Private Healthcare: What's the Point?

I'm pretty late to the scene, but Shouldice Hospital in Thornhill, is being purchased by Centric Health Corp. The usual suspects are unhappy, but Andre Picard is taking his traditional stance, scorning the guardians of Canada's healthcare system for their sanctimony, and looking down at them from his calm, collected, nonpartisan perch at Canada's newspaper of record.

Picard is right that opponents of private healthcare use somewhat catastrophic rhetoric about private healthcare delivery. Our cherished public health insurance is precisely that: insurance. Canadian healthcare doesn't follow the Beveridge Model common to the UK and Scandinavia, where doctors work directly for the government. We only receive health insurance through the government, the single-payer for healthcare. The really egregious horror stories from the  States center around private insurance, rather than private delivery. The American system of private health insurance really is a clusterfuck―at least until 2014― and Canadians are right to reject it.

A private company running a hospital isn't worth losing your shit over on quite the same level.But Picard is wrong to dismiss concerns about who owns the Shouldice Hospital.

Much of the furor surrounding the sale of the Shouldice depends on the fact that Centric Health Crop. is publically traded, although it isn't immediately clear what's troubling about that, given that the Shouldice is already a for-profit institution.

Keep on hustling for that paper

The hospital wouldn't necessarily change under the ownership of a public company; it isn't exactly true that a public company is required to maximize profit, anymore than a privately held, for-profit company is required to maximize profit. But I do think there's a risk of physicians' professional ethic weakening, and being replaced by an ethic of profit maximization, as Atul Gawande described in his New Yorker piece on the galloping price of care in McAllen, Texas. If you don't want to trudge through thousands of words of the New Yorker, take a quick look at this asshole's website: he's an anesthesiologist and the C.E.O. of a doctor-owned for-profit hospital. I wouldn't want this guy putting me under.

That's not because the miasma of capitalism leads to surgical complications, it's because a doctor-patient relationship is just about the worst information asymmetry imaginable, and a doctor's professionalism is the only thing stopping her from robbing you, or any insurer.

The differences between publicly traded, privately held, and non-profit organizations is less stark than political rhetoric might suggest, but it makes sense to organize healthcare differently than public companies, and it makes sense for healthcare professionals to speak a different language than for-profit companies. It shows a commitment to rejecting profit-maximization. And that commitment is meaningful and important. When an ethical system dies out, it can be very hard to revive it, and regulation can't replace it, given that a doctor will always understand specific situations better than any regulator, and can game regulations as easily as a patient.

So there are definite downsides to allowing an expansion of private medicine, and I've yet to hear any plausible benefit. Conservatives often confuse markets with private ownership, but profits won't sprinkle magic private-sector fairy dust on an institution, and private ownership won't make healthcare markets less messy. So I've gotta ask: what the hell is the point?

At best, the real action in improving outcomes and lowering costs is orthogonal to debates about private versus public care.

Still, public insurance is more important than public delivery, so if you take one lesson from this blog post, it should be that it's fucking insane that public health insurance doesn't cover prescriptions. You kind of need those sometimes.