Instead of making the Canadian dental program look more like Canadian public health care, why don't we do the reverse — move health care to the dental-plan model?
Interesting thought. I disagree about the healthcare piece more broadly though. I think if our leaders had more imagination they could craft public healthcare that looked more like the Norwegian country’s public system. Government funded but privately provided and competitive. I’ve increasingly come to believe that many public health groups across Canada are management heavy and not getting good value for the money.
But Canadian healthcare is privately provided now. Doctors are independent private-sector business people (or, rarely in Canada, employees of private-sector corporations, most of these being university medical schools.) Almost no doctors are civil servants. Hospitals are, except for provincial psychiatric hospitals, private not-for-profit corporations with voluntary boards. Unlike doctors, they receive almost all their income as a global budget from tax money that is meticulously regulated by the provincial Ministry of Health, which exerts a constraint on the volume of service that they can provide. So how, exactly, is this different from Norway? I don’t know. I’m asking. Does Norway allow hospitals to bill the government for every service they sell, the way the Americans do, and the way our doctors do? That sounds like a recipe for runaway cost explosion.
Ive not researched it in depth because quite frankly, most Canadians would resist any change to public health care. But my understanding is it’s the best of both worlds from someone who lived over there.
There’s not much pay difference between US and Canadian doctors. Where most expenses come up for US healthcare is unexpected hospitalization and emergency treatment or things like cancer care. A broken ankle costs just shy of $3000 in the US (without surgery but counting ortho consult, x rays, crutches, air cast, physio instructions on using crutches, and emergency room treatment) I’d guess the amount actually billed to Alberta health for a similar visit is not that far off.
I am directly involved in one aspect of healthcare in the US so have a pretty clear view of one tiny piece of the US puzzle. The care in the US is quite different than in Canada for some things. And for others it’s identical but without the long wait times. There has to be a way to do things better in Canada.
Good. Fast. Cheap. Pick any two. It might not be possible to make things any “better” in Canada or anywhere. It all involves choices and trade-offs. I think we Canadians thought we had scored the hat trick back in the 1980s where we were the envy of the world. All we had to do was stamp out extra-billing and we’d be in paradise. Now, not so much. “Good”, most of the time. Not fast and not cheap. The price of each service is pretty OK cheap but we try to provide a vast number of them free to everyone. But we are still the second most expensive system, per capita, in the G20 even with the efficiencies of public administration. The U.S. is #1 by a long way ahead of course.
Thanks for admitting you don’t really know what you’re talking about with Norway. It is hard to compare a foreign country when you don’t live there. Here in Ontario, the emergency doctor got maybe $50 for seeing me for my broken ankle and the orthopaedic surgeon less than $100 for the consult, plus I think three fracture clinic follow-up visits at, say, $35 each if no surgery. (If I had needed surgery the post-op follow-up is included in the surgical fee.). Plus a few bucks to the radiologist for reading the X-rays. I paid for air cast and crutches out of pocket. If I had needed physio at $50 a visit, (9 years ago), or drugs, that would have been out of pocket, too. I’m self-employed. The hospital ER where I went didn’t charge Ontario Health anything for my visit, or for the fracture clinic. It just came out of the global budget. As in the U.S., that would have been by far the largest cost — a lot of unionized labour to pay — but it’s almost impossible to measure specifically for one episode. If I’d been a non-resident visitor, the hospital would have billed me directly but I have no clue what that would have been. And of course they gouge visitors to help balance the budget, just as American hospitals do for people who aren’t part of an insurance scheme that the hospitals have to give discounts to to be “in network.”
Thing is, I didn’t really need to be seen in ER, all set up to treat heart attacks and gunshot wounds. There was just no other place to go. Years ago my old GP could have sent me for an X-Ray in his own office and then asked a surgeon to have a look at me. But my GP today is an an office 50 miles from where I broke my ankle on the way to work downtown. If I’d called her she would have told me to go next door to ER. They looked after me well. I was back at work by noon, on crutches.
I’ve been paying for “health services” - physiotherapy, hospital stays, drugs, massage therapy, orthotics, eye glasses - for as long as I can remember. I know too many people who have gone to Montreal for a new knee or hip. The Canadian health care system is a mish-mash of “someone pays” services. Seems to me though that the more “free” it is, the harder it is to get it. I don’t care anymore who pays, I just want to be able to get it when I need it. Thank God I can afford it. Sadly, too many can’t. That’s a recipe for a revolution.
Staunch conservatives will have to explain how it’s acceptable for SunLife and their huge profit margins to be running our healthcare system when it’s simultaneously unacceptable for other industries (like sectors of our food supply) to have the same outcome. The overselling and variability of services in dentistry in particular is absurd. I can pay cash to have my cavity filled for significantly less than what is billed to private insurance, which is again, the same inflationary practices that other industries of accused of.
Staunch conservatives should oppose all forms of health insurance, public and private, because insurance encourages the provision of unnecessary services — if it’s free you have no price resistance and will buy more service than you need or can afford. It also encourages cost inflation by unscrupulous providers unless prices are rigidly controlled and regulated, as for doctor fees in Canada. The dentists will be next. And all forms of public health insurance require tax increases or more borrowing or both. Expanding private insurance eventually requires that everyone be forced to buy it, to protect the insurance company from adverse selection. This in effect allows insurance companies to impose and collect their own taxes on people with, in this case, good teeth who don’t want to buy dental insurance.
I should have said we oppose *compulsory* forms of health insurance, like tax-funded public and legally mandated private insurance.
You are not required to have fire insurance on your house if it is not mortgaged. The fire insurance on a mortgaged house is to protect the security of the mortgagee. If you were independently wealthy and could afford to rebuild your own paid-off house with your own money you are free to do so. Risky, though. You do have to pay municipal taxes to support the fire department....even though most house fires occur in poor neighbourhoods where renters and squatters pay very little property tax.
You have to have third-party liability insurance on your car because you can hurt other people if you cause a crash and their damages need to be paid. No third parties suffer if your teeth fall out or if you have diabetes. You don’t have to carry collision insurance on your car. I don’t because it’s old and fully depreciated.
The way we pay health insurance now it’s as if under fire insurance the insurance company paid to replace light bulbs and furnace filters and paid your gas bill and electricity and cleaning lady for you, as well as repairing fire damage and other catastrophes....with no deductible! And you could rebuild your house better than new with no limits on what the insurance had to pay. Health insurance, if mandatory through taxes, should cover only catastrophic illnesses the way fire insurance does and there’s should be some reasonable limit. People should save up through their lives to pay their own chronic medical needs as they get old and decrepit. Doctors would face price resistance and this would keep costs down as doctors competed for the business.
But comprehensive free cradle-to-grave health, dental, and drug insurance (and physio, and home nursing, and ...!). No way. We aren’t young enough, healthy enough, or wealthy enough to do that. We might have been once, but not today.
That's the thing, Canadians loathe paying for their health care but we aren't wealthy enough anymore to provide universal health care on a no fee basis.
Susan, I am not a "staunch conservative" although I marginally lean to the right. However ....
I take great issue with your idea that conservatives "should oppose all forms of health insurance ...." That assertion is similar to arguing that a conservative should not have insurance on their house or their car. The point of insurance is NOT to give you free stuff but to recognize - and pay - a price. The insurance is simply a way to take into account that there is a cost and to ensure that you get the required service (house repair after fire; auto repair after accident; dental, etc. service needed; and so forth) at a reasonable cost.
Clearly, there is a cost to private insurance and by splitting the potential for claims among all subscribers the resulting repairs, etc. are more modest. In other words, there is no free lunch; reduced cost, perhaps, but not free.
But not controlled by government regulation the way physicians’ fees are. The dentists set their own fees by peer pressure or self-regulation only. A lot of people may not know that physician fees are regulated by the government because they never see a doctor bill. They only hear about what the media call doctors’ “salaries”.
Right, which is essentially price-fixing no? Btw my point was not that the author was necessarily a staunch conservative, but certainly this publication has many followers who are such. And we just saw a few pieces that feature a railing against the dairy “cartel” - to which most responders agreed should be abolished. I just don’t see why it’s okay to shift profits from front-line workers and professionals to insurance companies in this particular case. Actually, I do, it’s because those profits will boost readers’ investment portfolios.
Well, yes. I invest in SunLife so I am thrilled they are making a good return off dental insurance. Now that I’m retired I don’t pay much income tax so I might even be making more from my SunLife stock than I pay for dental insurance in taxes. Which I can’t use anyway because our income as a couple is more than $90,000. We pay cash out of pocket. I’m kind of starting to like American ideas in healthcare. If they won’t let you make a claim off the insurance at least you can share in the profits of the insurance company. Not just for plutocrats, you know. Lots of widows and orphans own insurance company stock because it is safe and lucrative. Nothing to stop you from investing, too.
SunLife and the like might not do so well if they weren’t reaping profits from tax-payer funded, civil servants, teachers etc.? I definitely would rather see higher wages in those positions and private insurance axed - The public is paying premiums for services that aren’t necessarily needed or even evidence-based.
Not sure I agree about home insurance regardless of mortgage, it would cost us all when lower-middle class folks are put on the street when their house burns down. So catastrophic insurance and liability is a must (especially as we have children in those situations to protect).
Again it’s also those lower-middle income folks who don’t benefit from the stock market. So I’d rather see their healthcare needs met by reducing administrative bloat in the public system. My problem with private healthcare has always been the insurance companies and the challenge of preventing brain-drain from the public system. There’s a huge philosophical dilemma if the poor are set up to receive inferior care.
Canadian health care is "narrow but deep", the product of a compromise between universality and fee for service focused on physicians and hospitals. (And a further compromise built around federal transfers and the Canada Health Act). Which is why it is stuck in a rut of sorts: it is difficult to reliably extend that to "broad and deep". To me it has always made sense to put an outer ring around core Medicare that looks more like the European models of public funded and privately delivered dental, vision, home and drug care. This is not "two tier" in the sense of abandoning equity; it would actually improve equity overall as people without unions or company plans can get a public option. And it would dovetail with existing private plans, easing the transition away from jobs and into retirement etc.
Right you are, Ken. (And the symbol for sarcasm is /s, FYI). We already have two-tier health care though, the private tier is the USA. If, that is, you have any money, can travel, are willing to post your medical particulars on a bidding site, and can get travel medical tourism insurance (not available over age 65). I'd rather just bring that tier back to Canada so they pay taxes and buy services here. Hell, maybe we could actually grow the economy by attracting medical "tourists" ourselves some day. Could also lure a lot of our doctors and nurses out of pandemic-induced retirement or back from their emigration...
Agree with you. The supply demand law of economics says that the higher the price the lower the demand. So something free has infinite demand forcing rationing based on some criteria like expected remaining life, bribes, nepotism, sexual favors, befriending someone in the political party in power or a combination of the above. Not sure how a revolution would work though. The Russian revolution and the Soviet system that followed had exactly the same result as the current Canadian health care model.
My own view is that competition will result in more supply and lower(ish) prices. I get my dental work at Los Algodones México (across from Yuma AZ) at about 1/6 the cost of the same work in Canada, with US trained dentists, much more modern equipment than in Canada no waiting for crowns etc. There are about 400 dental practices in this smallish town so you have real competition. Some of the practices are owned by US dentists who can offer competitive rates in Mexico because they are not gouged by liability insurers.
Absolutely not. The Canadian Dental plan is the embodiment of the worst of the American system. Administered by a for-profit insurance company, eligibility has more loop holes than a shag rug.
Hi Susan, As a very long time taxpayer, what counts is value for money. Nothing is actually 'free' and the Dental Plan is one of worst planned and administered programs of a government who has a string of them.
Not sure that value for money is sufficient for counting. Chicken may give better value for money than scallops but it doesn’t mean you can afford an infinite amount of chicken for everyone who wants you to buy it for them. For the people demanding free chicken to say, “Be thankful we’re not demanding you buy us scallops” is cold comfort. In a steeply progressive tax system where almost all income taxes are paid by a small percentage at the top, a social program really can be free. Neither the beneficiaries nor the low-tax bystanders see any money coming out of their pockets to pay for it but feel good about themselves that the poor elderly are getting their teeth fixed. Galen Weston’s family pays for it all.
I don’t disagree that the dental coverage was poorly conceived, being thrown together just to keep the NDP from abandoning the C & S agreement...which they then did anyway. My question to you is, Should the new government expand it or cancel it?
The problem with your analogy is that it does not consider the issue of how redistribution affects productivity. The question is not whether chicken is better value than scallops but whether the chicken realizes greater economic output value when involuntarily distributed from one economic stakeholder to another.
A "free" cancer screening is an economic transaction that produces some economic loss amongst taxpayers. But if the consequence of the free cancer screening is that a low-income individual accesses said screening where they would not have done so otherwise (in a sufficiently timely manner), then said individual by virtue of their longer lifespan plausibly produces greater economic output than they otherwise would have without the "free" screening. In that case, the taxpayer is still a net loser to the transaction, but this loss is more than offset by gains to the recipient and other economic actors.
So the actual value-for-money question is not how the public spending on cancer screenings compares to other potential government spending, but whether the publicly-paid cancer screenings solve a market inefficiency so as to improve general economic productivity.
That might be true and your argument holds in theory. My direct experience, though, is that health screening programs never incorporate into decision-making the possible taxes paid "back" by individuals saved from premature death by early diagnosis. The closest we come to value for money is estimating how much it will cost to save a year of life, *if* the screening program has indeed been shown to prevent untimely death. (Not all have, and that is another topic. Let's assume for economic purposes that screening "saves lives.") We don't try to estimate the taxes paid or income earned by the extra survivors, though. We do one of two things: we assign an economic value to a theoretical average life, arrived at by analysis of some fascinating trade-off literature, and compute whether we broke even or not. Or we just compute the cost per quality-adjusted life-year "saved" and quote that as dollars per QALY without trying to estimate the actual value of the life. This latter approach leaves it up to the resource allocators whether, say, $100,000 per QALY is a reasonable outlay.
When you look at these numbers in a cold light, you find that almost everything we do in medicine/public health, including screening and vaccination, is disappointingly expensive for the life value achieved (compared to, say, not getting fat and not smoking.) Even if you assume that all the "saved" lives grow up to be richly productive taxpayers or child raisers (aka mothers), you'd never come out ahead in dollars and cents. The best you can say for really good screening and vaccination programs -- these are almost all applied to children with many QALYs ahead of them -- is that they prevent disability and early death at an acceptable net cost. But none of them are known to improve general economic productivity so that society makes money off them. You don't save money by getting rid of measles -- it seriously harms only a few children and MMR vaccine given to every child in the country year after year is not cheap -- but it's still a good, affordable thing to do. Yet it must compete for tax dollars with other things government has to allocate resources to. And you don't save money by screening for even those cancers where early diagnosis actually does save lives. (We don't talk like this at work, but offering free screening to poor people is an even worse economic bet because *those people* won't end up paying much in income taxes anyway, whether they live long or die young. We just want to help them not get cancer of the cervix, a poor woman's cancer. Even still, even with free screening for all, wealthy women get more Pap screenings despite their much lower risk of getting cervix cancer. This remains a frustrating refractory inequity in cancer.)
Hence it is like chicken vs. scallops. A "chicken" screening program may give better value for money than a "scallop" program but because you still have to lay out net dollars for the chicken, you can't do an arbitrarily large program and expect it to be self-funding, even in the long run. All you can do, with limited resources, is choose the chicken program over the scallop program as delivering more bang for the buck. But the bucks are still limited because the payback in bucks is negligible.
Taxing the wealthy to give free real chicken to everyone who can't afford it might improve over-all productivity. I grant you that. Scallops perhaps not.
Good day Ken Boessenkool. Thanks for the article. I agree with most of your points on this, however, if you look at the drug plan that people over the age of 65 get in Ontario, we can claim the same things. It is not inclusive as it's eligibility is determined by age and not all drugs are covered so can be deemed as not being comprehensive. In Canada and specifically Ontario we pay over 50% of our disposable income to taxes. If the drug and dental plans were all inclusive and comprehensive the costs would be significant, where would the funds come from to pay for it?
As far as I can tell we have it pretty bad as we pay very high taxes and then don’t get the service we supposedly are paying the high taxes for. I balk at the answer to just fly to US and pay for it again. There has to be another way.
I guess my answer would be "neither". Just clean up the administration of the existing program. As you know, once a service is in place, it takes several bulldozers and the loss of a lot of votes to remove it.
So,from personal experience this year : 3 trips to dentist [required prior to radiation], total bill just over 1500, cost to me 100 and change. Works for me however you slice it , Dippers and Liberals notwithstanding.
The issue with Canada's ban on necessary health services isn't that it is based on economic justification, it's that it is based on a belief of a zero-sum world. It's inherently classist. They think they are taking from the "rich" to give to the "poor." It's so naive it hurts.
Interesting thought. I disagree about the healthcare piece more broadly though. I think if our leaders had more imagination they could craft public healthcare that looked more like the Norwegian country’s public system. Government funded but privately provided and competitive. I’ve increasingly come to believe that many public health groups across Canada are management heavy and not getting good value for the money.
But Canadian healthcare is privately provided now. Doctors are independent private-sector business people (or, rarely in Canada, employees of private-sector corporations, most of these being university medical schools.) Almost no doctors are civil servants. Hospitals are, except for provincial psychiatric hospitals, private not-for-profit corporations with voluntary boards. Unlike doctors, they receive almost all their income as a global budget from tax money that is meticulously regulated by the provincial Ministry of Health, which exerts a constraint on the volume of service that they can provide. So how, exactly, is this different from Norway? I don’t know. I’m asking. Does Norway allow hospitals to bill the government for every service they sell, the way the Americans do, and the way our doctors do? That sounds like a recipe for runaway cost explosion.
Ive not researched it in depth because quite frankly, most Canadians would resist any change to public health care. But my understanding is it’s the best of both worlds from someone who lived over there.
There’s not much pay difference between US and Canadian doctors. Where most expenses come up for US healthcare is unexpected hospitalization and emergency treatment or things like cancer care. A broken ankle costs just shy of $3000 in the US (without surgery but counting ortho consult, x rays, crutches, air cast, physio instructions on using crutches, and emergency room treatment) I’d guess the amount actually billed to Alberta health for a similar visit is not that far off.
I am directly involved in one aspect of healthcare in the US so have a pretty clear view of one tiny piece of the US puzzle. The care in the US is quite different than in Canada for some things. And for others it’s identical but without the long wait times. There has to be a way to do things better in Canada.
Good. Fast. Cheap. Pick any two. It might not be possible to make things any “better” in Canada or anywhere. It all involves choices and trade-offs. I think we Canadians thought we had scored the hat trick back in the 1980s where we were the envy of the world. All we had to do was stamp out extra-billing and we’d be in paradise. Now, not so much. “Good”, most of the time. Not fast and not cheap. The price of each service is pretty OK cheap but we try to provide a vast number of them free to everyone. But we are still the second most expensive system, per capita, in the G20 even with the efficiencies of public administration. The U.S. is #1 by a long way ahead of course.
Thanks for admitting you don’t really know what you’re talking about with Norway. It is hard to compare a foreign country when you don’t live there. Here in Ontario, the emergency doctor got maybe $50 for seeing me for my broken ankle and the orthopaedic surgeon less than $100 for the consult, plus I think three fracture clinic follow-up visits at, say, $35 each if no surgery. (If I had needed surgery the post-op follow-up is included in the surgical fee.). Plus a few bucks to the radiologist for reading the X-rays. I paid for air cast and crutches out of pocket. If I had needed physio at $50 a visit, (9 years ago), or drugs, that would have been out of pocket, too. I’m self-employed. The hospital ER where I went didn’t charge Ontario Health anything for my visit, or for the fracture clinic. It just came out of the global budget. As in the U.S., that would have been by far the largest cost — a lot of unionized labour to pay — but it’s almost impossible to measure specifically for one episode. If I’d been a non-resident visitor, the hospital would have billed me directly but I have no clue what that would have been. And of course they gouge visitors to help balance the budget, just as American hospitals do for people who aren’t part of an insurance scheme that the hospitals have to give discounts to to be “in network.”
Thing is, I didn’t really need to be seen in ER, all set up to treat heart attacks and gunshot wounds. There was just no other place to go. Years ago my old GP could have sent me for an X-Ray in his own office and then asked a surgeon to have a look at me. But my GP today is an an office 50 miles from where I broke my ankle on the way to work downtown. If I’d called her she would have told me to go next door to ER. They looked after me well. I was back at work by noon, on crutches.
I’ve been paying for “health services” - physiotherapy, hospital stays, drugs, massage therapy, orthotics, eye glasses - for as long as I can remember. I know too many people who have gone to Montreal for a new knee or hip. The Canadian health care system is a mish-mash of “someone pays” services. Seems to me though that the more “free” it is, the harder it is to get it. I don’t care anymore who pays, I just want to be able to get it when I need it. Thank God I can afford it. Sadly, too many can’t. That’s a recipe for a revolution.
I agree free and unavailable is worth nothing.
I am happy to pay as long as it is available.
Staunch conservatives will have to explain how it’s acceptable for SunLife and their huge profit margins to be running our healthcare system when it’s simultaneously unacceptable for other industries (like sectors of our food supply) to have the same outcome. The overselling and variability of services in dentistry in particular is absurd. I can pay cash to have my cavity filled for significantly less than what is billed to private insurance, which is again, the same inflationary practices that other industries of accused of.
Staunch conservatives should oppose all forms of health insurance, public and private, because insurance encourages the provision of unnecessary services — if it’s free you have no price resistance and will buy more service than you need or can afford. It also encourages cost inflation by unscrupulous providers unless prices are rigidly controlled and regulated, as for doctor fees in Canada. The dentists will be next. And all forms of public health insurance require tax increases or more borrowing or both. Expanding private insurance eventually requires that everyone be forced to buy it, to protect the insurance company from adverse selection. This in effect allows insurance companies to impose and collect their own taxes on people with, in this case, good teeth who don’t want to buy dental insurance.
I should have said we oppose *compulsory* forms of health insurance, like tax-funded public and legally mandated private insurance.
You are not required to have fire insurance on your house if it is not mortgaged. The fire insurance on a mortgaged house is to protect the security of the mortgagee. If you were independently wealthy and could afford to rebuild your own paid-off house with your own money you are free to do so. Risky, though. You do have to pay municipal taxes to support the fire department....even though most house fires occur in poor neighbourhoods where renters and squatters pay very little property tax.
You have to have third-party liability insurance on your car because you can hurt other people if you cause a crash and their damages need to be paid. No third parties suffer if your teeth fall out or if you have diabetes. You don’t have to carry collision insurance on your car. I don’t because it’s old and fully depreciated.
The way we pay health insurance now it’s as if under fire insurance the insurance company paid to replace light bulbs and furnace filters and paid your gas bill and electricity and cleaning lady for you, as well as repairing fire damage and other catastrophes....with no deductible! And you could rebuild your house better than new with no limits on what the insurance had to pay. Health insurance, if mandatory through taxes, should cover only catastrophic illnesses the way fire insurance does and there’s should be some reasonable limit. People should save up through their lives to pay their own chronic medical needs as they get old and decrepit. Doctors would face price resistance and this would keep costs down as doctors competed for the business.
But comprehensive free cradle-to-grave health, dental, and drug insurance (and physio, and home nursing, and ...!). No way. We aren’t young enough, healthy enough, or wealthy enough to do that. We might have been once, but not today.
That's the thing, Canadians loathe paying for their health care but we aren't wealthy enough anymore to provide universal health care on a no fee basis.
Susan, I am not a "staunch conservative" although I marginally lean to the right. However ....
I take great issue with your idea that conservatives "should oppose all forms of health insurance ...." That assertion is similar to arguing that a conservative should not have insurance on their house or their car. The point of insurance is NOT to give you free stuff but to recognize - and pay - a price. The insurance is simply a way to take into account that there is a cost and to ensure that you get the required service (house repair after fire; auto repair after accident; dental, etc. service needed; and so forth) at a reasonable cost.
Clearly, there is a cost to private insurance and by splitting the potential for claims among all subscribers the resulting repairs, etc. are more modest. In other words, there is no free lunch; reduced cost, perhaps, but not free.
Dentist fees are also already controlled with a yearly “fee guide”
But not controlled by government regulation the way physicians’ fees are. The dentists set their own fees by peer pressure or self-regulation only. A lot of people may not know that physician fees are regulated by the government because they never see a doctor bill. They only hear about what the media call doctors’ “salaries”.
Right, which is essentially price-fixing no? Btw my point was not that the author was necessarily a staunch conservative, but certainly this publication has many followers who are such. And we just saw a few pieces that feature a railing against the dairy “cartel” - to which most responders agreed should be abolished. I just don’t see why it’s okay to shift profits from front-line workers and professionals to insurance companies in this particular case. Actually, I do, it’s because those profits will boost readers’ investment portfolios.
Well, yes. I invest in SunLife so I am thrilled they are making a good return off dental insurance. Now that I’m retired I don’t pay much income tax so I might even be making more from my SunLife stock than I pay for dental insurance in taxes. Which I can’t use anyway because our income as a couple is more than $90,000. We pay cash out of pocket. I’m kind of starting to like American ideas in healthcare. If they won’t let you make a claim off the insurance at least you can share in the profits of the insurance company. Not just for plutocrats, you know. Lots of widows and orphans own insurance company stock because it is safe and lucrative. Nothing to stop you from investing, too.
SunLife and the like might not do so well if they weren’t reaping profits from tax-payer funded, civil servants, teachers etc.? I definitely would rather see higher wages in those positions and private insurance axed - The public is paying premiums for services that aren’t necessarily needed or even evidence-based.
Not sure I agree about home insurance regardless of mortgage, it would cost us all when lower-middle class folks are put on the street when their house burns down. So catastrophic insurance and liability is a must (especially as we have children in those situations to protect).
Again it’s also those lower-middle income folks who don’t benefit from the stock market. So I’d rather see their healthcare needs met by reducing administrative bloat in the public system. My problem with private healthcare has always been the insurance companies and the challenge of preventing brain-drain from the public system. There’s a huge philosophical dilemma if the poor are set up to receive inferior care.
Interesting insight
Canadian health care is "narrow but deep", the product of a compromise between universality and fee for service focused on physicians and hospitals. (And a further compromise built around federal transfers and the Canada Health Act). Which is why it is stuck in a rut of sorts: it is difficult to reliably extend that to "broad and deep". To me it has always made sense to put an outer ring around core Medicare that looks more like the European models of public funded and privately delivered dental, vision, home and drug care. This is not "two tier" in the sense of abandoning equity; it would actually improve equity overall as people without unions or company plans can get a public option. And it would dovetail with existing private plans, easing the transition away from jobs and into retirement etc.
Right you are, Ken. (And the symbol for sarcasm is /s, FYI). We already have two-tier health care though, the private tier is the USA. If, that is, you have any money, can travel, are willing to post your medical particulars on a bidding site, and can get travel medical tourism insurance (not available over age 65). I'd rather just bring that tier back to Canada so they pay taxes and buy services here. Hell, maybe we could actually grow the economy by attracting medical "tourists" ourselves some day. Could also lure a lot of our doctors and nurses out of pandemic-induced retirement or back from their emigration...
Agree with you. The supply demand law of economics says that the higher the price the lower the demand. So something free has infinite demand forcing rationing based on some criteria like expected remaining life, bribes, nepotism, sexual favors, befriending someone in the political party in power or a combination of the above. Not sure how a revolution would work though. The Russian revolution and the Soviet system that followed had exactly the same result as the current Canadian health care model.
My own view is that competition will result in more supply and lower(ish) prices. I get my dental work at Los Algodones México (across from Yuma AZ) at about 1/6 the cost of the same work in Canada, with US trained dentists, much more modern equipment than in Canada no waiting for crowns etc. There are about 400 dental practices in this smallish town so you have real competition. Some of the practices are owned by US dentists who can offer competitive rates in Mexico because they are not gouged by liability insurers.
Absolutely not. The Canadian Dental plan is the embodiment of the worst of the American system. Administered by a for-profit insurance company, eligibility has more loop holes than a shag rug.
You must not be a taxpayer. Free everything for everybody is great until the taxpayers run out of money they are willing to give you.
Hi Susan, As a very long time taxpayer, what counts is value for money. Nothing is actually 'free' and the Dental Plan is one of worst planned and administered programs of a government who has a string of them.
Not sure that value for money is sufficient for counting. Chicken may give better value for money than scallops but it doesn’t mean you can afford an infinite amount of chicken for everyone who wants you to buy it for them. For the people demanding free chicken to say, “Be thankful we’re not demanding you buy us scallops” is cold comfort. In a steeply progressive tax system where almost all income taxes are paid by a small percentage at the top, a social program really can be free. Neither the beneficiaries nor the low-tax bystanders see any money coming out of their pockets to pay for it but feel good about themselves that the poor elderly are getting their teeth fixed. Galen Weston’s family pays for it all.
I don’t disagree that the dental coverage was poorly conceived, being thrown together just to keep the NDP from abandoning the C & S agreement...which they then did anyway. My question to you is, Should the new government expand it or cancel it?
The problem with your analogy is that it does not consider the issue of how redistribution affects productivity. The question is not whether chicken is better value than scallops but whether the chicken realizes greater economic output value when involuntarily distributed from one economic stakeholder to another.
A "free" cancer screening is an economic transaction that produces some economic loss amongst taxpayers. But if the consequence of the free cancer screening is that a low-income individual accesses said screening where they would not have done so otherwise (in a sufficiently timely manner), then said individual by virtue of their longer lifespan plausibly produces greater economic output than they otherwise would have without the "free" screening. In that case, the taxpayer is still a net loser to the transaction, but this loss is more than offset by gains to the recipient and other economic actors.
So the actual value-for-money question is not how the public spending on cancer screenings compares to other potential government spending, but whether the publicly-paid cancer screenings solve a market inefficiency so as to improve general economic productivity.
That might be true and your argument holds in theory. My direct experience, though, is that health screening programs never incorporate into decision-making the possible taxes paid "back" by individuals saved from premature death by early diagnosis. The closest we come to value for money is estimating how much it will cost to save a year of life, *if* the screening program has indeed been shown to prevent untimely death. (Not all have, and that is another topic. Let's assume for economic purposes that screening "saves lives.") We don't try to estimate the taxes paid or income earned by the extra survivors, though. We do one of two things: we assign an economic value to a theoretical average life, arrived at by analysis of some fascinating trade-off literature, and compute whether we broke even or not. Or we just compute the cost per quality-adjusted life-year "saved" and quote that as dollars per QALY without trying to estimate the actual value of the life. This latter approach leaves it up to the resource allocators whether, say, $100,000 per QALY is a reasonable outlay.
When you look at these numbers in a cold light, you find that almost everything we do in medicine/public health, including screening and vaccination, is disappointingly expensive for the life value achieved (compared to, say, not getting fat and not smoking.) Even if you assume that all the "saved" lives grow up to be richly productive taxpayers or child raisers (aka mothers), you'd never come out ahead in dollars and cents. The best you can say for really good screening and vaccination programs -- these are almost all applied to children with many QALYs ahead of them -- is that they prevent disability and early death at an acceptable net cost. But none of them are known to improve general economic productivity so that society makes money off them. You don't save money by getting rid of measles -- it seriously harms only a few children and MMR vaccine given to every child in the country year after year is not cheap -- but it's still a good, affordable thing to do. Yet it must compete for tax dollars with other things government has to allocate resources to. And you don't save money by screening for even those cancers where early diagnosis actually does save lives. (We don't talk like this at work, but offering free screening to poor people is an even worse economic bet because *those people* won't end up paying much in income taxes anyway, whether they live long or die young. We just want to help them not get cancer of the cervix, a poor woman's cancer. Even still, even with free screening for all, wealthy women get more Pap screenings despite their much lower risk of getting cervix cancer. This remains a frustrating refractory inequity in cancer.)
Hence it is like chicken vs. scallops. A "chicken" screening program may give better value for money than a "scallop" program but because you still have to lay out net dollars for the chicken, you can't do an arbitrarily large program and expect it to be self-funding, even in the long run. All you can do, with limited resources, is choose the chicken program over the scallop program as delivering more bang for the buck. But the bucks are still limited because the payback in bucks is negligible.
Taxing the wealthy to give free real chicken to everyone who can't afford it might improve over-all productivity. I grant you that. Scallops perhaps not.
Yeah. I think he was being sarcastic there. We're on the same page.
I hope so. I have always appreciated all Ken's previous postings.
LOL. Thanks, Ken. I enjoyed that thoroughly!
Hi Matt & Jen
I just subscribed to the Line
I enjoy you opinions and thoughts
It’s easy to see Alberta / Ontario mind set between both of you
I really wanted to ask a question
For the next podcast. Matt has shut down questions but I will ask anyways 🤞🤞
My question is : part 1
Who do you think Justin Trudeau is actually working for ?
Its beyond obvious it’s not the Canadian people.
Part 2
Do you think the liberal MPs realize they have destroyed the country on purpose?
Even if you answer back in text be great 👍
New Subscriber
Beau Johnston
Saskatoon
Good day Ken Boessenkool. Thanks for the article. I agree with most of your points on this, however, if you look at the drug plan that people over the age of 65 get in Ontario, we can claim the same things. It is not inclusive as it's eligibility is determined by age and not all drugs are covered so can be deemed as not being comprehensive. In Canada and specifically Ontario we pay over 50% of our disposable income to taxes. If the drug and dental plans were all inclusive and comprehensive the costs would be significant, where would the funds come from to pay for it?
As far as I can tell we have it pretty bad as we pay very high taxes and then don’t get the service we supposedly are paying the high taxes for. I balk at the answer to just fly to US and pay for it again. There has to be another way.
I guess my answer would be "neither". Just clean up the administration of the existing program. As you know, once a service is in place, it takes several bulldozers and the loss of a lot of votes to remove it.
So,from personal experience this year : 3 trips to dentist [required prior to radiation], total bill just over 1500, cost to me 100 and change. Works for me however you slice it , Dippers and Liberals notwithstanding.
The issue with Canada's ban on necessary health services isn't that it is based on economic justification, it's that it is based on a belief of a zero-sum world. It's inherently classist. They think they are taking from the "rich" to give to the "poor." It's so naive it hurts.