If Mr. Ruess can link us to a Canadian of any prominence who has stated that it's the "best in the world", then we aren't talking about a strawman argument...but I don't think he can.
We aren't the best, but we aren't bad. Not just outcomes, but costs must be compared. The use of ordinals ("ranked 16th", "30th best") is statistically worthless. What if the 15 better were better by meaningless amounts? Don't use ordinals.
A clearer story is told in "The Spirit Level", about income inequality. Nearly all healthcare outcomes relate more-closely to your GINI number than to any specifics of your health care system. The US has the worst, by far, because they really are exceptional in the area of income inequality. Canada has worse income inequality than most of the health care systems at the top of the charts (France, Italy).
Remarkable health-care outcomes for comically small outlays of money are being realized by Costa Rica, including amazingly good pandemic results, because they made a focus on public health first. The public health visits leading to more critical care, early on, rather than a crisis-response model where health care becomes aware of you when you stagger in. (See The Atlantic for the article, "Why It's Better to be Poor in Costa Rica")
Here's a thing to get upset about, though. I screwed up, the other day, liking a National Post comment so much I copied it - and forgot to save the name of the commenter. He's a physician from rural Nova Scotia:
======
When I came to Canada in 1985 from the UK, to be a rural physician in a post no Canadian had been willing to fill for the two years it had been advertised, I ran, with one other doctor, a 29 bed rural hospital, with 24 hour ER, lab and X-ray. We had one administrator, the board in charge were local worthies (unpaid) and the budget was just over 1mCDN/year.
...Now it has eight beds, the 'urgent care' is open 7 hours a day, but not every day, it has no lab and X-ray availability is sporadic. And it's run by five docs, two NPs and we were up to 14 administrators when I quit in 2015. Goodness knows what the budget is now, but it's whatever is spared us by the large and greedy regional hospital (75 beds and 4 admins in 1985, 50 beds and 70 admins when I quit). They also make all decisions for us and there is no local control.
Seems to me the old ways, before the government decided to reign in health care spending by appointing managers for everything, were cheaper and far more effective.
==============
...that tracks with things that happened in my career, totally different industry, but the takeover of the professional administrators proceeded similarly, with comparable effects on productivity.
I guarantee you that a review would bog down. These people are the Kings of Bogging Down. The people in charge of health care are spiritual brothers of those who spent tens of millions on an inquiry about MMIW - with police pointing out the whole time that amount of money would have been $100,000 - a "staff year" - for every case open.
The only suggestion I could come up with in two decades of being bogged down by my own management was that a parallel organization has to start up, with the same basic mission (in this case, "run a clinic") but none of the same required structures.
In fact, it was a medical model that computer science-management theorist Fred Brooks came up with for programming, he called it "The Surgical Team". In a surgical team, everybody but the surgeon, is a helpmeet to the surgeon. The person actually hands-on to the problem is also the boss. In bureaucracies, those actually solving the problem are at the bottom, and must plead with "superiors" (who couldn't do the job, pesonally) for resources to do their damn job. Those at the top theoretically then have the responsibility for the outcome, but in practice, they are protected from all consequences of poor performance. They don't have the frustration while at work, like the front-liners, and they aren't fired when the number of employees per bed rises, either.
That doesn't necessarily put the doctors in charge of a hospital. Everybody knows you go there for the *nursing*, the doctors are their consultants. We'd find out how many administrators were really needed for a hospital, if the nurses were in charge.
During the campaigns for the last two elections the candidates barely even discussed our healthcare, our loss of standing on the world stage, the abysmal flow of capital out of this country, or our debt, to which has only multiplied. These are the things most politicians concentrate on for the welfare of the country. With the Government of the day they are too busy virtue signaling, demeaning and dividing people while destroying the economy and indebting generations of Canadians. They have no time to consider healthcare so they will will throw money at it by adding another layer of bureaucratic waste to do further studies. It will amount to the usual government rhetoric, virtue signaling, promises, but zero change and higher taxes. I have lost any faith in this Government, our institutions, and the country as a whole.
The biggest problem is our spineless politicians. I mean, its obvious, if a system isn't working well, you look to where it is working well. But will anyone in power do it? No. Because they wet their pants at the thought of receiving the wrath of the health care cultists who have drunk the kool-aid and forever more believe in the ultimate perfection of our health care system. They are just like any other cultists; they refuse all facts and believe the 'true belief'. They are pathetically ignorant people and the politicians that kow-tow to them shiver in fear. Wait times contributed to the death of my wife and these people reject any change for the better. I'll sign off now before I go over the top saying what I think of them.
We emigrated to Canada from the UK many years ago. We thought things were better and cheaper than in the UK, but I talk to my sister all the time and it annoys me that healthcare in the Uk sounds so much better than Canada. Everything just about in the UK sounds better than Canada. Sometimes I’m tempted to go back but we have family here now. Public transport is better. Over 60s get free bus rides anywhere. She gets free hearing aids. My other sister lives in BC. She’s been trying to afford hearing aids for years. They have public and private healthcare in the UK. I know you can get quicker surgery if you can afford to pay and there is some arrangement when you do that benefits a public patient too.
Is it not possible to see what other countries do that is more successful than our system and do what they do.
And yet thousands of new Canadians are licensed to practise medicine back home in their advanced countries but can't seem to jump through our purposefully obtuse hoops.
We literally have Cambridge trained doctors in Canada who can't get licensed immediately. That is just obscene protectionism.
Equality in mediocrity is a feature, not a bug, for a critical mass of Canadians. Tall poppyism in health care.
Canadian health care is mediocre at best and just isn't good enough. But it is better for poor people than what the US offers and that is good enough for most people in Canada, until they actually need to use the health care system.
Canada should literally just copy the systems of our peer nations who do better than us, there are 29 examples to choose from. But we aren't confident enough, and besides Canadians can't resist defining equality as preventing "the rich from skipping the line."
Canada's health care system represents what is best and worst about Canadians. Will it change, nope, too confrontational. We will muddle with workarounds for those who can afford them, all while trying to avoid the "two tier" label that gets the class warriors all worked up.
I suggest the issue about "improving" Canada's health care system for many, if not most, reformers is more privatization and profit oriented operations. That's always, it seems, the subtext of the discussion.
Indeed, I don't recall the more vocal health care reformers bringing up other aspects of health care. But, perhaps I'm wrong. What health care reforms are being debated that are not about privatization?
You mean health professionals want to work for more money and with less BS like everyone else? Ask private school teachers why they teach there instead of the public system.
Let's assume your what you say is true. How would paying health professionals more and reducing the "BS" improve the health care system for patients? It wouldn't, of course.
You're conflating some health professionals' legitimate compensation and conditions concerns and the quality and quantity of service available for patients. They are two very different things, requiring different solutions.
Define patient satisfaction first if all. Not every patient wants the same thing. Some just don't want to pay anything out of pocket. Some want the best care available irregardless of cost. Some want health care as quickly as possible. Data has shown happier staff provide better quality services, no matter the industry. Proper compensation, appreciation and working conditions contribute to that.
This is all standard business school teachings and health care is nothing if not a business, no matter what Canadians believe.
You've arrived at a wrong conclusion if you think I, personally, am not wholly in favor of "happier staff...better quality services...[and] Proper compensation, appreciation and working conditions." Foundational to a quality health care system is people.
However, health care is not, necessarily, a business, any more than policing and fire fighting are. Business implies profit. Profit ensures patients' best interests are not paramount.
Isn’t this issue of serious healthcare reform what the present government and/or the NDP for Pete’s sake need to pick up the ball and address credibly (sic) and openly?
Why is nobody bringing up these aspects of reform, as Stephen Best has stated?
Thanks for calling Canadians smart and sensible people but I really don’t think we are either. If we were we wouldn’t put up with the chronic under achieving of governments both federal and provincial that have contributed to the slide down the scale of our health care systems. For the money and labour numbers involved in this sector it appears more boondoggle than trophy achievement.
One thing the pandemic has shown is how unkind, unbending Canadians are. They have been very quick to throw anyone under the bus who isn't willing to get on the bus In the latest example Ronald McDonald House in Vancouver just evicted a family whose 4 year old has cancer. Utter cruelty - yet I see loads of people defending the decision, parents are “too stupid to get vaxed they deserve this”. I won't bother linking to it as it will be all over twitter.
I read your first sentence, and was thinking, "yeah, how can you not bend to wear a strip of cloth on your face if it would save a stranger's life"...when I saw where you were going.
Very aware of the mote in thy brother's eye, not the beam in thine own.
Canada is in the midst of a social panic that is going to destroy small businesses leave a generation of kids scared for life and completely wreck the economy (mostly in reference to house prices). You ask me to save a strangers life I'm asking you to save the country I love. You ask me to save a strangers life I ask you to save the life of a cancer patient who can't get surgery! So on and so forth. As an aside I compared Germany 500 to 1500 per 100,000 to Ontario's 25 per 100,000 - yet Ontario is in lockdown schools shut while Germany is mostly open. Very sad, I feel sorry for my nephews nieces who will see their futures wrecked 😿
Somehow we had 30% unemployment for much of the 1930s, followed by 30% of the workforce abroad fighting for 1939-1945...and the economy was roaring by 1948.
In short, I think people are hyperventilating about "the country" and "the economy". Both have shown resilience against much larger challenges.
Almost none of my same-age Ontario friends own a home or condo. But I’m struggling to think of anyone I graduated with in the U.S. who doesn’t own a single-family detached home, and usually a quite large one. Across all industries and states.
What happens when a whole generation of kids become a renter class unable to build wealth. Read today how Toronto investors are driving up rents in Sudbury, too the point many can't afford to rent. The FPTP systems means a populist party will never gain power while the main parties terrified of upsetting the status quo won't do anything to help.
Like most things in Canada that involve both Federal and Provincial governments, there is little progress. Since health care is primarily a provincial responsibility a national solutions to health care woes is very difficult to orchestrate even for single elements such as long term care.
Are woeful politicians don't have the necessary skills or desire to fix long term problems.
Unfortunately Canada/provinces are not a very serious country anymore.
Part of this discussion has to be how much Canadians are willing to pay in taxes for improved healthcare - something that oddly doesn't seem to come up much. Sure, there are diminishing returns to shoveling more money into the system, but at the end of the day improved care will require more staff and more infrastructure, which means more money. A lot more. It would be naïve to pretend otherwise or that restructuring alone will get us out of this mess.
Wait, just a moment, VG. If you read the column you see that, relatively, we already spend a lot of money but get inferior results.
I have no problem with the idea that there may need to be more spending in area A or area B but I really have a problem with simply throwing money at a system that has demonstrably proven itself unable to efficiently spend the money it gets.
My conclusion is that we need not American style healthcare but, instead, French style or Swedish style or UK style or Japanese, etc. The point is, we really do need to get a system that works instead of breaking down. We are near a breakdown point in terms of our healthcare system right now and the problem is NOT Covid but is, instead, it is the wretched system that we have. So, go for the French, Swedish, UK, Japanese, etc. style but not the American or Canadian style.
Further, I have talked to American doctors in social settings and they are absolutely convinced that Canadian healthcare is awful. Interesting hearing their (warped) point of view. On the other hand, Canadians stupidly think that the American healthcare system is uniformly awful. Both biases are absolutely incorrect: correct in part but incorrect as a whole.
As near as I can tell, both systems want three things, good quality outcomes, universality and speed. As with so much, you can have two of the things but not all three. The Americans have chosen outcomes and speed and the Canadians have chosen universality and outcomes. Therefore, the Americans have sacrificed universality and the Canadians have sacrificed speed. Obviously this is a tremendously flawed and simplistic explanation but it does apply and explain a lot. Quite simply, each of the two countries are trying to achieve two main goals and to criticize either country because it doesn't attempt the third goal is foolish.
So, go for French, Swedish, UK, Japanese, etc. But not Canadian and not American.
From what I know of the NHS it's awfully similar to the highly centralized, state run Canadian system - which in itself is worth asking some questions. A lot of European countries have a very mixed system: I currently work in Germany and although I'm on the public plan I still have a third party insurance provider, which I could choose freely. Healthcare is heavily regulated but my contribution doesn't go to the state. But that's never going to happen in Canada, due to our proximity to the US. Realistically, we need to work within the confines of what is politically and socially palatable.
-removing most federal involvement in health care. The current arrangement, with its ambiguous accountability, leads to finger pointing (ex. increased federal funding is the only way to fix healthcare).
-liberate healthcare (and all government) workers from forced union representation. Government workers have unfair bargaining advantages:
--their employer has large poential to raise more revenue
--their employer is typically a monopoly service provider that can pass on increased labor costs
--their employer typically provides services to which customers have emotional attachments
-introduce some elements of competition to drive innovation. Healthcare is so huge and complicated, that this can be done piece-meal. If, for example, contracting out a particular service in a particular region does not improve service levels, the service can be brought back in-house at the end of the contractual terms and something else tried
Looking at the US, I always thought there was a bit of a "meanness/F-you" attitude among a large enough chunk of the US population that would never allow single payer/universal access to take hold there. Its not that they dont want it for themselves, they just dont want to pay it for THOSE people. Substitute "THOSE people" for whatever hated outgroup you despise. I didnt think that sentiment was here in Canada, but I think the debate Quebec opened up about punishing people who are not vax'd exposed a real vitrol that I didnt think was nearly as wide spread here in Canada. Mind you this is on social media (Twitter/reddit etc) but even among my leftie friends (I consider myself very left politically and socially). There seems to be a very strong attitude to punish / scold and exclude that wasnt there before. Two years ago if you asked should fat people or smokers or those who engage in unhealthy behaviour should pay more for health care, I doubt there would be significant uptake. I kinda of wonder about that now :(
As a layperson living in Alberta, would somebody with knowledge and an opinion clue me into what the Kenney government's plans to offer two tier health actually were, and whether or not they would have recreated the more abysmal parts of the American system up here?
The column by Harrison Ruess disparaging Canada's healthcare system confuses apples and oranges. While we have reason to be concerned about health outcomes in Canada - such as healthy life expectancy or recovery from heart disease, or vaccination rates among young children - these are not the direct responsibility of the healthcare system. The healthcare system is a huge repair shop. But if we want to achieve better health outcomes, and we should, then the real focus of attention should be on the social determinants of health, the factors that determine why some populations are healthier than others. Angus Deaton has given us recent data in his book, The Deaths of Despair, in which middle-aged unemployed white males predominantly are dying from opioid overdoses. In Canada it is estimated that between January 2016 and June 2021 some 24,626 Canadians died from apparent opioid toxicity deaths - this did not result from a failed healthcare system but from the despair in the lives of those who died and the predatory and the shameful behaviour of private companies that pushed opioid usage fatal levels in pursuit of higher profits. There are great disparities in health outcomes and healthy life expectancy in Canada based on socio-economic status. These are not the consequence of a failed healthcare system but of the social and economic conditions under which many Canadians live. The median hourly wage for a typical Canadian worker, adjusted for inflation, between 1976 and 2019, rose by $1 an hour - that's just $1 spread over 45 years, or just over 2 cents a year - but those in the upper quintiles did much better. Who do you think has a better health outcome? Our goal in Canada should be to raise the health outcome gradients for the bottom quintiles in our society, so that the health outcomes of those in the bottom quintile are almost level with those in the top quintile. Throwing more money at hospitals or privatizing the system won't do that. Reuss has got it all wrong - a nicely written polemic to show another area where Canada fails. But it is, of course, much easier to blame on the healthcare system when the goal of a healthier population across all socio-economic quintiles requires much different policies. And since the U.S. data is even more discouraging it is not a model for Canada to follow. If we want a healthier population the focus must be on the social determinants of health rather than putting the responsibility n our healthcare system, David Crane
Russ, you note that "... the Canadian population is aging, so our health-care needs will increase ..."
That can be said about pretty much any industrial country so that shouldn't be used as an excuse for our substandard healthcare system. It absolutely be taken into account but it is not an excuse that should be used to allow the inadequate system that we have to continue.
"it is not an excuse that should be used to allow the inadequate system that we have to continue."
For sure. What I'm saying that the health-care challenge is going to become more and more important over time.
To me this is a big reason why the "less taxes, smaller government" view doesn't make much sense - health care is expensive, and we know health-care spending is going to increase as the population ages. If we're trying to cut overall taxes and spending at the same time, everything else (like education spending) is going to get crushed.
My problem is that the governments have botched so badly the healthcare issue that the only thing that more money would do is to throw that more right down the same black hole. I don't see the governments reforming ANYTHING until they are actually broke.
That means that the healthcare system will continue to deteriorate and ultimately crash and burn. That isn't good news for me because I am "of an age" [I'm 71] and I have those wonderfully named "underlying issues," both of which will result in me ending up as one of the first who will be hit with the results of this bad management.
At age 71, I expect that I will have, probably at best, about 10 years before I get much, much more dependent on the healthcare system. I am already a consumer of healthcare through more doctor visits, etc., etc. than during my working years. I can foresee the need near the end of that period for greater medical intervention and I truly don't expect that it is likely to be available to me.
So, yes, aging is a real factor but we can't simply yell, "Aging" and throw dollar bills at the system and expect good results. Truthfully, we absolutely need to revamp the system immensely and, given the time involved in studying, implementing, etc., I will be right there in the lineup for services when they have to make the change. But they need to start now anyway, even if it hits me simply because the longer the wait, the greater the difficulty and the longer it will take to arrive at a proper fix.
I say start the very long repair process now even though I am likely to be in the first wave that gets hit as collateral damage on the fixes.
I don't want more taxation thrown at healthcare now as that simply means it will take longer for the fixes to get started and get implemented.
Ultimately, if we get healthcare reformed we may see lower taxes, the same as now or higher taxes but we can be absolutely certain that higher taxes going to healthcare now with now reform will mean much higher taxes later.
"I don't see the governments reforming ANYTHING until they are actually broke."
I suppose I'm more optimistic - the provincial governments pay a lot of attention to older voters like yourself! In terms of specific recommendations for reform, I found Charles Wright's essay pretty persuasive. https://reviewcanada.ca/magazine/2009/11/too-much-health-care/
Thank you for the link; the article was very interesting.
I am pleased that you are optimistic about potential change in the healthcare system; as I stated, I am pessimistic. Simply put, I see politicians and bureaucrats as being afraid of offending some group and not dealing with the inefficiencies, etc. A good example of how the politicians and bureaucrats give in to pressure is the example of Avastin that is referenced in the article.
So, while I would like to be optimistic, I am not.
If Mr. Ruess can link us to a Canadian of any prominence who has stated that it's the "best in the world", then we aren't talking about a strawman argument...but I don't think he can.
We aren't the best, but we aren't bad. Not just outcomes, but costs must be compared. The use of ordinals ("ranked 16th", "30th best") is statistically worthless. What if the 15 better were better by meaningless amounts? Don't use ordinals.
A clearer story is told in "The Spirit Level", about income inequality. Nearly all healthcare outcomes relate more-closely to your GINI number than to any specifics of your health care system. The US has the worst, by far, because they really are exceptional in the area of income inequality. Canada has worse income inequality than most of the health care systems at the top of the charts (France, Italy).
Remarkable health-care outcomes for comically small outlays of money are being realized by Costa Rica, including amazingly good pandemic results, because they made a focus on public health first. The public health visits leading to more critical care, early on, rather than a crisis-response model where health care becomes aware of you when you stagger in. (See The Atlantic for the article, "Why It's Better to be Poor in Costa Rica")
Here's a thing to get upset about, though. I screwed up, the other day, liking a National Post comment so much I copied it - and forgot to save the name of the commenter. He's a physician from rural Nova Scotia:
======
When I came to Canada in 1985 from the UK, to be a rural physician in a post no Canadian had been willing to fill for the two years it had been advertised, I ran, with one other doctor, a 29 bed rural hospital, with 24 hour ER, lab and X-ray. We had one administrator, the board in charge were local worthies (unpaid) and the budget was just over 1mCDN/year.
...Now it has eight beds, the 'urgent care' is open 7 hours a day, but not every day, it has no lab and X-ray availability is sporadic. And it's run by five docs, two NPs and we were up to 14 administrators when I quit in 2015. Goodness knows what the budget is now, but it's whatever is spared us by the large and greedy regional hospital (75 beds and 4 admins in 1985, 50 beds and 70 admins when I quit). They also make all decisions for us and there is no local control.
Seems to me the old ways, before the government decided to reign in health care spending by appointing managers for everything, were cheaper and far more effective.
==============
...that tracks with things that happened in my career, totally different industry, but the takeover of the professional administrators proceeded similarly, with comparable effects on productivity.
The administration angle is huge. No one disputes the front line staff are doing their best, but go up the chain and I've heard horror stories.
It's time for a top-down audit of where the money is going.
I guarantee you that a review would bog down. These people are the Kings of Bogging Down. The people in charge of health care are spiritual brothers of those who spent tens of millions on an inquiry about MMIW - with police pointing out the whole time that amount of money would have been $100,000 - a "staff year" - for every case open.
The only suggestion I could come up with in two decades of being bogged down by my own management was that a parallel organization has to start up, with the same basic mission (in this case, "run a clinic") but none of the same required structures.
In fact, it was a medical model that computer science-management theorist Fred Brooks came up with for programming, he called it "The Surgical Team". In a surgical team, everybody but the surgeon, is a helpmeet to the surgeon. The person actually hands-on to the problem is also the boss. In bureaucracies, those actually solving the problem are at the bottom, and must plead with "superiors" (who couldn't do the job, pesonally) for resources to do their damn job. Those at the top theoretically then have the responsibility for the outcome, but in practice, they are protected from all consequences of poor performance. They don't have the frustration while at work, like the front-liners, and they aren't fired when the number of employees per bed rises, either.
That doesn't necessarily put the doctors in charge of a hospital. Everybody knows you go there for the *nursing*, the doctors are their consultants. We'd find out how many administrators were really needed for a hospital, if the nurses were in charge.
But that would be two tier health care by definition and that is "unCanadian."
During the campaigns for the last two elections the candidates barely even discussed our healthcare, our loss of standing on the world stage, the abysmal flow of capital out of this country, or our debt, to which has only multiplied. These are the things most politicians concentrate on for the welfare of the country. With the Government of the day they are too busy virtue signaling, demeaning and dividing people while destroying the economy and indebting generations of Canadians. They have no time to consider healthcare so they will will throw money at it by adding another layer of bureaucratic waste to do further studies. It will amount to the usual government rhetoric, virtue signaling, promises, but zero change and higher taxes. I have lost any faith in this Government, our institutions, and the country as a whole.
The biggest problem is our spineless politicians. I mean, its obvious, if a system isn't working well, you look to where it is working well. But will anyone in power do it? No. Because they wet their pants at the thought of receiving the wrath of the health care cultists who have drunk the kool-aid and forever more believe in the ultimate perfection of our health care system. They are just like any other cultists; they refuse all facts and believe the 'true belief'. They are pathetically ignorant people and the politicians that kow-tow to them shiver in fear. Wait times contributed to the death of my wife and these people reject any change for the better. I'll sign off now before I go over the top saying what I think of them.
They are mostly protectionist unions.
We emigrated to Canada from the UK many years ago. We thought things were better and cheaper than in the UK, but I talk to my sister all the time and it annoys me that healthcare in the Uk sounds so much better than Canada. Everything just about in the UK sounds better than Canada. Sometimes I’m tempted to go back but we have family here now. Public transport is better. Over 60s get free bus rides anywhere. She gets free hearing aids. My other sister lives in BC. She’s been trying to afford hearing aids for years. They have public and private healthcare in the UK. I know you can get quicker surgery if you can afford to pay and there is some arrangement when you do that benefits a public patient too.
Is it not possible to see what other countries do that is more successful than our system and do what they do.
The only other solutions I've ever heard for proposing better outcomes are in the "more privitization" vein.
Canada has two big challenges to delivering quality affordable healthcare:
i) Canada has an extremely spread out population making it much more difficult to deliver health solutions.
ii) Canada also has a very culturally similar neighbour who pays far more to physicians far more leading to a brain drain.
And yet thousands of new Canadians are licensed to practise medicine back home in their advanced countries but can't seem to jump through our purposefully obtuse hoops.
We literally have Cambridge trained doctors in Canada who can't get licensed immediately. That is just obscene protectionism.
Equality in mediocrity is a feature, not a bug, for a critical mass of Canadians. Tall poppyism in health care.
Canadian health care is mediocre at best and just isn't good enough. But it is better for poor people than what the US offers and that is good enough for most people in Canada, until they actually need to use the health care system.
Canada should literally just copy the systems of our peer nations who do better than us, there are 29 examples to choose from. But we aren't confident enough, and besides Canadians can't resist defining equality as preventing "the rich from skipping the line."
Canada's health care system represents what is best and worst about Canadians. Will it change, nope, too confrontational. We will muddle with workarounds for those who can afford them, all while trying to avoid the "two tier" label that gets the class warriors all worked up.
I suggest the issue about "improving" Canada's health care system for many, if not most, reformers is more privatization and profit oriented operations. That's always, it seems, the subtext of the discussion.
Indeed, I don't recall the more vocal health care reformers bringing up other aspects of health care. But, perhaps I'm wrong. What health care reforms are being debated that are not about privatization?
You mean health professionals want to work for more money and with less BS like everyone else? Ask private school teachers why they teach there instead of the public system.
Let's assume your what you say is true. How would paying health professionals more and reducing the "BS" improve the health care system for patients? It wouldn't, of course.
You're conflating some health professionals' legitimate compensation and conditions concerns and the quality and quantity of service available for patients. They are two very different things, requiring different solutions.
Define patient satisfaction first if all. Not every patient wants the same thing. Some just don't want to pay anything out of pocket. Some want the best care available irregardless of cost. Some want health care as quickly as possible. Data has shown happier staff provide better quality services, no matter the industry. Proper compensation, appreciation and working conditions contribute to that.
This is all standard business school teachings and health care is nothing if not a business, no matter what Canadians believe.
You've arrived at a wrong conclusion if you think I, personally, am not wholly in favor of "happier staff...better quality services...[and] Proper compensation, appreciation and working conditions." Foundational to a quality health care system is people.
However, health care is not, necessarily, a business, any more than policing and fire fighting are. Business implies profit. Profit ensures patients' best interests are not paramount.
Yeah, for starters how about some kind of a white paper on health care reform?
Isn’t this issue of serious healthcare reform what the present government and/or the NDP for Pete’s sake need to pick up the ball and address credibly (sic) and openly?
Why is nobody bringing up these aspects of reform, as Stephen Best has stated?
Thanks for calling Canadians smart and sensible people but I really don’t think we are either. If we were we wouldn’t put up with the chronic under achieving of governments both federal and provincial that have contributed to the slide down the scale of our health care systems. For the money and labour numbers involved in this sector it appears more boondoggle than trophy achievement.
One thing the pandemic has shown is how unkind, unbending Canadians are. They have been very quick to throw anyone under the bus who isn't willing to get on the bus In the latest example Ronald McDonald House in Vancouver just evicted a family whose 4 year old has cancer. Utter cruelty - yet I see loads of people defending the decision, parents are “too stupid to get vaxed they deserve this”. I won't bother linking to it as it will be all over twitter.
I read your first sentence, and was thinking, "yeah, how can you not bend to wear a strip of cloth on your face if it would save a stranger's life"...when I saw where you were going.
Very aware of the mote in thy brother's eye, not the beam in thine own.
Canada is in the midst of a social panic that is going to destroy small businesses leave a generation of kids scared for life and completely wreck the economy (mostly in reference to house prices). You ask me to save a strangers life I'm asking you to save the country I love. You ask me to save a strangers life I ask you to save the life of a cancer patient who can't get surgery! So on and so forth. As an aside I compared Germany 500 to 1500 per 100,000 to Ontario's 25 per 100,000 - yet Ontario is in lockdown schools shut while Germany is mostly open. Very sad, I feel sorry for my nephews nieces who will see their futures wrecked 😿
Somehow we had 30% unemployment for much of the 1930s, followed by 30% of the workforce abroad fighting for 1939-1945...and the economy was roaring by 1948.
In short, I think people are hyperventilating about "the country" and "the economy". Both have shown resilience against much larger challenges.
Agree thinking more along the housing bubble - unsure how this will play out
Can't edit comments but noticed this tweet.
Almost none of my same-age Ontario friends own a home or condo. But I’m struggling to think of anyone I graduated with in the U.S. who doesn’t own a single-family detached home, and usually a quite large one. Across all industries and states.
What happens when a whole generation of kids become a renter class unable to build wealth. Read today how Toronto investors are driving up rents in Sudbury, too the point many can't afford to rent. The FPTP systems means a populist party will never gain power while the main parties terrified of upsetting the status quo won't do anything to help.
Like most things in Canada that involve both Federal and Provincial governments, there is little progress. Since health care is primarily a provincial responsibility a national solutions to health care woes is very difficult to orchestrate even for single elements such as long term care.
Are woeful politicians don't have the necessary skills or desire to fix long term problems.
Unfortunately Canada/provinces are not a very serious country anymore.
Part of this discussion has to be how much Canadians are willing to pay in taxes for improved healthcare - something that oddly doesn't seem to come up much. Sure, there are diminishing returns to shoveling more money into the system, but at the end of the day improved care will require more staff and more infrastructure, which means more money. A lot more. It would be naïve to pretend otherwise or that restructuring alone will get us out of this mess.
Wait, just a moment, VG. If you read the column you see that, relatively, we already spend a lot of money but get inferior results.
I have no problem with the idea that there may need to be more spending in area A or area B but I really have a problem with simply throwing money at a system that has demonstrably proven itself unable to efficiently spend the money it gets.
My conclusion is that we need not American style healthcare but, instead, French style or Swedish style or UK style or Japanese, etc. The point is, we really do need to get a system that works instead of breaking down. We are near a breakdown point in terms of our healthcare system right now and the problem is NOT Covid but is, instead, it is the wretched system that we have. So, go for the French, Swedish, UK, Japanese, etc. style but not the American or Canadian style.
Further, I have talked to American doctors in social settings and they are absolutely convinced that Canadian healthcare is awful. Interesting hearing their (warped) point of view. On the other hand, Canadians stupidly think that the American healthcare system is uniformly awful. Both biases are absolutely incorrect: correct in part but incorrect as a whole.
As near as I can tell, both systems want three things, good quality outcomes, universality and speed. As with so much, you can have two of the things but not all three. The Americans have chosen outcomes and speed and the Canadians have chosen universality and outcomes. Therefore, the Americans have sacrificed universality and the Canadians have sacrificed speed. Obviously this is a tremendously flawed and simplistic explanation but it does apply and explain a lot. Quite simply, each of the two countries are trying to achieve two main goals and to criticize either country because it doesn't attempt the third goal is foolish.
So, go for French, Swedish, UK, Japanese, etc. But not Canadian and not American.
From what I know of the NHS it's awfully similar to the highly centralized, state run Canadian system - which in itself is worth asking some questions. A lot of European countries have a very mixed system: I currently work in Germany and although I'm on the public plan I still have a third party insurance provider, which I could choose freely. Healthcare is heavily regulated but my contribution doesn't go to the state. But that's never going to happen in Canada, due to our proximity to the US. Realistically, we need to work within the confines of what is politically and socially palatable.
Yes fellow expat here, and I've often commented the same!
Read Roy's comment above. More can be done with less if its done with intelligence rather than bureaucratic greed.
Intelligence will require:
-removing most federal involvement in health care. The current arrangement, with its ambiguous accountability, leads to finger pointing (ex. increased federal funding is the only way to fix healthcare).
-liberate healthcare (and all government) workers from forced union representation. Government workers have unfair bargaining advantages:
--their employer has large poential to raise more revenue
--their employer is typically a monopoly service provider that can pass on increased labor costs
--their employer typically provides services to which customers have emotional attachments
-introduce some elements of competition to drive innovation. Healthcare is so huge and complicated, that this can be done piece-meal. If, for example, contracting out a particular service in a particular region does not improve service levels, the service can be brought back in-house at the end of the contractual terms and something else tried
Looking at the US, I always thought there was a bit of a "meanness/F-you" attitude among a large enough chunk of the US population that would never allow single payer/universal access to take hold there. Its not that they dont want it for themselves, they just dont want to pay it for THOSE people. Substitute "THOSE people" for whatever hated outgroup you despise. I didnt think that sentiment was here in Canada, but I think the debate Quebec opened up about punishing people who are not vax'd exposed a real vitrol that I didnt think was nearly as wide spread here in Canada. Mind you this is on social media (Twitter/reddit etc) but even among my leftie friends (I consider myself very left politically and socially). There seems to be a very strong attitude to punish / scold and exclude that wasnt there before. Two years ago if you asked should fat people or smokers or those who engage in unhealthy behaviour should pay more for health care, I doubt there would be significant uptake. I kinda of wonder about that now :(
Interesting article and comments.
As a layperson living in Alberta, would somebody with knowledge and an opinion clue me into what the Kenney government's plans to offer two tier health actually were, and whether or not they would have recreated the more abysmal parts of the American system up here?
The column by Harrison Ruess disparaging Canada's healthcare system confuses apples and oranges. While we have reason to be concerned about health outcomes in Canada - such as healthy life expectancy or recovery from heart disease, or vaccination rates among young children - these are not the direct responsibility of the healthcare system. The healthcare system is a huge repair shop. But if we want to achieve better health outcomes, and we should, then the real focus of attention should be on the social determinants of health, the factors that determine why some populations are healthier than others. Angus Deaton has given us recent data in his book, The Deaths of Despair, in which middle-aged unemployed white males predominantly are dying from opioid overdoses. In Canada it is estimated that between January 2016 and June 2021 some 24,626 Canadians died from apparent opioid toxicity deaths - this did not result from a failed healthcare system but from the despair in the lives of those who died and the predatory and the shameful behaviour of private companies that pushed opioid usage fatal levels in pursuit of higher profits. There are great disparities in health outcomes and healthy life expectancy in Canada based on socio-economic status. These are not the consequence of a failed healthcare system but of the social and economic conditions under which many Canadians live. The median hourly wage for a typical Canadian worker, adjusted for inflation, between 1976 and 2019, rose by $1 an hour - that's just $1 spread over 45 years, or just over 2 cents a year - but those in the upper quintiles did much better. Who do you think has a better health outcome? Our goal in Canada should be to raise the health outcome gradients for the bottom quintiles in our society, so that the health outcomes of those in the bottom quintile are almost level with those in the top quintile. Throwing more money at hospitals or privatizing the system won't do that. Reuss has got it all wrong - a nicely written polemic to show another area where Canada fails. But it is, of course, much easier to blame on the healthcare system when the goal of a healthier population across all socio-economic quintiles requires much different policies. And since the U.S. data is even more discouraging it is not a model for Canada to follow. If we want a healthier population the focus must be on the social determinants of health rather than putting the responsibility n our healthcare system, David Crane
Morality rates?
Also, the Canadian population is aging, so our health-care needs will increase over time.
So how do we improve health care in Canada? Charles Wright has a suggestion: cost-benefit analysis. https://reviewcanada.ca/magazine/2009/11/too-much-health-care/
Russ, you note that "... the Canadian population is aging, so our health-care needs will increase ..."
That can be said about pretty much any industrial country so that shouldn't be used as an excuse for our substandard healthcare system. It absolutely be taken into account but it is not an excuse that should be used to allow the inadequate system that we have to continue.
"it is not an excuse that should be used to allow the inadequate system that we have to continue."
For sure. What I'm saying that the health-care challenge is going to become more and more important over time.
To me this is a big reason why the "less taxes, smaller government" view doesn't make much sense - health care is expensive, and we know health-care spending is going to increase as the population ages. If we're trying to cut overall taxes and spending at the same time, everything else (like education spending) is going to get crushed.
I cannot disagree with your points. But.
My problem is that the governments have botched so badly the healthcare issue that the only thing that more money would do is to throw that more right down the same black hole. I don't see the governments reforming ANYTHING until they are actually broke.
That means that the healthcare system will continue to deteriorate and ultimately crash and burn. That isn't good news for me because I am "of an age" [I'm 71] and I have those wonderfully named "underlying issues," both of which will result in me ending up as one of the first who will be hit with the results of this bad management.
At age 71, I expect that I will have, probably at best, about 10 years before I get much, much more dependent on the healthcare system. I am already a consumer of healthcare through more doctor visits, etc., etc. than during my working years. I can foresee the need near the end of that period for greater medical intervention and I truly don't expect that it is likely to be available to me.
So, yes, aging is a real factor but we can't simply yell, "Aging" and throw dollar bills at the system and expect good results. Truthfully, we absolutely need to revamp the system immensely and, given the time involved in studying, implementing, etc., I will be right there in the lineup for services when they have to make the change. But they need to start now anyway, even if it hits me simply because the longer the wait, the greater the difficulty and the longer it will take to arrive at a proper fix.
I say start the very long repair process now even though I am likely to be in the first wave that gets hit as collateral damage on the fixes.
I don't want more taxation thrown at healthcare now as that simply means it will take longer for the fixes to get started and get implemented.
Ultimately, if we get healthcare reformed we may see lower taxes, the same as now or higher taxes but we can be absolutely certain that higher taxes going to healthcare now with now reform will mean much higher taxes later.
"I don't see the governments reforming ANYTHING until they are actually broke."
I suppose I'm more optimistic - the provincial governments pay a lot of attention to older voters like yourself! In terms of specific recommendations for reform, I found Charles Wright's essay pretty persuasive. https://reviewcanada.ca/magazine/2009/11/too-much-health-care/
Thank you for the link; the article was very interesting.
I am pleased that you are optimistic about potential change in the healthcare system; as I stated, I am pessimistic. Simply put, I see politicians and bureaucrats as being afraid of offending some group and not dealing with the inefficiencies, etc. A good example of how the politicians and bureaucrats give in to pressure is the example of Avastin that is referenced in the article.
So, while I would like to be optimistic, I am not.
Again, thank you for the article reference.