Problems with Health Care and Insurance and the
Canadian System
November 1st 2005
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I've looked at
the Canadian "healthcare" system pretty regularly over the past few
years, and they really are not all that happy with it. Canadians who
can afford it, and cannot (or think they cannot) afford to wait,
cross the border for their healthcare procedures, particularly if it
involves a large machine like an MRI or a CAT scan (or similar).
The problem with Healthcare Insurance in the United States is pretty
complex: First, you have too many people getting something for
nothing; that overburdens the doctors, who have to make a profit,
too, and the hospitals, who have to make a profit ... and at who's
expense do you suppose they are going to exact that profit? So they
drive up the cost of caring for people.
Second, you have a society that is all too happy to sue just about
anyone for just about anything. A Doctor is highly educated, to be
sure, but every doctor I know makes mistakes. They're human, after
all; and all it takes is that ONE mistake on or around that ONE guy
or girl who wants to turn it into a spin at the Lotto with virtually
guaranteed results. To fend off all the lawsuits, any MD worth their
cotton balls invests heavily in Malpractice Insurance; which costs
them plenty and, as we've already discussed, doctors have to make
profits, too ... and so the cost gets passed on to the consumer or
their insurer, whichever is the easiest from whom to collect.
Then you have the insurance companies themselves who
are almost CONSTANTLY trying to bid the doctor's bill down: They
base this bid-down price on a formula that uses what they call "the
prevailing competitive price," but I have yet to find a doctor (who,
by the way, in case I didn't mention it, has to make a profit so
that he can live) who actually charges the PCP. SO, if the MD
doesn't alter the bill, the victim...I mean, the patient gets to
cover the overage which is in ADDITION to any deductible or co-pay.
Finally, you have the patients, themselves. We are increasingly
a society of hypochondriacs. Whereas our fathers and mothers
typically treated their own colds and flu at home as well as those
of their children, today's family is more likely to make a cough
into a visit with the pediatrician. The medical community has
convinced us we cannot tell whether we have a cold or a flu, and
that it's important that we know the difference (even though the Tx
is nearly identical and there is nothing you can do to actually CURE
either one). SO, whereas actuarially sound rates might be based on
4-6 trips per year to the MD or specialist, the average human bean
visits his or her MD upwards of 8 or 9 times (these aren't real
numbers, I don't know the real numbers...just using these for
explanatory purposes).
SO, what's the solution?
- Put emergency medical care under a seperate,
state-controlled system and pay for it with some kind of "use" tax
on something widely available and that just about everyone uses.
- Forbid lawsuits against doctors or hospitals
unless the actual damages exceed a strong, and high, economic
threshold (like, say, $100,000) and, then, limit awards to only
the actual damages...no "punitive" damages. If the doctor was NOT
negligent, but actually did the misdeed purposely, then arrest him
or her, try him or her, make his or her estate pay everything to
the victim, and throw him or her in jail.
- Allow Doctors to charge as much as they need to
charge to earn a profit; which will be lower than they charge
today because they won't need as much (or any) malpractice
insurance...and they won't be treating people for free.
- Limit the number of trips a body can make to
the MD for superfluous crap like colds and flu (unless life
threatening, for example, to an asthmatic or the elderly).
- Enjoin insurance companies to work WITH the
doctors on loss mitigation programs like "heart smart" and
"Beating Diabetes." Insurance agents and companies can be very
large knowledge repositories and they are almost expert at risk
management...use them.
That's how I see it, anyway...from the inside.
By Dave Davis
Dave is an insurance specialist living in the Midwest
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