{Sorry, Harel et al, but our doctors and most hospitals are still private in Canada as well as in much of Western Europe.}  harelb@math.cornell.edu (Harel Barzilai - Grad - Brown) writes: >		 ===================================  >		 H e a l t h   C a r e   R e f o r m  >			 By Camille Colatosti  >		 Z magazine (see bottom), March 1993  >		 ===================================  >... >The single-payer model, sometimes called national health insurance,  >eliminates private insurance companies and removes health care from  >employment. The government provides free health care to all U.S.  >residents. And there are no out-of-pocket costs.   Wrong.  In better EC countries that use pure (but public) health insurance (like we use in Canada) rather than self-enclosed HMO-like socialized medicine, 30% of our costs comes from private supplementary insurance and/or copayments.  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, 30% of health costs in Europe are out of private funds and 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.  That the French had deductibles and copayments in their insurance fund is to their credit ... I am in the minority for advocating such back in Canada (to make the Canadian insurance look more like real health insurance -- which actually it is).  The new Reform Party, a breakoff of traditionalists from the Conservatives with a mildly "libertarian" faction, hold our public health insurance as an untouchable but that just a few people have to be reminded that it's not free (the average Canadian/European is more fiscally naive than their American counterparts on issues like these).  I'm one of the few people who favour copayments (forget about leftists, even our conservatives attack me for it on the Canadian newsgroups) to make it look more like real insurance, 'cos the 100% insurance payment is hidden (unlike in France) and if you didn't know it, you'd believe it actually is socialized medicine (American conservatives/libertarians and Canadian leftists are the only ones who seriously call it that).  Canadians aren't worried about the Americans, who spend 14%; we're worried about the French and Germans who spend 7% to our 9% ... so the insurance is looking at things that shouldn't be paid for out of general funds like physicals for insurance policies, sick notes, electrolysis, etc.  The reason that the Canadian health insurance hasn't spiralled out of control despite being open and universal is that unlike Americans, there is no urge to spend all of your benefits' worth, and more if you can ... we're a different culture.  >Like the play or pay model, managed competition leaves in place two  >elements of the current health care system that reformers most often  >criticize: the private, for-profit insurance industry; and the  >employer-based system of coverage. Managed competition compels  >employers to enroll their workers in large pools of health insurance  >customers. Entire industries may, for example, sponsor a pool or  >network. Insurance companies, doctors, hospitals and other health  >care providers then bid for the pool's business, competing- in  >theory- on the basis of price and quality.   "Managed Care" relies on HMO's, which are unknown in most western nations that use only public health insurance like Canada, France and Germany (I'm Canadian, and my German father-in-law-to-be says of HMO/NHS approaches, "We left that behind with East Germany!"). Sure, HMO/NHS controls costs because you have managers strangling doctors with budget strings.  In Canada, we use the public health insurance approach as in France and Germany, with all private doctors and both private and public hospitals.  It is all pure insurance without HMO's.  The divisions are different, with the Germans using a couple hundred interlinked "sickness funds" over a century old while Canada divides by their provinces (who run the insurance fund and set local fees with the doctors monopoly; federal funds cover the fees disbursed.)  With such an open-ended system, it's no surprise that Canada is #2 to the U.S. in costs; all-insurance is the most expensive way to go. The French and Germans use the same approach but have larger populations in more compact geography to improve scales of economy.  gld