From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: Canadian Health Insurance (was: health care industry woes)
Summary: time for the FAQ, folks ...
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: The Bates Motel
Distribution: usa
Date: Thu, 19 Nov 1992 16:51:39 GMT

clarinews@clarinet.com ((May/Standard Broadcast News)) writes
in clari.canada.newscast:
Re: Newscast of the hour (18) Sep 9 4 pm EDT
>	
>	(Bush-Health)+
>	The Canadian medical care system has become a campaign tool 
>for U.S. President George Bush. Once again while campaigning, he has 
>referred to the Canadian system as a reason for NOT having national 
>health care in the United States - something advocated by the Democrats 
>under Bill Clinton. Bush said many Canadians have to go to places like 
>Cleveland to get a heart bypass - because in Canada they have to wait 
>at least six months. (18)

While some people do not care to distinguish, there are major and
radical differences between socialized medicine of the UK and (because
the risks are beyond the free market) public universal (real) health
insurance as in Canada, France and Germany.  Britain and Italy have
true socialized medicine with civil servant doctors and nationalized
hospitals.  It is like an HMO, with a bureaucrat on the doctor's
shoulders.  In Canada, it is just whole insurance and you spend your
benefits as you choose and as the medical market allows; in fact, the
Canada Health Act has certain provisions that prevent government
intrusion into the direct provision of health (a concern if a radical
leftist NDP administration such as Dave Barret's in 70's B.C. ever
wanted to attempt to socialize their province's system ... I do not
consider Canada to be "socialized").

The information used by American 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 nearly 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 ~3 months, and only so because
emergencies get bumped to the front ...

CNN had a hard time finding convincing evidence of the mythical
massive queues for their focus series on Canada's medicine in early
June, 1992.  With our population base, we can only sustain a certain
absolute number of specialists.  Consumers Reports, and to a much
greater extent the Globe & Mail (Canada's NYT/WSJ), have pointed out
the origins of some of those queue numbers: decade(s)-old statistics
and short-term transients purposefully misrepresented to an ignorant
U.S.  audience (on Canada; no flames here, just the way it seems to
be) as the status quo.

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.

Also, the Summer 1992 edition of France magazine (available from most
college French departments and branches of the Alliance Francaise)
describes their system, which is very very very similiar to Canada's
(and may have been the basic model we chose; I don't know the history
here ...).



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 a
big PPO (Preferred Provider Organization), 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/PPO).  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 PPO, 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 to ...  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.  In
Quebec last spring, a consortium of private insurers publicly warned
against any thoughts of privatizing parts of that province's plan.

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.  However, according to The Economist magazine there is a
seperate and private medical sector operating in competition to NHS.

You would be surprised to hear that the defenders against any kind
of token $5-$10 deductibles in Canada are the federal Conservative
Party of Brian Mulroney, against a proposal by the Quebec Liberal
Party of Robert Bourassa (not "liberals" like Jerry Brown).  (Our
system works on autopilot, and federal Health Minister Hon. Benoit
Bouchard spends 99% of his time on the Constitutional conferences
currently going on ... it's been ages since anything on the health
system has come up since his praise of CNN's focus series in June.)

There are other ways in which people have achieved universal coverage
without resorting to Sovietic systems ...  One problem may also be
that most people in the U.S. don't have a clue about Canada (or
Europe) let alone the health system(s) there, except to take what
media spin doctors of the right and left tell them.  Also, none of the
various jury-rigged proposals put forth in Washington (DC) and Oregon
represent European-Canadian systems.  Please note that these are not
ways that other parts of the western world do things, nor should
unknowledgeable allegations of such be made on an international
network such as USENET...

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 last spring, but its regular 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 class differentiations in the U.S. and Canada will remain due to
the presence of "private supplementary" and those who can pay for it.
Unless the private sector bails out of basic, like they did in Canada.]

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare				
> gld@cunixB.cc.columbia.EDU		Oct 26/92: Just say "OUI!"
> gld@cunixc.BITNET			(Let's worry about the economy!)


~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare				Jesus Saves!
> gld@cunixd.cc.columbia.EDU 		Gretzky gets the rebound -
> gld@cunixc.BITNET			he shoots, he scores!
Newsgroups: talk.politics.medicine