From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Subject: Re: Canadian healthcare system
Organization: Purdue University Statistics Department
Date: Tue, 26 Jan 1993 14:15:16 GMT

In article <1993Jan26.051652.2061@newshub.ccs.yorku.ca> wc4209@writer.yorku.ca (Irene Berkovich) writes:
> Broekman) writes:
>>In article <C1FC0p.6EM@mentor.cc.purdue.edu> 
>>hrubin@pop.stat.purdue.edu (Herman Rubin) writes:
>>>There are several things wrong with it, and it is not all that much 
>>>cheaper than the cost in the US.  One generally agreed problem is that
>>>many "standard" procedures are not done in Canada, and while the Canadian
>>>plan often picks up the costs, it does not pay the travel, and it does
>>>not help defray the development costs, which US care does.  For another,

>>Of course, were I Canadian, I could take a year off from school without
>>worrying about paying for things like allergy and asthma medication.

> The Canadian health plan only covers medication costs for seniors
>(>65) and welfare recipients.  If you're poor, but not poor enough for
>welfare you're out of luck.

Another example of hidden income taxes.  ALL eligibility rules are 
income taxes in the true sense of the word.  

>>>one must find a primary care physician, and all else must be referred
>>>through that doctor; I believe that changing such is difficult.  Also,

>  There is absolutely no difficulty at all changing family doctors.
>One simply requests their records be transferred and voila.  I think
>it's a good thing that all referrals be done through the family
>doctor.  Most times nno referral is needed at all because the family
>doctorr can manage the problem quite well without running the expense
>to the system of a much higher paid specialist.

Who decides if the family doctor can manage the problem quite well?  I do
not mean that specialists are the answers; often the answer, as I have stated
here before, requires those who can put lots of things together.  Even some
of the MDs posting here agree that the medical schools do not teach that; 
reasoning with many interacting causes is far from easy, and quite often
requires intelligent use of computation.

>>The healthcare plan I'm currently on (via my parents) also requires finding
>>a primary care physician, and changing such isn't particularly easy.

This is an indication of what may even be the worst problem.  The healthcare
systems, whether run by government or by insurance companies, are the very
antithesis of insurance.  They must put in cost control procedures to take
care of the "tragedy of the commons", allowing the multitude of users not
to pay their marginal costs.  No individual has any responsibility to 
control the costs of his/her individual healthcare.

So why do insurance companies participate?  Insurance companies, to nobody's
surprise, are out to make money.  They normally handle risks by using large
samples.  Now which is a safer risk:  paying the health costs after $20,000
of a person's own money is spent, and charging a low premium, or paying all
the health costs, and charging a much higher premium?  Any reasonable 
calculation will show the latter is safer.  But the former encourages
consideration by the user, while the latter does not.


-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@snap.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!snap.stat!hrubin(UUCP)
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