Monday, August 10, 2009

Canadian Health Care Caricature

This spells out the stark differences between the Canadian single payer system and the so called US system. The numbers may be overstated or making somewhat unfair comparisons, but hardly hides the real disparity in patient outcomes. I have already posted of the unreality of a system that delivers no service to a third of the population of a primary human need while charging effectively double for delivery to those able to pay. Of course the ‘administrators’ attempt to hide this with financial sleight of hand. Welcome to Wall Street.

I share this with my many American readers mostly because they are the victims of this abusive nonsense.

I have also posted that the best way to make a public system highly competitive is to have it administered by the individual states. Or do you want congress mandating not just the medicine you can use but also the price? Fifty plus states and territories stops that cold.

The point been made, is that once you get past the frantic propaganda of the US insurance lobby and take the most cursory look at the facts, the Canadian single payer system works quite well. Can it be better? Of course, but that is a case of investing in resources and that is often done through the communities anyway. After all, a world class coronary unit is going to be built in one of several large cities, just like in the USA.

Whatever the faults of our system, it was able to air medivac my sister in law from Regina, Saskatchewan to Toronto, Ontario for an extraordinary and successful brain surgery procedure that was almost unique. In the USA, costs would surely have excluded almost everyone from getting this type of service unless they had the cash on hand.

This article shows that the attacks emanating out of the US are now attracting a response from informed commentary. This is surely going to heat up. There is too much at stake with the present US status quo however clearly flawed it is.

I also suspect that the life expectancy for Canadian doctors exceeds that of their compatriots in the US since they can book time off and not set up a business to collect money.

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.

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