Monday, June 25, 2007

A Canadian-Style Health Care System--How Would We Get From Here to There?

The movie "Sicko" inevitably gets us talking about making over America's health care system into one that would resemble the single-payer government-run systems like those in Canada, Britain, France--or now even Cuba!

I find the proposal a simplistic one.

Having spent so much time in Europe and Canada working with health care policymakers and major stakeholders there, let me first tell you I have a great respect for where they are. Their systems (well maybe except Cuba) work very well for them. In fact, I have lived in Toronto and carried an OHIP card and the system worked pretty well for our family.

If the U.S. had made Medicare universal for all of our citizens in 1965, as Canada did for its people, my sense is that we'd have a very different system in the U.S. but one that worked and was far more affordable because we would have made the transition when the system was a whole lot less expensive, complex, and addicted to perverse incentives. We would also have a lot less medical technology and knowledge throughout the world today. We probably wouldn't know what we were missing.

In 1965, the U.S. likely (and unwittingly) traded universal and much more affordable care for a system that has subsidized a disproportionate amount of the rest of the world's health care breakthroughs during the last 40 years.

But that is all a hypothetical discussion.

A big problem I have with those who now advocate moving to a single-payer system is how really poorly thought-out their proposal is. Proponents seem to presume that you can get from Point A to Point B in one easy move.

The problem is that since 1965 those who operate in the the U.S. health care system have become something akin to drug addicts--they are addicted to all the incentives we have--good, bad, and perverse.

The huge question now is how do you get the health care players cured of these incentive addictions and onto an efficient course.

Today, the U.S. health care system is like three big rigs on the highway, one each representing patient, provider, and payer expectations, nose to nose traveling down the interstate, their speed out of control at 80 mph, with no effective traffic cop keeping them under control. On a date certain, we make it all look like Canada. The result would be tantamount to all of those big rigs simultaneously having to lock-up the breaks because they would have to slow so dramatically.

You can’t just jam on the breaks and pretend the system can be quickly remade. It’s going to be a whole lot more complex than that.

Instead of hearing from single-payer advocates that this is the system we should adopt (and all of our problems will magically go away on a date certain), I'd like to see them give us a plan for how we will actually transform the health care system to one that is entirely under a government framework of controls.

How will doctors and hospitals respond to much lower payments ? The biggest difference between the U.S. and Canada/the EU is the health care provider prices?

How will we drive the existing excess health care infrastructure down to a sustainable level?

How will the politicians deal with patient expectations that are today open-ended and will have to be much more aggressively managed?

If the government runs it, it is by definition a political health care system. Do you think some of the most powerful political constituencies in the U.S. (doctors, hospitals, drug companies) are just going to sit idly by and magically behave themselves? How will a political system suddenly kick in and do what it can't do today--not be dominated by these powerful interests? Which politician is going to say "no" to the patient/voter?

Don't just give me the simplistic, "It's all in the expense overhead." Ya, but expense savings are one-time. The much bigger problem is the underlying and fundamental growth in health care costs. That's the big one and it relates to the above questions.

Tell me what the transition plan looks like and be realistic about how you get there.

Tell me how you politicize the entire U.S. health care system and the stakeholders just go along selflessly taking far less--perhaps humming the "Internationale."

You might want to go out on the Interstate this afternoon, get the car up to 80 in heavy traffic, and slam on the brakes--that would be good practice for what you are proposing.

A Review of the Movie "Sicko"--Michael Moore Blew It!

The Cost to Administer Medicare Versus the Cost to Administer Private Health Plans--The Difference Isn't Anything Close to 25%

There is a Health Care Reform Plan That Doesn't Duck the Big Issues--and More Than 100 Heavyweight Stakeholders Support It!
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