Medicare Malpractice

And the walls, they come a tumblin' down:

Operators of a private Kamloops pain management clinic which has Canada's only stand-up MRI machine say patients from as far away as Newfoundland are coming for imaging studies, and paying from $900 to $1300 out of pocket for such scans.

Dr. Richard Brownlee, the neurosurgeon who co-owns The Welcome Back MRI and Pain Management Centre, said he bought the MRI from an American supplier and installed it at a cost of over $2 million because he believes it has advantages over conventional technology. It allows for imaging of patients in the weight-bearing positions on the spine and joints in which they experience their pain. Scanning patients when they are lying down, as in conventional MRI machines, does not achieve that, he contends.

But don't worry, if we can't have quality at least we have equality. Oops. Spoke too soon:

A Quebec woman who claims that she paid a doctor $2,000 to expedite surgery for her cancer-stricken mother is raising questions about whether bribery is being practiced in the province's health-care system.

Vivian Green said she was doing what she had to in an effort to save her elderly mother, who had been diagnosed with pancreatic cancer after she developed a pain in her side.

[..]

The office of Quebec Health Minister Yves Bolduc issued a statement urging anyone with information about bribery in the province's health-care system to report it to the Quebec College of Physicians.

"If this practice does exist it is completely unacceptable," the minister's office said.

If? Very droll. Should they ever do a remake of Casablanca, hopefully the above ministerial flack will be cast in the role of Captain Renault. Shocked, shocked to find corruption in the Quebec health care system? Unlike, say, the Quebec construction industry? Or local Quebec politics? Or provincial Quebec politics? 

I cannot tell you the number of Canadians I've met who are stunned by stories like this, as a different generation of Canadians was shocked by the sex scandals in the mainline Christian churches. Canada is no longer, in any real sense, a Christian country, and so we've replaced our old priesthood with a newer and more secular version. The old ones wore black, the new ones wear white. 

It seems impossible to many Canadians, even the well educated and experienced, that Canadian doctors would take bribes. I suspect very few would accept actual envelopes across the desk. Too crude. But what about making a few calls for a close friend? Or relative? Or the major donor for a new wing to the hospital? Or a well connected businessman or politician? How about the editor of a major daily? Fear and greed take many forms.

As we have been reminded over the years, La Belle Province is very much a distinct society, in good ways and bad. As a whole, the Quebecois have never had the same legalistic hang-ups as the WASPish bits of the Dominion, and they certainly never bought into the Medicare as hallmark of Canadian identity routine. 

This is less finger wagging than a statement of fact. What are commandments in much of the country, are but mild legally themed suggestions in daily Quebec life. A certain contempt for unjust authority is a good thing, as well as a suspicion of authority in general. The other solitude's world weariness is something we anglais should, sparring, learn to appreciate.

Ms Green should be applauded for doing what she could to save her mother. To borrow from the amateur sociologists on the bench, it's the system that made her bad. You don't see ordinary consumers bribing car dealers, grocery clerks, hot dog vendors, real estate agents or baristas. It's not necessary. You pay the listed price and get your good or service. Should a front line employee take to looking the other way, while patrons engaged in "shrinkage," as the retailers call it, he'll be shown the door soon enough.

What makes bribing a doctor a temptation is that it is effectively illegal to simply pay him out of pocket. Whereas in most areas of our daily life we can strike a deal with other people, we can't make a deal with the doctor. Whatever the rhetoric or legalistic technicalities, the doctor works for the provincial government, not us. As with most things government touches there is both too much, and too little, at the same time. Too much paperwork and red tape, and too little of the actual good or service people want.

This comes about when the legal price is set below the market clearing price, what consumers are actually willing to pay. Sure, the doctor might want to work an extra few hours, but only at a higher price. Each additional hour of work cuts down on his personal time, so he wants additional compensation to make up for it.

The government, however, sets a flat rate, so the doctor works his set hours and then hits the golf course. The doctor loses the extra income, and the patients loses the time to be treated more swiftly. This creates a shortage in two ways. It reduces the number of doctors in the system, who seek higher overall incomes elsewhere in the economy, and reduces the amount of service hours provided by the doctors who stay on.

When Medicare's defenders are challenged on its impracticality, they often retort that it's the only way of guaranteeing that the poor get access to care. As our growing waiting lists attest, the guarantee of Medicare isn't worth the order paper it was tabled on.

If the fear is that the poor won't be able to get health care, why not provide the same solution we use to ensure the poor can eat and be housed. The rather simple expedient of giving them money, or a voucher, to meet those expenses? No one, outside of the loonier sections of the NDP, would suggest that the solution to hunger is to nationalize Loblaws. Most Canadians understand that Minister's Choice would make a poor brand.

Medicare survives because it rests upon an ethical ideal. It may not work in the technical sense of not providing sufficient and accessible care, but it is "fairer." It is not fair, by any rational standard, to have old people suffer waiting for hip replacements, because doctors are not being paid what they're worth. It is not fair that political considerations determine the location of hospitals and the purchase of equipment.

The definition of "fair" used by Medicare's defenders it that it is equal for all. The rich and poor have access to the same service. We are all the same. Any attempts to jump the queue are selfish and subvert the good of the whole. It is our duty to sacrifice our interests, even our lives, for the alleged benefit of everyone else. No matter how often editorial writers dip Medicare in 100% Pure Canadian Maple Syrup, the meaning and the message is clear: From each according to his abilities, to each according to his needs. 

It didn't work elsewhere in the twentieth century, don't expect it to work in twenty-first century Canada.

Comments

[nomdeblog]

In Denmark a dentist will do a root canal for a farmer’s pig. Commerce in high tax bracket countries turns to the barter system. Greece cannot collect taxes.

Until governments return to a very basic role of taxing for military and infrastructure reasons and getting out of the services business, the citizens will simply become more creative in circumventing the tax structure. Even Tommy Douglas did not intend that the government provide three “free” opinions on hangnails.

[Publius]

My dentist is Portuguese, so we try to settle these things in the manner traditional to our people...