Summary:
In the
universal health care debate, Canada is once again
getting dragged into the fracas, shoved around by
both sides as either an exemplar or a warning — and,
along the way, getting coated with the obfuscating
dust of so many willful misconceptions that the
actual facts about How Canada Does It are completely
obscured in the melee. As a
health-care-card-carrying Canadian resident and an
uninsured American citizen who regularly sees
doctors on both sides of the border, I'm in a unique
position to address the pros and cons of both
systems first-hand.
2008 is shaping up to be
the election year that we finally get to have the Great American
Healthcare Debate again. Harry and Louise are back with a
vengeance. Conservatives are rumbling around the talk show
circuit bellowing about the socialist threat to the (literal)
American body politic. And, as usual, Canada is once again
getting dragged into the fracas, shoved around by both sides as
either an exemplar or a warning -- and, along the way, getting
coated with the obfuscating dust of so many willful
misconceptions that the actual facts about How Canada Does It
are completely lost in the melee.
I'm both a
health-care-card-carrying Canadian resident and an uninsured
American citizen who regularly sees doctors on both sides of the
border. As such, I'm in a unique position to address the pros
and cons of both systems first-hand. If we're going to have this
conversation, it would be great if we could start out (for once)
with actual facts, instead of ideological posturing, wishful
thinking, hearsay, and random guessing about how things get done
up here.
To that end, here's the
first of a two-part series aimed at busting the common myths
Americans routinely tell each other about Canadian health care.
When the right-wing hysterics drag out these hoary old bogeymen,
this time, we need to be armed and ready to blast them into
straw. Because, mostly, straw is all they're made of.
1. Canada's health
care system is "socialized medicine."
False. In socialized medical systems, the doctors work
directly for the state. In Canada (and many other countries with
universal care), doctors run their own private practices, just
like they do in the US. The only difference is that every doctor
deals with one insurer, instead of 150. And that insurer is the
provincial government, which is accountable to the legislature
and the voters if the quality of coverage is allowed to slide.
The proper term for this
is "single-payer insurance." In talking to Americans about it,
the better phrase is "Medicare for all."
2. Doctors are hurt
financially by single-payer health care.
True and False. Doctors in Canada do make less
than their US counterparts. But they also have lower overhead,
and usually much better working conditions. A few reasons for
this:
First, as noted, they
don't have to charge higher fees to cover the salary of a
full-time staffer to deal with over a hundred different
insurers, all of whom are bent on denying care whenever
possible. In fact, most Canadian doctors get by quite nicely
with just one assistant, who cheerfully handles the phones,
mail, scheduling, patient reception, stocking, filing, and
billing all by herself in the course of a standard workday.
Second, they don't have
to spend several hours every day on the phone cajoling insurance
company bean counters into doing the right thing by their
patients. My doctor in California worked a 70-hour week: 35
hours seeing patients, and another 35 hours on the phone arguing
with insurance companies. My Canadian doctor, on the other hand,
works a 35-hour week, period. She files her invoices online, and
the vast majority are simply paid -- quietly, quickly, and
without hassle. There is no runaround. There are no fights.
Appointments aren't interrupted by vexing phone calls. Care is
seldom denied (because everybody knows the rules). She gets her
checks on time, sees her patients on schedule, takes Thursdays
off, and gets home in time for dinner.
One unsurprising side
effect of all this is that the doctors I see here are, to a
person, more focused, more relaxed, more generous with their
time, more up-to-date in their specialties, and overall much
less distracted from the real work of doctoring. You don't
realize how much stress the American doctor-insurer fights put
on the day-to-day quality of care until you see doctors who
don't operate under that stress, because they never have to
fight those battles at all. Amazingly: they seem to enjoy their
jobs.
Third: The average
American medical student graduates $140,000 in hock. The average
Canadian doctor's debt is roughly half that.
Finally, Canadian
doctors pay lower malpractice insurance fees. When paying for
health care constitutes a one of a family's major expenses,
expectations tend to run very high. A doctor's mistake not only
damages the body; it may very well throw a middle-class family
permanently into the ranks of the working poor, and render the
victim uninsurable for life. With so much at stake, it's no
wonder people are quick to rush to court for redress.
Canadians are far less
likely to sue in the first place, since they're not having to
absorb devastating financial losses in addition to any physical
losses when something goes awry. The cost of the damaging
treatment will be covered. So will the cost of fixing it. And,
no matter what happens, the victim will remain insured for life.
When lawsuits do occur, the awards don't have to include
coverage for future medical costs, which reduces the insurance
company's liability.
3. Wait times in
Canada are horrendous.
True and False again -- it depends on which
province you live in, and what's wrong with you. Canada's health
care system runs on federal guidelines that ensure uniform
standards of care, but each territory and province administers
its own program. Some provinces don't plan their facilities well
enough; in those, you can have waits. Some do better. As a
general rule, the farther north you live, the harder it is to
get to care, simply because the doctors and hospitals are
concentrated in the south. But that's just as true in any rural
county in the U.S.
You can hear the
bitching about it no matter where you live, though. The
percentage of Canadians who'd consider giving up their beloved
system consistently languishes in the single digits. A few years
ago, a TV show asked Canadians to name the Greatest Canadian in
history; and in a broad national consensus, they gave the honor
to Tommy Douglas, the Saskatchewan premier who is considered the
father of the country's health care system. (And no, it had
nothing to do with the fact that he was also Kiefer Sutherland's
grandfather.). In spite of that, though, grousing about health
care is still unofficially Canada's third national sport after
curling and hockey.
And for the country's
newspapers, it's a prime watchdogging opportunity. Any little
thing goes sideways at the local hospital, and it's on the front
pages the next day. Those kinds of stories sell papers, because
everyone is invested in that system and has a personal stake in
how well it functions. The American system might benefit from
this kind of constant scrutiny, because it's certainly one of
the things that keeps the quality high. But it also makes people
think it's far worse than it is.
Critics should be
reminded that the American system is not exactly instant-on,
either. When I lived in California, I had excellent insurance,
and got my care through one of the best university-based systems
in the nation. Yet I routinely had to wait anywhere from six to
twelve weeks to get in to see a specialist. Non-emergency
surgical waits could be anywhere from four weeks to four months.
After two years in the BC system, I'm finding the experience to
be pretty much comparable, and often better. The notable
exception is MRIs, which were easy in California, but can take
many months to get here. (It's the number one thing people go
over the border for.) Other than that, urban Canadians get care
about as fast as urban Americans do.
4. You have to wait
forever to get a family doctor.
False for the vast majority of Canadians, but True
for a few. Again, it all depends on where you live. I live in
suburban Vancouver, and there are any number of first-rate GPs
in my neighborhood who are taking new patients. If you don't
have a working relationship with one, but need to see a doctor
now, there are 24-hour urgent care clinics in most neighborhoods
that will usually get you in and out on the minor stuff in under
an hour.
It is, absolutely,
harder to get to a doctor if you live out in a small town, or up
in the territories. But that's just as true in the U.S. -- and
in America, the government won't cover the airfare for rural
folk to come down to the city for needed treatment, which all
the provincial plans do.
5. You don't get to
choose your own doctor.
Scurrilously False. Somebody, somewhere, is getting paid
a lot of money to make this kind of stuff up. The cons love to
scare the kids with stories about the government picking your
doctor for you, and you don't get a choice. Be afraid! Be very
afraid!
For the record:
Canadians pick their own doctors, just like Americans do. And
not only that: since it all pays the same, poor Canadians have
exactly the same access to the country's top specialists that
rich ones do.
6. Canada's care plan
only covers the basics. You're still on your own for any extras,
including prescription drugs. And you still have to pay for it.
True -- but not as big an issue as you might think. The
province does charge a small monthly premium (ours is $108/month
for a family of four) for the basic coverage. However, most
people never even have to write that check: almost all employers
pick up the tab for their employees' premiums as part of the
standard benefits package; and the province covers it for people
on public assistance or disability.
"The basics" covered by
this plan include 100% of all doctor's fees, ambulance fares,
tests, and everything that happens in a hospital -- in other
words, the really big-ticket items that routinely drive American
families into bankruptcy. In BC, it doesn't include "extras"
like medical equipment, prescriptions, physical therapy or
chiropractic care, dental, vision, and so on; and if you want a
private or semi-private room with TV and phone, that costs extra
(about what you'd pay for a room in a middling hotel). That
other stuff does add up; but it's far easier to afford if you're
not having to cover the big expenses, too. Furthermore: you can
deduct any out-of-pocket health expenses you do have to pay off
your income taxes. And, as every American knows by now, drugs
aren't nearly as expensive here, either.
Filling the gap between
the basics and the extras is the job of the country's remaining
private health insurers. Since they're off the hook for the
ruinously expensive big-ticket items that can put their own
profits at risk, the insurance companies make a tidy business
out of offering inexpensive policies that cover all those
smaller, more predictable expenses. Top-quality add-on policies
typically run in the ballpark of $75 per person in a family per
month -- about $300 for a family of four -- if you're stuck
buying an individual plan. Group plans are cheap enough that
even small employers can afford to offer them as a routine
benefit. An average working Canadian with employer-paid basic
care and supplemental insurance gets free coverage equal to the
best policies now only offered at a few of America's largest
corporations. And that employer is probably only paying a couple
hundred dollars a month to provide that benefit.
7. Canadian drugs are
not the same.
More preposterious bogosity. They are exactly the same
drugs, made by the same pharmaceutical companies, often in the
same factories. The Canadian drug distribution system, however,
has much tighter oversight; and pharmacies and pharmacists are
more closely regulated. If there is a difference in Canadian
drugs at all, they're actually likely to be safer.
Also: pharmacists here
dispense what the doctors tell them to dispense, the first time,
without moralizing. I know. It's amazing.
8. Publicly-funded
programs will inevitably lead to rationed health care,
particularly for the elderly.
False. And bogglingly so. The papers would have a field
day if there was the barest hint that this might be true.
One of the things that
constantly amazes me here is how well-cared-for the elderly and
disabled you see on the streets here are. No, these people are
not being thrown out on the curb. In fact, they live longer,
healthier, and more productive lives because they're getting a
constant level of care that ensures small things get treated
before they become big problems.
The health care system
also makes it easier on their caregiving adult children, who
have more time to look in on Mom and take her on outings because
they aren't working 60-hour weeks trying to hold onto a job that
gives them insurance.
9. People won't be
responsible for their own health if they're not being forced to
pay for the consequences.
False. The philosophical basis of America's privatized
health care system might best be characterized as medical
Calvinism. It's fascinating to watch well-educated secularists
who recoil at the Protestant obsession with personal virtue,
prosperity as a cardinal sign of election by God, and total
responsibility for one's own salvation turn into fire-eyed,
moralizing True Believers when it comes to the subject of Taking
Responsibility For One's Own Health.
They'll insist
that health, like salvation, is entirely in our own hands. If
you just have the character and self-discipline to stick to an
abstemious regime of careful diet, clean living, and frequent
sweat offerings to the Great Treadmill God, you'll never get
sick. (Like all good theologies, there's even an unspoken
promise of immortality: f you do it really really right, they
imply, you might even live forever.) The virtuous Elect can be
discerned by their svelte figures and low cholesterol numbers.
From here, it's a short leap to the conviction that those who
suffer from chronic conditions are victims of their own
weaknesses, and simply getting what they deserve. Part of their
punishment is being forced to pay for the expensive, heavily
marketed pharmaceuticals needed to alleviate these avoidable
illnesses. They can't complain. It was their own damned fault;
and it's not our responsibility to pay for their sins. In fact,
it's recently been suggested that they be shunned,
lest they lead the virtuous into sin
.
Of course, this is bad
theology whether you're applying it to the state of one's soul
or one's arteries. The fact is that bad genes, bad luck, and the
ravages of age eventually take their toll on all of us -- even
the most careful of us. The economics of the Canadian system
reflect this very different philosophy: it's built on the belief
that maintaining health is not an individual responsibility, but
a collective one. Since none of us controls fate, the least we
can do is be there for each other as our numbers come up.
This difference is
expressed in a few different ways. First: Canadians tend to
think of tending to one's health as one of your duties as a
citizen. You do what's right because you don't want to take up
space in the system, or put that burden on your fellow
taxpayers. Second, "taking care of yourself" has a slightly
expanded definition here, which includes a greater emphasis on
public health. Canadians are serious about not coming to work if
you're contagious, and seeing a doctor ASAP if you need to.
Staying healthy includes not only diet and exercise; but also
taking care to keep your germs to yourself, avoiding stress, and
getting things treated while they're still small and cheap to
fix.
Third, there's a
somewhat larger awareness that stress leads to big-ticket
illnesses -- and a somewhat lower cultural tolerance for
employers who put people in high-stress situations. Nobody wants
to pick up the tab for their greed. And finally, there's a
generally greater acceptance on the part of both the elderly and
their families that end-of-life heroics may be drawing resources
away from people who might put them to better use. You can have
them if you want them; but reasonable and compassionate people
should be able to take the larger view.
The bottom line: When it
comes to getting people to make healthy choices, appealing to
their sense of the common good seems to work at least as well as
Calvinist moralizing.
10. This all sounds
great -- but the taxes to cover it are just unaffordable. And
besides, isn't the system in bad financial shape?
False. On one hand, our annual Canadian tax bite runs
about 10% higher than our U.S. taxes did. On the other, we're
not paying out the equivalent of two new car payments every
month to keep the family insured here. When you balance out the
difference, we're actually money ahead. When you factor in the
greatly increased social stability that follows when everybody's
getting their necessary health care, the impact on our quality
of life becomes even more signficant.
And True -- but
only because this is a universal truth that we need to make our
peace with. Yes, the provincial plans are always struggling. So
is every single publicly-funded health care system in the world,
including the VA and Medicare. There's always tension between
what the users of the system want, and what the taxpayers are
willing to pay. The balance of power ebbs and flows between
them; but no matter where it lies at any given moment, at least
one of the pair is always going to be at least somewhat unhappy.
But, as many of us know
all too well, there's also constant tension between what
patients want and what private insurers are willing to pay. At
least when it's in government hands, we can demand some
accountability. And my experience in Canada has convinced me
that this accountability is what makes all the difference
between the two systems.
It is true that Canada's
system is not the same as the U.S. system. It's designed to
deliver a somewhat different product, to a population that has
somewhat different expectations. But the end result is that the
vast majority of Canadians get the vast majority of what they
need the vast majority of the time. It'll be a good day when
when Americans can hold their heads high and proudly make that
same declaration.
Next week: More
mythbusting on common conservative canards about efficiency,
innovation, and competitiveness.
In the previous post, I
looked at ten of the most common myths that get bandied about
whenever Americans drag Canada into their ongoing discussions
about healthcare. In this follow-up, I'd like to address a few
of the larger assumptions that Americans make about health care
that are contradicted by the Canadian example; and in the
process offer some more general thinking (and perhaps talking)
points that may be useful in the debates ahead.
Government-run health
care is inherently less efficient -- because governments
themselves are inherently less efficient.
If anything could finally put the lie to this old conservative
canard, the disaster that is our health care system is Exhibit
A.
America spends about 15%
of its GDP on health care. Most other industrialized countries
(all of whom have some form of universal care, either
single-payer or entirely government-run) spend about 11-12%.
Canada spends about 8-9% -- and most of the problems within
their system come out of the fact that it's chronically
underfunded compared to those other nations. If they spent what
the UK or Germany do, those problems would mostly vanish.
Any system that has
people spending more and getting less is, by definition, not
efficient. And these efficiency leaks are, almost entirely, due
to private greed. There is no logical way that a private system
can pay eight-figure CEO compensation packages, turn a handsome
a profit for shareholders, and still be "efficient." In fact, in
order to deliver those profits and salaries, the American system
has built up a vast, Kafkaesque administrative machinery of
approval, denial, and fraud management, which inflates the US
system's administrative costs to well over double that seen in
other countries -- or even in our own public systems, including
Medicare and the VA system.
Not incidentally: one of
the benefits of single-payer health care is that it largely
eliminates the entire issue of "fraud." You can only "cheat" a
system that already views its primary business as rationing and
withholding care. In Canada, where the system is set up to
deliver health care instead of profits, and medical access is
considered a right, this whole oversight machinery is far
cheaper and more compact. In general, the system trusts doctors
and patients to make the right choices the first time. As a
result, people generally don't have to lie, cheat, and grovel to
get the system to deliver the care they need. They just go and
get it -- and walk out without a moment's dread about the bills.
Shareholder profit,
inflated CEO salaries, and top-heavy administration -- all of
which serve to work against the delivery of care, not facilitate
it -- are anti-efficiencies that siphon off 20-25% of America's
total health care spending. These are huge sums; yet it's mostly
money down a gold-plated rathole. In the end, it doesn't provide
a single bed, pay a single nurse or doctor, or treat a single
patient.
We'll have rationed
care
Don't look now: but America does ration care. And it does it in
the most capricious, draconian, and often dishonest way
possible.
Mostly, the US system
rations care by simply eliminating large numbers of people from
the system due to an inability to pay. Last year, one-quarter of
all Americans didn't go to a doctor when they needed one because
they couldn't afford it. Nearly that many skipped getting a
test, treatment, prescription, or follow-up appointment
recommended by a doctor. In Canada, those same numbers are in
the 4-5% range; in the UK, 2-3%. Also: nearly 20% of all
Americans had a hard time paying a medical bill last year; and
these stresses now trigger over half of all personal
bankruptcies in the country.
Furthermore, nominally
having health insurance is no guarantee against financial ruin,
as Sicko amply illustrated. Being cut off or denied by
your insurance company is rationing, too. And there are vast
numbers of fairly well-off Americans -- many of them
middle-aged, and too young for Medicare -- who have pre-existing
conditions that render them uninsurable at any price. They're
one heart attack, one diabetic event, or one bad turn away from
financial disaster. Please don't insult these people by telling
them that the American system doesn't ration care.
Another persistent (and
ridiculously mendacious) rationing myth about the Canadian
system is that old people are cut off from treatment and left to
die. I've never heard about a single case of this in Canada; but
it happens routinely to Americans on Medicare and many private
policies, which have strict limits on how long you can stay in
the hospital with an acute illness. When the benefits run out,
ready or not, they send you home. If you die, you die. The
Canadian plan has no such limits: you stay for as long as you
need to. But in the US, these limits fit the very definition of
"rationed care."
Effectively shutting
one-quarter of the population out of the medical system
entirely, and putting many of the rest on short rations,
certainly does make things so much nicer for those happy few who
are still in it. In fact, Americans have these missing millions
to thank for their system's impressively short wait times. Only
4% of American have to wait more than six months for
non-elective surgeries, while 14-15% of Canadian and Britons do.
(Don't blame this on government care, though: in Germany and the
Netherlands, the number is closer to 2%.) When conservatives
start bellowing about Canada's terrifying wait times (which, by
the way, are carefully triaged: it's rare for people to die
waiting, though it happens), we need to remind them that there
are 75 million Americans who have been wait-listed forever.
If my friend's Aunt Millie gets her emergency hip surgery today
because I'm willing to hobble along for an extra couple months
before getting my knee surgery -- well, for any morally serious
person, that choice should be a complete no-brainer.
You can't have
medical innovation without the incentives provided by the free
market.
As in the US, Canada's government funds major medical research
that has led to
a continuous stream of new medical breakthroughs
. (And as this link
shows, the rate of innovation didn't slow down in the least when
Canada moved to single-payer in the 1960s.) All of the country's
medical schools are located within public research universities.
The university that houses my local medical school, the
University of British Columbia, ranked ninth in North America
last year -- in league with UC, Stanford, and other powerhouses
-- in total public and private research grants received by its
labs. Among other things, it leads the way in genetics (David
Suzuki is emeritus faculty), and stem-cell research (having
attracted a handsome roster of American scientists whose
research was thwarted by the political situation at home).
Because the Canadian
health care system is driven by delivering care instead of
profits, the focus of research is sometimes different -- and
often wider-ranging. While there's plenty of pursuit of patents
and innovations, there's also considerable research put into
questioning whether new treatments are really more effective
than older ones; and in pursuing possible treatments that may
not be patentable by anyone. The system is focused first on what
works; and after that, on what might make someone some money.
Single-payer health
care will make America less competitive.
I can't believe people still have the gall to argue this point,
but apparently, they do. There are several reasons this is
flat-out wrong:
Jobs, Jobs, Jobs
-- It's no secret that public health care is making Canada a
more attractive business environment for large manufacturers,
who typically have very high insurance overhead. Toyota and GM
have both moved plants to Canada in recent years, in large part
to avoid the spiraling costs of insuring American workers.
(Toyota also cited Canada's better-educated workers, but that's
another issue for another day.) As long as $900 of every car GM
makes is going to supply health care to the people who make it,
the US's current system of employer-based health care is going
to continue to drive skilled jobs out of the country.
A Smarter, More
Entreprenurial Workforce -- Being relieved of insurance
worries also makes individual citizens more competitive. How
would your life choices change if you didn't have to worry about
health care? Would you go back to school and get your PhD in
lepidoptery? Start a blog -- or a small business? Work part-time
and travel? Tell your boss where he can stick it? Spend a few
years at home with your kids?
Countries with universal
coverage free up their citizens to take advantage of personal
development opportunities that, in the long run, stimulate the
economy and create a more skilled, traveled, educated, and
fulfilled workforce. Americans, on the other hand, routinely
stay chained to jobs they hate -- and are forced to pass up on
chances to expand their horizons and their fortunes -- because
they can't afford to jeopardize their health care coverage. Our
health care mess has reached a point where it jeopardizes not
only our lives, but also our liberty and our ability to pursue
happiness -- as well as the long-term strength of the economy as
a whole.
Increased Financial
and Social Capital -- When families are bankrupted by
medical bills, or are thrown into poverty when a working member
is disabled because they can't afford proper care, or simply
break down and fall apart under the stress of debt and illness,
it's not long before the country's entire social fabric begins
to show the wear and tear -- along with the sense of optimism
and the common good required for a democracy to function.
Part of what makes a
country competitive is its own commitment to the common good.
I've often been impressed by the very tangible sense of civic
pride and shared effort my Canadian neighbors have in the fact
that they're taking the best possible care of their own,
regardless of status, age, or ethnicity. Every encounter with
the medical system reminds them that they're all in this
together. A medical system that routinely drives families into
bankruptcy or divorce court is actively destroying, rather than
adding to, the essential social capital that makes the whole
society function.
No Deferred
Maintenance -- Decades of foregone medical care are starting
to catch up with Americans. We're seeing serious declines on
many fronts: infant mortality, lifespan, cancer rates, heart
disease rates, and increased diabetes. On most of the major
markers of public health, America is nowhere near the top tier
anymore. In some areas, there are a few small former Communist
countries doing better than we are.
Business relies on
healthy workers who aren't distracted by their own illness or
that of a family member. America's uninsured, increasingly
unhealthy workforce is in no position to compete on equal terms
with the strong, healthy workers of other countries who are
getting the care they deserve.
We have more
important matters to tend to -- like national security and the
war.
Getting everyone insured is, unequivocally, a clear matter of
national security.
Our
every-man-for-himself attitude toward health care is a security
threat on a par with unsecured ports. In Canada, people go see
the doctor if they're sick for more than a day or two. It was
this easy access to early treatment, along with the much tighter
public health matrix that enables doctors to share information
quickly, that allowed the country's health care system to detect
the 2003 SARS epidemics in Toronto and Vancouver while they were
still very localized, act within hours to stop them before the
disease spread any further, and track down and treat exposed
people before they got too sick to be helped. In both cases, the
system worked flawlessly. The epidemic was stopped within days
and quashed entirely in under a month, potentially saving of
millions of lives.
In the U.S., that same
epidemic might easily have gone unnoticed for critical days and
weeks. If the first people to get sick were among those 75
million without adequate insurance, they probably would have
toughed it out a few extra days before finally dragging their
half-dead carcasses into an ER somewhere. Not only would they be
much farther along in the course of the disease -- and thus at
greater risk of death themselves -- every one of them could have
infected dozens or even hundreds of other people in the
meantime, accelerating the spread of the epidemic.
Worse: America's
underfunded public health system might have taken several days
to piece together the whole picture of an epidemic; and perhaps
another week or two might have passed before the E. Coli
conservatives in charge (having thrown out the science-based
management plans thoughtfully developed by the bureaucracy)
cooked up some kind of half-assed ideology-driven decision about
how to proceed. (It would, of course, involve spectacular
amounts of lying to the public.) By that point, tens of millions
could have been infected, leading to a death toll that would
make 9/11 and Katrina look like minor statistical blips.
Think about superbugs
and the ongoing waves of immunological imports from the world's
swamps and jungles. Think about terrorists with bioweapons. And
then think again about the undeniable fact that every single
underinsured American is a gaping hole in the safety net that
protects us all from a catastrophic epidemic. This really is one
of those cases in which none of us are safe as long as even one
of us is left at risk. And from a purely economic standpoint:
would you want to invest in a country where there was a
significant risk that an epidemic or a bio-attack, managed by
incompetent officials, might force you to shut down your
business at a moment's notice?
As for the war: Bush's
Folly will generate upwards of half a million veterans, many of
whom will require some kind of sustaining care for the rest of
their lives. VA funding ebbs and flows with the national
political will, and veterans often fall behind other priorities.
But if they can enter the same health care system every other
American depends on, then we can only forget their interests by
forgetting our own as well.
I feel a lot better
knowing my taxes are taking care of my fellow Canadians rather
than buying bombs to drop on Iraqi towns, supporting a
fully-equipped CIA gulag, or funding Baghdad pizza deliveries
via Halliburton. It's hard to become a worldwide empire when
you're putting half your tax revenue into hospitals and doctors,
as Canada does. But, on the other hand, it's hard to insure your
citizens when half your tax revenue is going to feed your war
machine.
In a very real sense,
America has chosen to secure its oil supply at the cost of its
own citizens' health. The more we spend on the former, the less
we have for the latter. And our own relative health -- both
physical and economic -- is starting to show the consequences of
that choice. Ultimately, all these things are connected: by
making ourselves energy independent, we might not only make
ourselves more secure, we'll also finally be able to invest in
the kind of health care that will make us truly competitive in
the world community.
The Bottom Line
In America, a lucky employee with gold-plated employer-based
coverage may well get access to A-level care (though that level
of coverage becoming rarer by the month, even among the
professional classes). On the other hand, about 50 million
under-insured Americans are barely scraping by with C or D-level
care; and the nearly 50 million with no insurance at all get
next to no care whatsoever. Worst of all: 18,000 Americans die
every year due to lack of access to healthcare. That's one every
30 minutes, around the clock, every day of the year -- the
equivalent death toll of six 9/11s every single year that
passes.
In Canada, everybody
gets at least B-level care, pretty consistently across the board
-- and, on occasion, quite a bit better than that. You might not
like those odds if you're one of the shrinking handful of
Americans who's used to A-level care; but if that's not you,
you'd be getting a much better deal in Canada.
The private sector has
had 20 years to prove that it could deliver low-cost, quality
care using those vaunted business-style efficiencies; and it has
failed us utterly and completely. This fact should be the
ultimate nail in the coffin of the old conservative canard that
"the free market always does it better." If that was true,
privatizing health care would have been the shining example that
proved it once and for all. Instead, all we got was a colossally
expensive national disaster that's denying full coverage to a
third of the country --- and putting our health,
competitiveness, financial and social capital, and national
security at risk in the process. It's also devastating the
aspirations of our entire middle class, which is being hollowed
out by our current health policies.
A famous Hebrew prophet
once advised his followers to take the log out of their own eyes
before trying to remove the splinter from someone else's. As
much as it hurts American pride to admit it, Canada and the rest
of the industrialized world has us roundly beat on this one.
Those who are so quick to criticize the Canadian system might be
better off holding their fire until they've shown us they can do
better. America, and the world, is waiting.