v140pxgt@ubvmsb.cc.buffalo.edu (Daniel B Case) writes: >gld@cunixb.cc.columbia.edu (Gary L Dare) writes... >>v140pxgt@ubvmsb.cc.buffalo.edu (Daniel B Case) writes: >>>gld@cunixb.cc.columbia.edu (Gary L Dare) writes... > >Okay, but do doctors willingly testify against each other in  >malpractice cases when they do go to court (obviously, absolutely  >essential to prove malpractice)? It used to be impossible to get >doctors here to do that (A possible advantage of the US system  >you won't hear about from the AMA).   Our doctors' monopoly is exactly the same as in the U.S., if not more powerful now that they can dictate insurance payment rates, but I don't know an answer to this one.  Anecdotally, my friends who are MD's (including my main buds from high school) talk about how hard it is to turn "state's witness" against someone else ... no direct experience there, though.  >Also, in some circumstances you may have to sue the insurance plan- >people here, after all, sue health insurance companies all the time.  >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. >It cost him and his family something like $6000 and the province,  >years later, still has only reimbursed them for $500 or so.  Well, what American private insurance plans cover travel expenses???  Since our public insurance plans are publicly accountable, one can raise a stink in the media to try and extort benefits beyond which one is entitled (hey, not Alberta's fault that he lives there) ...  If he lived in Cheyenne, WY his private insurance would've told him to go to hell for the travel expenses and that's that.  An HMO would have just kept quiet and let him go blind.  >>>Well, yeah, tell us about the National Defense Medical Centre >>>outside Ottawa. >>  >>It serves the same purpose as the Bethesda Naval Hospital ... since >>not all hospitals can provide everything, maybe they have some stuff >>that others don't?  (Ottawa's population is only a quarter million, >>if you include the surrounding counties.) > >My point was that something that should necessarily remain  >unpoliticized has become very politicized, to the detriment  >of its mission.  I don't think that this has been shown with the DMC ...  >>>The problem is, in a system where hospitals' annual budgets are >>>>approved by the government, how do you keep political considerations >>>out of medical decisions?  I bet that if you're an MP or MPP, or good >>>friends with one, you're put on any hospital's "urgent" care list no >>>matter how minor your problem. Which is OK unless you're someone who >>>gets bumped off the list for some bigshot. >>  >>People of influence will get their way in any system, American or >>European.  It's the "Golden Rule" - he who has the gold makes the >>rules. (-; > >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 ...  >Yeah, but private nonprofit foundations have to make money somehow,  >especially in the hospital business.   Yes, and the Tories in Ottawa are trying to make them do that rather than hope for a bigger grant from the feds and their province the  next time around.  Whether it's using mop a couple of weeks longer or even selling services to Americans (remember, our system is cash based and since our health care infrastructure is overbuilt except in specialties that require larger populations to generate business, why not?  The alternative is closing unused wards ... business.).  >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!!).  >>The GDP figures are combined public and private expenditures for total >>outlay, and  are compiled use the same methods by the OECD that yield  >>the 13-14% figure for the U.S. > >But don't the US figures include dentistry and optometry where the  >Canadian one (until recently, anyway) didn't?  Since we have always been evaluated in an OECD style, I don't see how ... remember, OECD counts both private and public funds, and in Canada like France and Germany, 30% of health care spending is private funds (i.e., not the basic health insurance money).  >>>So what happens if the health care systems financially collapse. >>  >>How?  They are collecting premiums ... and I'm an advocate of having >>copayments like the French do in their system ... > >Well, if you spend more than you take in, you go bankrupt. It's that >simple. If the provincial insurance systems find themselves paying >out more than they get in revenue, they won't be able to pay for >everybody's primary care. Yes, the infrastructure will be there.  >But will everybody be able to continue using it at the same rate.  Minor copayments can flush out abusers.  Remember that our "system" is only an insurance policy.  But our costs aren't rising fast enough to ensure adequate copayments/deductibles ... last year, Quebec's user-fee proposal came out with the number of "$5" as the necessary hike that could be done through a copayment rather than give the QMA a raise.  And it's not contract time yet, as far as I can tell from UPI Clarinet ...  Even the new Reform Party, a breakoff of traditionalists from the Conservatives with a mildly "libertarian" faction, holds 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). But no mention of copayments anywhere to be seen ... but cutting public spending all over the place, and bringing back the death penalty, with little haste if elected.  >I know that, for Pete's sake, I live right on the border. I know the >Canadian system isn't socialized medicine (unlike Britain's NHS).   Sorry! (-;  It's just that I even run into people from Buffalo and from Michigan who don't know ...  >The point is, that means that if the money runs low in the plan, >you're out of luck unless you can afford it yourself.  Yeah, but there'd be a lot of lead-time and a health-care crisis that would preclude it.  If provincial governments (as bad as some of them are; heck, we have the NDP cleaning up a spending mess made by the Conservatives in Saskatchewan - embarassing!) can be so irresponsible, there is still reallocation --- health insurance is so important that it's about the only thing that can inspire open rebellion and violent insurrection outside of the hockey rink.  Right now, attempts to get the system and its users to learn good habits are being treated like cod-liver oil ...  >>>Would the private insurers take up the slack? They'd be under no >>>obligation to. Of course, they could eventually make money again,  >>>but if what you say is true, they'd be loathe to do so (and out of >>>practice in handling such basic services, too). >>  >>Some of the companies providing extra insurance are subsidiaries of >>American companies, and their parents provide full insurance down >>here.  Regardless, all firms up north can easily turn on cable TV >>to see how well the American firms are doing by being involved in >>basic coverage.  The private firms are making too much money after >>having gotten rid of basic coverage.  They run around patting them- >>selves on the back for their own cooperation in providing extras  >>for those people who "deserve it". > >Yeah, but eventually it's going to create a kind of two-tiered  >effect that will be noticeable after a while, like in Britain.   Most Americans are fearful of a single-tier system ... (-;  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.  Anyways, the numbers show that costs have held steadier than those in the U.S. and barring any future Chernobyl-like crisis, sudden transients in spending are unlikely.  In fact, the health allocation is one of the most well-behaved sectors of spending up north so any talk of bankruptcy is talk-radio fodder far away from the border.  >If the provinces hit fiscal rough spots and have to cut back, the >things private insurers have to offer will seem less and less like >luxuries and the gap will be more and more noticeable.  This won't be overnight, and something like this would force Canada to have a system more like the French one ... but that's not a bad thing, and the change will be minimal (i.e., add copayments and frustrate the socialists chanting "Hey, it's *free*!").  gld