Topic: For policy wonks...
Healthcare: When Politics Become Personal, A Canadian View
In the almost four years that Just Above Sunset has been on line the topic of healthcare has come up almost twenty times. The topic bubbles up now and then because it is a matter public policy, and for most Americans, personal. The costs keep rising, employers are playing less and less and employees more. And for what? The World Heath Organization rates healthcare in the United States rather low - France most recently had the best system in the world. We have approximately forty-four million uninsured, a rather high morbidity rate, a rather high rate of infant mortality, and we spend the most per capita on healthcare. What up with that? Could it have to do with for-profit providers and administrators, a private systems lightly regulated by the government, and a tradition of health insurance provided only by employers? It is somewhat a free-market approach. We have decided the government has no business in running a "single-payer" system, supported by taxpayers, that assures every citizen can get access to medical care. We trust to market forces and "freedom to choose" - if people want care and will pay for it, the vendors will compete for their dollars, offering more and more and better and better care, at lower and lower cost, as they compete with each other for those dollars. Well, it's a theory, or, more precisely, and ideology.
But we have a mixed-mode system. The government provides Medicare for those for whom the system has no answers, the poor and unemployed and elderly (and Wal-Mart workers). The government takes care of veterans. And hospital emergency rooms and regional trauma centers are required by law to treat whoever walks in, or is rolled in, regardless of their ability to pay for immediate, necessary treatment. Of course, the latest issue is Medicare Part D - the government covering the cost medications for the poor and unemployed and elderly (and Wal-Mart workers). That program is not going well - so complex no one much can understand how to use it, designed to protect and boost the profits of the pharmaceutical industry, not bad for the HMO's, absurdly expensive for the government, and driving even Texas pharmacies into bankruptcy - but not the topic here.
Here the topic is the whole idea of just who pays for what. Everyone chips in for the national defense, and for roads and such (infrastructure), for police and fire services. We, alone among all the nations in the industrialized world, don't seem to want to move healthcare into this category of "basic stuff the government does for the common good paid from general funds." We like the market model, with exceptions we make grudgingly. We're not getting our money's worth, given the statistical results, and cars built in the United States cost GM and Ford around fourteen hundred dollars more per unit, to cover employee and retiree health insurance, but that's just the way it is. We prefer that to "big government" running things, or even just collecting and administering the funding. We've made our choice.
Other countries have made other choices. From April 17, 2005 see Healthcare in America is the Best? - looking at our system, the one in France, the one in the UK, and a few others. From October 2, 2005 see The Nation's Health - Our Man in London, Mike McCahill, on how their system is working there. From July 10, 2005 see Oh, Canada! - on the cost of building cars here and in Southwestern Ontario, where a whole lot of "American cars" are actually built.
And the topic is in the media right now. See The Health Care Crisis and What to Do About It - Paul Krugman and Robin Wells in the March 23rd New York Review of Books, making the case for a health-care system that is not only "single payer" - the government handles the finances - but is pretty much "single provider," with the government supplying the services directly.
The counterargument to that appear in the Washington Post, Friday, March 17th, from Michael Kinsley - To Your Health: Why Modest Reform Is Preferable To Single-Payer Health Care (also posted at SLATE.COM and syndicated widely) -
The argument that follows is "let's not go so fast" - this is pretty radical.
The Washington Monthly (Kevin Drum) here says this "sure gets tiresome sometimes" -
Well, keeping us scared is the current mode of governance in use these days. We're used to being scared. Terrorists? Universal healthcare? Whatever. (Drum also points to others commenting here and here.)
The Canadian Experience
One reader, Ross Mallov, has much to say about their system of universal healthcare, call it Canadian Medicare, and how it works in contrast to ours. Ross Mallov, by the way, is a dual citizen of the United States and Canada. He has lived in Canada since very early childhood, and attended university in Halifax, Nova Scotia.
Here's the real story -
And he adds this -
So there you have it. What they have up north kind of works. And what we have down here?
The two countries are so much alike - my two years working in London, Ontario was a breeze and quite comfortable, and I have only fine memories of the good, slyly funny, just decent people who became my friends there. But there were differences - there wasn't much free-market right-wing ideology, nor much or the left - just an effort to get what was going on and do the best for everyone concerned. The aggression and pushiness was confined to the London Knights minor league hockey games. And this is the country that gave us curling (men with brooms).
There's much to consider here.