The Breakfast Table

Health Care Rhapsody

Dear David,

Good morning! I figured my reference to Canadian health care might get your goat.

Funny, this morning there’s a front-page story in the New York Times about HMOs overcharging the Medicare system, racking up billions in unjustified administrative costs. Our system, too, seems to be unaffordable-not because providing health care itself is too expensive, but because HMOs, even when they’re honest in their billing, are charging up the wazoo for paperwork that could be consolidated under a ssingle-payer system. The Washington Monthly of June 1998 has an article by Pat and Hugh Armstrong with Claudia Fegan called “The Best Solution,” praising Canada’s system. They tell about a patient, Larry Haven, who was hospitalized in the U.S. after a heart-attack scare. When he was discharged he received an itemized bill covering everything from his sample tube of toothpaste to an aspirin to a laxative he didn’t take. Haven later went to the hospital in Canada with a real heart-attack, and received no bill at all. The main point the authors make is that it is inefficient to charge each individual patient for every last aspirin. Of course the biggest problem in the U.S. is that so many people are uninsured or underinsured, dependent on employers, as more and more people work in unstable, part-time and temporary jobs without benefits.

All those CAT scans in Washington, D.C. are not necessarily indicative of good care-just duplication of expensive services. The Rational Option, a book by physicians at the Harvard Med School and founders of Physicians for a National Health Program, lays out a single-payer plan described by the Congressional Budget Office as the most cost-effective of all plans. The authors claim that, while Canadians wait longer for high-tech procedures like knee surgery, they get emergency care as quickly as Americans. Nor is it true that everybody gets care in the U.S. We’re rationing care here by income and insurance status. People who can’t afford care that’s not covered by insurance have to dig into their own pockets, and those who don’t have very deep to dig go without.

High taxes stink. But according to the Armstrongs, Canadians spend roughly the same proportion of public money on health care that we spend in the United States, for a much more inclusive system. In 1995, Canada spent 7 percent of GDP on health, compared with 6.6 percent U.S. GDP that American ponied up in taxes.

I’ve gone on way too long here, so I’ll let you weigh in. As for the rest of the morning’s news, I am simply appalled at the murder of an 11-year-old girl by a 7-and 8-year-old in Chicago. This is the lead story everywhere. It defies punditry, really. Just awful and tragic and a sign of real sickness in our society.