RE: Debate Canadian vs USA Health Care Systems 
By Walter Sorochan, Emeritus Professor: San Diego State University

Posted May 18, 2011; updated October 11, 2021.

[ This is a response to the an article by Ed Bugod, that appeared as “Thoughts from a Canadian on the Canadian Socialized Medical System,” Whiskey and Gunpowder,  April 18, 2011.  Article Canadian-USA health care system is no longer active.

The debate was about whether the Canadian health care system was better than that of United States.  The arguments about the best health care system focused on which  system was more economical. 

In discussing the cost of providing health care numerous times, Bogul neglected to develop the argument about the economic merits of universal health insurance.Reference was made to the Canadian system costing about half that of United States; but the real reason --- why the Canadian health care system cost much less per capita, was overlooked. The answer lies in understanding how insurance works.

The value of good insurance is spreading the losses of a few over to the contributions from many. Insurance is based on the law of large numbers. The risk of one or a few are shared by the many.  And the more persons sharing the risk, in turn, the lower the cost of the risk to the few at risk. Insurance how it works

Both health care systems are expensive.  Why expensive? We assume the expenses were for both health care systems as these function today; that is, providing treatment medicine. Both basically treat the symptoms and not the cause of an illness or disease. So treating the sick involves alleviating suffering and pain by giving the hurting sick a pain killer and keep them on long term medication. This is profitable for the drug companies but not the sick person.  This is a recognized flaw of current conventional medicine. Such approaches make both systems dysfunctional, self-cyclic, never ending care and expensive! 

The Canadian health care system costs less because the cost is spread over an entire [ universal ] single payer Canadian population; By contrast, in United States, the cost is spread over multiple smaller insurance companies, each covering a smaller segment of the USA population.  Large population numbers bring down the cost of health care!

The bigger issue in health care that is related to cost of the delivery system is a philosophical one: who should be served by the health care system:  the masses, the healers or the profiteers?  This is a philosophical issue and it was not addressed by Bogul.

The health care system debate needs to start with some common sense philosophy and not trivial tad-bits! The ancient Greek philosophers would have an entirely different approach to this debate. They would define the terms and seek to find strength in the justice of a heath care system.

The Greek Philosopher's Nature of Justice. "The question which opens this immense dialogue is: what is justice? Several inadequate definitions are put forward, but the most emphatically presented definition is given by a young Sophist, Thrasymachus. He defines justice as whatever the strongest decide it is, and that the strong decide that whatever is in their best interest is just. Socrates dismisses this argument by proving that the strong rarely figure out what is in their best interest, and this can't be just since justice is a good thing." For more info:  Analysis:Plato on justice

Plato's argument: "So what is the substance in health care?  I would argue that the substance is justice and fairness of a health care system.  In the case of this health care system debate, the economic, medical and political aspects of the health care system would be without real strength, or Greek substance, for no concern was made about whether either health care system functioned in a justifiable and fair manner. Such substance would ask the hierarchical questions of who the system would serve? Is it a just health care system for the few or the many? Who takes priority …. the few or the many? These questions need to be answered first before dealing with the cost issues!

The realistic approach to health care has to be a philosophical basis of doing the most good for the most persons. This approach carries more weight and is more important than the minor points mentioned in the article.

Blaming a political system for a failing health care system, whether it be democracy, socialism or dictatorship, is a moot one. From a Greek point of view, this article needed to focus on the country’s civic responsibility for its people. This was slightly inferred. But the state’s responsibility to its populace is similar to that of a parent to its children. Is taking care of a family’s children any different than a government taking care of it’s people? The state, like a parent, has a parallel obligation to protect the health of its citizens.

Now let us put the shoe on the other foot: Should a citizen have the right to expect good health care from society? Does a worker need good health to be productive? Does a country benefit from a healthy citizenry? What are the justifications for such expectations? The ancient Greeks would love this part of the debate! So what is the real incentive for either country to maintain a healthy society? The answer is very simple: Healthy workers produce more goods for a longer time, pay taxes and in turn, have money to buy the necessities of life and bolster a healthy national economy. The Gross Developmental Product [ GDP ], a measure of the wealth of a country, goes up.

Another ethical question not discussed: Is it proper or just for a health care provider to profit from serving a sick or dying person?  Is doing so any different from a funeral director selling a funeral casket to a distraught and mourning relative of a dead person, thereby taking advantage of the relative’s emotionally vulnerable status? A sick person grasps for straws while struggling to make informed decisions and stay alive. Where is the justice in profiting from a sick person? Is it just to ignore giving health care when the sick person cannot pay for it; thereby perhaps infecting others with his/her malady?

There was inference that socialist and communist approaches had attempted to provide a different type of a health care system and had failed in the past. But their approaches were based on the medical treatment model of United States and Canada.

The health care system of the United States and the western world today, initially framed by Flexner in 1904 to 1910, is an old dinosaur of band-aided programs.  Flexnir Report is no longer active. It is based on a medical model of treating symptoms to relief pain. This approach can never be made economical and workable as long as it ignores the cause of disease. This old system needs to be re-built with a new framework, not patched up, and brought into the technology of this century.

Now what if we had an entirely different approach to treatment medicine, such as a working preventive model that fixes the cause and minimizes treatment. The new focus would be on preventing sickness and promoting wellness. Focus on positive incentives for individuals to practice good health habits. Such a system was working for a while in ancient China. A physician would get paid for keeping his patients healthy but not when they got sick! Is there some merit in this approach?

Some would argue that we have had semblances of health promotion and it did not work! But a real preventive disease-sickness system has never been tried in neither Canada nor United States. The health promotion efforts in the 1980’s failed because it was poorly conceived, there was no real framework and there was no support for it.

What would such a preventive care system be like? For starters, there would be “effective” economic-social incentives for well-being at all levels of society. There would be meaningful political and economic incentives for all age levels.  Article Enthoven Econ incentives is no longer active. Simple but relevant incentives like giving parents and their children regular public recognition for being healthy at school assemblies would stir interest in maintaining well-being. Another good start would be fixing legislation about the non-medical aspects of well-being; like organic food grown locally instead of importing it long distances, nutrition, exercise  Get paid to exercise, and other life style issues like obesity Get paid to lose weight and smoking. Preventing chronic diseases and disorders over the long run would provide savings to defray the cost of health care. Such a fix would provide support at all levels of society, stop 'profit sickness' falling through the cracks and avoid the hypocrisies of today.

Many chemicals are legislatively allowed by both governments to continue causing nutritional deficiencies in both populations. There are currently numerous counter-productive and anti-health practices, including fluoridating and chlorinating water that cause more harm than good.  For example: today’s use of bromides in pesticides in agriculture need to be prohibited because bromides interfere halogen hierarchy ] with iodine intake which is an essential nutrient. Indeed, all the halogen family of bromide, fluoride and chlorine all interfere with the immune system and absorption of iodine in the body [ chemistry 101 ]. Such deficiencies are now suspected of causing numerous health disorders and cancers.

Another anti-health argument may be found in agricultural subsidies for corn, beef and sugar. These need to be eliminated so the free health market can really do its job. Then there are the issues of insurance and drug companies impacting on marketing medications and their influence on elections, political campaigns and legislation.  Pharma

The economic and political systems in both countries encourage expensive and fraudulent medical practices. This is a matter of justice and honesty at the money trough! An honest system, from the national government to the local community, would support a public health policy for promoting health instead of making people sick.  selling sickness soc

A preventive health care system would focus on fixing the causes of chronic diseases and minor illnesses. The center piece of the system, the medical curriculum, needs to be overhauled to focus on fixing the causes of illnesses, fostering prevention and promotion. The process of flawed medical research also needs mending. Many health care providers would welcome such an honest and overdue approach to improving the health care system.

So the debate should be about the kind of health care system that is best for the majority of people. The best system is the one that has philosophical justice as the basis for health care; not the power of milking profit from the health care system.

Neither Canada nor the United States has a good health care system. Current attempts by President Obama to reform a broken and a none-working health care system is not the answer.   Obama health care reform  Health care reform 2011  The current medical model is modeled on profiting off the sick. We need to fix the little things at the local level that people on main street find meaningful and the big things at the political level that blind politicians as watchdogs and responsible care takers.

Today’s health care systems in Canada and United States are not sustainable. Band aiding either one is simply throwing good money at broken systems. By the way, there is no health care system that is the best in the world!

This is my take on the debate. The debate needs an ancient discus thrower and not a hockey defenseman throwing his weight around!