Categories: Coyne v. Wells, Video

Coyne v. Wells on Jim Prentice, Danny Williams, and sacred cows

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by macleans.ca on Tuesday, February 9, 2010 8:00am - 26 Comments

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Tags: Andrew coyne, Danny Williams, Jim Prentice, paul wells

http://intensedebate.com/people/Thwim Thwim

Good Lord, I agree with Coyne on health-care, point for point. Private provision within a public-pay system.

http://intensedebate.com/people/jolyon jolyon

"I’m actually not a conservative — either in name, or in any other way. If forced to describe myself, I’d say I’m a socialist, because by any usual or sensible definition, I would be.

I favour public pensions, public health care, public education, public unemployment insurance. I favour a whole battery of things involving the state function. In fact, I’ve had tangles with some of my conservative friends over things like user fees for health care, or the necessity of carbon taxes to combat global warming." Andrew Coyne

http://network.nationalpost.com/np/blogs/fullcomm…

Dot

Good discussion. A few observations.

I watched the video of Prentice (someone provided the link in Wells's mag article) making those remarks about Quebec, and I found them pretty innocuous. Therefore, blown way out of proportion. I can recall, however, back in the early 90's that HQ's strategic plan included being a world leader in producing electric cars. I wonder if that sort of industrial strategy underpins their efforts to impose tougher emissions standards on internal combustion engines, and establishing electric vehicle charging facilities – using more of their highly subsidized hydroelectric power within Quebec. Maybe.
Dot

Re Wells: Stelmach's "cap and trade" scheme. I think you may have misspoke. You were probably referring to Carbon Capture and Storage "CCS" (his many times promoted $2 billion investment.) So, yes, if you allocate both the capital cost and the operating cost of running CCS (capturing the CO2 out of the air, compressing it, pipelining it and injecting it) against the CO2 captured , you can get a cost/tonne CO2 – which is equivalent to a carbon tax (except the gov't pays some if not most, not the polluter).

One other thing. Stelmach has often claimed that Alberta was the first to implement a true carbon tax of $15/tonne for large emitters. This is based upon intensity targets. If you do the math (and I have elsewhere) this works out to be about $0.15 overall per barrel of oil for a company like Suncor, which in reality is just a rounding error – the cost of doing business. And then again, it's not really a "tax" as the money collected goes into a technology fund, to be used, perhaps, as above. Much of it is p.r. to appease some critics and won't really affect operations of the oil sands producer (the penalty/cost is not high enough). Still, it's a start.

http://intensedebate.com/people/Inkless Inkless

I did indeed mean CCS. I get my Rube Goldberg schemes mixed up sometimes.

http://intensedebate.com/people/Thwim Thwim

Paul: A justification why someone might be okay with buying their place in queue, so long as that purchase involves an airplane ticket as well: As a nation, we have limited resources — artificially limited some would argue, given the number of students that want medical certification and the very few that are admitted into the program to attempt to attain it. However, the resources here are limited. As a result, when you queue jump here, you're putting another Canadian further down the pile. When you take an airplane to the states, you're not touching our resources. If the Americans don't like that Canadians paying for services increases the demand in the US (and thus their prices) it's up to the US to stop it.

matt

Dot, sorry, you're wrong. The fund established under the SGER accounted for ~55% of large emitter compliance in 2009, for around $100 million, and the rest was traded offsets. That's not a "rounding error." Intensity or net, carbon dioxide was sucked out of the air and green technology (and CCS projects too) will receive significant funds.

http://intensedebate.com/people/jolyon jolyon

1) You will be able to knock me over with feather if Cons move against oil sands in any significant way. New tax/policy against oil sands sounds like good way to blow up party, not way to win next election.

2) Of course Feds and Provs can comment about one another – we should always encourage debate and argy-bargy – boo to the people who encourage less discourse.

3) Not that this will ever happen but I wish government would create referendum on health care system – give Canadians three choices – status quo and two foreign systems that combine private/public like Germany and Singapore. There are a few other examples that work just as well. Educate public as much as possible and let people decide what they want to do. Pols are too cowardly to make changes on their own, that's why I suggest referendum.

4) Macleans should do their own version of bloggingheads. You could change commentators from week to week.

http://intensedebate.com/people/PhilCP PhilCP

we should always encourage debate and argy-bargy – boo to the people who want less discourse

In favour, with the provisio that it is possible to 'argy-bargy' without insults and hyperbole – there is no need to tolerate obnoxious behaviour while working through disagreements.

http://intensedebate.com/people/PhilCP PhilCP

Regarding different standards for automobile emissions, doesn't California (still) have higher standards than many other states?

Along with Thwim above, I am also completely on board with Coyne regarding health care – no problem with private provision within public pay. Isn't that pretty much the reality of our existing system?

I'll be very surprised if we learn that Danny Williams had an ultra-routine procedure, and just wanted to bypass a wait-list issue within his own system.

http://intensedebate.com/people/Thwim Thwim

It isn't.. quite. Hospitals, for instance, must be entirely public.

http://intensedebate.com/people/PhilCP PhilCP

I knew that I was over-simplifying wrt "Isn't that pretty much the reality of our existing system?", especially as it relates to hospitals. I was really only indicating that we are already quite a distance away from a purely publicly paid and publicly provided system.

But perhaps I do misunderstand what Coyne is suggesting
– As long as public pay also means public direction in terms of deciding what is covered and what isn't and setting guidelines to determine treatment priorities and the like, I'm still OK with the 'Coyne proposal'.
– If the proposed system reduces public participation to simply signing the cheques to cover any and all health-care services provided by private providers, I would have grave concerns.
– If the propsoed sytem 'outlaws' any public provision of services, I might have concerns. I don't see any reason why you could not have a mix of public entities providing services in competition with private entities.

http://intensedebate.com/people/Thwim Thwim

Well, my idea of it is that public payment means that the public (aka gov't) will decide what it is willing to pay for each procedure. It is then up to private enterprise to determine how best to fulfill it at that rate. Of course, the public needs to be monitoring things to ensure that waits don't get out of hand, and if they do, to adjust the rates accordingly with respect to demand. Obviously in those circumstances, treatment priorities are simply a matter of dollars provided for each activity.

The danger of having a mix of public entities providing services in competition is that the government has a vested interest in making sure public entities do not fail.. even when perhaps they should because they're not delivering appropriate service. The only real use for a public provider (after a transitionary period of course)– if both public and private are being paid the same rates, would be to establish a baseline of service which private holders must exceed if they want to get business. However, that might be accomplished just as easily with legislation, without the moral hazard of a publically operated hospital.

http://intensedebate.com/people/PhilCP PhilCP

I do recognize the 'challenges' that come with allowing public entities to compete with private entities in the area of providing health care services, but I do see them as challenges that could be overcome rather than fundamental reasons that would absolutely prevent the co-existance of public and private providers.

And you have correctly identified the main reason that I would like to maintain room for public provision of services – providing a baseline (your words) or 'keeping them honest'. In fact, I would actually entertain the idea of guaranteeing public providers a minimum percentage of all procedures, even at a smallish loss, just to make sure that we have that baseline information.

And I wonder if the private sector would actually be anxious to get involved in ALL aspects of providing health care services; I suspect that there might be some activities that aren't all that lucrative, and are left to the public providers.

http://intensedebate.com/people/Halo_Override Halo_Override

"Open the kimono"? I love you, Paul, but I didn't need that discordant mental image while I'm thinking about Jim Prentice and looking at you two.
matt

Why didn't anyone report on Chretien going to the States for treatment and pass on the skiing fib? Was it the best kept secret ever? Affection? Too personal?

AT1

I'm flabergasted. How did Chretien manage to keep that quiet and did journalists know about it at the time? After all, didn't Chretien, and subsequently Martin, run explicitly on the premise that they would stop people like Klein and others from undoing medicare? How often was the bogeyman of Convservative efforts to increase health privatization repeated mindlessly, including by the media? Shame.

Dot

http://www.canada.com/edmontonjournal/columnists/…
http://intensedebate.com/people/TwoYen TwoYen

Paul speaks of private insurance to top up treatment in France. This is the same system available in Japan, which has universal medical and drug coverage for all citizens but also allows for private insurance for those who wish to use private hospitals to top up. Based on my own extensive experience in the Japanese health care system over the past few years I found that this approach works well.

What I really like about the Japanese system is the ability to choose one's own doctor. Frankly, I found this helps to keep docors on their toes as the competiton for "clients" means that doctors find ways to run their private clinics more efficiently. A little bit of market discipline goes a long way…
John

Apologies for the naive question, but could someone elaborate on Coyne's statement that Canadian patients can pay for private care in most provinces as long as both the patient and the doctor opt out of Medicare? I thought most provinces have legislation which make it practically impossible (or illegal?) for private health clinics to survive? A link to further reading would be appreciated. Thanks in advance!

http://intensedebate.com/people/Thwim Thwim

No, the legislation is that you can either take clients on the public system, or you can't. But what you cannot do is take a mix of them.

However, because we have publically paid-for/funded health care, there's very few clients who want to go to a completely private clinic. So they generally have a hard time surviving here in Canada. So the legislation doesn't directly prevent them, but practically it does.

John

Thanks, Thwim! That's really interesting and it was actually news to me. A few more questions, if you have time:

(1) Are Canadian doctors allowed to open a private clinic to see if it works and, if not, close it up and return to the public system?

(2) If I want to go to a private clinic within Canada, I assume I have to pay out of pocket because we don't have medical insurance in Canada for basic care?

(3) This article in the LA Times (http://articles.latimes.com/2009/sep/27/nation/na… stated that private clinics in BC and Quebec are "technically illegal". I assume the journalist was ill-informed?

Thanks in advance. It's really interesting to learn the nuanced details behind the legislation. Do pass on a link for further reading if you know of a good source.

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