June 27th, 2009 by Happy Hospitalist in Better Health Network, Health Policy, Humor
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You want to know what the process is like for a physician to make a living as a physician?
Look only toward the Medicare Tomato. Imagine for the moment that you have been taken out of reality and into the alternate bizarro world of the Medicare Tomato. In this analogy, the Medicare Tomato represents a day in the life of a practicing physician.
You’re getting verrryyyyyy sleeeeepppppeeeee………….
I love tomatoes. They are one of my favorite foods. Buying tomatoes used to be easy. I would search the Sunday newspaper for the specials of the week. There are multiple grocery chains in my neck of the woods. There are multiple types of tomatoes.
Roma
Hydroponic
On the vine
Organic
Slicing
Cherry
Grape
The variety and quality are endless. Different stores offer different varieties. They try to differentiate themselves in quality and in price.
I have my pick of the tomato litter. I can go to any store I want.
I base my decision on price, geographic location, how the tomato looks and feels, and what I would use them for.
Life is great. I find a tomato I like for a price I consider reasonable. The store is happy. I am happy. I take my tomatoes, and I pay cash for my product. Sometimes I pay by credit card just to earn that extra 1% cash back.
One night I was awakened by a terrible thunder clap. A terrible storm had swept through over night. I didn’t think much of it. But the consequences of that brewing storm soon became obvious. That storm signified the end of the free market trading of cash for tomatoes, in which both customer and grocer were happy with the payment for services rendered.
Enter the massive government take over. A massive coup on the tomato market. By a midnight Congressional mandate, the destruction of the free market exchange of money for tomatoes was replaced and regulated by the Medicare National Tomato Bank (MNTB).
Tomatoes, by nature of their nutritional content, have been deemed a right for all Americans. By Congressional mandate, all Americans (and illegals) were given a Right to tomatoes. No American should ever be allowed to live without their tomatoes.
Wow, I thought. That’s great. I get free tomatoes for life. Life couldn’t be better. Born out of thin air was an entire nation of entitled tomato eaters. (ETEs) I was ecstatic. Somebody loves me, I remember thinking. However, that feeling of joy quickly faded.
Immediately after removing free market principles from the tomato market, the MNTB instituted the principles of most resistance. If something can be regulated, it will be. The word quickly spread through out this great nation of ours that the government would now make tomatoes a right for everyone.
The demand for tomatoes took off. Grocery stores everywhere were selling out. Nobody could keep tomatoes in stock. The grocery stores were ecstatic too. They simply sold their tomatoes and sent the bill to Uncle Sam. Uncle Sam sent them a check for their price of tomatoes. The grocers were happy. They sold out every day. The people were happy. They were getting free tomatoes. ETEs everywhere loved their Congress.
Unfortunately, the MNTB was not happy. They were footing the bill. And that bill was exploding. That $200 billion dollar tomato bill was quickly rising. Faster and faster. 10% a year. Year after year. The MNTB soon realized that they could not afford to continue paying for free tomatoes for everyone. In an effort to reign in the costs of the MNTB, Congress did something completely anti-American. They took capitalism out of the tomato market.
Cutting back on the benefits to the people was considered political suicide. How could these professional regulators, who promised tomatoes for ETEs everywhere; How could they ever back down. They could never ration the tomato consumption. They would be kicked out of office for even suggesting such a thing.
In their brilliant strike of genius, they decided to try something that had never been tried before in the world of capitalism. They would reign in the cost to the MNTB, not by cutting the demand (political suicide), but by instead instituting a policy of 80% payment of market prices.
By now, the people are happy. Their free tomatoes are safe. Their lives as ETEs live on. The grocers? Not so happy. They have just been taken to the cleaners. Their glorious tomato days have just ended. Instead of receiving just payment for a just product determined by market prices, a payment agreed upon between the customer and the producer, they have just been taken out of the loop. To the tune of an 80% payment rate.
This policy had a profound effect on the grocer’s mind set. No longer did they feel the desire to provide the best possible tomato at the best possible price. A price agreed upon between consumer and grocer. No longer did they feel the desire to offer a better tomato to compete with their grocer down the street. When the 20% cuts went into effect, the grocer’s responded by offering fewer tomatoes for sale. Gone were the hydroponic. Gone were the organic. The profit was leaving, and so were the choices of tomatoes available to the ETEs via the MNTB.
At 80%, they could still make a decent profit, so they sacrificed some margin for quality, in an attempt to keep market share. But as the MNTB soon learned, these false price controls did nothing to reign in the cost to the National Tomato Bank. Grocers responded by selling more technologically advanced super duper genetically modified purple tomatoes. The MNTB would pay for them, and pay at a much higher rate, considered a more valuable product via the relative value unit system (RVU) of tomato price controls, which was now in place to differentiate the value of each tomato.
While the benefit of these tomatoes over the cheaper tomatoes was suspect, the MNTB paid for them anyway, as part of the overall MNTB rules and regulations passed by the lifetime regulators known as Congress. What the MNTB soon realized was that the grocers were pushing far fewer of the cheap tomatoes and more of the expensive tomatoes.
Because they got paid more for selling expensive tomatoes. The MNTB got exactly what it paid for. In an effort to decrease costs, they actually got a high cost, low value tomato market, courtesy of the RVU system they signed off on. The cost to the MNTB exploded.
The volume of specialty tomatoes grew exponentially. As the grocers realized they could not make a living on the cheap tomatoes, they moved toward selling the expensive ones with marginal additional value. In response to the continued explosion of cost related to its cost controls, the MNTB did three things.
- They again dropped the payment rate to 50% of current cost for all services, including super duper purple genetic tomatoes.
- They set a sustainable growth rate where in the cost of all tomatoes to be paid by the MNTB would be set in stone, and determined by inflation and population growth
- They established a strict set of rules and regulations known as Evaluation and Management codes for the grocers to get paid by the MNTB.
The first response exacerbated the problem. Since the super duper technology tomatoes were paid at a higher rate, more and more grocers stopped offering cheap tomatoes. They simply removed the variety of product. They removed their rings of service. One product fits all.
The cheap primary tomato market was killed off. What remained was the expensive specialty tomatoes that continued to maintain a high value of importance, relative to the primary tomato market, to the MNTB. As the consumption of specialty tomatoes grew exponentially, the death of the primary tomato market simultaneously led to massive cost increases in the total cost of the MNTB program. The volume continued to explode, without so much as a brake on the demand. Because folks, tomatoes are a right, as decreed by the professional regulators.
Now, to make sure the groceries weren’t cheating the MNTB, the government instituted strict rules and regulations that had to be followed to get paid. Any deviation from those rules and the grocers risked fines of tens of thousands of dollars and jail time for defrauding the MNTB. Long gone were the days of submitting a bill and getting paid based on market prices.
Now you had to submit incredibly complicated paper work to get paid not what you were due, but what the MNTB says you were due, the rates set forth by the sustainable growth rate, as determined by the false economies of the MNTB. For each and every sale made to an ETE, the grocer had to submit to the MNTB a letter detailing the encounter the grocer had with the ETE.
This shall be known as the “progress note:”
A consumer came in today at 12:04 pm on March 7th, 2008. He did not complain of any tomato headache. He had no gas pains. He appeared to be in good spirits. He was not orange. His lips were drooling for a chance at free tomatoes. He appeared angered at the lack of options and declining quality. He was at one point found to be pointing and yelling profanities. He took 7.4 pounds of the super duper genetically altered tomatoes (verified by government scales) with a big fat giant grin on his face, yelling, “I ain’t paying for it”, all the way out the door.
By now, several years into the program, the grocers were tiring of the process. Every ETE that bought tomatoes, took the expensive ones. The cheap ones could no longer make a profit and the makers of the cheap tomatoes had all left the business. The payment rate of the cheap tomatoes had put all the cheap tomato growers out of business.
All that was left was the single brand of expensive tomatoes that the MNTB still considered beneficial to the public at large. It turns out that the lobby group for the special genetic laboratory that earned a profit in royalty for every genetic tomato sold; It turns out that they contributed $250,000 last year to the Congressmen who sponsored the MNTB program.
In a few short years, what was once a thriving market of choice and quality in the tomato market was dwindled down to a single choice of expensive, but marginally beneficial tomatoes, whose sole ability to prosper was based on the corrupt contributions of a few corporate talking heads in high places…
The grocers were mandated by law to make sure that ETEs, who missed their appointment to buy their tomatoes were contacted on at least 16 different attempts to make sure they were aware of the consequences of not consuming their tomatoes and the consequences of not complying with the healthy tomato initiative as set forth by the MNTB. The burden of life was fully placed on the grocers and personal responsibility and common sense was completely removed from the ETEs.
The grocers had to hire additional accountants to run the paper work. They had to buy additional equipment to track the tomato statistics. 10% to the bottom line for the billing and collections department. The overhead of the grocer sky rocketed. While the payment rate from the MNTB plummeted. The grocer was caught in a swirl of capitalistic cost structure with a socialistic payment model. It was not sustainable…
The ETEs would wait for hours to get out of the grocery store and home with their specialty tomatoes. As the costs to the MNTB continued to explode, the government thought of more creative ways to try and keep the entitled tomato market alive. It put the burden of tomato quality on the shoulders of the grocers. Once again, another cost to burden and another way to reduce payment. It created quality incentives which, were at first optional, but eventually would carry a negative payment structure. Do it or lose more money.
The state of the entitled tomato market was in shambles.
A low quality, low choice, over burdened, over regulated, over expensive cost structured had replaced a once thriving enterprise of choice and competition between grocers. With time, one by one, the grocers left the tomato market. Access to free tomatoes by ETEs was dwindling. No longer could the ETEs walk to the grocer down the street. They had to drive miles to see the government mandated access to tomato market. Known as the emergency tomato grocer (ETG), the MNTB created rules and regulations that forced this group of grocers to stay open at all costs. No matter what. And to accept the price paid by the MNTB.
The result was a massive influx of ETEs into these government mandated ETGs. The waits piled up. Hours and hours of waiting a day. The entitled would come from miles around to get their free tomatoes. They would come, even though they hand hundreds of pounds sitting in their brand new stainless steal top of the line fridge. They wanted more, and they would get it by any means possible.
Eventually, the ETGs closed as well, as the payment rates failed to fund the operating costs of the grocers. Even the mandated ETGs closed up shop. One day, even the super duper specialty tomato and its high payment rate couldn’t keep the grocers and the ETGs from doing the inevitable.
They all quit selling tomatoes. All of them. The groceries moved on to selling canned goods and dairy, which carried a cash only high margin profit. The ETGs closed down, causing the back up access for ETEs to collapse on its own weight. The public, so used to getting free tomatoes as their right, was suddenly found scrambling for alternative sources of their free tomatoes.
The grocer decided to go back to the way it was before. The tomato lover and himself. He would start to sell tomatoes again, but he would only accept cash or credit. He would provide a quality product at a reasonable price and let the people decide what price they wanted to pay. He got rid of the forces of destruction and allowed his customers to tell him once again what it was that they wanted.
The Medicare Tomato is the reality of health care delivery today. It is the backwards approach to the rationing of a service that is finite. There is no question about it. Health care is not an unlimited resource and the policies of rationing will always best be determined by the personal financial stake that everyone has in their health care. It doesn’t mean cash only or insurance only, or free care for all or universal access. It is a rational approach to demand control, whether that be means tested or income dependent. Whether that means balance billing or high deductable policies. Whether that means shopping for service and quality through price transparency. Whether that means strictly catastrophic insurance coverage. Whether that means tort reform to reign in defensive medicine. Whether that means judicious use of a gate keeper Medical Home model. What ever it means.
It does not mean price control.
You can’t control costs by controlling price. It will never ever ever ever ever ever ever happen.
Thanks for listening. I think I’ll go eat a salad.
*This blog post was originally published at A Happy Hospitalist*
June 10th, 2009 by EvanFalchukJD in Better Health Network
3 Comments »
Did you know that doctors are paid too much, wrongly complain about medical school debt, and falsely believe there is a medical malpractice crisis?
Did you know that doctors are hopelessly conflicted sellers of medical care, motivated by the search for extra income?
Well, then you haven’t read the Washington Post’s Steven Pearlstein’s work on health care reform.
“It’s the doctors, stupid,” he begins his column today. At once, he recycles the tiredest of political phrases and tells his readers exactly what he thinks of them. But it’s not the column that is most telling, it’s the live web discussion that followed. I participated in it, and can share with you the highlights. It’s a revealing insight into the thinking of a mainstream DC columnist.
To save you the trouble, here’s a summary of Pearlstein’s views: Doctors learn a craft that they owe to the rest of us as a public good. But instead of doing this, they take advantage of knowledge to make as much money as they can. They do it willfully – like an insider-trading stock broker – but they also do it because they just aren’t all that competent at what they do.
Think I’m making this up? Read:
On medical school debt:
I think we allow doctors to make too much of their debt. . . In major metropolitan areas, that debt looks pretty small when compared to the lifetime earnings that doctors accumulate in private practice over many years. They more than make up for their investment, as it were. But they use this debt to justify their elevated incomes for the next 30 years — and make no mistake about it, doctors in the U.S. do make ALOT more than docs elsewhere, on average. . . . My suggestion is that we socialize the cost of medical education, that is have the government pay for it, in exchange for a couple of years of community service. That way, we get the community service and we eliminate the No. 1 reason given by docs to justify getting paid more than docs everywhere else.
According to the Bureau of Labor Statistics, a freshly minted family care doctor has a median wage of less than $140,000 a year. According to the AMA, these same doctors have, on average, about $140,000 in educational debt. Thirty years seems about how long it would take to pay off that debt, and you can forget about buying a house, a car, or paying for your own kids’ school under those circumstances. I’m sure many medical students would love the Joel Fleischman plan, but we should do that because maybe it will help more people become doctors, not because we think doctors are exaggerating the impact of debt equal to 100% of your gross pay.
On how our system ought to allocate medical resources:
There is no reason why people can’t travel an hour to a big hospital to have a baby, for example, in a big modern maternity ward that does lots of deliveries and has enough volume to be able to afford all the latest equipment in case something goes wrong. I mean how many times in your life do you have a baby that you can’t drive an hour to have it done, rather than insisting that every community hospital have its own maternity ward. It’s just one example of the inefficiency built into the system by people — that would be you and me — who insist on things that, in the end, don’t have ANY impact on the quality of care. In fact they have negative impact.
I don’t know if Pearlstein has ever had a baby before, but just being an hour away from a hospital is unthinkable for most expectant moms in the weeks prior to delivery. And what is someone to do who lives an hour away and has a complication during the pregnancy? Pearlstein’s prescription seems to be that they should eat cake.
On the freedom of patients to choose their medical care:
The emphasis on being able to choose your own doctor in every instance is another, as if most of us have a clue as to who are the best docs and who aren’t. These are the kinds of irrational things we need to try to work out of the system, because they wind up being very costly.
Yes, for goodness’ sake, let’s get rid of the irrational desire of a sick person to want to pick their own doctor. Even Senator Kennedy’s “American Choices Act” guarantees the right of patients to choose their own doctor. I don’t know where Pearlstein is on the political spectrum with this view, except perhaps a certain territory between China and South Korea.
On how doctors are hopelessly conflicted in giving medical advice by their desire to make money:
But first we need the evidence to show that it isn’t a good idea. Then, once we have the evidence the doc has to follow the protocol and explain to the family why it’s not a good idea and not merely blame the big, bad insurance company for being so heartless–which, by the way, a lot of docs do, so they can look like the good guys. Of course they’d love to do the surgery in many cases because they’d like the business and the extra income, so they are hopelessly conflicted. . . . .
[B]uying medical care is not like buying lawn furniture. . . in medical care you rely to an extraordinary extent on the advice of the doctors (i.e. the sellers). And its also not an area where you are inclined to be very price-sensitive — is anyone going to go the the Wal-Mart of surgeons if they think their life may depend on it. . . . But it is NOT true that a well-informed consumner will always make the right choice about medical options — they still need the advice of doctors, who under the current system have a very noticeable conflict of interest.
I’m actually not sure that Pearlstein has even been inside of a Wal-Mart. Because they consistently have high quality merchandise at the lowest prices. In fact, if more hospitals worked like Wal-Mart the problems that plague our health care system today probably wouldn’t exist.
Responding to a commenter who said that the notion that defensive medicine is a large expense is “totally false:”
Indeed. But doctors don’t believe this, no matter what evidence you present them.
Yes, evidence is like kryptonite to doctors.
I asked Pearlstein if a doctor ran over his dog or something. He didn’t directly respond, simply saying “Maybe you should talk to Atul [Gawande].”
Now that’s the only sensible thing he said.
June 1st, 2009 by DrRob in Better Health Network
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Dear patient:
I am sorry you are so frustrated with me. I’m frustrated too.
People used to look on me as a good thing, but now everyone makes me out to be public enemy #1. It’s not my fault. I was made to give you what you need: medical care; but then they kept changing me and making things harder. One side doesn’t seem to know what the other is doing. Changes are made without realizing the consequences. Now instead of giving care, I just make it harder. Now instead of making people get better, I actually harm some people.
It makes me sick to think about it.
I don’t want that to happen to you. I don’t want you to get lost in the paperwork, rules, authorizations, and red tape that seem to define me these days. So instead of being lost in the system, take my advice to live by as you go through me. I mean that literally: these rules may just be the difference between living and dying, so listen closely.
1. Find a home base.
There has to be someone you can go to for trustworty advice. The rest of care is confusing, and you probably won’t know who to trust. Some people will lie to you and others will just confuse you. You need a translator. You need a mooring in the turbulent waters. You need somewhere you can go to orient yourself and know which way is up.
That person may be your PCP – that is the best-case scenario – but it may be someone else. Find someone who doesn’t intimidate you who can answer any question you have. Ask them lots of questions.
2. Don’t fragment your care.
Some people think that healthcare is like going to the supermarket. The shelves may be in different places and the prices may vary some, but the basic stuff they sell is the same anywhere you go. This is a dangerous way to get care. The more places you go, the less each place will know about you. Doctors who are seeing you for the first time can’t do as good of a job as those who know you well. Plus, the more places you go, the better chance that you will get bad care. Not all doctors are created equal.
So if something isn’t an emergency, don’t go to the ER. What constitutes an emergency? Not a baby crying during the night. Yeah, it may be more convenient to go to the ER or urgent care center (as you don’t miss as much work) but you may pay a big price for it. If you can wait to see your doctor, do it. If you can’t get in to see your doctor when you are sick, then maybe you should find another.
3. You are your own keeper.
One of the biggest mistakes people make is to assume someone is watching out for them. They get tests done and assume no news is good news. They go to specialists and assume their PCP knows about it. They spend weeks in the hospital and have all of their medications changed, and think that this information is passed on. It may be, but often it is not. The only one who knows about all of your care is you. The only one who can reliably watch out for you is you.
I know you like your doctor and think she is on top of everything. Unfortunately, good people are stuck in a horrible system. A ton of care is done blindly – without any inkling of what is going on at other locations. You must make sure these parties communicate. You must make sure news gets back to your PCP.
Does this suck? Yeah, it does. Big time. Why should you have to be the record keeper? Why should you be the watch-dog? It’s my fault. I give no reason at all for doctors to communicate, but instead discourage them from doing so. Everyone is working hard to do the job in front of them, and once you are gone from the hospital, specialist, or ER, they have no motivation to communicate. In fact, doing so loses them money.
Some are great at communicating, but many are not. Don’t gamble with your life in this area. Make sure that communication happens.
4. Don’t BS
If you can’t afford a drug, don’t act like you are going to take it. If you are scared about a brain tumor, don’t assume the doctor knows your fear. For some reason, some people feel the need to do PR work when seeing the doctor. They want to look smart and strong even when they are confused and weak. This is pure stupidity.
Tell the truth. Say what you are feeling. Express your fears, and ask as many questions as you need to ask. This also holds true if the patient is your elderly parent or your child. If you wonder about the advice you are getting, get a second opinion.
5. Famous people can be idiots
Oprah is fun to watch and she is a genuinely smart lady, but she isn’t a healthcare expert. I can’t be so gracious with other celebrities. Famous people like attention, and so they will usually get it any way they can. Many of them think that their soap-box makes them smart. None of them are likely to show ignorance – they are good at faking it.
The fact is, they are probably famous only because they are good looking. You don’t see many ugly famous people. This is a bad way to seek medical advice. Would you choose a surgeon based on their sex-appeal? Would you trust the life of your child to someone who got famous because they looked good naked? Don’t be a fool. Trust people who are trustworthy; not people who look good in front of a camera.
6. Don’t overdo it
I can only do so much for you. Everyone dies and most people suffer in life. Some people have bought into the American mindset that says all pain should be avoided. This is a bunch of crap. Don’t medicate every struggle or seek solution for all suffering. Some people seem surprised that life has these things in it. Don’t be; it’s normal.
I don’t say this because I like to see people suffering. I say it because people are putting unfair expectations on me. I can’t beat death. I can’t do the “happily ever after” thing, and I only have so much money. Plus, sometimes people hurt themselves by seeking too much treatment. There are docs out there who will give antibiotics for every runny nose and others who dispense narcotics like candy. Don’t go there. The price you pay is far more than monetary.
That’s just scratching the surface. There is so much more I could say, but the politicians are beating at my door and I have to go. Just remember that nobody else lives in your body. You are the bottom line when it comes to your care. Yeah, I may make it tough sometimes (sorry about that), but that should only make you fight harder to make sure you get the care you need. You can get good care, but it doesn’t happen if you are passive.
I am about to get a big make-over soon, so the walls of my maze will change. Chances are, however, the advice I just gave will still apply no matter what I end up looking like.
Stay strong,
Healthcare
*This blog post was originally published at Musings of a Distractible Mind*
March 13th, 2009 by Dr. Val Jones in Health Policy
4 Comments »
This post is a continuation of my discussion of foreign healthcare systems, and what the US can learn from them… I’ve summarized one particularly provocative and outspoken Canadian’s opinion below:
Is Canada’s healthcare system a political monopoly?
Dr. Brian Crowley is the Founder and President of the Atlantic Institute for Market Studies in Halifax, Nova Scotia. He describes the Canadian healthcare system this way:
Canadian Medicare operates in an unregulated, tax-financed, pay-as-you-go model. Our provincial governments are our monopoly provider. They not only pay for necessary care, but they also govern, administer, and evaluate the services that they themselves provide. They define what we call “medically necessary services” and pay for 99% of all physician services. They also forbid the use of private insurance for medically necessary services. They set the budgets for nominally private healthcare institutions. They appoint the majority of their board members and have explicit power to override management decisions.
Under these circumstances, no hospital or hospital administrator can be expected to take any responsibility or initiative because decisions will always be second-guessed by those in political power.
Before the advent of competition in our telephone industry, dissatisfied customers faced the massive indifference of a bureaucracy that took their business for granted, despite some theoretically powerful regulatory agencies. Administrators of the Canadian healthcare system likewise suffer no direct consequences for poor customer service. They aren’t even answerable to a regulatory agency. Accountability is a vague political concept which cannot be enforced in any meaningful way. Like all monopolists, Canada’s healthcare authorities abuse their positions of power.
Dr. Crowley argued that the provincial governments have no desire to measure how many people are waiting for health services, how long they’ve been waiting, or how many people leave Canada to get treatment south of the border. (He claims that the US is Canada’s secret safety valve.) Apparently the province of Ontario contracted with New York State for cancer care for their patients when wait times became politically untenable.
A couple of years ago, the Supreme Court of Canada ruled that the healthcare system violates Quebec’s charter of rights because it collects taxes, promises healthcare in return, forbids competing suppliers and then often doesn’t deliver the care. The justices summarized the situation this way: “A place in a queue is not healthcare.”
Canada-wide average wait times for surgery is 17.8 weeks, though in Saskatchewan, wait times for hip replacements are as long as a year and a half. That’s after a physician has ordered the surgery. Getting to see a physician in the first place is very difficult. Statistics Canada reports that 1/5 of Canadians do not have a family doctor.
In Canada, family physicians are the gatekeepers of the health care system. Patients cannot obtain access to specialist services without having a general practitioner referral. The doctor shortage is so severe now that doctors have begun resorting to lotteries to kick people off their patient rosters, (see Tom Blackwell, MD Uses Lottery to Cull Patient List, National Post, August 06, 2008); and Canada is about to face a wave of retirements in the system that will greatly exacerbate the shortage.
As for the comparability of wait times in the US and Canada, Dr. Crowley suggests reviewing a letter from a US physician published in the Wall Street Journal a few years ago (Susan Weathers, MD, published April 30th, 2004). Dr. Weathers works in a county hospital and in reference to her uninsured patients she writes,
[The Canadian health care system] resembles the county hospital where I work. Our patients pay little or nothing. They wait three months for an elective MRI scan and a couple of months to get into a subspecialty clinic. Our cancer patients fare better than the Canadians, getting radiotherapy within one to three weeks. The difference is that our patients are said to have no insurance (a term used interchangeably with “no health care”), whereas Canadians have “universal coverage.”
Dr. Crowley suggested that the Canadian healthcare system has become an unresponsive monopoly though it wasn’t supposed to be that way. It was designed to usher in a “grand era of choice.” It was supposed to be a healthcare system in which people would be able to get all the healthcare they needed without having to “worry about the cost.” Dr. Crowley concluded that “some of the ideas bandied about in Washington will lead to the worst features of the Canadian system without that having been anybody’s intention.”
