Tuesday, April 21, 2009

Response regarding Canada's System...

From Carl, a Tight Head Prop...

Health care in Canada
Between You and Carl Pilon

April 20 at 7:08pm
Hey there!

Let's be serious for a sec, so I can answer your question: doctors are not required to participate in the single-payer system; however, if they opt out, they have to *completely* opt out, that is, they cannot receive *any* payments from their province's health insurance board.

This leaves MDs in a bind as there are very few people who could afford to pay what it would cost to go see a doctor. Also, MDs like that would not get operating privileges in hospitals, so that would restrict their practice even more. One could argue that if enough MDs of enough different specialities opted out and got together they could create their own private hospital, but the cost of setting up such a facility, and of keeping it running – staffing it with nurses, respiratory therapists, x-ray technicians, etc. –, would drive up the fees so high that potential patients would be few and far between.

Also keep in mind that what private medical insurance that is available in Canada – which as you probably know does exist, most employees getting some kind of coverage through their jobs – does not cover (obviously) what is provided by any given province's public health care plan. In several provinces, it is actually against the law for insurance companies to provide coverage for e.g. MD fees. However, this type of provision was struck down as illegal by the Qu├ębec Court of Appeals (highest court in that province) a few years ago, so it is now possible to buy a policy which would be akin to a US health care policy in that province. I'm not aware that insurers have rushed to create products to fill that niche; there is probably no demand for it, because a) there are no providers (as I've outlined above) that one could pay with such a policy and b) it would be so costly that it would be out of the reach of all but very few. Those very few already paying taxes that go in part towards health care coverage, I'm not sure they'd be keen on paying some more to gain access to not a whole lot more.

Finally, I think it's important to point out that doctors operate private practices here. There are private clinics all over the place; the capital difference is that payment is provided from *one* insurer, as opposed to many as in the US. Doctors here are adamant that they are 'private entrepreneurs', which I find hilarious… but it's true. One of my closest friends is an anaesthesiologist here, doing *quite* well for himself, and I like to tease him that he's as much a civil servant as I am, seeing as his salary his paid for by the state, just like mine. He's actually right, though, in saying that he's not, as he can decide (up to a point: the hospital where he works does have expectations regarding a job that needs to be done!) how, how much, and when he'll work. It's up to him.

Does that clarify things a bit?
April 20 at 7:25pm
In the US, MDs are dropping off Medicare and Medicaid like twink underwear in the Castro.

So, if the US Feds create a universal health insurance system, my guess is that they won't have any MDs.

Our country is HUGE. Too much money flowing for any big changes.

They'll throw money at IT, electronic medical records, whatever. They'll run a experiment, giving the states the option to take the Fed program.

In fact, I know of two legislatures that'll reject a Fed HC plan. Interesting.

States Rights is one of the Hurdles to health insurance in the US. Each has his own uniquely stupid rules, ergo, insurance companies can't compete across state lines, pooling risk with a larger population.

Our real challenge is cost. Without addressing costs, nothing else will matter much.

Cheers for the insight..

April 20 at 7:54pm
All health care programs are run by the provinces. The Feds used to give a lot of money – in the beginning, it was 50-50. Now federal funding is much lower, but they still put some money in the kitty, and because of that funding provinces have to play by the fed rules, which are the 'five pillars of Canadian public health care'.

Let's see if I remember:
– Portability (e.g. if you move to another province you're still covered)
- Universality
- Public provision
- er... no cost / co-pay
= and… something else.

In any event, a few years ago Alberta wanted to introduce co-pay; the federal Health minister said "Na-han, not while you're taking our dough!". Alberta responded "You're only footing 11% of our bill, so we'll just say no and find the money somewhere else so we can do what we want." In the end they didn't, but that did scare a few member of the Toronto 'one-nation' intelligentsia. Which is always a good thing in my mind.

Cost is a challenge everywhere, but what complicates matters in the US is the layer of administrative costs that are generated by the massive insurance bureaucracy. There is a reason why American health care is 50% more expensive per capita compared to 2 other expensive systems (France's and Canada's, which are among the OECD's most expensive after the US') with outcomes that are slightly worse (in terms of life expectancy, infant mortality rate, infant birth weight, etc. ) than either. And of course it's even more expensive compared with others in the OECD.
April 20 at 8:16pm
I disagree in quality of care, but that's another debate.




  1. "Our country is HUGE. Too much money flowing for any big changes."

    I would disagree with that a little, if change is really needed and wanted than it could be done by the Gov. But who really does want a change in the HC system in the US? Maybe the ordinary folks but that's about it.

    Take care, Elli

  2. Elli,

    I think you're right. Our Senate is where the deal will be made, if any, and I don't any significant changes.

    What they'll do is throw money at Health IT.

    As to the folks? I don't know. I feel that the negative reporting on the economy has them worried about jobs and income, with HC taking a back burner.

    That's because it's NOT an election year. ;)

    Cheers for the Comments! Any insight from our Northern Brethen is welcome.