I do not agree with some of his conclusions he draws from what Obama wants to do, but he then turns to the facts at this time when comparing the two systems and on that issue, this article is useful.
Moving beyond Tommy Douglas
Shaun Francis, National Post
July 9, 2009
Financial Post
Recently, U. S. President Barack Obama suggested the economic downturn makes making major changes to the health-care system more important, not less. According to The New York Times, Obama said a major health-care initiative "has to be intimately woven into our overall economic recovery plan." He added: "It's not something that we can put off because we are in an emergency. This is part of the emergency." Comprehensive reform of the American medical system could seriously damage Canadian health care.
If Obama's reforms provide health insurance to the 45 million Americans who don't currently have it, U. S. demand for doctors' services will increase. Doctors' salaries will rise, and many Canadian doctors will be lured south. Indeed, the brain-drain has already begun: According to the Canadian Medical Association, in 2006 roughly one out of every nine new Canadian-trained doctors went to work in the U. S.
When it comes to health care, our political leaders don't seem to share the same sense of urgency as the U. S. President. Canadians identify our health-care system as a national treasure, but I'd argue that it's actually a national liability. The fact is, people in the U. S. and Europe who have health insurance have better access to a similar or higher quality of health care than Canadians.
In a recent study by the Organisation for Economic Co-operation and Development (OECD), Canada placed 22nd out of 26 nations in doctor-to-patient ratio with just 2.1 doctors per 1,000 people (the average is three doctors per 1,000 people).
Moreover, wait times in all specialties have increased, and general surgery wait times nearly doubled between 1993 and 2008. Of course, before you get to line up in the queue to see a specialist or surgeon you need a referral from a family physician. But it's hard to get this referral if you are one of the five million Canadians without a primary care provider. That means 17% of Canadians are forced to take their health concerns to already overloaded emergency rooms or medical clinics.
Matters are bound to worsen during this recession. As a nation, we spent an estimated $172-billion on health care last year. But faced with funding shortfalls, provincial governments will be forced to slice their spending, and health care is certain to be affected. Wait times will go from bad to worse, and it will get even more difficult to find a family physician.
However, there is a solution. Endangered by American reforms, Canada should reform its own system according to the philosophy of "consumer-directed health care," employed by such countries as Switzerland and the Netherlands. Doing this would return thousands of dollars to the pockets of Canadian taxpayers, ease the family physician shortage by luring doctors to Canada and decrease queues for surgical procedures by making the whole system more responsive to consumer demand.
Here's how the system works: Consumers pay for many medical expenses out of personal tax-free health savings accounts. For example, Jim is a 35-year-old, nonsmoking and healthy male with a good job working for a consulting firm. Under the tenets of consumer-directed health care, his employer would contribute some set amount -- say, $2,000 annually-- to his tax-free health savings account. On top of this, Jim pays a certain amount each month for private catastrophic medical insurance with a high deductible of, say, $1,250. If Jim couldn't afford the insurance premium, the government would subsidize it on a sliding scale based on a means test.
During Jim's annual visit to a general practitioner (cost: $250), the physician orders a CT scan ($500). If it turns up clean, and Jim remains healthy the rest of the year, then the remaining $1,250 in his account stays safe and tax-free, so that the following year, after another employer contribution, Jim has $3,250.
But let's say the CT scan does display something troubling -- a polyp that indicates colon cancer, perhaps. In that case, Jim would begin a course of cancer treatment.
He would pay for the first $1,250 of the treatment with the remains of his health savings account, and the remainder of the cost would be paid by his private insurance.
Consumer-directed health care resembles the current system in many key ways. Everyone continues to be covered by health insurance; those who can't afford to pay for insurance themselves have it subsidized by the government. Nevertheless, differences exist. Introducing limited capitalism into our health care also brings with it capitalism's efficiencies and capacities for innovation. For example, doctors would have greater freedom to charge for their services in the new system. And the freedom and capacity for innovation would bring more doctors to Canada to practise -- decreasing or eliminating altogether our doctor shortage.
Perhaps the biggest difference would exist on the consumer side. Because individuals would be paying for their health care from their own pockets, they would expect more value and service in exchange for their hard-earned money. In the new system, Jim wouldn't tolerate a physician who kept him waiting for two hours, without an apology -- he'd just find another, more punctual doctor.
Wait times for surgeries would decrease because more doctors would be more motivated to perform greater in-demand procedures. Therefore, a larger variety of medical care would be available. Customers might pay $20 for a quick appointment at a clinic that emphasizes fast, efficient service. Others might opt to pay more to subscribe to a "concierge" type of health care, where family physicians limit their practices to several dozen families so as to provide a high level of attention and service to each client -- including telephone consultations and house calls.
Finally, in the same way that auto insurance rewards ticket-free drivers with lower monthly premiums, private insurance could reward people who live healthier lifestyles -- i. e., non-smokers might pay cheaper premiums compared to smokers. Rewarding healthier lifestyles also seems likely to create a macro effect, reversing troubling health trends by encouraging people to live well-balanced lifestyles through the most effective means: their wallets.
All this may sound radical for a nation that voted former Saskatchewan premier and medicare founder Tommy Douglas as the "greatest Canadian." But in the face of the Obama administration's health-care reforms, doing nothing is bound to worsen the Canadian situation. -
Canada
Subscribe To
Posts
Comments