Two Models of Health Care Rationing: Sick and Sicker
By Dr. SUSAN ROSENTHAL, M.D.
Everyone knows that Canadians live longer and have lower infant mortality rates than Americans. In Sicko, Michael Moore suggests that a Canadian-style medical system would solve this problem. Surprisingly, the evidence indicates that it would not.
A cross-border team of 17 researchers (including high-profile supporters of the Canadian system) examined a variety of medical problems, including cancer, coronary artery disease, chronic illness and surgical procedures. With the single exception of end-stage kidney disease, where Canadian patients fared better, they found no consistent difference in patient outcomes between the two nations.1 As I have argued elsewhere, the United States has the worst health statistics in the industrialized world because it is the most unequal society in the industrialized world.2
Although Canada’s medical system does not produce generally better patient outcomes, it is more equitable and far more economical. In 2003, the average American spent almost twice as much for medical care as the average Canadian. Exorbitant medical bills are a constant worry and a major cause of personal bankruptcy. Profit-taking is responsible for the high cost of American medicine. However, the Canadian system is also subject to market forces.
Contrary to popular belief, Canada does not have a single-payer medical system. Government pays about 70 percent of medical costs, including most hospital and physician care. Individuals and private insurance companies pay the remaining 30 percent for prescription drugs, dental and vision care, ambulance, medical devices, home care and other services.
To contain costs, both the United States and Canada ration medical care, but they do this in different ways. In the U.S., more than 47 million people have no medical insurance at all. The Institute of Medicine estimates that 18,000 people die every year as a result. In Canada, lack of access is more equitably spread across the population in the form of long waits for assessment and treatment. We don’t know how many Canadians die while waiting for treatment, because no one is counting the bodies.3 The Canadian model of rationing is sick, and the American model is sicker because it unfairly discriminates against those who cannot pay. Neither is good enough. Medical care is a human right and should not be rationed at all.
Disgust with the American medical system has built support for HR 676–The United States National Health Insurance Act–a single-payer system where medical care would be publicly financed and privately delivered. Winning HR 676 would be a tremendous victory. However, the Canadian experience shows that private delivery of medical care opens the door to parasitical profit-taking.
The Canadian experience
Until the 1960’s the American and Canadian medical systems were nearly identical. Those with the highest incomes obtained the lion’s share of medical services even though those with the lowest incomes experienced the most illness. The logical solution was a government-run system to provide medical care for all, but doctors and private insurers rejected what they called “state medicine and socialism.”
During the upturn of the 1960s, the pressure grew for universal health care. To contain demand, the federal government launched a Royal Commission to “study” the problem. The Canadian Labour Congress (CLC) made its preference clear.
“We favor a system of public health care that will be universal in application and comprehensive in coverage. We favor a system that will present no economic barrier between the service and those who need it. We are opposed to any provision which will require some people to submit themselves to a means test in order to obtain service. We look to a system of health care that will be regarded as a public service and not as an insurance mechanism.”4
The public-service model, where government is both payer and provider, was rejected. Instead, the Medical Care Insurance Act of 1966 established a publicly-financed system that would be administered and delivered by the private sector, “free of government control or domination.”
The province of Quebec took a different route. Pressured by workers’ demands that culminated in the 1972 General Strike, Quebec incorporated medical services into a broad social benefits system, paid for and provided by the provincial government. The Quebec working class is rarely credited for producing the most comprehensive medical system in North America.
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