Money for Health Care

[dutchie]

canuck, CF members can most certainly collect EI. In order to collect EI, you need the following:

1) to have worked enough hrs in the last 52 weeks or since your last claim (they average a reg force members day to 7 hrs).
2) to have a separation from employment (layoff, fired without cause, quit with cause, illness, injury, pregnant, caring for newborn/adopted child, etc)
3) have all records of employment for the last year (or sometimes 2 yrs).
4) apply for benefits.

most reg force soldiers never collect EI only because they don't get a separation of employment....but if they did (either by layoff or for maternity/parental, sickness, compasionate care, etc), they can collect.

lots of reserve soldiers have collected EI (this one included), particularly after Roto, if they don't have a civie job to come back to.

but this is off topic - just thought I'd clear this up.

regarding health care, the beauty of this debate is that there will never be complete consensus. Views held by folks like Kirkhill are valid and sound, from one perspective. Others views that differ (as mine do), are also just as sound and valid. Each person has their own comfort level of what they want to pay for what service. One area we all will agree on is that we pay way to much for far too little. I believe the system can be fixed and remain exclusively public, although I am not adverse to some small amount of private care - we already have it now.

To me, and to most Canadians I think, public health care is sacred. It may be 'broken', but it's possible to fix it and keep it public. Some would say the CF in the early-mid 90's was just as broken then as the health care system is now. Sure, the numbers aren't the same, but do you remember the situation back then? The CAR was disbanded, morale was rock bottom, soldiers were in food bank lineups due to poor pay, the Somalia inquiry made us all look like savages, scandals were so frequent and apathy among citizens was so high the media didn't really report them anymore, corruption stories (both real and gossip) were rampant, etc, etc.....we didn't get rid of the CF, did we? You might think it's crazy, but looking back, was it that far off? The CF is also sacred, so we fixed it. It isn't perfect, but I for one think it's better now than even 6 or 7 yrs ago. We can do the same with the Health Care system.

 

[Infanteer]

I can see this thread is falling into the common trap of confusing public-managed delivery with universal coverage.

I agree with universal coverage; nobody should be left to their own devices if faced with a medical catastrophe (my immediate family having two in the last few years, I can attest to this).

I do not agree with public-managed delivery.  Big government basically fucks up what ever it touches; that's why we have the problems we do today.  Look through my comments that I provided on the other thread, the principle of government delivered health care is silly; if anyone can offer up a good justification on why someone's personal health should be managed by a red-tape bureaucracy, then I'm all ears.

This is the essence of Grazer's book.  As long as proper health care is universal, it doesn't matter who delivers the service, as long as it is properly and professionally regulated.

 

[canuck101]

As long as proper health care is universal, it doesn't matter who delivers the service, as long as it is properly and professionally regulated.

I agree with you totally.  As my father has always said if you can go into a privately built and operated hospital and they except your health card why are people getting upset. If they can do it for less money do it.  The government is not always the best.

 

[dutchie]

I agree with Infanteer in that I don't think that the government should directly manage the health care system. But I also don't want to see private enterprise manage it without any accountability to the tax payer. I admit to not being fully informed on how it is managed right now. I know that when my wife was in St. Paul's Hospital not too long ago due to pregnancy complications, I saw indications that the hospital is being run by a company/organization called Providence....not sure if this is due to it's Catholic roots or not. I also know that technically, hospitals are not run by the provincial government, but regulated by them.

I don't want to see a system where the government is involved in the day-to-day running of hospitals, or other care facilities. To my knowlege they don't do that now anyway. Doctor's offices are already private, but they are funded and regulated by the gov. Simply put, they are free to make money (obviously), but cannot do whatever they want, or charge what they want. They for instance must abide by a price list system for procedures and visits, and 'get in line' when scheduling surgeries at hospitals. The problem is funding. The government provides this funding, and if there isn't enough money to do all of the procedures that need to be done, a waiting list is created. I think the gov funds each 'Health Authority' separately, and it's the regional health authorities that determine how and where the money is spent.

So, in short, currently, Big Government, to my knowledge, does not manage the system, but regulates it and funds these quasi-government 'Health Authorities', and also sets guidelines and groundrules for spending in each region. Conversely, I definitely don't want a system where the government simply funds the system but private enterprise decides how to spend it. I don't want to give private companies (whose sole objective is making money) a blank cheque with no system of accountability to the tax payer. We need to reduce the fat (ridiculous salaries for non-skilled workers, endless redundancy and meaningless bureaucracy, etc), streamline the system administratively and fiscally, and increase funding........if you want all care facilities to be run and managed by completely private companies, fine, but god help them if they run a profit....that means I paid too much tax.

 

[I_am_John_Galt]

If a private health-care provider makes a profit, that indicates that they have provided the service at a lower cost than the mandarin's estimate.

In a competitive system, this would suggest that any number of private providers could offer the same service at a price less than the government's estimate.

In a socialist system, the profit motive is irrelevent and thus there is very little motive to produce at lower cost: it is actually inherently inflationary as there are a lot of DIS-incentives to producing at lower cost (i.e., 'why not pay myself more money and raise the price: it is not as if a competitor is going to undercut me').

Thus, in the absence of regulatory interference, the exact same service could be provided at lower cost AND at a profit in the competitive system (vis-a-vis the socialist system).

The quality of service is invariably better in the competitve system, too (by much the same rationale).

 

[Kirkhill]

Hear, Hear John.

 

[Bruce Monkhouse]

What you forget is they save money by undercutting the quality and if necessary the quantity of care you will receive.
That and the fact they will simply turn tail and leave if the profit margin isn't there and then your left with the same need and no one who really knows how it works. What is required is better public money managers.

All those who think about less wages being the answer to health care funding, remember, you pay peanuts, you get monkeys...........  monkeys looking after your surgery.

 

[dutchie]

If a private health-care provider makes a profit, that indicates that they have provided the service at a lower cost than the mandarin's estimate.: absolutely right.

In a competitive system, this would suggest that any number of private providers could offer the same service at a price less than the government's estimate.: right. this is ok as long as quality of care reduction is not used to create savings.

In a socialist system, the profit motive is irrelevant and thus there is very little motive to produce at lower cost: only if it is run privately. If it is run by a public organization, then cost concerns can be maintained.

'why not pay myself more money and raise the price: it is not as if a competitor is going to undercut me').:my answer....."no problem, you're fired". the notion that you cannot have fiscal responsibility in government is understandable (based on past performance), but fundamentally wrong. Fiscal irresponsibility (in government) is something we have allowed to happen, but it's not something that has to continue.

Thus, in the absence of regulatory interference, the exact same service could be provided at lower cost AND at a profit in the competitive system (vis-a-vis the socialist system).k....why not keep it public, reduce the cost, and eliminate the profit, thereby saving more, and reducing the chance patient care is compromised for the sake of profit? I am not completely against private delivery, but I think it should be primarily publicly delivered.......consider our vasty rural population. Not much incentive for the private company to provide good care in an area of low population, outside of the fishbowl of the city. This also leaves no options for the consumer. In the city, you could go to another hospital in the next suburb......but what do you do if the next closest hospital is 100 miles away? You take the crappy subpar care.

The quality of service is invariably better in the competitive system, too (by much the same rationale).: do you mean service in the sense of 'customer service' or service as in the quality of medical care? I will concede the former, but challenge the latter. A public system's priority should be quality of care first, financial responsibility a close second. A private systems priorities will be profit, with no real secondary priorities. Saving my tax dollars is definitely not even a consideration to the private entrepreneur, nor do I think it should be.

 

[Bruce Monkhouse]

Wed, September 15, 2004

Money alone won't fix health care

It will take courage, leadership and a sense of reality, says Christina Blizzard -- and they're all in short supply

By CHRISTINA BLIZZARD -- For the Toronto Sun


Pointing the finger at the salaries of cooks and cleaners as the reason for soaring health costs may cut some ice in some circles, but give me a break.

In a report this week, the usually sensible Mark Mullins of the Fraser Insitute reveals that cooks and cleaners in Ontario hospitals make on average 30-60% more than those in the private sector and nurses earn at least 14% more than in other provinces.

Okay, Mullins also pointed out also that the number of hospital workers earning more than $100,000 per year has tripled since 1996.
 

The point, one supposes, is that hospitals should be privatized, thereby saving all that money on salaries -- and there may be some validity to that theory.

But if you really want to find all the big salaries in hospitals, you might want to look a little higher and pick on the really big fish. Forget about those cooks and cleaners. Heck, forget about those hospital staff making $100,000 -- many of them are highly educated professionals such as microbiologists.

The truly bloated salaries are those of hospital CEOs and other senior hospital bureaucrats, who regularly tip the pay scales at half a million dollars a pop. And we're worrying about cleaners?

In the private sector, a person making half a million bucks is expected to perform to high standards. Certainly, he or she is expected to balance the books and deliver services in a timely fashion. Yet many hospitals in this province fail to do just that.

Leadership by example

In any organization, leadership is by example. And if you have an overpaid upper management level, chances are the people at the lower end of the pay scale are going to want a few crumbs.

By all means, contract out services such as food preparation and cleaning if it's going to lead to substantial savings. But while you're at it, take a carving knife to the executive suite and pare back the fat there as well.

In Ottawa, meanwhile, the country's premiers and Prime Minister Paul Martin are bickering about just how much isn't enough to run the country's health system.

The answer, of course, is that as long as this country insists on sticking -- selectively -- to the narrow rules of the Canada Health Act, there will never be enough money in the pot to pay for all the services we demand from the system.

You have to have sympathy for Martin. First, the premiers feel they have him over a minority government barrel. This isn't so much a negotiation as it is a health care holdup.

But it isn't just money that's needed to make the health system work. Until governments at all levels can figure out a way to get costs under control, we might as well kiss goodbye half the provincial government. More than that, in fact, since the growth in health spending is spiralling out of control.

And the numbers aren't chicken feed, as John Williamson of the Canadian Taxpayers Federation noted yesterday.

According to the CTF, this year, provinces and territories will spend approximately $83.5 billion on health. Ottawa will write them a cheque for $24 billion for health, education and social services transfers. Add that to tax points the feds exchanged with the provinces in 1977, and Ottawa's total funding for health care is nearly one-third.

"That's higher than the 25% benchmark the provinces are now demanding from the federal government," says Williamson. If Ottawa's $9.7-billion equalization payment is included as well as the $6 billion it spends on health services for natives, veterans and research, its contribution is higher still, at around 40%, he argues. That's not chump change.

Nothing innovative

It would be reassuring if the provinces were offering some innovative ways to get costs under control. Not a chance.

In this province, Premier Dalton McGuinty's plan to buy back MRI and CATscan clinics from the private sector is an indication that he's going in exactly the opposite direction -- the typical Liberal all-things-to-all-people plan, that will result in even longer waits and even more money from the public purse.

The kind of change that's needed doesn't take more money. It takes courage, leadership and a sharp dose of reality. Where, oh where are the politicians with those qualities?


 


--------------------------------------------------------------------------------
Sums it up for me.

 

[dutchie]

bruce:

re:All those who think about less wages being the answer to health care funding, remember, you pay peanuts, you get monkeys...........  monkeys looking after your surgery. - i suggest paying hospital workers not delivering care a far reduced wage, not the surgeons.......why should I pay someone $23/hour to scrub a toilet? That assinine.

 

[Bruce Monkhouse]

Maybe because that cleaner is also cleaning the same area where your innards might be exposed to some of the nasty things that breed in a less than sterile enviroment.

 

[I_am_John_Galt]

The competitive market will provide WHATEVER is demanded by the aggregate of general population.

If lowest-cost healthcare is desireable: ti will be supplied.
If highest-quality healthcare is diesireable: it will be provided.
If best customer service is desireable: it will be there.
If instead of lab coats, Doctors dressed like Elvis is desireable: sales of Blue Suede Shoes will skyrocket (and in the competitve market there will be MUCH Less Conversation and MUCH More Action).

While I will accept that it is theoretically possible (in the sense of an infinite number of monkees on typwriters...) that some lawyer might luck into the optimal allocation of resources (i.e., how much should a particular surgeon be paid, or a particular orderly) it seems *highly* unlikely, and the maket has proven time and time again to make MUCH better allocations (i.e., the better surgeons get paid more, and Bruce's 'monkeys' make no money and thus quit medicine and join the circus or whatever).

Despite the Special Interest's (and the CBC's) propaganda to the contray, the fact is that when a service is provided by a dynamic and active open market, consumer's needs (of which lower prices is only one aspect) are MUCH better met.  Private companies will simply cease to exist if they do not provide what, how and where is wanted.

The idea that "fiscal responsibility" can control costs is somehting that works in the VERY short term at best.  People don't get fired in crown corporations for anywhere near the same reasons they do in the private sector.  I used an outrageous example to make the point, here's another that perhaps is more realistic: who do you think will negotiate harder against a union looking for an unreasonable raise: a gov't lawyer who (worst case) will get paid a little less for agreeing to too much, or the entrepreneur who stands to lose his income, company, house, life savings, etc. (and which employees do you think are going to be more agreeable, the ones that have everything to gain and nothing to lose, or those that stand to lose their livelihoods)?  In the movie "Days of Thunder" Nicole Kidman said to Tom Cruise: "Control is an illusion, you infantile egomaniac!  Nobody controls anything." to which I would add: "especially if you are the government trying to control spending."

This has been proven to be empirically true: just look to the bread MRI lines in the USSR Canada that simply don't exist in competitive systems.  AGAIN, it is the Canadian provinces that are having to close hospitals and limit services: that the Provincial Governments have finally been forced to confront reality and defy the feds by allowing private treatment centres is only the very beginning (one can only hope!) of a very good thing.

I love my country  , but there are some pretty strange economic theories that are accepted by it's people without question!

 

[Bruce Monkhouse]

What most of you private health-care people are missing is the point that was brought up earlier, profitability.

I am not saying that we need to rework the health-care system, in fact in many threads I have argued we need to officially have two-tier healthcare so that the profit from that can be used to bolster the public system.
But to say the private system is so much better, etc, etc for the "general " public is amazingly stupid and short-sighted.
Example, McDonalds is a very well run corporation, however upon leaving Napanee, Ont and heading north on hwy.41 you will travel 124 miles before you encounter another Big Mac. If there isn't enough of a profit margin here for hamburgers how in the world will there be enough for a profit hospital?

 

[I_am_John_Galt]

Maybe because that cleaner is also cleaning the same area where your innards might be exposed to some of the nasty things that breed in a less than sterile enviroment.

What makes you think that same idgit working for the government with one of the strongest unions in the country protecting him is going to be any more diligent than a guy working for a private contractor, who stands to take his whole company under (let alone his own livelihood)?

 

[Bruce Monkhouse]

I don't consider 12 bucks an hour a" livlihood", thats a job you do untill you land the" real one"

 

[I_am_John_Galt]

Example, McDonalds is a very well run corporation, however upon leaving Napanee, Ont and heading north on hwy.41 you will travel 124 miles before you encounter another Big Mac. If there isn't enough of a profit margin here for hamburgers how in the world will there be enough for a profit hospital?

How many hospitals are there now?  How many do you think in another 10 years of Stalinist healthcare?  If it makes economic sense* for a (realtively expensive) publicly-run hospital to be located in any particualar place, it makes MORE sense for a (relatively cheaper) privately-run hospital to be located in the same place (regardless of who is foooting the bill)!

I hate to break it to you, but Government monopolies (on anything) do a really piss-poor job of providing services: nonetheless, the point is that spending in this type of system will *always* grow faster than inflation: it is the very definition of unsustainability.  There is no REAL incentive for government ministries and crown corporations to do anything other than increase costs!  Using private sector profits to subsidize a public system is merely delaying the inevitable: the public system will grow and grow and grow and quality and service will get worse and worse and worse ... (then you'll REALLY have two-tier healthcare).

*as in "utility" not just financial cost!

 

[Bruce Monkhouse]

QUOTE,
I hate to break it to you, but Government monopolies (on anything) do a really piss-poor job of providing services: nonetheless, the point is that spending in this type of system will *always* grow faster than inflation: it is the very definition of unsustainability.   There is no REAL incentive for government ministries and crown corporations to do anything other than increase costs!   Using private sector profits to subsidize a public system is merely delaying the inevitable: the public system will grow and grow and grow and quality and service will get worse and worse and worse ... (then you'll REALLY have two-tier healthcare).

No, please, feel free to break it to me as you obviously KNOW better than I.
In other words if your going to throw out kife like that last post without any meaningful backing than don't waste my time.
If you have any proof of things that have been privatised that have cost less,ie.private jail-oops-nope...hwy 407-oops,nope...

 

[I_am_John_Galt]

I don't consider 12 bucks an hour a" livlihood", thats a job you do untill you land the" real one"

Um, so your argument is now that an Electrician working in a hospital making $25/hour is a career, but an Electrician working anywhere else for $15/hour is a summer job?

 

[dutchie]

I have done some pretty shitty jobs for pretty shitty pay, so I feel for the guy scrubbing toilets for $12/hour. But the fact is that scrubbing toilets is unskilled labour, ie, anyone should be able to do a good job with minimal training. I wish we had an economy that allowed everyone to make a killing regardless of their duties....but that's not reality (unless your a communist). That type of economy doesn't exist and never will.

There will always be those who make a small living, and those that make a large one. Most of the former are unskilled, most of the latter highly skilled and/or educated. Most of us fall somewhere in the middle, struggling to gain a large salary, while trying to avoid the small one. That is capitalism.

My capitalist views are trumped by my desire to ensure fair, affordable, and quality health care for every Canadian......so I am willing to sacrifice some capitalist abition for this.

 

[Bruce Monkhouse]

...as long as its not you?...nice