From: duwors@csi.uottawa.ca (Robert J. Du Wors)
Subject: Re: Canadian vs US health care (was "ACM downgrades Catastrophe Medical Insurance")
Organization: Dept. of Computer Science, University of Ottawa
Date: Tue, 15 Sep 92 14:40:07 GMT

In article <1992Sep14.192334.8846@musclefish.com> czei@musclefish.com (Michael Czeiszperger) writes:

>She now works full time, but has NO insurance because the US Insurance
>Companies are allowed to get away with immoral behavior that *should*
>be illegal.  The whole purpose of insurance is share the cost of health
>care among everyone in the population, so no one person's life is
>ruined with devastating health costs.  What good is the US system when
>people who work for small businesses and don't make a fortune are
>screwed?  To everyone who thinks the US system is working, I hope
>someday *you* loose your health care and need to go the doctor, and
>see what happens to a large percentage of the US population.

Having lived recently under both systems, its obvious that each has its
relative strenghts and weakness.  The above comment nails down an inherent
problem with all insurance: medical, life, etc.  Is insurance just another
excuse to make huge sums of money behind a wall of legal protection, or
does it imply some kind of social contract to share the risk?  Outside
of the medical area, there is no US/Canada difference, except possibly
the legal system here is vastly more abusive and solidly behind the
insurance companies (please don't get me going on Ontario auto insurance
as legally enforced fraud).

Both systems have strong tendencies to be far to dependent on technology,
a legacy I suggest, of WWII and the cold war.  And just as technology
can be used to avoid fundamental social choices, so it can be used to
avoid fundamental issues of health and delivery of health care (especially
of the "alternate" variety).  Both systems have the highest costs in
the world, both have strong biases toward "heoric" medicine.  Financially,
the biggest difference is the grossly inefficient collection and clerical
practices of the US insurance industry.  Subtract that out and total
expenditures are about the same.  Except, the U.S. leaves out a third of
its population.   Centralized and standardized financial 
management would be the single biggest step forward for the U.S. and
might be used to cover at least some of those left out.  (Of course
this assumes the desire to do so, certain idealogies like the idea of
poor people suffering, or why work hard to avoid it?)

The Canadian system has a few unexpected wrinkles.  While American doctors
tend to be increasingly somebody's mere employee, Canadian doctors are
in a a safe business, with guarantees of no bad debt.

On the balance, however, political passions aside, both systems are 
in desperate financial shape and getting worse.  Both systems have
out stripped the ability of their economic bases to support them.
Rationing is inevitable, it is only a question of choosing the
basis for rationing, e.g. medical investment in children versus the
aged (how's that for a hot topic the politicians won't admit openly
and honestly, but they have already taken sides with a vengence).

Of course the solution is simple at the personal level, never get sick!  :-).

Rob D.

From: seek@world.std.com (SEEK)