Canadian-style health care for the U.S.?

Great Debates
1

In this thread the question of health care came up. Rather than hijack that thread, I thought I’d post this one.

In the U.S. we have private health care insurance for people who can afford it. We have MediCare for people who cannot. Unfortunately, and in my unresearched opinion, there seems to be little or no overlap. There are millions (?) of uninsured people in this, the monetarily richest country on Earth.

I think it would be a good thing for the U.S. to have Canadian-style universal health care. I rarely go to the doctor myself, so my insurance contributions are subsidising people who need more health care. Would Canadian-style healthcare be a good thing for the U.S.? It seems to me that with such a system, people’s basic needs can be provided for. I think that it would provide for greater needs as well. I think that private health care could be provided through a person’s employer or that it can be purchased by individuals to supplement government-provided insurance.

The advantages that I see are these:
[ul]
[li]People under the government’s “umbrella” coverage could go to their own doctors instead of having to go to a free clinic.[/li][li]People would not have to worry about, “Is this covered? Do I have enough insurance?”[/li][li]Doctors would be assured of payment, as their patients would have government-guaranteed coverage.[/li][li]People who have additional coverage supplied by their employers, or who purchase their own supplemental insurance, should not have to wait nine months for an MRI or other expensive procedure. (I don’t see how changing the method of payment would suddenly reduce the number of MRI machines, heart surgeons, trauma doctors, etc.)[/li][/ul]

As I said, I have done no research. My perceptions may be completely wrong, and I know that errors will be pointed out by other posters.

But I think that in an enlightened society every citizen’s health care should be funded by the taxes he or she pays. Although I am a strong supporter of the U.S. military (Navy family, and all), I think that National Health Care could be funded by shaving a few percent off of the military budget. (Do we need a missile defence shield? I don’t think so.) I think that Canadian-style National Health Care would me sufficient for most U.S. citizens.

This is what I think. How about you?

2

Well, considering that Canada currently has a 9-month waiting list for MRI scans, is suffering a huge drain of people to the U.S., and is generally moving towards a more U.S. styled health care system, I’d say it’s a bad move.

And be ready for a 9-12% payroll tax to pay for it. At least.

3

I’d rather have an Austrian style health care system for the US :D.

Basically it is a mixture of public and private. The government organizes people into mass groups based on occupation and/or geography and then goes to the insurance companies and have them compete to provide coverage for these blocks of people. For those that cannot pay premiums out of their paycheck (ie, the poor block), the government pays.

4

That may be so; but I don’t see MRI machines disappearing if the method of payment changes. I also don’t think that there are millions of people just waiting for free MRIs. Certainly there are people who need MRIs that can’t afford them; but I can’t imagine that there are so many that there would be a backlog, considering the number of machines that (I assume) are in the U.S.

I don’t know what percentage of an employee’s compensation is used for health care coverage. Employees typically pay a token amount (in my case I think it’s about $20 per pay period) and the employer pays the rest. While I agree that there would probably be increased taxes, I think that those employers that do not wish to pay for supplemental coverage for their employees would be paying the same amount as they are already paying, but to the government in the form of payroll taxes.

And government-paid health benefits would certainly lower the cost for some people. For example, my mom’s husband is paying $700 per month in insurance premiums because of a heart valve problem. That’s almost as much as I pay for rent! People like my mom’s husband would benefit from government-sponsored health care. For people like me, who are healthy, there shouldn’t be much difference – except that if we lose our jobs we won’t have to worry about sudden illness or accidents.

Also, as I pointed out, I think that by trimming our military budget alone will pay for the coverage; and we’re already paying for that. (It may also make the rest of the world less nervous that we may choose to use our military might.)

ISiddiqui: A mixture of public and private is what I had in mind. I don’t know about organising people in “blocks”, though. I think we should all have a U.S.-issued health care card that the government would use to pay the health care providor. Why not use Social Security cards, since they are required and we all have our own numbers? Additional insurance could be bought privately.

(I understand the system you’re describing, and I see how it is different from what I was thinking of.)

5

I’m not sure the government should pay EVERYTHING. The ‘blocks’ would keep insurance premiums low (since they couldn’t discriminate based on individual ailments, but could price differently based on inherant health risks of a certai job). I think insurance companies should be able to seperate people of different jobs to fully charge premiums that would be fair. Some people might have to pay more for participating in riskier jobs, but that would be more fair to the insurance companies (we don’t want to drive them out of business).

6

No matter what our circumstances are, or for those who are more unfortunate, for whatever reason, all Canadians can be assured of a level of health care that can only be exceeded by wealthy Americans. I say assured, because I hope that Johnny L.A.'smother’s husband or his mother for that matter can continue to fork out $700 per month for health coverage. That is so fucking ridiculous. I’m surprised he doesn’t get a heart attack from the anxiety of suddenly not being able to keep up the premium.

If we have problems up here with our health care system, it is largely because of political squables between conservative leaning provincial politicians who want to maintain their constitutionally guaranteed control of the health care system, while having the federal government pay for it WITHOUT STRINGS ATTACHED. Until these petty problems are settled Canadians will have to do with slightly less than optimum health care. And the money’s there . We’ve had huge federal budgetary surpluses for quite a few years now.

Keep in mind when assessing the cost of the Canadian system as opposed to the American system the rising relative importance of drugs in health care. Americans are crossing the border in droves to buy American drugs at less than half price because our government can negotiate the best price. This is a huge difference, especially when you get older.

Is anyone satisfied with their HMO ?

7

You will find many articles right now about the difficulties facing the Candian health care system. It’s true, we have some pretty serious problems and a major report was just issued on a revamping of our system with a massive cash infusion. We’ll see if that happens, polls have shown Canadians want our system fixed but don’t want to pay any extra taxes to do it.

It seems to me a real problem is the waste that happens in our system. I was talking to a doctor aquaintance of mine who told me he estimates 80% of his time is wasted on frivolous appointments. He may have been exaggerating to me, but we really have to cut this down. When people don’t have to pay for every trip to the doctor they tend to go more often even if they don’t need to. There was some research here into (I beleive) Sweden’s system where it is also publicy funded but you have to pay a nominal user fee for every visit. Maybe they’ll try to adopt something like that.

Regardless of our problems with long waiting lists and such, it is a great comfort to know that even if something serious happens to you, you will not lose your house and all your life savings to pay for it. We periodically get horror stories of that happening south of the border, don’t know how common that is though.

8

Oregon had a measure on the ballot that would have implemented a Canadian like healthcare system, but unfortunately it got voted down. I voted for it, for what it’s worth.

Hopefully, next election it will win. I was so annoyed by how arguments on the ballot referred to the Canadian health care system as a “disaster” but without providing any concrete examples. Common sense may yet prevail.

9

This is what I’m talking about. I feel that people should be assured of coverage without having to pay outrageous amounts for it. I think that people should have coverage even if they are unemployed or cannot afford to pay for it.

We typically have to pay a “co-payment” for each visit. For example, $10 per visit.

Of course most people have to pay something for hospital visits. An insurance company might pay 80%, but the rest comes out of the insured’s pocket (typically with an annual cap of a few thousand dollars).

I don’t have a problem with co-payments. I don’t have much of a problem with sharing hospital stays (up to a point). I just think that health care should be funded by the government instead of private companies. I’m sure we’ve all heard about HMOs that refuse to cover treatments. I know I’ve heard of a couple of horror stories where the HMO apparently decide that it’s cheaper to let a patient die than to pay for treatment. (Sorry, no cite for that. Just stuff I hear on NPR from time to time.) I think that if the government did the paying we would hear less of corporate greed costing people’s lives. For me, I think it’s simple: Make an appointment, go to the doctor, give your Social Security card and ten or twenty bucks to the receptionist, get the treatment, and the government pays. Additional insurance could be purchased to cover expenses (such as 20% of a hospital stay) if the government keeps such out-of-pocket expenses to discourage people from going for treatment “frivolously”.

Indeed, he used to have a high-pressure job managing buildings for Hilton Hotels. After being laid off he got a job that pays a fraction of what he was making before. He was recently offered a position similar to what he had before, but opted to keep the no-stress job he has. Basically, he’s working to pay for the insurance.

10

Canada has plenty of MRI machines. They are sitting idle, because we can’t afford the maintenance and personnel to run them. Our MRI machines are running at something like 30% of capacity, yet we have 9-month waiting lists. It’s crazy.

But not surprising. When you over-ride the market and try to rule by fiat, the inevitable result is a series of shortages and gluts. For example, in my home town of Lethbridge we had two hospitals about 2 blocks from each other, which were about 75% utilized. But then some politician got elected on a promise to improve health care, and the end result was the construction of an immense regional hospital a couple of blocks from the other two. Now they’re all running way below capacity. In the meantime, other less politically-connected communities have no hospitals at all.

My wife is a nurse, and I’ve seen first-hand how it goes. When the public is relatively happy with health care, it stops being a political hot-button, and the government cuts it to the bone. Then it goes into crisis, and the result is a huge cash infusion which gets spent frivolously. For example, they cut nurses salaries a few years ago, and suffered a huge drain of nurses to the southern states. Then when the economy turned around, suddenly the nurses got a huge raise (17-22%). Now senior nurses make something like $65,000 a year, but there’s a huge shortage. But the high salaries will eventually bring more students into the nursing colleges. But by the time they are ready to enter the workforce our budget will be busted and nursing salaries will be cut again. Then we’ll wind up with a glut for a while.

The bottom line is that society can’t afford all the health care it wants. There is scarcity, and you can’t fix that by passing a law. Right now, prices in the U.S. control the demand for health care, so some poor people don’t get the same treatment as the rich. But if you remove prices as the limiting factor, you wind up having to limit it through restriction in supply. Thus, you get long waiting lists.

So you can choose - you can have a system controlled by prices, or one where everyone has ‘access’ to health care, but no one gets timely care.

I read an article in the paper a couple of weeks ago that said that, although many people point to the higher average lifespans in Canada as opposed to the U.S. as a sign that our health care is better, the proper measure is to see how long people’s lifespans are AFTER they enter the health care system. And apparently, the U.S. kicks our ass in this regard. More people in the U.S. survive cancer and heart disease than they do in Canada. The difference was quite startling. I remember the number for one form of cancer (lung cancer, I think), where the average lifespan for a diagnosed Canadian was 5.7 years, whereas it was almost 10 years in the U.S. The big part of that is probably earlier detection because you guys actually USE your MRI machines…

11

I’d love to see that article, Sam. For all the bellyaching I’ve always seen about long waiting lists for MRIs and such, I’ve never seen any data showing that those waiting lists lead to greater morbidity or mortality. (Those data may exist, I’ve just never seen them.)

My impression is that, in that example, there are nine-month waiting lists for more elective sorts of imaging procedures. If you really need an MRI right now–as in the case of an acute stroke–you get it now.

This also ignores the fact that we do way too many procedures like these in the US; MRIs are not quite the big offenders that CT scans are in that regard. It could be that most of the people who wait nine months for an MRI in Canada and most of the people who get one more quickly in the US would be just as well off without getting it at all. (That’s why I’m curious to see the numbers in your article.)

I would love to see a universal health care system, but it won’t work unless our politicians can work together and be dedicated to its success. It would be better by far than what we have, at a lesser cost, if we had cooperation between patients, doctors, and politicians, a willingness to fund it adequately, and acceptance of its limitations. As none of these things are likely, I have to join the chorus of those who agree that something must be done about our health care system, but damn if I know what.

Dr. J

12

I’ve been digging for it, but I can’t find it online. I’ll try some more.

In the meantime, here’s the latest fraser institute report on waiting lists in Canada: http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=413

According to the study:

[ul]
[li]Compared to 1993, waiting time in 2001/02 is up by 77%, an historic high for this country. [/li][li]The average wait from GP to treatment averaged across all 12 specialties, among the 10 provinces surveyed, was 16.5 weeks in 2001/02, up from 16.2 weeks last year. [/li][li]Wait times between consultation and actual treatment increased across the country between 2000/01 and 2001/02, rising from 9.0 weeks to 9.2. [/li][li]Patients also experience delays in accessing CT scans (5.2 weeks), MRIs (12.4) and ultrasounds (3.2). (note: this contradicts my 9-month figure, so I will withdraw that until I get better data)[/li][li]The survey also asked physicians what percentage of their patients sought care outside the country. Patients needing radiation oncology showed the highest rate at 3.7%. For all specialties, about 1.3% of patients left the country for treatment. (note: I suspect this number is low, because people will under-report this to their doctor)[/li][/ul]

And there is no sign here that the situation is getting better, and plenty of signs that it’s getting worse (such as that 77% increase in waiting times since 1993, despite the fact that health care spending as a percentage of GDP increased from 6.5% to 9.5% over the same period).

Also, Canada has a huge benefit in that we live next door to a large, vibrant, free medical system. Canada’s rates of investment in medical research are poor. Many of our more difficult, expensive cases go to the U.S. where treatment is better, offloading costs from the Canadian health care system.

13

Doesn’t the Canadian health system provide global coverage to Candian citizens? Or are Canadians abroad left to their own devices?

14

It purports to provide full coverage, but as I’ve shown, waiting lists sometimes make that impossible.

The head of the Canadian Chamber of Commerce died while on a one-year waiting list to have his brain tumor diagnosed.

The premier of Ontario, a champion of Canadian health care, chose to go to the United States for cancer treatment, because if you have the money American health care is better than Canada’s. Especially cancer treatments.

15

[Anecdotal Evidence]

A good friend of mine who is Canadian and still lives in Canada waited a year for a diagnosis of lung cancer and another year before he could start radiation and chemotherapy in Canada. His odds of long term survival are far lower now than they were two years ago when the cancer was still in early stages. He will probably die because he didn’t get diagnosed and treated fast enough. Sometimes I wish the people who wanted Canadian style health care in the U.S. would ask him if he thinks he had ‘adequate access to high quality health care’ before they start trying to change things here. [/Anecdotal Evidence]

And FWIW, I’m not a rich person, but I have an excellent level of health care some of you apparently don’t believe is possible for the average middle class working American stiff.

16

I’m not sure what the plan is for long-term travellers overseas such as the snowbirds, but for short-term trips, we must purchase tavel insurance.

We could be on the cusp of a major revolution in our health care system. There is a real public and political will to revamp and modernize it. If you want Canadian style, maybe wait a couple years to see how ours develops.

It’s a real challenge when you want European social programs and an American economy.

17

I hate how these arguments always turn into pragmatic debates. Whether or not it “works” or how well it might work does not matter. What matters is if it is morally correct. Does the government have the right to even be in the health care industry?
Take the recent example of the new anti-terrorism laws being passed in the US. The debate is not whether or not folks think that they will work, or how well they will work. The debate is whether or not they are right in the first place. If we were to have strict racial profiling of Muslims and Arabs in the US, it would very likely be a significant hindrance to terrorism, but would it be moral to do so?
What annoys me most is when people whom I know are against large government controls will then argue from standpoints that grant the assumptions that these controls and programs are basically good and moral, just not feasible. It is self-defeating and ultimately useless; the other side has won the real debate before it has started. It reminds me of the old Winston Churchill quote :

[qoute]Winston: “Madam, Would you sleep with me for 1m Pounds?”
Unknown woman: “Yes sir, I think I would”
Winston: “Well, how about 1 Pound?”
Unknown woman: “Winston! What sort of woman do you think I am?”
Winston: “Madam, that matter has already been solved. Now we’re just bartering over your price.”[/qoute]

18

My family coverage costs $600/month on the company group plan. Add in my Medicare deductions and all the co-pays ($25 per doctor visit, $20 per prescription), and I don’t get terribly worried about the prospect of a 9 - 12% payroll tax instead.

19

Americans already pay a huge amount of their income tax to Medicare and Medicaid. Combined, those programs consume as much tax money as the Department of Defense. A Canadian-style system would presumably REPLACE those programs; the marginal cost would be minimal, if Canadian costs were matched.

20

If the cost stays the same, but more people are covered, then the overall cost of medical care will necessarily have to increase. No getting around that. I believe that 9-12% makes up the additional amount needed to cover the new costs. After all the U.S. already pays close to 15% of GDP on health, and there’s no way a 9-12% payroll tax would cover that.