Single-payer health care in Canada and… the USA?
I’m currently part-way through another round of my winter session online course on Michael Ondaatje and was responding today to a discussion board thread in which my students were talking about some of the things they know about Canada. One student brought up the health care system and I responded as follows:
As I often tell my students, learning more about another country (and
particularly one that’s as close to home geographically, culturally, and
historically as Canada) can teach Americans a lot about their own
country as well. As D…. pointed out, I think one of the things that
should really make Americans look more critically at their own
healthcare system is the lack here of universal health care, something
that every other well-off country in the world enjoys. Universal health
care is not “free” health care at all. Canadians pay for it in taxes and
employers also pay health care premiums. However, the Canadian
government still pays less per capita than the American government and
the premiums paid by businesses per employee is about 10% of what UVM
contributes towards my insurance. As D… also rightly pointed out,
though, the Canadian system is also far from perfect (very long wait
times for particular tests, specialists etc). Knowing about how another
system works, though, is crucial to being able to see what works and
doesn’t work well enough in your own system. Canadians often use the
American system in that way to both argue for what we should be doing
(better access, shorter wait times etc) and shouldn’t (privatized
insurance etc).
Who knew that this would also be the subject of a couple of really interesting NY Times pieces over the last couple of days. In Paul Krugman’s editorial “A Healthy New Year” (which you might not be able to open without being a TimesSelect subscriber) he states that “The U.S. health care system is a scandal and a disgrace. [. . .] In 2005, almost 47 million Americans — including more than 8 million children — were uninsured, and many more had inadequate insurance.” Krugman goes on to bring up some of the points I always tell my students:
Some say that we can’t afford universal health care, even though every year lack of insurance plunges millions of Americans into severe financial distress and sends thousands to an early grave. But every other advanced country somehow manages to provide all its citizens with essential care. The only reason universal coverage seems hard to achieve here is the spectacular inefficiency of the U.S. health care system.
Americans spend more on health care per person than anyone else — almost twice as much as the French, whose medical care is among the best in the world. Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation. How do we do it?
[. . .] The truth is that we can afford to cover the uninsured. What we can’t afford is to keep going without a universal health care system.
Krugman, like Anna Bernasek’s article from this past Sunday’s NY Times entitled “Health Care Problem? Check the American Psyche,” says that “If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.” As Bernasek points out, the greatest obstacle to such a plan is not really the logistics of making such a drastic change but rather convincing Americans that such a system would be possible and that it would actually be to their own benefit.
Even though “the economic case for a single-payer system is surprisingly strong” and “as demonstrated in France, Britain, Canada, Australia and other countries with functioning single-payer systems, significant savings can come without hurting the overall health of the population,” the case for a single-payer system is a hard one to make here. “Most Americans just don’t believe it can be done,” Bernasek writes. “The health care crisis may turn out to be more of a problem of ideology than economics.”
Canada, interestingly enough, proves to be one of the key examples Bernasek offers as to the positive aspects of the single-payer system and to people’s aversion to this idea here, which Bernasek seems to find as hard to fathom as I do.
Consider Canada’s system. Professor Anderson points out that in the 1960s, Canada and the United States spent roughly the same per person on health care. Some three decades later, though, Canada spent half as much as America. How did Canada manage this? By controlling the use of medical equipment and hospital resources, which statistics show has helped Canadians keep a lid on costs without measurably compromising the overall health of the population.
Despite everything that is known about the economic benefits of a single-payer system, there’s one big stumbling block: many Americans don’t believe in it. They have heard horror stories from abroad, often spread by partisan advocates, focusing on worst-case examples. Such tales play upon the aversion of many Americans to government involvement in the economy.
Victor R. Fuchs, an economics professor at Stanford and a specialist in health care economics, explained it this way: “The Canadian system is a nonstarter for the U.S. even though it’s a good system for Canadians. You’re dealing with two very different countries. We were founded on life, liberty and the pursuit of happiness. They were founded on peace, order and good government. It’s a difference of values.â€
I, frankly, don’t see how life, liberty, and the pursuit of happiness (they sure were a great band, weren’t they?) can make the idea of giving everyone in the US access to much more affordable health care while still positively affecting the bottom line a “non-starter.” But maybe that’s just my Canadian “difference of values”…. I don’t think so.
13 comments
Healthcare remains a tough subject worldwide. Although the level of care here in South Africa is high, there are severe staff shortages that causes tremendous hardship where the ‘ordinary’ folk without medical aid are concerned. Our system is far from perfect.
There are already many countries that apply salary deduction to a person who wants to have a basic health insurance (which may also include the immediate family members). Maybe the U.S. can try this one out. However, the next question would be: What about the unemployed?
Healthcare is the basic buiding block of a society. United States is a huge country and is very wealthy. Although there are a lot of extremely wealthy people, there are also a lot of people who can not afford medical insurance, and according no appropriate healthcare. Although Maxism has not been realised in Europe, European countries indeed have learned something from Maxism. They put high taxation on rich, then provide better social benefits system (including healthcare) for ordinary people.
Yes, I can understand the staff shortage in South Afica. It was a same case with that in the UK as well. In the UK, recent years the government has considerably increased the salary for healthcare staffs, thus attracting more people working in this sector.
All in all, government policy is important for healthcare. So I agree always learning in other countries will be beneficial for the policy makers
Great post! Healthcare and more importantly free healthcare will always be a massive issue and one that will never be resolved to suit the masses.
Aptly said. Knowing about others is vital too.
It seem like it’s a good think for good proved medical treatments. My employer pays $15,000 for my health insurance and I pay $800 a year. Wouldn’t it be smarter to use that money to fund a government program. My employer has 750,000 employees. They could start there and with other governemt employees to see how it will work.
I agree with you, health care is a tough subject. Maybe we should think of offering more support to the poors such as Canada did.
The current health care system we have here in the U.S. is simply not working. I think this could possibly be a better and effective way that we should look into.
I found your blog on google and read a few of your other posts. I just added you to my Google News Reader. Keep up the good work. Look forward to reading more from you in the future.
With healthy care being such a huge topic and concern it is hard to narrow down what is going to provide the best solution. When you really think about the over all picture worldwide, is there a solution that fits all, NO! I rally don’t see how universal health care can be the solution. Who is going to manage it and define it?
I just can not see it happening properly. I am sure that the quality will diminish and as usual the taxes collected will not be fair to all. Then you have to really look t how well all that money will be used.
I just an not see it working and the push for it is like most social programs, presented a good for all involved. We all have clearly seen that that is not always the case. It is sold to o one front and then regulated differently after it has been establish.
I don’t want to be negative about it however I really don’t want to be forced into another false fronted program.
Although Maxism has not been realised in Europe, European countries indeed have learned something from Maxism. They put high taxation on rich, then provide better social benefits system (including healthcare) for ordinary people.
In my opinion Health Care should be freely accessible to all people. The USA is suppossed to lead the way for other western countries yet poverty prevents access to health care in the US as it does in third world countries.
If you look at Australia you will see that free health care does not detract from a wealthy society.
The problem with the healthcare system in the United States is that everyone wants the best and lot’s of it but no one wants to pay for it. The young and healthy can’t justify paying into a system and the old and sick can’t afford to go it alone. The government can’t continue to print money and pile up debt until the US becomes a second tier debtor country. The only REAL solution to control cost is by reducing consumption. This means rationing! Anything else is just short term, smoke and mirrors wishful thinking.
Respectfully
Kirby Horton