Paul Krugman: Health Care Terror

So-called reforms in universal systems recently are resulting in increased co-pays and shifting of costs to individuals. The Canadian system has always been less extensive than many European systems in that most dental work, long term care, and drugs are not covered. However there are provincial add ons that provide some pharmacare but usually involving co-pays of some description. One significant feature of the Canada Health Act is that co-pays or user fees are not allowed but of course this does not apply to what provinces have added on such as pharmacare.

July 9, 2007 / New York TIMES
Op-Ed Columnist
Health Care Terror
By PAUL KRUGMAN

These days terrorism is the first refuge of scoundrels. So when
British authorities announced that a ring of Muslim doctors working
for the National Health Service was behind the recent failed bomb
plot, we should have known what was coming.

"National healthcare: Breeding ground for terror?" read the on-screen
headline, as the Fox News host Neil Cavuto and the commentator Jerry
Bowyer solemnly discussed how universal health care promotes
terrorism.

While this was crass even by the standards of Bush-era political
discourse, Fox was following in a long tradition. For more than 60
years, the medical-industrial complex and its political allies have
used scare tactics to prevent America from following its conscience
and making access to health care a right for all its citizens.

I say conscience, because the health care issue is, most of all, about
morality.

That's what we learn from the overwhelming response to Michael Moore's
"Sicko." Health care reformers should, by all means, address the
anxieties of middle-class Americans, their growing and justified fear
of finding themselves uninsured or having their insurers deny coverage
when they need it most. But reformers shouldn't focus only on
self-interest. They should also appeal to Americans' sense of decency
and humanity.

What outrages people who see "Sicko" is the sheer cruelty and
injustice of the American health care system — sick people who can't
pay their hospital bills literally dumped on the sidewalk, a child who
dies because an emergency room that isn't a participant in her
mother's health plan won't treat her, hard-working Americans driven
into humiliating poverty by medical bills.

"Sicko" is a powerful call to action — but don't count the defenders
of the status quo out. History shows that they're very good at fending
off reform by finding new ways to scare us.

These scare tactics have often included over-the-top claims about the
dangers of government insurance. "Sicko" plays part of a recording
Ronald Reagan once made for the American Medical Association, warning
that a proposed program of health insurance for the elderly — the
program now known as Medicare — would lead to totalitarianism.

Right now, by the way, Medicare — which did enormous good, without
leading to a dictatorship — is being undermined by privatization.

Mainly, though, the big-money interests with a stake in the present
system want you to believe that universal health care would lead to a
crushing tax burden and lousy medical care.

Now, every wealthy country except the United States already has some
form of universal care. Citizens of these countries pay extra taxes as
a result — but they make up for that through savings on insurance
premiums and out-of-pocket medical costs. The overall cost of health
care in countries with universal coverage is much lower than it is
here.

Meanwhile, every available indicator says that in terms of quality,
access to needed care and health outcomes, the U.S. health care system
does worse, not better, than other advanced countries — even Britain,
which spends only about 40 percent as much per person as we do.

Yes, Canadians wait longer than insured Americans for elective
surgery. But over all, the average Canadian's access to health care is
as good as that of the average insured American — and much better
than
that of uninsured Americans, many of whom never receive needed care at
all.

And the French manage to provide arguably the best health care in the
world, without significant waiting lists of any kind. There's a scene
in "Sicko" in which expatriate Americans in Paris praise the French
system. According to the hard data they're not romanticizing. It
really is that good.

All of which raises the question Mr. Moore asks at the beginning of
"Sicko": who are we?

"We have always known that heedless self-interest was bad morals; we
know now that it is bad economics." So declared F.D.R. in 1937, in
words that apply perfectly to health care today. This isn't one of
those cases where we face painful tradeoffs — here, doing the right
thing is also cost-efficient. Universal health care would save
thousands of American lives each year, while actually saving money.

So this is a test. The only things standing in the way of universal
health care are the fear-mongering and influence-buying of interest
groups. If we can't overcome those forces here, there's not much hope
for America's future.

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