From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: Death of Canada (Was: Death of America)
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: The Bates Motel
Date: Sun, 13 Dec 1992 18:49:52 GMT

cmk@athena.mit.edu (Charles M Kozierok) writes:
>gld@cunixb.cc.columbia.edu (Gary L Dare) writes:
>
>some time about a year ago, a "job fair" for doctors was held in toronto
>by Humana, the big US hospital company. they expected about 200 doctors
>to show up. 400 showed up. this made the front page of the toronto star,
>with everyone screaming "oh, the big bad americans are coming here to
>steal our doctors". humana's reply: "steal them? they're begging us to
>come up here and give them jobs in the states".

So how many were actually hired?  Humana took advantage of an
opportunity to stage a show to embarass a system that they would
perceive to embarass them (by the way, although we don't have hospital
corporations I do not have a problem with that ... France and Germany
have the same insurance scheme that we run and also do have for-profit
hospitals ... a bigger population and more compact geography comes in
somewhere, though).  The doctors had a show to create a preemptive
strike against the Rae government, especially since their College of
Physicians and Surgeons are going to present a new rate hike proposal
soon.  Humana comes up all the time, and are usually just looking for
hospital administrators not real practicioners.  It's all a game.  A
friend of mine was there (he practices out in Whitby), much of it was
a show.  If anything, he learned a bit about business from the session
and since there's no prohibition against private clinics buying MRI's
or other high tech equipment (you realize the government does not do
the health care, right?  So they don't buy the machines.) just like 
hospitals ... maybe he can convince his senior partner to forgo their
new boats and more winter vacation time shares to ... *invest in the
practice.*  (Remember what I said about Canadian risk aversion ...)

>i do know that any doctor who practices in ontario is willing to have 
>the government tell him how much his training, hard work and experience
>are worth. i wouldn't.

As would any doctor looking at setting a rate schedule with private
insurance companies pressing down on him/her or having to surrender 
to the control of HMO bureaucrats who *directly* interfere in the
practice of medicine.  The only difference is that the main health
insurance company is the universal one run by the province (which
private insurance wants nothing to do with).  By the way, I hope that
you're not confusing the doctors' own monopoly mechanisms like the
College of Physicians and Surgeons (in every state and province) and
licencing procedures (law, yes, but from standards set by the College)
with Big Brother.

>you've avoided the point though. the government still decides.
>and there is NOTHING to prevent them from drastically reducing
>coverage in the future. 

You mean like private insurance is now weaselling people all over
the United States?  I've read in the Times recently that 100,000
Americans a month are getting booted for using the insurance that
they paid for when they were healthy ...  As a Canadian, you know
how cherished our health insurance is and it's the only thing ...
not Quebec independance, not Alberta withholding oil ... that will
spark an insurrection.  Any time someone has tried to screw with
our autopilot system, they get burned ... Mike Harcourt's NDP just
tried to put on a salary cap on B.C. doctors' annual billings and 
with less than a year in office, have nailed their coffin as a 
single term administration according to the latest Angus Reid polls.

>>Come again?  Our public and not-for-profit private (e.g., Mount Sinai,
>>Davis Jewish General in Montreal) hospital are autonomous.  If public
>>or private auditors find that their capacity is being underutilized,
>
>you've picked a couple of exceptions, yet again. when i lived in 
>toronto there were articles about the shortage of beds in hospitals 
>almost every day.

The population in Toronto is booming ... can't be said about the
other parts of our country.  Go out to Kingston, even Ottawa and
London, and it's a different story.  Even in Toronto, it may be
the case that some people will not go to Mount Sinai because it
is perceived by some people to be a "Jewish" hospital* (it's a
private hospital with a strong philanthropy, primarily Jewish
but not exclusively).  Again, it's the shopper's fault there.

(* My friends had interned at Sinai, and told me about this very
irrational thinking among some people.)

So if you had a network of hospitals (let's exclude the private
ones) and some were underutilized, why pay for that space?  Why
not save the money, move it to where it's needed (hospitals take
a while to build, esp. in Toronto which is so built-up already).
Makes market sense to me irregardless of the orientation ...

>not at all. i said the government decides. i didn't say they did a
>good job of it! there was a big stink last year when it became known
>how much money OHIP (the ontario government's health insurance agency)
>paid to send canadians to american hospitals. i'm sorry i don't have
>access to the article to quote an exact number, but i believe it was
>in the hundreds of millions.

OHIP arranged for people in the western third of Southern Ontario to
go to Michigan, where some clinics and hospitals accept OHIP as their
payment.  So what if people spent their benefits there?  They were
supposed to.  What kind of law or morality is there that the benefit
must be spent in Ontario?  That is the xenophobic reasoning that the
press would give for a case like that ... Sure, have them truck all
the way to London or Hamilton or Mississauga on a four hour ride.  A
hospital is a hospital unless yer nationalist strings get tweeked (if
you read that in the Toronto Star, that explains everything; I like
their Sports and their Arts/Entertainment, but they're xenophobic
when it comes to issues like this).

>>>centrally planned health care.
>>
>>Nobody tells you how to spend your benefits.
>
>but they tell you how you may not spend them. OHIP covers only certain
>things, and it prohibits doctors from providing additional services
>for a charge. that is socialized medicine in my book.

What additional services?  If you're talking about amenities, there
is private insurance or cash for private rooms, etc.  All insurance
is limited; it's just hard to find American insurance that is as all
encompassing as OHIP (remember, my standard is what my girlfriend is
getting from her dad and his rich Euro-American pharmaceutical firm).

>i already explained this. as long as the government controls what is
>covered, and how much doctors area allowed to be paid, i consider
>it socialized medicine. maybe we just disagree on the term.

As I had mentioned, the doctors know how to work the system and are
nominally in the drivers' seat.  I've seen them from the inside, the
government is along for the ride.  Since all our doctors are board
certified (at least the ones our age), they can pick up and leave
any time if they weren't getting what they wanted.  Follow the next
rate setting negotiations, you'll see.  The government itself will
make noise for political gain, but the doctors have 'em by the 
short 'n curlies ...

>>I can respect your opinions, but not to the point of twisting
>>things around or (e.g.) to rationalize your newfound libertarianism.
>
>who are you to qualify it is new-found? at least i don't call
>you "mccarthy" for identifying it as such.

Excuse me, I didn't mean to be insulting.  Annually, there is a
Canadian EE/CS type who was traditionally apolitical and usually very
healthy as to have not ever dealt with medical care up north, and
getting a job in Silicon Valley is exposed to Libertarianism by his
(so far, no hers (-;) colleagues ... in a vacuum, there isn't a lot to
go on so they get caught repeating things that they should know better
is not true.  Obviously, from articles that I've read since that one,
your positions have been held longer and go back a ways although the
interpretation of events and the way things are don't quite jive with
the actual setup (then again, those are things that ordinary Canadians
don't pay much mind to --- I certainly didn't 'til I got bombarded by
questions from people here at Columbia and had to remember, fast).

>well my point is to counter all the "(sigh) i wish we had health
>care like they do up in canada. it's so *wonderful*" garbage i keep
>hearing down here. THAT is the propoganda.

You are also the first Canadian, of whatever political stripe, to come
out against our health insurance system in the three years that I've
wandered in and out of this group.  (Besides me -- a Manitoba Tory and a
Quebec Liberal -- there has been an Alberta Tory and a British Columbia
Reformer who have engaged Americans on this topic ... no NDPers, for
some reason unless I'm forgetting someone).  Funny that with all the
Canadian celebrities out there, nobody has been able to get one to
lobby for private health insurance down here ...

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