Canadian Politics Today

I stopped following the thread for awhile but I want to ask about the idea of introducing user fees with the condition that they can only do so if service levels improve on the CIHI metrics.

The idea being that an enterprising health organization could start charging for services if they use the revenue to improve overall services.  This would incentivize (TimG - economics !) better management and possibly push organizations to review all of their operations for find improvements.

This would prioritize quality while bringing cost management more into the forefront.

I've asked the other guy - he's got nuthin! In your acceptance of the merit of introducing health care user fees, do you have any actual quantitative measures to support your implied resulting money windfall... cause everything I've come across speaks to the amount of user fee monies as, "inconsequential" relative to the overall health care budgets... less than mice-nuts... less than dust covering mice-nuts! Oh wait now, just how big a user fee are you proposing?

Fatal Flaws: Assessing Quebec’s Failed Health Deductible Proposal --- https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed//Working_Paper_Stabile.pdf

... the  Government  of  Quebec proposed reforms in its 2010/11 provincial budget in an effort to bring in revenue in the form of a health deductible -- a $25 charge per medical visit. The objectives of the deductible were both to raise revenue and to inform citizens of the costs of their use of healthcare services.

In this Working Paper we evaluate the revenue generating potential vis-à-vis the distributional effects  of  the  proposed  health  deductible.  Our  findings  suggest  that  the  revenue  potential from  the  proposed  $25  deductible  was  small,  representing  less  than  1  percent  of  the  $27 billion  public  healthcare  budget  in  Quebec.  Charging  patients  for  care also  results in  a reduction  in  the  use  of  healthcare  services.  Including  savings  to  the  government  from  this reduced utilization would have raised the net revenue of the proposal to approximately 1.5 percent of the public healthcare budget.

No we need to consider both: aggregate data says "no risk to waiting 8 weeks for an MRI" so no need to fund - individual says "I don't think I should have to put up with the stress of waiting 8 weeks for an MRI". Substitute MRI for almost any non-life threatening treatment like knee surgery. The individual's POV is reasonable.

so... a TimG healthcare system driven by layperson determination of need, layperson assignment of medical resources, layperson assignment of medical facilities, layperson want and layperson ability to pay --- surely a marketplace marvel! Your manufactured schemes and the 'Fraser Institute like aggregate wait time data', somehow never factor actual medically determined and prioritized wait time benchmarks.

since you've chosen to settle in on MRIs here, let the waldo offer you medically determined wait time perspective, ala the medical professionals within the Wait Time Alliance, as below --- perhaps before you make yourself look any more foolish, you might choose to present MRI wait time data delineated to these benchmark guidelines. (protip: emergency cases never show on wait lists... cause they're dealt with immediately, as medically determined):


and lordy, even a cursory review of that Fraser Institute "buried" data shows that just a few provinces are significantly skewing the overall headline blasting, "Canadian National MRI wait time" figure... clearly it is to private healthcare advocate advantage to not emphasize particular province results - that just gets in the way of blasting headlines!

This disconnect can be addressed by allowing individuals to spend their own money. This is not currently allowed and this is a significant problem with the system that undermines public confidence.

again, citation request... vis-a-vis your determined, 'significant problem undermining public confidence'

and yet you come back empty when you're repeatedly challenged to show such a "working healthcare marketplace"... one where tax incentives offered to a country's citizens resulted in reduced healthcare services consumption... without actually compromising health. Apparently its quite the bar for you to meet - quite the challenge you're not able to address!

Without compromising health is the key. Healthcare use is generally considered a strong indicator of access to care and is associated with better health outcomes. Tim’s talking about reducing use as if that’s a good thing when the WHO and social epistemologists would emphatically disagree. In fact one of the key goals of the WHO is to INCREASE healthcare use, especially regarding preventative care.

I'm not really interested in the legal maneuvers. What galls me is that this should not happen in Canada. We should have far better care for those unable to take care of themselves. We all know there isn't enough money for everything, sure, but the Ontario government recently renegotiated loans in order to temporarily lower electricity rates which will cost Ontario citizens almost $40 billion over the next 30 years. Why? Because there's an election this year. This was done for political reasons, for self-interest. So the government can find money for whatever it sees as in its own interests, but doesn't give a **** about poor guys like this.

Nor is it alone. The federal government is no better. What's Trudeau got to say about health care? Not a damn thing. He's too busy courting ethnic votes and prancing around in ridiculous ethnic outfits.

The SCC has recently taken the position that if benefits cannot be offered to everyone in an 'equitable' way benefits should be offered to no one.

I saw nothing like that in the link you provided.  It seemed to be about a boy who was dyslexic, and a school district which failed to provide enough educational support.  The court seemed to be saying that it was part of the responsibility of the school system in Canada to provide education in such a way that all kids could reach their full potential, even the kids with particular challenges.

I note that the boy, being fortunate enough to have a parent who was able to pay, attended a private facility and is now a plumber - able to make a decent living, support himself and pay taxes.  For families with fewer financial resources, or who do not live in an area that has an appropriate private school, the school system is their best and perhaps only option.  Isn't it better to spend the money when the child is young so they can become employable tax-payers, rather than deserting them to become permanently reliant on government money?

I saw nothing like that in the link you provided.  It seemed to be about a boy who was dyslexic, and a school district which failed to provide enough educational support.

The district did *not* fail to provide support. It did not provide *enough* support as defined by the impossibility subjective criteria that the SCC used. You need to understand how rulings like this work in the real world. Districts have budgets and have to set priorities. Some parents might have some very expensive program that may or may not help their kid but they insist it will. The district used to have the option of saying it is too expensive compared to other options. Now they don't. Furthermore, such constraints mean the people providing these services will inflate their fees because the schools are "constitutionally obligated" to pay them whatever they demand.

I note that the boy, being fortunate enough to have a parent who was able to pay, attended a private facility and is now a plumber - able to make a decent living, support himself and pay taxes.

For many disabilities such a positive outcome is not remotely plausible. Yet the school district is now expected to cut programs that benefit all students so a minority can have access to programs that may not have any real impact on their future achievements.

No matter what bleeding hearts would like to believe resources are finite and it is always necessary to set priorities.  As soon as the court tries to take away the ability of managers to set budget priorities because of some subjective definition of "equality", it really does become a choice between offering the program to no one because it is too expensive to offer it to everyone.

What criteria was that, exactly?  From the article I thought education that was designed to help kids to reach their best potential'.  How is that subjective, exactly?

Are you serious? The statement 'reach their best potential' is purely subjective because no one can really predict how effective any given program will be for any given student. Furthermore, when dealing with disabilities we often have no way to measure success since we can't know what "might of been". The end result is administrators will have no choice but to do what parents demand whether it is reasonable or not because no matter what statistical evidence districts may have, parents can always argue that expensive program "X" is necessary for their darling to reach his/her "full potential".

I did not see any of that in the article.  Do you have some additional cites that supports what you are saying here?

Only about 100 years of government spending programs with budgets that quickly spiral out of control when there is no accountability. Does "Mike Duffy" ring a bell?

I missed the part in the article that said school districts had to cut programs that would benefit all kids for the benefit of the few.  Perhaps you can provide some proof of that as well?

The SCC specifically said it should have cut other program to pay: https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/12680/index.do

The next question is whether the District’s conduct was justified.  The District’s justification centred on the budgetary crisis it faced during the relevant period, which led to the closure of the Diagnostic Centre and other related cuts.  The Tribunal’s findings that the District had other options available for addressing its budgetary crisis should not be disturbed.  The Tribunal accepted that the District faced financial difficulties during the relevant period.  Yet it also found that cuts were disproportionately made to special needs programs.  Despite their similar cost, the District retained some discretionary programs, such as the Outdoor School — an outdoor campus where students learned about community and the environment — while eliminating the Diagnostic Centre.

I don't know about you but giving all students a chance to learn about community and the environment has a social benefit too but the court says it does not matter because the needs of a few disabled kids are more important.

Once again, I did not see that in the article.  Proof?

WTF? It is the only rational conclusion from the courts logic. i.e. if there is not enough money to provide disabled people "equal" access then governments cannot practically offer the program.