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Canadian federation is already very loose. I see little to be gained by further reducing it. The provinces are more likely to persecute certain regions (see Harris Tories or the recent treatment of Halifax, for example) than the federal government. I also enjoy the manner in which the federal government is generally on the fore of progressive social policy. Without federal influence, or at least a strong federal government, we would not have the medicare system we have today, or many other aspects of the social safety net that give Canada its high quality of life.
 
>Canadian federation is already very loose. I see little to be gained by further reducing
>it. The provinces are more likely to persecute certain regions (see Harris Tories or the
>recent treatment of Halifax, for example) than the federal government. I also enjoy the
>manner in which the federal government is generally on the fore of progressive social
>policy. Without federal influence, or at least a strong federal government, we would not
>have the medicare system we have today, or many other aspects of the social safety net that
>give Canada its high quality of life.

It is not persecution.... it is a simple matter that in a parlimentary system (another issue I have).... you end up with the government -- and the opposition. Members of government tend to spend money on their own ridings and less on the opposition. The only reason you don't see the same sharp end of the stick with the federal government.... is nearly all of Ontario is in the red -- whereas Alberta is nearly all in the blue -- therefore people will see more benefits if they are in the red (liberal) ridings.

Yes, the federal government can be very progressive -- especially when they create unfunded mandates for provinces. It is the province that has to deal with the spiralling cost of healthcare, while the federal government just says -- here have another buck (after previously cutting 2 bucks) and we will set all the rules.... And if Alberta dare "experiment", the feds cut off funding (but not taxing) Albertans.....

All that ends up doing is that you end up using the federal government as a provincial government replacement (because you don't like the government that was democratically elected in your province)....

Also a lot of money gets spent on duplication -- which leaves less money for actual healthcare and education (generally the first and second priorities in any province). The federal government cuts into taxes (same person pays both federal and provincial taxes) that would be best used to meet provincial priorities.
 
You're wrong... very little health care spending is actual administration. It's 1.3% of total health care expenditures. Contract that with the USA, which has upwards of 10% administration.

It's a myth that the federal government "sets all the rules" for the provinces. The Canada Health Act is a very general document... While the federal government may use the CHST as a bit of a stick to keep the provinces in line, the provinces have ultimate control over health care. For that matter, provinces has a lot of leeway in operating under the CHA. Most of the reluctance to institute reform comes from the opposition of the electorate (ie, they don't want 'privatisation' in its many guises) or by the medical professionals. Primary health care has the potential to save a great deal of money while providing better care, but the provinces are loath to take it beyond small pilot projects for fear of a backlash from the medical community.

Secondly, the provinces, especially Ontario and Alberta, have no one to blame for tight budgets but themselves. The Harris Tories slashed taxes enormously, manufacturing the budget crisis we are now experiencing. Our health care spending in terms of percentage of GDP hasn't increased much over the past decade or so, and it is still far less than what the USA spends to provide health care to its citizens. Consider that the USA has tens of millions of individuals with little or no health care coverage. Our system is cheap, and better in many ways.

The health care system needs reform (toward salary-based employment of doctors, an increase in the role of nurse-practitioners, and more money strictly for capital investment), and an increase in funding. There is no reason why we cannot provide quality, efficient, and timely service in Canada with our public insurance system. Medicare is not unsustainable.... it just needs some tweaking, and the political will to get it done.
 
>You're wrong... very little health care spending is actual
>administration. It's 1.3% of total health care expenditures.
>Contract that with the USA, which has upwards of 10%
>administration.

The duplication in spending is not healthcare related, it is several government functions are duplicated at the federal and provincial levels. There should be a clear seperation between what is federal and what is provincial. And yes, healthcare in the US is messed up (as well -- just differently).

>It's a myth that the federal government "sets all the rules"
>for the provinces. The Canada Health Act is a very general
>document... While the federal government may use the CHST
>as a bit of a stick to keep the provinces in line, the provinces
>have ultimate control over health care. For that matter,
>provinces has a lot of leeway in operating under the CHA.
>Most of the reluctance to institute reform comes from the
>opposition of the electorate (ie, they don't want
>'privatisation' in its many guises) or by the medical
>professionals. Primary health care has the potential to save a
>great deal of money while providing better care, but the
>provinces are loath to take it beyond small pilot projects for
>fear of a backlash from the medical community.

I have seen Alberta get "publicly" threatened several times. Funny thing is my sister is a diabetic (currently in Ontario) and she feels she would be better off getting a job in Alberta because several new procedures are covered in Alberta but not Ontario.

>The health care system needs reform (toward salary-based
>employment of doctors, an increase in the role of
>nurse-practitioners, and more money strictly for capital
>investment), and an increase in funding. There is no reason
>why we cannot provide quality, efficient, and timely service
>in Canada with our public insurance system. Medicare is not
>unsustainable.... it just needs some tweaking, and the
>political will to get it done.

Nurse practitioners yes, making doctors civil servents no.
 
Alberta was threatened for something they were musing, not something they were actively planning to institute.

I see no problem with the private sector providing diagnotic services, but only if they can do it based on a similar cost model as the hospitals. Where does it get us if the private sector provides the service but charges twice as much? The only thing I really insist on is public insurance. As soon as you allow people to pay for their own services directly or through private insurance and "queue jump", you'll have the same effect on health care spending as with with public education. As the wealthy move their children to private education institutions, they pressure the government to decrease funding to the public system and thereby lower taxes. This process merely accelerates as public education (inevitably) decreases in quality. All well and good, except that you end up with a large poor class which is stuck with substandard schools with substandard educators. Such a system dramatically increases the chance of cross-generational poverty--ie, creating a poor, less-educated economic caste.

We will see similar results if we allow a private health care system. While there will always be a certain degree of queue jumping (with the USA next door), it is best to limit it and make it inconvenient.


"Nurse practitioners yes, making doctors civil servents no."

Why would such a thing be so evil? I have no opposition to doctors having their own practices, but I think many doctors would prefer a salaried position where they are not pressured to go for quantity over quality in terms of patient care. Doctor visits are substantially shorter than in other countries, and this leads to many potential health problems. I imagine many doctors might prefer to take their 70, 80, 90k per year (whatever it would have to be) and a 40 - 45 hour work-week. They wouldn't have to worry about managing the financial and administrative aspects of a practice. As civil servants, I'm sure they could have a pension and benefits programme surpassing that of even the Ontario Teachers. It's just my opinion, but I think it would help substantially with retention and recruitment.

Aside:

I think we should offer a $50 tax credit for people who come in for an annual physical. Too many people avoid going to the doctor or leave health problems until they are well advanced, increasing the cost to treat them several times over.
 
I have no problem with people paying for their own healthcare..... just not in a "topup" fashion where the bill is surcharged. Either it is paid in full by health coverage, or paid in full by the individual..... the individual will still pay taxes for health coverage for others. A doctor is either in or he is out... it would be the doctors choice. As far as queue jumping, it is not the same queue.... the vast majority would still be in the public system so it would always be a high priority.

>>"Nurse practitioners yes, making doctors civil servents no."

>Why would such a thing be so evil? I have no
>opposition to doctors having their own practices,
>but I think many doctors would prefer a salaried
>position where they are not pressured to go for
>quantity over quality in terms of patient care.
>Doctor visits are substantially shorter than in
>other countries, and this leads to many potential
>health problems. I imagine many doctors might
>prefer to take their 70, 80, 90k per year
>(whatever it would have to be) and a 40 - 45 hour
>work-week. They wouldn't have to worry about managing
>the financial and administrative aspects of a
>practice. As civil servants, I'm sure they
>could have a pension and benefits programme
>surpassing that of even the Ontario Teachers.
>It's just my opinion, but I think it would
>help substantially with retention and recruitment.

Woo, Woo! Yes I could see the doctors lining up
right now to become a civil servent.... A beauracracy
that you have to get approval from -- that would
make decisions on which medical conferences you can
attend -- what medical upgrade courses you can take
(and how many in any given year). It is my understanding
that civil servants (I do not believe a teacher is a civil
servant but an employee of a crown corporation) are the
most demotivated worker out there... generally not
very happy -- it is just a job.
BTW, the doctors can setup offices of multiple doctors,
or be "employed" (and lose a cut of fees) if they want.
90k would not cover the salary for doctors.

I have not seen the doctors association clamouring to be salaried government employees.... in fact I believe they have stated they
feared that.
 
According to billycorgan, doctors have $60k in take-home pay after taxes. 90k would cover their salary if they didn't have to pay for overhead, etc.

You don't seem to realise that having a private system, by its very existence, compromises the public system. A private system will poach the best doctors from the public system, decreasing its quality. As its quality decreases, more and more people get private health insurance. As more and more get private health insurance, there more pressure there is to decrease funding for the public system in favour of a tax cut.

And there you have it, the American system. Private insurance for the upper and much of the middle classes, and some middle and most of the lower class are left with substandard care, if any at all.

I think it's fine if people want to pay (queue-jump)... they can go to the USA.
 
The difference between teachers and other employees of the government is just quibbling.
 
There are other problems with private-sector health care... specifically, a conflict of interest. The profit motive doesn't necessarily mesh well with the Hippocrates Oath. For example, if a health industry is driven solely by profit, it's not in its interest for people to be healthy. The optimal situation for it is when everyone is sick but surviving (barely - requiring many expensive daily pills). Consider whether an effective cure for AIDS or cancer would be a good thing for such an industry - isn't it more profitable to just have people barely survive on cocktails of medication for years?
 
>According to billycorgan, doctors have $60k in take-home pay after taxes.
>90k would cover their salary if they didn't have to pay for overhead, etc.

It varies by doctor and area of expertise. Also be careful when someone says they have
a takehome pay of 60K after taxes..... I have a takehome pay of less than that, but I make
more than 90K. Depends if you incorporate yourself, what tax shelters you contribute
to, etc.

>You don't seem to realise that having a private system, by its very existence,
>compromises the public system. A private system will poach the best doctors from
>the public system, decreasing its quality. As its quality decreases, more and
>more people get private health insurance. As more and more get private health
>insurance, there more pressure there is to decrease funding for the public system
>in favour of a tax cut.

Ya, ya ya... private system by its very existence threatens the public system.
Now where is the proof? I mean that we are supposedly the only western country
that forbids doctors from opting out of the public system.... there should be lots
of examples in Europe or Japan.

We must therefore remove the doctors right to choose.... it is for the
betterment of society :p


>There are other problems with private-sector health care... specifically, a conflict
>of interest. The profit motive doesn't necessarily mesh well with the Hippocrates Oath.
>For example, if a health industry is driven solely by profit, it's not in its interest
>for people to be healthy. The optimal situation for it is when everyone is sick but
>surviving (barely - requiring many expensive daily pills). Consider whether an
>effective cure for AIDS or cancer would be a good thing for such an industry -
>isn't it more profitable to just have people barely survive on cocktails of
>medication for years?

Hmmmm.... The Hippocrates Oath was created when there was no public systems :p

As far as drug prices.... the US customers are being ripped off with help from there
local congressmen..... O and don't get me started with the Patent system, a system
that is overly abused.... A system created by the government to give companies a
government backed monopoly over an extended amount of time.... instead of allowing
the free-market to drive down prices. I don't mind patents for revolutionary advances,
but not for evolutionary advances.
 
There is no incentive to perform research without patents... It is extremely expensive to research, test and gain approval for a new drug.

Examples? The British system. The public system suffers alongside a burgeoning private sector.
 
I have worked in the United Kingdom (and the United States). I had no problem with the public system.
 
Highly scientific proof of the efficacy of those systems.

You also mentioned that you earned more than $90k per year... You hardly could be described as lower class. Private systems are the best for those who can afford it.
 
I cannot say I exercised it since I am only one....

but I did use the public system
 
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