More indepth Q&A on a rational health care system

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Now, I can't speak to healthcare coverage, because I am in the P&C business, but I can tell you that what DOES happen a lot of the times is that people will assume they have coverage for things that they do not, and then seek to reclaim those costs. That's more a function of not reading their policy than insurance companies trying to "screw" their customers.

Information asymmetry has a lot to do with this as well. Most average people can't understand the legal jargon that comprises insurance policies, and this benefits the insurer. Tell people that they're covered for any treatment that is medically necessary, and then let them pay for it through their taxes, probably at a rate that costs them less than the equivalent private insurance package.

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And again, I feel the need to remind you that very rarely will you have lawyers directly under the employ of an insurance company. Insurance companies will generally contract panel councils, and many insurance companies use the same law firms.

Whether it's one lawyer working on 100 cases, or two lawyers each working on 50, it's the same thing. Whether it's an in-house lawyer or a contracted council, it makes no difference (in fact, it might actually cost more).

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I absolutely agree with you, which is why I suggest that a big factor in removing these costs is to modify the way that torts are handled.

This would not absolve your system of its vast bureaucratic waste.

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Of course it does! Same population will, generally, require the same amount of manpower to file claims, determine scope of coverage, underwrite, etc. All you'd be doing is bring it under one umbrella. 10 underwriters doing the same amount of work is going to cost the same whether they are working for 2 companies or 10.

You're misguided here, Todd. Economies of scale. Fewer secretaries, fewer facilities, fewer everything, basically.

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Excuse me? Did you just suggest that I don't have a brain?

No. What I meant to say was "Every health policy expert with a brain knows that they need some sort of socialized, universal health insurance system." I apologize for implying otherwise.

EDIT: Addressed Phred's comments

Phred wrote:
[Talking about the the volume of diagnostic imaging machines.]

Equipment density is a poor barometre of quality. A much more important and appropriate question is 'do you have enough equipment to meet the needs of your population.' If you have an MRI machine for everyone in your city, your system is costing you way too much.

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Then of course there was the widely reported case that ended up in front of the Quebec Supreme Court, where some guy whose name escapes me at the moment tried to recover from the Canadian government the costs of his travel and treatment to England (I think it was) because he would have had to wait some absurd amount of time to have it done in Canada, and it was a condition where time was of the essence.

You have your facts in a knot. The procedure in question was elective. In other words, the person's doctors decided that time was not of the essence.

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I see a lot of arguing over "efficiency" here. In medicine, "efficiency" is not a cut and dried concept. Are we talking dollars and cents efficiency or timeliness efficiency? Because if it is the latter, the US system wins hands down.

No, the U.S. system loses. Why? Forty million people wait forever.

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And even if we are talking dollars and cents, don't forget that in Canada, prescription drugs are not covered. So someone waiting a year and a half for an "elective" surgery (a knee operation or hip operation, say) could burn through thousands of dollars of pain medication waiting for the surgery.

The system is not perfect. We need a national pharmacare program. Prescription drugs provided in-hospital are covered under medicare.

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In the meantime, they might also be disabled to the point they cannot work properly, or even at all, which means extra costs to other government redistribution programs such as workman's compensation or disabilty benefits or unemployment insurance or whatever.

These issues are factored into the physicians decision regarding the urgency of the procedure.

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Then of course there is the whole quality of life issue -- how do you assign a dollar value to that? It's no picnic being semi-crippled and suffering chronic pain for months (or in some cases a year or more) on end.

Unless, of course, you're poor and can't afford insurance at all?

Again, all of these issues are factored into urgency.

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It is this last reason more than any other that leads so many Canadians to cross the border and get themselves treatment immediately. Sure, they could wait and eventually get it done for "free" in Canada. Did you ever stop to think WHY so many prefer to spend the money to get fixed up NOW rather than wait months and save a couple thousand bucks? Do you think it is because these people are stupid or something? Remember, the folks who get this work done outside Canada never get reimbursed for their expenses -- they still pay the same taxes as everyone else. Yet they dig into their own pockets regardless. These people get socked twice -- they are paying US prices for the medical care they actually receive AND they are paying Canadian prices for that same care which was never delivered. But to these folks, it's worth it.

Would you like to support any of your claims with any evidence? Do you have figures that indicate how many Canadians cross the border for medical care annually?

If a patient has to wait an inappropriate length of time for service, it is the result of a medical error by a physician. Medical error is as likely to happen under one system structure as it is under another.