Health Care: Go Canadian
The U.S. should adopt its northern neighbor’s system of state-paid medical care for all its citizens. Pro or con?
Pro: Follow the Maple Leaf
I find Top 10 lists are a useful way to quickly distill large and complicated issues down to the bare essentials. So here are my Top 10 reasons the U.S. should adopt Canada’s single-payer health-care system.
1. All Americans would have health insurance. This is the right thing to do because it reflects and promotes core values and notions of citizenship: equality, compassion, and social solidarity. Sickness doesn’t discriminate. Neither should health care.
2. Health would improve. On almost every critical measure (life expectancy, infant mortality, etc.), Canada rates higher than the U.S., and we’re among the best in the world.
3. It would cost less. Canada spends 9.8% of GDP on health care, while the U.S. spends more than 15%. A single-payer system is the less expensive way to go.
4. Patients would have more choice. In Canada, patients can choose whatever doctor, specialist, and hospital they want. Treatment decisions are left to patients and their doctors. No insurance companies meddle in our choices.
5. Quality of service would improve. In Canada, health providers never have to choose between their wealth and a patient’s health. Our system forbids that choice. The vast majority of Canadians are highly satisfied with the quality of care they receive. In Canada, patients rarely sue physicians.
6. It would reduce the bureaucracy. Patients in Canada show their health card and get care. Health providers bill the government directly and get paid. It’s that simple.
7. Fewer Americans would go bankrupt because of health-care costs. This is a major problem for many U.S. families. It rarely happens in Canada.
8. It would benefit business. Companies in Canada have a competitive advantage because they don’t have to provide basic health-care coverage for their workers.
9. It would diminish labor strife. Health care is incidental in labor negotiations in Canada. It’s a large and growing pitfall in contract negotiations in the U.S.
10. It would serve democracy. Most Americans want major, not incremental, health-care reform. Many Americans support a single-payer system. It is about responding to the wishes of the people.
Con: Take a Cocktail Approach
It’s not that I think Canada’s national health-care system is a bad one. But I don’t think we should lift any one country’s health-care system to replace the one in the U.S. that is so damaged and dysfunctional.
Canada’s system is not without its detractors. The complaints range from long waiting times to dramatic inconsistencies of care depending on the province one lives in. There are so many caffeinated critics of changing to “socialized medicine” in the U.S. that, even if the system we convert to isn’t actual socialized medicine, Canada’s well-chronicled complaints would provide ammunition for the status quo crowd.
Instead, a new Administration in Washington should put together a bipartisan commission to study, with a deadline, the systems around the world that spend less on health care than the U.S. but get better results. In the end, there would be a “best of all worlds” solution that both major political parties would have played a part in building.
The biggest complaint, and often the myth, of nationalized systems is that everyone has inordinate waiting times for surgeries and treatments. In some countries, this has held true. At one point in Canada, residents of Saskatchewan waited two years for an MRI. But in Japan, there is virtually no waiting. In Germany, wait times for surgeries can be a few weeks, just like in the U.S. In Britain today, hip and knee replacements happen within three months of the asking. That’s faster than I was able to get one in the U.S.
The U.S. system needs four major overhauls, and we should cherry-pick from Britain, Germany, Japan, Switzerland, and Taiwan, to name a few, to find the right structure for each fix.
1. Medical insurance must convert to a nonprofit enterprise.
2. Prices for medical procedures and drugs must be negotiated each year, and fixed at one price by the government, insurance companies, and health-care providers.
3. Medical malpractice awards must be limited and set the same way drug and treatment costs are, rather than battled out in court one by one.
4. Medical records and billing must convert to “smart cards” to spare patients unconscionable administrative costs and paperwork.
It will take leadership and courage in Washington to stand up to special interests like trial lawyers and global drug companies and medical-device makers who are invested in the skyrocketing costs of U.S. health care as a way of subsidizing the sounder, fairer systems around the world.Opinions and conclusions expressed in the BusinessWeek.com Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.