between different countries. On that scale America spends more than any country on earth except France.

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Originally Posted by Mark in Oshawa

So I hardly say the true cost of healthcare in any nation is honestly appraised when the cost of public healthcare is masked in political smoke and mirrors. The much vaunted NHS has had all sorts of horror stories said about that in the press, so What is real? What is just myth? If the NHS is so wonderful, why would anyone take private healthcare? I would wager you do have a good system, but I am not there to judge. I am also going to say you are not here to judge our system either. I can just say this: IF the Canadian system was rated so highly by the UN not long ago, then why am I finding fault with it? Trust me, I have no desire to start paying for private insurance unless my taxes get cut, but I KNOW There is no going back.

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The NHS is NOT a one-size-fits-all answer to people's healthcare problems around the world. I believe I have always been open about that.

See, this is the problem, for you it has to be black and white. I MUST be arguing that the NHS is the best system in the world if I'm defending public healthcare right? WRONG.

You compare private healthcare in America with public healthcare in Canada yet the former is hardly viewed as perfect by Americans themselves, even the most ardent supporters on this forum would acknowledge that the system has major flaws.

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Originally Posted by Mark in Oshawa

As to your record of the UK and Japan's public system doing such wonderful innovation, understand this: Americans have provided most of the Nobel prize winners in Medicine in the last few decades. They must be doing something right there also.

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Am I talking to the same Mark that derided the Nobel prize for awarding a peace prize to Obama? Why is the Nobel prize suddenly a gold standard for comparing research?

Do you read medical journals Mark? Do you deal with new medical developments? Do you keep track of the amount of research produced by each country? Don't you think the volume of quality research produced by each nation is a better indication of innovation than cherry picking the 'best' each year by a Swedish board that you rubbished not so long ago?

America does produce a lot of quality research but is hardly the only player in the system as you portray it to be. In fact I'd argue it produces less than its size and economic prowess would suggest it would compared to Britain with a fifth of its population and Japan with half. The amount of research the USA produces is neither an endorsement or indictment of privately funded healthcare. It is an independent factor, more a reflection of the state of the American pharmaceutical and other medically related industries than the state of American healthcare itself.

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Originally Posted by Mark in Oshawa

I am not against the public system, but I refuse to by the myth it is BETTER. I am for a system that supports both, but the public system must never be bloated and run to the favour of those who work in it, as opposed to the patients.

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I am not arguing that public is better than private. I'm trying to get you to understand that your sweeping statement that public is worse than private makes as much sense as saying that wheeled transport is rubbish compared to flying.

Why don't you go away and read up about the Canadian, British and French systems, how they differ in concept, execution and organisation. Why don't you go and research the difference between reimbursement at the point of use compared to a fully state owned healthcare system, both of which are publicly funded. Why don't you then go on and research the strengths and weaknesses of each system, and what the public complain about with each one, because those systems are as different from each other as cars, motorbikes and trains are (all wheeled transport, see?).

Once you do that you'll realise how simplistic your comparison between public and private healthcare is.

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Originally Posted by Dylan H

They can both be right don't you think? Canada may deliver pretty good healthcare to its citizens yet people can still find faults with the system, do you understand that the two are not contradictory?.

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We are having this debate in this country right now because unlike Britain, where the citizen has a choice, in Canada we do NOT, and it is the 3rd rail of Canadian politics. We have people in the healthcare system telling us it is the BEST possible system in the world, while there are numerous issues we see in our own lives and anchedotal evidence, and then stories in the press comparing what we have happening here to other nations. It is a VERY current debate here, and while I have always acknowledged we have pretty good care, it is terribly expensive in the sense we are paying a large tax load to support it. I know from my experiences with government that the money likely is NOT being used effciently. A Health minister here resigned in disgrace over a billion dollar boondoggle in just the registry program to make all medical records electronic.

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Originally Posted by Dylan H

I'm talking %age of GDP when I compare spending between different countries. On that scale America spends more than any country on earth except France..

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That is fine, but I don't think that GDP per person number is accurate when you have a state run system. Maybe it is. I would like to see how the number is calculated in each case. I am not by the way saying Americans don't pay a lot. You do remember I made the analogy of how the US are the fat guy with lots of money buying all the new technology first....

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Originally Posted by Dylan H

The NHS is NOT a one-size-fits-all answer to people's healthcare problems around the world. I believe I have always been open about that.

See, this is the problem, for you it has to be black and white. I MUST be arguing that the NHS is the best system in the world if I'm defending public healthcare right? WRONG.

You compare private healthcare in America with public healthcare in Canada yet the former is hardly viewed as perfect by Americans themselves, even the most ardent supporters on this forum would acknowledge that the system has major flaws..

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The Americans also are turning themselves inside out to stop the creation of a public option. Polls there say a majority don't want it. Many on here cant figure it out. I am telling you I thiink I know why after talking to many of them over the years, they don't TRUST the government.

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Originally Posted by Dylan H

Am I talking to the same Mark that derided the Nobel prize for awarding a peace prize to Obama? Why is the Nobel prize suddenly a gold standard for comparing research?.

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Outside of the contentious Nobel prize for peace, the Nobel committees for medicine, physics, literature and the like award actual achievements and have rarely if ever been seen as a political football. Even you have to admit that the Nobel prize for "peace" being given to a man who just got elected and did nothing else was a bit ridiculous.

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Originally Posted by Dylan H

Do you read medical journals Mark? Do you deal with new medical developments? Do you keep track of the amount of research produced by each country? Don't you think the volume of quality research produced by each nation is a better indication of innovation than cherry picking the 'best' each year by a Swedish board that you rubbished not so long ago?

America does produce a lot of quality research but is hardly the only player in the system as you portray it to be. In fact I'd argue it produces less than its size and economic prowess would suggest it would compared to Britain with a fifth of its population and Japan with half. The amount of research the USA produces is neither an endorsement or indictment of privately funded healthcare. It is an independent factor, more a reflection of the state of the American pharmaceutical and other medically related industries than the state of American healthcare itself..

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I do not read medical journals. I resent you holding that over a lay person such as myself. I know you are in the medical professions so on this I am going to be at a disadvantage having this part of the debate. I am just telling you that I am of the opinion ( and I am entitled to have one last I looked) that the public funded medical system often isn't as efficient with the money spent. There is no profit motive from management to try to keep costs down, but like most bureaucracies under most governments, it will often have managers more concerned by the number of people they are in charge of than the job they do. The hospital right here in this town is one where my mother worked as a nurse for years, and I know the fact that any time the budgets tightened, the people laid off were often the front line staff while it seemed the bureaucracy that ran it often were unscathed. It isn't to say that this is uncommon or cruel either, but I find it astounding that the bureaucrats who run institutions such as hospitals always find ways to ensure their jobs and salaries, while the people who deal with the realities of providing healthcare often are forced to cope with less. THAT is where I base my distrust of the public system.

Trust me, I may not like the American system if Ihad to pay for healthcare either, but at least I know I would have choices there.

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Originally Posted by Dylan H

I am not arguing that public is better than private. I'm trying to get you to understand that your sweeping statement that public is worse than private makes as much sense as saying that wheeled transport is rubbish compared to flying.

Why don't you go away and read up about the Canadian, British and French systems, how they differ in concept, execution and organisation. Why don't you go and research the difference between reimbursement at the point of use compared to a fully state owned healthcare system, both of which are publicly funded. Why don't you then go on and research the strengths and weaknesses of each system, and what the public complain about with each one, because those systems are as different from each other as cars, motorbikes and trains are (all wheeled transport, see?).

Once you do that you'll realise how simplistic your comparison between public and private healthcare is.

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It isn't a simplistic argument at all. By the way, I have to keep stating this. I live in a public system world. I am not given a choice to have a real point of comparsion. I have read many news articles and there is endless pontificating in the press here because as I stated, it is part of the debate in Canada. Have I done the miles of research you wish ? No, but I read all I can on the subject.

My point in this thread was not really to condemn the public system entirely, and it is to my discredit I let it go that way, but I do want to know more about things as the NHS from people who live in it, and the American system from people who live there. I stated a few times, I am not given the option. THAT is what really galls me. I think if there was a private option at least in my nation, maybe the public system would be forced to compete and maybe be the system that the NHS seems to be to those of you living In Britain.

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Originally Posted by Mark in Oshawa

We are having this debate in this country right now because unlike Britain, where the citizen has a choice, in Canada we do NOT, and it is the 3rd rail of Canadian politics. We have people in the healthcare system telling us it is the BEST possible system in the world, while there are numerous issues we see in our own lives and anchedotal evidence, and then stories in the press comparing what we have happening here to other nations. It is a VERY current debate here, and while I have always acknowledged we have pretty good care, it is terribly expensive in the sense we are paying a large tax load to support it. I know from my experiences with government that the money likely is NOT being used effciently. A Health minister here resigned in disgrace over a billion dollar boondoggle in just the registry program to make all medical records electronic.

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I am not going to question this paragraph at all, except to say that your original posts attack public healthcare systems in a sweeping generalisation without trying to make it Canada-specific. Some of your criticisms clearly are Canada specific as you are now clarifying.

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Originally Posted by Mark in Oshawa

That is fine, but I don't think that GDP per person number is accurate when you have a state run system. Maybe it is. I would like to see how the number is calculated in each case. I am not by the way saying Americans don't pay a lot. You do remember I made the analogy of how the US are the fat guy with lots of money buying all the new technology first....

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%age GDP spend is pretty accurate when looking at overall healthcare spend, both public, private separately or together. I suspect there isn't a better way of quickly comparing different countries' spend.

Sure, the Americans are first to buy new tech, along with the French and Japanese who are also renowned for adopting new medical technology and drugs quickly. Both the latter run state funded systems. Your point is?

BTW, the Americans are often overcharged for their new technology, precisely because they don't negotiate en-bloc but as individual hospitals with little negotiating power. Thats not subsidising poorer countries like Canada or the UK, thats merely being ripped off and not something to be proud about.

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Originally Posted by Mark in Oshawa

Outside of the contentious Nobel prize for peace, the Nobel committees for medicine, physics, literature and the like award actual achievements and have rarely if ever been seen as a political football.

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This is incorrect. The awards for medicine and literature certainly are often political in nature. There have been quite a few years when American writers for example have been passed over when American foreign policy hasn't been internationally popular.

Certainly in the medical field the awards are often a joke with seemingly random members of research teams being awarded but the rest forgotten, or again research groups from politically unfavourable countries being passed over. Often, the groups that are awarded tend to be the ones the media have recognised as being worthy which is hardly the same as having the best research at a particular time being rewarded.

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Originally Posted by Mark in Oshawa

I do not read medical journals. I resent you holding that over a lay person such as myself. I know you are in the medical professions so on this I am going to be at a disadvantage having this part of the debate. I am just telling you that I am of the opinion ( and I am entitled to have one last I looked) that the public funded medical system often isn't as efficient with the money spent.

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Then perhaps you may avoid using condescending tones in informing me about US research as measured by Nobel prizes? Touche.

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Originally Posted by Mark in Oshawa

There is no profit motive from management to try to keep costs down, but like most bureaucracies under most governments, it will often have managers more concerned by the number of people they are in charge of than the job they do. The hospital right here in this town is one where my mother worked as a nurse for years, and I know the fact that any time the budgets tightened, the people laid off were often the front line staff while it seemed the bureaucracy that ran it often were unscathed. It isn't to say that this is uncommon or cruel either, but I find it astounding that the bureaucrats who run institutions such as hospitals always find ways to ensure their jobs and salaries, while the people who deal with the realities of providing healthcare often are forced to cope with less. THAT is where I base my distrust of the public system.

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I am not a fan of bureaucracy either, but here again you point to something that appears to be specifically worse problem for Canada than many other places. Other countries with entirely state funded healthcare have found ways of avoiding this situation by leaving hospitals etc in private hands and reimbursing the patient for any healthcare costs. Those systems are entirely state funded too, yet you dismissed them earlier because of course public funded services are not efficient right?

In fact most countries, the NHS included, involve some kind of competitive system at some levels in order to ensure cost-control. If Canada does not have such a system then perhaps that would be a reform worth adopting.

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Originally Posted by Mark in Oshawa

It isn't a simplistic argument at all. By the way, I have to keep stating this. I live in a public system world. I am not given a choice to have a real point of comparsion.

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What is a real point of comparison?

In the UK there is a movement (not big at the moment) talking about privatising the NHS. They claim the private sector is more efficient, yet they fail to acknowledge how the NHS subsidises the private sector which is free to cherrypick what services it provides and what it doesn't. Outside a small part of London there is no emergency private care, get knocked down by a car and you have no choice but to go to the NHS, the private sector isn't interested in a high investment low profit area like emergency care. The private sector does not have to pay for training staff at all either, thats the job of the universities and NHS, both state funded. If the NHS wasn't there, private healthcare costs would escalate.... The picture is always more complicated than it looks.

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Originally Posted by Fiero 5.7

Except for charity and non-profit hospitals, the rest of them are businesses designed to make a profit in the USA.

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The basic profit motive that drives businesses suggests that in order to maximise profits, you either need to charge more for the goods and/or services, or reduce your input costs to produce those goods and/or services.

This might be fine if you're trying to make consumer products or possibly a motor car, but do you really want that as a patient? How is patient care improved by either lowering costs or charging higher prices?

Alternatively you've just told me that richer people are actually a better class of people and deserve better treatment; if that's the case, well done:
We hold these truths to be self-evident, that all men are created "equal",
Separate but equal!

Dylan, I guess Iam torn. I am not dismissing your points, but you are not pointing to ANY waste in any public system, and I find it hard to believe we are the only nation in the western world with wasteful public spending. I refuse to believe that but I also refuse to buy the argument that major HMO's in the US are not buying technology or developing it for a good price either. Remember, they want that margin to be in their favour.

I do agree 100% that the private sector will cherry pick under a mixed system, but that is up to the regulators and government to set out the areas where the public and private system compete. I think there are areas where private care is superior. For instance the one concession in our public system is in dental care. It is HEALTH care but it is all private. I can go into my wife's office (she is a hygienist) and do a cash deal to get a filling done. Or I can go through insurance. I can negotiate price. THAT is the kind of flexability have across the board in their healthcare, and I would love to see more of that. I suppose there some expensive things to be done that wouldn't be really a good plan for, but the goal for me in my mind is to see more choice for the 'consumer'.

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Originally Posted by Rollo

The basic profit motive that drives businesses suggests that in order to maximise profits, you either need to charge more for the goods and/or services, or reduce your input costs to produce those goods and/or services.

This might be fine if you're trying to make consumer products or possibly a motor car, but do you really want that as a patient? How is patient care improved by either lowering costs or charging higher prices?

Alternatively you've just told me that richer people are actually a better class of people and deserve better treatment; if that's the case, well done:
We hold these truths to be self-evident, that all men are created "equal",
Separate but equal!

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Nowhere here, and at no time anywhere, have I stated that richer people are a better class of people. For you to sit there declaring to the world that I told you that as a fact tells me you need to spend more time on reading comprehension.

While all men are created "equal", there's nothing in the rulebook that says they have to stay or finish that way.

What a patient cares about is getting out of there as fast as possible, while feeling better than they did when they came in. The patient wants a nurse or staff to respond promptly when the call button is pushed.

The only area I could see patient care being improved by cutting costs would be by firing an incompetent, abusive, uncaring staff member and replacing them with a superior employee at a lower beginning salary. That would be a short term example until the new staff members catches up in the pay scale. I can't speak for the medical folks, but in other business, very seldom are people hired in at top dollar. Companies like to be able to monitor a new employee and step up their pay scale as they prove their ability and willingness to work within the system. I can easily see however, where lowering costs would also lower a patients bill if those savings were passed on.

Higher costs can easily mean an improvement in patient care or the potential of improved care. A small example would be a crash cart being available for each wing as opposed to one to a floor. Xray or MRI equipment being available. You may not use it, but you're going to pay for a little bit of it. Theres all kinds of stuff at hospitals you get to pay for that you'll never see. On the other hand, if you do need it, you'll be happy they already have it instead of having to wait for them to go buy one.

Rollo, you seem to like your NHS and thats fine but the majority of Americans have said they don't want the plan Obama is trying to force them to take. Why should you get all ramped up over the American medical system?

Now if you're just an angry, international socialist who believes in enforced equality for all, might I suggest prison. Prison is the closest thing to utopian socialism that the West offers. You have the guards, responsble for law enforcement, rule enforcement, and your protection. Then you have the equal. All of you get the same rulebook, the same clothes, the same food, and the same medical care. You'll be provided with a roof over your head, a place to sleep, 3 meals a day, and recreational and educational opportunities. But you won't like it. Human nature is alive in prisons too. So there's an unofficial "class" system in prison because there will always people that are willing to do more and risk more in order to have more. And there will always be the bottom feeders, barely willing to do the minimum in a low skill or no skill job that somehow figure they are entitled to that Ferrari too or nobody should have one.

Fiero, I wondered when you would respond. Nice rebuttal. It has been my contention for years that the myth that life was fair has to be killed. You get what you want to work for and in America, you can buy better healthcare. Still doesn't change the fact that there is a defacto national healthcare already, it is called Medicare and it is going broke. I think if Obama had not done anything but improved that, he would be past all of this; but alas he wants national healthcare for all and was willing to build a flawed foundation to get there.

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Originally Posted by Mark in Oshawa

but you are not pointing to ANY waste in any public system, and I find it hard to believe we are the only nation in the western world with wasteful public spending.

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No Mark, and here we return to that black and white thing again. I've not argued that public healthcare doesn't waste more than private, I've argued that the situation is more complex than that and that other countries have taken measures to limit waste by introducing competition.

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Originally Posted by Mark in Oshawa

I refuse to believe that but I also refuse to buy the argument that major HMO's in the US are not buying technology or developing it for a good price either. Remember, they want that margin to be in their favour.

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HMOs don't tend to develop, they tend to purchase technology and utilise it. They may act as partners for research but don't drive it. Research is done by universities and drug/medical technology companies.

You may not believe that HMOs pay more, it may be worth trying to look up how much drugs cost but ultimately there are few organisations that can compete with an entire country negotiating en-bloc. Its the principle of economy of scale, you pay less per unit if you buy lots of units.

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Originally Posted by Mark in Oshawa

I do agree 100% that the private sector will cherry pick under a mixed system, but that is up to the regulators and government to set out the areas where the public and private system compete. I think there are areas where private care is superior. For instance the one concession in our public system is in dental care. It is HEALTH care but it is all private. I can go into my wife's office (she is a hygienist) and do a cash deal to get a filling done. Or I can go through insurance. I can negotiate price. THAT is the kind of flexability have across the board in their healthcare, and I would love to see more of that. I suppose there some expensive things to be done that wouldn't be really a good plan for, but the goal for me in my mind is to see more choice for the 'consumer'.

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I don't want you to think I disagree with your personal criticisms of Canadian healthcare, if anything they tally with what I've heard from other people. Where I disagree is where you seamlessly go from your criticisms of your local experience and apply it to public healthcare worldwide. Thats where you go wrong.

Frankly I do find it incredibly odd that in Canada there is no private healthcare option, I even suspect that in the EU that would be illegal under free competition regulations (assuming there is legislation banning private healthcare) and I agree that freeing that sector up would be beneficial to most parties. That is where the debate should be in Canada, and I'm surprised that the political debate hasn't gone that way.