Friday, February 19, 2016

Doctors don't want to get Berned

A quickie before holidays next week.

Found this opinion piece by an American pediatrician:

I’m a Doctor. Here’s Why I Oppose the Single-Payer Revolution

It appears like there's a civil war brewing among American liberals/progressives, between those approving of Hillary Clinton's incremental approach to policy reform, and those inspired by Bernie Sanders' vision of a radically redesigned social contract for the U.S.

There's almost certainly a big component of anti-Hillary-ism driving this, but it's strange to see the same kind of enthusiasm that propelled Obama to the White House now getting behind a somewhat dumpy old Jewish guy. I'll leave it to the Bill Mahers and Trevor Noahs of the world to comment on the politics of it, but the significance of the dispute shouldn't be overlooked. Paul Krugman himself has come out warning that Sanders' supporters might be indulging themselves in the same kind of magical thinking that's plagued the GOP base for years (who does Jesus prefer, Ben Carson or Ted Cruz?)

What does any of this have to do with the pediatrician's piece? Quite a bit, and it's applicable to the way we need to think about the Canadian health care system as well.

The arguments in the New Republic piece against single-payer health care aren't based on ideology or idealism. They're based around the cold, hard details of how the system works (apart from just "not well"), and the critical problems that a radical shift in policy could create. If there's one thing anybody who's worked in or with a government institution can attest to, it's not the policy that matters so much as the practical, nitty-gritty questions of implementation.

As an example, you'll often hear calls for the federal government to increase its role in leading national health care, beyond just cutting cheques and doing whatever the hell Health Canada does. Sounds great, and it might even make fiscal sense once the dust settles.

The problem is that such a major shift would kick up a shit-ton of dust, with no way to predict where and how said dust will settle. Federalization of health insurance, as an example, would result in tens of thousands of public servants shifted around and within jurisdictions, and that's before all the early retirements and stress leave payouts are factored in. That's just the public would federalization affect independent providers and hospitals?

A system as complex and interconnected as health care doesn't do well under radical shifts. We'd be much wiser to look for reforms that are straightforward to implement (a national pharmacare plan in Canada) rather than design (single payer health care in the U.S.). Then look aggressively for obsolete and redundant policies, and do away with them safely--we don't do nearly enough of that, but that's a rant for another day.

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