• 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 If it’s repealed or swept aside, both left and right might be able to focus on a more plausible goal: not a perfectly universal system, but more modest reforms that would help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.

    • Is there any reason to believe that the ability of other countries to provide superb, technologically advanced care to their citizens depends on America’s largely unregulated pharmaceutical and medical technology sectors as well as the fact that we do not in fact have a single payer system? I hear this alot.

      • Reply to Simon;

        Ezekiel Emanuel wrote a series in the New York Times in Oct/Nov 2011 where he discussed how to reign in medical costs. He concluded that we could “save a bundle” by the way we treat chronic diseases. This is by using “high touch” medicine and eliminating fee for service reimbursement. What more effective way to do this than having a single payer “medicare for all” system. As long as medicine is administered and practiced for profit, with a patchwork of insurance companies fighting for “covered lives” as they call it, we’ll never have the system we want or deserve.

      • As many people have noticed over the years, the US pharmaceutical houses spend a lot more money on sales and advertising than they do on research. They aren’t interested in coming up with breakthrough drugs because the effort would just cost too much. They would have to check out thousands of different drugs and spend a lot of money doing the basic investigations into how our physiology works at the molecular level. They would rather let NIH fund that with grants to research universities, which means that it isn’t our laissez faire attitudes toward the pharmaceutical houses that is responsible for any American predominance that may exist, but rather our support for basic research in our universities.

    • You speak of the ACA as if it were dead and gone already. I hope you’re wrong.

    • I like how all conservatives pick Canada and the UK to lament about the woes of “socialized medicine,” in spite of the fact that they do a heck a lot more good stuff for more people than we do and don’t leave anybody out as health care beggars.

      But ask them about France or Germany, who kick our butts up and down the streets all day, every day in cost and quality and fairness, and they all claim ignorance. If you are going to bloviate on comparative international health care, you should at least pick up a fricking book or article now and then!

    • What it is, is that pharmaceuticals and other medical companies can charge more in the US than in other places for the same treatments, so it pads their bottom line.

      But don’t buy for a minute that companies can’t adjust. and still make a profit

      • That the US pharmaceutical houses budget a lot more for advertising and public relations than they do for research tells you all you need to know about where they make their money. It isn’t in producing breakthrough pharmaceuticals and treatments.

    • I’m sure Canada does benefit in some ways. They also bear some costs. For example our system bids up the wages of medical personnel. If the only argument for our current system resides in medical innovation, I’d say that we should make the system more efficient and disciplined, and then divert 10% of the resulting savings to basic science, clinical, and health services research. We would come out way ahead.

    • Thanks for your response Harold. I am curious what you think of the ideas of Clayton Christenson and Eric Topol. I have not read either of their books but thought perhaps you might have some insight. They seem to belong to the Consumer Driven school of health reform.

      Here are some links:



    • Simon, what possible mechanism could plausibly provide other countries’ ostensible ability to free-ride on our less-regulated healthcare markets?
      The only possible connection I could envision wld be something analogous to Europe’s and parts of Asia’s deferring onto us a substantial part of their defense costs. But that makes little sense to me — it’s not as if we’re spending any of our $ — gov’tal or corporate — in their economies’ healthcare sectors (other than AIDS-aid, disaster-relief, or Medecins-sans-Frontieres and suchlike charitable spending, which have zip to do with our regulatory regimes).
      And though it’s clearly true that US Big PhaRma sells drugs for far lower prices in most of the rest of the world than they do here, it’s also clearly true that they wouldn’t be doing so below the cost of manufacture.
      (And their usual plaints that they need obscenely high profit margins to cover their immense r&d costs have long since been debunked in numerous ways: the $ spent on marketing, rather than research; gaming the patent laws, &c&c.)
      But I’m not a professional in any field (medecine, law, economics, insurance, or IR) that would position me to know how such connections might be made, and it’s entirely possible that there are some.
      Wherever you’ve encountered such claims, have any provided any hints on such?
      And if it is actually so, does that in any way require us to keep overpaying egregiously for our healthcare, in order to keep subsidizing the healthcare of the other 6.7+ billion humans?

    • I personally do not believe the ACA is dead and gone. You would start to believe that if you read some of the articles after the Supreme Courr oral arguments last week but I listened to them, albeit while multitasking at work. I felt that the few call ins I did hear from persons who have been brushed aside by our health care system who would otherwise have benefitted the most if many of the current ACA befits were already in place were enough to demonstrate that we really must move forward and implement reforms quickly. Not that I think we should just go with what we have for time’s sake, but rather the ACA provides enough building blocks for us to continue to use.

      I agree with you Harold, there is Jo reason why there must be a trade off between medical costs and social protection. In our current system we blame our high costs on our innovation and amazing health care when in reality our costs are derived from our lack of social protections.

      Mixed into the arguments last week were call ins from consumers who demonstrated how pourly we have educated our public on health care utilization. There were call ins to cspan from person eligible for Medicaid but refuse to sign up for the stigma. They were agaibst the ACAs ecpansions of Nedicaid and “intrusions” into prrsonal health care but claim they get the health care they need when they need it. Granted it was unclear if they received charity care or if they paid out of pocket, but either way that is problematic especially if catastrophic care becomes necessary and too expensive for them.

      I don’t think it is yet clear toast just how much our system can be improved and just how the ACA is vital for this.

    • “Douthat is an excellent writer”

      No, he’s not. He’s a supercilious, pontificating hack who starts with a conclusion and then works backward to come up with some sort of a justification no matter how tortured and distorted.

    • Not a mention anywhere of the massive amounts of Freedom™ Canada is foregoing by following the path they have chosen, I see.

      (Freedom™ and Free™ are registered trademarks of the Republican National Committee. Used with permission. All rights reserved.)

    • Moved to Toronto a few years ago after losing my IT job in the US.

      Just over a year after my wife and I moved to Toronto, we had a baby boy who had a cleft lip and palate.

      Now, this was not unexpected as prenatal tests had told us about it. I was amazed at the quality of care. From the moment we found out that our child would be born like that, a whole team of people made up of a geneticist, a social worker, speech pathologist, dentist, pediatric plastic surgeon met with us to discuss options, and what we should expect.

      Our son had his lip repair surgery at age 5 months and palate repair at age 11 months. Now 5 years later, he is still getting regular speech therapy, and is scheduled to have his palate re-aligned later this year.

      The cost to us for all this? $0! That includes all the prenatal genetic tests, expected dental treatements he will need to right his teeth, and everything in between.

      I thank my lucky stars that we decided to move to Toronto. No one will ever be able to convince me that the Canadian health care system is inferior to the US one.

      Also the lies that are preached in the US about wait times, are disgusting. For critical, life saving surgeries the wait times are no longer than those in the US, although for non-critical surgeries they are longer.