Talk:Two-tier healthcare

1992 UK General Election Ad
From memory (I was only 10 at the time) the UK's Labour Party ran a TV advert for this election, claiming that Conservative policy was causing a two-tier health system. It featured two children with the same illness, one from a wealthy family and one not-wealthy, and ended with one sleepign happily and the other crying in pain, with the slogon 'Don't let it end in tiers'. I'm surprised this doesn't seem to be mentioned anywhere on Wikipedia--MartinUK (talk) 22:07, 27 June 2008 (UTC)

I
I am removing the Left Wing bias on this article and will attempt to make a fair article. It's embarrassing.

Supreme Court of Canada decision on Quebec
Now that the Supreme Court has found that Quebec's ban on two-tier health care goes against the Quebec Bill of Rights, and thus invalidated Quebec's ban on private health insurance covering primary care, I have added it to the article. I certainly hope no one edits it out of the article even though it is a stated and documented fact, especially for political reasons. Socialism and Marxism has its own articles if you care to further your beliefs using Wikipedia.


 * Well, anonymous poster, I'm a socialist but I wish you'd put in more about it. One of the problems with the current debate about health care in Canada is that reality is ignored in favour of reiteration of questionable doctrinal beliefs. After which more money is thrown at the health care system without getting any assurance it will be spent sensibly.


 * The real problem in Canada is that the citizenry, left or right or centre, doesn't want to think about facts but prefers to lecture other people about how immoral they are. That seems to be the NDP position, for example, and Roy Romanow's (you may be interested in this socialist commentary about the Romanow report which elaborates on this idea). John FitzGerald 13:36, 6 March 2006 (UTC)

Need help removing POV statement
This sentence is found near the end of the article: In any case, because of these issues, the Canadian people are overwhelmingly opposed to the notion of two-tier health care because this would promote social inequality.  "Overwhelmingly" reads as POV. How do we know it is "overwhelmingly" and not "most" or "many"? Also, how do we know those who opposed to "the notion" do so for the reason stated above? If there are so many opposed to it, isn't it possible that some of them do so for other reasons? AED 3 July 2005 05:54 (UTC)
 * Agreed, I have rewritten that section to state that Canadians are "largely opposed" to it, and gave the Canadian Alliance's forceful denials of supporting the idea as evidence. - SimonP July 3, 2005 11:34 (UTC)
 * Good work. It does read much better now. AED 3 July 2005 18:55 (UTC)
 * I do recall having once read a poll suggesting that, in fact, (slightly) more than 50% of Canadians were in favour of some variety of private health care, with the surprising fact that the lowest proportion of support occured in Alberta (at something like 52%?). However I have no citation nor recollection of who did it or when it was done and as such will be making absolutely no changes until I can prove anything. David Corbett 15:00, 1 March 2006 (UTC)

Updating Ideas
It would be really useful if the page could have more about Europe, ie, France, Germane, Switzerland, and the Netherlands. Because I remember seeing a report on Global BC a couple or so, years back about how "incredible" their public-privet health systems are, or something like that. If somebody could do some fact finding, maybe the article could be even better. Windscar77 06:04, 16 May 2007 (UTC)
 * It does look rather lop-sided, though I think that's inevitable for much the same reasons that right to bear arms is very US-biased: that in each case, debate centres on one particular country. People don't talk much about two-tier healthcare in Europe because it's simply a fact of life: the almost-across-the-board opposition to it in Canadian politics is as alien to our politics (I'm British) as the almost-across-the-board support for the Second Amendment in the US. Canada's system is (I think) the only single-tier public one in any country other than Cuba, so it might be hard to find sensible comparisons. Loganberry (Talk) 00:14, 24 September 2008 (UTC)

Canada ban on private practise for care covered by medicare
The section seems POV because is gives the arguments for a change in the rules but does not give the arguments against a change. I remember in the UK many years ago, when there were NHS waiting lists, NHS patients would sometimes be told that their surgery was non-urgent and that their turn an the NHS list would not come around until, say, 8 months time. But then be told in the same breath that they could be treated (often by the same surgeon and even in the same hospital) the following week if he or she opted to pay for private care. This form of queue jumping based on wealth seemed inequitable to many people and against the principle of equal access embodied by the NHS. The waiting lists have largely gone away but the NHS still allows private care in its hospitals and the practice was never abolished. I guess the Canadian rule prevents inequity of this kind. But its just my guess. Can someone with greater knowledge of the Canadian Medicare history balance this section up with an explanation of why the present rule is in place and what arguments are put up against a change in the status quo?--Tom 23:52, 7 August 2007 (UTC)

Quick question about Canadian English

 * Quebec, due a court ruling against the public system...

That reads a little strangely to me, since to me due alone would only be used in a context such as "Quebec, due a million dollars in public funds..."; you'd have to say "due to" in the sentence quoted above. It'd be useful, though, to be reassured that the use quoted is correct Canadian English, so that I don't accidentally "correct" it in other articles. Loganberry (Talk) 00:17, 24 September 2008 (UTC)

Canada?
I just restored some text that had been deleted from the "Canada" section (mainly because it was the only sourced information in the whole article) but it seems to me that, really, Canada doesn't need to be here at all. After all, as is pointed out in the text, Canada doesn't have 2-tier healthcare, and it's the only country in the article that doesn't. Is there any consensus to delete the whole section?

Also, this article could really use some references. It really reads like it could be opinion/original research as it stands right now. I will see what I can find. Dawn Bard (talk) 16:13, 13 May 2009 (UTC)


 * Sourced opinion is still opinion. Neutral point of view is a fundamental Wikipedia principle and cornerstone of Wikipedia. Otherwise, anyone could write a blog (which is not original research) then include it in Wikipedia. The "sourced" section you restored merely referenced an opinion blog. As they say on Dragnet: "Just the facts, Ma'am." Perspectoff (talk) 16:45, 13 May 2009 (UTC)
 * It seems to me that it is perfectly reasonable to have sourced pro- and anti-views covered - it's handled well in Single-payer health care. And as it is now, the article isn't necessarily free of opinion or original research.  The section on the US, for example, calls the American system 2-tier, which is not how Wikipedia's article Health care in the United States describes it, and that article is well sourced.


 * But I'm really thinking now that Canada, Sweden, etc., don't even really belong within the scope of this article, because they aren't 2 tier. Dawn Bard (talk) 16:57, 13 May 2009 (UTC)
 * I think Canada has a place here, as the term "two-tier health care" is a very frequent one in political debates here. (See this famous image for instance) - SimonP (talk) 19:34, 13 May 2009 (UTC)
 * Okay, that is a good point. The article as it is now, though, just describes Canada's non-2-tier system (and not particularly well), not the debate over 2-tier healthcare here.  The policy debate is more topical than the description, in my opinion.  Dawn Bard (talk) 19:40, 13 May 2009 (UTC)

One tier / two tier
I absolutely do not agree the tiering arrangement set down by the editor that has done this. In fact it is also making me wonder about the title of the article because tiering implies that one sits above the other either in scope or quality or some other measure and I am not sure that is true.

I do not see that France's system is fundamentally "tiered" any differently from, say Canada's system. So why one appears in one grouping and the other in the other is a complete puzzle. I am not sure whether Sweden has much of a private health care system, but I'd be surprised if it had no private facilities.

The UK clearly has two types of delivery systems, one a more-or-less unified public system and a separate private hotch/potch of providers and networks making another grouping, but even that line is beginning to get a bit blurred. I think Spain and Italy are broadly similar to the UK in this respect. The public facilties in these countries being the larger, the public systems tend to be better equipped and better manned.

But most of the other countries seem to have a mix of public and private provision with complete free choice and no qualiy or scope differential so the idea that there is some kind tiering here is ridiculous.

What do other editors think?--Hauskalainen (talk) 00:57, 27 May 2009 (UTC)


 * I agree completely - this article is a mess. As it is right now, I'd vote "delete" if it were listed in AFD - it's completely unsourced.  In spite of my comments above about excluding Canada, because it has "one-tier", my recent attempts to research the term "two-tier healthcare" lead me to believe that the phrase is mostly used in the ongoing political debate in Canada about allowing private healthcare to compete with the public system.  In other words, purely two-tier healthcare isn't a reality anywhere; it's a catchphrase, a theory, largely used in Canadian political debates (with some use in other countries, as well, of course.)  Would there be any support to changing the scope of the article completely to reflect that - to reflect that it is just a theory, really?  Or maybe a fork article on the use of the term in Canadian politics?  I don't think the article should be just a list of countries with unsourced (and quite possibly POV) descriptions of their healthcare systems.  The page as it is right now is essentially the work of one editor who dropped in and changed the whole thing whithout any sources, and doesn't reflect any consensus.  Dawn Bard (talk) 14:18, 27 May 2009 (UTC)

I have heard the term in the UK also so its not just used in Canada. It is used when it seems that the public system is so badly underfunded that people have to buy private insurance because the public system gets so bad. Thus my understanding is that it refers to a good tier and a bad tier and not, as the article had implied, merely a public and a private tier. I think that is aso how the term is used in Canada. We have both public and private tiers in the UK but they are comparable in quality if not in scope, so people in the UK do not think that the current system constitutes a two tier system. As I said before, tiering implies one above the other (presumably in quality) and not really parallel systems.

In the UK there was a fear of a drift towards two tier health care under the conservatives in the 1980s and 1990s but it was not explicitly admitted by the party which continued to say the NHS was safe in their hands. But the queues and the aging infrastructure told a different story. The Blair government instituted reforms and pumped in more money and built new facilities so the worse nightmare of a significant creation of two tier system (one a kind of Cinderalla service always struggling to perform, and a decent private tier for the rich who could afford better) was avoided. And I have to disagree that there is no two tier service anywhere or that it is a theoretical possibility. South Africa would be a good example. There are excellent hospitals if you have the money and yet public provision is very sparse. China I believe is the same. Most European countries as well as Canada, Australia and New Zealand have private and public funded parallel systems. The U.S. actually is the odd one out because it has no guarantee of universal care´, there is little public provision for care of adults unless you are dirt poor, and the government does not use its financial muscle to obtain good value for the public system as other countries large and small have done.

Despite the present sparcity of references I do think that the article is of value because it is a term that is in use.--Hauskalainen (talk) 21:32, 27 May 2009 (UTC)

I have updated the lead to reflect the view that the tiers are created when the public universal system is underfunded which is certainly the meaning as used in the UK and Canada.--Hauskalainen (talk) 21:41, 27 May 2009 (UTC)

Horrendous writing
The list of countries and discussion of their healthcare systems is done very "casually" and the United States section is POV and poorly written in particular. Also, the complete lack of citations is probably less than optimal. —Preceding unsigned comment added by 64.151.45.242 (talk • contribs)

Original author's response
This discussion reflects the vicious political debate regarding US health care, even to the point of wanting to "delete" the article for a variety of reasons. To deny multi-tiered health care is like denying the existence of social classes. In the US there is a lot of denial about the levels of health care available to different classes of society, and the wealthiest (usually Republican) usually are the most vocal in their wishes to deny the class structure of health care delivery. Yeah, ok, I could have used lots of references. Initially this article linked to the health care articles within Wikipedia for all the countries listed. Aggressive editors like to denigrate internal Wikipedia links as references, but they are quite valid. To be honest, I was writing a national and state health care platform at the time I wrote this article, and the vitriol contained herein mirrors the vitriol in political circles (Wikipedia is a microcosm of society, isn't it?). The two-tiered health care term is very widely used in political discussions -- I am appalled at the blatant censorship techniques suggested here.

Canada is not a formal two-tiered health care system, but is a de facto one. In fact, detractors often described "the US health system" as the second-tier of the Canadian system. I am not some uninterested party who writes Wikipedia articles and has childish esoteric debates over categories of Wikipedia references -- I am a co-ordinator of health services in rural US communities, on the front line of these issues. Thank the fates that we currently have a US president who recognizes the issues facing a large majority of our citizens, no matter what nonsense several petty Wikipedia denizens bandy about. Perspectoff (talk) 14:17, 18 April 2010 (UTC)