2009 has been an eventful year for me. One of those events was the opportunity for this adjunct professor of health administration to travel to Canada to learn a little about the Canadian health care system. Like many Americans, I have been guilty of considering Canada as the attic where our strangely bilingual cousins who have some weird relationship with the British Royal Family live.
There is so much to learn from Canada's health care system as we think of reform. Oh and the Canadian health care system has a name--Medicare. You know, the same name as our government-operated health care program that is eating the Federal budget like a PAC Man on methamphetamine? Here are some observations:
You Say Single Payer-I Say Socialized--proponents of the Canadian system like to point out that in socialized systems doctors are employees of government. In Canada, doctors do not work for the government, instead the government is the only payer. You say potaaato, I say potahto. The docs still have their own offices, overhead, etc. Government run health care is socialized health care.
Payment/Insurance does not Equal Access to Care Interestingly enough, Canada proved that payment for care does not equal access. My favorite quote on this is from Canadian Supreme Court Chief Justice Beverly McLachin, "Access to a waiting list is not access to health care." Access is such an issue that Canada has a 10 year plan to improve wait times. There are websites operated by each Territory/Province publishing the wait times for covered procedures. Just a couple of examples--Manitoba-15 weeks for a Stress Test; British Columbia--8 weeks for cataracts surgery and 12 weeks for knee replacement.
Taxes? Many like to cite Canada's 29% average federal tax rate as proof that government funded health care won't be expensive. I say, not so fast. Since the Territories/Provinces operate these programs, lets add in the average ~15% tax that are collected at this level. For those who are math challenged that's 44% income tax. Did I mention a tax up to 1.95% on employers, too.
Premiums Yes. In addition to the tax load and the 30% average out of pocket expenditures for health care, many of the Territories/Provinces charge a monthly premium for this care. Folks under US Medicare you need supplemental insurance for very high co-pays and deductible (unless you join a private managed care plan), many items aren't covered and in some areas, not a single physician will accept assignment(in other words you pay and wait for the government to reimburse you). Does this sound familiar?
Private insurance is another cost for Canadians Until 2005, when the Canadian Supreme Court ruled that Canadians have the right to buy private insurance, Canada, Cuba and North Korea were the only countries in which private health insurance was illegal and one was not allowed to pay privately for any service covered by Medicare.
Payer's Choice Don't forget that the payer decides what is covered. Consider that Canada is a country without any restriction on abortions and it pays for those services through Medicare. There are waiting list for so many services, but the money is there to make sure that even someone in the last trimester of pregnancy can get an abortion without a wait. If we, in the United States, turn our health care over to government, we will turnover our right to decide what services we want covered.
Instead of building a system that 3 of the Supreme Court Justices in Canada see as possibly unconstitutional, why not just fix our system. How you ask?
http://www.opinionjournal.com/editorial/feature.html?id=110006813
Address the 10% fraud and abuse in the health care system.
Address the 5-9% costs of excessive liability in our system (by this I mean frivolous lawsuits, punitive damages, the defensive practice of medicine. No, I do not mean taking away a persons right to sue for real damages related to medical malpractice or abuse)
Use the real numbers to discuss the issue of the uninsured. If we have 50 million uninsured, consider that we have between 12 and 20 million illegal immigrants here who do not have access to insurance. Government health care will not, should not address this prior to addressing the issue of illegal immigration. What about those with access to affordable insurance who do not enroll--students, young adults,etc.
Let's not throw out a system that works for 84% of Americans without first addressing the problems that we can easily fix.
