Wednesday, August 19, 2009
Steamboat Springs Why do so many Canadians come to the U.S. for health care?
This question is raised in defense of the status quo in the current health insurance debate. The answer is quite simple. Once you know your health problem and have the funds to go anywhere, the U.S. does have the more advanced health care delivery system. The incentives in our health care economy drive scarce resources to specialty care. No matter what program is adopted by Congress, this structural problem will not be solved.
Primary-care physicians are a dying breed being replaced (somewhat) by ER physicians who can bill at up to five times what an office-based physician can bill and to whose bill the hospital in which he/she works can double or triple that amount. Health insurance made available for everyone will solve one problem but increase another. Once a person has been entered into the sickness care system and is piling up bills for necessary and non-necessary services, his out-of-pocket charges will be significantly reduced and the onus of bankruptcy will likewise decline. But it will increase another. There is no way to avoid the cost of the ER because there are not enough primary-care physicians to handle the onslaught of an additional 46 million financially capable users.
Canada has a ratio of one primary care physician to about one specialist. The U.S. ratio is more like 1:3. No wonder Canadians who can pay come to the states for care. No wonder Canadian doctors trained to be specialists like to work in the states, where their income is so much greater.
It is the different structure of health care personnel and concomitant availability of services in our two countries that produce the cross-border demand, nothing else.