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Question Period: Digging out of the health care hole

Public health care iconoclast Dr. David Gratzer argues that public health care is inherently wasteful

Mark Milke - December 4, 2006

Americans and Canadians are over-insured for medical services and need RRSP-style health care savings accounts, argues Winnipeg-born and trained Dr. David Gratzer. Best known for his 1999 award-winning book on Canadian health care, Code Blue, Gratzer is widely quoted in publications such as The New England Journal of Medicine and The Canadian Medical Association Journal. Now a senior fellow at the Manhattan Institute, he has testified before U.S. congressional committees, pressing for health care reform in the U.S. The physician, who divides his time and practice between Toronto and New York, now has a new book out, The Cure: How Capitalism Can Save American Health Care. Gratzer spoke recently with Western Standard's Mark Milke.

WS: Your book almost seems to prefer American health care. You know the retort will be that Canada spends less on health care as a percentage of its economy than does the United States, thus, doesn't that prove our system is more efficient?

Dr. David Gratzer: I think it makes it cheaper; I don't know if it makes it more efficient. That seems to be the "Fiat" argument--that it's the best car in the world because it's the cheapest. In Canada, there's the soft bigotry of low expectations, where much of our health care policy is simply built on national pride and self-congratulations. The Canadian waiting lists have affected our quality of care in Canada, and it's evident from studies on cancer outcomes and . . . coronary artery disease, among others.

Your critics will point to the universality of Canadian health care as evidence of a better system.

The federal government's own statistics show 1.2 million Canadians are actively searching for a family doctor. Canadians are not getting the health care they want or deserve. I'm not advocating an end to all government involvement in health care, but it's a government-run system that cost-contains through rationing. This is a system that came out of [British] Lord William Beveridge's report released in, what, 1942, when penicillin was cutting-edge medicine, mental health care meant asylums, and polio was a death sentence. Today, medicine has dramatically changed; in Canada our health finances haven't particularly changed.

In The Cure, you argue that Canadians and Americans don't have too little health insurance, but, really, too much, courtesy of governments that insist on it.

I think there's great commonality between problems in Canada and in the United States. The core economic approach just doesn't work. If you look at health insurance as insurance, medicare is not insurance. Insurance is meant to protect you from unforeseen or unlikely events. You buy car insurance in case of a car accident. You hope you never have one, but if you do, you're covered. You don't buy car insurance for the possibility that your spouse tires of the colour and wants a new paint job, or the windshield wipers are no longer so good, or your gas tank is running on empty. If we did, car insurance would be much more expensive. Likewise in Canada, health-care insurance covers everything under the sun, from checkups to casts for your ankle.

Speaking of over-insurance, you note the example of New York state, where eligible Medicaid recipients can buy a month's supply of Viagra for just two dollars. How did New York figure out what constitutes a "month's supply"?

More articles by Mark Milke