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What Obamacare Means for Canada (Hint: Brain Drain)

Posted: 06/28/2012 11:20 am

The diagnosis is in. Earlier today the U.S. Supreme Court ruled on the constitutionality of the sweeping health care law championed by President Barack Obama in an eagerly awaited decision that further divided an already divided nation.

The stakes for Americans could not have been higher: upholding the Affordable Care Act ("Obamacare" if you're inclined to call it that) is going to have an impact on the lives of every American. But what were the stakes for Canadians? Were we mere spectators to this theatre? Or did we have an interest in the outcome of the play? Why should it matter to anyone in Canada that the Affordable Care Act was upheld?

Without going into the minutiae of the 2,700 page bill, which weighs 108 pounds in its entirety, it provides health insurance to 32 million previously uninsured Americans (roughly the population of Canada), prevents health insurance companies from discriminating against applicants based on pre-existing conditions and forces most Americans to purchase a health insurance plan. Setting aside whether or not you believe health care is a human right or that Barack Obama is a socialist, consider for a moment the sheer scale of what this endeavor proposes: a population equivalent in size to that of Canada's acquiring health insurance by 2014, a very short period of time.

Now that we know the Supreme Court has decided the bill is constitutional, Canadians should turn their minds to how it will affect our interests. Thursday's decision means (presuming Mitt Romney does not become President in 2012 and repeal it) that 32 million uninsured Americans will enter a health care market in which supply is largely fixed -- there is no equally large mass of new doctors, nurses, radiologists and the like entering the medical profession to deal with this sudden bulge of customers.

Granted, the 32 million already consume medical services (largely in the form of emergency room visits) but even if they switch over to less expensive primary care doctors (saving the United States an enormous amount of money), where will the supply for these new doctors come from, "eh"?

These new patients will create a surge in demand for medical products and services. Skilled Canadian nurses and doctors, already in demand south of the border, will be drawn in even greater numbers from our own small pool of trained professionals. The "brain drain" so far as medical expertise goes, a drain that has been running unplugged for many years and has sucked a tremendous amount of medical talent out of our country, will widen.

Canadian companies who sell products to American hospitals or other health care providers now stand to earn hundreds of millions of dollars from the massive surge in demand for their services and the guarantee that the U.S.taxpayer will be footing the bill. The Affordable Care Act could actually be a mini-boom for Canadian companies who are positioned to service the American health care system.

The boom might not just be financial; domestic Canadian political groups who fear the slow creep of privately run clinics in Ontario and British Columbia are now likely energized. Their side has, in a sense, won an important argument in one of the last holdouts in the industrialized world to the idea that health care is some kind of a right.

Moves by provinces such as Alberta to allow the operation of private clinics will have less political currency as politicians will have to convince ordinary Canadians why they should run in the opposite direction of the American taxpayer -- towards private care instead of away from it.

The President has been successful in enacting the largest social program since Franklin Roosevelt's New Deal in 1936. It will be difficult for Mitt Romney to counter a resume with a legislative achievement this significant come November. Consider for a moment what the climate in Canada and the United States might have been if the bill was overturned this morning.

Here in Canada, it would serve as encouragement for groups who have been trying to convince Canadians that the cracks in our system (long wait times for surgeries or the use of diagnostic equipment) are doomed to become fatal fissures. They would feel as though they'd won a significant argument, that exchanging individual freedom for socialized medicine is an unfair trade. Canadians who themselves feel a quiet discontentment with our health care system would be more amenable to provinces experimenting with private clinics.

The bills' defeat would have given Mitt Romney political strategic missiles to lob at the President during his re-election campaign. Nearly all of his first term would have been spent working on a piece of legislation that did nothing for the American people. It could have been the beginning of the end for the Obama presidency,

America's justices will have decided more than a question of law today, they have have decided to a large extent the future direction, the future health, in a very literal way, of their nation. Let's hope they had the right prescription.

 

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HUFFPOST SUPER USER
nete peedham
10:44 AM on 06/29/2012
Brain drain? Doubt it...Canadians emigrating to the US ALREADY investigated obtaining US health insurance...this'll only affect the brain-dead who think that the US is heaven on earth.
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HUFFPOST SUPER USER
SeanMartin
Everything in moderation.
10:18 AM on 06/29/2012
>> "Granted, the 32 million already consume medical services (largely in the form of emergency room visits) but even if they switch over to less expensive primary care doctors (saving the United States an enormous amount of money), where will the supply for these new doctors come from, "eh"?"

India and China, more likely. Seriously. The US Congress will give them a pass to come and work here over anything we have to offer.
09:00 AM on 06/29/2012
the long waits for surgeries are being engineered by those that want to bring HMO style care to Canada so that fewer and fewer of us will get quality healthcare and so that HMOs and their CEOs can get even more rich

it's a ruse - and the harpo gov't is going to sell it like snake oil

not to mention those doctors going to the u.s. are in a for a culture shock with lawyers and malpractice insurance being only 2 of the many headaches
not to mention being told how to run your practice by HMOs
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07:23 AM on 06/29/2012
I don't buy this.
07:28 AM on 06/29/2012
Exactly, I know lots of CDN nurses that moved back home. Life satisfaction is not just about money.
08:43 PM on 06/28/2012
American doctors, once they are out of residency, as a whole do not work anywhere near as hard as the doctors in Canada. (Yes I have first hand experience in this as I have been a health care worker.) All this means is that many may have to forgo their Wednesday afternoon of golf so they can rake in some more cash.
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HUFFPOST SUPER USER
SeanMartin
Everything in moderation.
10:19 AM on 06/29/2012
.. and pay off those absurd medical school bills.
HUFFPOST SUPER USER
sgillhoolley
Occupy the discussion.
05:35 PM on 06/28/2012
Short Term: Increase doctor pay to bring it closer to what they can make in the US for essential services.

Long Term: Increase tuitions for medical school AND deduct 10% of that debt for every year that the doctor works in Canada, 20% if they work in a remote area that is in desparate need.
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HUFFPOST SUPER USER
SeanMartin
Everything in moderation.
10:20 AM on 06/29/2012
Short term: sorry, but we cant afford an increase. There just isnt any money available, thanks to 40 billion for useless jets and God only knows how much for subs that dont work.

Long term: yes.
HUFFPOST SUPER USER
sgillhoolley
Occupy the discussion.
11:54 AM on 06/29/2012
Of course we can afford it.  It is merely an issue of willpower.  We can choose to cut spending in other areas to account for it, or raise taxes on corporations (we have one of the lowest corporate tax rates in the world).  There are plenty of places to find the money...if we really want to.
03:55 PM on 06/28/2012
According to the OECD Health Data 2012 report (available www.oecd.org) in 2010 both the United States and Canada had "2.4 Physicians, density per 1 000 population". In other words, the USA has the same number of doctors per capita as does Canada.

The American healthcare system is notoriously inefficient and wasteful, which Obamacare doesn't do anything about.

But the contention that Canadian doctors and nurses will now flood to the USA in droves is somewhat spurious. Many doctors and nurses have spouses who would not be able to get green cards to work in the USA. If a nurse or doctor is single and footloose, they might want to relocate to the USA, but if they are married and the move would mean their spouse would be earning zero dollars, it could put a damper on the idea.

When Tommy Douglas introduced the first Medicare into Saskatchewan, there were dire predictions about how many doctors would flee the province. But guess what? It turned out that most physicians preferred to practice medicine and not have to act as bill collectors, and most physicians stayed and found they did just fine with Medicare.
HUFFPOST SUPER USER
sgillhoolley
Occupy the discussion.
05:37 PM on 06/28/2012
You think doctors and nurses will have a tough time getting a green card if the US has a shortage of doctors due to this law? I think that is counter-intuitive. There are several issues that would discourage Canadian doctors moving south (insurance paperwork and malpractice insurance come to mind), but those have always been there, so the repulsion factor is already at play. If the US makes it easier for doctors to move south, SOME will.
07:06 PM on 06/28/2012
I didn't say the doctors and nurses would have a tough time getting green cards. It's the spouses and children of the doctors and nurses who would not have green cards immediately, and who would not be allowed to work in the US. So, a two-income family would become a one-income family, and the spouse's career would be on hold.
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03:52 PM on 06/28/2012
"These new patients will create a surge in demand for medical products and services."

If there's going to be a huge surge in the amount of health care delivered, that means health spending will increase. So why did they call it the "Affordable Care Act" again?
07:08 AM on 06/29/2012
Because it costs less than managing their health through the emergency rooms.

Are you telling me that this point had escaped you ?
02:57 PM on 06/28/2012
I believe that private clinics should be allowed and encouraged in Canada-The people who can afford them are freeing up spaces in the system to allow the "average" Canadian access to treatment to the folks who need specific care---Having said that, if the private clinics require the use of our hospitals to
'repair' the diagnosis- they should have to wait at 'the back of the line' until 'regular' Canadians are served---if they claim 'first place' then no private clinics should be allowed---private does not equal 'special' in our health system,.
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04:06 PM on 06/28/2012
The flaw in your comment: “I believe that private clinics should be allowed and encouraged in Canada” What would inevitably happen in the situation you describe is the cream of the medical profession would be recruited by the private clinics, and we would inherit a second class healthcare system.
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HUFFPOST SUPER USER
Drg40
Representative Democracy is all we have.
05:08 AM on 06/29/2012
From UK experience the flaw is greater than you suggest. The private medicine system contributes little to education (amongst other things) so the number of medical staff is not increased. The resouces consumed by a "private patient" is significantly greater than those consumed by "others", therefore, supply being fixed, the nature of the service to "others" declines. I have no objection to private medicine as long as those who use it pay the FULL costs, but then, of course, only bankers, politicians and Murdoch employees could afford it. In short, in the UK, private medicine is yet another means by which the rich sponge on the poor
04:08 PM on 06/28/2012
1. i am not sure how having private clinics would speed up or free up anything. we would still have the same amount of doctors doing the same amount of work..

2. this system of putting private clinic people at the back to be reassessed sounds like you just doubled the work. and we would have been better off in the public one in the first place?
02:26 PM on 06/28/2012
I don't buy into the logic of this piece.
HUFFPOST SUPER USER
sgillhoolley
Occupy the discussion.
05:38 PM on 06/28/2012
Can you explain the disconnect that you have noticed?
02:55 AM on 06/29/2012
The piece is illogical because of things outside the author's discussion: the fact Obamacare forces people to pay private insurers exhorbitant prices or pay a penalty labelled as a "tax" by the Roberts decision. Other factors, such as the indentured servitude caused by massive non-dischargeable student loans, will bring about their own brain drain. Meanwhile, factors the guy mentions, such as the spurious claim that Obamacare will increase health spending, are absurd because it is the job of health insurers to deny, not provide, care.
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lilkitten22
Be the change that you wish to see in the world
02:13 PM on 06/28/2012
I would hope it doesn't start up private clinics, we don't need them, but the way this country is going, and who is in charge, it might happen..
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04:18 PM on 06/28/2012
There are tons of private clinics in Canada. Most family doctors do not work directly for the government, but rather run their own businesses.
06:35 PM on 06/28/2012
Also, many of our "private" clinics are publically funded. A lot of people do not realize the money given to these clinic and they have NO competition. Therefore, we as the "public" have no say in what we need and are unable to go elsewhere is the service is terrible. As noted above - our Dr's are mostly paid privately. X number of #'s per visit. So, if they spend 15 seconds with you or 15 minutes they are paid the same. Ever notice those signs "only one concern at a time" In the US this doesn't happen as much as each Dr. is liable and always at risk for being sued.
02:09 PM on 06/28/2012
Astute medical personnel wil avoid the move south if they don't want to get caught up in the social upheaval that will be occurring with the collapse of the U.S. dollar. We will feel some of the effects here but nowhere near the mess that is coming south of the border.
04:21 PM on 06/28/2012
lolz ok, ron paul. by the way, there's nothing stopping canadian citizens working abroad from returning if their situation in their host countries become unpleasant. like, duh-doy
HUFFPOST SUPER USER
sgillhoolley
Occupy the discussion.
05:42 PM on 06/28/2012
Don't laugh, I moved back to Canada two years ago, after living in the US for 15. It is a HUGE mess down there. The average American family has lost 40% of its' wealth in the last 5 years. People remain unemployed for years. Homes have lost huge amounts of value, and are frequently underwater (where the mortgage is larger than the value of the home). They are DEEPLY in debt, with huge deficits that show no signs of getting smaller, and involvement in two failed wars that have drained their coffers and gutted their military (45% have been disabled....that's right, 45%, a huge number that has a long-term drain on the treasury). Do not kid yourself, the USA is going down, fast. You won't recognize it in 5 years from now. Mexico will want to finish the wall that the US started (but ran out of funds to finish).
01:49 PM on 06/28/2012
Insurance companies are the real winners today. They have more than a trillion in tax dollars heading their way, Big Pharma wins
01:28 PM on 06/28/2012
I don't see how a system which requires people to pay for private insurance at exhorbitant rates will cause a brain drain away from Canada. A few doctors might move south to make more money, but more people will likely flee the US system if they have opportunities to do so.
HUFFPOST SUPER USER
sgillhoolley
Occupy the discussion.
05:43 PM on 06/28/2012
Great, here come the illegals ;)
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Turdinthepunchbowl
I float, therefore I am
01:09 PM on 06/28/2012
The taxpayer subsidizes everyone. Private small businesses get huge tax breaks for capital expenditures, and who makes up the lost revenue? This is a subsidy. The small business person does not pay the actual cost to run their business, the taxpayer assists them greatly. The myth of the self-made small business person is just that. He/she has been assisted greatly by the state at the expense of the taxpayer.