As a rational Canadian watching the completely irrational American ‘debate’ on health care these past few months, I find that it would almost be funny if it weren’t so infuriating. As a skeptic, I can’t understand why other skeptical organizations/blogs/podcasts are not debunking the outright lies being promoted by anti-reformers, especially given the number of doctors in the skeptical movement.

Fear: Why is it working?

Some of the lies anti-reformers are spewing about health care reform: You won’t get to choose your doctor. There will be a government bureaucrat standing between you and your doctor. Grandma will be euthanized if she gets sick. Health care will be rationed. Everyone will be forced to pay for abortions, sex-change operations, and health care for illegal aliens. Death panels!!!

But people are believing it. Anti-reformers have launched a campaign of outright lies and absurdities and people believe it. Why?

Why are the fear tactics quashing rational debate about health care? Because appeals to emotion generally trump appeals to logic. (It’s the bane of a rationalist’s existence.) And the most powerfully motivating emotion is fear. Fear is our most primal emotion; survival is linked to it.

Many cultures, and certainly most western cultures, are uncomfortable with death. We don’t like to discuss it, and we don’t know how to handle it when we (or someone we care about) are confronted with it.

The American federal government has long encouraged Americans to make living wills and have end-of-life-care discussions with their doctors. It’s not new. The Bush administration advocated it. It’s a good idea. It’s a smart idea. It’s an important idea. People should have all of their wishes honoured when their inevitable end comes, and those wishes cannot be honoured if they’re not known (in the form of a living will). And people should make informed decisions about their end-of-life care by discussing options with their doctor.

‘Obamacare’ is not presenting anything new, just the concept the the government will pay for said end-of-life-care consultations.

The scare tactics of the anti-reformers turned this simple, innocuous concept into a monstrously scary prospect (death panels!!!) and the American public freaked out. Suddenly they were being forced to confront the idea of their own mortality. That’s scary. Even after millions of years of brain evolution, existential fear trumps logic and reason.

Fear is also contagious. This is a mechanism of evolutionary biology. Survival of a species requires signalling danger to others and being receptive to danger signals.

So fear of death is one culprit. Others include fear of change and losing the things they have, fear of diminished freedom of choice, and fear of government. Fear, fear, fear. Fear trumps reason.

The truth about U.S. health care

Again, as an outsider, I see the ‘debate’ about health care in the U.S. as patently ridiculous. I know enough about the current American system to know that most of what the anti-reformers are erroneously claiming about health care reform are things that exist in their current system.

“I don’t want some bureaucrat standing between me and my doctor!” or “I won’t be able to choose my doctor!” are two protests commonly heard in the past couple of months. But insurance company executives currently stand in the way of Americans and their doctors, and the public’s choices are already limited.

If an American is lucky enough to be able to afford a health care plan, or have a job that provides one, she will still have to pay out of pocket if she goes to a doctor or hospital not on her insurance company’s ‘in-network provider’ list. An in-network provider is one contracted by the insurer for agreed-upon rates. An out-of-network provider is one not contracted with the insurer. If Americans go to a doctor or hospital that is ‘in-network’ then they will pay less than if they go to an out-of-network doctor or hospital. In some cases they will have to foot the entire bill. So if you’re an American who is unconscious and being rushed to the hospital, you’d better regain consciousness long enough to tell people which insurance company-approved hospital to take you to so you don’t go bankrupt.

People in the current American health care system can be denied coverage by their insurers for pre-existing conditions, or denied reimbursement of drugs not approved by their insurer. Doctors and nurses spend a good part of their day on the phone with insurance companies to make sure that certain treatments and drugs are covered by their patient’s health care plan (often they are not). Sick people are often turned away by a hospital because that hospital isn’t on their insurer’s pre-approved list. And yet some Americans believe that they currently have free choice, that no one is standing between them and their doctor?

We keep hearing that America has the best health care system in the world. It’s true that the U.S. spends more (by all measures) than every other country. In fact, it is the most expensive in the world. But the World Health Organization ranks France, Switzerland, Britain, Canada, and Japan higher than the U.S. in health care. The U.S. ranks 37th. Forty-six million Americans can’t afford health care. Seventy-five percent of those who file for bankruptcy because of medical costs had insurance when they got sick and went bankrupt anyway. The system is run by huge health insurance corporations that make enormous profits off of denying care to patients.

And this is the system that anti-reformers are fighting, fighting, to keep.

The truth about Canadian health care

I live in Canada and I am appalled (and a little naïvely surprised) at the lies being bandied about regarding the Canadian health care system. In Canada we have universal, single-payer, non-profit health care called Medicare. It is a single-payer system: The government pays the medical bills, but doctors and hospitals are private and independent (as opposed to socialized medicine, like the NHS in Britain, where doctors are paid by, and hospitals are owned by, the government). In Canada, the provincial governments and the federal government are responsible for providing non-profit health insurance to all citizens—they pay for it, they don’t run it. And citizens pay no deductibles or co-payments in most cases (some medications and treatments are not covered or are only partially covered).

Canadians do not have to fight with insurance companies (or the government) for reimbursement. We are not denied care. We do not go bankrupt from medical bills. We do not have to suffer from illnesses or injuries because we cannot afford medical care. Canadian doctors and administrators do not have to waste precious time fighting with insurance companies, or turn patients away because they are not ‘in-network.’ Drug prices are negotiated by the government with the pharmaceutical companies, which keeps costs down. Doctors are reimbursed monthly by the government, which means no time-consuming paperwork for thousands of different insurance companies. (In the U.S. which has between 1,000 and 1,500 different insurance companies, about 30% of health care costs are purely administrative—overhead costs that single-payer, not-for-profit systems do not have.)

Why does Canada pays less for a better system? Here, health care is a basic human right; it is not for profit. Health care is not a market. Therefore, it is not motivated by companies trying to make as much money as possible. We don’t have bloated administrative costs, high-paid insurance company executives, ridiculous bonuses, and millions of dollars spent on marketing. It is a not-for-profit system.

Canada pays for more hospital days and doctor visits per capita than the U.S., but spends 40% less. We pay medical personnel less, our equipment and services cost less, the government negotiates drug prices with pharmaceutical companies, and the government is responsible for financing health care through its budget so therefore must keep its costs down.

In Canada, general health insurance is not tied to employment, so you’re free to quit your job and change jobs without having to fear, “What if I get sick or hurt?” And health care is not age- or prior condition-based.

Canada’s health care system is not perfect by any means. It is sadly true that there are wait times in the Canadian system. But it is a problem that has improved exponentially over the years due to better administration and management. If you require surgery and waiting a while is not life-threatening (for example, cataract surgery), then you may have to wait a couple of months. But if you require essential, life-saving surgery, you won’t have to wait at all.

Shona Holmes is a Canadian woman who has made the rounds on American talk shows condemning the Canadian system. She claims that she was diagnosed with brain cancer and needed emergency surgery, but was forced onto a waiting list so she went the States for her life-saving surgery. The truth is that Shona Holmes did not have cancer, she had a benign cyst, which is not life threatening. She probably would have had to wait two or three months in the Canadian system, but instead she went to the U.S., mortgaged her house, and paid $100,000 out of pocket. Had her non-life-threatening benign cyst been a life-threatening malignant cancerous tumour, the Canadian health care system would have provided Shona Holmes with surgery immediately, and she wouldn’t have had to pay one red cent. But because she went to the States, she mortgaged her future. (This woman has been thoroughly debunked: see here, and here, and here, among other places.)

Yes there are wait times in Canada, but nobody waits for emergency surgery.

Despite its imperfections, inadequacies, and increasingly classist structure (due to its deterioration over the years and movement towards a two-tiered system), Canadian Medicare is still a universal health care system that ensures no Canadian will ever go bankrupt, lose their house, go into debt, become homeless, or die because they have an accident or get sick.

Not too long ago Tommy Douglas was voted “The Greatest Canadian” by a national poll. Tommy Douglas is Keifer Sutherland’s grandfather. He is also the person who ushered in Canada’s universal health care system. The greatest Canadian.

Further reading:

“A Canadian doctor diagnoses U.S. healthcare.”

A no-holds-barred article by Matt Taibbi in Rolling Stone.

A more detailed primer on the Shona Holmes story.