Friday, August 14, 2009

America's love affair with ignorance

There has been a lot of blogging recently about an editorial in Investors Business Daily. A summary of some of the best-known blogs can be found on the BBC website. In addition to what one finds there, a reflective piece occurs as part of a recent post on Bodhipaksa's blog site, Bodhi Tree Swaying

The BBC site notes that a theme in the debates among bloggers is whether the author of the Investors Business Daily was deliberately lying about the British national health care system or simply misinformed. As I have heard some of the questions coming from the audience at town-hall meetings on the proposed health care reforms in the United States, I have been astonished at the level of ignorance being manifested in the questions. As I have written before, it is astonishing to me to hear comments about “the” Canadian health care system. (As I pointed out in that blog posting, Canada does not have a health-care system; each province has one, and the details are different from one province to another.) I have heard almost everything from Americans but accuracy in descriptions of Canadian health care; even Americans who are relatively well-informed about the world in general seem to know very little about their neighbors to the north. In this post I plan to draw attention to a few features of the systems that I personally experienced while living in Manitoba, Alberta, British Columbia, Ontario and Québec, Canada and to say why I would love to see similar features in the United States.

  • Universal coverage. There may be people living in Canada who are not covered by any health insurance, but it is not because they cannot afford insurance or because they have been rejected as a bad risk by an insurance company. There are various ways to make sure that low-income people are covered. One method is to subsidize people below a given level of income as reported in their annual income tax filings. Another is to pay for health care out of taxes, which automatically means that those who make (and spend) a lot of money pay more into the health care system, and those who earn or spend little pay less into the system.
  • Excellent medical care. Twice when I was in hospital in Canada for surgical interventions that I never would have been able to afford in the United States, I met patients from the United States who had come to Canada for medical procedures more advanced than any they could find in the United States. They were not there because the price was lower for procedures than the price would be in their own country; they were there because they could get in Canada medical attention that was not available at all in the United States. Canadian medical research is among the best in the world, and it becomes available to the public much more quickly than it would do in a profit-oriented systems.
  • Cost-efficient medical care. Because most medical insurance is provided through government-run plans, billing is simple and can be carried out by far fewer clerks and bureaucrats than is the case in a system in which there are numerous insurance companies, each with its own forms and regulations. Medical procedures are routinely approved in Canada, unlike the case in the United States where insurance companies, motivated by the need to make profits to pass on to their shareholders, spend time and money finding reasons to deny claims. (In my own experience, I never had to appeal a single medical expense during my thirty-six years in Canada. Since moving back to the United States, I have had to appeal several decision made by my insurance company.
  • Employers do not pay for employee's health care. One of the greatest advantages of a single-payer system is that health care costs are borne by a combination of the person insured and the government, not by the insured person's employer. This means small businesses In Canada are not burdened by having to pay the same high costs as their American counterparts. When the North American Free Trade Agreement first came into effect, this became one of the first major issues of dispute. American small businesses complained that Canadian competitors had an unfair advantage, because they had no health-care premiums to provide for their employees. Strangely, rather than demanding a single-payer in their own country, American companies insisted that it was only just for them to impose tariffs on Canadian goods and service.
  • Canadian pharmaceutical providers are limited in the amount of profits they can make on a product. If you have an e-mail account, it is likely you (or your spam filter) receive several e-mails a week advertising pharmaceutical products at Canadian prices. Canadian prices are lower than American prices for exactly the same products, because the Canadian government places a cap on the amount of profit a pharmaceutical company can make on a given product. The profit margin is still reasonable, but it is not allowed to become exorbitant as American profit margins are allowed to get.

The Canadian health-care systems provided by the provinces I have lived in are far superior to anything I have experienced in the United States. (Having said that, I have heard enough about the Kaiser plan in California to think it would make an excellent model for health-care in the United States.) What has amazed me most about the debates in the United States is that from the very start the most sensible plan of all—a single-payer system—has been “off the table.” None of the various proposals being considered in the United States would make the US health-care system even close to either the British or the Canadian systems or anything that is available in Europe or Japan. Almost as astonishing to me has been the sheer ignorance that prevails in the United States about why health care is so substandard in the United States. In place of accurate information and careful argumentation, one finds in this debate very little but misinformation and inflammatory rhetoric. If Americans do not wake up and take an interest in matters that are to their own advantage, they will end up with the inferior kind of health care that willfully ignorant people probably deserve.