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Moonlight_Graham

2-tier Health Care

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There was recently a huge story in Canada where a man in Quebec (i think) won a landmark court decision from a judge who granted him the right to use private health insurance.

 

aka 2-tier healthcare in Canada. Now there's stories of U.S. insurance companies rubbing their hands at all the new potential $$$.

 

Anyways, how do you feel about this? No 2-tier healthcare, just universal (i believe about 46% of all our tax dollars go towards our healthcar system)? Or do you think Canada (or the U.S. for that matter) should have a combo of both and have a choice etc.? Or just private healthcare?

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We've seen how private healthcare works (or rather doesn't work). We've seen how medical bills are responsible for half of all bankruptcies in the US. No thanks. The biggest problem with our system is that it's underfunded, thanks to a decade of reckless cuts in the name of deficit slashing (I'm in favour of paying down debt as well, but you don't cut taxes and then say that services have to be cut as well because there's no money - quality health care is an essential service, low taxes are a luxury). The second biggest problem is understaffing, so here's what you do: student loans that don't have to be repaid as long as you stay and work in Canada. Combine free tuition with an anti-brain drain incentive. "But where will all this money come from?" Canada has been constantly cutting taxes for the past fifteen years, we don't need to keep doing it. Just stop. No more tax cuts, taxes in Canada are already among the lowest in the first world, we don't need lower taxes.

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We've seen how private healthcare works (or rather doesn't work). We've seen how medical bills are responsible for half of all bankruptcies in the US. No thanks. The biggest problem with our system is that it's underfunded, thanks to a decade of reckless cuts in the name of deficit slashing (I'm in favour of paying down debt as well, but you don't cut taxes and then say that services have to be cut as well because there's no money - quality health care is an essential service, low taxes are a luxury). The second biggest problem is understaffing, so here's what you do: student loans that don't have to be repaid as long as you stay and work in Canada. Combine free tuition with an anti-brain drain incentive. "But where will all this money come from?" Canada has been constantly cutting taxes for the past fifteen years, we don't need to keep doing it. Just stop. No more tax cuts, taxes in Canada are already among the lowest in the first world, we don't need lower taxes.

Well now Bizud you are finally making some sense ;)

 

I really like those ideas. However, do you think the free student loans would work in the long run? Once a doctor is, say, 35-40 years old & made some money, don't you think he'd be willing to pay off his loans and bolt to the U.S. to make a load of more money + less taxes. I don't know the answer to this question, but i'm sure some would still bolt and your idea would still definately help the brain-drain situation.

 

Also, with under-funding, how much more can we put towards health-care. As i said before, 46% of our taxes goes toward health-care. Also figure that healthcare is going to cost much more over the next 20 years & cost would would rise if we did these anti-brain-drain incentives. Maybe would could raise taxes, but would it still be enough?

 

How about this idea: a lot of people go to their family doctor or E.R. every-time they stub their toe or cough, so how about charging everyone, say, $2 bucks everytime they see their doctor or maybe even when they go to the E.R. Of course, there would be no charge for people with severe/long-term problems (cancer, handicaps etc.) and for children under age 10 (kids/babies are always sick)?

 

I don't agree with a U.S.-type healthcare style. But i think some privitization couldn't hurt. Whats wrong with private MRI clinics? You don't even need doctors to run an MRI, you just need technicians. If someone wants to pay for an MRI, it will let them get service and at the same time reduces the wait for people in the public-system. For those that can afford it, they can always get care in the U.S., so we don't need bigtime private care (unless the U.S. goes Universal).

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This is a matter that I think about a great deal, as my parents as well as one of my step parents, and a few of my friends are nurses.

 

While I firmly believe that health care should be free for everyone, I also think that it is getting to the point where we have to realize that the Canadian health care system is incredibly broken.

 

In terms of nurses, while compensation is important, by far the largest reason for leaving is the deplorable conditions that nurses are forced to work in. The task list of nurses in Canada is ever expanding, and the new duties are often ones that have nothing do with their training, such as heavy lifting and cleaning shit. Another source of great frustration is the outdated, and poorly maintained equipment that they are expected to use.

 

Now I would be lying if I said that the additional money offered by the USA hospitals, along with the lower taxes, were not huge incentives for nurses moving to the US. However, when you couple that with much, much better working conditions, and being provided with the proper tools to really help people, its a pretty easy decision for many to move south.

 

Consistent under staffing is a problem with our health care system. In the case of doctors, this is a direct result of a lack of doctors. However, in the case of nurses, this is not necessarily true, 50% of nurses in Canada are work full time, while I would be a fool to say that all the other 50% want to be full time (a lot of nurses like to be able to work 0.5's or 0.7's) but there are a significant number of nurses who are available to work more than they do, but management is not interested in using any nurse in a manner other than that that perfectly fits their agenda.

 

The second biggest problem is under staffing, so here's what you do: student loans that don't have to be repaid as long as you stay and work in Canada. Combine free tuition with an anti-brain drain incentive.

 

I would estimate the maximum debt of a nurse exiting a Canadian school to be $30k-$40k, typically, these people graduate with minimal debt ($1k-$2k). Student loans aren't a big deal to a nurse for the most part, at least to the point where a grace period would be effective in terms of retention. No strings attached free tuition would increase enrollment, but also in number of those leaving. A contract free tuition (ie. free tuition for 4-5 years of working in Canada) would probably not be used by many students.

 

In terms of doctors, Canada's med school tuitions have consistently been quite low, but are rising. However, it is still unusual for a Canadian med student to graduate with more than ~20k-50k debt, not exactly debilitating, especially in the US, where med students routinely carry 100k in debt. Furthermore, if we really want to keep our best, we have to recognize that these are the people that probably have full fellowships all through out their schooling, and as a result carry virtually no debt.

 

As far as bonuses go, it would be nice, in know a lot of US hospitals recruiting nurses offer $10k bonuses, along with substantial relocation packages, often on a 2-3 year contract. For Canada to be competitive on bonuses, we would have to pony up some serious cash, and with very little guarantee. Bonuses for doctors would have to be significant, ie. on the order of 50k, for them to be interested, and like I said, we have to aggressively court the BEST doctors we have.

 

 

How about this idea: a lot of people go to their family doctor or E.R. every-time they stub their toe or cough, so how about charging everyone, say, $2 bucks everytime they see their doctor or maybe even when they go to the E.R. Of course, there would be no charge for people with severe/long-term problems (cancer, handicaps etc.) and for children under age 10 (kids/babies are always sick)?

 

I don't know if a small copay is the way to go, but I completely agree that wasteful behavior needs to be cut down on. I have lived in the US for the last year, and have realized how often I, and my friends in Canada, would go to the doctor or emergency when it was absolutely unnecessary. Free health care is fundamental, however, people must be made to respect how valuable it really is. To sum this up, while health care is free when you walk in the door, it is not FREE, everyone pays, and it should not be abused, but it will be.

 

In the end, while monetary incentives could solve some problems in the short term, I firmly believe that the only path to long term sustainability is to force the people in charge of management to develop more efficient techniques. The management of their resources, particularly their personal, is extremely poor, and is really what is costing so much.

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Some good points raised on both sides of the argument.

 

I think the solution is forcing people to pay for visits deemed unnecessary. However then the problem arises of how do you deem what is necessary. Or worst yet, people don't go to the doctor for fear of having to pay. Or you can get a certain amount of free visits a year and then you must start paying (unless you're under the age of 18, or have an ongoing medical condition).

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Randomlylinked, thanks for the very interesting read.

 

I have been hospitalized before, and i totally believe the saying that nurses "are the backbone of the healthcare system". They are the grunts, and do a lot of the work and spend the time with the patients. Certainly can't be appreciated enough. You're lucky to spend 30 minutes with a doctor.

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