The good folks at The Fraser Institute recently put out an interesting bet, right here, on the Huffington Post. After publishing their latest instalment of international health care systems, the authors seem sold on travel as a means of enlightenment. If only Canadians could get an airplane ticket and visit another country, notably a European nation, they would come to see that what has set back Canadian health is nothing more than an aversion to "upfront fees, private insurance and private delivery."
Presented with the opportunity to pick from any of the health systems the world has to offer, who in the right mind would choose Canada's backward single-payer model after reading their post? Turns out a country did have the opportunity the choose. That country was Taiwan, and the person who headed the task force was Harvard economist, William Hsiao. His interview in the New York Times below:
Q. What was your assignment as head of this task force?
A. We had to design a national health insurance plan for Taiwan, based on international experience. Government officials wanted to understand how other advanced countries fund and organize health care and learn from their successes and failures, so I made a study of the systems in six high-income countries -- the United States, the U.K., Germany, France, Canada and Japan.
Q. And what was your conclusion at the end of this study?
A. We adopted a single-payer system along the Canadian lines. I did not invent it. I'm just in the transfer-of-knowledge business.
Q. Why did you choose the Canadian model?
A. Canada has a single-payer system with universal insurance coverage. It offers people free choice of doctors and hospitals, and it has competition on the delivery side between public and private hospitals. The quality of health services is very high, and people were very satisfied with the system from the 1980s through the mid-1990s.
Professor Hsiao goes on to note that Canadian dissatisfaction arose when budgets tightened and wait times lengthened. Logically then, Mike Milke and Nadeem Esmail plead for us not to forget the Netherlands- their shining example of a country that was able to cut through the Gordian Knot of wait times. The authors fail to mention that since the health reforms of 2006, Dutch health care spending has been spiralling upwards (second only to the United States in per capita terms) and 'that no day passes without the financial sustainability of their health system being on the news'.
The authors also make much ado about choice in Switzerland. Why not? They have for all transported us to the sophisticated land of Jean-Jacques Rousseau. Here is how, Uwe Reinhardt, a child of Europe, student of Canada and celebrated James Madison Professor of Political Economy at Princeton concludes on the Dutch and Swiss health care systems:
Both systems slouch in the direction of what we think of as "regulated or managed competition" in the US. Allowing citizens a choice among tightly regulated health insurers provides the illusion of competition, but it is just that, an illusion.
It is an illusion because the prices at which insurers buy health care for the insured are typically out of the insurer's control.
Furthermore, there is virtually no ability to exclude providers with relatively low quality of services.
But perhaps there is value in the eyes of citizens in a system that provides the illusion that it is not a government-run health insurance system.
When it comes to Sweden, the valuable lessons drawn by the Fraser group were in part a "a greater reliance on competition and private ownership". A paper by Elizabeth Bradley, however, underscores the shortcomings in fractioning health care from the total umbrella of social spending. She found that industrialized countries that spent more on other social services (such as education, housing and old age support) in relation to conventional health care performed better on a whole host of outcomes. Unfortunately, there may be more to "Swedenizing" health outcomes than user fees or efficiency gains alone.
Surprisingly, perhaps, was the Fraser Institute's decision not to include an American road trip on this summer vacation. Maybe a case of been there, done that. Or when the Business Roundtable (a self-identified conservative group of American CEOs) laments a critical value gap relative to other OECD countries, that probably makes for a quiet drive.
I can only imagine that this globe trotting exercise must be a lot of fun, if not disingenuous. For those of us who may never get to visit these countries, there are even Fraser memes. It's a bit of a shame that an organization with such resources (yet with serious questions surrounding its non-partisan status), would rather cherry pick under the guise of research for investor interests. Even more regrettable is when they try to cast others as blindly wed to the status quo or just landlocked on innovation, while discarding the efforts for serious reform on issues such ascoordinated care and pharmacare back here at home. And when it comes to the value and redistributive power of Medicare, we remain quite a ways from the Dark Ages.
This summer, though, I think we should all take up the Fraser Institute's wager of getting to our favourite destination-albeit with one caveat- committing to evidence as our tour guide while there.