It's Americans these days who are restricted to "in-plan" doctors

Los Angeles Times
August 3, 2009
A Canadian doctor diagnoses U.S. healthcare
By Michael M. Rachlis


Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.


The U.S.' and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results?


On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.


On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.


Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.


Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.


Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.


The Canadian system does have its problems, and these also provide important lessons.


However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas.


On closer examination, most of these problems have little to do with public insurance or even overall resources.


Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.


U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's, experience than ever. Why?


American democracy runs on money.


Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors.


Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.


(Michael M. Rachlis is a physician, health policy analyst and author in Toronto.)

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