What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Tuesday, April 18, 2006

Strike Two on the Truth

Chapter two of the booklet “The Bottom Line” is dedicated to debunking the “Myth----Private Insurance will increase access and choice for individuals”. They claim the Reality is: “Private insurance doesn’t increase access”. I gather from much of their material that they do not distinguish between access to the public system and access to private insurance, and they certainly don’t look at a sum total of access. They seem to look only at access to “insurance”. They quote international figures that show that wealthy people are more likely to have private insurance than poor people. Duh! They say people with chronic illnesses are not insurable. Duh! As long as the government keeps up the funding for the public system, diverting people to a differently funded system will work, just do it right.
Perhaps we need to review once again why the taxpayers support a publicly funded health care system ----- to provide medically necessary care for the poor and chronically ill. The authors quote a case where a patient was turned down for private insurance because her parents had cancer. My suggestion is that the patient should have shopped around. At age 60 I got the best rate of life insurance available for that age group, locked in for ten years, and not only did my parents die of cancer, but my sister died of cancer at age 47 and my brother at age 52. I grant that in order to have competition in the insurance industry, the system has to offer more than dribbles of business. There has to be sufficient competition to have competitive bidding by a number of providers.
The authors mention that even with government subsidies to Blue Cross, some patients with chronic illnesses cannot afford the premiums. I agree. If you have read my previous suggestions, I have suggested a National Pharmacy plan, federally funded. Remember, the idea is to care for the chronically ill! Insurance should be for; “The possibility of a health event that may be costly”. If people have a KNOWN illness, we as a society have an obligation to provide a safety net for them. I don’t want insurance companies to be health care providers; I want them to be “Insurance” Companies. For there to be a demand for their policies, however, there must be a reason for someone to pay more, and the job of the insurance company is to provide options for the insured in the event of unexpected negative health situations.
Unfortunately, it would seem that some people think those who pay premiums should not get anything in return.
Let us take a wage earner who makes $100,000.oo annually and pays $30,000.oo annually in taxes. He already is supporting the public system more than a taxpayer who is paying $10,000.oo annually. He waits in a medical “risk” line like everyone else in our public system. This is how our society functions at present, right or wrong. What bothers me is not that scenario, it is the people that feel that even if the taxpayer were to pay $10,000.oo in premiums a year in addition to his $30,000.oo tax bill, he should not realize any benefit (queue jump), even for elective surgery (Socialist thinking is he should pay $10,000.oo more in taxes because the government knows how to make sure the dollar is well spent better than he does). Taking this person out of the public system provides an additional space in the public system; therefore it is a win/win situation.
For a subtitle that uses the word “truth”, the authors do their best to avoid it. “Prior to 1961”, they state, “only 53% of Canadians were covered by health insurance, leaving approximately eight million Canadians without coverage”. Well, I really don’t know about other provinces in Canada or what the authors mean by health insurance, but when I started practice in Medicine Hat, Alberta, in June, 1963, all patients were covered for Hospital and cancer care. Further, 90% of patients were covered for doctor’s fees. Medical Services Incorporated (MSI) was the main carrier (a non profit carrier) but there were many others. Nowhere is Alberta’s success or MSI mentioned so far in their booklet.
The authors contend a parallel private system does not reduce wait times for the following reasons:
1) Private insurers can afford to pay care givers more and therefore care givers move to the private system.
Why can private insurers afford to pay more? They have advertising costs and higher administrative costs as pointed out by the authors. The TRUTH is the public system CHOOSES to pay less. And they have done that effectively (as pointed out by the authors) in our monopolistic system because they CAN; so much so that there is a world shortage of most health professionals. Strange, there is no shortage of dentists, veterinarians, or lawyers.
2) They say that premiums are not open to public scrutiny.
They must mean government scrutiny. Surely the person paying the premium would be aware of the benefits. If the consumer feels he is getting value for the money, then “scrutinizing” the company books isn’t necessary.
3) They claim doctors going to the private system won’t take their patient load with them.
The easy solution for surgeons (they are the ones with long risk lists) is to simply keep their allotted operating room schedules in place. Their private work would be in addition to their public work. In many cases this would add 40% to their productivity.
4) Those with higher health needs will be left in the public system.
Duh! Remember, the public system is “supposed” to look after the chronically ill (higher health needs).
I would contend that if a parallel system is not lowering the wait lists, the system has been poorly devised and implemented. The bottom line is increasing a surgeons productivity from 60% to 100% will have an impact on “risk” time. Strike two on Diana Gibson and Colleen Fuller.

Addendum: Danielle Smith has a good article on this subject in today’s Herald Editorial Page. She quotes countries and stats that show parallel systems can shorten wait times.

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