Thursday evening, I attended a screening of The Healthcare Movie, a new documentary exploring the divergence of the Canadian and American healthcare systems over the past half century. Documentaries like Sicko do rightly point out America's inferior system- both in financial sustainability and quality of care. The important aspect missing from Sicko is history. Why does the United States not have the same healthcare setup as its economic equals? Why have so many politicians, from Ted Kennedy to Teddy Roosevelt, failed?
There has been historical opposition from the American Medical Association and in the last fifty years, private insurance companies. The famous Ronald Reagan Speaks Out Against Socialized Medicine (video) was part of an AMA campaign. Since the second Red Scare, connecting universal health insurance with the Soviet Union (or more recently, just saying "socialism" a couple dozen times) has been an effective method of stopping both universal coverage, as well as the initial, much stronger drafts of Medicare, Medicaid, and the Affordable Care Act.
In the last gladiatorial contest charitably called a 'debate', the insurance lobby spent $102.4 million. This helped not only kill the public option (thus not really changing all that much in the long run), but also attacked things like the Medical Loss Ratio, which cut into profit margins. Non-profit healthcare companies have been hustled out of the debate because they can't practice price discrimination- price discrimination of course being how any sort of private insurance operates. Thus their market share has been engulfed. The ACA's effect on private health insurance companies is to be seen, but it seems unrealistic that the MLR and other measures will drive them all out of business.
The story in Canada in 1962 was not much different. When Tommy Douglas, premier of Saskatchewan, proposed the measure it caused a huge firestorm. When it actually was implemented there was a 23 day strike of the province's doctors- in which doctor 'scabs' were brought in from Great Britain and other countries, while the population at large began setting up community health clinics for them. Eventually the doctors broke.
In the end, there was not a massive salary cut for doctors. In fact, nothing changed in the way doctors practiced- they could have their own practice, work with other doctors, work at a hospital- whatever they wished. And the big thing sold them (and brought me new perspective) was a simple fact:
Under a single-payer system, doctors do not have to spend time and effort getting their money.
In American medical practice, there is a huge billing component for every doctor. Someone needs to work through a multitude of insurance companies, each with a multitude of plans. Not every client can pay, or pay on time.
Now turn all those clients (500-2,000 for a private practice doctor) into one client, who is really good at paying on time. Suddenly, compensation is much easier. Doctor pay has been increasing and keeping ahead of inflation, so this is the cherry on top.
Douglas and the democratic socialists in Saskatchewan didn't achieve their goals easily. It took two major things to succeed:
1. A true bully pulpit, not just by the executive, but by thousands of people who educate themselves, turn their knowledge into terms that are not only understandable, but arouse a sense of social justice.
2. A complete disregard for your political future. Private health insurance will not go away quietly. Nor will you be able to convince everyone when the system does not exist yet. If you're looking to keep your elected office, or use this as a stepping stone, you may not be right for the fight.
It is exciting to be getting involved in the fight for single-payer in my home state of California. Healthcare for All, along with other organizations, including the state chapter of Physicians for a National Health Program. Single-payer has been on the precipice of reality for decade now- twice being vetoed by Governor Schwarzenegger, and more recently dying in the Senate due to Democratic abstentions and two votes against the bill.
Tommy Douglas and his allies didn't ever achieve a federal health insurance program- rather their model became adopted by all the other provinces, with strong assistance from federal Parliament. Single-payer on the federal level is, unfortunately, a distant prospect. But Vermont has led the way with a bold, if incomplete, single-payer system. Once waivers to the ACA become available in 2014, much of the federal money sent to Vermont (or hopefully, California) can be used to form a truly unified and world-class system.
It's time for a second healthcare battle. It's time to go all the way. It's time for single-payer.