Sunday, September 13, 2009

(No.51) American reaction to my Toronto Star 'op-ed' on health care reform

As a preface to my recent column (No.50) on I informed readers that "the Toronto Star, Canada's largest circulation newspaper, published on Sept.9, 2009 an 'op-ed' opinion article I wrote presenting a Canadian view of the U.S. heath care debate: 'A puzzled Canadian ponders surreal U.S. health-care debate' ."

The headline on my article as it appeared was the Star's creation. Actually I don't feel particularly puzzled by what's going on in the U.S. health care reform debate given the level of misinformation and propaganda circulating about the Canadian health care system, about the bad things that will happen if a "public option" (i.e., a government health insurance option as one alternative to the private insurers' plans) is made available to Americans, and all the way to nonsense about "death panels" to be created to "pull the plug" on the elderly in order to allow big government to reduce health care costs.

I anticipated reaction from the U.S. to my article and it was not long in coming. The column reappeared quickly on U.S. websites where it provoked predictable responses pro and con, including from among those Americans whose fears of "government run health insurance" appear routinely to overcome their understanding of the facts. The interest in my opinions in the world of internet websites ranged from those who want the U.S. to have a single payer health care system (HealthCare-Now) to business-oriented audiences (AllBusiness) to political blogs (Progressive Democrats of America).

In terms of emails sent directly to me by Americans, there was some hostility. Two themes predominated: a conspiratorial view ("why would you distort the facts other than to promote a false agenda for what purpose???????") and the 'fact' that "tons of critically ill Canadians" are forced to come to the U.S. every year to get health care. Such 'facts' are apparently meant to stand as irrefutable evidence that the Canadian health care system is a failure, that it is inferior to the U.S. system and therefore are evidence of why there should not be (further) U.S. government involvement in running health care.

I find it mildly amusing that in the debate in the U.S. most of the voices I hear raised against President Obama's proposed "public option" ignore, either because they don't realize it or are afraid of damage to their own argument, the fact that many millions of Americans are already in their government's version of a single payer, government health care system -- Medicare and Medicaid. Still the opinion polls currently indicate a declining level of public support for the President's health care approach. Fear and scepticism are growing.

The apparent susceptibility of many Americans to misinformation about health reform and the kind of anti-health reform propaganda churned out by Fox News and assorted lobby groups, while particularly discouraging since it is occurring in a country with 45-47 million people who have no health insurance, is perhaps not all that surprising. After all, enough lower and middle class Americans were persuaded to vote against their own economic interests to twice put George W. Bush in the White House.

As a minor illustration of how creative opponents of health care reform can be, one correspondent informed me that the number I had used for uninsured Americans was wrong (I had used one of the three numbers consistently used by respectable American media, i.e., 45 or 46 or 47 million). The truth was, he declared, that it was really only a few million uninsured, the rest in any total of the uninsured being illegal immigrants. In fact the U.S. Census Bureau says there were 46.3 million people who said they lacked health insurance throughout 2008 and that the percent of adults ages 18 - 64 [Americans become eligible for Medicare coverage at 65] without health insurance increased from 17.2% in 1990 to 20.3% in 2008.

I choose not to waste my time replying to emails (anonymous or otherwise) from those among my American correspondents who apparently believe that I am some sort of shill for foreign 'socialized medicine' and at the same time are impervious to serious concerns about the health care system among their fellow citizens. There are a great many thoughtful Americans who have tried repeatedly in this health care reform discussion to underline that most germane of realities, one I cited in my op-ed in the Toronto Star: the U.S. has a health care system on which is spent far more per capita and as a share of GDP than any other country and for this excessive cost Americans have a health care system which produces inferior results for society as a whole.

Canadians who follow this debate in the U.S. understand that there are many millions of Americans who want substantive health care reform and many (admittedly a smaller proportion) who also want the U.S. to adopt a Canadian-style single payer health system. I heard from several. Happily, since this is my column, I enjoy both the freedom and the luxury of choosing to quote one such correspondent rather than focus exclusively on the opponents of U.S. health care reform:

from an American in Florida: "This group insurance professional thanks you for an accurate and pertinent piece on both our system and the Canadian system of health care."

For geographic balance here is a line from an email sent to me by an Ontario resident: "I read your op-ed in today's Toronto Star. I often work in the U.S. and for the first time someone summed up what I felt like to be Canadian."

President Obama's level of support, as reflected in the latest opinion polls, continues to weaken while political polarization increases. During the past 8 months or so the percentage of Americans who strongly disapprove of the way he's doing his job has increased from 6% to 35% while those who strongly approve has dropped from 41% to 24%. Doubtless the fierce misinformation campaigns against his health insurance reform initiative have played a major part in this change.

It appears likely that the President will not be able to get both the House and Senate to pass health care reform legislation if it contains even a modest "public option" but I think there will be many Canadians wishing him success with this very difficult, even Sisyphean political task. I believe the U.S. health care reform battle has served to remind many Canadians why they should be thankful for their own national health care system -- even with its imperfections.

I know that it has had that effect on me.

Alastair Rickard