Tuesday, January 22, 2008

Single Payer Naysayer

Want a single-payer system? Sure, we all do – right? Free healthcare for everyone and we all live happily ever after.


One of the most basic reasons that single-payer will not work is that it’s controlled by government. I don’t need to point out the troubles that are staring the NHS and Canadian systems in the face to make this point (and therefore did not provide links – you can get them yourself if so inclined).

Instead, imagine why patients are scared of the VA. Put yourself in their place – having to be seen by government paid healthcare providers who do “only what’s in their job description” and nothing more. A friend of mine has yet to receive adequate care for his illnesses and has begun to utilize homeotherapy - he's sick and tired of being "treated like shit by dumbass docs". I’ve seen some awful events, terrible care, and a complete lack of responsibility for patients at the VA during my few rotations. All perpetrated because the government employee mentality sinks in and once caring people become clock-punchers.

Beyond that, think of the military heroes whose medical care is being taken care of by places such as Walter Reed and other embarrassments of governmental medical care. Having spent 2 months in an army base I can tell you that more often than not the patients, doctors, nurses, and techs were more than frustrated by the ridiculous administration set in place to hinder movement through the system. What’s even more outlandish are the wait times in order to even see a doctor – months. Would you want to wait months for care? Months to receive surgery?

You can already see the impact imparted upon the medical field by beaurocracy crazy pencil pushers (regardless of association). If you haven't read or seen the images of nurses waiting to clock in and out in order to avoid infringements I can tell you it's completely absurd - patient care suffers. JCAHO is another entity who seems hell bent on making ridiculous mandates in the name of "patient safety". Do you really think that a single-payer system wouldn't be frought with these forms of "suit abuse"?

Then consider that your choice of doctor will be limited. Your care, paid for by your hard work and budgeting, will be reduced to “equalize” the care between poor and “rich” alike. Now consider whether you still really want a single-payer system. What's more, have you ever had or knew someone who had an HMO medical plan? Right.

That's government healthcare, clearly not "the answer" as preached by idealists all over the US.

Personally I feel that I and my family should be able to get the care that we work for, pay for, and earn through responsible actions. I do not want to receive mediocrity in order to help those who are less fortunate, immature, drug-addicted, slothful, and polybabydadics be spoon-fed more than they already receive.


Ladyk73 said...


Be careful about what you say about the VA. It is the biggest healthcare agency in the world. There are good things, and their are bad things.
I see alot of good things, and I intern there. And silly you, as a SW intern, I read and contribute more the patient's chart then the med students! ;-)

Lots of research comes out of the VA.

Beach Bum said...

A few thoughts about your post, from a Canadian's perspective.

There are definately problems in the Canadian system. IMO, the problems you cite have nothing to do with your central arguement, which seemed to be that a single monolithic organization can't possibly direct an endeavor as complex as health care. I agree. I would suggest that you don't know what you're talking about in terms of the Canadian system, and that the problems in the Canadian system arise for different reasons. Canadian health care is not monolithic, and while I won't go into a detailed description of how it works (or doesn't), it is most definately not a single government organization making decisions for the Party Faithful.

There are several things that are different about the Canadian system that make me want to return to Canada to practice when I'm finished med school, problems notwithstanding, and several of them are not at all related to universal insurance.

What I like about the Canadian system, and what I think Americans can learn from:

-everyone has health insurance. The line is: if you have money, it's better to get sick in the US, if you're middle class it probably doesn't matter, and if you're poor, it's better to be sick in Canada. There have been study after study that suggest that outcomes in Canada are better than in the US, on average. There's no question that wait times for non-emergent care sometimes have an impact on outcomes or quality of life, but that is balanced by the fact that all Canadians have access to care. To put it bluntly, Canadians tend to get care earlier, and as a result, have better outcomes.

(Call me a bleeding heart, but I do like the idea of the community working together to care for the less fortunate. And make no mistake, Canadians are very aware that they are paying for their health care. Our income tax bills every year drive that home. But the vast majority of Canadians would rather pay high taxes than end up with what the US has.)

-Canada is the only country in the world where Physicians are self-regulated. There is less government interference in the way that doctors practice medicine. There can be problems with this model, but overall it works well to make sure Physicians are the ones making decisions about how physicians practice. What this means, though, is that unlike the NHS in the UK, or the US, government does not tell Canadian doctors how to practice. (Another misconception is that the health care system in Canada is owned and operated by the state. The vast majority of hospitals and health care facilities in Canada are owned at a lower level, mostly by municipalities and other local governments. What the provincial and federal governments control is payment, because they are basically the insurance company for every resident.)

-The legal climate is such that it is very hard to win a huge settlement for malpractice. There are a couple of reasons for this. First, judges set award amounts in Canada, and tend to be more reasonable than juries. Second, Canadian doctors belong to an organization called the Medical Protective Association, which defends lawsuits against its members with vigour.

-Canadians practice a less procedural form of medicine. They tend to intervene less, and stress lifestyle changes over procedures. There has been some interesting studies that look at care in Canada vs the US, and they have pointed to some significant differences in how medicine is practiced, with no difference in outcomes. I suspect that there are cultural differences in medicine in many parts of the world that we all could learn from.

I am often puzzled by statements like yours, where you say, in essence, "there are problems in Canadian health care, so it can't possibly have any features to emulate." Isn't that a little like the pot calling the kettle black? There are many problems in the US system which might be solved, or at least helped by adoption of different ways of doing things. There are facets of the Canadian system that make it very attractive, just as there are things that don't work very well. But to dismiss it out of hand, without knowing its strengths as well as its weaknesses, is to be uninformed.

I personally think that it's impossible to get the perfect health care system. You can't have it all, nor can you pay for it all. Canada has chosen to provide health care for all of its residents, with the inevitable cost in terms of infrastructure and availability. The US has chosen to provide it all, but only to those who can pay for it. I think that compromises have to be made somewhere. I happen to prefer the compromises that the Canadian system contains, to those inherent in the US system.

Your comment about beaurocracy strike me as absurd. There is no question that beaurocracy can be stifling to an organization. But to suggest that the US system doesn't contain stifling beaurocracies is laughable. As complex and as big an endeavor as health care is in the 21st century, how do you propose to structure it so as to remove the evil beaurocracy? I don't think it can be done.

It's easy to just blame Canada, but if you really want to reform your health care system, it might be helpful to look at what's working well in other systems, rather than dismissing them, just because they aren't perfect.

Wow, I've written a novel. Sorry about that.


Liana said...

Hey, Beach Bum beat me to it... he brings up pretty much all the points I wanted to make. I remember reading a survey on Canadian identity once, and one of the things we hold nearest and dearest to our hearts is our health care system. So yeah, get us started and we can go on yapping for days.

MSG, you wrote: "Personally I feel that I and my family should be able to get the care that we work for, pay for, and earn through responsible actions. I do not want to receive mediocrity in order to help those who are less fortunate, immature, drug-addicted, slothful, and polybabydadics be spoon-fed more than they already receive." I'll be the first to admit that I'm a bleeding heart socialist, and maybe that's why I interpret your comment as harsh... my personal view is that I've ended up where I am because of a combination of luck and hard work. It's very easy for me to imagine a situation where I suddenly end up as one of the have-nots. I think it's unfair to blame those who have inadequate health care in the U.S. and characterize them as lazy, dumbass drug addicts.

Plus, I would need to see more evidence supporting your suggestion that free healthcare/single-payer in the U.S. would necessarily mean mediocrity for all rather than good care for some and no care for others. I do know that health care expeditures in the U.S are currently much, much higher per capita than in Canada. In some ways, the ready availability and indiscriminate use of expensive technology in the U.S. can actually compromise care... I'm thinking about a study I saw that showed that in the U.S., the trend was to get a CT scan before doing an appy which ironically ended up delaying surgeries, whereas Canadian docs were much more likely to rely on their clinical judgement, resulting in "cheaper" care but better outcomes.

Damon said...

Very worthwhile data, thank you for your article.
Indian recipes | Wings recipes | symptom checker