From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Newsgroups: sci.med,talk.politics.medicine
Subject: Re: Canadian healthcare system
Date: 26 Jan 93 22:46:48 GMT
Followup-To: talk.politics.medicine
Organization: Deep Space Nine (DS9)

hrubin@pop.stat.purdue.edu (Herman Rubin) writes:

>There are several things wrong with it, and it is not all that much 
>cheaper than the cost in the US.  

That's 'cos other than the basic insurance aspect, the two systems are
virtually identical with the same AMA/CMA-infiltrated medical monopoly.

>One generally agreed problem is that many "standard" procedures are
>not done in Canada, and while the Canadian plan often picks up the
>costs, it does not pay the travel,

Americans must also cross state borders (or to Quebec if you live in
Vermont) at their own expense because they live in sparely populated
areas ... Canada's population is only 26 million, and it only has 4
cities west of the Great Lakes: Vancouver/1.5 Million, Edmonton and
Calgary/700,000 each, and Winnipeg/550,000; someone from not on the
list will complain, but there's a big drop after Winnipeg ... let's
put it this way, some of our medical markets just aren't big enough
to support a steady clientele for some kinds of private practicioners!

>and it does not help defray the development costs, which US care does.

It seems to me that the National Cancer Institute and NIH are public
entities; am I wrong?  And you should ask Paul Tsongas where his bone
marrow transplant procedure was developed (hint: last World Series).
The above claim passes by most Americans because most developments
which happen outside of the U.S. are not reported in domestic media
under the assumption that the readership would not be interested.

>one must find a primary care physician, and all else must be referred
>through that doctor; I believe that changing such is difficult.  

In other words, it is like American private health insurance ... it is
up to you to pick up the Yellow Pages (which you cannot do in an HMO).

>Also, there are other cost-cutting limitations.

Since Canadian provincial governments don't actually do the health
care, I'd be REALLY interested to find out what these thigs are! (-;

>The biggest problem is that it is run by government bureaucrats, who
>SO FAR have not been too bad.  "To err is human; to foul things up
>takes a computer; to really make a mess of things takes a government."

This is entirely ideological ... the numbers and functions of these
"bureaucrats" is minimal, as the government health insurance merely
routes money to doctors and hospitals who bill them -- just like an
insurance company should.  They'd do the same jobs at AllState, but 
no haggling ...

>wc4209@writer.yorku.ca (Irene Berkovich) writes:
>>  There is absolutely no difficulty at all changing family doctors.
>>One simply requests their records be transferred and voila.
>
>Who decides if the family doctor can manage the problem quite well?

You are responsible for monitoring your own health care there, as you
would having only private insurance (no paternalistic HMO) in the U.S.

>So why do insurance companies participate?  Insurance companies, 
>to nobody's surprise, are out to make money.  They normally handle 
>risks by using large samples.

Interesting that you brought up private insurance's view, because ...

Dennis G. Shea <DGS4@psuvm.psu.edu> wrote a few weeks ago:

>What did you think of HIAA's reversal of position?

As a Canadian, I'd say that it's "deja vu all over again."  Mind you,
there was no health crisis in the 1960's (nor is there one there now)
and basic health insurance was pretty minor, so the private insurance
was glad to fork that portion over and keep the almost-pure profit
portion covering amenities (private/semi-private rooms, telephones
and televisions, private ambulance transport coverage) and travel
accident plans.  Same in France and Germany.

U.S. private insurance is feeling pressure from HMO's, and managed
competition will push people into the pseudo-socialized medicince
of HMO's and away from real insurance whose benefits people spend
on their own.

Private insurance in Canada chose not to broker our health insurance
plans as they figured on making bigger profits concentrating on just
their own territory.  The idea of private brokerage of the universal
risk pool with additional coverage filling out the private insurance
companies' current offerings was proposed, and we almost had that
system up north.  A close family friend and also our family lawyer
was part of the commission in Walter Weir's Manitoba Conservative
government that worked on the transfer of private health insurance
into a universal risk pool, and really wanted the private brokerage
idea to fly --- but Canadian businessmen are much more risk-averse
than Americans and went for their wallets.

>an4140@anon.penet.fi writes:
>
>>I heard a radio program extolling the virtues of the Canadian national
>>health care program.  The guest could find nothing wrong with it, and
>>said it ought to be the model for the US. 
>
>>Surely there must be another side to this argument.  Are there no
>>shortcomings to the Canadian system?  And even if that were so, is
>>it adaptable to the US?  

Please note that my articles pointing out realities of the Canadian
public health insurance system is not an advocacy for transplanting 
it to the United States, where there are significant differences in
political culture, temperament, and implementational logistics.  It
merely points to fallacies in the criticism, which should be equally
applied to France and Germany if valid -- but the critics would get
eaten alive if they did ('cos people take French and German in college
but Canada's a black hole; anyone out there taking Canajun? (-;).

Our health insurance is wide open, and the implementation of any kind
of access control like token deductibles of $5-20 (proposed by
Quebec's Liberal government in Spring '92, torpedoed by Ottawa's
Conservate federal government) to eliminate nuisance factors (e.g.,
hypochondriacs) is at the bottom of the public agenda.  Such stability
is not guaranteed in the United States, and probably more than one of
you are hesitant over the possibilities of the situation spiralling
out of control ...

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare
> gld@columbia.EDU 			GO  Winnipeg Jets  GO!!!
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