Saturday, August 8, 2009

(No.44) pt 1: Insurance companies & U.S. health care reform

Earlier this year, before the political battle over health care reform reached its current fever pitch, I was in Tuscaloosa answering questions from University of Alabama business students. They were interested in my views, as a Canadian and a former insurance company executive, about what they had been told about the Canadian health care system. My impression was that much of what they had heard from special interest spokespeople had been the sort of right wing nonsense which has subsequently characterized the Canadian angle (and much else) in the health care reform debate in the US.

So strongly do Canadians value their single payer government health care system (I explained to them) that any change seen as a threat to it is the third rail of Canadian politics -- touch it and you are dead. Most Canadians value the system's quality of care. Many do still complain about wait times to see specialists in certain fields although government has moved to address this issue in recent years. By April 2009 at least 75% of patients in Canada receive non-emergency surgeries within appropriate wait-time benchmarks. If asked to single out an aspect of Canadian society superior to that of our American neighbours, most Canadians would cite first our health care system.  

What I might also have told those students, something highlighted for me in the American public debate of the past few months, were some things Canadians regard as puzzling if not perverse in the anti-'public option' arguments (some incorporating, usually inaccurately, negative references to the Canadian health care system). Indeed, as I write this, it is looking more and more as if a 'public option' in the American health care [reform] legislation as even a handicapped alternative to coverage offered for sale by insurance companies may well not survive all no matter how inadequate or watered down. 

Many Canadians who follow the US health care reform debate wonder about, for example:

-- use of wildly misleading references by American opponents of fundamental health care reform involving a public [i.e., government] option to wait times for 'government' health care in Canada  despite 47 million Americans having no health insurance at all and therefore forced, if in need of treatment, to line up in hospital emergency rooms to say nothing of the thousands of Americans who line up periodically in the early morning in parking lots across the US hoping to receive free treatment for their medical and dental problems provided periodically by "Remote Area Medical" volunteers.

-- how any opinion poll in the U.S. could supposedly discover 77% of Americans prepared to say that they are generally satisfied with their health care when so many millions of their fellow citizens are uninsured and when many millions more are under-insured; with 3/4 of those families who file for illness-related bankruptcy actually having health insurance; and with health insurance premiums having increased 3 times faster than wages between 2000 and 2008.

-- the negative representation of Canadians' experience with and attitude to their 'government heath care' as part of the propaganda campaign in the US against the old 'beware socialized medicine' bogeyman when that argument is at odds with the reality. For example: 85% of Canadians have their own primary care physician and 92% would recommend that doctor to a relative or friend; 95% of Canadians with chronic conditions have a regular place of care; and of those requiring ongoing medical care, most were able to see a doctor within 7 days.

-- the widespread use of an exceptional and misleading Canadian medical case as part of the organized opposition to the inclusion of a 'public option'  in any reform of the US health care system. This case involves a television commercial sponsored by one of the special interest groups and features an Ontario woman who (American viewers are told) had to go to the US to have a life-threatening brain tumour removed in order to save her life. Why? Because of an alleged 6 month wait time in Canada for treatment. The patient has since admitted to a 3 month wait time involving a benign Rathkes cleft cyst, the removal of which at a Mayo Clinic in Arizona cost her $97,000 she is now seeking to recover from the province where its removal would have cost her nothing.

( To be continued in the next post -- no.45 -- to 

Alastair Rickard