Thursday, July 02, 2009

A smart and scary article on health care

Our inability to manage health care is one of the great public policy failures of the last 25 years, at least. The same issues and the same lack of information come up again and again and again.
Given Kevin Falcon's musings on private and two-tier care, this New Yorker article is must reading.


Anonymous said...

We already have in BC a system very similar to the Medicare system that the doctors of McAllen, Texas, seem to be taking advantage of. The patient cost differences must relate more to differences between the characters and motivations of the doctors than to the systems.

Maybe if the cost of an MD degree didn't leave the graduates several hundred thousand dollars in debt before they see their first patient, they might not be so motivated to earn the big bucks while still young and able. I'm guessing, but expect that t he cost of the same degree in the US would be higher than in Canada. The corollary of "You get what you pay for" would be "You don't get what you don't pay for". We don't seem willing to pay for the training of the doctors but we expect them to take care of all of us.

What do you think an MD - with ten or eleven (or more) years of post- graduate study and residency under his belt - should earn, say compared to a BC Liberal cabinet minister, no education to speak of, and starting at $150,000 minimum plus pension almost immediately?

Raymond Graham

wstander said...

Raymond Graham

Please. Forget the straw man analogies. Comparing apples to oranges is even more realistic than comparing salaries in disparate occupations. At least apples and oranges are both fruits.

There is no logic in comparing incomes of doctors with those of politicians, athletes, movie stars, or whatever. The issue is, as the article states, what it the primary motivator behind the doctor's career- making money or providing optimum health care to his of her patients?

paul said...

I'd argue the issue is also, once you have decided what reasonable compensation is, how you structure the system so that increased income comes with better health results for patients. There's no connection in Canada or the U.S. now. The doctor who sees a high-volume of patients, offering limited care to each, can be paid more than a doctor who spends time counselling patients on disease management or prevention.

Anonymous said...

Don’t forget the rural doctors loan forgiveness program. If you decide to practice in a designated rural area here in BC for 3 years you get your student loans forgiven. For a young doctor that can be a good deal not to mention taking advantage of cheaper real estate in these areas as well.

Anonymous said...


You may not want to think that many doctors feel under-appreciated as reflected in their legislated pay schedules - maybe you're right. Paul comment is getting nearer to the dilemma that doctors are faced with. But why should doctors be legislatively forced to ask themselves such questions? What's wrong with comparing salaries of others - that's exactly what the government does when justifying high payments for their bureaucrats? And when our doctors compare their incomes with those of their southern counterparts, guess what.
If we want to retain universal health care we have to train and retain many more doctors than are we are at present. That means pay them fairly. And yes, the new recruits can spend another three years in the sticks to have their (provincial government portion of only) student loans forgiven. Or they can emmigrate to the US, pay them off in a year, bank the rest, and stay there making the kind of salaries that I believe 10 or 12 years of post grad study should entitle them to.

Raymond Graham

paul said...

Another question that should be asked is whether front-line health care providers need 10 or 12 years of post-grad study.
Would we have better overall health outcomes if patients were seen by providers with two years of post-grad training and a year of apprenticeship?
Outcomes for some people would inevitably be worse - a tricky diagnosis missed, for example.
But improved access to care overall might result in better results for far more people.
And, of course, compensation could reflect the reduced years of training and increased supply of practitioners. (Same question should be asked about the steady increase in the number of years nurses have been asked to spend in training.)

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