Howard Dean on single payer

While the health care debate has abated somewhat in the US, it is still ongoing in Canada.  On Monday, there was a debate, on whether people “would rather get sick in the U.S. than in Canada”.  One of the participants was Howard Dean.  The Globe and Mail interviewed him before the debate:

People tend to forget that you already have some socialized medicine in the U.S., as well as a large single-payer system.

Medicare is not socialized, not in the U.S. and not in Canada. It’s a single-payer system. Despite what is often said, your system is not socialized, it’s a single-payer insurance system. The Veterans Health Administration, however, which has 25 million people in it, is a truly socialized system – it’s government-owned and government-operated and it’s worked very well. In fact, the VHA is the No. 1 rated system in the country, according to patients.

Health-care reform dominated the headlines for a long time. Was it successful?

We didn’t pass reform. All we did pass was putting more money into what we already have. It’s successful in a sense that 1) we got a major bill passed, which is something for a new administration; 2) we created a system that’s going to force reform because of the financial realities; 3) a great many more people are going to have coverage. But this system is still not nearly as effective and efficient as the Canadian system.

You’re a physician. There is an assumption physicians don’t like a universal system because, with less competition, they come out losers.

I know a lot of American physicians who would much rather practise under a Canadian model. There is less malpractice, more actual health care, and a lot less bureaucracy like insurance forms to fill out. I think it depends on why you went into medicine. If you want to make a lot of money, the Canadian system is not for you; if you really like to take care of patients, the Canadian system is well suited.

What’s the single most important lesson that Americans can take from the Canadian system?

It covers everybody with a relative lack of bureaucracy. I know Canadians think there is bureaucracy, but you haven’t seen anything until you work in a system with several hundred insurance companies that all do something different. American hospitals have a whole floor occupied by a billing office. You don’t have that in Canada.

Conversely, what’s the most important lesson Canadians can take from the U.S. health-care system?

I’m afraid I’m not sure there is one. There is more cutting-edge innovative technology, but the cost of that is to pay 70 per cent more than Canadians do for health insurance. Canadians will have to decide if that’s a lesson they want to learn.

Bottom line, which system is better for the patient?

I’ve spent a lot of time in both countries and there is no doubt that you’re better off getting sick in Canada.

I don’t have much to add to the content Dr. Dean offers here.  I agree with it.

But why is it that politicians only seem to be able to speak honestly and clearly when they aren’t talking to Americans?  Where was this guy during the health care reform debate?  Instead we got confusing and confounding stuff like this and this and this and this, ending with this.

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