Canada - Still Much Better Health System

When the Clinton administration tackled health care reform in 1993, Canada's national health care system—which operates without a private insurance industry—was held up as a model by progressives and a disaster by conservatives. The United States rejected any positive lessons from the Canadian single-payer model in 1993, and we are living with the results of that decision today.

...the cost gap between the United States and Canada has only widened since 1993, and per capita health care expenditures in the United States are now almost double those in Canada ($6,401 vs. $3,359). Canada's per capita health expenditures rose about 65% from 1993 to 2005, while costs in the United States rose by over 90%.

A Commonwealth Fund survey finds that, compared with adults in six other countries, "U.S. adults are most likely to go without health care because of the cost and more likely to say that the health care system needs to be rebuilt completely."

Ezra Klein: "Rudy Giuliani's case for the superiority of our "free market" health care system goes something like this: While on health insurance provided by New York state, he was treated, using a surgery developed by Europeans, for prostate cancer, a disease that most commonly afflicts those covered by the federal government's single-payer health care system."

Paul V. Dutton on the French health system:

the World Health Organization rated it the best in the world in 2001 because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country's population. The United States ranked 37.

The French system is also not inexpensive. At $3,500 per capita it is one of the most costly in Europe, yet that is still far less than the $6,100 per person in the United States.

An understanding of how France came to its healthcare system would be instructive in any renewed debate in the United States.

That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine." Virtually all physicians in France participate in the nation's public health insurance, Sécurité Sociale....

It's not uncommon to visit a French medical office and see no nonmedical personnel. What a concept. No back office army of billing specialists who do daily battle with insurers' arcane and constantly changing rules of payment.

Moreover, in contrast to Canada and Britain, there are no waiting lists for elective procedures and patients need not seek pre-authorizations. In other words, like in the United States, "rationing" is not a word that leaves the lips of hopeful politicians. How might the French case inform the US debate over healthcare reform?