Canada and the Health Care Debate

A week on holiday in Canada turned me into a target of sorts, constantly trying to dodge sharply pointed questions about the U.S. health care debate. Suffice it to say that our neighbors to the North feel like pawns in our political wars, and they don't like it one bit. What's more, I think they have a point.

What has Canadians up in arms is what they see as an all-out effort to attack their national health care system with lies and disinformation. They mostly blame Republicans, but Democrats get heat for not coming to the rescue, and we all get accused of being selfish and narrow minded.

If you've been paying any attention at all, you know that the health plan being pushed by Obama and congressional Democrats has been roundly criticized as an attempt -- front door or back -- at establishing a national health care plan akin to the one in Canada. To show what a terrible idea that is, the opponents claims that Canadians are dying in droves while waiting for simple but life-saving procedures. Horror stories abound, each one worse than the last, and always with the warning that this is what Americans can look forward to if the Democrats get their way.

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Never mind that Democrats are pushing nothing close to Canada's national single-payer plan, insisting they want to build on the employer-based system that exists and that no one will be forced to switch plans. But some Democrats do want a public option to compete with private plans, and Republicans claim that would be the camel's nose under the tent. That's a hard sell. If Medicare and Medicaid, huge federal programs, weren't the nose under the tent, there's no reason to think a public option will be.

Canadians are furious that Americans feel a need to attack their system to make a point. More important, they think the criticism is unfair. Canadian aren't shy about admitting their system isn't perfect. There are waits, sometimes long ones, in some parts of the country. And there have been a few horror stories.

But they're quick to point out that there are far more horror stories in the U.S, where about 50 million people have no insurance and many more are seriously underinsured and don't know it until it turns out to be too late. Even if these underinsured can still manage to get care, they often face financial ruin.

The difference, Canadians say, is simple. They are willing to put up with a good, albeit not perfect, system for the sake of the general good. They say Americans, on the other hand, back insurance for everyone, at least in principle, but those of us with money and the kind of jobs that come with insurance aren't willing to make sacrifices to help the rest (that's the selfish part).

There's some truth to this and it goes to the heart of the political challenge facing Obama and others who favor universal coverage. Polls do, indeed, show most Americans want to extend coverage, but the polls also show that most of us like the coverage we have and don't want an overhaul to make it less desirable. Satisfying both goals is tough when money is lacking. Something has to give. And the question is whether we will all accept a little more risk in order to help the less fortunate.

Canadians insist they're not trying to tell us what to do. They know that the free enterprise system means the rich are always going to do better than the poor. If that's our choice, so be it. But they'd prefer we keep them out of our internal squabbles.