Posted by: Jeff | February 24, 2010

The Least of These

Rather than rely on Canada’s universal health care system, the Premier of Newfoundland has apparently decided to travel to the United States (Miami specifically) for heart surgery. While it’s not entirely clear that the surgery Danny Williams needed wasn’t available in Canada, or exactly why he decided he needed to travel to the United States, sure as there’s carts to horses various conservatives are already declaring this a vindication of American health care and a repudiation of Canada’s “socialist” universal system. After all, if Canadian health care is so great, why did Williams feel the need to come to America?

Even if we assume that Williams could not have gotten the treatment he needed anywhere but America, I don’t see how this argument holds any water. Put bluntly, Danny Williams is a very rich man. He is the Premier of a Canadian province. He sits atop the pinnacle of power in his society. No matter where he goes, he is going to get the best health care on offer. And I would not dispute for a moment that, if you are rich, America has the best health care in the world. (This answers Jeffrey Anderson’s question about why no “Obamacare-supporting” politician goes to Canada for medical care – they don’t need to.)

But in that little qualifier – “if you are rich” – lies pretty much the entire problem. Williams has the luxury of traveling to another country if his own cannot provide the treatment he needs. Many, many Americans and Canadians do not. So really, why should we give a damn whether the American or Canadian system is better for Danny Williams? He’s rich. He’ll be fine regardless. The question we should be asking is which system is better for the overwhelming majority of people – Americans and Canadians both – who are not Danny Williams and will never be Danny Williams. In fact, I’d go farther and say we should be asking which system is better for the very poorest of either country, as I’m a believer in the dictum that “the greatness of a nation is measured in how it treats its weakest members.” (And while we don’t bring up religion that often on The Regimen, I can’t resist pointing out that this was Christ’s dictum as well.)

What this logic highlights, I think, is the extraordinarily odd standard used by those people who declare that America has “the best health care in the world,” and that adoption of a European-style universal system would ruin that. American health care is like a few islands of excellence in a sea of mediocrity. The rich and (to a slightly lesser degree) the middle class get the excellence, and everyone else gets the mediocrity. The poor, quite often, get screwed entirely.

The way people have discussed the threat of rationing in the context of universal health care, for example, has implied that rationing doesn’t currently go on in America. But it does. Free markets are rationing systems – they determined who gets how much of a limited resource. And health care is a limited resource, like anything else. So in the American system, which remains, for all its distortions, a far more market-based one than the Canadian system, people are rationed health care based on whether they can afford it. If they’re rich, if they’re healthy, if they’re working for an employer who provides benefits, or if they qualify for Medicare, then they’ll probably be taken care of by the system.

But if they don’t fall into any of those groups, then not so much. Meanwhile, the Canadian system rations health care according to need. Your ability to pay for health care, or for insurance, is of far less consequence than it is here.  (And incidentally, this is how we in America avoid Canada’s longer wait times – by pricing large portions of our population out of being able to get good care entirely.)

On top of all this, the fact that we provide nearly limitless health coverage for certain groups, via things like Medicare and employer-based benefits, only serves to further drive up the costs of health care (increased demand begets increased price) which makes life even harder on the most disadvantaged of our citizens.

Shall I go on? Overall health outcomes for the United States population are not measurably better than they are for Canada’s. Yet as a society, we pay considerably more per capita for our health care than does Canada. We’re forking out more money and receiving no comparative increase in value.

So by the moral standard of concern for the least of these, which system is preferable? I think the answer should be obvious.

Yet opponents of universal health care seem to think that what matters is simply having the islands of excellence, even if large portions of the populace have little-to-no access to the islands. As if excellence is a goal in and of itself, regardless of whether that excellence is widely available. Like I said, it’s an odd standard.

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