Alberta PC's way out front

[Slava]

Originally Posted by Jacks

You're assuming that government provides service as efficiently as the private sector. In my experience they aren't even close.

I've worked for private corporations and now work in conjunction with some for my own business. I don't doubt that the public sector could be more efficient, but anyone who touts private corporations as a model of efficiency based on the fact that they're private alone is simply misguided. There is a lot of bureaucracy and red tape in dealing with some of these organizations. It doesn't disappear with the public/private distinction.

[darklord700]

Originally Posted by Slava

I've worked for private corporations and now work in conjunction with some for my own business. I don't doubt that the public sector could be more efficient, but anyone who touts private corporations as a model of efficiency based on the fact that they're private alone is simply misguided.

The point is not whether private is more efficient than public sector but accountability. Public sector has little accountability, their employees can take multiple smoke and coffee breaks, 20 sick days a year and strike when they want to. When all else fails, the government can always raise taxes to pay for all the inefficiency. Private companies in a competitive market don't have the luxury to raise prices at will.

[crazy_eoj]

Originally Posted by Slava

I've worked for private corporations and now work in conjunction with some for my own business. I don't doubt that the public sector could be more efficient, but anyone who touts private corporations as a model of efficiency based on the fact that they're private alone is simply misguided. There is a lot of bureaucracy and red tape in dealing with some of these organizations. It doesn't disappear with the public/private distinction.

There is absolutely no incentive to remove red tape and bureaucracy within a publicly entity.

Profit and competition motive are the only effective ways to reach true maximum efficiency and cost effectiveness.

Anyone who has dealt with government operations versus a private business doing the same can easily see the difference. This isn't some proposed theory, it's demonstrated to be true time and time again across the entire world both today and in the past.

Again, our health care costs have increased exponentially over the past decade. Suddenly, we are looking at health care costing 50% of our entire provincial budget. Increases of over 25% in just a decade, and yet no improvement in any measurable results.

The Wildrose Party is the ONLY party even discussing some tangible and realistic changes to improve health care for all Albertans. The entire left wing spectrum from PC - Alberta Party proposes to increase spending even more as if what we've been doing will somehow suddenly work.... at what point does this entire system fail? Do we really need to see more people dying in ER waiting rooms? Suffering on waiting lists? Sleeping in hallways? Or should we be grown ups and follow the example of countries who have been more successful than our own?

[Cowboy89]

A few points vis-a-vis Private vs. Public health care:

In no circumstances will Private solutions end up with cheaper health care due to efficiencies. Main reason is that when there's a single payer what ends up happening is health care gets rationed so that expenditures come in under some semblence of control. What that means to the end user is wait times for elective surgeries, ER waits, Diagnostic log-jams (MRIs, scans of many types), gatekeeper General Practitioners, massive wait times for specialists. Your experience from the viewpoint of AHS is that of an expense rather than a customer that brings in revenue.

Private enterprise can most definately create capacity to solve all of the above problems but don't be surprised if overall health costs had to double or more to get there and access to even basic care ends up highly difficult for some segments of society. Also over time the very nature of insurance company vs. Health Provider ensures an element of cost inflation that's egregious. What ends up happening is the customer/patient ends up getting gouged because ultimately health is an unavoidable expense. As a response of insurance companies paying out these inflated prices they jack premiums and lawyer the hell out of their policy wordings so that the average person cannot pick out what they're really covered for or not so they can get out from paying for the most expensive things (which usually end up being the life vs. death kinds of procedures).

[MarchHare]

Originally Posted by darklord700

The point is not whether private is more efficient than public sector but accountability. Public sector has little accountability, their employees can take multiple smoke and coffee breaks, 20 sick days a year and strike when they want to. When all else fails, the government can always raise taxes to pay for all the inefficiency. Private companies in a competitive market don't have the luxury to raise prices at will.

So what's you're saying is the invisible hand of the free market will ensure that a profit-motivated* company will provide the best service for the lowest price to win business from its competitors, right? Since the American healthcare model is built on private insurance providers competing with each other, it should naturally be more efficient than Canada's government-run single-payer system, then?

Why don't you Google some research studies that have been conducted comparing the costs of medical care in the US versus Canada and the associated health outcomes of patients with the same condition on either side of the border. You might be surprised by the results.

*I'm not a communist hippy and I don't use that term in a pejorative sense; there's nothing wrong with making an honest buck.

[MarchHare]

There is absolutely no incentive to remove red tape and bureaucracy within a publicly entity.

Profit and competition motive are the only effective ways to reach true maximum efficiency and cost effectiveness.

If eliminating red tape and bureaucracy is your goal, a single-payer system is vastly more efficient than multiple competing insurance providers.

American practices spend $83,000 per doctor every year dealing with health insurers and other payers, whereas Ontario only doles out $22,000, according to the study published in the journal Health Affairs.

[...]

What's more, nurses and medical assistants in the U.S. spend 20.6 hours per week on administrative duties associated with payers and health insurers, whereas in Ontario, that work amounts to just 2.5 hours.

[...]

In Canada, most health costs are covered under provincial medical plans, which means that most of the time, there's just one payer to deal with.

In the U.S., every patient pays differently, either individually or through health insurance, and each health-insurance company has its own policies for billings and submissions. The paperwork associated with payment can pose a huge burden.

http://www.torontosun.com/2011/08/05...fficient-study

[crazy_eoj]

Originally Posted by Cowboy89

A few points vis-a-vis Private vs. Public health care:

In no circumstances will Private solutions end up with cheaper health care due to efficiencies. Main reason is that when there's a single payer what ends up happening is health care gets rationed so that expenditures come in under some semblence of control. What that means to the end user is wait times for elective surgeries, ER waits, Diagnostic log-jams (MRIs, scans of many types), gatekeeper General Practitioners, massive wait times for specialists. Your experience from the viewpoint of AHS is that of an expense rather than a customer that brings in revenue.

Private enterprise can most definately create capacity to solve all of the above problems but don't be surprised if overall health costs had to double or more to get there and access to even basic care ends up highly difficult for some segments of society. Also over time the very nature of insurance company vs. Health Provider ensures an element of cost inflation that's egregious. What ends up happening is the customer/patient ends up getting gouged because ultimately health is an unavoidable expense. As a response of insurance companies paying out these inflated prices they jack premiums and lawyer the hell out of their policy wordings so that the average person cannot pick out what they're really covered for or not so they can get out from paying for the most expensive things (which usually end up being the life vs. death kinds of procedures).

Thanks for that note Cowboy. Could you please outline why the introduction of private care insurance and delivery in Switzerland and England has lead to opposite outcomes than what you have predicted above? It seems the evidence does not back up the statement.

[crazy_eoj]

Originally Posted by MarchHare

If eliminating red tape and bureaucracy is your goal, a single-payer system is vastly more efficient than multiple competing insurance providers.



http://www.torontosun.com/2011/08/05...fficient-study

Once again, we aren't talking about going to an American System, please leave the red herrings in the pond.

[automaton 3]

Originally Posted by Slava

I read the Wildrose policy write up on healthcare and there are a lot of questions I have after reading it. The general idea seems to be one where they would spend money to use private providers instead of public providers today. How are private providers going to provide these services cheaper than the public system does today? Private corporations do so to earn a profit, so clearly the government has to be paying a mark-up for these services that are otherwise provided.

Deregulation of electricity in Alberta is case in point...didn't quite work out as expected by the government of the day.

[Resolute 14]

You are asking too much there, crazy_eoj. It is SOP in Canada to always assume that the only possible change is to go to the evil American system. Intellectual dishonesty of the highest degree.

[MarchHare]

Originally Posted by Resolute 14

You are asking too much there, crazy_eoj. It is SOP in Canada to always assume that the only possible change is to go to the evil American system. Intellectual dishonesty of the highest degree.

I said nothing about Canada switching to the American system. My post was nothing more than a rebuttal to the claim that competing profit-motivated enterprises will always be more efficient and have less bureaucracy and red tape than the private [edit: typo: I meant public!] sector. I even cited a research study to back up my point* unlike some other posters who make claims without providing any supporting proof. So who's being intellectually dishonest here?

*This particular study happened to be a comparison of the efficiency of Canadian and American healthcare providers, but I wasn't suggesting that the US model is the only other option. Apologies if that caused confusion.

[Cowboy89]

Originally Posted by crazy_eoj

Thanks for that note Cowboy. Could you please outline why the introduction of private care insurance and delivery in Switzerland and England has lead to opposite outcomes than what you have predicted above? It seems the evidence does not back up the statement.

There isn't a magical ideological bullet here where private solutions answers concerns simply due to inefficiencies. Due to high barriers and costs to enter the business, the Health industry wouldn't perform competitavely on price as other businesses do. With a profit incentive most definately there will be more capacity for health services. Just don't think that you won't have to pay for it one way or another (With your health if you can't pay or don't want to pay, or with your wallet if you do.)

Converesely we should look at the big picture if you want to compare England and Switzerland to Alberta. I'd ask for you to show me where someone who makes $250K/year can pay a marginal blended federal and provincial tax rate of 39%, doesn't have to pay for health care on top of taxes, and lives in a province or country that has $200 Billion in a soveriegn wealth fund from Oil and Gas riches. The Wildrose would would have you believe you can live in that province, but the reality is that you have to pick two of the three (And thanks to Oil and Gas we're very fortunate for it to be possible to get 2 of 3 of these outcomes). Either pay up for your private health care, have government infuse pretty much all of their O&G royalties into expenditures, or deal with higher taxes.

BTW this is coming from someone who probably will vote Wildrose because maybe the Wildrose is the lesser of two evils considering that PCs have chosen in the past to go with the 'spend all of the royalties' solution and now want to tax more with the caveat that you have to trust them that they'll properly manage the building of the the Heritage Fund and not pork barrel it out to 41 years worth of friends and civil servants that are owed favors (Fat chance!!).

[Jacks]

The problem is that the public system is given a lump sum of money to operate, everything from that point on is an expense to them. There is no incentive to help more people or to improve customer service because every person who walks through the door of a hospital is a loss of money to them. If hospitals were paid based on what they preformed then there would be incentive to do the best and most efficient job possible, the more people they help the more funding they would get.

Don't get me wrong, 95% of the people working in the health field are good people looking to do a good job but the way the system is designed is terrible.

[crazy_eoj]

Originally Posted by Cowboy89

There isn't a magical ideological bullet here where private solutions answers concerns simply due to inefficiencies. Due to high barriers and costs to enter the business, the Health industry wouldn't perform competitavely on price as other businesses do. With a profit incentive most definately there will be more capacity for health services. Just don't think that you won't have to pay for it one way or another (With your health if you can't pay or don't want to pay, or with your wallet if you do.)

Converesely we should look at the big picture if you want to compare England and Switzerland to Alberta. I'd ask for you to show me where someone who makes $250K/year can pay a marginal blended federal and provincial tax rate of 39%, doesn't have to pay for health care on top of taxes, and lives in a province or country that has $200 Billion in a soveriegn wealth fund from Oil and Gas riches. The Wildrose would would have you believe you can live in that province, but the reality is that you have to pick two of the three (And thanks to Oil and Gas we're very fortunate for it to be possible to get 2 of 3 of these outcomes). Either pay up for your private health care, have government infuse pretty much all of their O&G royalties into expenditures, or deal with higher taxes.

BTW this is coming from someone who probably will vote Wildrose because maybe the Wildrose is the lesser of two evils considering that PCs have chosen in the past to go with the 'spend all of the royalties' solution and now want to tax more with the caveat that you have to trust them that they'll properly manage the building of the the Heritage Fund and not pork barrel it out to 41 years worth of friends and civil servants that are owed favors (Fat chance!!).

I can see where you are coming from but I don't necessarily agree with your points. When we rank health outcomes versus what we pay for inputs, Canada ranks dead last when compared with pretty much all of central Europe. The good news is our outcomes are good, the bad news is we pay far more than any of those countries. The only main difference being we support a wholly owned government monopoly on health services whereas Europeans have accepted a mixed private/public partnership.

Government run businesses and services all generally lack motivation to eliminate waste. They are all incredibly expensive compared to private endeavors. Our Canadian Health system seems to follow these general rules as well.

I don't think there can by any rational argument why we shouldn't follow the European model as advocated by the Wildrose Party and try to improve healthcare without bankrupting the province.

[Slava]

Originally Posted by crazy_eoj

I can see where you are coming from but I don't necessarily agree with your points. When we rank health outcomes versus what we pay for inputs, Canada ranks dead last when compared with pretty much all of central Europe. The good news is our outcomes are good, the bad news is we pay far more than any of those countries. The only main difference being we support a wholly owned government monopoly on health services whereas Europeans have accepted a mixed private/public partnership.

Government run businesses and services all generally lack motivation to eliminate waste. They are all incredibly expensive compared to private endeavors. Our Canadian Health system seems to follow these general rules as well.

I don't think there can by any rational argument why we shouldn't follow the European model as advocated by the Wildrose Party and try to improve healthcare without bankrupting the province.

Is that based on anything in particular or just rhetoric? Everything that I've seen shows that private enterprise is no cheaper and frankly even posters in this thread who would vote for the Wildrose seem to note that point.

If it is indeed more expensive then we can only assume increasing healthcare costs under a Wildrose government, or a reduction in services to keep the budget in check.

[Makarov]

Originally Posted by crazy_eoj

I can see where you are coming from but I don't necessarily agree with your points. When we rank health outcomes versus what we pay for inputs, Canada ranks dead last when compared with pretty much all of central Europe. The good news is our outcomes are good, the bad news is we pay far more than any of those countries. The only main difference being we support a wholly owned government monopoly on health services whereas Europeans have accepted a mixed private/public partnership.

Do you have any links to these reports? I'm sincerely curious to read them.

Originally Posted by crazy_eoj

Government run businesses and services all generally lack motivation to eliminate waste. They are all incredibly expensive compared to private endeavors. Our Canadian Health system seems to follow these general rules as well.

Simply not true. I work for a provincial government and I can assure you that we are constantly under tremendous pressure to increase efficiency (thanks to increasing workloads and stagnant or shrinking budgets.) Governments get elected for delivering more for less.

[Azure]

Not the Alberta government. They get elected for promising to spend more because apparently they have more.

In fact, how many governments throughout the world have been elected because they promised to balance the budget and provide efficient public services all at the same time?

[MarchHare]

In fact, how many governments throughout the world have been elected because they promised to balance the budget and provide efficient public services all at the same time?

All of them?

Whether they actually deliver is a whole other issue, of course.

[Azure]

Originally Posted by MarchHare

All of them?

Whether they actually deliver is a whole other issue, of course.

I'm not so sure. Europe for one is having a tough time reducing the debt, deficit or size of the public workforce. They might talk about delivering more efficient services, but they hardly ever talk about doing that AND cutting costs.

Obama ran on the idea of changing things but IIRC he never actually talked about cutting costs or balancing the budget.

[Makarov]

Originally Posted by Azure

Not the Alberta government. They get elected for promising to spend more because apparently they have more.

Maybe. But that isn't the claim that I responded to. I responded to the claims that "governments all generally lack motivation to eliminate waste" and are "all incredibly expensive compared to private endeavors". Those aren't true.

Originally Posted by Azure

In fact, how many governments throughout the world have been elected because they promised to balance the budget and provide efficient public services all at the same time?

Um, a lot. Indeed, many governments in both Canada and Alberta have been elected on exactly this platform in recent memory.

And further, the issue of whether it makes sense to balance government budgets in the midst of economic recessions is a perfectly legitimate debate to have (at least, as I understand it, according to economists.)