Swamp Water Jurisprudence: Health care: Should we look North to Canada?


(9/20/2017)

by Judge Dennis Challeen

To quote the editor-in-chief of THE WEEK (July 21, 2017): “Most Americans now see health care as a right, not an optional consumer good. The U.S. spends 50 to 100 percent more of its gross domestic product than other advanced nations do on health care, to produce a system that still leaves millions uncovered and ranks at the bottom of every independent assessment of quality. If we were a saner, more rational nation, we’d begin a new health care debate with a blank piece of paper. Congress and the White House would study successful health care systems in nations such as Singapore, Switzerland, and France, which are not purely socialistic or free market ... No one is left out, but free market competition drives costs down and improves care. If this is possible elsewhere, why not here? Partisan ideology — and our endless debate about the role of government — stands in the way. A saner, more functional nation? I know: It’s just too much to ask.”

There is no Constitutional right to medical treatment. When our founders created our government, common medical treatments were drinking laudanum (addictive opium and mostly alcohol mixed with flavoring, used as a painkiller) and bloodletting or leeches to get rid of “bad blood,” which unwittingly only weakened or caused infection. Not understanding bacteria and viruses, doctors didn’t sterilize hands or instruments. Life expectancy was about 40 years. The cures were usually more harmful than the ailments.

 

The concept of insurance goes back thousands of years. It began with helping — being a good neighbor. If one’s house burned down, the neighbors joined in and helped rebuild it. Health insurance is a more complicated concept, but nevertheless, when we get sick or need a hospital bed at a cost beyond our means, our neighbors, through premiums and taxes, join in — to a degree — to keep us from bankruptcy.

If we are to get national health care it must be created by Congress, with perhaps some state input. We must study the successful countries that have a combination of private insurance for those who can afford it, or total one-payer system with the government in control. Our present Medicare system for the elderly, 65 years of age or older, is a working example that many urge should be improved and expanded to cover everyone.

There are several issues that must be resolved. The first is whether to cover all citizens from birth throughout life. If we fail to do so, many uninsured would use emergency care but could not pay their bills, which then must be unfairly borne by the hospital, the other insurance companies or the government (taxpayers); the alternative is to turn them away to die in their homes or on the streets.

Another major issue is insuring people with preexisting health issues. Insurance companies for obvious reasons don’t want these patients because they are more likely to run up huge medical bills. People with these preexisting conditions will face extremely high premiums from private insurers that the average person cannot afford, and thus not seek medical help as their conditions may worsen, causing premature death.

If the politicians choose to cover all citizens, the cost will be extremely expensive and some cost saving laws will need to be considered. The government may have to consider co-pays to discourage some people from abusing the system. And the government would have to negotiate lower drug prices with “big pharma,” which it does not now do.

Some countries sell supplemental insurance similar to those in America for Medicare recipients, for those who choose better care than what the government provides (e.g., private rooms, special drugs, preventive medicine, special nursing care, private clinics and hospitals). Another factor is to vigorously investigate and prosecute people who defraud the system. Limits on malpractice suits are always controversial.

Our Canadian neighbors have a universal, government-paid system. We hear Canadians come to America for better health care. This may be true for a few wealthy people who seek rare treatment (e.g., heart, lung transplant) but not the average person. Also, there is the assertion that Canadian doctors are flocking to the United States to practice; it appears that there is a two-way street, with roughly the same number of doctors going both ways.

There is also the claim that Canada experiences long waiting lines for service. The problem is more Canadians seek medical care because it is readily available for all; truth is, the serious cases get immediate attention while routine cases may require a wait. In contrast, Americans without insurance avoid the high cost and go without any care. Canadians acknowledge their system has faults. They have trouble delivering health care to remote rural areas and to Canadian indigenous communities. 

However, Canadians strongly support their health care systems and a 2009 poll found “86.2 percent of Canadians surveyed supported or strongly supported public solutions to the health care problem, and found 91 percent of Canadians prefer their health care system compared to a U.S.-style system.”

One issue that we should all agree upon is, whatever health care Congress creates for the common citizen must apply to Congress also. We cannot have a self-serving privileged class at taxpayer expense.

 

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