Ottawa Sun
Published: Wednesday, March 24, 2010

Health fight not done: Transformative reform still needed on both sides of the border

U.S. President Barack Obama's health-insurance -- not health-care -- reform victory is quasi-historic and he has rightly staked a whack of political capital, if not his presidency, on its embryonic implementation.

However, the sad reality for both Canadians and Americans is that deliberate and transformative health-care system reform is still a dream, at best. And this is mostly due to the wilful ideological intransigence that permeates meaningful public discussion on this issue on both sides of the border.

Having spent most of past week in Florida, I inhaled the wall-to-wall media coverage of the health debate and it is clear that Americans are as misinformed as to what our "socialized medicine" system does and does not do as we are in the dark as to the differences between HMOs, PPOs, Medicare-Part D, Medicaid eligibility, etc.

The scars of the U.S. system are well known. Highest per capita spending on the planet with -- according to several studies -- some 25% to 35% of costs going to, or wasted, in administration and overhead.

Then there are the estimated 43 million uninsured Americans, but this number captures many men between 18 and 45 who choose not to be insured since that group's No. 1 cause of death is an accident, and there are oodles of Americans moving between jobs and consequent insurance plans at any one time.

Nonetheless, the principle of universal coverage espoused in Canada, most of Europe and other industrial nations, is seen as a basic right and the U.S. situation is deplorable in this respect.

Meanwhile, thanks to our single-payer model our administrative costs (net of salaries) are closer to 10%, but this neglects the countless hours that doctors, nurses, allied health professionals and administrators spend on complying with quality surveys, accreditation exercises or the Byzantine bureaucracy of regional committees, ministerial bodies and, at times, dubious liaison efforts which litter health-care governance in Canada.

In fairness, really sick and critically injured Canadians and Americans get great medical attention quickly. But for the chronically ill, the elderly, the disabled, at-risk demographics, and almost everyone else our care is rationed.

FIGHT FOR COVERAGE

In America, this is done via price and private insurance complexity. In Canada, we ration by resource shortages, waiting lists and, yes, private insurance complexity.

Just ask any Canadian cancer patient who has had to fight for extended coverage during treatment with their insurer (if they even had coverage) for a myriad of costs not covered under their provincial plan.

And we haven't even broached the subject of sub-par innovative drug therapy access in Canada (ranking near the bottom of OECD) or the fact that we pay sky-high prices for generic, off-patent medications.

Meanwhile, American patients pay top dollar for innovative biopharmaceutical therapies and effectively subsidize this consumption by the rest of the planet.

An enlightened and transformative approach for both nations would be to adopt the best practices from Europe, where public and private insurance and provision blend to deliver better outcomes in terms of life expectancy, infant mortality and quality adjusted life years.

This scribe -- along with others -- argued as much before the Romanow Commission back in April 2002; eight years later, the status quo rules. And unlike our American friends, there is no political or societal leader in sight willing to even try to engage Canadians in this crucial debate.