Canada May Have the Cure For US’s Medicare Ailment June 21, 2011Posted by rogerhollander in Canada, Economic Crisis, Health.
Tags: Canada, canada health, health care, health care spending, health costs, health reform, healthcare, medicare, paul krugman, roger hollander, single payer, sustainable health, tommy douglas
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Roger’s note: A few FACTS about the Canadian Health Care System to counter the lies put forward by the shameless Tea Party and other right-wing Republican Evangelical types. (1) users have absolute right to choose their physicians; (2) to make the system more efficient, one needs to be referred to a specialist by her family physician; (3) some provinces have community clinics where one can join — at no cost, of course — and receive care from salaried health care professionals (doctors on salary, can you imagine such a radical notion?!?); the founder of the Canadian Health Care System, Tommy Douglas, was voted the greatest Canadian of all times in a poll conducted by the Canadian Broadcasting Company; (4) the rumours about long waits for service have a grain of truth to them, but this is not because of a flaw in the system; rather it is due to right-wing provincial governments reducing funding; but in emergency situations care is not delayed. I am a Canadian, and I have lived under both the US and Canadian health care systems, and there is absolutely no question which is more efficient and humane. The Canadian system of early intervention at no cost to the patient or her family saved the life of my two-year old daughter when she had spinal meningitis. When my father visited us in Canada from the States and took ill, I brought him to the office of my family physician, who treated him. The office, however, was stumped as to what to do about payment. They never had to collect money before and didn’t know what to do with it. In Canada, you go to the doctor or laboratory and present you health card. No money changes hands. No co-payments. Imagine!
Tuesday 21 June 2011
Crystal Bentley is examined by Dr. Tom Novak at a clinic in Oshawa, Canada. (Photo: Donald Weber for The New York Times)
I keep hearing people say that Medicare in its current form is not sustainable in the United States, as if that were an established fact. It’s anything but.
What is Medicare? It’s single-payer coverage for the elderly.
Other countries have single-payer systems that are much cheaper than ours — and also much cheaper than private insurance in America. So there’s nothing about the form that makes Medicare unsustainable, unless you think that health care itself is unsustainable.
What is true is that American Medicare is expensive compared to, say, Canadian Medicare (yes, that’s what they call their system) or the French health care system (which is complicated, but largely single-payer in its essentials); that’s because American-style Medicare is very open-ended, reluctant to say no to paying for medically dubious procedures, and also fails to make use of its pricing power over drugs and other items. So Medicare will have to start saying no; it will have to provide incentives to move away from fee-for-service, and so on and so forth. But such changes would not mean a fundamental change in the way Medicare works.
Of course, what the people who say things like “Medicare is unsustainable” usually mean is that it must be privatized, converted into a voucher system, or whatever. The thing is, none of those changes would make the system more efficient — on the contrary.
So this business about Medicare in its present form being unsustainable sounds wise but is actually a stupid slogan. The solution to the future of Medicare is Medicare — smarter, less open-ended, but recognizably the same program.
Just a further data note. Canada’s Medicare is actually a lot like Medicare in the United States, but less open-ended and more serious about cost control. Here’s a chart showing Canadian spending on health versus American spending, both as percentages of gross domestic product.
Hmm. Canadian Medicare looks pretty sustainable, especially as compared to the American system, which has much more private insurance.
Now, Canadian health care isn’t perfect — but it’s not bad, and Canadians are happier with their system than we are with ours in the United States. So anyone who tells you that Medicare as we know it — a single-payer system that covers everyone over a certain age — is unsustainable is ignoring the clear evidence that other countries somehow manage to make similar systems quite sustainable.
Paul Krugman joined The New York Times in 1999 as a columnist on the Op-Ed page and continues as a professor of economics and international affairs at Princeton University. He was awarded the Nobel in economic science in 2008.
Mr Krugman is the author or editor of 20 books and more than 200 papers in professional journals and edited volumes, including “The Return of Depression Economics” (2008) and “The Conscience of a Liberal” (2007). Copyright 2011 The New York Times.
Healthy Opinions About Health Care June 21, 2009Posted by rogerhollander in A: Roger's Original Essays, About Health, Canada, Health.
Tags: canada health, canada health care, health care, health care reform, health costs, health insurance, health opinions, healthcare reform, hmos, national helath, new york time poll, opinion polls, private health insurance, roger hollander, single payer, tommy douglas, universal health
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Roger Hollander, www.rogerhollander.com, June 21, 2009
We Canadians know a good thing when we see, and live it and enjoy it and depend on it. I’m not talking about maple syrup, although that might come in a distant second. It’s our national health plan. In the forty one years I have lived in Canada I have never once heard any politician from any political party suggest its abolition (not that the Tories do not do their best to defund and attempt to erode it). It would be political suicide. A few years ago a CBC poll asked Canadians who in their estimation was the greatest Canadian of all times. The hands down winner was Tommy Douglas, the man who, as Premier of the prairie Province of Saskatchewan, introduced universal health care to Canada (he also happened to be Donald Sutherland’s father-in-law).
What Canada has is NOT government health care. It is rather universal health insurance with a single insurer, the government (organized province by province). Contrary to myth, and unlike HMOs and other private health insurance in the States, Canadians have an absolute right to choose their own physicians. Furthermore, in all my years living in Canada not once have I walked into a doctor’s office, clinic, laboratory or hospital and had to open my wallet (other than to produce my plastic health card). When my father was visiting from the States and needed to see my primary care physician, the office staff had to fumble around trying to figure out how to take a cash payment from him. It had never happened before.
The Canadian health care provider, be it a physician, laboratory, etc., simply fills out a form and sends it to the government for payment according to a scale that is negotiated between the government a provider organizations such as the Canadian Medical Association. There are no blood-sucking private health insurers to send costs through the ceiling and squeeze out bigger profits with co-payments and by denying treatment. The Canadian plan is funded by employer and employee contributions.
Despite massive disinformation campaigns about the Canadian health care system that are funded and promoted by the health insurance industry, the pharmaceutical industry and the Republican Party, a majority of Americans favor what is referred to as a single-payer system over the existing Rube Goldberg system in the States that passes for health care, a system that costs more, yields poorer results, and leaves tens of millions without coverage.
A CBS News/New York Times poll that was published in today’s New York Times (http://www.nytimes.com/2009/06/21/health/policy/21poll.html?_r=1&hpw) showed that 72% of respondents supported government health insurance with only 20% opposed (the poll did not refer to a “single-payer” plan, but rather a public plan that would compete with private plans; other polls have shown a majority in favor of single-payer).
Surprisingly, the poll showed 50% of Republicans in favor with 30% opposed. 87% of registered Democrats approved and 73% of Independents.
50% of all respondents thought government would do a better job than private insurance companies in providing medical coverage against 34% who thought it would do a worse job. 59% thought government would do a better job of holding down health costs while 26% thought they would do worse.
But here is what for me is the most interesting and telling statistic that arises out of the poll. Respondents were asked if they were willing to pay higher taxes so that all Americans have health insurance that they can’t loose no matter what. 57% said yes and 27 % said no. That’s better than a two to one ratio. And here’s the kicker: of those who earn less than $50.000 annually, 64% are willing to pay more so fellow Americans are not denied health care and 27% are not. For those earning more than $50,000, 52% are willing and 44% are not.
Look at those numbers carefully. While only 27% of poorer Americans are not willing to help their fellow citizens, a whopping 44% of those with greater means don’t give a damn.
This is what I call compassionate conservatism.
Tags: big pharma, canada helath, canadian health care, canadian healthcare, clintons, health, health care, health care costs, health care reform, health costs, health insurance, health insurance industry, healthcare, healthcare costs, healthcare reform, Medicaid, medicare, paul rogat loeb, pharmaceutical industry, private health insurance, rick scott, Robert Reich, roger hollander, singel-payer, single payer, tommy douglas
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Will serious health reform meet the fate of the scorpion and the turtle? In that fable, the scorpion pleads with the turtle to carry him across a river. The turtle resists, fearing the scorpion’s sting, but the scorpion reassures him that he’d do nothing so foolish, since both would drown if he did. Finally the turtle agrees. Halfway across, the scorpion betrays his promise with a lethal sting. As the turtle begins to drown, he asks why he took both their lives. “It’s just who I am,” the scorpion replies.
I fear we’re about to get stung again. When people look back at the failure of the Clinton-era health care initiative, they point, accurately, to an opaque process that produced a baroque Rube Goldberg mess that satisfied no one. That happened even before the insurance industry went on the attack with their Harry and Louise ads. But another missing element parallels our current challenge-appeasement of the insurance companies as the plan’s centerpiece, and the inevitability that these same interests will betray us again.
The Clintons assumed the insurance companies were too powerful to confront, so the plan had to go along with them. But once they assumed any bill had to get the companies’ approval, no plan could work, because it had to build in ways for the companies to maintain their profit margins and the immensely wasteful overhead they spend on advertising, processing claims, and turning down as many sick people as they can. Their approach also creates corollary wastes, like the third of the expenses of the average medical office that go toward dealing with insurance company paperwork.
Our health care crisis is so dire that the simple single-payer approach, as in Canada, should be at least seriously debated. Compared with us, most Canadians are satisfied with their system, in contrast with a recent US poll where 49 percent said our health system needed fundamental changes and 38 percent said it should be completely rebuilt. Canadians get a full choice of doctors (unlike in the US, where households have to switch doctors when employers change their insurance or insurance companies change their preferred provider lists). Tommy Douglas, the Canadian New Democratic Party leader who pushed through national health care in the mid-60s (replacing a system like ours), was recently voted Greatest Canadian in a recent contest, beating hockey star Wayne Gretzky and Prime Minister Pierre Trudeau.
Even if single payer isn’t politically achievable yet, there’s no reason to take it off the table from the beginning. Doing so means most Americans never get to hear the contrast in cost savings, in allocation ease, in impact on ordinary citizens and their health outcomes. They never get to hear the story that might allow them to overcome current fears about losing the health care they have, being unable to see their preferred doctor, or being condemned to the Purgatory of endless waiting. Maybe we’ve been so conditioned that we can’t quite get the support for a full-fledged switch. A recent Kaiser Foundation poll still gives single-payer a narrow 49 to 47 percent majority, vs 67 percent for including a fully competitive public option, and maybe that isn’t enough. But at least we need to tell the story, so the probably inevitable compromise works down from full public coverage, as opposed to considering options that gut even the option of serious public coverage entirely.
Instead, because we’ve accepted the premise that the private insurance companies have to be included, we’re now starting to consider including a public option only if it includes poison pills that will doom it to fail, like requiring it be triggered by a set of exceedingly unlikely circumstances deferred to the indefinite future. Or requiring it to play by rules so onerous that it can’t achieve its straightforward cost savings. Or turning it over to the states, so Big Pharma and Big Insurance interests can simply, as Robert Reich warns, “buy off legislators and officials as they’ve been doing for years.”
But why assume that the insurance companies are our friends? Why appease them at all? It’s not as if they’ve played a helpful role in our current system. Rather, they’ve gamed it in every possible way, leaving our country with the highest health care costs in the world and worst health outcomes of any advanced industrial country. While they’ve made promises to cut costs, their promises are only that (like the scorpion’s), and they’re already lobbying with everything they have to gut any seriously competitive public option. Add in examples like former HCA/Columbia CEO Rick Scott. after his company paid a $1.7 billion fine (the largest in US history) for defrauding Medicare, Medicaid, and the program that serves our armed forces, he is now organizing attacks on any public program (hiring the PR firm that coordinated the “Swift Boat” attacks on John Kerry). We need to challenge the insurance companies, not appease them. There’s no evidence that suggests they’re constructive players, or are likely to do anything except defend their own parochial interest.
The insurance companies and other major financial interests are talking a good line of late. They have no choice if they don’t want to be cut out of the game. But ultimately, they are who they are, and their behavior reflects this. It makes no sense to embrace a partner who you know will ultimately betray you.
Maybe the public private mix is the best compromise we can get at the moment. But we must raise our voices now to demand a full debate on the other alternatives, like single payer, and then if necessary settle for something that gives a public option a chance, under equitable rules, to see how it plays out in efficiency, service, and cost. Trusting the insurance companies and stacking the deck to guarantee that private options will prevail merely assures we continue our dysfunctional system until its human and financial costs drown us all.
Paul Rogat Loeb is the author of The Impossible Will Take a Little While: A Citizen’s Guide to Hope in a Time of Fear, named the #3 political book of 2004 by the History Channel and the American Book Association. His previous books include Soul of a Citizen: Living With Conviction in a Cynical Time. See www.paulloeb.org To receive his articles directly email email@example.com with the subject line: subscribe paulloeb-articles.