09/21/98 THE RISKS OF TINKERING WITH CANADIAN HEALTH CARE

THE RISKS OF TINKERING WITH CANADIAN HEALTH CARE

As a Canadian citizen and a resident of Britain, I must point out that Britain's mixed system is far worse than the one in Canada: In Britain, waiting times are measured in months, not weeks (''Canada's health-care system isn't a model anymore,'' News: Analysis & Commentary, Aug. 24-31).
Private health care competing with a publicly funded system is the thin edge of a wedge to separate the two completely--ultimately leading to the demise of universal coverage. The reason is simple: People using the private system would not want to pay for both systems when they are using only one. Being wealthier, they would be more capable of exerting political pressure to reduce their taxes, leaving the public system to strangle from underfunding.
Contrary to what the Fraser Institute would have us believe, people rarely directly pay for medical care in any system. Most prefer to ''socialize'' their risk privately through insurance. As in the U.S. and elsewhere, insurance companies would have incentives to cherry-pick their clients. No doubt many would find themselves denied coverage, perhaps because of age or preexisting medical conditions. Children from families not able to afford coverage would be most at risk.
A single-payer system is still much more efficient, at least from an administrative and bargaining point of view, than any mishmash of private insurers can ever be, so total costs would be expected to rise. This isn't to say private elements can't, or shouldn't, be introduced to improve efficiency, but their impact on universality should first be put to the test. While the trend is toward private coverage, I question its motives and ultimate desirability.
Marc Charron
Troon, Scotland