Rationing under U.S. Medicare and Canadian Medicare
The Waiting Game
By Paul Krugman
The New York Times
July 16, 2007
…it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.
That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.
http://select.nytimes.com/2007/07/16/opinion/16krugman.html
Comment:
By Don McCanne, MD
Paul Krugman’s comments apply not only to hip replacement, but also to other queue problems reported in Canada, such as cataract surgery, cancer therapy, and non-urgent cardiac surgery. In the United States, these services are provided predominantly under Medicare, our public insurance program.
Excessive queues are eliminated by making minor, selective adjustments in the capacity of the system, and by simple queue management techniques. Compared to the global costs of establishing and maintaining a health care system, the costs of these adjustments are negligible.
Responsible stewards of any health care system, whether public or private, will make these appropriate adjustments. The difference is that the public system would be adapted to accommodate everyone, whereas private systems accommodate only those with the ability to pay.
All systems ration care. Excessive rationing due to limited capacity is very easily remedied, as has been demonstrated in many nations with publicly-financed health care systems. Rationing by ability to pay, in contrast, results in suffering and death.
It’s time for the United States to include everyone in our health care system. We can deal with the queue problem by monitoring the system and making minor adjustments as appropriate. That shouldn’t require any more effort than we already expend on monitoring financial hardship and impaired health outcomes, including death, due to our highly flawed system of financing health care.