People tend to forget that you already have some socialized medicine in the U.S., as well as a large single-payer system.

Medicare is not socialized, not in the U.S. and not in Canada. It’s a single-payer system. Despite what is often said, your system is not socialized, it’s a single-payer insurance system. The Veterans Health Administration, however, which has 25 million people in it, is a truly socialized system – it’s government-owned and government-operated and it’s worked very well. In fact, the VHA is the No. 1 rated system in the country, according to patients.

Health-care reform dominated the headlines for a long time. Was it successful?

We didn’t pass reform. All we did pass was putting more money into what we already have. It’s successful in a sense that 1) we got a major bill passed, which is something for a new administration; 2) we created a system that’s going to force reform because of the financial realities; 3) a great many more people are going to have coverage. But this system is still not nearly as effective and efficient as the Canadian system.

You’re a physician. There is an assumption physicians don’t like a universal system because, with less competition, they come out losers.

I know a lot of American physicians who would much rather practise under a Canadian model. There is less malpractice, more actual health care, and a lot less bureaucracy like insurance forms to fill out. I think it depends on why you went into medicine. If you want to make a lot of money, the Canadian system is not for you; if you really like to take care of patients, the Canadian system is well suited.

What’s the single most important lesson that Americans can take from the Canadian system?

It covers everybody with a relative lack of bureaucracy. I know Canadians think there is bureaucracy, but you haven’t seen anything until you work in a system with several hundred insurance companies that all do something different. American hospitals have a whole floor occupied by a billing office. You don’t have that in Canada.

Conversely, what’s the most important lesson Canadians can take from the U.S. health-care system?

I’m afraid I’m not sure there is one. There is more cutting-edge innovative technology, but the cost of that is to pay 70 per cent more than Canadians do for health insurance. Canadians will have to decide if that’s a lesson they want to learn.

Bottom line, which system is better for the patient?

I’ve spent a lot of time in both countries and there is no doubt that you’re better off getting sick in Canada.

I don’t have much to add to the content Dr. Dean offers here.  I agree with it.

But why is it that politicians only seem to be able to speak honestly and clearly when they aren’t talking to Americans?  Where was this guy during the health care reform debate?  Instead we got confusing and confounding stuff like this and this and this and this, ending with this.

When I’m guessing, or talking on a topic where I don’t feel confident, I will say so.  I will also use less declarative language.  This is especially true when discussing politics.

But if you turn on the TV today, you’re likely to see – sometimes in the same segment – people declaring as absolute truth that health care reform is going to pass or fail.  Obviously both can’t be true.  Even Megan McArdle notes this:

The opinions on both sides seem so confident, and so incompatible, that one group of people is clearly borderline delusional.  I don’t see how they can be right–even if passing health care makes the party better off (I’m doubtful), it does not improve the fortunes of members in conservative districts who do not get much mileage out of their affiliation with the Democratic Party (and will get even less mileage if they are seen as enabling unpopular legislation).

But of course, borderline delusional people don’t think they’re delusional, or else they wouldn’t be delusional.  So there you are: either it’s a done deal, or it’s dead.  There’s no longer much middle ground in between.

President Obama answered questions from House Republicans for an hour.  Both sides were completely civil.  Both sides treated each other with respect.  President Obama answered questions without using sound bites or rhetoric.  He was clear, and on the record, and he can be “fact checked” ad nauseum.

Moreover, when all was said and done, I bet both sides felt better.  I bet both sides feel they might have more in common than they previously thought.

I think this may do the country some good.  I wish it had happened earlier.  It should happen more often.

Bottom line, no one knows what’s in store for health care. I was encouraged by what I heard tonight; I was reminded of why I’ve been optimistic in the past.

I still think they can get this done. Something. It has to get better.

Back to policy tomorrow.

That said, I’ve found it impossible at times to ignore the politics of the situation.  Today is certainly one of those moments.

No matter what anyone says, they don’t know what’s going to happen.  Congress could choose to abandon health care reform tomorrow.  Or, the House could pass the Senate bill tomorrow and have it signed by President Obama before the week is up.  Who knows?

I will say this.  A year ago, when President Obama was inaugurated, the Democrats occupied the White House, had a significant majority in the House, and had 58 Senators.  That was when they promised to deliver health care reform and began to work on it.

Today, the Democrats occupy the White House, have a significant majority in the House, and have 59 Senators.  That doesn’t seem like a time to panic.

If they can’t get it done, it’s by choice; they can do it.  But if they choose not to, if they choose to let the effort die, then I find it hard to understand why anyone should vote for them again.  What’s the point?  People (especially Democrats) voted for them so that they would choose to vote for health care, one of the most important Democratic priorities of, well, ever.  If they decide not to vote for it, when they can, then they are saying that – out of fear for themselves – they are willing to drop the best chance for reform they’ve ever had.  Just because they are afraid.

If they abandon this, then why should they be trusted with any other priority?

I understand there are times when they can’t get things done because the Republicans are obstructing them.  This isn’t one of those times.  They have bigger majorities than the Republicans have had in almost a century. The bill has passed the Senate.  All they need to do is vote.

They wanted this job.  They knew they could lose it.  If they act in their best interests, and not in the best interests of their constituents and party, then I understand (for the first time) why people might choose to stay home next election.  There isn’t much point in further support.

OK.  I’m done.

Back to policy.

Well, FireDogLake decided to test the theory.  They put out a poll to see if getting an individual mandate would hurt the re-election chances of Rep. Vic Snyder (D-Ark.).  I think he heard about it.

Rep. Vic Snyder (D-Ark.) announced his retirement today, mixed–but mostly dire–news for Democrats, who were hopeful that he could hold on and defeat his likely, scandal-tainted GOP opponent Tim Griffin. One of the possible reasons for the retirement? A poll conducted by SurveyUSA, paid for by the progressive blog Firedoglake, which tested negative messages about the health care reform bill and whether it made voters sour on Snyder.

A kind interpretation of the motives of FDL might have been to convince him to change his vote.  That obviously didn’t work (as I argued at HuffPo).  Another interpretation is that FDL wanted to punish Rep. Snyder for supporting health care reform, which they oppose.

Rep. Snyder wasn’t a very conservative member of the caucus.  He wasn’t even a member of the Blue Dogs.  Of course, one would hope that FDL felt his replacement would be more likely to support the more progressive kind of health care reform they desire.

He’s from a pretty red state.  That’s not likely.

I’m not a political expert, but I really don’t understand how this isn’t more destructive than constructive.  I’m happy to have someone explain to me how this will lead to more progressive reform.

Although I certainly recognize the politics of health care reform, and will discuss them in interviews, I really don’t enjoy doing so.  It depresses me.  And – since that’s not really my job – I don’t have to do it.

I’m trying to stick to the policy and its implications.  Sometimes I fail – and let my thoughts on the politics slip through.  You should know I’m trying not to, though.

A December 6th press release from Senate Minority Leader Mitch McConnell read:

One day later, the next day, he put out another press release:

I just can’t stomach hypocrisy – from anyone.  This is just too important.  If you oppose health care reform as prescribed, if you are willing to talk about what you think is wrong with it and how you would improve it, if you are willing to do so open and honestly – they you and I will get along just fine.

This, however, is just politics without convictions.  It’s dangerous.

Well, my question:   On several occasions you have said that even if something is passed we will be able to make changes.  It’s been said that if we pass some form of health care now, we can adjust it to fit our needs later, as all programs will not start right away.  So with that being said, if Republicans get voted back into office either controlling congress or in four years at the top, what is to stop the Republicans from: #1 simply changing the plan to something they want or #2 from just voting to drop all changes and start this all over again.  Is it just the money that was already spent that would stop this or could the Republicans simply just change the plan if and when they get control?

Excellent question.  The short answer is yes, they could change the plan.  But the truth is that it is very, very hard to scale back popular entitlement programs once they are in place.  Republicans opposed Social Security and yet attempts to privatize it or scale it back have destroyed careers.  Medicare was touted as socialism by many before it passed.  And Republicans have been in power many years since then, and it has only grown.  In fact, Democrats voted against Medicare Part D years ago; do you hear anyone screaming for its repeal now that they are in power.

If history tells us anything, it is that after health care reform is passed, it will be popular among many, many people who will have Medicaid, subsidies to purchase insurance, and more security with what they have.  It is much harder to get rid of things than to get them passed.  That’s why those opposed to the bill are fighting so hard to make sure that doesn’t happen.

So can someone help me understand me why Senator Baucus spent months and months in secret talks, delaying this whole process, to craft a “bipartisan compromise” that has no Republican support whatsoever?  He’s given in on the public plan (raising the cost), on subsidies (lowering access), even on advance directive counseling reimbursement (no comment).  For what?  He’s produced a bill so far from the others that it’s losing Democratic support – in his own committee!

Why would you negotiate to a point where you gain no support from the other side and lose support on your own?  Who wins?  What’s the angle?

Someone please explain it to me!