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DéJà Vu All Over Again
Don't look toward Canada for health care!


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That famous American forecaster Yogi Berra got it right when he quipped, “It’s déjà vu all over again.” It has been nearly ten years since the Clinton’s health-care plan was laid to rest and California’s Proposition 186, which also would have put the control of health care into the hands of government, was rejected by the voters. And yet, the idea of universal coverage is rearing its head again.

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In the past few months, we have seen former vice president Al Gore, Democratic presidential hopeful John Kerry, and other prominent politicians around the country announcing that universal coverage is the only viable solution to the problems facing the health-care industry in the U.S.

In an effort to counter this growing movement, President Bush, in his January 28 State of the Union address, said that his second goal for America is, “high quality, affordable, health care for all Americans.” He went on to say, “The American system of medicine is a model of skill and innovation — with a pace of discovery that is adding years to our lives. Yet for many people, medical care costs too much — and many have no coverage at all. These problems will not be solved with a nationalized health-care system that dictates coverage and rations care.”

He continued, “we must work toward a system in which all Americans have a good insurance policy…choose their own doctors…and seniors and low-income Americans receive the help they need. Instead of bureaucrats, and trial lawyers, and HMOs, we must put doctors, and nurses, and patients back in charge of American medicine.”

These are admirable goals; yet, in spite of the rhetoric, the president went on to call for a massive expansion of the government’s role in our health care. He called for a $400 billion increase in Medicare spending over ten years and a subsidized drug program for seniors. If he is serious about restoring the doctor-patient relationship, he should have called for the expansion of Medical Savings Accounts (MSAs) that so many Americans are calling out for. Bush, while claiming that a nationalized system will not solve our health-care problems, he is moving us much closer to that end.

As a former Canadian now living in the U.S., I know firsthand the failures of the Canadian single-payer medicare system. Implemented in 1971, the system provides excellent evidence of what happens to the quality of health care when government is the sole provider and why the United States should not embrace such a system.

For example, Canadians have become outraged over the quality of and access to health care. In response, Prime Minister Chretien established in April 2001, a commission to investigate the system and come up with some viable cures. After 18 months of investigation, $15 million in costs, 357 pages, hundreds of studies and symposia, the commission report, “Building on Values: The Future of Health Care in Canada,” has concluded, to no one’s surprise, that there is nothing wrong with the troubled system that more money won’t cure.

Other than the U.S. and Switzerland, Canada spends more on health care, on an age-adjusted basis, than any industrialized country. But the commission recommends a total $15 billion in new spending between now and 2006, which will further tax an already overtaxed populace. A Canadian earning $35,000 a year pays $7,350 for government health care that many regard as “free.”

The Canadian health-care industry is already over-regulated, but the commission is calling for more regulations. Unlike those in Britain, Canadians enjoy few private alternatives. But the commission calls for fewer still, even as citizens face long waiting lists for surgery.

Additional spending has not reduced waiting lists, which are longest in Saskatchewan, the province once led by commission head Roy Romanow. In Saskatchewan, birthplace of Canada’s government health care, median waiting times for surgery increased from 9.8 weeks in 1993 to 28.9 weeks in 2001.

Romanow’s recommendations are at odds with the reality of other countries that deliver better health care at less cost. According to a report by the World Health Organization, the best performing countries include France, Japan, Sweden, and Australia. These countries all spend less than Canada. They do have user fees and private alternatives that the commission rejected. And the top-performing countries have private, for-profit health-care services, which Mr. Romanow also rejected.

What the best performing countries have not done is imitate Canada’s system, which Mr. Romanow wants to preserve and expand. In his view, to allow private alternatives, as even Sweden does, is to create a two-tier system in which money, not need, determines treatment. Allowing someone to purchase treatment or surgery that they need, and which has been denied or delayed by the government, is supposedly a violation of “Canadian values.”

Denying choice and alternatives, especially to those who are suffering, is not a value worthy of the name. Politicians see government health care as a badge of Canada’s moral superiority over the United States. Yet the U.S. is the destination of an increasing number of Canadians because they have found that government health care promises a lot more than it can deliver.

If Canada’s system lived up to rhetoric, there would be no need for a “Commission on the Future of Health Care in Canada.” In spite of the problems and outrage by Canadians over their dissatisfaction, admirers of the Canadian system, like Senator Ted Kennedy and Debbie Stabenow, continue to tout the Canadian system as the remedy for what ails the American system.

There are problems with the American model. Yet, motivated by ideology and nationalism, politicians are trying to fix it with more money, more regulation, and fewer private alternatives. That’s a bad habit.

A single-payer system promotes higher taxes, limits technology, produces waiting lists, rations care, and prolongs suffering. It would be disastrous for the United States to imitate Canadian health care at any time, but particularly now when its flaws have become undeniable, even in Ottawa, the nation’s capital. Medicare reform, medical savings accounts, and consumer-driven care will make for better health care in America.

American policymakers should remember the adage, “history is not one thing after another, it’s the same thing over and over again.” A universal health-care system run by government will reduce the quality and access to health care for all Americans. It’s a prescription for disaster.

Sally C. Pipes, a Canadian, is president and CEO of the California-based Pacific Research Institute, and author of the forthcoming book The False Promise of Single-Payer Health Care. She can be reached at [email protected].



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