It sounds like for these procedures, the reason you cannot pay is not because they don’t want money, it’s so that you aren’t paying to jump in line for a service that is meant to be equally offered. It would be like paying extra at the DMV so that you get to the counter before all the plebeians that can’t afford to pay extra.
But, just like the DMV (in Ohio, anyway), if I find the wait too long at one county’s office, I can go to the next one over instead, where there may be a shorter line.
Being able to jump the line is a feature of every health care system in the world. Except Canada’s and the hermit kingdom. It’s not some radical free market idea.
Being able to “jump the line” is not a “health care feature” at all; for non-urgent elective care it’s an amenity just like a luxury private room or Michelin-star quality hospital lunches. No one has an intrinsic problem with rich people getting amenities. Indeed, I wonder how those who make such allegations think that major league athletes in Canada get immediate access to medical specialists and top-tier diagnostic imaging when they get an injury. The problem arises when queue-jumping becomes a symptomatic part of a structural change in the health care system that creates a two-tier system with differing levels of quality and competency and, ultimately, worse medical outcomes for the public system.
I’ve explained at least three times now some of the reasons that it’s important for Canada to avoid the pitfalls of going to two-tier, and if certain posters want to assidiuously ignore these explanations and plow ahead with comparing the Canadian health care system to a communist dictatorship then I have nothing more to discuss with them.
The way it works in Canada is that timely access to health care is based on triage. There is no wait for urgent cases, and generally no wait for much of anything once you’re in hospital. Elective cases often have wait queues because it generally doesn’t much matter except for convenience. It’s not ideal but it’s far preferable to bankruptcy, denial of care, outrageous insurance costs, and the economic stratification of something as fundamental as health care.
And it works. A good example is the oft-cited hip replacement surgery. Those who don’t understand how the principle works will often mention that an elderly person falling and breaking a hip might be in a dangerous situation with the possibility of serious complications. But such a case would be triaged as urgent. The waits for these kinds of surgeries are for chronic cases that have been slowly building over many years where the patient finally decides to do something about it, not for life-threatening injuries.
Two-tier works in Europe because it’s a different economic and social climate that lacks the insidious influence of American health care commercialism, and because it’s structured in ways that may not be politically feasible in Canada – and would be unthinkable in the US. For instance, in some countries all health care is essentially privately insured, but is very tightly regulated and appropriately subsidized, so the rich just get a different flavor of it. In others – notably the UK – most doctors are salaried and have an obligation to the public system that has no parallel in Canada where most doctors are independent businesses. As such, there’s not much to keep them from jumping ship to a much more lucrative private tier. We already see this dramatically in special fields like dermatology and plastic surgery, where the doctor can either deal with real medical procedures at public rates or with aging females wishing to look younger who come bearing big wads of cash. Guess where many of these doctors choose to spend most of their time, and guess what that does to their medical waiting lists?