American Healthcare: Don't Be Silly.
Came across this article in the paper a few days ago, and managed to track it down because, dammit, he's right.
From The Province:
Guest column: Vested interests within America's medical system promote a caricature of Canada's universal health care
By Michael M. Rachlis, The Province August 5, 2009
Universal health insurance is on the American policy agenda for the fifth time since the Second World War. 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.
There are lessons to be learned from studying 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 United States' 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 for home care, long-term care, drugs and durable medical equipment, although there are co-pays.
In the U.S., 46 million people have no insurance, millions are underinsured and health-care bills bankrupt more than one million Americans annually.
Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
Canada spends 10 per cent of its economy on health care; the U.S. spends 16 per cent. The extra 6 per cent of GDP -- more than $800 billion per year -- is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has up to 90 per cent lower administrative costs than private policies. And providers and suppliers can't charge as much when they have to deal with a single payer.
Lessons No. 2 and 3: Single-payer systems reduce the duplication of administrative costs and can negotiate lower prices.
Because most of the difference in spending is for nonpatient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung-transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20 per cent lower.
Lesson No. 4: Single-payer plans can work because their funding goes to services, not overhead.
The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.
However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. A U.S. government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes.
These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th-century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse.
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.
That's because U.S. democracy runs on money. Drug and insurance companies have the fuel. Hundreds of billions of premiums are wasted on overhead that could fund care for the uninsured, but industry executives and shareholders see bonuses and dividends.
Traditional U.S. ignorance of what happens in Canada makes it easy to mislead people. The U.S. media, legislators and even presidents have claimed 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.
Rachlis is a physician, health policy analyst and Toronto author.
© Copyright (c) The Province
From The Province:
Guest column: Vested interests within America's medical system promote a caricature of Canada's universal health care
By Michael M. Rachlis, The Province August 5, 2009
Universal health insurance is on the American policy agenda for the fifth time since the Second World War. 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.
There are lessons to be learned from studying 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 United States' 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 for home care, long-term care, drugs and durable medical equipment, although there are co-pays.
In the U.S., 46 million people have no insurance, millions are underinsured and health-care bills bankrupt more than one million Americans annually.
Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
Canada spends 10 per cent of its economy on health care; the U.S. spends 16 per cent. The extra 6 per cent of GDP -- more than $800 billion per year -- is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has up to 90 per cent lower administrative costs than private policies. And providers and suppliers can't charge as much when they have to deal with a single payer.
Lessons No. 2 and 3: Single-payer systems reduce the duplication of administrative costs and can negotiate lower prices.
Because most of the difference in spending is for nonpatient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung-transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20 per cent lower.
Lesson No. 4: Single-payer plans can work because their funding goes to services, not overhead.
The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.
However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. A U.S. government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes.
These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th-century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse.
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.
That's because U.S. democracy runs on money. Drug and insurance companies have the fuel. Hundreds of billions of premiums are wasted on overhead that could fund care for the uninsured, but industry executives and shareholders see bonuses and dividends.
Traditional U.S. ignorance of what happens in Canada makes it easy to mislead people. The U.S. media, legislators and even presidents have claimed 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.
Rachlis is a physician, health policy analyst and Toronto author.
© Copyright (c) The Province