Medicare rule changes urged Time to make room for private health care, chairman says
The Toronto Star
April 9, 2002
By Theresa Boyle
Canadians should be allowed to pay out-of-pocket for some medical procedures now covered by provincial health insurance plans, says (Tony Fell) the head of the University Health Network. (The University Health Network is the largest academic health sciences centre in Canada. It encompasses Toronto General Hospital, Toronto Western Hospital and Princess Margaret Hospital.)
He said the ban on extra billing of patients by physicians for "more exotic medical services and treatments over and above basic health care" should be lifted. The Canada Health Act should be opened up to allow private coverage of a hip or knee replacement "to facilitate a better golf game," he said, offering an example. He had no other examples available.
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Comment: If a joint replacement is not medically indicated, then it really wouldn't facilitate a game of golf and shouldn't be done, regardless of the funding source. Of course, the example chosen is ridiculous and would never be a basis for privatizing Canada's Medicare system.
But efforts continue in Canada to open the private markets in health care which can only result in two-tiered health care. Initially, the affluent will use the private approaches primarily to bypass the queue. But then the public Medicare program will be treated like a safety-net or welfare program and will be chronically under-funded. The irony is that health care for the wealthy will not improve significantly in spite of a greater infusion of personal funds, but health care for those with modest or low incomes will deteriorate because of inadequate public funding. Canada must reject privatization schemes that would defeat the public good.
Jeff Kirsch, Deputy Executive Director, Families USA, responds to Donald Light on employer coverage (March 30):
In the recent discussion of employer coverage via your email, Don Light wrote:
"In a detailed study of private employers, Marquis and Long found that 51.5% of small employers offer health insurance (many with high co-premiums that workers feel they cannot afford), but they also found that only 58.1% of all other employers offered health insurance. This is a strikingly low number for a system based on employers in a large, affluent nation."
Please pass along to Don the following information from a Kaiser Family Foundation/Health Research and Education Trust survey report on employer coverage (http://www.kff.org/content/2001/20010906a/EHB2001_sof.pdf , see page 3 ). Their data are very different than those cited by Don.
In the summary of this 2001 report from, the authors state that employer-sponsored coverage reaches 2 out of 3 Americans. Don may be using different criteria for "small" employers, but the report says that 65% of small business (3-199 employees) offered health coverage, and that virtually all firms with over 50 employees offer coverage. The breakdown of firms offering coverage looks like this: 58% of the smallest (3-9 employees); 76% of firms with 10-24 employees; 90% of firms with 25-49 employees; and 96% of firms with more than 50 employees.
Of course, this doesn't mean that all employees are eligible for coverage (overall about 20% are ineligible because of issues like waiting periods or minimum work hour requirements); nor does it mean that all those eligible elect to take it (about 17% of those offered coverage don't take it for cost reasons or because they have other coverage, such as through a spouse).
I'm not responding because I think that employer coverage is the answer to our many problems. Clearly, there are many concerns about the quality of coverage employees receive and how much they must pay. And there are more reasons to be worried about the movement of some employers to defined contribution policies (teaming catastrophic coverage with MSA-type schemes).
But the fact remains that approximately 9 out of 10 Americans with private coverage get their coverage from their employer, so we need to monitor that closely and work for improvements. Moreover, as much as we might want to move to a national health insurance system, we face a mighty challenge from those who want to move to an individually-based market system using individual tax credits. This threat is growing and it is not advocated just by the right-wing: many moderate Republicans and Democrats also support individual tax credits. In the face of that serious challenge, our sense is that supporting existing employer coverage becomes an important piece of the strategy to hold the line against an individual tax credit approach to health care "reform."
Hope this adds to the debate. Jeff
Ida Hellander, M.D., Executive Director of Physicians for a National Health Program, responds to Jeff Kirsch on employer-sponsored coverage:
Jeff's figures exclude Medicare beneficiaries -- if you add Medicare then Light is right. Also, much of that "employer-sponsored" coverage is actually publicly-funded coverage for government workers. If you exclude them, private employers only COVER 43% of Americans (not 90%!!) and only PAY for 21.2% of health costs.