Former governor of Vermont and chairman of the Democratic party Howard Dean, not surprisingly, endorses President Obama’s desire for a public health-plan option. He has been a supporter of a single-payer health-care system for years, and celebrating the idea as a stepping stone to a fully government-run system.
Dean is also a medical doctor, but his fervid support of a more politicized health-care system puts him in a distinct minority among physicians. The American Medical Association, broadly representative and hardly hard-line, came out decisively against the public option earlier this month.
There is much discussion in the administration and Congress about the public option and what it will mean for the health care of Americans. Everyone agrees that the goal is to achieve affordable, accessible, quality health care for all of us. The question is: How do we achieve the goal?
There are two visions for achieving this goal. One focuses on patient-centered solutions where doctors and patients are put in charge of their health care. The other vision focuses on increasing the role of government in our system. This is the vision of the president and Howard Dean. They want to take over the 53 percent of the system that government does not already control. In other words, they support “Medicare for All.”
One of the key planks of President Obama’s reform is the option of a public plan as a supposed path to universal coverage and lower costs. The public plan, based on Medicare rules, would offer an alternative to private insurance coverage. The private plans and the public plan will be housed in a new National Insurance Exchange. The government will impose heavy regulations such as “community rating” (where everyone pays the same premium) and “guaranteed issue” (no one can be denied coverage) on all plans in the exchange. The government plan, which does not have to make a profit, after all, will be priced cheaper than the private plans and, as a result, the private insurers will be “crowded out” and we will be on the road to a Canadian-style “Medicare for All” system.
Costs will not be reduced, however, when more and more people sign up for the government plan. The Lewin Group predicts that 119 million people out of about 160 million who currently have employer-based insurance will be moved to the public plan.
Today, the U.S. is spending about 17 percent of GDP on health care, and the president and others have said it is too much. However, when people think health care is “free” or inexpensive, they will use a lot more of it and costs will increase. Then, the government will have to set a global budget and care will be rationed. Dr. Dean and Mr. Obama fully understand this and, in fact, are counting on it, though they will try not to admit it.
In Canada, costs are kept under control because of a global budget set by the government where the share of GDP spent on health care is about 10 percent. However, the demand for health care is much greater and as a result, care is rationed, there are long waiting lists for treatment, and patients suffer from a lack of access to the latest technological innovations.
If we follow this course, Americans will face the same rationed care and long waiting lists. We will not have universal access to health care and costs will be very high. Madam Chief Justice Beverly McLachlin of the Canadian Supreme Court said in a ruling in June 2005 that the ban on private health care in Quebec was illegal because of the long waiting lists. She remarked, “Access to a waiting list is not access to health care.”
Howard Dean and President Obama will have reached their dream of a government-run health care system for all. Only then will former presidential candidate Dean unleash his victory scream. But the American people will then no longer enjoy the best health-care system in the world. Canadians have an escape valve. When they are on a long waiting list for urgent care, they come to the United States and pay out of pocket for their care. Where will we as patients go when we are denied care?
— Sally C. Pipes is president and CEO of the Pacific Research Institute. Her latest book is The Top Ten Myths of American Health Care: A Citizen’s Guide.