Aaron Carroll, associate professor of Pediatrics at Indiana University School of Medicine, has a seven-point defence of Canada’s Medicare system:
1) Doctors in Canada are not flocking to the US to practice
2) Canadians are not flocking here [to the US] to get care
3) Doctors are not less satisfied practicing in Canada than the US
4) Claiming that hip replacements and cataract surgeries happen faster in the US does not prove that a single payer system doesn’t work
5) Canada’s wait times aren’t due to its being a singe-payer system
6) Since Canada adopted their single payer system, infant mortality has dropped below that of the US
7) In Canada, they may “ration” by making some people wait for some things, but here in the US we also “ration” – by cost
Medicare in Canada is similar to Medicare in the United States. But there are important differences. A major one is that everyone in Canada is covered, not just the elderly. Another difference is that there are no co-pays in Canada, whereas there are large co-pays in the US. Also, Medicare is a provincial responsibility, though partially funded with federal tax dollars. Some of the Canadian provinces provide more generous benefits than others (especially for dental work and prescription drugs). What is the same in both countries is that medical providers, by and large, work on a fee-for-service basis. Medical insurance in Canada is socialized, but not the provision of medical care. Canadians can, and do, purchase supplemental private insurance to cover what is not covered by government insurance, such as private or semi-private hospital rooms, and some dental and prescription drug bills.
Each of Dr Carroll’s seven points are important. I encourage you to read them. As a sample, here is point #3:
How satisfied are physicians with their practice? It’s not a perfect measure, but it’s an important one:
Given the rhetoric of how much physicians hate reform, you would think doctors were very happy before reform passed. You’d be wrong. With the exception of Austria [sic-Australia] and Germany, fewer doctors were satisfied with practicing medicine [in the US] than any other surveyed country.
Aaron Carroll, “In defense of Canada“, The Incidental Economist, 5 June 2011.
Even more surprising, to me, is the satisfaction of doctors practicing in the UK, compared to Canada and, even more markedly, to the US. British doctors, for the most part, work for salary whereas most doctors in the US and Canada work on a ‘fee for service’ basis. In both counties, it is widely believed that doctors would not appreciate any move away from private billing. It is very possible, apparently, that this belief is without foundation. Interestingly, the Tories in Britain are moving to the US/Canadian practice of ‘fee for service’.
I have one small complaint about an otherwise excellent post. ‘AUS’ is the code for Australia. The code for Austria is ‘AUT’. I live in Austria, so am sensitive to confusion of Austria with Australia. (I have nothing against Australia, but I prefer that mail intended for my address in Austria not be sent to Australia.)
HT Paul Krugman.
