From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: health care industry woes
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: The Bates Motel
Distribution: usa
Date: Thu, 19 Nov 1992 16:35:28 GMT

jstewart@alfred.carleton.ca (John Stewart) writes:
>starr@genie.slhs.udel.edu (Tim Starr) writes:
>
>>One possible contributing factor to this would be the fact that the 
>>government has "sovereign immunity" from liability, which cuts down 
>>the amount of malpractice suits it has to face when it coercively 
>>monopolizes medicine.
>
>Governments in Canada are not immune from liability, they can be taken to
>court just like any other organization/individual.  In the case of medical
>malpractice, it would be the doctor and/or hospital that would be sued.
>In general, liability is much less of a problem in Canada than it is 
>in the US.

As I have pointed out in other articles, all of our doctors in Canada
are private.  They have to buy malpractice insurance.  Their premiums
are lower, though, due to the generally smaller presence of litigation
outside of the U.S.  

Also, erroneous assumption that government is involved in the Canadian
health care provision process.

>>Health care in England and Canada, where they have national health 
>>insurance, is rationed by line: people have to hurry up and wait in 

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 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").

>>This is why there's an "underground railroad" for Canadians in need
>>of immediate treatment to get it in the States.
>
>I've seen no evidence that Canadians in need of immediate treatment 
>were forced to wait in line.  There are waiting lists for some forms 
>of elective surgery, for example heart bypass operations.

A common myth repeated among Americans upon the assumption that our
government(s) is involved in the health care process, rather than the
market.

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.

In CNN's series looking at the real health care system in Canada this
past June, a Toronto woman who had to go down to Washington, D.C. for
a procedure was interviewed by Catherine Crier and no matter how hard
Crier pushed her, would not criticize OHIP (Ontario Health Insurance
Plan) for her plight -- nobody in her province nor Quebec (forget
about the smaller-population provinces next door like Manitoba) was
practicing in that medical area, and that even Americans had to travel
to D.C. for it.  She also reminded Crier that the USA is ten times
bigger than Canada and would likely have more stuff ...

(Actually, that's 11 times based on the latest census figures.)

Waiting lists have been debunked by Vancouver's conservative Fraser
Institute, and CNN could not find any convincing ones during their
June focus series on the health care system in Canada.  It was also
one of the first times in the U.S. that I've seen the distinction that
we have private doctors in Canada, and that the only public portion is
centered on provincial (not federal - surprise! (-;) health insurance.

Travel between Canada and the United States is purposefully built-in
due to the fact that both our systems are the same and other than the
way that we do insurance, are highly subject to how the population is
distributed plus market forces on where doctors locate, thus resulting
in medical travel in both directions as well as over domestic state/
provincial borders.

The reality is that the numbers of Canadians coming to the U.S. for
care are in the one or two dozens (Dennis G. Shea can back me up with
hard numbers here, since I don't have any more Canadian newspapers
handy after recycling day), and fall into two categories:

1. Very wealthy Canadians who will not wait a week despite what their
own doctor tells them.  A very small number, done outside of their
public health insurance (out of pocket).  More often, it's ...

2. Canadians who don't have a highly-specialized practicioner close to
them, and a trip to the States would be faster than a trip into
Ontario or Quebec (the two provinces with ~2/3rds of our population,
from the Great Lakes and through the St. Lawrence).  With 9% of the
U.S. population, things are even worse when you consider that we only
have 4 cities west of the Great Lakes (Vancouver, Edmonton, Calgary
and Winnipeg -- and that's shaky by the American definition of city).
Because of the market nature of North American health care outside of
insurance, a highly-specialized practicioner must locate in a center
with large population base and let clients come to them to get enough
work.

When everybody in Canada and the U.S. just paid cash, up to 20 years
ago, everyone knew that people from Nova Scotia or Montana had to do
medical travel for reasons of geography.

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ 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