Proponents of government-run health insurance choose to disregard the facts

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Appeared in The Mark

The saddest thing about the health care reform debate in both Canada and the United States is that those who advocate for government-run health insurance have no regard for the facts, and no apparent concern for the interests of patients. Bob Rae's misinformed commentary about the case of Shona Holmes is an example of this.

Ms. Holmes is an Ontario woman who traveled to the United States to receive medical treatment that she could not get at home without enduring a long and risky wait. Her experience is featured as a case study in the failure of government run health insurance and is at the centre of the current debate about health reform in the U.S.

Mr. Rae did not accurately present the facts of the Holmes case, characterizing her condition as a benign tumour. For those interested, the website of the Mayo Clinic where Holmes was treated has posted the details of her story.

Benign is in the eye of the beholder because Mayo Clinic doctors diagnosed Holmes as having a Rathke's cleft cyst (RCC). The clinic's website describes this as a rare condition in which a fluid-filled sac grows near the base of the brain and eventually can cause hormone and vision problems. According to the Mayo Clinic's version of events, by the time she first saw an American neurosurgeon, Holmes had lost half the vision in her right eye and 25 per cent in her left eye.

Mr. Rae says Holmes was insured by OHIP, Ontario's provincial public health insurance program. Yet even after an MRI confirmed that she had a brain tumour, Holmes was put on a waiting list that was five to six months long before she could see a Canadian specialist. What practical good is Ontario's so-called universal public health insurance if the system couldn't provide timely access to the medical treatment Holmes needed? Access to a waiting list is not the same thing as access to healthcare.

Indeed, all kinds of myths about healthcare in Canada and the U.S. are commonly cited by advocates of government-run health insurance.

Take for instance the claim that 47 million Americans have no health insurance. Dr. Herrick of the National Center for Policy Analysis annually updates a detailed analysis of U.S. Census figures that are used to make this claim. According to his research, 85 per cent of U.S. residents in 2007 were privately insured or enrolled in a government health program. Of the uninsured, 18 million had household incomes above $50,000 and could afford health insurance; and 14 million qualified for government programs but had not enrolled.

Herrick concludes that 32 million people, or 70 per cent of the uninsured, could easily obtain coverage but have chosen to forgo insurance.  That means 95 per cent of U.S. residents either have health coverage or access to it.

Meanwhile, Statistics Canada reports that about three per cent of the Canadian population surveyed in 2007 (excluding northern Territories and aboriginal reserves) were without access to a regular primary care physician except through ER admission at a hospital, or other non-regular means during the previous year. An additional three per cent had no access at all to a primary care physician by any means. Without access to primary care, patients cannot get diagnosis, referrals for specialist treatment or prescription drugs. In other words, they are in practical terms, no better off than uninsured Americans.

There are plenty of other myths - like Mr. Rae's argument that large numbers of Americans file for bankruptcy due to uninsured medical expenses. In 2006 Dranove and Millenson published a critique of this argument in the journal Health Affairs showing that uninsured medical expenses were cited in only 17 per cent of bankruptcy filings. Further, they found that medical expenses were only one of several reasons for bankruptcy cited in these cases. In fact, medical expenses accounted for only 12 to 13 per cent of unsecured debts among the small percentage of bankruptcy filers who cited medical expenses as one of several other reasons for their bankruptcy claim.

The implication of the medical bankruptcy myth in the U.S. is that it would not occur under a government-run health insurance system. But research commissioned by the Office of the Superintendent of Bankruptcy in 2006 showed that 15 per cent of bankrupt seniors in Canada cited medical reasons, including uninsured medical expenses, as the primary cause of bankruptcy. Furthermore, recent research published by the Fraser Institute shows that in 2006 and 2007, the only two comparable years on record, personal bankruptcy rates were actually higher in Canada than in the U.S.

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