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‘Efficient integration’


 

Keith Martin wants to reform the health care system.

If we fail to modernize our health care system and live with the illusion that we have the “best” system, more and more people, particularly those of modest means, will fail to receive the care they need. This would be a national disgrace — and an entirely avoidable one at that. We can have the best health care system in the world, but we must adopt those solutions that will allow us to achieve this noble goal. We must have courage and we must not fear change.


 

‘Efficient integration’

  1. The integration he writes about is completely possible and legal within the current system. A mix of public and private providers is already the norm, with primary care mostly a private undertaking, but a great deal of acute care is also paid for by thir party insurers. Provinces already mix block funding of hospitals with payments for insured services. More of that could be done, under the existing principles of medicare. Unless this is all code for some other dramatic change in healthcare he didn’t include in his article, everything he’s talking about relates to the administration of healthcare, which is a provincial responsibility. Maybe he should run for the BC legislature.

  2. and live with the illusion that we have the “best” system

    My eyes tend to glaze over whenever our pols start with such assertions.

    I don’t know anyone who thinks Canada has “the best system.” I think Dr. Keith Martin’s shilling for the CMA here, a body that usually disgraces itself when it comes to health care reform.

    • Well, in fact, many Canadians do think we have the best system, which is why there is always so much resistance to making even the tiniest changes.

  3. I agree with Martin that out healthcare system needs to be modernized. Where he loses me is in his assertion that the solution is a two tier system. Martin goes on citing European examples but fails to show a direct link between a for-profit system and success.

    As for the CMA, let us be clear on the fact that doctors stand to make tremendous financial gains under a private system and that alone makes their opinion suspect. I find it interesting that doctors – the CMA at least – favour privatisation but the nurses oppose it.

    • It should be clarified that the nurse’s union opposes it not necessarily the nurses themselves.

      • There are quite a few nurses unions across the country and not ONE of them supports privatisation. Are you saying that the leadership of every single one of these groups is disregarding their rank and file?

        • Nurses’ unions – every province has at least one – across the country are uniformly against private care.
          The national umbrella organization of nurses’ unions oppose it.
          The nurses’ associations – serving a different purpose and slightly different constituency – are opposed.
          Having worked with and for nurses for 30 some years, I’ve talked to a lot of people who’ve worked around the world under different systems and without exception they’ve been supportive of public systems. And the more public the better.
          I’m sure there are nurses out there who support private care. But I haven’t met any.
          Doctors , individually and in some groups , have a long history of supporting private care. Nothing new there. It’s a long history so I won’t go into it here.
          But it’s worth noting that that the main cost drivers of the health care system are those that remain in private hands.

    • I find it interesting how Canadians are always told to “listen to the experts” who “know what they’re talking about” when it comes to “complicated issues”. All of the experts except doctors, that is. Some doctors might stand to benefit by certain reform initiatives, sure. But some scientists stand to benefit from the widescale acceptance of global warming as the most important issue of all time ever. But “that alone” doesn’t seem sufficient to make their opinions suspect.

      Its a pretty simply formula really: when the experts say something you agree with, they’re right and their message should be heeded. If they say something you don’t like, just call their motivations into question, and bada bing bada boom, you got yourself a rebuttal. Or, alternatively, point to another interested party (lets say, nurses), who, unlike the first group, aren’t motivated by material benefit but rather by altruism and a genuine incorruptible concern for the common good.

      Here’s a wild idea: consider everyone’s opinions suspect from the outset, and proceed accordingly.

      • Olaf, don’t be so naive, ok? Please explain how it is that ALL of the nurses’ organisations, be it a union or an association, unilaterally oppose privatisation but the CMA supports it? As a matter of fact, I can think of at least two doctors’ groups who also oppose privatisation.

        Do you know of any other health professional org besides the CMA that supports privatisation? Because I don’t.

        • What a hilariously typical response – I really couldn’t have imagined one that more conclusively proved my point. Kudos. Can you think of any other reasons, other than the quest for pure, unvarnished truth, that other groups may oppose “privatization”? Are doctors uniquely evil and greedy compared to all other health professionals, because that is the unavoidable implication of your argument.

          If anything, I would think that the apparent unity of nurses organizations (ALL of the nurses!) and the fact that there are actually dissenters among doctors organizations would provide sufficient motivation to give your head a shake. But I’m not holding my breath.

          • “Are doctors uniquely evil and greedy compared to all other health professionals, because that is the unavoidable implication of your argument. ”

            Of course not. I’m merely suggesting that perhaps it is you who is sticking a head in the sand over the fact that a significant increase in income represents an undeniable incentive for some. I pointed to the fact that the CMA stands alone among health professionals in advocating for privatisation and that this would indeed make their opinion suspicious. If it is true that privatisation is the solution to all our woes, why oh why are they the ONLY health professsional group advocating for it?

            How about you give your own head a shake, Olaf, and answer the question. I take it from your pompous response that you too cannot think of anyone other than the CMA that holds this position, yes?

        • I don’t tend to take any union’s opinion – or that of other type of professional organisational umbrella group for that matter – without an enormous grain of salt. All such organisations are organised around promoting the best interests of the group, not the system or society in which they operate.

          Of course the nurses would be nervous about a change in their work environment that may include two-tier employment environments. Just like cops would be nervous about the effects on overtime and staffing levels if we legalized pot. In any similar hypothetical case, there is a strong motivation to fear the end results on your personal level, and to reverse engineer the argument to come up with reasosn why it might be bad for others.

          What’s important is the guiding principles we try to address in debate. Lining up umbrella groups’ endorsements or criticisms is not nearly as important as deciding what we ultimately want in the end.

          My objective would be to have something along what Martin describes, basically: universal care that doesn’t bankrupt you when you hit one of the biggies in the health care Pandora’s box of calamities and reasonable levels of service for all. If having wealthier folks paying for faster service doesn’t jeopardize care for those less well off, I’m not going to complain, it might even free up those services to be administered sooner.

          • “Of course the nurses would be nervous about a change in their work environment that may include two-tier employment environments. Just like cops would be nervous about the effects on overtime and staffing levels if we legalized pot. In any similar hypothetical case, there is a strong motivation to fear the end results on your personal level, and to reverse engineer the argument to come up with reasosn why it might be bad for others.”

            Brad, and the CMA members don’t have that fear? Or could it be that the nurses along with everyone else that actually works in healthcare are onto something when they tell us that the solution to our problem does not lie in the creation of a two-tier system?

            Just askin’

          • P-Junk –
            “Brad, and the CMA members don’t have that fear? Or could it be that the nurses along with everyone else that actually works in healthcare are onto something when they tell us that the solution to our problem does not lie in the creation of a two-tier system?

            Just askin’”

            It was good of you to ask, since I apparently wasn’t clear. My examples were merely illustrative and not exclusive. My point was not to challenge any group in particular but to caution that all such groups have self interest at heart before all other interests. In my opinion that’s how they are organized, staffed and operated. When a national interest debate is involved, they may pretend to an altruistic position on behalf of society, but I believe such institutions are mostly incapable of such behaviour – not the individuals therein, but the group itself – and that such statements usually mask self interest.

            In my opinion, they can be asked for facts, if the questions are carefully posed and answers carefully vetted, but their opinions aren’t worth the oxygen. In fact, invoking them in the way blog strings often do serves mostly to distract from the principles of the debate and allow for ad hominem attacks on the messenger, not the message.

            For example, this blog was about Martin’s opinion on health care. MYL made a side swipe remark about the CMA, you came in with a rejonder and raised him some nurses and Bingo! we’re off on a rabbit hunt trading bon mots about the relative merits of one special interest group over another and not the actual issue.

            Oompus Boompus of course falls into the other blog string group that free rides on others’ blogs to actually blog his own ideas at lengthy tedious detail. While tiresome and eye glazing, at least it’s an attempt at substance. You called him a name.

          • MYL made a side swipe remark about the CMA…

            I did? Really? Where?

          • MYL – My abject apologies, you weren’t even on the string above. I must have been switching too quickly from one string to another. It was the comment above by Just Passing Through to which I should have referred.

            Again, sorry.

            Brad

          • Apology accepted, although I will try to recover from the notion that it is plausible that I even make “side swipe remarks.”

            As for the CMA, of course it is an advocacy group to promote the message of Canada’s physicians. But, then, if naked self-interest were the prime motivator of a medical doctor, I am willing to bet that he or she is not a CMA member at all, on account of him or not still actually working in Canada…

      • “some scientists stand to benefit from the widescale acceptance of global warming as the most important issue of all time ever”

        Could you clarify, Olaf? You mean increased research grants or something else? Perhaps surprisingly, grants don’t really change the take-home pay of your average scientist. And the salary difference between a crappy scientist and a award-winner isn’t very much. If I find the cure for cancer tomorrow it might help my long-term employment prospects, but I won’t be rushing out to buy that fleet for Porsches I have my eye on.

        • The main incentive is that most people want to be saviours – there’s a lot of incentive to declare yourself enlightened and willing to play your part in saving the world. Everybody dreams of saving the world some day. So people are generally ready to believe in apocalyptic scenarios, because it gives them a mission in life.
          We have such scenarios appearing every decade, whether over-population scares, bird flu scares, or other doomsday scenarios. Sometimes there are even real threats that require attention, such as nuclear war or ozone depletion. But with all those scare stories on the back-burner, we’ve got ourselves a false one, the great global warming fraud, with religious believers everywhere doing their part to fix a non-existent problem.

      • Some doctors have some expertise in some specialized areas of medicine. And that’s good. Some of them claim to have expertise in the stock market or real estate or coaching soccer or Swedish cars or health systems. Dr. Martin has claimed his expertise since his days as a Reform Party stalwart. And that’s fine. But his expertise is as useful as yours or mine.
        The only doctor that I’m aware of who has devoted time to study of the system is Michael Rachlis. Aside from publishing two well received books on the system he’s largely disappeared from public debate – largely because his expertise is regarded as inconvenient. It does not accord with the product of Donner-seeded think- tanks that provide so much of the “expertise” we are faced with. And then there are the health care economists …….

    • You you really need it spelled out? The most highly rated systems in the world are coincidentally the ones that have a mix of public and private elements.

      Of course, to the pure socialist ideologue, that is just a coincidence. There is never anything worth paying attention to when it comes to reality.

      Of course the solution is a two tier system, if all of the systems in the world rated higher than ours are two-tiered systems! Sorry to break your religious certainty.

      • And separatists ……. you forgot separatists ….

  4. LibFail, this may come as a surprise to you but very few people consider the Liberals to represent left-wing ideologies, the Dion-era being the exception.

    The only difference between Harper and Iggy, as far as I am concerned, are Harper’s fangs and perpetual growl.

  5. What an angry victim.

  6. I’ve already criticized Dr. Martin elsewhere in more detail.
    Just a few of the choicer points.
    The evidence he bases his premise on was collected under the direction and on the watch of the two most pro-Privatization Presidents in CMA history – and also – no doubt with more than small coincidence – from BC – the same province where Dr. Martin is an elected MP.
    The reaction of the rank and file to what these gentlemen tried to do to the voice of their profession is that the incoming President (in contrast to the last two – NOT the proprietor of a private practice) is head of an Ottawa Hospital – a former President of Doctors without Borders / Medecins Sans Frontieres – and a STRONG advocate of public Health Care.
    Health Care under the CHA is evolving and becoming more efficient and more effective – not as fast as folks like Roy Romanow would like – but fast enough that we don’t have to throw the baby out with the bathwater – as Dr. Martin might be suggesting.

    • How long do the waiting lists have to get before you think it’s a problem?

      • Why don’t you just take a trip down to the States and pay for it yourself? You know? Put up or shut up?

      • I have an issue with the constant moaning about our system. I was born with a degenerative bone condition, and was put on a hip replacement list at thirteen. Within a month of being on the list, I had a new hip. I did have to travel quite far for it, because in my rural area the technology was not there to perform pediatric replacements. Three weeks ago I began experiencing extreme pain in the leg where the replacement was performed. I talked to the surgeon on the phone and had x-rays taken and email to him the same day I contacted the office, and saw him in person a week later. I am currently waiting two weeks for an MRI. All of this? Cost me nothing.
        For the most part, the system works. Whilst you may have to wait to see a dermatologist or chiropodist, cardiologists, oncologists, pediatricians and orthapaedic surgeons all tend to have reasonable wait times for urgent conditions.

        • Although obviously, this is purely my perspective and sheer anecdotal evidence, which we all know sucks.

          • I am so proud of you :-)

  7. The laws of economics are *laws* – not guidelines. You cannot take something valuable and make it free. If you attempt to make it free then you will end up with either rationing, with out-of-control deficit spending, with an upside-down demographic pyramid, or all three.

    There is no such thing as the “best” taxpayer-funded health care system because such a thing is impossible. In the short term it may look great, as if Santa Claus, the Easter Bunny and the Tooth Fairy all teamed up to visit everyone all the time. But it’s unlikely to last for more than a generation or so as the spending commitments gradually overtake the ability of people to pay.

    Not only is such a thing impossible because of the nasty unpleasantness of the Law of Supply and Demand, if you try to be everyone’s health care Santa Claus then you’re up against a couple of other “slight” problems. These are due to the impossibility of a government monopoly to mimic a free market in even the slightest degree.

    The first problem is that government central planners cannot possibly gather and hold in their brains (or their computers) every piece of information about the wants and desires of every health care patient under their jurisdiction. Therefore they cannot possibly allocate health care resources effectively. This law is the Impossibility of Economic Calculation under Socialism.

    The second problem is that once you establish a monopoly by force and eliminate free market choice and competition, there is no way for consumers to prevent the elites who run the system from abusing the setup for their own gain, or running the system is a slipshod and negligent manner. The bureaucracy explodes in size, their salaries and office budgets grow out of proportion, while the actual services become more and more obsolete and inefficient. This falls under Lord Acton’s dictum, “power corrupts, absolute power corrupts absolutely”.

    The third problem is that when you are giving people the necessities of life even if they do absolutely nothing to work for it, and you punish people for bettering themselves by taxing them at a higher and higher rate, you are killing initiative and hard work and rewarding sloth. You get more sloth, less work, and eventually people realize that they don’t even have to pretend any more to act like they have either freedom of choice or responsibility for themselves. Turning health care into a socialist commune means that it is against any one individual’s interests to put more into maintaining the commune than anyone else. This law is the Tragedy of the Commons.

    Compare Canada’s (or any other western country’s) public health care system with North Korea’s public food system and you will see that the exact same laws of economics are at work, regardless of what anything thinks should happen.

    – rationing
    – low quality
    – elephantine bureaucracy
    – inefficiency
    – obsolescence
    – elites enjoy special privileges
    – media full of rubbish propaganda
    – 99% of public ignorant and brainwashed

    • And here I thought that all the pro-liberalisation-free-market-capitalists had all gone into hiding…

      • Scroll wheel works.

      • No, you’ll find at least a few sensible people almost anywhere. Thankfully.

  8. government central planners?
    We have Commissars?
    Do tell!

  9. “The laws of economics are *laws* – not guidelines. You cannot take something valuable and make it free. If you attempt to make it free then you will end up with either rationing, with out-of-control deficit spending, with an upside-down demographic pyramid, or all three.

    There is no such thing as the “best” taxpayer-funded health care system because such a thing is impossible. In the short term it may look great, as if Santa Claus, the Easter Bunny and the Tooth Fairy all teamed up to visit everyone all the time. But it’s unlikely to last for more than a generation or so as the spending commitments gradually overtake the ability of people to pay.

    Not only is such a thing impossible because of the nasty unpleasantness of the Law of Supply and Demand, if you try to be everyone’s health care Santa Claus then you’re up against a couple of other “slight” problems. These are due to the impossibility of a government monopoly to mimic a free market in even the slightest degree.

    The first problem is that government central planners cannot possibly gather and hold in their brains (or their computers) every piece of information about the wants and desires of every health care patient under their jurisdiction. Therefore they cannot possibly allocate health care resources effectively. This law is the Impossibility of Economic Calculation under Socialism.

    The second problem is that once you establish a monopoly by force and eliminate free market choice and competition, there is no way for consumers to prevent the elites who run the system from abusing the setup for their own gain, or running the system is a slipshod and negligent manner. The bureaucracy explodes in size, their salaries and office budgets grow out of proportion, while the actual services become more and more obsolete and inefficient. This falls under Lord Acton’s dictum, “power corrupts, absolute power corrupts absolutely”.

    The third problem is that when you are giving people the necessities of life even if they do absolutely nothing to work for it, and you punish people for bettering themselves by taxing them at a higher and higher rate, you are killing initiative and hard work and rewarding sloth. You get more sloth, less work, and eventually people realize that they don’t even have to pretend any more to act like they have either freedom of choice or responsibility for themselves. Turning health care into a socialist commune means that it is against any one individual’s interests to put more into maintaining the commune than anyone else. This law is the Tragedy of the Commons.

    Compare Canada’s (or any other western country’s) public health care system with North Korea’s public food system and you will see that the exact same laws of economics are at work, regardless of what anything thinks should happen.

    – rationing
    – low quality
    – elephantine bureaucracy
    – inefficiency
    – obsolescence
    – elites enjoy special privileges
    – media full of rubbish propaganda
    – 99% of public ignorant and brainwashed”

    It’s amazing what a room full of monkeys with endless keyboards – can come up with….

    • Give the monkeys some credit!

    • Great comments, I could not agree more, with all of it.

      • Oh, now I realize they were not your comments. I take that back, you’re wrong.

  10. “In fact, invoking them in the way blog strings often do serves mostly to distract from the principles of the debate and allow for ad hominem attacks on the messenger, not the message. ”

    Actually, Brad, that pretty much sums up your take on nurses unions and associations, does it not?

    • You could not have mistaken me more if you tried. I didn’t attack them in order to devalue their take. I questioned the value of ANY interest group to provide useful opinion on an issue that effects them. I think their facts might be of interest, but not their opinion.

      I do not believe debate is served particularly well by citing special interest groups’ opinions. I believe that for the reasons stated: they are self interested and they almost invariably attract ad hominem attacks that distract from the debate. Ad hominem is more along the lines of “oh, they’re a bunch of _________’s that ____ in the dark with dwarves. Of course they would think that.” My take was generic to the use of special interest groups in general as sources or citations in support of a point.

      Would you agree that there is a difference?

      • “I do not believe debate is served particularly well by citing special interest groups’ opinions.”

        But Brad, it is those “special interest groups” who are advocating for or against privatisation.

        “I questioned the value of ANY interest group to provide useful opinion on an issue that effects them. ”

        Brad, honestly, can you think of a single person in this country that wouldn’t be affected by the outcome of this debate?

        • “But Brad, it is those “special interest groups” who are advocating for or against privatisation.”

          Precisely. Why cite an advocate – or opponent – as a validating source? In doing so you are relying on either a sense of their inherent decency or value to get your point over, or you are trying to use them as an authority. Either way, their motives are flawed and they are unqualified to provide dispassionate opinion.

          It’s exactly like saying the CPC says this or the LPC says that. What value does that add to a thoughful consideration of an issue? Just because they hold that position, it should matter?

          “Brad, honestly, can you think of a single person in this country that wouldn’t be affected by the outcome of this debate?”

          Nope. And I value every one of their opinions. They are each uniquely qualified to express their feelings and to enter into the debate and sift the salient points. But unless they are qualified both by virtue of their professional training and have a track record of thoughtful, well reasoned publication, and their personal biases are out front and center, I don’t want any one individual cited as an authority anymore than I do a professional organization or union that is designed specifically to think first about its members, and doesn’t have a second tier of designed motives.

          These kinds of professional groups and unions have inserted themselves into the political debate far more than is generally realized. They are accepted far too readily as both political actors AND as authorities. I used cops before as an example. Their associations are very quick to involve themselves in debates on drugs and guns and other crimes as *advocates* – your word, and it is very appropriate – of a particular way of dealing with the issue. I think that is fair play. They are set up as advocacy groups for their members. But to turn to them as authorities at the same time, to play to a sense that they are alturistically and intrinsically good and decent in order to validate their takes is to ignore their inherent conflict of interest.

          I would far rather be engaged in the actual ideas of medical care and why you think one way is better than another based on principle, evidence from other jurisdictions and, to a degree, on philosophical inclination. I do not want to have you bid a nurse’s association’s word against my doctor’s association. I want to know what you think and why, on your evidence, your principles and your philosophy.

  11. As the husband of a Family Practice Physician … The doctors and nurses on the ground are not the one’s advocating for any kind of privatization. The political ‘wing’ of the CMA is composed of specialist practitioners.

    • How does that make any sense?

      YOu are saying that the people who have decided to make a difference, advocating for change, are in fact the ones that are advocating for change. How surprising.

      As soon as someone decides to get involved in the debate, to you they are now “political”, and that disqualifies them from the debate.

      • You do like to put words in peoples mouths.

        The people on the ground also want change. They are too busy delivering the service to be management.

        As to your third paragraph, that is nonsense. You read the pejorative value into my use of the word “political”.

  12. Dougrogers – “As the husband of a Family Practice Physician … The doctors and nurses on the ground are not the one’s advocating for any kind of privatization. The political ‘wing’ of the CMA is composed of specialist practitioners.”

    Excellent point.

    In Ontario – family physicians got so fed up with specialists “special interests” taking over the board of the OMA – they formed a separate group – for Family Physicians – so that their concerns would actually be heard!

    • “Taking over”? What’s with all the conspiracies today? Either this fringe group is a small minority, or they should just get on the board themselves. What’s the problem? They don’t like to speak up at board meetings?

      • sf, the highly paid specialist physicians are, simply, the ones who have time to become involved in the management of the CMA, and the OMA. They also tend toward the Rightish side of the political spectrum, tend to be the high and over-achievers, and tend to a personality type that needs to be in charge and tell people what to do. Birds of a feather.

        • If specialists have so much time, why are the waiting lists for appointments with specialists so long? I can see a GP in a day. It takes months to see a specialist, no matter what the field, whether kidney, cancer, surgery, opthamalogy. Even obstetricians are impossible to find in some places.
          Secondly, I see no evidence for the claim that specialists are righties and GPs are lefties. Frankly, I find it hard to believe there is such a frank difference between GPs and specialists in any way whatsoever. I’ve noticed no difference myself over my lifetime. So what if a specialist needs to take charge sometimes? It seems to me that is the type of person who would be most aware of the flaws in the system, and it is also the specialists who can see the suffering that is happening while people are waiting on waiting lists.

          • “If specialists have so much time, why are the waiting lists for appointments with specialists so long?”

            Because there are so few of them; because their income is high – and capped; because the gatekeepers of the service, the hospitals have only so many operating rooms, and because funding for the high end costly services is restricted because people howl that the cost of socialized medicine is so high.

            2nd paragraph. I do see evidence. Keith Martin. and the word I used was ‘tend’ not ‘are’.

            “So what if a specialist needs to take charge sometimes? ”

            This is exactly the personality type attracted to specialities… surgeons, for instance….. I never said it was a problem to be aggressive and take charge. I say that these are the personality types you see at the high end. Just because someone can take charge doesn’t mean they have the solution to the problem.

            “It seems to me that is the type of person who would be most aware of the flaws in the system, and it is also the specialists who can see the suffering that is happening while people are waiting on waiting lists.”

            Everyone in the system sees this problem, especially the nurse in a Family Practice office who personally makes the calls to the hospital, to the receptionists, to the specialist secretary, to book those appointments with specialists. This knowledge is not privileged to the specialist.

            Exceptional needs *are* met quickly.

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