Thursday, February 14, 2008

Oh, Canada...Oh, U.S.

[Showing the sometimes convoluted chain of references on the World Wide Web, I heard about this on Washington Monthly, which came through Ezra Klein, which has the original link to Sara Robinson.]

Sara Robinson's post discusses the myths held in America about Canadian health care. I haven't posted very much about health care; I'm no expert on the subject, and I probably don't have anything new to contribute. As a result, I really can't evaluate Sara's post on the merits. I am an American consumer of health care, however, and I can't say I'm thrilled with a system that has 15% of the population uninsured, more underinsured, and, despite pressures, resists all attempts to improve itself.

I won't go through this post point by point. It does seem to address most of the concerns we hear in the U.S. about single-payer systems, not by painting an unbelievably rosy picture (there are wait times for certain procedures, citizens do pay higher taxes for it), but by arguing that, on the whole, it serves the needs of the average Canadian better than our non-system.

What I object to in the discussion of the American way of health care is, first, the slogan, not based on any objective reality, that we have the "best health care in the world" - one of the few things that Bill Clinton and George W. Bush agree on. Second, that we just need to tweak the current system, perhaps with a bit of market discipline, and any problems we have will disappear.

We never seriously entertain the possibility that there are structural problems, that doctors may make too much, that we may overly restrict entry to medical school, that the massive number of profit-seeking third parties (insurers, medical corporations, hospital corporations, pharmaceutical companies) may take more out of the system than they give back. I think one of the major reasons for the failure of the Clinton health care plan 15 years ago was the attempt to place an extra governmental layer around the existing structure, rather that zero-basing it and looking at what is needed. (The current candidate plans, while somewhat tweaked, suffer from the same problem.)

To fix the problems, then, it would be good to look at plans that work better, not criticize them because they aren't perfect. That will necessitate us looking past the special interests, and focusing on the interests of the people. Canada may not be the ideal model for the U.S., but they're doing something right, and we should climb past the myths expressed in Sara's post and glean what we can from their successes.

[Final blogging note: my use of "Sara" for the author of the referenced post intends no disrespect. I am a bit old school in certain ways, and the fact that I don't know Sara Robinson means that I am a bit uneasy in using her first name so casually. But that does seem to be the Internet way of things, so Sara will be Sara, and Kevin will be Kevin, and you can call me Andro.]

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