Canadian Medical Association
CMA Policy Statement
July 2007
To sustain Canada’s health care system for the next generation, changes need to be made to bring about a new vision for Medicare. The CMA identifies this future vision as “Medicare Plus.”
The Chaoulli decision has established that patients cannot be denied a private sector insurance and treatment option. The Quebec government has since made provisions in its legislation to comply with the decision, however it has so narrowly circumscribed the terms and conditions under which private insurance contracts might be offered and delivered that it is highly unlikely private coverage will be offered.
The ability of physicians to choose whether or not to participate in the public health insurance plan has been a key feature of Medicare since its inception. Physicians are willing to accept reasonable limits on their ability to opt in or out of the public health plan to ensure that adequate access to medical services is maintained. To achieve this, an effective regulatory framework is required to govern the intersection of public and private health care and there must be concerted effort on the part of stakeholders to investigate the implications of and opportunities to minimize conflicts of interest. When considering options for the delivery of publicly insured services by the private sector, it is critical that the integrity of the public system is maintained and that Medicare remain the cornerstone of Canadian health care.
The CMA recommends that:
When access to timely care cannot be provided in the publicly funded system, Canadians should be able to use private health insurance to reimburse the cost of care obtained in the private sector.
And…
The case against private insurance
By Naomi Lakritz
Calgary Herald
August 2, 2007
It’s been said that during the 12 or so years they spend in medical school, doctors learn to think of themselves as gods.
Well, the gods must be crazy. Or greedy. Or both. How else to explain the Canadian Medical Association’s ridiculous support for physicians’ right to work simultaneously in both a public and private system, including the introduction of private health insurance — and the gall to label this as standing up for their patients?
It is patently obvious they are standing up for their bank accounts, not their patients. That they are so eager to place patients at the mercy of insurance companies, whose subterfuges for skipping out on claims are well-documented in the U.S., shows their patients’ best interests are the last priority.
A recent New York Times article profiled Gordon Hendrickson, 66, of Albuquerque, whose best bet to beat pancreatic cancer was risky surgery performed by a Houston specialist. His insurance company refused to pay for the surgery. Hendrickson had it done anyway. Today, he is cured, but owes $80,000 in medical bills.
Is this what the CMA wants to inflict on Canadians?
“Of the people who go bankrupt in the U.S., 50 per cent of the time it is because of medical bills. Of that 50 per cent, 75 per cent had health insurance,” says Dr. Ida Hellander, executive director of the Chicago-based Physicians For a National Health Program.
Insurance companies are putting the screws to American patients in insidious ways.
In a telephone interview, Hellander says it’s hard to find a policy with a deductible less than $1,000. Some policies have deductibles up to $5,000.
“A thousand dollars is a lot of money. So people have chest pains and they won’t go to the ER because they’ll have to pay that $1,000 deductible,” she says.
Another nasty trend is co-insurance — when you go to the hospital, you pay 20 per cent of the bill before your insurance kicks in.
Insurers have also dropped mental health coverage, so people with mental illnesses are going untreated. Only the most indigent can get their mental health care funded by the government. Also, if you have a pre-existing condition, insurance companies will do their best to link it to everything else you visit the doctor for, in order to avoid paying the bill.
And the CMA wants to subject Canadians to these kinds of nightmares?
Equally absurd is the CMA’s claim that these reforms would allow doctors to spend more time with patients. Sure, they would — with the private patients whose visits are more lucrative for the doctor.
The public patients might be fitted in if there are a few minutes left over in the doctor’s day from filling out the insurance forms for his private patients.
According to an article in the Ventura County Star, 80 per cent of doctors in California are frustrated with the huge amount of time they spend filling out insurance forms.
Don McCanne, a retired family physician and senior health policy fellow with the PNHP, says doctors will be “cream-skimming the more profitable patients,” to the detriment of the public ones.
Economist Paul Krugman, also writing in the New York Times, shatters one of the cherished myths of Canada’s proponents of private health, when he discusses hip replacements. This surgery is always seized upon by the private-health cheerleaders as something for which there is no waiting in the U.S. system:
“There’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.
“That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare because it has more lavish funding.”
Krugman also points out that the insurers themselves cause waiting lists to grow, citing the example of Mark Kleiman, a UCLA professor, who nearly died waiting for a biopsy because his insurance company stalled approving it.
“There’s no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their ‘medical losses’ — the industry term for actually having to pay for care,” Krugman writes.
Reached at his home in San Juan Capistrano, Calif., McCanne calls the CMA’s interest in private care “self-serving” at a time when Canada really needs to repair the public system’s flaws.
“Frankly, they’re greedy,” he says. “Private insurance is the worst thing they could do.”
Amen to that, Dr. McCanne.
http://www.canada.com/calgaryherald/news/theeditorialpage/story.html?id=ab96889d-3cbc-4d5d-87ce-ad46de9db0a3
And the latest…
CBC News
Health Minister Tony Clement has rebuffed the Canadian Medical Association in its call for greater privatization of medicare.
Clement said the federal government will not allow so-called dual practice, which allows doctors to work in both the public and private health systems. In an interview, he referred to such an arrangement as a two-tier system.
Clement said the doctors’ organization is entitled to its opinion but the government believes the CMA proposal would breach the Canada Health Act.
The minister was responding to a letter from the Registered Nurses Association of Ontario, which called on Prime Minister Stephen Harper to uphold the single-tier system.
http://www.cbc.ca/cp/health/070801/x080121A.html
Reason to rejoice…
It is important to understand that the greed brush does not paint all physicians. Just as dedicated physicians in the United States formed Physicians for a National Health Program (PNHP) in response to the flawed reform proposals of the American Medical Association, dedicated physicians in Canada have formed Canadian Doctors for Medicare (CDM).
Their Mission:
“The mission of CDM is to provide a voice for Canadian doctors who believe in and support Canada’s publicly funded system for physician and hospital care, and who reject private insurance and direct payment for these medically necessary services.”
http://www.canadiandoctorsformedicare.ca/mainpage.html
Comment:
By Don McCanne, MD
Amen.