The virtues of single-payer

News & Observer (Raleigh, NC)
Sep 11, 2009

CHAPEL HILL - Opponents of health-care reform have tried to twist the idea of a single-payer system into some sort of threat to the American way of medicine. They are wrong. As someone who spent half my working life in Canada and half in the United States, I've been covered by two single-payer health systems, one in Canada and now under Medicare. They both work.

I have yet to meet my first Canadian who would exchange his or her health-care system for what we have. I have also given a number of talks at retirement communities in North Carolina, and I usually ask for a show of hands of those who would like to give up Medicare. I have yet to see a hand go up.

The Canadian system is based on four cornerstones:

* Universality -- everyone is covered.

* Portability -- one is covered no matter where one lives, and one can move anywhere with little change in coverage.

* Availability -- one has access to basic health care everywhere, and if it is necessary to go to a major center for specialized care, that is where one goes.

* Comprehensiveness -- there are no exclusions from reasonable coverage.

All this is done under a single-payer system. If this looks very much like Medicare, it is.

Health care is costly. This is one area in which we Americans are undisputed world leaders. Our costs average $7,290 per person per year. Our Canadian neighbors, who on average live almost three years longer than we do, pay out only $3,895 per person per year. To put this in perspective, if we could ever achieve the Canadian number, we would save $1 trillion per year.

Over the course of a lifetime, we spend an extra $265,000 per person on health care and get three fewer years to show for it.

Much discourse is afoot these days on how we don't want the government involved in our health care. We are told that we don't want "socialized" medicine like Canada has even though Canada's system is not socialist. We are told that Canadian health care is rationed and that there are long lines to see doctors. The one place there are no lines is at the border waiting to enter the U.S. to obtain health care.

Yes, we have good care here, but ours is rationed, reserved for those who can pay and for those lucky enough to work for a company that still provides subsidized insurance for its employees.

Here in the Research Triangle we live in the shadow of two of the top teaching hospitals in the country. There are few places in the entire world with better access to care. But imagine for a moment that you are a single, unemployed mother with three young children living in rural North Carolina.

Where do you go when someone gets sick, and how do you pay for it if you do go?

There are other ways our health-care system affects us in this global economy. Not too long ago, Toyota, after looking throughout North America for two years, put a new Lexus plant in Cambridge, Ontario. One of the primary reasons was the lower health-care costs that manufacturers enjoy in Canada versus in the U.S.

And curing the problem of our uninsured through private for-profit health-care insurance is virtually impossible. According to a study by the Rand Group, a 50 percent reduction in health insurance premiums would reduce the number of uninsured only by 3 percent.

Universal health care should be a right, not a privilege, in this the richest country in the world. If a criminal in our country has the right to a lawyer, shouldn't someone who is sick have the right to a doctor?

John Kay of Chapel Hill is a recently retired business executive.