You would not learn from reading Dr. Berger's article, “Canadian Health-Care System Not the Answer for U.S., Single Payer No Panacea,” (TAP, 43/1) that the U.S., compared to Australia, Canada, Germany, New Zealand, and the United Kingdom, has the most expensive health-care system, both in terms of cost per person and percent of gross domestic product, and the poorest quality of health care (Davis et al., 2007). For example, U.S. infant mortality rate is higher than that in Canada, the United Kingdom, Australia, Germany, Spain, France and Japan.
Although he is comparing the Canadian system to the U.S. system, you would learn nothing about the millions of Americans who have neither health care nor access to psychiatric care. Nor would you learn that virtually all health-care experts acknowledge that a single payer system is the least expensive health-care system (though they don't all agree it would be the best system) and therefore one that could provide health care to all members of the society. Certainly he doesn't acknowledge that the health-care system for the elderly in the U.S. (Medicare) is a government run, single payer system which has remained extraordinarily popular, although very hard on its medical providers. What Dr. Berger highlights is that Canadian psychoanalysts are underpaid, and that Canadian patients have long delays before obtaining medical care (the U.S. and Canada rank lowest in the prompt accessibility of appointments with physicians).
It seems clear that in his dichotomous nosology Sir Isaiah Berlin would have characterized Dr. Berger as a hedgehog (a focused worldview, an ideological leaning, and strong convictions) rather than a fox (pragmatic, more prone to self doubt, and inclined to see complexity and nuance).
Joseph Schachter
Joseph Schachter, M.D., received a Ph.D. from Harvard University, an M.D. from NYU Bellevue, and psychoanalytic training at Columbia University Psychoanalytic Center. He was a training analyst at Pittsburgh Psychoanalytic, and is an honorary member of the William Alanson White Society.
Dr. Schachter's gratuitously offensive response to my article—making insulting comparisons of me to various animals—reflects the simplistic nature of his comments.
Many years ago economist Irwin Stelzer rejected the notion of comparing the qualities of health-care systems in different countries according to the percentage of GDP spent. In most areas of life, if you spend less you run the risk that you will receive poorer quality of whatever it is that you are buying. It applies to your clothes, your food, your housing, and to almost any service you can think of.
If Americans have been prepared to pay more for their health care, then maybe that is because what they expect to receive in most cases is prompt care, of very high quality, in comfortable surroundings. In countries that spend less, each of those benefits may be much reduced. Most readers will have heard about very long waiting times for consultation and treatment in Canada.
The quality of diagnosis and treatment in the U.S. remains far above that of most other countries, and the physical quality of clinics and hospitals remains far superior to all except a very small number of highly expensive and exclusive private institutions.
Similarly, it is absurd to choose just one item of measurement—such as infant mortality levels—and imply that such a statistic can demonstrate the superiority of one system over another, when there might be numerous other factors affecting any such statistic, and when other measurements might produce different results.
I would urge Dr. Schachter and other readers who might still think that the Canadian system might be the solution to the admitted deficiencies in current U.S. health care, to read the superb testimony titled “Canadian Care. So Many Lessons, So Little Time” just recently presented to the Pennsylvania House of Representatives by Brian Lee Crowley, president of the Atlantic Institute of Market Studies. This brilliant survey explains in greater detail the pitfalls of allowing medical care to become more socialized and politicized than it is already.
Joseph Berger
Joseph Berger, M.D., grew up in London and studied and worked as a doctor in the socialized British system. He trained as a psychiatrist in the United States and has practiced for the past 35 years in Canada.