ALDA & Associates International, Inc. Newsletter
March/April 2018
Single-Payer Health Care – It Is Not Worth Waiting For by David H. Fater
The American people have heard the call from Presidential candidate and Vermont senator, Bernie Sanders, "Medicare for All". What Bernie Sanders is actually advocating is a Single Payer system which has been in effect in Canada since the 1960's. The Democrats have picked up the rallying cry and most Americans don't understand is the inherent penalties associated with this system. Those penalties may not be fines or increased premiums but rather serious adverse health consequences.
Physicians in Canada, who have wanted to provide timely, state-of-the-art medical care to Canadians who were unwilling to wait months—even years—for care or surgery that they needed. Unfortunately, private clinics are prohibited from charging most patients for operations that public hospitals provide for free. So most, if not all, of the citizens in Canada are driven into the national system. Unfortunate;ly, Canada’s single-payer health-care system, ironically known as Medicare, is notoriously sluggish. People stuck on Medicare waiting lists can only dream of timely care. Last year, the median wait between referral from a general practitioner and treatment from a specialist was 21.2 weeks, or about five months—more than double the wait a quarter-century ago. Worse, the provincial governments lie about the extent of the problem. The official clock starts only when a surgeon books the patient, not when a general practitioner makes the referral. That adds months and sometimes much longer. In one case, a woman learned she’d have to wait 4½ years to see a neurologist.
The wait to see a specialist for a consultation is now 177% longer than in 1993, while the wait from consultation to treatment is 95% longer than in 1993. At 10.9 weeks it is more than three weeks longer than the 7.2-week wait considered clinically reasonable. The shortest waits are in radiation and oncology. But long waits for orthopedic surgery, neurosurgery and ophthalmology, among others, far exceed what’s recommended and aren’t benign. This is the non-monetary penalty borne by the citizens/patients. The negative consequences from these waiting times include increased pain, suffering, and mental anguish and oftentimes poorer medical outcomes—transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities. Not only that but this can add substantially to the cost for the health care system. This is directly opposite to what is being emphasized in the United States which is quality care and lower costs.
An additional burden that patients may endure might include the requirement that they may also have to forgo wages while they await treatment. Demand for diagnostic technology also outstrips supply, creating shortages in the form of lines: This year, Canadians could expect to wait 4.1 weeks for a computed tomography (CT) scan, 10.8 weeks for a magnetic resonance imaging (MRI) scan, and 3.9 weeks for an ultrasound.
Some patients would gladly go to a private clinic for expedited care, paying either directly with their own money or indirectly via private insurance. But Canadian law bans private coverage for “medically necessary care” the public system provides and effectively forbids clinics from charging patients directly for such services. The government views this behavior as paying doctors to cut in line. Doctors who accept such payments can be booted from the single-payer system.
So, Americans should be asking the question "If the Single Payer system is so good, then why do so many Canadians come to the United States for much of their primary care in addition to their specialty care?" Nothing is really ever free. We need to keep pushing to reform the system with the Triple Aim of quality care with better outcomes, lower costs and increased patient satisfaction.
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To explore ways in which we can provide assistance in developing or refining your strategy in this evolving health care environment, please contact David H. Fater at dfater@alda-associates.com or Richard M. Cohen at rcohen@alda-associates.com