Transcript Assertion: Canadians are better served by their health care system

N675 – USF – Susan Strasser
Healthcare Ethics and Policy
Fall Semester, 2005
Assertion: Canadians are better
served by their health care system
than Americans are by theirs.
Pro
Jennie Vanderlaag
Dan Keller
Con
Meg Lyskawa
Michaela Coyne
Assertion: Canadians are better
served by their health care system
than Americans are by theirs.
The Con side accepts the debate assertion.
The Sequence of Speakers
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Pro 1 (Jennie)
Rebuttal of Pro 1 (Meg)
Con 1 (Michaela)
Rebuttal of Con 1 (Dan)
Pro 2 (Dan)
Rebuttal of Pro 2 (Meg)
Summary of Pro Side (Dan)
Summary of Con Side (Michaela)
Q&A and Evals (Meg)
Pro 1 – Jennie (1 of 6)
Canada’s health care system serves its
people better by giving them:
• Universal coverage
• Better outcomes
• A fair method of funding
Here are the details…
Pro 1 – Jennie (2 of 6)
The Canadian system offers universality
• Robust public sector
• Canadian term “solidarity”
– vs. US culture: each for self
• Every Canadian resident is covered
• Portable, comprehensive
• Decreed by the Canadian Health Act
(CHA) of 1984
Pro 1 -- Jennie (3 of 6)
• Better outcomes
– The classic measurements of outcomes are infant mortality and life expectancy.
Infant Mortality Rates, 2005
(Source: Canada Bureau of Reproductive & Child Health)
Country
Infant Mortality Rate
(deaths per 1,000 births)
Sweden
Australia
Canada
United States
Russia
Angola
2.8
4.7
4.8
6.5
15.4
191.2
Pro 1 -- Jennie (4 of 6)
Country
Life Expectancy (Years)
Australia
80.4
Canada
80.1
France
79.6
Spain
79.5
United States
77.7
Russia
67.1
Pro 1 -- Jennie (5 of 6)
• Funded fairly (not regressive)
– Who pays?
• “Fair” means “according to ability”
– Example: In the US, all workers pay FICA.
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Federal Insurance Contribution Act
Amounts withheld from paychecks
7.65% with a cap at $90,000
Regressive
Pro 1 – Jennie (6 of 6)
Summary
Canadians have:
• Universal coverage
• Better outcomes
• A fair method of funding
Americans don’t.
Rebuttal of Pro 1 – Meg (1 of 4)
• First, I shall rebut Jennie’s three points
(universality, outcomes, and fairness).
• Then I’ll explain why Canada has lower
quality of care.
– We don’t want that in America.
• Then Michaela will present an entirely
different approach to fixing the US system.
– Let’s not make the mistakes they made in
Canada.
Rebuttal of Pro 1 – Meg (2 of 4)
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Universality
We agree that universal healthcare is an essential
feature of a just healthcare system.
We agree that it’s lacking in the U.S. system.
However, adopting the Canadian system is not the
solution. The Canadian system has problems, too.
One of its problems is its two tiers:
– Wealthy people can buy their way to the front of the
line in Canada.
Rebuttal of Pro 1 – Meg (3 of 4)
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Outcomes
The claim is that outcomes are better in Canada.
However, the cited statistics omit morbidity.
Canadians live longer but they are sicker.
This is partly due to longer waiting times for services.
– For diagnostic tests and therapeutic procedures, Canadians
often wait four months or more.
• Americans would not accept that. Nor should they.
Rebuttal of Pro 1 – Meg (4 of 4)
Fairness
• The claim is that the Canadian system is more fair.
• We dispute that. Canadians pay much higher taxes.
Taxation rates, as percentages of GDP:
– Canada: 36.8%
– USA: 28.5%
• Increasing taxes to the Canadian level in the USA
would drain an additional $250-500 billion from
our pockets.
• Why would that be more fair?
Con 1 – Meg (1 of 1)
• Canada has lower quality of care.
– E.g. there are more MRIs in Orange County
than in all of Canada.
– Patients want technology; it’s one aspect of
quality.
– Canadians endure longer waiting times.
– The Canadian system suffers from staffing
shortages.
Con 1 – Michaela (1 of 10)
A better way to fix the US system
• Let’s not make the mistakes they made in
Canada.
Con 1– Michaela (2 of 10)
• Canada’s growing shortage of doctors has severely limited
timely access to health care.
• Medical school enrollment was decreased in the 1990’s
due to a projected over supply of physicians
• Currently there are more physicians retiring than medical
school graduates entering practice.
• Biggest shortage is among family physicians
• Entire communities are understaffed, requiring patients to
travel long distances for health care services.
Con 1– Michaela (3 of 10)
• Wait times can be excessive for:
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routine visits
specialist appointments
treatments
diagnostics
• Median wait time from general practitioner referral to
specialist consultation is now 7.3 weeks.
• From specialist appointment to treatment is an additional 9.2
weeks for most treatments.
• Elective cardiovascular surgery is longer, with an average wait
time of 10.3 weeks.
• For orthopedic surgery the average wait time increases to 19.3
weeks.
• For MRIs, CT scans and bone densitometry wait times can be
more than 4 months.
Con 1– Michaela (4 of 10)
• Many believe quality universal health care
is not being realized in Canada given the
current delays.
• There is growing:
– health care provider frustration
– patient dissatisfaction
– public sentiment in favor of some privatization
Con 1– Michaela (5 of 10)
The United States
• National health expenditure in 2002 was
1.4 trillion (14.9 % of GDP)
• National health expenditure per capita is
over $5400.
• Health expenditures in the U.S. are twice
as much as the average of other wealthy
nations.
Con 1– Michaela (6 of 10)
• Health care in the U.S. is excessively expensive for a
number of reasons, including:
– Very high administrative costs (largely resulting from a fragmented
payment system)
– Inflationary prices for individual products, equipment and services
– The need to treat advanced disease in the uninsured &
underinsured who couldn’t afford preventive care or early care
– Special interest groups e.g. pharmaceutical companies profiting
from and perpetuating excessive costs.
– The cost of prescription drugs in the U.S. averages 50% higher
than in other advanced industrialized countries.
Con 1– Michaela (7 of 10)
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Universal Health Care Proposal for the U.S.
Objectives
Universal, quality and timely health care for all
A government funded package of comprehensive health
care services for all
Responsive to needs of patients, e.g. maximizes choice
Responsive to needs of health care providers, e.g. ensures
autonomy
Emphasizes prevention, health maintenance, primary care
Fewer resources directed into secondary and tertiary care
Strong patient education component
Con 1– Michaela (8 of 10)
• Health care delivered and managed by a government – non
profit collaboration
• Health care services provided by a strong network of:
– public health clinics & hospitals
– former safety net facilities
– non-profit health care organizations w/ Kaiser as the model
• Minimizes administrative costs
• Reduces inflationary health care costs (drugs, diagnostics,
treatments, surgeries)
• Effective cost control measures
Con 1– Michaela (9 of 10)
• Administration by national, state & county health boards
composed of all invested groups:
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Patients
Health care providers, incl. pharmacists, P.T. O/T. etc.
Taxpayers
Management (government & non-profits )
Federal government
State government
Medical suppliers (supplies, equipment, drugs, etc.)
• Ongoing oversight and evaluation by an independent body
• Central role – government & non-profits
• Peripheral role – private for-profit sector, if a need is
demonstrated
Con 1– Michaela (10 of 10)
Funding Sources
• Federal and state governments would continue to contribute to funding
health care
• Tax on activities detrimental to health, e.g.
– Cigarette smoking
– Alcohol consumption
– Air pollution production (by individuals and businesses)
• There would be a set percentage of income tax paid by all taxpayers.
• This tax would go directly to the established universal health care funding
agency.
• Taxes would increase but would be largely offset by the elimination of
premiums, deductibles, cost sharing, employer mandates, co-pays and
other out-of-pocket expenses.
• Taxes would decrease over time as the simplification, efficiency, reduced
costs, inclusiveness and wise spending of the new system pays off.
Con 1 – Michaela (3 of 3)
• Summary
• We have debunked these three points:
– Universality
– Outcomes
– Fairness
• And we have claimed that adapting the Canadian
system for the US would:
– Not be the best way to fix our system
– We can reinvent our system better
Rebuttal of Con 1 – Dan (1 of 2)
• Meg said that Canada has lower quality of care.
– Aren’t better outcomes proof of quality?
• The morbidity claim is a red herring. Longer waits do not equal
poorer health.
• Emergency needs get emergency speed of service.
– It’s a myth that Canada lacks technology.
• Several peer-reviewed studies debunk it.
• “Critics who allege that Canada has insufficient technology…
[measure this in terms of] the number of units available for certain
procedures rather than the number of procedures performed…
Canadian units perform at far higher volumes… but procedure rates
do not vary greatly between the two countries.” (Deber, 1993)
– This is actually a strength of the Canadian system: a cost
control mechanism.
Rebuttal of Con 1 – Dan (2 of 2)
• Michaela said there’s a better way to fix the
US system than simply borrowing the
Canadian.
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We are mincing words.
When our system provides universal coverage…
And is funded fairly…
And has a single payer…
We’ll have a system much like Canada’s!
Pro 2 – Dan (1 of 4)
First, let’s review the big picture:
the flow of money in Canada’s system.
• Note that the health care providers
have a single input.
That makes it a
single-payer system.
Pro 2 – Dan (2 of 4)
Next, here is the flow of money in the US system.
• It’s not single-payer – count them!
Pro 2 – Dan (3 of 4)
• Lower costs by eliminating the middlemen.
– These are the insurance companies.
– They enjoy their strong position thanks to their lobbying
power in Washington.
– They consume 15-25 cents of every health care dollar yet add
no value.
– They reduce access to care. That’s what makes them
profitable.
– Our many-payer system comes at a high price.
– Each perceives its job to be “…making costs stick to the
other guy’s rear end.” (Uwe Reinhardt)
– Patients are the losers.
– In both US and Canadian Medicare (same name in both
countries) systems, the administrative overhead is less than
1%.
Pro 2 – Dan (4 of 4)
• In fact, a multi-payer system deprives providers of
autonomy.
– There are numerous well-documented cases in which
physician’s incentives prompt them to withhold care
– Medical experts -- not actuaries -- should be the ones who
establish standards of medical practice.
Rebuttal of Pro 2 – Meg (1 of 2)
• You claim that we can lower costs by
eliminating the middlemen.
– Yes, the Canadian system lowers costs, but it
does it by rationing.
– The Canadian system is ailing.
– Patients overuse services which drives costs up.
– Rationing by increasing waiting times is like
the old Soviet system.
Rebuttal of Pro 2 – Meg (2 of 2)
• You claim that a multi-payer system deprives
physicians of autonomy.
– Yes, physicians should have autonomy but they won’t
get it from big government.
– Too much government involvement defies the principle
of autonomy.
– Implementing the Canadian single payer plan would
reduce our health care choices.
– It would be better to have the private and public sectors
coexisting to provide universal health care.
Summary of Pro Side (Dan)
• The Canadian system has…
– Universal coverage. The U.S. does not.
– Better outcomes. The U.S.’s poor numbers are
inexcusable.
– A fair method of funding. The U.S. is regressive.
– Technology. Claims to the contrary are misinterpretations.
– Lower costs. No middlemen.
– More physician autonomy. Less pressure to withhold
services.
• If you fix these problems, you get a system like
Canada’s.
Summary of Con Side (Michaela)
• Canada has lower quality of care. In America we
demand better.
• Canada holds down costs by rationing and with
long waiting times. Americans wouldn’t accept
that.
• We like our lower taxation rate.
• Big government does not belong in the middle of
our health care system.
• The Canadian system has its strengths but it
wouldn’t work here. We propose a better solution.
Q&A and Evaluations (Meg)
• Meg takes questions from the audience
– Directs them to each of the four of us
• We hand out the evaluation forms
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http://www.irs.gov/irb/2005-04_IRB/ar13.html
Kaiser Commission on Medicaid and the Uninsured. (2005). Medicaid: Addressing the Future. Retrieved
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