What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Monday, July 10, 2006

Ghetto-izing Health Care

A retired teacher told me a while back that the education system had reached a point of deterioration such that she felt she could no longer function as an educator. She was able to relate the various steps of deterioration along the way, and the people and special interest groups that were involved in the transition. Unfortunately I am not able to do so, but the basic steps were as follows:
1) Many years ago someone thought (and possibly rightly) that our children with special learning needs were not receiving the attention they deserved.
2) Special classes (facilities) and bussing (access) was set up for these children at considerable cost to the education system.
3) Then it was decided that the system would lend itself to feelings of inferiority, and segregating in this group of students was not conducive to there mental well being.
4) People in high places grabbed on to this premise and decided to integrate children with special learning needs into the main stream classes (besides much money could be saved by doing this).
5) To placate teachers and concerned parents, it was agreed that teacher’s aides would be put in place to assist teachers since now these students took up a disproportional amount of the teacher’s time.
6) Because of cost factors, class sizes have slowly grown and teacher’s aides have been become a scarce resource.
7) Parents with children who did not have special needs, became concerned that their child was not getting enough of the teacher’s time. Some decided to home school and those that could afford it often moved their children to private schools.
8) This increased the relative number of special needs children in each teacher’s class.
9) My understanding is that somewhere along the way the department of education felt that a percentage of their cost to educate a child could be applied to the cost of private schooling (probably with pressure from parents who believed the cost of education should “follow the child”).
10) More parents could then turn to private schooling for their children and as a consequence, the ratio of special needs children in each teacher’s class in the public system again increased.
To me, the above scenario is an example of how well meaning people, made well meaning decisions, and “ghetto-ized” our public education system (segregation through social, economic, or legal pressure).
To my consternation and horror, on the Rutherford radio talk show a few days ago, Alana Delong (one of the Alberta Tory leadership hopefuls) suggested that perhaps this was the way to go with our health care system. The government could look at their cost of a treatment in the public system, go to the people who are on a waiting list, offer them eighty percent of the projected cost of doing the procedure, and the patient could go to a private provider (if they wished to jump the queue) and pay the difference, thus shortening the waiting list.
What a bone head idea! Firstly, you can bet the government will “low-ball” their projected cost. Secondly, it blatantly underscores the check-book or credit card as the way to get faster treatment; and it takes away incentive for government to provide more resources to shorten wait lists in the public system. They can simply foist patients off on the private sector, and the patient’s bank account, at a fraction of the government tab. Through benign neglect of the public health care system, governments could indirectly coerce patients to opt to pay for their own health care or stay in the equivalent of a “death camp”. The end result would eventually be a public Medicare Ghetto where the poor, the frail elderly, and the chronically ill would be segregated into a public health care system that has a strong disincentive to provide Universal Care, and has as its most successful cost effective policy, coercing people to use the private system. God help us!


Blogger Money Bags4Me said...

Okay you lost me here.

From reading your bio it sounds like you are a Randian Objectivist. Which would mean your not a big fan of public medicine.

But this post seems to show you against a two tier system. Maybe I haven't read enough of your posts to figure it out but can you clarify your overall position?

11/7/06 7:13 AM  
Blogger michie said...

It's interesting that as soon as a person says that the current healthcare system needs to be reformed, they are automatically 'for' private American-style healthcare. I'm not trying to put words in your mouth money bags4me, however I get this impression from people a lot.

I think a person can appreciate the benefits of the public system while also seeing that it desperately needs reform... not because they are against the public system and it's theoretical values and strengths, but because it is simply not sustainable in its current form.

11/7/06 8:07 AM  
Blogger Al said...

I believe that there definitely is a place for a basic but comprehensive public health care system BUT, it must be set up in such a way that the government's feet are held to the fire to perform, and it must be directed to those people that truly require a "safety net". The system also needs to have built in to it the capability of people to provide for themselves if they so choose.
The simplest way to do this is to allow people to take out insurance for unforseen events. Should an untoward health event occur, the insurance would pick up the tab. Should that same person be considered at some point to be chronically ill and insurance premiums become prohibitive, the public system would still be there for them.
I believe that most able bodied people in an affluent society like ours should make every attempt to provide for themselves and bear responsibility for their actions. It generates pride and healthy change.
The proposal that I criticized in my blog puts the incentives in the wrong place. There is an incentive for governments to opt out of their responsibility of providing a first class health care system, and no incentive for people to change their life styles. At least insurance companies would discount premiums for healthy life styles.
My understanding is that ghettos first came about as a proactive function to segregate the Jews. In today's world I believe that most ghettos come about because of benign neglect on a personal, community, government and societal level. There has been an ongoing and persistent erosion of the human spirit by (possibly) well meaning people to put incentives in the wrong place. This has brought about such a profound sense of entitlement on the part of Canadians that we have become resentful of those that do well and can't wait for the next government hand-out. This is exemplified by the NDP and left-leaning Liberals who are for increasing taxation so they can make Canada a "nanny" state, are hostile to the Americans, and feel our global obligations only extend to our borders (against involvement in Afganistan). It is a me-me-me attitude. In effect we are not being allowed to grow up.

11/7/06 12:27 PM  
Blogger David MacLean said...

In Switzerland the government guarantees health insurance -- and it is means-tested. They don't focus on the delivery, per say, but the payment is guaranteed.

I was lost on this post as well.

11/7/06 2:03 PM  
Blogger Money Bags4Me said...

Thanks for the clarification, good points.

11/7/06 5:03 PM  

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