Ross Douthat should visit Canada

In today’s Times, Ross Douthat writes:

The reality is that the more treatments advanced medicine can offer us (and charge us for), the harder it becomes to guarantee the kind of truly universal, truly comprehensive coverage that liberals have sought for years. The individual mandate conceals these realities, but it doesn’t do away with them. If it’s repealed or swept aside, both left and right might be able to focus on a more plausible goal: not a perfectly universal system, but more modest reforms that would help the hardest-pressed among the uninsured.

Douthat is an excellent writer. At some gut level, his argument seems intuitive that there is a fundamental tradeoff between medical cost and social protection. High and rising health care costs indeed stress America’s particular blend of social insurance systems.

Douthat’s basic framing is less compelling when one looks around the world and to see what actually happens in other wealthy democracies….(HAP)

Many of these countries have superior cancer statistics to those of the U.S.. They provide cancer care within more disciplined and universal financing systems that provide far greater protections to patients against catastrophic expenses.  The U.S. certainly does excel in some areas of cancer care. As Aaron Carroll notes, much of this care is actually provided to seniors under Medicare. So it’s odd to argue that our best performance provides a strong argument against more universal financing systems.

In many respects, the quality of Canadian medical care compares favorably to that provided in the U.S. I was in Toronto last month visiting families staying in Ronald McDonald House while they receive care at the Hospital for Sick Children. Every family I spoke to was staying at the House because a child had a serious malignancy requiring prolonged advanced treatments such as high-dose chemotherapy with stem cell rescue. Sick Kids is an impressive institution that provides much high-tech care.

The parents I spoke with communicate on Facebook with American families struggling with the same medical challenges and similar medical treatments. It’s embarrassing to hear Canadian parents express relief that they don’t live across Lake Ontario in Rochester or Buffalo. Canadian families face their own financial and personal challenges when a child is seriously ill. They are less likely to lose their homes, and they don’t get crushing hospital bills. This country spends so much more on medical care than Canada does. Yet we’re hard-pressed to treat families decently when a child becomes desperately ill.

We can address many of these systemic failings without going the whole way to a Canadian-style system.  The Affordable Care Act tangibly made our system better and more humane. It phased out annual and lifetime caps on reimbursements for serious conditions. It  established protections for people with preexisting conditions and more effective curbs against common unethical industry practices directed against seriously-ill people within the individual and small-group insurance markets.

I wish I had heard more about these human realities in Supreme Court oral argument last week. It’s not about broccoli or burial insurance.

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