Private insurance is no answer

In his commentary on a recent BCMJ editorial, Dr William Arkinstall describes Canada’s medical system as “dismal” (2007;49[6]:296). To learn about dismal, I suggest he read the recent CMAJ article discussing the hard decisions Canadian military surgeons must make in Afghanistan, where civilian patients transfered to local hospitals face likely death because of inadequate life-support technology. One of the physicians said such decisions “simply would not be made in Canada.”[1] 

Certainly we could all use more resources, but private insurance is unlikely to solve more problems than it would create. Private care will not reduce wait times at our public clinics and hospitals, and may increase them as specialists abandon the public sector. Private clinics will take the least complicated and most lucrative cases; the rest will be left to public care, as is happening now in Great Britain’s flirtation with privatization.

Boosters of private care and insurance often promote a European model. They fail to take into account NAFTA, which would give US insurance companies and corporate hospital chains preferential access to Canada. These powerful companies are unlikely to alter their business model for Canadians. Canadian physicians should realize how much US physicians despise managed care, how clinically intrusive insurance companies and HMOs are, how patients are denied care despite doctors’ recommendations, and how expensive for physicians it is to chase payments from several companies. After all, insurance companies make money by keeping it, not by paying it out. 
Dr Arkinstall said that employers would provide medical insurance for their employees. His assumption is naive. Canada’s medical system is considered a competitive advantage by some economists. Providing medical coverage for employees is burdensome. According to a Reuters story, only 60% of US small businesses offer health insurance to employees, and costs are rising 15% per year.[2] A businessman complained to the reporter, “I’m not qualified to make the best decision for all these employees… Health care is a pain in the butt.” And having multiple payers is inefficient. In the United States, almost a third of health care dollars go to administration and profit; Canada spends 54% less per capita on administration.[3]

As the Conversation on Health shows, the government is accountable to citizens. That may not always satisfy physicians, but private companies are accountable to owners and stockholders. US physicians have made little progress in making Aetna and Wellpoint responsive to them; what makes Canadian physicians think they’ll do any better?

—Randall F. White, MD
   Vancouver