Conservatives For Patients rights, the Swift Boat Health Smear Group headed by disgraced health executive Rick Scott, has released a new ad, and POLITICO, in turn, has penned another blog post presenting the advertisement.
In what can best be described as a marriage of Betsy McCaughey (the government intends to control what’s in your medicine cabinet!) and Sally Pipes (Canadian health care is coming!), the ad warns that the Federal Coordinating Council For Comparative Effectiveness Research was modeled “after the national board that controls Britain’s health system” to institute “government control over your health care choices.” Two doctors testify to the horrors of medicine in Great Britain and Canada, respectively:
SCOTT: “Deep inside the stimulus bill, Congress buried an innocent sounding board: the Federal Coordinating Council For Comparative Effectiveness Research. It’s not so innocent — it’s the first step in government control over your health care choices. This federal council is modeled after the national board that control’s Britain’s health system. Listen to Britain’s Dr. Karol Sikora about what happens to patients once the government takes over.”
DR. SIKORA (GB): “They’ll lose their own choice, completely…lose control of their own destiny within the medical system.” […]
DR. DAY (Canada) “Patients are languishing and suffering on wait lists, our own Supreme Court of Canada has stated that patients are actually dying as they wait for care…
Watch it:
Scared yet? Well, you shouldn’t be. As Media Matters Action Network explains here, and I’ve written here, here, and here, comparative effectiveness research will ensure that doctors and patients have access to information about treatment effectiveness without the filter of a drug industry representative. As Newt Gingrich explains, “today, only about 10 percent of all health care is based on evidence. That means that 90 percent of the care we receive is, basically, informed opinion. We need a rigorous, clear system to measure the costs, benefits and value of a given procedure, technology or drug.”
Most notably, Obama has rejected a British/Canadian-like single-payer reform and most policy makers are looking for a “uniquely American solution” that preserves the employer-sponsored system and creates a hybrid public-private partnership. In other words, American reforms would look a bit like the Swiss health system in which the government “leaves the provision of health care and health insurance in private hands” but creates a marketplace within which insurers can compete on price, and not avoid insuring the sickest patients.
But if we put the ad’s false comparison aside, CPR do raise two more important questions: 1) do the British and Canadian systems deliver inferior care, and 2) do these systems really ration care and restrict patient choice?
Britain has a single payer universal system funded by higher taxes. If you fall ill, you go to see your general practitioner who acts as a gate keeper to specialists. Waiting lists for non-essential care is a significant problem and patients do experience delays in receiving treatment. But are British patients worse off than Americans and “do they have a health care system that delivers worse outcomes?” Ezra Klein asked these questions back in December and concluded that “the answer to both is no”:
In the case of ill health, they’re actually in much better health than their American counterparts, though that’s a function of lifestyle more than hospital choice. And in the case of health outcomes, it sort of depends. You’re probably better off getting your breast cancer treated in America and getting your diabetes treated in Britain. In the aggregate, however, the evidence is fairly clear that the British are better off. Health researchers look at a measure called “amenable mortality,” which refers “to deaths from certain causes that should not occur in the presence of timely and effective health care.” In other words, deaths that are prevented by contact with the health care system.
The British government-financed model sounds like too much government for most Americans, and Obama’s proposal rejects the model. The same is true for Canada. The government finances the system through a Medicaid-like arrangement in which Canada’s 10 provinces and 2 territories jointly fund health care. Each province establishes provider reimbursement rates and physicians work in private practice and are paid on a fee-for-service basis. Everyone has access to care, but Canadians do wait longer for services than most Americans. As one study of waiting times for knee-replacement surgery in the United States and Ontario found, the median waiting time for an initial orthopedic consultation was two weeks in the United States and four weeks in Ontario. But while waiting times for initial orthopedic consultation and for knee-replacement surgery were longer in Ontario than in the United States, “overall satisfaction with surgery was similar,” the study concluded. Canadians also have longer life expectancy, lower infant mortality rates, and lower rates of obesity.
No health care system is perfect and the British and Canadian models present a litany of problems. But still, it is the United States that ranks last in all dimensions of a high performance health system: quality, access efficiency, equity, and healthy lives. Unfortunately, rather than explore the actual context of Obama’s reforms or try to discern what the world’s health care systems can teach us about health care reform, CPR simply magnifies the very real flaws of the Canadian and British systems to scare Americans into accepting a status quo that already rations care.
Update:
Ben Smith writes that the Wonk Room “is convinced, Media Matters-style, of a sinister nexus between CPR and POLITICO.” There is nothing sinister about it. CPR advertises on POLITICO and POLITICO promotes CPR ads. It’s a relationship of financial convenience. We’re just asking that POLITICO inform readers of the potential conflict of interest.
Update:
,During a conference call with reporters today, Sen. Chris Dodd (D-CT) said, health care reform “has to be an American plan, it’s not a Canadian plan or a British plan, or anybody else’s plan… we want to give people options.”[updat