From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Newsgroups: talk.politics.misc,talk.politics.theory
Subject: Re: Canadian vs US health care
Date: 14 Sep 92 18:44:31 GMT
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Distribution: usa
Organization: Deep Space Nine

>pajerek@kadsma.kodak.com (Don Pajerek) writes:
>>
>>These sound like objections to a British-style National Health Service,
>>in which the actual medical services are provided by the government, 
>>not the Canadian system in which all services are still provided 
>>privately. I too am very leery of the British NHS.

I agree about not giving government power to decide about health care,
that's why I support universal health insurance as we do it in France,
Germany and (of course (-;) Canada.  The fidiciuary fund pays private
doctors (who invest in their practices), and modern public and private
hospitals.

There are private alternatives in Britain, according to The Economist,
but you have to pay for that on top of what you've paid for NHS already.

nelson_p@apollo.hp.com (Peter Nelson) writes:

>  It depends on whether under a Canadian style system I can still
>  choose my own doctors, tests, etc.   In most insurance systems,
>  including the US one, the insurance provider can place lots of
>  restrictions on many aspects of service.  

As I pointed out in the previous posting, opening a yellow pages in
any Canadian city will show you that some/most specialists will list
themselves explicitly.  I typed in an English four-line listing for a
Dr. Dumas in Montreal, you'll recall.  While there is nothing to stop
any private Canadian doctor from doing their 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 few 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.  Canada only has four real cities
[Vancouver (1.5 Million), Edmonton and Calgary (~750,000 each), and
Winnipeg (600,000)] west of the great lakes.  For example, the western
province of Saskatchewan is the size of 3 or 4 midwestern states but
has a total population of 800,000 (and at least one private MRI); each
of the cities of Edmonton and Calgary in neighbouring Alberta have as
many people - AND so does my girlfriend's home *county* in New Jersey
(or for that matter, the Upper West Side of Manhattan where we live).

Since the "Canadian system" begins and ends with insurance then it is
really the market (location of private doctors' practices vs. a quite
whackily skewed population distribution) that kills it in terms of
access to uncommon procedures (relative to the population).  Quick
check of any 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 big part in our constitutional debate (Quebec, 1 province
with 25% of population, vs. 4 Western province with < 20%); its impact
on availability of certain health services is not seen as a problem
with the health care system itself for Canadians, but a common sense
fact of life that would exist whether we had our current public health
insurance or using an American-style all-private system.  Canadians
travelled when citizens in both countries paid cash up 'til 20 years
ago, when health insurance was considered a frill, for the same
geographic reasons.  Too bad that our population growth reinforced
existing distributions ...

>  Also recall that one of my objections to the Canadian system was
>  high taxes.   

Nothing is free, but in most provinces your company will list the
portion deducted as your health insurance premium as an item line 
on your pay stub.  Our high taxes come from everything else when
you remove the health insurance portion.  We're only 26+ Million
covering an enormous area, so you can imagine the overheads both
private and public ... have always been there. )-;

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare				
> gld@cunixB.cc.columbia.EDU		Oct 26/92: Just say "OUI!"
> gld@cunixc.BITNET			(Let's worry about the economy!)