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Universal Health Care: A Debate On Health Care in the U.S. and Canada

StoryOctober 15, 2004
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We host a debate on Canada’s health care system, where universal health care is an institution, and the U.S. where its benefits are still the subject of debate. We are joined by Sally Pipes of the Pacific Research Institute and Dr. Michael Rachlis, a health policy analyst and author of Prescription for Excellence.[includes rush transcript]

Universal health care is an institution in Canada. But in the U.S.–its benefits are still being debated by doctors, patients, and politicians. After Iraq, it’s the most important issue in the presidential election. In fact, President Bush has come out with an ad attacking John Kerry’s views on expanding Medicare.

  • Bush Health Care Ad

Since we have the privilege of speaking to people on both sides of the border today about Canadian issues, we thought it would be interesting to put the Canadian heath care system to the test in the U.S.

  • Sally Pipes, President of the Pacific Research Institute and author of a new book called “Miracle Cure: How to Solve America’s Health-Care Crisis and Why Canada Isn’t the Answer.”
  • Dr. Michael Rachlis, a health policy analyst and author of “Prescription for Excellence: How Innovation is Saving Canada’s Health Care System.”

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: Universal health care is an institution here in Canada, but in the United States, its benefits are still being debated by doctors, patients and politicians. After Iraq, it’s the most important issue in the presidential election. In fact, president Bush has come out with an ad attacking John Kerry’s views on expanding Medicare.

ADVERTISEMENT: John Kerry and liberals in Congress have a health care plan. It includes the I.R.S., Treasury Department, and several massive new government agencies. Your doctor? In here somewhere. But not in charge. This $1.5 trillion government program puts bureaucrats, not your doctor, in charge of your health care decisions. One more reason we can’t risk the liberals in congress and John Kerry.

GEORGE W. BUSH: I’m George W. Bush and I approve this message.

AMY GOODMAN: Since we have the privilege of speaking to people on both sides of the border today about Canadian issues, we thought it would be interesting to put the Canadian health care system to the test in the United States. To help us do that, we’re joined by two guests who’ve spent a lot of time and energy on this very question. Sally Pipes is the president of the Pacific Research Institute. It’s a free market think tank. She wrote a new book called Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t The Answer. She’s a Canadian who now lives in the United States and joins us from Washington, D.C. Dr. Michael Rachlis is a health policy analyst and author of Prescription for Excellence: How Innovation is Saving Canada’s Health Care System. He joins us in our Toronto studio. And we welcome you both. Dr. Rachlis, let’s begin with you. How well would you say that Canada’s health care system would work in the United States?

DR. MICHAEL RACHLIS: Well, every health system has problems, but I think that by and large the American System has a lot more problems. We need to remember that up until 50 years ago, both countries had pretty much the same health care system. We had the same health status. We lived the same length of time and we spent the same amount on health care. And during the last half century, while everything else about our two countries was moving closer and closer together politically and economically, we developed very different health systems. And as a result of that over the last fifty years, Canadians now live two-and-a-half years longer than Americans, they have an infant mortality rate 35% less, we spend about 50% less on a G.D.P. basis than the Americans do — about half per capita cost as the Americans do. Everybody in Canada is covered for basic medical/hospital care. 44 million Americans have no coverage. Another 50 million Americans have such inadequate coverage that 500,000 declare personal bankruptcy every year because of medical bills. While spending less can and tends to get more: We have more visits with doctors per capita. We have more surgery per capita, we have more days in nursing homes and more days in hospitals, we get less heart surgery, we have fewer M.R.I. scans, but we do get more bone marrow transplants and more lung transplants per capita. So even in the high-tech area, it’s not all in the American favor, we do have problems with our system, but I think that reaching for the American system in Canada would be getting a can of gasoline to put out a fire. I do think that this — I sometimes asserted that Americans are so different than Canadians that they, you know, they cannot get up in the morning without having 45 million Americans who can’t get health care. But I don’t think Americans are that different from Canadians. I think that this system, while it’s not perfect in Canada by any means, would be a big advance for the United States.

AMY GOODMAN: Sally Pipes, your response?

SALLY PIPES: I guess there are two — the real issue to me is there are two ways to go. There are problems in Canada with their health care system and certainly the new Prime Minister, Paul Martin and Mr. Crétien before realized that. He spent $15 million on the Romano Commission Report to see how the problems with the health care system in Canada could be solved because of the long waiting lists and the lack of technological equipment that plagues Canada right now. And then Mr. Martin just had a three-day summit with the Provincial Premiers looking at solutions, because of the problems that I just outlined. In the United States, we have problems with our health care system, too. I think that the question is, do we want to take the American people to a more government-run system, as Mr. Kerry is talking about, or do we want to move to a more — a system which empowers individuals, and not the federal government? And so, I mean there are numerous statistics about the length of waiting times in Canada under the O.E.C.D. [Organisation for Economic Co-operation and Development], Canada ranks 20th out of 25 nations in terms of M.R.I’s per million. They rank 16th out of 25 O.E.C.D. countries with C.T. Scans. The stories that I have from friends and from the media, there is a real problem with Canadians not being able to get health care, particularly when they need to see a specialist. You know, the Fraser Institute has shown the average wait from seeing a G.P. to a specialist today is about 17.7 weeks, double what it was ten years ago. The government realizes this is a problem. Canada is losing about 250 doctors a year to the United States. So, that is a real problem. On the other hand, we do have 45 million uninsured in America. But we have to look at who are the uninsured. Of those, 16% of them are people earning over $75,000. And 30% earn over $50,000 a year. 14.2 million of those people are eligible for Medicaid and the state children’s health insurance program but have not signed up for it. We have 8.2 million Americans who are chronically uninsured. Those are the people that do need to be taken care of, but I think we need in America to empower individuals through programs such as health savings accounts combined with catastrophic coverage. I think in that way, we’re going to see even better care and the uninsured will be reduced and the costs will go down, because when people spend their own money, they spend it more carefully, than when they spend someone else’s.

AMY GOODMAN: Dr. Rachlis.

DR. MICHAEL RACHLIS: I know that Ms. Pipes’ plan which includes something called the medical savings account is difficult to describe in just a few minutes on the radio. It claims that by making the system essentially more private, by having higher co pays, by having less government involvement, that somehow this is going to lead to cost control. It won’t. The lessons of the industrialized world are that the United States is basically the only country that has — that relies mainly on the market for the delivery of health services and the financing of health services, rather. It is the only country that has this terrible problem with coverage. So, and it also is the country that has by far the highest cost. The U.S. is spending this year almost 15% of the economy on health care compared to less than 10% in Canada. And we’re near the high end of other countries, Germany, France spend more or less what we do, Sweden spends less. Britain spends a lot less. So, the United States spends the most and has massive coverage problems. And people who aren’t from the United States, the analysts who are not from the United States, tend to think that the problems are related, that the only way that the cost control is when you get a single payer system where one organization in Canada, the government, pays 70% or so of our health bills. They can negotiate tougher with hospitals and physicians, and at the same time, have everyone covered. So, I think that Americans tend to think that you can’t get cost control when you go to universal coverage, it will make it worse. The lessons in Canada and other countries are that the only way to get cost control is cover everybody.

AMY GOODMAN: This obviously is an enormous issue in the United States in the presidential debate, medical savings accounts, very much being proposed by President Bush. Sally Pipes, when you look at the range of the debate in the United States, whose side are you coming down on. Are you supporting President Bush as you put forth the medical savings accounts?

SALLY PIPES: Well, Amy as you know, I’m Canadian, so I cannot vote in the elections here. I certainly support the President’s idea for empowering individuals through health savings accounts, which are a tremendous improvement over medical savings accounts, which you mentioned, because you can put your money away tax-free in a health savings account and then carry it forward if you don’t use it all. And so, that’s a tremendous advantage that wasn’t in the previous medical savings account. Also with the — that combined with catastrophic health insurance is very important. But I think the premiums for the catastrophic that the people numbers for the catastrophic should be tax-free and I also think when individuals spend money out of pocket, that that money should be — you should be able to deduct that from your tax bill. I think in this way, we’re going to get more Americans covered and certainly we have seen since health savings accounts were introduced in the past in December of 2003, that the people that have been signing up for them have not been high income people, but they basically people earning around $50,000 a year, and less. Because of the people that I mentioned that are uninsured, that are making over $50,000 a year it’s not that these people don’t get health — they don’t have health insurance, but it doesn’t mean they don’t get health coverage. Last year, the Americans — Americans spent $125 billion out of pocket for health services. I think this is an important point, that some people choose not to buy health insurance because it is expensive, or they —- they decided they don’t want to spend their money in that way. I think that we also need to allow individuals to buy health insurance on a national basis -—

AMY GOODMAN: Sally Pipes, are you suggesting that the system in the United States is cheaper than in Canada, in reaching more time people.

SALLY PIPES: I’m not suggesting it’s cheaper right now. We have had cost escalation. But also, the average income of Americans is higher than it is in Canada, and so —- but we will see costs reductions if people take control. Right now, when most people in America that have health insurance get it through their employer because of the tax preference after World War II, when wage and price controls came in. So when people pay a co-pay when they go to the doctor, they think that that’s the cost of health care, so they demand more technological treatments, they demand more surgeries. But when they’re back in the driver’s seat, they’re going to be more careful about what they ask for. And also, you know -—

AMY GOODMAN: Let me have Dr. Rachlis.

SALLY PIPES: Can I just say one more thing, that when people don’t have health insurance if they turn up at an emergency room and they are getting care and that’s very expensive and that has to be covered by those of us who are paying premiums.

AMY GOODMAN: Dr. Rachlis.

DR. MICHAEL RACHLIS: Well, I’m looking at a New York Times article from last year about Kevin Thorton, a fellow who has got serious stomach problems, found that the tests cost too much money to investigate, didn’t go ahead with it. A couple of years earlier a fellow named Larry Cozy, from New Orleans actually walked into bank with a holdup note and went in his car to wait to be arrested so he could go to jail cause he couldn’t afford care for colon cancer so he got out of the jail. There are millions of Americans who are not getting adequate care. And Ms. Pipes is recommending the savings account idea, which we haven’t gone into a lot of detail. But it does include the idea that you have to pay a lot of your own care before you hit a certain level, which is your deductible. And we know from studies at all over the world, including the United States, that when people have to pay for care, they’re less likely to get it, and that diseases that could be treated early fester. In the United States, they are convinced that getting people to pay more and more for their own care, talk about a need for new ideas, this is the oldest idea in the book, taking money out of our own pockets to pay the doctor, that if you do this, you are going to get cost controls but economists in other parts of the world say when you get multiple payers, including people paying privately, prices up and costs up overall. And that’s exactly what happens.

AMY GOODMAN: I’m going to interrupt with a last question and get a quick response. I don’t know if you both as Canadians were insulted in the presidential debates when the issue was raised of people going to Canada to get cheaper drugs and President Bush saying he has resisted that, because he is concerned about the safety the of those drugs being made in Canada. Sally Pipes, your response.

SALLY PIPES: Drug re-importation is a very serious issue. The Canadian market cannot supply the demand that’s coming in America, but the real issue is, politicians in the U.S. want cheaper prescription drugs. And the only way they can do that is by putting price controls on our drugs, which will have a negative impact on research and development innovation because most of the drugs today that are manufactured are developed in the United States, which leads to longer and healthier lives for all of us.

AMY GOODMAN: Dr. Rachlis.

DR. MICHAEL RACHLIS: I guess my comment would be in Canada we often say people in Toronto don’t know anything about the rest of the country. I’m afraid people in the United States often know almost nothing about the rest of the world. I love Americans. My wife is an American I go there all the time. But Americans are extremely narrow about the rest of the world and therefore it is exceedingly easy to mislead Americans because they don’t know what’s going on in the other parts of the world. I guess my closing comment would be that–to quote Winston Churchill, regarding–he was talking about something else, but regarding Americans–finally fixing their health system and making it like other wealthy countries, but Churchill said, can be relied to do the right thing after trying everything else. They have tried everything else in their system. They have tried to privatize the system even more. It’s just raised costs and increased the number of people who are uninsured. Eventually Americans will realize that the only way to get 100% coverage and control costs is to cover everybody with a single paying plan.

AMY GOODMAN: Well, I want to thank you both very much for being with us. Our guests have been Sally Pipes president and CEO of the Pacific Research Institute, author of book, Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada is Not the Answer. Speaking to us from Washington, D.C. Dr. Michael Rachlis, health policy analyst and author of the book, Prescription for Excellence: How Innovation is Saving Canada’s Health Care System. He was in Toronto with me here.

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