Rana Foroohar (“The pursuit of profit bodes naught for US healthcare,” Opinion, April 11) raises a number of important concerns about how the introduction of more market-like forces into US healthcare should raise some concerns. But attempts to completely flatten all market signals also lead to suboptimal results.
Canada is a prime example of this. Compare all Canadian medical services that exist within the “public system” (GPs, hospitals) with those that operate outside of it (dentists, physical therapists, optometrists, psychologists, etc.).
What you find outside of the public system is that the bottlenecks are far less, and even decreasing. The number of Canadians per dentist has been steadily declining for the last 25 years. The supply meets the demand.
The exact opposite has happened for primary care physicians, where the ratio has deteriorated every year since 1968, but especially in the 1990s, when the Canadian provinces actually destroyed the capacity to save.
The Canadian state deliberately reduced medical school admissions and removed intensive care unit and hospital beds so it wouldn’t have to pay for them. And by making the private provision of these services virtually impossible, the Canadian government has inverted the supply-demand curve with devastating consequences.
In short, we must find ways to use market signals while pursuing humanistic values.
There is no definitive answer to this dilemma.
Mark a Wolfgram
Ottawa, ON, Canada