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Thursday, December 09, 2010

Medicare Malpractice

And the walls, they come a tumblin' down:

Operators of a private Kamloops pain management clinic which has Canada's only stand-up MRI machine say patients from as far away as Newfoundland are coming for imaging studies, and paying from $900 to $1300 out of pocket for such scans.

Dr. Richard Brownlee, the neurosurgeon who co-owns The Welcome Back MRI and Pain Management Centre, said he bought the MRI from an American supplier and installed it at a cost of over $2 million because he believes it has advantages over conventional technology. It allows for imaging of patients in the weight-bearing positions on the spine and joints in which they experience their pain. Scanning patients when they are lying down, as in conventional MRI machines, does not achieve that, he contends.

But don't worry, if we can't have quality at least we have equality. Oops. Spoke too soon:

A Quebec woman who claims that she paid a doctor $2,000 to expedite surgery for her cancer-stricken mother is raising questions about whether bribery is being practiced in the province's health-care system.

Vivian Green said she was doing what she had to in an effort to save her elderly mother, who had been diagnosed with pancreatic cancer after she developed a pain in her side.


The office of Quebec Health Minister Yves Bolduc issued a statement urging anyone with information about bribery in the province's health-care system to report it to the Quebec College of Physicians.

"If this practice does exist it is completely unacceptable," the minister's office said.

If? Very droll. Should they ever do a remake of Casablanca, hopefully the above ministerial flack will be cast in the role of Captain Renault. Shocked, shocked to find corruption in the Quebec health care system? Unlike, say, the Quebec construction industry? Or local Quebec politics? Or provincial Quebec politics? 

I cannot tell you the number of Canadians I've met who are stunned by stories like this, as a different generation of Canadians was shocked by the sex scandals in the mainline Christian churches. Canada is no longer, in any real sense, a Christian country, and so we've replaced our old priesthood with a newer and more secular version. The old ones wore black, the new ones wear white. 

It seems impossible to many Canadians, even the well educated and experienced, that Canadian doctors would take bribes. I suspect very few would accept actual envelopes across the desk. Too crude. But what about making a few calls for a close friend? Or relative? Or the major donor for a new wing to the hospital? Or a well connected businessman or politician? How about the editor of a major daily? Fear and greed take many forms.

As we have been reminded over the years, La Belle Province is very much a distinct society, in good ways and bad. As a whole, the Quebecois have never had the same legalistic hang-ups as the WASPish bits of the Dominion, and they certainly never bought into the Medicare as hallmark of Canadian identity routine. 

This is less finger wagging than a statement of fact. What are commandments in much of the country, are but mild legally themed suggestions in daily Quebec life. A certain contempt for unjust authority is a good thing, as well as a suspicion of authority in general. The other solitude's world weariness is something we anglais should, sparring, learn to appreciate.

Ms Green should be applauded for doing what she could to save her mother. To borrow from the amateur sociologists on the bench, it's the system that made her bad. You don't see ordinary consumers bribing car dealers, grocery clerks, hot dog vendors, real estate agents or baristas. It's not necessary. You pay the listed price and get your good or service. Should a front line employee take to looking the other way, while patrons engaged in "shrinkage," as the retailers call it, he'll be shown the door soon enough.

What makes bribing a doctor a temptation is that it is effectively illegal to simply pay him out of pocket. Whereas in most areas of our daily life we can strike a deal with other people, we can't make a deal with the doctor. Whatever the rhetoric or legalistic technicalities, the doctor works for the provincial government, not us. As with most things government touches there is both too much, and too little, at the same time. Too much paperwork and red tape, and too little of the actual good or service people want.

This comes about when the legal price is set below the market clearing price, what consumers are actually willing to pay. Sure, the doctor might want to work an extra few hours, but only at a higher price. Each additional hour of work cuts down on his personal time, so he wants additional compensation to make up for it.

The government, however, sets a flat rate, so the doctor works his set hours and then hits the golf course. The doctor loses the extra income, and the patients loses the time to be treated more swiftly. This creates a shortage in two ways. It reduces the number of doctors in the system, who seek higher overall incomes elsewhere in the economy, and reduces the amount of service hours provided by the doctors who stay on.

When Medicare's defenders are challenged on its impracticality, they often retort that it's the only way of guaranteeing that the poor get access to care. As our growing waiting lists attest, the guarantee of Medicare isn't worth the order paper it was tabled on.

If the fear is that the poor won't be able to get health care, why not provide the same solution we use to ensure the poor can eat and be housed. The rather simple expedient of giving them money, or a voucher, to meet those expenses? No one, outside of the loonier sections of the NDP, would suggest that the solution to hunger is to nationalize Loblaws. Most Canadians understand that Minister's Choice would make a poor brand.

Medicare survives because it rests upon an ethical ideal. It may not work in the technical sense of not providing sufficient and accessible care, but it is "fairer." It is not fair, by any rational standard, to have old people suffer waiting for hip replacements, because doctors are not being paid what they're worth. It is not fair that political considerations determine the location of hospitals and the purchase of equipment.

The definition of "fair" used by Medicare's defenders it that it is equal for all. The rich and poor have access to the same service. We are all the same. Any attempts to jump the queue are selfish and subvert the good of the whole. It is our duty to sacrifice our interests, even our lives, for the alleged benefit of everyone else. No matter how often editorial writers dip Medicare in 100% Pure Canadian Maple Syrup, the meaning and the message is clear: From each according to his abilities, to each according to his needs. 

It didn't work elsewhere in the twentieth century, don't expect it to work in twenty-first century Canada.

Posted by Richard Anderson on December 9, 2010 | Permalink


There's an excellent rant that you won't wee posted to the faculty lounge bulletin boards or published in the MSM any time soon.

The looters and thugs have an institutional lock on the Canadian mindset when it comes to health care. The political class knows, thanks to decades of "progressive" taxation, that beneficiaries out-number contributors and the "system" is therefore irreversible.

Atlas doesn't shrug in Canada, he reads the National Post and curses at the TV and idiotic relatives while slowly and most pleasantly destroying brain cells sipping on Single Malt.

Posted by: John Chittick | 2010-12-09 10:19:57 AM

Oops, that should have been, see posted..

Posted by: John Chittick | 2010-12-09 10:21:53 AM

There's no reason to bribe a Canadian doctor, when you could just spend the bribe money at a US clinic. I've been faced with that option for several different conditions. I could have gotten an MRI within one week, but opted to wait 3 months for a "free" exam. I also waited months for eye surgery. I could have spent the money, and had these procedures done out-of-province, but decided to wait in line.

I can't picture a situation where bribery would be your last resort. Neither can I picture a situation where one doctor could manipulate the system with any success. There would have to be enough cash to bribe administrators, as well as the medical staff. Only the wealthy have that sort of stroke, and they have no problem going to private clinics, elsewhere.

Posted by: dp | 2010-12-09 11:57:27 AM

It's funny hearing equality used as a justification for the Canadian medicare system. As long as government controls health care provision, decisions about who does or doesn't get care are inherently political, and like all politics, vulnerable to corruption of some sort or another.

This doesn't mean walking into the ER with a suitcase full of bills, but rather something more subtle like good ol'-fashioned influence peddling.

For all the inveighing our politicians do against a "two-tier" system, do we really think the average person off the street is going to receive the same quality of care as a premier or a minister when they go to the hospital?

Posted by: Spazmo | 2010-12-09 12:52:36 PM

My experience of abandoning the system and opting for timely surgery in the US involved a referral to a Surgeon whose office determined ranking in the referral waiting list and then again in scheduling the surgery. Therefore the doctor could certainly influence who gets the treatment when. I believe the hospital bureaucrats who ration Operating room use, related facilities, and logistics wouldn't get involved until the Doctor has scheduled the Operating room. I've never heard of documented monetary bribes until now. I suppose they are significantly more risky than preferred queue jumping for fishing buddies, friends, dignitaries etc.

And as to the patient, what's a few grand for a bribe when your next best alternative is potentially ten times that (or more) in the US.

Posted by: John Chittick | 2010-12-09 12:57:58 PM

John- I stopped short of shopping around for prices in the US. An MRI is available in some regions of Canada for under $1000. I'd be curious to see some actual prices for surgery in the US.

You're correct that a few grand would be a cheap alternative to the US market, but why would any doctor risk losing his license for a few grand? I'm assuming the bribe would have to be a minimum of five figures.

Posted by: dp | 2010-12-09 2:25:09 PM

Medical care in the US is not as expensive as people think. Also, using the US system to get your diagnosis, then returning to Canada for surgery is a good way to move up in the queue.

For the lady involved, a bribe is probably cheaper than going to the US for surgery, since you are just topping up the pay for the surgery, not covering the entire cost.

Lastly, if your doctor wants to expedite your surgery it gets done. No need to try to influence nurses, administrators, etc.

Posted by: bb | 2010-12-11 6:52:45 AM

This is an interesting article.

Posted by: Tom | 2010-12-11 8:41:38 AM

Why call it a bribe? Call it a "user fee" and get the procedure done. It's not like anyone is excluded; all they have to do is pay the fee. It's a lot better than what's in place now.

Posted by: AB Patriot | 2010-12-11 6:06:23 PM

In a total hip replacement surgical procedure, the painful parts of the damaged hip are replaced with artificial hip parts called a prosthesis, a device that substitutes or supplements a joint. The prosthesis consists of steel parts: a socket, ball, & stem. The outer shell of the socket is usually made of metal & the inner shell consists of plastic, or the whole socket may be plastic. When the metal ball is joined with the socket, the new hip can permit for smooth, frictionless movement

Posted by: Hip Replacement Recall | 2011-03-08 3:56:41 AM

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