Second, the Canadian system delivers care privately (such as office, clinics, or hospitals) yet is financed by taxpayer dollars. For the most part, doctors are free to run their practices as private businesses. Depending on the province, physicians can bill patients separately for noncovered services, such as cosmetic dermatology or certain imaging and lab studies. Some rheumatologists in Quebec will charge their patients an additional $40 for the cost of supplies for joint injections. Other physicians have taken a page out of the American concierge medicine experience and adapted it to their system. Because there is a dire shortage of primary care physicians (PCPs), many are charging patients annual membership fees of about $200–$500 in order to join a practice. If a patient chooses not to join, then they must contend with an a la carte menu of eye-popping charges for the work their doctors perform. For example, the fee to fax a prescription refill can run as high as $30, and an e-mail reply to a patient costs about $50 to $75. Many of the provincial regulators have allowed these charges to continue, preferring not to clash with the dwindling number of PCPs.
Third, the system is fairly simple to operate. Everyone is issued a healthcare card, which serves as the “credit card” to cover services. This is great for the patient because there is no paperwork to complete and for the most part few, if any, copayments. Physicians submit their charges electronically so that most offices can run on a skeleton support staff. There is only one insurance plan to deal with and the rules and coverage are universal. According to a recent study in Health Affairs, physicians in Ontario only spent about 27% of the total money spent by the average U.S. physician in administrative costs. The per-physician cost of dealing with payers was $22,205 a year in Canada and $82,975 in the United States. They also wasted (my word) only 1/10th the amount of time spent by U.S. physicians in dealing with health plans, according to the study.
This ties into the fourth point; there is single list of covered procedures and charges. This is fairly straightforward when compared with the Untied States, where there are separate lists for Medicare, Medicare advantage plans, Medicaid, the Blues, the privates, the indemnities, the HMOs, and so on. In Canada, the submitted physician charge and the payment are identical. It is a non-negotiable amount and does not vary from provider to provider. No more bloated “paper charges” in an effort to drive up the cost of the receivable.
Potential Problems with Single Payer
So these are some of the wonderful attributes of the single-payer universal healthcare system. A casual observer may wonder why this type of plan has met with so much resistance in the United States. I think I can offer a few reasons.