Eight doctors from the U.S.-based Physicians for a National Health Program visited Toronto's Women's College Hospital for an inside look at Canada's single-payer health care system. Hosting the trip was family physician Danielle Martin, chair of Canadian Doctors for Medicare.
New York dermatologist Elizabeth Rosenthal, board member of the New York metro chapter of Physicians for a National Health Program, spoke to The Globe and Mail about what she learned during her visit.
Your association of 18,000 physicians has long advocated for a single-payer health care system in the United States. Canadians cherish medicare but are mindful of its limits. What are your thoughts?
You think there are all these things wrong, and we're all sitting here drooling. This is our ultimate universe. Any time doctors mention anything, they say it's all covered and patients don't have to worry about paying for it. That's why I'm drooling.
What is the most surprising thing you have learned so far?
I learned that doctors are compensated much better than what we presumed they were here and their work lives are very nice. In the U.S., most doctors are afraid of two things with a single-payer system: they will lose money - of course, they won't say that - and that they are going to lose autonomy.
What is work life like for an American doctor?
You spend so much time hassling with insurance companies, you just can't imagine. You have to fight with them to get paid.
How about your patients? Do they seem in favour of a single-payer system?
I go on about it to my patients, saying, "We should have what Canada has and they say, 'You mean we have to cover the illegal immigrants? What about that person over there, he's fat and he smokes, I should pay for his health insurance?" Things happen to people, it's insurance and the only way we will be able to afford health care is if everybody chips in.
You sound like a renegade. What's your story?
I grew up in a family of doctors. My father was a general practitioner, my father-in-law was a doctor, my husband's a doctor, about a dozen first cousins are doctors, as was my grandfather and great uncle. It's like the family business. Most of our politics were towards the left. I grew up in New York City and I'm Jewish. I've seen medicine change a lot.
How is medicine different today than it was when you began practising in 1967?
I am 68 years old. When I started, it was much less expensive and doctors didn't advertise. The business side of medicine is taking over like a creeping eruption. I'm not an entrepreneur and I didn't go into medicine to run a business. I wanted to take care of people.
How does a doctor deal with the delicate issue of payment?
The first thing a patient does is show me their insurance card. If I'm not in their plan, I won't get paid, unless the patient pays me.
The U.S. system spends twice as much as other industrialized nations on health care, yet it still leaves more than 50 million without health coverage. Why has reform been so difficult?
We're always racking our brains and always bemoaning the fact that it shouldn't be so hard. Part of it is cultural. With Canadians, it's a community - we're all in this to help each other. In the U.S., it's the frontier - I'm going to take care of myself and you can't tell me what to do.
The new U.S. health care bill - the Patient Protection and Affordable Care Act - has been described by your group as using an aspirin to treat cancer. Isn't it an improvement?
There's lots of ways to improve the health care system. The first thing we have to do is get rid of the private health insurance industry because the administrative costs that they entail, we say it adds costs but no value to the system. We don't think health care should be an opportunity for profit, we think health care is a human need, like the fire department. But in our country, it's treated as how you make a buck. And we will be mandated to buy their lousy health insurance.
This interview has been edited and condensed