US Should Avoid Emulating Canadian Healthcare
I am mostly on the same page as Dr. Goldfarb in the health care debate, although I’m a lot more skeptical that there’s much to learn from reforms to the UK’s National Health per se. In his most recent response I think he misses my points. I dislike the current UK system just about as much as he does but, for all the talk (which Margret Thatcher engaged in as well), there’s little evidence that the UK is really going to have anything close to a free market system at the end of the reform. There are three major places where I’d take exception to his characterization of my views:
First, “single payer” and “single provider” are, indeed, very different. Single payer systems have the government pick up medical bills; single provider systems have them run all hospitals and employ all medical professionals as well. This is important: a single payer system simply involves government controlling one side of the equation while, in a single provider system, it controls both. Under single payer, the government is a monospony in that it buys all health care but not a monopoly in that it also sells all healthcare. Of course, no system fits perfectly into any given box. Provincial ownership of many major hospitals does, indeed, move the Canadian system in the direction of single provider just as Medicare gives the United States a partial single payer system for its elderly and disabled citizens. Still, the distinctions are useful and important.
Second, the U.S. has the most to learn (for good and for ill) from countries with systems the most like ours. The UK system is very different. The way medical practices and hospitals are structured in Canada, on the other hand, is 99 percent similar to that in the United States although the methods of paying for care are very, very different. The Canadian system, on balance, is probably better than the one in the U.S. for primary care and routine problems like a broken bones but much worse at things like doing medical research, providing high-tech imaging, and treating cancer. Canada, not the UK, provides the best example as to why the United States shouldn’t adopt a single payer system.
Finally, while I agree that it would be a disaster to create a single, national integrated delivery systems like the VA, getting care within the context of an integrated system works for many people in many cases. Advocating for more coordination of care isn’t a bad idea. In the private sector, Utah’s Intermountain Health, Ohio’s Geisinger, and Kaiser Permanente do seem, by some measures, achieve better results than other private sector entities and, often, charge somewhat less for it. They’re models in certain respects as is the VA.
Bottom line: I’ll watch the UK reforms with interest but I think that we should pay much more attention to Canada than to the UK in deciding what to do and what not to do.