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Two nations suffer from a lack of health-care options
by Mark Milke
Many
Canadians think our health-care system is tops just as some Americans believe theirs to be superior, though for very different reasons.
Maybe we're both delusional. And maybe the flaws within our systems are more similar than we realize as are some prospective remedies.
A new book out from a former Winnipeg resident aims to pop our respective balloons. If you're an American visiting Canada, sorry, but your bubble
goes first. In The Cure, David Gratzer, now a Toronto-New York physician (who commutes, apparently) tries to explain what's wrong with U.S.
health care.
For example, Gratzer dissects trial lawyers and U.S. Food and Drug Administration civil servants. Thanks to the deadly combination of litigators
and "meek FDA bureaucrats," the average cost of developing a prescription drug today is $900 million US. That's up from $138 million US 30 years
ago (and yes, adjusted for inflation).
 The
remedy for health-care hyper-inflation is not for Americans to re-import drugs from Canada. Re-importation from a less wealthy country
won't change the cost of drug development nor the need to recoup those costs somewhere.
The solution, writes Gratzer, is for the American equivalent of Health Canada to determine more quickly whether a drug is safe,
approve it, and then see how well or if it works.
That way, at least those who otherwise might die while a new experimental drug works its way through a bureaucratic and potentially
litigious maze will instead have some increased hope of efficacious treatment.
But if speedier experimental drug approvals down south are one way to help the health-care system, plenty of defenders of
status-quo Canadian policy will hate his subtitle: How capitalism can save American health care.
They should refrain from shutting their minds until they actually get through the book, at which point, Gratzer will have cured
a few naysayers of their condition.
Think U.S. health care is bad? Full of bean-counters in health maintenance organizations who look at dollars while people die?
Gratzer agrees. But both the U.S. and Canada have the same core problem.
American health-care penny-pinchers reside deep in the bureaucracies of HMOs and in government health-care programs.
Our equivalents are in government health ministries.
That such administrators might all be well-intentioned is irrelevant. The problem is the broken payment link between patient and provider.
And that creates a perverse incentive.
"What would car insurance cost," asks Gratzer, "if people insisted on plans that had limited deductibles? Or policies that included
not just major body work, but also oil changes and gas and a paint job every time your spouse got tired of the car's colour?"
American health maintenance organizations insure a lot. Canadian governments insure almost everything. In the U.S., insured users
pay indirectly through insurance premiums and occasionally up front but even then only a portion of the true cost.
Here, we pay through taxes. User fees, even for minor treatments, are outlawed. That third-party payer system in both countries,
sensible for catastrophic events, is not so smart for minor treatments. The practical result is that we don't investigate treatment
options based on quality or price as we might for dental services, automobile insurance, or food.
To continue the doctor's car insurance example in the Canadian context: While some American are not insured
(far fewer than the 46 million often touted, a myth Gratzer demolishes), would any of us think we had workable car insurance, if, after
an accident, it took a year or two for our car to be repaired or replaced? Yet plenty of Canadians wait that long for hip surgery.
Gratzer proposes several reforms, sensibly designed, that point to a way out of Canadian lineups and away from America's private health
care bureaucracies.
If governments and bureaucracies can often be an impediment to sensible ideas, they can also on occasion stumble into decently
designed reforms. Gratzer trumpets two: In Colorado, the severely disabled poor can "choose a program that empowers them with health
dollars; participants are able to hire and fire their own caregivers, and to use moneys for life-enhancing equipment," writes the physician-author.
On the insurance side, the physician praises a U.S. federal government plan as the perfect model because it offers employees
"a choice from more than 240 competing plans." The result is cost-containment driven by employees, not HMO heads, and even though it
covers in more detail the big-ticket items insurance should cover: long-term care, catastrophic events, and prescription drugs.
In short, and in addition to reformed drug approvals, Gratzer argues for more choice above and below the 49th parallel: Individual health care
that is portable, smarter taxpayer-targeting for those in need, and RRSP-style health-care savings accounts with possible contributions not
only from individuals and families, but employers and taxpayers where necessary. (The latter reform would help bust the otherwise soon-coming,
baby boom crack-up in health care.)
Revolutionary but useful, readable tomes on public policy such as health care don't often come from gentlemen wearing white lab coats.
The Cure is a notable exception.
Mark Milke is author of "Nation of Serfs?"
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