PNHP

Fraser: Canadian patients worse off than uninsured Americans

Fraser: Canadian patients worse off than uninsured Americans

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.
http://am.eri.ca/researchandpublications/publications/6216.aspx

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

Fraser: Canadian patients worse off than uninsured Americans

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.

http://am.eri.ca/researchandpublications/publications/6216.aspx

Comment:

By Don McCanne, MD

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

Thinking big on health

Editorial
Bangor Daily News
Sept. 24, 2008

Maine’s former Sen. George Mitchell, who led a recent conference in Portland, is one of many who are pressing for a bipartisan solution to the nation’s mounting health care crisis. The time for action should come under a new Congress and a new president.

The meeting was the third of four regional forums organized by Sen. Mitchell and three other former senate majority leaders (Republicans Howard Baker of Tennessee and Bob Dole of Kansas and Democrat Tom Daschle of South Dakota). The group plans to present a consensus proposal early next year.

A similar effort is headed by Sen. Edward M. Kennedy, chairman of the Committee on Health, Education, Labor and Pensions, with emphasis on the need for a universal health care system. While fighting an aggressive brain tumor, he has directed his aides to hold meetings to build bipartisan support for a major initiative.

Still another proposal in the works is a universal health care plan put forward by Sens. Ron Wyden, D-Oregon, and Robert Bennett, R-Utah. Their Healthy Americans Act would replace the current employer-based system with government oversight and subsidies of private health care plans that individuals select. It would guarantee coverage as good as that which federal employees receive. Funding would come from a tax of from 3 percent to 26 percent on employers. The Congressional Budget Office and the Joint Committee on Taxation say that the plan could take full effect in 2014, would break even the first year and create budget surpluses in successive years.

A doctors’ organization, Physicians for a National Health Program, has been pressing for single-payer national health insurance. It points out that the United States now spends twice as much as other industrialized nations on health care, while Americans lag in life expectancy and infant mortality rates and 47 million lack health coverage. It argues that 31 percent of the nation’s health care cost now goes into the private insurance bureaucracy and paper-work and that a single-payer plan would save more than $350 billion a year.

These and other proposals may seem like a hodgepodge of competing ideas, but the time has come for agreement and creation of a new system that will serve efficiently the health needs of all Americans. It should be universal, ending the expensive resort to emergency rooms by the uninsured and under-insured. It should break the connection between health benefits and employment, which came about by accident in World War II, when benefits were a way to avoid government caps on pay raises. It should draw on the experience of other countries.

Sen. Mitchell wisely acknowledged the divisive influence of entrenched pressure groups and conflicting political philosophies. But a fresh look at the crisis could sweep aside those problems and reach a national agreement. The cost, the uncertainty, the shortcomings of the present system are too much to bear. And that’s not to mention the burden of paperwork on doctors, clinics, hospitals and consumers.

http://www.bangornews.com/detail/51357.html

America Needs A New New Deal

By KATRINA VANDEN HEUVEL and ERIC SCHLOSSER
Wall Street Journal
SEPTEMBER 27, 2008

The Bush administration has proposed the most expensive government spending plan in American history, allocating as much as $700 billion to a Wall Street bailout. The proposal was attacked by members of both parties, who immediately began negotiations to find an alternative. The Bush plan was not only a political blunder; it was also a complete repudiation of the administration’s own economic policies. It could not be justified by any of the core beliefs governing free enterprise and the free market.

As with the decision to invade Iraq, the administration sought to commit the federal government to massive spending without a clear exit strategy. Most important, it drew upon the New Deal’s legacy of government intervention in the marketplace — without any of the New Deal’s fundamental concern for the well-being of ordinary Americans.

This year happens to be the 75th anniversary of the New Deal, a revolution in governmental philosophy that began with the Emergency Banking Act of 1933. That first piece of New Deal legislation was a hurried response to the worst banking crisis in U.S. history — until now.

President Franklin Delano Roosevelt outlined the problem clearly in his first fireside chat, a week after taking office. “We had a bad banking situation,” Roosevelt said. “Some of our bankers had shown themselves either incompetent or dishonest in the handling of people’s funds. They had used the money entrusted to them in speculations and unwise loans . . . It was the government’s job to straighten out this situation and do it as quickly as possible.”

President Roosevelt’s banking plan ended the panic. But it did much more than that. In Roosevelt’s words, it “reorganized, simplified, and made more fair and just our monetary system.”

Compare those aims and that achievement with what the Bush administration proposed. Having championed the free market, small government and deregulation for years, the administration asked taxpayers to assume the costs of Wall Street’s poor investments — while allowing Wall Street to hold on to the good ones.

The size and scale of the Bush administration’s proposal are mind-boggling. During the New Deal, the Roosevelt administration spent about $250 billion (in today’s dollars) on public-works projects, building about 8,000 parks, 40,000 public buildings, 72,000 schools and 80,000 bridges. The entire cost of all the New Deal programs (in today’s dollars) was about $500 billion. The secretary of the Treasury now wants to spend perhaps twice that amount, simply to prevent a financial collapse.

Of course, something must be done — and quickly. “Government intervention is not only warranted,” President George W. Bush said last week. “It is essential.” With those nine words, he contradicted the governing philosophy of the Republican Party for the past 30 years.

According to President Roosevelt, the New Deal had three fundamental aims: relief, reform and reconstruction. On Wednesday night, President Bush described his far more expensive but far less inclusive spending plan as merely a “rescue effort.” Mr. Bush’s proposal — to hand over $700 billion to Wall Street banks without any Congressional oversight, without any means to prevent conflicts of interest, or without any measures to help ordinary Americans — was disgraceful.

What we really need is a new New Deal: a systematic approach to the financial and economic problems of the U.S.

Firstly, we need relief for ordinary Americans. At the moment, four million households are behind on their mortgage payments and facing foreclosure. Some estimates suggest that an additional two million may face eviction next year.

On Wednesday in this newspaper, Sen. Hillary Clinton called for a revival of the Home Owner’s Loan Corporation (HOLC). Organized in the early months of the New Deal, the HOLC avoided widespread foreclosures by purchasing troubled mortgages from banks and then reissuing them with more favorable terms. It proved a tremendous success — for homeowners, taxpayers and banks.

A new HOLC should be created immediately, and with the power to keep people in their homes.

As winter approaches, millions of families will need help keeping those homes warm. During the past year, the cost of heating oil has increased about 30%. Meanwhile, the Bush administration is now trying to cut funding for the Low Income Energy Assistance Program. Instead of cutting, the federal government should more than double the current budget of $2.6 billion. That is awfully small change on Wall Street these days.

Second, we need reform. In recent years, one federal regulatory agency after another has been handed over to the industries they were created to regulate. It should come as no surprise that during the Bush administration the U. S. has witnessed the largest recall of contaminated beef in its history, thousands of deaths from unsafe prescription drugs, and one of our worst financial meltdowns.

Advocates of the free market must confront the fact that both the Great Depression and the current financial chaos were preceded by years of laissez-faire economic policies. Strictly enforced regulations not only protect consumers, they protect companies that behave ethically from those that don’t. The sale of tainted baby food in China demonstrates, once again, that when industries are allowed to police themselves, there’s absolutely no limit on what they’ll do for money.

Third, we need reconstruction, not only of America’s physical infrastructure, but also of its society. Today close to 50 million Americans lack health insurance. About 40% of the nation’s adult population is facing medical debts, or having difficulty paying medical bills. A universal health-care system would help American families, while cutting the nation’s long-term health-care costs. And a large-scale federal investment in renewable energy and public-works projects would build the foundation for a strong 21st century economy.

Contrary to the myth of the free market, direct government intervention has played a central role throughout American economic history, subsidizing the growth of the railroad, automobile, aerospace and computer industries, among others. It will take well-planned government investment to break our dependence on foreign oil and create millions of new Green jobs.

The events of the past month have proven, beyond any doubt, that the federal government must actively address America’s great social and economic problems. That necessity was recognized by Franklin Delano Roosevelt during the 1930s — and by his cousin, President Theodore Roosevelt, a generation earlier.

The opposing view, promoted by President Bush until recently, is now as bankrupt as one of our leading investment banks. A Wall Street bailout plan that relies upon the mechanisms of the New Deal, while betraying its underlying spirit, should be rejected. Federal relief should not be aimed at the top and somehow expected to trickle-down.

A new New Deal wouldn’t require another alphabet soup of federal agencies, micromanaging every aspect of the economy. It would simply ensure that federal spending is driven by the needs of every American. Anything less than this — any proposal that rewards those who created the problem and penalizes those who can least afford it — is a raw deal.

Ms. vanden Heuvel is editor of the Nation. Mr. Schlosser is author of “Fast Food Nation” (Harper Perennial, 2002).

Germany's lessons for H. Aaron and his cautious approach

Healthy Choice

By Henry Aaron
The New Republic
September 29, 2008
A lot of Democrats want universal health care to be the next president’s top priority. But it shouldn’t be.
The ‘Big Bang’ Approach to Health Reform is the Wrong Strategy.
Congress is unlikely to change how the entire U.S. health care industry operates with one bill. And if it did so, it would probably make a hash of the job. Differences among the states in the cost and style of delivery of health care approximate those of the European Union. More importantly, apart from periods after major wars or depression, democracies typically make large social and economic changes gradually, through laws enacted successively over many years.
So, rather than ‘betting the administration’ on one shot, the sensible strategy would be to enunciate a broad vision for reform and propose practical steps to move in the envisioned direction. Get them through Congress, see what works and what doesn’t, and then move forward again.
http://www.tnr.com:80/politics/story.html?id=208db068-4a74-4083-b14c-79e8b21b97ae

And…

Health Care Financing Reforms in Germany: The Case for Rethinking the Evolutionary Approach to Reforms

By Percivil M. Carrera, Karen K. Siemens and John Bridges
Journal of Health Politics, Policy and Law
October 2008
Abstract (excerpt)
In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI (social health insurance) systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.
Concluding Remarks (excerpt)
An appraisal of health care financing reforms in Germany since reunification offers three lessons. First, while evolutionary reforms may be more politically feasible than radical reforms, evolutionary reforms are inadequate in addressing the issue of the sustainability of health care financing. Second, the impact of evolutionary reforms can be substantial when they extend and build on and not contradict or undermine previous measures. Finally, the biggest challenge to health care financing reform is the aversion to take the revolutionary route.
http://jhppl.dukejournals.org/cgi/content/abstract/33/5/979?etoc

The logic of Henry Aaron and other incrementalists seems to be as follows: Comprehensive reform of health care financing is not feasible because, if it were, we would have it by now; therefore we should abandon any thoughts of a single comprehensive reform package and move forward with tinkering around with various steps to see “what works and what doesn’t.” Of course, the discontinuity of this framing belies the alleged logic.
Aaron suggests that history shows us that only “major wars or depression” motivate democracies to make “large social and economic changes.” Is our current war too small, with too few U.S. casualties? Is our current recession too shallow, with too few unemployed and bankrupt? Is the home foreclosure rate too low, and the meltdown of the financial services industries too limited? Perhaps, perhaps.
If these don’t concern us enough, then what about the sputtering of the engine of the great American Dream? You know, that Dream that everyone could have a home, educational opportunities, healthy food, transportation, retirement security, and… health care. That engine has been redesigned to produce wealth transfer – a transfer of wealth from the masses who have increased our nation’s productivity, to the few who commandeered the machinery of Wall Street. Isn’t the sunsetting of the American Dream a crisis of proportions that finally would make us demand action?
If we are going to make our economy work for everyone, we are going to have to have to take “the revolutionary route” to health care financing reform. If we don’t fix our health care financing system, we will continue to see further erosion of the other elements of the American dream.
We do know how to do it, but first we are going to have to send Henry Aaron and his ilk off to their policy laboratories to tinker with their evolutionary reforms that never get us there. We can’t allow them to stand in our way any longer.
We need to throw out the current health care financing system and replace it with a system that would pay for all necessary health care services for everyone: a single payer national health program.
As Katrina vanden Heuvel and Eric Schlosser stated in today’s Wall Street Journal, “A universal health care system would help American families, while cutting the nation’s long-term health care costs… A new New Deal… would simply ensure that federal spending is driven by the needs of every American. Anything less than this — any proposal that rewards those who created the problem and penalizes those who can least afford it — is a raw deal.”
America Needs A New New Deal
http://online.wsj.com/article/SB122246953790280655.html

Germany's lessons for H. Aaron and his cautious approach

Healthy Choice

By Henry Aaron
The New Republic
September 29, 2008

A lot of Democrats want universal health care to be the next president’s top priority. But it shouldn’t be.

The ‘Big Bang’ Approach to Health Reform is the Wrong Strategy.

Congress is unlikely to change how the entire U.S. health care industry operates with one bill. And if it did so, it would probably make a hash of the job. Differences among the states in the cost and style of delivery of health care approximate those of the European Union. More importantly, apart from periods after major wars or depression, democracies typically make large social and economic changes gradually, through laws enacted successively over many years.

So, rather than ‘betting the administration’ on one shot, the sensible strategy would be to enunciate a broad vision for reform and propose practical steps to move in the envisioned direction. Get them through Congress, see what works and what doesn’t, and then move forward again.

http://www.tnr.com:80/politics/story.html?id=208db068-4a74-4083-b14c-79e8b21b97ae

And…

Health Care Financing Reforms in Germany: The Case for Rethinking the Evolutionary Approach to Reforms

By Percivil M. Carrera, Karen K. Siemens and John Bridges
Journal of Health Politics, Policy and Law
October 2008

Abstract (excerpt)

In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI (social health insurance) systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.

Concluding Remarks (excerpt)

An appraisal of health care financing reforms in Germany since reunification offers three lessons. First, while evolutionary reforms may be more politically feasible than radical reforms, evolutionary reforms are inadequate in addressing the issue of the sustainability of health care financing. Second, the impact of evolutionary reforms can be substantial when they extend and build on and not contradict or undermine previous measures. Finally, the biggest challenge to health care financing reform is the aversion to take the revolutionary route.

http://jhppl.dukejournals.org/cgi/content/abstract/33/5/979?etoc

Comment:

By Don McCanne, MD

The logic of Henry Aaron and other incrementalists seems to be as follows: Comprehensive reform of health care financing is not feasible because, if it were, we would have it by now; therefore we should abandon any thoughts of a single comprehensive reform package and move forward with tinkering around with various steps to see “what works and what doesn’t.” Of course, the discontinuity of this framing belies the alleged logic.

Aaron suggests that history shows us that only “major wars or depression” motivate democracies to make “large social and economic changes.” Is our current war too small, with too few U.S. casualties? Is our current recession too shallow, with too few unemployed and bankrupt? Is the home foreclosure rate too low, and the meltdown of the financial services industries too limited? Perhaps, perhaps.

If these don’t concern us enough, then what about the sputtering of the engine of the great American Dream? You know, that Dream that everyone could have a home, educational opportunities, healthy food, transportation, retirement security, and… health care. That engine has been redesigned to produce wealth transfer – a transfer of wealth from the masses who have increased our nation’s productivity, to the few who commandeered the machinery of Wall Street. Isn’t the sunsetting of the American Dream a crisis of proportions that finally would make us demand action?

If we are going to make our economy work for everyone, we are going to have to have to take “the revolutionary route” to health care financing reform. If we don’t fix our health care financing system, we will continue to see further erosion of the other elements of the American dream.

We do know how to do it, but first we are going to have to send Henry Aaron and his ilk off to their policy laboratories to tinker with their evolutionary reforms that never get us there. We can’t allow them to stand in our way any longer.

We need to throw out the current health care financing system and replace it with a system that would pay for all necessary health care services for everyone: a single payer national health program.

As Katrina vanden Heuvel and Eric Schlosser stated in today’s Wall Street Journal, “A universal health care system would help American families, while cutting the nation’s long-term health care costs… A new New Deal… would simply ensure that federal spending is driven by the needs of every American. Anything less than this — any proposal that rewards those who created the problem and penalizes those who can least afford it — is a raw deal.”

America Needs A New New Deal
http://online.wsj.com/article/SB122246953790280655.html

A healthy perspective

Just home from the States, Julie Mason is reminded of how good we have it

By Julie Mason
The Ottawa Citizen
Published: Sunday, September 21, 2008

Every year, after a few weeks of sun and sand at a quaint little beach village south of the border, we contemplate moving to the United States. (This was before the possibility of a gun-toting hockey mom standing only a 71-year-old’s heartbeat away from the presidency.) We imagine an end to eight-foot snow banks, winters that last from October to May, and discussions of national unity.

Then, as always, we have The Conversation.

This time it was over dinner with friends. One is a retired nurse, age 59, who could be a role model for active living and nutritious eating. Slim, fit and healthy, she planned her retirement budget to allow for comfortable living and travel. Then she and her husband moved to California where she suddenly became one of the nation’s millions of “uninsurables.”

The disease that leaves her unable to get health insurance isn’t cancer, heart disease, diabetes or osteoporosis — she has migraines. As a result, no insurer in the state will sell her private health insurance. If she was working, she could get insurance through her employer, but retired and not yet at the Medicare-eligible age, she falls between the cracks.

Luckily for her, California is one of the states that created a backup for patients who have been denied insurance. In a state of 36 million people, only 7,100 Californians can enroll in this “high-risk pool” — there’s a waiting list — and they can stay in the plan for only three years. There’s an annual limit to how much the plan will pay, and many states have a lifetime cap. For this, enrollees pay premiums that can be twice the cost of those paid by other folks. Her insurance costs $12,000 a year.

Our other dinner companion is a successful artist, married to another artist and mom to a nine-year-old boy. They all have normal good health. As self-employed artists, they must buy their own health insurance. While no dollar figure was discussed, she said her monthly premium is more than rent on her small apartment in Manhattan.

They tell us about other friends and relations. One family has a child born with a serious condition requiring extensive surgery and life-long monitoring — the employer’s insurance paid the first seven-figure medical bill; but dad had to change jobs and the new insurance plan is much more restrictive. Now the family worries as much about their ability to pay as they do about their child’s health. Another family lost their longtime pediatrician when the breadwinner changed jobs — going from one plan to a more restrictive managed-care plan that tells them which doctors they must use.

And these are the people who have insurance. Another 47 million aren’t covered at all.

It’s the fundamental American problem: how to make sure you can get and keep affordable insurance that will cover you and your family.

It’s hard for Canadians to imagine the choices Americans must make to ensure health care. Can I take this more interesting job or will I lose coverage? Will I be able to send the kids to camp if my premiums go up? What if my illness isn’t coverage later? What if I get sick while I’m waiting to get insurance?

It’s just as hard for Americans to get it that ordinary Canadians like our health care system.

A few months ago, I was called by a newspaper reporter in St. Petersburg, Florida, doing a story on Canada’s “socialized medicine.” She’d heard I’d spent lots of time with hospitals and doctors. She seemed incredulous when I said my out-of-pocket medical costs for two years of cancer treatments — surgery, chemo and radiation — had been a few hundred dollars for drugs to treat nausea.

She wouldn’t believe me. In her article, she insisted I was one of a few Canadians who like our health care system, and that my experience was “not typical.”

Polls consistently show our health care system is one of the things Canadians value most about our country. With all its warts and flaws, our universally accessible system is as fundamental to defining who we are as a people as the Maple Leaf and beavers.

No system is without problems, and we must identify them to fix them. But it’s easy to forget we have created a health care system that, with all its frustrations, lets each and every one of us get quality care. We can and should work to improve it, but we should never turn our back on its astonishing benefits.

(c) The Ottawa Citizen 2008

Germany’s lessons for H. Aaron and his cautious approach

Healthy Choice

By Henry Aaron
The New Republic
September 29, 2008

A lot of Democrats want universal health care to be the next president’s top priority. But it shouldn’t be.

The ‘Big Bang’ Approach to Health Reform is the Wrong Strategy.

Congress is unlikely to change how the entire U.S. health care industry operates with one bill. And if it did so, it would probably make a hash of the job. Differences among the states in the cost and style of delivery of health care approximate those of the European Union. More importantly, apart from periods after major wars or depression, democracies typically make large social and economic changes gradually, through laws enacted successively over many years.

So, rather than ‘betting the administration’ on one shot, the sensible strategy would be to enunciate a broad vision for reform and propose practical steps to move in the envisioned direction. Get them through Congress, see what works and what doesn’t, and then move forward again.

http://www.tnr.com:80/politics/story.html?id=208db068-4a74-4083-b14c-79e8b21b97ae

And…

Health Care Financing Reforms in Germany: The Case for Rethinking the Evolutionary Approach to Reforms

By Percivil M. Carrera, Karen K. Siemens and John Bridges
Journal of Health Politics, Policy and Law
October 2008

Abstract (excerpt)

In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI (social health insurance) systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.

Concluding Remarks (excerpt)

An appraisal of health care financing reforms in Germany since reunification offers three lessons. First, while evolutionary reforms may be more politically feasible than radical reforms, evolutionary reforms are inadequate in addressing the issue of the sustainability of health care financing. Second, the impact of evolutionary reforms can be substantial when they extend and build on and not contradict or undermine previous measures. Finally, the biggest challenge to health care financing reform is the aversion to take the revolutionary route.

http://jhppl.dukejournals.org/cgi/content/abstract/33/5/979?etoc

Comment:

By Don McCanne, MD

The logic of Henry Aaron and other incrementalists seems to be as follows: Comprehensive reform of health care financing is not feasible because, if it were, we would have it by now; therefore we should abandon any thoughts of a single comprehensive reform package and move forward with tinkering around with various steps to see “what works and what doesn’t.” Of course, the discontinuity of this framing belies the alleged logic.

Aaron suggests that history shows us that only “major wars or depression” motivate democracies to make “large social and economic changes.” Is our current war too small, with too few U.S. casualties? Is our current recession too shallow, with too few unemployed and bankrupt? Is the home foreclosure rate too low, and the meltdown of the financial services industries too limited? Perhaps, perhaps.

If these don’t concern us enough, then what about the sputtering of the engine of the great American Dream? You know, that Dream that everyone could have a home, educational opportunities, healthy food, transportation, retirement security, and… health care. That engine has been redesigned to produce wealth transfer – a transfer of wealth from the masses who have increased our nation’s productivity, to the few who commandeered the machinery of Wall Street. Isn’t the sunsetting of the American Dream a crisis of proportions that finally would make us demand action?

If we are going to make our economy work for everyone, we are going to have to have to take “the revolutionary route” to health care financing reform. If we don’t fix our health care financing system, we will continue to see further erosion of the other elements of the American dream.

We do know how to do it, but first we are going to have to send Henry Aaron and his ilk off to their policy laboratories to tinker with their evolutionary reforms that never get us there. We can’t allow them to stand in our way any longer.

We need to throw out the current health care financing system and replace it with a system that would pay for all necessary health care services for everyone: a single payer national health program.

As Katrina vanden Heuvel and Eric Schlosser stated in today’s Wall Street Journal, “A universal health care system would help American families, while cutting the nation’s long-term health care costs… A new New Deal… would simply ensure that federal spending is driven by the needs of every American. Anything less than this — any proposal that rewards those who created the problem and penalizes those who can least afford it — is a raw deal.”

America Needs A New New Deal
http://online.wsj.com/article/SB122246953790280655.html

FEHBP basic premium up 13 percent

Health Insurance Costs to Spike an Average 8 Percent

By Joe Davidson
The Washington Post
September 26, 2008
Health insurance premiums for federal employees will jump almost 8 percent… the Office of Personnel Management announced yesterday.
Premiums for most workers, however, will climb even more next year — about 13 percent — which is the increase for enrollees in the Blue Cross and Blue Shield plans. Sixty percent of federal workers are enrolled in one of the Blue Cross and Blue Shield plans.
Colleen M. Kelley, president of the National Treasury Employees Union, was not impressed. “It is very discouraging to see average increases of this magnitude,” she said, “particularly given the bargaining power OPM should be able to exercise as manager of the nation’s largest group health plan.”
http://www.washingtonpost.com/wp-dyn/content/article/2008/09/25/AR2008092502677.html?hpid=sec-business

So you want the health insurance program that the members of Congress have? This is it: the Federal Employees Health Benefits Program (FEHBP). This is the plan that several politicians have supported as an option to purchase in place of your current coverage, if you should no longer want to keep that.
Prior studies have questioned whether FEHBP is an appropriate option for moderate income individuals. The employees’ portion of the premiums plus the out-of-pocket cost sharing is not affordable for them should they have significant health care needs. In fact 100,000 federal employees eligible for FEHBP are not covered by the program, many because they cannot afford their portion of the premiums.
The politicians frequently discuss guaranteeing basic coverage, “without the bells and whistles,” and refer to the FEHBP Blue Cross/Blue Shield plans as a model. The premiums for this basic coverage will increase 13 percent for 2009. 13 percent!
The Office of Personnel Management, the largest purchaser of health benefits in the nation, has been ineffective in containing runaway costs in the FEHBP program. We desperately need a new model of health care financing. It is time to seriously consider adopting a single payer monopsony. Then everyone could have affordable health care.

FEHBP basic premium up 13 percent

Health Insurance Costs to Spike an Average 8 Percent

By Joe Davidson
The Washington Post
September 26, 2008

Health insurance premiums for federal employees will jump almost 8 percent… the Office of Personnel Management announced yesterday.

Premiums for most workers, however, will climb even more next year — about 13 percent — which is the increase for enrollees in the Blue Cross and Blue Shield plans. Sixty percent of federal workers are enrolled in one of the Blue Cross and Blue Shield plans.

Colleen M. Kelley, president of the National Treasury Employees Union, was not impressed. “It is very discouraging to see average increases of this magnitude,” she said, “particularly given the bargaining power OPM should be able to exercise as manager of the nation’s largest group health plan.”

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/25/AR2008092502677.html?hpid=sec-business

Comment:

By Don McCanne, MD

So you want the health insurance program that the members of Congress have? This is it: the Federal Employees Health Benefits Program (FEHBP). This is the plan that several politicians have supported as an option to purchase in place of your current coverage, if you should no longer want to keep that.

Prior studies have questioned whether FEHBP is an appropriate option for moderate income individuals. The employees’ portion of the premiums plus the out-of-pocket cost sharing is not affordable for them should they have significant health care needs. In fact 100,000 federal employees eligible for FEHBP are not covered by the program, many because they cannot afford their portion of the premiums.

The politicians frequently discuss guaranteeing basic coverage, “without the bells and whistles,” and refer to the FEHBP Blue Cross/Blue Shield plans as a model. The premiums for this basic coverage will increase 13 percent for 2009. 13 percent!

The Office of Personnel Management, the largest purchaser of health benefits in the nation, has been ineffective in containing runaway costs in the FEHBP program. We desperately need a new model of health care financing. It is time to seriously consider adopting a single payer monopsony. Then everyone could have affordable health care.

NAFTA-based suit threatens Canada's medicare

Suit seeks to open Canadian health care to privatizers

By Frances Russell
Winnipeg Free Press
September 24, 2008
Canada’s growing flirtation with private for-profit health care has led to the first legal assault on Canadian medicare under the investor-state clause of the North American Free Trade Agreement.
Alone among the world’s trade treaties, NAFTA allows foreign investors to sue the Canadian government directly if any public policy or governmental action denies them investment or profit opportunities.
Now, a group of 200 private investors led by Arizona businessman Melvin J. Howard is planning to use the NAFTA national treatment mechanism to pry open Canadian medicare — often described by neoconservatives as “the last great uncracked oyster in the North American marketplace.”
Howard and his partners want to open a private surgical centre in B.C. similar to the Cambie Clinic owned by Dr. Brian Day, past-president of the Canadian Medical Association, but are facing what they call anti-American roadblocks in several municipalities.
The use of NAFTA’s Chapter 11 to put medicare out of business — more accurately, to make it a for-profit, private, and likely American, business — has long been feared by medicare’s supporters. They have never believed government assurances that NAFTA grandfathered medicare beyond the reach of foreign insurance companies and health maintenance organizations (HMOs) seeking to replace it with U.S. private for-profit medicine.
It’s significant to note that NAFTA’s Chapter 11 effectively gives foreign investors greater rights than Canadian investors, because Canadians are restricted in their ability to sue their own government.
(Mike McBane, co-ordinator of the pro-medicare National Health Coalition) says privatizers and foreign investors are emboldened by what he calls a “perfect storm:” a federal government that believes in provincial autonomy, not national standards; the 2005 Supreme Court Chaoulli decision that private medical services do not abridge medicare and are a fundamental human right; and the CMA’s new support for two-tier medicine.
He cites a speech Prime Minister Stephen Harper gave in 2001 when he was president of the National Citizens Coalition in which he stated: “(W)hat we clearly need is experimentation — with market reforms and private delivery options within the public system. And it is only logical that, in a federal state where the provinces operate the public health care systems and regulate private services, that experimentation should occur at the provincial level.”
Continues McBane: “The dangerous thing is, you establish a private clinic and then it gets sold… We know why foreign investment wants it because they see public health care budgets as a cash cow.”
http://www.winnipegfreepress.com/subscriber/columnists/top3/story/4229990p-4871159c.html

Canadians, who much prefer their public medicare system to the U.S. private-market version of health care, have long feared that NAFTA would open up their health care system to an invasion of U.S.-style, investor-owned, market-based insurers and providers. The U.S. experience has proven that these entrepreneurs can cause health care costs to skyrocket, while greatly impairing equitable coverage and access.
The door has been opened; the “oyster has been cracked.” The U.S. entrepreneurial invaders have invoked NAFTA to force the introduction of expensive, corporate, for-profit, upper-tier health care to serve Canada’s more affluent citizens. Once in place, the public medicare program will see a gradual decline in funding because of the lack of a strong political voice (moneyed voice) representing lower-income individuals.
Chronic underfunding of Canada’s medicare will convert it into a bottom-tier, U.S.-style Medicaid program with impaired access since providers will bail out of the public sector and move into the lucrative, upper-tier private sector. (Just as with Medicaid, some dedicated physicians will remain in the public sector simply because it is the right thing to do, but they will have to work with much more limited resources.)
Tommy Douglas, the father of Canadian medicare, was selected by the people as “The Greatest Canadian.” The people must now consider what Tommy Douglas would have had to say about investor-owned health care. Perhaps it’s time for the citizens of Canada to demand that their political leadership revisit NAFTA.

NAFTA-based suit threatens Canada's medicare

Suit seeks to open Canadian health care to privatizers

By Frances Russell
Winnipeg Free Press
September 24, 2008

Canada’s growing flirtation with private for-profit health care has led to the first legal assault on Canadian medicare under the investor-state clause of the North American Free Trade Agreement.

Alone among the world’s trade treaties, NAFTA allows foreign investors to sue the Canadian government directly if any public policy or governmental action denies them investment or profit opportunities.

Now, a group of 200 private investors led by Arizona businessman Melvin J. Howard is planning to use the NAFTA national treatment mechanism to pry open Canadian medicare — often described by neoconservatives as “the last great uncracked oyster in the North American marketplace.”

Howard and his partners want to open a private surgical centre in B.C. similar to the Cambie Clinic owned by Dr. Brian Day, past-president of the Canadian Medical Association, but are facing what they call anti-American roadblocks in several municipalities.

The use of NAFTA’s Chapter 11 to put medicare out of business — more accurately, to make it a for-profit, private, and likely American, business — has long been feared by medicare’s supporters. They have never believed government assurances that NAFTA grandfathered medicare beyond the reach of foreign insurance companies and health maintenance organizations (HMOs) seeking to replace it with U.S. private for-profit medicine.

It’s significant to note that NAFTA’s Chapter 11 effectively gives foreign investors greater rights than Canadian investors, because Canadians are restricted in their ability to sue their own government.

(Mike McBane, co-ordinator of the pro-medicare National Health Coalition) says privatizers and foreign investors are emboldened by what he calls a “perfect storm:” a federal government that believes in provincial autonomy, not national standards; the 2005 Supreme Court Chaoulli decision that private medical services do not abridge medicare and are a fundamental human right; and the CMA’s new support for two-tier medicine.

He cites a speech Prime Minister Stephen Harper gave in 2001 when he was president of the National Citizens Coalition in which he stated: “(W)hat we clearly need is experimentation — with market reforms and private delivery options within the public system. And it is only logical that, in a federal state where the provinces operate the public health care systems and regulate private services, that experimentation should occur at the provincial level.”

Continues McBane: “The dangerous thing is, you establish a private clinic and then it gets sold… We know why foreign investment wants it because they see public health care budgets as a cash cow.”

http://www.winnipegfreepress.com/subscriber/columnists/top3/story/4229990p-4871159c.html

Comment:

By Don McCanne, MD

Canadians, who much prefer their public medicare system to the U.S. private-market version of health care, have long feared that NAFTA would open up their health care system to an invasion of U.S.-style, investor-owned, market-based insurers and providers. The U.S. experience has proven that these entrepreneurs can cause health care costs to skyrocket, while greatly impairing equitable coverage and access.

The door has been opened; the “oyster has been cracked.” The U.S. entrepreneurial invaders have invoked NAFTA to force the introduction of expensive, corporate, for-profit, upper-tier health care to serve Canada’s more affluent citizens. Once in place, the public medicare program will see a gradual decline in funding because of the lack of a strong political voice (moneyed voice) representing lower-income individuals.

Chronic underfunding of Canada’s medicare will convert it into a bottom-tier, U.S.-style Medicaid program with impaired access since providers will bail out of the public sector and move into the lucrative, upper-tier private sector. (Just as with Medicaid, some dedicated physicians will remain in the public sector simply because it is the right thing to do, but they will have to work with much more limited resources.)

Tommy Douglas, the father of Canadian medicare, was selected by the people as “The Greatest Canadian.” The people must now consider what Tommy Douglas would have had to say about investor-owned health care. Perhaps it’s time for the citizens of Canada to demand that their political leadership revisit NAFTA.