Thursday, August 13, 2009

(No.45) pt 2: Insurance companies & U.S. health care reform

The previous post to (No.44) presented the first part of an essay presenting a Canadian perspective on the U.S. debate over health care reform. The essay concludes with this post No.45 (below).
The fact is that a huge contributor to the rapidly rising cost of U.S. health care is the central involvement of insurance companies. They add significant cost to the system from both administrative complication and inefficiency as well as the pursuit of profit. Canada constructed a health care 'insurance' system from which insurance companies were excluded in favour of single payer, state-financed insurance. 

Thoughtful Americans understand that insurance companies are needed for an efficient, patient-oriented health care system as much as a fish needs a bicycle. Never mind the silly cliche about the dangers of government standing between patients and their doctors; the minimizing of the payment of health claims by an insurance company is, for executives interested in their compensation and in career management, what their insurance companies' role in health care is about.

I think what many Canadians may find most puzzling involves an unfortunate conjunction of several factors:

  1. a U.S. political system that continues to be the captive of special interests like insurance and 'big pharma' companies spending many millions of dollars annually lobbying against even small steps toward  what is obviously needed in the US -- a single payer health care system or, at the very least, a public option for those buying health insurance.                                                 
  2. a credulous American public many of whom seem prepared to believe what appears to most Canadians as laughable propaganda about 'socialized medicine' from the political right and various special interests, and against any hint of advantage to be derived by patients from a public health care system.                                                                                                         
  3. the absence of impact on so many members of the U.S. Congress of indisputable facts, including American spending of a higher proportion of its GDP on health care than any other OECD country (nearly 17%) but without securing the best health outcomes for its citizens (in Canada the comparable figure is 10% of GDP).                                                                            
  4. according to the World Health Organization, U.S. spending of 23% more per capita on health care than does the Canadian government; and                                                                      
  5. the fact that advocates of what to most Canadians is the best and only serious option for most Americans, i.e., a single payer system similar to the U.S. Medicare system for seniors, are not only NOT given a seat at the table in this Washington debate but have been deliberately excluded from any genuine participation by the politicians of both Democratic and Republican parties.                     
The current U.S. health care system and the opposition to meaningful and desperately needed reform strikes me (and I think I have lots of company among Canadians) as being as bizarre as American gun laws. I suspect the latter would likely be the second prominent difference most often cited by Canadians between their society and that of our neighbours.

[Upcoming on -- comments on the 2nd quarter results of  Sun Life and Manulife.]

Alastair Rickard