From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: National Health Care
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: Curious Goods (formerly Louis Vendredi Antiques)
Date: Sat, 22 Aug 1992 20:23:19 GMT

<jbrow@glv.com> writes:
>DGS4@psuvm.psu.edu writes:
>> 
>> Ah the old "theft" argument.  I've heard that line so often I don't
>> even dignify it with a reply anymore.  Your facts are wrong.  Canada
>> has wonderful doctors and health care.  So does France.  So does
>> Germany.
>
>It's amazing how the Canadian health care system is so wonderful, yet 
>almost all the Canadian relatives (who live near the U.S. border) of 
>one friend of mine venture down to the U.S. for most of their health 
>care (while simultaneously mouthing off about how wonderful the 
>Canadian system is).

It's too bad that Canada's system is not as Sovietic as some people
would like it to be for their own ideology.  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 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).  Going to California is often faster from
western provinces than going to Ontario for a rare procedure that's
not found in the West.  A second aspect is that while there is nothing
to stop any private Canadian doctor from doing practice any sort of
obscure procedure, certain locations especially in Western Canada will
not get them very much in the way of business, and thus billings!
Demands for such a procedure would dictate that such a doctor should
locate to somewhere with a high population density and let patients
from a large zone come to them.  For example, the province of
Saskatchewan is the size of 3 or 4 midwestern states but has a
population of 800,000; each of the cities of Edmonton and Calgary in
neighbouring Alberta have 800,000 people -- but so does my girlfriend's
home county in New Jersey (or for that matter, the Upper West Side of
Manhattan where we now live).  Since the "Canadian system" begins and
ends with insurance then it is really the market (locating of private
doctors' practices vs. a whackily skewed population distribution) that
kills it in terms of access to uncommon procedures (relative to the
population).  Quick check of a junior high school atlas and some
market common sense bears out my assertions above ... our geographic
lopsidedness has historically severely affected Canada's political
landscape and even now plays a part in our constitutional debate;
its impact on availability of certain health services is not a
problem for Canadians, but least of our worries.

Divorcing the insurance aspects of our two countries, medical travel
is consistent with the continental population patterns and market-wise
location of private medical practitioners (assuring them of an even,
constant supply of work) -- this includes Americans from border areas
getting prenatal checkups in Eastern Canada with authorization from
their insurers.  In true socialized medicine as Britain has, they'd
put a civil servant doctor into Saskatchewan for brain surgery and let
them do one procedure a year while playing golf (or hockey (-;) the
rest of the time -- that would be highly inefficient!!

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 ...

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.

It might be hard for Canada to privatize its health insurance because
our private insurers would balk; they're making too much money on
non-medical supplementary health insurance benefit plans (private bed,
telephone, cellular phones, etc.) for individuals and private
companies.

gld


Disclaimer: This in no way advocates a direct transplant of Canada's
public health insurance system, just clarifying a few things about how
things are set up there.  It just works for Canadians, and I do not
see why Americans have a desperate need to knock it down unless some
quarters just can't accept that it does work for us.  Guessing games
about how Canada is set up (politically, geographically, etc.) can
be amusing until one realizes that an American audience often does
not have any sources to check their veracity ... those Labatt beer
commercials showing a guy going to a bar in Vancouver harbour via
canoe don't help matters, either. (-;

Addressing comments made by another writer, just how much worse is
Canada's material standard of living under public health insurance?
Things do seem to be all right if one watches the "Kids in the Hall"
(HBO/Comedy Central, but prime time broadcast in Canada); "E.N.G."
(Lifetime); some of the CBS "Crimetime" programs opposite The Tonight
Show; or, various other Canadian programs that show up in syndication
or (esp.) cable.  Looks pretty generic North American (usually in a
no-name city (-;) ...

--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare				Elections 1992-93:
> gld@cunixB.cc.columbia.EDU		* Jean Chretien (Canada)
> gld@cunixc.BITNET			* Perot^H^H^H^H^H Elvis! (USA)
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