I'm puzzled. I've encountered someone who's very much for #M4A but loudly decries "centralized medicine"? Does he not realize that single payer systems, like the NHS or Medicare-for-All, are the very epitome of "centralized medicine"? 
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There are plenty of clinical guidelines here. You don't have to follow them. They're *guidelines*. And people talk about pay for performance. Never seen it.
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I don't disagree. I'm just saying there are significant differences in the degree of centralization. Your acquaintance may have meant that. Of course, they may have just had no idea what they were talking about.
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The provinces administer the plan in Canada (and in Australia it's the states that do it). But doctors don't work directly for the state, they bill the state and (outside of hospitals and CLSC/community clinics in Quebec) are privately run clinics or practices. I'm not quite...
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...sure about how CLSCs bill the government to be honest but they're run by the state and inspired by a community clinic that was started to serve what was at the time (and continues to be for the most part) a very working class/poorer area of Montreal.https://ccpsc.qc.ca/en/history
End of conversation
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There are also entirely private practices/clinics in Canada that operate outside of the medicare system (healthcare providers have to exclusively private or public). This is somewhat controversial and generally not that profitable unless it's a specialty like psychiatry or pain.
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