Ben, we have more than two tiers -- know that WCB patient are treated sooner in BC hospitals, and there are others.

Also, some people have benefits at work, and these include extended health benefits. What is that except another tier?

I for one don't understand the view that a parallel system can't work in Canada when it works so well in other jurisdictions. Also, the last time I checked I had to pay out of my pocket to go to the dentist or to get my eyes examined. It seems private health care for these specialties works just fine -- why not orthopaedic surgery?

It is a travesty in this country that I can legally pay to have my dog's health taken care of but I can't to have my child's.

Finally, how did PGRH get an MRI? Well, there were a lot of private donations from our community towards the cause. Quesnel doesn't have an MRI. What is this but a "rich" community affording healthcare that a "poor" community can't?

If every household threw $100 in the pot we'd have $2.5 million to put towards a cancer clinic. Do you think we'd have a better chance of getting one if we offer to pay for it out of our own pockets? Yes. Two tier? Yes.

It's time to welcome "two tier" with open arms. It's been here all the time.

Whether we have a one-tier, two-tier or twenty-tier health care system depends as much on semantics as it does on facts. In other words, how we define a tier determines how many we have, and it is not really the point anyway. The point is about equal access for everybody in a taxpayer funded system. We all pay taxes and we should all get benefits. It is fundamental to our society in Canada that taxpayer funded services are open to all in a fair and equal manner, without discrimination on any basis, including how much money you have in the bank.

It is true that people with enough money, or the ability to borrow it, can go to other countries. More power to them, with one caveat. Don't use a penny of my tax money if you do that. In fact, if that caveat were to be followed in Canada I would have no objection to those treatments being provided here. Interestingly, when Medicare was first set up this was possible, and restrictions were put on later. Just as interestingly, nobody built a fully patient funded facility, they all wanted tax money shoveled into the pot. I repeat - Not a single penny of my tax money for people who want to jump the queue..

Where does that leave so called "private" clinics. Well, first of all they are not "private", except as to who owns them. The funding is certainly not "private". These places want to give preferential access to those who can afford it, but still charge most of the cost back to the taxpayer. They still want to bill Medicare for most of the money. It is that aspect of it that is offensive.

In such a system, any service provided is at the expense of the public system. How so? Governments do not provide open ended amounts for health care. They provide a finite amount in a budget for each Health Area. Any money paid to a facility reduces the amount available to other facilities. In other words, $100,000 paid to a "private" facility reduces the amount available to a public facility by $100,000. What this means in practice is that jumping the queue for the well off means a person who is not well off waiting a little longer, and that is discrimination.

In addition, we have a shortage of health care workers, not just doctors but OR nurses and others as well. Doctors may have spare time to increase the amount of work they do and the number of patients they see, although I note many of them complain about the numbers they are expected to treat at the moment, but OR nurses do not have spare time. To increase surgery, for instance, would mean training more. Who would get the experienced ones. The well off "do me now I can pay" brigade or the not well off pensioner on a limited income? Would the pensioner have to make do with an OR staffed with new graduates? Health care requires experience gained over time. How long would that take?

What about the other services. An example is that all tissues removed at surgery, with a few exceptions, must by law be referred to an anatomic pathology laboratory both to check for disease and to ensure surgery was warranted. Where will this be done? Will the "private" facility set up its own laboratory or will it send tissue from the few patients it gets to the public facility? If the latter, who will pay the costs? I suggest this would be a typical example of how the public system would be expected to subsidise the "private" clinics, reducing their costs at taxpayer's expense and increasing the amount going into some anonymous investor's back pocket. There are other post-surgical services similar to this which are automatically included in the costs of a hospital surgery, but not in "private" clinics.

I people want "private" health care then let them find $50 million (enter the amount of your choice) and build a hospital. Then let them find $20 million dollars and equip it. Then let them find another $20 million dollars and staff it with people trained at their expense. Then let them find patients and charge them the full amount for their treatment, down to the last penny. Not one cent of my tax money for private health care!

>"If every household threw $100 in the pot we'd have $2.5 million to put towards a cancer clinic. Do you think we'd have a better chance of getting one if we offer to pay for it out of our own pockets? Yes."<

Great idea! Just let me know where to deposit the 100 bucks+ after the Prince George Cancer Clinic Fund has been properly established!

Let's get the ball rolling!

>Ammonra:"If people want "private" health care then let them find $50 million (enter the amount of your choice) and build a hospital....Not one cent of my tax money for private health care!"<

I would bet you dollars for donuts that as soon as that private clinic were to be up and running the government would approach it to buy operating time to alleviate the long line-ups in the public system!

People would demand that!

Socialist countries in Europe have used a combination of public and private healthcare successfully for many generations. Patients can put extra money out of their own pockets into the public system by upgrading their hospital rooms to private or semi-private, etc.

We must look at the successes elsewhere and find positive solutions for our troubled healthcare delivery.

We can also find a uniquely Canadian combination that satisfies everyone, don't you think?

Of course we can find a Canadian solution, and I don't think it would be too difficult. There is a major push among some people to get private services going at all costs. Why? The subject only arises because the public system does not provide sufficient services that are needed. Note I say "does not" rather than "can not", because the reason is that governments, both Federal and Provincial, have taked deliberate decisions to not provide all the services needed. They can thus tout themselves as saving money, but they do so at the expense of people's health, while the fact is that the infrastructure is already there in many cases and improvements could easily be made in the public system. You get what you pay for, by and large, in this world. Pay it into the public system and have adequate services, or pay it through a private system at a higher cost, that appears to be the choice. One way or another the money will be paid if we are to have proper services. What on earth is so bad about spending our own tax money on ourselves? I have never understood the fixation that money spent on private services is supposed to be better than money spent on public services, when public services in health care are so much more efficient because of the shear numbers that are handled. Ben commented in his article that an alternative to private services was to open another OR and increase surgery that way. That is the way I prefer. Couple that with full time employment for health care workers instead of part time and perhaps a real indentation in the backlog could be made. It requires that money be spent, and in either case it will be taxpayer's money, and that is the real bottom line.

Why is it that others feel the need to dictate what type of services I choose to use? What type of health care I prefer? Which health care professionals I have to see?

It seems that there are those who have no problem using or abusing my tax dollars to burden our health care system.

I suggest we all have the ability to choose whatever type of health care we want. Hasn't anyone noticed that what we are currently doing isn't working? Percy

Ammonra: ..."because the reason is that governments, both Federal and Provincial, have taken deliberate decisions to not provide all the services needed."

Surely, that is an oversimplification of a very complex problem which requires co-operation from all participants for a lasting solution.

Never before has there been so much money pumped into our healthcare system as there is now.

During the nineties we had the same problems, and perhaps in many instances worse than now because B.C. added another $ 1.7 billion to the debt of the province each and every year.

Now we finally have beaten the deficit devil and are not paying for today's benefits with the earnings of future generations anymore.

No, I don't think it is an oversimplification at all. I worked in Health care all my life, and one thing was really plain, and that was that Governments of all types, Federal, Provincial, left wing, centrist and right wing all use it as a political football. They attack the party in power when they are in opposition, then reverse their opinions while in Government. I have watched it affect my work over and over and over again.

We are repeatedly told that throwing money at the problem isn't the answer. That's true. On the other hand, nobody has ever suggested that money be thrown at the problem. Health care workers at all levels have only suggested that the public health care system be adequately funded to provide the services the public needs (not necessarily wants). Unfortunately, for public relations reasons, governments won't do that. They are concerned about appearing to be profligate with tax money, so underfund and then brag about how much they are spending.

A few comments on the view that "we are spending more now than ever" stuff. OK, we have more people living in BC now that ever before, so what else would you expect, and doesn't that mean tax revenues are more now than ever too? Inflation increases as well, does it not and wouldn't that also increase the amount spent? The fact is that an objective evaluation of the amount spent on health care indicates it is pretty much the same now as it ever has been.

Several years ago I looked at the amounts spent on health care over many years as a percentage of the Gross Provincial Product, and it was about 9%. It has been in about that range for decades. The figures are all available from the provincial government. I invite you to go back twenty years and compare the amounts yourself. They have not changed much, but at times we have had a really good health care system, usually when just a little more has been spent.

Keep in mind as well, that health care also depends on education. Training people is also necessary, and several years ago the training programs for health care workers were severely cut, and have not yet recovered. That is the underlying reason for the shortages in health care personnel. The governments did that, but refuse to take responsibility for it. Instead they use it as an excuse for not providing services.

Incidentally, the deficit devil was beaten before the present government. We did have three surplus budgets, which were then urinated away by tax cuts to the well off and corporations, and which plunged us back into the deepest deficits this province has ever seen. As a consequence, the services people wanted from the public sector were severely curtailed and thus we have the present situation with everybody clamouring for what was taken away. There are those who believe the attacks on health care were deliberate to promote the private sector, but I do not agree with that. I think the present government just didn't give a damn.

>"We did have three surplus budgets, which were then urinated away by tax cuts to the well off and corporations, and which plunged us back into the deepest deficits this province has ever seen."<

There were NO actual surplus budgets, only 'projected' surplus budgets!

The federal Conservatives during Multoney's term boasted of having a balanced, surplus budget. They took in a certain amount of taxes and spent most of it. Except, they excluded the annual amount of borrowing needed to pay the interest on the federal debt. This borrowed deficit amount was annually added to the total debt which soon grew to several hundred billion. To this day he boasts that he had balanced budgets, which of course is utter complete nonsense.

In one year alone he added $ 60 billion to the federal debt, all the time claiming that the budget was balanced.

In B.C. the NDP did not pay the annual debt servicing costs out of the "balanced, surplus" budgets, but simply borrowed and added on average $ 1.7 billion to the debt of the province. Total over ten years: $ 17 billion.

Those who wish to see this as a fact will do so; others will forever choose to ignore the indisputable factual evidence that the debt of the province was doubled in the short period of ten years.

I find it exasperating that the debt numbers are allowed to be shoved aside when in fact a daily amount of about $ 7 million dollars is paid out of our taxes to service the provincial debt.

Wouldn't that kind of money be of better use in the healthcare system?

To mention the word "debt" to most people seems to be the equivalent of loudly venting digestive gases during a Tupperware party!

"Those who wish to see this as a fact will do so; others will forever choose to ignore the indisputable factual evidence that the debt of the province was doubled in the short period of ten years."


It is also indisputable and factual that the government which followed increased the debt substantially, all the while touting their fiscal responsibility. Another fact some choose to ignore.

Of course its frustrating that interest must be paid to service debt. Of course it would be better to spend the money on health care and other necessary things. The reality is that we have to pay for that, and not only because the NDP had to borrow money during harsh economic times when the World's economy was on a downswing, but also because the Liberal government borrowed money while the World's economy was recovering.

Nevertheless, we need a health care system and it has to be paid for. Crying into our milk about our provincial debt load won't make the payments. Do we want a decent health care system or not? If we do, then pay the money. If we don't, then stop complaining! One thing is certain, introducing a system where sick people have to pay money they don't have to get treatment will also increase costs. Taxes may take money out of the economy, but so do user fees, access fees, facility fees, and all the other "voluntary tax" fees that a private "pay for access" system entails.

Ammonra:"Do we want a decent health care system or not? If we do, then pay the money. If we don't, then stop complaining!"

We are discussing how the system can be improved with the available funding. Most of the experts say that it isn't just a question of more money.

B.C.'s Balanced Budget legislation requires the budget to be factually balanced. Now, there remains the 64 thousand dollar question: How do we slice up the pie to make sure that everyone gets a reasonable piece?

Actually we were discussing whether we should have multi-tiered health care with for-profit involvement or only public. The concept of doing it within the available funding has only been mentioned in your last post. If that is the case, then so-called "private" health care would certainly be out because it involves more money being spent by patients or MSP.

Balanced budget legislation is political flim flam. The budget is set by the same people who determine whether it is balanced. If more money is needed to run health care then all the MOH and MOF have to do is put it in the budget, then make sure they spend the amount budgeted, and the legislation will have been followed. It does not restrict government spending at all. Besides which, aren't we being told we have big surpluses now? There must be lots available.

You did note that the experts say it isn't "just" a matter of more money. As I noted in one of my posts this is a common beaurocratic and political excuse for not providing sufficient funding. The word "just" does, however,infer that increased funding is one of the components of an improved health care system. There are other factors, for sure, but more money is most certainly one of the biggies. If you think health care is inneficient, then think again. Pressure has been applied for improved productivity throughout the system for over twenty years. There's no more fat to cut.

ammonra:"Actually we were discussing whether we should have multi-tiered health care with for-profit involvement or only public. The concept of doing it within the available funding has only been mentioned in your last post."

I decided to advance the discusssion to the next stage:

Since you have from the very beginning rejected the idea of a 2 tier system I assumed that it would be more worthwhile or productive to discuss the one remaining option of having public healthcare only, within the budget restraints.

Of course, if budgets are only a figment of the imagination of those who invent them, then there is really not much left to discuss anymore, is there?

Perhaps the questions of affordability and ability of the taxpayers to support any system become totally irrelevant.

Cheers!

Among the first posts it was been pointed out that we do in fact have a two tiered system. What I rejected from the beginning was using taxpayer money to subsidise preferential access to treatment in a for-profit system parallel to the public system, and held that the public system was better equipped to deal with increased services.

I also did not say budgets were a figment of someone's imagination, I said they can be changed and are under the control of the government. In other words the controllers of funding are quite capable of budgeting whatever amount they choose. It is their choice, as these decisions always are. The public has made it clear time and time again that they can afford a decent health care system. Time and time again they have publicly supported the hospital in PG, it is only the uncooperative politicians and their supporters who can't see it. Governments make choices, sir, and the choices thay have made in health care have been bad ones.

Personally I think there decisions about our health care should be taken out of the political arena and put in the hands of a citizen's assembly to determine long term policy about service levels and funding. It might also help if we put in chare people who were committed to making the system work rather than think they are corporate eexecutives.

Ammonra: "Personally I think their decisions about our health care should be taken out of the political arena and put in the hands of a citizen's assembly to determine long term policy about service levels and funding. It might also help if we put in chair people who were committed to making the system work rather than think they are corporate executives."

Well, I certainly have no problem with any of those suggestions! Unfortunately the whole healthcare debate has been forever hijacked by politicians for their own advantage and made
into the hot(test)button issue that it is.

Some politicians carefully nurture the notion that any government that was not elected by a left of centre philosophy is intentionally cruel, uncaring and indifferent to the needs of the people as far as healthcare is concerned.

That is a pity. It creates camps of feuding adversaries and loss of focus on the real issues that need to be addressed.

My opinion is that one can make many imaginary budget projections and wish lists but what if none of these match up with what is really do-able?

Budget constraints are dictated by the ability to increase taxes or borrowing.

If somebody would suggest an increase in taxes in order to fix once and for all the shortcomings of our healthcare system and maintain it in an excellent condition from then on - well, I certainly wouldn't object to that increase.

Cheers!

I have been on-line for awhile so I say hello to all.
The two tier system can work,unfortunately we can not trust gov.t to put the"savings"back into the health care system.But I think if your rich and can pay for surgery,you can pay for someone on the waiting list to have that same surgery.If your not so rich to pay for both,then you wait with the rest of us.