Point, Counterpoint

Former U.S. president Bill Clinton warned Canada last night not to go down an American-style, privatized health-care road. In the U.S., 34 per cent of the health-care budget goes to administrative costs, he said, compared with Canada's 19 per cent.

And closely supporting the numbers . . .

After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

I would like to see a breakdown of those figures. From the carrier side, admin is more in the 8 - 12% range. Where does the other 19 - 23% come from?

But if costs were the only factor, we wouldn't have this to factor in.

A Canadian company that arranges cardiac, orthopedic and cosmetic surgery in India, France and other countries says wait lists at home are driving Canadians' demand for its services. "Waiting lists are so out of control in this country, many patients are willing to pay anything to obtain swift access to the services they need,"

And this comment . . .

There is little doubt that per capita health care administrative costs are lower in Canada than in the United States, as Woolhandler et al. report (Aug. 21 issue),1 even though the precise magnitude of the gap is open to debate, a point that Aaron makes in his accompanying editorial.2 However, the Canadian single-payer system results in chronic shortages of medical services because of underfunding. The underfunding problem is usually considered to be a separate issue from the single-payer system itself,2 but the very structure of the single-payer system may cause the problem.

In the United States, persons who wish to spend more on health care than the norm have a simple way of doing so: they can purchase premium private medical insurance. Notwithstanding the Medicare prescription-drug plans currently being discussed, it is generally not an option in the United States to increase medical expenditures through the taxation system, given contemporary political and fiscal constraints. In Canada, however, increases in medical expenditures are possible largely only through the taxation system. And even if, as some surveys suggest, most Canadians are willing to spend more on health care,3 taxpayers cannot be sure that any given tax increase will actually go to health care expenditures. Therefore, Canadian taxpayers generally resist tax increases, and underfunding and chronic shortages result.