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Single payer criticism often untruthful

By James Burdick, M.D.
The Baltimore Sun, Feb. 9, 2015

After discouraging election results, Vermont Gov. Peter Shumlin abandoned his effort to establish a single payer health system. This is bad news not only for the Green Mountain State but for all Americans. Governor Shumlin had been one of the only major U.S. office holders with the backbone to advocate this remedy for our ailing health care system.

The single payer system is already working well in Canada. The Canadian Medical Association strongly supports the system and is working to improve it. But some enemies of reform here are using Canadian stats and the Shumlin setback to decry the single payer system.

Arch-conservative Sally Pipes, president of the Pacific Research Institute and a prominent foe of single payer, claims that Vermont dodged a bullet. In the National Review, Ms. Pipes noted that "78 percent of Canadians over 45 are worried that they won't be able to access care when they need it."

So what? It is the rare Canadian who wants to cancel his or her health care system.

In fact, the 78 percent number she cites is from a Canadian Medical Association report, advising a change in funding strategy. The report is an endorsement of continuing the system by improving it. Of course any national system needs updating and other tinkering to keep it running smoothly. But we do not even have a functioning system in the U.S. to evaluate.

Ms. Pipes has joined other naysayers of health care reform in pointing to lengthy waiting times for care in Canada. Americans need to be aware that this is harmful propaganda. Yes, Canadians have to wait a few months for some elective procedures. They recognize this and are working on it. But Canadians typically find that if they get sick they will be well taken care of without a big bill afterward.

The truth about such comparisons with the U.S. was highlighted when a Canadian newspaper responded with indignation to Sen. Mitch McConnell's claim that the U.S. health care system was superior to Canada's because of the waiting times. A spokesperson for the Republican senator's home state of Kentucky, asked by an Ontario newspaper reporter what waiting times were typical in the U.S., admitted to not knowing what these were but said "anyway, they can always go to an E.R."

A country's waiting times represent averages for all citizens. In the U.S., our citizens without insurance would have to be included in our averages for comparison with other countries that do have national health coverage. In effect, the skewed comparison with other countries would be so distorted as to be meaningless.

This sort of disinformation is common in the health care debate: Statistics are applied manipulatively, leading to grossly incorrect generalizations being used to criticize "universal" health care systems. This is not civic discourse. It is nothing but a big lie.

But let's look further ahead. Given the extensive benefits for many from the Affordable Care Act, how do business interests vested in the status quo argue that more comprehensive reform is not the answer? For that big lie, proponents of the status quo say we must blame the ACA. In truth, the political impediments that prevented more complete legislation in 2010 are the cause of the trouble we've had.

With the ACA we made a good start, but there is much more to be done in order to enable our health care system to work for everyone. It is critical to recognize and neutralize malicious misinformation directed against further health care reform. The real fix lies in the prospect of a single payer system along the lines of the Vermont legislation.

Although moving directly to a national system such as single payer would be the most prompt and effective next step, the present political climate provides little hope for this. Perhaps gradual coalescence of state programs would work. After all, gradual provincial participation is the way the federal Canadian health care system grew to maturity. Efforts such as those in Vermont, and the similar "Health Care is a Human Right" campaign in Maryland, provide encouraging steps toward that goal.

But even that is a political fight few of our politicians seem to have the gumption to wage right now. Keeping the debate truthful will at least level the playing field.

Dr. James Burdick is a professor of surgery at Johns Hopkins University School of Medicine. He is writing a book detailing his plan for patient-centered health reform. His email is jburdic1@jhmi.edu.

http://www.baltimoresun.com/news/opinion/oped/bs-ed-single-payer-2015020...