Healthcare from the Perspective of a Dual Citizen

I am a dual citizen of both the United States and Canada, who grew up on the Canadian side of the border. Between my mother who is a physical therapist, and members of my family who suffer from chronic illness, I have had much exposure to the Canadian healthcare system. In my early twenties, I moved down to the U.S. and had the opportunity to work in the U.S. healthcare system, specializing in matters pertaining to insurance coverage. While I am usually prepared to share my personal opinions on just about anything, I do feel as though I have a unique perspective on the issues currently being debated in the United States.

At present, no one can talk definitely about the “facts” and “myths” of healthcare reform—the bill is still being written. The current House and Senate versions of the bill are extremely different, and it is difficult to predict how these two pieces of legislation will be reconciled. Moreover, President Obama has been quite ambiguous about many of the details pertaining to his initiative. In the wake of this uncertainty, the popular debate surrounding healthcare reform has focused on the merits and disadvantages of public healthcare.

Although I acknowledge its shortcomings, I personally prefer the U.S. healthcare system to that of Canada. The U.S. system is state of the art, fast, service-oriented, and people have a lot of choice when choosing a provider. In Canada, wait times are significantly longer, there are far fewer providers, and visiting your local hospital can be like going to the DMV. That being said, the system has always sufficed for my friends and family, and most Canadians are happy with their care. In both systems, unique circumstances can lead to a denial of coverage for certain treatments. Similarly, in both systems, the individual can file an appeal and subsequently go to court if their appeal is rejected. In my experience, denial of coverage is far more common in the U.S. system than the Canadian—though most U.S. insurers will eventually pay after some coercion.

All factors considered, I DO NOT believe that a public system would be a “good fit” for the United States. Why? Right now 85% of Americans are insured and are receiving some of the best medical care in the world. Moreover, polls indicate that the vast majority of Americans are happy with the care they receive. Private healthcare is also a thriving industry in the U.S. (16% of the GDP) that provides thousands of Americans with good jobs. At present, Obama is not proposing a public single-payer healthcare system. However, many Americans—including myself—believe that the proposed “government competitor” is a thinly-veiled attempt to create an entity that could evolve into such a system. Many in the Democratic Party, including Obama himself, have declared their preference for single-payer healthcare.

At present, all indications suggest that the “public option” will not be able to pass the U.S. Senate. To this end, I believe it is time for Americans and their elected officials to “move on” and begin focusing their efforts on other aspects of healthcare reform. We should start by implemented some simple changes that will significantly drive costs down for everyone:

1. Increase competition within the pharmaceutical market by allowing the importation of generic prescription drugs from Canada and Europe.
   
2. Increase competition in the insurance industry by allowing insurance companies to operate across state lines, and allow small business to collectively bargain for the same insurance rates that large employers and unions receive.
   
3. Increase opportunities for individuals to purchase insurance by encouraging the formation of group policies through churches, local clubs, professional organizations, and co-ops.
   
4. Reform malpractice law to lower malpractice premiums and decrease the enormous amount of unnecessary testing that doctors perform to protect themselves from frivolous lawsuits.

Then create a targeted solution to help those in our country who still cannot afford insurance. There are several simple ways to do this:

1. We already have a program for those who cannot afford health insurance—it’s called Medicaid. However, many people who cannot afford private insurance earn too much to quality. One simple solution is to raise the income restriction on this program.
   
2. Subsidize the private insurance premiums of individuals based on their Adjusted Gross Income—the higher an individual’s AGI, the lower the subsidy and vice versa. This is my personal preference. Many uninsured individuals can afford to pay part, but not all the monthly premiums for the insurance plan offered by their employer. This approach would provide financial assistance based on need, discourage employees from quitting their job to receive Medicaid, and avoid the government having to assume full financial responsibility for the health care of these individuals.

Needless to say, all of the above suggestions would require careful legislation to ensure effectiveness and avoid abuse. However, I think they are good starting points that would receive broad bipartisan support and have a significant impact.

As a Republican libertarian who believes in free market principles, I would certainly prefer to not need forms of subsidization. Long term, I would very much like to see policy changes that would permit everyone working a full-time job to be able to purchase private insurance without any assistance. But this “correction” would undoubtedly take time, and in the here and now it is evident that there are hardworking Americans who cannot afford healthcare. Ultimately, there is a time and place for compassion to supersede the ideals of free market doctrine. However, the deficit is real and very dangerous to the future of our country. If Americans are committed to ensuring that all citizens have healthcare, they must make some hard choices about which government services are most important, and how much tax they are willing to pay to keep them.