Thought experiment: What if the critics are right, to some degree, and our current health system isn't sustainable? Alternatively, what if Canadians elect someone who opens the doors to provatization? (leave your objections aside for now).

What private (as in non-government) system could work that promotes social and community health. Not necessarily a national or even a provincial system, but what might work? What wouldn't? How could a community or region build a progressive, effective, efficient and innovative health care system?

I see a few options.

1. Corporate health. Worst case scenario. See: US.

2. Non-profit corporations/organizations managing health care. Various examples around the world, with mixed results. I'd like to learn more about it.

3. Co-operative health care system. What would this look like? How could health care be effectively democratized, without compromising quality or efficiency? Are there any examples around the world?

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1. Corporate health. Worst case scenario. See: US.

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As to the US case, in addition to the obvious problem that health care is often provided by large for-profit corporations that are more interested in money than health outcomes, there is also the separate but related fact that health care access is tightly linked to employment, and therefor becomes an added mechanism for employers to control and render subservient their workers.

I posted an article about this on Babble a few months ago that I will re-post here:

"The Inhuman State of US Health Care: How Does Class Power explain the US Health Care Sector?" By Victor Navarro, Monthly Review vol. 55 no. 4 (September, 2003).

I don't think that there is necessarily anything wrong with employers offering some health benefits, but I think that unless we are going to guarantee full employment, access to at least the basic services has to be conceived as a fundamental right that arises from "citizenship" or community membership, not as a job-based privilege.

[ 01 September 2004: Message edited by: robbie_dee ]

Let's stick with the thought experiment: How could a progressive, non-government operated health care system operate? What would be good about it, or bad?

We seem to have this nervous tic in the Canadian left that has developed from fighting the neocon advances across our entire social infrastructure. Defensive fights never win against a determined, and well resourced, adversary.

So what are our alternatives? How could we build a health care system that improves on the current system in terms of care and health outcomes, is not directly operated by the government, and is not a corporate nightmare?

How would they keep the structure and implementation democratic, while recognizing and valuing the obvious expertise of the practitioners.

A few key questions: how and where would the money flow? What would be the decision making bottlenecks, and how could they be resolved? How could such a system ensure equal access to high quality services for all, particularly in low-income neighbourhoods? A health co-op in the slums would be fine, but would work better as part of a larger one that included a full range of members.

What would be the appropriate scale for a health co-operative? A single hospital and it's 'catchment area'? A community? A region? A province? Where would economies of scale be overtaken by structural inefficiences and administrative lag in such a system?

But on the other hand, I wonder if the health care situation is only reflective of the failure of the economic model in which it resides.

I'm not sure that we can debate health care in isolation. So long as being sick is profitable, as it is within the GDP system, I think health care will continue to undergo unmanageable inflation no matter what form of provider you chose.

I suggested this in another thread, but I think that privatized medical systems act as a costly catalyst which undermines alternative health systems.

Privatized medicine provides financial incentives to develope new techniques **for those who can afford it**. And once life-saving procedures have been developed it is, obviously, difficult for public health systems to refuse their adoption to a much greater number of recipients, but that multiplies the costs and economies of scale do not seem to apply...

So efforts to consider health care alone could be synonymous to palliative care - treating the symptoms - isn't that the treatment strategy for the terminally ill?

[ 01 September 2004: Message edited by: britchestoobig ]

[ 01 September 2004: Message edited by: britchestoobig ]

[ 01 September 2004: Message edited by: britchestoobig ]

Big pharma relies on the claim of high R&D costs as justification, but their behavior regarding drugs researched through public funding is instructive...

In the United States, taxpayer funds are funnelled to drug researchers through the National Institue of Health (NIH). Check out NIH Pharms Out Profits

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"The story of Taxol, as told in a recent General Accounting Office report, is achingly familiar to observers of NIH. Researchers, heroes really, begin testing plant species for anticancer activity as early as the 1950s. They notice that extract from the bark of the yew tree works against tumors, and other scientists eventually isolate the paclitaxel and figure out how it prevents cell divisions. NIH conducts the clinical trials and proves that paclitaxel has potential. But since NIH cannot legally produce or market drugs, it enters into a transfer agreement with Bristol-Myers Squibb in 1991, after 30 years of research. Under the deal, the corporation takes all of NIH's research, finishes the clinical trials, markets the drug, and prices it autonomously. NIH ignores its own rules that require the company to show evidence the drug would be reasonably priced. For their troubles, NIH and the taxpayers get a measly 0.5 percent of sales as royalties, even though NIH's rules allow royalties of 5 to 8 percent."

Oops, thats not the whole story for Taxol: The NIH deal did not specify a reasonable markup, and Bristol-Myers Squibb sold doses at a greatly inflated price...apparently gouging even further by charging Medicare $500 *more* than they did private doctors.

So yeah, pharma can be greedy lets not forget.

[ 01 September 2004: Message edited by: britchestoobig ]

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Originally posted by Oliver Cromwell:
That sounds right - but then again, you don't want to entirely shut down the incentive for drug companies to do research, either. It can indeed be argued that many new treatments jack up costs without little measurable effect on healt outcomes. But private research does occasionally hit a home run.

It's a hard problem. No-one should claim that there's a simple solution.

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Between 1955 and 1992, about 90 per cent of all cancer drugs that came out of the States were initially discovered by NIH researchers on the taxpayers payroll. Taxol, the best selling cancer drug in history, was discovered by taxpayer funded research in the U.S. .

Big pharma rarely produces a blockbuster drug, for sure. They're better with upset stomach potions and post-nasal drip remedies.

But it's not like they don't have any incentive to actually sink some of their profits into research and development. Afterall, the extended 20 and 30 year drug patent protection that the American left warned us about during the Mulroney era will expire eventually.

Need an aspirin v.XXXVIII ?.

[ 01 September 2004: Message edited by: Fidel ]

ps: Big pharma's still haven't produced anything as life saving as Banting's insulin discovery or Salk and Sabine's polio vaccines. And they didn't have mega-billion dollar revenues to prop them up.

cheers!

[ 01 September 2004: Message edited by: Fidel ]

BUT, if we are to discuss privitizing the healthcare system, then we should also catagorize the many different health-care fields first and then decide if there is any "opportunities" within that field for privitization.

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Originally posted by Oliver Cromwell:
Okay, fine: all those new drugs generated by the private sector are useless frills. So why do we need public funds to pay for them? Presumably the idle rich can pay for their own hair loss and impotency treatments.

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Oliver, the system is flawed. We could return to the notion of well funded academic research for the public good. The fact that pharma is in control now doesn't necessarily distill down to their being the best agents to do it.

Power and influence, the history of interaction between politicians and their campaign contributors, and finally the role played by post war corporate image programs have contributed to the system as it is today.

Like you said above, there are no easy solutions, but if we want to find solutions we have to be willing to consider the full nature of the system as it has come to be.

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Originally posted by Oliver Cromwell:
Okay, fine: all those new drugs generated by the private sector are useless frills. So why do we need public funds to pay for them? Presumably the idle rich can pay for their own hair loss and impotency treatments.

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I wish the idle rich would pay for the building of new hospitals and cost of staffing and maintaining them. We can't even get them to opt out of medicare and pay their own way as it is.

Hair loss drugs ?. How come there are so many bald people running around then ?. The truth is that Merck discovered the DHT hormone inhibiting effects of finasteride by accident. The drugs intended purpose was to alleviate the effects of BPH - benign prostrate hyperplasia. The ancient herbal remedy for sore pee-pee, Saw Palmetto, works just as effectively, has fewer side effects and is prescribed moreso by European physician's not under the spell of large pharmaceutical companies waving bogus research data.

[ 01 September 2004: Message edited by: Fidel ]

If private research hasn't produced anything worth paying for, then there's an easy solution to the health care funding problem: pay only for drugs that are produced by non-profit research institutions.

Clearly the problems, and prospective solutions, are complicated. But we should be thinking about how efficiently the system works and be willing to explore whether alternatives to the current manner in which pharmaceuticals are developed might be more effective over the long run.

You seem to be operating from the a priori assumption that privatized competitive environments are the best venue for productive research. What's your evidence for this?

[ 01 September 2004: Message edited by: britchestoobig ]

I think a co-operative of drug research institutes would be the way to go. Big enough for economies of scale and broad enough to deal with a significant range of problems. Public evaluation of priorities and pricing. If the significant public researchers were all in the co-op Big Pharma would have to do its own basic research.

What does a democratic health system look like? How does it work? How does it ensure equal access to quality care without stifling innovation or sacrificing efficiency?

I refuse to accept the copout logic that the universe we currently inhabit prevents any progressive health system from happening. We can make a system that works well, I just don't know how to do that.

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Originally posted by britchestoobig:

I'm not sure that we can debate health care in isolation. So long as being sick is profitable, as it is within the GDP system, I think health care will continue to undergo unmanageable inflation no matter what form of provider you chose.

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I'm not trying to give you a copout answer, though I will admit that thanks to my post the thread veered away afterwards.

I am only trying to suggest that there are two ways to look at the problem. Yours seems to be bottom up (or maybe single issue in isolation), I just wonder if we should be thinking about it from top down.

Look, within the current global economic system, practices that are not amenable to financial investment capital can, and will, face considerable opposition.

Look at the U.S., who are the greatest opponents of single-source (i.e. government) health insurance? The politicians who win election after election due in no small part to campaign contributions from health insurers, and likely also the wealthy who are heavily invested in health companies.

You're telling me the tree is on fire, but hell man look around you! The whole damn forest is smoldering...

I just wonder if we need to take a bigger perspective. Not to expend effort on attempting to fix health care, but rather to begin to use it as a clear example of the failures of the economic model in order to make wider and more stable changes.

After a quick re-read, please please remember my point about being ambivalent. I'm not saying "I know we should take the bigger picture", but rather that I am conflicted and thought it would be important to note my alternative argument...

Maybe this should be a thread all on its own...changing the system: top down or bottom up?

[ 02 September 2004: Message edited by: britchestoobig ]

[ 02 September 2004: Message edited by: britchestoobig ]

Sooner or later, 5 or 40 years from now, the stars will align for the Conservatives and they will win an election. If they look anything like they do now, they might not bring in privatization themselves, they'd just let Klein & Co. do it without raising a finger to stop them (provincial powers etc).

At that point, we will need to have a thought out, useful and progressive plan for creating a private health system that works for everyone.

I agree that the current world climate is not conducive to standing in the way of capital. Yes, the forest is burning. Fine, but we can fight the fire globally as well as fighting for trees we particularly value.

There are a lot of very successful cooperatives, in Canada and elsewhere. There are also some excellent credit unions etc. They could be effective models for a successful cooperative health system.

I think the answer lies with the Federal Government. It has to have standards and it has to regulate those standards. If the standards are stiff enough, the regulations enforced, and violaters heavily penalized, then most private companies will not want to join in. The trick is to stop greed from abusing the system.

[ 02 September 2004: Message edited by: James ]

[cynicism]It won't be likely to happen while the boomers are in their dotage though, they need that public care. We'll see deficits first (for those of us who follow to pay off by privatizing our own care).[/cynicism]

But something might happen next week or next year that changes everything. So we need to talk about it.

I am for privatization myself, b/c right now our system is hypocritical. Certain people can jump the wait line: those with workers' compensation board claims, those who can afford to go to the states, those who know the right people...

Also, Why should I pay for someone else's bad health? If someone eats like shit their whole lives, smokes and doesn't exercise and needs heart surgery, why should I be forced to pay for it?

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Originally posted by Dagny:
The allowal of Privatization is inevitable. How long until someone takes a racism claim to the Supreme Court about this situation?

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Also, Why should I pay for someone else's bad health? If someone eats like shit their whole lives, smokes and doesn't exercise and needs heart surgery, why should I be forced to pay for it?

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So, are you going to live forever with that good health of yours? No matter how healthy you are, the overwhelming majority of the money spent on your health care will be in the last year of your life. Unfortunately, that's when you are also least billable, for obvious reasons. What you are saying is that you shouldn't have to pay until then, and then someone else should have to pay for those costs.

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We shouldn't be so afraid of two-tier, remember that the only other two countries in the world with as little freedom in who gets to provide healthcare are Cuba and N. Korea.

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Originally posted by Dagny:
Also, Why should I pay for someone else's bad health? If someone eats like shit their whole lives, smokes and doesn't exercise and needs heart surgery, why should I be forced to pay for it?

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If you plan on paying, say, $50,000 cash for a short stay in the hospital some day, then fine. But if you intend on having PRIVATE health insurance to pay for your private medical costs, then you are still paying for someone else's bad decisions. When you pay for your private auto insurance, you are paying for someone else's bad driving. When you pay for your private fire insurance, you are paying for some else's lit cigaratte falling into some else's couch.

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Originally posted by Dagny:

Why should I pay for someone else's bad health?

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Originally posted by Dagny:

We shouldn't be so afraid of two-tier, remember that the only other two countries in the world with as little freedom in who gets to provide healthcare are Cuba and N. Korea.

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Ya, but Cuba has more physician's per capita than any other western nation. They also donate more physicians to poor Latin American countries than any other. For several years running, Cuba's infant mortality rates have been lower than that of the Yankee imperialists who insist on waging a vindictive and obsolete cold war trade embargo on Cuba. In fact, there are poor American youth in Cuba and receiving six years of free medical school and have pledged to work in poor, non-serviced and underserviced regions of the United States after graduating.

The USA has the greatest degree of private for-profit health care delivery of the developed world, and yet they have the worst infant mortality rates as well as the only 1st world nation not to provide universal access.

More physician's(one or more) are needed in Canada's smaller cities and remote Northern regions. Many Canadian's are going without a family doctor right now. We're also short of medical specialists and technologists of all kinds. Similar problems exist in the States where infant mortality and child poverty are just better than Mexico's.

And at the same time that these abysmal health and social statistics are nailed up, Canada and the U.S. are allowing college and university tuition fees to skyrocket. Our young people are now faced with shouldering enormous student loan debt sentences. It's like having a mortgage without a house. Large debts are a scary thing to young people these days. Is this encouraging young people in Northern regions to move away from home and get an education ?.

So, say you still had the single-payer public *funding* model, but had co-operatives delivering the service. OK, and say that instead of paying on a fee-for-service basis, you had the co-operative responsible for a population/region. Give patients some flexibility, so if they want to go to a different one from the nearest to where they live, they can, and they're on the books of the place they normally go, added in as part of their population.
So you pay a co-op based on the size of their patient population, with a markup for geographically dispersed populations. And you take some measures at the beginning for a baseline and keep track, of factors like average lifespan, infant mortality, and some kind of physical quality of life index, that kind of stuff. Whatever indicators seem reasonable. The co-op gets bonuses when the indicators improve. How they do it is up to them; if they can get results by tough lobbying for cleanup of the local air pollution, fine. If they can get the locals to all take up sports, fine. If they can keep everyone healthy without doing much actual surgery or stuff, then they've got a light workload and they're all well off.