Health Forum - Bringing Canadian health care to the U.S.

Author

Bringing Canadian health care to the U.S.

fresh~horses

2004-10-16, 2:06 am

Dear Health Care Activists,

The Thursday, October 14 San Francisco Chronicle carried a good
article on the Canadian health care system. It is pasted below. The
article presents us an excellent opportunity to write letters to the
editor in support of SB 921, the Health Care for All Californians act
and HR 676, the United States National Insurance Act. Both SB 921 and
HR 676 would legislate a single payer health care system.

Sincerely,
Don Bechler
Chair
Health Care for All
San Francisco
415-695-7891

1. We need to pass Senate Bill 921, the Health Care for All
Californians Act, so that we can have a system that insures everyone.

2. The Canadians have a health system, but need more money. We have
the money, but have no system. SB 921 would provide the system.

3. Canadians are not excluded from health coverage because of
"pre-existing conditions". That is only a term used by the US
insurance industry to avoid the sick and insure only the healthy. With
SB 921, everyone will be covered regardless of their health status.

4. Because Canada can bargain as a nation with the drug companies,
their costs are less. We could dramatically lower our drug costs in
California with the collective bargaining power of SB 921, the Health
Care for All Californians Act.

5. With SB 921, the Healthcare for All Californians act, the cost of
health care for California businesses would be competitive with Canada
and all the other industrialized nations. And California would have a
competitive advantage over other states.

IN CRITICAL CONDITION: HEALTH CARE IN AMERICA CANADA'S WAY
What a universal health care system delivers, good and bad

Barry Brown, Chronicle Foreign Service

Thursday, October 14, 2004

Toronto -- Discovering he had colon cancer came as a shock to John
Kioussis, but after 10days in the hospital, attended by a battery of
medical specialists, technicians, nurses and other
staff, his bill came to less than $85 in American dollars - and that
was only for his phone and cable TV.

Under Canada's government-funded health insurance system, Kioussis'
care, from the first visit to a family doctor, through visits to two
specialists of his choice and his hospital stay, was free, paid for by
Ontario's publicly funded universal health coverage.

"When you're sick like that and off work, the last thing you want to
worry about is how to pay the bill," said Kioussis, 55. "I had
excellent care and one of the top specialists in the country, the same
doctor who would treat the prime minister."

That's the side of Canadian health care familiar to many Americans --
a system that provides free cradle-to-grave treatment to all,
regardless of income or employment status.

The fact is, though, that Canada's system is riddled with problems,
many stemming from inadequate funding. As a result, delays of several
months are common before seeing a specialist or getting nonemergency
surgery.

For his part, Kioussis said the month he waited between seeing his
family doctor and his surgery did not seem unreasonable. He admitted,
though, that because of a personal connection between his brother and
the surgeon, the doctor operated on him just before he left for
vacation.

Although delays and other problems have caused support to dip
slightly, Canadians still overwhelmingly back their universal health
program. They think of their health care system as a mark of their
national identity, something that separates them from Americans.

Meanwhile, a recent ABC News poll showed that while Americans value
the quality of U.S. health care, 62 percent think the nation should
shift to a universal health insurance program like Canada's.

As a result of the sharply differing approaches Canada and the United
States have taken toward financing health care, their medical systems
have developed in contrasting ways.

The United States has more hospital beds per person than Canada
because most American hospitals are private,
while almost all Canadian hospitals are publicly funded. As a result,
American hospitals compete for patients, while Canadian hospitals
"don't fund excess capacity," said Sharon Sholzberg-Gray, chief
executive of the
Canadian Healthcare Association.

By many measures, Canadians are healthier than Americans, with a
longer lifespan and lower infant mortality, even though they spend
much less on medical care. Canadians devote about 10 percent of their
gross domestic product, the total of a nation's goods and services, to
provide full health coverage for all citizens. American health costs
account for about 14 percent of GDP, yet 45 million Americans have no
health insurance
and many more have limited coverage.

One of the main culprits pushing up the cost of care in the United
States is the expense of administering a plethora of complicated
health plans. It has been estimated that any large health insurer in a
midsize U.S. state spends more on administration than is spent on
health administration in all
Canada.

Dr. Catherine Kurosu is a gynecologist at two San Diego hospitals. A
Canadian, she said the biggest differences between the two systems are
that poorer Americans won't seek medical care until their problems
have become
serious. In addition, she said, American insurers often play games to
avoid paying bills.

In San Diego, a lot of pregnant women -- especially illegal immigrants
-- show up with problems that could have been avoided with prenatal
care, she said. The idea that they can't get this kind of care "still
seems foreign to me," she said.

"My patients are always interested in finding out about the health
care system when they find out I'm Canadian," she continued.

When it comes to billing, the Canadian system is a simple matter of
sending an invoice to the Ministry of Health, which pays on a
fee-for-service basis, she explained. In the United States, there are
so many insurance companies, each with its own rules covering not only
the patient but also the doctor -- as Kurosu learned when she had to
wait months for an insurance company to approve her.

U.S. health insurers nickel and dime doctors by always sending bills
back and questioning everything, she said. "It's like a game to see
how long they can forestall payment."

Eleven years ago, Colleen Burns started a medical imaging business in
Buffalo, N.Y., right across the border from Ontario. She expected 20
percent of her business would come from Canadians willing to pay $300
to $600 in U.S. for quicker access to high-tech diagnostics. Instead,
the proportion is only about 8 to 10 percent, she said.

Canadians need to feel a sense of urgency and have the money before
coming to the United States, "because they can get an MRI for free in
Canada," she said.

The health system is now itself in need of emergency care in order to
continue offering the benefits Canadians have come to think of as
their birthright, according to many experts.

Dr. Albert Schumacher, president of the Canadian Medical Association,
warns that shortfalls of cash and
medical staff have left the system unsustainable without major reform.

Twenty years ago, Canada's federal government unified the various
health insurance programs run by the provinces.

Ottawa offered to pay 50 percent of the programs' operating budgets,
provided the provincial plans accepted
five basic principles, including nationwide acceptance of each
provincial plan, comprehensive coverage and no
out-of-pocket costs (co-payments or deductibles) for insured services.

"But since then, the federal share has dropped to as low as 14
percent," said Schumacher, a family physician from the border city of
Windsor, Ontario.

In the 1990s, Canadian governments at all levels began attacking their
budget deficits with single-minded intensity. With health care
accounting for about 40 percent of public sector spending, hospitals
were closed, physician fees were frozen or cut, nurses were laid off,
and spaces for medical students and medical technicians at
government-funded universities and colleges were cut back.

Along with a money crunch, Canada "has a terrible shortage of
physicians, " particularly specialists and
surgeons, a high proportion of whom are over 55 and ready to retire,
Schumacher said.

Fixing the health care system has become a high priority for Canada's
political leaders.

Last month, Prime Minister Paul Martin made good on his main election
promise to inject more cash into provincial health programs and move
to shorten waiting lists.

At a national health care summit, Martin told provincial leaders
Ottawa would ante up the equivalent of an additional $34 billion in
U.S. funds over 10 years to provincial and territorial health
programs, as well as an
additional $3 billion to ease wait times for hip replacement
surgeries, cardiac and cancer treatments. He also agreed to a plan for
monitoring waiting lists to determine the best method of reducing
them.

As in the United States, the main problems bedeviling Canada are the
soaring cost of prescription drugs and an
aging population. Canada's provinces had called on Ottawa to use its
hefty budgetary surplus to launch a
national drug plan and leave to them the remaining health care costs,
including home care and services like
psychiatry and chiropractics.

But during the summit, provincial leaders abandoned that effort in
exchange for more overall funding from Ottawa.

Sholzberg-Gray of the Canadian Healthcare Association said another
challenge plaguing the Canadian system is the drain of doctors and
nurses lured by higher pay and lower taxes in the United States.

"There is also a circular effect, because some doctors come back so
they don't have to collect bills," she added.

On the issue of waiting lists for nonemergency surgery, Sholzberg-Gray
believes the federal government should
establish time limits for treatment.

One feature of Canada's health care system is that if someone wants to
bypass the public program and, for
example, pay a doctor to perform hip replacement surgery after hours,
he cannot. Because of fears that slipping the doctor a little
something extra could lead to the breakdown of the equal-
access-for-all principle, paying
for insured services is illegal.

Those who believe that more private care clinics would solve the
problem of funding and shortages have taken
their case to Canada's Supreme Court in an effort to open the system.

ODD MAN OUT

The United States is the only developed nation without universal
health care. Although health insurance systems
worldwide are straining as populations age, safety nets have largely
remained in place. Here are brief descriptions of insurance systems of
several nations..

France

Health care as percentage of GDP: 9.6

Health expenditure per person: $2,567

Universal care funded through mandatory health insurance provided by
Social Security, with private supplemental coverage filling gaps..

Germany

Health care as percentage of GDP: 10.8

Health expenditure per person: $2,820

All individuals are enrolled in government-approved health insurance
plans partly financed by employer and employee contributions, although
high- income workers may buy private insurance instead..

Japan

Health care as percentage of GDP: 8

Health expenditure per person: $2,131

A dual system in which workers enroll in insurance programs through
their jobs, while all others join Japan's
national health insurance plan..

United Kingdom

Health care as percentage of GDP: 7.6

Health expenditure per person: $1,989

A publicly funded National Health Service provides free care, with the
option of private insurance for those
wanting treatment outside the state system..

United States

Health care as percentage of GDP: 13.9

Health expenditure per person: $4,887

Federal and state governments pay most of the cost of care for seniors
and the poor, with employer or
individually financed insurance available for others. About 45 million
people lack coverage.

*2001 figures

Source: World Health Organization, Chronicle research

FIVE-PART SERIES

This week The Chronicle is examining in depth the causes, effects and
responses to rising health care costs in
America.

MONDAY
Why health care costs are rising fast. Plus the Bush and
Kerry health care plans.

TUESDAY
Retirees hit hard as health benefits are lost.

WEDNESDAY
Health care tops the labor-management agenda.

TODAY
How Canada provides health care for all.

FRIDAY
Employees are digging deeper to pay for health insurance.

Page C - 1

George Conklin

2004-10-16, 7:06 pm

"fresh~horses" <fresh~horses@despammed.com> wrote in message
news:abf8de5b.0410152022.2b713703@posting.google.com...
> Dear Health Care Activists,
>
> The Thursday, October 14 San Francisco Chronicle carried a good
> article on the Canadian health care system. It is pasted below. The
> article presents us an excellent opportunity to write letters to the
> editor in support of SB 921, the Health Care for All Californians act
> and HR 676, the United States National Insurance Act. Both SB 921 and
> HR 676 would legislate a single payer health care system.
>
>
> Sincerely,
> Don Bechler
> Chair
> Health Care for All
> San Francisco
> 415-695-7891
>
>
>
> 1. We need to pass Senate Bill 921, the Health Care for All
> Californians Act, so that we can have a system that insures everyone.
>
> 2. The Canadians have a health system, but need more money. We have
> the money, but have no system. SB 921 would provide the system.
>
> 3. Canadians are not excluded from health coverage because of
> "pre-existing conditions". That is only a term used by the US
> insurance industry to avoid the sick and insure only the healthy. With
> SB 921, everyone will be covered regardless of their health status.
>
> 4. Because Canada can bargain as a nation with the drug companies,
> their costs are less. We could dramatically lower our drug costs in
> California with the collective bargaining power of SB 921, the Health
> Care for All Californians Act.
>
> 5. With SB 921, the Healthcare for All Californians act, the cost of
> health care for California businesses would be competitive with Canada
> and all the other industrialized nations. And California would have a
> competitive advantage over other states.
>
>
> IN CRITICAL CONDITION: HEALTH CARE IN AMERICA CANADA'S WAY
> What a universal health care system delivers, good and bad
>
> Barry Brown, Chronicle Foreign Service
>
> Thursday, October 14, 2004
>
> Toronto -- Discovering he had colon cancer came as a shock to John
> Kioussis, but after 10days in the hospital, attended by a battery of
> medical specialists, technicians, nurses and other
> staff, his bill came to less than $85 in American dollars - and that
> was only for his phone and cable TV.
>
> Under Canada's government-funded health insurance system, Kioussis'
> care, from the first visit to a family doctor, through visits to two
> specialists of his choice and his hospital stay, was free, paid for by
> Ontario's publicly funded universal health coverage.
>

This will scare the heck out of the AMA. It would want to add at least
$10,000 in extra uninsured charges in order to discourage people from
getting cancer. Libertarians would agree.

George Conklin

2004-10-22, 4:06 am