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Universal Health Care For Elephant, Mouse

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By GENE COSTAIN

Special to the Tribune

Published: January 24, 2009

Ben Jonson was a cantankerous, 17th century British dramatist who despised the early days of journalism because he thought it was overrun with propagandists and charlatans.

I'm no modern-day cynic, but the record of news coverage on universal health care has been rife with ideological cant and tall tales. In my view, journalists have formed a kind of parasitic osmosis with powerful interests that impairs robust debate.

The broad contours of the debate are well-known. The Republican thesis was often uttered by Newt Gingrich, who feverishly railed against the alleged horrors of Canada's "socialized medicine." Michael Moore took up the left-wing cudgel with his surprisingly touching documentary "Sicko" about the selective access to U.S. care.

My meager standing for wading in is that in the past 25 years I've lived half of that time in Canada and the other half here in the last Western refuge of commoditized medicine.

Some of the raw statistics about U.S. health care are startling when they are laid out in cold type. For instance, the American system one for which the world's rich hop jets to access all but disenfranchises 47 million Americans. The United States rates 37th in the world in terms of quality and system fairness, according to the World Health Organization, and Canada ranks 30th. If that isn't enough to chew on, the last free-market Republican presidential candidate candidly admitted the system was imploding.

The issue is complex, and we know more than a few well-heeled Canadians cross into the United States to get quicker care or superior technologies. In a country of America's size and wealth, that is bound to happen - it's a matter of scale. Another tidbit, the Organisation for Economic Co-operation and Development reports that Americans pay about $6,700 per capita for health care compared with $3,700 for Canadians.

You can count on this debate coming back in full force during the first years of the Obama regime.

I have been making mental notes on the accumulated fallacies and misnomers about the Canadian universal system. Your neighbor to the north has always been a great case study, because the country is a near mirror image of America on many levels.

My first memory of family struggle over medical bills was in 1962, when my mother was about to give birth to the last of seven kids. The single-payer system - in which all health care providers bill a single entity - was still a few years away. Just before she went into the hospital to deliver, I overheard an anxious conversation she had with my father about how they were going to pay the anticipated $300 hospital bill. My working-class father supported us on a salary of $55 a week. Within a few years, that financial anxiety vanished, and all they had to deal with was a small plastic card, with the added bonus of virtually no paper trail.

My move to America in 1996 meant facing a small pile of bureaucratic paper before starting my doctorate in Tennessee. During my adult life in Canada, a little card was my official point of contact with the health care bureaucracy. Forget about annoying co-pays, a new concept for me. The relative wonder of it all captured my imagination, and for years I've been monitoring debates about the issue in a vain search for balance, especially as it relates to some of the good things you don't hear about the Canadian system.

Let me frame this in a larger context. The late Canadian Prime Minister Pierre Trudeau said that living next door to America was like a mouse sleeping with an elephant. Canada has one-tenth of the U.S. population, and its citizens are largely resigned to (but secretly admire) the large American pachyderm. Despite the similarities, Americans have missed out on an honest depiction of what Canadians think about their system.

There is one key element in the Canadian story that Americans rarely hear about in their media. Polls show that Canadians would not trade their single-payer system for all the tea in Indonesia. Most Canadians say their health care is their most valued citizenship asset. That is not hyperbole: For years, Gallup polls have chronicled this high regard for the system. It makes you wonder why we don't often get this view here - after all, there are plenty of Canadians sunning themselves in these parts.

In Canada, no middle-class person ever declares bankruptcy because of medical bills, but in the land of the free and the home of the brave, tens of thousands go that heart-breaking route.

One of the most persistent challenges is that there are long waiting lines for some services in Canada; my experience is that both systems are virtually indistinguishable. An informal consensus of family and friends in Canada, including my aging mother, is that the medial service is good to great. I have honestly not heard of one major medical service horror story.

These wily parka wearers manage to live three years longer and have a lower infant mortality rate than in America. And Canadians pay about half per capita what Americans pay for their entire system. Part of it is no insurance giants or middlemen. There is one more vital reason that the system works well for Canadians.

One of the structural reasons for the relative success of Canada's system is that the political and ideological battles for the single-payer system were waged and won decades ago. America is now the only Western country to miss that boat, and with the powerful interests arrayed against a single-payer system, don't hold your breath waiting for it to happen here. The Canadian system also works well because it has been around 40 years and the Canadians demand it: Wise politicians tend to stay in office by keeping their fingers off health care.

Some critics of the Canadian system anecdotally compare it unfavorably to services available for a price in America. In my view, this is more a matter of scale because America dwarfs most countries in size and wealth. In some ways, that criticism of Canada is also unfair; after all, America is the richest country, and in a nation of this size, with its technological riches, it naturally will have a wider array of services than a country one-tenth of its size. It's like comparing good-sized apples with 10-pound watermelons.

But who is to blame for Americans not receiving these political, cultural and news representations? One reason is that journalists here are like reporters in other nations, they root around in their backyards for sources and social insight.

Many Americans want to do something about expanding this impoverished dialogue; one of them is Drew Altman of the Kaiser Foundation (not connected to health care giant Kaiser Permanente) who has hired eight journalists for that foundation's new Health News network. He and a few others are trying to put a finger in the dam. Considering the importance of these issues, Altman says there's a dire need for serious journalism and he wants his news agency to be a counterweight to all of the political spin and misinformation of the special interests that often dominate debate.

That news agency, the increased interest and dire needs are moving us in the right direction. If we can get reporters speaking truth to power and fanning out to talk to real people - even better.

As the debate returns this year, we may get a more expansive rendering of the story because everyone agrees the system is broken. But it won't happen unless more journalists, filmmakers and bloggers chip in with a more balanced rendering of this Byzantine story. It might make the cynical ghost of Ben Jonson happy.

91.2 percent

Number of Canadians who accessed routine care, 2001

3 to 4 weeks

Median waiting time for Canadians seeking specialized services, 2005

18.1 percent

Number of Americans younger than 65 covered by public health plans, 2006

66.5 percent

Number of Americans covered by private health insurance plans, 2006

43.3 million

Number of uninsured Americans younger than 65, 2006

Sources: Statistics Canada, Centers for Disease Control and Prevention

Gene Costain is a University of Tampa journalism professor.

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