Public vs private healthcare (was: RE: [CNN] Bush 2,909,465; Gore 2,907,722.)

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From: Lisa Dusseault (
Date: Wed Nov 15 2000 - 09:41:33 PST

"Canada ranks 20th in the world for the availability of CT and MRI scanners
by population, behind Hungary and Egypt, and waiting times for cancer
surgery and radiation is months longer than in the U.S., whose system it is
patriotic to despise." --

Well, I've at least had >4 years of health care in both Canada (socialized
medicine) and US, and I'm uncomfortable with both. I think a lot of it is
personal preference, since I don't see glaring differences between the
systems. Some people prefer to live in a paternalistic society in general.
Some people prefer to have more freedom of choice in return for less

*** On the pro-Canadian-system side:

 - I can't remember having to wait longer than 3-5 weeks for a doctor's
appointment with a specific general practice doctor in Canada. I've now
been waiting 4 months here in Mountain View. Granted, it's a busy area, and
the last month's delay has been due to the doctor's pregnancy, but still,
I'm not impressed.
[Now, you might argue that if I went to a less-desirable doctor, I could get
in immediately, and you'd have a point there too.]

 - I personally find it very annoying to have to choose my doctors from
lists pre-approved by my insurer. Previously, when I went to an HMO, it was
even worse-- I had to go to one of their doctors. This is probably not even
noticed by those who have lived with the American system for a while.

 - I could have gotten all sorts of unnecessary surgery in Canada if I'd
tried :) One doctor recommended foot surgery to remove a "bone spur" on the
side of my foot that flared up painfully one winter. I stopped wearing
rented downhill ski boots, and it went away and hasn't particularly bothered
me since.

 - I'm very glad my nephew who is diabetic (but has parents who lack an
ability to make sacrifices for the future) lives in Canada. The hospitals
have very carefully trained his mother to care for him. When he has an
episode, he gets dealt with immediately, rather than dealing with insurance.
(I was in Stanford Emergency last night with a friend with a needle through
her toe, and watched everybody spend 10 minutes doing paperwork. I suppose
if they'd had people with chest pains or breathing problems those people
wouldn't have had to wait. To be fair, I also have to admit that if you go
out-of-province in Canada, you may have to pay up front and then see if your
province will reimburse you.)

 - The Canadian medical system is not mired in legal restrictions or
handicapped by worries about litigation. (On the other hand, there are more
than a few government restrictions).

 - Our teeth are fine. We have fluoridated water, socialized dental care
including orthodontia, and are all told how to brush properly :)

 - It bothers me for some reason -- I'm not sure why -- that Americans have
to get paid to donate enough blood to use. The Canadian attitude is
cooperative enough that enough free blood donors to keep the system going.

 - As I've hopped from HMO to insurer to insurer, EVERY TIME I've had the
new people run me through exactly the same annoying, time-consuming
diagnostic tests, in efforts to diagnose a chronic problem that is, still, a
chronic problem. The Canadian system would run those tests once and trust
the results of the previous clinic, unless new evidence arose that required
a rerun of the tests. Obviously, the tests haven't helped; they've always
come out the same (negative). The tests seem to be more of an excuse not to
take any other action.

 - As you pointed out, the US system is hardly competitive. I don't
realistically have the choice to go with any other insurer than what my
employer offers me, and employers are extremely restricted by regulations.
So, take your pick. Either your government unfairly taxes corporations to
pay for socialized medicine, or your government unfairly regulates
corporations to pay for somewhat privatized medicine. I think the litigious
nature of the American legal system (or American psyche) probably makes as
much of a difference.

 - I'd point out that whereas in a public system everybody has to wait for
some procedures, in a private system some people virtually have to do

*** On the pro-American-system side:

 - it seems to be true there are waiting lines for any procedure for which
personnel is rare. E.g. my community went through a severe scarcity of
anaesthesiologists, and this delayed surgery schedules.

 - I guess you could attribute the "tainted blood" scandals to public
medicine. Since the Cdn gov't has the monopoly on the blood supply, people
had no choice where to get their blood.

 - I've heard the criticism that expensive gadgets like MRIs can hardly be
found in public health systems. Seems to be true.

 - Personal choice is limited, of course. It's currently a big debate for
the exciting election in Canada (OK, perhaps not as exciting as the American
election, but good enough for us Canadians). Alberta is strongly to the
right in the Canadian political spectrum, and Alberta's premier tried to
introduce some private clinics that could offer medical procedures without
waits for those who could pay. Proponents argue that this takes the
pressure off the public system; opponents argue that it takes the best
doctors away from the public system. Now Stockwell Day, the leader of the
Alliance party, the party that sprang from our West recently, is being
smeared by other parties for "destroying" socialized medicine. Thus
everyone is spouting slogans like "no two-tier health care". Of course.
It's thrilling, in a Canadian way.
This is a really good article on one-tier vs. two-tier:
Anyway, note that outside Alberta, Canadians do not have the choice to pay
for getting an operation they want that is normally paid for by the
government (operation like lasik are entirely outside the public medical
system and thus privately available.)

 - It's very hard for rural areas to find doctors. Don't know if this would
be easier or harder. Similarly, it's hard for Canada to keep its
expensively-trained newly-graduated doctors (and computer programmers) when
they could earn x2 in the US market.
(On a related note, did anybody notice that Canada is offering to _pay_
companies who hire computer science graduates from Canadian universities,
and keep them in Canada for three years? Yikes!)

 - The Canadian system, with its combination of public medical education and
public medical service and special programs to keep doctors where they don't
want to be, is very expensive.

My sister is now in med school in Canada, so I'm learning more about the
system even as I continue to live here.


For anybody who's gotten this far, I'd like to raise the debate a level:
why is health care getting to be a bigger and bigger issue, in Canada/US/UK,
even as standards are rising and more helpful procedures and medications are
available? I see:
 - boomers are rich and aged & concerned about healthcare in those countries
 - New procdures & medications are expensive & costs are rising at least as
much as quality is rising.
 - We're so well-off we don't have anything else to worry about.


> -----Original Message-----
> From: Jeff Bone []
> Sent: Monday, November 13, 2000 10:36 PM
> To: Tony Finch
> Cc: Sophie Maddox; FoRK@XeNT.CoM
> Subject: Re: [CNN] Bush 2,909,465; Gore 2,907,722.
> Tony Finch wrote:
> > Jeff Bone <> wrote:
> > >
> > >Give it up. Socialized medicine does not work in a capitalist economy.
> >
> > Seems to work OK in the UK.
> Really? Don't mind waiting six months for a doctor's visit,
> then? Hell, we
> complain about *HMOs* in the US, do you *really* think we would
> be okay with
> social medicine? And, have you seen their *teeth,* for godssakes.
> BTW, every time this comes up, somebody brings up the damned UK.
> Tony, where
> do you live? I'd love to hear from somebody that's actually
> lived in and had
> healthcare in both the US and the UK.
> > >The hybrid system and its corresponding governmental impact on private
> > >healthcare is the ROOT CAUSE of rising healthcare prices, and
> if you don't
> > >believe me I can give you my pop's e-mail address, he's been managing
> > >hospitals for 30 years and has quite a bit to say on the matter.
> Well, I'm no expert, but his line on this is that the increasing
> regulation of
> healthcare over the last 3 decades as a part of Medicare / Medicaid has
> basically made it impossible for hospitals and clinics to operate
> profitably at
> a reasonable direct cost to the consumer of healthcare services. Overhead
> related to administration of those plans, regulations for
> staffing, all kinds
> of gov't interference with market forces. I buy it.
> > I thought it was because insurance companies will pay whatever price
> > is demanded,
> A First!!! I've never heard insurance companies described as generous
> before!!! (And btw, what *have* you been smoking? Insurers
> actually pay a
> (significant, but still) fractional amount of what doctors bill them.)
> > and employers pay whatever premiums are demanded. There's
> > very little downward pressure on prices.
> Why shouldn't there be? Why isn't the healthcare market
> *competitive*? Essay
> question for bonus points.
> >
> >
> > Tony.
> > --
> > en oeccget g mtcaa f.a.n.finch
> > v spdlkishrhtewe y
> > eatp o v eiti i d.

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