Our turn


 

This should perhaps feature prominently among the questions asked of every party leader whenever they next respectively make themselves available to the press.

“We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” Doing said in an interview with The Canadian Press. “We know that there must be change,” she said. “We’re all running flat out, we’re all just trying to stay ahead of the immediate day-to-day demands.”

… “It’s not about choosing between an American system or a Canadian system,” said Doig. “The whole thing is about looking at what other people do. That’s called looking at the evidence, looking at how care is delivered and how care is paid for all around us (and) then saying ‘Well, OK, that’s good information. How do we make all of that work in the Canadian context? What do the Canadian people want?’ “

Doig says there are some “very good things” about Canada’s health-care system, but she points out that many people have stories about times when things didn’t go well for them or their family. “(Canadians) have to understand that the system that we have right now – if it keeps on going without change – is not sustainable,” said Doig.

Perhaps not surprisingly, Drudge has, as of this hour, deemed this a top item for his readers.


 

Our turn

  1. We all agree that the system is imploding…

    No we don't. Next.

    • I didn't realize you were a doctor and member of the CMA, Robert, and thus so entitled to count yourself among the "we" of that statement.

      • You make it sound as though all doctors and all members of the CMA think the system is imploding. You're quite incorrect on that.

        • Actually, it's the incoming president of the CMA who makes it sound like that.

          • The third president in a row who has been saying that.

  2. We do need to improve access for rural and aboriginal communities, but so do the Americans. We need to prepare for an aging boomer generation, but so do the Americans. Fortunately, because we mandate universality in our system, we have an honest view of the entire "risk pool". Conversely, 50 US states have 50 different insurance systems with scores of insurance companies operating within each one — and no common level of coverage or service — with all of them wishing to dump unprofitable customers onto the public system to improve their bottom lines. They have a massive Federal healthcare system on top of this (for gov't employees, the military, Medicare, Medicaid, etc.). And yet they still manage to omit 47 million people from coverage and inadequately insure as many as 50 million more.

    Canada's system needs to evolve, but it certainly isn't imploding.

    • As an American w/ a Canadian wife, I can tell you *access* is not a problem in the States. That is a strictly Canadian problem. We don't wait 6 months for tests. If the doctor prescribes them, we can have them that week and often even the same day.

      You are also completely incorrect about the makeup of the U.S. system. We do *not* have "50 US states (with) 50 different insurance systems". The system is largely private. Why is that so unusual? Last time I checked, Canada like the US had many, many vendors for cars, TVs, carrots, etc. Why does health care need to be different? Competition improves service.

      Funny thing about the comments on this forum. Every one of the many Canadians I know is envious of the health care my wife and I receive. Maybe you are all extremely healthy and in your 20's? Wait until you get to middle age.

      • Welcome to the club. I too am an American with a Canadian wife. I lived for 30 years under the US system, with an insiders view of healthcare and the hospitals in which my father worked — which covered most of New England and New York state.

        Perhaps I wasn't clear in my prior comment, but I was referring to the INSURANCE system, not the healthcare delivery system, when I spoke of 50 states with 50 systems. Health insurance is regulated at the state level in the US. This isn't an opinion, it's a fact. While many insurance companies operate nationally, they must do so under rules set by each state. Consequently, insurers incur massive administrative costs in operating scores of sub-national subsidiaries. These costs are passed on to the premium payers. With dozens of insurers per state… you get the picture?

        Drop by the billing department of a US hospital and ask them if "Competition improves service."

        I have to disagree that "access isn't a problem" in the US. Travel to rural Maine or Pennsylvania or Upstate New York and you'll see just how far people have to travel for the best care money can buy.

        The system is only partly private — Medicare, Medicaid, Social Security, military, veterans, gov't workers and other components/users of the healthcare system in the US are gov't run or gov't paid.

        The entire healthcare debate has been (purposefully) warped, here and in the US. In Canada, we have universal coverage and single-payor insurance. These two factors are the major differences between the US and Canadian systems. The rest is about culture, business and politics. They're legitimate areas of debate, but honesty would be helpful.

        PS: I have, unfortunately, had to use the Ontario system for rather serious stuff. I've never had to wait more than a few days for diagnostics (MRI, etc.) or access to a specialist. Of course, I took the time to get a family doctor and live in a city with several teaching hospitals — which is the best thing you can do to improve access for yourself and your family, whether you live in Canada or the US.

      • You're mistaken (or misread my comment). Insurance (not "healthcare") is regulated at the state level in the US. National insurance companies incur — and pass on — massive admin costs to premium payers because of this, having to operate subsidiaries in several states. Hospitals incur large admin costs dealing with dozens, even hundreds, of different insurers per state — each covering or not covering different treatments at different levels. PS: you're not the only American with a Canadian wife ;)

      • Apologies for the double post. For some reason, the comments "reply" function wasn't showing the first one for a long time. the second one was a second attempt. Then they both showed up.

        Please excuse.

  3. "Imploding" is definitely the wrong word as whatever is happening, it isn't anything resembling a sudden collapse. But "needs to evolve" isn't right either.

    Canada's health care costs have risen faster than GDP and considerably faster than inflation since day one of our system. The cost of delivering health care is slowly taking up a greater and greater percentage of government budgets. And service levels are declining. There are very few more clear-cut examples of unsustainable than that.

    • Health care costs have risen faster than the GDP and inflation in every industrialized nation. The cost of delivering health care is slowly taking up a greater and greater percentage of government/personal budgets in every industrialized nation. Service levels are declining in every industrialized nation.

      So what exactly is your point?

      • So you agree with JulesAime that it is becoming unsustainable. Slowly, but surely.

        Do you not think we need to change somethings about our system?

      • You're absolutely correct, every industrialized nation is seeing the same problems. And since every industrial nation, including the USA, has a system that is substantially government-controlled (the only difference is degree) that suggests that government-controlled systems can only be maintained for a while no matter which particular system you use.

        One argument against people like me who keep rudely pointing out the mathematics that show the system is unsustainable is that is that there are lots of perfectly rational reasons for going with an unsustainable system. If we think that it is going to last for all, or even most of our lifetimes or even that while it will fail it won't fail tomorrow, we might decide to just keep going. I'd even suggest that that is what most Canadians have already decided to do.

        • Less government control won't fix the problems. It'll just shift them from the collective onto the individual.

        • But what evidence is there that health-care costs won't continue to rise faster than GDP and inflation no matter what kind of system is in place?

      • You're absolutely correct, every industrialized nation is seeing the same problems. And since every industrial nation, including the USA, has a system that is substantially government-controlled (the only difference is degree) that suggests that government-controlled systems can only be maintained for a while no matter which particular system you use.

        One argument against people like me who keep rudely pointing out the mathematics that show the system is unsustainable that is that there are lots of perfectly rational reasons for going with an unsustainable system. If we think that it is going to last for all, or even most of our lifetimes or even that while it will fail it won't fail tomorrow, we might decide to just keep going. I'd even suggest that that is what most Canadians have already decided to do.

    • From 1990 to 2003, healthcare spending grew at a rate of 2.4%–about the same as GDP.

      But healthcare spending SHOULD be growing faster than GDP because we have an aging population. Except it didn't dur to massive healthcare cuts in the mid-nineties. that's the real problem.

      http://www.kff.org/insurance/snapshot/chcm010307o

  4. "Imploding" is definitely the wrong word as whatever is happening, it isn't anything resembling a sudden collapse. But "needs to evolve" isn't right either.

    That said, costs have risen faster than GDP and considerably faster than inflation since day one. The cost of delivering health care is slowly taking up a greater and greater percentage of government budgets. And service levels are declining. There are very few more clear-cut examples of unsustainable than that.

  5. Time for Death Panels. Hopefully they're not as depressing as the EI Committee.

  6. I am not convinced that what the doctors are proposing is really more patient centred. Indeed, it strikes me that Ouellet's concept is to make the system more doctor centred. His proposals to allow limited 2-tier health care is really about making it sustainable by bringing in more revenue i.e. keep public funds flowing to the maximum extend taxpayers will allow and top it up with money from individuals. While it is possible for an inefficient system to be sustainable if it has enough resources available it is hardly optimal.
    It would be much better to make the health care system sustainable by making the system more effective. This has to mean an expanded role of nurses, physician assistants etc. Perhaps rather than providing yet another round of conscious raising concerning our health care system, Dong and her colleagues should work with the other professionals in health care to provide some specific cost reduction – enhanced treatment measures.
    I know that some believe that making the system private will automatically make it more efficient. To the extent this is true, it is limited to an essentially one-dimensional return on investment to shareholders. There is a major structural issue with private health care in that a large portion of our need comes near the end of our lives. The typical first-time home buyer is young, healthy and has many years of earnings to pay off their mortgage. In principle, they could also start paying for their health care through insurance, but it is interesting to look at that investment you are asking them to make.
    You are asking for them to pay for something they will not use for decades.
    You are asking them to pay a company that may not exist in decades.
    You are asking them to enter into a detailed contractual relationship where the specific nature of the service will not be known for decades. (I expect health care will look very different in 2040.)

  7. I thought Paul Martin had "fixed health care for a generation" so I'm not sure what that doctor is talking about.

  8. It seems like Quebec doctors are leading the charge in trying to create a better health system, which I find odd but wish them the best of luck. I wonder why Quebec is having a proper debate about two-tier health care while in the ROC there's barely a whisper about change.

    • One tier (public), one tier (private), two tier are barely relevent. WDM alluded to the real issue. In our current system, doctors dictate when and which care is appropriate. Ethically they are expected to extent life without minimal regard for cost with all of the treatments available to them, and indeed advocate for access for those treatment options not available. The vast majority of life extending medical interventions are made near the end of life and provide either a modest extension or perhaps no extension at all, but an improved quality of life.

      We now have a whole wack of old people and more options (many of them expensive) to extend their lives than every before. If we operate under the principle that all life is precious, then society has to come to grips with putting an increased portion of our resources towards health care. Another option is to put an acceptable price tag on life. (Sounds completely unpalitable but it is done all the time in military operations. ) Two tier does nothing unless you restrict expensive proceedures on terminal patients to the private sector. This solves the ethical quandry for libertarian minds, if you are wealthy enough you can live a little longer, otherwise…
      The above is my rational opinion, but my emotional response when friends and relatives have passed is very different. I am not at all sure I want to live in society in which economic efficiencies dominate our thinking about end of life and I certainly don't claim to have any of the answers. What I do know is that the debate about when to use expensive procedures is the real debate we need to have and that debate should not be restricted to doctors.

    • I agree that it is odd. It is encouraging that there are at least a few people who have the guts to do something as the system continues to deteriorate.

  9. Canada spends almost exactly the OECD average on healthcare and the growth rate in our healthcare spending has been about 2.4% over the better part of the last two decades.

    That is not an "implosion" and it certainly isn't "unsustainable".

    The real problems in our healthcare system are two fold.

    First, in the 1980s supply-side economists convinced governments all over North America that they were graduating to many doctors (see "suplier induced demand"). This idea is now widely deiscredited, but training numbers for doctors and nurses never fully caught up.

    Second when massive healthcare cuts were imposed in the mid-nineties the first expenditures to be red-lined were infrastructure expenditures. We're now suffering a hangover of that time as we begin to reinvest.

    http://www.kff.org/insurance/snapshot/chcm010307o

    • That is not an "implosion" and it certainly isn't "unsustainable".

      I think I'd believe my own lying eyes, and the opinions of the last 3 CMS presidents, over your ridiculous conclusions based on spending numbers, which have nothing to do with patient experiences.

      • Patient experiences?

        Those of us who use the system frequently and are still here because of it also have patient experiences. The difference here is that we don't have professional PR firms funding a speaking tour and TV ads saying how great the system is. You want to base your statements on patient experiences, then get them all, or realize how ridiculous health-system analysis by anecdote really is.

    • Don't confuse the issue with numbers or facts or history. This is a comment thread, for crying out loud!
      Write something in ALL CAPS or make a John Baird face and scream "The Liberals had 13 years!!!!!"

      Honestly, if there's one indication of how far the level of discourse in Ottawa has fallen, it's the mute response to our healthcare system being used as a punching bag in the US.

      Red Tories (even many Blue ones), Liberals, Dippers and the Bloc have all generally supported or healthcare system because, despite needing improvements, it works and is popular. It's sad to see that even in a minority gov't situation the parties cannot today line up behind the one issue that the overwhelming majority of Canadians agree upon.

  10. It's good to recall that the first reaction to Saskatchewan's initial medicare plan was
    a doctor's (unsuccessful) strike. I think that doctor's vaunted intelligence could more
    usefully be targeted to this stuff …..

    http://www.chron.com/deadbymistake/