Recently, the Canadian Supreme Court overturned a provincial law in Quebec banning private health insurance. What the ruling basically said was that it was unconstitutional to ban private health insurance when and where the mandatory participation public system was so significantly underfunded as to create waiting lists that can cause deaths. By implication, properly fund the existing system and there is no problem regarding its constitutionality.

Critics of Canada’s approach to providing universal, comprehensive and affordable health care for all of its citizens have pointed to this ruling as further evidence of the superiority of the free market based, incoherent “non-system” that we have here in the United States. Spinning the Canadian ruling in this manner obfuscates the all-important distinction between organization and funding.

In order to stay clear-headed about what is being debated, it is imperative to distinguish between whether or not a healthcare system is organized in a fair and just manner and whether or not it is funded adequately. The problem with the Canadian system is not the system as it is organized. It is the low level of funding (a political decision). The problem with our system is the system itself, the massively cost-inefficient manner in which it is organized (also a political decision), not the funding of our system.

The United States’ system spends twice as much per capita on health care as does the Canadian system. Double the spending per capita in the Canadian system and their Supreme Court will have nothing to say about the constitutionality of their system.

While we spend twice per capita, because of the way in which our system is organized, we experience an ever-increasing number of uninsured, now totaling 45 million. The National Academy of Science has recently estimated that about 18,000 Americans die unnecessarily as a direct result of being uninsured. What do you think the Canadian Supreme Court would have to say about the constitutionality of our system as judged by their standards?

The Canadian people have implemented a national health insurance system designed to insure that everybody is in and nobody is out. In spite of decades of opportunity for the private health insurance sector in this country to find a way to provide for comprehensive (not bare bones high deductible) coverage, as measured either by universality of coverage or cost containment our system has been a catastrophic failure.

It seems obvious that after decades of trying with religious zeal, to apply the principles of free market competition to the health care sector as an unquestioned and unquestionable good, we have to honestly look at the outcome. Free markets are designed to distribute goods and services according to price, the ability to pay. They do a masterful job of doing so. Thus, they always create winners and losers according to the ability to pay. With regard to televisions and automobiles this seems fair and just. However, when applied to health care services, the losers lose their well-being or as noted earlier if uninsured, maybe their lives.

We can continue to worship at the altar of free market ideology in the health care sector and continue to recite the mantra that if competition hasn’t worked for the last couple of decades then we just need to find new ways to apply more of it. Or we can look at all the data which overwhelmingly concludes that competition in the health care sector increases, not decreases costs due to wasteful duplication of administrative overhead, marketing costs and often technology.

Medicare and Medicaid exist today only because the private health insurance sector abandoned the elderly and the poor while screaming that they could not be expected to insure people who had such a great need to use their health insurance. Why have health insurance if it cannot insure against catastrophic financial loss for those who wind up needing it the most? In the late 1950’s less than 15% of the elderly had any health insurance and thus the government had to step in to do what free market competition failed to do in this country in the health care sector.

So don’t get taken in by “zombie arguments”. These are arguments that long ago should have died due to a lack of evidence, reason or rationality but cannot be killed due to the vested interests that continue to promote them in order to profit from keeping the current health care system in place. Instead, dare to touch the third rail of health care reform policy debate. Ask yourself, what added value do over 1500 private sector insurance companies provide to our health care system when we still have 45 million uninsured, and an additional approximately 45 million underinsured?

Why is this so? Private sector health insurance companies have long ago abandoned their original purpose and value to our society by spreading risk across a group and now spend our premium dollars screening new business in order to avoid risk. The easiest way to make a profit in the health insurance industry is to refuse to insure those most likely to use their insurance. This is a major contributor to the dilemma of the unconscionable number of uninsured and underinsured that we have in this country today.

Then ask yourself what kind of country do you want to live in? One in which the ability to receive adequate health care services is a right, a public good like an education, police or fire protection; or a privilege distributed by the competitive free market according to the ability to pay? And if you cannot afford to pay spiraling out of control health care insurance premiums or have an undesirable pre-existing condition which renders you ineligible for coverage, a private sector health insurance leper, then what?

No health care system is perfect. The tragedy of our current health care system is that tens of millions of people in this country go without health care services, suffer and some die needlessly due to a lack of health insurance. Simultaneously we spend almost twice as much per person on health care as every other industrialized country on the planet. More than enough money is being spent in our current system to cover everyone according to both the Congressional Budget Office and the General Accounting Office. However, we lack the political will to reorganize our system to achieve universal coverage. Thus, critics should be careful of throwing stones at a somewhat underfunded Canadian universal health care system that provides comprehensive services for all. Is our free market based approach really superior as judged either by the fair and just manner it serves all citizens or by its efficient expenditure of scarce resources for the benefit of all?

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