State of The Union

JR, People aren't treking off to the U.S. for routine treatments, but the are for specialized treatments. I say this knowingly because of a specialist in NYC I know who has told me about all of the Canadian patients she sees. They can't get timely treatment for a fairly uncommon, but not rare, disease she specializes in, so they come to her and pay out of pocket.

And honestly, people aren't dropping dead in the streets in the U.S. Really. I can't really back this up with anything that isn't anecdotal, but you are probably more likely to die of a heart attack in an overcrowded emergency room in Toronto than you are in New York.

This is what I do know about Canada's system. You spend nearly as large a percentage of GDP on health care as we do (you are third highest in the world). There is nothing innovative about your system. Where you do manage to "cut costs," you do it with rationing and with price controls--which just shifts the cost to the U.S. market. In effect, we supplement your health care. We are so large, that we don't have a U.S. to glom off of, so we can't be "innovative" like that. And if we tried the price controls route, R&D as we know it would severely drop off and we could kiss many of the medical advances we've enjoyed in the past half century goodbye. It is a fact that medical advances by and large come out of the U.S. There is a reason for that.

Still, when you add it all up, the typical Candian hands over between 45 and 55 percent of his paycheck to the government for everything. That is middle class Joe. I say no thanks to that. The typical Canadian is in effect spending about $4,000 a year for his or her "free" healthcare. Some pay more than that, some less. The wealthy supplement the poor. That buys you a system with no choices, in which there are the warts I posted about yesterday.

It isn't like $4,000 a year doesn't buy you health care in the U.S. I can choose to spend less than that if I want a catastrophic plan that covers the big things, but leaves me with a high deductible for the little things. Or I can spend more than that and get a comprehensive plan that covers me well beyond the care I could get in Canada. Those are choices I would not get in Canada.

The only part of your system that has any merit is the "universal" aspect of it--wealthier people paying for health care for poor people. But such a plan is problematic for equity reasons. How poor is poor enough? We already have medicare and medicaid in place and they are cracking at the seams because the cost of health care is rising much faster than the economy. It's symptomatic of the basic problem with any "universal" plan--it's untenable because health care has gotten so expensive. It's a conundrum that your country is already facing and is going to be smacked with over the next decade. Your system does nothing to change the fact that medical costs are rising like crazy. So as time goes on, you will have two choices: hand over more and more of your paychecks to your system or cut costs by rationing even more. Either way, Canada is facing a breaking point in which people are going to be incredibly unhappy because they are paying more than they want or not getting the standard of care they want. It's no different than what we are dealing with. You just have put in an inefficient system that rations health care in ways I wouldn't want (albeit, you cover everyone) without any choices.