Lewin analysis of candidates' proposals

Posted by on Thursday, Oct 9, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

McCain and Obama Health Care Proposals: Cost and Coverage Compared

The Lewin Group
October 8, 2008

In this study, The Lewin Group estimated the cost and coverage impacts (for 2010-2019) of the health reform proposals introduced by Senators McCain and Obama. Our key findings are that the McCain proposal would reduce the number of uninsured from a projected number of 48.9 million people in 2010 by 21.1 million people if fully implemented in that year. The Obama plan would reduce the number of uninsured by 26.6 million people. The McCain proposal would result in a net increase in federal spending (i.e., net of offsets) of $2.05 trillion over the 2010 through 2019 period compared with a net federal cost of $1.17 trillion under the Obama plan over this same ten-year period.

The Candidates’ Proposals

The McCain proposal would expand coverage through private insurance and decrease regulation of health insurance markets. His plan would provide a refundable tax credit of $2,500 for single filers and $5,000 for families that have private health insurance from an employer or as an individual in the non-group market. Insurers would be permitted to sell insurance across state lines, thus sidestepping state minimum benefit and insurance rating regulations.

The McCain proposal would establish federally subsidized high-risk pools called the Guaranteed Access Program (GAP) to cover those denied coverage due to health status. The Campaign indicates that half of the losses under the GAP would be paid with an assessment on private insurance with the federal government providing the remaining half.

The Obama proposal would expand coverage through public and private insurance and increase federal regulation of insurance markets. His proposal would expand Medicaid eligibility to include all very low-income adults and would provide premium subsidies for people with low to moderate incomes. Insurers would be prohibited from denying coverage or setting insurance premiums on the basis of health status. Also, the Obama plan would provide small employers with a tax credit for the purchase of insurance and would create a federally subsidized reinsurance program to cover “catastrophic health” expenses in employer plans.

Senator Obama’s plan would also create a “National Exchange” offering a selection of private health insurance options comparable to those now offered to members of Congress and federal workers. The exchange would be open to individuals, the self-employed and small employers. In addition, the Obama proposal would create a new publicly-operated insurance program called the “National Plan” that would be available as an alternative to private coverage in the National Exchange.

Unlike the McCain plan, the Obama proposal would establish a minimum standard of covered benefits.


The release of this report from The Lewin Group has provoked a debate on whether it accurately reflects the numbers of individuals that would gain coverage under the McCain and Obama proposals respectively. Although this debate is legitimate, it misses the most important point. We don’t really care how many people nominally have health insurance; we want to know whether or not people are protected from financial hardship should they need health care.

The McCain proposal aims to make premiums for private health plans affordable by deregulating the market. Premiums can be kept low by (1) creating a market of underinsurance products (limited benefits and greater cost sharing, especially through high deductibles), and by (2) insuring only low risk individuals who can pass medical underwriting standards.

The Lewin report makes the assumption that when the McCain plan is fully implemented in 2010 the number of individuals with private employer coverage will decrease from 157 million to 148 million. That level of decrease might be true at the beginning of the program, but incentives are likely to cause a further dramatic decline in employer-sponsored coverage. If an individual can obtain a very inexpensive plan in a deregulated market, and the government is going to provide a $2500/$5000 tax credit, why would an employer want to continue to offer an expensive comprehensive plan, and why would an employee pass up a pay increase offered by the employer for those who decline coverage?

Once a large number of healthy employees move into the individual market, the employer-sponsored plans will be subject to adverse selection. The spiraling costs of premiums will cause employers to terminate their plans, especially since a President McCain’s proposal would have opened up the individual market to plans with affordable premiums, albeit underinsurance plans.

Since the deregulated market insures only healthy individuals, the individuals who actually need health will have to look elsewhere for coverage. Sen. McCain understands this, and that is why he has proposed the Guaranteed Access Program (GAP) to insure these individuals with greater needs.

This is where there is a problem with defining the success of a reform proposal by the numbers of insured individuals. The very large number of individuals purchasing underinsurance plans are healthy, but most of the spending is on the smaller group with needs that will be forced to obtain coverage under GAP. The Lewin Group estimates that of those with chronic health conditions who are currently uninsured, only 24 percent would be covered by the McCain proposal. These are people who most desperately need coverage, yet three-fourths of them would remain uninsured.

How does McCain propose to pay the high costs of those who do make it into GAP? Half would be paid by federal subsidies (taxes), but the other half would be paid by assessments on individual private insurance plans. Suddenly the cheap premiums for these underinsurance products aren’t so cheap anymore since half of the excess costs of the high-risk pools are moved back into the underinsurance pools. What will happen to the enrollment rates for these underinsurance products when the premiums are jacked back up to unaffordable levels?

When people tell you that the McCain plan is almost as good as the Obama plan in reducing the number of uninsured, you now have a response. The McCain proposal provides nominal coverage with uninsurance plans for those who are healthy, but it doesn’t pay the bills for those who actually need health care.

Presidential debate – health care as a right

Posted by on Wednesday, Oct 8, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The Second Presidential Debate

October 7, 2008

Tom Brokaw: Is health care in America a privilege, a right, or a responsibility?

John McCain: I think it’s a responsibility…

Barack Obama: Well, I think it should be a right for every American…


Asking whether health care is a privilege or a right often leads to a not very productive ’tis so, ’tis not debate. But when the question is asked with the added choice of responsibility, and then answered, the answers can be very revealing.

If you believe that health care should be an individual responsibility, you might design reform based on a relatively unregulated market of private health plans.

If you believe that health care should be a right, you might design reform based on social solidarity with government guaranteeing that all of us receive the care that we need.

Proposals floated during political campaigns are rarely the final definitive proposals, especially with an issue as complex as our dysfunctional health care financing system. But it is important to understand the fundamental beliefs of those who we would elect to establish new policies addressing the problems that we face. A system that honors the right for everyone to obtain the health care that they need will look very different from a system that assigns the responsibility for obtaining health care to the individual.

What reform does business want?

Posted by on Tuesday, Oct 7, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Business Cool Toward McCain’s Health Coverage Plan

By Kevin Sack
The New York Times
October 6, 2008

American business, typically a reliable Republican cheerleader, is decidedly lukewarm about Senator John McCain’s proposal to overhaul the health care system by revamping the tax treatment of health benefits, officials with leading trade groups say.

The officials, with organizations like the U.S. Chamber of Commerce, the Business Roundtable and the National Federation of Independent Business, predicted in recent interviews that the McCain plan, which eliminates the exclusion of health benefits from income taxes, would accelerate the erosion of employer-sponsored health insurance and do little to reduce the number of uninsured from 45 million.

Officials with eight business trade groups contacted by The New York Times predicted the McCain plan would raise costs and force some employers to stop providing health benefits.

A recent survey of 187 corporate executives by the American Benefits Council and Miller & Chevalier, a consulting firm, found that three-fourths felt the repeal of the tax exclusion would have a “strong negative impact” on their workers. Only 4 percent said they would provide additional pay to fill any gaps.


Where does American business really stand on health care reform?

Employers remain very concerned about rising health care costs. Because of our failure to reform our health care financing system, employers have been responding by shifting more responsibility to their employees. There has been an increase in the use of high-deductible health plans, which slow the rate of premium increases for the employer, but makes health care less affordable for the employees by requiring greater out-of-pocket payments when health care is accessed. Many employers now have decided not to offer health plans; the rate of coverage through employer-sponsored plans has continued to decline, especially amongst small businesses.

The McCain proposal is designed to relieve employers of the responsibility of providing employer-sponsored plans, both by eliminating the tax benefit for the employees and by offering individuals tax credits for purchasing plans in the individual market. It is not only the Obama camp that recognizes the erosion of health coverage that this would cause, the business community recognizes it as well. Most American businessmen are concerned about the welfare of their employees. They really don’t want a solution that would have a “strong negative impact” on their employees.

So would business be more supportive of the Obama proposal? The most important component of his proposal is to offer a market of quality plans similar to those used by federal employees. But isn’t that what they have now? Isn’t that precisely why the business community is seeking relief? Even Barack Obama understands that these plans are too expensive, and many would still have to go without coverage.

The American business leadership certainly understands the single payer model. One of the most important principles for a successful business is to reduce waste, and that is precisely what the single payer model does, by design. Adopting a single payer system would allow us to cover everyone, and would allow us to finance it equitably through a single universal risk pool.

When we desperately need sound business principles to drive health care financing, it really seems silly to digress into a not-very-intellectual debate over free markets and the government, as if they were two distinct entities between which a choice had to be made. Nebulous debates lead to nebulous results (and is probably the reason why conservatives keep drawing us into that debate).

Some leaders in the business community must be ready to support sound business principles in revamping our highly flawed health care financing system. An intellectual debate over ideology might make for an interesting pastime, but first we have to get our dollars in order. Every businessman understands that.

Over 5,000 US physicians have signed an Open Letter calling on the Presidential candidates and Congress to “stand up for the health of the American people and implement a non-profit, single payer national health insurance system.” The letter is being circulated by Physicians for a National Health Program, a single-payer advocacy group. Excerpts from the appeal will be published in full-page advertisements in the Oct. 13th editions of The New Yorker and The Nation magazines.

What is radical is not the content of the letter. It reviews that the Republican strategy of using tax incentives to help people buy health insurance on the private market will leave more Americans without adequate insurance and the Democratic strategy of mandates and incremental expansion of public programs has repeatedly failed on the state level. It reminds our political leaders that a single payer health care reform could realize administrative savings of more than $300 billion annually – enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans.

What is radical is the fact that so many physicians, traditionally a conservative group, are coming out in public support of single payer health care. The strong physician support for this letter, with signers including some of the most prominent names in American medicine, reflects physicians’ growing realization that continued reliance on the private insurance industry is bad for both patients and doctors. The letter’s release follows a survey in the Annals of Internal Medicine this spring that shows 59 percent of U.S. physicians support national health insurance, a jump of 10 percentage points from five years ago.

Doctors are trained to make a diagnosis and prescribe the most effective treatment. This letter sends a strong message to our political leaders that the most effective treatment for what ails our health care system is single payer national health insurance.

Way off on health care reform

Posted by on Monday, Oct 6, 2008

You would think that John McCain would have gotten it right on his health care plan for the country, after his own experience with four malignant melanomas and multiple surgeries. You would think that experience would have inspired him to propose a plan that covers everyone, and do so affordably, both for the individual and for our country. You would think that health care would be a high priority for him, and that even if economics is not his strong suit, he would have done his homework.

McCain’s central idea for health care reform is his solution for every issue: let the markets determine the outcome, with unfettered competition as the driver. Ironically, he continues to tout this philosophy even as Wall Street crumbles around us, and financial companies look for bailouts from the government.

McCain would raise taxes for working people, by taxing their health insurance benefits. This would lead to younger healthy workers opting out of employer insurance, which would raise employer health insurance costs for the remaining workers, leading to more and more employers terminating coverage for their employees. Working individuals would be thrust into the private insurance market.

Navigating the private insurance market is not only daunting, but it can be dangerous for your health. Age and health status are factors the insurance companies look at to determine whether they will take the risk of insuring an individual, and they try to weed out anyone who is sick or likely to get sick. They want your premiums, but they don’t really want to pay out any money for health care. So workers who now have insurance in group plans through their employers will have to fend for themselves in the private market, and may not be able to get insurance.

McCain wants “to restore control over our health care system to the patients themselves,” and he thus proposes a tax credit of $2,500/ person for the purchase of health insurance. When cheaper policies cost $6,500/person and carry deductibles of $1,000, with co-payments every time you try to access benefits, $2,500 is a paltry sum if you actually have to use your insurance. This is health insurance in the private market: increasing costs for fewer benefits.

McCain also proposes decreasing the regulation of health insurance, allowing people to buy insurance from companies that don’t operate in their states. This would benefit only the insurance companies, who would be able to avoid state legislation requiring certain necessary health benefits, like mammograms. And doctors would have even more paperwork, more administrative costs, and more headaches than they do now, as they try to deal with even more insurance companies.

Health care costs would rise because of increased administrative costs for private insurance companies, as it is more expensive to underwrite policies for individuals than it is for groups. We already spend $350 billion in unnecessary administrative costs because of the private insurance industry.

Four economists reported their analysis of the McCain plan in the journal “Health Affairs,” concluding that it would radically transform the U.S health insurance landscape, with little impact on the number of the uninsured, while raising costs, reducing benefits, and leaving people with fewer consumer protections.

The problems with our health care system are extremely serious. Projected health care spending for 2008 is almost $2.4 trillion, which is close to $8,000 per person. This represents 16.6 percent of the gross domestic product in the United States. In spite of our spending on health care, which is twice that of any other industrialized country in the world, 46 million Americans remain uninsured. Many more are underinsured and have to pay so much in out-of pocket costs that they forego needed health care, even though they have health insurance.

According to a Commonwealth Fund study, there was a 60 percent increase in the number of the underinsured between 2003 and 2007. The underinsured tend to defer preventive care, choosing not to get mammograms or have their cholesterol checked. Underinsured adults with chronic conditions are not filling their prescriptions. Being underinsured affects personal health, as well as the cost of providing health care in our country, since not getting needed health care only means bigger health care bills down the road when the problems are more serious.

I agree with Senator McCain that it is time for a radical change in our health care system, and I agree that health insurance should be divorced from employment. But radical reform is useful only if it addresses the problems in our current health care system, and McCain’s plan does not do that.

A national single-payer health program, administered by the government rather than private insurance companies, would cover everyone, provide more comprehensive benefits, and do so without raising health care costs. With the $350 billion saved in administrative costs, everyone could have health insurance coverage. And national health insurance has a proven track record in other countries, where health care costs are lower and people live longer. Single-payer health care reform is the only meaningful reform, and is now supported by 15,000 members in Physicians for a National Health Program.

Medical causes of home mortgage foreclosures

Posted by on Monday, Oct 6, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures

By Christopher Tarver Robertson, Richard Egelhof, & Michael Hoke
Health Matrix
Vol. 18:65 2008

In recent years, there has been national alarm about the rising rate of home foreclosures, which now strike one in every 92 households in America, and which contribute to even broader macroeconomic effects.

These factors — loose lending, irresponsible borrowers, a flat real estate market, and rising interest rates — have together become the “standard account” of home foreclosure.

Policymakers and scholars may be surprised to learn that even in the midst of this spike, one of the largest causes of home foreclosures was none of the above. We studied homeowners going through foreclosure in four states and found that medical crises contribute to half of all home foreclosure filings. If these patterns hold nationwide, medical causes may put as many as 1.5 million Americans in jeopardy of losing their homes each year.

Half of all respondents (49%) indicated that their foreclosure was caused in part by a medical problem, including illness or injuries (32%), unmanageable medical bills (23%), lost work due to a medical problem (27%), or caring for sick family members (14%). We also examined objective indicia of medical disruptions in the previous two years, including those respondents paying more than $2,000 of medical bills out of pocket (37%), those losing two or more weeks of work because of injury or illness (30%), those currently disabled and unable to work (8%), and those who used their home equity to pay medical bills (13%). Altogether, we found that about 7 in 10 of our respondents either self-reported a medical cause of foreclosure, or experienced one of these indicia of medical disruptions in the years before foreclosure.

Altogether, these findings suggest that the standard account of mortgage foreclosure is missing a large portion of the story. Mortgage foreclosures are not just the results of bad loans, bad properties, or bad borrowers. Instead, many mortgage foreclosures are the result of unpredictable medical disruptions that impact both the incomes and the expenses of family finances.


The authors of this study indicate that the results are only preliminary, primarily due to limitations in methodology. Although we cannot quantify precisely the extent of the problem, the qualitative conclusion is certainly valid. Just as with personal bankruptcy, medical debt in both insured and uninsured individuals contributes to loss of homes through mortgage foreclosures.

This past month has demonstrated to all of us the importance, for our entire economy, of establishing policies that would ensure that default of home mortgages would be a relatively rare event. Eliminating medical debt certainly would not prevent all home loan defaults, but it would prevent a great many of them, even if we cannot yet precisely quantify how many.

Simply changing to a more efficient, single payer national health program would be one of the least expensive measures that we could undertake to help reduce home mortgage foreclosures.

Almost everyone would like to see measures that would reduce the negative impact of our financial crisis that was precipitated by mortgage-bcked securities. Some of us also would like to see that everyone has affordable access to health care, even if it is only an additional benefit of a financial rescue package.

The V.P. debate and the agenda for health reform

Posted by on Friday, Oct 3, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The Vice-Presidential Debate

October 2, 2008

Sarah Palin: (in her closing statement) It was Ronald Reagan who said that freedom is always just one generation away from extinction. We don’t pass it to our children in the bloodstream; we have to fight for it and protect it, and then hand it to them so that they shall do the same, or we’re going to find ourselves SPENDING OUR SUNSET YEARS TELLING OUR CHILDREN AND OUR CHILDREN’S CHILDREN ABOUT A TIME IN AMERICA, BACK IN THE DAY, WHEN MEN AND WOMEN WERE FREE.

Video and transcript:


Ronald Reagan Speaks Out Against Socialized Medicine LP recording, 1961, Woman’s Auxiliary of the AMA

Ronald Reagan: Write those letters now. Call your friends, and tell them to write them. If you don’t, this program (King-Anderson version of Medicare) I promise you will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade every area of freedom as we have known it in this country, until, one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don’t do this, and if I don’t do it, one of these days, you and I are going to SPEND OUR SUNSET YEARS TELLING OUR CHILDREN, AND OUR CHILDREN’S CHILDREN, WHAT IT WAS ONCE LIKE IN AMERICA WHEN MEN WERE FREE.

WHAM campaign (Women Help American Medicine):

mp3 audio of “Ronald Reagan Speaks Out Against Socialized Medicine”

If you really care about the future of our health care system, you should give some thought to the motivation of the McCain/Palin camp in selecting this closing statement for her debate.

Obama and Biden support a greater government role in ensuring that more individuals have affordable health care and health care coverage. McCain and Palin support freedom and individual responsibility in accessing health care and health care coverage. If you need health care, well designed public policies can work for all of us, but private policies can work only for those with the financial means to obtain adequate coverage.

For her closing statement, the McCain/Palin advisors selected the most notorious attack on a government role in health care, deceptively cloaked in the rhetoric of freedom. That should tell you something.

Commonwealth Fund on candidates' proposals

Posted by on Thursday, Oct 2, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The 2008 Presidential Candidates’ Health Reform Proposals: Choices for America

By Sara R. Collins, Jennifer L. Nicholson, Sheila D. Rustgi, and Karen Davis
The Commonwealth Fund
October 2008

The presidential candidates’ health care reform proposals offer fundamentally different visions of the future of health insurance in the United States. Both candidates propose reforms in which the health system would continue to be structured around private insurance markets, with a supporting role played by public insurance programs. But their plans diverge significantly on the way a reformed system should operate.

McCain would change the tax code to encourage people to buy coverage through the individual insurance market and effectively loosen state rules governing the sale of insurance by allowing people to buy policies across state lines. Obama would encourage the continuing participation of employers in the health insurance system, expand eligibility for Medicaid and the State Children’s Health Insurance Program (SCHIP), and create a new insurance market “exchange” — with consumer protections, choice of public and private health plans, and income-based premium subsidies — that would largely replace the individual market.

According to one estimate… in 10 years McCain’s proposal would reduce the number of people who are uninsured by 2 million out of a projected 67 million. Obama’s plan would reduce the number of uninsured people by 34 million in 10 years.

Executive Summary:

Full Report:

So these are the “choices for America.” We currently have 46 million people who are uninsured. After ten years of McCain’s plan, we would have 65 million uninsured, but ten years of Obama’s plan would leave only 33 million people without insurance. Only 33 million!?

The phrase, “both candidates propose reforms in which the health system would continue to be structured around private insurance markets,” should set off deafening alarm bells and sirens. Schemes designed around U.S.-style private insurance markets can never achieve our goal of affordable health care for everyone.

Some say that we could do it if we required everyone to participate through individual and employer mandates. With an average family policy now priced at $12,600, not including deductibles and copayments, it is unrealistic to require individuals and small businesses to purchase coverage and health care with money that they do not have. Even Sen. McCain understands that the government is going to have to ante up, but that alone is still not enough since his proposal would leave 65 million uninsured.

With a national health expenditure of $2.4 trillion, we already have enough to fund a universal risk pool that would pay for all necessary services for absolutely everyone, but only if we were to do it through a single payer national health program. If we were to attempt it using private plans that were truly effective in preventing financial hardship, and that had government subsidies that would make the premiums affordable, the inefficiencies would add close to half a trillion dollars to our national health care bill, and too many individuals would still fall through the cracks.

So what about choices for America? Which candidate? Or which health reform proposal?

In a September 30 interview with the Des Moines Register editorial board, Sen. McCain provides us with some insight to these choices: “I’ve always been a free enterprise person who thinks that families make the best choices for themselves and their future. That’s a dramatically different philosophy than my Democrat friends, in my view, who think that government is the answer. Sen. Obama wants to create a huge health care bureaucracy for America.”

Sen. Obama has said that, if starting from scratch, we would create a single payer system. That’s the health reform proposal that Americans should choose if we’re really serious about including absolutely everyone in an affordable program. And which candidate do you think would approve this message?

Video of Sen. McCain’s Des Moines Register interview:

Gov. Schwarzenegger again vetoes single payer bill

Posted by on Wednesday, Oct 1, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Schwarzenegger vetoes universal health care

By Aurelio Rojas
The Sacramento Bee
September 30, 2008

For the second time in three years, Gov. Arnold Schwarzenegger on Tuesday vetoed legislation that would have established a government-run universal health care system.

Senate Bill 840 by Sen. Sheila Kuehl, D-Santa Monica, would have set up a single-payer system in which the state would assume the role that private insurance companies now play.




By Anthony Wright
Health Access Weblog
October 1, 2008

Some of the bills vetoed:

SB 840 (Kuehl) SINGLE PAYER: Would establish a process to create a single-payer health care system in California that would enable all residents to have health coverage.

SB 973 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices.

SB 1440 (Kuehl) CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio — requiring every insurer to spend at least 85 percent of premiums on patient care.

AB 2 (Dymally) HIGH-RISK POOL: Would have reformed the Managed Risk Medical Insurance Program (MRMIP), which provides coverage for “un-insureables” who have “pre-existing conditions.” Efforts would make the high risk pool more affordable and available and eliminate the annual $75,000 cap on benefits.

AB 1945 (De La Torre) INDEPENDENT REVIEW: Would establish an independent review process if an insurer wants to rescind coverage, and raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history.

AB 1887 (Beall) MENTAL HEALTH PARITY: Would require health plans to provide coverage for all diagnosable mental illnesses.

AB 1962 (De La Torre) MATERNITY COVERAGE: Would require all individual insurance policies to cover maternity services.


This was Gov. Schwarzenegger’s year for comprehensive healthcare reform in California. By the end of this year all Californians were going to have affordable health care.

He previously vetoed Sen. Kuehl’s single payer legislation, dismissing it as socialized medicine. He then embarked on a “post partisan” process of bringing all stakeholders together to create a comprehensive model of reform with “shared responsibility.” The extensive negotiations resulted in a legislative product that neither the Republicans not the Democrats could support, and it died in committee.

Many legislators then wanted to separate out some of the beneficial features of the package and introduce them as individual bills. Gov. Schwarzenegger had said that the delicate compromises necessitated by the political process required that the legislators accept either the entire package or none of it. He stated that he would veto individual measures because they served some interests and not others. He has proven that, in this matter at least, he is a man of his word.

He was given a second opportunity to approve a plan that would accomplish his stated goal: affordable health care for everyone. He once again vetoed Sheila Kuehl’s single payer bill, placing his personal ideology above the health of the people.

He did sign a bill requiring restaurant chains to post the number of calories of food items on their menus. Not much for the Year of Health Reform.

Fraser: Canadian patients worse off than uninsured Americans

Posted by on Tuesday, Sep 30, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The Hidden Costs of Single Payer Health Insurance

A Comparison of the United States and Canada

by Brett Skinner, Mark Rovere, and Marisha Warrington
Fraser Institute
September 2008

In practical terms, Canadian patients are unable to buy quicker access or better care than what the government health insurance program provides. In this sense, Canadian patients on waiting lists are worse off than uninsured Americans who may legally use their own money or credit to buy health care if they lack insurance coverage.

The Canadian single-payer system is an example of what not to do in health care. The fact is that single-payer systems are probably the worst way to achieve universal health insurance coverage. If Canada is currently witnessing the failure of its own single-payer health insurance system, why would Americans want to adopt such a system for themselves?

Nevertheless, the problem of the uninsured needs to be solved before a “tipping point” is reached and Americans have a Canadian-style health policy disaster foisted upon them by single-payer advocates who are not fully disclosing all the facts about health care in Canada.

The evidence indicates that the best approach to achieving universal health insurance coverage is to make people prioritize their own income toward the purchase of their own health insurance, not to make some taxpayers buy health insurance for everyone through a redistributive, government health insurance monopoly.


This report will be used by the opponents of single payer health reform in the United States. You should be aware of it so that you can dismiss it as a resource lacking credibility.

The Fraser Institute supports “a free and prosperous world through choice, markets and responsibility.” The quote from their report leaves no doubt as to their ideological preferences for relying on individual responsibility, and rejecting government health insurance.

This report itself is typical of the Fraser Institute in that it presents a very dishonest case in support of their ideology (while accusing U.S. single payer advocates of not fully disclosing all the facts about health care in Canada, a blatantly untrue assertion). Although the report is rife with distortions and untruths, only one example will be discussed here since the compromise in methodology is representative of the others.

The U.S. Census Bureau reported that the uninsured rate of the U.S. population was 15.8 percent in 2006. The Fraser Institute adjusted the number down to 7.9 percent by excluding those who could have been insured, even though they weren’t. (Those who were uninsured for part of the year were also excluded from the Census Bureau numbers; thus the numbers, just as easily, could have been adjusted upwards to represent the total uninsured for all or part of the year.)

Although 100 percent of Canadians are insured, they classified 6.0 percent as “effectively uninsured” because they were unable to establish a relationship with a primary care physician (a problem that we also have in the United States, though no adjustment was made for that).

Thus they conclude, “Based on these figures, the estimated percentage of the population that was ‘effectively’ uninsured for non-emergency, necessary medical services at any given time during 2007 was roughly the same in both countries: 7.9% in the United States, versus 6.0% in Canada.”

Zero percent uninsured in Canada is the same “effectively uninsured” rate as 15.8 percent uninsured in the United States!? In full self-confidence, you can tell the single payer opponents that they can take their Fraser report and… (censored).

Additional comment from a reader: I believe the important thing to keep your eye on in this discussion is OUTCOMES. At the end of the day, this is the measure of whether our system is succeeding or failing. As we found in our research for the American Human Development Report, with $3,326 per person per year, Canada is buying an average of 2.5 additional years of life for their citizens, as compared with our annual expenditure per person of $6,401 on healthcare– nearly double! Canadian life expectancy at birth is 80.4 years, ours is 77.9. Again, looking at other important measures of bang for the buck, Canada has lower infant and child mortality rates than the U.S., far lower rates of low birth weight babies and more. A focus on outcomes seems to be me to be the way to cut through the ideologically-charged discussion of “nanny government” and socialized medicine. I’m attaching a nice editorial board piece that just came out in the Seattle Post-Intelligencer using this argument: http://seattlepi.nwsource.com/opinion/380652_healthed.html.

Thx for excellent work following the news and research on this critical issue,

Sarah Burd-Sharps, Co-Director
American Human Development Project

About this blog

Physicians for a National Health Program's blog serves to facilitate communication among physicians and the public. The views presented on this blog are those of the individual authors and do not necessarily represent the views of PNHP.

News from activists

PNHP Chapters and Activists are invited to post news of their recent speaking engagements, events, Congressional visits and other activities on PNHP’s blog in the “News from Activists” section.