Monday, August 3, 2009

U.S. Health Reform From The Eyes Of A Canadian Medic

The August recess by Congress will make or break the healthcare insurance reform plans as advocates on all sides will make their pitch to the people. The battles will be fought primarily in town hall meetings and media commercials.

I forecast a major glitch in this scenario. Opponents will stack the town hall meetings and those who should listen most likely will be on vacation. As far as I can tell, the Obama administration must answer this question:

How can you cover the estimated 47 million uninsured Americans without raising taxes and increasing the deficit while at the same time not reducing benefits to those already insured? I have an un-American possible solution which I will address later.

The August blitz is intended to drive home the message that revamping the healthcare system will protect consumers by ending unpopular insurance industry practices, such as refusing patients with pre-existing conditions, according to the game plan reported in The New York Times by reporters Sheryl Gay Stolberg and David M. Herszenhorn.

“I think what we want to communicate is that this is going to give people who have insurance a degree of security and stability, the protection that they don’t have today against the sort of mercurial judgments of insurance bureaucrats,” said David Axelrod, a senior adviser to Obama, adding, “Our job is to help folks understand how this will help them.”

This is where it gets confusing because later on in the NYT story is a statement from Karen Ignagni, president of America’s Health Insurance Plans who "noted that the industry had endorsed many of the administration’s proposed changes, including ending the practice of refusing coverage for pre-existing conditions."

So who's telling the truth? I'm convinced not many. For example, if America's Health Insurance Plans group is on record supporting most of Congress's proposals, why is House Speaker Nancy Pelosi promising a “drumbeat across America” to counter what she termed a “shock and awe, carpet-bombing by the health insurance industry to perpetuate the status quo”?

Borrowing an old Indian phrase, these people are talking with forked tongues. Pelosi, many of the 52 conservative "Blue Dog" Democrats and others in addition to Republicans all have received an aggregate of millions of dollars in campaign finance contributions from health field providers. That's one cynical perception.

What gives? One aspect of health insurance reform strongly urged by liberal Democrats is a government-run public option to compete against the private carriers and opposed by Ignagni's group. Many fear this will lead to a single-payer system patterned after those run in Canada and the Euro nations.

So what's wrong with a nationalized health care system? Depends what side of the equation you believe. I suppose for every 10 Canadians you could find, a majority would support your view whether you're for or against it. I'm a skeptic culled over the years listening to people defend or bash hot button issues. I prefer to listen to someone who knows what he's talking about.

Such a person is Michael M. Rachlis, a Canadian physician, health policy analyst and author in Toronto who wrote an op-ed article for today's Los Angeles Times. Here are some salient lessons Rachlis said we should consider:

Lesson One -- Single payer will provide insurance to nearly all Americans, an estimated one million filing bankruptcy each year because of catastrophic medical bills.

Lessons Two and Three -- Single payer can reduce duplicating administrative costs and negotiate lower prices. Canada spends 10% gross national product on health care; the U.S. 16% an $800 billion difference. The U.S. Medicare system has about 80% lower overhead than private Medicare Advantage policies.

Lesson Four -- Single payer can deliver more services because of lower overhead. Although there is a shortage for heart surgeries, Canadians live three years longer than Americans and the infant mortality rate is 20% lower.

Lesson Five -- Canadian healthcare delivery problems often cited by critics have nothing to do with its single-payer system and can be fixed by re-engineering for quality. Canadians wait months for an appointment with family physicians, elective surgeries and managing chronic disease. Rachlis said streamlining their own system has improved and cited an experimental model in Toronto where you can now get your hip assessed in one week and get a new one, if you need it, within a month.

Rachlis ends his article in bombastic style:

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" (HMO) doctors.

Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

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