the Canadian Health Care System is Better than ….. it could be? Nope!

Prompted by:

21 Ways the Canadian Health Care System is Better than Obamacare  click to see article

The Nader Page http://www.nader.org

IMHO .....this is an incomplete and simplistic comparison/contrast on (?Ralph?)Nader.org from an unidentified “outsider” with an agenda (although the letter is address to “America”, from “Canada”) …. trying to make “the point” that a “single-payer system is superior to Obamacare". I agree that the end-game of Prez Barry O’ and his ilk (Menshevik/ Fabian/ Syndicalist/ Corporatist/ Social-Democratic) is indeed a universal “single-payer” system -  the foundational “rock” of the post-modern Socialist-Utopia that the “we know better” do-gooding-patricians envision for the plebeians/ proletariat/ “precariat” (a new-ish "ism" - a portmanteau based on "precariously-employed" and the now out-of-time descriptor “proletariat”)

While I agree that Obamacare is the signature abomination of his administration:
-as a healthcare system;
-as an un-phased replacement for the existing American employment-based healthcare system;
-as an example of a new technology roll-out;
-as an example of a government central program that no one but the initiator’s identity-socio-econo-politico “humiliated” victim-class constituency desires/benefits from;
-in its implementation – fraught with innumerable, mid-stream, partial re-jiggings/ delays/ lies described as mis-speech/ obfuscations/ denials-of-intended (never mind UN-intended) consequences ….an abomination in so many, too many ways …

BUT ….. be it ever-so bumbling … the Affordable Healthcare Act WILL be the “disrupter”/ unsettling-point/ tipping-point that can (if not halted and repealed) lead to the accomplishment of the ultimate goals of it’s designers (see Menshevik/ Fabian/ Syndicalist/ Corporatist/ Social-Democratic).

The article’s headline and numbered points lay claim to the premise that “the Canadian Health Care System is Better than Obamacare” …. okay – based on what I’ve said above, I agree, but that’s not the point — the EXISTING AMERICAN system is better than Obamacare ….EVERY healthcare system is better than what Obamacare is destined to be.

So much for rhetoric in the abstract — I wish to shed light on the Canadian Healthcare FUNDING system – what it is, what it isn't and most importantly why it is NOT, in truth, what it is imagined/ portrayed to be in articles like the one that stimulated this post.

The Canadian system is a “funding” system. It’s about money. And just-long-ago enough Politics that the history has been re-written (by the victors).

It’s about “buying votes” with programs stolen in the 60′s from the UnioNDP/CCF platform so that Lester B. Pearson could get a majority government

It’s about proposing a potentially, unsustainably-expensive program to be funded with the voters’ own money and promising the same voter that there will be enough money (from ‘somebody else’s’ pocket) to fund the original voters’ “Universal, Accessible, Portable, Comprehensive, Publicly-administered on a non-profit basis” needs … forever.

This proposal MIGHT have been fiscally-sustainable (the risk that it might not be sustainable was the reason why Tommy Douglas stalled implementing H/care in Saskatchewan) IF …. the post-WW2 baby-boom was perpetual, if people continued to die at around 68 years of age, if prime interest rates never varied beyond the 4-6% range, if oil and commodity prices stayed constant, if inflation was constrained to 2-4%, if the extra healthcare that was to be provided didn’t change any of those variables, if the world’s monetary/ foreign currency system stayed on the Bretton-Woods Gold standard and if the USA continued to collaborate with Canada on the Branch Plant economy system that allowed southern Ontario and southern Quebec to subsidize the rest of the country (without letting on that the subsidy was really the return of a portion the RoC’s own money that had purchased the American-branded products manufactured-for the CDN market in southern Ontario and southern Quebec Branch Plants).

Unfortunately most of those “ifs” didn’t stay constant – by 1968-72 most everybody knew the baby-boom was over, the rest all just unfolded higglety-pigglety under the detached and aloof command of a Prime Minister who was a rich-man’s son, accustomed to getting anything he wanted (and then quickly got bored), thought he was the smartest guy/gal in the room and thought we could outsmart anyone on any topic (given 2-3 days to bone-up on cumulative human knowledge-base on that file).

Also unfortunately the J.M.(“in the long run…we’re all dead”) Keynesian idea that it was perfectly-OK for gov’ts to “borrow-to-spend-in-recessions, then save/repay debt-in-surplus times” was only HALF implemented BECAUSE the surpluses never came …. the borrowing to pay the interest on past borrowed money was the killer …esp when global interest rates were skyrocketed by the central banks (to stop people borrowing a) to lock-in ever-increasing tangible asset prices b) stop people borrowing to buy "big ticket" items on the assumption that their incomes would rise "due to inflation AND c) to stop them borrowing to buy services/ consumables/ wasting assets that disappeared before the loans were retired)

As I say the Canadian system is about FUNDING not providing Healthcare. The original 1965 “deal” (since Hospitals are a legislative “power” “distributed” by the 1867 BNA Act to the Provinces - because in 1867, hospitals were all run by Faith/ Religious/ Church organizations - NB primarily R Catholic in Quebec & N.B.provinces and by protestant orgs in the others) was that the Confederal govt would “set the rules” on national healthcare coverage etc, the provinces would implement the plan(s) and in exchange for the Provinces allowing the ConFeds to mess-around in Provincial jurisdiction, the Confeds agreed to pay 50% of the costs.

Until they could no longer afford to pay that 50% (the essential component that the whole bi-level agreement was predicated upon)…. so something had to give, then something else had to give and so on and so on for the last 30- 40 years.

So finally I get “to it” …

The Canadian system is funded by income tax dollars and it is a “re-distributive” system –those who pay income taxes (i.e. excluding the tax-contributions of non-income earners, of low-income earners [regardless of assets] & excluding the well-deducted, trust-protected, tax-deferred etc income of everyone who has good tax advice AND enough income to take advantage of these shelters/ avoidance/deferral provisions of the Income Tax Act) fund the program for those who pay no taxes.

Now some will quibble with me about “what” tax dollars are used to “pay” for healthcare because ALL the tax inputs flow into a General Consolidated Fund, rather than into “dedicated” funds of revenue for attribution to “dedicated” expense types, but pls hold on, I have more on that in a para or two.

The best thing about the Canadian Healthcare “Insurance” plan (that is run without “insurance” risky-lifestyle principles) is that it includes everybody – the largest pool of contributors possible is included. “Everyone” (tacitly and wittingly or not) agrees to contribute based on the assurance that if anything “terrible” happens to one of their family members, healthcare will be provided immediately, competently, completely and fully by the system. Like all (non-Whole Life) insurance … we buy it, but hope to never need to make a claim.

We all ‘hope” that a catastrophic disease or accident does not befall us, but rest easy knowing that we/ours will be taken care of by professionals in wonderfully equipped clinics, hospitals et al if such a tragedy occurs.

Amazingly (this is an open secret that dares not be spoken about) … notwithstanding the social, moral, ethical, egalitarian, fraternal, equality aspects of our plan ….. we all cheat on it.

The citizen patients, visiting-from-a-nearby-jurisdiction patients, just-about-to-succumb prospective citizen patients (and their relatives) PLUS the doctors, nurses, administrators etc etc …. we all “fiddle with” the system to further our self-interest. We go to the Doctor for every little thing, participate in procedures done “in hospital” (free) that might be done “in clinic/office” and accept appointments within 9-5 business hours to get time off work (with pay), the Doctors charge for what the plan permits and know how much “fudge” there is in the billing system, the hospitals (until recent budget squeezes) are huge enterprises with lots of executives and Boards with lots of little cracks that money can fall/be directed through – and why not ….everybody’s doing it, it’s too big a money/ procedure/ personnel machine to catch every little excess or personal indulgence and (until recently) there seem so much of an abundance of funding …. that a little wast/ re-direction of $ resources is never going to affect the Big Picture …and what the heck .... everybody’s doing it …all the time… for years …. it’s built-in, like “spillage” at a tavern.

This behaviour proves that Canadians are human beings and prove that the Human Condition is alive and well in in a single payer system too (irrespective of this one's 13-headed sub-system apparatus) in at least a few ways:

——- Self-interest almost always prevails.
——- Incentives can distort.
——- Remuneration drives “work results”, most of the time.

PLUS cheating “the government” is not really considered a crime/ offense /sin against Canadian society.

It’s not considered an infraction against the common weal because a) everybody’s doing it and b) because “they” (the nebulous agglomeration of people, processes, mandates, authorities, hierarchies, sovereignties, over-reaching legislation/ regulations, unintended consequences and vote-buying schemes that we lump together into a single entity we call “government”) tax us too much and “they” waste so uch money and “they” are so glibly swarmy and “haughtily superior” when “they” stand up on TV to attempt-to-dispel that very (widely-held) notion about dissatisfaction with gov’t using power-pointy-headed stats on efficiency, effectiveness, openness, accountability etc on past performance (often compared to some totally-incomparable jurisdiction, using criteria that are impossible to verify —but surely-to-goodness sounding credible) AND/OR when “they” announce a study group/ commission/ task force/ panel-of-experts that will improve the future efficiency, effectiveness, openness, accountability etc that some crisis or colossal screw-up has unearthed.

Here’s the “rub”and the “nub” —

An amount just-about “equal to” all the personal income taxes (PIT) collected at both sovereign orders of Cdn government (~$200 billion) is spent on Healthcare Funding by the 3 Territories, 10 Provinces and the ConFederal (still-called the “General” gov’t in the BNA Act 1867) orders of government, which means IF …. Joe/Carol Canuck didn’t have to supply the money to central-command through personal income taxes to provide their contribution to “free” healthcare, their PIT could be reduced to zero – so much for “free” healthcare ….unless, of course you don’t pay taxes ….

Is it not common knowledge that Canadian personal income taxes are higher than elsewhere in the free-enterprise zone …. that’s why.

This and the next point are want USA commentators don’t YET grasp …

Is it not a cost-advantage to employers/businesses in Canada to NOT have to offer basic-intermediate healthcare as a “company benefit” … yes, because the employee pays that benefit him/herself.

Is it not common knowledge that…. nothing is free. AND does it make a bit of sense that the more hands that touch a gov’t funding envelope, the smaller that original “contributed” sum becomes – for paying to beneficiaries. – This is where the “economies of scale” rebuttal comes in –”We handle such huge quantities of money that the tiny bit that is used to cover the full-parity pay, full benefits, sweetheart defined-benefit pensions of three-four-five levels of public-sector-unionized workers (plus management/ supervisors) on at least two levels of government is ‘almost nothing’ in the greater scheme of things, -by centralizing the process we save money” …again compared to what?

Compared to leaving the tax-dollars in the “earners” hands and letting him/her buy insurance based on the risks involved in the taxpayer’s life activities?

No it’s more expensive that that … because the system’s concept demands that it collect from a subset of the population to fund the whole’s needs/benefits AND pay for the central administration (on at least two levels)
Here’s the next bit that is only now dawning on the general Cdn public (as it impacts their individual circumstance)

The Cdn system is NOT single-payer – the Confederal gov’t collects tax-money and re-distributes it (not $1 in from a given province and $1 out to the same jurisdiction) using a “formula” that changes from time to time.

In addition, once the 3 territories and 10 provinces receive their “transfer payment” from the Confederal gov’t, they add some of their local provincial tax money (and if not enough, they use borrowed, money-at-interest to make-up the shortfall) and then distribute it within their jurisdiction according to a “formula” that also changes from time to time.

The provinces/territories pay doctors inside and outside of hospitals, pay hospitals and all the rest of the system in categories of care ….. everything type of healthcare is in a “spending envelope” …. except:
-for the Healthcare-type services/ procedures/ treatments/ etc that are “not listed” in a given category;
-or become “de-listed”/discontinued-for-funding in a category that used to cover it;
-or fall into a category that is not covered at all ….

Over time, the list of covered services/ procedures/ treatments/ etc changes as the “formulae” change and the dollar amounts allocated change by %, by $ or by category (or all/any at once):
a) as inflation adds to costs of material, labour and premises;
b) as inflation undermines the value (purchasing power) of a dollar;
c) a category becomes “too expensive” or over-used (according to a formula),;
d) as more beneficiaries in another category take advantage of a new service (joint replacements);
e) as the voting clout of a group of beneficiaries in any category increases/decreases;
f) as overall funding from a senior order of gov’t is reduced;
g) as overall spending in a provinces budget must be cut-back (budgets $ grown slower than demographics and inflation would dictate);
h) as the budget for the provincial healthcare Ministry (or any/all Ministries) is cut (slower budget $ growth vis a vis demographics and inflation)

Bottom line … gradually the voter is paying more and more … for less and less coverage. But the voters still feels good about being led to believe it’s the best system in the world and the voter is still often heard describing the free healthcare system s/he enjoys in Canada.

The Best system in the World — compared to $ spent on Healthcare /GDP … good ol’ Gross Domestic Product the great obfuscation tool (we used to say smoke and mirrors tool)

Do you remember when “they” used to say “GNP – Gross National Product” well they world economists switched to GDP – because it was bigger – making all the %’s lower. – Smoke and mirrors.

Anyway – GNP or GDP (you can look up the difference) are both NON measures for government expenditures (or debt levels), BECAUSE gov’ts do not control the WHOLE of the economy (with GNP or GDP measures), gov’ts ONLY control their Budgets (and some additional non-budget items that are part of their operations) …. a much smaller number.

IF …. the gov’t near you says it DOES control/ direct/ influence-more-than-any-other-entity the WHOLE GDP/GNP – it’s a firing or indictable offense … since they’ve done such a lousy job of “maximizing” it and “minimizing” the waste and damage.

What’s to be done?

Three choices (or all of them) PLUS “do nothing and hope for the best” …

1) Eliminate one level of gov’t in the administration (fewer hands touching each $ contributed:

2) Dedicate the tax dollar contributions to a separate account as is done with CPP:

3) Change the “from dollar one to infinity” aspect of coverage.

I suggest Nation-i-fying Healthcare funding -since everybody is “in the plan”, have just one administration – so no blame-game can ensue – no more “not our jurisdiction” nor the “other guys” cut the funding. The provinces will agree – despite how much they love to say they “provide” the hospital/healthcare system, they’ll love even more getting rid of this whale-sized albatross that grows more enormous every year. The provinces will have to “give back the tax points” that have been negotiated/ granted over time from/by the Confederal gov’t so that the amount of tax revenue that used to be collected up to the Confeds and then immediately fed-back down for the ConFeds share of provincial healthcare. This reduction in budget by about 40-50% in the provincial budget expenditures and revenue will help them get acclimatized to their “proper” (BNA Act) role handling “private and local matters” – not being independent, self-willed sub-sovereignties that are too big for their own britches.

For now (as much as it pains me to say), collect the income taxes using the same fiddle-fudge tax code we have now, but don’t put the dollars into Consolidated General Revenue. Take the funds “off the Budget” (as per CPP) and set the “rate” of tax that will generate the amount of $$ to fund the system, based on 105% of last year’s spending.
In this way, if money is saved, the “rate” can go down.

Finally, since there is an “unlimited demand for a free service” we must put some checks on the consumer.
My suggestion is to have the consumer cover the first $2400.00/year in healthcare expenses (in cash, or by use of private, get-it-yourself insurance, based on their life-style risks, age etc like any actuarial-table established insurance plan). Self-insurance or “terrible-risk” or “pre-existing condition” insurance would be no more than the max = $2400/yr or $200/mth

But, by removing $2400 x 33 million = $79.2 Billion from the annual national guaranteed-costs-to-cover expenditure ($79.2 Billion lets say $60Bn as % of $200Bn = 30%) the amount needed for taxes to fund could be reduced by 30% — every TAXPAYER’S burden could be cut by 30% from current levels…except the people who don’t pay taxes would still pay zero … how could they dream of complaining?

Since EVERYBODY would be paying $200/mth (or less if their life-style risks deemed them worthy of lower private premiums) – a VERY reasonable sum based on what we’re hearing about USA consumers being “dumped off their old plans” and being saddled w huge new premiums AND huge deductibles ie they pay the first $6000, 8000, 9000/yr)
and since EVERYBODY would have the same vested-interest in keeping “cheating” down and watching what the Cdn healthcare professionals and other practitioners are doing with their taxpayers FIRST $2400 and the rest of it ……since every saving would contribute to lower total costs and trickle down to lower % of income required to FUND the dedicated expenditures from dedicated taxation streams.


PS You don’t have to accept or believe what I say …. but why would you not?

What’s in it for me to try and deceive you?

I’m not asking you for anything … except to verify the possibility for yourself that these notions and concepts are viable

Rce

Dec 26/2013