2nd tier court decisions

[Sothy]

I'm going to post more tomorrow, but the Chaouilli decision by the Supreme Court of Canada last week is very interesting/unusual because the "right" was happy with judicial activism and the "left" was pissed (in stark stark contrast to "same sex" marriage being okayed by the court).

I just posted this now to see if anyone is still reading and thinking about these things...(by the way I am happy with both the same-sex decision and the Chaouilli decision, so either I'm crazy, too flexible, or onto something)

ps. for those who aren't in Canada or who are young enough not to care about their health...

prior to Chaouilli, one could not buy private health insurance in Canada (still can't as no company is that quick). So, while one could (somewhat legally at best) buy private MRIs, private surgeries, etc. private insurance was either illegal or restricted in such a way that no doctors were available to practise outside of the public Medicare system (ie. their pay rate was tightly controlled and there would be no financial benefit in leaving).

While the court didn't dictate how governments should allow for more choice in health care in the country, it did say that the Quebec restriction (the other provinces are uncertain at this point in time, but they will go the way of Quebec according to all the pundits) on private insurance was unconstitutional as it meant that only the very rich could buy private medicine and the rest of society had to wait in line (as 20k for an operation is too much) even though that was bad for one's health. Thus, the government of Quebec will likely have to allow private insurance companies to be set-up in their province. This means that the average citizen can get private insurance...

but is all good? Insurance companies won't insure for pre-existing conditions, they won't want to insure for expensive procedures, and private surgical facilities can cherry-pick the most profitable operations, with the most amount of cost-certainty, away from the public system, which will lead to an increase in the salaries of medical practitioners, etc.

Also, if the rich have their health provided for, what will come of the public system?

Still, given all of this, the same Supreme Court (albeit different members) that made abortion legal, that made same-sex marriage legal, that has consistently pointed out that Aboriginals have rights that can't be ignored, sided with "rich" individuals and "allowed" a bit of hiercharcy to form...

Are they too far ahead the rest of us?

[Dialectic]

I too agree with this decision. I look forward to hearing more of your thoughts.

[angi]

So will there now be a two-tiered system where a person could either be fully dependant on state health care, buy private insurance, or do both?

Health care is kind of BS deal. If you do a straight state-run system, then you have rationing and people don't get the level of care that they would in a private insurance system. You also don't get the state of the art technology and innovations because those things usually are closely tied with funding/pure capitalism. However, in the private insurance system (ie American) no one can afford or qualify for insurance unless it is provided for by their employers. What you end up with is a lot of people that are uninsured. There seems to be no answer.

Although I would not mind going back to the days when you just paid your doctor directly out of your pocket and your doctor charged amounts where this was actually feasible. But the costs of health care have been so inflated by greedy insurance companies (and doctors to an extent) this is no longer plausible.

*shrug*

[da Tao]

I agree with the decision only because it is precipitating a (psuedo-)crisis, and that is important for a swift kick in the ass for lots of people. Of course, if badly managed this can destroy medicare as we know it.

There is something to be said for disciplined pluralism. More on this later.

From some Swiss mountain, da Tao

[minbo]

There is a small but growing movement of General Practicioners in the US that are refusing to take Insurance. Their reasoning is that the insurance companies pay schedule per visit is so low that the GP's have to essentially churn through a large quantity of patients for equal pay. This results in overworked doctors and lower quality of care per patient. The office visits charge for non-insurace accepting doctors is higher per patient, but the doctor spends much more time with the patient per visit such that their overall gross take per day is similar. They do advocate however getting perscription medicine coverage as well as coverage for any advanced/critical care. The costs for an average teen through older adult is actually than conventional insurance stratagies, as even though you pay more per visit, when you are healthy you don't have any costs. For children and elderly this stratagy does not work well as they visit the GP's more often, though the costs for self-insurance for GP visits and supplimental medical insurace are still not too far above full medical insurance prices.

About perscription medicine coverage, the whole debate about perscription medicine for medicare misses the entire point. The more commonly used drugs should not cost anywhere near as much as it does. Certainly when a new drug comes out the costs will be high to re-coup development costs, but after it has been about for a number of years and the costs repaid, if the drug companies did not operate quite as much as a cartel with the implicit cooperation of most insurance companies, medical procurement companies, doctors/hospitals and lawmakers, the costs would naturally ramp down. If the prices for these drugs were lower than the need for perscription medicine coverage via medicare would be so much lower that the additional cost for it would not be much of an issue. There is something wrong when an AIDS drug cocktail in the US costs over $10,000 but Cipla Ltd can offer it for $350 a year to MSF and developing nations and be profitable. That gap is just too large to simply be extra costs in meeting USDA regulations plus "reasonable" profit.

[Sothy]

I am severely behind schedule as far as this thread is concerned, but hopefully will get to it by the end of the weekend.

Regarding self-insurance, the problem is that it is the healthy group that doesn't need doctors (ie. me) who pays for the sick who need them (ie. me when I'm 80). As soon as people "opt out" the system as a whole becomes more questionable, parallel private options can work because everyone is still opted in, they just aren't using/have a different usage option available, that is different than what is happening in the USA.

The USA is the only (well, maybe one other (Switzerland?)) country in the OECD that doesn't have some type of price control on their drugs. That's a seperate issue in many ways...(although it all plays in as far as Canada is concerned as our medicare system is a bit whack with drug coverage but I'll talk about that later (or so I plan)).