Commentary

Russ: Canadian health care – facts, not fears

Editor’s note: This commentary is by Lee Russ, a member of the Vermont Workers’ Center. He is a semi-retired legal writer and editor, who was the lead author of “Couch on Insurance.”

Canada, O Canada, how some Americans love to disparage you — especially your health care system. In an editorial titled “Decoding the Language of Green Mountain Care” almost a year and a half ago, John McClaughry informed readers that:

… an examination of the Quebec system can quickly lead to the conclusion – largely justified – that single payer health care will unavoidably result in rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and, of course, much higher taxation.

Similar scare stories, usually involving anecdotes of some medical nightmare befalling a Canadian citizen forced to rely on Canadian health care, continue to make the rounds of our state, courtesy of the various groups opposed to Vermont’s planned system of universal, publicly financed health care. Many of them can be found on VTDigger, especially in the comments to articles about health care reform.

Are these dire warnings prophetic? Are they totally made up? It’s far easier to find the scare stories than it is to find any concerted effort to examine their truth. Which is both unfortunate in that it distorts our discussions of health care, and unnecessary in that many sources of legitimate, reasonably objective information about Canada’s health care system are readily available.

In fact, Canadian professor Antonia Maioni spoke at Lyndon State College in 2011 on the Canadian health care system, giving a lengthy review of the Canadian system’s nuts and bolts, including its flaws and its virtues. You can watch the entire talk yourself; it’s online (it lasts just under an hour). I watched it all, including the Q&A following the talk in which a member of the audience pressed Maioni about these horror stories. Her response: really not true. Not to say that there aren’t problems in Canada, but the horror stories … really not true.

And how do the Canadian people themselves feel about their health care system? If you believe the scare stories, Canadians are outraged. But I’ve talked to many Canadians about it and have yet to find one that doesn’t prefer Canada’s system to ours.

 

One of the most striking aspects of Maioni’s talk is her comparison of the billing departments at a major Canadian Hospital and an American hospital in Plattsburgh, N.Y. At the Canadian hospital, the billing department was in a relatively small room, and consisted of “maybe seven desks.” The billing department of the Plattsburgh hospital took up “a whole wing” of the facility.

Many of the scare stories thrown around in the U.S. concern claims that doctor are fleeing that nation. The facts? Well … Canada tracks its health care system very closely. The Canadian Institute for Health Information (CIHI) issues an annual report on the “Supply, Distribution and Migration of Canadian Physicians.” The 2012 report found that:

  • There were more than 75,000 physicians in Canada in 2012, a 3.6 percent increase over 2011.
  • Between 2008 and 2012, physician growth rates outpaced population growth rates threefold, resulting in 214 physicians per 100,000 population in 2012.
  • During each of the five years profiled in the report, more physicians returned from abroad than moved abroad.

A 2009 “Survey of Primary Care Physicians in 11 Countries” also found that Canadian doctors tended to be more satisfied than American doctors:

  • 75 percent of Canadian doctors were satisfied or very satisfied with practicing medicine, compared to 64 percent of American doctors.
  • Insurance restrictions on medications or treatment posed major time concerns for 48 percent of American doctors, but only 19 percent of Canadian doctors.
  • 58 percent of American doctors thought their patients often had trouble paying for care, compared to 27 percent of Canadian doctors.

The U.S. fared better in terms of waiting times to see a specialist and ease of access to specialized diagnostic tests. Both countries’ doctors thought their health care system needed work, but 15 percent of U.S. doctors thought the system needed to be “completely rebuilt” compared to only 4 percent of Canadian doctors.

A related scare story is that Canadians are flocking to the U.S. for health care because they are dissatisfied with their own system. The facts once again differ. The scare stories are usually based on anecdotal evidence about the number of Canadians treated by some medical practice in the U.S. But as long ago as 2002, researchers who took a serious look at the issue concluded that, despite the persistence of the myth of Canadian medical care refugees, “Surprisingly few Canadians travel to the United States for health care.” For example, in the 1996 Canadian National Population Health Survey (NPHS), ”Only 90 of 18,000 respondents … indicated that they had received health care in the United States during the previous twelve months, and only twenty indicated that they had gone to the United States expressly for the purpose of getting that care.” That’s a hair over one tenth of one percent who came to the U.S. specifically for care.

And how do the Canadian people themselves feel about their health care system? If you believe the scare stories, Canadians are outraged. But I’ve talked to many Canadians about it and have yet to find one that doesn’t prefer Canada’s system to ours. My personal experience is backed up by the recent Washington Post piece: “Canadians don’t understand Ted Cruz’s health-care battle” (Sept. 25, 2013), in which Matt Miller interviews two experienced Canadian businessmen on how the Canadian system works, and how Canadian businesses feel about it.

One businessman tells the author “how baffled he and Canadian business colleagues are when they listen to the U.S. health-care debate. He cherishes Canada’s single-payer system for its quality and cost-effectiveness (Canada boasts much lower costs per person than the United States). And don’t get him started on the system’s administrative simplicity — you just show your card at the point of service, and that’s it.” In fact, that Canadian is “amazed at the contortions of the debate in the United States.”

The second Canadian businessman, an “avowed capitalist” who has “experienced both systems first hand,” says that Canada’s lower spending, better outcomes and universal coverage make it superior by definition, and it’s “incredibly hassle-free.” Unlike in the United States, where his wife spent hours fighting with the health plan or filling out reams of paperwork every time his kids went in for an earache, in Canada, “the entire administrative cost is pulling your card out of your pocket, giving it to them and putting it back.” He also says that Canadian divisions of multinational firms love Canada’s system, and that his peers view the U.S. debate as “ideological and not based on economics.”

Even when commentators accurately cite criticism of the Canadian system, they often manage to leave out information even more critical of the U.S. system. Daniel McCauliffe, for example, in a commentary in June 2012, cited a Globe & Mail commentary for the proposition that “Even Canadians realize that their single-payer system is not working well.” While the Globe & Mail commentary did, indeed, talk about things the Canadian system needed to do better, McCauliffe failed to mention that the fourth sentence in the Globe & Mail piece says, “When it comes to health care, only the United States is morally bankrupt and economically inept.” Clearly the author of that commentary thought the Canadian system was working far better than the American system.

Canada’s system is not perfect; ours is far less so. At this point, the only thing that makes sense for all of us, including those who opposed reform, is to take a hard look at how to make our own publicly financed universal health care system even better than the system in Canada. We can do that by 2017 when the system takes effect. We can do it with facts; we cannot do it with fear.

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  • The Canadian system is far superior to the mess we have in the US now.

    I have friends who work in the US but reside in Canada because there is no way they could afford treatement in the US.

    Vermont needs Free Universal Healthcare to free us all of the worry of what will happen if we get injured or fall ill.

    • Dan McCauliffe

      But the single payer Canadian system is inferior to most of the European health care systems that are mixed payer systems, not single payer.

      Mr. Russ insinuates that I was arguing that the US systems was better than the Canadian one. That was not the case . I was arguing that we should reform our health care system for universal access but in the mold of the better European health care systems, not in the mold of the trouble-prone Canadian system.

      Here is the section from my commentary that mentions the Globe and Mail quote that Mr. Russ takes out of context:

      “At this juncture we should be asking ourselves why we are modeling Green Mountain Care after the Canadian health care system. Even Canadians realize that their single-payer system is not working well. A recent Globe and Mail commentary by had this to say:

      “One of the most important lessons we have to take from Europeans is that we need a combination of a well-regulated private system and a well-managed public system. Every health system worth its salt has a mix of private and public delivery and payment.””

      I encourage you to read it for the details of my argument.

      http://vtdigger.wpengine.com/2012/06/13/mccauliffe-canadian-health-care-system-not-a-good-model-for-green-mountain-care/

      • Lee Russ

        Mr. McCauliffe,

        I did not intend to insinuate that your 2012 commentary was arguing that the Canadian system was inferior to the US system. The reason I brought your commentary up at all is that someone reading it could easily conclude that, as the bulk of it is devoted to the Canadian system’s supposed flaws. I doubted that someone reading your 2012 commentary would ever imagine that the author you were quoting on the need to modify Canadian health care also said ““When it comes to health care, only the United States is morally bankrupt and economically inept.”

  • Elise Seraus

    I would caution that perhaps it (single payer) worked in Canada, at least more or less… It worked poorly in the country I lived in for nearly 20 years… Was rationed care, have a bum shoulder for it… They don’t cover a mammo or a pap smear, although both are completely affordable out of pocket (if you know their worth and insist on getting them). There was ZERO preventative care… (ie. above) and never a BP check… EVER! (Turned out my husband has, as do many of his family, high blood pressure, undiagnosed until we moved here!). Sooooo, perhaps it is how it is managed, but my e

    • Elise Seraus

      Sorry, not loving my ipod!
      In my experience, single payer was awful…

      • Lee Rus

        Elise,

        Like any system, a single payer system will only work as well as the people running it make it work It obviously has to be properly funded, and the necessary resources have to be allocated.

        I’m really curious which country you’re talking about.

    • Walter Carpenter

      “Was rationed care, have a bum shoulder for it… ”

      I’ve been through the same here in our free-market system. What country were you in?

    • All in all, that is better than a low level uninsured worker gets in the US. Basically health concerns are left unaddressed until they go to the emergency room and even then sometimes things are not addressed. It’s better in VT from what i hear but down south i have heard stories of people rejected from treatment via emergency roomm because the hospital had reached some quota.

      • walter carpenter

        Martha, I have known people in Vermont who have been evicted from hospitals because they lacked insurance. Although it is probably much worse down south, it is not unique to there.

  • Walter Carpenter

    “At this point, the only thing that makes sense for all of us, including those who opposed reform, is to take a hard look at how to make our own publicly financed universal health care system even better than the system in Canada. ”

    I wish this universal system could come earlier than 2017. The thing to remember is that we already have 3 universal care systems and yet have 50 million uninsured in this nation. Why cannot we just extend these universal care systems — Medicare, Medicaid, VA — to all Americans?

    • Keith Stern

      We have Social Security operating deeply in the red, veterans having to fight for their rights as veterans, and medical providers dropping out of Medicare/Medicaid. All in all the government is doing a great job and needs to be expanded.

      • Walter Carpenter

        “We have Social Security operating deeply in the red, veterans having to fight for their rights as veterans, and medical providers dropping out of Medicare/Medicaid. All in all the government is doing a great job and needs to be expanded.”

        I disagree about social security as well as Medicare/Medicaid. The VA is clogged because of all these wars we keep getting ourselves into. And how much has the Congress, especially before Obama, cut from the VA budget? Yet, none of these are helped by a congress we have now determined to cut taxes for the wealthy, to cut these programs, to manufacture a crisis where one does not exist, all to starve them so to prove they do not work.

        • Keith Stern

          You can disagree if you want but you are ignoring the truth. The SS deficit began in 2010 and has been getting larger. That was in the news. A hospital in Boston closed because it had such a huge number of Medicare patients that it could not meet operating budgets. The closure was also in the news.
          As far as there being no crisis, you are not understanding reality. 1/3 of all the money on the planet is the amount of the US debt. The money invested into buying the debt could be used to build factories, expand businesses, invest in medical advances and technology, etc. throughout the world.
          Just because you can’t understand this doesn’t mean it isn’t a problem.

          • Much of US debt was in incurred to pay for millitary expenditures. If the US were to withdraw from the many conflicts it is in all around the world and stop funding conflicts in foreign lands the picture at home might be brighter.

            I’d rather some of that money be spent to care for people.

          • John Greenberg

            Here we go again: “You can disagree if you want but you are ignoring the truth. The SS deficit began in 2010 and has been getting larger. That was in the news.”

            Go to http://www.ssa.gov/oact/tr/2013/VI_A_cyoper_hist.html#207122 and you can see for yourself that in 2010, the Social security trust fund had a net surplus of $92.2 billion, and, as a matter of fact, has had net increases every year since 1983. It also had surpluses in 2011 and 2012.

          • Lee Rus

            The option of doing nothing isn’t really an option. The current health care system here is starting to implode under the cost burden.

            As for Medicare and Social Security, the system needs adjustment, as any system will require from time to time. The anti-tax mania that prevails in the Republican ranks is the major obstacle to making the needed adjustments.

            I believe you mentioned one correction in a past post: raising the FICA ciling. I’d go further: capital gains should not be exempt from Soc Sec and Medicare tax.

            Underlying all of these points is the fact that we have allowed globalization to export our work. With fewer people working and at lower wages, obviously the funds coming in to Soc Sec and Medicare are diminished, and more people require the aid of Medicaid.

            But the point of the original article remains: the Canadian system pretty much works and all the scare stories about it not working are spread for a purpose.

          • Keith Stern

            I can’t speak for the Canadian system because I haven’t studied it. I will say I do believe in a single payer system but one that is handled by a for-profit company. It would be handled more efficiently and if it doesn’t do an adequate job, unlike the government, it can be replaced by another company.
            Just the cost of the website and the fact that it is a failure when it was launched should be a good indicator of the incompetence.
            And instead of disrupting an entire system to provide better healthcare for a small percentage, the government could easily offer catastrophic coverage to those who need it based on a sliding scale where that would kick in. That way the government isn’t paying first dollar coverage and insurance companies would offer policies to take care of the deductible at a small cost.
            Auto insurance and health care insurance already utilizes a form of that and it apparently works.

          • Walter Carpenter

            “You can disagree if you want but you are ignoring the truth.”

            Perhaps, Keith, because it is not the truth. The link John put up shows it. Here, also, to back John’s link up, is something from Bernie on the social security issue:

            http://www.sanders.senate.gov/newsroom/must-read/on-social-security?utm_source=vtbuzz&utm_medium=email&utm_content=Headline+IMG+featured&utm_campaign=Vermont+Bernie+Buzz+11-01

            “The Koch brothers, Pete Peterson and other billionaires are spending huge amounts of money trying to cut Social Security and other vitally important federal programs. As part of this campaign, an enormous amount of misinformation is floating around. Let me try to set the record straight by answering a few of the questions that people are asking my office.

            Is Social Security “going broke?”

            No! Social Security is not going broke. According to the Social Security Administration, the Social Security Trust Fund has a surplus today of $2.8 trillion. This sum, plus revenue that comes in every day, can pay out every benefit owed to every eligible American for the next 20 years. In 2033, unless Congress acts, Social Security will be able to pay out only 75 percent of benefits owed. Congress must act and make Social Security strong for the next 50 to 75 years..”

            “A hospital in Boston closed because it had such a huge number of Medicare patients that it could not meet operating budgets.”

            Keith, Do you have a link to that hospital in Boston you said closed because of too many medicare patients. It cannot be just because of that. Most hospitals in Boston are teaching hospitals, connected with UMass, Harvard, and so on. And if Medicare is so bad, we are so many hospitals in Vermont (maybe other states as well, but I do not know) embracing these Accountable Care Organizations (ACO’s) which are Medicare/Medicaid based?

            The thing to remember here is that a hospital would just not close because of Medicare. There has to be something else too. And in single-payer type systems the hospitals are not subjected to so-called “market forces.” As Lee quoted in his editorial about the billing departments of a Canadian versus US hospitals: At the Canadian hospital, the billing department was in a relatively small room, and consisted of “maybe seven desks.” The billing department of the Plattsburgh hospital took up “a whole wing” of the facility.”

          • Walter Carpenter

            “I will say I do believe in a single payer system but one that is handled by a for-profit company. It would be handled more efficiently and if it doesn’t do an adequate job, unlike the government, it can be replaced by another company.”

            Why can’t the government be replaced? We are the bosses of the government, after all. It might sound strange in this era of Grover Norquist, the Koch’s, and their minions trying to destroy the government and deny us a voice in it, but we are the government’s bosses.

            I doubt a private for-profit company could handle a single-payer system. For one, it would be excessively expensive. A for-profit company would have to tack on vastly higher costs above and beyond medical care, including their profit. To turn a profit and meet Wall Street’s expectations, they would also have to cut back on “medical losses,” or paying claims. Our current system has already shown how this is done.

        • Todd Taylor

          Walter,
          Nationally, the VA has over 500,000 claims pending and nearly 100,000 pending appeals.
          The average new claim processing time appears to be 12 to 18 months while appeals may take several years. Dozens of deaths due to negligence continue to occur each year; despite this the administrators somehow manage to get their ‘bonus’, sometimes in the 5-figure range, on time. Yes, the VA is quite a system. Imagine the uproar if applying for medicaid, food stamps or home heating assistance took even half as long as our wonderful VA?

          • Lee Rus

            That’s terrible. But why is this happening?

            What did people think would happen when newly inured vets from our current wars entered a system in which spending was static or even reduced?

          • Walter Carpenter

            “Yes, the VA is quite a system.”

            Yes, Todd, I am aware of the problems with the VA. I have veteran friends in the system, a couple from as far back as WWII. I also know people who work there. The VA would be a whole lot better off if it was funded properly. Below are two articles on what has happened to its funding, which was being cut when we were sending more and more troops into the cauldron of Iraq. Then you have the great recession of 08 to factor in. Then, you have the system being overwhelmed in spite of these funding woes with veterans needing help from Afghanistan and Iraq, together with those of Grenada, Vietnam, Korea, even WWII, and whatever other wars we’ve been in since WWII. But like it or not, the VA is still a nationalized/socialized single-payer health care system.

            CNN.com – Democrats slam budget cuts for veterans’ services – Mar 19, 2005
            http://www.cnn.com/2005/ALLPOLITICS/03/19/dems.radio/

            Veterans face budget increase, then big cuts – politics | NBC News
            http://www.nbcnews.com/id/17117430/#.UnWXlpFARZg

          • John Greenberg

            “Nationally, the VA has over 500,000 claims pending and nearly 100,000 pending appeals. The average new claim processing time appears to be 12 to 18 months while appeals may take several years.” Out of how many claims submitted? How do these numbers compare to private insurance?

          • Keith Stern

            @ John Greenburg: The information in the link you sent defies logic. I don’t know if they tweaked the numbers or flat out lied but logic alone should tell you it isn’t true.
            Why would you believe the surplus is rising when there are more people going on SS every day and the unemployment/underemployment rate has risen so much since 2008? The fact is there are 1 1/2 workers for every 1 person collecting. Can you see how they can pay more than is being paid out and have a surplus?
            Again:
            Social Security already adds to budget deficits.

            Since 2010, Social Security has taken in less money through payroll tax revenues than it pays out in benefits, generating cash-flow deficits. Social Security’s 2012 cash-flow deficit was $55 billion.

            Social Security covers cash-flow deficits by drawing down interest payments from the U.S. Treasury on previous trust fund borrowing. Cash-flow deficits mean the Treasury can no longer cover interest payments to the Social Security trust fund by issuing additional IOUs; instead, it must produce actual cash from taxes or borrowing. Thus, Social Security is adding to today’s deficits.

          • Lee Russ

            Keith,

            John’s numbers are correct. The tables in this source show how that surplus is derived:

            http://www.ssa.gov/oact/trsum/

            You can’t just compare payroll taxes received to benefits paid out–you have to consider the interest earned on the reserve, plus any other revenue.

          • Keith Stern

            There is no interest paid because the government is broke. It’s a Ponzi scheme. They are simply transferring money from one place to pay others. If a citizen did this it would be illegal. People go to jail for it.
            They can show you all the surpluses they want on paper but if they needed the money tomorrow, there wouldn’t be any.

          • Lee Russ

            You can’t discuss the solvency of the program and simply declare that interest has to be ignored because the entity paying the interest is broke. It’s simply a non-sequiter.

            The interest paid to individual investors in our treasury bonds is still interest, right?

          • Todd Taylor

            John Greenberg,

            I fail to see how this relates to numbers of private insurance claims submitted. It isn’t a claim for medical care received, it’s a claim to show service-connected claims that will allow the VA to provide care for a particular illness. Given that roughly two percent of the population has any type of military service, don’t you think there are probably more ‘claims’ (that happen to be a completely different type) awaiting resolution by the other 98 percent?

          • John Greenberg

            Todd:

            Your original statement wasn’t clear about the nature of the “claims” so you’re right: there is no analogy to private insurance.

            The point I was trying to make remains, however. Figures like these need to be placed in context and then compared to alternatives (when possible). No system is perfect, and your point, as I understood it, was to suggest that the VA is poorly run.

            To reach than conclusion, however, I would want to see how the VA’s error and delay rates compare to alternative systems. If it’s the best among all the alternatives, I would reach quite different conclusions than the one your non-comparison would have me make. That’s especially so if the error and delay rate, on a percentage basis is actually rather low.

        • John Greenberg

          Keith Stern writes: “@ John Greenburg: The information in the link you sent defies logic. I don’t know if they tweaked the numbers or flat out lied but logic alone should tell you it isn’t true.
          Why would you believe the surplus is rising when there are more people going on SS every day and the unemployment/underemployment rate has risen so much since 2008? The fact is there are 1 1/2 workers for every 1 person collecting. Can you see how they can pay more than is being paid out and have a surplus?”

          The link I provided is from the Trustees of the Social Security Trust Fund; these are official figures.

          Lee Russ already answered your next question: the Social Security Trust Fund has accumulated massive surpluses over the last 30 or so years. It will take more than a few bad years to offset them.

          • Keith Stern

            No use with you. There is no money, period. It is spent. The money must be borrowed.

          • Robert Hooper

            Keith, you seem to be a bit stuck on your interpretation of economic reality. SS is not borrowing money, they are reclaiming funds that the congress decided should be open to borrowing by the feds to fund other programs. For decades, the SS trust fund has been in surplus income vrs outgo, but the funds were invested in the USA, which paid crappy returns. There may not be cash, but there are IOU’s aplenty. When you say the link defies logic, please consider that the problem may not rest with the information in the link. often an open mind is required to fairly accept logic.

            Todd, your waiting list for certification of partial or complete service connected disability is not relative to the system delivering straightforward healthcare to the existing members. You are floating apples into this orange discussion. The VA healthcare system is doing pretty well, except for the underfunding that is happening as a result of the conservatives who would rather WAVE a flag than fund benefits for those who DEFENDED it and are owed our thanks for their service.

          • Keith Stern

            John one last try: Social Security is not borrowing money, it is cashing in the bonds replacing the actual surplus in cash. The federal government has no money, it is running a $17 trillion debt that it has borrowed to pay obligations. So for SS to cash in a bond the government has to go borrow the amount of that bond somewhere to provide SS with that money. That is in effect increasing the debt. The money in treasury obligations within the government is an accounting exercise and doesn’t increase the debt. Having to borrow the money to give to the agency does.
            If you still can’t understand it you will have to search for a video that may show you how it works.

          • Keith Stern

            John in your response to Todd, once again we get the knee jerk liberal response blaming the conservatives. The Democrats controlled the federal government for a full 2 years. Explain why they never corrected so much damage liberals claim the Republicans did to programs and agencies. Obamacare proofs they could do anything they wanted without Republicans preventing it. So what happened?

  • Ruth Gaillard

    The same applies to the UK’s National Health Service. My family in England don’t understand when I try to explain co-pays, deductibles, lifetime limits, pre-existing conditions, denial of coverage, delay of payment, rescission of policy, donut holes etc, they just go to the doctor when necessary.

    • Lee Rus

      That’s exactly the response I always get when I talk to Canadians about our system. Sympathy, laughter and confusion.

      • walter carpenter

        “That’s exactly the response I always get when I talk to Canadians about our system. Sympathy, laughter and confusion.”

        Me, too,. I work in the tourist business and meet many Canadians as well as people from overseas, all with single-payer systems. I get the same reaction: “sympathy, laughter, confusion.”

  • Keith Stern

    One thing your editorial fails to consider is the quality of the people in government between the two countries. Take into consideration that Canada isn’t buried in debt like the US. Take into consideration that Canada is not going to war every few years. Take into consideration they know how to take advantage of their natural resources compared to here.
    Is Canadian’s government loaded with incompetence and corruption like here? Do their politicians lie to their constituents as they do here? Are contracts awarded based on relationships rather than given to the best qualified with the lowest bid as opposed to here?
    Do Canadian politicians actually reason things out before they vote as opposed to here?
    The same people who passed the ethanol bill, Cash for Clunkers, and Obamacare can get anything right?

    • Walter Carpenter

      “One thing your editorial fails to consider is the quality of the people in government between the two countries.”

      You have raised a good point here. Yet, when you make the charges about lying, corruption, etc..which I agree with you on, look at behind the scenes. This whole shutdown idiocy was well orchestrated. Remember who is behind it and why: the koch brothers, Exxonmobile, the big health insurance companies, etc. the reason we could not get a public option, for example, and some real competition, is because of the health insurance companies spending a million or so a day to block it. Personally, I think our system of government, with its billion dollar campaigns, is broken and dysfuctional. Time for a change.

      • Sadly the Koch’s have their tentacles in Canadian politics as well. They have been busy furthering their business interests there as well as encouraging Canadian politics to get closer to the worst of US politics.

    • Lee Rus

      Keith,

      I didn’t consider it because the point of the article is that the Canadian system pretty much works, not the competence or integrity of American politicians.

      Frankly, if you’re saying that America has lost the ability to act in the public interest, then I think we are simply doomed. I don’t believe we’ve reached that point, and certainly not within Vermont’s state government.

      I see the concerted efforts of the anti-tax, anti-government folks, from Grover Norquist to the Kochs to Fox news to Ted Cruz and so on, as the major cause of our federal government’s current incompetence and paralysis. As for corruption, it’s always been with us and will always need to be battled.

      Giving up and killing government certainly isn’t the answer.

      We’ve had versions of this discussion elsewhere: where is the anger about tax dodging corporations, tax breaks for fund managers, decreased taxes at the same time we fight two incredibly expensive wars, and on and on.

      • Walter Carpenter

        “We’ve had versions of this discussion elsewhere: where is the anger about tax dodging corporations.”

        Good question, Lee.

      • Keith Stern

        Actually as a candidate one of my plans was to end tax shelters and loopholes. I discussed this when I debated Peter Welch several times. He never even discussed it and has never offered any legislation to end the practice. As far as I am aware neither has Leahy or Sanders.
        As for the Social Security system going broke, there is no real trust fund. It holds treasuries but the thing you fail to realize is the treasuries or worthless unless the government either prints or borrows the money to cover them. It is the same as a destitute person writing you an IOU for $100 for example. That IOU is worthless until the guy gets the money first.
        Social Security already adds to budget deficits.

        Since 2010, Social Security has taken in less money through payroll tax revenues than it pays out in benefits, generating cash-flow deficits. Social Security’s 2012 cash-flow deficit was $55 billion.

        Social Security covers cash-flow deficits by drawing down interest payments from the U.S. Treasury on previous trust fund borrowing. Cash-flow deficits mean the Treasury can no longer cover interest payments to the Social Security trust fund by issuing additional IOUs; instead, it must produce actual cash from taxes or borrowing. Thus, Social Security is adding to today’s deficits.

  • Grace Gershuny

    Great commentary. I’d guess that at least a few of that handful of Canadians who come to the US for treatment are like my friend Nelson, a Canadian who suffered from a brain tumor. He was able to take advantage of a then experimental proton beam therapy in Boston, all paid for by Canadian Medicare, which saved his life. The docs there told him he was lucky – US health insurers would not pay for this treatment.

  • Dan McCauliffe

    Mr. Russ conveniently doesn’t discuss how the Canadian health care system ranks compared to European health care systems. It is important to realize that Canada doesn’t do so well compared to most of the European countries that offer universal access and in most cases spend less on health care than does Canada.

    I think that the general public and many single payer advocates are unaware that the best health care systems in the world are not single payer yet offer universal access.

    I have read so many op-ed pieces and comments on how the US needs to adopt a single payer health care system, as in the European countries and Canada. Well guess what – virtually all of the European health care systems are not single payer. What are considered to be the best health care systems in the world are not single payer but are mixed payer systems with both public and private funding.

    Canada is one of the few remaining single payer health care systems in the world, and this may change as the long waiting times are harmful to patients and creating an impetus to reform the Canadian system to be more like the mixed payer systems of Europe. http://blogs.vancouversun.com/2012/08/01/will-canadas-health-care-system-evolve-into-european-parallel-private-model-charter-of-rights-case-will-decide-it

    A 2010 study found Canada dead last in timeliness and quality of health care compared to six other developed countries. It ranked 6th overall, just ahead of the US. http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx

    In the 2010 Euro-Canada Health Consumer Index, Canada’s single payer health system ranked poorly compared to the many mixed payer systems in Europe. Canada ranked 25th compared to 33 European countries. http://www.fcpp.org/files/1/ECHCI2010%20Final.pdf

    The 2012 Euro Health Consumer Index is available, but did not include Canada. However, there is still much to learn from this latest analysis. The results of this latest study show how consumer empowerment, and abandoning the single payer model leads to better health care system results.

    From the full report: http://www.healthpowerhouse.com/files/Report-EHCI-2012.pdf
    The Swedish authors of the latest study state:

    “The Dutch have established a European model to copy – NOT LEAST BY ABOLISHING SINGLE-PAYER SYSTEMS.” (Cap emphasis is mine.)

    “The NL [Netherlands] is characterized by a multitude of health insurance providers acting in competition, and being separate from caregivers/hospitals. Also, the NL probably has the best and most structured arrangement for patient organization participation in healthcare decision and policymaking in Europe.”

    “Here comes the speculation: one important net effect of the NL healthcare system structure would be that healthcare operative decisions are taken, to an unusually high degree, by medical professionals with patient co-participation. Financing agencies and healthcare amateurs such as politicians and bureaucrats seem farther removed from operative healthcare decisions in the NL than in almost any other European country. This could in itself be a major reason behind the NL landslide victory in the EHCI 2012.”

    The highly rated Netherlands’ mixed payer model is clearly not the future of Vermont’s Canadian-style single payer system with bureaucratic top-down control, that disempowers patients and their providers in medical decision making.

    The above study was critical of the single payer systems for good reason: they do poorly compared to other universal health care systems such as the Dutch and Swiss systems. It should also be noted that Canada spends about the same on health care as do the Netherlands and Switzerland.

    We should all be striving for the best health care system for Vermont that provides universal access while preserving high quality, containing costs, and avoiding rationing through long waiting times or other measures that cause patients harm. The single payer system, as used in Canada, is not the best suited system for achieving these goals.

    We should be looking at the best European health care systems as models for health care reform in VT and in the US, not the inferior single payer Canadian model.

    http://vtdigger.wpengine.com/2012/06/13/mccauliffe-canadian-health-care-system-not-a-good-model-for-green-mountain-care/

    • Lee Russ

      The purpose of my piece was simply to address whether the scare stories about Canada are true, not to compare the specific Canadian system to all the specific health care systems throughout the industrial world.

      The fact remains that Canada’s system appears to be working better, and to be more popular with its citizens, than America’s system.

      I agree that we should be “striving for the best health care system for Vermont that provides universal access while preserving high quality, containing costs, and avoiding rationing through long waiting times or other measures that cause patients harm.”
      Our state has already enacted a health care reform plan and is working toward implementing it. It shares some attributes with Canada’s approach, but that is not to say that Vermont is “adopting the Canadian system” wholesale. All of us in VT have an opportunity to work with the Green Mountain Care Board to ensure that our system is designed to be as effective as possible. Just as important is that we monitor its operation and make needed adjustments based on that monitoring.

      What prompted my commentary was the fact that so many opponents of our reform have gone out of their way to scare Vermonters with untrue/exaggerated tales of Canadian terror. This not a tactic that will help us achieve the best health care possible.

      I have read the Health Power House report you quoted in your comment. While that report is complimentary toward the Netherlands, it also notes that waiting times in that country are less than stellar and that the costs are relatively high.

      What I found most interesting in the report’s discussion of the Netherlands was this: “the NL probably has the best and most structured arrangement for patient organization participation in healthcare decision and policymaking in Europe.” More information on that structured arrangement could be very useful to VT’s health care reform.

  • Dan:

    Thanks for an informative article. I’d say what you say is true with a very very important caveat.

    The very poor cannot pay for additional quality insurance in European countries, Canada or the US.

    I feel that analysis of health systems is best done by looking at how the most disadvantaged people are treated.

    The wealthy will always have better care in a system with mixed payment. Even in Canada, there are doctors who accept private payment.

  • Craig Powers

    We need to control our own destinies and make choices about our own health care options. We do not need people like Lee Russ, or his brethren at the VT Worker’s Center, making decisions for us because they think they know it all, or know what is best.

    A perfect example of government overreach is the current VT debacle of small groups and individuals being mandated to purchase their coverage via a completely broken website. Here is a classic case of government trying to make decisions for close to 100,000 individuals and falling flat on its behind after months of lying to the public. No doubt, Mr. Russ will shoot back that single payer is a much better government system than ACA because there are less people involved and they are all accountable government employees (which are always better and more accountable than private workers). Do not be fooled by this empty and dreamy rhetoric. The proof has been clearly displayed for all to see over the last few days. Mr. Russ conveniently ignores this proof.

    VT had three years to make a simple website work and failed miserably. Now people are scrambling to figure out the ramifications of this failure and make sure that they have health care coverage before Jan 1. Hours of wasted time and unneeded stress for many when there was already a decent system in place (including VHAP and Catamount!)

    If the State of VT cannot get a simple website up and running (and lying directly to the public that ALL was fine), how can anyone begin to trust that single payer will be instantly successful on January 1, 2017? Especially in a small state like VT! Mr. Russ cannot even answer simple questions like how does VT’s single payer work when a VT resident has a health issue in CA or how is this all going to be paid for?

    It always amazes me how the single payer crowd just blows off those pesky little details. I guess that is easy to do when one believes that government will just be there to take care of everyone and can never, ever make a mistake. Vermonters are starting to wake up and realize that VT’s approach is flawed and unworkable. That is why the single payer proponents are beginning to lash out and start their name calling of those who disagree with them.

    • Lee Russ

      “when there was already a decent system in place (including VHAP and Catamount!)”

      I can’t really imagine many people thinking that the current system is anything but broken. If you think the current system works, I doubt there’s anything I can say to you.

      “single payer proponents are beginning to lash out and start their name calling of those who disagree with them”

      Where do you see this being done?

      I’m certainly not trying to answer questions that are in the process of being decided (payment system, out-of-state care, etc). In fact, the commentary was limited to a single point: are the Canadian horror stories true? They certainly don’t seem to be.

      • Walter Carpenter

        “Hours of wasted time and unneeded stress for many when there was already a decent system in place (including VHAP and Catamount!)”

        They were decent if you could qualify for them. They were not universal. If your income was too high, well, so what, out you go. Tough luck. And I wonder if the Vermonters stuck with employer-sponsored policies which carry thousands of dollars in deductibles and co-pays would think that the current system is especially decent. Having been on these types of policies before, I know how terrible they really are. You conveniently pay for something you cannot use because it is too expensive.

        “single payer proponents are beginning to lash out and start their name calling of those who disagree with them”

        As Lee said, “where do you see this being done?” If anything, it is the opponents to universal care who are lashing out at proponents of universal care.

        • Lee Russ

          I don’t think that recognizing the current system as broken is the same as being “in favor of” the insurance plans offered under the ACA. My preference is to get to 2017 and universal care.

          But even when it comes to the ACA, what a lot of people, who apparently had the top level of health insurance, don’t seem to realize is exactly how many Vermonters were paying huge deductible and lots of copays in an attempt to lower their premium to something they had a prayer of affording.

          In 2012 I paid over$10,000 in premiums for a 2-person policy, which came with a $4,000 deductible and plenty of co-pays. And every year, more Vermonters were unable to afford these kinds of price, and more employers were required to either stop providing coverage for their employees or to require that employees contribute ever higher amounts of money.

          If you want to get a clearer picture of how many Vermonters really could not afford insurance and were somehow ineligible for a state plan, talk to someone who is involved in running a free medical clinic for those folks.

        • Walter Carpenter

          “But you’re in favor of VT Health Connect, which carries thousands of dollars in deductibles and co-pays? Color me confused.”

          LOL….It is confusing, whether or not it is colored:)

          I am not in favor of the exchanges, except that they are making some baby steps away from the disaster we now have. This I support. I would much rather have universal care than the private insurance mode of high-deductibles, huge premiums, which excludes people and impedes access to care. There are elements of Obamacare/Vermont Health connect, however, which I do support — divorcing health from employment, no pre-existing conditions, some kind of a cap on deductibles and so on — which are necessary to move toward universal care in 2017. For these reasons I support what Vermont Health Connect doing.

    • Walter Carpenter

      “We need to control our own destinies and make choices about our own health care options. ”

      How do you control your own destinies and make choices in health care options when you cannot afford the insurance because it is too expensive, cannot get on it because of a pre-existing (not in Vermont, but elsewhere), are not income eligible, and do not have employer sponsored insurance? And if by some stroke of luck, you have employer-sponsored insurance, how do you control your destiny if you have the “choice” of either accepting the employer’s insurance or nothing?

  • Jason Kelley

    Thanks to Lee Russ for this antidote to the specious stories that pop up on this side of the border about health care in Canada.

    I would point out that Canada has not one but multiple single payer systems that we can learn from, one in each province and territory.

    I couldn’t agree more with Marina Brown that the exten to which nations provide equitable health care to the poorest is a great indicator of health equity. Numerous cross-border comparisons looking at multiple health domains show that Canada has addressed this problem far better than the US. I’d be happy to send references to the peer reviewed specialty publications that address this if anyone is interested.

  • Sue Andrews

    We recently spent a week in Cape Breton and the wife of our host, unfortunately, was hospitalized for the entire time we were there. I was incredibly impressed with the care she received.

    What people don’t realize is that the US already has rationing. It is based on affordability in large part, so many people are excluded from the get go. It is also based on capacity/ availability. Bennington County has not had any primary care doctors taking new patients in the past several years with the exception of a two month window last year. We did not have a psychiatrist in the county for several years; the one who is now employed by the hospital can only two-visit assessments and not follow-up as she does not have the time. We did not have a dermatologist for several years. The OB/ GYNS are way overbooked.

    I would also argue that many of our practitioners are extremely demoralized, and this is in large part due to our own maddening bureaucracies. Very few new grads go into primary care and even fewer are interested in practicing in rural areas. The ones who do make that choice are overwhelmed financially by the level of support staff required just to deal with the bureaucracies.

    What we do have is technology. And I think that it will be difficult for Americans to let go of that technology. Those of us who are fortunate enough to have access to care want “nothing but the best.” The problem is, when we look at health care outcomes and compare those of the US with those of other countries, our technology is not enough to put us on top.

    We have a long way to go. I, for one, would be much happier paying higher taxes so that we could all have access to a universal system.