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The Fraser Institute, Better Treatment, Better Care (1)

Better Treatment, Better Care (1)

Welcome to Danielle Smith's Fraser Forum, this program is part of a series

of podcasts doing in-depth interviews on free enterprise and personal liberty i'm

your host Danielle Smith president of the Alberta Enterprise Group. Go to

fraserforum.org where you can subscribe comment on the program and see links to

the studies we discuss you will also find archives of previous episodes our

email address is danielle fraserforum.org we'd love to hear from

you. [Music]

One of the interesting arguments that we often hear in canada is well if we if we

allow private hospitals to exist in canada the americans would immediately

come up and create an American health care system so we're afraid of the mayo

clinic coming to Toronto we're afraid of johns hopkins setting up in downtown

calgary uh we're afraid of cedar sinai coming to downtown vancouver what are we

afraid of when we have world-class healthcare facilities delivering some of

the best healthcare in the world south of the border yes there are issues in

the american universal the american system but there is some incredible

health care down there and some incredible knowledge and wouldn't it be

wonderful if we had the opportunity to access some of that in this country

[Music] well hello again i am delighted for this

edition to be speaking with nadeem esmel senior fellow at the fraser institute

about a topic i have been following for literally decades now a lot because of

the work of my guest as well as other scholars at the fraser institute we're

talking about healthcare and how we're going to fix it nadeem thank you so much

for your time today i sure appreciate it thanks for having me on i'm not kidding

when i say i've been watching this for decades uh i was a an intern at the

fraser institute in the mid 90s when i first got

got to see the waiting your turn hospital waiting list survey and so i

have watched it every single year coming out hoping and hoping that we were going

to see trends going in the right direction and why don't you share the

bad news what's actually happened uh year over year in that waiting u-turn

survey the trend continues to go in the wrong direction we're reaching peaks and

highs continually year after year and we've tried to dig into this and try

to understand why is this happening as spending is growing in fact even when

you do a statistical analysis the more money we put into the health care system

in canada the longer the waiting list get which is exactly the opposite of

what the oecd has found occurs in europe where a hundred dollars of extra per

person spending brings waiting lists down and canada brings them up that's

how dysfunctional the healthcare system is so when can you talk a little bit

about what that survey shows just so people know where the problem lies

because you look at a couple of things and if i remember how you do it you

actually you ask real doctors frontline doctors and frontline specialists how

long it's taking between between treatment diagnosis and as and when they

get their their actual treatment can can you just sort of elaborate a little bit

so people understand why it's getting so bad

so the survey goes out to medical practitioners physicians in 12 major

medical specialties across the country we contact every physician we're able to

contact and we ask them how long it takes for a

patient to see the doctor on an elective or routine basis and then we ask about a

special specific set of surgeries and how long a patient would wait from today

for those surgeries or treatments and we also ask about the weight test for mri

ct and ultrasound and the weight to see the surgeon or the specialist plus the

weight to receive those treatments on a weighted basis gives the total wait time

nationally so we're going physician but we're going

specialty by specialty treatment by treatment and then aggregating up based

on the number of treatments actually performed to get the aggregate number

and if i recall this you started this at fraser institute before anyone else but

there have been other waiting list surveys that that that validate and and

replicate the findings that you have right

that's right this was started in the early 1990s dr michael walker professor

stephen globerman got together they created the survey it started in british

columbia moved national the first national i think was 1993. i stewarded

from the 2000 to about 2012. and we have gone every year out to the uh to the to

the medical literature to the economic literature to try and verify the numbers

that we have and what we found is that if anything waiting your turn actually

understates the actual patient's experience in canada

certainly governments have gone unmeasured if you look at the oecd's

charts of how governments measure the canadian official stop watch starts

later than every other country in the developed world stopwatch begins and we

still record officially wait times that are competitive with our colleagues who

start their stopwatch much earlier it's a terrible state of waiting

it's it is a terrible state and i guess the the part i need you to unbundle a

little bit is is it doesn't make sense to a regular person looking at this

saying okay we've got waiting lists you would think the right answer would be

well let's just give more money to health care and so governments dutifully

have given more money to health care the federal government has given more money

to health care so why would it be that giving more

money is resulting in worse outcomes that just seems to be upside down

it's it's a very interesting setup and what few people realize is that we

actually have one of the developer world's best funded universal access

healthcare system uh the canadian healthcare system ranks among the most

expensive in the developed world and yet international surveys show that we

actually have some of the longest waiting lists for access to healthcare

in the developed world and it all comes from the structure of the health care

system itself the incentives that are ingrained in a system that has a lack of

user fees that does not have activity-based funding for hospital care

that does not have private parallel provision of medical services and that

does not have private competition in the delivery of hospital services we've

taken a very unique policy construct and as a result we're doing a terrible job

for canadian patients and for the taxpayers that are funding their care

we're going to talk about each of those in detail i want to know if the canada

health act itself has created these structural problems

because if you're in a position where the federal government ties funding to

provinces based on these five principles and there's something wrong with one of

the five principles then you're in a position where you're kind of locked

into never changing the system so let's see if we can go through these one at a

time and you can and you can tell me if if we our starting point needs to be

throwing out the canada health act so we've got public administration

universality comprehensive accessible and i have transportable i

think that's the the the final one let's talk about public administration

and when i think about that that says to me

essentially that you have a single insurer for the services that are

covered which on the surface i don't necessarily object to because i can

imagine it there's probably a lot of streamlining that you have of having a

single insurance plan everybody understands what you can cover

what you can't what gets paid as opposed to having hundreds or even more

private insurers that you would have to deal with is is the public

administration the problem or um should i be looking at that some other

way i think public administration is not is

not one of the central concerns with the canada health act but there is a

peripheral one and that is by locking us into a single insurer and it's

interesting public administration says it can be a non-profit authority

assigned by government it doesn't have to be government but by locking us into

a single authority we immediately under the canada health act disallow a policy

approach followed by a country like germany switzerland the netherlands

where we have multiple competing insurers inside the universal construct

those countries understand that competing insurers allows individuals to

tailor insurance policies to their own unique circumstances and needs to adjust

deductibles and premiums to go into managed care because it might save them

premium by restricting choice of physician it gives all sorts of options

specialization for particular medical conditions someone who's a diabetic

might prefer an insurance an insurer that specializes in that someone with a

heart condition might prefer that sort of a specialized insurer this blanket

one size fits all approach that's that's almost demanded by that particular

principle or term in the canada health act does disallow one policy construct

but it doesn't stop the system from being better a better functioning health

care system okay that you know that's good to know and

when we get into looking at some of the individual systems as well let's explore

that a little bit more let's talk about universality because i think

universality should mean this it means should mean that nobody

loses their house or goes bankrupt because of an inability to pay medical

bills it should be the coverage for catastrophic you don't

want anybody making a choice not to receive essential treatment

because they're they're worried about the cost of it so

that's fine but i don't know that this system where we have um we have to pay

for every little thing in the hospital and physician services i don't i don't

know that that's the best definition of universality and i think you've

you've looked around the world and universality means a lot of different

things in a lot of different places what's the essential component of

universality for you i think universality is the normal goal

but it's a common goal it's shared by just about every developed nation around

the world it's the goal of ensuring access to care

regardless of ability to pay i think there also needs to be in a time frame

to provide that provides comfort and peace of mind waiting for health care is

not a benign process health conditions advance people deteriorate the

medications we have to take for pain while we're waiting for the joint

surgery have an impact on our livers and our livelihoods it impacts our ability

to earn a living to look after our families to enjoy our time with our

loved ones so to me universality is care uh regardless of ability to pay in

a time frame that provides comfort and peace of mind that's not what the canada

health act says canada health act says 100 of the insurable population on

uniform terms and conditions so again disallowing this opportunity for people

to tailor their universal health care experience to their own unique

circumstances and needs but generally a fairly benign goal or an important goal

but a fairly benign piece of the canada healthcare do you do you think in canada

we can re-interpret universality the way you

described or do you think that that principle needs do you need a

legislative change this is what i'm trying to to sort of sort through as we

have this conversation is how much of a straight jacket some of these principles

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Better Treatment, Better Care (1) Mejor tratamiento, mejor atención (1) Meilleur traitement, meilleurs soins (1) Лучшее лечение, лучший уход (1) Daha İyi Tedavi, Daha İyi Bakım (1) Краще лікування, кращий догляд (1) 更好的治疗,更好的护理 (1) 更好的治疗,更好的护理 (1)

Welcome to Danielle Smith's Fraser Forum, this program is part of a series Bienvenue au Fraser Forum de Danielle Smith, ce programme fait partie d'une série Ласкаво просимо на Фрейзер Форум Даніель Сміт, ця програма є частиною серії

of podcasts doing in-depth interviews on free enterprise and personal liberty i'm de podcasts faisant des entrevues approfondies sur la libre entreprise et la liberté personnelle. Je suis подкастів, які роблять глибинні інтерв'ю про вільне підприємництво та особисту свободу, я

your host Danielle Smith president of the Alberta Enterprise Group. Go to votre hôte Danielle Smith, présidente de l'Alberta Enterprise Group. Allez sur

fraserforum.org where you can subscribe comment on the program and see links to fraserforum.org où vous pouvez vous abonner pour commenter le programme et voir les liens vers

the studies we discuss you will also find archives of previous episodes our les études dont nous discutons. Vous trouverez également des archives des épisodes précédents. Notre

email address is danielle fraserforum.org we'd love to hear from adresse e-mail est danielle fraserforum.org. Nous aimerions avoir de

you. [Music] vos nouvelles. [Musique]

One of the interesting arguments that we often hear in canada is well if we if we L'un des arguments intéressants que nous entendons souvent au canada est que si nous Um dos argumentos interessantes que ouvimos frequentemente no Canadá é: bem, se nós se nós Один з цікавих аргументів, який ми часто чуємо в Канаді, - це те, що добре, якщо ми

allow private hospitals to exist in canada the americans would immediately permettions aux hôpitaux privés d'exister au canada les américains viendraient immédiatement permitisse a existência de hospitais privados no Canadá, os americanos iriam imediatamente дозволити приватним лікарням існувати в канаді, американці негайно

come up and create an American health care system so we're afraid of the mayo et créeraient un système de santé américain donc nous avons peur de la clinique mayo à criar um sistema de saúde americano para que tenhamos medo da maionese приходьте і створіть американську систему охорони здоров'я, щоб ми боялися майонезу

clinic coming to Toronto we're afraid of johns hopkins setting up in downtown venir à Toronto nous avons peur que Johns Hopkins s'installe au centre-ville de a clínica que vem para Toronto tem medo que a johns hopkins se instale na baixa ми боїмося, що в Торонто з'явиться клініка Джона Гопкінса, яка розміститься в центрі міста

calgary uh we're afraid of cedar sinai coming to downtown vancouver what are we Calgary euh nous avons peur que cedar Sinai arrive au centre-ville de Vancouver De quoi avons-nous calgary uh estamos com medo que cedar sinai venha para a baixa de vancouver o que é que nós somos калгарі ми боїмося, що кедр синай прийде в центр ванкувера що ми

afraid of when we have world-class healthcare facilities delivering some of peur lorsque nous avons des établissements de santé de classe mondiale offrant certains des receio de quando temos instalações de saúde de classe mundial que prestam alguns dos

the best healthcare in the world south of the border yes there are issues in meilleurs soins de santé au monde au sud de la frontière oui, il y a des problèmes dans os melhores cuidados de saúde do mundo a sul da fronteira, sim, há problemas em

the american universal the american system but there is some incredible le système américain universel, mais il y a des soins de santé incroyables

health care down there and some incredible knowledge and wouldn't it be là-bas et des connaissances incroyables et ne serait-ce pas

wonderful if we had the opportunity to access some of that in this country merveilleux si nous avions la possibilité d'accéder à certains de ces éléments dans ce pays

[Music] well hello again i am delighted for this [Musique] bien bonjour encore une fois, je suis ravi que cette [Ну, привіт ще раз, я дуже радий цьому.

edition to be speaking with nadeem esmel senior fellow at the fraser institute édition parle avec nadeem esmel senior fellow à l'institut fraser видання поспілкується з Надім Есмел, старшим науковим співробітником Інституту Фрейзера

about a topic i have been following for literally decades now a lot because of d'un sujet que je suis depuis littéralement des décennies maintenant grâce sobre um tema que tenho vindo a seguir há literalmente décadas, muito por causa de onlarca yıldır takip ettiğim bir konu hakkında про тему, за якою я стежу вже буквально десятиліттями, багато в чому через

the work of my guest as well as other scholars at the fraser institute we're au travail de mon invité ainsi que d'autres chercheurs de l'institut fraser, nous

talking about healthcare and how we're going to fix it nadeem thank you so much parlons de soins de santé et de la façon dont nous allons y remédier nadeem merci beaucoup falando sobre os cuidados de saúde e como vamos resolvê-los nadeem muito obrigado

for your time today i sure appreciate it thanks for having me on i'm not kidding pour votre temps aujourd'hui je l'apprécie vraiment merci de m'avoir invité je ne plaisante pas pelo vosso tempo hoje, agradeço-vos muito, obrigado por me receberem, não estou a brincar

when i say i've been watching this for decades uh i was a an intern at the quand je dis je regarde ça depuis des décennies euh j'étais stagiaire à l' quando digo que ando a ver isto há décadas, era estagiário na

fraser institute in the mid 90s when i first got institut fraser au milieu des années 90 quand j'ai vu pour la première fois l' Instituto Fraser em meados dos anos 90, quando comecei a

got to see the waiting your turn hospital waiting list survey and so i enquête sur la liste d'attente de l'hôpital en attente de ton tour et donc je l' consegui ver o inquérito sobre a lista de espera dos hospitais e por isso

have watched it every single year coming out hoping and hoping that we were going ai regardé chaque année en espérant et en espérant que nous allions assisti a este filme todos os anos, com a esperança de que o vamos fazer дивилися його щороку, коли він виходив, сподіваючись і сподіваючись, що ми поїдемо

to see trends going in the right direction and why don't you share the voir les tendances aller dans la bonne direction et pourquoi ne partagez-vous pas les para ver as tendências que vão na direcção certa e porque não partilha as щоб побачити тенденції, які йдуть у правильному напрямку, і чому б вам не поділитися

bad news what's actually happened uh year over year in that waiting u-turn mauvaises nouvelles ce qui s'est réellement passé euh année après année dans cette enquête de más notícias o que é que realmente aconteceu ano após ano nessa reviravolta de espera

survey the trend continues to go in the wrong direction we're reaching peaks and demi-tour en attente la tendance continue d'aller dans la mauvaise direction que nous atteignons des pics et des a tendência continua a ir na direcção errada, estamos a atingir picos e

highs continually year after year and we've tried to dig into this and try sommets continuellement d'année en année et nous avons essayé de creuser cela et d'essayer ano após ano, e tentámos investigar o assunto e tentar

to understand why is this happening as spending is growing in fact even when de comprendre pourquoi cela se produit alors que les dépenses augmentent en fait, même lorsque para compreender por que razão isto está a acontecer, uma vez que as despesas estão a aumentar, de facto, mesmo quando

you do a statistical analysis the more money we put into the health care system vous effectuez une analyse statistique, plus nous investissons dans le système de santé se fizermos uma análise estatística, quanto mais dinheiro colocarmos no sistema de saúde

in canada the longer the waiting list get which is exactly the opposite of au Canada, plus plus la liste d'attente s'allonge c'est exactement le contraire de no Canadá, mais longa é a lista de espera, o que é exactamente o oposto de

what the oecd has found occurs in europe where a hundred dollars of extra per ce que l'ocde a trouvé en europe où cent dollars de dépenses supplémentaires par o que a ocde descobriu ocorre na europa, onde uma centena de dólares extra por

person spending brings waiting lists down and canada brings them up that's personne font baisser les listes d'attente et le canada les soulève c'est à as despesas das pessoas fazem baixar as listas de espera e as do canadá fazem-nas subir, isso é

how dysfunctional the healthcare system is so when can you talk a little bit quel point le système de santé est dysfonctionnel, alors quand pouvez-vous parler un peu

about what that survey shows just so people know where the problem lies de ce que cela l'enquête montre juste pour que les gens sachent où se situe le problème sobre o que esse inquérito mostra, para que as pessoas saibam onde está o problema

because you look at a couple of things and if i remember how you do it you parce que vous regardez un certain nombre de choses et si je me souviens comment vous le faites, porque se olha para um par de coisas e, se bem me lembro, como se faz

actually you ask real doctors frontline doctors and frontline specialists how vous demandez en fait à de vrais médecins, des médecins de première ligne et des spécialistes de première ligne combien de se perguntarmos a médicos reais, médicos de primeira linha e especialistas de primeira linha, como насправді ви запитуєте справжніх лікарів, лікарів на передовій, фахівців на передовій, як

long it's taking between between treatment diagnosis and as and when they temps cela prend entre le diagnostic du traitement et au fur et à mesure qu'ils Quanto tempo está a demorar entre o diagnóstico do tratamento e como e quando скільки часу проходить між постановкою діагнозу та початком лікування

get their their actual treatment can can you just sort of elaborate a little bit obtenir leur traitement réel pouvez-vous simplement élaborer un peu obter o seu tratamento efectivo pode elaborar um pouco mais

so people understand why it's getting so bad pour que les gens comprennent pourquoi ça va si mal

so the survey goes out to medical practitioners physicians in 12 major alors le sondage est envoyé aux médecins médecins dans 12 grandes

medical specialties across the country we contact every physician we're able to spécialités médicales à travers le pays nous contactons tous les médecins que nous sommes en mesure de

contact and we ask them how long it takes for a contacter et nous leur demandons combien de temps il faut pour qu'un

patient to see the doctor on an elective or routine basis and then we ask about a patient consulte le médecin sur une base élective ou de routine, puis nous demandons un

special specific set of surgeries and how long a patient would wait from today ensemble spécifique spécial de chirurgies a nd combien de temps un patient attendrait à partir d'aujourd'hui conjunto específico de cirurgias e quanto tempo um doente esperaria a partir de hoje

for those surgeries or treatments and we also ask about the weight test for mri pour ces chirurgies ou traitements et nous posons également des questions sur le test de poids pour l'IRM para essas cirurgias ou tratamentos e também perguntamos sobre o teste de peso para a ressonância magnética

ct and ultrasound and the weight to see the surgeon or the specialist plus the et l'échographie et le poids pour voir le chirurgien ou le spécialiste plus le ct e ultra-som e o peso para ver o cirurgião ou o especialista mais o

weight to receive those treatments on a weighted basis gives the total wait time poids pour recevoir ces traitements sur une base pondérée donne le temps d'attente total à l' para receber esses tratamentos, numa base ponderada, dá o tempo de espera total

nationally so we're going physician but we're going échelle nationale, nous allons donc médecin, mais nous allons a nível nacional, por isso vamos médicos, mas vamos

specialty by specialty treatment by treatment and then aggregating up based spécialité par spécialité traitement par traitement, puis agrégeons en fonction especialidade por especialidade, tratamento por tratamento e, em seguida, agregação com base спеціальність за спеціальністю, лікування за лікуванням, а потім узагальнення на основі

on the number of treatments actually performed to get the aggregate number du nombre de traitements réellement effectués pour obtenir le nombre total no número de tratamentos efectivamente realizados para obter o número agregado

and if i recall this you started this at fraser institute before anyone else but et si je m'en souviens, vous avez commencé cela à l'institut fraser avant quelqu'un d'autre mais e se bem me lembro, começou isto no Instituto Fraser antes de qualquer outra pessoa, mas і, наскільки я пам'ятаю, ви почали це робити в Інституті Фрейзера раніше за всіх, окрім

there have been other waiting list surveys that that that validate and and il y a eu d'autres sondages sur les listes d'attente qui valident et houve outros inquéritos sobre listas de espera que validaram e Були проведені інші дослідження списків очікування, які підтверджують і і

replicate the findings that you have right reproduisent les résultats que vous avez raison reproduzir os resultados que tem direito відтворіть результати, які ви отримали правильно

that's right this was started in the early 1990s dr michael walker professor c'est vrai cela a commencé au début des années 1990 dr michael walker professeur Так, це було започатковано на початку 1990-х років доктором Майклом Вокером, професором

stephen globerman got together they created the survey it started in british stephen globerman s'est réuni ils ont créé le sondage il a commencé en stephen globerman juntou-se e criou o inquérito que começou na Grã-Bretanha

columbia moved national the first national i think was 1993. i stewarded colombie- britannique a déménagé national le premier national je pense était 1993. j'ai été steward Колумбія стала національною. Перша національна, здається, була в 1993 році. Я був стюардом.

from the 2000 to about 2012. and we have gone every year out to the uh to the to de 2000 à environ 2012. et nous sommes allés chaque année au euh au au desde o ano 2000 até cerca de 2012. e temos ido todos os anos para o uh para o to

the medical literature to the economic literature to try and verify the numbers moi la littérature scientifique à la littérature économique pour essayer de vérifier les chiffres медичну літературу з економічною, щоб спробувати перевірити цифри

that we have and what we found is that if anything waiting your turn actually que nous avons et ce que nous avons trouvé, c'est que si quelque chose qui attend votre tour

understates the actual patient's experience in canada sous-estime réellement l'expérience réelle du patient au canada, les subestima a experiência real dos doentes no canadá

certainly governments have gone unmeasured if you look at the oecd's gouvernements n'ont certainement pas été mesurés si vous regardez les graphiques de l'ocde sur la os governos não foram certamente medidos se olharmos para os dados da OCDE

charts of how governments measure the canadian official stop watch starts façon dont les gouvernements mesurent le chronomètre officiel canadien démarre gráficos sobre a forma como os governos medem os arranques do cronómetro oficial canadiano

later than every other country in the developed world stopwatch begins and we plus tard que tous les autres pays du monde développé le chronomètre commence et nous

still record officially wait times that are competitive with our colleagues who enregistrons toujours officiellement des temps d'attente qui sont compétitifs avec nos collègues qui

start their stopwatch much earlier it's a terrible state of waiting démarrent leur chronomètre beaucoup plus tôt c'est un état d'attente começar o seu cronómetro muito mais cedo, é um estado de espera terrível

it's it is a terrible state and i guess the the part i need you to unbundle a terrible c'est un état terrible et je je suppose que la partie dont j'ai besoin que vous dégroupiez un é um estado terrível e eu acho que a parte que eu preciso que você desfaça um

little bit is is it doesn't make sense to a regular person looking at this peu est que cela n'a pas de sens pour une personne ordinaire qui regarde cela en um pouco é que não faz sentido para uma pessoa normal que olha para isto

saying okay we've got waiting lists you would think the right answer would be disant d'accord, nous avons des listes d'attente, vous pensez que la bonne réponse serait dizer que temos listas de espera, seria de esperar que a resposta correcta fosse

well let's just give more money to health care and so governments dutifully bien, donnons simplement plus d'argent à les soins de santé et donc les gouvernements ont consciencieusement bem, vamos dar mais dinheiro aos cuidados de saúde e assim os governos obedecem

have given more money to health care the federal government has given more money donné plus d'argent aux soins de santé le gouvernement fédéral a donné plus d'argent deram mais dinheiro para os cuidados de saúde o governo federal deu mais dinheiro

to health care so why would it be that giving more aux soins de santé alors pourquoi serait-ce tha Donner plus d' para os cuidados de saúde, então porque é que dar mais

money is resulting in worse outcomes that just seems to be upside down argent entraîne de pires résultats qui semblent être à l'envers o dinheiro está a resultar em piores resultados, o que parece estar de pernas para o ar

it's it's a very interesting setup and what few people realize is that we , c'est une configuration très intéressante et ce que peu de gens réalisent, c'est que nous avons en é uma configuração muito interessante e o que poucas pessoas se apercebem é que nós

actually have one of the developer world's best funded universal access fait l'un des systèmes de santé à accès universel les mieux financés au monde, le tem, de facto, um dos melhores financiamentos do mundo para o acesso universal

healthcare system uh the canadian healthcare system ranks among the most système de santé canadien se classe parmi les plus sistema de saúde uh o sistema de saúde canadiano está entre os mais

expensive in the developed world and yet international surveys show that we chères du monde développé et pourtant les enquêtes internationales montrent que nous avons en caro no mundo desenvolvido e, no entanto, os inquéritos internacionais mostram que

actually have some of the longest waiting lists for access to healthcare fait certaines des listes d'attente les plus longues pour l'accès aux soins de santé

in the developed world and it all comes from the structure of the health care dans le monde développé et tout vient de la structure du système de

system itself the incentives that are ingrained in a system that has a lack of santé lui-même, les incitations qui sont enracinées dans un système qui manque de

user fees that does not have activity-based funding for hospital care frais d'utilisation qui n'a pas de financement basé sur l'activité pour les soins hospitaliers

that does not have private parallel provision of medical services and that qui n'a pas de prestation parallèle privée de services médicaux et qui que não dispõe de uma prestação paralela privada de serviços médicos e que

does not have private competition in the delivery of hospital services we've n'a pas de concurrence privée dans la prestation de services hospitaliers, nous avons não existe concorrência privada na prestação de serviços hospitalares que

taken a very unique policy construct and as a result we're doing a terrible job adopté une politique tout à fait unique construire et, par conséquent, nous faisons un travail terrible

for canadian patients and for the taxpayers that are funding their care pour les patients canadiens et pour les contribuables qui financent leurs soins,

we're going to talk about each of those in detail i want to know if the canada nous allons t parler de chacun de ces éléments en détail, je veux savoir si la

health act itself has created these structural problems loi canadienne sur la santé elle-même a créé ces problèmes structurels

because if you're in a position where the federal government ties funding to parce que si vous êtes dans une position où le gouvernement fédéral lie le financement aux porque se estivermos numa posição em que o governo federal vincula o financiamento a

provinces based on these five principles and there's something wrong with one of provinces en fonction de ces cinq principes et qu'il y a quelque chose qui ne va pas avec l'un des

the five principles then you're in a position where you're kind of locked les cinq principes, alors vous êtes dans une position où vous êtes en quelque sorte enfermé os cinco princípios, então está numa posição em que está como que bloqueado

into never changing the system so let's see if we can go through these one at a dans le fait de ne jamais changer le système, alors voyons si nous pouvons les examiner un par un

time and you can and you can tell me if if we our starting point needs to be et vous pouvez et vous pouvez me dire si si nous avons besoin de notre point de départ à tempo e pode dizer-me se o nosso ponto de partida precisa de ser

throwing out the canada health act so we've got public administration jeter l'acte de santé du canada afin que nous avons obtenu l' a eliminação da lei de saúde do canadá para que tenhamos uma administração pública

universality comprehensive accessible and i have transportable i universalité de l' administration publique complète accessible et j'ai transportables Je universalidade abrangente acessível e eu tenho transportável i

think that's the the the final one let's talk about public administration pense que ce discours de la l'une finale Groupons au sujet de l' administration publique penso que esta é a última, vamos falar de administração pública

and when i think about that that says to me et quand je pense à ce sujet qui me dit e quando penso nisso, isso diz-me

essentially that you have a single insurer for the services that are essentiellement que vous avez assureur unique pour les services essencialmente, que tem uma única seguradora para os serviços que são

covered which on the surface i don't necessarily object to because i can couverts auxquels je ne m'oppose pas nécessairement en apparence car je peux coberto, o que, à primeira vista, não me opõe necessariamente, porque posso

imagine it there's probably a lot of streamlining that you have of having a imaginer qu'il y a probablement beaucoup de rationalisation que vous avez d'avoir un imagine que, provavelmente, há muita racionalização que tem de ter um

single insurance plan everybody understands what you can cover régime d'assurance unique tout le monde comprend ce que vous pouvez couvrir plano de seguro único toda a gente sabe o que pode cobrir

what you can't what gets paid as opposed to having hundreds or even more ce que vous ne pouvez pas ce qui est payé au lieu d'avoir des centaines ou même plus o que não se pode o que é pago, em vez de ter centenas ou mesmo mais

private insurers that you would have to deal with is is the public d'assureurs privés avec lesquels vous auriez à traiter est l' as seguradoras privadas com as quais teria de lidar é o sector público

administration the problem or um should i be looking at that some other administration publique le problème ou euh devrais-je regarder cela d'une autre

way i think public administration is not is manière je penser que l'administration publique n'est

not one of the central concerns with the canada health act but there is a pas l'une des préoccupations centrales de la loi canadienne sur la santé mais il y en a une

peripheral one and that is by locking us into a single insurer and it's périphérique et c'est en nous enfermant dans un seul assureur et c'est periférica, que é o facto de nos prendermos a uma única seguradora e é

interesting public administration says it can be a non-profit authority intéressant l'administration publique dit qu'elle peut être une autorité à but non lucratif uma administração pública interessante diz que pode ser uma autoridade sem fins lucrativos

assigned by government it doesn't have to be government but by locking us into attribuée par le gouvernement il n'est pas nécessaire que ce soit le gouvernement, mais en nous enfermant dans atribuído pelo governo, não tem de ser o governo, mas ao fechar-nos em

a single authority we immediately under the canada health act disallow a policy une seule autorité, nous interdisons immédiatement, en vertu de la loi canadienne sur la santé, une approche uma única autoridade imediatamente nos termos da lei da saúde do canadá não autoriza uma apólice

approach followed by a country like germany switzerland the netherlands politique suivie par un pays comme l'allemagne la suisse les pays-bas abordagem seguida por um país como a Alemanha, a Suíça e os Países Baixos

where we have multiple competing insurers inside the universal construct où nous avons plusieurs assureurs concurrents dans la construction universelle em que temos várias seguradoras concorrentes no âmbito da construção universal

those countries understand that competing insurers allows individuals to ces pays comprennent que les assureurs concurrents permettent aux particuliers d'

tailor insurance policies to their own unique circumstances and needs to adjust adapter leurs polices d'assurance à leur propre situation et doivent ajuster les adaptam as apólices de seguro às suas circunstâncias e necessidades específicas para se adaptarem

deductibles and premiums to go into managed care because it might save them franchises et les primes en fonction de entrer dans les soins gérés car cela pourrait leur faire économiser des franquias e prémios para aderir aos cuidados geridos, porque isso pode poupar-lhes

premium by restricting choice of physician it gives all sorts of options primes en restreignant le choix du médecin cela donne toutes sortes d'options une

specialization for particular medical conditions someone who's a diabetic spécialisation pour des conditions médicales particulières une personne diabétique

might prefer an insurance an insurer that specializes in that someone with a pourrait préférer une assurance un assureur qui se spécialise qu'une personne souffrant de pode preferir uma seguradora especializada em que alguém com um

heart condition might prefer that sort of a specialized insurer this blanket maladie cardiaque pourrait préférer ce genre de un assureur spécialisé, cette o problema cardíaco pode preferir esse tipo de seguradora especializada

one size fits all approach that's that's almost demanded by that particular approche globale universelle qui est presque exigée par ce uma abordagem de tamanho único que é quase exigida por essa

principle or term in the canada health act does disallow one policy construct principe ou terme particulier dans la loi canadienne sur la santé n'autorise pas un concept de politique,

but it doesn't stop the system from being better a better functioning health mais cela n'empêche pas le système d'être meilleur un système de santé qui fonctionne mieux d'

care system okay that you know that's good to know and accord que vous sachez que c'est bon à savoir et

when we get into looking at some of the individual systems as well let's explore lorsque nous examinons également certains des systèmes individuels, explorons

that a little bit more let's talk about universality because i think cela un peu plus, parlons d'universalité parce que je pense que l'

universality should mean this it means should mean that nobody universalité devrait signifier cela, cela signifie que personne ne

loses their house or goes bankrupt because of an inability to pay medical perd sa maison ou ne fait faillite parce que d'une incapacité à payer les factures médicales

bills it should be the coverage for catastrophic you don't , cela devrait être la couverture pour les cas catastrophiques que vous ne contas deve ser a cobertura para catástrofes que não

want anybody making a choice not to receive essential treatment voulez pas que quelqu'un fasse g un choix de ne pas recevoir de traitement essentiel querem que qualquer pessoa que opte por não receber tratamento essencial

because they're they're worried about the cost of it so parce qu'ils s'inquiètent du coût de celui-ci alors

that's fine but i don't know that this system where we have um we have to pay c'est bien mais je ne sais pas que ce système où nous avons euh nous devons payer tudo bem, mas não sei se este sistema em que temos um, temos de pagar

for every little thing in the hospital and physician services i don't i don't pour chaque petite chose dans les services hospitaliers et médicaux je ne sais pas je ne para cada pequena coisa no hospital e nos serviços médicos, não tenho, não tenho

know that that's the best definition of universality and i think you've sais pas que c'est la meilleure définition de l'universalité et je pense que

you've looked around the world and universality means a lot of different vous avez regardé dans le monde entier et l'universalité signifie beaucoup de olhámos à volta do mundo e a universalidade significa muitas coisas diferentes

things in a lot of different places what's the essential component of choses différentes dans beaucoup d'endroits différents quelle est la composante essentielle de l' coisas em muitos sítios diferentes qual é a componente essencial da

universality for you i think universality is the normal goal universalité pour vous, je pense que l'universalité est l'objectif normal,

but it's a common goal it's shared by just about every developed nation around mais c'est un objectif commun, il est partagé par à peu près tous les pays développés

the world it's the goal of ensuring access to care du monde, c'est l'objectif d'assurer l'accès aux soins

regardless of ability to pay i think there also needs to be in a time frame quelle que soit la capacité de payer, je pense qu'il doit également y avoir un délai independentemente da capacidade de pagamento, penso que também tem de haver um prazo

to provide that provides comfort and peace of mind waiting for health care is pour fournir qui procure confort et tranquillité d'esprit attendre des soins de santé n'est para proporcionar conforto e paz de espírito à espera de cuidados de saúde é

not a benign process health conditions advance people deteriorate the pas un processus bénin les conditions de santé évoluent les gens détériorent les não é um processo benigno as condições de saúde avançam as pessoas deterioram-se a

medications we have to take for pain while we're waiting for the joint médicaments que nous devons prendre pour la douleur pendant que nous attendons la

surgery have an impact on our livers and our livelihoods it impacts our ability chirurgie articulaire ont un impact sur notre foie et nos moyens de subsistance cela a un impact sur notre capacité têm um impacto nos nossos fígados e nos nossos meios de subsistência, afectam a nossa capacidade

to earn a living to look after our families to enjoy our time with our à gagner leur vie pour s'occuper de nos familles pour profiter de notre temps avec nos para ganhar a vida para cuidar das nossas famílias para desfrutar do nosso tempo com os nossos

loved ones so to me universality is care uh regardless of ability to pay in proches, donc pour moi l'universalité c'est des soins euh quelle que soit la capacité de payer dans

a time frame that provides comfort and peace of mind that's not what the canada un laps de temps qui offre confort et tranquillité d'esprit ce n'est pas ce que le um período de tempo que proporciona conforto e paz de espírito que não é o que o canada

health act says canada health act says 100 of the insurable population on la loi canadienne sur la santé dit que la loi canadienne sur la santé dit 100 de la population assurable selon a lei da saúde diz que a lei da saúde do canadá diz que 100 da população segurável em

uniform terms and conditions so again disallowing this opportunity for people des termes et conditions uniformes, donc encore une fois, refusant cette opportunité pour les gens termos e condições uniformes, pelo que, mais uma vez, não é possível dar esta oportunidade às pessoas

to tailor their universal health care experience to their own unique d'adapter leur expérience de soins de santé universels à leurs propres para adaptarem a sua experiência de cuidados de saúde universais à sua própria

circumstances and needs but generally a fairly benign goal or an important goal circonstances et besoins, mais généralement un objectif assez bénin ou un objectif important circunstâncias e necessidades, mas geralmente um objectivo bastante benigno ou um objectivo importante

but a fairly benign piece of the canada healthcare do you do you think in canada mais une partie assez bénigne des soins de santé au canada pensez-vous qu'au canada mas uma parte bastante benigna do sistema de saúde do canadá

we can re-interpret universality the way you nous pouvons réinterpréter l'universalité de la façon dont vous l'avez

described or do you think that that principle needs do you need a décrite ou pensez-vous que ce principe a besoin avez-vous besoin d'un

legislative change this is what i'm trying to to sort of sort through as we changement législatif c'est ce que j'essaie de faire en quelque sorte trier comme nous

have this conversation is how much of a straight jacket some of these principles avons cette conversation est de savoir à quel point certains de ces principes sont une camisole de force ter esta conversa é saber até que ponto alguns destes princípios são um colete-de-forças