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‘It’s a false debate’


 

Bob Rae wades far enough into the American health care debate to say we should stay out of it.

If the U.S. falters in their quest for a better system, it will be their loss. I don’t really hear many voices in their political system arguing for “the Canadian solution.” It’s a false debate. The questions are simple. Should anyone be denied health care because of their income, disability, or illness? (No.) Should patients be able to choose their doctors, and advocate for speedy, effective treatment? (Yes.) Should insurers, taxpayers, and premium payers be worried about how to control costs as an ageing society combines with great technological advance to produce an expensive mix? (Yes.)

Keep Canada out of the U.S. debate. We’ve never suggested exporting our system. We have our own debates and our own issues, and because of the moral choices we made 40 years ago they are different from the American paradigm. We should be proud of what we have, but we need to keep the focus on how to improve it, how to combine access, excellence, and innovation. We shouldn’t treat health care as some kind of taboo subject. We should keep what we have and make it better. And hope our friends in the U.S. will find their own answers to the questions that lie at the heart of health care everywhere.


 

‘It’s a false debate’

  1. Pretty much hit the nail on the head with that one.

  2. Indeed. That's one of the more intelligent things I've read from any politician in some time.

      • I had the same positive reaction when I read Rae's article. Everyone who criticized the Prime Minister for failing to wade into the US health care debate should read it.

      • So he's an intellectual then? That could be a problem.

    • Whereas our current Prime Minister spouts this drivel and expects it will endear him to the electorate?

      "You know, there's two schools in economics on this, one is that there are some good taxes and the other is that no taxes are good taxes. I'm in the latter category. I don't believe any taxes are good taxes."

      Physician, heal thyself.

      • I presume he would make an exception for the ones that pay his salary.

        • I have a sneaking suspicion that he – or indeed any PM past or future – would happily take the office even if it paid a dollar a year.

          • Right. And the gold-plated pension on that would be…….?

          • how many of those 'reformers' that swore off their pension ended up taking it/backed off their commitment????

        • Red herring. I have a sneaking suspicion that he – or indeed any PM past or future – would happily take the office even if it paid a dollar a year.

      • Because it's inconceivable that Harper might have meant something slightly more nuanced than you take him to mean? For example, that he might have meant that all taxes have a negative impact in that they involve taking money from people who could have otherwise spent that money on other things. That would as opposed to economic view that says that some taxes can have a positive effect by slowing down certain kinds of nonproductive or over heated spending. Amazingly enough, there actually are arguments among economists on just this point.

        If you take the first view, as Harper does (which is clear from the larger context of the answer he gives) then it would follow that any tax cut will have positive effects: that is to say, it would not have been better to cut income taxes or corporate taxes. Thus, as he says to Reguly, he does not regret cutting the GST. You don't have to agree with that but it's not drivel.

        • Jules, how does someone with such a coherent comment as this, end up with a -32 rating?

          Who did you piss off?

          • how does one even achieve a -32 with a total of 4 comments? is this a glitch Macleans folk? if not I am jealous Jules!

          • Indeed, a remarkable accomplishment. Perhaps he told the wrong people he drives Morgentaler around Washington, in a Hummer, and likes to run over stray cats.

          • Indeed, a remarkable accomplishment. Perhaps he told the wrong people he drives Morgentaler around Washington, in a Hummer with a gun rack, and likes to run over stray cats.

          • Well, at last check the four comments have +1/+1/-3/-5, for a net of -6 in just over 5 hours of commenting. Perhaps intensedebate takes that -6 and extrapolates that up to about -32 in 24 hours?

          • that i am sure is as good a theory as any Phil. Jules the human internet commenter hurricane!

          • Thanks for pointing it out to me. I wouldn't have noticed otherwise. Should I worry about it?

            I'm very new here (I only just verified this morning after fishing the verification e-mail out of the spam filter).

            I sort of hope that sea_n_mountains is right and that it's just a glitch. That someone would willfully do this is, while a little flattering, disturbing.

          • Unfortunately, it looks sea_n_mountains may be mistaken as your rating is down further. The 'reputation' metric is badly flawed. If you have the temerity to opt for unconventional wisdom rather than conventional wisdom, you are going to pay the price. It seems most of the 'thumbs' are determined by the popularity of the message rather than how sound it is. Don't pay any attention.

          • Unfortunately, it looks sea_n_mountains may be mistaken as your rating is down further. The 'reputation' metric is badly flawed. If you have the temerity to opt for unconventional wisdom rather than conventional wisdom, you are going to pay the price. It seems most of the 'thumbs' are determined by the popularity of the message rather than how sound it is. Don't pay any attention, or if you do – wear it as a badge of honour.

          • I've given you a few thumbs up to see if that will 'help'. I'm reasonably confident that you are not too concerned. From my perspective I just have an interest in knowing how stuff works.

            Happy commenting!

          • i think it must be a glitch… not sure why Ed is rejecting it as a possibility but you are now plummeting further int he whole now even with positive feedback.

            Not sure it is anything to worry about tho…i haven't seen ratings tied to action by Macleans folk by anybody. that seems reserved for more asinine commenters/comments.

            we could test it out by creating a new 'dummy account', makes some faux comments rank them really negatively and watch what happens.

  3. My world has just changed! I agree with Bobby R. – oh my god a slight shiver just went up and then down my spine … so that means either I have latent NDP tendencies or someone just walked over my grave.

  4. I would say Rae's point #3 illuminates the fallacy in his points #1 & #2.

    Should anyone be denied health care because of their income, disability, or illness? (No.)

    health care – knows no bounds – there is no limit to the amount that can be spent or the demand for what will have to be, at the end of the day, a finite resource. Even in the most well funded program imaginable, people will have to be denied due to disability and illness. As much as I would love to spend a billion dollars giving Rick Hansen the use of his legs back, finding a billion dollars is going to be tricky.

    Should patients be able to choose their doctors, and advocate for speedy, effective treatment? (Yes.)

    -only within the limits as expressed above. It is a finite resource.

    Rae's moment of profundity is really just a disservice to the army of professionals that have to make very difficult choices in the provision of health care resources. Point #3 is the only valid one, and he is not really offering much to advance that.

  5. I would say Rae's point #3 illuminates the fallacy in his points #1 & #2.

    Should anyone be denied health care because of their income, disability, or illness? (No.)

    health care – knows no bounds – there is no limit to the amount that can be spent or the demand for what will have to be, at the end of the day, a finite resource. Even in the most well funded program imaginable, people will have to be denied due to disability and illness. As much as I would love to spend a billion dollars giving Rick Hansen the use of his legs back, finding a billion dollars is going to be tricky.

    Should patients be able to choose their doctors, and advocate for speedy, effective treatment? (Yes.)

    -only within the limits as expressed above. It is a finite resource, and that is the tricky part of the issue.

    Rae's moment of profundity is really just a disservice to the army of professionals that have to make very difficult choices in the provision of health care resources. Point #3 is the only valid one, it is not particularly enlightened, and he is not really offering much to advance that discussion.

    • Even allowing for your 'tarnishing' of Bob's comments, his comments are still pretty good in comparison to the standard rhetoric that is often served up instead by our elected officials.

      • I would say his comments on this issue are pretty lame but he is a great communicator. Look at the rah-rah-Rae responses here, when there really wasn't much substance. A great communicator can do that.

        • Yeah, I'm not saying that the comments are novel or ground-breaking or the silver bullet solution or anything too close to that, just that in comparison to the sometimes over the top nonsense that we get from too many people (who I suspect actually know better), it is actually a welcome breath of fresh air.

    • Health care doesn't necessarily have to result in a cure or a fix. Morgellons Disease is still a mystery to doctors but that does not mean the patients do not receive some form of health care. They still visit their doctors who try the best they can to ease their discomfort.

      We also do the same for those who are dying from a terminal illness. Just because we can't cure a mystery illness or fix a broken body doesn't mean people are denied health care.

    • If he had said "Should anyone be denied health insurance because of their income, disability, or illness?," would your qualms be reduced? I don't want to put words in Bob Rae's mouth, but with #3 in mind I think it's a universal mandate for coverage and a ban on the ability to deny coverage for "pre-existing condition," etc., that Rae is driving at.

      • Not at all, because Rae is talking about it in the context of comparison to the United States. The pertinent issue is whether the Canadian model will be able to, in the foreseeable future, provide a set of health services that are rapidly expanding and increasingly expensive to an aging population. The U.S. is responsible for much of the upward spiral in costs because their private funding encourages an 'at all costs' approach to consuming health services. Extremely expensive procedures are easily marketed and become the new standard of care.

        Canada is struggling mightily to keep up with a reasonable standard of care delivered in a timely manner, but the upward spiral in costs will have to matched by upward spirals in government funding if we stay with exactly the same model. And of course, it is a little late in the game to be raising the whole two-tier complaint because it is already well established in Canada, with no government having the conviction to come up with the money to provide all services to all people regardless of the cost, or merits of the treatment. The sensible approach is to continue well-reasoned dialogue on how to keep our standard of care the highest possible, such as that provided by Marlene, above. The two tier system is among us, we should pay attention to the ramifications of it, rather than continually whining about its necessity.

        • You suggest that private funding (in the US) encourages an 'at all costs' approach to consuming health services.

          Can you elaborate on that thought? My first impression is that private funding would cause the true costs of a health service to become more visible (at least to the insurer, if not the end consumer) which would tend to reduce demand. What am I missing?

          • In a privately funded system, the rational choice for an individual may be to put all the resources available to him/her toward treatment regardless of how desperate or hopeless the situation may be. Desperate matters draw desperate measures. It encourages the rich to explore exceedingly expensive treatments that may have very little additional benefit when compared to more standard treatment. The patient's needs is not evaluated as against the competing interests of others, but strictly on rational it is for that individual, and sometimes even when it is no longer rational, even on an individual basis.

          • Thanks for the response.

            If I understand you correctly, the situation you described does not include treatments payed for by private insurance; you are talking about individuals who, by whatever means, are going beyond whatever public or private insurance coverage that they might have had and are coming up with additional cash to fund a treatment.

            Assuming that I have that part correct, I think you are somewhat overstating its importance. The push to develop, trial and then market new treatments is going to continue regardless, although without that supply of early 'self-funded' patients that the US system delivers I can agree that the process would be marginally slower.

          • It is not limited to situations outside of private insurance. I think you are greatly underestimating the effect on upward pricing of the consumer based US model, versus the public service model in Canada. In the US model people are constantly seeking out better private plans that provide for more expensive treatment, and they will purchase treatment that is not covered by their insurance. When it comes to one's own health, people are determined to get the best, its not like buying a car. Providers have marketing departments that recognize the no upper limit qualities in the American system. But you don't have to buy into my reasoning, just have a look at the per capita spending differences between Canada and the US.
            Canada – $3,678
            US – $6,714
            That is not a marginal difference.

          • In theory the US model could have that tendency for people to constantly seek out better private plans (plans that offer better treatments), but I wonder to what extent that actually happens:
            – how many people actually shop their insurance needs around; if I use my own auto / home / life insurance poilicies as an example, not all that much
            – when I do shop my policies around it is usually after something (bad) has happened (crappy service, rejected claim, significant premium increase); in the case of heath insurance it is no good to go policy shopping after you have been diagnosed with a condition that requires one of these expensive treatments that we are discussing
            – I thought that much of the private health insurance coverage in the US is actually group insurance provided through employers, so in those cases employees would only be able to lobby their employers to provide better coverage, not the ability to actually change insurers
            – I can understand that health insurance companies will want to increase the number of (healthy) policy holders, but they will also have a strong incentive to minimize liabilities; it is not obvious to me why, when choosing between those two competing interests, the insurance companies wouldn't tend to resist efforts to increase their liabilities

            I was aware that the US spends more (16% of GDP in US, 11% in CAN) and agree that the difference is not marginal; a goodly portion of that comes from increased overhead (more actuarial types, more claims review personnel) and I'm guessing that part of that also comes from higher than 'required' volume of lower cost procedures (more MRIs per person).

            Again, thanks for the continued clarifications; I seek to increase my understanding.

  6. If Canadian politicians listened better and were pro-active in fixing the problems here, then individuals like Ms. Holmes would not have to go to the U.S. to make her concerns about her treatment here known. I'm itching to find a news organ in the U.S. who is willing to hear my story since our media doesn't want to publicize the problems many patients are having with doctors, the Colleges that monitor them, government officials and lawyers who are willing to sue for medical malpractice. I'd love for the people in the United States to hear what I've been through with my health care experiences – especially if it means our health care providers, lawyers and politicians are called out for their incompetences.

    And since when don't Canadians, Canadian politicians and Canadian media not debate everything America does every chance they get? Canadians have been conditioned to salivate at the mere mention of 'America' which elicits contemptuous responses. I find Rae's commentary laughably hypocritical even bizarre.

  7. If Canadian politicians listened better and were pro-active in fixing the problems here, then individuals like Ms. Holmes would not have to go to the U.S. to make her concerns about her treatment here known. I'm itching to find a news organ in the U.S. who is willing to hear my story since our media doesn't want to publicize the problems many patients are having with doctors, the Colleges that monitor them, government officials and lawyers who aren't willing to sue for medical malpractice because our own governments pay the medical malpractice fees for physicians who hire law firms that try to turn gold from a sows ear. I'd love for the people in the United States to hear what I've been through with my health care experiences – especially if it means our health care providers, lawyers and politicians are called out for their incompetences.

    And since when don't Canadians, Canadian politicians and Canadian media not debate everything America does every chance they get? Canadians have been conditioned to salivate at the mere mention of 'America' which elicits contemptuous responses. I find Rae's commentary laughably hypocritical, even bizarre when we Canadians criticize everything America does.

  8. My Goodness!! I cannot believe it. I agree with something said by Bob Rae re health care. This is a first. Let's hope politicians from all parties take heed.

  9. Excellent points Bob.
    Distilled the essence of the problem down to a few pithy words.

    What Shona and Miss Marlene are facing is not easy – but at least our system protects all from catastrophic costs that complex care needs can result in. Conditions that cause catastrophic costs in the HMO world are denied – it seems to be – or at least severely rationed.

    The other thing that neither lady touched on – the panels of experts that decide on what is included in the formulary (of approved pharmaceuticals) and surgical / nuclear treatements – do so taking risk into account – how experimental is this procedure – and what is the consequence of treating a Shona or anyone else in a way that would cause them to go to litigation if the outcome is not all they desired…

    • I think Marlene's posts are worth another read. Our system is not protecting all – it is failing miserably in providing health care to those with mental health issues. A typical care scenario can go something like this: keep the patient in an Emergency waiting room for upwards of 24 hours, consult for two minutes, release untreated.

      The same can be said of people who give up while on waiting lists or simply die before being treated. I agree that the Canadian system works better than the American one, in offering generalized health care, but it is not quite the panacea it is made out to be.

      • I'm confident that any reasonable person who takes a step back will agree that our current system is not the panacea that it is made out to be. The real question is "Are practical improvements possible without sacrificing its current strengths?"

        • Precisely, and the recognition that this will always be a constant struggle, along with the struggle of what can be determined to be legitimately outside of public coverage without diminishing public coverage.

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