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And you think we have problems ?

Stanley Feld M.D. FACP, MACE

Canada has been very proud of its government directed single party payer Healthcare System. Everyone in Canada automatically has health care coverage. The system in Canada has been compared to the American Healthcare System. The impression through the media has been that Canada’s System is what an effective healthcare system should be However, last year, the Canadian Supreme Court ruled that people of Canada should be entitled to buy private health insurance. Prior to the Supreme Court decision, a choice of private insurance was forbidden.

The headline in The National Post of Canada on Saturday June 3, 2006 read,

“51% say private care OK”.

The Supreme Court decision has brought the argument about the purchase of private healthcare insurance into public debate. A percentage of the population has been dissatisfied with the Medicare system for a long time. However, no one talked about it. In theChaoulli decision, the Supreme Court declared Quebec’s ban on private health insurance is unconstitutional.

A survey of 3,000 Canadians brought out some incredible opposing opinions. Fifty-one per cent of respondents identify with the statement “If we are unhappy with the service we receive from Medicare, we should have the right to spend our
own money to buy health care outside the public Medicare system.”

49% believe that “when it comes to health care, everyone should be equal and no one should be allowed to spend their own money to get better services.”

An overwhelming majority of respondents believe the government should focus on making the public system better so no
one feels any need to pay for private health care. This is a clear indication that there are endogenous defects in the single party payer government directed healthcare system in Canada.

The identical sentiments are prevalent in England. The Hillary Clinton “Healthcare Reform initiative”
advocated a single party payer system similar to the Canadian system. The advantages of both the Canadian system and British system were widely quoted at that time.

Why is our system and their system creating such discomfort among patients and physicians? One is supposedly a private system (United States Healthcare System) and one is a government run system (Canada). The answer is obvious to me. Each of them limits access to care.

A system that is truly market driven, and lets the patients exercise control over their choice of care would be a system that would work. If the patients were responsible for their care and had control of their own healthcare dollars the defects in the system would be their responsibility.

The answer is found in examples in the retail arena. Wal-Mart and Target have done so well because they sell quality products at a transparently affordable price. If the quality decreases or the price is too high, people will switch to a different vendor. Why has Target done better in the clothing area than Wal-Mart? Target has better quality and style at about the same price! Target figured out how to get a competitive advantage. Wal-Mart is presently redoing the clothing section of its business to compete.

People are not stupid. They know when their freedom of choice and access is restricted. When freedom is restricted the people react; hopefully our politicians respond. If things get bad enough, people will elect different representatives.

  • Al Malvehy

    I ran into your blog through Brad’s (who I had a very pleasant lunch at the Louvre with two weeks ago). I appreciate your comments but, to a great extent, I feel like they ignore the premise of insurance that healthy people subsidize unhealthy people who are, incidentally, the people least likely to be able to work and afford medical care. The other part that gets difficult is the “person with no foresight” problem, an epidemic in the U.S., I assure you; that is, what do you do with people who find it much cheaper to not buy insurance rather than buy it and then, for example, get cancer, run over by a car or appendicitis? The idea is good in theory, but in practice, most people would have a difficult time saying, “you’re out of luck, buddy.” I have thought long and hard about these issues and I can’t think of any good answers. I don’t trust the government to take my temperature, let alone administer my health insurance and I don’t see private industry providing a lot of answers without 60% of the country going blind first. I’ll keep tuning in. Take care.
    The reason I am giving the history of why we got into this pickle will weave the solution. A clue is money talks. Free money talks louder than money you have to earn.
    I think the solution will be compelling. Please hang on and it will be obvious
    Stanley feld M.D.,FACP,MACE

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