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From: [e-mail] (Gary L Dare)
Subject: Re: EIGHT MYTHS about National Health Insurance (Pt II)
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Reply-To: [e-mail] (Gary L Dare)
Organization: PhDs In The Hall
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Date: Sun, 18 Apr 1993 20:26:33 GMT
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[e-mail] (Daniel B Case) writes:
>[e-mail] (Gary L Dare) writes...
>>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
>~~~~~~~~~~~~~~~~~~
>
>And maybe that's not such a good thing. I also read somewhere that
>it is next to impossible in Canada to litigate against the health 
>system-class action suits are nearly impossible, and you can't sue
>the provincial health officials at all.

Since our doctors are private and the "system" is just an insurance
plan, litigation would not involve the insurance fund.  Our lawyers
do not work on contingency, so that if you were to sue for malpractice
then you'd better be sure of winning to cover your fees ... likewise,
if you were a doctor and subject of a suit, it's time to sweat.

>>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.
>
>Oh no. Don't let the AMA know about this. They have enough power as it 
>is. Ask most Americans whether they'd like the doctors' lobby to get 
>more powerful.

A few weeks ago, the president of the Canadian MA wrote a letter to
the NYT to decry a lobbyist's advert repeating the same old trash.
This is significant because the AMA and the CMA are interlinked
organizations and he would not have done it without the approval 
of his AMA cronies.

>Well, yeah, tell us about the National Defense Medical Centre outside
>Ottawa.  Theoretically it's limited to service personnel, but some
>studies I've heard about have suggested that about half the patients
>there are civilians who not only have connections but aren't "urgent"
>at all.

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.)

>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. (-;

As for annual budgets, those are actually annual grants for facilities
(e.g., mops, pans, etc.) given to hospitals of which most are private
nonprofit foundations (btw, I have no problem with having aggressive
for-profit hospitals like the French, who use our approach ... but in
the Paris region they have almost as many people as Canada does so
their market is much more diverse).  The rest has to be made up for
by billings from patients who use their services.

>>>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.  
>
>Hmm. How much difference would it make in the figure of percentage 
>of GNP spent on health care if dentistry and optometry were included 
>in the accounting?   Maybe Canada spends proportionately just as much 
>on health care as we do.

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.

>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 in order to make it look
more like the real insurance that it is.  The private doctors and 
hospitals will still be there after the insurance (hypothically)
disappears, as they were there before it appeared.

>Bob Rae, the second least popular man in Ontario, warned Ontarians a
>few years ago that if they didn't stop cross-border shopping in such
>huge numbers, "the services they expect from the province just won't
>be there in a few years"

For one thing, I think that Bob Rae is an idiot ...

>He didn't say so, but I knew he meant the OHIP.

Most of OHIP comes from separate premiums on your paycheck if you are
a player ...  he wants to spend our money on other things than the
health insurance.  Our high taxes are high for other spending but
health insurance, which is separate and optional, and it is being 
spent in a nonpartisan manner by every party. )-;

OHIP is just a health insurance plan; it does not provide any kind
of health care, that is up to you and your private doctors.

>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".

>>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.
>
>Again, I doubt Americans would like giving the insurance companies that
>much power. I half wonder if the Canadian health insurers didn't go 
>along with the provinces and the federal government years ago because
>they knew that there was a good chance of the public system going bust
>in the long run, and then afterwards they could clean up (Okay, this 
>sort of contradicts what I said higher up. But it's another possibility).
>They'd have an added bonus when arguing against government
>involvement in their industry-as they could then point to its failure
>instead of just citing theoretical principles.

I agree ... they were in a win-win situation.  But right now, it seems
that they have won bigger, when you look at how full their coffers
are.  Friends from my sisters' MBA class were still being flown out
for job interviews individually with insurance firms in London, ON,
(Canada's insurance capitol a la Hartford) along with generous expense
privileges this year despite the ongoing post-recession blues.

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare
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