Wednesday, August 20, 2008

Re: Betting your health on Canada's doctor lottery - National Post

Kelly McParland's August 7 editorial, "Betting your health on Canada's doctor lottery," suggests that doctors leave Canada because of the health care system. Undoubtedly some do, and some highly trained surgical specialists can earn significantly more in the United States. But what about U.S.-trained physicians who come to Canada because of the system? They exist and I am one of them.

According to the Canadian Institute for Health Information, more doctors returned to Canada than moved abroad in 2004, 2005 and 2006. Perhaps they were lured by low administrative costs, low malpractice insurance rates, and guaranteed payments. And if Canadian doctors think "government interference" is a problem in Canada, wait until they have to struggle with insurance companies for payment, have their patients' treatment dictated by insurance industry bureaucrats, or find they must treat patients for free. The U.S. is the only industrialized country that relies on charity care for a large proportion of its population. In Canada, I can treat all patients without having to worry about whether they have insurance coverage.

The assertion that all or even most U.S. physicians "practice the best medicine possible without government interference" is wrong. The U.S. government funds close to half of health care, and that money comes with many strings attached. The insurance industry has plenty of strings attached to the remainder of health care financing. I've been there, I know, and I'm glad I'm now in Canada.

Randall White, M.D., FRCPC


Life Insurance Canada said...

Thank you for interesting view, however, not so surprising for me. As a Toronto life insurance broker dealing health insurance too I am a bit involved in today's battle of (not)spreading private health insurance in Canada and doctors are usually on the side of NOT spreading it. Yes, for doctors it's much easier to deal with our system, on the other hand, don't you feel restricted? Don't you feel you want to have liberty to ask how much you want for your work? Don't you want liberty to have your own practice?

Randall White said...

Thanks for your comment. My point is that the insurance industry does not provide physicians with "liberty." In order to manage the risks of adverse selection and moral hazard, insurance companies are selective in who they will cover, which restricts whose care they will pay physicians for. Furthermore, in the US, the insurance industry has amassed so much political influence that it can act unilaterally, and physicians are unable to collectively bargain for fees.

In Canada, any doctor can have his or her own practice. Very few of us are direct employees of the government, although we do bill provincial health plans. Research shows that Canadian physicians spend less time and money on administration compared with US physicians, who have to contend with multiple payers.

A recent poll found that 59% of US physicians support moving to a single payer system. A glance at US medical blogs reveals how reviled the insurance industry is. So it's unlikely most Canadian physicians will be in favor of commercializing health care financing.