Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, July 30, 1990 TAG: 9007310329
SECTION: EDITORIAL PAGE: A/7 EDITION: METRO
SOURCE: JOHN SHELTON, M.D.
DATELINE: LENGTH: Medium
The federal-provincial national health-insurance scheme operated in Quebec much as it operated in the rest of Canada. The system covered all office and hospital services. Every person had access to health care, and the physicians were paid by mailing an invoice for each patient - much like a credit-card invoice - to the provincial government every two weeks. (There were no collections problems.)
Almost everyone was reasonably happy with this very workable though imperfect system. The medical care was as good as that offered in the United States.
In 1981, waiting periods for office appointments in Montreal were comparable to ours. Waiting periods for such operations as cardiac-bypass grafting and total hip-replacement were also comparable to ours, although now the wait for these procedures can be six months to a year in some parts of Canada.
In Quebec, physicians by law could not add surcharges to government reimbursements for their services, but they could in Ontario and several other provinces. Medical practice was less lucrative in Canada than here, but the pay was certainly adequate.
The patchwork health-insurance system in this country does not work to the benefit of the average consumer of health services. Health insurance is expensive, often too expensive for those who have to buy it themselves.
It often requires one- to two-year waiting periods before it will pay for services for any pre-existing condition. This means that people with medical problems who change jobs, are laid off or become self-employed are left without coverage for their conditions.
People with chronic medical problems can become locked into their jobs because of their insurance coverage. When a physician and an insurance company get into a dispute about whether a service is necessary or covered, the consumer - not the errant party - winds up stuck with the bill. Groups can and do occasionally cancel members' coverage, leaving chronically sick persons with no health insurance.
Then there are those with no health insurance. In the United States, 20 percent of the general population and 25 percent of the children live at or below the poverty line. Forty million people have no health insurance, and probably half that many more have inadequate insurance. The most common cause of personal bankruptcy in the United States, I've read, is still unforeseen medical expense. This is a national disgrace.
The health of the population is a most basic asset to any nation. I think it is ludicrous that taxes provide parks, garbage pickup and highways, but no universal access to basic medical care and preventive services. Only the United States and South Africa in the industrialized West lack some kind of national health plan.
In genuine emergencies, everyone gets care, and the question of ability to pay arises later. But there is no provision for ongoing care of chronic conditions like diabetes and coronary disease for people of little means.
Medicaid, which in Virginia denies benefits to people whose income is 40 percent or more of the poverty level, is by definition inadequate. Health departments and free clinics have limited resources and a limited reach. The insurance companies, of course, cannot plug this huge gap and stay in business.
While it sounds very expensive, a national health plan may actually save the nation money, because it will force resolution of such issues as resource allocation, tort reform and the equitable settlement of malpractice claims.
We have the most expensive health-care system in the world - 12 to 14 percent of gross national product - and it suffers from the most uneven access, the poorest cost-containment and the most arbitrary settlement of malpractice and injury claims. Canada and West Germany, with universal access, spend 9 to 10 percent of GNP on their systems.
Requiring employes to provide health insurance to all employees, as suggested in Congress is simply too expensive for small employers. Also, this idea still makes no provision for those between jobs, the self-employed and the self-employed working poor such as those who do odd jobs for a living.
Whatever plan we adopt, this nation needs a health-insurance plan providing universal access and physician incentives. It is simply a matter of social and economic justice.
by CNB