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Report Shows How Deeply Medical Community Is Divided on Health Care System

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Aug. 21--Showing just how deeply the medical community is divided on universal health, two Harvard professors reported today that the US spends $209 billion more than Canada to run its health care system -- money that could be spent covering the uninsured instead of on advertising -- a claim that a leading economist disputed in the same medical journal.

Dr. Steffie Woolhandler and Dr. David Himmelstein, both physicians at Cambridge Hospital and longtime supporters of a Canadian-style single-payer health system, published a study in today's New England Journal of Medicine analyzing a crucial element in the debate over universal health care.

They compared spending on health-care administration in the United States, which has multiple insurance companies and government programs paying the bills, and in Canada, which has a single payer -- the government -- which covers everyone.

Adjusting for the United States' larger population, the doctors calculate that the US spends $209 billion more than Canada, a divide that has grown despite managed care, computer billing, and other business principles intended to make the US system more efficient.

They say America's excess spending is largely due to costs like advertising by competing companies and health-care providers that must bill multiple insurers, at least 755 in Seattle alone.

But in an unusual editorial, indicative of the disagreement surrounding universal health care, economist Henry Aaron of the nonprofit Brookings Institution said the physicians' claims are exaggerated, partly because it's too difficult to compare two countries with such different systems.

Dr. Jeffrey Drazen, editor-in-chief of the New England Journal, said about 10 percent of the editorials the journal publishes disagree with authors' findings. But he said the journal decided to publish the paper regardless of whether Aaron agreed with the Harvard authors because "this is an area of concern on people's minds."

"It brings depth to the field and that's our job," he said. "We get a lot of papers about issues that are already resolved, and we don't think they merit space in our pages. This is clearly an area of hot debate."

Last week, thousands of US physicians endorsed a broad proposal that would abolish for-profit hospitals and insurers, and transfer all Americans into an expanded and improved Medicare program for all ages, reigniting the debate over universal health care a decade after President Clinton failed in his efforts to broaden coverage substantially. The Journal of the American Medical Association published the new proposal, which was also co-written by Woolhandler and Himmelstein.

While Aaron's editorial does not represent the view of the New England Journal, which hasn't taken a position, an editorial accompanying the JAMA article saying it's time to consider universal health did represent the position of that journal.

In his editorial, Aaron said that even if the US spends much more than Canada running its health-care system, it doesn't mean America can or should adopt a single-payer system.

"The US health-care administration, weird though it may be, exists for fundamental reasons," including a "pervasive popular distrust of centralized authority," "insistence on individual choice," "the continuing and unabated power of large economic interests," and "the virtual impossibility of radically restructuring the nation's largest industry -- an industry as big as the entire economy of France," he wrote.

But Woolhandler said that before Canada had national health insurance "their system was virtually identical to ours."

"It's not technically impossible to change," she said. "It just boils down to a question of politics and whether you think American democracy works, and if we are capable of changing things if it's in the interest of the majority of the American people."


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