Canadian Health Care: Effective and Popular
On Wednesday, Jeff Alworth asked if health care is the sleeper issue in the 2008 election, provoking a long, lively, and informed discussion on the topic. One of the themes that emerged involved the Canadian health care system and whether or not it was effective and popular. Daniel Cohn, a professor of public policy in Toronto's York University specializing in health policy, offered a detailed overview of the Canadian system.
First off what Canada has: We don’t have one system, we have several. Each province runs its own show within a very lose federal framework. If they obey five general principles they get substantial grants. If they don’t obey the principles they can be fined (though the fines are often trivial and more meant to make a political point than to actually punish). The principles are universality (all permanent residents must be eligible for coverage), portability (coverage must be good whether the resident is at home or in another part of Canada), comprehensiveness (all medically necessary services provided by physicians, hospitals and diagnostic tests as defined by the province must be covered), public administration (the province must have a publicly managed not-for profit system for insuring people), [and] accessibility (services must be reasonably available in terms of timeliness, geography and no fees can be charged at point of service).
After that everything is up for debate. Some provinces insure things others don’t. Some provinces have premiums for health insurance, some have a dedicated portion of income tax, some fund it 100% out of general revenue. Some provinces have regional authorities that directly manage facilities, others (such as Ontario) leave that in the hands of charitable and not for profit corporations. Some provinces have aggressive programs to contract out care to for-profit firms (who provide treatment at no cost to the patient). One thing that is constant is that MDs are predominantly private and bill the provincial insurance schemes for their work, whether in their office or a hospital. They are not employed by the provincial governments. Some work on straight fee for service, others have different compensation, such as capitation. A lot of stuff is not covered and that is why most families have supplemental insurance for things like drugs, medical supplies and devices, dentistry and non-medically necessary stuff (such as private and semi-private rooms in hospitals). Low income families and seniors usually have public coverage for those things. As in the US marginal workers and entrepreneurs are the least likely to have this private coverage.
Second off public opinion: A few years back Matthew Mendelsohn did a meta-analysis of polling data on Canadian health care. He found that Canadians were well aware of the issues and options and had reached a considered opinion that our system works best for us. Canadians may want reform but not wholesale change. You can read the study on the website of The Commission on the Future of Health Care in Canada which commissioned the study. To date I have not seen anything that would lead me to believe that Mendelsohn’s conclusions are no longer valid. What is important is that Canadians did not just support the system because of the care they felt they were receiving, but because it resonated with their values, specifically that high quality health care is a right, and as a right ought to be available to all regardless of location or socio-economic status.
I myself tested something similar with a study of attorneys in the province of Alberta. Attorneys are a relatively political informed group (so they know the issues), they are also a relatively prosperous group (the sort of people who could theoretically benefit from market-based care as they can afford it and would be attractive risks to insurers). Finally Alberta’s government has been among the least supportive of the present health system and has regularly sought to undermine it. The people I surveyed nevertheless overwhelmingly endorsed the present system. Most felt they would not get better care if privately financed care for medically necessary services were introduced. What turned the majority in favour of the present system into a landslide was a sizable portion which supported the present system even though they felt they would get better care if privately financed care were introduced for medically necessary services. I found decent evidence that these people based their support exclusively in the values promoted by the system. You can read that study "Canadian Medicare is there a Potential for Loyalty: Evidence from Alberta" in the Canadian Journal of Political Science 2005, Volume 38(2) [.pdf here].
This relationship of support for the system to values is why I am hesitant to give detailed advice to Americans. Let me just say whatever plan people develop, it had better fit the values of your society or it will never gain traction and might positively hurt you politically as the losers will fight back and whip up the fear of those who think they might be worse off as a result of your reforms.
As an aside let me quickly point out that the idea that scores of Canadians sneak across the boarder with private insurance to get medically necessary elective surgery is bogus. Although I have heard some radio ads for this sort of coverage (in the Greater Vancouver Area, but no where else) I have not found a major carrier that provides it. In other words, it is not a huge business or the Aetna’s of the world would be in on it. In fact most private insurance for what we call “extended care” the stuff provincial plans exclude, specifically refuse to pay for out of country care other than that which is related to an emergency (heart attack, broken arm, etc. on vacation or business trip). A couple of years back some researchers did a study of billing recorders in hospitals near the Canada US boarder and could find little or no documentary evidence that there was a transboarder trade in elective surgeries. See SJ Katz et al. “Phantoms in the Snow: Canadians use of Health Care Services in the United States,” Health Affairs May/June 2002.
Finally, the reason the above noted sort of insurance is hard to find relates to what I see as the single biggest problem with the present system for financing US health care. It sucks as a business! In fact many Americans with private sector coverage for health costs don’t even have health “insurance” any more. What they in fact have is employer financed care which is “managed” by an insurance or similar firm. The insurance companies bailed on providing insurance and decided to focus on managing benefits as the risks in providing health insurance are just too unpredictable to accurately price in a way that will make the product both profitable and affordable to clients....
So that’s my little contribution. In sum health care for medically necessary care sucks as a business (and we don't even have your tort problem up here in Canada as judges not juries decide damage awards). Whatever you choose to do make sure it resonates deeply with the values of your society or people will not be willing to sacrifice their own interests. I just you hope you get it together before GM and Ford go bust and trigger a meta crisis in your health system.
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Aug. 10, 2007
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Aug 10, '07
An extremely useful contribution. Those here advocating for a Canadian style system would do well to pay attention to the issues of "national values".
Aug 10, '07
Let me just say whatever plan people develop, it had better fit the values of your society or it will never gain traction and might positively hurt you politically as the losers will fight back and whip up the fear of those who think they might be worse off as a result of your reforms.
Agreed. I was watching Joe Biden (who I neither like or dislike) on TV last night and he was talking about his health care plan in little detail. What he did talk about that was so refreshing was the transition that would have to take place and the public process and consensus building.
Whatever health care system we end up with in the future (cause' this one is broken), it will be a system that is uniquely American at the end of the day and will need a broad consensus across this whole country of not just politicians but also the stakeholders and patients.
Here in Oregon we've taken some of the incremental steps , more especially this past legislative session. What we need to do is continue the good work and make sure the conversation gains more volume and attention. One thing I'd suggest is to join the conversation with others across the state at: We Can Do Better
We all need a voice in what the future health care system will look like. The exchange and network building has to begin now and at the state level to place the pressure on the Feds that we're gonna need.
11:33 a.m.
Aug 10, '07
Yeah, the values thing has really been what has resonated with me, too. It seems antithetical to American values to let our fellow citizens get sick and die merely because they are without insurance. It may be that I'm out of step with American values, but I'm not going down without a fight. If Hannity wants this country, he's gonna have to take it from the old FDR liberals.
Aug 10, '07
yes to the national values issue.
also, the other thing to keep in mind is that, whether we like it or not, the insurance industry is here and they're politically viable. so any health care reform that uses as a premise "look how much money would be saved if we didn't sink so much into the administrative cost that is the insurance industry", while practically speaking may be correct, is politically a non-starter.
which is too bad, but i think we ignore it at our peril.
that's one of the things that i liked about ron wyden's bill - that he takes into account the political realities and recognizes that he will need insurance industry buy-in to be able to pass it. we'll see if it can emerge from the lobbyist's influence relatively unscathed.
12:19 p.m.
Aug 10, '07
The point about national values on this issue begs the question. While I agree that universal coverage is a Democratic value, a progressive value and one that I hold, do we know with actual data how many people in the country hold that value?
What's the break-down of percentages who hold that value in Oregon?
Aug 10, '07
National values? How do US attitudes toward healthcare differ from other humans? I bet, not very much. We all want good healthcare for ourselves and our families and friends, and we are not happy to see healthcare denied to those who cannot pay for it.
The national values issue is really about national propaganda, as in "Americans don't want SOCIALIZED medicine," and "government can't do anything right." Industry and political PR machines will continue to tell us our values are inconsistent with single-payer healthchare, employing such platitudes and spinscicles. Progressives' task is to remind Americans that single-payer is the only system consistent with their true values.
1:23 p.m.
Aug 10, '07
That is a bold unsubstantiated assertion. There are more than a few GOP/libertarian voters who hold a social darwinist view on this issue (and numerous others). To think that universal healthcare is a given as a core principal held by all humans is a staggeringly presumptive (and false) assertion.
Aug 10, '07
lestatdelc,
First, what you quote are questions, not values.
Second, the values that I suggested are widely held are the desire for good healthcre for self, friends and family along with discomfort at seeing others denied care. Single-payer healthcare, which is the term I used, is a system which can address those values, it is not a value in itself.
Third, government policy in democratic states should reflect the will of the majority. ALL people do not need agree on policy nor hold the same values. There will always be those who do not give a damn about others. I believe they are a minority of Americans.
Aug 10, '07
By the way,
Poll Shows Majority Back Health Care for All
Aug 10, '07
and then we know:
In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system.
Care to try again, lestatdelc?
Aug 10, '07
lestatdelc,
But if my use of "all of us" is what set you off, I would gladly amend that to "the vast majority of people."
Aug 10, '07
I think the Founding Fathers would have liked Prof. Cohn's description of Canadian health care, because it basically conforms to the Constitution, which doesn't specifically designate health care as a federal government responsibility; therefore, it should be left to the states to decide. It's not so simple now, because we've departed so far from states' rights doctrine, but the beauty of the Canadian provinces' model is apparent. Oregonians should be making their own decisions about health care, education, environmental policy, etc. People who want to live like Bush Republicans could move to Texas. The success of smarter models would have a wonderfully stabilizing effect on national politics and I doubt we would be enduring this neocon lunacy today.
Aug 10, '07
America has the best health care of all!
How many times have you heard that?
So what's more in line with American values than a health care system that produces perfect health for everyone?
What could be wrong with that? What would be cheaper than providing health care to a bunch of folks who have perfect health?
So come on American, let's do it! Let's design a health care system that secures perfect health for everyone!
3:44 p.m.
Aug 10, '07
I wasn't disagreeing with that. I was using that as the given we were discussing
Well technically we are a representative republic, not a direct democracy. So in broad-brush terms we can generally agree that we are a democratic (small d) nation, but that only goes so far. Were we simply ascribe to the principle of majority rules we would still have slavery, Jim Crow laws and a whole raft of egregious policies in place.
Of course. but that goes to my question previously posed.
I hope they are, which is why I had previously posed the question, are they a minoirty nationally (and in Oregon) or not. What is the percentage break-downs for each?
Thank you for those links, which addresses the issue I was asking about, what level of support do we as a nation have for universal coverage? Does anyone have break-downs about Oregon specifcally?
Huh? You seem to be under the impresion I am arguing most people don't support universal coverage. I was asking at what levels is there support for it and then pointing out it is erroneous to assert it is a universal human truism that everyone supports such a principle.
I wasn't "set off" but that was what I was speaking to in my post directed at your statement. I was previously just asking what data we have about support for the princples of universal coverage (nationally and here in Oregon) which you constructively posted some polling links for.
3:54 p.m.
Aug 10, '07
Yes and no. The Canadian system DOES make it a Federal mandate that each province (i.e. state) provide universal coverage and some core features, such as portability, etc.
Additonally, "state's rights" is certainly a double-edged sword. Take sparsely populated by physically large states (Alaska, Montana, etc.) and the example of transportation infrastructure. WIthout Federal resources as an equalizer, such states are demographically disadvantaged out of the gate compared to other states. Likewise, civil rights issues expose the other aspect of keeping too much of a doctrinaire ":Federal hands off states" approach to issues which we either hold as core principles and values as a nation and in our social contract.
That said, I don't think I am alone in saying that within a framework approach at the Federal level, and a state level approach at policy implementation and system implementation and oversight, is one that has merit. It gets back to the concept of states being proving grounds for competing approaches for serving the public, which I would agree has merit on some level.
3:58 p.m.
Aug 10, '07
Perhaps my snark meter is a bit out of sorts today, but are you serious?
Aug 10, '07
Perhaps my snark meter is a bit out of sorts today, but are you serious?
If that's a question of me, then the answer is yes.
Are you serious, lestatdelc? Is that your first name? Or your last name?
4:15 p.m.
Aug 10, '07
Neither. My name is Mitch Gore. I have used this online handle for over decade.
Aug 10, '07
My name is Mitch Gore. I have used this online handle for over decade.
Okay, your name is Mitch Gore, yet you call yourself lestatdelc - and you ask if I'm serious. I wrote, yes.
Are you serious?
4:49 p.m.
Aug 10, '07
Depends on the discussion. On actual issues and politics I am usually quite serious (though I also have fun when engaged in it and appreciate witty repartee). I ask the question if you are serious because often over-the-top comments are intended as sarcastic humor.
Since you stated your post upthread was serious, said post strikes me as strawman baiting or simply a batshit crazy position. In other words, it reads as so whacky that it comes across as someone either clowning it or off the deep-end. Hence my question.
Aug 10, '07
Ted,
The problem with state-based health care insurance is the same as the problem with local programs for the homeless. Good programs attract the needy from elsewhere, increasing local cost, so we end up with a race to the bottom where no one has a good program. A national system or national mandate administered by state eliminates that pressure. Of course, we would need to address illegal immigration in a forthright manner, or we would end up being health care provider to the western hemisphere [excluding Canada].
5:36 p.m.
Aug 10, '07
Good points Tom, and beat me to it. I do agree with Ted in so far as leaving states freedom to implement the programs, though I my thinking was with this proviso; I believe that such state-level autonomy to craft the programs within the larger Federal framework of core functional requirements to mitigate the issue which you have articulated is basically what I was getting at.
As I was trying to get at up-thread, the needs of, and ways to implement a program are going to different for a state like Rhode Island which is has its entire pollution within an area not much larger than the Portland metro area, vs. states like Alaska, North Dakota or even Oregon.
Median incomes, revenue base, local cost of delivery, etc. will all be variables between states can better asses and deal with, but which the Federal government can help to mitigate such issues of revenue disparity, via block grant funding, broader objective guidelines and targeted requirements for level of basic coverage, etc.
Aug 10, '07
I don't see why you call this a "a batshit crazy position", and I'm not off the deep-end.
I asked a bunch of questions relative to the goal of perfect health for everyone as a goal for designing a health care system. Then you diverted the matter with the question of seriousness - as if there's something not serious about health care.
So how would you design a health care system to secure perfect health for everyone?
Aug 10, '07
Robert Gourley writes:
"I don't see why you call this a "a batshit crazy position", and I'm not off the deep-end.
I asked a bunch of questions relative to the goal of perfect health for everyone as a goal for designing a health care system. Then you diverted the matter with the question of seriousness - as if there's something not serious about health care.
So how would you design a health care system to secure perfect health for everyone?"
Because perfect health is impossible. Human evolution insures that it is impossible. Therefore, the only possible conclusion one can draw from your question is that you're either "batship crazy" or are simply being an a**hole and trying to sabotage an otherwise productive discussion.
Your point is pointless, your argument and your tone irreverant and irrelevant in the extreme and you don't deserve to have a point of view if the best you can do is ask utterly moronic questions.
Go back to your Corvallis cage.
Aug 10, '07
"Parting at the Crossroads: The Emergence of Health Insurance in the United States and Canada" by Antonia Maioni (1998, Princeton University Press) is a pretty good - albeit academic - look on why Canadians have universal coverage and we don't. A few sentences from the first chapter:
"The presence of a social-democratic third party in Canada spurred universal health insurance to national prominence as a viable alternative in the health reform debate and served as a beacon for political pressure that led to the passage of legislation. By contrast, the absense of an independent voice for the Left in the United States ensured that the agenda for national health reform would be confined to the Democratic Party."
It's hard to disagree.
Aug 11, '07
Because perfect health is impossible.
Well if perfect health is defined as not needing the attention of a doctor, or needing a stay in the hospital, or not needing any other medical attention - then one can think of lots of folks who have perfect health.
Go back to your Corvallis cage.
You obviously imagine that you have the power to command me. That kind of delusional ranting would not qualify as coming from one with perfect health - so it's no wonder you are so unfamiliar with the subject.
The value of a goal of perfect health for everyone, however unattainable, is it would shift the current focus in the health care debate. What's wrong with the goal of perfect health for everyone? How would designing a health care system to meet that goal hurt anyone? And if cost is truly such a great consideration, what would be cheaper than a system designed to produce healthy people who need the least amount of medical attention?
11:47 a.m.
Aug 11, '07
Which is a bat-shit crazy propositon. We woud not need healthcare coverage at all if peopel never got sick, never needed to see a doctor or never need to be hospitalized.
However here on planet earth, people get sick, they get injured and at times need to see a doctor and/or stay in a hospital. It is why we need healthcare coverage in the first place.
Aug 11, '07
Which is a bat-shit crazy propositon.
There's no evidence for this. In fact there is evidence this is simply the judgement of a person with a particular point of view:
you're either "batship crazy" or are simply being an a**hole and trying to sabotage an otherwise productive discussion.
Your point is pointless
your argument and your tone irreverant and irrelevant in the extreme and you don't deserve to have a point of view if the best you can do is ask utterly moronic questions.
So anyone expecting a rational conclusion from you is bound to be disappointed.
Now if anyone is interested in rationally discussing the goal of designing a health care system to secure perfect health for everyone - I'm very interested in reading what you think.
Folks who haven't the brain power to conceptualize something like this will no doubt enjoy a meeting of the minds with Mitch Gore.
Aug 11, '07
Robert Gourley maunders:
"Now if anyone is interested in rationally discussing the goal of designing a health care system to secure perfect health for everyone - I'm very interested in reading what you think.
Folks who haven't the brain power to conceptualize something like this will no doubt enjoy a meeting of the minds with Mitch Gore."
No one is interesting in having this discussion with you because it betrays an ignorance or arrogance so deep that no meaningful discussion is possible. You have not framed your proposed "discussion" in a meaningful way.
Why don't we eliminate doctors, hospitals and all pharmaceuticals and go back to an earlier day. We let natural selection cull out all the "non-perfect" individuals and let nature do whatever it takes. That solves the medical care problem in a very creative way. There is no medical care and everyone gets one flip of the coin. Heads you win, tails Nature wins. Perfect health. Problem solved.
Aug 11, '07
Why don't we eliminate doctors, hospitals and all pharmaceuticals and go back to an earlier day. We let natural selection cull out all the "non-perfect" individuals and let nature do whatever it takes. That solves the medical care problem in a very creative way. There is no medical care and everyone gets one flip of the coin. Heads you win, tails Nature wins. Perfect health. Problem solved.
I guess that's one way of designing a health care system with perfect health as the goal. Perhaps human intervention could be summed up with roving hit squads licenced to eliminate all who have less than perfect health. But I doubt such a system would be too popular, let alone lawful.
I was thinking of something more along the lines of what's available today, but with a focus of perfect health for everyone. One of the features of such a system is it would be easy to track folks who had less than perfect health, and to stratify numbers to look for better ways of seeking the goal. If the goal was some less that perfect health for everyone, then what level of poor health is a better goal?
Aug 11, '07
If the goal was some less that perfect health for everyone, then what level of poor health is a better goal?
Whoops! That's,
If the goal was some less than perfect health for everyone, then what level of poor health is a better goal?
Aug 11, '07
Robert Gourley opines:
"was thinking of something more along the lines of what's available today, but with a focus of perfect health for everyone. One of the features of such a system is it would be easy to track folks who had less than perfect health, and to stratify numbers to look for better ways of seeking the goal. If the goal was some less that perfect health for everyone, then what level of poor health is a better goal?"
You need to spend a few days walking around with doctors as they go through their days. You can lead horses to water but you can't make them drink. This gets back to one of my pet peeves - personal responsibility. There has to be some accountability for people who deliberately take reckless chances with their health and we all end up paying for them, and often suffering along with them. I'm thinking smokers, people who, for reasons only of convenience, not money, refuse to take blood pressure medication, diabetes drugs, etc and then become an even bigger drag on the system when they let their infirmities become out of control.
That's why a goal of perfect health is a fool's errand. Since perfect health disappears at the moment of conception, there is no way to set that as a goal. Health maintenance is a good strategic goal, preventative care, equally strategic, but the participants in this endeavor have to take the responsibility to do their part. This is not a one-sided deal. And Americans are particularly adept at rationalizing their own poor health practices. Doctors and other providers cannot help the patient who won't help him/herself. How do you suggest we motivate patients to seek preventative care and to follow through on the care. How do we encourage people to walk more, drive less; to eat less fast-food; to smoke less; to, generally, eat less; drink less; drive more safely, and on and on and on. We're all pretty smug and complacent and only see a crisis if it happens to us directly. People may say "there but for the grace of god go I" but they're really thinking, "glad it ain't me, tough luck for the other guy".
So I've tried to treat your question seriously and I've provided some elements based on my personal experiences and those of my wife who deals with this stuff 10 hours every day of the week.
The words "perfect health" are, frankly, oxymoronic. Unless you believe we were created in "the image of God", perfection is not a goal in nature; nature's goal is to optimize adaptation for whatever the demands are at any given instant in time. Today's perfection is tomorrow's disaster. Since I spent my career teaching human evolution, evolutionary theory, skeletal biology, and gross anatomy to premeds, I have a pretty good understanding of the problem and my reasons for objecting to your term stands on fairly solid ground.
To cap this, let's just remember the old TV commercial "You can't fool mother nature".
Aug 11, '07
That's why a goal of perfect health is a fool's errand. Since perfect health disappears at the moment of conception, there is no way to set that as a goal.
Actually there's some folks who have less than perfect health upon conception.
You list behavioral and other obstacles to a goal of perfect health, and generally seem willing to give up rather easily. Remember I suggest perfect health might be a state of not needing medical attention - not your wife's, or any other professional's. I believe there to be a fair number of folks who would fit in that category as I type - but under our current health care system we cannot know how many, or what portion of the population is so represented.
Folks with behavioral problems preventing them from reaching perfect health would fit another category - probably one stratified and evidencing some who have a harder time reaching the goal than others in a different category. But that information will only benefits those who want to work towards the goal - it's of no use to those who want to give up.
So, if perfect health for everyone isn't a desirable goal, then what level of poor health for everyone seems more desirable?
Aug 11, '07
Semantics of perfect health care aside, the current system is broken. A cogent and meaningful discussion needs to take place. If the Canadian system works so well, why are so many elective heart procedures performed in the US on citizens of Canada? Why did Canada's blood supply have a huge Hep C contamination debacle within the past 5 years?
What needs to be done to get the discussion moving?
Aug 11, '07
I'VE HAD SINGLE PAYER HEALTH PLAN MOST OF MY 62 YEARS. WORKS JUST FINE. 1945 TO 1966 DAD IN AIRFORCE 1966 TO 1970 ME IN USMC. 100S OF THOUSANDS TREATED.
Aug 11, '07
You can ignore everything on this list and still provide everyone with the security that they will have a minimum level of health care available to them and their family regardless of how high up they are in the company or whether their company stays in business.
people need to take some responsibility for their lack of healthy choices those at the minimum coverage level need to understand that choice is going to cost more Rationing will occur; deal with it business needs to decide to trust as they switch 8 percent or more of current health insurance costs to payroll taxes in support of this other system government needs to pare down existing mandated insurance coverage that needlessly raises insurance costs Funding needs to be based on a sustainable approach * The illegal immigrant question must be factored in and dealt with before anything is implemented
Aug 11, '07
Semantics of perfect health care aside, the current system is broken.
The current system may be a product of difference meanings for different forces shaping the system - particularly with regard to the profit motive.
That's why coming to a common agreement on the goal of reform may be the one unifying force to shape meaningful change.
Designing a system to aquire perfect health for everyone may provide that unifying force.
Aug 12, '07
"This relationship of support for the system to values is why I am hesitant to give detailed advice to Americans. Let me just say whatever plan people develop, it had better fit the values of your society or it will never gain traction and might positively hurt you politically as the losers will fight back and whip up the fear of those who think they might be worse off as a result of your reforms."
That's precisely the problem - America has NO values.
Aug 12, '07
America has NO values.
There's much to complain of American values, and relevant to the subject, Michael Moore does a great job in Sicko, but to say they don't exist at all is flat out lazy.
Aug 12, '07
There has to be some accountability for people who deliberately take reckless chances with their health and we all end up paying for them, and often suffering along with them.
As Michael Moore's Sicko suggests, Americans will never have an effective health care system until they start caring for each other. Who can defend the mental health of those who act against their own self interest, like electing an idiot for President?
It may seem hopeless, but giving up is for sissies.
Aug 12, '07
Just a reminder. Michael Moore is in the entertainment business. What is scary is the extent to which people from all political persuasions seem to rely on the entertainment media for their information.
7:54 p.m.
Aug 12, '07
Don't miss today's lengthy New York Times editorial on this subject.
An excerpt:
Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.
Aug 13, '07
Just a reminder. Michael Moore is in the entertainment business. What is scary is the extent to which people from all political persuasions seem to rely on the entertainment media for their information.
Yes, Michael Moore's provided information like the level of care received by folks who have served at "Ground Zero" in New York. Now if you want to see something really scary, look at the number of "W" bumper stickers around you.
No wonder we don't have an effective health care system, we're surrounded by folks who haven't the brains to design one to secure perfect health for everyone.
Aug 13, '07
Ross,
You are correct that Moore presents his information as entertainment. That is the only kind of information that a large segment of society absorbs. It does not mean that Moore is incorrect. His entertainment may be corrective for the entertainment that keeps telling us we don't want "socialized" health care.
There is plenty of academic work demonstrating the inefficiency and inequity of US health care. Academic work has little political effect unless wealthy interest build a PR campaign around it.
The powers that be have created a populace who do not think hard because it makes their heads hurt. Moore is working with his audience as it is.
Aug 13, '07
It does not mean that Moore is incorrect.
No. But I think it is naive to think he provides anything other than an entertaining, and somewhat snarky, take on his subject. There is no doubt a lot of truth in what he has to say, but we would be well-advised to be cautious about how complete a picture he paints.
Aug 13, '07
I think it is naive to think he provides anything other than an entertaining, and somewhat snarky, take on his subject.
Those who have seen his films will often find the contrary, and only a fool would believe otherwise.
Aug 13, '07
Moore is working with his audience as it is.
Having petitioned folks to become part of the solution after showings of Sicko, I can say the movie is having an effect. Here in Corvallis Regal Cinema's extended showings by two weeks, and more than 90% signed petitions and gave contact information for further action. Changing our miserable health care system will be done one person at a time, Moore's movie really helps!
Aug 13, '07
Trishka, your point about our having to recognize the insurance industry is intriguing, since virtually all of the business-led reforms since the wave of deregulation that began in the 1970s are explicitly premised on NOT recognizing legacy costs. Nobody said "OK, we can't deregulate trucking because of all the wage cuts it will lead to" or "We can't enter NAFTA because all the jobs will go south" -- no, insurance executives, like so many others in the investor class were SCREAMING that we HAD to compete with the lowest labor costs and that, if we couldn't, it's just too damn bad. Inefficiency, they said, must be rooted out if America is to remain competitive.
Meanwhile, when we notice that virtually all of the corporate takeover of health care financing only DIMINISHES the care we get (less care, less well being, stratospherically higher costs), suddenly we're supposed to take account of the tender sensibilities of the insurance gang?
What happened to the insistence on efficiency? What happened to "running things like a business?" No business I know would reject running health care at 2% overhead (rather than 25%) just because some old white guys had gotten so used to the soft life.
Insurance companies in virtually every risk area but especially in health care are parasites whose primary goal is to DENY claims and to fight policyholders tooth and nail to bargain down claims. They further victimize victims of terrible diseases, crippling accidents, and poverty, and they do NOTHING--NOTHING--to justify any consideration.
Turns out the GOP fascination with competitiveness and efficiency is all a crock---when someone suggests getting rid of the useless fat in health insurance (the health insurance companies), suddenly we're all required to bow to their needs.
Puke.
Aug 14, '07
What happened to the insistence on efficiency?
It has never been compentently applied with regard to an American health care system.
While much of the rest of the world has been making effective stabs at it, Americans have failed to design a health care system to secure perfect health for everyone. Maybe we just wanted a challenge, let everyone else get a head start so with a marvelous burst of highly effective governing skills we can put them all in our dust - NOT!
There's some small signs of hope that folks are finally waking up - too little to bet much money on.
Aug 14, '07
Those who have seen his films will often find the contrary, and only a fool would believe otherwise.
Unfortunately, most Americans agree with you. They believe what they are told by people whose overarching purpose is just to tell and interesting story.
You should try getting people who are waiting in ticket lines to sign the petitions. You will probably have just as much luck.
Aug 14, '07
You should try getting people who are waiting in ticket lines to sign the petitions. You will probably have just as much luck.
It worked better getting folks after viewing Sicko, for one thing this was a multi-movie places. Asking folks to be part of the solution before seeing the movie would be like asking them to endorse the current idiotic system of health care.
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