My first article highlighted some key challenges with the sole public option health model in Canada. On the U.S. side, the quality of health care is exceptional for those that receive comprehensive health & dental benefits plans through large or employee-centric employers such as Microsoft. The “for-profit” health care model attracts top-notch physicians and enables health care providers to invest in the latest technologies, facilities upgrades and research ventures.
However, this model does not benefit those that either cannot afford health insurance or have insurance carriers that play the game of constantly raising premiums while finding creative ways to drop coverage when it is needed the most.
One can’t beat the insurance companies up too much – after all, they do not insure people from a philanthropic motive – the large public ones are under extreme pressure from us (shareholders) to meet or exceed profit expectations on a quarter-to-quarter basis.
While the Canadian model might excessively prolong the time it take for a patient to receive treatment, the U.S. model denies non-discretionary treatment to a percentage of its population. Neither model works particularly well.
The answer has to lie somewhere in the middle – a two-tier model that provides a public option of mandatory services to all legal residents of the country with private providers that can also provide these services in addition to other discretionary services that are not covered by the public option.
To address the abuse of the public option, a minimal user fee should apply to all visits ($5-10) which would be waived for the truly destitute.
To avoid local and foreign health care professionals from directly going to the more profitable private providers there should be a mandatory requirement of a minimum number of years of service in the public system.
There should also be the option for foreign-trained doctors to start working in the public system immediately or after an extremely short evaluation period – having met some foreign-trained doctors that were forced to drive cabs in Canada to support their families while at the same time the waiting lists for getting a family physician are growing, there has to be a compromise.
To get to a model like this, it will require significant change in thinking for both U.S. and Canadian citizens. For the U.S., it will mean greater involvement of government than before, and likely higher taxes. For Canadians, it will mean sacrificing the sacred cow of public-only health at the altar of “doing the right thing”. This will not be an easy change, but nothing worth doing is ever easy.
No one has said it better than Ted Kennedy (as quoted by President Obama): “What we face is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”