Thursday, October 30, 2008

Kurisko on Canadian Health Care

The non-partisan group Center of the American Experiment has published the following interview with Dr. Lee Kurisko, a radiologist who used to practice in Canada and who now practices in Minnesota, entitled "A Conversation about Canadian and American Health Care".

I highly recommend reading the whole thing, especially if you want a perspective from someone who has been in the trenches.

I've selected a few excerpts to highlight.

On inequality:
...I've seen more inequity and disparity in Canada than the United States, as far as access to care. As I mentioned, we had huge waiting lists. Our MRI waiting list was 13 months long. Our CT scan waiting list was seven months long. People in that system really were just left to suffer to a much greater degree than they are here in the United States.

One thing that you see that is not talked about very much is that Canadians with influence or connections tend to get medical attention more quickly. I would get telephone calls from various doctors requesting that their patients be moved up on the waiting list. If they made a reasonable case, I would do so, whereas there were other doctors who just referred people for imaging tests, and I never heard specific requests from those doctors. Their patients would just go to the end of the waiting list because they didn't have the same level of advocacy. The other thing -- and it's kind of a deep, dark secret -- is if you are connected to somebody in the medical system, you're much more likely to get your medical intervention done more quickly, whether by knowing a doctor, knowing somebody in the hospital administration, or whatever.
On the "dying in the streets" argument:
...In Canada there's a false perception, which I actually held for many years, that if you don't have health insurance in the United States, you literally do not get care. There's a perception in Canada that in the United States if you don't have insurance and you have a problem, you’re going to get turned away and that people are just dying in the streets for lack of health care. I've been in America for almost six years, and I've yet to see anybody who’s been turned away for health care -- at least in Minnesota. Whereas, the reality is that Canadians are turned away for health care in many different ways -- through waiting lists for access.
On central planning vs. the free market:
When I was working in Canada, we had this personnel meltdown when we had only three radiologists for 250,000 people. I was director of the department at the time, and I said to the hospital administration, "We need a rolloscope." A rolloscope is a device where the X-rays and CT scans are set up on the scope, and you can push a button and go from case to case to case. It really expedites your ability to read the cases promptly. I was reading about 40,000 cases a year at that time, which is just an enormous number, especially if you're reading without a rolloscope. The hospital said, "Well, you know, what? There's no money in the budget for us to buy your rolloscope. Perhaps, you could plead the case to the Ministry of Health. Perhaps, they can make a special dispensation of dollars so that you can get this rolloscope." The radiologists in Thunder Bay eventually got the rolloscope three years later, but there was no money to hire a clerk to load the films, so it just sat and collected dust for another year.

When I moved to Minnesota, I worked at St. Francis Medical Center in Shakopee, and we were seeing increasing volumes and just getting busier, and busier, and busier. My partner and I approached our organization, Consulting Radiologists Limited, and said, "We need a rolloscope. We've got these increasing volumes." They looked and said, "Hey, you guys are phenomenally productive. We want to facilitate your productivity. Here's your rolloscope." We had the rolloscope in a month, and we had someone to load it, too. That's the free market versus central planning.
On health insurance:
Certainly, I'm not against health insurance. I would never go without it, but, on the other hand, a lot of policies are not just insurance. They're prepaid medical plans. When everything is covered, then there's no restraint. I want insurance for the catastrophic illness that I may get or if I get in a bad car accident and I have really high costs. I don't really want to have to pay insurance for routine things like my daughter's sore throat or immunization or something like that, which is routine and expected.

A good analogy would be house insurance. House insurance is pretty reasonably priced, and it is because we have it for unexpected problems, like our house burning down or being robbed. My premiums reflect the fact that these are unlikely eventualities. On the other hand, if house insurance was based on all of my needs for my household -- floor wax, paint, dishwashing soap, new clothes, or whatever -- then, as a consumer, I would say, "The sky is the limit. Let's paint the walls every week. Let's put in new carpets every week." The cost for home insurance would be astronomical, and yet that is the exact situation that we have with the standard health insurance in the United States right now.
Dr. Kurisko also offers many insightful observations about tort reform, health savings accounts (HSAs), Medicare, and how government policies create artificial medical shortages.

I highly recommend reading the whole thing!

(Via StateHouseCall.)