v140pxgt@ubvmsb.cc.buffalo.edu (Daniel B Case) writes: >gld@cunixb.cc.columbia.edu (Gary L Dare) writes... >>  >>>I heard about a guy in Alberta who came down with some rare eye  >>>disease that he had to take repeated trips to Seattle to get treated. >>  >>Well, what American private insurance plans cover travel expenses??? > >Well, it wasn't just the travel expenses. It was the whole treatment.  When you buy insurance where you live, it is based on the local rates. Tourists coming from, say, Utah will find that there is a difference in what their insurance will cover FOB Provo and what they get stuck with at Lenox Hill or Mount Sinai if they fall ill in the Big Apple.  >>>But to what extent does it affect the system? And why is an urgent  >>>care list necessary in the first place? It's worth thinking about. >>  >>It's regular practice in a hospital to figure out who needs to get >>at what facilities.  Don't Americans have to arrange in advance for >>operations too?  I think that there are two standards being applied >>here, and that Canada can't give Beverly Hills-style treatment to >>everybody.  It's not a big brother list ... it's more like calling >>around town for a table for dinner ... > >But Americans need far less advance time to book operations.  It would depend on where you live, downtown Toronto or Mile 101, British Columbia (just like Cheyenne, WY vs. Boston, MA).  Again, geography rears its ugly head.  Since our health care providers are private, they depend on an adequate market size in order to sustain enough business.  Since our health care professionals have equivalent take-home pay to  their American cousins, it's not that they're being paid too little to provide services.  >>>whether Canadians would be thrilled at the prospect of their own  >>>health services catering toward Americans, who would be willing  >>>to pay more than they do, is another issue entirely), it must be  >>>noted that they said they were doing it partly because their grants  >>>from the province were getting smaller If those grants are so  >>>insubstantial, why the need to attract foreigners to make up the  >>>difference? >>  >>You answered the question yourself ... "private nonprofit foundations >>have to make money somehow", and I think that it's about time that >>they acted like the private hospitals that they are.  Personally, >>I'm fed up with Canadian socialists trying to tell everyone that >>their health care is free when we are actually buying insurance >>(that's one at you, Bob Rae!!). > >True, but I was thinking...Does/can anybody compete with the provinces >to offer basic health coverage? I remember reading that that sort of  >private health insurance is actually illegal in Canada.   I have only hear Americans say that it's illegal ... but I could be wrong, just have never heard it from a Canadian source.  our private insurance has recently balked in Quebec when the Liberals proposed privatizing some aspects of routine care ... also, our insurance was put in place when no NDP (Labour) governments were in power in any province to derail the effort 'cos they wanted real socialized medicine.  >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.  >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.  >(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 ...  Canada is a very old-money kind of place, and the 1989 Free Trade Agreement saw a lot of odd alliances: labour unions and establishment old money who wanted to preserve their traditional monopolies on one side, and entrepreneurs and internationally oriented businesses and professionals on the other.  The final Trudeau administration and the first Mulroney government had a high percentage of nouveaux riches who knew what it was like to make your own money, and that motivated the McDonald Commission under Trudeau which set up Brian's initiative (Macaroni was against free trade 'til he did a head count of his caucus after the 1984 election).  >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. (BTW, there are always pacifists in the news arguing about their portion of taxes, but never people arguing over health insurance alternatives ... and we're talking about a press that is hostile to whomever is in government, regardless of party; one of their few redeeming characteristics, it seems (-;).  >Also, in the April 14 Globe and Mail, there was a letter from the >director of trauma services at St. Michael's Hospital in Toronto >responding to an article on a study comparing heart surgery in >California and Canada in which some Canadian doctor worried that >American analysts would seize on the results as proof that Canada >rationed vital services. The doctor (I can't recall his name) said >that Canada *is* rationing vital services "as any physician can >plainly see". He said that a system in which people are refused >treatment because they can't afford it is no different from a system >in which people are refused treatment because the government can't >afford it as a result of deliberate underfunding of the health >insurance plan. In fairness, he did say that both the US and  >Canadian systems are in the same situation.  The only way to hit at the Canadian system is transient periods of high demand, which is more a function of the doctors monopoly's tight fist on the licencing.  An obvious difference is that in such a transient period, the rationing is of the nature of a mob battling over Cabbage Patch Dolls^TM as we've seen recently as opposed by rationing by ability to pay ... but the former is a *transient* situation and if a large body of insured patients were to deluge the California health infrastructure, the same would result --- rationing among the insured population.  With smaller markets, there is much less flexibility when dealing with our insured population than California (which by the way, has 1/3rd more people than Canada in a MUCH more dense area).  So he is correct in that the resources are fixed (for a particular time window, or as a function of the doctors monopoly licencing according to the market steady state) in either case.  As for being "refused treatment" the government of the day would be shredded to tatters if something like that were to happen; Canadians can be geographically bad, too, not realizing that their health care is private while only their insurance isn't ... too many people have bought into socialist trype that we have socialized medicine.  >I know, I know, the monopoly power of Canadian doctors often leads >them to overstate the problems with the system in order to get more >money from the government (another case of businessmen, once >scratched, becoming socialists).    Right, as I've pointed out above ...  >But hasn't that just shifted the locus of the problem from one place >to the other? It hasn't really solved it.  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.  >People too often tend to put prescription cold medicine on their  >insurance when they really don't need to.  That's why I've argued for deductible and copayments rather than education, which is what most Canadian fiscal conservatives are arguing for (the leftists?  "Ah, just let 'em spend!" --- yeah, right!).  Also, note that only a few provinces cover prescriptions under some high dollar threshold ... in most, it's your private insurance that covers it just like in the U.S.  Still, it all adds up in the OECD measures.  >In fact, Buffalo may be the only place in the US where people >get Don Cherry jokes (:-).  We get the Sabres' feed as a replacement game on ESPN tonight (the Devils' local metro NY coverage supplants the main ESPN game).  >(The NDP cleaning up a Tory spending mess? And just when I thought  >I understood Canadian politics).  Yeah, it's a sad story and Saskatchewan Tory leader Grant Devine has been on a nonstop PR campaign to save his sorry butt.  The Sask NDP have taken a neo-conservative turn like Hawke, Gonzalez and Mitterand did.  >has anybody considered following Singapore's example and going to a >system where the company and the state buys basic and catastrophic >coverage for everybody, and then you also have an IRA sort of thing >to which you and your employer can can contribute for medical >expenses only? It would tend to discourage you from overusing it.  The medical IRA would have limited use, as you'd need a lower catastrophic threshold else there'd still be a drain on the public purse if someone exhausts their IRA.  Also, Singapore has a much more autocratic mentality which has seaped down into its masses (if Singaporeans that I've met are any indication ... I don't mean any disprespect here) where they'd let you just die.  >One of the good things about being the last country to create a >national health care system, should we decide to, is that we have >everybody else's mistakes to learn from.  That's true ... the question is how much leeway is there between the U.S. approach and the second-most capitalist approaches of Canada, France and Germany.  >>Seriously, there are few areas that have sufficient population for a >>two/more-tiered system like what the French have ... a health policy >>prof, D.G. Shea, has cited studies in the NEJM that indicate having >>a population of 500,000 is necessary for adequate competition ... >>and in Canada, there are only four cities west of the Great Lakes >>with that population or larger. > >But there are many cities in the US with that kind of population.   Yes, many ... and pretty close to a lot of smaller towns or not too far from a bigger town.  Just take a look at a detailed atlas ... or better, take a flight from Pittsburgh or Rochester to Toronto. My first time across Lake Ontario to NYC, I was amazed by the increase in density ... and the Toronto region is the densest  in all of Canada.  >There was one about a group of doctors in Calgary who have opened >Canada's first US-style MRI clinic, as an alternative to the >provincially owned one.  It's about time!  I've ragged on my own doctor friends as to why they don't invest in their own private practices ... in the end, it's their money.  But they choose to spend it on America's Cup pipedreams, and that's none of my business.  As for "provincially owned" ... for sure it's against the law in Canada for governments to be directly involved in the provision of health care except in the military or native reser- vations.  What that term actually means is that the facility gets by on public grants to meet shortfall from *lack of use* ... no kidding. Medical practice itself is much more conservative up north.  My own best friend did two clerkships at the Mayo Clinic in Rochester, MN, and is no stranger to high tech medicine ... but his boat comes first.  >There were some people expressing concern that it was the first wedge of >two-tiered health care and that it might violate the Canada Health Act.  No, it's probably socialist whiners who are offended that we have private practices ... and always have.  They can all take cash anyways ... so why not have a particular facility?  The Canadian big government mentality often imagines government where it does not even exist ...  Since the French and Germans have become more entrepreneurial and less laidback without sacrificing their culture and values, then Canadians can do the same.  As I've pointed out above, the law states that it is illegal for the *government* to provide any health services except for the military and natives.  Look, nobody stopped the clinic when they planned on the MRI ... nobody stopped them when they bought it.  Nobody seems to be stopping them from using it, either.  Much ado about nothing.  Thank goodness that hockey playoffs have started ...  >While it seemed currently unjustified, there was one anecdote told by >the head of the partnership to demonstrate the MRI. He showed an >image of an injured knee, which happened to belong to the manager of >the bank who approved the loan. He said that without it, the guy >might have had to wait a month or more at the provincial MRI, then >another length of time for treatment, after which the muscles would >have atrophied and rehabilitation would have been that much harder  >If that isn't the first whiff of two tiers, I don't know what is.  I'm certain there is exaggeration somewhere, because the GAO study of Canada cited often on USENET did not find access to MRI to be a problem.  I'll bet the doctor is relying on people having listened  to American trash talk on cable so that he can puff his chest a bit. There are already a few treatment regimens for knee injuries without relying on MRI ... unfortunately, I've had a few. )-;  And I'm not a banker. (-;  gld