The American health care debate: an unfinished lesson in politicking

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Excerpted From Policy Options November 2009
The American health care debate: an unfinished lesson in politicking

Americans, the late Senator Daniel Patrick Moynihan told me many years ago, take their politics seriously, and to suggest otherwise is not to have read American history. At its extreme the health care debate pits rich against poor, seniors against youth, and exacerbates political polarization. It is about competition, cost and coverage with echoes of the culture wars in the debate on ‘alien rights’ and abortion. It can also be funny and informative — watch, for example, Will Ferrell’s viral video with Mad Men’s Jon Hamm and other Hollywood celebs. It is politicking in the raw.

Obama has made health care his signature issue. Politically it is extraordinarily ambitious. It means taking on a sector that represents one-sixth of American GDP and interests that include the medical profession, the drug industry, insurers and seniors. Reform would change the lives of all Americans, especially the more than 133 million Americans living with chronic diseases and disabilities.

Obama aims to succeed where every president, going back to Teddy Roosevelt, has either faltered or failed.  Succeed and he will replenish his political capital and reverse his declining popularity, essential ingredients to continue his radical program of reform on climate change, education and immigration. Failure, as former President Clinton recently warned the Democratic caucus, increased the likelihood of significant setbacks in next year’s midterms with the spectre of the 1994 debacle when the Republicans won back both the House and Senate after the scuttling of the Clinton health care reforms.

With the health care campaign already saturating American airwaves, it will likely become the mother of all advocacy ad wars. According to the Campaign Media Analysis Group, during the first half of 2009, there were roughly 47,000 TV ads on health care. Their cost was nearly double what the insurance industry spent in 1993 and 1994 for the famous “Harry and Louise” ads, which helped kill ‘Hillarycare’.

Canadians’ confidence in our own health care system could suffer collateral damage as a result of the no-holds-barred fight south of the border. It could also send the wrong message to potential investors and immigrants who hitherto have rightly seen Canadian Medicare as a lure for settlement.

When I was in California as our consul-general and did talk radio, I could always count on at least one apocryphal story about a mythical person who had died from “cheap Canadian drugs.” The questioning was predictable: “What about those ‘bad’ generic drugs that you have to use?” My response was equally predictable: That we use the same generic drugs, usually imported from Ireland or India, and we buy in bulk, like the Veterans Administration. That many of the clinical trials on the drugs that we both use are done by Canada’s university research hospitals.  And that health care research is as integrated as car-making in finding the cures for whatever ails us. And did you know that the infant mortality rate in the US is significantly higher than in Canada, and that American mothers are much more likely to die in childbirth? Or that our seniors live longer?

As we witnessed over e-health in Ontario, the early communications around H1N1 immunization, and overdue remedial action on intellectual property, we have some improvements to make. Yet overall, we have good reason to be proud and confident in our system and to utilize it as an asset when we make the case for Canada to immigrants and investors.

As Canadians begin the annual migration south to Palm Springs, Scottsdale and Miami, they will inevitably face the same kind of questions that I encountered, especially as the American debate approaches what Obama hopes will be the finish line. Our snowbirds need a brief primer on the Canadian system. It should underline the basic principles – public, portable, universal and comprehensive – and address the mythology. Production of such a primer would be a useful public service of our health care profession. On the golf course, watching the ball games, over dinner and drinks – in these situations standing up for Canada makes sense.  Americans will expect it. And who knows, maybe our friends and neighbours will listen and draw some salutary lessons from real Canadian experience.