Canadian Healthcare Going Private?

If you think that a public option is essential to healthcare reform, and perhaps you believe that a single payer system like Canada would be the ideal, you might want to note that Canada seems to be going in the opposite direction from our Congress.

Kim Murphy begins her reports at the LA Times with a horror story:

Reporting from Vancouver, Canada - When the pain in Christina Woodkey's legs became so severe that she could no long hike or cross-country ski, she went to her local health clinic. The Calgary resident was told she'd need to see a hip specialist. Because the problem was not life-threatening, however, she'd have to wait about a year.

So wait she did. In January, the hip doctor told her that a narrowing of the spine was compressing her nerves and causing the pain. She needed a back specialist. The appointment was scheduled for Sept. 30.

"When I was given that date, I asked when could I expect to have surgery," said Woodkey, 72. "They said it would be a year and a half after I had seen this doctor."

So earlier this month, she drove across the border into Montana and got the $50,000 surgery done in two days.

"I don't have insurance. We're not allowed to have private health insurance in Canada," Woodkey said. "It's not going to be easy to come up with the money. But I'm happy to say the pain is almost all gone."

One response to this is the appearance of a number of private healthcare clinics in Canada.

Hoping to capitalize on patients who might otherwise travel to the U.S. for speedier healthcare, a network of technically illegal private clinics and surgical centers has sprung up in British Columbia, echoing a trend in Quebec. In October, the courts will be asked to decide whether the budding system should be sanctioned.

Call me paranoid if makes you feel better, and if it's legal if you're in Canada, but I consider it a serious loss of liberty where private health insurance should be illegal and clinics that dispense timely treatment to suffering septuagenarians have the status of a medical marijuana center in the U.S. To be sure, at this stage of the game, no one in Congress is talking about prohibiting private insurance. But bringing private insurance under a very tight regulatory control, such that it may not survive or be able to freely operate, is part of the current legislative proposals.

A little Googling turned up this 2006 article by Clifford Kraus from none other than the New York Times:

VANCOUVER, British Columbia, Feb. 23 — The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise.

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 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.

Consider the force of the highlighted words: Canada's "publicly financed health insurance system is gradually breaking down."

Julie Hirschfeld Davis at Real Clear Politics notes that the fears of America's seniors are a major element in the current debate. They had better be, in a democracy where the elderly are disproportionately likely to vote. It is reasonable to worry how much and in what ways ObamaCare will move us toward something like the Canadian system. If the answer is a lot and in all the wrong ways, America's seniors will not have the option Ms. Woodkey had. But if Montana falls, well, there's always Mexico.

Comments

[Miranda]

But if we go public, Canadians won't be able to cross the border for care anymore.
This would make the illegal clinics more profitable. Or it would mean that Canadians would have to travel a greater distance.

[KB]

I think it unlikely that we are going anywhere near the Canadian system. Sorry Cory. I also find it hard to believe the Canadian government is really going to crack down on these clinics. Once you allow them to operate, people get dependent on them and that creates a power constituency.

[A.I.]

An irony of the current health care debate is senior's concerns/fears the quality of their own government-financed health care may be reduced if similar coverage is offered to younger Americans. And sadly, those opposed to change are more than willing to shamelessly exploit those fears no matter how unfounded they may be.

That said, the problem you describe in Canada, KB, has a counterpart here. It is the conflict(s) between specialty and general service hospitals. Orthopedic surgery, for example, is a profit center for full-service hospitals; so a number of orthopedic surgical centers have sprung up to compete for that segment of the health care business. Unfortunately for general-service hospitals, some services they offer are not profitable--at least at the scale used in the communities they serve. And when these hospitals lose profits from orthopedics, maintaining the unprofitable services often becomes impossible even though those services may be essential to the community.

A number of schemes have evolved for regulating such “cherry picking”. All inhibit the exercise of “free markets” and may increase costs and/or extend waiting periods for certain services within a community. But, the regulation is deemed necessary for the greater good of maintaining essential services provided by the general services hospitals. This is happening despite most people younger than 65 being covered by private insurance plans. Thus, linking the problems faced by Canada solely to its single payer system is not justified as similar problems would continue even if private insurance were allowed.

[A.I.]

By the way, as anecdotal examples of health care shortcomings go, Ms. Woodkey's situation would seem a rather poor example. The article states: "When the pain in Christina Woodkey's legs became so severe that she could no long hike or cross-country ski, she went to her local health clinic." That seems to say the pain became more severe over a period of years, but she did nothing until it was so severe, she could no longer stand it. Had she sought help sooner, she likely would have received treatment long before the pain became unbearable despite waiting periods encountered under Canada's single-payer plan.

[Macgregor]

65% of Americans want the Public Option and I support it too along with the Majority in this country. This is one essential ingredient in any meaningful healthcare reform bill…the Public Option should not be up for compromise. That is the one thing that the Democrats must stick to supporting or kill healthcare reform all together. Good news is that 25 Blue Dogs in the House are committed to supporting the Public Option.

[caheidelberger]

And then there's this: the Conference Board of Canada issues a report card that ranks Canada 10th overall in health care. They get a B. The U.S. ranks 16th, last among industrialized countries studied. Japan, Switzerland, Italy, Norway, Sweden, France, Finland, Germany, adn Australia beat us both.

http://news.yahoo.com/s/nm/20090928/hl_nm/us_canada_health

I'll have what they're having... and the Canadians would be idiots to move toward what we're having.

[KB]

A.I.: Seniors may be fearful because they are less well informed and shrewd than You and I, or again, they may be fearful because they somehow better at judging their own intersts than you or I. I reserve judgement on that.

I understand that public or non-profit hospitals may depend on cash cow medicine to fund other care that doesn't pay for itself, and I am sure that regulations that "increase costs and/or extend waiting periods for certain services within a community" by protecting such hospitals against competition benefit the hospitals. I am not so certain that they are "necessary for the greater good of maintaining essential services provided by the general services hospitals." It is one thing to tax the nation to cover less profitable but essential services, and another thing to use regulation to limit the choices of consumers in order to shore up the system. That is clearly what the Canadian system does in a big way.

ClintonCare would have done the same thing, prohibiting individuals from paying for medical care directly in order to prevent any doctors and clinics from competing with the public system. Current legislation would not be nearly so extensive, at least at first, but it would move us in that direction.

Your second note seems odd to me. Perhaps Ms. Woodkey should have gone to see a doctor sooner, but if the rule is that the less severe the condition, the more years you have to wait to see a doctor before you can start waiting for treatment, it is not clear that she would have been treated any faster. What matters here is that the Canadian system considered years of pain and a seventy-two year old who had to give up cross country skiing was apparently one of those things the system deems necessary for the greater good. Maybe that has to be, but surely an American senior might not be entirely a fool to be worried about that.

Cory: the Canadians are moving toward our system. They are, idiotically in your view, establishing and using illegal clinics and crossing the border to such centers of technology as Montana. Such clinics would not exist, nor would Canadians be going south, unless their system was denying them something they can easily and quickly get down here. The question is whether we want to go that route. I say no. I am guessing most seniors would agree.

The Conference Board of Canada report you mention measures only a range of statics on mortality. That standard does not correlate well with available medical care. For example, U.S. infant mortality rate is inflated not because of a lack of adequate healthcare, but because we do a lot more to save premature infants. That lead to a higher mortality rate in the first year of life. Other countries are better at just saying no when trying to save a premature baby doesn't look cost effective. That is also one reason why our system spends more money. Maybe we should be more like the others in this regard, but I think we might ought to know that that is one way to move higher up the CBC ranking.

Macgregor: the President's handling of healthcare is frowned upon now by a majority of Minnesotans. Even Walter Mondale carried Minnesota. There may be a consensus about the abstract idea of a public option, but the details have cost the President a lot of support.

[A.I.]

I know of no rule in the Canadian system saying: "...the less severe the condition, the more years you have to wait to see a doctor before you can start waiting for treatment." So far as I know, Canadians are free to see a doctor at any time. They may wait a day or so for an appointment--as is the case here--but they can always see a doctor. And if his diagnosis is that a certain procedure is needed to correct an advancing problem, it would seem the patient would be put in the queue for treatment, not told he must reach a certain pain threshold before being scheduled for treatment. If you have proof Canadians follow some other protocol, I would like to see it.

Also, the scenario offered assumes Ms. Woodkey was being left to suffer while awaiting treatment. I'm not a doctor, but I would think there would have been some pain abatement regimen available and offered--perhaps cortisone. Or are we to believe Canadians are heartless dim wits worshiping at the shrine of socialized medicine with nary a care for the suffering of others.

As to my example of specialized hospitals harming general services hospitals and regulations being imposed against the former, whether or not the practice is justified is moot. The point is, regulations are imposed here in the name of the greater good. I believe sometimes special assessments (taxes) on specialty hospitals also have been imposed. The point is, the U. S. system faces problems similar to those of the Canadian system and counter measures imposed in turn create other similar problems. So one can hardly say our "free market" system is superior on the grounds you cite.

But beyond all the back and forth over the downsides of either system, another point you have made remains: no one is proposing a single-payer system for the U.S. If a public option is included in a reform package, it still is far from single-payer. A Ms. Woodkey will still have the option of buying private insurance. But, she will be assured that nowhere in the fine print does the policy exclude treatment for a back problem because she broke her wrist ten years ago, thus leaving her to pay $50,000 for treatment on top of the thousands already spent on useless insurance.

[A.I.]

OK, I should have said that while there are people proposing single-payer, such a system will not be part of any reforms passed by congress at this time.

[KB]

A.I.: Ms. Woodkey was told in January that "since her condition was not life-threatening," she could see not a specialist about her hip until September. That sounds like a rule to me! She was told that it would be another year and a half after that before she could expect surgery. I am sure there would be pain-abatement treatments. Perhaps two and a half years on pain killers is just what the 72 year old needed. And maybe you are right that she could see a doctor who could proscribe such medicines before, say, September. This is a nightmare. Yet you seem determined to argue that it is no big deal.

Yes, you are right, what is in the healthcare bills is not Canada. Canada is what Barney Franks would like to be in the bill. Single payer is what President Obama used to be for before he was against it. Yes, you would be able to purchase private insurance under any of the Democratic plans I know about. But not outside the "exchange" which would be tightly controlled by Congress. All such restrictions have the same purpose as the government healthcare monopoly in Canada: to control the costs for government by limiting the choices of consumers.

[A.I.]

Wrong KB. Absolutely, indisputably wrong! The purpose of restrictions imposed by insurance exchanges is to establish standards to curtail or eliminate some of the most egregious practices of private insurance companies: life-time caps, rescission, increasing premiums because of illness, etc. Saying government's purpose is to control its own costs by limiting consumer choice is simply preposterous.

Does this strange assertion stem from a belief that Democrats want to take over our lives? Do you think they want to establish themselves as a permanent ruling party by making us dependent on goods and services they provide? Is any departure from laissez faire socialism?

As to Ms. Woodkey, I didn't say there were no rules delaying her treatment. I said the rules likely weren't what you implied they were. Yes, this particular type of treatment is delayed if the condition is not life-threatening. But it is not delayed on a basis of degree of pain. Nothing you have said disputes my initial point that had she sought help sooner, she would have been put into the queue and likely would have been treated before the pain became so severe as to limit her activities.

As for nightmares, consider Ms Woodkey's plight had she been an uninsured U.S. citizen unable to acquire $50k and her malady struck at age 52. Of course she would have options. She could divest herself of most of whatever she might own and apply for Medicaid (talk about making someone dependent on government), or she could muddle through for 13 years and get treatment through Medicare. At least in Canada, she would receive treatment nealy 11 years sooner without having to sacrifice her earthly possessions.

One final point: The wait for orthopedic surgery is not the same in every Canadian province. The Canadian government distributes money to the provinces which, in turn, administer their own health care systems. Some provinces are better administrators than others. Each faces different challenges which effect availability of services. So criticizing the entire Canadian system on the basis of what happens regarding one type of treatment in one province is not legitimate.

[Macgregor]

KB, spin it all you want. Yawn...

[KB]

A.I.: One of us confused. When Ms. Clinton created her system, back in the early 90's, one of the provisions was that it would be illegal to seek medical care outside the system, which is to say, to pay a doctor directly. The provision in this case had nothing to do with insurance companies. Likewise with the illegal clinics in Canada. Why are they illegal? They aren't denying service or insurance to anyone, they are providing it in a more timely fashion than the government seems able to do. The reason for these kinds of monopolies is to keep patients (and their money) and doctors from leaving the public system, thus making it more expensive.

And why, under the Baucus plan, are persons legally required to have insurance and penalized if they fail to get it? Why are they threatened with jail if they fail to pay the penalty? I am sure you would say that it's a justified rule, since they cost the system something. I think that is a reasonable argument, though it would be an unprecedented kind of legislation. Has the federal government ever required someone to purchase a service or face fines and jail? But reasonable or not, the purpose is to control costs, no?

And lets face it, a lot of the uninsured are the people least likely to get sick. So this requirement will bring in a lot more revenue than is needed to cover the cost of the new payers. A lot of the evil insurance companies are salivating over this as it may mean millions of new customers brought in under a shotgun wedding.

I think you and I have beat poor Ms. Woodkey near to death, but one final note. Maybe she should have gone to the doctor sooner, but sometimes people don't make good choices. I thought that the whole idea of reform was to extend coverage to people regardless. The fact remains that when she did go she was told she would have to wait almost a year to see a specialist, and another year and a half to get treatment. I hope the Democrats seize on your remarks and use them to defend their plans. They haven't lost all support yet.

[KB]

Macgregor: If public support were as you say, the Democratic plans would be sailing through. But yawn if you want to. Better yet, go to sleep. I'll wake you up a year from this November's first Wednesday.