Health Care: "Reform" = "Universal"
I've been reading and listening to talk about health care "reform" recently. As you will realize, for those of us in the US right now that's not a surprise, since it's the one thing all politicians are talking about while they try to figure out how to do nothing about it.
The discussion right now seems to center on nuances (a popular political buzz-word, too) about a "public option"; the nuances are all about how to make sure that the "public option" is neither. Mostly the politicians seem to be trying to hear the whispers of the big insurance companies (the "health professionals" in this scenario) about how to do the "public option" correctly–imagine what "correctly" means in that context.
My own opinion is that we in the US need to implement, and should implement, a universal health-care system and that the so-called "single payer" way to do it is probably the best way to do it. I have friends who tell me that implementing single-payer health care is the worst idea, but the only explanation I've heard for why it's the worst seems to be to say "because it's the worst" very loudly and slowly.
Here's my nuanced position: I do not support the idea of universal health care as a "right"; I merely believe that universal health care is something that a rich, powerful, and compassionate country can and should do. I don't really care, either, whether one wants to call it "socialized medicine"; we know what we're talking about here and I don't care what it's called when it's called names by conservative critics whose tactic is to create fear and confusion about change.
But, all this aside, I have some campaign strategy advice for the politicians who claim to be working on health-care "reform". We know that there will be a great kerfuffle and that when the dust settles that the result will be declared health-care "reform", regardless of whether it actually changes anything about how health care is delivered and paid for in the US. Substitutes that appease the health-insurance industry will be noticed.
In the minds of the average American voter, "reform" on this issue will be judged by how close it comes to creating actual universal health care. Universal health care, free of paperwork and red tape, is an easy concept to comprehend and an obvious target from which to measure how short politicians fall from hitting the target. It's also something that normal people will be able to recognize when they see it.
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on Monday, 22 June 2009 at 19.22
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The province of Saskatchewan was the first jurisdiction in Canada to initiate single-payer universal health care. The doctors went on strike. Other doctors moved in to take their place, and most of the striking doctors came back. Somehow even they realized that actually getting paid for seeing patients who couldn't afford to pay was better than not getting paid for seeing them. (In Canada, at least, and back then at least, doctors never thought about not seeing patients who couldn't pay them — something about the Hippocratic oath or some silly nonsense like that).
The American newsmedia flocked to Saskatchewan. One or two reporters actually managed to get the pronunciation right, though most didn't. After all, right here, in the middle of the cold war, was socialized medicine. Saskatchewan was right next door to America, and it was Commie!
Universal single-payer health care came into place in all of Canada in, I think, 1962, the same year I started university. Like all other health care plans, it has been bedevilled by sky-rocketing health care costs. No matter how much governments put into health care, there is never enough money, nor can everyone be satisfied. I've never had any problems with the system. In most of Canada patients pay nothing for standard health care. Here in British Columbia, we pay insurance premiums. As a single person, I pay $52/month. A family pays, I believe, $108. The Medical Services Plan (as it's called in British Columbia) doesn't pay for every. Just almost everything. Doctor's visits. Specialist visits. Surgery. Hospitalization. It doesn't pay for ambulance services, it doesn't pay for drugs. In BC it no longer pays for physiotherapy or eye care. It has never covered dental costs. My extended medical coverage, which comes from my (former) employer as part of its benefit/pension plan, pays for everything that the MSP doesn't. When I turn 65 this fall, the MSP will begin covering most of my drug expenses and vision care. I will also begin to receive our Old Age Security Pension (another Socialist creation that started in Saskatchewan).
In recent years the "health professionals" you mention have been working hard to convince us that our health care system is not working, that it's failing all Canadians. The Conservative government has been either believing them or promoting them, I'm not sure. But they tend to think that everything Bushian is fabulous and right for the nation.
The Canadian health care system is not perfect. People can wait unconscionably long times for some tests and "elective" surgery. Sometimes the system gets blamed for people dying while they wait for organ transplants, but of course it's the lack of available organs, not the health care system, that's the problem there. But in Canada everyone is covered by heath insurance. Employers aren't disadvantaged by paying for their employees' health insurance. Employees don't lose their coverage if they get laid off. No-one is bankrupted because of medical expenses.
A story: I was having coffee in a local coffee shop one day recently, talking to one of my neighbours. Another man interrupted us with a story. There are two sisters, one living here, on in the South-West. Both had the same surgery. The Canadian sister went down to visit the American sister. They began comparing notes. The American sister said her surgery had cost $50,000. "And how much did yours cost?" she asked her Canadian sibling. "Nothing," she replied. The American sister wouldn't believe her; there was a major falling out; and the Canadian visitors were kicked out of the house.
on Monday, 22 June 2009 at 23.15
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Bill, thanks for your remarks. Perhaps I'd have more to say if I didn't keep throwing up my hands at the stupidity and duplicity of most of our politicians–not to mention the incredible piles of money that the "health-care professionals" have to throw at them to maintain the status quo.
on Monday, 22 June 2009 at 23.55
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What finally prompted the introduction of universal health care in Saskatchewan was the growing awareness that people were dying needlessly, simply because they couldn't afford to go to a doctor. And in that long-ago age of innocence, doctors (some of them) and politicians (some of them) actually cared enough to think that was wrong. One certainly cannot convict the one-issue (tax-cuts-solve-all-problems) Republicans in your country of that! Nor the insurance companies that fund them, and way too many Democrats too.
One of the many lies that are told to the American public is that, in Canada, we cannot choose our own physician. And it is just that — a lie. We may not be able to get the doctor we really want, because that doctor is no longer taking new patients. But it's not because the government tells us, No, you have to go to another doctor, one we choose for you. It's because that doctor's patient list is full.
on Tuesday, 23 June 2009 at 11.50
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I'm hoping that the "government chooses the doctor" lie will play less well these days than it did in the early 90s when "health-maintenance organizations"–clinics with groups of doctors on rotation–were more common here, when the HMO was thought the best way to cut cost and deliver care but people hated the mere possibility of having to see different doctors willy-nilly.
on Thursday, 25 June 2009 at 13.41
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This morning on one of the Seattle NPR stations I heard an interview with Washington governor Chris Gregoire. She had met with the President yesterday to talk about health care. One thing she was sure of was that "single payer" was no where on the radar screen. No one was talking about it. "We don't need a European health care system. We don't need a Canadian health care system. We need a made-in-America health care system."
Indeed. Let's re-invent the wheel. Americans are good at that sort of thing, way better than those Europeans or Canadians. Now let's see. Right now our health care system is running on rectangular wheels. What we need is really good made-in-America square wheels to make it go much better. But no way are we going to go for round ones — we'll leave that silly invention to the Europeans and the Canadians!
on Thursday, 25 June 2009 at 17.07
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They really, really, really want to keep single-payer ideas "off the table"–far off, probably because even admitting it near the table would be the camel's nose under the tent in health-care reform. In this context, of course, "europe" and "canada" are coded scare words meant to evoke images of the evil "socialism".
However, I still find myself believing that universal, single-payer health-care is the idea against which normal people are gauging the extent of actual reform–and the veracity and success of the reformers.