2020, an unprecedented 10.9% of the GDP of the European Union was devoted to health care (Figure 5.3). Germany and France dedicated the highest shares to health at over 12% of their respective GDP. Sweden, Austria, the Netherlands and Belgium also spent over 11% of their GDP on health. The lowest shares of the overall economic output allocated to health were in Luxembourg (5.8%), Romania (6.3%), Poland (6.5%) and Ireland (7.1%). Across the whole of Europe, the United Kingdom and Switzerland were additional high spenders on health (with shares at around 12%), while Türkiye allocated the lowest share (4.6%). OECD report here are European health care spends as % GDP
It seems to me that all of us who have commented here have (or think we have) some ideas as to how to solve the issues. Does anyone know if a study has been made of the various health care systems in the rich/developed world where cost / clinical outcomes have been carefully evaluated? I think this wold be a good way to start, once we have real data we will know better how to proceed. I know that I am biased toward a free at point of use system with higher general taxes but that is just because I used to work in NHS and am a child of the 60s socialist states in Europe. In spite of this I also can see the problems you describe in Canada and I know the problems in UK; Scandinavia (with highertaxes) works ok but for how long g within creasing aged populations?
To avoid these inhetent biases, which we all have, we need good data before jumping on any particular system.
Regarding health care, a free at point of use system is the best. But,like the NHS in the UK, it gets underfunded (often for well intentioned reasons) and then decline is rapid. Your situation seems remarkably similar to the dental health system in UK. That system has deteriorated into different levels of care which depend on geography and spending power of the individual. I think that we must either pay more taxes or "limit free at point of use" procedures to things like preventative health, A and E and ICU etc and have a part payment system for non urgent elective procedures.
The way to prevent racism is by education and reduction of poverty in general, a much better use of tax dollars than these "media virtuous" actions.
Just some thoughts, how do others think about possible solutions.
Peter, interesting health care point. I was under the impression the NHS allows for private delivery of services with govt funding? is that the case ? Here in Canada we can have some limited private services, but hospitals and medically necessary treatments (as a rule) must be administered publicly (that is, not for profit). In my mind, this stifles innovation and cost improvement measures which might improve overall health services,
James, you are correct, in that with dentistry the dentists are private persons not state employees. Most NHS doctors are however state employees and senior doctors are allowed to carry out some private practice as well. I think that private health care is not always "efficient", US costs for a treatment are more expensive than similar procedures in most of Europe. You are correct when you say that directed innovation is required to improve cost/ outcome ratios. The problem is that (as with so many other social issues) inbuilt pre conceived ideas and politics stand in the way of rational problem solving.
Hiring Asian and Indian medical workers won't satisfy DEI type requirements in the US. Does it in Canada? As you know in the US, Asian males of all types are subject to more real discrimination that even us "white males". The DEI logic of systemic racism is not general racism type beliefs being opposed, like MLK did, but active support of racism for people whose long dead relatives were victims. With full DNA analysis the genetic leakage between groups may show some surprising results and a lot of hank-pankey going on. Even N. Korea only goes back 3 generation.
apprapos of this thread, I just read in John Dahl’s wonderful book this passage about Darwin’s grandfather:
“Erasmus Darwin was regarded as one of the finest physicians of his age with a reputation for generosity. Erasmus refused payment from his poorer patients and even provided them with food and blankets.”
Dahl, John. Darwin's Second Voyage: An Evolutionary Odyssey (p. 206).
I hear ya Dr.... but you know, just try and say to fellow canucks we have to do something to correct the state of health care across Canada, and you will the most wild eyed parochial screams and screams of trying to "americanize" health care, So, things just get worse and worse and worse....
I get your references to the DIE activities, but perhaps your point would be stronger by noting current plans to dedicate 4 billion (at start) to national dental care. I certainly have no problem with a national dental care plan, but perhaps it is a bit like repairing your home stereo system when your roof really needs some serious attention....
But- if it makes you feel any better, just hang on another 50 years or so and its just not our problem anymore :)
On another note, I quite enjoyed your winter photographs.... we dont have any snow here in the GTA so I am experiencing it vicariously through you. Happily so I might add all the best oh, and hey, how about more about your galapagos trip. We've always dreamed of that adventure but time doesnt really permit
THanks, on all counts.. I will be writing about the galapagos when I can get back on schedule, which seems pretty hard of late.. Right now, snow is finally melting, but we will see what next week brings. :)
If you are able to find a place where this is not a problem, I suspect it will be in Alabama or Mississippi. Probably best to wait it out. Like so many attempts to do something desirable but new., it takes some fiddling to get an acceptable solution. Black and brown folks in this country have gotten the short end of the stick (if any end at all) for three hundred years. A few years of inconvenience while various things are tried hardly balances past injustices.
A similar lack of doctors in rural areas of the USA was recently reported in the Washington Post. That investigation found the main reason was that doctors (and their families) preferred to live in the cities or suburbs even if the pay in the rural communities was made higher. Perhaps obvious, but there is no easy answer.
I was born in Alberta and have lived in BC since 1996. Your description of PEI is not unlike the Alberta that I grew up in. Albertans looked for community and private solutions to sometimes major problems rather than expecting government to get involved, i.e. spend money and increase public servants. A former NDP activist made the observation that "Canadians love big government: they just don't want to stand in line to get it." It's especially true in the areas that effectively elect the government in any federal election, i.e. southern Ontario, urban Quebec, and the Lower Mainland of BC. Albertans have had to endure elections that were decided before the polls even closed in their province. The position that Alberta has taken on DIE programs, white liberal guilt initiatives, and s-called "gender" issues have been predictably criticized by the "Amen Corner" of academia, publicly-funded media, and various unions (especially the teacher's unions), etc. Something has to give in Canada as, outside of wartime, it's never been a country but a group of states with very different political and economic visions and expectations.
Well, USA has exported to the world the philosophy of extreme capitalism. When you cannot kill public services, like health care (Medicare in the US, fort example), just starve them. You often condemn identity politics, but you seem to fail to realize that the biggest identity problem is capitalism as practiced in and exported by the USA. Republicans and right wingers cheer. The left is contemplating its navel.
condemning capitalism is, by itself, pretty sterile. It exists, and is an essential part of the world.. working within it, and I think one has to, seem more practical. My two cents
one might argue capitalism has created the abundant world in which we live, and drives innovation. not looking to start an argument so much as offer another perspective.
AN AMERICAN SICKNESS by Dr. Elisabeth Rosenthal is a good explanation of how the American health care system got so screwed up — little by little, step by step. I’m lucky because I have probably the best insurance there is and I live in a big enough city that state-of the-art facilities and doctors. However, it ain’t cheap. It reminds me of that line from the song: Everything[s free in America, for a small fee in America.” I've always heard the Canadian system of national health is better, but maybe not-- I hope they can correct the faults.
Thanks Mike.. I had good insurance for the most part in the US.. problem was I didn't have catastrophic health problems.. but my experience in Canada has certainly made me rethink things a little... private/public partnerships seem the way to go.
Mike - one key difference is that health care up here is funded through general tax revenues collected at the federal level, and doled out at provincial levels. Many think health care is free- but it roughly costs 40-50% of your tax dollar depending on the province in which you live. Maybe 200 000 or so live in PEI - so the per capita percentage of overall tax burden is certainly higher.
Regardless, our system has very good advantages such as anyone, regardless of situation, can get medical treatment. A key downside is our system does not innovate well, and depending on circumstance you might have to get into a queue....
I do not know enough about how the american system works, particularly as it concerns those without insurance coverage. I cannot imagine denial of service simply for lack of coverage, and have heard mixed stories about that being the case.
I think you summarized things perfectly.. in the US the ludicrous and criminal aspect of the health care system is that you have insurance when working, but when not, and when you most need it, you don't have it.
Dr. Krauss, I know what you mean. I don't have data to support it, but I think a few more dollars in taxes would be a lot more economical than the nightmare system most people deal with now. I was just composing a message in reply to James OHalleran. I’ll just include it here.
Many states are offering Medicaid health insurance to people with very limited income and resources. People like me, who work for large employers can purchase health insurance through their employer — the employer and employee split the cost. I recently retired from the federal government. Part of my retirement package includes the ability to remain in the Federal Employees Health Care system and pay the same rate as active employees. Plus I have Medicare because of my age. Medicare pays first, and the FEHC pays the deductible and co-pays. It sounds great but the total cost approaches nearly $500 per month — I.e. free for a small fee. On the other hand, when illness strikes, I get premium care.
The real problem is for folks who must buy insurance on their own — super expensive with very high deductibles and co-pays. As a result, many people go without insurance, and when distaster strikes, they get hit with huge bills in addition to illness or injury
agree completely.. I was in a somewhat similar position as you, and when I retired I had access to good health care and medicare, but not at the costs I paid before I retired.. More like $1500/mo.. though that included coverage for my wife.
interesting. of course you need to balance that 1500 monthly premium you paid directly against the indirect payment you make through federal and provincial taxation.. Supplementary coverage here is still required if you want private/semi private rooms and pharmaceutical drugs are not covered up here.
what strikes me is how keenly aware you both are about actual health care premiums, whereas here most are not aware of true costs.
mike, those without insurance - can and would hospitals deny them treatment, knowing you cannot get blood from a stone?
I've not heard of anyone being denied care. There used to be a federal law (Hill Burton Act) that required any hospital that received federal money of any kind to treat indigent people. I'm not sure if Hill Burton is still in effect or it it expired. many people use emergency rooms as primary care.
Counties used to have hospitals & clinics, but they are increasingly transitioning to private institutions. People can also go to university hospitals & clinics. Regardless where people without insurance get treatment, they are likely to be chained to large bills.
2020, an unprecedented 10.9% of the GDP of the European Union was devoted to health care (Figure 5.3). Germany and France dedicated the highest shares to health at over 12% of their respective GDP. Sweden, Austria, the Netherlands and Belgium also spent over 11% of their GDP on health. The lowest shares of the overall economic output allocated to health were in Luxembourg (5.8%), Romania (6.3%), Poland (6.5%) and Ireland (7.1%). Across the whole of Europe, the United Kingdom and Switzerland were additional high spenders on health (with shares at around 12%), while Türkiye allocated the lowest share (4.6%). OECD report here are European health care spends as % GDP
It seems to me that all of us who have commented here have (or think we have) some ideas as to how to solve the issues. Does anyone know if a study has been made of the various health care systems in the rich/developed world where cost / clinical outcomes have been carefully evaluated? I think this wold be a good way to start, once we have real data we will know better how to proceed. I know that I am biased toward a free at point of use system with higher general taxes but that is just because I used to work in NHS and am a child of the 60s socialist states in Europe. In spite of this I also can see the problems you describe in Canada and I know the problems in UK; Scandinavia (with highertaxes) works ok but for how long g within creasing aged populations?
To avoid these inhetent biases, which we all have, we need good data before jumping on any particular system.
Regarding health care, a free at point of use system is the best. But,like the NHS in the UK, it gets underfunded (often for well intentioned reasons) and then decline is rapid. Your situation seems remarkably similar to the dental health system in UK. That system has deteriorated into different levels of care which depend on geography and spending power of the individual. I think that we must either pay more taxes or "limit free at point of use" procedures to things like preventative health, A and E and ICU etc and have a part payment system for non urgent elective procedures.
The way to prevent racism is by education and reduction of poverty in general, a much better use of tax dollars than these "media virtuous" actions.
Just some thoughts, how do others think about possible solutions.
Thanks to you both for your thoughts on this.. a difficult nut to crack, but ultimately some private/public combo seems the only way to go.
Peter, interesting health care point. I was under the impression the NHS allows for private delivery of services with govt funding? is that the case ? Here in Canada we can have some limited private services, but hospitals and medically necessary treatments (as a rule) must be administered publicly (that is, not for profit). In my mind, this stifles innovation and cost improvement measures which might improve overall health services,
James, you are correct, in that with dentistry the dentists are private persons not state employees. Most NHS doctors are however state employees and senior doctors are allowed to carry out some private practice as well. I think that private health care is not always "efficient", US costs for a treatment are more expensive than similar procedures in most of Europe. You are correct when you say that directed innovation is required to improve cost/ outcome ratios. The problem is that (as with so many other social issues) inbuilt pre conceived ideas and politics stand in the way of rational problem solving.
thanks for the input. i appreciate the conversation. Just hope you arent a Man U chap :)
No Arsenal, I was born almost next door to their old ground.
Hiring Asian and Indian medical workers won't satisfy DEI type requirements in the US. Does it in Canada? As you know in the US, Asian males of all types are subject to more real discrimination that even us "white males". The DEI logic of systemic racism is not general racism type beliefs being opposed, like MLK did, but active support of racism for people whose long dead relatives were victims. With full DNA analysis the genetic leakage between groups may show some surprising results and a lot of hank-pankey going on. Even N. Korea only goes back 3 generation.
apprapos of this thread, I just read in John Dahl’s wonderful book this passage about Darwin’s grandfather:
“Erasmus Darwin was regarded as one of the finest physicians of his age with a reputation for generosity. Erasmus refused payment from his poorer patients and even provided them with food and blankets.”
Dahl, John. Darwin's Second Voyage: An Evolutionary Odyssey (p. 206).
I hear ya Dr.... but you know, just try and say to fellow canucks we have to do something to correct the state of health care across Canada, and you will the most wild eyed parochial screams and screams of trying to "americanize" health care, So, things just get worse and worse and worse....
I get your references to the DIE activities, but perhaps your point would be stronger by noting current plans to dedicate 4 billion (at start) to national dental care. I certainly have no problem with a national dental care plan, but perhaps it is a bit like repairing your home stereo system when your roof really needs some serious attention....
But- if it makes you feel any better, just hang on another 50 years or so and its just not our problem anymore :)
On another note, I quite enjoyed your winter photographs.... we dont have any snow here in the GTA so I am experiencing it vicariously through you. Happily so I might add all the best oh, and hey, how about more about your galapagos trip. We've always dreamed of that adventure but time doesnt really permit
THanks, on all counts.. I will be writing about the galapagos when I can get back on schedule, which seems pretty hard of late.. Right now, snow is finally melting, but we will see what next week brings. :)
If you are able to find a place where this is not a problem, I suspect it will be in Alabama or Mississippi. Probably best to wait it out. Like so many attempts to do something desirable but new., it takes some fiddling to get an acceptable solution. Black and brown folks in this country have gotten the short end of the stick (if any end at all) for three hundred years. A few years of inconvenience while various things are tried hardly balances past injustices.
if it were just that, I wouldn't worry.. it is re re-meregence of system racism though anti-racism initiatives that worry me..
A similar lack of doctors in rural areas of the USA was recently reported in the Washington Post. That investigation found the main reason was that doctors (and their families) preferred to live in the cities or suburbs even if the pay in the rural communities was made higher. Perhaps obvious, but there is no easy answer.
So good health care does not come cheap.
Data is from OECD report.
I was born in Alberta and have lived in BC since 1996. Your description of PEI is not unlike the Alberta that I grew up in. Albertans looked for community and private solutions to sometimes major problems rather than expecting government to get involved, i.e. spend money and increase public servants. A former NDP activist made the observation that "Canadians love big government: they just don't want to stand in line to get it." It's especially true in the areas that effectively elect the government in any federal election, i.e. southern Ontario, urban Quebec, and the Lower Mainland of BC. Albertans have had to endure elections that were decided before the polls even closed in their province. The position that Alberta has taken on DIE programs, white liberal guilt initiatives, and s-called "gender" issues have been predictably criticized by the "Amen Corner" of academia, publicly-funded media, and various unions (especially the teacher's unions), etc. Something has to give in Canada as, outside of wartime, it's never been a country but a group of states with very different political and economic visions and expectations.
Well, USA has exported to the world the philosophy of extreme capitalism. When you cannot kill public services, like health care (Medicare in the US, fort example), just starve them. You often condemn identity politics, but you seem to fail to realize that the biggest identity problem is capitalism as practiced in and exported by the USA. Republicans and right wingers cheer. The left is contemplating its navel.
condemning capitalism is, by itself, pretty sterile. It exists, and is an essential part of the world.. working within it, and I think one has to, seem more practical. My two cents
I said "extreme capitalism". παν μετρον αριστον!
one might argue capitalism has created the abundant world in which we live, and drives innovation. not looking to start an argument so much as offer another perspective.
AN AMERICAN SICKNESS by Dr. Elisabeth Rosenthal is a good explanation of how the American health care system got so screwed up — little by little, step by step. I’m lucky because I have probably the best insurance there is and I live in a big enough city that state-of the-art facilities and doctors. However, it ain’t cheap. It reminds me of that line from the song: Everything[s free in America, for a small fee in America.” I've always heard the Canadian system of national health is better, but maybe not-- I hope they can correct the faults.
Thanks Mike.. I had good insurance for the most part in the US.. problem was I didn't have catastrophic health problems.. but my experience in Canada has certainly made me rethink things a little... private/public partnerships seem the way to go.
Mike - one key difference is that health care up here is funded through general tax revenues collected at the federal level, and doled out at provincial levels. Many think health care is free- but it roughly costs 40-50% of your tax dollar depending on the province in which you live. Maybe 200 000 or so live in PEI - so the per capita percentage of overall tax burden is certainly higher.
Regardless, our system has very good advantages such as anyone, regardless of situation, can get medical treatment. A key downside is our system does not innovate well, and depending on circumstance you might have to get into a queue....
I do not know enough about how the american system works, particularly as it concerns those without insurance coverage. I cannot imagine denial of service simply for lack of coverage, and have heard mixed stories about that being the case.
I think you summarized things perfectly.. in the US the ludicrous and criminal aspect of the health care system is that you have insurance when working, but when not, and when you most need it, you don't have it.
Dr. Krauss, I know what you mean. I don't have data to support it, but I think a few more dollars in taxes would be a lot more economical than the nightmare system most people deal with now. I was just composing a message in reply to James OHalleran. I’ll just include it here.
Many states are offering Medicaid health insurance to people with very limited income and resources. People like me, who work for large employers can purchase health insurance through their employer — the employer and employee split the cost. I recently retired from the federal government. Part of my retirement package includes the ability to remain in the Federal Employees Health Care system and pay the same rate as active employees. Plus I have Medicare because of my age. Medicare pays first, and the FEHC pays the deductible and co-pays. It sounds great but the total cost approaches nearly $500 per month — I.e. free for a small fee. On the other hand, when illness strikes, I get premium care.
The real problem is for folks who must buy insurance on their own — super expensive with very high deductibles and co-pays. As a result, many people go without insurance, and when distaster strikes, they get hit with huge bills in addition to illness or injury
agree completely.. I was in a somewhat similar position as you, and when I retired I had access to good health care and medicare, but not at the costs I paid before I retired.. More like $1500/mo.. though that included coverage for my wife.
interesting. of course you need to balance that 1500 monthly premium you paid directly against the indirect payment you make through federal and provincial taxation.. Supplementary coverage here is still required if you want private/semi private rooms and pharmaceutical drugs are not covered up here.
what strikes me is how keenly aware you both are about actual health care premiums, whereas here most are not aware of true costs.
mike, those without insurance - can and would hospitals deny them treatment, knowing you cannot get blood from a stone?
I've not heard of anyone being denied care. There used to be a federal law (Hill Burton Act) that required any hospital that received federal money of any kind to treat indigent people. I'm not sure if Hill Burton is still in effect or it it expired. many people use emergency rooms as primary care.
Counties used to have hospitals & clinics, but they are increasingly transitioning to private institutions. People can also go to university hospitals & clinics. Regardless where people without insurance get treatment, they are likely to be chained to large bills.