Monday, March 8, 2010

Oh, Canada!

I was lucky enough to sit at dinner tonight with a group of Canadians, including a very talented woman who works in the Canadian health care system.
A few interesting questions and comments:
"Why do Americans think we don't have MRIs in Canada? We've got all the technology you have!"
"Why do Americans think we don't get to choose our own doctors in Canada? Who tells you this stuff?"
"Why do Americans think it's ok to be the richest country in the world and leave 30 or 40 million of your own people without health care or health insurance?"
The questions weren't antagonistic. Or hostile.
They were asked in the spirit of genuine concern. Concern for the mis-perceptions that continue to cloud the US understanding of how health care actually works in Canada, and concern for a system in the US that the Canadians genuinely think is, well, unthinkable.
Here's what we came to agree on.
Canada's system treats everyone equally. Rich and poor alike. This is, perhaps, fair, but only guarantees that wealthy Canadians game the system.
America's system has incredible highs--if you're wealthy--and incredible lows--if you're poor.
Both systems would benefit from meeting somewhere in the middle: letting wealthy people pay more for faster access to health care, or better quality health care, if they want it, while guaranteeing at least a standard of health care for all, even the poorest citizens.
Kind of like Germany, it turns out, where, once you reach a certain level of wealth, you have to move into a private system, and your higher costs go to subsidize the care of the poorest citizens. The wealthy get what they want, and they have to pay for it. The poor get what they need, and while it isn't as good or fast or accessible as what they wealthy get, it is provided to them as a public good.
Oh, Canada!
There's a lot to be learned on both sides when we sit down to talk as friends!

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