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Originally Posted by Documad
You mean if you pay him or her yourself and if the doctor accepts you as a patient? I'm really confused about how it works. If doctors retained freedom of choice then I assume that some doctors don't accept patients on the government plan. And how does it work if everyone on the government plan wants to go to the same doctor? On a basic economic level, how does it work if the best doctor can't charge more? Or does your plan just cover a certain percentage or a certain amount and you cover everything over that so that there can still be price competition?
When I had family living in the UK they couldn't get to the doctor they wanted and they couldn't get the procedure they wanted so they paid a private doctor. It was so fucked up. I have no idea how Canada does it though.
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Well, it's somewhat complicated to explain, but Wikipedia has all the answers. The thing to keep in mind is that health care in Canada falls under provincial, and not federal, jurisdiction (although the feds do provide some of the funding). Every province is required by federal law to cover all medically necessary care, but outside those legally defined boundaries - for things like eye care or dental care or cosmetic surgery - there are wide variations from province to province. This is why most Canadians either pay cash for eye and dental care, or get employer-sponsored insurance to cover it.
With that in mind, you could sum up the Canadian health care system as publically funded, but privately delivered. The vast majority of doctors are private practitioners who bill the provincial health authorities for their compensation on a fee-for-service basis; the money for this comes from general provincial revenues (ie taxation) and federal transfer payments. So it would seem to me that Canadian doctors have just as much leeway to choose their patients or charge for their services as doctors anywhere else; the difference is the Canadian single-payer system - the provincial governments assume the burden of payment, rather than the individual patients themselves. It's quite different from in the UK where the entire service is fully nationalized at the federal level.
I can illustrate these things with my personal experience, which I've described in another thread - when I dislocated my shoulder for the third time, I went to a practitioner who was extremely off-putting and didn't want to treat me until I injured it for a fourth time. I said fuck this and went to another practitioner, whom I'd seen before, who put me on the operating table two weeks later, for the same low price of zero dollars. You see, doctors do have latitude to exercise their discretion in choosing whether to treat patients, and patients do have latitude in choosing their practitioners. But the key point is that it's free. And so far as price competition - well, first of all that's not the be-all and end-all of human relations. But if patients gravitate to the better practitioners, these then have more opportunities to bill the province for services rendered, and will thus make more money. I'm sure it's not as simple as that, but the point is Canada isn't some kind of mini-USSR where the doctors are all standing next to the patients in circular bread lines.