
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.


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.


I don't think that this has been shown with the DMC ...


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 ...


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.).


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!!).


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).


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.


Sorry! (-;  It's just that I even run into people from Buffalo
and from Michigan who don't know ...


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 ...


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.


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