Posted by  Jon Whitelaw, at 3:29 p.m.  

We don't have enough doctors because a lot of them are moving to the US (ie. brain drain). If we can stop this, there will be more doctors in Canada. Sure doctors would choose private over public but the number of rich in the country is limited. The number of actual private doctors hired will only be dependent on the number of sick rich. Similar to the private highschools in this country, many public teachers would love to go to private schools, but there is only so many positions as the people who can afford this luxury are limited. To say that doctors in the public system would quit and sit at home waiting for a private clinic to hire them makes no sense at all.

With private healthcare, the universal system is MORE accessible as the poorer are not waiting for millionaires who can afford to pay tax for the system in addition to their own private treatment are not making longer lines or taking free healthcare.

Two-tier healthcare at first seems like it is favouring the rich, but in the end it will benifit everybody who uses the system. More doctors, less lines, lower costs, etc. This is not just for the rich, but the poor as well.

With respect to Lance Armstrong, he is an american where private healthcare is the norm and where the system was made to be dependent on private care. Two-tier is a totally different concept. The proposed system has universal coverage for all people, and millionaires are still eligible for this care. The only difference is the rich can opt to pay for another care giver.

Lots of areas survive and work well having a public mainstream system and a parallel private system. Take private secondary school, take public transit, take security companies. Should rich people all take public transportation as it is unfair for those who cannot afford charter buses or cars? Should businesses not be allowed to install security guards, security systems, or body guards as this gives more protection than the average citizen than public police coverage? Sure body guards are paid much better than police, but the number of positions are limited as they only serve the rich. Policemen do not sit at home waiting for a bodyguard position to open, as it pays more.

How do you propose we stop losing doctors to the brain-drain?

"In 1996, 731 physicians left Canada. Although another 218 doctors returned, the net loss was 513 physicians — a number roughly equivalent to 30% of the annual output from Canada's 16 medical schools."

Posted by  Anonymous, at 4:58 p.m.  

There are other ways of avoiding brain drain; the option of forgiving student debt if they stay in Canada after graduation, for example, and other types of incentives.

I'm with Stef. The only sort of "two-tiered" system I'd ever be in favour of would be a sort of sliding-scale payment system, where if you make enough that you can easily pay for the treatment you're seeking, than you do so. (i.e. if you're a millionaire, you pay for the treatment, leaving provincial resources less strained for the less fortunate.) But that's not the type of tiered system you're talking about.

Posted by  Jon Whitelaw, at 5:27 p.m.  

Forgiving debt and spending more to keep doctors here is quite costly, especially for a system that is already tight on cash. Having a parallel private system allows companies to invest capital into the healthcare system though the incentive of profits from customers. The government would basically be receiving free care for the wealthy as some will opt for the private care.

The government can only do so much as they offer services with no return, for investment to increase to levels where lines are actually shortened, doctors don't leave, and costs are lowered, we need private investors in the form of private clincs.

The problem with the idea of a "sliding-scale", is it forces those who would not opt for the private care to increase their care costs.

For example you could have a family who are technically rich based on income, but have several kids going through university, maybe some poor investments in the stock market, a massive mortgage on an expensive house, large car payments, etc. This family if they get in a car accident for example should not have to foot the bill for everyone to get care.

The benifit of the system I am proposing is that it is a choice. Pay for the service if you want it. Similar to public and private high school, the rich have a choice to send their kids to a private school or public, they should not have to pay extra for public school as it should be as stef said: universally accessible. Under this system, everyone has access to free, government provided, mainstream quality healthcare. The only difference is the decreased costs, less brain drain, and shorter waiting lines.

Fact is, Canada has two-tiered healthcare, so do most developed countries, this is not a US idea, it is a european/canadian idea.
Ontario is the only major province not to allow private clinics. I think we are missing out on a great opportunity to help all canadians looking for healthcare.

Thanks for the responses ladies :)

Posted by  Jon Whitelaw, at 5:47 p.m.  

In response to stef, yes we are talking about human lives. Under this sort of healthcare reform, we are improving care for all canadians, increasing accessibility, and putting relief on the public system.

My analogy to security is very similar as it is saving lives as well. This is the purpose of the body guard, save the person's life when put in danger. This rich person is getting better protection than the public offered police system. It is a small number of people that take advantage of this as there are only a few rich and has little or no effect on the rest of the public. Execept the police do not have to waste forces on protecting this one person.

I 100% agree that people should not pay for healthcare. I'm saying that the rich leaving the public system will allow the public system to do more for the mainstream healthcare recipiants.

For example, lets say canada allows private clinics in ontario, instead of spending money caring for 100 patients, 2 may decide to go to a private clinic (as they are rich, can afford it, and made this choice). Not only are these rich people buying an MRI for them to use, but the public/government system just saved the cost of paying 2 people's care. They can use this money to buy another MRI or increase the public (vast majority) doctors. Then because those 2 rich people left the line waiting for a scan, the poorer people behind them get faster service. Also, because the 2 people who left the line to go to the private hospitol, they are paying the many doctors that would have gone to the US, to stay in Canada.

The problem with our system is that by paying for everyone, the poor and rich both get the shaft. Both have to wait for each other to get care as the government has very limited funds. There is a limit to how much we can spend on this universal system, and we see this in the waiting lines that people have to put up with. Private investment can seriously help our system, we should embrace it for the benifit of all canadians.

Stef: Questions. Do you think we have universal school in canada?
Do you think we have universal healthcare in canada.
Why do you think the provinces who know how to operate healthcare in canada (Saskatchewan being the inventor with a perminent NDP gov't in power, Quebec being one of the most socialist states in North America) have almost all opted to allow private clinics?

Posted by  Anonymous, at 8:51 p.m.  

Some of your logic is flawed, Jon - the comparison with private education is problematic in a couple of ways.

One - health care, and everyone's equal right to access to health care, can be a bit more imperative than that of education; for example, if the child of a poor family has a similar affliction to the child of a wealthy one, and the wealthy child gets the treatment only because their parents can pay more, the poor child may not ever get to reach an age where whether they get to go to private school or public school.

Furthermore, you say that not all doctors will be able to enter the private sphere: "Sure doctors would choose private over public but the number of rich in the country is limited. The number of actual private doctors hired will only be dependent on the number of sick rich. Similar to the private highschools in this country, many public teachers would love to go to private schools, but there is only so many positions as the people who can afford this luxury are limited. To say that doctors in the public system would quit and sit at home waiting for a private clinic to hire them makes no sense at all." Well, exactly. The thing about teachers though, is that they are paid comparatively well here; when education students leave Canada, it is usually because they were unable to find a position here in this country, and need to seek opportunity elsewhere. The same cannot be said for health care; the reason behind the medical brain drain is that doctors are better paid elsewhere.

So, yes - you institute the tiered system. The doctors who can enter the private system, do; those who don't, still leave. So there might not be more doctors for the public sphere - more doctors for those who can afford more expensive care, but not necessarily for those who can't.

It may be expensive for solutions such as debt relief - I'd have to get numbers on it, but it quite possibly would not be prohibitively so. A number of students I know who are going to medical school do not have need of loans. And not all students who have loans would take advantage of that option. But I'm willing to bet that there would be fraction of graduates who would take advantage of that option (which I feel is a fair deal - they're staying to serve the health and lives of the citizens who helped pay for their education, seems like a fair trade) which would perhaps be a similar number to that of the number of doctors who would enter the private field if two-tiered was introduced. They stay in Canada, settle into their lives here, and their income stays within our economy. Seems like a good deal.

But the main thing is, there must be incentive to work in the public health field for our system to work - not merely dangling the carrot of private care. There are a number of other options; tax-exemption for a set number of years after graduation, for example (the only thing a conservative representative ever suggested that I thought had any merit at all), which again gives doctors 10 years to get their lives entrenched up here in the snowy north, so they're more likely to stay here in the long term.

I've also been kicking around ideas for extra funding - but I'd doubt that you'd agree with them. I'm of the personal opinion that industry that contributes to mass public ill health ought to pay a tax directly to the health care coffers. Tobacco companies, for one, for purposely including addictive properties to a product that is a main catalyst for a myriad of health concerns that taxpayers now must pay out of pocket to help heal people. Companies that pollute air and water, emit greenhouse emissions, coal and oil - all environmental factors that contribute to long-term health complications. It would nice if some of those profits went to help heal the people they've made ill.

There also ought to be stringent anti-corruption measures taken; for example, I need a nurse to administer one of my prescriptions to me, but since I've come home, our local clinic is refusing to let one do so - they say a doctor must see me first, even though another doctor had already prescribed the medication. And what that is, is a way to bill $50 to the taxpayers that is completely unnecessary - and I've written my local MP about it, because that sort of thing adds up. The system must be universal, accessible, and efficient.

Again, I say - solutions for brain drain have to be based on making working in the public sector more attractive. It may take more creativity than slapping simplistic "free-market" theory as a universal fix-it solution, but in the long run will be more effective and morally preferable.

Posted by  Jon Whitelaw, at 10:06 p.m.  

Rachel,
I actually agree with a lot of stuff you have mentioned above. There are a few things i'd like to point out though:

Your example of the poorer kid not being able to reach school as they are not able to get the care they need, comes back to my point that even though the richer kid will get service faster; the poorer kid will also get faster and better care as the resources saved from the richer kid can be diverted to other areas of the public system to help the poorer kid (quality and waiting time).

Doctors who leave due to the brain drain do leave for higher pay, I agree. This pay can only be offered by private institutions for the prospect of profit, if we can retain most of the doctors who go to the US for more money, these addtional doctors will increase access for all Canadians (poor and rich).

"So, yes - you institute the tiered system. The doctors who can enter the private system, do; those who don't, still leave."
Yes of course but instead of hundreds of doctors leaving a year, you'd have far less as the best and brightest doctors are able to achieve the higher salary here rather than moving to the US.

While i see both proposals working that you have mentioned (loan payback/tax cut), i feel the tax break has more widespead appeal as it can be applied to all doctors, not just the ones who took out loans. Also the doctors would instantly see increased revenues on their paycheck rather than decreasing debt. (as odd as this sounds, most people pay more attention to how much they earn than how much they spend)

Those being said, I think the private system will have a much better effect than paying doctors more, it is the private investment that is the real jewel in this equation. Instantly you have more hospitols, more equipment and other facilites. This can also allow Canada to step up as a research leader, as the most respected, experienced doctors will not jump ship to the US for more money, funding and better practice. Maybe we can start to import americans and allow them to stimulate our economy instead of Canadians going to the US or Quebec for care. I'd be interested to see just how many doctors, nurses, patients, money is wasted from ontario NOT having private care.

As for your extra funding ideas: I agree that tobacco companies should be accountable if they knew what they were selling is harmful (but this has been proven). I also agree that polluters should pay for damages to people's health, if the laws were there and they broke them. Although if companies act in good judgement and have no intention of harm i have a tough time bringing them to justice as they had no evidence of wrongdoing. This becomes a problem for example with fast food, donuts, junk food. With exercise, and the odd treat, these foods can be fine. But excessive abuse of these products can cause many health problems. Does that mean Canada can sue every food producer in the country? Very difficult to say.

Also, greenhouse gases do not contribute to long term health problems. Kyoto which addresses the greenhouse gas issue has nothing to do with public health and everything to do with global warming.

Good to hear you wrote your MP about that. I am all for efficient use of goverment funds, and I'm glad you are active in helping with this. I totally agree in your situation, resolution and proposals.

Two-tier healthcare is a universal system, unless you want to argue that Quebec, Alberta, and BC do not have universal healthcare. This just allows all canadians to be better off. The more we improve the public system the better off everyone will be as well. Both can be accomplished, making all canadians better off, I don't see how helping all canadians can be deemed less moral.

Posted by  Christine, at 1:59 p.m.  

Stefanie, where are you, I would like to see another rebutt...

Posted by  Jon Whitelaw, at 6:00 p.m.  

Christine, how bout you offer some thoughts on the matter. I'm interested to hear some of your ideas! :)

Posted by  Christine, at 11:08 p.m.  

I just like to read the banter... i'm with Stef

Posted by  Jon Whitelaw, at 8:50 a.m.  

As idealistic as that sounds, the reality is while life does not have a price, healthcare does. While two-tiered healthcare does sound like a questionable concept, it exists in canada and most of the developed world, it would make everybody better off. I do not advocate private care to take advantage of it, I, like the vast majority of Canadians would use the universal, free, public healthcare offered within tiered healthcare. The rich may get better care, but as long as government does it's job similar to public education, everyone will get faster, better quality care.

Our healthcare system needs serious reform...everybody knows this, this is a very practical idea, and I hope it continues, with Quebec, BC and Alberta leading the way.

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