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Canada vs. U.S. Health Care – “You Can’t Handle The Truth!”

Posted on | March 7, 2017 | 2 Comments

Mike Magee

In the 2008 classic movie, A Few Good Men, Jack Nicholson explodes under the relentless pressure of prosecutor Tom Cruise, and yells “You can’t handle the truth!” A careful critical examiner of the US health care dilemma in 2017, in the shadow of our neighbor to the north, might easily draw the same conclusion.

As we’ve seen in the prior three segments of this series, the US health system diverged sharply from the Canadian approach in 1947, 1957, 1965 and 1984. As our costs escalated out of control, uninsured numbers rose and performance lagged, leaders expended energy defending our system as “the best health care in the world”, and defamed the Canadians and others with unsubstantiated claims that they were piggy-backing on our system to cover their own weaknesses.

In contrast to our own penchant for opaqueness, complexity and tolerance of conflict of interest, the Canadians – while far from perfect – have attempted to continuously and responsibly evolve their system and have transparently exposed their strengths and weaknesses to the light of day. As a result, Canadians support their system in far greater proportions that do the Americans.

The fact that Trump and the Republican Congress have no real plan beyond repealing Obamacare, or that the Democrats and President Obama did not manage perfection while facing constant opposition over eight years, could lead many to believe that this whole mess is just too complicated to understand let alone fix.

But the pathway out, on the surface, is pretty clear. Everyone needs to be covered to share risk. The administration and choices need to be simple and clear so that the general public can understand and participate. Elements that add cost but not value must be eliminated. And accountability must be anchored by a strategic long term plan, committed national and regional leadership, and a vision and value proposition.

What is increasingly apparent, and the truth we refuse to acknowledge, is that the problem is not the system specifically, but rather our culture and values which have been hijacked. Beginning just after WWII, but accelerating in the 1970’s and 1980’s, cross-sector leaders in energy, finance, health care and the military coordinated a deliberate attempt to seize control of power in industry, non-profits and government in pursuit of career advancement, profits, and power. These “complexes”  focused on dismantling checks and balances, and managed, in a twisted dialogue among themselves, to simultaneously chase government subsidies while excoriating government intervention.

As multi-nationals expanded so did large profit-chasing, entrepreneurial “non-profits” who diligently avoided taxes while aiding and abetting the rapid expansion of poverty and income disparity. Between 1960 and 2015, “non-profits” percentage of the GDP grew three fold with 1.6 million “non-profits” now employing 10% of all American workers. As boundaries blurred, associations of associations evolved to allow coordination of government relations strategies. Attendants at their conventions were multi-sector true believers in the free-market and profits. Their cover? The claim that entrepreneurial zeal and imagineering would, through discovery, solve all of America’s problems. And those problems were growing at an alarming rate, fueled by organizations like the U.S. Chamber of Congress which spent over $1 billion lobbying in the past decade.

With President Reagan in power, enabling legislation opened the floodgates. New laws, like the 1980 Bayh-Dole Act, actively incentivized government-industry-academic non-profit collusion. In its wake, community needs faded as corporations became persons and free speech morphed into free spending. This was an opaque and deliberate hostile takeover, executed by experts with patience and near unlimited resources. Bill Moyer’s notion of “public action for public good” became a quaint euphemism for old-fashioned, out-of-touch PBS dreamers.

What felt like progress was finally revealed for what it was in the 2008 financial crisis. But this near societal collapse at the hands of free-market zealots surprisingly only tightened the embrace between the state and the private sector. The 2010 Citizen United and 2014 McCutcheon decisions solidified an American world of opaque complexes, integrated cross-sector, conflicted and cooperative power elite who continued to shift the distribution of wealth to their own kind as everyday Americans became more and more disillusioned.

So the truth we can’t handle is that, unlike Canada, we have let our highest ideals slip away from us, and we’re not quite sure how to right this ship. And yet, until we acknowledge that truth, we can’t address U.S. health care which now encompasses nearly 1/5 of our economy.

This is a nation where business and government are now largely indistinguishable from one another. This is a nation where checks and balances have melted in the face of a half century of deliberate assault creating a world absent countervailing self-correcting instincts. This is a world that for the chosen few celebrates individualism in the extreme and survival of the financially fittest, an environment where free-market ideologies routinely fail us, but then are re-subsidized and reinforced and recast by compromised insiders.

Under these conditions, we should not be surprised that the Trump administration and Congressional Republicans are now presenting health policy solutions that would increase complexity, further burden the poor and disadvantaged, and add cost at every turn.

As one commentator concluded, “Today health care in America is dominated by the medical-industrial complex…a mix of intimately interacting for-profit businesses, non-profit enterprises, and government agencies…every part of it is completely dependent on government spending and completely integrated with public-sector institutions and programs. Huge non-profit enterprises play a central role not just in the actual administration of health services but also in the generation of profits for the for-profit sector….the American health care system is both built on and reinforces an individualistic, free market ideology that simultaneous embraces government subsidization and scorns government intervention.”

That’s the truth we can’t handle. But we must. Next time – how we’ll fix it.

Comments

2 Responses to “Canada vs. U.S. Health Care – “You Can’t Handle The Truth!””

  1. Tim Parrish
    March 8th, 2017 @ 9:40 pm

    Do you send all members of Congress your healthcommentary.org? Just curious.

  2. Mike Magee
    March 9th, 2017 @ 8:04 am

    No, Tim unless they subscribe. But would welcome you and others to share liberally!

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