On Fairness in Canadian Healthcare

 

shutterstock_249846172-e1453904472642I’m a week into my first trip to North America since 2011, and the first time I’ve been to Canada since my childhood. I’ve been visiting a famous Canadian healthcare complex and have been struck by a few things as an Aussie. I’m impressed by the professionalism of my colleagues and the standard of the technology being used to treat patients surgically. I am also struck by the fact that all the doctors I have spoken to are harshly critical of Canadian healthcare as it stands, and think that some kind of reform or change is needed.

Australia, like Canada, has universal healthcare but the similarity ends with this sentence. If you don’t like the waiting time, or the options presented to you, or your physician, or even just the decor of the public hospital in Australia, in most cases one can obtain the same service from a private doctor or hospital. In fact, once can choose to see the same surgeon from the public hospital in a private setting, if one wants. This usually comes at a price, but is always faster, and often in a “nicer” institution. None of that can happen if you are a patient in Canada, by law, because “fairness” and “equality.”

Fairness and equality as enshrined in the Canada Health Act make it illegal in that nation for a patient to be billed privately for medical treatment that is already covered by the public system. Physicians are also barred from providing both public and private health care. This was all very well thought out and designed by the left-leaning Liberal Party and enshrined into law by their majority government in 1984. (Message: Elections matter.)

As a result, a patient of limited income who requires a non-urgent operation was told by a surgeon today that he will go on the waiting list and is likely be seen in about a year. The same patient with money will most likely drive or fly to the US and get the same operation done privately at considerable cost, but with a better medical outcome and fewer risks than the poor counterpart.

The outcome is not “fair” or “equal.” Even left-leaning Canadian publications know it. However it feels fair to the Canadian people, and I have been told by medical colleagues here that changing the Canada Care Act to allow the existence of private care would be met with stiff public resistance. It seems like another case of Stalin’s Chicken.

With that sad tale, I bid farewell to Canadia and hello to Murica. Flyover country and the south await. Life is full of learning, I wonder what I shall see there?

Published in Healthcare
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  1. PJS Coolidge
    PJS
    @PJS

    Hopefully you will have time to see some Ricochetti.  Welcome to Murica, dude.

    • #1
  2. Antipodius Inactive
    Antipodius
    @Antipodius

    thanks PJS!

    • #2
  3. Brian McMenomy Inactive
    Brian McMenomy
    @BrianMcMenomy

    So sad that such a nice country (nice enough we let our daughter go to college up there) has such a screwed up sense of fairness.  Anyway, welcome to ‘Murica.  You’ll see a fantastic country with a ton of great people; unfortunately, we’re going through election-related madness like I haven’t seen since 1968 (and those were riots…oh yeah I was also just shy of 2 years old at the time).  If you find yourself in Seattle, you’ll find gorgeous views, great food culture and leftists.  Enjoy the 1st two, and roll your window up when confronted with the 3rd.

    • #3
  4. Tenacious D Inactive
    Tenacious D
    @TenaciousD

    Antipodius: As a result, a patient of limited income who requires a non-urgent operation was told by a surgeon today that he will go on the waiting list and is likely be seen in about a year.

    There is a big difference between urgent and non-urgent procedures in Canada. Things like cancer treatments are pretty responsive, but I don’t find your anecdote about non-urgent wait times surprising.

    • #4
  5. Vance Richards Member
    Vance Richards
    @VanceRichards

    Antipodius: As a result, a patient of limited income who requires a non-urgent operation was told by a surgeon today that he will go on the waiting list and is likely be seen in about a year.

    “Yeah, but it’s free” is the response I’ve heard from more than a few Americans who think we should copy Canada. Sad.

    • #5
  6. Derek Simmons Member
    Derek Simmons
    @

    Antipodius: The outcome is not “fair” or “equal.” ……. However it feels fair to the Canadian people

    Well, if it feels fair what more can we ask?

    PS: Thanks for the insights; hope our “single-payer” system under President Sanders looks more Aussie than Canuck. Perhaps it will since Bernie seems to like what the Swedes have and I know there’s is more like what you describe as ‘Australian.’

    • #6
  7. Amy Schley Moderator
    Amy Schley
    @AmySchley

    PJS:Hopefully you will have time to see some Ricochetti. Welcome to Murica, dude.

    If your travels take you to the Kansas City area, do let me know!

    • #7
  8. PHCheese Inactive
    PHCheese
    @PHCheese

    Socialism = shared misery.

    • #8
  9. La Tapada Member
    La Tapada
    @LaTapada

    Thanks for sharing this. I like having a view of things from an “outsider’s” point of view. Share with us your impressions of the U.S. I’d like to hear them.

    • #9
  10. Leslie Watkins Member
    Leslie Watkins
    @LeslieWatkins

    Great post. Very informative. Might you give us a sketch of how the system in Australia works? Is it more a mix of private and public? How is it paid for? Regarding Canada, I cannot imagine a government making it illegal for someone to purchase treatment privately, especially since, as you note, wealthy patients will do so anyway by going elsewhere. I do worry about that kind of thinking becoming more pervasive here in the States. Hope you have a great trip.

    • #10
  11. Majestyk Contributor
    Majestyk
    @Majestyk

    Can I just make a modest proposal?

    How about if we formalize the fact that what we already have is a two-tier healthcare system.  There exists in this country a system for those who can do all of their own paying up front and a system for those who are indigent.  How about we simply give priority to people who are paying customers for healthcare (i.e., no waiting if you can pay) and make those who don’t pay move to the back of the line, to be seen when all of the paying customers have been seen?

    Thoughts?

    • #11
  12. Tuck Inactive
    Tuck
    @Tuck

    Majestyk: Thoughts?

    LOL.  That’s pretty clearly not “compassionate conservatism”…

    • #12
  13. Raw Prawn Member
    Raw Prawn
    @RawPrawn

    I recall, a few years ago, the Minister of the NSW Government responsible for health care explaining that a simple clerical error was the reason why patients in western Sydney were waiting twelve months for a first appointment with an oncologist. There was nothing wrong with the system.

    • #13
  14. RushBabe49 Thatcher
    RushBabe49
    @RushBabe49

    Antipodius, Ray Kujawa and I also live in Seattle area.  Meet up??  Welcome to the Greatest Nation on God’s Green Earth!

    • #14
  15. The Dowager Jojo Inactive
    The Dowager Jojo
    @TheDowagerJojo

    Hi Antipodius! Seems like Australia is not that different from Canada, except you don’t have to leave the country to get your better faster care for a price.  Well I guess that’s a big difference.

    In the early 1990’s I was new to paying for my own health insurance on an individual (not employer) policy and I wasn’t liking it.   I thought the system was pretty punishing to the self-employed or job-transient, and was open to Clinton proposing something better.  My sister was incensed at the Hillarycare proposal, and I suggested maybe she just hadn’t had to make her way in healthcare without an employer.

    She adjusted my thinking by pointing out that under Hillarycare (which must have taken Canada as a model) it would be a crime to go to your doctor and pay him for his services.  With a  moment’s reflection  I realized that without that draconian provision the “free” care would quickly become the worst available, so you’d have to pay twice for decent care.  Also, it’s an affront to liberty of doctor and patient.

    I’m interested if skeptical about parallel public-private systems.

    • #15
  16. Manny Coolidge
    Manny
    @Manny

    Canada does have non-government healthcare where individuals can pay for it.  It’s called the United States of America.

    • #16
  17. Kay of MT Inactive
    Kay of MT
    @KayofMT

    Hop across the border to Kalispell MT and take a look at the parking lot at the Kalispell Medical Center. About half the cars there are from Canada, as well as at the other medical centers around the area, Whitefish, etc.

    However, I buy my pharmaceuticals from Canada.

    There are several Ricochetti in Kalispell area, more in other areas.

    • #17
  18. Tuck Inactive
    Tuck
    @Tuck

    Kay of MT: Hop across the border to Kalispell MT and take a look at the parking lot at the Kalispell Medical Center. About half the cars there are from Canada, as well as at the other medical centers around the area, Whitefish, etc.

    So the obvious question: would Canada maintain this ban on alternative private practice if they were as isolated as Australia?

    If I recall, a large percentage of the Canadian population lives within driving distance of America…

    • #18
  19. Kay of MT Inactive
    Kay of MT
    @KayofMT

    Tuck: If I recall, a large percentage of the Canadian population lives within driving distance of America…

    I think Mark Steyn said about 99% of the Canadian population. And if it gets any colder in Canada, they will probably all move to border towns. Kalispell is about 260 miles from Calgary, and Seattle is about 143 miles from Vancouver.

    • #19
  20. derek Inactive
    derek
    @user_82953

    Harshly critical. My GP for many years, now retired cursed under his breath when talking about the system.

    Many are not aware of how close to collapse the system came two decades ago. Stupid (no other way to describe it, Marxist economics applied to health care) policies in an attempt to limit supply and contain costs made a system with unbelievably stupid incentives and inefficiencies. It became a necessity to make sure you had enough money put aside for ‘elective’ surgery that would put you in a situation where you couldn’t work but would wait for years for treatment.

    The commodity boom that lasted a long time injected cash into government coffers, and the level of service rose to tolerable, but that has run dry now and the real effects of the largest line item in provincial budgets being half or more of the budget during times of double digit decreases in revenues.

    The younger generation will not tolerate waiting for some bureaucrat to get around to giving them second rate care. Good for them.

    • #20
  21. Brandon Phelps Member
    Brandon Phelps
    @

    Majestyk:
    Majestyk

    Can I just make a modest proposal?

    How about if we formalize the fact that what we already have is a two-tier healthcare system. There exists in this country a system for those who can do all of their own paying up front and a system for those who are indigent. How about we simply give priority to people who are paying customers for healthcare (i.e., no waiting if you can pay) and make those who don’t pay move to the back of the line, to be seen when all of the paying customers have been seen?

    Thoughts?

    This is already kind of the way it is in Kalifornia. Our first daughter (adopted) is enrolled in Medi-Cal because she used to be in the foster care system. MediCal is health care for poor people, and the sorts of facilities that serve poor people have nice long lines. She was our first and we didn’t know any better, initially and thought medicine had gone to hell in a handbasket. Then when our second (bio) kid came along we experienced the open market for health care. We did things like telemedicine on our phone. With him we went from zero to medicine in hand in less than an hour. With our first it would be all day and possibly into the next.

    • #21
  22. Larry3435 Member
    Larry3435
    @Larry3435

    A lefty’s idea of “equality” is always to identify the most unfortunate and destitute members of society, and tear everyone else down to that level.

    • #22
  23. The Dowager Jojo Inactive
    The Dowager Jojo
    @TheDowagerJojo

    Larry3435:A lefty’s idea of “equality” is always to identify the most unfortunate and destitute members of society, and tear everyone else down to that level.

    Everyone else but him, because he does so much good for humanity he deserves more.

    • #23
  24. mikeInThe716 Member
    mikeInThe716
    @mikeInThe716

    We need to reframe this debate by referring to ‘Single-Payer’ as ‘Choice-Crime’ or Restricted-Care. Or something…

    Any suggestions?

    • #24
  25. bridget Inactive
    bridget
    @bridget

    Majestyk: How about if we formalize the fact that what we already have is a two-tier healthcare system. There exists in this country a system for those who can do all of their own paying up front and a system for those who are indigent.

    My preference would be to do something very similar, and lock the standard of indigent care in place.  For example, we might say that we aren’t going to give them access to on-patent drugs, high-end hospitals, super-new surgical procedures (unless there is an incredible difference in care), fast diagnosis, etc.

    Basically, say “Here’s the pile of goodies that the taxpayer will give to anyone who wants it, here’s the timetable upon which you will get diagnosis and treatment for common ailments, and it’s completely dignified and good care, but it’s really 1990s level care.  You want the super-modern care, on-patent drugs, same-day diagnosis, experimental treatments, and that awesome physician who is ranked the best in the nation? Buy it yourself.”

    • #25
  26. bridget Inactive
    bridget
    @bridget

    As a result, a patient of limited income who requires a non-urgent operation was told by a surgeon today that he will go on the waiting list and is likely be seen in about a year.

    One of the many problems with leftism and big government is that it takes a few decades to get to this point, but it’s inevitable that it will come.

    If, within a year of the passage of ObamaCare, people’s wait times for discretionary surgery went from two weeks to a year, there would be rioting in the streets. If doctors retired en masse, and the ones who took their places were 30 IQ points and a lot of compassion short of the old ones, people would stop crying about paying physicians enough money to drive BMWs and put the kids through college.  Medical R&D won’t stop today, and new stuff will come out onto the market at approximately the same rate for years because there’s years of new stuff in the pipeline.

    It’s tough when the changes happen slowly, because we look like nutters for talking about how socialism will destroy our almost-sci-fi healthcare.

    • #26
  27. Kay of MT Inactive
    Kay of MT
    @KayofMT

    bridget:

    Majestyk: How about if we formalize the fact that what we already have is a two-tier healthcare system. There exists in this country a system for those who can do all of their own paying up front and a system for those who are indigent.

    My preference would be to do something very similar, and lock the standard of indigent care in place.

    What you are saying, if a person hasn’t got the money to pay for care they deserve to die. Only the rich deserve good medical care.

    • #27
  28. The Reticulator Member
    The Reticulator
    @TheReticulator

    Kay of MT:

    bridget:

    Majestyk: How about if we formalize the fact that what we already have is a two-tier healthcare system. There exists in this country a system for those who can do all of their own paying up front and a system for those who are indigent.

    My preference would be to do something very similar, and lock the standard of indigent care in place.

    What you are saying, if a person hasn’t got the money to pay for care they deserve to die. Only the rich deserve good medical care.

    Who said anything about “deserving”?

    • #28
  29. Majestyk Contributor
    Majestyk
    @Majestyk

    Kay of MT:

    bridget:

    Majestyk: How about if we formalize the fact that what we already have is a two-tier healthcare system. There exists in this country a system for those who can do all of their own paying up front and a system for those who are indigent.

    My preference would be to do something very similar, and lock the standard of indigent care in place.

    What you are saying, if a person hasn’t got the money to pay for care they deserve to die. Only the rich deserve good medical care.

    That is not what I’m saying.

    I’m saying that in reality, the health care system cannot continue to defy gravity by drawing no distinctions in services or expectation between those who are doing the paying and those who are doing the consuming.

    As conservatives, we shouldn’t be coming at this from the perspective of saying that people have a “right” to healthcare; a “right” to other people’s labor and materiel.

    • #29
  30. bridget Inactive
    bridget
    @bridget

    Health care isn’t like air. The reality is that we are paying people for decades of training and intense work, whether they be physicians or researchers. Either we do not let them be paid what they are worth, or we force people to provide luxury health care for all. The latter, of course, results in rationing.

    Of course, there is nothing stopping you from spending your own money on health care for the poor: I was only proposing what the government could be on the hook for.

    • #30
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