August 11, 2009
The health care debate-10: More comparisons with Canada
(For previous posts on the issue of health care, see here.)
The Canadian system is a single-payer system in which the federal government sets certain baseline services that have to be provided and then the provinces have some flexibility in what they provide over and above that. This means that there can be variability from province to province in the quality of health services with currently Ontario seeming to have the most complaints. Thom Hartmann talks to Sarah Robinson, who explains how it works.
But as to the question as to whether Canadians would prefer the US system to what they have there, this is an easy one: No. When the Canadian Broadcasting System held a poll to select the greatest Canadian of all time, the winner was Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country.
Let's look at the comparisons.
This report quotes a multi-nation study that found that:
One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.
Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33 percent of Americans who got such speedy care. Only Canada scored lower, with 27 percent saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.
Four in 10 U.S. adults told researchers that they had gone without needed care because of the cost, including skipping prescriptions, avoiding going to the doctor, or skipping a recommended test or treatment. (my emphasis)
Michael Rachlis, a Canadian doctor, exposes more myths in an article in the Los Angeles Times of August 3, 2009, where he does a side-by-side comparison of the Canadian and US health systems:
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.
He then draws some lessons:
- 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.
- 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.
And what about the bureaucracy? In an interview, Uwe Reinhardt, a professor of political economy at Princeton University compares the two countries:
Edie Magnus: We were in a hospital that was affiliated with McGill University [in Canada], and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?
Uwe Reinhardt: You'd be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University [in the US] and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don't have to do it. But take Duke University, for example, has more than 500,000 and I believe it's 900 billing clerks for their system. (my emphasis)
It is time to put the lies about Canada to rest. My colleague Ross Duffin (whom I must thank for sending me several of the links in the posts about Canada) put it best in a blog post way back in 2005:
[D]on't talk to me about inferior medical care in Canada. Its low reputation here is based solely on scare-mongering, knee-jerk anti-socialism, and just plain ignorance. A lot of people make a heck of a lot of money in the health care industry in this country, and would hate to see the system change, no matter how much it would benefit Americans to change it. And they can afford to spend a lot of money on advertising and lobbying to keep things just they way they are, thank you very much.
That seems to me to be exactly right.
POST SCRIPT: Bill Maher on health insurance reform
Bill Maher's final segment on New Rules says what I have been saying all along, that the US is essentially a pro-business/pro-war one party state with two factions, which is why some Democrats are allying themselves with Republicans to block meaningful health care reform.