Single-Payer Setback: Canadian Doctors Without Contract For Over Two Years

OHIPPhysicians in Canada’s largest province, Ontario, have rejected a contract negotiated between the Ontario Medical Association and the provincial health ministry. The more than two-year old dispute shows no sign of ending.

Every Canadian is covered by his provincial government’s health plan. So, doctors have only one plan with which to contract. Each doctor cannot decide how much he wants to charge his patients. Instead, he is dependent on a centrally bargained contract which determines fees for every procedure and practice from the skyscrapers of downtown Toronto to windswept hamlets on the frozen shores of Hudson’s Bay.

No wonder it takes more than two years to negotiate a contract. According to local media, the doctors’ demands were threatening to bust an already heavy-laden budget:

The hardline stand of Ontario’s doctors raises questions across the country about how to balance the labour rights of a well-organized profession with spiralling health costs that threaten to swamp provincial budgets as populations age and guaranteed federal health transfers grow at a slower rate.

At least the doctors did not go on strike, like young doctors in Britain did recently. It is hard for Americans to imagine the entire profession of medicine walking off the job like U.S letter carriers did in 1970. However, labor strife among physicians appears to be common in countries where the government monopolizes payment for medical care.

The hostile relationship that develops between the medical profession and the state in countries with single-payer health systems makes a mockery of the so-called guaranteed “right” to health care that underpin single-payer proposals from politicians like Bernie Sanders.

Comments (13)

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  1. Barry Carol says:

    In the end, how much any of these socialist societies are prepared to spend for healthcare as a percentage of GDP is a political decision. It probably doesn’t reflect the actual healthcare needs of the population. The reality is that money is a constraining resource and medical care has to be rationed somehow. Canada does it with waiting lists at least for situations that aren’t an emergency or immediately life threatening.

    • Ron Greiner says:

      Barry, you say, “rationed somehow. Canada does it with waiting lists at least for situations that aren’t an emergency or immediately life threatening.”

      Sure, sure, that’s why Canadians flock across the border into the USA for heart surgery so they don’t die on the waiting list in the frozen north.

      Stop trying to make Socialized Medicine sound acceptable Barry.

      • Barry Carol says:

        Ron — My comment was a mere statement of fact. It was not intended to make their system sound acceptable or unacceptable. The UK made a political decision to spend an even lower percentage of GDP on healthcare than Canada does. That’s their choice too.

        Separately, I’ll be neither you nor I have any idea how many Canadians come here each year for heart surgery or any other type of surgery for that matter or how many would have died if they waited their turn in Canada. It’s probably a pretty tiny percentage of the population that is both able and willing to pay cash for an expensive surgical procedure like heart surgery in the U.S. even if they receive a comparatively competitive cash price quote.

    • Allan says:

      When is money not a constraining resource? Money is a constraining resource in every sector of the economy at the same time it distributes information. One of the reasons policies you support don’t work is because your policies don’t permit money to disseminate needed information.

    • Archer Crosley says:

      And why is it a reality that healthcare must be rationed? The goal is to arrive at a pluralistic, competitive marketplace where healthcare becomes inexpensive. When healthcare is inexpensive – and there is no reason why it should be expensive – there is no need to ration it at all. But with the irresponsible government in control, doling out huge contracts to their crony capitalists and buddies, healthcare will become unbelievably expensive and will therefore need to be rationed.

      • John Fembup says:

        “I will cover all your healthcare needs that I can provide at my establishment for so many dollars per month. I only require a copay for each visit that I may waive at my discretion in order to modulate patient flow.”

        Archer, I wish my physician would say that to me and I understand how those ideas simplify your office admin. But, it seems to me the ideas are rooted in insurance (capitation; copays). I don’t understand how they might have a favorable impact on your cost to deliver medical care to your patients: the cost of your education, your liability, rent, office staff, office equipment and maintenance, instruments, supplies, your time, etc. etc. Your revenue side is protected. Your cost side is not.

        From a wider perspective, overall medical costs equal the cost per “unit” (however one defines units) times the number of units. Problem is – the unit cost and the number of units both grow over time.

        Even if those sources of cost growth can be restrained, I don’t see any practical way around at least some permanent forms of rationing. I say this mostly because resources are always limited but medical demands are not.

        Besides, our so-called leadership has spent the past 50+ years virtually ignoring What might be done to restrain the growth of medical coasts. Instead, they’ve occupied themselves designing complicated insurance schemes like Medicare and Obamacare to “cover” those costs. That strategy has clearly failed; it has arguably allowed, even stimulated, yet more growth in cost.

        Perhaps physicians could figure out a better way – but physicians are pretty busy already. We’re left with effectively few who will, or can, address our problem. That’s the rest of the reason I just don’t see any practical way around at least some permanent forms of rationing medical care.

  2. Devon Herrick says:

    One thing proponents of single-payer who want Medicare-for-All fail to appreciate is that the way health care systems like Canada’s saves money underpaying providers and rationing equipment. Medicare does not do much of that. It does pay 20% less than private insurers. But that’s not the same as acting like a monopsony.

    • Karl Stecher says:

      Medicare underpays physicians terribly. As an example I have used, If it were Gasicare it would be paying the gas station owner about 60 cents a gallon today. And private insurers pay more, but still miserable. Further…Medicare has the greatest percentage of rejected claims (claims sent from the doctor’s office to Medicare for payment) of any insurer…which must then be resubmitted, costing more overhead. Primary care doctors and specialists are both equally stiffed. Primary care doctors often race through a long schedule of patients, as the reimbursement is so low that they cannot afford to spend more time and keep their office alive. That is the sad reality of the business side of medicine…which medical students had no idea they would be getting into when all they wanted to do was see patients and treat.
      Medicare “rations” by delaying or prohibiting newer and more effective drugs (and, of course, more expensive).
      Medicare does not cover hearing, dental, or vision (except cataracts, macular degeneration detached retina). And purchase, by the patient, of a Medicare supplemental policy is usually necessary, due to the deductibles in standard Medicare.

  3. Ron Greiner says:

    Obamacare is creating Single-Payer in the USA.

    —In 2017 there will be only one insurer selling health care plans in the Obamacare exchanges in one-third of the country, according to an analysis from Avalere experts.

    Avalere, a health care consulting firm, compared the health insurance carriers that offered Obamacare coverage in 2016 to the carriers who have announced their intention to exit the exchanges in 2017, such as Aetna, Humana, UnitedHealthcare, and some co-ops.

    The experts projected that 36 percent of exchange market rating regions in the United States in 2017 will have just one health insurance carrier, and 55 percent of regions will have two or fewer carriers. This is a significant increase from 2016, when only 4 percent of regions had one or fewer health insurance carriers and 33 percent of regions had two or fewer insurers.—

    Forget FREEDOM -Hillary thinks this is a huge success and she has cancelled all campaign stops because she is so far ahead in the media.

  4. Yes, the reimbursement is poor under Medicaid as well. The survival of decent healthcare will come down to why providers entered medicine in the first place. If you entered to get rich you’ll leave or you’ll sell out. If you entered for autonomy you’ll struggle along by yourself and figure a way to survive. Ultimately, the only salvation for healthcare will come from those providers who keep the embers burning. Not a bad legacy.