harelb@math.cornell.edu (misc.activism.progressive co-moderator) writes: >F<O>CUS/HEALTH: EIGHT MYTHS about National Health Insurance (Pt II) > >    An office visit that's $52 in Seattle is $18 in Vancouver >    (Canada).  That's because, among other things, they've given their >    government power to bargain with doctors and hospitals over fees.  The difference in the litigation environment is reflected in the fees.  Lack of defensive medicine and near-absence of malpractice is really why we spend less using the most expensive approach of pure insurance in Canada (along with France and Germany) without HMO's --- the NYT has admitted that malpractice insurance fees are an order of magnitude lower in Canada but doctors take-home pay is almost equal to American doctors; also, minimal bureaucracy 'cos the system is so-o-o simple (early March).  Part of the deal for using the all-insurance approach like the French and Germans do (hey, why don't they criticize France and Germany?  Is it because too many people take French and German in college to make the accusations stick? (-;) was to preserve the doctors independance. Since the provincial wings of the CMA are the ones that go to bat when the fee schedule hikes are presented, the politically-bent doctors were just cackling when they realized the CMA would grow in strength rather than diminish, especially when unopposed unlike in socialized medicine approaches like Britain's National Health Service.  >"`You've got to remember, you've got a waiting list as well, but it's   >not as obvious. If you're poor and you don't have insurance, you don't   >    go to a surgeon. In the States you ration by ability to pay.'"    For non-life threatening things, market arguments adequately cover why certain procedures are in scarcer demand.  I have MD friends who can't make a living as specialists back in Manitoba not due to the insurance rates but because they won't get enough customers -- the CMA medical monopoly's grip on doctors licencing (as in the US) aside -- so they must move to larger places.  However, this does not refute debunking of waiting lines for urgent AND routine care, as has been done in the U.S. by Consumers Reports, health policy studies cited by Prof. Dennis E. Shea on USENET, CNN, NYT, etc.  Doug Fierro has posted a NYT article from 3 weeks ago about Canada's health insurance approach, on Talk.politics.medicine.  There is one small error in the article: not all of our hospitals are private.  >WOULDN'T NATIONAL HEALTH INSURANCE MEAN THAT AMERICANS WHO ARE NOW   >FULLY INSURED MIGHT HAVE TO SETTLE FOR LESS?   > >In Canada, provincial insurance covers all health costs except dental   >care, eyeglasses, prescription drugs, ambulance service, and private   >hospital rooms, -- so many Canadians do end up buying some private   >insurance. A policy to cover all of these things runs about #40 to $40   >a month.    Of course, the one thing to note is that in the Canada/France/Germany case, private insurance *offloaded* the basic coverage to the public sector.  They realized they were keeping low-risk/high-profit extra insurance for things like private/semi-private rooms (vs. ward accomodation), dental, glasses, etc. for corporate or personal benefits, they'll have nothing to do with you if you want to be covered for basic care.  At that point, they wouldn't even consider a "voucher" approach to broker the universal coverage and sell policies to make up the difference in the federal guidelines and market stuff.  >******************************************************************   > >WOULDN'T FREE CARE ENCOURAGE PEOPLE TO RUN TO THE DOCTOR FOR EVERY   >ACHE AND PAIN?   > >People who get free treatment *do* go to the doctor and hospital about   >a third more often than those who have to pay a share of their medical   >bills.   > >Still, Canadians -- who pay nothing at the doctor's -- have a lower   >per-person health bill than we do.  It is "free" in that there are no deductibles nor copayments (two things which I advocate to make the Canadian insurance look more like real health insurance -- which actually it is).  I know that when working in Alberta, Ontario and Quebec, I was aware that I was paying for health insurance - e.g., in Toronto, OHIP fees were listed on my pay stub; Manitoba did not collect at paycheque time, but only annually at income tax time (built into the tax rate).  Only fiscal naifs will proclaim that it's free, along with the Canadian Left for that is part of their brainwashing agenda.  The French do have copayments, though.  France Magazine's Summer  1992 edition has a fantastic presentation of their basic insurance coverage, including a sample chart of copayment percentages.  For  1-30 days, you're covered for 80% of the public hospital rate, 100% afterward.  With extra private insurance, you can get into a private hospital and be covered for any differences beyond the public hospital rate.  The public insurance covers 100% beyond 30 days, or the same cash amount for a private hospital and the difference is paid out-of-pocket or according to your supplementary private insurance. Over 2/3rds of French have some form of extra private insurance.  So, the other 30% of health costs in Europe are out of private funds, not gleaned from other taxes.  The GDP figures are combined public and private expenditures for total outlay using the same methods that yield the 13-14% figure for the U.S.  >ISN'T THE PRIVATE HEALTH INSURANCE INDUSTRY JUST TOO BIG   >AND POWERFUL TO KILL?   > >Dismantling the health segment of our insurance industry would be   >"politically thorny," in the quiet words of one advocate for a   >national plan. Some 1,200 firms now sell more than $192 billion in   >health insurance. They'd put up a hard fight. Not only has the industry   >grown eightfold since Canada shut down its own health insurers, but  >our government leaves politicians more open to lobbyists than does   >Canada's parliamentary system.  Health insurance does exist in Canada and in Western Europe, its just that it doesn't cover basic care.  You can opt out in Canada and Germany, but you'll have to go uninsured as a result because there are too few other people that do so --- i.e., no market.  When private insurance realized how much money they'd make without the risks involved in basic insurance (e.g., neurosurgery) versus deluxe amenities (e.g., having to call Granada TV to replace a rental set on the fritz in someone's private hospital room), they started to pat themselves on the back for their social responsibility.  In Quebec last spring, a consortium of private insurers publicly warned against any thoughts of privatizing routine, low cost parts of that province's public health insurance plan.  gld