Hi everyone, sorry to not have posted anything for a while. I was busy with the joys of income tax. Although my accountant did most of the real work for me, it still took a lot of effort from me to get ready.
I wanted to write today on the intersection of politics and medicine and how much influence politics really has on how we practice. In the US doctors are facing a lot of pressure from the Obama administration, including significant financial repercussions, to become employees of hospitals or health care organizations. There are some advantages of this approach, cost certainty being a big one. However small independent business provide a lot of advantages too – control over your own work hours and hiring practices being big factors. Which one is best, I don’t really know, although I certainly like being in private practice and the freedom it allows.
In Canada of course we have just had an election that has produced a majority Conservative government. It will be interesting to see what comes of health care. I think of all the parties the Conservatives are most likely to allow experimentation. The health care debate in Canada is very odd. Many people, including the opposition NDP, staunchly defend the status quo, claiming equality is only preserved in a publicly-run system. However, the system is poorly administered, with a lot of bureaucracy and inefficiency; patient comfort is secondary to the demands of test and provider schedules; and health care costs will only continue to rise as new tests and medications are developed, people live longer with more comorbid health problems, physicians become more specialized, and more nursing and other care providers are required. We already pay a lot of taxes and at some point, whether sooner or later, people will hit a wall. I personally do think more private care delivery will be required, with standards in place to avoid price gouging and overly preferential treatment for the rich and other criticisms levelled at two tier systems. It is interesting to note that countries that are rated highest in health care delivery, such as the rich Western European and Scandinavian countries, have a mixture of public and private care delivery.
Interesting thought experiment: imagine two old people, one rich and one poor, both suffer from severe hip osteoarthritis. Everything medically about them is the same: same comorbid conditions, hip ailment, etc, and that both require identical hip replacements. Now imagine that in our public system the wait for this procedure is over a year long, which it is in some areas of the country. During this time they both suffer in agonizing pain, and get gastrointestinal side effects from their pain medications.
Now imagine competing public and private health care systems are established. The rich person gets their hip replacement in a week. The poor person, who uses the public system, waits 3 weeks. But both operations are done to a high standard and both people do well afterwards. Which is the better scenario? Is the two week difference a big deal? What if it were a month?
Now I freely admit I pulled these numbers out of thin air and am imagining a hypothetical situation. Who knows how the wait times would change with a second tier. But I think we should design a better future and have a real discussion and stop putting our head in the sand. I don’t know what the right answer is. But I do know, when the Conservatives get around to addressing health care, I will be contacting my MP (and provincial MLA) to see what their plans are. I think the main principle we want to preserve is good access for all, covering all medically necessary procedure – does it need to be exactly the same for everybody? How close? Who decides?
I did not mention anything about hospital politics – that is a topic for another time. As always I am interested in your thoughts, please leave me a comment.
I did my training in the USA and I saw first hand how a free market health care system can provide benefits, namely quicker access to care while still maintaining a high level of quality. However, per capita health care cost is the highest out of any developed nation. It's also a myth that people in the USA without insurance don't get health care. There is Medicaid (for the poor) and Medicare (for the elderly). Legally, hospitals cannot turn away patients who are in need of emergency care, so the image of people dying because they don't have money is largely untrue.
I think a big reason why Canada has done well with health indicators (infant mortality, obesity, life expectancy, etc) in comparison to USA is because our population has a high "medical IQ", and hence better educated to take care of ourselves and live healthy lives. In the USA, there is a huge population that has a low "medical IQ". It would be interesting to see if a study could be done comparing the health indicators in Canada to the population in USA that has medical insurance.
Anyways, I'm for more private medical care in Canada. A free market health system creates healthy competition and thereby drives efficiencies. With government regulation and oversight, I don't think we have to fear about quality issues. In the USA, the regulating bodies have great power over hospitals. Furthermore, in a free market, customer service and good outcomes are paramount. A hospital/clinic with a poor reputation won't do well financially like any other business.