From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: An Approach to National Health Care
Keywords: entitlement national health care
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: The Bates Motel
Date: Wed, 18 Nov 1992 16:39:28 GMT

rrb@corona.CSS.GOV (Robert Blandford) writes:
>
>(2) The virtues of this approach are that costs would be contained through
> competition, the best health care would be available to the poorest,
> preventative care would be encouraged, and there would be no waiting
> lines as occasionally happens in Canada due to absence of price com-
> petition for the best doctors, (Consumers Report, Aug- Sept, 1992).

CR has pointed out that many of the "waiting lines" are short-term
transients, but due to lack of Canada information down here in general
(unless a major disaster or Quebec nationalist happening comes up (-;)
those numbers are purposefully represented as status quo.  However, it
is true that from each provincial insurance has its own pro-rated fee
schedule and Canadians can only vote with their feet to spend their
insurance benefits on a good doctor.  And to other readers, please
note that our doctors are private; sure, they accept the public
insurance but they also take foreign (US) medical insurance (often
w/differentials) and also have a cash schedule as well.  (Recently,
Ontario's OHIP plan announced that non-personal visits such as for
insurance policy checkups will no longer be covered by their fund; 
you gotta pay cash or use private supplementary insurance.)

>(3) A politically possible path to this system might be to first change
> to the Canadian system, (as recommended by Consumer's Reports), which
> this system resembles in its comprehensiveness, and in its daily routine
> from the patient's point of view;

Actually, the fair comparison between Canada and the U.S. is between
someone living in a dense urban area like downtown Toronto, Ontario
and someone with the best American insurance.  Even then, the Toronto
person has the disadvantage that their metropolitan area has smaller
population than major counties like Bergen, NJ.  My girlfriend has
what is arguably the best American insurance through her father, a
high-level research exec in a major Euro-American drug firm (they are
originally from Germany), and seeing that family through a number of
sicknesses, nothing from the consumer viewpoint differed from what I
have seen* with my friends and family up north, or hanging out with
medical friends in Toronto and Montreal.

* I rarely get sick myself, and my encounters with our university's
campus clinic reinforces my disdain for real socialized medicine or
for pseudo-socialized medicine via HMO's.  Heck, when an Italian
Columbia friend working in Silicon Valley tells me that seeing his
wife through an HMO was worse than seeing their National Health
Service-style socialized medicine, you know something is wrong ...

> and subsequently lower costs and improve fraud resistance by
> incorporating the fixed entitlement which would do away with price
> fixing boards as found in Canada (and in practice in the US) and
> introduce competition.

Ummm ... by "price fixing boards" do you mean the doctors' monopoly
setting the rates for the insurance fund schedules to meet?  That is
how our rates are set up north ... doctors ask for a high figure, the
provincial insurance hedges, and then the rates go up within ballpark
of what the doctors really want.  They're really in the driver's seat.

>(29) This entitlements approach has many of the cost-containing and
> humane features of the Canadian system with the additional cost- con-
> taining feature that costs are set by competition and not by government
> boards who have various conflicts of interest. This should result in
> better cost containment than in Canada and thus for more medical care
> delivered.

As a Canadian who has spent 25+ years (cumulative) of thirty living,
working and being politically astute up north, could you please tell
me what these government boards are?  Maybe I'm missing some technical
details (Dammit, Jim, I'm an engineering scientist, not a doctor! (-;)
here or it's a case of American vs. Canadian terminology/viewpoint.

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