From: v140pxgt@ubvmsb.cc.buffalo.edu (Daniel B Case)
Subject: Re: EIGHT MYTHS about National Health Insurance (Pt II)
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In article <1993Apr18.001116.19872@news.columbia.edu>, gld@cunixb.cc.columbia.edu (Gary L Dare) writes...
>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
~~~~~~~~~~~~~~~~~~

Then why do we really need national health insurance then? Wouldn't it just make
more sense to find some way to cut down on the cost of malpractice insurance?

And maybe that's not such a good thing. I also read somewhere that it is next to
impossible in Canada to litigate against the health system-class action suits
are nearly impossible, and you can't sue the provincial health officials at all.

> 
>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.

Oh no. Don't let the AMA know about this. They have enough power as it is. Ask
most Americans whether they'd like the doctors' lobby to get more powerful.

>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.

Well, yeah, tell us about the National Defense Medical Centre outside Ottawa.
Theoretically it's limited to service personnel, but some studies I've heard
about have suggested that about half the patients there are civilians who not
only have connections but aren't "urgent" at all.

The problem is, in a system where hospitals' annual budgets are approved by the
government, how do you keep political considerations out of medical decisions?
I bet that if you're an MP or MPP, or good friends with one, you're put on any
hospital's "urgent" care list no matter how minor your problem. Which is OK 
unless you're someone who gets bumped off the list for some bigshot.

>>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.  

Hmm. How much difference would it make in the figure of percentage of GNP spent
on health care if dentistry and optometry were included in the accounting? 
Maybe Canada spends proportionately just as much on health care as we do.

> 
>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.

So what happens if the health care systems financially collapse. Bob Rae, the
second least popular man in Ontario, warned Ontarians a few years ago that if
they didn't stop cross-border shopping in such huge numbers, "the services they
expect from the province just won't be there in a few years" (Fortunately for
them (and less fortunately for the retailers here in Western New York) the 
Canadian dollar went back to a more realistic value). He didn't say so, but I
knew he meant the OHIP. What would happen if his warning turned out to be the 
truth? Would the private insurers take up the slack? They'd be under no 
obligation to. Of course, they could eventually make money again, but if what
you say is true, they'd be loathe to do so (and out of practice in handling 
such basic services, too).

> 
>>******************************************************************  
>>
>>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.

Would that it were free. Americans would start another revolution if they had
to pay taxes at Canadian rates.

>>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.

Again, I doubt Americans would like giving the insurance companies that much
power. I half wonder if the Canadian health insurers didn't go along with the
provinces and the federal government years ago because they knew that there was
a good chance of the public system going bust in the long run, and then 
afterwards they could clean up (Okay, this sort of contradicts what I said
higher up. But it's another possibility). They'd have an added bonus when 
arguing against government involvement in their industry-as they could then 
point to its failure instead of just citing theoretical principles.
