From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: Canadian health insurance -- Is Microsoft the next?
Followup-To: talk.politics.medicine,soc.culture.canada
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: The Bates Motel
Date: Mon, 4 Jan 1993 03:20:07 GMT

bauwens@acs.ucalgary.ca (Luc Bauwens) writes:
>
>Stuff about medical system in Canada.  I wonder what this got to do
>with comp.os.os2.advocacy...   So, see the follow-up line,
>redirected to soc.culture.canada.

Actually, send it over to talk.politics.medicine, too ...

[Hey, wouldn't "Kids in the Hall" have a field day if Canada's health
care system were done the way that U.S. propogandists say it is???]

>ckincy@cs.umr.edu (Charles Kincy) writes:
>
>>robert.heuman@rose.com (robert heuman) writes:
>>>
>>>I will note, however, that there is a substantial difference between 
>>>the US and Canada when it comes to MRI and other high-tech, high 
>>>expense facilities.  In Canada ALL treatment hospitals are PUBLIC and 
>>>are expected to share high-cost facilities, rather than buy their own 
>>>where the volumes do not warrent.  

Sounds like the local market isn't big enough in that case ...

>>>In the US there are a lot of high  tech set-ups, but primarily at 
>>>PRIVATE hospitals, and the charges for their use are exorbitant.  
>>>Check out the PUBLIC hospitals and see if the ratio of MRIs and 
>>>CTScanners is any higher than in Canada.  I rather doubt it.

Okay, two things ... all hospitals are "public" in that they bill the
provincial insurance fund (or foreign medical insurance for tourists)
for the procedures done on people who walk in the door ... it's real
insurance, no HMO/UK NHS-socialized-medicine crap.  However, many many
hospitals are run by private not-for-profit foundations: Mount Sinai
in Toronto, Mortimer Davis Jewish General in Montreal (the Bronfmans
of Seagram fame are big supporters), St. Boniface in Winnipeg and the
Grace Hospital in Winnipeg (run by the Salvation Army).  Montreal has
many Catholic Church-run hospitals like Jeanne d'Arc (Joan of Arc).
Their philanthropies raise funds (like the Mount Sinai here in NYC)
and the endowment is entirely at their discretion.  Then, there are
real public hospitals like in the United States ...

(As a note, I don't know why we don't have private for-profit
hospitals like France, who have almost exactly the same system but
a larger population in a compact geography ... hey, that's the ticket!)

The hospitals themselves are seperate from the insurance fund ... what
prevents the government from taking active participation in the health
care are provisions *against* socialized medicine, where *government*
bought equipment is the government's to have and to pay to maintain.

>>Hey, ok, I will grant this point to you...but:
>>
>>>There is one last point to be made.  Canada is larger than the US with 
>>>approximately 10% of the population of the US.  In addition, most of 
>>
>>Right.  See, this is the problem.  Canada has about the same population
>>as California.

No, it's Canada 26 Million, California 33 Million.  The largest province,
Ontario, has the population of the greater Bay Area.  The distribution of
the population is very skewed ... the English-speaking population over in
Montreal is larger than that of 5 other provinces (but they don't have a
seat at the Constitutional conference table).  With all due respect, get
an atlas and check the pages with the bubble thingies-showing population
size per area. (-;

>If anything, it would seem to me that with a larger population,
>econmies of scale should be achievable.  Furthermore, a denser
>population also allows for cheaper service.  Even if that were 
>not the case, why wouln't costs at worst scale with population?

Actuarial types can explain this amortization very well ... it's
from week one of their classes.  You deal with a large population
and can safely assume a Gaussian curve (or Chi, depending on who
you believe ...).

France and Germany have the same system as Canada but much larger
populations in a more compact geography.  However, I do caution
that there is a cultural factor that we Canadians share with the
Europeans that make the system work for us despite the propoganda
that has been successfully planted and repeated (Hey, how many of
you think that we live in igloos? (-;) in the U.S. --- the reality
is that the systems work for us, but it's up to the Americans to
figure out if it'll ever work for them.

>>Now that we've examined a few problems with the Canadian system,
>>let me suggest that what works in Canada probably will not work in
>>the US.  A nationalized health care system increases exponentially
>>in cost as the population increases.  
> 
>Why would that be?  And if you were right, then perhaps you should
>cut your country into millions of small villages and perhaps everybody
>would live forever :-)...

"A nationalized health care system" presumes that there is a third
party besides the patient and the doctor ... Canada's "system" (and
that of France and Germany) is only an insurance fund.  You pull out
the Yellow Pages and pick a doctor ... and few Americans now have
that kind of insurance luxury.  Rather, they have to say "pretty
please, with sugar on top" to an HMO exec counterpart to the U.K.
National Health Service accountant for your district ...

>Furthermore, the average population of the Canadian province is less
>than half the average state population in the US.  Furthermore, medical
>care fall within the *provincial* responsibility.

We only have four cities west of the Great Lakes: Vancouver (1.5 M),
Edmonton and Calgary (750 K each) and Winnipeg (550K).  Sorry to those
of you reading in Regina, Saskatoon (Hi, Glenn!) and Brandon, but from
an American/European definition of "city", the 'Peg barely cuts it ...

>>  It's designed to be inefficient.  Unfortunately,
>>that means socialized health care in the US would cost oh, so much more.
>
>I won't argue with your claim that the US government may be designed
>to be less efficient than the Canadian one.  I wonder why one would
>want to *design* a governement to be inefficient, though.  As for
>the result, you probably know better than I do :-).

Why do Americans assume that everyone's government is like theirs? (-;

Seriously, Canada's public sector traditions are directly descended
from Europe's and not a result of recent application of socialism, but
centuries of tradition marked by Napoleon, Disraeli, Bismarck, etc.
And before someone points to the increasing EC and NA freer trade
(which I'm all gung-ho for), that's got nothing to do with any of the
non-market aspects of the culture (and I'm saying that as a vehement
free trader).

>Two more points: in the Canadian system, health care is provided by 
>*private*, non-government medical organizations.  It's merely the 
>*insurance* business that's run by the provinces.

There is nothing to stop a private practice from getting all the high
tech tools they can buy ... our doctors have nearly equivalent take-
home pay to their American counterparts*, but lower gross due to the
near-absence of malpractice.  Being a less enterprising *culture*,
our doctors don't invest as aggressively or else can't do so due to
the size of the market (hey, I live in the Upper West Side of NYC 
(Manhattan) with more people than any of the western provinces).

I'm always citing my best friend from high school, who's making six
figures as a specialist just outside of Toronto.  He's a sailing
freak, as are the partners in the private practice where he is an
"associate" (to use lawyers talk; doctors don't have ranks) ... so
guess where they stick their booty.

(* The reason for the $3,000 differential is that with our smaller
population, we cannot even think of supporting certain specialized
practices ... if you erased all borders and counted only people with
insurance, the migration patterns to L.A., NYC, etc. would match the
continental market exactly ... obscure specialists will located in
the densest area that can support them to assure a reasonable stream
of work, or guinea pigs for "experimental" procedures --- in doctors'
jargon, that means something that nobody has yet been able to perform
enough to consider "usual business".)

>And you can have universal, government-garanteed health care entirely
>run by private organizations, and even have them compete against each
>other.

One of the original ideas for universal health insurance in Canada was
to have private insurance broker a public risk pool for basic medical
needs, and sell policies that fill out the extra amenities (private
rooms, telephone, etc.) and insurance and travel coverage that they
already sell.  The privates got greedy at the last minute and just
went to selling the extras as seperate private supplementary health
insurance, in group benefits plans to companies/organizations or
individually through a Blue Cross attached to the provincial medical
plan.  I got the former through my jobs, for example.

Note that the seperate private supplementary health insurance is also
sold in Canada by many subsidiaries of American insurance firms ...
they know exactly what the score is, and that is why the HIAA came out
with a statement backing the universal coverage concept just two weeks
ago in the news.  For older Canadians (and those who studied history),
it's deja vu all over again (-; ...

Also, note that this past spring a private health insurance industry
group in Quebec ran a low-scale scare campaign against any noises made
about reprivatizing parts of that province's plan by their government.

>It seems to me that the major problem of medical costs in the US is
>that it's in effect a monopoly totally controlled by the medical 
>profession, ...

Actually, Canada's system is also controlled by the doctors' monopoly
up there ... the CMA and its front-end surrogates in the provincial
Colleges of Physicians and Surgeons infiltrate their members into
every nook and cranny of the system ... sure, there's only one fee
schedule for each province's insurance -- but guess who sets it! (-;

>Furthermore (and this is a key to the issue of cost-effectiveness),
>the Canadian system does a great job at spending enough money where
>it's most cost-effective: in preventative medicine.  
>
>And yes, there may be some basis to the argument that 8% of the
>GNP to medical costs is still too much.

"Kids in the Hall" would have a field day if Canada's health care
system were done the way that the U.S. propogandists say it is ... 

With all the Canadian celebrities that are receiving American exposure 
I do not know of a single one who has become a spokesman against our
"system" (I do not advocate it for the US, I'm just trying to clarify
reality -- there are some major cultural differences in values and
behaviour Canada/France/Germany vs. USA): Jason Priestley (of 90210),
Neil Young, Joni Mitchell (married to an American and living in LA),
Michael J. Fox, Peter Jennings ... it's a massive list and you'd think
that there'd be *someone* with a valid beef centered particularly
around the way we do insurance up north ...  the Canadian population
in California alone is estimated at around 1 Million.  (I'm sure that
includes children of Canadians and their spouses; it is a number that
is oft-repeated up north, and still amazes me.)

Pass me another pile of that beaver gizzard pudding, will ya? (-;

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare
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