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August 25, 2006

Let's Get Some Evidence Here

Dan Drezner writes:

I've said repeatedly on this blog that health care policy puts me to sleep most of the time. I usually stay awake long enough, however, to hear many left-of-center colleagues praise the Canadian single-payer system to no end.

Finally, I thought, I'm going to find out who all these prominent leftists extolling the virtues of Canada's mediocre system are. I excitedly clicked on the link, only to find:

Loyal readers of danieldrezner.com are aware that while I'm aware that health care is important, I find it difficult to maintain focus when the issue comes up.

I am dimly aware, however, that Canada's single-payer system is frequently cited by liberals as their preferred form of health care reform.

So that's two posts where he mentions all the lefties giving tongue baths to CanadaCare, and two posts where he refuses to name any names. In the first, he's "dimly aware" of these advocates, in the second, they're so prevalent as to routinely impinge on his consciousness before he dozes off. Odd, no?

I've previously debunked the myth of Canada's superlative system, but for those who need a refresher course, go here. In short, no one who's serious about health care lauds Canada's approach. It's just not a very good system. Arguably, ours is worse (and it's definitely more expensive), but we're talking shades of black here.

The impetus for Drezner's post is the ascendancy of Brian Day, a Canadian physician who advocates a French-style public-private hybrid, to the head of the Canadian Medical Association. The CMA is like our AMA -- a physician association that fights for the interests of their members. In this case, they want higher pay, and have elevated someone who agrees with them (Canada is a pure monopsony system, and so easily limits physician salaries). This is a case of doctor's seeking their self-interest, not the Canadian system failing. Further, Day, a radical by Canada's standards, is advocating a move towards a European style system: Government guaranteed floor of care with the option to spend privately to achieve infinite heights. In other words, he advocates the exact same thing that I, and almost all liberals, do.

August 25, 2006 | Permalink


You horrible person: In your previous post you praised GASP! - the French system!

This is outrageous - we are supposed to hate the French and everything to do with them.

Seriously, I lived in Canada and your right the Canadian system isn't great - but it's a heck of a lot better than the US one. In every health care metric they are ahead. Two notes though:
1) There isn't really one canadian system, each province (state) has its own variant. T
2) One of the biggest problems that the Canadians have to deal with is the distorting effect of the messed up US system on their border. This impacts, doctor retention, nurse retention, and pharmacy costs.

But you nail the bottom line: proposals to use "market forces" in health care are ridiculous - because we know that they don't work in huge swathes of the system.

There has to be a system-wide change.

Posted by: Samuel Knight | Aug 25, 2006 12:44:59 PM

ezra: email Drezner and explain that the Rx in Medicare was the price we paid for the tax free HSA. I thought all Republicans knew that but Dan Drezner is a little slow.

On 1/25/06 - your "corruption matters" you write//The legislation passed on November 22, 2003, right around dawn. The vote was held open an unprecedented three hours to ensure passage (by contrast, when Democratic leaders held a vote open for 15 extra minutes in 1987//

Ezra, you forgot to mention the arm twisting on conservatives on the MMA was done with the tax free HSA.

Speaker Hastert said, "I figured out the difference between the 2 political parties talking with Hillary and the subject was MSAs (Now HSAs). Hillary said, No, No, No, MSAs put too much money in the private sector."

An MSA/HSA baptism!!

Also, the MSA is passed in Medicare too with the MMA. (Don't tell anyone)

I loved your "Donut-Hole" comment.

Posted by: Ron Greiner | Aug 25, 2006 12:58:09 PM

Doesn't Drezner still call Krugman "shrill" because Krugman was right too early about the Bush administration?

Drezner is an academic. I wonder how seriously Drezner takes the criticisms of any students who fall asleep most of the time in the back of his classroom.

Posted by: nemo | Aug 25, 2006 1:02:59 PM

Unfortunately, Canadians suffer from only comparing our system to the American one. The result is that we cling to all its features, including the bad ones. Still, if the Canadian system was really so bad, why is it electoral suicide for a politician, no matter how right wing, to call to change it? You can be pro-life, anti-gay marriage, pro-death penalty, and in favour of bombing Lebanon and get elected in this country, but you can't hint that you want the American medical system.

Posted by: Pithlord | Aug 25, 2006 2:52:53 PM

Pithlord is right.

Want to end your career in Canadian politics: suggest adopting the US health care system.

Posted by: Samuel Knight | Aug 25, 2006 3:03:14 PM

A few years ago my wife and I became disabled. I believe that our medical system needs a overhaul. I believe we need national health care. I'll leave the details to people smarter than I am.

We have been notifed that as of 12/31/2006 our medicine will no longer be paid for. They advised us to load up now. I am a disabled Pastor that our church dropped my life and family health insurance when I became disabled.

Posted by: James Moody | Aug 25, 2006 3:04:12 PM

ezra: I was in Paris in 1996 when I found out that back in the states the first MSA application was approved. That's when my tax free MSA app was approved first. We were staying at the La Grand Hotel across from the old Paris Opera, were the German Generals stayed. The first day we were there these French people were demonstrating below my balconey for better health insurance. I kid you not.

Better not use the French Socialized Medicine as the one to follow now that the Canadian nightmare has been ruled unconstitutional. I couldn't find a French hospital bigger than a 7-Eleven food store. Here in America all of the hospitals are huge buildings full of high tech equipment. The difference is amazing.

The La Grand caught on fire and my wife was the one who informed the front desk. They sent ONE little red van that they called a fire truck. It was pathetic. I have photos. Every little town has huge fire trucks in America. Darn French are tightwads.

In the south of France the Nice's Hospital was on the second floor of some little building. The second I heard Arafat was in a French hospital I knew he was a dead man.

You better just think up a whole new way for Socialized Medicine than some other low rent country. Call it the American way for Socialized Medicine.

It was nice that the company rented out the Paris Opera to have dinner there after the fire. The La Grand is a fire trap. Don't stay there. That place would never pass code here in the US.

Posted by: Ron Greiner | Aug 25, 2006 3:38:08 PM

Yes, Canada's system looks better because it borders the US. I'm sure that successive Canadian governments have taken advantage of the big dysfunctional mess downstairs to remind the voters that it could be a heck of a lot worse.

But, anyway. The French system is the most compelling model. And if anyone thinks that it's not sufficiently individualistic for American tastes is arguing from pure ignorance.

Posted by: ahem | Aug 25, 2006 3:40:30 PM

I couldn't find a French hospital bigger than a 7-Eleven food store.

You didn't look very hard, did you?

Posted by: ahem | Aug 25, 2006 3:43:22 PM


Talk about "market forces" is invariably code for "do as the most influential corporations wish". Indeed, the whole point of a big corporation is to shelter a large chunk of a large number of supply chains from market forces.

If they actually threatened to use market forces, the apologists of HCI corporations would scream bloody murder.

Posted by: BruceMcF | Aug 25, 2006 4:22:17 PM

now that the Canadian nightmare has been ruled unconstitutional.

Your ignorance astounds me.

Posted by: Adrock | Aug 25, 2006 5:14:49 PM

Ohmygod, and then I went to Brittney, and she was like, wow, France sucks! And, like, Taylor thinks Canadia is so dumb -- and she calls it, like, Canadia, that is so funny! And if you would just look at this Amway stuff, wow, you would be so into it! Yeah, I make a little, but look what you could do! Amway is tasty fun! France is full of nerdlingers! OMFG you are so funny!

Posted by: wcw | Aug 25, 2006 6:28:25 PM

now that the Canadian nightmare has been ruled unconstitutional ... leaving people in breathless anticipation ...

... is this some specific detail of the Canadian system that has actually been declared unconstitutional ...

... or is this an interpretation of a decision from the same kind of brilliant legal minds that "determined" that warrantless wiretaps are really OK ...

... you can feel the suspense building. Where do you go to put money on some bizarre misinterpretation of the MD case?

Posted by: BruceMcF | Aug 25, 2006 6:45:14 PM

now that the Canadian nightmare has been ruled unconstitutional.

Ron's already been told he's either mistaken or lying on this point, but it's not surprising that he continues to parrot it along with his other talking points.

Awwwk! Buy my HSA! Awwwk! HSA! HSA!

Posted by: paperwight | Aug 25, 2006 7:22:22 PM

Well, Ezra, Canada might not have a great system. But if I don't get into some group somehow (I'm self-employed) very soon, I'm going to try to emigrate there. Why? Because I have a serious condition and insurance I pay an arm and a leg for, which won't cover my very expensive medication. In fact, in 5 years, it hasn't paid a penny out on my behalf, and yet it is the only insurance I can get.

In the past year, I've known an elderly lady who was bankrupted during her husband's final illness-- he wasn't old enough for Medicare. She was 67 years old, and is working full-time retail because she can't afford to quit-- all their retirement savings are gone.

A friend and her husband want to divorce-- he's got a girlfriend. But the wife will lose her husband's insurance if they divorce, and her job doesn't offer benefits. Hence, no divorce.

A young couple I know wants to marry but can't-- the young woman has a chronic illness and is currently on her mother's government insurance -- but will lose that if they get married.

A woman with asthma has gone bankrupt twice because of medical bills related to her hospitalization. The credit agencies still harass her for payment. She is employed, but her small employer cannot get group insurance because of her pre-existing condition.

I was just up visiting Canadian friends, and they can't even believe any of this-- that Americans must make life decisions based entirely on the availability of health insurance. And they can't believe people die for lack of care. They vastly prefer their system to ours... and so do I. It's not perfect, but they don't have to live in constant fear of losing healthcare.

This is just about the worst system in the developed world.

Posted by: wash | Aug 25, 2006 11:54:06 PM

Liberals would hate French medical care becuase GASP! RICH PEOPLE GET BETTER HEALTH CARE THAN POOR PEOPLE.

Any public/private hybrid is going to operate that way. Go to France and see for yourself how the rich people "opt out" of the public system and go private.

The only way to achieve the liberal dream of everybody, rich and poor, getting the same mediocre health care is to have a CAnadian system that OUTLAWS private medical systems. Unfortunately for libs everywhere, a Canadian court just declared that any system in which private enterprise is outlawed is unconstitutional.

Posted by: joe blow | Aug 26, 2006 4:19:27 AM

This is how to reduce costs, but that doesn't seem to be the focus here. Instead, it's "How can we make our society more socialized".


Dr. Shetty, a leading cardiologist, strives to make sophisticated healthcare available to all, regardless of their economic situation or geographic location. He founded the Narayana Hrudayalaya Hospital (NH) in Bangalore in 2001 and previously co-founded the Asia Heart Foundation. Together the network of hospitals performs 32 heart surgeries a day, making it one of the largest in the world. Almost half of the patients are children and babies. 60% of the treatments are provided below cost or for free. This has been economically viable thanks to drastically reduced costs due to high volumes and economies of scale, several cost saving methods and donations. In addition, Dr. Shetty built a network of 39 telemedicine centers to reach out to patients in remote rural areas. In order to make healthcare viable on a massive scale to the poor, he has launched the "Yeshasvini" health insurance program in association with the government of Karnataka at a cost of only RS 10 per month to 2 million farmers.

Posted by: Fred Jones | Aug 26, 2006 11:55:18 AM

Also, I might add that the article that was broadcast on GMA stated that the average cost of open heart surgery was $2,000 US with a 99% survival rate.

Posted by: Fred Jones | Aug 26, 2006 11:59:33 AM

But Fred, why would major US corporations work towards solutions that increase the provision of results without increasing the flow of funds in the opposite direction? The delivery of results are a means to an end, and only one part of the mix ... if advertising marginal or non-existent benefits over existing lower cost drugs delivers better revenue flow than finding high cost, high benefit treatments, then its time to put money into advertising.

Its fine to deliver low cost, high benefit treatment to medium and low income people in South Asia ... as long as you do not interfer with the delivery of high cost treatment of whatever benefit in high income nations.

Posted by: BruceMcF | Aug 27, 2006 2:31:41 PM

Let's just put an end to the canard that private health care services werw and are still outlawed in Canada. This is false. Blatantly false.

Doctors were always allowed to open private practices, get patients who purchased health services from their own pockets. What doctors cannot do is to practice privately in this manner AND also be paid by the single-payer insurance system. Double-billing is forbidden, as is double-dipping.

Posted by: GCaron | Aug 28, 2006 10:09:59 AM

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