The Texas state pledge

[ECSNorway]

---

Well, that's assuming that you want a populace that has a decent general education.
If you want to ensure that only those people with the money can get good general educations (and have conned yourself into thinking that you belong to that group), well then calling the public school system the tool of Satan is perfectly logical.

---

Or you could have what the USA has now: A system in which the rich can get a decent education, and the poor are brainwashed into thinking they can get one when they actually aren't, so that their political overlords can continue to abuse them under the mask of "helping" them.
--
Sucrose Octanitrate.
Proof positive that with sufficient motivation, you can make anything explode.

[CattyNebulart]

I would not trust the US goverment to run a tricycle, let alone anything larger or more complex like say a healthcare system. On the other hand the current system isn't working and needs to be fixed and private companies can't do it.
The American governmental system is broken and I can't see it being fixed in my lifetime. Glad I don't live there anymore.
I think the American government needs to be rebuilt from the ground up, starting with the electoral system, and it needs to be done by someone who is not corrupt and who knows what the hell they are doing.
I think in most things the US should take the example of denmark. healthcare provided by the state, a decent minimum wage, and people get paid to go to school. (instead of the other way around). Now if they could do it without the xenophobia (though denmark has nothing on xenophobia compared to the good old USA.)
E: "Did they... did they just endorse the combination of the JSDF and US Army by showing them as two lesbian lolicons moving in together and holding hands and talking about how 'intimate' they were?"
B: "Have you forgotten so soon? They're phasing out Don't Ask, Don't Tell."

[rmthorn]

---

I would not trust the US goverment to run a tricycle, let alone anything larger or more complex like say a healthcare system. On the other hand the current system isn't working and needs to be fixed and private companies can't do it.

---

I'm not sure I would trust healthcare (or social security, or emergency services) in the hands of private enterprise. All private companies care about is making a profit. Health care isn't about making a profit, it's about making people well, or lessening their pain, even if it's not profitable to do so.
And as for the stupendous selfishness of people saying "but I don't want to pay for other people to get better", what about the taxes you already pay? They might be used to build roads that you will never drive on, or schools that you (if you have no children) will never need. Heck, they might even get used for something that you don't agree with, like drug rehabilitation clinics. Is spending some of that money on health care really any different?
I live in Australia, where we have a government run medical system (with the option of private health insurance). If I break my leg, or get hit by a car, or my endometriosis flares up again, I can go down to the hospital and get treated without paying anything, regardless of whether I am rich or poor. Yes, a certain amount of my taxes (including the Medicare Levy, which is 1.5% of my annual income) goes towards it, regardless of whether I get sick or not, but I don't care. I like that system, and I wouldn't trade it in for whatever bullshit system you have going in the States.

[CattyNebulart]

---

I'm not sure I would trust healthcare (or social security, or emergency services) in the hands of private enterprise. All private companies care about is making a profit. Health care isn't about making a profit, it's about making people well, or lessening their pain, even if it's not profitable to do so.

---

I agree, that was sort of my point. The current american system has been privatizing and getting worse. the two are related.
I'd suggest that America surrender and become a colony of... hmm what would be a good choice, anyway the colony of some country that could properly fix their institutions and get rid of the corruption that plagues America. Maybe even restore the rule of law but that seems a little too ambitious.
E: "Did they... did they just endorse the combination of the JSDF and US Army by showing them as two lesbian lolicons moving in together and holding hands and talking about how 'intimate' they were?"
B: "Have you forgotten so soon? They're phasing out Don't Ask, Don't Tell."

[M Fnord]

Maybe we could divide the country back up along the original colonial lines. The east coast goes back to Britain, the Mississippi-Missouri valley goes back to France, and the western parts go back to Spain.
...well, it makes sense to *me*.---
Mr. Fnord
http://fnord.sandwich.net/
http://www.jihad.net/
Mr. Fnord interdimensional man of mystery

FenWiki - Your One-Stop Shop for Fenspace Information

"I. Drink. Your. NERDRAGE!"

[Kokuten]

---

I'd suggest that America surrender and become a colony of... hmm what would be a good choice, anyway the colony of some country that could properly fix their institutions and get rid of the corruption that plagues America. Maybe even restore the rule of law but that seems a little too ambitious.

---

I defy you to name a country on this dirtball that is truly held to the rule of law.Wire Geek - Burning the weak and trampling the dead since 1979Wire Geek - Burning the weak and trampling the dead since 1979

[Morganite]

I'm not convinced that privitization = making things worse.
We don't really have a privately run health care system. We have a system that's a mixture of public and private that gives us all the wastefulness that a public system can provide and all the corruption that can be gotten from a private system.
Personally, I would trust a fully privatized system more than a fully government-run system, because there's more direct accountability for one's results. But I don't really expect that to happen either.
-Morgan.
"Oh, poor Lyner... Dating so many underaged girls, he can't remember them all."
-Krusche

[Epsilon]

---

I'm not convinced that privitization = making things worse.

---

This is because you did not look at that list I put up in this thread.
Privatized health care is worse health care. My proof is that public health care (that is government funded and mandated) is much better, cheaper and more reliable than private health care wherever it exists.
You want to know what places have private health care? Places like Ghana, which is reasonably modern for an African nation. In those places, if you can't pay health care costs up front they will throw you on the street.
THAT is fucking private health care.

---

We don't really have a privately run health care system.

---

Yes, you do. What you have is a system that is designed to seamlessly transfer money from the government to private sector industries, which then run the health care system however they please. It is a huge corporate welfare scam. It is similar to the program of massive subsidies that supports the corn farmers, which is the reason high fructose corn syrup is so dirt cheap which is the reason it is in everything in the US.

---

We have a system that's a mixture of public and private that gives us all the wastefulness that a public system can provide and all the corruption that can be gotten from a private system.

---

You've been listening to too much Limbaugh and Coulter. Public/governmently run programs are not inherently wasteful. Nor are private system inherently corrupt.

---

Personally, I would trust a fully privatized system more than a fully government-run system, because there's more direct accountability for one's results.

---

The difference is that public system are accountable to everyone and private systems are accountable only to their shareholders.
------------------------
Epsilon

[Morganite]

No, your list proves that the places we have right now with public health care are doing better than the places that have private health care. It doesn't necessarily show the true potential of any system.
I don't consider the US system to be fully private, because so much of the money does come from the government.
Somehow, I doubt you'll hear Rush going off on the inherent evils of the private system. However, I never said they were inherently anything. What I was saying that those are the things I find them more likely to be due to what is involved. And what I've seen in other cases suggests that when you have a privately run organization that gets a very large portion of it's money from the government, you are likely to get the worst of everything. (CIETC seems to be a pretty good demonstration of this.)

---

The difference is that public system are accountable to everyone and private systems are accountable only to their shareholders.

---

Incorrect. Private businesses are first accountable to their customers. If they don't provide the quality that's expected of them, they'll lose their customers to someone who can. There's no reason this should work differently for health care than for any other service.
-Morgan."Mikuru-chan molested me! I'm... so happy!"
-Haruhi, "The Ecchi of Haruhi Suzumiya"
---(Not really)

[Ayiekie]

---

There's no reason this should work differently for health care than for any other service.

---

There are many, many reasons this should work differently for health care. Starting with the fact that many services simply aren't going to be in competition due to relatively low demand and high costs of installation and maintenance.
Also, health care is a right, not a privilege. It shouldn't ever be left up to the market to decide who gets health care or what quality it should be.

[Epsilon]

Okay, put up or shut up time.
Morganni: Is health care a basic human right? Yes or no.
Don't futz around or avoid the question. Do you believe that human beings have the right to live and be healthy or not?
-----------------
Epsilon

[ECSNorway]

Epsilon: Anything that costs others time, effort, and money to provide is not a basic human right, period, end of sentence. It is a service that is provided by people who work to do so.--
"I give you the beautiful... the talented... the tirelessly atomic-powered...
R!
DOROTHY!
WAYNERIGHT!
--
Sucrose Octanitrate.
Proof positive that with sufficient motivation, you can make anything explode.

[Epsilon]

---

Epsilon: Anything that costs others time, effort, and money to provide is not a basic human right, period, end of sentence. It is a service that is provided by people who work to do so.

---

So...
Access to police services and/or firefighters is not a basic human right?
It costs us time, effort and money to allow people to vote. It would be much more efficient if we did not bother to set up voting booths, advertise voting days and went through the trouble of actually counting votes. Therefore since it costs time, money and effort to provide, voting is not a basic human right.
Shit. That argument is fucked up. It takes time, effort and money to support every human right.
---------------
Epsilon

[rmthorn]

---

Epsilon: Anything that costs others time, effort, and money to provide is not a basic human right, period, end of sentence. It is a service that is provided by people who work to do so.

---

Um, wow.
ECSNorway, can you give an example of *anything* in today's modern society that doesn't cost others their time or money to provide? What you're basically saying is that nothing is a basic human right, is that correct?

[ECSNorway]

It costs nothing to "provide" the right to free speech. (It can cost money to exercise it, depending on whether you wish to simply speak in person, publish in print, or on the internet.)
It costs nothing to "provide" the right to freedom of assembly. You choose who you want to associate with. (You may incur costs in doing so, such as travel expenses.)
It costs nothing to "provide" the right to keep and bear arms. (You may incur costs to exercise that right, such as time and effort to satisfy firearms licensing requirements and of course to purchase a weapon.)
All of these are recognized as basic human rights by the Constitution. All of them cost the individual money, time, and effort to exercise. In what way is a "basic human right to health care" different?
What you are asserting is a "basic human right" not to health care itself, but to the time and effort of those who provide it, without compensation thereunto. --
"I give you the beautiful... the talented... the tirelessly atomic-powered...
R!
DOROTHY!
WAYNERIGHT!
--
Sucrose Octanitrate.
Proof positive that with sufficient motivation, you can make anything explode.

[rmthorn]

---

What you are asserting is a "basic human right" not to health care itself, but to the time and effort of those who provide it, without compensation thereunto.

---

So, basically, if you (or your wife, or your kids) get hit by a car, or develop cancer, and you're too poor to pay for treatment, then it's okay for you / them to die horribly and painfully, right? I mean, obviously if you're too poor to pay for medical treatment, then you / they are worthless and expendable, right?
Jeez.

[Epsilon]

---

What you are asserting is a "basic human right" not to health care itself, but to the time and effort of those who provide it, without compensation thereunto.

---

Yeah, because what I totally said was that we shouldn't pay doctors and nurses and... wait, no I didn't.
It costs money to provide for police.
Are you saying that we, as human beings, should deny this essential human service to people who can't pay for it?
I am saying that in the interest of human rights that yes, people should be taxed based on their level of income and that a portion of this tax shoudl go towards the maintenance of things that are essential for human rights. Among these are police, firefighters and emergency services, including hospital care.
If it costs money to provide a basic human right than we, as a society, should pay that fucking cost.
If you don't agree with that basic assumption then I hold out not hope for you.
----------------------
Epsilon

[ECSNorway]

---

If it costs money to provide a basic human right than we, as a society, should pay that fucking cost.

---

So you assert that every human being should be issued at birth with a taxpayer-funded bullhorn, printing press, church building, computer, internet service, and firearm, just to reference the Basic Human Rights I referred to earlier?--
"I give you the beautiful... the talented... the tirelessly atomic-powered...
R!
DOROTHY!
WAYNERIGHT!
--
Sucrose Octanitrate.
Proof positive that with sufficient motivation, you can make anything explode.

[Ayiekie]

In your own previous post you asserted you didn't need anything to have freedom of speech; now you say it requires Internet access? Real clear stream of logic, there, bucko.
Nice dodge of the question at hand, BTW.
Should people who can't pay for medical care be turfed out to fend for themselves? This is right by your worldview? Yes/no?

[ECSNorway]

---

In your own previous post you asserted you didn't need anything to have freedom of speech; now you say it requires Internet access? Real clear stream of logic, there, bucko.
Nice dodge of the question at hand, BTW.

---

You don't need to have anything to have freedom of access to health care, either, just no armed guards to turn you away from the hospital. The items I listed are no less important to the exercise of those rights, though, than a doctor is to the "right" to health-care.
Should people be turned away from the hospital when they seek care? No, obviously not, especially if they are in need of life-saving attention. But history has proven that government-operated systems are, quite simply, far less efficient than private insurance companies which have to compete with each other. They require a certain degree of regulation to prevent abuse but a taxpayer-fraud-funded system has, quite simply, been proven to be so problematic as to drive people who can do so to leave the country for care.
Take the British/Canadian model that you all seem to be so fond of. Literally millions of people are stuck on waiting lists to get treated for life-threatening conditions. Hundreds of thousands of people every year are dropped from the lists because they have, quite simply, waited so long that they have grown too sick to be treated.
The main cause of health insurance cost increases in the US, right now, is the increase over the past two decades in malpractice suits and awards related thereto. These suits have driven up the cost of (mandatory!) malpractice insurance for medical practitioners, which leads to two direct effects: increase in cost of care (and thus increase in cost of insurance), and decrease in the supply of practitioners.
At the turn of the century, for example, Texas suffered from a massive shortage of doctors, traceable directly to massive proliferation of malpractice lawsuits (even though 90%+ of these cases would be dismissed, there were still legal fees involved, and at any particular time more than half of all doctors in the state had one or more cases pending!). In 2003 the state legislature passed a bill limiting awards above the actual costs incurred by the patient, and malpractice insurance rates underwent a significant decrease, resulting in many doctors returning to practice in the state.
In conclusion, we DO have a system of health insurance already in place for the poor; it's called Medicaid. The difference is that we only provide it to those who can document that they're unable to afford private insurance; and unlike Canada, we haven't outright BANNED private insurance.--
"I give you the beautiful... the talented... the tirelessly atomic-powered...
R!
DOROTHY!
WAYNERIGHT!
--
Sucrose Octanitrate.
Proof positive that with sufficient motivation, you can make anything explode.

[Ayiekie]

---

Should people be turned away from the hospital when they seek care? No, obviously not, especially if they are in need of life-saving attention. But history has proven that government-operated systems are, quite simply, far less efficient than private insurance companies which have to compete with each other. They require a certain degree of regulation to prevent abuse but a taxpayer-fraud-funded system has, quite simply, been proven to be so problematic as to drive people who can do so to leave the country for care.

---

Yeah, see, ECS, actual reality and statistics are in disagreement with you here. Either that or simply nobody in the world has ever regulated companies enough to produce the magical efficiency you predict, unless you define efficiency as "outrageous profits to pharmaceutical companies".

---

Literally millions of people are stuck on waiting lists to get treated for life-threatening conditions.

---

I live here. You're a liar, or you're listening to liars. The fact is, our system has been underfunded and sabotaged for decades; it's still better than America's, we pay less for it in taxes than they do for theirs, and the vast majority of people with life-threatening conditions get prompt treatment.
And there's plenty of countries which have even better public health care than Canada's, because it's actually funded by the government rather than being consistantly undermined.
The US, meanwhile, is fighting with Cuba for 28th place.

[Epsilon]

---

But history has proven that government-operated systems are, quite simply, far less efficient than private insurance companies which have to compete with each other.

---

Put up or shut up time.
Quote your sources.
I can quote many sources which say that Canada's health care model is better than the US one. And I can then point to all the countries which are better than Canada. I don't think Canada is doing good right now. I think that at the moment it is being sabotaged. Once upon a time it was much better and I would like to see it move back to what it was. The way to do this is with more public funding, not less.
And what is this magical "efficiency" you seem to be talking about. Please define it.

---

The main cause of health insurance cost increases in the US, right now, is the increase over the past two decades in malpractice suits and awards related thereto.

---

Yup. That's the only reason. *patpat*

---

and unlike Canada, we haven't outright BANNED private insurance.

---

Hmm. That must be why I have a health insurance policy, because its been banned in my country.
Norway, you are critically uninformed about everything you have talked about. Do you have any ideas you do not parrot from right-wing talking points?
------------------
Epsilon

[rmthorn]

---

Take the British/Canadian model that you all seem to be so fond of. Literally millions of people are stuck on waiting lists to get treated for life-threatening conditions. Hundreds of thousands of people every year are dropped from the lists because they have, quite simply, waited so long that they have grown too sick to be treated.

---

Here are some figures for waiting times (in days) for patients waiting for elective surgery by public hospitals in Australia in 2005 (the latest available report):
www.aihw.gov.au/hospitals/waitingtime_data.cfm
As you can see, the longest waiting periods are for Opthalmic surgery, at a little over 2 months. I myself had to wait 6 weeks to get in for gynaecological surgery (and it wasn't a life-threatening situation). My grandfather had to wait for a little over a year for a kidney transplant, largely because he has a rare blood type.
These examples and figures are hardly indicative of the situation you describe.

[Rev Dark]

ECSNorway dropped trousers and squeezed this one out.

---

Literally millions of people are stuck on waiting lists to get treated for life-threatening conditions. Hundreds of thousands of people every year are dropped from the lists because they have, quite simply, waited so long that they have grown too sick to be treated.

---

Millions of people? 60,000,000 was the estimated population in the UK as of Sep 2005. Millions indicates more than one. Lets call it two million. That would mean that about 3% of the entire population is stuck on a waiting list for treatment of life threatening illness. Not receiving it. Waiting for it. Let me be the first to say, I have my doubts. In Canada the population is approximately 33,000,000. That would mean that 6% are on a waiting list for treatment of life threatening illness. Even halving your hyperbole inflamed 'literal' numbers from millions to a single million gives us approximately 3%.
The first step in learning to separate crap from cream is the smell test. Simple math is a great way to inhale that smell deeply. For the record, did you begin your breakfast with fresh strawberries and clotted crap?
Shayne

[ECSNorway]

Ayiekie, you've demonstrated repeatedly that all you have to bring to any political discussion can be summarized as "Anything that conservatives say is nothing but a 'talking point', not a fact, and therefore a lie; and any fact that anyone can come up with to argue against my position is nothing but a GOP talking point, therefore a lie, therefore I can ignore their argument and focus on belittling, berating, and insulting conservatives, because that's the only way I can get off these days".
As for facts, let's see what the president of the Canadian Medical Association had to say on the topic:

---

Would I be wrong in stating that the Canadian Medical Association, over the last 20 or so years, has been a defender of Canada's medicare monopoly and a single-tier health insurance system?
I don't think that's accurate. For example, at the last annual meeting of the CMA, over 70 per cent of delegates endorsed a motion to support increased private sector involvement in the delivery of health care.
Yes, but that was in the wake of last June's Supreme Court ruling on wait lists. A lot has changed since then. I was talking more generally about the CMA's position through the last couple of decades. Do you think that support for private alternatives within the public system has always been there?
I think it's always been there. And, to me, it's not a coincidence that in a COMPAS poll published about a week before the last federal election, 70 per cent of Canadians felt the government should be looking to other jurisdictions -- such as those in Europe -- where there are systems that have a mix of private and public health care. The one group that seems to have been out of sync is government. I mean, the public and physicians seem to have a very similar percentage that support looking at the private sector, and I think it's due to a recognition that the system is not working as we want it to.
I don't want to belabour this point, but the public attitudes have changed only recently. What I was asking is whether there has been a similar sea change in the attitudes of physicians.
I think so. Now, I would like to go on record as saying that I don't think the private sector is going to cure the ills of the Canadian medical system. It's just one small component that I think will help to increase the level of accountability of the public system. There are lots of other things wrong with the medical system as it's operating in Canada, and I don't want to be perceived as a single-issue person, because I'm not.
The Supreme Court of Canada, as mentioned, decided last June that patients who need treatment urgently and who are on waiting lists should have private alternatives to the public system.
Yes, the Supreme Court stated that Canadians are suffering and dying on wait lists and that governments across the country have shown inertia in dealing with the plight of patients. I think it is important to note that this is the same court that legalized abortion, that endorsed same-sex marriage, and that gave prisoners the right to vote. This is not a right-wing court. This is a liberal-leaning court that has said things aren't right. In fact, one of the phrases they used is, access to a wait list is not access to health care, and they struck down the segments of the Quebec health law that outlawed private insurance for medically necessary services.
What has the impact of the decision been in the medical community?
I think it's pushed people to realize that finally, while governments have shown inertia, the court has rejected inertia and has ordered the governments to either clean up their act and get rid of wait lists or, if they can't get rid of wait lists, they cannot legally force patients to wait and suffer while their health deteriorates. That's the essence of the whole decision. Now, if governments across the country can deliver the promises of the Canada Health Act and provide health care without wait lists in an expeditious time and eliminate the suffering that the court referred to, then I would endorse that and so would every physician. Until the rationing of health care became a major problem, even those of us who entered the area of non-government health care weren't thinking along these lines. It was only in the late '80s and early '90s that, as resources were being denied to patients, and doctors were not being allowed to treat patients because there was no funding to open up the operating rooms and so on, that's when private alternatives became an issue.
You see this as a government-created problem?
It is governments that are directly responsible for the dawning of the age of private health care in this country. Governments are directly responsible through their neglect and incompetence in dealing with issues in the past. But now governments are starting to act. A large part of the reason is that the courts have given legitimacy to private care, but also there are economic realities. Provinces are now spending close to 45 per cent of their provincial budget on health care, and it's a reality that crime is rising because health care is draining resources from law enforcement, education is suffering because health care is draining resources from education, the environment, other important social programs. Citizens are being denied important things because of this black hole of health care. For more than 40 years, we've promised to give everything to everyone in unlimited amounts for free. The first government response to these economic realities was to ration health service. Well, that's no longer acceptable to Canadians, it's no longer acceptable to doctors, and it's no longer acceptable to the courts.
You mentioned that this isn't really an ideological issue anymore, and I don't think it's a partisan issue anymore. All the major federal parties seem ready to accept some measure of private care . . .
Even Jack Layton had his own hernia done!
But that said, a couple of your predecessors at the CMA have been quite critical of past Liberal governments for wrapping themselves in the Canada Health Act and demonizing doctors who worked in both private and public care. Do you expect the change of government is going to make progress easier or harder?
I think that the change of government is not likely to make a big difference, but I do think we're at a pivotal moment in the development of the Canadian health system. We have an opportunity here that no other country has. We're being forced to change by a combination of economics and legal requirements, but we can now design the best health system in the world. There's an opportunity to look at the countries with universal health systems -- not the United States -- and take the best of what they have to offer and learn from the mistakes they've made and accommodate our system so that we don't make the same mistakes. Canada can rise up the rankings from its 30th-ranked status in the world by the World Health Organization to the top five where countries like Switzerland and Belgium and France and Germany lie.
Do you think Canadians understand how low they're ranked?
I don't think they do, and that's the job of Maclean's to tell them that they're ranked so low!
And surely the CMA, too.
Well, you're right. The one thing that doctors understand -- because we're the ones who are pressured -- is that our patients are suffering. Having close to two million Canadians on wait lists -- either waiting to see a doctor or waiting for surgery or waiting for a test -- is unacceptable in a system that on the one hand ranked 30th in the world but, on the other hand, is at $4,400 per capita, [which is] more than any of those countries ranked above us. There's something wrong with those statistics, and governments need to take a hard look at the way they have handled and managed the system over the last 20 years.
You're not president of the CMA yet, but you are a member of the Canadian medical community. Is it not something of a disgrace that it took the judiciary rather than the medical establishment to come out and say that the waiting lists in Canada had reached a point of inhumanity?
Well, I've been saying it for a long time, and I think a lot of my colleagues have been saying it for a long time.
I've looked at CMA clippings going back 10 or 20 years, and I didn't see anywhere near as clear a statement as we got out of the Supreme Court.
I think that doctors, by nature, tend to want to make things work within a system, and it's a Canadian trait to be calm and collected and try and work things through the system, but that has failed. I think you're right, we have failed as a nation, and particularly we have failed as physicians to perhaps assert ourselves in the way we should have. I think it's wrong to blame doctors for the mess that governments have gotten us into, and I think that one lesson we need to learn is that to have allowed governments over the last 25 years to rely on health policy experts -- for example like those who said one of the problems is too many doctors and let's close the medical schools, and here we are now with a legacy of a shortage of doctors -- I think that we have a duty as physicians to be more assertive in letting the government know we have a better understanding of priorities in health care and health care delivery than individuals who have been advising them and have gotten them into this mess in the past.
With health care costs in Canada -- total private and public spending -- up, I think, over $130 billion a year, and still climbing, even with some private outlets, is the ability to provide health care outstripping our ability to pay for health care?
I think so. But there's a lot we can do. We've got to learn why France can spend more than 40 per cent less per capita than we do and have no waits in their public system. I mean, there has to be a reason why you can get a hip replacement or an MRI within a week in France and yet you might wait between six and 18 months or two years in Canada, and yet they're spending 40 per cent less than us. And I'm talking about public systems here. For some reason we have bought into this sales pitch, this propaganda, that we have a wonderful health system, when, as the Supreme Court noted, many patients are suffering and dying on wait lists. And one of the reasons we've been stuck is because any hint of reform has been attacked as a trend toward Americanization. My answer to that is the World Health Organization ranks the U.S. system 37th in the world, and why would the 30th-ranked system want to copy the 37th when we can copy one of the top five? And so I think reform is coming. Governments are nervous about how to go about this, but we already see at least three provincial governments being proactive in that regard.
You're speaking of Alberta, B.C. and Quebec?
Yes. And I think that other governments will be forced to follow suit. They cannot sustain the costs of health care while crime increases and education is starved of funding.
I just want to ask you one more question about the private/public mix. One of your predecessors as president of the CMA, Dr. Albert Schumacher, I think, suggested a 95/5 per cent public/private mix. Does that sound right to you?
Well, we already have a 70/30 mix if you count dentistry and drugs. I suppose Dr. Schumacher must have been talking about the physician, or the direct delivery of what we define as medically necessary services, and I think it needs no more than five per cent or 10 per cent. In other words, there's no desire on my part, nor on the part of most doctors, to have a large component of private funding and delivery of health care, but I think that the public system needs some yardstick by which it is graded, measured and called to be accountable, and that has been lacking until the last few years. And to me, the so-called care guarantees and the contracting out are perfectly valid mechanisms to embrace the private sector. In other words, the patient doesn't necessarily have to pay out of their pocket for anything, that simply by allowing the private sector to compete alongside the public sector will help make the public sector better.
There've been some articles in the Canadian Medical Association Journal and other places about doctors and academics having financial interests in some of the drugs for which they're writing guidelines. How big a concern is that, and is there enough being done about it?
I think that it's important. I believe in disclosure. For example, I'm a surgeon, and as a surgeon in our current system, a public system, if I see a patient who needs surgery, and advise that patient to have surgery, I will stand to make a financial gain. A bad doctor will abuse that type of situation. These issues really speak to the ethics of physicians. If I say to you, "I think you should have this medication, but I must warn you that I did research for this drug and I was actually paid something by the drug manufacturer," then you as a consumer can choose whether to accept the recommendation of that drug. I think it's all about disclosure, and when there's a failure to disclose I think that's wrong, but I think the reality is we live in a capitalist society and the drug and equipment manufacturers are where most of the designs of new equipment and the generation of new technologies and drugs come from. We need their help in funding research. I think it all comes down to disclosure.
A CMA survey reported that half of the doctors in Canada were in an advanced stage of burnout, that one in 10 were using sedatives and one in five using tranquilizers. Other studies showed high rates of suicide among doctors. The CMA is a professional association, and from what I've been able to see it has nothing but voluntary programs to combat any of this. Is that something that needs to be addressed?
Part of the reason for that is overwork and unhappiness with the way our practices have developed. We have a doctor ratio of 1.9 per thousand, and that compares with 3.5 per thousand in a recent survey of 12 European countries. And doctors are leaving the workforce, they're retiring early, and that puts more load on the existing workforce. What is the reason for that? The reason is that 15 to 20 years ago health policy analysts told governments that there were too many doctors and doctors were the cause of the problem, so they cut back on medical schools and now we have a major shortage of doctors. So that's not easily fixable. You can't just produce new doctors in a year or two.
There's no question the system has problems, but when you're shown statistics like this about the health and well-being of doctors, surely doctors have to take some responsibility for it themselves, and surely as a professional organization the CMA has to take some responsibility for its members. This voluntary approach doesn't seem to be working.
Well, I think that as a national association, yes. As you know, the jurisdiction of health care is provincial, and I think all provincial colleges of physicians have programs in this regard. Could they be better, and could they be more forceful or more effective? I'm sure they could be, and I think you raise a very valid point.

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(Interview with Kenneth Whyte of Macleans Magazine, March 2006)
From the Lancet, Oct 2006:

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In Day's view, the Canadian health-care system worked well in the 1970s and early 1980s when the cost of care was still fairly low. But from the middle of the 1980s, expensive new technologies, complex operative techniques, and costly drugs began to drive up expenditure. To slow the rise, Day says, Canada's public health system began to ration care by restricting access to services, and the waiting lists for services began to grow. "My operating-room [OR] time was whittled down from 22 hours per week to 5 hours a week", says Day. "I had 450 patients waiting to get into the hospital, and yet I had only 5 hours of OR time."
Such restrictions accelerated Canada's brain drain, Day contends. At the time, he was chair of the Residency Academic Program of the Department of Orthopaedics at the University of British Columbia. "Over a 6-year period, of the 16 residents we graduated only five were left in Canada", Day says. "They didn't want to leave, but we couldn't give them any OR time." Today, the average time between referral by a patient's family doctor to treatment for an elective orthopaedic procedure is 40.3 weeks, according to an annual survey of waiting times in Canada by the Fraser Institute, a conservative think tank based in Vancouver.

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