You guys from Canada are beating us.....Geeeez ! Look at this...

[tcartwri]

Looks like Canadiens making under $11000 pay no federal income tax.
Income taxes in Canada - Wikipedia, the free encyclopedia

Loren

Someone making 11K a year is basically on full time public assistance. It would be very very difficult to live on that amount.

 

[Knight9]

If there is one thing that seems to be brought up about our Canadian health care system it's long waiting times for medical procedures...but you couldn't prove it by ANY of my experiences. Last major procedure was just over three years ago, symptoms reared their ugly head on May 25 (couldn't pee) so into emergency and they catheterized me. They kept me in until the 27 while they ran tests and found out I had a cancerous kidney. I was admitted into the hospital on June 10th (a Wednesday) to have it removed and I was home again the following Monday. All in all, I think that's pretty good service, eh?

It seems to me that urgent things like this get ok to average care. To me the problems seem to focus around the triage, admittance, and care of emergency type medicine, and a complete lack of family doctors for general day-to-day care. One of the main problems with emergency ward clogging is that folks go there with the flu or a small booboo because they DON'T have a family doctor! Vicious cycle.

 

[tcartwri]

It seems to me that urgent things like this get ok to average care. To me the problems seem to focus around the triage, admittance, and care of emergency type medicine, and a complete lack of family doctors for general day-to-day care. One of the main problems with emergency ward clogging is that folks go there with the flu or a small booboo because they DON'T have a family doctor! Vicious cycle.

Don't kid yourself, that's a common thing on both sides of the border. People theses days want satisfaction 'right now' .

 

[CinderSchnauzer]

It is a good post, but one notable deficiency is putting aside access and quality for a minute but not picking it up before mentioning moaning and groaning.

If a country has a national system, and folks are moaning and groaning about anything, rather than invite them to go out of country, Canada could decide that instead of comparing themselves to other countries as a hallmark of success, success will be found in comparing customer experience with customer expectations. If I thought for a minute a national system in the US would care one fig about what I thought about the system once entrenched, I'd probably dread it less. But once it's here, it's here, and it might as well be Congress or the presidency for all the bickering and politics that will surround the entrenched medical / governmental complex.

The Access / Quality thing was actually part of my "moaning / groaning" comments, but I was probably too short and not explicit enough. I believe, for the most part CDN's don't have a lot of problems with "quality of care" as a whole. As with any system there will always be someone who has a horror story as to how their encounter went horribly wrong. The major complaint is access to the system and access to not only family Docs but to Specialists. Many CDN's are proponents of privatization as a cure for access problems and also that privatization will solve efficiency problems - usually associated with anything run by the Gov.

To a large extent, Physician access is controlled by GOV funding for a large majority of Docs, restricted access to CDN medical schools and restricted access to a CDN license to practice for foreign trained physicians. Since the GOV provides major funding for Docs, they know that each additional FP or Specialist will add $XXX costs to the bill for provincial healthcare - which might lead to the need for increased taxes - which could PO the voters - who might not elect them next time.

I think there is an argument to be made that unrestricted access and quite possibly privatization come at a higher cost. To me instant access suggest excess capacity. One of the main reasons CDN's have longer wait times is that access is effectively rationed within the system - by the primary payor - the Provincial Gov. Health care is rationed, because for the most part citizens do not want to pay higher taxes and a lot of them seem to think that privatization will solve the problem - somehow without raising the cost. they complain - "we have no choice" therefore, my comment - if you want choice - go to Buffalo - and pay extra.

The Gov is constantly pushing hospitals to become more efficient. Within hospitals there are several areas where one can achieve efficiency. One is represented by labor. In an average hospital in the range of 70% of all expenses are related to wages / benefits. So to achieve efficiency there are essentially two solutions. Use less people or use lower paid people. So staffing can be rejigged. Use less RN's use more RPN's, use more Personal Support Workers, fire managers and extend the span of control for those left. After a while the only way these measures can be taken to the next level is to discontinue programs or close beds. For example, an emergency department could be compared to a Fire Department. A certain level of staff have to be in place at all times, whether busy or not.

The other type of efficiency relates to doing things faster or in a less costly way. In the good old days a mother and baby probably stayed in hospital for a week, now they may be sent home next day. Hip replacement or gall bladder surgery was a major event - now much of that is done as a Day Surgery. In theory, this efficiency cuts down the length of stay in a hospital bed, but on the other hand provides an opportunity TO DO MORE. In effect, by being efficient, the hospital has created an opportunity to increase cost.

The average CDN and probably most in the US likely think when a CDN shows up at the hospital with Health Card in hand, the hospital is funded for their procedure. While CDN hospital funding is slowly changing the majority of Gov funding is based on block funding received twice a month (just like a pay cheque) regardless of volume of patients or procedures performed. There is some movement to case based funding, however, the Gov still determines the actual price paid. In a case of complete silliness, if the hospital had no paitents, they would make out like bandits. The more they do the more it costs and the less they make.

Let me try to put this in the context of an industrial analogy.

The hospital can hire and to a certain extent fire staff. Most CDN hospitals are highly unionized and often contracts are negotiated on a Provincial basis. Therefore the hospital has limited control over the actual cost of labor. Certain basic skill sets are required for tasks - RN's

The output of the hospital is constrained by block funding provided by the GOV and volume is largely dependent on Patients who show up unannounced or sent by the Docs (independent contractors) who have no real interest in the cost, except as it my limit their ability to do more procedures - based on rationing of services, since the hospital has limited funds.

To summarize, you have an industrial plant making blue paint. Funds for production are set, provided and rationed by the GOV. The Docs determine how much blue paint will be made, but don't really care how much it costs. The public complains the there is never enough blue paint, they can't get it when the want it and it already costs too much, BUT, somehow, if only they had a choice to buy their blue paint from a private company, it would be available cheaper and whenever they want.

I don't think the information I presented held up the CDN system as a "hallmark of success" It was data, which showed, as do numerous other studies that per capita health spending in the US is significantly higher than in Canada. My main point was that if CDN's think they want a US style system - combination GOV and Private - then it is probably going to cost someone more - at a time when a lot are complaining the current system costs too much.

 

[3930dave]

I'm with most Canadians, a supporter of our public health system. There is always room for improvement (example below), but generally works well.

The push for privatization, IMO, is mostly just about $$$$. Governments are trying to balance budgets, and corporate and private interest here (Ontario, Canada) are salivating over the prospect of medical windfall $$$ coming their way. (Need an example, just Google "ORNGE" - I think that even the politicians (privately) are impressed at how big a scam this was.).

This potential shift is only about a very few people at the top making stupid amounts of money. (Here, I'm not considered a socialist, more a small C conservative - and actually close to Attila the Hun on some subjects). Working Canadians only stand to get charged more (probably much more) for health care under a private system.

A friend of mine raised a good point though - if there was a nominal fee (say $20-30) at least for an initial visit (let's say I need stitches for a cut, I pay $20 for the visit for the stitches, but nothing for followup), it would do a lot to cut down the nuisance visits (as the OP said, BoBo's, sniffles....). This suggestion is not really about the money, just a way to cut down on nuisance visits, and to help focus doctor/nurse time management towards serious cases.

Yeah, me and my male friends are of the John Wayne, "don't go to the Doc unless you are half dead" era. Never said we were bright ! :laughing:

There are regional differences, even within a province, esp. our bigger ones. A good friend in BC waited the better part of 3 years to get a gall bladder yanked - at that point, it was leaking badly. He's a tough guy, and managed to keep going in a physically demanding job all that time - but it shouldn't have happened that way.

I do get that gall bladder problems can be hard to diagnose (seen it with my own family), but the delay was mostly just getting the surgery scheduled. BC is having real problems properly funding certain medical areas. Unfortunately, a lot of the budgets get chewed up in the BC dealing with street drug problems.

I'm confident that the medical professionals in BC are doing the best they can, with what they have to work with - just saying things here (Canada) are not 100% perfect, but it is a good system overall.

Stay healthy, Rgds, D.

 

[CinderSchnauzer]

The push for privatization, IMO, is mostly just about $$$$. Governments are trying to balance budgets, and corporate and private interest here (Ontario, Canada) are salivating over the prospect of medical windfall $$$ coming their way. (Need an example, just Google "ORNGE" - I think that even the politicians (privately) are impressed at how big a scam this was.).

This potential shift is only about a very few people at the top making stupid amounts of money. (Here, I'm not considered a socialist, more a small C conservative - and actually close to Attila the Hun on some subjects). Working Canadians only stand to get charged more (probably much more) for health care under a private system.


Stay healthy, Rgds, D.

There is no question that US residents, at least those with adequate health insurance, have quicker access to services than CDN's, especially those services of a specialized nature. One of the factors allowing quick access is undoubtedly privatization and the opportunity to make a profit by providing those services. The potential for profit is enormous. As a quick example, Humana Inc and Kiaser Permanente posted combined profits of approx $3.4 billion in 2011 and that is only two of the many companies involved. Is it any wonder there are numerous advocates pushing for privatization of CDN healthcare?

When health services are provided through public for profit corporations and premiums are either personal pay or corporate funded the Gov can actually appear to come out a winner - no matter how high the price. In theory, they can reduce taxes - always seen as a good thing and in addition - no matter what happens to prices they can take a "not my problem - we have no control over private enterprise" view.

For CDN readers, I'm reminded of the often raised suggestion that the Liquor Control Board of Ontario should be privatized. Prices would go down and selection would increase. Alberta is often held up a a shining example of how well this works. Guess what? Travel to Alberta and buy a case of your favorite beer - it costs considerably more than in Ontario. So much for that myth. There may be lots of dingy little corner stores selling beer, but only the real popular brands - selection is limited.

Privatization, especially of healthcare may not the solution many imagine.

 

[3930dave]

The LCBO is one of the biggest buyers of wine in the world - lots of leverage there. The LCBO makes money - I have no problem with a govt selling booze and reducing taxes (OK, I'm a dreamer) elsewhere.

Similarly, many of our provinces have quite a bit of clout, going up against drug companies. I certainly get how that is viewed as a "problem" in certain circles.

Yes, being able to walk away from health care (aging population) is going to be really attractive to govt actuaries, and anybody else with protected health benefits.

Private health really only makes sense if you are making mid 6 figures+/year. As with many things, at that level of income, you have plenty of options at your disposal.

Having money is no absolute guarantee though. As I recall, the actor Michael Douglas was in Montreal shooting a movie when doctors there finally determined that he had cancer. Various US experts missed that one. Not a cross-border slag on my part, just saying that diagnoses can be missed independent of the perceived expertise/service level available.

Having a major medical problem, and not being able to afford treatment; that is a terrible thing to have to face.

Stay well, D.

 

[300UGUY]

Where can such a system be found with any certainty other than Canada?

Effective advocates of this passed and upheld law should site specifically how the law addresses the issues from the past about which they are complaining (if they bring these up in support of the change.)

Detractors will have the task of siting the new problems that start happening that are the result of the law. These should and could rightly be countered in part or whole by new advantages properly noted and attributed to the law.

But continuing along like nothing has changed when in fact this law IS the law of the land, that simply makes no sense to me.

Did you find basis in the law that the house would be saved? Are you absolutely sure that in the future that the house and the child will not both be lost? Apparently the care was adequate to at least save the child, regardless of whether folks believe that a house is an asset, and whether a person actually HAS to lose a house due to medical.

It would also be helpful if you told the person's exact financial position in the house for the benefit of us who believe that all our financial resources can be brought to bear in a life threatening situation. I believe you are telling the truth as you know it, but each time you have told this story, I have become more and more resistant to it due to the lack of financial details.

Mace's story was for a person, not people in aggregate, and he gave details. You are trying to use a person minus details, and propel the person as an example of the aggregate. When we talk about individuals, and use them as examples for change, I want to know most everything about them, and I can get pretty judgmental too. Frequently, we want to use individual point in time examples of people, and ignore all the lousy decisions and missteps they make in their lives. It is a violation of freedom to force some to indemnify others from their avoidable mistakes (and probably the unavoidable ones too, but it is not as clear,) and failure is as important an outcome as success to the cause of freedom among men.

I started composing a pretty lengthy reply. But then I thought about what you said. I won't bother. You are spouting nonsense about the "cause of freedom". Please, it's not about freedom. It's about whether your fellow citizens ( btw, my bro is a vet ), get health care. It's about money. And you appear to be somebody doesn't care about anybody except you and your family. It's a case I've got mine, and screw you.

 

[IslandTractor]

Last question why do so many Americans not want a health care system similar to ours or something in Europe?
My questions are not meant to be antagonizing, but rather spark further discussion on the topic to further my understanding. Sorry in advance if someone get offended.

IMO the main reason many Americans react negatively is that 1) they know nothing about it, 2) they have been bombarded for fifty years with propaganda about how terrible "socialized medicine" is, 3) they have also swallowed hook line and sinker the notion that US medicine is the best in the world.

The fact that the Canadian system is efficient, effective, more evidence based and provides care that for the vast majority is as good or better than any US community hospital or medical center can deliver gets lost in the hyperbolic ideologically based rumor mongering that all too often substitutes for rational discussion of the topic here.

Wait time arguments seem to predominate discussion of the Canadian vs US system. Horror stories of needing to wait until next week for an elective MRI or having elective surgery delayed seem to get a lot of traction as evidence that the Canadian system doesn't work. What doesn't get brought up is that one of the reasons the healthcare system in the US is bankrupting us is precisely because you can get a MRI at your local grocery store and therefore physicians order them like they were ordering a coffee at Starbucks. An American orthopedic surgeon is very likely to have you get an MRI before he ever examines you while that would virtually never happen in Canada or Europe. That creates a very profitable market for MRI scanners which are then purchased and installed between the bread and soup aisles at your local mall. Just like Starbucks. How did we ever manage before?

Elective surgery is another bugaboo. In Canada you are likely to wait longer. In the US you are more likely to have unnecessary surgery. Personally I'd rather wait than be fodder in the medical industrial system we have where medical decisions every day are influenced by the profit motive rather than patient need.

As an earlier post pointed out, the Canadian system is far more cost effective and Canadians live longer too. You would think that the Tea Party with its concerns about national debt, budget deficits and keeping US industry competitive would leap to embrace a change towards the efficient Canadian model (or the different but equally efficient British model) but quite the opposite has happened. Politics makes it impossible for those right of the political center to accept much less promote anything that can conceivably be labeled as "socialism" even if it would otherwise be desirable. If the lefties and liberals advocate it, it must be wrong. Politics is therefore the answer to the question of why so many Americans think they don't want a Canadian type healthcare system.

 

[WilliamBos]

Thank you for the explanation.

IMO the main reason many Americans react negatively is that 1) they know nothing about it, 2) they have been bombarded for fifty years with propaganda about how terrible "socialized medicine" is, 3) they have also swallowed hook line and sinker the notion that US medicine is the best I the world.

The fact that the Canadian system is efficient, effective, more evidence based and provides care that for the vast majority is as good or better than any US community hospital or medical center can deliver gets lost in the hyperbolic ideologically based rumor mongering that all too often substitutes for rational discussion of the topic here.

Wait time arguments seem to predominate discussion of the Canadian vs US system. Horror stories of needing to wait until next week for an elective MRI or having elective surgery delayed seem to get a lot of traction as evidence that the Canadian system doesn't work. What doesn't get brought up is that one of the reasons the healthcare system in the US is bankrupting us is precisely because you can get a MRI at your local grocery store and therefore physicians order them like they were ordering a coffee at Starbucks. An American orthopedic surgeon is very likely to have you get an MRI before he ever examines you while that would virtually never happen in Canada or Europe. That creates a very profitable market for MRI scanners which are then purchased and installed between the bread and soup aisles at your local mall. Just like Starbucks. How did we ever manage before?

Elective surgery is another bugaboo. In Canada you are likely to wait longer. In the US you are more likely to have unnecessary surgery. Personally I'd rather wait than be fodder in the medical industrial system we have where medical decisions every day are influenced by the profit motive rather than patient need.

As an earlier post pointed out, the Canadian system is far more cost effective and Canadians live longer too. You would think that the Tea Party with its concerns about national debt, budget deficits and keeping US industry competitive would leap to embrace a change towards the efficient Canadian model (or the different but equally efficient British model) but quite the opposite has happened. Politics makes it impossible for those right of the political center to accept much less promote anything that can conceivably be labeled as "socialism" even if it would otherwise be desirable. If the lefties and liberals advocate it, it must be wrong. Politics is therefore the answer to the question of why so many Americans think they don't want a Canadian type healthcare system.