From: golchowy@alchemy.chem.utoronto.ca (Gerald Olchowy)
Subject: Re: National Health Care
Organization: University of Toronto Chemistry Department
Date: Thu, 27 Aug 1992 12:25:25 GMT

In article <1992Aug27.012253.3686@brownfield.glv.com> <jbrow@glv.com> writes:
>
>I also do not mean to pick on Canada (at least most of the time :-) ), and I  
>appologize if some people have taken offense at my postings.  However, American  
>liberals have chosen the Canadian system as the main argument for American  
>Nationalized Health Care (whether their proposals are like the Canadian system,  
>or not).  Also several Canadians posting here have insinuated that America is  
>somehow "behind the times" for not already having a system like Canada or  
>Europe.  I do not believe this.  I believe that a nationalized system would  
>provide us with an even larger, more uncaring bureaucracy than exists in  
>today's system (at least today's insurance companies pay attention to you when  
>you get a lawyer, this won't be so when the government takes over).
>

The private health care bureaucracy in the US can and is as uncaring
as any public bureaucracy.  If an NHI system retains doctor choice,
it has the potential to be a much more caring system, because the
patient can choose their doctor, and the doctor doesn't have to 
worry about their patient's ability to pay.  Most Canadians get
more caring service for those exact reasons, doctors don't have to
worry about ability to pay as in the US, and Canadians have more
doctor choice than poor people with limited ability to pay and most
people in HMO's in the US.  It is more efficient because there is one set of
forms since there is a single payer, and fees are collectively
bargained between doctors and the public insurer.  Both patients
and doctors also have a much less bureaucratic hassle which also
contributes to a more caring doctor-patient inaction.  The differenc
in what is spent in Canada on health care and what is spent in the
US is almost entirely excess bureaucratic expense in the private
US system.

I totally agree that NHI without doctor choice would be a disaster...
it need not be that way...the people in Canada have essentially formed
a patients union to bargain with the doctor's "union" and the
insurance cartel (which in Canada now happens to be a public one)...that
is why administrative costs are lower in Canada...there is a system
of checks and balances between the insurer, the doctors, and the
patients.

In the US, there is no patients union to take on the AMA and the
private insurance cartels...there is no system of check and balances.

Health care has a non-market component...the necessity that sick
people get health insurance...you can't make a profit insuring sick
people...the market is thus insufficient to deal with health care.

The health care market has to be regulated to achieve a non-market
oriented objective...i.e. insuring everyone.  If one is going to
regulate a market, one has to make sure a system of checks and balances
exists between the major components and players in the regulated
market to ensure efficiency.  Doctor choice is obviously one of these.
The right of doctors to collectiviely bargain and the right of patients
to collectively bargain with the insurance cartel is another.

In the US, the government already massively intervenes in the health
system subsidizing the well-off by not taxing health benefits provided
by employers...the US system just isn't fair and doesn't have a set
of checks and balances to control costs.

Gerald

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