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https://www.counterpunch.org/2013/11/22/21-ways-the-canadian-health-care...

The article's site provided by Dont_punch_grandpa - Thank you.

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Ralph Nador is proposing a revision to the U.S. health care model to the one used in Canada. The selective compartive stats sound like the sub-text in an Ayn Rand novel: free care for everyone, end the bureaucracy, from each according to his ability, to each according to his need. I just can not see a brain surgeon going into the office or manufacturing because all the doctor slots were filled. As dreaming goes, we are stubborn and would rebel; just stop working before we conformed to dictates that end or limit our choices. We are pampered americans. We try to rock.

I looked at a study on Internet: Other comparative statistics.

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How much do doctors make in Canada vs USA?

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Primary care physicians include family doctors, pediatricians, internal-medicine specialists and obstretician-gynecologsts. Those in the U.S. earn an average after expenses in 2008 of $186,582, versus $125,000 in Canada, $159,000 in Britain and just $92,000 in Australia. Sept 14, 2011.

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What are the 2016  study stats? We've had near meltdown of the world economy and a new healthcare system installed. Doctors under social medicine forced to earn less due to caps on their salaries has and will cause Canadian specialists to consider other practice location options - the U.S. for one. Also consider the AMA contributions to the affordable health care act which maintains the status quo for physicians. We are, after all, capitalists – we compete for everything – even the right to live. Compassion loses, earning lots of money wins. Our government is inefficient and expensive: social medicine would not work here – overhead would kill it out the gate. Lack of will would do it in at the proposal and debate level. PACs and lobbyists would sit-in at Representatives and Senator's portals for months.

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Downsizing the insurance industy alone would be monumental and plagued with resistance from the investment sector. Wall Stree would have to be reconfigured to down-shift for the smaller outlays between medical service and goods providers and manufacturers. Note: Millions have always been excluded from upper echelon club structures like the board room and accessibility to truley affordable health care.  Except for the Civil War, we have not rebelled since in a way that made changes of this ilk. The sixties tried, but there is no arguing with martial law and really accurate guns.

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Orthopedic surgeons in Canada make less than half the $440,000 average net income of colleagues in the States while doing more procedures, two U.S. health-policy professors concluded in one of the most detailed looks yet at the differences in doctor compensation between nations.

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Doctors would cease care and march on Washington. This concepts takes on the most powerful group in the U.S. after insurance industry gate keepers. The U.S. economy would collapse: Medical companies and suppliers who are all over Wall Street would declare, "The Game Is On!" Remove the price tag on medicine  and the dollar goes to hell. Not even the Federal Reserve could stop the crash. A new study on the demographics of physicans in the U.S. and Canada, Australia, Russia, The Netherlands, and China is needed for this discussion.

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I’m not saying the Nader suggestions are not great in comparing U.S. health care delivery vs Canada’s. Universal coverage from birth with tax dollars apportioned equitably compared to current cost outlays would be a starting point. A slow weening, leaving physician pay in tact, while ending the bureaucracy and insurance companies has merit. It would take decreasing the military budget and tax money apportionments to all 50 states. Any percentage of the trillions that keep the country running (though badly) transferred to health care is anti-american. Government is mandated to never invest in programs that favor one group over other established groups. (It does it all the time actually, but for PR purposes that would be the argument). Congress would lose its re-election money. Enter campaign financing reform - an colloray to health care reform of this magnatude. Imports from outside the country would have to be re-examined, possibly curtailed to support U.S. manufacturers. Retooling to make medical equiptment and drugs here would bite the pharmaceutical industy hard. Real hard. Oh how those economic wheels turn once they get rolling. 

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A Constitutional amendment would be necessary guaranteeing americans free health care. Anyone without a birth certificate would be excluded – sorry immigrants and guests. Talk about mass exodus of illegals from the country. Talk about foreigners staying out willingly. They would get sick and die here if they could not pay. Oops. This means advent of safety net elimination as it stands now and an only americans need apply system. Interesting. How do you turn away sick people with no birth ceirtificate or card. They have to pay - but then the cost would not be bank account breaking, theorectically, because prices would be so much lower.. Artifical card based fraud would become a new norm. Everyone registered is something the ACLU will really adore. The lawyers would have their day in court on the bigger brother argument.

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Canada should not ignore the wage gap, as a sudden shortage of certain specialists in the States could trigger a drain from here, said Dr. John Haggie, president of the Canadian Medical Association. Canada saw a net loss of doctors to the U.S. in the 1990s, as provinces instituted doctor pay caps and tried to rein-in fee increases as a way to corral health costs.

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Educating doctors here is expensive, as noted by the amount of student debt health care subspecialties incur for a slot in the health care chain of service provision. Limiting or ending the practice of importing health care providers to attend U.S. citizens in American institutions would be hard to pass since we fail miserably at education. Places to start – locate the genius born and persevering and finishers and stir them into medicine. Good luck with that, if exceptionally smart, you avoid working hard here and pursue other areas of fun and interest. This is why millionaires run for office and win. They get an inside on where to invest. Talk about insider trading. Anyway, we suck at educating our citizens and have to import doctors from all over the world.

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We recruit world wide for talent and pay them well to keep them as long as possible. Presently, less health care dollars and reimbursement models are sending foreign doctors home or to other countries. Physicians who had planned to retire from their current employer are being forced out - too expensive. U.S. and foreign dotors are leaving to compete in better paying economic regions of the world. Doctor's pay is decreased by private companies that are buying health care systems and hospital. First move after acquisition: decrease physican pay. Heaven help us if doctors go into politics to protest the eroding away of guaranteed Constitutional freedoms.  :D.  

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Of course, the comparison of physician pay scales does not take into account cost of living differences. It is cheaper to live in Canada than here (and Germany and Australia, China, and Russia). Nador looks only at the movement of the country to the extreme left vs the practicality of translating all the data into a cohesive and possible system. A rebellion by the capitalist would ensue and everything would just stop functioning. Go figure. Why the radical left is out of touch and failing world-wide. (I like the hype, I can't envision the execution of the ideologies as doing anything but discriminating against black people). Freedoms and rights would have to be adjusted - and there goes the farm.

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I am not a capitalist apologist, having been on the deep downside of that system most of my 67 years under it, but survival is possible and advancement. Those stories seem to get lost in the glowing lights and auras of a communistic/socialistic based health care system or any other system. Another rub. The flag wavers would rebel. Physicians, especially neural surgeons would leave the field, manipulate the stock market, and retire a billionaire at the ripe old age of 38. It's called unexpected consequences.

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Don't get me wrong, a lot of the ideas in Canadian medicine bear consideration. Free pharmacy meds and durable equipment has a lot of merit. Leave the physicians alone, they are smarter than most and accustomed to being accurate. Let them wring their best solution from the federal government - they are important part of the amerian economy and their voices will be heard and their concerns addressed.

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About health care cards issued at birth, we count our citizens with Social Security Cards already - now issued at birth, bye the bye. The ten year census tells us basically demographics and how many american have indoor plumbing. Apportionment of taxes are corrupted by lopsided military budgets and the price of Medicare and Medicaid - hence the debate, but freeing up dollars never interprets into lower taxes, have you noticed? What happens to those dollars once the boomers are pushing up daisies and petunias.

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Universsal health care for citizens with a rider attached to finance nation-wide infrastructure has merit and a shot politically. Who would vote against free doctor visits and no bankrupt status if needing surgery and guaranteed clean water and energy? Who? It sounds good. It will still carry a high price tag to initiate and to maintain, a lot like the wall between U.S. and Mexico. The costs are seldom publicized including the overruns and delays that always occur with any project sponsored by a U.S.  governement department or mandate. 

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Provincial medicare agencies pay an average fee of $652 to surgeons in Canada for a hip replacement. Government programs like Medicaid in the States reimburse almost triple that, while U.S. private insurers offer an average of just under $4,000 per hip operation.

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Hospitals want blue cross and not Medicare patients – for the above reasons. It also explains why the indigent on Medicaid get locked out or go bankrupt. Add in the additional surgeries Canadian surgeons across the board perform annually and compare those figures to U.S. performance: it takes the “cushy” out of being a surgeon in the U.S. Don’t mess with the lifestyle. Canada had to raise doctor’s salaries to staunch the exodus of physicians to the U.S. A market response. Capping procedure costs makes a lot of sense – but not income dollars. Talk about resistance: earmarking a percentage of taxpayer dollars to healthcare and away from the states and the military would fail – power groups and interest groups would win. Money and power relationships are being attacked by Nador, as ususal (most of which seem great rhetorically – practicality is missing and I get lost in the how to inside all the this would be better psychology). I’m a die hard capitalist because I’m black and have wanted a chuck of the American pie lifelong.

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Changing mental conditioning is Nador’s goal and he’s good at it. Moving millions to act is a capitalist’s ad campaign speciality, however, and they would win. Period. We are controlled here. Free choice is an illusion. A socialist form of government with referendum ability would have to be instituted first – Nador’s dream America. Won’t happen. Calling the American health care system Obamacare is so racist, Ralph. Who are you addressing? White america. Go ahead, I'm a die hard minority too. I'm used to being overlooked. It's America!

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The study’s authors, though, say all the countries surveyed ought to examine the wide differences in pay for primary-care versus surgical specialities, and how that affects doctor career choices.

“Primary care is not seen in every country as the most important area for (doctors) to train in,” said Prof. Laugesen. “By paying physicians more in one speciality, there can be changes in that perception.”

Paying all physicians equitably would affect career choices and there would be tons of doctors opening private practices all over the country. That seems to be missing from the Nador model. Small towns need qualified doctors and that is a crisis reality presently as well. Physican supply and demand is subject to all kinds of forces: location is one, pay, and cost of living (varies widly) and lifestyle – living in suburbs near large cities is still the norm. The country doctor is dedicated and not as wealthy as his urban counterpart. Who wants to provide care in Apalacha (can't spell Apalachia) when they could live in New York or Boston? Physicians, as an aggregate, are smart, and socially conscious – granted. But when personal choices are dictated by need of the many – instead of by the physician – there’s the rub.

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There’s too much money here. Congress would have to contract the money supply and lower standard of living across the board – charging taxes of 80% to the top 1% of the rich to uber rich. Talk about getting out of the country with all that wealth fast if not already done. With a million anyone here could retire to a small Island and live well the rest of their days. (If the ocean-creek don't rise, that is). At least with five to fifty million in cash and capital, a doctor could live anywhere they chose and quite well. Hmmmm... We must be careful who we attack as a nation.

I’m not advocating for uber rich I’m saying that I want to be uber rich and that is a powerful incentive to erase from the American psyche of desires and motivations. Of course, when it all collapses (as is inevitable with the lopsided distribution of wealth here and elsewhere) some of this might be possible. During the Depression, any pay was better than none and it would have to be under similar conditions world-wide to make the kinds of changes from American business medical models to a Canadian form of health care provision. I like you, Ralph, but you were born in the wrong time and place. We have not evolved to your level yet.

I’m just sayin.

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Stella L. Crews

07-29-17

228p

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