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Comment by refurb | Hacker News Reader

What does "underfunded" mean?

The UK has a similar system to Canada. Costs are controlled by controlling the funding. You set a cap to what you'll spend and let the system figure out how best to allocate those funds. It's a big reason why the cost per capita for healthcare is quite low - you simply choose not to spend more.

The demand for healthcare spending is almost infinite. You can set it up so everyone get an MRI the same day the doctor orders it. If you cut back and it takes a week for a non-urgent MRI is that a "proper" level of funding? How about waiting one month? Two months?

The truth is, a country needs to decide how much money they are willing to spend on healthcare. Some spend very little, some spend a lot. There is no "fully funded" system, only trade offs.

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You can start by paying doctors/nurses a better wage for the shit they have to put up with for the last 2 years

Our Ontario government capped nurse pay to 1% per year which is effectively a 8% paycut/year given the current inflation

As a start, that means that your costs have substantially increased to provide the same amount of healthcare as before. That makes the funding problem bigger. I'm not sure how it is in Canada, but the NHS in the UK employs about 1.4 million people - and a lot of the problems with it are actually problems with our social care system being broken and leaving it nowhere to discharge patients to, which accounts for another 1.6 million workers. The UK's population is about 70 million people in total, a reasonable proportion of which are either too young or retired. This is only going to get more daunting as the population ages here and in other western countries, and as new treatments are developed and healthcare expectations increase.

On top of that, the real economy's capacity to supply workers with stuff to buy with their income is in deep trouble worldwide right now and everyone is feeling it. That means real wage drops across the board and real damage to the ability to actually fund something like this.

> As a start, that means that your costs have substantially increased to provide the same amount of healthcare as before.

Yes, that's how inflation works. Not a new problem, and GDP generally grows accordingly as well.

Unfortunately that's in line with the Bank of Canada's recommendation:

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"Mr. Macklem: [... T]he high inflation that we have today is not normal. It's not here to stay. We are resolute in our commitment to bring inflation down. We are taking action and we will continue to take action to bring inflation back down. So as a business, don't plan on the current rate of inflation staying. Don't build that into longer term contracts. Don't build that into wage contracts. It is going to take some time, but you can be confident that inflation will come down.

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- Tiff Macklem, Governor and CEO of the Bank of Canada in a webinar hosted by the Canadian Federation of Independent Business. Transcript here: https://20336445.fs1.hubspotusercontent-na1.net/hubfs/203364...

The reason he speaks to that is that he's worried about inflation increase due to a wage-price spiral. Depressing wages is a way to prevent that. And I'll mention now; I have no idea how true this is.

Generally it has nothing to do with money. What you actually need to decide as a nation is how many people will work in the healthcare service, rather than in the private sector producing stuff others consume.

Healthcare is an insurance service itself. It's designed to keep people going so they can continue to contribute to society.

The more productive the producing sector, the more of society you can have working in healthcare.

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