From an article by Kevin Charles Redmon in Salon (March 26)
Single-payer healthcare solves a lot of problems – dizzying insurance premiums, pre-existing condition jeopardy – just not all of them.
Prejudice, like diabetes, is a condition for which no drug yet exists, and, as a new bit of research in the Canadian Medical Association Journal demonstrates, even physicians working in a universal care system aren’t immune to its effects.
Stephen Hwang, an internist at the University of Toronto, wanted to know just how endemic socioeconomic discrimination was in local clinics. “I provide care for a number of people who are homeless and marginalized in society,” he says, “and they not infrequently mention to me that they feel that, in the past, they’ve been treated differently by certain healthcare providers. They feel that it was simply because they were poor or homeless.”
Hwang, along with colleagues Michelle Olah and Gregory Gaisano, decided to explore that complaint by calling the offices of 375 primary-care physicians in Toronto, posing as a first-time patient. Half the time, the “patient” explained that he was an executive at a major bank, just transferred to town, looking for a new family doctor; in other cases, the “patient” was a welfare recipient whose caseworker had instructed him to start receiving annual check-ups.
The authors discovered that a rich patient’s odds of getting an appointment were nearly one in four, while a poor patient’s were one in seven. While “physician reimbursement is unaffected by patients’ socioeconomic status” in a universal system, they write, affluent Canadians “received preferential access to primary care” over their lower-class countrymen.
“What we found was about what we suspected was going on,” says Hwang, who went to medical school at Johns Hopkins and studied public health at Harvard before moving to Toronto. “Having practiced in both the U.S. and Canada, I think that while the Canadian system of universal health insurance provides much more equitable access for people of all income levels and social background, what it doesn’t eliminate is a universal predisposition to treat people differently because of their status in society.”
Or perhaps better referred to as a ‘two-tier’ system by stealth?
Once again, whether you’re rich or whether you’re poor, it’s better to be rich…
Although the conclusion of the investigators is one I would have expected, it does not suggest to me that it is an indictment of our single-payer health-care system, as a system or that it is dysfunctional. It is, rather, a justified criticism of medical education and regulation.