Free but Deadly—Canadian Doctors Want You to Die Sooner!

By Boss Gu, rewritten in English by Mr. Y

Hello everyone, this is Boss Gu.

Yesterday, I came across a long article about a patient who got medical treatment in Canada. The article was called “The Death of My Wife,” and it was heartbreaking. The author’s wife, a PhD student in Canada, underwent multiple physical exams that revealed no issues. Then one day, she was suddenly diagnosed with lung adenocarcinoma and died two months later.

Throughout the entire diagnosis and treatment, there were many inconceivable incidents:

1. Waiting: They had to wait forever for appointments, tests, and even the doctor’s assessment. Even after she was found to have cancer, the doctor still acted unreasonably slowly.

   
   

2. Hidden medication: There was a medicine that might have helped, but the doctor claimed there was none. That drug wasn’t approved locally, but the doctor never told the family about it.

   
   

What’s most shocking was that the doctor seemed not to care about saving her at all - he kept telling the patient and her family to give up.

At first, the patient had a strong will to live, but when the doctor told her there was no available treatment, she broke down.

At that point, the doctor immediately asked if she wanted to stop all treatment. Even though her husband disagreed, the doctor carried out euthanasia by giving her a strong dose of anesthetic.

It was so sad. The author’s love for his wife and his helplessness were very moving. In the comments section, somebody even said that cancer may be not the main cause of death.

Putting aside our emotions, let’s ask this question: why do these Canadian doctors want their patient to die so much? Even when the husband begged for help, the doctors didn’t seem to care and just set up end-of-life care.

Today, the free medical system in developed Western countries is a typical planned economy, the most direct manifestation of which is that the serious patients have no right to choose; as the cost continues to increase, the quality of medical care continues to decline.

Very Different Personal Experiences in China (Mainland)

Not long ago, I saw a totally different situation with one of my relatives who had acute pancreatitis and went into the ICU.

The doctors kept saying there was hope and told us not to give up. Even though it was very expensive, our big family gathered enough money to keep trying.

But soon, this relative's condition got worse. The doctor then told us there was no point in continuing and that we should take him home. He passed away a few hours later.

The cost of ICU treatment was about 20,000 RMB a day. The doctor advised us to continue treatment, which clearly had a profit motive.

At the same time, it was true that acute pancreatitis can sometimes be successfully treated in the ICU. So, the doctor’s advice could have been both professional judgment and financial interests.

Another example, one day, my mother was waiting for a bed in a large hospital. While waiting, one of her friends introduced a Traditional Chinese Medicine (TCM) practitioner who promised that he could help.

My mother believed in TCM, so she spent a few thousand RMB on herbs. The TCM herbs didn’t work at all, and so she gave up. Clearly, she was scammed.

That TCM doctor even dared to promise results for treating Parkinson’s disease - a disease that Western medicine still doesn’t fully understand.

Obviously, the TCM practitioner was just out to make money, but since my mom trusted him, I didn’t want to push back too hard.

The Stark Difference Between Chinese and Canadian Doctors

From these stories, we can see a clear line between how Chinese and Canadian doctors act:

• Canadian doctors seem like “gods”: they don’t care if they can make money or not from you; in fact, they may find patients a burden and sometimes even prefer that their patients die sooner.

  
  

• Chinese doctors act more like “businessmen”: they want you to spend as much as possible. They know desperate patients, like drowning people, will do anything for even a small chance of survival.

  
  

Which type of doctor do we really need?

Are Canadian doctors truly gods? Of course not. Everyone has their own interests, no matter what their background is. People everywhere, regardless of ethnicity or education, have their own interests at heart. No one is truly godlike.

Canada has long been touted as a model for free health care, or more accurately, a publicly funded system. That money comes from taxes and insurance paid by every taxpayer.

If you look deeper, though, you’ll see where the problems come from.

Why “Free” Healthcare Is Never Truly Free

There’s an inherent contradiction between universal, tax-funded healthcare and people’s unlimited demand for medical services, that is, inevitable scarcity.

No matter how rich a country is, and no matter what strategies it implements, truly free healthcare is impossible because medical service is a form of consumption with no upper limit, while the world's resources are destined to be limited.

When healthcare is publicly funded, people tend to use more of it, since it’s not directly out of their own pocket. Consequently, any publicly funded healthcare system must find ways to control costs, or otherwise it will run out of the annual healthcare budget in the first half of the year, leaving no funds for the latter half.

If you were the manager of such a system, what would you do to control the cost?

Usually, it is the doctors in the medical system who have the expertise to determine whether a patient needs surgery, whether a patient needs to be hospitalized, which medicines to use and so on.

Naturally, if you want to control costs, you must start from the following perspectives.

1. Eliminate the profit motive of doctors to prescribe more and do more.

In Canada, some doctors get a fixed salary (it doesn’t matter how many patients they treat), some are paid for each patient, and some use a mix of both. In ‘Chinese Wife’ case, once the doctor had met some kind of quota, there was no financial incentive to prolong or save the patient’s life, since it didn’t affect the doctor’s income.

2. Limit total spending on each disease group.

Canada implements DRGs (Diagnosis-Related Groups) controls (a system now also being adopted in China). DRGs groups hospitalized patients according to their primary diagnosis, treatment procedure, age, complications, etc. Each group is assigned a set total budget. If costs go over that amount, the doctor might get punished. In China, if it goes way over, the doctor might even have to pay the extra.

This system aims to push patients out of the hospital sooner and reduce spending. Inevitably, it leads to early discharge and lower quality of care.

DRGs also affect doctors’ choices of medication. If a drug is too expensive, they won’t use it. Sometimes, doctors may end up wanting patients to die sooner so they don’t occupy the bed too long and cause trouble.

China is starting to see this too. Doctors will sometimes tell patients to leave or go somewhere else once the hospital reaches its quota.

When you cap total healthcare spending, the quality inevitably drops.

That’s exactly why in Canada, the UK, and other developed countries with a similar public healthcare system, people often wait for months or even years for procedures, that’s how the system reduce demand and spending.

For example, lung adenocarcinoma can often be found simply with a lung CT scan at its early phase, leading to a cure. But in Canada, getting a CT scan can be tough. You start with your family doctor, who measures your heart rate, blood pressure, weight, and performs an auscultation. Their attitude is generally very good, but that’s it. If you want a CT or an ultrasound, it’s not going to happen unless there’s a very strong reason. Otherwise, the doctor could be punished for “misusing public healthcare funds.”

If you insist on the check, you have to go to a private clinic, but the costs are astonishing, maybe 1,600 CAD (about 9,000 RMB) for an MRI, 8,000 RMB for a CT, plus consultation fees.(note: in China, the average cost for doing the same tests are several hundred RMBs) The cost of a private medical examination can easily be equivalent to tens of thousands of RMB in Canadian dollars.

For most ordinary people in these countries, the public system won’t allow these tests easily, and private medical care is too expensive.

This is the reality. In Canada, more than 40% of the government’s budget already goes to healthcare, leaving rare space for further expansion. Cutting quality becomes the only way out. That’s the path any universal healthcare system is bound to take.

To make matters worse, doctors also face big risks here. Canada has a no-fault medical liability system, which means doctors can be forced to pay compensation even if they did nothing wrong. As a result, Canadian doctors tend to take a conservative approach with severely ill patients. If they attempt new treatments or surgeries and the outcome is poor, even without mistakes, they might get sued.

Doctors also have to pay for expensive insurance. So, it’s sometimes simpler to turn the patients away, even if that means the patient might die. Nobody wants to spend months going to court, even with insurance.

It can be seen that Canada's medical system is in line with the calls of some Chinese people to eliminate the profit-making nature of doctors. Indeed, these Canadian doctors don’t aim to earn money from you, but they also won’t go out of their way to save you.

You can’t expect a doctor who is under cost control, pressure to free up beds, and the lawsuit risks to prioritize your life at their own expense.

Is a Profit-Driven Doctor Better?

From the perspective of marginal benefits, the answer is certainly yes.

There was a long-term consensus among overseas Chinese that if they got a serious disease, they would prefer to fly back to China - even if they had to pay out of pocket or risked being overtreated.

At least the Chinese doctor would try to save you.

Even if you pay for medical treatment entirely out of your own pocket, the cost of treating a disease in China is still much cheaper than in private hospitals in Europe and the US. The cost of many tests is only one-tenth of that in private hospitals in the US.

As long as patients can choose, a doctor’s profit motive won’t necessarily throw the market into chaos.

Think of someone selling you a super expensive down jacket and claiming it could save your life in extreme cold. Will you buy it? Most people won't. You know that they want profit, but you also know the actual situation, you have your own reasons for (or against) purchasing.

When my relative was in the ICU, I joined a family talk about whether to spend the money. My family members decided that, even if there was only a tiny hope, we wanted to try. We viewed pooling tens of thousands of RMB as a type of emotional expenditure. You can’t say that’s wrong - it’s a normal human response. Otherwise, we’d regret it forever. The ICU doctors urging us to persist or telling us to give up wouldn’t have changed our decision either way.

By the same token, if the family cannot find the resources to afford treatment, you might give up no matter what the doctor says, and that’s normal too. Your budget is limited.

In 2016, the Wei Zexi incident in China triggered a public outcry. Many top hospitals told him there was no cure. But because he was young, and his parents refused to give up. He tried all kinds of treatments, spending a huge amount of money. He still didn’t make it in the end.

Similarly, I couldn’t stop my mom from using TCM.

When people are in pain, they’ll look for any hint of hope, folk remedies, even placebos - just for a sliver of hope. The biggest suffering is having no hope at all.

People with terminal illnesses will rush at any glimmer of hope. Even if they know rationally that there is little hope, but what if in case it really works? Some people said that these people are scientifically illiterate, and the comment may be partly true. However, if people want to live, they must always give meaning to their future lives. If they spend the rest of their days in pure agony, many people wouldn’t accept it. These useless treatments are one of their hopes.

That’s why even though I don’t agree with TCM scientifically, I support a free market where people can choose. Some folks even hire Taoist priests or do rituals. If it helps them feel better, why not?

Anyone should be free to seek hope in whatever way they choose. A profit-motivated doctor isn’t that scary if you can still choose. Faced with a serious illness, I can compare doctors, do my own research, check reviews, tap into personal networks, and assess the expertise of various healthcare providers. and so on.

I’ve even read a trove of research papers regarding my mother’s Parkinson’s disease. In our information-rich society, there are many patients who become as good as doctors after suffering from long-term diseases.

Several years ago, there was a very good virtual Hospital(Tianya Hospital) on Tianya BBS Forum. Patients with various diseases wrote down their diagnosis and treatment processes on this forum. Some patients had already been quite professional and could clearly explain the efficacy and side effects of different drugs. Medical consumption is highly uncertain. Even if you meet the best doctor in China, there are still risks. All you can do is try to minimize the risks.

The Danger of Moving Toward a “Utopian” System

China today is following in Canada’s footsteps. Policymakers believe that by eliminating doctors’ profit motive, they can reduce healthcare spending yet maintain quality of care. This is just wishful thinking.

Any system that ignores human nature, where you assume doctors will work selflessly without any personal incentive, will end up with doctors who simply don’t care. They’ll take their fixed salary, while indifferent to whether you live or die.

The only way to foster a truly robust healthcare market is to marketize health insurance and medical practice, removing excessive regulations in the process. If not, Chinese patients may soon face the same situation as ordinary Canadians: healthcare may be gratuitous, but it can also be deadly, because Canadian doctors would rather see their patients die sooner!

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