Second Opinion: Oh, Canada - Defending Single-payer Healthcare

October 1, 2008

Dermatologist Steven Fenichel on the wisdom of single-payer healthcare.


After reading your July-August article “Voting for Change: Is True Reform Finally at Hand This Election Year?” I object to your omission of any discussion of what is arguably the best solution for American healthcare: a single-payer national heath insurance program, or NHI, similar to the system already in place in Canada.

As a physician with firsthand experience practicing in both countries (I did my residency in Toronto) - and since, distressingly, your article did not address single-payer healthcare at all - allow me to explain how this system works.

The Canadian system is financed mainly by a progressive income tax. The delivery of Canadian healthcare is very much a private enterprise; it is not “socialized” medicine, as many of its critics charge. A Canadian physician is paid only when caring for his patients. This is very different from the socialized British system, where physicians are paid whether or not they give care.

Regardless, would these same critics of socialized medicine attempt to undo government funding for our police and fire protection on the grounds that these services, when funded publicly, amount to “socialism”?

But perhaps one would argue that our current system is preferable to a single-payer one because a Canadian-style system is too expensive. The American public can’t afford to fund everyone’s healthcare, can it?

Well, consider that the Organization for Economic Cooperation and Development (OECD) recently reported that U.S. public healthcare spending per-capita is already greater than that of any other nation: $3,600 spent per-capita, compared to second-place Canada, whose taxpayers spent $3,100.

But in Canada, that amount covered every Canadian. Americans, on the other hand, spent an additional $2,500 out of their own pockets; the total U.S. per-capita spending was $6,100, according to the OECD. And yet despite this massive public/private expenditure of $2 trillion, 45 million Americans had no health insurance.

The money spent on the American healthcare system shows little concern for cost efficiency. Private insurers have administrative costs ranging from 20 percent to 30 percent. This contrasts with Medicare, which operates with a 3 percent overhead. In Canada, where insurance companies are barred, only 1 percent goes to operating costs; the rest goes to paying healthcare providers for actual patient care.

One reason private insurers have such high overhead is the staggering amount some of them pay their executives. William McGuire, the former CEO of UnitedHealth Group, had to give back more than $600 million in ill-gotten compensation under a deal struck with the Securities and Exchange Commission in December. But he gets to keep about $800 million worth of stock compensation. The CEOs of Cigna, Aetna, and Humana pocketed about $46 million combined in 2006.

Article 25 of the United Nations’ 1948 Universal Declaration of Human Rights states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or lack of livelihood in circumstances beyond his control.” More succinctly, Dr. Martin Luther King stated: “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”

The Canadian government and her people view healthcare as a human right. But here in America, far from being a human right, healthcare is treated more like a marketplace commodity.

Only when the chokehold of big money contributions by insurance companies and Big Pharma is broken will healthcare for all become a reality. What could be more critical for real homeland security than knowing that your family, neighbors, and countrymen will never have to fear losing their home or going bankrupt because of medical bills?

My organization, Physicians for a National Health Program, says: “We’ve tried and failed with incremental reforms for 100 years. The time has come for single-payer national health insurance, an improved Medicare for all.”

Steven Fenichel is a dermatologist in Ocean City, N.J., and a member of Physicians for a National Health Program, a single-payer healthcare advocacy group.

This article originally appeared in the October 2008 issue of Physicians Practice.