Saturday, December 03, 2005

In Defence of Universal, Single-Payer Public Healthcare, REDUX

Since Stephen Harper's recent pronouncement in favour of Single-Payer, Universal Public Healthcare and his clear statement that

"There will be no private, parallel system,"Stephen Harper in Winnipeg, Friday December 2, 2005

I thought it would a good idea to repost this pertinent post I made last June. Read this agian in light of Mr. Harper's statements and lets have a real debate now

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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.

19 Comments:

At 12:57 AM, Blogger v said...

Meet the Conservative candidate for Brossard-La Prairie, Tenzin Dargyal Khangsar:

"He was also the main coordinator of the recent visit of His Holiness the Dalai Lama, winner of the Nobel Peace Prize, last April to Ottawa. He is co-founder of Invidex, a software technology firm serving the television industry. Founded in 1999, today the company has more than fifty employees and has raised about $10 million from investors and counts many of the world's top broadcasters as clients. Prior to his career in sales, he was a sports broadcaster-journalist for CBC-TV Montreal and produced two documentaries on Tibet for RDI and Musique Plus. Of Buddhist faith and highly spiritual, Tenzin is a graduate of McGill School of Management with a double major in Finance and International Business.
...
I also understand that he is the first representative of the Tibetan community to run for elected office anywhere in the world, and by doing so he makes all Canadians proud."

http://www.tenzin.ca/

 
At 1:41 AM, Blogger John Murney said...

Great post Mike, way to go!
Also very interesting about Tenzin.

 
At 2:19 AM, Blogger DazzlinDino said...

I bet enough could be saved every year for a new MRI just by trimming some "prok fat", both in government and administration....

 
At 8:35 AM, Blogger Mike said...

Dazz,

You'll notice that many of the recommendations I pose do not include more money, but changes in rules and regulations. I also don't think there is as much "pork fat" as you think in the system. The system has suffered for 15 years from massive cuts in funding. Some of that money has to be put back in. Even Stephen Harper's plan will require a CPC government to pay the money needed to fufil his wait times obligation. I say pay that to a public system with lower administration costs. Harper says pay it to private health firsm.

That's really the debate now.

John,

Thanks!

Anonalogue,
Yes Tenzin is interesting. And this has what to do with healthcare of the actual subject of the post? Nothing. Shill for the CPC sonewhere else. If you post off topic again, your post will be deleted. If you can't have an intelligent debate, go away. Presenting some guy whose a Buddhist will not make me vote for the CPC.

 
At 5:48 PM, Blogger ALW said...

No time for a long long response, but a few quick things:

Re: serving public good not private stockholders, you are not considering the possibility that those who operate within the system are in fact looking out for their own interests and not the public's. In fact, this is the problem that permeates every government department: there is no incentive to run things efficiently because the usual disciplinary forces that exist in the marketplace are absent. I realize this is a common point of contention between left and right, but there's overwhelming evidence that public entities are inefficient and static simply as a consequence of the perverse incentives the system sets up. It's the same reason we don't have state-run grocery stores etc.

There is a difference between proposing to do away with the public system (which nobody is doing) and proposing to inject market elements into it.

Re: good for business - you are saying that health care is a business subsidy? That's not a good thing. Why do New Democrats support subsidies to private corporations, and then want to turn around and hammer them on the tax end? Why not just subsidize them less,and tax them less? The result is the same!

re: administration costs - the figures are misleading because we can't really separate the costs to administer the civil service as a whole from the costs of the health care field specifically. Just because the costs are murky doesn't mean it's less. It would also run counter to the laws of economics, but hey.

Re: other examples: are you saying that it's the Constitution that prevents us from having an effective mixed public/private system?

re: perverse incentives, why is it that you assume in a public system all doctors are noble, altruistic people, but that as soon as there's a private system they all turn into self-interested, greedy individualists? Do you really believe that most doctors will try to prolong the suffering of people if there's a financial incentive?

Your don't seem to entertain the possibility that increased funding is just throwing more money down the hole. Health care costs are fast outstripping GDP growth and overall government revenues. At what stage - 60%? 70% - will people say "whoa, maybe this is eating up too great a % of our social spending"?

I know you mean well, but I don't think you've considered the underlying economics of a public monopoly. I am glad that you agree with Chaoulli. I hope that however it happens, the system gets fixed, and pronto. People are dying.

 
At 7:05 PM, Anonymous arthurdecco said...

In response to a few of the issues brought up by alw:

There is no evidence that public entities are any more inefficient and static than the private sector. Why do people on the right keep repeating this gigantic lie?

And to equate health care with grocery stores...geez!

Health care is definitely a business subsidy. Even troglodyte economists admit this is true.

As to the "underlying economics of a public monopoly"...You surely aren't suggesting that any privately administered system would be more efficient, are you? ...Because it has been proven time and time again that our present method of managing health care costs substantially less than the American private system.

Imagine how many more efficiencies we could create by simply fine-tuning our present public system, as Mike has suggested.

All of these arguments in favour of a public/private or fully private systems are disingenuous at best and dishonest as hell at their worst. It’s simply another ploy to remove public monies from the pockets of the citizenry to place it in the pockets of those who don’t need or deserve it. Just look at the mess the Americans have made of health care with their greed-based system!

No one has ever provided me with an explanation of why it is so necessary to let private businesses administer health care. Healthcare is NOT another product – it is a public service. We are NOT clients or customers of the health care system! When we require help from our health care system, we are PATIENTS! I refuse to permit them to identify me as anything other than a patient.

And frankly, I don’t think it’s necessary to divert our health care funds into the pockets of those with too much money already just because we’re ill and unable to care for ourselves. Talk about taking advantage!

And to use the phrase, "People are dying." as a buttress for your argument? Well, I've got news for you, alw; even MORE people will die in a private system.

Don't believe me? Look it up.

 
At 8:21 PM, Blogger Mike said...

ALW,

Aurtherdecco has said it a little more passonately than I but I will address your concerns in order:

"re:serving the public good..."

Despite your theory, it has been shown that publicy run isnurance schemes are in fact more efficient than the same private systems. My example of the study by Dr. Relman is an indication of this - despite what your want to believe, a mixed system like in the US actually costs more than our system - 300% more per capita in fact. Auto insurance is another - Manitoba and BC have significantly lower costs than similar system elswhwere, such as Ontario and Alberta. There are some instance where the government does a job better and more effectively.

"re: good for business..."

I'm saying its a subsidy of sorts. GM, in my example, has themselves stated that they save $1500 USD per vehicle in Canada because they don't have to administer health benefits or even the coordination of benefits with other companies. That is a huge savings for them and can go toward their bottom line. And GM is not alone (just in case you try to bring up their recent problems and layoffs) - Toyota at the CAMI plant just down the road from you is there for the same reason. It is certainly one of the factors they used in deciding to build another plant in Ontario. Businesses that don't have to wrestle through the mires of red tape and burocracy that insurance companies create make more money. This gain, at about $1500 dollars per car in GM's case, must out weigh the supposed tax issues you raise.

"re:administration costs"

I'm sorry you don't beleive it, but Dr. Relman has published these finding in the New England Journal of Medicine. Which is easier and cheaper to administer, the system with the single point of contact or the one with multiple, competing HMO's, insurance agencies, etc? The costs aren't murky. The cost to the company is less, the cost to the hospital is less and the cost to the doctor is less. Hospitals in the US have 30% of their staff dedicated to Accounts recievable. Perhaps you should have another look at this, its not as murky as you assume.

"re: other examples"

I'm saying that our particular Federal system is different enough, with different enough divisions of powers and levels of government that making comparisons with countries like the UK and France (with no "province" - national level followed by municipal). Thus claiming we can have a mixed system because France
has one is too simplistic and is comparing apples an oranges. Like I said, Australia is the country most like ours and its mixed system is failing.

"re:perverse incentives"

Have you read "Freakonomics"? It not whether they are good or bad, its that they will act in this self-interest. This has been documented to be happening in UK and other European countries. Doctors aren't nescesarily don't it even consciously, but they will do it. It not about prolonging agony as much as it is using the threat of prolonged agony to get financial gain.

"Health care costs are fast outstripping GDP growth and overall government revenues"

If you are going to make that kind of allegation, you are going to have to provide some evidence. The only thing I have seen is the recent "report" by the Fraser Institute (so I already suspect their methodology and numbers, given their honesty with 'Tax Freedom Day'), which tries to say this. Now I will try to find the time to fisk that report later, but my understanding is they never separated insured and non-insured procedures, never took into account the retiring procedures and lowered costs in these areas as the baby boomer bubble gets older. But more on that later. Given that billions were removed from the system over the last 15 years, I'd be surprised if costs weren't rising with the new influx of money lately.

Now as I said, cost can be controlled with some of the things I mentioned above, like removing the doctor as the bottle neck to care. Like stopping the evergreening of drugs - drug costs are the single largest increase in healthcare costs in the last 5 years. I don't buy into the new meme that healthcare is unstainable (because Ralph Klein says it but never back it up).

Our system worked in 1990. When it was adequetly funded. Given that new technologies have lowered the cost of business in other areas, the same can certainlyapply to healthcare.

I agree with Chaoulli in the sense that I think that we must be guaranteed healthcare in a reasonable time. I agree with the Chief Justic when she saidd that had the government been providing healthcae in that time, then the case would have failed. For me the solution is to properly fund the system (back up to 25% then eventually to 50% for Federal contributions) so the private insurance option isn't needed. I still think they seriously misunderstood the systems in Europe.

 
At 8:16 AM, Anonymous Jeff said...

Tenzin is running for the Conservatives? Awesome!

 
At 10:17 AM, Anonymous arthurdecco said...

Mike,

I stand in awe of your reasoned and considered approach to dealing with these issues while talking with those "who will not see".

Forgive me; I think I'm stuck with passion as my personal tool of persuasion. lol

(btw, that annoying troll is back again.)

 
At 1:14 PM, Anonymous Jeff said...

You call that passion, arthur? I call what you've got a classic case of left wing extremism. Paranoid, prone to ranting without addressing the issue, no solutions, name calling, fear mongering, and uncontrollable rage.
These traits only make you look desperate and unbalanced. Try to get a grip, would you?

 
At 1:27 PM, Anonymous Jeff said...

Mike, the problem you are failing to address is that Tommy Douglas never intended the Canada Health Act to be used for every single complaint and need that is presented. If I get a hip replacement and the hospital issues me a standard hip but I want the upgraded one, shouldn't I be allowed to pay for a better hip if I choose? Second, how do you quantify how long someone should have to wait until they are provided care? The only way to get public healthcare to the level whereby it can provide fast and efficient service is to pump massive amounts of money into it. And even then, there will probably be those that want faster service. You see the dilemma? You can't please everyone and in a free market democracy, people should have choice. Btw, we already have choice anyways. If a person wants, they can take a trip across the border and recieve immediate care. Why are we allowing the US to continue to provide us services that we can provide ourselves? Two tiered access is already available. Why don't we acknowledge this and build more private clinics so that people aren't forced to travel long distances and give their hard earned Canadian dollars to American firms? Could the real issue be that you are afraid unions will lose even more influence on our healthcare and this would be a blow to the NDP that relies on union support?

 
At 3:42 PM, Blogger Mike said...

jeff,

"the problem you are failing to address is that Tommy Douglas never intended the Canada Health Act to be used for every single complaint and need that is presented"

Its not. There are a great many things not covered which are covered by extened insurance plans. In ontario, that includes optomistrists, semi-private and private rooms, certain types of physiotherapy etc. Feel free to go to the links provided to see what Tommy Douglas wanted. Its pretty clear and its not what you imply.

"If I get a hip replacement and the hospital issues me a standard hip but I want the upgraded one, shouldn't I be allowed to pay for a better hip if I choose? "

Jeff, your not shopping for a care or a purse. Its not like you can get the 'turbo sport model'. Upgrades to medical technology are introduced and used in our current system quite quickly. Most people simply want a hip that works.

"Second, how do you quantify how long someone should have to wait until they are provided care? "

Well, I agree with the Conservative Party of Canada - ask the experts. They trotted out a group called the 'Wait Times Alliance' when they announced their healthcare plan last week.

"The only way to get public healthcare to the level whereby it can provide fast and efficient service is to pump massive amounts of money into it. And even then, there will probably be those that want faster service. You see the dilemma? "

For 15 years, the Liberals and various provincial governments cut massive amounts of money out of the system. It's only reasonable that at least some of that money be put back in. There also the non-funding related changes proposed in my post that would help out as well.

And ther is no dilemna. The Supreme Court itself said in Chaoulli that if wait times were reasonable in the public system, that case would have failed. As long as the wait times are 'medically acceptable' then it doesn't matter if someone wants a hip in 3 weeks instead of 2.

"Could the real issue be that you are afraid unions will lose even more influence on our healthcare and this would be a blow to the NDP that relies on union support? "

Well, I think Buzz Hargrove has put THAT myth to rest, no hasn't he? I, and I would suggest the NDP in general, support public medicare because it is free and universal and is the best system we have, by all the measures and studies I have indicated above. Trust me, if a mixed system like France really was provabley the best, I would support it. But its not.

Need I remind you that our system worked before it was slashed to the bone by the Liberals? We had none of these problems in 1990. I can remember when provincial governments were ADDING procedures to the list, not removing them. Wait times were minimal.

We can have that again, with a little re-investment and tweaking of the system.

So why is it when Stephen Harper says "There will be no private, parallel system", CPC supporter such as yourself come out of the woodwork and demand just that? And then you wonder why you get tarred with the 'hidden agenda' brush all the time...

I want the best possible healthcare system for Canada. According to the research, studies and facts, that is a well funded, single-payer, universal public healtcare system. Just like Stephen Harper supports.

 
At 3:45 PM, Blogger Mike said...

D'oh!

"someone wants a hip in 3 weeks instead of 2"
should, of course, read, 2 weeks instead of 3.

 
At 4:17 PM, Blogger ALW said...

I posted a tongue-in-cheek response to this on my blog.

While I obviously admit that my satirical example isn't exactly analagous, a lot of the arguments apply.

 
At 1:32 PM, Blogger Ted L. Nancy said...

Excellent post.

I'll just add this thought to the conversation, and let Mike tell me if it's worth anything.

If 16% of Canadians couldn't access our health care system, we'd have shorter waiting lists too.

Bit too dramatic, and lacking the thoughtfullness that pervades this post, but something that somehow seems to get left out when comparisons are made between the U.S. and Canada.

 
At 2:34 PM, Blogger Candace said...

Mike: "Harper says pay it to private health firms." He did? You realize we already have a mix of about 70% private, 30% public (I can hunt down a link if need be). Doctors are private corps, so when you visited your obstetrician, you were in a private clinic. You paid, however, with your healthcare card.

Apparently Alberta has private hospitals. I dunno - I go to whatever hospital is closest when my daughter does a lip stand while mountain biking or falls off a galloping horse. I use my healthcare card & don't pay a thing. I could care less if the hospital is part of a private organization or a public one, I just don't think a kid with a broken arm should have to spend 3 hours in ER to get a cast.

 
At 3:03 PM, Blogger Mike said...

Candace, that may well be true (and yess, I'd like the link ;) ) but what you cannot do, according to the Canada Health Act, is bill both privately and publicly. You cannot legally go to a doctor and get treatment and have your provincial plan pay for part and you pay extra to "top it off" - so called extra-billing. But this happens in places, including that Alberta hospital. Also, the cost of the operation in that Alberta private hospitalis about 10% higher. So, why would the government want to pay more?
Shouldn't we be trying to get the best bang for our buck?

The real issue is of course, that there aren't enough of those doctors - for a variety of reasons, including provincial medical associations keeping doctor gtraduation numbers artificially low - to support a system where there are both private and public. In that situation, we must go with the system that is both most inclusive and cheapest to run (when properly funded). That system is the public one.

According to recent recearch from the Canadian Institite for Health Information shows that most recent growth in Healthcare expenditures is by perscriptions and non-persceitpion drugs and the fact that new government money is finally flowing (and thus, being spent after years of cut backs). Note in that story that private healthcare costs are rising faster than public...

 
At 1:40 PM, Anonymous marquesi said...

If a licensed physician wants to provide services for pay to a patient, he has the RIGHT to complete the transaction.

If a patient wants to purchase medical services from a physician, he has the RIGHT to complete the transaction.

That is all that matters.

The biggest problem at present is a shortage of physicians. But if we had enough of them, it would blow the whole socialist argument that too many of the best would be drawn into the private sector at the expense of the public one.

This issue is not about health care, it's about control. The only people trying to get rid of private health care are those who want to run everybody's lives. They need to be fought as strongly as possible.

 
At 2:10 PM, Blogger Mike said...

marquesi,

You are right, they do have that right. They just can't work in the public system at the same time - they must be wholely private. They also can't use public hospitals, they must be wholey private.

And given that most people can't afford that kind of system (see the US) this is why those kinds of doctors don't exist in huge numbers. that is why people aren;t flocking to the US for this kind of treatment - they can't afford it. This is why we have the medicare system we have - so people can seek medical treatment without going broke, or loosing their homes.

THAT is all that matters.

I have shown that our public system is more universal, cheaper to administer and more fair to the vast majority of people in this country, with facts and studies and comparisons with other countries.

You have argued that rich folks ought to be able to buy their healthcare and beable to jump the queue for no other reason than they have money.

You are right about one thing - we need more doctors. I think with more doctors both systems can coexist. Until then, the most fair one gets the nod, and that is our single-payer public system.

Now I have argued facts and you have bellowed ideology at me. A bankrupt ideology based on greed as a virtue and every man for themselves. In other words, I'm guessing your a libertarian. Since that pretty much means you live in a utopian fantasy land every bit as wrong and bankrupt as Communism (you are just the Un-commmunists) and like to ignore facts that disprove you pet theory, I'll assume this is the end of our discussion.

Now

 

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