I would like to make a few points concerning cost comparisons and quality.
Whenever you make comparisons between the US health care system and other nationalized or socialized systems you ought to keep in mind a number of factors that give a false impression that the US system is less efficient. The purported cost of the nationalized systems generally does not include the administrative cost, borne by the government and the taxpayers, of raising the revenue to pay for those systems. The economic distortions caused by higher tax rates in countries such as Canada and Australia are not considered. The lost wages and productivity of workers, who are sitting around for 18 months waiting for orthopedic procedures, are generally ignored. The fact that many of these countries are getting a free lunch in terms of medical research from US medical schools and through payments by American insurers to pharmaceutical companies is a fact that polite people just wont discuss.
To address the quality issue, I am going to take the liberty of re-posting a portion of the Canadian Supreme Courts opinion in a case that tested the constitutionality of Quebecs prohibition on the purchase and renewal of private medical insurance. This might open your eyes about what Canadas highest court had to say about the quality of Quebecs single payer system. The link to the entire opinion follows immediately.
http://csc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
A. Deprivation of Life, Liberty or Security of the Person
110 The issue at this stage is whether the prohibition on insurance for private medical care deprives individuals of their life, liberty or security of the person protected by s. 7 of the Charter.
111 The appellants have established that many Quebec residents face delays in treatment that adversely affect their security of the person and that they would not sustain but for the prohibition on medical insurance. It is common ground that the effect of the prohibition on insurance is to allow only the very rich, who do not need insurance, to secure private health care in order to avoid the delays in the public system. Given the ban on insurance, most Quebeckers have no choice but to accept delays in the medical system and their adverse physical and psychological consequences.
112 Delays in the public system are widespread and have serious, sometimes grave, consequences. There was no dispute that there is a waiting list for cardiovascular surgery for life-threatening problems. Dr. Daniel Doyle, a cardiovascular surgeon who teaches and practises in Quebec City, testified that a person with coronary disease is [translation] sitting on a bomb and can die at any moment. He confirmed, without challenge, that patients die while on waiting lists: A.R., at p. 461. Inevitably, where patients have life-threatening conditions, some will die because of undue delay in awaiting surgery.
113 The same applies to other health problems. In a study of 200 subjects aged 65 and older with hip fractures, the relationship between pre-operative delay and post-operative complications and risk of death was examined. While the study found no relationship between pre-operative delay and post-operative complications, it concluded that the risk of death within six months after surgery increased significantly, by 5 percent, with the length of pre-operative delay: A. Laberge, P. M. Bernard and P. A. Lamarche, Relationships between the delay before surgery for a hip fracture, postoperative complications and risk of death (1997), 45 Rev. Epidém. et Santé Publ. 5, at p. 9.
114 Dr. Eric Lenczner, an orthopaedic surgeon, testified that the one-year delay commonly incurred by patients requiring ligament reconstruction surgery increases the risk that their injuries will become irreparable (A.R., at p. 334). Dr. Lenczner also testified that 95 percent of patients in Canada wait well over a year, and many two years, for knee replacements. While a knee replacement may seem trivial compared to the risk of death for wait-listed coronary surgery patients, which increases by 0.5 percent per month (A.R., at p. 450), the harm suffered by patients awaiting replacement knees and hips is significant. Even though death may not be an issue for them, these patients are in pain, would not go a day without discomfort and are limited in their ability to get around, some being confined to wheelchairs or house bound (A.R., at pp. 327-28).
115 Both the individual members of the Standing Senate Committee on Social Affairs, Science and Technology who intervened in this appeal and the Canadian Medical Association cited a Statistics Canada study demonstrating that over one in five Canadians who needed health care for themselves or a family member in 2001 encountered some form of difficulty, from getting an appointment to experiencing lengthy waiting times: C. Sanmartin et al., Access to Health Care Services in Canada, 2001 (June 2002), at p. 17. Thirty-seven percent of those patients reported pain.
116 In addition to threatening the life and the physical security of the person, waiting for critical care may have significant adverse psychological effects. Serious psychological effects may engage s. 7 protection for security of the person. These need not rise to the level of nervous shock or psychiatric illness, but must be greater than ordinary stress or anxiety: New Brunswick (Minister of Health and Community Services) v. G. (J.), [1999] 3 S.C.R. 46, at para. 60.
117 Studies confirm that patients with serious illnesses often experience significant anxiety and depression while on waiting lists. A 2001 study concluded that roughly 18 percent of the estimated five million people who visited specialists for a new illness or condition reported that waiting for care adversely affected their lives. The majority suffered worry, anxiety or stress as a result. This adverse psychological impact can have a serious and profound effect on a persons psychological integrity, and is a violation of security of the person (Access to Health Care Services in Canada, 2001, at p. 20).
118 The jurisprudence of this Court holds that delays in obtaining medical treatment which affect patients physically and psychologically trigger the protection of s. 7 of the Charter. In R. v. Morgentaler, [1988] 1 S.C.R. 30, Dickson C.J. concluded that the delay in obtaining therapeutic abortions, which increased the risk of complications and mortality due to mandatory procedures imposed by the state, was sufficient to trigger the physical aspect of the womans right to security of the person: Morgentaler, at p. 59. He found that the psychological impact on women awaiting abortions constituted an infringement of security of the person. Beetz J. agreed with Dickson C.J. that [t]he delays mean therefore that the state has intervened in such a manner as to create an additional risk to health, and consequently this intervention constitutes a violation of the womans security of the person: see Morgentaler, at pp. 105-6.
119 In this appeal, delays in treatment giving rise to psychological and physical suffering engage the s. 7 protection of security of the person just as they did in Morgentaler. In Morgentaler, as in this case, the problem arises from a legislative scheme that offers health services. In Morgentaler, as in this case, the legislative scheme denies people the right to access alternative health care. (That the sanction in Morgentaler was criminal prosecution while the sanction here is administrative prohibition and penalties is irrelevant. The important point is that in both cases, care outside the legislatively provided system is effectively prohibited.) In Morgentaler the result of the monopolistic scheme was delay in treatment with attendant physical risk and psychological suffering. In Morgentaler, as here, people in urgent need of care face the same prospect: unless they fall within the wealthy few who can pay for private care, typically outside the country, they have no choice but to accept the delays imposed by the legislative scheme and the adverse physical and psychological consequences this entails. As in Morgentaler, the result is interference with security of the person under s. 7 of the Charter.
120 In Morgentaler, Dickson C.J. and Wilson J. found a deprivation of security of the person because the legislative scheme resulted in the loss of control by a woman over the termination of her pregnancy: see Morgentaler, at pp. 56 and 173.
121 The issue in Morgentaler was whether a system for obtaining approval for abortions (as an exception to a prohibition) that in practice imposed significant delays in obtaining medical treatment unjustifiably violated s. 7 of the Charter. Parliament had established a mandatory system for obtaining medical care in the termination of pregnancy. The sanction by which the mandatory public system was maintained differed: criminal in Morgentaler, administrative in the case at bar. Yet the consequences for the individuals in both cases are serious. In Morgentaler, as here, the system left the individual facing a lack of critical care with no choice but to travel outside the country to obtain the required medical care at her own expense. It was this constraint on s. 7 security, taken from the perspective of the woman facing the health care system, and not the criminal sanction, that drove the majority analysis in Morgentaler. We therefore conclude that the decision provides guidance in the case at bar.
122 In Rodriguez v. British Columbia (Attorney General), [1993] 3 S.C.R. 519, Sopinka J., writing for the majority, held that security of the person encompasses a notion of personal autonomy involving, at the very least, control over ones bodily integrity free from state interference and freedom from state-imposed psychological and emotional stress (pp. 587-88). The prohibition against private insurance in this case results in psychological and emotional stress and a loss of control by an individual over her own health.
123 Not every difficulty rises to the level of adverse impact on security of the person under s. 7. The impact, whether psychological or physical, must be serious. However, because patients may be denied timely health care for a condition that is clinically significant to their current and future health, s. 7 protection of security of the person is engaged. Access to a waiting list is not access to health care. As we noted above, there is unchallenged evidence that in some serious cases, patients die as a result of waiting lists for public health care. Where lack of timely health care can result in death, s. 7 protection of life itself is engaged. The evidence here demonstrates that the prohibition on health insurance results in physical and psychological suffering that meets this threshold requirement of seriousness.
124 We conclude, based on the evidence, that prohibiting health insurance that would permit ordinary Canadians to access health care, in circumstances where the government is failing to deliver health care in a reasonable manner, thereby increasing the risk of complications and death, interferes with life and security of the person as protected by s. 7 of the Charter.
125 The remaining question is whether this inference is in accordance with the principles of fundamental justice.
f the state [interferes] with security of the person, the Charter requires such interference to conform with the principles of fundamental justice: Morgentaler, at p. 54, per Dickson C.J.
