Ob-Gyns with 10 Month Waiting Lists

In 1971, when I applied for Landed Immigrant status (roughly speaking, getting a “green card”) in Canada, one of the requirements was a physical examination.

I knew nothing about the Canadian health care system, much less any doctor in Toronto. Yellow pages in hand, I called doctors until I found one who could examine me on the schedule mandated by Immigration Canada. This essentially random act resulted in my first exposure to the workings of the Canadian health care system.

At the appointed hour I explained to the doctor the reason of my need for a physical exam. In a clipped British accent, which I at first thought might be quaintly typical of Canadian professionals, he explained how health care worked. He told me that the government set fees for all procedures and that he accepted the rate they would pay for my physical.

What he would not accept was payment from the Ontario Ministry of Health for that service. He expected me to pay.

While I’m absorbing the fact that Ontario is going to pay for this physical even though I’d been in the country for only 2 weeks, he explained that the Province would send reimbursement directly to me. When I received this check I was to pay him with the proceeds. (With a little stretch you can imagine that this arrangement had something in common with HSAs.)

Having given this speech before he did not pause for Q&A, but went directly to the statement that he had moved to Canada from Britain to avoid being a government employee. He’d accept the government fee schedule, but he would not take their money.

Being well steeped in the literature of libertarianism and objectivism, I grasped his point immediately.

There existed a market related pricing mechanism. If you were happy with the doc you had, and if he would accept the government payment as a total payment, the transaction would be complete. If you liked a doc who wanted more money, you were allowed to pay it and he was allowed to accept it.

The government had set a floor price for the “commodity”. My new doctor wasn’t going to give the health bureaucrats the satisfaction of kowtowing to it. He was preserving the right to set his own fees.

Over the course of the next decade the Federal government decided that doctors should no longer set fees for their own services. Doctors, on the other hand, still thought it reasonable that they be allowed to set their own fees, a practice labeled by the government as “extra billing.”

That is, if the doc charged more than the government fee schedule, you had to pay the difference.

When the phrase “extra billing” stuck, you knew the docs were toast.

Since the individual provinces actually paid the doctors, the Feds had no direct control. They simply threatened to withhold “Federal” funds, i.e., the taxes collected from individuals in the provinces but sent to the Feds, if “extra billing” was not outlawed by that province. (Like our own 55 MPH speed limit, or .08 blood alcohol.)

To cut to the chase: After desultory provincial opposition the market for health care was banned. The result is a health care system declared unconstitutional by the Canadian Supreme Court.

Julia Necheff, of Canadian Press, reports that as result of this failure of central planning the Canadian Medical Association proposes a “parallel private health care” system.

What?! If doctors had continued to be allowed to set their own fees there would not be this (particular) crisis in Canada’s health care system. This Rube Goldberg fix would never have had to be proposed

The mealy mouthed comments from Canadian Medical Association President-elect Dr. Ruth Collins-Nakai, merely demonstrates the fact that doctors in Canada have become proletarian lackeys, much less government employees:

[She] disputed that the medical association is endorsing private health care, as critics have charged.

The primary concern of physicians of Canada is that patients have timely access to quality care based on need, not ability to pay, said Collins-Nakai, a pediatric cardiologist in Edmonton.

If you’re going to quote Marx: “from each according to his ability, to each according to his need”, as a defense of anything called “private” business, maybe you should just shut up.

Some of the Canadian Medical Association voters got it right:

Supporters of the motion said too-long waiting lists are an urgent problem, the system is faltering and it needs help from the private sector.

“Governments have had 40 years to get the monopoly system right and the casualties are piling up – one of them has been my wife,” said Dr. John Slater of Comox, B.C.

“I have stopped believing in Santa Claus and I have stopped believing the government will ever fix the monopoly system.”

The simple solution is market pricing; already shown to work. A parallel private system can only be elitist, and its only virtue would be to make Prime Minister Paul Martin’s private health plan available to a few more wealthy Canadians.