Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment.
But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.
The country’s publicly financed health insurance system — frequently described as the third rail of its political system and a core value of its national identity — is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine.
Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court.
“We’ve taken the position that the law is illegal,” Dr. Day, 59, says. “This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.”
The article continues with:
Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.
But a Supreme Court ruling last June — it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists — appears to have become a turning point for the entire country….
But most Canadians agree that current wait times are not acceptable.
The median wait time between a referral by a family doctor and an appointment with a specialist has increased to 8.3 weeks last year from 3.7 weeks in 1993, according to a recent study by The Fraser Institute, a conservative research group. Meanwhile the median wait between appointment with a specialist and treatment has increased to 9.4 weeks from 5.6 weeks over the same period.
Average wait times between referral by a family doctor and treatment range from 5.5 weeks for oncology to 40 weeks for orthopedic surgery, according to the study.
The long wait times, the doctor shortages, and the overall bureaucratic nature of a nationlized health care system probably also explains this:
More on the picture can be found here and the full article from the New York Times can be found here.
Update: Newmark’s door has more.
I didn’t know Canada had a law against charging for something that is provided free (at least in medicine)…
Interesting read, HP… I’m guessing this case will have an interesting development.
Its simple. They need to spend more money, but don’t want to. Brain drain to the US is the major cause - who wants to work for half the pay?
Does this mean the whole system should be put in the trash? No. Canada spends half as much as the US per capita - $2,163 versus $4,887 in 2001 - and live longer, and healthier.
I’ve experienced health care on both sides of the border (2 provinces & 22 years, 1 state - two kinds of insurance & 4 years) and I have to say I much prefer the northern type. Healthcare in the US is decent at fixing you once there is a problem, but has no interest in preventing the problem in the first place.
The problems you mention are inherent in any government health care system. As long as people tend to prefer lower taxes, politicians will always want to cut costs on something as expensive as health care, and as long as the pay for doctors isn’t allowed to reach the equilibrium point a free market would let it, you will get many doctors who will go to where the pay is better and/or you will have less intelligent doctors entering the medical profession.
For more on this, Thomas Sowell goes into more detail here, here, and here.
As far as statistics comparing the two health cares, well that is misleading too, since accurate comparisons between the two are hard to find. For example, you can’t simply compare life span, since the United States has a larger crime rate than Canada, we eat more fast food, we have a different make up, etc, you get the idea.
However, there are some clear differences between Canada’s health care system and the United States. For example, the United States is the clear leader in medical inventions; in other words, it is the United States that sells medical inventions cheap to Canada, not the other way around. So much of that ‘cheap healthcare’ in Canada is a direct subsidy from the United States.
In addition, Canadian’s wait significantly longer to get health care service than Americans do especially with regard to more expensive medical procedures, for example see here and here.
All of the above probably explains why the United States - more than any other industrialized nation - has the highest survival rates for cancer patients. We have more qualified doctors, better medical inventions, and a shorter waiting time to diagnosing early, all in all giving us a higher survival rate for those who already have cancer.
Last but certainly not least, let us not forget that Canada’s health care system is relatively new. It takes time for people to reorder their lives, to go through medical schools, and so forth, and as such, I can only see Canada’s health care system getting worse. A price cap on doctor pay is sure to bring in lower quality doctors or push high quality doctors to find new areas of work, a problem that is only getting worse in Canada not better. In addition, like all welfare systems around the world, it takes a few years, sometimes an entire generation, for a community to absorb the generous welfare system around them, and when that happens, you will have more and more people using the system inefficiently, thereby draining more money from the system, and making it even more expensive. Which means politicians will have an even bigger problem of being forced to cut costs even more or raising taxes that also hurts the economy as a whole.
So in conclusion, I see Canada’s health care system as a current failure, and a failure only headed towards more failure.
HP,
Read the links, they illustrated how different our (probably cultural) attitudes are towards healthcare. Infrastructure vs. consumer services.
I should hope a country of 300 million and double the per capita spending on healthcare is the leader in medical inventions compared to a country of 30 million. Unfortunately, that doesn’t mean your population is healthy.
As I mentioned before, Canada needs to get their ass in gear and up the funding. Consider if you will, that Canada has only recently started to increase funding to healthcare, after a good decade and a half of cuts. Costs in the US, as you mentioned Canada buys from, have seen double digit growth for what, going on 7 years now? Personally, I find it amazing that they have made do with the existing level of funding.
The US has a lot of cancer patients, and the most money spent in the world on healthcare. I would expect nothing less than the best cancer treatment in the world. Of course, our rates would be a lot better if we focused on smoking, but that’s another topic. Now I’m just pouring gas on the fire.
Canada has had a budget surplus for several years now, and has been paying down the national debt. I don’t see them having to raise taxes.
But never mind all this. Lets get to the heart of the matter. If HP was King, how would healthcare be run? At twice the price, and mediocre results for your overall population, clearly it can’t be the US model.
Hey ChrisN,
Thanks for responding. When I made the point that the United States invents (significantly) more life saving drugs than Canada does and also sells it to them at a lower price, it was to make two points, one that by refusing to implement price controls, the United States allows incentives to be lined up so that drugs are invented in the first place. The second point was that Canada’s ‘cheap’ health care system is directly subsidized by United States pharmaceutical companies that sell life saving drugs to Canada at a significantly lower price than they do here in the United States. In other words, much of Canada’s cheap health care is not as cheap as people think, atleast not if United States pharmas were taken out of the picture.
Second, whether or not Canadians stop smoking is not going to change the fact that the United States has a significantly higher cancer survival rate than Canadians do. That may change the number of cancer patients, but it won’t change the survival rate of those who already have cancer. In addition, the problem with Canada’s health care system is not restricted to cancer patients, just getting simple hip surgery, for example, can be a long waiting time in Canada compared to the United States.
But you ask a very poignant question, what is the proper solution for health care? As you have mentioned above, health care cost in the United States have been rising rapidly, and something needs to be done to change that. So if HP was king, the way I would model our health care system is the same way Thomas Sowell mentioned in his three part articles above, namely, I would do the following things,
1. I believe that one of the primary reasons why health care costs have significantly skyrocketed are because of patients insulation to costs, for example, see here, here, here, and here, so I would first and foremost remove the tax advantage the government gives to employers on health care so that employers can slowly but surely start reducing the amount of health care they cover for employees, thereby making the individual employee start paying more of their own health care costs.
2. For the same reasons mentioned above, I would make health care costs transparent to the patient, making them pay each and every health care cost with out of pocket money (up to a certain catastrophic point, explained below). If the executive of a company wants $40,000 hip surgery, she should pay for it herself, not have the rest of us pay for it through our tax money. Currently health care insurance, with the exception of small co-pay, covers almost every thing involved with health care. This would be analogous to having your car insurance company cover your gas, your tires, and everything else involved with wear and tear on your car. How much more do you think car insurance would be if they operated that way?
3. After reading the previous point, one of the first things that should come to mind is how will people, especially the really poor, pay for such health care costs? Well that would be solved by mandated health insurance savings accounts. In other words, something like Bush’s health savings accounts should be created where everybody is required to put money into and where it is separated from employer such that when you move from company to company it goes with you. When you need health care you can take the money from there.
4. Health insurance should only involve catastrophic costs. Meaning that when I buy health insurance it should only be purchased for catastrophic purposes, for example, at anything that costs $50,000 and higher my insurance would pick up the tab. Anything less would have to be paid for with out of pocket costs with #3 above. What is considered catastrophic could depend on my income level, with the rich having a higher catastrophic limit than the middle class etc. This is essentially the way all other insurances work, car insurances, for example, only cover you for anything above $1,000, home insurance even higher, etc…No other insurance except health insurance covers you for day to day things.
5. Last but certainly not least, another way to help reduce health care costs is to help increase the pool of payees, meaning that everybody should be required to have health insurance, including young adults. One of the ways in which health insurance brings down the costs is by spreading the costs among various payees, however, if the only people paying into health insurance are those that tend to get sick, this spreading will be very inefficient, and thereby be more expensive to those who need it most, thereby pushing less and less people to get health insurance, again, driving up costs, and pushing less people to get it, in an ongoing spiral that hurts everybody. One way to stop this is to mandate that everybody have catastrophic health care, including, and especially, the young. As a matter of fact, this is why insurance works so well, mainly because many of those who don’t always need it still continue purchase it, many times because it is mandated by the government. For example, car insurance, home insurance, and fire insurance, are all insurances that work, all precisely because you are forced to have them, thereby making them cheaper.
But the really poor you say, how will they be able to pay for health care? Well since the poor bring in special circumstances I think they should be handled in a special way. The poor, and ONLY the poor, should have their catastrophic health care, and their over the counter health care costs, directly paid for by government welfare, for humanitarian purposes. The money that we save with the above implemented policies will more than pay for this small cost, and in the end leave everybody better off.
This won’t work you say? This will cause inefficiencies, people will be hurt, and health care will suffer you say? Well, it already is working and is working pretty darn well. Just look at, for example, laser surgery and other elective surgery:
For more on my proposed policy solution above, read this post and the comments that followed and this other post on the same topic.