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Jewish World Review June 15, 2005 / 8 Sivan, 5765 Between restrictions and chaos By Froma Harrop
http://www.JewishWorldReview.com |
Most every uninformed debate on health care in the United States
has its Canadian moment. The guy against universal coverage pounds the table
and says: "People in Canada wait three months for an MRI! We don't want that
here."
Not a bad conclusion. We don't want the Canadian way of
delivering medical services. But that doesn't mean we don't want universal
coverage. Nearly every industrialized country guarantees health coverage for
all without the shortcomings of the Canadian system.
Under Canada's single-payer setup, the government writes all the
checks for health care. Of the 28 developed countries that offer universal
coverage, only Canada bans private medicine.
Herein lies the problem that a recent Canadian Supreme Court
decision may start to fix. The court has just lifted the prohibition on
private health insurance in the province of Quebec.
The ruling has cheered table-pounders from America's
conservative wing. Many are using it to hit the dream of universal coverage
over the head. And left-leaning Canadians working their own neuroses are
helping them. Both groups are misguided.
"We've become stuck in the weird dichotomy that private sector
involvement in health care means abandoning the universal access nature of
our program," says Nadeem Esmail, senior health policy analyst at the Fraser
Institute, a Vancouver-based think tank. Not so.
The Supreme Court case centered on George Zeliotis and his bum
hip. Zeliotis' arthritic hip was torturing him, but the Montreal retiree had
to wait a year for hip replacement surgery. Private insurance, which he
could not buy, might have helped him avoid the long waiting list. (Loopholes
in certain provinces let Canadians patronize private clinics, as long as
they pay with cash.)
The court said that Zeliotis had the right to buy private health
insurance, when the public system didn't provide timely care. The heavens
opened on Canadian politics. "The ban in other provinces still stands,"
policy analyst Esmail says, "but it's on shaky ground now."
Some Canadians fear that the court ruling threatens their
beloved tradition of equal-quality care for all citizens: It would add a
second tier of private coverage for rich people, a process they denounce as
"Americanization."
Like it or not, Canadians already have a two-tier health system.
The second tier happens to be in the United States. Zeliotis could have gone
to Detroit and had his hip replaced for something in the neighborhood of
$35,000. He couldn't afford it. But affluent Canadians can and do avail
themselves of American medicine.
Rather than obsess about rich people getting fancier medical
services, health-system planners should ensure that the bottom tier gets
good care. They should think "floors," not "ceilings."
Canada spends more on health care than any other industrialized
country with universal coverage, but it doesn't get great results, according
to a Fraser Institute study. The World Health Organization ranks Canada's
health-care system 30th in the world. The No. 1 system is France's, which
allows private medical services to augment its public program. (Canadians
could just as easily call allowing private insurance the Frenchification of
their system as the Americanization of it.)
The American debate often skips past the reality that, like the
French, we already offer a mix of public and private health care. U.S.
taxpayers provide health insurance for select groups — Medicare serving the
elderly and Medicaid for the poor. What makes us different from France is
that we don't cover everybody, we spend a ton more per-capita on health
services and we sit 37th in world rankings.
Canadians and Americans, meanwhile, seem to nurture mirror-image
delusions about their health-care systems. Canadians believe that private
health care can't coexist with a universal system serving rich and poor.
Americans think that 45 million uninsured people is the price they must pay
for the freedom to buy the medicine they want.
Both peoples are presented a false choice, between a restrictive
single-payer system and total chaos, American-style. Other models, on other
continents, are definitely worth a look.
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© 2005 Creators Syndicate |
Arnold Ahlert | |||||||||||
