v140pxgt@ubvmsb.cc.buffalo.edu (Daniel B Case) writes: >gld@cunixb.cc.columbia.edu (Gary L Dare) writes... >>  >>>You're not buying insurance so much as being coerced into one  >>>insurance plan. >>  >>No, it is optional ... as it is optional for doctors to accept it. >>There are isolated religeous communities in particular that ask for >>exemptions (and one e-mail from a Christian Scientist in Edmonton >>verified for me that it is indeed negative option).  I guess that you >>can argue that there is a right to having a particular insurance, but >>so far I've not come across that up north ... and I take pains to keep >>tabs with news from home. > >It's optional, but what if you don't want basic coverage on the  >government's terms? You said before that if you opt out, you're  >basically uninsured.  There are two things at work here ... the public insurance is very wide in what it will cover, as the amortization is also universal. No private plan can boast of a plan that fits a Gaussian curve ... and as our private sector has discovered, they're better off not offering insurance coverage that their customers are going to use. (-;  >>>And that turns the private insurers offering the frills into an >>>effective cartel-they don't really need to compete because, as you put >>>it, they're in a "win-win" situation and they're guaranteed to turn a >>>profit  >>  >>Believe me, they probably had orgasms when they figured that out.  And >>according to my sister the yuppie, they pat themselves on the back to >>the point of ungraciousness at Chamber of Commerce luncheons. > >So, in a sense, they've stopped being truly capitalists if they don't  >have to worry about competing anymore. You might say that the total  >effect is one of socialized medicine-a government providing the basics  >and a cartel providing the extras. There is no alternative to the system,  >desirable or not.  The alternative to the system is no system at all (patients opted out, doctors opted out, or both).  But that only for insurance ... and you can't force a private insurance company to sell you a plan that they will not offer.  And remember that the actual health care is delivered by private entities who collect from the public insurance voluntarily. Again, they can't force a private entity to spring to life to pay them.  Plus, there is the matter of culture and values ... I'm basically anti-tax and anti-government, by Canadian standards ... yet I can't bring myself to make the same arguments as you do, despite that I understand where you're coming from.  Up north, you're so much more likely to find someone protesting taxes going to defence than health insurance premiums to only one fund for basic coverage ...  >>>(Interesting side note-have any new insurance companies started >>>up-from scratch-since Medicare became standard in Canada? >>  >>I actually have doubts that any new ones have emerged since WW I ... >>no, scratch that ... there are a few in Western Canada, and *quite*  >>a few in Quebec as part of the post-1980 Quebec Miracle (out with the >>nationalism, in with the French capitalism).  La Groupe des Cooper- >>antes built a new tower by the Eaton('s) store at Les Terraces, and if >>you were able to catch Urban Angel on CBS's Crimetime you'd see it as >>the well-lit one with double-turrets at the top.  As for Ontario, >>which still dominates and anchors business up north ... > >I meant new companies, not new buildings.  Yes, primarily in Quebec and in Alberta.  Sorry, I musta lost you in that verbose blurb ...  >>>It's not really insurance if you don't have alternatives >>  >>Well, you have to realize that in our society that's like saying >>that "it's not really national defence" because you can't hire >>your own Rambo squad instead or even opting out as a pacifist. > >True, but I would be more comfortable with a system in which basic  >care provided by the government was optional, not mandatory.  In Canada and Germany, it's not mandatory.  However, it is negative option in that you must request the exemption.  That the private sector will not provide private basic coverage if offered the option (as in the Quebec case) tells me something about what they know ...  >>Either way, the transient situations are hard to deal with since the >>changes in the private medical care resource take place at a slower >>rate than the ability of people to fall sick esp. in the light of >>disasters (e.g., Chernobyl) or bad luck (a sudden wave of heart >>disease). A doctor needs 4-6 years of training, plus internship  >>and specialty training. > >Another problem with the US system that should be resolved. Doesn't  >Canada have something like ten times the proportion of GPs to specialists  >that the US does?  Yes, but part of the reason is that our most of our markets are too small to sustain many specialists, sometimes not even one, so you pretty well have to be a GP to get paid.  And if you do get the training, the doctors monopoly might block your getting of a licence because there is already someone in the business and who cannot fill his/her appointment book.  That we have a CMA doctors monopoly is something that the American AMA-oriented medical lobby NEVER tells you down here ...  >The problem is, in a specialty your skill often directly correlates >to your pay (a good cardiologist makes more than a merely adequate >cardiologist) more than it does in general practice. In that >circumstance, it's hard to blame people for going into specialties.  No, I respect people who do specialties (okay, all of my MD friends are (-;) but there's the question of our small market dynamics up north ... if anything, that our private doctors and hospitals sell their services to Americans to generate more business will inflate their effective population served, and thus make some specialties finally viable (i.e., there will be enough customers).  We just do not have enough sick Canadians in absolute numbers otherwise.  >I personally think an approach like Germany's would be best-where the >companies compete for batches of people. Rochester, a little east of >us, was able to get almost all of its population covered that way.  Uh ... Germany basically uses our method, with their many sickness funds.  The competition is fake if it exists at all, because they're all interlinked.  Look in Der Spiegel or Stern (my girlfriend is in our German department  and her uncle is a private practicioner in Saarbrucken) ... no ads for health insurance.  While Canada organizes by province, Germany organizes the paperwork around big corporations and regional offices.   But remember that we have provinces that have the same population as some major German corporations.  Germans have public health insurance, just that it is brokered by smaller entities (actually, brokerage of basic by private firms who'll sell extra insurance to fill out their policies, sort of a voucher system, was one of the first ideas floated in Canada, too).  Remember, the Germans don't have HMO's ... a telling sign, 'cos Rochester does and they're also a company town.  >But there was a Washington Post article recently about that that said >Canadian doctors often use myelograms instead of MRIs, which require >spinal injections and can cause seizures and headaches. Mickey Kaus, >in the New Republic, probably spoke for most Americans when he said >"Who needs that?" I think people here generally like to believe they >can easily get the most high-tech treatment even if they really can't >afford it.  I'll have to let a Canadian MD jump in to verify that claim, but I've come to learn to suspect anything in the American press about our "system".  If much or some of it were true, you'd have to take us for idiots for tolerating it.  And given that our insurance was installed during a period when there were only Liberal and Tory governments federally and provincially, and the socialists are still chafing, they would've pressed for real socialized medicine to fix things ... think about it.  After all, we are using the U.S. as a metric to make comparison ... both for keeping-up-with-the-Joneses as for confirming that we did something right.  gld