– Brian Lee Crowley is the founding president of Atlantic Institute for Market Studies (AIMS), a public policy think tank in Canada (pictured left) and Valentin Petkantchin is director of research at the Paris-and Brussels-based Institut économique Molinari. The views expressed are their own. –
President Barack Obama’s package of heathcare reforms – mandatory health insurance, public health option and increased federal government financing – is being sold as preserving independent high quality care and choice for patients while keeping down costs. Taxpayers and patients in both Canada and France know better.
Unfortunately, our experience is that once the government gets its nose in the healthcare tent, not only is spending not contained, but health care professionals lose their freedom to practice. Left with few choices, patients face shortages and waiting lists.
Washington’s proposed new public health insurance option, while not imposing Canadian-style single-payer monopolistic public health insurance immediately, will almost certainly lead to that result in the end.
One of two things will happen. If doctors prove reluctant to accept patients covered by the public option and it is thus unable to compete successfully with private insurers, the politicians will not stand idly by.
Physicians’ freedom to practice outside the public option will become increasingly hedged with restrictions, perhaps ultimately ending up, as in Canada, with doctors in the public system being prohibited from taking private patients.
Or, more plausibly, in the short term at least, private insurers will gradually withdraw from the business, incapable of winning against a government-subsidized “competitor.”
In both cases, competition in the health insurance sector will progressively vanish and the U.S. will wake up with a monopolistic-style health insurance system, à la France or Canada.
Consider yourself warned.
Our respective health care systems have proven incapable of reining in rising costs. Health spending in France, while lower than the U.S., is among the highest in the world, whatever the indicator, despite decades of mandatory, subsidized health insurance. After 1988, the public health care system has regularly been in the red, with deficits numbered in the billions of euros. The forecast deficit for 2009 alone: 9.4 billion euros (over US$13 billion).
French officials are scrambling to take more control of the system to bring these costs down, but Canada, where government controls all “medically necessary care,” shows that this is no solution at all. A growing share of Canadian provincial budgets is also swallowed by the health care system, going in 20 years (1983-2003) from 32% to 41% and on the way to 50% in a few short years. As a portion of GDP, and adjusting for population age, Canadian health care spending even ranked ahead of France’s in 2005.
But the oxymoron of government cost containment is not the only problem. In the name of restraining costs – so fashionable currently in Washington – governments are adding further inefficiencies by piling on more bureaucracy.
Since 1996, there is a cap on national health care spending in France and growing pressure on health care professionals in the public system to cut costs. In 2004, patients’ choice of physician and specialist was also severely limited.
Independent private medicine – once one of the main pillars guaranteeing quality and timely care in the French system – is being slowly strangled. At the end of 2008, nurses lost their freedom to practice where they please, while a new law will do the same for physicians by imposing an annual financial penalty if they refuse to practice where the government tells them to. Specialists’ fees are increasingly regulated. The last pillars of competition among providers, and choice for French patients, are thus undermined.
Canada again is a good example of where the logic of such policies will lead the French and the Americans in the future.
North of the border, decades of total government control over health care have led to chronic doctor shortages and waiting lists. Roughly 1.7 million Canadians were unable to find a family doctor in 2007 and have to queue in impersonal clinics where they exist. Yet only a physician can order tests or get a patient in to see a specialist.
Despite continual infusions of fresh tax dollars, waiting times for hospital treatment went from an average of 7.3 weeks in 1993 to 17.3 weeks in 2008, although there was a minuscule decline last year as a result of massive political pressure. The problem is so severe that the Supreme Court of Canada acknowledged in a historical 2005 ruling that patients die as a result of waiting lists for public health care.
Finally, coverage of new drugs is delayed by a year or more for patients relying on the public system. Even with this delay, by October 2007 less than half of new drugs launched between 2004 and 2006 had been listed for payment.
Based on experience in both our countries, government health insurance and government financing inescapably lead to a crackdown on health care providers and bureaucratization of the entire health care system. Americans should look carefully at our experiences before going any further down the slippery slope of state-controlled health care.
Sounds to me like the systems in Canada and France do not work. Do the authors have a system that does work. If you know the systems please tell us what will work. We have plenty of people trying to take our money for giving us information on things that don't work.
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As a Canadian, our “Healthcare system” is not perfect and we pay a high economic price for this ‘right’. Our taxes are among the highest in the world, and yes, we pay and pay and pay. Most of the above stories I have read are true for me…its difficult to find a family doctor but there are clinics…our hospitals are entirely government run. We take care of all including the drug dealers shot on the news every night. i would like to see a different type of set up here but its difficult. What would you rather choose? Profit driven scumbag insurance companies or ineffectual government run? I
I find it deeply disturbing that the US government wants to increase their involvement in the healthcare industry when they already handle close to 40% of it currently. This is why the US system needs to be changed. Obama doesn’t understand that the government is the one that is making my healthcare system worse, not the so-called “evil corporations”. Just look at the budgets for Canada, France, and state’s that have an large reliance on government programs here in the US. They have bankrupted us.
I work in retail and grocery sales, and the people I see coming in with government food stamp cards not only do not need them, but they regularly abuse them. This is not a small minority either, I would say 4 out of 5 people that use EBT cards do not use them to buy large quantities of food. These “people” have better things than my own family, and I work 60 hours a week just to help us get by (which therefore means I can’t get government help, even though I work hard).
The last thing the US needs is to cover even more expenses for these fat slobs that continously abuse the charitable American people. I don’t want to pay for someone elses irresponsibility. I have five kids to worry about!
I’m a Canadian, and I have been really well served by our health care system. My whole family has.
Years ago, my little brother got hit by lightening while on a canoe trip in Northern Quebec…our public health care system even covered his transport out to a small hospital, and his entire hospital stay. He lived; he’s fine; our family wasn’t bankrupted.
I’ve had X-Rays, chemo, bonesetting, Pap smears, regular checkups, ultrasounds, and anything else I needed, as has everyother member of my family.
I paid nothing at all for the the expenses related to childbirth at home with a midwife. I had two midwives and a student helping me, and this was all covered by OHIP and was actually cheaper than a simple, normal delivery in a hospital; I did meet with an OB GYN, too, in case we’d had to movethe delivery to the hospital; that was free, too. I loved that I cost the system less but got a better service, with more pre-and post natal care.
Every day for three days after my daughter was born, the midwives came to my home to check on us, and I had tonnes of follow up for both physical and mental health; I was fine, but if I’d had post-partum depression, they’d have caught it, and I’d have been treated.
All the blood and lab work relating to the pregnany and birth and the care of my newborn was free, as were her shots and checkups this year.
I love our health care system. It has made a huge difference in my life and in the life of my family. It makes me proud to pay taxes. And my taxes rise at a much more stable rate than health insurance premiums do, and they are based on my income, not on my chronic health problem.
I like that we get cheaper drugs than Americans do, because our system organizes bulk purchases. I love that I do not have to fear medical bills. I don’t even have to pay medical bills. Vision care is pretty easy to pay out of pocket, and dental care can be expensive, but good habits and a good dentist are keeping my costs low.
I chose my own doctor. No bureaucrat has ever refused to authorize a proceedure I needed.
Our system would be better if we started our consideration of population health with our neighbourhood plans and zoning. We need to encourage walkable neighbourhoods and real communities: driving = crashes and smog and many health problems.
I’d also like to see us looking at nutrition and food security, and at restoring the phys. ed. programs that have been cut from schools; taxing junk food would be good, too. I’d like to see first aid and even paramedical training taught in school.
People are working to get better translation services so immigrants can get care in their languages; I’d like to see that recieve more funding.
Care in community settings is better for immigrant and poorer people; more of this would be good. In Toronto, we have heroic street health nurses and great clinics for homeless youth. This is awesome, as are the sexual health clinics that do anonymous AIDS testing: at risk teens get tested!
We need to do better on care for Native Canadians, starting with clean water on reserves, and housing.
I love that some jurisdictions that are very Chinese are looking at funding aspects of Chinese traditional medicine, not just the Western “here’s a pill” way; I love that our system is slowly becoming more open to different healing paradigms.
We do need more family doctors; the specialists are politically influential, so our healthcare dollars are sent to them while many have to hunt hard for primanry care doctors still taking new patients; we have foreign trained doctors we aren’t letting be doctors. That’s a problem.
Also, we need to open up more medical school places in universities; good students who in earlier times would have gotten in now can’t: no room. The nurse practitioner option is great. Nurses and paramedics deserve better treatment in our system.
Our system has some problems, but Americans keep trying to fit our issues into catagories that are really about them. When they hear “some Canadians are disatisfied”, they assume that the debate we have about our systems is about the same range of potential options they understand or are considering. It isn’t.
You guys have more uninsured children than we have total population, and the worst infant mortality in the Western world. We don’t want what you’ve got as an alternative to what we have.
We sometimes have longish waits. But a longish wait for free care is better than no care at all, and you all have waits in your system, too.
In the USA, it took my ex almost a month to get a test to tell him what blood type he belonged to, and he had “great” private insurance.
In Canada, I got our daughter’s pink eye diagnosed and medicine for her within an hour of walking in off the street.I took her to a neighbourhood walk-in clinic; we didn’t even need an appointment; the eye drops cost ten bucks.
We like our system; check out decades of election polling. We also named the guy who invented it the “greatest Canadian” in a big national contest.
We want to tweak our system, to change the emphasis, to redirect it in ways that are true to our nature, towards inclusivity, prevention, and deep health-promoting strategies. We don’t want US health care– Yikes!
Our system started in one province first.
Perhaps letting states decide if they would like to create and run a strong public option would work in the USA; there is a big difference between running a public system with 34 million people and one for 300 million and more.
The USA has many distinct cultures within it, and some will take better to a public plan than others will. That said, please change UA law to allow doctors to cross state lines to donate health care services for free; Remote Area Medical is calling for this change.
For the USA, I like the current mixed notion, which allows people to keep their private insurance if it is good, but I hope a strong public option gets approved.
Sorry this is so long. Good Luck.
You can tell where the priorities lie in a country when they can send off $800 billion in taxpayer money to save their bankers in crisis.. but start whining if they have to help out their fellow american in a health care crisis.
According to SourceWatch (http://www.sourcewatch.org/index.php?ti tle=Atlantic_Institute_for_Market_Studie s), Brian Lee Crowley, one of the authors of this article, works for a think tank that is patronized by the pharmaceutical companies Pfizer and Merck Frosst. It would be nice if Reuters required its sources to disclosure their own personal financial interests when spreading their propaganda.
In Canada the health care is free. BUT if you want a dentist you have to pay. If you want medicine, you have to pay, if you take an ambulance, you have to pay, if you want an MRI or Ultrasound without waiting for a couple of months, you need to pay. And by pay I mean you need to have extra insurance over and above OHIP (or whatever provincial plan you belong to). I had cancer this year and I’m very glad I had extended health care benefits from my employer. Even so, I still had to pay $200 per day to get a private room at the hospital. Nothing is perfect and neither is the CDN health care system. But the alternative of being unemplyed with no coverage at all seems to be contrary to human decency if you ask me. We all benfit from having a healthy society after all.
As a Canadian who deals with a chronic disease (Crohn’s Disease) I can tell you that the much maligned system here is a god send to me. I have been able to access all of the x-rays, ultrasounds, colonoscopy, blood tests, and even surgery and a hospital stay at zero cost to me. I would not have been able to afford these if it wasn’t for our health care system here in Canada.
Sure, I had to wait for a couple weeks for a few of the tests or procedures, but that’s nothing compared to being unable to get the procedures at all. I talk to other Crohn’s Disease sufferers in the USA and several of them are suffering without treatment because they can’t afford the thousands of dollars these procedures cost.
You can judge Canada all you want, and yes we pay higher taxes to get these services, but I would not trade it for anything. It is more than worth the occasional wait times (not as bad as the press makes it seem) and higher taxes. I’m sure that the extra taxes I pay for Canada’s health plan is MUCH less than the cost of all the procedures I have needed. It is the reason why I am now living a happy, pain free life with my Crohn’s properly diagnosed and under control.
I also get private heath insurance via my employer which covers the costs of prescriptions, dental, ambulance rides, and semi-private hospital rooms and other extras.
As a Canadian living in one of the cities that is supposed to have the worst wait times (Windsor), I can tell you the system works very well for me.
Also, when my brother and his wife had a baby, when my sister needed stitches, and when my mom went through treatment for breast cancer all of these things went well and were at zero cost to us. How many new American parents are saddled with a hospital bill, and how many Americans avoid proper treatment due to money reasons? You be the judge.
Who says there is a perfect answer to the health care problem? The more restrictions put on doctors the worse the quality of care gets. The more tinkering that the government does with our nation’s healthcare, the less willing the bright young minds of today are going to be willing to step up as the next generation of doctors. We will end up with restricted doctors of average intelligence.
Both of these authors should be cursed with the worst curse to be found in mythology! To come out with such bold faced lies is an insult to our intelligence. Who is funding these guys? Oh, wait, I bet it will be a health care insurance company or some link to one.
One of the major reasons for moving back to Canada is the health care system here for ourselves and our
family. It has worked and continues to work well for
routine medical needs and specialized needs ( one of
my sons has Crohn’s Disease and has received superb
care utilizing the health system here ). In addition,
it is important to know that everyone in this
country can be eligible for universal health care unlike
the United States where too many are without access.
Health care in Canada and France do work! American’s travel to those countries for affordable health care. Where did this comment come from? Someone needs to do the research before they make comments.
We have a tendency in America to argue for or against a concept based on our own personal philosophy or view of the world, what advances our personal interests, or the interests of our party, family, organization, or region. Perhaps viewing the issue from a management or systemic perspective might result in innovative approaches to the issue. The American national mindset, citizen philosophy, lack of citizen motivation to be proactively healthy, and governance model make the socialization of health care in America very problematic, particularly at this point in time. A country needs to know its limitations.
Please tells us do doctors in France and Canada refuse patients with pre existing conditions???
And also please tell us how much people pay for drugs in those countries versus here???
If you’re blind and you can’t see you that the insurances make big profits out of sick people here in the us then you better look closer..And make no mistake there is NO country with the perfect health care system but there must be a basic health plan free to all just like France, Canada England and all other countries…Health care shouldn’t be a priviledge but a RIGHT!
Keep on fearmongering to the ignorants of this country with your ‘facts’
“If only the US government would focus on ‘governing’ and not portray itself as a diety over the basic laws of economics. And how rational it might be to govern based not only on the merits but to identify a specific problem and address only that specific problem within the context of the US Constitution.”
- If the economists and financial wizards didn’t demand the “deity” for billions - and received them - then you could have had a valid point. The american government is like one of those hindu deities you have to bring a book of gold leaves and rub them on their fat bellies.
Health Care - When disease strikes, it doesn’t care about who is rich or poor. A rich man will have the flu just the same as the poor man and I know of many rich people who use the public health care system in their countries, even though they can use the private.
Having universal health care is LIBERATION for populations.
You are free to engage in working for yourself, your family and the common good when basic medical needs are met. Taxes are for those things exactly: water and sewer systems are thought to supply and maintain good health standards, otherwise disease would be rampant (like it was prior to its inception.)
The effort of the many will make the effort of the few more bearable. It doesn’t help me with the expenses of my private health insurance, that there are scores of people sick and deprived out there.
Wonder why most countries with a national health care system seem to be happy? Because they don’t live in desperation.
To be desperate is not to be free and brave, it’s just negative all around. It forces jealousy of those who can’t have it for the ones who do.
Oh no, here comes another terrible warning from Canada
7/10 say its working well.
Well obviously those 30% would prefer the American system right?
82% prefer the Canadian system to the American system.
The problem must be the heavy hand of government right?
55% think it should be more public, 27% believe the balance is right, 12% believe it should be more private.
Epic fail for Reuters and this “Thunk Tank”, if you want a good opinion on France and Canada’s healthcare system, ask the people, not the pundits.
Pharmaceutic companies: Our pharma companies innovate in every arena. They all provide indigant programs with free drugs. They do the research that lets us survive. They pay the dividends in our 401K’s. They are a business. They stop innovating, we start dying.
Whats benefits the population at large the most:
Stop giving prisoners better healthcare access than teachers. Stop giving healthcare for free to non-American residents and visitors. Stop allowing liver and kidney transplants to alcholics, drug users, prisoners. What politican will be brave enought to make these choices?
Doctors: 8-12 years of training, hugh med school debt for years, insurance company limits on fees. Doctors can advise, prescribe, and perform procedures. They can not make an idiot patient actually take their medicine, get some exercise, or follow a diet. American healthcare costs are higher, because American’s choose to sit on their but, eat junk food, and take no personal responsibility for their health or anything else. However, Americans want their bypass immediately lest they die or to see the specialist because they read on the internet about a disease they do not have. The Europeans walk and exercise more, eat healthier –so their cost goes down. Or they die waiting for the bypass…
Oh and by the way, poor school performance by students is not due to poor teachers, its due to poor involvment by the parents. When Americans really take responsiblity for their lives and children, healthcare and education will improve. Until then, let me keep my money.
The current Obama plan will be worse than the Brit/Canada model. Healthcare coverage could have been increased if the senators had voted to allow small businesses to band together accross state lines to form purchasing pools for health insurance. Premiums would be substantially reduced. Considering that small business employee the majority of Americans that would settle the issue quickly. For people who choose or can not work or get insurance, then allow Doctors to get a tax credit for care to the uninsured based on the difference between the medicare fee schedule and maybe a mandatory 10 or 20 dollar copay. Why should our bright students go into healthcare to have mountains of debt, limited income, and malpractice headaches. If the senators want to decrease the cost of healthcare, legislate strict malpractice reforms and caps on fees. Unfortunately many of the legislators are lawyers and would never take on that crowd. Thanks to our politicians for driving away the American medical student and opening the flood gates for Foreign Medical Gradutates. We have brilliant minds in our country, why wouldn’t we want them to take care of us?
Why should health care be a right? If it is, where does the line stop? Why isn’t food or water a right? I’m so tired of people wanting everything handed to them. If you want health care go out and get a job where your employer can help you pay for it. All people are “created equal” this means we all can choose what we do with our life and where we can work. I’m so tired of supporting others with my tax dollars. Keep health care in the free market system!!
Neither Canada nor France are experiencing a health care crisis.
You are.
And you have the gall to criticize them … LOL!
The authors write: “Roughly 1.7 million Canadians were unable to find a family doctor in 2007 and have to queue in impersonal clinics where they exist.”
Scary, scary!! I live in Canada, and although I have a family doctor, today I decided to drop into a nearby walk-in medical clinic. These clinics are all over the place in urban areas — almost as common as Starbucks. You don’t need an appointment, and many of them don’t even give appointments. I had never been to this clinic before today, so they didn’t have any of my info beforehand. Nevertheless, I was in, saw the doctor, and was out within about an hour. The charge to me: nothing. There was no paperwork; required administration info was processed with a few clicks on the computer by the very friendly receptionist. No one will have to send me a bill or follow up to try to collect. The doctor (friendly, as it turned out, and who, like nearly all doctors in Canada, does NOT work for the government) is guaranteed full payment for service, on time, by the province’s medical services agency.
So be afraid, all you Americans. Be very afraid. If you don’t listen to the insurance companies, the pharmaceutical industry, and right-wing ideologues, you could end up in the same pickle as Canadians.