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Jeff said:
Gonch, you need to let go of this 14 month thing.

So I should ignore that which causes me concern? ;)

That you can quote one instance in a system that isn't even what has been proposed does not imply anything about the quality of the care.

I'm quoting the source that was given to me (linked to) as an argument for universal health care of some kind in this country. If the Canadian health care article is so irrelevant then why was it pointed to in the first place?

You're drawing the line from socialized care to long wait times for elective surgery.

In this case, yes. Because the article in the link given says in pretty clear terms that the author feels 14 months to wait is better than nothing. I couldn't disagree more. Elective or not.

You ignore that the wait time is not likely a symptom of the system itself, but something else entirely, like there aren't enough doctors. There's no rationing go on here, which I assume is what you fear.

I fear having worse health care than I do now. Nothing more, nothing less.

My entire argument in this thread is based entirely on the link. My entire argument is against that kind of system being put in place (assuming the same results).

If our administration is proposing something better that allows care for all while allowing peoplke with care to receive the same or better care (on all factors), then awesome. I seemingly can't make that clear enough.

Why are you holding me or anyone else accountable for a linked opinion piece? I didn't write it!

Becuase it was linked to as if it were some source of what is right about a universal health care system. I simply pointed out that waiting 14 months for a surgical procedure didn't seem like very good system - 12 hours later, here we are.

If that is the chosen representation (and so far it's the only actual example of such a system in this entire thread) of universal health care then the system blows and support of such a system blows too.

Don't hold me accountable either, I'm just working with what was given to me. :)

So it is a zero-sum game?

In the short run yes. In the long run, the pressures towards efficiency will deliver win-win value. But, there will still be some procedures that are possible and affordable for you today under the current model that will either be much more expensive to you (if a fraction of costs are passed through) or impossible (if value is judged by a third party). That's just the way it has to work if incentives for value-for-dollar are to come into play.

Edited to add: to put it baldly, spending hundreds of thousands of dollars to extend your life near its end by a few weeks or months simply is poor return on the money. That money could be much better spent on something else. And, even today, it's not "your" money, unless you completely self-insure---those costs are spread around everyone in your risk/insurance pool. And, those extreme expenditures are routine in current health care best practices.

(Yes, I have seen Logan's Run. No, I don't want to live in that world.)

Brian Noble said:
Edited to add: to put it baldly, spending hundreds of thousands of dollars to extend your life near its end by a few weeks or months simply is poor return on the money. That money could be much better spent on something else.

Oddly enough, this is an aspect of the whole thing that I think I'm pretty much ok with. I might have a different opinion if I were 40 or 50 years older.

So are you just using this as an example of the 'give' that has to happen at one end for the 'take' to happen at the other or is this the example of how it will be successful - cutting off the elderly because the young are more valuable?

It seems awfully selfish to expect someone to give you health care at the expense of another? ;)

(Yes, I have seen Logan's Run. No, I don't want to live in that world.)

:)

Lord Gonchar said:
Becuase it was linked to as if it were some source of what is right about a universal health care system.

Not at all. It was linked to simply because it helps destroy many of the myths people have about such systems. It doesn't purport to show anything beyond that. Hell, the title of the piece is Debunking Canadian health care myths, not How I learned to stop hating socialism and start loving universal health care.

I simply pointed out that waiting 14 months for a surgical procedure didn't seem like very good system - 12 hours later, here we are.

You need to let that part go - the only point of that part was that the woman would not have had the procedure at all in our system.

And why are you so worried about that? How many hips have you had replaced in the last decade? ;)

Don't hold me accountable either, I'm just working with what was given to me. :)

No, not really. You're misrepresenting what was presented to you in order to make a point.

Brian Noble said:

So it is a zero-sum game?

In the short run yes. In the long run, the pressures towards efficiency will deliver win-win value.

Not entirely like our automobile industry, when it's "broken", the fix often requires additional demolition before reconstruction can begin.

Edited to add: to put it baldly, spending hundreds of thousands of dollars to extend your life near its end by a few weeks or months simply is poor return on the money. That money could be much better spent on something else. And, even today, it's not "your" money, unless you completely self-insure---those costs are spread around everyone in your risk/insurance pool. And, those extreme expenditures are routine in current health care best practices.

In Public Health, it seems the dollars spent on extreme measures (like extending Farrah's life by a couple months) eat up an inordinately laarge slice of the health care pie. Screening, early detection and intervention, prevention - these are areas where the "bang for the buck" has been proven time and time again...only to be ignored because of a variety of factors. Coming back again to the automobile industry, the ones who already HAVE the money have infinitely more political clout than those who have the better long-term ideas.

So are you just using this as an example of the 'give' that has to happen at one end for the 'take' to happen at the other or is this the example

An example. I suspect there would be other situations in which care you'd expect to receive today at negligible marginal cost will be either expensive or impossible.

I like turtles :)

Man this sounds like a Keith Olberman vs Greta Van Susteren debate :-) I love it. Its good that some of our most important and provocative debates can be found on coaster forums.

While I am not fully educated on the whole issue, I do think that universal health care is something we need. Also, I am not sure I understand Gonch's argument about inconvenience. What do you have to lose if we get universal health care? As the White House has stated, if you like your current insurance provider, you can keep it. This is just making sure that the disenfranchised are guaranteed the same care as those who can afford it.

delan said:
What do you have to lose if we get universal health care?

Money. The timeliness in which I receive care. The quality of care I receive.

And if Brian has his way, my grandmother. ;)

Brian Noble said:
I suspect there would be other situations in which care you'd expect to receive today at negligible marginal cost will be either expensive or impossible.

Kind of crazy that we'd be ok with a third party (the Govt?) deciding who is worth caring for and who isn't in the name of better care for all. It is seemingly straight out of Sci-Fi. (then again, most good sci-fi has a grip on the realities of the future)

EDIT - someone is going to argue that the insurance companies kind of play that role now, but I'm not sure it's entirely the same in concept.

But if the system is right, the government doesn't decide. Doctors do. That's the way they roll up north, by the way. Doctors make the decision.

Happy Canada Day!

Ok, but that seems to fly directly in the face of the completely reasonable stuff Brian is telling me.

If the docs are deciding, then what's the incentive to be efficient? Isn't that exactly what him and I have been going back and forth with? The fact that the current system is thorough and inefficient and a new system would certainly have to be efficient at the cost of a certain degree of thoroughness?

If the docs are deciding then it still seems in their best interest to order every test imaginable in the name of both thorough care and big paychecks. Someone has to keep the costs in line.

The current system is inefficient because there's a giant bureaucracy at the insurance companies of people saying what they will or will not pay for. The 30% vs. 1% overhead stat is pretty compelling to me. Doctors aren't thinking about costs, and shouldn't be forced to. They should be thinking about what the patient needs.

I get paid under that 30% "administrative overhead cost" rubric. And I'd rather lose my job than lose the one GOOD chance we've had at universal care...

Lord Gonchar said:
Kind of crazy that we'd be ok with a third party (the Govt?) deciding who is worth caring for and who isn't in the name of better care for all.

Jeff said:
But if the system is right, the government doesn't decide. Doctors make the decision.

Lord Gonchar said:
If the docs are deciding then it still seems in their best interest to order every test imaginable in the name of both thorough care and big paychecks. Someone has to keep the costs in line.

Jeff said:
Doctors aren't thinking about costs, and shouldn't be forced to. They should be thinking about what the patient needs.

Surely, you see why I'm a little confused.

Seems that, as usual, you and I are talking slightly different angles of the same topic...and we do that a lot.

Someone has to be deciding what health care is 'worth it' and which isn't. I understand that right now to a degree that's the insurance companies. But who would it be if we went to a universal health care system?

If it's implemented right, the doctors. Has anyone suggested otherwise?

Yes, you suggested otherwise.

You said:

"Doctors aren't thinking about costs, and shouldn't be forced to. They should be thinking about what the patient needs."

So who decides what care is worth the cost and what care isn't?

It is so lame to jump in on a conversation like this so late in the game. But it has been really interesting so far and has sparked some questions for me. I don't know much about universal health care systems.

If any third party is eliminated from the equation and all decisions about health care are made between the patient and the doctor, how can we be sure the right decisions are made? ( I know the question has been asked, but it hasn't been answered yet.)

If I walk into the doctor's office complaining of frequent headaches, the doctor decides if I should receive a CAT scan or some aspirin. Both have widely different costs associated with them and widely different profit for the doctor.

It seems like a red flag when the person who makes the most money on the course of action gets to decide what is best. It seems to me that would be like walking up to the concession stand and letting the park determine how thirsty I am and whether I should purchase the 44 oz drink for $3.50 or the 20 oz for $2.00.

Accountability continues to be the source of concern in any system we choose. Without it, it makes no difference how we run things. It will still likely be more costly.

More costly than the current system or the ideal system?