Those Wacky Canadians!

Several items from up North, in response to the "serious" Rep. Paul Ryan proposal to get rid of Medicare. Previous entries: why Ryan's plan -- approved by the House last week with only four Republicans voting against it -- would indeed mean the end of Medicare, and larger problems with controlling late-in-life medical costs.

First, a primer from a reader in Montreal (I think - or someplace up there):

>>Here is how health care is financed in Canada.

1- The state determines how much money is available for heath care from the budget of the year. Say $1.00 [billion] etc

2- The state then asks the various medical professionals for a price for say 50,000 broken legs to be repaired, 20,000 births, you name it. The statistics of the needs of the country are known from previous experience.

3- The medical professionals discuss between themselves how to divide the available money for the various procedures. They know that it takes 10 minutes to do this and two hours to do that.

4- They return to the state with a price list for each procedure.

5- The state then guarantees that every medical act will be paid according to the price list.

6- The medical professionals know that they will get paid immediately upon completion of services. The only paper to fill is a credit card slip of paper containing the identification number of the physician and the procedure with the agreed price.

7- That is it. No collection agency, no discussion with an insurance about the need to do an MRI etc.. Whatever is ordered by the doctor is executed. If a question arises, then it is the medical association that looks into the matter and decides. The association has the power to remove the license of the offending doctor.<<

In a follow up note, the same reader adds:

>>There is a social impact as well.   Since health care is free, when a doctor screw things up (yes it happens in Canada) fixing the problem is also free. Hence the patient does not develop the anger of paying his bills and losing his home for the mistake of somebody else.

Result: A Montreal friend orthopedic surgeon specializing in spine surgery told me that he pays $5,000 per year for malpractice insurance per year.  

Compare that with the $250,000 for insurance of the average surgeon in Dallas, TX. The doctor must recover the insurance fee by charging more, and you end up in a vicious loop.

Fairness and justice makes life easier for everyone.<<

Also in the North American Solidarity theme, note this passage from (Toronto-born) David Frum's recent essay on why Republicans have lost their political and philosophical bearing by treating society as an atomized chaos of Ayn Randian standalone economic units, rather than as an organic whole in which public programs play an important part:

>>I cannot take seriously the idea that the worst thing that has happened in the past three years is that government got bigger. Or that money was borrowed. Or that the number of people on food stamps and unemployment insurance and Medicaid increased. The worst thing was that tens of millions of Americans - and not only Americans - were plunged into unemployment, foreclosure, poverty. If food stamps and unemployment insurance, and Medicaid mitigated those disasters, then two cheers for food stamps, unemployment insurance, and Medicaid.<<

I am a proudly nationalistic Yank, but I look with respect to these pensées septentrionale.

To round things off, a view from a practicing physician right here in the USA:

>>The real winners in the Ryan plan are the same as for Obamacare: the insurance companies. 

As always, follow the money.  Who gives the most money to whom and whose lobbyists are writing legislation.

My father was also a doctor who originally was against Medicare, in fact, his partner at the time, Dr. Ed Annis was leading the charge against Medicare.
The real reason health care costs are out of control is how Medicare was set up to begin with.  It encouraged fee increases and paid for any and all new equipment.  Practically every time Medicare has come up with new rules and regulations to save money by screwing the doctors, doctors have found new and creative and mostly more expensive ways of practicing.  It's largely a great stupid expensive game.<<

The reference to Dr. Edward Annis shook up something in the childhood memory bank. It is worth reading about his extraordinary efforts, as a public speaker for and then the president of the American Medical Association, to oppose the creation of "socialized medicine" through Medicare. These included renting out Madison Square Garden for a big anti-Medicare doctors' gathering. American politics has been fractious for a long time.

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James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

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