Friday, June 17, 2005

In Defence of Public, Universal Single-Payer Health Care

In the wake of the recent Supreme Court of Canada decision on private health insurance, the debate over whether we should have public, private or mixed system has been re-ignited. I believe that the best choice for us is a fully public, universal single-payer system - fix our current system so that it operates as it was intended.

Why a Public System?

1. Public Healthcare serves the Public good, not private stockholders

A public, single-payer system exists to provide healthcare for the citizens of Canada. All decisions made within the system have as their sole criteria the health needs of the patient. Private Insurance and private health delivery exist to make money for their owners and stockholders. They must maximize profits and minimize payouts. Private health insurance is no different. Insurance companies will find reasons to not pay, to disallow claims, to raise rates or to refuse insurance all together (for "pre-existing conditions,"for instance). It is a bitter irony that Mr. Zeliotis, one of the complainants in the Supreme Court decision that opened the door to private insurance, would not have qualified for the coverage he sought.

In the end, private insurance will make money for insurance companies but will not help sick people get faster service. Wendy Hope, vice-president of external relations for the Canadian Life and Health Insurance Association, says that if insurance for medically necessary service comes into being, people on waiting lists won't be eligible. People with pre-existing illnesses or conditions wouldn't qualify for coverage.

"Insurance is a product that protects against the eventuality of something happening," Hope explains. "You can't buy insurance if you're already ill."

If you are sick "that's why there is public insurance."

Only the public system will serve the sick.

That is not to say that I think out system is working properly right now. I agree with the Supreme Court - waiting lists are too long and that does constitute a violation of a person's life and security of the person. It needs fixing after years of mismanagement and underfunding. The solution is not to allow private insurance, which won't help anyway, but to fix the system we have - add new funding and implement the recommendations of the Romanow Report.

Or we can have a healthcare system that is run like our dental care system.

2. Public Health Care is good for business

General Motors pays $1500 per car in health insurance costs in the private system in the US. It pays $500 per car in Canada. That's between 5 and 10% of a car's value. Having a publicly run and administered healthcare system can actually make Canada more attractive to large businesses like GM, because of the money they save on paying for and administering these benefits.

Now they may have to administer extended benefits (extra medical not covered by the public system. These are procedures deemed not medically necessary or extras like single-rooms or free ambulance rides), but this is still much cheaper than the full blown version in the US.


3. Public Health Care is Cheaper to Administer

According to Dr. Arnold Relman, Professor Emeritus of Medicine and Social Medicine at Harvard Medical School and Emeritus Editor-in-Chief of the New England Journal of Medicine, public health care is cheaper to administer and the experience in the United States is that private insurance actually drives up administrative costs. The US spends $752 per capita more than we do on administration. According to some pretty good research by Ezra Klein, that's 300% more. Private ownership also drives costs up.

Clearly then, introducing private healthcare will not make the system more efficient, but actually make it more expensive. That is just not good fiscal responsibility.

Basically, from a more pragmatic point of view, these are the biggest reasons to stay with public healthcare and not allow more private care.

Public healthcare is more client responsive and client focused, is better for business in general and is cheaper to run. It makes good economic sense as well as being more equitable and fair.

Other Questions:

1. 'But France is #1 and it has a mixed system. Why can't we?'

Canada is not France. Their culture, economics and government are different enough that implementing a French-style system here simply won't work. The 'private' part of the system is funded from mandatory deductions similar to the public system:

"The funds are private entities under the joint control of employers and unions, which are in turn supervised by the state. As might be expected, that doesn't work particularly smoothly, and there's a constant battle for authority and control. Creative tension, one might kindly call it. The funds are mandatory, no one may opt-out, and they're not allowed to compete with each other nor micromanage care." - Ezra Klein
There is no way that will work in Canada. In France, even their 'private' healthcare is heavily controlled and managed by the government and unions. French doctors are paid 1/3 what doctors in the US and Canada are paid. How many doctors would be willing to take a pay cut, considering doctors in Ontario almost went on strike a few months ago in order to get a long-overdue raise? Not many.

While the French model may seem great on the surface, it is clearly unworkable in Canada and not the kind of 'private' that the conservatives in this country would support.

2. What about the rest of Europe? They all rank ahead of us with mixed systems too?

The same issues exist. Most European countries do not have the same kind of federal structure to government that we have and if they do, they do not have the same separation of powers between the federal government and the provinces\states that we do. What may work for Germany or Sweden or Japan will not work in our unique Canadian federation, devised by Sections 91 and 92.

Also it is noteworthy that advocates of the mixed system pick these countries. One of the few countries in the world that is most like our own (in government division) is Australia where this didn't work. The advocates of mixed systems never mention Australia.

3. Having a parallel system will reduce the wait times the court talked about.

No according to recent studies. In England and Australia, these studies have shown that wait times in the public system actually increase when a parallel private system exists. In Manitoba, patients whose doctors worked in both systems had to wait 2.5 times longer for cataract surgery than patients whose doctors worked only in the public system (26 weeks v. 10 weeks).

Doctors in such systems have a "perverse incentive" to keep public waiting lists long - it forces people in to a private system where they will pay more and doctors will earn more.

4. User fees will reduce abuse and lower medical costs

Again, according to the Canadian Health Research Foundation, this is not true. What this does is discourage the poor, who are less healthy in the first place, from not seeking early medical attention. They let their illnesses proceed until they end up costing the system much more in the long run. "Penny wise and Pound foolish" best describes the situation. Ironically, this very situation was one of the major factors that lead Saskatchewan to create the first Medicare system in Canada in the first place. Medicare is the solution to this problems, this problems isn't a solution for medicare.

Conclusions and Possible Solutions:

I firmly believe in equality of opportunity and access for all Canadians in healthcare. I believe strongly that healthcare decisions should be made on medical need, not ability to pay. The very rich should not be able to hire away the best medical expertise or buy their way to the head of the queue.

That being said, I recognize that long waiting lists for procedures are in fact endangering Canadians lives and causing undue suffering. I agree with the Supreme Court decision. I also recognize that the very rich can already buy their way to the head of the line by going to the US or to the very clinic our PM attends in Montreal. I recognize that in some instances and in some provinces we have a defacto two-tier (or more) system. What this means is that I recognize that our public system is broken and needs to be fixed, not replaced.

1. Return Federal funding eventually to 50%, as it was in the 70's. This is long term. A good start would be to get it to at least 25%. This will help alleviate 12 years of budget cuts and underfunding.

2. Alleviate waiting lists with the assistance of the medical profession. Look for creative ways to prevent the system from being overwhelmed - specialty clinics instead of ER for frontline diagnosis, SARS like protocols for entry to ERs (I got the fastest service in 10 years when I had to get stitches during the SARS crisis - a lot of people who normally clog up the ER with things that can be looked at by a walk-in clinic or family doctor were not there.).

3. Hire and train more doctors, nurses and nurse practitioners. Much of the strain on the system is because we do not have the people to do the jobs we expect. More doctors will certainly shorten waiting lists.

4. Re-allocate responsibility. In consultation with healthcare professionals, see what kinds of medical attention can be taken care of by professionals other than doctors - nurse practitioners, nurses or mid-wives, for instance. Spread the work more intelligently, so the doctor shortage stops being a bottleneck to care.

5. Reduce costs in other places. Drug costs have eaten up most of the new spending on healthcare. Stopping the "evergreening" of drugs, which prevents the introduction of cheaper, generic version.

6. Invest in new diagnostic equipment and the staff to run them, again to help with early detection so that cheaper, faster treament options are used.

7. Implement the Romanow Report. It's been out for 2 years. The government has done nothing.

8. See number 7.

None of the above needs to mean higher taxes. A re-commitment and re-allocation of funds could certainly do it. This is a combination of spending and conservation.

There may be other ways to help. But we must do something now to ensure that we have a world class healthcare system that can serve all Canadians, regardless of their status of location in the country, rather than give perks to the rich and business opportunities to insurance companies.

What do you think?

For your Reading Pleasure:

The Canadian Health Sciences Reseach Foundation Mythbuster page.
Dr. Relman at the Healthcare Coalition. They also provide more compelling evidence for public healthcare rather than private.
Rick's blogs entries below. Besure to follow the links.
Policagrll has two entries that discuss her personal experiences with the dental system and the drug system, which demonstrate that private insurance won't help. a very compelling read.

The Canada Health Act and an overview.

The Report of the Romanow commission.

Not a read, but be sure to watch this video series about the birth of Medicare in Saskatchewan. See if you can see how many of the same arguments for private insurance weren't born out in reality.

29 Comments:

At 1:04 PM, Blogger Greg said...

Wow Mike, this is great. Thanks for all the info.

 
At 2:58 PM, Blogger Rick Barnes said...

I will be pointing people here for this info and try to expand on it (now that is funny you have done a lot here).

Thanks for this post.

 
At 3:28 PM, Blogger Timmy the G said...

Fantastic source of info, Mike. Well done and (of course) well-reasoned.

 
At 4:00 PM, Blogger John Murney said...

Mike, I applaud your efforts to keep us informed on this most important of subjects.

 
At 4:21 PM, Blogger ALW said...

Well, I disagree with the premise you depart from (i.e. I value personal freedom over state-enforced social program equality) but you make a better case than most.

One thing you aren't addressing is the costs issue. Costs keep going up, Mike. It never ends. How do we control costs spiralling up? Vague references to "reducing costs" won't cut it. This is government we are talking about here. It isn't the least bit dogmatic to observe that market mechanisms are an imperative to efficient allocation of resources. Indeed, the whole argument against using market mechanisms for particular things is that efficiency isn't the most important thing. Fine. But to eliminate mechanisms that control huge cost overruns, you run the risk of going too far the other way. So for those promoting a single-tier public system, you will need to find a way to address this.

I think "universal public health care" is a misnomer. What you really mean is "we should make private health care illegal." Notice when you frame it in the positive light, it obscures the corollary, which is that you're prohibiting, banning, removing something. I don't think there are any serious suggestions by anyone, regardless of their political stripe, to weaken the public system or take away funding. The actual debate is just what else we allow outside the public sphere.

I hope you realize that most of the studies you have cited will be met with the same skepticism that conservatives are met with when they cite Fraser Institute studies. These organizations have a ideological and political bias, just like unions, and will selectively pluck statistics which favour their position.

The constitution is not an obstacle to health care reform. Political will is. The two are not analagous. One is the law, the other is circumstance.

Finally, I applaud efforts to show that a public system is more effective, efficient etc (even though I don't think these efforts succeed) because I fully reject the framing of the debate as rich against poor. Health care is not a right, it is a privilege which has widespread consensus in this country. Rich people have access to many things of higher quality in the world - cars, food, clothes, housing etc - and there is no proof that any of this means that those who are poorer somehow get less quality things than if the rich were banned from buying "higher tier" goods. The exact same principle applies to health care. It is fallacious to assume that if we ban higher quality health care for rich people, someone everyone will have access to it. Instead, no one will have access to it. It is not about fighting over a fixed quantity of services, it is about expanding the total amount of services - by giving people who are currently not providing them an incentive to provide them.

 
At 4:31 PM, Blogger ALW said...

I just paid a visit to mythbusters, and they completely prove my point: this is economic illiteracy in action. They call this a "logical flaw" in the parallel private argument!!!:

"Since healthcare practitioners can't be in more than one place at the same time, creating a parallel private system simply takes badly needed doctors and nurses out of our public system hospitals"

Um, but the whole argument that I would make is that part of the reason we have a shortage is that there's very little incentive to become a doctor when you end up underpaid, overworked, and constrained in how you can practice. This is basic economics. Incentives matter. If you allowed a parallel private system, you wouldn't be splitting the same quantity of doctors between the two: you'd have more doctors. But then, given that most left-wing economists view wealth as a fixed quantity to be fought over an redistributed, rather than the total quantity being expanded, this isn't surprising.

Also, morally speaking I think it's really poor justification to keep a public system on the grounds that all the doctors in it are just itching to get out: "We have to lock the doors or they'll escape!"

 
At 8:50 PM, Blogger Mike said...

Aaron,

Thanks for the compliment and I fully understand that you probably don't agree with the premise.

;)

I agree that costs are rising, that is part of the problem. But "spiralling upward" is a bit over the top. This is a two way street here. Costs are rising, but, since it's based on a percentage, so should the government's tax income. This becomes an issue of management - how to best allocate the resources. The public system certainly can improve in this area. The costs go up in a private system as well. How do they deal with it? Raise rates? Drop coverage? Restrict payouts? The private system must also deal with these things in addition to ensuring that profit is made for shareholders. It means little difference to my bottom line if I end up paying more to the government or to an insurance company - except I know that the government will at least not be concerned with making a profit off me.

I am also for personal choice and freedom but in a much more practical sense. What about having that freedom on a level playing field? That freedom of choice does not, practically, apply to everyone, when not everyone can afford to excercise it. Mr. Zeliotis may have the 'freedom to choose' private insurance, but since practically he can't ever excercise it, becuase no insurance company would every cover him.

As for the sources, I also appreciate that they may be from what you consider 'biased' sources. I would say that the sources are 'biased' that way because of the research they did, not because they thought one way first and then did research to back it up. If you can come up with studies that can refute the numbers, then that's what should be presented. I personally found a report from the Fraser Institute about Swedish healthcare quite good and compelling. It didn't hold up under further research, but when I first read it, I thought it made quite good arguements, despite where it came from (I felt like having a shower after reading and agreeing with it, but I didn't automatically discount it because of its percieved source). Much of the research I linked to has citations and links with it that you can follow to check out the information. Please, if the information is wrong I would like to know.

As for your "economic illiteracy" I would agree with your accessment if our medical schools were only half full, or if they were having problems recruiting students. They don't - classes are full and people are being turned away from the profession in droves. They do, however, have quotas on the numbers of doctors they graduate every year. If you read further through the mythbuster paper's you'll also see that they aren't leaving in droves. Now some leave for the US because they can make money to quickly pay off their enormous student debt load, and never return. A great many also go into research for biotech and drug firms rather than practice. The shortage is created by graduating too few doctors, too few of whom are going into practice, while at the same time not allowing foriegn trained doctors the ability to practice here. Plus our system is quite 'doctor centric' and requires doctors to ok a great deal things that could also be handled by nurse practitioners - minor perscriptions and diagnosis, referals to specialists etc. These nurse practitioners are less costly than doctors and can free up doctors for other areas in the system.

You should realize this is simple supply and demand. Cuts at the federal and provincial levels in the 90's reduced the number of doctors and nurses. They reduced the number of hospitals and hostpital beds. At the same time our population grew. And during this time, medical schools graduated less doctors due to self-imposed quotas (the CMA not the government). So now we have towns like Cobalt that can't attract doctors because there simply aren't enough. There is a doctor shortage in Canada because there aren't enough being graduated.

Lastly, while I do agree that in some instances, market forces can be more efficient (yes, its true, an NDP who is also a business person!), healthcare isn't one of them. People do not enter the healthcare market "freely" as they do when they buying cars or even food.
They either enter under duress or have to negotiate under duress - the duress of sickness of emergency medical situations. This puts all the bargaining power in the hands of the supplier or insurance company. This is not free and equal bargaining. A person with a sick relative, child or who is sick themselves will pay any price and agree to almost any condition for the immediate relief of their situation, even if they have insurance. The supplier can ask for and get nearly anything under this duress. That isn't trade, that's exploitation and borders on legal extortion. For me, it is no different from a person asking for $100 from a man hanging off a cliff, and getting it, before they help them up. And refusing to help them if they don't pay. Basic economics presumes at least some sort of equality (or at least not a huge disparity) among the parties. This isn't so with those using the healthcare system.

Sorry for being long winded. I do appreciate your posts because they do make me think and justify my position better. Again, I take my position based on my research on what I think the best system for us is. If you've read some of my posts elsewhere, you'll know that I would have been happy to find out a mixed system like Sweden was the answer. Unfortunately, it didn't bear out. But please, if you can show the data I'd be glad to hear it out.

OT: Where in London do you live? I used to live above the Black Friar's Cafe back in 91.

 
At 2:38 PM, Blogger v said...

Solid article, Mike. I might quibble with a couple things here but it would be bad form to slag an article this good with a snotty partisan two-line retort.

Allow me the indulgence, though, of pointing out that you, Stephen Harper, the CPC policy declaration, and I all agree in our support of universal healthcare, the Canada Health Act, and stable and transparent funding for medicare.

And if I may add one point: I'd rather see the federal government increase healthcare funding than starting a new childcare program or making asymetrical special side deals with vote-rich(tm) provinces and cities.

 
At 2:57 PM, Blogger Herbinator said...

Hmmm, throw money at the problem.

I used to address all problems that way when I was once rich. Now I prefer to resolve problems, not so much by choice but out of necessity. Maybe there is a parallel here.

 
At 3:19 PM, Blogger Mike said...

Anonalogue,

Thanks. I'm glad there is some common ground here. Perhaps that means a meaningful solution can be found. Now, if you'll allow me an indulgence, Mr. Harper and his supporters like Ralph Klein have not always been such great supporters of universal public healthcare - Mr. Harper has, on many occasions in the last 15 years, called for the dismantling of the Canada Health Act and the introduction of private healthcare in Canada. I'll reserve my judgement on his recent conversion for a while longer, if that's ok. ;)

Besdes, Herbinator has taken up the call for the snotty partisan retort.

Herb, "throwing money at it" is NOT the only solution proposed. Much of the Romanow Report is not "throw money at it". A great deal can be saved by changing rules, spreading responsibilities and graduating more doctors. But lets not forget, sometimes when a problem is caused by taking too much money out, the solution is to put some money back in. This money can taken by re-prioritzing, perhaps in a way like anonalogue suggests, rather than in your thinly vieled fear of more taxes.

 
At 4:24 PM, Blogger v said...

Reasonable enough, but I do think Harper has seen the light: that despite loaded questionish polls ("Do you agree that being able to buy some private medicare is OK?") of late Canadians really like their healthcare, and that even if Harper did oppose the CHA he understands it would be unwise to campaign on dismantling healthcare. And short of a Conservative majority - almost impossible under present circumstances - Harper can't implement any PaleoNeoTheoCon agenda anyway. He'll have to be kept in check by one of the three left wing parties.

On that note , it's somewhat discouraging as a CPC supporter to see Harper's past policy stances get a disproportionate amount of exposure compared to Martin's demonstrated record of cutting social spending and effectively dismantling healthcare.

 
At 5:36 PM, Blogger Politicagrll said...

Doctors and nurses may be leaving but is anyone keeping a good record of who is coming back?

My aunt's family had 2 children who became doctor's, one pharmacist and one nurse (Master's level...more administrative nurse).

Two never left Canada, The one who was a nurse went to the US but came back (although she is a citizen now). Same for the doctor who went to the US.

She went because there weren't many positions for nurses at her level and for her husbands career. And they pay a hell of a lot more for nurses in the US at her level. Him, well i never really got it. But they both came back to Canada, and the nurse is raising her family in here. I don't think she has any intention of working in the US again.

There is already a certain amount of "brain drain" from the US to Canadian in technology companies because it can be a nice to live here. If we were less strict on foreign credentials there might be an evening out of the medical people moving back and forth, which seems to be an issue that it would help to address

 
At 5:47 PM, Blogger Mike said...

Anonalogue - yeah, fair enough. Martin's feet haven't been held to the fire nearly as much as Harper or a much as they should.

Politicagrll - My sister is currently a nurse in Arkansas. She has married an American and won't be coming back (unless they institute the draft down there, in which case 'Welcome to Canada, Brother-in-law!'). That being said, I also know a great many nurses who went down and have returned. According to the mythbusters link above, leaving doctors only account for 2% of the total and an equal amount are returning.

 
At 1:06 AM, Blogger Psychols said...

Mike, what an excellent post.

I think a key point you made is that our medical schools are full. The need for a parallel system to attract Doctors to a lucrative private system is lacking given that we have little difficulty attracting them to the public system.

Spiraling health costs result from pharmaceuticals, the cost of specialized treatment and an aging population. That is not unique to a public system. The US spends more than anyone on health care yet wrestles with spiraling costs more than we do.

 
At 10:37 AM, Blogger Politicagrll said...

A large part of the increased cost of medical care is due to changing in the generic system that were brought in as side deals with the FTA and NAFTA which had previously allowed very cheap generics very fast.

Not that generics work for all folk all the time. But allowing them to be made a lot cheaper and, when they work for individuals giving them generally would take some strain off the system as well (Rx costs are a large part of hospital costs).

Before the FTA i believe (but don't remember exactly) the generic period was about 5 years...regardless it was a full generic.

Now there is a 20 year patent. While generics start to become available before that there is strict pricing (ie first generic has to be 80% of normal cost). Canada agreed to this to get the FTA and NAFTA through (or just bowed to US pressure on it).

Evergreening of drugs is a problem as well. When they can show a benefit fine, but often the company takes the original drug off the market. sometimes with absolutely no studies to show it will work better in it's new form so generics don't come in in the normal 20 years, it can take 40...

Mike: i'll check out that link. I'm glad to hear a lot of folks do come back to Canada. I've thought it was higher than made out because of my cousin's family. Nice to know it is happening overall.

 
At 6:08 PM, Anonymous Princess Monkey said...

Mike: What an awesome post. Thanks for compiling all this information for us, and for providing such an articulate debate. You da man.

 
At 12:13 PM, Blogger andym said...

Kudos to you, Mike, on this article, and your site. I too am pointing people your way. It is nice to see that I'm not alone on the left in Ottawa.
Ciao, dude!

 
At 3:36 PM, Blogger ALW said...

Mike,

Okay, with respect to costs, you are right to say costs go up whether the system is public or private – but the difference lies in the way each system responds to such increases. Or should I say, lack of response: in the public system there is not at all. There’s no reallocation of resources. There’s no rationalization. Why would there be? There’s absolutely no incentive to do so! How is this easily remedied under the public umbrella?

It’s true that profit-driven enterprises have to create value for shareholders, but this is precisely the reason they’re going to be more efficient than government enterprises. Government enterprises aren’t not only concerned about not making a profit off you, they’re not concerned about helping you, either. That might sound cold, but if it’s fair to assume that most businesses are selfish cutthroat affairs, I think it’s fair to make the same assumption about politicians. So really, the government isn’t the shining beacon of light here. It’s not as if the government is the valiant defender while the private sector tries to screw us. Government screws us too: and unlike the private sector, they can get away with it a lot easier!

I knew it was a mistake to use the word freedom (it usually is) because it just turned into a debate over what it actually means. For the record, I don’t believe in positive freedoms, only negative ones – because positive ones by definition violate negative ones.

But suppose we take your example about Mr.Zeliotis. Even if some people were to enjoy a freedom that others do not, this is not, prima facie a bad thing – if I gain, but you don’t lose, are you any worse off? No. So I think it’s critical to the public health care argument that you prove a private system will harm – not just “not improve for everyone” – those who don’t have access to it. If I’m stuck at number 4,652 on the waiting list, and other people behind me end up getting treatment, am I any worse off? I might be if I could otherwise have access to that treatment. But if I couldn’t – and this is the catch – then would it matter? I would argue no.

The issue with medical schools isn’t a public/private issue; it’s a licensing issue that physicans are responsible for. They’ve turned the profession into a closed shop. Of course, its possible that the reason there’s no university spots – either public or, hypothetically, private – is because if you shoved in more people into the profession, there wouldn’t be enough money to go around to pay everyone! If you have $1 million fixed budget and 10 doctors, that’s 100k each. Putting in another ten doctors without upping the budget just halves everyone’s income. What doctor wants to see that happen? Not too many.

So I know this is where you’d say “well, then just pour in more $”. But the problem with public funding is you never know where it’ll be next year or five years down the road. Because the decisions are made for political reasons, doctors want to cover themselves by making it hard to get in. Can you blame them? I can’t. Of course, when the money is coming from private hands, like most industries, this problem is nowhere near as acute (though it happens to a degree with lawyers).

It’s interesting that you noted that the public system we have is very ‘doctor-centric’. Well, why is that? If you’re not a fan of big government like myself, you chalk that up to classic bureaucratic non-expertise: a privately-run hospital would never do such things, because it’s inefficient.
To clarify, spending on health care went up massively in Ontario between 1995 and 2002. They closed buildings, it’s true, but the money stayed in the system. So where did it go? And it can’t be coincidence that the crisis stretches pretty much coast to coast in spite of the fact that not all provincial governments cut, or cut as much. It’s too much to be coincidence. If there was a “good” way to run a public system, wouldn’t some place have found out where that is? (Please don’t say Cuba!)

I’m glad to hear you’re pragmatic about market forces! And, you may be surprised to know that sometimes I don’t think market is the most appropriate mechanism. What I keep looking for is an answer as to why health care isn’t one of them. What are the characteristics of it that make it different than other services?

People enter the food market under pain of starvation – you can’t not eat. And not all entry into the health care “market” is on pain of imminent or even pressing duress. I grant it for emergency situations, but that’s not the lion’s share of what we’re talking about here.

I also take issue with your characterization of bargaining power. First of all, it presumes every doctor would try to rip you off if there weren’t laws to stop them (incidentally, if they were that bad of character why should a law even stop them?). Also, competitive principles still apply. If some doctor acted the way you claimed in that scenario – extortion-like – and this made the newspapers, how many people would ever use that doctor? What kind of reputation would this person have in the community? There are other deterrents – and I would argue more effective ones – than simply passing laws.

I’ll look for some more studies in my spare (ha!) time. I am glad to hear you are keeping an open mind on this. All sides of this debate just want better health care for Canadians. We have our preferred methods and biases but the objective is of course the same!
Oh – I live on Western Rd, just north of Oxford.

 
At 4:05 PM, Blogger Mike said...

Aaron,

Actually, I found an interesting article or two by the herbinator.

This one and this one.

He seems to have an interesting twist between my position and yours - a fully public system with market-like forces driving the efficiency. I'm still a little wary, but intrigued. I intend to dig into it a bit, but I certainly would like your perspective.

What do you think?

I'll try to have a look at your post and see what I can rebutt ;) when I have the chance.

 
At 10:57 PM, Blogger DazzlinDino said...

Well put Mike, personally I don't think there is much hope for our system, but well put. Saskatchewan has opened thinks like the MRI's for 24 hours a day now, that should help things out there. Not sure what the life expectancy of an MRI unit is on 24hr operation, guess we'll find out.

Good site by the way, made my favorites list, keep it up.

 
At 11:30 PM, Blogger jeff said...

From The 7 Things You Can't Say as a Canadian:


Only private enterprise can save public health care.
Tommy Douglas, the CBC’s Greatest Canadian, brought us universal health care. But even his plan didn’t originally pay for everybody’s ingrown toenails. His primary goal was to make sure nobody faced financial ruin if they got sick.

Today we have a system where controlling costs is more important than treating patients, and where ideology is crippling us. In some places, including Toronto, people go blind waiting for cataract surgery. The government could restore their sight tomorrow simply by sending them to a private clinic instead of to a hospital. The cost to the government would be exactly the same. But in Canada, private is a dirty word, and so the government would rather you go blind. Poor Tommy would be spinning in his grave.

http://www.readersdigest.ca/mag/2005/07/cant_say_in_canada.php

 
At 1:49 PM, Blogger The Internationalist said...

This is a great post. You make a very strong case and I'm in full agreement. In fact, I've made similar points myself elsewhere, but not as clearly and it's nice to so many pro-medicare arguments in one place.

 
At 12:36 AM, Blogger ktk said...

Let's not forget the one point that you missed in your explaination. The union. If (sorry, when) privatization comes into play the union will suffer the loss of its' members (c'mon now say it with me, members=money) and they will try to roll heads over it.

It's that the real issue? You've done a great job of pulling the covers over it and carrying on. There's a future for your writing skills as some Liberal Strategist I'm sure.

 
At 8:46 AM, Blogger Mike said...

szm,

The issue of unions was not actually at the top of my mind. Even in our current system with unions, the numbers show we deliver healthcare more cost -effectively than a private system.

Besides, rollbacks against unions in private healtcare won;t free up more dollars for health (as you seem to be implying), it will free it up for the profits of the private shareholders.

The nurses union here in Ontario is one of the greatest champions for public healthcare because of the quaility. These folks were decimated under Mike Harris so I hardly think a public system will be a fortress for unions.

The real issue is providing the best, fairest and most available healthcare for Canadians, and in my opionion, based on the research above, a public single-payer system is the best.

And I'll use my writing skills as an NDP strategist, since that's the party I belong to.

 
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Universal health care can be a great impact on our health care system. It is unfortunate to hear so many lack health insurance. We really need to improve our health care system. Health insurance is a major aspect to many and we should help everyone get covered.

 
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