Tuesday, October 07, 2008

Canadian Health Care

I haven't had a post about socialized medicine in a long time, so I'm feeling overdue here.

How's that vaunted Canadian health care system doing? Not so good--although I'd say that a market solution seems to be forming.

Queue-jumpers who can afford to pay at private clinics do so, and that means people in the public system wait longer, she added. In Ontario and Manitoba, Mehra said, they found local hospitals have reduced MRI hours because technologists have gone to for-profit clinics.

Mehra also said a little ominous:

"The contention that for-profit health care can exist along with a public system is not true," said Natalie Mehra, the report's author and director of the coalition. "It is a take-away from the public health-care system."

So you take what the government gives you, and nothing more. That doesn't sound like a free people to me.


mazenko said...

Once again, it seems like quite a few Americans like to criticize health care systems with which they have no experience. Granted, Canada is not the best system to look to, and it's the one that American critics always spotlight. However, much of the criticism is anecdotal, and there are as many shocking anecdotes about the American system. I'm sure we could go story for story for days if not weeks.

However, that's not the only answer. I lived under a national insurance system when I lived in Taiwan worked, and it worked quite nicely. It wasn't government health care, like Canada and Britain, but national health insurance. I had a health card that I showed it to my doctor in exchange for medical services, just like I use my insurance card now. However, the difference is that the money I paid in taxes in Taiwan (a whopping six percent) was refunded to me at the end of the year, whereas Blue Cross and Cigna kept whatever was left from my $12000 in yearly premiums as profit. They provided no health care for me, but their executives sure eat well.

Granted, you could criticize the quality of the health care in a place like Taiwan, though I would probably recommend you don’t unless you have lived there. My family received care every bit as effective and efficient as that we receive in the states for a fraction of the cost. In Taiwan, as well as Switzerland, France, and Germany, there is a blend of public and private in which providers bid to service the large pool of customers represented by the government. It’s exactly what currently works so well for our congressmen and 9 million federal employees in FEHBP. It just cuts out the profit of the middleman who is making money on our fear of getting cancer and the bills wiping out our family’s savings. Thus, government oversight - not control - isn’t as bad as you think it is.

Darren said...

If the same Congress that has oversight over banking and securities would have oversight over my health care--no thanks.

In *this* country, I can't name too many entitlement programs that aren't bursting at the seams already to stay solvent. I can't imagine adding another one.

Darren said...

Actually, the guy who created the Canadian health care system doesn't like it anymore:

allen (in Michigan) said...

Mazenko, if you're going to dismiss criticism of socialized medicine as anecdotal you ought to provide support that's not anecdotal.

There are several criticisms of socialized medicine that are inherent to the concept and don't depend either anecdotes or statistics.

Socialized medicine, being a political institution, decision-making carries an important, and over time, increasing component of political consideration. The history of socialized medicine strongly suggests that as political considerations take a higher profile medical care suffers.

Since there's inevitable, and overt, rationing in all socialized medicine systems there's the strong incentive to cheat. If you've got political influence you, and people you care very much about, don't have to wait the months to see a specialist. Not only is that incentive corrosive of democratic principles it's also a zero-sum transaction: those with little political influence get less medical care *because* people with more political influence get more medical care.

The political component of socialized medicine inevitably leads to a two-tiered system; overt in Cuba and the old Soviet Union, less obvious in more democratic countries.

I've gone on longer then I intended but socialized medicine gets my blood boiling so I'll finish with the relatively old news that the Quebec Supreme Court decided, shockingly, that waiting for medical care until you die doesn't fulfill the promise of access to medical care written into the law creating the Canadian socialized medicine system.

DADvocate said...

My personal doctor and his wife, also an M.D., both immigrated to Maysville, KY from Canada. They're not just going to for-profit clinics, they're going to for-profit countries.

Without our free enterprise system working in the health care industry, we wouldn't be getting all the doctors that come here from other countries. I know several just in the little burg of Maysville.

Ellen K said...

While such as system as exists in Switzerland or Taiwan-both smaller and largely homogeneous nations works for them, with the demanding nature of Americans, I would expect any program to be more frills oriented than bare bones. At some point cost will become an issue, and then we would get to the point of deciding which people would deserve service and which would not. At that point, do we deny grandpa a costly operation because he's old and won't live much longer anyway? Or do we deny services for the severely disabled? Or do we counsel pregnant women to abort babies that may have something perceived as a disability such as deafness? It's the slippery slope conundrum, and it is here waiting.

mazenko said...


While my response was anecdotal, I simply pointed out that I actually have experience in a system of national health insurance - NOTE: there is a key difference in that and socialized medicine. On the other hand, your response is purely theoretical, but if you want to provide some examples of medical care now suffering in Taiwan, Switzerland, or Germany, go ahead. Of course, I can provide as many statistics of problems with the American system. You probably have, and can afford, nice health care in this country. Many can't.

The issue, of course, for some is the presence of basic medical care for all (not emergency rooms) Other countries provide that efficiently and effectively. Once you get into more complex procedures like hip replacements and cancer treatments, it becomes more difficult. That's true in all systems. Health care is rationed and restricted in the United States as well. People with pre-existing conditions can't get coverage and can't afford treatment. People who max out cancer or chronic illness benefits go into bankruptcy and are also denied care. It's no different than the nationalized systems you oppose, though I doubt you've lived under.

Dadvocate provides an interesting anecdote as well. Though, I know of no statistics about people emigrating for health care only.

Ellen argues that the system won't work here, yet there's no reason to think that extending FEHBP to all Americans wouldn't work. Currently, the program covers 9 million federal employees and it is blend of public and private as users get to choose the plan they want, and providers bid for customers. Since we know larger pools lower costs, it stands to reason that a pool of 300 million would be even better than a pool of 9 million. If I paid my 12000 in premiums to a single fund that would then refund that which I didn't use, I might be inclined to limit my use of health care - hence a free market solution to keep consumption and cost down. That way, my medical dollars don't just create profit for an insurance company that provides no health care, but would actually pay for the health care system. How is that a bad idea?

allen (in Michigan) said...

Indeed, one of my objections is purely theoretical but you've chosen to simply ignore it.

It's an understandable response given that those who enjoy FEHBP are exactly the people I'm referencing with my description of the inherently two-tiered nature of socialized medicine. You get better medical care because other people get poorer medical care taxation being a zero-sum game.

> Since we know larger pools lower costs, it stands to reason that a pool of 300 million would be even better than a pool of 9 million.

Do we know that? So a high school with 5,000 kids in it will have lower costs then a high school with 500 kids?

Economies of scale aren't automatic as the Soviets found out and economies of scale don't preclude the necessity for the discipline provided by the free market. Also, as the Soviets found out.

You're so-called free market excludes one important decision any market-based transaction requires and that's the option of not participating. Mandatory participation, like mandatory attendance doesn't encourage the sort of cut-throat competition made the computer you used to post your message affordable to people of average means.

Mandatory anything means those who are the beneficiary of the mandate don't have to concern themselves with making their offerings attractive to people who are unpersuaded of the value of the product rethink their assumption. When you've got 'em by the balls as Lyndon Johnson said, their hearts and minds, and wallets, will follow.

mazenko said...


I completely agree on the "mandatory" issue, which is why I like the Swiss and German systems, where everyone is guaranteed basic care, but anyone and everyone can purchase private insurance on their own. Those with more wealth can purchase as much private care and insurance as they'd like.

Speaking anecdotally, this appeals to me as a consumer and a taxpayer. Currently, I have only catastrophic high-deductible insurance for my wife and kids because the employee sponsored plan would cost me $1700/month out of pocket. Trust me - having an HSA and seeking insurance on an individual basis is not easy, nor is it cheap. That's why the plans of conservatives scares me so much. I can't afford what they propose, expecting that it will drop prices.

Additionally, I am covered as part of my group plan because my cafeteria benefits are affordable for me only. Because I have pre-existing conditions, I could not get insurance, or affordable insurance, on the open market, even though my consumption is very low, as are my costs. I'm very healthy, but a pre-existing condition - even one that is controlled - is an impediment to me standing alone in the free market.

For that reason I would have to disagree with Darren that he would rather trust the market than the government. Keep one thing in mind about health care and insurance. Insurance companies are in the business of collecting premiums and denying claims. As long as that is the essence of health care in this country, all people are at risk.

People who argue for our current system almost always have either no health problems or extremely generous employee-sponsored health care or both. Of course, once that changes, I've found so do those individuals' principles and votes.

allen (in Michigan) said...

> Keep one thing in mind about health care and insurance. Insurance companies are in the business of collecting premiums and denying claims.

Not quite.

Insurance companies are in the business of making a profit. If insurance companies were in the business of collecting premiums and denying claims then they'd have damned few customers, wouldn't they? In fact, if that were an accurate description of the insurance business there wouldn't be any reason for the existence of the industry. So other then as a talking point on a pro-socialized medicine white paper, and to inflame emotions, the description doesn't have much utility.

> As long as that is the essence of health care in this country, all people are at risk.

All people are always at risk. That's the reason for the existence of the insurance industry.

> People who argue for our current system almost always have either no health problems or extremely generous employee-sponsored health care or both. Of course, once that changes, I've found so do those individuals' principles and votes.

That's a pretty trite, and self-serving summation.

It's also inaccurate in the implication that the current system isn't largely the system you hanker after.

Much of the medical industry is already socialized to a very significant extent. There's interference in the medical industry at every level of government that can exert influence and over every segment of the industry. No small part of the rise of medical costs is as a result of government interference in the medical industry and it's unreasonable to expect the inevitable inefficiency of government management to diminish after the industry's one hundred percent socialized.

By the way, no response to my observation that socialized medicine is inherently anti-democratic and erosive of democracy?

I confess, I'm puzzled by the generalized lack of interest in the inevitable division of access to medical between the connected and the proles in a socialized system. It makes my blood boil but seems to excite little interest generally or even among conservatives.

Darren said...

Allen, one of my big beefs with socialism is that there's *always* a two-tiered system. Heck, remember GUM department store in the Soviet Union? As I recall, only open to party members!

mazenko said...

Well, Allen,

It seems as if we both have valid assertions about and criticisms of the current systems both here and abroad, and that those ideas are both theoretical and anecdotal. When discussing this issue with people like you and Darren, I concur that the free market if often a better choice than state control (ie. I'm no fan of the English or Canadian systems). Though I like to think I'm pragmatic about the limits of both, and I hope we can find the most efficient and effective blend of each. Realistically, Taiwan is a bastion of free market unregulated capitalism, yet it uses government oversight of health care. I think they and the Swiss do it better than we.

To your credit, insurance companies wouldn't stay in business if they denied all the claims. It's a delicate balance for them on how much they pay out, and they are effective in managing that, so as to not lose customers. Realistically, most of us would be willing to pay for our day to day care, and we only have insurance for those break the bank times of medical catastrophe such as cancer.

Your assertion about socialized medicine being anti-democratic is, in my opinion, largely theoretical and rhetorical. We don't live in a completely democratic state, and we acknowledge the strength of communities. As taxpayers we pool our money for highways and schools and police departments, etc. We also know there are forces greater than we against which we would like some assistance. I have many friends who oppose organizations like FEMA, yet I'm willing to pay for that common good. I don't, however, assume it will be inherently good, and public oversight of government programs is absolutely necessary.

You may find my struggles to insure my family on my own in the free market to be "trite," but I hardly think I'm being unreasonable. My neighbor who had a stroke and lost her house because of medical bills after her insurance company dropped her wouldn't find her situation trite or insignificant either. Your entitled to your opinion, but we're not "welfare mongers" looking for a handout.

Ultimately, I believe we're at a tipping point on this insurance issue. As Charles Morris notes in "The Trillion Dollar Meltdown," there will be changes made, and it's not worth discussing whether government will be involved. That's a given, especially given the events of the last few months. The argument should be on how to make that involvement the most efficient and effective.

It was a pleasuring debating this with you.


Darren said...

Now *this* is an example of a reasoned, respectful debate between people who disagree with each other. I'm glad to have hosted it here on this blog.

No name-calling, no references to Hitler, no foul language. It's sad that such low standards have to be applauded, but that seems to be the nature of the blogosphere these days, so I acknowledge the good when it happens.