Wednesday, August 22, 2007

Canadian "single payer" health care system sometimes winds up with families paying for care in U.S.

On Tuesday, Aug 21, 2007 The Washington Times ran an interesting op-ed (print p A15) “Oh Canada? A unhealthy health plan,” by Robert Goldberg, vice president is the Center for Medicine in the Public Interest, which appears to be connected to the Center for Media and Democracy

The writer discusses Arnold Relman (former editor of the New England Journal of Medicine), who recently wrote a piece "What Americans Should Learn from the Canadian Health Care Disaster" Aug. 15, 2007, in the Toronto Globe and Mail opposing a Canadian Medical Association proposal to allow some private billing of patients and allowing the Canadian health care system to purchase services from for-profit sources. (The newspaper link may require registration and credit card purchase).

The writer notes efforts by the Canadian single-payer system to pump resources to reduce waiting queues and improve specialties have not always worked. He cites a case were a family paid an American facility cash to care for an MRI for a child with a brain tumor because of a four-month waiting list in Canada.

Rust-belt cities like Buffalo, Cleveland and Detroit are reported to have booming hospital industries caring for Canadian and foreign paying patients.

Michael Moore’s film “Sicko” gave a glowing report on Canadian single payer health care, and on Britain’s National Health Service. Of course, we know from more recent history that Britain’s lower salaries for physicians (compared to the U.S.) has represented a security issue. Many families in these countries report that the socialized system (more so in Britain) works well for them. Indeed, it sounds as if recommended screenings (colonoscopies, mammograms) during middle age can be scheduled and diagnosed conditions treated before they become life threatening. On the other hand, I wonder if I could have gotten an immediate state-of-the-art repair of my acetabular fracture from a fall in 1998 that I got at the University of Minnesota from employer-provided health insurance, and got back to work in three weeks, never to miss a day again. I wonder if I would have laid in traction for three months in Britain or Canada.

Goldberg’s article raises the specter in a single-payer system, other family members could be “shaken down” to pay sacrificially to pay for quicker treatment, setting up a long list of potential social conflicts over “filial responsibility” discussed elsewhere. However, I have not heard about this kind of problem before from Canada.

It should be noted that neither Canada nor Britain pays for long term custodial nursing home care for the aged unless they are indigent. Nursing home issues resemble those in the U.S. and are becoming more serious as there are fewer children and longer periods of disability at the end of life. Some Canadian provinces have filial responsibility laws (like many American states) although they seem to be rarely enforced.

But, of course, the debate over single payer for regular health care should go on. It needs to be understood, however, that nursing homes present a separate issue.

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