Matt Miller - The Archives

Canadians don't understand Ted Cruz's health-care battle
The Washington Post, September 25, 2013

When you're being forced to endure another rabid Sen. Ted Cruz (R-Tex.) soliloquy on Obamacare's threat to human freedom, it's easy to forget how absurd our health-care debate seems to the rest of the civilized world. That's why it's bracing to check in with red-blooded, high testosterone capitalists north of the border in Canada—business leaders who love Canada's single-payer system (a regime far to the "left" of Obamacare) and see it as perfectly consistent with free market capitalism.

Take David Beatty, a 70-year-old Toronto native who ran food processing giant Weston Foods and a holding company called the Gardiner Group during a career that has included service on more than 30 corporate boards and a recent appointment to the Order of Canada, one of the nation's highest honors. By temperament and demeanor, Beatty is the kind of tough-minded, suffer-no-fools wealth creator who conservatives typically cheer.

Yet over breakfast in Toronto not long ago, Beatty told me how baffled he and Canadian business colleagues are when they listen to the U.S. health-care debate. He cherishes Canada's single-payer system for its quality and cost-effectiveness (Canada boasts much lower costs per person than the United States). And don't get him started on the system's administrative simplicity—you just show your card at the point of service, and that's it. Though he's a well-to-do man who can pay for whatever care he wants, Beatty told me he's relied on the system just as ordinary Canadians do, including for a recent knee replacement operation. The one time he went outside the system was to pay extra for a physical therapist closer to his home than the one to which he'd been assigned.

It's just "common sense" in Beatty's view that government takes the lead in assuring basic health security for its citizens. He's amazed at the contortions of the debate in the United States, and wonders why big U.S. companies "want to be in the business of providing health care anyway" ("that's a government function," he says simply). Beatty also marvels at the way the U.S. regime's dysfunction comes to dominate everyday conversation. He shakes his head recalling how much time and passion American friends devoted one evening to comparing notes on their various supplemental Medicare plans. Talk about your sparkling dinner conversation.

Roger Martin, another Toronto native and avowed capitalist, spent years as a senior partner at the consulting firm Monitor before becoming dean of the Rotman School of Management at the University of Toronto, where he recently completed a 15-year stint. He advises U.S. corporate icons like Proctor & Gamble and Steelcase. He lived in the United States for years and has experienced both systems first hand.

Martin told me that Canada's lower spending, better outcomes and universal coverage make it superior by definition. Plus, it's "incredibly hassle-free." In the United States every time he took his kids in for an earache his wife spent hours fighting with the health plan or filling out reams of paperwork. In Canada, he says, "the entire administrative cost is pulling your card out of your pocket, giving it to them and putting it back."

There's more. Canadian divisions of multinational firms love Canada's system because when they bid on projects they have no health costs to load in. Also, there's no crazy "job lock" as with the employer-based system in the United States—where people with (say) a sick child cling to their job for fear of being pronounced uninsurable. His peers, he says, view the U.S. debate as "ideological and not based on economics."

"The whole single payer thing just makes sense," Martin adds. "You don't spend time trying to shift costs." It's hardly perfect: a few folks go to the United States to jump the line on certain elective procedures, and Canada, like others, free rides on American's investment in pharmaceutical innovation (funded by higher U.S. drug prices). But, he adds, "I literally have a hard time thinking of what would be better than a single-payer system."

The moral of the story? Don't let the rants of cynical demagogues like Cruz confuse you—it is entirely possible to be a freedom loving capitalist and also believe in a strong government role in health care. Remember, Obamacare features a much smaller such role than does Canada's approach—or England's, where Margaret Thatcher would have been chased from office for proposing anything as radically conservative as the Affordable Care Act.

One well-known billionaire told me a few years back that the right answer for the United States was single payer for basic coverage, with the ability for folks to buy additional private supplements atop that. But he won't say this in public; the gang at the club just wouldn't understand. Maybe when U.S. business leaders muster the common sense of their Canadian counterparts, they'll deliver the message the Ted Cruzes of the world need to hear: sit down and shut up.