By Dr David Laing Dawson
As Donald Trump famously said, “Who knew health care was so complicated?”
In Ontario recently, with the Ford government, the words “privatization” and “health care” were connected in the same sentence.
At the least it seems privatization once again surfaced as a possible means of fixing two persistent problems in our publicly funded care. The first of these problems is wait times for certain investigative procedures and certain kinds of surgeries. (For the most part these are all investigations and surgeries that can wait; that is they are not life threatening emergencies. And when I do get my appointment for an MRI of my knee I know I may have to wait a few hours, or be bumped if some urgent case arises.)
The second is so called hallway medicine. People admitted to hospital lying on gurneys in the hallways waiting for beds. This is indeed a complicated issue but not one that can be resolved by throwing the word privatization around.
But rather than address these issues I am writing this to call out a seldom mentioned problem with a “private” system of health care. And that is over treatment. If the patient is rich or his insurance very good the many private clinics in the USA are given an incentive to over investigate and over treat. Scans, blood tests, pills, surgeries, and residential care.
And to some extent the nature of the over treatment is then dictated by what the insurance company is willing to pay for. This is one aspect of the opioid epidemic. In many cases medicare or insurance will pay for pills being prescribed but not physiotherapy or gym membership. And over treatment is not benign.
Some early democratic presidential candidates are promoting medicare for all. Immediately other “experts” and politicians are saying we (the USA) can’t afford medicare for all. Nobody points out, and this is true, if you take all the money the US pays now for Medicare and divide it by the entire population, their per person cost is already higher than our (Canadian) per person cost and we cover everybody.
It is, compared to Canada, the wild west down here (as I am writing this in Florida). I have just watched TV ad after TV ad for prescription medicine, surgeries, assistive devices paid for by medicare, and then, seemingly unrelated but pertinent I think, an ad for a little packet of spring water along with testimonials of curing cancer, being able to walk again after paralysis, and good fortune in the form of a lottery win that paid off the mortgage and a check for $17000 inexplicably arriving in the mail.
I think the experts mentioned above are right. The USA cannot afford a full public universal health system, at least not without a massive public health information/promotion/prevention campaign, and not without accepting a whole bunch more regulation and over sight.