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Posted on October 16, 2007

Politicians ignore U.S. health fiasco

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Note: Diane Francis is a well-known conservative analyst in Canada. Even the right-wing acknowledges the value of the Canadian health system.

Note: Canadian physicians working in the U.S. are just 1.1 percent of the U.S. physician workforce, which is similar to the percentage of U.S.-trained physicians working in Canada (0.8 percent) (“The Metrics of the Physician Brain Drain”, Fitzhugh Mullan, MD NEJM 10/27/05).

Corporate control of Congress prevents reform

Diane Francis
Financial Post
October 9, 2007

American health care is an oxymoron and the system represents our major trading partner’s biggest competitive disadvantage going forward.

And yet it is the 800-pound gorilla in the room that’s ignored during these presidential-election primaries and runoffs. Nobody touches the fact that this is a huge business and economic issue, besides a socio-political one.

Canadians are lucky on this one. We may have lineups and our newspapers may occasionally publish horror stories about someone left on a gurney for hours outside an emergency room.

But the U.S. system is the worst-executed in the world and its private-sector interests have convinced the government to insure the riskiest people — namely veterans, indigents and seniors — while leaving the gravy to private-sector insurers to profit from.

Government in the United States provides medical care for more than half of the population, in these high-risk subgroups. But if government covered all the population, younger and healthier, the cost per capita would decline because these would be spread over a less-expensive population of clients.

So the private sector gets to do what it wishes, which is to cover those who maximize its profits, and the governments are drubbed for the costs of Medicare, Medicaid and other programs for the needy or risky.

So the United States has two medical systems: One private-sector for the well-off, where insurance companies simply pass along costs, rather than wrestle with them, as do privately owned hospitals, clinics, labs and physician practices. And another that takes care of the old, disabled, impoverished or militarily wounded.

It’s hard to imagine the human suffering that has resulted from this situation. Canadians don’t have the anxiety about health care that underlies American existence. People there don’t leave jobs, don’t start new ones or businesses because they fear losing insurance benefits.

Insurance companies, according to congressional testimony by one physician, pay doctors bonuses based on how many claims for medical care they refuse.

And yet, most of the presidential candidates duck the issue whenever possible, although it’s becoming harder now that Michael Moore’s documentary Sicko has done a good job exposing the system.

But the economic problem is overlooked by everybody. The United States is spending 15.3% of its GDP on medicine and that doesn’t include the cost of litigation over medical bills. Forecasts are costs will hit 20% of GDP by 2012. More disadvantages: - 49 million people without any insurance. The same number inadequately insured. - Despite that shortfall, the United States spends far more per capita than other OECD countries, and has worse results by measures such as lifespan or infant mortality. Estimates are medical costs will hit 20% of GDP by 2016. - Costs are high, even though the system is so poorly executed, because the rich are over-serviced and pampered and the poor under-serviced or ignored. - One estimate is that half of U.S. personal bankruptcies are because of high medical bills due to a catastrophic illness. - Congress is co-opted by pharmaceutical giants, the American Medical Association (the country’s most powerful trade union), insurance companies and ambulance-chasing lawyers.
Meanwhile, medical professionals are paid much higher salaries and fees than elsewhere in the world, which has resulted in a serious brain drain of personnel from Canada and Europe. Some 9,000 Canadian doctors now practice south of the border and thousands more nurses.

For that and many other reasons, Canadians should urge Americans to do major surgery.

More info on my blog at financialpost.com/dianefrancis