From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: EIGHT MYTHS about National Health Insurance (Pt II)
Nntp-Posting-Host: cunixb.cc.columbia.edu
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: PhDs In The Hall
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harelb@math.cornell.edu (misc.activism.progressive co-moderator) writes:
>F<O>CUS/HEALTH: EIGHT MYTHS about National Health Insurance (Pt II)
>
>    An office visit that's $52 in Seattle is $18 in Vancouver
>    (Canada).  That's because, among other things, they've given their
>    government power to bargain with doctors and hospitals over fees.

The difference in the litigation environment is reflected in the fees.

Lack of defensive medicine and near-absence of malpractice is really
why we spend less using the most expensive approach of pure insurance
in Canada (along with France and Germany) without HMO's --- the NYT
has admitted that malpractice insurance fees are an order of magnitude
lower in Canada but doctors take-home pay is almost equal to American
doctors; also, minimal bureaucracy 'cos the system is so-o-o simple
(early March).

Part of the deal for using the all-insurance approach like the French
and Germans do (hey, why don't they criticize France and Germany?  Is
it because too many people take French and German in college to make
the accusations stick? (-;) was to preserve the doctors independance.
Since the provincial wings of the CMA are the ones that go to bat when
the fee schedule hikes are presented, the politically-bent doctors
were just cackling when they realized the CMA would grow in strength
rather than diminish, especially when unopposed unlike in socialized
medicine approaches like Britain's National Health Service.

>"`You've got to remember, you've got a waiting list as well, but it's  
>not as obvious. If you're poor and you don't have insurance, you don't  
>    go to a surgeon. In the States you ration by ability to pay.'"  

For non-life threatening things, market arguments adequately cover why
certain procedures are in scarcer demand.  I have MD friends who can't
make a living as specialists back in Manitoba not due to the insurance
rates but because they won't get enough customers -- the CMA medical
monopoly's grip on doctors licencing (as in the US) aside -- so they
must move to larger places.  However, this does not refute debunking
of waiting lines for urgent AND routine care, as has been done in the
U.S. by Consumers Reports, health policy studies cited by Prof. Dennis
E. Shea on USENET, CNN, NYT, etc.

Doug Fierro has posted a NYT article from 3 weeks ago about Canada's
health insurance approach, on Talk.politics.medicine.  There is one
small error in the article: not all of our hospitals are private.

>WOULDN'T NATIONAL HEALTH INSURANCE MEAN THAT AMERICANS WHO ARE NOW  
>FULLY INSURED MIGHT HAVE TO SETTLE FOR LESS?  
>
>In Canada, provincial insurance covers all health costs except dental  
>care, eyeglasses, prescription drugs, ambulance service, and private  
>hospital rooms, -- so many Canadians do end up buying some private  
>insurance. A policy to cover all of these things runs about #40 to $40  
>a month.  

Of course, the one thing to note is that in the Canada/France/Germany
case, private insurance *offloaded* the basic coverage to the public
sector.  They realized they were keeping low-risk/high-profit extra
insurance for things like private/semi-private rooms (vs. ward
accomodation), dental, glasses, etc. for corporate or personal
benefits, they'll have nothing to do with you if you want to be
covered for basic care.

At that point, they wouldn't even consider a "voucher" approach
to broker the universal coverage and sell policies to make up
the difference in the federal guidelines and market stuff.

>******************************************************************  
>
>WOULDN'T FREE CARE ENCOURAGE PEOPLE TO RUN TO THE DOCTOR FOR EVERY  
>ACHE AND PAIN?  
>
>People who get free treatment *do* go to the doctor and hospital about  
>a third more often than those who have to pay a share of their medical  
>bills.  
>
>Still, Canadians -- who pay nothing at the doctor's -- have a lower  
>per-person health bill than we do.

It is "free" in that there are no deductibles nor copayments (two
things which I advocate to make the Canadian insurance look more like
real health insurance -- which actually it is).  I know that when
working in Alberta, Ontario and Quebec, I was aware that I was paying
for health insurance - e.g., in Toronto, OHIP fees were listed on my
pay stub; Manitoba did not collect at paycheque time, but only
annually at income tax time (built into the tax rate).  Only fiscal
naifs will proclaim that it's free, along with the Canadian Left for
that is part of their brainwashing agenda.

The French do have copayments, though.  France Magazine's Summer 
1992 edition has a fantastic presentation of their basic insurance
coverage, including a sample chart of copayment percentages.  For 
1-30 days, you're covered for 80% of the public hospital rate, 100%
afterward.  With extra private insurance, you can get into a private
hospital and be covered for any differences beyond the public hospital
rate.  The public insurance covers 100% beyond 30 days, or the same
cash amount for a private hospital and the difference is paid
out-of-pocket or according to your supplementary private insurance.
Over 2/3rds of French have some form of extra private insurance.  So,
the other 30% of health costs in Europe are out of private funds, not
gleaned from other taxes.  The GDP figures are combined public and
private expenditures for total outlay using the same methods that
yield the 13-14% figure for the U.S.

>ISN'T THE PRIVATE HEALTH INSURANCE INDUSTRY JUST TOO BIG  
>AND POWERFUL TO KILL?  
>
>Dismantling the health segment of our insurance industry would be  
>"politically thorny," in the quiet words of one advocate for a  
>national plan. Some 1,200 firms now sell more than $192 billion in  
>health insurance. They'd put up a hard fight. Not only has the industry  
>grown eightfold since Canada shut down its own health insurers, but 
>our government leaves politicians more open to lobbyists than does  
>Canada's parliamentary system.

Health insurance does exist in Canada and in Western Europe, its
just that it doesn't cover basic care.  You can opt out in Canada
and Germany, but you'll have to go uninsured as a result because
there are too few other people that do so --- i.e., no market.

When private insurance realized how much money they'd make without the
risks involved in basic insurance (e.g., neurosurgery) versus deluxe
amenities (e.g., having to call Granada TV to replace a rental set on
the fritz in someone's private hospital room), they started to pat
themselves on the back for their social responsibility.  In Quebec
last spring, a consortium of private insurers publicly warned against
any thoughts of privatizing routine, low cost parts of that province's
public health insurance plan.

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare
> gld@columbia.EDU 			GO  Winnipeg Jets  GO!!!
> gld@cunixc.BITNET			Selanne + Domi ==> Stanley
