I think Mitchell's statement is correct if we add one small caveat: "The US has the best health care in the world for the rich .

Unfortunately they've convinced people with insurance that what they have is the best of all possible worlds unless we tax everyone so heavily that unemployment will climb to double digits permanently and that living standards will stagnate. Faced with that, people who have coverage shrug and say they're happy with what they got. It's all a phony argument, of course, but we need to deal with it.

Forman's complaint with McConnell's take on reality reminds me of Little Bill's equally inapposite complaint:

Little Bill Daggett: I don't deserve this... to die like this. I was building a house.

Will Munny: Deserve's got nothin' to do with it.

It would hardly matter what the Republicans say, if the Democrats talked back. Instead, we get the Baucuses and the Conrads and McCaskills and the Feinsteins and the LIEbermans, and the Bayhs....saying, "Oh dear, the Republicans said (insert every one of the Republican talking points here) so of course we must compromise with (repeat all the Republican talking points again).

Mitch McConnell has collected a cool 1.8 million in campaign contributions from lobbyists in the health industry.

Every time he opens his mouth, it's GlaxoSmithKline, Blue Cross Blue Shield, and Kindred Healthcare that's talking.

"A study released in 2007 by the Commonwealth Fund" has the US and Canada basically tied for last place except on one "safe care" count where the US is ranked #1 overall.

That makes Canada a highly suspect comparison for how to do health care better.

I am going to venture a guess here...I am guessing with the amount of traffic this site gets that there are lets say 100 lurkers for every active commenter here. And if all you liked minded lurkers write, or call, your representatives and tell 2, or more, like minded people you know to do the same and to pass it on to at least 2 more people they know...we might be able to change some minds in Washington.

Just a thought...

I agree with Mark Halperin's take.

"Major health care reform" is DOA.

I'm not defending our current health care system (I think it's a mess), but if we're going to reform the system it's important to understand both its weaknesses and its strengths. Too often in these debates, the proponents of reform ignore or dismiss what's good about our current system while the opponents ignore or dismiss what's bad.

In my opinion, the American health care system does two things extremely well:

At least part of the excess money we pay for our health care funds these two strengths of our system. Removing money from the system may very well limit our ability to innovate and provide advanced care. This isn't necessarily bad. In fact, as others have pointed out, despite all the high-tech care, health outcomes overall are just mediocre in the US. Simpler, cheaper types of care--applied more regularly and broadly across the population--might actually be a better way to invest our health care dollars. But for those with illnesses that are hard to treat or are currently untreatable, pulling back on innovation and high-tech care might mean a diminished chance of survival. So there may be some trade-offs in reducing the cost of health care. They may be good trade-offs, but we should make sure we understand them before we move forward along any particular course of reform.

It's very hard to make a blanket statement about which country provides the best health care. It is probably true that the US excels at the kinds of treatments that require high cost, high tech interventions, but does more poorly at managing chronic conditions (there's a recent David Cutler paper on this)

It's also entirely possible to provide all your citizens with health insurance and then provide poor or very inefficient coverage.

What is clear is that the US does not really provide BETTER care across the board than any similarly developed countries despite the fact that we pay almost twice as much per person for it.

The truth is you do not have to compare the US with other countries , you can simply compare the US to itself. So the question becomes, why do we spend three times as much per person on Medicare patients in Mc Allen, TX than in El Paso without noticeably superior results? Or as Uwe Reinhardt has said: " How can it be that the best health care in the world costs twice as much as the best health care in the world?"

We are clearly doing many many things in the practice of medicine and in the delivery of care that costs a lot of money but does not produce better health.

In fact, it turns out that many things that improve quality of care, also cost less. This was Edwards Deming's insight that worked out so well for those company's with enough foresight to implement them (e.g. Toyota). They can and should be applied to medical care as well.

Sometimes I think we need to shake conservatives by the collar and yell "THESE ARE CALLED 'STATISTICS'. They are facts. Use them when you are forming your opinions."

I think the key difference between conservatives and progressives like myself is this: conservatives don't believe in government health care out of PRINCIPLE- the principle that government intervention should be minimal. Progressives support reform because there are statistics, scholarly analyses, and examples of other countries with public health care that support their opinions.

If you don't have evidence to support your opinion, you are a danger to yourself and to society.

Reposted from the Denver Post.

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Rhonda Hackett of Castle Rock is a clinical psychologist.

Debunking Canadian health care myths

By Rhonda Hackett
06/07/2009

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada’s taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada’s health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn’t when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada’s government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don’t get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists’ care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not “socialized medicine” but “social insurance” systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren’t enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn’t the big bad “socialist” bogeyman it has been made out to be.

Copyright 2009 The Denver Post.