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The best fix is a national health care option
By Ellen Wedum
In 2005, Toyota chose to locate its RAV4 assembly plant in Ontario, Canada. One of the major selling points was Canada’s national health insurance system, which saves the auto manufacturer large sums in benefit payments compared with costs in the United States.
The United States spends 15-17 percent of its gross domestic product on health care, which provides a mishmash of coverage for only 85 percent of Americans. For France and Germany, that drops to around 11 percent to cover everyone. Canada and Sweden pay roughly 10 percent and 9 percent of GDP respectively for a basic national health care program for all.
Now let’s compare the results for just two statistics, infant deaths per thousand births and life expectancy.
For infant deaths, the United States is the worst, at 6.4 per thousand births. France is at 4.2, Germany is at 4.1, Canada is at 4.6 and Sweden is at 2.8. For life expectancy, the average American lifespan is the shortest, at 78.0 years. France is at 79.9, Germany is at 79.0, Canada is at 80.3 and Sweden is at 80.6. (Click here to see the comparison.)
Wow. We pay the most and get the worst health care. For Toyota, that would have meant higher benefit expenses and, overall, a less healthy, less productive work force.
The Canadian system
France, Germany, Canada and Sweden have government-provided national health care programs that guarantee every citizen basic health insurance. And if their governments can do it for less, I believe our government can too. I’m going to give some details of the system in Canada, just because I have read more about it than the others and because it is the country closest to ours.
The Canadian national health care system is funded by taxes but is administered by the individual province or territory. It is a basic insurance plan, with just one set of rules for reimbursements, not the thousands of different sets of rules (the health insurance industry, the HMOs, the military coverage, Medicare and Medicaid, etc.) that the United States has.
Contrary to the lies about “socialized medicine” being spread by right-wing commentators, Canadian doctors are independent contractors. Canadian citizens are free to buy additional health insurance if they choose.
Doctors in Canada do make less than United States doctors. But they have lower overhead. For example, they don’t have to pay a full-time staffer to deal with over 100 different insurers, all of whom are determined to deny care whenever possible. In Canada the system is set up to deliver health care instead of profits, and medical access is considered a right. In the United States, the health insurance industry calls delivering health care a “medical loss.”
‘You do what’s right’
If you watched the Senate hearings on health care, you heard the representative for the business roundtable tell the Senate committee that American companies cannot compete with foreign companies that have national health insurance because American companies must provide that health insurance for their employees at considerable cost to the bottom line.
The Canadians have had their “single payer” national health insurance since the 1960s. Sara Robinson writes, “Canadians tend to think of tending to one’s health as one of your duties as a citizen. You do what’s right because you don’t want to take up space in the system, or put that burden on your fellow taxpayers.”
In the last 60 years in the United States, the emphasis has been on deregulation, the “free” market, and Greed is God. Can Americans switch from a “me-first” philosophy to one of feeling a personal responsibility for the general welfare?
Bottom line #1: A few years ago, a TV show asked Canadians to name the greatest Canadian in history; and in a broad national consensus, they gave the honor to Tommy Douglas, the Saskatchewan premier who is considered the father of the country’s health care system.
Bottom line #2: If you are one of the approximately 180 million Americans who is paying monthly premiums for private health insurance, keep in mind that a quarter to a third of your premium goes to pay million-dollar salaries to the company’s CEOs, plus political donations of $1.8 million (in 2008 alone) to Senator Baucus, chairman of the Senate Finance Committee, plus the hiring of all those lobbyists who are telling congress that America doesn’t need national health insurance.
So please contact your congressional delegation and let them know you want a national health care option similar to the Canadian system. A toll-free number for reaching the Capitol switchboard is 800-828-0498.
Wedum, a Democrat, is running for the New Mexico House District 59 seat next year.
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Furthermore, the treatment that patients get for cancer may give them a slightly longer life, But it is likely to give them a longer, more unpleasant, more expensive life too.
A peaceful death and something left over for the children to inherit would be preferable, IMHO.
Yikes!
Did you really just try to put a positive spin on folks not getting cancer treatment because of bureaucratic sluggishness by saying that they at least die without having to go through the unpleasant treatment? That's, uh, not exactly a ringing endorsement of Canadian health care.
Ellen Wedum: Death! It's cheaper than health care!
Yeah, that'll be an awesome bumper sticker.
I also like how you mixed up life expectancy with health care, as though other cultural aspects like diet and exercise don't have anything to do with it. You know what would really boost our average life expectancy? If we put fat people into exercise camps. We could even hook their treadmills up to the energy grid and kill two birds with one tubby stone. I wonder what T. Boone Pickens is up to . . . heck, I wonder what Al Franken is up to. While we're at it, we could strap Harry Teague to a treadmill and start working off his carbon footprint.
Salud!
Ellen, a public option doesn't lead to more choice, if in the long run, it will eventually crowd out the private sector, and if it "competes" on an uneven playing field. The way this is being proposed, the public plan is essentially the Fannie Mae/Freddie Mac of health care, backed with the full faith and credit of the U.S. government. Thus, it wouldn't compete fairly, and cannot be paid for without raising taxes by over $1 trillion. This is why many Americans look at the Obama approach with such skepticism and why this isn't really "choice."
jpestrada wrote: "Even through public option – which to my mind would do nothing more than limit choice …"
Good grief, how can the addition of a public insurance option LIMIT choice? The more options, the more choices. Duh. Thanks for the NYorker article reference. I will check it out.
Dr. J wrote: "it is hard to imagine how the government could run anything that is cheaper, better, and more efficient than private enterprise. …"
Again, good grief! You are completely ignoring the available data. Cheaper and more efficient fot the profits of the insurance companies, yes.
Efficient for the customer? NO. Here is another health care story for you:
Russet, Cloudcroft NM
"I have 'good' insurance, but every year the premium goes up, the copays go up, and the list of covered drugs and procedures gets smaller. For every new medication, I have to argue with the insurance to get even minimal coverage. It took our insurance A YEAR [my emphasis--EW] to pay for my husband's surgery, and during that year we didn't know how much of it we would be liable for (the answer is, enough to keep us struggling with the bills for a while)."
To be fair and objective, there are many people who lived in Canada and Norway when I did that loved the socialized medical system. They were typically young and had few complex or dfficult health problems. For them, it was cheap and accessable (though wait times were long compared to America for appointments). However, again the old and infirm with chronic diseases were treated like refuse.
I have no problem with a "public option", but agree with jpestrada that it is hard to imagine how the government could run anything that is cheaper, better, and more efficient than private enterprise. I do think the public option is just the camel's nose in the tent. When the hump arrives later you will all see that and it will be the end of choice, and option no more.
I suspect the only way the government can make a "public option" cheaper and better is the traditional government Big Lie, heavily subsidizing the system with massive taxpayer money while trying to hide it from view. Sooner or later people will learn you cannot trust government.
Also, I've written a detailed rebuttal to Ellen Wedum's citation of Paul Krugman's 4 year-old OpEd in the comments to Carter Bundy's 7/8/09 article (proof that even NMSU-educated folks like me can prove a Nobel Laureate wrong). Bottom line: Canada has hardly received any of Toyota's (or any other auto company's) investment since '05. The big winner? The USA…plants and good paying jobs right in America's heartland.
In contrast, Canada's health "care" system hasn't helped them create any jobs whatsoever.
To be fair, Ellen, what is really missing from this whole debate is how on earth the government would effectively reign in costs through a public plan. Even through public option – which to my mind would do nothing more than limit choice – there is no evidence whatsoever to suggest that the government can force costs down. Just look at Medicare.
For more insight on the cost side of the equation, take a deeper look at the example of McAllen, TX, located in the poorest county in America. Medicare per capita spending is the highest there than anywhere in the country. But yet compared to El Paso – just as poor as McAllen – Medicare per capita spending is half.
So although government is largely paying the bills in both places, why are costs so different? Something else is at play (hint: it has nothing to do with government paying the bills), and I encourage all of you to read this article: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande.
One more comment: keep in mind that the health industry currently has 350 lobbyists and is spending $1.4 million PER DAY to hang on to their profitable monopoly and prevent the MINIMAL requirement of a public insurance option.
That's what your health insurance premiums are paying for.
It seems interesting that nobody is responding to what Dr. J is saying. He has lived in a country that already has government run healthcare, and his own choice would be "I would take America's imperfect system over the socialized system of no choices any day". I have spoken with quite a number of people who have lived in Canada and they share the same sentiment. The care is in many cases "sub-standard" because someone else chooses for you. That is exactly what we need to fight against here at home. We make decisions for ourselves.
jpestrada I apologize, we must have been typing at the same time. I was referring my comments to wedum59 not you. I agree with your position and that of DR. J. Choice is the KEY!!
Ms. Wedum, your example of your friend and your attitude about the situation is what socialized medicine is about. Someone else (outsider) making a choice for someone to die "peacefully" without incurring much costs (thus saving the government system money) with aggressive, extraordinary treatments. But I ask you, will you be the one to make that decision for your friend? How about Obama? How about some bureaucrat in DC?
In my opinion that decision is up to the afflicted and their family, not an outsider with money motives. Choice is the key, and having lived in socialized medical systems and seen it's ravages on people (I assume you have no first hand experience, you just read things you agree with and quote them at the exclusion of more objective data), I would take America's imperfect system over the socialized system of no choices any day.
jpestrada said… "Ellen, you really should probably stop using international trade arguments to justify liberal policies like nationalized health care. It's clear from your article, as well as other comments you've made on this site that you really have no understanding of international trade or how companies make their site selection decisions."
OK, read the article ("Toyota, Moving Northward") by the winner of the Nobel prize in economics Paul Krugman. I think he knows more about this than you do:
http://www.nytimes.com/2005/07/25/opinion/25krugman.html
Oliver, sorry you didn't get what I was trying to say…perhaps I should have been more clear. Wedum uses the so-called "international competitiveness" argument to support her claim that international investment chases after countries that offer nationalized health care. That's simply not true…companies do not make decisions on where to invest (e.g., locate plants) based on this. Even Christina Romer, who chairs Obama's Council of Economic Advisors has said this argument is "schlocky." Therefore, whatever side you're on of the heath care debate (and I'm on the side of market-based reform), it isn't useful to invoke this argument, particularly in the way that Wedum has done.
I think the above poster missed the point. The point is they had a choice. They made the decision to fight the cancer and are suffering the cost of that choice. You are saying it is better to have the gov make that choice for us. I believe I should have the right to make the choice and not the gov. I then suffer the consequences for that choice. This country was founded on our right to chose and it is something I still hold dear.
Ellen, you really should probably stop using international trade arguments to justify liberal policies like nationalized health care. It's clear from your article, as well as other comments you've made on this site that you really have no understanding of international trade or how companies make their site selection decisions.
The Toyota example you begin with is a great example of your ignorance. To make your argument, you'd have to explain why then the U.S. is the #1 recipient of foreign direct investment (that is, foreign companies building facilities and hiring American workers). That's over 5 million workers and over $230 billion in investment.
Also, were you aware that Toyota just announced last week that they are investing $500 million in retooling a plant in Indiana? Compare that to what the U.S. automakers are doing…you know the ones like Government Motors that are weighed down by tax-free, gold-plated health care plans and who are shutting down plants all across the country?
Dr. J, Your comment contradicts the longetivity data.
Furthermore, the treatment that patients get for cancer may give them a slightly longer life, But it is likely to give them a longer, more unpleasant, more expensive life too. I recently lost a friend to cancer who had his nose and upper jaw removed, followed by chemotherapy, followed by another operation in which they removed all his lymph nodes, followed by more chemo, then the cancer got into his brain and he died.
I have not had the heart to ask his widow how much they lost in deductibles and co-pays, but I know they had to sell their home and become renters in 2006.
A peaceful death and something left over for the children to inherit would be preferable, IMHO.
Ellen Wedum
Having been resident in two socialized medical system countries (Canada and Norway), I find this article uses cherry-picked data and misleading half-truths. The most egregious and offensive parts of these country's socialized medical care is the rationing and heavy handed interference of the government wrt a person's treatment choices and options. In Norway they have what they call the "government death", which is when old people try to get cancer or other aggressive treatment for chronic diseases. They are put on waiting lists for many months, and many die waiting or come to America for on demand care.
These rationing and restrictions costs less than America's free enterprise system of course, but what is your grandma's or grandpa's life worth? In Canada, Norway, and a host of other socialized medical care countries, they use the old and infirm to "balance" the books and cut costs. Is that what you want for America? If so tell your Congressmen to vote for ObamaCare.
Among many reasons you can't compare the U.S. to Canada: percent of GDP spent on military spending: U.S.-4.06%, Canada-1.1%. Now you can argue that the U.S. spends too much but there is no doubt why Canada's is so low.
Let's not mention lawyers, socio-economic factors, etc.
One solution is if you like theirs so much, move to Canada.