Canadian Health Care, Subsidiarity, and Medical Calvinism

Last updated on: April 20, 2017 at 11:27 pm by Morning's Minion

Canadian Health Care, Subsidiarity, and Medical Calvinism 2017-04-20T23:27:55-05:00 Morning's Minion

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I highly recommend Sara Robinson’s ten myths of Canandian health care. Unlike many of the know-nothing critics of single-payer systems, Ms. Robinson has ample experience of the US and Canada health care systems, and deals with the basic facts. The whole thing is worth a read. I will not reproduce everything here, but the second point is particularly interesting:

“2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:

First, as noted, they don’t have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself in the course of a standard workday.

Second, they don’t have to spend several hours every day on the phone cajoling insurance company bean counters into doing the right thing by their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid — quietly, quickly, and without hassle. There is no runaround. There are no fights. Appointments aren’t interrupted by vexing phone calls. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off, and gets home in time for dinner.

One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring. You don’t realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who don’t operate under that stress, because they never have to fight those battles at all. Amazingly: they seem to enjoy their jobs.”

I’ve noted many times that, in the domain of health care, whether health insurance is covered by a large private sector insurer or a government entity makes little difference in terms of the principle of subsidiarity. After all, why is it that people raise the subsidiarity card against government-run insurance, but have no problem with large impersonal private insurance schemes, especially in the US system where the insurance company’s profits depend on minimizing “medical losses” (which means denying as many claims as possible, or refusing insurance coverage in the first place)? By the way, the Canadian system is run by provincial governments. But far more important from the Catholic perspective is the need for a family doctor and a personal relationship between doctor and patient. And on that front, the US falls far short. Part of the reason is specialization. But part of the reason is that dealing with layers and layers of nasty and aggressive insurance companies places a barrier between doctor and patient. The US system is broken and bankrupt on more than just the financial scale.

I would also like to draw people’s attention to her ninth point, where she characterizes the US approach as “medical Calvinism’:

“People won’t be responsible for their own health if they’re not being forced to pay for the consequences.
**False.**The philosophical basis of America’s privatized health care system might best be characterized as medical Calvinism. It’s fascinating to watch well-educated secularists who recoil at the Protestant obsession with personal virtue, prosperity as a cardinal sign of election by God, and total responsibility for one’s own salvation turn into fire-eyed, moralizing True Believers when it comes to the subject of Taking Responsibility For One’s Own Health.

They’ll insist that health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to an abstemious regime of careful diet, clean living, and frequent sweat offerings to the Great Treadmill God, you’ll never get sick. (Like all good theologies, there’s even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, it’s a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They can’t complain. It was their own damned fault; and it’s not our responsibility to pay for their sins. In fact, it’s recently been suggested that they be shunned, lest they lead the virtuous into sin.

Of course, this is bad theology whether you’re applying it to the state of one’s soul or one’s arteries. The fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us — even the most careful of us. The economics of the Canadian system reflect this very different philosophy: it’s built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other as our numbers come up.

This difference is expressed in a few different ways. First: Canadians tend to think of tending to one’s health as one of your duties as a citizen. You do what’s right because you don’t want to take up space in the system, or put that burden on your fellow taxpayers. Second, “taking care of yourself” has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if you’re contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while they’re still small and cheap to fix.

Third, there’s a somewhat larger awareness that stress leads to big-ticket illnesses — and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, there’s a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use. You can have them if you want them; but reasonable and compassionate people should be able to take the larger view.

The bottom line: When it comes to getting people to make healthy choices, appealing to their sense of the common good seems to work at least as well as Calvinist moralizing.”

She hits on a critical point here. Surveys show consistently that about two-thirds of Europeans view the poor as unlucky, while roughly the same percent of Americans view the poor as lazy. Calvinism in action! The same holds true for health care, where individual responsibility for one’s health is a sign of virtue. It explains the lure of actuarial over social insurance– the idea that one’s insurance premia should be related directly to one’s personal health risks (think medical savings accounts) instead of being based on the principle of solidarity, whereby the young and the healthy subsidize the old and the ill, knowing that they will be helped when they reach this stage in life. Needless to say, the priorities in Catholic social teaching are somewhat different.

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