Is health care prohibition in our future?

One scenario envisioned by health reformists is to prohibit doctors from practicing outside a government-run system.

This is the situation in Canada, leading to single-tier health care. Opting out of Medicare and other health insurers remains the last trump card doctors have in negotiations. Removing that option would enslave physicians to the whims of government control. Most health policy wonks would like nothing more than to see that.

Astute cardiologist DrRich however, wonders whether what patients would think. He asks how patients would react by not being able to spend more money for a higher tier of care. Essentially, this will lead to a world of “health care prohibition,” where black-market, cash-only medical services would sprout up catering to patients unwilling to tolerate the restrictions of a single-payer system.

I personally see the public backlash to be a mortal obstacle. American patients are used to choice and having premium, on-demand health care. That will never change.

DrRich adds relevent historical context, saying “prohibition did not work for alcohol, is not working for drugs, and will certainly not work for healthcare.”

Comments are moderated before they are published. Please read the comment policy.

  • Anonymous

    One example is the NFL or other high level athletes. Are they supposed to sit behind Wally from the YMCA that tore his ACL playing an over 40 pickup game? We have one trump card that would go above even this if they took that away. Quit practice altogether and tell everyone sorry no one is on call at the local ER. I’d much rather teach Biology at the local community college or run my restaurant fulltime than be dictated to on such a level and give the ultimate finger to wonks such as this.

  • Anonymous

    no way this would fly. what percent of physicians do you envision staying in practice if they were required to work under such a plan, for whatever the government felt was an appropriate salary? take into account the debt burden and other sacrifices needed to become a physician would not change, and the lawyers are too powerful for the threat of a catastrophic lawsuit to lessen any time soon. how do you think a move to such a system will affect the number of applicants to medical school?

    you’d be left with no doctors.

  • Anonymous

    Looks like some folks are confused and mightneed to visit and review the definitions for “national” and “socialized”. AFAIK, private practice options are available in both Canada and the UK. Of course, one would have to pay full fees unless they purchased individual health insurance to supplement the care they paid for with taxes.

  • Anonymous

    Re Anonymous (8:57 pm). Yes it will fly. It did in Canada. Yes, a few doctors will quit. But most, faced with actually having to give up their careers or submitting to the system will submit. It happened in Canada.

    Re Anonymous (10:31 pm). Wrongo. There’s no real private practice option in Canada. (I’m a Canadian and know what I’m talking about). Yes, technically it’s true, a physician can opt out of the system and run a private practice. But in Canada the choice is to be entirely in or entirely out of the system, and “entirely out” means effectively “no patients”. So virtually every physician is in the system.

  • shadowfax


    I have a problem with how you framed this — it feels fundamentally dishonest. You lead with, “One scenario envisioned by health reformists is to prohibit doctors from practicing outside a government-run system.” Now I confess that I could not read the original post at Covert Rationing, as something seems to be jamming my interwebs just now, but I am not aware of ANY health reformers who advocate such a system. Absent a concrete example of this “scenario,” your lede might be more accurately phrased as: “Those skeptical of health care reform are afraid of a scenario in which doctors are prohibited from practicing outside of a government-run system.”

    But you falsely imply that such a proposal is being advocated by reformers. That is simply fear-mongering. If you can cite an example of such an advocate, meaning a pro-reform health policy wonk with more credibility than me, please do so. Even so, you would do well to clarify for your readers that the nightmare scenario alluded to is not endorsed by any one of the democratic leaders who are working on health care reform.

    Really, I get tired of the regressives whipping up a frenzy of opposition to the NHS and CanadaCare when neither is under consideration in the US. Geez. Get with it, people.

  • Anonymous

    So what happens to plastic surgeons who take cash only?

  • Anonymous

    anon 3:54-

    i would still have to assume that without some assistance in the drawbacks of being a physician in america, the percentage of physicians that would quit under such a system would be greater here. my impression is that medical education is more costly in america, the legal climate is far worse, and patients have a worse attitude.

    if all of those things were to remain the same and we were to adopt “the canadian system”… why not move to canada and practice there, where i’m working under the same conditions but less likely to be sued?

    if implementation of such a system were to result in worse outcomes, you can be sure the physicians will be held responsible by the patients and their lawyers.

  • Anonymous

    You are mistaken. In Canada, doctors can opt out of the social system. They then bill their patients whatever they like and the patients go to the Provincial health care system to be reimbursed. Such reimbursement is according to a schedule. There are some private health care clinics in highly populated areas, however in most of the country it is not economically feasible to fully separate. Still, doctors here seem quite content with the system, albeit they are like all people and want more, more, more.

  • Anonymous

    Primary care now offer long hours, lots of paperwork, little respect and lower pay/hour than many nonphysicians.

    One of the few things that keeps me in medicine is the hope that a well run practice may find success in a niche business such as cash only. If the government regulates that hope away, then I’ll cut my losses and get out of medicine as fast as possible.

  • Anonymous

    Seems in Canada, you can be 100% in, or 100% out, no in-between. Sorta like USA Medicare, where you’re in or you’re opted-out. I know there’s controversy, and an opinion that docs can see some Medicare privately, others in the system. I’d love to see that litigated and decided once and for all.

    From time to time, I’ll see grumbling in the Canadina press over queue-jumping. The elite pro athletes, politicians or the politically-connected, Worker’s Comp for favored employees, etc.

    The more spectacular one was Jean Chrétien, who went to Mayo for medical care, and was outed when he was needed to attend King Hussein’s funeral and couldn’t be found. Certainly don’t begrudge him for wanting treatment at Mayo, but he had to lie about it.

  • Anonymous

    actually in Canada, you can only be 100% in. Physicians in Canada have been robbed of their most basic human rights -rights to be able to contract with another (in other words, the right to pursue happiness). All Canadian doctors are forced into the contract with the government. If they see a private patient, they can lose their license and the patient can be fined heavily. There are no other professionals who have been so deprived of their rights. Dentists, accountants, lawyers, pharmacists have maintained their rights.

Most Popular