Maggie Mahar provided readers with a valuable service in “How Much Do We Really Know About Canadian Healthcare?“, a post from Sara Robinson, a dual citizen of Canada and the US with first-hand information about both systems.  Her post is a great example of policy analysis from the ground up.  Sara points out that the Canadian system involves:

• single-payer insurance
• an average physician debt burden of approximately half of the $140,000 for US graduates
• variation in wait times and physician access, increasing as one moves north from the urban areas in southern Canada
• basics covered, such as physician fees, ambulance, diagnostic tests, inpatient care
• in most provinces, medical equipment, pharmacueticals, chiropractic and physical therapy, dental and vision exams are not covered expenses
• about 10% higher taxes on average than in the US to cover expenses, in addition to monthly fees which most employers pick up ($108/mo. for a family of 4 in British Columbia)
• waiting for magnetic resonance imaging (MRI) is the usual reason that Canadians travel across the border

In “Healthcare Insurance: The Massachusetts Plan”, Michael Doonan and Stuart Altman showed that uncompensated care is never free. (Cohn KH and Hough D The Business of Healthcare. Westport:Praeger, 2007,v.3:35-60, Greenwood Publishing Group, Inc.)

Regardless of where we stand on the market forces-outside regulation continuum, I hope that we can agree that:

• a significant amount of scarce provider time and financial resources are diverted into non-value-added tasks presently
• our ability to cross-subsidize unprofitable services that matter to our communities (like mental healthcare) with profitable services is diminishing as reimbursement stagnates or decreases and expenses rise

I confess my bias, that improved collaboration between physicians, allied healthcare professionals, hospital leaders, board members, payers, and politicians can improve care for our communities.  Please share your thoughts with me. 

• Will 2008 be a year in which we reflect on and come to greater consensus on a vision for healthcare
• What will it take to have a uniform reimbursement process to which all payers will subscribe
• Upon what successes in the US (and elsewhere) can we build

I welcome your input.