The parameters of a debate (II) - Macleans.ca
 

The parameters of a debate (II)


 

Last week—shortly before he announced his impending resignation—Liberal MP and doctor Keith Martin offered some dos and don’ts for health care reform. Yesterday afternoon I received an e-mail from the office of Liberal MP and doctor Hedy Fry, who after seeing those proposals mentioned here, had jotted down a series of counter proposals.

Here then are Ms. Fry’s dos and don’ts.

Don’t agree with a parallel public and private Medicare system. It killed NHS in UK in the 60s. Was there.

Do think we should have public Medicare for all Canadians regardless of ability to pay.

Don’t think it should cover all wants.

Do think we should set up clinical guidelines for medically necessary services and lab tests and technology. It’s called gatekeeping with objective, evidence-based decisions.

Do think we should run hospitals, labs and elective surgeries on a 24 hour basis.

Do think hospitals should only be for acute care. Build a public Home Care system for sub-acute and chronic care.

Do think we should send motor vehicle and worker’s comp injuries to private clinics/hospitals. They are private insurers and shouldn’t hold up waiting lists.

Do think we should let private hospitals and labs be built and contract out to the public system under public administration and CHA rules.

The principle of Medicare is public administration not public delivery. Check it out. Your doc is in private practice as is the local lab, and your local hospital is probably built and run by a not-for-profit organization…was always thus.

Don’t think when you’re ill, care is an option/commodity; it is a necessity. Market place principles cannot apply.

Do know that poverty is a major indicator of health.

Do know that Medicare is nothing like education.

Do know that Canada can provide and afford the care we need when we need it.

Don’t know any country that can afford the care we want whenever we want it.


 

The parameters of a debate (II)

  1. Rational, reasonable….I think most Canadians would find this acceptable.

    Don't know what this means though….'Do know that Medicare is nothing like education.'

  2. "Don't agree with a parallel public and private Medicare system. It killed NHS in UK in the 60s. Was there."

    I wonder where she was because NHS is biggest single expense in UK – they spend more than $200 billion on health annually. It is awfully expensive service for something that is dead.

    I also wonder wtf Frey is talking about when she writes 'Do know that Medicare is nothing like education.'

    And she speaks/writes like a true progressive technocrat – we can afford health care people 'need' but services that people 'want' are beyond the pale. I think Canadians would be happier with service if we got to decide the difference between need and want and not faceless bureaucrats who only care about saving money on services so they can pay themselves more in salaries.

  3. It is awfully expensive service for something that is dead.<i/>
    She's addressing a specific timeframe and, presumably, initiatives within; not the long term outcome.

    I think Canadians would be happier with service if we got to decide the difference between need and want and not faceless bureaucrats who only care about saving money on services so they can pay themselves more in salaries.

    A) every study that's been done shows that bureaucratic overhead in the public system is substantially lower. In fact, the biggest bruhaha in the US Healthcare Reform bill is that the government dictated that insurers/Providers have to get the money split between Administration and Patient Care back down to 20%/80% from ~50/50 it floats at now

    B) if you think a private insurer isn't going to decide the difference between want and need for you, you really haven't been paying attention. There's an extensive history and track record of them trying to get out of paying for anything at all*. It's why I laugh at her suggestion that we shove those with private disability and accident insurance out of public hospitals/care infrastructure. That'll end just as well as Veteran's Services is being run now because they both run under the exact same principles of "care" – get the person off my outgoing cash flow books ASAP – these days.

    There will always be someone who tells you what you're going to be allowed to get for "free"; in my experience here it's always been my doctor not some person at a call centre in Ottawa. Furthermore, the most common time want runs into need is when someone wants a procedure no on here is trained to do and/or is experimental/trial in nature with limited information as to it's effectiveness and frequently high expense. Insurers don't pay for that kinda stuff either because they're not going to throw money at something that might work (better) when they have something on the book that will work with known outcomes – see principle of care rule 1 above.

    *the most infamous case for this isn't medical – they tend to get resolved quietly – but the lawsuit that ultimately had to be settled by the SCC whereby the IC insisted the Customer committed arson on their home despite no proof and multiple police inspectors telling them otherwise in an effort to run them out of cash and make them go away without reimbursement.

  4. "Do think we should send motor vehicle and worker's comp injuries to private clinics/hospitals. They are private insurers and shouldn't hold up waiting lists."

    Here in BC can I still go to a public hospital? My motor vehicle insurance is through a crown corp.

    As for the rest of it, the thing I don't understand about the health care debate in this country is that defenders of the current system label anything else "American-style", which apparently is worse than Hell. Last I looked, WHO's rankings put the US below us, but still something like 20 countries ahead of us. What are they doing? Can't we do some of that? We already put a lot of money into the system (I think BC is more than 40% or 45% of the provincial budget), and it just seems like we could have a better system.

    I'm not sure how Medicare is nothing like education. Both are absolute essentials to everyone, and no one seems to be up in arms over private schools.

  5. Everytime the healthcare system topic comes up in Canada, we have people who argue for the 'American-style' system….and Canadians don't want that. Period.

    If we could talk about it in an open-ended way….maybe the French system, maybe the Japanese system….we might get somewhere.

    But suggest American health-care, and the discussion is instantly dead in the water.

  6. "I wonder where she was because NHS is biggest single expense in UK – they spend more than $200 billion on health annually. It is awfully expensive service for something that is dead"

    Ah…but how's that mone spent…there's the rub?
    One of the things that happened was allowing two tier care inside the hospital – for a little extra [ probably reasonable out of pocket originally, no doubt invetiably progressed to PI and tax write offs] you could have your own room, your own doctor. Eventually it undermined the system as it was more lucrative for doctors and specialists to gravitate there. In time the public system started to deteriorate – it became self fullfilling – as the public side of things deteriorated it created more demand for private care – a little like under-funding the public school system[ public in Canada, not the UK of course] Perhaps if they had regulated the amount of time doctors could spend in public and private care within the NHS this might not have happened.
    I've no real idea how the Blair govt modernised NHC, so i am speaking of relatively ancient history.

  7. I think what she's talking about is that some people have argued that a semi-private medicare option might be to run it sort of like student loans. That is, gov't guaranteed loans/grants that can pay for those in need, while allowing the system to charge those who can afford to pay on their own.

    Arguments against this are, of course: Education is a choice a person can make rationally, while health care isn't. Education is an investment cost which can lead to better earnings (so better ability to repay), while health care is a maintenance cost which will allow, at best, a resumption of the previous level of earnings.

    Of course, if she actually is responding to some of the comments from our last medical go-round, she may also be responding to some of the people saying, "Well we just need to move more health money into education to train the doctorsm," which you and I both know isn't the bottle-neck.. hence "Medicare is not education"

    Those are my guesses, anyway.

  8. Yes, because America is Evil. Except, apparently, for Obama and Jon Stewart. Maybe Sean Penn too.

  9. Maybe if there were a grown-up conversation about it, some folks wouldn't have to resort to reflex anti-Americanism, and could form a coherent argument. Most Canadians want a better health-care system. It seems to me you'd be happy with the status quo, no matter how bad, as long as it was better than America's system. That seems to be setting the bar pretty low.