Saturday, August 29, 2009

The London Free Press
By Rory Leishman

United States President Barack Obama has touched off a lively and informative debate over the best way to reform health care, but in Canada, no politician of any party is willing to do the same. Why is that? Why is there so little support for major medicare reforms in Canada.

After all, it’s plainly evident that the Canadian system is far from perfect. In a recent international survey, the Commonwealth Fund found that the proportion of adults with chronic health problems who had to wait four weeks or longer for elective surgery was 33 per cent in Canada, but only eight per cent in the United States.

Among the 30 members of the Organization for Economic Cooperation and Development (OECD), Canada ranks fifth in total health care expenditures per person, yet lags in advanced medical technology. For example, Canada has just 6.7 magnet resonance imaging (MRI) units per million population, far below the OECD average of 11.0 and the record 25.9 MRI units per million in the United States.

Given Canada’s shortcomings in medicare services and equipment, it’s hardly surprising that the five-year survival rates for cancer are significantly lower in Canada than the United States.

Granted, the U.S. health-care system is also beset with serious problems. Costs are out of control. Over the past 15 years, total U.S. health care spending has more than doubled to $7,290 per person. That’s almost twice the Canadian level and much the highest in the world.

Some 47 million Americans do not have even basic health insurance, while millions more fear they could also end up with no coverage if they lose their jobs or contract a serious illness. That’s scandalous.

To remedy these defects, Obama initially proposed a comprehensive public-sector medicare plan to compete with private medical insurance. However, he seems to be backing away from this “public option” under pressure from critics who apprehend that it would be ruinously costly and lead to the imposition of a Canadian-style medicare monopoly.

In a recent column in The New York Times, Paul Krugman, the left-wing, Nobel-prize winning economist, pointed out that a public option is not the only route to universal coverage. As an alternative, he speculated that Obama might endorse the Swiss medicare system, which relies entirely on private insurance companies to provide affordable medical care for everyone under strict government regulation.

The Swiss model requires every resident to purchase a basic medicare policy from one of several competing private insurance companies. To assure affordability, the government subsidizes premiums for the needy and requires the health insurers to offer basic coverage to all applicants at a uniform rate, regardless of age or medical history. The additional expense of insuring higher-cost clients is offset through a system of reinsurance.

Unlike Canadians, the Swiss are allowed to contract with private insurance companies for supplementary benefits beyond the basics required by the government. Yet on an age-adjusted basis, the total costs of medicare in Switzerland are no higher than in Canada.

This Swiss model works. It provides the Swiss people with superior medicare services without the long waiting times, shortages of medical technology and other chronic deficiencies that plague Canada’s grossly inefficient, public-sector, medicare monopoly.

Krugman is not alone in taking note of the Swiss success. After extensive study, the Dutch Parliament decided in 2006 to replace the Netherlands’ inefficient and unresponsive mixture of public and private medicare with an all-private system on the Swiss model. The Dutch health ministry boasts that the new system delivers “more choices for customers, more competition and guarantees of affordability.”

Let us hope the Obama administration likewise embraces the Swiss model of medicare that relies on competing private insurance companies to provide efficient and affordable coverage for everyone under strict government regulation. Perhaps eventually, even Canada might do the same.

The Dutch health ministry persuasively argues that there is no alternative to competing private insurance companies as a means of ensuring “better quality of care, greater cost consciousness, better affordability and more tailor-made care through greater influence by customers.”

Saturday, August 08, 2009

Effective compassion for the needy

The London Free Press,
By Rory Leishman

Anyone who dares to present a reasonable challenge to some received nostrum of conventional thinking should beware: They are liable to come under vicious personal attack.

Dambisa Moyo is well aware of the problem: Instead of rationally evaluating the thesis of her compelling book Dead Aid: Why Aid is Not Working and How There is a Better Way for Africa, many critics have maligned her as a cruel, grasping and heartless conservative.

Among Moyo’s fiercest detractors is Jeffrey Sachs, professor of economics at Columbia University and consultant on economic development to the United Nations Secretary General. In the left-wing Huffington Post on May 24, he derided Moyo as “an African-born economist who reportedly received scholarships so that she could go to Harvard and Oxford but sees nothing wrong with denying $10 in aid to an African child for an anti-malaria bed net.”

That criticism must have stung. Moyo is a former student of Sachs’s at Harvard. In a polite and measured response to his personal attack, she explained that she has rejected an aid-based strategy that “hurts more than it helps” in favour of working towards “a sustainable solution where Africans can make their own anti-malaria bed-nets (thereby creating jobs for Africans and a real chance for the continent’s economic prospects) rather than encouraging all and sundry to dump malaria nets across the continent (which incidentally, puts Africans out of business).”

Sachs was unimpressed. In another rejoinder, he charged that Moyo is “unmoved by the massive suffering” of Africans afflicted with malaria.

Coming from a leading academic like Sachs, such vitriol is disgraceful. It’s also false and malicious.

In the course of a brilliant career, Moyo has served as a consultant for the World Bank and as a senior executive with Goldman Sachs. But in no way can she be dismissed as a cold-hearted conservative. To the contrary, she has demonstrated her compassion for suffering humanity, by generously volunteering her time and money to charities.

Currently, Moyo serves as a patron of ARK (Absolute Return for Kids), an agency founded by a group of hedge-fund managers in 2002 that employs over 1,200 staff to provide health and educational services to needy children in Asia, Africa, Eastern Europe and the United Kingdom. Moyo and her fellow patrons and directors of ARK contribute expert managerial advice to the agency and defray all of its administrative costs through their personal donations so that 100 per cent of all other donations go directly to ARK’s programming for children.

Moyo also serves as a director of Room to Read, another non-governmental and non-profit agency. Room to Read constructs schools, builds libraries, operates computer labs, provides scholarships and has donated literally millions of English-language and local-language books to some 10 million impoverished children in Asia and Africa.

Executive Director John Wood is a former Microsoft executive. He was moved to leave Microsoft and found Room to Read, after witnessing the pitiful resources of a Nepalese rural school while on a trekking vacation in 1998.

Room to Read has a savvy board of directors and an experienced management team that works in conjunction with 14 knowledgeable Asian and African nationals who are employed as regional and local managers. Together, the Room to Read staff have established an exceptional record for efficiency and effectiveness in helping impoverished students. According to the agency’s audited report for 2008, Room to Read devoted 85 per cent of total spending to programming, while allocating only 15 cents of every donated dollar to fund-raising and administration.

Moyo exemplifies the meaning of true generosity: Instead of clamouring for more government spending of other people’s money on failed foreign-aid programs, she donates her own time and money to non-governmental agencies with a proven ability to help the needy overcome their disadvantages.

By this standard, it’s evident that many of us – perhaps including Sachs – are a lot less generous, compassionate and effective in helping the needy than Moyo.

(Canadians can make tax-deductible donations to Room to Read Canada through the online charity