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Tuesday, April 07, 2009

"When it Comes to Healthcare, the U.S., Britain and Canada are Hurting"

Are you tired of waiting for health care reform?:

When it comes to healthcare, the U.S., Britain and Canada are hurting, by Ezra Klein, Commentary, LA Times: ...Long lines come up frequently in the American healthcare discussion, the symbol of all that is to be feared about a government-run system. And it's true that in Canada and Britain, the two countries most often cited in discussions of what nationalized healthcare might mean, some patients report having to wait months for some elective treatments. Sometimes.

But we've got waiting lines too... We've just managed to hide our lines through clever statistical gimmickry. ... Moreover,... most countries don't have waiting lines or the uninsured. Not Germany or France or Japan or Sweden, all of which have more of a mix of public and private options. But Canada is next door, and Britain speaks our language, so we tend to spend a lot of time comparing our system with these systems...

In light of the "Health Affairs" data, smugness about our speedy access to care seems a bit peculiar. If someone can't afford care, we record their waiting time as zero. ... But a more accurate accounting would record that wait as infinite, or it would record when the patient eventually ends up in the emergency room because the original ailment went untreated. Research like this raises a simple question: Would you rather wait four months for a surgery or be unable to get it altogether?

Just last week, House Republicans expressed their preference for the latter. ... They call for "a new Medicare program" in which enrollees are given a check "equal to 100% of the Medicare benefit," which they can then take to the private market to purchase their own care.

This proposal has a purpose beyond dismantling a popular government entitlement program. Currently, Medicare does not abide by a budget. It is not run like the Canadian or British healthcare systems. Instead, it pays whatever is deemed "reasonable and necessary." Because of that, costs are shooting through the roof: ...

The Republican plan gives Medicare a budget. Costs grow only as fast as the check grows. ... But this is, in effect, almost precisely the strategy of Britain and Canada: It is the government imposing an arbitrary budget on its healthcare spending.

The difference is that the British and Canadian governments try to apportion that health spending so that the whole population gets care. That can mean, alongside other cost-saving measures, longer waits for services. The Republican budget simply would give individuals a fixed check. That will mean that patients who exceed that sum and don't have money of their own go without needed care.

So Americans will continue to brag that no one waits, and Canadians and Britons will continue to brag that no one goes without. And somewhere, the French and the Germans and the Japanese and the Swiss and many others will wonder why we insist on choosing between such awful extremes.

Will substantial reform actually happen? Our current system is on an unsustainable trajectory so there will have to be big changes at some point, and before the crisis I thought there was a pretty good chance of moving forward in the near term, but with all that has happened recently, I'm not sure the political atmosphere will allow it.

    Posted by on Tuesday, April 7, 2009 at 03:33 AM in Economics, Health Care, Politics | Permalink  TrackBack (0)  Comments (108)


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