re eight myths about national health insurance pt ii v pxgt 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 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 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 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 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 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 rd 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 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 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 je me souviens gary l dare gld columbia edu go winnipeg jets go gld cunixc bitnet selanne domi stanley
