David R. Henderson  

"Canadafornia" Medical Care

Henry Waxman Wants Less Regula... Cowen on Vaticanomics...

Here's an excerpt from my chapter, "Free and Healthy at Half the Cost," in The Joy of Freedom: An Economist's Odyssey. I was writing about the single-payer health care system in my native Canada.

It's hard to say that the Canadian government guarantees health care, at least in the usual sense of the word "guarantee." In fact, what the government really guarantees is that if you get health care, you won't be allowed to pay for it, and it is this guarantee that makes you have to wait to get it. The government also guarantees something else: If health care providers try to set up their own clinics and charge willing patients for medical care, the government will shut them down.

I was reminded of it by an e-mail I received yesterday from an economist friend in California. He has asked that I not use his name. The term "MediCal" is California's version of Medicaid. He wrote:

My wife is a psychotherapist and accepts many low-income patients who are referred to her by the County Mental Health Dept. which also reimburses her (at less than half of her normal rate). Some of those patients are covered by MediCal and their funding has been yanked due to the budget crisis. My wife offered to continue seeing these people as private patients at a very low rate, e.g. $30/hr. She was informed that such a transgression would not only cut her off from all future County referrals but might also cost her her license to practice her profession.

Comments and Sharing

COMMENTS (20 to date)
JPIrving writes:

Horrifying. Forget the economic arguments for private health care, where does the California government get the authority for this? The world is going mad.

Dr. T writes:

"My wife offered to continue seeing these people as private patients at a very low rate, e.g. $30/hr. She was informed that such a transgression would not only cut her off from all future County referrals but might also cost her her license to practice her profession."

What's even more horrifying is that they government would have said the same thing even if she treated them for free.

To JPIrving's question: The California government got such authority from the voters who established and enlarged it. Welcome to the Super Nanny State.

Justin P writes:

Anyone read Road to Surfdom lately?

Was it Caplan or Cowen that said recently on a blog that most of the rhetoric being used for Obamacare is the same that was used in the 20's and 30's for socialism? It doesn't matter, because it's unfortunately true.

Jared writes:

Justin P,

This doesn't change the substance of your comment, but it's 'Road to Serfdom'. I believe that the road to Surf-dom also runs through California.


RL writes:

You might suggest to your friend that his wife should write a letter to the editor of major California papers, explaining that she was saddened to learn her license would be threatened if she offered to volunteer to see her former state-paid patients at a large discount, and is concerned that this might have some implications for Obama-care.

Marcus writes:

Yet more government failure and not so much as a peep out of the media.

I'd love to buy your book but it's not available on the Kindle. Speaking of which, is EconLog ever going to be available on the Kindle?

Adam writes:

That's great. I'll taking surfing over socialism any day. Maybe we can get off the Road to Serfdom and take the Road to Surf-dom. One of the problems, however, is that people on the Road to Serfdom drive on the left and those on the Road to Surf-dom drive on the right. Be careful out there.

hacs writes:

So, health care needs to be a right, instead of a contingent privilege . That manner, the violation of the right to health care of each patient by the MediCal could be invoked against such accusation. More than that, she could ask for the completion of her remuneration (judicially, if it is necessary).

Colin Fraizer writes:

How about a Kindle edition of that book? It should be easy to publish and I'd pay for it.

Liam writes:

David, as a fellow Canadian living abroad I could not agree about Canadian Health Care more. What is evem more outrageous is that Canadians even willing gave up "Extra Billing". So if I require a CAT Scan I need to go to the US to get it unless I am willing to wait 6-8 months. But what is more shocking is that if you submit the bill to Ontario Health Insurance Plan (OHIP) they will reimburse you! Do away with Mandatory insurance and do away with Government Healthcare.

David R. Henderson writes:

How about a Kindle edition of that book? It should be easy to publish and I'd pay for it.

Thanks, Colin. I'll look into it.

Michael writes:

Another Medi-Cal story for you:

I am a Nurse Case Manager in a busy pediatric surgical subspecialty. Last year it became apparent that we were losing money in spite of being very busy. The fundamental problem was our payor mix. We found that every time we saw or did surgery on a Medi-Cal patient we lost money, did not even pay our overhead. Every time we saw a private patiet we made money. As long as the mix, the ratio, of private to public, was 60/40 or better we could stay in business. We decided that we had to change the mix. We set up an unwritten set of rules. We would see any private patient for virtually any reason on demand. For Medi-Cal patient we began a strict screening process based upon medical appropriateness, essentially evidence based practice standards. On a daily basis we refuse physician referrals that don't meet these standards. My rough estimate is that we deny approximately 20% of referrals. This routinely frustrates or infuriates doctors and parents who strongly feel they are being illegimately denied care they need and desire. This is Obamacare in microcosm. It is two tier medical care and we can all look to a similiar outcome with any public option.

Bob writes:

This reminds me a lot of my Dentist. One time during a checkup, he noted that he was not allowed to give free dental care to the poor of the US (not sure exactly why). Instead, he went to Mexico every year and gave free care there.

Since it has been a while since I have seen him because he got tired of all the government regulations and "retired", I can not add more information to this.

Wm. Gallagher writes:

some people seem to have time to waste.

Troy Camplin writes:

That's the thing: the poor in this country already receive this kind of health care -- long waits, bad care, etc., because they receive government care. In other words, making the rest of health care and insurance nationalized will only make it so that the middle class and rich will have the same care as the poor in this country. The poor won't be helped, the middle class and the rich will only be punished. That's what this is all about. Make no mistake.

hacs writes:

Everyone is telling stories about the problems of Doctors and/or Nurses, so, to vary a little, I will tell a story of Schizophrenic, Bipolar, Depressive, Borderline, etc., patients of a charity program that in this crisis are being abandoned. Only the riskier patients continue to be attended, but very poorly (each 3 or 4 weeks). Therapists and psychiatrists are overcharged with more than 90 patients each one. Many professionals were fired and the program hasn't perspectives to hire new ones. It is lacking medicines essentials to the mental stability of those patients. They are being discarded, though their serious limitations and risks of suicide, because in this crisis the charity program suffered deep cuts. It was the first target of cost cuts. So, it's really important that everyone is paid by his/her work, principally health care workers, but not at the cost of the health or life of others (the patients).

Jim Glass writes:

Here in New York a doctor came up with plan offering basic health care services for a flat rate of $79 per month in offices across the city.

The government put him out of business.

It said flat rate fees for service are a form of insurance (tell that to the phone company) making him an illegal, unregulated insurer.

~~~ quote ~~~

"If they leave me alone, I can serve thousands of patients," he said.

The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under a fixed rate. That's something only a licensed insurance company can do.

"The law is strict on how insurance is defined," said an Insurance Department spokesman.

blink writes:

David, by taking Tyler’s words out of context you have obscured his point. His comment about the pope standing not too far to Obama’s left is a tongue-in-cheek dismissal of E. J. Dione’s hyperbole (that the pope is “well to Obama’s left on economic matters”). Still, prevailing opinion does place the pope – along with nearly all of the elected politicians in Europe – to Obama’s left and Tyler’s article undermines that notion.

Justin P writes:

Ha ha yeah yeah...I can't spell.

That would be a worthwhile study...the economics of surf. We can do all "research" at the beach...can I get "stimulus" funds for that? ha ha

MediCal horror stories are only the beginning. If Obamacare gets passed, the bright side will be I'll get into a PharmD program really easily since the shortage of ALL health care workers will be Epic!

David, I agree in principle, but thought that private clinics were mushrooming in Canada.

Comments for this entry have been closed
Return to top