Here's a comment from a good friend in Canada, quite active in healthcare struggles./m
From: "Colleen Fuller" <[EMAIL PROTECTED]> To: "'michael a. lebowitz'" <[EMAIL PROTECTED]> Subj: RE: Re: [PEN-L] walter reed, privatization, and public health Interesting discussion. I tend to agree with the last fellow who said that "there does seem to be evidence that having government act as health insurer rather than primary direct employer of medial labor weakens (but does not eliminate) its ability to cut funds for its healthcare system." Single payer systems are insurance-based. The main difference between public and private insurance is that public insurance operates on a non-profit basis and the risk is spread among a larger population which pays taxes instead of premiums. Public insurance is not usually burdened with deductibles and co-pays, so such systems are better able to embrace the principle of universality. However, health insurance systems as a whole are less efficient than publicly-funded models. The main reason Canada has such a system is because physicians aggressively insisted on fee-for-service, something that is difficult to maintain in a publicly-funded system. The Douglas government in Saskatchewan had initially introduced something that resembled the NHS; the compromise with the striking medical profession was a publicly-insured system of medical care. Hospitals were not technically in the insured system -- they were and are publicly-funded institutions mandated to provide "insured services". But they aren't reimbursed on an insured service basis like physicians are. By law hospitals are publicly funded and non-profit -- and currently "global funding" of hospitals is under attack by private providers. In publicly-funded systems, governments are much more than just "primary direct employers of medial labour". They are able to play a more effective role in ensuring equitable distribution of health resources across the population, for example. Evidence does suggest that these systems are more efficient because of the more effective use of resources to meet specific public policy objectives. I'm not sure what the last writer means when he says that "Sweden and Finland, though decent systems, have worse results than France". OECD data show very little difference in major indicators like infant mortality and life expectancy. Japan and Iceland typically show better results -- and Japan's life expectancy is over 85 years, compared to ~82 years for France and Canada. If, by "results", he means health outcomes then Japan's system would be the best by these measures. But health outcomes don't have to do with health systems exclusively. Access to care and medicine is important but so is a roof over your head and the general level of equality and equitable distribution across the economy. That must be one reason that Cuba's population is healthier than many other wealthier countries. It doesn't matter what kind of economic system one is talking about: all health care systems are a reflection of public policy. Even the American one. Colleen Fuller (604) 255-6601 Vancouver, B.C. Michael A. Lebowitz Professor Emeritus Economics Department Simon Fraser University Burnaby, B.C., Canada V5A 1S6 Currently based in Venezuela. NOTE NEW PHONE NUMBERS Can be reached at Residencias Anauco Suites Departamento 601 Parque Central, Zona Postal 1010, Oficina 1 Caracas, Venezuela (58-212) 573-6333, 571-1520, 571-3820 (or hotel cell: 0412-200-7540) fax: (58-212) 573-7724
