Disclaimer, I'm breaking the rules of the Original Poster since I'm American, but I also have more experience on this subject than most.

In America, there is no question that money will buy you better health care.

I'm Canadian, so i too benefit from our system of universal coverage. My mother was also a nurse, and my wife is a nurse. I also worked 15 years in Canadian hospitals, including 10 years in downtown Toronto.

I am pleased with our system, overall, although as with health care in many Western nations with aging populations and declining government funding, our system has been under stress for some time, with too few nurses and doctors (both of which often move to the US for higher-paying full time jobs with lucrative signing bonuses, etc), too many part-time staff, longer waiting times, etc.

In closing, our system is not perfect, but it takes care of us, and it is a natural fit for our culture and mindset as Canadians. We are not afraid of a bit of socialism -- indeed, we embrace it, and the word is not a 'bad' word here, as it was in your recent US election.

Right now in Washington, the biggest resistance to the Obama plan are private insurers, who feel they won't be able to compete with a public option. One Democrat stated that she didn't care about the financial viability of the insurers, she cared about getting Americans health care.

“[Canada and Great Britain] don’t have the appreciation of life, as we do in our society, evidently. A lot of people are gonna die. This ‘government option’ that’s being touted as this panacea — the savior of allowing people to have quality health care at an affordable price — is gonna kill people.”

— Congressman Paul Broun, in a July 10 http://mediamattersaction.org/blog/200907100007 - statement on the floor of the House

Any comments from our Canadian or British friends on this one?

Medicare versus insurers

I notice from comments that a fair number of readers think that Medicare has had runaway costs. What you need to ask is, runaway compared to what?

Here’s the raw fact, from the http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf - National Health Expenditure data : since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%. The rise in Medicare costs is just part of the overall rise in health care spending. And in fact Medicare spending has lagged private spending: if insurance premiums had risen “only” as much as Medicare spending, they’d be 1/3 lower than they are.

I completed an MBA in healthcare administration a few months ago, and work in the healthcare systems industry (I only mention this to indicate that hopefully my thoughts are somewhat based on objective information).  While I’m not a doctor or healthcare provider, nearly every doctor, nurse or technician I know seems to agree that our current model in the U.S. is not sustainable; and I’m willing to believe them considering the annual per capita cost of healthcare in this country is increasing faster than any other industry (including energy). 

Someone mentioned earlier that one problem with “socialized” medicine (i.e., a universal, single-payer system) is that people will “abuse” it; for example, going to the hospital for trivial conditions.  It seems to me our current system that leaves 47,000,000 people uninsured yet at the same time requires hospitals to treat people who show up in the emergency room is more fraught with abuse; especially considering 1) ER care is far more expensive than outpatient primary care; and 2) their conditions are more often than not far more advanced (and thus require more extensive and expensive treatment) than if they would have had access to preventive or at least primary corrective care.  And in reality the whole ‘redistribution’ argument doesn’t hold much water since hospitals simply pass on the costs incurred in treating uninsured patients (as well as those who don’t pay and those whose insurance underpays) to the rest of their patients in the form of higher rates anyway.  The reason the ‘list price’ of a splinter removal is $1,200 (an exaggeration, granted) is that the healthcare provider has already factored in their losses for treating uninsured patients, underpayments from Medicare and the like, and a percentage of uncollectable charges into that price so that they will (hopefully) cover their costs for the year overall.  So really we’re all paying for each other’s healthcare expenses anyway, we choose not to see it that way. (source HHS.gov)

The ‘government’ essentially controls much of healthcare anyway through interstate commerce laws as well as through policies enforced under Medicare that establish fair pricing for procedures that even most private insurance companies base their reimbursement and coverage policies on as well.  The federal government even decides for the most part where hospitals will exist and how many beds they will have.  It’s interesting to me that some of the areas where we’ve seen people up in arms in town-hall meetings with their congressmen are regions served by critical-access hospitals, similar in concept to the older county public hospital concept where the federal government has established special rules, subsidies and reimbursement policies designed to keep those facilities open even though they operate at a loss, just to ensure those populations are served.

And as for public funding of healthcare, nearly half of all spending on healthcare in the U.S. today comes from publically-funded sources (Medicare, Medicaid, SCHIP, Indian Health Service, DoD hospitals, VA, workmen’s comp, OEO); and another 40% comes from what someone earlier pointed out are essentially socialized sources anyway (i.e., health insurance) which in nearly all cases is subsidized by employers or government agencies.  So while all of that money eventually comes out of all out pockets in one form or another, virtually all the money spent on healthcare today gets allocated based on decisions of some bureaucrat – the difference is simply whether that person works for a faceless corporation interested in profit or a faceless government troll interested in policy.  Again as someone already pointed out, at least one of those I have some options of removing from office if their decisions if they fail to serve my needs.

For me the real question here isn’t one of fiscal policy or politics or civil rights though.  The real question is whether we as an American society want to entrust the single most important aspect of our lives to the free market.  We decided long ago that primary and secondary education was too important to entrust to corporations, which is why nearly the entire country operates public schools versus for-profit ones and all of us are entitled to a ‘free’ education.  Same goes for sanitation (i.e., sewage and drinking water).  Same goes for oversight of construction including commercial building, roads and in many places even parks.

If anyone really wants to dive deeper on the subject I would strongly recommend Senator Tom Daschle’s book where he presents his proposal of a national health board, similar to the federal reserve board that would be staffed with industry experts and headed by an independent chairman to set healthcare policy.  Daschle believes this is the only type of structure that can work effectively since it removes policy from politics, meaning independent experts take policymaking for healthcare away from Congress and the White House.

Critical: What We Can Do About the Health-Care Crisis (Paperback) by Tom Daschle - http://www.amazon.com/Critical-What-About-Health-Care-Crisis/dp/0312561644/ref=sr_1_1?ie=UTF8&qid=1250100481&sr=8-1 -