It's no fun being the whipping boy for anti-government Republicans and Blue Dog Democrats.
For once, Canada is the subject of serious political discussion in Congress. It's just that it invariably involves Senator Mitch McConnell dishing up horror stories of Canadian-style, rationed health care.
As with any good whipping boy, the Americans' focus on what's wrong with the Canadian health-care system is really just meant to divert attention from what ails theirs. But if it takes unflattering U.S. exposure to spur reform here, maybe some good will come of all the "ugly truth about Canadian medicare" talk south of the border.
Unfortunately, Canadians and Americans share remarkably similar attitudes about health-care reform. They both want it - just as long as it doesn't involve them.
Ask Rowena Ventura. The 44-year-old part-time health-care worker in Cleveland has no health insurance herself. She has a disabled husband, can't afford to see a doctor about the lump on her left foot and just moved her sick mother in with her. But President Barack Obama's quest to extend health coverage to all Americans scares her. "You just can't ask any more of me. You just can't," she told The New York Times.
If those who would benefit most from public health care are skeptical, those with nothing obvious to gain from it are downright hostile. Few of them seem to realize that they're already paying for the 47 million Americans without health insurance and millions more with inadequate coverage.
The uninsured and underinsured overwhelm hospital emergency rooms. They're billed for the service, but rarely pay. Hospitals recover the cost by jacking up the fees they charge health insurers to care for those with coverage. The insurers pass that cost on to individuals or employers; the bosses recoup the sum by paying employees less than they would otherwise earn. This is just one reason why the U.S. health-care system is the world's most expensive - costing 16 per cent of gross domestic product - yet has a sadly checkered record to show for it.
Health-care costs in Canada are nearing 11 per cent of GDP, "cheap" by comparison. But on an age-adjusted basis, our system is a sinkhole. Japan has 50 per cent more seniors than Canada, yet spends a quarter less on health care - with better outcomes.
Within a decade and a half, the proportion of Canadians 65 and over will rise to 20 per cent. A decade later, a quarter of us will be among the Cocoon crowd. In 2006, it cost $1,832 per capita to provide health care for every Canadian from one year old to 64. It cost $9,967 to care for every person 65 and over. The era of health-care hyperinflation has just begun.
Everyone agrees that reform is critical. The Canadian Medical Association, the lobby group for the country's 80,000 doctors, has even made it the theme of its annual meeting this month. It's right there on the program cover: "Health Care Transformation: We can all do better."
For the doctors, it's not clear that "all" includes them. The CMA will unveil the results of a fact-finding mission to Europe to investigate reform there, from Denmark's downloading of chronic care onto municipalities to Britain's funding of hospitals based on the number of patients they treat.
But how Canada pays its doctors should be on the table, too. The current fee-for-service method - under which physicians bill provincial health plans for every individual procedure they perform - still dominates, even though it encourages unnecessary procedures, unwieldy paperwork and proven fraud.
Ontario has moved to pay some doctors (who volunteer) on a capitation basis - that is, based on the number of patients in their practice rather than the number of times they see them. But a recent study in the CMA Journal suggested that such doctors chose healthier patients who turned more often to hospital emergency wards for non-urgent matters. No savings there.
Quebec's move to pay some specialists significantly lower fees per service, in exchange for a base salary, has had better results. A recent study in the Journal of Health Economics showed that the doctors performed fewer services, but saw patients longer and devoted more time to teaching, suggesting "a potential quality-quantity substitution."
Some of the best U.S. hospitals, including the Mayo Clinic and the Cleveland Clinic, employ only salaried doctors working in interdisciplinary teams. So no doctor loses money by not treating a patient.
Still, the vast majority of U.S. doctors, like their Canadian counterparts, cling to the old fee-for-service model. And no government wants to take on the doctors lobby, not when Canadians trust their physicians so much more than their politicians.
Konrad Yakabuski