Perhaps because the Americans, by right of conquest, claimed they were now the legitimate government of Iraq ? And so could make all decisions for the Iraqis, big and small.
They made some very exciting decisions regarding seeds.
The example I quoted met every criteria for inclusion in the scope of the OP’s question.
Yes, Canadian dental care probably is best described as following the same model as American health care. Private pay, or if you are lucky, most “good” jobs have dental benefits. These typically cover 80% of regular dental procedures, 50% of orthodontics with yearly and lifetime maximums. Some coverage for welfare cases, elderly, etc.
The Canadian system is great in emergencies, but if something can be delayed, it will. Examples:
My boss needed a new hip. He’d broke both legs in a snowmobile accident, one leg then shorted than the other, wear away the hip. So he goes on the list for hip replacement, wait 8 months. Near that time, gets the pre-op evaluation - Xray shows two big scrws in the thigh. Duh, why do you think he needs a new hip?
So he gets off the hip list, onto another list to have the screws removed. 6 months later he gets operation, they are out. Back on the hip list -at the end. Another 6 months, finally gets his operation.
Or my wife - frequent gallstone attacks. Rules say (government insurance, must follow rules) - verify gallstones with ultrasound first. Our rural hospital says, sorry, It’s July, the ultrasound tech quit, we’re trying to hire another. Put her on the list for an ultrasound? Sorry, wont start that list until thy have a tech. Put her on the list for gall bladder removal? Sorry, not til the ultrasound. Her doctor calls a friend in a big city hospital, gets an appointment in a few weeks, operation (with 2 days notice, there’s a vacancy) within a month. about 2 moths later, local hospital cals to see if she wants an ultrasound.
The problem is bureaucracy. Quality is judged on wait times, so the priority is not speedy service but ensuring the wait list is as short as possible, so any excuse to not put you on the list.
OTOH, my wife’s grandfather at 85, slipped and fell and shattered his hip trying to open the hospital door for his wife during a doctor visit. He had a new hip by midnight. When it’s an emergency, our system is great.
but the point I make for anyone discussing this issue - Canada spends a huge proportion of its taxes on health care, and it still needs more. The difference is, we don’t have a massive military or an air force with all those cutting edge planes. (We’ve spent well over 10 years dithering back and forth about the YF35 and probably would buy very many anyway.) So consider the massive amount the USA spends on its military - that money would have to go into health care instead… and you’d have to have the doctors screaming as their fee schedules are chopped down to reasonable amounts… and hospitals are nationalized or made non-profit.
One proposal floated once in a while is that Canadians should pay a small fee for each doctor visit. (say, $20 or $35) The general feeling is that this would unfairly impact the poor; the people who can afford it aren’t going to let it slow them down, and the people who can’t, will skip going to the doctor even if they need to; so how do you set the same bar to all incomes? Basically “make em pay” is interpreted as “reduce the load on the system by discouraging people from going to the doctor when they need to.” This system apparently works well in the USA.
It was a hit and run, and I only managed to get a partial plate as I as more concerned with preventing the driver from running over my dog during his escape. My personal morality drove the decision to not spend shared resources without need.
Sorry, to get back to the OP - the concern in Canada is not outright appeal, it’s that the “death by a thousand cuts” would cause Medicare to whither away in bits and pieces as neglect causes it to be unusable. People with the means would then have no choice but to use alternate user-pay systems. It’s a constant battle.
(For example - there are only so many MRI or Xray techs. If there are private clinics siphoning these employees away from the public system, then the public system wait times suffer even more. This pushes up those employees’ wages in the public system, causing others to demand equal raises, making taxes higher, etc. etc. Or, if as previously mentioned, the private clinics do not necessarily do the required quality of work - everyone suffers. Or, they hire less qualified workers since they are private…)
No, only YOU appear to “know” that. There’s a reason that all provincial and federal governments, regardless of political stripe, continue to support the single-payer model, and as I said earlier, there are good and valid pragmatic reasons why the two-tier model would not work in Canada, a fact long recognized by the principles of the Canada Health Act.
Your problem here is that just such studies have been done, and their conclusions accepted – except apparently by yourself and other free-market ideologues. Read the Romanow Report. Nowhere does it advocate the intrusion of American-style “free-market” health insurance. In fact, it emphatically asserts the opposite, such as the following: “… a common declaration of Canadians’ and their governments’ commitment to a universally accessible, publicly funded health care system” and “Confirming the principles of public administration, universality and accessibility”. It also recommends that "Federal and provincial governments should prevent potential challenges to Canada’s health care system by: Ensuring that any future reforms they implement are protected under the definition of ‘public services’ " and that they should “make explicit allowance for both maintaining and expanding publicly insured, financed and delivered health care.”
Read the report and educate yourself. The only ones getting “shouted down” are those making unsubstantiated claims. Moreover, you are making them in the form of a hijack in a thread that is not even about that.
Iraq is a little weird.
Yes, al-Bakr (Sadams predecessor) did set up a westernized Hospital based healthcare system, paid for by oil money.
Saddam didnt really do anything to ruin this, but of course his Secret Police and Baathist preferences had a toll.
However, it was more or less destroyed during the 1991 Gulf War. Later sanctions and Saddam wanting to spend what little money he had on more toys made things worse.
It fell into a quagmire. in 1994 in order to help fund it, it became more fee based.
After we kicked Saddam out, GWB appointed a Right wing Christian crony , one Jim Haveman, who hired another GWB crony run company* Abt Associates* and of course-** Bechtel **. Bechtel of course took the money and ran. Most primary health clinics were left unfinished as well as the promised Basra Children’s Hospital.
Corruption (on the part of the Iraqis, too) and cronyism helped along the death of the rebuilding, but what killed it was the lack of security in Iraq- bombings etc.
By no means was it a switch from “Saddam’s universal health care” to private run health care. The Iraqi central government-run public health care system still remains in place.
http://www.irfad.org/healthcare-in-iraq/
Canada doesn’t actually have a universal healthcare system.
It has 13 different single-payer systems – one for each province and territory.
There are only three constants:
- everything medically necessary will not cost you anything out of pocket
- the largest problem is always the administration and co-ordination of care
- Most Canadians have absolutely no idea how it works, with GMANCANADA’s complaint being a prime example.
I could go on for days, having lived in three provinces and one U.S. state, and having a wife who is a doctor.
But easily, between the two countries, I pick Canada’s every time.
I think the conservative Fraser government actually did roll back Medibank in Australia back in 1977. It wasn’t until Labor were elected in 1983 that universal healthcare was re-introduced as Medicare.
Since then successive governments have been attacking Medicare by stealth by not increasing the fees payable to doctors (from Medicare) adequately, so that more and more doctors are resorting to charging above the scheduled fee. Causing more people to take out private health insurance thereby eroding the importance of Medicare bit by bit.
@Wolfpup - You’re more than entitled to your opinion about how great the Canadian system is. If you think doubled wait times in the last 20 years are completely acceptable, hats off to you. Canada's health care wait times in 2016 longest-ever recorded: Fraser Institute report | CTV News
If, as another poster noted, Canada has close to the same spend on healthcare as France, yet we’re ranked 29 places lower than them in results. and that is perfection to you, that’s great. To me it suggests an opportunity to at least look ways we might improve.
Regarding the Romanow report: read what you just wrote - the Romanow report is an ideologically and philosophically driven report. I would have loved it to say “In Canada our goal is to have the best possible health care for our citizens regardless of the mechanism and system that drive it” That would be unbiased.
Secondly: things change and continue to do so. Look at how wait times have increased since it was written. 15 years ago I had no trouble getting a family doctor in Toronto. When my daughter turned 16 2 years ago we gave up after about 30 referrals. Very few family doctors are taking new patients!! My father needed to see a proctologist in Niagara Falls for a high PSA test - 18 week wait!! This is not acceptable by any standard and there is no plan to fix it from what I can see.
I’m simply saying is that in my opinion the system is broken and we should at least look at options to make it work better.
As I said in my first post this is the exactly challenge with Canadians similar to you, you don’t want a fact based discussion. You simply want to stifle discussion.
Also, in Terms of md2000’s post, using terms like “retrograde governments” and “slippery slope” imply a clear ideological viewpoint. They are hardly fair and balanced, unless of course one agrees with that ideology.
And please no more straw man arguments about me suggesting a switch to a US style system. I explicitly said I think the US system is bad, but that doesn’t mean Canada is perfect. It is not an either / or world. I’ve been absolutely clear I don’t have the answer.
In my simplistic uneducated view, it seems to me hybrid is best, but if the answer is that we move to a French style universal system with whatever that entails, so be it. Maybe the answer is that we have the best system we can ever hope to achieve and the extra 1% France spends would get us nothing, so be it, at least we’ve looked at it.
I think the most important thing is that we have that honest discussion about the pro and cons of our system and what we want from it and what we can afford. Rhetoric like “slippery slopes” does nothing to help this.
The French system is in fact hybrid. Doctors are overwhelmingly private practices (while hospitals are mostly public), and paid by the patients (then reimbursed by the health care system). They have to decide between following the state pricing scheme (most of the generalists do that) and I believe have some fiscal incentive to do so, or to overcharge (most of the specialists). Some rare doctors in public hospitals have a private practice with free prices along with their public hospital practice at fixed prices (to retain them).
In both cases, the Public Health system reimburses the same amount to the patient. A majority of people have supplementary insurances, for the most part non profit mutual insurances, to cover the difference and things not covered or very poorly covered by the public scheme (like dentistry).
Large hospital are pretty much all public, while private hospitals are typically small and filling niches (highly specialized in a specific procedure, or at the contrary offering more pampering and basic procedures).
Note that the French system was created on the basis of a system similar to the American one, where you got health insurance (though mostly non-profit) from (good) employers. Basically it centralized the system and made it mandatory for all employers. In fact it wasn’t truly universal until around 1990 (until then, only employees, retired people and people receiving unemployment benefits were covered, with separate mandatory schemes for self-employed people). Until then, if you had been unemployed for a long time, you were out of luck.
As a result, our insurance payments still come out of the payroll rather than from the general state budget, and the system itself isn’t directly administrated by the government, but by a technically private agency, with the negociations about what will be reimbursed and how happening normally first between main unions and representative “employer unions” (even though the state has the final say, since it only can decide to raise a mandatory payroll payment or to change regulations doctors must follow, for instance, and as a result frequently takes over the decision making too).
In any case, it’s not a government national health insurance like the British NHS. It’s closer to the German hybrid system, if anything.
Well yes, but the governments that want to introduce/allow pay-for-use facilities (i.e. private MRI clinics) are typically what could be called “Conservative” both in ideology and often in party name. Oddly enough the socialist party (national or provincial) does NOT want these private facilities. The middle of the road Liberals are occasionally two-faced about this. So yes, it is an ideological issue - but not in my mind, it’s in the real world.
Unlike the Australian system, the Canadian system explicitly forbids tacking additional fees on Medicare services for exactly that reason. When a majority of Ontario’s doctors go to the point of charging at least 10% or more over the fee schedule, it really wasn’t “free health care” was it?
If for-profit hospitals were also allowed (clinics by another name) then it is a quick slide into the American for-profit system. If you “explicity think the US system is bad”, then isn’t that a slippery slope? I don’t know where you think extra-billing and private health care institutions would lead us. the third alternative is the UK system, where the people who should be noisiest about fixing the system (like you and me) could probably afford not to have to put up with it. Oddly enough, that is almost the US system again. In the USA, Medicare pays for the poor, if they can find a doctor willing to accept paltry fee schedules.
Everyone knows the system is broken. The governments budget (i.e. ration) to ensure that they limit services. Hospitals claim they don’t ration, i.e., hip and knee replacements to X per year, but they “budget” the resources. Spots in medical school are limited. For example, many years ago the NDP in Manitoba popularized the term “hallway medicine” to describe the Conservatives unwillingness to spend to fix an underfunded system. They promised to “end hallway medicine”. In the election last year, the Conservatives railed against “hallway medicine” (resources so scarce people are parked in gurneys in the corridors) and promised to fix what the NDP had failed to fix. It’s a perpetual problem. However, nobody wants to pay what it costs, nobody wants to raise taxes, and everyone has the “Rob Ford delusion” that there are simply millions of dollars wasted that can be saved to fix things. If we paid as much in taxes and had a lower standard of living like France, maybe we could make Canada great again.
Canadian Medicare, like democracy, is the worst system except for the rest.
So to reiterate for the OP, it’s not being “voted out” any time soon, but it is a constant battle to keep the system from falling apart. I suspect the same applies to any other country with a taxpayer-supported system. What’s the Lewis Carrol’s “Red Queen’s Race” metaphor? “I’m running as fast as I can just to stay in the same spot.”
That’s unfortunately an illusion that you find everywhere. Most people seem to think that everything should be done better without them paying a cent more in taxes because of all this waste (and in particular money spent on “useless” things they so happen to not benefit from).
I’m mainly just going to respond to this one item because it actually is relevant to the topic of the thread. Bringing up US style health care is absolutely NOT a straw man because the immediate proximity of the US and its massive health care industry is a clear and present threat to health care in Canada. We have a number of the wretched mercenary American health insurers who were banned from practicing their sordid trade in Canada still skulking around offering supplementary insurance and constantly trying to expand the scope of what that entails. Meanwhile we have things like “executive health clinics” springing up offering “premium” health services that require cash payments or coverage by the aforementioned thieving insurance companies, some of them offering services that are on the edge of legality or beyond, including occasional private diagnostic imaging ventures where you skip the queue for cash, that are clearly outside the law. Some of these places are run by US for-profit health care providers, currently mainly interested in sourcing patients for their US centers, but boy would they love to be allowed to operate here with the kind of impunity they enjoy in the US.
If there is this much gray-area health care for the rich already springing up, one can only imagine what would happen if it was legal and part of national health care policy. Instead, there’s a very good reason that the Canada Health Act explicitly forbids such practices – an Act that was passed by Parliament unanimously. Simply put, it’s because carnivorous American wolves are howling at the door – wolves with billions of dollars to be made in the Canadian health care market while they bleed off all the best resources for themselves and decimate the public health care system. It doesn’t happen in Europe because Europe doesn’t have the same proximity of such market forces and because it has a different culture; Germany has embraced public health care principles since the time of Bismarck, and the UK medical establishment – as distinctly opposed to the AMA – strongly supports the NHS system. So most European countries have two-tier systems but with very low utilization of the private system.
As for the rest of what you wrote, calling the Romanow report “ideological” just sounds like whining that you don’t agree with its conclusions. Either that, or you don’t agree with the premise that a health care system should not just be “the best” for some unnamed group, but the best for everyone, and should embody the fundamental Canadian values of fairness and equal universal access – which is also the only way to effectively manage costs. If you don’t agree with those values you may have different solutions, but most of us strongly support them.
The problems you cite – family doctors, non-critical elective wait times, etc. – have myriad and complex causes – medical school spaces, certification of foreign doctors, urban population increases from immigration, and general matters of funding levels. Many of them are also exaggerated out of all proportion – remember, many of us have lived in Canada all our lives, in multiple provinces, and have experience of other health care systems, too. We strongly support our health care system from direct personal experience – we’re not just talking abstract theory or ideology.
I think it’s worth chucking in that there’s a lot of opposition in the UK to the trade pact that was in discussion between the EU and the USA on precisely the point that it was said to open a way for US health insurers to use the investor dispute system to force public services like the NHS to be in commercial competition with them in the UK - not just allowing them to bid for whatever private sub-contracts the NHS wanted to offer, or to set up in the existing private market, but actually to break up the NHS for commercialisation.
I don’t know how true that is, or whether any putative deal between the Brexited UK and the Trump administration would be any different.
I should also point out that the problem you hear about in the rural areas (and North) of Canada is that none of the doctors want to go there, they all want to live in the big cities. Not just lifestyle, but that is where the more varied hospital opportunities are also. When doctors even in Toronto refuse new patients - it’s not because they are rolling in the money, it’s not to make a political point, it’s not a nefarious scheme to push us to a US style system. It’s because they already have as many patients as they can handle, enough to fill their appointment calendars for weeks ahead. Ditto for specialists - even more so.
So the question is why? Some suggest that the governments have also rationed medical school spots (they also control education budgets) to keep costs down. The internships for the classic Syran/Indian/Pakistani doctor driving a cab - those spots are also budgeted by the government. Do Canadians use doctors too much, based on “free”? (Don’t think so, they also clog up ER queues typically waiting for hours - hardly frivolous complaints).
it all comes down to money. Canadians want their system fixed, but don’t want to pay for it. Can’t have it both ways.
This is also a warning for the USA - when things do become cheaper for many Americans, there will be a flood of patients catching up on what they’ve ignored due to cost.
It sounds like the big problem in both Canada, and the US if we were to try to emulate Canada, is lack of doctors. What are the wait times in the UK and France versus Canada and is it related to any bottlenecks in the training/approval of physicians? If the US were to move toward a more truly universal health care, if we didn’t really ramp up the supply of medical personnel, we’d be seeing long waits and fully booked physicians as well just because there wouldn’t be enough people to go around.
I wonder if there’s a way to increase the supply without compromising quality. Or, if you do compromise quality, if it would be worth it because more people would receive timely if somewhat worse care. While I certainly wouldn’t want to be among the scores of people dying at the hands of a barely qualified doctor, I wonder if anyone’s done the math and calculated if the hundreds of thousands of people who would see their doctors quicker would be worth it in terms of adjusted life years.
Well, I guess not seeing a doctor because one can’t afford it, pretty well equals not seeing a doctor because of wait-times.
The difference is Canada has income tax rates not much far off the USA, and sales taxes in the 10% to 15% range. IIRC, European VAT taxes can be 5% or more higher and the countries are not renowned for their low income taxes. This stuff costs.
I ran across a different model in NZ when I was there. Cut my hand badly - a St. John Ambulance clinic(?) patched it up. No doctors involved. Canada is inching that way - toward allow nurses and pharmacists to do some of the lesser jobs previously allocated to doctors. Perhaps that will take the load down a notch (Do I really need an appointment every year to renew my blood pressure medication?). This was the model of Mao’s “barefoot doctor” scheme in China - give some intermediate practitioners some decent amount more knowledge than the average peasant and send them out to do basic health care.
Except drugs, no?