Canadian Health Care: Don't Criticize What You Don't Understand

OK. I've had it. I'm sick and tired of people bagging the Canadian health system when they have no fucking idea how the system works.

And yes, I do know how it works. I think my background in health systems management and public health, my experience working in both systems, and the fact that part of my family lives there and receives care there as patients gives me a bit more insight than the other bastards that spew off criticism about shit they don't understand.

"You have no control, you can't see who you want, you'll die on a wait list...." and so on. All bullshit. But it makes for the sort of great fear-mongering for our political machine....

To be fair, I really don't know if Kevin, MD feels this way about the Canadian system, but he did choose to point out that "...it looks like the grass is not always greener..." in the Canadian system.

No, the grass is never always greener. But sometimes, it looks pretty damn good. You know, in order to get really green grass, you sometimes need to put up with some shit and fertilizer in your lawn. Suck it up. They live longer than we do, and they don't go bankrupt because of health care expenses.

In any case, here's my retort, also posted in comments on the site:

Don't bag the Canadian system with a blanket statement. I'm an American doc that has experience in both. The propaganda does no one any good.

No, it's not perfect there. But the grass, from the perspective of public health, is a whole lot greener.

It would be a flaw in reasoning to attribute the problems they face with the sole fact that they have a single payer system.

1. They need more controls around utilization (we actually have much tighter regs via managed care in this country), and could use greater efforts in disease management, etc. They do need copayments, guidelines, etc.

2. The single payer component actually reduces overhead and improves accounts recivable significantly.

3. They have much less med school debt (if any).

4. They have much lower malpractice costs.

5. One can't generalize, as the problems differ by province (as does the way in which physicians are paid)...the provincial governments that have implemented salary caps for primary care physicians are insane.

6. Some provinces face a problem with churning by physicians, over-referral, over-utilization to feed the churning beast (downstream churning to specialists, etc.)

7. My take is that there is too much choice and too much freedom in the Canadian system, and that tighter controls and true management of care (cost & value) is what's necessary. I also think competition needs to be amped up.

Too much freedom and too little "management" of care with skewed incentives (again insufficient rewards for primary care docs to manage care and to manage populations) are the issue....NOT the single-payer methodology alone.