Blog minders,

Please try not to let erroneous captions like this get thru. Canada has a single payer system not a socialized medicine structure. Ms. Fairbanks should be more careful with her verbiage which may allow such misinformation to be perpetuated indefinitely in the blogosphere. As we go forward with enacting health care reform in an atmosphere where many creative conceptions of socialism are advanced, let us try to be precise here with the terminology.

Pay attention to Kati who cited this fact in an earlier post!!!

Ann,

For the ignorant like me could you explain what the difference is between socialized and single payer systems?

Spike

Spike,

Kati made this point originally and reinforced it in a subsequent entry.

Although the term can be used loosely, a socialized medical system typically defines a system where the government directly employs the physicians, owns the hospitals and establishes the cost/payment scheme from the federal budget. This is the system of Britain, Finland and Cuba.

The single payer system just simplifies the payment for medical services since there is only one "insurance company". Physicians can actually earn higher salaries than in this country since they and by proxy hospitals receive 100% reimbursement for services, a number US physicians and hospitals are not even close to. Citizens have universal coverage and therefore universal access to care. It eliminates a great deal of paperwork and to a certain extent minimizes the variation embedded in a two-tiered medical system.

Thanks for your query. Very few people seem to be interested.

Ann Newton:

Physicians can actually earn higher salaries than in this country since they and by proxy hospitals receive 100% reimbursement for services, a number US physicians and hospitals are not even close to.

Can you show a link to data showing where physicians in Canada earn more than their U.S. counterparts?

I don't really see a substantive difference. Single payer is a single price control system and therefore also socialized medicine. It is also socialized in the sense that it is rationed equally.

Canada has a somewhat limited two tier mixture of public and private health care. Elective surgeries ie. non-medical plastic surgeries, liposuction, dental surgery etc. are not covered but rather done in a private clinic at a patient's or third party insurer's expense.

Doctors can elect whether to accept government payments but they cannot extra-bill patients for covered services. Being in the system they cannot conduct outside medical activities ie. part covered services - part private services. They can of course prepare medical reports usually for a lawsuit on a privately compensated basis.

The provision of health care is in fact a provincial (think states) responsibility - the federal Canada Health Act which apportions medicare funding to a province imposes penalties and restrictions on the availability of funding depending on the attainment of national standards.

Within each province hospitals are usually non-profit organizations operated by an independent board of trustee. Some provinces have gone so far to organize hospitals into regional care boards charged with the care in specific regions. Surgeons and nurses in hospitals are paid by the hospital. There are some privately owned hospitals - usually providing private medical health care but there has been a rise in private walk-in clinics where the clinic employ the doctors and the bills medicare.

Family doctors and specialists will usually operate out of their own premises - their remuneration to cover their rent, overhead, insurance, staff etc. is on a per service basis. (I remember the last time my wife was oregnant - 10 years ago - that my doctor's compensation for: 6 monthly appointments, 6 bi-weekly appointments and the actual delivery was $900). The per-service compensation is negotiated on a contract basis between the provincial government and the relevant College of Physicians. As essential services - contractual negotiations are strictly supervised.

Within a province there is no difference in the covered services between areas and little in the compensation for services ie. rural/urban divide although of course there is some amenities/lifestyle issues between urban and rural centres.

There are some significant differences between provinces in the covered services and the compensation for covered services. It is not a single price system - nor is it rationed equally at least between provinces.

Maybe you can explain this to me:

"Canada outlaws most private health care. "

<link>

1) The Fraser Institute is a right wing nutjob think tank. 2) Being quoted by a fellow at another right wing think tank. 3) This is 5 years old. As noted in another post for non-essential, non-emergency health care the waiting time in Canada can be longer (although that has changed in a positive direction in most of Canada). Of course if you lack insurance, have a high co-pay or your insurance does not cover your particular needs in the United States well then I guess you are just out of luck. see: <link>

I don't think the U.S. system doesn't need to be fixed. I just don't think the Canadian system or the European socialist system is the da bomb either.

What did he mean by illegal?

Did Canada recently change its laws or something? Why would they do that?

The Supreme Court of Canada did in a recent decision:

<link>

The rationale being that not being able to pay for private services that would skip the queue infringed their rights.

So something is rotten in the State of Canada.

If a long time hard working citizen who payed his taxes and employed others can't get ahead of the habitual criminal for the same disease and severity, then Canada has a problem especially if the first citizen is paying for the additional enhanced care. After all what was the point of working hard?

Um, a nicer home, vacations, freedom?

If I recall correctly in the United States prisoners get free medical care - at taxpayers expense when, as you said a long time hard working citizen who payed his taxes and employed others gets denied insurance or inadequate coverage? And that is fair because?

Log - splinter.

I never said the U.S. system was great or didn't demand change, but people here are looking to Canada and Europe as the answers. They aren't the answer by far but lowering the cost of healthcare is.

All systems have their problems. Biggest problem in U.S. health care? People die because they don't have insurance, or get denied health insurance because they had a "pre-existing" condition, or are charged through the roof in E.R. (or, if you bail out on the E.R. the tax payer or other person who uses the hospital facility gets to pay for it through higher medical expenses). Even if you find those too extreme, we pay 10 times more for worse service. It's one thing to pay a lot of money and then get that return through the value of the service (and that's from Fox news). As it stands, we are being extorted. The biggest problem in Canada seems to be long lines. I don't think anyone wants to adopt the exact system of Britain/Canada/France et al. Just modify our system to make it better and provide greater access. The best proposal seems to be expanding medicare so people who can't afford all the bells and whistles of regular private insurance still have an option to get screened. Maybe the quality would be worse (though, according to the same Fox news report of an independent study, government health care would give people better service for their money) but its something. The rich and well off can still have their high end premium plans that cover liposuction. The biggest argument against this is that it will drive down the price of private insurance companies. I doubt it. It looks like UPS and FedEX seem to do fine when competing with the socialized post office. Further, if government health care will really be bad, then who would want it? As stated, the rich and well off can still pay for their own insurance which is "better". The only people that would probably go to the expanded medicare are people that don't buy or can't afford insurance now anyway.

I will waste my breath one more time.

It is the cost of healthcare that is the problem first of all then the cost of insurance (including malpractice). These issues can be addressed with light handed regulation that is in no way price control.

Examples:

1) All doctors visit should be audio recorded and all procedures should be audio/visual recorded. Those who opt out be it doctor or patient (or both) would then be at a disadvatange when in court on a malpractice suit. $100,000/yr malpractice premiums could then be lowered. Statistics could be brought to bear on health care outcomes and bad doctors could be removed more expeditiously. Patients would have a recording of doctor's instructions.

2) Rather than socialize medicine socialize insurance (i.e. convert them to non-profits) as a last resort.

3) Require that x number of new policies have to be for people having pre-existing conditions. Govt. actuarial scientist could be used to determine a reasonable rate.

4) Automate billing to include a govt. XML standard that insurance and providers must adhere to in order to communicate electronically and hopefully process fully programmatically.

5) Outcome based care. Where you pay for say a heart operation $30,000 and you get care until you are fully recovered. Requires knowing your expenses up front and incentivizes providers to do it right the first time.

6) (Contemporary example) Instead of society spending $600 Million for a new Miami Marlins stadium, society spending $300 Million for new doctors and nurses committed to serving x years in Dade county. Forget the stadium.

....

The list of things to try first are limitless and more effective and more market orientated for better results.