I arrived in Canada recently. Like most foreigners, I had heard reports of the largesse of the Canadian healthcare system, which provided free healthcare to its population. But like most people, I always knew there was no such thing as a free lunch.
These are times of extensive debate around healthcare, in the US and most Western countries. No one country seems to have discovered the panacea for its healthcare ills, but it’s become clear that some systems function better than others and what works in one country may not in another.
The US seems enamored by the socialized medicine model of Canada and European countries. 2016 presidential candidate, Bernie Sanders, was reportedly in awe of the Canadian system with its free for all healthcare. However, dig a little deeper, and not all is as rosy as presented. Around this time, I came across a talk by David Gratzer, a psychiatrist, licensed to practice in both Canada and the US. He presented common sense solutions to the problems plaguing the Canadian system, while reinforcing the strength of America’s capitalistic system of healthcare.
His approach is detailed in his book “The Cure: How capitalism can save American healthcare”. It’s a riveting read, and begins with the breakthrough that occurred in medical science in 1941, with the discovery of penicillin. Before World War II, medical care was provided through a relatively free market, like other consumer goods and services, but with government controls on wages, companies began to offer inducements like medical care, which was made tax exempt. This government intervention was the beginning of the establishment of a bureaucratic, top-down system.
The book has entertaining anecdotes, particularly on the ‘America-bashing leftist’, Michael Moore, who personally enjoys the fruits of successful entrepreneurship while advocating a socialist system of government for his countrymen. I remember watching Moore’s documentary called, Sicko, which bestowed fulsome praise on Cuba’s socialist economy and medical system, while berating the American government for neglecting care for swathes of its citizenry. But as Dr Gratzer points out, there are plenty of factual errors in Moore’s documentary and too many unverified hard-luck stories. Public health care systems do not match the performance of the market-based one.
For example, 5-year survival rates for cancer in men are 45% in England v 66% in the US. British, like Canadian patients, wait much longer to see specialists, risking the potential of patients becoming incurable while on the waiting list. Novel drugs are easily available in the US, screening standards are better and the American system is on the cutting-edge of new technologies and treatments.
One of the most simple recommendations, however, one with far-reaching implications is to make health insurance like other types of insurance, covering catastrophic events only. This would bring down premium costs and without government mandates, people will be free to choose from a variety of plans to suit their needs best. Empowering the consumer to make healthcare decisions will bring down unnecessary spending and lower healthcare costs by fostering greater competition among health insurance policies.
For the hot-button issue of prescription drug-pricing, Gratzer suggests reducing the scope and overreach of the FDA, by focusing on bringing drugs to market faster, generating post-approval surveillance data and limiting requirements to safety testing while making efficacy testing voluntary.
The writer points out how politicians who advocate reimportation of drugs from the Canadian market, do not realize that drug innovations are not coming out of Canada because government controls stifle innovation.
I personally prefer two-tiered systems like the Indian model where both private and public sectors offer services to different groups of people. Most private hospitals provide good quality services at reasonable cost and compete with each other to keep costs from rising. The public sector provides accessible care to poorer patients or those in rural areas. It’s far from perfect, but it has the potential to work much better, if only the government wouldn’t keep imposing arbitrary price controls, uncertain regulations and poor intellectual protection.
In an era when people are being coaxed by politicians to believe government is the answer to all their problems, including healthcare, this book is a valuable addition to the work expounding on the power of consumer choice, to make the system work better for all people.