It has been suggested that I prefer the Canadian-type healthcare system over our own American system. From an economic-business-political-ideological policy perspective, I can understand how one might reach that conclusion. However, although the different analyses and conclusions which fall within its domain are what currently guide the creation of legislation pertaining to our American healthcare system, this perspective needs to be replaced (as our guide) because not only is it not based on the medicine of medicine, the doctor patient relationship, it actually thwarts development of same and makes this fundamental essence of health care the servant of economic-business-political-ideological policy.
Thus, I am directly opposed to the Canadian system, which keeps costs in check in part by controlling the supply of certain services– for example, imaging and surgical facilities and the specialist physicians necessary to carry out the procedures. The result is the growth of waiting lists for some procedures. (“Privatizing health care is not the answer: lessons from the United States” by Marcia Angell MD CMAJ October 21, 2008 179(9) (http://www.cmaj.ca/cgi/reprint/179/9/916) Thus, the payer is, in effect, practicing medicine instead of simply administering payment of the bill for medical decision making, which occurs within the doctor patient relationship. I do not believe that people living in any country send their money to public payers (government’s taxes) or to private payers (health insurance companies’ premiums) with the expectations that these business administrations will be making medical decisions, which is, in effect, what a waiting list is.
As well, I am not in favor of physician entrepreneurship or entrepreneurship in general in the American healthcare system. There is a brief, instructive discussion about the dollar quest of US healthcare businesses in the article referenced above. What needs to change in the American system, for sound healthcare reform, is its underlying ethos, its aspirations. The dollar quest should be replaced by the quest, a demand, for the medicine of medicine, the doctor patient relationship, to be open to everyone in an affordable manner, which makes the dollar bill the servant, the fundamental support, of this demand as opposed to the opposite, which is the current state of affairs.
This sounds idealistic, naive and corny, and it is exactly what we need from our politicians and their economic advisors. So far, those plans and ideas for change that have been offered to and/or hoisted upon us by politicians of every party designation; their advisors from different spheres; think tanks, which support one agenda or another; lobbyists, who disguise themselves with different designations; and others are nothing more than convoluted tweakings of our already dysfunctional system. These people, who function in the veiled reality of this realm, which obstructs real, beneficial change, will never be able to recreate the wheel because they are so dependent on it. We need to change current reality, i.e., recreate the wheel of American healthcare policy, so that it is guided by the medicine of medicine not the business of medicine.
I do not favor the Canadian system, the British system, or the American system. I favor a complete overhaul, the fundamentals of which I have described in my books: Equal Health Care For All (2007) and Socialized Health Care Reform (2010)
R. Garth Kirkwood, MD