Thursday, January 10, 2013

What Canadian Medicine Says About The Future Of American Healthcare

The practice of medicine in the United States is in trouble. Everybody knows that something has to be done before the entire house of cards falls under the weight of rampant medical malpractice suits, rocketing health insurance premiums, noncompliant and demanding patients, and dissatisfied physicians. Much has been made about Canadian medicine and how it can be a model for us to emulate, or avoid depending on one's perspective.

I have to admit that I know little about how healthcare works up north other than hearsay and what I've read in lay periodicals. Now Bleeding Heart has a nice summary of what Canadian doctors face in their single payer system the we here are inexorably driving towards.

Do the Canadians have the perfect system? No of course not. Nobody does. They face similar income inequality between specialties that we confront here, and its inherent jealousies and finger pointing. In a single payer system, everybody essentially gets the basic medical necessities for free. He doesn't go into the stories of long waiting times for elective surgeries and procedures that are the bedrock of skeptics of the single payer program. However he does confirm that in an ill advised attempt at saving money, Canadian doctors once had their incomes capped. This of course led to people working up to the cap then taking the rest of the year off. Apparently that is no longer the case.

It seems like the whole arrangement is a cat and mouse game, with doctors trying to earn maximum compensation, the patients wanting maximum treatment, and the government attempting to pay the least amount they can get away with. While their doctors have union representation, since they're all considered employees of the state, that doesn't mean they get a larger voice in how precious loonies are divvied up. The state can still raise or cut reimbursements on the whims of politicians.So the budget for physician pay may go up three percent each year. But that three percent isn't distributed equally amongst all doctors. Some specialties may get more and some less, with some taking a pay cut. All this is negotiated between the doctors' unions, otherwise known as medical associations, and the federal government. Sometimes no negotiations are done and the government rules by fiat.

Has this been a hardship for doctors? Apparently it has been very traumatic for physicians who are used to the compensation they once received before the implementation of this structure and are now saddled with large or multiple mortgages and unrealistic family budgets. However the younger doctors who have never know any other way of practicing medicine will be more realistic with their income expectations and should do just fine.

Let this be a cautionary tale for U.S. physicians as we sale into the uncharted waters of ObamaCare.

1 comment:

  1. As a Canadian anesthesiologist, I can tell you that most of what you say is quite true. I will point out, howver, that we are in fact NOT considered employees of the state. We are considered self-employed, and we bill only 1 (state-funded) insurance program.

    If nothing else, this affords us a degree of independance which, I understand, is not always shared with our US counterparts. I am free to practice the medical side of anesthesia without answering to anyone. If I decide a patient is unfit for surgery, there is absolutely nothing the surgeon can do about it. except whine. I am not an employee of any anesthesia providing group, so I do not have any fear of my contract not being renewed because of the complaints of surgeons or hospital administrators.

    Finally, my medical association does act as a union, of sorts, and negotiates a collective fee agreement. But this is done provincially, not federally. So we do have the issues with interprovincial pay differentials.