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

Great Debates
21

How about a mixed system, where the government pays for basic care (and I realize there would be a huge amount of haggling over what is “basic”), but people could buy private policies for more complex/experimental things?

I can’t believe I paid $4500 out of pocket for emergency care for a broken leg, plus one night in the hospital, because I was 2 days short of having insurance on my new job. (And that wasn’t ICU; I wasn’t even hooked up to an IV. It was basically just to have the nurses keep an eye on me for the night and bring me drugs and edpans when I needed them.) I wasn’t eligible for COBRA coverage, because my former employer was too small. I figured, I’m young and healthy, I can go 30 days without insurance, right? But is one night of their time really the equivalent of a couple months of my salary?

I did receive excellent care, but come on! Something with this system is broken! Setting a broken leg doesn’t require advanced experimental techniques, or any equipment fancier than an X-ray machine.

22

Sorry, no cite for this one other than class notes, but the health administration costs in the US are also supposed to be a great deal higher than those in Canada.

I’m a nursing student right now and I just took a tour of a level 3 NICU the other day. I can’t even begin to imagine how expensive it is to keep a child there for months at a time and I’m betting most of those parents are very relieved at being able to concentrate on the health of their child instead of worrying where the money is going to come from.

23

Just to pipe in as another random anecdote, I’m a barely-middle class guy with excellent health coverage. It’s a perk of my wife’s job - she pays something like $20/month to cover both of us, and the care is exceptional. One year waiting lists my ass.

Sam Stone:
You say that the average wait between consultation and treatment is roughly nine weeks? Jeebus! What, exactly, constitutes " consultation" and “treatment”? For instance, my wife calls the doctor, makes an appointment for a few days later, goes in, and usually is prescribed medication that day, though sometimes it take a day or so for test results to come back. Is that what is meant by “treatment”, or does “treatment” entail more drastic things, like operations?

Muad’Dib:
I think, in principle, it would be nice if everything were a function of morality, but sometimes pragmatism has to weigh in. If, for example, a government-run health care system would save 50,000 lives per year, and make an additional 200,000 lives significantly better, for a small cost to everyone, I would say the social benefits outweigh the blow to liberty, such that everyone would be better off in the long run. True, it would be counter to libertarian ideals, but libertarian ideals sometimes run aground in the muck of the real world. Fortunately, in this case, the moral solution and the practical solution are the same - a privately run health system.

Jeff

24

I don’t understand how you’re coming to these conclusions, and your math is wonky. First of all, government-paid health care in the United States is more expensive than in Canada. I would assume that one of the benefits of switching to a Canadian-style system would be that it is demonstrably CHEAPER.

An ADDITIONAL 9% payroll tax is a ridiculous exaggeration - that hike alone would be around three quarters of a trillion dollars, almost twice as much money as the US federal government spends on Medicare and Medicaid now. Plus, Americans already spend about $400 billion a year on Medicare and Medicaid, so your payroll tax is bringing total federal health expenditures to about $1.2 trillion, or about 50% of the entire federal budget. So what you seem to be saying is that by switching to a system that costs Canada less than what the US pays now, the US would TRIPLE its public health costs. I don’t understand that.

Total Canadian government health spending for ALL government, federal and provincial, is about $40-45 billion USD per year - per capita, roughly the same as what the US is spending TODAY in Medicare and Medicaid. and that’s just the US federal government; there’s also state outlays and far more personal outlays involved. I do not understand why a Canadian system would cost them three times as much.

25

Perhaps I was hasty calling for a “Canadian-style” health care plan. If I may clarify (and I know that it’s late in the thread), what I’d really like to see is A) “Canadian-style” in that everyone in the country has access to government-paid health services, and B) these health services would be provided regardless of a person’s employment status or income. Of course we have “free clinics”, but from what I’ve heard from people who have used then they are kind of squalid and the staff don’t seem to care or take pride in their work.

I know people who have been diagnosed with a medical condition and have been prescribed medication, but the clinic refuse to provide the medication because “if you’re coming to a free clinic, then you’re going to abuse any drugs we give you because you’re poor and that’s what poor people do.” Granted, there are people who do abuse prescriptions and many of those who do are poor. But Winona Ryder isn’t poor, and she was caught with prescription drugs and was assumed to be abusing them.

What irks me about the U.S. system is that some people who need drugs are not getting them because of preconceptions and prejudices. It seems unfair that people such as my mother’s husband have to spend most of their paycheques on medicine and insurance premiums. Why should Eva Luna have to shell out big bucks to be healed just because she’s new on the job? Why should people lose their coverage just because they’ve lost their jobs, often or even usually through no fault of their own?

The purpose of paying taxes is to provide services to the people who are paying them. The U.S. is the richest country on the planet. The government provides roads and other infrastructure. They provide personnel to find the bad guys after we’ve been victimized by hoods. It provides protection from foreign aggression. It inserts itself into myriad aspects of our lives. Isn’t it just right for the government to provide basic health care for all of its citizens? Even with government-provided health care, cannot people exercise their right to buy additional coverage if they so desire? And if they cannot afford additional coverage, shouldn’t the government be their to at least provide the essentials? I believe studies have shown that more frequent doctor visits result in a healthier population, which in turn has the effect of lowering health costs.

Call it “Canadian-style” or “Australian-style” or “Swedish-style” or whatever you like. I chose the first because Canada is close. But whatever it’s called, I think that every citizen deserves to live without the fear of financial ruin arising from illness or injury. And I think that every citizen deserves health coverage without regard to his or her employment status or income.

26

But what if there isn’t enough health care to go around? When you lower the price of something, you stimulate demand.

I’m also aware that the U.S. pay more for health care as a percentage of GDP, but all that means is that the U.S. system could be improved. But even that is not clear, because the two countries are not directly comparable. The U.S. has much higher incidence of violent crime, and also is much more litigious.

27

Yea like 39,000,000 Americanssuddenly going for free annual check ups. That will wreck the American economy !

28

I never go to the doctor. If I didn’t have to payfor health care I would go all the time.

29

Yeah, that is one of the challenges with a publicly finded system, it tends to get abused. I can understand it in some ways, when it’s your health you don’t want to risk something turning into a serious problem if you have the ability to get it checked out for free. My partner has a coworker that goes to the doctor everytime she has a cold. User fees and an education campaign are needed I think.

I’m 30 and I rarely go to the doctor because I don’t want to waste resouces for those who need it, my time will come later.

30

Interesting thread. Sam Stone, you’re in Canada and I’m not, so I can’t really argue with you. But you are the first Canadian that I’ve heard saying that Canada’s health care system is bad. I admit that I don’t know a lot of details. Maybe the Swedish system is better, or the Australian one. (My general impression is that northern Europeans do all social stuff better than anyone else, but I can’t really back that up.)

I do know that 30 years ago, when my father broke his back (in the US), he had a health insurance plan at the factory where he was working. But it was a limited plan, and he had to pay some himself. More importantly, since his back was broken and he spent the next two years, more or less, in a hospital bed, he lost his job–and his insurance. Within a few weeks, all the money he had saved for his children’s college education had vanished. Within a few months, his house was gone. Now, thirty years later, he’s doing a little better, barely. He has another house, but it’s a big step down from what he had before. My parents get by with social security and a little veteran’s pension, and they struggle to pay for their own health insurance. They plan carefully to decide how many times a month they can afford to go out to dinner at the local cafeteria.

My father was never a rich man, never was likely to be a rich man. He was a sharecropper’s son and he didn’t finish high school. But he was doing all right, when I was a teenager. It was looking like his future would be okay–not luxurious, but decent. Almost overnight, he became a poor man, because of an accident on the job. A broken back has got to be a misfortune for anyone, but it shouldn’t have been like that. It ruined his life, and pretty much ruined my mother’s, and did some pretty serious damage to my life and my sisters’ lives, too.

The old man always paid his taxes, served his country, fought in the big war, Purple Heart and all that. I just wonder what the hell a government is for, if not to take care of the health care needs of people like him. The nearest veteran’s hospital is an hour’s drive away, and filthy and disgusting to boot. Sure, the US has used its tax revenues to build some decent roads and schools, and an enormous monster of a military. But I think it owes its citizens some sort of health care plan too, something beyond Medicare and Medicaid. Not sure it should be modeled on Canada’s plan, but all my Canadian co-workers say that they never worry about the financial impact of catastrophic illness or injury. I do wish I could say the same.

By the way, I’m a US citizen, though I live in Korea. The health care system here is a lot better than in the US. Okay, not better, but available. Here, I have a semi-modern health care system at my disposal automatically. The last time I lived in the US, I was standing in line with the junkies on the sidewalk at the free clinic in San Francisco’s Tenderloin district. I had a job, and the flu, but no insurance.

31

Of course, if you went to the doctor more often, the effect of preventive health care may make it less likely you’ll develop something that costs a LOT of money to fix.

I think you’d find eventually that even when it’s free, going to the doctor isn’t a big barrel of laughs. I only go if I absolutely have to.

32

In Canada, we have waiting time in the Doctor’s office as well. Quite often over half an hour beyond schedule. Pretty hard to schedule your time around a doctor’s appointment. Inconvenient.

33

Happens here all the time, too. I don’t think single-payer care would save us from bureaucratic foulups, it’s just that a smaller proportion of them would have to do with billing and payment.

34

The market failings that are mentioned above about single-payer health care…i.e., it getting overused if it is free…pretty much would apply already to those of us who have reasonably good private health insurance. I.e., once we have the insurance, we no longer have the price incentive to avoid medical treatment. I’m sure this results in some overuse … But, it doesn’t seem to be out of control.

Admittedly, many people have small copayments in private health care but there are ways one could work out such a copayment system with a single-payer system too, although one would want to strike a balance between discouraging frivolous visits and pricing people out of getting health care when they need it.

35

I agree with jshore. I have health care through my employment. I have to pay $10 per doctor’s visit, and $10 for prescriptions. And yet I rarely go to the doctor. I had a cyst removed and treatment for excess stomach acid this year, but other than that the only time I go to the doctor is for my FAA flight physicals. These physicals happen every two years, and I pay for them myself ($75). I’d rather go to work than be sitting in a doctor’s office for “nothing”. I think most people who have health care coverage don’t abuse their coverage.

So a single-payer, government-run plan, which I perhaps erroneously referred to as “Canadian-style”, would make no difference to me. However, such a plan would cover – what was the number? 39,000,000? – people who lack coverage now. Many of these people need coverage. Many more basicaly work to be able to afford insurance instead of building a life. Most of those people can afford $10 or $20 per visit, and I think that would discourage “frivolous” visits; and at the same time universal health coverage would be there for them when they needed it.

36

Precisely. I don’t know that this is a standard use of ‘irresponsible’ to characterize that behavior, but I’ll agree that it is at least probably more than necessary.

It is likely, as RickJay noted, that this behavior for me—and others that are similar to me (oh, they’re out there!)—would fade in time, though there would probably still be many who continued the behavior as well.

I’m 26 and I never go. I don’t see this behavior changing any time soon, though (as Rickjey also noted) it would probably be best for my health to stick to preventitive medicine whenever possible.

37

Bullshit.

It may be that way in some places, but definetly not everywhere. Mrs. Bernse had to wait 4 weeks for hers, and if we wanted one sooner she could have went to Edmonton and had it in about 2.

And we live in Armpit, Northern Alberta.

38

Washington Monthly had an excellent article last year that examined the dynamics and various interests behind critiques of the canadian system. Outside of the government in power it is in virtually no ones interest to portray the system as functioning adequately. Health care professionals want more money and facilities, opposition parties want to attack the current government and right wing groups want to show the failings of socialism. As if that were not enough, american health care groups are also very involved in finding fault with our system for debates like this one.

Add to this the fact that every aspect of health care in Canada is political and resolved through messy public debate. In the US if your HMO or insurer is inadequate you (theoretically) have market solutions. In canada you call the newspaper and get on the front page.

This isn’t to say there are not significant problems with our system but imagine your average hmo or insurer subject to that kind of scrutiny.

Waiting lists are a favorite subject for those critiquing the system. While there are real problems they can be deceptive. For the most part, those who need immediate treatment almost always receive it, those who can wait often do. My girlfriend waits months to see her endocrynologist for instance but it makes little difference in her case. Another friend with a serious thyroid problem gets in right away. Some of the anecdotes mentioned above sound more like negligence from the primary care physician than a symptom of waiting lists.

Other facts have to be treated with a certain amount of skepticism. Sam’s statistics on canadians seeking treatment in the US, for instance, include the vast number of snowbirds who live in the U.S. for half the year. They also include those sent to the US for treatment paid by our system. For those that are left, the statistics give us no indication that there is a significant difference in treatment outcome. When you do look at treatment outcomes generally significant differences are hard to find. http://www.ices.on.ca/PDFs\TechnicalReports\99-04-TR.pdf

I wouldn’t necessarily suggest that the US adopt our system but yours is really screwy. Private health insurance only works because the health care system is massively subsidized by public spending. In fact, on a per capita basis, US public spending on health care is the same as ours just to provide for the half of the population private industry wants no part of because they are old, poor or sick.

39

bernse: I had already retracted that, when another analysis I linked to above contradicted that number.

40

Apologies. Sorry for not opening my eyes and reading more closely!