January 28, 2009
How the U.S. measures up to Canada’s health care system

The Worldfocus signature story Canada’s hospitals cut the paperwork, emphasize care explores Canada’s health care system.

In this extended interview, Uwe Reinhardt, a leading adviser on health care economics and professor of political economy at Princeton University, compares the Canadian and American health care systems. Reinhardt criticizes the U.S. health care culture and expresses his optimism about the Obama administration.

As part of Worldfocus’ Health of Nations signature series, correspondent Edie Magnus conducted this half-hour interview with Uwe Reinhardt on January 20, 2008, the day of President Barack Obama’s inauguration.

Reinhardt blogs at The New York Times’ “Economix” blog. A transcript of the interview is below the video.

Edie Magnus: What do you think of Canada’s national health care system?

Uwe Reinhardt: I think it’s a high performer in the following sense: Canadians spend half as much per capita on health care as we do in the U.S., and yet if you go up there, sure you have to wait for some MRI image or for some heart procedures, but overall the system produces very good health outcomes. People are more satisfied there with their care than Americans are with theirs. So if you diagnosed it like a physician, you’d give that system an A and you’d have a hard time giving more than a B to ours.

Edie Magnus: Why do you think it is that most Americans don’t see it that way?

Uwe Reinhardt: Most Americans, first of all, are bombarded with propaganda. You don’t know how many think tanks are paid by certain industry — insurance, drug, organized medicine — to feed out negative stories about the Canadian health system. They do of course have mishaps, as do we, but there is a whole industry collecting them and beaming them out here. That is one.

Secondly, people are always more comfortable culturally with whatever they have than with some other system.

Third, people imagine having the worst illness, and if you are really very sick in the U.S., you generally do have more hope than in any other country if you are very sick, particularly if you are well insured. But if you sort of live the average life of Americans and have a Canadian system, they have better primary care, easier access to it. They would never go bankrupt over health care, because they don’t do that up there. They would realize what they are missing here.

Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

Edie Magnus: When we pay a medical bill, how much of that bill goes to these kinds of administrative costs?

Uwe Reinhardt: Well, in general what you’ll find in our official statistics, we’re spending 7 percent on administration, but that only accounts for the insurers’ administrative costs and that includes Medicaid, which burns only two percent of its money throughput on administration. On the other hand, Medicare and Medicaid both cost the hospitals administrative costs that are booked as medical care, but it’s really administrative costs.

Steffie Woolhandler and David Himmelstein of Harvard did a study comparing Canada and the U.S. looking at what it costs employers, providers, doctors and hospitals and the insurance mechanism and compared Canada and the US, and they found that we in 1999, spent $300 billion on administration for all these three functions, and that was about 24 percent of national health spending there, but they say it was actually 31 percent because of the fraction of spending that they could actually identify and link to administrative costs. So they came to 31. So it’s somewhere between 25 and 30 percent that goes for administration and it doesn’t even include the patients’ time of billing. Anyone who has had anyone really sick in their family knows how much time you spend haggling over the bills and they have none of that in these systems.

Edie Magnus: I know that there’s some dispute about all those numbers, about what percentage of our spending the administrative costs represent, but you have said that with what America could be saving in administrative costs, that it could completely fund universal health care for all Americans.

Uwe Reinhardt: Oh yes, I’m totally convinced of that.

Edie Magnus: How is that possible?

Uwe Reinhardt: Well for one, many insurance companies have a nomenclature that when they issue a bill, when the hospital issues a bill, the insurance company can’t understand it. So there are entities, enterprises that translate that from the insurance companies’ nomenclature into the hospitals’ nomenclature and vice versa.

Edie Magnus: Alright, but tell us, I’m not sure my mother would understand this explanation…

Well I mean, just imagine a hospital sees a horse and it says I code that as H-O-R-S-E, and the insurance company uses French for that, C-H-E-V-A-L, and now the computers, they can’t mesh this unless there is a translator in between who says “Oh, horse for that insurance company means cheval.”

Edie Magnus: And this goes on every day between hospitals and insurers?

Uwe Reinhardt: This goes on every day. They don’t understand the way that they “code” things. So I hope Obama will come and say, “You guys had 30 years to figure it out and obviously you couldn’t. I’ll figure it out for you. Here’s a nomenclature. You must use it, and if you don’t, you don’t get paid, period.”

Edie Magnus: Can you talk about that and how it contributes to our administrative headaches?

Uwe Reinhardt: Well, I once did a dumb thing: I asked an insurance executive “What do you pay in New Jersey for a colonoscopy?”

And he just laughed at me and said, “What a silly question. There is no price for a colonoscopy. We have a different price for every hospital. And for the same hospital, we might have six prices depending on the insurance product, is it an HMO, etc.”

So I said, “This is mad. How many could there be?”

He says, “There could be 30, 40 for us, but then with Aetna, they could have another 30, and everyone has a different contract, so a hospital might receive 60, 80,100 different prices for a colonoscopy, depending on which insurance company and what contract it is. So when you say ‘What are the private market prices?’ there is no price.”

And I said, “Well how, when you have consumer-directed health care, where people are supposed to shop around, what are you going to tell them?”

And he said, “We can’t, really. What would you tell them?”

There is no real price, and every price has been negotiated and haggled over. So imagine what it costs compared to a system where a government negotiates with a physician association. Here’s the fee schedule, and that’s it, and everyone uses the same fee schedule. You can put that into a computer. You have a little card like an American Express card. The price list is already there. You swipe it through, the doctor keys what he or she did and here’s your bill. Well here you have to look at what contract was it and the coding turns out to be wrong, and the bill isn’t clean.

I know an entrepreneur who is a multi-zillionaire, and I said, “What did you do before to be so rich?”

And he said, “I can write clean bills for doctors.”

And I said, “What is your product?”

He said, “My computer knows every managed care contract in this area, hundreds and hundreds of them, and if the doctor tells me the product, the insurance contract, and I know what the doctor did, my machine can type a bill that the doctor never could get right, and submit it to insurance, and we get paid 30, 40 days faster and more accurately, and we split – the doctor doesn’t pay me – we just split the extra money and make the doctor.

I have another friend in Princeton. He gets all of these bills, his wife was ill and he says, “I don’t do the claiming, there is a company that specializes in claiming for you. You just turn over all your stuff and they submit the bills.” So you now have companies that help doctors bill, and then you have companies that help patients pay these bills.

There was a company, I think it was a subsidiary of United, that wrote software to help hospitals bill better and get every dime they could from insurance companies and sold other software to help insurance companies that helps them defend themselves against the doctors’ billing. It’s laughable. It’s hard to explain it without laughing, but we do.

I tell you, if you gave a keg or two of beer to six Princeton undergraduates and said “Drink till you fall over, and then design something really mischievous,” they couldn’t come up with what we adults have come up with being sober, or seeming to be sober. This is a totally insane system.

Edie Magnus: And if we could save those administrative dollars, is there an amount that you think we would save?

Uwe Reinhardt: I think we should be able to cut it in half, what we spend. That would still be more than most other nations spend, but we should use other nations as a benchmark and say, “They can do it for this, so let’s at least cut ours in half.” We would still be spending more than these other nations, but Obama should simply set a goal. Like Kennedy said we’ll go to the moon in so many years, Obama said in so many years we’re going to save that much on administration and I’m going to put someone in charge of it and we’re going to keep books.

Edie Magnus: And to the person who hears that and thinks, “Yeah, but you know, sometime I’m going to be in a jam, I’m going to want some care, and if we go to this other system it might not be available to me…“

Uwe Reinhardt: Mind you, I’m not advocating the Canadian system. It works well for them. I’m not saying we need to have this, but I’m saying whatever we have, if you have government saying there is going to be one computer system, that doesn’t mean one manufacturer, but whatever they make has to interoperable. Whatever language they use has to be the same. We’re going to speak English, so to speak. One nomenclature. You have to call this operation by one code, no matter who it is. There have to be common billing forms. Not every company has its own incomprehensible explanation of benefits, you know. Every hospital bill is just a living insult, when you actually get one as a patient. There has to be something people understand.

And it turns out that after giving it to the industry for 30 years to straighten out and they didn’t, it will have to be the Obama government that says, “Guys we’re going to rig this for you. You can have all the machines you want, all the software. You can buy it from whomever, but it has to obey these rules.”

Just like electric plugs. No matter who makes the stuff, there has to be one plug. But for some reason, the electric industry has been able to settle on one plug. The Cell phone industry has still not settled on one charger. You have to have chargers that vary by thing. The earplugs for the cell phones are different depending on the model. This is nonsense. You give the industry time and if you can’t figure it out, kids, we’ll figure it out for you.

Edie Magnus: Why do you think it is that Canadians are, in large percentages, so much more satisfied with their health care system?

Uwe Reinhardt: I think, for one, you don’t have this constant fear when you go to bed, if whether tomorrow you have health insurance. You know you will. You almost feel it when you go to the airport and you ask these people. That’s not something they worry about. Here you ask any waitress “Are you insured?” Half the time they’re not even insured. If they have it, they don’t know if they have it tomorrow.

One of the interesting things is 250 finance people have been laid off. That industry is going to be small in the future. They’re not going to have health insurance. I think a lot of those people who hated the Canadian system and socialized medicine and so on will discover it might not be a bad idea to have a safety net for some things — education for your kids, health care when you get sick, justice when you are in the courts — and for some reason to think that rugged individualism can cope with this is nonsense.

Edie Magnus: Would national health care work in the United States?

Uwe Reinhardt: Yes.

Edie Magnus: Would Canada’s plan work in the United States?

Uwe Reinhardt: Well, it works. We have a Canadian health plan in America. It’s called Medicare. It works. Don’t tell me medicare doesn’t work. Tell that to the elderly. One way to test it is to say “Let’s take it away.”

Edie Magnus: But it is running out of money.

Uwe Reinhardt: No, it’s not, no way. It’s not running out of money. I mean we still have a surplus in that account. At some point in the future it will run out of money unless we raise premiums, that is, payroll contributions. We’ll have to do this. But the idea that that it runs out of money and General Motors, which is almost bankrupt, doesn’t, tell me about who is running out of money. GM is living on taxpayers’ blood transfusions. Why? Over health care. They ran out of money, not Medicare. I think this is a myth.

Of course, if you keep payroll tax where it is, it will run out money. But the elderly could contribute more to it and they will. Payroll taxes can be raised a little bit. Higher income recipients probably have to contribute more to it. These are really solvable problems, but Medicare is a Canadian style heath care system.

Edie Magnus: If it seems such long odds that we will ever have a single payer system for all of the United States, what’s the point of comparing us to Canada?

Uwe Reinhardt: You have to have benchmarks. You can’t just say, “We’re unique therefore we can simply spend the whole GDP on health care.” You do have to ask how does Canada do it. How does Germany do it? How does Taiwan do it? How do other nations do it? And if you think you are way out of line, if you’re spending twice as much as the people who are culturally similar to us — their income is somewhat lower but not that much lower than ours, we’re really one North America — you’d really have to ask yourself. Now mind you, you could also look within the US. Utah and Oregon are much, much cheaper than Massachusetts or Miami. So you could look at Canada, but you could also look within the U.S. where you have these variations. But why should you not be able to learn from other countries, particularly when you run a huge single payer system, and Obama is going to put in another single payer system, this public “Medicare light” plan for people under 65? So yeah, we can learn something from Canada. They can learn a lot from us.

Edie Magnus: If you don’t have all the free market forces in health care, would you have as much competition, innovation?

Uwe Reinhardt: Innovation, in the pharmaceutical products and devices, maybe not, because the money wouldn’t be as generous. I mean, we’ve had an unbelievable generous… I mean, if you spend twice as much, you will fund a lot of innovation with it and you’ll fund a lot of waste with it, both. We’ve had both, waste galore and innovation galore. You might have less innovation, but I think a good science policy could contravene that.

In other words, you could fund and support drug companies, not through the price of the drugs, but by giving them grants, government grants. We need a drug for Alzheimer’s, and like the defense contractors — we need a jet that can do these missions -– we need a drug that does Alzheimers. And the government is going to lend research contracts to the pharma. industry, and you get your cost reimbursed, but the winner who has the best product — you have a fly by like you do with jets — and the winner gets the contract. So there are other ways of funding devices and of funding drugs and other innovations than just through the price, you know? We have to think of other ways to do this. There is no reason why we couldn’t have a flourishing innovative high tech industry, even if we stepped down on prices, which the private sector will too.

You look at what the Bush administration has done with drugs, turning the Medicare Part D to private industry, and what did they do? They persuaded millions of the elderly to switch out of brand name drugs into generics, totally devastating the drug industry. This wasn’t done by the government. It was done by private enterprise, by private, competitive enterprise.

Edie Magnus: You’ve sort of alluded to this, but are you optimistic that America, starting today with a new president, can get it right with health care?

Uwe Reinhardt: Well, “get it right…” that’s partly an ideological thing, but get it done in this sense… You could say there are certain requirements we have of our health system. An American family where a member is stricken with cancer shouldn’t go broke. That’s easy to achieve. Do you have to do it the Canadian way? No. We can do it our way, even if it’s a little pricier.

A requirement that when somebody thinks they have major illness they should able to get access and not have to worry about whether they can pay the bill. There are certain things you can write down that health systems should achieve, and you say “We’re going to go there our own way. We’re not going to copy Germany, we’re not going to copy Canada, but we want to end at the same point,” and that is that you can go to bed and not worry about losing your health insurance when you lose your job. And those things are achievable, and the Obama plan, if you look at it, has all that in it. It says we keep the system we have, but we put some new things in, like this government program for the people under 65 such that when you lose your job, you don’t lose your family’s insurance, and we can do this. I’m optimistic.

Now a year ago I would have said we’ll never do it, because we’re a bunch of spoiled children.

Edie Magnus: Now we’ve been slapped upside the head…

Uwe Reinhardt: We’ve been slapped upside the head, and in fact people are talking about it, T-shirts, “Grow up America.” I’ve always told my wife “I never understood Americans till our kids became teenagers, and then I understood this whole culture.” It’s a teenage culture. That’s all I really know about Americans, people who want the best health care, they don’t want to pay high premiums, don’t want to pay taxes – this is juvenile. And I think Obama’s inauguration speech was basically very serious, saying, “You know, we have to grow up. We now have to grow up.” I’m much more hopeful now that children in distress will rediscover the virtue of mothers.

In fact I wrote a piece, “I hate Mom and the Government Too,” and I say that it’s amazing, given how teenagers curse mothers, that mothers somehow, that evolution didn’t do away with them, that the reason evolution kept them there is that when the kids get in trouble they run to Mom. And look at what happens now. GM driving overnight, begging mom, that is, government, to help them. The bankers of New York, you know, who used to sit in their golf carts cursing government regulation, running to Washington, to Mom, “Please help us.” And I think, like teenagers at some point discover the virtue of moms who can give them help, the American people will discover, “You know what, there are good things about government, like there are about moms. When you get in trouble they’re really cool to have around.” And I think we’re at that moment, and that is why I believe health reform has a hope. We could literally get this done this year.

Edie Magnus: And just to be clear, Obama’s plan is not national health care, right? It’s not a single payer system…

Uwe Reinhardt: If you mean a nationalized health care with a single…

Edie Magnus: Yes. Government funded, government run, the taxpayers pay, everyone gets it…

Uwe Reinhardt: No. It’s not that. It says you keep whatever you have as long as they’ll give it to you, but if they don’t give it to you anymore, Mom is here for you. You can go out there. You can ride your bike, but if you get hurt you can come here. If the private sector has not sold you a private health insurance policy, we will.

I can’t see what could be fairer that to say to everyone you can play all these games, but there are certain rules. You have to, in the end, cover people. And if you, the private health insurance agency, are not able to do it, we can do it. The government can do it.

And we’ll discover this more and more. Our banking system, you’d be surprised what that’ll look like. It will be highly regulated, like a utility. It’ll be small. It’ll do what it was supposed to do rather than being a gambling casino, which is what it became. You know, they too behaved like teenagers. In fact, this piece I just wrote, it’s actually only for the student newspaper, “I Hate Mom and the Government Too,” the Financial Times printed it, the German Zeit printed it, because everyone understood that that’s what it really was. We had all become teenagers, irresponsible, naughty, and so on, and I think we will become a much better nation because of this calamity.




USA’s system is broke but it has nothing to do with capitalism and everything to do with our government. The reason costs are out of control in America is the cost and risks to practice as a Doctor are tied to a legal system run amok. The malpractice costs, over-regulation costs and liability costs to bring doctors, medical products and procedurs and drugs to the market are overwhelming. Governement run plans don’t have these costs as they just cap their liabilities by proclimation. US system is proven to be light years superior to the rest of the world for innovation in drugs and treatment but the corrupt relationships and influence that big business and lawyers have is the primary problem to solve. Corruption is in all governments but the US system is more fragile and negativlehy affected by corruption at the top.
We can give up the fight and become more socialists like our Canadian neighbors and friends across the pond but it will result in less innovation and less world wealth and world oppurtunity to be shared than we have now. Would it be worth it?


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We have to be selfish to think that our health care system is better that Canada where every citizen is covered. In the U.S. more than 50% do not have access to health care; and there is no wait because they don’t even have that choice (like Canadian do).


I believe that some of the health-care options from Canada are very good ideas. The fact that some people are on here arguing about which is better like its a contest between the countries instead of a serious problem basically proves the fact that America is a immature nation who is acting like a bunch of spoiled teenagers. Which actually makes sense because we are a very young nation in comparison to some others. All the layoffs that just happened and continue to happen all over the country are causing people to lose their medical insurance and if they have children it makes it even worse say their child has health problems they get dropped because of layoffs and then the child CAN NOT be re-insured because of preexisting conditions it’s ridiculous and a poorly constructed system that is based on the greed of everyone involved. Whether it be the companies or the people who run to the emergency rooms for every little thing wrong with them because they can. I am from America I was born here raised here and I’ll most likely die here I am the mother of 4 my husband works his butt of and I run a home based business while going to college and the last thing I need to worry about is whether I can pay my medical bills. My daughter just started having seizures at the beginning of the year its documented in her charts now if my husband changes jobs the insurance companies call that a preexisting condition and she is basically not able to be insured how is that a fair and just system?????


Americans health care system is most def. better. The waiting list to recieve help is absurd! no one shoud have to wait that long for a treatment.


[…] an interview with Worldfocus.org, Dr. Uwe Reinhardt, James Madison Professor of Political Economy at Princeton University and a […]


[…] the U.S. measures up to Canada


[…] the U.S. measures up to Canada


Sorry. I actually meant to say, go here: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html


The ultimate purpose of a health care system is to keep you alive and well. On that basis, to compare the US system to the Canadian system, is absurd. The Canadian system is so far ahead of the US system any comparison is asinine. A more meaningful comparison would be between the US system and that of Wallis and Fatuna, an overseas French colony in the Pacific. Go here: https://www.cia.gov/library/publications/the-world-factbook/geos/wf.html


I have friends with business, that insure their employees, fully themselves. One business pays $110 a month for Kaiser Medical, for employees and themselves. There only costs are a $10 co-payment.
Another, employer insure 4 employees with Blue Cross, for $140 per month.
If someone has pre-conditions, the costs are more
and the cost go up for children, and wife. Often, the wife is covered by her own companies.
I have free Kaiser from my employer, and the service is great, and they are always improve service.
People with no health care, can go to the public hospital, it does it cover, the 40 million uninsured. We have about 10 million illegals, that use this service for babies.
In San Francisco, about 1.2 billion dollars, in property taxes, goes to support our public hospital.
A lot of young people gamble, and choose not to carry health insurance.
Other people, with houses, and money choose not to carry health insurance.
Old people over 65 are covered by medicare. Ex-military people have veterans coverage.
We have junkies, homeless, illegals, un-insured,
people that are taken care of by the public
hospitals. In other words, everyone is covered here in the U.S.A., in case of serious illness.
In San Francisco, we fund the public hospital with 1.2 billion in taxes.
People, that gamble, not to have insurance, will be billed for the costs. If the go bankrupt, their house can’t be taken, but a percentage of their salary can be taken.
There is a saying, that there are big lies, little lies, and statistics. Anyway, it’ hard to compare apples, and oranges.
I read a study in our news, from McGill University, that Canadian health expenses are more expensive, if adjusted.
If you operate, a private clinic in the U.S.A., you have to pay: taxes on profits, property taxes, rent, mal-practice insurance (up to $300,000 for a surgeon),employee taxes, costs of medical school, employees,advertisements,employee medical insurance,phone, and so on. It’s had to compare this with, socialized medicine where in Cuba doctors are paid 75 dollars a month, and they pay no rent, or France’s system, where doctors can be paid $75,000 a year, for a 35 hour week..
If we go to another system, a lot of tax dollars paid by private medical clinic, or private insurers, will not be collected too.
Anyway, medical service here is more complicated, but my Kaiser plan is excellent. If we do not like our service, we can transfer to another plan. My employer, offers, about 6 other plans.
The Obama plan, is over 1,000 pages long, and no one knows what’s in the plan yet, even Obama. We need to debate, and debate te issue, instead of passing a bad bill. My friends support it, even though, they refuse to send their children to public schools, and I doubt, they have studied this proposal.
Do we abandon a system that covers 260 million people, to give some different kind of coverage for 40 million uninsured, now covered by our public health system? How do we keep costs down? How do we keep up and pay for research, and development of new drugs? Will a government system work, with no balance sheet, of costs, and expenses to worry about, and dependent,on union election support, keep raising higher, and higher taxes, until are taxes are 75% of income, like Denmark? We are worried about the government controlling 30% of the economy, instead of 15%. We already have to work until June to pay our taxes. We are worried a step-by-step 1984.


Carl’s story is sad, but it’s hard to draw any conclusions from it without more details. Maybe the cancer was so far advanced that it was untreatable.My mother-in-law also died of cancer in Canada, but it was at such an advanced stage that no treatment would have made any difference. Maybe the heart conditions were also so advanced that immediate by-pass wasn’t called for. We also don’t know the time period; Canada, especially Ontario, has instituted a number of changes to speed up care. This is one of the strengths of the Canadian system; it responds to problems in the system. I’m an American who lived in Canada for 28 years, and I and my family always received prompt, excellent healthcare there. I’d choose that system any day over what we have in the U.S.


The U.S.A. the most powerfull nation on earth can not take good care of it’s oun people you must be jocking how can this be ?! How can we clame to be so powerfull and free but we as a people can not have the freedom of a happy and healthy life where the government cares for the people some people may call this socialism I call it Freedom and Justice with equality for all this is what it is to be a true American this is what the american dream is all about!!!


The question that many americans with health coverage are not asking themselve is that once they get a terminal illness an use all their sick days. They also loose coverage unless they can keep paying for coverage. In this case I would prefer the Canadian system over the US system which require loosing home and any little saving you have.


As Mr. Reinhardt says, in essence, the ultimate U.S. problem is that there is huge administrative waste resulting in too little bang for the health care buck. While it’s tempting to blame certain segments of the industry or lobbyists/politicians, in the end it is a failure of the free enterprise model to “compete” its way to an efficient delivery system. That’s probably because health coverage was never sold to individuals and families, but rather furnished through employers due to the historical anomaly of wage controls during WWII that led to such non-wage benefits as health coverage. The anomaly stayed after the war ended, and individuals never had a meaningful opportunity to make, and pay for, their own coverage choices. Employers had to choose for them, choosing a one-size-fits-all for their employees, and paying hugely for the privilege. Employees took the path of least resistance by accepting what they got, and over-utilizing more expensive drugs, procedures, etc. since the were “alreqady paid for”, i.e., overconsumption of services, adding enormous additional cost but little additional health welfare. Meanwhile providers have controlled the information flow, so nothing became more efficient, just more profitable for the coverage sales organizations. The most efficient system always will be one in which individual consumers make informed choices among lower or higher cost alternatives where they are impacted by the cost, so they make higher-cost choices because they are worth the cost. Our system probably is too broken to get to such a place from where we are now, so unfortunately the government will have to set up a framework that best approximates what the collective decision-making of consumers might have wrought.


Germany lost two wars…but the Germans and european never lost their health insurance when they lost their job,nor lose their home when they lose the job or get sick.
I believe the richest country in the world should have insurance for every citicen.


Points well taken from both sides. Now, WorldFocus, how about some more world focus?
Please tell us how other countries with nationalized health care do…i.e. Germany, Japan, France, Brazil. Regarding the expensive treatments in the US, there is a growing trend to go overseas for certain surgeries and treatments, especially to Asia. So, this trend may increase and it may make it easier for us to provide basic coverage for all. In all the discussions, this is overlooked. It sure seems like people today go to the doctor or emergency room for basic ailments and the medical professionals play along with this and bill insurance for various reasons…so they won’t be sued for malpractice.
Another aspect of our costly system is the “office consultations” that most doctors do.
Often, these visits could be done by the doctor reviewing the files in his/her office without the patient there, then deciding on the treatment and scheduling it. Too often, a patient has to sit in a waiting room for a long time, only to go into an examining room and then seeing the doctor looking at the file/charts for the first time….
and prescribing drugs, of course, without so much a test. Has anyone looked at Humana’s approach? They seem to have many answers to our system. How about a report about them?….and on Massachusetts, doing universal health care there, implemented by a Republican governor, no less, in a bipartisan effort. It’s frightening to change our system as we have so many innovations. Yet, have we become too dependent on someone else and a drug for our inner strength and healing?


It seems that all the opposition to single-payer health care can do is lie, offer propaganda, distortion and none of the truth for why single-payer health care is good for all of us. If the private insurance industry cannot do the job they should get out of the business. We should not suffer because they are failing. Peoples health, welfare and needs are far more important than keeping private insurance in business. They have failed to deliver to too many and only deliver to the few who can pay the exorbitant costs they ask.


We only have to answer one question: Why can the richest country of the world not afford a national health care system if all of Europe can?

Reinhardt is very knowledgeable – is anybody listening?

Alexa Fleckenstein M.D., physician, author.


My two Aunts from Canada Died a year apart from each other waiting for a heart bypass. My Uncle
who had cancer was told they would keep him pain
free!But no treatment. He was 66 years old.
So much for your health system.


USMLE does not control docs, the docs who cannot pass the test to. Each state has licensing requirements, as does Canada. IMO, the test and standards are tougher for non Canadians in Canada than the US. I know, many a Canadian born doc and nurse are now in the US.
US trained docs are often not allowed into Canada. That is controlling the pool. The US does not have the shortage Canada does. Stop the stupid comparasions to the health care systems. There is no comparasion. THe US is far better. My mom and other familiy members were on US medicare or medicaid, No wait lists, no delays, but quality care compared to my own bad experiences, plural in two regions of Ontario. To many docs in Canada will nto allow nurses or techs to do what they do in the US and elsewhere. To many docs in Canada illegaly charge cash for services. To many docs in Canada are busy on this board that board and research and assisting in surgeries when a good trained nurse could do that job, thus creating even more shortages of any services.

Go to http://www.ahrq.gov http://www.medlineplus.gov http://www.iom.org and on and on and on
How much many and time is wasted on silly comparasions when these docs should be doing direct care and wasting money!


It is my understanding that Uwe Reinhardt was/is council to AHRQ which looks at health care quality and safety. This over-arching issue was not really addressed in the interview in any explicit way.

Implicitly, the administrative quagmire, touched upon, contributes to the deterioration of quality and safety. But the practices of doctors and allied health staff have to be such that preventable errors are prevented and positive outcomes as a result of intervention are achievable for the patients’ quality of life. Ways of ascertaining this requires a level transparency the medical establishment is not inclined to permit. Said establishment is to whom the government/mom needs to read the riot act.


[…] 29, 2009 by Will Shetterly How the U.S. measures up to Canada’s health care system | Worldfocus Edie Magnus: What do you think of Canada’s national health care […]


Excellent critique of the US health care. It is a shame that doctors are deliberately excluded from practicing through manipulated mechanicism like USMLE in order to create shortage and control prices and eliminating the free market dynamics that would control and bring down the cost of health care.
Why is it that Americans are force to pay an exorbitant price for pharmaceuticals by citing safety concerns and preventing import of drugs from oversea by the consumers ( who can not afford to pay the local prices ) when the drugs dispensed at the pharmacy often come from overseas anywhere? We are been deprived of the basic right to medical care.

Mom the government is suppose to be there when we need help but when a person really needs help the system rejects them. Thus a small problem becomes a big problem and increases the cost a thousand fold. It is moronic to claim that mom the government is there to help when in fact it is a facade ( an illusion). The 50 million and growing number of uninsured people screams for immediate change. A universal health care system which provides basic health care coverage should be mandated. It will definitely help lower cost through early and timely intervention. No doctors should be wasting their talents, knowledge and skills when millions are without medical care. Those who can pay may upgrade to private care with better opportunities for selection but the baseline coverage must be in place.

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