By Michael M. Rachlis
Los Angeles Times
August 3, 2009
Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.
The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?
On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.
On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.
Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.
Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.
The Canadian system does have its problems, and these also provide important lessons.
However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas.
On closer examination, most of these problems have little to do with public insurance or even overall resources.
Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.
U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?
American democracy runs on money.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our “socialized” system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to “in-plan” doctors.
Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.
(Michael M. Rachlis is a physician, health policy analyst and author in Toronto.)
http://www.latimes.com/news/opinion/la-oe-rachlis3-2009aug03,0,538126.story
Comment:
By Don McCanne, MD
August will be the month of sound bites on health care reform.
One of these sound bites is “unfair competition.” It is really a silly argument designed to suppress even the most feeble of reform efforts.
But the really unfair competition this month will be between those who can explain the relatively complex health policies that can benefit everyone (except those who are wasting our resources), and those who have at their command the very effective tool of simple sound bites. These sound bites relieve the listener of any responsibility to try to understand these complex issues.
Should the dialogue on reform move into discussions of effective health policies, the opponents will be ready with their sound bite diversions, including those based on the caricature of the Canadian experience suggesting that their government takeover of health care has caused Canadians to flee to the United States should they need health care – a lie supposedly “proven” by rare, bizarre anecdotes.
When the distortions and lies about Canada are brought up, interrupt (they do) with the response that Canada has a health care financing system that includes everyone and keeps health care affordable.
The United States needs the same. We need to include everyone in a system that is affordable. The problem for single payer advocates is that the program that the administration is trying to sell us will leave five percent of us out and make affordability even worse.
The real tragedy is that this war on health care financing reform will be settled by sound bites. On that war, the bad guys always win.