> to hear many left-of-center colleagues
> praise the Canadian single-payer system
> to no end.

Could you name them and link, please? Just about everything I have read in the last 10 years from centrists (i.e. those who in Rovian terms are now called "left of center") to actual leftists has acknowledged that Canada's hybrid semi-single-payer/semi-national health system is sub-optimal, and that for models we need to look at the very successful German system [1].

Of course, that doesn't stop the Radicals or the traditional media from trying to spin every health care story into a "Canada! Canada!" fest, but why would you choose to participate in that?

Cranky

[1] Of course the French came up with that one first and run theirs quite well, but such a comparision won't do.

BTW - what DO the private insurance companies DO in the US health system that justifies their 30-04% rakeoff? I can't figure that one out myself.

I don't understand the title ... "So much for Canada as a single-payer utopia" seems much more accurate. But then, as the previous poster has noted, no one ever said Canada was the example to follow if the US decides to switch to a single-payer system.

Besides, an argument such as "single payer systems aren't perfect either" isn't very powerful anyway.

LSR

Seriously, Dan, no leftist thinks Canada or the UK have good systems. Read Ezra's Health of Nations series. The model should be France, not Canada (or Germany, as Cranky says). And even so, can you tell me in all honesty that the problems reported in the piece are worse than those in the US? Because Dean Baker doesn't think you can.

Now there's an orginal argument: "Single payer is the best system; it's just that Canada doesn't do it right." Canada is clearly inching toward a mix of private/public payers, because there are so many Canadians who are fed up with long waits and poor care. Germany's system is already a hydrid with significant copayments. The French are just too stubborn to fix the obvious failings in their system. The US has the best care overall and greatest variety of payment plans, but leaves many people without coverage. All-in-all, I don't see how you can point to any one country as a good model to follow. The debate seems to be more about religion than finding a health care system that serves everyone's needs reasonably well at a reasonable cost.

Cranky, the last I read on this subject a couple years ago, insurance companies average 5-6% profit on health insurance. Where did you get your figures?

Really, OpenBorderMan? Because the WHO disagrees. A lot. We're 37th; France is first, and not a bad system to emulate.

Compelling stuff:

"...[W]aiting times have more than doubled for certain procedures during the last 13 years..."

Which procedures? A routine MRI? Then I'd be concerned. Experimental procedures? A lot less troubling. And a 13 year time frame? How much has Canada's population increased vis a vis it's medical practitioners?

Of course, I just had to wait 45 minutes beyond my scheduled appointment time at my allergist's office today, so maybe this isn't the best time for this conversation.

> Now there's an orginal argument: "Single
> payer is the best system; it's just that
> Canada doesn't do it right." Canada is
> clearly inching toward a mix of private/public
> payers, because there are so many Canadians
> who are fed up with long waits and poor care.
> Germany's system is already a hydrid with
> significant copayments.

Seems that the statements a bit later in your response actually support my original point!

Cranky

What is with this expression "single payer system"? If the government made it a crime to privately write or publish a book, would we call this a "single publisher system"? Ask just about anyone what "single payer system" means and I'm sure they will not know.

We should be referring instead to "the Canadian illegalization of private health care". We should be asking: "If we choose to have a public health care system, should we make private health care illegal (as in Canada, and almost no where else)?"

I've written about this more here.

When I administered medical groups in the midwest we received a steady stream of faxed resumes from Canadian physicians willing to do about anything to get out of Canada.

And facilities close to the border get a stream of Canadians who do not wish to wait three months for an MRI on a torn rotator cuff.

(The best story is from a doc who did a residency in England, he said it was terrible when a patient had a kidney stone late in the quarter and the doc had already used his quota of Demerol).

Our health care system needs work, but let's not make it worse.

Dan,
You might not nod off at the mention of healthcare, if you had ever faced the reality of being without healthcare for yourself and your family. Also if you were about 10-20 years older, and not so young and invincible, healthcare issues might seem a little more relevant. I am just guessing here about you, but I see the lack of healthcare, and problems around the healthcare system,as one of the MOST pressing domestic issues that this nation faces.

I don't want to sound like Tony Snow here, but I have a question for Dan and those who are supporting his OP in this discussion: what is your plan?

The US medical system is collapsing. It may not appear so to the young, the heathly, and those with decent insurance coverage (which includes just about every academic blogger). But the working middle class and the small/medium businesses are getting hammered harder and harder every year by rising costs and decreasing availability of either insurance or reinsurance. There has been a lot of blog-talk this week about the division of the US into the haves and have-nots, but the division of general wealth is nothing as to the division in availability of health care. Things are bad out there and getting worse.

And that doesn't even take into account the n0 million Americans who have no health plan of any type (and receive minimal care). Nor the possibility that General Motors will declare bankruptcy and dump at least 1 million people onto Medicare.

And finally, have we eliminated recessions? Cause if not, when the next one hits 10s of millions of fat sassy middle-middle class citizens are going to find out the hard way (1) what it is like not to have health insurance (2) what happens to your long-term health care prospects if you go even one day without health insurance coverage.

So again guys: what is your plan? Status quo? Thank you sir may I have another? The Radicals love to talk about how the European systems are not sustainable; I am putting forth the proposition that the _US_ system is not sustainable. Whatcha gonna do?

Cranky

> a steady stream of faxed resumes from
> Canadian physicians willing to do about
> anything to get out of Canada.

s_t_r,
Again, no one is talking about implementing the Canadian system here. The British went first and tried national health. Good experiement; bad results. The Canadians went second with semi-national health. Good experiment; poor results. The Germans and French _learned from those experiences_ and designed a different system that so far is achieving good results.

I used to work for a large multinational with a lot of travellers. Some of my Canadian coworkers did indeed "suddenly realize" they had health problems while visiting US sites and rush to HR to get a voucher for the local hospital. My German and French coworkers on the other hand would _literally_ drag themselves to the airport and fly home no matter how sick they were rather than subject themselves to the US health care system. I know that is hard for USians, the citiznes of the greatest nation on Earth, to accept, but it is true.

Cranky

Minipundit,
WHO rates Canada's system better than the US and Cuba's only slightly worse. Give me a break! Like I said, it's more about religion than about serving everyone's needs reasonably well at a reasonable cost.

> Like I said, it's more about religion
> than about serving everyone's needs
> reasonably well at a reasonable cost.

OpenBorderMan,
Cogent criticism. What is _your_ going-forward plan?

Cranky

Cranky, I doubt that you would like my suggestion, but here goes. Like I said, in my opinion, the main problem with the US system is lack of coverage for part of the population. Most states already have a program that provides basic coverage for those that can't get it elsewhere, but it's too expensive for most people. On the other hand, hospitals are already required to treat emergencies for free when the patient can't pay. Surely it would be more cost effective to combine the two concepts into a basic low-cost coverage of "last resort". Liberals deride the concept of a multi-tier system as being unfair to the poor, but (news flash!) we already have a multi-tier system. Comments anyone?

I like it, but what do the numbers look like, and how can you prevent politicians from trying to get votes by offering to expand the coverage if they're elected?

The so called "Problem" with the Canadian System, is not that its a "bad system." It worked perfectly well for 25 years from its inception. The "problem" with it is that it suffered chronic under funding during the 1990s.

What people outside Canada fail to realize completely is that Healthcare is primarily the domain of Provinces, not the federal government. So the whole "single payer" debate is actually far more nuanced than one would guess. there are very big differences in quality between the provinces. Its ironic that the NYT article quotes Vancouver General Hospital, because (if memory serves me) British Columbia was the first to try private clinics, and now has the most of them in Canada. The article completely fails to mention that BC’s problems are due to the unpopularity of Premier Gordon Campbell with the Public Sector Unions. Campbell is attempting to cut down the second (?)highest per capita debt load in Canada because of the disastrous policies of the previous NDP party, a very left wing party that destroyed BC’s economy during the 1990s. He has had a tempestuous relationship with the public sector unions, up until last year. So this article is really very highly suspect from the start.

Among other difference between Provinces is that Four allow for private insurers, while the rest don't. That’s very significant actually, and changes the nature of healthcare from one province to another.

What the Federal government does is it regulates the provinces, primarily through what is called the Canada Health Act. The CHA gives specific standards for how provinces must carry out healthcare to be eligible for federal transfer payments. Its is the reason why Canada has a public healthcare system, though its been recently challenged by a Supreme Court ruling cited in the article.

Now the real problem with Canada's healthcare system actually stems back to the early 1990s, when the Liberal Party of Canada came to power (Actually Federal reductions occurred during the 1980s under the Tory government, but the big break happened in 1995). In order to slash the massive federal deficit it cut Federal transfer payments to the provinces, and replaced them with a program that gave the provinces far less cash. This amounted to a fair chunk of cash. Since Healthcare usually amounted to the largest proportion of Provincial budgets, it was usually the first to get cut.

The truth is that the system is not broken, but its just underfunded. But there have been moves to address this, as with the 2004 Health Care Accord. But now that a lot of money has been injected into the system, alot of it has to go to address a decade's worth of delayed capital upgrades that were put off during the years of fiscal restraint.

Really the issue comes down to simple economics. Canada spends approximately 10% of its GDP on healthcare, compared to about 16% for the United States. This is reflected by the poster above who claimed that Canadian doctors are clamoring to come to the US. Well the private system often pays 1/3rd more than the Canadian system, so its not surprising that people move south. However he neglects to mention that many of these people return after a couple years, because they don’t like the US system. I think given the comparisons between Canada's and US systems, we are doing quite well, when you consider we have universal healthcare, compared to the significant number of people in the US that don't have any coverage at all. The wait time problem is serious, but there have been major steps to address it as I noted above. The reason why France is doing so well is that it enjoyed above average spending during the 1990s and does so today. A recent fact finding trip by the BC government found that it wasn’t that great of a model at all.

Finally there is one aspect that people should remember, Canada has always had a de-facto two tiered healthcare system. Its called the United States.

Oh golly, they even quote the Fraser Institute. Its kinda like the Heritage foundation (sans Foreign policy debate), but in the Canadian context often horribly out of synch with reality.

What do Canadians have to complain about? They can just come here for care. I am sure there are lots that do so NOT.

actually it is a myth that many Canadians seek care in the U.S. According to a study in the authorative journal Health Affairs (21(3) 19; 2002) 80% of abulatory care facilities near the border treated 1 or less Canadians per month, and of a representitive survey of 18,000 Canadians found that only 20 had gone to the U.S. seeking care.

Please see the slideshows at www.pnhp.org

Why do these attacks on Canada's health care system remind me of earlier claims Iraq had the bomb?

> Why do these attacks on Canada's health care
> system remind me of earlier claims Iraq had
> the bomb?

Well, we know a priori that the health care system in the United States is The Best in the World(tm).

We know anecdotally that some Canadians travel to the United States for health care [1]. Heck, I even provided some anecdotes myself.

Therefore, we conclude that Canada's health care system is a total failure.

And we deduce that the current health care system in the United States cannot and should not be changed in any way.

QED.

Cranky

[1] That the US has the largest health care system in the world and therefore has specialized resources and just plain system capacity not available elsewhere as a result of its sheer size, and that soliciting business from overseas to make more profit on some of these resources is just good sense, could not possibly explain why any furriners travel to the US to see a doctor. Nope.

I wonder how seriously Drezner takes the criticisms of any students who fall asleep most of the time in the back of his classroom.

I've noticed patterns in right wing logic and argument and Drezner is following one of them here. It's the way he's using insinuation that creates an impression which doesn't bear close examination.

In the argument over health care, progressives want to change our current collapsing system and design something else, using other systems in advanced countries as models. Drezner is not a progressive. He doesn't state clearly where he is coming from re: health care. But he criticizes the Canadian system taking the point of view that more privatization should be included within it. In the context of the American debate, this reads as a defense of privatized health care, our current system.

But this is Drezner's insinuation, not an argument. Going closer to the facts, it becomes clear that including privatized elements in a national health care system is the European model, not the American disaster. So when Drezner appears to be defending something like the American system, he is actually defending a more European system - which I doubt is his real view.

The very premise is misleading. Really Drezner should come out of his cave and articulate some of his ideas for healthcare.

> The very premise is misleading. Really
> Drezner should come out of his cave
> and articulate some of his ideas for
> healthcare.

One of the problems with the whole health-care debate, as noted above, is that a very large percentage of policy analysts, up-and-coming economics Ph.Ds, and congressional staffers are 25-35 year old men with zero or at most one child, in good health themselves, and with access to at least basic health care for their occasional broken ankles and sore throats. Other than perhaps dealing with their parents (who probably don't tell them the details anyway), they have no personal experience with the kinds of chronic health conditions that appear around age 40. And having spent so much of their lives in academic cocoons (university health services may not be great, but can keep anyone of undergrad/grad student age in basic health for minimal cost) they just don't have any visceral understanding of what it means to be trapped in a situation where you simply cannot get health services you need to stay alive and/or keep your children alive. For any meaningful value of "alive" that is.

Cranky