In the spirit of my new intention to keep my posts here on the shorter side of the street (unlike in the past), I offer you the following rant.
I’m a bit late on weighing in on the health care debate, I admit. The American discussion about health care reform always rings so very foreign to my, well, foreign ears. It is one of the few areas where I feel my Canuck-ness holding me back from really and truly being able to participate in the discussion in a full-bodied fashion.
Score one for cultural relativism, I suppose.
Of a heartening note is the degree of recognition that seems to be present about the need for reform. Of course, what that reform winds up looking like is the fat in this fire. One of the lines of thought that always causes my head to shake is the doom, gloom, and, frankly, fear mongering that debaters on both sides often exhibit when talking about the single-payer systems in other comparable countries like Canada and the UK. To listen to some health care advocates talk, you’d think that communist Russia was a picnic compared to what we poor proletariat saps endure on a day-to-day basis.
Well, as a Canadian who follows US politics closely, let me respond to your smears with a hearty: het!
Listen, no intellectually honest Canadian (or likely Brit, though I’ll let those food boiling bastards speak for themselves) is going to look you in the eye and tell you that the system of health care we have in this country is perfect. There are problems. And how to go about fixing those problems is a constant source of debate in Canadian political discourse. But these stories and examples that you yanks pull out about the about the crumbling state of our commie health care system fundamentally contributing to the deterioration of the average Canadian’s health just doesn’t ring true to the vast majority of our ears.
Look, for the vast majority of Canadians, our single-payer health care system works reasonably well. Ours is not the perfect system, and we have some significant challenges to address within it. But a majority of Canadians receive a good quality of health care and live a pretty reasonable quality of life as a result. That reality might account for why Canada consistently scores quite high on the UN’s Human Development Index.
Maybe.
So holster your health care ammo when talking about my socialist outpost of a country and quieten your shaking knees at the thought of a single payer system. How that system works is still very much up for debate and while I tend to hold a reasonable degree of skepticism about government overreach, it remains the case that there are some areas where government, as opposed to markets and corporations, is a better arbiter. Certainly this is true in terms of the onus required of your businesses, particularly small, to both stay competitive in this dour market and maintain their employee benefits.
I’m just sayin’.
And, frankly, given the choice between dealing with problems about how your large, sometimes unwieldy, but universally accessible system can best attend to the needs of basically every citizen of the country and how to deal with as many as 47 million citizens of your country not having any real system available to them at all, I’m pretty sure I know which set of problems I’d prefer to have on my plate.
But that’s just one moose lover’s opinion.
Kim 
Karen Edmisten 
Pierre Corneille 
London conference venues 
Will Truman 
Patrick Cahalan 
Cornelius 
wardsmith 
Borat: “I do a picture, only small, of the Tishnik Masacre. Where many Uzbeks…crushed!”
Kindly Gray Hippie: “How did you feel when you drew this?”
Borat: “Very proud!”.
KGH: “I’m just listening with sadness…a little sadness for your people…?”
Borat: “Yes…no, it is not sad. It is us who do the kill!”
When in doubt,
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As a half Canadian I’d like to put my oar in on behalf of my childhood nation. I agree, the Canadian single payer has its flaws, but I’ve experienced it closely at least twice in my lifetime and in both occurrences it acquitted itself well. My grandmother and my Father both died of cancer (Lung and Leukemia) a decade apart thankfully. While I remember the black emotional turmoil of those times I do not require my family suffering any direct financial fear on account of the costs of their treatments. My Grandmother lingered and I recall no word of limiting of care. My Father was treated with stem cells after having his rebelling immune system burned out with chemo and perished due to the inability to handle the anti-rejection drugs which kept his donated immune system from trying to murder him. My Mother never had to pay much beyond some modest co-pays on treatment and drugs. I can not imagine how much worse the experience of loosing loved ones would have been had we also had the specter of financial concerns hovering over us. I don’t know that single payer would be good for America but I do know that based on my experiences it would be the towering height of hypocrisy for me to view the Canadian system with anything other than mild gratitude.
Don’t you know that philosophy is far more important then experience. The philosophy of many people says that single payer, or any other kind of national health care, does not work and will result in tyranny. So there.
Well I know that anecdotal experience is not a very strong form of evidence. And as a center leftist I view expanded government programs with a jaundiced eye. But what can I say? The Canadian system has been very good to me and to mine. I know that the theory says there are failings and I’ll acknowledge them but I just haven’t felt them. Every country seems to have their sacred cows. Canadians definitely have their health care system as one. There are worse things in the world for a country to obsess over.
I’m not Canadian but I’m married to one. When discussing health care with her, and the merits of our system vs. their system, I like to point out that the “My name is Joe and I AM CANADIAN” guy moved here the second he found a little bit of fame.
You deserve a serious response. I apologize for my humorous (fsvo “humor”) one.
Without breaking down the 47 million number (something worth doing) or getting into discussions about cultural homogeneity (also a fun one), I think that it is fair to ask whether the US’s umbrella of security has allowed for money that would have otherwise been spent on guns to have been spent on butter.
When socialized health care was instituted (I want to say a few years after WWII ended, no?) in Canada, the Canadians pretty much decimated their military spending. Allowed to be, effectively, isolationist in their military stances, they had the license to institute social services (one sees this in much of Europe as well).
Canada does have a much more Universal Health Care system than the US has. It’s very good to a large number of people. Indeed, indeed it does.
People say that Social Security is the third rail of American politics. If that is true then defense spending is some sort of Uber-third rail. We could all be flying nuclear powered hover cars, let alone insure everybody, if we didn’t spend quite so much on defense.
Yeah, don’t get me started. It’s the quickest, easiest way to divert funds to your district. Make sure that your supporters are able to keep their jobs making special aluminum pull tabs for military-grade ammunition containers. The military can even say “we don’t need that, we don’t use it, don’t make it” and people will scream “BUT HOW MANY PEOPLE WILL LOSE THEIR JOBS???”
E.D. wrote a post about Bastiat writing about this, actually.
Acute hospital care became free of charge in 1957 in Canada. It wasn’t until 1966 that physician services got the same status.
At any rate, if you could choose between invading Iraq and having universal health coverage, it’s pretty clear what the right choice is. It’s also pretty clear where Republican priorities are.
Invading Iraq wasn’t the problem. It was staying there and acting like a half-assed colonial power after deposing the government there.
That’s an irresponsible a comment on two levels. First, whatever Rumsfeld’s dreams may have been, both we and the commander-in-chief were told what the deal was by Gen. Powell before we went in, and the C-in-C fully accepted that. But even if the entire government had honestly believed we could just get in and get out, that in itself would have been irresponsible, because even if Powell had kept silent about the obligations we would incur from elective war aimed at regime change, we would have still incurred them. Which is to say Powell was right: we didn’t buy anything we didn’t take off the shelf ourselves.
Here are a couple breakdowns of the 47 million number that make it seem suspect.
The president, health-care wonks like Ezra Klein, and many others on the left drop the 47 million figure pretty carelessly. I wish there were a more authoritative/consensus estimate…
You may have missed the doctor’s best point: “a lot of people with insurance don’t get good health care.” My insurance costs roughly $6000 per year (single man, non-smoker, under 35). But it has a lifetime maximum if I get sick, along with all kinds of crazy co-pays, deductibles and garbage like that before we get to the maximum. So I overpay if I’m healthy; and I can go bankrupt if I get sick. Basically everyone in the entire country who has private insurance is in this situation; who cares if the definition of the uninsured is imprecise?
Isolationist?
No. Unlike the US, we just avoid starting wars. We’re fighting in Afghanistan for the single reason that we’re backing up you guys because you were attacked.
I would like to say that in terms of cost generally, I think you do have a point. I don’t think military spending is the real trade-off, though. We have a 5% (formerly 7%) sales tax on virtually everything which is roughly equivalent in revenues to expenditures on health care. The difference is that most people in the US are far more tax-averse than most Canadians, so it would be difficult to implement a system like that in America.
“I think that it is fair to ask whether the US’s umbrella of security has allowed for money that would have otherwise been spent on guns to have been spent on butter.”
Fair to who? Canadians save money on their system, because single-payer health care is much cheaper than what we have.
Whom.
Their single-payer health care system was built upon a homogenous society’s idea that The Government ought to broker the payments to health care.
The Sainted FDR in his infinite wisdom, however, instituted salary caps in the US to help deal with the financial problems and companies, wishing to compete for labor (more like compete for the right to exploit labor, amirite?) asked if they could offer health care in addition to the capped salaries. The government okayed this… and our system diverged from the idea that the Canadians and British implemented after WWII ended.
All that to say: I blame the Democrats for why we don’t have Single-Payer Health Care today.
Blame? If you don’t want it, you should credit the Democrats with that.
They did not give me (disease), they gave me (other disease).
It’s hard for me to be grateful that I didn’t get (disease) from them. Those who are complaining that we have (other disease) when we ought to have (disease) may be interested in knowing why… and the answer is FDR was trying to make everything good for everybody.
There’s good and bad to lots of these various systems. You could point to dozens and say about each – “Look, it’s great! It’s better than ours! Let’s do that!” But you can’t as easily spell out how it could be implemented here.
The Dutch system is getting the “best of its class” ratings in Europe and it’s far more free market than any of its neighbors’ systems or ours. And it’s cheap because competition brings down prices.
But how could we implement that here?
Um, the problem is it’s very, very hard to point to the US system and say it’s better than ANY of the various other Western systems. That’s the key: virtually every other system is better than ours. Go ahead, randomly pick one, and legislate it; things will likely get better.
I wouldn’t be so certain about that.
I don’t understand this “how” question. Just… do it. It’s not like we have some magical sui generis things that are completely unlike the rest of the world. Like our corporations are made out of cheese or something.
Scott, what’s your take on this comment at Megan’s?
Tom’s comment is a total joke. First of all, Canadians and Americans over 65 are almost all covered by government health insurance, which is funded about 40% more per capita in the US. Some of this is because things cost more in the US; some is more generous benefits. But there is no large difference in expenditures or outcomes for old people.
So we are talking about health care for people under age 65. This is where American health care costs three times as much as the Canadian version but achieves poorer results. You’re dreaming if you don’t think bureaucrats control your health care options in the US – they just happen to be employed by private insurers that, unlike the government, cannot be voted out if they do a poor job covering health care.
We don’t need to look at Canada for a model. We have a model in the United States that works for Americans: Medicare and Medicaid. My wife is a doctor – government-paid health insurance is great for her patients, particularly in catastrophic situations. The system is simple; approval is smooth; it pays out. People with private insurance spend all of their time fighting to make it work when they really should be paying attention to their illness.
The total cost of our health care system is a different story. But private insurers – who’ve raised premiums 100% in 7 years – are no solution to that. Our entire health insurance system will crumple in a heap in 2016 if the government isn’t involved in setting up a sustainable cost structure.
It’s a funny thing: Americans believe they’re the best in the world at everything. And it’s often true, usually because Americans do work hard as a nation and don’t settle for mediocrity. But on health care for people under 65, most Americans will tie themselves in knots trying to explain why an obviously crappy system is something better.
> We don’t need to look at Canada for a model. We have a model in the United States that works for Americans: Medicare and Medicaid
This makes sense if you have infinite amounts of money. Every health-care analyst knows that a national Medicare would have to be significantly pared down to reduce costs. Which would be like Canada. So looking at Canada when considering single-payer is the correct thing to do.
And I think Tom’s post sheds some light on why that isn’t such a good idea.
I wouldn’t call the things Tom writes “reasons.” Tom does make four assertions:
1) The doctors don’t have to cater to ridiculous demands for unnecessary tests, and have no incentive to give them.
2) [Canada is] large enough that most of us don’t see the direct comparison with the American system, (which is nice, but three times the price).
3) [Canada is] insulated enough so that when the doctor’s say “there’s nothing we can do”, you can believe it without feeling guilty about not destroying your family’s finances to pay for some sliver of hope.
4) We benefit from the American innovations when they’re finally brought down to a cost that our bureaucrats consider acceptable.
#1 seems like a benefit of the Canadian system.
#2 implies that Canadians know nothing about the American system, other than it’s expensive. I’ll admit that when I lived in Canada, I too was convinced that Americans with jobs had health insurance that was just as good as what we got in Canada, and didn’t require you to pay out-of-pocket. I was wrong, and I think this is another point in Canada’s favor (if it’s indeed a point.)
#3 – the vast majority of people who get told “there’s nothing else we can do,” are over 65. So they are getting *government* health care whether they’re in Canada or the US. I’ve watched my grandparents die in the hospital – in both Canada and the US – and there was no apparent difference. You’re really throwing out a law school hypothetical here: a wealthy person with the absolute best health insurance and a lot of savings is reputed to have more access to expensive treatments than a wealthy person in Canada. It’s possible. But most Americans under 65 would be bankrupt well before this point because their health insurance would have cut them off or otherwise run out. So what really happens is that you get the same treatment in either country, and in the US you have the added bonus of going bankrupt.
#4 – again, there’s an implication that somehow things are different in the US. My company just changed insurance; my new prescription drug plan only covers generics, even if you’ve been taking an effective drug for years. This cannot be taken as evidence that the US system is better than the Canadian one.
The only point that I cannot refute is the idea that if we continue to subsidize the drug makers, they will produce more and better drugs that they would not produce if we paid them the same prices for their drugs as every other country does. My doctor wife refutes this, but hey, what does she know? She’s only involved in delivering care, dealing with public and private health insurance and deciding when there’s nothing more you can do.
Excellent post. My first hand experience with the NHS makes the state of the US debate rather baffling ot me.
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