Gayle Brekke, FSA, and Joyce Cheney (aka Kurisko;)) are joined by Dr. Lee Kurisko, a Canadian radiologist who left practice in Thunder Bay, Ontario, to pursue a career stateside after becoming disillusioned with Canada’s centralized approach to healthcare delivery. His firsthand knowledge of waiting lines, physician and staff shortages, and outdated imaging equipment forced a change of heart from the great confidence he initially felt in Canada’s healthcare system. He soon discovered greater efficiency and less rationed care in the U.S. and while our current system is not without challenges, he feels it is far superior to Canada’s system. Canadians, Dr. Kurisko explained, are indoctrinated into the notion that government should provide healthcare and that U.S. citizens are being left in the cold because the government does not directly arrange and pay for all medical treatment. He shares how the Canadian cultural ethos takes considerable pride in the government’s role in healthcare. Indeed, surveys suggest that Canadians remain very proud of their system even though approximately 17 percent lack access to a primary care physician. This ethos is even more puzzling when you consider that in Canada, a primary care referral is needed in order to receive specialty care; those who do not have a primary care physician also do not have access to specialty care in Canada.
Dr. Kurisko’s move to the United States was in part driven by exhaustion, where he and his two colleagues daily confronted 10 to 14 hours of workload meant for 13 radiologists. He states that because governments are constrained by budgets (vs. profits seen with private enterprise) – it leads to a severe and perverse form of rationing which is not only impractical but immoral as well. The view that healthcare is a right necessarily implies that medical providers’ freedoms can be curtailed; after all, someone must provide the discounted or free service that another person claims a right to receive.
The inherent complexity seen in healthcare pleads the case for bottom-up solutions that lead to less rationed, better quality care. He suggests that because healthcare is so important, it behooves us to consider limiting the role of government.
Dr. Kurisko advocates for an uninterrupted doctor-patient relationship without arbitrary price controls. He suggests that a better value proposition is possible if we embrace transparent pricing that facilitates the delivery of a desired service – just as we do with other goods and services provided in the United States. In that sense, healthcare is not special. Our conversation touched on “proper” insurance, which only covers large, unexpected losses and preferably is purchased individually and not through an employer. Over-insurance (that is, using insurance for routine, inexpensive care) causes excess testing and other excessive utilization, which of course, contributes to out-of-control spending. Lastly, he emphasizes the need for supply-side solutions associated with charity care to address our nation's indigent patient population. How to induce or layer such change within our current system, vexed with bureaucracies and vested interests, remains to be seen. But it is a challenge we should not shrink from in light of Medicare insolvency concerns and ever-growing healthcare demand that continues to eat up a larger percentage of our GDP. At least we have greater clarity on what to avoid as we promote a more bottom-up approach to healthcare reform, thanks to Dr. Kurisko’s insights about the issues confronting Canada's healthcare system.
