H4, are you saying there is a 1:1 correlation of spending to results? I would argue that a private system will be much more efficient and cost less for the quality of care. If however you stick to more money=better care then I have some fantastic beach property to sell you.

More money does not equal better, especially when in regards to a government operation. Our education system is a perfect example of this.

My point went completely over your head CK. The private system is in fact more expensive than universal systems. It actually comes out to being approximately 2.5 times as expensive per capita when compared to universal systems. This flies in the face of the "private is more efficient" mantra of New Public Management and Alternative Service Delivery and on the surface it should be easy to see why: public systems don't retain a % of the money thrown into the system as profit, whereas the private system does.

As such, my point was that if people are concerned about public system being worse on a quality basis, then a simple solutions is to invest a similar amount of $ as they do now. Under those circumstances by extension the system MUST be better funding and of higher quality than other public systems. It may not be a 1:1 ratio, but I never argued it was. For you to claim that there isn't a correlation between quality of care and funding for care, well then I have a bridge to sell YOU.

The issue that most healthcare systems are having now is that they can't afford to continue to increase funding, especially given the rapidly increasing costs of current care.

Here is where we differ...the American healthcare system, but pretty much every metric, is the best in the world. Treatment for everything is of a higher quality than anywhere I've read about, so if you have something to show on that front, I would like to see it.

Your argument about public care being better with more money than public care with less has little basis. The education system in America is a perfect example of more money showing no results. The war on poverty, as in the other thread, is another example of 16 trillion dollars being thrown out the window.

A public system has no reason whatsoever to be efficient. I don't know how many programs I've looked into where the government creates jobs simply to create jobs. They are not looking to get the best bang for your buck, they are looking to employ more people. Couple this with the fact that a government program is a defacto monopoly (which everybody hates with a passion for some reason) and it adds to the reasoning that they have no reason to keep costs low for your benefit. Privatization is the only way to keep costs low because they compete against each other. They have motive to provide the best care at the best price. The problem with our system is the regulation surrounding hospitals and insurance as it is. What we have now is the halfway solution that is worse than freedom and chains. Either the government has to leave it alone or take it all over. So a comparison of what a free market healthcare system would do to what we actually have is inaccurate.

Now, if we want to talk about healthcare costs in relation to government intervention, we could go there. As the government has become more involved, costs have risen as a % of GDP. I found a couple sites with OECD data, and all looked similar to this:
http://upload.wikimedia.org/.../Health_costs_USA_GDP.gif

Now, this isn't only in America, other countries have all had costs rising as a % of GDP, however they have curbed the actual care they get and as such it didn't rise as sharply.
http://media.economist.com/...isease_health_as__gdp.jpg

As for your last point, I would argue the governments around the world are the problem in creating that increase in costs.

In a small nutshell..The younger,"fairies in the wind",easily mislead,not politically savvy voters, got Obama in both times.
I sit here and cry for the TRILLIONS of $$ that my, yet to be born great and great-great grandchildren will have to pay in all the taxes they will be burdened with to sponsor this failed Presidency.

Why are you talking about the American education system as an example of how more money in health care is ineffective?

Governments that have invested more revenue in health care have seen increased results, the proof is very much in the pudding and the data exists. Even in my home province (Ontario) there is data that they love to highlight that shows how much metrics like wait times improved in lockstep with government's increase investment in health care funding from 2000 - 2008.

Yet you are making value arguments based on program spending in a completely different policy area, and claiming it is definitive?

As for health care metrics, you better look again. America actually has amongst the worst health care figures in the industrialized world (once you factor in the number of people that receive no care at all. This is a demographic that must be included in any analysis of a SOCIETIES health care system, but Americans love to ignore it for the convenience its omission provides for their ideological arguments), however, that still isn't particularly relevant to my point, which related solely to the argument that universal systems have to be cheaper and lower quality, this is not the case as quality is correlated with funding.

"A public system has no reason what so ever to be efficient" once again this is a value statement based on theory. I have a graduate degree in economics so I have read all of this theory as well, New Public Management and the like. Guess what... unless you have supporting data it is just theory, and there is plenty of opposing theory out there including arguments that government programs are more efficient than private sector provision.

People love to argue how government is less efficient than the private sector. Show me some quantifiable proof please, otherwise you are just blowing ideological hot air.

The increases in health care costs are due to a number of factors and to try to claim it is the fault of government or any one particular stakeholder is being far too simplistic.

snawdog... you seem to ignore that you supported gw bush and he ran the country off a cliff... so your grandkids will be paying trillions for THAT.

What would happen if there were HMOs for education too? Would the private sector do a better job at educating our children? (facetious eye roll)

Haxor, great post mang. Couldn't have said it better myself.

Oh once you factor in...blah blah blah H4, that is all I read from that. Who decides how much to weight that? No, by metrics, it is the best care in the world. I've yet to read one report who in detail explains the better care by other countries.

H4 you are asking for specifics, but fail to give any of your own. Yes I have theories, based on empirical evidence of things around me, books I've read, other reaches of government, etc. I could ask to show where government is more efficient and say you are blowing smoke, but do I?

Did you just say America has the best care in the world?

This is far, far too simplistic for the reality-based community. That's code for Democrat - because Republicans don't bother with fact in anything they do.

The assertion that the "urban" vote was somehow responsible for the Romney/Ryan ticket’s loss is, quite simply, absurd. For one thing, such an argument cannot explain the success of Obama/Biden in states such as Florida, Virginia, Iowa, Colorado, or Nevada, none of which have what could fairly be called major urban areas.

For another, it’s a clearly phony argument once you give it even a moment of thought. It's Ryan's next statement which revealed the actual reason why Republicans lost. "I don’t think we lost it on those budget issues, especially on Medicare — we clearly didn’t lose it on those issues," he said. No, actually, Paul: You don't want to have to admit that you lost on the field of ideas.

Instead, he's forced to make a phony argument about "urban" voters who were never going to vote for a Republican anyway.


Even though I disagree with him on many issues, President Obama did not campaign on giving free stuff to people no matter how much conservatives want to tell themselves that he did. What the President did do quite effectively is appeal to a wide variety of interest groups by giving them the impression that he actually cared about the problems they were dealing with. This is something that Romney never seemed to be able to do.

in the US you might be ble to pay for faster treatment, but it's not necessarily better simply because you paid more money for it. probably get prettier nurses to ogle though.

Ronmeycare is pretty much the model Obamacare is built on.

I'm not even sure why this is even an issue. Mitt Romney ran away from it because it was a liability this election.

He's a spineless SOB for it, but when he signed it into law, it was meant to be his legacy issue.

And again, the individual mandate central to both Romneycare and Obamacare 'WAS' a Republican idea, before the party went apefluff right-wing after 2008.



I've heard this mentioned on the talk shows post election, but I think the fact that Republican operatives can go on TV and blame the democrats for starting this 'war on women' thing is kind of ridiculous and probably offensive to the same women you just turned away. It's essentially blaming the otherside for a wedge issue the Republicans introduced.

And abortion/women's right had been a reliable wedge issue for decades for the Republicans. Split the soft democratic vote away with fearmongering about abortions and turning it into a debate about piety.

But the big story this election is how these wedge issues are beginning to fail as even young republicans find the whole anti-gay, anti-abortion, anti-contraception (hint: it's cheaper to put women on the pill than to abort a fetus) anti-fact based stance of the GOP repulsive.

Healthcare for all Americans can't be that bad the issue I have is ppl being able to come to this country and recieve healthcare for free without being a citizen or having anchor babies.. forgive me if anyone here is an anchor baby no pun intended.. but it has to stop somewhere many of them have been here for years but never tried to become a citizen why? because the government never really tried to enforce it. But why do we allow immigration if we are in such a bad economy? wouldnt that make it worse? or not? I am a Republican but I can see things from a Democratic perspective as well. There are pros and cons from both sides but I feel we are losing our right to be here as Americans.

Yes, I'm familiar with Canadian arguments citing OECD. My question would be in coverage and additional fees. The cost output in the U.S. incurs all of the added fees, specialist costs, homecare, drug coverage, etc. My understanding, and correct me if I'm wrong, is that the FFS model there doesn't include those costs and that many Canadians carry supplemental insurance.

Believe it or not, your costs are remarkably similar to mine in terms of health insurance cost when counting my company's expenditure on coverage for me and my own expenditures. At least based on this study: http://www.fraserinstitute.org/...thcare-insurance-2012.pdf . I suppose you could make the counterpoint that I'm also paying Medicare taxes, which would substantially increase my pay. However, I don't need supplemental insurance of any variety.

The other difference between the systems worth noting is the relative income variance. Again, correct me if I'm wrong, but Canada doesn't have a large illegal immigrant population that you're subsidizing emergency care for. (This comment should evoke some fierce debate on here, I would note I'm not advocating against providing the care--just saying it costs money).

We can't afford to spend up to half of our state's expenditures on health care the way some of your provincial governments do. It's not possible at our current tax rates. Federally, we incur far higher defense costs (something many of our closest allies have no problem relying upon so they can keep their costs down) prohibiting us from vast federal-to-state transfers. So I'm not really sure it's a fair comparison.

Iowa aside, where do you think large swaths of people live in FL, VA, CO or NV? In VA, it's predominantly the Norfolk/VA Beach/Hampton Roads, Richmond, and Northern VA (yes, Trife and his folk out west have some population, but not much).
In FL, more than 1/4 of all the people live in the Census Bureau's Miami-urban area. Almost half of Florida's population lives in a Census-designated urban area over 500,000.... and that's not counting Pensacola, Tallahassee, Kissimee, et cetera.

72% of Nevada's population lives in Clark County.

The Denver metropolitan area accounts for just about half of the entire Colorado population.

I'm wondering how you have missed this.

In canada, before you can receive treatment, it is required that you show your healthcard/hospitalization number. They don't give these away at the airport you know... So illegal immigrants don't have health coverage in canada... On the other have, refugees have BETTER coverage than canadian citizens. They get dental and eyecare along with universal healthcare (avg canadian citizens require supplemental insurance for dental, eye, and prescription). That kind of bothers me...

Supplemental private insurance isn't required in Canada (other than if you are travelling out of the country, of course). I have never heard of anyone requiring private health insurance, nor have I ever seen it advertised nor do I believe it is even offered as an option here.

Unless you are talking about dental care or optromitrist (sp?), they are not covered by public insurance (eye doctor visits used to be, but were delisted a few years ago). Those things are covered in the benefits packages for most full time jobs though, and there may be private insurance available for them as well but I'm not sure.

The costs of visiting specialists etc is covered by public insurance. Drug prescriptions are not fully covered but are highly subsidized (most drugs only require a flat "dispensing fee" to recieve),

Canada does have issues with illegals (or even more problematic: refugee claimants, often fraudulent) although I agree it isn't nearly as severe as it is the the United States. Funny enough the biggest externalities on the Canadian health care system is Americans with fake health cards defrauding our system for free service that they can't afford at home (it happens a lot).

I have not read the Fraser institute report (but I will), although I will caveat before I read it that the Fraser institute is recognized as being extremely libertarian bias, beyond the point of objectivity.

I agree total healthcare costs would increase, but that is a consequence of expansion in the number of people covered.

ok I read the report, for the most part it seems objective. However I question the methodology behind the calculation as it only seems to account for the average cost per taxpayer, rather than the average cost per insured resident (which is a larger base and as a result, would cause the average cost figures to decrease).

I also question how they obtain some of their tax roll figures because they claim the average tax roll contribution for a person earning less than $12k is $2k. There is no way to reach this conclusion as people in this income bracket pay no income tax, qualify for property tax deferrment (if they owe any property tax) and receive sales tax credits that exceed the average amount of sales tax they actually pay. As a result these people on average have a negative tax contribution and as a result, cannot possibly be contributing to health care funding.

Actually hax, if you call the office for your hospitalization card in canada before you leave the country, you will be covered by canadian coverage for something like 6 consecutive months (maybe its less) but I know when I travelled to europe for 2 months, my health care covered me.

If I would have needed healthcare in europe I'd have had to pay for it...but then get reimbursed when I got back. Supplemental health coverage for travel can be purchased if you want it paid for while you are out of the country.

that may vary depending on what province you are in.
That is another point that makes comparing "canada" to the US hard, health care is provincial and the systems are different in each province.

Do they publish the elective versus covered procedures somewhere? I'm intently how they compare. It's actually a big issue here as well in that regard. I also wonder what standards they use to justify certain specialist usages. I had a chat with a physician from British Columbia a month ago at a work function and it was about how he had confronted similar scope of practice battles in Canada. His point in the difference between the systems being primarily in specialist payment being determined by provincial governments.

As for supplemental, yes I meant for prescription drugs and dental (my understanding was that even emergency dental isn't covered under the typical Canadian plan).

The fraser institute is well known for poor use of statistical methodology.. meh:P "Cost per taxpayer" is actually a pretty meaningless statistic since that term is not well defined. Technically anyone who busy something subject to GST/HST is a taxpayer. I also love people at the municipal level who claim I'm not paying property taxes because I live in an apartment when in fact my rate is higher than theirs..

There is actually not a lot of proof that "the private sector" is more efficient in areas that do not lend themselves well to competition or have huge barriers to entry.
Ontario has *many* glaring examples of this which I'm not going to get into.
How does replacing a government run agency with a private monopoly improve things?


And as H4 mentions: each province has it's own health care which is similar for many things but not identical in terms of coverage. The federal government only oversees it.

I'm sure they do, I will have to dig to find it.

Generally people get referrals to specialists from a general practitioner. The issue here is the wait times to see specialists can be pretty long, which is pretty universally recognized as an issue in Canada and considered a metric where we need to improve.

Yeah payments for various procedures and services are set by the government and not by the doctors.

This was a big issue in Ontario recently as the Ontario Ministry of Health tried to negotiate reduced fees for certain procedures as part of their austerity drive. Ontario ended up legislating lower fees for the procedures when they couldn't reach an agreement with the doctors. The government's rationale at the time was that new technologies have led to cost savings for those procedures and as a result fees should be reduced.

Correct trumper. I had a tumor removed along with my impacted wisdom tooth. Not preventable, definitely necessary medically, but because they had to remove my wisdom tooth made it a dental procedure and not covered by sask health. I didn't have supp ins... $2500 later

z

Sidebar: Why does dental insurance coverage always seem to be rather fluffty? :)

because the only way for insurance companies to make money is to take in more than they pay out. so if it's something that a majority of people need they don't want to pay the bill.

Interesting, the tumor would easily have qualified it as medical here (at least under most of the policies I know) as well as impacting. Although until impact, even with 99% certainty it will occur, they won't cover and it's considered elective. Something I've never understood, but assumed someone with actuarial tables figured out it saved more money.

Sorry for the inquisition, I find it all very interesting. Who decides how the waiting line works for specialists? I ask because it would seem that delaying many procedures may ultimately lead to more complications and thus more costs to the system. And are physicians running the government-related agencies tied to this?

Doctors and specialists are private practices and they do their own scheduling of appointments. I believe there are regulations regarding priority consideration for cases where expediency is a concern, but I'm not up on the specifics of that.

For the most part the government does not micro-manage the system, they simply pay the fees the doctors forward to them much the same way private insurers do in the US.

In fact the government micromanages people's care less than private insurers do in the US (From my understanding it is common for HMOs in the US to only cover care at prescribed hospitals or clinics/practices. That does not happen here, people are free to go to any doctor/clinic/hospital etc. they choose).

Well, trumper, its debatable... If I'd have had my wisdom teeth out before that one impacted, there would not have been a tumor or cyst. So I guess it's my dentists fault for not doing regular pan x rays

I'll start with hospitals.. my explanation may not be 100% accurate but it is more or less my understanding:
For Ontario: Hospital boards run hospitals and they are generally appointed by the Ministry of Health. They determine how many specialists (in a hospital ect). Your priority in line depends on what you need the specialist for and things do get prioritized in certain cases. If you live in a large urban center you are actively discouraged from making a voluntary treck to a rural hospital for service.
The shortage of doctors/physicians in Canada is artificially created by limiting the number of people who can be doctors (thanks to a certain party back in the 1980s who reduced the number of spots). Policies and procedures are reviewed by the medical association which is made up of doctors and/or other medical personal. Emergency works the same way to a larger extent although from what I understand that's just how emergency works in most hospitals universally:P

If it's not a hospital/clinic then it is as H4 described. Many people in Canada have supplementary medical coverage for dental but not all. IF you earn under a certain amount you can qualify for aid (or your kids can). Out of pocket medical costs are partially tax deductible once they exceed a certain percent of your income, although I never paid the dentist enough for it to really make any difference to me personally while I didn't have dental coverage.