This is a follow up to “Touching Innocence,” below. A blogger named Russell Roberts writes,
Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.
The New York Times reports that the Canadian system is imploding. …
You already know where this is going … the Times report discusses problems with the Canadian system, and says some private health care is rushing in to pick up the slack. Whereupon blogger Russell gloats a bit about how superior the U.S. health care system is, and how fortunate Canadians will be when their public system breaks down entirely and they can have a health care system just like ours.
Russell goes off track with the first sentence — “Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.” Although I’ve met such people, in fact the Canadian Model is a bugaboo of the Right. Try to discuss national health care with a rightie, and the first sentence out of his mouth will be, “You mean like in Canada?” Then he will go off on a tirade about the problems with the Canadian system. (Unless you remind them of the underfunded British system, which is the other good “bad” example of a system with problems.)
And, I’m sorry to say, I also run into uninformed lefties who seem to think our only choices are a Canadian-style single-payer or the overblown mess that is the U.S. “system.”
As I wrote earlier today, just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system, with the exception of the United States. And every nation has worked out its own system; it is not true, as the uninformed would have it, that there is only the Canadian Model or ours. People who have looked at the myriad systems on the planet say that Canada’s is not necessarily the model we should be emulating. Other countries (notably France, whose system is ranked #1 in overall performance by the World Health Organization) have mixed public and private systems, with public “universal coverage” supplemented by private insurers and hospitals for those who want to pay for them. This may be where Canada is heading now.
Ezra Klein wrote a series of posts on the health care systems of various other countries. France’s system, he says, is not only more cost-effective than ours, it also provides better care for most people.
France’s health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.
So France spends less, gets more, and does so through a public-private hybrid that’s heavily, heavily public.
The hospitals offer about 8.4 beds per 1,000 people (America, btw, offers 3.6. Ouch.) The public sector provides 65% of the beds, private hospitals — which operate on a fee-for-service basis — make up the rest, and primarily concentrate on surgeries. French citizens choose which one to go to and get the same reimbursement at either. How’s that for choice? Not good enough? The French also get to choose their physicians, their physicians get to choose where they practice, and there’s patient-client confidentiality.
Everyone I’ve ever met who’s lived in France even a short time sings the praises of the French health-care system. This is not to say that Americans with lots of money or top-notch insurance don’t get as good, or better, care. But, I’m told, if you don’t have lots of money or insurance, try to arrange to have your health problems in France.
The Canadian health care system is slowly breaking down, The New York Times says. The U.S. system, by contrast, is not slowly breaking down. Parts of it are already broken, and what’s left of it is hurtling toward disaster at breakneck speed.
Once again, Jane Bryant Quinn:
America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they getâ€”as the cliche goesâ€””the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).
To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.
Here Sebastian Mallaby explains why Bush’s health savings accounts will make our system even worse. In another column, Mallaby concludes,
Beyond the imperative of restraining prices, the biggest challenges in health care are to get insurance to everyone and to create incentives for preventive treatment — even though prevention may pay off 30 years later, by which time the patient will have gone through multiple switches in health plans. The most plausible subsidizer of universal insurance is government, and the only entity with a stake in lifelong wellness is the government. Is the administration ready to see that?
See also “Single-Payer Health Would Increase US Competitiveness” by Hale Stewart at BOP News.
This is a huge topic, and this evening I don’t have the time to go into the detail the topic requires. But whenever I see a rightie snicker about the problems of other health care systems, I wonder what it’s going to take to get them to see that our system is a disaster in progress. Corpses in the streets? Oh, wait, we’ve been there already. I’m afraid it’s what Quinn says — the shock of being dumped out of the “winners” rank. Until then, it’ll take major surgery to get their heads out of their butts.
When the wingnuts rail against nationalized health care, remind them that Israel has one of the best universal health care systems in the world. Moreover, they also have pretty good pension and social welfare programs.
Then ask them how they feel about our subsidizing health care for Israelis while Americans go without. Toss in the fact that this harms our economy.
Picking on Israel is always a dicey matter, but the fact is that they have better health and welfare programs and we are essentially paying for those programs, at least in part, while our folks do without.
As a follow up regarding France’s system, see A Conservative Convert to Socialized Medicine. In the article, Britain and France’s systems are compared – the two countries are similar in population, and Britain’s system has a reputation similar to Canada’s. The difference is that France spends more and gets better coverage. It all depends on how much you want to spend – you get what you pay for.
This is one of those articles I’ve bookmarked, to have ready to send to lefties and righties alike, as it has a former opponent singing the praises of France’s system.
Could the righties be a product of their leader or chose their leader because they like it simple? Canadian model vs US model, no need to complicate things by discussing amalgams of two systems, neither of which necessarily follow the two simplistic models.
Life is rarely simple. Medical care is complicated if done well. One can disagree with Bush and not be a traitor. Either/or is usually not the argument for inlightened folks.
Even the currently-underfunded UK system is miles better than what most Americans have. And making it as good as it used to be is just a matter of recognizing that Margaret Thatcher was not good for your health and Major and Blair aren’t much use either – put it back the way it was, before people started trying to “modernize” it.
Wikipedia’s comparison of American vs Canadian health systems has more detailed statistics and, while overall the Canadian system comes out on top by a wide margin, the article outlines a few of the flexibility problems with the existing Canadian system.
Yes, the RAND study randomized people to varying levels of co-pays. Those with higher co-pays consumed less healthcare.
And had worse health.
I’m simply saying there may be a better, third way.
There are all kinds of ways already. If you look at all the national health care systems in all the countries that have national health care systems, which is a lot of them, you’ll find several dozen ways. And since all these nations have had these systems for many years, by studying them we can see what has worked over time and what hasn’t. I mentioned France because by most measures it seems to be getting the best results, but there are many other nations getting better results than we are.
Or, we can do it the American way, which is to reinvent the wheel and come up with some monstrous boondoggle of a program that mostly benefits corporations and rich people, and leaves poor people without decent health care. Oh, wait, that’s what we have now.
It’s pretty clear to me, if you have a private health care system the one and only goal of private insurance companies is to make profit. How can their making profit benefit those of us who need medical care? It’s an oxymoron to say, privatization is good for the people. It is impossible for privatization to be good for the people. They are in the business to cut benefits while having the highest legal premiums that our corrupt and paid off legislators allow them.
Let’s elect a strong third party that represents the masses rather than a party that only works for the corporations who fund them. Work for public financing of political campaigns to keep corporate bribes out of the hands of those who claim to represent us.
We about the fact that medical errors kill more people in this country than breast cancer, AIDS and traffic accidents. I read an article in the NYT that talked about new fail safe instruments for laparosoopy. I think keeping our patients alive should be number one first and foremost.
Pingback: The Mahablog » Je m’amuse.
very good site. thx
Pingback: The Mahablog » Dear Media, Part I: Diagnosis
Pingback: The Mahablog » The Canada Bugaboo
Pingback: The Mahablog » Why Is the Right Afraid of Universal Health Care?
Pingback: The Mahablog » No Room at the Maternity Ward