>g…@prairienet.org (Gary L. Dare) writes:

>>But a public HMO is not a single-payer insurance, whether as PPO or voucher.

>Why is this important?  Firstly, this is independent of the point being
>discussed.  Secondly, the discussion is based on private-supported health
>care vs. public-supported care.  With PPOs and vouchers, the government
>just gets involved in a different way.

The title of this subject deals with Proposition 186 in California,
to implement what some Americans believe to be a single-payer.

>There is the constant treat of imposition of user fees …

Correct, Marc-Yvan Cote of the Quebec Liberals tried for three years
in a row to implement $5-20 token deductibles and was rebuffed each
time by the Mulroney Conservatives (who were their allies; sorry to
the American audience for our getting into Canadian politics but it
may be enlightening to a few of you) … and the reasonable practical
idea was to make some people run to the corner Pharmaprix (what they
call Shoppers Drug Mart there) for a box of bandages or a bottle of
aspirin rather than make a doctors appointment for a "free" one.

>and in BC, the government is trying to reinvent their system. A former
>BC Health Minster frequently says (paraphrasing), "It is interesting
>that while the Americans are moving toward a Canadian-style health
>care system, the Canadian system is going south."

And this is coming from a member of the New Democratic Party, the left
wingers who run around claiming to have invented our "system"?  Also,
I’d hardly call the B.C. system typical with the mass unionization of
hospitals (which themselves remain standalone and independent in the
face of a monolith) under the previous NDP regime of Dave Barrett.
Just because the left finally got its claws in and are trying to
make the Ontario and B.C. insurance more than that, and restrictive,
should not be taken as an indictment when at the same time, the very
same principle is allowing Alberta to move to a more voucher-like
stance having "private clinics" whose services are reimbursable
and can extra-bill — but made possible because they renounce
all other perquisites involved in accepting the public insurance
such as having their malpractice covered, etc.  The very same
federal guidelines, yes …

>>>Their system is extremely over-burdened, even with a massive increase

>>A parallel private fee-for-service system still exists outside for the
>>upper-middle and upper classes, so they remain in a two-tier mode as …

>So you are advocating that American abandon one system that doesn’t work
>for another one that doesn’t work?

That blurb was put in for education because a couple of other writers
have already mentioned here and in Soc.culture.canada that most people
in the U.S. are under the belief that i) everyone else has a public
HMO like Britain and ii) whatever they use, it is monolithic.  That
is not the case at all.  As a non-HMO, the Canadian single payer or
the continental European voucher (benefits or cash) are cash-based
systems oriented on value of service.

>This is acknowledged every day by promenient Canadians, who in turn
>would not give up their inferior health care to ensure that 100% of
>their population never goes without.

Since the system is public insurance with private medical services,
you can’t control the doctors and the hospitals.  Since it’s the
same medical infrastructure throughout North America, how is it
that the Canadian care is inferior … for markets of their size?
[I'm originally from Winnipeg, by the way ... lived in quite a few
places since then ...]

On the other hand, you can log into Victoria Freenet and read the
local B.C. boards … Karen Gordon is very loud about crushing the
private sector and believes it to be public enemy #1.  Even those
who want to socialized the actual health care (not just insurance)
acknowledge that the care is private sector.  And if not, then why
do they have the ability to opt out?  [In other words, accept the
public insurance payment voluntarily, and with perqs.]

>The question that must be answered is this: "Is guaranteed health
>care a right of a resident of the United States, just as primary school
>education is considered right?"

Despite protestations of the left that health care is a right, it is
a nonpartisan stand (including the Reform Party) that access to health
care through the provision of insurance benefits is good policy.

gld
—
~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare                                   g…@prairienet.org
  "Support NAFTA – Eat Mexican!"     uk…@freenet.victoria.bc.ca
   (El Teddy’s ad, NYC)               (formerly g…@columbia.edu)

- Hide quoted text — Show quoted text -

In article <CvIIzt….@optilink.com> cra…@optilink.dsccc.com (Clayton Cramer) writes:
>In article <CvGxE4….@ecsvax.uncecs.edu>, conklin <geo…@nccu.edu> wrote:
>>In article <3438ut$…@engnews2.Eng.Sun.COM> a…@mises.Eng.Sun.COM (Al Date) writes:
>>>Nonsense.  For example, the vaunted statistics on infant mortality
>>>are totally skewed by international discrepancies in reporting.
>>>In Japan, if a baby dies, it is not considered infant mortality
>>>unless it is a crib death.  In the USA, ANY post-partum death
>>>or full-term still-birth is counted.

>>   You don’t know what you are talking about.  Infant mortality
>>only if the baby died in a crib?   Dream on.  Lies repeated on
>>internet does not make them true.  Tell me, if the baby died
>>while sleeping in a chair is that not infant mortality in
>>Japan?

>Odd.  But I was at the library over the weekend, looking up international
>crime statistics.  One of the books I looked through* mentioned infant
>mortality rates, and made the point that the U.S. counts infant mortality
>in a much stricter way than nearly every other nation, inflating our
>counts.  Even after adjusting for similar reporting schemes, they did
>agree that we have a high infant mortality rate relative to other
>Western nations.

>The white population of the U.S. has an infant morality rate that is
>pretty typical of other Western industrialized nations.  The poor
>showing the U.S. makes is because of the black and Hispanic population.
>At least some of this is because of poverty, but some of it is because
>of the high rates of drug abuse (including alcohol and tobacco) in the
>black American population.

>*I didn’t write down any of the data, because I wasn’t looking for
>infant mortality stats.

>–
>Clayton E. Cramer {uunet,pyramid}!optilink!cramer  My opinions, all mine!

   Infant mortality statistics seems to have moved from
the abstract scholarly world to the Reader’s Digest (really).

   There are many studies of why our infant mortality rate is high.
Europe knows how to count dead babies too.  Even taking into account
any possible differences in reporting, our rate is still high.
   The U.S. white population has a rate similar to but not quite
as low as most of Europe.  African Americans have a higher rate, but
hispanic populations have a rate similar to whites.  As I
recall my NSF seminars on demography, the native American population,
which has socialized medicine by the way, has an infant mortality
rate similar to whites up until discharge from the hospital.  After
that it jumps up again, reflecting the results of poverty.
    Being young (i.e. the mother being under 18)
probably does not cause a rise in infant
mortality by itself.  Combined with lack of access to health
care, fear of going at all, an lack of coverage for pregnant
"children" in a parent’s policy, there alone is enough reason
to expect a rise.
    The best estimates are that the differences between the US and
Europe on infant mortality as a whole is half social and half
access to the medical system.  The correlates of poverty
remain even in the British system, by the way.
    It takes a great deal of effort on the part of any human
population to keep infant mortality rates low.  Keeping young
children healthy takes work too.  High tech is not always
the answer either.
    And then is the issue of nutrition……

–
# George Conklin; Geo…@NCCU.EDU  |  Edison did not have a fancy      #
# N. C. Central University         |  internet signature.              #
# Durham, North Carolina USA       |  That means that I cannot either  #
# 919 560-6222 (work)              |  since he didn’t tell me how.     #

>mj…@hcsd.hac.com (Mark Jebens) says:
>>kni…@cup.hp.com (Paul Knight) writes:
>>>The notion that the potential demand for health care is infinite is
>>>absolutely wrong.

>>As it turns out, this was the major flaw in thinking when National Health
>>was set up in Britian.  It was assumed that as people became healthier,
>>they would need less medical care.  Instead, people went to get
>>treatment for minor illnesses that they would have braved out before.

>Unlike the American HMO’s that are based on NHS methodology, there are
>no deductibles in the British public HMO.  Not even Thatcher could put
>any in place.  They just can’t bring themselves to do it …

The reason the British can’t do it is because they believe that health
care is a right.  Making people pay even small amount may cause some people
not to be able to afford the co-payments, thus denying them their rights.

>But a public HMO is not a single-payer insurance, whether as PPO or voucher.

Why is this important?  Firstly, this is independent of the point being
discussed.  Secondly, the discussion is based on private-supported health
care vs. public-supported care.  With PPOs and vouchers, the government
just gets involved in a different way.  

Here in Canada, for instance, even though the PPOs are run by a government
corporation, there is no way anyone could possibly claim that they are free
of government influence.  There is the constant treat of imposition of user
fees and in BC, the government is trying to reinvent their system. A former
BC Health Minster frequently says (paraphrasing), "It is interesting that
while the Americans are moving toward a Canadian-style health care system,
the Canadian system is going south."

>>Their system is extremely over-burdened, even with a massive increase
>>in funding over the last decade.  The quality of care is disgraceful,
>>yet the average person cherishes it because it was better than the care
>>they received in the pre-war years.

>A parallel private fee-for-service system still exists outside for the
>upper-middle and upper classes, so they remain in a two-tier mode as
>they always have.  But it’s not different from Americans triaged by
>their wonder HMO after dumpings hundreds and thousands for subscribing,
>and having to get fee-for-service outside on their own nickel because
>they need care and that’s too late for buying insurance.

So you are advocating that American abandon one system that doesn’t work
for another one that doesn’t work?  The 90% of American that do have
health insurance or who can afford doctors on their own have the best
health-care in the world.  This is acknowledged every day by promenient
Canadians, who in turn would not give up their inferior health care to ensure
that 100% of their population never goes without.

The question that must be answered is this: "Is guaranteed health
care a right of a resident of the United States, just as primary school
education is considered right?"

Mark Jebens
mj…@hcsd.hac.com

>I have seen data that show that there are more MD’s in the US.

Small wonder … the U.S. comprises roughly 1 out of 3 people in
the western G7 economies.

>One of the problems is the relatively low number in the primary
>care areas.

You have to realize that in Canada, we have small absolute numbers
in populations … low densities, small markets.

>Classical economics just doesn’t work to explain medicine.  Where
>there the highest number of specialists, the costs are the greatest.

Sure it does.  A brain surgeon in Moose Jaw, Saskatchewan is lucky
to work once a year … the whole province has about 700,000 people
while next door in Alberta, the cities of Calgary and Edmonton each
have around 750,000 … the specialist market sees higher absolute
numbers in Alberta for the same actuarially predicted demand.

gld
—
~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare                                   g…@prairienet.org
  "Support NAFTA – Eat Mexican!"     uk…@freenet.victoria.bc.ca
   (El Teddy’s ad, NYC)               (formerly g…@columbia.edu)

>kni…@cup.hp.com (Paul Knight) writes:
>>The notion that the potential demand for health care is infinite is
>>absolutely wrong.

>As it turns out, this was the major flaw in thinking when National Health
>was set up in Britian.  It was assumed that as people became healthier,
>they would need less medical care.  Instead, people went to get
>treatment for minor illnesses that they would have braved out before.

Unlike the American HMO’s that are based on NHS methodology, there are
no deductibles in the British public HMO.  Not even Thatcher could put
any in place.  They just can’t bring themselves to do it …

But a public HMO is not a single-payer insurance, whether as PPO or voucher.

>Their system is extremely over-burdened, even with a massive increase
>in funding over the last decade.  The quality of care is disgraceful,
>yet the average person cerishes it because it was better than the care
>they received in the pre-war years.

A parallel private fee-for-service system still exists outside for the
upper-middle and upper classes, so they remain in a two-tier mode as
they always have.  But it’s not different from Americans triaged by
their wonder HMO after dumpings hundreds and thousands for subscribing,
and having to get fee-for-service outside on their own nickel because
they need care and that’s too late for buying insurance.

gld
—
~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare                                   g…@prairienet.org
  "Support NAFTA – Eat Mexican!"     uk…@freenet.victoria.bc.ca
   (El Teddy’s ad, NYC)               (formerly g…@columbia.edu)

>   You don’t know what you are talking about.  Infant mortality
>only if the baby died in a crib?   Dream on.  Lies repeated on
>internet does not make them true.  Tell me, if the baby died
>while sleeping in a chair is that not infant mortality in
>Japan?

Odd.  But I was at the library over the weekend, looking up international
crime statistics.  One of the books I looked through* mentioned infant
mortality rates, and made the point that the U.S. counts infant mortality
in a much stricter way than nearly every other nation, inflating our
counts.  Even after adjusting for similar reporting schemes, they did
agree that we have a high infant mortality rate relative to other
Western nations.

The white population of the U.S. has an infant morality rate that is
pretty typical of other Western industrialized nations.  The poor
showing the U.S. makes is because of the black and Hispanic population.
At least some of this is because of poverty, but some of it is because
of the high rates of drug abuse (including alcohol and tobacco) in the
black American population.

*I didn’t write down any of the data, because I wasn’t looking for
infant mortality stats.

># George Conklin; Geo…@NCCU.EDU  |  Edison did not have a fancy      #
># N. C. Central University         |  internet signature.              #
># Durham, North Carolina USA       |  That means that I cannot either  #
># 919 560-6222 (work)              |  since he didn’t tell me how.     #

–
Clayton E. Cramer {uunet,pyramid}!optilink!cramer  My opinions, all mine!
Prohibiting law-abiding people from owning guns because they might be stolen
by criminals is like prohibiting women from going out at night because they
might be raped.

>g…@prairienet.org (Gary L. Dare) writes:

>>Research is funded by NIH-type structures, public subsidies and
>>private charity elsewhere – not health insurance – just like in
>>the U.S.

>   Does the NIH provide the return-on-investment for pharmaceutical
>and medical device companies?  Do these companies, which account for
>the bulk of medical discoveries, count on public subsidies and private
>charities for sales?  It’s the anticipation of income from health care
>payments from, yes, insurance companies that drives these innovations.

I was referring to medical procedures like skin cancer of the chest
with interdisciplinary thoracic surgury, etc.  But thanks for the
topic of pharmaceuticals because I’d like to point out that the
industry is quite healthy all over including Canada and Europe …
my father-in-law-to-be is a research exec for an international firm
and it’s a profitable market all around; he’s in Sicily right now,
where the firm got a big subsidy from Italy to set up shop with
jobs that route people away from the Mafia.  In other areas, drug
research has returned to Canada in the past 3 years with patents
being restored to 12 years from 5 years, and talk of going all
the way back to 17.  Or that’s what people at Abbott Labs in
Montreal are telling us on Soc.culture.canada anyways …

gld
—
~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare                                   g…@prairienet.org
  "Support NAFTA – Eat Mexican!"     uk…@freenet.victoria.bc.ca
   (El Teddy’s ad, NYC)               (formerly g…@columbia.edu)

>zt…@eden.com (Peter Jackson) says:
>>Bear in mind that foreign state-run schemes have benefitted incalculably,
>>at no cost to themselves (see my signature), by innovation produced by our
>>*relatively* free market, all subsidized by the American health care
>>consumer. Imagine if you can how attractive these systems would be
>>otherwise.  

>Research is funded by NIH-type structures, public subsidies and
>private charity elsewhere – not health insurance – just like in
>the U.S.

   Does the NIH provide the return-on-investment for pharmaceutical
and medical device companies?  Do these companies, which account for
the bulk of medical discoveries, count on public subsidies and private
charities for sales?  It’s the anticipation of income from health care
payments from, yes, insurance companies that drives these innovations.

–
dak

>a…@mises.Eng.Sun.COM (Al Date) writes:
>> We know that single payer means politicized rationing of
>> medical services.  We know that any risks you want to take
>> with your own body will become the subject of criminal law.

>    The only rationing comes from insufficient
>    funding.  If Canada would match our 14% of GDP
>    I am sure there would be no rationing there.

It looks like overt "rationing", but there is not HMO public
or public on Canadian soil (outside of native reserves and
military bases).  People in the U.S. are quite unaware that
Canada’s population is small and unevenly distributed with
low densities … our population center of Southern Ontario
is on the order of Minnesota-Wisconsin … Quebec province
has the same population as metro Chicago (8 million) while
there are only four cities over 500,000 west of the Great
Lakes.  The markets sizes and economies of scale can’t be
matched, and where they can be is why Canada’s federal
government (regardless of who is in power) is gung-ho
for free trade whether the 1989 FTA, NAFTA or GATT.

>    But they as a society are content with
>    spending only 9% of GDP on health care.

That’s all we’re able to spend in the above scenario.
It is PPO fee-for-service in a random environment.

>    Germany spends on 7% of GDP.

Germany has a large, dense population and gains incredible
efficiencies from economy-of-scale.  Their system is really
simple anyways, just a regionally-indexed cash subsidy for
people to get private coverage and purchase fee-for-service
health care.  That and a common form (which is an issue that
is surprisingly missing from all the ideas whizzing past me).

BTW, my prediction is that the incremental Republican plan of
John Chaffeeis the most likely to be passed (despite starting
as a dark horse) but private insurance will demand subsidies
like in Germany, Switzerland and Holland to underwrite taking
of all comers and waiving preexisting conditions.

gld
—
~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare                                   g…@prairienet.org
  "Support NAFTA – Eat Mexican!"     uk…@freenet.victoria.bc.ca
   (El Teddy’s ad, NYC)               (formerly g…@columbia.edu)

|       In return for a 2.5% income tax Californians will
|       get all their medical bills paid, with no deductibles
|       and no copayments.  All their prescription drugs will
|       be covered, long term care, mental health, and emergency
|       dental.  Every Californian will be covered.  No
|       exceptions and no preconditions.

For only a 2.5% income tax. No way.
—
Mob rule isn’t any prettier merely because the mob calls itself a government
It ain’t charity if you are using someone else’s money.
Wilson’s theory of relativity: If you go back far enough, we’re all related.
Mark.O.Wil…@AtlantaGA.NCR.com