From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: Ridiculous Health Insurance Policy
Followup-To: talk.politics.misc
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: Curious Goods (formerly Louis Vendredi Antiques)
Date: Wed, 29 Jul 1992 16:44:48 GMT

ahsiung@labs-n.bbn.com (Anita Hsiung) writes:
>Dan Lam writes:
>>Leon C. Hsu writes:
>>>
>>>Let me tell you about life in Canada (or at least Ontario).
>>>... is, everyone is covered for reasonable medical expenses,
>>         ^^^^^^^^
>>
>>EVERYONE?  including foreign students or other non-Canadians?
>>Just curious.

As I mentioned in an earlier follow-up, being taxed on your fellowship
stipend gets you coverage under your provincial HMO (that, coupled to
having legal status to be in the country itself).

>I'm also curious.  What is the income tax schedule in Canada?  Is it
>like the 15% to 28% here in the U.S.?  Also, what exactly is covered
>under the universal health care?  Does catastrophic care count?

In Canada, the top rate is about 50% compared to around 40% when you
count the most expensive state and local income taxes combined.  The
higher overheads are both good (excessive street cleaning, like Paris
(NY Times magazine, July 19/92, has a great article on Paris economics))
and bad (more handouts/grants/etc., bribing people with their own money)
as a result of European values (what some American critics simplisticly
dismiss across-the-board as "socialism" ... not all of it, I'm afraid).

The rest of this article is a summary I post around USENET explaining
what the real Canadian health care system is like.  This dispels spins
by both the American right and "left" on what our system does ... it is
a hybrid public/private system like in richer European countries.  The
follow-ups are being sent out of this newsgroup to an appropriate place.

[One further note, the information used by critics about "dying in line"
come from a study by Vancouver's conservative Fraser Institute (and thus
the cited references to British Columbia) commissioned more than a decade
ago, when even Americans waited 6 months for bypass operations (which is
said to be overdone in the States anyways).  A follow-up Fraser study in
response to how their American cousins used their old numbers exists but
has been conveniently ignored by people who "can't get at it" although it
has been available for almost a year.  Current queue times are two months,
and only so because emergencies get bumped to the front ...]



Canada has a public health insurance system ("PHI" in Americanese)
funding private doctors, and public and private hospitals.  They are
paid on a per-procedure basis according to a fee shedule as per any
insurance plan in America.  Doctors' guilds in each province negotiate
the fee schedule, and their offices run the standard billing software
(97% are billed to the provincial plan).  Each province is in effect
an HMO, with every resident having access to choosing their own doctor
and hospital in that province (outsourcing to bigger, richer provinces
upon approval of the insurer/HMO).  France and Germany also have PHI;
all three are known as fiduciary in legalese (i.e., not an arm of the
government to pound on particular people, a fave American paranoia;
it's just a passive pool that pays bills from earmarked tax funds).

The fee schedule is for the provincial HMO, but doctors in some
provinces can charge higher rates in cash, too, and let the patient
get the reimbursement.  No doctor is obligated to bill the provincial
HMO, but if you're in Canada it'd be stupid not too ... you'll find
the odd loner who is bogged down by ideology and goes the cash-only
route.  Since our doctors run private practices with billing software
(97% of the database entries are to the provincial health fund) they
can take cash.  In fact, a couple of my medical friends have said that
they'll only take cash from Americans (and let them sort things out
with their insurance) because they have been weasled by American
private health insurers when presenting bills for their clients.

Oh yeah, there is also private insurance in Canada for stuff that is
not basic medical (bandages to brain surgery).  This gives you perks
like one would get in a premium U.S. hospital like private room, a
cellular telephone, etc.  Private insurers are happy that it's all
they have to sell to individuals and for corporate bennies, and if the
Tories or Liberals ever dared to "go American" the political moneymen
at London Life, etc. will raise holy hell (friends in insurance tell
me that, anyways) before flashing their political donation money.

On the other hand, Great Britain runs a National Health Service (NHS)tm
which is closer to what Americans call "socialized medicine".  Doctors
are salaried out of the public purse and a bureaucrat oversees the use
of services (gee, doesn't this sound familiar? (-;).  NHS is not PHI.

While I cheer the U.S. for being a leader in creating free markets
around the world (trade harassment of imports aside), the medical
coverage issue is ideologically polarized, too overly simplified (see
paragraph #2), and what we call "not invented here" in engineering ...
Canada, France and Germany are not valid labs to gain experience from
although their doctors and hospitals are (or can be, in the latter
case) private.  The terrorist Georges Habash was treated at a private
hospital in France, and most of its customers pay it out of their
public health.  However, I am aware that the US public and government
have a more hostile relationship than we know in the rest of the West
...  I'm not proposing any solutions for you guys, just trying to set
the record straight.

My own prediction is that the U.S. will go to a system where basic
coverage is covered by a public pool, but brokered by private firms
who will offer what we call "private supplementary" up north on top of
it all (basically, filling out what their current policies are).  The
same differentiations in the U.S. and Canada will remain due to the
presence of "private supplementary" and those who can pay for it.

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare				Elections 1992-93:
> gld@cunixB.cc.columbia.EDU		* Jean Chretien (Canada)
> gld@cunixc.BITNET			* Perot^H^H^H^H^H Elvis! (USA)
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