Health Care: From the Horse's Mouth

Here's a nice article in the LA Times by Michael Rachlis, a Canadian doctor and policy analyst, trying to set straight the record about Canadian universal medical coverage versus the "private care" offered in the US. (I put private care in quotes because almost half of US coverage is public universal coverage -- but restricted to the old -- while a very large segment has no health coverage.)

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.

Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.

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.

On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead.

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Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

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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.

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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.

There are a lot of good lessons to be learned by looking at the Canadian experience. But the fanatics on the right in the US simply won't consider "socialized" medicine. Funny thing, 99% of Canadians would never ever go back to the old system. We love the government medical system. It works! (Sure it could be improved, and it is from time to time, but it is head and shoulders above what the US has to offer... except for the really expensive new fancy high-tech medical technology. There the US has the lead. But who gets it? Only the very, very rich.)