From: pdl2r@galen.med.Virginia.EDU (Peter D. Lauren)
Newsgroups: alt.politics.clinton,alt.politics.bush,talk.politics.misc
Subject: Re: National Health Care
Date: 23 Aug 92 18:51:22 GMT
Organization: University of Virginia


In article <BtFyFL.Fu@mentor.cc.purdue.edu> hrubin@pop.stat.purdue.edu (Herman Rubin) writes:

>Will a proposed national procedure
>be any better?  Government bureaucrats are opposed to innovation, as are the
>insurance company bean counters.  Medicaid requires that one be almost broke
>to receive the benefits.  
>

The problem which you mention about Medicaid is that it is based upon the
dubious philosophy that anyone who can afford private health insurance should
see that as their source of medical coverage.  This is the philosophy which
drives arguments in favor of the current American health insurnace system as
opposed to a Canadian-style system.  One can see how damaging this philosophy
is when it comes to medicare.  It provides a strong disincentive to people
moving off welfare because, once they start to make some money, they lose
their medicare coverage.  Three quarters of the people without medical
insurance belong to the working poor.  Thus, if we want to encourage people
to move off welfare and to better themselves, we need universal health
coverage to remove this disincentive.

>>Which is an argument for people having some form of catestrophic health
>>insurance rather than insurance which covers 'all medical costs'.  People
>>wonder why insurance is so high.  Imagine how much auto insurance would
>>cost if it covered fill ups, tune ups, oil changes, etc.  Insurance should
>>be just that, insurance.  Minor medical procedures, check-ups, etc.,
>>should be covered by the individual.  Doctors fees can be increased
>>simply because the customer (patient) isn't paying the bills.  When
>>you intervene in a market transaction so that the customer doesn't
>>realize what the good or service he is buying costs, its not surprising
>>that the market 'fails'.
>
>Very definitely so.  My current doctor suggested something, and said,

The analogy to auto-insurance is totally irrelevant.  Auto-insurance is
intended to cover costs associated with accidents and, possibly theft/vandalism
etc.  It is not intended to cover the costs associated with inadequate
maintenance.  As a medical researcher, who has worked in the areas of both
cardiology and oncology, I know that early detection is vital for the
successful treatment of cancer and cardiovascular disorders which, between
them, account for over 70% of deaths in this country.  How many pap smears
or mammograms could be covered for the cost of successfully treating breast
cancer or cervical cancer (assuming it were even possible when treatment
does not proceed until the disease has reached its advanced stages)?  If
you want to save money, you should favor a Canadian-style system. If
health care administration in the US had been as efficient as in Canada,
69-83.2 billion dollars would have been saved in 1987  (Woodhandler, S. &
Himmelstein, D.U., New Eng. J. Med. 324(18):1253-8 (1991)).  The administrative
structure of the US health care system is increasingly inefficient compared
with Canada's national health program (same source). 
>
>
>In the meantime, doctors' fees are substantially regulated.  Anyone who
>thinks that doctors in a particular form of practice are of equal abilities
>is nothing more than a fool.  Also, doctors are only paid for procedures by
>the various coverages.  A doctor can send a patient to a specialist, and 
>this will be covered.  But for a doctor to confer with the specialist, or
>(horrors) to consult the medical literature, frequently no mean task, to 
>find out what the unusual condition is, or what unusual treatments are
>available when the standard ones fail, is not covered at all.  Cases have
>been posted to sci.med where referrals to 30 physicians failed to get
>anywhere, but a single knowledgable physician solved the problem quickly
>and cheaply.  In this national system, the 30 physicians ended up with
>their full fees--there is nothing in these socialist schemes to achieve
>quality work by intelligent people.
>

What "socialist schemes" are you talking about?  I have read this chapter
several times have have only found vague generalizations.  I am
continually amazed how so many people point out a problem in the AMERICAN
system and then use it to attack the CANADIAN system.  Why do you think
that well over 50% of Canadians are satisfied with their health care
system while only ~10% of Americans are with theirs (Harvard study)?  
It cannot be
accounted for by consumer expectation as Canada used to have a system
virtually identical to what the US had at the time.  Thus Canadians can
compare their system with the system which the US had when it was working
a lot better than it is now.  They still prefer the national health insurance
program.  The fact is, the Canadian system works, the American system
doesn't.

Peter Lauren.
Newsgroups: alt.politics.clinton