Whenever politicians talk about health care reform, Americans probably fear most the systems Britain and Canada have. It makes no difference that Reid and many others who have benefited from them extol their virtues. These systems are so different from what the U.S. does that they’re not likely to be implemented soon anyway.*
Britain is one of the few democracies that goes whole-hog: Your health care is paid for through direct taxation by the government, which also employs the doctors and nurses who see you. The downside, of course, is that taxes are high. Britain still spends less on health care than the United States does, but it may not feel that way if you’re paying 17 percent tax on a sandwich at the Pret-a-Manger.
Also, the government has to pay attention to cost, and can act like a gate-keeper on certain kinds of medications. This might feel like it makes more sense when you’re the taxpayer than it does when you’re the sick person who wants a treatment. In any event, Reid was not approved for shoulder surgery, or really any other kind of intervention, except the stiff-upper-lip treatment. Just learn to live with it, they told him.
Both Britain and Canada also install waiting-lists for non-emergency procedures, with the justification that if health care is free for individuals the temptation to overuse it is strong. This is the way a non-market system can internalize a cost on its users. Britain invested a lot of money after true and exaggerated scandals involving their wait lists; tales of patients waiting on gurneys while they slowly died. That’s the upside to government involvement, the government is ultimately answerable to voters. In Canada, the wait-list problem hasn’t been overcome, and that was the only country in which Reid didn’t get to see a specialist because of the wait. The upside, if he’d waited around for about a year, is that everything would have been totally free.
Reid posits that Canada provides the U.S. with another important lesson: Universal health coverage started first in one province, and then after it was proven popular and workable spread to the entire country. It’s called the demonstration effect. Maybe,he says, if more states like Massachusetts could provide universal coverage and actually control costs, the entire country would eventually get on board.
Another benefit, though, is that because both Canada and Britain will have to pay for the entirety of their citizens’ care from birth to death, they have a great incentive to keep you relatively healthy. So it really is care for your health, more than managing your sickness. Something tells me that wouldn’t wash in the U.S., though: you basically have the government telling you what you should and shouldn’t do.
*Though, as Reid points out, the VA system works just like the British NHS, and Medicare and Medicaid work like the Canadian single-payer system.
