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Machjo

Should we adopt two-tier health care?

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I've been looking into health care systems recently, and have found that many of the best systems in the world are two-tier:

http://en.wikipedia.org/wiki/Two-tier_health_care

I liked the Singaporean model, which the WHO ranks sixth in the world.

According to the WHO's ranking in 2000,(http://www.photius.com/rankings/healthranks.html), Canada's Health Care ranked 30th worldwide:

1 France

2 Italy

3 San Marino

4 Andorra

5 Malta

6 Singapore

7 Spain

8 Oman

9 Austria

10 Japan

11 Norway

12 Portugal

13 Monaco

14 Greece

15 Iceland

16 Luxembourg

17 Netherlands

18 United Kingdom

19 Ireland

20 Switzerland

21 Belgium

22 Colombia

23 Sweden

24 Cyprus

25 Germany

26 Saudi Arabia

27 United Arab Emirates

28 Israel

29 Morocco

30 Canada

Why would the US be stupid enough to try to model its system on the Canadian one? The Canadian one is barely two-tier, mostly socialized. The best ones have proven to be two-tier systems. If the US were smart, it would be looking abroad to better models. Then again, if Canadians weren't so dogmatic, we'd be looking abroad too.

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Should we adopt two-tier health care?

Yep.

Why would the US be stupid enough to try to model its system on the Canadian one?

I don't think they will.

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Canadian health care isn't socialized. The government doesn't own much of anything related to it.

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Over my dead body.

What's with the fanaticism? I guess Machjo was spot on when he said Canadians are "dogmatic" when it comes to this issue.

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Yes, we are. Polls show that Canadians want a system thats even more public.

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Over my dead body.

The 2003 rankings put us third.

http://www.guardian.co.uk/society/2003/nov...dicineandhealth

The new rankings

Sweden

Norway

Australia

Canada

France

Germany

Spain

Finland

Italy

Denmark

Netherlands

Greece

Japan

Austria

New Zealand

United States

Ireland

United Kingdom

Portugal

interesting. Your link points out criticisms of the last one because it included all deaths regardless of causes. This would still suggest then that Canada ranks 30th on that front. Whether health care is responsible or not, why the poor performance by Canada?

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Yes, we are. Polls show that Canadians want a system thats even more public.

Who cares what polls show. I'd rather know what works. Health care shouldn't be a popularity contest.

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Over my dead body.

The 2003 rankings put us third.

http://www.guardian.co.uk/society/2003/nov...dicineandhealth

Keep in mind that the rankings by the WHO (and, I assume the rankings given in the article you referenced, are NOT strickly a ranking based on how good a country's health care system is.

When the WHO developed its rankings, it actually took several factors into account. Some were directly related to health care (e.g. responsiveness). However, other factors were related to finances (for example, how health care costs were distributed in a population) and equality. So, in theory, a country where health care is uniformly poor with costs paid for by the government could in theory rank higher than a health care system where the health care ranked from good to excellent but the costs are born by individuals who have differing abilities to pay.

Last time I checked, the U.S. ranked high on some of the factors (including responsiveness where it was rated #1), but it saw its overall ranking reduced because the costs are not distrubuted in a way that's seen as 'fair' by the WHO.

If you look at quality of health care alone (which some people think should be the only measure, the U.S. should not be ranked much higher than it is.

Here is an article by the CATO institute that goes into a deeper explaination. (Note: the CATO institute is a think tank that usually follows Libertarian principles, so this source is not exactly unbiased. However, their description of the WHO ranking system is accurate.)

http://www.cato.org/pubs/bp/html/bp101/bp101index.html

And, in case you didn't believe the CATO institute article, here's an article from the Canadian Medical Association that gives a similar description to how the rankings were made.

http://www.cmaj.ca/cgi/content/full/164/1/84-a

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What's with the fanaticism? I guess Machjo was spot on when he said Canadians are "dogmatic" when it comes to this issue.

Because two tier is system designed to drain the collective brain power off those who need it the most.

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Because two tier is system designed to drain the collective brain power off those who need it the most.

So why are they ranking higher overall? IN a two-tier system, the rich pay into medicare but choose to opt out, thus leaving more funds for the rest. This actually helps the poor. That's what I meant by dogmatism. Prepared to hurt the poor just to keep the rich down.

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That makes absolutely no sense. The private system steals resources from the publicly funded system. They pay more and so they take the best out.

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So why are they ranking higher overall? IN a two-tier system, the rich pay into medicare but choose to opt out, thus leaving more funds for the rest. This actually helps the poor. That's what I meant by dogmatism. Prepared to hurt the poor just to keep the rich down.

Becuase they spend 3-4% of their GDP on health care then we do. You want the best health care system in the world find where to make the cuts to increase the spending to meet France, England, Spain's health care systems.

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That makes absolutely no sense. The private system steals resources from the publicly funded system. They pay more and so they take the best out.

Yes, but then they take the best, they also pay for it, thus leaving the public system off the hook in having to support them, thus allowing more public funds going towards supporting the rest, Sure, the rich still get the best, but they pay for it and pay in addition to taxes, thus reducing the overall burden on the poor, thus benefitting the poor too. So both the rich and the poor benefit.

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Becuase they spend 3-4% of their GDP on health care then we do. You want the best health care system in the world find where to make the cuts to increase the spending to meet France, England, Spain's health care systems.

I could agree to that.

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Yes, but then they take the best, they also pay for it, thus leaving the public system off the hook in having to support them, thus allowing more public funds going towards supporting the rest, Sure, the rich still get the best, but they pay for it and pay in addition to taxes, thus reducing the overall burden on the poor, thus benefitting the poor too. So both the rich and the poor benefit.

That has to be the most round about way of saying, "the poor get what we give them and if they die well screw them" I have ever read.

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That has to be the most round about way of saying, "the poor get what we give them and if they die well screw them" I have ever read.

That's why they are called "poor".

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That has to be the most round about way of saying, "the poor get what we give them and if they die well screw them" I have ever read.

OK, let's simplify this:

Let's say the population of the land of Mapleleaf has ten people, and the government invests 1,000 dollars in healthcare. Now that's 100 dollars per person. Now one man decides to pay his own way, yet still has to pay his taxes. This would leave 111.11 dollars for each of the rest of them. It may be that the rich man takes the best physician. But with the money saved, the system can now spend more money per patient to hire other physicians. Thus, while the rich mans' health care improves, so does tht of the others. Sure, his improves more than theirs, but then again, he's also payng twice, for himself and them, to be fair.

Does that make more sense?

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Now that's for a two-tier system. For a pure socialized system, that option above would not be available to the rich man, meaning that he must suck up resources from the public ssytem that could otherwise have been used to help the others instead.

What is the sense of forcing a rich man to suck up resources from the public system if he'd rather pay his own way and still pay his taxes? Any sane person would agree that he's actually doing the others a favour by doing this. And yet we ban it?

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That has to be the most round about way of saying, "the poor get what we give them and if they die well screw them" I have ever read.

Actually, we could flip your argument around and say "the rich will use medicare whether they like it or not,e ven if it means less healthcare for everyone".

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Actually, we could flip your argument around and say "the rich will use medicare whether they like it or not,e ven if it means less healthcare for everyone".

But it doesn't mean less health care it means equal health care.

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OK, let's simplify this:

Let's say the population of the land of Mapleleaf has ten people, and the government invests 1,000 dollars in healthcare. Now that's 100 dollars per person. Now one man decides to pay his own way, yet still has to pay his taxes. This would leave 111.11 dollars for each of the rest of them. It may be that the rich man takes the best physician. But with the money saved, the system can now spend more money per patient to hire other physicians. Thus, while the rich mans' health care improves, so does tht of the others. Sure, his improves more than theirs, but then again, he's also payng twice, for himself and them, to be fair.

Does that make more sense?

Or there could be one doctor for all of Mapleleaf land and rich man offers that doctor 2000 dollars to be his doctor exclusively, for the public sector to get him back everyone now has pay 300 dollars each. Ouch. Inflation in a competitive system it sucks.

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The US system doesn't do nearly as well as ours on many fronts. They do well in cancer survival though. Some two tier systems do better.

http://www.openmedicine.ca/article/view/8/1

If anyone hasn't read the article, let me summarize: The authors went through a bunch of medical journals, and looked for articles that allowed them to compare the outcomes of patients in Canada and the U.S. If an article showed better results under the Canadian system, they 'awarded' the study to Canada. If an article showed better results under the American system, they 'awarded' the study to the American system. The results showed more studies showing superior outcomes under the Canadian system when compared to the American system.

Keep in mind that there are several significant problems with this particular article...

- The authors may have a bias... One of the authors (Guyatt) was an NDP candidate. least two of them (Lexchin, Yalnizyan) has written for the Canadian Center for Policy Alternatives, a 'left wing' think tank. Another 2 of them (Himmelstien, Wollhandler) are American doctors who were pushing for a single-payer Universal health care system in the U.S. And that's just a quick check. I haven't found any sort of indication that any of the authors had either 'conservative' leanings, or favoured for-profit private sector health care.

(Now, I myself did publish a link from the Cato instutute, which itself might be biased; however, both I and they were upfront with the organization's principles, and I did back up their information with a more unbiased source)

- This is a meta-study. I'm always suspecious of such studies, regardless of topic... How do you know that they didn't just happen to stumble upon (either by accident or purpose) those studies that actually prove their point? They claim to have taken steps to prevent their researchers from bias, however, the fact is that they're still taking a sample of a sample (giving a smaller pool from which to draw results, making it more prone to errors).

- Much of the basis for the claims made in the article (that the U.S. does not have a better medical system) is based on the number of studies showing improved outcomes in Canada. Yet if you look at the studies favouring Canada (Table 3), you'll see that many of their studies are basically repetitions... For example, it points to 5 studies showing Canada's health care system is better at handling renal failure than the U.S. But they're 5 studies showing the same thing! Even if Canadian patients were better treated for renal failure than the American counterparts, the fact that 5 studies repeated the same thing gave more weight to the pro-Canada side than it deserved.

- Very little effort is made to relate the success of treating certain diseases with improved mortality/quality of life. Thus, in that study, a disease that affects only a tiny number of people (such as AIDS) is given as much weight as a diseases that kills a relatively high number of people (such as heart disease).

- In addtion, I had problems with certain individual studies. For example:

* One study showing better results in Canada was restricted to only low income

patients. But if you're trying to analyse the OVERALL health care system, you

can't very ignore what could be a huge portion of your population

* Once study dealt with AIDS; however, success in handling HIV may be due

more to patent law than the quality of health care.

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So what you're saying, in a rod about way, is that only studies that say the US is better are right. I got that.

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