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The Canadian Rationing Canard

It’s looking increasingly clear that the right’s strategy for attacking the Obama administration’s health care proposals is to attack totally made-up ideas that have nothing to do with what Obama has proposed. Steve Benen fills us in:

There’s a project, for example, called “Patients United Now,” organized by the same outfit that sponsored Sam “Joe the Plumber” Wurzelbacher’s anti-EFCA efforts. The group, Americans for Prosperity, has a new television ad featuring a Canadian woman who said she came to the United States to be treated for brain cancer, because in Canada, she would have had to wait six months to see a specialist, a delay that would have killed her.

To hear the woman tell it, Canada’s system is a dystopian nightmare, in which the government forces taxpayers to “wait a year for vital surgeries,” and bureaucrats restrict access to medicine and treatments. She concludes by telling the viewer, “Now Washington wants to bring Canadian-style healthcare to the U.S., but government should never come in between your family and your doctor.” She encourages Americans, “Don’t give up your rights.”

Jonathan Cohn has a good rundown of the basic falseness of this ad. But I think it’s worth zeroing-in on the specific issue here. The way Canadian healthcare works is basically that if you want to see a doctor, you go see a doctor and the government pays the bill. This is a “single-payer” system (with the government as the single payer) and it in no way resembles what Obama has proposed. But it is what they do in Canada. A system like this can either cost a ton of money (sort of like our Medicare) or else you can control the costs by giving the program an explicit budget and then rationing access to care. And in Canada, they essentially have opted for the latter route. Sometimes a person wants treatment but the government won’t pay.

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But why is it that in that instance a person would travel to the United States for health care? Obviously, the Canadian government won’t pay for that either. So if you’re going to have to pay privately, why do it in the USA? Why not just do it in Canada? Well, it turns out that in addition to its system of government-financed health insurance, Canada does a lot to curtail people’s ability to purchase health insurance and health care services privately. This is done for basically reasons of egalitarian ideology — they’re all in it together. But it’s also politically viable in part because the vast majority of Canadians live very close to the United States. So prosperous Canadians who are theoretically disadvantaged by this system can, in practice, take advantage of the American “safety valve” and go south of the border. This helps keep the Canadian ruleset politically sustainable.

But not only is Obama not proposing anything like Canada’s single-payer system, he’s really not proposing any restrictions on people’s ability to buy private health insurance. Much as Canadians have the option of going to America to buy health services, Americans will always have the option of going to America to buy health services. But for most Americans, buying health services is difficult because health care is expensive. Obama’s proposals are aimed at making it possible for more people to afford health care. If what you have instead is money burning a hole in your pocket that you desperately want to spend on health care, nobody is going to stop you.