The price of getting sick -

The price of getting sick

Two-thirds of Canadians favour patient rewards, penalties to cut costs


Fifty-nine per cent of Canadians feel that health care costs are cutting into funding for education, transportation and pension benefits, according to a new poll by Ipsos Reid for the Canadian Medical Association. It’s full of contradictions: Ninety-one per cent of participants said making the health care system more efficient and effective would reduce health care spending—but only 35 per cent of Canadians were confident that government and administrators could pull this off. And 66 per cent of Canadians surveyed supported implementing rewards and penalties to get people to live healthier—but only 47 per cent are confident this will lead to actual improvements. Forty-nine per cent of people said they would pay 10 per cent more in taxes if they were sure the money would go to health care. But 46 per cent said that patients should pay a portion of he cost of the medical care they get.

Canadian Medical Association

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The price of getting sick

  1. Hmmm… "rewards and penalties" to get people to live healthier, eh? Interesting idea.

    I suppose that could take the form of paying a "price", some kind of "fee", for behaviour that produces bad health. You'd pay it to the government and they would use it to offset the cost of your healthcare. Or wait! You could just pay it to the medical facility you use and save some government paperwork! Just think of the efficiency that approach could provide!

    Then, let's see, you'd be motivated not to do unhealthy things, because it would cost you money…. and med facilities would be motivated to treat you well, because they'd get more "fees" that way.

    Ah, but wait…there's a problem. What about medical problems that don't result from your behaviour or can't be predicted? Like car accidents? Wait…wait…I've got it! You could buy insurance for such situations, sort of like car insurance…so you'd be covered in the event of a serious and unpredictable problem! You could even have this "health insurance" cover all your regular medical issues, but of course they'd have to charge more if your behaviour tends to cause health problems or if you already have a serious problem with a high likelihood of having to receive treatment.

    I wonder if a system like this has ever been tried anywhere??

    • America. And its crumbling.

      • I know. It's just too bad that there are only two health models in the whole world: Canada and America.

    • If only it were really that simple…

    • So you're arguing for mandatory insurance then, like auto insurance?

      • Yes that's right, and Burns is suggesting that his love has thorns and requires rain in order to grow.

        • It's a valid question. Mandatory insurance is damn-near required in order to avoid a downward spiral in affordability, as poorer and lower-risk individuals drop their plans, which leads to an increase in premiums, which lead to slightly less poor and slightly higher-risk individuals to drop their plans, which leads to a further increase in premiums, and so on.

    • I've heard of places called "Europe" and "Asia" where such amazing things have been tried. I've also heard there are reasons for our advanced standard of living, things called "private enterprise", "entrepreneurs", "competition", and "the profit motive", yet I've heard that such things are sadly lacking in our health system, I wonder where we might find such things.

      • 1) Most of our health care providers are privately owned. There IS a profit motive, though hardly as strong as under other countries' systems and not nearly as it could be in ours.

        2) You know, I wrote this long thing about how European- and Asian-style health care systems employ heavy regulation to make their systems work, a necessity in the face of the many economic pitfalls of true free-market health care, in order to make up the lack of spending from the government on such systems. I decided to do a bit of fact-checking, just to make sure my memory was right on that. What I found was more surprising – their governments pay for a larger percentage of health care than ours does!

        Don't get me wrong, there are certainly more market mechanisms in their systems than in ours, and it seems to lead to somewhat lower costs which is why I think such a system ultimately has more potential, but if you're looking for small government, it ain't there.

  2. The post isn't full of contradictions, it just show how cynical most people are, esp. when it comes to healthcare.

    Most people have an idea of what they think is the right direction to go, or how they think the system should be improved. However, we just don't believe that the government/ our society has the resolve or ability to pull it off

    • Cynical? You mean honest, realistic, and pragmatic. The answers are what I'd expect from such a survey.

      Of course government does not have the ability to pull it off. It's called the failings of a command economy, the failings of a monopoly, the failings of a system with perverse incentives. You can't hire a few hundred people to control a system with millions working parts and expect anything but inefficiency. You can't create a system in which people are incentivized to withhold services as much as possible. You can't create a system that has no rewards for innovation and entrepreneurialship. It's been shown over and over and over and over again in history.

      • I agree with you, however, pessimism and reality are not mutually exclusive…

        • Yes, true. I suspect the system will have to fall apart at the seams before people are willing to accept the necessary changes.

  3. We have to be clear about what we are talking about here. We want people to live healthier vs. charging user fees at health care facilities. The former results in decreased obesity; decreased smoking and better driving. The latter would only result in people not attending the doctor and delays in detection and treatment for illness. One big step in encouraging healthy living is to make junk food more expensive than healthy food. Start subsidizing healthy foods and tax foods that have no nutritional value and are contributing to bad health. Also, start looking at offering reduced user fees at public pools etc. for the lower income people. Tax credits are great for people who make money but not so great for the poor. If you look at the money saved in health care costs, you will see the worth in making these investments.

    • Frankly, I don't want the government to assume control over every aspect of our lives. You are describing a nightmare.

      • You do realize that we largely do everything healthcare insider described, and have been for half a century, right? We put consumption taxes on unhealthy products (alcohol, tobacco) and we have subsidies on food products (I would argue the wrong food products). Public services are already subsidized for the poor, by nature of our taxation system, and are often further subsidized in a more direct way – lower user fees at a public pool are hardly novel.

        I mean, if you consider that an Orwellian nightmare, fine, but you must have spent the last fifty years screaming your head off in fear, because that "nightmare" has been around for a long time.

  4. I fail to see any contradictions in the survey.

    • There is one: two thirds think that rewards/penalties for behaviour should be enacted, but less than half think this will actually accomplish anything.

      • The rewards/penalties thing is the one thing I disliked about the responses.

        • I'd disagree with rewards/penalties for "healthy" or "unhealthy" behaviour. But there is always a penalty for actually being unhealthy: someone ends up paying for the health care. In a free market system that person is the one who is sick or their relatives. In our system it's the taxpayer. There's no escaping the penalty though.

  5. I am not suggesting that we take away anyone’s “choice” but rather give them the ability to make good affordable choices. Even in the hospital cafeteria, fresh fruit and veggies are a prohibitive price, while poutine is dirt cheap. Now you tell me, do you as a taxpayer want to pay for open heart surgery at more than $100 thousand dollars a pop to see the patient go downstairs and order up some poutine?
    The reality is that half of our population is overweight; many are obese. We have an epidemic of diabetes in the young and it is a heck of a lot cheaper to promote good health than to try to control chronic illnesses. If that happens by subsidizing fruits & veggies and taxing junk like pop & chips, so be it. Also, if waving user fees at public facilities gets kids working out, great! We know that poverty; poor education levels and poor health habits are often linked. How can you get healthy if you don’t have the proper information, can’t afford the food and don’t have a place to go to get the exercise?