Facts on Health Care: what people are afraid of

[Big Black Dog]

He was saying that as a joke... but of course that won't be mentioned.

Sorry, but it's Republicans that are systematically trying to destory these insitutions (social security, etc...). People love Medicare hate to tell you.

The post office, along with many large corporations go through blocks of losses. I worked for a company that had over 3 years of huge loses... they have money set aside to cover these loses. NO INDUSTRY can accurately predict it's next fiscal year. If this were possible, then there's be a lot of rich traders on the market, but there aren't. Most don't make it.

The mail industry JUST LIKE the newspaper industry is going through major market changed. And you're going to have loses until they adjust to the market (which they are doing).

I don't agree with your assessment. I think you're full of road apples.... If you can remember that far back, the Republicans have not been the only group to manage Social Security and Medicare in this country. Everytime it comes election time, all the politicians jump up and down and say we need to "fix" Social Security and Medicare. Well, guess what? After the elections are over nothing is ever done except for Congress to raid the money set aside for these two programs to pay for pork back in their home districts. Republican and Democrats alike are both guilty of this. You can call it a joke if you wish, but the Post Office is deep in the red and it will be so again next year. If you really want to turn your life over to be run by the government, then I think you are an idiot. It's proven history that the government can't run Medicare and Social Security and they can't manage your precious health care either. Take a deep breath and try to quit beating the liberal democrat drum long enough to think for yourself.

 

[AllieBaba]

The post office is fucked. They're considering closing down for one more day a week.

 

[KittenKoder]

The arguments being thrown around about the Health Care Plans being socialist or something like that are bogus, but they are not only based on how to pay for things...they are red herrings about a government take over of the health care system---hospitals, doctors, etc.

We should be debating how to P-A-Y for health care. What do we already pay and what would a single payer or other type plan look like.

Really ... so who would you have decide how much it will cost us?

As I said, you are only looking at 1/10th the picture.

How much does it cost us now...private and public? We all pay for the uninsured in emergencies. Many people get government paid insurance coverage (vets-tricare, eldery, disabled, children, etc...). No serious person I know of is proposing a government takeover of hospitals and doctors and pharmacies.

What is teh cost now? think...

Do you have any idea why the costs are high? Do you really think that if the government was involved that companies would be able to over charge for their products? Medical care is a product and service, thus the laws of capitalism apply.

 

[OneWorld]

I don't agree with your assessment. I think you're full of road apples.... If you can remember that far back, the Republicans have not been the only group to manage Social Security and Medicare in this country. Everytime it comes election time, all the politicians jump up and down and say we need to "fix" Social Security and Medicare. Well, guess what? After the elections are over nothing is ever done except for Congress to raid the money set aside for these two programs to pay for pork back in their home districts. Republican and Democrats alike are both guilty of this. You can call it a joke if you wish, but the Post Office is deep in the red and it will be so again next year. If you really want to turn your life over to be run by the government, then I think you are an idiot. It's proven history that the government can't run Medicare and Social Security and they can't manage your precious health care either. Take a deep breath and try to quit beating the liberal democrat drum long enough to think for yourself.

Ummm... the Republicans stole the funds out of social security. I'm not going to say that Democrats aren't to blame for this either, but both Regan and Bush straight stole the funds from social security to pay for their large deficit spending (I should note that Clinton did add SS to the budget, but did not steal it). This is common knowledge on the left, but I have to remember that you guys really don't know what's going on. Additionally, Republicans are consistent obstructionist when trying to "fix" these issues. Bills have been on the table, and they've wanted nothing to do with them. I've watched this over and over again in my life time.

Saying that because a company posts it's first loses ever that it means the government can't run anything is just putting belief blinders on. You have a brainwashed belief (which is false) that the government can't run anything (I know, our military sucks right?). Every company or industry goes through down trends... every one. Can you admit that the advent on the internet and how people pay bills is going to drastically kill the industry as a whole?

This whole argument about government run health care is absurd though. You guys won already, we're not having a single payer health care system (which is what we should have if we had an educated population, which unfortunate we don't). All the bill is doing is adding a government option. If you don't want it, then keep your private health care and it's escalating costs with poor results.

 

[OneWorld]

Do you have any idea why the costs are high? Do you really think that if the government was involved that companies would be able to over charge for their products? Medical care is a product and service, thus the laws of capitalism apply.

Most other countries populations have realized that a for profit health care system creates corruption and greed. When lives are at stake, there are some things that should not be driven by profit motivations, otherwise the result is what we currently have...

It doesn't work... so if the Republicans acknowledge that the system is broken, where is their plan to fix it? Why haven't they done anything when they had all 3 offices?

 

[Vel]

Really ... so who would you have decide how much it will cost us?

As I said, you are only looking at 1/10th the picture.

How much does it cost us now...private and public? We all pay for the uninsured in emergencies. Many people get government paid insurance coverage (vets-tricare, eldery, disabled, children, etc...). No serious person I know of is proposing a government takeover of hospitals and doctors and pharmacies.

What is teh cost now? think...

Do you have any idea why the costs are high? Do you really think that if the government was involved that companies would be able to over charge for their products? Medical care is a product and service, thus the laws of capitalism apply.

KK.. One of the reasons that the costs are so high is because people don't write a check to pay the doctor. They never question whether this or that is necessary because they never actually see the price of the services. If you aren't paying the bill, how often do you ask the price?

 

[manu1959]

Do you have any idea why the costs are high? Do you really think that if the government was involved that companies would be able to over charge for their products? Medical care is a product and service, thus the laws of capitalism apply.

Most other countries populations have realized that a for profit health care system creates corruption and greed. When lives are at stake, there are some things that should not be driven by profit motivations, otherwise the result is what we currently have...

It doesn't work... so if the Republicans acknowledge that the system is broken, where is their plan to fix it? Why haven't they done anything when they had all 3 offices?

the quality of the care available is just fine.....it is how to pay for it and what it costs to use the health care system......

the republican plan was to let you write off your premium costs and limit lawsuits....

you know incentivize people to buy health care....like cash for clunkers.....

 

[OneWorld]

the quality of the care available is just fine.....it is how to pay for it and what it costs to use the health care system......

the republican plan was to let you write off your premium costs and limit lawsuits....

you know incentivize people to buy health care....like cash for clunkers.....

It's fine although we are at the bottom of the list for every major stat in this area? Hmmm... are you really being serious. I honestly don't go to medical doctors in this country unless I need something cut out of my body. That's about all they are good at is surgery. Other than that, they are purposely ignorant on health, and honeslty imho know little about it.

I should add that my wife's main passion is child birth. She donates her time to unplanned mothers as a doula (labor assistant) and deals with doctors all the time. She also teaches free natural child birth classes, which I have assisted with from time to time.

In the childbirth community in America, cessarian section has grown from about 5% annually to over 35% (and in some counties like ours much higher) since 1970. Why? Because it makes them more money, it's quicker, and they claim "safer" which means less chance of law suit. Yes unfortunately the statistics don't prove this, since we are last on the list in death at birth, etc...

There is no field in the medical community that I can really point to and say they have the best interest of the patient at heart. I'm open to hearing if you know of one though.

 

[OneWorld]

KK.. One of the reasons that the costs are so high is because people don't write a check to pay the doctor. They never question whether this or that is necessary because they never actually see the price of the services. If you aren't paying the bill, how often do you ask the price?

Not trying to offend, but this is really poor reasoning... try again.

 

[KittenKoder]

Damn ... people are naive ... you want to give the FDA (responsible for the current high costs) more power to charge more for their licenses? Just not very smart.

 

[manu1959]

the quality of the care available is just fine.....it is how to pay for it and what it costs to use the health care system......

the republican plan was to let you write off your premium costs and limit lawsuits....

you know incentivize people to buy health care....like cash for clunkers.....

It's fine although we are at the bottom of the list for every major stat in this area? Hmmm... are you really being serious. I honestly don't go to medical doctors in this country unless I need something cut out of my body. That's about all they are good at is surgery. Other than that, they are purposely ignorant on health, and honeslty imho know little about it.

I should add that my wife's main passion is child birth. She donates her time to unplanned mothers as a doula (labor assistant) and deals with doctors all the time. She also teaches free natural child birth classes, which I have assisted with from time to time.

In the childbirth community in America, cessarian section has grown from about 5% annually to over 35% (and in some counties like ours much higher) since 1970. Why? Because it makes them more money, it's quicker, and they claim "safer" which means less chance of law suit. Yes unfortunately the statistics don't prove this, since we are last on the list in death at birth, etc...

There is no field in the medical community that I can really point to and say they have the best interest of the patient at heart. I'm open to hearing if you know of one though.

your opinions are noted.....my experience over the past 50 years with my children and my family are quite different.....

what country do you travel to for your yearly check up....

 

[OneWorld]

Damn ... people are naive ... The Republicans keep pushing to have the FDA (responsible for the current high costs) more power to charge more for their licenses? Just not very smart.

...

 

[OneWorld]

your opinions are noted.....my experience over the past 50 years with my children and my family are quite different.....

what country do you travel to for your yearly check up....

My experience is most people have no idea the effects of what their doctors are doing, and they don't question them. Ummm... look at how and why the pharmaceutical company has become so powerful. They are pumping poisions into people's bodies, without knowing long term effects to act as a band-aide to the real problem.

Western medicine almost never understands the root cause of an issue, while there are other systems that do.

I don't have yearly check-ups, and when me or my family is sick, we heal ourselves (use homeopathy or alternative methods). We rarely get sick though because we have very good diets and are pescetarians. 98%+ of disease is from poor diet induced by a stressor.

 

[manu1959]

your opinions are noted.....my experience over the past 50 years with my children and my family are quite different.....

what country do you travel to for your yearly check up....

My experience is most people have no idea the effects of what their doctors are doing, and they don't question them. Ummm... look at how and why the pharmaceutical company has become so powerful. They are pumping poisions into people's bodies, without knowing long term effects to act as a band-aide to the real problem.

Western medicine almost never understands the root cause of an issue, while there are other systems that do.

I don't have yearly check-ups, and when me or my family is sick, we heal ourselves (use homeopathy or alternative methods). We rarely get sick though because we have very good diets and are pescetarians. 98%+ of disease is from poor diet induced by a stressor.

nice sweeping generalization.....

interesting...my uncle lived as you describe....he made it to 67 died of prostate cancer that a yearly check up would have prevented....

 

[Vel]

KK.. One of the reasons that the costs are so high is because people don't write a check to pay the doctor. They never question whether this or that is necessary because they never actually see the price of the services. If you aren't paying the bill, how often do you ask the price?

Not trying to offend, but this is really poor reasoning... try again.

Do you think so? Please feel free to point out the flaw in my reasoning.

 

[AllieBaba]

KK.. One of the reasons that the costs are so high is because people don't write a check to pay the doctor. They never question whether this or that is necessary because they never actually see the price of the services. If you aren't paying the bill, how often do you ask the price?

Not trying to offend, but this is really poor reasoning... try again.

Do you think so? Please feel free to point out the flaw in my reasoning.

Your reasoning is perfect.

 

[Maple]

that the europeans and canadians are so in love with there system. Read it and weep.
Europeans Unhappy With Socialized Medicine Turn to Private Sector
BY REBECCA GOLDSMITH



HAMBURG, Germany -- Europeans once lived and died by their national health plans.

In exchange for steep taxes, they received a lifetime of free or low-cost medical care. They expected doctors to diagnose their ailments, drugs to make them feel better and hospitals to perform necessary procedures.

But this once-sacred social pact is starting to break down. Fed up with long waits and worried about the quality of medical care, European patients are losing faith in government-run health systems. Informed by the Internet and motivated by cheaper travel, many now seek medical care abroad and buy private health insurance.

In response, some European governments are doing the unthinkable: handing parts of their public health-care systems to the private sector. The experiments promise to release patients from a government monopoly and improve care through competition. The outcome could make or break national budgets -- and ultimately determine whether socialized medicine survives.

The changes in Europe contrast with what is happening in the United States, where people are looking to government leaders to address soaring medical costs and the 43 million people who have no health insurance. This suggests Americans should be careful what they wish for, said Robert Moffit, director of the Center for Health Policy Studies, part of the Heritage Foundation, a conservative think tank in Washington, D.C.

"The government can guarantee you universal coverage," he said. "What the government can't guarantee you is the care that you want when you want it."

Just ask Franco Chiocca.

The London clothing wholesaler could have had a hip replacement near his home, for free, through England's National Health Service. But he was unwilling to wait months or years. Instead, he researched his alternatives online and found a clinic in Germany.

Hours after landing here, where he didn't speak the language, Chiocca, 52, lay on an operating table, sedated and cut open by doctors he had just met. Eleven days later, he walked out of the Endo-Klinik on crutches with a plastic joint that cost him 9,300 euros, or about $12,340.

"A professional person like me cannot wait too long," said Chiocca, who makes $211,000 a year before paying $77,000 in taxes -- much of which funds England's health care system. "Dealing with clients all day, I have to be on my feet."

Chiocca's decision to pay out-of-pocket and get back to work faster wouldn't seem unusual in the United States. But in Europe, his willingness to forfeit public benefits is part of a revolution in socialized medicine.

Today, more Europeans are using the Internet to shop around for medical procedures as easily as they would for a television. They are as comfortable catching a flight to a foreign city as they are driving to their country homes. And they can compare prices across borders more easily than their parents because half of Europe now uses the same currency, the euro.

In short, they are behaving more like American consumers.

"They're tending to know a lot more than they used to about how they can be treated and what's available, whether it's in (their) country or others," said Ken Anderson, an American in charge of negotiating private contracts for England's Department of Health. "Since those patients are also voters, politicians listen to them."

For European governments, limiting supply has been the traditional way to contain health care costs. The downside is waiting lists.

Patients have had to wait not just for elective procedures, but even for medically necessary surgeries.

England, whose health service is one of the most generous in Europe, made patients wait an average of 18 months for an operation in 1997 -- including for simple-to-fix but disabling conditions such as cataracts and worn joints. Since then, the average has fallen to less than nine months.

While England and other countries have taken measures to curtail waiting lists, "health tourism" remains strong.

"Three years ago, there were people who didn't want to wait two years for an operation," said Hans Finck, managing director of German Medicine Net, a medical broker who helps bring British patients to Germany for care. "Now, they don't want to wait nine months."

In June, the Stockholm Network, a European think tank that advocates market reforms, released a survey that showed patients across eight countries in Europe were losing faith in their health plans. More than four in five of 8,000 people surveyed said that without improvements, the quality of health care would stagnate or decline during the next decade. Most expressed a willingness to travel for treatment.

Maurice Williams, a 55-year-old construction business owner, said he turned to an Internet company called Treatment Choices because he faced a wait in England for heart bypass surgery, which his doctor said he needed immediately to live. The company gave him a list of places where he could get the surgery right away.

"I felt pretty let down," he said while convalescing at a cardiac center in Lahr, Germany. "Living in England all those years, paying all that money into the system ... Now I'm sick, knocking at death's door, and I can't get help."

European discontent with national health systems also is reflected in the trend toward private health insurance, once almost unheard of in countries with socialized medicine. The number of Britons with private medical coverage, for example, grew 10 percent during the past five years, according to the health care analysts Laing and Buisson.

Brits spent $7.7 billion on health insurance products in 2003. Private medical insurance covered 12.7 percent of the population, while 8 percent had health cash plans, which are similar to health savings accounts in the United States.

The free-market principles governing America's health care system encourage competition between health insurers and providers who want to sign up patients and clients.

Such competition was rare in Europe until recently. One unexpected outcome of the expansion of the European Union, which grew to 25 countries in May from 15, is national health care systems must compete with one another.

The EU requires member countries to allow the free flow of goods, services and people across national borders. For decades, the pledge excluded health care, which was planned and administered by each country.

But a recent series of rulings from the European Court of Justice compel EU members to reimburse citizens for care they get in other countries, whether they are there for work, vacation or simply to seek care in a "reasonable" time frame.

As a result, "health tourism" is rapidly becoming a mainstream alternative to socialized medicine across Europe.

In another decade or so, traveling internationally for care will become standard worldwide, said James Rice, an American international health care policy expert.

"It's not just going on holiday and getting their boobs lifted," he said. "Eventually, it's going to be a broader pattern of people looking for services and products where they can find good values, and they won't respect political borders."

Some European nations already are poaching patients from their neighbors. Hungary, Slovakia and the Czech Republic are starting to promote health tourism as a way to capitalize on low-wage but highly trained medical staff.

In the Hungarian border town of Mosonmagyarovar, Germans come in droves to choose from dozens of dentists. In former Iron Curtain getaways such as the Hungarian capital of Budapest and the Czech resort of Karlovy Vary, previously known as Karlsbad, investors are trying to turn resorts and sanitariums into medical clusters drawing patients for everything from cosmetic surgery to diagnostic tests, eye surgery and joint replacements.

The prospect of losing patients to neighboring countries, or accommodating floods of foreign patients, has become a budgetary and planning nightmare for many European health bureaucrats.

"Health-care systems in Europe are becoming increasingly interconnected and patients increasingly mobile," said David Byrne, the former European commissioner for health and consumer protection. "These developments need a coherent political response. The issues will not go away, and patients rightly expect that we address them."

After scouring the world for answers, some of Europe's top health officials believe they have found salvation for socialized medicine in an unusual place: the United States and other countries where capitalism guides health care.

Sweden and the Netherlands were two of the first in Europe to enlist more private investment in health care. More recently, regions of Germany and Spain began selling state-owned hospitals to for-profit companies to raise money and increase efficiency. The Irish government wiped out waiting lists by shipping patients to private facilities in Ireland, Northern Ireland and England. France and Italy are just starting to explore ways to farm out public health care to the private sector.

The most radical changes are happening in England, whose powerful National Health Service is purported to be the world's third-largest employer after China's Red Army and India's railways. The NHS, as it is known, employs 1.3 million people in the United Kingdom, out of a total population of 60 million.

Historically, the government built, owned and ran all public hospitals in England. Citizens supported the service through income tax and a 17.5 percent "value added tax" on nearly every purchase.

Now, England's Department of Health, which oversees the NHS, is borrowing heavily from private health-care models pioneered in the United States, such as outpatient surgery centers.

In effect, the government is shifting to a system where it acts as more of a regulator than a primary provider.

Last year, officials began awarding contracts to outside companies to build, finance and operate outpatient medical centers to perform procedures such as body scans and cataract surgery. By 2008, the government expects to farm out as much as 15 percent of its elective procedures -- up to $8.7 billion worth a year -- to for-profit and nonprofit investors.

Feb. 8, 2005

(Rebecca Goldsmith is Europe correspondent for The Star-Ledger of Newark, N.J. She can be contacted at [email protected].)

Not for commercial use. For educational and discussion purposes only.



--------------------------------------------------------------------------------
TOPICS: Business/Economy; Culture/Society; Editorial; Foreign Affairs; Germany; United Kingdom
KEYWORDS: europehealthcare; healthcare; socialismfailure; socializedhealthcare; socializedmedicine

 

[oreo]

Obama realizes this also with the government run postal service. I just have to post this on all health care boards. These are HIS words today.

As long as they have a good product and the government plan has to sustain itself through premiums and other non-tax revenue, private insurers should be able to compete with the government plan, Obama said.

"They do it all the time," he said. "UPS and FedEx are doing just fine. ... It's the Post Office that's always having problems."

I wonder what problems a government run health care system would entail, hmmmm skyrocketing taxes on everything and everyone, rationing of care, check out the taxes on gasoline in all of the countries who have socialized medicine- go to Ask Jeeves- taxes on gasoline in Italy, see the comparison over the last 20 years, they are more than double ours.

Maple here is your link so these liberals can hear it themselves.

Obama--on video--giving us a perfect example of why the Federal Government should not offer a public plan or a take over of the health care industry.

The U.S. post office is currently 14 BILLION dollars in red ink.

[ame]http://www.youtube.com/watch?v=5XTi-WdOu2s[/ame]

 

[AllieBaba]

Sweden, the Netherlands, Germany and Spain.

It's like a bad joke. Can you say...eugenics & inquisition?

 

[Maple]

Sorry it's so long but it's an important and very informative article- it gives the history of Canada's health care system.









Socialized Medicine: The Canadian Experience

by Pierre Lemieux




The Canadian public health system is often put forward as an ideal for Americans to emulate. It provides all Canadians with free basic health care: free doctors' visits, free hospital ward care, free surgery, free drugs and medicine while in the hospital -- plus some free dental care for children as well as free prescription drugs and other services for the over-65 and welfare recipients. You just show your plastic medicare card and you never see a medical bill.

This extensive national health system was begun in the late 1950s with a system of publicly funded hospital insurance, and completed in the late 1960s and early 1970s when comprehensive health insurance was put into place. The federal government finances about 40 per cent of the costs, provided the provinces set up a system satisfying federal norms. All provincial systems thus are very similar, and the Quebec case which we will examine is fairly typical.

One immediate problem with public health care is with the funding. Those usually attracted to such a "free" system are the poor and the sick -- those least able to pay. A political solution is to force everybody to enroll in the system, which amounts to redistributing income towards participants with higher health risks or lower income. This is why the Canadian system is universal and compulsory.

Even if participation is compulsory in the sense that everyone has to pay a health insurance premium (through general or specific taxes), some individuals will be willing to pay a second time to purchase private insurance and obtain private care. If you want to avoid this double system, you do as in Canada: you legislate a monopoly for the public health insurance system.

This means that although complementary insurance (providing private or semi-private hospital rooms, ambulance services, etc.) is available on the market, sale of private insurance covering the basic insured services is forbidden by law. Even if a Canadian wants to purchase basic private insurance besides the public coverage, he cannot find a private company legally allowed to satisfy his demand.

In this respect, the Canadian system is more socialized than in many other countries. In the United Kingdom, for instance, one can buy private health insurance even if government insurance is compulsory.

In Canada, then, health care is basically a socialized industry. In the Province of Quebec, 79 per cent of health expenditures are public. Private health expenditures go mainly for medicines, private or semi-private hospital rooms, and dental services. The question is: how does such a system perform?

The Costs of Free Care

The first thing to realize is that free public medicine isn't really free. What the consumer doesn't pay, the taxpayer does, and with a vengeance. Public health expenditures in Quebec amount to 29 per cent of the provincial government budget. One-fifth of the revenues come from a wage tax of 3.22 per cent charged to employers and the rest comes from general taxes at the provincial and federal levels. It costs $1,200 per year in taxes for each Quebec citizen to have access to the public health system. This means that the average two-child family pays close to $5,000 per year in public health insurance. This is much more expensive than the most comprehensive private health insurance plan.

Although participating doctors may not charge more than the rates reimbursed directly to them by the government, theoretically they may opt out of the system. But because private insurance for basic medical needs isn't available, there are few customers, and less than one per cent of Quebec doctors work outside the public health system. The drafting of virtually all doctors into the public system is the first major consequence of legally forbidding private insurers from competing with public health insurance.

The second consequence is that a real private hospital industry cannot develop. Without insurance coverage, hospital care costs too much for most people. In Quebec, there is only one private for-profit hospital (an old survivor from the time when the government would issue a permit to that kind of institution) but it has to work within the public health insurance system and with government-allocated budgets.

The monopoly of basic health insurance has led to a single, homogeneous public system of health care delivery. In such a public monopoly, bureaucratic uniformity and lack of entrepreneurship add to the costs. The system is slow to adjust to changing demands and new technologies. For instance, day clinics and home care are underdeveloped as there exist basically only two types of general hospitals: the non-profit local hospital and the university hospital.

When Prices Are Zero

Aside from the problems inherent in all monopolies, the fact that health services are free leads to familiar economic consequences. Basic economics tells us that if a commodity is offered at zero price, demand will increase, supply will drop, and a shortage will develop.

During the first four years of hospitalization insurance in Quebec, government expenditures on this program doubled. Since the introduction of comprehensive public health insurance in 1970, public expenditures for medical services per capita have grown at an annual rate of 9.4 per cent. According to one study, 60 per cent of this increase represented a real increase in consumption.1

There has been much talk of people abusing the system, such as using hospitals as nursing homes. But then, on what basis can we talk of abusing something that carries no price?

At zero price, no health services would be supplied, except by the government or with subsidies. Indeed, the purpose of a public health system is to relieve this artificial shortage by supplying the missing quantities. The question is whether a public health system can do it efficiently.

As demand rises and expensive technology is introduced, health costs soar. But with taxes already at a breaking point, government has little recourse but to try to hold down costs. In Quebec, hospitals have been facing budget cuts both in operating expenses and in capital expenditures. Hospital equipment is often outdated, and the number of general hospital beds dropped by 21 per cent from 1972 to 1980.

Since labor is the main component of health costs, incomes of health workers and professionals have been brought under tight government controls. In Quebec, professional fees and target incomes are negotiated between doctors' associations and the Department of Health and Social Services. Although in theory most doctors still are independent professionals, the government has put a ceiling on certain categories of income: for instance, any fees earned by a general practitioner in excess of $164,108 (Canadian) a year are reimbursed at a rate of only 25 per cent.

Not surprisingly, income controls have had a negative impact on work incentives. From 1972 to 1987, for instance, general practitioners reduced by 11 per cent the average time they spent with their patients. In 1977, the first year of the income ceiling, they reduced their average work year by two-and-a-half weeks.2

Government controls also have caused misallocations of resources. While doctors are in short supply in remote regions, hospital beds are scarce mainly in urban centers. The government has reacted with more controls: young doctors are penalized if they start their practice in an urban center. And the president of the Professional Corporation of Physicians has proposed drafting young medical school graduates to work in remote regions for a period of time.

Nationalization of the health industry also has led to increased centralization and politicization. Work stoppages by nurses and hospital workers have occurred half a dozen times over the last 20 years, and this does not include a few one-day strikes by doctors. Ambulance services and dispatching have been centralized under government control. As this article was being written, ambulance drivers and paramedics were working in jeans, they had covered their vehicles with protest stickers, and they were dangerously disrupting operations. The reason: they want the government to finish nationalizing what remains under private control in their industry.

When possible, doctors and nurses have voted with their feet. A personal anecdote will illustrate this. When my youngest son was born in California in 1978, the obstetrician was from Ontario and the nurse came from Saskatchewan. The only American-born in the delivery room was the baby.

When prices are zero, demand exceeds supply, and queues form. For many Canadians, hospital emergency rooms have become their primary doctor -- as is the case with Medicaid patients in the United States. Patients lie in temporary beds in emergency rooms, sometimes for days. At Sainte-Justine Hospital, a major Montreal pediatric hospital, children often wait many hours before they can see a doctor. Surgery candidates face long waiting lists -- it can take six months to have a cataract removed. Heart surgeons report patients dying on their waiting lists. But then, it's free.

Or is it? The busy executive, housewife, or laborer has more productive things to do besides waiting in a hospital queue. For these people, waiting time carries a much higher cost than it does to the unemployed single person. So, if public health insurance reduces the costs of health services for some of the poor, it increases the costs for many other people. It discriminates against the productive.

The most visible consequence of socialized medicine in Canada is in the poor quality of services. Health care has become more and more impersonal. Patients often feel they are on an assembly line. Doctors and hospitals already have more patients than they can handle and no financial incentive to provide good service. Their customers are not the ones who write the checks anyway.

No wonder, then, that medicine in Quebec consumes only 9 per cent of gross domestic product (7 per cent if we consider only public expenditures) compared to some 11 per cent in the United States. This does not indicate that health services are delivered efficiently at low cost. It reflects the fact that prices and remunerations in this industry are arbitrarily fixed, that services are rationed, and that individuals are forbidden to spend their medical-care dollars as they wish.

Is it Just?

Supporters of public health insurance reply that for all its inefficiencies, their system at least is more just. But even this isn't true.

Their conception of justice is based on the idea that certain goods like health (and education? and food? where do you stop?) should be made available to all through coercive redistribution by the state. If, on the contrary, we define justice in terms of liberty, then justice forbids coercing some (taxpayers, doctors, and nurses) into providing health services to others. Providing voluntarily for your neighbor in need may be morally good. Forcing your neighbor to help you is morally wrong.

Even if access to health services is a desirable objective, it is by no means clear that a socialized system is the answer. Without market rationing, queues form. There are ways to jump the queue, but they are not equally available to everyone.

In Quebec, you can be relatively sure not to wait six hours with your sick child in an emergency room if you know how to talk to the hospital director, or if one of your old classmates is a doctor, or if your children attend the same exclusive private school as your pediatrician's children. You may get good services if you deal with a medical clinic in the business district. And, of course, you will get excellent services if you fly to the Mayo Clinic in Minnesota or to some private hospital in Europe. The point is that these ways to jump the queue are pretty expensive for the typical lower middle class housewife, not to talk of the poor.

An Enquiry Commission on Health and Social Services submitted a thick report in December 1987, after having met for 30 months and spent many millions of dollars. It complains that "important gaps persist in matters of health and welfare among different groups."3 Now, isn't this statement quite incredible after two decades of monopolistic socialized health care? Doesn't it show that equalizing conditions is an impossible task, at least when there is some individual liberty left?

One clear effect of a socialized health system is to increase the cost of getting above-average care (while the average is dropping). Some poor people, in fact, may obtain better care under socialized medicine. But many in the middle class will lose. It isn't clear where justice is to be found in such a redistribution.

There are two ways to answer the question: "What is the proper amount of medical care in different cases?" We may let private initiative and voluntary relations provide solutions. Or we may let politics decide. Health care has to be rationed either by the market or by political and bureaucratic processes. The latter are no more just than the former. We often forget that people who have difficulty making money in the market are not necessarily better at jumping queues in a socialized system.

There is no way to supply all medical services to everybody, for the cost would be astronomical. What do you do for a six-year-old Montreal girl with a rare form of leukemia who can be cured only in a Wisconsin hospital at a cost of $350,000 -- a real case? Paradoxically for a socialized health system, the family had to appeal to public charity, a more and more common occurrence. In the first two months, the family received more than $100,000, including a single anonymous donation of $40,000.

This is only one instance of health services that could have been covered by private health insurance but are being denied by hard-pressed public insurance. And the trend is getting worse. Imagine what will happen as the population ages. There are private solutions to health costs. Insurance is one. Even in 1964, when insurance mechanisms were much less developed than today, 43 per cent of the Quebec population carried private health insurance, half of whom had complete coverage. Today, most Americans not covered by Medicare or Medicaid carry some form of private health insurance. Private charity is another solution, so efficient that it has not been entirely replaced by the Canadian socialized system.

Can Trends Be Changed?

People in Quebec have grown so accustomed to socialized medicine that talks of privatization usually are limited to subcontracting hospital laundry or cafeteria services. The idea of subcontracting hospital management as a whole is deemed radical (although it is done on a limited scale elsewhere in Canada). There have been suggestions of allowing health maintenance organizations (HMO's) in Quebec, but the model would be that of Ontario, where HMO's are totally financed and controlled by the public health insurance system. The government of Quebec has repeatedly come out against forprofit HMO's.

Socialized medicine has had a telling effect on the public mind. In Quebec, 62 per cent of the population now think that people should pay nothing to see a doctor; 82 per cent want hospital care to remain free. People have come to believe that it is normal for the state to take care of their health.

Opponents of private health care do not necessarily quarrel with the efficiency of competition and private enterprise. They morally oppose the idea that some individuals may use money to purchase better health care. They prefer that everybody has less, provided it is equal. The Gazette, one of Montreal's English-speaking newspapers, ran an editorial arguing that gearing the quality of health care to the ability to pay "is morally and socially unacceptable."4

The idea that health care should be equally distributed is part of a wider egalitarian culture. Health is seen as one of the goods of life that need to be socialized. The Quebec Enquiry Commission on Health and Social Services was quite clear on this:

The Commission believes that the reduction of these
inequalities and more generally the achievement of
fairness in the fields of health and welfare must be
one of the first goals of the system and direct all
its interventions. It is clear that the health and
social services system is not the only one concerned.
This concern applies as strongly to labor, the
environment, education and income security.5

A Few Lessons

Several lessons can be drawn from the Canadian experience with socialized medicine.

First of all, socialized medicine, although of poor quality, is very expensive. Public health expenditures consume close to 7 per cent of the Canadian gross domestic product, and account for much of the difference between the levels of public expenditure in Canada (47 per cent of gross domestic product) and in the U.S. (37 per cent of gross domestic product). So if you do not want a large public sector, do not nationalize health.

A second lesson is the danger of political compromise. One social policy tends to lead to another. Take, for example, the introduction of hospital insurance in Canada. It encouraged doctors to send their patients to hospitals because it was cheaper to be treated there. The political solution was to nationalize the rest of the industry. Distortions from one government intervention often lead to more intervention.

A third lesson deals with the impact of egalitarianism. Socialized medicine is both a consequence and a great contributor to the idea that economic conditions should be equalized by coercion. If proponents of public health insurance are not challenged on this ground, they will win this war and many others. Showing that human inequality is both unavoidable and, within the context of equal formal rights, desirable, is a long-run project. But then, as SaintExupery wrote, "Il est vain, si l'on plante un chene, d'esperer s'abriter bientot sous son feuillage."6

Report of the Enquiry Commission on Health and Social Services, Government of Quebec, 1988, pp. 148, 339.
Gerard Belanger, "Les depenses de sante par rapport a l'economie du Quebec," Le Medecin du Quebec, December 1981, p. 37.

Report of the Enquiry Commission on Health and Social Services, p. 446 (our translation).
"No Second Class Patients," editorial of The Gazette, May 21, 1988.
Report of the Enquiry Commission on Health and Social Services, p. 446 (our translation).
"It is a vain hope, when planting an oak tree, to hope to soon take shelter under it."


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Mr. Lemieux is an economist and author living in Montreal.

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This article appeared in the March 1989 issue of The Freeman. Copyright © 1989 by The Foundation for Economic Education. Permission to reprint this article is granted provided appropriate credit is given and two copies of the reprinted material are sent to The Foundation.